Essentials of Home Nursing
The successful home nurse knows that her duties range all the way from super vision of sanitation to soothing the patients mental discomforts
MILDRED GREY JACKSON
Women and their Work
PREVENTION is now the keynote of all health administration. Public precautions, however, cannot attain to the acme of endeavor, until the hearty co-operation of mothers and homemakers is assured. It is vastly important, therefore, to familiarize oneself with the principles of personal and household hygiene, and public sanitation, and honestly endeavor to put those principles into practice in the home.
In safeguarding the health of her household, the home nurse must control and regulate its hygienic affairs as regards the following:
1. The water supply. If living in a community where the supply is questionable, send a sample to the provincial bureau for examination. In the meantime boil the water.
2. Look to your drainage.
3. Be sure as to the cleanliness of your milk and butter supplies.
4. Acquaint yourself with the principles of ventilation.
5. Heating. Is your house heated in a way to keep up the standard of comfort and safety? The air of most houses in winter is too dry. You should see that moisture is provided.
6. Plumbing. Keep your sinks, hoppers, bathtubs and wash-tubs in a sanitary condition by frequent cleansing.
7. Garbage. Be scrupulous in your disposal of refuse. Leave nothing exposed as a breeding place for flies.
8. Refrigerators, cupboards, and cellars must always be kept clean.
Some Kitchen Hints
9. Vermin. Guard carefully against flies, ants, cockroaches, rats and mice. Flies, if they gain access to your house leave their nauseous trail over all that they touch.
Nothing is exempt from their invasions; nothing is too filthy for their habitation.
They will fly direct from their choicest haunts to your daintiest foods, to your baby’s lips, to the best they can find in your house.
Look to the screening and sanitary care of all such, where there is not a system of sewage disposal.
\/TANY hours a day are spent in the kitchen. Keep your kitchen clean, bright, airy, and cheerful generally.
Kitchen cleanliness depends, in part, on: Cleanliness of utensils, tables and floors; protection of food from flies, dust and vermin; care in disposal of garbage, and cleanliness of receptacles, and a sanitary method of washing dishes. Have a basin for washing the hands hanging beside the sink. Do not make a washbasin of
your sink. Soapless dishwater and unrinsed dishes are not uncommon. Dishcloths, mops and brushes should be clean and fresh smelling. Pots, pans and kettles should be as clean as the dishes, and washed and rinsed as thoroughly. Dish cloths and towels should be washed after each meal, and hung up to dry and air. The hands and finger-nails of the cook should be kept smooth and clean. Could you make a pudding or set your bread in your dishpan? If not, why not?
Among practices to be avoided are the following:
Licking the fingers when preparing food, instead of washing and wiping them. Why not pin a small towel to your side when you are cooking?
Using the handkerchief, picking the teeth or nose, and then handling food without washing the hands.
Using the dish towel as a hand towel.
Using the cooking spoon to taste sauces, salads, etc., and then putting it back into the food.
Allowing water or juice to drip from the hands into salads, fruits or vegetables, instead of drying hands and fruit and handling them daintily and carefully.
Not washing the tops of milk bottles.
Coughing into food.
Touching the edges of drinking glasses or cups with fingers that have handled soiled handkerchiefs or other articles of clothing.
Going back to work with unwashed hands after going to the toilet.
There are many others. Those cited should suffice to make one think and notice oneself and others.
Where domestic help is employed, have your own code of rules regarding sanitary precautions written or typewritten, and insist on their observing these rules while they are in your employ. Young girls going into domestic service have often had no instruction as to nicety and cleanliness in the handling of food, dishes, and kitchen utensils.
How Diseases Are Transmitted
ITAISEASE is transmitted in various ways. Water, food, ^ flies, and milk are the great public routes of community infections, but these routes do not operate in every disease. Our public health officials, both provincial and local, are doing.all that can be done in safeguarding the health and wellbeing of the population, as far as these things are concerned.
Then arises the very pregnant question of the disposal of bodily discharges, from which follows a long train of evil results.
So many diseases are contracted through contact with discharges from the mouth and nose, that one must be constantly on guard. The ‘common cold’, measles, whoopingcough, diphtheria, mumps, pneumonia, sore throat, and tuberculosis work havoc in these avenues.
