CHAPTER XV. ILLS OF BABY. (Part 3)

of strength in some great agon}"." A nurse's life work is one of sacrifice to God and hu- manity, and sacred in the eyes of both. The Duty of the Nurse Toward the Physician. — "Fill up each hour with what will last. Buy up the moments as they go : The life above, when this is past. Is the ripe fruit of the life below." The nurse and the physician should have entire con- fidence in each other in order that satisfactory results may be obtained. The nurse should always be loyal to the physician in charge, and scrupulously faithful in earning out his orders and treatments loyally and faithfully, without modifying or changing them in any way. If a nurse by her conduct or words shows a want of confidence in the attending physician, it may be a means of destroying all confidence between the physician and patient. Never by word or look cast a reflection upon the ability of the attending physician ; speak with confidence in his skill and ability to handle the case, and the nurse should impress upon her pa- tient the importance of relying upon the doctor's skill and following- his directions implicitly. Never bv word or look cast a reflection of a doubt as to his ability to handle the case. Xowhere is faith more necessary than in the sick room. Without this confi- dence the doctor can do but little, the patient is made miserable, and often life depends upon it. The methods of one physician may differ somewhat from the methods of another, but both obtain uniformly 233 good results. A nurse may think what she chooses. but never question the physician's methods. The nurse acting as his assistant, is bound to carry out his treatments loyally and faithfully without modifying or changing them in any way. She should be broad and just adhere loyally to the methods prescribed by the attending physician. She should remember she is a nurse and not a physician, and not assume responsi- bilities that do not belong to her; moreover, if she fol- lows and carries out loyally the orders of the physician, she has done her duty, and is not to be held responsi- ble for untoward results. Be frank with the physician. The nurse should con- sider no symptom too small or trivial to consult him about. He will appreciate it and trust her. The phy- sician relies on the nurse in observing and recording the symptoms, and on the information thus obtained lie often bases his diagnoses and prognoses. He as- signs to the nurse exclusively the duty to carry his treatments into effect, and in so doing he feels as- sured that his patient is in safe hands. Keep an accurate record of all symptoms. Do not consider anything too trivial to make a note of; better err by making your notes too full than omit something which you ma}' consider small but which may have an important bearing on the case. Be careful of the little things : they mean so much both to the success- ful issue and comfort of your patient. Above all else inspire the patient and the patient's family with con- fidence in the attending physician by your words, man- ner and loyalty to him. It is not so much through any actual words that the nurse inspires the patient and friends with confidence in the attending physician as the manner in which she receives his orders 234 and her readiness in carrying- them out, all of which are readily intercepted by anxious friends. A nurse should never show by her manners towards the phy- sician any shadow of rudeness, even, although she should have but little respect for him or his ways. If a nurse knows full well, beyond the shadow of a doubt, the physician is not doing his duty, either because he is ignorant or indifferent, and she can not consci- entiously remain under his direction or carry out his treatment. Under these circumstances it would be wrong for her to continue on the case ; it would reflect on her character and she would become a party to mal- treatment. In such a case tell the physician frankly you can not continue on the case and your reasons why, and for the patient's safety suggest to the family or friends the necessity of calling in some other phy- sician in consultation. If for any can^e a nurse is obliged to oppose the doctor, guard against doing it in the presence of a third party, or in the hearing of the patient. Always some distance from the patient's room. Any special feature in the case or regarding the patient, the nurse should make an opportunity for speaking to the doctor about them outside of the patient's room. And at the conclusion of the visit, after all orders and instructions have been given the nurse by the physician, the nurse should retire for a few minutes and leave the patient alone with the physician so that she may have an opportunity to sav anything she wishes to tell him in private. Be honest with the physician. "Honesty is the best policy" and a priceless virture in all walks of life, but especially is it so in the nursing profession. Be honest then with the physician. If you neglect to carry out an order or treatment, or make a mistake, have the 235 moral courage to tell him. None are so perfect that mistakes are impossible. All may make a mistake. In acknowledging a mistake the nurse will gain the con- fidence and respect of the physician. In trying to hide a mistake or omission she can not fail but to create a doubt and mistrust which no matter how faithful she may be in the future, she can never efface. The nurse's duty to the physician, then, consists in loyalty to him, in carrying out his orders, observing carefully everything and reporting same