PART I HOME NURSING (Part 1)

PART I HOME NURSING MATERIAL AND SPIRITUAL EQUIPMENT OF THE HOME NURSE Ethics of Nursing— What Room Should be Chosen— Care in Ventilation- Devices for Ventilation — Freeing the Invalid from Noise — Simple Furnishings in Sick Room — Bedsteads — Mattresses — To Make a Sick Bed — Daily Care of Sick Room — Care of Utensils — How to Save Steps THE thought of accepting an invalid as a member of the household is always a trying one, and often brings consternation into otherwise quiet homes. Possi- bly a few suggestions may lighten the burden of such a situation, and encourage the mother, sister, or wife who is to act the part of nurse pro tern, and who needs to know something of the equipment, both material and spiritual, for such an undertaking. The clean gingham dress of the hospital nurse, worn both winter and summer, is a familiar sight, and Dress of typifies that absolute cleanliness w7hich is both her ing nurse personal and her professional characteristic. It is quite possible for the acting nurse also to don a cot- ton gown, which should be simple and easily laundered. Having once felt the comfort of such a working-dress she will hardly wish to return to the heavy woolen skirts so unsuitable for the sick-room. We all recognize the absurdity of a nurse's going, as one once did, to take charge of a case and appear- ing before her patient arrayed in a pink silk waist, yet the same incongruity would not appear so great if one of the family, or a familiar friend who was serving in the capacity of nurse, were the offender. The prin- ciple, however, is quite the same in either case. (7) 8 HOME NURSING But far more important even than the matter of The f dress and quite within the possibility of every one, is care of the need of frequent bathing on the part of the nurse perso™ anc* proper attention to neatness in the details of her toilet — the clean, well-trimmed nails and hair care- fully and simply arranged. Deft hands, quick insight, a gentle bearing, good Blessed temper and a generous dash of humor are priceless cli3.r3.ctci"" istics in a blessings in a sick-room, and may be cultivated in a sick-room vefy jarge measurej if their value is sufficiently appre- ciated. The nurse who pounds the pillow on the pa- tient's bed or clumsily jars it every time she passes, who is ill-natured and unkempt, or who reveals by her manner that her work is arduous, is distinctly work- ing against the recovery of her patient, though she may little realize the cost of her thoughtlessness. ETHICS OF NURSING It is no time when a person is sick to regale him The Gold- with grewsome or unpleasant tales; yet how often a en ue garrulous neighbor delights in the opportunity of set- ting forth some harrowing incident while, it may be, the distressed patient is too weak even to protest. The ethics of nursing is a large subject, but perhaps, after all, the practice of the Golden Rule is its simplest ex- pression. CHOICE OF A ROOM As regards the chief features of importance in the selection of a sick-room, namely, the securing of good air, quiet, and plenty of sunshine, we must recognize The room that there are many households where these conditions best adapted- can not be ideal. But wherever a choice is possible, the vaiid'T use room best adapted for an invalid's use should be se- lected even at the cost of some inconvenience to other EQUIPMENT OF THE NURSE 9 members of the family, since comfortable and hy- gienic surroundings are a large factor in the recovery of a patient, and model conditions will be described, because the ideal must always be the standard toward which we progress. An airy, spacious room, having a southern expos- ure and several windows, so that the sunlight can Having flood daily, and far enough removed from the noise conditions of the kitchen or front door to secure absolute quiet, affords the best possible conditions for a very ill pa- tient. VENTILATION If once we heartily believed the truth that the body starves for lack of oxygen as it plainly does for lack of food, there would be no necessity for the protest against tightly closed and ill-ventilated rooms. The starvation for oxygen, it is true, is much more slow, and it may be years before one sees evidence of the depletion the body is undergoing in cases where the supply is insufficient, whereas the daily demand for food is a crying one that can not be overlooked. In spite of our ignorant efforts to keep out the fresh The body's air, enough oxygen sifts in through the cracks of oxygen doors and windows to satisfy, in a small measure, the demands of the body, and thus relieve the feeling of suffocation which is the most urgent call of the or- ganism to supply its need. If this were not so, the suf- fering would be such that one could not tolerate the conditions. As proof of the impoverishment that ex- Proof of 1 1 1 ,. • 11 -11 thls need ists under bad conditions, one has only to .cite the phys- ical effects upon the system observed after a night spent in a closed room — the dull head, lack of appetite, lassitude, and general depression — and compare this, if one has ever experienced it, with the feeling of ex- 10 HOME NURSING uberance and delight in nature felt after a night spent in the open air. It is when disease comes, hcwever, in sick- that the real difference between the well and the ill- nourished body is most apparent. Not infrequently people who have never known sickness, but who have all their lives disregarded