By “THE NEW DOCTOR.”
The Hospital Nurse
There was a time when every man was nursed through sickness by his wife or daughter. Then there appeared upon the scene a class of women who were styled “monthly nurses,” who took over the more onerous part of nursing, but who did not overthrow the whole of the duties of the invalid’s relations.
These monthly nurses were for the most part ignorant women, and often slovenly and drunken. They threw over the old and best system of nursing, and in its place introduced the worst.
A little later the monthly nurse gave place to the certified nurse, who is taught her profession and is in all respects a very great improvement upon her prototype.
Nowadays it often happens among the wealthier classes that as soon as a member of the family is ill, a physician is sent for; a nurse is appointed; and the relatives practically desert the invalid till he is well again.
Fortunately the wealthy classes are a small minority, and but few of us can afford the great expense of this treatment. We said fortunately, for though it has its advantages, it has very great drawbacks. And we are of opinion that in most cases of sickness the best nurse for an invalid is his nearest female relative.
People think that physicians always advise a certified nurse and object to a patient’s wife or sister turning amateur nurse for the time being. We can assure you that this is not the case. Of course, it is an advantage to the physician if he can have a nurse whom he knows to look after his case; but, as a general rule, he is indifferent in the matter, except in some diseases, when the aid of a person skilled in nursing those suffering from that disease is indispensable.
We address these notes to amateur nurses; but really you are as much professionals as are your trained colleagues. Nursing, like housekeeping or cooking, is one of the duties of the gentler sex, and is not a profession at all.
Every woman is by right of her sex a nurse, but every woman is by no means a good nurse. To be a really good nurse requires a great many qualities and a certain amount of knowledge which many have not got. Nursing—even nursing one’s dearest relative—is a difficult and onerous duty, and the first and most important virtue which must be possessed by nurses is patience.
We call a sufferer a “patient,” but the term would be better applied to the nurse. For the good nurse is patient when she could, if she willed so, be impatient; but the sufferer makes a virtue of necessity when he is patient—and very often he is by no means patient.
The second virtue required is kindness. Oh, always be kind when you are nursing an invalid. It is here where an invalid’s relatives are more desirable than paid nurses. It is a most brutal thing to be unkind to an invalid. All the knowledge of nursing in the world is not worth half so much as patience and kindness.
In the course of our professional duties we have become acquainted with many nurses, including some of the most famous of the time. And if you ask us what is the chief difference between these best nurses and the ordinary probationers, we answer without hesitation, “They are more kind and patient.” Of course they are more skilled, more experienced, and—take it to heart—more obedient; but kindness is their chief characteristic.
The nurse must always be absolutely obedient to the physician, and she must carry out his directions to the letter, and neither add to nor deduct from his treatment. It is not only the good nurse who is obedient. A woman who departs from the mandates of the physician is an encumbrance—nay, more than an encumbrance—she is distinctly detrimental to the health of the patient.
“A little knowledge is a dangerous thing,” especially in medicine. Nurses—I mean certified nurses—have a little knowledge of medicine; and if they lack obedience, their knowledge becomes a very dangerous thing indeed.
If you are patient, gentle and kind, obedient and ready to do your duty, however irksome it may be, and if also you are clean, you will make a good nurse. As regards the knowledge of nursing—well, it really is of very secondary importance! If you are nursing and you are a little doubtful about any point, you have only got to ask the physician, and he will make all clear.
But there are many points in nursing which everyone ought to know. Probably most of you do know them; but repetition will do no harm, for we are all liable to forget.
It is thought by some persons that all advice on nursing should be written by nurses. But here we object. Surely the physician is entitled to say what he requires?
We certainly consider that we have a right to have our say in a matter which concerns us more than anyone else save the patient. We physicians are responsible for the well-being of the sick. We are to blame, and we are blamed, when the results are disastrous. If we employ a careless nurse, and she, by her bungling, thwarts recovery, we are to blame. It is upon us, not upon the nurses, that retribution falls. And perfectly rightly. We do not complain at this. Still, we consider that we have a right to advise those who wish to nurse our patients.
And so this will explain the apparent anomaly of a physician writing a paper on nursing.
The sick-room must be large and airy, but free from draughts. There should be at least two windows in the room, and, if possible, they should have a south or west aspect. Before the invalid takes to this room, the floor, the windows, all the paint, etc., should be thoroughly cleaned by ways of which you know more than we do. If the ceiling has a cornice this should be dusted. The chimney should be swept and everything seen to so that a fire may be lighted at any minute, and that it may light and draw without any of the unpleasant accidents which so often occur when a fire is lighted in a room for the first time.
