Realizing the force of the law—no neurosis without a psychosis—the nurse will try to eliminate unnecessary irritations to physical comfort, while she helps the patient to adjust himself to the ones which are inevitable. It is the doctor’s problem rather than hers, except as she carefully fulfils orders, to eliminate the toxic causes of psychosis. It is hers to help the patient to meet adequately the effects of the infections or toxins, and to prevent as far as possible the surrender to uncontrolled nervousness. Her object is to have him face the psychosis as one of the simple facts of science, then turn the sick mind’s attention to more important things; she would encourage will to force endurance; she would stimulate the feeling life to the forward look of confidence and faith, or to acceptance of life’s suffering as a challenge. The nurse knows that pains beyond the power of endurance the doctor will lighten. And the patient’s reaction to discomfort and suffering, the understanding nurse, without any preaching, can very largely influence.
The Power of Suggestion
One almost universal condition found in illness is hypersuggestability. Here is the nurse’s despair and her hope. Suggestion may come from without or from within. When from within, we call it autosuggestion.
Many of the sick are temporarily resting their reasoning faculties and their judgment. The sick body is causing a feeling of “jangling nerves,” and the mind, too, is strongly tempted to be sick. So every harsh sound, every jolt, almost every sentence spoken in their hearing suggests immediate nervous reactions. The mind does not wait to weigh them. The nervous system reacts to them the second the impression is registered. The whole self is oversensitive, and the very inflection of a voice has enormous significance. Let the nurse remember that her way of giving a treatment, her expression, or her very presence becomes a potent stimulus on the second, one to which the patient’s mind responds like a flash-light when the button is pressed.
The nurse must comprehend the principle of the nervous effect on the patient of all that is done and said, and realize her tremendous privilege in making those stimuli wholesome. The nurse who has a sympathetic insight, with unswerving loyalty to orders, can carry them out with the average patient, unpleasant though they may be to him, in such a way that his wholesome emotional response will be called forth, a response of co-operation, or of faith or of good breeding, or of “downing” the impulse to indulgence; or a response directed toward holding the nurse’s interest and attention, and so keeping her in the room; such a response as will gain some privilege, etc.
But there are some patients in whose cases ordinary persuasion, suggestion or requests fail. They are too nervously or mentally sick to be moved by logic, or to respond with customary grace to a request which their reason is not awake to answer. All usual suggestions may fail of effect. And for these few, in order that health may be at all assured, even the discipline of force may be necessary. But the nurse must use this only as a last resort, of course, and in accordance with the doctor’s orders, and then solely as treatment leading toward the ways of health. Before turning to this final method she should clearly, firmly, and kindly explain the principle of the discipline if the patient’s mind is at all capable of grasping it. In any case, force should be used only as the surgeon uses his knife. It hurts, but only to help and to save; and it is not called upon when other methods can secure the needed results. But force, thus limited in its application, may prove the only suggestion which will bring about the action necessary to health on the part of the patient. Force unwisely and unkindly used proves a damaging suggestion, causing reactions of fear or anger; or it may lead to delusions of persecution and to strengthened resistance.
Many suggestions come to the patient from within. Discomfort in the right side may suggest appendicitis. A slight indigestion, often purely nervous, may be interpreted as inability to care for certain diet, etc. The wise nurse will displace as many of these as she can by casual suggestions on her own part. She will demand of herself that her very presence be quieting, calming, happy; that her conversation with her patient shall vibrate with a certain something that gives him courage and strengthens the desire and the will to health; that her care of him shall prove confidence-breeding. The patient’s attitude, when he is at all suggestible, is largely in the nurse’s hands, and she can make his illness a calamity by dishonest, fear-breeding, or suspicion-forming suggestion. After all, the whole question here is one of the normality of the nurse’s own outlook on life and people. The happier, truer, and more wholesome it is, the more really can she help her patient to both bodily and mental health. Of one thing let the overzealous nurse beware. Do not irritate your patient by a patent, blatant, hollow cheerfulness that any one of any sense knows is assumed for his benefit. Personally I know of no more aggravating stimulus.
What We Attend To Determines What We Are.—This is one of the first laws of education. If the child’s attention from birth could be controlled, his future would be absolutely assured. But attention is a thing of free will and cannot be forced by others. It can be won through interest or self-directed by will. The child’s attention is entirely determined by interest, interest in the morbid and painful as truly as in the bright and happy. Punishment interests him tremendously because it affects him, it interferes with his plan of life, it holds his entire immediate attention to his injured self. But something more impelling quickly makes him forget his hurt feelings and he is happy again. The average sick person is emotionally very much like the child. His will at the time, as we noted before, is tempted to take a rest, and his interest is ready to follow bodily feeling unless something more impelling is offered. The nurse who can direct attention to other people, to analyzing the sounds of the street, to understanding something of the new life of a hospital or sick room, to planning a house, or choosing its furniture or equipping a library, or supplying a store; to intelligent references to books or current events; or to redecorating the room—all in his mind; to an appetizing tray, a dainty flower, a bit of sunshine, a picture, etc., is fixing the patient’s attention on something constructive, helping him to get well by forgetting to think of himself.
Thus the nurse, knowing the laws of attention, can keep herself alert to divert and direct her patient’s thought to wholesome interests. Knowing the possibility of thought substitution, she can open up new channels of thinking. Knowing the power of the will to assist in health bringing and health keeping, she can sometimes stimulate long-dormant determination. Let her beware, however, of making the convalescent too dependent upon help from without, but prick his pride to gradually increasing doing for himself. Arouse his reasonable ambition, but let him realize that life must be taken up again a step at a time; and that he can do it. If limitations must be accepted, try to inspire the feeling of pride in accomplishing the utmost possible within a limitation, and an acceptance of the inevitable without bitterness.
Attending to the unhappy, the painful, the boring without looking beyond makes life unhappy, painful, and a bore. Not that the nurse should ignore these realities, but she can accept them whole-souledly herself as not the final things, as merely the rocks that can be used to stand upon and get a view of the something better for everybody. When they are thus used by the wholesome mind, facts, the very barest and meanest of them, can be made useful as stepping-stones to the happier facts beyond them.