with this unwillingness to remain with a patient when he is
convalescing? When a temperature has to be taken but once a day,
or when the doctor only makes visits twice a week, when all the
routine of the sick-room gives way to a more natural atmosphere,
many nurses do not feel at ease, they do not read aloud
pleasantly, they do not care for books, and, if the patient asks
for this amusement, the reading is a torment to the nurse, and I
imagine it does not afford much pleasure to the listener. A nurse
once gave me a graphic description of her efforts to read "Romola"
to a convalescent typhoid patient. The poor nurse knew nothing of
Florence or of the Italian language, and her struggles over the
foreign words in that book must have been funny enough. Her
patient was not much edified--of that I am certain. If a nurse
does not read aloud understandingly, she should make every effort
to learn. She thereby increases her usefulness, and makes herself
more acceptable to her patients. She adds to her own value. She is
worth more. No nurse can tell when this method of passing the
weary hours will be required of her, as it is almost certain that
a patient of intelligence will ask for some mental refreshment.
Another pleasant way to pass the long hours of convalescence, is
by playing games with your patient. I am sure no training school
for nurses has added the study of cribbage, pinochle, bezique,
chess, checkers, backgammon, or dominos to its curriculum. All
these are two-handed games, the playing of which will help the
convalescent to forget himself and his past illness and present
weakness. The nurse, if she knows only one game that is unfamiliar
to the patient, gives him new thoughts while she teaches him, and
it is quite astonishing how much pleasure such simple things can
give both to teacher and pupil. I would suggest that nurses in
their club houses or homes could profitably fill some vacant
evenings practising these two-handed games. I am sure they would
never regret the time so spent.
If the convalescent is a woman, the means of amusing her are more
varied and more congenial perhaps. In addition to reading aloud
and playing games, there is the vast realm of "fancy work," where
most women feel at home. It is a pity, so few women nowadays know
anything about knitting, crochetting or tatting,--many do not even
know which is which. A lady asked me very innocently, not long
ago, how I could tell the difference between knitting and
crochetting! Since Irish crochet has returned to favor, however,
many have once more taken up their crochet needles. The nurse who
can deftly turn her hand to these dainty arts, and can teach them
to her patients, or any of the patient's family, has the means of
making herself a very acceptable companion, apart from her nursing
skill. Embroidery is very fascinating, and appeals to every woman.
A dainty little garment for your patient, embroidered while you
watch her return to health, will be long treasured by her. For a
nurse, what art, what accomplishment can she have that will not
help some poor invalid, that will not shorten the weary hours for
some sick body, or bring consolation to a weary soul? A perfect
nurse is one who brings comfort to her patient. It is because
trained nurses bring more comfort that they have replaced the old
style nurse; the more comfort the nurse brings, the more
successful she is. The ability to talk well, when talk is needed,
to read well, to amuse understandingly, to wisely meet each need
of the invalid as it presents itself, this is to be the ideal
nurse.
X
HOW SHALL A NURSE OCCUPY HER DAYS OF WAITING?
To many nurses the time between cases is dreaded as a period when
money is being spent for necessary maintenance, and none is coming
in; a nervous time, as the ring of the telephone which may mean a
call is wished for or dreaded, perhaps both; an anxious time, as
no one knows how long she may have to wait; a dreary time, as the
days drag on and still no call comes. It _is_ a trying time,
but much can be done in these days of waiting that is delightful
in the doing, and that will prove a source of pleasure to all
future patients, and no little profit to the nurse also.
Let me preface my few hints by saying that all patients and
patients' friends expect the nurse to know all about the diseases
and their cures, the care and management of the sick,--that is
common, ordinary nurses' business,--but there too many nurses
stop; they often can go no further; and when one comes to a family
and adds to this a broad culture, and an intelligent interest in
the topics of the day, the respect and admiration of the patient
and family are unbounded, and their surprise genuine.
I would like, if possible, to impress upon the nurse graduate that
really there is much to learn after she has left the training
school. All the technic of hospital and operating room is fresh in
mind, but there is so much that lies necessarily outside the walls
of a hospital, and this knowledge that comes with experience is a
great part of what makes a successful nurse.
