Digest — Female Nursing in Military Hospitals by Florence Nightingale

Digest.

PAGES
THOUGHTS SUBMITTED BY ORDER		1–28
CONCERNING
I.	Hospital Nurses.
II.	Nurses in Civil Hospitals.
III.	Nurses in Her Majesty’s Hospitals.
I.	Hospital Nurses	1–9
	Twenty Observations on how to improve Hospital Nursing.
II.	Nurses in Civil Hospitals	9–14
	Twenty-three Heads for Regulations as to Nursing in Civil Hospitals.
III.	Nurses in Her Majesty’s Hospitals	15–19
	Twenty-two suggestions in the event of the introduction of Female Nursing into Military Hospitals.
Various systems of Female Nursing during the Crimean War in the Military Hospitals		19–28
Of the French and Sardinians		19–22
Russians		22, 23, 26–28
English		23
Proposed Duties of Female Nurses in Military General Hospitals		23, 24
The Hospital Serjeant, or Ward Master will not be superseded—he will still have too much to do for any one man properly to perform, and part of his duties must be given to another officer		24–26
Note in regard to the Russian Nurses employed in the War-Hospitals of the Crimea		26–28

SUBSIDIARY NOTES AS TO THE INTRODUCTION OF FEMALE NURSING INTO MILITARY HOSPITALS IN PEACE AND IN WAR		1–133
I.	Five Conditions essential to this service	1–3
II.	Our Nurses were of four kinds	3
	Absolute subordination to the Medical Officer as to Medical Orders essential and practised by us	4
III.	1. Qualified subordination essential of Superintendent-General to Director-General and Principal Medical Officer	4–6
	2. Also of Matron and Nurses to Principal Medical Officer and Staff-Surgeons	6, 7
	3. Female service can only be introduced gradually, and introduction regulated by Director-General	7–9
IV.	1. Shall Roman Catholic Sisters be introduced?	9, 10
	2. Or Anglican Sisters?	10
	3. Power of Police in Civil Hospitals	11
	Power of Police in Military Hospitals	12–15
	4. Pay and Rations of Nurses	15–20
	On the whole it would seem best, where practicable, to board the Nurses, not to “ration” them, nor to let them “find themselves.” Community of cooking implies economy of nourishment	17–20
	5. Washing to be “put out”	20, 21
	6. Cleaning their own Rooms	21–23
	7. Nurses to keep keys of closet in Wards	23
	8. Pay, dress, and duties of Matrons	24–28
	More properly named Superintendents	27
	Lady Volunteers had better begin by being Nurses, not Superintendents ex-officio	28
	9. Sundry Regulations as to Nurses	29–31
	10. Have the Patients’ Diets sent hot, and ready divided, from kitchen	31
	11. What Ward duties the Nurses should do themselves	31
	And why	32, 33
	Patients should not be made quasi Orderlies	34
	Visitors in Military Hospitals	35
	12. Regulation-Number of Orderlies—depends on the size of wards whether sufficient	35–41
	What is the regulation-attendance in Naval Hospitals	37
	What in Civil Hospitals	38
	Comparative Cost of Nursing in larger and smaller wards	39–41
	13. Hospital floors	42–51
	Sanitary necessities	42
	Trial of Hospital floors, oiled and polished with “laque” as in Berlin Hospitals, recommended on sanitary grounds and for ease of cleaning	43–51
	14. Ventilation of Wards	51–52
	15. Special Wards, whether desirable or not	53–54
	16. Opinion as to Superintendent-General paying Nurses’ wages, and as to Governor’s jurisdiction over Nurses	54–56
	17. Wages and Pensions of Nurses	56–60
	Three rules in raising Wages	56
	Five general principles as to Wages and Pensions	58
	Six applications of the foregoing principles	58, 59
	Seven heads for Regulations as to Nurses’ Wages and Pensions	59, 60
	18. Proportion of Nurses to Patients	61, 62
	19. Precautions in sending Nurses on Foreign Service	62
	Hospital Laundries	63
Addenda, with regard to Female Nursing in a Military Hospital on the Pavilion, or Lariboisière Plan		63–90
I.	Four conditions to be considered in adopting the Pavilion Plan	63
	1. Economy of attendance	64
	2. Facility of supervision	65
	3. Desirableness of doubling the Pavilion, in a Military Hospital, in order to give to each Nurse but one floor to serve	65
	4. Nurse to sleep near her Ward	66
	Importance of lighting by gas	67
II.	1. One Nurse must serve the whole Pavilion, in a Military Hospital, if single Pavilions be adopted	68
	2. Nurses’ day in such a Pavilion	68, 69
	3. What the responsibility of Nurses is for
	discipline of Ward or Pavilion	70, 71
	4. Importance of Lifts	71
