Wald, Florence Sophie

UXL Encyclopedia of World Biography, (2003)

Florence Sophie Wald

Florence Wald (born 1917) is credited with starting the hospice movement in the United States. Wald's model for hospice care has served as the basis for the treatment of dying patients and their families.

Nurse and Yale Dean

Florence Wald was born Florence Sophie Schorske on April 19, 1917, in New York City. Her parents were Theodore Alexander Schorske and Gertrude Gold-schmidt Schorske. Wald had an older sibling, but little else is known about her childhood. Wald was raised and educated in Scarsdale, New York, and graduated from Mt. Holyoke College in 1938. She received a master's degree in nursing from Yale University in 1941.

Wald's first nursing job was as a staff nurse at the Children's Hospital in Boston in 1941 and 1942. During the next 15 years, she worked at various nursing jobs in New York. She worked at the Henry Street Visiting Nurse Service and held research positions at the cornea research laboratory of the New York City Eye Bank and in the Surgical Metabolism Unit of the College of Physicians and Surgeons. During the final stages of World War II, Wald served in the nursing branch of the Women's Army Corps.

Wald began teaching at Rutgers University School of Nursing in New Jersey in 1955. In 1957, she became assistant professor of psychiatric nursing at Yale University School of Nursing. A year later, she was named acting dean of the nursing school and in 1959 she became Yale's permanent dean. She held the position until 1967. Wald married Henry Wald, a health facility planner, in 1959. The couple had two children: Joel David Wald and Shari Johanna Wald.

During Wald's tenure as dean, she initiated many changes in the nursing curriculum, guiding the program to a more scholarly approach. One of her concerns when developing the new curriculum was the involvement of the patient, his or her family, and nurses in the patient's care. Normally in this era, doctors made all medical decisions and their authority was not questioned.

Met English Hospice Advocate

In 1963, Wald met Dr. Cicely Saunders, an English physician who was a pioneer in the field of hospice. Saunders, who had been trained as a nurse and physician, visited the United States to share her ideas about hospice care. Saunders had worked for two years in clinical trials of palliative care in St. Joseph's Hospice in London before establishing her own hospice facility, St. Christopher's, in London.

Saunders told Yale medical students about her approach to treating terminally ill cancer patients. She advocated easing pain and suffering in the final stages of life so the patients and their families could concentrate on their relationships and prepare for death. Saunders's goal was for patients to discover what they wanted, not yield to doctors' decisions to prolong life as long as possible. Pain-relieving drugs were an essential part of hospice care.

Wald described her reaction to Saunders in the essay "The Emergence of Hospice Care in the United States" in the book Facing Death: Where Culture, Religion, and Medicine Meet. She wrote, "She made an indelible impression on me, for until then I had thought nurses were the only people troubled by how a terminal illness was treated. In the Yale University Nursing School, where I was dean, faculty and students had found themselves at cross purposes with doctors when patients asked questions about their illness."

Wald explained that doctors evaded questions about treatments that failed and rebuffed nurses who tried to intervene on behalf of patients. Nurses were beginning to realize the importance of patients expressing their thoughts and feelings about treatment and getting involved in decisionmaking. But in the male-dominated medical profession, nurses could do little more than stand by as patients suffered through never-ending treatments that did not work.

As dean of the nursing school, Wald sought to revamp nursing education to focus on patients and their families and involve them in their medical care. Fortunately, the time was right for change. During the 1960s, among other social movements, women were demanding equal rights and opportunities, and institutional authority was generally being questioned.

The women's movement affected how doctors and nurses related. Wald explained, "… the women's movement gave promise that the gender barrier between doctors (predominantly men) and nurses (predominantly women) would be lowered—that doctors would hear what nurses said and nurses would challenge doctors. The health care hierarchy was shaken. Nurses became more capable of expressing themselves and began to expect recognition."

Saunders returned to the United States over the next few years, and the hospice movement attracted more and more attention. Saunders and Elizabeth Kubler-Ross, an expert on death and dying, traveled around the country giving lectures on the hospice movement.