I will not touch here upon what every nurse knows so well,
relating to the "preparedness" of clothes, satchel, and
instruments. We take it for granted that all this is ready. The
case before has been a hard one, we will imagine, and several days
have been given to the luxury of whole nights in bed, and whole
days of resting; this is all done, and the next case is awaited.
The best thing to do first is for the nurse to examine a little
her mental equipment, see what she has stored away in her mind
that can help the next patient, or that can assist in fighting the
battle of hygienic cleanliness versus disease-bearing dirt. Let
her consider whether she reads aloud acceptably, understandingly.
Has she a good list of books which most women would enjoy? Does
she know what books to suggest for the children? Can she tell what
would interest the boys, or what a man would like to listen to?
Does she know humorous books, interesting histories, or
biographies? Here, then, is occupation for many idle days.
To go to a public library is always a pleasure, to make friends
with the librarian is an added pleasure, as is also the making
one's self familiar with some good books that can always be
procured, and that will give pleasure and profit to patient after
patient. This search for good literature will give happiness in
the quest, and happiness in the reading. Librarians are usually
glad to direct one to the books needed, and many delightful hours
may be spent in the library, and all the while the comfortable
feeling experienced that the pleasure felt will be transferred
later to future patients.
The subject of hygiene is taught in most training schools, and
indeed in many day schools as well; but this is a branch of
knowledge that is growing so rapidly that, unless the very latest
discoveries are learned, the nurse may find herself of use merely
when the infection has done its work.
I wonder how many nurses have made use of the bulletins issued by
the U. S. Department of Agriculture in Washington. These are
called Farmers' Bulletins, but many of them are of use to all
mankind, be they farmers or not. They are free to any who ask for
them, and up to the present time about five hundred have been
issued. They are upon all sorts of subjects--Flies, Malaria, The
Destruction of Rats, Care of Food in the House, Fruit as a Food,
Cereal Breakfast Foods, etc., etc., subjects _ad infinitum._
Here, then, is a mine of information open to anyone who asks; all
one has to do is to write to the Secretary of Agriculture and ask
to have sent a list of the Farmers' Bulletins published by his
department, and from the list any bulletins may be selected, and
they will be sent. Ask for what is needed; it is all meant for the
education of the public. The information is absolutely reliable,
and represents the best thought of the country--expert advice by
the foremost scientists.
I have often thought that a nurse who made the nursing of children
a specialty, or even those who nursed children occasionally, would
be much profited by a course in a Kindergarten Training School.
The private duty nurse, however, having but a few days at her
disposal, cannot do anything as extensive as that; but a very good
substitute is at hand, in the kindergarten department of any of
our public schools. It is most interesting to go to a public
school, ask to see the Principal, and let the nurse explain her
visit, and show her how helpful it would be to future little sick
folks, if she might be allowed to study some of the kindergarten
methods, and permission will readily be given. When the nurse
reaches the room of the "littlest ones," let her sit down, and
quietly watch what is done for them, and how they are managed. The
kindergartner will be glad to tell where she finds the charming
stories she relates; she will give models of the wonderful things
her pupils cut out of paper, the canoes, the men to sit in them,
the wigwams, the sleds, automobiles, swings, stoves, trees,
apples, etc., etc., articles well-nigh innumerable, and all so
simple and so deftly made. A small convalescent could be amused
for weeks with the things one could learn in a few hours in one of
our city kindergartens. I speak of the things I know, for I have
tried it, and I never yet found a Principal who was not glad to
have her kindergarten studied, nor a kindergartner who was not
pleased to know that she could assist in the work of nursing sick
children, even in this seemingly roundabout way.
In all of our large cities are fine art galleries, and in many
there are fine loan collections on exhibition every summer. There
are, besides pictures in these loan collections, many things; some
curious, some beautiful, and all of them interesting. Some days
spent in these galleries will bring much knowledge and beauty into
one's life. Time must be taken for these visits; no one can
appreciate the patience and skill of oriental handiwork in a
hurry. If unacquainted with the exhibits, a catalogue should be
purchased, and each one studied until one knows why it is there,
and what is its beauty. I remember seeing, one day, in a
collection, a cup of jade, with a very finely wrought handle; I
thought it fine, but did not appreciate it until the Custodian
told me that it took the artist twenty years to carve that one
cup, jade is such a hard stone. This cup was so valuable that the
Kensington Museum, in England, had paid an immense sum of money
for it, as a nearly perfect specimen. This information was my
reward for close study of an exhibit. In these exhibitions one
could spend many vacant days with much pleasure and profit.