Not only in winter but at any season, even in the middle of summer, the fire should be ready. In our uncertain climate we often have a bitterly cold and wet day in the midst of very hot weather. We have seen trouble from neglecting this precaution.
Then everything in the room should be dusted or cleaned. Any superfluous objects which are likely to hold dust should be removed; but do not let the room look like a prison cell. An invalid spends most of his time looking about him, and an empty room will soon become distressing to him. Personally we prefer a carpet in a sick-room—at all events, unless the floor is polished, and there are no cracks. But the carpet should be beaten before the room is occupied.
Of course, we do not know whether you yourself will have to do this work, but if it is done by another, you must see that it is properly done. It is the duty of the nurse to see that the room is in good order, even through she does not clean it herself.
The bed should always have a hard mattress. A water bed may be required, but under no circumstances should an invalid have a feather bed. See that there are one or two good new blankets on the bed. Flimsy quilts may well be dispensed with. It is better to let the bed stand out in the room, and not be placed in an alcove or near a wall.
The bed of an invalid should be made every day—made properly, not merely the sheet pulled up and the upper blanket rearranged. Creases in the lower sheet are very wrong, for they make the patient uncomfortable and predispose to bed-sores. Crumbs in a bed are worse still, and very great care must be taken to see that the bed is perfectly free from them.
The patient must have his hands and face washed every morning and evening. He should always be washed with warm water. To tell if the water is of the right temperature, dip the tip of your elbow into it. Your hands are not sufficiently sensitive to warmth to be safe guides.
Hot bottles are often needed by invalids. They should never be filled with boiling water. They must be made of earthenware and covered with flannel jackets. The water must be of a temperature of about 100° to 120° Fahrenheit. They should never be left in the bed after they have got cold. Another point to remember is that you must see that the bottles do not leak. We have seen a nurse place an uncovered bottle of boiling water at the feet of a patient with paralysis. He did not feel the heat, but next morning the nurse found, to her horror, that the patient’s feet had been burned out of all recognition, and from these burns he died. We have seen and heard of many similar cases, but fortunately the result is not often so disastrous.
The ventilation of the sick chamber is very important. Unless the room is very draughty, it is usual to leave the window open throughout the day. If the weather is gusty, or the situation is exposed, some other method of ventilation may be acquired. A fire is a very satisfactory, though not a theoretically perfect, method of ventilating a room. As a matter of fact, the ventilation of the room depends entirely upon the room itself and its arrangement. On his first visit you should ask the physician how the room should be ventilated, and this will relieve you from any responsibility in the matter. Remember that the commonest of all mistakes in the treatment of illness is insufficient ventilation.
We were going to devote the whole of this article to the question of diet in sickness, but our space is more than half taken up by preliminary matters, so we must be brief.
The question of feeding invalids is always a troublesome one. People who are sick and are in bed all day, lose their appetite, take violent dislikes to some articles, and develop an abnormal desire for dietetic curiosities which they would never eat when they are healthy.
We remember attending a woman who refused to eat anything we put before her. We tried milk, very nice puddings, and chickens, and we do not know what not. But, no, all to no purpose! She would eat nothing. The matter was becoming serious, for the poor woman had had nothing to our knowledge for three days, and we were thinking whether forcible means would have to be used to give her nourishment. But the extraordinary part of it was that she gained strength and was recovering from her disease by rapid strides.
But we solved the mystery by entering the room suddenly and finding her munching a little green apple and a tartlet! Apparently she had developed an extraordinary desire for green apples, pastry and cocoanuts! Knowing that had she asked to be allowed to have these things, she would have been refused, she worried a lady-visitor into buying the things for her. And she had been living on green apples, pastry and cocoanuts for four days! When asked what quality she so much fancied in this strange dietary, she said—
“The apples are so nice and sour, and the cocoanut is so scrunchy!”
Whatever you put before an invalid in the way of food must look appetising. We have seen great greasy chops, half cold, served up to an invalid—a meal which would disgust a labourer. You cannot be too careful about the appearance of food given to people whose appetites are not what they should be. Let the cloth be spotlessly white, let the glass be nicely cleaned with a glass cloth and no stray fluffs left upon it, let the plate be hot and the cover—never forget the cover from a dish given to an invalid—brightly polished, and let the dish smell nice and be tastefully arranged. Never serve up food in large quantities except to convalescents, who never seem to be satisfied. You may think these details are trifling, but it is attention to these trifles which distinguishes a good from a bad nurse.
