Manual of home nursing and hygiene : including first aid to be rendered in cases of accidents and emergencies

Front matter

22101916708

Med

M A 1ST XT A JL.

Preface

The present volume is offered to the Public as a text-book on Sick Nursing, and, is intended to supply a want much felt by nurses and probationers attached to Hospitals, where there are no Dressers or even a bouse Surgeon ; it also meets the requirements of families residing in the country, or, in foreign lands, where it often happens that the services of a medical man cannot he obtained for many hours, or, sometimes even for several days.

The arrangement of the subject is based, principally on a syllabus which I drew up for “ The Association for Instructing Soldiers’ Wives in Nursing,” and partly on a course of Lectures to Women, delivered to the advanced classes of the St. John Ambulance Association.

The work has been written somewhat hurriedly, during the spare intervals of a London general

Preface.

practice ; but even in its present form, I trust that it may prove useful, not only to the members ol the ■classes of the Associations above-named, but also to many others who may be engaged in attending on the sick, whether at their own homes, or in public institutions.

Although, in the treatment of the subject, I have chiefly described those methods which I have found by practical personal experience to be the most useful, I have, nevertheless, to acknowledge the help received from the works of Heath, Sydney Ringer, Yeitch, and Robert Smith.

I would also take this opportunity of tendering my sincere thanks to Surgeon-Major Cuffe, C.B., Mr. Percy Potter, Lady Strangford, Mrs. Haig- Brown, and other friends, for their kind assistance and co-operation.

Harry Crookshank.

22, Elgin Crescent W.

January, 1881,

CORRIGENDA.

Page 9, line 10, after “every” read “serious.”

,, 9, ,, 20, for “stimulants” read “spirits.”

,, ii, ,, io, insert “ convalescent” patient.

,, 12, ,, 9, for “first-rate” read “good.”

,, 14, ,, 5, for “certainly” read “probably.”

„ 16, ,, 25, for “eagerly” read “easily.”

., 29, ,, 19, after “night” add “except in very cold or

windy weather.”

,, 182, ,, 13, after “dressing” insert “of.”

,,221, ,, 14, after “it” insert “frequently.”

MANUAL

OF

HOME NURSING AND HYGIENE.

Chapter I

Introductory Remarks — The Nurse — Her Duties and Requirements — Qualification — -Sleeping Accommodation — Dress — Administration of Food and Stimulants — Feeding Helpless Patients — Administration of Medicines.

INTRODUCTORY REMARKS.— There is no better object in life to which a woman can devote her skill, or for which she is more specially qualified by nature, than to administer relief and comfort to the sick and helpless ; and although the high position of the vocation of a nurse is not yet fully recognised by the general public, its great importance is none the less true, as the well-being, and oftentimes the sole charge, of a patient’s life are consigned to her hands.

The qualifications, both physical and moral, essential for

B o

The Nurse.

the formation of an efficient nurse, are so numerous that no woman should lightly undertake the calling. Many of its duties, and not the least important ones, are exceedingly menial. The responsibilities are often very great, the nurse being answerable to the medical attendant that all his orders are faithfully carried out ; and during his absence from the sick-room the care of the patient is entirely entrusted to her charge.

Many disagreeable things have to be put up with from the patient, or even his relatives and friends; and frequently, when under the most trying circumstances the greatest kindness and forbearance have been exhibited by the nurse, any signs of gratitude or appreciation for the services rendered may be entirely wanting.

If, however, the good of one’s fellow-creatures was the nurse’s sole desire in accepting the duties of the office, these difficulties will be cheerfully borne and overcome; and the nurse will then have the satisfaction of knowing that in many cases the patient’s life has been saved, and his health and strength restored, by her good nursing, rather than by the medicines taken, or the professional skill of the medical attendant.

