Scott, Anne premature suffering and death necessary? 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. No one would undervalue vaccination; but it becomes of doubtful benefit to society when it leads people to look abroad for the source of evils which exist at home. Let then women, if they will give medicine, give homoeopathic medicine. Her skirts (and well if they do not throw down some piece of furniture) will at least brush against every article in the room as she moves. It is quite She piles the pillows one-a-top of the other like a wall of bricks. essential, a temperature must be secured which shall not chill The use of aperients may be entirely superseded by it. patients will suffer cold much more in the morning than From a closed court, especially physicians and surgeons invariably close them while patient himself. A little piece slipping down, and flapping with every draught, will distract a patient. Richards, Professor David A. Who is it who knows when the wind is in the If you offer it a thought, especially one requiring a decision, abruptly, you do it a real not fanciful injury. That he is committing suicide, and that he wants preventing. Yet nobody learns the lesson. Using a commonsense approach and a clear basic writing style, she proposed a thorough regimen for nursing care in hospitals and homes. Advisers the same now as two hundred years ago. of roasted coffee daily will diminish the waste" going on in the body "by one-forth," and Dr. Christison adds that tea has the same property. No, not one. It is an important part, so to speak, of ventilation. *. It is an ever recurring wonder to see educated people, who call themselves nurses, acting thus. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. in the east.". But it would seem as if it did not occur to us that we must also supplement the person in charge of sick or of children, whether under an occasional eclipse or during a regular absence. *. She wrote Notes on Nursing - first published in 1859, but reprinted here in its revised and enlarged 1860 edition - in order to share her knowledge with women who were nursing their families at home. Five points essential. An uninhabited room, a newly-painted room, * an uncleaned closet or cupboard, may often become the reservoir of foul air for the whole house, because the person in charge never thinks of arranging that these places shall be always aired, always cleaned; she merely opens the window herself "when she goes in.". tendency to chilling is discovered, hot bottles, hot It is constantly objected,–"But how can I obtain It does not seem necessary to mention this. This may be a want; just as But two things are certain:–. A change of mind in others, whether it is regarding an operation, or re-writing a letter, always injures the patient more than the being called upon to make up his mind to the most dreaded or difficult decision. Such cases happen But it is a serious cause of suffering, in lightly built houses, and with the irritability peculiar to some diseases. 2. Unquestionably the latter may, and often does, turn out to be wrong. I am obliged to be away on Tuesday. as invariably opens them whenever the doctors have The very fact of the accident happening proves its own case. Wise and humane management of the patient is the best safeguard against infection. But even if there is not, you must carry water there to 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. Saadatian, E. Accidents arising from the nurse's want of observation. Can you insure that it is not undone when your back is turned? Een kat mag naar een koning kijken 11 1.1 De betekenis van het narratief 12 1.2 Een visie op kennis 12 1.3 De relevantie van vragen 14 1.4 De vrijheid om te veranderen 15 2. * A curious fact will be shown by Table A, viz., that 18,122 out of 39,139, or nearly one-half of all the nurses, in domestic service, are between 5 and 20 years of age. And this school-mistresses of any class, nor nurses of children, nor Cleanliness and fresh air from open windows, with unremitting attention to the patient, are the only defence a true nurse either asks or needs. 2. 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. No mockery in the world is so hollow as the advice showered upon the sick. But I really believe there is scarcely a greater worry which invalids have to endure than the incurable hopes of their friends. True; and how much more impertinent is it to give your advice when you can know nothing about the truth, and admit you could not inquire into it. Ill-informed medical men aid in sustaining the delusion, by laying the blame on "current contagions." That he ought to be called to a sense of duty, and is flying in the face of Providence;–then know that your patient is receiving all the injury that he can receive from a visitor. One can, therefore, only press the importance, as being yet greater in the case of children, greatest in the case of sick children, of attending to these things. Not cry, "Lord, bless you, sir, why you'd have thought he were a dying all night." I have often seen the private nurse go on dusting or fidgeting about in a sick room all the while the patient is eating, or trying to eat. What would the friend say, if he were the medical attendant, and if the patient, because some other friend had come in, because somebody, anybody, nobody, had recommended something, anything, nothing, were to disregard his orders, and take that other body's recommendation? Wonderful is the face with which friends, lay and medical, will come in and worry the patient with recommendations to do something or other, having just as little knowledge as to its being feasible, or even safe for him, as if they were to recommend a man to take exercise, not knowing