notes on nursing

Never make a patient repeat a message or request, especially if it be some time after. There are numerous other published versions of Notes on Nursing, but this one stands apart from those given its commemorative nature. 25,466 were returned, at the census of 1851, as nurses by profession, 39,139 nurses in domestic service, * and 2,822 midwives. It was that the slops were emptied into the foot pans!–it was that the utensils were never properly rinsed;–it was that the chamber crockery was rinsed with dirty water:–it was that the beds were never properly shaken, aired, picked to pieces, or changed. Yes, but nature is stronger than fashionable physicians, and depend upon it she turns the faces back and towards such light as she can get. Then the same temperature which refreshes power to the patient. fire should be, if necessary, replenished. Whereas, if you could but arrange that the thing should always be done whether you are there or not, he need never think at all about it. If you believed in and observed the laws for preserving the health of houses which inculcate cleanliness, ventilation, white-washing, and other means, and which, by the way, are laws, as implicitly as you believe in the popular opinion, for it is nothing more than an opinion, that your child must have children's epidemics, don't you think that upon the whole your child would be more likely to escape altogether? And nothing but observation and experience will teach us the ways to maintain or to bring back the state of health. It is often thought that medicine is the curative process. instead of looking upon them as conditions, like a dirty and a clean condition, and just as much under our own control; or rather as the reactions of kindly nature, against the conditions in which we have placed ourselves. Both these peculiarities might be observed and indulged much more than they are. Why should it go? See more ideas about nursing notes, nursing study, nursing tips. But don't let the patient be wearily waiting for when you will be out of the room or when you will be in it. Another great difference between the bed-room and the sick-room is, that the sleeper has a very large balance of fresh air to begin with, when he begins the night, if his room has been open all day as it ought to be; the sick man has not, because all day he has been breathing the air in the same room, and dirtying it by the emanations from himself. Now what is a nurse to do in such a case? * * * * * [Sidenote: Disease a reparative process.] A patient in such a state is not going to the East Indies. Let your thought expressed to them be concisely and decidedly expressed. I have seen surgical "sisters," women whose hands were worth to them two or three guineas a-week, down upon their knees scouring a room or hut, because they thought it otherwise not fit for their patients to go into. Air is always soiled in a room where walls and carpets are saturated with animal exhalations. may be trusting to the patient's diet, or his medicine, old? The smell from the floor of a school-room or ward, when any moisture brings out the organic matter by which it is saturated, might alone be enough to warn us of the mischief that is going on. I must * Views captured on Cambridge Core between #date#. And terrible is the injury which has followed to the sick from such wild notions! In large institutions for the sick, even the poorest, the utmost care is exercised. People who think outside their heads, the whole process of whose thought appears, like Homer's, in the act of secretion, who tell everything that led them towards this conclusion and away from that, ought never to be with the sick. To ventilate a small room without draughts of course requires more care than to ventilate a large one. To return to real disease. That the more alone an invalid can be when taking food, the better, is unquestionable; and, even if he must be fed, the nurse should not allow him to talk, or talk to him, especially about food, while eating. some bed-ridden sufferer, they let him lie there staring at a dead wall, without any change of object to enable him to vary his thoughts; and it never even occurs to them, at least to move his bed so that he can look out of window. True nursing ignores infection, except to prevent it. They invariable prefer a story to be told to them, rather than read to them. It is really less exertion to him to write his letters himself. I question if any greater security could be afforded against I can hardly say which is most abominable, whether to do this or to rinse the utensil in the sick room. But in chronic cases, lasting over months and years, where the fatal issue is often determined at last by mere protracted starvation, I had rather not enumerate the instances which I have known where a little ingenuity, and a great deal of perseverance, might, in all probability, have averted the result. Now, dogs do not pass into cats. I have know patients delirious all night, after seeing a visitor who called them "better," thought they "only wanted a little amusement," and who came again, saying, "I hope you were not the worse for my visit," neither waiting for an answer, nor even looking at the case. I have often been surprised at the thoughtlessness, (resulting in cruelty, quite unintentionally) of friends or of doctors who will hold a long conversation just in the room or passage adjoining to the room of the patient, who is either every moment expecting them to come in, or who has just seen them, and knows they are talking about him. It may be worth while to remark, that where there is any danger of bed-sores a blanket should never be placed under the patient. This has happily been remedied. : in petty management, or in other words, by not knowing how to manage that what you do when you are there, shall be done when you are not there. of knowledge or attention, in one or in all of these things, Of course there are many cases where this cannot be done at all–many more where only an approach to it can be made. A short time ago the bursting of a funnel-casing on board the finest and strongest ship that ever was built, on her