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INDEX TO VOLUME SIXTY-FIVE
JANUARY-DECEMBER 1969
ABSTRACTING AND INDEXING
Index of Canadian nursing studies available,
16 (Jun)
ACCREDITATION
CCHA rejects CNA bid for representation, 9
(Jun)
AIKEN. Ruth E.
Bk. rev., 56 (May)
AISH, Arlene
Joined staff of Queen's University, (port),
22 (Oct)
ALBERTA ASSOCIATION OF
REGISTERED NURSES
Alberta and British Columbia announce
contributions to ICN, 13 (Mar)
Alberta nurses accept new contract, 15
(Sep)
Holds district rallies to study bill 119, IS
(Nov)
ICN receives $8,000 from AARN, 9 (Jun)
Membership increases in 1968, 8 (Jul)
"Nurse in Society" is AARN convention
theme, 10 (Aug)
Presents brief to cabinet, 1 3 (Apr)
Rejects bill 119 will meet with health
minister, 13 (Dec)
ALCOHOLISM
A comparison of the perceptions of public
health nurses and their alcoholic pa-
tients . . . (Williams), (abst), 52 (May)
ALEXANDER, Mary
Bk. rev., 37 (Jul)
ALLAIRE, Virginie, Mother
Obituary, (port), 22 (Apr)
AMERICAN NURSES' ASSOCIATION
ANA releases current RN data, 16 (Dec)
ANA supports AMA's move against discri-
mination, 16 (Mar)
Interim executive director appointed by
ANA, 19 (Aug)
A look at ana's legislative program, (Linda-
bury), 22 (Jul)
AMPUTATION
The amputee and immediate prosthesis,
(Shewchuk, Young), 47 (May)
ANDERSON, Patricia S. B.
Lecturer, school of nursing, Queen's Univer-
sity, 20 (May)
ANDRAS, Andy
Health care fragmented labor leader tells
assembly, 1 1 (Nov)
ANGUS, M. D.
Aging and learning, 41 (Nov)
ANNABLE, Charlotte A.
Instructor, Sask. Institute of Applied Sci-
ences, 22 (Apr)
ANTISEPSIS
OR nurses discuss infection in hospitals, 10
(Feb)
ARCHITECTURE
see Hospitals - Planning and construction
ARNOLD, Gail A.
Helping the patient face reality, 41 (Sep)
ARPIN, Kathleen
RNANS considers principles of curriculum
building, 8 (Jul)
ASSOCIATION OF NURSES OF
PRINCE EDWARD ISLAND
Holds annual meeting, 10 (Aug)
ASSOCIATION OF NURSES OF
THE PROVINCE OF QUEBEC
CEGEP system explained at ANPQ general
meeting, 9 (Jan)
Committees discuss uniform nursing tech-
niques, 13 (Jan)
Donates $50,000 to ICN congress, 12 (Mar)
Elects new offices, 1 8 (Dec)
Professional liability insurance available to
ANPQ members, 12 (Apr)
To study nursing profession in Quebec. 10
(Sep)
Two scholarships offered in Quebec, 16
(May)
ASSOCIATION OF OPERATING
ROOM TECHNICIANS
OR technicians form association, 12 (Oct)
Robert W. Hades elected first president,
12 (Oct)
ASSOCIATION OF REGISTERED
NURSES OF NEWFOUNDLAND
Moves to new headquarters, 14 (Feb)
Newfoundland donates $1,840 to CNA for
ICN costs, 9 (May)
ATTITUDES
Quality of care makes the difference,
(Matthews), 50 (Nov)
Relationship between attitude and person-
centeredness of nursing care, (Perry)
(abst), 44 (Dec)
Relationships between attitudes to nurs-
ing .. . (Bailey), (abst), 52 (May)
AUDIO VISUAL AIDS
AV-aids for nursing subject of US study, 10
(Feb)
Don't push your luck, 53 (Nov)
Electronic video recording simplifies film
showing, 14 (Feb)
Emergency 77, 39 (Jul)
Hyperbaric fire control - fire behavior and
extinguishment in hyperbaric chambers,
39 (Jul)
Immediate post-surgical prosthesis, 39 (Jul)
The minis have it, (Hill), 44 (Nov)
A new handbook of educational material for
guidance, health, and sex education, 52
(Jan)
Overcoming resistance to change, 39 (Jul)
RNAO holds regional conferences on audio-
visual aids, 9 (Jan)
Surgical film catalog. 52 (Jan)
The way I see it, 39 (Jul)
AUXILIARY WORKERS
OR technicians form association, 12 (Oct)
AWARDS
CNF announces scholarship winners, 9 (Sep)
CNF scholarship fund drops to $25,000 for
1969, 7 (Feb)
Canadian Red Cross established nursing
fellowship, 15 (Jul)
Good Citizenship award in Victoria, B.C ,
18 (Sep)
Jean C. Leask recipient of the R.D. Defries
Award, 16 (Jul)
MARN awards bursaries, 16 (Dec)
Male student wins recruitment poster
contest, 14 (Jul)
NBARN awards scholarships, 21 (Nov)
Nicole Du Mouchel awarded the Warner-
Chilcott scholarship, 19 (Jan)
Nursing sister receives OBE, 1 7 (Mar)
RNABC announces awards, 21 (Nov)
RNABC loans offered, 16 (May)
Red cross bursary offered to Ontario nurses,
19 (Apr)
St. John Ambulance announces bursary
awards, 1 1 (Oct)
3M donates fellowship, 10 (Aug)
Too Uttle, for too long, from federal govern-
ment, (Good), 29 (May)
Two scholarships offered in Quebec, 16
(May)
White Sister donates $30,000 scholarship,
10 (Aug)
B
BAILEY, A. Joyce
Relationships between attitudes to nurs-
ing . . .(abst), 52 (May)
BALL, Charles
Bk. rev., 41 (Mar)
Ban, Laura
Nursing associations - are they coming or
going? (Zilm), 31 (Sep)
Whoo-Fur pinned down at last, 9 (Jun)
BARRAS, Marilyn
Appointed director of nursing, Humber
College of Applied Arts & Technology,
Toronto, (port), 22 (Aug)
BARRON, Purification
Lecturer, (port), 18 (Sep)
BEAUDRY-JOHNSON, Nicole
New services help patients and staff, 39
(Mar)
BEGALKE, Rose-Aline
Instructor, Sask. Institute of Applied Sci-
ences, 22 (Apr)
BENNETT, Maureen
Bk. rev., 47 (Dec)
BESWETHERICK, Margaret Ann
Professor, University of Alberta, (port), 22
(Feb)
BHADURI, Basanti
Lecturer, (port), 1 8 (Sep)
BIEBER, Ottilia M.
Appointed public health nursing education
consultant, (port), 19 (Jan)
BIRLEY, James B.
Bk. rev., 56 (May)
BIRTH CONTROL
Libcrian government doubtful of family
planning clinics, 1 7 (Aug)
III
BLAIR, Heather
Bk. rcv.,50(Jun)
BLOOD
Canada's rare blood bank, (Carter), 35 (Mar)
The coagulation of Harry, 38 (Oct)
How much bleeding? (Bruser), 44 (Jan)
BONDY, Doreen M.
Family health service: the PHN and the GP,
(Jones), 38 (Sep)
BOOK REVIEWS
Addiction Research Foundation, A prelimi-
nary report, on the attitudes and behav-
iour of Toronto students in relation to
drugs, 5 1 (Oct)
Alford, Harold J., Continuing education in
action, 59 (May)
AUgire, Mildred J., Nurses can give and
teach rehabilitation, 41 (Mar)
Alyn, Irene Barrett, Saunders tests for self
evaluation of nursing competence, (Gil-
lies), 68 (Feb)
American Hospital Association, Infection
control in the hospital, 66 (Feb)
American Nurses' Association, ANA region-
al clinical conferences, 50 (Jan)
American Psychiatric Association, A
psychiatric glossary, 51 (Nov)
Andreoli, Kathleen G. et al, Comprehensive
cardiac care, 37 (Jul)
Asperheim, Mary Kaye, The pharmacologic
basis of patient care, 50 (Aug)
Avery, Mary Ellen, The lung and its disord-
ers in the newborn infant, 52 (Jan)
Azneer, J. Leonard, (Kessler, Caccamo),
Resuscitation: a programmed course, 52
(Jan)
Barnes, Elizabeth Psychosocial nursing, 54
(Sep)
Btishen, Bernard R., Doctors and doctrines,
51 (Oct)
Bloom, Arnold, Toohey medicine for
nurses, 47 (Dec)
Bowen, Eleanor Page, Biology of human
behavior, 52 (Jan)
Bowley, Agatha H., The young handicapped
child, (Gardner), 53 (Aug)
Brackman, Claire, Essentials of nursing, 53
(Nov)
Brock, Margaret Gaughan, Social work in
the hospital organization, 54 (Sep)
Brooks, Stewart M., Programmed introduc-
tion to microbiology, 52 (Jan)
Broome, W. E., Nurses technical manual
1968-69, 47 (Dec)
Burrell, Lenette Owens, Intensive nursing
care, (BuneU) 47 (Dec)
Burrell, Zeb L., Intensive nursing care,
(Burrell), 47 (Dec)
Cable, James Vemey, Principles of medi-
cine, 52 (Aug)
Caccamo, Leonard P., Resuscitation: a
programmed course, (Kessler, Azneer), 52
(Jan),
Campbell Donald, A nurse's guide to
anaesthetics, resuscitation and intensive
care, (Norris), 53 (Nov)
Canadian Nurses' Association, Countdown
1968, 46 (Apr)
IV
Canadian Nurses' Association, Presence, 9
(Sep)
Carnevali, Doris L., Nursing care planning,
(Little), 5 1 (Nov)
Chaffee, Ellen E., Basic physiology and
anatomy, (Greishemier), 56 (Sep)
Chen, Philip S., Chemistry: inorganic, organ-
ic and biological, 56 (May)
Cherescavich, Gertrude D., A textbook for
nursing assistants, 58 (Sep)
Christie, A. B., Infectious diseases, 70 (Feb)
Cowless Education Corp., How to pass
entrance examinations for registered and
graduate nursing schools, 5 1 (Jan)
Community Health Nursing Faculty, Work-
book for community health nursing prac-
tice, 49 (Jan)
Craddock, Denis, Obesity and its manage-
ment, 52 (Nov)
Crelin, Edmund S., Anatomy of the new-
born: an atlas, 54 (Sep)
Daniel, Gerald S., The treatment of mental
disorders in the community, (Freeman),
57 (May)
Dauer, Cart C, Infectious diseases, 49 (Jun)
Dolan, Josephine A., History of nursing, 66
(Feb)
Dominian, Jack, Marital breakdown, 65
(Feb)
Ellis, Richard W. B., Disease in infancy and
childhood, (Mitchell), 50 (Jun)
Ferrer, H. P. Screening for health; theory
and practice, 58 (Sep)
Foote, William R., Human labor & birth,
(Oxorn), 50 (Aug)
Freedman, Marilyn Gottehrer, Clinical nurs-
ing workbook for practical nurses, (Han-
nan), 50 (Jan)
Freeman, Hugh L , The treatment of mental
disorders in the community, (Daniel) 57
(May)
Frobisher, Martin et al. Microbiology in
health and disease, 58 (Sep)
Gardner, Leslie, The young handicapped
child, (Bowley), 53 (Aug)
Garrod, P., Antibiotic and chemotherapy,
(O'Grady), 37 (Jul)
Gillies, Dee Ann, Saunders tests for self
evaluation of nursing competence, (Alyn),
68 (Feb)
Gordon, E. B., Basic psychiatry, (Sim) 56
(May)
Greisheimer, Esther M., Basic physiology
and anatomy, (Chaffee), 56 (Sep)
Gunzburg, H. C, Social competence &
mental handicap - an introduction to
social education, 52 (Aug)
Hadley, Anne, The medical secretary as a
word technician, 49 (Apr)
Hannan, Justine, Qinical nursing workbook
for practical nurses, (Freedman), 50 (Jan)
Hoffman, Qaire P., Simplified nursing,
(Lipkin, Thompson), 50 (Jan)
Hospital for Sick Children, Toronto, Celiac
disease recipes for parents and patients, 66
(Feb)
Hum, B.A.L. Storage of blood, 42 (Mar)
Johnson, Warren R., Human sexual behavior
and sex education: perspectives and prob-
lems, 58 (May)
Johnston, Dorothy F., Essentials of com-
municable disease with nursing principles,
38 (Jul)
Johnston, Dorothy, F., Total patient care,
foundations and practice, 68 (Feb)
Kesler, Henry H., The knife is not enough,
54 (May)
Kessler, Edward, Resuscitation: a pro-
grammed course, (Caccamo, Azneer), 52
(Jan)
Kilgour, O.F.G., An introduction to the
physical aspects of nursing science, 57
(Sep)
Klug, Barbara, The process of patient teach-
ing in nursing, 65 (Feb)
Lipkin, Gladys B., Simplified nursing, (Hoff-
man, Thompson), 50 (Jan)
Little, Dolores E., Nursing care planning
(CarnevaU), 5 1 (Nov)
Lockerby, Florence K.. Communication for
nurses, 49 (Jan)
Louise, Mary, Sister The operaring room
technician, 38 (Jul)
Macfarland, Mary E.. History, School of
Nursing, Toronto General Hospital, vol.2,
1932-1967, 37 (Jul)
Mackey, H.O., Handbook of diseases of the
skin, 49 (Jun)
Manfreda, Lucy, Psychiatric nursing, 48
(Apr)
Marlow, Dorothy R., Text book of pediatric
nursing, 53 (Nov)
Mercy Hospital, Pittsburgh, A manual for
team nursing, 66 (Feb)
Millar, Susanna, The psychology of play, 50
(Aug)
Mitchell, J. P.. Urology for nurses, 41 (Mar).
Mitchell, Ross G., Disease in infancy and
childhood, (Ellis), 50 (Jun)
Moroney, James, Surgical principles,
(Stock), 57 (May)
Myles, Margaret F., Textbook for midwives,
46 (Apr)
Norris, Walter, A nurse's guide to anaesthet-
ics, resuscitation and intensive care,
(Campbell), 53 (Nov)
O'Grady, Francis, Antibiotic and chemothe-
rapy, (Garrod), 37 (Jul)
Oxorn, Harry, Human labor & birth,
(Foote), 50 (Aug)
Owen, David, A unified health service, et al,
69 (Feb)
Partheymuller, Margaret T. Forces affecting
nursing practice, (Petrowski), 59 (Sep)
Penchansky, Roy, Health services adminis-
tration: policy cases and the case method,
70 (Feb)
Perkins, John J.. Principles and methods of
sterilization in health sciences, 55 (May)
Petrie, Asenath, Individuality in pain and
suffering, 49 (Jan)
Petrowski, Dorothy D. Forces affecting
nursing practice (Partheymuller), 59 (Sep)
Primrose, Rosellen Bohlen, Pediatric surgery
for nurses, (Raffensperger), 53 (Aug)
Raffensperger, John G. Pediatric surgery
for nurses, (Primrose). 53 (Aug)
Saunders, Mary, Health visiting practice, 56
(May)
Saunders, William H.. el al. Nursing care in
eye, ear, nose, and throat disorders, 41
(Mar)
Schor, Stanley S.. Fundamentals of bio-
statistics, 50 (Aug)
Schurr, Margaret. Leadership and the nurse:
an introduction to the principles of
management, 51 (Nov)
Seager, C. P., Psychiatry for nurses, social
workers, and occupational therapists. 56
(May)
Senn, Milton J. E.. Problems in child behav-
ior and development, (Solnit), 54 (May)
Shamsie, S. J. Adolescent psychiatry, 50
(Jan)
Sim, Myre, Basic psychiatry, (Gordon), 56
(May)
Slatt, Bernard J.. The ophthalmic assistant,
(Stein), 49 (Jun)
Smeltzer, C H. The interview in student
nurse selection, 68 (Feb)
Smith, Alice L. Microbiology and patholo-
gy, 50 (Jun)
Smith, Alice L. Principles of microbiology,
52 (Nov)
Solnit, Albert J.. Problems in child behavior
and development, (Senn) 54 (May)
Stein, Harold A., The ophthalmic assistant,
(Slatt), 49 (Jun)
Stock, Francis E,. Surgical principles,
(Moroney) 57 (May)
Sutherland, John D.. The psychoanalytic
approach, 51 (Jun)
Sutton, Audrey Latshaw, Bedside nursing
techniques in medicine and surgery, 56
(Sep)
Swansburg, Russell C , Inservice education,
59 (May)
Thomas, James Blake, Introduction to
human embryology, 46 (Apr)
Thompson, Ella M.. Simplified nursing,
(Hoffman, Lipkin), 50 (Jan)
Thomson, William A.R.. Sex and its prob-
lems, 4 1 (Mar)
Ujhely, Gertrud, Determinants of the nurse-
patient relationahip, 48 (Apr)
Vanderpoel, Sally, The care & feeding of
your diabetic child, 67 (Feb)
Volk, Wesley A., Basic microbiology,
(Wheeler), 54 (Sep)
Weiser, Russell S.. et al. Fundamentals of
immunology for students of medicine and
related sciences, 51 (Oct)
Wheeler. Margaret F.. Basic microbiology,
(Volk), 54 (Sep)
Williams, Sue Rodwell. Nutrition and diet
therapy, 52 (Aug)
Wolman, Benjamin B. The unconscious
mind - the meaning of Freudian psycho-
logy, 65 (Feb)
Wooldrige, James K. et al Behavioral sci
ence, social practice, and the nursing
profession, 54 (May)
Zeitz, Ann N., et al. Associate degree
nursing: a guide to program and curricu-
lum development, 47 (Dec)
BOOKS
49 (Jan). 65 (Feb), 41 (Mar), 46 (Apr), 54
(May), 49 (Jun), 37 (Jul). 50 (Aug), 54
(Sep), 51 (Oct), 51 (Nov). 47 (Dec).
BOONE, Margaret I.
Lecturer, school of nursing, Lakehead Uni-
versity, (port), 20 (May)
BOSSE, Marielle
NBARN scholarship, 21 (Nov)
BRAWLEY, Arleen
Muriel Archibald Scholarship, 21 (Nov)
BRIDGES, Daisy C.
The growth and development of a profes-
sion, 32 (Jun)
BRUNET, Jacques
Laval University accepts a challenge, (Ga-
gnon), 44 (Aug)
BRUSER, Michael
How much bleeding? 44 (Jan)
BUGAYONG, L.
Bk. rev., 53 (Nov)
BURGOYNE, Eileen
Bk. rev., 41 (Mar)
BURNIE, R.
Two-year-old Michael - ill and in hospital,
46 (Nov)
BURWELL, Elinor
Bk. rev., 50 (Aug)
BURWELL. Dorothy M.
Psychodrama, 44 (May)
BUTLER, Ada
RNABC bursary, 21 (Nov)
BUTLER, Laura E.
President, RNAO, (port), 20 (Jun)
BUTZ Irma
Appointed assistant director of nursing,
Douglas Hospital, Verdun, Quebec, 22
(Jun)
CEGEP
Montreal to close English language hospital
schools of nursing, 8 (jul)
CABELLI Anita
CNF award, 9 (Sep)
CAHOON. Margaret C.
Associate professor. University of Toronto,
(port), 23 (Apr)
CALKIN, Joy
Bk. rev. 67 (Feb)
CAMILLUS, Sister
Bk. rev., 52 (Nov)
CAMPBELL, S. Maureen,
Instructor, Sask. Institute of Applied Sci-
ences, 22 (Apr)
CANADIAN ASSOCIATION OF NEURO
LOGICAL AND NEUROSURGICAL NURSES
Canadian neuro nurses form association, 13
(Sep)
CANADIAN CONFERENCE OF
UNIVERSITY SCHOOLS OF NURSING
CCUSN Atlantic region assesses need for
master's program, 10 (Jun)
CCUSN elects executive, 7 (Jan)
CCUSN (A) submits brief to Maritime union
study, 15 (Oct)
University nurses present brief to Caston-
guay Commission, 12 (May)
Western region of CCUSN holds annual
meeting, 10 (May)
CANADIAN COUNCIL OF
HOSPITAL ACCREDITATION
CCHA rejects CNA bid for representation, 9
(Jun)
CANADIAN HOSPITAL
Attacks new postal rates, 16 (Sep)
CANADIAN HOSPITAL ASSOCIATION
CNA, CMA, CHA discuss hospital medical
staff relations, 14 (Apr)
"Design, Then Build," renowned consultant
tells CHA, 18 (Aug)
Metric conversion kits available from CHA,
13 (Dec)
"Organize resources" Minister tells CHA, 10
(Jul)
To study nursing education, 10 (Jul)
Time out at the Canadian Hospital Associa-
tion convention, 10 (Jul)
CANADIAN MEDICAL ASSOCIATION
CNA, CMA, CHA discuss hospital-medical
staff relations. 14 (Apr)
CANADIAN MENTAL HEALTH
ASSOCIATION
Approves volunteer services for emotionally
disturbed children, 9 (Jul)
CANADIAN NURSE
CNA's journals reclassified as third class
mail, 9 (May)
Journals' postal problems discussed by CNA
board, 7 (Mar)
Postal rate increases may affect CNA
magazines, 7 (Feb)
Postal rates, (Lindabury), (editorial). 3
(Feb)
Thought and action, (Van Raalte), 25 (Mar)
CANADIAN NURSES' ASSOCIATION
Ad Hoc committee completes draft for
standards tor nursing service, 7 (Jul)
Asks government for a million dollars more,
12 (Apr)
Associate director to participate in WHO
conference in New Delhi. 1 1 (Oct)
CCHA rejects CNA bid for representation, 9
(Jun)
CNA executive director honored, 10 (Dec)
CNA, CMA, CHA discuss hospital-medical
staff relations. 14 (Apr)
CNF to receive CNA funds for research in
nursing service, 10 (Dec)
Countdown 1968, Ottawa, 46 (Apr)
Executive director predicts change in sci-
ence of nursing not in art of nursing, 1 2
(Dec)
Gold chain honors nurses, 7 (Jul)
Greek gift to CNA, 10 (Sep)
Guide on nursing service standards to be
published by CNA, 1 1 (Dec)
Lobbying, (Lindabury), (editorial), 3 (Jul)
Needed: a full-time lobbyist, (Lindabury),
(editorial), 21 (Jul)
New CNA bylaws approved at special meet-
ing, 9 (Dec)
1968-70 goals approved, 8 (Apr)
1969 fee$ are due, 16 (Mar)
V
Nursing assistants are here to stay, (Kergin),
33 (Apr)
Provisional board to be set up for CNA
testing service, 10 (Dec)
Official directory, 80 (Aug) XVIII (Dec)
Special ad hoc committee meets, 7 (Feb)
Special CNA meeting to be held this year to
consider bylaws, 8 (Mar)
Testing service to locate in Ottawa, 8 (Mar)
Thought and action, (Van Raalte), 25 (Mar)
CANADIAN NURSES ASSOCIATION
Works with DBS to publish statistics, 12
(Nov)
CANADIAN NURSES ASSOCIATION
AD HOC COMMITTEE ON FUNCTIONS
Report to be sent to provinces for further
study, 9 (Dec)
Special ad hoc committee meets, 7 (Feb)
Special committee will report to board, 11
(Nov)
CANADIAN NURSES' ASSOCIATION.
ARCHIVES
Gift to CNA Archives, 9 (Jan)
CANADIAN NURSES' ASSOCIATION.
BIENNIAL CONVENTION, 1968
Copies of speeches requested, 13 (Jan)
CANADIAN NURSES' ASSOCIATION.
BOARD OF DIRECTORS
Adopts Education Committee motions, 10
(Dec)
Qinical nursing statement revised by CNA
board, 1 1 (Dec)
Orientation day for new board members, 7
(Mar)
CANADIAN NURSES' ASSOCIATION
COMMITTEE ON NURSING EDUCATION
CNA board adopts education committee
motions, 10 (Dec)
CANADIAN NURSES' ASSOCIATION
CONVENTION 1970
Biennial convention to open on a Sunday,
12 (Dec)
Plans underway for CNA convention, 11
(Nov)
CANADIAN NURSES' ASSOCIATION.
LIBRARY
Accession list, 54 (Jan), 70 (Feb), 43 (Mar),
50 (Apr), 60 (May), 51 (Jun) 39 (Jul), 54
(Aug), 60 (Sep), 51 (Oct), 54 (Nov), 49
(Dec)
CNA library wants theses, 12 (Oct)
Mailing charges both ways on CNA library
loans, 10 (Mar)
New look in CNA Library, 1 1 (Oct)
Resources and use of CNA library, (Parkin),
32 (Mar)
CANADIAN NURSES' FOUNDATION
Announces scholarship winners, 9 (Sep)
Board meets and appoints new officers, 15
(Apr)
A dollar, a dollar, follow the scholar,
(Lindabury), 37 (Mar)
Editorial, (Lindabury), 3 (Mar)
Elects new board, ponders financial prob-
lem, 12 (Mar)
McGill student nurses contribute to CNF,
18 (Aug)
VI
SRNA announces annual CNF donation, 13
(Mar)
Scholarship fund drops to $25,000 for
1969, 7 (Feb)
To receive CNA funds for research in
nursing service, 10 (Dec)
CANADIAN RED CROSS
Established nursing fellowship, 15 (Jul)
Red cross bursary offered to Ontario nurses,
19 (Apr)
CANADIAN WELFARE COUNCIL
Visiting homemaker services in short supply,
19 (Aug)
CANCER
Cytology screening - a program that
works (MacLean), 40 (May)
Lung cancer on rise in Canada, 14 (Jan)
CARR, Mary
Bk. rev., 56 (Sep)
CARROLL Majorie
Lecturer, (port), 18 (Sep)
CARTER, Len
Canada's rare blood rank 35 (Mar)
CARTER, Terry Lynn
The coagulation of Harry, 38 (Oct)
CASHIN, Joan
Nursing sister receives OBE, (port), 17 (Mar)
CASTONGUAY, Therese
Two-year versus three-year programs, (Cos-
tello), 62 (Feb)
CHAMBERS Sharon
Bk. rev., 58 (Sep)
CHAPMAN, Kate
Honorary member SRNA, 22 (Aug)
CHICAGO UNIVERSITY
RN internship program starts at Chicago U.,
16 (Dec)
CHRISTIE Mary
Retired, 22 (Oct)
CHRISTMAS
Home for Christmas, (Ferrari), 25 (Dec)
CHURCH Jean L.
Obituary, (port), 16 (Jul)
CLARK, Kathleen M.
Appointed an instructor. University of
British Columbia School of Nursing, 18
(Sep)
CLARKE Marilyn H.
Bk. rev., 53 (Nov)
CLARKE INSTITUTE OF
PSYCHIATRY
No salary increases offered, 8 (Aug)
COCHRANE, Frances M.
Bk. rev.,41 (Mar)
COHEN, Anthea
Nurses are not neurotic, 45 (Jun)
COLLECTIVE BARGAINING
Alberta nurses accept new contract, 15
(Sep)
Collective bargaining workshops held across
Manitoba, 15 (Mar)
Contracts signed by Saskatchewan Nurses,
20 (Nov)
Hamilton nurse educators return to work,
14 (May)
Harder bargaining ahead for Canadian
Nurses, 18 (Jun)
Hospital nurses in NB submit mass resigna-
tion, 8 (Aug)
Hospital personnel relations bureau set up,
18 (Apr)
Montreal nurses sign contract with Queen
Elizabeth Hospital. 14 (Feb)
NBARN organizes for collective bargaining,
13 (Jan)
New Brunswick nurses sign new contract, 14
(Dec)
New Brunswick nurses to be granted collec-
tive bargaining rights, 15 (Mar)
New Brunswick nurses withdraw resigna-
tions, 10 (Sep)
No salary increases offered, 8 (Aug)
Nurse educators go on strike, 7 (Apr)
Nurses negotiations with NBHA deadlocked,
8 (Jul)
Ontario supreme court to settle terms of
nurses' contract, 14 (Sep)
Professional institute is bargaining agent for
federal nurses, 12 (Apr)
Public health nurses return to work, 13 (Jul)
Strike of 18 nurse* educators, (Lindabury),
(editorial), 3 (Apr)
UNM hold second annual meeting, 12 (Jan)
See also Labour unions
COLLEGE OF NURSES
College of nurses to close waiver clause, 14
(Sep)
COLONEL, Gayle
RNABC bursary, 21 (Nov)
COMMISSION ON RELATIONS BETWEEN
UNIVERSITIES AND (GOVERNMENT
CNA asks government for a million dollars
more, 12 (Apr)
COMMUNITY SERVICES
Family health service: the PHN and the GP
(Jones, Bondy), 38 (Sep)
COLPITTS, H.G.M.
Bk. rev., 37 (Jul)
CONFERENCES AND INSTITUTES
EC nurses begin two workshops, 16 (Jan) .
CNA, CMA, CHA discuss hospital-medicall
staff relations, 14 (Apr)
Collective bargaining workshops held across
Manitoba, 15 (Mar)
Conference held for dialysis nurses, 15
(Dec)
Curriculum conferences held in Vancouver
and Victoria, 13 (Mar)
Family physicians meeting sees debut of
medical convention T.V., 1 7 (Dec)
Health manpower conference to be held in
Ottawa, 9 (Sep)
NBARN sponsors inservice education work-
shop, 15 (Apr)
NLN conference to consider health in com-
munity, 15 (Apr)
Operating room nurses meet, 1 7 (Dec)
Pembroke hospital sponsors team nursing
workshop, 14 (Jan)
RNAO holds regional conferences on audio
visual aids. 9 (Jan)
Summer workshop for nurse-teachers, 15
(Sep)
Two workshops at UWO, 20 (Aug)
Workshops on test construction to be held
in London, 16 (Mar)
COOK, K.L.
Bk. rev. 38 (Jul)
COOME Barbara
Rooming-in brings family together, 47 (Jun)
COOPER, Carol Ann
Recipient of the Margaret MacLaren bursa-
ry, 1 1 (Oct)
COSTELLO, C. G.
It's depressing! 43 (Sep) ^
Two-year versus three-year programs, (Cas-
tonguay), 62 (Feb)
CRAGG, Catherine E.
The child with leukemia, 30 (Oct)
CRAWFORD, John N
Retirement as deputy minister of National
Health, 18 (Dec)
CROTIN, Gloria G.
Medicolegal problems can arise in the coron-
ary care unit, 37 (Apr)
Nursing supervisors' perception of their
functions and activities, (abst), 48 (Jun)
CRYDERMAN, Eileen
Retired, (port), 18 (Sep)
CUNNINGHAM, Helen
Director of nursing services, Ottawa Civic
Hospital, (port), 23 (Apr)
CUNNINGS, Bente
Interim executive director of MARN, (port),
20 (Dec)
CUTHBERT, Ruby
Bk. rev., 59 (Sep)
D
DANIELS, Leota
Bk rev., 50 (Jan)
DATES
20 (Jan), 25 (Feb), 20 (Mar), 24 (Apr), 22
(May), 24 (Jun), 18 (Jul), 23 (Aug), 20
(Sep), 24 (Oct), 22 (Nov), 21 (Dec)
DAVELUY; DanieUe
Peruvian adventure, 36 (Sep)
DAVIS, Beatrice
Director of Victoria Hospital, School of
nursing, London, Ontario, (port), 20 (Dec)
DAVIS, Beth
Bk. rev., 50 (aug)
DAVIS, Theresa M. A.
CNF award, 9 (Sep)
DAWES, J. M.
Bk. rev., 47 (Dec)
DAY NURSERIES
New services help patients and staff, (Beau-
dry-Johnson), 39 (Mar)
DECHENE, Jean-Paul
Bk rev., 52 (Jan)
DE GARZON, Elvia C.
Nursing in Colombia, (Restrepo), 37 (Jun)
DELAHANTY, M. V.
Staff-hne conflict in hospitals, 35 (Nov)
DEPT. OF NATIONAL HEALTH
AND WELFARE
Dr. Lossing retires, 22 (Oct)
Health & welfare department marks 50th
anniversary, 21 (Apr)
Retirement of Dr. John N. Crawford, 18
(Dec)
Three nurses appointed to federal task
forces, 8 (Apr)
DIABETES
Insulin injection - a new technique, (St.
James), 32 (Jul)
DIAGNOSIS, LABORATORY
Clinical laboratory procedures, (Watson,
Neufeld),41 (Feb)
DICK, Dorothy
Association's aims too remote says MARN
president, 8 (Aug)
DICXER, K
Safe care for mother and baby, 31 (Dec)
DICKINSON, Grant
Male student wins recruitment poster con-
test, 14 (Jul)
DINEEN, Donna
Bk. rev., 50 (Jan)
DION, Nicole
Appointed executive coordinator, United
Nurses of Montreal, (port), 17 (Sep)
DIPLOMA PROGRAMS
See Education
DISASTERS AND EMERGENCIES
Emergency hospital institute displays in-
stant hospital, 12 (Jul)
"Good Samaritan" act passed by Alberta
legislature, 15 (Oct)
DOMINION BUREAU OF STATISTICS
CNA works with DBS to publish statistics,
12 (Nov)
DOMKE,Caroline
Instructor, school of nursing. University of
B.C., 20 (May)
DOYON, Jacques
Medical photography - a century of prog-
ress, 40 (Jun)
DRUGS
Aspirin may cause ulcers, 13 (Jan)
Drug adverse reaction program - and the
nurse's role, (Napke), 40 (Dec)
Drug prices drop, 1 7 (Dec)
Committee to investigate nonmedical use of
drugs, 19 (Oct)
Medication errors can be prevented, (Tho-
mas), 50 (May)
DUMAS, Edna
Registrar of SRNA, 18 (Sep)
DU MOUCHEL, Nicole
Awarded the Warner-Chilcott scholarship,
(port), 19 (Jan)
DUTRISAC, Claire
Mind your own business, 46 (Aug)
DUVILLARD, Marjorie
Appointed deputy executive director of the
ICN, (port), 16 (Jul)
FADES, Robert W.
Elected first president of the Association of
Operating Room Technicians, (port), 12
(Oct)
EARLE, Eleanor R
Retired as supervisor public health nursing,
20 (Dec)
EARLE, Nora
Member of the Royal Society of Health, 22
(Oct)
ECONOMICS, NURSING
And now your income tax . . ., (Mallett), 34
(Apr)
CNA works with DBS to publish statistics,
12 (Nov)
Breakthrough for nurses at St. Joseph's
Hospital Guelph, 12 (Oct)
CNA sets 1970 salary goals: $7,200 for
diploma nurses, $8,460 for university
grads, 7 (Mar)
Federal government nurses get more pay, 11
(Oct)
Nurses' associations granted salaries that
exceed those set by OHSC, 16 (Mar)
No salary increases offered, 8 (Aug)
OHSC raises bonus rates for service person-
nel; teachers' bonuses remain same, 9
(Jan)
PEl nurses granted salary increases, 14 (Mar)
RNAO recommends $7,000 as minimum
salary for RN, 14 (Jun)
EDUCATION
Board approves nursing education motions,
10 (Mar)
CEGEP system explained at ANPQ general
meeting, 9 (Jan)
CHA to study nursing education, 10 (Jul)
Charge made for study tours to UK, 21
(Apr)
Correlates of approval and disapproval re-
ceived by students at selected schools of
nursing, (Hayward), (abst), 52 (Sep)
Commuting students study en route, 12
(May)
Community college in Ontario to start
nursing program 14 (Mar)
Community colleges and nursing education
in Ontario, (Quittenton), (abst). 46 (Jan)
Curriculum conferences held in Vancouver
and Victoria, 13 (Mar)
A dollar, a dollar, follow the scholar,
(Lindabury). 37 (Mar)
VII
Effectiveness of clinical instructors as per-
ceived by nursing students, (Joseph),
(abst), 44 (Dec)
An exploratory study of the professienal-
ization of Registered Nurses in Ontario . . .
(Kergin), (abst),52 (Sep)
First nurses graduate from Memorial Univer-
sity, 8 (Jul)
Inservice for teachers, too? (Post), 29 (Sep)
Laval University accepts a challenge,
(Brunei, Gagnon), 44 (Aug)
McGill to offer master of nursing program,
1 1 (Oct)
Message from the executive director,
(Mussallem), 3 (May)
Montreal to close English language hospital
schools of nursing, 8 (Jul)
More nursing schools move within frame-
work . . . education, 9 (May)
NB nurses discuss trends in diploma pro-
grams, 16 (Dec)
NBARN sponsors inservice education work-
shop, 15 (Apr)
Nurses and educational change, (Kergin), 28
(Dec)
Nurses discuss future of nursing education,
10 (May)
Nursing home administration course starts
in Ontario, 14 (Dec)
On the delegation of responsibility, (Nance),
29 (Nov)
RN internship program starts at Chicago U.,
16 (Dec)
RNANS considers principles of curriculum
building, 8 (jul)
Ryerson Institute offers short courses for
RNA, 20 (Nov)
Senior civil servant misquoted in newspaper,
14 (Dec)
Several reasons for drop in enrollment says
RNANS, 9 (Feb)
Student enrollment increases in Nova
Scotia, 20 (Nov)
A study of the needs of graduates from two
year diploma nursing programmes in Cana-
da, (MacLeod), (GiU), (abst), 44 (Dec)
Summer workshop for nurse-teachers, 15
(Sep)
Student observation at postmortem exami-
nations, (Lindabury), 57 (Feb)
A study of the attitudes of nurse faculty
members in a selected Canadian province
. . .(Richard), (abst), 53 (May)
Too little, for too long, from federal govern-
ment, (Good), 29 (May)
Trends reversing in nursing education, 13
(Sep)
Two-year program discussed at RNANS
annual meeting, 19 (Aug)
Two-year versus three-year programs,
(Costello, Castonguay), 62 (Feb)
U of T school of nursing celebrates 50th
anniversary, 13 (Dec)
UBC celebrates golden jubilee, 8 (Mar)
University nurses present brief to Caston-
guay Commission, 12 (May)
EDUCATION, CONTINUING
Aging and learning, (Angus), 41 (Nov)
Board approves revised continuing educa-
tion statement, 8 (Mar)
VIII
Extension courses continue to be popular,
14 (May)
The prediction of college level academic
achievement in adult extension students,
(abst), (Flaherty), 49 (Aug)
EDUCATIONAL MEASUREMENT
Two-year versus three-year programs (Cos-
tello, Castonguay), 62 (Feb)
EQUIPMENT
"Fasten seat belt, please", 16 (Jan)
A new design for stryker turning frame
covers, (Young), 45 (Jan)
EUTHENASIA
Royal College of nursing against voluntary
euthanasia, 15 (Jul)
EVANS, Helen
Bk.rev., 53 (Aug)
EVANS, MoUy
Bk. rev., 46 (Apr)
FACULTY
A study of the attitudes of nurse faculty
members in a selected Canadian province
. . . (Richard), (abst), 53 (May)
FAIRLEY, Grace M.
Deceased, 18 (May)
FAULKNER, Carole J. Aalto
Lecturer, school of nursing, Lakehead Uni-
versity, (port), 20 (May)
FEES
NBARN holds meeting to vote on fee
increase, 20 (Nov)
1969 feeSaredue, 16 (Mar)
FELICITAS, Mary, Sister
Gold chain honors nurses, 7 (Jul)
Whoo-Fur pinned down at last, 9 (Jun)
FELIX, M. A.
Bk. rev., 58 (Sep)
FENWICK, Ethel Gordon
The growth and development of a profes-
sion by Daisy C. Bridge, (port), 32 (Jun)
FERRARI, H.E
Home for Christmas, 25 (Dec)
FILMS
See Audio-visual Aids
FILM REVIEWS
52 (Jan), 39 (Jul), 53 (Nov), (Dec)
FLAHERTY, M. Josephine
Bkrev., 51 (Jan),68 (Feb)
Granted the degree of Doctor of Philoso-
phy, 17 (Mar)
The prediction of college level academic
achievement in adult extension students,
(abst), 49 (Aug)
President-elect RNAO, (port), 20 (Jun)
FLEMING, Florence M.
Retired December 31, 1968, 21 (Feb)
FLEURY, Agnes
Director of nursing service, Manitoba Re-
habilitation Hospital, (port), 20 (Dec)
FOURNIER, Valerie
Bk.rev., 65 (Feb)
Do your own thing in Montreal. (Lcgault)
31 (May)
FORREST, Jean W.
Appointed assistant professor of the School
of Nursing, The University of Western
Ontario, (port), 22 (Jun)
FRANCIS, M.
Bk. rev., 52 (Nov)
FRIESEN, Gordon
"Design, Then Build," renowned consultant
tells CHA, 18 (Aug)
FRYE, C
The nurse is a specialist in the artificial
kidney unit, 33 (Dec)
GAGNON, Claire
Laval University accepts a challenge, (Bru-
nei), 44 (Aug)
GAGNON, Madeleine
Medical illustration - an art and a science,
42 (Jun)
GARDNER, Robin
Bk. rev., 56 (Sep)
GERIATRICS
Aging and learning, (Agnus), 41 (Nov)
A guide for the public health nurse to assist
elderly patients . . . (Wilson), (abst), 50
(Sep)
GIRARD, Alice
ICN president receives order of Canada, 19
(Jan)
GILL, Catherine, Sister
A study of the needs of graduates from two
year diploma nursing programmes in Cana-
da, (abs), 44 (Dec)
GITTINS, Laveena Anne
Coordinator, school of diploma nursing
SIAAS, (port), 24 (Feb)
GLASS, Helen P.
Awarded the Dr. Katherine E. MacLaggan
Fellowship, 9 (Sep)
GODARD, Jean
Bk.rev., 57 (Sep)
GOLDBERG, B. June
Bk. rev., 51 (Oct)
GOOD, Shirley R.
Appointed the first director of school of
nursing at the University of Calgary, 17
(Sep)
CCUSN Atlantic region assesses need for
master's program, 10 (Jun)
CNA asks government for a million dollars^
more, 12 (Apr)
Too little, for too long, from federal govern-
ment, 29 (May)
GORDON, Ethel M.
Retired, (port), 23 (Apr)
GORRILL.GIennaM.
Joins leaching statT of Red Deer Junior
College, (port). 18 (Jan)
GRACE GENERAL HOSPITAL. ST. JOHN'S
"Miles lor books" answer to shortage, 12
(Oct)
GRAHAM. Loral
Countdown to congress, 26 (Jan)
Resigns as assistant editor, (port). 17 (Mar)
GRANT. Dorothy Metic
Lady Mary Wortley Montagu - eighteenth
century crusader, 34 (Jul)
GRANT. Kathryn
The Countess Mountbatten Bursary for
students, 11 (Oct)
GRIBBEN. Anne
Director of employment relations for the
RNAO. (port), 18 (May)
GUNN.Jean
The growth and development of a profes-
sion by Daisy C. Bridges, (port), 32 (Jun)
GUPTA. Anna
Bk. rev., 54 (May)
H
HACKER, Carlotta L.
The bluebirds who went over, 31 (Nov)
A new category of health worker for Cana-
da? 38 (Jan)
Private duty - private choice, 25 (Jul)
HACON, W. S
Senior civil servant misquoted in new^aper,
14 (Dec)
HARRIS, K. Anne
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
HARRY, Jean S.
Honorary member SRNA, 22 (Aug)
HAYWARD, Margaret
Correlates of approval and disapproval re-
ceived by students at selected schools of
nursing, (abst), 52 (Sep)
HAZLEWOOD. Barbara
Bk. rev., 54 (Sep)
HEALTH
Housing affects health, 16 (Jan)
HEALTH MANPOWER
Health care fragmented labor leader tells
assembly, 1 1 (Nov)
Health manpower conference to be held in
Ottawa, 9 (Sep)
A new category of health worker for Cana-
da? (Hacker), 38 (Jan)
Physicians' assistant, (Lindabury), (editori-
al), 3 (Jan)
HEART
Advances in surgery for coronary artery
disease, (Trimble). 32 (Jan)
Medicolegal problems can arise in the coro-
nary care unit. (Crotin), 37 (Apr)
Nursing the patient after heart surgery,
(Wass), 35 (Jan)
The value of revascularization surgery,
(Vineberg), 28 (Jan)
HELLENIC NURSES' ASSOCIATION
Greek gift to CNA, 10 (Sep)
HEMMING. Isabel
The Countess Mountbatten Bursary for
students. 1 1 (Oct)
HEMODIALYSIS
Hemodialysis in the home, (Wood), 42
(Apr)
The nurse is a specialist in the artificial
kidney unit, (Frye), 33 (Dec)
HENDERSON. Virginia
Library display at ICN congress, 10 (Jun)
HERD. Agnes
Bk. rev., 48 (Apr)
HICKNELL. Marjorie
Assistant director of nursing, Oshawa Gene-
ral Hospital, Ontario, (port), 18 (Jan)
HILL. E.J. M.
The minis have it, 44 (Nov)
HOME CARE
Visiting homemaker services in short supply,
19 (Aug)
HORN, Ethel
Study tour in England and Scotland, 22
(Jun)
HORTON, Carol
Margaret Sinn Fund bursary, 21 (Nov)
HOSPITAL FOR SICK CHILDREN, TORONTO
Collecting urine specimens from children,
(Pask), 35(Oct)
HOSPITAL NURSING SERVICE
see Nursing service
HOSPITALS
Mind your own business, (Dutrisac), 46
(Aug)
New services help patients and staff,
(Beaudry-Johnson), 39 (Mar)
HOSPITALS - ADMINISTRATION
Hospital personnel relations bureau set up,
18 (Apr)
Nurses for nursing (Pahner), 36 (May)
Staff-line conflict in hospitals, (Delahanty),
35 (Nov)
Work progressing for standardized termi-
nology, 16 (Feb)
HOSPITALS - PLANNING
AND CONSTRUCTION
"Design, Then Build" renowned consultant
tells CHA, 18 (Aug)
Hospital design is a nursing affair, (Wylie),
42 (Oct)
How to prolong a ho^ital's lifespan,
(Zeidler), 39 (Oct)
HOWARD, Frances M.
Bk. rev., 70 (Feb), 54 (May), 51 (Oct)
CNF award, 9 (Sep)
Left staff of the Canadian Nurses' Associa-
tion, (port), 17 (Sep)
Recipient of the Margaret MacLaren bursa-
ry, 1 1 (Oct)
Team work: the way to play the game, 29
(Aug)
HUFFMAN, Verna
Nurse included in Canadian delegation to
WHO assembly, 13 (Nov)
HUMAN RELATIONS
An approach to the phases of niu'se-patient
relationships (Wallington), (abst), 50 (Sep)
Effects of interpersonal difference, social
distance, and social environment on the
relationship between professionals and
their clientele, (MacKay), (abst), 45 (Dec)
An exploratory study of the relationship
between physical and social-psychological
distance and nurse-patient verbal inter-
action, (Tissington), (abst), 44 (Dec)
Helping the patient face reality, (Arnold),
41 (Sep)
The nurse and the sociopathic personality,
(Marcus), 49 (Oct)
HUNTER, Brenda
The Countess Mountbatten Bursary for
students, 1 1 (Oct)
HUNTER, Theresa
The Countess Mountbatten Bursary for
students, 1 1 (Oct)
HURLEY. Elizabeth F., Sister
Director, nursing service, St. Vincent's Hos-
pital, Vancouver, 21 (Feb), port, 22 (Oct)
HUSTON, M. J.
Bk. rev., 37 (Jul)
HYPERBARIC OXYGEN
Hyperbaric oxygen units - high pressure
nursing, (ZUm), 37 (Feb)
HYLTON, Lynsia
Bk. rev., 59 (May)
IDEA EXCHANGE
44 (Jan), 46 (Sep)
IGNACIO, Corazon
Inservice education coordinator, St. Eliza-
beth Hospital in North Sydney, N.S., 23
(Apr)
IMAI, Hisako Rose
CNF award, 9 (Sep)
IMMUNIZATION
First licence granted for Rubella vaccine, 20
(Aug)
Lady Mary Wortley Montagu - eighteenth
century crusader, (Grant), 34 (Jul)
IN A CAPSULE
24 (Jan), 30 (Feb), 22 (Mar), 30 (Apr), 25
(May), 28 (Jun), 19 (Jul), 26 (Aug), 26
(Sep), 26 (Oct), 26 (Nov), 23 (Dec)
INDEXES
see Abstracting and indexing
INDIANS AND ESKIMOS
Health care for remote-area Indians, 1 1 (Jul)
INFECTION CONTROL
Infections in the hospital, (Pequegnat), 27
(Mar)
IX
INFECTIONS
Insulin injection - a new technique, (St.
James), 32 (Jul)
INSERVICE EDUCATION
see Education
INTENSIVE CARE UNITS
Medicolegal problems can arise in the coro-
nary care unit, (Crotin), 37 (Apr)
INTERNATIONAL COUNCIL OF NURSES
Election results, 19 (Aug)
The growth and development of a profes-
sion, (Bridges), 32 (Jun)
Meet the ICN staff, 10 (Jun)
New ICN executive, 21 (Aug)
President receives Order of Canada, 19 (Jan)
3M donates fellowship, 10 (Aug)
INTERNATIONAL COUNCIL OF NURSES.
CONGRESS 1%9
ANPQ donates $50,000 to ICN congress, 1 2
(Mar)
Alberta and British Columbia announce
contributions to ICN, 13 (Mar)
Continuity of patient care discussed by ICN
panelists, 14 (Aug)
Countdown to congress, (Graham), 26 (Jan)
Daily registration fee for ICN congress
reduced, 8 (Apr)
Do your own thing in Montreal, (Foumier,
Legault), 3 1 (May)
ICN Congress breaks all registration records,
7 (Aug)
ICN Congress registration continues to lag,
12 (Jan)
ICN Congress report, 30 (Aug)
ICN election results, 19 (Aug)
ICN interest session debates role of re-
habilitation nurse, 1 7 (Aug)
ICN interest session speakers examine nurs-
ing legislation, 16 (Aug)
ICN nominations announced, 18 (Apr)
ICN receives $8,000 from AARN, 9 (Jun)
ICN registration triples, 13 (Mar)
International forum in Montreal, (Quinn),
(editorial), 3 1 (Jun)
Internationally-known nurses debate prac-
tice of nursing at ICN interest session, 14
(Aug)
Lester Pearson cancels ICN commitment, 9
(May)
Library display at ICN congress, 10 (Jun)
Library issues discussed by ICN paneUsts, 14
(Aug)
Minister announces national nurse week, 15
(Jun)
Montreal as I see it . . ., 35 (May)
Newfoundland donates $1,840 to CNA for
ICN costs, 9 (May)
Nurses' Christian Fellowship at ICN, 16
9 (May)
Nurses reluctant to write ICN delegates told,
18 (Aug)
Parlez-vous fran9ais? Espanol? Deutsche? ,
25 (May)
Provincial associations help with ICN con-
gress, 14 (Apr)
RNABC contributions to ICN reach $8,400,
(May)
RNABC donates $5,000 to CNA for ICN
costs, 14 (Jan)
RNAO plans programs for ICN visitors, 14
(Apr)
Registration picks up as cut off date nears, 9
(Feb)
Some thoroughly modem millies, 10 (May)
Special sessions for ICN congress registrants,
13 (Mar)
Students want voice at ICN begin to speak
out on issues, 7 (Aug)
Too much treatment a danger warns ICN
psychiatry panelist, 16 (Aug)
Two students selected to attend ICN Con-
gress, 15 (Apr)
UR a PR for ICN, says PRO, 9 (Feb)
Well-known speakers to address ICN, 7 (Jan)
White Sister donates $30,000 scholarship,
10 (Aug)
Whoo-Fur pinned down at last, 9 (Jun)
Whoo-fur-lCN's furry mascot, 9 (May)
IRENE, Mary, Sister
Bk. rev., 65 (Feb)
IRWIN, Margaret E. V.
Librarian, Victoria Hospital School of Nurs-
ing, (port), 18 (Jan)
JACKSON, Robert
Bk. rev., 49 (Jun)
JAMIESON, Janie E.
Keep the private duty directories running,
45 (Jan)
JENNY, Jean
Bk. rev., 54 (May)
JONES, PhylUs E.
Bk rev., 49 (Jan)
Family health service: the PHN and the GP,
(Bondy), 38 (Sep)
JOHNSON, Mary Elizabeth
Assistant professor, school of nursing.
Queen's University, 20 (May)
JOSEPH, Mary
Effectiveness of clinical instructors as per-
ceived by nursing students, (abst), 44
(Dec)
KAMP, Dorothy
Director of nursing service, General Hospital
in Windsor, (port), 18 (Sep)
KEELER, Hazel B.
Retiring as director of the school of nursing,
U. of Saskatchewan, (port), 22 (Aug)
KERGIN, Dorothy J.
A dollar a dollar follow the scholar, 37
(Mar)
An exploratory study of the professionaliza-
tion of Registered Nurses in Ontario and
the implications for the support of change
in basic nursing educational programs,
(abst) 52 (Sep)
KERGIN, D
Nurses and educational change, 28 (Dec)
Nursing assistants are here to stay, 33 (Apr)
KERNEN, H.
Bk rev., 52 (Jan)
KERR, Jean
Gift to CNA Archives, 9 (Jan)
KERR, Marion Estelle
Recipient of the Margaret MacLaren Bursa-
ry, 1 1 (Oct)
KEYES, Mary Elizabeth
Honorary member SRNA, 22 (Aug)
KIDNEYS
Conference held for dialysis nurses, 15
(Dec)
Hemodialysis in the home, (Wood), 42
(Apr)
KIKUCHI, June Fumiko
CNF award, 9 (Sep)
KIRKLAND, Lois
Bk. rev., 57 (May)
KLIEWER, Pauline Annette
Guilt: an operationally defined concept,
(abst), 50 (Sep)
KLINGMAN, Joyce M.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
KOTASKA, Janelyn G.
Bk. rev., 51 (Oct)
KOTLARSKY, Carol
Became editorial assistant, (port), 17 (Mar)
KOWALCHUK, B.
Making a comeback, 29 (Oct)
KUTSCHKE, Myrtle A.
Bk rev., 49 (Jan)
LABOR UNIONS
Management nurses organize in New Bruns-
wick, 17 (Oct)
Nurse educators go on strike, 7 (Apr)
UNM elects new officers, 14 (Feb)
See also Collective bargaining
LACROIX, Eljane
Montreal as I see it . . ., 35 (May)
LANDON, Annetta L.
Retired, (port), 22 (Apr)
LANE, Marlene A.
The relationship between the physical ad-
justment of children to diabetes . . .,
(abst), 46 (Jan)
_LAVAL UNIVERSITY
Laval University accepts a challenge, (Bru-
net, Gagnon), 44 (Aug)
LAWFORD, Valda
Bk. rev., 54 (May)
LAWLEY, Kathleen
RNABC bursary, 21 (Nov)
LAYCOCK, S. R.
Bk. rev., 4 1 (Mar)
LEASK, Janice
The Countess Mountbatten Bursary for stu-
dents, 1 1 (Oct)
LEASK, Jean C.
Recipient of the R.D. Defries Award, (port),
16 (Jul)
LECKIE, Nessa
Director of nursing Douglas Hospital, Ver-
dun, (port), 22 (Oct)
LEE, Margaret N.
Bk. rev.. 52 (Jan)
LEGAULT, Agathe
Do your own thing in Montreal, (Foumier),
31 (May)
LEGISLATION
AARN holds district ralhes to study bill
119, 15 (Nov)
Fear of malpractice suits reaches Canadian
nurses, 1 2 (Jul)
"Good Samaritan" act passed by Alberta
legislature, 15 (Oct)
ICN interest session speakers examine nurs-
ing legislation, 16 (Aug)
A look at ana's legislative program, (Linda-
bury), 22 (July)
Medicolegal problems can arise in the coro-
nary care unit, (Crotin), 37 (Apr)
Mind your own business, (Dutrisac), 46
(Aug)
Professional liability insurance available to
ANPQ members, 12 (Apr)
■'Write it down" OHA panel suggests, 13
ff)ec)
LETTERS
4 (Jan), 4 (Feb), 4 (Mar), 4 (Apr), 4 (May),
4 (Jun), 4 (Jul), 4 (Aug), 4 (Sep), 4 (Oct),
4 (Nov), 4 (Dec)
LEUKEMIA
The child with leukemia, (Cragg), 30 (Oct)
LEVESQUE, Virginia D.
Appointed director of nursing at Oromocto
Public Hospital, (port), 18 (Sep)
LEWIS, Heather
Recipient of the Margaret MacLaren Bursa-
ry, 1 1 (Oct)
UBRARIES
Library issues discussed by ICN panelists, 14
(Aug)
Library display at ICN congress, 10 (Jun)
"Miles for books" answer to shortage, 12
(Oct)
Resources and use of CNA library, (Parkin),
32 (Mar)
LICENSURE
Needed: a full-time lobbyist, (Lindabury),
(editorial), 21 (Jul)
LIGUORI, M. Sister
A "two-way street, 30 (Mar)
LINDABURY, Virginia A.
C)anadian Nurses' Foundation, (editorial), 3
(Mar)
A dollar, a dollar, follow the scholar, 37
(Mar)
International Council of Nurses. Congress
1969, (editorial), 3 (Aug)
Lobbying, (editorial), 3 (Jul)
A look at ana's legislative program 22 (Jul)
Needed: a full-time lobbyist, (editorial), 21
(Jul)
Physicians' assistant, (editorial), 3 (Jan)
Poison ivy, (editorial), 3 (Sep)
Postal rates, (editorial), 3 (Feb)
Strike of 18 nurse educators, (editorial), 3
(Apr)
Student observation at postmortem exami-
nations, 57 (Feb)
Your image (editorial), 3 (Oct)
LOBBYING
Lobbying, (Lindabury), (editorial), 3 (Jul)
A look at ANA's legislative program, (Linda-
bury), 22 (Jul)
Needed: a full-time lobbyist, (Lindabury),
(editorial), 22 (Jul)
LOGAN, M. Kathleen
Assistant director of nursing, St. Vincent's
Hospital, Vancouver, 21 (Feb)
LONERGAN, Margaret M.
Nursing consultant. .Mental Health Branch,
B.C. Department of Health Services,
(port), 18 (May)
LOSSING, E. H.
Retires, 22 (Oct)
LUBIN, Bernard
Bk. rev., 65 (Feb)
LUSSIER, Rita J. M.
CNF award, 9 (Sep)
LYSS, Liny E.
Assistant professor, school of musing. Lake-
head University, (port), 20 (May)
M
MACAULAY, Mary
Bk. rev., 52 (Aug)
MacDONALD, E. M
Parents participate in care of the hospitaliz-
ed chUd, 37 (Dec)
MACDONALD, Marcella
Bk. rev.,41 (Mar)
MACDONALD, Sandra Arleigh Shanks
Lecturer, U. of Alberta, (port), 22 (Feb)
McELROY, PhyUis E.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
McEWAN, Elaine Audrey
Lecturer, school of nursing, Univ. of New
Brunswick, (port), 22 (Apr)
Women's feelings about the figure change in
pregnancy, (abst), 53 (May)
McGILL UNIVERSITY
McGill student nurses contribute to CNF,
18 (Aug)
McGill to offer master of nursing program,
1 1 (Oct)
McGill University project in Baffln Zone, 16
(Dec)
McKILLOP, Madge
President of the Saskatchewan Registered
Nurses' Association, (port), 18 (Dec)
McILRATH, Ruth E.
Director of nursing, Shaughnessey Veterans
Hospital, Vancouver, (port), 21 (Feb)
McIVER, Sheila
Good Citizenship award in Victoria, B.C.,
18 (Sep)
McIVER, Vera
Communal dining, 45 (Apr)
MACK, Hope
RNANS Honorary membership, 22 (Aug)
MacKAY, Ruth C
Effects of interpersonal difference, social
distance, and social environment on the
relationship between professionals and
their clientele, (abst), 45 (Dec)
MACKENZIE, Florence I.
A study of the relationship between the
information about the patient as a per-
son . . ., (MacKenzie), (abst), 47 (Jan)
MACKIE. Jean E.
Director, Algoma Regional School of Nurs-
ing, Sault Ste. Marie, (port), 24 (Feb)
MACKINNON, Alice R.
Professor, U. of Alberta, (port), 22 (Feb)
McLEAN, Margaret
Three nurses appointed to federal task
forces, 8 (Apr)
MacLEAN, Margaret A.
Cytology screening - a program that
works, 40 (May)
MacLENNAN, E. A. Electa
RNANS, Honorary membership, 22 (Aug)
MacLEOD, Ella
A study of the needs of graduates from two
year diploma nursing programmes in Cana-
da, (abst), 44 (Dec)
McMASTER UNIVERSITY.
SCHOOL OF NURSING
McMaster student nurses request financial
aid, 19 (Aug)
MacMILLAN, Irene
Bk. rev., 52 (Aug)
MacLEOD. Thelma
Bk. rev., 48 (Apr)
McSHEFFERY, Mary
Muriel Archibald Scholarship, 21 (Nov)
McWILLIAM, Carol Lynn
Bk. rev., 46 (Apr)
Clinical instructor. New Brunswick, 22
(Feb)
MADELEINE, Sister
Bk. rev., 66 (Feb)
MALLETT, Frederick S.
And now your income tax . . ., 34 (Apr)
MANITOBA ASSOCIATION OF
REGISTERED NURSES
Announced three appointments to its pro-
fessional staff, 20 (Dec)
XI
Association's aims too remote says MARN
president, 8 (Aug)
Co-sponsors program for inactive nunes, 16
(Jan)
MARN awards bursaries, 16 (Dec)
Official opening of MARN headquarters. 10
(Mar)
Surveys staffing patterns, 1 2 (May)
MANNARD, Lynne
The Countess Mountbatten Bursary for
students, 1 1 (Oct)
MARCUS, Anthony M.
The nurse and the sociopathic personality,
49 (Oct)
MARITIME UNION STUDY
CCUSN (A) submits brief to Maritime union
study, 15 (Oct)
NBARN submits brief on Maritime union,
15 (Dec)
MARY IRENE, Sister
Bk. rev., 58 (Sep)
MARY OF CALVARY, Sister
Bk. rev., 66 (Feb)
MATERNAL HEALTH AND WELFARE
A descriptive study of the behavior mothers
exhibit, in response to each other . . .
(Saunders), (abst), 50 (Sep)
Safe care for mother and baby, (Dicker), 31
(Dec)
MATTHEWS, C. J.
Quality of care makes the difference, 50
(Nov)
MEASLES
First licence granted for Rubella vaccine, 20
(Aug)
MEDICAL ILLUSTRATION
Medical illustration - an art and a science,
(Gagnon), 42 (Jun)
Medical photography - a century of prog-
ress, (Doyon), 40 (Jun)
MELNYK, Emily
Epidermolysis bullosa, 33 (Feb)
MEMORIAL UNIVERSITY
First nurses graduate from Memorial Univer-
sity, 8 (Jul)
MEN NURSES
Quebec male nurses seek legal recognition,
19 (Apr)
MENTAL HEALTH
CMHA approves volunteer services for
emotionally disturbed children, 8 (Jul)
MENZIES, D. W.
Bk. rev., 70 (Feb)
MERTZ, Hilda
Appointed to the faculty. University of
Toronto School of Nursing, 18 (Jan)
MILITARY NURSING
The bluebirds who went over, (Hacker), 31
(Nov)
Nurses hold memorial service, 12 (Jan)
Nursing sister receives OBE, 1 7 (Mar)
XII
MILLER, Donna C.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
MILLER, Kathleen R.
CNF award, 9 (Sep)
MILLER, T. M
Public relations officer of MARN, (port), 20
(Dec)
MINKUS, Judy
Recipient of the Margaret MacLaren Bursa-
ry, 1 1 (Oct)
MINER, Louise
Three nurses appointed to federal task
forces, 8 (Apr)
MITCHELL, Beverly
Appointed to the faculty, University of
Toronto School of Nursing, 18 (Jan)
MITCHELL, Eleanor
Asistant, editor. The Canadian Nurse,
(port), 22 (Apr)
MITCHELL, Elizabeth H.
Honorary member SRNA, 22 (Aug)
MONTGOMERY, MicheUne
Bk. rev., 51 (Nov)
MONTREAL GENERAL HOSPITAL
Gift to CNA Archives, 9 (Jan)
MOORE, Edna L.
Obituary, 22 (Apr)
MOSS, Frances May
Executive secretary, (port), 24 (Feb)
MOTIUK, Margaret A.
Appointed assistant director of nursing,
Rockyview Hospital, Calgary, (port), 20
(Jun)
MOTTA, Grace
Retires, 18 (Sep)
MOVER, Patricia A.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
MRAZEK, Margaret L.
CNF award, 9 (Sep)
MUMBY, Dorothy M.
Bk. rev., 49 (Jun)
MUNRO, John
A challenge that confronts us, 40 (Aug)
MURRAY, Audrey
Director of nursing service, St. Paul's Hospi-
tal, Vancouver, (port), 20 (Jun)
MURAKAMI, T.Rose
CNF award, 9 (Sep)
MURPHY, Frances
Lecturer, U. of Alberta, (port), 22 (Feb)
MUSSALLEM, Helen K.
CNA executive director honored, 10 (Dec)
Canadian elected chairman of PAHO nursing
committee, 7 (Jan)
Message from the executive director, 3
(May)
Press conference at CNA House, (port), 16
(Jul)
MYLES, Margaret F.
Honorary member SRNA, 22 (Aug)
N
NAEGELE, Kaspar
Naegele fund trustees report on progress of
children, 20 (Apr)
NAGANO, Sada
Nursing in Japan, 35 (Jun)
NAMES
18 (Jan), 21 (Feb), 17 (Mar), 22 (Apr), 18
(May), 20 (Jun), 16 (Jul), 21 (Aug), 17
(Sep), 22 (Oct), 18 (Dec)
NANCE, J. Leith
Lecturer, University of Alberta, (port), 22
(Feb)
On the delegation of responsibiUty, 29
(Nov)
NAPKE, E
Drug adverse reaction program - and the
nurse's role, 40 (Dec)
NATIONAL LEAGUE FOR NURSING
Conference to consider health in communi-
ty, 15 (Apr)
Margaret E. Walsh, general director, 22
(Oct)
NATIONAL MANPOWER CONFERENCES
Health care fragmented labor leader tells
assembly, 1 1 (Nov)
NATIONAL NURSE WEEK
Minister announces national nurse week, 15
(Jun)
NERA, N.
Bk. rev., 54 (Sep)
NEUFELD, A. H.
Qinical laboratory procedures, (Watson), 41
(Feb)
NEUROLOGY
Canadian Neuro Nurses form association, 13
(Sep)
NEVITT, Joyce
Bk. rev., 47 (Dec)
NEW BRUNSWICK ASSOCIATION
OF REGISTERED NURSES
Achieves record high membership, 15 (Dec)
Awards scholarships, 21 (Nov)
Employment relations officer, Glenna
Rowsell, (port), 21 (Aug)
Holds meeting to vote on fee increase, 2
(Nov)
Hospital nurses in NB submit mass resigna-
tion, 8 (Aug)
New Brunswick nurses sign new contract, 14
(Dec)
New Brunswick nurses withdraw resigna-
tions, 10 (Sep)
Nurses negotiations with NBHA deadlocked,
8 (Jul)
Organizes for collective bargaining, 13 (Jan)
Presidents' conference, 14 (Mai)
NEW BRUNSWICK ASSOCIATION
OF REGISTERED NURSES
Submits brief on Maritime union, 15 (Dec)
Two nurses honored, 22 (Aug)
NEW PRODUCTS
22 (Jan), 27 (Feb), 28 (Apr), 24 (May), 26
(Jun), 17 (Jul), 24 (Aug), 22 (Sep), 24
(Nov), 22 (Dec)
NEWS
7 (Jan), 7 (Feb), 7 (Mar), 7 (Apr), 9 (May),
9 (Jun), 7 (Jul), 7 (Aug), 9 (Sep), 11
(Oct), 1 1 (Nov), 9 (Dec)
NIGHT NURSING
RNABC urges protection for nurses, 19
(Nov)
NIGHTINGALE, Helen T.
Bk. rev., 58 (May)
NORMA, Dick
Appointed to the faculty, University of
Toronto School of Nursing, 18 (Jan)
NORMANDIN, Alberta
Honorary member SRNA, 22 (Aug)
NURSES, INTERCHANGE OF
Charge made for study tours to UK, 21
(Apr)
NURSING
ANPQ committees discuss uniform nursing
techniques, 13 (Jan)
ANPQ to study nursing profession in Que-
bec, 10 (Sep)
CNA executive director predicts change in
science of nursing, not in art of nursing,
12 (Dec)
A challenge that confronts us, (Munro), 40
(Aug)
Qinical nursing statement revised by CNA
board, 1 1 (Dec)
An exploratory study of the professionaliza-
tion of Registered Nurses in Ontario and
the implications for the support of change
in basic nursing educational programs,
(Kergin), (abst), 52 (Sep)
The growth and development of a profes-
sion, (Bridges), 32 (Jun)
Internationally-known nurses debate prac-
tice of nursing at ICN interest session, 14
(Aug)
Nurses are not neurotic, (Cohen), 45 (Jun)
NURSING - FOREIGN COUNTRIES
New Zealand nurse visits CNA, 18 (May)
Nursing in Colombia, (Restrepo, Garzon),
37 (Jun)
Nursing in Japan, (Nagano), 35 (Jun)
Peruvian adventure, (Daveluy), 36 (Sep)
NURSING CARE
A challenge that confronts us, (Munro),
40 (Aug)
Continuity of patient care discussed by ICN
panelists, 14 (Aug)
Nursing the patient after heart surgery,
(Wass), 35 (Jan)
Team work: the way to play the game,
(Howard), 29 (Aug)
Relationship between attitude and person-
centeredness of nursing care, (Perry),
(abst), 44 (Dec)
The relationship between continuity of
nurse-patient assignment and the patient's
knowledge of self-care, (Purushotham),
(abst), 52 (May)
A study of the relationship between the
information about the patient as' a
person . . . (MacKenzie), (abst), 47 (Jan)
A study to determine - is the nurse in a
double-bind when caring for patients on
isolation care? (Peterson), (abst), 46 (Jan)
Unit assignment - a new concept,
(Sjoberg), 29 (Jul)
NURSING HOMES
Communal dining, (Mclver), 45 (Apr)
Nursing home administration course starts
in Ontario, 14 (Dec)
NURSING EDUCATION
See Education
NURSING MANPOWER
ANA releases current RN data, 16 (Dec)
MARN co-sponsors program for inactive
nurses, 16 (Jan)
see also Health manpower
NURSING SERVICE
Ad Hoc committee completes draft for
standards for nursing service, 7 (Jul)
Criteria used by employers when selecting
nursing staff in varying sized hospitals,
(Trout), (abst), 52 (Sep)
Draft standards to be tested, 10 (Mar)
Guide on nursing service standards to be
published by CNA, 1 1 (Dec)
Nurses for nursing, (Palmer), 36 (May)
Nursing organization - circa 1969, (Ste-
wart), 59 (Feb)
Nursing supervisors' perception of their
functions and activities, (Crotin), (abst),
48 (Jun)
Student nurses debate role of the supervisor,
18 (Jun)
A study to determine the influence of
selected factors in choosing a head nurse's
position, (Proulx), (abst), 48 (Jun)
A study to determine who, in the opinion of
nurses and physicians, should be responsi-
ble for teaching the hospitalized patient,
(Shantz), (abst), 52 (May)
A study to explore the relationship between
absence events . . ., (Wilson), (abst), 46
(Jan)
"Too many supervisors" RNABC meeting
told, 10 (Jul)
NURSING TEAM
Pembroke hospital sponsors team nursing
workshop, 14 (Jan)
Team nursing workshops held in Alberta, 10
(Jun)
Team work: the way to play the game,
(Howard), 29 (Aug)
OBERHOLTZER, Rene
Lecturer, U. of Alberta, (port), 22 (Feb)
O'BRIEN. Beverly
RNABC bursary, 21 (Nov)
O'BRIEN, Moira L.
Bk. rev., 54 (Sep)
OBSTETRICS
A descriptives study of the behavior
mothers exhibit . . ., (Saunders), (abst), 50
(Sep)
Father should dominate says Hamilton
doctor, 16 (Jan)
Quality of care makes the difference,
(Matthews), 50 (Nov)
Rooming-in brings family together,
(Coome), 47(Jun)
Safe care for mother and baby, (Dicker), 31
(Dec)
Women's feelings about the figure change in
pregnancy, (McEwan), (abst), 53 (May)
OCCUPATIONAL HEALTH
Sub-committee on occupational health
meets in London, 10 (Feb)
O'CONNOR, Helen
Bk. rev., 49 (Apr)
ONTARIO HOSPITAL ASSOCIATION
"Write it down" OHA panel suggests, 13
(Dec)
ONTARIO HOSPITAL SERVICE
COMMISSION
OHSC raises bonus rates for service person-
nel; teachers' bonuses remain same, 9
(Jan)
OPERATING ROOM
OR nurses discuss infection in hospitals, 10
(Feb)
OR technicians form association, 12 (Oct)
Operating room nurses meet, 1 7 (Dec)
ORDERLIES
Orderly training program to open in BC in
fall, 14 (Jul)
OTTAWA UNIVERSITY.
SCHOOL OF NURSING
Appointments, 18 (Sep)
Student nurses debate role of the supervisor,
18 (Jun)
PALMER, Helen
Nurses for nursing, 26 (May)
PAN AMERICAN HEALTH
ORGANIZATION
Canadian elected chairman of PAHO nursing
committee, 7 (Jan)
PANKRATZ, SteUa
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
PAPADOPOULLOS. Andreas
Recipient of the Margaret MacLaren Bursa-
ry, 11 (Oct)
PARKIN, Margaret L.
Resources and use of CNA library, 32 (Mar)
PASK, Eleanor G.
Collecting urine specimens from children,
35 (Oct)
PATIENTS
Helping the patient face reality, (Arnold),
41 (Sep)
XIII
It's depressing! (Costello), 43 (Sep)
Quality of care makes the difference,
(Matthews), 50 (Nov)
PATON, Nora
Director of personnel services, RNABC,
(port), 22 (Aug)
PECHIULIS, Diana D.
CNF award, 9 (Sep)
PEDIATRICS
Butterfuly with a broken wing, 20 (Apr)
The child with leukemia, (Cragg), 30 (Oct)
Collecting urine specimens from children,
(Pask), 35 (Oct)
Parents participate in care of the hospitaliz-
ed child, (MacDonald), 37 (Dec)
Quebec school children suffer from mal-
nutrition, 15 (Oct)
The relationship between the physical ad-
justment of children to diabetes . . . (Lane),
(abst), 46 (Jan)
Survey of follow-up of visual defects in
grade one school children in central Alber-
ta health units, (Smith), (abst), 49 (Aug)
Two-year-old Michael - ill and in hospital,
(Bumie), 46 (Nov)
PEEVER, Mary
Appointed chairman, department 6f nursing
education at Mount Royal Junior Colege,
(port), 18 (Jan)
PENSIONS
Old age pension to increase in 1970, 20
(Oct)
PEPLAU, Hildegard
Interim executive director appointed by
ANA, 19 (Aug)
PERIODICAL PRESS ASSOOATION
Answers editorial on postal rates, 13 (Dec)
PEQUEGNAT, Dorothy
Bk. rev., 66 (Feb)
Infections in the hospital, 27 (Mar)
PERRY, Sheila E.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
PERRY, Susan
Relationship between attitude and person-
centeredness of nursing care, (abst), 44
(Dec)
PESTELL, Derek
Bk. rev., 59 (May)
PESZAT, Lucille C.
Appointed coordinator of formal continuing
education programs, RNAO, (port), 17
(Sep)
PETERS, Blondina F.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
PETERSON, Alva L.
A study to determine - is the nurse in a
double-bind when caring for patients on
isolation care? (abst), 46 (Jan)
PETTIGREW, LiUian
CNA associate director to participate in
XIV
WHO conference in New Delhi, 11 (Oct)
Official opening of MARN headquarters,
(port), 10 (Mar)
PHARMACOLOGY
A "two-way" street, (M. Liguori), 30 (Mar)
PHILLIPS, A.J.
Smoking habits of Canadian nurses and
teachers, 40 (Apr)
PHYSICIANS' ASSISTANT
Editorial, (Lindabury), 3 (Jan)
A new category of health worker for Cana-
da? (Hacker), 38 (Jan)
PISHKER, Frances
Bk rev., 50 (Jan)
PITT, Shirley E.
Bk rev., 52 (Jan), 66 (Feb)
POOLE, PameU
Time out at the Canadian Hospital Associa-
tion convention, 10 (Jul)
POST, Shirley
Inservice for teachers, too? 29 (Sep)
POSTAL RATES
"Canadian Hospital" attacks new postal
rates, 16 (Sep)
POSTMORTEM EXAMINATIONS
Student observation at postmortem exami-
nations, (Lindabury), 57 (Feb)
PRACTICAL NURSING
Nursing assistants are here to stay, (Kergin),
33 (Apr)
PRINGLE, Dorothy M.
Bk. rev., 51 (Jun)
The use of a conceptual model to evaluate
psychiatric nursing therapy, Pringle (abst),
45 (Dec)
PRIVATE DUTY NURSES
Keep the private duty directories running,
(Jamieson), 45 (Jan)
Private duty - private choice, (Hacker), 25
(Jul)
PROULX, Yolande
A study to determine the influence of
selected factors in choosing a head nurse's
position, (abst), 48 (Jun)
PROSTHESES
The amputee and immediate prosthesis,
(Shewchuk), (Young), 47 (May)
PSYCHIATRIC NURSING
Come with me, Lori, (Warwick, Wilting), 48
(Sep)
The nurse and the sociopathic. personality,
(Marcus), 49 (Oct)
The use of a conceptual model to evaluate
psychiatric nursing therapy, (Pringle),
(abst), 45 (Dec)
PSYCHIATRY
Guilt: an operationally defined concept,
(Kliewer), (abst), 50 (Sep)
Psychodrams, (Burwell), 44 (May)
Summer camp holiday for Douglas Hospital
patients, 16 (Sep)
Too much treatment a danger warns ICN
psychiatry paneUst, 16 (Aug)
PSYCHOLOGY
It's depressing! (Costello), 43 (Sep)
PUBLIC HEALTH NURSING
A comparison of the perceptions of public
health nurses and their alcoholic pa-
tients . . . (Williams), (abst), 52 (May)
Family health service; the PHN and the GP,
(Jones, Bondy), 38 (Sep)
A guide for the public health nurse to assist
elderly patients in the achievement of
selected functional tasks at home, (Wil-
son),|Kabst), 50 (Sep)
PUBLIC RELATIONS
CNA sends suggestions to task force on
information, 10 (Feb)
(Theck your image - it's slipping! (Zilm),
45 (Oct)
Editorial, (Lindabury), 3 (Oct)
UR a PR for ICN, says PRO, 9 (Feb)
PURUSHOTHAM, Devamma
The relationship between continuity of
nurse-patient assignment and the patient's
knowledge of self-care, (abst), 52 (May)
QUEBEC COMMISSION ON
HEALTH AND WELFARE
University nurses present brief to Caston-
guay Commission, 12 (May)
QUEBEC SOCIETY FOR
CRIPPLED CHILDREN
Butterfly with a broken wing, 20 (Apr)
QUINN, Sheila
International forum in Montreal, (editorial),
3 1 (Jun)
QUITTENTON, R. C.
Community colleges and nursing education
in Ontario, (abst), 46 (Jan)
R
RAJCSANYI, Dorothy E.
Associate director of education, VON,
Greater Montreal branch, 22 (Jun)
REBAN, Catherine
Instructor, Mount Royal Junior College,
(port), 18 (Jan)
RECRUITMENT
Male student wins recruitment poster
contest, 14 (Jul)
RECTOR, Laurel
Employment relations officer of MARNj
(port), 20 (Dec)
RED CROSS
see Canadian Red Cross
REGINA GREY NUNS'
HOSPITAL
Two-year versus three-year programs
(Costello, Castonguay), 62 (Feb)
REFRESHER COURSES
Making a comeback, (Kowalchuk, 29 (Oct)
REGISTERED NURSES' ASSOCIATION
OF BRITISH COLUMBIA
Alberta and British Columbia announce
contributions to ICN, 13 (Mar)
Announces awards, 21 (Nov)
BC nurses begin two workshops, 16 (Jan)
Contributions to ICN reach $8,400, 9 (May)
Donates $5,000 to CNA for ICN costs, 14
(Jan)
Elects new officers, 7 (Jul)
Loans offered, 16 (May)
Mature students to be admitted to BC
schools of nursing, 16 (Jun)
"Too many supervisor" RNABC meeting
told, 10 (Jul)
Urges protection for nurses, 19 (Nov)
REGISTERED NURSES' ASSOCIATION
OF NOVA SCOTIA
Considers principles of curriculum building,
8 (Jul)
Executive secretary, Frances May Moss,
(port), 24 (Feb)
Honorary memberships, 22 (Aug)
Several reasons for drop in enrollment, says
RNANS, 9 (Feb)
Two-year programs discussed at RNANS
annual meeting, 19 (Aug)
REGISTERED NURSES'
ASSOCIATION OF ONTARIO
Delegates approve affiliate status, 12 (Jun)
Elects new officers, 20 (Jun)
Holds regional conferences on audiovisual
aids, 9 (Jan)
Honorary life membership for Gladys
Sharpe, 22 (Jun)
Nursing associations - are they coming or
going? (ZUm), 31 (Sep)
New director of employment relations, 18
(May)
Ontario supreme court to settle terms of
nurses' contract, 14 (Sep)
Plans programs for ICN visitors, 14 (Apr)
Possible change in RNAO bylaws, 13 (Jan)
Recommends $7,000 as minimum salary for
RN, 14 (Jun)
Students discuss pros and cons of own
provincial association, 12 (Jun)
REHABILITATION
The amputee and immediate prosthesis,
(Shewchuk, Young), 47 (May)
ICN interest session debates role of rehabili-
tation nurse, 17 (Aug)
R£ID, Helen Evans
Bk. rev., 50 (Jun)
REID, Winnifred M.
Director of nursing at Bumaby General
Hospital, (port), 20 (May)
REIGHLEY, Ronald S.
CNF award, 9 (Sep)
RESEARCH
CNA Library wants theses, 1 2 (Oct)
Index of Canadian nursing studies available,
16 (Jun)
RESEARCH ABSTRACTS
46 (Jan), 52 (May), 48 (Jun), 49 (Aug),
50 (Sep), 44 (Dec)
RESTREPO, Lucia A.
Nursing in Colombia, (Garzon), 37 (Jun)
RHEAULT, M. Claire
A comparison of students' achievement on a
sequential learning experience with other
measures of student" progress, (abst), 47
(Jan)
RICHARD, Hubert, Sister
A study of the attitudes of nurse faculty
members in a selected Canadian province
in relation to their educational functions,
(abst), 53 (May)
RICHMOND, Mary L.
Bk. rev., 46 (Apr)
RIEHL, Joyce
The Countess Mountbatten Bursary for
students, 1 1 (Oct)
RILEY, Marilyn S.
CNF award, 9 (Sep)
RIPPON, Maiion
An unlikely author, 20 (Aug)
RITCHIE, Judith A.
CNF award, 9 (Sep)
RIVARD, Virginia
Bk. rev., 52 (Nov)
ROWS ELL, Glenna
Employment relations officer, NBARN,
(port), 21 (Aug)
ROYAL COLLEGE OF NURSES
Against voluntary euthanasia, 15 (Jul)
Charge made for study tours to UK, 21
(Apr)
RYAN, Sheila M.
CNF award, 9 (Sep)
RYERSON INSTITUTE, TORONTO
Ryerson Institute offers short courses for
RNS, 20 (Nov)
RYMER, SheUa
Bk. rev., 69 (Feb)
SABOURIN, Marie Therese
New director, nursing service, RNABC,
(port), 17 (Mar)
SAFETY
RNABC urges protection for nurses, 19
(Nov)
SALARIES
See Economics, Nursing
SANE, OUvia M.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
STE-CROIX, Armande Sister
Honorary member SRNA, 22 (Aug)
ST. JAMES, Peter
Insulin injection - a new technique, 32
(Jul)
ST. JOHN AMBULANCE
St. John Ambulance announces bursary
awards, 1 1 (Oct)
ST. JOSEPH'S HOSPITAL,
GUELPH
Breakthrou^ for nurses at St. Joseph's
Hospital Guelph, 12 (Oct)
SANDILANDS, Maijorie
Lecturer, U. of Alberta, 22 (Feb)
SASKATCHEWAN INSTITUTE OF
APPLIED SCIENCES
Sixteen new instructors, 22 (Apr)
SASKATCHEWAN REGISTERED
NURSES ASSOCIATION
Announced retirement of Grace Motta, 18
(Sep)
Announces annual CNF donation, 13 (Mar)
Contracts signed by Saskatchewan Nurses,
20 (Nov)
Eight former nurses awarded honorary
memberships, 22 (Aug)
Madge McKillop elected President, 18 (Dec)
SASKATOON UNIVERSITY HOSPITAL
Unit assignment - a new concept,
(Sjoberg), 29 (Jul)
SAUNDERS, Peggy
A descriptive study of the behavior mothers
exhibit . . ., (abst), 50 (Sep)
SCANLAN, Judith M.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
SCHAAP, Margaret Isobel
Director of nursing, Winnipeg Municipal
Hospital, 21 (Feb)
SCHUMACHER, Marguerite
Less paperwork and bureaucracy if nursing
is to survive, 16 (Jun)
SCOTT, Mary Jane
NBARN scholarship, 21 (Nov)
SEIVWRIGHT, Mary Jane
Appointed nurse adviser. International
Council of Nurses, (port), 20 (Jun)
SEYMOUR, Cath e rine M.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
SHACK, Joyce O.
Director of nursing service, Plummer
Memorial Public Hospital, Sault Ste. Ma-
rie, (port), 23 (Apr)
SHANNON, Julia E.
CNF award, 9 (Sep)
SHANTZ, Shirley Jean
A study to determine who, in the opinion of
nurses and physicians, should be responsi-
ble for teaching the hospitalized patient,
(abst), 5 2 (May)
SHARPE, Gladys
Awarded an honorary doctor of laws degree,
22 (Oct)
Honorary life membership in the RNAO, 22
(Jun)
SHATTUCk, Audrey M.
Honorary member SRNA, 22 (Aug)
SHERRARD, Myma
Bk. rev., 47 (Dec)
XV
Three nurses appointed to federal task
forces, 8 (Apr)
SHEWCHUK, M.
The amputee and immediate prosthesis,
(Young), 47 (May)
SHIRLEY, S. Y.
Bk. rev., 49 (Jun)
SILVERTHORN, A.
Psoriasis - The stubborn malady 38 (Nov)
SJOBERG, Kay
Unit assignement
(Jul)
a new concept, 29
SKIN DISEASES
Epidermolysis bullosa, (Melnyk), 33 (Feb)
Poison ivy, (editorial), (Lindabury), 3 (Sep)
Psoriasis - The stubborn malady, (Silver-
thom), 38 (Nov)
SLATER, Myrna
Director of the division of public health
nursing, Toronto, (port), 18 (Sep)
SLINGER, S. J.
Bk. rev., 52 (Aug)
SMALLPOX
Lady Mary Wortley Montagu - eighteenth
century crusader, (Grant), 34 (Jul)
SMOKING
Smoking habits of Canadian nurses and
teachers, (Phillips), 40 (Apr)
SMITH, Dorothy (McPhail)
Survey of follow-up of visual defects in
grade one school children in central Alber-
ta health units, (abst), 49 (Aug)
SMITH, Ethel M.
CNF award, 9 (Sep)
SMITH. Lois
Honorary membership NBARN, 22 (Aug)
SMITH, Roselyn
Bk. rev., 53 (Aug)
SNIVELY, Mary Agnes
The growth and development of a profes-
sion by Daisy C. Bridges, (port), 32 (Jun)
SOCIETIES, NURSING
Nursing associations - are they coming or
going? (ZUm), 31 (Sep)
Relationships between attitudes to nursing,
job satisfaction and professional organiza-
tion membership, (Bailey), (abst), 52
(May)
See also names of nurses associations
SPECIALISM
The nurse is a specialist in the artificial
kidney unit, (Frye), 33 (Dec)
STAFFING
Criteria used by employers when selecting
nursing staff in varying sized hospitals,
(Trout), (abst), 52 (Sep)
MARN surveys staffing patterns, 12 (May)
Unit assignement - a new concept,
(Sjoberg), 29 (Jul)
XVI
STAINTON, M. CoUen
Instructor, Mount Royal Junior College,
Calgary, (port), 23 (Apr)
STARR, Dorothy S.
