members of each regard their chosen work. What is the prevailing
theme of the religious newspapers? Is it complaints from the
ministers that they are not appreciated, or that their life wears
on their nerves? Not that surely, but we read of more and more
work to be done; more and more need of the gospel to be preached
and lived, that all may be attracted to it. What do we read in the
medical journals? Not how often Dr. Jones or Dr. Smith has been
called up at night, or how often they have been dismissed or
maligned by ungrateful patients; neither do they talk of such
things. Do they complain that they are kept from the presence of
"Society?" Not so, and why? Their enthusiasm is such that these
matters are accepted as part of the inevitable, and the higher,
nobler aim is so real that the lower and meaner consideration of
personal comfort sinks into insignificance. What is the soldier's
favorite tale? Not that all through the war he had to drink his
coffee without cream, that he did not have sheets on his bed, and
that he ate from a tin plate. Would he ever speak of such things,
except to show that a man can for a noble aim accept inconvenience,
and laugh over it? Yet the soldier has probably been used
to these comforts and many more all of his life in his home;
but viewed in the light of his enthusiasm for the country he
is striving to save, and seen by the side of her peril, such
inconveniences sink into their merited nothingness.
Now the profession we have entered is, we are told, a noble one.
We have been ranked shoulder to shoulder with the doctors, we have
been compared to soldiers, we have been assured that our
opportunities for doing good to souls are second only to those of
the ministers. What more do we want? We want this, and we want it
very much. We want the courage to accept our trials which must
come if we are to have any glory. It is all very fine to be called
a ministering angel, but it is pleasanter to minister to those who
are appreciative. We _can_ be heroic, in an emergency, but if
we are not properly thanked, we do like to growl a little. It is
gratifying to our vanity to be ranked with our masculine
associates, but when it comes to the hard, thankless tasks which
they accept without a murmur, then we proceed to show that we know
what is what, and that our refined tastes cannot be so inconsiderately
treated.
The trouble with these fretful nurses is that they _are_
nurses. If they are not satisfied with the profession they have
chosen, why do they not make a change and enter some other? Do
they not know when they enter the work that it is hard, do they
not hear on every side that it is exacting and confining? They
knew it perfectly well before they began, why then do they
complain? Why not say candidly, "I cannot have such enthusiasm for
my fellow-men that I can forget myself," and then do something
that is easier?
The Superintendent of the training school shows each new aspirant
for the nursing profession that the life is not an easy one, that
patience is one of the most necessary characteristics for the
nurse. She tells her of the trials, the irritations, the unreason,
the tiresomeness of sick people, and still women will come to the
school, and forgetting the warnings, they will complain when some
exasperating incident occurs. If a nurse, from overwork and the
consequent weakening of her nervous energy, has lost her patience,
she will be a wise woman if she drops out of nursing work for a
year or more; this will probably help her, complaining never will.
Do you feel that your patient is cross or unreasonable? That is
most likely, and is to be expected in nine cases out of every ten.
Put yourself in your patient's place for a little while; try to
realize what it is to have a pain, constant and sickening; to have
it every minute of the twenty-four hours; try to imagine the
fatigue of a respiration of forty; the ache and restlessness of a
fever of 103 degrees; the agony of longing to change a position when it
cannot be done; the despair of a hope for recovery growing daily
less, or the realization of absolute weakness that comes with
early convalescence; try to imagine yourself bearing some of these
ills with nerves and brain weakened by disease, and you will not
wonder that your patient is irritable, that he thinks the minutes
of your absence are "hours," that the unevenness of the bed is
"hard lumps," that the food is "slops," and the medicine "no
good." Remember that he is a prisoner, and he has a cruel jailer;
his bed is his prison, his disease is his jailer, and he suffers
whatever torments his jailer chooses to inflict. Now prisoners are
not, as a rule, a happy class of men; so bear with your prisoner
and help him. Complaining about his shortcomings will never make
them any the less. He is sick. Oh! the pathos of that short
sentence, "He is sick;" that says all. You are well, or you ought
to be; therefore bear with him.