In the case of typhoid, cholera, dysentery, and infantile paralysis, they leave the body in the urine or bowel discharges. While the loathsome social diseases are frequently transmitted by toilet scats, bath tubs, towels, kissing, and hand-shaking.
In this connection, we should remember that: everybody is
busy distributing saliva; the fingers are being constantly raised to the lips or nose; innumerable articles, for one reason and another, are'placed in the mouth; if saliva were blue or red instead of colorless, the fingers would constantly be stained; the same may be said of the nose and ears.
The hands, most of all, carry all sorts of germs from one person to another, because hands carry mouth spray,
sputum, nose, bladder and bowel discharges, to other people’s hands and to things other people touch.
Try' not to handle any food, cups, spoons or other things, which other people may put into their mouths, unless your hands are first washed clean. Try to get other people to be as careful as you are.
Much more could be written along these lines, but enough has been said to show there is no excuse for personal carelessness.
The secret of keeping well, and of helping others to keep well is to know how to avoid infection—personal contact, exchange of saliva, the ‘broadcasting’ method of sneezing and coughing, and the ‘stay-in’ habit are the principal things to be avoided.
The Home Nurse’s Supply Cupboard
IF YOU have not already arranged for ^ a nurse’s supply cupboard in your household, do so now. Preparedness is the twin sister of prevention, and there comes a time in every home when you will need certain remedies or equipment, perhaps, to save a life.
Either buy one of the neat cabinets for sale in the furniture stores, or have the handy man of the house make you one or have shelves arranged in a closet, where a door can be hung and a lock attached.
Children should never be allowed access to this cupboard. The key should hang high out of reach. The contents of the cupboard should always be in order and you should know on which shelf to find things. When an article is taken out for use, it should be cleaned and put back in its own place as soon as it is not needed. Keep your supplies up in the same way you keep your pantry stocked. Your need may come suddenly and you should be found ready with ‘your lamps trimmed and your oil burning'.
The following lists are suggested. Many other things might be added, and in a great many cases many might be omitted, or substitutes made. Each person must be practical in her own special way. Get your family doctor to offer suggestions.
Miscellaneous Supplies: 1. A fountain syringe with attachments; one infant bulb syringe (if there is a baby in the house); one foot bath; one bedpan and douche pan (combination); one rubber sheet, or piece of oilcloth; one slop pail, wuh cover; one whisk; a roll of old linen; two old soft blankets; two extra pillows made of excelsior (for support); three small pillows or pads made of cotton batting; one small tray, medicine size; one medium sized tray; an individual teapot, cream pitcher and sugar bowl; a graduated medicine glass; one feeding cup; one eye dropper; a small glass tube, one pair of scissors; safety pins large and small; a clinical thermometer; bath thermometer; hotwater bag; ice-bag and rubber gloves.
Surgical Supplies: One granite handbasin and two smaller ones: one nail brush: one pair dressing forceps, a probe and small spatula; one granite pitcher, quart size; one pound absorbent cotton; one spool adhesive plaster; one dozen bandages: half dozen five yards by one inch, half dozen five yards by two inches; one small package surgical gauze; five yards each cheese cloth and factory cotton; half pound boric acid powder; twenty-five tablets bichloride-mercury and one ounce green soap solution.
Medical Supplies: Cathartics, pills,
epsom salts, seidlitz powders, castor oil, calomel, quarter grains, milk of magnesia; camphorated oil, four ounces; glycerine, four ounces; your favorite liniment; your favorite ointment; one jar of some vaporub for colds; linseed meal, two pounds; mustard, one tin; soda and salt, ginger, quarter pound; a tube of sterile vaseline, turpentine, four ounces; gasoline, four ounces; aspirin tablets.
Great care should be exercised in handling medicines. Here are a few rules that should be followed:
1. Keep a small note book in whiclr-to write your doctor’s orders. Get him to read and sign them, then nothing will be overlooked or forgotten.
