[Sidenote: The Hospital Ward]
It is in the hospital ward that the major portion of routine hospital
work is accomplished, and where the nurses who will have much of the
responsibility of the hospital work of the future will be trained
in habits of accuracy and neatness, in proper systems of ward work
and good hospital housekeeping. Inasmuch as the number of hospital
officers varies with the size and demands of the hospital, it should
be understood that for the purposes of these papers the hospital
housekeeper combines the position of superintendent of nurses and
matron—the plan that is generally conceded to be productive of the
greatest degree of harmony. In all but small hospitals, competent
assistants in both the nursing and domestic departments will be needed,
but the authority and responsibility of affairs domestic should be
centered in one woman. Whatever may be the opinion of hospital trustees
on that point, no one who has lived for a year in a hospital where
the superintendent of nurses and the matron were equal in authority,
and pulling in opposite directions, will sigh for a repetition of the
experience.
The architecture of the hospital ward, and the general plans of the
building, will have not a little influence in creating difficulties
for the housekeeper and in adding to, or lessening, the burdens of the
nursing staff.
Tiled floors and walls are ideal for wards, but too expensive for every
hospital to have. Even five feet of tiling on ward walls is greatly to
be desired. Denied that luxury, as many hospitals are, the next best
thing is to have the walls finished in cement or hard plaster, which,
if well coated with enamel paint, will admit of thorough cleansing and
disinfection.
Heavy moulding and sharp corners which afford a lodging place for
dust and germs should not be there. The ceilings should be high, and
ample air-space provided for the number of patients for which the ward
is designed. The ventilating shafts, windows and radiators should be
arranged with reference to the proposed location of the ward beds.
When the hospital housekeeper can manage it, each ward will have its
own linen room, with abundance of linen. It adds no small item to the
number of miles a nurse is obliged to walk each day, if every time she
needs a clean sheet, towel or gown she has to walk half the length or
the whole length of a long hall to get it.
A little forethought and consideration for the nurse’s part in the
hospital economy, in arranging the plans of the building, would result
in at least avoiding unnecessary labor for those who will have no small
part in carrying out the humane designs of the hospital.
[Sidenote: Soiled Clothing]
Of equal importance is it to have a “clothes chute” on every floor,
connecting with the sorting room in the basement. This will render
unnecessary large receptacles for soiled linen. The storing of
quantities of soiled bed and body linen in the vicinity of the hospital
ward for even a few hours can never be anything else but injurious.
The atmosphere cannot be pure while soiled linen is there to give off
its impure odors. Very dirty linen should be rolled in a separate
bundle. Pins should be removed and disinfection attended to before
being sent to the laundry. Clothing belonging to patients should be
plainly marked with the owner’s name. In most cases it will prove
more satisfactory to all concerned for the hospital to decline to be
responsible for laundering articles of personal wear for any patient.
There is always danger of their being lost or torn.
[Sidenote: Buying Beds]
The ward beds should be of uniform height and style and well coated
with enamel paint. In buying beds several important points are to be
considered. If beds are offered which require two men, and a hammer,
and a box of bolts and a wrench, to get them adjusted, they should not
be considered, even if listed at a dollar each. They are dear at any
price, when one considers the prices that prevail in the labor market,
the strain on human patience, and the fuss that the moving of such a
bed to another room or ward entails. It is a mistake, too, to buy beds
without inquiring the length. Six-foot patients are not uncommon, and
these find it very distressing when put in a bed that is too short. The
bed should be at least six feet four inches in length.
In all hospital beds, there should be some kind of bar at the foot,
that will keep the mattress from slipping down. Some hospitals have
attempted to remedy this defect in beds by having boards sawed and
placed as foot boards, but these are unsightly, and if the right kind
of bed is bought such makeshifts will not be necessary. Before ordering
a quantity of beds, it is well to get a trial bed, and thus be sure
of the quality of mesh in the wire mattress, and that other details
are satisfactory. No beds without back rests should be purchased, for
in the majority of cases a back rest will be necessary. Separate back
rests must be purchased and stored when not in use, and these are
rarely as satisfactory as when attached to the bed.
It is well, also, to look closely into the plan of the back rest. Some
have a round iron rod across the lower edge If such a thing is there, a
sensitive, nervous patient will discover that rod, and worry till she
or it is removed.
In ordering beds it is wise always to state the height from the
ground that is desired, or low beds may be sent. About twenty-four or
twenty-six inches is the usual height desired. It is possible to secure
beds that can be adjusted to any desired height. The disadvantage of
such beds is the difficulty of adjustment so that each corner will be
exactly as high as the other corners. Each one must be measured, and
the moving of the wire mattress up and down on the legs of the bed,
makes it impossible to keep the enamel on the legs.