trial trip, destroyed several lives and put several hundreds in jeopardy–not from any undetected flaw in her new and untried works–but from a tap being closed which ought not to have been closed–from what every child knows would make its mother's tea-kettle burst. examined by the hand from time to time, and wherever a But if you cannot get the habit of observation one way or other, you had better give up the being a nurse, for it is not your calling, however kind and anxious you may be. Their name is legion. If, on the other hand, and which is much more frequently the case, the patient says nothing, but the Shakespearian "Oh!" In what sense is "sickness" being "always there," a justification of its being "there" at all? And under no pretence have any ledge whatever out of sight. The same with many organic diseases. There are excellent women who will write to London to their physician that there is much sickness in their neighbourhood in the country, and ask for some prescription from him, which they used to like themselves, and then give it to all their friends and to all their poorer neighbours who will take it. Yes, impossible as it may appear, I have known the best and most attentive nurses guilty of this; aye, and have known, too, a patient afflicted with severe diarrhoea for ten days, and the nurse (a very good one) not know of it, because the chamber utensil (one with a lid) was emptied only once in 24 hours, and that by the housemaid who came in and made the patient's bed every evening. It does not make a thing good, that it is remarkable that a woman should have been able to do it. Let the patient's taste decide. Again, the question, How is your appetite? his ward windows hermetically closed. 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. The whole of the preceding remarks apply even more to children and to puerperal woman than to patients in general. Of one thing you may be certain, that anything which wakes a patient suddenly out of his sleep will invariably put him into a state of greater excitement, do him more serious, aye, and lasting mischief, than any continuous noise, however loud. If a patient is cold, if a patient is feverish, if a The It is after it is over. Nevertheless the person in charge never seems to look the impossibility in the face. The cheerfulness of a room, the usefulness of light in treating disease is all-important. But, if the patient has had a good day, it is stronger and steadier, and not quicker than at mid-day. Would not the true way of infusing the art of preserving its own health into the human race be to teach the female part of it in schools and hospitals, both by practical teaching and by simple experiments, in as far as these illustrate what may be called the theory of it? These were mostly country patients, but not all. That would be a useful invention. * This is important, because on this depends what the remedy will be. First published in 1859, "Notes on Nursing" was written by the innovative female nurse Florence Nightingale, the woman responsible for improving hospital conditions in war-torn Crimea. You will find that there is barely a teaspoonful of solid nourishment to half a pint of water in beef tea,–nevertheless there is a certain reparative quality in it, we do not know what, as there is in tea,–but it may safely be given in almost any inflammatory disease, and is as little to be depended upon with the healthy or convalescent where much nourishment is required. These are easily known by the smell, and can be avoided. Remember, that many patients can walk who cannot stand or even sit up. But the Registrar-General would certainly never think of giving us as a cause for the Shall we begin by taking it as a general principle--that all disease, at some period or other of its course, is more or less a reparative process, not necessarily accompanied with suffering: an effort of A room remains uninhabited; the fire-place is there may be a want of hospital room for adults. is fresher than the other where I spend only 2. Courts of justice seem to think that anybody can speak "the whole truth, and nothing but the truth," if he does but intend it. But somehow nurses never "think of these things." I have often heard a patient say to such a mistaken reader, "Don't read it to me; tell it me." Again, all laundresses, mistresses of dairy-farms, head nurses, (I speak of the good old sort only–women who unite a good deal of hard manual labour with the head-work necessary for arranging the day's business, so that none of it shall tread upon the heels of something else,) set great value, I have observed, upon having a high-priced tea. Many such I have had as patients who scarcely ate anything at their regular meals; but if you concealed food for them in a drawer, they would take it at night or in secret. But nursing, as a handicraft, has not been treated of here for three reasons: 1. If he can feed and clean the animal himself, he ought always to be encouraged to do so. Almost all superstitions are owing to bad observation, to the post hoc, ergo propter hoc; and bad observers are almost all superstitious. I have seen these "kind" fellows (and how kind they are no one knows so well as myself) move a comrade so that, in one case at least, the man died in the act. For the above reasons, whatever a patient can do for himself, it is better, i. e. less anxiety, for him to do for himself, unless the person in charge has the spirit of management. One of the greatest observers of human things (not physiological), says, in another language, "Where there is sun there is thought." But no particle of dust is ever or can ever be removed or really got rid of by the present system of dusting. the morning, both to nurses and patients, and to the superior But much more often, their (so called) "fancies" are the most valuable indications of what is necessary for their recovery. The well are scarcely ever more than eight hours, at most, in the same room. Ventilation and skin-cleanliness equally essential. chill is most apt to occur towards early morning at the The nurse I have known such–in one case death ensued. A patient may be left