test of a nurse’s capacity than the way she keeps her patient’s
bed. Some nurses are eternally fidgeting till they work the unhappy
invalid into a frenzy. Others, again, in their dread of disturbing
him, let the patient toss everything to the wildest confusion,
trusting to one grand and general clearing up to set matters
right. A good nurse keeps things straight almost unconsciously,
taking advantage of any chance the patient gives to smooth out the
crumpled sheet, or tossed bed-clothes, with a strong even pull, or
to replace a heated, crushed pillow with a fresh cool one (though
careful that, if cool, it is not chilly). Remember when smoothing
a sickbed never to jerk or twitch the clothes, and be always sure
your attempts do not endanger anything that may be lying on the
bed, and whose downfall would most certainly disturb and flurry the
invalid. A wide bed in a measure is a substitute for having 2 beds,
as considerable relief may be obtained by using alternate sides of
the bed; moreover, you can cool one side when the patient is on the
opposite side, by turning back the clothes so as to let the air
reach the lower sheet. Bed linen should always, if possible, be
exposed to the open air, in the sun and wind, before using, as this
freshens it most effectually, whilst a drop or two of good lavender
or rose water sprinkled on sheet and pillow-case add greatly to the
pleasantness. The best way of making a bed so as to give the least
possible disturbance to the sick person, and prevent bed sores, is
laid down in these rules:--(1) Keep the sheet below the patient
perfectly smooth; (2) wash the parts where the bone is prominent
daily with soap and warm water, dry them well, rub them over with a
little spirits of wine or whisky to harden the skin; (3) change the
patient’s position frequently; (4) never let him lie on a blanket; a
freshly-made bed, a good sponge over with vinegar and water, would
often, after a restless, sleepless night, have the good effect of
making the patient fall into a sound sleep. It is best to make a
good lather with the soap, and not to use much water. Zinc-powder
and boracic acid powder are often used to powder the back after the
washing.
A very common torment of invalids is the weight of the bed clothes.
They are heavy, but not warm. For the rich, blankets and eiderdown
quilts are easily obtained; but for the poor, paper is far better
than many more costly coverlids. It is by no means necessary to spend
money on a paper blanket, though these are excellent; a few sheets
of brown paper, or even newspapers, pasted together to the size of
the bed, add greatly to the warmth and practically nothing to the
weight. If it is not the beat possible covering, it is very good, and
absolutely costless.
It is often necessary to change the sheets without disturbing the
patient. This can be done either from side to side or from head
to foot. The former method consists in loosely rolling up the
soiled sheet sideways, from the side of the bed where there is most
unoccupied space, until the roll can be pressed against the patient’s
side. The clean sheet, previously loosely rolled up from side to
side, is then unrolled over the uncovered part of the bed, until the
clean roll lies by the side of the soiled one. The patient is now
lifted over on to the clean sheet, the soiled sheet is taken away,
and the spreading of the clean sheet is completed. The second plan is
to roll up a clean sheet loosely from end to end. Beginning at the
head of the bed, the soiled sheet is rolled down from underneath the
bolster, and the clean sheet unrolled after it, and arranged in its
place. The shoulders of the patient should then be raised a little,
and the soiled sheet rolled down from under them, while the clean
sheet is unrolled to follow it. The hips, and lastly the legs and
feet, are to be gently raised one after another in a similar manner,
the soiled sheet taken away at the foot of the bed, and the unrolling
of the clean sheet completed.
With paralysed and other helpless patients, frequent washing or
sponging is more necessary, and the draw-sheet becomes useful. This
consists of a small sheet folded lengthwise 2 or 3 times, so that
when placed beneath the patient it may reach from the middle of the
back to the knees. One end of the folded sheet should be the part
first used, the rest being loosely rolled up to within a few inches
of the patient’s side. As the sheet becomes soiled, the unused
portion is unrolled sufficiently for the soiled part to be drawn
from under the sick person, and a clean part substituted. The soiled
portion is rolled up as it is withdrawn, and secured by a safety-pin.
A piece of waterproof sheeting or a strip of thin oil-cloth passed
beneath the draw-sheet still further protects the bed.
