Episode 6 - Taking Food - Notes on Nursing - Florence Nightingale

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Episode Transcript

(00:00):
Section six, taking food. Everycareful observer of the sick will agree in
this that thousands of patients are annuallystarved in the midst of plenty, from
want of attention to the ways whichalone make it possible for them to take
food. This want of attention isas remarkable in those who urge upon the

(00:22):
sick to do what is quite impossibleto them as in the sick themselves,
who will not make the effort todo what is perfectly possible to them.
For instance, to the large majorityof very weak patients, it is quite
impossible to take any solid food beforeeleven a m. Nor then if their
strength is still further exhausted by fastingtill that hour. For weak patients have

(00:47):
generally feverish nights and in the morningdry mouths, and if they could eat
with those dry mouths, it wouldbe the worse for them. A spoonful
of beef, tea of arrowroot,and wine of egg flip every hour will
give them the requisite nourishment and preventthem being too much exhausted to take at

(01:08):
a later hour the solid food whichis necessary for their recovery. And every
patient who can swallow at all canswallow these liquid things, if he chooses.
But how often do we hear amutton chop, an egg, a
bit of bacon ordered to a patientfor breakfast, to whom, as a

(01:29):
moment's consideration would show us, itmust be quite impossible to masticate such things
at that hour. Again, anurse is ordered to give a patient a
teacupful of some article of food everythree hours. The patient's stomach rejects it.
If so, try a tablespoonful everyhour. If this will not do,

(01:49):
a teaspoonful every quarter of an hour, I am bound to say that
I think more patients are lost bywant of care and inch nuity in these
momentous minutiae in private nursing than inpublic hospitals. And I think there is
more of thee entante cordial to assistone another's hands between the doctor and his

(02:13):
head nurse in the latter institutions thanbetween the doctor and the patient's friends in
the private house. If we didbut know the consequences which may ensue in
very weak patience from ten minutes fastingor repletion, I call it repletion.
When they are obliged to let twosmall an inval elapse between taking food and

(02:34):
some other exertion owing to the nurse'sunpunctuality. We should be more careful never
to let this occur. In veryweak patience, there is often a nervous
difficulty of swallowing, which is somuch increased by any other call upon their
strength, that unless they have theirfood punctually at the minute, which minute
again must be arranged so as tofall in with no other minutes occupation,

(03:00):
they can take nothing until the nextrespite occurs, so that an unpunctuality or
delay of ten minutes may very wellturn out to be one of two or
three hours. And why is itnot as easy to be punctual to a
minute? Life often literally hangs uponthese minutes. In acute cases where life

(03:23):
or death is to be determined ina few hours. These matters are very
generally attended to, especially in hospitals, and the number of cases is large
where the patient is, as itwere, brought back to life by exceeding
care on the part of the doctoror nurse or both in ordering and giving
nourishment with minute selection and punctuality.But in chronic cases lasting over months and

(03:49):
years, where the fatal issue isoften determined at last by mere protracted starvation.
I had rather not enumerate the instanceswhich I have known where a little
genuity and a great deal of perseverancemight, in all probability have averted the
result. The consulting the hours whenthe patient can take food, the observation

(04:12):
of the times, often varying whenhe is most faint, the altering seasons
of taking food in order to anticipateand prevent such times. All this which
requires observation, ingenuity, and perseverance, and these really constitute the good nurse
might save more lives than we whatof. To leave the patients untasted food

(04:36):
by his side from meal to meal, in hopes that he will eat it
in the interval is simply to preventhim from taking any food at all.
I have known patients literally incapacitated fromtaking one article of food after another by
this piece of ignorance. Let thefood come at the right time and be
taken away, eaten or uneaten atthe right time. But never let a

(05:00):
patient have something always standing by him, if you don't wish to disgust him
of everything. On the other hand, I have known a patient's life saved
he was sinking for want of foodby the simple question put to him by
the doctor. But is there nohour when you feel you could eat?
Oh? Yes, he said,I could always take something at o'clock and

(05:26):
o'clock the thing was tried and succeeded. Patience very seldom, however, can
tell you this. It is foryou to watch and find it out.
A patient should, if possible,not see or smell either the food of
others or a greater amount of foodthan he himself can consume at one time,