Assistant professor of nursing, Ottawa
University, (port), 21 (Aug)
STATISTICS
ANA releases current RN data, 16 (Dec)
CNA works with DBS to pubhsh statistics,
12 (Nov)
STEED, Margaret E.
Appointed consultant in Alberta, (port), 21
(Feb)
STEPHENS, Shirley W.
Bk. rev., 56 (May)
STEPHENSON, M. Jane
Honorary membership NBARN, 22 (Aug)
STEVENSON, Doris D. N.
Director of nursing education at Holy Cross
Hospital in Calgary, 22 (Feb)
STEVENSON, Edith G.
Retired, Ottawa Branch of Medical Services,
(port), 22 (Aug)
STEVENSON, Helen T.
Appointed director of Nursing, Saskatche-
wan Institute of Applied Arts and Sci-
ences, Saskatoon, (port), 17 (Sep)
STEWART, Diane Y.
Nursing organization - circa 1969, 59
(Feb)
STINSON, Shirley M.
Appointment on faculty of the University
of Alberta, (port), 20 (Jun)
STONE, Jennifer
RN ABC bursary, 21 (Nov)
STUCKER, Beatrice E
Nurse consultant, maternal and child health
service for Ontario, 20 (Dec)
STUDENTS
A comparison of students' achievement on a
sequential learning experience with other
measures of student progress, (Rheault),
(abst), 47 (Jan)
Correlates of approval and disapproval re-
ceived by students at selected schools of
nursing, (Hayward), (abst), 52 (Sep)
Effectiveness of cUnical instructors as per-
ceived by nursing students, (Joseph),
(abst), 44 (Dec)
McMaster student nurses request financial
aid, 19 (Aug)
Mature students to be admitted to BC
schools of nursing, 16 (Jun)
Students discuss pros and cons of own
provincial association, 1 2 (Jun)
Students want voice at ICN begin to speak
out on issues 7 (Aug)
SURGERY
Advances in surgery for coronary artery
disease. (Trimble), 32 (Jan)
Nursing the patient after heart surgery,
(Wass), 35 (Jan)
The value of revascularization surgery,
(Vineberg), 28 (Jan)
SURRING, Nevin N.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
SUTHERLAND, Jean
New Zealand nurse visits CNA, 18 (May)
SYMON, Mary A.
Instructor, Sask. Institute of Applied Sci-
ences, 23 (Apr)
SYPOSZ, Dorothy
Bk. rev., 68 (Feb)
TANNER, Grace
Gift to CNA Archives, 9 (Jan)
TASK FORCE ON LABOUR
RELATIONS
CNA sends suggestions, 10 (Feb)
TAYLOR, Effie J.
The growth and development of a profes-
sion by Daisy C. Bridges, (port), 32 (Jun)
TELEVISION
Family physicians meeting sees debut of
medical convention T.V., 17 (Dec)
TESTS AND MEASUREMENTS
CNA testing service to be located in Ottawa,
8 (Mar)
A comparison of students' achievement on a
sequential learning experience with other
measures of student progress, (Rheault),
(abst), 47 (Jan)
First Quebec hospital goes metric, 15 (Dec)
How much bleeding? (Bruser), 44 (Jan)
Metric conversion kits available
from C.H.A. 13 (Dec.)
Provisional board to be set up for CNA
testing service, 10 (Dec)
Schools evaluate tests as educational aids,
12 (Jan)
Workshops on test construction to be held
in London, 16 (Mar)
THOMAS, Sharon
Medication errors can be prevented, 50
(May)
THOMPSON, Doris S.
Bk. rev., 58 (May)
THORNE, Anne D
First director Saint John School of Nursing,
New Brunswick, 20 (Dec)
3M COMPANY
3M donates fellowship, 10 (Aug)
TISSINGTON, F. Qaire
An exploratory study of the relationship
between physical and social-psychological
distance and nurse-patient verbal inter-
action, (abst), 44 (Dec)
TOD, M. Louise
Harder bargaining ahead for Canadian
nurses, 18 (Jun)
TORONTO UNIVERSITY.
SCHOOL OF NURSING
Appointments to faculty, 18 (Jan)
TRANSPLANTATION
A moral and legal look at organ transplants,
12 (Jul)
TRETIAK, Sally
Bk. rev., 28 (Jul)
Joins teaching staff of Red Deer Junior
College, (port), 18 (Jan)
TRIMBLE, A. S.
Advances in surgery for coronary artery
disease, 32 (Jan)
TROUT, Margaret F.
Criteria used by employers when selecting
nursing staff in varying sized hospitals,
(abst), 52 (Sep)
TURNBULL, LUy M.
Chief nursing officer of the World Health
Organization, 20 (Jun)
u
UNIFORMS
Haute couture on the wards, 13 (Jan)
Check your image - it's slipping! (Zilm),
45 (Oct)
UNITED NURSES OF MONTREAL
Elects new officers, 14 (Feb), 20 (Nov)
Executive coordinator, Nicole Dion, 17
(Sep)
Hold second annual meeting, 12 (Jan)
Montreal nurses sign contract with Queen
Elizabeth Hospital, 14 (Feb)
UNIVERSITY OF ALBERTA
Faculty appointments, 22 (Feb)
UNIVERSITY OF BRITISH COLUMBIA
CNA Executive director predicts change in
science nursing, 1 2 (Dec)
UBC celebrates golden jubilee, 8 (Mar)
UNIVERSITY OF MONTREAL
U. of M. graduates form alumi association,
16 (Feb)
UNIVERSITY OF WESTERN ONTARIO
Two workshops at UWO, 20 (Aug)
VACCINATION
Lady Mary Wortley Montagu - eighteenth
century crusader, (Grant), 34 (Jul)
VAN BERGEN, Hilda
RNABC bursary, 21 (Nov)
VAN RAALTE, Ernest
Thought and action, 25 (Mar)
VAN TROYEN, Phyllis
Bk. Rev., 50 (Aug)
VARCO, Doris Ann
Margaret Sinn Fund bursary, 21 (Nov)
VICTORIAN ORDER OF NURSES
Holds 71st annual meeting, 15 (Jun)
VINEBERG, Arthur
The value of revascularization surgery, 28
(Jan)
w
WALKER, Karen V.
Assistant director of nursing Qarke Institute
of Psychiatry, (port), 22 (Aug)
Bk. rev., 56 (May)
WALLINGTON, Marjorie A.
An approach to the phases of nurse-patient
relationships, (abst), 50 (Sep)
WASLSH, Margaret E.
General director of the National Leagae for
Nursing, 22 (Oct)
WARNER, Dorothy
Deceased, 22 (Oct), 18 (Dec)
WARWICK, Lorraine E.
Come with me, Lori, (Wilting), 48 (Sep)
WASS, Judith R.
Nursing the patient after heart surgery 35
(Jan)
WASSON, Dorothy
Bk. rev., 51 (Nov)
WATSON, E. M.
Qinical laboratory procedures, (Neufeld),
41 (Feb)
WHITAKER, Judith
Press conference at CNA House, (port), 16
(Jul)
WHITE SISTER UNIFORM INC.
White Sister donates $30,000 scholarship,
10 (Aug)
WHITNEY, Marie
Assistant director, school of nursing, St.
Paul's Hospital, Vancouver, 10 (Jun)
WHITTON, Charlotte
Gold chain honors nurses, 7 (Jul)
WIEBE, Lydia
Director of nursing service for Grace Gene-
ral Hospital, Winnipeg, (port), 20 (May)
WILLIAMS, Marguerite C.
A comparison of the perceptions of public
health nurses and their alcoholic pa-
tients . . . (abst), 52 (May)
WILSON, Hazel A.
Appointed to the Ontario Department of
Health, (port), 18 (Jan)
A study to explore the relationship between
absence events and the scheduling of time
and work assignements . . . (abst), 46 (Jan)
WILSON, PhyUis Margaret A.
A guide for the public health nurse to assist
elderly patients (abst), 50 (Sep)
WILTING, Jennie
Come with me, Lori, (Warwick), 48 (Sep)
WOOD, Sheila
Hemodialysis in the home, 42 (Apr)
WOOD, Vivian
Bk. Rev., 50 (Aug)
Two workshops at UWO, 20 (Aug)
WORLD HEALTH ORGANIZATION
CNA associate director to participate in
WHO conference in New Delhi, 11 (Oct)
Chief nursing officer, Lily M. Tumbull, 18
(Jun)
New Zealand nurse visits CNA, 18 (May)
Nurse included in Canadian delegation to
WHO assembly, 13 (Nov)
Work in Africa continues, 19 (Oct)
WRITING
Nurses reluctant to write ICN delegates told,
18 (Aug)
An unlikely author, (Rippon), 20 (Aug)
WROBEL, D. M.
Bk. rev., 42 (Mar)
WYLIE, Norma A.
Hospital design is a nursing affair, 42 (Oct)
YEO, Iva J.
Bk. rev., 68 (Feb)
YOUNG, Jessie F.
A new design for stryker turning frame
covers, 45 (Jan)
YOUNG, Z.
The amputee and immediate prosthesis,
(Shewchuk), 47 (May)
ZEIDLER, Eberhard H.
How to prolong a hospital's lifespan, 39
(Oct)
ZILM, Glennis
Bk. rev., 54 (Sep), 51 (Nov)
Check your image - it's slipping! 45 (Oct)
Hyperbaric oxygen units - hi^ pressure
nursing, 37 (Feb)
Nursing associations - are they coming or
going? 31 (Sep)
Plans to do free-lance writing, (port), 21
(Feb)
ZITKO, GUdys Anne
RNABC bursary, 21 (Nov)
XVII
PROVINCIAL ASSOCIATIONS OF REGISTERED NURSES
Alberta
Alberta Association of Registered Nurses,
10256 ~ 112 Street, Edmonton.
Pres.: M.G. Purcell; Vice-Pres.: R. Erickson, A.
Tetarenko, M. de Hamel; Committees -
Nurs'g Service: M. Godfrey; Nurs'g Educ: G.
Bauer; Staff Nurses: I, }Ao^%ey\Super'y Nurses:
A. Clyne; Prov'l Office Staff - Pub. ReL: D.J.
LaBelle; Employment Rei: M.L. Tod;Comm;Y-
tee Advisor: H. Cotter; Registrar: DJ. Price;
Exec. Secretary: H.M. Sabin; Office Manager:
M. Garrick.
British Columbia
Registered Nurses' Association of British Co-
lumbia. 2130 West 12th Avenue, Vancouver 9.
Pres.: M.D.G. Angus; Past Pres.: M. Lunn;
Vice-Pres.: R. Cunningham, A. Baumgart; //o«.
Treasurer: T.J. McKenna; Hon. Sec: Sister
Kathleen Cyr; Committees - Nurs'g Educ: E.
Moore; Nurs'g Service: N. Stevens; Soc. &
Econ. Welf: A.l. Mooney; Finance: T.J.
McKenna; Legislation & By-Laws: C.J. Winning;
Pub. Rei: B.A. Geddes; Exec. Director: E.S.
G\a.hdm\ Registrar: H. Grice.
Manitoba
Manitoba Association of Registered Nurses, 647
Broadway Avenue, Winnipeg 1.
Pres.: D. Dick; Past Pres.: H. Glass; Vice-
Pres.: E. M. Nugent, O. Gebhard; Com-
mittees - Nurs'g Service: A. Croteau; Nurs'g
Educ: K. DeMarsh; Soc. & Econ. Welf:
L. Abbott; Legislation: M. Wilson; /I ccA-ed/fm^;
K. McLaughlin; Board of Examiners: M. Nu-
gent; Educ. Fund: J. Winkler; Finance: H.
Beath; House: M.E. Wilson; Nurs'g Consultant:
Sister Beatrice Wambeke; Pub. Rei Officer: Mr.
T.M. Miller; Registrar: M. Caldwell. Int. Exec.
Dir: B. Cunnings; Empi Rei Officer: L.
Rector.
New Brunswick
New Brunswick Association of Registered
Nurses, 231 Saunders Street, Fredericton.
Pres.: 1. Leckie; Past Pres.: K. Wright; Vice-
Pres.: H. Hayes, A. Robichaud; Hon. Sec: M.
MacLachlan; Committees ~ Soc. & Econ.
Welf: B. Leblanc; Nurs'g Educ: A. Grouse;
Nurs'g Service: M. Sherrard; Fi/iance.- A. Robi-
chaud; Legislation: H. Hayes; Exec Sec: M.J.
Anderson; Registrar: L. Gladney;/4(?i;. Com. to
Schools of Nurs'g: Sister Florence Darrah;
Nurs'g Assistants Com.: A. Dunbar.
Newfoundland
Asociation of Registered Nurses of Newfound-
land, 67 LeMarchand Road, St. John's.
Pres.: E. Summers; Past Pres.: Sister Catherine
Kenny; Pres. Elect: A. Simms; Vice Pres.: J.
Nevitt; Committees - Nurs'g Educ: R. Dew-
ling; Soc <S Econ. Welf: J. Lewis; Exec Sec:
P. Laracy;/lssr Exec. Sec: M. Cummings.
XVIII
Nova Scotia
Registered Nurses' Association of Nova Scotia,
6035 Coburg Road, Halifa.x.
Pres.: J. Fox; Past Pres.: J. Church. Vice Pres.:
Sister C. Marie, E. Rhindress, E.J. Dobson;
Committees - Nurs'g Educ: V. Ri\ey: Nurs'g
Service: F. Gass; Soc. <& Econ. Welf: M.
Bradley; f.x-ec. Sec: F. Moss; Recording Sec:
E. MacLaughlin.
Ontario
Registered Nurses' Association of Ontario, 33
Price Street, Toronto 289.
Pres.: L.E. Butler; Pres. Elect: M.J. Flaherty;
Committees - Socio-Econ. Welf: E.A. Eagle;
Nurs'g: M.E. Gourlay; Educator: I. A. Brown;
Administrator: B.I. Robinson; Exec. Director:
L. Barr; Asst. Exec. Director: D. Gibney;
Employment Rei Director: A.S. Gribben;
Coordinator Formal Contin 'g Educ. Program:
L.C. Peszat; Director. Prof'l Devei Dept.: D.M.
Adams; Pub. Rei Officer: 1. LeBourdais;
Director. Testing Service: D.R. Colquhoun;
Librarian: F.E. Geddis; Regional Exec. Sec:
I.W. Lawson; M.I. Thomas, F. Winchester.
Prince Edward Island
Association of Nurses of Prince Edward Island,
188 Prince Street, Charlottetown.
Pres.: B. Rowland; Past Pres.: Sister Marie
Cahill; Vice Pres.: E. MacLeod; Pres. Elect.:
CM. Corbett; Committees - Nurs'g Educ: S.
DriscoU; Nurs'g Service: F. Gates; /"ui. Rei: C.
Gordon; Finance: Sister Marie Cahill; Legisla-
tion & By-Laws: H.L. Bolger; Soc. & Econ.
Welf: H. Mclnnis; Exec. Sec-Registrar: H.L.
Bolger.
Quebec
Association of Nurses of the Province of Que-
bec, 4200 Dorchester Blvd. West, Montreal.
Pres.: H.D. Taylor; Vice-Pres.: (Eng.) R. Atto,
K. Rowat; (Fr.) M. Jalbert, R. Bureau; Hon.
Treasurer: M. Ellis; //on. Sec: E. Morin; Com-
mittees - Nurs'g. Educ: M. Callin, D. Lalan-
cette; Nurs'g Service: E. Strike, Sister Lorraine
Beaudin; Labour Rei: M.M. Wheeler, G. Hotte;
School of Nurs'g.: M. Barrett, P. Provencal;
Legislation: E.C. Flanagan, G. (Charbonneau)
Livailee; Sec-Registrar: H.F Reimer.
Saskatchewan
Saskatchewan Registered Nurses" Asociation,
2066 Retallack Street, Regina.
Pres.: M. McKillop; Past Pres.: A. Gunn; 1st
Vice-Pres.: E. Linnell; 2nd Vice-Pres.: C. Boy-
ko; Committees - Nurs'g Educ: J. Byam;
Nurs'g Service: J. Belfry; Chapters & Pub. Rei:
M. Harman; Soc. & Econ. Welf: O. Yonge;
Exec. Sec: A. Mills; Registrar: E. Dumas;
Employment Rei Officer: A.M. Sutherland.
YV CANADIAN
S^ ASSOCIATION
Board of Directors
President Sister M. Felicitas
President Elect E. Louise Miner
1st Vice-
president Marguerite Schumacher
2nd Vice-
president Margaret D. McLean
Representative of Nursing
Sisterhoods Sister J. Bouchard
Chairman of Committee on Social &
Economic Welfare Louise Tod
Chairman of Committee on Nursing
Service Margaret D. McLean
Chairman of Committee on Nursing
Education Kathleen E. Arpin
AARN M.G. Purcell, President
RNABC M.D.G. Angus, President
MARN D. Dick, President
NBARN I, Leckie, President
ARNN E. Summers, President
RNANS J. Fox, President
RNAO L.E. Butler, President
ANPEI B. Rowland, President
ANPQ H.D. Taylor, President
SRNA M. McKiUop, President
National Office
Executive
Director Helen K. Mussallem
Associate Executive
Director Lillian E. Pettigrew
General
Manager Ernest Van Raalte
Research and Advisory Services
Director Lois Graham-Cumming
Nursing
Coordinator Harriett J.T. Sloan
Library, Margaret L. Parkin
Information Services:
Public Relations Valerie Fournier
Editor, The Canadian
Nurse Virginia A. Lindabury
Editor, L'infirmiere
canadienne Claire Bigue
January 1969
6 8 86
The
Canadian
Nurse
countdown to congress
the medical assistant
revascularization surg
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Plan now to attend the International Council of Nurses'
Quadrennial Congress.
Space is limited and going fast!
To avoid disappointment, and save money, clip the coupon
below and reserve space at the advance fee of $40.00 for
all sessions (if space is available after January 22, 1969
the fee will be $60.00 for all sessions).
NOTE. There is no provision for daily registration. On days
that space is available admission at the door will be
$1 5.00 — first come first served.
PLACE BONAVENTURE, MONTREAL CANADA • JUNE 22-28, 1969
I
To: ICN Congress Registration, 50 The Driveway, Ottawa
Please send registration forms and instructions to:
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I
'lANUARY 1%9
THE CANADIAN NURSE 1
A "Core" Text for Assistant Nursing Personnel
For . . .
Nursing Assistants
Home Healtli Aides
Geriatric Aides
Nursing Home Personnel
Psychiatric Aides and
Technicians
Medical Assistants
inservice Education
Practical Nursing
i (IMDIIFIFn NIID^IKG By Claire P. Hoffman, R.N., M.A.;
I JinrLintl/ nunjinw ^^^^^ ^ ^.^^.^^ ^^^ g^_ ^^^ ^^^ ^ Thompson, R.N.,B.S.
The 8fh Edition has been revised to meet the needs of a rapidly increasing
number of workers on the health team. Content has been updated and stream-
lined, resulting in a concise text, but with full coverage of pertinent material
from anatomy and physiology through specific nursing measures in the major
clinical areas. The authors painstakingly explain not only how to give nursing
care, but the reasons behind each step. The book, ideal for use in intensive
courses for nursing assistants, home health aides, psychiatric technicians, is
also suitable as o "shorter" text for practical nursing. Study projects and
summaries follow each chapter. The Appendix includes a glossary, conversion
tables, and a list of commonly-used drugs with physiologic action, side effects,
and contraindications.
692 Pages 8th Ed. 1968 112 lllusl. plus an 8-Page Color Insert Paper, $5.25
Suggested for Reinforcement
2 PROGRAMMED MATHEMATICS OF DRUGS
lUn CAIIITinilt By Mabel E. Weaver, R.N., M.S.;
MV JULUIIUnj „„,; y^r^ J Koehler, R.N., M.N.
Step-by-step instruction on the application of basic
mathemotics to the administration of drugs and solutions;
includes a chapter on medication for infants and children.
109 Pages 1966 Printing with Revisions Paper, $2.40
3 INTR0DUCT10H TO ASEPSIS:
A Programmed Unit By Marie M. Seedor, R.N., Ed.D.
This programmed text covers the prevention and control
of infection; medical and surgical asepsis. An ideal self-
teaching and self-evaluation text.
275 Pages 1964 Paper, $3.75
4 PERSONAL AND VOCATIONAL
RELATIONSHIPS IN PRACTICAL NURSING
By Carmen F. Ro.ss, R.N., M.A.
A book for the student and the practitioner that offers
sound advice on ethical behavior and responsibilities.
3rd Edition in preparation
5 PRACTICAL NUTRITION
By Alice B. Peyton, M.S.
The emphasis is on the principles of good nutrition, and
how they can be used to help preserve optimum health.
Contents include: Normal Nutrition; Diet Therapy; Food
Economics.
434 Pages Illustrated 2nd Edition, 1962 $3.75
' J.B. LIPPINCOTT COMPANY of CANADA LTD.
I 60 FRONT ST. W. TORONTO 1, CANADA
' Please send me the books I have circled below:
I 12 3 4 5 6 7 cloth 7 paper 8 9
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6 INTRODUCTORY MATERNITY NURSING
By Doris C. Bethea, R.N., M.S.
This new book supplies all of the information required by
the practical nurse for optimum care of mothers and
infants. Physical care and psychosocial considerations
are included.
223 Pages 83 Illustrations 1968 Paper, $4.00
7 FOUNDATIONS OF PEDIATRIC NURSING
By Violet Broadribb, R.N., M.S.
Concise and patient-oriented, this text offers common-
sense guidance and specific suggestions for action in the
key areas of pediatric nursing. The child's reaction to
illness is stressed.
573 Pages Illustrated 1967 Paper, $5.60 Cloth, $8.00
A Textbook of
Patient Care
By Alice M. Robinson, R.N. M.S.
The aide's role and function in the care of the mentally
ill are realistically described. Rather than technics, atti-
tudes toward patients are emphasized.
226 Pages 3rd Ed. 1964 Illust. Paper, $3.25
8 THE PSYCHIATRIC AIDE:
9 FUNDAMENTALS OF NURSING:
The Humanities and the Sciences in
Nursing
By Elinor V. Fuerst, R.N., M.A.; and LuVerne
Wolff, R.N., M.A.
A problem-solving approach to the principles underlying
all nursing action, emphasizing the "core" content common
to every area of practice.
New Ed. in preparation
n Payment enclosed
n Charge and bill me
T
Lippincott
2 THE CANADIAN NURSE
JANUARY 196'
The
Canadian
Nurse
^
'^^
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 1
January 1%9
26 Countdown to Congress L. Graham
i
28 The Value of Revascularization Surgery A. Vineberg
32 Advances in Surgery for Coronary Artery Disease A.S. Trimble
35 Nursing the Patient After Heart Surgery J.R. Wass
38 A New Category of Health Worker for Canada? C. Hacker
44 Idea Exchange
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
7 News
1 8 Names
20 Dates
22 New Products
24 In a Capsule
46 Research Abstracts
49 Books
52 Films
52 Accession List
Executive Director: Helen K. Mussallem •
Editor: Virginia A. Lindabury • Assistant
Editors: Glennis N. Zilm • Loral A. Graham
• Circulation Manager: Berjl Darling •
Advertising Manager: Ruth H. Baumel •
Subscription Rates: Canada: One Year,
$4.50; two years, S8.00. Foreign: One
Year, $5.00; two years, $9.00. Single copies:
50 cents each. Make cheques or money orders
payable to the Canadian Nurses' Association.
• Change of Address: Four weeks' notice; the
old address as well as the new are necessary,
together with registration number in a provin-
cial nurses' association, where applicable. Not
responsible for journals lost in mail due to
errors in address.
® Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
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Photographs (glossy prints) and graphs and
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.Authorized as Second-Class Mail by the Post
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Return Postage Guaranteed. 50 The Driveway.
Ottawa 4, Ontario.
lANUARY 1969
In recent months, rumblings about
"physicians' assistants" have been
reverberating across the country. At a
medical meeting in Toronto in
September, a well-known medical
educator spoke strongly in favor of
setting up programs for physicians'
assistants in Canada; an equally well-
known medical educator stood up and
disagreed with this proposal. The
subject is being written about and
discussed with fervor by doctors, most
of whom have strong opinions one
way or the other. Nurses should
become interested in this controversy,
mainly because the creation of this
category of health worker would affect
patient care as well as the nurses' role
in providing this care.
The physicians' assistant role was
created in the U.S.A. to bridge "the
professional gap" between nursing and
medicine and to relieve harassed
doctors of much of their routine work.
Does it logically follow that because
this is good for the U.S. (and this is
questionable) it is good for Canada?
The answer is "no." What is needed
in Canada is more dialogue between
the medical and nursing professions to
find other ways of filling any present
"gap"
It is the patient who will suffer if
another category of health worker is
added to the 50 existing ones. As the
editor of the American Journal of
Nursing pointed out in a July 1967
editorial on the subject of physicians'
assistants, "The present multiplicity of
professional health workers — each
prepared to fulfill the specific functions
of his euphemistically designated
specialty — has already clouded and
confused the scene beyond the
comprehension of most health workers,
not to mention the patient."
This month we present an article
based on interviews of several doctors
and nurses who hold opposite views
about the value of the physicians'
assistants (p.38). We agree with those
who believe that there is no need for
such workers in Canada.
As Dr. A.L. Chute, dean of
medicine at University of Toronto, says
in this interview: "I don't think there's
any necessity for creating a new breed
of cats." — V.A.L.
THE CANADIAN NURSE 3
letters
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Widen your horizons
I would like to thank you for Joyce Irwin's
article in the July issue "Widen Your Hori-
zons."
The public library that I attend was very
helpful and provided me with some wonderful
summer reading. So far, I have read eight of the
books mentioned in the article and found all of
them very interesting. There are still a few
mentioned in the article that I would like to
read, especially the ones by Monica Dickens. -
Esther V. Repol, Scarborough, Ont.
ICN Congress
I am writing to you in regard to the
Congress of the International Council of Nurses
to be held in Montreal in June 1969.
Five students from our hospital, myself
among them, attended the Canadian Nurses'
Association convention in Saskatoon last
summer. All of us who attended now realize the
value that these conventions hold both for
students and graduate nurses.
We have the good fortune of being close at
hand for the 1969 convention but would like to
aid those who will have difficulty raising funds
to attend.
Could you give me any information about
student nurses who would like to attend the
convention but cannot raise the funds? Our
student council would like to supply transport-
ation, lodging, and convention expenses for a
student (or more than one, depending on costs)
who could not otherwise come to Montreal. -
Linda G. Carter, Montreal.
I understand that some nurses coming
fiom abroad for the International Council of
Nurses' Quadrennial Congress will have to find
accommodation at the lowest available prices.
A few of my friends and myself would be ready
to offer rooms without charge to these col-
leagues. - Pierrette Delage, Montreal
These letters have been brought to the atten-
tion of the Congress coordinator at CNA
House. The editors.
We would appreciate receiving as soon as
possible requests from any provincial associa-
tions or other groups who wish to schedule a
private cocktail reception or dinner during the
International Council of Nurses Congress to be
held June 22-28, 1969 in Montreal
We have blocked a number of salons in the
Queen EUzabeth and Bonaventure Hotels, but
cannot hold these rooms too much longer if we
do not receive specific requests for reservations.
Please write; Convention Division, Panex
Inc., Place Bonaventure, Montreal 3. - (Mrs.)
Laila Chisnell, Congress Coordinator, Montreal
4 THE CANADIAN NURSE
Office Nurse
As a practicing office nurse one year
removed from active hospital nursing, I agree
wholeheartedly with Miss Christie in her article
"Girl Friday, R.N." (Nov. 1968). However, I
also believe that the R.N. in the office can be
much more than an extremely competent
medical secretary.
In my office, which specializes in obstetrics
and gynecology, I am being used far more
effectively as a nurse because 1 spend all the
time allotted for office visits with the patients.
During this time I am able to teach general
health rules to individual patients and to their
famUies, fulfil my duties related to physical and
lab procedures and explanations of special
treatments, and gather information about the
patient's history so that the doctor can use his
time with the patient more efficiently.
In this manner the doctor and I work as a
team to help patients understand and solve
their problems, thereby giving good medical
care, both mental and physical, to the patient.
- Mary Ann Cutler, Reg.N., Hamilton, Ont.
Smug disrespect toward doctors
An article and two letters published recently
in THE CANADIAN NLTRSE have brought into
sharp and uncomplimentary focus questionable
nursing attitudes I have observed during the
past seven years. The article was "A doctor
looks at nursing education" (July. 196&) by
S.C. Robinson, M.D. The two letters were both
in the October issue - Albert Wedgery's letter
headed "Tug-of-war attitude" and Marie
Martin's "Incompetent interviewers."
I believe that there is a great lack of com-
munication not only between doctors and
nurses, but also between nurses and nurses, and
between nurses and patients. 1 contend that this
lack of communication stems at least in part
from disparaging and often ignorant attitudes
adopted by many nurses toward non-nurses.
Doctors have been too tolerant of sloppy
nursing habits, although not unaware of them.
They have been too ready to accept re-
sponsibihty for nurses' shortcomings as well as
their own and in so doing have allowed nurses
to assume airs of inflated self-importance for
pseudocapabilities.
Mr. Wedgery echoes Dr Robinson's views
when he writes "... we need immediate and
listing dialogue so that nursing does not con-
tinue to get further away from medicine. I
suspect that this breach has resulted because
doctors as a group have not been concerned
about the developments in nursing education
and the changes in nursing practice."
Dr. Robinson writes "This, (the breach in
dialogue) 1 believe, is the fault of the medical
profession."
Not entirely. I believe that Dr. Robinson has
been far too generous in absolving nurses from
a healthy share of the blame.
In my experience, most doctors regard
nurses with a great deal of respect as individuals
and as members of the health team. Almost all
doctors are not merely willing but eager to
instruct and inform in any area of patient care
when the nurse displays an interest.
Mr. Wedgery asks "... how often and in
what manner have doctors communicated with
nurses as members of the team? " I ask, how
often and in what manner have nurses sought
communication with doctors as members of the
team and been rejected?
Conversely, 1 have encountered in nurses at
all levels an incredible degree of smug disrespect
toward doctors, albeit hypocritically concealed
from the physician behind a pretentious mask
of servitude.
This is clearly evidenced not only in remarks
by staff nurses in dressing rooms, such as "Old
flint-face doesn't need half the instruments he
asks for" but more appallingly, in direct
comments by nurse interviewers. For example:
"We really aren't interested in what the doctors
have to say; what we want is a record from the
nursing office or a report from a director of
nursing."
Does the nurse interviewer assume that the
director of nursing from her office can better
assess the nurse's capabilities than the surgeon
to whom she passes the instruments? Yet, as
Marie Martin points out in her letter "These
same persons admit they have no idea . . . what
type of procedure is carried out for any con-
dition."
Today, "reassurance" to the patient too
often consists of "Don't worry, Mr. Jones; you
just relax and everything will be alright."
The nurse is not insincere in her attempts to
give reassurance; .she is simply thoughtless. She
finds it difficult, or doesn't attempt, to picture
the patient out of the context of the hospital
environment and his illness. She doesn't
imagine him as a well social being making con-
tributions as necessary to society as her own.
For example, his time is just as valuable as
her own. But nurses - and doctors - seem to
lose sight of this, as can be observed day and
night in the outpatient and emergency depart-
ments of most large hospitals, where patients
with comparatively minor ailments are forced
to await treatment for anywhere from two to
six hours. Though I don't believe that the main
fault here lies with the nurses, I do think they
could display a little awareness and sympathy
for the inconvenience imposed upon the
person.
After waiting two hours, a friend of mine
politely asked how much longer the wait might
be, thinking she might pass part of the interval
having coffee. "If you don't want to wait you
JANUARY 1%9'
can come back tomorrow," retorted the nurse.
It is important to be aware of the psy-
chological changes occurring in a person who is
sick; but it is also important to realize that the
person is not always sick and that even when he
is sick the changes are not total and his personal
integrity remains.
If nurses sincerely wish to attain Mr.
Wedgery's goal of "a truly professional nursing
service to the public," then they might well
become acquainted with the fact that the
public is people, not merely patients. - Carole
Stafford, Reg. N., Toronto.
Stand up and be counted
Re the vis-a-vis about a paid provincial pre-
sident (August 1968): I wholeheartedly say
"yes."
It is most refreshing to hear Monica Angus'
point of view, in which she urges the bedside
nurse to take a more active part in decisions
affecting the welfare of patients, and the
working conditions and salaries of nurses.
I am told that there is a fresh wind blowing
in nursing, which is long overdue. We must
participate at the local level and stand up to be
counted. - Berta Schmidt, R.N., Cert. P.H.N.,
Victoria, B.C.
Why can't the CNA ?
At the request of the editorial staff of THE
CANADIAN NURSE 1 attended the Registered
Nurses' Association of Ontario regional confe-
rence on the use of audiovisual aids in nursing
held in Toronto from November 1 1 to Novem-
ber 14. I had not seen the latest issues of the
magazine, nor received any special briefing.
Toward the end of the first day, a few ques-
tions occurred to me; I understand that some of
them were also asked in an editorial in the
October issue (page 33). Throughout the con-
ference, delegates kept asking me what the
Canadian Nurses' Association was doing in cer-
tain areas. On my return to Ottawa, I found out
that as often as not, nothing was being done.
The first speaker was David Clee, professor
of education in charge of the Educational
Media Center at the College of Education, Uni-
versity of Toronto. He told how teaching has
turned away from the didactic, rote-learning
approach to that of teaching through dialogue
and the enquiry method, using techniques in
which the student is the center of the curri-
culum and emphasis is on the learning process.
The lectures and discussion periods that
followed pinpointed several problems:
1. Older teachers, used to the authoritarian
approach, feel useless and frustrated when they
are faced with a classroom made up of discuss-
ing, questioning groups, rather than a block of
listening students. There is a need for special
training of these teachers.
2. Many teachers do not know how to use
equipment and are afraid to experiment with it.
As Lou Wise, assistant director. Visual Aids
Department, Toronto Board of Education -
JANUARY 1969
the second speaker - pointed out, the use of
media no longer means ordering the odd 16mm.
film and showing a few slides. In Toronto,
workshops have been held for the past eight
years showing teachers how to make 8mm.
movies for use in highschools, and students are
participating. The Toronto School Board's
Teaching Aid Service supplies technicians for
servicing equipment and helping and advising
teachers; they hope to have such a technician in
all pubUc and separate schools in the city..
Mr. Wise forecast the establishment of a
16mm. film-production center for all the
nursing schools in Ontario.
3. For the last two or three years, nursing
teachers have been producing their own 8 mm.
films. They have begun to reahze that there is
much duplication of effort and that there is a
need for centralization for purposes of exchan-
ges. As a matter of fact, the RNAO set up this
series of conferences on audiovisual aids
because a voluntary group of nursing school
teachers wanted to pool their resources to set
up a central agency for auxiliary teaching aids.
When this group approached the RNAO last
fall, RNAO decided that the need was shared
by the province, and organized the conferences
on audiovisual aids. Through the RNAO, this
group of nursing teachers presented a brief in
April 1968 to the Ontario Council of Health,
asking for funds to pay the salary of a person
who would assess the audiovisual needs in the
province. This brief has already been studied by
subcommittees, and is expected to go before
the council itself any day now.
This need cannot be just province-wide.
What is beeing done in other provinces? Should
not the CNA act as a coordinating body? (I
asked one of the members of the RNAO plan-
ning committee whether she thought that the,
CNA should be handling a project of this nature
and the comment was, "They don't seem to
have the money and if fees were raised again,
there would be a howL The need is urgent; we
have to do something now; we can't wait for
CNA.") The RNAO is supposedly short of
money also; if they can find a means of raising
funds, why can't the CNA?
There was unanimous condemnation of
Trainex film strips, as well as of some other
commercially provided visual aids such as slides,
because of the gross errors of technique de-
picted. This points out the need for the esta-
blishment of a committee, or at least the
appointment of one person to provide consul-
tative services to commercial companies. This
person or committee could also advise the
textbook companies almost all of which are
now putting out slide series to accompany their
nursing textbooks. The speakers and the dele-
gates unanimously felt that many of the com-
mercial sUdes, though accurate and well produ-
ced, were unsuitable for their teaching needs.
4. Library services: As I mentioned,
textbook companies are now providing slides to
accompany books. Is there any reason that
these slides should not be available in the same
place as the textbooks? Many high school
libraries (and not only in the main cities - one
of the delegates from a small northern town
said the system was in use there in grade se-
ven! ) offer study carrels in which students can
view slides, 8mm. films, and other material; the
equipment is supplied by the library. I met one
nursing school librarian who is setting up a
five-year plan for the incorporation of audiovi-
suals; she is thinking of putting teaching aids
such as transparencies in the same section as
textbooks on the subject.
5. Barbara Smith, Coordinator of Libraries
of the Board of Education for the town of
Mississauga talked about "Preparing for Infor-
mation Service in your Future." She pointed
out that already the services offered by many
libraries include:
- Computerized information retrieval and
bibliographical control (computers indicate
whether book is in library and, if not, when it is
to be returned; all records of the library are
made available. Dial access to films, tapes,
records, etc. (You sit in the carrel, dial for the
necessary film and see and hear it in the carrel).
Facsimile transmission of hard copy
through the telephone (printed text is actually
reproduced before you).
On-line computer terminals (these look like
typewriters; they are linked to a main library
where a computer prints information on the
typewriter-like machine in front of you).
Miss Smith said that centraUzation and
cooperation are necessary if we are to harness
the large amount of information that we are
deluged with constantly. Committees are
necessary to evaluate materials so that what is
produced can be either shared or reproduced.
Decisions dealing with information storage and
retrieval should be made with automation in
mind. This could save millions of dollars. Miss
Smith mentioned a computerized central me-
dical library in Washington; is it not Ukely that
a central computerized library will be necessary
in Canada in the not-so-distant future, and
should not the CNA start to plan for it?
6. Other questions regarding CNA that were
put to me at the conference include: "Is there a
quick reference guide to evening classes and
other classes given in nursing schools across
Canada? " and "Do you have any French books
in your library? I don't remember having seen
any."
This brings up another major issue. When
plans are being made to introduce audiovisual
aids and other forms of automation, should not
provision be made at the very beginning to have
biUngual services? For example, if you are
planning to have transparencies, overlays should
be provided in both languages; soundtracks also
should be in both languages. When shdes or
other materials are ordered from a commercial
source, attemps should be made to obtain the
text in French: you will notice that more and
more commercial audiovisual aids are made
available in both languages.
The CNA is a national association; it is
incredible that of its professional staff, only the
editors of L 'infirmiire canadienne speak fluent
French. When the association plans to intro-
duce changes made necessary by automation,
should it not without hesitation hire additional
professional staff that is bilingual? - Ramona
Macdonald, former assistant editor, L 'infirmiire
canadienne. CI
THE CANADIAN NURSE 5
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It's so much easier to administer — takes just 2
minutes. No preparation. No after-use handling.
Microlax is easier on patients, too. Even for post-
operatives and children. Acts fast (5 to 20 minutes).
Microlax costs less than any other disposable enenna!
6 THE CANADIAN NURSE
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lANUARY 1%9
news
Canadian Elected Chairman
Of PAHO Nursing Committee
Washington, D.C. - A Canadian nurse has
been elected chairman of a newly-formed
committee that advises the Pan American
Health Organization on ways and means of
developing its nursing program in Latin Ameri-
ca.
She is Dr. Helen K. Mussallem. executive
director of the Canadian Nurses' Association.
Ottawa. She was elected chairman of the first
meeting of the P.AHO Technical Advisory
Committee on Nursing. The seven-member,
international group is made up of experts from
Brazil. Canada. Chile, Colombia, Mexico,
Panama, and the United States.
The ratio of nursing personnel for Canada
an the United States, according to PAHO figu-
res, is 2.2 nurses and 2.6 nursing auxiliaries for
every physician. It is 0.7 and 1.6 respectively
for the countries of Middle America, and 0.4
and 1.1 respectively for those of South Ameri-
ca. Thus, a major item for discussion was the
type of program Latin American countries
might develop to alleviate the nursing shortage,
rated the area's most serious health-personnel
problem. How a country can best put its nurses
to work in the care of patients was another
item on the agenda, as was the education of
university trained nurses, and of nursing
auxiliaries.
CCUSN Elects Executive
Ottawa, Ont. - The executive officers of
the Canadian Conference of University Schools
of Nursing were named at a meeting of CCUSN
Council held in Ottawa. November 5 to 7, 1968.
Margaret MacPhedran, director of the School of
Nursing. University of New Brunswick, was
named President.
Sister Jean Eudes, Mount St. Vincent Uni-
versity, is first vice-president. Jean Godard,
McGill University, is secretary, and Carolyn
Pepler, University of New Brunswick, is trea-
surer. Margaret Hart, University of Manitoba, is
past-president.
Regional advisors are: Margaret Bradley,
Dalhousie University, for the Atlantic region;
Sister Marie Bonin, University of Montreal, for
the Quebec region; Marion Woodside, Univer-
sity of Toronto, for the Ontario region; and
Ahce Baumgart, University of British Columbia,
for the Western region.
The CCUSN Council, which consists of the
deans and directors of the 21 university schools
of nursing plus two representatives from each
ot the four regions, was meeting concurrently
with the Association of Universities and
Colleges of Canada (AUCC).
CCUSN is an organization of university
schools of nursing in Canada and has existed
since 1942. This summer at its annual meeting
JANUARY 1%9
Well-Known Speakers To Address ICN
Ottawa. - Many well-known persons from
every corner of the globe will address the ple-
nary sessions at the 14th Quadrennial Congress
of the International Council of Nurses in Mont-
real, June 22-28, 1969. The Canadian Nurses'
Association's coordinator with the ICN Con-
gress Committee, Harriet J.T. Sloan, told CNA
staff in December that most Congress speakers
have now been obtained.
Lester B. Pearson, former prime minister of
Canada, will speak at the first plenary session
on Wednesday, June 25. The topic of this
morning session is Forecasting The Future, and
Mr. Pearson will discuss the cultural, social, and
economic factors that will affect nursing. Chair-
man of the morning's session will be Mile Alice
Clamageran, of France, first vice-president,
ICN.
Other speakers at the first plenary session
include: Dr. J.D. Wallace, executive director,
Toronto General Hospital, and Miss N.K.
Lamond, South Africa. Their sub-topic is
"Technological Change in Nursing." Miss Lucy
Germain, assistant director, Pennsylvania
Hospital, Philadelphia, USA, will then discuss
"Technological Change in Administration."
Implications of Change is the topic of the
afternoon plenary session on Wednesday, June
25. Chairman Mrs. K. Pratt, Nigeria, third vice-
president. ICN, will introduce the speakers,
who are: M. Claude TeHier. a Montreal barris-
ter, and Miss J. Sotejo, dean of nursing. Univer-
sity of the Philippines. Their sub-topic is
"Technological Change and the Law." Dr. Leo
A. Dorais, director of permanent education.
University of Montreal, and Miss Nelly Garzon,
faculty. National University of Columbia,
Bogota, Columbia, South America, will speak
on "Technological Change and Human Rela-
tions."
Thursday morning's plenary session. Educa-
tion for Today and Tomorrow: Basic Programs,
will be chaired by CNA President Sister Mary
Felicitas. Speakers and their topics are: Dr.
Phihppe Garigue, dean, faculty of social
sciences. University of Montreal: "Patient and
Family-Centered Care"; Miss Ingrid Hamelin,
Finland: "Program Patterns in Basic Nursing
Education"; Miss Florence Mackenzie, director
of nursing education. The Montreal General
Hospital: "The Hospital School in Canada";
and Dr. Mildred Montag, professor of nursing
education. Teachers College, Columbia Univer-
sity, N.Y.: "The Junior College Program in the
U.S.A."
Later on Thursday morning, a panel will
discuss "The Basic Program at the University
Level." Panelists include: Dr. Rozella Schlo-
tfeldt, U.S.A.; Miss Sheila CoHins, U.K.: Miss T.
INTERNATIONAL
COUNCIL OF NURSES
T4lh QUADRENNIAL
CONGRESS 1969
MONTREAL CANADA
^P
CONSEIL INTERNATIONAL
DES INFIRMIERES
XIVcCDNGRES
QUADRIENNAL 1969
MONTREAL CANADA
Agah, Iran; Miss M. Kaneko. Japan; and Mr.
M.A. .Ahad. India.
The plenary session on Thursday afternoon
will be chaired by Miss E. Louise Miner. CNA
president-elect. The topic is Education for
Today and Tomorrow: Post-Basic and Post-
graduate Programs. Mile Jane Martin. France,
will speak about 'Aims for Tomorrow." A
panel discussion about "Teaching Tomorrow's
Nurses" will be chaired by Dr. Gerald Nason
president of the Canadian Teachers' Federation.
Panelists include: Miss B. Salmon. New
Zealand; Miss W. Hector. U.K.; Mile J. Demau-
rex, Switzerland.
Speakers at Friday morning's plenary
session include: Gilles Paquet, Carleton Univer-
sity, Ottawa, who will discuss "Health Care
Economics"; Bernard Blishen, dean, graduate
studies, Trent University, whose topic is
"Socialized Medicine or Not? "; Miss E. Cant-
well, U.S.A., who will discuss "The Nurse-
Personal Security"; and Mrs. G. Zetterstrom
Lagervall, Sweden, who will talk about "The
Professional Association and Economic Secu-
rity for the Nurse."
Dr. Robert Merton. the well-known U.S.
sociologist, is the first speaker at the Friday
afternoon session, which will be chaired by Miss
Ruth Elster, Germany, second vice-president,
ICN. Under the topic Leadership in Action, Dr.
Merton will discuss "The Nature of
Leadership." He will be followed by Miss J.C.
Rodmell, Australia, and Miss Antje Grauham,
Germany, who will discuss "Leadership and the
Administrative Process" and "Education for
Leadership" respectively.
The two final speakers on Friday are: Mrs.
Jytte Kiaer, Denmark, who will speak about
"Leadership for Technological Advance in
Nursing"; and Professor Charlotte Searle, South
Africa, who will discuss "Leadership in the
Nursing Context of Tomorrow."
The ICN governing body, the Council of
National Representatives, meets Monday and
Tuesday, June 23 and 24, All Congress
participants are invited to attend these sessions
as observers.
THE CANADIAN NURSE 7
Special
offer to CN A
members
/ #
"The Leaf and The Lamp'
CNA's Diamond Anniversary Publication
The Canadian Nurses' Association proudly
announces that its 60th anniversary publication.
The Leaf and The Lamp, will be available in
mid-May.
An overview of the first 60 years of the CNA,
The Leaf and The Lamp brings quickly into focus
Canadian nursing as it is today, and will be
tomorrow; then dips back into history for a review
of the origins, beginnings and highlights of the
profession in Canada.
It is a fact-filled book that will be a handy
reference. The Leaf and The Lamp is a must for the
bookshelf of every nurse — student, active or
retired — and for everyone interested in nursing
and its future.
Advance Offer— $2.50 per copy
A pre-publication offer enables you to order the book now at
$2.50 per copy. Be among the first in Canada to obtain a copy of
the first press run of this important document.
To: Canadian Nurses' Association
50 The Driveway, Ottawa 4, Ontario
Please send me (No. of copies)
of The Leaf and The Lamp
at the pre-publication price of $2.50 per copy.
I enclose a cheque D or money order D
NAME
ADDRESS
Present position
Registration No
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8 THE CANADIAN NURSE
JANUARY 1%9
news
it radically changed the structure of the Confe-
rence in an effort to take a stronger and more
active role in higher education for nurses.
OHSC Raises Bonus Rates
For Service Personnel;
Teachers' Bonuses Remain Same
Toronto. — The Ontario Hospital Services
Commission has agreed to raise the bonuses to
university-trained nursing service personnel and
not to lower the bonus paid to university-
trained teachers of nursing. The OHSC had
previously suggested that salary bonuses paid
for university educational preparation should
be equal for nursing service personnel and
nursing education personnel, but wanted to
equalize the two by lowering the teachers'
rates.
The new rates for both service and educa-
tion personnel are $40.00 a month for one-year
university preparation, $80.00 a month for
bachelor's preparation, and $120.00 a month
for master's preparation. This is the same rate
that has been given to teachers for the past
three years.
The service personnel rates were raised from
a $25.00/$55.00/$100.00 scale.
The new rates were put forward at a
meeting of representatives from the Ontario
Hospital Association, the Ontario Hospital
Services Commission, and the Registered
Nurses' Association of Ontario.
The rates are lower than those recommend-
ed by the Registered Nurses' Association of
Ontario. However an RNAO spokeman said
that the organization was satisfied with the new
rate.
CEGEP System Explained
At ANPQ General Meeting
Montreal - The operation of the Colleges
d'enseignement general et professionel was the
topic of a speech given by Therese D'Aoust to
the general meeting of the Association of
Nurses of the Province of Quebec. The meeting
was held in Montreal October 31 to November
1.
CEGEP colleges offering nursing have in-
creased from 12 in 1967 to 20 in 1968. Dawson
College in Montreal is expected to open the
first English-language school in September,
1969.
Miss D'Aoust explained that there is only
one category of instructor within the system,
responsible for theory, clinical teaching, clinical
programs, supervision of cUnical orientation,
clinical evaluation, laboratory sessions in
nursing care, and evaluation of nursing care
demonstratidns.
Rita Lussier, of the Quebec Hospital Asso-
ciation, questioned Miss D'Aoust about the one
category of instructor, saying that a nurse
seldom has experience in all fields. Miss
D'Aoust pointed out that the instructor would
be responsible for only one field of nursing
care.
JANUARY 1%9
Two members of The Montreal General Hospital Alumnae Association examine a
collection of nurses' uniforms, caps, and other mementos representing the years
between 1915 and 1960. The Ottawa branch of the alumnae association donated
the display to the Archives of the Canadian Nurses' Association, Ottawa On the
left is Miss Grace Tanner, sister of the founder of the alumnae association; on the
right is Miss Jean Kerr, who at 97 is the oldest living graduate of The Montreal
General Hospital Photo was taken in the CNA library.
Qualifications of instructors in the CEGEP
system are: a master's degree for directors, and
a baccalaureate degree for instructors. Preferen-
ce is given to those who held positions in
hospital schools of nursing. An experienced
nurse without the required qualifications, but
with an outstanding ability to communicate
would be considered. Opportunities are
provided for instructors to improve their quali-
fications within the system.
RNAO Holds Regional
Conferences On Audiovisual Aids
Toronto. - "Today's child is in an image-
structured, not a print-structured world, busi-
ness is 25 years ahead of education in the use of
the media and the Church is 25 years behind
education." This is how David Clee, professor
of education in charge of the Educational
Media Center at the College of Education,
University of Toronto, explained the "why" of
audiovisual aids in education to the 125 dele-
gates attending the Regional Conference on
Audiovisual Aids, sponsored by the Registered
Nurses' Association of Ontario, held in Toron-
to, November 11 to 14. Mr. Clee stressed the
importance of personal qualities of the teacher
and of non-verbal means of communication
within the context of the new dialogue ap-
proach in teaching: "What I'm told I forget;
what I see, I remember; what I do, I under-
stand."
Lou Wise, assistant director of the Visual
Aids Department, Toronto Board of Education,
highlighted advances in the use of visual aids in
the high schools in Toronto and illustrated how
some of these aids could be used.
Patricia Prentice, nursing instructor, school
of nursing, Ryerson Polytechnical Institute,
showed how slides could be prepared and used
in nursing education. Betty Bennett, of the Quo
Vadis School of Nursing, pointed out some of
the ways in which tapes could help nursing
teachers. The advantages and disadvantages of
overhead projectors using opaque materials and
transparencies were explained by Sylvia Mount-
ney of the Nightingale School of Nursing.
Heidi Yamashita, assistant director. Nightin-
gale School of Nursing, gave a breakdown of
the costs, equipment, and planning required for
the production of home movies.
THE CANADIAN NURSE 9
What a way to start the day!
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10 THE CANADIAN NURSE
JANUARY 1%9
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SJANUARY 1%9
THE CANADIAN NURSE 11
news
The closing speaker was Barbara Smith,
coordinator of Ubraries, Board of Education for
the town of Missassauga. Miss Smith stressed
the role of libraries as service centers and
summarized the types of services presently
available and outlined the library services of the
future. She also called for greater cooperation
between experts in the fields of nursing educ-
ation and information science.
The lectures were supplemented by question
and discussion periods as well as demons-
trations.
ICN Congress Registration
Continues To Lag
Ottawa. - To date, only 219 Canadian re-
gistered nurses and 1 1 Canadian nursing stu-
dents have registered for the 14th Quadrennial
Congress of the International Council of Nurses
to be held in Montreal June 22-28, 1969. "We
are somewhat concerned about this slow regis-
tration," Harriet J.T. Sloan, the Canadian
Nurses' Association's coordinator for the ICN
Congress Committee, told CNA staff at a
December meeting, "as it is most essential that
there are sufficient Canadian nurses to act as
hostesses for our international guests." Miss
Sloan pointed out that 2,822 of the 6,213
registrants (45.4 percent) at the ICN Congress in
Montreal in 1929 were Canadian.
The Congress, which begins on Sunday,
June 22, with an Interfaith Meeting at Notre-
Dame Cathedral, is expected to attract over
12,000 nurses from all over the world. As of
December 6, registration of foreign nurses was
400.
The ICN Congress registration fee is $40 if
received by CNA before January 22. Late re-
gistrations will be accepted, but the fee will be
$60 after that date.
Student registrants are welcome to attend
all sessions of the Congress, including the color-
ful opening ceremonies on Sunday, June 22.
Two hundred students from Canada are allowed
to register. Applications will be processed on a
first-come, first-served basis.
Schools Evaluate Tests
As Educational Aids
London, Ont. - "Testing: Frustration or
Facilitation" was the theme of the workshop
held on November 8 and 9, 1968 in Holdsworth
Auditorium, Victoria Hospital, London, School
of Nursing. The program, which was planned as
an inservice project for the combined faculties
of St. Joseph's Regional School of Nursing and
the Victoria Hospital School of Nursing was
attended by 70 teachers.
Dr. Josephine Flaherty, a specialist in the
field of evaluation and testing, shared ideas
from her experience and research. Group
discussions provided an opportunity for the
exchange of ideas and concerns encountered in
evaluating nursing students.
12 THE CANADIAN NURSE
Ottawa. - The Nurses' Alumnae Association of the Ottawa General Hospital and of the Univer-
sity of Ottawa School of Nursing, held its first Memorial Tribute Service to Canadian Nurses
before the Nurses' Memorial, Hall of Honor, Parliament Hill, on November 10.
Margaret Olsiak (right), president of the Alumnae Association, presented a wreath on behalf of
her Association. Margaret D. McLean, second vice-president of the Canadian Nurses' Asso-
ciation, represented CNA at the Service. She addressed the assembly and placed a floral tribute
before the Memorial.
Shown with Miss MacLean and Miss Olsiak are Rosario Gendron (left), parliamentary secretary
to Health Minister John Munro, and Father Paul-Emile Sanschagrin, University Chaplain.
United Nurses Of Montreal
Hold Second Annual Meeting
Montreal- The second annual meeting of
the United Nurses of Montreal took place
Friday evening, November 29, in the audito-
rium of the Royal Bank Building, Place Ville
Marie.
The United Nurses of Montreal is a union of
Professional nurses formed in 1966 by the
EngUsh Chapter, District XI of the Association
of Nurses of the Province of Quebec.
It represents 3,000 nurses in 21 English-
speaking hospitals on the island of Montreal, as
well as nursing personnel in the Northern
Electric Company, the Protestant School Board
of Greater Montreal, the City of Westmount,
the Victorian Order of Nurses (Greater
Montreal, Lachine-Dorval and Ste Anne de
Bellevue branches), the Children's Service
Center and Child Health Association.
Presented by Wendy D. Rogers, president,
on behalf of the executive and board of direc-
tors, the report covered the union's activities
from November 1, 1967 to October 31, 1968
for both the general membership and the asso-
ciate group.
Among the subjects Mrs. Rogers summa-
rized were the number of contracts signed,
progress of negotiations, finances, education
and future plans.
Particular emphasis in the report was given
to the union's efforts to teach member nurses
the significance^of the clauses in the contracts
and their importance to them as individuals and
to the profession. This was done through orga-
nized workshops and UNM councillors.
She also dealt with the progress of the
publicity, health insurance, pension plan, and
financial committees. One of the union's
greatest achievements, stressed Mrs. Rogers, was
the formation of the Joint Committee on
Nursing. This committee is made up of five
members of the UNM, representing various
levels in the nursing profession, and of five
administrators, representing the administration
of Enghsh-speaking hospitals in Montreal It has
been working on a definition of the role of the
nurse and will continue working out definitions
of the different categories of nurses and of
nursing itself.
Tribute was paid to executive secretary
Margaret K. Stead. Mrs. Rogers said that Miss
Stead's knowledge of labor relations and her
expert guidance through negotiations had been
invaluable assets to UNM. Mrs. Rogers was also
gratified to note that the UNM had become
involved in government and professional activi-
ties. For example, last March it was invited to
send a representative to the meetings on the
Superior Council of Nursing, a government
JANUARY 196S
committee under the Minister of Health, which
studies, among other subjects, the workload of
nuises.
The UNM is also a member of the advisory
committee set up by the Department of Educa-
tion for the CEGEPs, under which system
nuises in the diploma course will be trained in
Quebec in the future.
Mrs. Rogers mentioned the union's fruitful
association with SPIQ, (Syndicat Professionnel
des Infirmieres du Quebec), a union of 3,000
nurses located chiefly in hospitals in Quebec
City and centers throughout the province.
Together, SPIQ and UNM represent more
than 6,000 nurses, the largest group of unioni-
zed nurses in the province.
The two unions present their contracts
together to the Association of Hospitals of
Quebec and the Department of HeaHh.
Negotiations commenced last April and
meetings take place regularly, reported Mrs.
Rogers. To date, a number of nonmonetary
clauses has been settled satisfactorily. Plans for
the future include restructuring the constitu-
tion of the UNM to provide for an enlarged
membership.
Copies Of Speeches Requested
So Requested Speeches Copied
Ottawa. - So many requests have been
received for copies of the papers presented at
the clinical sessions held during the Biennial
Convention of the Canadian Nurses' Asso-
ciation in July that the Association has decided
to publish them.
Valerie Foumier, CNA Public Relations
Officer, has announced that the papers will be
presented in mimeographed form in a single
volume. The cost will be $2.50.
Not all the papers are presented, as some
speakers did not supply copies of their
speeches. However, the volume contains those
papers from the sessions on nurses and the
practice of nursing, continuity of patient care,
Canadian testing service, clinical fields in
nursing education, and clinical research in
nursing.
NBARN Organizes
For Collective Bargaining
Fredericton. - The Provincial Collective
Bargaining Committee of the New Brunswick
Association of Registered Nurses met for the
first time on November 28th and 29th, 1968.
This historic meeting, which was held in Frede-
ricton, was a further step in preparation for
collective bargaining under anticipated labor
legislation. Committee members were assisted
by Glenna Rowsell, Consultant in Social and
Economic Welfare of the Canadian Nurses'
Association, Ottawa.
The Provincial Committee will form part of
the provincial collective bargaining structure.
This structure was designed to function on a
province-wide basis under the anticipated legis-
lANUARY 1%9
lation. The 12-member committee represents all
nurses' staff associations in the province.
The majority of nurses in New Brunswick
are included under the new Public Service
Labour Relations Bill, which has gone through
second reading in the Legislature. This will
provide the collective bargaining framework for
nurses and other public servants once it is decla-
red law. The Bill would provide a choice of
arbitration or strike vote for public service
employees.
At present, New Brunswick nurses do not
have collective bargaining rights.
Possible Change
In RNAO Bylaws
Toronto. - Members of the Registered
Nurses' Association of Ontario will be asked to
vote on changes in the categories of member-
ship at the Annual Meeting May 1-3, 1969. If
accepted, the changes, which were recom-
mended by the RNAO board of directors at its
meeting November 22-23, would take effect in
1970.
Prior to 1966, there were four types of
membership in RNAO: honorary, active, asso-
ciate, and inactive. In 1966, the bylaw was
changed, reducing the number of categories to
two: honorary and regular. The present mem-
bership fee for regular members is $35 per year.
The RNAO board of directors recommends
that the bylaws be changed to permit:
9 An affiliate membership with a fee of $18.
for the non-working nurse. If the nurse returns
to work, she would pay a differential fee of
$17.
• An out-of-the-province affiliate membership
at $12.
• An affiliate membership with a fee of $18
for registered nurses who are enrolled for full-
time study at university.
• An associate membership with a fee of $18
for graduate, non-registered nurses who are
members of local collective bargaining units
recognized by RNAO under the requirements
of the Labour Relations Act in Ontario. This
change would be reviewed in three years.
• Present membership in RNAO, which is
voluntary, is approximately 13,000.
Aspirin May Cause Ulcers.
Chicago. - Aspirin may contribute to the
formation of gastric ulcers, according to a
report presented to the 54th Annual Clinical
Congress of the American College of Surgeons
in Atlantic City.
Drs. Rene Menguy and Martin H. Max, of
the Pritzker School of Medicine, University of
Chicago, said investigation showed that aspirin
taken orally significantly impairs the abiUty of
cells to produce a protective mucous coating.
Recent research with dogs has shown that
aspirin administered so that it does not come
into contact with the stomach lining causes an
increased loss of cells from the lining, due to
the action of circulating aspirin rather than
direct contact.
Over 20 million pounds of aspirin is consu-
med annually in the United States.
Haute Couture On The Wards
MontreaL - It isn't a famous Dior or Ba-
lanciaga model - but it looks just as good.
The new uniform for nursing students at the
Colleges d'enseignement general et profession-
nel (CEGEP - Colleges of general and profes-
sional education) was designed to be both
practical and beautifuL
The white, one-piece, loose-fitting, short-
sleeve dress buttons down the left front in a
modified "Ben Casey" style. A uniform for
male students has a similarly shaped jacket
worn with white trousers.
The uniforms will be worn in all CEGEPs
throughout the province. They have been on
trial in three schools already and have proved
satisfactory.
ANPQ Committees Discuss
Uniform Nursing Techniques
Montreal - Two meetings of the nursing
and education committees of District XI, of the
Association of Nurses of the Province of
Quebec, were held in October and September
to establish uniform nursing techniques that
might be applied in hospitals throughout the
province. The meetings were intended to
provide opportunities to analyze and develop
the nursing techniques.
Sister Bernadette Poirier, director of nursing
at Notre-Dame Hospital in Montreal, spoke of
the basic criteria of the nursing profession, the
purpose of nursing studies, and outlined rela-
tionships between nursing and the government.
P. Desautels, Claudette Domingue, and Evelyn
Adam took part in a round-table discussion
following the talk.
The two meetings were held at Jean Talon
Hospital and Notre-Dame Hospital in Montreal.
Some 225 nurses attended.
THE CANADIAN NURSE 13
news
RNABC Donates $ 5,000
To CNA For ICN Costs
Vancouver. - The Registered Nurses' Asso-
ciation of British Columbia donated $5,000 to
the Canadian Nurses' Association in December
to help defray expenses for the 14th Quadren-
nial Congress of the International Council of
Nurses to be held in Montreal June 22-28,
1969. RNABC is the second province to make a
donation. Last month the Registered Nurses'
Association of New Brunswick donated $5,205.
Commenting on RNABC's generous contri-
bution, 0r. Helen K. Mussallem, CNA executive
director, said that the gift is a most welcome
one in view of the heavy expenses that are in-
volved in being the hostess country.
At least four provinces, including British
Columbia, Ontario, Manitoba, and New Bruns-
wick are sending their public relations officers
to help the CNA press team at the ICN Con-
gress. More than 100 representatives from
nursing journals, newspapers, TV, and radio are
expected to cover the Congress.
Pembroke Hospital Sponsors
Team Nursing Workshop
Pembroke, Ont. - "There's a better way -
find it." That is the motto Thora Kohn, an U.S.
expert on team nursing, told 83 nurses attend-
ing a three-day Workshop on Team Nursing
held at the Pembroke General Hospital, Octo-
ber 22 to 24. Mrs. Kohn is author of two books
on team nursing. Team Nursing Leadership and
Communication in Nursing.
The Workshop, part of the hospital's in-
service education program, was attended by
nurses from six eastern Ontario centers. It
included topics on communication, formulation
and use of nursing care plans, team conferences,
easy steps in team nursing, and leadership in
team nursing.
Dorothy Desjardin, inservice education
coordinator at Pembroke General Hospital and
chairman of the workshop committee, com-
mented on the interest and eagerness of nurses
to reorganize their methods of team nursing.
"We would like to emphasize for the benefit of
other nurses the advantages of team nursing and
the fact that it can be implemented in most
nursing unit assignments," she said.
Lung Cancer On Rise In Canada
Offjwa.-The death rate from the lung cancer
epidemic plaguing Canada increased 10 percent
between 1966 and 1967, reports the Minister of
National Health and Welfare John Munro. The
disease caused 4,318 deaths in 1967, up from
3,844 in 1966. Of these deaths, 3,700 occurred
among men, 618 among women. The rate per
100,000 population, statistically standardized
to the 1961 census population to allow compa-
rison, was up for men from 32.9 in 1966 to
36.3 in 1967. For women the increase was from
5.3 to 5.8.
Lung cancer is now the leading cause of
14 THE CANADIAN NURSE
death from cancer in Canada for men and for
men and women combined. Twenty-four
percent of male cancer deaths and five percent
of female cancer deaths were due to this disease
in 1967.
"The tragedy is that so many lung cancer
deaths are preventable," Mr. Munro said. "Most
are attributable to cigaret smoking. Obviously
the best prevention is for a person to never start
the habit. However, it usually takes many years
of exposure to cigaret smoke before lung cancer
develops. As long as the disease is not already
present, on discontinuance of smoking the risk
of its development gradually decreases until it
approaches that of a non-smoker. The risk of
other cigaret-smoking diseases - chronic bron-
chitis, emphysema, and coronary heart disease
- also decreases when the habit is dropped.
"There is, unfortunately, a time lag between
changes in smoking practices and mortality
from related diseases." Mr. Munro added.
"Favorable changes in the former are not
immediately refiected in the statistics.
However, the benefits of discontinuing smoking
are already indicated by the experience of
British doctors, a large number of whom have
stopped. Between the periods 1954-57 and
1962-64, the doctors' lung cancer death rate
decreased 30 percent while that of British male
population increased 25 percent.
AMNIHOOK
disposable amniotic membrane perforator
economical
time-saver
provides
protection for
both mother
and child
AmniHook provides the doctor with an improved
technique for inducing labor by amniotomy. The
instrument's rounded, blunt end and protected
sharp point are designed to safeguard mother and
fetus against injury. AmniHook has benefits for
the hospital too. Each AmniHook is individually
sterile-packed and ready for use, so it may be
stored right in the labor room. Once used, the
AmniHook is discarded, saving both the time and
expense of resterilization.
L^ HOLLISTER
HOLUSTER INC., 211 E. CHICAGO AVE., CHICAGO, ILL. 6061!
lANUARY 1969
We won't take just any nurse
Only those committed narses willing to work
for a low salary under demanding conditions in
any of 45 developing countries around the world
To pick up this professional challenge,
you have to be highly motivated. Eager
to put your own talent to work. Aware
of the need of developing countries for
mature, competent people, ready to
lend a hand. You have to decide to
spend two years of your life working
on the world's number one problem —
development.
If we're getting to you, you aren't
just any nurse. You're the kind of
nurse we need at CUSO.
Tell us what you can do. We'll tell you where you are needed.
I would like to know more about CUSO (Canadian University Service Overseas)
and the opportunity to work overseas for 2 years. My qualifications are as follows:
I hold-
(degree or diploma)
Post graduate courses, if any.
-in nursing, from.
(university or school of nursing)
My present type of work is-
Other experience
Name
i#i.5^:
Address-
Send to: CUSO (Information)
151 Slater Street, Ottawa, Ontario
-Prov.
CUSO
Development
Is our business
JANUARY 1%9
THE CANADIAN NURSE 15
news
MARN Co-sponsors Program
For inactive Nurses
Winnipeg. - If Manitoba is to attain the
recommended minimum of 450 nurses per
100,000 population by 1970, an annual in-
crease of five percent must be maintained. To
this end the Manitoba Association of Registered
Nurses and the Manitoba Hospital Commission
are co-sponsoring a refresher course for inactive
nurses who have been previously registered.
The shortage of nurses in Manitoba eased
slightly during the fall after an acute shortage
during the summer. There are still shortages in
parts of the province, however.
Although no new hospital beds were opened
in Metropolitan Winnipeg during 1968, addi-
tional facilities are presently being planned or
are in construction, and they will require addi-
tional nurses. MARN maintains the shortage is
due to too many nurses being held in adminis-
trative or clerical duties, while non-skilled
personnel are caring for patients. The high
mobility rate of Manitoba nurses increases the
problem.
BC Nurses Begin Two Workshops
Vancouver. - Twenty-three nurses began
the first in a series of Intravenous Therapy
Courses at St. Paul's Hospital, Vancouver, on
Sept. 9. The courses are sponsored by the
hospital, the Registered Nurses' Association of
British Columbia, and the B.C. Hospital Asso-
ciation. The second in the series is to begin
February 14. The entire group takes a week of
theory and then groups of four nurses return
for the clinical part of the course. Because of
this, the second course will extend until June
27.
The first in a series of eight-week Intensive
Care Nursing courses begins at Vancouver Gen-
eral Hospital on January 6. This is sponsored by
The Vancouver General Hospital, RNABC, and
BCHA. The B.C. Hospital Insurance Service is
underwriting the cost of the full-time instruc-
tor, Shirley Stokes, who has worked for several
years in the cKnical area of intensive care and
emergency at The Vancouver General Hospital.
Housing Affects Health
Ottawa. - Health workers can influence
planning for housing and help to ensure that it
is based on social, cultural, and personal needs,
according to a consultant with the Department
of National Health and Welfare.
Dr. H.N. Colburn presented a paper entitled
"Health and Housing" to the Canadian Confer-
ence on Housing, meeting in Toronto October
20-23. Health workers have a special contribu-
tion to make, according to Dr. Colburn,
because of their knowledge of people as indi-
viduals rather than masses. For the most part
they are not making this contribution, he
stated.
Dr. Marvin Lipman, a consultant on urban
environment with Central Mortgage and
16 THE CANADIAN NURSE
"Fasten Seat Belt, Please'
Pontiac, Mich. ~ The American Seat Beh Council's new safety slogan, "Don't be a
Buckle Boob," is penetrating even into hospital halls, as noted here. Barbara M.
Gast of Royal Oak, Michigan, buckles up in her wheelchair at St. Joseph Mercy
Hospital, Pontiac, Michigan, at the direction of nurse Jane Gallagher. Hospital
installed, the belts protect weak or very ill patients who might otherwise tumble
from chairs. American Safety Equipment Corporation helped solve the problem
with a special adaptation of its airplane seat belts, standard on many airlines.
Barbara, who had an accident with her car on her way to classes at Oakland
University, now has a double appreciation of the value of seat belts.
Housing Corporation, stresses an increasing
need for a greater range of choices in housing
environment for all Canadians, including low-
income groups. More amenities to make the
home not merely a shelter, and more opportu-
nities in housing to allow for varied forms of
management and ownership are also necessary.
The Canadian Conference on Housing was
sponsored by the Canadian Welfare Council,
with the financial support of Central Mortgage
and Housing Corporation, the Ontario provin-
cial government, and industry.
Father Should Dominate
Says Hamilton Doctor
Vancouver. - The dominant member of the
family should be the father, even during preg-
nancy and labor, according to Dr. Murray
Enkin of Hamilton, Ontario.
Dr. Enkin was speaking to a meeting spon-
sored by the National Childbirth Trust in
Vancouver October 3. He said that the domi-
nant role during pregnancy and labor can be
maintained by training the husband, who then
trains his wife, in the psychoprophylactic
method of childbirth. During labor, it is the
husband who will give the commands, rather
than a doctor.
Dr. Enkin, who teaches the psychopro-
phylactic method at St. Joseph's Hospital,
Hamilton, illustrated his lecture with slides.
Some 100 nurses, prenatal teachers, and obste-
tricians attended the meeting. □
[be A BLOOD D0N0R|
JANUARY 1969
New Nursing Books
Understand how and why drugs act
The Pharmacologic Basis of Patient Care
by Mary Koye Asperheim, B.S., M.S., R. Ph., University of Wisconsin
Hospitals.
This brand new text and reference uses a refreshing
new approach to pharmacology. Instead of giving a
list of diseases, drugs, and dosages to be memorized
by rote, it explains the basic principles and concepts
so that you understand how specific drugs work and
why they ore used. Miss Asperheim gives excellent
brief reviews of the chemistry and physiology involved
in drug action, and offers a concise "refresher course"
in the mathematics of drugs and solutions. She dis-
cusses methods of administration; the absorption, fate,
and excretion of drugs; allergic reactions and immu-
nity. Then she takes up each class of drugs in turn,
from topical antiinfectives to radioactive drugs. All
important information on each drug is presented in
one place. Chapters on diagnostic drugs, toxicology,
and drug addiction and habituation complete the
coverage. Each chapter opens with an outline of the
important concepts to be discussed, and ends with
questions for discussion and review.
417 pages, illustrated. $7.60. New — Published October, 1968.
Facts that concern every nurse
The Nurse and the Law
by Harvey Sarner, LL.B.
In this fact-filled new book, an experienced attorney
gives sound, constructive advice on problems that
every practicing nurse must face daily. In a clear,
direct style, he explains such complicated subjects as
malpractice, negligence, liability, and privileged com-
munications. He discusses contracts, wills, and work-
men's compensation; tells how to get the best insurance
coverage for your particular needs at the lowest cost;
shows you how to make secure provision for your own
retirement; and points out ways you can minimize
your taxes. A wise counselor, Mr. Sarner advises you
not only on how to meet legal problems, but on how
to ovoid them — advice that no nurse can afford to
be without.
219 pages. $7.05. New — Published April, 1968.
Appreciate nursing's heritage
History of Nursing
by Josephine Dolan, R.N., M.S., University of Connecticut.
From the magic of the witch doctor to the miracles of
modern surgery, this well-known text traces the influ-
ences of religion, medicine, and the biological and
social sciences and weaves them into a comprehensive
picture of the emergence of nursing as a profession.
In the New (12th) Edition, just published, Miss Dolan
has completely revised and considerably expanded the
text and added thirty new illustrations. You'll find the
most recent developments in nursing practice descri-
bed, including Project HOPE, the Peace Corps, and the
important changes in the structure of the National
League for Nursing that were effected in 1967.
380 pages
1968.
with 310 illustrations. $9.20. New — Published August,
Concise review of current clinical nursing
Saunders Tests for Self-evaluation
of Nursing Competence
by Dee Ann Gillies, R.N., M.A., Cook County School of Nursing,
and Irene Barrett Alyn, R.N., M.S.N., University of Illinois.
This new self-teaching and self-evaluating review of
clinical nursing is ideal for students and graduates
who are preparing for examinations as well as for
nurses changing to a new specialty or returning to
practice after an absence. For each specialty area —
Maternity and Gynecologic, Pediatric, Medical-Surgical,
Psychiatric — the authors describe typical case histo-
ries and presenting situations, then ask a series of
perceptive questions about them. As the cose develops,
more information is introduced and more questions
asked. Each unit includes a helpful bibliography and
there is a complete index. Perforated IBM-type answer
sheets (and correct answers) ore provided.
426 pages. $7.30. New — Published April, 1968.
— ^ -■ - ' - .V'i^JH
W. B. SAUNDERS COMPANY Canada Ltd., 1835 Younge Street, Toronto 7
Please send on approval and bill ma:
n Asperheim: Pharmacologic Basis of Patient Care ($7.60) D Dolan: History of Nursing ($9.20)
D Sarner: The Nurse and the Law ($7.05) D Gillies & Alyn: Self-evaluation ($7.30)
Name: ..
Address:
aty:
.Zone: Province:
lANUARY 1%9
CN I-69
THE CANADIAN NURSE 17
names
Sally Tretiak Glenna M. Gorrill
Sally Tretiak (B.A., U. Manitoba; R.N.,
Winnipeg General; M.A. (Admin.N.Ed.),
Columbia U., New York) and Glenna M. Gorrill
(R.N., Gait School of Nursing, Alta.; Dipl.
Teach, and Superv., U. Alberta; B.Sc. N., Leth-
bridge Junior College, U. Alberta; M.N., U.
Washington)„have joined the teaching staff of
Red Deer Junior College in Red Deer, Alberta.
Miss Tretiak served with the World Health
Organization as an educator in south-east Asia
before becoming associate professor at the
school of nursing, University of Alberta. Her
earlier career inclu<Jed numerous positions as
staff nurse, supervisor and instructor in Mani-
toba, Ontario, and Nova Scotia.
Miss Gorrill's career has been centered in
Lethbridge, Alberta. She was head nurse at Gait
Hospital; assistant associate director of nursing
service at Lethbridge Municipal Hospital; and
associate director of nursing education at Gait
School of Nursing.
^^M^^^ Mary Peever (R.N.,
^^^^H|H||l Royal Victoria H.,
^^^^^^^k Montreal; Cert.P.H.N.,
W.^ _ ^P B.N., U. Man.; M.Sc,
■T^V^'IKPH U. Colorado) was
^ y^w^ ^r appointed chairman of
•*' -9 W the department of
^ '■■^^^Jf' nursing education at
■Al ^^f Mount Royal Junior
mt^t^i College, Calgary, in
August 1968. Prior to this appointment. Miss
Peever was instructor in maternal and child
nursing at the College (see "Names" April
1968).
Appointed assistant professor in public
health nursing at the University of Saskat-
chewan is Jean Coppock (R.N., Alberta H.,
Ponoka; B.N., McGill; M.Sc, Boston U., Mass.).
After working as a staff nurse and then head
nurse at Alberta Hospital in Ponoka, Miss
Coppock was appointed nursing supervisor at
Lamed State Hospital, Kansas. After spending
two successive years as staff nurse at Eloise
State Hospital in Wayne, Michigan, and at St.
Francis Hospital in Honolulu, Hawaii, she re-
turned to Canada where she was appointed
head nurse at Alberta Hospital in Edmonton.
From 1964 to 1966, she was employed by
18 THE CANADIAN NURSE
the World Health Organization at the University
of Ghana, Africa, as instructor in clinical
psychiatric nursing.
Three appointments have been announced
to the faculty of the school of nursing at
Oshawa General Hospital, Ontario.
Marjorie Hicknell
(Reg.N., St. Mary's H.,
Kitchener; Dipl. N. Ed.,
B.Sc.N., U. Western
Ont.) has been named
assistant director of
nursing education. Miss
^ ^^I^^^H Hicknell has worked in
^ <^'»^a Sudbury, Edmonton,
London, and Sarnia as a
staff nurse. She spent eight years as a teacher in
the school of nursing, Victoria Hospital in
London, Ontario.
Megan Russell (B.N., U. Manitoba) has been
appointed as a teacher. Mrs. Russell previously
taught at The Children's Hospital of Winnipeg.
Audrey Wilson (Reg.N., Toronto General;
B.Sc.N., U. Western Ont.) is named medical-
nurgical teacher. Mrs. Wilson worked for 10
years at the Montreal Neurological Institute as
general staff nurse, head nurse, and instructor.
Hazel Wilson
(Reg.N., Ottawa Civic
H.; Cert. Admin. &
Superv., P.H.N.,
B.Sc.N., U. Toronto;
Cert. P.H.N. , M.Sc.N.,
McGill) has recently
been appointed to the
Research and Planning
Branch of the Ontario
Department of Health.
Miss Wilson worked as a public health nurse
in Alberta, Manitoba, and Ontario. From 1951
- 1959 she was supervisor of nursing in the
Kenora and district health division. Prior to
attending McGill, she was regional consultant
with the public health nursing branch of the
Ontario Department of Health.
The board of directors of the American
Nurses' Association has announced the resig-
nation of Judith G. Whitaker, R.N., as
executive director. Before assuming her post in
1958, Mrs. Whitaker had served as deputy exe-
cutive director for six years.
The president of ANA, Dorothy A.
Cornelius, paid tribute to Mrs. Whitaker,
saying: "During her tenure as executive direc-
tor, the Association has increased its member-
ship, more than doubled its staff and operating
budget, and effected a basic reorganization in
order to extend its activities and functions on
behalf of nursing in the public interest. Mrs.
Whitaker has visited and worked with the con-
stituent associations in all 50 states and has
served on a variety of national and international
commissions dealing with virtually every aspect
of nursing."
Mrs. Whitaker has agreed to continue to
serve as executive director until September
1969 to enable the Association to select a
successor. The board of directors has expressed
regret in accepting the resignation but hopes
that Mrs. Whitaker will continue at least for a
time to serve the Association in some other
capacity.
Margaret E.V. Irwin
(Reg.N., Hamilton Civic
H.; B.Sc.N., U. Western
Ont.; B.L.S., U.
Toronto) has returned
to the Victoria Hospital
School of Nursing as
librarian.
Before attending
library school. Miss
Irwin worked successively as staff nurse, in-
structor, and librarian at the Victoria Hospital
School of Nursing.
Catherine Reban
(B.Sc.N., U. Sask.) has
been named instructor
of nursing funda-
mentals at Mount
Royal Junior College in
Calgary. Miss Reban
worked for a number of
years with the Saskat-
chewan Department of
Public Health in Rosetown and with the
Alberta Department of Public Health in
Calgary. She also taught maternal and child care
for one year at University Hospital in
Saskatoon.
Several new staff members have been
appointed to the faculty of the University of
Toronto School of Nursing. Named assistant
professors are: Norma Dick (B.A., B.Sc.N., U.
British Columbia; M.Sc.(A), McGill), formerly
supervisor of inservice education at The Van-
couver General Hospital; Hilda Mertz (B.
S.(N.Ed.), U. Pittsburgh, Pennsylvania; M.S.N.,
Yale U., Connecticut), formerly director of
clinical nursing in McLean Hospital, Massachu-
setts; and Beverly Mitchell (B.Sc.N., U. British
Columbia; M. P.H., Michigan U.), who, prior to
her appointment, was director of nursing servi-
ces. Mental Health Services, Vancouver.
lANUARY 1%9
ICN President Receives Order of Canada
Alice Girard, president of the International Council of Nurses, was among 27
outstanding Canadians who were invested in November with the Medal of Service of
the Order of Canada. The investiture ceremony took place at Rideau Hall, Ottawa
and was presided over by Governor-General Roland Michener.
After the ceremony, a private dinner was held at Government House. Dr.
Mussallem, executive director of the Canadian Nurses 'Association, attended as Miss
Girard's guest
Named lecturers are: Michelle Brideau
(B.ScN., U. Ottawa; M.Sc.N., U. Western On-
tario); Diana Gendion (B.Sc.N., Florida State
U.; M.N.Ed., U. Syracuse, New York); Margaret
Wyness (B.Sc.N., U. British Columbia); Vivian
Ewart. Jane Harlock, Elizabeth Jack, Eva
Kandorovskis, Mary McCulley, Judith MacKay,
Ruth Winkler, all graduates of the University of
Toronto School of Nursing.
The newly appointed lecturers will assist in
cUnical teaching.
Ottilia M. Bieber (R.N.,
Regina Grey Nuns' H.;
Dipl. P.H.N., U. Saskat-
chewan; B.N., McGill)
has been appointed
public health nursing
education consultant
with the public health
nursing division of the
Saskatchewan health
deparment.
Miss Bieber will take part in the expansion
and coordination of field experience in public
health nursing for students from the university
and the diploma schools of nursing in Saskat-
chewan.
Before joining the provincial health depart-
ment in 1957, Miss Bieber held positions in
doctors' offices, general hospitals, and was an
epidemiology worker with the venereal disease
control division of the British Columbia health
and welfare department.
Since joining the Saskatchewan department,
she has provided public health nursing service as
a staff nurse and was assistant to the regional
JANUARY 1%9
nursing supervisor in the Weyburn-Estevan
health region. She was promoted to regional
nursing supervisor of the Yorkton-Melville
health region in 1960 and transferred to a
similar position in the Regina rural health
region in 1963.
Nicole Du Mouchel
(R.N., Ste.-Justine H.,
Montreal; B.Sc.N.
(Admin.), Institut Mar-
guerite d'Youville,
Montreal; M.Sc.N., U.
Montreal) has been
awarded the Warner-
Chilcott scholarship,
which will enable her to
study nursing abroad. Upon her return, she will
report in detail on her trip.
This is the second year that the pharma-
ceutical firm Warner-Chilcott has offered a
scholarship to students graduating from the
faculty of nursing. University of Montreal. Last
year, Mariette Desjardins and Sister Lorraine
Beaudin toured the Scandinavian countries on a
Warner-Chilcott scholarship. The report of this
trip is about to be published.
This year, three students at the master's
level qualified for the scholarship: Sister Rachel
Rousseau, Lisette Arcand, and Nicole Du
Mouchel. As the judges could not come to a
decision, lots were drawn. The name of the
winner was announced at the annual meeting of
the Association of Nurses of the Province of
Quebec held in Montreal, October 31 to
November 1, 1968.
Next Month
in
The
Canadian
Nurse
• hyperbaric oxygen units
• two-year nursing programs
nursing service organizations,
— a modem approach
Photo credits for
January 1969
Toronto General Hospital, p.36
Dominion-Wide, Ottawa, p.8,39,43
EUefsenLtd., p.l2
Jack Marshall & Co. Ltd.,
Cooksville, p.40
Graetz Bros. Ltd., Montreal, p.41
JuUen Lebourdais, Toronto, p.42
Tara Dier, Ottawa, p.43
THE CANADIAN NURSE 19
nm flUMiiv PRODucis
POSEY SIT-'N SAFETY BELT
(Potent Pending)
Holds patient upright on commode, stroight-
bock, or wheelchoir; prevents slumping for
word. Secures potient to commode with
sofety privacy ond without nurse s constant
supervision. Shoulder strops may be used in
the front, straight over the shoulders or
criss-crossed. Adjusts to fit virtuolly oil po-
tients. Cot. No. 4220. $14.85 eoch.
POSEY VELCRO WHEEL CHAIR
SAFETY STRAP
Keeps patient from falling out of his wheel
choir. Fits virtually any size patient. Self-
adhering surfoce provides easy, quick ad-
justment. Eosily ottoched; strop remains ot-
toched to choir when not being used; for
added safety, if desired, choir moy be equip-
ped with one strop across waist and one
across lop. Mode of 2-inch wide Velcro
covered, webbing. No. 4188 (2-piece), $6.30
each.
WRIST OR ANKLE RESTRAINT
A friendly restraint available in infant, small,
medium ond large sizes. Also widely used for
holding extremity during intravenous injection
No. P-450, $6.00 per pair, $12.00 per set. With
DECUBITUS padding, No. P.450A, $7.00 per
pair, $14.00 per set.
POSEY PRODUCTS
Stocked in Canada
ENNS & GILMORE LIMITED
1033 Rangeview Road
Port Credit, Ontario, Canada
August 1968 - June 1969
The National League for Nursing is
sponsoring o series of 12 two-day
workshops in several U.S. cities for
persons involved in administration,
planning, and evaluation of hospital
nursing services. The first workshop
was held in San Francisco August 9,
1968, and the last will be held in
Miami Beach, June 26-27, 1969.
The workshops ore designed for
nurses and others interested in nurs-
ing audits, new staffing patterns, and
hospital staff development programs.
Further information and applica-
tion forms for registration may be
obtained from the Department of Hos-
pital Nursing, National League for
Nursing, 10 Columbus Circle, New
York, New York 10019.
January 20-23, 1%9
February 10-13, 1%9
March 20-23 1969
April 14-17, 1%9
Regional conferences on the use of
audiovisual aids in nursing, sponsored
by the Registered Nurses' Association
of Ontario. To be held in London in
January, Sudbury in February, Ot-
tawa in March, and Fort William in
April. Fee: RNAO members, $25; non-
members, $35. Write to: RNAO, 33
Price St., Toronto 5.
