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

by Ellen N. La Motte

To have an ideal sick-room, there is no necessity for its being depressing by its bleak ugliness, or bare and dismal as a cell. Washable muslin curtains may be permitted, and there is no objection to pictures and ornaments in moderation. It is bad enough to have tuberculosis, without penalizing the patient by removing from him all those little treasures which give him pleasure and harm no one.

In selecting a good room for the patient, the nurse may find it necessary to have him exchange with some other member of the household. In this event, great care must be taken that the room vacated by the patient is thoroughly cleaned and disinfected before being occupied by anyone else. There are also circumstances which render it unwise to make this exchange: for example, say that we have a moderately advanced case, whose improvement is doubtful. He is occupying a room with one window—not ideal, but fair enough. There is also another room in the house, containing several windows, altogether brighter and larger, but occupied by three or four people, so far healthy and sound. To exchange rooms under such conditions would be bad policy—it would be of little advantage to the patient himself, while the other people would be subjected to overcrowding and bad ventilation, which would decidedly lower their resistance. Those in prolonged, intimate contact with a consumptive must not be allowed to reduce their vitality in any way.

To arrange a good sanitary room for a patient does not in the least mean that he will use it. Such a room would doubtless appear well in a photograph, illustrating the “before and after” phases of the nurse’s activity, but this does not necessarily mean that the patient is isolated and harmless. He will probably use his nice room for sleeping purposes only, and it is what he does with the remainder of his time that counts. He comes into contact with the household at meals, in the evenings, and on innumerable other occasions, and the consciousness of an immaculate bedroom should not lessen the nurse’s anxiety about the kitchen, the living-room, and the family sofa. There is where the danger lies.

Porches. In some houses we find a porch readily available for the patient’s use, where he can sleep and spend most of his daylight hours. It is sometimes difficult to induce him to make use of it, however. We must also remember that there is a great difference in porches. Some are narrow, unroofed, exposed to sun and wind, have disagreeable outlooks, for instance, as on unsavoury alleys, and in other ways are unfit to be used as living-rooms. They should be used, of course, whenever practicable, since undoubtedly the patient will get more air, and more constantly changing air, than if he sleeps indoors. Yet it is well to realize that a place where the patient is unsheltered, uncomfortable, and where he cannot sleep or have a quiet mind, is often far less valuable than a good bedroom which may give him all of these necessities.

Patients in well-to-do circumstances can equip their porches admirably, both with awnings and with canvas screens. These latter should roll up from the floor, rather than down from the roof. Screens and awnings can be made to order by any awning or sail maker; the price varies with their construction, from about five dollars upward. To teach a patient to use a porch for sleeping and also to use it as a living-room should be the nurse’s constant endeavour. Even an ideal porch is like an ideal bedroom—only valuable if it is used.

Gardens and Tents. Many houses have little yards or gardens, easily adaptable for open-air living. A tent may be erected for sleeping purposes, if the space is large enough and the family can afford it. Women and children are usually afraid to sleep under such exposed conditions, and in consequence refuse to make use of what would otherwise be an excellent opportunity. These gardens may be used during the day, however, and the patient made comfortable in a reclining chair or lounge. But excellent as they appear theoretically, the extremes of our climate, excessive heat and cold, often make them unpractical for the consumptive’s use. Under such circumstances, these little back yards often become anything but ideal places in which to “take the cure.”

Flat Roofs. We also find flat roofs or sheds attached to certain houses in the tenement districts. These sometimes offer excellent conditions for long hours out-of-doors, and may also be used as sleeping-porches. The nurse must be alert to seize all opportunities which present themselves, and to teach her patients to utilize them.

Clothing and Bedclothing. In her effort to teach her patient to sleep out-of-doors, and to spend most of his waking time there, the nurse must remember that in winter this is impossible, if he is insufficiently clad. The vitality of the consumptive is always below par, consequently he needs much more clothing than would a healthy person under the same conditions. It is impossible to expect patients to remain out-of-doors if they are cold and uncomfortable, and before insisting upon open-air treatment the nurse must see that it is possible for them to take it. If they lack the necessary clothing—underwear, blankets, sweaters, overcoats—these may be procured through some charitable association. It is a part of the nurse’s duties to arrange for this assistance, the question of which will be dealt with in a later chapter.

Artificial Heat. In addition to extra clothing, artificial heat is nearly always necessary, and this may be procured by means of hot-water bottles, hot bricks, stove lids, and so forth. The clothing itself may be sufficiently warm, and a hot brick may be all that is necessary to keep the patient in the yard, rather than in the kitchen. The patient must learn to live in the open-air—and the family must also learn that their safety lies in keeping him there, and is well worth the trouble of filling a hot-water bottle now and then. A hot kitchen is the worst place in the world for a coughing consumptive—and a coughing consumptive is the worst thing in the world for a hot kitchen—and the inhabitants thereof. It is fortunate that the rule works both ways, so that both sides may be appealed to.

Rest. The three things necessary to improvement are rest, fresh air, and food. Not one alone, nor two alone, but all three together, if results are to be obtained. It is very difficult to impress upon the patient that rest is not exercise, and that nothing is as bad for him as exertion. He instinctively associates fresh air with exercise, and does not realize that fresh air and rest is the combination required. If a physician is in charge of the case, he of course would direct the amount of exercise to be taken, but if, as often happens, there is no doctor in attendance, the nurse must use her own knowledge of what is best. In a sanatorium the usual rule is that all patients with more than 99 degrees of fever shall stay in bed. After a hemorrhage, absolute rest is of course indicated.