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- Making Good On Private Duty - 10/15 -

One frequently hears the private duty nurse deplore the necessity of her remaining with a patient during convalescence. "I wish," such a one would say, "that I never need stay with a patient after the temperature has been normal for ten days," or, "I do not mind the first two weeks of an obstetric case, then there is something to do, but after that I am ready to leave," or again, "When my patient is ready to go out driving, I always wish she would drive me home; half-sick people are not to my taste." I have often wondered if this feeling is not caused by the atmosphere of the hospital which has, during training, been the nurse's home,--the hospital, where the patient leaves at the earliest possible moment of recovery, to make room for someone else. The pupil nurse gets used to the excitement of critical illness, used to the hard work of constant watching and fighting for the patients' lives, and that, and only that, it seems to her, is nursing. So when she goes to her private cases, and her patient has a long period of convalescence, she feels out of place, she does not seem to be doing what she was trained to do, and she frets over it, until some happy day when the doctor releases her, and she is at liberty to go once more to some one who is at death's door.

Nurses seem to feel that caring for a convalescent is not "nursing," but there they are mistaken. After a serious illness it takes a long time to restore the patient to perfect health, some function may need the close watching which only trained eyes can give, and it is not beneath the dignity of the nurse to remain, and keep watch until every part is once more in perfect working order. Many nurses feel that it is not nursing to amuse a patient, but it is nursing to help him on to the healthy plane from which he has fallen, to play games with an invalid and to watch him, to read with him, and to watch, to walk or ride or travel with him, and to watch, always to watch, that the dreaded symptom does not appear, that the one part which still needs care gets it.

A surgeon does not spend all day, every day, with his gloves on, and his scalpel in his hand; he is not _always_ operating, or even arranging for operations; he can find time to see patients, to sit and talk with them, to advise them, to cheer them, even to tell funny stories to them, but all the time he is watching them. A lawyer is not always pleading in the court room, a clergyman is not forever in the pulpit. The lawyer when talking to his client is just as truly a lawyer; the clergyman, when visiting his congregation, is just as truly a clergyman,--the sermon on Sunday is the climax, if I may so express it, of his week's work. The lawyer's speech to the jury is the point to which all his efforts tend after, perhaps, weeks of preparation. So the convalescence of a patient is the post climax of the nurse's undertaking. She begins with the climax, severe illness, operation, or obstetric case, whatever it may be, gradually the stress lessens, the whole atmosphere of the house becomes natural as the patient progresses toward recovery; but the process is not complete, and the nurse's work is not done until the doctor pronounces her trained care no longer necessary; then she may go, and feel that her work has been thoroughly done-no small comfort surely.

I wish I could show my young sister nurses how good _for them_ this period of the patient's convalescence might be. The delightful rest of regular sleep, and regular meals comfortably eaten at a table instead of in solitude from a tray, the opportunity for regular exercise--these things come as a real luxury when one has been nursing a critically-ill patient, and anxiety has been with one, night and day. This is the period when the nurse's nerves, strained to their utmost, can regain their tone, where the responsibility borne by the doctor and shared by the nurse is not so great a weight, and the knowledge of one more victory over death, one more human life saved, gives a joyousness to the day that is good to experience.

The satisfaction of knowing that by your help the patient has come, perhaps, from the gates of death; the pleasure of noting day by day the return of healthful sensations, the gradual ever- growing desire to once more take his accustomed place in the life work that has been interrupted--all these are missed by the nurse who flies from convalescents.

May it not be that the change in occupation has something to do with this unwillingness to remain with a patient when he is convalescing? When a temperature has to be taken but once a day, or when the doctor only makes visits twice a week, when all the routine of the sick-room gives way to a more natural atmosphere, many nurses do not feel at ease, they do not read aloud pleasantly, they do not care for books, and, if the patient asks for this amusement, the reading is a torment to the nurse, and I imagine it does not afford much pleasure to the listener. A nurse once gave me a graphic description of her efforts to read "Romola" to a convalescent typhoid patient. The poor nurse knew nothing of Florence or of the Italian language, and her struggles over the foreign words in that book must have been funny enough. Her patient was not much edified--of that I am certain. If a nurse does not read aloud understandingly, she should make every effort to learn. She thereby increases her usefulness, and makes herself more acceptable to her patients. She adds to her own value. She is worth more. No nurse can tell when this method of passing the weary hours will be required of her, as it is almost certain that a patient of intelligence will ask for some mental refreshment.