he had broken his leg. the victim says, "It's all right," and that we are not mad. And of how much importance it is that it should I remember (in my own case) a nosegay of wild flowers being sent me, and from that moment recovery becoming more rapid. is the bed already saturated with somebody else's damp before my patient comes to exhale in it his own damp? A man is now a more handy and far less objectionable being in a sick room than a woman. And the answer will be the same, whether it is just merging into cholera, whether it is a trifling degree brought on by some trifling indiscretion, which will cease the moment the cause is removed, or whether there is no diarrhoea at all, but simply relaxed bowels. This is called extravagant. It will not be directly traceable, except by a very careful observant nurse. And you should therefore look to the position of the beds of your sick one of the very first things. All these things require common sense and care. Butter is the lightest kind of animal fat, and though it wants the sugar and some of the other elements which there are in milk, yet it is most valuable both in itself and in enabling the patient to eat more bread. You see them lying there with miserable disappointments, from which they can have no escape but death, and you can't remember to tell them of what would give them so much pleasure, or at least an hour's variety. But a careless nurse, be her rank and education what The reverse is the conclusion of experience. Unless nurses can be brought to attend to considerations of the kind of which we have given here but a few specimens, a very weak patient finds it really much less exertion to do things for himself than to ask for them. It is the highest folly to judge of the sick, as is so often done, when you see them merely during a period of excitement. An open window most nights in the year can never hurt any one. Or did Nature But the singularity in Legion's mind is this: it never occurs to him that everybody else is doing the same thing, and that I the patient must perforce say, in sheer self-defence, like Rosalind, "I could not do with all.". Simply copy it to the References page as is. Care should be taken in all these operations of sponging, washing, and cleansing the skin, not to expose too great a surface at once, so as to check the perspiration, which would renew the evil in another form. be immediately met with anecdotes and instances to prove the To recur to the first objection. This is by no means the case. * If you like to clean your furniture by laying out your clean clothes upon your dirty chairs or sofa, this is one way certainly of doing it. Now this is actual experiment. Patients are sometimes given to a similar habit, and it often happens that the bed clothes are so disposed that the patient must necessarily breathe air more or less contaminated by exhalations from his skin. A healthy person who allows himself to sleep during the day will lose his sleep at night. If you shake the chair on which he sits, he has a point by which to steady himself, in his feet. Besides this, there is a constant degradation, as it is called, taking place from everything except polished or glazed articles–E.g., in colouring certain green papers arsenic is used. How intense is the folly, then, to say the least of it, of the friend, be he even a medical man, who thinks that his opinion, given after a cursory observation, will weigh with the patient, against the opinion of the medical attendant, given, perhaps, after years of observation, after using every help to diagnosis afforded by the stethoscope, the examination of pulse, tongue, &c.; and certainly after much more observation than the friend can possibly have had. But intermittent noise, or sudden and sharp noise, in these as in all other cases, affects far more than continuous noise–noise with jar far more than noise without. The art of nursing, as now practised, seems to be expressly constituted to unmake what God had made disease to be, 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. Petty management better understood in institutions than in private houses. would be ludicrous, if it were not painful. Read aloud slowly, distinctly, and steadily to the sick. If you knew how unreasonably sick people suffer from reasonable causes of distress, you would take more pains about all these things. There is the want of observation simple, and the want of observation compound, compounded, that is, with the imaginative faculty. Again, the question is sometimes put, Is there diarrhoea? This is a doctor's subject, and I will not enter more into it; but will simply repeat, do not go on taking or giving to your children your abominable "courses of aperients," without calling in the doctor. NOTE.–The effect of music upon the sick has been scarcely at all noticed. The play of a fire-engine would then effectually wash the outside of a house. I will only remark here, that wind instruments, including the human voice, and stringed instruments, capable of continuous sound, have generally a beneficent effect–while the piano-forte, with such instruments as have no continuity of sound, has just the reverse. Irresolution is what all patients most dread. A piece of good news will do the same. The doctor indeed cannot. The patient must inevitably alternate between cold damp after his bed is made, and warm damp before, both saturated with organic matter, * and this from the time the mattresses are put under him till the time they are picked to pieces, if this is ever done. And to cultivate in things pertaining to health observation and experience in women who are mothers, governesses or nurses, is just the way to do away with amateur physicking, and if the doctors did but know it, to make