Nursing home

“ The patient and family gained the important value of confidence through the caring of the home health nurse; with the nurse's commitment to caring, they gained faith in themselves, their ability to deal with new health-related situations as they arose, faith that they wouldn't be left alone, faith that they were known as persons valuable in their own right and worthy of care. This is the value of nursing, the reason nursing exists as a distinguishable social and human service. ”

“ The nurse who is able to go into a home quietly and unobtrusively and accept what she finds, even carpets and draperies, and still do clean work, is doing better nursing than the one who arranges a faultless room but upsets her patient and disrupts the household in the process. ”

“ The beginning has been made, the first crusade has been fought and won, to bring—a truly 'national' undertaking—real nursing, trained nursing—to the bedsides of cases wanting real nursing among the London sick poor, in the only way in which real nurses can be so brought to the sick poor; and this is by providing a real home, within reach of their work, for the nurses to live in—a home which gives what real family homes are supposed to give—materially, a bedroom for each, dining and sitting-rooms in common, all meals prepared and eaten in the home ”

“ To have the rural nurse a resident in the community, her services for all regardless of any lines of distinction, to have intelligent nursing care for patients in their own homes, and instruction and demonstration given in the principles of hygiene, not only of person but as applied to home surroundings, are advantages which have been appreciated wherever the visiting nurse is established. ”

“ Many communities not in the registered area and remote from the centers of active social propaganda will be given stimulus to organize for nursing service, and from this other medical and social measures will inevitably grow. It requires no far reach of the imagination to visualize [62] the time when our country will be districted from the northernmost to the southernmost point, with the trained graduate nurse entering the home wherever there is illness, caring for the patient, preaching the gospel of health, and teaching in simplest form the essentials of hygiene. ”

“ Do not attempt a full nursing visit unless the patient meets you more than half way. Every patient is to be encouraged to come to the Center for as much of the nursing care as is possible for that individual woman. In the care of all patients it is the nurse’s responsibility to make every effort to solve (by working 424with every existing agency) such home problems as might effect the health of the mother or baby or disturb the mother’s peace of mind. ”

“ In overcoming this prejudice, a great deal depends upon the character of the institution itself. It is not enough to establish hospitals:—they must be attractive and comfortable to such a degree that they become highly desirable to prospective patients. They must be well run, well managed, the food must be good, and the patients well treated. To obtain segregation, we must have hospitals which offer great advantages over the home.
Home Care of the Advanced Case. If there are no hospital facilities, it then becomes the nurse’s duty to give nursing care to the bed-ridden patient. ”

“ Nurses will not be expected to assist in special nursing except in training centers, or in temporary emergencies when it is impossible to hospitalize claimants, or where there is no person available to give instruction in home nursing. ”

“ The standard of nursing expected at the base hospitals in England is considerably higher than abroad, where the patient often feels he is merely resting on his way home. “Bed-sores are not always avoidable abroad,” writes a well-known Army doctor, “but they must never occur in a hospital in England.” The shortage of trained nurses makes the maintenance of this high standard no easy matter. ”

“ In most instances the patient who is to be delivered at home will have to occupy her accustomed room and there is no alternative. Should there be a choice of rooms, however, one should be selected that is cool and shady, if the confinement takes place during the summer, but bright and sunny for occupancy during most of the year; it should be conveniently near a bathroom if possible, and have an adjoining room for the nurse and baby to occupy. ”

“ But apart from such grave cases, there are many forms of illness which may safely be trusted to home-care, provided there is a fair amount of knowledge of those general rules which lie at the root of all degrees of successful nursing. Not that every woman is fitted to undertake the care of a sick-room. A certain, and not small amount of physical strength is absolutely needful, as well as some special qualifications, natural or acquired, which are equally essential. ”

“ But when one out of four nursing homes in America does not provide quality care to their residents, and when people living in substandard nursing homes have as much fear from abuse and neglect as they do from the diseases of old age, we must do more. ”

“ The preparations for operations in hospitals are all so carefully planned and systematized that in the presence of such emergencies the nurse will merely have to carry out the customary routine, but in a patient’s home she may have to exercise a good deal of originality in attempting to meet the needs of the occasion and imitate hospital provisions. ”

“ The plan adopted requires that the instruction in Home Nursing shall be given by enrolled Red Cross nurses, who must, in a large measure, be secured through the local committees. As the work develops we hope that nurses especially qualified to instruct women in the principles of right living and the home care of the sick may be found willing to devote their whole time to this instruction. Even two classes a day would give a fair income and an opportunity to render valuable service to a community. ”

“ Much as we should like ideally to equip and prepare every room to be used for a home confinement, we cannot overlook the importance of having preparations made with as little disturbance as possible to the patient and her household. ”

“ The next responsibility of the nurse is to advise the patient in arranging for care at the time of delivery, this advice being based upon the patient’s physical condition, the circumstances of her home life and the available facilities for care. Although hospital care may be the ideal for all patients, from an obstetrical standpoint, the mother cannot always be removed from her home with safety to the family circle. ”

“ A recent study from the Department of Health and Human Services reports that more than half of America's nursing homes don't have the minimum staffing levels necessary to guarantee quality care. And too often the staff that is there isn't properly trained. ”

“ It gives us300 hope for a better state of things. An institution for training nurses in connection with the infirmary has been built and organised. This is a matter of necessity, because all who wish to nurse efficiently must learn how to nurse in a hospital.
“Nursing, especially that most important of all its branches—nursing of the sick poor at home—is no amateur work. To do it as it ought to be done requires knowledge, practice, self-abnegation, and as is so well said here, direct obedience to and activity under the highest of all Masters and from the highest of all motives. ”

