Notes on Nursing

Nonfiction | Book | Adult | Published in 1860

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Summary

Chapter Summaries & Analyses

Preface-Chapter 4

Chapters 5-7

Chapters 8-10

Chapters 11-13

Conclusion and Supplementary

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Tools

Beta

Discussion Questions

Chapters 11-13Chapter Summaries & Analyses

Chapter 11 Summary: “Personal Cleanliness”

Careful attention to the skin’s health and cleanliness is essential in aiding recovery, especially in children, as the skin plays a major role in shedding illness. Even a good washing can provide a patient with great relief and comfort. Though any amount of washing is better than none, washing with warm water and soap is clearly the most effective. The water’s quality is important too: The softer the water, the more relieving and effective it is and the healthier the skin can become.

Chapter 12 Summary: “Chattering Hopes and Advices”

Counter to popular thinking, little is worse for patients than to endure “the incurable hopes of their friends” (70). While an attempt to cheer a patient and offer something positive to look forward to may seem positive, it often ends with patients feeling demoralized because they’re not improving properly or their illness is being mocked by the flippant way they’re treated. Exaggerating the possibility of recovery and downplaying real fears doesn’t help patients.

Honest, frank discussion is best in these situations, as it puts the patient at ease. Anything more is bound to seem tinged with false hope, and it’s exhausting for the patient who’s ill and attempting to recover to listen to such hopes and to either agree with the visitor or attempt to explain the situation’s severity—neither of which helps the patient. Patients would rather hear positive news about other people or other things; a simple word of distraction can lift patient’ spirits and transport them out of their misery.

Chapter 13 Summary: “Observation of the Sick”

“The most important practical lesson for nurses,” Nightingale says, “is to teach them what to observe” (76). After the care of nursing—and largely because the care of nursing requires it—observing the patient carefully in all ways is vitally important. The ability to relate the truth to another nurse or doctor depends on the nurse’s observation skills; only the most skilled and practiced nurses can relate all that’s true about a patient without any admixture of falsehood or guesswork.

In other practical matters, many think the nurse’s purpose is to relieve the patient of physical exertion, when the relief of mental exertion is often far more necessary. The nurse’s duty is to think for the patient, to provide what’s necessary without the patient having to think about it, and to anticipate the patient’s needs. Again, doing this well is possible only when the nurse carefully observes the patient; without observation, a nurse can contribute almost nothing positive.

Failure of observation is the root cause of much superstition too: When a nurse fails to observe something critically important, the real cause of a malady or symptom becomes mysterious. Nursing, when carried out properly, is never mysterious or an innate genius simply present from birth. Skill, learning, practice, observation, and experience all inform the actions of a nurse. A nurse who seems to have power over a patient or an uncanny supernatural ability is simply a nurse who carefully observes the patient.

Patients usually do what they’re told, trusting in healthcare workers. When a patients fall into a final illness and die, their death is too often a surprise or follows a period when they seemed to recover. However, careful observation should at least have given a warning:

Let people who have to observe sickness and death look back and try to register in their observation the appearances which have preceded relapse, attack, or death, and not assert that there were none, or that there were not the right ones (87).

Those in charge of death appreciate nurses who are careful in observation and keen of mind, who can concisely and accurately report their patient’s condition. In many instances, the one who observes a patient best can give the most accurate diagnosis, even beyond the most skilled and trained physician who has just met the patient.

Chapters 11-13 Analysis

In the final section, Nightingale shifts her attention from largely environmental factors to the human factors that play into a patient’s health or injury. First, Nightingale discusses the personal hygiene of both the patient and nurse. Referring to the skin’s importance, she insists that regular washing is not just a matter of preference or comfort but a crucial element of recovery, as the skin plays a large part in defending against illness. Given that the skin is the largest organ of the human body, she’s correct, though again she’s pushing back against the many who didn’t consider it important in her day. Even in the 21st century, we too often consider personal hygiene more a matter of personal preference than a necessity—evident, for example, in the massive public relations campaigns necessary simply to remind people to wash their hands to prevent viral transmission.

Shifting from human physical health and cleanliness, Nightingale next discusses the mental health of patients and how visitors can greatly affect a patient’s wellbeing by their presence and their choice of conversation topics. Visitors often assume that speaking of their positive hopes for the patient’s recovery or assuring the patient that things will soon be alright will benefit the patient. The thinking is that positive hopes and affirmations will cheer the patient and encourage them to continue to heal and be assured of a swift recovery. This, Nightingale warns, is a false assumption and can instead be harmful.

What best serves patients is to conserve their strength and maximize their chance to rest and thereby maintain the equilibrium of a peaceful mind. When visitors insist on speaking about hopes for the patient’s recovery—hopes that may be unfounded and result from projection (more to comfort themselves than the patient)—it tends to make a mockery of what the patient is enduring, which forces the patient to either agree under pain of duress or disagree and correct the visitor, causing the patient inconvenience and exertion. This truth and wisdom in this are clear to anyone who has ever been sick—and to anyone who has ever been a patient’s caretaker. Additionally, visitors often utter such hopeful words because they want them to be true (due to their love for the patient) and not because they have insight into the probable outcome.

In the last chapter, Nightingale conclusively summarizes a fundamental aspect of nursing that she addresses in pieces throughout the work: the importance of observation. Fundamental to effective nursing is the ability to properly and carefully observe a patient at all times or—when the nurse can’t be physically present themselves—to delegate the responsibility to others. All the care that a nurse can take to heal and assist a patient may prove useless without careful and methodical observation, as the patient’s circumstances are crucial in ascertaining the best course of action and the best way to apply theoretical knowledge. Were all things equal regarding the patient’s condition, theoretical knowledge and a one-size-fits-all scheme of healthcare might work in most cases. However, this isn’t how things occur in life, and the patient’s condition provides nuances that must inform the practical implications of theoretical truths.

Such nuances are attainable only through close observation by a specially trained and experienced nurse who can observe the patient’s daily rhythm and thereby distinguish important details from extraneous ones. In addition to the medical functions that such observation enhances, it can help the nurse unobtrusively meet the patient’s basic needs. A careful and observant nurse can anticipate a patient’s needs by carefully observing the patient’s habits and actions because changes in the patient’s circumstances are more noticeable.

In addition, careful observation goes a long way toward debunking superstition concerning sickness or healthcare. Too often, a lack of observation and proper knowledge leads to “old wives’ tales” about the cause of illness or symptoms; in certain cases, such wisdom is true and results from experience over many generations. In many instances, however, long-held beliefs aren’t helpful and can easily be rooted out and abolished through careful observation of the patient and the circumstances of an illness.