Still, at first, night-nursing does seem formidable, especially when, as often happens, it is made to follow upon an anxious day. The only wise method of beginning is to lie down in the afternoon, after a warm bath if possible, and try to read yourself to sleep. If you fail, the rest itself will be some preparation; and if you succeed, you will be surprised to find how easy your work will be. Take a good meal, and wash your hands before going into the sick-room; but do not commence work before eleven o’clock at the earliest. Beginning night-work too early is a mistake, especially where there is a natural tendency to fall asleep under the influence of warmth and quiet; but by making it as late as eleven or half-past, you will have a much better chance of keeping awake without a struggle. Ordinarily, too, a nurse not going on duty early will be able to take the lead in washing the patient in the morning and in making his room tidy. When this is done, she should give directions for the day, and, if possible, not enter the sick-room again till it is her turn to mount guard. The only drawback to this plan is that there may be difficulty in arranging to meet the doctor; but a little management will generally smooth the way, especially if helpers are reliable.
On leaving the sick-room, the night-nurse should at once go for a brisk walk, if possible with a pleasant companion, and the walk ought to occupy a couple of hours; but if exercise has not been a habit of life, it will be well to begin with less and gradually increase. It must be remembered that a dawdling lounge is useless, and that the walk must be brisk to be of any real service. On returning, the nurse should at once go to bed and have her sleep out. But if she feel particularly wide awake, a warm bath will supplement the effects of exercise. On waking, she should take a cold or tepid bath according to habit. A nurse should be careful to change her under-linen as often as convenient.
One other thing must be borne in mind in regard to night-work, and that is, the necessity for taking food during the hours of watching. A nurse who takes proper time for sleep, misses at least one meal in the day, whilst needing more than the ordinary allowance of food; so that it is her duty to take nourishment during the night. A meal between two and three will help her through the hardest part of the twenty-four hours; and as soon as she feels hungry or weary, a glass of milk with an egg in it, a cup of cocoa, or some light soup, will give the needed support, and will also make a great difference to the ease of keeping awake and on the alert.
If these rules are carefully followed out, we venture to say there will be very little cause to dread even the most trying part of nursing—night-work.
And now as to the sick-room itself. If a choice is possible, let the room selected be of good size, cheerful, and quiet. It needs to be fairly large, because air is consumed by nurse as well as patient; for this reason, a dressing-room adjoining is of great service. Except in acute and dangerous illness, it is better if the nurse can sleep away from the patient, always provided there is ready means of communication. Helpless patients, as a rule, have a natural dread of being left alone; but few will object to a nurse’s going to bed in an adjoining room, as long as they have the means of calling her at a moment’s notice. If she be a light sleeper, a piece of tape tied to her wrist, the free end being left within easy reach of the patient, will be enough; or instead of tying the tape to her wrist, she may fasten a small bell, letting it rest over the head of her bed. Where the patient is very weak, an excellent contrivance is a piece of india-rubber tubing with a whistle at one end, and a compressible air-ball at the other. The latter should be placed on the patient’s pillow, and by the slightest possible effort, he will be able to make the whistle sound. Of course, a nurse who adopts such methods must have dressing-gown and slippers at hand, that she may obey the summons instantly, for nothing is more likely to irritate a patient than being kept waiting at night.
The sick-room should, if possible, face south or south-west, so as to get the benefit of the sun. Should the light be too strong, it is easily regulated by drawing down the blinds, or by hanging up a piece of some dark material; and in convalescence, the cheerful light of the sun plays an important part. In a sunny room, however, it is necessary to exclude the early morning light. The rising sun begins—in summer—to shine just at a time when, if the patient sleeps at all, he will be most likely to doze off; and it need hardly be said that to allow him to be awakened then is to deprive him of one of his best chances of improving.
But whilst cheerfulness is an essential of a sick-room, it is hardly less important that it should be free from liability to sudden noises. It should, therefore, never face a thoroughfare; nor, in a large family, be so situated as to necessitate much in the way of footsteps overhead. In cases where there is a nursery, it is well to take that for the invalid, at whatever risk of injury to other rooms; for nothing can be more distressing to a patient’s nerves than the constant pitter-patter of small feet, added to the tumbles and screams inseparable from nursery-life. At the same time, a room at the top of the house has the serious disadvantage of causing much extra up-and-down-stair work, so that in small, grown-up families, it is well to choose a room as low down as possible. In houses where there are bedrooms behind the sitting-rooms, it is convenient to take one of such, especially where there is the comfort of a slab outside, of the use of which we shall have more to say later on.
A sick-room should not have French-windows, those opening at the top and bottom being much better for ventilation; and if possible, there should be either venetian or sun blinds, for the easier regulation of light. Before beginning to nurse a case, it should be ascertained that bolts and sashes of windows, cords and pulleys of blinds, hinges of doors, and ventilators, are all working easily and quietly. It would seem hardly necessary to add that a fireplace with a good grate, and a chimney that does not smoke, are also essential.
Before removing a patient to the room that has been selected, it should be well cleaned, the doors and windows left open, and a fire lighted. By the time the latter has burned up brightly, the air of the room will be perfectly fresh, and one of the nurse’s first considerations will be how to keep it so. Her aim should be so to arrange ventilation that at no time should an incomer perceive any closeness or smell; in other words, the air of the sick-room ought to be as pure and fresh as the outside air; but in our climate this is not always easy, and will never be accomplished without constant thought and attention.
To understand how important is the question of ventilation, it is well to consider what it is that causes air to become impure, and consequently unwholesome. The air we breathe consists, roughly speaking, of two gases, oxygen and nitrogen. The former is absolutely necessary for the maintenance of animal life; it is drawn into the lungs, to be mixed with the blood, and used in various operations of the body; consequently, the pure gas of oxygen becomes used up, and the air we breathe out has changed its character, and is charged with the poisonous gas, carbonic acid. If the same air continues to be breathed over and over, carbonic acid increases its proportions with each inspiration, and fatal results follow. From this it will be seen that even in health there is positive necessity for providing a supply of fresh air, as well as for the removal of that which has become vitiated. But in sickness, the need is even greater, as the air given off from the lungs of the invalid will contain a larger proportion of poisonous matter. Impure air has always a tendency to ascend, and the secret of successful ventilation consists in getting rid of the warm, vitiated air floating at the top of a room. Once get this out, and nature, abhorring a vacuum, will pour in a fresh supply of pure air. You may sometimes be able to do this by opening the window wide for a few minutes, your patient being meanwhile covered up with an extra blanket, and a light handkerchief over his face. But in cold weather, this would lower the temperature of the room too much, and in any case it is hardly a method for the unprofessional nurse, unless with the doctor’s special permission. And even if this is allowed, it will not be enough, as the air consumed by you and your patient requires constant as well as thorough changing.