THE NURSE : her Character and Qualifications.— It is absolutely necessary, in order to become a good nurse, that the person choosing the vocation should be physically capable of enduring the fatigue and confine-

Character and Qualifications.

ment of the sick-room, otherwise her health and strength are likely to break down at the very time, perhaps, when her services are most wanted ; and this is particularly liable to occur if the case in hand requires very much night watching.

Then, again, in many people, lengthened confinement in-doors produces a depressed or irritable state of mind, which not only prevents them from doing their work as it ought to be done, but also re-acts on the patient’s spirits, very much to his or her disadvantage. In such cases it is far better for the nurse at once to give up the care of the patient to some one more fitted than herself for the office.

In selecting a nurse, especially for any public institution, her moral character must be beyond question. Anything like levity in the presence of the patient is very unseemly, whilst, on the other hand, a cheerful and lively disposition is very requisite. She should ever show a willincr readiness to do whatever is required of her, never exhibiting any temper or incivility, but in every action a spirit of kindliness and forbearance, particularly to the patients under her care.

Sobriety , honesty , and truthfulness are, among the nurses, indispensable qualifications, and, above all, must she be trustworthy in her work, and by close attention to her duties gain the implicit confidence of both doctor and patient.

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She must be quiet in her manner, methodical and tidy in her habits, and punctual in her engagements. She should move about the room with as little noise as possible, open and close doors and cupboards silently, and take every precaution to prevent startling the patient, or suddenly awaking him when asleep. Every vessel, bottle,, or instrument in use must have its proper place, and when no longer required, must be removed from the room, or put carefully away.

Avoid stuffing all kinds of miscellaneous goods into cupboards, for they only take up valuable space, and tend to collect dirt and dust. Let the cupboards be well scrubbed and dusted, and ready for use when wanted.

In dealing with the sick, the nurse requires a great amount of common sense, together with considerable tact in managing , and firmness , both of character and hand , though it should be coupled with gentleness. Patients must never be allowed to have their own way when it is against the orders of the doctor, but the nurse must firmly, yet gently, insist on carrying out all orders given her by him, and he alone is responsible for the results.

She should cultivate the habit of observation in every feature of the malady, and inasmuch as the less a patient has to look after himself the better, the nurse ought even to think for him, and so anticipate his wants and desires.

Duties to Patients.

She should also observe the patient’s idiosyncrasies, and, to a certain extent, give way to them. Some patients like being left alone, others prefer company. As her object in life is to save the lives of others, and her duties bring her constantly in face of suffering and death, the nurse should be a woman of delicate feeling, ot religious character, and devoted to her calling.

DUTIES TOWARDS THE PATIENTS.— She should show a personal interest in their affairs, inquiring into their domestic life, sympathising with them in their troubles, administering comfort and encouragement to them where necessary, and, by her advice, helping to lessen their anxieties, and thereby greatly assisting in their cure. She should also try to cheer up the patient, but must never do so by raising unfounded hopes in the case, .and should avoid repeating accounts of similar cases she may have nursed, especially if they did not recover favourably.

The nurse’s duties towards her superiors are very plain : ever bearing in mind the subordinate position she occupies, excepting where the care of the patient is concerned, she should always be civil and respectful to her employers, never disputing their orders, but always setting aside her opinions and wishes for theirs. In private houses, she must remember that towards her employers she is in the same position as the other domestic servants, with

Personal Requirements.

whom she cannot be too guarded in her behaviour and conversation, or be too careful to avoid interfering with their work, or the ordinary arrangements of the house.

The relations oj the nurse to the doctor are distinctly marked. She must strictly carry out his orders as to diet and medicine in the treatment of the patient, and must never presume to use her own judgment in the non-fulfilment of his wishes. The doctor’s duty is to order — the nurse’s to obey. If this position is not maintained the nurse must be got rid of, and another one put in her place.

