[Sidenote: Petty management.]
All the results of good nursing, as detailed in these notes, may be
spoiled or utterly negatived by one defect, viz.: in petty management,
or in other words, by not knowing how to manage that what you do when
you are there, shall be done when you are not there. The most devoted
friend or nurse cannot be always _there_. Nor is it desirable that she
should. And she may give up her health, all her other duties, and yet,
for want of a little management, be not one-half so efficient as another
who is not one-half so devoted, but who has this art of multiplying
herself--that is to say, the patient of the first will not really be so
well cared for, as the patient of the second.
It is as impossible in a book to teach a person in charge of sick how to
_manage_, as it is to teach her how to nurse. Circumstances must vary
with each different case. But it _is_ possible to press upon her to
think for herself: Now what does happen during my absence? I am obliged
to be away on Tuesday. But fresh air, or punctuality is not less
important to my patient on Tuesday than it was on Monday. Or: At 10 P.M.
I am never with my patient; but quiet is of no less consequence to him
at 10 than it was at 5 minutes to 10.
Curious as it may seem, this very obvious consideration occurs
comparatively to few, or, if it does occur, it is only to cause the
devoted friend or nurse to be absent fewer hours or fewer minutes from
her patient--not to arrange so as that no minute and no hour shall be
for her patient without the essentials of her nursing.
[Sidenote: Illustrations of the want of it.]
A very few instances will be sufficient, not as precepts, but as
illustrations.
[Sidenote: Strangers coming into the sick room.]
A strange washerwoman, coming late at night for the "things," will burst
in by mistake to the patient's sickroom, after he has fallen into his
first doze, giving him a shock, the effects of which are irremediable,
though he himself laughs at the cause, and probably never even mentions
it. The nurse who is, and is quite right to be, at her supper, has not
provided that the washerwoman shall not lose her way and go into the
wrong room.
[Sidenote: Sick room airing the whole house.]
The patient's room may always have the window open. But the passage
outside the patient's room, though provided with several large windows,
may never have one open. Because it is not understood that the charge of
the sick-room extends to the charge of the passage. And thus, as often
happens, the nurse makes it her business to turn the patient's room into
a ventilating shaft for the foul air of the whole house.
[Sidenote: Uninhabited room fouling the whole house.]
An uninhabited room, a newly-painted room,[1] an uncleaned closet or
cupboard, may often become the reservoir of foul air for the whole
house, because the person in charge never thinks of arranging that these
places shall be always aired, always cleaned; she merely opens the
window herself "when she goes in."
[Sidenote: Delivery and non-delivery of letters and messages.]
An agitating letter or message may be delivered, or an important letter
or message _not_ delivered; a visitor whom it was of consequence to see,
may be refused, or whom it was of still more consequence to _not_ see
may be admitted--because the person in charge has never asked herself
this question, What is done when I am not there?[2]
At all events, one may safely say, a nurse cannot be with the patient,
open the door, eat her meals, take a message, all at one and the same
time. Nevertheless the person in charge never seems to look the
impossibility in the face.
Add to this that the _attempting_ this impossibility does more to
increase the poor patient's hurry and nervousness than anything else.
[Sidenote: Partial measures such as "being always in the way" yourself,
increase instead of saving the patient's anxiety. Because they must be
only partial.]
It is never thought that the patient remembers these things if you do
not. He has not only to think whether the visit or letter may arrive,
but whether you will be in the way at the particular day and hour when
it may arrive. So that your _partial_ measures for "being in the way"
yourself, only increase the necessity for his thought.
Whereas, if you could but arrange that the thing should always be done
whether you are there or not, he need never think at all about it.
For the above reasons, whatever a patient _can_ do for himself, it is
better, i.e. less anxiety, for him to do for himself, unless the person
in charge has the spirit of management.
It is evidently much less exertion for a patient to answer a letter for
himself by return of post, than to have four conversations, wait five
days, have six anxieties before it is off his mind, before the person
who has to answer it has done so.
Apprehension, uncertainty, waiting, expectation, fear of surprise, do a
patient more harm than any exertion. Remember, he is face to face with
his enemy all the time, internally wrestling with him, having long
imaginary conversations with him. You are thinking of something else.
"Rid him of his adversary quickly," is a first rule with the sick.[3]
For the same reasons, always tell a patient and tell him beforehand when
you are going out and when you will be back, whether it is for a day, an
hour, or ten minutes. You fancy perhaps that it is better for him if he
does not find out your going at all, better for him if you do not make
yourself "of too much importance" to him; or else you cannot bear to
give him the pain or the anxiety of the temporary separation.