2. Do not keep anything in the cabinet that is not plainly labelled.
3. Never give a drug in the dark or in a dim light. Safety First.
4. Never give any kind of medicine about which you are not absolutely sure.
5. Do not keep medicine bottles around with a dose or two in them. Conditions change and medicines deteriorate.
6. Avoid opium, bromides, and sleepproducing medicines.
7. Ask your doctor if your patient should be awakened for medicine or nourishment.
8. Never give a pill, capsule or tablet that has escaped from the container. You are not quite sure what it may be.
9. A graduated medicine glass should be used in giving medicine. Measure exactly. Do not guess.
10. Always shake the bottle before pouring out the medicine.
11. Read the label twice, before pouring out, and after.
12. Do not talk when giving medicine. Keep your mind on what you are doing.
13. Laxatives act most quickly on an empty stomach.
14. Tonics are usually given half an hour after meals. Medicines to stimulate the appetite are given before meals.
15. Never prescribe for another person, unless it is some simple home remedy.
16. A piece of orange or lemon will usually take away any disagreeable taste.
17. Do not keep medicines or solution beside the patient’s bed. Keep them out of sight.
The home nurse must veritably be ‘as wise as a serpent and as harmless as a dove’, to keep her patient comfortable in mind and body, and keep the wheels of domestic life going their continuous round to the satisfaction of herself and other members of the family.
Perhaps, it would be as well in this article to mention here the mental coim fort of the sick one, as this is something that is frequently overlooked. Mental repose is as vital to the sick person as physical rest, and for that reason the home nurse should:
Never discuss the patient’s condition with her, or with any one else in her hearing.
Never tell her what medicine she is getting, if that can be avoided.
Never tell her what her temperature and pulse are.
Never lean or sit on a patient’s bed, and avoid knocking into it in passing.
Never whisper in or near the sickroom even if the patient is apparently unconscious.
Notice when a light worries a patient or when she is in a draught.
Never rock in the sick room.
Keep door and window hinges well oiled and never allow doors or windows to bang.
Always respond to a patient’s request as quickly as possible, especially when she has asked for a drink or other attention.
Try to relieve the patient’s mind about family affairs. Anxiety and irritation retard recovery.
Be wary about visitors. You are not always ‘entertaining angels unawares’.
A sick person should see very few visitors. It is a tax on the nervous system and retards recovery. The home nurse should use sufficient tact to show appreciation of their sympathy and interest and at the same time protect her patient. No visits at all should be allowed after eight or eight-thirty in the evening. A patient should be cared for and settled for the night by nine or nine-thirty. Even if the patient is inclined to talk, the home nurse should not encourage it but tactfully should induce her to rest. If the nurse wishes to save her patient’s feelings she will keep everything as orderly as possible as she goes along. It is very de-
pressing to the average adult to see a room in a constant state of disorder, trays, with dishes, medicine bottles and glasses, soiled dressings or bedding. If it is the tired mother who is ill gladden her heart by keeping her room above reproach.
Little things that a person would scarcely notice when well become magnified in the mind of a sick person and cause both mental and bodily irritation.
Practical Points to be Remembered
LACK of elaborate conveniences and J supplies must not interfere with the necessary treatment. Substitutes must be found, or improvised. Flatirons and stove-lids may take the place of hot water bottles; newspapers and table oilcloth can be used instead of rubber sheeting; shawls and comforters, for blankets; cooking utensils sometimes must be pressed into service for surgical basins. A bureau drawer has been utilized before now for a baby’s crib. The scrubbing and boiling gets rid of our enemies, disease germs, and very common vessels may become instruments of blessing when used in the right way at the right time. Sunshine, fresh air and soap and water are nature’s disinfectants.
If a patient is about to undergo an operation, she must be spared all unpleasant thoughts, questions, yarns and suggestions, which will be likely to arouse anxiety and fear. Keep tears, fears, and doubts out of the sick room, and admit pleasantries, smiles and good cheer, even though hope be on the wane. A cheerful, hopeful outlook goes a long way toward hastening convalescence, and preventing relapses.
Do not go into a hysterical panic when children meet with their daily bumps, falls, or even greater injuries. Either make little of the injury, and laugh it away, or better still ignore it, when you see it is not really serious. Don’t threaten to break the tables and chairs, and all the naughty articles of furniture that have been in the way. Too much soft sympathy weakens the child morally and helps to make him cowardly.
