XIII. Observation of the Sick
Florence Nightingale, 1860Observation saves lives — not curiosity
Be specific, not vague in questions
Symptoms — what to watch for
Evidence of neglect must be recognized
Report facts, not opinions
Value of precise questioning
Every detail matters — leading questions mislead
XIII. Observation of the Sick
📌 MOST IMPORTANT PRACTICAL LESSON
"The most important practical lesson that can be given to nurses is to teach them what to observe — how to observe — what symptoms indicate improvement — what the reverse — which are of importance — which are of none — which are the evidence of neglect — and of what kind of neglect."
🎯 EXAM FOCUS: The Problem with "Is he better?"
There is no more silly or universal question than "Is he better?" What you want are facts, not opinion. The only sensible answer would be: "How can I know? I cannot tell how he was when I was not with him."
📌 EXAMPLES OF MISLEADING INFORMATION
- Question: "How often have the bowels acted?" Answer: "Once, sir." This means utensil emptied once — it may have been used 7-8 times.
- Question: "Is patient weaker than 6 weeks ago?" Answer: "Oh no — he can get across the room now." Nurse didn't observe that 6 weeks ago he sat up and occupied himself — now lies still doing nothing.
- Question: "Has he had a good night?" One patient thinks "good night" = 10 hours without waking. Another thinks = intervals of dozing. Same answer given for sleepless patient and one who slept normally.
🔍 LEADING QUESTIONS ARE USELESS
"Was there noise in the street last night?" If there wasn't, patient reported without more ado to have had a good night — ignoring that patient may have been kept awake by pain, anxiety, fever.
Patients give only exact amount of information asked for, even when they know it's completely misleading. The shyness of patients is seldom allowed for.
📋 WHAT OBSERVATION IS FOR
It is not for piling up miscellaneous information or curious facts, but for the sake of saving life and increasing health and comfort.
If you suspected patient was being poisoned by copper kettle, you would instantly cut off all possible connection — without regard to curious observation lost.
⭐ WHAT A CONFIDENTIAL NURSE SHOULD BE
- To be depended upon
- No gossip, no vain talker
- Never answer questions about sick except to those with right to ask
- Strictly sober and honest
- Religious and devoted woman
- Respect for her own calling (God's precious gift of life placed in her hands)
- Sound, close, quick observer
- Woman of delicate and decent feeling
📝 Key Takeaways for NCLEX
- Teach nurses WHAT to observe and HOW to observe
- Report facts, not opinions
- Leading questions are useless - they give misleading answers
🧠 Mnemonic Summary
- NURSE: Nature heals, Universal skill, Reflective practice, Sanitary knowledge, Everyday application
Source: Notes on Nursing: What It Is and What It Is Not, Florence Nightingale, 1860. First American Edition.