the laws of health in re- spect to ventilation and whose bodies have lived on a meagre supply of oxygen, are not able to resist the approach of disease. For the sick-room, low windows admitting an abun- dance of fresh air and sunshine are much needed, while the addition of a balcony opening out provides attrac- tively for the convalescent days, both in summer and winter. Open win- Window-boxes help to make the chamber cheerful, in^iid°r and are in no way objectionable; but plants filling a side boxes wnidow and shutting out the sunshine should be con- for plants demned. If the window is arranged to lower from the top — and all windows should properly be so arranged, since the foul air of a room has a tendency to rise — venti- lation in cold weather is made easy. By reversing the position of the sashes, a current of air escapes in the centre between the unevenly fitting framework. But Good better still for use in the winter, is a board four or five ofetve°n-S inches wide and perhaps an inch thick, just long tiiation enough to fit the window if slipped under the lower sash. This method provides a larger current of air in the centre between the sashes, and in either case there is no draught possible. Another device is to fasten a piece of cloth across the lower part of the window from side to side, so that the air can not blow directly into the room when the bottom sash is raised. The use of small screens will not be forgotten, and often one may be improvised by means of a clothes- EQUIPMENT OF THE NURSE 11 horse and a couple of sheets or light shawls. A high- The use , , , , , , - of screens back chair may also serve the same purpose, and for a baby's crib an open umbrella does very well if noth- ing better is at hand to protect against the draught. A fireplace provides another means of ventilation besides adding greatly to the charm of the room. Ventilation is generally a possibility in any sick- room, but absolute quiet is not so easily secured, and on this account certain cases must be sent to the hospital. It must be borne in mind that when the doctor ad- vises the hospital it does not necessarily mean the des- what peration of the case, but very possibly that the in- a hospital creased facilities for the proper care of the patient imv ieb which the hospital affords are demanded in order to hasten recovery. NOISE There are some devices by means of which an in- valid may be spared the irritation of trifling noises and the sharp, sudden sounds always much more an- noying than the dull, continuous rumble of the street or the general stir about the household. A creaking door-hinge can be oiled, even if one has nothing but How to vaseline with which to do it, and on the door of the l^noiiel" sick-room, which must be frequently unlatched, a in horne -1 J nursing small towel may be twisted from one handle to the other to prevent its closing tightly, or a rug be pulled across the threshold to serve the same purpose. Windows which rattle can be made secure by the aid of a few pegs whittled from burnt matches, and Devices should be attended to before the patient is settled for the night. If a dripping faucet can not be turned off, a cloth may be tied over it, and the loose, creaking boards in the floor may become such familiar spots 12 HOME NURSING to the thoughtful nurse that she almost unconsciously avoids them. If a grate fire or stove is in the room, the care of it may be made far less trying to the nerves of the sick one if the coal is placed in a large paper and laid on the fire when replenishing it, in- stead of being shoveled in the usual way. A wooden poker can be substituted for an iron one, and large clinkers removed with the hand instead of turning them down with the ashes when a new fire is to be built. Whispering is always exasperating to a sick per- The tone son, and whatever conversation is necessary in the voice room or immediately outside the door should be carried on in low, quiet tones, but never in a stage whisper. One's manner of addressing a patient should be considerate, particularly if he is very ill. He should never be startled by loud or abrupt tones from behind, but having first gained his attention speak distinctly but with quiet voice. These suggestions Hints for are scarcely necessary to one who has had experience perienced with sick people, but to the uninitiated, particularly if she be young and vigorous, without "nerves" her- self, they may possibly be of value, as it is a most difficult thing to realize exactly how an ill person craves the relief from noise and confusion or appreci- ates any effort to minimize such for him. FURNISHINGS OF THE SICK-ROOM As to the furnishings of the sick-room, the No fumi- greatest simplicity is required both from the hygienic essentials and from the aesthetic standpoints. The sleeping- room, even in health, should be a place free from the unnecessary adornment of heavy hangings and Crowded bric-a-brac, gathering millions of microbes EQUIPMENT OF THE NURSE 13 which elude the most careful housewife. If possible, let the walls be painted some neutral tint restful to the eye, so that they may be easily cleaned, and have no more furniture in the room than is absolutely necessary for use. A bed, table, easy-chair, lounge, and screen constitute the essential furniture. A hard- wood floor is best, but if it is necessary to carpet, straw matting is better than wool, and can be found in very attractive styles. Lightweight rugs that can be taken out