You have chosen a hard profession, but we are told it is the
noblest one a woman can follow. Why is it noble? Exactly because
it is hard, and the hardness consists in your forgetting yourself
and giving your strength to others. There are many hard lives that
are not in the least noble, but there is no noble life that is not
hard. A coal miner has, I suppose, a hard life, yet no one calls
it a noble one; why? Because he works solely for his wages, and he
complains and "strikes" when his wages and his hours do not suit
him; but a doctor going from house to house, and in spite of all
discouragements carrying cheer and hope; a city missionary going
to the degraded, the ignorant, and by his own efforts helping his
fellow-men to a better life, to a knowledge of God--these are
noble lives. You can see I am sure the difference, and you will
not gainsay me when I assure you that the doctor and the
missionary, though they may not be satisfied with themselves, or
with their manner of working, are happy men, happy because they
live outside of themselves. The coal miner who is not content with
his wages is miserable, because he himself and his needs loom up
before him so large that every thing else is shut out. It is
because you take a hard task and do it well, that so much praise
is given to nurses. If you undertake a difficult task and fret
over it all the time you are doing it, if you propose to benefit
your fellow creatures and grumble because you have not comforts,
or appreciation, or gratitude, where does the nobility go? Where
is the heroism? If the task is easy, agreeable, delightful, the
idea of heroism, of nobility, of all high aspiration dies
directly. Did any one ever do a grand work and have an easy time
while doing it? Did Florence Nightingale have all the comforts of
life when she did her great work? Was it not by her indomitable
perseverance, her great patience, and her enthusiasm for others
that she won such an honored place for herself? You know almost
before I say it, that there can be no loftiness of purpose, no
enthusiasm, if there are not difficulties to be conquered, and you
all know that complaining about sick people will never alter their
characteristics, and that complaining about the nervousness of the
relatives will never make less unreasoning, when they are fearful
that a loved one is going to die.
Do we want gratitude and appreciation? We get it very often, and
very often we do not; and when this last is the case, we may
reflect that we are in very good company. How did the French
reward Joan of Arc? The warmth of their gratitude led her to the
stake. Galileo, as reward for his discovery, was put into prison
and loaded with chains, as were also Christopher Columbus and Sir
Walter Raleigh, a notable company these, and every one suffered
from the ingratitude of their fellow-men. Many more examples you
must call to mind, of ingratitude more base than any thing we
shall ever be called upon to bear.
The profession of nursing is still one of the most recent that
women have engaged in. The world had until the past few decades
been so used to being nursed by the old-fashioned nurse, who was a
servant, and who never expected any treatment but that of a
servant, that it has taken some years to always remember that we
are not servants, in the usual acceptation of the term; but no one
will be convinced of the fact that we are ladies by our
_telling_ them so. If you are a lady, with a lady's
refinement, every one in the house will know it, will feel it, and
you will never mention the subject; they must feel it, then there
will be no arguing on the subject. It must be demonstrated by your
deftness, your quietness, your cheerfulness, your education, your
intelligence, your quick appreciation of other good qualities. We
must all of us show the world that it is being nursed by its
compeers, that a lady can do even the most revolting service in a
way that robs it of its difficulties; and when the hard part of
the illness is over, when your patient is ready and anxious to be
entertained, you can show that you are not a machine for carrying
out the doctor's orders; that you are capable of something more
than the ability to take temperature, pulse, and respiration.
We must remember that even yet we are, in a way, pioneers of one
part of that great woman movement in the world. It is not enough
to educate one family up to the realization that we are its
equals; the next house we go to, the same work may have to be done
over again; but each time it is done, and done well, the whole
profession has been benefited, which is an aim worth striving for.
VIII
THE NURSE AS A TEACHER
It does not occur to every nurse, when she graduates, that she has
been preparing herself, during all these strenuous years of study
and hospital work, for the life of a teacher. She fondly imagines
that she is a nurse, and only that; but after she has been doing
private duty for a year or more, she realizes that she is
generally a teacher as well as a nurse, and that often she is a
missionary also.
Perhaps no private duty nurse needs to be told what subject she
must teach; the patient or the patient's friends never let her
rest until she has told the "why" of every thing she does, or does
not. There are, however, some important subjects that the nurse-
teacher should try to make very clear to every patient.