“ Where serious illness visits a household, however, and protracted nursing is likely to become necessary, a professional nurse will probably be engaged who has been trained to her duties. Such nurses may be obtained from the nursing homes in connexion with most of the large hospitals throughout the country. Their usual fee is two to three guineas a week. The advantages of employing such a nurse in cases of serious illness are many. The patient receives every care and attention from one who, by training and experience, has learnt of what attentions such a patient stands most in need. ”

“ Miss Nightingale asks in her little book on “Trained Nursing for the Sick Poor,” published in 1876.
“By, more than anything else, making the hospital such a home as good young women—educated young women—can live and nurse in; and, secondly, by raising hospital nursing into such a profession as these can earn an honourable livelihood in.”
In her “Notes on Hospitals,” published in 1859, she pointed out what she considered the four radical defects in hospital construction—namely:—
1. ”

“ And in fact, the administration and the President believes very strongly that it's a federal responsibility to protect seniors in nursing homes and to have a stringent inspection regime of nursing homes -- the so-called good and the bad -- to make certain that when families put seniors in nursing homes, those nursing homes are safe and reliable and protect our seniors. ”

“ If these rules are carefully followed out, we venture to say there will be very little cause to dread even the most trying part of nursing—night-work.
And now as to the sick-room itself. If a choice is possible, let the room selected be of good size, cheerful, and quiet. It needs to be fairly large, because air is consumed by nurse as well as patient; for this reason, a dressing-room adjoining is of great service. Except in acute and dangerous illness, it is better if the nurse can sleep away from the patient, always provided there is ready means of communication. ”

“ The duties of nurses ought also to be distinctly confined to attendance on the sick, and no menial work, such as scrubbing floors and the like, should be demanded of them; a proper staff of servants ought to be employed for such purposes. It is also desirable that a separate pavilion for lodging the nurses should be set apart, and that fair and reasonable time for rest and recreation should be allowed. Some discussion has taken place as to the advisability of placing the nursing of a hospital in the hands of a sisterhood or a separate corporation. ”

“ John’s House, if it steers clear of the rock of prudery, undoubtedly possesses great advantages over a system of hospital nursing by promiscuous instruments. Not because it includes a Sisterhood, a system, in which I, for one, humbly but entirely disbelieve; but because the [7] laborious, servile, anxious, trying drudgery of real hospital work (and to be anything but a nuisance it must ever remain a very humble and very laborious drudgery) , requires, like every duty, if it is to be done aright, the fear and love of God. ”

“ Even for the class whose homes are too crowded to admit of nursing being properly or safely done in them, I cannot but think that small Cottage Hospitals, where the wife or mother or daughter would be free to perform her natural duties by the bedside, and where she would be shown how best to perform them, would be infinitely preferable for every reason, moral and physical, to our present Palaces of Pain. ”

“ In the first stage of sickness, while doubt and a little perplexity hang over the household as to the nature of the sickness, there are some things about which no doubts exist: the patient's room must be kept in a perfectly pure state, and arrangements made for proper attendance; for the first canon of nursing, according to Florence Nightingale, its apostle, is to "keep the air the patient breathes as pure as the external air, without chilling him." ”

“ Time, strength, and this modicum of comfort, enter much into a Nurse’s health—and health is essential both for efficiency and economy.
Where the Nurse sleeps at a distance from her ward, her efficiency, both as to superintendence and work, especially at night, in dangerous cases, is seriously impaired.
If she sleeps at a distance from her ward, her comfort, also, such as it is, is destroyed. Whatever a Nurse does for herself, she must do by fits and starts. ”

“ I would not, however, expressly exempt the patients from being made useful in nursing the sick. A lazy or ill-conditioned patient might make it a handle to refuse to do or grumble at doing things which he ought to do, such as (a thing frequently required) giving and emptying a bed-pan to an ordinary patient who cannot leave his bed, while the Nurse and Orderlies are doing other things in the ward; assisting to move a helpless patient, if all the Orderlies are not at hand; sometimes watching or attending for an hour or so a critical case, &c., &c., &c. ”

“ Simplification and avoiding all trouble which can be spared to the Departments are very important. I would not therefore insist upon a little kitchen for the Nurses, nor upon a very capital arrangement in some of the Sisters’ rooms in Guy’s Hospital, where, behind a decent little door in the sitting-room, there is a sink, with water laid on, a little safe for meat, &c., at top, and a complete little apparatus of the very few utensils required for cooking one woman’s meals; so that a Nurse can cook and wash-up, in her own room, without carrying things out of it. ”

“ Suppose the Lariboisière plan retained, as proposed at Aldershot, for a Military Hospital, with wards of twenty-four beds each—then, with fear and trembling, but with the firm conviction that it is better for human nature, most of all, for nursing human nature, to have somewhat too much than a great deal too little to do, I respectfully recommend that one Nurse serve the three wards of each Pavilion. ”

“ The surgical nurse must be ever on the watch, ever on her guard, against want of cleanliness, foul air, want of light, and of warmth.
Nevertheless let no one think that because sanitary nursing is the subject of these notes, therefore, what may be called the handicraft of nursing is to be undervalued. A patient may be left to bleed to death in a sanitary palace. Another who cannot move himself may die of bed-sores, because the nurse does not know how to change and clean him, while he has every requisite of air, light, and quiet. ”

“ Walk through the wards of a hospital, remember the bed sides of private patients you have seen, and count how many sick you ever saw lying with their faces towards the wall.
X. CLEANLINESS OF ROOMS AND WALLS. [Sidenote: Cleanliness of carpets and furniture.]
It cannot be necessary to tell a nurse that she should be clean, or that she should keep her patient clean,—seeing that the greater part of nursing consists in preserving cleanliness. No ventilation can freshen a room or ward where the most scrupulous cleanliness is not observed. ”