THIRD ARTICLE.
In our last paper we spoke of the choice of a sick-room; we shall now proceed to discuss its management. In commencing to nurse a case that promises to be anything like lengthy, it is well to consider how to save unnecessary dust and unnecessary labour, whilst keeping the room in its proper state of cleanliness. With this end in view, heavy woollen draperies, retaining dust and bad smells, should be avoided; and if curtains are used at all, they should be of lace, or some light, washing material. The best chairs are those with simple wooden frames and cane seats and backs. Should a sofa be necessary, and a regular invalid couch not procurable, nothing is better than a chair-bed—provided it does not creak—fitted with washing-covers to its cushions. Much has been said for and against the use of carpets in a sick-room; and taking all into consideration, we see no reason for changing our opinion that, in ordinary cases, it is better to let them remain; they make a room pleasanter and more natural, and do away with the noise of scrubbing, incidental to a boarded floor.
If there are cupboards, they should be cleaned out before beginning to nurse, and in no case must they be used as receptacles for food or for anything that has become soiled in using. A chest of drawers is a comfort if used with discretion; but in home-nursing, it often proves the reverse of useful, and serves as a treasury for all sorts of things which have no business in a sick-room.
Pictures have a brightening effect, but they must hang straight, or your patient may worry himself with endless efforts to make them fit in with the pattern of the paper; though, if possible, the paper should be without those decided markings which so often add to the distress of unduly sensitive nerves.
Growing-plants have a cheerful look, and are not deleterious, as many suppose; cut flowers may also be indulged in, with the exception of those which have a heavy, sickly smell; but it is better to remove them at night. In summer, it is necessary to take precaution against the patient’s being disturbed by the buzz of insects; a fly-catcher at the open window will generally be sufficient; but such things in the room itself are worse than useless.
Small washable ornaments may be allowed to remain, but not to a greater extent than suffices to give the room its customary appearance, for it must be remembered that all useless articles increase the number of dust-receptacles and make the process of tidying-up more lengthy. I have seen mantel-boards and brackets covered with cloth, and literally crowded with ornaments, which have not been properly dusted for weeks because it made the patient sneeze! Such instances point the moral in regard to cloth-coverings as well as superfluous ornaments.
A folding-screen is an almost indispensable article of sick-room furniture; it not only serves to keep off draughts and the glare of the fire, but in convalescence is useful for putting round the invalid’s chair. By its help, too, ventilation is made so much easier, that, if nothing pretty and ornamental is to be had, it is worth while to extemporise a screen with an ordinary clothes-horse and sheet; but a chintz or holland cover, bound with braid and made to tie on, is much more cheerful than the dull expanse of a sheet.
And now for the most important article of furniture, the bed, on which depends so much of the patient’s comfort or discomfort. If possible, have a light iron frame without a foot-rail, or with only a low one. For an adult, the bed should measure not less than six feet three inches in length and about three feet in width. Greater width increases the difficulty of reaching the patient, and it is astonishing the journeys such a thing as a handkerchief will make over a large surface of bed. The height of the bed is another serious consideration, for should it be too low, the nurse will find it add considerably to the back-aching tendency of nursing; and if too high, the constant straining up to the patient will be quite as bad. The rule then, is, that the bed when made shall be so proportioned to the nurse’s height as to enable her to lift and attend to the patient without any undue effort. In home-nursing, the bed question is often overlooked altogether, or made much more of a difficulty than it need be; and though that relic of unenlightened days, the four-poster, is almost extinct in some households, most of the beds are large, and to alter the furnishing of a room seems beyond the imagination of the ordinary housekeeper. But surely, in time of illness, the first consideration should be how best to mitigate the patient’s sufferings and lighten the nurse’s labours; and in all but quite slight cases, it is worth considerable effort to secure the right kind of bed and bedding. This brings us to another home-nursing difficulty; for in spite of recent progress in hygienic knowledge, there are still not a few individuals who are foolish enough to prefer the unwholesome softness of a feather-bed to the healthy firmness of a good hair mattress. Yet few victims to this enervating habit fail to complain of the lumps, only to be got rid of by a large expenditure of strength and time. And if this be so in ordinary life, how much more complicated do matters become when the patient is too weak to bear to be removed for the necessary shaking, and is yet in a state to feel every discomfort with added force. Indeed, so true is this, that in serious illness, a feather-bed may be reckoned as an invincible enemy to comfort and cleanliness; and it is better not to allow your patient to remain under such unfavourable circumstances, even though it involve a few hours of dissatisfied grumbling. It may make things easier if the change is ushered in by allowing the feather-bed to remain under the mattress till the patient has become accustomed to the new order of things, when it will be well to substitute flock for feathers.
