There is nothing more trying in a small way than to have you

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MAKING GOOD ON PRIVATE DUTY

MAKING GOOD ON PRIVATE DUTY

PRACTICAL HINTS TO GRADUATE NURSES

BY

HARRIET CAMP LOUNSBERY, R.N.

PRESIDENT WEST VIRGINIA STATE NURSES' ASSOCIATION SANITARY SCHOOL

INSPECTOR FOR CHARLESTON INDEPENDENT SCHOOL DISTRICT

"Not to be ministered unto, but to minister"

PREFACE

Though technic is constantly changing, methods improving, and the

teaching in our schools grows better and more comprehensive, the

old problems in private work are ever to be faced, and still the

young sister in our nursing world needs to be counselled, guided

and helped. It is for these young private duty nurses that this

book has been written.

For six years I went up and down one of our large cities doing

private nursing, and I can remember, as if it were but yesterday,

the curious little sinking of the heart I used to feel, as I

mounted the steps of a house where there was a new patient needing

my care. "Would I do everything right?" "Could I please the

patient and the friends?" "Would the doctor be satisfied with my

efforts?" "How would I feel when I was leaving?" "Encouraged or

hopeless?" "Happy or sad?" A strange house looks so forbidding,

"would this one ever look friendly?" There is time, while walking

up the steps, for these and many more such thoughts to crowd into

the nurse's mind. Once in the presence of the patient, however,

all this quickly changes, and action puts all wondering and doubt

to flight.

The "hints" here given are the fruit of my own experience and that

of the graduates of the school of which I was the superintendent.

Many long talks we had, when they felt the need of coming back to

their hospital home for advice and comfort. It is an earnest wish

to help the young graduate over the intricate paths that the

inexperienced nurse must often tread that has led me to revise

some early contributions [Footnote: Printed by permission of the

_Trained Nurse_.] to the _Trained Nurse_ and write a few

new ones, which have within the past year appeared in the

_American Journal of Nursing_.

In the chapter "Hints to the Obstetrical Nurse," there is little

or nothing that is commonly taught in the class-room.

All of that is so well done, repetition here would be tiresome.

All the asepsis is familiar to every graduate. She knows how to

sterilize any and every thing, but sometimes she does not know the

best way to wash and dry the baby's little shirts or knitted

shawls. Sometimes she will not realize that if the layette cannot

be purchased at a store, old table linen makes the best diapers

for the newborn baby, and that his pillowcase should not have

embroidery in the center.

I wish in this part to give the nurse such hints that she may be

able to help any woman who wishes to prepare for her confinement.

I have been asked so many times to tell a young expectant mother

just _what_ to get, that I have made for convenience as full

a list as is necessary for any baby or mother, with some hints as

to the washing of the baby. The rest it is expected every nurse

who graduates from a training-school would know. The table for

calculating an expectant confinement was cut from a medical paper

and given me by a physician some years ago. He did not know who

wrote it, nor do I, but he always used it, and I have found it

most accurate.

The recipes I have given are, I know, reliable, having all been

tested many times. Most of the articles of food every nurse has

probably prepared, but exact proportions have a dreadful way of

slipping out of one's memory. Whether it is a pint of milk or a

quart that must be mixed with two eggs for a custard might not

seem much of a problem to a housekeeper, but to a nurse who has

perhaps not made a custard for a year it might carry many

difficulties.

I have tried to help in this most important part of a nurse's

duty, and not only as to the food served the patient, but the

_manner_ of serving it, which last is truly to a sick person

of as much importance as the food itself. The few leaves I have

left blank are for such additional recipes as every nurse will

gather as she goes from house to house. Any cook will be glad to

give some hints as to how she does this or that, and no nurse

should be too proud to learn from the cook, or anybody else. I

shall never forget the fat little Irish woman who taught me to

make clam broth, or how much pride she took in my first success.

To ask the family cook for advice is sometimes good policy; she is

often so ready to resent any extra work caused by the sickness or

the nurse, it pays well to conciliate her, by asking for her aid

or counsel. To feel that she can teach the "Trained Nurse" will

often make a friend of the cook, and this will make things

pleasanter all around. It is with the hope that these homely and

perhaps somewhat old-fashioned hints may be of real service, that

this little book is sent forth to do what good it may to those who

are setting out on their professional careers. It is ever to the

young that we elders look, knowing, as Mrs. Isabel Hampton Robb

has truly said, "Work shall be lifted from our hands and carried

on to loftier ideals and higher aims by the strong young hands,

hearts and brains of future nurses." H. C. L.

Charleston, W. Va.