(05:47):
or even hear food talked about,or see it in the raw state.
I know of no exception to theabove rule. The breaking of it
always induces a greater or less incapacityof taking food. In hospital wards,
it is of course impossible to observeall this, and in single wards,
where a patient must be continuously andclosely watched, it is frequently impossible to

(06:11):
relieve the attendant so that his orher own meals can be taken out of
the ward. But it is notthe less true that in such cases,
even where the patient is not himselfaware of it, his possibility of taking
food is limited by seeing the attendanteating meals under his observation. In some
cases, the sake are aware ofit and complain. A case where the

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patient was supposed to be insensible butcomplained as soon as able to speak,
is now present to my recollection.Remember, however, that the extreme punctuality
in well ordered hospitals, the rulethat nothing shall be done in the ward
while the patients are having their meals, go far to counterbalance what unavoidable evil

(06:55):
there is in having patients together.I have often seen the privatenes urse go
on dusting or fidgeting about in asick room all the while the patient is
eating or trying to eat. Thatthe more alone an invalid can be when
taking food, the better is unquestionable. And even if he must be fed,

(07:15):
the nurse should not allow him totalk or to talk to him,
especially about food while eating. Whena person is compelled by the pressure of
occupation to continue his business while sick, it ought to be a rule,
without any exception whatever, that noone shall bring business to him or talk

(07:36):
to him while he is taking food, nor go on talking to him on
interesting subjects up to the last momentbefore his meals, nor make an engagement
with him immediately after, so thatthere can be any hurry of mind while
taking them. Upon the observance ofthese rules, especially the first, often

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depends the patient's capability of taking foodat all, or if he is amiable
and forces himself to take food,of deriving any nourishment from it. A
nurse should never put before a patientmilk that is sour, meat or soup
that is turned, an egg thatis bad, or vegetables underdone. Yet

(08:18):
often I have seen these things broughtinto the sick in a state perfectly perceptible
to every nose or eye except thenurses. It is here that the clever
nurse appears. She will not bringin the pecant article, but not to
disappoint the patient, she will whipup something else in a few minutes.
Remember that sick cookery should half dothe work of your poor patient's weak digestion.

(08:43):
But if you further impair it withyour bad articles, I know not
what is to become of him orof it. If the nurse is an
intelligent being and not a mere carrierof diets to and from the patient,
let her exercise her intelligence in thesethings. How often we have known a
patient to eat nothing at all inthe day because one meal was left untasted

(09:07):
at that time he was incapable ofeating. At another the milk was sour,
the third was spoiled by some otheraccident. And it never occurred to
the nurse to extemporize some expedient.It never occurred to her that, as
he had had no solid food thatday, he might eat a bit of
toast to say, with his teain the evening, or he might have
some meal an hour earlier. Apatient who cannot touch his dinner at two

(09:31):
will often accept it gladly if broughtto him at seven. But somehow nurses
never think of these things. Onewould imagine they did not consider themselves bound
to exercise their judgment. They leaveit to the patient. Now, I
am quite sure that it is betterfor a patient rather to suffer these neglects

(09:52):
than to try to teach his nurseto nurse him if she does not know
how it ruffles him, and ifhe is ill, he is in no
condition to teach, especially upon himself. The above remarks apply much more to
private nursing than to hospitals. Iwould save to the nurse, have a
rule of thought about your patient's diet. Consider remember how much he has had

(10:16):
and how much he ought to haveto day. Generally, the only rule
of the private patient's diet is whatthe nurse has to give. It is
true she cannot give him what shehas not got, but his stomach does
not wait for her convenience or evenher necessity. If it is used to
having its stimulus at one hour today and to morrow, it does not

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have it because she has failed ingetting it, he will suffer. She
must be always exercising her ingenuity tosupply defects and to remedy accidents which will
happen among the best contrivers, butfrom which the patient does not suffer the
less because they cannot be helped.One very minute caution, Take care not

(11:01):
to spill into your patient's saucer.In other words, take care that the
outside bottom rim of his cup shouldbe quite dry and clean. If every
time he lifts his cup to hislips he has to carry the saucer with
it, or else to drop theliquid upon and to soil his sheet or
his bed gown or pillow, orif he is sitting up his dress,

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you have no idea what a differencethis minute want of care on your part
makes to his comfort and even tohis willingness for food end of Section six.