EQUIPMENT AND CARE OF THE SICK ROOM
Adequate care of the sick consists to a large extent in rendering their
physical and mental surroundings as favorable as possible. Obviously, a
sick person, since his strength is already depleted, needs not only to
have his resistance increased in all possible ways, but also to have all
his remaining strength conserved by eliminating every unnecessary tax
upon it. In sickness even slight fatigue, chill, or nervous strain,
insufficient ventilation, or improper feeding, may become factors of
immense importance. Nothing is trivial if it affects the welfare and
comfort of a patient.
Even when perfect provision for the care of the sick is out of the
question, every effort should be made to insure as satisfactory
arrangements as possible. Ideal conditions are seldom found except in
buildings originally planned for the sick; yet in many houses a few
simple changes will produce excellent results. Of course, it is not
necessary in every case to adopt all the following suggestions. Common
sense must be the guide. For instance, in illness that is slight and
likely to be of short duration, a patient may be more distressed than
benefited by radical changes in his surroundings. Except when certain
essentials are concerned, great consideration should be given to a
patient's preferences; yet on the other hand it is not reasonable to
make an entire family miserable in order to gratify some slight whim.
CHOICE OF A SICK ROOM.--A south or east exposure is generally best for a
sick room. A south room may be undesirable in very hot weather, but
sunshine during a part of the day is essential. The room should be
quiet, near the bath room, and well removed from odors from the kitchen.
It should be situated so that good ventilation is possible. It is
desirable though not necessary for it to have more than one window; in
summer the windows must be thoroughly screened. It should be possible to
open the window without exposing the patient to a direct current of air,
and to open the door without placing him in full view of all who pass
through the hall.
It is essential for the patient to have a room to himself. Unless he
needs care or help or watching at night, not even the person caring for
him should sleep in the room. Neither should the rest of the family
keep their possessions in the sick room. Closets opening into the room,
bureaus, and chiffoniers should be emptied of the belongings of other
members of the family, to prevent people from tiptoeing into the sick
room at all hours to remove garments. The sick room should for the time
belong exclusively to the patient, and resulting inconvenience should be
borne by well members of the family.
Every possible precaution should be taken to exclude from a sick room
unnecessary noises of all kinds; flapping curtains, squeaky doors and
rocking chairs, heels without rubber, creaking corsets, noisy
petticoats, ticking clocks, refractory bureau drawers, and rustling
newspapers are among the everyday sounds that irritate the nerves of
sick and well alike. Ordinary out-of-door noises do not usually disturb
the sick, except when the country patient is brought to the city, or the
reverse; but nearby and generally avoidable noise is the kind that
distracts and harasses nervous patients.
Whispering is an annoying sound and should not be allowed, either in the
patient's room or just outside the door. Whatever the subject of
conversation may be, the patient thinks that he is under discussion.
Anything undesirable for him to hear should be settled well out of his
hearing, and in speaking to him there is no possible objection to an
ordinary well modulated voice.
Usually a person's own room is more restful and less disturbing than a
strange place, but if it serves as a work room as well as a bed room, it
may easily be the worst place during sickness. The sight of a desk piled
high with papers or a basket overflowing with accumulations of family
mending may actually delay recovery; even the room itself may constantly
suggest work, and work necessarily left undone. The essential thing to
remember is that mental rest is no less important than physical, and
every effort should be made to secure them both.
FURNISHING.--Superfluous articles add to the care of a sick room, and in
consequence they should be removed at the outset. All the furnishings
that remain should be easy to clean, but it is not necessary for a sick
room to look bare and desolate.
The woodwork as in any other room should have a hard finish, and angles
and corners that harbor dust should be as few as possible. Hard wood
floors without cracks are best from the point of view of cleanliness and
convenience. A few light, washable rugs make the best floor covering,
but very small rugs on highly polished floors slide easily and are
decidedly dangerous. Carpets diminish noise, but are objectionable from
every other point of view.