CONTENTS

CHAPTER

I. THE NURSE AND HER PATIENT

II. THE NURSE AND THE DOCTOR

III. THE NURSE HERSELF

IV. THE NURSE AND HER PATIENT'S FAMILY, FRIENDS AND SERVANTS

V. GENERAL REMARKS ON FOODS AND FEEDING

VI. THE NURSE AS RELATING TO HER TRAINING SCHOOL AND TO HER FELLOW

NURSES

VII. WHY DO NURSES COMPLAIN?

VIII. THE NURSE AS A TEACHER

IX. CONVALESCENCE

X. HOW SHALL A NURSE OCCUPY HER DAYS OF WAITING?

XI. SOME HINTS FOR THE OBSTETRICAL NURSE

XII. AS TO WASHING THE BABY

XIII. THE VALLEY OF THE SHADOW

I

THE NURSE AND HER PATIENT

You may think it unnecessary for me to tell you any more about

"the patient." You will say, perhaps: "Have I had all this

training, and must I yet be told how to treat a patient?" I answer

that you have been taught how to watch the progress of disease,

how to follow intelligently the doctor's orders, also certain

manual arts, your proficiency in which is unquestionably most

necessary, but there is much more comprehended in the meaning of

the term "a good nurse" than this. How often do we hear stories of

nurses who were good--_but_--who were skillful--_but_--

and after the _but_ comes a long list of such faults as do

not show so much in hospital life, where the routine and the many

rules and the constant supervision make them less likely to become

prominent. "She bangs the doors." "She breaks the fine china."

"She wears heavy shoes," or "She talks too much," or "She is

pretty and spends too much time over her front hair"--but why go

on? You have all heard such tales--_ad nauseam_, and if you

are wise, you will set up a sign-post against every one of these

snares into which your sister nurses have fallen, and on this you

will print in large, clear letters: "Danger! Walking on this place

forbidden." So much by way of apology for treating you once more

to a lecture on "the patient."

The relation between nurse and patient should, from the first, be

a more than amicable one. You have come to bestow the priceless

blessing of unwearied, skillful care upon one who should

thankfully receive it, and believe me, if you do not go to your

patient with a feeling of thankfulness to God for allowing you to

assume such a sacred trust as the care of a human life, you are in

no condition to undertake the work. Your nursing should be, in a

way, an exponent of your own spiritual state; looking at it in its

highest aspect, an outward and visible sign of an inward and

spiritual grace.

In the first place, then, you must be in entire sympathy with the

sick one--and here do not mistake me--by sympathy I do not mean

sentimentalism. The two emotions are as far asunder as the poles.

Sympathy, then, you must have, and if you do not intuitively feel

it, let me tell you what to do to rouse your dormant feelings. Try

earnestly to put yourself in the patient's place. Has she had an

operation of some kind, and you have all night been trying to keep

her quiet on her back, and she has been begging you to let her

turn "never so little?" When you go to lie down, and have,

perhaps, a backache, and feel tired, instead of settling yourself

in the most comfortable position you can, lie straight and square

on your back and say to yourself, "Now I can't turn over," and

imagine you have by your side a nurse who will not let you turn.

You will find out in the course of an hour that your patient has

had a good excuse for all her complaints, and the next night you

will know just where to slip your hand in the hollow of the back

or under the shoulders to give a little ease. The patient will

profit by such exercise on the part of the nurse, and your

sympathies will be quickened. Never forget that _the patient is

sick_, and you are _not_. You can, you must be firm in what

you know is for your patient's best good, but you must never

be dictatorial or argumentative. It is hard, I know, to bear with

all the foolish, unreasonable whims of sick people, but if you are

true nurses you will do it. There are, however, several consoling

thoughts which have always helped me, and which I will tell you.

In the first place, always remember, as I said before, that the

sick one _is_ sick, and on that ground you can overlook much.

In the second place, remember that it will not last long. A few

days or weeks will surely bring a change. She cannot, in the

nature of disease, remain for long in the very trying stage,

unless indeed she have some kind of mania, and of course if that

is the case, you need pay no attention to her whims. If she says

white is black, let it go. It does not make it so to have her say

so, but if you argue the point, and bring all your wisdom to bear

upon your demonstration, you may bring her pulse and temperature

up to a point that will do her a real injury.

_Tact_, as you know, is worth everything to you, and by it

you will win your way to all hearts. Try then to feel as the

patient does, and you will know by instinct how to treat her, and

will, perhaps, be often rewarded for some little deed by the

pleased surprise with which she will say, "How did you know I

wanted it done?" You need not tell her how you knew, but you may

be sure she will appreciate you all the more for your prescient

thoughtfulness. Her pillows may be flat and hot, her hair

uncomfortable, her under sheet wrinkled or untucked from the

bottom; all these and a dozen more little things can be arranged

so easily, and they conduce so much to the sick one's comfort when

done, that you must ever have them in your mind.

Be most careful also as to your patient's belongings, her top

drawer, her various boxes, and her linen closet. You must keep all

these things just as she did. You may think it a very foolish

thing for her to have three piles of handkerchiefs, each of a

different age, or degree of fineness, but if that is her way, she

will be better satisfied if she knows you will not lay a fine

handkerchief over a more common one. So keep them as carefully

divided as if they were the two parts of a Seidlitz powder.

Hang her clothes up carefully whenever she goes back to bed, be it

once or oftener during the day. Separate them and hang them up;

don't pick all up together and put them over a chair. Put her

shoes away, lay the stockings on a shelf or put them inside the

shoes. Fold her pretty shawl or kimono and lay it in a drawer. Let

her see that you know a good thing, and know how to take care of

it.