By all means hospital beds should have castors, and care should be
exercised to see that these castors are so constructed and adjusted
that they will not fall out every time the bed is moved. There is a
great difference in castors and in their durability.
For the general wear and tear of a hospital, the cotton-felt mattress
is giving better satisfaction than the hair mattress, and it is
somewhat less expensive. It is a good plan to have a few pads made of
bed ticking thickly inlaid with cotton batting. These should be made
the same size as the bed, with rings at the corners to secure them. For
very filthy or unconscious patients these pads are desirable, as they
can be washed and boiled as often as necessary. A couple of these pads
makes a bed as comfortable as a mattress.
[Sidenote: Bed Making]
The mattress should be carefully protected by a rubber sheet securely
fastened at the corners. Every nurse thinks she knows how to make a bed
before she goes to a hospital for training, but as a matter of fact
very few do. It is sometimes a difficult thing for the nurse to learn,
but it is one of the most important of the early lessons in ward work.
The appearance of the ward beds, and the way in which they are made,
is a good index to the character of the nurse in charge. If the spread
is on crooked, the open ends of the pillow covers pointing in opposite
directions, and the bed has the loose appearance of having been thrown
together without method, one may naturally expect the general work of
the nurse to be slipshod and unreliable. It is well to teach nurses to
stand at the ward door occasionally, and take a critical survey of the
ward, noting down the things out of order. A nurse who is watchful in
observing signs of disorder in her ward may naturally be expected to be
a careful observer of signs of disease.
Order, which is said to be Heaven’s first law, should be one of the
first laws of ward work. Even the height of the curtains of the windows
add to or detract from the appearance of the ward. The beds should be
an equal distance apart and in a straight line. The head of the bed
should never be used as a drying-place for wash cloths or towels, nor
as a hook on which to hang bath robes and wrappers.
[Sidenote: Ward Lockers]
Aseptic ward tables of iron and glass are now being used in some
hospitals, but it is doubtful if their use will ever be general. They
answer some of the purposes of a ward table, but not all. Even very
poor patients prefer to have their own combs and toilet articles,
their own handkerchiefs and stationery, their own books and flowers.
If some place is not provided for these numerous small things, which
the average patients find it necessary to have close by, they will
inevitably resort to stowing their “things” under the mattress—a custom
not to be tolerated by the neat housekeeper. Good housekeeping requires
that in a hospital, as elsewhere, a place be provided for everything
and everything be kept in its place. Until the proper aseptic ward
table is invented and offered at a reasonable price, the small wooden
locker, well coated inside and out with enamel paint, will continue
to be used. These lockers can be made to order for a very moderate
price, usually from three to five dollars each. They should be about
20 inches in width, 30 inches from the floor, 14 inches deep, and
mounted on castors. The drawer should be about 4 inches deep and there
should be a shelf in the lower part. A daily inspection of bedside
lockers is necessary, or apple cores, fruit peelings, remnants of food,
and refuse of various kinds will accumulate. All cupboards and linen
rooms should have daily attention, and should be in such perfect order
that the doors may be thrown open at any time for inspection without
embarrassing the nurse in charge.
[Sidenote: Care of Patient’s Clothing]
The outer garments of the patient and those not needed during illness
should be taken charge of by the nurse on the entrance of the patient,
and the list recorded in a book provided for the purpose in every
ward. Each article should be labelled, and placed in the locker in
the general clothes room, and the number of the locker noted with the
list of clothing in the record book. An accurate and uniform system
of clothes records throughout the hospital should be insisted on.
Unless this is done confusion when the nurses’ places are changed will
be inevitable. Carelessness in this duty on the part of a nurse has
resulted in no small discomfiture to the hospital officers. Clothing
has been mislaid and not found for weeks after the patient has left the
hospital, and the whole institution has been branded with negligence
by the patient and his friends. All the kindness received, and the
most skillful professional treatment, will often be lost sight of, if,
through the carelessness of a nurse, the hospital is unable to render
to the patient the clothing entrusted for safe-keeping. Money or
valuables should never be kept either in private room or hospital ward,
but sent to the office to be deposited in the safe.
[Sidenote: Ward Medicine and Records]
Though many well-regulated hospitals have a medicine cabinet in every
ward, the custom does not generally prevail, nor is it desirable that
it should. The less a patient knows, sees or thinks of medicine,
except the dose intended for him at the time, the better. The custom
of hanging clinical records over the foot or at the head of the bed is
another custom that might better be abandoned, even though it be very
convenient for the nurse. Patients are only too prone to meditate upon
and discuss their symptoms, in spite of all efforts to induce them to
trust themselves entirely to doctors and nurses, and cease questioning
and worry. Some sympathizing friend or convalescent patient may be
depended upon to keep them informed when an unpleasant symptom is
recorded. This will occur in spite of all rules and vigilance. It is
not easy under any circumstances to keep ward patients from discussing
their ailments and symptoms. Especially is this true in women’s wards.