February 17-19, 1969
Second Canadian Conference on Hos-
pital-Medical Staff Relations, Chateau
Frontenac, Quebec City. Theme: Better
communications for better patient
care. Sponsored by Canadian Hospital
Association, Canadian Medical Asso-
ciation, and Canadian Nurses' Asso-
ciation.
February 24-27, 1%9
Association of Operating Room Nurses,
16th annual meeting, Cincinnati, Ohio.
March 24-29, 1%9
Symposium on recovery room and in-
tensive care nursing, Grace General
Hospital, Winnipeg. Registration: $20.
For further details: Miss J.W. Robert-
son Director - Inservice Education,
Gra'ce General Hospital, 300 Booth
Dr., Winnipeg 12.
April 13-17, 1969
American Association of Neurosurgi-
cal Nurses Meeting, Cleveland, Ohio.
Information may be obtained from:
Miss S.M. Sawchyn, 99 Fidler Ave.,
St. James 12, Manitoba.
May 19-23, 1%9
National League for Nursing, 1969
convention. To be held in Cobo Hall,
Detroit, Michigan. Fee: NLN members,
$15; non-members, $25. Write to:
NLN, 10 Columbus Circle, New York,
N.Y. 10019.
May 21-23, 1%9
Registered Nurses' Association of Brit-
ish Columbia, annual meeting. Bay-
shore Inn, Vancouver. Write: RNABC,
2130 W. 12th Ave., Vancouver 9.
May 21-23, 1969
Canadian Hospital Association, 2nd
national convention. Civic Centre, Ot-
tawa.
June 1-13, 1969
Eighth annual residential summer
course on alcohol and problems of ad-
diction, Trent University, Peterbor-
ough, Ont. Co-sponsored by I rent
University and the Addiction Research
Foundation, an agency of the province
of Ontario.
June 16-18, 1969
Conference on nursing education for
visitors to the International Council of
Nurses Quadrennial Congress. Spon-
sored by the school of nursing and
alumni association. University of To-
ronto. June 19-20: tours in Toronto
and environs to be arranged at re-
quest of persons attending conference.
Apply to the Secretary of the School,
University of Toronto School of Nurs-
ing, 50 St. George St., Toronto 5.
June 22-28, 1969
COUNCIlDiPIUKtS
COM It II laTfRWiioaAi
DESINFIOMIf*!!
iivtcoacxt
au*DMI(MM IMI
20 THE CANADIAN NURSE
International Coun-
cil of Nurses' Qua-
drennial Congress,
Montreal. Fee: be-
fore Jan. 22, $40;
after Jan. 22, $60.
Write to: ICN Con-
gress Registration,
50 The Driveway,
Ottawa 4, Ont.
August 8-10, 1969
Reunion of Moncton Hospital School of
Nursing Alumnae, New Brunswick.
Members of all classes, 1909-1969,
welcome. Write to: Alumnae Reunion
Committee, c/o The Moncton Hospital,
Moncton, N.B. ^
JANUARY 1969
Teach your students
nutrition as a vital part of
total patient care!
A New Book!
Williams
NUTRITION AND
DIET THERAPY
Your students in "Nutrition and Diet Therapy" courses can gain a lucid
understanding of nutrition's vital role in nursing care with the aid of this
precisely written new text. Correlating basic nutrition with patient-cen-
tered nursing, this superbly illustrated new book presents its subject in a
manner which clearly reflects today's total patient care concept. Through-
out this new text, basics of nutrition are interpreted specifically for ap-
plication as dynamics in nursing care through an appropriately drawn
balance of normal and applied nutrition. It helps the student to clearly
see the correlation of food chemistry, human body chemistry, and physi-
ological and emotional needs with the overall aspects of effective care.
CUnical application of all scientific principles aids the patient-centered
focus. Separate units emphasize the role of nutrition in public health;
nutrition in the basic nursing specialties (obstetrics, pediatrics, psychi-
atry, and rehabilitation); and nutrition in the clinical management of
medical and surgical disease. Each aspect is considered in the context of
human need. Diagrams, illustrations, study questions, outlines and
glossaries illuminate basic concepts . . . and thought-provoking dis-
cussion questions introduce each chapter. A student workbook provides
a knowledge of biochemical concepts and their clinical applications
through a problem-solving approach. A helpful teacher's manual offers
valuable advice on planning and conducting your course in nutrition.
By SUE RODWELL WILLIAMS, M.R.Ed., M.P.R., Instructor in Nutrition and Cli-
nical Dietetics, Kaiser Foundation School of Nursing; Nutritional Consultant and
Program Coordinator, Health Education Research Center, Permanente Medical
Group, Oakland, Calif. Publication date: February, 1969. Approx. 672 pages, 7"x
10", 117 illustrations, including original drawings by George Straus. About $9.75.
Fij. 12-8. Research in food chemistry. A chemist in
the U.S. Department of Agriculture's Agricultural
Research Service makes an adjustment on a mole-
cular still used in a project to aid in the manufac-
ture of dry milk. (USDA photograph.)
A completely up-to-dat
comprehensive, and
authoritative new text thl
Includes such outstandingf
features as:
• An excellent correlation of basic
trition with nursing care;
Easy-toHinderstand information in tfw
basic substances essential to body
chemical function and their general
specific purposes in health and
se;
An excellent presentation of the
broad community aspects of nutri-
tion, prevention and control;
# Discussions of nutrition and its role
in conception, growth and develop-
ment, and childhood nutrition defici-
ency disease states;
Discussions of nutrition in medical-
surgical nursing that explore specific
areas in detail, providing a manual
of diet therapy with emphasis on
metabolic aspects.
THE C.V. MOSBY COMPANY, LTD
86 Northline Road • Toronto 16, Ontario
'lANUARY 1%9
Publishers
THE CANADIAN NURSE 21
new products {
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
New Covers for Stryker Frames
Sets of a newly designed cover for the
Stryker Turning Frame are now available. These
new covers were designed by nursing staff and
have the following advantages: more comfor-
table for the patient as they remain smooth and
tight on the frame; easy to apply; the one size is
easily adjusted to fit different sized frames.
For further information and prices, write to
G.A. Hardie & Co. Ltd., 1093 Queen St., W.,
Toronto 3.
Disposable Bulb Syringe
This sterile, disposable bulb syringe for use
in hospitals has finger grips and printed calibra-
tions. The unit, called Medaseptic D, has a full-
draw vinyl bulb with the same suction power as
a standard reusable bulb.
Medaseptic D has a catheter tip with a tip
protector. Materials used to produce both the
bulb and syringe are inert and will not affect
the fluids they touch. Shatterproof polypropy-
lene is used in the production of the unit's
barrel.
Further information is available from Baxter
Laboratories of Canada, Limited, 6405
Northam Drive, Malton. Ont.
22 THE CANADIAN NURSE
Publication Available
A recently published booklet entitled
Highlights of a Study on Single- Unit Drug Dis-
pensing gives highlights of an Owens-Illinois
survey on single-unit drug dispensing in
hospitals, which was completed in early 1968.
Single-unit drug distribution is a system of
packaging drugs in individual doses ready to
administer to the patient.
Among advantages of dispensing of drugs in
unit doses are: possible reduction of medication
errors; more efficient administration of medi-
cations and utilization of hospital personnel;
better inventory control; and better cost
accounting.
Findings of the study have prompted
Owens-Illinois to develop a unit-dose packaging
system.
Marketed under the trade name Uni-Pak, the
system consists of amber vials in two sizes,
aluminum convenience closures, cappers, and
hinged plastic boxes for packaging medications.
Further information may be obtained from
Owens-Illinois, Toledo, Ohio 43601.
Climestrone Tablets
Climestrone Tablets are the water-soluble
conjugated form of estrogens, extracted from
natural sources (equine) and standardized with
the addition of sodium estrone sulfate.
These tablets arc indicated in the treatment
of menopausal symptoms; postmenopausal
osteoporosis; to supplement declining estrogen
levels in the postmenopausal female; functional
uterine bleeding; postpartum breast engorge-
ment and other conditions associated with in-
sufficient endogenous estrogen.
Cyclic therapy (a 3-week regimen followed
by a 7-day rest period) is recommended to
avoid continuous stimulation of breast and
uterus.
Full information is available from Charles E.
Frosst & Co., P.O. Box 247, Montreal 3.
, P.O. Box 247, Montreal 3.
jyn-Aid
Gyn-Aid is a new medical device for keeping
a patient's legs spread apart during an ex-
amination in which the lithotomy position is
required, such as pelvic, rectal, or urological ex-
amination, or minor surgery.
Designed by a gynecologist, Gyn-Aid saves
the physician's time and allows the patient to
relax. Slight pressure inward by the thighs holds
the Gyn-Aid in place without strain.
Gyn-Aid is manufactured of strong plastic,
which is unbreakable with normal use. As it is
applied over the drape sheet, frequent cleaning
is not required.
Further information may be obtained from
Custom Products Company, 2614 N. Seaman
Ave., El Monte, California 91733.
* * »
Plastazote
Plastazote, a new thermoplastic splinting
material, is made of foamed, very light poly-
ethylene. It is molded directly on the patient's
body. Plastazote is nontoxic, unaffected by
acids and alkalies, and can be kept clean by
washing with hot water and detergents.
Plastazote, used with or without rein-
forcement by lamination, is supplied in perfo-
rated sheets in one-quarter to one-inch thick-
nesses. It is prepared in a thermostatic oven at
140°C. for a minimum of five minutes. It is
then applied to the patient and molded to his
exact shape. After about 20 seconds, as it cools,
it begins to set.
In addition to limb and body supports, Plas-
tozote has extensive application in the ortho-
pedic footwear field, providing insoles that give
immediate relief to the patient.
For further information write to the
Medical Division, Smith & Nephew Ltd., 2100 -
52nd Ave., Lachine, Que.
JANUARY 1969
new products
Miniset
This new vein infusion set, called Miniset. i>
useful for infusing either intravenous solutions
of blood to restless patients, infants, or patients
with fragile, rolling veins.
The new set features a slim, one-piece design
which permits the needle to be held close and
flat against the skin. Soft and flexible securit\
wings on the needle permit a firm grip for con-
trolled needle placement. When taped flat
against the skin, these security wings assure
conformation to skin contours.
Miniset also contains a short, thin-wall,
stainless needle, which provides greater fluid
flow, even with smaller gauges.
The Miniset's flexible tube, security wings,
and short needle reduce the possibility of
pressure necrosis or phlebitis.
Further information is available from Baxter
Laboratories of Canada, Limited, 6405
Northam Dr., Malton. Ont.
Nourishment Station With
Microwave Oven
This microwave and nourishment station is
a self-contained work station which provides all
faciUties for service of regular meals, between
meal nourishment, and special diets.
Patients trays can be prepared in the central
kitchen and wheeled directly into the micro-
lANUARY 1%9
wave and nourishment station's holding refri-
gerator. Food to be heated is removed from the
holding refrigerator and placed in the micro-
wave oven unit. The patient is served directly
from the microwave oven, which insures that
the food is hot and attractive.
The station also includes two hot plates
(one with thermal eye), an automatic coffee
maker with 60-cup-per-houi capacity, and an
ice dispensing unit which makes, stores, and
dispenses sanitary ice directly into the patient's
container.
Other faciUties include: dry storage area
with adjustable shelves, utility drawer; tilt-out
removable waste receptacle; counter space;
large stainless steel sink with soap dispenser and
hot and cold water faucets; paper towel dispen-
ser: counterlevel and overhead fluorescent
lights, and two three-prong electrical outlets.
Write to the Market Forge Co, 35 Garvey
St., Everett, Mass. for a descriptive brochure.
Transport Seat
This transport seat is ideal for carrying a
patient short distances in crowded areas. The
seat may remain under the patient during air-
plane trips or while he is in the wheelchair.
Straps over the attendant's shoulders help
distribute the patient's weight. The straps may
be removed when not in use. The transport seat
is excellent for moving invalids on and off air-
planes or other vehicles.
Address inquiries to: Posey Products
stocked in Canada, B.C. Hollingshead Ltd., 64
Gerrard St. E., Toronto 2.
Actified-A
Actifed-A is indicated for the relief of con-
gestion, aches, pain, and fever associated with
colds and sinusitis. It is an orally effective
potentiated combination of "Sudafed" (de-
congestant), ActidU (high potency antihista-
mine) and acetaminophen (effective analgesic
and antipyretic).
For further information: Burroughs
Wellcome & Company (Canada) Limited, 60
Riverview Ave., LaSalle, P.Q.
Largest-selling among nurses ! Superb lifetime quality .
smooth rounded edges . . . featherweight, lies flat . . .
deeply engraved, and lacquered. Snow-white plastic will
not yellow. Satisfaction guaranteed. GROUP DISCOUNTS.
SAVE: Order 2 Identical Pins as pre
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With t line I With 2 line;
letterine I letterint
METAL aim PtASIIC
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♦ IMPORTANT Please add 25c per order handling charge on all orders of
3 pins or less GROUP DISCOUNTS 25 99 pins. 5'., 100 or more. 10%.
Remove and refasten cap»»,0., Tp,aa
band inslanlly for launder- I 'Of)* iSCs
ing or replacement! Tiny \JqU iWV*J
molded black plastic tac, „ ' P Cap C
dainty gold cadeucem. No. U ^^^ ^
6TacsPerSet 200 U ooiy
SPECIALI 12 Sets (60 Tacs) »9. total
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World famous Cross wnlmg instruments wilh
Sculptu'ed Caduceus Emblem Lilelime guarantee
U Kl (iOLD riLLtP LUSTROUS CHHQME
I No. 6603 $8.00 No. 3503 $5.00
No. 6602 8.00 No. 3502 5.00
No. 6601 16.00 No. 3501 10.00
Personalized ^/NDAGE
SHEARS
6" professional, precision shears, forged
irt steel Guaranteed to stay sharp 2 years,
No. 1372B Shears (no initials)
SPECIAL! 1 Doz. Shears
Initials (up to 3} etched
^00 ppd.
$20. total
add 50c per pair.
ZIPPO Lighter
with Caduceus
Emblem
Famous Zippo, chrome finish, engraved gfeen and
-"- Caduceus Lifetime "Fix-it-free" Guararitee
yello'
No. 1610 Lighter
6.00 ea. ppd.
*^^T3„u.«-. Waterproof NURSES WATCH
Swriss made, raised silver full numerals, lumin. mark-
ings. Red-tipped sweep second hand, chrome stainless
case. Stainless expansion band plus FREE black leather
strap. 1 yr. guarantee.
No. 06-925 12^ la. ppd.
Sterling Silver "Click-Apart" KEY RING
Keep car key on small rmg, detach
instantlir for parking lot, servicing, etc.
No. 8968C (Caduceus) or 8968 (plain)
(Add $1. for up to 3 engraved initials)
75ea. OT ,
PRINCESS GARDNER NURSES BILLFOLD
Fine imported pigskin, reptile band, bill
divider, com pocket. lemovable photo-card
case, key slots, etc. With gold stamped
•^x Caduceus or plain Specify Brown, Red oi Blue.
Jy No. 30R55C (Caduceus) or 30H55 (plain)
itamped Initials add $1.) 5.00 ea. ppd.
TO: REEVES COMPANY, IHIebofo. Mau. 02703 U.S.i.
I ORDER NO. ITEM QUANT. PRICE I
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Send to
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1
THE CANADIAN NURSE 23
in a capsule
A heart of rubber
Hearts of rubber may some day be added to
the crooner's tunes about hearts of gold and
hearts of stone. The Goodyear Tire & Rubber
Company is busy developing an artificial heart
made of natural rubber and polyurethane. It
has kept sheep and calves alive as long as 50
hours. The researchers hope that by 1970 the
rubber heart can be used to keep people alive
until a human heart becomes available for
transplant.
The tire company is working in cooperation
with medical research teams at the Cleveland
(Ohio) Clinic and the University of Utah.
Goodyear spokesmen say that rubber resembles
human tissue more closely than any other
substance. It expands and contracts much like
natural tissue and will do so in rhythm with the
artery to which it is joined.
The rubber heart can pump two gallons of
blood a minute. It is powered by an external
source of air power but, in future, may be
powered by portable nuclear reactors.
Jim Wright, Goodyear's man with many
hearts, to date has built more than 30 rubber
hearts.
The enigmatic sex
Men - cheapskates and spendthrifts, fickle
and faithful, aggressive and timid, possessive
and protective, Casanovas, perfectionists,
narcissists, egoists, playboys, and bores.
They're all in L'homme cet animal retif,
which literally translated means "man - this
restive animal." "Retif," however, is an elusive
word; its meaning lies somewhere among obs-
tinate, unmanageable, unpredictable, and
incomprehensible. In short, it says the same
thing about men that men have been saying
about women for centuries - they're impos-
sible to pin down and impossible to understand.
L'homme cet animal retif, is co-authored by
Colette Gagnon, a federal government trans-
lator, and Agathe Legault, assistant editor of
L'infirmiere canadienne. It's the product of
consultations with clairvoyants, schoolmarms,
graven images, lovers, beautiful people, hypo-
crites, hearts of stone, separatists, executives,
Romeos, rigolos, gigolos, robots, aristocrats,
mama's boys, career women, Ophelias, guardian
angels - and others.
If you're the last bit serious about brushing
up your French, reading this book may be the
24 THE CANADIAN NURSE
most enjoyable method you've discovered in a
long time. A person who speaks French fluently
would spend one or two hours chuckling over
the foibles of men bared in this book. If your
French is anything less than fluent, you'll spend
longer, but the diverting cartoons and casual
style will beguile you into spending the time to
decipher Mile Legault's and Mile Gagnon 's
witty and penetrating remarks about that lova-
ble yet infuriating sex.
It's published by Lidec Inc., 1083 Van
Home Avenue, Montreal 154, and sells in
Canada for two dollars.
A very special place
"For business or pleasure, stay at Toronto's
***, a very special place. It's like a few days in
Rome ... or Paris ... or even swinging London
town. The *** can turn a business trip into a
relaxing time. Dine, dance, or stay awhile at
Toronto's ***, a very special place."
So goes the ad, murmured over the air in
liquid, seductive tones. It seems that certain
Ontario nurses succumb to the insidious pre-
sence of the media, because they recently
staged a four-day conference at the hotel in
question.
It's too bad, though, that they didn't check
the price list. Or if those who planned the
conference did, it's regrettable that the rank
and file nurse who attended the conference
wasn't given a sneak preview of incurrable
expenses.
If Nurse Patricia likes an abstemious. Con-
tinental breakfast of juice, rolls and coffee, she
must be prepared to be relieved of $1.75. If
she's used to hearty English breakfasts of juice,
cereal, bacon and eggs, toast and coffee, she'll
have to dig into her pocket to the tune of
$3.25. Not to mention tips.
Did you know that substantial breakfast of
fresh orange juice, ham and eggs, toast and
coffee can be had at Oscar's, New York's
Waldorf Astoria's breakfast nook, for two
dollars? But then that's expensive American
money.
A lot of nurses lost a number of pounds
during that conference. They went on the
cheap at breakfast, skipped lunch, and dined on
$3.25 omelets for dinner (no coffee). They
would have sneaked elsewhere for meals if their
sleeping accommodation hadn't been an island
paradise with taxi service only, to the finer
spots in the heart of the city.
No wonder nurses are agitating for higher
.salaries.
Fix Bozo sick leg
Were you upset when you noticed Bozo's
missing foot in the December mini-editorial?
The presses rolled to a dead stop when our
efficient liaison with the printer noticed this
glaring "error" in the artwork!
JANUARY 1969
Who Prefers
explosion-proof suction units?
"We do," say most 0. R. nurses.
Here's why :
Gomco Explosion-Proof Suction Pumps are
ready for life-protecting service because of
their dependable, quiet operating pump, pre-
cision regulating valve and gauge, explo-
sion-proof, heavy-duty motor and
sealed-in switch. Cabinet, portable,
and stand-mounted units.
Are your operating rooms prop-
erly equipped with Gomco? For
latest catalog, see your dealer
or write: GOMCO SURGICAL
MANUFACTURING CORP., 828
E. Ferry St., Buffalo. N.Y. 14211
No. 929 explosion-proof
major suction unit.
Countdown to Congress
During 1968 the message in nursing journals all over the world has been
"Come to Canada for ICN Congress 1%9." Here's what nurses in other countries
have been reading about us.
Loral Graham
If they can make it, you can make it
In the past year, Canada, Canadians,
and Canadian nurses have received im-
pressive coverage in the nursing journals
of the world. Nurses all over the world
know that Canadian nurses will be
hostesses for the largest Congress in the
history of the International Council of
Nurses. They have been told that Canada
is a country as wide as the distance be-
tween Stockholm and Bombay; that it is
a country with a distinct international
Mrs. Graham is Assistant Editor of T H E
CANADIAN NURSE,
26 THE CANADIAN NURSE
flavor, and that Canadians move easily and
readily in international circles. And
they've been assured of one thing more: a
cheerful, warm, welcome from the Can-
adian Nurses' Association and its 80,000
members.
The Irish Nurses' Journal, a pocket-
sized magazine, devoted seven-and-one-
half pages of the 20 pages of its August
issue to ICN and the 1969 Congress. The
editorial, although not specifically about
ICN, was entitled "Focus on the Future,"
the theme of the Congress. An article by
Martha G. Shout, Nurse Adviser to the
JANUARY 1969
ICN, outlined the history of ICN and its
contribution to the 20th century. A full-
page "Nursing in Canada Statistical
Survey" told Irish nurses how many
nurses there are in Canada, where they
work, and where they were educated.
Australian nurses have been saving
their money since August 1967 when they
were first informed in The Australian
Nurses' Journal that they could combine
six- to eight-week world tours with their
visit to Montreal in June 1969. Their tours
will include visits to intriguing places like
Bangkok, Acapulco, Papeete, Nandi,
Beirut - and Vancouver. Belgian nurses,
too, have been offered package-deal
tours, but their tours will be centered in
North America. Canadian points of
interest on their itinerary include Ottawa,
Toronto, and Niagara Falls; the remainder
of their time will be spent in the United
States seeing nature's wonders in the
Grand Canyon, trying to resist the slot
machines in Las Vegas, breathing smog in
Los Angeles, and craning their necks in
New York City.
Other national nursing magazines have
corresponded with the Canadian Govern-
ment Travel Bureau and the National
Film Board to give their nurses a glimpse
of some of the more spectacular or color-
ful aspects of Canada's geography and
history. Danish nurses have paused to
look at the postcard favorite, Maligne
Lake in Jasper National Park; a rare
closeup of curly-horned mountain sheep
also in Jasper National Park; and one of
the classic photographs taken in the
Yukon Territory in the 1890's showing a
string of prospectors in overalls, braces,
JANUARY 1969
and floppy wide-brimmed hats mucking
for gold in a long, wooden sluice.
In their national nursing magazine,
French nurses have had an apportunity to
view a photo of "un spectacle qui vous
coupe le souffle" - the Maid of the Mist,
Niagara Falls. They may also know a little
more than most Canadians do about
Jeanne Mance, thanks to a photo of her
statue in Quebec City and an article by a
doctor from Langres, France about her
life of service to the sick in 1 7th century
French Canada.
The Netherlands Jaarboekje 1968 dis-
played an imaginative, colorful cover on
which a map of the Netherlands, a
symbol of the Dutch nursing organ-
ization, and a globe representing the
International Council of Nurses, were
linked by rays of the sun. The Philippine
Journal of Nursing printed an article
about the Congress in a section entitled
"Around the World in Nursing," illus-
trated with sketches of a nurse reading a
newspaper, and a globe. The Nigerian
Nurse entitled a reprint of the program of
the Congress "Countdown to Montreal."
Since March 1968, the monthly
Nursing Journal of India has printed five
articles about Canada and nursing in Can-
ada. The Jamaican Nurse, a colorful
journal with a black and orange cover,
devoted three pages of its April-May issue
to Canada and the Congress. German
nurses, in Deutsche Schwestern Zeitung
have had an opportunity to read a history
of nursing in Canada from its beginnings
in Quebec City, as well as articles on
nursing education in Canada by CNA's
consultants in nursing education, Marga-
ret Stees and Shirley Good.
The award for the most engaging copy
concerning the ICN Congress must, how-
ever, go to the Japanese Journal of
Nursing Kango. According to the typed
insert stapled ontu the inside front cover,
an "Invitation of the Applicants to the
14th ICN Convention" can be found on
page 101. Sure enough, on page 101 is a
neat half-page boxed item complete with
title in bold type. Otherwise, to my
uninitiated eye, it is a decorative display
of Japanese characters. Scrutinizing it a
little more closely, however, I found the
significant arable letters 14, 1969. and ICN
buried among the artful symbols.
The Hellenic Nurse ran an equally in-
timidating page of script on the 1969
Congress but had the mercy to head it
with a bilingual (French and English)
symbol of ICN '69. The Journal of
Nursing published by the Nurses' Asso-
ciation of the Republic of China was even
more benevolent to Western and, in
particular, English-speaking readers. This
magazine printed an entire page in
English the complete program of the
Congress. One can scarcely quibble over
typographical slipups such as "poas-
besic" for "postbasic". The mind boggles
over the problems of setting even one line
in Chinese in the magazine you are now
reading!
All smiles aside, the message that
nursing journals all over the world have
been relaying to their readers is
capsulized" in the nurses' journal of
Colombia: "Bienvenida al Canada." If
they can make it you can make it - see
you there! D
THE CANADIAN NURSE 27
The value of
revascularization surgery
Revascularization procedures offer an excellent chance of a good result in
98 percent of patients with coronary artery insufficiency.
Arthur Vineberg, M.D.
Throughout the past 23 years of
experimental and clinical attempts to
increase the oxygenated blood supply to
ischemic myocardium, surgeons have
been guided by the following generally
accepted facts:
1. Coronary atherosclerosis involves the
coronary arteries in their epicardial
courses.
2. The disease is diffuse and progressive,
gradually involving main stem and surface
branches of the coronary vessels.
3. The arterioles lying within the
myocardia of the right and left ventricles
are disease-free except in severe diabetic
and hypertensive patients. There are three
main arteriolar zones, namely, those
supplied by the right, anterior
descending, and circumflex coronary
arteries respectively.
4. The heart muscle contains large,
lake-like vascular spaces (myocardial
sinusoids) lying between muscle bundles
into which extra coronary oxygenated
blood can be introduced without
formation of hematoma.
Based on these facts, all our
revascularization efforts have aimed at
introducing new sources of oxygenated
blood deep in the left ventricular
myocardium and, more recently, into the
right ventricular myocardium. It has been
our aim to revascularize the entire heart
through the coronary arteriolar networks,
Dr. Vineberg is a former associate professor of
surgery at McGill University, Montreal, and is
now senior cardiac surgeon at The Royal
Victoria Hospital, Montreal.
28 THE CANADIAN NURSE
which are normally supplied by the
diseased coronary arteries. This has been
accomplished by introducing multiple
sources of extra cardiac blood and by
uniting separate arteriolar zones so that
all arterial blood entering the heart
muscle is distributed throughout the
entire heart.
To this end, the left internal mammary
was implanted into the left ventricular
wall in 1945 in the experimental animal.
During the succeeding five years, we
learned that an internal mammary artery
implanted into the left ventricle of a
normal dog's heart would remain patent
for years, providing it was implanted deep
in the interior wall. It started to bud in 12
days and formed true, arterial branches
that joined surrounding intramyocardial
arterioles between the third and sixth
week. When the anterior descending and
circumflex coronary arteries were
narrowed at their origins in the
experimental animal by ameroid
constrictors, the implanted internal
mammary artery formed anastomoses
with the arterioles of the entire left
ventricle at the end of six months or
longer; there were never communications
with the right coronary system.
Tri-arteriolar zones
There are three areas in the left
ventricle where the terminal branches of
all three coronary arteries end. I have
termed these tri-arteriolar zones.
Theoretically, an implanted internal
mammary artery placed into one of the
tri-arteriolar zones is capable of
JANUARY 1969
REVASCULARIZATION OF ENTIRE HEART BY RIGHT AND LEFT
VENTRICULAR IMPLANTS, EPICARDIECTOMY WITH BLOODLESS
OMENTAL GRAFT VINEBERG.
RIGHT IMPLANT
INTO RIGHT
VENTRICLE
LEFT IMPLANT
INTO LEFT
VENTRICLE
EPICARDECTOMY
FREE OMENTAL
GRAFT
!f?-
THESE OPERATIVE PROCEDURES CONVERT HEART
INTO ONE LARGE ARTERIOLAR NETWORK AND ARE
EFFECTIVE REGARDLESS OF THE TYPE OF CORONARY
CIRCULATION OR LOCATION OF ISCHEMIA.
revascularizing the entire heart. The first
of these is on the interior surface of the
left ventricle near the apex. It is here that
whenever possible single implants have
been placed in human hearts.
The second tri-arteriolar zone lies
more laterally near the junction of the
diaphragmatic and lateral surface of the
left ventricle. This zone has been
I implanted accidentally in the past and
deliberately since October 1967. Arteries
lying in both of the above-mentioned
zones have been examined by injection
studies from 3-1/2 to 17-1/2 years after
implantation and have frequently been
' JANUARY 1%9
shown to fill all three coronary arteries
retrograde to points of coronary
occlusion.
The third tri-arteriolar zone lies high
up on the posterior wall of the left
ventricle in its inner one-third, making
access to this zone technically difficult.
1 believe it is better to leave the
patient's own arteries alone and to
provide multiple, large and small
by-passes that do not block throughout
the years.
If placed in the inner half of the left
ventricular wall, internal mammary
arteries implanted into the myocardium
will remain open even though there is no
myocardial ischemia. This is because the
artery is surrounded by arterioles with
diastolic pressures of 40 mm. Hg, as
compared with the diastolic pressure of
80 mm. Hg within the implanted internal
mammary artery itself. It has always been
our objective to connect with the
arterioles in the myocardium, not, as has
been suggested by some, with the surface
vessels.
To remain open, a superficially
implanted vessel requires a markedly
diseased superficial vessel so that there
will be a pressure differential between the
two vessels. Operations that attempt to
connect with the surface vessels are not in
accordance with the principle of
myocardial revascularization that we have
enunciated and followed since 1950. The
coronary vessels in their epicardial
courses become diseased. In time,
implanted internal mammary arteries
primarily communicating with such
vessels will be more likely to block off
than if they were deeply implanted,
connecting with intra-myocardial
arterioles, such as has been experienced
with grafts in peripheral vascular surgery.
Implant in man
In 1950, the first internal mammary
artery implant was performed on a man,
placing the artery in the anterior wall of
the left ventricle. Since that time, many
hundreds of patients have undergone the
single internal mammary artery
implantation for relief of myocardial
ischemia due to coronary artery
insufficiency, with less than two percent
operative mortality and an overall 80
percent improvement. Clinical experience
clearly indicated that the internal
mammary artery, after implantation,
took at least nine months to function.
For this reason, patients with angina
decubitus did badly when the internal
mammary artery alone was implanted.
Accordingly, in 1956 I stopped doing
single internal mammary artery
implantation operations in patients with
angina decubitus or chronic left
ventricular failure and did not operate on
such patients until December 1962, when
the supplementary procedure of free
THE CANADIAN NURSE 29
omental graft had been fully tested in the
laboratory.
There have been many critics of the
internal mammary artery implant
procedure. At first it was called a
string-like artery that always blocked.
This, of course, is not true. 1 have
patients who have been operated on and
studied up to 17-1/2 years after internal
mammary artery implantation. Many of
these patients have died from other
causes, such as fights, cancer, pneumonia,
and meningitis.
A total of 42 patients were examined
at autopsy and injection of the internal
mammary artery with Schlesinger mass,
which does not penetrate anything
smaller than an arteriole, filled the entire
coronary circulation. Thirty-eight of the
42 patients (88 percent) studied many
years after surgery had fully patent
internal mammary arteries with extensive
mammary coronary anastomoses. Four of
these patients were examined 3-1/2, 4,
12-1/2 and 17-1/2 years after internal
mammary arterial implantation. All their
coronary arteries were blocked at their
origins and the internal mammary artery
was the only artery in the heart.
Twenty-two patients underwent coronary
arteriographic studies of the internal
mammary artery for 6 months to 12-1/2
years after surgery. Seventeen of these (77
percent) showed good
mammary-coronary anastomoses. Of the
64 patients studied, either by pathology
or by cine angiography, 54 patients (84
percent) had fully patent internal
mammary arteries that formed
mammary-coronary anastomoses with the
surrounding arterioles.
Free omental graft
It became clear that the internal
mammary artery only supplied the
arteriolar zone into which it was
implanted. For this reason,
epicardiectomy was added to open
collaterals between the anterior
descending and the circumflex areas.
Epicardiectomy of the left ventricle,
however, does not open collaterals
between the right and left coronary
arteriolar systems. This has been
accomplished by the free or bloodless
omental graft.
After many years of experimentation,
it was found that the free omental graft
penetrates the wall of the aorta, the
pericardium, and the epicardium covering
the coronary arteries to obtain arterial
blood for itself. When the bloodless
omental graft is thus interposed between
the pericardium and heart, it obtains
oxygenated blood on both its surfaces by
forming arteriolar communications
30 THE CANADIAN NURSE
between its own vessels and the
pericardial vessels and those of the aorta
and diaphragm. This oxygenated blood
flows from high to low pressures and thus
from extra cardiac sources into omental
vessels and thence into the coronary
systems.
Removal of the epicardium assists the
graft to form its communications with
the heart, arteries, and arterioles. Such a
graft distributes oxygenated blood from
right to left or left to right coronary
systems, as well as adding another extra
source of oxygenated blood to the
ischemic myocardium. When combined
with implantation of left internal
mammary artery into left ventricular
wall, patients with angina decubitus can
be safely operated on with good results.
Likewise, patients with chronic left
ventricular failure have had their chronic
left ventricular failure reversed. Over 200
patients have undergone the combined
operation of left internal mammary
artery implantation, epicardiectomy, and
free omental graft. For those patients
who have no angina at rest, the operative
mortality has been under 4 percent, with
an overall 90 percent improvement.
The free omental graft as a
revascularization procedure has a long,
documented, experimental background.
In addition, it has been used clinically for
nearly six years. We now have clinical
evidence of its viability in both living
patients and in patients who have died
from strokes and other causes, up to four
and three-quarter years. Not only has
there been viable omentum, but the
vessels within the omentum have been
shown, through Schlesinger mass
injections, to be in full communication
with the coronary arterial system and the
arterial network in the mediastinum.
When the free omental graft fails to
live, it is because proper epicardiectomy
and sero-pericardiectomy have not been
carried out, nor has the omental graft
been fixed by multiple sutures to the
heart and to the aorta. Like the original
internal mammary artery, this valuable
operative procedure is under criticism and
will continue to be so until it is used
properly.
With the addition of the right internal
mammary artery implanted into the right
ventricular wall, there has been no
operative mortality and no late mortality
up to two and one-half years. This
includes seven patients who had angina
decubitus at the time of surgery.
Type of patient
It should be made clear in reporting
results, what type of patient is operated
upon. In our own series, 75 percent of
the patients have had from 1 to 6
myocardial infarctions 25 percent have
had left ventricular failure, and 27
percent have had left ventricular
hypertrophy. There has been reversal of
left ventricular failure in 65 percent of
the patients operated upon who suffered
chronic left ventricular failure at the time
of operation, and 80 to 90 percent of the
patients have no pain, slight pain, or less
pain.
It is also important to know the
condition of the left ventricle with regard
to function, size, and distribution of scar.
In the many series of cases reported by
others, it is quite clear that the majority
of patients have had minimal or no
myocardial infarctions at the time of
surgery and few, if any, have chronic left
ventricular failure. This is obvious as it is
impossible to place two internal
mammary arteries into the left ventricular
wall when there is a good sized scar in
either the anterior or posterior walls or in
both walls of the left ventricle.
It is likewise important to know where
the points of occlusion are located in the
coronary arteries, particularly if they are
in the main stems or wherever they are
more distal. Results will vary greatly
when the occlusion in the coronary artery
is 3 to 4 cm. away from the origin and
not at the origin.
Evaluation
Evaluation of postoperative results
must include the evaluation of the clinical
condition of the patient. It cannot be
entirely cine angiographic evidence of the
relief of a localized perfusion deficit. The
relief of anginal pain, the correction of
chronic ventricular failure, and the ability
of the patient to return to his or her
former occupation are also important.
In evaluation of the results of surgery,
cine angiographic evidence of patent
internal mammary artery or arteries
showing that extra cardiac blood is
reaching the heart muscle is of great
value, but it does not supply the proof
that the patient has been relieved of his
symptoms. Surgeons like myself, who, in
addition to implanting one or two
arteries, are supplementing the procedure
with epicardium and free omental graft
find it impossible to outline by cine
coronary arteriography the multitudinous
small arterioles that deliver blood to the
ischemic heart via the free omental graft.
Limitations
With usage, certain limitations have
become apparent.
Limitations of Left, Internal Mammary
JANUARY 1%9
Artery Implantation into Left Ventricular
Wall
1. Damaged left internal mammary artery
from other chest injuries. Rare.
2. Previous ligations of internal mammary
arteries at the second inter-space. Rare.
3. Damage due to extensive pleuritis.
Extremely rare.
4. Atherosclerosis of left subclavian
artery at point of origin of internal
mammary artery. Rare.
5. Hypertrophy of left ventricle. An
implanted artery, even though it remains
open, is too small to supply a large
muscle mass alone. Two implants plus
epicardiectomy and free omental graft are
ideal.
6. Diffusely streaky, scarred left
ventricle. Implanted internal mammary
arteries in such ventricles have no run-off
and few arterioles for its branches to
anastomose with.
7. Thin-walled, left ventricles, caused by
myocardial ischemia, are difficult to
implant. Some have been implanted
successfully.
■Limitations of Epicardiectomy
1. Obliterative pericarditis from
myocardial infarction or previous
operation. Rare.
2. Extensive sub-epicardial fat deposits.
3. Diffuse intermittent scar.
'Limitation of Free Omental Graft
Applied to Omental Surface
The greater omentum itself may be
absent (gastrectomy) or scarred
(peritonitis) or damaged from previous
operations. In the latter situation, the
lesser omentum is used.
Limitations of Multiple Internal
'Mammary Artery Implantations
1. Thin, fat, or scarred anterior wall of
the right ventricle, making right internal
mammary artery implantation into right
ventricular wall hazardous or impossible.
Rare.
2. Extensively scarred anterior or
posterior walls of the left ventricle permit
left internal mammary artery
implantation only. Usually, there is not
enough good muscle in such ventricles to
accept more than one artery.
limitations of Gastro-Epiploic
Artery Implantation
Unlike the internal mammary artery,
the gastro-epiploic artery is frequently
itherosclerotic. In addition, it cannot be
mplanted into the left ventricular
Dosterior wall if this is scarred or is not
ong enough to go laterally.
ANUARY 1%9
Limitations of Segmental Resection,
Patch-Graft or A rterialization
By Vein Graft
A small percentage of patients have
segmental disease. In the majority of
cases, the disease is diffuse.
The principle of treating localized
obstruction in the surface arteries is
wrong, if long duration of relief from
myocardial ischemia is expected. As
coronary artery disease progresses,
obstructions may occur distal to the
point of the localized area of arterotomy.
These will lead to a reduction of flow and
eventual occlusion in the segmentally
treated area.
Recently, surgeons at one of the
clinics that had performed a large series
of segmental patch-grafts indicated that
they were no longer doing this type of
operation because 29 percent of their
patch-grafts had blocked and 13 percent
had become narrowed. In other words, 42
percent were not functioning
satisfactorily. These surgeons have
suggested, instead, a vein replacement
graft. There is no evidence to suggest that
the arterioles in the myocardium become
diseased, nor is there any evidence that
the internal mammary artery implanted
within the arteriolar network develops
atherosclerosis.
The various operations that we have
developed and have listed along with
some others, with their limitations, is our
reason for constantly searching for
additional techniques of myocardial
revascularization to supplement the
internal mammary artery implant
procedure. However, the combined
operations of left internal mammary
artery into left ventricular wall alone, or
in combination with right internal
mammary artery into right ventricular
wall, epicardiectomy and free omental
graft, can be used for total cardiac
revascularization in practically all
patients, as one can see from the
foregoing list of limitations. There are
many centers claiming to perform our
operations, but they are not following
techniques that I have proven to be of
value.
Intramyocardial Omental Strip Implant
This operation is our most recent
addition to our revascularization
procedures. In this procedure the great
omentum, after its removal from the
colon, is laid upon a piece of plate glass
and three strips of omentum containing
one or two blood vessels are cut out
one-half inch wide in such a way that the
upper end of the strip communicates with
a wide and fan-shaped piece of omentum
containing numerous vessels. The
fan-shaped piece of omentum is wrapped
around the ascending aorta and the
narrow tails are threaded through the left
and right ventricular walls, both
anterioriy and posterioriy. This operation
has proven to be of value in maintaining
the life of an animal with triple ameroid
coronary artery occlusion.
The intramyocardial portion of the
omental strip forms arteriolar
communications with the arterioles of the
myocardium within eight days, and the
portion around the aorta does likewise by
tapping the aortic wall so that the aortic
blood flows into the ventricular
myocardium within eight days.
Since an implanted omental strip graft,
unlike an implanted internal mammary
artery, requires no run-off, but actively
attaches itself to any arteriole in its
vicinity, taps the aorta, and conveys
oxygenated blood from high to low
pressure areas in the myocardium, this
operation is planned for the treatment of
large, intermittently scarred left ventricles
in failure, in combination with resection
of large anterior and/or posterior scars.
The omental strip implant is still
experimental and will not be applied by
us in the treatment of the large heart in
heart failure until it has been more
thoroughly tested in the laboratory. It is
in the third year of experimental testing.
It may be the answer to the
intermittently diffusely scarred large
heart.
We have not developed new
revascularization procedures because of
dissatisfaction with our original internal
mammary artery implant, but rather to
support this procedure and for use when
the heart pathology makes a systemic
artery implant unlikely to succeed. As
long as 30 percent or more of the left
ventricular muscle mass remains,
revascularization has a chance to work.
Many patients with large hearts upon
which 1 have operated are still alive;
others have lived from two to four and
three-quarter years after surgery, many
with marked improvement.
Until such time as the rejection
phenomenon has been solved, a
combination of revascularization
procedures with or without local excision
of large left ventricular scars must be
given serious consideration for all large
hearts before heart transplantation is
considered. Revascularization procedures,
either direct or indirect, offer an
excellent chance of a good result in 98
percent of patients with coronary artery
insufficiency. □
THE CANADIAN NURSE 31
Advances in surgery
for coronary artery disease
A summary of some of the major developments in cardiovascular surgery
and a glimpse at possible advances in the future.
A.S. Trimble, M.D., B.Sc. (Med.), F.R.C.S. (C), F.A.C.S.
Arteriosclerotic coronary artery dis-
ease is the commonest cause of car-
diac disability and death in Canada
and the United States. Although the
surgical management of the chronic
form of this condition has now become
commonplace, this was not so eight
years ago. Indications, methods of in-
vestigation, and surgical techniques
have changed during that period. This
review will summarize some of the
major advances in the field and briefly
describe the latest developments in
treating the acute form of heart attack.
History
The pioneering research of
O'Shaughnessy' and Vineberg-' laid
the experimental foundation for revas-
cularization of the myocardium. Dr.
Vineberg's animal and clinical work
proved that a bleeding internal mam-
mary artery drawn into a tunnel in the
left ventricular myocardium would de-
velop collateral flow to th.; heart's own
coronary arteries. This flow supplied
by the implanted mammary vessel was
adequate to prevent death in animals
when the coronary artery was ligated
and, in humans, led to relief of angina
pectoris.
Despite this remarkable work there
was little enthusiasm for the technique
and only limited clinical application.
There were two major reasons for this.
The vagaries of the symptom, angina,
were well recognized and often place-
bos or minor surgical techniques, such
as sympathectomy, led to improvement
32 THE CANADIAN NURSE
in some cases. Also, the demonstration
of a patent artery had not been done
in the living, but shown by injection at
autopsy.
Early in the 1960s, two major de-
velopments led to a complete change in
the attitude of the medical profession.
At the Cleveland Clinic, Sones* devel-
oped the technique of selective coro-
nary cineangiography. This involved
the passage of a catheter up the bra-
chial or femoral artery and its inser-
tion into the coronary artery. Dye was
then injected and high speed radio-
graphs taken to outline the lumen of
the vessel. Organic occlusions and ste-
noses in each coronary artery could
thus be documented accurately and
related to symptomatology. Later, these
same techniques were utilized to show
patency and collateral flow from the
injected internal mammary artery. This
flow could be correlated to symptomatic
improvement in the living, and thus a
scientific means of evaluating the proce-
dure was at hand. Sophisticated engi-
neering developments of cineangiography,
such as videotape and instant replay, have
since been applied.
The other major contribution was
the long-term follow-up of some 30
patients by Bigelow at al."'"'^ These
doctors utilized the Sones' method to
correlate symptomatic improvement
Dr. Trimble is on the staff of the Car-
diovascular Unit and Division of Cardio-
vascular Surgery, Toronto General Hospital.
and internal mammary patency in pa-
tients as long as 13 years after opera-
tion. Their presentation finally led to
wide general clinical application of the
internal mammary or Vineberg revas-
cularization operation.
Indications and contraindications
Angina on effort, or with emotion,
which interferes with the patient's abil-
ity to work or enjoy life, has been the
prime indication for operation. Usually
a trial of medical therapy is under-
taken first. Results to date suggest thai
less disabled patients will be offeree
the benefits of the operation in future
Long-term follow-up will eventuallj
justify the decision to make this a forrr
of prophylactic surgery in the asymp-
tomatic individual who has had a hear
attack.
Patients over the age of 60 anc
young patients, who usually have i
severe family history of the disease
are considered less suitable. Gros;
obesity, a recent coronary occlusion
and congestive failure are contraindi
cations.
Investigations
The routine history, physical exami
nation, chest x-ray and electrocardio
gram are followed by two special tests
An exercise test, walking on a tread
mill, documents the appearance of an
gina after a certain distance. At thi:
time an electrocardiogram is taken am
compared to one taken while the pa
tient was at rest. Changes indicatin;
cardiac ischemia are often shown, sug-
gestive evidence that the pain is related
to organic disease. Then a selective
coronary cineangiogram, previously
described, is carried out.
This catheterization study docu-
ments the extent of the disease in the
major coronary arteries and their
branches. In addition, dye is injected
into the left ventricular cavity to assess
the efficiency of left ventricular con-
traction. This has proven to be a most
important criterion for acceptance for
operation.
Patients demonstrating a moderate
to marked reduction in systolic con-
traction, that is, the scarring has been
so diffuse in the myocardium that little
normal muscle remains, are usually
denied the procedure. The risk is high
and the chances for symptomatic im-
provement slight. The catheterization
procedure, although entailing a small
risk, is thus essential for proper pa-
tient evaluation.
Two basic operative procedures are
now available in chronic/arterioscler-
otic coronary artery disease: revascular-
ization and direct coronary artery
surgery.
Revascularization procedure
At the Toronto General Hospital,
the technique most commonly used is
similar to that originally described by
Vineberg.'- * ■'' The fifth interspace is en-
tered through a left anterolateral thora-
cotomy. The fifth costal cartilage is
divided prior to insertion of the rib
spreader to prevent traction on the in-
ternal mammary artery and subsequent
spasm. The artery is then carefully dis-
sected, dividing the intercostal
branches between silver clips, and in-
cluding in the pedicle the accompany-
ing vein and some periadvential tissue.
At the level of the sixth interspace it
bisects and at this level is divided. The
dissection is then carried proximally to
the second interspace. It is then wrap-
ped in paparavine-soaked gauze to
prevent spasm.
A window is created in the fibrous
pericardium exposing the anterolateral
surface of the left ventricle. A tunnel
JANUARY 1%9
is made in the middle third of the
myocardium, usually parallel to the
left anterior descending coronary artery
over a distance of 3 to 4 cm. Two or
three clips are cut from side branches
at the appropriate level in the internal
mammary artery and, actively bleeding,
it is drawn into the tunnel. The distal
end is then secured with a suture.
Prior to the resection of fibrous peri-
cardium, the pericardial fat pad is dis-
sected off, retaining its superior ped-
icle. It is applied to the abraided epi-
cardial surface of the left ventricle.
The adhesions produced allow extra
blood to enter through the pedicle and
perhaps induce a more even distribu-
tion of blood to the ventricle.
Finally, a low stellate, high dorsal,
left sympathectomy is done to prevent
coronary artery spasm and possible
myocardial infarction in the early post-
operative period. The occurrence of
this complication entails the major
operative risk.
Variations
(a) Site of the Tunnel: There is, as
yet, no proof that improved results are
obtained if the artery is implanted in
the area of ischemia — posterior or
anterior. Some surgeons, however, pre-
fer to create the tunnel in a site that
prior electrocardiograph recordings
and direct visual evidence suggest to
be the worst area.
(b) Bilateral Implants: Using a ster-
num-splitting approach, both internal
mammary arteries are dissected out as
previously described.** The right is then
inserted into a tunnel in the anterior
wall of the left ventricle and the left
mammary into the posterior wall. This
operation entails a somewhat greater
mortality and morbidity as compared
to a single implant, but may be found
to offer superior results once long-term
follow-ups become available.
Results
Single internal mammary artery im-
plantation entails an operative risk of
two to three percent in properly select-
ed cases.'"'-' The bilateral procedure has
a slightly higher mortality. Follow-up
studies show that 70 to 90 percent of
patients are improved. This means that
there is a major relief of angina —
sometimes total — a reduction in med-
ication, and resumption of a more nor-
mal existence.
Although not statistically proven,
there is suggestive evidence that al-
though the operation will not prevent a
subsequent coronary thrombosis and
myocardial infarct, it will make such
an event less morbid and improve the
chances of the patient surviving. It is
for this reason alone that some centers
may accept asymptomatic, post-infarct
patients for operation. In most in-
stances patient improvement can be
correlated to a patent internal mam-
mary implant, which, at cineangiogra-
phy, demonstrates good collateral flow
to the patient's own coronary arteries.
Direct coronary artery surgery
The majority of the patients cath-
eterized at the Toronto General Hos-
pital demonstrate tri-coronary artery
disease — either occlusion or stenosis
— of a varying degree. Some centers
investigate less disabled patients and
in some a localized block in the prox-
imal portion of a single coronary ar-
tery is demonstrated. These centers
have operated on a number of patients
using coronary endarterectomy or by-
pass grafting.
(a) Coronary Endarterectomy: To
date, the left coronary artery has not
proven amenable to direct procedures
for anatomical reasons. A growing ex-
perience is developing with such opera-
tions on the proximal right coronary
artery. Endarterectomy, usually with
vein-patch angioplasty, was originally
attempted because of its known suc-
cess in carotid and femoral arteries. It
involves an enucleation of the athero-
matous plaques over the area of sten-
osis or occlusion. The results published
to date suggest an operative mortality
of 20 to 25 percent, with 60 percent
late improvement. Late occlusions
demonstrated by cineangiography ap-
peared common, however, and as a re-
sult the following procedure is being
evaluated.
(b) Bypass Grafting: Saphenous vein
THE CANADIAN NURSE 33
bypass grafts from the ascending aorta
to the coronary artery distal to the oc-
clusion are now being evaluated. As
described above, these procedures have
proven valuable in peripheral vascular
surgery. Initial results suggest a lower
mortality than endarterectomy and im-
proved late results in coronary artery
disease.
Acute coronary artery disease
Acute coronary occlusion leading to
myocardial infarction — a heart at-
tack — often leads to sudden death.
A large number of patients, however,
do live long enough to enter hospital
and there die, either from ventricular
arrhythmias or congestive failure. In
this group, advance has been made in
both curative and supportive tech-
niques.
Curative
Over 15 years ago, Murray sugges-
ted that immediate resection of the
dead muscle resulting from an acute
coronary occlusion might lead to a
higher survival rate.'" Subsequently,
Heimbecker documented in animal ex-
periments that this procedure, infarc-
tectomy, could lead to a high survival
rate." Human experience remains lim-
ited to date. The indications in patients
appear to be irreversible arrhythmias
or congestive failure.
Supportive
(a) Non-Surgical: The development
of coronary units,'- based on principles
evolved in acute therapy units, has im-
proved the survival rate from acute
myocardial infarction. The advances
include continuous electrocardiograph-
ic monitoring, respiratory support, and
new drugs.
(b) Mechanical: A diverse number
of mechanical supportive techniques
have been devised and tested in animal
experimentation. To date there has
been limited clinical application. The
various methods include artificial
hearts, ventricular compression de-
vices, counter pulsation, and partial
bypass to mention a few. All have at-
tributes and feasibility at least in the
experimental laboratory. Many prob-
lems, however, arise from their use —
including thrombosis, red cell and pro-
tein destruction, power source.
A great deal of research is now
making inroads into these problems.
The development of an effective arti-
ficial heart — either for total or par-
ital support — or a heart-lung ma-
chine capable of functioning for long
periods would appear to be necessary
for any of these devices to prove func-
tional.
Disabling coronary artery disease
Two conditions should be defined:
34 THE CANADIAN NURSE
ventricular aneurysm and the "end
stage" cardiac, who cannot be improv-
ed by a revascularization procedure.
Ventricular aneurysm
This is an uncommon late complica-
tion of myocardial infarction, which
can lead to disabling angina or conges-
tive failure. The scarred area of in-
farcted myocardium balloons out to
form an aneurysm — usually filled
with clot that impairs myocardial func-
tion.
Utilizing cardiopulmonary bypass,
the aneurysm can be excised. In a
group of selected cases reported by
Key et al'-' from the Toronto General
Hospital, the operative mortality was
about 10 percent with marked im-
provement at follow-up. This might be
described as infarctectomy in the
chronic form of coronary artery dis-
ease.
End Stage Myocardial Scarring
Most of the 74 heart transplant re-
cipients so far reported suffered from
disabling coronary atherosclerosis.
These patients had reached the end
stage of their disease and no treatment
— medical or surgical — could im-
prove their condition. The major prob-
lems include donor supply and rejec-
tion. Although transplantation remains
a highly experimental procedure, its
judicious, well-studied, continued ap-
plication in the treatment of these pa-
tients with no other hope for any life
at all appears justified.
The future
This short review points out the two
major areas in which future research
will be concentrated. In the manage-
ment of acute coronary thrombosis,
with its high mortality, a wider appli-
cation of the infarctectomy operation
should occur. The perfection of mech-
anical devices, both as supportive tech-
niques and as artificial heart replace-
ments, will be the real advance in the
next 25 years.
In the severely disabling form, heart
transplantation will continue. If the
basic scientists can ultimately identify
and prevent the rejection phenomenon,
and if the donor supply can be im-
proved, it might become a routine
procedure. Our experience to date with
prosthetic valve replacement leads us
to speculate that a truly mechanical
heart will ultimately be developed.
Whatever the case, the advances of the
next 25 years in cardiac surgery will be
as exciting as those of the past 15
years.
References
I. O'Shaughnessy, L. An experimental
method of providing collateral circula-
tion to the heart. Brit. J. Surg. 23:665.
1956.
2. Vineberg, A.M. Development of an an-
astomosis between the coronary vessels
and a transplanted internal mammary
artery. Canad. Med. Ass. J. 55:117,
1946.
3. Vineberg, A.M. Treatment of coronary
artery insufficiency by implantation of
the internal mammary artery into the
left ventricular myocardium. J. Thorac.
Surg. 23:42, 1952.
4. Sones, F.M. Jr. and Shirey, E.K. Cine
coronary arteriography. Mod. Cone.
Cardiov. Dis. 31:735, 1962.
5. Bigelow, W.G., Basian H., and Trusler,
G.A. Internal mammary artery implan-
tation for coronary heart disease. J.
Thome. Cardiovasc. Surg. 45:67, 1963.
6. Bigelow. W.G., Aldridge, H.E., Mac-
Gregor, D.C. Internal mammary im-
plantation (Vineberg operation) for cor-
onary heart disease: cineangiography
and long term follow-up. Ann. Surg.
164:457, 1966.
7. Aldridge, H.E., MacGregor, D.C, Lans-
down, E.L., and Bigelow, W.G. Internal
mammary artery implantation for the
relief of angina pectoris — a follow-up
study of 77 patients for up to 13 years.
Canad. Med. Ass. J. 98:194, 1968.
8. Favaloro, R.G. Double internal mam-
mary artery implants — operative tech-
nique. J. Tliorae. Cardiovase. Surg. 55:
457, 1968.
9. Favaloro, R.G., Effler, D.B., Groves,
L.K., Sones, F.M. Jr., and Ferguson, D.
G. Myocardial revascularization by in-
ternal mammary artery implant proced-
ures: clinical experience. J. Thome. Car-
diovase. Surg. 54:359, 1967.
10. Murray, G. The pathophysiology of the
cause of death from coronary throm-
bosis. Ann. Surg. 126:523, 1947.
11. Heimbecker, R.O., Chen, C, Hamilton,
N., and Murray, D.W.G. Surgery for
massive myocardial infarction — an ex-
perimental study of emergency infarc-
tectomy. Surgery, 61:51, 1967.
12. Brown, K.W.G., MacMillan, R.L., For-
bath, N., Meligrana, F., and Scott, J.W.
Coronary unit — an intensive-care cen-
ter for acute myocardial infarction. Lan-
cet, Aug. 17, p.349, 1963.
13. Key, J. A., Aldridge. H.E., and MacGreg-
or, D.C. The selection of patients for
resection of left ventrical aneurysm.
J. Tliorae. Cardiovase. Surg. (In print).
D
lANUARY 1969
Nursing the patient
after heart surgery
Rapid developments in cardiac surgery in the last 15 years have meant exciting
changes in nursing. Today, words such as mechanical respirators, cardiac monitors,
central venous pressure, tidal volumes, defibrillators and blood gases, are as
common to the surgical nurse as the word "heparin" was to her counterpart
18 years ago.
ludith R. Wass
Each patient facing heart surgery
approaches the event with fear, hope for
the future, and expectations of the sur-
geon, the nurse, and the hospital. Often it
is difficult for him to discuss his post-
operative care, as he is afraid to acknow-
ledge the risks that he knows are involved
in heart surgery.
Naturally, previous surgery and
hospital admissions influence the pa-
tient's attitude to the operation he faces.
Even so, each patient goes to surgery with
the knowledge that his heart is his link to
life.
In the days preceding surgery, the pa-
tient meets a variety of people - physio-
therapists, x-ray technicians, blood tech-
nicians, clerks. Somehow the nurse must
interpret the roles of these health workers
to the patient, and, at the same time,
provide an atmosphere that allows him to
express his fears, hopes, and expectations.
ICU nurse visits
Preoperative teaching is geared to the
patient's understanding and acceptance of
the operation. Usually the questions he
asks indicate what further information he
requires. Generally, however, he needs ex-
planations about intravenous therapy,
monitoring, chest drainage, oxygen
therapy, deep breathing, and coughing.
Prior to surgery, the patient receives a
Miss Wass, a graduate of Toronto General Hos-
pital School of Nursing, is Department Super-
visor of the Cardiovascular Surgical Service at
T.G.H. This year she is attending McGill to
complete her bachelor of nursing degree.
JANUARY 1%9
visit from the nurse who will look after
him postoperatively in the intensive care
unit. This visit benefits both patient and
nurse. The patient feels more secure in
knowing the nurse who will be so im-
portant to him postoperatively, and the
nurse is able to evaluate the patient's
physical state before she receives him in
her unit. Also, the visit allows her to
identify her patient as a person - some-
thing that her preoccupation with tech-
nical skills in the ICU unit might other-
wise inhibit.
The patient's family is not neglected
during this preoperative period. Family
members are told of the time of the pa-
tient's surgery, the visiting hours, and the
number of visitors allowed. They are
assured that the surgeon will talk to them
shortly after the surgery, and that they
may visit their relative within a few hours
of the operation.
Circulatory assesment
Postoperatively, the nursing objective
is to maintain the patient's circulatory,
respiratory, and neurological status.
Checking of the vital signs - blood
pressure, apical rate, respiration, central
venous pressure - is the first task. In our
intensive care unit, we record blood
pressure with the sphygmomanometer
and apical rate with a stethoscope.
Direct observation of the patient's
skin, lips, and nail-bed color is important.
A nurse's ability to observe, perceive, and
report the slightest change is invaluable if
prompt treatment is to be given. An
electronic monitor, which reports electro-
THE CANADIAN NURSE 35
encephalograms and arterial pressure,
helps the nurse in her observations.
Obviously the nurse must have a fair
amount of knowledge about the monitor-
ing equipment. She has to learn about the
basic arrythmias and be able to recognize
their appearance on the oscilloscope. Pre-
mature ventricular beats, atrial flutter,
atrial fibrillation, ventricular tachycardia,
and bundle branch block are common in
patients having valves replaced or a mitral
valvotomy. Patients with pacemakers im-
planted have to be observed carefully for
irregularity in pattern and the develop-
ment of heart block. The sensitivity of
arterial pressure monitoring assists the
nurse with the critically ill patient in
whom blood pressure readings are
inaudible.
Fluid balance
Chest drainage is recorded frequently
to determine the need for blood replace-
ment. The nurse has to be aware of the
acute problems of hemorrhage and
cardiac tamponade, and should correlate
the observations of vital signs and chest
drainage.
Central venous pressure is an excellent
indication of hypo - or hypervolemia.
Measurement of central venous pressure is
accomplished via a catheter that leads
from a median cubital vein to the
superior vena cava and right atrium. A
rise in CVP is reported immediately since
it generally indicates that the patient's
circulatory system is being overloaded
with excess fluid. Overloading increases
the work of the heart, which may be un-
able to cope with this added stress.
Urinary output is decreased in the
early postoperative period as the en-
docrine response to stress of surgical
trauma, described by Selye, includes the
increased production of an antidiuretic
hormone, ADH. ADH controls water
absorption in the tubules; it is a posterior
pituitary hormone. Output is recorded to
evaluate the functioning of the patient's
renal system. An output of less than 20
cc. an hour is reported promptly. Specific
gravity is measured every eight hours to
determine if the concentration of the
urine being produced is adequate. De-
creased urinary output may be the result
of hypovolemia, hypotension, or renal
shutdown.
36 THE CANADIAN NURSE
The vital signs are the first task after heart surgery. Modern equipment in intensivi'
care wards helps the nurse record quickly, accurately, and efficiently.
Respiratory evaluation
Most patients having open heart sur-
gery will return to the unit with an endo-
tracheal tube in place. This is connected
to a respirator, such as the Mark VII,
Bird, or Engstrom. Secretions are
suctioned frequently from the tube to
maintain a clear airway and prevent
aspiration into the lungs. Sputum and tra-
cheobronchial aspiration specimens are
sent to the laboratory routinely for cul-
ture.
Patients are encouraged to deep
breathe and cough every hour, and
maximal inflations are done with an
Ambu bag to inflate the lower lobes of
the lungs. The nurse measures tidal
volumes every hour to determine the
volume of air being expired with each
breath. The anesthetists in our unit prefer
to maintain a volume of over 300 cc.
when a patient is on a respirator. Inter-
pretation of this information in relation
to respiratory rate and total amount of
air expired in one minute is an importan
observation. The patient may be hyper
ventilating to obtain an adequate amoun
of air.
Blood samples are drawn from ar
indwelling arterial catheter at specifu
times for calculation of the arterial blooc
gases. This catheter is kept patent b)
flushing it with a heparinized saline solu
tion. Measurement includes the pH, p02
C02, 02 saturation.
The nurse watches for any change ir
blood gas content that would indicate res
piratory distress. Her observations includt
increased respiratory rate, restlessness
labored respirations, anxiety, and ;
change in level of consciousness. (Foi
complete discussion of blood gases anc
their significance, see "Blood Gases" b\
C. Betson, the Canadian nurse Sep
tember 1968.)
Evaluation of neurological status
The patient admitted to the intensive
JANUARY 196'
care unit following heart surgery is
observed for response to verbal and physi-
cal stimuli. This neurological evaluation is
important because of the possibility of
cerebral embolism during open heart sur-
gery. Air not completely evacuated from
the left ventricle prior to closure may
result in an air embolism. Also, calcium
or fibrin can be dislodged from the
calcified valve and cause an embolism.
These observations are continued
throughout the patient's stay in the unit.
It is necessary also to evaluate the pa-
tient's response to time, place, and
person. Motor ability can be tested by
asking liim to grasp the nurse's hand and
move each extremity independently. Sen-
sory response of the extremities to touch
and pain is another important obser-
vation.
Physical comfort of the patient is
assessed frequently as pain wUl prevent
him from coughing and deep breathing
adequately and can also be a cause of
hypotension. Analgesics are prescribed by
the surgeon; the drug most commonly
used in our unit is Pantapon Hydro-
chloride 2 mg. per cc. of solution, given
intravenously as necessary.
The patient may respond adversely to
narcotics if he is in shock, has renal im-
pairment, or decreased pulmonary func-
tion. For tliis reason, the nurse is aJert for
any signs of toxicity caused by drug
administration. At the same time, she
knows that delay in administering anal-
gesics will decrease their effectiveness.
Physical comfort can also be achieved
by basic nursing measures. A daily bath is
given to all patients as their body temper-
ature is elevated postoperatively and they
often perspire profusely. A flannelette
sheet used as a drawsheet is less likely to
cause skin irritation when a patient needs
many changes of linen. Turning the pa-
tient frequently adds greatly to his com-
fort, particularly if a soothing back rub is
given at the same time.
Emotional support
The underlying fear of all patients who
have had cardiac surgery is the knowledge
that death may be just a few heart beats
away. Added to this fear is the strange
bewildering experience of the intensive
care unit environment at a time when he
is least able to cope with this additional
lANUARY 1%9
stress. The patient will naturally look to
the nurse for support and understanding.
The unusual behavior seen in an in-
tensive care unit may be attributed to
both physical and psychological com-
plications. Metabolic disturbances, drug
reactions, and electrolyte imbalance may
lead to disorientation, visual, or auditory
hallucinations. For example, the first in-
dication of respiratory failure may be
confusion and restlessness.
The effect of the environment of the
unit and the intensified nursing measures
on patient behavior cannot be ignored.
The activity in the intensive care unit is
often at a high level, day and niglit. Chest
routines, monitoring, and hourly observa-
tions of vital signs all are required on a
24-hour basis. A day-night routine is
difficult to establish with the acutely ill
patient and exhaustion soon leads to
bizarre behavior.
Studies of an open heart recovery
room by D.S. Kornfeld* have demon-
strated that patients may experience any-
thing from perceptual illusion to auditory
and visual hallucinations. Disorientation
to time and place has been noted in many
patients.
Relatives also may be reassuring for
the patient. A short visit with a loved one
provides contact with his personal world.
Often a cup of tea held by a wife is more
willingly taken by the patient.
The nurse must remember the pa-
tient's need for privacy when attending to
his care. Often, he is embarrassed by his
complete helplessness and dislikes being
exposed unnecessarily.
To summarize, the monotony and
timelessness of the unit, the limitations
placed on the patient's movements by
monitoring equipment, and arterial and
venous pressure lines all appear to con-
tribute to the changes seen in patients
during their stay in the unit. Therefore,
the nurse has to recognize tliese
psychological changes and be prepared to
help the patient cope with them. Without
respect for the dignity of the individual,
the nurse becomes a technician - skilled,
but unable to give her patient the "tender
* D.S. Kornfeld, S. Zimberg, and J. Main,
Psychiatric complications of open heart sur-
gery. New England J. Med.. 273:287-292,
August 1965.
loving care" so necessary in this unit.
Simple measures help
Wliat can a nurse do to provide com-
fort and relief from anxiety for the
patient? Often the simplest measure is
enough. Turning the pillow over,
remembering to put a little ice in the
drink, placing a pillow at his back while
he is sitting at the side of the bed. giving a
back rub that reaches the aching muscles.
These basic nursing measures, combined
with a warm smile and a soothing voice,
do much to make the patient feel at ease.
With the era of cardiac transplants
now here, nursing will be faced with new
challenges for the refinement of special-
ized skills and techniques. The unique
contribution of the nurse in the care of
the heart patient must keep pace with the
advances in surgery.
Bibliography
Bordicks, Katherine J. Patterns of Shock Im-
plications for Nursing Care. Toronto, Mac-
millan, 1965. p.7-40, 64-135.
Braimbridge, M.V. and Ghadiali, P.E.
Postoperative Cardiac Care. O.xford, Eng.
Blackwell Scientific Publications, 1965.
p.9-17, 26-35.
Gurd, F.N. Pathogenesis and treatment of
shock. Canad. Nurs. 62:33-37, Oct. 1966.
Modell, Walter, et al. Handbook of Cardiology
for Nurses. New York, Springer, 1966.
Nett, Louise M., and Petty, T.L. Acute respira-
tory failure. Amer. J. Nurs. 67:1847-1853.
September 1967.
Powers, Mary Ann E. and Storlier, Frances. The
apprehensive patient. Amer J. Nurs.
67:58-63, January 1967. D
THE CANADIAN NURSE 37
A new category
of health worker for Canada?
Medically trained people, known as
"physicians' assistants" or "medical
assistants, " have recently been employed
in certain areas of the United States to
relieve doctors of much of their routine
work. At Duke University. North
Carolina, a two-year course of training
was initiated, which prepared, as phy-
sicians' assistants, people who had a
medical background but who lacked the
opportunity or academic qualifications to
become doctors. The Duke trainees have
mostly been medical corpsmen. Their
duties have included such tasks as taking
histories, drawing blood, collecting
specimens for gastric analysis, doing basal
metabolism rates, electrocardiography,
and skin-testing for allergies. A t Denver,
Colorado, "nurse practitioners" have
been trained to take on comprehensive
well-child care and to identify and refer
chronic conditions. Other institutions in
the United States are following this lead.
In Russia the feldshers have, for many
years, been acting as doctors' assistants.
In Europe trained midwives often serve
similar functions.
Should Canada also train and employ
such people? Is there a need for them
here? If there is a need, would nurses
suffer by the introduction of a new class
of worker? Would it be better if nurses
gave the necessary assistance to phy-
sicians?
THE CANADIAN NURSE Sent thc
author, a freelance writer and researcher,
to interview some of our doctors and
nurses who have expressed strong
opinions on this controversial subject.
Their views are given here.
38 THE CANADIAN NURSE
Carlotla L. Hacker, M.A.
Dr. J. B. R. McKendry is convinced
that there is a real need for physicians'
assistants in Canada, first because of the
demand for primary contact medical
people, and second because a fairly high
proportion of medical troubles are rela-
tively easy to manage. He believes that
with a situation of too many chiefs and
not enough Indians, it is at present the
chiefs who are spending much of their
time doing simple repetitive tasks.
"It's a waste of physicians' training,"
says Dr. McKendry. "it's demeaning for
them to be doing these tasks, and it's ex-
pensive for society to have them do
them."
Dr. McKendry, who is Chief of the De-
partment of Metabolism at the Ottawa
Civic Hospital, feels that, in his own case,
he could quickly train a person to be of
enormous help to him in managing the
large numbers of patients who have un-
complicated diabetes and in handling the
straightforward routines.
"A doctor is limited now in what he
can do in a day by the fact that he's only
got two hands, two eyes, and 24 hours.
But he could almost double his effective-
Carlotta Hacker is an English and History
graduate of St. Andrews University in Scotland.
Her writings include articles and short stories
for Pan Boolcs, London's Observer, The
Cornhill Magazine, and for the Blue Cross
periodical Blue Gold. In 1965 she contributed
an article to THE CANADIAN NURSE on the Can-
adian Medical Expedition to Easter Island. Her
book, ... And Christmas Day on Easter Island
has recently been published by Michael Joseph
Ltd. of London, England.
ness if he had someone who would take
off his hands the repetitious mix of work
that inevitably is found with his more de-
manding cases. Then he would not only
have the time, but also the energy, to deal
effectively with these more demanding
cases."
Dr. McKendry does not think that a
nurse, as such, would fully answer these
requirements. What he would like to see
is the creation of a new category of
worker who would work for the phy-
sician on a straightforward, employer-
employee basis and be paid by the phy-
sician. And he would prefer this person to
be called practitioner-associate rather
than physician's assistant. "This might
then be shortened to practitioner," he
says, "and then the doctors would prop-
erly retain their own title as doctors."
The fact that Dr. McKendry has views
even on the name for these people is
some indication of the thought he has
given to this category of worker. He has
already written a number of papers on
the subject, he has studied the courses for
physicians' assistants offered at Duke
University and at Colorado, and he has
visited Russia and observed the feldsher
training facilities there. The result is a
clear idea of how practitioner-associates
could be introduced into Canada.
He suggests the following as a possible
program.
The position of practitioner-associate
would be open to nurses, to ex-
servicemen with medical experience or to
any other group with some medical
knowledge, and to high school graduates.
It would require a four-year course, al-
lANUARY 196S
Dr. J. B. R. McKetjdry: "Maybe the ambitious vanguard of nurses should be pulling off
and going into a new cadre of professionals.
though previous work in medicine or
nursing could count as credits and could
shorten the course. The course itself
should be sponsored by a university in
affiliation with hospitals, clinics, and
doctors' offices for practical training.
The first three years would concen-
trate on classroom and laboratory work
and would be in an institute attached to a
university. Dr. McKendry believes that
many universities would be glad to form
such institutes, particularly those uni-
versities that at present are unable to
open full-scale medical schools because of
financial and practical difficulties. The
fourth year would be devoted entirely to
clinical and specialized training in the
appropriate field. For example, a
practitioner-associate who was preparing
to work under an obstetrician as a trained
midwife would take his final year in a
department of obstetrics.
Having successfully completed his
course, the practitioner-associate would
receive a diploma and a license permitting
him to practice in the area in which he
had trained, under the supervision of a
doctor, and on a one-to-one basis with
the doctor.
Dr. McKendry stresses the importance
of this one-to-one basis. He does not
intend that a doctor should employ more
than one assistant, partly because a good
working relationship is easier to establish
with one person than with a group, and
partly because supervision is easier. And
supervision is essential as the physician
would be morally and legally responsible
for the actions of his assistant. An Act of
Parliament would be necessary to
stipulate tiie legal responsibilities of
practitioner-associates and the physicians
who employed them.
With regard to finance, Dr. McKendry
lANUARY 1%9
suggests that the practitioner-associates
should be subsidized during training, just
as medical students are being subsidized
at present.
"The country can afford this much
more readily than it can afford to double
the number of MDs," he says.
After training, the assistants would be
paid by the doctors who decided to em-
ploy them. Renegotiation of contract
every two years should be a basic princi-
ple. This, together with the good
employer-employee relationship which is
envisaged, would minimize possible
agitation from a practitioner-associate's
union, for it would enable a really com-
petent practitioner to command a salary
equivalent to the value of his work.
There should be no ceiling to this cate-
gory: if an assistant were to prove he had
the ability of a potential MD, then he
should be permitted to enter medical
school, counting his diploma as a credit
toward his medical degree.
But how are nurses going to feel about
all this? Well, by this scheme, they would
also be given the chance of mobility,
according to Dr. McKendry.
"And such nurses as might resent the
creation of practitioner-associates are
probably the very nurses who should try
to qualify for the position," he suggests.
"Maybe the ambitious vanguard of nurses
should be pulling off and going into a
new cadre of professionals. Then the
other nurses could get back to nursing."
How will the patient feel? "By and
large, 1 think that when a doctor, in
whom a patient has trust, designates
someone else as his replacement or
assistant, then the patient accepts this,
knowing that if he is very sick or if there
is some great emergency, then the doctor
is available and will be called."
What about computers and electronic
aids? Mightn't we soon find that
machines could replace assistants in much
of their work?
"We are all equipped with computers
in our heads that are vastly superior to
any computer that can be envisaged in
the next century," Dr. McKendry
answered. "There may be a little help
from electronic communications, but
they, too, depend on what's fed into
them."
On all counts. Dr. McKendry is con-
vinced that a new category of worker is
the solution to the problem of the over-
worked physician.
"Without something like the approach
that I'm describing," he says, "we won't
begin to meet the need for primary
contact personnel in this country in this
century."
"The primary contact person - the
person who is to see the patient and
decide what is wrong with him - should
not be anything less than a doctor."
In this statement. Dr. A. L. CHUTE is
referring to normal conditions where a
doctor is available - not to isolated parts
of Canada. He does not think that in
normal circumstances an assistant should
be responsible for deciding which patients
require the attention of an MD.
But it is not only in primary contact
work that Dr. Chute opposes the idea of
physician's assistants. He questions the
need for them at all in Canada, mainly
because he questions whether there really
is a shortage of physicians here.
"And unless you predicate a shortage
of physicians, there isn't any reason to
say that there should be physicians' assist-
ants," he argues.
With many years of experience as
Chief of Pediatrics at Toronto's Hospital
for Sick Children, with medical wartime
service, with teaching experience at the
University of Toronto as Professor of
Pediatrics, and now as Dean of Medicine,
Dr. Chute's interests range over a wide
spectrum of medical subjects. His
reaction to the present subject is to ques-
tion whether perhaps medicine is suffer-
ing from a distribution problem rather
than from an actual shortage of phy-
sicians.
"We provide training posts for people
indiscriminately," he says. "We are train-
ing three or four times as many surgeons
as we need. If we reduced the number of
training posts for surgeons and made
more training posts available for other
people, then we might redirect our
qualified manpower into more effective
areas."
Similarly, Dr. Chute believes that if
the position of the family doctor were
made more attractive - for instance, by
the formation of group practices, so that
a genera] practitioner would know that a
weekend off work really was a weekend
THE CANADIAN NURSE 39
Dr. A. L. Chute: "I don't think there's any necessity for creating a new breed of cats."
off - then this, too, might direct doctors
into more needed areas.
But even if there does prove to be a
shortage of physicians, Dr. Chute does
not like the idea of creating a new
category of worker, because another cat-
egory would splinter everything further.
There would be new union problems and
another group of people worrying about
their rights and privUeges, without the
end purpose - patient care being
accomplished.
"No," he says. "I don't think there's
any necessity for creating a new breed of
cats."
Dr. Chute would far rather see a draw-
ing together of the existing ranks of
health workers, a drawing together into a
team approach aimed toward the welfare
of the patient. He believes that present
gaps in medical care could be filled by a
better use and a more appropriate train-
ing of the people already available. He
points out that for years nurses have been
performing much of the work that the
medical assistants at Duke University list
in their duties. Where necessary, they
could take on more.
In other words, specialize the nurse.
Break free from the thesis that "a nurse-
is-a-nurse-is-a-nurse and they all get paid
the same." Let nurses, who have the
ability and the desire to do so, take a
40 THE CANADIAN NURSE
course of training for some particular job.
But let them, like specialist doctors,
receive recognition and financial rewards
for their extra training. And, just as
specialist doctors are still in fact doctors,
let specialist nurses remain nurses. There's
no reason to call them anything different.
"This is the real answer," says Dr.
Chute. "Nursing has to be specialized,
and then automatically you've got your
doctor's assistant."
MLLE Julienne Provost and Mlle
Mariette DESJARDINS see things
otherwise; a nurse is a nurse, and she
should in no way aspire to be a little
doctor.
Sitting in their office at the University
of Montreal, these two Assistant Pro-
fessors of Nursing eagerly discussed the
advantages and disadvantages of intro-
ducing doctors' assistants into Canada.
They look neutrally on the suggestion,
seeing the assistant as being neither super-
ior nor inferior to the nurse: like the
social worker, he or she would simply be
something different. However they would
not wish the physician's assistant to be
recruited from the nursing staff, any
more than they would wish a nurse to fill
much the same function by becoming
over-specialized.
Mlle Provost is particularly concerned
about the fonction independante of the
nurse: her true role in caring for the
patient. If the nurse is to be entirely
removed from this, either as a specialist
nurse or as a physicians' assistant, then
she would no longer be following her
vocation. Even a clinical nurse should
remember ttiat she is primarily a nurse
and should see that something of this role
is retained.
But, as Mile Desjardins pointed out, if
there were more clinical or specialist
nurses they probably could take over the
assistant physician's functions while pre-
serving their independent function, as
shown in the Colorado University experi-
ment. But, if the physician's assistant
were recruited outside nursing, and if he
were to take over some non-nursing work,
then it could return nurses to nursing.
However, both instructors are aware of
the possible problems: How will the
cUnical nurse feel about the creation of
this new category of worker? Will she
feel threatened by it? And who will be
responsible for physicians' assistants who
are working in a hospital - the doctor or
the hospital administrator? Will assistants
give orders to nurses and, if so, will nurses
be obliged to obey the orders? They
should be licensed, but they may be
difficult to control if they are licensed.
How will the public be protected?
Mile Provost and Mile Desjardins
would like to see a survey conducted that
would answer these questions and would
evaluate the need for such assistants in
Canada. One can learn a certain amount
from the experiment in the United States,
but physicians' assistants there, particu-
larly at Duke University, are fulfilling
specific needs, one of which is the em-
ployment of medically-trained ex-
servicemen. So they suggest that an
opinion poll should be taken among our
own doctors, specialists, and clinical
nurses; that a research project be started
and that some experiments be made here
to see how such assistants would fit the
Canadian needs. For both Mlle Provost
and Mlle Desjardins do feel that physi-
cians' assistants might well serve a useful
function within medicine in Canada,
provided they are introduced carefully
and with vigilance.
ALBERT WedgERY does not share
this view. Although he believes that there
is a need for an assistant to the doctor, he
is not by any means convinced that this
means creating a new category of worker.
"It's all very well to say: 'we need an
assistant so we'll set up a new category of
worker,' but every time you create some-
thing new, you have to live with it."
Mr. Wedgery can foresee a host of
problems that will have to be lived with if
physicians' assistants are introduced into
Canada. Inevitably there will be the form-
ation of unions pressuring for higher
lANUARY 196"
Mile J. Provost: "Physicians'
medicine in Canada. "
assistants might well serve a useful function within
Mile M. Desjardins: "If the physicians' assistants were to take over some of the work
presently being done by nurses, it could help to return nurses to nursing. "
salaries and for a stronger position within
medicine. There will be legal difficulties,
particularly if, as in the United States, the
assistants are not licensed. And then there
is the matter of control: the assistants
might be able to set up on their own,
charging what fees they liked and func-
tioning as they liked, unless they were
registered with some organization that
could control them.
"And I have a feeling," he says,
"though I may be entirely wrong, that
this whole medical assistant thing is a
stop-gap, that it's abortive.
He suspects that it wouldn't be long
before, physicians' assistants wanted to go
further in medicine, and the only future
he can see for them is that they should be
allowed to use their experience as credits
toward entering medical school. In which
case, unless a very large number of assist-
ants were trained, we would be back at
stage one, with doctors needing helpers.
As President of the Registered Nurses'
Association of Ontario and as one who
has considerable experience in nursing,
Mr. Wedgery is naturally concerned about
the effect the formation of this category
would have on nurses. He fears that
physicians' assistants could potentially
separate the nurse from the doctor. He
also fears that they might remove from
the nurse's duties such procedures as
starting iiitravenouses and taking blood
pressures. While he is certainly not
suggesting that nurses should take over
medical practice, he would like the
medical procedures that have been per-
formed competently by nurses for a long
time now to be recognized as nursing
practice and placed in the nursing curricu-
lum. For he feels strongly that whatever
brings the nurse closer to the patient can
become part of nursing.
"Otherwise," he says, "if the bulk of
nursing is going to be done by nursing
assistants and the medical procedures
done by the physicians' assistants, then
what are the nurses going to have left to
do? We can easily find ourselves in
danger of isolating ourselves - like
painting ourselves into a corner."
Specialization will have to come. This
Mr. Wedgery recognizes as inevitable.
Even so, he would like to see a return to
total patient care, and some move could
be made toward this if it were nurses who
were to give the necessary assistance to
the physicians.
"It seems to me that, because of the
background of nurses, because of their in-
timate daily and hourly contact with the
patient, there is no reason why nurses -
probably specially trained over and above
the normal nurse's education - should
not be doing these tasks."
» lANUARY 1%9
"I think that there is a need for
physicians' assistants in Canada and 1
think that, if the scheme is developed
well, it may be a very good thing.
THE CANADIAN NURSE 41
A. Wedgery: "Every time you create something new, you have to live with it. "
Margaret McLean, Senior Nursing
Consultant, Hospital Services Branch, De-
partment of National Health and Welfare,
settled back in her chair and stated her
case clearly.
First, she distinguished between the
type of medical assistants employed in
Colorado and the type employed at Duke
University. She considers the former to
be similar to clinical specialists in pe-
diatric nursing and sees no reason for
such people to be placed outside nursing.
But the situation at Duke University is
different. The people there are not per-
forming as nurses. They are assistants to
the doctors and therefore they should be
classed as such.
Miss McLean sees the physician's
assistant as being just that: his assistant.
Not someone who does a little bit of
nursing and a little bit of laboratory work
and so on, although he may bring some of
the nurse's present jobs back into medical
practice. "After all, is it nursing to draw
blood from a vein? " Miss McLean asked.
The assistant's main purpose will be to
relieve the doctor of much of his routine
work, including primary contact work.
However, he must not be allowed to
come between the doctor and the other
health professionals, such as nurses,
dietitians, and physiotherapists.
From the legal and practical points of
42 THE CANADIAN NURSE
view, Miss McLean feels that the doctor
will have to take responsibility for the
work of his assistant, and the assistant
will have to be licensed. The alternative —
that of licensed nurses being given further
training in special subjects - would not
produce the type of person that is
required, for nurses have additional func-
tions and additional loyalties. The result
could be an uneasy compromise and yet
another "grey area."
But of course nurses could train to
become medical assistants, if they were
prepared to leave nursing.
"Some nurses would like to be doctors
and they might see this as a status thing,"
says Miss McLean. "But it wouldn't
attract me! "
She does not foresee any great
depletion in the nursing force by the
creation of this new category, nor does
she think that it should give rise to
rivalries. "The nurse who Hkcs caring for
the patient is not the one who is going to
become a medical assistant."
For the training of the physician's
assistant, Margaret McLean inclines
toward a two-year course, althougli it
miglU have to be longer; this would have
to be decided by the medical profession.
She is conscious tuat the success of the
experiment will depend very much on
how it is handled and how controlled.
and therefore she suggests that only a few
medical assistants should be taken on
initially. The curriculum could then be
modified, where necessary, with the next
group of trainees.
One thing she would like to see clearly
defined at the outset is the role of the
physician's assistant - just as she would
like there to be a clear and mutual under-
standing of the roles and objectives of all
other health workers. If this can be
agreed harmoniously among doctors and
nurses, and understood by the assistants
themselves, then she feels that the intro-
duction of tliese assistants into medical
practice could be of great benefit to
Canada.
"I don't believe that just because
something is right for one country, it's
automatically operationally right for
another country,'' said
Dr. Shirley Good firmly. "You have
to look at the needs, you have to look at
the distribution of population, and I
question seriously whether we need
another kind of health worker: one more
person who will come between the physi-
cian and the patient and health care."
Looking at Duke University, for
instance. Dr. Good, who is Consultant in
Higher Education, Canadian Nurses' Asso-
ciation, can see an identified need for
physicians' assistants there and she can
see that there is a large number of
medical corpsmen available to fill the
need. But Canada does not have the same
manpower problem as the United States,
nor does Dr. Good feel that our physi-
cians necessarily require similar
assistance.
"1 don't think we have a shortage of
physicians or a shortage of nurses, but I
do think there is a shortage of nursing. "
If nurses were to extend their abilities
to give greater nursing care and if capable
nurses were given more latitude to
develop their skills, then nursing itself
could be improved and the existing void
between the work of doctors and nurses
could be filled. So, although Shirley
Good does not hold that we should copy
tlie pediatric program at Colorado, she
could view with equanimity something
like that happening here, if it proved to
be necessary, as the Colorado students are
registered nurses taking further training
for a specific purpose.
But, to create a whole new category of
worker: No!
Why should we? asks Dr. Good. Have
we proved that it is really necessary? If
far more use were made of existing tech-
nical aids and more use made of the
resources within the nursing profession,
then we shouldn't require another
worker.