We will begin with the baby, as the babies are with us always, and
if doctors and nurses, science and sanitation have their way,
there will some time be no call but that of the baby, for nurse or
doctor either. The ignorance of the young mother is proverbial;
her wish to know about her baby and its care is pathetically
earnest. The new life is so precious, she would take such good
care of it, if she only knew how. Here is a pupil eager for
knowledge, ready to do all that can be intelligently taught to
her. The nurse should have very clearly in her mind all the
mysteries of digestion, all the reasons for regularity in feeding,
the necessity for fresh air, for long and uninterrupted slumber,
for loose clothing, for regular bathing. She should be able to
give the mother the rules for her own living that she may be able
to provide the best milk for the baby, or, if the little one has
to be artificially fed, the methods of preparing the particular
food chosen should be explained, and the indications of
indigestion pointed out. All this is real teaching, real
missionary work, and if well done will help the mother immensely
and probably save the baby many attacks of colic or worse. Washing
the baby is usually regarded by the young mother as a terrible
ordeal. No nurse should leave her young-mother patient until she
is fully able to perform this task. Let the mother watch, a few
mornings, while the nurse does all the work, then let her undress
the baby, when the nurse can take him and finish the operation.
Day by day let her do a little more, as her strength and ambition
permit, until at the end of a week she is fairly used to handling
the child and can, perhaps, keep him until the last finishing
touches are put on. The nurse should always be near, to help, to
advise, to take the child should the mother become exhausted.
Finally, she should go into another room, and, leaving all things
ready, allow the mother to perform the duty by herself, letting
her know that at any time she will be relieved if necessary. In
this way the mother becomes accustomed to the child, and the bath
is always a pleasure to her. How many times have we heard pathetic
stories of a young mother trying for the first time to wash the
baby?--the tears of despair, the nervous blunders, the exhaustion
when the performance was brought to a hasty close. All such
stories mean that the nurse in charge was not a teacher and that
her work when she left the case was not completed.
Suppose that this baby is the third or fourth, the mother knows
what to do for the new little one, but how about the others? She
is still anxious to do what is right, or perhaps she is not
anxious, and her attitude toward the children is not what it
should be. Perhaps she does not realize that she will be called to
account for these souls intrusted to her care, that these bodies
will do their part in life, well or ill, as she treats them wisely
or foolishly. Here is true missionary work. A thoughtful,
intelligent, judicious nurse can show a mother that an adenoid may
be responsible for Johnny's inattention, as it causes dullness of
hearing, how Mary's fretfulness is caused by too little sleep or
by insufficient ventilation of her room at night. She can explain
how irregular eating causes the children to be cross and
irritable. She can show why the first teeth should be removed when
the second begin to push towards the gum. She can teach the mother
that the headaches so often met with, in children who go to
school, are due, perhaps, to eye strain, and can not be corrected
with pills, and should never be soothed with headache powders. She
can show the evils of the gallons of soda water too many young
women swallow, of the injudiciousness of allowing young girls to
congregate in drug stores. These last two evils, "soda water and
the drug store habit," the mother may know nothing about. She is
busy at home with the "little ones," and the fourteen- or sixteen-
year-old girl only too often is allowed to wander off "down town"
with other young girls, and what she does there would astonish
many a mother.
Every nurse should know how to teach her patient to guard herself
and her children from tuberculosis. She should be able to show
what the early symptoms are, what is then necessary to do, what
care should be taken of the sputum, of the patient's food, of his
eating and drinking vessels, his bed and bedding. She should know
how to teach a tuberculosis patient to care for himself, how he
can avoid giving his disease to others, if he stays at home; and
where he will find proper hospital or sanatorium accommodations if
he goes away.
Most mothers are very thankful for practical hints from one who is
supposed to know, and who, during a four to six weeks' stay, makes
herself one of the family, and offers advice in the _right
way_ and _at the right time_.
