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- Making Good On Private Duty - 4/15 -

what you must have. Believe me, you will be rewarded for the temperate use you make of all the dainties you see, by a clear complexion, and good color, which will make you "good to look at," especially good for a sick person to look at.

As to the nurse's night toilette, it is quite a problem sometimes as to just what is best to wear. When the patient is not ill enough for the uniform to be retained for night duty, the nurse should be comfortable enough so that she can sleep; yet dressed enough for any emergency. I think a house gown of pretty material much neater than the kimono. Be sure this fits about the shoulders, and never have loose flowing sleeves. A white frill in the neck looks very trim, and is always becoming. The corset and all tight clothes should be removed, stockings and underwear kept on. The hair should be arranged simply, but not allowed to hang in a loose braid, unless you are _very_ sure you will not see any but the patient, and even then it may be unwise, as a braid of hair has an exasperating way of slipping from its proper place (hanging down the back) and dipping into whatever you are stooping over. Dressed thus, with night shoes to protect the feet, one can lie down on a lounge and sleep very comfortably, being freed from tight clothes, and yet being entirely presentable, no matter what happens. To undress regularly and put on the diaphanous low-necked short sleeved night dress of the present mode, and go to bed, when you are sure you will have to get up one or a dozen times during the night is not good judgment, I think. You get out of a warm bed, and if you only put on your shoes and stockings, your patient must wait while you do it. If anything serious occurs suddenly, you either run the risk of taking cold from being insufficiently clad while doing what must be done, or your patient must wait while you dress--both bad.

Never get into bed with your patient. This seems to most people a quite unnecessary caution, but it is the commonest experience of the successful nurse, that a woman, feeble and nervous, should ask and almost insist that she shall lie down by her, or get into bed with her. I always wonder that a sick woman can not realize that she is not a pleasant bed-fellow, but she seldom does. Of course you are not to tell her that she is not fit to sleep with, but you _can_ say that she needs and ought to have the whole bed to herself, and you will sit by her and hold her hand, or if she insists on it, you can lie down, with your house gown on, on the _outside_ of the bed, being careful to give her plenty of space, and when she is asleep, get up quietly and lie down on your lounge, which should be placed so that you can see her every movement.

Never let the patient think for a moment that you fear her disease; if she has diphtheria, do not tell her or the family that you have a delicate throat or that it is sore, and do not examine it by the help of a hand-glass where any one can see you. Do not go to such cases if you really fear them, but if you go, and have reason to feel that you have contracted the disease, tell the doctor as soon as you can, and if he thinks you ill, he will send you home. Never tell a patient you have a weak back or any weakness. Tell the doctor and he will see to it that you have rest or medicine, but do not let the patient know it. Never go about a sick room with a long face; it is enough for the sick one to have to be sick; the family sympathies are all enlisted for her. You are there to be a help and a comfort, not an added anxiety. Of course these remarks do not apply to any of you who are tired from a long, exhausting case. The family in such instances are ready and willing enough to let you rest. Keep your cheery manner: all higher considerations aside, it is money in your pocket to look cheerful. I have known one or two good, faithful, conscientious nurses who were dismissed from case after case, merely because they looked "so doleful." It may seem curious to place a commercial value on a smile, but in reality it amounts almost to that.

Be very careful to have your dresses fit you perfectly, and have them well laundered, especially do not have them too stiff. In this connection I cannot do better than to relate an incident that I heard of some time ago. A nurse went to care for a patient whose first nurse had been called to her own home, and she had not been in the room an hour before the patient called her and taking her hand said, "My dear, I can't tell you how thankful I feel that your dress is not too short in the waist. Miss----'s dress was frightful!" This was only a nervous woman's whim, but our success as nurses depends in many cases on just such whims, so it is well to be careful. When the patient is well enough for you to come to the family table at meal time, be sure to have on a spotless apron, and let no sickroom odors announce your presence. It is worth more to a nurse to have soft, dry, warm, sympathetic hands, than to have the prettiest face ever seen under a cap, so be careful of them; after using any antiseptics always have at hand glycerin and rose water, cold cream, or something soothing to use. Never put a cold or clammy hand on a patient. If it is cold and dry it can be laid on a hot, aching head, but never do so if it is the least damp. If the hand is always damp, pour on it a little alcohol, or eau de cologne, if that is preferred, or some toilet water, then put it on the patient's head, and it will be all right. A simple and very cold lotion is alcohol and water, about equal parts, and a piece of ice added. Hold your hand in this a moment and then gently comb the patient's hair (that which grows on top of the head) with the dripping fingers, taking care not to let any cold water-drops fall on the face. This is wandering somewhat from my subject, but I will let it stand and speak of one more thing that is good to remember. Never lay a warm hand on a patient's head, or a cold one on the body. If you have to rub your patient's body, and your hand is warm and damp, shake a little talcum powder into it, or use a little cold cream, cocoa butter, or lanolin, and the dampness will not be perceived. Alcohol may also be used, or bay rum.