to bleed to death in a sanitary palace. a short hour before the inmates are put in. Dust accumulates there, and will never be wiped off. Reckless amateur physicking by women. Most people are familiar with the name of Florence Nightingale and the image of 'the lady with the lamp'. Depend upon it, the people who say this are really those who have little "to think of." In cases of long recurring faintnesses from disease, for instance, especially disease which affects the organs of breathing, fresh air to the lungs, warmth to the surface, and often (as soon as the patient can swallow) hot drink, these are the right remedies and the only ones. Another remark: although there is unquestionably a physiognomy of disease as well as of health; of all parts of the body, the face is perhaps the one which tells the least to the common observer or the casual visitor. To leave the patient's untasted food by his side, from meal to meal, in hopes that he will eat it in the interval is simply to prevent him from taking any food at all. Then enter the ‘name’ part Let the food come at the right time, and be taken away, eaten or uneaten, at the right time; but never let a patient have "something always standing" by him, if you don't wish to disgust him of everything. The everyday management of a large ward, let alone of a hospital–the knowing what are the laws of life and death for men, and what the laws of health for wards–(and wards are healthy or unhealthy, mainly according to the knowledge or ignorance of the nurse)–are not these matters of sufficient importance and difficulty to require learning by experience and careful inquiry, just as much as any other art? Unnecessary noise, then, is the most cruel absence of care which can be inflicted either on sick or well. 2020. The second has observed just as little, but imagination immediately steps in, and he describes the whole thing from imagination merely, being perfectly convinced all the while that he has seen or heard it; or he will repeat a whole conversation, as if it were information which had been addressed to him; whereas it is merely what he has himself said to somebody else. Notes on Nursing would be an excellent choice. Much more precise might be our observations even than this, and much more correct our conclusions. And oh, the crowded national school! If An almost universal error among nurses is in the bulk of the food and especially the drinks they offer to their patients. *. "It has been slept in every night.". probably the shutters are kept always shut; perhaps some kind of That breathing becomes an almost voluntary act, even in grown up patients who are very weak, must often have been remarked. "Average mortalities" merely tell that so many per cent. It does not seem necessary to mention this. But a careless nurse, be her rank and education what I have never known persons who exposed themselves for years to constant interruption who did not muddle away their intellects by it at last. But never pronounce upon him from merely seeing what he does, or how he looks, during such a conversation. The "somebody" charged with opening the door is one of two, three, or at most four persons. These notes are the formal documentation that nurses make when charting, based on the notations and scribbles nurses gather during a patient visit. to prevent dangerous draughts. The same laws of health or of nursing, for they are in reality the same, obtain among the well as among the sick. Again, milk and the preparations from milk, are a most important article of food for the sick. * It is absolutely essential that a nurse should lay this down as a positive rule to herself, never to speak to any patient who is standing or moving, as long as she exercises so little observation as not to know when a patient cannot bear it. Irresolution is what all patients most dread. But it is very generally neglected with private sick. This is undeniably too often the case. * The common idea as to uninhabited rooms, is that they may Yes, God always justifies His ways. They come in by the door, and somebody must open the door to them. Using a commonsense approach and a clear basic writing style, she proposed a thorough regimen for nursing care in hospitals and homes. In certain diseased states much less How well a patient will generally bear, e.g., the putting up of a scaffolding close to the house, when he cannot bear the talking, still less the whispering, especially if it be of a familiar voice, outside his door. Sadly large has been my experience in death-beds, and I can only say that I have seldom or never seen such. ascertained, while there is universal experience as to the Therefore, that they should be able, without raising themselves or turning in bed, to see out of window from their beds, to see sky and sun-light at least, if you can show them nothing else, I assert to be, if not of the very first importance for recovery, at least something very near it. I have often thought how wise a piece of education this would be for much higher objects; and in our calling of nurses the thing itself is essential. Her directives are widely applicable today. Author Ruth Davies 1 Affiliation 1 College of Human and Health Science, Swansea University, United … Standard Format of a Nursing Note: First thing that goes on the nursing note […] Buenos Aires, Vinícius With the second you never know where you are–you never know when the consequences are over. "Oh no, sir; you know it is very long since he has been up and dressed, and he can get across the room now." Men whose profession like that of medical men leads them to observe only, or chiefly, palpable and permanent organic changes are often just as wrong in their opinion of the result as those who do not observe at all. The patient's stomach must be its own chemist. There is nothing more to be said. That the writer, who has herself seen more of what may be called surgical nursing, i.e. The patient will often not even mention what has done him most harm. More patients have been lost in this way than is at all generally known, viz., from relapses brought on by being left for an hour or two faint, or cold, or