Notes on Nursing

1. Nursing is the Art of Optimizing Conditions for Nature to Heal

It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient.

Disease is reparative. Florence Nightingale posits that disease is often nature's attempt to heal, a reparative process against prior poisoning or decay. Suffering is frequently not from the disease itself, but from external factors hindering this natural process.
External factors matter. Lack of fresh air, light, warmth, quiet, cleanliness, or proper diet and punctuality are common culprits. Addressing these fundamental needs is the essence of nursing, distinct from medical treatment which focuses on removing obstructions.
Nature alone cures. Medicine and surgery remove obstacles, but nature performs the actual healing. The nurse's role is to place the patient in the best possible conditions for nature to act, ensuring the environment supports, rather than hinders, recovery.

2. Pure Air is the Absolute First Essential for Health

To KEEP THE AIR HE BREATHES AS PURE AS THE EXTERNAL AIR, WITHOUT CHILLING HIM.

First canon of nursing. Keeping the air pure is the most critical aspect of nursing, without which other efforts are futile. This means ensuring constant fresh air circulation, ideally from outside, avoiding stagnant or contaminated sources like corridors or sewers.
Avoid chilling patients. While ventilation is key, it must be achieved without making the patient cold. Proper bedding, hot bottles, and fire can maintain warmth even with open windows, especially when the patient is in bed.
Night air fallacy. The fear of night air is unfounded; the choice is between pure night air from outside and foul air from within. Sleeping with windows shut is a major cause of illness, as the body is more vulnerable to foul air during sleep.

3. Healthy Houses Require Five Key Elements

There are five essential points in securing the health of houses:—Pure air. Pure water. Efficient drainage. Cleanliness. Light.

Foundational health. These five elements are non-negotiable for a healthy dwelling. A deficiency in any one contributes to illness, often blamed on other causes like contagion or "mysterious dispensations."
Common deficiencies. Poor construction often neglects air circulation, prioritizing profit over health. Impure water sources, especially wells, are still common. Inefficient drainage, particularly untrapped pipes or drains under the house, allows noxious sewer gases to enter.
Cleanliness and light. Lack of cleanliness, from dusty furniture and saturated carpets to dirty walls, pollutes the air from within. Dark houses are inherently unhealthy, lacking the purifying and vitalizing effects of light and sunlight, which are essential for both physical and mental well-being.

4. Effective Management Ensures Care Continues When You're Absent

All the results of good nursing... may be... negatived by one defect, viz.:... by not knowing how to manage that what you do when you are there, shall be done when you are not there.

Multiply yourself. A devoted nurse cannot be present every moment, but effective management ensures essential care continues. This involves planning and organizing so that tasks like airing the room or maintaining quiet are done consistently, regardless of the nurse's presence.
Avoid patient anxiety. Patients are often burdened by worrying if necessary things will be done in the nurse's absence. Telling patients when you leave and return, and ensuring reliability, reduces their apprehension and uncertainty, which are more harmful than physical exertion.
Being "in charge". This means not just doing tasks yourself, but ensuring others perform their duties correctly and that systems are in place to cover absences. This skill is often better understood in institutions than private homes, where lack of management leads to preventable accidents and suffering.

5. Unnecessary Noise and Suddenness Harm the Sick

Unnecessary noise, or noise that creates an expectation in the mind, is that which hurts a patient.

Noise creates expectation. It's not loudness, but noise that makes a patient anticipate something, like voices outside the door, that is most damaging. Sudden noises or being abruptly woken from sleep are particularly harmful, disrupting the patient's ability to rest and recover.
Avoid suddenness. Never startle a patient. Approach them from the front, speak gently, and avoid sudden movements or interruptions, especially when they are thinking or moving.
Quiet movements. Nurses should cultivate quiet, steady movements. Rustling dresses, creaking shoes, rattling objects, and hurried actions are painful annoyances that increase a patient's nervousness and fatigue.

6. Variety and Light are Crucial for Mental and Physical Recovery

Variety of form and brilliancy of colour in the objects presented to patients are actual means of recovery.

