Waterproof Pockets. These are little calico bags, dipped in paraffin, or some similar preparation which makes them fairly waterproof. These are pinned inside the coat pocket, and the patient uses them as a receptacle for his soiled napkins, when he is out on the street, or in other places where he cannot carry his sputum cup. The napkins are burned upon his return.
Books of Instruction. These little books are more or less valuable, but are by no means intended to take the place of the verbal instruction which it is the nurse’s duty to give. They serve merely to refresh the memory after she has gone. They can be procured at small cost through the various anti-tuberculosis organizations, and most Boards of Health print them for their own distribution. The best of them are inadequate.
Stocking the Bag and Distributing Supplies. When the nurse starts forth on her morning rounds, her bag should contain enough supplies for the patients she proposes to call on. Each should be given enough to last until her next arrival. It is sometimes possible to direct either the patient himself, or some member of his family, to come to the office and get a fresh stock whenever necessary. By putting this slight responsibility on the family, it is made to realize how necessary are these supplies, but it should not relieve the nurse of her obligation to visit such a household, and keep it under as close observation as any other case. If a nurse thus trains a certain number of patients to come themselves for the supplies, she will be able to reserve the contents of her satchel for those patients who cannot call for them, or who are too indifferent to do so.
Supplies should always be given out freely, and the patient should not feel that he is put under any obligation by accepting them. They are intended for his personal use and convenience, and he should be made to realize this. Otherwise, some patients may hesitate to accept all that they really need. If a patient needs four or five fillers a day, he should unquestionably have them—otherwise he may practise small economies which will mean unnecessary exposure for his family. On the other hand, the nurse must see that the supplies are used for the purpose intended—we have sometimes known handkerchiefs used as a decoration for kitchen shelves, simply because the nurse had given away far more than was necessary.
Nursing Supplies. In addition to the prophylactic supplies, the bag also contains a number of articles used in caring for bed-ridden or very ill cases. Naturally, these articles are not given to the patients, but are used from case to case, as necessity arises. They include a bottle of alcohol, boracic ointment, talcum powder, gauze, adhesive strapping, absorbent cotton, and a thermometer. The nurse should always carry an apron, to be worn when doing any nursing work.
The most common dressing is that of bedsores; many patients with pleurisy have to be strapped; others have drainage tubes, which must be taken out and cleaned. These extensive dressings are not those which the nurse should properly be required to attend to, since a patient ill enough to require an extensive dressing, is a patient who should be sent to a hospital. Hospital accommodation, however, is unfortunately very limited, and the nurse is often obliged to do these dressings while waiting for a vacancy to occur. It is no part of the programme to keep these advanced cases at home rather than in an institution; on the contrary, the nurse must make every effort to get them away—but until this can be accomplished, it is her duty to care for them at home.
CHAPTER V
Records and Reports—The Patient’s Chart—Closing the Chart—The Card Index—Nurse’s Daily Report Sheet—Weekly and Monthly Reports—Examination of Charts.
Records and Reports. Every association, whether it be private or municipal, supporting one nurse or fifty, should keep careful records concerning its patients, and concerning its nurses’ work. These two sets of records should dovetail and form a cross file; by looking at the patient’s chart, one should be able to note the condition of each individual case, and how often and on what dates he was visited. By looking at the nurse’s record, one should be able to know exactly how she had employed every moment of her day, and to see the number of patients she had visited during the course of it. The patients’ charts account for the patients—the nurse’s daily report accounts for her work among them.
The Patient’s Chart. Each patient should have a chart made out for him at the moment when he is taken on the visiting list. This also applies to suspects, or those for whom the diagnosis is not positive, but whom the nurse is required to visit and care for. This also applies to those moribund patients, who may live but a few hours after being reported, and who die before a second visit can be made. Whether he has been on the list a year or an hour, it is necessary to account for every patient who passes under supervision, and to record the result in each case. Unless this is done, accurately and promptly, it will be impossible to estimate the amount of work, and its value to the community.