Linen, Household and Personal. All linen, including clothing and bed linen that has been used by the patient, should be boiled before it is washed. There seems to be some prejudice against this previous boiling, as the family are apt to maintain that it makes it more difficult to get the linen clean afterward. The nurse should overcome their objections, and emphasize the necessity for the utmost caution in regard to this infective material.
Disinfectant and Other Supplies. At a later visit, the disinfectant may be given, as well as the waterproof pockets and books of information. During the first visit, it is better to give only the most important of the supplies—the tin cup, fillers, and napkins—and to save the rest for another time. For on her first visit the nurse is a stranger—later, she becomes a friend. Therefore she will make better headway if on her first appearance she does not burden the family with too much instruction and too much detail. It is better to say too little than too much, better to leave something unsaid until the next time, rather than overwhelm those she visits with a mass of advice which they cannot assimilate. Her first visit has been made as the bearer of distressing news, no matter how gently and carefully it may have been broken, and the distress and confusion which often arise fill the minds of her hearers to the exclusion of nearly everything else.
During her later visits, she will have ample opportunity to say all that should be said—and at each succeeding call she will find that much of what she said the time before has been forgotten, misapplied, or altogether ignored. Tuberculosis work means the constant and incessant repetition of the same thing, trying by every device imaginable to point the way, to make an impression, to obtain some slight degree of carefulness which may mean the protection of other people.
Phthisiphobia. People frequently reproach the nurse with the fact that her teaching tends to alarm the patient and his family, and to produce a community phthisiphobia which works great hardship in individual cases. As far as the community is concerned, fear of tuberculosis is a good, wholesome sentiment, and infinitely preferable to ignorance and indifference. We cannot have too much of a public opinion which declines to be exposed to this disease, and which will therefore provide the machinery to cope with it. As far as the family is concerned, we have never been able to produce enough fear of tuberculosis. It would greatly facilitate the campaign if the first feeling of alarm and apprehension could become permanent, instead of very transitory and fleeting. Tuberculosis is so slow and insidious in its onset,—there is nothing spectacular, by which we can demonstrate to the ignorant mind the relation between cause and effect, exposure and infection,—that the educational method alone is inadequate to deal with the situation. If the alarmed patient and his household could or would continue the preventive measures which at first so strongly appeal to them, and which in the beginning they apply with boundless enthusiasm, we should have comparatively little difficulty. But the disease is chronic and slow; the scare wears off, and the cry of “Wolf, Wolf” loses its value. And then follows a relaxation of prophylactic measures. Each time the nurse must stir them up anew—encourage, threaten, alarm, coax, bribe,—do everything in her power to awaken them from their mental apathy and drowsiness, which, as in morphia poisoning, precedes death.
CHAPTER XI
Inspection of the House—The Patient’s Bedroom—Porches—Gardens and Tents—Flat Roofs—Clothing and Bedclothing—Artificial Heat—Rest—Fresh Air—Food—Cooking—The Bedridden Patient.
Inspection of the House. On her first visit the nurse must inspect every room in the patient’s home, with a view to knowing what possibilities it affords for treatment and isolation. Some contain no facilities whatsoever; some but meagre ones, while in others may be found excellent opportunities which the patient must be taught to use. Before advising any change or rearrangement, several factors must be considered: the stage of the disease, number in family, financial condition, home surroundings and the institutional facilities of the community. The course to be taken depends whether or not there is a hospital, or whether or not the patient must wait some time before admission. The first object is the protection of the family, but all those measures which bring this about, offer at the same time the maximum advantage to the patient himself. To remove him to an institution is the best way to accomplish both ends. If this cannot be done, the nurse must endeavour to secure conditions in the home which as nearly as possible approach those of an institution. The closer this approximation, the greater the gain to both patient and those who surround him.
The Patient’s Bedroom. The first thing to be considered is the patient’s bedroom, or sleeping quarters. He should have this room to himself, sharing it with no one. If this cannot be arranged, he should at least have a bed to himself. This bed, and that of the other person, or persons, should be placed at opposite ends of the room, and as far apart as possible.
The more windows in the room the better; these should be kept open to their fullest extent. In some houses, where the windows are small, it is often possible to lift out the entire sash, thereby admitting more air. The bed should be placed directly at the window, so that the patient may lay his pillow on the window sill if he chooses. He should be instructed to sleep facing the opening, in order to get all the air he can. The nurse should rearrange the furniture as she wishes it, otherwise misunderstandings may occur. If the family object to her moving it but promise to do this themselves, she must be careful to inspect the room again on her next visit, to see that this has been properly done. Even with families that have been under supervision a long time, it is well to inspect the bedrooms occasionally, for the patient’s bed always has a tendency to retreat into a remote corner of the room, especially in winter.
The floor should be bare, and this, together with all other plane surfaces should be washed several times a week with hot water and soda. Great caution must be exercised in making a sanitary sick-room, but, in her enthusiasm to produce ideal conditions, the nurse must remember that articles used for months by the patient, and suddenly banished from his proximity, may be very deadly elsewhere. In advising that carpets and curtains be removed, she must be careful what becomes of them. If germ-laden carpets are sold, or given to the neighbour next door, they would better remain where they are. Poor people find it hard to withstand the temptation to sell or give away serviceable articles, which is of course but natural, but the nurse must be on guard against such occurrences.