I found Florence Nightingale’s Notes on Nursing book in the library and I’ve been rapt by it all week. First published in 1859 it’s an assortment of her ideas and tips on how to nurse ‘the sick’. The profession has come a long way since her day but most of her observations are still absolutely relevant even if done slightly differently now.
I’m pretty sure I would have liked her – she evidently does not have much time for the ‘reckless physicking of amateur females’ (Gracious me Florence, neither would I!). Her writing style cracks me up – full of commas, dashes, sentences half a page long, somewhat rambly but there is usually a point in the end!
Here is what she had to say on:
Ventilation and personal cleanliness
Never be afraid of open windows, people don’t catch cold in bed. This is a popular fallacy. The time people take cold (and there are many ways of taking cold, besides a cold in the nose,) is when they first get up after the two-fold exhaustion of dressing and of having had the skin relaxed by many hours, perhaps days, in bed, and thereby rendered more incapable of re-action, the same temperature which refreshes the patient in bed may destroy that patient just risen.
Of all methods of keeping patients warm the very worst certainly is to depend for heat on the breath and bodies of the sick. Do you ever go into the bedrooms of any persons of any class, whether they contain one, or two, or twenty people, whether they sick or well, at night, or before the windows are opened in the morning, and ever find the air anything but unwholesomely close and foul? In disease where everything is given off from the body is highly noxious and dangerous not only must there be plenty of ventilation to carry off the effluvia but everything which the patient passes must be instantly removed away, as being more noxious than even the emanations from the sick.
Just as it is necessary to renew the air around a sick person frequently, to carry off morbid effluvia from lungs, so it is necessary to keep the pores of the skin free from all obstructing excretions. 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 perspiration, which would renew the evil in another form.
The various ways of washing the sick need not here be specified – the less so as doctors ought say which is to be used. Every nurse ought be to careful to wash her hands very frequently during the day, if her face too so much the better.
I’m with you on the open windows thing Flo, but not on taking doctors orders I’m afraid!’
Petty management
All the results of good nursing, as detailed in these notes, may be spoiled or utterly negatived by one defect, viz.:in petty management, or in other words, by not knowing how to manage that what you do when you are there, shall be done when you are not there.
If you look into the reports of trials or accidents, and especially suicides, or into the medical history of fatal cases, it is almost incredible how often the whole thing turns upon something which has happened because ‘he’ or oftener ‘she’, ‘was not there’. The person in charge was quite right not be there, but the fault lies not in his being away but in there being no management to supplement his being away. To be in charge is certainly not only to carry out the proper measures yourself but to see that every one else does so too; to see that no one either wilfully or ignorantly thwarts or prevents such measures.
“Umm, so basically, tell people to do as you do AND do as you say?”
Noise
It is, I think, alarming, peculiarly at this time, when the female ink-bottles are perpetually impressing upon us ‘woman’s’ particular worth and general missionariness’, to see that the dress of women is daily more and more unfitting for them in any ‘mission’, or usefulness at all. Compelled by her dress, every woman now either shuffles or waddles – only a man can cross the floor of a sick room without shaking it. What has become of woman’s light step? A firm light quick step, a steady hand are desiderata; not the slow, lingering, shuffling foot, the timid, uncertain touch. Slowness is not gentleness, though it is often mistaken for such; quickness, lightness and gentleness are quite compatible.
With regard to reading aloud in the sick room, my experience is, that when the sick are too ill to read themselves, they can seldom bear to be read to. Children, eye-patients, and uneducated persons are exceptions. Never read aloud in fits and starts to the sick – the extraordinary habit of reading to oneself in the sick room and reading aloud to the patient any bits which will amuse him is unaccountably thoughtless.
‘ Nurses must not faff about, and if they do, must at least do it quietly – yes?!’
Taking food
One is of the belief that beef tea is the most nutritive of all articles. Now, just try and boil down a lb. of beef into beef tea, evaporate your beef tea, and see what is left of your beef. You will find that there is barely a teaspoonful of solid nourishment to half a pint of water in beef tea; nevertheless there is a certain reparative quality in it, we do not know what, as there in in tea; but it may safely be given in almost any inflammatory disease, and is as little to be depended upon with the health or convalescent where must nourishment is required.
‘Thank goodness for Bovril – not sure we can be boiling beef down to a teaspoonful when there is so much else to do!’
