To lift a helpless patient is by no means an easy task to inexperience, and should never be attempted without help. When the patient is utterly helpless, two long poles or broom-handles will be needed; these must be tightly rolled round in the under sheet and blanket, and the patient can then be moved, as in a stretcher, by four bearers.
To move a patient from side to side, the draw-sheet alone is needed. Rolling one end close to the body, the nurse goes round to the other side of the bed, and by taking hold of the rolled-up part, will be able to turn the patient gently over with perfect ease. Where the draw-sheet is not being used, it is a good plan to let a heavy patient lie on a strong roller-towel, which can be used as above; and if two people grasp it firmly on each side, they will be able to move the patient up and down in bed without fatigue or injury. This plan is especially useful in dropsy, when the patient becomes a dead, heavy weight, and is often restless to a painful extent.
In many cases, a patient, otherwise helpless, will be able to move at least his position by the use of a strong towel or cord tied to the foot of the bed. Hospital-beds are almost invariably provided with a cord and handle for the patient to grasp; but a better thing still is a netted hammock, a simple contrivance consisting of a piece of netting—of twine or coarsest knitting-cotton—four yards long by one and a half wide, the loops at each end being drawn up with tape; these tapes are tied to the foot of the bed; and the netting not only serves as a cord, but, thrown over the patient’s head and drawn out across his shoulders and back, forms a most easy, comfortable support. I have seen patients sitting up thus, who had mournfully declared it an impossibility, and whose delight at the change of position was a thing to be remembered.
In grasping any part of a patient’s body, be very careful not to take hold with the finger-ends; the whole hand should be used, and the fingers slightly spread out; anything like a hesitating touch is exasperating, and indeed hesitation in any way must be carefully avoided in dealing with the sick. It is well to remember that a certain amount of work has to be done, and a certain amount of noise must follow; make up your mind how much, and go to work thoroughly, quickly, and quietly; quiet, though, must be natural, not laboured; the tiptoe, whispering style is torture to sensitive nerves; a firm, even tread and a distinct way of speaking should be cultivated; the latter, especially, will make all the difference to a patient’s comfort. To be constantly on the strain to hear is by no means soothing; and whispered conversation as to the patient’s condition must never be indulged in. Some people, realising this, will go out of the sick-room, to carry on low-toned consultations just outside the door and within hearing of the patient, who involuntarily strains every nerve in the endeavour to catch what is being said. Such treatment is even worse than unnecessary noise, and all discussion relating to the patient must be carried on where there is no possibility of his hearing it. It is a safe rule to avoid detailing the patient’s symptoms to relatives or friends; sensitive, delicate minds are often made to suffer unnecessarily, from the consciousness that sick-room details are being made the subject of curious inquiry and remark.
It not seldom happens that in delirium, or extreme weakness, the patient will let out some cherished secret, and this should be as jealously sacred to the nurse as though the confidence had been voluntary, the only allowable violation being when the revelation made throws any light upon the patient’s illness; in such a case, the doctor must be told; and this brings us to a most important point—the relations between doctor and nurse, a point which is seldom understood by the inexperienced.
The nurse’s responsibility is great; she has many duties to perform, some of them apparently slight, yet really of vital importance; but at the same time, she is only acting under orders, and when those orders have been faithfully carried out, her responsibility ends; it therefore follows, that whatever her private opinion, she must never alter the treatment without the doctor’s express permission, and whatever she may think, she should never, by word or deed, seek to lessen the patient’s confidence in the patient’s doctor. It sometimes happens that injudicious friends suggest remedies of their own, and insist upon their being used; any such interference should be at once reported to the doctor, for how else can he form a right opinion as to the patient’s condition? Yet so often is this overlooked, that, I believe, in many home-nursed cases the doctor’s treatment is never allowed fair-play; and I have even known a prescription, that had been torn up by the doctor as unsuitable, carefully pieced together after his departure, and used. Perhaps in no other point is there such a marked difference between the trained and untrained nurse. The former has been taught that her power lies in obedience; the latter, ignorant of her very ignorance, ventures to meddle in matters which, had she but a little more knowledge, she would understand to be beyond her.
Not a little of the nurse’s value depends on her ability to give the doctor a proper report of how matters have been going during his absence. A patient will often pull himself together and even feign convalescence for the doctor’s visit, which is necessarily brief; whilst the nurse, spending hours with him, sees every varying mood and symptom; at the same time, she must remember that the doctor does not want her opinion, but asks only facts, which will enable him to draw his own conclusions. From this it will be seen that the nurse needs to understand what to notice and how to report her observations.
As to what to notice—each illness has its specific symptoms, about which the doctor will make special inquiries, and he will also expect to hear what effect has followed the use of remedies; but in addition to these, there are general symptoms to be taken account of in all illness. Amongst those most frequently overlooked by the inexperienced nurse, are: The appetite, whether good, failing, fanciful, or voracious. The skin, whether moist or dry, hot or cold; and whether sensitive to touch. Sleep, its character and duration; whether quiet, disturbed, broken, or uninterrupted, and whether the same by day and night. Posture, whether the patient lies very flat, or likes to be raised, or prefers to keep on one side; in going to sleep, the easiest attitude will be chosen, and any marked change in this respect should be noticed. Temper and spirits, whether equable or variable, moody, cheerful, excitable, calm, depressed, or inclined to tears. Countenance, whether liable to changes of complexion or expression.
When visitors are allowed, the effect upon the patient should be noted; and at any cost, in serious cases, those whose influence is depressing or exciting must not be admitted.
A nurse should also, without being fussy, keep an eye to any fresh symptoms that may appear, and duly report them; but nothing is more worrying than to be constantly teased with such questions as: ‘Are you in pain?’ ‘Do you feel better now?’ ‘Will you let me look at your tongue?’ Those who have endured the martyrdom, know what it means, and know, too, how little information can be gleaned by such methods. Let a nurse be sympathising by all means, but let her sympathy show itself in caring for her patient’s wants, and in efforts to save him from worry as well as from pain.