again you must have the family help you. Of course _no_
visitors are allowed until the doctor gives permission. So far all
is easy, but when they are admitted you will do well to make a
little plan with the family. Tell them the patient may be seen at
such an hour. Perhaps between eleven and twelve, perhaps between
two and three, just as you consider her brighter in the morning or
afternoon. Ask them who of the first and dearest friends is the
quietest and most discreet, and then say that if they will kindly
arrange for one visitor only to come each day, it would be so much
better for the convalescent. The friends can always do this and
they never object. They tell Mrs. Jones to come on Monday at two,
and stay just fifteen minutes. On Tuesday Mrs. Smith can come, and
so on, until by the end of the week the arrangement ceases to
cause any comment, and soon, if all goes well, and the convalescence
goes on without interruption, _your_ rules and extreme care
can be relaxed to suit the patient's own fancy.
Always carefully note if any visitor tires your patient, and
manage so as not to let her come again until the sick one has more
strength. It is better, I think, to sit in an adjoining room when
your patient has a visitor. This gives you a chance to come into
the room when the person has stayed long enough, and generally
your entrance tells her very plainly that she ought to go, and she
departs without you saying a word. If she does not, you will have
to tell her that the doctor is very particular about not letting
the patient talk too much, etc., etc., and get her out in that
way. Be careful, when the visitor has gone, not to sit down and
talk at length yourself. Give the patient a little nourishment,
turn over her pillows, and if she seems at all wearied make her
comfortable for a nap and let her sleep.
As to the servants they require pretty careful handling. Above all
things, keep on the right side of the _cook_. If you have to
go to the kitchen to do any of the cooking, do not make a
_mess_, or, if you do, don't run off upstairs and leave it.
Gather up your utensils and put them into the sink, and let the
water run over them, and ask for the dishcloth: and if you do it
pleasantly, the cook will probably tell you to "Niver need thim
things," and you will thankfully obey her. If you really cannot
stop to make all tidy after your cooking, you can say, "I'm sorry
to make you extra work with these dishes, but I must hurry back
upstairs." Some such little speech, with a pleasant smile, will
make all things easy for you below stairs, and for the sake of all
the friction it will save you, it is well worth the trouble. Often
the cook will be glad to do the cooking if you tell her how; be
careful to tell her, if it is eaten and enjoyed; and never let her
know if it is rejected. Get rid of it upstairs by some contrivance,
and be sure not to order that dish again. In many cases
of course the cook will know all the little dishes the sick one
will fancy, and you will have very little to do with her. Such
instances are somewhat rare, and very delightful when they occur.
If there is much extra washing, you may have to use much diplomacy
as regards the laundress; and if it is very disgusting washing, it
is well to have a large pail, with a cover, upstairs. Thoroughly
disinfect the clothes before you send them to the washing, as the
odors are often sickening, and the laundress, like other servants,
is very much afraid, usually, of clothing from a sick-bed. Carry
or send the clothes to the washing as soon as possible after
removing them from the bed; never, on any account, allow them to
remain in the room.
The nurse cannot be too careful as to the amount of clothes she
sends to the laundry. She should of course keep herself and the
patient scrupulously clean; but she must reflect that private
families do not have an unlimited store of towels and sheets, and
if she is extravagant in this matter it will seriously detract
from her acceptability.
In concluding, let me remind you that all these hints are intended
for nurses going from one strange place to another, as you would
in nursing fevers, or short surgical cases. Nurses who have
chronic cases need none of these rules. They fall into a routine,
and if they are detained in the family for any length of time,
that shows that their work and methods are right, as far as that
patient and family are concerned. But let them be careful when at
last they leave the case, and go amongst strangers. The ways of
one family are not the ways of another, and they must exercise
much discretion to accommodate themselves to the new environment.
