THE PRACTICAL TEACHER. WARD SISTERS AS TEACHERS.

Kai Tiaki : the journal of the nurses of New Zealand, Volume XXII, Issue 4, 1 November 1929, Page 183

THE PRACTICAL TEACHER. WARD SISTERS AS TEACHERS.

From ever\- point of view the Ward Sister is the practical teacher of the training nurse. The Tutor Sister can only teach m theory and by demonstration ; and has so short a time to teach m, later she coaches for examinations. Gives lectures and more demonstrations, hut she is not there to do the main teaching; that is the training of nurses, the actual handling of her patient, and her method of applying the theory taught her. To obtain the ideal teaching system, the Ward Sisters would of necessity need to attend classes m which the theory is taught and the practical work demonstrated, from the lecture-room point of view. Not because their theory or practice are not good, but because, to attain the ideal aimed at, there should be only one way taught and practised throughout the whole school. The main argument against this is that so many of the staff have their own methods, not necessarily agreeing on every point. This, to my mind, is no argument at all against the one method throughout m teaching. The point is, that only one working theory should be taught, 'the main factors and general principles. Different surgeons may treat a dressing differently perhaps, but the right way to set the tray, the right way to prepare the patient, the right way to aseptical'ly treat the wound and surroundings remain the same practically. Generally speaking the Ward Sisters are so busy and so worried over their patients that they do not admit altogether their second duty, the training of the nurses. The heads of the Training School realise this and their sympathy is with the Sisters, but their Training School conscience cannot let it rest there. The training nurses must learn through the individual patient, and no one but the Ward Sisters can be the teachers. I would suggest some means of bringing about this ideal.

(1) That the Sisters write fuller and more explicit reports m the wards. In many cases these are scrappy, and m some are, 1 believe, actually written by the staff nurse. In this report the Sister could state the probable or actual diagnosis, the treatment for the day and each day, and m giving the verbal report to her senior nurse, enlarge upon the new or very ill cases, and show the trend of the treatment and the effect. Much valuable work is done m this way by some Ward Sisters. 2. To give chart clinics on the special cases. This may be clone by the special or four-hourly charts left for inspection or while instructing nurses m special chart work. The nurses attention should always be drawn to the case notes and treatment generally, and the temperature chart be combined with these as subjects for discussion. Here again will be the plea that there is no time. Yet many Sisters already do this and do excellent work on this method. One of the busiest and best Ward Sisters I have known taught her nurses this way. 3. The ever-present question of economy. No one is more desperately tired of this subject than those of us who struggle on and try to enforce it. Like the poor it is always with us, but why not tackle it from the head of the school down to the last probationer and then pause to marvel at the result. In the lecture-room we may appeal to the classes, we may demonstrate, give examples, but human nature being what it is, our efforts will probably be forgotten m the rush of the wards. Yet we must teach this m our Training Schools not only to take effect while nurses are training to save public money, but for the sake of the individual patient after. One of the commonest complaints made against the trained nurses is that they are wasteful, especially m the matter of drugs, food and linen. The individual patient generally cannot afford this and

we have no right to turn nurses out without teaching' them. But who can teach them but the Ward Sisters. They will be weary — almost hopeless and tired m doing it, but the united efforts must tell. Without their help we get no further. May I quote one example : — An appeal was made to the staff of a hospital to try and manage with a little less of a certain article. They responded readily, and all admit they have sufficient to use still. The united efforts and help of the Sisters 'to save on one article is saving the hospital £1.000 a year. There are man}' other directions for teaching I could indicate, but I must not take any more of your time. lam convinced that without the co-operation of the Ward Sisters our efforts m the lec-ture-room will not be altogether fruitful, and I may add that those Sisters (and there are man}') who are training and teaching nurses m their wards, wall agree with me fully. They are so often the victims, through the nurses, of the few who do not teach as they work. WARD TEACHING. There is no doubt that the Ward Sister is essentially the practical teacher, but important qualifications are necessary m the choice of a Ward Sister. Refinement and personality create a good atmosphere m the ward. [Educational, professional and administrative qualifications, combined with teachingability, are essential — it is one thing to know the theory, but quite another to impart that theory and combine it with accumulated practical knowledge. As a teacher the Ward Sister has the nurse eight hours daily. She has the power of creating a good atmosphere m her ward and stimulating the interest of her nurses m their work — imparting to them her knowledge m the daily ward routine. It can be done if only Ward Sisters will realise how important a part they play m the teaching of the nurses. The ideal teaching is the rapid correlation of theory with practice, the theory