In any case, who would license physi-
cians' assistants? To whom would the
licensure fees be paid? If, like other
groups, they licensed themselves, would
JANUARY 1969
r
M McLean: "Some nurses would like to be doctors and they might see the physicians'
assistant role as a status thing. "
Dr. S. Good: "Just because something is right for one country, it's not automatically
right for another "
they then demand to be a profession in
their own right and begin to fight physi-
cians? If, on the other hand, physicians
licensed them, then presumably the
physicians would be legally responsible
for them. If this were so, or if the assist-
ants were unlicensed, would the physician
responsible lose his license if something
happened to the patient? And where
would these workers get their code of
ethics?
Another point Shirley Good raised
was: Who will pay physicians' assistants?
It's all very well to say that doctors will
provide the salaries, but will a doctor
really be prepared to accept such a large
drop in his own income? It could
amount to $10,000 a year or more. If the
government pays, then up goes the
medical insurance.
There is the possibility, too, that we
could be making work rather than
reducing it, for someone will have to
teach these people. Will it be doctors who
do so?
Dr. Good was also concerned about
the effect such a category of worker
might have on the nursing profession. It
could push nurses back both financially
and psychologically so that they found
themselves in the position of nurses' aides
or nursing assistants.
She would far prefer to see nurses
themselves being given the chance to
branch outwards so that those who
wished could take on more clinical and
technical work.
"You see, the nurse, if specially train-
ed, can bring with her into technical work
the kindness and humanness that is her
unique function. And a thoroughly
educated person in a balanced educa-
tional center should be capable of
bringing this sensitive approach to patient
care in an age of technology." D
JANUARY 1%9
THE CANADIAN NURSE 43
idea
exchange
How Much Bleeding?
When a doctor is called to the tele-
phone, whether it be day or night, and
whether he be an intern, resident, fam-
ily physician, or specialist, and he is
told that a patient is "bleeding heav-
ily," that information should have a
specific meaning.
Often it is extremely difficult for a
nurse to communicate to the doctor a
reasonable conception of the amount of
bleeding. Uncertainty on his part re-
sults in wasted visits to see patients
who are not actually bleeding exces-
sively, as well as the anxiety that en-
sues when he is unable to make these
visits immediately.
To avoid these difficulties, a system
was developed 15 years ago that has
been used in our hospital ever since.
Three perineal pads are prepared.
Onto the first one, 10 cc. of blood is
dropped from a syringe, 30 cc. onto
the second, and 60 cc. onto the third.
These three pads are then laid side by
side with a card under each showing
the amount of blood, and a color pho-
tograph is taken. This picture is en-
larged to eight inches by ten inches and
used in the nursing school and on each
female ward as a ready reference.
Since this system has been used, the
nurse has been able to report with rea-
sonable accuracy that "the amount of
blood is about 50 cc. per hour" or
"the blood amounts to 10 cc. on a pad
that has been in place for two hours."
This system can be put into use in
any hospital prepared to spend a few
dollars for photographs and will elim-
inate a great deal of aggravation and
unnecessary effort.
Incidentally, the word "saturated"
should be avoided, or used only to in-
dicate that the pad drips from one end
when help up by the other. — Mi-
chael Bruser, M.D., F.A.C.O.G., Mi-
sericordia General Hospital, Winnipeg.
44 THE CANADIAN NURSE
Keep The Private Duty
Directories Running
Recently we learned that memoers
of some Private Duty Registries or Di-
rectories have encountered a problem
similar to that faced by our members
in 1966, and we thought that informa-
tion about the way we solved our prob-
lem might be helpful.
In November, 1965, the Registered
Nurses' Association of British Colum-
bia notified the Victoria Private Duty
Registry that RNABC could no longer
provide financial support for the Regis-
try after March 1, 1966. Immediately,
the private duty nurses appointed a
committee to explore ways and means
of replacing the former registry to con-
tinue to provide a central service for
private duty calls from the public, phy-
sicians, and hospitals.
A questionnaire was sent to many
Private Duty Registries across Canada
through the provincial registered
nurses' associations to learn how they
functioned. Many replies were received
and the information thus obtained was
carefully studied.
After careful consideration the pri-
vate duty nurses decided to establish an
unincorporated association — The
Victoria Private Duty Registered (B.
C.) Nurses' Directory.
Bylaws were drawn up and present-
ed to the members. Receipt books
were prepared, and officially adopted
for use by directory members only. Ar-
rangements were made with a local
telephone answering service for 24-
hour answering service coverage, in-
cluding week-ends and statutory holi-
days. A Kardex system was prepared
for the answering service office, listing
names of available nurses, phone num-
bers, and preferred hours and type of
work.
In February 1 966, cards were sent to
doctors, major hospitals, and also pri-
vate hospitals. Lists of current members
of the Victoria Duty Registered (B.C.)
Nurses' Directory were sent to depart-
ments of nursing service of the major
hospitals.
We also notified the press, and re-
ceived good publicity about the new
Directory.
March 1, 1966, the "change-over"
proceeded smoothly. The Directory has
functioned satisfactorily for almost
lANUARY 1969
three years now.
The Executive Committee, which as-
sumes responsibility for the Directory
is appointed by the membership and
consists of a president, a vice-presi-
dent, treasurer, recording secretary,
and registrar. Salaried stafl is not em-
ployed nor an office maintained (other
than the telephone answering service
office). The registrar maintains the
Kardex for the telephone answering
service and the lists for the hospital
nursing service departments.
Services of the executive members are
on a voluntary basis, but the registrar
receives a small honorarium to reim-
burse her for expenses incurred during
the year.
Nurses who wish to join the Direc-
tory must be current members of the
RNABC and also complete a com-
prehensive application form. The fee
for registration with the Directory is
$20 a year or a semi-annual fee of
$10. Each member must obtain a copy
of the official bylaws and agree to
abide by them. Official receipt books
are supplied; there is a small charge
for these booklets.
Fees to the patient are presently $20
for an eight-hour shift, however these
fees will be reviewed when so indicat-
ed.
Rapidly changing trends in nursing
make it necessary for private duty
nurses to keep abreast of changes. The
Directory's regular monthly meetings
help in this way, and arrangements
have been made for the members to at-
tend inservice classes and lectures at
the major hospitals. Refresher courses
at the University of Victoria and the
University of B.C. are also available
for our members.
The Directory has been working
satisfactorily, is in sound financial con-
dition, and the telephone answering
service provides the private duty nurses
with an interested and efficient service.
We find that our cooperative effort has
worked. Other Directories who would
like more information should write to
the President, Mrs. M. Fitzgerald, 966
Hampshire Rd., Victoria, B.C. — Ja-
nie E. Jamieson, R.N., Registrar, Vic-
toria Private Duty Nurses' Directory.
A New Desing For
Stryker Turning Frame Covers
A study of the nursing care of pa-
tients on the Stryker Turning Frame
showed the need to design special cov-
ers. The aim was to make the patient
more comfortable and facilitate nursing
care.
The covers described in this article
are the result of many months of work
and experimentation. They have been
in use for a trial period and have the
following advantages over those used
previously.
• The comfort of the patient is in-
creased and it is easier to give nursing
care.
• The covers are all one size and can
be adjusted to fit the different-sized
frames.
• Covers can be applied quickly and
easily.
• Covers are securely fastened and
remain smooth and taut.
The material used for making the
covers is preshrunk flannelette, double
thickness. The border on either side is
bleached duck, which provides a firm
edge and prevents tearing. The covers
are applied over the canvas already on
the frame.
Awning cord is laced through metal
gromets spaced at regular intervals in
the border. The lacing holds the covers
so that the upper surface is smooth
and taut. The size of the cover can be
adjusted to fit the frame by folding it
under at the head and/or foot. Several
rows of stitching inside the border pre-
vent the flannelette from tearing when
the stabilizers are being put into place.
Valero closures are used on the covers
for the forehead, arm, and foot sup-
ports.
The cover was such a success that
we submitted the design to a local
company. It has taken a copyright on
the product and will be selling sets of
covers (see "New Products," page 22 ).
— Jessie F. Young, Supervisor, Neu-
rosurgical Nursing, Toronto General
Hospital, Toronto. D
JANUARY 1969
THE CANADIAN NURSE 45
research abstracts
Peterson, Alva L. A study to determine - is
the nurse in a double-bind when caring for
patients on isolation care? Montreal, 1968.
Thesis (M.Sc.N.(A)). McGill.
The study is concerned with the nurse's
approach to caring for patients on isolation care
in single rooms on a medical or surgical nursing
unit. To test the hypothesis that a nurse in this
situation is in a double-bind, a comparison has
been made of her approach to caring for
patients under two situations: isolation and
protective care. Both of these situations require
the performance and maintenance of barrier
nursing techniques - nursing measures
necessary to prevent the transmission of patho-
genic organisms.
The sample consisted of 61 third-year
student nurses at a large general hospital school
of nursing. A questionnaire of 35 statements
directed toward each situation, isolation and
protective care, was used to determine the
nurse's assessment of her approach and the
feelings of the patient in both instances. The
difference between the means of the scores for
isolation and protective care was statistically
significant at the .001 level. The findings
supported the hypothesis.
Lane, Marlene A. The relationship between
the physical adjustment of children to
diabetes and the marital integration of their
parents. Montreal. 1968. Thesis
(M.Sc.N.(A)). McGill.
This study is concerned with the
relationship between family interaction and an
ill member's adjustment to his disease. The
hypothesis states that there is a positive
correlation between the adjustment of a child
to his diabetes and his parents' marital inte-
gration.
Twenty-two families were selected from the
clinic and private files of a large children's
hospital; the families met certain criteria
including the child's age and family com-
position. Twenty families agreed to participate.
Marital integration is defined as agreement
on family goals and lack of role tension be-
tween the couple. This was measured by
Farber's Index of Marital Integration, ad-
ministered to parents in their home. Child's
adjustment to his disea.se is defined as a lack of
physical symptoms of poor control and was
measured by a six-category scale specifically
constructed for the study. The six categories
provide for deviation from normal in areas of
46 THE CANADIAN NURSE
hospitalization, illness, reactions, urine tests,
blood sugars, and growth. The data were
collected from records in the home and in the
hospital.
Spearman's rho was used to measure the
correlation between ranking of parents and
children.
Gross analysis of the ranking of marital inte-
gration and child's adjustment does not indicate
a relationship. More specific analysis shows a
positive relationship between the child's
physical adjustment and the lack of tension in
his parents. This relationship is significant at
the level of p. - less than .005.
Quittenton, R. C. Community Colleges and
Nursing Education in Ontario. Windsor,
1968.
This report was prepared with the close
collaboration of members of the nursing pro-
fession and hospital administrators in the area.
It explores the need for a regional school of
nursing in Windsor. The author recommended
not to establish a regional school, but to
augment the existing hospital nursing schools
with the addition of a diploma nursing school,
administered by St. Clair College and func-
tioning as the core of a broad health science
education unit. This nursing school would
operate on a two-year program, with mature
students constituting at least half the enroll-
ment. The report contains comprehensive
supporting data for this overall recom-
mendation.
Studies are made of post-secondary enroll-
ments in Ontario with forecasts predicting
increased student competition for the hospital
nursing schools. It is shown that bedside clinical
training time available in Windsor could support
a total student enrollment 50 percent above the
current level, and Ontario nursing enrollments
could double without any increase in hospital
beds. It points out that student recruitment is
not limited by availability of potential students,
student financing, hospital school places,
clinical training time, or demand for graduates,
but rather by admission practices, training en-
vironment, and conditions of employment.
Population and hospital patient-day pro-
jections, coupled with a declining output of
physicians in Ontario (based on a ten-year
average proven performance a percentage
drop three times that of the diploma nurse
output), indicate that by 1975 an output of
250 diploma nurses per million patient days, or
a total output of 4,650 diploma nurses, would
be required to maintain the overall 1955 level
of Ontario health services. Comparisons made
between Windsor and the rest of the province
reveal that Windsor's output of total nursing
personnel is about 25 percent better than the
provincial average and the local hospital schools
should therefore be encouraged to continue
their outstanding performance rather than
become incorporated into one regional school.
Despite this superior performance, the expected
growth of these hospital schools is inadequate
to meet the forecast needs. For this reason a
diploma program in the community college is
recommended.
Wilson, Hazel. A study to explore the
relationship between absence events and the
scheduling of time and work assignments of
registered nurses and nursing assistants in
selected units of a general hospital.
Montreal, 1968. Thesis (M.Sc.N.(A)). McGill.
This study explored the hypothesis that a
relationship exists between absence events of
nursing personnel and unsatisfactory situations
relating to the scheduling of time and work
assignments.
An absence event was defined as any
absence from work for one or two days
duration when the individual was scheduled to
work.
The subjects were 177 registered nurses and
63 nursing assistants on 23 nursing units of a
large general hospital. The number of absence
events of all nursing personnel who had worked
on each nursing unit during the six-month
period, September 1, 1967 to February 29,
1968, was obtained from the personnel cards.
There was a total of 982 absence events per 433
nursing positions.
A mean absence events score was computed
for each nursing unit. Analysis of variance indi-
cated that units above and below the mean
differed significantly.
By means of a rating-type scale question-
naire, nursing personnel were asked to indicate
the frequency of occurrences and extent of
satisfaction with 10 statements each relating to
the scheduling of time and to the scheduling of
work assignments. A favorableness of occur-
rence score was obtained for the items of time,
for the items of work, and for time and work
combined. Nursing units were assigned to
groups above and below the mean of the favor-
ableness of occurrence scores, and an analysis
of variance was employed to assess the
difference of the groups on mean absence
events scores.
JANUARY 1969
research abstracts
The hypothesis was upheld for the sched-
uling of time but not for the scheduling of
work assignments.
Rheault, M. Claire, s.g. A comparison of
students' achievement on a sequential
learning experience with other measures of
student progress. Montreal, 1968. Thesis
(M.Sc.N.(A)). McGiU.
The major purpose of this study was to
throw more light upon the all-time problem of
evaluating student nurses who are learning to
nurse. Present systems of evaluation in nursing
education tend to appraise personality traits
rather than students' progress. It follows that
complex behaviors pertaining to students' and
evaluators" attitudes, opinions, and habits
shadow more or less an objective evaluation,
and consequently the improvement or change
in the student nurses' performance.
Assuming Gestalt wxiters' theory; "What
happens to a part happens to the whole," a
sequential learning experience called "daily
plans for patient care" and performed by
beginning students during the first term of
study, was analyzed using a content analysis
technique. The results were compared with
other measures of progress used by the nursing
teachers for the same students at their nursing
school. The object was to demonstrate that
students could be evaluated by assessing their
progress on the DPPC.
The hypothesis stating "Students' perform-
ance on the daily plans for patient care is a
reflection of her overall behavior in the school"
had to be rejected, but the theory holds firmly
for some of the individual measures of progress
used by the school. Nevertheless, it is im-
possible that the method of assigning marks on
the daily plans for patient care, in this study,
may have influenced the result.
Mackenzie, Florence I. a study of the
relationship between the information about
the patient as a person which is recorded on
the nursing care plan and the information
about the same person as recorded by the
student after nursing the patient. Montreal,
1968. Thesis (M.Sc.N.(A)). McGiU.
This study is concerned with the problem of
whether students tend to conform to the
pattern of nursing care that they see practiced
in the setting where they are learning to nurse.
The hypothesis tested was that there is a rela-
tionship between the type and amount of in-
formation about the patient as a person as
recorded on the nursing care plan and the type
and amount of information recorded by the
nursing student about the same patient.
A content analysis of the written nursing
caie plans for 10 nursing units in one hospital
revealed that the information about the person
could be placed in three categories: social-
cultural, medical history and continuity of care,
and emotional supportive. A form was designed
on which this type of information could be
recorded. Fifty-eight first-year students from
10 hospital nursing units in one hospital partici-
pated in the study. Data were collected from
the nursing care plans of 104 patients assigned
to these students. After caring for the patients
during one day, the students recorded in-
formation about the same 104 patients. The
amount of information written by the student
was then compared with the amount of in-
formation from the nursing care plans.
The data were analyzed first by computing
correlation coefficients for each category of in-
formation and for the total amount of informa-
tion. A positive relationship at the .01 level of
significance was found. In the 10 nursing units
the information from the students was ranked
on the basis of the mean scores, and Spearman
rho correlation coefficients were calculated. A
positive significant relationship was found in all
categories with the exception of the social-
cultural category.
These findings tend to support the hy-
pothesis as stated. Q
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lANUARY 1%9
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THE CANADIAN SLRSE 47
Now available
THE SECOND EDITION OF
COUNTDOWN
CNA'S YEARBOOK OF CANADIAN NURSING STATISTICS
One-third larger than last year's edition, COUNT-
DOWN 1968 contains commentary and 133 sta-
tistical tables updated to present the latest
available data on nursing manpower, education, and
salaries.
An exciting addition this year is the inclusion of
salaries paid to nurses employed in public general
hospitals throughout Canada.
A cross-reference between COUNTDOWN and
FACTS ABOUT NURSING, published by the
ANA, is available from CNA.
Act now. Continue your collection of COUNT-
DOWN with the 1968 edition by clipping and
mailing the coupon below.
TO: Canadian Nurses' Association
50 The Driveway
Ottawa 4, Ontario
Please send
per copy, to:
Name
(no. of copies) of Countdown 1968, at $4.50
Address
Citv
Province
Position
Money Order D Cheque D
For$
Enclosed
48 THE CANADIAN NURSE
JANUARY 1969<
Individuality in Pain and Suffering by
Asenath Petrie, B.Sc, Ph.D. 153 pages.
Chicago, The University of Chicago
Press, 1967. Canadian agent: University
of Toronto Press, Toronto.
Reviewed by Myrtle A. Kutschke, Assis-
tant Professor, School of Nursing, Mc-
Master University, Hamilton, Ont.
In this book, the author includes her
own previously published work, that of
others, and her current research.
The writing style is clear. The research
method is described briefly in the text and
in detail in the appendices. Although a
rudimentary knowledge of statistics would
allow the reader to understand the detail of
the findings, clear interpretations are in-
cluded.
In respect to research method, variables
seem to be controlled statisfactorily. How-
ever the reader may have some quarrel
with the small numbers in several samples.
Also, "normal" subjects tend to represent
groups readily available, such as student
nurses. Some work was done to ensure that
student nurses were not a bias sample. Ran-
dom sampling is not evident.
Her research concerns individual varia-
tion in pain tolerance and sensory depriva-
tion. "The results of the study . . . suggest a
neurological or physiological basis for this
variation. . . ." Using a simple kinesthetic
test, individuals are placed in one of three
categories in relation to their reception of
stimuli. The three categories are augmenter,
reducer, and moderate. As the words indi-
cate, the augmenter tends to enlarge stimuli
received, the reducer tends to decrease stim-
uli, and the moderate leaves the stimuli
unchanged.
Findings indicate that patients tolerating
pain poorly are augmenters, while those
tolerating pain well are reducers. The re-
verse is true for sensory lack or isolaticm.
The author explains that the augmenter per-
ceives pain more fully and therefore has
more sensation to tolerate. The reducer on
the other hand has minimal sensation to
endure. Because the reducer makes poor use
of sensation, however, he feels the discom-
fort of isolation or sensory deprivation more
intensely than does the augmenter.
Juvenile delinquents, alcoholics, and schiz-
ophrenics were among the groups tested.
Each group showed a characteristic pattern.
For example, there is a higher percentage
of reducers among juvenile delinquents than
among the control group. The author sug-
JANUARY 1%9
gests that some of the destructive behavior
of juvenile delinquents may be methods of
increasing stimuli to overcome feelings of
sensory deprivation. She states that these
findings may be useful in planning programs
of rehabilitation and prevention.
The effect of drugs on the relief of pain
differs between the augmenter and the re-
ducer. These findings are important to the
nurse in anticipating results of administra-
tion of analgesics. If persons do vary neu-
rologically or physiologically in their toler-
ance of pain and sensory lack, this data
must be included in the problem-solving pro-
cess of planning individualized nursing care.
For example, an augmenter in a busy in-
tensive care unit may find the bombardment
of stimuli intolerable, while a reducer in a
single room may find the relative lack of
stimuli stressful.
This book is a good basis for clinical
nursing studies.
Nurse researchers could design experi-
mental studies to develop nursing interven-
tions that would compensate for a patient's
tendency to augment or reduce.
Communication for Nurses, 3rd ed., by
Florence K. Lockerby, A.B., M.A. 120
pages. St. Louis, Mosby, 1968.
The third edition of this book proposes
to tell the nurse how to communicate with
her patients, her fellow workers, and the
general public. Unfortunately, it has some
difficulty in communicating with its readers.
Unlike the previous two editions, this one
is directed not at student nurses but at nurses
in general. With this more mature and
knowledgeable audience in mind, the author
is less chatty and uses more impersonal
constructions and jargon.
The content as well as the style has been
changed. Whereas half of the second edition
is devoted to an explanation of communica-
tion in everyday life, only the first 27 pages
of the third edition discuss communication
in general. The rest of the book concerns
communication for nurses.
Two changes in this edition could be
considered improvements. This edition is
more meticulously organized. Each chapter
begins with a numbered outline of the chap-
ter's contents and ends with a series of de-
tailed questions on how to apply information
contained in the chapter. More real-life ex-
amples in the form of anecdotal accounts of
clinical experiences are used.
However, the author has become immers-
ed in the complexities of language and rare-
ly surfaces to enlighten the reader. For ex-
ample: "In such situations, the following
factors confound the participants' symboliz-
ation and mutual perception:
1. Peripheral involvement of other people
2. Emotional symbolization of incident
3. Disruptive lapse of time."
Such factors confound the reader as well.
The final chapter of the third edition is
substantially the same as the final two
chapters of the second edition. This section
is specifically directed to the student nurse.
It contains useful examples of how the stu-
dent can establish rapport with her patients
and help to create a favorable image for
her hospital. It explains the value of active
participation in nursing organizations, con-
ferences, and workshops. How to deliver a
public speech is outlined and notes on how
to write for publication are given.
For the person interested in developing
his writing ability, the annotated bibliogra-
phy alone — which has been enlarged in this
edition — makes this book worthwhile.
Most of the books listed are directed prim-
arily at writers.
Workbook For Community Health
Nursing Practice compiled by Commun-
ity Health Nursing Faculty, University
of Washington School of Nursing. Palo
Alto. California, Pacific Books, 1968.
Reviewed by Phyllis E. Jones, Assistant
Professor, University of Toronto.
This book contains the material required
during the community nursing experience of
students in the school of nursing at the Uni-
versity of Washington. It is intended "to
guide the student in the application of com-
munity health nursing prniciples and skills
as a family and community health worker
in the home, clinic, school and community."
It is a student workbook, designed to fit
a three-ring binder and composed of remov-
able perforated pages. The contents include
a variety of guides: for observation of home
visit, community analysis, family analysis,
process recording, and self-evaluation. A
listing of assignments required of students
during this practice period is included. State-
ment of policies regarding student work
should be helpful to students and agencies
alike; these relate to such things as time in
the agency, health, uniform, and transporta-
tion.
This book will be of greatest use in the
educational setting for which it was design-
THE CANADIAN NURSE 49
ed. The statements of philosophy and ob-
jectives are brief and how to use the book
is not explained. Therefore, this book could
not be transferred without modification to
other settings. It does, however, serve as an
example of an attractive and effective meth-
od of organizing aids to learning developed
for a specific setting. It will particularly
interest educators who deal with similar
questions of organizing teaching aids.
Simplified Nursing, 8th ed. by Claire P.
Hoffman, R.N., M.A., Gladys B. Lipkin,
R.N., B.S., Ella M. Thompson, R.N., B.S.
692 pages. Toronto, J.B, Lippincott, 1968.
Reviewed by Leota Daniels, Instructor,
Payzant Memorial Hospital, Windsor.
This text presents a comprehensive view
of the fundamentals of nursing. A realistic
approach to the human side of nursing is
stressed. Although procedures are simplified,
the principles of good nursing care are
adeptly presented.
The first unit describes the community in-
volvement required of the modem nurse.
TTie importance of personality, interperson-
al relations, spiritual factors, and legal as-
pects of nursing care to both practical and
professional nurses is stressed.
The second unit acquaints the student
with her role in relation to the family as
well as the patient. Unit 3 deals with the
functions of the human body. Colored dia-
grams are labelled in simple terms bringing
the information to the level of every stu-
dent. Glandular and organic function and
body structures are well outlined.
The simplified approach to nursing is ap-
plied in succeeding units to topics such as
nutrition, special diets, rehabilitation, nurs-
ing arts. Many of the more involved med-
ical procedures such as hemodialysis, the
cardiac pacemaker, and fetal monitoring are
outlined in principle to help the student
understand these involved medical tech-
niques.
Unit six deals with the therapeutic ap-
proach to various disorders and abnormal-
ities such as orthopedic, psychiatric, and
cardiovascular diseases. A patient-centered
approach involving individual needs is stres-
sed.
The concluding unit concerns maternal
and child care. The appendix includes a
brief but comprehensive classification of
therapeutic agents. Guidelines are given to
the skilled observation of the effects of
many widely used medications. A glossary
of medical terms is also included.
This text is a comprehensive approach to
nursing fundamentals. It can be easily under-
stood by the student of practical nursing.
50 THE CANADIAN NURSE
This edition will also be helpful to the in-
active nurse who wishes to return to the
profession.
Adolescent Psychiatry, edited by S.J.
Shamsie, M.D. 84 pages. Pointe Claire, Que.,
Schering Corporation Limited, 1968.
This book contains the complete proceed-
ings of the first conference on adolescent
psychiatry held in Canada at the Douglas
Hospital, Montreal, in June 1967.
Commenting on the publication, the editor.
Dr. Shamsie said: "In this one volume we have
attempted to trace the development and treat-
ment of adolescent problems, with particular
emphasis on Canadian experience."
Subjects covered include: "The Varieties of
Adolescents' Behavioral Problems and Family
Dynamics" by Dr. R.L. Jenkins, professor of
child psychiatry at the University of Iowa, and
"Biological Growth during Adolescence" by Dr.
J. Robertson Unwin, director of adolescent
services at the Allan Memorial Institute in
Montreal.
Dr. Henry Kravitz, psychiatrist in chief at
the Montreal Jewish Hospital discusses the
"Management of Adolescents in the General
Hospital Setting." Dr. Jean L. LaPointe, super-
intendent of the Mont Providence Hospital
writes about "Educational Problems in
Disturbed Adolescents."
The "Adolescent in the Family," the
"Adolescent in Juvenile Court," and
"Adolescence as Rebirth" are covered respec-
tively by Dr. Ronald B. Feldman, director of
family and child psychiatry at the Jewish Gen-
eral Hospital, Dr. S.J. Shamsie, chief of
adolescent services at Douglas Hospital, and
assistant professor of psychiatry at McGill Uni-
versity, and Dr. Vivian Rakoff, director of
psychiatry research at the Jewish General.
Clinical Nursing Workbook for Practi-
cal Nurses, 3rd ed., by Marilyn Gottehrer
Freedman. M.A., R.N., and Justine Hannan,
M.A., R.N. 207 pages. Philadelphia, F.A.
Davis, 1968. Canadian agent: Ryerson,
Toronto.
Reviewed by Donna Dineen, Charge Nurse.
A uxiliary Staff, St. Mary 's General Hospital,
Kitchener, Ont.
This manual is an up-to-date workbook for
the education of the student practical nurse.
It is divided into three sections. The first
unit on medical and surgical nursing reviews
body structure and function, and common
systemic disorders, including the nursing care
and pertinent drugs used in the treatment of
these common medical-surgical conditions.
The second section, maternal and child
health, deals with the pre and postpartum pa-
tient, nursing care of the newborn, and care of
the sick child. Its major objectives are to
protect the health of the mother and child and
to lower the mortality rate. It points out how
the practical nurse can best help her patients to
attain these goals through her knowledge, skills,
and attitudes.
The third section concerns the care of the
mentally ill. It covers psychopathology,
psychosis, and personality disorders with their
appropriate nursing care, including shock and
chemotherapy.
This book covers the entire practical nurses'
course well. Its presentation is concise and com-
plete. Although the psychiatry chapter and
medications cover more than is actually
necessary for the nine-month course, it proves
to be interesting additional learning. The biblio-
graphies are extensive, and therefore useful for
extra assignments. Each new topic is preceded
by an anatomical diagram; however, at times
they appear jumbled and are too small to
clarify needed details.
This manual would be of much assistance to
the instruction of practical nurses.
ANA Regional Clinical Conferences,
American Nurses' Association, 1967. Phi-
ladelphia/Kansas City. 322 pages. New
York, Appleton-Century -Crofts, 1968.
Reviewed by Frances Pishker, Lecturer,
School of Nursing, Queen's University,
Kingston, Ont.
This book is a compilation of papers
presented at American Nurses' Association
Regional CUnical Conferences in 1967.
Fourteen papers presented at general
sessions are concerned with three major issues:
the nurse's involvement in health planning from
national to local levels in the health care system
in the United States; the use of computers in
hospital; and discovery, dissemination, and
utilization of the expanding body of nursing
knowledge. Thirty papers presented at clinical
sessions are evenly divided among the following
areas of nursing practice: community health,
geriatrics, maternal and child health, medical-
surgical, and mental health and psychiatric
nursing. Two papers presented at general
clinical sessions are concerned with new
methods of continuing education for graduate
nurses: teaching new, highly speciaUzed care
techniques, and the use of communications
media in inservice education programs.
The clinical sessions are particularly interest-
ing. Nurse cUnicians, teachers, and researchers
discuss new approaches to nursing care in
papers based on experimental studies, pilot
projects, and case presentations. Some papers
are primarily considerations of theory, and a
few are refreshingly controversial. The section
on geriatric nursing is well worth special
attention for the dynamic and vital approach it
brings to health care problems of aged people.
Nancy llio's discussion of health care in an
urban ghetto is a high point in the community
health nursing section. The psychiatric and
mental health nursing sessions include a number
of exceptional papers.
The papers are six to eight pages in length,
clearly presented, and easily read. Advantages
of brevity are occasionally out-weighed by
superficial treatment, but this may be a carping
criticism in view of the overall merits of the
publication. One can hardly expect such a large
number of papers to be of uniform quality.
This volume has a lot to offer nurses
engaged in direct patient care. It should be a
JANUARY 1969
useful addition to nursing libraries and to the
personal collections of nurses who either do not
have access to a variety of periodicals or cannot
find time to read them. Good references are
provided with each paper, and the nursing
teacher and student will find this book
profitable when used in conjunction with
source material.
How to Pass Entrance Examinations for
Registered and Graduate Nursing
Schools compiled by editors of Cowles
Education Corp. 399 pages. Toronto. W.B.
Saunders, 1968.
Reviewed by Dr. M. Josephine Flaherty,
Lecturer, Department of Adult Education.
The Ontario Institute for Studies in
Education. Toronto.
This book is written for nursing school
candidates. It purports to prepare such can-
didates for all the variations of academic and
nursing tests used in current nursing entrance
e.xaminations. The latter include pre-entrance
tests (for candidates seeking admission to basic
nursing programs), which are thought to
measure a candidate's aptitude for nursing as
well as his general scholastic aptitude, and
nursing achievement tests, which are written by
graduate nurses seeking admission to university
schools of nursing.
The book provides general information and
advice about applying for admission to nursing
school examinations in the United States, and
instructions regarding how to take and score
sample tests in the book. Sample tests include
verbal, numerical, mathematical, reading com-
prehension, science, general information, and
social studies tests for prenursing candidates,
and medical-surgical nursing, maternal and child
nursing, psychiatric nursing, and science in
nursing tests for the graduate nurse students.
With each group of tests, a short note on the
nature of the tests and a set of "do's and
don'ts" for dealing with the tests are given.
Without a set of well-defined objectives, it is
impossible to evaluate the validity of any test
or group of tests; hence no attempt has been
made to do so in this review. It is probably
more appropriate to look at the purpose for
which the book was written and to attempt to
assess its usefulness on the Canadian nursing
scene.
If the purpose of an aptitude test is to help
to estimate the future success of an individual
in a particular occupation or educational pro-
gram, it seems reasonable to sample certain
psychological characteristics and acquired skills
that are believed to be requisite to success in
the specified occupation or educational pro-
gram. Such measurement should be uncon-
taminated by specific preparation or practice
by the candidate for the aptitude test itself.
This "how to pass" text is intended to give
students some practice in test-taking: this in
itself is probably not a bad idea, as it may help
to dispel students' fears about the format and
conduct of the test situation. However, the
book also suggests that candidates study the
correct answers carefully, score themselves,
determine their area of weakness, and "plan a
program of intensive study to insure success on
the professional nursing school admission
tests." This sort of procedure appears to lose
sight of aptitude measurement, and to em-
phasize the content of the pre-entrance ex-
amination. Surely the aim of the schools should
be to select candidates who really possess the
characteristics and skills considered necessary
for success in nursing rather than those can-
didates who are able to find out what is likely
to be on the aptitude examination and learn the
correct responses, without necessarily under-
standing why those responses are correct.
Similarly, with graduate nurse examinations,
the objective is to assess the abilities and skills
required by a candidate during her basic edu-
cational program in nursing and during her
work experience in the profession. Attempts to
practice or prepare specifically for the tests
would tend to defeat the purpose of the ex-
amination program. Hence, one should question
whether a "how to pass" book such as this one
has any merit.
Although the sections on "do's and don'ts"
of test-taking might be helpful to students who
arc unaccustomed to writing obiective ex-
THE
FULLER
SHIELD:
Keeps dressings firmly in place
Prevents soiling of clothing, bed linen
The ideal post-operative dressing for patient
comfort, nursing convenience. The FULLER
SHIELD, designed on undergarment lines, is a
protective dressing especially made to maintain
anal, perianal or sacral dressings comfortably
in place v\^ithout binding, without use of tapes.
Surgeons order two FULLER SHIELDS
for each patient. (One on and one off.)
Nurses are glad they do.
Request samples through your hospital
purchasing agent.
w'
WINLEY-MORRIS lTd
JANUARY 1%9
THE CANADIAN NURSE 51
aminations, the purpose and hence the content
of the rest of the book seem to have little to
recommend it for use by nursing school can-
didates. This book is not recommended for
inclusion in nursing school libraries.
Biology of Human Behavior by Eleanor
Page Bowen. R.N,, Ed.M. 607 pages. New
York, Appleton-Century-Crofts, 1968.
Reviewed by Margaret N. Lee, Associate
Professor, School of Nursing, Laurentian
University, Sudbury, Ontario.
In her preface to Biology of Human
Behavior the author points out that the book is
designed as a textbook for schools of nursing
that offer one integrated science course.
The contents are divided into units and sub-
divided into chapters. These describe the anato-
mical and physiological functioning of the
various systems of the human body and discuss
the consequences of impairment to these
systems. Each chapter ends with a discussion of
the nursing implications of the contents of the
chapter.
The illustrations are in black and white,
although colored illustrations would probably
have been more useful for students.
This book is written at a level that may
make it useful to beginning students whose
background of high school science is limited,
and who have chosen to follow a nursing
curriculum that includes only one integrated
science course. It would be less useful to
students in a baccalaureate degree program in
nursing.
A Programmed Introduction to Micro-
biology by Stewart M. Brooks, M.S. 100
pages. Saint Louis, Mosby, 1968.
Reviewed by H. Kernen, M.A., R.T.,
Director, Medical Laboratory Technology
Program, Saskatchewan Institute of Applied
Arts & Sciences, Saskatoon.
Programmed texts are often most useful
when integrated with a standard text used as a"
basis for a course of lectures. This text seems
particularly well integrated with Textbook of
Microbiology by Kenneth L. Burdon and R. P.
Williams, 6th edition.
This book is divided into three parts: Fun-
damentals of Microbiology, Practical Aspects of
Microbiology, and Microorganisms and Disease.
There are 21 diagrams. The program is
linear, the template easy to operate, and it is
less tedious than many linear programs.
Not all students like or profit from pro-
grammed texts and certainly not all students
approach programmed texts in the same state
of mind or use them in the same manner. To
my surprise a group of nursing students in the
Saskatchewan Institute of Applied Arts and
Sciences, who were having difficulties earlier
52 THE CANADIAN NURSE
this year in learning microbiology, used this
text in a novel manner with good results: they
studied together as a group looking at one book
and discussing aloud the possible answers to
each frame.
Resuscitation : A Programmed Course
by Leonard P. Caccamo, M.D., Edward
Kessler, M.D. and J. Leonard Azneer, Ph.D.
113 pages. Toronto, The Ryerson Press,
1968.
Reviewed by Jean-Paul Dechine, M.D.,
Chief, Anesthesia-Resuscitation Depart-
ment, Laval Hospital, Quebec City.
This book, presented in the form of a ques-
tionnaire, reviews each phase of cardio-
pulmonary resuscitation, thus enabling the
reader to evaluate his knowledge.
Each principle is very well explained and
completed by illustrations.
Blank space has been left for personal ob-
servations.
This book should be used as a basic text-
book as well as a reference book by all para-
medical personnel involved in cardio-pulmonary
resuscitation.
The Lung And Its Disorders In The New-
born Infant, 2d ed., by Mary Ellen
Avery, A.B., M.D., 285 pages. Toronto,
W.B.Saunders, 1968.
Reviewed by Shirley E. Pitt, R.N., P.H.N.,
Nursing Coordinator, Home Care
Department, The Children's Hospital of
Winnipeg, Winnipeg.
This second edition, written primarily for
medical clinicians and investigators, is an
excellent reference book for all professional
personnel who are working with the newborn
infant. It is especially valuable for nurses
who work in maternity nurseries or newborn
intensive care units.
This up-to-date, detailed text is divided
into three parts.
The first section discusses normal deve-
lopment and physiology of the fetal and
newborn lung. Subheadings cover the topics
of intrauterine respiration in the fetal lung,
the aeration of the lung at birth, perinatal
circulation, the regulation of respiration,
methods of study of pulmonary function in
infants, and roentgenographic evaluation of
the chest.
Part II outlines the disorders of respira-
tion in the newborn period, including con-
genital anomalies, infections, aspiration
syndromes, and persistent pulmonary dys-
function in premature infants. This section
has an informative chapter on hyaline
membrane disease and other conditions
associated with hyaline membranes.
In the last section, the doctor talks about
artificial respiration. Topics discussed inclu-
ded recuscitation at birth, infants at special
risk at birth, evaluation of the newborn
(APGAR rating), and criteria for recuscita-
tion and the techniques of recuscitation.
Dr. Avery states that the intent of the
clinical summary in the text is to stress that
there are many causes of respiratory distress
in the newborn period; she goes on to say
that the most likely diagnosis can be suspec-
ted from the history and by inpection of the
infant. The most helpful diagnostic aid is the
chest film.
Two New Catalogs
A new Handbook of Educational Material
for Guidance, Health, and Sex Education has
been prepared for schools. The 16-page catalog
lists filmstrips, slides, films (16mm), and film
loops (Super 8 or Standard 8). The audiovisual
materials are available for purchase to aid in
instruction or guidance, health, and family life
education for teenage audiences.
Nursing educators may wish to be familiar
with these aids as high school students entering
nursing will likely have seen some of these
materials. Public health nurses will be interested
in knowing of new audiovisual aids for use in
schools. Some of the materials may be suitable
as aids in anatomy and physiology lectures in
diploma programs.
Requests for the catalog should be sent to
Mclntyre Educational Materials Ltd., at 3333
Metropolitan Blvd. East, Montreal 455, P.Q. or
at 123 Eglinton Ave. East, Toronto 12.
Davis and Geek has released a November
1968 supplement to its Surgical Film Catalog.
The catalog lists new additions to the Davis and
Geek Surgical Film Library.
One of the new films, cntitled"Sychronous
Combined Resection of the Rectum," was
filmed in Canada at two Toronto hospitals. It
describes details of a two-team abdomino-
perineal resection for carcinoma of the rectum.
Davis and Geek Surgical Film Library loans
medical and nursing films to Canadian hospitals
and educational facilities; the library has some
250 subjects with approximately 1,300 prints
available. Further information about the films
may be obtained by writing to Davis and Geek
Film Library, c/o P.O. Box 1039, Montreal 3,
Quebec. D
accession list
Publications on this list have been received
recently in the CNA library and are listed in
language of source.
Material on this list, except Reference items,
including theses, and archive books that do not
circulate, may be borrowed by CNA members,
schools of nursing and other institutions.
Requests for loans should be made on the
"Request Form for Accession List" and should
be addressed to: The Library, Canadian Nurses'
Association, 50 The Driveway, Ottawa 4,
JANUARY 1969
accession list
No more than three titles should be re-
quested at any one time.
BOOKS AND DOCUMENTS
1. Analyzing and reducing employee turn-
over in hospitals. New York, United Hospital
Fund of New York, Training Research and
Special Studies Division, 1968. 94p.
2. An approach to the teaching of psy-
chiatric nursing in diploma and associate degree
programs: a method for content integration and
course development in the curriculum by Joan
E. Walsh and Cecilia Monat Taylor. New York,
National League for Nursing, 1968. 78p.
3. L'avortement par Serge Mongeau et
Renee Cloutier. Montreal, Editions du Jour,
1968. 173p.
4. The challenge of changing patterns; re-
port of the first conference of National League
for Nursing Western Region Committee on
Community Nursing Service. San Mateo, Calif,
Mar. 22-23, 1968. San Francisco, 1968. 46p.
5. Clinic nursing: explorations in role inno-
vation by Herman Turk and Thelma Ingles. Phi-
ladelphia, F.A. Davis Co., 1963. 192p.
6. Cooper's nutrition in health and disease
by Helen S. Mitchell et al. 15th ed. Philadel-
phia, Lippincott, cl968. 685p.
7. Emerging sectors of collective bargaining.
Montreal, McGiU University. Industrial Rela-
tions Centre, 1968. 120p.
8. Etudes sur le parler frangais au Canada.
Prepare par La Societe du Parler fran^ais au
Canada. Quebec, Les Presses Universitaires
Uval, 1955. 220p.
9. Fate, hope and editorials; contemporary
accounts and opinions in the newspapers
1862-1873, microfilmed by the CLA/ACB
microfilm project by Helen Elliot. Ottawa, Can-
adian Library Association, 1967. 190p.
10. The graduate education of physicians
by the Citizens Commission on Graduate
Medical Education. Report commissioned by
the American Medical Association. Chicago,
American Medical Association, 1966. 114p.
11. Guidelines for discftarge planning by
Janis H. David, Johanne E. Hanser and Barbara
W. Madden. Downey, Calif., Attending Staff
Association of Rancho Los Amigos Hospital,
C1968. 52p.
12. Health care needs; basis for change.
Papers of the first regional conferences. New
York, National League for Nursing. Council of
Hospital and Related Institutional Nursing Serv-
ices, 1968. 63p.
13. History of nursing by Josephine A.
Dolan. 12th ed. Philadelphia, Saunders, 1968.
380p.
14. Hospital safety and sanitation with spe-
cial reference to patient safety. Michigan, Uni-
versity of Michigan, School of Public Health,
C1962. 208p.
15. The Merck Index; an encyclopedia of
chemicals and drugs. 8th ed. Rahway, N.J.,
Merck & Co., 1968. 171 3p. R
16. Pharmacology and drug therapy in
nursing by Morton J. Rodman and Dorothy W.
Smith. Philadelphia, Lippincott, cl968. 738p.
17. The photography of H. Armstrong Ro-
berts. Philadelphia, 1968. 96p.
18. The physician by Russel Lee, Sarel
Eimerl and the editors of Life. New York, Time
Inc., cl967. 200p.
19. A practical style guide for authors and
editors by Margaret Nicholson. 1st ed. New
York, Holt, Rinehart and Winston, cl967.
143p.
20. Professionalism and salaried worker or-
ganization by Archie Kleingartner. Milwaukee,
Wisconsin, Industrial Relations Research Insti-
tute, University of Wisconsin, 1967. 113p.
21. Psychiatric nursing in general hospitals.
Proceedings of the Canadian Conference on
Nursing in Psychiatric Divisions of General
Hospitals, First, Montreal. November 1958.
Montreal, McGill University, 1958. 84p.
22. Questions and answers about contact
lenses by Barnes-Hind Pharmaceuticals, Inc.
New York, DeU, 1968. 64p.
23. Report of the Nursing Seminar, Tehe-
ran, Iran, 9-19 November 1966. Alexandria,
World Health Organization, Regional Office for
the Eastern Mediterranean, 1968. 50p.
24. Report of the Ontario Cancer Treat-
CHASE
HOSPITAL
DOLLS
For demonstrating and practicing the
newest nursing techniques • lavage and
gavage • tracheotomy and colostomy,
and their post-operation care • nasal
and otic irrigations • catheterization and
all abdominal irrigations * subcutane-
ous, intramuscular and intradermal injec-
tions • and all standard nursing procedures.
Let us tell you about the new features we
have added to this world-famous teaching
aid. Write to
M. J. CHASE Co. Inc. — 156 Broadway
Pawtucket — Rhode Island
JANUARY 1%9
THE CANADIAN NURSE 53
accession list
ment and Research Foundation, 1965/67. Tor-
onto, 1968. 209p.
25. Reports to the general annual meeting,
44th. Toronto, Ontario Hospital Association,
1968. 66p.
26. Risume du rapport (par G.M. Weir) de
I'enquete au sujet de la formation des gardes-
malades au Canada. Prepare par le docteur
Alfred T.- Bazin. Traduit par le docteur J. -A.
Baudouin. Montreal, Autorise par le Comite de
Regie de I'Association des Gardes-Malades Enre-
gistrees de la Province de Quebec, 1932.
136p. R
27. Survey methods applied to schools of
nursing and hospital nursing services. Pro-
ceeding of short course held at Indiana Uni-
versity, July 38-August 9, 1947. Bloomington,
Indiana. Indiana University, Division of Nursing
Education, 1948. 21 Op.
28. Team nursing; a programmed learning
experience by Russell C. Swansburg. New York,
Putnam's, cl966, 1968. 4v.
29. The writer's handbook. Edited by A.S.
Burnack. Boston, The Writer, Inc., cl968.
765p.
PAMPHLETS
30. Basic cataloguing tools for use in Can-
adian libraries; a report to the CLA technical
services section. Rev. ed. by Beryl L. Anderson,
Ottawa, Canadian Library Association, 1968.
28p.
31. Basic guidelines on press relations for
management. Toronto, Public & Industrial
Relations Ltd., 1968. 13p.
3 2. Catalogue of films on world de-
velopment. Ottawa, Canadian Council for Inter-
national Development, 1968. 32p.
33. Code for nurses with interpretive state-
ments. New York, American Nurses' As-
sociation, 1968. 12p.
34. Check and double check in education
by Fred E. Whitworth. Ottawa, Canadian
Council for Research in Education, 1967. lOp.
35. Education for nursing the diploma way.
New York, National League for Nursing. De-
partment of Diploma Programs, 1968. 40p.
36. Graduate training for family practice.
Kansas City, American Academy of General
Practice. Commission on Education, 1967. 24p.
37. Handbook for nurses on leprosy by
Eileen Greenwood. Vellore, India, 1967. 27p.
38. A manual on training in family medi-
cine. Don Mills, Ont., The College of I-amily
Physicians of Canada. Committee on Advanced
Training, 1967. 25p.
39. Nurses' guide to Canadian drug legisla-
tion by David R. Kennedy. Toronto, Lippin-
cott, 1968. lip.
40. Project for the preparation of teachers
for associate degree programs in nursing.
College of Nursing. University of Florida. Vol.
5, fifth and final report to the W.K. Kellogg
Foundation, Jan-Dec. 1964. Gainesville, Fla.,
1964. 39p.
41. R e-employment factors of inactive
nurses in Wisconsin. Prepared by the Wisconsin
Nurses' Association, Inc. Milwaukee, Wisconsin,
1968. 42p.
GOVERNMENT DOCUMENTS
Canada
42. Bureau du Conseil Prive. Secretariat des
Sciences. La psychologic au Canada par M.H.
Appley et Jean Rickwood. Ottawa, 1967. I45p.
43. . La statistique de I'etat civil,
1966. Ottawa, Imprimeur de la Reine, 1968.
213p.
44. Bureau of Statistics. List of hospital in-
dicators, 1966. Ottawa, Queen's Printer, 1967.
17p.
45. . Survey of higher education:
part 1: fall enrolment in universities and
colleges. Ottawa, Queen's Printer, 1968. 61p.
46. Conseil Economique du Canada: Difi
pose par la croissance et le changement.
Ottawa, Imprimeur de la Reine, 1968. 235p.
47. Dept. of Manpower and Immigration.
Career decisions of Canadian youth; a com-
pilation of basic data, vol. 1, 1967, by
Raymond Breton and John C. McDonald.
Ottawa, Queen's Printer, 1967. 203p.
48. . University, college and tech-
nological; guide; graduations, enrolments,
salaries. Prepared by . . . the Professional and
Technical Occupations Section, Manpower In-
formation and Analysis Branch, Program De-
Request Form for "Accession List"
CANADIAN NURSES' ASSOCIATION LIBRARY
Send this coupon or facsimile to:
LIBRARIAN, Canadian Nurses' Association, 50 The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in the
Canadian Nurse, or add my name to the waiting list to receive them when available:
Short title (for identification)
issue of The
Item
No.
Author
Requests for loans will be filled in order of receipt.
Reference and restricted material must be used in the CNA library.
Borrower Registration No.
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Address
Date of request
54 THE CANADIAN NURSE
JANUARY 1969
accession list
velopment Service. Ottawa, 1968. 45p.
49. Dcpt. of National Health and Welfare.
Earnings of physicians in Canada. J 966.
Ottawa, 1968. 33p.
50. . Report. 1967. Ottawa,
Queen's Printer, 1968. 261p.
51. National Library of Canada. Canadian
theses 1965/66. Ottawa, Queen's Printer, 1968
195p.
Ontario
5 2. Department of Labour. Research
Branch. Wages, hours and overtime pay pro-
visions in selected industries. Ontario, 196 7.
Toronto, 1968. 25p.
Quebec
53. Ministere de la Sante. Les services
sociaux scolaires. Quebec, Service de I'lnforma-
tion des ministeres de la Sante, de la Famille et
du Bien-ttre social, 1968. 146p.
54. Ministere de la Sante. Trois
experiences-pilotes du gouvernement du Que-
bec: retour a la vie normale par . . , et les minis-
teres de la Famille et du Bien-etre social du
Quebec. Quebec, 1968. 36p.
Saskatchewan
55. Department of Education. Evaluation
of the state of nursing education in Saskat-
chewan. July 1. 1967 ~ June 30, 1968. Regina
1968. 13p.
U.S. A.
56. National Archives and Records Service.
Office of the Federal Register. U.S. government
organization manual, Washington, U.S. Gov't
Print. Off. 842p.
57. National Center for Health Statistics.
Employment during pregnancy. Washington,
Public Health Service, 1968. 30p.
^8- • Nursing and personal care serv-
ices: received by residents of nursing and per-
sonal care homes. United States, Mav-June.
1964. Washington, Public Health Service 1968
41p.
STUDIES DEPOSITED IN
CNA REPOSITORY COLLECTION
5 9. Canadian graduate nurse students
studying for master's and doctoral degrees in
National League for Nursing accredited pro-
grams in colleges and universities in the United
States of America, June 1968 by Shirley R.
Good. Ottawa, Canadian Nurses' Association
1968, 63p. R
60. The cottage hospital and the R.N.: some
aspects of and demand on the cottage hospital,
1965. St. John's, Newfoundland, Dept, of
Health, 1965. 26p. R
61. Evaluation of the activities of nursing
unit personnel, 1959-1965 by Nursing Con-
sultants, Hospital Operating Standards Division
in cooperation with the Statistical Research
Division. Toronto, Ontario, Hospital Services
Commission, 1968. 266p. R
62. A study of the relationship between the
information about the patient as a person
which is recorded on the nursing care plan and
the information about the same person as
recorded by the student after nursing the
patient by Florence I. Mackenzie. Montreal,
1968. 39p. Thesis (M.Sc.N.(App.)) - McGill.R
63. A study to determine the influence of
selected factors in choosing a head nurse's
position by Yolande Proul.x. Boston, 1968.
78p. Thesis (M.Sc.N.) - Boston. R
64. A study to explore the relationship be-
tween absence events and the scheduling of
time and work assignments of registered nurses
and nursing assistants in selected units of a
general hospital by Hazel Wilson. Montreal,
1968. 53p. Thesis (M.Sc.(App.)) - McGill. R
65. A study to explore the relationship be-
tween the consensus of perception of the roles
of the head nurse and assistant head nurse in a
hospital unit and to the stability of the unit by
Mary Irene MacMillan. Montreal. 1968. 51 p.
Thesis (M.Sc.(App.)) - McGill. R
66. A study to determine who. in the
opinion of nurses and physicians, should be re-
sponsible for teaching the hospitalized patient
by Shirley Jean Shantz. Seattle, Wash., 1968.
138p. Thesis (M.N.) - Washington. R
67. Theoretical basis for the teaching of eye
nursing in a Peruvian diploma nursing program
by Sister Leona Hebert. Saint Louis, Missouri,
1967. 68p. Thesis (M.Sc.N.) - Saint Louis. R
68. Timing studies of nursing care in relation
to categories of hospital patients by J. Asa K.
MacDonell, Unnur Brown and Barbara
Johansson. Winnipeg, 1968. 162p. R
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THE CANADIAN NURSE 55
classified advertisements
ALBERTA
ALBERTA
BRITISH COLUMBIA
Opportunity for team teaching in nursing in a Junior
College setting. INSTRUCTORS (3) to be appointed in
1969 — one with Psychiatric Nursing preparation;
and one with Pediatric or Maternal Child preporo-
tion; and one other with either preparation. Qualifi-
cation is Master's degree in clinical specialty pre-
ferred. Bachelor's degree accepted for temporary
appointment. Active and auxiliary hospital proviides
clinical experiences. Total student enrollment of 70.
Total staff of seven for nursing. Apply for further
details to: Director, Department of Nursing Educa-
tion, Red Deer Junior College, Red Deer, Alberta.
REGISTERED NURSES FOR GENERAL DUTY in a 34-
bed hospital. Salary 1968 $405-$485. Experienced
recognized. Residence available. For particulars con-
toct: Director of Nursing Service, Whitecourt General
Hospital, Whitecourt, Alberta. Phone; 778-2285.
Ganera) Duty Nurses for active, accredited, well-
equipped 65-bed hospital in growing town, populo-
tion 3,500. Salaries range from $405 — $485 com-
mensurate with experience, other benefits. Nurses' re-
sidence. Excellent personnel policies and v^orking
conditions. New modern wing opened in 1967. Good
communications to large nearby cities. Apply: Di-
rector of Nursing, Brooks General Hospital, Brooks,
Alberta.
GENERAL DUTY NURSES (2) for snnall modern Hos-
pital on Highwoy No. 12. East Central Alberta.
Salary range $430 to $510 including Regionol
Differential. Residence available. Personnel policies
as per AARN and A.H.A Apply: Director of Nursing,
Coronation Municipal Hospital, Coronation, Atbertc.
GENERAL DUTY NURSES for 94bed General Hos
pital located in Alberta's unique Badlands. $405-
$485 per month, approved AARN and AHA per-
ADVERTISING
RATES
FOR ALL
CLASSIFIED ADVERTISING
$11.50 for 6 lines or less
$2.25 for each additional line
Rates for display
advertisements on request
Closing date for copy and cancellation is
6 w/eeks prior to 1st day of publication
month.
The Canadian Nurses' Association does
not review the personnel policies of
the hospitals and agencies advertising
in the Journal. For authentic information,
prospective oppliconts should apply to
the Registered Nurses' Association of the
Province in which they are interested
in working.
Address correspondence to:
The
Canadian ^
Nurse ^
50 THE DRIVEWAY
OTTAWA 4, ONTARIO.
sonnel policies. Apply to: Miss M. Howkes, Directo-
of Nursing, Drumheller General Hospital, Drumhel-
ter. Alberi=. 1-31-2A
General Duty Nurses for 64-bed active treatmeni
hospital, 35 miles south of Calgary. Salary range
S405 - $485. Living cccommodaTion available in sep-
arate resiaence if aesirsd. Full mainrencnce m
residence S50.00 per month Excellent Personnel
Policies and working conditions. Please apply ic:
The Director of Nursing, High River General Hos-
pital, High River, Alberto. i-46-lA
GENERAL DUTY NURSES for 200-bed active treatment
hospital. Salary S405-S485. Credit for pest experi-
ence and postgraduate training. Employer-employee
participation in medical coverage and superonnuo-
rion. Apply: Director of Nursing Service, St. Michael's
General Hospital, Lethbridge, Alberto.
GENERAL DUTY NURSES (2) for modern, 25-bed ac-
tive treatment hospital, 20 miles north of Lethbridge.
Salary and personnel policies in accordance with
the AARN and Alberta Hospital Association Recom-
mendations. Residence facilities available. Apply to:
Director of Nursing, Municipal Hospital, Picture
Butte, Alberta.
General Duty Nurses required by 150-bed general
hospital presently expanding to 230 beds. Salary
1967, $380 to $450; 1968 — $405 to $485. Experi-
ence recognized. Residence available. For poriiculars
contact Director of Nursing Service, Red Deer
General Hospital, Red Deer, Albertc.
General Duty Nursing positions are available in o
lOO-bed convalescent rehabilitation unit forming
part of a 330-bed hospitol complex. Residence
available. Solory 1967 — $380 to $450. per mo.
1968 — $405 to $485. Experience recognized. For
full particulars contact Director of Nursing Service.
Auxiliary Hospital, Red Deer, Alberta.
BRITISH COLUMBIA
DIRECTOR OF NURSING required for 30-bed hospital
B.C. Interior. New 41-bed hospital in late planning
stoge. New industrial activities will necessitate
further exponsion. Apply with full particulars of
training ond experience to; The Administrator, Lady
Minto Hospital, Ashcroft, British Columbia.
OPERATING ROOM INSTRUCTOR with University
preparation, for a 450-bed hospital with a school of
nursing, 145 students. Apply: Associate Director,
School of Nursing, St. Joseph's Hospital School of
Nursing, Victoria, British Columbia.
COME TO PACIFIC NORTHWEST — Gateway to
Alaska, Friendly community, enjoyable Nurses' Resi-
dence accommodation at minimal cost. RNABC con-
tract in effect. Salaries — Registered $508 to $633,
Non-Registered $483, Northern differential $15 a
month. Travel allowance up to $60. refundable
after 1 2 months service. Apply to: Director of
Nursing, Prince Rupert General Hospital, 551-5th
Avenue Eost, Prince Rupert, British Columbia.
B.C. R.N. for General Duty in 32 bed General Hospi-
tal. RNABC 1967 salary rote $390 - $466 and fringe
benefits, modern, comfortable, nurses' residence in
attractive community close to Vancouver, B.C. For
application form write: Director of Nursing, fraser
Canyon Hospital, R.R. I, Hope, B.C. 2-30-1
Cenoral Duty Nurses for active 30-bed hospital.
RNABC policies and schedules in effect, also North-
ern aliowonce. Accommodations avoiloble in res-
idence. Apply: Director of Nursing, General Hospital,
Fort Nelson, British Columbia. 2-23-1
GENERAL DUTY NURSES (two). Fully accredited 25-
bed hospital Rogers Pass Areo Trans Conoda High-
way. Comfortable Nurses' Residence. RNABC Agree-
ment in effect. 3 months allowed to gain B C. Regis-
tration. Apply: Mrs. E. Neville, R.N., Director of
Nursing, Golden & District General Hospital, P.O.
Box 1260, Golden, B.C.
General Duty Nurses for new 30-bed hospital
located in excellent recreational area. Salary and
personnel policies in accordance with RNABC. Com-
fortable Nurses' home. Apply: Director of Nursing,
Boundary Hospitol, Grand Forks, British Columbia.
GENERAL DUTY NURSES for 63-bed active hospital
in beautiful Bulkley Valley. Booting, fishing, skiing,
etc. Nurses' residence. Salory $466. -$490., main-
tenance $70., recognition for experience. Apply:
Director of Nursing, Bulkley Valley District Hospital,
Smithers, British Columbia.
General Duty Nurse for 54-bed active hospital in
northwestern B.C. Salaries: B.C. Registered $405, B.C.
Non-Registered, $390, RNABC personnel policies
in effect. Planned rotation. New residence, room and
board: $55/m. T.V. and good social activities.
Write: Director of Nursing, Box 1297, Terrace, British
Columbia. 2-70-2
GENERAL DUTY AND PRACTICAL NURSE needed for
70-bed General Hospital on Pacific Coast 200 miles
from Vancouver. RNABC contract, $25. room and
board, friendly community. Apply; Director of Nurs-
ing, St. George's Hospital, Alert Bay, British Colum-
bia.
GENERAL DUTY, OPERATING ROOM AND EXPERI-
ENCED OBSTETRICAL NURSES for 434-bed hospital
with school of nursing. Salary: $508-$633, these
rotes ore effective January 1969, plus shift differ-
ential. Credit for past experience and postgraduate
training. 40-hr. wk. Statutory holidays. Annual incre-
ments; cumulative sick leave; pension plan; 20
working days annuo I vacation; B.C. registration re-
quired. Apply: Director of Nursing, Royal Columbian
Hospital, New Westminster, British Columbia.
GRADUATE NURSES required for 30-bed hospital in
interior B.C. Salaries and conditions in accordance
with RNABC agreement. Excellent accommodation
available at an ottractive rate. Apply; Matron,
Lady Minto Hospital, Ashcroft, British Columbia.
GRADUATE NURSES for 24.bed hospital, 35-mi. from
Vancouver, on coast, salary and personnel prac-
tices in accord with RNABC. Accommodation avoilo-
ble. Apply; Director of Nursing, General Hospital,
Saucmish, British Columbia. 2-68-1
Graduate Nurses for General Duty in modern
225-bed hospital in city (20,000) on Vancouver
Island. Personnel policies in accordonce with RNABC
policies. Direct enquiries to: The Director of Nurs-
ing, Regional General Hospital, Nanoimo, B.C.
GRADUATE NURSES required for GENERAL DUTIES in
small hospital in Southern B.C. Pleasant working
conditions and recreational facilities available. Stort-
ing salary $475 per month for B.C. Registered
Nurses. Room and board $40 per month, ten statu-
tory holidays, holiday and sick leave benefits. Apply
giving full particulars of training, experience ond
references to: Administrator, Slocan Community Hos-
pital, New Denver, British Columbia.
LABRADOR
WANTED GENERAL DUTY NURSE for Churchill Falls,
Labrador. Must be fluent in both English and French.
For details pleose write: Miss Dorothy A. Plant, Inter-
notionol Grenfell Association, Room 701A, 88 Met-
calfe Street, Ottawa 4, Ontario.
NOVA SCOTIA
56 THE CANADIAN NURSE
GENERAL DUTY NURSES: Positions available for
Registered Qualified General Duty Nurses for 138-
bed active treotment hospital. Residence occorri-
modotion available. Applications and enquiries will
be received by: Director of Nursing, Blonchard-Froser
Memorial Hospital, Kentville, Nova Scotio. 6-I9-I
GENERAL DUTY NURSES — registered, for 12-bed
hospitol recommended salaries and work benefits.
Apply to: Administrotor, Musquodoboit Valley Me-
morial Hospital, Middle Musquodoboit, Halifax Coun-
ty, Nova Scotia.
JANUARY 1969
February 1969
The
Canadian
Nurse
clinical laboratory procedures
hyperbaric oxygen units
- high pressure nursing
student observation
at postmortem exam
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The
Canadian
Nurse
^
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 2
February 1969
33 Epidermolysis Bullosa E. Melnyk
37 Hyperbaric Oxygen Units — High Pressure Nursing G. Zilm
41 Clinical Laboratory Procedures E.M. Watson, A.H. Neufeld
57 Student Observation at Postmortem Examinations V.A. Lindabury
59 Nursing Organization — Circa 1969 D.Y.Stewart
62 Two- Year Versus Three- Year Programs C.G. Costello and
Sister T. Castonguay
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
21 Names
27 New Products
65 Books
7 News
25 Dates
30 In a Capsule
70 Accession List
Executive Director: Helen K. .Mussallem •
Editor: Virginia A. Lindabury • Assistant
Editor: Loral A. Graham • Editorial Assist-
ant: Carol A. Kotlarsky • Circulation Man-
ager: Berjl Darling • Advertising Manager:
Ruth H. Baumel • Subscription Rates: Can-
ada: One Year. S4.50; two years, S8.00.
Foreign: One Year, S5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association, • Change of Address:
Four weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
® Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on white paper)
are welcomed with such articles. The editor
is not committed to publish all articles sent,
nor to indicate definite dates of publication.
.Authorized as Second-Class Mail by the Post
Office Department. Ottawa, and for payment
of postage in cash. Postpaid at Montreal.
Return Postage Guaranteed. 50 The Driveway,
Ottawa 4, Ontario.
Editorial
FEBRUARY 1%9
Parliament's approval of Bill C-1 16,
which, among other things, excludes
professional publications from the
benefit of second class mailing
privileges ("News," p.7), came as a
shock, if not as a surprise.
For the Canadian Nurses'
Association, whose publications
THE CANADIAN NURSE and
L'injirmiere canadienne probably will
be affected by this new legislation, the
postal boost comes at an inopportune
time: CNA just does not have the
money in this 1968-70 biennium to
pay any additional mailing costs.
At present, the combined cost of the
two journals to each CNA member is
$3.00 yearly. That is, out of the $10
paid to CNA by each member
annually, $3.00 is put aside for the
operating expenses of the two journals.
(In provincial associations whose
membership exceeds 20,000, the
annual fee per member in the 1968-70
biennium is $6.)
This is anything but an exorbitant
cost for the publication of two
professional journals. In fact, it is a
minuscule amount when compared
with the budget of other monthly
publications of a similar size and
nature.
When the new postal rates are
increased this April, annual mailing
costs of THE CANADIAN NURSE and
L'injirmiere canadienne will probably
increase by $1 .80 per member. In other
words, the total costs of the two
journals to each CNA member will rise
from $3.00 yearly to $4.80.
This month, the CNA Board of
Directors will examine the journals'
financial plight and decide on the
action to be taken. We believe that a
special general meeting should be
called to ask for an increase in the
CNA membership fee. If CNA
members believe there is value in
having an Association journal, they
must be willing to pay for it. — V.A.L.
THE CANADIAN NURSE 3
letters
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Back seat for human rights
At one time a nurse was an adminis-
trator of her own domain, in complete
control, and completely responsible. She
did rounds with the doctor and carried
out his orders from a notebook with a-
mazing precision. Most nursing care was a
challenge to her and a satisfactory day's
work. She used her own intuition and
maturity coupled with common sense and
experience.
Today, science has advanced and the
law is enforced. Human rights have taken
a back seat and money and status have
taken a front seat. The nurse has only to
try and read the doctor's orders, sign her
signature 50 times per day, and make sure
it is the right one. She has to keep closed
lips to abuse and misuse and smile like an
idiot.
Qualifications 1921: a registered nurse
obtained a hospital diploma with as-
surance, professional pride, and respect.
Qualifications 1968: a registered nurse
has the aim of a university degree at some
state of senility and has a well informed
theory of non-professional status until
she reaches that stage. - C. Mooney,
Vancouver.
Needed: PR expert
I take exception to the letter in the
November issue in which a B.C. nurse
criticized Monica Angus' article in the
August issue.
Surely this is what the provincial
organizations of nursing have needed for
years: if not a paid president, a paid
public relations expert.
In this day of rapid communications,
immediate explanation of events stated
precisely at the heiglit of public interest is
mandatory. Only a well-paid public re-
lations expert, well informed about the
nurses' stand on financial matters es-
pecially is able to give nurses rapid, in-
tense results. As an R.N. of 14 years and
a member of the Registered Nurses' As-
sociation of Ontario. I cannot agree that
senior staff members are cognizant of the
problems of the staff nurse; if they are
aware, they are too inarticulate or
browbeaten by years of passive nurse-
doctor relationships to fight for anyone.
As examples, instances this past
summer and fall when a "public re-
lations" expert would have been useful
are cited:
1 . An article in the Globe and Mail
about staff shortage at the new Scarbor-
rougli Hospital, the use of part-time staff,
and foreign nurse employment.
4 THE CANADIAN NURSE
2. The public health nurses' stand in
Scarborough was broadcast on the nation-
al news. Surely a follow-up on an after-
noon women's show could have been at-
tempted.
3. The closing of a wing of a London
hospital.
4. The phasing out of small hospitals
to make way for a regional hospital in the
Grey County area. Ontario Hospital Com-
mission members were interviewed, but
where were the nurses?
5. The recent hospital association
meeting initiated snide remarks about
hospital costs and staff expenses. Would
the public not support us if they knew an
R.N. has a take-home pay of less than
many postal workers?
6. The atrocious reporting on the
Canadian Nurses' Association meeting.
Probably the delegates were too ashamed
to be interviewed about basic minimum
salaries, since they couldn't agree on
$7,000.
7. The Commission on the Status of
Women, deprecated on some television
shows, for example, Hamilton Hot Line.
Did any R.N. phone in or write to the
announcer?
8. The recent announcement that nursing
instructors' salaries would be decreased in
the London area.
We need an aggressive, articulate,
well-paid woman to communicate on
many subjects. A national CNA expert
could probably be utilized more economi-
cally than nine provincial ones. We need
coverage immediately, not one or three
months after a nurses' meeting. Pre-
ferably, our representative should not be
an RN. Let's do better if we are going to
have any girls in nursing 10 years from
now. - R.N., Ontario.
A nurse never stops working
People often say: "Isn't that too bad.
She just graduated from nursing, now
she's getting married, and soon she will
stop working to have a family." Little do
they know how far they are from the
truth!
I graduated and got married in August
1965. I worked in a newborn nursery for
a year, took a postgraduate course in the
care of the premature infant, and worked
in a premature intensive care unit for
another year. After that, my husband and
I adopted a baby and I stopped working
or so I thought!
No sooner had I settled down to the
routine of staying at home, than people
in the apartment, knowing I was a nurse,
started calling.
First case a large sty in a little girl's
eye. "Should I compress it? " asked the
mother. "Should she stay home from
school? " After consulting my trusty
medical-surgical book, we decided what
should be done.
Soon after that, I was asked to remove
a splinter from a little boy's foot and a
tiny bug trapped in the corner of his
sister's eye. Other questions were: "What
should I give my husband for his cold? "
"My baby is constipated. Is it all right to
put brown sugar in the formula? "
Often friends would call and ask
questions about a relative's illness. "How
long will he be in hospital? " or "Why did
this happen? " I always had to be careful
to find out what the doctor had told
them and then try to enlarge on this.
Several friends had premature babies. I
usually sent a note with some helpful
hints for when the baby came home
about feedings, burping, clothing - things
that nurses sometimes forget to tell these
mothers and that the mothers never think
of asking about.
I think every nurse in the community,
whether she works in a hospital or not,
never really stops nursing. She is cons-
tantly giving advice, answering questions,
and bandaging cut fingers. She must, at
all times, have a handy supply of gauze,
tape, alcohol, and iodine, both for her
own family and all the neighbors.
Ask any housewife/mother/nurse and
she will tell you: "My work is never
done! " - Ruth Smellie, R.N., Calgary.
Afraid to criticize
We are bitteriy disappointed in Mr.
Wedgery's letter in the December issue.
We all know where the profession is going
- downhill fast. This is mainly due to
poor economic status, but it is also in-
creased by hospital administrators who
want to decrease hospital budgets,
doctors who carp and criticize and have
little empathy with the nurse, and en-
croaching paramedical "professions"
poorly trained but cheaper to pay as in-
halation therapists.
We are attacked in the hospital field
and deserted by university colleagues
who produce courses dealing in abstract
sociological philosophies and semantics,
and lack clinical data.
We are clinical practitioners, be we in
the hospital or public health field. We
need pertinent medical data. The hospi-
tals are not giving enough inservice edu-
FEBRUARY 1%9
cation to active nurses much less to semi-
retired nurses. That is why we go to
doctors' lectures. We need facile, succinct
lectures.
Why don't we attend meetings airing
the ills of nursing? No nurse working in a
hospital dares initiate any criticism at
chapter meetings; the directors are sitting
there glowering. Possibly one solution
would be to divide meetings into groups
of peers - a sad commentary on nursing,
but too true.
If Mr. Wedgery really wants to
promote nursing discussion on the pro-
fession, he should start group discussions
on topics such as how can you - at this
hospital — increase nursing salaries? But
he should not criticize nurses interested
in doctors' lectures. This is the mark of a
profession: we are interested in growth
and education. - Three Ontario R.N.'s.
Tender loving care
Is T.L.C. passe? Having been on the
receiving end of nurses' professional ser-
vices in various hospitals this past year I
feel more than qualified to say how
ashamed I am to call myself an R.N.
Today's nurse seems more turned
inward, concerned about working hours,
salaries, vacations, and directing others to
do her job. She has no time to help the
multiple sclerosis patient on or off the
bedpan, or give the necessary back care or
mouth care. She is too busy for five-
minute kindness. "Someone else will be
in shortly" is an expression heard fre-
quently. The paralyzed patient has tears
running down her cheeks because the
nurse takes too long with the necessary
analgesic asked for one-half hour ago and
she thinks she is forgotten. This could be
you someday - a person in need whom
no one seems to hear. Are you guilty of
not caring? - Joyce Mossop, R.N.,
Thetford Mines, Quebec.
Book about nurses
I am preparing a book which will be a
collection of short humorous stories
about nurses and patients in hospitals,
offices, and any other place where nurses
come into contact with their patients.
I would appreciate it if nurses would
send me stories of humorous incidents
that have happened to them and I will
include them in my book.
Fifty percent of the proceeds will be
pledged to Oxfam Relief of Canada and
the remainder of the proceeds will, I
hope, cover my expenses.
Nurses may send jokes, short stories,
or incidents to me at: 5830 Cote St. Luc
Rd., Apt. 2, Montreal 253. - Dawn
Moynihan, R.N. D
FEBRUARY 1%9
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THE CANADIAN NURSE 5
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For a complimentary pair of white shoelaces, folder showing all the smart Clinic styles, and list of stores selling them, write:
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6 THE CANADIAN NURSE FEBRUARY 1%9
news
Postal Rate Increases
May Affect CNA Magazines
Ottawa. - Mailing costs for the Ca-
nadian Nurses' Association's magazines,
THE CANADIAN NURSE and L 'mfimiere ca-
nadienne, may increase by more than 15
times the present costs when the new
mail rates and classifications go into
effect April 1, 1969. "If the magazines
are required to pay the new third class
rates, then the monthly costs of sending
the magazines wUl rise from S770 to
SI 1,072 for an average-sized issue," said
Ernest Van Raalte, CNA General Manag-
er. "Postage on returned journals and
other direct mail costs would bring the
total monthly postage to approximately
$12,000."hesaid.
"The new rates, if applicable to CNA
magazines, would mean that an additional
$135,000 would have to be found in this
year's present CNA budget." Mr. Van
Raalte said. "CNA has applied for ex-
emption from this increase, but word
from the Post Office Department has not
yet been received."
The Association, which agreed to hold
its budget for the 1968-70 biennium to
the 1966-68 figures, does not have the
money to cover these increases without a
major cutback in some other of its
planned expenditures, Mr. Van Raalte
told a reporter for the Canadian nurse
The Board of Directors and the special
Ad Hoc Committee on Functions, Re-
lationships, and Fee Structure have been
notified about the new rates and the
possible effects, he said. This will enable
the Board to make an interim decision
about financing these additional costs at
its meeting in February, he added, and
the special committee, which was set up
at the biennial meeting to investigate the
questions of fees and the division of labor
between the provincial and national as-
sociations, can consider this additional
financial problem before submitting its
report.
Helen K. Mussallem, executive director
of CNA, says that if CNA has to pay the
increase, she can see only three possible
solutions. "We can cut back the present
CNA programs to find the additional
5135,000. or we can cut back and modify
the present form of the CNA magazines,
although that may mean a loss of
advertising revenue; the only other alter-
native would be to raise the money
through increase of CNA fees at the next
general meeting." she said. She pointed
out that the Board will probably debate
these alternatives at the Board meeting
FEBRUARY 1%9
beginning in Ottawa, February 1 1 .
Several other professional journals are
also facing the problem of the increased
postal rates. Arthur Kelly, managing
editor of the Canadian Medical Associa-
tion Journal, was quoted in an Ottawa
paper as saying that to continue, the
CMAJ might have to become a monthly
or semi-monthly publication, rather than
continue as a weekly. Dr. Kelly said that
he expected postal fees for the CMAJ to
increase to Si 40.000 a year from the
present SI 8.000.
When Postmaster General Eric Kierans
introduced Bill C-1 16. which included the
changes in mail rates and classifications,
he explained that the changes in respect
to newspapers and periodicals had two
main objectives, says a release from the
Post Office Department. "The first is to
take a long step toward assuring that
second class mail pays its fair share of
postal costs. The second objective is to
modify and clarify the terms and con-
ditions under which the statutory second
class rates apply and thereby establish a
more logical basis for determining en-
titlement to second class privileges," says
the release.
These changes are mainly to exclude
non-profit associations, which do not pay
taxes, from qualifying for second class
mail privileges.
Canadian Printer & Publisher, the
magazine of the Canadian printing indus-
try, quoted the Postmaster General as
saying, "Over the past 10 years alone, the
Canadian public has disbursed a total of
approximately S300 million to publishers
by way of a subsidy on second class mail
rates."
The magazine goes on to point out
later that two magazines. Time and
Reader's Digest, both U.S. -owned and
with low editorial costs because most of
the material is shipped from the U.S.
parent. wUl continue to enjoy the low
rates and large subsidies.
CNF Scholarship Fund
Drops To $25,000 For 1%9
Ottawa. ~ The Canadian Nurses'
Foundation reports that approximately
525,000 will be available for 1969 fellow-
ship awards, less than half the amount
awarded in each of the past two years.
As of August 31, 1968, the balance in
the scholarship fund was 513,000, and in
the general fund SI 1,000. As all adminis-
trative costs are met by the Canadian
Nurses" Association, a transfer of SI 0,000
from the general to the scholarship fund
will be considered at the annual general
meeting at CNA House. February 1 1 .
Any significant donation before May 1
could increase the amount available for
scholarships.
Two provincial organizations have
announced their intention to make
annual grants to CNF. The Registered
Nurses' Association of British Columbia
will make a per capita grant to the
Foundation, the amount to be decided
each year. The Alberta Association of
Registered Nurses will contribute 51.00
per member each year.
Membership in the Foundation stood
at 1,494 in August, 1968. Donations
amounted to a total of 516,366 at the
same date, including donations by indi-
vidual members, provincial associations,
and other groups.
The general meeting in February will
also consider reports of the Board of
Directors, the secretary-treasurer, audi-
tors, and committees, and discuss the
establishment of the calendar year as the
financial year of the Foundation.
Special Ad Hoc Committee Meets
Ottawa. - The first meeting of the
special Ad Hoc Committee on Functions.
Relationships, and Fee Structures was
held at CNA House January 9 and 10,
1969. The committee, generally dubbed
the "Special Committee." was set up at
the biennial general meeting of the Cana-
dian Nurses' Association last June after
considerable discussion on the questions
of fees and of the divisions of labor and
responsibilities between the provincial
and national associations.
Chairman Jean S. Tronningsdal told
the Canadian nurse after the meeting
that the committee has spent two very
busy days and has made a good start. "We
have a lot to do in a short period of
time." said Mrs. Tronningsdal, "and we
realize that we will have to pace our
efforts. We must finish our task by
Jjnuary 1970, so that the provincial
associations can receive and study our
report before the biennial meeting in
June 1970." she explained.
During the meeting, committee
members agreed to appoint a secretary
from the group on a rotating basis, Mrs.
Tronningsdal said. Madge McKillop,
University Hospital. Saskatoon, was given
the task for this meeting. Marie Sewell.
New Mount Sinai Hospital. Toronto, will
(Continued on page 9)
THE CANADIAN NURSE 7
COUNIOOIMI TO GONERESS
Only four months to go to the
INTERNATIONAL COUNCIL OF NURSES'
14th OUADRENNIAL CONGRESS
Place Bonaventure, Montreal, Canada,
22 to 28 June, 1969.
PROGRAM HIGHLIGHTS:
Sunday, 22 June
3.00 p.m. Interfaith Service
8.00 p.m. Opening Ceremony
Monday and Tuesday, 23 and 24 June
Open meeting of Council of National
Representatives (CNR)
Wednesday, 25 June
"Focus on the Future"
a.m. Plenary session —
Forecasting the Future
p.m. Plenary session —
Implications of Change
Thursday, 26 June
"Focus on the Future"
a.m. Plenary session —
Education for Today and To-
morrow. Basic Programs
p.m. Plenary session -
Education for Today and To-
morrow. Post Basic and Post-
graduate Programs
5.00 p.m. Voting for ICN Officers by
CNR
8.00 p.m. Students' Congress
Friday, 27 June
"Focus on the Future"
a.m. Plenary session —
Security for Tomorrow
p.m. Plenary session —
Leadership in Action
8.00 p.m. Closing Ceremony
Admission of new member
associations to ICN
New ICN Officers
announced
Saturday, 28 June
Canada Hospitality Day.
N.B.
* Special Interest Sessions - 19 topics in English and French, will be
running Monday through Friday
* International Nursing Exhibition - runs Monday through Wednesday
FOR FURTHER IN FORMA TION, INCLUDING R EG 1ST R A TION
KITS, PLEASE WRITE TO:
ICN Congress Registration,
50, The Driveway,
Ottawa 4, Ontario.
8 THE CANADIAN NURSE
FEBRUARY 1%9
(Continued from page 7)
take on the secretarial duties at the next
meeting.
Mrs. Tronningsdal said that the next
meeting of the committee has been set
for May 8 and 9, 1969, at CNA House. In
the meantime, the committee well seek
information on certain specific matters
from the provincial associations, the
CNA, and CNA permanent staff
members.
Members of the committee include:
Mrs. Tronningsdal, Miss McKillop; Miss
Sewell: K. Marion Smith, Vancouver;
Madeleine Jalbert, Quebec; Marilyn
Brewer, Fredericton; Dorothy Wiswall,
Halifax; Sister Mary Irene, Charlotte-
town; and Elizabeth Summers, St. John's
Nfld. Sister Mary Felicitas. president of
the CNA, is a member exofficio. All
members attended the meeting.
An interim progress report will be
presented to the CNA Board of Directors
meeting in February, Mrs. Tronningsdal
said.
Several Reasons For Drop
In Enrollment, Says RNANS
Halifax. - Nova Scotia newspapers
recently reported critical drops in the
student nurse enrollment in the provincial
nursing schools. Figures from the Reg-
istered Nurses' Association of Nova
Scotia support the reports. Only 264
students registered in diploma schools
this year, compared to 430 last year,
reported Gertrude Shane, RNANS public
relations officer.
"However, there are several reasons for
the decrease," Mrs. Shane added.
"Although emphasis has been placed on
the raising of standards, other factors are
involved," she said.
Michael MacDonald, director of the
Nova Scotia Hospital Association, was
quoted in the press saying that the
entrance standards, raised this year by
RNANS, had contributed to the drop.
RNANS raised the educational require-
ment for entrance to a school of nursing
to grade 1 2 (equivalent to senior matric-
ulation) from grade 1 1 . Mrs. Shane ex-
plained that this was part of an overall
program to improve nursing education in
the province.
RNANS has published several studies
calling for reforms in nursing education
during the past few years. Recom-
mendations included the phasing out of
diploma schools with less than 40 stu-
dents, the adoption of a two-year
program, improved curricula, and other
changes. In Sydney, N.S., five hospital
schools have suggested amalgamation
into a central school. This would make
FEBRUARY 1%9
UR a PR for ICN, Says PRO
Ottawa. - "Every Canadian nurse will need to be a public relations officer, if the
International Council of Nurses Congress is going to succeed," Valerie Foumier,
public relations officer for the Canadian Nurses' Association told her provincial
counterparts at a recent meeting in Ottawa. The public relations officers from the
10 provincial associations had gathered in Ottawa December 12 and 13, 1968 for a
meeting devoted almost exclusively to discussions on public relations for the
forthcoming ICN Congress in Montreal in June. The PROs were shocked at the low
registration of Canadian nurses for the Congress.
The PR Conference, the second which has brought public relations counterparts
from all the provinces to Ottawa, discussed ways and means of promoting ICN in
the provinces, and other matters, including division of duties between CNA and
provincial PROs, when to start sending information to local media, and the
organization of the press rooms at ICN.
B.J. McGuire, of Forster, McGuire, Ltd., PR consultant to CNA and in charge of
public relations for the ICN Congress, said that 100 to 150 media people,
representing TV, radio, newspapers, wire services, magazines, and nursing press, are
expected to be seeking information during the Congress. He explained the tentative
plans for press facilities, and indicated areas where qualified public relations people
would be needed. Six provinces have offered to send their public relations staff
member to Montreal to assist CNA with staffing press rooms during the Congress.
Peter Regenstrief. newspaper columnist, TV communicator, and professor of
political science at the University of Rochester, Rochester, N.Y., was guest speaker
during the Thursday afternoon session.
better use of existing facilities and of
qualified faculty.
She said that nursing must compete
for the best students with other pro-
fessions, such as teaching, social work,
and paramedical fields. Greater numbers
of students are entering the university
program. Requirements now are the same
for both the diploma and the degree
courses in the province.
Another factor in the drop in enroll-
ment in the nursing schools might be the
low pay rates for nurses in the province,
Mrs. Shane said. "Young women of the
kind we need at the bedside are aware
that salaries in nursing are lower than in
other fields. Dedication alone will not
attract the caliber of student who can
cope with today's medical advances and
modem hospital techniques," she said.
Mrs. Shane added that the executive of
the Association is concerned about the
drop and will consider all aspects of the
matter at its next meeting.
Registration Picks Up
As Cut Off Date Nears
Ottawa. - Canadian registration for
the forthcoming Congress of the Inter-
national Council of Nurses picked up
rapidly as the deadline for full regis-
tration approached. Harriet Sloan, the
Canadian Nurses' Association's coordi-
nator for the ICN Congress, reported that
as of January 10, 1969. 756 Canadians
had registered for the international meet-
ing.
"This is nowhere near the 2,000 Cana-
dians that we expect will be registered by
June, but it is picking up rapidly now,"
(Continued on page 10)
THE CANADIAN NURSE 9
(Continued from page 9)
Miss Sloan said. "However, it does rep-
resent a jump of 286 during the week
from January 3 to 10," she said.
The last day for full registration privi-
leges was January 22. Nurses can still
register. Miss Sloan points out, but the
fee has risen from $40 to $60.
Breakdown of registration up to
January 10, 1969 is:
British Columbia 54
Alberta 44
Saskatchewan 16
Manitoba 34
Ontario 280
Quebec 247
Nova Scotia 1 1
New Brunswick 29
Prince Edward Island 2
Newfoundland 1
718
Students 38
Total 756
CNA Sends Suggestions
To Task Force on Information
Ottawa. - In answer to a request from
the federal government's Task Force on
Government Information, the Canadian
Nurses' Association submitted four sug-
gestions in December for improving the
government's information services.
Helen K. Mussallem, executive director
of the CNA, made the suggestions in a
letter to D'Iberville Fortier, chairman of
the Task Force. In it she said that the
government information services should
have facilities and personnel to:
• collect and publish data relevant to
the supply of adequate nursing personnel
for the long-term needs of Canadians;
• produce and disseminate information
on the nursing profession for the use of
high school guidance counselors and
others to encourage the entry of students
into the profession;
• respond to enquiries from foreign
nurses regarding emigration to Canada to
practice nursing;
• notify CNA about planned gov-
ernment activities concerning nurses to
encourage participation by nurses and to
Sub-Committee On Occupational Health Meets in London
London, England. - The first meeting of the Nursing Sub-Committee of the
Permanent Commission and International Association on Occupational Health was
held in London, October 21 to 26, 1968.
The Sub-Committee was established in Vienna in 1966, to gather information on
the preparation and experience of occupational health nurses throughout the world,
and to prepare reports to help countries raise standards of occupational health
nursing. Reports of the meetings will be presented at the sixteenth congress of the
Permanent Commission and International Association on Occupational Health in
Tokyo in September, 1969.
