Monday, 26 May 2014

8 March 1884 - 'A Few Hints on Nursing for Our Girls' by A Hospital Nurse - Part 1

The fact that almost every woman has at some time to act as a sick-nurse is generally acknowledged, but only very little provision is made for training our girls to be intelligent and efficient aids to the doctor, when their turn comes to take the management of a sick room.  I wish on this occasion as a nurse of some experience to address the readers of THE GIRL’S OWN PAPER as young nurses, and to give a few simple hints which may be useful either in attending sick friends, or on meeting with some of those cases of accident to which we are liable every day of our lives; cases in which a little knowledge and presence of mind may avert a great deal of trouble, sometimes may save even life itself.

To begin with, I have a piece of encouragement to give you as inexperienced nurses, if you are suddenly called upon to act.  Remember that loving care, unselfishness, and obedience will make up for a great deal.  If you can get your patient to like your attendance, and not to object to receive your assistance when necessary, you may, by obeying your doctor in every point, carry through a case very creditably without regular training.  Still, study and experience are not to be undervalued; for one thing, even if you have had but a little, it is a comfort to yourself to know that you have at least a fair idea how things ought to be done from having done them before, or having seen others do them.  I know from personal experience that even when the patient and friends are satisfied, and the doctor complimentary, there is yet a keen sense of incompetence, or at least of uncertainty; a feeling that if so-and-so had been done otherwise it would have been better; a haunting fear of something absolutely necessary for the well-being of the patient being left undone.  This is all very foolish.  When we go into hospital for training, we learn that what we have to do is carry out orders; not to originate, or to fancy that things have been forgotten.

However, we must come now to practical matters.  Suppose you have a member of your family laid up at home with a bad knee and the doctor orders a blister, would you know how to apply it?  First be sure you know the exact place where it is to go on.  Some doctors mark it on the patient’s body, and it is a very good plan.  The place should be washed clean, of course, leaving the mark.  When you get the blister-plaster, if there is a little bit of stuff like silver paper over the flies (the brown part), take it off before applying, unless the patient’s skin is exceedingly tender.  Warm the blister slightly, holding the back to the fire.  The doctor will tell you about how long it is to stay on and the signs by which you will know when it is to be taken off.  The ointment for dressing the blister should be spread upon a piece of lint or old linen cut to the right size before the plaster is removed.  Have a pair of sharp scissors ready or, failing them, a needle will do.  Then take the blister off as gently as you can without dragging.  The best way to do this is to take it with both hands and draw it towards the middle from the edges.  Have a piece of cotton-wool or old linen to catch the “serum” as the fluid that runs out is called, and if the blister has risen much it may be well to put a saucer underneath to save the sheets.  In hospitals there are trays for such purposes.  Snip or prick the blister at its lowest part, and the fluid will run out.  If possible, do not let any flow over the healthy skin, as it is apt to scald.  You may help it out with a little gentle pressure.  There will be some dead loose skin.  Opinions differ as to whether it should be cut off at first or not.  It will come away in time.  It is always removed if the blister is to be kept “open”; but the doctor will explain this to you.  By keeping it open I do not mean leaving it uncovered; this is never done.  I mean keeping up the irritation by means of some smarting ointment.

A blister should be dressed at least every morning and evening until the place heals up.  In some parts of the body the dressing will keep its place if laid on, but it is generally well either to bandage it loosely or to fasten it down with two or three strips of strapping or diachylon plaster.  If you use this for any purpose, heat it first by holding the back – the linen side – to the fire, or by putting it round a vessel of hot water.  Otherwise unless the skin is very hot it will not stick.

Sometimes a poultice has to go on when the blister comes off.  In this case if you have to attend to all yourself, you must open the blister first, and cover the place with a piece of lint or old linen, while you make the poultice, which would be quite cold if you made it first, besides, it does not take long to prepare, and ointment is often very tedious to spread.

If you are set to make a poultice and are not in good practice, do not be afraid of having it too hot.  It is much more likely to be too cool with all your pains.  Do not be afraid, either, of having it too big if for a surgical case.  In poulticing the breast cut a hole for the nipple.