It is the nurse’s duty to report to the doctor at each visit the result of the treatment that has been pursued, or any changes she may have noticed in the patient’s condition since his last visit ; and even at the risk of being dismissed by her employers, she should acquaint the doctor with any interference by the patient’s friends or relatives in the treatment of the case during his absence. And this is more particularly to be borne in mind nowadays, when so much gratuitous medical advice is invariably pressed on patients by those about them, who should know a great deal better.

PERSONAL REQUIREMENTS. — In the management of her own health the nurse will require special arrangements to be made as to her sleeping accommodation , her nourishment , and recreation. She should be provided with a

How to Dress.

separate room, communicating, if possible, with the sick-room, where she could take her meals regularly and retire to rest at night. No woman should act as nurse, day and night. If the case requires constant supervision, two nurses will be needed, so that one can rest while the other is with the patient.

Seven hours of undisturbed rest is necessary, and it is advisable that every nurse should be away from her patient at least nine hours out of every twenty-four, of which two hours should be spent in out-door exercise, especially when nursing infectious cases : fresh air and exercise keep the functions of the body in good, active condition, and so enable her not only to perform her duties more satisfactorily, but diminish the chances of her own health breaking down, and her liability to catch the disease.

Her personal wants must be considered, and she must be made as comfortable as possible in her new temporary home. She will require a comfortable bed, a fire in her room, and her meals prepared for her; these she should have either in her own room (in infectious cases) or with the other servants, somebody in the meanwhile taking her place at the bedside. Both day and night nurses ought to take food before going into the patient’s room.

HOW TO DRESS. — The nurse should always be clean and neat, both in her person and dress, and should there-

Clean Hands.

fore study quiet neatness in the colours of her wearing apparel. For this purpose a grey serge, alpaca, or print dress, which can easily be cleaned, is the most serviceable. Woollen materials are to be avoided, as they retain bad smells and infection; and rustling silk dresses, because of the noise they make in moving about.

Avoid high-heeled boots ; slippers are more serviceable in-doors. If cuffs, collars, or caps are worn, they must always be scrupulously clean, for nothing mars the good appearance of a sick-room so much as untidiness in the dress of the attendant.

The nurse should change her under-linen frequently. She should carry, attached to a band round the waist, a pair of scissors, a pincushion, well filled, a pair of dressing forceps, a thimble, and a few needles. She should always wash her hands and face before having her meals, and whenever she leaves the sick-room for any length of time.

The hands must be carefully washed after dressing wounds or removing soiled vessels from the room, and especially before handling the patient’s food. Could anything be more distressing to a sensitive patient than to see a slovenly nurse remove soiled vessels, or old surgical dressings from the room, and immediately proceed to prepare his food, without having first of all washed her hands ?

Food and Stimulants.

After dressing wounds in surgical cases, or attending to patients suffering with erysipelas, the nurse should carefully rub her hands over with a mixture of vaseline and carbolic acid — i part to 20 — and then wash them well in a disinfecting solution of carbolic acid and water, or Condy’s fluid. Want of attention to this point has often been the cause of spreading erysipelas or gangrene among the neighbouring wards of an hospital. ADMINISTRATION OF FOOD AND STIMULANTS.— In every case the nurse should be provided, by the medical attendant, with written directions, as to the nature and quantity of food, and the times of its administration. One of the golden rules for the nurse to remember is, that no food other than that which is prescribed by the doctor, must be given to the patient. The same rule holds good with regard to stimulants, but in some cases the nurse may be given greater license, and use her own judgment, whether at times it must be given more freely, or withheld altogether.

Stimulants should always be diluted with water, and generally taken with food, and the quantity of alcohol given must always be accurately measured in a graduated glass.

Food is usually given at stated intervals, every two 01- three hours, but in many cases it has to be given very much more frequently, and oftentimes administered all

Stimulants.

through the night ; this is often done without rousing the patient from sleep, by gently placing a spoon, filled with beef-tea, or milk, between the lips, and letting it trickle slowly into the mouth.