to him, and cordial relations cannot fail to be established between physician and nurse when the latter proves herself to be. his faithful and loyal assistant, and he in his turn shows, by his manners and address, his confidence in and his respect for her. The Nurse and Her Patient. — "Ask of God to give thee skill In comfort's art, That thou may'st consecrated be And set apart Unto a life of sympathy : For heavy is the weight of ills In every heart And comforters are needed much Of Christ-like touch." All things whatsoever ye would that men should do to you, do you even so to them. — Matthews vii, 12. We have selected as a means of livelihood nursing as a profession, and a noble profession it is, sacred in the eyes of God and man. Nursing is a vocation for which every one is not adapted, particularly this deli- cate branch of the profession. Tact, courtesy, adapt- ability, power of invention, unselfishness, sympathy, 236 kindness, refinement of character, common sense and a love of her profession are characteristic of the true nurse, and great is her power for good. When sum- moned to attend a case of illness it is well for the nurse to remember that hers is a mission of mercy, and that it is her duty to bring fortitude, courage and hope into the afflicted home where dread and fear dwell. She must bring hope and cheerfulness into the sick room by her gentle looks, kindly pleasant smiles and softly uttered words. She should be dignified yet modest, gentle, kind and sympathetic, yet firm and determined when necessary. If she could only remember to fol- low in every instance the golden rule, to do unto her patients even as she would have done unto herself, or unto one of her own loved ones, she would not be apt to make many mistakes. From the moment a nurse enters a home, she should endeavor to win the confidence of her patient and the family. Many sick persons object to a trained nurse because of fear that their loved ones will be banished from the sick room. The family should not be denied the privilege of the sick room, or restrictions placed on their visits unless it is the order of the attending physician, or when the nurse sees it is harmful to the patient ; then she should tell the physician, and he will give orders accordingly. A nurse should avoid showing any marked authority ; always give due consideration to any suggestion of- fered, and give way to any wishes respecting the pa- tient, when such a course would not be harmful. A nurse should so conduct herself that the family will gradually learn to lean on her and feel before many days she is indispensible. She should be tactful, evade questions when she finds it necessary, but should not be mysterious in her actions. A simple explanation 237 will often allay great fears. She should guard the in- terests of the patients intrusted to her, that her high mission in life may be fulfilled. Secrets even dearer than life itself will often be instrusted to her keeping. In all homes there are secrets. A nurse should remem- ber in entering the private sanctuary of a home, to keep her eyes open and her mouth closed. "Silence is golden." Shakespeare says, "Give thy thoughts no tongue." If she finds disease lurking where she did not expect to find it, if she hears the rattle of the bones of the skeleton in the closet, she should remember her trust is a sacred one and what she may have heard or seen on these occasions in this confidential capacity should be held as sacred and in the strictest confidence. A nurse should never gossip. Avoid it as she would poison, for it will be to her a deadly poison if she does. To refrain from this is, I am sure, more easily said than done, for the strongest temptation generally comes from the patients themselves. But a nurse should be no tale-bearer. She should never mention the family affairs of any patient. People do not care to hear the praises of others sung continuously or hear of their faults. It is true, at the time, the enquirer may be amused or entertained; but sooner or later those friends will distrust her, they will think, if she talks about Mrs, B. to me, she will talk of me to others. A nurse can not accept these confidences and betray them and continue honest, and the contempt and failure she so richly deserves will be her portion. Perhaps the best way, after all. will be for the nurse to meet the issue frankly and say she feels it to be a matter of duty never to talk about her patients ; it is true the enquirer may feel a little hurt or annoyed by the refusal, but in her heart she must confess the 238 loyalty which refuses to discuss professional affairs is highly commendable, and she will respect the nurse for it, A nurse should be a woman of character, with purity of life and speech. The sick room is no place for vulgar jest. The life of a nurse should be most circum- spect and honorable. Her life enters into and bears a closer relation to the life of the patient than she may think. Her position at the bedside of the sick gives her a license to converse on subjects not men- tioned in mixed audiences. She should use the privi- lege fearlessly and without coyness, but when the threshold of the sick room is crossed, she should re- member she is a woman and let her conversation be in keeping with her sex. With all men with which she may be brought into contact in the performance of her duty, physicians, the patient or his family, she should maintain always a courteous but strictly profes- sional impersonal attitude. Be gentle in word and action, and faithful in the performance of her duty. Always remembering she has the highest mission in- trusted to her. She should be faithful to her trust and true to her womanhood. She should have a heart so as to be a blessing to her patient and the family. A mechanical nurse is a failure. Always remembering that sympathy and kindness are twin virtures which must be possessed by evenr nurse who wishes to make a success of her calling and accomplish the vast amount of good that lies within her power in the broad field she has chosen for her life's work, and "When the lessons of life are all over And the Master says our school is dismissed, May we all meet in heaven together, Not one of our number be missed." 