SECOND ARTICLE.
Before commencing our subject proper, the sick-room, it may be well to consider two points very frequently neglected in home-nursing. First, as to a nurse’s dress. Unless the case be infectious, nothing is better than some soft woollen material that will not rustle or creak, after the fashion of silk or print, but that will bear washing should the necessity arise. If the patient’s taste is known and can be consulted, all the better; but if a favourite dress is too valuable to be devoted to sick-room wear and tear, a ribbon bow of some soft bright colour, and spotless collar and cuffs, will help to give that air of quiet cheerfulness which is soothing to senses so often rendered painfully acute by illness. Should there be more than one patient to attend to, or should the one be quite helpless, there will be a considerable amount of injury to clothing by rubbing against the beds, &c., which probably accounts for the style of dress affected by the professional nurse, which consists usually of a costume of either black flannel or stiff print. The former is so unsuitable, that it may be regarded as amongst the last relics of barbarism; and the latter, though economical and clean-looking, has the great drawback of creaking to an unlimited extent, and, moreover, would give the home-nurse an unnatural appearance—a thing to be studiously avoided.
As regards economy, a good substitute for a costume bristling with starch will be found in a large apron with a full bib, and loose sleeves to draw up and tie over the elbows. Even these should be made of a pretty and soft material; for, in our experience, colour and cheerful surroundings seldom fail to exert a beneficial influence. As an instance of the decided effect of colour, take the case of a baby, who at six months had taken no notice whatever of his surroundings; his parents were beginning to fear the possibility of blindness, when a friend coming in one day wearing a bright necktie, the sober little face relaxed, and a smile brought expression to the hitherto vacant features. The fact was little Hugh had never seen anything but black on his nurses, and the sight of a bit of bright colour woke up new ideas of pleasure. I have said that illness often brings back much of the sensitiveness of childhood, and for this reason, in dealing with the sick, even small details are worthy of careful consideration. As to what a nurse should wear on her feet, there are few people who would not be horrified at the idea of creaky shoes; but I am by no means sure that the popular notion of list slippers for sick-room use is not a worse evil. Any one who has experienced the sensation of being wakened by a sudden presence at his bedside, can see how injurious must be the same experience to the invalid, who is in a state far more susceptible to shock, and who, once frightened, will not easily lose the dread of a repetition. So, on these grounds, wear only ordinary house-slippers without heels; and in walking across a patient’s room, be careful to tread quietly, but at the same time in a firm, even way, and never on tiptoe, nor in that elaborately slow, hesitating manner which keeps an invalid on tenter-hooks of anxious watching.
Our second point—the care of a nurse’s own health—is one on which it is impossible to strike too serious a note of warning, for important as it is, there are very few who give it practical consideration. Yet, over-zeal is sure to defeat itself, and nature, the sternest balancer of accounts, only allows a certain amount of work to be done, and rigidly exacts the penalty from those who forget or ignore her wise limitations.
All institutions sending out nurses have fixed rules as to a certain number of hours for sleep and exercise, without which, experience teaches, no one can safely carry on the laborious duties of a sick-room; yet the inexperienced imagine they can do what the trained nurse wisely refuses to undertake, and make attempts at such work as nursing both by night and day. Such attempts generally retard the patient’s recovery, and always cause more or less injury to the nurse whose zeal has been without knowledge. In all cases where the patient is ill enough to need night-watching, two nurses are absolutely needful; but one may with advantage take the lead, and never leave the patient without arranging that he shall be properly cared for in her absence. The strongest, physically, had better be chief; and it will be well if she can undertake the whole of the night-work.
It is this question of night-work that is the bête noire of inexperience; but properly managed, and given an average amount of health, there is no reason why there should be any great fatigue, even with prolonged night-watching. The one essential thing is, to understand and remember that there must be a good allowance of sleep, and at least two hours devoted to brisk, open-air exercise. It is one of the rarest things to find the latter point remembered in amateur nursing, and I have known cases where the whole female portion of a family has remained indoors for weeks, simply for want of understanding the vital importance of fresh air and exercise to counterbalance the unaccustomed strain of nursing. No wonder that in such cases, depressed spirits and shaken nerves become associated with night-nursing, when, as a matter of fact, it is only ill-regulated zeal that is to blame.
Still, at first, night-nursing does seem formidable, especially when, as often happens, it is made to follow upon an anxious day. The only wise method of beginning is to lie down in the afternoon, after a warm bath if possible, and try to read yourself to sleep. If you fail, the rest itself will be some preparation; and if you succeed, you will be surprised to find how easy your work will be. Take a good meal, and wash your hands before going into the sick-room; but do not commence work before eleven o’clock at the earliest. Beginning night-work too early is a mistake, especially where there is a natural tendency to fall asleep under the influence of warmth and quiet; but by making it as late as eleven or half-past, you will have a much better chance of keeping awake without a struggle. Ordinarily, too, a nurse not going on duty early will be able to take the lead in washing the patient in the morning and in making his room tidy. When this is done, she should give directions for the day, and, if possible, not enter the sick-room again till it is her turn to mount guard. The only drawback to this plan is that there may be difficulty in arranging to meet the doctor; but a little management will generally smooth the way, especially if helpers are reliable.