V
GENERAL REMARKS ON FOODS AND FEEDING
Always have all food presented to an invalid as tempting as
possible. Use pretty china and glass, if you are permitted to do
so, yet not the very finest the house affords; that might make the
patient nervous lest some evil befall it. Absolutely clean napkins
and tray cloths, a few green leaves about the plate, a rose on the
tray; the chop or piece of chicken, the bird or the piece of steak
ornamented with sprigs of parsley, the cold things really cold,
and the hot ones _hot_, these are necessities of invalid's
feeding, that mark the nurse who has a proper appreciation of a
sick person's delicate sensibilities. Have all plates, cups and
saucers _hot_, when they are for the reception of hot toast,
coffee, tea, etc. Hot water plates are very convenient, and easily
procured at any large china shop; but if they cannot be found, put
the hot plate containing the chop over a bowl of boiling water,
and cover with a hot saucer, fold a napkin around the baked
potato, and you can carry the tray containing the dinner through
cold halls and up staircases and it will arrive at your patient's
room _hot._ Be careful not to fill the bowl so full of hot
water that it will spill. Never fill a cup so full that it will
spill its contents over into the saucer, it makes a disgusting
looking _mess._ Have all fruit _cold,_ oranges and grapes
especially. Always look over a bunch of grapes and cut off
the soft ones before you hand them to a patient. If you have
foreign or California grapes, hold them for a moment under the
cold water faucet and let the water run through the bunch, and all
the cork dust will then be washed out.
If you peel and quarter an orange for your patient never let her
see you do it, unless you are perfectly sure you will not get your
hands covered with juice. Wash your hands before you bring it to
be eaten.
Be careful not to have any suspicion of grease about the beef tea,
broths, etc. A quick and easy way to remove all grease, is to fill
a cup or bowl _brimming_ full, let it stand a few moments
that the grease may rise to the top, tip the cup a very little to
one side, and the grease, to the last atom, will flow over the
side of the cup; pour your broth carefully into a clean hot cup,
and serve. Beef juice is more palatable with a little very brown
toast.
Remember, that an invalid hardly ever likes any food made sweet.
No matter what the taste may be in health, in sickness, sweet
things are nauseous; for this reason ice cream bought at
confectioners' is often rejected. Salt also must be used with
caution, if the mouth and lips are tender, as is often the case;
use the salt sparingly in all broths, etc.
If your patient cannot take milk, when, as in typhoid fever, the
doctor wishes the diet to be wholly or for the most part of milk,
try at first to remove the thick, bad taste by giving a little
pure water or carbonic acid water after it. If that will not do,
mix the carbonic acid water with it, and have both nice and cold.
If a glass of milk is too much (and it will be in nine cases out
of ten, especially if it is cold), give half a glass; if that is
still too much, give quarter of a glass, or put more water with
it. Never repeat a dose (of food) if it nauseates the patient.
Make some change in quantity or quality, and you will, if you
watch carefully, find out the right proportions.
A person lying flat down in bed cannot, of course, drink from a
glass or cup, and a feeding cup is apt, by pouring too freely, to
cause choking. A bent glass tube is the best arrangement, the
patient can drink easily through this, and can regulate by
sucking, the rapidity with which the food is taken. The tube
should be cleaned immediately after each using, and if any beef
tea or other food cannot be dislodged by letting water run through
it, pass a string with a knot tied in it, through. Make the knot
big enough to touch all sides of the tube, have it thoroughly wet,
and the cleansing will be easily and quickly accomplished. If a
patient prefers drinking from a glass, and can be raised in bed,
always lay a napkin under the chin before you give the drink, and
on no account have the glass or cup more than half full, if you
do, it will surely spill.
In giving medicine that tastes very bitter or unpleasant in any
way, bring, at the _same time_ with the medicine, some water,
milk, or whatever may be preferred, to take after it. Also a
napkin to wipe the lips, especially if the patient be a man.
Always keep milk, beef tea, etc., _covered_ in the
refrigerator, and, if you can, see that this is cleaned every day.
But this might cause the cook to feel aggrieved, so I put it as a
suggestion merely. But if the refrigerator has a _smell,_ and
the cook seems touchy, the milk, etc., better be kept upstairs on
some sheltered window-ledge, and carefully covered.
If you have your own little refrigerator upstairs, see to it that
it is cleaned _every_ day. Never put away anything in tin
pails; always use earthen or china bowls or pitchers.
BEEF TEA.
Beef from the round, finely chopped and free from fat.
Proportions, 1 lb. beef to 1 pint of water, cold. Let the beef
soak in the water, stirring occasionally, for two hours; then put
it on the stove and heat it until the red color disappears; never
boil it. Skim off all grease, salt to taste.
BEEF JUICE.