Another pleasant way to pass the long hours of convalescence, is by playing games with your patient. I am sure no training school for nurses has added the study of cribbage, pinochle, bezique, chess, checkers, backgammon, or dominos to its curriculum. All these are two-handed games, the playing of which will help the convalescent to forget himself and his past illness and present weakness. The nurse, if she knows only one game that is unfamiliar to the patient, gives him new thoughts while she teaches him, and it is quite astonishing how much pleasure such simple things can give both to teacher and pupil. I would suggest that nurses in their club houses or homes could profitably fill some vacant evenings practising these two-handed games. I am sure they would never regret the time so spent.

If the convalescent is a woman, the means of amusing her are more varied and more congenial perhaps. In addition to reading aloud and playing games, there is the vast realm of "fancy work," where most women feel at home. It is a pity, so few women nowadays know anything about knitting, crochetting or tatting,--many do not even know which is which. A lady asked me very innocently, not long ago, how I could tell the difference between knitting and crochetting! Since Irish crochet has returned to favor, however, many have once more taken up their crochet needles. The nurse who can deftly turn her hand to these dainty arts, and can teach them to her patients, or any of the patient's family, has the means of making herself a very acceptable companion, apart from her nursing skill. Embroidery is very fascinating, and appeals to every woman. A dainty little garment for your patient, embroidered while you watch her return to health, will be long treasured by her. For a nurse, what art, what accomplishment can she have that will not help some poor invalid, that will not shorten the weary hours for some sick body, or bring consolation to a weary soul? A perfect nurse is one who brings comfort to her patient. It is because trained nurses bring more comfort that they have replaced the old style nurse; the more comfort the nurse brings, the more successful she is. The ability to talk well, when talk is needed, to read well, to amuse understandingly, to wisely meet each need of the invalid as it presents itself, this is to be the ideal nurse.



To many nurses the time between cases is dreaded as a period when money is being spent for necessary maintenance, and none is coming in; a nervous time, as the ring of the telephone which may mean a call is wished for or dreaded, perhaps both; an anxious time, as no one knows how long she may have to wait; a dreary time, as the days drag on and still no call comes. It _is_ a trying time, but much can be done in these days of waiting that is delightful in the doing, and that will prove a source of pleasure to all future patients, and no little profit to the nurse also.

Let me preface my few hints by saying that all patients and patients' friends expect the nurse to know all about the diseases and their cures, the care and management of the sick,--that is common, ordinary nurses' business,--but there too many nurses stop; they often can go no further; and when one comes to a family and adds to this a broad culture, and an intelligent interest in the topics of the day, the respect and admiration of the patient and family are unbounded, and their surprise genuine.

I would like, if possible, to impress upon the nurse graduate that really there is much to learn after she has left the training school. All the technic of hospital and operating room is fresh in mind, but there is so much that lies necessarily outside the walls of a hospital, and this knowledge that comes with experience is a great part of what makes a successful nurse.

I will not touch here upon what every nurse knows so well, relating to the "preparedness" of clothes, satchel, and instruments. We take it for granted that all this is ready. The case before has been a hard one, we will imagine, and several days have been given to the luxury of whole nights in bed, and whole days of resting; this is all done, and the next case is awaited.

The best thing to do first is for the nurse to examine a little her mental equipment, see what she has stored away in her mind that can help the next patient, or that can assist in fighting the battle of hygienic cleanliness versus disease-bearing dirt. Let her consider whether she reads aloud acceptably, understandingly. Has she a good list of books which most women would enjoy? Does she know what books to suggest for the children? Can she tell what would interest the boys, or what a man would like to listen to? Does she know humorous books, interesting histories, or biographies? Here, then, is occupation for many idle days.

To go to a public library is always a pleasure, to make friends with the librarian is an added pleasure, as is also the making one's self familiar with some good books that can always be procured, and that will give pleasure and profit to patient after patient. This search for good literature will give happiness in the quest, and happiness in the reading. Librarians are usually glad to direct one to the books needed, and many delightful hours may be spent in the library, and all the while the comfortable feeling experienced that the pleasure felt will be transferred later to future patients.

The subject of hygiene is taught in most training schools, and

Making Good On Private Duty - 10/15

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