No such thing. You _ought_ to go, we will suppose. Health or duty
requires it. Then say so to the patient openly. If you go without his
knowing it, and he finds it out, he never will feel secure again that
the things which depend upon you will be done when you are away, and in
nine cases out of ten he will be right. If you go out without telling
him when you will be back, he can take no measures nor precautions as to
the things which concern you both, or which you do for him.
[Sidenote: What is the cause of half the accidents which happen?]
If you look into the reports of trials or accidents, and especially of
suicides, or into the medical history of fatal cases, it is almost
incredible how often the whole thing turns upon something which has
happened because "he," or still oftener "she," "was not there." But it
is still more incredible how often, how almost always this is accepted
as a sufficient reason, a justification; why, the very fact of the thing
having happened is the proof of its not being a justification. The
person in charge was quite right not to be "_there_," he was called away
for quite sufficient reason, or he was away for a daily recurring and
unavoidable cause; yet no provision was made to supply his absence. The
fault was not in his "being away," but in there being no management to
supplement his "being away." When the sun is under a total eclipse or
during his nightly absence, we light candles. But it would seem as if it
did not occur to us that we must also supplement the person in charge of
sick or of children, whether under an occasional eclipse or during a
regular absence.
In institutions where many lives would be lost and the effect of such
want of management would be terrible and patent, there is less of it
than in the private house.[4]
But in both, let whoever is in charge keep this simple question in her
head (_not,_ how can I always do this right thing myself, but) how can I
provide for this right thing to be always done?
Then, when anything wrong has actually happened in consequence of her
absence, which absence we will suppose to have been quite right, let her
question still be (_not,_ how can I provide against any more of such
absences? which is neither possible nor desirable, but) how can I
provide against anything wrong arising out of my absence?
[Sidenote: What it is to be "in charge."]
How few men, or even women, understand, either in great or in little
things, what it is the being "in charge"--I mean, know how to carry out
a "charge." From the most colossal calamities, down to the most trifling
accidents, results are often traced (or rather _not_ traced) to such
want of some one "in charge" or of his knowing how to be "in charge." A
short time ago the bursting of a funnel-casing on board the finest and
strongest ship that ever was built, on her trial trip, destroyed several
lives and put several hundreds in jeopardy--not from any undetected flaw
in her new and untried works--but from a tap being closed which ought
not to have been closed--from what every child knows would make its
mother's tea-kettle burst. And this simply because no one seemed to know
what it is to be "in charge," or _who_ was in charge. Nay more, the jury
at the inquest actually altogether ignored the same, and apparently
considered the tap "in charge," for they gave as a verdict "accidental
death."
This is the meaning of the word, on a large scale. On a much smaller
scale, it happened, a short time ago, that an insane person burned
herself slowly and intentionally to death, while in her doctor's charge
and almost in her nurse's presence. Yet neither was considered "at all
to blame." The very fact of the accident happening proves its own case.
There is nothing more to be said. Either they did not know their
business or they did not know how to perform it.
To be "in charge" is certainly not only to carry out the proper
measures yourself but to see that every one else does so too; to see
that no one either wilfully or ignorantly thwarts or prevents such
measures. It is neither to do everything yourself nor to appoint a
number of people to each duty, but to ensure that each does that duty to
which he is appointed. This is the meaning which must be attached to the
word by (above all) those "in charge" of sick, whether of numbers or of
individuals, (and indeed I think it is with individual sick that it is
least understood. One sick person is often waited on by four with less
precision, and is really less cared for than ten who are waited on by
one; or at least than 40 who are waited on by 4; and all for want of
this one person "in charge.")
It is often said that there are few good servants now; I say there are
few good mistresses now. As the jury seems to have thought the tap was
in charge of the ship's safety, so mistresses now seem to think the
house is in charge of itself. They neither know how to give orders, nor
how to teach their servants to obey orders--_i.e._, to obey
intelligently, which is the real meaning of all discipline.
Again, people who are in charge often seem to have a pride in feeling
that they will be "missed," that no one can understand or carry on their
arrangements, their system, books, accounts, &c., but themselves. It
seems to me that the pride is rather in carrying on a system, in keeping
stores, closets, books, accounts, &c., so that any body can understand
and carry them on--so that, in case of absence or illness, one can
deliver every thing up to others and know that all will go on as usual,
and that one shall never be missed.
[Sidenote: Why hired nurses give so much trouble.]
NOTE.--It is often complained, that professional nurses, brought into
private families, in case of sickness, make themselves intolerable by
"ordering about" the other servants, under plea of not neglecting the
patient. Both things are true; the patient is often neglected, and the
servants are often unfairly "put upon." But the fault is generally in
the want of management of the head in charge. It is surely for her to
arrange both that the nurse's place is, when necessary, supplemented,
and that the patient is never neglected--things with a little
management quite compatible, and indeed only attainable together. It is
certainly not for the nurse to "order about" the servants.