Alcohol. The question of giving alcohol frequently arises in this work. If a doctor is in attendance, he will prescribe it or not as he chooses. But if the nurse alone is in charge of the case, and the matter is left to her decision, we feel that the ruling of the Phipps Dispensary of the Johns Hopkins Hospital is a wise one to follow—no alcohol for the consumptive under any circumstances. This means that there shall be no eggnogs, made with brandy, sherry, rum, etc.; no sherry with raw eggs—no indulgence in wine, beer, or alcoholic stimulants of any sort.
The Bedridden Patient. When the patient is confined to bed, the nurse’s task becomes easier. Isolation, therefore better protection to the family, is more readily secured than when he wanders from room to room, leaving a trail of germs behind him. It is well to exclude from the sick-room every one except those in actual attendance upon the patient; this is especially necessary in the case of children, to whom the danger is greatest. Neighbours and friends should also be excluded, and if they refuse to consider the risk, the plea for exclusion should be made on the ground that visitors are disturbing and harmful to the patient.
In the sick-room we sometimes find the young children of neighbours, whose mothers are all unconscious of the danger to which they are exposed. If through sheer indifference, the patient’s family does not exclude these children, it would then become the nurse’s duty to seek out their parents and warn them. When a patient’s household becomes indifferent to community welfare, the nurse should then extend her teachings farther afield—into the next house or block if need be—and try to protect others who are unknowingly exposed to infection.
In brief, these are the duties of the nurse in the home of the patient. At her first visit, she cannot say everything she wishes, but later it will be possible to do so. In many cases, the household will be suspicious, antagonistic, or not inclined to want her, so that she must feel her way cautiously, step by step. It may take two, three, four, or even a dozen visits to accomplish her object, and before she can drive her points home with the requisite vigour. When the situation is acute, and the danger great, it is difficult and discouraging to make haste slowly, yet this policy will pay in the end. It is better to proceed cautiously with an uneasy family, winning them gradually from point to point, than to arouse their resentment by an impatient enthusiasm which sees no wisdom in delay.
In dealing with patients, the nurse must speak plainly; it will not do to insinuate or imply. What she has to say must be said straightforwardly, in simple words adapted to the intelligence of her hearers. The situations one encounters in this work are often sad and trying to a degree, and it would be far easier to insinuate a disagreeable or painful thing than to speak out plainly. The nurse who cannot express herself clearly, forcibly, and convincingly will get poor results. She must be able to meet prejudice with reason, to impose her view upon another, and to convince the ignorant that what she says is right.
There is an old fable which all public health nurses should remember—the old story of the Wind and the Sun, who both tried to remove the Traveller’s cloak. The Wind tried first, and he blew and blustered, but his frantic efforts only made the Traveller clutch it tighter. And then the Sun tried. He shone, blandly, warmly, gently, and in a few moments off came the cloak. It is the method of the Sun, rather than of the Wind, which usually wins out.
CHAPTER XII
Care of the Family—Examination of the Family—Taking Patients to Dispensaries—Children—Tuberculosis in Children—Open-Air Schools—The Danger of Sending Patients to the Country.
Care of the Family. We have already said that the first consideration is the patient’s family, or those individuals who come in contact with him. Therefore, as soon as he himself is under satisfactory supervision, the nurse must turn her attention to the other members of the household who need her even more. A majority of the nurse’s patients are either advanced or last-stage cases, many of them having a history extending over months or perhaps even years of illness. If during this time the nature of the disease has been unknown; or known, and no precautions have been taken, there is great likelihood that other members of the family have also become infected. To discover these suspicious cases and get them examined and under treatment as soon as possible, is one of the nurse’s first responsibilities. Next, she must give careful attention to those other members of the family who so far have apparently escaped. She must not over-alarm or frighten them, but she must keep before them the fact that they are in close contact with a highly infectious disease, and that whatever lowers their resistance, increases in like manner their chances of contracting it. They must employ every means in their power to raise their vitality to a point where they cannot be reached. An infectious disease does not, as a rule, gain entrance into a constitution strong enough to resist it.
To this end, the nurse should pay particular attention to the personal hygiene of the exposed family. Their bedrooms and sleeping quarters should receive as careful consideration as do those of the patient. Every one in the house should be taught the value of fresh air, and the necessity of sleeping with wide-open windows; the measures needed to get people well are equally necessary to keep them well.