In furnishing houses people ought to realize more frequently than they
do how greatly nervous fatigue may be increased by ill chosen wall
coverings. Plain papers or tinted walls are best for bed rooms and the
color should not be harsh or striking; soft gray, green, or buff is
good. The design is no less important than the color; a design that on
casual inspection appears quite harmless may become an instrument of
torture to a person unable to escape from it for a single hour. Weak or
nervous patients sometimes become quite exhausted from attempting to
follow an intricate pattern, or from counting over and over a design
that is frequently repeated on the wall. If the patient sees grotesque
faces and figures in the design the paper is more objectionable still.
Necessary furniture includes the bed, which will be discussed in detail
later, a small table to stand by the head of the bed, a dresser, two
chairs, and a wall thermometer. If the patient is able to sit up three
chairs are needed, of which one should be an armchair with a high back.
No rocking chair should be allowed in the room unless the patient
himself prefers to sit in one; no one else should be allowed to rock in
the room, since the motion is almost always annoying to patients.
Elaborate, carved, or upholstered furniture is unsuitable in a sick
room, but if it must be used it should have washable covers.
Other desirable articles of furniture are a couch, screen, foot-stool
and a second, larger table. In few cases, if any, is anything further
really necessary, although patients frequently desire special articles
to which there can be no objection.
Most ornaments add much work and little beauty, and have no place in a
sick-room. No heavy unwashable curtains or hangings should be allowed,
but simple washable curtains and clean white covers for the tables and
dresser are desirable. Pictures, if suitable, give much pleasure, but
must be used with discretion. It goes without saying that the subjects
should be pleasant, but not everyone realizes that complicated subjects
are undesirable and that pictures of people or things in motion should
be avoided; patients are sometimes worried to see motion that is forever
incomplete.
Flowers give great pleasure to the sick by adding color and variety and
interest to their surroundings. They should be carefully tended and
given fresh water daily. Fading flowers and forlorn plants should be
removed from the sick room, and those having strong, heavy odors should
not even be admitted. They do not need to be very many or very
expensive; indeed, a potted plant or a few cut flowers are often more
acceptable than the great masses of costly flowers that are daily
brought to the private wards of hospitals.
VENTILATION.--A patient needs fresh air certainly as much as a well
person, and probably even more. His room should be thoroughly ventilated
night and day. A fireplace makes the problem easier, but in most cases
an open window is the main dependence. It should be possible to open
windows at the top as well as at the bottom, and the patient may be
protected from a direct draught by a screen, or by a sheet stretched
along the side of the bed and fastened at the head and foot by tying it
around the posts.
Ventilating a room without subjecting the patient to draughts is not
always easy. One method is to insert a board three or four inches high
under the lower sash so that air is admitted between the two sashes.
Another way to ventilate without causing a draught is to remove one or
two panes of glass and tack cheese cloth over the opening; or to tack
cheese cloth to the lower edge of the upper window casing and to the
upper edge of the upper sash, after the sash has been lowered about a
foot. Once or twice a day the room should be thoroughly aired by opening
windows and doors until the air has been completely changed. The
patient, including his head, must be well-covered during the process.
An electric fan is useful in summer, but it should not be close enough
to the bed for the patient to feel air blowing upon him.
HEATING.--Great care should be taken to maintain a suitable temperature
in the sick-room, and for this purpose a thermometer in the room is a
necessity. Between 65° and 68° is generally the best temperature, and
hot water bags and extra covers may be given if the patient is chilly.
During a bath or other treatment in which the patient is more or less
exposed the temperature should be 70°. The temperature at night may be
lower; how low will depend largely on the patient's condition and on
what must be done for him during the night. Hot water, steam heat, or
electricity is best for the sick room. Gas or oil stoves should never be
used except in emergencies, and then for a short time only.