Then as to the food itself. Of course you must never give an invalid anything without first asking the physician whether he may have it. We shall never forget calling to see a patient who had typhoid fever. It was our second visit, and as we entered the room, we saw the patient—a young girl—vigorously attacking a beef-steak! And the nurse—she was a trained nurse—looking on with approval. We asked why the girl had been allowed meat when we had expressly said that she was under no circumstances to have any other food than milk. The nurse replied—
“Oh, sir, I do not believe that patients with typhoid fever should be fed on milk. I think it is far better to give them solid food!”
We are afraid that we lost our temper at this criminal disobedience. What answer we gave we do not remember, but we secured the nurse’s discharge within an hour. Whether it was due to this unfortunate affair or not we cannot say, but certainly this was one of the worst cases of typhoid that we have seen.
Whatever you give to an invalid must be of the very best. Let your custards be made with new-laid eggs—oh, you may laugh! but custards are sometimes made with bad eggs. Let the chicken be young and the fish fresh and nicely boiled, or if it is fried let it be nice and brown and free from grease.
You should never give food to an invalid which has been kept overnight, and never serve up the same dish two days running. Invalids very rapidly tire of everything, and as varied a diet as possible must be provided for them.
The drinks of persons suffering from fevers often occasion considerable difficulty. Nowadays we let fever patients have as much to drink as they like, though in the old days the fluids were restricted.
Invalids should always have tables at their bedsides, and a drink of some sort should be placed beside them that they may quench their thirst whenever they please.
Whatever drink they are taking, it should be prepared fresh every morning and evening. It is a great mistake to leave jugs of stale lemonade or other drinks in a sick-room.
In cases of fever, and indeed in all diseases, it is well to have plenty of ice on the premises. You will find that many invalids prefer sucking ice to drinking, and it is better for them, because it is less likely to injure the stomach.
Lemonade made from fresh lemons and boiling water, strained and iced, is perhaps the best drink for invalids. Aerated lemonade should not be given, but the other aerated waters may be administered freely in most cases.
Talking about ice, you must be very careful where you get it from. In London the ice supplied is usually quite pure, but in the country, and still more abroad, you must be very careful about ice. If it is possible to obtain it, the best ice is that made at home from distilled water with a freezing machine.
Milk given to invalids should always be scalded. Barley-water must be made fresh at least once a day. Under no circumstances may it be kept overnight, for it rapidly decomposes, and sometimes becomes highly poisonous. Toast-and-water, our pet aversion when we had measles, is a thing of the past. We have never ordered it nor seen it ordered.
From diet we pass to medicine. You cannot carry out the instructions of the physician too carefully. Always measure out physic with a clean glass measure. A “drop” or a “teaspoonful” is a most uncertain quantity. Remember that a drop is a minim, a teaspoonful is a dram, and a tablespoonful is half an ounce. But these measures are now old-fashioned, and in a few years will be obsolete.
We now use the decimal system, and order so many “c.c.’s” of fluid (i.e., so many cubic centimetres) to be taken. One cubic centimetre equals not quite seventeen minims. You can easily obtain decimal measures at the same rate as the old forms.
The time of the day at which medicines are given is extremely important. We will give you an example of this. We ordered Mrs. —— a sleeping draught containing chloral to be given at 9 P.M. The nurse, Mrs. ——’s daughter, forgot to give the draught at the time stated, so she gave it her as soon as she woke up in the morning! If you forget to give physic at the time stated—especially if it is a draught to be given at bedtime—do not give it at all until you have again seen the physician. But there is no excuse for anyone to forget to give the patient his medicine at the right time.
Before the physician calls see that the room is tidy and the place well arranged. Of course we can do our business as well in a coal-cellar as in a palace. But you have no idea what a difference it makes to yourself and your patient if the physician is not inconvenienced in any way. We are all human, and if we see that the nurse is doing her best to make her patient comfortable, it stimulates us to do all that we possibly can. And if the nurse is an amateur, and we see that she is giving her whole attention to her work, we are more likely to relieve and instruct her as far as lies in our power. If when we call we see the room is in disorder, with stale food about the place and signs of negligence on the part of the nurse, we are inclined to get away as soon as possible, knowing that whatever we order stands a very fair chance of remaining undone.
One last word. You have a very great advantage over trained nurses in that, as you are related to the invalid, you can cheer him, you can read to him, and generally comfort him.
We have nothing to say against trained nurses. In some diseases the help of a woman skilled in nursing is essential. What we want to do is to impress upon every woman the fact that it may become her duty to nurse her relative or friend, and that, if she will put her whole mind into the work, she will be as competent to nurse invalids through most diseases as are her specially skilled sisters.