of the lecture-room practised m the ward. Where is there a better and wider field for this than m the ward? A nurse learns by seeing, doing", and hearing, especially the first two mentioned, and the actual contact with the ward patient, and instructions given there are not easily forgotten — but she must know that it is to her Ward Sister to whom she can look for that instruction and teaching. As mentioned m the previous paper — too much cannot be expected of the Tutor Sister, she has not the actual patient to demonstrate upon, she can only impart the theory and demonstrate whenever possible. There is a large field of teaching m the ward kitchen, even m the menial work performed by the nurse. The importance of cleanliness and its bearing upon the recovery of the patient is not sufficiently emphasised and taught. Much more interest would be taken if a probationer realised that the cleanliness of her lamp shades was as important as the correct aseptic treatment of a wound by the senior nurse. Xeglect of the smaller details frequently is the cause of spreading infection, and who better than the Ward Sister could teach "ward ethics?" An ideal standardised system could possibly be obtained m a simpler way than the necessity of Ward Sisters attending lectures. The method suggested is by Conferences attended by Tutor and Ward Sisters over which the Matron presides. These could be held at regular intervals, a resume of the theory and demonstrations given m the lecture-room outlined by the Tutor Sister. Any suggestions for changing or improving such methods openly discussed and decided upon, and the decision of the Matron would mean the standardising of these methods m teaching throughout the hospital. This would not only be of economic value, but would prevent friction and aid co-opera-tion between the Tutor and Ward Sisters,

Many Sisters who would not care to at tend lectures would iri all probability be keen to take part m these conferences. It is true they all have their own methods, but after all there are very few who are not willing to exchange their methods for others, so long as they are raising the standard of nursing service, and of benefit to the patients. We are all learners and must be broad-minded enough to pool our methods for this cause. Co-operation is not only necessary between the Tutor and Ward Sisters, but also with the Medical Staff, particularly House Surgeons. So much of the Sister's time is wasted m this way — frequently the greater part of the morning is taken up by the House Surgeons — irregular m their daily visits — writing up cases as they go round the ward — this all encroaches upon her valuable time, which could be spent m teaching and supervising her nursing staff. House Surgeons should realise a Ward Sister's time is as valuable as their own. She has other work to do than waste time going round the ward with them unnecessarily. The point raised that Ward Sisters are often too busy to attend to the nursing education of the nurses has one point m its favour. It is an impossibility for the Ward Sister to do justice to her patients and the teaching of nurses when the wards are overcrowded as at present m many hospitals. A ward equipped for 30 patients is made to accommodate 40 to 50 patients, and one person is m charge. The overcrowding tends to slackness m attention to details by the nursing staff, and the necessary supervision, teaching and active interest required of the Ward Sister to get efficiency is impossible. The number of patients m a ward should not exceed 25, then only can personal teaching and supervision be carried out efficiently. Again m many cases the Sister has to attend the theatre several mornings a week — meanwhile her ward must manage with a charge nurse and frequently not a very senior one — hence there is no one to supervise, teach and direct the staff m her absence. Much

valuable time is lost m this way. In hospitals where this is necessary, the ward should be m charge of a trained nurse during the Sister's absence. m teaching economy, if the cost of dressings, drugs, crockery, linen, etc., were brought to the notice of the nurse, not only m the lecture-room, but m the wards, the value of the articles would be better realised. In one hospital at the end of each month a list of drugs and dressings supplied is sent to each ward with cost of articles, also a breakage list and cost. This, to a large extent, introduces a competitive spirit, each ward vicing with the other to economise. Knowing the cost of articles also attaches greater value to the article. The Ward Sister has the crude material to shape when new probationers enter her ward. If that Sister has a keen, sympathetic understanding with her nurses, watching, educating and developing the future ones, she must make some impression and so help to improve the standard of the nursing profession. NURSING SERVICE. Miss Wright read a Paper on Nursing Service. A Ward Sister's Nursing Service is very difficult ; m fact, almost impossible to define, as it depends firstly, on the amount and nature of the work m ward, and secondly on the number and efficiency of her nurses. The position a Ward Sister has to maintain is one of high importance. By her efforts she impresses on the nurses that their work must always be directed towards serving the patients, the all-im-portant persons for consideration. Everyone — doctors, matrons, nurses, patients and their relatives look to the Ward Sister as the one responsible for trie maintenance of a peaceful environment for the patient, wherein the patient's mind will be set at rest. The wellbeing of the patient is the standard by which the Nursing Service may be judged.