In whatever town a nurse lives she should familiarize herself with
the philanthropic efforts of the place. In the largest cities it
is not possible to know them all, but she should know about some
of the settlement work, the day nurseries, the babies' hospitals,
the rescue work, the homes for aged. Of course she will know about
the hospitals and dispensaries, but what is done for the poor, the
ignorant, the sinful, and the stranger--these she should learn.
Many times she could do much to help these institutions, by
relating, simply and truthfully, when occasion offers, what she
has seen, of the great needs of such efforts, and the heroic work
of those who go down and live amongst the needy and try to uplift
them. Many a rich, idle patient might become interested and give
money, if not time, to help in these good works; and my experience
shows that they generally need all the help they can get. So the
nurse should know about the anti-tuberculosis work, the night
schools, the playgrounds on the roofs of the school-houses, all
the philanthropic work of her town, and she cannot know about it
unless she takes some of her vacant days, her days of waiting, and
turns them into days of learning, and the expansion of both her
mind and her heart.
Another pleasant way to spend some days of waiting is to study the
trolley system of the town where you live. Learn how far it can
go, to how many other towns. If a river is near, become familiar
with its steamboats. Excursions on boat or trolley will be
delightful, and will teach the best routes, the best terminal
stations, and the best restaurants, and some day when a patient is
well enough to take an excursion, some part of his own immediate
neighborhood may be shown him which he has never seen before.
Believe me, all this will be appreciated. Space fails me to tell
of music to be heard, theatres to be enjoyed, and all to be used
hereafter for the benefit of those to whom you will be called to
minister. The information constantly gathered in the "days of
waiting," rightly used, intelligently imparted to the patient or
her friends, will make of the nurse such a broad-minded,
sympathetic woman that everyone who employs her will appreciate
the fact that she has a wide culture, and brings to her patient
something besides mere technical skill.
XI
SOME HINTS FOR THE OBSTETRICAL NURSE
THE BABY'S WARDROBE.
When a nurse goes to see a woman who wishes to engage her, some
months hence, to care for her baby and herself, it is very nice to
be able to give her, should she ask, a list of all the things she
will need, both for her own comfort and the baby's.
The following is a good sensible wardrobe, and will be found
ample, though many articles more or less fanciful will, most
probably, be added by friends. The things enumerated below should
last the baby until he is put into short clothes:
Slips, 10. Dresses, 8 to 10. Pinning blankets, 4. Flannel skirts,
4. White skirts, 5. Shirts, 4. Bands, plain flannel, 4. Bands,
Jersey made, 4. Diapers first size, 17 inches square, 20. Diapers
second size, 20 inches square, 30. Diapers third size, 26 inches
square, 30. Knitted blankets, plain white, 2; if with any color, 4
to 6. Knitted sacques, 4 (two sizes). Little pillow (hair), 6
cases. Crib sheets, 6. Crib blankets, 2.
FOR BASKET.
Two small gold safety pins. Large safety pins, I box. Small safety
pins, i box. Powder box and puff. Coudreay's powder. Small box of
equal parts borax and powdered sugar. Old damask towels. One cake
old white castile soap, or Colgate's nursery soap. One bottle
unscented vaseline. As many sachets as you can get. Some few yards
of the narrowest ribbon, pink and blue. Two old handkerchiefs. One
lap protector. Brush and comb. Absorbent cotton.
FOR THE MOTHER.
All the old sheets in the house. Rubber sheet, double width. A
square of rubber sheeting single width. An old comforter.
[Footnote: When the Kelly pad is used for the delivery, the
old comfortable, the blankets and the single width rubber
sheet need not be provided.]Two or three old blankets. Fountain
syringe. Paper basin. Towels ad libitum. Six or seven night
dresses, three of them old. Undershirts, if worn in bed, 4
(large). Bandages, 6. Cheese cloth, 10 yards. Absorbent cotton, 2
lbs. A large flannel sacque, or a nightingale. Soft unbleached
muslin, 2 or 3 yards. Colgate's fumigating wafers, I box. Bedpan,
I.