Some patients will wake the moment food is due, others will sleep over the interval, and the nurse has to decide herself how long the patient should be allowed to sleep over the time without taking food. The nurse must bear in mind that there is a great difference in the power of digestion during health and sickness, and that the patient is unable to take the usually regular large meals, so that the food must be given in small quantities, and very frequently repeated. The best plan is for the nurse to ascertain from the doctor the amount of food he wishes the patient to take in twenty-four hours, and then make a scale of quantities for regular intervals.

The doctor should always impress on the nurse the necessity that exists for regularity in giving food, stimulants, or medicines. When the time for a meal is due, it should be ready, and the patient not be kept waiting for it ; if the patient is able to take solid food, it should be well cooked, well served, and well up to time ; otherwise, the desire for food which nature creates, when the hour for a meal approaches, gradually subsides, and half an hour after

Sick Diet.

the appetite entirely disappears ; the food then is refused, and faintness or prostration is the result. This is especially noticeable in convalescent patients recovering from severe fever.

The food should be nicely served up ; if hot, let it be hot, and not lukewarm ; do not let the plate be crowded with meat, and see that the plate, knife, fork, and spoon are scrupulously clean, and not merely wiped over with a cloth, and left quite greasy.

It often happens that between meals a patient will express a wish for something to eat, which must immediately be granted, or the desire very soon disappears. The nurse should therefore always have ready at a moment’s call some form of nourishment such as custard pudding, jelly, biscuits, wine, or milk, which must not be kept in the sick-room, but outside, in some cool place, for not only do they become stale and poisoned by being kept in the room, but nothing gives the patient a greater distaste for food than constantly seeing it before him. It should be placed on a table, outside the room, and carefully covered over with fine gauze, to protect it from dust and flies. The quality of the food must be changed frequently, without waiting till a distaste for any particular article of diet has been produced; patients, for instance, will after a while loathe the very sight of beef-tea if it is

Change of Diet.

-constantly given ; whereas, if chicken broth, mutton broth, or mock-turtle soup are occasionally substituted, no such feeling will be produced. Another good substitute is to cut slices of Brand’s concentrated essence of beef (sold in skins), and make into sandwiches with thin bread and butter.

A thorough good nurse should not only know when food is properly cooked, but should herself be a first-rate cook, and know how to prepare many little dishes to tempt the patient with. Food should never be forced upon a patient; a little persuasion should be employed to make him take something, if only in small quantity, but do not worry him by pressing it on him. Very often he may be tempted to eat, if the food is brought to him as a surprise, especially any little delicacies that are out of season ; if, however, he refuses to be tempted, do not leave it at the bedside, hoping that perhaps he will take some later on, as it almost invariably under these circumstances remains untasted, and very rapidly spoils.

Drinks, too, must be frequently changed, as they absorb the poisonous gases in the room, and soon become unfit to drink.

The nurse must be very careful in preventing the patient from receiving food, from friends or relatives, without the doctor’s orders; and on visiting days, in

Feeding Patients.

public institutions, it is as well to examine under the! pillows, to see that nothing has been secreted there, as cases have been known where patients recoveringfrom typhoid fever have suddenly died from perforation of the bowels, caused by eating fruit injudiciously supplied by visitors.

10W TO FEED PATIENTS. — If the patient is more or less helpless and unable to sit up in the bed, the nurse must pass her left arm behind his shoulders and gradually raise him into an upright posture (except in cases of heart disease, where it is absolutely necessary that the patient be kept lying down), and feed the patient with a spoon held in the right hand. Any liquid food is put into a feeding cup having a spout to it, or into an ordinary tumbler, and sucked through a glass tube, 12 or 14 inches in length, with a curve at the end nearest the mouth.

In feeding helpless patients with an ordinary cup, it should not be more than half filled ; the nurse then raises the patient’s head, and putting the cup to his lips, lets him slowly draw the contents into his mouth; avoid pouring it into his throat or spilling it over the night-dress.

