Health Literacy for Caregivers

10 Health Literacy for Caregivers


The work of a caregiver is usually based on generosity and bonds of affection. That is the caregiver’s greatest strength, but it is not enough. Everyone in such a position needs to learn how to become an effective provider of care, so that the effort expended produces the best result for the patient, and for the caregiver. What we call ‘health literacy’ today, was also a preoccupation in Florence Nightingale’s time.



Knowledge of the laws of health •••


As she notes in her Conclusion to Notes on Nursing, it is not the job of a caregiver to replace the physician or the nurse. Building a working relationship with these health professionals is, however, part of the caregiver’s responsibility. Effective communications among such a team depends on the caregiver learning at least the basics about the patient’s condition and how to provide the type and quality of care that will meet the patient’s needs. Florence Nightingale called this ‘knowledge of the laws of health’ or ‘sanitary knowledge’. Today, this apprenticeship in the basic rules of hygiene and of caregiving is part of what is generally referred to as health literacy. This chapter begins with Florence Nightingale’s remarks on that and related subjects. It continues with guidance on health literacy for today’s caregivers and patients. The Internet and other virtual or real networks are a component of what it means today for a caregiver to be ‘literate’ about health, and so the chapter concludes with guidance on sources of information and assistance available to the caregiver through these modern means of self-education.




imageNotes on Nursing — Florence Nightingale


Nevertheless let no one think that because sanitary nursing is the subject of these notes, therefore, what may be called the handicraft of nursing is to be undervalued. A patient may be left to bleed to death in a sanitary palace. Another who cannot move himself may die of bed-sores, because the nurse does not know how to change and clean him, while he has every requisite of air, light, and quiet. But nursing, as a handicraft, has not been treated of here for three reasons:


That these notes do not pretend to be a manual for nursing, any more than for cooking for the sick; That the writer, who has herself seen more of what may be called surgical nursing, i.e. practical manual nursing, than, perhaps, any one in Europe, honestly believes that it is impossible to learn it from any book, and that it can only be thoroughly learnt in the wards of a hospital; and she also honestly believes that the perfection of surgical nursing may be seen practised by the old-fashioned “Sister” of a London hospital, as it can be seen nowhere else in Europe.


While thousands die of foul air, &c., who have this surgical nursing to perfection, the converse is comparatively rare.


Both for children and for adults, both for sick and for well (although more certainly in the case of sick children than in any others), I would here again repeat, the most frequent and most fatal cause of all is sleeping, for even a few hours, much more for weeks and months, in foul air, a condition which, more than any other condition, disturbs the respiratory process, and tends to produce “accidental” death in disease. I need hardly here repeat the warning against any confusion of ideas between cold and fresh air. You may chill a patient fatally without giving him fresh air at all. And you can quite well, nay, much better, give him fresh air without chilling him. This is the test of a good nurse. In cases of long recurring faintnesses from disease, for instance, especially disease which affects the organs of breathing, fresh air to the lungs, warmth to the surface, and often (as soon as the patient can swallow) hot drink, these are the right remedies and the only ones. Yet, oftener than not, you see the nurse or mother just reversing this; shutting up every cranny through which fresh air can enter, and leaving the body cold, or perhaps throwing a greater weight of clothes upon it, when already it is generating too little heat. “Breathing carefully, anxiously, as though respiration were a function which required all the attention for its performance,” is cited as a not unusual state in children, and as one calling for care in all the things enumerated above. That breathing becomes an almost voluntary act, even in grown up patients who are very weak, must often have been remarked. “Disease having interfered with the perfect accomplishment of the respiratory function, some sudden demand for its complete exercise, issues in the sudden standstill of the whole machinery,” is given as one process: – “life goes out for want of nervous power to keep the vital functions in activity,” is given as another, by which “accidental” death is most often brought to pass in infancy. Also in middle age, both these processes may be seen ending in death, although generally not suddenly. And I have seen, even in middle age, the “sudden stand-still” here mentioned, and from the same causes. To sum up: the answer to two of the commonest objections urged, one by women themselves, the other by men, against the desirableness of sanitary knowledge for women, plus a caution, comprises the whole argument for the art of nursing.



Real knowledge of the laws of health alone can check this.


It is often said by men, that it is unwise to teach women anything about these laws of health, because they will take to physicking, – that there is a great deal too much of amateur physicking as it is, which is indeed true. One eminent physician told me that he had known more calomel given, both at a pinch and for a continuance, by mothers, governesses, and nurses, to children than he had ever heard of a physician prescribing in all his experience. Another says, that women’s only idea in medicine is calomel and aperients. This is undeniably too often the case. There is nothing ever seen in any professional practice like the reckless physicking by amateur females.