If the nurse’s height will allow of two mattresses, it is a good plan to alternate them so that the under one of yesterday shall be the upper one of to-day. Those who have not tried this simple way of securing a change, will hardly believe the comfort it affords to a helpless patient.
On the same principle, it is a great alleviation to the monotony of long illness if the room will allow of two beds, one for day, the other for night; and this arrangement permits the thorough airing of bed and bedding, which it is otherwise so difficult to secure.
Bed-hangings are happily following the lead of the ancient four-poster, and will soon be only remembered as things of the past; and in illness, even the valance, still in use, had better be banished. Pillows should be firm and not too soft; and bolsters should have covers of their own, and not be rolled round in the under-sheet, according to a common and very shiftless process. I have known the sheet to be tucked round the bolster in such a careless way that by the patient’s merely getting into bed it has been pulled out of place, and has continued a fruitful source of irritation for the rest of the day.
How to keep the under-sheet smooth and free alike from crumbs and wrinkles is one of the professed nurse’s arts, and is just one of those apparently small matters, neglected as such by inexperience, which make home-nursing the unsatisfactory thing it often is. Yet those who have gone through a tedious illness can hardly fail to remember the discomfort of what a tiny patient used to call ‘rucks.’ To him, poor little man, rucks made stopping in bed a misery; and his incessant demands to have them removed, suggested to even his inexperienced nurse the idea that there might be a right and a wrong way to such a commonplace thing as bed-making. The right and only proper way of arranging a bed for illness is to give special, minute attention to the placing of under-blanket and sheet. If the former can be dispensed with, especially in summer-time, it will be well; but very few patients will agree to this, and it is hardly of sufficient importance to argue about, except in special cases, when the doctor will probably give his veto.
In an ordinary way, be careful to choose a thin blanket, without holes of course, but one that has been pretty well worn, and that, therefore, will not greatly add to the heat of the patient’s body. Then—more important still—the blanket must be considerably larger than the bed, in length as well as width. The mattress being arranged as evenly as possible, the under-blanket should be laid upon it, and well tucked in at top and bottom, as well as sides, till there is not a crease or wrinkle of any sort. The under-sheet must now be put on in the same way, and the nearer it resembles a drum in tightness the better. A few minutes spent in extra care at this point will save the patient hours of discomfort later on.
Should there, unfortunately, be no covered bolster, the sheet, after being securely tucked in at the bottom, must be drawn tightly upwards, and the bolster rolled round in the free end and then placed well up against the bed-head. The difficulty is to get the sheet tightly stretched without pulling the bolster away from its proper place. The number of pillows must be regulated by the nature of the patient’s malady and partly by his previous habits. In ordinary cases, one large pillow is enough, and it is a good plan to place it lengthways, one end resting against the bed-head, and the other on the mattress, thus avoiding the hollow between the patient’s shoulders and the bed, which is a fruitful source of uneasiness and restlessness. In convalescence and in many forms of illness, pillows play an important part, and we shall have more to say about them later on.