First spread out your linen or whatever you are going to spread upon so as not to waste time after the poultice is mixed, then scald out the vessel in which you are going to make it.  Throw away that water and pour in some more, as much as you think will do, from a kettle hissing and boiling furiously, put your meal in by degrees, stirring it in quickly until you have a thick smooth paste with no dry meal at the edges of the bowl.  Always stir in the same direction, not backwards and forwards.  Turn out on your linen and spread it evenly, about a quarter of an inch in thickness; cut the edges straight, leaving a good margin of linen to turn in like a hem.  The linen should be double.  I have often seen poultices spread on lint, but it is great extravagance, for large ones, at any rate.  Tow does very well for the purpose, but is requires some practice to lay it properly, and a badly-made tow poultice is very uncomfortable.  Dipping the knife or spatula into boiling water makes it easier to spread the meal.

When taking off a poultice or any dressing, if it sticks never drag it; moisten it slightly with warm water and it will come away.  If a poultice is likely to remain a good while unchanged, and is over an open sore, a very little oil spread upon it will keep it from sticking.  Some people recommend oil with all linseed poultices.  I do not.  It is hard to put little enough, and it is rather dirty.  A properly made poultice ought not to stick, but in a case where one might not like to disturb a patient during the night I should use oil, as if left on many hours a poultice is apt to get dry.

A mustard poultice is an old-fashioned remedy for cold on the chest.  The approved way to make it was to use cold water, and spread it on brown paper with a little bit of muslin over the front to protect the skin.  This could not be kept on long.  Perhaps ten minutes or a quarter of an hour is as long as one could bear it from the time it is first felt.  Nowadays I generally see linseed meal mixed with the mustard, or mustard leaves are used.  They are very good and clean and easily applied.  When you take off a mustard leaf lay a folded pocket-handkerchief or a piece of old soft linen over the place.

The nicest way of making a bread poultice that I know is to grate up stale bread in a colander, pour a little boiling water upon it, and stir it up with a knife.  It takes much less water than you would think, as it should be a pretty stiff paste, and if sloppy it is no good and will fall to pieces before coming off.  With a little oil spread over it, it is a very soothing application but this does not make a very hot poultice.  If heat is required, and you use bread, first scald out your vessel, put in a little boiling water and then some coarsely crumbled bread, stir it, and leave by the fire or in the oven to soak for five minutes or so.

Most extraordinary mistakes have been made about blisters and poultices, though they seem simple things.  It is not fair, however, to expect people to know what they have never been taught.

Not long ago I left a blister on a patient, and asked his wife, a middle-aged woman, if she knew what to do when the time came to take it off.  She told me that she had never seen a person blistered but once, and then she fainted.  The first blister I put on, many years ago, did not rise.  If it had risen I should certainly not have known how to treat it, though probably some one in the house could have told me.  It is, however, very stupid and very wrong of people nursing the sick not to ask for directions in a case of this kind if they are not quite sure that they know what to do.  In some arts we learn a good deal by one of our own mistakes, but a nurse’s mistakes mean suffering to her patient, and this being the case she ought never to be ashamed to confess ignorance and ask for instructions. 

A clever person not long ago who was too lazy or too proud to ask for directions in a simple matter, set about making a linseed poultice by blending up the meal with cold water – I suppose with a vague idea of making starch.  If it ever reached the spreading stage it must have been a nice sticky mess.  Many years ago a doctor in the North of Ireland, prescribing for one of his out-patients, gave the wife a blister, a bottle of medicine, and some other things that were required, with, as he thought, full directions how to use them.  Calling a few days afterwards to see how the man was getting on, he found that the woman had put all he had given her into a saucepan and boiled it, giving the mess afterwards to the patient as a dose.  The doctor said that the man would most certainly have been poisoned, only that the flies of which the blister was composed made him very sick, and he brought the whole thing up, so that after all no great harm was done.