and shaken every day may be used on the hardwood floor. A set-bowl in any bedroom is always objection- able, and is not to be tolerated if the modern method Avoid bad of open plumbing has not been adopted. The con- stant escape of poisonous gases by means of leaky traps is something that should be guarded against at all costs. But it is a simple matter, fortunately, to cover or plug up the escape holes, and water may be kept standing in the bowl if the bedroom is so equipped, though the better plan, of course, is to re- move all plumbing to an adjacent room not used for sleeping. The most suitable bedstead for a sick-room is readily admitted to be the single or three-quarter The bed size iron frame with double woven wire mattress and position having a height of two or two and a half feet. This frame painted white can be easily and thoroughly cleaned, and its height makes it convenient for lifting and moving a patient. It should stand in the room in such a position that the patient does not directly face the light from any window, and also so as to be easily accessible from both sides. In spite of the supposition that the feather bed Never a has been relegated to the garret- or made over into bed pillows, it is still necessary to emphasize the fact 14 HOME NURSING that it is wholly unsuitable for an invalid's use. It is quite impossible to take proper care of a patient unless this is discarded. It retains the heat of the body, and if it becomes damp is an offence, if not a positive menace. It is also very difficult to lift a person from side to side as he lies in the hollow. The hair mattress is, of course, the most satis- factory bed, yet some patients complain of the tuft- ings, and it must be admitted that if the strings give way the hair may move and cause irregularities in the surface of the bed. The mattress manufactured Mattress by the American Interlaced Curled Hair Company tuftings of Philadelphia, Pa., is especially sanitary, and as the hair is in sheets it requires no tufting and is easily kept in order. The ticking can be slipped off and washed, and as the interior itself is very porous it is cooler and can be more easily cleansed and fumigated than any other mattress more compactly made. In The value cases of long illness a second bed is of great value, beds and by bringing both beds close together the patient can be drawn on a blanket or stout sheet from one mattress to the other and the mattress thoroughly aired on a balcony or in another room every day. A mattress turned once a day does not readily get out of shape, but in case it begins to sag, a light shawl or blanket folded not too thick can be placed under the centre to keep it level. 'Mattresses should Care occasionally be wiped over with a cloth wet in some mattress antiseptic solution and put out of doors to dry. A whisk-broom may be used instead of the cloth if pre- ferred and the mattress thoroughly sprinkled with the solution. EQUIPMENT OF THE NURSE 15 PREPARATION OF A SICK-BED To prepare a sick-bed, place first a stout pad to cover the centre of the mattress, and over this, drawn Thf Paf ' and under tightly and evenly, the bottom sheet, which should be sheet neatly tucked in at the corners. Next should always come a protector of some sort large enough to ex- tend from the edge of the pillow to within two feet of the bottom of the bed. This protector may be of black or white rubber, enamel cloth (which, however, cracks easily), or sheets of tar paper folded' between newspapers, if rubber is not obtainable or if the patient has serious objection to its use on account of its heat. In cases where there is no immediate cause _ The pro- for the rubber sheet it may be placed next to the tector and mattress, and thus serve to protect it in case of any accident occurring. The rubber sheet is to be covered by what is known in hospital phraseology as the "draw-sheet," an ordinary-sized sheet folded with two hems to- gether, though, if desired, a single piece of cotton of the width of the doubled sheet would answer the purpose quite well and be somewhat more easily laundered. This is put on so that the hemmed edges come at the bottom and the other edge high enough under the pillow to prevent the possibility of a rest- less patient getting the elbow under it. It should be tucked in at one edge evenly and then drawn as tight Care as possible from the other side, pulling always at the draw sheet centre first, and, after tucking that in, making smooth the rest of the side. In tucking in the draw-sheet with a patient in bed, this method of procedure is essential if the sheet is to be made tight. The patient, if able, should lift the hips slightly while the sheet is being tightened. 16 HOME NURSING A draw-sheet properly put on ought to add much to a patient's comfort, as it ensures a smooth, firm surface underneath the back and it can be changed so easily that the patient need have no sense of fatigue while it is being done. The covering for the bed ought always to be light, Blankets but sufficiently warm, and the top sheet should fold than quilts over the edge of the blankets to keep them from becoming soiled. Blankets, or even lightweight shawls, if one is reduced to an extremity, are far better than bedquilts of any sort, and two light blankets are warmer than one very heavy one, be- cause of the layer of air between them which acts as an additional covering. The coverlet, if heavy, may be replaced by a sheet, though dimity is being sold