Bedding and pillows should not be too soft, otherwise the patient
is continually sinking into hollows, and becoming hot and restless
in consequence. When a patient needs to be propped up, the greatest
mistakes are made. Pillows are jammed and wedged in at the patient’s
back till he is completely built in. A cheap and simple pillow which
doctors strongly recommend as a support in such cases is made of
chaff, or chopped straw, and stuffed hard. It is covered with any
cheap material, and is shaped like a writing desk--that is to say,
it is made to slope. It should be a little longer than an ordinary
pillow, and should be 8-12 in. deep behind and 3-4 in. in front.
Ordinary pillows (1 or 2) placed upon this as a basement make a
capital back-rest for persons suffering, say, from bronchitis. Such
a rest has many advantages: it does not give way, hence the patient
no longer finds himself from time to time in a deep hole; it allows
the arms and shoulders free movement; it is also cooler, and permits
more frequent change of posture. In propping a patient up it should
always be remembered that the back needs support as well as the head
and shoulders.
A very great comfort to sick people, especially to those who have to
be left much alone, is to be furnished with some simple arrangement
by which they can raise themselves into the sitting posture and so
maintain themselves with slight effort. This can be attained by
fixing a length of strong webbing to the foot of the bed, and placing
knots upon it at intervals, so as to enable it to be more readily
and firmly grasped. A netted bed-rest, 3 yd. in length, is a very
simple and useful contrivance; its main use is the same as that of
the knotted webbing, but by allowing it to pass round the back of
the invalid, and spreading it out, it makes an exceedingly pleasant
bed-rest, fashioned on the principle of the hammock. A swing bed-rest
has several advantages. It is very cool, and allows a free play of
air on all sides of the patient, which is a very important advantage.
It permits, moreover, considerable movement, and does away with the
fatiguing restraint of keeping the body in one position. If the
ventilation through the network be too great, or the weather be cold,
a pillow can be placed against the patient’s back, within the rest.
Instead of the rest being netted, it may be made of strong towelling,
which will bear rougher usage. Its strength and serviceability will
be increased by stitching here and there bands of webbing; and at
each of its narrower ends strong broad tapes must be fastened, by
which it can be secured to the foot of the bed. Such netted bed-rests
can be had (5_s._ 6_d._ each) at the Depot for Ladies’ Work, 16, King
Street, Manchester.
Bedridden patients, and those who are paralysed or otherwise reduced
to a condition of great weakness, often complain that they are
continually slipping down in the bed. Often a box or footstool is
slipped in at the foot of the bed, that the patient’s feet may be
pressed firmly against it to prevent slipping. But this cannot be
long continued where the legs are weak, for the muscles become
exhausted, the knees give way, and then the slipping goes on just
as badly as ever. This can be prevented, if a little round pillow,
3-4 in. only in diameter, be fixed so that the patient, though lying
down, as it were sits upon it. Such a pillow, to answer its purpose,
must be tied in its position very securely, and this may be done by a
piece of webbing attached to each end, and tied either to the head or
sides of the bedstead.
Following is a way to make pillows with paper stuffing. Use any sort
of paper, and tear all into small square or oblong pieces. Then roll
each piece between the finger and thumb into a tiny spiral, exactly
as if beginning to make round spills. It is very little trouble to
do. It is a most suitable occupation for blindman’s holiday, or for
people with weak eyesight; and the pillows, as may be supposed, are
far more elastic than if made of the same paper, flat. Of course, it
is most suitable for an under pillow, if one has a choice; but so
long as there are so many unfortunate invalids without any pillows at
all, the plan is worthy of remembrance.
A table to stand on the bed is very convenient for trays, &c. It can
be bought ready made, and is not at all expensive, or a very little
ingenuity is needed to make one. About 2 ft. long, hollowed out on
one side, and 1 ft. broad, is a good size. The legs may be 6-7 in.
high.
The bed can be refreshed and aired by raising and lowering the
clothes so as to produce a fanning motion. To turn a pillow without
fatiguing the patient, put the hollowed palm of one hand at the back
of his head while with the other you quickly reverse the pillow and
replace it. To lay a bed with a waterproof sheet for temporary use,
first make the bed with a blanket beneath the under sheet, and then
spread the waterproof, a blanket and another sheet, without tucking
in. When done with, it is only necessary to draw out the waterproof
with its blanket and sheet, leaving the patient on a fresh sheet.
No amount of care will keep crumbs out of a sickbed; they catch in
every fold and frill and pass up the sleeves, and demand a search
after every meal in which bread figures. To avoid rucks in the under
sheets, stretch it tight on the mattress and fasten it down with
safety pins.