Layettes can be purchased at any good department store, but many
expectant mothers prefer to make all the clothes for the little
one. These lists are for the benefit of these mothers.
These look, perhaps, like two very formidable lists, but a second
glance will convince any one that all these articles are
absolutely necessary, and none of them are expensive.
The slips should be made very plainly. The material may be as fine
as can be bought, but beyond a few tucks about the yoke, and a
little lace or fine embroidery about neck and sleeves, should be
perfectly plain. The dresses, of course, are somewhat more
elaborate, but the fashion now decrees that infant's clothing
shall be perfectly plain, and a most sensible fashion it is.
Pinning blankets are open all down the front, and are usually made
in the shops with a broad band of stiff white muslin, which shows
that the people who made them never tried to dress a baby. The
band should be of flannel or coarse linen many times washed so
that it may be soft, and the pins will go through many folds of
it. Flannel skirts are usually made of two breadths of flannel,
and are more or less embroidered. These are not left open, except
just enough to make the dressing easy. Shirts are made so well in
stores that few people care to knit them. They should always be
high in the neck and long sleeved, and it is better to get two
sizes, as, if the baby is small, it never can be comfortable in a
large shirt that does not fit.
The four flannel bands should be 6 inches wide by 17 or 18 long,
torn the length way of the flannel and left just as torn. Not
hemmed or ornamented in any way. No hemming or stitching can be so
fine that it will not mark the baby's flesh. Besides this, if you
have these plain bands and find they are several inches too big,
nothing is easier than tearing off a strip and making them fit. If
the child has a very large, round abdomen, they can be made to fit
over it nicely by taking two little tucks on the lower edge, about
half an inch from the middle of the band, and letting the tucks
run up about an inch or a little more, tapering it off gradually.
When these are discarded and the Jersey made bands are put on,
always put them on the baby feet first, as it is hard to get them
over the shoulders.
The very best material for the first small diapers is old, soft
table damask. The better the quality, the softer it will be; be
sure they are exactly square. Nothing is more trying, in a small
way, than to get a diaper that cannot be folded true. These should
be made double and the edges turned in and sewed around. By the
time the baby has outgrown them they will be fit only for the rag-
bag, and may be thrown aside. The second size diaper, also the
third should be many times washed to make them soft enough for
use. These may be used at first folded eight times and put under
the baby next the damask diaper, between that and the pinning
blanket, and will often save the nurse the trouble of changing the
baby's clothing, because it is wet through. In this way they will
get more washings and be softer when you have to use them next the
baby's skin.
Cotton flannel, with a good nap and not a very close web, is very
good also and can be used instead of the damask where that cannot
be procured. Put it on with the nap next the skin. It is an
excellent absorbent.
The baby should have at least one little (rather flat) hair
pillow, covered on one side with blue or pink silk, on the other
with plain white over the ticking. The prettiest pillow cases I
ever saw were made of broad hemmed pocket handkerchiefs. Two sewed
neatly together round three edges, and on the fourth button holes
for mother-of-pearl studs. The handkerchiefs may be fine or not,
embroidered or plain, and may have lace sewed on the edge, but
they can't help being pretty, and the embroidery will never be in
the middle. I shall never forget my pity for one poor little mite
I saw once, who, on waking from his sleep, was discovered to have
the print of an embroidered S on his cheek. It had been worked in
the centre of the little pillow case by some loving but ignorant
hands. When the baby uses the pillow, let him sleep on the white
side; at other times turn up the colored side and the pink or blue
will show very prettily through the linen. If you let the child
sleep on the colored side he may, most likely will, vomit some
sour milk on it, sooner or later, and the beauty of your pillow
will be gone.
If the regular little crib blankets are thought too expensive, a
very good substitute may be made from white eiderdown cloth, which
is warm, soft, and not at all costly.
The gold safety pins are intended for the final pinning of the
dress in the front and in the back. Of course any little
ornamental baby pin answers the purpose just as well, and, indeed,
an ordinary safety pin will do should no other be at hand.