Round steak cut an inch thick; slightly broil like beefsteak for
the table, cut into squares of an inch, squeeze in a lemon
squeezer, skim carefully and salt. Serve either very cold, or
place the cup containing the juice in a bowl of boiling water,
stir carefully, and as soon as the juice is warm serve. If left a
moment too long it is spoiled, as it curdles. One pound of beef
makes an after dinner coffee cup almost full of juice.
BEEF TEA IN A BOTTLE.
Put into a Mason's preserve jar, tightly corked, one pound of beef
chopped as for ordinary beef tea. Put this into a kettle of cold
water, with a saucer on the bottom, let it come slowly to a boil
and boil for an hour. Take out of the bottle and squeeze the beef.
SCRAPED BEEF.
Take a piece of lean round steak, scrape with the edge of a spoon
until the place scraped has no more meat on the surface, but only
the white fibre, cut this off with a sharp knife, exposing once
more a fresh surface. Season, and spread raw on bread and butter,
or make into little cakes and broil slightly, according to the
doctor's orders, or your patient's taste.
MUTTON BROTH.
Mutton from the neck. Proportions, 1 lb. of mutton to 1 quart of
water, put the mutton and the water (cold) on the back of the
stove, let it come slowly to a boil, boil until the meat is ready
to fall from the bones. After straining out all the meat etc. add
one tablespoonful of rice or barley. Simmer half an hour after
adding rice or barley.
CLAM BROTH. NO. 1.
Take 1 qt. clams. Strain off the juice and chop the clams fine,
return clams to the juice and simmer one hour. Put on to scald as
much milk as juice. Strain out the clams, thicken with a little
corn starch, making about as thick as cream, pour juice into a
bowl and add the milk.
CLAM BROTH. NO. 2.
Same as above, only cut off the hard part of the clams, chop the
soft parts and leave them in the broth. For convalescents.
CLAM BROTH. NO. 3.
Take little neck clams unopened, wash them very clean with a
brush. Place them on the top of the stove in a clean dry pan, and
when the shells open take them off, remove the clams and pour the
juice into a cup. To be served hot. If it is too strong, add a
little boiling water. This is for very sick people; give only a
teaspoonful at a time. It sometimes corrects nausea.
CHICKEN BROTH.
A fowl, not too young, cut in pieces, 1 qt. water to 1 lb. fowl.
Put it on the stove in cold water, let it heat slowly, then boil
gently until the meat is ready to fall from the bones, strain,
skim and add rice, boil once more for 1/2 hour. Salt to taste.
Serve with toast or hot crackers.
OYSTER BROTH.
Equal quantities of juice and milk, put each in separate vessels
on the stove; when the juice comes to the boil, skim and slightly
thicken, pour in the milk boiling hot, add the oysters one by one,
let them remain on the stove about five minutes, or until the
beards begin to curl, and they are no longer slippery. Serve with
crackers heated very hot.
OYSTERS BROILED.
Dry the oysters, large ones are best, in a towel, have a piece of
toast slightly buttered on a hot plate, near, pour over this a
little hot oyster juice, not enough to make the toast wet through.
Arrange the oysters on a fine buttered broiler, cook over a brisk
fire like steak, until the beards curl. Turn them often. It takes
about five minutes. Arrange them on the toast, add a little salt
and a very little butter, serve very hot.
BROILED CHICKEN.
The chicken must be young, split down the back. Lay on the
gridiron and broil evenly, turning frequently. Serve on a piece of
buttered toast, salt and slightly butter the chicken. A little
parsley garnishes the dish prettily.
All birds to be broiled should be split down the back and broiled
evenly, laid on thin toast and served hot.
BEEF STEAK.
Steak must be cut 3/4 inch thick, and evenly broiled, rare, unless
particularly requested to do otherwise. Be careful not to smoke
it; the grease dropping into the fire may make trouble in this
way.
OATMEAL GRUEL.
Take two large iron tablespoonfuls of oatmeal freshly cooked for
breakfast, add one cup of boiling water, slowly stirring all the
time, then add an equal quantity of milk. Let all boil for ten
minutes, and strain through a fine wire sieve. If you have no
cooked oatmeal put 1/2 cup raw oatmeal in a double boiler with two
cups of boiling water and cook for two hours, then proceed as
above. It makes the gruel richer to add all milk, or 1-1/2 cups of
milk and 1 cup of cream. Be sure not to forget the salt. Never put
any sugar in unless requested to do it by the patient.