the nurses obedient to them,–helps to them instead of hindrances. Air from the outside. Compare the dirtiness of the water in which you have washed when it is cold without soap, cold with soap, hot with soap. It becomes saturated with offensive matter, which scouring is only wanted to bring out. school-girl, neither mothers of families of any class, nor In England, people do not come down the chimney, or through the window, unless they are thieves. A dark house is always an unhealthy house, always an ill-aired house, always a dirty house. This document includes the following: The time and date; The name of the patient * Upon this fact the most wonderful deductions have been Of the sufferings of disease, disease not always the cause. Chemistry has as yet afforded little insight into the dieting of the sick. Patient had better not see more food than his own. If they can take a bit of bread with the hot cup of tea, so much the better, but not instead of it. How to cite “Notes on nursing” by Florence Nightingale APA citation. indicates the organic matter of the air. There can be no more false observation. What medicine does. Omit the word "sudden;" (for sudden death is comparatively rare in middle age;) and the sentence is almost equally true for all ages. And he will, in order to do them, (very innocently and from instinct) calculate the time his nurse is likely to be absent, from a fear of her "coming in upon" him or speaking to him, just at the moment when he finds it quite as much as he can do to crawl from his bed to his chair, or from one room to another, or down stairs, or out of doors for a few minutes. and shut them easily himself. 3. Perhaps the best illustration of the utter absurdity of this view of duty in attending on "infectious" diseases is afforded by what was very recently the practice, if it is not so even now, in some of the European lazarets–in which the plague-patient used to be condemned to the horrors of filth, overcrowding, and want of ventilation, while the medical attendant was ordered to examine the patient's tongue through an opera-glass and to toss him a lancet to open his abscesses with? Yet this "of course" seems as little thought of, as if it were an obsolete fiction. It appears as if the part of a mistress now is to complain of her servants, and to accept their excuses–not to show them how there need be neither complaints made nor excuses. That none of them had ever seen a case of the kind of poisoning supposed. unknown. To return to real disease. Yet it appears that scarcely any improvement in the faculty of observing is being made. intend mothers to be always accompanied by doctors? How can a medical officer mount guard all day and all night over a patient (say) in delirium tremens? Far more care is therefore necessary to keep up a constant change of air in the sick room. Such education in women would indeed diminish the doctor's work–but no one really believes that doctors wish that there should be more illness, in order to have more work. It cannot be necessary to tell a nurse that she should be clean, or that she should keep her patient clean,–seeing that the greater part of nursing consists in preserving cleanliness. An almost universal error among women is the supposition that everybody must have the bowels opened once in every twenty-four hours, or must fly immediately to aperients. Also take care that your lid, as well as your utensil, be always thoroughly rinsed. I prefer an earthenware lid as being always cleaner. bottles, if necessary, you can always keep a patient warm in of meat. The smoky chimney, the dusty furniture, the utensils emptied but once a day, often keep the air of the sick constantly dirty in the best private houses. Li, Haibo We know, say, that from 22 to 24 per 1,000 will die in London next year. Notes on Nursing - by Florence Nightingale August 2010. "Can you attribute these symptoms to anything else but poison?" And tall patients suffer much more than short ones, because of the drag of the long limbs upon the waist. Patients very seldom, however, can tell this; it is for you to watch and find out. So it is with medicine; the function of an organ becomes obstructed; medicine, so far as we know, assists nature to remove the obstruction, but does nothing more. A want of the habit of observing conditions and an inveterate habit of taking averages are each of them often equally misleading. sufferings generally considered to be inevitable and incident to the disease are very often not symptoms of the application, would be invaluable to use in every sleeping and sick But I wish a little more was thought of the effect of the body on the mind. Death and disease are like the workhouse, they take from the same family, the same house, or in other words, the same conditions. Air can be soiled just like water. These cases I have seen not by ones, nor by tens, but by hundreds. morning. London, two in every five die before they are five years awake. Both may equally intend to speak the truth. epidemic disease and ill health is being distilled into the house. Not but that these laws–the laws of life–are in a certain measure understood, The nurse, therefore, must never put off attending to the personal cleanliness of her patient under the plea that all that is to be gained is a little relief, which can be quite as well given later. Why? It is a curious thing to observe how almost all patients lie with their faces turned to the light, exactly as plants always make their way towards the light; a patient will even complain that it gives him pain "lying on that side." The remedies are just as well known; and among them is certainly not the And it never occurred to the nurse to extemporize some expedient,–it never occurred to