[t is much easier for a Ward Sister to perform skilled work herself, than to see that others carry it out satisfactorily ; but although the Sister owes her first duty to the patients., seeing" that they get efficient service, she also owes a duty to the nurses m training. In consequence, much work must be left m the hands of the trainees, to afford them the opportunities of practical experience, which is an essential part of their training. To be -able to do the work better than her juniors and to keep at the highest pitch of efficiency, the Ward Sister needs a certain amount of practice. She should be able and prepared to undertake any ward duty, from scrubbing and cleaning to the most highly skilled work. This readiness and ability tends to make the humblest task seem of vital importance and nurtures a junior's pride m her work — an important factor m raising the standard of nursing generally. The chief Nursing Service is the general observation of work and patients. Morninp Round. After receiving the night report. Sister should do a round of her cases introducing the individual touch and so assuring the patients that their well-being is her personal concern. Her powers of observation, so very important a factor m nursing, should be exercised with regard to the condition of the patients. (a) See if they give evidence of having had a restful and refreshing sleep. (b) Make enquiries of the patients themselves and check their replies by the night nurse's report. (c) Note the chart with reference to T.P.R. and excretions. (1) Charting of T.P.R. Note if indicative of careful taking and recording, if doubtful, e.g., if temperature has no evening remission or pulse and respiration are not m expected ratio. Note this and make a point of checking that nurse's work next time temperatures are taken.

(2) Stools. Patients' stools should be inspected at intervals to ensure that they are satisfactory, i.e., that the daily motion charted, is a complete evacuation and not a mere passage of foeces, with the possibility of an impacted mass. (a) Note the contents of the expectoration cups. (b) Observe general condition :>f patient with regard to comfort and appearance. (1) Comfort. If readjustment of pillows is indicated, to attend same and so, by example, train her nurses to observe and rectify mistakes without instructions. (2) Appearance. Whether patient gives evidence of making satis factor}- progress m his or her particular case, or whether more skilled nursing attention is required. Morning work varies with ward. Surgical Ward. (1) The Ward Sister frequently spends most of her morning m the theatre and leaves her ward work and management m the hands of the Charge Nurse, so before going to the operation theatre she should : (a) See that all necessary preparation is being made for theatre cases, with regard to clothes, injections, etc. (b) Give all important information to the Charge Nurse, so that she may ably hold the reins of ward management while Ward Sister is absent. (2) On non-operating morning she should : (a) Undertake or supervise skilled treatment to ensure patients are not running any risks from improper attention. (b) Do m turn the various dressings, .so that she is not wholly dependant on verbal reports as to the progress of wounds.

Medical Ward. (1) Administration of medicines, if not actually carried out by the Ward Sister, should be supervised by her. (2) Ward Sister should accept full responsibility of: (a) Sending- medicine bottles to the Dispensary for refilling. (b) Renewing stocks of pills, etc., to be sure that stale pills are never given. (c) Charge of the poison cupboard key and herself checking amounts of all poisonous drugs administered. Meals. (1) The Ward Sister should superintend the serving of meals and see for herself if all patients have had sufficient and suitable diet, as ordered, and m a satisfactory condition. (2) Should see that no waste occurs : (a) From carelessness (upsetting food, etc.)--(b) Serving too large helpings. (c) Not ordering more than necessary. (d) Sending surplus food back to the kitchen, or seeing that it is used for the evening meal. Afternoon Work. When on duty is usually devoted to general management. (a) Attending to any necessary duty as it arises. (b) Performing any duties omitted m morning, owing to r/ressure of work. Evening Work Consists of: ( 1 ) Giving what assistance is necessary with ward work. (2) Personally attending to individual patients, by seeing that 'they are comfortable and have every inducement to a restful night. (3) Compiling a concise report of day's work with orders for the night, the feport being a complete and comprehensive record of the patient's conditions.

Miss Lambie, m reply, said : "In regard to the first point. We knowit is much easier to do the job ourselves than to teach other people to do it. It is stated ''the Sister of the ward must be an expert, and must be able to do any work at all m the ward itself. 1 Of course, the teacher must be an expert, but she must watch not to do too much herself, failing to teach other people. In hospital I had not been taught more. In hospital wards you do see the Sisters doing the job themselves rather than take the time to teach the nurses under them. It is much more difficult to teach the work than to do it yourself. "Another point m connection with the staff of surgical wards. In many hospitals it is the practice of the Sister to take the cases to the theatre. If she does the ward is m charge of the Senior Nurse, who is probably a nurse m training. Honoraries may visit the ward — relatives may visit the ward, and if the Sister is not there, the same informatoin may not be given except by the Sister who knows all the circumstances of the case. "Also m regard to the question of reports. There is very great need for the reports to be accurately written from each duty, so that no mistakes may be made m regard to the nursing service from one duty to another."