Fomentations or stupes are often ordered to relieve pain.  There is a particular kind of material called spongio-piline used in hospital for the purpose, but a stupe can be made quite well by wringing out coarse flannel in boiling water.  If not wrung every day, a fomentation is about the most miserably uncomfortable thing that can be imagined, and is almost certain to give the patient cold.  A good way to prepare one is get a strong towel and lay iyt over a wash-hand basin; then lay your flannel in the towel, and pour boiling water upon it until it is well soaked.  By twisting the ends of the towel in opposite directions, you will not scald your hands, and you will be able to wring the flannel dry.  Two people can prepare a fomentation much more easily than one.  To relieve acute pain opium is sprinkled on the flannel before applying, and turpentine is sometimes ordered as a counter-irritant.  If the stupe is to be plain hot water, bring the flannel to the bedside in the towel so as to keep it as hot as possible, shake it up just before applying, and it will keep warm much longer.  Fold a dry towel and lay it over the fomentation when you put it on.  In hospitals a piece of waterproof material is generally used for this purpose.  Sometimes these stupes have to be changed very frequently, but the doctor will tell you this.  If you have many to prepare it will be worthwhile to make a regular “wringer”, by running a stick or lath into a hem at each end of the towel.  By twisting these sticks in opposite directions, you can wring with little or no fatigue.  The wrists soon get tired doing it the other way.

When a doctor asks you any question about yourself or anyone else, be quite sure you understand what he means.  If you do not, tell him so.  I remember once hearing a girl unintentionally quite deceiving a physician about a shivering fit she thought she had had; it was probably just a little chilliness, but she made herself out so very much worse than she really was, that he thought she must have had a severe rigor, as it is called, and sent her to the fever hospital, where, I believe, they rather laughed at her and sent her away in a day or two as having nothing the matter.

Another thing: When you get a prescription made up at a dispensary, be sure you understand how the medicine is to be given.  Doctors have ways of their own of writing directions, meant for the dispenser, not for you.  A girl once brought me a piece of paper that had been given her with a bottle; from having been some time in the hospital as a nurse I could explain it to her, but before I went I could have made nothing of it.  In most of the London hospitals I believe they have printed labels for all the bottles, “Take two tablespoonfuls three times a day” and so on.  It is a good plan and ought to be universally adopted.  If you do not understand the directions, however, and ask the dispenser, he will always tell you when and how the physic is to be taken.

There are a few simple things to be noticed in giving medicines that you may as well understand.  It may perhaps be an unnecessary caution to tell you if you are directed to give, say, a tablespoonful of anything, only to measure it in the spoon and bring it to the patient in a cup or glass.  I have known a spoon put to the sick person’s lips with the dose.  A moment’s thought will convince you that is a most slovenly and uncomfortable proceeding.  Always wash your cup and spoon immediately after giving medicine.  If you have to give castor oil, first rinse your vessel and spoon in cold water; then put your milk, or brandy-and-water, or whatever you are going to give it on, into the glass, measure the oil in a spoon, and pour it as carefully as possible into the middle of the glass, not letting a drop touch the sides.  It is well to pour out castor oil near the patient, as carrying it across a room is apt to shake it up . When it is desirable to make the oil act quickly it should be stirred up in hot water.  This must be a most abominable dose; but, given as I have described, castor oil need not be hard to take at all.  However, some children, and grown people too, are very obstinate, and if this medicine is ordered will point-blank refuse to take it.  For them we had a plan in hospitals of shaking the oil up with about twice the quantity of peppermint-water in a soda-water bottle.  Any bottle, of course, would do, provided it was clean and big enough.  It takes a good deal of shaking until it comes into a sort of creamy stuff.  It seems to me that this would be far nastier than the oil in its usual form; but I am bound to say that I have seen a boy who would roar for half an hour if you suggested castor oil in his hearing, but would take this mixture without the slightest fuss.  A nurse, who has had large experience, told me that she never knew a child object to it.

Sometimes when a pill is ordered for a patient one is rather put aback by the statement that he or she never did and never could swallow such a thing.  I have sometimes been able to persuade one of these incompetent people to try a very simple plan, which I never knew to fail even with a small pill, which is more difficult to swallow than a big one.  Put it back as far as possible on the tongue, and take a drink of water; it is almost sure to go down.  In case of a child, however, or a patient who is determined that he cannot take a pill on any terms, the best way i s to scrape it up and mix it with a little sugar in a teaspoon.  Then, of course, there is no further difficulty. 

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