Put away fine china or glass and bric-a-brac, if she is very ill,

and you need space for necessary glasses or other articles. It

will be a pleasant way of beguiling the tedium of some long day in

her convalescence to bring forth and arrange them in their

accustomed places. Be careful of books, table-covers, and all the

articles of luxury and beauty you will find in many of our city

houses. Remember that these things belong to some one else, though

you are for the present custodian, and think how provoked you

would feel if some stranger should come to your home, and, even if

she did nurse you back to health, she left many nicked plates,

broken vases and handleless cups behind her. I think you would not

want her to nurse you again.

I saw recently in an English magazine devoted to nursing, a very

clever article on "Talk." The writer, a nurse, thought subjects

were scarce. She says: "We must not talk to the patient about her

own complaint, that would make her morbid; or about the doctor,

for that would be gossip; or the hospital, for hospitals are full

of horrors; or the other nurses, for that might lead to talking

scandal; or about other patients, for that would be betrayal of

confidence. Now what _are_ you to talk about when a patient

is well enough to talk, and your talking to her will not hurt her

(but on this point be very sure before you air your eloquence)? It

is indeed quite a question, and the nurse must often use all her

ingenuity to keep the patient to the right subjects, for even

patients, though they hold it so reprehensible in a nurse to talk

gossip, do not disdain to serve up their neighbors occasionally to

the nurse, with some very highly seasoned scandal sauce, and here

the honor of the nurse must come into play; let her forget it if

possible, as woe will betide the poor girl if in her next place

she unwittingly lets out any of the secrets she has heard in these

long talks. Try then to steer clear of the neighbors. If your

patient be a cultivated person, and you yourself know anything

about books, you have a never-failing topic. All the latest books,

the famous books, the most entertaining books, and if you can read

aloud and the patient likes to hear you, read to her, and it will

do both good--only be sure not to tire her by reading too much at

one time. Talk of interesting places you have visited and she will

do the same, of pictures you have seen, and last, but not least,

you can talk about clothes. Generally the first serious piece of

business a convalescent concerns herself about is the purchase and

making of some new clothes. She wants something new and fresh, and

if you can give her any new ideas on the subject or tell her of

any pretty materials you have seen in the shop windows, you will

prove as entertaining as if you talked on any of the forbidden

topics, and many times more useful."

I would like, in closing this chapter, to say a word as to reading

the daily papers. If your patient is a woman, she will want to

know just about what you, yourself, would be interested in, and

this is very easy; but if your patient is a man, it is harder to

know what he will want; politics, the money market, etc., which

most women skip over. If then your patient is a man, commence on

the first page and read slowly the headings of the news items,

when one strikes him, as desirable to hear, he will tell you to

read it; when you get through the news you may turn to the

editorial page and do the same there. Unless you know your patient

very well do not attempt to enlighten him as to the stock market

quotations, for it is, I suppose, well nigh impossible for an

ordinary woman to read them so that a man will understand her. He

will probably laugh over your well meant endeavor, and ask you to

"kindly let him look at the paper," when he will in a moment find

out what you have been trying to say.

II

THE NURSE AND THE DOCTOR

I suppose no nurse goes through a training school without being

duly impressed by all the doctors on the staff of lecturers that

they, the doctors, are the generals of the campaign. She and her

fellows are the aids, and that she will be kind enough to remember

this fact, and not make suggestions to him, the doctor, or give

him the fruits of her ripe experience of three years in a

hospital, and more or less time, as may be, since she has

graduated. But though this I think you all know, there are some

points of your connections with the doctor which may not be quite

so clear.

In the first place, then, remember that you are his _aid,_

you are to help him in every way you can, you are never to work

against him, never weaken the patient's confidence in him. If you

do not understand why he does thus and so, ask for an explanation,

if you know him pretty well, and if your questions are reasonable

ones, and intelligently put, he will be glad to answer you, and

explain all you wish explained; but if you do not know the reason

of a certain order, and, moreover, if he will not tell you, do not

assume that he does not know, or that he is cross; it may be some

very uncertain, delicate experiment is being tried, and all he

wants you to do is to tell him, with a free unbiased mind, what

you see. Always, however, be loyal to him with the patient. When

you are asked a thousand questions as to, "Why doesn't the doctor

do this, or why does he do that?" you can always say that he does

it, or does it not, for the patient's best good, of that you are

assured, and they must be also.

You collect the facts and put them in an orderly way before the

doctor; upon your observations and reports he bases his theories

of the disease in many cases. You can see what perfect faith he

must have in you, and how true you must be to him in order to

secure your patient's best good. I have often heard doctors say,

when speaking of a favorite nurse, as if it was the only virtue

worth mentioning: "I am perfectly certain that when I am not

present she will _faithfully_ carry out my orders." Entire

faithfulness takes precedence, I think, and deservedly so. Your

accomplishments may be many, but if you have not this faithfulness,

this obedience to the doctor as a rudder to the ship of your

professional character, no matter how great may be the load

of learning and accomplishments and good intentions, your

self-will and vanity will bring you to the rocks where ruin is

inevitable.