But this is just what the really experienced and observing nurse does not do; she neither physics herself nor others. And to cultivate in things pertaining to health observation and experience in women who are mothers, governesses or nurses, is just the way to do away with amateur physicking, and if the doctors did but know it, to make the nurses obedient to them – helps to them instead of hindrances. Such education in women would indeed diminish the doctor’s work, but no one really believes that doctors wish that there should be more illness, in order to have more work.



What pathology teaches. What observation alone teaches. What medicine does. What nature alone does.


It is often said by women, that they cannot know anything of the laws of health, or what to do to preserve their children’s health, because they can know nothing of “Pathology,” or cannot “dissect,” – a confusion of ideas which it is hard to attempt to disentangle. Pathology teaches the harm that disease has done. But it teaches nothing more. We know nothing of the principle of health, the positive of which pathology is the negative, except from observation and experience. And nothing but observation and experience will teach us the ways to maintain or to bring back the state of health. It is often thought that medicine is the curative process. It is no such thing; medicine is the surgery of functions, as surgery proper is that of limbs and organs. Neither can do anything but remove obstructions; neither can cure; nature alone cures. Surgery removes the bullet out of the limb, which is an obstruction to cure, but nature heals the wound. So it is with medicine; the function of an organ becomes obstructed; medicine, so far as we know, assists nature to remove the obstruction, but does nothing more.


And what nursing has to do in either case, is to put the patient in the best condition for nature to act upon him. Generally, just the contrary is done. You think fresh air, and quiet and cleanliness extravagant, perhaps dangerous, luxuries, which should be given to the patient only when quite convenient, and medicine the sine qua non, the panacea. If I have succeeded in any measure in dispelling this illusion, and in showing what true nursing is, and what it is not, my object will have been answered.



Now for the caution.


It seems a commonly received idea among men and even among women themselves that it requires nothing but a disappointment in love, the want of an object, a general disgust, or incapacity for other things, to turn a woman into a good nurse. This reminds one of the parish where a stupid old man was set to be schoolmaster because he was “past keeping the pigs.” Apply the above receipt for making a good nurse to making a good servant. And the receipt will be found to fail. Yet popular novelists of recent days have invented ladies disappointed in love or fresh out of the drawing-room turning into the war-hospitals to find their wounded lovers, and when found, forthwith abandoning their sick-ward for their lover, as might be expected. Yet in the estimation of the authors, these ladies were none the worse for that, but on the contrary were heroines of nursing. What cruel mistakes are sometimes made by benevolent men and women in matters of business about which they can know nothing and think they know a great deal.


The everyday management of a large ward, let alone of a hospital – the knowing what are the laws of life and death for men, and what the laws of health for wards – (and wards are healthy or unhealthy, mainly according to the knowledge or ignorance of the nurse) – are not these matters of sufficient importance and difficulty to require learning by experience and careful inquiry, just as much as any other art? They do not come by inspiration to the lady disappointed in love, nor to the poor workhouse drudge hard up for a livelihood.


And terrible is the injury which has followed to the sick from such wild notions! In this respect (and why is it so?), in Roman Catholic countries, both writers and workers are, in theory at least, far before ours. They would never think of such a beginning for a good working Superior or Sister of Charity. And many a Superior has refused to admit a Postulant who appeared to have no better “vocation” or reasons for offering herself than these.


It is true we make “no vows.” But is a “vow” necessary to convince us that the true spirit for learning any art, most especially an art of charity, aright, is not a disgust to everything or something else? Do we really place the love of our kind (and of nursing, as one branch of it) so low as this? What would the Mere Angelique of Port Royal, what would our own Mrs. Fry have said to this?


I would earnestly ask my sisters to keep clear of both the jargons now current every where (for they are equally jargons); of the jargon, namely, about the “rights” of women, which urges women to do all that men do, including the medical and other professions, merely because men do it, and without regard to whether this is the best that women can do; and of the jargon which urges women to do nothing that men do, merely because they are women, and should be “recalled to a sense of their duty as women,” and because “this is women’s work,” and “that is men’s,” and “these are things which women should not do,” which is all assertion, and nothing more. Surely woman should bring the best she has, whatever that is, to the work of God’s world, without attending to either of these cries. For what are they, both of them, the one just as much as the other, but listening to the “what people will say,” to opinion, to the “voices from without?” And as a wise man has said, no one has ever done anything great or useful by listening to the voices from without.


You do not want the effect of your good things to be, “How wonderful for a woman!” nor would you be deterred from good things by hearing it said, “Yes, but she ought not to have done this, because it is not suitable for a woman.” But you want to do the thing that is good, whether it is “suitable for a woman” or not. It does not make a thing good, that it is remarkable that a woman should have been able to do it. Neither does it make a thing bad, which would have been good had a man done it, that it has been done by a woman. Oh, leave these jargons, and go your way straight to God’s work, in simplicity and singleness of heart.

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Dec 3, 2016 | Posted by in NURSING | Comments Off on Health Literacy for Caregivers

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