III.	1. “Casualty” Cases should be in a completely appointed set of Wards, apart	72
	And why	73
	2. Restraint or non-restraint in Violent Cases	74
IV.	Simplicity of Construction essential to Discipline	75
	Polished impervious Walls.
	Covered Exercising Place.
	Reserve Wards	76
V.	Nurses’ Meals to be sent them Cooked	76
VI.	Arrangements for a Pavilion and its Wards	77–90
	2. Where should Wardmaster sleep?	77
	3. And Orderlies sleep?	77
	4. And dine?	78
	7, 8, Scullery to each Ward, and what to be done in it	79
	Poultice-making	79
	9. Presses in Ward	80, 81
	10. Nurses’ Room	82
	Lavatory, Water-Closet, Sink	83
	Baths	84
	11. Summary of arrangements	85
	Scullery Appurtenances	86
	12. Nurses’ Sleeping Quarters	86
	Ward for Sick Nurses	87
	13. Classification of Patients	88
	14. Nurses to be called by their Wards	88
	15. Foul Linen	88
	16. Washing Bandages	89
	17. Splints, &c., where to be kept	89
	Cotton Lint never to be used	89
	18. Classification of Nurses	90
	Superintendent’s Store Room	90
Addenda as to Mixed Nursing by Nurses and Orderlies in Military Hospitals on the Double Pavilion Plan		91–117
I.	Orderlies’ Duties	91–108
	Proportion of Nurses, Ward Masters, and Orderlies to Sick	91–93
	Wine to be always administered by Nurse	93
	Orderlies—their Duties vary according to appurtenances of Ward	94
	If Hot and Cold Water are laid on, and there are Lifts, one Orderly’s Service saved to each 30 Sick	94, 95
	Night-Duty of Orderlies	95–108
	Scheme of Night-Service for three Orderlies watching by turns	96, 97
	Exercise for Orderlies	97
	Night Refreshment for Orderlies	98, 99
	Where are the Night Orderlies to sleep?	100
	Comparative Merits of different Systems of Night Nursing in Home and in Foreign Hospitals	101–3
	An Assistant Ward Master should go round the Wards at Night	104
	Extraordinary System of Night-Nursing in the Army at present	105–8
II.	Twelve Sundries in organizing a Military Hospital	108–114
	1. Nurses’ Room	108
	2. Medical Officer’s Room	108
	3. Water-Closets	109
	4. Warm and Cold Water Supply	109
	5. Corridors	109
	6. Lobby	110
	7. Material of Ward Utensils	110
	8. Reserve Wards	111–112
	Necessity of Annual Cleansing of the whole of a Hospital
	9. Occasional Revision of Rules	113
	10. Defect in German Organization of Nursing	113
	11. Nurses’ Exercise	113
	12. Number of Ward Masters	114
III.	Regulations	114–117
	1. Deprivation of Visitors salutary in certain Wards	114–16
	2. Numbering Patients saves time	117
	3. Prohibition of Swearing	117
	Conclusion	117
Additional Hints as to Pavilion Hospitals suggested by the Construction of the Lariboisière Hospital at Paris		118–127
I.	Ventilation	118–120
	Artificial Ventilation never freshens a Ward
II.	Oiled Boards versus Parquets	120–124
	Cleaning polished and oiled Boards much less laborious, and freshens the Ward much more than the frottage of Parquets.
	Mode of Cleaning them at Berlin	122–124
III.	Ten Cautions in Building Hospital Pavilions	124–127
	Size of Wards. Our own Regimental Hospitals extraordinary for their many holes and corners	125
Casualty Wards		126
“Contagion” and “Infection” Defined		128–132
	Idea of “Contagion” invented by Men to excuse themselves for the neglect of all Sanitary arrangements	128
	In the ordinary sense of the word, no such thing as “Contagion”	129
	Nor as inevitable “Infection”	130
	“Infection” and Incapable Management, or Bad Construction, convertible terms	131
	“Epidemics” do not spread—they develop themselves in Constitutions made ripe for them by Sanitary neglects	131
	Note on certain “Observations” by Sir John Hall	132, 133

Thoughts Submitted as to an Eventual Nurses’ Provident Fund		1–19
	Actual Wages and Prospects of Nurses	1–3
	Some further Provision desirable	4–6
	Of what Nature?	6–15
	With regard to Kind?	6–8
	With regard to Persons?	8
	With regard to Objects?	9–15
	Material Objects?	9–12
	Children, in the case of Nurses, a Temptation to Petty Dishonesty and taking Bribes	11, 12
	Sanitary Objects?	13
	Moral Objects?	13–15
	Hospitals not places for Penitents	14, 15
	Rules to be followed in giving Assistance	15–17
	Prospects of Eventual Support	18, 19
	Note as to the Number of Women employed as Nurses in Great Britain	20, 21
	Tables of Ages, &c.	21
	Note as to Teaching Nursing—Institution at Madras	22, 23

PRIVATE AND CONFIDENTIAL.

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