Do not fear losing your own individuality and independence. "He

who obeys well, governs well," is a very old, and a very true

saying, and your responsibilities will never cease. The more

faithful you are to orders, the more trust and confidence will be

reposed in you. You will have not only your patient, but the

entire family looking to you for directions, for, upon your

faithfulness, and the tact with which you administer your

authority, will depend much of your success as nurses.

Be careful not to sever your relations with any patient unless

your doctor knows all about it. Never leave your charge, no matter

how urgent the reason may be, unless you tell him. You may be

sick, or the place may be unsuited to you, or you to the place,

and you may know that it is best for you to go. But speak first to

the doctor, tell him candidly why you wish to go, and take counsel

of him how you should act. If he tells you you may go, and you

know that your place must be filled, do not offer as your

substitute your best friend, or anyone else. If he wishes your

counsel he will ask, and then you may tell him of anyone you think

will suit the position, but do not offer your friend, as he may

have some favorite of his own to put in your place. Of course the

patient or her friends must know about the contemplated change--

that I take for granted. Having consulted the doctor, will make

everything satisfactory to the most careful practitioner. So, as

said before, never go away from your patient, leaving in your

place a nurse whom the doctor does not know. He has, in most

cases, selected you for his patient, and he wants you, you may not

be all he wishes you were, but still such as you are, _there_

you are, he knows what you can and what you cannot do; and it is a

great piece of impertinence for a nurse to go away unknown to the

doctor, leaving a stranger in her place. The consequence, so far

as he is concerned, will most likely be to have her name crossed

off his list as "unreliable"--so be careful.

As to your records, keep them faithfully; the doctor usually looks

them over very carefully, but sometimes you find one who passes

them over in a lofty manner, rather trying when you take such

pains with them. You may conclude that it is not necessary to keep

them accurately in such a case, but this same doctor may ask you

some day how long ago it was that the patient's temperature took

such a sudden rise, or how many days it is since she first had

solid food, and if you have accurately kept and carefully

preserved your records, you can tell without a moment's

hesitation. It is better, more business-like, and every way to be

commended, that the nurse should keep, and be exceedingly

particular about these records. If the doctor will write his

orders on the fresh daily record at his morning visit, it is a

great help to the nurse, but very often he is in a hurry and you

must write them yourself. If you have to do this, take your record

and write as he tells you, _when_ he tells you. If the orders

are at all intricate it is your only way of being absolutely sure

you have everything correct. It is a protection to you also, if

the family are inclined to criticise.

A nice little point for you to remember is always to leave the

doctor _alone_ with the patient for a few moments, if it is

at all possible, at each visit, Wait until he has asked all the

questions he wishes, or until you have told him all that is

necessary to tell before the patient, and then on some errand,

real or imaginary, leave the room. Of course, if the patient is

desperately ill, you cannot do this, nor will it then be

necessary.

It is a good plan to wait for the doctor at the head of the

stairs, or at the foot, if you are likely to be over-heard, and

tell him there all you could not say before the patient as to her

condition, etc. He likewise may have something to say,--some

final instruction to give, some caution he would not wish the

patient to know of. This is also the time to speak about yourself

if you are sick or tired, or unhappy in your position. Perhaps

neither of you have anything to say, and a friendly nod and a

"patient is doing nicely, nurse," will send you back to the sick-

room feeling that your work is appreciated, which always goes a

long way toward making the hard places easy. Your patients may be

very curious as to what you have to say to the doctor, but you can

readily and truly tell them that there are many things you have to

say to him, that would be hard for you to say before them, and

hard for them to hear too, and these are things you arrange

outside.

Always be sure to have on a convenient table, if your doctor be of

a homoeopathic school, a little covered tray, and on it two

glasses, clean, and turned upside down to keep them from dust,

teaspoons and covers for the glasses, also a small pitcher of

fresh water. Many doctors of the old school also use some

medicines in water, so it is best to have glasses always at hand.

Do not sit down when the doctor is making his professional call,

unless he or the patient requests it. He will probably sit at the

side of the bed, your place is at or near the foot. If the doctor

knows the patient well, as a friend, and is inclined to stay a

long time, chatting, you can go quietly to another part of the

room, and take up your work or reading, but be sure the doctor has

finished asking you questions before you go.

Use sparingly technical terms. If your patient's feet are

oedematous, tell the doctor they are much swollen; if he

_ask_ if they are oedematous tell him "yes," but do not

volunteer to name the peculiar kind of swelling. If the abdomen is

tympanitic, tell him it seems much distended; and if he questions

much further, answer the questions fully and intelligently. If

your patient has the symptoms of phlebitis, tell him of the rise

of temperature, the swelling of the leg, the tenderness along the

course of the vein, and he will know that you know and appreciate

the gravity of the disease; but be sure you do not attempt to give

the symptoms a name, that is not your place.