In men’s wards the newspapers are read, the political situation is
discussed, city improvements and occurrences are talked about, all
sorts of subjects occupy the time of those who are able to talk, but
a different state of things entirely prevails in the women’s wards.
What they get to eat, how they feel, and the nurses and doctors furnish
the general topics there. To have a clinical record to gossip about
might divert attention from the nurses and doctors, but even these
long-suffering individuals would willingly sacrifice themselves as a
topic of conversation rather than have the patients read the records
and constantly discuss their symptoms.
[Sidenote: Adjuncts to the Hospital Ward]
The tendency in modern hospitals is in favor of smaller wards, as
affording better facilities for proper classification and separation of
patients. A nurses’ utility room adjoining every large ward or located
conveniently near two or three small wards, where medicines, clinical
records, supply charts and blanks, order books and the memorandum books
necessary for ward work are kept, is a much appreciated convenience
in some hospitals. Opening off this room is the ward diet kitchen,
where the refrigerator and food supplies for the ward are kept, and
the facilities for quick preparation of special diets for individual
patients.
[Sidenote: Quiet Room]
A much needed adjunct to a hospital ward is an isolation or “quiet”
room, to which a patient whose presence is offensive to the other
occupants of the ward may be removed. Whenever possible, a dying
patient should be separated from the other patients in the ward.
Gruesome tales that are disgraceful have been told of patients passing
out of life in full view of the other occupants of the ward, without
even the measure of privacy a screen affords. It is a melancholy
comfort to relatives and friends to be with the patient in his last
hours, and this cannot be permitted in a ward without confusion and
discomfort to other patients. When planning a ward for the care of the
sick or the poor, the object, of course, is the saving of lives, but
people will die in hospitals in spite of the best skill and care, and
the poor man is surely entitled to a quiet place to die in. There is
much in hospital life to blunt the sensibilities of those who live in
such institutions constantly. Familiarity with suffering and death robs
them of mystery and awe, but it should never be allowed to detract from
the reverent care of the dying and dead. “Put yourself in his place,”
is a good rule to observe in dealing with even the most unworthy of
Adam’s sons.
[Sidenote: Matters Miscellaneous]
The ease with which the routine work of the ward goes on will depend
largely on proper facilities and a proper system. There should be a
regular order for the work of the day—a time for bed making, a time
for sweeping and dusting and washing the ward floors, a time for the
daily cleaning of the bath rooms and toilet rooms and refrigerators and
cupboards. Interruptions may be expected, but unless a routine order of
work is established the cleaning will be executed in haphazard style.
Neither nurses nor maids can be depended on to use their judgment
in such matters. If left to plan their work, they will probably be
found sweeping their wards when the doctors are ready to begin their
dressings, and the time for other things will depend on their ideas of
the importance of the various duties. The habit of doing things quickly
and thoroughly should be formed by every one who has any responsibility
of the routine work of a hospital, where everything should move with
clock-work precision. So much time can be wasted by lack of system, or
in talking or dawdling. The untidy habit of leaving glasses or utensils
dirty till a sufficient quantity has accumulated to make it a necessity
to wash them, should never be tolerated.
It ought not to be necessary to mention the necessity of plenty of
tools and the right kind of tools for ward work—plenty of basins, and
syringes, and dressing pans, and instruments, and drinking-cups, and
medicine glasses, and the thousand and one little things that go to
make up the complete furnishings of the hospital ward. But, as a matter
of fact, many nurses go through their course of training hampered by a
lack of facilities for proper work. One set of instruments for dressing
is provided, where several are needed at the same time; insufficient
linen to keep the beds and their occupants clean is the rule, and so on
indefinitely.
[Sidenote: Destruction of Appliances]
On the other hand, head nurses and hospital housekeepers lament over
the carelessness of nurses and the constant destruction of hospital
appliances. Just what course to pursue with the girl who every few
days puts a rubber catheter or rectal tube or nozzle on to boil, and
lets it burn up; who pours boiling drinks into glass tumblers, and
thereby keeps up a constant breakage; who leaves hypodermic needles
without wires, and finds them useless when needed again; who breaks
medicine glasses and fails to report the accident, till the head nurse
finds her measuring medicine with a spoon; who puts the thermometer
into the mouths of delirious patients or children, and goes away and
forgets it; who lets the sterilizer boil dry; who puts glass syringes
and appliances in unsafe places, and returns to find them broken—just
what course to pursue to correct these destructive tendencies is an
ever-recurring problem to the hospital housekeeper. Nurses who are most
careful and conscientious in carrying out the doctor’s orders, and
in their duties to the patients, frequently lack that fine sense of
honor regarding their duty to the hospital and the care of materials.