=Sickroom accessories.=--These are of a varied character, and will be
described under separate headings.
_Poultices._ Linseed.--The great art of poultice-making consists
in applying it to the patient sufficiently hot, and, therefore, it
is advisable to warm all the materials before beginning. Put the
linseed (crushed or meal) before the fire or in the oven for 20
minutes to heat. Use by preference a tin bowl, and scald it with
boiling water; then pour in as much boiling water as will be needed
for the poultice, sprinkle in the hot linseed with one hand, and
stir vigorously with a knife to the required thickness. To judge of
this requires some practice. A poultice should be somewhat moister,
if applied to an open wound, than if it is intended to relieve some
internal pain; but in no case ought it to be sufficiently moist to
stick in patches to the skin of the patient. The next step is to take
a square of rag or paper ½ in. larger all round than the poultice is
intended to be; spread the linseed on this about ½ in. thick, leaving
the edges clear; fold the rag over on each side, and apply at once,
covering with a pad of cotton wool and a layer of indiarubber or oil
silk to keep the heat in. It is a good plan to oil the face of the
poultice with a feather, as this effectually keeps it from sticking
to the skin, even if it is not well mixed, and it is better than to
put the poultice into a muslin. If, however, the muslin is preferred,
on no account should a bag be made, for the poultice cools while it
is being put in. A large piece of old linen, folded over at the back,
like a parcel, keeps the linseed in, and makes at the same time a
pad to cover it. Failing linseed meal, you can use either oatmeal
or bran; if oatmeal, then boil it with the water like porridge. A
poultice should be larger than appears absolutely necessary. It is
intended to allay pain and inflammation, and as the pain probably
extends beyond the inflamed part, a large poultice should be made
to cover the inflamed part. Dr. Atkinson says that meal deprived
of its oil is far better than that from which the oil has not been
extracted. The latter does not retain its heat as long, and, unless
covered by some fabric, is not so easily removed as the poultice made
from the former. The exhausted meal takes up more water, and retains
its heat longer. In making a poultice, the meal should be thoroughly
stirred with a spoon while boiling water is gradually added, and when
of proper (rather soft) consistence, should be spread on linen. The
ability to bear the heat on the back of the hand is a good test of
the degree to be used. The poultice should be applied directly to
the skin, without intervening fabric, and be covered on the outside
with good oiled-silk. A teaspoonful of laudanum may be sprinkled on
the surface to increase its anodyne effects, or in place of water
may be used a boiling infusion of camomile or poppy-heads. When the
skin is inflamed, 3 grs. sulphate zinc or alum may be added to each
oz. of water. A solution of 1-40 of carbolic acid may be used instead
of simple water in the case of sloughing wounds. Once in 4 hours is
a good rule to follow in changing poultices on the chest, the front
and back being covered by separate poultices, and only one should be
removed at a time. A fresh one should be ready when the change is
made. Frequent changes are most grateful in cases of abdominal pain.
To relieve spasm, as in colic--intestinal, biliary, or renal; to
relieve inflammation of the pleura (lining membrane of the chest),
the lungs, the liver, or other organs, it is essential to apply the
poultice as hot as possible, while protecting the skin from being
scalded. In order to do this, a flannel bag should be prepared, a
convenient size being 12 in. by 8; this should be closed at 3 edges
and open at the fourth; one side of it should be 1-1½ in. longer than
the other, and it is convenient also to have 4 tapes attached at the
points which form the corners when the bag is closed, in order to
keep the poultice in position. Besides this, another strip of flannel
should be prepared of the same breadth as the length of the bag,
and long enough to wrap round it once or oftener. Crushed linseed,
bowl, and spoon should be got together, and the spoon and bowl
thoroughly heated by means of boiling water; the poultice should then
be made with perfectly boiling water, and rather soft. As soon as
it is ready, it should be poured into the bag, previously warmed by
holding it before the fire; the flap which is formed by the longest
side of the bag should now be turned down and fastened in its place
by a few long stitches with a needle and thread; it should then be
quickly wrapped in the strip of flannel (also previously warmed),
and fastened _in situ_, if necessary, by means of the tapes. It may
be covered outside with a sheet of cotton wool. In this way the
poultice may be applied boiling hot to the skin without burning; the
2 layers of flannel which are at first dry allow the heat to pass
very gradually indeed to the skin; as the moisture of the poultice
soaks through them they become better conductors, and the heat passes
more quickly, but the increase is so gradual as not to cause any
painful sensations whatever, but only one of soothing and comfort.