On leaving the sick-room, the night-nurse should at once go for a brisk walk, if possible with a pleasant companion, and the walk ought to occupy a couple of hours; but if exercise has not been a habit of life, it will be well to begin with less and gradually increase. It must be remembered that a dawdling lounge is useless, and that the walk must be brisk to be of any real service. On returning, the nurse should at once go to bed and have her sleep out. But if she feel particularly wide awake, a warm bath will supplement the effects of exercise. On waking, she should take a cold or tepid bath according to habit. A nurse should be careful to change her under-linen as often as convenient.
One other thing must be borne in mind in regard to night-work, and that is, the necessity for taking food during the hours of watching. A nurse who takes proper time for sleep, misses at least one meal in the day, whilst needing more than the ordinary allowance of food; so that it is her duty to take nourishment during the night. A meal between two and three will help her through the hardest part of the twenty-four hours; and as soon as she feels hungry or weary, a glass of milk with an egg in it, a cup of cocoa, or some light soup, will give the needed support, and will also make a great difference to the ease of keeping awake and on the alert.
If these rules are carefully followed out, we venture to say there will be very little cause to dread even the most trying part of nursing—night-work.
And now as to the sick-room itself. If a choice is possible, let the room selected be of good size, cheerful, and quiet. It needs to be fairly large, because air is consumed by nurse as well as patient; for this reason, a dressing-room adjoining is of great service. Except in acute and dangerous illness, it is better if the nurse can sleep away from the patient, always provided there is ready means of communication. Helpless patients, as a rule, have a natural dread of being left alone; but few will object to a nurse’s going to bed in an adjoining room, as long as they have the means of calling her at a moment’s notice. If she be a light sleeper, a piece of tape tied to her wrist, the free end being left within easy reach of the patient, will be enough; or instead of tying the tape to her wrist, she may fasten a small bell, letting it rest over the head of her bed. Where the patient is very weak, an excellent contrivance is a piece of india-rubber tubing with a whistle at one end, and a compressible air-ball at the other. The latter should be placed on the patient’s pillow, and by the slightest possible effort, he will be able to make the whistle sound. Of course, a nurse who adopts such methods must have dressing-gown and slippers at hand, that she may obey the summons instantly, for nothing is more likely to irritate a patient than being kept waiting at night.
The sick-room should, if possible, face south or south-west, so as to get the benefit of the sun. Should the light be too strong, it is easily regulated by drawing down the blinds, or by hanging up a piece of some dark material; and in convalescence, the cheerful light of the sun plays an important part. In a sunny room, however, it is necessary to exclude the early morning light. The rising sun begins—in summer—to shine just at a time when, if the patient sleeps at all, he will be most likely to doze off; and it need hardly be said that to allow him to be awakened then is to deprive him of one of his best chances of improving.
But whilst cheerfulness is an essential of a sick-room, it is hardly less important that it should be free from liability to sudden noises. It should, therefore, never face a thoroughfare; nor, in a large family, be so situated as to necessitate much in the way of footsteps overhead. In cases where there is a nursery, it is well to take that for the invalid, at whatever risk of injury to other rooms; for nothing can be more distressing to a patient’s nerves than the constant pitter-patter of small feet, added to the tumbles and screams inseparable from nursery-life. At the same time, a room at the top of the house has the serious disadvantage of causing much extra up-and-down-stair work, so that in small, grown-up families, it is well to choose a room as low down as possible. In houses where there are bedrooms behind the sitting-rooms, it is convenient to take one of such, especially where there is the comfort of a slab outside, of the use of which we shall have more to say later on.
A sick-room should not have French-windows, those opening at the top and bottom being much better for ventilation; and if possible, there should be either venetian or sun blinds, for the easier regulation of light. Before beginning to nurse a case, it should be ascertained that bolts and sashes of windows, cords and pulleys of blinds, hinges of doors, and ventilators, are all working easily and quietly. It would seem hardly necessary to add that a fireplace with a good grate, and a chimney that does not smoke, are also essential.
Before removing a patient to the room that has been selected, it should be well cleaned, the doors and windows left open, and a fire lighted. By the time the latter has burned up brightly, the air of the room will be perfectly fresh, and one of the nurse’s first considerations will be how to keep it so. Her aim should be so to arrange ventilation that at no time should an incomer perceive any closeness or smell; in other words, the air of the sick-room ought to be as pure and fresh as the outside air; but in our climate this is not always easy, and will never be accomplished without constant thought and attention.
