"The reflection of England's light": the instructive District Nursing Association of Boston, 1884-1914.

This article examines the extent to which the Instructive District Nursing Association (IDNA) of Boston was influenced by the English system of district nursing. The schemes had the same aims and motivation, but the differences in their organizational structures, in particular the lack of specialist training and professional supervision of the Boston nurses, affected the IDNA's work with its poor, mainly immigrant patients. It is clear that much was achieved, but it is also apparent that problems increased as the work expanded. Attempts to solve these difficulties can be traced through the introduction of a nurse supervisor, establishment of a training school, and eventual radical reorganization. The IDNA also had a leading role in the expansion of the visiting nurse movement throughout the United States. I discuss attempts to establish national standards, particularly through the formation of the National Organization for Public Health Nursing (NOPHN). With the disparate arrangements in the U.S. health care system, the NOPHN was unable to reach a workable consensus and failed to produce a comprehensive and cohesive national system similar to that which had been established in England.