The poultice also naturally keeps much longer hot, and the necessity
for changing it arises much less frequently. The difference between
the effect of a poultice made in the ordinary way and in the manner
just described is sometimes exceedingly striking. It is, perhaps,
less marked in cases of inflammation than in those of spasm.
Bread.--In a small and perfectly clean saucepan have a teacupful of
boiling water. Add breadcrumbs, or the crumb of a stale loaf: 1½-2
oz. will be sufficient for this quantity of water, and let it soak
over the fire for about 5 minutes. Then turn it into a piece of rag,
and spread it of suitable size and evenly. This plan ensures its
being hot.
Mustard.--If a mustard poultice is wanted it can be made in the same
way as linseed, save by adding a certain proportion of dry mustard
to the linseed. Some persons prefer to boil a little mustard in the
water that is to be used. Dr. Tyson, of Philadelphia, recommends the
addition of molasses to mustard in making plasters. This furnishes a
mild persistent counter-irritant which can be worn for hours. Leaves
of so-called “mustard paper” may be made as follows: The mustard must
be deprived of all fatty matters; the adhesive agent must contain
neither alcohol, resin, nor fatty matter; nor must it be of the
nature of a plaster. Submit the mustard farina to strong pressure,
and wash with sulphide of carbon or petroleum essence. Spread on
paper an adhesive liquid formed of a solution of 4-5 parts caoutchouc
in 100 parts mixed carbon sulphide and petroleum essence. Sprinkle
over the freshly coated paper by means of a sieve, the prepared
mustard. Pass between two rollers, and afterwards gently warm to
promote volatilisation of the liquid solvents used. Cut to pattern as
required.
_Court Plaster._--This is generally bought. To make it, soak
isinglass in a little warm water for 74 hours, then evaporate nearly
all the water by gentle heat, dissolve the residue in a little proof
spirits of wine, and strain the whole through a piece of open linen.
The strained mass should be a stiff jelly when cool. Now stretch a
piece of silk or sarcenet on a wooden frame, and fix it tight with
tacks or pack-thread. Melt the jelly and apply it to the silk thinly
and evenly, with a badger-hair brush. A second coating must be
applied when the first has dried. When both are dry, apply over the
whole surface 2 or 3 coatings of the balsam of Peru. Plaster thus
made is very pliable and never breaks.
To make it without silk, mix enough collodion with castor oil to
render it elastic when dry, the oil having profusely been rubbed
with some zinc oxide. Into this mixture dip glass plates, and, after
drying, redip and redry 2 or 3 times, or until a film of suitable
thickness is obtained. Upon this paint the usual solution of
isinglass to give it adhesiveness, and, after again drying, separate
it from the glass.
_Applying cold to the Head._--Take one fold of cotton or linen rag,
soak it in cold water, the colder the better, squeeze dry and apply
it as rapidly as possible. Do not take a large piece of cloth folded
several times, and keep squeezing it in your hand till it is quite
hot and then put on. One fold of cloth, the thinner the better,
dipped often in the cold water and rapidly applied gives great relief
in headaches, for example. If you can procure ice put a piece in the
water. Ice is sometimes ordered to be kept constantly on the head; to
keep it from melting, wrap it up in flannel, or put it in sawdust,
and in a cool place. To break ice, use a large needle. Ice-bags can
be bought for 3_s._-4_s._, or it may be put in a bladder and applied
to the part, or a bag may be made of guttapercha and chloroform. By
putting a little chloroform along the edges and folding them over,
you can make a very useful bag for ice; the ice should be broken in
small pieces before being put in the bag, and be removed as soon as
it melts.
_Fomentations._--A very good, perhaps the best, plan is to put a
piece of flannel, folded 4 or 5 times thick to the required size,
into a potato-steamer over boiling water. In this way it soon becomes
hot, and little or no wringing is necessary. Where a potato-steamer
is not to be had, however, the following plan should be adopted.
