Nightingale wards and Nelson's Inhalers

Previously I mentioned the ward sister who called everybody Sweetie Pie regardless of age, race or gender. It made me think back to the ward she ran (and I use that word loosely) which was a single storey medical ward in one of the oldest buildings in the hospital. The ward was set out in ‘Nightingale’ fashion with beds down either side the length of the ward and a Sister’s office at one end with a sluice at the other. All the patients were male aside from the occasional female patient in a side-room when beds were short elsewhere. Just like ITU the ward relied on oxygen and air tanks for its many chest patients and much time was spend manoeuvring these tanks around the bed areas.
The biggest tanks sat shoulder high and were caged in wheeled metal trolleys (as they are now) with a big metal bar on the side for a handle. Moving the tanks meant tipping the cage back on to its two wheels, holding the weight steady and pushing or pulling the trolley into position. There was no more bed space then than there is now and it was an awkward business working in such a limited area; the tanks were heavy and the cold, hard metal of the cage painful if knocked into. Moving around the patient to wash them or provide mouth care, meant working around the tank, the bedside table, the locker and the bed itself. There might also be cot sides, a bed cradle and a monkey pole on the bed (for the patient to lift themselves up with) to contend with.

In every hospital that I’ve worked in since, space has been a problem in wards and side rooms alike. Only recently I was in a side room in a modern hospital and the patient needed a hoist to move from bed to chair. The space limitation of the room (which only had the bare necessities in) was as much a risk to the patient and ourselves as the actual moving procedure we were carrying out. Whilst there is guidance on minimum bed space even now it would seem not all hospitals meet this http://www.informedesign.org/Rs_detail.aspx?rsId=3555

Caring for medical patents can be hard on the back, with patients often highly dependent on the nursing staff to wash, feed, toilet and move them. Having said that, male medical wards had the distinct advantage over female medical wards because the men could use a urine bottle whilst the women always had to be lifted onto a bed pan or commode (the ‘she wee’ hadn’t been invented yet!).

Personally, I liked the variety of working in medicine and I loved the sense of involvement with the patients because they were often in for longer than the surgical ones. Despite the Ward Sister’s out of date approach to nursing (she wore a frilly white cap, sat in the office for long periods of time, fawned over the doctors, avoided the patients and went to the hairdressers on Friday afternoon during shift time) it was a friendly ward and I learned a lot about all round nursing care. At home now I have a Nelson’s Inhaler (bought second hand) which still smells of tincture of benzoin (Friar’s Balsam), one sniff of which takes me back thirty years. They were brilliant for ‘chesty’ patients; we would put a teaspoon of tincture in the china inhaler, add boiled water, sit it in a deep plastic tray and pack around with towels. Then the patient would lean over the inhaler and put the mouthpiece in his mouth and gently inhale. Very soothing and worked a treat.

One advantage of the Nightingale ward was the sense of camaraderie that sometimes developed between patients. Although it is a very public space to be ill in, patients can also see and speak to each-other easily, they can see where the nurses are and they have a sense of the ward routine and activities so there is less risk of isolation. Privacy and dignity was not easy to achieve though and having your bowels open on a commode with just a thin bit of curtain between you and the man in the next bed either side (plus their family if you chose to go between 2pm-4pm or 7pm-8pm) must have caused many a bout of constipation.

The curtains round the beds would rarely stay closed. If the curtains went to be laundered the replacement ones were never long enough or wide enough. No disposable curtains back then either. Nor were there any duvet covers as there are in some wards now. Every bed was made properly with sheet corners folded in and top sheets folded back to show approximately 12 inches of white over the blue bedspread (blue because it was the men’s ward; the women had pink of course). When we made the beds we would put a central pleat in the top sheet to ensure some looseness over the patient’s feet because tight sheets over the foot cause pressure damage and foot drop.

Now, pressure damage, that’s something I will definitely be coming back to…