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Archive for the ‘Hints and Tips…’ Category

Taken from Florence Nightingale’s 1859 ‘The Art of Nursing.’

‘All the results of good nursing may be spoilt or utterly negativised by one defect – petty management, or in other words, not knowing how to manage that what you do when you are there, shall be done when you are not there. A nurse must learn to think for herself: now, what does happen in my absence?  I am obliged to be away on Tuesday.  But fresh air, punctuality etc, none of these things are less important to my patient on Tuesday than they were on Monday..’

‘A firm, light, quick step and a steady quick hand are the desideration*; not the slow, lingering, shuffling foot, the timid, uncertain touch….’

Even the way a nurse walks is important! 

* Never seen this word before in your life?  Me neither.  Google barely knows what it means.  Shock horror!  But apparently it means to ‘wish or to see happen.’  Those pesky Victorians and their pesky vocabulary!

 

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Florence Lees had some ingenious (and possibly lethal) nursing methods!

For cholera cases, she recommended that nurses ‘maintain an exceptionally high temperature in their patients rooms.’ 

In order to achieve this, they might usually use bronchitis kettles.  If a nurse hasn’t got one to hand, ‘A good substitute can be made by fitting long tin ‘pea shooters’, as children term them, one inside the other until the required length is obtained, when this extemporary tube can be fitted over the spout of an ordinary kettle, half filled with boiling water and placed on the fire.  This extemporary tin tube can be bent to any shape required, and made of any length.’

Taken from ‘A Guide to District Nurses’, 1890.

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‘To raise a heavy helpless patient: – cut three yards of coconut matting binding into three lengths, sew a firm loop at either end of each length.  Pass one length of the matting under the patient about the small of the back, gently draw it higher, then pass the second under, drawing it down lower; the third one, passed under the body in the same way, should be drawn down as low as the thighs.  When the straps are in place, pass a stick through the loops on either side (a broomstick cut in half should answer the purpose), get an assistant to come on each side of the bed and tell them to catch hold of the sticks and pull steadily against each other, with back straight, not bent.  A slight effort on their part will move the patient easily off the bed.’

If you can follow these instructions, you’re cleverer than I am.  I’m not even sure they make sense.  Can you really make a hoist out of a broomstick?  district nurses of the past were nothing if not inventive.

Taken from the September 1st issue of the Queen’s Nurses’ Magazine – only the second issue ever!

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Taken from Florence Lees’s ‘A Guide to District Nurses’, here’s an extract on the ‘essence’ of a DN in 1890.  District nurses of today, recognise yourselves here?!

‘The district nurse rarely sees the doctor, and in many cases, not at all.  His orders are given in writing, and she must be so well trained as to observe and report correctly and briefly on every case under her charge, but to allow no change to pass unnoticed, and to be able to apply provisionally suitable treatment until the medical man shall have arrived.

The very essence of district nursing is that the nurse should have such tact as well as skill that she will do what is best for her patients, even against their will, knowing how to manage the weakest and most irritable and doing all that is necessary for them, ‘without their knowing it’, as a poor patient once told me.  Is is not part of her duty to go after or distribute alms or relief, or else her work should become all almsgiving and little else.’

It’s an interesting thought to consider: many nurses have said in the past that there is both a ‘science’ and an ‘art’ to nursing.  The science you can learn through books: how an eye works, how to dress a wound, the list goes on!  The art is a little more intangible – perhaps something you can only pick up through the experience of dealing with patients and their families.

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From a nurse in Penshurst, Kent.

‘The patient suffered from chronic pneumonia with ulceration of the lungs; his left lung was very badly affected and his right slightly so, he had several attacks of haemoptysis was was spitting up the characteristic sputum.

The shelter was fixed up in a field at the end of the garden adjoining his cottage and he was carried out there on June the 28th.  He has remained out there day and night since.  His temperature is lower and the haemoptysis has ceased, his cough is better, he is not spitting up anything at all and is slightly gaining flesh.  We have had a bell fixed from his house so that he can ring for his wife if he wants anything.  There was a curtain which we hooked across the front for washing etc.  He is sponged all over daily, has a hot water bottle always to his feet and the Doctor has given him a printed paper with directions for his food – what he must eat and what he must avoid.’

Nurses of today, what do you think?  It seems to me that sticking someone in a field is quite a novel way to treat a patient!  But, I suppose, district nurses had to use whatever treatments they had to hand!  It is definitely a profession for the practical-minded.

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Florence Lees’s 1890 ‘Guide to District Nursing’ lists the initial observations a district nurse should make on her first visit to her patients.  Do you think there’s any continuity?  Do nurses still need to make the same sort of observations today?  Are they still looking out for the same sorts of symptoms or has modern medicine moved on?

‘Notice generally head, neck, chest, abdomen, limbs, eruption, oedema, colour, shape, posture in breathing, lying flat, semi-erect, on one side etc.  The posture of the patient is often indicative of the disease from which he is suffering.  Ask them:

Pain – has it come on quickly, or lasted some time?  That is, is it accute or chronic?  Is it a shooting pain or stabbing, so commonly complained of in cancers? (Often not felt, only felt when suggested.)  Is it a twisting pain, such as patients sometimes complain of  in hernia or colic?  Is the pain on the surface, or increased and diminished by pressure?  (Pain is often expressed at a spot distant from the seat of the disease.)

A nurse must observe whether her patients bowels are acting in a regular manner.  The frequency of action and character of evactuations, whether solid or fluid.  The colour as regards presence or absence of bile, the admixture with matter, mucus or blood.  (Nice!)

A nurse must observe the general intelligence of the patient: memory, speech, slowness of manner, giddiness, sleep, dreams, fits.  Observe the frequency of the respirations, regularity, difficulty, colour of breath, if attended with pain…

Make careful notes of any changes which come over wounds (and whether heralded by shiverings and sickness), the colour, quantity, odour of pus etc.

Special observation must be devoted to the patient’s expression.  Look for the flushed painful expressions observable in many accute diseases of the chest and in fever; for pallor and pain and a pinched expression at the onset of inflamation of the abdomen; for the sudden pallor of faintness, the flushings morning and evening of hectic, the risus sardonicus in lockjaw and tetanus etc.  There is another expression of countenance which should not be omitted: a worried, harassed expression.’

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Writing in 1890, Florence Lees did not have many tools to hand in her work as a district nurse.  What she did have was a great sense of iniative.  Thinking outside the box, she used whatever might be at hand in her patient’s houses!  Here are some of her tips.

‘If your patient does not have a brush to clean his teeth, a piece of wet linen wrapped around the forefinger of the nurse and dipped in a solution of condy * and water is very effectual for cleansing the roof and gums of a patient unable to do this himself.  The linen should be removed from the nurse’s finger with her forceps for the fresh piece to be put on.

A very good urinal for men is an empty jam pot.  It is easily handled and cleaned.  For women the best shoe-shaped urinal is an old-fashioned butter or sauce boat, where it can be procured.

Where the water is foul it is always best to boil it before filtering it.  A good extemporary filter can be made out of a common flower pot.  Place a piece of sponge in the hole at the bottom.  Over this lay two inches of charcoal and then two inches of clean sand.  Place this flower pot over the jug or vessel which is to contain the water when filtered.  It will be found to answer as well as any ordinary filter.’

* I haven’t written this wrong, I presume it’s some kind of obscure Victorian herb?  Or, can anyone correct me?  Google failed me.

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