The Permanent Commission and International Association on Occupational
Health was established in 1906 in Milan, Italy, and for many years remained an
organization of specialist physicians. Nurses were invited to present papers to its
meetings for the first time in 1948, but it was not until 1963 that the first Canadian
nurse member was accepted. By 1968 there were four Canadian nurse members.
The London meeting of the Nursing Sub-Committee raised its membership to six
from the five established in Vienna by admitting another American member. From
left to right they are: Ruth Sayanjarvi (Finland), Sally Wagner (USA), Mary
Blakeley (UK), Sarah Wallace (Canada), Gunnell Pramberg (Sweden), and Mary
Louise Brown (USA).
10 THE CANADIAN NURSE
minimize duplication of effort.
The Task Force on Government In-
formation, which will submit its re-
commendations by March 1, 1969, was
commissioned to study the structure,
operation, and activities of federal de-
partmental information organs in Canada
and abroad. It will make re-
commendations to the government on
ways communication can be improved by
the government's information services.
AV-AIDS For Nursing
Subject Of US Study
New York. - A survey to provide
information about audiovisual materials
available for nursing is underway in the
United States. The study, which will help
the American Nurses' Association-
National League for Nursing Film Service,
is supported jointly by the U.S. Depart-
ment of Health and the two nursing
associations.
The Health Department will provide
$49,056 to the study for one year and
the nursing organizations will contribute
$8,930, bringing the total amount for the
project to $57,986.
A survey questionnaire will be sent to
users and producers of nursing audio-
visual materials. It will concern 16 mm
and 8 mm film, filmstrips, videotapes,
slides, audiotapes, computer instruction
programs, and recordings. A list of all
materials reported and a list of those
recommended for use in schools of nurs-
ing and health agencies will be prepared.
OR Nurses Discuss
Infection in Hospitals
Montreal. - Asepsis was the main
topic of discussion at the tenth annual
meeting of the Operating Room Nurses of
Quebec, held October 30 and November
1, 1968, in Montreal.
Lucette Lafleur, bacteriologist at
L'Hopital Sainte-Justine, Rene Roux,
surgeon at I'Hotel Dieu, Montreal, and
Claude Morin, clinical instructor at
L'Hopital Notre-Dame, Montreal, partic-
ipated in a panel discussion entitled
"Asepsis in the Operating Room." A
question and answer period after the
panel presentation enabled the audience
to participate.
Dr. Lafleur attributed the recurring
problem of infection to the increasing
numbers of new operations, such as neu-
rosurgery, spare parts surgery, and some
heart surgery. She suggested several
methods for improving techniques, inclu-
ding use of hexachlorophene or detergent
in cleaning and, when possible, fumi-
gation of the theatres. Contamination ol
air in the operating rooms depends on the
number and length of the operations, she
said, adding that it would be necessary tc
remove all air from the room to sterilize
(Continued on page 14,
FEBRUARY 1%*»
The
disposable
diaper
concept
What are its advantages?
In providing greater comfort and safety for
the infant:
More absorbent than cloth diapers, "Saneen"
FLUSHABYES draw moisture away from baby's skin, thus
reducing the possibility of skin irritation.
Facial tissue softness and absence of harsh laundry
additives help prevent diaper derived irritation.
Five si:es designed to meet all infants' needs from
premature through toddler. A proper fit every time.
Single use eliminates a major source of cross-infection.
Invaluable in isolation units.
In providing greater hospital convenience:
Polywrapped units are designed for one-day use, and
for convenient storage in the bassinet. Also, Saneen
Flushabyes do not require autoclaving — they contain
fewer pathogenic organisms at time of application
than autoclaved cloth diapers. •
Prefolded Saneen disposables eliminate time spent
folding cloth diapers in the laundry and before
application to the infant. Easier to put on baby.
Constant supply. Saneen Flushabyes eliminate need
for diaper laundering and are therefore unaffected by
interruptions in laundry operations.
Elimination of diaper misuse, which may occur with
cloth diapers. »Thc U-Richc Bacteriology Study— 1963
More and more hospitals are changing to Saneen Flushabyes disposable diapers.
Write us and we will be glad to supply you with further information on clinical studies, cost analysis, and disposal techniques.
Use these and other fine Saneen products to complete your disposable program:
MEDICAL TOWELS. ■•PERIWIPES" TISSUE. CELLULOSE WIPES. BED PAN DRAPES, EXAMINATION SHEETS AND GOWNS.
aneen
"^ FKClit Company Limited, 1350 Jane street, Toronto 1 5. Ontario, Subsidiary of Canadian International Paper Company sta
*8-H4 •■Saneen". ■■Flushabyes". '■Pen-Wipes" Reg'd T,Ms. Facelle Company Limited
comfort • safety • convenience
VISUAL AIDS
Lippincotf
FILM LOOPS
in Fundamentals of Nursing
An economical, efficient, time-saving method of
teaching basic nursing skills and technics
About film loops
LIPPINCOTT loops are short (3-4 minutes) s/7enf motion
pictures in color, permanently loaded (no threading) on
a continuous reel or "loop." The use of Super 8mm.
film and the Technicolor 810A Projector assure instant
projection of clear, bright pictures.
Easy to use
Each loop is enclosed in a rigid plastic cartridge. You
simply snap the cartridge into the small projector, turn
the knob and the film is on. The loops may be started
or stopped at any point. This allows the instructor
flexibility in emphasizing key points in the classroom,
and permits the student, when viewing the film without
the instructor, to stop the film and carefully study any
procedure she has trouble grasping.
Easy storage and handling
Collections of loops may be placed anywhere: class-
rooms—nursing stations— nursing labs— libraries. An
accessible library of loops— and the projector which is
so compact that It will fit into a desk drawer— offer
immediate demonstration in any location.
Advantages of this teaching medium
In the classroom: Instructors can reinforce their
lectures and eliminate repeated demonstrations.
Because of the remarkable close-up lens, each
student is able to see a demonstration as if she
were standing next to the instructor. There is no
problem of a large percentage of students not close
enough to "see how it was done."
For self-Instruction: Students can view and quickly
review material, according to their individual needs
and at a time and place convenient to study. A
skilled demonstration is immediately available for
the nursing laboratory, the library, or the nursing
station.
LIPPINCOTT'S Film Loops in Fundamentals of Nursing
BED MAKING
Making an Unoccupied Bed,
Parts I and II complete, $47.50
Making an Occupied Bed,
Parts I and II complete, $47.50
Manipulation of Linen,
Parts I and II complete, $47.50
HYGIENE
Bed Bath, Parts I and II complete, $47.50
Back Rub $23.75
Care of Dentures $23.75
12 THE CANADIAN NURSE
TECHNICOLOR SUPER MOVIE PROJECTOR
Model 810A $229.95
POSITIONING AND EXERCISE
Prevention of External Rotation
(Trochanter Roll) $23.75
Prevention of Drop Foot,
Parts I and II complete, $47.50
INJECTION TECHNIC
Preparation of an Injection from a Vial $23.75
Preparation of an Injection from an Ampule $23.75
Preparation of an Injection from a Tablet $23.75
Subcutaneous Injection:
Site Selection and Administration $23.75
Selection of Site for Intramuscular Injection:
Deltoid $23.75
Selection of Site for Intramuscular Injection:
Lateral Thigh $23.75
Selection of Site for Intramuscular Injection:
Ventrogluteal $23.75
Selection of Site for Intramuscular Injection:
Dorsogluteal $23.75
Administration of an Intramuscular Injection:
$23.75
Prices for film loops include instructor's manuals and student guides.
Additional loops in preparation
Let us show you what this valuable new teaching aid
can do! A detailed catalog covering Lippincott Loops
and the Technicolor Projector will be mailed to you
upon receipt of filled-in coupon on opposite page.
FEBRUARY 1%
TO LEARNING
Lippincott
MULTICOLOR TRANSPARENCIES
for the Overhead Projector
MAKE LEARNING MORE EFFECTIVE
MAKE CLASSES MORE EXCITING
An Instructor-Oriented Aid!
LIPPINCOTT transparencies, in vivid color, supplement
and strengthen course content.
This teaching tool offers numerous advantages:
The instructor faces the class in a well-lighted
room.
Units can be presented in any sequence and at
any pace.
Instructors can use marking pencils (easily eras-
able) to develop key points.
Part of a transparency can be exposed as desired,
merely by masking the rest with a piece of paper.
Many transparencies have attached overlays for
step-by-step presentation.
In other words, transparencies are "loaded with
teaching power."
JUST RELEASED!
Anatomy and Physiology (142 transparencies; 519
overlays) $632.50
Inhalation Therapy (89 transparencies; 92 overlays)
$392.50
The Patient and Circulatory Disorders (54 transparen-
cies; 99 overlays) $287.50 (Units I, II, III)
The Patient and Fluid Balance (64 transparencies;
158 overlays) $382.00
Also Available:
Fundamental Nursing Principles (159 transparencies;
89 overlays) $718.00
Applied Mathematics: (Unit I) Metric System &
Apothecaries Equivalents (12 transparencies; 5 over-
lays) $62.00
Applied Mathematics: (Unit II) Preparing Solutions,
Calculating Amount of Solute and Solvent (12 trans-
parencies; 26 overlays) $79.00
Applied Mathematics: (Unit 1 1 1) Calculating Drug Dosage
(12 transparencies; 36 overlays) $90.00
First Aid (52 transparencies) $135.00
Mouth to Mouth Resuscitation: (10 transparencies;
15 overlays) $37.50
Bandaging and Splinting (103 transparencies) $268.80
Emergency Surgery (220 transparencies) $545.00
Emergency Childbirth (51 transparencies) $112.00
Dental Hygiene (23 transparencies) $82.50
Each Series includes an Instructor's Manual
TRAVELGRAPH Overhead Projector
$210.00
A word about the Lippincott guarantee . . .
Every transparency and overlay is fully guaranteed not
to peel, chip, discolor, or fade. If any of these conditions
occur, the transparency will be replaced free of charge.
To help you select the units best suited to your curricu-
lum, detailed brochures illustrating each transparency
and overlay in each series have been prepared. Please
fill in and mail this coupon, checking those series that
especially interest you.
J. B. LIPPINCOTT COMPANY OF CANADA LTD., 60 Front Street West, Toronto 1, Ontario
1—
Please send me the following
material: U Complete film loop catalog
Transparency brochures as checked:
1 n Anatomy and Physiology
1 n Inhalation Therapy
1 D The Patient and
j Circulatory Disorders
D The Patient and
Fluid Balance
□ Fundamental Nursing Principles
U Applied Mathematics: Unit 1
n Applied Mathematics: Unit II
n Applied Mathematics: Unit III
n First Aid
Q Mouth to Mouth Resuscitation
[J Bandaging and Splinting
u Emergency Surgery
□ Emergency Childbirth
n Dental Hygiene
n The VISUALCAST Overhead
Projector
1 Name
Address
1 Position
City
Prov.
cm /fiq
EBRUARY 1%9
THE CANADIAN NURSE 13
ARNN Moves To New Headquarters
St. John's. - Staff of the Association of Registered Nurses
of Newfoundland have moved into their new building in
Central St. John's and are making preparations for the
official opening to take place early in April. The new
offices, adapted from a two-story family home, were
purchased last fall by the ARNN at a cost of $35,000.
The main floor has been altered into a large Board
Room with an adjoining office for the president, a main
office area for permanent, professional staff, and a general
work area for secretarial staff. Upstairs, there are five
rooms; one has been established as a library and one has
been turned over to the Newfoundland Student Nurses'
Association. The ARNN may rent the others until the
space is needed.
"After our old, desperately-crowded quarters, the staff
appreciate the larger amount of space," said PauUne
Laracy, ARNN executive secretary. "It is pleasant to no
longer have to stack boxes on top of boxes, or on the
floor, or on desks, or anywhere space could be
discovered."
The photograph shows the executive and staff in front
of the new ARNN building on moving day last September.
UNM Elects New Officers
Montreal. - The United Nurses of Montreal elected
new officers to the executive committee and board of
directors at their annual meeting, November 29. Wendy D.
Rogers (center), continuing UNM president, welcomes
Mary Anne Adams (right), of The Montreal General
Hospital, who was elected first vice president, and Monika
Berlage, Montreal Children's Hospital, secretary.
Newly elected directors of the executive committee
are: Audrey Crouse, Royal Victoria Hospital; Liz Ireton,
Montreal Children's Hospital; and Janet Funke, St. Mary's
Hospital.
Newly elected officers of the Board of Directors are:
Carolyn Robertson, Montreal Neurological Institute, as
first vice-chairman; Hilda Dariington, Lakeshore General
Hospital, secretary; and Mary Costello, Montreal Chil-
dren's Hospital, Shirley Alexander, Royal Victoria Hospi-
tal, and CoUeen McGillvary, Jewish General Hospital,
directors.
Margaret Masters, Jewish General Hospital, continues
as chairman of the board of directors.
(Continued from page 10 j
it completely. Some control of air con-
tamination is obtained by limiting the
number of people entering and leaving
the operating room, and by restricting the
number of unnecessary movements, and
reducing talking to a minimum.
Dr. Roux suggested the operating area
could be divided into three sections: an
inner aseptic area that would be the
operating theatre; an intermediate area
for scrubbing; and an outer general ex-
change area. Entrance to any of these
three operating areas would require a
change to OR garb. Dr. Roux recalled the
Canadian Hospital Accreditation Board's
recommendations, and advised that each
hospital study its own special problems of
infection and particular needs. He also
recommended the establishment of a
committee to investigate the problem of
infection in hospitals.
Miss Morin spoke of a plan to prepare
nurses and other hospital personnel for
their operating room tasks. She em-
14 THE CANADIAN NURSE
phasized the need for knowledge of
asepsis by all personnel in the hospital.
Montreal Nurses Sign Contract
With Queen Elizabeth Hospital
Montreal. — A contract reducing the
work week from 40 hours to 36-1/4
hours was signed by the United Nurses of
Montreal and the Queen Elizabeth Hospi-
tal in Montreal, November 15, 1968. In
addition to the reduced hours, nurses
working on the night shift will have
coffee breaks and one extra day off in
every seven worked to compensate for
the meal periods given in the day shift. A
nurse in charge of a unit on evening or
night shifts will receive an extra 65 cents
per shift in addition to the premium for
that shift.
The new contract also stipulates that
credit for previous experience of a new
employee will be determined on the basis
of experience in nursing acquired in
hospitals or in public health nursing
witliin the past 1 0 years. The starting rate
will be determined by completed years of
experience. Annual increments will be
given at the completion of each year of
experience. The first annual increment
will be given on the completion of an
additional year, comprising months prior
to employment by the hospital and those
completed in the hospital. Future in-
crements will be given on the anniversary
of the date of this first increment.
The contract was negotiated by Wendy
Rogers, president of UNM, and Margaret
Stead, executive secretary. The UNM is a
union of professional nurses formed in
1966 by the English Chapter, District XI
of the Association of Nurses of the
Province of Quebec.
Electronic Video Recording
Simplifies Film Showing
New York. - A new method of storing
and playing audiovisual material foi
(Continued on page 16
FEBRUARY ^W.
Used by more than 80,000 nurses-
Sutton's Bedside Nursing Techniques in Medicine and Surgery
is one of the most widely used books of its type ever published.
Now it has been completely revised and updated in a new Second Edition.
A valuable source book of advanced clinical nursing techniques, this popular text has
now been made even more valuable in the new revised Second Edition, now in press.
The newest concepts of hospital care, the latest equipment, currently preferred medi-
cations and diets, and the most recent diagnostic and therapeutic methods in medicine
and surgery — all are explained in this new edition. In clear, precise language supple-
mented by more than 750 explicit drawings, Mrs. Sutton tells precisely how to perform
hundreds of nursing functions — from intramuscular injection to caring for the patient
in hyperbaric oxygen therapy. Among the new material in this revised edition are
sections on:
Reverse isolation
IPPB respirators
Hypodermoclysis
Tubeless gastric analysis
Fluid and electrolyte balance
Heart transplants
Controlling hemorrhage from esophageal varices
Intra-arterial infusion of anticancer agents
In the first part of the book. Mrs. Sutton describes the basic techniques that are
common to all areas of clinical nursing. Then she takes up the more specialized
techniques used in disorders of each of the body systems. This arrangement provides
a natural division that corresponds to that of the nursing specialties. Each of these
chapters is subdivided under such headings as Diagnostic Procedures, Therapeutic
and Rehabilitative Procedures, Additional Procedures to Review, Diets to Review,
and Medications to Review.
Nurses by the tens of thousands have found "Sutton" unparalleled as an advanced
text, as a "refresher," and as a reference at the nursing station. It is even more valuable
in the new revised edition. Reserve your copy now!
By Audrey Latshaw Sutton, R.N., formerly Director of Nursing Service. Edgewood
General Hospital, Berlin, N.J.; Instructor, Wilmington, Del., General Hospital.
About 460 pages with about 760 illustrations. About $9.20. Ready March.
W. B. SAUNDERS COMPANY CANADA LTD., 1835 Yonge Street, Toronto 7
Please reserve in my name a copy of Sutton's Bedside Nursing Techniques in Medicine and Surgery,
(about $9.20) to be sent and billed when ready.
Name:
Address:
City:
Zone:
Province:
'EBRUARY 1%9
CN 2-69
THE CANADIAN NURSE 15
news
(Continued from page 14)
hospitals, schools, and home has been
introduced by the Columbia Broadcasting
System. The Electronic Video Recording
system stores 52 minutes of film in a
cartridge seven inches in diameter, and is
simple enough for a child to operate.
EVR records pictures and sound much
as long-playing records store sound. The
system consists of the thin film stored in
the cartridge, and a player that transfers
the sound and pictures to a standard
television set.
Despite the small size of the film,
pictures will be clearer than the conven-
tional television picture, and there will be
no interference or "ghost image" because
the system is connected directly to the
television set. The film is stored with a
thin layer of air between each layer of
film to protect it from damage by dust
and dirt, and cannot be torn because
there are no sprocket holes.
The EVR player is attached to the
television antenna terminals by handclips.
The cartridge is placed on the player, the
television is turned to a channel that is
not broadcasting, and the starter button
pushed. The film is automatically thread-
FOR WOMEN ONLY
. . . LAXATIVE NEWS!
"When I think of the suffering I could
have avoided if I'd known about COR-
RECTOL* sooner! A friend recommended
it and we've found it fine for every age
group from Grandma to ten-year-old
daughter." — Mrs. E.H.
CORRECTOL has been specially developed
for a woman's delicate system. Its secret
is a non-laxative regulator that simply
softens waste. And, CORRECTOL contains
just enough mild loxatiye to give regu-
larity 0 start. Working together, these
two gentle ingredients in CORRECTOL
give a womon effective relief, even fol-
lowing childbirth.
CORRECTOL
*reg'd. T.M., Pharmoco (Canada) Ltd.
Montreal. - Graduates of the University of Montreal Faculty of Nursing met
November 2 and 3, after the annual meeting of the Association of Nurses of the
Province of Quebec, to form an alumni association. The meeting, held in the
auditorium of city hall, had been planned since July. After considerable debate, it
was agreed that graduates of ITnstitut Marguerite d'Youville, which became part of
the University of Montreal in June 1967, would be able to become members.
Officers elected at the meeting are, left to right: Huguette Pelland, treasurer;
Claudette Beauchemin, vice-president in charge of public relations; Ginette Roger,
president; Sister Denise Lafond, secretary-archivist; Sister Rachel Rousseau,
secretary-registrar. Absent is Lisette Arcand, vice-president.
ed, and can be advanced or rewound
rapidly, slowed for careful viewing of a
particular scene, or frozen altogether. The
system can be operated in normal light,
and there is no projector noise to distract
viewers.
Hospitals and schools are expected to
be among the first purchasers of EVR
because of its value in education. It will
make films easier to show and store, and,
since it can be operated in normal light,
notes can be taken from the films. The
same film can be hooked to several
television sets, so that a large number of
students can see the films.
Although EVR was developed by CBS
as an offshoot of the space research it is
conducting for the US government, the
system will be manufactured by Motorola
Inc. Educational films will be handled by
Tfie New York Times Book and Educ-
ational Division.
The first black and white model of
EVR should be ready for the market by
July, 1970. The first color model is
expected to be produced by the second
half of 1971. Exact costs of the system
have not yet been announced.
Work Progressing For
Standardized Terminology
Ottawa. - The National Working Party
on Standardization of Terminology in
Hospitals has continued to hold bi-
monthly meetings since its inception in
February 1968.
The Working Party was established
under the sponsorship of the Department
of National Health and Welfare and the
Canadian Hospital Association to develop
standardized terminology relating to
various aspects of hospitals and hospital
personnel. Its 1 5 members come from the
Dominion Bureau of Statistics, various
professions, hospitals, and provincial
hospital insurance plans throughout the
country.
Donald F. Moffatt, consultant in ho-
spital administration with the Depart-
ment of National Health and Welfare, and
chairman of the Working Party, told
THE CANADIAN NURSE that he expects a
glossary of terms to be produced in about
a year. The Working Party has held five
three-day meetings so far.
RED CROSS
IS ALWAYS THERE
withYOURhelp
m
16 THE CANADIAN NURSE
FEBRUARY 196?
^ fti
V-
h
your
Own
hands:
..w***'
soft testimony to your patients' comfort
Your own hands are testimony to Dermassage's effectiveness. Applied by your
soft, practiced hands, Dermassage alleviates your patient's minor skin irritations
and discomfort. It adds a welcome, soothing touch to tender, sheet-burned
skin; relieves dryness, itching and cracking ...aids in preventing decubitus
ulcers. In short, Dermassage is "the topical tranquilizer". , . it relaxes the patient
. . . helps make his hospital stay more pleasant.
You will like Dermassage for other reasons, too. A body rub with it saves your time
and energy. Massage is gentle, smooth and fast. You needn't follow-up with
talcum and there is no greasiness to clean away. It won't stain or soil linens or
bed-clothes. You can easily make friends with Dermassage— send for a sample!
Now available in new, 16 ounce plastic container with convenient flip-top closure.
M^mA^ -jLiuyJLay a<UO~ttiJt'tAjU JUljk^U.'vut^
f-*^.
I vdkiM ,
Inssagi
<**d body mammft
EBRUARY 1%9
LAKESIDE LABORATORIES (CANADA) LTD.
64- Colgate Aven ue • Toronto 8, Ontario
THE CANADIAN NURSE 17
> t
i% m-
Quick-change
artist
The new Uromatic'
plastic irrigating system
for quicker hook-ups
Sets-up fast, changes fast. That's uromatic plastic
irrigating container. The new plastic irrigation solu-
tion container that stops irrigation procedures from
becoming irritation procedures. They're lighter, easier
to handle, and safer to hong than conventional gloss
bottles. Now every procedure is a safe procedure.
The UROMATIC container changes everything but
the technique.
Three special ports let you use familiar
techniques. But there is one big dif-
ference. No troublesome metal
closures or cops. Set-ups and
change-overs are faster and
more aseptic than ever before.
As you insert the set, the spike
completely occludes the
administration port opening
before it punctures an inter-
nal safety seal. No fluid
escapes. No air enters. It's
automatic. The second port lets
you add supplemental solutions
when required. Or may be used
for series hook-ups. A third, middle
port may be clipped for use as a
convenient pouring spout. From set con-
nection through bottle change-over, it's the
smoothest procedure available.
And the safest. You'll wonder where the vent went.
And why. The uromatic container doesn't need it.
Atmospheric pressure produces flow. A dependable,
continuous flow. There's no vent to clog or leak and
disrupt the entire procedure. And no vent, no air. Air-
borne contaminants are locked out. Safety is locked in.
These are just some of the features you should
know about. Discover them all. A complete bro-
chure is available at your request.
The uromatic plastic irrigation container.
Irrigation without irritation.
IMITED
Now available
THE SECOND EDITION OF
COUNTDOWN
CNA'S YEARBOOK OF CANADIAN NURSING STATISTICS
One-third larger than last year's edition, COUNT-
DOWN 1968 contains commentary and 133 sta-
tistical tables updated to present the latest
available data on nursing manpower, education, and
salaries.
An exciting addition this year is the inclusion of
salaries paid to nurses employed in public general
hospitals throughout Canada.
A cross-reference between COUNTDOWN and
FACTS ABOUT NURSING, published by the
ANA, is available from CNA.
Act now. Continue your collection of COUNT-
DOWN with the 1968 edition by clipping and
mailing the coupon below.
TO: Canadian Nurses' Association
50 The Driveway
Ottawa 4, Ontario
Please send
per copy, to:
Name
(no. of copies) of Countdown 1968, at $4.50
Address
Citv
Province
Position
Money Order D
Cheque D
For$
Enclosed
COUNTDOWN
A S S C C
20 THE CANADIAN NURSE
FEBRUARY 1969
names
Margaret E. Steed
(Reg.N.. Toronto
Western H.: Cert.
Teaching & Superv.,
B.N., McGUl U.;
M.A., Columbia U.,
New York) has been
appointed by the
University of Alber-
ta as consultant to
schools of nursing in Alberta.
Prior to this appointment. Miss Steed
was consultant in education, Canadian
Nurses' Association, a position she held
from 1964 to 1968. As education con-
sultant. Miss Steed visited schools of
nursing all over Canada on a consulting
basis. She also served as secretary for the
International Council of Nurses Exchange
of Privileges program that sponsored in-
ternational nurse visits.
In her new position. Miss Steed re-
places Marguerite Schumacher, now direc-
tor, department of nursing education at
Red Deer Junior College, Alberta. Miss
Steed will be responsible for consulta-
tions and visits to schools of nursing in
Alberta, and for organizing workshops
and continuing education programs for
nurses and nursing instructors.
Miss Steed taught for many years in
the school of nursing at Toronto Western
Hospital. From 1956 to 1962 she was
assistant director of nursing at Kitchener-
Waterloo Hospital.
Sister Elizabeth F. Hurley (R.N., St.
Joseph's H.. Saint John. N.B.: B.Sc.N.,
Seattle U.. Wash.) recently was appointed
director of nursing service at St. Vincent's
Hospital in Vancouver. Sister Elizabeth
formerly worked as a staff nurse at St.
Joseph's Hospital in Saint John, New
Brunswick and as supervisor at St. Vin-
cent's Hospital in Vancouver.
M.Kathleen Logan (R.N.. St. Joseph's
H., Saint John. N.B.; Dipl. Teaching,
B.N., Dalhousie U.) has been named as-
sistant director of nursing at St. Vincent's
Hospital. Miss Logan formerly worked as
general duty nurse at St. Joseph's Hospi-
tal. Saint John, New Brunswick and in
the Montreal Neurological Institute.
Margaret Isobel Schaap (R.N., Regina
General; Cert. Teaching & Superv., U.
Manitoba) is the new director of nursing
at Winnipeg Municipal Hospital. Previous
to her appointment. Mrs. Schaap worked
at Municipal Hospital as a general duty
FEBRUARY 1%9
and head nurse, and as assistant director
of nursing. Mrs. Schaap has also held po-
sitions at Regina General Hospital, Onta-
rio Hospital in Woodstock, St. Joseph's
Hospital, Winnipeg, and the Shriners
Hospital for Crippled Children in Win-
nipeg.
Florence M. Fleming (B.A., U. Alber-
ta; R.N., Vancouver General; Cert. Nurs-
ing Service Admin., U. Toronto) edu-
cation secretary of the Registered Nurses'
Association of British Columbia since
September 1964, retired on December
31, 1968.
After receiving her Bachelor of Arts
(in Science) degree. Miss Fleming attend-
ed the Normal School in Calgary and
taught in Alberta higli schools for eight
years.
For ten years after her graduation
from The Vancouver General Hospital
School of Nursing, she worked in that
hospital first as a general duty nurse and
later as assistant night supervisor and ex-
ecutive assistant in the department of
nursing.
Miss Fleming was an instructor at The
Vancouver General Hospital School of
Nursing for 1 1 years before joining the
RNABC professional staff.
Corps until 1946 and was awarded the
Associate Royal Red Cross Medal.
Ruth E. McIIrath
(R.N., Winnipeg
General H.) has been
appointed director
of nursing at Shaugh-
n e s s y Veterans
Hospital in Vancou-
ver. She joined the
staff of the hospital
as supervisor in May
1947 and became assistant director of
nursing service in 1961.
After graduating from Winnipeg Gen-
eral Hospital School of Nursing in 1936.
Mrs. McIIrath was a staff nurse and then
supervisor in the maternity department of
the hospital until 1941. She was a general
duty nurse there until 1942, when she
joined the Royal Canadian Army Medical
Corps.
She served as a lieutenant nursing
sister in army hospitals in the Pacific
Command and on the Canadian hospital
ship Lady Nelson. She went overseas as
captain (assistant) matron with the No.
24 Canadian General Hospital. Following
service in England, she served in Italy and
Holland. Mrs. McIIrath served with the
GlennisN. Zilm, assistant editor of
THE CANADIAN NURSE since October 1964,
left the staff at the end of January. She
plans to do free-lance writing while she
completes her final year of journalism at
Carleton University this Spring. After
that Miss Zilm's plans are uncertain, but
she will be on hand to help the Canadian
Nurses' Association's public relations
team at the ICN Congress in June 1969.
A 1958 graduate of the combined
nursing program at The Vancouver Gener-
al Hospital and the University of British
Columbia, Miss Zilm had considerable ex-
perience in nursing before joining the
journal staff. Her experience included
nursing administration in a small hospital
in British Columbia, public health nursing
in the School Health Service in Sydney,
Australia, and clinical instruction at the
Royal Columbian Hospital in New West-
minster.
Miss Zilm has become well-known to
many Canadian nurses during her four
years as assistant editor. In both 1967
and 1968 she visited hospitals and public
health agencies in all the Western
provinces to explain the policies of
THE CANADIAN NURSE and to encourage
nurses to write articles for their national
magazine. She gained many friends for
THE CANADIAN NURSE 21
names
the journal during these visits, and was
responsible for obtaining much inter-
esting material for journal readers.
As a direct result of Miss Zilm's
eagerness to obtain new information and
to pass it on to other nurses, the "Idea
Exchange" pages were born. Her cre-
ativity has been shown in many other
ways, not the least of which are the
"News" pages, the department that has
become the most popular among readers.
In addition. Miss Zilm has written many
well-researched articles for the journal,
one of which appears in this month's
issue (p. 37).
The staff of the Canadian nurse
and L'injirmiere canadieivie, as well as
the readers of these magazines, will miss
Glennis Zilm. We wish her well in her
journalism career, wherever it may lead.
-V.A.L.
Several new staff
members have joined
the faculty of the
school of nursing at
j^^— The University of
'1*^^ Alberta.
Alice R. MacKin-
non (R.N., U. Alber-
ta H., Edmonton;
B.Sc, U. Alberta.
M.N., U. Washington, Seattle) has been
appointed assistant professor.
A native Albertan, Mrs. MacKinnon
spent six years in the United States and
Canada in public health nursing, edu-
cation, and supervision. She returned to
Edmonton to become principal of the
School for Nursing Aides, a position she
held for five years. During the next five
years, she was associate director of nurs-
ing education at the school of nursing.
Foothills Provincial General Hospital, Cal-
gary. She is currently teaching nursing
education in the postbasic degree, basic
degree, and diploma programs.
^ Margaret Ann
Beswetherick (R.N.,
Vancouver General;
Dipl. Teaching &
Superv., U. British
Columbia; B.N.,
M.Sc, McGill U.)
has been appointed
assistant professor.
Miss Beswether-
ick began her career as a general duty
nurse at The Vancouver General Hospital,
following it with experience in a small
hospital. After completing the diploma
program in clinical supervision at the Uni-
versity of British Columbia, she became a
member of the teaching staff of The Van-
couver General Hospital for six years. She
then attended McGill University, first to
attain a bachelor of nursing degree in
22 THE CANADIAN NURSE
administration in hospitals and schools of
nursing and later to obtain a master of
science degree in nursing education and
administration. She then served as asso-
ciate director of nursing education at
Kingston General Hospital for two years,
leaving this to become nursing advisor to
the Registered Nurses' Association of
Nova Scotia. While in Nova Scotia, she
served also as a consultant on nursing
service for the Nova Scotia Hospital In-
surance Commission.
She is currently teaching nursing ad-
ministration.
Gloria C. Gehlert (R.N., U. Alberta H.,
Edmonton; B.Sc, U. Alberta) has been
appointed lecturer.
After graduation, Mrs. Gehlert spent
two years in Hawaii as a general duty
nurse, returning to Alberta to take a
public health nursing position with the
City of Edmonton Health Department for
two years. Following this, she served for a
three-year period as a clinical instructor
in medical-surgical nursing at the Uni-
versity Hospital, Edmonton and subse-
quently completed the postgraduate
course in cardiology nursing there. She is
presently teaching in the four-year basic
degree program in the advanced medical-
surgical area.
Sandra Arleigh
Shanks MacDonald
(R.N., Victoria
Public H., Freder-
icton; B.N., Dipl.
Teaching & Superv.,
Dalhousie U.) has
been appointed
— J J^^ lecturer.
m jS^M Mrs. MacDonald
has graduate nursing experience in both
operating room and emergency de-
partments in hospitals in the Maritimes.
She is presently teaching in the basic
degree program in the advanced medical-
surgical area.
Marjorie Sandilands (R.N., U. Alberta
H., Edmonton; B.Sc, U. Alberta) has
been appointed lecturer. Following ex-
perience as instructor in pediatric nursing
at the University Hospital, Edmonton,
she is currently teaching maternal and
child health and junior medical-surgical
nursing in the basic degree program.
L e i th Nance
(R.N., Alberta H.,
Ponoka ; B .N.,
McGill U.) has join-
ed the faculty as
lecturer in psychia-
tric nursing jxi the
four-year basic
degree program.
Prior to completing
her degree at McGill, Miss Nance spent
several years in general duty and teaching
in Alberta, Hawaii, and Australia. Follow-
ing this, she served as an instructor in
psychiatric nursing at The Montreal Gen-
eral Hospital, leaving to join the World
Health Organization with postings in
Egypt and Burma.
Rene Oberholtzer
(R.N., U. Alberta H.,
Edmonton; B.Sc, U.
Alberta) has been
appointed lecturer.
Following experi-
ence in public health
nursing with the
city of Calgary
Health Department,
Mrs. Oberholtzer returned to the univer-
sity to teach fundamentals and senior
medical-surgical nursing in the basic
degree program.
Frances Murphy
(R.N., St. Paul's H.,
Vancouver; B.ScN.,
U. British Columbia)
has joined the staff
as lecturer in psy-
chiatric nursing in
the basic four-year
degree program.
Following general
duty experience at St. Mary's Hospital in
New Westminster, B.C., Miss Murphy held
public health nursing positions with the
Metropolitan Health Committee in Rich-
mond, B.C. and with the Calgary Health
Department. She leaves her position as
clinical instructor in psychiatric nursing
at the Royal Inland Hospital, Kamloops.
Joyce Sharpe (R.N., U. Alberta H.,
Edmonton; B.Sc, U. Alberta) has joined
the faculty as sessional demonstrator.
Following two years of public health
nursing in Alberta with the Sturgeon
Health Unit, Mrs. Sharpe is presently con-
cerned with the planning and supervision
of public health nursing experience and
related duties with the on-campus well
child chnic for families of students at-
tending the University of Alberta.
Carol Lynn McWilliam (B.N., U. New
Brunswick) has been named clinical in-
structor at the University of New Bruns-
wick School of Nursing. Mrs. McWilliam
was formerly employed as a staff nurse at
Victoria Public Hospital in Fredericton.
Doris D.N. Stevenson (R.N., Calgary
General; B.Sc, U. Alberta; M.N., U.
Washington, Seattle) has replaced Sister
Marguerite Letourneau as director of
nursing education at Holy Cross Hospital
in Calgary.
Mrs. Stevenson was formerly assistant
director of nursing at Rockyview Hospital
in Calgary. She also worked for seven
years at Medicine Hat General Hospital,
Alberta, as clinical instructor and super-
visor, science instructor, and associate
director of nursing education. She spent
one year at Royal Alexandra Hospital in
Edmonton as science instructor and at
the University of Alberta Hospital in
Edmonton as a general duty nurse.
(contimied on page 24)
FEBRUARY 1969
New 2nd Edition!
Lerch
ADD
NEW DIMENSION
TO TOTAL
PATIENT CARE
A New Text!
Kaluger-Unkovic
PSYCHOLOGY and SOCIOLOGY
An Integrated Approach to
Understanding Human Behavior
Here is the first nursing-oriented text which fully integ-
rates psychology and sociology to give the student a more
complete understanding of her role in total patient care.
Through a careful integration of these two important dis-
ciplines, this new text helps the student effec-
tively develop a frame of reference for under-
standing the total person. To do this in the
most effective manner, a straight text presen-
tation of principles has been combined wnth a
unique case study approach. Actual case histo-
ries are developed around physiologic, psycho-
logic and sociologic elements to show real peo-
ple with medical problems. They are presented
in a medical context and related to an institutional
setting. These case materials are conveniently located
at the end of the text but can be utilized at any point
you prefer. A complimentary test manual and teacher's
guide is provided instructors adopting this text.
By GEORGE KALUGER, Ph.D., Professor of Psychology and
Education, Shippensburg State College, Shippensburg Pa • and
CHARLES M. UNKOVIC, Ph.D.. Chairman and Professor of
Sociology, Florida Technological University, Orlando, Fla. Pub-
lication date: April, 1969. Approx. 496 pages, 7"x 1 0", 42 il-
lustrations. About $10.85.
WORKBOOK FOR MATERNITY NURSING
Add new meaning to your courses in "Obstetric and Maternity
Nursing" with the aid of this extremely effective supplement
to text, lecture and clinical experience. This carefully revised
and updated new 2nd edition clearly reflects today's total
patient care, psycho-social orientation in nursing. You will
find new information to help the student correlate the parents'
emotional fulfillment with the technical aspects of her duties:
a new introductory unit dealing with such topics as biological,
THE C. V. MOSBY COMPANY, LTD.
86 Norlhlme Road • Toronto 16, Ontario
FEBRUARY 1%9
physiological and psychological aspects of pregnancy
and parenthood; and an increased number of clinical
problem-solving situations. Pages are perforated and
punched, and a helpful answer book is provided all
instructors adopting this workbook.
By CONSTANCE LERCH, R.N., B.S.(Ed.). Philadelphia, Penn-
sylvania. Publication date: April, 1969. 2nd edition, 303
pages plus FM l-VIII, 7V4" x 1 0V2", 33 illustrations. Price,
$5.40.
M
Publishers
THE CANADIAN NURSE 23
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NADIAN NURSE should be ac-
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TheCanadian Nurse
&
1 Oept-. 50 The Dfi
(Continued from page 22)
Frances May
Moss (B.A., Dalhou-
sie U.; R.N., Royal
Victoria H., Mon-
treal; Dipl. Teaching
and Superv., Dipl.
Admin., McGill U.)
is the new executive
secretary of the
Registered Nurses'
Association of Nova Scotia. Mrs Moss
leaves a position she has held for the past
13 years as instructor of medical-surgica^
nursing at MUlard Fillmore Hospital
School of Nursing, Buffalo, New York.
Mrs Moss worked at Victona General
Hospital in Halifax for 13 years as as-
sistant director and director of nurses.
She also was an instructor at the Sydney
City Hospital, Nova Scotia, and head
nurse at Royal Victoria Hospital, Mon-
treal.
Laveena Anne
^^^ Gittins (B.Sc.N., U.
^^^R^ Saskatchewan) has
^^P^M been appointed
^^^ ^H coordinator of the
CJ "^ jr school of diploma
^_ nursing, Saskat-
\ ^ chewan Institute of
Applied Arts and
Sciences. Mrs.
Gittins has worked at Saskatoon City
Hospital as a staff nurse and as an m-
structor; at the Saskatchewan Institute ot
Applied Arts and Sciences as instructor;
and at Weyburn Union Hospital, Saskat-
chewan as head nurse.
The new director
of the Algoma
Regional School of
Nursing in Sault Ste.
Marie is E. Jean
^ -^^ (^ Mackie (R.N., Royal
^^^^^^^ Alexandra Hospital,
^^^^^^^1 Edmonton; Cert.
^^^■^^M Teaching Superv., U.
•■^^^■^ Toronto; B.N.,
McGUl U.; M.N., U. Washington, Seatde).
Miss Mackie was formerly chairman of
the department of nursing education at
Mount Royal Junior College, Calgary.
Miss Mackie has devoted her nursing
career to education. She was nursing arts
teacher for five years at the Royal Alex-
andra Hospital School of Nursing; clinical
teacher at Calgary General Hospital for
six years, and assistant director of nursing
education for two; and medical-surgical
nursing teacher at Everett Commumty
College, Washington, for one year. D
k=» ~
Next Month
in
The
Canadian
Nurse
• Rare Blood Groupings
• Today's Hospital
and Infection Control
• CNA Library Services
Photo credits for
February 1969
Miller Services Ltd., Toronto,
cover photo
Crombie McNeUl Photography,
Ottawa, p. 9
Tootons Studios,
St.John's,Nfld.,p. 14
Roy Nicholls, Willowdale,
Ont., p. 38
Normalair, Yeovil, p.39
Toronto General
Hospital, p. 40
FEBRUARY 19(
24 THE CANADIAN NURSE
February 10-13, 1%9
March 20-23, 1%9
April 14-17, 1%9
Regional conferences on the use of
audiovisual aids in nursing, sponsored
by the Registered Nurses' Association
of Ontario. To be held in Sudbury in
February, Ottawa in March, and Fort
William in April. Fee: RNAO mem-
bers, $25; non-members, $35. Write
to: RNAO, 33 Price St., Toronto 5.
August 1968 - June 1%9
The National League for Nursing is
sponsoring a series of 12 two-day
workshops in several U.S. cities for
persons involved in administration,
planning, and evaluation of hospital
nursing services. The first workshop
was held in San Francisco August 9,
1968, and the last will be held in
Miami Beach, June 26-27, 1969.
The workshops are designed for
nurses and others interested In nurs-
ing audits, new staffing patterns, and
hospital staff development programs.
Further information and applica-
tion forms for registration may be
obtained from the Department of Hos-
pital Nursing, National League for
Nursing, 10 Columbus Circle, New
York, New York 10019.
February 11-12, 1969
February 13-14, 1%9
Workshops on "how to achieve better
integration in the nursing program."
First workshop to be held in Edmon-
ton, second in Calgary. Conducted by
Miss Dorothy Rowles, Ryerson Poly-
technical Institute, Toronto.
February 17-19, 1%9
Second Canadian Conference on Hos-
pital-Medical Staff Relations, Chateau
Frontenac, Quebec City. Theme: Better
communications for better patient
care. Sponsored by Canadian Hospital
Association, Canadian Medical Asso-
ciation, and Canadian Nurses' Asso-
ciation.
February 24-27, 1969
Association of Operating Room Nurses,
16th annual meeting, Cincinnati, Ohio.
March 3-28, 1%9
Advanced program in health services
organization and administration.
School of Hygiene, University of To-
ronto. Part two of course to be held
in March 1970. For additional infor-
mation and registration data write:
Dr. R.D. Barron, Secretary, School of
Hygiene, University of Toronto, To-
ronto 5.
March 10-12, 1%9
15th annual combined meeting for
doctors and nurses sponsored by the
American College of Surgeons, Boston,
Massachusetts. Further information is
available from ACS, 55 East Erie St.,
Chicago, Illinois 60611.
March 18-20, 1%9
Institute on Administration for Hospi-
tal Administrators and Directors of
Nursing Service, conducted by Amer-
PROFILE OFA MEMORIAL NURSE
((
YOU'RE SURE TO FIND IT
On Manhattans fashionable Fifth, the shops
range from the "5 & 10" to the elegance of
Sak's Fifth Avenue. You can shop to your
heart's content at expanding Memorial, loo.
You are needed now in Recovery, Research,
Pediatrics, Intensive Care, Neurology & Neu-
rosurgery, Clinical Specialities-Medical &
Surgical Nursing."
For the RN who wants to find her true self,
call or write: MRS. BEATRICE A. CHASE,
Director of Nursing.
(212) 879-3000
• HOUSING FACILITIES • TOP SALARIES • EXCELLENT BENEFITS
• 4 WEEKS VACATION • MANY OTHER EXTRAS
MEMORIAL HOSPITAL
of MEMORIAL SIOAN-KEITERING CANCER CENTER
444 East 68th Street, New York, N.Y. 10021
An Equal Opportunity Employer
■FEBRUARY 1%9
THE CANADIAN NURSE 25
icon Hospital Association. To be held
at the American Hospital Association,
840 North Lake Shore Drive, Chicago,
Illinois 60611. Apply to above
oddress.
March 24-29, 1969
Symposium on recovery room and in-
tensive care nursing, Grace General
Hospital, Winnipeg. Registration: $20.
For further details; Miss J.W. Robert-
son, Director - Inservice Education,
Grace General Hospital, 300 Booth
Dr., Winnipeg 12.
April 13-17, 1969
American Association of Neurosurgi-
cal Nurses Meeting, Cleveland, Ohio.
Information may be obtained from:
Miss S.M. Sowchyn, 99 Fidler Ave.,
St. James 12, Manitoba.
May 13-16, 1969
Alberta Association of Registered
Nurses, annual convention, Macdo-
Second Conference
Hospital - Medical Staff Relations
16 to 19 February, 1969
Chateau Frontenac, Quebec City
Jointly Sponsored by:
Canadian Hospital Association
Canadian Nurses' Association
Canadian Medical Association
PROGRAM
Participants are divided into four sections, each including: Trustees;
Administrators; Medical Staff Representatives; Nursing Representatives.
Each section is further divided into two types of groups: A — profes-
sional; B — mixed.
Sunday, 16 February
Registration
Meeting of Group Leaders
Group Orientation — sectional
Reception
Monday, 17 February
Registration
Opening Ceremonies
Keynote Speaker: Dr. E. W.
Barootes, Regina, Sask., CMA
Executive Committee member
Meetings — sectional, A and B
Tuesday, 18 February
Meetings — sectional, A and B
Reception
Official Dinner
Wednesday, 19 February
Keynote Speaker: Dr. A. B. C.
Powell, Medical Director, Work-
men's Compensation Board of
Ontario — "the Team Approach
in the Hospital"
Reports of Sections
Summation
Topics for discussion include:
— purpose of the organization
— process of delegation
— creating opportunities to participate in decision-making
— process of communications.
nald Hotel, Edmonton, Alberta.
April 14 - May 9, 1969
May 12 - lune 6, 1969
Rehabilitation Nursing Workshops,
University of Toronto. Four-week
course for R.N.s employed in acute
general and chronic illness hospitals,
nursing homes, public health agencies,
and schools of nursing. Tuition fee:
$150. Apply to: Division of University
Extension, Business and Professional
Courses, 84 Queen's Park, Toronto 5,
Ont.
May 19-23, 1%9
National League for Nursing, 1969
convention. To be held in Cobo Hall,
Detroit, Michigan. Fee: NLN members,
$15; non-members, $25. Write to:
NLN, 10 Columbus Circle, New York,
N.Y. 10019.
May 21-23, 1969
Registered Nurses' Association of Brit-
ish Columbia, annual meeting. Bay-
shore Inn, Vancouver. Write: RNABC.
2130 W. 12th Ave., Vancouver 9.
May 21-23, 1969
Canadian Hospital Association, 2nc
national convention. Civic Centre, Ot
tawa.
May 28-30, 1969
The New Brunswick Association o\
Registered Nurses, annual meeting
New Brunswick Hotel, Moncton.
June 1-13, 1969
Eighth annual residential summei
course on alcohol and problems of ad-
diction, Trent University, Peterbor-
ough, Ont. Co-sponsored by Tren
University and the Addiction Research
Foundation, an agency of the province
of Ontario.
June 16-18, 1969
Conference on nursing education foi
visitors to the International Council o1
Nurses Quadrennial Congress. Spon-
sored by the school of nursing one
alumni association. University of To-
ronto. June 19-20: tours in Torontc
and environs to be arranged at re-
quest of persons attending conference.
Apply to the Secretary of the School,
University of Toronto School of Nurs-
ing, 50 St. George St., Toronto 5.
June 22-28, 1969
26 THE CANADIAN NURSE
International Coun-
cil of Nurses' Qua-
drennial Congress,
Montreal. Fee: be-
fore Jan. 22, $40;
after Jan. 22, $60.
Write to: ICN Con-
gress Registration,
50 The Driveway,
Ottawa 4, Ont. D
FEBRUARY 196>^
new products
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
Hotchkiss Otoscope
The Hotchkiss Otoscope is a new otos-
copic system with coaxial lighting (the
same principle as the headmirror),
designed to improve and simplify ear ex-
aminations and instrumentation.
Designed by Dr. John E. Hotchkiss, a
San Francisco otolaryngologist, the new
system eliminates parallax error - a basic
deficiency of standard otoscopic systems.
It also provides up to four times brighter
illumination than traditional otoscopes.
The optical head weighs only 2-1/4
ounces and measures 4-3/4 inches from
the eye piece to the speculum tip. The
instrument is designed to be held by the
thumb and index finger of one hand leav-
ing the mid-finger to straighten the canal
and the other hand free for instru-
mentation, positioning the patient's head
forpneumoscopy. An improved speculum
design permits instrumentation under full
magnification and eases the pneumatic
procedure.
Other features of the instrument in-
clude an around-the-neck power supply, a
5x magnification unit, corrective lens for
bifocal wearers, and completely dis-
posable specula. In addition, by use of a
photographic adaptor and single-lens
reflex camera, the otoscope can be used
for photography of the ear drum and
nasal passages.
FEBRUARY 1%9
Additional information may be obtain-
ed from "Smith Kline & French, Inter-
American Corporation, 300 Laurentian
Blvd., Montreal 379.
New Canadian Allergy Service
Winley-Morris Co. Ltd.. in conjunction
with Purex Laboratories Inc., New York,
announces the establishinent of a new
Canadian Allergy Service under the Purex
label.
Available from Montreal stocks are
testing kits, treatment solutions, and
accessories for a complete allergy prac-
tice.
Prices and catalogues are available on
request from Winley-Morris Ltd., 2795
Bates Rd., Montreal 251.
Bedside Toilet
This electrically operated, recirculating
flush toilet may be wheeled to the
patient's bed. The Mobile Monomatic
toilet eliminates patient stress and the
psychological block often associated with
bedpans and commodes. The toilet also
substantially reduces nursing involvement
with toilet duty and provides approved
sanitation for areas that lack plumbing
facilities, without costs of plumbing re-
habilitation.
Because of the unit's proprietary
chemical, the toilet provides immediate
bacteria and odor control and results in
less annoyance to other patients in the
area.
For further information: Gerry Ste-
vens Companies, 145 Wellington St.,
Toronto 1, Ont.
Child-Resistant Pill Bottle
This new child-resistant pill bottle,
designed to prevent many of the acci-
dental poisonings that occur every year, is
marketed under the name "Palm-N-
Turn." The new container consists of a
polypropylene cap on a crystal poly-
styrene vial. To open the container, you
must press the cap into the palm of the
hand and give the vial a quarter turn to
the left.
The pliable plastic cap has notches in
it that fit over the lugs on the vial when
the container is closed. You can pry it,
twist it, or shake it, but it won't come
off. By pressing it into the palm of your
hand, however, a springy plastic disc
inside the cap is depressed to release the
notches from the lugs. A quarter turn
then releases the cap completely.
Even if a youngster learns the knack,
he's unlikely to be able to use it because
it takes about 12 pounds of pressure to
depress the plastic spring. While this is
very little effort for an adult, it is about
three pounds more than a typical five-
year-old can bring to bear.
It is manufactured by Reflex Corpora-
tion, Amhurstburg, Ont.
Allergy Chart
To help mothers avoid allergens more
completely, Gerber Products Company
THE CANADIAN NURSE 27
new products
(Continued from page 27)
has prepared a chart listing the many
Strained and Junior foods available for
babies and indicating which, if any, of the
four common allergens each food con-
tains. Most food allergies among infants
are caused by one of four common foods:
milk, wheat, egg. and citrus fruit. Spot-
ting the offender is usually fairly simple.
and avoiding that food in its pure form is
equally simple. These four foods,
however, are also found as ingredients in
many combination foods.
With the chart handy, a mother can
determine at a glance whether a particular
food contains the food element to which
her baby is allergic. The chart is coded
with the letters M (Milk), W (Wheat), E
(Egg) and C (Citrus Fruit), and also con-
tains a listing of all gluten-free Gerber
Baby Foods.
Reprints of the chart are available
from doctors or free on request from
For nursing
convenience...
patient ease
TUCKS
offer an aid to healing,
an aid to comfort
Soothing, cooling TUCKS provide
greater patient comfort, greater
nursing convenience. TUCKS mean no
fuss, no mess, no preparation, no
trundling the surgical cart. Ready-
prepared TUCKS can be kept by the
patient's bedside for immediate appli-
cation w^henever their soothing, healing
properties are indicated. TUCKS allay
the itch and pain of post-operative
lesions, post-partum hemorrhoids,
episiotomies, and many dermatological
conditions. TUCKS save time. Promote
healing. Offer soothing, cooling relief
in both pre-and post-operative
conditions. TUCKS are soft
flannel pads soaked In witch hazel
(50%) and glycerine (10%).
TUCKS — the valuable nur-
sing aid, the valuable patient
comforter.
\A/ \VINLEY-MORRIS>HV>
AA MONTREAL CANADA
TUCKS is a trademark of the Fuller Laboratories Inc.
Gerber Products Company, Niagara Falls,
Ontario.
Surgical Drain
This versatile new surgical drain
features a triple-lumen construction that
permits the drain to serve as an overflow,
suction, and sump drain, depending upon
the individual surgical requirement.
It will be known as the Abramson
Drain, named after its inventor, Daniel J.
Abramson, M.D., F.A.C.S., of the Wash-
ington Hospital Center, Washington, D.C.
The triple-lumen drain is elliptical with
a large central lumen of approximately
1/4-inch I.D., and two companion tubes
molded into the outer margins of the
ellipse. The center lumen can be used for
overflow, suction, drainage, or irrigation,
or both tubes may be used for the same
function.
Therefore, depending upon how the
three lumens are used, the Abramson
drain fulfills many functions.
The prospect of clogging is reported
by Davol to be minimized by the triple
lumen design and the large eyes on the
distal tip.
Indications for use of this drain are:
clean surgical wounds in which excessive
drainage or bleeding may occur, such as
operations on the biliary tract, thyroid,
or breast; potentially infected wounds
such as occur in trauma or emergency in-
testinal resections; established infections,
as in peritoneal, pelvic, sub-hepatic or
other abscesses.
Made of soft, pliable, medical grade
PVC, the Abramson Drain is available in
surgically sterile, 1 8-inch lengths.
Evaluation quantities are available to
hospitals from Davol Inc., Providence,
Rhode Island.
28 THE CANADIAN NURSE
642 Tablets
642 tablets (propoxyphene HCl 65
mg.) are indicated for the relief of moder-
ate pain. They are of value in providing
symptomatic relief for: muscle and joint
pain, premenstrual and postpartum pain,,
dysmenorrhea, pain associated with in-
fection, postoperative pain, headaches,
atid post traumatic pain.
Orally administered, propoxyphene
hydrochloride produces effective plasma
levels within one hour, as evidenced by
plasma experience. Less than 10 percent
of the unchanged drug can be recovered
FEBRUARY 1%9
new products
from urine collected over a 24-hour
period.
642 tablets are round, yellow, and
film-coated, and are available in bottles of
100 and 500 tablets. Full information
may be obtained from: Charles E. Frosst
& Co., P.O. Box 247, Montreal 3.
Cytec
Cytec is a modern method of sputum
analysis for the detection of lung cancer
in its most curable and easy-to-treat
stages.
The Cytec system consists of an elec-
tronic computerized cyto-screening anal-
yzer that can measure cell parameters and
distinguish the difference between normal
and abnormal cells, and a kit for the
collection of early morning cough speci-
mens.
Modern bio-engineering techniques
now permit optical scanning of free float-
ing sputum cells at the rate of 200 per
second for approximately 20,000 cells
from a four-day specimen, as compared
with only a few hundred cells possible by
conventional methods.
Significantly, these same optical scan-
ning techniques permit accurate detection
of the early biochemical changes in
nucleus and cytoplasm known to occur in
the premalignant cell, some 36 months
prior to any radiological evidence.
If used in mass screening of an entire
population, the Cytec test can lead to
significant reduction of the mortality rate
in this disease.
Senokot Syrup
This pleasant tasting syrup is indicated
for the effective correction of consti-
pation. Each 5 ml. contains the equiva-
lent of 2 ml. of Standardized Senna
Syrup Concentrate standardized to an
average value of 5 mg. Sennosides A and
B per ml.
Senokot Syrup is particularly accepta-
ble to children and the elderly. It offers
FEBRUARY 1%9
the advantage of teaspoon, not table-
spoon dosage.
Further information is available from
The Purdue Frederick Company (Canada)
Ltd., 123 Sunrise Avenue, Toronto 16,
Ont.
Valium Injectable
After four years of clinical investi-
gations by over 200 Canadian phy-
sicians, Hoffman-LaRoche Limited,
Montreal, has released an injectable form
of Valium, one of the most widely pre-
scribed psychotropic drugs. Valium In-
jectable is especially useful when rapid
onset of action is required in acute anxie-
ty or tension states related to stressful
conditions.
Each 2 cc. Valium ampoule contains
10 mg. diazepam. It is indicated for the
relief of anxiety states including those
present before minor surgery and prior to
esophagoscopy and gastroscopy; relief of
muscle spasm in cerebral palsy and athe-
tosis; and control of prolonged seizure
activity in status epilepticus.
For further information: Hoffmann-La
Roche Limited, Montreal 9. D
ASSISTOSCOPE
DESIGNED WITH THE NURSE
IN MIND
Acoustical Perfection
▲ SUM AND DAINTY
▲ RUGGED AND DEPENDABLE
▲ LIGHT AND FLEXIBLE
A WHITE OR BLACK TUBING
▲ PERSONAL STETHOSCOPE TO FIT
YOUR POCKET AND POCKETBOOK
Order from
M
WINLEY-MORRIS CO. LTD.
Surgical Products Division
MONTREAL 26 QUEBEC
^
ASSISTOSCOPE
DESIGNED WITH THE NURSE
IN MIND
Acoustical Perfection
A SLIM AND DAINn
A RUGGED AND DEPENDABLE
A LIGHT AND FLEXIBLE
A WHITE OR BLACK TUBING
A nrsohal sUTHOScopi ro fir
voun POCKii ANo PoaaeooK
WINLEY-MORRIS CO. LTD
2795 BATES RD. MONTREAL, P.O.
Please accept my order for
'Assistoscope(s)' at $12,95 each
□ White tubing Q Black tubing
NAME -
ADDRESS
Residents of Quebec add 8% Provincial
Tax.
.J
ales
Made in Canada
THE CANADIAN NURSE 29
in a capsule
Canadian quirks
Who says you can't tell a Maritimer
from a British Columbian? Or an Ontar-
ian from a Newfoundlander? Or that les
Quebecois have succumbed to English-
Canadian habits? According to Marketing
magazine, advertisers have doUars-and-
cents evidence that we're all individual -
in our eating habits at least.
Take potato chips, for instance.
Quebeckers consume by far the most
potato chips of any of their compatriots
in the other nine provinces. Toronton-
ians, however, are more economy minded
when they buy potato chips; 59-cent-
and-up bags capture 75 percent of the
Toronto market. In the less affluent
Maritimes, however, five-and ten-cent
bags corner the market.
Easterners appear to like their coffee
quick and easy whereas Westerners prefer
to wait awhile to savor theirs. Much more
instant coffee is sold in the eastern
provinces; Westerners not only prefer the
ground variety, but drink it much
stronger than do Easterners.
Quebec, though, has the most individ-
ual eating habits of all 10 provinces.
Manufacturers claim that in other parts of
Canada they couldn't give away the
spruce beer that is a bestseller in Quebec.
Quebec also is the largest per capita soft
drink market in the world. And Quebec-
kers don't restrict their buying to spruce
beer, ginger ale, or colas; they drink
everything from cream soda to lemon-
lime.
Les Quebecois consume 80 times as
much molasses as other Canadians. They
eat two olives to an Ontarian's one. They
buy more expensive cuts of meat than
their richer Ontario neighbors. They turn
up their noses at the quick dinners in a
can — such as chili con came and weiners
and beans — that other Canadian house-
wives couldn't do without. And despite
their larger families, they prefer their
fruit juices in 20-ounce to 48-ounce tins.
The key to success on the Quebec
market, according to one food marketer
quoted in Marketing, is "make it sweet,
make it red and make it chocolate. And
you've got it made."
In any case, there's no such thing as a
national food market in Canada. "It's a
whole lot of smaller markets, each one
with its own peculiarities in different
product categories," says a food market-
ing expert.
You couldn't look that one up in your
Funk and Wagnalls.
Beautiful nurses
Nurses are renowned for their beauty
all over the world and Canadian nurses
are no exception. It was Canadian nurses.
30 THE CANADIAN NURSE
after all, who established the image of Air
Canada's gorgeous hostesses. You may
recall as well that last year's Miss Canada
was a student nurse. And now, a Cana-
dian nurse has been chosen by Breck Inc.
to be a "Breck girl."
You're probably familiar with the
head-and-shoulder pastel portraits that
appear in popular magazines to advertise
Breck shampoos. At a recent symposium
of operating room supervisors held in
Niagara Falls, representatives from John
H. Breck, Inc. chose blonde Virginia
Gardhouse, an operating room supervisor
at Queensway Memorial Hospital in Etob-
icoke, Ontario to pose as a Breck girl.
Miss Gardhouse will receive a pastel
portrait of herself and have the added
thrill of seeing her portrait in magazines
all over North America.
Cold type
Did you wonder whether you needed
new glasses after reading last month's
THE CANADIAN NURSE ? Our priutcr IS uslng
a new kind of type, called cold type,
which is set by an IBM machine. The
January issue was the trial run for this
type and there were a few problems.
For one thing, the type was rather
small. We hope that the larger type you
are now reading will be easier on the eyes.
Another slipup was in the bold type
headings, some of which were misprinted.
For instance, did you notice the "new
desing" featured in the Idea Exchange?
We hope that these wrongs have been
righted in this issue.
Back to nature
From time to time we receive unusual
requests for use of space in this magazine
but the most unusual of all was surely
this: a "naturist-nudist" camp wishing to
advertise in the canadun nurse and run
"one and many repeats."
Nurses would be naturals for member-
ship in this camp, the management believ-
ed, because they have such a lot of
responsibility and are on their feet day
and night. They could find "real re-
laxation in our camp." A bonus for nurse
members would be building up their body
resistance against many possibilities of
infections.
We never did receive the actual copy
for this advertisement, but we must admit
that we were curious about what aspects
of life in the camp it might illustrate! D
FEBRUARY 1969
We want
a special kind
of nurse*
We want a nurse who can handle
two jobs: one who can nurse the
men of the Canadian Armed
Forces and who can accept the
responsibihties of being a com-
missioned officer. That's why
we're offering a salary of more
than $590.00 a month. It's inter-
esting work. You could travel to
bases all across Canada and be
employed in one of several
different hospitals.
It's challenging.You'll never find
yourself in a dull routine. And, in
addition, you have the extra pres-
tige of being made a commis-
sioned officer when you join us.
If the idea intrigues
you, you're probably
the kind of special
person we're looking
for. We'd like to have
you with us.
Write: The Director of
Recruiting, Canadian
Forces Headquarters,
Ottawa 4, Ontario.
GO WITH US! THE CANADIAN ARMED FORCES
VB04t3
:BRUARY 1%9 THE CANADIAN NURSE 31
when traumatic pain
stops the action-
stop the pain with
PONSTAN
(mefenamic acid, Parke-Davis)
A DISTINCTLY DIFFERENT ANALGESIC
■ non-narcoticH single chemical entity ■ oral administration
■ well tolerated ■ demonstrated effectiveness*
•In a controlled study of 920 patients with pain of varied etiology, including
muscular aches, sprain, backache, dysmenorrhea, toothache, and bursitis,
relief of pain after only one dose of PONSTAN was reported as good to
excellent in 85% of the patients.
indications: Relief of pain in acute and chronic conditions
ordinarily not requiring the use of narcotics.
DOSAGE AND ADMINISTRATION: Adults and adolescents over 14 years of age—
500 mg. (2 capsules) as an initial dose, followed by 250 mg. (1 capsule)
every six hours as needed. The major portion of clinical experience with
PONSTAN has varied from single doses to 84 days of therapy.
contraindications: Intestinal ulceration; diarrhea as a result of taking the
drug; safe use in pregnancy not established; in children under 14 years
of age until pediatric dose has been established.
precautions: Administer with caution to patients with abnormal renal
function, inflammatory diseases of the gastrointestinal tract, or those on
anticoagulant therapy. Discontinue if diarrhea or rash occurs.
SIDE effects: Mild and infrequent at doses up to 1500 mg. per day;
dose-related, being more frequent with higher doses. Most frequently
reported: drowsiness, dizziness, nervousness,
nausea, diarrhea, G.i. discomfort, vomiting.
FOR DETAILED INFORMATION ON PRECAUTIONS
AND SIDE EFFECTS SEE PRODUCT BROCHURE
AVAILABLE ON REQUEST.
supply: Kapseals® of 250 mg. in
bottles of 100 and 500.
PARKE-DAVIS
PASKE. DAVIS a COMPANY. LTD
MONTRgAL 9
CP-3S7Ga
i(>. '.
^¥C
^^.-■iite
E'^.
.A\
^^V.
^
w R t «. Cr
Epidermolysis bullosa
The story of two children who, with considerable care and support, have learned
to cope with a rare, chronic, hereditary skin disease.
Emily Melnyk
The skin you are born with is yours
for life - however long that may be. It is
more than a protective covering - it is an
organ ranking in importance with the
brain, the heart, and the lungs. Your skin,
because it is with you from the beginning,
is peculiarly your own, even more than
your personality. No other person's is
quite like it An example of this unique-
ness is your fingerprint pattern that never
duplicates that of anyone else.
But nature can play tricks with the
oackaging of our bodies, as the histories
of the following two children with a rare
disease called "epidermolysis bullosa"
show. When Christ said, "Suffer little
children to come unto me," He must
surely have had in mind little ones such as
Stephen and Marie, for their climb along
life's highway is indeed frightening and
hazardous.
"Are these burn cases? " ask student
nurses and visitors to Bloorview ChUdrens
Hospital after seeing two of our patients,
Marie and Stephen.
On hearing the medical terminology
for the condition "epidermolysis bullo-
sa," most people remark that this is a
mouthful; after an explanation of the
treatment and nursing care involved, all
comment that this is also a handful!
Epidermolysis bullosa is an uncom-
mon, chronic, hereditary disease of the
skin, exhibiting several clinical forms and
characterized by the development of
sub-epidermal bullae following slight
friction or trauma. These bullae contain a
fluid that is usually serous but quite often
hemorrhagic or purulent. They tend to
FEBRUARY 1%9
enlarge with pressure and eventually
break down into painful, shallow denuda-
tions which, on healing, leave scars.
First observed by Dr. Von Hebra in
1870 and described by Dr. T. Fox in 1879,
epidermolysis bullosa received its present
name from Dr. Koebner in 1886. In most
countries, the name commonly used for
this condition is chronic pemphigus.
Currently, it is classified into four
basic types:
1. Simplex: This type accounts for 45
percent of all cases. It is self-limiting,
non-scarring and inherited by Mendelian
dominant trait. Bullae, containing clear
fluid, appear on the hands and feet. They
generally heal without scarring and tend
to decrease in severity as a patient grows
older. There may be transitory pigmen-
tation associated with the healing. The
mucosal epitheUum is rarely involved.
Patients have a normal span of life.
2. Hyperplastic Dystrophic: Approxi-
mately 30 percent of patients with chronic
pemphigus fall within this classification.
It is transmitted by a single autosomal
recessive gene. Onset may occur at any
time from birth to maturity. The mucosal
epithelium is involved in about 20 per-
cent of the cases. Bullae result from
minor trauma to the skin, and contain
either clear or hemonhagic fluid. Healing
Mrs. Melnyk, a graduate of University School of
Nursing, Graz, Austria, is Assistant Director of
Nursing Education at the Bloorview ChUdrens
Hospital in Toronto. She expresses her appre-
ciation to Dr. Otto Weininger, psychologist, and
the nursing staff at Bloorview Childrens Hos-
pital, for their help in preparing this article.
is accompanied by scarring. White
papules, one to two mm. in diameter,
frequently appear due to involvement of
the sebaceous ducts.
3. Hypoplastic Dystrophic: This clas-
sification accounts for 25 percent of all
cases and is also transmitted by a single,
autosomal recessive gene. According to
well-known dermatologists, there are six
patients in Canada with this type. The
onset is at birth; the newborn baby's skin
may have a few sub-epidermal bullae at
the time of delivery. These increase in
size during the first few days of life.
Widespread bullae develop following very
minor trauma, and affect both skin and
mucosa. They heal with extensive scar-
ring. The skin becomes thick and xero-
dermic in appearance; nails are deformed
or absent; teeth are hypoplastic with
extensive early cavities. The eyes, respir-
atory tract, esophagus, anus, and vagina
may be affected. Contractures, disappear-
ance of the distal portions of digits, and
total encasement of the hands in scar
tissue have been known to follow.
In severe cases, dwarfism (cachexia) is
manifested. Marie is a good example of
this aspect. In the past, many in this
category died before reaching maturity.
However, because of lack of research
evidence it is hard to determine (due to
the rarity of the disease, the short lives of
those afflicted, and thus the lack of
opportunity for extensive research) if this
were due to the primary condition or to
secondary infection and loss of blood.
New concepts of treatment involving the
use of steroids, and advances in plastic
surgery promise a better prognosis for the
THE CANADIAN NURSE 33
^
Marie, aged 14, was admitted to Bloor-
view Childrens Hospital in Toronto
with epidermolysis bullosa when she
was two years and three months old.
future.
Both Stephen and Marie have all the
characteristics described in this type of
epidermolysis bullosa. The intelligence
quotient of both our little patients (75 to
80 - low average) is a coincidence. It is
not one of the characteristics of the
condition.
4. Letalis: This type is very rare.
Infants die after a few weeks.
Etiology
Epidermolysis bullosa is caused by a
genetic defect and represents some type
of biochemical imbalance, presently
unknown. The epidermis is frequently
separated from the corium of the skin
and in the dystrophic type involving
mucosal epithelium it separates from the
underlying tunica propria. Researchers
have hypothesized that the underlying
cause is a vascular defect, deficient elastic
tissue, or dysfunction of the hyaluroni-
dase hyaluronic acid system.
During the early 1 950's, patients were
treated in various ways. In 1952, Dr.
Langhof used an ointment containing
heparin to prevent blistering. Deficiency
of heparin was considered responsible for
imperfect hyaluronidase metabolism. In
1957 Dr. Dorn treated two families with
heparin and ephedrine hydrochloride. In
34 THE CANADIAN NURSE
that same period early reports concerning
ACTH treatment were disappointing.
At the present time, the beneficial
results achieved with corticosteroids are
thought to be due to two independent
effects: 1. control of the inflammatory
process and reduction in tissue damaged;
and 2. restoration of the normal adhesive
mechanism of the epidermal cells and
prevention of blood loss.
In March 1967, G.L. Severin described
the management of epidermolysis bullosa
in children with topical application of
steroids — 0.2 percent fluocinolone aceto-
nide cream.
Treatment
These little patients need an intensive
program of regular supportive care. The
objectives are:
• To prevent bullae formation.
• To prevent the spread of established
bullae.
• To prevent secondary infection and
expedite healing.
• To prevent contractures.
The following measures are helpful in
attempting to attain these objectives:
• Bedding should be of soft, smooth
materials. Infrequent handling of the
patient as well as careful feeding are
advisable. For instance, hot, pureed
food should not be given. Physical stress
and trauma must also be avoided.
• Incision of bullae, or careful removal of
four to six mm. of tissue, is performed
to decompress tense lesions and prevent
spread of infection.
• Bathing with an antibacterial cleansing
agent and application of antibiotic
ointment help to protect the denuded
areas.
• Passive range of motion exercises, as
tolerated, are beneficial.
At Bloorview Childrens Hospital, only
the supportive type of treatment is used
at present. With advanced techniques in
plastic surgery, surgical reconstruction of
the hands may be anticipated in the
future.
Stephen
Stephen, aged 9 years and five months,
has been a patient at Bloorview Childrens
Hospital for just over two years. He is an
only child. A report from the Ontario
Society for Crippled Children's district
nurse states, "Stephen's mother seems to
have had an excellent understanding of
the child's illness and her attitude toward
his disability is very understanding. When
Stephen was at home she did his dressings
several times daily, and was able to carry
out the doctor's orders."
Stephen's treatment and medications,
as will be seen from the following outline,
are intended to promote general physical
well-being to the greatest extent possible,
and to protect his fragile body from the
added burden of superimposed infection.
Chlor-triplon Syrup I tsp. t.i.d. with each meal
Winstrol 2 mg. b.i.d.
Orbenin 125 mg. q.6 h.
Prednisone 5 mg. t.i.d.
Poly-vi-sol 0.6 cc. o.d.
Nupercainal ung. to relieve pain from lesions
"One more dressing and I am ready to hug you, "Marie said
after her daily
FEBR
dressing.
UARY 1969
In epidermolysis bullosa, bullae develop following minor trauma and affect both
skin and mucosa. They heal with extensive scarring.
nique is not necessary, but surgical clean-
liness and loving patience on the part of
the nurses who care for Stephen are
required.
The soft tulle gauze is lifted with the
forceps and placed on a clean working
surface. A minimum amount of Triburon
Creme is applied with a spatula and the
gauze is then applied to the area. This is
repeated until all denuded areas and
blisters have been covered.
Stephen's arms are dressed first and
then a tubular stockinette sleeve is pulled
on gently to hold the gauze in place. A
specially-made flannel vest joins at the
shoulders with the arm stockinette, and
effectively secures the dressings on his
back and chest.
His legs are dressed in the same
manner as his arms. However, part of the
stockinette covering his foot is doubled
over to form a sock. Stephen wears a
minimum amount of clothing. Small
pieces of perforated Saran Wrap are
put over his elbows and knees when he
attends school to protect his books and
school materials from becoming oily.
Stephen is handled as little as possible
throughout this part of his care. Other
than lying down once for his leg dres-
sings, he sits up for the entire procedure.
When his dressings are completed,
Stephen receives his nose and eye drops.
Mouth care is given after each meal and at
bedtime.
Physiotherapy for this little boy con-
sists of breathing exercises and gentle
passive movement of his extremities to
prevent contractures. Occupational thera-
pists teach him how to perform various
activities of daily living, for example
dressing himself - he is now able to put
on his own shirt - and encourage him to
be as independent as possible. He is also
learning to type, using his four unaffected
fingers and his wrists.
Stephen is co-editor of Bloorview's
Morning Glory, a newspaper containing
articles about the hospital written by the
Neosporin ear and eye drops q.i.d.
Metamucil h.s. or mineral oil, occasionally
3 percent hydrogen peroxide diluted to
1/2 strength and used t.i.d. as mouth wash
Fer-in-sol 1 cc. t.i.d.
Dressings of Triburon Creme once a day,
or as necessary
High protein diet using baby foods
Weekly urinalysis
Hemoglobin estimation as necessary
Alpha-Keri in bath
Stephen starts his day at 7:00 a.m.
While still in bed, he begins to remove his
dressings — this usually takes him about
half an hour. He prefers to do this by
himself because, as he explained, he is
afraid of the pain that might occur should
a staff member remove a dressing too
suddenly. Every second day he has a
warm tub bath to which has been added
Alpha-Keri oil and Phisohex. Usually he
stays in his bath for at least 20 minutes,
enjoying it while his hair is washed with
Nivea Creme shampoo. During the
shampoo, his head is held in a backward
position to prevent soap from getting into
his eyes.
Unfortunately, even though he enjoys
his bath, he cannot be bathed daily
because his lesions become jelly-like and
do not dry as quickly. His dressings,
however, are changed at least once a day
or more often, if necessary.
After his bath, Stephen is lifted out of
the tub to the dressing table, a piece of
Saran Wrap is placed beneath his but-
tocks, and he is left to dry for a few
minutes.
Stephen's nurse makes sure that the
supplies she needs to complete his care
are on the dressing trolley. This includes
two stainless steel pans, 6" x 4", contain-
ing autoclaved squares of soft tulle gauze
covered with Petroleum Jelly. Another
small container, filled with alcohol, holds
hfting forceps and scissors. Triburon
Creme, spatulas, and other treatment
materials are also available. Sterile tech-
FEBRUARY 1969
children. He has a keen sense of humor
and is the source of most of the funny
tales that are published.
Stephen is very active, pushing himself
around in his wheelchair and in general
maintaining a very independent attitude.
Since his physical condition does not
permit him to reach for objects or to
push buttons for elevators, he uses a
specially-designed small rod that he
carries about constantly. This permits
him to overcome some of his limitations
in school.
He is progressing moderately well in
school. His teacher says that he "works
very conscientiously" and that he "has
completed all of his work with very good
results." He has successfully met the
requirements for grade three work in
reading, spelling, and arithmetic and is
now progressing into grade four. Stephen
enjoys school and its many challenges.
Two weeks after his admission to
Bloorview, Stephen was seen by a phychol-
ogist. The results of tests carried out
then indicated that he was functioning
within the low average intellectual range.
There has been no significant change in
this level.
According to the psychologist's assess-
ment, Stephen is constantly striving to
maintain control over feelings of hostility
or aggression: "The particular way in
which he seems to maintain this control is
by trying to figure out what exists within
the particular situation that is either
threatening or potentially harmful to
him." Thus, when confronted with spe-
cific situations, Stephen views them as
threatening to himself and tends to react
to each one in similar, if not identical,
ways.
The particular kind of harm that he is
most concerned with at this point is
physical danger that might exacerbate his
skin condition. He even feels that any
expression of anger on his part is poten-
tially damaging to his skin, since it might
excite others to become angry with him
and to harm him physically. Certainly
there are times when he feels angry, but
he controls any expression of this fairly
well. Stephen also tries to deal with other
small aspects of his existence through
meticulous attention to minute detail.
This serves to suppress impulsive action
and hostility.
According to the psychologist, "The
general emotional patterning is one where
feelings and impulses to aggression are
strong, but are most unacceptable and
their direct expression is severely repres-
sed." Stephen's reaction is seen as inter-
nalized aggression with a proneness to
indiscriminate perception of and response
to frustration with passive feelings, denial
of aggression, and overly amenable,
socially nice behavior.
He tries hard to be pleasant and to
have a smiling face at all times. As a
result, it becomes extremely difficult to
THE CANADIAN NURSE 35
have him talk freely about his real feel-
ings. The Projective Psychological Tests
indicated that his anxiety level is high and
that most situations present difficulties
for him. This anxiety must be seen in
relationship to Stephen's inability to cope
with the external world, through fear that
it will harm him. In a way, he is being
realistic, but since he does not really test
his world to find out what its advantages
or disadvantages are, he remains in a kind
of cocoon whereby real feelings are
denied or inhibited by rigid intellectual
processes or by complusive attention to
small detail.
Stephen's reaction to mental stress is
poor. He has little emotional energy with
which to respond to stressful situations.
His usual response is to withdraw, feeling
that he has done something wrong. This
pattern of feeling angry with himself
becomes most marked when he is under
any kind of real emotional stress.
There has been marked improvement
in his relationships with other children -
he is learning to share toys, records and
books. He has a few favorites among the
nursing staff to whom he tells a few of his
"secrets."
Marie
And now let us meet Marie, aged 14,
who has really never known any other
home than Bloorview Childrens Hospital.
She was admitted when she was only two
years and 3 months old.
Marie is small for her age. Physically,
she resembles a child of approximately 6
years. However, she refuses to be unduly
limited either by her size or her physical
illness. She pushes herself around in her
wheelchair; she feeds herself; she writes,
using protective coverings for her hands.
Her medications and treatment are
very similar to Stephen's:
Meticortone 2.5 mg. t.i.d.
Lederplex liquid 1/2 tsp. t.i.d.
Fer-in-sol 1.2 cc. t.i.d.
Poly-vi-sol 0.6 cc. o.d.
Metamucil h.s. - mineral oU occasionally
Petroleum Jelly dressings to body o.d.
Alpha-Keri oil and mild soap for bath
Cortef ung. to open lesions
Soft or pureed diet - she is unable to chew
or masticate food well
High protein, carbohydrate, and fat diet
Weekly urinalysis
Frequent hemoglobin estimations
Marie's dressing procedure is similar to
Stephen's except that Petroleum Jelly is
used instead of Triburon Creme. Her
physiotherapy consists of gently passive
extension of wrists, elbows, and knees,
and active exercise of joints and shoulders
three times weekly. She attends cooking
class as part of her occupational therapy
program. Her favorite pastimes are color-
ing and painting, which she does rather
well, holding a pencil or brush between
36 THE CANADIAN NURSE
the backs of her bandaged hands. Each
drawing usually occupies a full page, is
very colorful, and full of small details.
She often has a central figure doing things
for younger children - caring for them -
and as a rule the "younger" children in
her drawings are using aggressive words,
such as "no," or "no, I don't."
Because of the severity of her physical
disability and her need for considerable
medical treatment, Marie has attended
school irregularly. As a result she has
advanced only to the grade 4-5 level, and
in fact some of her work is still at the
grade 3 level. She is presently reading at
the grade four level; her spelling is within
the grade five level, but her mathematical
ability is only within the grade three
range. Her teachers are encouraging,
however. They note that she is a "hard
worker, enjoying class activities."
Intellectually, Marie has the capacity
for further academic achievement. Chil-
dren of her intellect usually can achieve
grade eight standing. Since she is interest-
ed in continuing her education, she will
no doubt complete this level.
Marie, too, underwent psychological
testing. The first such examination was
carried out when she was just two months
of age. Her general level of intellectual
functioning was found to be within the
lower range of the dull normal grouping
(l.Q. 80-90).
Just prior to her admission to hospital,
she was again tested. While her level of
intellectual functioning remained essen-
tially the same, she appeared to have the
potential to function within the low
average range. It is possible that the
hospital environment failed to provide
her with sufficient stimulation on a con-
sistent basis to enable her to funcfion on
the higher level.
Marie's emotional development
presents another aspect that must be
considered in relation to her physical
illness, and not just as the end result of an
impoverished institutional life in terms of
human affection. There are times when
she is upset and angry, with subsequent
physical distress, but she is unable to
verbalize her feelings or to "act them
out" in aggressive behavior. She considers
"good" behavior in terms of provision of
physical care. An expression of anger is
"bad" since it may mean the withholding
of the care that she needs.
"Physical care increase" satisfies
another of her strong needs. Her passive
dependency needs - the need to rely
upon, to be cared for, to be given
psychological support — come into the
open especially at times of emotional
stress. Marie likes to be the center of
attenfion.
Her lack of family relationships is
compensated for by a close relationship
with a mature nurse — a member of a
religious order — who is extremely inter-
ested in Marie and able to give her the
necessary psychological support. She
visits Marie regularly, is always available
by telephone, and has become a mother
figure for the little girl.
Although bodily contacts are frequent-
ly painful, Marie likes her friends to pat
her occasionally, and appreciates the
close contact that she has with the nurses
during her early morning treatments.
"One more dressing and 1 am ready to
hug you," was the remark overheard one
morning as Marie and her nurse finished
off that part of her daily routine.
Conclusion
You have read about two children
whose hopes for the world of tomorrow
may remain unfulfilled. The songs that
they can sing are perhaps less sweet than
those they had dreamed of singing. Their
wishes are no less noble because they may
never be realized.
With knowledge, experience, and
physical help, we can make little lives
such as these not just more tolerable but
as happy as possible. As nurses we must
think positively when caring for such
children. We must be like the miner who
remarked that he had hunted for gold for
25 years. He was asked how much he had
found. "None," he replied, "but the
prospects are good! "
Bibliography
Andrews, G.C. Diseases of the skin, Phila., W.B.
Saunders, 1954.
Fox, T. Notes on unusual or rare forms of skin
disease. IV. Congenital Ulceration of skin (2
cases) with pemphigus eruption and arrest of
development generally. Lancet 1:766-767,
May 31, 1879.
Greenberg, S.I. Epidermolysis bullosa. Arch.
Derm. 49:333-334, May 1944.
Herlitz, G. Kongenitaler Nicht Syphilitischer
Pemphigus: Fine Ubersicht Nebst Beschrei-
bung Finer Neuen Krankheitsform (Epider-
molysis Bullosa Hereditaria Letalis). Acta
Paediat 11:315-311, 1935.
Lewis, I.e., Steven E.M., and Farquhar, J.W.
Epidermolysis bullosa in the newborn. Arch.
Dis. Child 30:277-284, June, 1955.
Lowe, L.h. Arch. Derm. 95:6:587, June 1967.
Noojin, R.O., Reynolds, J.P. and Croom, W.C.
Genetic study of hereditary type of epider-
molysis bullosa simplex. Arch. Derm.
65:477^83, April 1952.
Severin, G.L., and Farber, E.M. The manage-
ment of epidermolysis bullosa in children.
Arch. Derm 95:3:302-308 Uaich 1961.
Shah, M.A. and Shah, M. Essential shrinkage of
the conjunctiva in epidermolysis bullosa
hereditaria. Brit. J. OphthaL 39:667-672,
Nov. 1955..
Swinyard, C.A., Swenson, J.R. and Reeves,
T.D. Rehabilitation of hand deformities in
epidermolysis bullosa. Arch. Phys. Med. and
Rehab. 49:3:138-142, March 1968. D
FEBRUARY 1969
Hyperbaric oxygen units
— high pressure nursing
A hyperbaric oxygen unit offers a new kind of high pressure challenge for a nurse.
She has to handle emergency treatments, surgery, bedside care, reassurance, and
teaching — all carried out in a tiny submarine-like chamber that simulates
treatment at undersea pressures.
Glennis Zilm
One day last year a young Ontario
man caught his hands in a farm reaping
machine. The wounds were large, open,
and deep; as well as the severity of the
wounds, an immediate danger was a gross
fulminating gas gangrene infection that
became apparent right from the time he
arrived at the local hospital.
After preliminary emergency treat-
ment - suturing and bandaging of the
wounds - he was transferred immediately
to the Toronto General Hospital. By that
time, crepitus - the most dread symptom
of the anaerobic infection — could be
heard in the shoulders and chest walls.
His blood pressure (taken on the leg) was
low, pulse was 180, respirations 40-50,
and temperature 105 degrees.
With only the classical methods of
treatment — antibiotics, serum, and
surgery — this young man would have
died. He lived and recovered because the
Toronto General Hospital has a hyper-
baric treatment unit.
Hyperbaric oxygen is rapidly gaining
value as a treatment method in various
parts of the world. Although techniques
of subjecting a patient to increased
atmospheric pressure were used as early
as 1662 and were in vogue in the 1800's,
only within the last decade have the
therapeutic possibilities been chnically
researched.
Major investigation into modem uses
of hyperbaric oxygen therapy was first
begun in Amsterdam, Holland, in 1956.
Since that time units have been set up in
many parts of the world. The Royal
Victoria Hospital in Montreal established
the first Canadian medical hyperbaric
FEBRUARY 1969
oxygen chamber in October, 1963.
Toronto General Hospital opened its unit
in 1964, and The Vancouver General
Hospital opened a unit in 1965.
Much background information on
hyperbaric treatment developed from the
techniques evolved to enable man to
build or repair structures under water.
Atmospheric pressures had to be raised
inside diving bells or caissons to corres-
pond to the increased water pressures
outside, and modem medical research
relies on knowledge of decompression
sickness, nitrogen narcosis, and other
physiological and psychological changes
documented by deep-sea diving teams.
Uses
The use of hyperbaric oxygen implies
that the patient is breathing in an atmos-
phere in which the pressure is greater
than atmospheric pressure (at sea level),
and in which he is provided with an
increased intake of oxygen (usually by
mask). As a result, oxygenation at the
cellular level is improved.
In normal atmospheric conditions and
breathing air, a person will show a partial
pressure of oxygen in arterial blood p02
of approximately 100 mm. Hg. Under
normal atmospheric conditions but
breathing pure oxygen, the subject can
raise his arterial p02 to 500-600 mm.