hungry, after getting up for the first time. This is called extravagant. (Yet no nurse can ever be made to understand this.) It is useless to multiply instances of this kind. But how few are there who can intelligently trace disease in their households to such causes! We must not forget what, in ordinary language, is called "Infection;"*–a thing of which people are generally so afraid that they frequently follow the very practice in regard to it which they ought to avoid. Conciseness and decision in your movements, as well as your words, are necessary in the sick room, as necessary as absence of hurry and bustle. not know when the wind is in the east. It has Were a trustworthy man in charge of each ward, or set of wards, not as office clerk, but as head nurse, (and head nurse the best hospital serjeant, or ward master, is not now and cannot be, from default of the proper regulations,) the thing would not, in all probability, have happened. No, this is not what people say. For disease, as all experiences hows, are adjectives, not noun substantives. The sun is not only a painter but a sculptor. I have seen a patient fall flat on the ground who was standing when his nurse came into the room. *. Always air your room, then, from the outside air, if possible. turned their backs. They also apply to the nursing of surgical, quite as much as to that of medical cases. The best wall for a sick-room or ward that could be made is pure white non-absorbent cement or glass, or glazed tiles, if they were made sightly enough. Questions, too, as asked now (but too generally) of or about patients, would obtain no information at all about them, even if the person asked of had every information to give. These are fruit, pickles, jams, gingerbread, fat of ham or bacon, suet, cheese, butter, milk. And, in these remarks, I by no means refer only to exceptional times of great emergency in war hospitals, but also, and quite as much, to the ordinary run of military hospitals at home, in time of peace; or to a time in war when our army was actually more healthy than at home in peace, and the pressure on our hospitals consequently much less. There are five essential points in securing the health of houses:–. Note you can select to send to either the @free.kindle.com or @kindle.com variations. Oh because, you say, we cannot keep it from infection–other children have measles–and it must take them–and it is safer that it should. Light essential to both health and recovery. To have the air within as pure as the air without, it I knew a very clever physician, of large dispensary and hospital practice, who invariably began his examination of each patient with "Put your finger where you be bad." He has never observed. epidemic disease and ill health is being distilled into the house. * But this is just what the really experienced and observing nurse does not do; she neither physics herself nor others. Whether the person thus read to be sick or well, whether he be doing nothing or doing something else while being thus read to, the self-absorption and want of observation of the person who does it, is equally difficult to understand–although very often the readee is too amiable to say how much it hurts him. Also take care that your lid, as well as your utensil, be always thoroughly rinsed. Unnecessary noise, or noise that creates an expectation in the mind, is that which hurts a patient. The air is stagnant, musty, But you want to do the thing that is good, whether it is "suitable for a woman" or not. But if people will be stupid, let them take measures to protect themselves from their own stupidity–measures which every chemist knows, such as putting alum into starch, which prevents starched articles of dress from blazing up. The reason why jelly should be innutritious and beef tea nutritious to the sick, is a secret yet undiscovered, but it clearly shows that careful observation of the sick is the only clue to the best dietary. It is a waste of power. * I have known two cases, the one of a man who intentionally and repeatedly displaced a dislocation, and was kept and petted by all the surgeons; the other of one who was pronounced to have nothing the matter with him, there being no organic change perceptible, but who died within the week. Patients are completely taken aback by these kinds of leading questions, and give only the exact amount of information asked for, even when they know it to be completely misleading. Never to allow a patient to be waked, intentionally or accidentally, is a sine qua non of all good nursing. making the sick repeatedly breathe their own hot, humid, * If it is used to having its stimulus at one hour to-day, and to-morrow it does not have it, because she has failed in getting it, he will suffer. They have ventured to cover the patients lightly and to keep the windows open; and we hear much less of the "infection" of small-pox than we used to do. But I go farther, and say, that healthy people never remember the difference between bed-rooms and sick-rooms, in making arrangements for the sick. Yet nobody learnt the lesson. The play of a fire-engine would then effectually wash the outside of a house. If you must have a carpet, the only safety is to take it up two or three times a year, instead of once. Not the Highland drover, certainly, exposed to the east It was also required reading at the nursing school she opened at St Thomas' Hospital, the first of its kind, and at other such establishments. If you wait till your patients tell you, or remind you of these things, where is the use of their having a nurse? * For the same reason if, after washing a patient, you must put the same night-dress on him again, always give it a preliminary warm at the fire. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. This is the almost universal experience of occupied invalids. In hospital wards it is of course impossible to observe all this; and in single wards, where a patient must be continuously and closely watched, it is frequently impossible to relieve the attendant, so that his or her own meals can be taken out of the ward. 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