LIGHTING.--Sunlight is one of the most powerful disinfectants, and for
this reason if for no other it is needed in every sick room. Sunless
rooms, moreover, even if they were wholesome, are too depressing to a
patient's spirits for use except perhaps in hot summer days. Ordinary
well-regulated light is best in a sick room, and except in a few
diseases, especially those in which the eyes are affected, it is
undesirable to darken the room or to encourage in any way an appearance
of gloom. The patient's eyes, however, should be protected from bright
lights shining directly upon them; in this connection it is well to
remember that lights and their reflections strike differently upon the
eyes of a person lying down from the way in which they strike the eyes
of persons sitting or standing, and a light that seems agreeable to the
attendant may therefore be painful to the patient.
Almost all persons sleep best in dark rooms, and in most cases it is
undesirable for a sick room to be lighted at night. The attendant,
however, must be able to see what she is doing and generally needs a
shaded candle, small night light, or electric flash. It should be
possible to see the patient clearly in case of need, otherwise serious
changes in his condition occurring in the night may pass unnoticed.
A reading lamp on the bedside table is desirable for patients allowed to
read, but reading in bed even with a well-regulated light is fatiguing,
and should not be continued for long uninterrupted periods. A pocket
flash light is safer than matches and a candle for patients who wish to
consult their watches in the night; indeed, matches in the hands of
patients always involve risk. Some patients find twilight a time of
great depression. In such a case it had best be shortened by drawing
the shades early, turning on the lights, and remembering not to leave
him alone.
CLEANING.--The sick-room should be kept thoroughly clean at all times,
and the less dust stirred up in doing so the better. Dry sweeping or
dusting should not be allowed. Ordinary brooms should be dampened or
covered with damp cloths, and dust cloths should be dampened also; but
dustless mops and dusters are still better. Vacuum cleaning is very
desirable; the noise, which is its only disadvantage, is not a serious
objection in most cases. The cleaning of rooms after a communicable
disease will be considered later.
A sick room must be kept tidy as well as clean. The effect of order is
quieting, but it should be maintained whether the effect upon the
patient is apparent or not. Food and medicine should not be kept in the
sick-room, and all used dishes, tumblers, soiled linen, etc., should be
removed at once. Unnecessary articles should not be found in the room at
any time; every necessary article should be kept in its place, and its
place should be a good one.
Maintaining order in the room does not mean that patients should be made
uncomfortable. All patients, especially old people, want certain
possessions within reach, and their wishes should be considered in spite
of the fact that the æsthetic effect is generally far from good. For
instance, a perfectly smooth bed is undesirable if in order to make it
smooth the patient must be tucked in so tightly that he is
uncomfortable. And it would be a mistake to remove an old man's
newspapers before he has read them, even if he persists in strewing them
all over the floor.
THE ATTENDANT.--One person and one person only should carry the entire
responsibility for the patient. She should plan for him as well as care
for him, should see the doctor and take the doctor's orders. Confusion
and innumerable mistakes result when several members of the family
attempt to do the talking and directing.
The attendant should wear washable dresses with sleeves that can be
rolled up, washable aprons, and shoes with rubber heels. All her
clothing should be comfortable. She should be neat in appearance,
scrupulously clean in person, and should keep her finger nails short and
smooth. Jewelry, especially rings and chains that rattle, and finery of
any sort are all out of place in a sick-room.
The attendant must learn that her own sleep, her diet, and her
out-of-door exercise are essential to the patient's well-being hardly
less than to her own. An amateur nurse often considers that going
without food and sleep is a proof of her devotion. In a passion of
self-sacrifice she neglects herself utterly for the first few days, and
as a consequence is quite useless at a later period when her services
may be most needed. An exhausted, sleepy nurse, trained or untrained, is
wholly unfit to be trusted with medicines and doctor's orders, to note
changes in the patient's condition, or to give him kindly attention.
Efficiency and fatigue have never pulled together since the world began,
and no one can do good work when suffering from lack of sleep and rest.