Hg. At three atmospheres pressure, the
subject will show an arterial p02 in-
creased to 1500-1800 mm. Hg. The
amount of oxygen dissolved into plasma
Miss Zilm was assistant editor of the canadun
NURSE at the time this article was prepared.
is directly related to the p02 so in
hyperbaric conditions the amount of
oxygen available to body fluids and
tissues is greatly increased.
This increase of oxygen at the cellular
level is useful in treating conditions such
as infections where lack of oxygen plays a
part (gas gangrene), carbon monoxide
poisoning, decompression sickness
(bends), ischemic diseases (threatened
gangrene, frostbite), and, in some instan-
ces, shock.
It may also help in s6me respiratory or
cardiac diseases, selected cardiovascular
accidents, plastic surgery, and vascular
occlusion where a terriporary ischemic
state may be reversed by medical or
surgical treatment.
Hyperbaric oxygenation also appears
to be effective as an adjunct to radiation
therapy and to some of the newer drug
therapies in the treatment of malignant
tumors. The theory behind the use of
hyperbaric oxygen treatment in malignan-
cies is based on recent discoveries that
tumor cells, because of the mass, are
often anoxic and have poor blood supply.
Normal cells, which have a good blood
supply and less pressure, are not overly
affected when subjected to hyperbaric
oxygenation, but the oxygen supply to
the tumor cells is increased, and the
effect of the radiation or drug is enhan-
ced at the cancer site.
Side Effects
Not all the effects of hyperbaric oxy-
genation are beneficial, although in
normal therapeutic situations side effects
are minimal. Two main types of side
THE CANADIAN NURSE 37
The members of the hyperbaric unit staff gather around to help lift the patient into the submarine-shaped chamber. A special
carrier helps slide the stretcher over the sill of the port-hole type door.
effects occur: physiologic and/or mechan-
ical.
An adverse effect of oxygen at increas-
ed pressure is oxygen toxicity or oxygen
poisoning. Although little is known about
the mechanism, lengthy exposure to high
concentration of oxygen even at normal
pressures leads to central nervous system
disturbance. Warning signs - sudden
apprehension, circumoral pallor, vertigo,
nausea, choking sensation, tremor —
lasting 20 to 30 seconds may precede
generalized convulsion. If oxygen is ter-
minated immediately and the patient
allowed to breathe air, recovery is prompt
and no adverse effects are noted.
Oxygen toxicity is extremely rare in
therapeutic concentrations, such as two
to three atmospheres for two hours or
less. However, in attempts to find out
more about the condition, investigations
are being carried out with electroence-
phalograms (EEC) as a means of indenti-
fying oxygen toxicity in its earliest stages.
As well as this physiologic oxygen
toxicity effect, mechanical side effects
are produced upon gases within the body.
Under hyperbaric conditions, gas in body
air spaces becomes compressed. Then, if a
rapid decompression occurs, the expand-
ing gas gets trapped in these spaces — or
bubbles may even appear in blood or
tissues — and this may cause serious
pressure effects.
Decompression sickness, or "bends," is
the name given to the symptoms occurr-
ing when a person has come up too
rapidly from a depth. It is occasionally
seen when deep-sea divers must be
brought to the surface too quickly. The
38 THE CANADIAN NURSE
theory is that minute gas bubbles occur in
the blood or tissue. In the early stages, it
causes severe joint and muscle pains;
later, it may even lead to death. The
nitrogen component in normal air is the
most likely to cause bubbles in blood or
tissues as nitrogen is not metabolized by
the body in any way; the specially con-
trolled therapeutic atmosphere of pure
oxygen is much less likely to cause gas
bubbles in blood or tissues.
Body air spaces usually affected are
the ear chambers, the gastrointestinal
tract, sinuses, and the lungs. During
pressure changes, air enters or leaves the
middle ear cavity through the normally-
closed eustachian tube, thus equalizing
pressure on the tympanic membranes.
Should the eustachian tube not open
freely when the pressure is reduced
following treatment, the eardrum may
stretch as the trapped gas expands,
causing pain or even perforation. Persons
with conditions that contribute to
blockage of the eustachian tubes — such
as head colds or sinusitis — are usually
not candidates for hyperbaric work.
Patients who require therapy may require
a myringotomy to prevent middle ear
discomfort.
Gas in the gastrointestinal tract,
caused by either swallowing air or by gas
production while in the hyperbaric
atmosphere, may lead to abdominal
distention during decompression. Anxiety
is a contributing factor because the
anxious person is prone to both excessive
air swallowing and increased gastrointes-
tinal activity. Diets with a low intake of
gas-producing foods may help.
Mechanical effects on the respiratory
system have serious complications.
Compressed gas trapped in a respiratory
passage, such as through obstructions
such as mucous plugs or breath holding
because of fright, can cause rupture of
alveoli, or even pneumothorax, interstitial
emphysema, or air embolism during
decompression. Special care must be
taken with persons who have any symp-
toms of respiratory conditions.
Minor mechanical effects are experi-
enced when gas is trapped in small air
spaces, such as between the teeth, and
causes pain on expansion; occasionally
patients will complain of this.
Decompression sickness and the
mechanical side effects of exposure to
high pressures are avoided by gradual,
staged decompression. Specific regula-
tions on the amount of time required for
decompression are controlled by an
experienced operator outside the cham-
ber.
The controllers — non-medical person-
nel who operate the pressure equipment
of the chambers in Canada's three units —
are all former Navy personnel who have
spent most of their lives in this work.
They are fully aware of the dangers of
decompression, having experienced pres-
surization and decompression many
times. When decompression is carried out
gradually and the patient and personnel
adequately prepared psychologically, the
effects are minimal and not bothersome.
Taking a dive
The team needed for hyperbaric
treatment includes a doctor and nurse
FEBRUARY 1%9
specially prepared in the method of
treatment, and qualified controllers who
regulate the pressure equipment for the
chamber. Medical staff must be trained in
the uses and effects of hyperbaric
treatment, and they must be qualified
"divers."
Vicid Kent, a graduate of The Vancou-
ver General Hospital and charge nurse of
the Hyperbaric Unit at the Toronto
General Hospital, explained the orienta-
tion procedure for new nurses who come
to work on that unit. A preliminary
screening of applicants is carried on by
the nursing department, and then the
applicant reports to the Hyperbaric Unit.
Mrs. Kent arranges for a physical check-
up to ensure that the nurse is physically
fit for exposure to hyperbaric pressures,
to provide base line findings that would
be available if any complaints developed
after diving, and to provide control
findings for research on the effects of
repeated exposures to dives.
The physical screening procedures
include a physical examination, ear-nose-
throat examination, audiogram, vital
capacity and pulmonary function tests,
electrocardiogram, blood tests, urinaly-
sis, electroencephalogram, eye exami-
nation, and full chest plate and x-ray of
long bones. These are carried out by the
various hospital departments, which are
aware of the special interests of the
hyperbaric oxygen department. Results
are sent to the Unit.
After the nurse has passed her
physical, she reports for a chamber
pressure and oxygen tolerance test under
the supervision of Mrs. Kent or one of the
doctors assigned to the unit. The apph-
cant and the examiner enter the chamber
and "descend" to a pressure equivalent to
165 feet below sea level (six times atmos-
pheric pressure). This is an unusually
deep dive, and it is unlikely that the nurse
will ever need to go to that depth again,
but she learns what it is like, and she has
a chance to determine her tolerance to
pressure. Dives of 100-165 feet may be
required to treat patients suffering from
decompression sickness; therapy dives are
usually only 33-66 feet.
Before and during the dive, the examin-
er explains what is going on and how to
minimize side effects. Staff are taught the
Valsalva manoeuver to equalize ear
pressure (this involves a kind of yawn
that stretches the openings to the eusta-
chian tubes and permits the pressure in
Several types of chambers are used for hyperbaric treatment. Tfiis small, patient-
only tank is used quite extensively in Britain
FEBRUARY 1969
the middle ear to be equal to that in the
outer ear).
After a few moments at 165 feet, the
pair "come up" to 60 feet of pressure,
and the applicant then takes 30 minutes
on straight oxygen. During this period the
examiner watches for any evidence of
oxygen toxicity, and uses the time for
discussion of equipment kept in the
chamber, the type of conditions that are
generally treated, and so on.
After the applicant has finished this
part of the examination, she and the
examiner "come to the surface." The
applicant must stay on hand in the unit
for at least 30 minutes, and this time is
used for teaching — about pressure,
emergencies, and about the Ufe and death
aspects of fire safety and pressure con-
trol.
The most serious worry for staff in the
units is fire, and all staff must be extreme-
ly fire conscious. Chambers are made
as safe as possible. All monitoring and
electrical equipment is isolated outside
the chamber and any equipment in the
chamber has passed rigid safety codes.
Any materia] or equipment taken into the
chamber is screened by a fire-conscious
controller. All clothing, bedding, wrap-
pers, and such are made of fire-resistant
cloth or have been treated to be fire
resistant. No oils, lubricants, or other
combustible materials are used. If anes-
thetics are to be used, they must be
non-combustible, and this has created
special challenges to the anesthetists in
some instances. Anesthetic gases are
avoided.
Safety features include fire blankets
that are kept inside the chambers, an
automatic sprinkler system, and individ-
ual face masks for every person in the
chamber. If a fire should start, the oxy-
gen flow shuts off, and compressed air is
delivered through the masks.
As J.H. Wilson, chief controller of
Toronto General's Unit explains, "If all
fire rules are followed, then there really is
no danger." Staff are constantly aware of
just how much the rules reaUy mean to
them.
The applicant, if she has passed all the
tests so far, then comes back to the unit
for another dive — this time to learn a bit
about the working of the pressure con-
trols from inside the chamber. Although
the nurses become quite knowledgeable
about the pressure controls, they only
practice at low pressures and only moving
"down."
Treatment dives
Work in the three chambers in Canada
involves about one-half the dives with
patients for treatment; the other half of
the dives are for research experiments. In
all three centers, medical staff carry out
experiments on animals to test the effects
of hyperbaric oxygen exposures and to
learn ways that it may be used more
THE CANADIAN NURSE 39
effectively in the future.
J^ost of the treatment work at
Toronto General is emergency work; the
other two centers do more routine
treatments, such as adjunct therapy for
cancer treatments and routine treatment
for plastic surgery.
The chamber in Toronto is too small
for surgical procedures, although some
experimental surgery is carried out on
animals there.
In The Vancouver General Hospital's
the largest in Canada, they have done
some surgery, although it is very
crowded. The chief controller, E.D.
Thompson, has used his ingenuity to save
any extra bit of space inside the chamber.
and has even adapted French racing car
headlights as operating lights as they are
small, yet provide excellent illumination.
Emergency call
Although the Toronto Unit is only
staffed with nurses on a part-time, day-
time only, five-day week basis, a control-
ler is on call at all times. He calls in nurses
and doctors from the lists of personnel
prepared to work on the unit.
The doctor on call is usually contacted
first, and only he can approve a dive. He
arranges for the other staff to be called
in. Either the doctor or a nurse dives with
the patient, and another medical staff
member (either doctor or nurse) must be
on hand outside the chamber with the
controller.
When the young patient with gas
gangrene, mentioned at the beginning of
the article, arrived at the Toronto Gener-
al's emergency department, the hyper-
baric unit staff were called in. Witliin one
hour he was in the chamber. The doctor
"went down" with him; one nurse and
two controllers were on hand outside the
chamber. "We really didn't have time to
do any psychological preparation as the
patient was too Ul to wait, but the staff
tried to explain fully as they went along,"
said Mrs. Kent. "He was only semicons-
cious, and delirious at times. He had a
myringotomy in emergency to help
relieve any ear pressure."
This patient was taken to 66 feet
(three atmospheres) very quickly. He
then went on 100 percent oxygen for
about 60 minutes. The improvement in
his condition was dramatic, and after
decompression he was taken to the operat-
ing room for debridement.
Immediately following the operation,
he was returned to the chamber for
another hyperbaric oxygen treatment,
and these were repeated every four to six
hours for a few more dives. The hyperbar-
ic oxygen treatment saved his life. D
77;e chamber at the Toronto General Hospital is large enougli for a patient and one or
two staff. A small entrance chamber permits another staff member to enter after the
main chamber has been pressurized.
40 THE CANADIAN NURSE
Tfiere's not much extra room inside the chamber - everything must be in its specific
place. In this photo, the nurse is wearing fire-resistant clothing.
FEBRUARY 1%9
Clinical Laboratory Procedures
This is a 1%9 revision of the summary first published in 1949 and
subsequently brought up-to-date in 1956 and 1960.
E.M. Watson, M.D., F.R.C.P. (C)
Revised by A.H. Neufeld. M.D.. Ph.D., F.C.I. C.
Everyone associated with the activ-
ities of a large, modem general hospi-
'tal must be impressed and at times
confused by the increasing number of
laboratory tests that are performed on
patients. It is, therefore, pertinent that
the interest of the nursing staff in labor-
atory investigations should not be lim-
ited to mere formalities such as fil-
ling out requisition forms, directing the
technician or the I.V. nurse to the pro-
per patient, and collecting and label-
ling of specimens. While these func-
tions represent important responsibili-
ties of the nurse in relation to the
proper conduct of laboratory tests, no
doubt she will exert a more intelligent
interest in her duties and have a better
understanding of the patient if she pos-
sesses some knowledge of the proce-
dures that are carried out. With a view
to supplying relevant information in a
condensed form, the following tables
are presented.
The arrangement has been changed
appreciably since the last revision. This
is based largely on the usual functional
and administrative divisions in the up-
to-date hospital laboratory. The follow-
ing order is not necessarily in order of
importance.
Hematological values
Blood, plasma or serum biochemis-
try values
Urine biochemistry values
Cerebrospinal fluid values
Blood Bank values
Function tests and investigations
FEBRUARY 1969
Tests identified by proper names
Frequently laboratory tests are or-
dered by using only the man's name,
even though other terms might apply
equally well and actually should have
been used. Technical and analytical
procedures often are known best by
the names of the men who discovered
them or were associated with their de-
velopment and popularization. The
most commonly used terms encounter-
ed follow:
Bence-Jones protein — the abnormal
protein found in the urine of about
50 percent of patients with myeloma
Bodansky unit — the amount of phos-
phatase required to liberate 1 mg. of
phosphorus; test result for alkaline
or acid phosphatases (see also Sig-
ma)
Coombs — a test used in pregnant
women and newborn infants relative
to Rh sensitization; also used in he-
molytic anemias
Duke — a method for determining the
bleeding time of a patient
Dr. Watson, now semi-retired, was for-
merly Professor of Pathological Chemistry,
Senior Associate in Medicine, Faculty of
Medicine, The University of Western On-
tario, and Clinical Pathologist at Victoria
Hospital, London, Ontario.
Dr. Neufeld is Director of Clinical Path-
ology at Victoria Hospital, London, Ontario,
and Head and Professor in the Department
of Pathological Chemistry at the University
of Western Ontario, London, Ontario.
Fishberg (concentration or dilution
test) — kidney function test to eval-
uate the kidney's ability to concen-
trate or dilute urine
Frei — a skin test for a venereal dis-
ease, lymphopathia venereum
Friedman — a test for pregnancy
Hinton — a test for syphilis
Ivy — a method for determining the
bleeding time of a patient
Kahn — a test for syphilis
Kepler or Kepler-Power — procedures
for the diagnosis of Addison's dis-
ease
King-Armstrong unit — an amount of
phosphatase required to liberate 1
mg. of phenol; test result for alkaline
or acid phosphatases
Kline — a test for syphilis
Kolmer — a test for syphilis
Lange's Colloidal Gold — a test on
C.S.F. as an aid in diagnosis
Lee and White — a test of blood coag-
ulation time, using venous blood
Mosenthal — a two-hour specific grav-
ity volume test for evaluating kid-
ney function
Papanicolaou — a technique for the
identification of cancer cells
Reprints of this article are available at the
following rates: single copy — $1.00; 100
copies — $80 ($10 for each additional 100)
1000 copies — $160 ($80 for each addition-
al 1000). Send order and covering remit-
tance to CNA Publications, 50 The Drive-
way, Ottawa 4, Canada.
THE CANADIAN NURSE 41
Quick — a technique for estimating
prothrombin (refers to a man's
name, not speed of performance)
Paul-Bunnell — a serological test for
infectious mononucleosis
Rumple-Leede — not a laboratory test,
but a method for determining capil-
lary fragility by inflating a blood
pressure cuff and counting the pete-
chiae in a circumscribed area of skin
Schilling — a radioisotope test for per-
nicious anemia
Sigma — the amount of phosphatase
required to liberate 1 mg. of phos-
phorus; test result for alkaline or
acid phosphatases (see also Bodart-
sky) ,
Singer — latex fixation test used in
connection with rheumatoid arthri-
tis
Somogyi — often referred to in relation
to serum amylase
Sulkowitch — a test for calcium in
urine
Van den Bergh — a test for liver func-
tion
Wassermann — the original test for
syphilis
Watson — a test for urobilinogen in
urine and feces
Westergren — a technique for perform-
ing the sedimentation rate
Widal — a serological test for typhoid
and paratyphoid fevers
Wintrobe — a special tube for deter-
mining red cell volume and sedimen-
tation rate
Ziehl-Neelsen — a stain for acid-fast
bacteria, usually for tubercle bacilli
Abbreviations and symbols
ABO — the main blood group system
Ac. — acid
A.C.D. — anticoagulant used in pre-
served blood
A.C.T.H. — Adrenocorticotrophic
hormone
A:G ratio — a figure obtained by di-
viding the value for the plasma or
serum albumin by that for the glob-
ulin
Alk. — alkaline
A.-Z. test — Ascheim-Zondek, a test
for pregnancy
A.F.B. — acid-fast bacillus; a charac-
teristic staining quality of the tub-
ercle bacillus
Av. — average
B.M.R. — basal metabolic rate
B.S. — blood sugar
B.S.P. — bromsulphalein; a liver func-
tion test
B.T. — bleeding time
B.U.N. — blood urea nitrogen
C. — centigrade
Ca. ■ — calcium
cc. — cubic centimeter
C.C.F. — cephalin-cholesterol floccu-
lation test; a liver function test
CI. — chlorine
42 THE CANADIAN NURSE
CO2C.P. — carbon dioxide combining
power of blood plasma
C.P.K. — the enzyme creatine phos-
phokinase
Creat. — creatinine; a constituent of
blood and urine
C.R.P. — C-reactive protein
C.S.F. — cerebrospinal fluid
Cu. — copper
C.V.I. — cell volume index
Diff. — differential; used with refer-
ence to a smear of blood or C.S.F.
to determine the types and percent-
ages of the white blood cells present
ECG or EKG — electrocardiogram
EDTA — an anticoagulant, frequently
used n blood samples for hematol-
ogy , ,
EEC — electroencephalogram
Eos. — eosinophil; a variety of white
blood cell
E.S.R. — erythrocyte sedimentation
rate; sedimentation rate
F. — Fahrenheit
F.B.S. — fasting blood sugar
Fe. — iron
F.S.H. — follicle stimulating hormone
of the pituitary gland
g. or gm. — gram
G.A. — gastric analysis
G.C. — gonococcus; the causative or-
ganism of gonorrhea
g.i. — gastrointestinal
HCG — human chorionic gonadotro-
phic factor. This factor is present in
pregnancy (pregnancy test) and ma-
lignant tumors of the testes
Hg. or Hgb. — hemoglobin
H. & E. — hematoxylin and eosin
stain; used in the preparation of
pathological material for examina-
tion
5HIAA — 5-hydroxyindoleacetic acid
Ht. — hematocrit
Ig — the blood immunoglobulins, such
as IgA, IgG, IgM, etc.
I.I. — icteric index; a chemical test on
serum to reveal the degree of jaun-
dice
ICDH — isocitric dehydrogenase, a tis-
sue enzyme
I.M. — intramuscular
I.V. — intravenous
K. — potassium
17KGS — 17-ketogenicsteroids, a
group of hormones in the urine from
the adrenal cortex
17KS — 17-ketosteroids; a hormone
assay on urine to study adrenal or
other glandular disorders
L. or 1. — liter
L.D.H. — the enzyme lactic dehydro-
genase
L.E. — lupus erythematosus
Lymph. — lymphocyte; a variety of
white blood cell
ml. — milliliter; 1/1000 part of a liter;
approximately the same as cc. but a
more exact expression of measure-
ment
M.C.H. — mean corpuscular hemo-
globin
M.D.H.C. — mean corpuscular hemo-
globin concentration
M.C.V. — mean corpuscular volume
mEq. — milliequivalent
mEq./l. — milliequivalent per liter
mg. or mgm. — milligram
Myelo — myelocyte; the forerunner of
the granular leukocytes
N. — nitrogen
Na. — sodium
Neut. — neutrophiles; a variety of
white blood cell
N.P.N. — non-protein nitrogen
O2 — oxygen
O.T. — old tuberculin; a skin test for
tuberculosis
p.a. — pernicious anemia
Pap. stain — Papanicolaou stain for
cancer cells
P.B.I. — - protein-bound iodine; an es-
timation used in connection with
thyroid function
pH — a symbol used to express acidity
and alkalinity
pCOi; — partial pressure of carbon
dioxide
PI. Ct. — blood platelet count
P.S.P. — phenolsulphonphthalein test;
a method for assessing kidney func-
tion
R.A. — rheumatoid arthritis
r.b.c. — red blood cell count
R.F. — rheumatoid factor, present in
blood in rheumatoid arthritis and
occasionally in lupus erythematosis
Rh — Rhesus; the Rh factor
Retic. — reticulocyte
RISA — radio iodinated serum albu-
min, a material for measuring plas-
ma volume
S.G.O.T. — serum glutamic-oxalacetic
transaminase
S.G.P.T. — serum glutamic-pyruvate
transaminase
S.I. — saturation index; a test used in
hematology
Sp. Gr. — specific gravity
TSH — thyroid stimulating hormone
of the pituitary gland
T3 — an in vitro test for thyroid func-
tion
T4 — a test for thyroxine, the thyroid
hormone
T.P.I. — Treponema pallidum immo-
bilization: a specific test of serum
for syphilis
U.A. — urine analysis
Ur. Ac. — uric acid
M — micro
MM — micro micro
VMA — Vanilmandaelic acid, a test
for adrenal medulla function
w.b.c. — white blood cell count
W.R. — Wassermann reaction
V.D.R.L. — flocculation test for sy-
philis
FEBRUARY 1%?'
Hematological Values
Most hematological analyses are carried out on blood collected either in a potassium-
ammonium oxylate or in EDTA. Exceptions to this are the prothrombin and partial
thromplastin time, collected in fluid anticoagulant, and the LE preparation on clotted
blood. Usually from 3-7 ml. is adequate for analyses.
Determination
Normal Value
Clinical Significance
Autohemolysis
0.5-3.6% without glucose
0.1-0.8% with glucose
differential test for certain
anemias (spherocytoxic)
31eeding time
Duke)
1-3 min.
prolonged when platelets reduced
(as in thrombocytopenia purpura)
31ood volume
60-90 ml./kg.
increased in polycythemia vera;
decreased in dehydration, shock,
hemorrhage, postoperatively, etc.
Carbon monoxide
lemoglobin
none
in carbon monoxide poisoning or
intoxication (car exhaust, etc.)
dot retraction
complete and perfect
in 24 hours
delayed and imperfect in thrombo-
cytopenia purpura (platelet deficiency)
Coagulation
.clotting time)
8-18 min. (test tube method);
1-5 min. (capillary
tube method)
prolonged in hemophilia, also
after heparin administration
i)ifferential
/hite cell count
Mature neutrophils
52-70%; 3,000-6,000 cu.mm.
Young neutrophils
3-5%; 150-400
Eosinophils
1-4%; 50-400
Basophils
0-1.5%; 15-150
Lymphocites
20-35% (up to 50%; in
children) 1,500-3,000
monocytes
2-6%; 100-600
increased in many infections;
decreased in agranulocytosis
increased in many allergic
conditions
increased in lymphocytic leukemia,
infectious mononucleosis and
whooping cough
ibrinogen
200-500 mg./lOO ml.
Fibrindex — less than
60 sec.
decreased or prolonged in
severe liver disease and in a
complication of pregnancy
olic acid
5-21 m^g./ml.
decreased in some of the anemias
lemoglobin
Adult male:
14-17.5 g./lOO ml.
Adult female:
12-15.5 g./lOOml.
Children:
11-13 g./lOOml.
Infants (1 day to 2
weeks): 15-22 g./lOO ml.
decreased in the anemias; increased
in polycythemia and hemo-
concentration (shock, burns,
myocardial infarction)
decreased in hemolytic disease of the
newborn (erythroblastosis)
-EBRUARY 1%9
THE CANADIAN NURSE 43
Determination
Hematocrit
Iron binding
capacity
L.E. preparation
Mean corpuscular
hemoglobin
Mean corpuscular
hemoglobin
concentration
Mean corpuscular
volume
Paul-Bunnell
(heterophile
antibodies)
Partial thromboplastin
time (PTT)
Prothrombin time
Plasma hemoglobin
Plasma volume
Platelets
Radioiron clearance
(■-■"Fe)
Normal Value
Male: 40-54%
Female: 37-47%
220-400 Mg./lOO ml.
none
27-32 MMg
33-38%
80-94/cu. M
negative
0.34%
40-60 sec.
12-16 sec, reported
with control
0-4.0 mg./lOO ml.
34-60 ml./kg.
150,000-450,000/cu. mm.
T 1/2— 120 min.
44 THE CANADIAN NURSE
Clinical Significance
decreased in the anemias;
increased in polycythemia and
hemoconcentration
decreased in hemolytic anemia
and hemochromatosis
positive in lupus erythematosis
increased in macrocytic anemia
(e.g. pernicious anemia); low
in hypochromic anemia
same as above
same as above
a test for infectious mononucleosis
a test for hemophilia-like states
mainly used in control of
anticoagulant therapy
increased in hemolytic anemia and
other hemorrhagic processes (mis-
matched blood, etc.)
decreased in hemoconcentration;
increased in some with hypertension,
Paget's disease and some other clinical
conditions
decreased in thrombocytopenia
purpura and other clinical conditions
decreased in iron deficiency;
increased in hemosiderosis and
aplastic anemia
Red blood cell
Adult male:
decreased in the anemias;
count
4-5 million/cu.mm.
increased in polycythemia and
Adult female:
hemoconcentration (shock, bums.
4-5 million/cu.mm.
myocardial infarction)
Infants:
5-7 million/cu.mm.
at birth, gradually
decreasing to adult
at 15 years
FEBRUARY 1969
Determination
Normal Value
Clinical Significance
Red blood cell
volume (i"I)
29-33 ml./kg.
decreased in blood loss;
increased in polycythemia vera
and hemoconcentration
Red cell fragility
(osmotic fragility
test)
hemolysis begins at
0.43% NaCl
hemolysis complete at
0.34-0.3% NaQ
fragility increased in hemolytic
jaundice; decreased in obstructive
jaundice
Plasma iron incorporation
(sspe)
75% and over in 7-10
days
decreased in hemolytic anemia;
a measure of the rate of formation
of red blood ceUs
Plasma iron turnover
(sspe)
0.061 mg./day/g.Hg.
important in study of iron
metabolism
Red cell survival
test (with ^'^Ct)
Half-life: 25-35 days
decreased in hemolytic anemias;
a test for the life span of the
red blood cell
Reticulocytes
0.5-1.5% of all red
blood cells
increased in pernicious anemia
following Vitamin B12 therapy and in
hemolytic anemias; decreased in
aplastic and pernicious anemia
Schilling test
jadio cobalt
Vitamin B12)
10% and over
(urinary excretion)
this is a specific test for
pernicious anemia
Sedimentation rate
Westergren)
Male: 0-9 mm./hr.
Female: 0-20 mm./hr.
increased in infectious and
inflammatory diseases
Total body water
tritium space)
50-70% of body weight
increased in edema; decreased in
hemoconcentration (bums, shock, etc.)
Vitamin B12
42-410 MMg./ml.
increased in acute and chronic
leukemia, infectious hepatitis, liver
cirrhosis; decreased in the anemias,
malabsorption, malnutrition
Blood, Plasma or Serum Biochemistry Values
In the majority of hospitals, all biochemistry analyses are carried out on serum. However,
some hospitals still use oxylated blood for ammonia, B.U.N, glucose and N.P.N.
Amounts of blood required for the analyses range from 5-10 ml.
Determination
Normal Value
Note
Clinical Significance
Aldolase
Male: less than
33 u.
Female: less than
19 u.
increased in viral
hepatitis, progressive
muscular dystrophy,
myocardial infarction
FEBRUARY 1969
THE CANADIAN NURSE 45
Determination
Ammonia
Amylase
Ascorbic acid
(Vitamin C)
Bicarbonate
Bilirubin
(Van den Bergh
test), total
Bilirubin,
Direct
Bromide
Calcium
Carbon dioxide,
CO2
Carbon dioxide
partial pressure,
PCO2
Normal Value
10-30 Mg./lOO ml.
60-160 Somogyi u./
100 ml.
0.6-1.2 mg./lOOml.
18-25 mEq./l.
0.1-0.8 mg./lOO ml.
0-0.2 mg./lOO ml.
0-1.5 mg./lOO ml.
9-11 mg./lOO ml.
4.5-5.7 mEq./l.
25-35 mEq./l.
35-45 mm.
46 THE CANADIAN NURSE
Note
test must be done
immediately
do not draw during
or just following
i.v. glucose or after
administration of
morphine
blood must be placed
in a tube surrounded
by ice and sent
immediately to the
laboratory
blood must be drawn
without stasis from
toumique
Clinical Significance
increased in severe
liver disease and bleeding
into gastrointestinal
tract, especially from
esophageal varices
increased in acute
pancreatitis; also in
parotitis, perforated
peptic ulcer, abdominal
trauma, after morphine,
etc.
low in scurvy
reduced in acidosis;
increased in alkalosis
increased in jaundice;
latent jaundice 0.5-2.0;
clinical jaundice above
2.0
increased in obstructive
jaundice
important in the diagnosis
of bromide poisoning
low in hypoparathyroidism,
sprue and steatorrhea;
increased in hyperpara-
thyroidism and some bone
diseases
increased in alkalosis
(respiratory obstruction,
vomiting, ingestion of
bicarbonate); decreased
in acidosis (diabetes,
over breathing, etc.)
same as above
FEBRUARY 196S
Determination
Normal Value
Note
Clinical Significance
CO2 combining
power
55-75 vol. %
see Bicarbonate above
Ceruloplasmin
30-35 mg./lOO ml.
decreased in Wilson's
disease
Chlorides
96-105 mEq./l.
decreased in vomiting,
starvation and after
gastrointestinal surgery
Cholesterol,
Total
Adults: 150-275
mg./lOO ml.
Children: 100-225
mg./lOO ml.
Infants: 70-125
mg./lOO ml.
increased in hypo-
thyroidism, diabetes and
nephrosis; also in
conditions associated with
hyperlipemia; in
hypercholesterolemia
Cholesterol,
Free
50-60 mg./lOO ml.
same as above
Cholinesterase
0.62-1.26 u.
decreased in hepato-
cellular jaundice, advanced
cirrhosis, after hepato-
toxic agents
Copper
80-120 /ig./lOO ml.
decreased in Wilson's
disease (hepatolenticular
degeneration)
Creatinine
1-2 mg./lOO ml.
increased in severe
nephritis
Creatine phosphokinase
up to 0.72 milli u.
increased in muscle wasting
disease, muscle trauma,
pulmonary infarction
C-reactive
protein
negative
increased in rheumatic
fever, rheumatoid arthritis,
lupus, myocardial
infarction, pneumonia,
pregnancy, etc.
Glucose
:fasting)
70-100 mg./lOO ml.;
total reducing
substance
80-120 mg./lOO ml.
up to 140 or 160
after meals
increased in diabetes
mellitus, Cushing's disease;
decreased in hyper-
insulinism
1 7-Hydroxycorticosteroids
5-20 Mg./100 ml.
heparinized blood
increased in Cushing's
disease, moderate in
infections, bums, surgery;
decreased in Addison's, etc.
iron.
50-200 /xg./lOO ml.
increased in hemolytic
anemias, hemochromatosis;
decreased in iron
deficiency anemia
FEBRUARY 1969
THE CANADIAN NURSE 47
Determination
Normal Value
Note
Clinical Significance
Isocitric
dehydrogenase
(ICDH)
50-260 u.
increased in diseases of the
liver
Lactic
dehydrogenase
(L.D.H.)
up to 450 u.
increased in myocardial
infarction, liver diseases,
etc.
Lipase
0.2-1.5 u.
mcreased in acute
pancreatitis
Lipids (total)
450-850 mg./100 ml.
increased in diabetes,
xanthomatosis, hyper-
lipemia
Magnesium
1.3-2.5 mEq./l.
draw in polyethylene
tube
changed in various un-
related diseases; also
magnesium poisoning
Non-protein
nitrogen (NPN)
25-35 mg./lOO ml.
see B.U.N, above
pH
7.35-7.45
drawn in a special
syringe without
stasis
increased in uncompensatec
alkalosis; decreased in
uncompensated acidosis
Phenylalanine
0-3.0 mg./lOO ml.
increased in certain mental
diseases
Phosphatase,
acid
0.13-0.63 Sigma u./
100 ml.
0.2-0.8 Bodansky u./
100 ml.
1-4 King- Armstrong
u./lOO ml.
increased in cancer of the
prostate with metastases of
bone; also in hemolysed
serum
Phosphatase,
alkaline
0.8-2.3 Sigma u./
100 ml.
1-4 Bodansky u./
100 ml.
3-13 King-Armstrong
u./lOO ml.
Child: 2.8-6.7
Sigma u./lOO ml.
increased in hyperparathy-
roidism and in bUiary
obstruction, rickets
Phosphorus,
inorganic
Adult: 2-4.5 mg./
100 ml.
Child: 4-6.5 mg./
100 ml.
increased in severe
nephritis and sometimes in
rickets; decreased in con-
ditions in which serum
calcium is elevated
Phospholipids
230-300 mg./lOO
ml.
important in relation to
disorders involving fat
metabolism
48 THE CANADIAN NURSE
FEBRUARY 1%f«
Determination
Normal Value
Note
Clinical Significance
Potassium
3.5-5 mEq./l.
serum must be
increased in renal failure
separated from the
and severe Addison's
cells within one
disease; decreased in
hour
diabetic coma
Proteins, adult
decreased as a result of
jy electrophoresis
~
marked and prolonged
total
6-8 g./lOO ml.
albuminuria, nephritis,
Albumin
3.2-5.6 g./lOO ml.
liver disease, starvation
jlobulins
1.2-3.2 g./lOO ml.
causing edema; increased
Alpha 1
0.1-0.4 g./lOO ml.
in infections, pneumonia,
Alpha 2
0.4-1.2 g./lOO ml.
multiple myeloma, etc.
Beta
0.4-1.0 g./lOO ml.
Gamma
0.4-1.5 g./lOO ml.
Fibrinogen
0.2-0.5 g./lOO ml.
Newborn:
Albumin
3.3-5.1 g./lOO ml.
alpha 1
0.12-0.32 g./lOO ml.
alpha 2
0.25-0.47 g./lOO ml.
beta
0.17-0.61 g./lOO ml.
gamma
0.4-1.41 g./lOO ml.
1 year:
Albumin
4.0-5.0 g./lOO ml.
alpha 1
0.15-0.35 g./lOO ml.
alpha 2
0.5-1.11 g./100 ml.
beta
0.52-0.83 g./lOO ml.
gamma
0.45-0.66 g./lOO ml.
3ver 4 years:
Albumin
3.7-5.5 g./lOO ml.
alpha 1
0.12-0.3 g./lOO ml.
alpha 2
0.35-0.95 g./lOO ml.
beta
0.47-0.92 g./lOO ml.
gamma
0.53-1.2 g./100 ml.
•^rotein bound
4-8 Mg./lOO ml.
increased in hyper-
odine (PBI)
thyroidism
tiodium
133-148 mEq./l.
•
increased after injudicial
use of NaCl solution in
patients with impaired
kidney function; decreased
in vomiting, gastrointestinal
disorders, tube drainage
(postop), diabetic coma,
Addison's disease
Transaminase
5.40 Ku
increased in myocardial
>.G.O.T.
infarction and infectious
hepatitis
Transaminase
5-35 Ku
increased in acute hepatitis
i.G.P.T.
and relapsing cirrhosis of
the liver
Triglycerides
0-150 mg./lOO ml.
increased in diseases
associated with hyper-
lipemia (diabetes, xanthe-
matosis, biliary cirrhosis,
etc.)
FEBRUARY 1969
THE CANADIAN NURSE 49
Determination
Normal Value
Note
Clinical Significance
Uric acid
2.5-5.5 mg./lOO ml.
increased in acute gout, in
nephritis and leukemia,
frequently in myelomatosis
Urine Biochemistry Values
Determination
Normal Value
Specimen Req.
Note
Clinical Significance
Amylase
60-225 Somogyi
units/ 100 ml.
Random
increased in acute
pancreatitis
Calcium
50-300 mg./
24 hr.
24 hr.
patient must be
on special diet
increased in hyper-
parathyroidism,
myelomatosis, etc.
Catecholamines
up to 103 Mg./
24 hr.
24 hr.
increased in adrenal
medulla tumors
Chlorides
170-250 mEq./l.
Random
important in con-
trolling saline
administration
Copper
up to 70 Mg./
24 hr.
24 hr.
preserve in
polyethylene
bottle
increased in Wilson's
disease
Copropor-
phyrins
50-300 Mg./
24 hr.
24 hr.
preserve in
polyethylene
botUe
increased in the
porphyrias
Creatine
0-100 mg./
24 hr.
24 hr.
preserve in
toluene
used in the study of
muscle diseases
Creatinine
0.8-1.5 g./
24 hr.
24 hr.
preserve in
toluene
normally excretion
constant; altered in
certain muscle
diseaases
Follicle
Stimulating
Hormone (F.S.H.)
before puberty:
less than 6.5;
Mouse U./24 hr.
after puberty:
6.5-52;
after menopause:
96-600
24 hr.
important in the
investigation of
endocrine
disturbances
Estrogens
ovulatory cycle:
4-64 Mg./24 hr.;
normal male:
4-25 Mg./24 hr.;
pre-pubertal male
and female:
4-25 Mg./24 hr.;
post-menopausal:
0-5 Mg./24 hr.;
pregnancy (3rd
trimester):
26-60 mg./24 hr.
. 24 hr.
preserve in
jolyethylene
jottle, iceep
cool
increased in tumors
of the ovaries;
decreased in
ovarian and
pituitary mal-
function
50 THE CANADIAN
NURSE
FEBRUARY 1969
Determination
Normal Value
Specimen Req.
Note
Clinical Significance
17 hydroxy-
corticoids
female: 5-18
mg./24 hr.
male: 8-25
mg./24 hr.
24 hr.
preserve in
polyethylene
bottle, keep
cool
important in the in-
vestigation of adrenal
and testicular
malfunctions
5-hydroxy-
indole-
acetic acid
(Serotonin)
60-160 Mg./
24 hr.
24 hr.
patient must
avoid eating
bananas during
collection
increased in
carcinoid tumors
17-lceto-
steroids
under 10 yr.:
0-4 mg./24 hr.;
10-15 yr.:
3-10 mg./24 hr.;
Adult female:
2-17 mg./24 hr.;
Adult male:
3-23 mg./24 hr.
24 hr.
preserve in
polyethylene
bottle, keep
cool
important in the
investigation of
endocrine
disturbances
(adrenal, testes)
Lead
0-0.12 mg./24
hr.
24 hr.
preserve in
polyethylene
bottle
increased in lead
intoxication
Potassium
25-100 mEq./l.
24 hr.
varies with
dietary intake
useful in the study of
renal and adrenal dis-
turbance, water and
acid-base balance
Pregnanediol
female:
3-10 mg./24 hr.
male:
0-1.5 mg./24 hr.
24 hr.
preserve in
polyethylene
bottle, iceep
cool
increased in corpus
luteum cysts and some
adrenal cortical
tumors; decreased in
threatened abortions
Sodium
130-260 mEq./l.
24 hr.
varies with
salt intake
same as potassium
'Urea
nitrogen
8-15 g./24 hr.
24 hr.
preserve in
toluene
important in the
investigation of meta-
bolic disturbances
Uric acid
0.4-1.0 g./
24 hr.
24 hr.
preserve in
toluene
useful in the inves-
tigation of metabolic
disturbances
Urobilinogen
Qualit.:
Pos. in 1:20
Quant.:
0.5-4 mg./24 hr.
Random or
24 hr.
preserve with
sod. carb. under
petroleum ether
increased in liver
diseases and hemolytic
jaundice
C
erebrospinal F
luid Values
Test
Normal Va
ue
Clinical Significance
Color and
appearance
clear
slight
needl(
and colorless; m
y blood tinged 1
; trauma; no clc
ay be
rom
t
cloudy, turbulent or grossly
purulent in meningitis; bloody
or yellow when hemorrhage involves
CNS
FEBRUARY 1969
THE CANADIAN NURSE 51
Test
Normal Value
Clinical Significance
Pressure
7-15 mm. Hg. (100-200 mm. of
water), pat. lying down;
15-22 mm. Hg. (200-300 mm. of
water), pat. sitting up;
Child: 3.5-7 mm. Hg. (50-100
mm. of water), pat. lying down
increased in meningitis, edema of
the brain, hemorrhage, neurosyphilis;
decreased in shock, dehydration and
spinal canal block
Cell count
0-5/cu.mm.; all lymphocytes
increased in the various types of
meningitis, poliomyelitis, neuro-
syphilis and encephalitis; pus cells
predominate in the acute bacterial
processes. Increased lymphocytes in
tuberculous meningitis, poliomyelitis
and neurosyphilis
Glucose
45-80 mg./100 ml.
increased in diabetes, encephalitis,
uremia and sometimes in brain tumor.
Decreased in acute meningitis, tuber-
culous meningitis and insulin shock.
Normal values usually found in
neurosyphilis
Proteins
15-40 mg./lOO ml.
increased in those conditions with an
increased cell count (see above);
increased in spinal cord tumor and
infectious polyneuritis
Chlorides
120-130 mEq./l.
increased in uremia; decreased in
tuberculous meningitis
Colloidal Gold
test
0000000000
abnormal forms in meningitis and
syphilis. Examples;
555554321000, paretic type curve
0244310000, leutic or tabetic type
curve 0000245520, meningitis type
curve
Globulin test
(qualitative)
neg.
increased values in all inflammatory
processes of the CNS
Bacteriologic
examination
neg.
important in differentiating between
bacterial, viral, and other causes of
meningitis
Serologic tests
for syphilis
neg.
for syphilis
Blood Bank Values
Determination
ABO groups
Values
0-45% of population
A-40% of population
B-10% of population
AB-5% of population
52 THE CANADIAN NURSE
Clinical Significance
essential to determine before blood
transfusion
FEBRUARY 1969
Determination
Values
Clinical Significance
iRh groups
D — Rhpos. 85% of pop.
d — Rh neg. 15% of pop.
important in pregnancy. The Rh neg.
mother with a possible Rh pos. fetus
might lead to erj'throblastosis fetalis;
also in persons receiving repeated
transfusions
Rh phenotypes
D causes most difficulties
in transfusion; others
(C, E) may cause difficulty
in crossmatch
difficulties are picked up in a
crossmatch; in rare instances no
crossmatch possible and then blood
must be given very slowly with close
observation
Crossmatch
match ABO group; in the
Rh group, D:d
essential in order to eliminate
transfusion reaction
Antibody screen
screening procedure for
other Rh phenotypes
same as Rh phenotypes
Coombs test
a test for Rh antibodies
Rh neg. mother with Rh pos. fetus
may lead to increased antibody to D.
Fortunately this can now be eliminated
by treating mother at parturition with
high titer anti-D serum
Cold agglutinins
when present, these
agglutinate patitnt's
red cells
essential to identify; this can be
either reversed or weakened by
warming the blood to 37°C
Amniotic fluid
analysis
test for several chemicals
(bilirubin, etc.)
in the Rh mother, tests will show
whether fetus is Rh neg. or Rh pos.
Function Tests and Investigations
Tests
Principle
Normal Value
Clinical Significance
AC-PC blood
glucose
person's ability to
handle dietary
carbohydrate
ac: 70-100 mg./
100 ml.
pc: less than
150 mg./lOO ml.
a screening test for
diabetes mellitus,
Cushing's syndrome,
etc.
Glucose
tolerance
a test of ability to
store and utilize
dietary carbohydrate.
The standard test, one
dose glucose (50 or
100 g.), blood samples
1/2 hr., 1 hr., 2 hr.;
occasionally 4, 5, or
6 hr. test required
blood glucose not
to exceed 150 mg.
and return to
normal in 2 hr.
for diagnosis of
diabetes mellitus,
Cushing's syndrome,
dumping syndrome,
etc.
Intravenous
glucose
tolerance
eliminate possibility
of impaired absorption
from the intestines
blood glucose
returns to normal
fasting within
1-1 1/2 hr.
same as for glucose
tolerance
FEBRUARY 1%9
THE CANADIAN NURSE 53
Tests
Principle
Normal Value
Clinical Significance
Insulin
sensitivity
test
test of patient's
sensitivity to insulin,
to promote withdrawal
of glucose from blood
stream. Dose: 0.25 u./
kg. body wt.
blood glucose
decreased about
45 mg./lOO ml. one
hr. after ingestion
of glucose with
insulin then with
glucose alone
test for hypopituitarism,
also useful in Addison's
disease
Bromsulphalein
Bromsulphalein, after
intravenous injection,
is excreted almost
entirely by the liver
0-7% in 45 min.
a liver function test
in patients without
jaundice
Cephalin-
cholesterol
flocculation
test
this test depends upon the
capacity of the blood
serum in patients with
parenchymal liver
disease to flocculate
a suspension of cephalin-
cholesterol emulsion
neg. and 1 + in
24 hr.
increased in hepato-
cellular and other
liver disorders
Galactose
tolerance
the liver is the only
organ which can convert
galactose to glycogen
and store it
less than 3 g. of
galactose excreted
in the urine during
a 5 hr. period
following ingestion of
40 g. of galactose
a liver function test
Thymol
flocculation
an alteration in the
plasma proteins in
parenchymal liver
disease causes pre-
cipitation of a
solution of thymol
ne2. and 1 -|- in 24
hr."
a liver function test;
can be used in patients
with jaundice
Thymol
turbidity
same as above
0.2-5.0 units
more valuable in the
diagnosis of acute than
of chronic liver
disease
Renal concen-
tration test,
diurnal
variation
based on the ability of
the kidney to properly
concentrate urine
morning specimen,
spec, gravity
1 .023 or higher
valuable in renal
diseases, especially
slowly developing
chronic diseases
Mosenthal
test
ability of kidney to con-
centrate urine after a
test meal
night spec, not to
exceed 575 ml.; spec,
gravity 1.018 and up.
Spec. grav. in day
specimens should vary
by 9 points or more,
reaching 1.020 in one
or two specimens
same as above
Phenolsulfon-
pthalein (P.S.P.)
excretion
the test is based upon
the principle that the
normal kidney rapidly
and efficiently excretes
this dye
30-50% excreted
in 15 minutes
principally a test for
tubular function;
therefore valuable in
diseases associated
with tubular malfunction
54 THE CANADIAN NURS
E
FEBRUARY 1%^
Tests
Principle
Normal Value
Clinical Significance
P.S.P.
fractional
same as above
60% and over in
2 hr.
same as above
Creatinine
clearance
measure rate of
elimination of creatinine
by the kidney
90 ml. and over/
min.
this is a test for
glomerular function.
Important in diseases
associated with glome-
rular malfunction
Inulin
clearance
inulin is excreted only by
glomerular filtration; the
test is a measure of rate
of excretion of intra-
venously administered
inulin
the amount of
inulin contained
in 100-150 ml. of
plasma excreted
per min.
a more specific test
than creatinine
clearance
Urea
clearance
a measure of the rate of
elimination of urea by
the kidney
60-95 ml. of
blood/min.
urea is filtered by the
glomerules and part re-
absorbed by the tubules.
It, therefore, is of
limited value in
diseases of the kidney
GI absorption
test with
triolein
131J
triolein is administered
by mouth; it is digested
in the GI tract by pan-
creatic lipase and
absorption facilitated
by bile
8% and over in
the 4th, 5th and
6th hr.
a test for malfunction
of bile and pancreas.
Therefore, important
in diseases of the
liver and pancreas
GI absorption
with oleic
acid 1311
oleic acid is given by
mouth and absorption
requires the presence
of bile
same as above
a test for normal pro-
duction and secretion
of bile; therefore,
useful in diseases of
the liver, and, with
triolein, eliminates
diseases of the pancreas
Xylose
tolerance
xylose, a pentose sugar,
is absorbed from the
intestine by diffusion
and not metabolised;
xylose dose given by
mouth
1 hr.: 29-49
mg./lOO ml.;
2 hr.: 20-60
5 hr.: 8-16
5 hr.: urine
xylose: 4-8 g.
a useful test for
gastrointestinal
absorption in
absence of renal
disease
ACTH
stimulation
ACTH hormone stimulates
the adrenal cortex to
secrete corticosteroids
increase of 8-16
mg./day of 17-
hydroxycorticoids;
increase of 4-8 mg./
day of 17-keto-
steroids
very useful to
differentiate diseases
of the pituitary and of
the adrenal cortex
(Cushing's syndrome,
etc.)
Congo Red
amyloid tissue has con-
siderable selective
affinity for Congo Red.
The dye is injected
intravenously and con-
centration measured
serially in blood
35% or less
retention
valuable in the
differential diagnosis
of amyloid disease,
primary and secondary
FEBRUARY 1%9
THE CANADIAN NURSE 55
Tests
Principle
Normal Value
Clinical Significance
Gastric
function
measure of acidity of
fasting gastric con-
tents and serial
samples after a test
meal (with or without
histamine)
fasting residual
5-100 ml.; after
test meal 30-300
ml. first hour;
titratable HCl
Female: 0-25
mEq./l./hr.
Male: 0-48
mEq./l./hr.
valuable test in
diseases of the
stomach
Maximal
histamine
gastric
secretion
this is a modification
of above and must be
carried out with great
care. The patient is
given a large dose of
antihistamine followed
by a large dose of
histamine. The prin-
ciple is to create
maximum response of
the stomach
Female basal:
0.5-2 mEq./l.
post-histamine:
10-24 mEq./l.
Mak basal:
1-3 mEq./l.
post-histamine:
10-30 mEq./l.
same as above
The LE test
(Paratoluene
sulphonic
acid test)
in certain diseases
abnormal granulocytes
appear in the blood
containing a large amount
of nuclear material
neg.
positive results are in
lupus erythematosis,
liver disease, myeloma-
tosis, and occasionally
rheumatoid arthritis
Sweat test
in certain diseases of
the pancreas there is
excess secretion of
sodium chloride in
the sweat
sodium 10-80
mEq./l.
chloride 4-60
mEq./l.
increased sodium and
chloride in the sweat
in fibrocystic diseases
of the pancreas
(mucoviscidosis)
Fecal fat
most dietary fat is
digested and absorbed;
increase in fecal fat is,
therefore, significant
1-7 g./24 hr.
7-25% (dry
weight)
increased amount in
sprue, steatorrhea,
etc.
Fecal
bacteriology
to establish presence of
abnormal bacteria in GI
tract; specimen must
be fresh
reported as "normal
flora" and any
abnormal organisms
differential diagnosis
in diseases associated
with diarrhea
Fecal mycology
to verify presence of
ameba, etc. in GI tract;
specimen must be fresh
presence of ova or
spores reported
same as above
56 THE CANADIAN NURSE
FEBRUARY 196?"
student observation
at postmortem examinations
Is observation of postmortem examinations helpful in supplementing a nursing
student's knowledge of anatomy, physiology, and pathology? How many
schools of nursing in Canada encourage their students to attend these
examinations? THE CANADIAN NURSE sent questionnaires to the educational
directors of 154 English-language schools of nursing in Canada to attempt
to answer these questions.
V.A. Lindabury
The question of whether nursing stu-
dents should be encouraged — or even
allowed — to attend postmortem exami-
nations as part of their clinical experience
has long been debated by nurse educa
tors. In conversation and in writing,
most educators reveal strong feeUngs
either in favor of or against the inclusion
of this experience in the nursing curricu-
lum.
Frequently the response of nurse
educators is colored by their own re-
actions to autopsies they attended when
they were students. As one respondent
wrote, "I found this a most distasteful
experience when 1 was a student. Because
of this, I discourage my students from
attending postmortems . . . ."
Questionnaire
One hundred and fifty-four question-
naires were sent to English-language
schools of nursing. The first question
asked respondents to check one of the
following to indicate their school's policy
on student observation of autopsies: (a) it
is compulsory for each student to attend
a given number of postmortem exami-
nations; or (b) it is not compulsory, but
students may attend at their own request,
if the instructor considers it a worthwhile
educational experience; or (c) students
are not allowed to attend postmortem
examinations. The respondents were then
asked to explain their reasons for the
Miss Lindabury is Editor of the canadun
NimsE . She acknowledges with thanks the
assistance of the 1 35 educational diiectois who
responded to this questionnaire.
FEBRUARY 1%9
policy they had checked.
The remaining questions were directed
to those respondents who had checked
(a) or (b) above. These respondents were
asked if instruction were given to the
students during the autopsy and, if it
were, by whom. They were also asked to
indicate whether students are required to
submit a written report following their
observation.
The final question asked the nurse
educators to indicate how nursing stu-
dents react to their observations of an
autopsy. For example, do students find
this experience helpful? In what way?
Are they upset by this observation?
Results of first question
One hundred and thirty-five of the
154 questionnaires sent out were return-
ed, a response rate of 87.6 percent. Of
these, 6 respondents (4.4 percent) stated
that their schools had no policy con-
cerning student observation at post-
mortem examinations: two gave no
reason for the absence of a policy, and
four stated that the school's faculty was
still in the process of constructing the
curriculum.
Three respondents (2.2 percent) said
that it was compulsory for students to
attend a given number of postmortem
examinations during their educational
program. Ninety-two respondents (68.1
percent) said it was not compulsory for
students to attend these examinations,
but that students could attend at their
own request if the instructor considered
it a worthwhile educational experience.
Thirty-four respondents (25.2 percent)
THE CANADIAN NURSE 57
stated that students were not allowed to
attend autopsies.
Reasons given
The three respondents who said that
student observation of a postmortem
examination was compulsory in their
schools gave almost identical reasons for
this pohcy. They looked on this experi-
ence as helpful to the student in her
learning of anatomy, physiology, and
pathology. One respondent added that
the experience ". . . assists [students] in
interpreting the purpose and process of
this examination to many various indi-
viduals."
The 92 respondents who were against
compulsory observation, but who allowed
it if requested by the student with the
instructor's permission, gave similar, but
more detailed reasons. One respondent
pointed out that students ". . . receive
only two weeks observation in the oper-
ating room, and therefore do not see as
much human body structure as we would
like." This respondent believed that
observation of an autopsy was a necessary
supplement to the student's under-
standing of body structure and the
disease process.
Nine (9.8 percent) of these 92 res-
pondents who allowed their students to
observe autopsies had misgivings about it.
These respondents said that most of the
faculty did not consider this type of
observation to be a worthwhile experi-
ence for students; however, because the
faculty believed students should be given
the opportunity to be self-directing, they
permitted the student to attend at least
one autopsy if she requested it.
Of the 34 respondents who said that
observation of autopsies was not included
as part of the learning experience, five
gave no particular reason. Eight reported
inadequate facilities, which prevent
students from attending postmortem ex-
aminations; one said that autopsies are
not performed in the hospital where the
school is located; and one said, "as a
regional school, we are independent of
any hospital . . . . " Two respondents said
that observation of an autopsy serves
only to satisfy "morbid curiosity"; an-
other said that the pathologist is reluctant
to have nursing students attend an autop-
sy. Two other respondents said that the
58 THE CANADIAN NURSE
experience was too "traumatic" and
"shattering" to be of any educational
value to the student. The remainder
questioned the value of such an experi-
ence and pointed out that the school's
objective was to increase interest in
nursing care, not in the pathology of
disease.
One respondent summed up her facul-
ty's reasons in this way:
"The traditional reason for permitting
students to view autopsies is to clarify
and otherwise augment their study of
anatomy. The reason for performing an
autopsy is not to teach students, but to
determine the cause of death. We do not
believe that these two complement each
other too well. Although it is a recog-
nized method of study and research for
medical students, we do not believe it to
be a valid or necessary educational tool
by which to teach student nurses gross
anatomy.
"The potentially negative variables are
these: 1. The age of the student: the age
of the patient (child, adolescent, infant,
etc.); 2. The extent of the autopsy:
[examination of] the cranium is usually
very upsetting . . . . ; 3. The attitudes and
techniques of the pathologist: the majori-
ty are positive, professional, and gentle —
but there are others to whom no student
nurse should be exposed.
"If the student has been caring for the
patient prior to his or her death, the
experience is sobering enough for the
average student without subjecting her to
the sequel of a postmortem. The cause of
death can be ascertained later from the
doctor, head nurse, or medical-records
department.
"If the student has not been caring for
the patient, the viewing of the post-
mortem is irrelevant . . . . "
Instruction during autopsy
Of the 95 respondents whose students
view autopsies (3 respondents reported
compulsory observation; 92 reported that
students are allowed to view autopsies,
although it is not a compulsory experi-
ence), 70 said that the autopsy is ex-
plained to the student by the pathologist,
in 20 instances, explanation during the
autopsy is apparently given by both the
pathologist and the instructor. Five of the
95 respondents did not answer this
section of the questionnaire.
Twelve respondents reported that a
conference with the students is held by
the instructor prior to the observation.
Seventeen respondents said that a group
discussion with the instructor was held
following the autopsy. Only four res-
pondents said that students were required
to submit written reports of their obser-
vations.
Student reactions
Most of the 95 nurse educators who
responded to this question believe that
students find the observation of a post-
mortem examination of some assistance
in understanding anatomy and the disease
process. Almost every respondent added,
however, that some students do find the
experience upsetting. Two respondents
said that careful preparation of the stu-
dent, similar to the preparation given for
other types of clinical experience, helped
to minimize any adverse emotional re-
action. One respondent said, "Students
seem to be able to look on [the post-
mortem examination] as an objective
learning experience after they have over-
come their initial distaste."
More than one respondent noted that
students are often upset by the sound ol
the bone cutter; other respondents saic
that students are more likely to be upsei
when they had previously nursed th£
patient on whom the autopsy was beinj
performed.
Twenty of the 95 respondents whi
indicated that their students observ
autopsies stressed the importance of th
attitude of the pathologist who teachei
the students. They believe the manner ii<
which the pathologist conducts thx
autopsy influences students' reaction t'
the procedure, and determines whether i
is a true learning experience. As on
respondent said, "The attitude of th i
pathologist is of utmost importance
preserving the dignity most student
accord the human being."
Although most nursing students aji
parently find the observation of autopsicf
helpful, some of them are left witi
conflicting feelings. Three responden
said that several students expressed thv
view that they would not allow an autO'i
sy to be performed on a member of thei
family, even though they recognized thi
value of a postmortem examination.
FEBRUARY 1!
Nursing organization —
circa 1969
The time has come to change the traditional organization of nursing service.
What better time could there be to put fresh ideas to the test than when a brand
new hospital is being planned ?
"Traditional patterns of nursing organ-
ation have served the past well, but they
mnot cope with the complexities of
lodern nursing service." This was the
oinion held by the nurses involved in
anning the University Hospital, a new
aching hospital to be located on the
impus of The University of Western On-
rio in London.
The 434-bed hospital is scheduled for
)mpletion in the (all of 1971. It will be
le final stage in the development of The
niversity of Western Ontario's Health
:iences Centre. The complex will in-
ude, under one roof, the Kresge School
' Nursing building, the Cancer Research
aboratory, the Medical Sciences
iilding, and the Dental Sciences build-
g. The University Hospital will contain
cilities for a school of medical re-
ibilitation.
The director of nursing. University
ospital, a permanent member of the
3spital planning group, and faculty
embers of the school of nursing at The
niversity of Western Ontario have been
osely involved in all phases of planning
e University Hospital. Working with the
edical faculty, architects, and planning
oup members, the nurses have ensured
at the new hospital will serve the three
'incipal functions of a university
)spital - teaching, research, and service
patients.
Definite ideas about how the depart-
ent of nursing should be organized have
rmed the basis of the planners' design
the patient-care areas. Form has
llowed function in the planning of the
itire hospital.
<*»BRUARY 1%9
Diane Y. Stewart, M.Sc.N.
The hospital will be a 10-story struc-
ture. The base, consisting of basement
and three floors, contains mainly services
for the hospital. Superimposed on the
base are two connected seven-story
towers. On each floor one tower contains
two 30-bed inpatient units and related
teaching facilities; the other tower
contains offices for clinical department
heads and their associates, research
laboratories, and an outpatient depart-
ment. Between the two towers is a bank
of elevators and facilities for handling the
service requirements of the entire floor.
Authority decentralized
When planning the organization of the
department of nursing, the following two
principles were considered: first,
authority should be decentralized from
the director of nursing to other nursing
staff, and second, nurses should be
relieved of non-nursing functions.
Decentralization of authority, that is
delegating decision-making to lower levels
in the organization, has been an im-
portant management principle in industry
for over 20 years. Naturally, decentral-
ization of authority is a matter of degree,
as basic decisions and policies must
receive attention at top levels.*
Miss Stewart is a graduate of the Victoria
Hospital in London, Ontario and received her
master's degree in nursing service adminis-
tratiop from The University of Western
Ontario. She is Director of Nursing at the
proposed University Hospital in London and
part-time Associate Professor of Nursing at The
University of Western Ontario.
In most nursing service departments
this concept has been overlooked; nursing
office supervisors are centrally located
and are responsible for most decisions. A
decentralized system would relocate
supervisors in their area of clinical
interest where they would work directly
with head nurses and staff and be
responsible on a 24-hour basis for organ-
izing, directing, and coordinating nursing
functions. In this way, the supervisor
would be given the authority and respon-
sibility she should have but would have
considerable latitude in exercising in-
dependent judgment and initiative.
With decentralization of authority the
head nurse would be granted increased
responsibility for decision-making and
planning and coordinating patient care.
There would be more involvement of
team leaders and staff nurses in the
decision-making process. Nurses have
repeatedly said that they want to have,
and should have, more responsibility.
With this structure, they should receive
the additional responsibility and so find
the work situation much more satisfying.
The director of nursing at University
Hospital will be directly responsible to
the executive director for directing and
coordinating the nursing care of all pa-
tients, providing inservice education for
nursing personnel, and directing a
program of nursing research in tlie
hospital.
Three nurses will be directly respon-
*Massie, Joseph L. Essentials of Management.
Englewood CUffs, N.J., Prentice-Hall Inc.,
1964, pp.51-52.
THE CANADIAN NURSE 59
T O \V E 12
60 THE CANADIAN NURSE
FEBRUARY 1969
sible to the director of nursing:
• The associate director of nursing
will be responsible for the overall
direction and coordination of nursing
care of patients in all patient-care areas.
• The administrator of nursing
education will direct educational
activities related to nursing in the hospital
and maintain liaison with the University
School of Nursing regarding clinical ex-
perience for nursing students, and
refresher and postgraduate specialty
courses for registered nurses.
• The administrator of mirsing
research will be responsible for the re-
search program related to nursing in the
hospital. She will cooperate with the
nursing staff to identify areas requiring
study, and plan and implement programs
of nursing research. She will cooperate
closely with the faculty of the school of
nursing to coordinate research projects
and studies, to share facilities and results,
and to avoid duplication.
These three nurses and the director of
'nursing will be the only nursing staff
occupying offices in the central nursing
administration suite. The remainder of
the senior nursing staff will be located on
the nursing floors.
Traditional roles changed
This structure involves a change in the
traditional roles of both the supervisor
and head nurse. For this reason, the titles
nursing administrator and nursing coordi-
nator were considered more appropriate
and meaningful.
A nursing administrator will be located
on each of the patient-care floors. Each
floor will represent a different service or
combination of services. The nursing ad-
ministrator will be a specialist in her
clinical area as well as an administrator.
She will be responsible over a 24-hour
period, for all inpatient and outpatient
nursing activities on her 60-bed floor. At
this level - close to the patient - many
decisions will be made wliich, in the past,
have been made by supervisors in a
central nursing office. There will be no
central nursing office supervisors.
Working with the nursing adminis-
FEBRUARY 1%9
trator on a floor will be two nursing
coordinators, one for each 30-bed unit.
Th'ese nursing coordinators, also
specialists in their clinical area, will be
responsible for the nursing activities on
their unit. They will organize their staff
into teams of graduate nurses, registered
nursing assistants, and nursing orderlies,
with graduate nurses as team leaders on a
rotation basis. It is hoped that in the
future, nursing orderlies will become
registered nursing assistants.
The nurse clinician or clinical specialist
concept is both creative and challenging.
However, nurses prepared at the master's
level are in short supply, particularly
those prepared in a clinical specialty. In
the University Hospital nurses will be
relieved of non-nursing functions and,
therefore, should have much more time
to spend with the patients. Consequently,
the nursing administrator and nursing
coordinator, both prepared in a clinical as
well as a functional specialty, will have a
dual role, but will spend most of their
time with staff and patients. This seems
to be the most economical and realistic
approach to take at this time and should
provide a role for senior nursing staff that
affords much job satisfaction.
Floor managers
Over the years, as patient care has
become more elaborate and extensive,
nurses have assumed responsibility for
many functions that they have neither
the preparation nor the time to perform.
To relieve nurses of this myriad of non-
nursing functions, the floor manager
concept has been proposed for the
University Hospital.
One floor manager, responsible to the
hospital administration, will be located
on each floor. His work will involve the
entire floor of inpatient and outpatient
areas, as well as teaching and research
areas. The floor manager will be expected
to coordinate efficiently the various
hospital services and functions that do
not have to be performed by staff re-
sponsible for the direct care of patients.
He will be responsible for non-nursing
functions such as duties related to equip-
ment, supplies, linen, house-keeping,
clerical work, maintenance and portering.
The employment of floor managers
should allow nurses to spend more time
with patients. Ultimately, there should be
an improved quality of patient care, a
lower turnover of nursing staff, a higher
staff morale, and increased job satis-
faction.
By decentralizing authority in nursing
service and employing floor managers,
each floor in the University Hospital
should function to a large extent au-
tonomously. A cooperative relationship
among the clinical department head or his
deputy, the nursing administrator, and
the floor manager should provide
adequate care and treatment of patients
on each floor over a 24-hour period.
The service departments will also be
organized in a way that will help ease
pressures placed in the past on nursing
staff. The dietary department will have
complete responsibility for all food
services. The pharmacy department will
assume full responsibility for the pro-
vision of total pharmaceutical services in
the hospital, such as the centralized unit-
dose medication system, clinical pharma-
cists, intravenous solution admixture pro-
gram, and automatic replenishment of
controlled drugs. The central processing
department will be responsible for
providing an adequate complement of
linen, equipment, and supplies to all in-
patient and outpatient areas, operating
and delivery rooms, and research labora-
tories. Linen and supplies in patient-care
areas will be delivered directly to nurse
servers in the patients' rooms. These, as
well as other improvements, sliould
certainly allow nursing staff to spend
more time with patients.
The future
In the University Hospital nurses are
attempting to meet the demands placed
on nursing service today by anticipating
the needs of tomorrow.
This is not a simple chore, but to
accept the restrictions of a traditional
nursing organizational structure would be
sheer regression! D
THE CANADIAN NURSE 61
Two-year versus
three-year programs
Do graduates of a two-year hospital nursing program compare favorably with
graduates of a three-year program? This is a vital question for nursing at this time.
This study reveals some unexpected observations.
In 1962 the Regina Grey Nuns'
Hospital introduced a two-year nursing
education program on an experimental
basis. It was introduced on the hypothesis
that if repetitions were eliminated in
classes and learning experiences were
carefully selected and well-guided, the
student could become a competent nurse
in less than three years.
The three-year nursing education
program was not discontinued when the
experimental two-year program was intro-
duced. To evaluate the respective merit of
the two- and three-year programs, a group
of students in each program was selected
for comparison.
In 1962 and 1963, 20 nurses were
assigned to the experimental program and
in each year 20 matched controls were
assigned to the three-year nursing
program. The two groups were matched
on age, father's occupation, abstract and
verbal reasoning ability, science aptitude,
reading ability, and personality variables
such as need to achieve, need for change
in environment, ability to endure, sense
of responsibility, emotional maturity,
and self-sufficiency. The matching was
done on the basis of measurements from
well-established psychological tests.
In addition to the 40 subjects chosen
in 1962 and the 40 selected in 1963,
three matched groups of special control
students were selected from the 1961,
1962, and 1963 classes.
These three matched groups were se-
lected for the purpose of determining
whether the two raters who were to rate
the performance of the nurses on the
ward changed their standards in any way
62 THE CANADIAN NURSE
C.G. Costello and Sister T. Castonguay
over the years. Such a change would have
made it difficult to interpret the findings
from the experimental and control
groups. No change in the standard of
raters was found to have occurred.
Both the experimental and the control
students followed a program in which
repetitions in classes were eliminated,
content was enriched, and concurrent
teaching was introduced. A detailed
account of the changes in the curriculum
is found in the complete report.
Ratings were made by independent
raters from outside the hospital who did
not know to which group the new gradu-
ates belonged; and special control groups
were set up so that the effects of the
repeated use of the rating scales could be
determined.
Dr. Costello is ] Professor of Psychology at
the University of Calgary. Sister Castonguay
was Superintendent of Nursing Education,
Dept. of Education, Province of Saskatchewan,,
at the time the article was written.
The analysis of the data obtained in this
project was done in 1968 with the assistance of
a Canadian Public Health Research Grant no.
608-7-116, and thanks are due to the Alberta
Department of Public Health for their approval
of the grant. Thanks are due also to the Saskat-
chewan Department of Public Health for their
approval of the expenses incurred in the con-
ducting of the experimental program. A more
detailed account of this study may be obtained
by writing to Mrs. CO. O'Shaugnessy, Director,
School of Nursing, Regina Grey Nuns' Hospital,
Regina Saskatchewan.
Other evaluations
Other evaluations of two-year pro-
grams have been carried out and, on the
whole, these evaluations have shown that
graduates from two-year programs com-
pare favorably with graduates from
three-year programs. However, all these
evaluation studies have suffered from seri-
ous methodological faults. For instance,
Lord (1962) presented a report on the
evaluation of an experimental program es-
tablished in Windsor, Ontario, in 1948.
Directors of nursing and physicians who
observed the nurses at work were asked
to rate them in relation to dependability,
knowledge of nursing theory, knowledge
of nursing practice, attitude to super-
vision, attitude to patients, all-round a-
bility, and capacity for growth. It was
found that, in the opinion of the di-
rectors of nursing, 48.3 percent, and in
the opinion of the doctors, 40.5 percent
of the experimental program graduates
were rated better than "other nurses."
The director of nursing also rated 50.3
percent of the experimental graduates as
"about equal" to other nurses and the
physicians considered 61 percent of the
experimental graduates to be in this cate-
gory.
Unfortunately, there were no control
students with which one could compare
the experimental graduates. Three "con-
trol" schools were selected in a manner
not identified in the report; two were
from Ontario and one was from Saskat-
chewan. Unfortunately, these control
schools were used only for comparison of
data concerning students' enrolment and
curriculum and not for comparison of the
FEBRUARY 1969
relative nursing skills of graduates from
the program. A further problem lies in
the vagueness of some of the dimensions
in which the ratings were to be done; for
instance "capacity for growth." Perhaps
even more serious is the fact that the
physicians and nurses doing the ratings
were aware of the fact that the graduates
were from an experimental program; thus
the important single-blind condition was
not met. The single-blind condition means
that raters are aware of the particular
educational program or other experience
to which the people being rated have
been subject. This is absolutely essential
if rater bias is to be avoided.
Similar kinds of criticisms can be made
of the studies that have been presented
by Schmitt (1957), Mussallem (1959),
Gotkin (1956), Gallagher (1956), the
Glasgow Royal Infirmary (1963), Montag
(1959), and Spaney and her colleagues
(1962).
Specific skills rated
To evaluate the experimental and con-
trol nurses at Regina Grey Nuns' Hospi-
tal, the following measuring devices were
used:
1 . A scale for the rating of nurses by
senior nurses: This was a list of 195
critical incidents related to nursing per-
formance, based on a list developed by
Gorham (1962). Each incident was a de-
scription of a specific aspect of nursing
behavior. Some examples are: "explains
ongoing procedures to patients"; "cor-
rects safety hazards in environment";
"double checks medical orders." Such
lists of critical incidents are generally con-
sidered more reliable than the usual rating
scales using abstract concepts such as "is
responsible," "is honest," "is consci-
entious," and so on. This 195-item scale
was used to rate the nurses by two inde-
pendent raters not employed at the Grey
Nuns' hospital, who observed the nurses
for a period of five days.* The nurses
were observed on the ward and an en-
deavor was made to vary the ward
experience in a similar way for all the
students. All the students wore the same
bands on their nursing caps, so that the
*We wish to thank our two independent
raters, Mrs. Agnes Gunn and Miss Florence
Roach, for their assistance.
FEBRUARY 1%9
group to which they belonged was un-
known to the rater.
2. Evaluation of students in a simu-
lated nursing situation: The students were
taken individually into the nursing labora-
tory. Nursing equipment was available
and other students played the role of
patients. Each student was given, in suc-
cession, three descriptions of a nursing
situation; each situation was selected at
random from one of three groups of
situations so that each student had one
difficult, one intermediate, and one easy
situation.** The students were observed
by two supervising nurses at the Grey
Nuns' Hospital. These two supervising
nurses independently checked whether or
not certain required behaviors occurred
and also the time taken to carry out the
particular nursing procedure.
3. The scores on the State Board
Test Pool Examination, the School of
Nursing Examinations, and the National
League of Nursing Achievement Tests
were analyzed.
4. Self-evaluations were made by the
students and evaluations were made by
their employers after three months and
again after one year following graduation.
5. Because it was feared that the ex-
perimental students during their edu-
cation might get preferable treatment
because they were experimental students,
some check on this was required. To do
this, the students in both the experi-
mental and the control groups were asked
to evaluate their supervisors using a list of
critical incidents. The students were also
asked by the use of a technique known as
the semantic differential to indicate their
attitude to things like the hospital, their
supervisors, and the physicians.
Unexpected results
When any student withdrew from the
**Examples of the situations are: 1. Your
patient has asthma. She has been dyspneic
during the night and the doctor has ordered
oxygen by nasal catheter. Please administer
nasal oxygen. 2. Mrs. Brown has had a perineal
repair five days ago. You are to give her peri-
neal care. 3. Mrs. Jones has just had a complete
bed bath. You are assigned to make her occu-
pied bed. She is a 47-yeai-old housewife hospi-
talized with chronic anemia.
school, whether she were an experimental
or a control student, her matched student
also had to be withdrawn from the ex-
periment to keep the two groups
matched. As a result, some of the com-
parisons between the experimental and
the control group are made on only 24
pairs rather than 40 pairs of students. It
should be remembered, however, that the
statistical procedures used account for
this reduced number of pairs so that the
significance of the results is not altered in
any way.
As noted previously, by analyzing
separately the data on the 1961, 1962,
and 1963 special control groups, it was
found that the two outside raters did not
change significantly in their use of the
rating scales. Despite the fact that specific
behaviors were being rated, the two raters
did differ from one another to quite an
extent however, so that the data for the
experimental and control students were
analyzed separately for the two raters. In
both analyses, the control students, that
is the three-year students, obtained a
higher score for their behavior on the
ward. In the case of one of the raters, this
difference in favor of the control students
was highly significant.
The two observers in the simulated
nursing situation agreed almost com-
pletely; therefore their observations were
combined. The three-year control stu-
dents did better than the two-year experi-
mental students in all three types of
nursing situation: the easy, the inter-
mediate, and the difficult. However, the
difference in favor of the control students
was only significant for one of the levels
— the intermediate. The control students
also performed the task more quickly
than the experimental students; in two
levels — the easy and the difficult — the
difference in favor of the control students
was significant.
In the State Board examinations, the
control students obtained a higher mean
mark than the experimental students but
only the difference in child nursing was
significant. On the School of Nursing ex-
aminations control students got better
marks than the experimental students in
every section but one (surgical nursing).
in two sections (obstetrical nursing and
psychiatric nursing) the differences were
THE CANADIAN NURSE 63
significant, although psychiatric nursing
was not written by all control students.
In the National League of Nursing exami-
nations, the control students did better
than the experimental students in all
sections except one (medical) but none of
the differences were statistically signifi-
cant.
Thirty-nine head nurses were asked to
indicate the score they felt a graduate
nurse should get on each of the following
ten aspects of nursing: application of
nursing principles, nursing judgment,
conscientiousness, human relations,
organizational ability, observational abil-
ity reaction under pressure, communi-
cation skills, objectivity, flexibility.
In their first evaluation, three months
after graduation, the control group
obtained a higher mean rating in each of
the ten parts. In three parts - communi-
cation skills, objectivity, and flexibility -
the difference in favor of the control
group was significant. The experimental
group scored significantly higher than
head nurses' expectations in their re-
action under pressure, but were signifi-
cantly lower in their communication
skills and objectivity. The control group
was significantly hi^er than head nurses'
expectafion in their nursing judgment,
organizational ability, reaction under
pressure, and flexibility.
In the second evaluation, taken 12
months after graduation, a shortened list
of critical incidents related to ward be-
havior was used; again, the control group
did significantly better than the experi-
mental students.
The two- and three-year nurses did not
differ in their attitudes to the supervising
nurses and the hospital situation in gener-
al, suggesting that neither group had had
preferential treatment.
Conclusive evidence
This study provides conclusive evi-
dence that the students in this three-year
program performed better generally than
students in the two-year program. To
what extent this is due to the difference
in the length of the program cannot be
determined precisely because the length
of the program is confounded to some
extent with other differences, such as cur-
riculum differences.
However, in view of the systematic
and objective method of evaluation used
in this study, the conclusions reached by
the observers must be seriously con-
sidered. This meticulous method of
evaluation may be summarized as
follows:
1. The experimental and control
groups did not differ initially on any of
tlie matching variables; therefore, any
differences found between them on the
dependent variables can with some con-
fidence be attributed to the effects of the
different programs.
2. The two external raters did not
64 THE CANADIAN NURSE
show any systematic change in their
ratings over time; this was indicated by
the lack of significant differences in the
ratings obtained by the students in the
three matched special control groups.
Therefore, the difference in the rafings by
the external examiners can be relied on
with some confidence.
3. The control students did better
when rated for their ward performance
by external raters.
4. The three-year students showed
more of the expected behaviors and per-
formed them more quickly in a simulated
nursing situation.
5. In the three written examinations -
State Board examinations. School of
Nursing examinations, and National
League of Nursing examinations - the
control students did better than the ex-
perimental students.
6. The control students obtained
better scores in employers' evaluations
both three months and 12 months follow-
ing termination of the course.
7. The scale for evaluating supervising
nurses and the semantic differenfial was
included in the study because it was fear-
ed that during the course the nursing
school faculty might have had a better
attitude toward the experimental stu-
dents. These instruments were designed
to detect any differences of this sort.
However, the results from the scale for
evaluating supervising nurses indicated no
differences between the two groups in
their perception of supervising nurses.
There was one significant difference on
the semantic differential but, as has been
suggested, because of the multiple com-
parisons that were made, no great reliance
can be put on this.
Interpret results carefully
The contrast in the results obtained by
this systematic and objective evaluation
study and those of more subjective and
less well controlled studies is obvious.
The results of this study are much less
favorable for two-year programs than the
other studies to which we have referred.
The results of this study, however,
must be interpreted with care and used
with equal care as the basis for practical
decision-making.
Some readers may very well feel — and
with justification — that though the con-
trol groups have done generally better
than the experimental students, the
difference in favor of the controls is not
so marked as to justify an extra year of
education. With some modification of the
two-year program, the difference in favor
of the three-year program may disappear
and, indeed, the findings may be com-
pletely reversed. It is also important to
keep in mind that since the experimental
students generally met the head nurses'
expectations and the registration re-
quirements, one can with confidence go
along with the educational trend of
"saving one year" of the student's time.
The very fact that the experimental
students were experimental may have put
them under greater stress or pushed their
drive level beyond an optimum level. It is
a well established fact in psychology that
too high a drive level will result in deteri-
oration in performance, particularly with
complicated tasks (such as nursing) and in
the case of relatively inexperienced
people (such as new graduates of
nursing).
It is not our intention to resort to
special pleading. It is true that the find-
ings in favor of the controls, though not
overwhelming, were unexpected. By this
time, however, several other classes have
been admitted to the program and im-
portant changes have been introduced in
the curriculum. It would be most inter-
esting to make an evaluation of the
program as it is offered in 1968, six years
after its first introduction into the school.
Bibliography
Gallagher, Anna G. Descriptive study of a
twenty-six month program for the basic
preparation of nurses. Philadelphia, 1965.
(Thesis (Ed.D.) - University of Pennsyl-
vania; unpublished).
Glasgow Royal Infirmary, Experimental
Nursing Training at Glasgow Royal Infirma-
ry. Edinburgh, Her Majesty's Stationary
Office, 1963.
Gorham, William A. Staff nursing behaviors
contributing to patient care and im-
provement. Nursing Res., 11:2:68-79,
Spring 1962.
Gotkin, Lassar G. An evaluation of the nurs-
ing performance of the graduates of ex-
perimental nursing programs in junior and
community colleges. New York, 1956.
(Thesis (Ed.D.) - Teachers College, Col-
umbia University; unpubUshed).
Lord, A.R. Report of the Evaluation of the
Metropolitan School of Nursing, Windsor,
Ontario. Ottawa, The Canadian Nurses'
Association, 1952.
Montag, Mildred. Community College Edu-
cation for Nursing. New York, Blakiston Di-
vision, McGraw-HUI Book Co., 1959.
Mussallem, Helen K. Spotlight on Nursing Edu-
cation. Ottawa, The Canadian Nurses' As-
sociation, 1960.
Schmitt^ Louise M. Basic Nursing Education
Study. Regina, Board of Administration of
the Centralized Teaching Program for Nurs-
ing Students in Saskatchewan, 1957.
Spaney, Emma, Matheney, R.V., Ehrhart, A.,
and Jennings, L. Employer expectations vs.
staff nurse performance, 1962, (mimeo-
graphed). Lj
FEBRUARY 1969
Marital Breakdown by Jack Dominian.
172 pages. Harmondsworth, England,
Penguin Books, 1968. Canadian agent:
Longmans Canada Ltd.
Reviewed by Valerie Foumier, Public
Relations Officer, Canadian Nurses'
Association, Ottawa.
The incidence of separation and di-
vorce continues to rise in the western
world. Society is only beginning to realize
that the whole area of marital breakdown
is a complex and serious problem that
needs more study and better solutions,
especially since this society is based upon
marriage as an institution.
Jack Dominian, a British psychiatrist,
explores this area of marriage breakdown
and urges society to give more attention
to the problem, particularly through re-
search. He presents a selected survey of
both sociological and psychological re-
search into marriage conducted in the
United States and Britain, and includes
his own observations.
Dr. Dominian stresses that the per-
sonality and the specific interaction of
the couple is the most important factor in
a marriage, and that "every major study
associates marital disharmony and un-
happiness with a high incidence of per-
sonality and neurotic difficulties in the
partners."
He picks out three traits typical of
psychological immaturity that contribute
most frequently to marriage breakdown:
failure to achieve the minimum of
emotional independence; deprivation and
insecurity; and failure to achieve enough
self-esteem. He goes on to discuss sexual
difficulties, birth control, and psycho-
logical illness.
Dr. Dominian believes that society has
three main responsibilities in the field of
marriage. First, it must try to prevent
marriages that have little or no chance of
success. He mentions particularly the
factors of age, premarital pregnancy, and
the engagement period, and believes
"ultimately prevention must be directed
towards an adequate preparation for
marriage."
Secondly, society should help in re-
conciliation, and he believes marriage
therapy involves total help with social,
material, and health problems. Finally,
society should provide an effective
system for the dissolution of marriage,
and here he discusses the role of religion
and the law in regard to marital break-
down.
One drawback for Canadian readers is
FEBRUARY 1969
that Dr. Dominian deals with British
divorce laws, regulations, and machinery
for counseling, which are in most cases
inapplicable to this country.
However, this is not a serious problem,
and his sensible, realistic and readable
approach to marital breakdown - which
applies just as much to Canada as to
Britain - should more than make up for
it.
Erratum
The book How to Pass Entrance Exami-
nations for Registered and Graduate
Nursing Schools reviewed on page 51 in
the January 1969 issue was erroneously
stated as being pubHshed by the W.B.
Saunders Company, Toronto. The book
was published by Cowles Education
Corporation, Look Building, 488 Madison
Ave., New York, N.Y.
The Unconscious Mind — The Meaning
of Freudian Psychology by Benjamin
B. Wolman, 244 pages. Scarborough,
Ont., Prentice-Hall, Inc., 1968.
Reviewed by Bernard Lubin, Ph.D.,
Professor, Department of Psychiatry,
University of Missouri School of Medi-
cine, Kansas City.
Fifteen years ago, publishers knew
that any book on psychoanalysis written
by almost any psychoanalyst would be a
a profitable venture. Intelligent laymen as
well as mental health professionals could
be relied upon to react almost by reflex
to the magic of the term "psycho-
analysis." A major change has occurred
since then. From its status as "the" major
theory of personality development and
method of personality change, psycho-
analysis was described recently as "the
best method available for training psycho-
analysts." The statement says a great deal
about the irrelevance of psychoanalysis to
many of today's problems. Conceptual
models and treatment methods once
thought to be "superficial" have been
shown to have much more predictive
power, to be much less expensive and
time-consuming, and to be appropriate
for a much larger proportion of the popu-
lation.
Readable accounts of psychoanalysis,
however, are still quite important,
whether as essays on recent professional
history, or, occasionally, as a source of
testable hypotheses. This is an unusually
readable and cogent account of the art.
As in many of his writings. Dr. Wolman
communicates in this work a sense of
total grasp of the subject matter and an
unusual ability to deal with highly com-
plex material. He writes in an appealing
manner v^thout sacrifice to the material
itself.
The Process of Patient Teaching in Nurs-
ing by Barbara KJug Redman, K.N.,
B.S.N., M.Ed., Ph.D. 140 pages. Saint
Louis, Mosby, 1968.
Reviewed by Sister Mary Irene, Direc-
tor, School of Nursing, Charlottetown
Hospital, P.E.I.
This is a new book designed to provide
the student with background knowledge
in the vital area of patient learning. In the
preface, the author offers this book for
the student of nursing who recognizes the
need for patient teaching and for the
advanced students and graduate nurses
who have not had formal instruction in
this area. Essential for competence in
patient teaching is interaction with the
patients being taught and sufficient
knowledge of the subject matter.
The text begins with an explanation of
the relevance of teaching to nursing. It
goes on to present its information in six
chapters that focus on the process of
teaching-learning. The first chapter, "The
Place of Teaching in Nursing" gives a
historical background of the topic, high-
lights the objectives of health teaching,
and assesses what is currently being done.
It closes with some realistic recommen-
dations for success in reaching the goal of
better patient education.
Other chapter topics are; overview of
the teacher-learning process; readiness for
health education; objectives of health
teaching in nursing; learning and teaching,
and evaluation of health teaching.
Many plans of instructional methods
and techniques are included. The book is
well documented and includes an ex-
tensive bibliography that is helpful for
further study. A few illustrative case
studies are also included to help the stu-
dent gain an insight into the practical
application of what she has learned.
Study questions are useful as review ma-
terial. The author emphasizes the need of
good patient and family teaching as a
basic factor in the healing process.
Tlirough her realistic approach to a pract-
ical problem and often a neglected res-
ponsibility, she has produced a book that
should be in every nursing library.
THE CANADIAN NURSE 65
History of Nursing , 12th ed., by Jose-
phine A. Dolan, M.S., R.N. 380 pages.
