Now that the nurse has acquired some knowledge of science from previous articles, she is prepared to take up the practical study of the nursing art. Like the medical student who has passed his earlier science examinations, and who goes into the hospital ward to apply practically the knowledge he has gained in the study and the lecture-room, the home nurse enters upon the second stage of her curriculum. She will now study the hygiene of the sick room and of the patient, and when we come to consider the third stage she will be taught how to deal with the different types of sickness.
The Question of Aspect
The general rule in a household when any member of it becomes ill is that he is nursed in his own bedroom. But in a case of serious illness, at least, the sick nurse should try to obtain the best possible room for her patient. The invalid who is nursed in a small, dark room difficult to ventilate and keep at a proper temperature is handicapped by environment. The ideal sick room is large and airy, with at least two windows, one facing south and one facing west. Light is a far more important factor in health and disease than most people know. Sunlight is beneficial to the higher forms of life, and injurious to the lower forms, such as fungi and germs. In damp, dark cellars fungus plants grow rapidly; in light, airy places the microbes of disease are destroyed. It has been proved by experiment that the tubercle bacillus will survive for weeks in the dust of a small, dark, ill-ventilated room, whilst direct sunlight and fresh air will destroy these germs in a few hours. The diphtheria poison also tends to hang about a house that is not freely penetrated by light and air. It can thus be seen that in sick nursing much depends upon the choice of a room. Sunlight is a mental tonic. The mind of a patient lying day after day in a sick bed becomes depressed if the sunlight rarely penetrates to his neighbourhood. In the afternoon and evening the sunlight is especially valuable.
Plenty of air is as necessary to the patient's welfare as plenty of light. The reader who has studied the article on respiration in Part 2 of Every Woman's Encyclopaedia knows that the occupant of a room is using up oxygen and giving out carbonic acid gas and other impurities. Therefore, thorough ventilation must achieved by the home nurse for the good of her patient. To ensure this the windows should never be absolutely closed, and the chimney-piece must be utilised for getting rid of the foul air. There are people - even educated people - who will block the chimney in their bedrooms, perhaps with the idea of keeping the room warm. Band-boxes, etc., have been found by enterprising doctors in the chimney-piece, whilst a bookcase filled with food for the mind is quite a common piece of furniture in front thereof!
The third point in the hygiene of the sick room is absolute cleanliness. No single article of furniture which is not absolutely necessary should find a place in the sick room. A small iron bedstead with spring mattress, and hair mattress on top, one, or perhaps two, chairs, a table for medicines, etc., and a small table at the bedside, besides a chest of drawers for linen, patient's clothing, etc., comprise all the furniture necessary. A large number of books, ornaments, pictures, and tables add to the work, harbour dust, and use up valuable air space. In infectious cases, also, the danger of spreading the infection is increased with every article permitted to enter the sick room. The ideal sick room has no carpet at all. The polished floor is more hygienic and more suitable, as well as more fashionable in this age of simple house furnishing. The simply furnished sick-room is not necessarily uninviting. The hospital ward, with its bright fire gleaming on the polished floors and walls, and its vases of flowers, has invariably a cheerful, homely appearance. Some pretty washing curtains at the windows, one or two artistic pictures, and a few flowers, which are removed at night, make the sick room inviting and yet strictly hygienic. Before the patient is moved into the room it should be cleaned and well ventilated; and, if possible, in the case of a long illness, the carpet should be removed, and one or two rugs substituted. In the case of infectious illness this is absolutely necessary.
Warming and Ventilating the Sick Room
Even in summer it is a good thing to have a fire in the sick room, because it assists ventilation by drawing the foul air up the chimney. Windows can be freely opened so as to prevent the temperature of the room from being too high. Between 55° and 65° F. is the best temperature for the sick room; 6o° is a very fair average, but in certain lung illnesses the temperature is generally required to be a little higher. The nurse must be careful to maintain the temperature at a uniform rate, and not to allow the room to be too warm at one time and too chilly at another. For this purpose it is necessary to have a thermometer, which should hang on an inside wall, not too near the fire or open window.