The person, then, who genuinely wishes to give her patient the best
possible care should not make a martyr of herself. She should go out of
doors daily; both fresh air and occasional absence from the patient are
essential to her physical and mental well-being. Moreover, she will be
showing her patient the greatest kindness in the long run if during her
recreation time she thinks of him as little as possible. Indeed, she
need not consider herself inhuman if she has a thoroughly good time.
On the other hand, a person who is responsible for the care of a patient
must be made to realize that she and she only is ultimately responsible
during the entire 24 hours of every day. Being responsible for a patient
does not mean that she should be with him every minute, or do everything
herself: it does mean that she should plan so effectively that
everything necessary is done, either by herself or by another competent
person. When she goes away for even half an hour, she should appoint
someone else to be responsible in her place and to her when she comes
back. She must consequently make very clear just what she wants done. If
there is medicine, nourishment, or treatment to be given, she can easily
make a list, with the time for each, and ask that each item be crossed
off the list as soon as the work has been done. She should not forget to
ask for the list when she returns.
What is really needed is a little executive ability. As Florence
Nightingale said:
"It is impossible in a book to teach a person in charge of
the sick how to _manage_, as it is to teach her how to
nurse. Circumstances must vary with each different case.
But it is possible to press upon her to think for herself.
Now what does happen during my absence? I am obliged to be
away on Tuesday. But fresh air, or punctuality is not less
important to my patient on Tuesday than it was on Monday.
Or: At 10 p.m. I am never with my patient; but quiet is of
no less consequence to him at 10 than it was at 5 minutes
to 10. Curious as it may seem, this very obvious
consideration occurs comparatively to few, or, if it does
occur, it is only to cause the devoted friend or nurse to
be absent fewer hours, or even fewer minutes from her
patient--not to arrange so as that no minute and no hour
shall be for her patient without the essentials of her
nursing."--(Notes on Nursing.)
It is exceedingly difficult to care for members of one's own family or
to be cared for by them. Too much or too little is almost invariably
expected by one person or the other, and where great affection is
involved not only is the strain increased on both sides, but often harm
results from too great unselfishness on either side or both. But
sometimes the reverse is true, and then one should remember that normal
behavior may be impossible for the sick. During weakness and pain,
irritability and unreasonableness are as characteristic as other
symptoms, and it is as foolish to demand a normal mental state from a
sick person as it would be to demand a normal temperature. For a
cheerful, reasonable, and unselfish patient--and there are surprisingly
many--one should be devoutly thankful, but patience and pity should be
given no less to those whose tortured nerves cause suffering to others
as well as to themselves.
Every woman who cares for the sick should remember that she is the
patient's chief if not his only link with the normal world, and that his
plight is pitiful indeed if she is complaining or irritable or
unwilling. Anyone who cares for the sick should remember also that she
is necessarily in a most intimate relation with the patient, and that
such enforced intimacy calls for extra consideration on her part, and
for the most scrupulous respect for confidential matters. It is
inexcusable even for members of the patient's family to discuss with one
another the patient's private concerns, or his queer or unreasonable or
annoying ways. During sickness the skeletons in most people's mental
closets walk forth, and anyone who misuses special opportunities to know
intimate affairs can only be classed with eavesdroppers and village
gossips.
EXERCISES
1. What are the essentials of a good sick room as to:
(_a_) Situation and exposure.
(_b_) Lighting and heating.
(_c_) Furnishing.
(_d_) Ventilation.
2. How may a sick room be ventilated without exposing the patient to
draughts?
3. How should the bed be placed in relation to doors, windows, and
walls?
4. How should a sick room be cleaned?
5. What in general are the duties of the attendant?
6. Make a plan of your own bedroom, and show what changes, if any, would
be desirable if it were to be used as a sick room.
FOR FURTHER READING
Notes on Nursing--Florence Nightingale, Pages 1-63, 84-105.