Children are usually fed with the ordinary feeding bottle, but a better plan is to use a small porcelain spoon, made in the shape of an ordinary sauce bowl, and

Feeding Insensible Patients.

holding about half an ounce. The lip of the spoon is placed in contact with the roof of the mouth, and the child, placing its tongue against the under surface of the spoon, sucks down the contents, which must not be poured into the throat, or else it will certainly pass into the windpipe and set up a fit of coughing.

Insensible patients, whether children or adults, are fed in the following way : — The face is turned to one side (say, left), and the cheek on that side drawn away from the teeth by the little finger of the left hand, the nurse then holding in her right hand a spoon containing beef-tea, brandy, or milk, pours it into the hollow of the cheek, between the cheek and the gums ; then taking away her little finger, she turns the patient’s head over to the right side, and the liquid food trickles past the back of the teeth behind the tongue to the top of the gullet, when the muscles of the oesophagus contract and immediately swallow it, the action of deglutition being performed involuntarily.

In all cases of fractured jaw or haemorrhage after removal of teeth, the food is generally given cold, and in order to prevent any bandages or plugs being moved, all nourishment must be in a liquid form and sucked through a glass tube, bent at right angles at one end, as above described. Sometimes the liquid food is frozen, small portions are then broken off and put into

Administration of Medicines.

the mouth, where they gradually nielt and are easily swallowed.

In cases of paralysis of the tongue and throat, where the power of swallowing is lost, the patients have to be fed with the stomach-pump, a long india-rubber tube, by means of which liquid food is injected into that organ, being passed behind the windpipe, through the gullet, into the stomach.

ADMINISTRATION OF MEDICINES.— As a general rule, medicines are to be given between meals ; if, however, they are ordered for special purposes, definite directions should be given as to the proper time and mode of their administration. Some medicines have to be taken the first thing in the morning, on an empty stomach ; others, immediately after taking food.

All medicines should be carefully measured, in a graduated glass, and given regularly at the hours prescribed, for many of them contain poisonous preparations ; and if the nurse forgets to give a dose at the proper time, and then gives a double one when the next is due, the consequences may be very serious, and even prove fatal to the patient.

An untrustworthy nurse, in order to save herself the trouble of giving the medicine during the night, has been known to give the whole of the medicine, which should have been taken during the night, at a single dose,

Medicines to Children.

before going to bed, thereby endangering the patient’s life.

Medicines and lotions should never be kept near each other, as accidents occur at night in giving one for the other; the latter should, if possible, be kept in fluted bottles, so that they can immediately be recognised by the touch when taken in the hand.

The glass in which the medicine is given should always be well rinsed out after each dose, and especially when using the same glass for several patients : a special glass should be used for strong smelling or oily medicines, which must never be poured out within sight or smell of the patient, but brought to him, together with anything that is given to cover the taste, so that it can be taken immediately after the dose.

Bottles containing acids, caustics, or blistering fluid, for testing the secretions and other purposes, must be very carefully put away, if possible, under lock and key.

In giving medicines to children, great tact and extra care is necessary: avoid forcing medicine down their throats by holding their hands and nose, or threatening, to send for the doctor, whom they will then look upon as their enemy, and not a friend.

Powders can be given, mixed with honey or preserve and pills will be eagerly swallowed, by splitting a chocolate cream in two, and hiding them in the centre.

The Sick Boom.

Chapter II

The Sick Room — Selection and Preparation — Furnishing — Warming — Ventilation ; Natural and Artificial — The Air vre breathe — Effects of Respiration.

SELECTION AND PREPARATION.— When the choice of the sick-room can be made, one should be selected at the very top of the house, particularly in infectious cases ; for the farther the patient is removed from the other rooms of the house in ordinary use, the less danger is there of the disease spreading among the other inmates ; and, again, it is farther removed from the scene of the usual daily domestic engagements, and therefore the patient is less likely to be disturbed by the noise which exists, more or less, in the lower regions of every household. It should always have a south or west aspect ; and if the house is in a main thoroughfare, or noisy street, should be at the back rather than the front, especially in those cases (cerebral disease) where absolute silence is of importance.