Take a strong towel or cloth, or a piece of ticking, and pin or
tack a deep hem in each end. Into these run two short, strong
sticks--anything will serve: a couple of iron spoons, and even a
small poker, such as is called a “curate,” though this last is rather
long for choice. Lay the towel, or “wringer,” as it is technically
called, over a large basin, so that the sticks hang outside; place
the folded flannel in the middle, and pour boiling water over. The
flannel can easily be wrung dry by one pair of hands, and if it is
not made by the bed side, it can be carried there without fear of
cooling in the wringer. Sometimes opium or turpentine is to be added.
The quantity of either to be used will be prescribed by the doctor,
and it should be sprinkled on the side of the flannel that is to go
next the skin, immediately before applying it to the patient. The
flannel should be covered with wool and oil-silk, just as a poultice
is covered. Fomentations are, in many cases, as efficacious as
poultices, and they possess, besides, the advantage of being easier
to make, and of costing practically nothing, since the flannels
can be used repeatedly. For the very poor, the cost of linseed for
poultices is often a serious item. There is no danger of scalding if
the flannel is squeezed so dry that it cannot drip nor wet the palm
of the hand.
Another plan is described as follows: Take your flannel folded to
a required thickness and size, dampened quite perceptibly with
water, but not enough to drip, and place it between the folds of a
large newspaper, having the edges of the paper lap well over the
cloth, so as to give no vent to the steam. Thus prepared, lay it on
the stove or register, and in a moment steam is generated from the
under surface, and has permeated the whole cloth, heating it to the
required temperature.
_Blisters._--Blisters and leeches should only be used under medical
direction. Before the application of either, the part should be well
washed with soap and warm water. Then, in the case of the blister,
it has only to be slightly warmed before the fire and left on until
“it rises,” and a good-sized vesicle has formed (which will usually
be in about 8-10 hours), when the water must be let out by snipping
the skin with the point of a sharp scissors--a perfectly painless
operation--and the blistered surface dressed with spermaceti ointment
spread on soft lint.
_Leeches._--Leeches can generally be induced to bite by putting a
few drops of milk or blood on the spots they are intended to take.
They will usually fall off of themselves when filled, but if they
remain on too long they must not be pulled off, but a little salt
shaken on them, which will soon make them let go. Another simple
and easy way of detaching leeches is to drop a few drops of camphor
julep (mist. camph.) on the part, when they will soon relinquish
their hold. The bleeding from their bites will also generally stop
without interference. If it should continue to an undesirable degree,
the nurse may nearly always stop it by making gentle pressure over
the bite with her finger, or applying a little powdered alum or the
muriated tincture of iron (tinctura ferri perchloridi). Never leave a
patient for the night until all bleeding has completely ceased. The
bleeding may be increased, when desired, by fomenting with warm water.
_Enemas._--A nurse is often required to administer an enema or
injection--which in many conditions of disease is a most valuable
method of treatment. Be careful not to disturb or uncover the patient
until quite certain that you have arranged ready to hand everything
that will be required. Almost any variety of injection apparatus
answers the purpose sufficiently well, but in using the rubber ones
care must be taken to squeeze out all air from the bulb before
commencing, else the air will be forced in by the first compression.
The most convenient position for the patient is lying on the left
side. Then the nozzle of the instrument, having been well greased
and warmed, should be passed slowly and carefully into the bowel,
the point being directed slightly backwards. On no account whatever
must the least force be used. If there is any difficulty or pain in
introducing the tube to the required distance, the nurse must wait
for a minute or two, when, in all probability, the opposing muscle
having become relaxed, it will pass in easily and without pain. The
injection should then be given very slowly and quietly, and without
any jerking or irregularity of motion, especially if it be desired
that it should be long retained; it must be stopped immediately
if the patient calls out that he can bear no more. Enemata are
generally either nutrient or purgative; but occasionally other
medicines are given in this way. The nutrient are of extreme value,
as it sometimes happens that, when nourishment can be taken in no
other way, sufficient may be supplied by this means to tide over the
period of danger. A good nutritive enema may be made as follows:
The yolks of 2 fresh eggs well battered in about ½ pint strong beef
tea, or in 2 tablespoonfuls (half a canister) of Brand’s extract of
beef, dissolved in warm milk. About ½ wineglassful port wine, or 1
tablespoonful brandy may be added in cases of extreme exhaustion.
It should be given at about blood heat--100° F. An active purgative
enema may be made with: 4 tablespoonfuls castor oil, 1 teaspoonful
oil of turpentine, and about 1 pint well-strained gruel, or soap and
water. An enema of plain soap and water often answers very well.