Some nurses are much troubled by excessive perspiration, especially under the arms, any hard work making the dress quite wet. The ordinary shields are not very good, as they are not absorbent enough. A piece of flannel basted inside of the shield is a help, as that is absorbent. The auxiliary space might be bathed with a solution of alum; alcohol is good or alcohol with white-oak bark. Many preparations for this trouble are on the market, most of them are good but some are expensive. A late copy of the _Journal of Nursing_ gives the following: "Take two ounces of baking soda, mix with half an ounce of corn starch, and use as a dusting powder, after the parts have been thoroughly cleansed and dried. It will check the perspiration and remove every particle of odor." This is very successful, but I find it leaves a slight yellow stain on a white dress. Another remedy from _Journal of Nursing_ is this: "Zinc oxide" applied to axillae twice a week, after bathing at night, will dissipate the odor. If the perspiration has a disagreeable odor, no effort should be spared to free oneself from what is a serious drawback to the acceptableness of a nurse.

Be very careful not to contract any little annoying habits, such as frequent clearing of the throat, sniffing, etc. You may have a catarrh, but use your handkerchief quietly; such noises are very disgusting, and these habits, I am sorry to say, are not rare, and seem very hard to conquer.

I suppose that I have better opportunities to hear stories of nurses and their doings, good and evil, than some have. I certainly hear some very curious things. The most extraordinary was of a nurse who always made it a rule, when she went to a patient's house, to stipulate immediately for her hours "off duty." She thought she was doing a very clever thing, and making a most commendable business-like arrangement. It will not be necessary for me to show you what a lack of tact she exhibited, and what an antagonistic feeling she aroused.

Never kiss your patient or allow yourself to show any demonstrative affection, unless you are very sure it will be welcome, and be careful even then. A kiss for "goodbye" when you leave the patient is usually quite enough, and many ladies are repulsed by anything of the kind. If you feel an affectionate regard for your patient, you can show it by your constant thoughtfulness and your care. Do not fear that you will lead lonesome, repressed lives; if you are the nurses you ought to be, you will have all the affection you want, and often more than you know what to do with. Never do any sewing or fancy work for yourself until you are sure there is none you could do for the patient. Remember that she pays for your time, and govern yourself accordingly.

Read to her, sew for her, play cards with her, but do not amuse yourself or regulate your wardrobe at her expense. When I say "sew for her" I do not mean make her dresses, but do the little odd things that mothers of families always do, and which must remain undone if she is sick, unless you do them. Do not write letters when on duty, and, above all things, do not write with a scratchy pen. To a nervous person the sound of a scratchy pen traveling over the paper is torturing, and it can be heard even if you are in the next room. A fountain pen is, I think, the best to use. See that it is full before you go to your case, and it will need no attention for three or four weeks. This pen makes no noise as you write, and you have it always at hand, and if you have to leave your letter in haste, you can put the cap on the pen and slip it in your pocket, and no one is in any danger of finding fault with the nurse for leaving an open ink-bottle for somebody to tip over.

Remember finally (and I think, from what I read in the daily papers, you are in no danger of forgetting this), that you are not domestics, and, while in an emergency I would have you shrink from nothing that needs doing, I do not think you should do any washing. Cooking you will very often have to do, but the ordinary housework does not come at all into your province. If your patient is a chronic invalid, I would have you make yourself useful in the house. Do the shopping, order the meals, anything that will show your patient you are anxious to help make the wheels of domestic machinery run more smoothly.

You must use all the tact you possess; you will not find two houses just alike, or two patients with the same tastes. A "lady" in an emergency does many things she usually leaves to the servants. So must you. There is sickness, trouble with the servants, every domestic wheel turning with difficulty, and, if you have time, if you can leave your patient without doing her an injury, you can, perhaps, by some little service earn much gratitude from the family, and help to remove the impression that trained nurses are "so helpless and need so much waiting on."

In conclusion, let me tell you, with all the earnestness of which I am capable, that upon each one of you rests not only the reputation of your school, but, in a measure, the reputation of the profession. No one needs to be told how much more widely known is an inconsistent Christian than a faithful one, how much harm one does and how comparatively little good comes of the others' faithfulness. And it is just so with you nurses, a careless nurse makes a far wider reputation than a careful one.

Making Good On Private Duty - 4/15

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