The Tuberculosis Nurse: Her Function and Her Qualifications / A Handbook for Practical Workers in the Tuberculosis Campaign

by Ellen N. La Motte

In making the best of things, the nurse must never over-encourage the patient. A half-starved, overworked person, suddenly put on a régime of fresh air, rest, and abundant food, will often make surprising advances—up to a certain point. This improvement may be so marked that it will raise false hopes of its continuance and the nurse must never jeopardize her reputation and the confidence imposed in her, by extravagant statements as to what may be accomplished. The overconfident patient mistakes temporary improvement for permanent cure. Tuberculosis is like a concealed enemy, crouched and ready to spring the moment one turns one’s back, and it requires constant vigilance to guard against it. If this fact could be securely drilled into the patients, there would probably be fewer relapses.

Truth for the Family. If now and then an exception may be made in informing the patient of his condition, there are no conceivable circumstances under which this knowledge should be withheld from his family. The significance and danger of tuberculosis must be fully explained to all who are exposed to it. It is the “family” who constitute public opinion as far as the patient is concerned, and we must depend upon it to keep the patient up to the standard of living which means his improvement and their protection. The nurse should fully explain the situation to some older, responsible member of the household. This can best be done out of the patient’s presence. She must speak very plainly, using words within the comprehension of her hearers, so that they cannot fail to grasp her meaning. The patient needs this knowledge in order to get better—the family need it in order to protect themselves. It is a sad fact, but a frank appeal to the selfish instinct is usually productive of better results than one made upon higher grounds. Both points should always be made, but the instinct of self-preservation may be aroused with less prodding than is needed to awaken rudimentary altruism.

Disposal of Sputum. The nurse has by this time prepared the way for the prophylactic supplies, which she carries in her bag. These consist of a tin cup, fillers, paper napkins, disinfectant, and so forth. She must teach the patient how to use and dispose of them, as well as their advantages—the latter reason not being always apparent to the ambulatory case. She must teach that danger to himself and others lies in the sputum coughed up from his sick lungs, and that the simplest way to receive it is in the little tin cup, whose waterproof filler can easily be burned. To the advanced case, with profuse expectoration, these light, convenient little cups are a great improvement over the household spittoon, which should be banished at once. Bed patients, or those too weak to raise even this light cup to their lips, may be taught to expectorate into the paper napkins, of which they should be given a large supply. A simple way of disposing of these napkins is to pin to the bedclothes a large paper bag (such as are used for groceries), into which they may be thrown. Failing a paper bag, a cornucopia made of newspaper will answer the purpose, the object being to let the patient himself place this infective material in a receptacle which can be burned in its entirety, without its contents being handled by anyone else.

The problem of destroying sputum cups and their contents is often difficult. The proper and only sure way is to burn them, and no other course should be considered. Yet in summer, when many patients have no coal fires, but merely gas or oil stoves, many difficulties arise. Under such circumstances the patient may wrap his cup in a newspaper, place it in a galvanized iron bucket, and then set it on fire. This is a nuisance, as well as somewhat dangerous, and since these fillers and their contents are hard to burn, the simpler method of throwing them in the gutter becomes an irresistible temptation. To see that these fillers are properly destroyed requires constant supervision and instruction and is one of the most important of the nurse’s duties.

The patient should destroy the fillers himself—they should be handled by no other member of the family, unless of course he is too weak and ill to do it. Even when very ill, however, it is nearly always possible for him to remove the filler from the cup and place it in a newspaper, which is then rolled up by someone else and carried out to the fire. Needless to say, the nurse must teach those who touch or handle this cup how important it is to wash their hands thoroughly afterwards.

Danger of Expired Air. After giving him the tin cup and fillers, the nurse must then give the patient a supply of paper napkins, and explain their purpose. These are primarily intended to hold over the mouth when coughing. The nurse must explain that bacilli are liberated in great numbers during these coughing attacks, and that it is harmful to live in a room filled with these invisible organisms. Most patients, knowing themselves to be infected, are indifferent to the welfare of those about them. Therefore, in trying to make him careful, the nurse will have to appeal to his selfish instincts, and show that what is bad for other people is equally bad for him, and so diminishes his chances of improvement.

It is comparatively easy to instruct a patient in the use of his sputum cup, but to obtain any sort of carefulness in this equally grave matter—liberation of bacilli in the expired air—is well-nigh impossible. This is partly due to the nature of the disease—in its most infectious stages, the patient is so racked with paroxysms of coughing, that it is impossible for him to keep his mouth covered, or to think of anything except his own sufferings.

On the street, these paper napkins may be used to spit into, the patient carrying them home again in the waterproof pocket pinned inside his coat. Fine details of this sort are difficult to insist upon, however—the convenience of the street and of the gutter making a stronger appeal than any newly acquired æsthetic valuations. This is of minor importance, however; the real danger lies in the home.

Isolation of Dishes. The consumptive should have special dishes provided for him, which should never be used by any other member of the household. If the family can afford it, they should buy dishes of a special pattern, unlike those in general use, since in this way the chances of mixing them are greatly lessened. Otherwise, constant care must be taken to keep them apart. The patient’s dishes should stand on their own corner of the shelf, be washed in a separate dishpan, and dried with a special towel. Once a week, for general cleanliness’ sake, they should be boiled. Any dish which may have got mixed with them, or has inadvertently been used by the patient, should be boiled before being used again in the household. The patient need not necessarily know that his dishes are isolated, since details of this kind are explained to the family rather than to the sick man.

If he is a bed patient, it is an easy matter to isolate his dishes, without his knowledge; when he is up and about, it is much harder. Patients are particularly sensitive about this, and some families, rather than risk hurting the feelings of the invalid, prefer to boil the dishes after every meal. This adds so much to the work of the busy household that after a time all attempts at isolation are dropped. This matter calls for considerable vigilance on the part of the nurse.