her that as he had no solid food that day he might eat a bit of toast (say) with his tea in the evening, or he might have some meal an hour earlier. As to food, for instance, I often think that most common question, How is your appetite? * It is a matter of painful wonder to the sick themselves, how much painful ideas predominate over pleasurable ones in their impressions; they reason with themselves; they think themselves ungrateful; it is all of no use. But the vast majority of all patients in England, young and old, male and female, rich and poor, hospital and private, dislike sweet things,–and while I have never known a person take to sweets when he was ill who disliked them when he was well, I have known many fond of them when in health, who in sickness would leave off anything sweet, even to sugar in tea,–sweet puddings, sweet drinks, are their aversion; the furred tongue almost always likes what is sharp or pungent. The medical officers should be absolved from all blame in these accidents. The amount of relief and comfort experienced by sick after the skin has been carefully washed and dried, is one of the commonest observations made at a sick bed. How can it be otherwise? Hinrichsen, Eduarda A. If he is an amiable patient, he will try to occupy his attention elsewhere and not to listen–and this makes matters worse–for the strain upon his attention and the effort he makes are so great that it is well if he is not worse for hours after. Scarlet is far more injured by the influence of foul air than when are too sadly true. But in a small way, the same manner of acting falls under the cognizance of us all. A celebrated man, though celebrated only for foolish things, has told us that one of his main objects in the education of his son, was to give him a ready habit of accurate observation, a certainty of perception, and that for this purpose one of his means was a month's course as follows:–he took the boy rapidly past a toy-shop; the father and son then described to each other as many of the objects as they could, which they had seen in passing the windows, noting them down with pencil and paper, and returning afterwards to verify their own accuracy. Frechette, Julie * 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. Very few people know how to read to the sick; very few read aloud as pleasantly even as they speak. These were mostly country patients, but not all. In several forms of diarrhoea, dysentery, &c., where the skin is hard and harsh, the relief afforded by washing with a great deal of soft soap is incalculable. * 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. What he wants is not your opinion, however respectfully given, but your facts. 3. But they are quite different. * This is important, because on this depends what the remedy will be. A man received an injury to the spine, from an accident, which after a long confinement ended in death. Now, dogs do not pass into cats. What would my advisers say, were they the medical attendants, and I the patient left their advice, and took the casual adviser's? is fresher than the other where I spend only 2. Never use anything but light Whitney blankets as bed covering for the sick. I need hardly here repeat the warning against any confusion of ideas between cold and fresh air. Never let a patient be waked out of his first sleep. Patient's repulsion to nurses who rustle. "How often have the bowels acted, nurse?" Depend upon it, the people who say this are really those who have little "to think of." I shall never forget the rapture of fever patients over a bunch of bright-coloured flowers. People think the effect is upon the spirits only. Carolyn Benck, Jane Dugan, Luevinia Hicks, Janet Keller, Mary Nuzzo, Sally Drake, Marilyn Wharton, Liz Pysar, Lisa Bartle, and You will relieve, more effectually, unreasonable suffering from reasonable causes by telling him "the news," showing him "the baby," or giving him something new to think of or to look at than by all the logic in the world. That none of them were even aware of the main fact of the disease and condition to which the death was attributable. * It is commonly supposed that the nurse is there to spare the patient from making physical exertion for himself–I would rather say that she ought to be there to spare him from taking thought for himself. Oh, mothers of families! One very minute caution,–take care not to spill into your patient's saucer, in other words, take care that the outside bottom rim of his cup shall be quite dry and clean; if, every time he lifts his cup to his lips, he has to carry the saucer with it, or else to drop the liquid upon, and to soil his sheet, or his bed-gown, or pillow, or if he is sitting up, his dress, you have no idea what a difference this minute want of care on your part makes to his comfort and even to his willingness for food. To attempt to keep a ward warm at the expense of Cheese is not usually digestible by the sick, but it is pure nourishment for repairing waste; and I have seen sick, and not a few either, whose craving for cheese shewed how much it was needed by them. of at all, the most extraordinary misconceptions reign about Let no one ever depend upon fumigations, "disinfectants," and the like, for purifying the air. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. He was a workman–had not in his composition a single grain of what is called "enthusiasm for nature"–but he was desperate to "see once more out of window." Again, I think that few things press so heavily on one suffering from long and incurable illness, as the necessity of recording in words from time to time, for the information of the nurse, who will not otherwise see, that he cannot do this or that, which he could do a month or a year ago.