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- Making Good On Private Duty - 5/15 -

If one physician is unskillful or unprincipled, the whole profession is not found fault with, but the individual is blamed and another one found who will do better, but it is not so in most cases where a nurse proves unsatisfactory. The whole profession suffers and every nurse sinks more or less if one of her sister nurses commits an indiscretion, or does any of the thousand things she ought not to do. I recollect very well, many years ago, a Brooklyn nurse, of about thirty-five years, married her patient, a boy nineteen years old. It made a great stir in the city, and, as I was living there at the time and the superintendent of a training school, I had to bear my share of the odium cast upon all nurses. For months after, almost every one I met took pains to tell me that hereafter they would keep their young sons out of the clutches of the designing nurse, and I doubt not, such slighting remarks were borne by every nurse in town, and it was not pleasant, to say the least of it, for any of us.

Keep your standards high. Let nothing but the very best satisfy you, as far as you and your work are concerned. Keep your mind well informed; if it is full of scientific facts, of skillful methods, of good literature, or fine pictures, there will be no room in it for the memory of all the disagreeable things every one must encounter in one's work, and if you do not remember them, you cannot tell others of them.

Finally, remember (and this lies at the root of it all) to keep your hearts right,--ever thankful that you are permitted to pursue this high calling, and ever striving to be more worthy of it, with many prayers that your life and conduct may show, what is better _lived_ than talked about, the grace and peace of God, which verily do pass man's understanding.



Try to realize when you go to a house where there is dangerous illness, that the family is glad to see you when you come. You have come to help them, to stay with them, to comfort them by your presence, by your knowledge, by your experience. They have needed you, have sent for you, and are to pay you for your time. There is a general sense of relief when you are once fairly installed in your place by the bedside, yet you are a stranger. Your friend, the doctor, has told them what a treasure you are. Mrs. This and Mr. That have perhaps let them know how invaluable you were when at their houses; but yet they must look at you a little, they must note if you make a pleasant impression on the invalid, if you are as skillful here as you were somewhere else, if you look with scorn on the plain furniture, or how much you will be displeased that the bath-room is at the other end of the house. They do not feel exactly critical: they are too tired or too anxious for that; but still, unless everyone is too exhausted from watching to do anything but thankfully surrender everything to you, you will be pretty closely looked after at first.

You must look for some espionage; and it is only right that you should be subjected to it. If _your_ mother was lying very sick, and some stranger, having knowledge and strength superior to your own, had to come and care for her, would you not feel that though you were glad to see her, glad she would give your mother the benefit of her superior skill, yet you would wish to consider her a little, to note when she did thus and so; or if she did something you did not understand, could you refrain from asking her why she did it?

Be patient, therefore, with the suggestions of the family, after all, though you know the disease and the probable course it will run, the chances for recovery, and what to do in emergency, etc., _they_ know the patient, all her peculiarities, her likes and dislikes, and if you are wise you will get and keep many little hints from those who have cared for her before you came. If she likes milk, will she insist upon tea? Does coffee keep her awake? Does she hate the sight of gruel, or beef-tea? Does she like much sugar in her drinks? All these are little matters of individual taste that you must find out for each patient, and if you have the necessary tact and forethought, you never need ask the patient one question; usually the friends are pleased to be consulted on such small matters, and gladly tell you all you wish to know. To be sure, they generally tell much more than you asked for; but that does not matter, it is better to listen patiently for five minutes to someone's tiresome descriptions than to repulse them, and so lose just so much kindly feeling from the one who wished to talk to you.

If the amateur nurse has been doing something actually wrong for the patient, do not tell her so. She did the best she knew how; but say, as pleasantly as you can, "I think perhaps _this_ would make our patient more comfortable," or "The doctor thinks such and such things are not now necessary, and it would be better to do this way." Then you can do what you know to be right, and not hurt the feelings of the one who has preceded you, and, feeling your way carefully, have everything just as it ought to be, and no one's feelings will be hurt, and no one will feel that you are looking down upon their ignorance; and here I would say that in your little confidential talks with the doctor, you could ask him to say a word to the family if they persist in doing what you know to be wrong. Ask him to give you orders before some of them, and that will set _you_ straight in a moment.