___________________________________________
I’m pretty sure I would have liked her – she evidently does not have much time for the ‘reckless physicking of amateur females’ (Gracious me Florence, neither would I!). Her writing style cracks me up – full of commas, dashes, sentences half a page long, somewhat rambly but there is usually a point in the end!
Here is what she had to say on:
Ventilation and personal cleanliness
Never be afraid of open windows, people don’t catch cold in bed. This is a popular fallacy. The time people take cold (and there are many ways of taking cold, besides a cold in the nose,) is when they first get up after the two-fold exhaustion of dressing and of having had the skin relaxed by many hours, perhaps days, in bed, and thereby rendered more incapable of re-action, the same temperature which refreshes the patient in bed may destroy that patient just risen.
Of all methods of keeping patients warm the very worst certainly is to depend for heat on the breath and bodies of the sick. Do you ever go into the bedrooms of any persons of any class, whether they contain one, or two, or twenty people, whether they sick or well, at night, or before the windows are opened in the morning, and ever find the air anything but unwholesomely close and foul? In disease where everything is given off from the body is highly noxious and dangerous not only must there be plenty of ventilation to carry off the effluvia but everything which the patient passes must be instantly removed away, as being more noxious than even the emanations from the sick.
Just as it is necessary to renew the air around a sick person frequently, to carry off morbid effluvia from lungs, so it is necessary to keep the pores of the skin free from all obstructing excretions. 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 perspiration, which would renew the evil in another form.
The various ways of washing the sick need not here be specified – the less so as doctors ought say which is to be used. Every nurse ought be to careful to wash her hands very frequently during the day, if her face too so much the better.
I’m with you on the open windows thing Flo, but not on taking doctors orders I’m afraid!’
Petty management
All the results of good nursing, as detailed in these notes, may be spoiled or utterly negatived by one defect, viz.:in petty management, or in other words, by not knowing how to manage that what you do when you are there, shall be done when you are not there.
If you look into the reports of trials or accidents, and especially suicides, or into the medical history of fatal cases, it is almost incredible how often the whole thing turns upon something which has happened because ‘he’ or oftener ‘she’, ‘was not there’. The person in charge was quite right not be there, but the fault lies not in his being away but in there being no management to supplement his being away. To be in charge is certainly not only to carry out the proper measures yourself but to see that every one else does so too; to see that no one either wilfully or ignorantly thwarts or prevents such measures.
“Umm, so basically, tell people to do as you do AND do as you say?”
Noise
It is, I think, alarming, peculiarly at this time, when the female ink-bottles are perpetually impressing upon us ‘woman’s’ particular worth and general missionariness’, to see that the dress of women is daily more and more unfitting for them in any ‘mission’, or usefulness at all. Compelled by her dress, every woman now either shuffles or waddles – only a man can cross the floor of a sick room without shaking it. What has become of woman’s light step? A firm light quick step, a steady hand are desiderata; not the slow, lingering, shuffling foot, the timid, uncertain touch. Slowness is not gentleness, though it is often mistaken for such; quickness, lightness and gentleness are quite compatible.
With regard to reading aloud in the sick room, my experience is, that when the sick are too ill to read themselves, they can seldom bear to be read to. Children, eye-patients, and uneducated persons are exceptions. Never read aloud in fits and starts to the sick – the extraordinary habit of reading to oneself in the sick room and reading aloud to the patient any bits which will amuse him is unaccountably thoughtless.
‘ Nurses must not faff about, and if they do, must at least do it quietly – yes?!’
Taking food
One is of the belief that beef tea is the most nutritive of all articles. Now, just try and boil down a lb. of beef into beef tea, evaporate your beef tea, and see what is left of your beef. You will find that there is barely a teaspoonful of solid nourishment to half a pint of water in beef tea; nevertheless there is a certain reparative quality in it, we do not know what, as there in in tea; but it may safely be given in almost any inflammatory disease, and is as little to be depended upon with the health or convalescent where must nourishment is required.
‘Thank goodness for Bovril – not sure we can be boiling beef down to a teaspoonful when there is so much else to do!’
___________________________________________
In 1853 she became Superintendent of the London Establishment for Gentlewomen during Illness but in 1857 she took to her bed, suffering from ‘fevers’ caught, she thought, during her time in the Crimea - we hope she had the windows open and aired the sheets daily!
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