10. What are the essentials of a good daily record? The following is an account that a mother gave of the first twenty-four hours of a child's illness. Make a chart for the patient, and include in it all the information the mother gave. Which do you consider more useful, your chart or the narrative?

"Yesterday, October 10th, Johnny came home from school about half past three, and said he was too cold to play outdoors. He lay down and slept till about five, when he vomited a large amount of undigested food. I took his temperature and found that it was 103.8, pulse 126, and respiration 28. At 10 that night his temperature was 102.5, pulse 116, and respiration the same as before. The next morning at 8 he had a temperature of 100.6, pulse 114, respiration 24. At noon his temperature was 101, pulse 118, respiration 24; and at 4 o'clock his temperature was 100.6, pulse 122, respiration 22. The doctor came at 6 o'clock yesterday afternoon; according to his orders I put Johnny to bed, gave him half a tablespoonful of castor oil at 6.30, and a special gargle. His throat was red and sore and he seemed to feel very miserable. The doctor took a culture from the child's throat. At 8.15 and again at 8.50 he had fluid bowel movements. At 9.30 he had a gla.s.s of milk, after which he slept until 6 a.m. when his bowels moved again and urine was pa.s.sed. He pa.s.sed eight ounces of urine at noon and four ounces at 3.30. He drank a gla.s.s of water at 6 this morning, and at 6.30 I gave him a cup of hot broth. At 8 he had a gla.s.s of milk, but at 10 he refused everything but a gla.s.s of water. At 1.30 he had a large dish of ice cream. He had a cool sponge bath last night at 9, and a cleansing bath this morning at 8.45. This morning his throat was still sore but not so red, and I saw that he gargled every half hour when he was awake.

This afternoon he seems brighter and asked for his harmonica, so his throat is probably more comfortable."

FOR FURTHER READING

Essentials of Medicine--Emerson, Chapters XVI, XVII.

The Human Mechanism--Hough and Sedgwick, Chapter XII.

Notes on Nursing--Florence Nightingale, Pages 105-136.

Why Worry?--Walton.

Those Nerves--Walton.

Tuberculosis: Its Cause, Cure, and Prevention--Otis.

Publications of the National a.s.sociation for the Study and Prevention of Tuberculosis--105 East 22d Street, New York City. (Pamphlets free on request.)

Publications of the National Committee for Mental Hygiene--50 Union Square, New York City. (Pamphlets free on request.)

Publications of the Mental Hygiene Committee of the State Charities Aid a.s.sociation--105 East 22d Street, New York City. (Pamphlets free on request.)

Publications of The American Society for the Control of Cancer--25 West 45th Street, New York City. (Pamphlets free on request.)

CHAPTER V

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 pa.s.s 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 hara.s.ses 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 acc.u.mulations 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 ma.s.ses 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 gla.s.s 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 pa.s.s 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 aesthetic 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 ap.r.o.ns, 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 pa.s.sion 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.