Monotony harms nerves. Long confinement to one room with unchanging surroundings severely impacts a patient's nervous system, similar to how monotonous diet affects digestion. This mental suffering is as real as physical pain.
Visual stimulation helps. Beautiful objects, variety in form and color, and especially direct sunlight have a tangible physical effect, not just a mental one. They relieve the harassed mind and aid recovery.
Provide variety and light. Ensure the patient's bed allows them to see out a window, ideally with sunlight. Introduce variety slowly, perhaps changing one picture daily or weekly. Don't deny patients simple pleasures like flowers, which purify air and provide visual relief.

7. Careful Observation of Diet is Paramount

The main question is what the patient’s stomach can assimilate or derive nourishment from, and of this the patient’s stomach is the sole judge.

Starvation amidst plenty. Patients are often undernourished not from lack of food, but from lack of attention to how and when they can take it. Weak patients may need small, frequent liquid nourishment before solid food is possible.
Punctuality is vital. Life can depend on giving food punctually, especially for weak patients whose ability to swallow is tied to their strength and schedule. Unpunctuality can mean hours without necessary nourishment.
Observe patient's response. The nurse must observe what food the patient can assimilate, not just what is chemically nutritious. The patient's "fancies" or aversions are crucial indicators. Never leave untasted food by the bed, as it can disgust the patient.

8. Bedding Can Be a Major Source of Illness

Feverishness is generally supposed to be a symptom of fever—in nine cases out of ten it is a symptom of bedding.

Saturated with effluvia. Ordinary bedding, especially thick mattresses and valances, traps moisture and organic matter exhaled by the patient. This unaired, saturated bedding reintroduces noxious substances into the patient's system.
Ideal bed setup. An iron bedstead with permeable springs, a thin mattress, and no valance is best. Ideally, use two beds, airing one for twelve hours while the patient occupies the other, without transferring sheets.
Comfort and cleanliness. Beds should not be too wide or high, allowing the nurse easy access and the patient to get in and out with less effort. Avoid heavy, impervious coverings and ensure pillows support the back and head without restricting breathing.

9. Personal Cleanliness is as Vital as Ventilation

Poisoning by the skin is no less certain than poisoning by the mouth—only it is slower in its operation.

Skin function in disease. In most illnesses, the skin's function is disordered, and nature uses it to eliminate waste. If this waste is not removed by washing or clean clothes, it hinders recovery.
Remove noxious matter. Keeping the skin clean is as important as ventilation for removing noxious matter from the system. Sponging and washing provide relief and aid vital processes.
Proper washing technique. Use warm water and soap, and rub the skin to remove exfoliated dirt. Even with limited water, thorough rubbing can achieve cleanliness. Nurses must wash their hands frequently.

10. Avoid Giving False Hopes and Useless Advice

But I really believe there is scarcely a greater worry which invalids have to endure than the incurable hopes of their friends.

Hopes are tiresome. Well-meaning friends often tire and depress the sick by making light of their danger or exaggerating recovery chances. This forces the patient to either exert themselves explaining their true state or feel isolated.
Advice is often ignorant. Casual visitors frequently offer advice on diet, doctors, or treatments without knowing the patient's condition or the medical attendant's plan. This is impertinent and harmful.
Give pleasure, not platitudes. Instead of useless advice or false hopes, visitors should provide pleasant distractions and real news from the outside world. Sharing good news or showing a baby can offer significant relief and variety to a confined patient.

11. Observation is the Nurse's Most Important Skill

The most important practical lesson that can be given to nurses is to teach them what to observe—how to observe—what symptoms indicate improvement—what the reverse—which are of importance—which are of none—which are the evidence of neglect—and of what kind of neglect.

Facts, not opinions. A nurse's value lies in accurate observation and reporting facts, not offering vague opinions like "Is he better?". Precise questions yield useful information (e.g., "How many hours did he sleep?" vs. "Did he have a good night?").
Observe beyond the obvious. Learn to distinguish between real and fancied disease, and recognize subtle signs of change in the patient's condition, diet intake, or response to treatment. Don't rely on leading questions or superficial appearances like facial color.
Observation for action. The purpose of observation is not merely collecting facts, but using them to save life and increase health and comfort. A nurse must be a quick, sound, and confidential observer, capable of acting on her findings or reporting them accurately to those who can.

Last updated: May 4, 2025