A deposit for breakage is now demanded in some hospitals when a nurse
enters for training. If this is not done the nurse should be made to
replace articles destroyed and to pay for repairs that are rendered
necessary by her carelessness.
Proper economy in the use of hospital goods is an important lesson
for nurses to learn early in their career, and one which will demand
frequent emphasis throughout their course. Gas stoves are left burning
when not in use, and help to swell the gas bill. Milk is left out of
the ice-box, and quickly becomes unfit for use. Materials of various
kinds that could be utilized are thrown away. The destruction or waste
of one article seems a very trivial affair, but in the aggregate such
trivial affairs amount to hundreds of dollars in the course of a year.
The cost of rubber sheets alone is an important item in ward expenses.
The best will soon crack if folded when not in use. If loops of tape
are fastened to the corners and the sheets hung against a closet wall
when not in use, they will be found to last twice as long.
[Sidenote: Screens]
Plenty of screens in a hospital ward is a necessity to proper nursing.
The poor appreciate privacy and refinement and delicacy as much as many
of their wealthier neighbors, and they have a right to such privacy
as a screen affords. The timid, frightened little woman who has just
been admitted, and who shrinks from the gaze of everybody, ought to
be screened off till the first awful feeling of strangeness wears
away. The patient who is critically ill needs also to be screened. The
general work of the ward requires the constant use of screens. One
screen for every two beds is not too many for the necessities of the
average ward. One of the most practical and altogether desirable ward
screens is made of a wooden frame, white enameled, covered on both
sides with white oilcloth. A set of clothes-bars, from four and a half
to five feet high, makes a very satisfactory frame, that is large and
yet light enough for one nurse to handle.
A fair equipment for a ward of twenty beds would be:
White enameled iron bedsteads, with adjustable back rests 20
Mattresses (hair or cotton-felt) 20
Spreads 40
Pillows (hair) 20
Pillows (feather) 20
Rubber pillow covers 6
Rubber sheets 20
Rubber sheets (smaller, for baths, dressings, etc.) 8
Sheets 120
Draw sheets 120
Blankets, forty pairs 80
Towels (for patients) 120
Bath towels 60
Surgical towels 80
Roller towels for lavatory and pantry 20
Bed trays (for meals) 20
Extension tables for reading, etc. 5
Stupe towels with sticks 10
Pillow covers 120
Night shirts or gowns 60
Dressing sacks or bath robes 10
Glass towels 12
Bedside lockers (with drawer and cupboard) 20
Folding screens, white enameled 12
Ward tables for nurses’ use, with drawers for charts,
records, sheets, etc. 2
Medicine cabinet, iron and glass, white enameled 1
Dressing carriage, glass and iron, white enameled 1
Pus basins, different sizes 6
Pitchers, agate ware 3
Covered cans for sterilized water (two gallons) 2
Jars for ointments 6
Jars for sterile dressings 3
Jars for bandages 2
Jars for absorbent cotton 2
Trays for instruments (agate ware) 4
Scissors for dressings 4
Leg rests, for elevations 2
Dressing forceps 4
Probes and directors of each 4
Covers for dressings 40
Bowls and basins, agate ware 8
Solution bottles (large) 6
Receivers for soiled dressings 4
Spatulas 2
Spirit lamp 1
Graduate glasses for surgical work 3
Thermometer (bath) 1
Syringes (glass) 4
Tape measure 1
Surgical air cushions 2
Rubber finger tips 12
Foot tubs 4
Vomiting basins 6
Graduate glasses for measuring urine 2
Scissors for general use 1
Bandage scissors 1
Soap dishes 4
Saucepans, graduated sizes 6
Brooms (common) 3
Brooms, hair 1
Brooms (birch for sinks, closets, etc.) 6
Dust pans 3
Water coolers 2
Medicine trays 4
Medicine glasses (graduated) 10
Drinking glasses 12
Refrigerator 1
Thermometer 1
Corkscrews 2
Hot water bottles 20
Bed-cradles 2
Immersion buckets for limbs 1
Wash basins 8
Nail brushes 10
Combs 6
Looking glasses 4
Bed pans 10
Urinals 10
Douche pans 4
Sputum cups 10
Catherostat 1
Bedside chairs, iron, white enameled, with rubber tips 20
Wheel chairs 3
Rockers 4
Two-bowl washstand on rubber-tired wheels for doctors’ use 1