With regard to ventilation, the home nurse must understand that she will never nurse a case successfully in a stuffy room. Many people sleep every night of their lives in a room with closed door and windows. Morning headaches and lassitude and a sickly complexion are some of the rewards of their stupidity. They are, however, out in the air two or three hours daily, and thus their systems are cleansed of the accumulation of poisons in the blood. The invalid, on the contrary, has to live and sleep in one room for days and weeks at a stretch. If the nurse does not supply him with fresh air he is compelled to breathe over and over again air from which the oxygen has been extracted, and which, every hour, is loaded with more and more carbonic acid and other poisons. The average quantity of carbonic acid in fresh air is four parts in ten thousand. If we could examine air which we expire as it comes from the lungs we should find that the amount of carbonic acid had increased 100 per cent.; that is, there are four hundred parts of carbonic acid gas in ten thousand parts of expired air. This gradually diffuses through the room, and unless fresh air is introduced the atmosphere becomes more and more poisoned, and more unfit to breathe. If the air becomes so foul as to contain twenty parts of carbonic acid gas in ten thousand the occupants would suffer from giddiness, nausea, and intense headache, partly from poisoning from the carbonic acid and partly from lack of oxygen.
How a Room is Ventilated
Now, it has been found that to keep the atmosphere of a room in a fair state of purity 3,000 cubic feet of fresh air should be supplied every hour for each person. If a patient and a nurse are occupying a room 16 feet square and 12 feet high, which holds about 3,000 cubic feet of air, that room would require to be entirely flushed with fresh air twice every hour. If only one person occupied the room, of course, once an hour would be sufficient to renew the air. It is, however, rather inconvenient to change the air completely all at once, so that we aim rather at having a continual supply of fresh air in smaller doses coming into the room, combined with continual removal of impure air. In the ordinary bedroom the best way to ventilate a room is to open the windows at the top, and by keeping a fire in the chimney ensure that there is a current of fresh air from the windows to the fireplace all the time. To prevent draught entering, the air should be directed upwards, and this can be achieved by raising the lower sash a few inches and inserting a long slab of wood which blocks the opening you have made. The fresh air now enters between the two sashes, and passes up to the ceiling without any sensation of draught. Ventilation is assisted by the fact that when air is warm it expands, and is lighter than cold air. In the chimney is a column of air filling the space. Whenever the fire is lighted the lower end of the column is warmed, becomes lighter, and then passes upwards in the chimney. Colder air from the room rushes in to take its place, which is warmed in its turn, and ascends. Thus the warm chimney is continually sucking up air from the room, and if the supply of outer air is kept up through the window the sick room is being steadily flushed with fresh air.
Night air is no more injurious than day air, in our climate, at any rate, and so long as the temperature of the room is given liberal doses of fresh air it is beneficial in health and disease. It must not be forgotten that if artificial light other than electric light is used in the sick room, in addition to the fire, a greater supply of air will be necessary. If a small piece of candle is lighted and placed in a tall tumbler covered with a saucer to exclude the air a practical illustration of how oxygen is used up after a given time can be obtained. The candle burns brightly for a little while. As the carbonic acid accumulates inside the vessel the light burns dimly, and finally goes out. If a minute crevice is left to allow air to enter, the light continues to burn quite well.
Regulating Draughts and Light
In the same way, if a small animal were to be put inside the vessel it would gradually find difficulty in breathing as it used up the oxygen, and finally would expire from asphyxia. Whilst plenty of light and air are essential in the sick room, the good nurse protects the patient from any unpleasantness in the shape of draughts or strong lights. A dark blind will exclude strong light if the patient's eyes are fatigued or sensitive to light. A screen will guard the patient from real or fancied draughts, and the bed can often be altered to permit the light coming from behind the patient's shoulder, if possible from the left. It is never a good thing to have the light shining right into the patient's eyes, and in convalescence a good light from behind facilitates reading to a considerable degree. It is in attending to these little details the nurse proves herself worthy of her position.