The little box of equal parts of borax and sugar should not be
forgotten. Mix the two very thoroughly, and if any little white
aphthous spots appear on baby's lips, tongue or cheeks, apply a
little of this mixture several times a day, and they will probably
all be gone by night. Put it on very carefully with the tip of
your finger slightly moistened so that some of the powder will
adhere. Examine the baby's mouth every day for these spots. They
are likely to appear any time after ten days or two weeks, and are
more often seen in weak children, or those who are fed by a
bottle. If the spots appear on a child who is taking the breast,
the nipples are very apt to be sore. Much care, therefore, must be
exercised in this matter.
Sachets are a real luxury in the drawers of the baby's bureau.
Atkinson's sachets are the best, though Colgate's violet is very
delicate and pleasant. Put one or two amongst the little shirts,
and some among the knitted blankets, but mostly have them in the
dresses, and be sure when you take out a clean dress, or slip, to
take the sachet and slide it into the neck of the slip that will
be worn tomorrow. Nothing can be more attractive than a clean,
sweetly smelling baby, and, _per contra_, nothing is more
disgusting than a wet, sour, cold, crying baby. If he be wet and
sour he will surely have cold feet and hands, and as surely will
he cry. Poor little thing! It is his only way of expressing his
opinion of the state of his toilette.
It is very pretty, when the baby is fresh and clean, and has on a
fine slip with lace edging the sleeves, to tie around the wrist,
outside of the sleeve, a piece of pink or blue ribbon. Make a nice
little bow and let the lace fall over the fat little hands, like a
frill. Be careful not to tie the ribbon too tight, and keep it
clean. If it becomes soiled or wet, take it off directly.
A lap protector is made by covering a piece of rubber cloth about
14 inches square with several thicknesses of old blanket. To cover
this have some slips like pillow cases, of linen or cotton, plain
or fancy, as the lady may have time or money. Slip the "protector"
in its case, and lay it on your own, or any one else's, lap who
wishes to hold the baby, and it perfectly protects from all
wetting.
TABLE FOR ESTIMATING THE PROBABLE DURATION OF PREGNANCY
Two hundred and eighty days, forty weeks, ten lunar months, or
nine calendar months are here estimated as the usual duration of
pregnancy (the actual computed average being 276-2/3 days). The
exact day of conception (_not_ the fertile coition), can
never be accurately determined; the only date from which
conception can be dated, and the probable confinement day
predicted with some chance of certainty, is the first day of the
last menstrual flow, adding to this one week (seven days) for the
average duration of the flow (with a few days lee-way). We count
nine calendar months forward, and have the approximate date of the
expected confinement. The most ready method is to add seven days
to the first day of the last menstrual flow, count back three
months, and add one year, when we have the future date when, or
about when, delivery may be expected.
An _exact_ estimate is but guess work; errors of one or two
weeks either way may be made by the most experienced, as in cases
where conception occurred shortly before the next menstrual
period, which did not then appear.
The present table is constructed on the above principle, the
second column representing the day of quickening, nineteen weeks
after the beginning of the last menstruation, with seven days
added; and the third column still twenty weeks later. The date of
quickening is still more variable than that of delivery, from one
to four weeks.
Intermediate dates may be fixed by adding the necessary number of
days to each column. Thus, for Jan. 11th, the second column should
read 31st of May, and the third column, October 18th, and so on.
Beginning
of last
Quickening. Confinement. Menstruation.
Jan. 1st.........May 20th.........Oct. 8th.
Feb. 1st.........June 20th.........Nov. 8th.
March 1st.........July 18th.........Dec. 4th.
April 1st.........Aug. 18th.........Jan. 6th.
May 1st.........Sept. 17th.........Feb. 5th.
June 1st.........Oct. 8th.........March 8th.
July 1st.........Nov. 17th.........April 7th.
Aug. 1st.........Dec. 18th.........May 8th.
Sept. 1st.........Jan. 18th.........June 6th.
Oct. 1st.........Feb. 17th.........July 8th.
Nov. 1st.........March 20th.........Aug. 8th.
Dec. 1st.........April 19th.........Sept. 7th.
ARTICLES FOR THE MOTHER'S USE.