We now return to the bed, furnished as far as the under-sheet and pillow. Should the patient be quite helpless, it will be necessary to place next, the contrivance known as a draw-sheet, which should consist of old linen or calico that has been washed to extreme softness. It should be folded lengthways till just long enough to reach from below the patient’s shoulders to his knees. This, with an under-piece of mackintosh, is carefully put in place and tucked in with the same care and tightness as the under-sheet.
In regard to the upper bed-clothes, they too require care in tucking in, especially at the bottom; and if so long as to need folding back, the folding must on no account be done at the top. I have seen patients with chest complaints literally labouring under the weight of clothes placed in exactly the wrong place. In illness, as a rule the feet need extra covering, and the breathing organs no more weight of clothes than is absolutely necessary. The upper-sheet being light, may be allowed to turn over for neatness, but blanket and counterpane must only come up to the patient’s neck. This folding back is such a common error, that it needs special notice, and in ordinary life, as well as in illness, should never be tolerated. The number of upper-clothes to be put on the patient’s bed will vary with circumstances; but, as a rule, in a room with a fire, one blanket and a counterpane will be enough. The great point is to secure warmth without weight, and for this purpose, the ordinary cotton counterpane is about as bad as possible. An excellent substitute is the kind of blanket known as the ‘Austrian,’ which is cheerful in appearance as well as light and warm. In cases of exhaustion, nothing is better than a chintz-covered down, which can be shifted or removed without disturbing the patient.
A good many amateur nurses err on the side of over-heating a patient, and do not understand its connection with restless tossing and broken sleep. Should these symptoms occur at night, especially if accompanied with a flushed face and moist skin, it is well to gradually reduce the number of coverings, carefully noticing the effect of so doing.
On the ground of their greater warmth, cotton sheets and pillow-cases are preferable to linen; but some people have a decided fancy for the latter, and it may safely be used, provided the sheets are warmed just before being put on the bed. Simple airing is not enough; I have known the chill of linen set a patient off into a shivering fit, although the nurse has been particularly strong in the airing line.
It is absolutely necessary that all the bedding used in illness shall be thoroughly aired, but, of course, it should never be done in the sick-room. Unhappily, it is by no means rare to find the fire screened from a patient by clothes-horse or chairs, covered with damp things, the vapour from which ought to be sufficient warning of the folly of such a practice. A good rule in this connection is that everything, down to cups and saucers, shall be removed from the sick-room as soon as soiled, and only returned to it in a condition for immediate use.
Re-making the patient’s bed is our next consideration. If well enough to go into another room, he should either be carried there, or laid on a sofa and wheeled in. As soon as he is out of the way, the window of the sick-room should be thrown open to its widest, and the bed-clothes taken off one by one, well shaken, and left so exposed that the air can circulate freely around them. The mattresses should share the same treatment, and if possible, be left for a few minutes before being replaced. The patient will indeed be peculiar who does not enjoy the refreshment of a bed thus aired.
But in helpless illness, the changing of bedding is a more complicated matter, and needs practice to make perfect. There are two ways of changing the under-sheet The first may be used when the patient is not quite helpless, and the nurse has to work alone. The soiled sheet is freed at the top, and after the removal of pillows and bolster, is rolled up to the patient’s head; the clean sheet, after being well tucked in at the top, is loosely rolled in such a way as to lie close against the soiled one; they must now be worked down together, rolling the soiled, and unrolling the clean, the patient raising himself on elbows and feet just enough for the nurse to pass the sheets under him. In this way it is possible to get the under-sheet smooth and tight; but it is not an easy thing, and an assistant should be had if possible. If help is to be had, and in all cases where the patient is quite powerless, it is better to adopt the second plan. Remove the pillows and bolster, so that the patient lies quite flat in bed; turn him over on his side with his back to you. Loosen the sheet lengthways, and proceed with the rolling and unrolling as before, till the rolls come close up to the patient’s back. Depress the mattress under him, whilst the assistant draws the sheet through, and in so doing, slowly turns the patient on his back. He will now be lying on the clean sheet, and the difficulty is over. The trained nurse will be able to do this without removing the upper clothing, and in no case should all the coverings be taken away. Draw-sheets may be removed in the same way, but being small, are easier to manage. Some people tack or pin the clean to the dirty, and draw through whilst an assistant keeps the patient raised. Changing the upper clothes is not such a serious undertaking, though seldom properly managed by amateurs. The counterpane and blanket may be taken quite off the bed, and given to an assistant to shake, outside the room; but the sheet must never be removed without an immediate substitute. A good plan is to loosen the soiled sheet all round, tuck the clean one well in at the foot, and draw the free end upwards, under the dirty sheet, which is gradually drawn away or rolled up. As a general rule, the patient’s bed should be made and his night-shirt changed at least once a day, and cases where this is not feasible ought not to come within the scope of home-nursing.
