6. Tales of a Student Nurse: Basic Nursing Skills

Step one of taking a patient's temperature was to retrieve the mercury filled glass thermometer from the Clean Utility Room where it waited in its disinfectant bath in a lid-covered, shallow, rectangular metal pan. Step two was to make sure the level of the mercury was down below the minimum temperature mark to ensure accuracy of the result. Mrs. Peak demonstrated a very specific flick of the wrist which was required to force the mercury down below that mark. She made it look so easy but we had to practice that flick gesture for most of the class before we got it right. Once the mercury fell to the magic spot, the thermometer was properly prepared for insertion under the patient's tongue. The patient was required to purse his/her lips around it, and keep the mouth tightly closed for approximately sixty seconds. Once removed, the temperature reading was indicated by the level mark to which the mercury had risen while under the patient's tongue. The used thermometer was then placed in a separate, lidded, cleaning solution-filled metal container which was located in the Dirty Utility Room. After soaking for a prescribed period of time, the thermometers were returned to the hospital's Central Supply Room for final cleaning and autoclaving. Once sterilized, they were distributed back to the Clean Utility Rooms and were ready for re-use.

Two other non-preferred body sites, the axilla (arm pit) and the rectum, were also used on occasion to take the patient's temperature. Mrs. Peak explained the specific patient presentations which demanded a temperature be obtained by using one of these two alternative sites. A rectal temperature was always considered the most accurate but for obvious reasons was, for the patient, the least desirable method. The axillary temperature was less accurate than either oral or rectal, but was frequently used on a resistant child. To take an axillary temperature, a regular oral thermometer was placed for at least a full minute in the armpit. A rectal thermometer, distinguished from the universal thermometer by a slightly broader and rounder probe, was inserted in that one orifice only. Rectal thermometers were kept in a separate disinfectant-filled container and, cleaned separately, were subject to the same cleaning and re-distribution process as described above. We were young, we were naive; she and her colleagues made it very clear to us why we should never insert a rectal thermometer in any orifice but the anus.

Taking a blood pressure was similar to the procedure used with today's electronic device: we used a stethoscope and a portable blood pressure cuff called a sphygmomanometer. Both tools were kept at the Nurses' Station but the risk of the stethoscope not being there when needed was perpetually high. Nurses always blamed the doctors who "forgot" to return the stethoscope to the station after using it to assess their patients during rounds. This was a universal problem, complained about by nursing staff on every unit of the hospital. Eventually, nurses collectively found a way to solve the problem. They began purchasing their own stethoscopes, writing their names on a patient wristband and fastening the identifying wristband to the stethoscope. As an extra safety measure, the stethoscope became part of the nurse's uniform. As a student, I wasn't permitted to alter my uniform in any way, but as soon as I graduated, I too wore a stethoscope around my neck at all times; it never again went missing.

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author
Barbara Tiessen is a retired RN who lives with her husband in southwestern Ontario but winters in the Rio Grande Valley of Texas. She researched her genealogy, wrote and self published The Schoenfeld Russlaender: A Mennonite Family's History in 2015. More recently her interest have focused on writing short stories.
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