Banging doors, creaking shoes, loud talking, incessant humming, or whistling, are all very trying to the nerves of a sick person. You can wrap coal in paper before laying it on your grate fire, and a wooden poker would do for a time instead of metal. Consider these points.
Remember you are with the patient all the time and have a much better chance to observe the details than the doctor, who sees the patient only occasionally, and you can be a great help to him and serve your patient best, by keeping a record of details. Questions may occur to you that you may want to ask; make a note of these on a little pad, which you always should carry in your pocket. Do not ask foolish unnecessary questions or report foolish obvious details. Be business like and not childish.
Write down the doctor’s orders, exactly as he gives them, and be sure you understand everyone of them before he leaves, and do not make a habit of annoying him in his busy office hours, by calling him to the ’phone to ask him something you should know if you' had kept your wits about you. Do not offer suggestions or tell him what some other doctor does. Write down such headings as medicine, baths, food, and so forth on your pad, and know just what is to be done.
If someone in your home is ill, and you do not understand the symptoms, do not wait until the middle of the night to call the tired doctor out. Consult him early in the evening. Remember your family is only one on his list and, after all, he is human, too, not a machine. Be loyal to him, do not think by changing around from one to another you can get better attention. You cannot expect anyone to
take a deep interest in you, if he is not sure of your faith and loyalty.
The Doctor’s Visit
^pHE following suggestions are offered in connection with the doctor’s visit:
1. The home nurse should have the bed, the patient, and the room, clean and tidy.
2. If a surgical dressing is to be done, have the room warm and the necessary articles ready—hot water, basins, towels, soap, and a couple of clean pitchers. Always provide a glass or basin of water, and a small towel or napkin for the doctor to use in cleansing his thermometer.
3. If an abdominal dressing is to be done you can prepare th° patient, while the doctor is making his preparations, by rolling back the bed clothes the proper distance and tucking a clean towel under the edge so that it will fold back over them. Turn up the patient’s gown in the same way, and fold a towel back over it. If there is an abdominal binder, take out the safety pins and leave it in place until the doctor is ready. Place a towel over a small rubber sheet and slip it under the patient to protect the bed. Ha\e a paper bag ready into which soiled dressings can be dropped and afterwards burned.
4. As soon as the doctor has finished, remove the towels, make your patient comfortable, and remove everything connected with the dressing from the room as quickly as possible. Air the room, give your patient a refreshing drink and permit her to rest awhile.
5. If there is to be a physical examination, always make sure that there is no more exposure than is necessary.
6. If the dressing or examination is about the lower part of the body fold the spread back under the blankets so they can be quickly removed when necessary without disturbing the sheet. Gather the middle portion of the sheet in between the thighs and legs, then bring up the sides to cover these parts.
7. If the chest is to be examined, take the arms out of the night-gown but leave it covering the arms and chest until the doctor is ready. When he uses the stethoscope move the nightgown as he requires. When he wishes to listen to the chest sounds without the stethoscope, place a small fresh towel over the patient’s chest.
8. If the patient is required to sit up for further examination of the back, button the nightgown around the neck, so that it will cover the chest, and place a towel over the back. Always be sure to put the same side of the towel next to the patient.
9. If the abdomen is to be examined, cover the chest with the nightgown, and a light shawl, if the air is cold, fold the covers down just below the abdomen. Have no more exposure than necessary. The doctor usually asks the patient to draw up the knees.
On the home nurse, therefore, devolves the duty of educating and discipling her household on the matters mentioned above, and, to begin with, she must discipline herself. She must look carefully to the details of her own health, lest she, herself, become an invalid while ministering to others.
Frequent bathing, exercise in the open air, plenty of sleep, reasonable and systematic recreation, and care as to diet, are all essentials to radiant health. We are all in search of happiness. Money cannot buy it. Abundant health is a primary requisite.
Take care of yourself. Be one of those who are always radiating health thoughts, success thoughts, uplifting helpful thoughts. These are the helpers of the world, the people who ease the jolts of life, and soothe the wounded, and give solace to the discouraged. ‘A merry heart goeth all the way, your sad tires in a mile, oh!’