Toronto, W.B. Saunders, 1968.
Reviewed by Sister Madeleine, Direc-
tor, School of Nursing, St. Joseph 's
General Hospital, Vegreville, Alto.
Teachers and students of history of
nursing will welcome this book, which
describes the evolution of the role of
nursing in the history of mankind.
The text shows the course of nursing
from primitive cultures to the present.
Historical facts are enhanced with many
interesting illustrations and diagrams.
Throughout the book, emphasis is placed
on the effect of the cultural, social,
economic, technical, and spiritual forces
affecting good nursing.
The last three chapters on nursing in
the twentieth century contain up-to-date
information on such topics as profession-
al organizations for nurses, nursing edu-
cation, evaluation of nursing, nursing in
occupational health, maternal and child
nursing, hospital social service, psychia-
tric nursing, and international relations.
The author shows how the changing pat-
terns of care of the sick and the refine-
ment of nursing have been the result of
the influence of wars, marked progress in
transportation and communication, and
remarkable inventions along with many
scientific achievements. Such timely
topics as medicare, aerospace nursing.
Project Hope, and the Peace Corps are
briefly discussed.
One other valuable asset of this book
is the inclusion of a history of nursing in
Canada.
This book would be most valuable in a
course correlating history of nursing with
professional adjustments.
Celiac Disease Recipes For Parents And
Patients 2d. ed. 87 pages. Published by
The Hospital for Sick Children, Toron-
to, 1968.
Reviewed by Shirley Pitt, Nursing
Coordinator, Home Care Department,
The Children's Hospital of Winnipeg,
Manitoba.
This soft-cover recipe booklet contains
an introduction by Dr. J. Hamilton. His
informative summary of the ins and outs
of celiac disease could be easily read and
comprehended by the average parent. An
earlier publication. Celiac Disease: A
Manual For Parents And Patients, pre-
pared by the staff at The Hospital for
Sick Children, Toronto gives a more
conplete description of the disease and
the principles of treatment. Dr. Hamilton
suggests that parents contact their doctor
66 THE CANADIAN NURSE
to answer questions that are unanswered
in these booklets.
The booklet's most commendable
feature is that it integrates the child and
the medical problem with the family set-
up. Families who are attempting to cope
with an ill child would benefit from more
literature written along these same lines.
The list of allowed and not allowed
foods is helpful, as is the sample meal
plan. This page would be more useful if
printed on separate tear-out cards, one
for the food hst, and one for the sample
meal plan. The cards could be placed in a
convenient place in the kitchen to be
used for quick reference by parents.
The section headed "General Sug-
gestions" presents a variety of helpful
hints for mother to follow in the pre-
paration of her child's diet. The in-
formation that glutin-free bread mix is
available by mail from a Toronto firm is
useful. However, no additional infor-
mation is supplied regarding the availa-
bility of this item in other Canadian
centers or its approximate cost, infor-
mation of importance to parents in pro-
viding the glutin-free diet to their child.
The recipes are indexed for quick
reference; throughout the recipes are
helpful hints for easy preparation and
storage.
This booklet is a useful aid for parents
caring for a child with celiac disease.
Pediatricians, pediatric nurses, and public
health nurses should be knowledgeable
of this book.
A Manual for Team Nursing developed by
Mercy Hospital, Pittsburgh, Pennsylva-
nia. 56 pages. St. Louis, The Catholic
Hospital Association, 1968.
Reviewed by Sister Mary of Calvary,
Director, Nursing Education, St. Mi-
chael's School of Nursing, Lethbridge,
Alberta.
This manual on team nursing is me-
thodically presented in four sections.
Section 1 includes the history of team
nursing, its philosophy, and some elabo-
ration on "Why Team Nursing." The
concept of team nursing is aptly describ-
ed by the authors as a "plan which en-
courages the development of leadership,
cooperation and conversation among all
members of the health team and recog-
nizes the individual worth more fully." It
involves planning, working, learning, and
conferring together, resulting in improved
patient care.
The diagrams used portray vividly
both the organizational set-up of tra-
ditional nursing with its task-oriented
care and patient-centered team nursing.
Section 2 deals with the imple-
mentation of the team nursing pattern.
This involves breaking down "resistance
to change," a characteristic that in-
variably accompanies any effort to de-
viate from the traditional. The personnel
comprising the team are outlined and the
role and responsibility of each member is
clearly dehneated. Samples of team as-
signment forms are included. The team
report and the team conference are part
and parcel of the team concept. These
serve to keep all members of the team
properly informed of the objectives they
are trying to achieve besides bringing
about concerted effort on the part of all
for more realistic patient-centered care.
The nursing care plan that results from
the team conference is described as a
brief word picture of the patient that por-
trays him as an individual. The plan serves
as a guide for all the members of the team
in carrying out patient care and helps in
the effective utilization of nursing care
hours.
A well selected hst of 21 nursing
problems is outlined in the manual for
the guidance of persons caring for pa-
fients. These, hopefully, will be useful in
helping to determine the individual needs
and problems of the padents but should
in no way take the place of observation
and experience.
Section 3 presents with clarity 13
steps toward a successful team nursing
program.
The last section contains an excellent
and extensive bibliography.
In the material presented in this nurs-
ing team manual there is evidence of
much thoughtful planning and forward
thinking. A study of this manual would
be invaluable to anyone who is contem-
plating replacing the traditional pattern
of patient care with the nursing team
concept.
Infection Control in the Hospital . 140
pages. Chicago, American Hospital As-
sociation, 1968.
Reviewed by Dorothy Pequegnat, In-
fection Control Officer, Ottawa Civic
Hospital, Ottawa.
This book is a collection and evalu-
ation of current useful information on
the control of nosocomial infections. The
authors recognize that each hospital
varies from the others, and that the appli-
cation of their recommendations there-
fore will vary, but that the principles pre-
sented apply generally to all hospitals.
If hospital facilities, practices, or pro-
cedures are at fault, the hospital can be
sued for corporate negligence. Therefore,
a hospital should at least adopt the mini-
mal standards as recommended in this
book by the American Hospital Associ-
ation and the Joint Commission on Ac-
creditation of Hospitals.
The book can be divided into three
parts. The first section deals with the gen-
eral organisation of hospital responsibili-
ties. It provides guidelines for the
establishment of an infection control
committee, employee health service, edu-
cation programs, and surveillance activi-
FEBRUARY 1%9
ties for the infection control nurse.
Sample forms are also given for reporting
of infections.
The second part of the book consists
of specific responsibilities within the
hospital: the individual responsibility of
the administrator, physician, and nurses,
and the departmental responsibilities of
the microbiological laboratory, pharma-
cy, central supply service, food service
department, laundry and hnen service, as
well as engineering and maintenance de-
partment.
The third part of the book deals with
prevention and control of infection. The
information includes architectural con-
siderations with a sample isolation plan,
microbial sampling programs, and, most
important, isolation techniques and pro-
cedures. Special problems are also con-
sidered: those of infected personnel and
carriers, hazardous areas such as the
blood bank, the surgical suite, and the
newborn nursery, and hazardous pro-
cedures such as inhalation therapy, trach-
eostomy, wound dressing, and catheteriz-
ation.
This book is most timely; not only
' does it present the problem of infections
;in hospitals but provides helpful guide-
lines and recommendations to help es-
tablish a workable infection control pro-
gram. It is a must for quick reference for
all department heads concerned with the
prevention and control of infections.
The Care & Feeding of Your Diabetic
Child by Sally Vanderpoel. 1 1 6 pages.
Toronto, Geroge J. McLeod, Ltd.,
1968.
Reviewed by Joy Calkin, Lecturer,
School of Nursing, The University of
New Brunswick, Fredericton, N.B.
The author, a nutritionist and mother
of a diabetic child for 10 years, has
written this book for parents. It would be
a valuable addition to a pediatric unit
parents' library, a pediatrician's office,
local community library, or nursing agen-
cy. However, its value is not limited to
parents. Its practicality and its orien-
tation toward helping the child and
parents adapt to diabetes make the book
valuable for anyone working with the
child with diabetes.
Two concerns must be balanced by the
parents of the diabetic child. How does
the parent help the child to gain inde-
pendence and self reliance, while at the
same time observing and controUing
"every phase of his life"? From her ex-
perience, the author describes certain pro-
cedures that are part of diabetic care. For
example, she gives her son his injections
when he is at home, and he gives them in
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her absence to "keep in practice." Her
rationale is that by giving the injections in
sites inaccessible for self-administration
(such as the buttocks) she helps her son
maintain the sites that he must use when
he provides his own care in the years
ahead.
Information and suggestions related to
food exchange (included in the ap-
pendix), school lunches, travel, special
occasions as birthdays, compHcations, in-
volvement in sports and other activities,
and the adolescent with diabetes are clear
and reasonable. The author notes some of
the problems she and her husband have
encountered and what kinds of solutions
they have used, and encourages parents to
see what works best in their situation and
family.
The brief history of diabetes mellitus
and its treatment will help prevent some
of the misunderstandings that occur
about diabetes. Note is made of the di-
rection of current research. The roles of
the specialist and general practitioner are
discussed in relation to their helpfulness
to the child and parents.
The tone of the book is realistic, yet
optimistic in relation to the "controlled"
diabetic, and Mrs. Vanderpoel notes that
there are advantages to the child and
family in spite of the chronic disorder.
She makes a plea for honesty, truth, and
knowledge for the child - so necessary
for adaptation to any chronic illness. Her
conclusion notes "that human personal-
The Face of Surgery
"NTeORtTV
< C. R. BARD (Canada) LIMITE
SINCE i»07 •
ITED 1
FEBRUARY 1969
THE CANADIAN NURSE 67
ities grow by encountering a difficulty
and mastering it . . . There is no need to
compensate him for the things that he
does not have or must do without. Given
the opportunity to do so, he will com-
pensate in his own wholesome way."
This book would be useful for parents
and health workers who seek this as their
goal of care.
Total Patient Care, Foundations and Prac-
tice, 2nd ed.. by Dorothy F. Johnston,
R.N.. B.S., M.Ed. 526 pages. St. Louis,
Mosby, 1968.
Reviewed by Iva J. Yeo, Instructor, St.
Boniface School for Practical Nurses,
Man.
The theme of this excellent textbook,
as stated in the preface, is the patient as
an individual, the constant need for the
practical nurse to record and report, and
the understanding on her part that she is
a member of the nursing team. This
second edition does not carry new
chapters but has updated many of the
original ones.
One chapter that has been rewritten
deals with the patient with staphylo-
coccal infections. In this chapter, the
practical nurse is given an understanding
of the sources of infection, clinical mani-
festations, nursing care, and prevention.
Isolation technique, including medical
and surgical asepsis, is not very detailed,
but a good basis is established. More in-
formation regarding this is given in an-
other chapter, which deals with com-
municable diseases. Because of the va-
riation in individual hospital poHcy,
further discussion is probably unneces-
sary.
In some areas, it might have been more
beneficial to focus a little more narrowly.
For example, much of the information in
Chapter 1 1 under subtitles "Blood Pro-
ducts" and "Diagnostic Tests and Pro-
cedures" could have been omitted or less
detailed. However, if the author's intent
was to provide a one-book reference upon
completion of the practical nurse's formal
education, she may have felt it necessary
to include the wider scope of technical
information.
Tlie text provides an extensive list of
current references at the completion of
each chapter plus a detailed glossary at
the end of the book. Many well-identified
illustrations, diagrams, and charts are of
particular merit. As noted in the first
edition, this textbook reflects changes in
concepts, ideas and attitudes, not merely
part of the evolutionary growth of nurs-
ing. It is a valuable addition to schools for
practical nurses and, as stated before, as a
68 THE CANADIAN NURSE
reference for the licensed practical nurse
working in areas such as smaller county
hospitals, convalescent or nursing homes,
or in private duty.
The Interview in Sludent Nurse Selection
by C.H. Smeltzer, Ph.D. 185 pages.
New York, G.P. Putnam's Sons, 1968.
Canadian publisher: The Macmillan
Company of Canada Ltd., Toronto.
Reviewd by Dorothy Syposz,
Lecturer, School of Nursing, Lakehead
University, Port Arthur, Ont.
This book is primarily directed to
faculty members of diploma schools of
nursing who are involved in interviewing
applicants. Although the major concern is
the interview as a tool in the selection of
students, other elements of selection are
also discussed to emphasize the necessary
balance in criteria.
The topics covered include answers
and information on almost all aspects of
the interview such as: the importance of
the interview in student selection, the
choice of faculty as interviewers, the de-
velopment of interview ability, common
faults of interviewers, methods of inter-
viewing, and the use of interview evalu-
ation in selection.
The author states his belief at the
beginning of the book that, if the inter-
viewing phase of selection is properly
conducted or can be improved, this part
of the selection process will contribute to
a reduction of the attrition rates. With
the purpose of improving the technique
of interviewing, the whole approach
stresses the practical aspects rather than
the theoretical. For instance, one chapter
discusses methods such as individual,
team, multiple interviewing, and types of
interviews with lists of specific questions
relating to the area to be explored, such
as personal background, work experience,
uiterest in nursing, and attitudes. Another
chapter deals with the vital aspect of re-
cording and consolidafing interview
summaries. Brief mention is made of
various methods of recording, and the re-
mainder of the chapter describes a
graphic chart developed by the author
and explains how this may be used. The
last chapter outlines briefly 34 problems
in interviewing candidates for entrance to
a school of nursing; these merit research
and study.
This practical book would be of value
to any teacher of nursing who is inter-
viewing prospective students, whether
they are in a diploma or collegiate pro-
gram, and to administrators who are con-
cerned with the interview as a tool in
student nurse selection.
Saunders Tests for Self Evaluation of
Nursing Competence by Dee Ann Gil-
lies, R.N., M.A., and Irene Barrett
Alyn, R.N., M.S.N. 282 pages. Toron-
to, W.B. Saunders, 1968.
Reviewed by Dr. M. Josephine Flaher-
ty, Assistant Professor, Department of
Adult Education. Vie Ontario Insti-
tute for Studies in Education, Toron-
to, Ontario. i
According to the authors, this book of
tests of nursing competence is designed
"both to instruct and to evaluate previous
learning." Since the test items are
comparable to those that nurses might en-
counter on licensure or graduate nurse
achievement examinations, the authors
intend the book to be of use to basic
nursing students, graduate nurses, and
nurse-teachers. They suggest also that
nurses returning to practice after an
absence of some years would find the
book of value as a "narrative redefinition
of a scene that has changed since their
last view of it."
The text is divided into four major
sections devoted to the following areas:
maternity and gynecological nursing,
pediatric nursing, medical-surgical nurs-
ing, and psychiatric nursing. Within each
secfion there is further subdivision into
disease-centered units where nursing situ-
ations are described and multiple-choice
test items based on these situations are
provided. A bibliography of books and
articles related to the subject areas being
tested is provided for each of the major
sections of the book.
Although the title of this book
mentions evaluation of nursing com-
petence, no attempt is made by the
authors to explain exactly what is meant
by nursing competence. It is presumed,
however, that the tests in this book,
nursing licensure examinations, and
graduate nurse achievement examinations
share a similar aim: to assess a candidate's
ability to use nursing knowledge in
making decisions that result in safe nurs-
ing practice. Judgments about whether
tests are appropriate for use in particular
situations are based on assessments of the
characteristics - such as validity, dif-
ficulty and so forth - of the tests. The
validity of any set of test items can be
determined only in terms of a well-
defined set of objecfives describing the
behaviors being measured, and with refer-
ence to a population that has been
identified. The authors mention that
items in each section vary considerably in
difficulty so that the abilities of both
undergraduate nursing students and
graduate nurses can be tested; however,
no attempt is made to define the specific
nursing behaviors that are expected of the
different groups of examinees. Hence,
users of this book may find it difficult to
identify appropriate test items and make
meaningful evaluations of nursing compe-
tence based on the given tests.
The usefulness of this book for nursing
students or graduate nurses who wish to
refresh their nursing knowledge is
quesfionable. Although correct answers
FEBRUARY 1969
are given for all items, the answers are
without explanation and some could
probably be debated. There is danger that
persons using this book might accept
given answers without understanding
them fully. Had the authors provided for
students a clear explanation of the use of
the test items as a means of identifying
weaknesses and gaps in knowledge, and
made specific suggestions for remedial
work, the book might have been more
useful.
Similarly, graduate nurses wishing to
refresh their nursing skills would likely
have difficulty understanding the nature
of changes in nursing without consider-
ably more detail than that provided in
this book. Hopefully, both students and
graduates would make use of the bibli-
ographies provided, but more direction
would probably be required.
While nurse-teachers might find the
book of some value as a source of ideas
for teaching and testing, they would have
to make careful assessments of the suita-
bility of the situations and items for their
particular settings; hence teachers' use of
the book is likely to be somewhat restric-
ted.
On the whole, this book seems to have
limited value as an instrument for self-
evaluation of nursing competence and is
not recommended for libraries in schools
of nursing.
A Unified Health Service by David Owen,
Bemie Spain, and Nigel Weaver. Edited
by Dr. David Owen, M.P. 148 pages.
Toronto, Pergamon of Canada Ltd.,
1968.
Reviewed by Sheila Rymer, Health
Educator, Department of National
Health and Welfare, Ottawa.
This book was coauthored by David
Owen, a doctor who is a member of the
British Parliament; Nigel Weaver, a
hospital administrator; and Bemie Spain,
a research worker in social and communi-
ty studies in London, England.
The chapter headings indicate that the
authors intend to describe the evolution
of Britain's National Health Service, its
present structure, the place of the general
practitioner, and the failure of the tri-
partite administration to provide a work-
able, coordinated health service. Pro-
posals are made for organization of a
unified health service, management and
administration of Area Health Boards, the
general practitioner and community ser-
vices, mental health services, and welfare
services. The appendix includes tables of
statistics and case histories.
Unfortunately for the reader unfami-
liar with British terminology, the authors
lapse into an alphabetical soup. If the
National Health Service is as confusing as
the book, it is a wonder patients get any
care at all.
Apparently the Service is organized
under three different administrations: 1.
hospitals and specialist services; 2. local
Health Authority services responsible for
prevention of illness, home nursing, mid-
wifery etc., and 3. Executive Council
Services, responsible for general practi-
tioners, dental practitioners, ophthaniolo-
gists, opticians, and chemists. Each of
these services has administrative units at
the local level and evidently no two have
the same boundary lines. This means that
a doctor discharging a patient from hospi-
tal and wishing to have him followed at
home has to know which office of the
Health Authority Service to call for each
of the districts in which he practices. It
means that there is no administrative
means for the sp)ecialist who has given the
patient hospital care to communicate
with the general practitioner, much less a
home visitor nurse who might be looking
after the patient at home. It means that
there is no means (in fact there are obsta-
cles) for interservice planning of programs
or facilities.
This book should prove useful for
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with 650 beds. Medical, Surgical
and Paediatric.
with 1000 beds. Medical, Surgical
and Obstetric.
Require Registered Nurses or nurses eligible for registration in Ontario.
Excellent wages, working conditions and benefit programme.
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Our two hospitals have excellent facilities, are fully accredited, and
are affiliated with McMaster University.
Please submit applications to:
Personnel Department
HAMILTON CIVIC HOSPITALS
296 Victoria Ave. N.
Hamilton, Ontario
FEBRUARY 1969
THE CANADIAN NURSE 69
those involved in planning community
health services in that it gives consider-
able emphasis to the need for communi-
cation among the growing numbers of
health specialists and organizations.
Infectious Diseases, 5th ed.. by A.B.
Christie, M.A., M.D., D.P.H., D.C.H.
371 pages. London, Faber and Faber,
1968.
Reviewed bv Dr. D.W. Menzies, M.B.,
Ch.B.. Ph.D., M.C.P.A. Medical Officer
in Charge, Field Study Unit, Epidemi-
ology Division, Department of Na-
tional Health and Welfare, Ottawa.
Since the time that this well-known
and useful text for nurses was first pub-
lished revolutionary changes have occur-
red in the treatment of infectious disease.
Tuberculous meningitis is no longer fatal,
poliomyelitis has been reduced to an item
on a printed page, and clinical diphtheria
is becoming more and more a rarity.
Condensing all this new knowledge
into a simple and readable style, combin-
ed with accuracy, is no mean feat. On the
whole the book does this well. The
section on hospital sepsis is a good ex-
ample of the author at his best.
Some sections do, however, require
further revision. The discussion on in-
fectious hepatitis specifies an incubation
period 25 to 35 days - which would
cause some eyebrows to rise. Usually, two
to six weeks is quoted. The incubation
period of serum hepatitis is somewhat
vaguely described as about 100 days.
Eiglit to 22 weeks is more in accord with
current thinking. A recommendation is
made to isolate the jaundiced patient at
home, in spite of the known probability
that other family members would already
be affected. The section on tetanus pro-
phylaxis requires some updating; its re-
commendations relating to antitoxin are
unfortunately imprecise. Illustrations no.
8, 9, 10, and 11 should be reconsidered.
They are not up to the general standard
of the book. It is also worth noting, in
the section about venereal disease, that
the "promiscuous" person is not neces-
sary unstable and immature, as the author
implies. Not only the psychologically
sick, but the apparently normal individual
contributes to the venereal disease pro-
blem.
In spite of these minor blemishes, the
book does what it sets out to do and its
continuing popularity is a measure of its
value. Nurses, health visitors, public
health inspectors, and student teachers
will find it very useful for reference
purposes.
70 THE CANADIAN NURSE
Health Services Administration: Policy
Cases and the Case Method edited by
Roy Penchansky D.B.A. Cambridge.
Harvard University Press, 1968.
Reviewed by Frances Howard, Con-
sultant Nursing Sen'ice, Canadian
Nurses ' A ssociation, Ottawa.
The editor's words in the preface of
tliis volume document the value of this
text as a reference text for both edu-
cators and practicing administrators,
whatever their area of management might
be: "It is . . . my belief that to develop
skills in the administrative processes it is
necessary to employ a teaching technique
that provides the student with guided ex-
perience in such processes and, further,
that the case method of teaching ... is
one of the most useful of such teaching
techniques."
The volume contains 12 case studies
describing real-life events that have oc-
curred not only in the western hemis-
phere but also in other parts of the world.
These case studies have an added ad-
vantage in that they provide historical re-
ferences not easily obtained from other
sources. In addition, there are specific
papers illustrating the use of the case
method in the education of health service
administration personnel. D
accession list
Publications on this list have been re-
ceived recently in the CNA library and are
listed in language of source.
Material on this list, except Reference
items, which include theses and archive
books that do not circulate, may be bor-
rowed by CNA members, schools of nurs-
ing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List" and
should be addressed to: The Library, Cana-
dian Nurses' Association. 50 The Drive-
way, Ottawa 4, Ontario.
No more than iliree titles should be re-
quested at any one time. If additional titles
are desired, these may be requested when
you return your loan.
BOOKS AND DOCUMENTS
1. ALA rules for fitins catalog cards by
Pauline A. Seeley. 2d. ed. Chicago. Amer-
ican Library Association, 1968. 260p.
2. World Iteallh or.vaiiizcitioii album.
Geneva, World Health Organization, 1968.
9lp.
3. And after that nurse? by Roger Brook.
London, Souvenir Press, 1966. 61 p.
4. Canadian society: .sociological perspec-
tives edited by Bernard Blishen, Frank E.
Jones, Kaspar D. Naegele, John Porter. 3d
ed. Toronto, Marmillan, 1968. 877p.
5. Cleaning and preserving bindings and
related materials by Carolyn Horton. Chica-
go. American Library Association, 1967. 76p.
6. The continuing education of women;
some programs in the United States of
America by Marion Royce. Toronto, De-
partment of Adult Education. Ontario Insti-
tute for Studies in Education, 1968. 155p.
7. Contraception divorce abortion; three
statements by Canadian Catholic Confer-
ence; discussion outline by CCC, Family
Life Bureau, Ottawa, 1968. 64p.
8. Diet manual prepared by Ontario Diet-
etic Association and approved by The On-
tario Medical Association. 2d ed. Toronto,
Ontario Hospital Association, 1967. Iv.
9. Final report of the New York (State)
University. Associate Degree Nursing Pro-
ject 1959-1964 to the W.K. Kellogg Foun-
dation. New York, N.Y., 1964. 102p.
10. Guidelines for discharge planning by
Janis H. David, Johanne E. Hanser and
Barbara W. Madden. California, attending
Staff Association of Rancho Los Amigos
Hospital. 1968. 52p.
1 1 . Health visiting practice by Mary
Saunders. Oxford, Pergamon. 1968. Il2p.
12. Infection control in the hospital. Chi-
cago. American Hospital Association. 1968.
I40p.
13. The lung and its disorders in the new
horn infant by Mary Ellen Avery. 2d ed.
Toronto, Saunders, 1968. 285p.
14. Manual of the international statistical
classification of diseases, injuries, and causes
of death. Vol. 1. 1965 rev. Geneva, World
Health Organization. 1967. 478p.
15. Note on the proceedings of the sixth
session International Labour Organisation
Advisory Committee on Salaried Employees
and Professional Workers. Geneva 4-14 De-
cember, 1967. Geneva, 1967. 88p.
16. Nurse! A guide for the establishment
of refresher courses for registered nurses.
New York, American Nurses' Association,
1968. 49p.
1 7. Occupational education; a challenge to
the two-year college edited by Bonnie E.
Cone and Philip D. Varo. North Carolina,
University of North Carolina, 1967. 55p.
18. The operating room supervisor at
work in New York by Edna A. Prickett.
National League for Nursing, cosponsored
by American Hospital Association, 1955.
112p.
19. Papers from the Canadian Confer-
ence on Educational Measurement, Sixth,
Laval University, Quebec, June, 1968. Otta-
wa, Canadian Council for Research in Edu-
cation. 1968. Contents. — Individualizing
educational measurement by J. Walla, P.
Somwaru. — Academic freedom in the
classroom by Thomas W. Whiteley. —
Teacher militancy by S.C.T. Clarke. — Two
necessary conditions for creativity by H.I.
Day and R. Langevin.
20. Patients; nurses; and chronic respira-
tory diseases. New York, National League
for Nursing. 1968. 46p.
21. The person as a nurse; professional
FEBRUARY 1969
accession list
adjiisimenis by Florence C. Kempf. New
York. Macmillan. 1951. 226p.
22. Pharmacie, par Yvan Toiiitou. Paris,
Masson, 1968. 223p.
23. The pharmacologic basis of patient
care by Mary Kaye Asperheim. Philadelphia.
Saunders. 1968. 417p.
24. Plan liospiialier d'lirgence. Montreal.
Hopital Notre-Danie. 1966. Iv.
25. The prediction of success in nursing
education: phase I and 2, 1959-67; a manual
for Luther Hospital sentence completions
and the luirsing sentence completions by
John R. Thurstin, Helen L. Brunclik and
John F. Feldhusen. Eau Claire, Wisconsin.
1967. 196p.
26. The prediction of success in nursing
education, phase 3. 1967-68 by John R.
Thurstin, Helen L. Brunclik and John F.
Feldhusen. Eau Claire, Wis.. 1968. 114p.
27. Proceedings of the Conference on
Training in Family Medicine, University of
Western Ontario, London, May 13 - 15,
1968 sponsored jointly by the Association of
Canadian Medical Colleges and the College
of Family Physicians of Canada. Toronto,
College of Family Physicians, 1968. iiip.
28. Reference: a programmed instruction
by Donald J. Sager. Ohio, Ohio Library
Foundation. 1968. 147p.
29. Report of the Commission on the
Canadian Public Health Association. To-
ronto, 1968. 62p.
30. Report of research project no. 1 by
M. L. Gingras. Toronto, Canadian Council
on Hospital Accreditation, 1968. 141p.
31. Report of a 1966-68 project to assess
Illinois' nursing resources and needs, present
and projected to 1980, and develop a pro-
gram of action to meet the state's needs for
nursing services sponsored by the Illinois
League for Nursing and the Illinois Nurses'
Association. Chicago, Illinois League for
Nursing, 1968. 64p.
32. Report of the Hospital Research and
Educational Trust 1968. Chicago. 1968. 25p.
33. Report of informal discussion of con-
tinuing education for women, May 9, 1968.
Toronto, Ontario Institute for Studies in
Education, Adult Education Department,
1968. Iv.
34. Report of a Seminar on Nursing Edu-
cation, Georgetown, Guyana, 17-30 April,
1968. Washington, Pan American Sanitary
Bureau, 1968. 75p.
35. Reports of the committees on nursing
service administration of the Nursing Ser-
vice Administration Seminar, University of
Chicago, Jan. 15 - June 8, 1951. Chicago,
University of Chicago, 1952. 21 Ip.
36. Sickness and society by Raymond S.
Duff and August B. Hollingshead. New
York. Harper & Row. 1968. 390p.
37. Student nur.ses in Scotland: character-
istics of success and failure by Margaret
Scott Wright and Audrey L. John. Edin-
burgh. Scottish Home and Health Depart-
ment. 1968. 153p.
38. Vietnam doctor: the story of project
concern by James W. Turpin with Al Hirsh-
berg. Toronto, McGraw-Hill, 1966. 21 Op.
PAMPHLETS
39. Community planning for nursing edu-
cation; the experiences of two state nurses'
associatioiu in planning for nursing educa-
tion in their areas by Lucille C. Notter and
Kathryn M. Smith. New York. American
Nurses' Association, 1968. 26p.
40. Evaluation of luir.ung staff. Milk
River, Alberta, Alberta Association of Reg-
istered Nurses, South District, Supervisory
Nurses' Committee, 1968. 7p.
41. Guidelines for cancer content in re-
fresher courses for registered nurses. New
York. American Cancer Association. 1968.
12p.
42. Guidelines for cardiovascular disease
Request Form
for "Accession List"
CANADIAN NURSES'
ASSOCIATION LIBRARY
Send this coupon or facsimife to:
LIBRARIAN, Canadian Nurses' Association,
50 The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in the
issue of The Canadian Nurse,
or add my name to the waiting list to receive them when
available.
Item
No.
Author Short title (for identification)
Request for loans will be filled in order of receipt.
Reference and restricted material must be used in the
CNA library.
Borrower
Registration No.
Position
Address
Date of request
FEBRUARY 1969
THE CANADIAN NURSE 71
accession list
content in refresher courses for registered
nurses by Haltie Mildred Mclntyre. New
York, American Heart Association, Commit-
tee on Nursing Education, 1968. 13p.
43. Hi filler education for nurses. Tel Aviv,
Tel-Aviv University, Faculty of Continuing
Medical Education, Department of Nursing,
1968. 4p.
44. The 1968 fact book on Canadian
consumer magazines. Toronto, Magazine
Advertising Bureau of Canada, 1968. 23p.
45. Nurse — facuhy census 1968. New
York, National League for Nursing, Re-
search and Development Staff, 1968. lip.
46. The occupational health nursing
course by Ida Sharpies. Vancouver, 1961.
34p.
47. Remarks on the adjunct to the pre-
amble of the "Code of Ethics" by Anny
Pfirter. Geneva, Comite International de la
Croix-Rouge, 1967. 21 p.
48. Salary pronouncement. New York,
American Nurses' Association, 1968. 4p.
49. Schools of nursing/ RN, 1968. New
York, American Nurses' Association, 1968.
pam.
50. Summary of library orientation pro-
grammes in eight Canadian university libra-
ries by Canadian Association of University
and College Libraries, rev. ed. Ottawa, Can-
adian Library Association, 1968. 15p.
51. Teaching medical-surgical nursing;
papers presented at the 1962 regional meet-
ings of the council of member agencies of
the Department of Diploma and Associate
Degree Programs, and ... by, Mildred L.
Brown, Charlotte Gray and Marie A.
Warnche. New York, National League for
Nursing, Department of Diploma and Asso-
ciate Degree Programs, 1963. 43p.
GOVERNMENT DOCUMENTS
Canada
52. Bureau federal de la Statistique. Clas-
sification Internationale des maladies, adap-
tee. Ottawa, 1968. 2v.
53. Bureau of Statistics. Advance stalls
tics of education 1968/69. Ottawa, Queen's
Printer, 1968. lip.
54. . Canada yearbook; official
.statistical annual of the resources, history
institutions and social and economic condi-
tions of Canada. Canada Year Book, Hand-
book and Library Division. Ottawa, Queen's
Printer. 1277p.
55. . Causes of death, Canada;
provinces by sex and Canada by sex and
age, 1966. Ottawa, Queen's Printer, 1968.
97p.
56. . Canadian statistical review;
annual supplement, 1967. Ottawa, Queen's
Printer, 1968. Iv.
57. . Statistics of private trade
.schools, 1965-66. Ottawa, Queen's Printer.
72 THE CANADIAN NURSE
1968. 4p.
58. . Vital statistics, 1966. Ottawa,
Queen's Printer, 1968. 213p.
59. Dept. des Impressions et de la Pape-
terie publiques, L'administrateur federal du
Canada, 1965-1968. Ottawa, Imprimeur de
la reine, 1965. Iv.
60. Dept. of Labour. Economics and Re-
search Branch. The behaviour of Canadian
wages and salaries in the post war period.
Ottawa, Queen's Printer, 1967. 120p.
61. Dept. of Manpower and Immigration.
Career outlook community colleges grad-
uates, 1968-1969. Ottawa, Queen's Printer,
1968. 58p.
62. . How to run a business, rev.
ed. issued jointly by . . . and Department of
Industry. Ottawa, Queen's Printer, 1968.
203p.
63. Dept. of National Health and Wel-
fare. Digest of symposium on control of
hazards in hospitals, September 19, 1967.
Ottawa, Queen's Printer, 1968. 53p.
64. Dept. of National Health and Wel-
fare. New dimensions in aging. Ottawa,
Queen's Printer, 1968. 7]p.
65. . Report of the survey of
health unit services in eight provinces of
Canada, 1960. Ottawa, 1961. 15 Ip.
Montreal
66. Department of Health Report, 1967.
Montreal, 1967. 21 Op.
Ontario
67. Dept. of Health. Research and Plan-
ning Branch. A study of withdrawals of stu-
dent nurses from schools of nursing in On-
tario; students enrolling in 1956-1961. Pre-
pared by . . . and the Vital and Health Sta-
tistics Unit in collaboration with the Col-
lege of Nurses of Ontario, Toronto, 1968.
62p.
Trinidad and Tobago
68. Ministry of Health. Report on a quan-
titative and qualitative survey of nursing
needs and resources. Trinidad Government
Printery, 1968. 55p.
U.S.A.
69. Bureau of Employment Security.
Manual for uses clerical skills tests. Wash-
ington, Government Print Off., 1968. 55p.
70. Department of Health, Education and
Welfare. Public Health Services. Utilization
review; a selected bibliography 1933-1967.
Arlington, Va., 1968. 19p.
71. National Center for Radiological
Health. An acclimation room for the detec-
tion of low radium 226 body burdens by
Samuel D. Campbell and Denis E. Body.
Washington, U.S. Public Health Service,
1968. 19p.
72. National Center for Radiobiological
Health. Radiation bio-effects. Summary re-
port, January - December, 1967. Washing-
ton, U.S. Public Health Service, 1968. 1 19p.
73. Secretary of Health Education and
Welfare. Health in America: The role of the
federal government in bringing high quality
health care to all American people; a report
to the President. Washington. 1968. 35p.
STUDIES DEPOSITED IN
CNA REPOSITORY COLLECTION
74. Community planning for a nursing
program in the Red Deer Junior College;
report to the Committee on Nursing Educa-
tion of the Red Deer General Hospital by
Jean Mackie, Red Deer, Alta., 1965. 64p. R
75. A comparison of students' achieve-
ment on a sequential learning experience
with other measures of student progress by
M. Claire Rheault. Montreal, 1968. 63p.
Thesis (M.Sc.(App)) McGill. R
76. Criteria used by employers when sel-
ecting nursing staff in varying sized hospi-
tals by Margaret Feme Trout. Toronto,
1964. 129p. Thesis (Dip. in Hosp. Admin.)
Toronto. R
77. Etude des infirmieres employees a
mi-temps au Quebec: la .satisfaction person-
nelle de ce groupe et la satisfaction institu-
tionnelle by Nicole DuMouchel. Montreal,
1968. 115p. Thesis (M.N.) Montreal. R
78. Nurses' .selection or avoidance of pa-
tients in the terminal phase of prolonged ill-
ness in selected medical and .surgical tinits
of a general hospital by Sister Jacqueline
Bouchard. Washington, 1964, 85p. Thesis
(M.Sc.N.) Catholic University of America. R
79. Nursing utilization study, pediatric
ward by K.J. Fyke. Regina, Saskatchewan,
Regina Grey Nuns' Hospital, 1966. 25p. R
80. The relationship between continuity of
nurse-patients' assignment and the patients'
knowledge of self-care by Devamma Purus-
hotham. Montreal, 1968. 41 p. Thesis (M.Sc.
(App)) McGill. R
81. The relalioiLship between the physical
adjustment of children to diabetes and the
marital integration of their parents by Mar-
lene A. Lane. Montreal, 1968. 58p. Thesis
(M.Sc.(App)) McGill. R
82. Relationships between attitudes to
nursing, job satisfaction and professional
organization membership by A. Joyce Bai-
ley. Cleveland, Ohio, 1968. 74p. Thesis
(M.Sc.N.) Western Reserve. R
83. Report to the Committee on Educa-
tion, University of Alberta on a suggested
curriculum for Red Deer Junior College in
affiliation with Red Deer General Hospital.
Red Deer, Alberta, Red Deer General Hos-
pital, Committee on Nursing Education.
Task Committee on Curriculum. 1966. 16p.
R
84. A study of the attitudes of nurse fa-
culty members in a selected Canadian pro-
vince in relation to their educational func-
tions by Sister Huberte Richard. Washing-
ton, 1963. 59p. Thesis (M.Sc.N.) Catholic
University of America. R
85. A study of the needs of graduates
from two year diploma programmes in Can-
ada, by Ella B. MacLeod and Sister Cather-
ine Peter. Boston, 1968. 74p. Thesis (M.
Sc.N.) Boston. R
86. A study to determine — is the nurse
in a double-bind when caring for patients on
isolation care by Alva L. Peterson. Montreal
1968. 48p. Thesis (M.Sc.(App)) McGill. R D
FEBRUARY 1969
March 1969 ,3 v
-•^^;v
UMIVERSITY OF OTTAWA,
SChOOL Of .NUasiWG
OTTAWA. ONT.
The
12-b9-«AC-ll-68
Canadian
Nurse
CNA members face
serious financial decisions
infection control
- a problem for hospitals
Canada's rare bloodjiank
_. ■
r^.
Does Jane Cowell know the facts
about dandruff?
Probably not!
The facts are dandruff is a medical prob-
lem and requires medical treatment. Ordinary
shampoos cannot control dandruff.
New formula Selsun can!
The doctors you know are undoubtedly
familiar with Selsun. And they prescribe it
because it's medically recommended. And
proven effective in 9 out of 10 severe dan-
druff cases.
Our new formula Selsun is as effective as
the old. We use the same efficient anti-
seborrheic — selenium sulfide. We've simply
improved the carrier. A more active deter-
gent produces foamier lather — a finer
suspension gives smoother consistency.
To top off new formula Selsun we added
a fresh clean fragrance and put it in an at-
tractive unbreakable white plastic bottle.
If you know someone with a dandruff prob-
lem tell them to ask their doctor about
Selsun. And if dandruff worries you — ask
your own doctor.
selsun
(Selenium Sulfide Detergent Suspension U.S. P.)
A PRODUCT OF ABBOTT LABORATORIES, LIMITED
GOimnmiini TO GONGKss
Only three months to go to the
INTERNATIONAL COUNCIL OF NURSES'
14th QUADRENNIAL CONGRESS
Place Bonaventure, Montreal, Canada,
22 to 28 June, 1969.
PROGRAM HIGHLIGHTS
Sunday, 22 June
3.00 p.m. Interfaith Service
8.00 p.m. Opening Ceremony
Monday and Tuesday, 23 and 24 June
Open meeting of Council of National
Representatives (CNR)
Wednesday, 25 June
"Focus on the Future"
a.m. Plenary session —
Forecasting the Future
p.m. Plenary session —
Implications of Change
Thursday, 26 June
"Focus on the Future"
a.m. Plenary session —
Education for Today and To-
morrow. Basic Programs
p.m. Plenary session -
Education for Today and To-
morrow. Post Basic and Post-
graduate Programs
5.00 p.m. Voting for ICN Officers by
CNR
8.00 p.m. Students' Congress
Friday, 27 June
"Focus on the Future"
a.m. Plenary session —
Security for Tomorrow
p.m. Plenary session —
Leadership in Action
8.00 p.m. Closing Ceremony
Admission of new member
associations to ICN
New ICN Officers
announced
Saturday, 28 June
Canada Hospitality Day.
N.B. * Special Interest Sessions - 19 topics in English and French, will be
running Monday through Friday
International Nursing Exhibition - runs Monday through Wednesday
1ARCH 1%9
FOR FURTHER INFORMATION, INCLUDING REGISTRATION
FORMS, PLEASE WRITE TO:
ICN Congress Registration,
50, The Driveway,
Ottawa 4, Ontario.
N.B.- Advance fee date of $40 extended to 31 March 1969
THE CANADIAN NURSE 1
BaiU Oil a Ifiw |i)aii(l(iii()n'. . .
begin your students' microbiology training with
this widely adopted text and companion laboratory manual
New 6th Edition! Smith
PRINCIPLES OF MICROBIOLOGY
Your students in this important course deserve this important text!
Clear, logically oriented discussions communicate the microbio-
logical foundation they will use in much of their clinical experience:
concepts of infection, sepsis, digestion, immunity, and other condi-
tions which play a vital part in their understanding of disease pro-
cesses. The newly revised 6th edition includes such timely topics as
DNA and RNA, the body's protective mechanism, and incubation
periods of communicable diseases.
By ALICE LORRAINE SMITH, A.B., M.D., F.C.A.P., F.A.C.P., Associate
Professor of Pathology, The University of Texas Southwestern Medical
School, Dallas, Tex. Publication date: April, 1969. 6th edition, approx. 672
pages, 7" x 10". About $10.20.
New 2nd Edition!
Smith
MICROBIOLOGY LABORATORY MANUAL
AND WORKBOOK
Twenty-nine exercises give effective progression through a range of
practical subjects in microbiology. Planned to involve students more
directly, this revision continues to use the framework of (1) time,
(2) reference sources, (3) intention, (4) tools, (5) technic, and
(6) observations. The number of illustrations and tabulations has
been increased. Pages are perforated and punched.
By ALICE LORRAINE SMITH, A.B., M.D., F.C.A.P.. F.A.C.P. Publication
date: May, 1969. 2nd edition, approx. 168 pages, TA" x 10V4" 11
illustrations. About $4.15.
A New Boo!<!
Young-Barger
By CLARA GENE YOUNG, Technical Editor and
Writer (Medical), retired, U.S. Civil Service; and
JAMES D. BARGER, M.D., F.C.A.P., Pathologist,
Sunrise Medical Center, Las Vegas, Nevada. Pub-
lication date: January, 1969. 295 pages plus
FM l-XII, 7" X 10", 11 illustrations. Price, $8.75.
INTRODUCTION TO MEDICAL SCIENCE
A basic semi-programmed introduction to the study of disease, this
unique new book can help all your beginning students and/or para-
medical trainees gain a broader understanding of how and why dis-
eases occur, and how they affect the body. It first explains disease as
a breakdown in body structure or function, indicated by such etio-
logic factors as neoplasia, hypersensitivity, or heredity; then dis-
cusses specific diseases commonly met in hospital admission.
■THE C. V. MOSBY COMPANY, LTD.
86 Northline Road • Toronto 16, Ontario
2 THE CANADIAN NURSE
Publishers
MARCH
The
Canadian
Nurse
^
^^p
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 3
March 1%9
25 Thought and Action E. Van Raalte
27 Infections in the Hospital D. Pequegnat
30 Idea Exchange
32 Resources and Use of CNA Library M. Parkin
35 Canada's Rare Blood Bank L. Carter
37 A Dollar, A Dollar, Follow the Scholar V. Lindabury
39 New Services Help Patients and Staff N. Beaudry-Johnson
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
7 News
17 Names
18 Dates
22 In a Capsule
41 Books
43 Accession List
46 Classified Ads
Executive Director: Helen K. Mussallem •
Editor: Virginia A. Lindabury • Assistant
Editor: Loral A. Graham • Editorial Assist-
ant: Carol A. Kotlarsky • Circulation Man-
ager: Berjl Darling • Advertising Manager:
Ruth H. Baumel • Subscription Rates: Can-
ada: One Year. $4.50; two years, S8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Four weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
® Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for "review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on white paper)
are welcomed with such articles. The editor
is not committed to publish all articles sent,
nor to indicate definite dates of publication.
.Authorized as Second-Class Mail by the Post
Office Department. Ottawa, and for payment
of postage in cash. Postpaid at Moiitreal.
Return Postage Guaranteed. 50 The Driveway,
Ottawa 4. Ontario.
Editorial
1ARCH 1969
The fact that the Canadian Nurses'
Foundation is still light on cash is not
really news. Ever since the five-year
grant from the W.K. Kellogg
Foundation ended in 1967, CNF has
had its back to the wall.
There are at least three reasons for
CNF's present financial plight: first,
many nurses — particularly those who
are presently inactive in nursing —
are unaware of the existence of the
Foundation; second, too many nurses
who know about CNF are unconvinced
of its importance and do not bother
to join; third, the present membership
fee of $2 is not enough to cover even
the secretarial and mailing costs (now
paid by the Canadian Nurses'
Association).
As we see it, the first two causes of
CNF's predicament must be tackled
by an intensive, coordinated public
relations program on a national and
provincial basis. The paltry number of
members (1,494 at present) is clear
proof that a haphazard approach to
publicity just does not work.
The answer to the third reason for
CNF's present dilemma is obvious:
raise the fee to at least $5. When
nurses become aware of CNF and its
importance to the profession, they will
not object to paying an additional $3.
The incoming CNF Board of
Directors will no doubt be encouraged
by the recent announcement that a
third provincial nurses' association has
now pledged annual donations to the
Foundation. We hope, however, that
the Board will recognize the need to
get the Foundation's message across to
all nurses, and will appoint one or
more of its members to be responsible
for an aggressive PR program.
— V.A.L.
THE CANADIAN NURSE 3
letters {
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
A new nursing publication
To increase communication among
faculties of Canadian university schools
of nursing, the staff of the School for
Graduate Nurses, McGill University, has
decided to sponsor a small newspaper to
provide a medium for assessing problems,
posing questions, and describing ideas and
plans of action by persons concerned
with university preparation and nursing
research.
We invite all faculty to contribute
articles, but also to respond in critical
fashion to the ideas presented in the
proposed paper. In other words, some
will put forth their views, while others
will respond with considered and
thoughtful commentary to provide dia-
logue on the problems and ideas therein.
We plan thiee issues of the publication
in 1969. The format, presentation, and
distribution of the paper will be simple;
however, the mailing list will include
schools and agencies other than those
classified as university. The School for
Graduate Nurses will finance the first
issue, but looks forward to contributions
for subsequent publications. Please
address all inquiries to: Nursing Publi-
cation, School for Graduate Nurses,
McGill University, 3506 University
Street, Montreal 112, Quebec. - Moyra
Allen, Associate Professor of Nursing,
McGill University, Montreal
Is nursing really going forward?
It was with great interest that I read
Dr. H.K. Mussallem's article "The Chang-
ing Role Of The Nurse" in the November
1968 issue of the Canadian nurse.
Although it was interesting and con-
tained a lot of forecasting, 1 disagree in
part with the author. The following
sentence puzzles me:
"This may mean that in the next
decade the practice of nursing could more
closely resemble the practice of today's
'family doctor' than of today's nurse."
A patient, who practically or theoreti-
cally depends on nurses for his physical,
physiological, emotional, social, and
psychological needs, can walk into any
drug store at any time of the day and buy
himself a pain reliever, such as Aspirin, a
laxative, or an antacid. Yet a nurse is not
allowed to use his or her imagination,
knowledge, and experience to give an
Aspirin when a patient has a headache, a
laxative when constipated, or an antacid
when indigestion is present. How on earth
is this nurse going to resemble a family
4 THE CANADIAN NURSE
doctor 10 years from now? I am taking
for granted that the nurse can make sure
that the patient does not have a gastric
ulcer, or is not allergic to Aspirin, has not
had a surgical intervention on his alimen-
tary tract or other contraindications.
Dr. Mussallem goes on to say: "If
certain trends continue, nurses could
become medical technicians, not nurses."
I think that this is already the case. With
the number of changes that are taking
place, it will certainly not be surprising if
someday one can become a nurse by
taking correspondence courses. Nursing is
becoming more and more theoretical
because many nursing experts have left
the hospital setting and disassociated
themselves completely from patients.
They buUd beautiful theories for the
benefit of nurses, and leave the patients
to nonprofessionals. Some experts have
spent more time accumulating degrees
than practicing nursing.
Hospital schools of nursing in Canada
are full of instructors who obtained a
nursing diploma, then rushed to the
nearest university for a degree - thus
buying themselves a passport to teach.
Does three months training as a student
on a medical, surgical, obstetrical, or
psychiatric unit qualify any nurse to
teach future graduate nurses? Is that not
putting the cart before the horse? Some
nursing instructors have never been in
charge even for a few hours.
I have known nurses from universities
and nurses from diploma schools. Give
me anytime nurses from diploma schools.
1 do not want theory; I want - rather the
patient wants - practice.
Has anybody come across the situation
when a nurse who has developed a good
primary relation with a patient suddenly
loses the confidence of that patient when
she very clumsily performs a nursing
procedure or applies a dressing? Has
anyone heard a patient say: "Nurse X is
ill-mannered or rude, but boy does she
know her stuff."
Where are we going to draw the line?
We want nurses with little practical ex-
perience, but with a degree, to teach and
make good practical nurses. Isn't our
logic faulty? - M.H. Rajabally, S.R.N.,
R.M.N. , Ottawa.
The patient — another professional
The article by Carlotta Hacker in the
January issue entitled "A New Category
ol Healtli Worker tor Canada? " provoked
me to raise questions.
The question of where this worker will-
stand in the hierarchy of hospital organ-
ization seems, to Miles Provost and
Desjardins, to be of little concern. To
quote: "They look neutrally on the
suggesfion, seeing the assistant as being
neither superior nor inferior to the
nurse."
I submit that neutrality will be non-
existent. The doctor's assistant will
almost immediately become superior to
the nurses issuing orders for treatment
and tests.
The second question is a crucial one.
This article is well-written, provocative,
and includes many professional opinions.
But I would suggest that one "profession-
al" has been overlooked - the patient. He
pays a phenomenal sum for health ser-
vices and he is quite sophisticated and
professional in his demands. Why not ask
him what he thinks of another category
of health worker? - A. Joyce Bailey,
Reg.N., Toronto, Ont.
Sacrifice to specialization
1 am writing with regard to the article
"A New Category of Health Worker for
Canada? " published in the January issue.
"Every stage in transition leading to
the industrial state has been marked by a
sacrifice to specialization. Every step has
moved man away from complete personal
involvement in the task at hand; instead
he usually specializes in a part of it," Say
Rogg and D'Alonzo in Emotions and the
Job. Although the above quotation deals
with industry, it can be applied without
revision to the medical and paramedical
professions.
Granted, the explosion of knowledge
makes it impossible for any one man tc
possess all knowledge or, in the medical
profession, take complete responsibility
for all aspects of a patient's care. How-
ever, some of the major problems ir
patient care today stem from the facu
that there are too many categories o!
workers attempdng to give care to the
patient.
I take particular exception to thf
terms used by Dr. McKendry in the
article: "It is demeaning for then
[doctors] to be doing these tasks." This ii
where many of the ills of nursing havr
begun. We have assigned so-called les
important tasks to auxiliary personnel s(
that nurses could be freed for apparentlj
more important duties. This has resulte(4
in the professional nurse sometimes beinf'
furthest away from patient contact. It i
MARCH 196!
This hand
was bandaged
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TUBULAR
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But the Tubegauz method is 5 times
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Many hospitals, schools and clinics
are saving up to 50% on bandaging
costs by using Tubegauz instead of
ordinary techniques. Special easy-
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69H9
MRCH 1%9
hard to believe that doctors now wish to
put themselves into this dilemma.
The creation of a new medical worker
raises a number of questions:
1. Where will the line be divided between
unique functions of the doctor and those
of his assistant?
2. Could not medical technologists be
trained in some of the functions the
doctor wishes performed by this new
medical assistant?
3. What will be the relationship between
the medical assistant and the nurse caring
for the patient?
4. How will the doctor and nurse, who
would be even further separated by this
medical assistant, communicate?
5. What or who would prevent a doctor
from hiring more than one medical as-
sistant?
With medicine now looking toward
family practice and team medicine and
toward concepts of treatment centers
where all facilities will be available to
members of a community who need
them, it is hoped that the notion of a new
medical worker will be abandoned and
that doctors, certainly aware of the neces-
sity of human contact, wOl attempt to get
closer to their patients, not further away
from them. - Alberta Casey, Lecturer,
Psychiatric Nursing, Ottawa.
Smoking nurses
In recent months I was Ul in two
different hospitals. In the large hospital I
was impressed with the high calibre of the
nursing service, and the kindness mani-
fested by the staff. One is aware that true
nursing takes into consideration the
whole person. It is not merely making
beds and bringing pills at stated intervals.
Perhaps by coincidence, I saw no
evidence of nurses smoking in the large
hospital, but considerable evidence in the
smaller hospital. Nurses are human
beings, subject to the same human
frailties as other members of society, but
we think of all members of the medical
profession as "working together for
health."
Much has been said recently about the
hazards of cigarette smoking, and much
more should be said about alcohol as a
health, social, and safety problem.
Is it not true that nurses should be
paying more attention to the Florence
Nightingale Pledge to which every nurse
on graduation solemnly subscribes: "I
will abstain from whatever is deleter-
ious ... I will do all in my power to
maintain and elevate the standards of my
profession." — Kate E. Watson, Vancou-
ver. D
Whenyourddy
starts at _
6 a.m... you're oji
charge duty.. ^
you \/e skimped
onmea/s...^
and on sleep...
you haven thad^
time to hem
a dress... ^
mal(e an apple pie.,
washyourhair..
evenpowder f/M
yournose
in comfort!^.
it's time for a change. Irregular hours and meals on-the-
run won't last. But your personal irregularity is another
matter. It may settle down. Or it may need gentle help
from DOXIDAN.
use
DOXIDAN*
most nurses do
DOXIDAN is an effective laxative for the gentle relief of
constipation wilhoul cramping. Because DOXIDAN con-
tains a dependable fecal softener and a mild peristaltic
stimulant, evacuation is easy and comfortable.
For detailed information consult Vademecum
or Compendium.
HOECHST
PHARMACEUTICALS
3400 JEAN TALON W , MONTREAL 301
DIVISION OF CANADIAN HOECHST LIMITED
MEMBes
I PMAC I
ClA.>
THE CANADIAN NURSE 5
soft testimony to your patients' comfort
Your own hands are testimony to Dermassage's effectiveness. Applied by your
soft, practiced Inands, Dermassage alleviates your patient's minor sl<in irritations
and discomfort. It adds a welcome, soothing touch to tender, sheet-burned
skin; relieves dryness, itching and cracking . . . aids in preventing decubitus
ulcers. In short, Dermassage is "the topical tranquilizer", , . it relaxes the patient
. . . helps make his hospital stay more pleasant.
You will like Dermassage for other reasons, too. A body rub with it saves your time
and energy, Massage is gentle, smooth and fast. You needn't follow-up with
talcum and there is no greasiness to clean away. It won't stain or soil linens or
bed-clothes. You can easily make friends with Dermassage— send for a sample!
Now available in new, 16 ounce plastic container with convenient flip-top closure.
'A-nAj^ -Y-^u^JLiu a.(UO'~tiiL'tAjL' (jUlitnjy^^.,cs^
•r-innr"'
6 THE CANADIAN NURSE
LAKESIDE LABORATORIES (CANADA) LTD.
64Colgate Avenue • Toronto 8, Ontario
MARCH ^^m
lournals' Postal Problems
Discussed By CNA Board
Ottawa. - The two journals of the
Canadian Nurses' Association, L'infir-
miere camdienne and The Canadian
Nurse, will continue to be published in
their present form, at least until the next
Board of Directors meeting in November,
even if the money has to be borrowed to
pay the increased postal rates that come
into effect April 1. This decision was
made by the CNA Board after members
had discussed in detail possible ways to
modify the present form of the journals.
One suggestion, that the journals be
published every second month instead of
every month, was rejected when it was
explained that the information in the
"News" section would be outdated in a
bimonthly publication, and that con-
siderable advertising revenue would be
lost.
A motion to investigate the cost of
publishing and mailing one bihngual
journal in the two languages (in the form
of a "flip" journal - French material at
one end, Enghsh material at the other
end) was withdrawn. The CNA general
manager, Ernest Van Raalte, pointed out
that the extra mailing and printing costs of
a single bilingual journal of 104 pages
sent to each member would amount to an
extra 514,921 on top of the $135,000
increase in mailing rates.
The CNA Board will discuss this finan-
cial problem again at its November 1969
meeting.
CNA Sets 1970 Salary Goals:
$7,200 for Diploma Nurses,
$8,460 for University Crads
Ottawa, — The national salary goal for
1970, approved by the Canadian Nurses'
Association's Board of Directors at its
meeting February 11-14, aims to close
the gap between starting salaries for
registered nurses and starting salaries for
other professional workers in the
country.
The salary goal, as recommended by
the Committee on Social and Economic
Welfare, would give the beginning practi-
tioner of a basic diploma nursing program
"no less than 57,200 per annum," and
the beginning practitioner of a baccalau-
reate program "no less than 58,640 per
annum." The 1969 national salary goal,
which was approved by the CNA general
membership at the biennial meeting in
1968, recommended that the diploma
graduate get 56,000 as a starting salary,
and that the baccalaureate graduate get a
MARCH 1969
Orientation Day for New Board Members
An orientation day for new members of the Canadian Nurses' Association Board of
Directors and provincial executive secretaries was held prior to the Board meeting
February 11-14, 1969. M. Geneva Purcell (left), president of the Alberta
Association of Registered Nurses, and Irene Lecicie (center), president of the New
Brunswick Association of Registered Nurses, are shown with Lois Graham-
Cumming, director of CNA's Research and Advisory Services.
salary "substantially greater."
In explaining her committee's decision
to recommend these increased salary
goals to the Board, chairman Louise Tod
said that a careful review of salaries paid
to members of comparable professions in
Canada had been made by the committee.
"We found that persons in other pro-
fessions, such as teaching, were still being
paid higher starting salaries than nurses,"
Miss Tod said. "As a matter of fact," she
added, "the salaries paid to nursing order-
lies in some provinces were very close to
those being paid to nurses in 1968."
Miss Tod pointed out that a 1967
survey conducted by the Department of
Manpower and Immigration showed that
starting salaries of nurses with university
education were at the bottom of the list
of 55 named professions. "If we are to
attract suitable persons into nursing and
retain them, we must bring nurses'
salaries in line with those of other pro-
fessionals," she said.
Other policies recommended by the
Committee on Social and Economic
Welfare and approved by the Board are:
• That in the inteiest of quality patient
care, social recognition and economic
reward should be given those nurses
who become expert nurse practi-
tioners.
• That the CNA recommend to provin-
cial nurses' associations that manage-
ment nurses be encouraged to utilize
existing legislation or, if necessary,
that the provincial organization seek
further legislation or alternate meth-
ods to represent effectively nurses
whose function is deemed to be mana-
gerial.
• That the Board of Directors initiate a
study of all federal legislation that has
implications for nursing and nurses,
and any necessary action be imple-
mented to effect changes.
These revised goals on Salary and
Employment Standards, along with new
Social Welfare Goals approved by the
Board, are to be published as a separate
document in 1969, and will be available
on request to all CNA members.
The Social and Economic Welfare
Committee, which held one meeting in
the 1968-70 biennium, will meet again in
Ottawa early in 1970, with the em-
ployment relations officers of the pro-
vincial associations.
THE CANADIAN NURSE 7
CNA Testing Service
To Be Located In Ottawa
Ottawa. -The Canadian Nurses' As-
sociation Testing Service will be located
in Ottawa. This decision, based on a
recommendation of the CNA Executive
Committee, which had investigated
physical facihties for the Service in Otta-
wa, was approved by the CNA Board of
Directors at its meeting February 11-14,
1969.
CNA becomes the official owner of
the testing service May 1, 1970, when it
takes over the existing testing service of
the Registered Nurses' Association of
Ontario, At present, a liaison committee,
composed of the 10 provincial registrars,
is working closely with the director of the
RNAO Testing Service, Dr. Dorothy
Colquhoun, to facilitate present planning
for test development.
The CNA Board considered whether
the new national testing service should be
incorporated, that is, have its own Letters
Patent and be set up as an independent
body similar to the Canadian Nurses'
Foundation, or whether it should be
under the control of the CNA Board of
Directors. Board members agreed that the
testing service should eventually be set up
under an independent board.
The CNA Board agreed to defer the
final decision until its meeting November
3-7, 1969, at which time Board members
will be asked to discuss the terms of
reference for a provisional board.
Considerable discussion centered on
the need to give instruction in item
writing and test construction to nurse
educators throughout the country. The
Board agreed that this responsibility rest-
ed primarily with the provinces, and that
CNA would set up self-supporting work-
shops only if necessary.
Special CNA Meeting
To Be Held This Year
To Consider Bylaws
Ottawa. —A Special Meeting of the
Canadian Nurses' Association will be held
sometime during the week of November
3, 1969, to consider amendments to the
Association's bylaws.
This decision was made by the CNA
Board of Directors at its meeting Fe-
bruary 11-14, after Board members
expressed concern about any further
delay in obtaining the issuance of Letters
Patent for the Association under the
Canada Corporations' Act. Without this
special general meeting, CNA would have
to wait until the regular general meeting
in June 1970 to have the bylaws ap-
proved by membership.
8 THE CANADIAN NURSE
UBC Celebrates Golden Jubilee
Vancouver. -The University of British Columbia honored the Golden Jubilee of its
School of Nursing and the memory of its first nurse director, the late Ethel Johns,
LL.D., on January 12 at a ceremony presided over by UBC Chancellor John M.
Buchanan. Elizabeth McCann, acting director of the School of Nursing, paid tribute
to the School's first three directors, Ethel Johns, Mabel F. Gray, and H. Evelyn
Mallory, and described the growth of the school from its first three students in
1919 to its present graduating class of 97.
Dr. Rae Chittick, professor emeritus, McGill University, deUvered a tribute to
Miss Johns, before Professor Margaret Street (left), presented a collection of medals
and medaUions to Basil Stuart-Stubbs (right). University librarian. The medals and
medallions were Miss Johns' gift to the Charles Woodward Memorial Room. The
ceremony was attended by representatives of the facuhy and Nursing Under-
graduate Society, and hospitals and organizations from Vancouver. A reception was
held afterward, and exhibits prepared by the hbrary staff were viewed.
The approval of bylaws will be the
only item considered at the special gen-
eral meeting in November. Each province
will be entitled to a number of votes
based on membership, and will assign
these votes to one or more delegates.
Board members were brought up-to-
date on CNA's progress in applying for
Letters Patent under the Canada Corpora-
tions' Act by Gordon F. Henderson, Q.C.,
legal adviser for CNA. Mr. Henderson said
that it is the Association's obligation now
to satisfy the Department of Consumer
and Corporate Affairs that the CNA
bylaws comply with the requirements of
Letters Patent companies.
"The one item that constitutes a
change of some substance," Mr. Hender-
son said, "is the change dealing with
withdrawal from membership in the Asso-
ciation. At present," he added, "the
corporate structure of CNA is worded in
such a way that the provinces named are
members, and there is no provision for
withdrawal for member associations. This
bylaw on withdrawal must be added," he
explained, "to comply with the Canada
Corporations' Act's requirements for
Letters Patent companies."
Other bylaw amendments of a more
formal nature will also be required, Mr.
Henderson said.
A copy of the old bylaws and the
proposed bylaws will be sent to the
provincial nurses' associations in mid-
April for study by their legislative and
bylaw committees. The final draft of the
bylaws will be sent to the provincial
associations at least two months ahead of
the special general meeting in November.
Board Approves Revised
Continuing Education Statement
Ottawa. -The revised statement on
continuing education prepared by the
Committees on Nursing Education and
Nursing Service of the Canadian Nurses'
Association was accepted by the CNA
Board at its meeting February 1 1-14.
The original statement had been refer-
red back to the committees for restate-
ment and clarification by the CNA Gen-
(Continued on page 10,
MARCH 1%S
WHO NEEDS
Aspirators?
Every hospital needs these time-
tested, precision built aspirators for post-
operative work, urological and broncho-
scopic suction, removal of mucus from
the throats of newborn and general bed-
side suction.
Gomco 789 shown in use weighs only 16
pounds, is easily carried, requires less than
1 sq. ft. of space.
Gomco 799 stand-mounted unit shown left.
Large capacity vacuum bottle. Mobile, easy
to move about.
Gomco 796 cabinet Aspirator — just right
for Recovery, Nursery, Out-Patient, Emer-
gency, and Dental Clinic.
Not shown — Gomco 791 stand-mounted
Aspirator and 792 portable — both with
o" to 25" vacuum, and Gomco 790 stand-
mounted O" to 20" vacuum.
See your dealer, or for newest catalog,
write: GOMCO SURGICAL MANUFAC-
TURING CORP., 828 E. Ferry St., Buffalo,
New York 14211
D*pt. c-a J
lU lf>ME NT
(Continued from page 8)
eral Meeting of July 1968. The revised
statement will appear in a future issue of
The Canadian Nurse.
The Board also agreed to a recom-
mendation from the Nursing Service
Committee that CNA's Social and Eco-
nomic Welfare Committee be asked to
consider: what social or financial re-
cognition could be given to nurses giving
excellent performance versus those giving
average performance; and ways to main-
tain standards of care when collective
bargaining agreements are drawn up.
The Committee met at CNA House
January 14 to 16 under the chairmanship
of Margaret McLean.
Board Approves
Nursing Education Motions
Ottawa. - The Board of Directors of
the Canadian Nurses' Association will
make efforts to initiate dialogue between
the allied health professions on the ques-
tion of proliferation of categories of
health workers, with a view to formula-
ting a policy statement.
This decision was taken on a recom-
mendation by CNA's Committee on Nurs-
ing Education, made at the Board meet-
ing February 11 to 14. The Board also
agreed to the following motions made by
the Committee:
• The regulation of entry into the nurs-
ing profession, including approval of basic
nursing programs, must rest with the
legally constituted professional nursing
body in each province. This move was felt
necessary since diploma schools of nurs-
ing are moving into the general educa-
tional stream, and concern has been
expressed as to whom has the legal
authority to approve programs in these
cases.
• Since some activities of non-nursing
personnel affect the welfare of those
receiving nursing care, nurses should col-
laborate in educational programs for such
workers.
• Those students studying nursing in
university programs should receive
priority in the use of hospital and health
agency experience until CNA's recom-
mended ratio of two categories of nurse
practitioners is reached. This ratio is one
graduate of a baccalaureate program in
nursing for every three diploma program
graduates. At present, some 94 percent of
working nurses in Canada hold diplomas;
the remaining six percent have degrees.
The Nursing Education Committee
met prior to the Board meeting, January
21-23, under the chairmanship of
Kathleen Arpin.
10 THE CANADIAN NURSE
Winnipeg. - Manitoba Lieutenant Governor Richard S. Bowles officially opened
the new headquarters of the Manitoba Association of Registered Nurses January 17.
Some 80 official guests watched as Lillian Pettigrew, associate executive director,
Canadian Nurses' Association, unveiled a cornerstone marking the occasion. Miss
Pettigrew is seen above (right) with Dorothy Dick, MARN president.
Miss Pettigrew, for many years MARN executive secretary, said, "This fine
building identifies the vitality of the profession in Manitoba and bears testimony to
the faith of nurses in the permanence of their services. May the facilities of this
handsome headquarters inspire their efforts and assure their success."
Items of historical interest to nursing were placed behind the cornerstone, to be
opened in 100 years. Included were biographical sketches of MARN's honorary
members.
Greetings were extended by Alderman Inez Trueman, from the City of
Winnipeg; Thomas B. Findlay, Counsellor of the MetropoUtan Corporation of
Greater Winnipeg; Dr. R.H. Tavener, from the provincial health ministry; and
Labour Minister C.H. Witney, representing Manitoba Premier Walter Weir.
Mailing Charges Both Ways
On CNA Library Loans
Ottawa. -As a result of increased
postal rates, the Canadian Nurses' As-
sociation's library will now require all
borrowers to pay mail charges both ways.
The decision was made by the Board of
Directors at its meeting February 11-14,
1969 and will be effective April 1, 1969.
Payment of mailing charges both ways
has always been a requirement under the
formal inter-library loan agreement. This
requirement has not previously been ex-
tended to individual or institutional bor-
rowers who do not use the standard
inter-library loan forms. Now, in addition
to paying the return postage, all bor-
rowers will be expected to refund, in
postage, the cost of mailing library ma-
terial to them.
Draft Standards To Be Tested
Ottawa. —The present draft standards
drawn up by the Ad Hoc Committee on
Standards for Nursing Service of the
Canadian Nurses' Association will be test-
ed in selected areas before final revision.
CNA Board of Directors, meefing
February 11 to 14, agreed to a plan for
testing these standards laid out in a
progress report by Committee Chairman
Irene Buchan: approval of areas selected
for testing will be sought; draft standards
will be forwarded; and each committee
member will be assigned to a particular
area for necessary discussion.
Purpose of the testing is to determine
whether these standards are concise, ap-
plicable, reliable, etc. Comments from
testing areas will be used in the final
revision.
The draft standards are in the form of
a self-evaluation guide, since the final
standards are planned as a tool for use by
nursing administrators in all nursing ser-
vices in evaluating and improving the
quality of nursing service.
(Continued on page 12}
MARCH 1969
when teen-agers want to know about menstruation
one picture may be worth a thousand words
Never are youngsters more aware of their own
anatomy than when they begin to notice the changes
of adolescence. And never are they more susceptible
to misinformation from their friends and schoolmates.
To negate half-truths, give teen-agers the facts —
using illustrations from charts like the one pictured
above. They'll help answer teen-agers' questions about
anatomy and physiology. These SVa" x 11" colored
charts of the female reproductive system were pre-
pared by R. L. Dickinson, M.D. and are supplied free by
Canadian Tampax Corporation Ltd. Laminated in
plastic for permanence, they are suitable for grease
pencil marking. And to answer their social questions
on menstruation, we also offer two booklets — one
for beginning menstruants and one for older girls —
that you may order in quantities for distribution.
Tampax tampons are a convenient — and hygienic
— answer to the problem of menstrual protection.
They're convenient to carry, to insert, to wear, and
to dispose of. By preventing menstrual discharge from
exposure to air, Tampax tampons prevent the embar-
rassment due to menstrual odor. Worn internally, they
MARCH 1%9
cause none of the irritation and chafing associated
with perineal pads.
Tampax tampons are available in Junior, Regular
and Super absorbencies, with explicit directions for
insertion enclosed in each package.
TAMPAX
SANITARY PROTECTION WORN INTERNALLY
MADE ONLY BY CANADIAN TAMPAX CORPORATION LTD.. BARRIE. ONT.
FREE CHARTS IN COLOR
Canadian Tampax Corporation Ltd.. P.O. Box 627, Barrie, Ont.
Please send tree a set ot the Dickinson charts, copies of the
two booklets, a postcard for easy reordering and samples of
Tampax tampons.
Name_
Address.
THE CANADIAN NURSE 11
Next Month
in
The
Canadian
Nurse
• Screening Program for
Cancer of the Cervix
• Hemodialysis in the Home
• Calculating Your Income Tax
^Z7
Photo credits for
March 1969
Crombie McNeill Photography,
Ottawa, p. 7
University of British Columbia, p. 8
David Portigal & Co. Ltd.,
Winnipeg, p. 10
Peter Bregg Photographer,
The Canadian Press, p. 17
St. Michael's Hospital, Toronto,
pp. 30, 31
Tara Dier, Ottawa, pp. 32, 33
Tom Bochsler Photography,
Hamilton, p. 38
Ed. Bermingham Inc., Montreal,
p. 40
(Continued from page 10)
This guide will include areas on: philo-
sophy; objectives; functional structure of
the nursing department; personnel,
material resources; and the nursing de-
partment within the total organization.
CNF Elects New Board,
Ponders Financial Problem
Ottawa. -Members at the annual
meeting of the Canadian Nurses' Founda-
tion elected a new Board of Directors to
serve a two-year term — then briefly
reviewed some of the problems that the
new Board will have to face.
Elected to the Board were: Jean
Church, Dorothy Dick, E. Louise Miner,
M. Geneva Purcell, and Albert W.
Wedgery from the Board of Directors of
the Canadian Nurses' Association; and
Alice Beattie, Sister Marie Bonin, Hester
J. Kernan, and Marion C. Woodside from
the membership-at-large. The new presi-
dent and vice-president will be elected
from the board at its first meeting.
Few solutions were proposed for the
Foundation's financial ills. This year,
members had to vote to transfer $10,000
from the general membership fund into
the scholarship fund to provide at least
$25,000 for awards. This is about one-
half the amount awarded in 1967 or
1968.
"Any moneys raised before awards are
given in May would, of course, be added
to the funds," retiring president M. Jean
Anderson reported.
Other suggestions to promote interest
in CNF and to raise money were dis-
cussed during the meeting and will be
taken to the Board for decision.
Members approved a suggestion from
the retiring Board that baccalaureate
awards again be deferred (for 1969-70) as
funds are so low.
One member suggested that CNF
should plan more and better promotion
and publicity campaigns. Miss Anderson
reviewed what had been done during the
past year and added that she hoped that
the provinces would undertake more res-
ponsibility in this area. Miss Anderson
added that the Board is considering a
promotion campaign to let nurses know
how they may leave money to the Foun-
dation in their wills. "We believe that
many nurses do not know that they can
do this, or know how to go about it," she
said.
A suggestion that the CNF meeting be
held concurrently with the CNA meeting
was made by one member-at-large. She
added that this might promote more
interest among nurses. This year's annual
meeting was held February 1 1 during the
12 THE CANADIAN NURSE
week of the CNA Board meeting so that
representation from all provinces would
be assured. About 35 of the 1,494 mem-
bers attended. Only 16 members had
attended the previous annual meeting.
A suggestion that membership fees be
raised from $2 to $5 was discussed and
several members suggested it would not
be feasible at this time. "We need a large
volume of members - and we'll never
attract them by raising the fees," was one
comment.
The new Board will meet within the
next few weeks to consider these matters.
ANPQ Donates $50,000
To ICN Congress
MontreaL-A gift of $50,000 has been
donated by the Association of Nurses of
the Province of Quebec to the XIV
Quadrennial Congress of the International
Council of Nurses, to be held June 22-28
in Montreal.
The decision to donate the money was
made by the Committee of Management
of the ANPQ in October, 1968, but the
gift was not announced until mid-January
when the cheque was received by Helen
K. Mussallem, executive director of the
Canadian Nurses' Association. According
to Helena F. Reimer, secretary-registrar
of the ANPQ, the gift was made for four
reasons: the heavy costs of the ICN
Congress; the fact that the ICN president,
Alice Girard, is a member of the ANPQ,
and that the Congress is to be held in
Montreal; and because the ANPQ is a
member of the CNA.
Dr. Mussallem thanked the ANPQ for
the donation, commenting, "This tangible
evidence of support is heartwarming to
those who bear the responsibility for the
execution and financing of the large
international convention."
ICN Registration Deadline
Extended To March 31
Ottawa. -The deadhne for the $40
registration fee for the 14th Quadren-
nial Congress of the International Coun-
cil of Nurses has been extended to
March 31 from January 22, according to
Harriet J.T. Sloan, ICN Congress
Coordinator.
The extension of the deadline is due
to delays in transmittal and processing
of registration forms, Miss Sloan said.
The fee for registration after March 31
will be $60.
The completed registration, together
with the necessary money, must be
received at CNA House, 50 The Drive-
way, Ottawa 4, by March 31 to qualify
for this advance fee.
The completed registration, together
with the necessary money, must be
received at CNA House, 50 The Drive-
way, Ottawa 4, by March 31 to qualify
for this advance fee.
MARCH 1%9
news
Curriculum Conferences Held
in Vancouver and Victoria
Ottawa.-Two conferences on curric-
ulum construction, sponsored by the
Registered Nurses' Association of British
Columbia, were conducted last month by
Sliirley R. Good, consultant in higher
education, Canadian Nurses' Association.
The first was held in Vancouver February
3 and 4, and the second in Victoria,
February 6 and 7.
"The request from RNABC was for a
conference dealing with curriculum as it
relates to concepts and principles," Dr.
Good told The Canadian Nurse. To deal
with this question. Dr. Good compared
the construction of curricula to con-
struction of buildings, and divided her
theme "Highrise for Curricula" into five
sections.
The first section, "selection of site,"
.considered the question of how a person
thinks, and the thought process. Critical
thinking was dealt with in the second
section, "concrete foundations." "Tools
of the trade" differentiated between con-
cepts and principles, and "windsway fac-
tor" dealt with concepts, definitions, and
statements of concepts. The final section,
"staircases," considered the design of a
nursing curriculum based on these ideas.
Throughout the conference, partic-
ipants divided into small groups to con-
sider vignettes presented for discussion.
They were asked to identify nursing
knowledge, the principles inherent in the
knowledge, and the basis for nursing
judgment and action.
Participants included instructors of
nursing assistants and psychiatric nurses,
as well as instructors in diploma and
university schools of nursing.
ICN Registration Triples
Ottawa, -Canadian registration for the
Congress of the International Council of
Nurses to be held in Montreal has almost
tripled since January 10, 1969. As of
February 10, 2,145 Canadians had regis-
tered for the June 1969 Congress, nearly
1,400 more than one month earlier. On
January 10, Harriet J.T. Sloan, ICN
Congress Coordinator, reported that 756
Canadians had registered for the inter-
national meeting.
Breakdown of registration up to Feb-
ruary 10, 1969 is:
British Columbia 98
Alberta 126
Saskatchewan 38
Manitoba 68
Ontario 693
Quebec 802
Nova Scotia 53
New Brunswick 107
Prince Edward Island 13
MARCH 1969
Newfoundland
Students
Total
10
2,008
137
2,145
Alberta And British Columbia
Announce Contributions To ICN
Ottawa, —The Alberta Association of
Registered Nurses and the Registered
Nurses' Association of British Columbia
recently announced contributions to the
International Council of Nurses XIV
Quadrennial Congress to be held in
Montreal June 22-28.
The AARN will donate S7,000 and the
services of its public relations officer,
Donald LaBelle, for the duration of the
Congress. The Association is also planning
a hospitality luncheon at which AARN
members will entertain a representative of
each international association attending
the Congress. The provincial council of
AARN is providing funds to district
executives to assist in defraying costs of
members attending the Congress.
The RNABC will also donate the
services of its public relations officer, N.
Fieldhouse, for the Congress, and $5,000
toward the cost of holding the Congress.
The Association will pay the living ex-
penses of RNABC staff at the Congress,
and of six nurse hostesses from BC. It wiU
also donate 12,000 Canadian flags and a
number of copies of the publication
Beautiful BC. Another $500 will be
donated to provide music for the Con-
gress.
SRNA Announces
Annual CNF Donation
Ottawa. -The Saskatchewan Regis-
tered Nurses' Association recently an-
nounced that a contribution of $1. per
member will be given annually to the
Canadian Nurses' Foundation, commen-
cing this year.
This brings to three the number of
provincial nurses' associations that have
pledged annual contributions to CNF: the
Registered Nurses' Association of British
Columbia, the Alberta Association of
Registered Nurses, and SRNA.
At the CNF annual general meeting
February 1 1 in Ottawa, president M. Jean
Anderson noted that small group dona-
tions from Alberta, British Columbia, and
Saskatchewan have increased in number,
probably because nurses in these pro-
vinces are more aware of the Founda-
tion's needs.
Special Sessions
For ICN Congress Registrants
Ottawa — Nineteen special interest
and clinical sessions will be presented
during the 14th Quadrennial Congress of
the International Council of Nurses in
Montreal, June 22-28, 1969. According
to ICN Congress Coordinator Harriet J. T.
V\m QUAlin PRODUCIii
POSEY HEEL PROTECTOR
(Patent Pending)
The Posey Heel Protector serves to protect
the heel of the foot and prevents irritation
from rubbing. Constructed of slick, pliable
plastic, lined with synthetic wool. Con be
washed or autoclaved. No. HP-63ALW.
$3.90 ea. — $7.80 pr. (w/out plastic shell)
$5.25.
NO. 66
POSEY SAFETY
BEIT
(Potent Pending)
of potlvnti
This new
Posey Belt
provides safe-
ty to o bed
patient yet
permits him
to turn from side to
side. Also allows sitting
up. Mode of strong, re-
inforced white cotton
webbing; with flonnel-lined canvas reinforced
insert. Strap posses under bed after a turn
around spring roil to anchor. Friction-type
buckles. Buckle is under side of bed out of
patient's sight and reoch. Also ovoiloble
in Key-Lock model which attaches to each
side of bed. Small, medium and large
sizes. No. 66. $8.25. Key-Lock Belt, No.
K66, $13.95. No. 66-T. (ties on sides of
bed) $8.tO.
POSEY SAFETY BELT
(Patented)
Allows maximum freedom with sofe re-
straint. An improvement over sideboards,
the Posey belt is designed to be under the
patient and out of the way. Belt and bed
strap ore of heavy white cotton webbing;
loop and pod of cotton flannel. Friction-type,
rust-resistant buckles. Small, Medium ond
Large sizes. Safety Belt, No. S-141, $6.90.
(Extra heavy construction with key-lock
buckles. No. 453, $19.80)
POSEY PRODUCTS
Stocked in Canada
ENNS & GILMORE LIMITED
1033 Rangeview Road
Port Credit, Ontario, Canada
THE CANADIAN NURSE 13
Sloan, most of the 19 sessions will be
presented in English and French beginning
Monday June 23 and ending June 27.
Topics for the special interest sessions
include: leadership and management; use
of computers in nursing service adminis-
tration; audiovisual media in nursing
education; the printed word (learning the
writer's skills); nursing journaHsm;
libraries in schools of nursing and for
professional associations; forming and
developing the national association; nurs-
ing legislation; and nursing research.
Topics for the clinical sessions include:
continuity of patient care; nurses and the
practice of nursing; psychiatric and
mental health nursing; implications for
nursing practice for patients with heart
surgery; outpost nursing; implications for
nursing practice with patients with renal
transplantations; occupational health;
emergency health preparedness; rehabil-
itation; and space age nursing.
F
at
your
fingertips...
secure
umbilical cord
ligation
\
When it's time to ligate the umbilical cord, a Hollister
Double-Grip^" Cord-Clamp should be within reach. Its
contoured finger-grips and wide jaw angle make one-
hand application easy.
Hollister's Cord-Clamp has other benefits too: a hinge
guard to keep even a large cord within the sealing area;
firm-holding Double-Grip jaws to prevent slipping; a
constant, even pressure to eliminate the dangers of seep-
age; and no need for belly bands or dressings. The clamp
has a permanent, blind closure. When it's ready for re-
moval—usually after 24 hours— the clamp is simply cut
through at the hinge. Hollister provides the clipper.
This disposable, lightweight Hollister Cord-Clamp may
be autoclaved, or it can be purchased in individual pre-
sterilized packets. Write for samples and literature, on
hospital or professional letterhead, please.
Q
HOLLISTER
IN CANADA: 160 BAY ST.. TORONTO I. ONT.
211 L CHICAGO AVE., CHICAGO, ILL. eOCII
14 THE CANADIAN NURSE
NBARN Presidents' Conference
Fredericton, -"The Chapter Chain -
Improvement Through Involvement" was
the theme of the seventh Presidents'
Conference held January 22-23 by the
New Brunswick Association of Registered
Nurses. Twenty-one presidents and vice-
presidents representing the 1 1 chapters in
the province attended the sessions, held
at NBARN headquarters.
Purposes of the conference were two-
fold: to assist present and future chapter
presidents in carrying out their respon-
sibilities of office; and to provide an
opportunity for chapter leaders to meet
and discuss common problems and ex-
periences.
The program covered several areas of
chapter programming, including chapter
bylaws, executive committees, standing
committees, program and finance com-
mittees. Problem-solving situations, a skit,
and group discussion were among the
methods of presentation.
Other items discussed were: NBARN
Act and By-Laws, job responsibilities of
provincial office staff, the new Public
Service Labour Relations Act, the 14th
Quadrennial Congress of the International
Council of Nurses and the 1970 General
Meeting of the Canadian Nurses' Asso-
ciation, to be held in Fredericton.
PEI Nurses Granted
Salary Increases
Charlottetown, PEI. —Prince Edward
Island nurses working in hospitals finan-
ced by Hospital Insurance have been
granted a salary increase raising their
basic salary from $326 to $396 per
month. The increase was effective Jan-
uary 1, 1969.
The increase falls short of the original
demands of the nurses: a 10 percent
increase retroactive to January 1, 1968,
and a further 15 percent increase effec-
tive January 1, 1969. This would have
brought the basic salary to S424 per
month. The nurses had been threatening
mass resignations previous to the settle-
ment.
Under the new terms, nurses would
reach a maximum salary of $458 in four
years, or in four increments. In the past
there had been five increments.
Nurses working for provincial govern-
ment hospitals and agencies are expecting
a similar increase, possibly retaining the
five increments. Their increase will be
effective April 1, 1969.
The basic salary for nursing assistants
has been increased to $250 with five
increments to a maximum of $357 per
month.
Community College in Ontario
To Start Nursing Program
Toronto. -In September 1969,
Humber College of Applied Arts and
MARCH 1%9
Technology will become the first com-
munity college in the province to add a
two-year diploma nursing course to its
curriculum.
The program, developed by Humber
College and St. Joseph's Hospital School
of Nursing, wUl be similar to the program
presently being carried out at St.
Joseph's.
Students who enroll in the College
program will use the clinical facilities at
St. Joseph's Hospital and Etobicoke Gen-
eral Hospital, when the latter is complet-
ed. Annual tuition fees will be SI 85 plus
the cost of books, uniforms, and labo-
ratory fees. Students will have six weeks
vacation annually.
In an interview with The Canadian
Nurse, Albert Wedgery, president of the
Registered Nurses' Association of On-
tario, commented favorably on Humber
College's plans.
"This announcement is an encouraging
sign of changing attitudes about the kind
of preparation that nurses need to func-
tion properly in today's complex
society," Mr. Wedgery said. "With other
Canadian provinces having moved, or
about to move, their diploma programs in
nursing into the stream of general educa-
tion, this new opportunity at Humber
College anticipates a similar, but gradual,
development in Ontario. Perhaps the
most enlightening aspect of this proposed
program," he continued "is the fact that
a hospital school of nursing, with a long
and notable history, has decided to merge
into an educational system that provides
a broader professional base for nursing
practice."
Collective Bargaining Workshops
'Held Across Manitoba
Ottawa.— A series of special educa-
tional workshops on collective bargaining
is being held across Manitoba, sponsored
by the employment relations committee
of the Manitoba Association of Register-
ed Nurses. The series runs February 1 7 to
March 13.
Conducting the workshops is Glenna
Rowsell, consultant in social and econ-
omic welfare for the Canadian Nurses'
Association, assisted by MARN staff and
members of the employment relations
;ommittee.
Two workshops are being held in
Winnipeg, the others in Swan River,
Dauphin, Flin Flon, Morden, Russell, and
Brandon. Aim of these workshops is to
Jiterpret to MARN members; clarifi-
;ation of collective bargaining; the func-
ion of a professional association in col-
ective bargaining; the responsibility of
vlARCH 1%9
individual members; and the effects of
working under a collective agreement.
New Brunswick Nurses
To Be Granted
Collective Bargaining Rights
Fredericton. —Some 3,600 New Bruns-
wick nurses were among 30,000 public
service employees recently granted full
collective bargaining rights in the Pubhc
Service Labour Relations Act, passed
December 4, 1968 by the New Brunswick
Legislature. Prior to this, only 20 percent
of the public service employees had
collective bargaining rights. Nurses were
among those excluded.