KOUMYSS.
Dissolve a third of a cake of compressed yeast (Fleischmann's) in
a little warm water (not hot). Take a quart of milk fresh from the
cow, or warmed to blood heat, add to it a tablespoonful of sugar,
and the dissolved yeast. Put the mixture in beer bottles with
patent stoppers, fill to the neck, cork, and let them stand for
twelve hours where the temperature is about 68 degrees or 70 degrees,
then put the bottles on ice, upside down.
MILK PUNCH.
One glass of milk, 1 or 2 tablespoonfuls of brandy, 2 teaspoons of
sugar.
Shake well or beat with an eggbeater. Give cold. Have patient take
slowly.
EGG-NOG.
One egg, half glass of milk, 2 teaspoons of sugar, 2 teaspoons of
sherry or brandy, ice. Beat the yolk of egg in a glass, add the
sugar and beat, then a little milk, continue beating, then four or
five pieces of ice about as big as a hickory nut; add brandy--
regulate to the taste of your patient--add rest of milk; beat
whites of eggs and add all but a teaspoonful with which garnish
the top. It should make a glass brimming full. Have a spoon with
which to eat it.
EGG LEMONADE.
One egg, one-half a lemon, 2 teaspoonfuls of sugar, beat the white
and yolk separately as for egg-nog; add the sugar to the yolk,
then the lemon juice, then the ice, lastly the white beaten to a
stiff froth.
WINE WHEY.
One pint of boiling milk, one-half pint sherry; add sherry to the
milk while scalding hot; stir a moment until the curd gathers;
strain through a fine muslin, sweeten. To be taken cold. This
takes a little practice to gather the curd as it should be done.
POACHED EGGS.
The best way of cooking for an invalid. Slip the egg, previously
broken into a saucer (the fresher the egg the better), carefully
into salted water which is boiling in a frying pan, then
immediately set the pan at the side of the stove so that the water
does not boil, keep it there for about five minutes. Let the water
be about two inches deep in the iron frying pan. Each egg must be
broken separately and slipped carefully into the water. When
cooked so that the white is firm but jelly like, no part being raw
or hard, take it out with a skimmer and slip it on a piece of thin
buttered toast, sprinkle a little salt and pepper on top, serve
immediately. Garnish with parsley.
SCRAMBLED EGGS.
Beat two eggs until thoroughly mixed, add two tablespoonfuls of
milk, salt and pepper. Pour into a very hot frying pan, buttered,
and stir constantly for about two minutes. Pour over buttered
toast.
SHIRRED EGGS.
Heat the shirring cup very hot. Put in a piece of butter as big as
a large pea. Shake it about and break in the egg. Let it remain on
the stove a few moments and serve in the shirring cup. Sprinkle
salt and pepper on it.
OMELETTE.
Beat very stiff two eggs, whites and yolks separately, add two
tablespoonfuls of milk and a little salt. Pour carefully into a
small frying pan, _hot_ and buttered. As soon as the egg is
_set_, slip a knife under one side and fold one side over the
other. Slip on a piece of toast and serve at once. A little finely
minced ham or parsley flavors it very well.
RENNET.
One pint of milk slightly warmed and sweetened and flavored, add
one large teaspoon of liquid rennet. Stir for a moment and set it
in a refrigerator. To be eaten with sugar and cream.
BOILED CUSTARD.
One pint of milk and 2 eggs. Beat the eggs, add the milk heated
almost to the boiling point. Stir in 2 tablespoonfuls of sugar.
Return to the double boiler, and cook for about 3 minutes,
stirring gently all the time. When done it will be about as thick
as cream. Be careful not to let it cook too much as it will
"separate" and be spoiled.
BAKED CUSTARD.
Same ingredients and proportions as for boiled custard, only let
milk be cold. Pour into custard cups. Stand these in a dripping
pan half full of warm water and bake in a pretty hot oven. Watch
carefully, bake 15 minutes.
THIN BREAD AND BUTTER.
Have a loaf of good home-made bread, yesterday's baking, cut off
the crust, then butter the loaf and cut the slice in this way,
buttering first and cutting afterwards. The slice can be made
_very_ thin and dainty, and the thinner it is, the better. A
patient will sometimes relish this when tired of all kinds of
toast or crackers.