The great sex question is almost sure to be discussed at such a
time. The advent of a new baby is such a wonderful thing that
nearly always the other little ones want to know (very naturally)
where it came from. Little folks are brimful of curiosity. It is
Nature's way, I suppose, of teaching them. Every new thing fills
them with admiration, with joy, and they must know all about it.
"Oh, mamma, what a lovely new pony! Where did you get it?" "Is it
really mine?" "Oh, papa, what a dandy, new sled! Where did you get
it? Can't I use it right now?" "Oh, have we got a new baby? A real
baby? Is it ours? Where did it come from?" "Can't I hold it?"
All are familiar with these expressions of wonder, of delight, of
joy of possession, but how to satisfy the eager mind aright is a
problem requiring our most careful thought. Books, papers, and
magazines tell us what to say and how to say it. All this should
be talked over, and, if the mother does not know, the nurse should
know what books to tell her to read.
The medical world to-day is much concerned over the question of
prostitution and its effect upon the coming race, through the
transmission of syphilitic taint to an innocent wife, who is
thereafter barren, or who bears syphilitic children. The folly of
the double standard, purity insisted on for the wife, unchasity
condoned in the husband; all these subjects are sure to be brought
up, and the nurse who goes prepared on these and kindred topics
can do an immense amount of good to the women she nurses.
She can show how useful the knowledge of chastity is to a boy-the
strength that comes from self-control, the weakness that follows
self-indulgence, the danger to himself and to those he really
loves when he contaminates himself with prostitutes. A young man
once said to a friend of mine, "Oh! if my mother had only warned
me of the suffering I would cause myself and others, I never would
have polluted my body and shamed my soul." The nurse should know
how to instruct the mother as to the signs of self-abuse in her
little boys, so that she may know what causes the nervous
movements, the pallor, the fitful appetite, the dark circles under
the eyes, the listlessness, the fondness for being alone--any one
of which should call for extreme watchfulness. All these things a
nurse should be sure to know, so that, as far as in her lies, she
should be one more earnest woman striving to make the world better
for her having lived and worked in it. A wise man has given this
quaint description of a perfectly educated man: "When a man knows
what he knows, when he knows what he does not know, when he knows
where to go for what he should know, I call that a perfectly
educated man." So with the nurse. When she finds a social problem
with which she is not familiar, let her turn to this list of
books, magazine articles, and pamphlets upon the subject: Chapman,
Rose R., The Moral Problems of Children; Dock, Lavinia L., Hygiene
and Morality; Hall, Winfield Scott, Reproduction and Sexual
Hygiene; Henderson, Charles W., Education with Reference to Sex;
Lyttelton, E., Training of the Young in the Laws of Sex; Morley,
Margaret W., The Renewal of Life; Morrow, Dr. P. A., Social
Diseases and Marriage; Saleeby, Caleb W., Parenthood and Race
Culture; Wilson, Dr. Robert N., The American Boy and the Social
Evil, The Nobility of Boyhood, 50 cents (contained in "The
American Boy and the Social Evil"); Hall, Stanley, Educational
Problems, Chapter on the Pedagogy of Sex, Adolescence, Youth;
Northcoate, H., Christianity and Sex Problems; Janney, Dr. Edward
O., The White Slave Traffic in America; Report of the 3 8th
Conference of Charities and Corrections, in Boston, June, 1911,
Sex-Hygiene Section; Kauffman, Reginald Wright, The House of
Bondage; Summary of the Chicago Vice Commission, in the May number
of _Vigilance_; Education with Reference to Sex in the August
number of _Vigilance_ (published monthly at 156 Fifth Ave.,
New York City, at five cents per copy); The Cause of Decency,
Theodore Roosevelt, _Outlook_, July 15, 1911; articles on The
Causes of Prostitution in _Collier's Weekly_, from time to
time, since April 1, by Reginald Wright Kauffman; articles on the
Necessity for Teaching Sex Hygiene, in _Good Housekeeping_,
beginning with the September number; Dr. Dale's articles on Moral
Prophylaxis, in the JOURNAL OF NURSING since the July number;
Instructing Children in the Origin of Life, Elisabeth Robinson
Scovil, in October JOURNAL OF NURSING; Leaflets and pamphlets
published by American Motherhood, 188 Main Street, Cooperstown,
New York; Publications of the American Association of Sanitary and
Moral Prophylaxis, New York City, JOURNAL OF NURSING, February,
1912.