I would have you be very careful as to what instruments you carry;

have them of the best. Let your thermometer be of the very best

make.

There is nothing more trying in a small way than to have your

thermometer doubted, and if you _know_ it is the best the

market affords, if you take it to the instrument maker and have it

tested once in a while, you need not fear, when you find an

unusual temperature, and report it to the doctor, and he quietly

proceeds to test your thermometer by his, which of course is

always correct. Be sure that your hypodermic syringe will work; if

the piston slips loosely after much using of brandy, aromatic

ammonia, etc., take it to be repaired, and see that the needles

are sharp, they become dulled very quickly; keep also the tiny

wires pushed through them. It is just as well to keep this syringe

in the room, its little case is very small and unobtrusive, and if

you keep it near your thermometer in some safe, handy place, you

will have it when some unforeseen emergency arises, and you do not

want to lose time going to your room for it.

III

THE NURSE HERSELF

It is just as necessary for the nurse to be careful of herself as

of the patient, though her care must be manifested in a far

different way. Always remember that to do really good work you

must have really good tools. No man owning, and intelligently

working a valuable machine, would keep it going at its highest

speed all the time. He takes care of it, keeps it clean, renews

defective parts, oils it; and then he expects it to run for so

many hours, and to run well,--to do its work thoroughly. But with

all his keeping it in order he does not make it work night and day

for weeks or months. Such folly is never heard of in an engineer;

but with us human beings, who own and manage a far more wonderful

machine than any steam engine, we hear of it often, and always,

_always_ the tale winds up with the inevitable catastrophe.

The business man develops paresis, the clergyman loses his voice

or his eyes, the nurse contracts some disease that incapacitates

her for work, in every case mother Nature makes the careless or

ignorant owner of the wonderful machine pay the penalty of the

misuse. It does not matter to Nature what the reason is for our

breaking the great laws; we can kill ourselves with philanthropic

work just as surely as with over indulgence. One trouble is, that

it does not always _kill._ A paralytic may live for years, so

does a man with paresis. When the wonderful God-given machine

works badly, or stops entirely, we look on, and sometimes wonder

why it is that those who are so helpful, such fine examples of

courage, of skill, of virtue, so hardly to be spared, are the ones

to be taken away. Do _we_ wonder, we who are nurses? Do we

not know what did it? Ah! yes--we know, we know, that such and

such a nurse was tired out when she went to still another case--

and when we heard she herself was ill we were not slow to say,

"Foolish girl! Did she suppose she was made of wrought iron and

sole leather?" But will _we_ take heed, and not do likewise,

or will we wonder, with the unthinking ones, why it is that the

good, useful people are always taken away? Do not deceive

yourselves; they are not "taken away," they take themselves away,

for God will not reverse His wise laws because we (no matter how

good we are) act in defiance of them.

Please remember I am only speaking now to the good nurses--the

enthusiastic ones,--poor nurses, lazy nurses have no temptation to

overwork themselves. They may die of indigestion, but they will

not die of exhaustion.

It seems to you so natural for others to be sick. You have seen

the sick by scores in the hospital, and have waited on them, felt

sorry for them, sympathized with them; but have you thought that

it was within the bounds of possibility that _you_ could ever

come into such a pitiable condition? You go from house to house in

your private nursing, always you find the sick, and it seems

natural, quite the proper thing. You care for them, they get well,

or die--and on you go to the next--but reflect on what made them

sick, and though you _know_ you are made of like flesh and

blood, do not conduct yourself as if you were not. "Oh, yes" (how

often have I heard it said), "I know she worked too hard, but I am

so strong, you never heard _me_ complain; I can nurse a fever

case for two weeks and never go out of doors for air or exercise."

Is it not foolish? Is it not wrong for any sensible woman to talk

thus?

Now listen to some few practical hints as to how to keep

yourselves in good working order. In the first place, then, never

go to a case unless you are feeling well. It is far wiser, as far

as you are concerned, and better also for the sick one, for you to

say so frankly, if you are not well. Tell the one who comes for

you, that you could not do justice to the case, as indeed you

could not. Sick people are as sensitive as babies to the subtle

influence exerted by the one who is so constantly over them. If

you are in full health and strength, your rubbing will be quieting

and effectual, your very presence, if you are careful and gentle,

will be soothing. On the contrary, if you yourself are suffering

and are using the nervous force you ought to be giving your

patient in hiding your own malady, your presence will not be so

eagerly welcomed; your patient will not know what is the matter,

but she feels rather a relief when you are absent. Going to a case

feeling perfectly well, the next thing is to keep well.