VI
THE NURSE AS RELATING TO HER OWN TRAINING SCHOOL AND TO HER FELLOW
NURSES
Always be loyal to your own school and hospital. It may not have
been in every respect perfect; but it is not necessary to tell
strangers of its imperfections: probably those in authority are
just as sensible of its short-comings as you are, and perhaps they
work harder than you do to right its wrong; in any case it does no
good to tell others of the things you disapproved. It may indeed
be that your criticism is one-sided and unfair, that the very
rules you hated and found hard to keep are the wisest ones, and,
if you let strangers see that you disapprove of these wise
regulations, the opinion they will form of your intelligence will
certainly not be flattering to you.
When you meet other nurses in your work, as you are sure to do,
and when you compare your school with the one the other nurse came
from, try to realize that the other school is neither wholly above
nor wholly below your own; each has probably its own merits and
its own drawbacks. You should not tell the other nurse any of your
own school's shortcomings, any sooner than you would tell them to
any other stranger; be loyal everywhere to the place where you
were fitted for your work.
Never tell revolting hospital stories to your patients. Some
people have the most morbid wish to hear dreadful details. I
remember a patient of mine, years ago, asking me in all good faith
to tell her the most horrible thing I had ever seen in all my
hospital experience. I asked her why she wished to hear such
things, and after some reflection she acknowledged that it was a
foolish, morbid curiosity. It is best to keep the dreadful side
entirely out of sight; there are plenty of bright, interesting,
pleasant things always occurring; tell of these. Tell of the
cunning little babies in the lying-in ward, the absurd little
black ones, the fat little German and Swede babies. Tell of the
surly drunken men that come, and how a week of cleanliness in bed,
with a broken leg, or it may be a cracked skull, will change them
into quiet, polite, pleasant patients; and how, later, they will
take their turn at washing dishes, with a docility that would make
their wives stupid with amazement. All such matters (and the more
you try to think of them, the more you will be able to recall)
will amuse and really edify your patient, many of whom think of a
hospital only as a place of terror.
Never gossip about your sister nurses; of the stupidity of one,
the untidiness of another, or the overbearing nature of the third.
It can do no good, and it lowers you in the estimation of every
one who hears you talk.
As for your duties to each other, I would have you always observe
the same punctilious etiquette outside that you do in the
hospital. When you are called to assist another nurse, remember
that _she_ is the head nurse; the case is hers. She gives
directions, and you follow them; be sure you do it faithfully. If
you have some one to assist _you_, be sure you arrange for
her rest and exercise, and that you leave intelligently written
orders when you go for your own rest.
Some very awkward complications may arise where there are two
nurses, and the worst, I think, is for the patient and family to
like the second nurse better than the first one, and to criticise
her and find fault with her to the other nurse. This is hard all
around. The second nurse expects the first one to be preferred,
and usually dislikes to go to such a case, for that very reason;
but if any of you find that under such circumstances you are
preferred, never allow the people to retail to you the faults of
the other nurse, and never gossip about her. She may not suit
them, but she is probably doing the best she can, and such idle
talk can do no good. If they _will_ talk, make all the excuses
for her you can, and never let her suspect from any action
of yours, that you are preferred above her. If, on the other hand,
you are the first nurse and some second one is called in, and
preferred before you, study her well. See how it is that she wins
the patient's confidence, when you did not. Try to find out, in a
quiet way, wherein lies her charm. If it is quietness, exactness,
cheerfulness, or ready tact--it must be something--and if you are
clever you must see how it happens that she is preferred. It will
be a good lesson for you. Perhaps you will never have such another
chance for learning what you have found out by experience you
lack. So do not waste your time by allowing yourself to feel
jealous, but use it as a time of study, and you may reap a rich
reward by winning your next patient's confidence.
VII
WHY DO NURSES COMPLAIN?
It seems to some of us, judging from the prevailing tone of
nurses' conversations, that this is a veritable age of discontent.
We hear that a nurse's life is confining; that it is wearing on
the nerves; it keeps one from enjoying society; it is not
sufficiently remunerative, etc., etc. We all know, without going
into further particulars, what a nurse could complain about, and
though each one's tale of woe may be perfectly true, it seems to
me we are not wise, as nurses, to allow the trials of our
professional life to occupy such a prominent position in our
thoughts.