The room should be spacious and lofty, airy and well

lighted by the sun, for except in eye and cerebral diseases,

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IS

Selection and Preparation.

direct sunlight is as necessary to rapid convalescence as fresh air.

In large public institutions, the difference in the position of the wards, in regard to the recovery of the patients, is very noticeable, the convalescence of those in wards with a northerly aspect being much slower, than those in the warmer and better lighted ones.

The room must be provided with windows, openingtop and bottom, and not with French windows. There should be no cracks in the panes of glass, which must be well cleaned, and the bolts and sashes must work easily, without making any noise when opened or shut.

In order to warm and ventilate the room properly a fire is necessary, and before using the room, the chimney, which should have a good draught, must be thoroughly well swept. Always remember to avoid a smoky chimney.

The room will require to be thoroughly scrubbed before use, for which purpose the carpet is removed,, and the floor well washed with soft soap and water, in which a small proportion of carbolic acid is dissolved ( I part in 200) : the walls, skirtings, and doors are then dusted over with a cloth, damped in a solution of carbolic acid and water of the same strength, the

Furnishing.

furniture employed being also subjected to the same treatment.

In sweeping out a sick-room, when the patient is in it, avoid sending the dust flying all over the place, by sprinkling the floor with carbolic acid and water, or damped tea-leaves. Linen should never be washed and dried in the sick-room, a very common practice among the poor classes.

URNISHING. — It must be borne in mind that all woollen goods attract dust and retain bad smells and infections much longer than cotton ones, and must therefore be removed from the room; hence, in infectious cases, the carpet, window-curtains, heavily upholstered chairs and sofas, must be taken away.

In private houses, except in dealing with fever cases, the carpet is not generally removed, as it gives a cheerless appearance to the room, and, further, bare boards create more noise. This, however, can be avoided by placing a strip of carpet down the centre of the room, and another by the side of the bed.

In hospitals, the floor is kept perfectly bare, noise being avoided by nurses, and patients being provided with slippers ; there is also greater facility in keeping the bare floor constantly clean, as anything spilled on it can be immediately wiped up, and the place well scrubbed with soap and water.

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Pictures and Flowers.

Blinds will be required to moderate the light; but curtains are better done away with altogether ; if, however, they are retained, they should be made of muslin or linen, as they are easily washed.

It is a good plan, in public institutions, to cover the walls with pictures or coloured texts, as they give a cheerful look to the wards, and something on which to repose the eyes. These pictures or prints are generally glazed over, so that from time to time they can be taken down and wiped over with a cloth damped in some disinfecting solution.

All unnecessary articles of furniture must be removed, all that is required being a bed, table, washhand-stand, and a few chairs, which should be plain wooden ones or cane-bottomed. If there are any cupboards in the rooms, they must be emptied and thoroughly scrubbed, and not used as receptacles for halfempty medicine bottles, stale food, and a miscellaneous mass of dressings, bandages, splints, and old rags.

It is necessary to be provided with different kinds of vessels for the patient’s use, and especially a portable bath. These, however, must not be kept in the sick-room, but only brought in when wanted, and then immediately removed.

Plants are decidedly healthy in a sick-room, as they help to purify the air by removing the carbon and

Warming of Sick Boom.

nitrogen from the carbonic acid and ammonia gases given off from the lungs and secretions. Flowers, too, help to brighten up the room, and there are few patients who do not appreciate a pretty bouquet ; on the other hand, flowers giving a heavy, sickly odour, are to be avoided, as they often greatly depress a patient and cause headache.

In summer, it is well to adopt some means of catch ing flies or attracting them from the bed and annoying the patient. In foreign countries, precautions have to be taken, by means of a gauze veil or muslin netting thrown over the bed and face, to protect the patient from mosquitoes and other poisonous insects.