Be careful about your _eating_. Your meals will of necessity

be often irregular, that is unavoidable, but eat only wholesome

things. Do not eat candy; and at dinner, which you will probably

have in the evening after the family are through, avoid patties,

and rich puddings, ice cream, and such like. You will always find

plenty of plain food and fruit in the most luxurious homes; eat

these and let the rest alone. If you want to keep your stomach and

whole digestive apparatus in good order, you must care for it, and

not overtax it. If you have a pretty good stomach it will bear a

good deal of abuse, but in the end it will grumble, and a

dyspeptic nurse is not an attractive object. As to your night

suppers, which you should always have, should your case require

constant watching, I would recommend plenty of coffee, tea, or

cold milk, if you can drink it, bread and butter, cold meat and

fruit. Never eat candied fruits, cake, or pies at night. Have eggs

if you care for them, and pickles if you like. Remember, the

plainest food, the most easily digested, the most nourishing is

what you must have. Believe me, you will be rewarded for the

temperate use you make of all the dainties you see, by a clear

complexion, and good color, which will make you "good to look at,"

especially good for a sick person to look at.

As to the nurse's night toilette, it is quite a problem sometimes

as to just what is best to wear. When the patient is not ill

enough for the uniform to be retained for night duty, the nurse

should be comfortable enough so that she can sleep; yet dressed

enough for any emergency. I think a house gown of pretty material

much neater than the kimono. Be sure this fits about the

shoulders, and never have loose flowing sleeves. A white frill in

the neck looks very trim, and is always becoming. The corset and

all tight clothes should be removed, stockings and underwear kept

on. The hair should be arranged simply, but not allowed to hang in

a loose braid, unless you are _very_ sure you will not see

any but the patient, and even then it may be unwise, as a braid of

hair has an exasperating way of slipping from its proper place

(hanging down the back) and dipping into whatever you are stooping

over. Dressed thus, with night shoes to protect the feet, one can

lie down on a lounge and sleep very comfortably, being freed from

tight clothes, and yet being entirely presentable, no matter what

happens. To undress regularly and put on the diaphanous low-necked

short sleeved night dress of the present mode, and go to bed, when

you are sure you will have to get up one or a dozen times during

the night is not good judgment, I think. You get out of a warm

bed, and if you only put on your shoes and stockings, your patient

must wait while you do it. If anything serious occurs suddenly,

you either run the risk of taking cold from being insufficiently

clad while doing what must be done, or your patient must wait

while you dress--both bad.

Never get into bed with your patient. This seems to most people a

quite unnecessary caution, but it is the commonest experience of

the successful nurse, that a woman, feeble and nervous, should ask

and almost insist that she shall lie down by her, or get into bed

with her. I always wonder that a sick woman can not realize that

she is not a pleasant bed-fellow, but she seldom does. Of course

you are not to tell her that she is not fit to sleep with, but you

_can_ say that she needs and ought to have the whole bed to

herself, and you will sit by her and hold her hand, or if she

insists on it, you can lie down, with your house gown on, on the

_outside_ of the bed, being careful to give her plenty of

space, and when she is asleep, get up quietly and lie down on your

lounge, which should be placed so that you can see her every

movement.

Never let the patient think for a moment that you fear her

disease; if she has diphtheria, do not tell her or the family that

you have a delicate throat or that it is sore, and do not examine

it by the help of a hand-glass where any one can see you. Do not

go to such cases if you really fear them, but if you go, and have

reason to feel that you have contracted the disease, tell the

doctor as soon as you can, and if he thinks you ill, he will send

you home. Never tell a patient you have a weak back or any

weakness. Tell the doctor and he will see to it that you have rest

or medicine, but do not let the patient know it. Never go about a

sick room with a long face; it is enough for the sick one to have

to be sick; the family sympathies are all enlisted for her. You

are there to be a help and a comfort, not an added anxiety. Of

course these remarks do not apply to any of you who are tired from

a long, exhausting case. The family in such instances are ready

and willing enough to let you rest. Keep your cheery manner: all

higher considerations aside, it is money in your pocket to look

cheerful. I have known one or two good, faithful, conscientious

nurses who were dismissed from case after case, merely because

they looked "so doleful." It may seem curious to place a

commercial value on a smile, but in reality it amounts almost to

that.

Be very careful to have your dresses fit you perfectly, and have

them well laundered, especially do not have them too stiff. In

this connection I cannot do better than to relate an incident that

I heard of some time ago. A nurse went to care for a patient whose

first nurse had been called to her own home, and she had not been

in the room an hour before the patient called her and taking her

hand said, "My dear, I can't tell you how thankful I feel that

your dress is not too short in the waist. Miss----'s dress was

frightful!" This was only a nervous woman's whim, but our success

as nurses depends in many cases on just such whims, so it is well

to be careful. When the patient is well enough for you to come to

the family table at meal time, be sure to have on a spotless

apron, and let no sickroom odors announce your presence. It is

worth more to a nurse to have soft, dry, warm, sympathetic hands,

than to have the prettiest face ever seen under a cap, so be

careful of them; after using any antiseptics always have at hand

glycerin and rose water, cold cream, or something soothing to use.

