FOURTH ARTICLE.
Having fully considered the choice and management of a sick-room, we now turn to those personal cares essential alike to the patient’s comfort and well-being.
We have already spoken of the need of absolute cleanliness in the sick-room; and as regards the patient himself, it is hardly possible to overestimate the importance of scrupulous attention to every detail affecting the purity of his immediate surroundings. Not only should bed and body linen be kept fresh and clean, but everything that has become soiled in using must at once be removed from the room. It is a very common practice in home-nursing to make a collection of dirty things, to be carried downstairs when any one is going; in this way, I have known a room to be fouled for hours, the patient being considered whimsical for complaining of odours not perceptible to his nurse. Now, any such complaint should receive immediate attention, and a nurse should never rest satisfied till she has discovered and remedied the evil. It not seldom happens that the patient’s sensitive condition makes him extra quick to discern such warning of danger; and the nurse who really desires to do her duty, instead of taking offence, will gladly avail herself of the help thus given; for it must be borne in mind that as surely as smoke indicates fire, so surely does a bad smell indicate a foulness of air, which will never be remedied till the cause has been removed. Remembering this, it will be seen how foolish is the practice of drowning unpleasant odours by the indiscriminate use of disinfectants; these have their special value—their proper sphere we shall consider in dealing with infectious diseases; but in ordinary illness, they are apt to be used simply as a covering-up of evils which demand entire and immediate removal.
As regards personal cleanliness, many people still retain the old-fashioned fear of washing, which used to condemn the patient to a state of dirt, equally uncomfortable and injurious. Of course, care and discrimination are needful, and if there is any doubt on the matter, it is better to ask the doctor’s opinion; but as a rule, daily washing of face, neck, and arms is possible in all cases fit for home-nursing; in addition, the legs and feet should be washed about every other day; and whenever practicable, a weekly bath should be given. For the daily wash, tepid water and a piece of flannel suit most patients best; but where cold sponging is a refreshment, it may be used, provided due care is taken to avoid a chill.
In cases where there is great feebleness, much care must be exercised in washing the patient and changing his body-linen. Before beginning, the nurse should see that the room is properly warmed, and that all she is likely to need is ready to hand; she must be careful that no draught shall reach her patient, and that he does not get a chill through unnecessary dawdling; at the same time, she must not hurry him, so as to increase the fatigue.
Any amount of washing is tiring to the very weak, and therefore toilet operations had better begin soon after breakfast. If possible, the body-linen should be changed at the same time. It is a good plan to keep two sets of under-linen going, so that the same may not be worn day and night. If the patient perspires much, the linen must be dried and warmed each time of changing; it is not enough that it has been once aired; every time it becomes damp the same process must be repeated. The same thing applies to towels, which are so often put away damp and used again without airing; no wonder that illness, resulting from cold, shivering or a fit of coughing, not seldom follows the washing process, whilst the simple precaution of using a towel well aired and warmed would do away with the discomfort.
Sometimes lying in bed produces great irritability of the whole skin, and the patient shrinks from any attempts at washing. In such cases, a soft sponge should be used, in one direction only, and that downwards; and a nice way of drying a sensitive part is to lay the towel smoothly over the place and pass the hand over the towel three or four times, very much as though drying a wet page with blotting-paper.
During the process of bit-by-bit washing, the bedclothes must be protected by a piece of mackintosh or thick towel; but should they become wetted, they must be changed at once, for even if not damp enough to do serious injury, there is sure to be some amount of discomfort; and everything, however small, that causes annoyance must be looked upon as a drawback to recovery, and treated accordingly.
In addition to the regular washing, any portion of the patient’s body that becomes accidentally soiled must be at once cleansed; and whenever the confinement to bed becomes lengthy, the back and shoulders should be washed every day with warm water and soap, thoroughly dried, and lightly dusted over with finely powdered starch. The patient must also be prevented from remaining too long in one position; and if too weak to move himself, it will be part of the nurse’s care to turn him from side to side every three or four hours. Where this is impracticable, pressure must be relieved by the use of cushions, those with a hole in the middle being most useful for the purpose. If these precautions are not taken, the most prominent bones, exercising undue pressure on soft parts, will cause them to give way, the skin will become tender and inflamed, and if not stopped in time, a painful wound, difficult to relieve or cure, will be the result. I have known cases where these wounds have caused infinitely more distress and pain than the patient’s actual disease; and yet, with few exceptions, it is only a question of care and attention. So true is this, that a trained nurse looks upon such wounds as a disgrace, and is constantly on her guard against them; but the inexperienced nurse neglects this necessary watchfulness, simply through ignorance of the danger to be avoided. But forewarned should be forearmed; and by taking care to avoid dirt, pressure, and creases in the bedding, even the most inexperienced stand a good chance of success in this most troublesome part of nursing. At the same time, if, in spite of care, any portion of the skin reddens or becomes sensitive, the doctor should at once be informed of the fact, for this is one of the best examples of the old saying, ‘Prevention is better than cure,’ and it is too late to cry out when the mischief is done.
If the patient is too weak to sit up and use a toothbrush, a piece of lint should be tied to the end of a small stick such as a penholder, and wetted with water to which a little Condy’s fluid has been added; with this, the nurse can easily clean the teeth and gums. Brushing the hair requires a certain amount of tact and gentleness; with female patients the hair is apt to get into a troublesome tangle, unless plaited up loosely and tied at the ends. Sometimes moistening the brush with toilet vinegar will be liked, and in not a few cases gentle brushing has a soothing effect. I remember one instance where, under this influence, and this alone, restlessness would subside into quiet, leading to refreshing sleep. The same effect may sometimes be produced by sponging the face and hands with tepid water, with or without the addition of a little vinegar or Eau de Cologne; and again, in other cases, letting the hands lie in a basin and gently pouring cold water on them will be found grateful. It is well worth a nurse’s while to study her particular patient’s taste, and to find out some such simple method of relieving the weariness and monotony of illness.