With tact, that most invaluable gift, you can get on with _almost_ every one, and when you find that there is no such thing as making friends with the family, you can tell the doctor, and he will let you go; but such places are very rare. Let all see that you are thoroughly interested in your patient, and do not hesitate to perform any little kindness that falls in your way for the rest of the family, and you will win all their hearts without a struggle.

When you go for your rest, be sure to leave carefully written directions for the one who is to take your place, just as you do when in charge of a hospital ward, you leave your orders written out when you go for your "off duty." Show her how to keep the sick-room record, and be sure she understands it all before you leave.

As for the visitors, they are often difficult to manage, and here again you must have the family help you. Of course _no_ visitors are allowed until the doctor gives permission. So far all is easy, but when they are admitted you will do well to make a little plan with the family. Tell them the patient may be seen at such an hour. Perhaps between eleven and twelve, perhaps between two and three, just as you consider her brighter in the morning or afternoon. Ask them who of the first and dearest friends is the quietest and most discreet, and then say that if they will kindly arrange for one visitor only to come each day, it would be so much better for the convalescent. The friends can always do this and they never object. They tell Mrs. Jones to come on Monday at two, and stay just fifteen minutes. On Tuesday Mrs. Smith can come, and so on, until by the end of the week the arrangement ceases to cause any comment, and soon, if all goes well, and the convalescence goes on without interruption, _your_ rules and extreme care can be relaxed to suit the patient's own fancy.

Always carefully note if any visitor tires your patient, and manage so as not to let her come again until the sick one has more strength. It is better, I think, to sit in an adjoining room when your patient has a visitor. This gives you a chance to come into the room when the person has stayed long enough, and generally your entrance tells her very plainly that she ought to go, and she departs without you saying a word. If she does not, you will have to tell her that the doctor is very particular about not letting the patient talk too much, etc., etc., and get her out in that way. Be careful, when the visitor has gone, not to sit down and talk at length yourself. Give the patient a little nourishment, turn over her pillows, and if she seems at all wearied make her comfortable for a nap and let her sleep.

As to the servants they require pretty careful handling. Above all things, keep on the right side of the _cook_. If you have to go to the kitchen to do any of the cooking, do not make a _mess_, or, if you do, don't run off upstairs and leave it. Gather up your utensils and put them into the sink, and let the water run over them, and ask for the dishcloth: and if you do it pleasantly, the cook will probably tell you to "Niver need thim things," and you will thankfully obey her. If you really cannot stop to make all tidy after your cooking, you can say, "I'm sorry to make you extra work with these dishes, but I must hurry back upstairs." Some such little speech, with a pleasant smile, will make all things easy for you below stairs, and for the sake of all the friction it will save you, it is well worth the trouble. Often the cook will be glad to do the cooking if you tell her how; be careful to tell her, if it is eaten and enjoyed; and never let her know if it is rejected. Get rid of it upstairs by some contrivance, and be sure not to order that dish again. In many cases of course the cook will know all the little dishes the sick one will fancy, and you will have very little to do with her. Such instances are somewhat rare, and very delightful when they occur.

If there is much extra washing, you may have to use much diplomacy as regards the laundress; and if it is very disgusting washing, it is well to have a large pail, with a cover, upstairs. Thoroughly disinfect the clothes before you send them to the washing, as the odors are often sickening, and the laundress, like other servants, is very much afraid, usually, of clothing from a sick-bed. Carry or send the clothes to the washing as soon as possible after removing them from the bed; never, on any account, allow them to remain in the room.

The nurse cannot be too careful as to the amount of clothes she sends to the laundry. She should of course keep herself and the patient scrupulously clean; but she must reflect that private families do not have an unlimited store of towels and sheets, and if she is extravagant in this matter it will seriously detract from her acceptability.

In concluding, let me remind you that all these hints are intended for nurses going from one strange place to another, as you would in nursing fevers, or short surgical cases. Nurses who have chronic cases need none of these rules. They fall into a routine, and if they are detained in the family for any length of time, that shows that their work and methods are right, as far as that patient and family are concerned. But let them be careful when at last they leave the case, and go amongst strangers. The ways of one family are not the ways of another, and they must exercise much discretion to accommodate themselves to the new environment.

Making Good On Private Duty - 5/15

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