Never put a cold or clammy hand on a patient. If it is cold and

dry it can be laid on a hot, aching head, but never do so if it is

the least damp. If the hand is always damp, pour on it a little

alcohol, or eau de cologne, if that is preferred, or some toilet

water, then put it on the patient's head, and it will be all

right. A simple and very cold lotion is alcohol and water, about

equal parts, and a piece of ice added. Hold your hand in this a

moment and then gently comb the patient's hair (that which grows

on top of the head) with the dripping fingers, taking care not to

let any cold water-drops fall on the face. This is wandering

somewhat from my subject, but I will let it stand and speak of one

more thing that is good to remember. Never lay a warm hand on a

patient's head, or a cold one on the body. If you have to rub your

patient's body, and your hand is warm and damp, shake a little

talcum powder into it, or use a little cold cream, cocoa butter,

or lanolin, and the dampness will not be perceived. Alcohol may

also be used, or bay rum.

Some nurses are much troubled by excessive perspiration,

especially under the arms, any hard work making the dress quite

wet. The ordinary shields are not very good, as they are not

absorbent enough. A piece of flannel basted inside of the shield

is a help, as that is absorbent. The auxiliary space might be

bathed with a solution of alum; alcohol is good or alcohol with

white-oak bark. Many preparations for this trouble are on the

market, most of them are good but some are expensive. A late copy

of the _Journal of Nursing_ gives the following: "Take two

ounces of baking soda, mix with half an ounce of corn starch, and

use as a dusting powder, after the parts have been thoroughly

cleansed and dried. It will check the perspiration and remove

every particle of odor." This is very successful, but I find it

leaves a slight yellow stain on a white dress. Another remedy from

_Journal of Nursing_ is this: "Zinc oxide" applied to axillae

twice a week, after bathing at night, will dissipate the odor. If

the perspiration has a disagreeable odor, no effort should be

spared to free oneself from what is a serious drawback to the

acceptableness of a nurse.

Be very careful not to contract any little annoying habits, such

as frequent clearing of the throat, sniffing, etc. You may have a

catarrh, but use your handkerchief quietly; such noises are very

disgusting, and these habits, I am sorry to say, are not rare, and

seem very hard to conquer.

I suppose that I have better opportunities to hear stories of

nurses and their doings, good and evil, than some have. I

certainly hear some very curious things. The most extraordinary

was of a nurse who always made it a rule, when she went to a

patient's house, to stipulate immediately for her hours "off

duty." She thought she was doing a very clever thing, and making a

most commendable business-like arrangement. It will not be

necessary for me to show you what a lack of tact she exhibited,

and what an antagonistic feeling she aroused.

Never kiss your patient or allow yourself to show any

demonstrative affection, unless you are very sure it will be

welcome, and be careful even then. A kiss for "goodbye" when you

leave the patient is usually quite enough, and many ladies are

repulsed by anything of the kind. If you feel an affectionate

regard for your patient, you can show it by your constant

thoughtfulness and your care. Do not fear that you will lead

lonesome, repressed lives; if you are the nurses you ought to be,

you will have all the affection you want, and often more than you

know what to do with. Never do any sewing or fancy work for

yourself until you are sure there is none you could do for the

patient. Remember that she pays for your time, and govern yourself

accordingly.

Read to her, sew for her, play cards with her, but do not amuse

yourself or regulate your wardrobe at her expense. When I say "sew

for her" I do not mean make her dresses, but do the little odd

things that mothers of families always do, and which must remain

undone if she is sick, unless you do them. Do not write letters

when on duty, and, above all things, do not write with a scratchy

pen. To a nervous person the sound of a scratchy pen traveling

over the paper is torturing, and it can be heard even if you are

in the next room. A fountain pen is, I think, the best to use. See

that it is full before you go to your case, and it will need no

attention for three or four weeks. This pen makes no noise as you

write, and you have it always at hand, and if you have to leave

your letter in haste, you can put the cap on the pen and slip it

in your pocket, and no one is in any danger of finding fault with

the nurse for leaving an open ink-bottle for somebody to tip over.

Remember finally (and I think, from what I read in the daily

papers, you are in no danger of forgetting this), that you are not

domestics, and, while in an emergency I would have you shrink from

nothing that needs doing, I do not think you should do any

washing. Cooking you will very often have to do, but the ordinary

housework does not come at all into your province. If your patient

is a chronic invalid, I would have you make yourself useful in the

house. Do the shopping, order the meals, anything that will show

your patient you are anxious to help make the wheels of domestic

machinery run more smoothly.

You must use all the tact you possess; you will not find two

houses just alike, or two patients with the same tastes. A "lady"

in an emergency does many things she usually leaves to the

servants. So must you. There is sickness, trouble with the

servants, every domestic wheel turning with difficulty, and, if

you have time, if you can leave your patient without doing her an

injury, you can, perhaps, by some little service earn much

gratitude from the family, and help to remove the impression that

trained nurses are "so helpless and need so much waiting on."

In conclusion, let me tell you, with all the earnestness of which

I am capable, that upon each one of you rests not only the

reputation of your school, but, in a measure, the reputation of

the profession. No one needs to be told how much more widely known

is an inconsistent Christian than a faithful one, how much harm

one does and how comparatively little good comes of the others'

faithfulness. And it is just so with you nurses, a careless nurse

makes a far wider reputation than a careful one.

