The Nurse
The Nurse.—The Lancet insists that there is no more excuse for a nurse making a “guy” of herself than for her being decked out in vulgar finery, with her hair got up after an elaborate style which it would take her half the day to arrange. Print dresses of pretty pattern, or grey alpacas, according to season, with a light white cap, linen cuffs and collars, scrupulously white and clean, and a coloured neck ribbon, would be infinitely preferable to the black costumes of the sisterhoods. The heavy woollen dresses worn by some sisterhoods are not all that is desirable in a sanitary point of view. They do not “show dirt,” it is true; but it would be better if they did; and in their folds it is not impossible that germs of disease may be carried about. It may be laid down as a rule that nothing in a nurse’s dress that rustles, creaks, flaps, or catches can be in place. It is evident that this rule forbids silk dresses, stiff stays, trailing robes, and ornaments that are likely to throw things down. High heels are, of course, quite out of the question, as is any fashion which interferes with easy movement on the part of the nurse. Quietness, softness, usefulness are the points to be aimed at in the costume of a nurse; and if brightness can be given by a ribbon, the brightness may well be superadded. A nurse should wear no rings, and her nails should be kept cut very close. The sleeves of her dress should admit of being turned or rolled up above the elbow.
Never think any change in the patient’s manner or appearance too trifling to tell the doctor of it. Unimportant as you may deem it, it may be the very symptom he is watching for. Tell the doctor everything fully and truly, and above all, obey him implicitly. Never act against his orders, or tamper with them in any way. If you think any change in treatment judicious, ask his opinion first before trying it, but do not do things unknown to him. In this watchfulness and strict obedience lie the chief difference between professional and amateur nursing, and also too often the great advantage gained by employing the former over the latter. The several symptoms should be written down by the nurse from time to time on a slip of paper, always at hand, for the doctor.
Always save whatever has been vomited by a patient for the doctor to see, and be able to give information as to when the vomiting took place, whether directly after food or liquid had been taken, or not; notice whether there was much straining or retching before actual vomiting occurred, also if it was preceded by pain, and the situation of the pain. Remove the vomit from the room immediately.
In the case of coughing, observe whether it comes on in paroxysms, or is incessant; whether it is dry and hard, or moist and accompanied with expectoration; whether it is worse at any particular time, and is attended with pain. If there is expectoration, this should be kept for the doctor’s inspection. If blood is brought up, note whether it is coughed up, vomited, or brought up from the back of the throat or mouth; remark whether the expectoration adheres to the side of the spitting-cup, or flows easily.
The number of times the bowels are moved in the 24 hours must be noted, and whether the motion is attended with pain, griping, or straining; also the colour of the motion, and, if the patient passes worms, whether they are round or flat, tape, or small and thread-like. Note in what quantities urine is passed; also how often, whether with any discomfort or pain either before or after, its colour and consistence, and if there be any deposit, its colour also.
Do not forget to give messages of inquiry, as sick people think much of such kindnesses. Do not read letters out without reading them to yourself first; you may come upon some passage about the patient that you do not care to repeat, and your hesitation will make him anxious and uncomfortable. In convalescence books are often a difficulty, and require most careful choosing. Something not exciting, but thoroughly amusing, is generally the best thing—the lightest novel you can find. In any case, be careful not to read too long at a time; the strain of listening and attending is very tiring. In extreme weakness, when there is nothing to be done, say something from time to time to take off the sense of loneliness, but do not ask unnecessary questions or touch your patient—it is very tiring; and never at any time lean against the bed and shake it, and do not put anything heavy over the patient’s feet; the weight tires, and a hot bottle warms much more effectually.
Remember that the process of settling for the night takes a long time, and be sure to begin early. Some people sleep better in the first part of the night, and you should notice the hour at which the patient gets sleepy, and arrange accordingly; if kept awake long past that hour, a restless night will be the consequence. It is never wise to wake the patient, even to give medicine, except by the doctor’s orders. You should have a small tray arranged with all the things you are likely to want in the night, except medicines. By means of the judiciously-placed screen, anything that has to be brought in can be quietly handed over the top without a sound. Door-hinges and handles should be carefully eased and oiled.
Real quietude means the absence of all excitement, and it must be remembered that anything out of the common will tend to excite the mind of a sufferer. Do not, therefore, walk on tip toe, for this, in addition to its unusual elaboration of the gait, invariably causes a certain amount of creaking. Speak in low tones, but do not whisper. A whisper will often awake a sleeper who would not be disturbed by an ordinary conversation; and never say “hush!” Let your clothes and foot covering be of as noiseless and unobtrusive a character as possible, and instead of gliding and tottering about like a rickety ghost, do not hesitate to walk. If you have occasion to say anything in the room, say it so that the patient can hear it if he wishes, and do not let him be aware of your conspiring privately with the others, especially at the door. The door has much to answer for. If it be visible from the bed, people open it cautiously, put their heads in and slowly withdraw again. If, as is more frequently the case, it is screened by the bed curtains, mysterious openings and shuttings are heard, unattended with any apparent ingress or egress, and sotto voce colloquies going on outside. When you enter, do so honestly and at once. Do not spend 5 minutes in turning the handle, thereby producing a series of irritating little clicks, finally terminating in a big snap, with which the door flies open. If the latch be at all rusty, a handle that is slowly wound back in this way will often stick, and either require to be rattled back in position, or, if left as it is, may start back suddenly, after a time, of its own accord, with a report like a pistol shot.
A bracket or table on the landing or in an adjoining room, where one can keep a basin, water, and a cloth for washing cups, &c., can nearly always be managed; and even if one has to carry everything up and down stairs, the comfort to the patient of systematic, dainty cleanliness more than repays the trouble. Some nurses seem to think it enough to place anything used outside the sickroom door, trusting to a chance maid seeing it and carrying it off. But this proceeding often worries the patient most exceedingly. He or she lies there and fidgets over the chance of that stray cup being whisked over by a passing skirt, with an ominous clatter and smash; and though this probably does not happen, the expectation of it keeps the mind on tenter-hooks, and prevents needful rest.
Let visitors sit between the door and the patient, getting the benefit of the air and not between him and the fire, thus getting in the direct current of foul air rushing towards the fireplace; they should be well in sight of the patient, and never admitted at meal times. While talking to the patient it is better to sit by the side of the bed and as near the pillow as possible, so that you may converse easily, while your face and body are turned in the same direction as his. By this means you can make all necessary observation of his features without enforcing the arrest of his eyes on your own, which is so embarrassing and disagreeable to one lying in bed, and is almost unavoidable when facing him. Keep him in as comfortable a position as possible, by all means, but do not be too demonstrative in smoothing the pillows and little offices of that sort. Fidgety attentions will worry and do more harm than downright neglect.