239 INDEX Abdomen in pregnancy....... 41 pigmentation of 42 Abdominal binder 31 in pregnancy 31 in puerperal 103 Abortion, time most lkely to occur 32 Abscess of the breast 156 Airing 191 Albumenuria 33 Anesthesia 90 Anesthetic, administering of, in second stage of la- bor ....90-91 Anatomy of the pelvis 17 Anus, occlusion of 217 oS Areola of pregnancy Areoias signs in diagnosis of pregnancy Articles necessary for the baby's bath 1*3 Articles necessary for obstet- rical cases 51 Asphyxia neonatorum 209 Atelectasis 213 Babies, blue 2J3 Babies, nervous J-»s Baby, how to bathe the 1<5 dress the |8d feed the 199 lift and carry the 187 often to nurse the 123 how to put the. to sleep... 184 kissing the 188 weaning the 20 7 feeding the 119 Bag, the nurse's obstetrical.. 60 Bands, the infant 54 Bandage, the occlusion 104 Baptism of the baby 96 Bath for the baby 174 for premature or delicate child 174 Bed of incubator 213 a baby's 184 preparation of the, for la- bor 77 how to change the pa- tient's 129-130-131 I Bed pan 127 Binder, breast 125 Bladder, during pregnancy 43 after delivery 108 during puerium 161 Blanket for the reception of the baby 81 Bones, os innominata 18 Bleeding 107 Bottles, the 205 how to prepare the 202 filling the 203 Bowels, in pregnancy 33-43 in puerperium Ill in infancy 188 in the new-born babe 217 Breast, Abscess of the 156 asepsis of the, during puer- perium 115 changes in, during preg- nancy 40 care of the, during lacta- tion 118 engorgement of the, in puerperium 154 enlargement of the, in the diagnosis of pregnancy.. 38 enlargement of the, in pregnancy 40 enlargement of the, in the new-born infant 227 inflammation of the 156 Breech delivery 140 Care of the baby. 170-171-172-173 Care of the cord 179 eyes 177 genitals 181 nails 182 navel 179 mouth 177 Catheterization in puerper- ium 109-110 Changes in the maternal organs caused by preg- nancy 40 Changes in the abdomen... 41 240 INDEX — Continued. Changes in the bladder 43 in the blood 40 in the bowels 43 in the breast 40 in the heart 40 in the liver 44 in the spleen 44 in the uterus 43 in the veins 43 Chill after labor 160 Chills 164 Chloroform, how to adminis- ter the 90 Circumcision 215-216-217 Clean, keep the baby 208 Cleanliness of the patient during- puerperium 112 Cleanliness, vaginal 35 Clothing of the baby 182 of the mother during preg- nancy . . 31 Colic 225 Colostrum 38 Complications during labor. ..132 management of the birth of the child in the absence of the physician 132-140 eclampsia 148 hemorrhage 144 prolapse of the cord 143 Complications of the puer- perium 150 engorgement of the breast. 154 tissues and cracks of nip- ples 156 mastitis 156 puerperal insanity 157 paralysis 158 septic phlebitis 158 subinvolution 159 sepsis 150 Conception 26 Constipation in the baby 217 in pregnancy 33 in puerperium Ill Contractions uterine 10~7 Convulsions 229 "Cord, tying the 93-95-137 the umbilicus 22 Corset in pregnancy 31 Cough 44 Cramp in leg 89 Decidua 21 Delivery of the placenta 139 Diaper, material for 54 Diet for infants 192 in pregnancy 29 in puerperium Ill Difficulty in nursing 223 Discharge, vaginal, during pregnancy 35 during puerium 162 of the new-born 227 Diseases, contagious 36 Doctor, preparation for, in the first stages of labor.. 79 Douche, after labor 100 Dress for incubator 214 in pregnancy 31 Dressings, vulva 112 Drink during pregnancy 30 Duration of pregnancy 48 Duties of her friends 47 Duties of the nurse after the arrival of the doctor 84 Duties of the nurse towards the physician 233 Eclampsia 148 Edema of the extremities- during pregnancy 43 Exercise for the baby 185 Eyes, care of the infant's 177 application of ice to the... 219 infection of the 218 irrigation of the 221 new-born, care of the 177 Feeding the baby 119 breast ng artificial 195 mixed 124 Fetus in uterus, position of.. 82 Fluid, the amniotic 22 Food 192 for the baby 192 how to prepare the 200 appliances needed for the preparation of the 201 materials needed for the preparation of the 200 formulas for the prepara- tion of the 195-196-197 Foods, other 206 Glands, mammary 25 Hands, sterilization of the... 58 Heart, the fetal 45 Heart, the mother's 40 Hemorrhage, general direc- tion 144 of abortion 148 recurring 147 placenta praevia 145 post-portum 146 secondary 148 umbilical 214 symptoms of 1 48 Hernia, umbilical 227 241 INDEX— Continued. Hiccoughs Hygiene of pregnancy. Inhaler, to make Ills of baby , Impressions, nervous . 227 28 92 209 , 46 Incubator, improvised 213 my ....213-214 Indigestion 225 Infection of the eyes 218 Insanity, puerperal 157 Instruments . 87 Involution 107 Jaundice, of the new-born. . .217 Kidneys in pregnancy 33 in puerperium 161 of the baby 190 Labor 59 preparation for 60 toilet of the patient for 69 dry 74 first stage of 67 care during 69-72 nurse's duties during first stage of 69-82 Second stage of 72 care during second stage of 72-93 rupture of the