If one physician is unskillful or unprincipled, the whole

profession is not found fault with, but the individual is blamed

and another one found who will do better, but it is not so in most

cases where a nurse proves unsatisfactory. The whole profession

suffers and every nurse sinks more or less if one of her sister

nurses commits an indiscretion, or does any of the thousand things

she ought not to do. I recollect very well, many years ago, a

Brooklyn nurse, of about thirty-five years, married her patient, a

boy nineteen years old. It made a great stir in the city, and, as

I was living there at the time and the superintendent of a

training school, I had to bear my share of the odium cast upon all

nurses. For months after, almost every one I met took pains to

tell me that hereafter they would keep their young sons out of the

clutches of the designing nurse, and I doubt not, such slighting

remarks were borne by every nurse in town, and it was not

pleasant, to say the least of it, for any of us.

Keep your standards high. Let nothing but the very best satisfy

you, as far as you and your work are concerned. Keep your mind

well informed; if it is full of scientific facts, of skillful

methods, of good literature, or fine pictures, there will be no

room in it for the memory of all the disagreeable things every one

must encounter in one's work, and if you do not remember them, you

cannot tell others of them.

Finally, remember (and this lies at the root of it all) to keep

your hearts right,--ever thankful that you are permitted to pursue

this high calling, and ever striving to be more worthy of it, with

many prayers that your life and conduct may show, what is better

_lived_ than talked about, the grace and peace of God, which

verily do pass man's understanding.

IV

THE NURSE AND HER PATIENT'S FAMILY, FRIENDS, AND SERVANTS

Try to realize when you go to a house where there is dangerous

illness, that the family is glad to see you when you come. You

have come to help them, to stay with them, to comfort them by your

presence, by your knowledge, by your experience. They have needed

you, have sent for you, and are to pay you for your time. There is

a general sense of relief when you are once fairly installed in

your place by the bedside, yet you are a stranger. Your friend,

the doctor, has told them what a treasure you are. Mrs. This and

Mr. That have perhaps let them know how invaluable you were when

at their houses; but yet they must look at you a little, they must

note if you make a pleasant impression on the invalid, if you are

as skillful here as you were somewhere else, if you look with

scorn on the plain furniture, or how much you will be displeased

that the bath-room is at the other end of the house. They do not

feel exactly critical: they are too tired or too anxious for that;

but still, unless everyone is too exhausted from watching to do

anything but thankfully surrender everything to you, you will be

pretty closely looked after at first.

You must look for some espionage; and it is only right that you

should be subjected to it. If _your_ mother was lying very

sick, and some stranger, having knowledge and strength superior to

your own, had to come and care for her, would you not feel that

though you were glad to see her, glad she would give your mother

the benefit of her superior skill, yet you would wish to consider

her a little, to note when she did thus and so; or if she did

something you did not understand, could you refrain from asking

her why she did it?

Be patient, therefore, with the suggestions of the family, after

all, though you know the disease and the probable course it will

run, the chances for recovery, and what to do in emergency, etc.,

_they_ know the patient, all her peculiarities, her likes and

dislikes, and if you are wise you will get and keep many little

hints from those who have cared for her before you came. If she

likes milk, will she insist upon tea? Does coffee keep her awake?

Does she hate the sight of gruel, or beef-tea? Does she like much

sugar in her drinks? All these are little matters of individual

taste that you must find out for each patient, and if you have the

necessary tact and forethought, you never need ask the patient one

question; usually the friends are pleased to be consulted on such

small matters, and gladly tell you all you wish to know. To be

sure, they generally tell much more than you asked for; but that

does not matter, it is better to listen patiently for five minutes

to someone's tiresome descriptions than to repulse them, and so

lose just so much kindly feeling from the one who wished to talk

to you.

If the amateur nurse has been doing something actually wrong for

the patient, do not tell her so. She did the best she knew how;

but say, as pleasantly as you can, "I think perhaps _this_

would make our patient more comfortable," or "The doctor thinks

such and such things are not now necessary, and it would be better

to do this way." Then you can do what you know to be right, and

not hurt the feelings of the one who has preceded you, and,

feeling your way carefully, have everything just as it ought to

be, and no one's feelings will be hurt, and no one will feel that

you are looking down upon their ignorance; and here I would say

that in your little confidential talks with the doctor, you could

ask him to say a word to the family if they persist in doing what

you know to be wrong. Ask him to give you orders before some of

them, and that will set _you_ straight in a moment.

With tact, that most invaluable gift, you can get on with

_almost_ every one, and when you find that there is no such

thing as making friends with the family, you can tell the doctor,

and he will let you go; but such places are very rare. Let all see

that you are thoroughly interested in your patient, and do not

hesitate to perform any little kindness that falls in your way for

the rest of the family, and you will win all their hearts without

a struggle.

When you go for your rest, be sure to leave carefully written

directions for the one who is to take your place, just as you do

when in charge of a hospital ward, you leave your orders written

out when you go for your "off duty." Show her how to keep the

sick-room record, and be sure she understands it all before you

leave.