If a pair of clean sheets a day cannot be managed, one may be made to do, by letting yesterday’s clean upper sheet be to-day’s lower one; but draw-sheets must be changed as soon as soiled, irrespective of number. Where mackintosh is used, it should also be frequently changed, washed over, and thoroughly dried, in the open air if possible.
The patient’s bed, it will be seen from the directions for making it, must never stand so that one side is against the wall, nor must it be in a direct current of air; but it is well if it can be so arranged as to face the fire and at the same time allow the patient to amuse himself by looking out of window. In badly finished houses, there is often considerable draught from cracks in door or window frame, and from this the patient must be carefully guarded by the judicious use of screens.
We now turn to consider how the sick-room may be kept in that state of perfect cleanliness essential alike to the patient’s comfort and recovery; and of all neglected points, this is perhaps the one most frequently forgotten or ignored; not one in a hundred of home-nurses having a conception of her duty in this respect. Difficult it undoubtedly is; but where the patient can be removed to another room for an hour or two once a week, it is quite possible for even inexperience to be successful.
We will suppose the weekly removal has taken place, and the nurse has to make hay while the sun shines. She first strips the bed, sending the clothes into another room to be aired; and throwing the window open to its widest, she directs her attention to the grate. The best way of removing the ashes is to carefully collect all the large pieces of coal and cinder, and then very gently draw the ashes away into a piece of stiff paper, which folded over them, will prevent any dust rising in their transit. After cleaning grate and fire-irons and making up the fire, the nurse turns her attention to the carpet, which, after being well strewn with damp tea-leaves, should be briskly swept with a hand-broom. If the furniture is simple, it may be washed over with a wet cloth and dried, all cushions or stuffed furniture being beaten out of the room. The window, often overlooked, should be nicely cleaned; and then the bed being re-made, the patient may be brought back into a room thoroughly well cleaned and aired. It is not necessary that a nurse should herself perform all menial work; indeed, it is much better she should not; but she ought to see that the above directions are faithfully carried out. For the rest of the week, the carpet should be wiped over with a damp (not wet) cloth, tied to the end of a long broom, and the furniture well and quickly dusted. It is not enough to merely wipe over furniture and let the dust loose; the duster should be folded over bit by bit as it becomes soiled, and once or twice during the process of dusting, shaken out of a window in another room or in the staircase. A room thus treated will keep in perfect order for some time; but should the illness be long, an effort must be made to take the carpet up about every six weeks or two months, that it may be beaten and thoroughly aired. If carpets are made in the sensible fashion of squares, secured by brass nails with broad heads, there will be little difficulty in managing this; but it will not hurt the carpet to let it remain loose.
In cases where the weekly removal is impossible, the floor must be wiped over carefully every day with a damp cloth, and tea-leaves used now and then, the patient being protected from the dust by screens; but this plan is only for use as a last resource in extreme cases. Under such circumstances, it is not a bad plan to have a small portion of the furniture, say a chair or table and an ornament or two, removed each day and thoroughly cleaned, out of the room; otherwise, it is almost impossible to keep things in proper order, in spite of daily dusting.