One last word and I have finished. Be careful, oh so careful, that
your instructions are acceptable, that your pupil is anxious to be
taught. Most mothers are anxious on these subjects; if one is
encountered who does not care, first try to make her care (and
this is a task, indeed), and then teach her what to do and how to
do it.
IX
CONVALESCENCE
One frequently hears the private duty nurse deplore the necessity
of her remaining with a patient during convalescence. "I wish,"
such a one would say, "that I never need stay with a patient after
the temperature has been normal for ten days," or, "I do not mind
the first two weeks of an obstetric case, then there is something
to do, but after that I am ready to leave," or again, "When my
patient is ready to go out driving, I always wish she would drive
me home; half-sick people are not to my taste." I have often
wondered if this feeling is not caused by the atmosphere of the
hospital which has, during training, been the nurse's home,--the
hospital, where the patient leaves at the earliest possible moment
of recovery, to make room for someone else. The pupil nurse gets
used to the excitement of critical illness, used to the hard work
of constant watching and fighting for the patients' lives, and
that, and only that, it seems to her, is nursing. So when she goes
to her private cases, and her patient has a long period of
convalescence, she feels out of place, she does not seem to be
doing what she was trained to do, and she frets over it, until
some happy day when the doctor releases her, and she is at liberty
to go once more to some one who is at death's door.
Nurses seem to feel that caring for a convalescent is not
"nursing," but there they are mistaken. After a serious illness it
takes a long time to restore the patient to perfect health, some
function may need the close watching which only trained eyes can
give, and it is not beneath the dignity of the nurse to remain,
and keep watch until every part is once more in perfect working
order. Many nurses feel that it is not nursing to amuse a patient,
but it is nursing to help him on to the healthy plane from which
he has fallen, to play games with an invalid and to watch him, to
read with him, and to watch, to walk or ride or travel with him,
and to watch, always to watch, that the dreaded symptom does not
appear, that the one part which still needs care gets it.
A surgeon does not spend all day, every day, with his gloves on,
and his scalpel in his hand; he is not _always_ operating, or
even arranging for operations; he can find time to see patients,
to sit and talk with them, to advise them, to cheer them, even to
tell funny stories to them, but all the time he is watching them.
A lawyer is not always pleading in the court room, a clergyman is
not forever in the pulpit. The lawyer when talking to his client
is just as truly a lawyer; the clergyman, when visiting his
congregation, is just as truly a clergyman,--the sermon on Sunday
is the climax, if I may so express it, of his week's work. The
lawyer's speech to the jury is the point to which all his efforts
tend after, perhaps, weeks of preparation. So the convalescence of
a patient is the post climax of the nurse's undertaking. She
begins with the climax, severe illness, operation, or obstetric
case, whatever it may be, gradually the stress lessens, the whole
atmosphere of the house becomes natural as the patient progresses
toward recovery; but the process is not complete, and the nurse's
work is not done until the doctor pronounces her trained care no
longer necessary; then she may go, and feel that her work has been
thoroughly done-no small comfort surely.
I wish I could show my young sister nurses how good _for
them_ this period of the patient's convalescence might be. The
delightful rest of regular sleep, and regular meals comfortably
eaten at a table instead of in solitude from a tray, the
opportunity for regular exercise--these things come as a real
luxury when one has been nursing a critically-ill patient, and
anxiety has been with one, night and day. This is the period when
the nurse's nerves, strained to their utmost, can regain their
tone, where the responsibility borne by the doctor and shared by
the nurse is not so great a weight, and the knowledge of one more
victory over death, one more human life saved, gives a joyousness
to the day that is good to experience.
The satisfaction of knowing that by your help the patient has
come, perhaps, from the gates of death; the pleasure of noting day
by day the return of healthful sensations, the gradual ever-
growing desire to once more take his accustomed place in the life
work that has been interrupted--all these are missed by the nurse
who flies from convalescents.