Nembutal

Introduction

Recently, I discovered handwritten nursing notes while sorting through old boxes in my father's home. These nursing notes from the 1940s had been carried through the years by my mother and had outlived her. Many of her papers had deteriorated in storage but these had been spared. It was wonderful to share my mother's experiences, and as I read her notes I felt as if I was there. I began to consider how the clinical experience of a nursing student in the 1940s compares with one in 2004.

A nursing case study 1949

Mrs Smith (a pseudonym) was admitted to hospital for surgery the next day. This case study is in my mother's own words.

A bed had been prepared for Mrs Smith and a hot water bottle and flannelette sheet were in position. A singlet and nightgown were placed on the bed. She was kindly received, reassured and assisted into her bed, Her clothes were listed in the clothes book, labelled and carefully put away in a locked cupboard. A specimen of urine was obtained and tested. This was found to be normal.

Over the past year Mrs Smith had been complaining of increased mistiness of vision in her right eye. A physical examination showed the lens of the right eye was noticeably thickened and had a greyish appearance, The nursing instructions were 'P.F.Q, Extraction Right Cataract, First case, 8:30am. Routine local anaesthetics cocaine and adrenalin, Atropine 2% to be instilled to eye 2 hours, 1 hour and ½ hour pre-operatively and Nembutal 1 ½ hours pre-operatively.'

The night before her operation, Mrs Smith was given a bath and an enema, The eyelashes of her right eye were cut short with a pair of small scissors, the points of which had been dipped in Vaseline to make it easier to wipe off the cut lashes. She was then warned of what would be expected of her after her operation. She was to lie as quietly as possible and especially to keep her head at rest and to avoid sudden turning of the head, coughing, sneezing or squeezing of the eyelids. She must let the nurses do everything for her until given permission to do things for herself and if uncomfortable must not lift herself up in the bed, but ring for the nurse. A bell would be left within reach, Mrs Smith quite understood and agreed to submit to this treatment. She was then settled comfortably for the night.

At 6.00am on the morning of the operation Mrs Smith's face was washed well and her hair attended to. She was given a light breakfast of tea and toast, and then given a clean singlet and nightgown. She passed urine. Operation stockings were put on and her teeth removed. At 8:00am Mrs Smith's face was again washed and dried. The skin area around the eye was swabbed with benzene. The routine local anaesthetic of the eye was then commenced. The eyes were kept closed between each drop.

At 8:30am Mrs Smith was taken to the operating theatre where a corneal section was performed. The capsule of the lens was incised, detached and extracted through the wound site and a corneo-scleral suture inserted. Atropine and Penicillin drops were instilled, and pads and bandages applied to both eyes. With extreme care, Mrs Smith was placed on her bed and returned to the ward in good condition.

For the first few hours Mrs Smith lay on one soft pillow, but in the afternoon another pillow was placed under her head and an air-ring was put in position. Mrs Smith was nursed at complete rest for six days. She was sponged daily and her pressure areas treated three times a day until she was allowed up and about on the eighth day. Three nurses were required for all nursing treatment during this period. Regular attention was paid to her hair and nails, as she could not attend to these herself.

The eye was dressed daily by the doctor. The bandage was removed from her left eye on the fourth day and a pad, metal shield and bandage covered the right eye. On the eighth day the suture was removed and the dressing left off. Mrs Smith was given dark glasses to wear but a pad and bandage were fixed in position over her right eye at night. Mrs Smith was charted codeine, two tablets, for pain if necessary which was required only once. Mist. Potassium citrate, ½ oz. four hourly was charted for the pain in her bladder region and a burning sensation on passing urine.

Mrs Smith was fed at meal times and care was taken not to rush as any coughing or spluttering may strain her eye muscles. The second day she was given a soft, light diet consisting of eggs, arrowroot and other milk foods and pureed vegetables. On the fourth day, meats were included in the diet, which after this gradually became normal.

Throughout her stay in hospital Mrs Smith was encouraged to take as much fluid as possible, and fruit and glucose drinks were made for her. These were necessary for good elimination.

On the third day after her operation, a liberal dose (one ounce) of P.A.P. emulsion was given to Mrs Smith. Then regular twice-daily doses of ½ oz. were given. It was necessary to keep the patient's bowels open in order to prevent her straining on the pan.

An enema was necessary once, four days after the operation, but after this bowel evacuations were regular.

Two weeks after her operation she was discharged, still wearing dark glasses. In several weeks these were to be replaced by glasses with a thick lens, which was to take the place of the normal lens. She could see fairly well out of her eye and was very pleased with her progress.

Conclusion

As I re-read my mother's nursing notes I considered how the nursing environment today is very different and yet the caring nature of nursing remains. Issues of pace and power stand out. In 1949, the nurse had two weeks to develop a trusting and professional relationship with her patient. The nurse provided the psychological and physical care needed to support the patient in strange surroundings. All normal adult responsibilities were taken from the patient once they were in the health care system.

Modern micro-technology, clinical skill and pharmacology have created a rapid increase in the pace of events. Today, the nurse would have only two to three hours to make the person at ease with the process, allay any fears and advise on post-operative self-care. Now the patient's experience involves several days of rest before resuming normal activity, albeit with a temporarily bloodshot eye. Today, the person is not a passive recipient of a series of unfamiliar procedures, but is encouraged to be an active partner in the process. The power shift from the health professional to the individual and their family is an expectation of today's society.

As a nurse more than half a century later, I believe that, both then and now, nursing is central to the patient's positive experience and ongoing well-being.

Acknowledgement

My mother was Una Calder Glasson, a nursing student in a New Zealand hospital in the late 1940s. I acknowledge her for the insight she has brought to me through her life and her written records.

Jo Bond (RN, BSc, Dip Sei (Otago), Dip Arts (ACU)) has been a nurse educator at Whitireia Community Polytechnic since 2000. She is currently working part time as a surgical nurse, with a particular interest in post-operative fluid physiology.

Copyright School of Nursing and Health Studies 2004
Provided by ProQuest Information and Learning Company. All rights Reserved