To understand how important is the question of ventilation, it is well to consider what it is that causes air to become impure, and consequently unwholesome. The air we breathe consists, roughly speaking, of two gases, oxygen and nitrogen. The former is absolutely necessary for the maintenance of animal life; it is drawn into the lungs, to be mixed with the blood, and used in various operations of the body; consequently, the pure gas of oxygen becomes used up, and the air we breathe out has changed its character, and is charged with the poisonous gas, carbonic acid. If the same air continues to be breathed over and over, carbonic acid increases its proportions with each inspiration, and fatal results follow. From this it will be seen that even in health there is positive necessity for providing a supply of fresh air, as well as for the removal of that which has become vitiated. But in sickness, the need is even greater, as the air given off from the lungs of the invalid will contain a larger proportion of poisonous matter. Impure air has always a tendency to ascend, and the secret of successful ventilation consists in getting rid of the warm, vitiated air floating at the top of a room. Once get this out, and nature, abhorring a vacuum, will pour in a fresh supply of pure air. You may sometimes be able to do this by opening the window wide for a few minutes, your patient being meanwhile covered up with an extra blanket, and a light handkerchief over his face. But in cold weather, this would lower the temperature of the room too much, and in any case it is hardly a method for the unprofessional nurse, unless with the doctor’s special permission. And even if this is allowed, it will not be enough, as the air consumed by you and your patient requires constant as well as thorough changing.
A fire is an excellent ventilator, as by it warm air is constantly being drawn up the chimney, whilst its place is taken by fresh; but a fire alone will not be sufficient, though it will enable you, often, to keep the window open an inch or two. This will in ordinary cases be quite sufficient; but it often happens that a patient unused to fresh air complains of the draught of an open window, and asks to have the door open instead. Never, if possible, yield to this. It is one of the commonest mistakes in home-nursing. As I said before, impure air ascends; and so, if your room be above the ground-floor, the heated, vitiated air from all the rooms below will come pouring through the open door of the sick-room. Yet, I have known cases of long-standing illness where there has been no attempt at ventilation other than through the door, and where the window has not been opened for months. In such cases, it not seldom happens that nurses complain of feeling heavy on waking—they and the patient have been using up the same air all night—and yet obstinately refuse to put the window down or use a ventilator, or even to see that the staircase window near the sick-room is kept open. The last-named expedient is the only one by which door-ventilation can be of any use; but it is far better to adopt one of the following plans, nearly always available and safe, even for the most delicate. The first is a very simple contrivance, which deserves a place in every bedroom where the window is not kept open at night. Get a piece of wood the exact width of the window and have it nailed to the lower sash; you will then have a space between the two sashes, through which cold fresh air will enter; the current will drive it up towards the top of the room, whence it will gradually sink through the lighter, warmer air; and this, with fire-ventilation, will keep an ordinary room fresh and sweet, at least in winter-time.
Another method is to have the window open at the bottom, and to place, a couple of inches away from the opening, a screen somewhat higher than the bottom of the lower sash. A third way is to open the window from the top, and across the opening nail a piece of muslin or perforated zinc. Both these methods give an additional current of air; but the screen in the one case and the perforation in the other prevent such a rush as to cause the patient to complain of cold. If he objects to one plan, try another; but never be satisfied with anything short of complete ventilation, at the same time being very careful to avoid all draughts.
To keep a sick-room at the proper temperature is another serious matter. From sixty to sixty-five is the ordinary temperature; but various diseases require modifications, and it is always well to ask the doctor what he wishes in this respect. The nurse should never trust to her own sensation, but get a thermometer, and hang it up near the patient’s bed. The temperature of a room will often vary by several degrees in different parts, and the nurse’s concern is that her patient shall be breathing the right degree of warmth, so the thermometer should be hung as near the bed as possible. Special care is needed at night, as the outside air will be considerably colder than by day, and the nurse will have to keep the fire proportionately larger. This and keeping the fire clear demand no little attention, especially when the patient does not sleep well and wakes at the slightest sound. When this is the case, it is well to start the night with a supply of coal done up in separate bits of paper. These may be dropped on one by one with hardly a sound. If the fire requires to be poked, use a piece of stick with a quick decided movement, which is better than worrying the patient by stealthy efforts to move first one piece of coal and then another. Here, a properly fixed gas radiating stove would be serviceable.
If sleep is a necessity for the patient, and he sleeps on till the fire gets very low, one of the forms of patent fire-lighters will cause less noise than the ordinary wood. Ashes should never be allowed to accumulate, and a wooden shovel for removing them is quite a comfort in a sick-room.
In very warm weather, of course the fire must be dispensed with; and there are days even in this country when to keep the temperature cool is no slight difficulty. The window should be open both at top and bottom, to give as much current as possible, and the register of the chimney must not be closed. Agitating the air with a large fan and sprinkling the window-sill with water are cooling; but best of all is a large block of ice placed in the middle of the room on a strainer, with a vessel below to receive the drippings.