The new Act, which comes into effect
on a date fixed by proclamation, forbids
employees to picket, parade, or dem-
onstrate, and forbids the employer to
replace striking employees. When nego-
tiation fails, the employees have the
choice of arbitration or strike action with
provision for continuation of essential
services if strike action is chosen.
Under the Act, employees are divided
into four categories. The majority of
nurses are included under the category of
TO PLAN FOR A LIFETIME
Marriage is a respontibilitY ')«>' often re-
quires both spirituol and medicol assistance
from professional people. In many instances
a nurse may be called upon for medical
counsel for the newly married young wo-
man, motheff or a mature woman.
"To Plan For A Lifetime, Plan With^Your Doc-
tor" is a pamphlet that was written to assist
in preparing a woman for patient-physician
discussion of family planning methods. The
booklet stresses the importance to the indi-
vidual of selecting the method that most
suits her religious, medical, and psychological
needs.
Nurses are invited to use the coupon below
to order copies for use as an aid in coun-
selling. They will be supplied by Mead John-
son Loboratories, a division of AAead John-
son Canada Ltd., as a free service.
MeadjiJiTiMn
LABORATORI ES
n
ORDER FORM To: Mead Johnson Laboratories,
95 St. Clair Avenue West,
Toronto 7, Ontario.
Please send copies of "To Plan For A Lifetime, Plan With Yeui
Doctor" to;
Nome
Address
l_
THE CANADIAN NURSE 15
hospital board employees. A small
number of nurses are in another category
that includes civil servants. The govern-
ment Treasury Board has been designated
as the employer for these groups for
purposes of the Act.
The Act authorized the establishment
of a Public Service Labour Relations
Board, to be an independent body
responsible for supervision of the in-
terests of employees and employers, and
safeguarding the interests of the public. A
Public Service Arbitration Tribunal, con-
sisting of a chairman and representatives
from labor and management, will also be
established.
The Act specifies that the collective
bargaining will begin with a 45-day
negotiation period. If no agreement is
reached, a conciliation officer must file a
report within 14 days. At the same time
the employer submits to the Public
Service Labour Relations Board a list of
individual employees and work categories
required to maintain essential services;
the union may contest these designations,
but the final decision rests with the
Labour Relations Board.
After the conciliation officer's report,
1 5 days are allowed for the estabUshment
of a conciliation board; this board is given
30 days to make its report. At this time
either party may request that the Public
Service Labour Relations Board declare a
deadlock. After the chairman is satisfied
that a deadlock exists, he has three days
to declare it and to see if the parties will
submit their disagreements to arbitration.
If they agree to arbitration, both groups
must submit statements on the points of
disagreement to the arbitration tribunal
within 14 days. Work continues during
this period. If both parties do not agree
to arbitration, the employees' bargaining
unit may hold a strike vote.
The New Brunswick Association of
Registered Nurses called the Act "fair and
reasonable." The Association is prepared
to apply for certification as a bargaining
agent as soon as possible under the new
Act.
Workshops On Test Construction
To Be Held in London
London, Onf. -Vivian Wood, assistant
professor of nursing at the University of
Western Ontario, will conduct a work-
shop on test construction at the Uni-
versity May 5-7.
The workshop will concentrate on a
discussion of measurement, exploration
of examination blueprint models, and
essay and objective examinations. Partic-
ipants will be developing skills in writing
16 THE CANADIAN NURSE
essay questions, developing blueprints for
examinations, preparing model essay
answers, and marking essay answers.
Skills in item-writing and item-analysis
will also be discussed, and the final
assessment of students will be explored
by examining the various models in
grading.
Cost of the course is $75, plus $7 per
night for accommodation. The course is
limited to 30 people.
1969 Fee$ Are Due
Ottawa. - Nurses in four provinces
will pay more for membership in their
provincial associations in 1969, accord-
ing to Ernest Van Raalte, general
manager of the Canadian Nurses' Associ-
ation.
Nurses' fees, however, are,on the av-
erage, lower than fees for other profes-
sional or union groups, Mr. Van Raalte
added. "For example, union dues for
postal workers are a minimum of $5 a
month - or $60 a year (the local unit
can set a higher rate if it wishes). This is
considerably higher than the association
fee for nurses, which includes other
benefits, such as membership fees in the
national and international nursing asso-
ciations and costs of the provincial
bulletins and the national nursing
magazine," he said.
Mr. Van Raalte said that associafion
fees for social workers are higher than
those of nurses; they range from a low
of $45 in one province to $65 in an-
other. The yearly association fee for
doctors in the Canadian Medical Asso-
ciation is $300.
Association fees for nurses registered
to practice (renewals) in the 10 provin-
cial associations are:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Nova Scotia
Ontario*
P.E.I.
Quebec
Saskatchewan
1968 1969
$30 $35
$37 $37
$35 $35
$30 $30
$27 $35
$25 $25
$35 $35
$25 $30
$25 $25
$27 $40
♦Ontario nurses also pay $5 to the
College for registration fees.
Nurses' Associations
Granted Salaries
That Exceed Those Set By OHSC
Toronto. —Through arbitration pro-
cedures, two groups of Ontario nurses
have been awarded salaries that exceed
those established by the Ontario Hospital
Services Commission.
The Nurses' Association, Metropolitan
General Hospital in Windsor, has been
awarded a starting salary of $480 for
general staff nurses, with a maximum of
$585 to be achieved by 5 annual incre-
ments of $21. Salaries for all other levels
included in the contract are also above
the OHSC stipulated figures. The Com-
mission's declared policy for nurses'
salaries for 1969 is based on a starting
salary of $470 for a staff nurse, with a
maximum salary of $570, achieved by 5
annual increments of $20 per month.
The Nurses' Association, St. Joseph's
Hospital, Peterborough, received starting
salaries of $475.
In the Metropolitan contract, provi-
sion is made for 3 weeks vacafion after 1
year, 4 weeks after 5 years, and 5 weeks
after 25 years. Teachers are to receive 4
weeks after 1 year, and 5 weeks after 25
years. One important provision in the
contract was for a continuing "Pro-
fessional Committee," made up of repre-
sentatives of the Nurses' Association and
the hospital. Under benefit plans, the
hospital pays 100 percent for single
coverage and 66-2/3 percent for family
coverage.
According to Isabel LeBourdais, public
relations officer, Registered Nurses'
Association of Ontario, "It is significant
that, except for nurses at Riverview
Hospital, Windsor, it is only the arbi-
tration procedure that achieves a break-
through from pre-determined standards
set by a third party [OHSC]that is not
present at negotiations."
The Nurses' Association, Riverview
Hospital, achieved the first collective
bargaining contract in a hospital in On-
tario. Under the present contract their
starting salary moves to $500 per month,
June 1, 1969.
ANA Supports AMA's Move
Against Discrimination
New York. - The American Nurses'
Associafion has congratulated the Amer-
ican Medical Association on its move to
eliminate discrimination on the basis of
color, creed, race, religion, or ethnic
origin. A meeting of the AM A in Miami in
December amended the bylaws of the
Associafion to discourage and ehminate
discriminafion in membership.
Dorothy A. Cornelius, president of
ANA, had sent a message to AMA pres-
ident Dwight L. Wilbur before the meet-
ing, expressing an interest in the proposed
changes, and citing the ANA's experience
in integration.
ANA began its fight to eliminate dis-
criminafion in membership in 1946 by
establishing a category of individual
membership, allowing Negro nurses in
states where the nurses' associations
practiced discrimination, to join ANA
directly. Discrimination in state and local
districts disappeared by 1964. D
MARCH 1%S
names
Loral Graham,
who joined the staff
of THE CANADIAN
NURSE as editorial
assistant in Septem-
ber 1967, and later
was promoted to as-
sistant editor, resign-
ed last month. Mrs.
A Graham and her
husband, who is employed by the federal
government's Department of External
Affairs, expect to leave Canada shortly
for a posting abroad. Accompanying
them will be a new member of their
family.
Mrs. Graham was graduated from
Carleton University with an honors
degree in English in 1966. She was
employed by the National Research
Council as an information services officer
'before joining the editorial staff of
THE CANADIAN NURSE.
During her one and one-half years with
'the journal, Mrs. Graham was responsible
for all of the magazine's departments
with the exception of the "News" sec-
tion. She wrote several lively articles, one
of which ("Defend Yourself, August
1968) received nation-wide pubHcity.
This same article had the distinction of
being the first article from the
CANADIAN NURSE to appear, in con-
densed form, in the New York Times.
Carol Kotlarsky
became editorial as-
assistant for the
CANADIAN NURSE
in February 1969. A
1967 journalism
graduate from Carle-
ton University, Ot-
tawa, Miss Kotlarsky
comes to Ottawa
from Quebec City where she was em-
ployed as an editor by the federal Depart-
ment of Forestry and Rural
Development.
While a student at Carieton University,
Miss Kotlarsky published articles in
School Progress, did contract writing for
the Canadian Government Travel Bureau,
and worked part-time for the Financial
Times of Canada.
Ottawa.-Governor General Roland Michener is seen presenting the Order of the
British Empire (military division) for gallantry to Captain (N/S) Joan Cashin, 27, a
night nurse with the Royal Canadian Army Medical Corps. The investiture took
place in a ceremony January 4 at Government House. Nursing Sister Cashin
received the OBE for her bravery in giving medical assistance at the crash scene of a
( zechoslovakian aircraft near Gander International Airport September 5, 1967.
Now stationed at Canadian Forces Base Trenton, Nursing Sister Cashin is credited
with saving many lives.
lARCH 1%9
University of Toronto has granted the
degree of Doctor of Philosophy to
losephine Flaherty (B.Sc.N., B.A., M.A.,
U. Toronto). Dr. Flaherty earned the
degree through the Ontario Institute for
Studies in Education and is the first
graduate of the University of Toronto
School of Nursing to obtain a doctorate.
After graduating from the school of
nursing, University of Toronto, in 1956,
Dr. Flaherty was charge nurse at the Red
Cross Outpost Hospital, Matachewan, On-
tario. From 1960 to 1962 she taught at
Nightingale School of Nursing, Toronto,
while working for her B.A. in history.
After lecturing at the University of To-
ronto School of Nursing for two years,
Dr. Flaherty took the M.A. degree in the
University's School of Graduate Studies,
at the same time acting as part-time re-
search assistant.
At the Ontario Institute for Studies in
Education, Dr. Flaherty is an assistant
professor in the Department of Adult
Education, where she teaches courses in
psychology and adulthood, and in re-
search and statistics. She is involved in
research in adult education and in edu-
cation for nursing and the professions. In
addition. Dr. Flaherty serves as a con-
sultant in nursing in the field of evalu-
ation and program planning.
Marie Therese Sa-
bourin (R.N., St.
Paul's H., Vancou-
ver; B.ScN., Seattle
U., Wash.; M.N., U.
Washington) is the
new director of nurs-
ing service for the
Registered Nurses'
Association of
British Columbia. She was formerly
director of nursing service at St. Paul's
Hospital, Vancouver.
Miss Sabourin was bom in Ottawa and
received her early education and teacher's
training there. After receiving her teach-
ing certificate in 1945, she taught in Ot-
tawa elementary schools for five years.
She has served on the nursing staff at
hospitals in Saskatchewan, Alberta, and
British Columbia and has been as active
member of professional nursing asso-
ciation activities. Q
THE CANADIAN NURSE 17
Leadership identified.
TM
Consider the responsibilities of leadership in products for intravenous therapy
...Quality standards must be the highest attainable. And these standards
must be maintained through constant testing.. .checking, and re-testing...
every step of the way. Making the finest products available is where our
leadership begins. And so that the finest is readily identified, we've changed
the names to make them more descriptive.
Ideniify wifh fhe leader ...C.R. BARD, INC.
BARDIC Inside needle catheter
— r-
BARDIC Inside needle catheter: The radiopaque catheter is gently inserted into the vein
from inside the bore of the non-coring needle. The needle is then withdrawn leaving only
the catheter in the patient's vein.
BARDIC'Around needle catheter
BARDIC Around needle catheter: The tapered catheter is inserted into the vein from
around the sharp, non-coring needle. The Around needle catheter placement technique
allows complete removal of needle leaving only the soft, pliant catheter in the vein.
INTEGRITV
J
'
C. R. BARD (Canada) LTD.
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SINCE 1907 0
®C. R. BARD, INC. 1969
March - May, 1969
Continuing education courses for
nurses, The University of British Colum-
bia. March 20-21: The nnoternity cycle
viewed as a developmental crisis.
May 1-2: Preoperative nursing care.
AAay 8-9: Nursing assessment. May
15-16: Nursing the adult with long-
term illness — sociological aspects.
For information write to: Continuing
Education in the Health Sciences, Task
Force Building, The University of Brit-
ish Columbia, Vancouver 8, British
Columbia.
March 20-21, 1969
Workshop on hearing, measurement,
and conservation, University of Toron-
to. Intensive training for occupational
health nurses, industrial audiometric
technicians, and safety supervisors.
Apply to: Special Programmes, Divi-
sion of Extension, University of Toron-
to, 84 Queen's Park, Toronto 5.
March 20-23, 1969
April 14-17, 1969
Regional conferences on the use of
audiovisual aids in nursing, sponsored
by the Registered Nurses' Association
of Ontario. To be held in Ottawa in
AAarch, and Fort William in April. Fee:
RNAO members, $25; non-members,
$35. Write to RNAO, 33 Price St.,
Toronto 5.
March 24-29, 1%9
Symposium on recovery room and in-
tensive core nursing, Grace General
Hospital, Winnipeg. Registration: $20.
For further details: Miss J.W. Robert-
son, Director - Inservice Education,
Grace General Hospital, 300 Booth
Dr., Winnipeg 12.
April 7, 1969
World Health Day
Theme: Health, Labor,
and Productivity.
April 13-17, 1%9
American Association of Neurosurgi-
cal Nurses Meeting, Cleveland, Ohio.
Information may be obtained from:
Miss S.M. Sowchyn, 99 Fidier Ave.,
St. James 12, Manitoba.
20 THE CANADIAN NURSE
April 14 - May 9, 1%9
May 12 - June 6, 1969
Rehabilitation Nursing Workshops,
University of Toronto. Four-week
course for R.N.s employed in acute
general end chronic illness hospitals,
nursing homes, public health agencies,
and schools of nursing. Tuition fee:
$150. Apply to: Division of University
Extension, Business and Professional
Courses, 84 Queen's Park, Toronto 5.
April 20, 1969
Second Annual Dialysis Symposium
for Nurses, held in conjunction with
annual meeting of American Society
for Artificial Internal Organs, at Chal-
fonte-Haddon Hall, Atlantic City, New
Jersey. Organized by the US Public
Health Service's Kidney Disease Con-
trol Program. For further information
write: Michael A. Byrnes, Information
Services Section, Dept. of Health, Edu-
cation, and Welfare, Public Health
Service, Health Services and AAental
Health Administration, 4040 North
Fairfax Dr., Arlington, Virginia 22203.
April 28 - May 2, 1%9
Final workshop of the Extension
Course in Nursing Unit Administra-
tion, Regina, offered in English and
French to registered nurses in adminis-
trative positions who are unable to
attend university. Sponsored by the
Canadian Nurses' Association and the
Canadian Hospital Association. For
further details and application forms
for the 1969-70 class, write to: Direc-
tor, Extension Course in Nursing Unit
Administration, 25 Imperial Street,
Toronto 7.
May 5-7, 1%9
Workshop for teachers on test cons-
truction, conducted by Professor V.
Wood, School of Nursing, The Univer-
sity of Western Ontario. Theme: Task-
oriented work sessions on essay ques-
tions, models for marking essay ques-
tions; objective examinations and
item-writing practice sessions; and
final assessment of student nurses.
Send applications to: Mi^s Angela Ar-
mitt. Summer School and Extension
Department, The University of West-
ern Ontario, London, Ont.
May 12, 1969
Alumnae Association of the Toronto
General Hospital School of Nursing,
75th anniversary. Events for the week
of May 12 include tours of the new
school and residence, graduation exer-
cises, and dinner at the Royal York
Hotel. For dinner tickets ($8.50) and
further information write: Mrs. Grieg
Brown, 27 Thorncliffe Park Drive, Apt.
301, Toronto 17.
May 13-16, 1%9
Alberta Association of Registered
Nurses, annual convention, Mocdo-
nald Hotel, Edmonton, Alberta.
June 16-18, 1%9
Conference on nursing education for
visitors to the International Council of
Nurses Quadrennial Congress. Spon-
sored by the school of nursing and
alumni association. University of To-
ronto. June 19-20: tours in Toronto
and environs to be arranged at re-
quest of persons attending conference.
Apply to the Secretary of the School,
University of Toronto School of Nurs-
ing, 50 St. George St., Toronto 5.
June 22-28, 1969
auAMiMui
International Coun-
cil of Nurses' Qua-
drennial Congress,
Montreal. Fee: be-
fore AAar. 31, $40;
after Mar. 31, $60.
Write to: ICN Con-
gress Registration,
50 The Driveway,
Ottawa 4, Ont. D
PROFESSIONAL NURSING
PERSONNEL
Personnel Office for Registered Nurses
HOSPITAL NURSING
INDUSTRIAL NURSING
PUBLIC HEALTH NURSING
50 Place Cremazie, suite 1406
Montreal, Quebec
Area Code (514) 388-4427
MARCH 1%S
COMING EARLY in 1969
BEDSIDE NURSING TECHNIQUES IN MEDICINE AND SURGERY 2nd Ed.
By Audrey Latshaw Sutton, R.N., formerly Director of Nursing Service, Edgewood Hospitol, Berlin, N.J.
and Instructor, Wilmington (Del.) General Hospital
Used by more than 80,000 nurses, this source book of advanced clinical nurs-
ing techniques has now been nnade even nnore valuable in the new Second
Edition. In clear, precise language supplennented by more than 750 explicit
drawings, Mrs. Sutton tells precisely how to perform hundreds of nursing func-
tions, from intramuscular injection to caring for the patient in hyperbaric oxygen
therapy. In the first part of the book she describes the basic techniques that are
common to all areas of clinical nursing; then she takes up specialized techniques
used in disorders of each of the body systems. Nurses by the tens of thousands
have found this book unparalleled as an advanced text, as a "refresher," and
OS a reference at the nursing station. It is even more valuable in the new Second
Edition. About 460 pages, with over 750 illustrations. About $9.20. Ready March.
NURSING OF CHILDREN: A Guide for Study
By Debro Hymovich, R.N., B.S., M.A., University of Florida
This new study guide and workbook in pediatric nursing does more than just
present facts and techniques. It uses a realistic case study approach that calls
for the creative integration of knowledge — just as actual nursing practice does.
In this book you read about a case as you would encounter it on the pediatric
service. You are asked to answer questions that review your knowledge of
anatomy, physiology, and pharmacology. You are asked to make plans for
nursing care and to interpret the results of tests, and you plan the instructions
and explanations and would give the patient's family. Nineteen specific condi-
tions ore discussed; among them they encompass almost the entire range of
pediatric nursing. About 2S0 poges, illustrated. About $4.90. Ready March.
FUNDAMENTAL SKILLS IN THE NURSE-PATIENT RELATIONSHIP
By Lianne S. Mercer, R.N., B.S.N., M.S., formerly of the University of Michigan, and Patricia O'Connor,
Ph.D., University of Michigan.
A nurse educator and a psychologist have jointly developed a teaching program
for the vitally important but often neglected skills of interpersonal relations. This
seven-hour instructional unit thoroughly covers such topics as "Utilizing
Resources in Patient Care," "Structuring the Professional Relationship," and
"Communication Skills." It answers such questions as: What should you say
if a patient refuses a treatment? How should you respond when a patient asks
about his diagnosis or prognosis? How can you get more information from
written records and from the patient himself when you need it? The principles
upon which effective nurse-patient relationships are based become clear as
you proceed through the program. About 150 pages. About $3.80. Ready AAorch.
GROWTH AND DEVELOPMENT OF THE YOUNG CHILD 8th Ed.
By the late Marion Breckenridge, M.S., formerly of the Merrill-Palmer Institute, and Margaret Nesbitt
Murphy, Ph.D., Purdue University.
Now in 0 new Eighth Edition, this text unfolds the physical, mental, emotional,
and spiritual development of the preschool child. It explains current concepts
of growth, development, and maturation and traces the interactions between
them. This book will enrich the understanding of anyone who works with
children. About 500 pages, illustrated. About $9.75. Just Ready.
W. B. SAUNDERS COMPANY Canada Ltd., 1835 Yonge Street, Toronto 7
Please send on approval and bill me:
Author: Book title:
Zonei „ Province:
CN 349
MARCH 1%9 THE CANADIAN NURSE 21
in a capsule
Don't call me: I'll call you
A doctor in Manitoba tells this amu-
sing anecdote:
"Following a cerebrovascular ac-
cident, 1 spent several months in the
rehabilitation ward of a large hospital. I
then was discharged to complete the
adjustment in my home. Arrangements
were made for the rehabihtation depart-
ment to loan me an ordinary metal urinal,
familiarly known as the 'bottle.'
"Following delivery of the 'bottle,' I
received a surprising letter. It stated:
You are responsible for maintaining the
loaned equipment in good condition. Our tech-
nician will call at your home in the near future
to show you how to use it.
"Although the letter came some time
ago, the technician has not yet called. 1
have just had to make use of the equip-
ment as best I could without the benefit
of his specialized knowledge."
Nursing can turn you on
Soul music and space suits are not
generally used to attract young people
into nursing. But a high school in Roches-
ter, New York, was the scene, and the
American Nurses' Association, in league
with Ex-Lax Inc., was the sponsor of just
such a happening.
The happening was called a "Soul
Seminar" and was aimed at underprivi-
leged junior high school students. Fifteen
hundred students, mainly Negroes, at-
tended.
"The Fantastic Entertainers," a Roch-
ester musical group, provided a "soul"
background, while the nurse of 2001 ~ a
moon-nurse - modeled her uniform,
complete with space boots and moon-
beam. A copy of a new pamphlet, "Nurs-
ing Can Turn You On" was given to every
student, and a Rochester nurse narrated
an original slide and "live" presentation
of "Nursing - Past, Present, and Future,"
which emphasized the history and contri-
butions of black women to nursing. A
Negro nurse educator gave a first-person
account of "Why 1 Became a Nurse," and
the students joined in a question and
answer period.
The ANA is deeply involved in matters
of human rights and has taken a public
stand on civil rights. The Association is
concerned about the low percentage of
Negro students entering nursing: although
1 1 percent of the U.S. population is
black, only 3 percent of nursing students
are Negro. The Rochester soul seminar
was only the beginning of an accelerated
drive by the ANA to make American
nurses more truly representative of all
Americans.
Want International friends?
You 're sure to find them at the ICN Congress in Montreal this June.
21 THE CANADIAN NURSE
A bacchanalian tale
Throughout history, wine has been
used as a tranquilizer. Modem doctors
have added to the therapeutic uses of
wine. They have prescribed wine for
anemic patients, since wine is rich in iron;
for diabetics, since dry wine is a no-sugar
energy source that requires no insulin; for
cardiovascular diseases, since it lowers
blood cholesterol and is relaxing; for
infectious diseases, since wine pigments
have antibacterial action; and for kidney
diseases, as wine is an effective diuretic.
In the January-February issue of
Modem Nursing Home, two Chicago
doctors strongly recommend that wine be
served in hospitals along with the evening
meal. Dr. Vincent Sarley, medical direc-
tor of Wrightwood Extended Care Facili-
ty, and Dr. Robert C. Stepto of the
College of Medicine, University of llli- ,
nois, have closely compared the attitudes j
of patients who drank wine with dinner "
with those of patients on a "dry" diet. It
appears that wine-imbibing patients not
only sleep better than their teetotalUng
fellows, but they also become supremely
satisfied with life in a hospital bed.
• 90 percent of wine-consuming patients
were happy with visiting hours and regu-
lations, whereas only 43 percent of non-
wine patients were.
• 100 percent of wine-drinking patients
found their beds comfortable, compared
with only 57 percent of non-wine pa-
tients.
• 85 percent of wine-drinking patients
were happy with their food, whereas only
43 percent of non-wine patients were.
• 43 percent of wine-drinking patients
liked their doctors, compared with only
1 8 percent of non-wine patients.
• 83 percent of non-wine patients com-
plained of being awakened too early in
the mornings, although only 40 percent
of the wine-drinkers did.
• 78 percent of wine-drinking patients
found their rooms quiet enough, in com-
parison with only 57 percent of non-wine
patients.
Lest you have visions of beaming
"wine patients" cheerily gobbling their
food between healthy swills from a large
green bottle and giving their nurse an
affable pinch and their doctor a rosy-
nosed smile before passing out for the
night with a final hiccup, Drs. Sarley and
Stepto report that the patients under
study were served only two ounces of
wine with dinner.
Now that's what we call the power of
suggestion! □
MARCH 1%9
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Remember the Foot Health Seminar - Hospital for Sick Children, Monday, June 2nd.
OPINION
Thought and action
This biennium, nurses must make a serious decision about the future role of
their national association. Nurses have directed the Canadian Nurses' Association
to enlarge its services — but at the same time they have decided to hold the
line on the budget. Some of the implications of this paradox are examined
in this article.
The financial status of the Canadian
Nurses' Association has become so tight
that even the cost of stamps threatens to
put the Association into the red.
Unfortunately, the cost of stamps is
not, for the CNA, a minor matter. In fact,
the postal rate increases that go into
effect April 1 will cause something of a
financial crisis.
At the next general meeting of the
CNA, nurses must make some serious
financial decisions. These need to be
considered carefully, because they will
influence the future of nursing in Canada
for some time to come.
At the last general meeting, the deci-
sion on finances was — for all practical
purposes — postponed. A special ad hoc
committee was appointed to investigate
all implications and alternatives of na-
tional and provincial responsibilities, in-
cluding fees. It will report back to the
general meeting in Fredericton in June
1970.
In the meantime, the CNA was asked
to tighten its belt, and to manage the
estimated 1 3 percent increases in costs on
the same budget as for the 1966-68
biennium. This, the CNA might have been
able to do, if it had not been faced with
the postal increases.
Postal rates are up. The cost to the
CNA for mailing journals will be about 1 5
times as much as it was before. These
costs will not wait until the next
biennium. They start next month. The
increased postal rates passed by the
House of Commons excluded the Ca-
nadian NURSE and L'infirmiere cana-
dienne from the privileged postal rates
they have enjoyed in the past. The
MARCH 1969
Ernest Van Raalte
journal mailing costs will rise by about 15
cents per copy or SI. 80 a year per
member. This is effective April 1, 1969.
As well, the CNA has had to go
forward with programs already com-
mitted, such as the National Testing
Service and the International Council of
Nurses' meeting.
The special ad hoc committee and the
Board of Directors will debate wisely and
report fully. The decision, however, rests,
as it always does, with you - the indivi-
dual nurse.
1966-68 — Years of Expansion
At the 33rd General Meeting of the
Association in Montreal in July, 1966,
the members endorsed a program of
increased activities for the national
association. They approved an increase in
membership fees from S6 to $ 1 0 to meet
these activities. This meant many changes
and an expanded role for CNA.
For the first time, the Association was
able to hold meetings of provincial per-
manent staff in counterpart groups. The
10 provincial members on social and
economic welfare, pubHc relations, nurs-
ing service, and nursing education were
able to come together to identify
common problems and work together
toward their solution.
An advisory service to provincial as-
sociations was begun. CNA consultants
went from coast to coast to conduct
collective bargaining workshops and con-
ferences (19 in that biennium), nursing
service workshops (9), Ubrary workshops
Mr. Van Raalte is General Manager of the
Canadian Nurses' Association, Ottawa.
(3), and a workshop for nursing faculty
(1). All provincial associations used the
services of CNA consultants in these areas
and as well turned to CNA for help in
research and statistics and in organization
and management.
The important work of communi-
cating information about nursing and its
behefs was expanded. Improvements in
THE CANADIAN NURSE and L'infir-
miere canadienne were effected, and eight
new books and pamphlets were produced.
These included Hie Leaf and the Lamp —
a history of CNA; Countdown 1967 -
the first book on Canadian nursing statis-
tics; PR Pointers - a practical guideline
for communications between nursing and
other groups; and CNA: What It Is, What
It Does — a pamphlet addressed to senior
government officials, allied organizations,
the press, and others in positions of
influence.
CNA also increased its participation in
the work of other organizations, for this
gave it the long-desired opportunity to
interpret beliefs and policies about nurs-
ing to other agencies. Relationships were
extended with groups such as the Can-
adian Medical Association, the Canadian
Hospital Association, the Canadian Public
Health Association, the Canadian Council
on Hospital Accreditation, and the De-
partment of National Health and Welfare.
A clearer understanding of nursing's goals
and pohcies was achieved through the
active participation of CNA representa-
tives at the many conferences and com-
mittee meetings with these agencies.
All these expanded activities were
designed to improve the status and con-
dition of Canadian nursing and to
THE CANADIAN NURSE 25
strengthen the position of the profession.
The results obtained since this program
went into effect in 1966 are remarkable.
1968-70 — Hold the Line
At the general meeting in Saskatoon in
July 1968, the Board of Directors report-
ed proudly on the activities of the
1966-68 biennium. They advised that
the $10 fee per member would accommo-
date rising costs and that the Associa-
tion's activities could be maintained at
the same effective level.
However, a motion was passed that
for the 1968-70 biennium only, in
member (provincial) associations whose
membership exceeds 20,000, the fuU
annual fee per member be S6.00 and m
member associations whose membership
is 20,000 or less the full annual fee per
member be $10.00 and that the Board of
Directors be empowered to adjust the
budget accordingly."
This had the effect of reducing the
income-per-member from $10.00 to
$8.67. The Board of Directors faced a
dilemma: to reduce expenditures by over
13 percent while costs were increasing in
similar proportion, and to do so without
damaging the effectiveness of the pro-
grams.
On another motion from the general
meeting, the Board of Directors
appointed a committee to study the
question of membership and fee structure
and make recommendations to the pro-
vincial associations six months prior to
the 1970 general meeting. This com-
mittee will examine, too, the national and
provincial associations' functions and re-
lationships and the incorporation docu-
ments and bylaws of CN A.
At present, all members of provincial
associations are members of the Canadian
Nurses' Association and the International
Council of Nurses. The fee for member-
ship in both these organizations is a part
of the annual fee that the provincial
association pays to CNA on behalf of the
member.
Prior to the Motion reducing the
annual fee for members in provincial
associations with over 20,000 members to
$6.00 for this biennium, all individuals
contributed equally to the financing of
CNA and ICN.
Balancing the budget
Based on a $10 per individual nurse
fee, the proposed 1968-70 budget look-
ed something like this:
ICN Individual member fee .40
Net cost of journals $ 3.00
Board and committee meetings $ 1 .94
Research and advisory services $ 1.72
Sponsorship $ 1.41
Library and archives .92
Public Relations .61
$10.00
With less money coming in, the Board
of Directors has to consider which of
these services can be cut. Certain of the
26 THE CANADIAN NURSE
costs - such as the ICN fee, costs of
holding statutory meetings, and building
costs - are fixed.
Even before the Board's first major
meeting of this biennium, the task was
further compUcated by the increase in
postal costs.
The Board of Directors and the Ad
Hoc Committee on Functions, Relation-
ships, and Fee Structure will look at each
area and propose how the Association
will meet its obligations during the next
year. They wiU closely examine the fol-
lowing areas:
ICN individual fee
The ICN is a federation of 63 nafional
nursing associations. Your membership
fee and similar fees from the individual
members of all the member national
associations around the world finance
the ICN. Canadian nurses, as hosts of
the ICN Congress in Montreal this
summer, can hardly withdraw
membership at this time.
Net costs of journals
Each member of the CNA receives
monthly issues of the journal in the
language of her choice. The $3.00
budget allocation represents the net
cost per member after advertising
revenue. It covers the salary and travel
expenses of the editorial staffs, and
the costs of postage, printing, trans-
lation, design, art, photography, and
all other costs connected with journal
pubUcation and circulation. The new
postal rates will raise costs by $1.80.
Changes in quality, size, or frequency
of pubUcation could considerably
reduce advertising revenue.
Board and committee meetings
This covers the travel costs and all
other expenses connected with con-
vening meetings of the Board of Direc-
tors, the Executive Committee, the
standing committees, and general
meetings that are mandatory by sta-
tute. It also covers the cost of ad hoc
committee meetings and other non-
statutory meetings convened for
special purposes.
Research and Advisory services
The research and advisory staff plan
and conduct all workshops and pro-
vide the advisory services to provincial
associations mentioned earlier. In
addition, they compile and publish
statistic^ data, write and publish
technical papers, participate on inter-
agency committees, prepare briefs to
government commissions, plan and
conduct provincial counterpart con-
ferences, and act as secretaries and
resource people to the various standing
committees. This portion of the fee
covers the salary and travel expenses
of the Research and Advisory staff,
and the cost of counterpart meetings,
collecting and processing statistical
data, and the printing of technical
publications.
Sponsorship
This is the amount set aside to contri-
bute to and administer such activities
as the Canadian Nurses' Foundation,
and CNA Student Loans and to sub-
sidize special nursing events, such as
the ICN Congress.
Library and Archives
This covers the costs of preparing
bibUographies and providing Ubrary
research services for all CNA studies
and programs. As well, book loans are
made to individual members across
Canada, and to nursing students and
others interested in nursing. The CNA
Library is the only comprehensive
collection of nursing literature in the
nation. Its repository collection of
nursing studies is a major resource for
research in nursing in Canada, and the
periodical collection of some 300 tities
is probably one of the best in the
world. The cost of all acquisitions,
subscriptions, binding and supplies, as
well as the salaries and travel expenses
of library staff, is covered by this
portion of the fee.
Public Relations
The public relations officer gathers,
prepares, and distributes information
about nurses and nursing activities to
the public through press, television,
and other media; to the provincial
associations through constant com-
munication with provincial counter-
parts; and to the members through the
news columns of the journals. She also
plans and conducts provincial public
relations counterpart meetings. This
portion of the fee covers the salary
and travel expense of the PRO, con-
sultant fees, the cost of counterpart
meetings, promotional publications,
and special public relations events.
The portions of fee allocated above for
the various activities cover all CNA costs,
including the cost of owning, operating,
and maintaining the national head-
quarters building and the salaries and
expenses of administrative and general
office personnel.
Think — because you must act
The problem is immediate, and it
places a serious responsibility on each
member of the Association. The Board of
Directors and the Ad Hoc Committee will
deliberate these problems on your behalf
and be prepared to make recommenda-
tions at tiie next general meeting.
But it is up to each individual nurse to
consider the alternatives objectively. You
must give direction to your voting de-
legates so that the right decisions are
made.
The future of nursing is in the hand;
of the nurses. The time has come foi
action. Action without thought oi
thought without action can be equallj
disastrous. C
MARCH 1%'
Infections in the hospital
Modern hospitals may be as up-Jo-date as tomorrow, but they have not solved
yesterday's problem — infection. Antibiotics alone cannot control infections;
the first line of defense rests with diligent staff members, aided by an active
infection control committee.
What do you mean I look a cyte? I am a
■te! "
Dorothy Pequegnat
Over 100 years ago, Joseph Lister
published his first notes on wounds and
abscesses and stressed the antiseptic
treatment of wounds. His liberal use of
phenol led to a decrease in the number of
infections, and so began the era of anti-
septics. This was replaced by the aseptic
era, based largely on the teaching of
Florence Nightingale.
In 1929, Sir Alexander Fleming
changed the whole outlook on microbial
disease with the discovery of penicillin
and thus began the antibiotic era. Anti-
biotics would put an end to infections, it
was thought, but as everyone must now
recognize, this hope has not been fulfill-
ed.
A noticeable decrease in infections in
hospital did follow the initiation of anti-
biotics, and the hospital and medical staff
became less concerned about the dread
"spiked temperature" and the "jaws of
death" on the temperature-pulse-respi-
ration charts. Then, about 1 2 years ago,
some bacteria, especially some strains of
Staphylococcus aureus, became resistant
to the antimicrobial drugs, causing gross
infection and sometimes mortality.
Early in 1958, the first of five yearly
ARCH 1%9
Mrs. Pequegnat has been the Infection Control
Officer at the Ottawa Civic Hospital since the
beginning of the present program in July 1967.
In 1966 she participated in a preliminary
research project, which led to the start of the
present program. She is a graduate of the
Ottawa Civic Hospital and has a certificate in
public health and a diploma in microbiology
(infection control) from the University of
Ottawa, Canada.
meetings was held at the National Re-
search Council in Ottawa. The objective
of these meetings was to provide a focal
point for the submission of proposals
regarding the control of Staphylococcal
infections in hospitals. In that same year,
a national conference on "Hospital
Acquired Staphylococcal Disease" was
sponsored by the United States Public
Health Service and the National Academy
of Sciences, and in England lectures were
started at the Royal College of Surgeons
on "Spread of Infections."
This world-wide concern over cross
infections in hospitals has led to today's
hospital infection control committees and
to considerable knowledge about hospital
infections. The organism that caused this
concern about cross infection in the
1950's — a particularly virulent and anti-
biotic-resistant strain of Staphylococcus
aureus - had developed, and was flourish-
ing in patients whose normal flora had
been destroyed by antibiotics. Anti-
biotics, in this instance, were not useful
as treatment. However, this virulent strain
has now more or less died out.
Today, most hospitals now do routine
antibiotic sensitivity testing on all
cultures to help identify any infection
with antibiotic-resistant bacteria.
For many years it was believed that
bacteria reproduced by simple binary
fission and that resistance to antibiotics
arose as a result of mutation. Recently it
has been found that bacteria may re-
produce by sexual conjugation and that,
by means of a so-called resistance transfer
factor, or R factor, resistance to one or
more antibiotics may be transferred from
THE CANADIAN NURSE 27
". . . and stop referring to me as 'that •' You're righ t .. ■ J t
foreign body. ' " pepp..p..p..a..a..a..a..a...CHOO.'
IS
one strain or species of bacteria to an-
other. Because of this, a relatively
harmless organism can pick up the R
factor causing infection or transfer its R
factor to a more virulent organism which
could cause gross infection.
Many new antibiotics are being
produced for use in hospitals today, but
it is important that antibiotics be recog-
nized as a second line of defense and that
hospital staff understand and strive to
block the many other channels where
infection can spread.
Endogenous or hospital spread?
Almost half the infections seen in
hospital are in patients admitted with
their infection. Those noted after the
patient has been admitted are called
"hospital acquired" infections. Infections
may also occur after the patient goes
home; these the hospital may never hear
about.
Many so-called "hospital-acquired" in-
fections really occur by endogenous
spread or are affected by one of many
variables; it can be difficult to say just
which are caused by cross infection. It is
important not to divorce the infection
from the circumstances surrounding it,
just as it is important that the hospital
examine procedures to prevent cross con-
tamination and cross infection.
Nurses and other personnel sometimes
fear infection; this can cause danger to
the patient both mentally and physically,
if it leads to an ostrich attitude and
neglect in nursing care. Much of this fear
is founded on inadequate understanding
of how infections are transmitted and on
28 THE CANADIAN NURSE
a failure to realize the safeguards offered
by good technique.
For example, gas gangrene is a very
serious condition for the patient and one
we hope never to see. However, incidence
of cross infection between patient and
ward personnel is almost unknown. The
organism Gostridium perfrigens, which
causes gas gangrene, is around us most of
the time, and some 20 to 30 percent of
the population are carriers, but the organ-
ism needs special conditions to produce
toxins. General cleanliness and the use of
steam sterilization rather than boiling or
cold sterilization lessen the chance of the
spore getting into deep tissue, as it once
did.
Even those hospitals with good in-
fection control programs will always have
problems with infections - especially
those admitted from the community.
Also, because of the use of immuno-
suppressive drugs, steroid therapy, long
surgical procedures, and increasing num-
bers of patients with traumatic injuries
and terminal disease, hospitals are dealing
with many more high risk patients who
are susceptible to infection. Hospitals
therefore must consider even more pre-
cautions.
In general, a large inoculum or gross
contamination will lead to cross in-
fection. Each department must carefully
examine its own area and set up rigid
standards for cleanliness, whether for the
incubator in the nursery, the whiripool
bath in physiotherapy, the dialysis
machine in urology, the ECG equipment
in the intensive care unit, or the general
housekeeping all through the hospital.
Personnel must also realize that to give
good nursing care it means coming in
close contact with patients. Good nursing
techniques help prevent cross infection,
but of all these good hand-washing is
most important.
Infection control also includes a well-
planned training program in which
personnel can consider the why behind an
infection as well as what should be done
about it.
Modern units make it easier
Many of the changes in today's hospi-
tals make infection control easier. Auto-
claves, gas sterilizers, disposable equip-
ment, new bacteria-resistant fabrics foi
blankets or staff clothing, or specially
filtered air conditioning are examples
New agents for cleaning, skin scrubs, anc
germicides are being tested as well.
All of this is to no avail, however
unless it is property used in the end. /
dirty mop in housekeeping will offset thi
effect of a good cleaning agent. A single
use, disposable item repeatedly used n(
longer carries the benefits it was designei
for - and may even serve as a carrier fo
infection. A closed drainage system wit'
a hole cut into it is no longer close^
drainage. "Sterile" packages crushed an
man-handled into a drawer may no longe
be sterile.
Even a hospital designed to the bet
advantage for control of infections is t
no avail unless the principle behind th
design is understood and carried out.
Staff have done many things in th-
same ways for so long that they may fir
it hard to change, but the hospital
MARCH 19i^
changing, the type of surgery is changing,
and equipment is changing. There are
many areas where the habits of the
personnel must change, too. Hair may
provide a reservoir for bacteria - which
means complete hair covering may be
needed in some areas besides the oper-
ating room. Constant movement stirs up
bacteria-laden dust particles - which
means that flow of traffic should be
controlled, especially in high risk areas.
Patients adnitted to the hospital with an
infection can unwittingly serve as carriers
to other patients - which means that
they need to be told of their potential
danger to others. Uniforms and clothing
worn outside the hospital increase the
probability of bringing in infection —
which means staff, especially those with
the high risk patient, should change at the
lospital.
Medical as well as nursing staff and
Dther personnel must realize that they
;ach play a role in microbial dissemi-
lation.
Constant surveillance needed
At the Ottawa Civic Hospital, an In-
fection Committee meets every month to
discuss infections occurring during the
nonth, problems that may be arising, or
my changes to be made. Day-to-day
urveillance is done by the medical bacte-
iologist, the director of health service,
ind an infection control officer.
Surveillance consists of case finding
md hospital monitoring. Case finding
neans actually looking for any possible
nfections in the hospital by having the
)acteriology department report all in-
ections to the infection control officer,
becking the elective and emergency
urgery list, and checking the diagnoses of
latients admitted to the hospital. Even
aore important are the routine visits to
he head of each department. Cooper-
tion, including reports about infections,
; thus ensured.
Screening procedures for infection are
ilso carried out for staff. Through the
ersonnel Health Service, stool cultures
re done routinely on all food handlers to
heck for the possible chance of a carrier,
lantoux testing is done on all negative
iberculosis reactors and chest x-rays are
one once a year on all staff. All staff are
ncouraged to report infections to health
:rvice.
This way it is possible to have an
verall picture of the types of infection in
4ARCH 1%9
the hospital at any given time.
Hospital monitoring means doing
bacteriological surveys of different hospi-
tal departments, such as kitchen and
operating rooms. There are two types of
monitoring, one is routine sampling and
the other involves a series of samples
from a specific area to search for the
solution to a specific problem.
Bacteriological sampling can indicate
constant trouble spots, such as hard to
clean areas, and can demonstrate the
efficiency of the present methods of
cleaning. When evaluating cleaning
measures, it is important to realize that
many extraneous factors may effect the
result. Environmental sampling cannot be
related directly to infections except in
rare and atypical cases. However, it can
be used to improve operational practices
and to attain the lowest contamination
level possible.
To isolate or not
Infections may be epidemic or en-
demic. Some infections, such as in-
fectious diarrhoea, or any communicable
disease, such as measles, should call for
immediate action and isolation for the
patient. The hospital population would
be watched for other cases to develop, as
this might signal the start of an epidemic.
Other infections, such as wound in-
fections, are watched over a period of
time to see if there is any indication of an
endemic pattern. If the same organism
keeps reappearing in a certain area, im-
mediate action is needed to try and find
its source and to clear up or remove the
reservoir.
Isolation procedures need not be rigid,
all-or-nothing routines. Many different
organisms cause infections, and, as well,
different grades of infection occur. It
would seem best to grade the isolation
procedure also, and correlate it with the
infection.
Complete isolation would be used for
the patient with, for example, a com-
municable disease, infectious diarrhoea,
or grossly contaminated burns. This
would mean that everything going into
that room would need to be decon-
taminated before being brought back into
general use.
Separation would be used for the
patient with, for example, an infected
wound. Care could be given in the general
ward or in a single room if one is
available. Everything coming in contact
with the wound would be contaminated.
This procedure requires complete under-
standing by the personnel caring for the
patient as well as by the patient himself.
Reverse isolation would be used for
highly susceptible patients, such as the
recipient of an organ transplant, the
uninfected burn patient, or a patient with
a low blood count.
The need for isolation also depends on
chemotherapy. The patient with a group
A beta hemolytic streptococci infection
responds rapidly to treatment with
pencillin and the chance of cross in-
fection is lessened. The tuberculosis
patient responds to treatment with Iso-
niazid, which again lessens the chance of
cross infection.
Conclusion
Increased awareness of the problem of
infection in hospitals, more knowledge
about how infections are caught and how
they are spread, wise application of the
advances in hospital technology, constant
surveillance, and adequate treatment for
infections are the goals of infection con-
trol.
The hospital is a complex community
requiring the help of many people to
keep it functioning. Infection control
committees can help, but infection con-
trol really depends on the cooperation of
each individual.
Bibliography
Green, V.W. Recent advances in the control of
hospital infections./ Hasp. Res. Vol.6, Jul.
1968, p.25.
Kabins, S.A. and Cohen, S. Resistance-transfer
factor in enterobacteriaceae. New Eng. J.
Med Vol. 275, Aug. 4, 1966, p.248-252.
Noble, W.C. Staphylococcus aureus on the hair.
/. Clin. Path. Vol 19, Nov. 1966,
p.570-572.
Schaeffer, R.L. Practical aspects of surface
sampling. Hospitals, Vol. 42, April 16,
1968, p.94-100.
Starkey, H. Control of staphylococcal in-
fections in hospitals. Canad. Med. Ass. J.
Vol. 75, Sep. 1, 1956, p. 37 1-380.
Williams, R.E.O. et al. Hospital Infection:
Causes and Prevention. London, Lloyd-
Luke, 1966. D
THE CANADIAN NURSE
29
idea
exchange
A "Two-Way" Street
Over the past years, there has been a great
deal written and said about the
contributions which the hospital pharma-
cists can make to nursing education and
nursing service. This is true, particularly
in the area of pharmacology, which
would cover such topics as therapeutic
agents, adverse drug reactions, metrology,
and preparation and administration of
drugs - but what of the contributions
nurses can provide to hospital pharma-
cists?
At St. Michael's Hospital in Toronto,
the Department of Pharmaceutical Ser-
vices holds weekly staff conferences and
it was such a meeting that gave birth to
the idea of nurses lecturing to pharma-
cists. The pharmacists themselves recog-
nized their lack of knowledge in so many
areas which go to make up a nurse's
"day."
If pharmacists are to play an active
part in the team, then an intelligent
approach is to recognize that they may
not know the situation as it exists "up on
the nursing units."
Some hospitals have begun programs
of "clinical pharmacy," which will be the
answer to many problems, however even
before the pharmacists can function in a
clinical pharmacy setting, they should
have a basic knowledge of nursing pro-
cedures, policies, and work-load.
At St. Michael's Hospital, when the
director of nursing service had given
approval to the tentative plan, the nurse-
coordinator of special projects, Dorothy
Shamess, went to work with the pharma-
cists and head nurses to set up the
educational program. Miss Shamess met
with pharmacists and discussed the areas
in which they were interested. These were
used as a basis for the program.
Even recent graduates from schools of
pharmacy have very limited knowledge
and experience in actual nursing pro-
cedures; the same holds true for those
pharmacists who, after spending some
time in the community pharmacy, have
entered the field of hospital pharmacy.
There is a trend, however, to include
clinical pharmacy in the medical science
complex of universities, and the day may
not be too distant when pharmacy stu-
dents will join with medical and nursing
students in the hospital wards for a more
Sister St. Matthew, supervisor and instructor of the Urology Unit, assisted by Miss Mulcahy, head nurse, explains to the pharmacy
staff principles of irrigation and dialysis.
30 THE CANADIAN NURSE MARCH 1969
neaningful course in clinical work.
CJioice of subjects
At St. Michael's, the following topics
.vere chosen as material to be included in
he inservice course for the pharmacists:
;olostomies. bladder irrigation and ca-
heterization, peritoneal dyalysis, treat-
nent. including corrpresses, of bed sores
ind ulcers, tube feedings, and charting.
Lectures were given weekly, on
Puesdays and Thursdays - each lecture
leing repeated so that all pharmacy staff
:ould attend. Initially the lectures were
'0 minutes in length, but as the program
ieveloped the lectures were extended to
ine hour.
Miss Shamess organized all the lectures
.nd demonstrations and the pharmacy
department was notified of the ar-
rangements on a weekly basis. The form
of the presentation varied with the topic
but in general it was a lecture, which
covered anatomy, physiology, etiology,
and treatment, followed by a demon-
stration at the bedside of the patient. At
the lecture on dialysis a film was shown,
giving a further explanation of peritoneal
dialysis. The lecture on charting included
information on the specific sections of
the chart, the use of medicine tickets, and
the Kardex.
The enthusiasm, not only of the
pharmacy staff but also of the nursing
staff was most encouraging to see as this
program proceeded along its scheduled
outline. Several of the nursing units
cooperated in this joint venture and were
pleased that they could help. Classrooms
on the units were made available to our
"students," the patients were prepared,
and the nursing staff present to assist us.
Pharmacists now have a better under-
standing of the techniques and pro-
cedures used on the nursing units. This
program has also provided an opportunity
for nurses to share their knowledge and
problems. Nurses and pharmacists have
come to know each other better and have
taken a good hard look at their common
"raison d'etre" - the care of the patient.
- Sister M. Liguori, Director of Pharma-
ceutical Services, St. Michael's Hospital,
Toronto.
I
liss Archer, nursing student, demonstrates the technique of dressings to five pharmacists during a special course in which
harmacists learned about nursing.
MRCH 1969 THE CANADIAN NURSE 31
Resources and use
of CNA library
The resources and services of the Canadian Nurses' Association's library support
the Association's studies and consultation programs, and supplement the local
library facilities that are available to members.
CNA librarian Margaret Parkin adds a
nursing cap to the display in the library 's
archives collection
Margaret L. Parkin, B.A., B.L.S.
Why an article about libraries and
library service, written by a librarian, in a
nursing journal? Well, for many reasons.
For one, nurses — in common with
persons in all professions and many trades
and occupations — have found that
libraries are an integral part of their
educational process, whether this educa-
tion is undergraduate, graduate, or
continuing. And, in today's world of
rapid technological advances and socio-
logical change, education is continuing
and essential for the practice of any
profession.
Also, it has been customary in recent
years to devote a page or two of the
March issue of the Canadian nurse
to libraries. A week in March used to be
designated "Canadian Book Week," and
many of us regret that this practice was
discontinued, even though it can truth-
fully be said that every week is "Book
Week."
Finally, the CNA hbrary is now in its
fifth year of service. Although its re-
sources and services have grown rapidly
and are well used from coast to coast and
around the world,* there are still those
who ask "How do we use the CNA
library? " "What services does the CNA
library provide? "
*In 1968, some 3,000 items were borrowed
from the library, 1,200 reference requests were
processed, and more than 2,500 copies of
bibliographies were distributed.
Miss Parkin is Librarian, Canadian Nurses'
Association, Ottawa, Ontario.
32 THE CANADIAN NURSE
What is library service?
To repeat the definition used in these
pages in March 1966, a library is a
collection of books, periodicals, doc-
uments, and other printed, written, or
audiovisual materials systematically
organized and made available for use. The
"use" may be recreational, educational,
or informative. The librarian is defined as
a custodian and purveyor of library
materials; she is liaison officer between
the library materials and the library users.
The "users" vary from the population of
a city who use a public library, faculty
and students who use a university Hbrary,
and members, students, or researchers of
a profession who use a library such as the
one at CNA House.
How are library materials made availa-
ble for use? Many people are convinced
that librarians gather all kinds of useful
information and materials and hide them
away so that only librarians can find
them. They also believe that librarians
want all the books in the library in tidy
rows on the shelves. These people are, of
course, wrong. The librarian's main objec-
tive is to make the hbrary resources
available for use. Her methods of a-
chieving this objective vary, depending on
the particular materials, their monetary
value, and whether or not they need to be
on hand for constant and ready con-
sultation in the library.
Circulation and reference are the two
basic forms of library service to users.
They are basic to almost all libraries -
public, university, industrial, and special
- in varying degrees.
The circulation service makes items
MARCH 1969
available for users to borrow and to take
away from the library for specified
periods of time. The more items in
circulation, the better is the library ser-
ving its users.
Directories, almanacs, yearbooks, en-
cyclopedias, large or many-volumed
dictionaries, atlases, and such material are
generally made available by reference
service. They may not be taken away
from the library, since they are required
for immediate consultation, either by the
user directly, or by the library staff on
behalf of users.
What are the CNA hbrary resources?
A final preliminary to discussing
CNA's library service is a brief outline of
the library's role and resources.
The CNA library is a special library, a
national nursing library. TTiis role governs
the selection of library materials, since its
resources must include documentation
and archive material about, or affecting,
nursing and nurses in Canada, and nursing
in other countries from which foreign
nurses may come to Canada, or where
Canadian nurses may serve. It is a re-
search library rather than a teaching
library. Nursing education and research,
nursing service, and the economic and
social welfare of nurses are emphasized
and the holdings in the clinical areas are
representative, rather than comprehen-
sive. To support national office con-
sultant and statistical services and the
work of CNA committees, there are
considerable holdings in sociology, sta-
tistics, labor relations, and higher edu-
cation.
CNA's library has always been bi-
lingual, with holdings in the English and
French languages, catalogued in the
language of source. The periodical racks
at the entrance to the library, as well as
those in the reading room, hold at least
75 journals with French titles; many
other journals are bilingual. The reference
shelf at the reading room door has
French- and English-language reference
tools, and all the shelves in the reading
room are marked in both languages.
TTie first collection on the Ubrary
shelves is the excellent series published by
Les Presses Universitaires de France, the
Que sais-je? series. It is very difficult to
find French-language texts in nursing
suitable for Canadian practice. However,
many more clinical texts are purchased in
the French language than in English, so
that the faculties of schools of nursing
can examine them and determine their
suitability for use in Canada. Canadian
government documents are either biling-
ual or are procured in both French and
English editions. Two years ago, a
mimeographed list of the library's
French-language material numbered 155
items. There are considerably more now.
Returning to the collection as a whole,
there are some 6,500 books and docu-
ments, classified in the National Library
of Medicine** system. In addition, there
are extensive vertical file holdings of
pamphlets, newspaper clippings, and
similar uncatalogued "short-life"
material.
The library has about 350 periodical
subscriptions, the majority of which are
health science journals and news bulle-
tins; a few deal with public relations,
journalism, labor relations, and library
science. About 50 journals of other
national nursing organizations are receiv-
ed in exchange for either L'infirmiere
canadieniie or the Canadian nurse
Indeed, a major portion of the periodical
collection is received on an exchange'
basis.
There are two special collections in the
CNA Library. The Archives Collection
contains documents and reports covering
the history and activities of the Associa-
tion, and books, documents, letters,
photographs, and artifacts related to nurs-
ing in Canada. The CNA Repository
Collection of Nursing Studies includes
studies about nursing in Canada, or
studies by Canadian nurses. In addition to
reports by government commissions and
departments, hospitals and other insti-
tutions and organizations, there are
doctoral theses and papers written by
students completing masters' degrees.
This collection, which contains about 300
studies, is rapidly becoming a major
resource for nursing research in Canada.
Associated with this collection, the
CNA has prepared an Index to Canadian
Nursing Studies. This index, which is
presently being revised, covers studies in
the same categories as the CNA reposito-
ry Collection, but includes all studies that
have been identified, not just those that
are in the Collection.
The Reference Collection contains the
usual language and medical dictionaries,
directories, almanacs, encyclopedias, and
university calendars. A large number and
a wide variety of index and abstract
journals are also found in this section.
**The National Library of Medicine in
Washington, the major health science library in
North America, was referred to recently as the
"computerized central medical library in Wash-
ington" which CNA should emulate. However,
as mentioned in the library article in the March
1968 issue of the Canadian nurse, the Ca-
nadian government has authorized a National
Medical (essentially Health Science) Library,
The library has about 350 periodical subscriptions, most of which are health science which is now developing under the auspices of
journals and news bulletins. the National Science Library.
MARCH 1969 THE CANADIAN NURSE 33
These include Hospital Literature Index,
Hospital Abstracts, Abstracts of Hospital
Management Studies, the Glendale Cumu-
lative Index to Nursing Literature, the
International Nursing Index, Canadiana,
the Canadian Periodical Index, the Can-
adian Education Index, Index Medicos,
and the National Library of Medicine
Current Catalogue. Reference resources
also include biographical files on Can-
adian nurses, reports, bylaws and per-
sonnel policies of provincial nurses' as-
sociations, provincial and federal legis-
lation affecting nurses, and data on nurs-
ing in other countries.
Audiovisual Resources are limited for
many reasons. Audiovisual aids generall;^
are designed to support specific education
programs and thus are beyond the role of
the CNA library at this time. Although a
central library of audiovisual materials
sounds desirable, the quantities required
to support all Canadian schools of nursing
would be extremely large. Such resources
would be expensive to assemble, and a-
loan service also would be costly.
The CNA library does have catalogues
of audiovisual aids from many agencies
that are helpful in finding available mate-
rials. The library also has sets of slides
prepared by the League of Red Cross
Societies on nursing history. These slides
are in almost constant use by schools of
nursing. Copies of CNA-sponsored films
are, of course, on deposit in the Archive
collection, but the loan service is carried
on by an outside agency.
Finally, mention must be made of that
invaluable library resource shared by
most hbraries, the Inter-Library Loan
System. This service is not limited to
nursing, and is immensely helpful in
extending an individual library's re-
sources. The federal government's
National Library of Canada on Wellington
Street in Ottawa maintains a National
Union Catalogue to which major libraries
in Canada report their holdings. By means
of this catalogue, material required for
serious research and study may be located
and borrowed on inter-Ubrary loan.
How is the lo.in service used?
Each month, a list of recent library
accessions, that is, books and documents
that have been added to the library
holdings, is published in the
CANADIAN NURSE and L'infirmiere
canadietine. Near the accession list is a
coupon that readers can clip out to
request items they would like to borrow.
These requests are filled as much as
possible in order of receipt. Books and
documents are sent out on loan for two
weeks with provision for maiUng time.
The only cost to the borrower is the
postage for return mailing.
Extension of the loan period can be
requested; the request is granted, if abso-
lutely necessary. However, prompt return
of borrowed material ensures that as
34 THE CANADIAN NURSE
many borrowers as possible can have the
material without waiting too long. Books
and documents, other than accession list
items, also can be requested by mail. If
the required material is in the library's
holdings, it will be sent on loan as soon as
possible. If not, the CNA hbrary, through
the National Library of Canada, tries to
find a library in Canada that has the
material, and advises the would-be bor-
rower.
As mentioned earlier, some categories
of library material, reference, and archive
items, must be used in the CNA library
and are not available for loans outside
CNA House. Studies from the CNA
Repository Collection are loaned only on
an Inter-Library Loan basis. Individuals
ask their own institutional, public, or
university library to obtain the required
study for them. The borrowing library is
then responsible for its safe custody and
return. Periodicals are also in the "cannot
leave CNA House" class. However, single
Xerox copies of articles requested are
supplied and a minimum charge is made
to cover the operator's time and the.
paper used. Xerox copies of articles
published in North American journals in
the current year are not suppUed since
these, presumably, are still available from
the publisher.
How Is reference service used?
Users in the Ottawa area, and re-
searchers and graduate students from
out-of-town come to the library to use
the reference resources, especially for
extensive searches and studies. In addi-
tion, library staff give reference service by
telephone and by mall. Reference ques-
tions range from addresses of schools of
nursing and names of directors to lists of
material on a topic or area of study.
A bibliographic service has developed
as a result of these requirements for lists
of reference material. Some 50 standing
bibliographies have been compiled and
are updated from time to time, depending
on user demand. Many reference ques-
fions are answered by sending a biblio-
graphy. The user can then request any
material of interest that is not available in
a local library.
The library staff is small. Because of
this, it is not always possible to do an
extensive reference search immediately or
to supply reference material by return
mail. However, if there is a specific
deadline for the material, every effort is
made to meet it.
As in the case of loans, library staff
search beyond the resources of the CNA
library for information required for re-
search and similar studies. Under-
graduates are guided to sources of in-
formation instead of being supplied with
data that is probably available in libraries
in their own areas. They are encouraged
to learn how to search and where to
search.
Who uses CNA library services?
As indicated earlier, this library,
located in the headquarters of the Can-
adian Nurses' Association, belongs to
Canadian nurses. It is a library for CNA
national office staff and the Association's
membership everywhere across Canada
and around the world. Its resources are
used by nurses in public health units,
hospital nursing services, by faculty and
students in schools of nursing, by gradu-
ate students and other research workers,
by consultants in government health
departments, and by non-Association
members with a need for information
about nursing.
Are consultation services available?
The CNA library is not, as mentioned
earlier, a teaching or cUnical library. Its
resources are intended to supplement, not
to replace, library facilities available to
nurses in their working or learning situ-
ations.
Every encouragement is given to librar-
ians who hope to establish and develop
good library resources for nurse practi-
tioners and nursing education. This en-
couragement is provided by giving con-
sultative service by mail, or through
library orientation sessions to the librar-
ians, who are generally non-professional.
Last year, 1 4 day-long sessions were given
at CNA House. The CNA Ubrarian was
senior resource librarian for two, five-day
workshops for non-professional librarians,
sponsored by provincial nurses' associa-
tions in the Maritimes and in the Prairie
provinces. D
MARCH ^%9'
Canada's rare blood bank
With the increase in the number of blood transfusions in the past few years,
some extremely rare blood types have been identified. The Red Cross and the
National Defence Medical Centre have both a file on and a storage unit for
these rare types. This article describes this service.
Len Carter
In a hospital in Singapore in August
1968, a Gurkha soldier serving with the
British forces lay seriously injured. He
needed a blood transfusion to save his
life.
But the type of blood he needed was
very rare. Called Bombay Oh. it was
discovered in the Bombay, India, area in
1952, and even there its incidence is only
one in 13,000. In Caucasians it is ex-
tremely rare.
A distress signal went out to the World
Health Organization. A check of the
International Rare Donor File of that
organization revealed that the only
Bombay Oh available was stored at Can-
ada's rare blood bank at the National
Defence Medical Centre in Ottawa.
The emergency call was relayed to
Canadian Red Cross headquarters in
Toronto, which in turn notified the rare
blood bank in Ottawa of the critical
situation. That evening the only two units
of Bombay Oh stored in the bank were
on their way to Toronto in a container
surrounded by tins of ice and packed in a
heavy duty cardboard box. The next
morning it was flown to Tokyo and from
there to Singapore.
Some while later the Red Cross report-
ed that the Gurkha soldier had pulled
ihrougli nicely, thanks to Canada's rare
olood bank and to an anonymous donor
n St. John's, Newfoundland, the only
egistered donor of this rare blood type in
Canada.
Only the "very rare" types
The Bombay Oh that saved a life
lalfway round the world is only one of
50 extremely rare blood types deep
MARCH 1969
frozen at Canada's only rare blood bank,
in Ottawa. These rare types include one
from a donor whose blood type is at
present the only one of its kind known.
Concrete plans for the rare blood bank
began in April 1964, although experi-
ments had begun as early as 1962. Plans
involved the National Defence Depart-
ment, the National Health and Welfare
Department, and the Defence Research
Board. The project, an outcome of a
study on the military application both of
rare blood types and of freezing blood for
storage, was completed in January 1965.
In August 1966 the National Defence
Medical Centre was officially designated
the rare blood bank for Canada, jointly
involving the National Defence Depart-
ment and the Canadian Red Cross Trans-
fusion Service. The blood bank is under
the direction of Dr. R.K. Smiley and Dr.
W.J.Wills.
By mid-September of that year there
were 24 units of rare blood in storage. At
present, there are approximately 80. The
storage unit can handle 125.
The Medical Centre handles the pro-
cessing and storage while the Red Cross
acts as the supply and issuing agent. Red
Cross depots across the country file the
names of Canadians found with rare
blood. All these names are then cata-
logued at the Society's head office in
Toronto and it is decided which blood
types are rare enough to ask for a special
collection for storage, either for possible
Mr. Carter is a medical reporter for The Ottawa
Journal and a freelance writer, and has three
stories cunently under production with the
Canadian Broadcasting Corporation.
world-wide use or for personal use in an
emergency or during elective surgery.
Units (500 cc.) of those rare enough
for banking are collected by the Red
Cross and are sent to the bank — usually
by air — to be processed for deep
freezing.
Donations of blood of more common
types are stored at just above freezing at
the local depots and must be used within
three weeks; deep frozen blood may be
kept as long as five years or even longer,
but at present deep freezing is too ex-
pensive for anything but the rarest types.
Rare blood sent anywhere in the world
or Canada is released through the Red
Cross's Toronto office.
To date, people with blood rare
enough for collection have been found in
all but three provinces. For instance,
there is an Indian living west of Edmon-
ton with an extremely rare type, which
Dr. Biro calls -D-, -D-. Part of a
chromosome in this man's blood cells is
missing.
The Red Cross's national rare blood
file recently proved its value when four
pints of one of the rarest blood types in
the world were needed to save the life of
a newborn baby girl in Oshawa, Ontario.
Two women in Nova Scotia and one in
Northern Alberta were known to have the
same blood type according to Red Cross
files; they combined through their blood
donations to help save the life of the
infant.
Special process for long-term storage
At the rare blood bank, the key piece
of equipment used in processing blood
for freezing and later reconstitution is the
THE CANADIAN NURSE 35
Warrant Officer B.S. Wambolt prepares a pack of red blood cells for freezing at the
National Defence Medical Centre's rare blood bank. Warrant Officer Wambolt
reconstituted the rare Bombay O^ blood that was shipped to Singapore last August to
save the life of a Gurkha soldier serving there.
Muggins Cytoglomerator. It was devel-
oped by Dr. Charles Muggins, a professor
of surgery at Boston's Massachusetts
State Mospital.
Priced at about SI 0,000, it is the only
one in Canada and as far as is known
there are only four or five others in the
world. Two are being used in Vietnam
and another aboard a specially equipped
United States destroyer.
The Cytoglomerator separates off
plasma, leaving about 300 cc. of cells.
These cells are put in a plastic sleeve
about three feet long and mixed with a
glycerol solution; the cells can then be
frozen without damage.
The suspended cells are then spread
along the length of the sleeve, which is
folded and placed in a carton. The carton
goes into the deep freeze unit at minus 85
degrees centigrade - the temperature of
dry ice or four times as cold as a home
freezer.
When an emergency call comes in for a
certain type of blood on hand, the frozen
cells are thawed at 40 degrees centigrade
and put back on the Cytoglomerator -
which can handle five units at a time
when necessary — where the cells are
cleansed of the protective glycerol solu-
tion by washing them three times in a
sugar solution.
The final step is to suspend the cells in
a saline solution - or in the original
serum, which also can be frozen - and
bag the results in a plastic pack connected
to the original sleeve. The pack is used to
administer the transfusion. Frozen cells
can be reconstituted for shipment in 40
minutes.
36 THE CANADIAN NURSE
Finding rare types
Dr. Biro explained that many people
think they have quite ordinary blood
types according to the two primary
methods of blood typing, and may not
discover otherwise until they either
donate blood or enter a hospital for
surgery. The two primary methods of
blood typing are the ABO system, first
described by Landsteiner in 1900, and
the D factor typing, which gives the Rh
positive or negative reading.
At Red Cross donor clinics, according
to a senior technician at the Ottawa
donor clinic, whenever they discover a D
negative reading, they also check to see if
the donor is negative to two other factors
" C and E.
However, says the technician, it is
more often that a person discovers he or
she has a rare blood type through the
extensive cross-matching done in a hospi-
tal prior to surgery.
Only this cross-matching process,
either major or minor, searches out blood
type rarities. The minor cross-match
detects antibodies in the serum of the
donor's blood that are capable of effect-
ing the recipient's blood cells. As the
donor antibodies are greatly diluted by
the recipient's plasma, however, they are
considered of "minor" importance. The
major cross-match is the more important
of the two because it detects antibodies
in the serum of the recipient, which may
damage or destroy the red cells of the
proposed donor.
Medical science says there is no posi-
tive reason for blood rarities other than
genetic variation and the fact that blood
types are not restricted to any particular
race.
Blood type rarity. Dr. Biro says,
depends on the presence or absence of
antigens on the red cells. The antigens
build up antibodies in the blood serum
against donated blood unless the red cells
of the donated blood have identical anti-
gens.
Once a person discovers he has an
extremely rare blood type, he should
consider donating blood to the Red Cross
and having it stored against the day when
a transfusion miglit be needed. An Otta-
wa doctor with a rare blood type has a
bleeding ulcer; he has donated blood to
the Red Cross and it is deep frozen as
kind of an insurance should he hemor-
rhage or require surgery for another
reason.
Mowever, in most cases there is no
guarantee that your rare blood type may
not be shipped out in answer to an
emergency call to save a hfe in the Outer
Hebrides before you require it.
Frozen blood more useful
The value of deep freezing is not
hmited to preserving rare blood types for
long periods. Reconstituted, deep frozen
blood of any type survives better in the
body of the recipient when transfused.
Freezing suspends the aging process —
each day l/120th of our red blood cells
die and are replaced by new cells — and
frozen blood when transfused even years
later is as fresh as the day it was
collected.
According to Dr. Biro, there is a
greater safety factor in frozen blood. For
instance, hepatitis, a virus infection of the
liver, can be transmitted from one person
to another through transfusion of blood
stored in the normal manner. Frozen
blood. Dr. Biro says, eliminates this and
other hazards.
Because there is less reaction to frozen
blood, he would like to see it used in
critical transfusions. Frozen blood has
been used extensively in organ transplant
surgery to reduce the possibility of re-
jection.
It is very likely that when the deep
freezing process has become less costly
and less time consuming, all future blood
donations will be deep frozen until need-
ed for transfusion. One of the many
advantages will be to eUminate the crisis
often faced by hospitals when there is a
shortage of donor blood. Q
MARCH 1969'
A dollar^ a dollar^
follow the scholar
Last May, THE CANADIAN NURSE presented an article about Dorothy ). Kergin
a 1967 recipient of Canadian Nurses' Foundation funds who was studying tor tne
doctor of philosophy degree at the University of Michigan in Ann Arbor.
Now, almost a year later, the editor of CNJ "follows the scholar" to her new
home in Dundas, Ontario, and to her place of employment, McMaster University's
School of Nursing in Hamilton, and talks to her about her responsibilities as
associate director of nursing.
Dr. Dorothy Kergin, in plaid slacks
and a comfortable-looking ski cardigan,
pointed out various landmarks, including
McMaster University, as she drove us
from the airport limousine depot in
Hamilton to her apartment in Dundas. It
was a bright Sunday morning in mid-
winter, and Dorothy's pleasure at living in
this small suburban community, two
miles distant from the university, was ev-
ident.
"We even have a mountain here," she
said, referring to the 250-foot-high Niag-
ara escarpment — known affectionately
by the natives as "The Hamilton Moun-
tain." "And we're far enough from the
city to avoid the usual traffic problems,
yet close enough to allow us to take
advantage of the amenities of city life,"
she added.
Dorothy settled into her Dundas
apartment and her role as associate direc-
tor of McMaster's School of Nursing early
last September, after completing a three-
year doctoral program at the University
of Michigan in Ann Arbor. She received
her Ph.D. degree in December, and ad-
mitted that the ceremony was one of the
most exciting experiences in her life. "My
friends tell me that I really 'lost my cool'
on graduation day," Dorothy chuckled,
"because 1 kept asking where my car keys
were — as I clutched themin my hand! "
Most of Dorothy's nursing career
before attending the University of Michi-
gan was spent in public health in her
home province, British Columbia.
(Readers will remember Dorothy as the
public health nurse with a rather unusual
reputation: when stationed at Princeton,
MARCH 1%9
V.A. Lindabury
B.C., she went routinely to the Copper
Mountain mining area in her district "in
search of disease and affection" — a quest
accorded her by an imaginative young
Copper Mountain schoolboy in his essay
on "What the Public Health Nurse Does
When She Comes to Town.")
Three main responsibilities
"I have three main responsibilities at
McMaster," Dorothy explained, as we sat
in her modern, eighth-floor apartment
sipping our second cup of strong coffee.
"I teach public health nursing and coordi-
nate the students' clinical practice in
public health; serve as associate director
of the school, working with Alma Reid,
the director; and have some responsibility
for research. Actually, I haven't had time
as yet to even think about research," she
added, "but I hope to remedy that in
March, after my teaching responsibilities
are over for the year."
Until mid-December, Dorothy taught
public health nursing theory to the 28
students in the final year of the basic
baccalaureate degree program in nursing,
and supervised the activities of 10 of
these students in the Hamilton-
Wentworth Health Unit. Her lectures
ended in December, and she and her
students spent considerably more time in
the clinic^ setting in January and Febru-
ary.
When not teaching, Dorothy usually
can be found at a committee meeting.
One committee she is on meets regularly
to make plans for the new school of
nursing, scheduled to open in the fall of
1970. "Our school will be part of the
Health Sciences Center," Dorothy ex-
plained, "and will be housed in the new
University Hospital, along with the med-
ical school. We'll probably be able to
more than double our yearly student
enrollment, which is now limited to 30
because of lack of facilities."
Dorothy is chairman of an interdisci-
plinary committee set up to explore
opportunities for joint activities for stu-
dent education, and to clarify some of
the role relationships among members of
the health professions. "These meetings
are quite stimulating," she said, "prob-
ably because each representative from
nursing, medicine, and social work has a
different idea about the proper role of
persons on the health team, and isn't
afraid to voice it."
We asked Dorothy what other respon-
sibilities she had at McMaster.
"Well, I'm in charge of public relations
for the school of nursing," she said, "and
in future will be working closely with the
Health Sciences Center's new public rela-
tions officer. As part of this, one of my
responsibilities this year is to update the
school of nursing's calendar."
This year, Dorothy is helping to make
arrangements for nurses from abroad who
wish to visit McMaster University School
of Nursing before attending the Inter-
national Council of Nurses' Congress in
Montreal in June. "We're working closely
with the Registered Nurses' Association
of Ontario and schools of nursing in
Hamilton in planning a short program on
nursing education immediately prior to
ICN," she said, "and we'll probably be
arranging visits for a few nurses after the
THE CANADIAN NURSE 37
Dorothy Kergin (center) looks at the architect's plans for the Weekly seminars are held so that students can discuss problems
new Health Sciences Center, with Alma Reid (right), professor they have encountered in giving public health care to the
and director of McMaster School of Nursing, and Henrietta families assigned to them. This seminar is chaired by Dr. Kergin.
Alderson, associate professor.
Congress."
In her spare time, Dorothy is writing
part of a chapter for a booic that will be
published by the University of Toronto
School of Nursing to commemorate its
50th anniversary in 1970. She will in-
corporate some of the findings from her
doctoral thesis into her writing.
Enjoys the university "atmosphere"
As we ate lunch, Dorothy talked about
her Ufe as a faculty member, reminding us
that this was her second experience at
university teacliing. Immediately before
embarking on her doctoral program, she
had taught public health nursing at the
University of Michigan.
"It's stimulating to work with students
at this level," she said. "You really have
to be on your toes and keep up-to-date
with everytliing. I came to this school,
which offers a basic baccalaureate pro-
gram, because I believe the graduate of
such a program is the foundation upon
which we should be building our profes-
sion.
"And I enjoy the university atmos-
phere," Dorothy added. "There are
plenty of educational opportunities here
that staff can take advantage of, such as
various lecture series, and it's interesting
to be associated with people in other
disciplines who have similar interests in
education, yet different backgrounds and
points of view."
Dorothy said that her doctoral pro-
gram has given her considerable under-
38 THE CANADIAN NURSE
Standing of the organization of univer-
sities and the relationsliips and respon-
sibilities that exist within the university
structure. "When certain things happen
here, I can think back and see the
rationale for them, so in this way the
doctoral studies were helpful. In another
way, just the broadening of one's back-
ground and understanding of other disci-
plines — sociology and psychology, for
example — is extremely helpful to any
teacher.
Enthused about CNF
Dorothy is a staunch supporter of the
purposes of the Canadian Nurses' Foun-
dation. As she told us before, she could
not have stayed at school to complete her
doctoral degree, if she had not received
financial assistance from CNF.
When we reminded Dorothy of CNF's
financial plight (to date, only $25,000 is
available for 1 969 fellowship awards, less
than half the amount awarded in each of
the past two years), she suggested that
the present two-dollar membership fee
should be increased. "Personally, I would
have no objection to paying a larger fee,"
she said, "and I think that most people
who are members, who are committed to
the concept that there should be a Can-
adian Nurses' Foundation, will continue
to support CNF, even if the membership
fee is increased.
"Why not publish an article on wills
and bequests, and put a bequest form for
CNF in THE CANADIAN NURSE? Dorothy
asked. "This might encourage nurses to
will money to the Foundation. Too
often, women don't bother making wills,
because they don't have families."
Dorothy also believes that the federal
government must be convinced of the
need for more traineeships for nurses. "I
believe that, in future, lobbying will be an
important role for the Canadian Nurses'
Association," she said. "A full-time CNA
lobbyist would be able to keep the
government informed of the Association's
viewpoints, and could also keep the
nursing profession aware of pending legis-
lation and its implications for nursing."
Back with people
Last year, when Dorothy was comple-
ting her dissertation for her doctoral
degree, she felt rather isolated, because
the demands of her studies cut her off
from her usual contacts with friends and
colleagues. This year, she is back with
people and enjoying it. And we have a
strong suspicion that the people Dorothy
works with are more than pleased to have
this former CNF scholar in their ranks.
Membership in the Canadian Nurses' Foun-
dation can be obtained by sending your name,
address, and cheque for two dollars to: CNF,
50 The Driveway, Ottawa 4. Donations in
addiiion to the two-dollar membership fee are,
of course, welcome. Membership fee and dona-
tions are tax-deductible. Q]
MARCH 1969
New services help
patients and staff
A description of two new services — a day nursery for the children of the
hospital staff and a consultation clinic for outpatients — at Montreal's
Santa Cabrini Hospital.
Nicole Beaudry-Johnson
To attract married women back to
nursing, some hospitals in Canada have
set up their own day nurseries to care for
the children of members of staff. The
Jardin Cabrini, at the Santa Cabrini
Hospital in Montreal, is the first such day
nursery to be set up in the Province of
Quebec.
Reverend Mother Sylvie of the
Missionary Sisters of the Sacred Heart,
the present superior of Santa Cabrini
Hospital, says that the day nursery re-
lieves the working mother of many
worries concerning the care of her child.
The mother's worries about leaving the
child with an unknown babysitter, a
neighbor, or a relative are eliminated: she
knows, too, that the child will receive
prompt treatment if he becomes ill.
Everything scaled down
The day nursery occupies large quar-
ters close to, but outside, the hospital's
center of activity. Everything is scaled
down to a child's size so that furniture,
drinking fountains, and bathrooms are
the right height for the child's comfort
and protection. Even the elevator has
been installed without buttons so that
even the most imaginative child cannot
operate it alone. A dining hall, a dormi-
tory, a playroom, a classroom, an infir-
mary, and a small waiting room for the
mothers are included in the day nursery
complex.
For a modest weekly fee, the tots
Mine Beaudry-Johnson is Associate Editor of
L 'infirmiire canadienne.
MARCH 1%9
spend their day under the same roof as
their mothers and receive the same care as
they would in the more expensive, private
day nurseries. Four competent attendants
- a nursery school teacher, a nun, and
two assistants look after their needs.
The nursery school teacher works from
9:30 to 11:30 a.m. and from 2:00 to
4:00 p.m.
The children enjoy music, painting,
singing, handicrafts, and, in summer,
various games that can be played outside
on the hospital's large stretch of lawn.
They get a hot meal at noon and two
snacks during the day. After dinner, they
have a rest period.
Toddlers are admitted to the day
nursery as soon as they are toilet trained,
and can attend until they are six. On
registration, all children are seen by a
doctor. The mother can bring her child in
as early as 7:30 a.m., and can leave him
until 5:00 p.m., giving her time to shop if
she wishes.
Increase in services
When the day nursery opened its doors
in September 1968, there were 40 regis-
trations. Mother Sylvie expects the
number to increase, and says she hopes
the service will soon be available for
school-age children. These children would
get their noonday meal at the day nursery
and would return there after class to wait
for their mothers. Mother Sylvie also
expects that the nursery will be able to
accommodate the children of other work-
ing mothers in the neighborhood in the
near future.
THE CANADIAN NURSE 39
Consultation clinics
Santa Cabrini Hospital's outpatient
clinic, which opened last July, operates
on the same principle as a doctor's office,
and offers all the advantages of the
available hospital services.
Patients come to the clinic on ap-
pointment, thus eliminating the long
waiting periods that are so typical of
most hospital outpatient departments.
According to clinic coordinator Dr. John
Xenos, most patients who come to the
clinic are without a family doctor or,
having seen a doctor, are dissatisfied with
the results. Many patients are immigrants
who do not know where to go for
medical assistance. An interpreter, who
speaks several languages, helps these
people to communicate their problems to
the doctor. The clinic seems to be a
success, as the number of patients attend-
ing has tripled since its opening.
Primary contact
The new clinic is composed of many
units, including prenatal clinics, clinics
for dental surgery and oph"thalmology,
orthopedic, cardiology, and internal
medicine clinics, and a department of
audiology.
A patient who attends the outpatient
clinic is examined by the "primary con-
tact" doctor - a general practitioner -
who sees him again or refers him to a
specialist according to his need. Four
general practitioners are on duty from
Santa Cabrini Hospital, designed by the
Italian architect Pellegrino De Sina, is one
of the most modern and best-equipped
hospitals in Montreal
8:30 a.m. to 3:30 p.m. Monday to
Friday. Specialists are on rotation duty,
and each day of the week is reserved for
consultations in a given specialty. Night
calls, when urgent, are referred to the
emergency clinic.
The primary contact doctor treats 65
percent of the patients, according to
statistics made available by Dr. Giallo-
reto, who is Chief of Staff and in charge of
medical teaching at Santa Cabrini Hospi-
tal. If a patient is referred to a specialist,
he later returns to the primary contact
doctor for further care.
Nurse's role
Irene Pelletier, assistant head nurse at
the outpatient clinic, explained that the
nurse's main role in the clinic is to
welcome the patient and calm his fears.
"For some reason," she said, "the patient
generally feels more anxious than he
would if he had gone to the doctor's
office. The surroundings are new to him.
We must be smiling, calm, and patient."
There are three nurses on duty at the
outpatient clinic. According to Miss Pelle-
tier, their work is similar to that carried
on in a doctor's office. "We record the
patient's weight and height, chart his vital
signs, and take blood samples for labora-
tory analysis.
The clinic nurses make certain that the
patient's records are complete, and make
a follow-up appointment for him. If the
patient is in financial difficulties, the
nurse refers him to the department's
social worker: otherwise the patient pays
for his visits. □
40 THE CANADIAN NURSE
The hospital's day nursery relieves the
working mother of her worries about the
welfare of her child
MARCH 196S
Nurses Can Give and Teach Rehabili-
tation 2nd ed., by Mildred J. AUgire,
R.N., R.P.T., M.A. 93 pages. New
York, Springer Publishing Company,
Inc., 1968.
Reviewed by Charles Ball, Director of
Nursing, The Perley Hospital, Ottawa,
Canada.
The second edition of this book,
written primarily for those engaged in the
care of the handicapped, is presented in a
style that makes it easy and enjoyable to
read.
For those who need to be convinced
of the values of rehabilitation, there is a
very good introduction. This is followed
by short but informative chapters on the
prevention and treatment of com-
plications in the chronically ill, emotional
problems in patients with chronic disabih-
ties, and nutrition in rehabilitation.
A welcome addition to this second
edition is the chapter on bladder and
bowel training.
A major portion of the manual is
devoted to physical rehabilitation nursing
care. General information is given on bed
posture, and 16 basic exercises are de-
scribed and illustrated. The importance of
assigning orJy exercises that meet the
individual patient's needs is stressed and
the necessity for patient activity is clearly
demonstrated. Rehabilitation in the home
as well as in hospital is discussed.
This manual would assist the student
in understanding the role of the nurse in
rehabilitation.
Sex and Its Problems edited by WiUiam
A.R. Thomson, M.D. 90 pages. Edin-
burgh and London, E. & S. Living-
stone Ltd., 1968. Canadian agent:
Toronto, Macmillan Co. of Canada,
1968.
Reviewed by Dr. S.R. Laycock, Van-
couver, B.C.
This book, designed to help the family
doctor in his understanding of sexual
problems, contains a series of 12 articles
written by medical men in Britain and
pubhshed in 1967 in the British periodi-
cal The Practitioner. The topics discussed
include: sexual problems of adolescence,
the impotent male, the frigid female,
infertility in the male and female, artifi-
cial insemination, sexual adjustment, and
the climacteric and medical aspects of
homosexuality and sexual perversion.
MARCH 1969
The articles are, on the whole, very
readable. Unfortunately, the two most
technical articles are the first in the book
and are likely to discourage the non-
medical reader.
The book is of special value to medical
students, general practitioners, student
nurses, and graduate nurses. The intelli-
gent layman would find the book in-
formative.
Urology for Nurses by J.P. Mitchell, T.D.,
M.S.(Lond.), F.R.C.S., F.R.C.S.
(Edin.). 324 pages. Toronto, The Mac-
millan Company of Canada, 1968.
Reviewed by Frances M. Cochrane,
Nurse-in-charge, Cystoscopy Room,
Royal Columbian Hospital, New West-
minster, British Columbia.
This book is an excellent guide to the
surgical aspect of urology. It is of interest
not only to nurses working on a urologi-
cal ward or in a cystoscopy cHnic, but to
orderlies working with nurses in these
areas. Detail about surgical operations
and instruments has been ampUfied to
cover the needs of the operating theatre
staff. The size of this volume does not
permit discussion of subjects such as
nephritis or venereal disease, neither of
which is now regarded as the respon-
sibility of a nurse working in a depart-
ment of urology.
Although the art of nursing is largely
one of practical application, it is always a
helpful stimulus to know the reason for
the various treatments prescribed and the
operations performed. Furthermore, in
these days when the Umits of our knowl-
edge are extending so rapidly, frequent
changes in methods of treatment will
occur. Sometimes these changes may even
appear to be a paradoxical reversal of
basic principles. It is with this concept in
mind that a certain amount of theory has
been presented in this book, theory that
may at first appear to be unnecessary for
a nurse's education. Recent advances,
such as the treatment of acute renal
failure by dialysis, are described in some
detail. More practical features, such as the
management of a cystoscopy clinic, are
also described in the belief that urology
will develop as a specialty in most hospi-
tals within the forseeable future.
To the nurse who is interested in why
and how compUcated investigations are
done, to the nurse who wants a detailed
guide to a cystoscopy clinic, or to the
nurse who simply wants to learn the
proper way to test urine, this book will
be invaluable. The author has included
every important detail while reducing
theory to a minimum. He preaches simple
common sense based on accurate knowl-
edge.
This book is well illustrated with
halftone illustrations and photographs. It
is especially valuable because of the limi-
ted number of books available on this
topic for use by nurses.
Nursing Care in Eye, Ear, Nose, and
Throat Disorders, 2nd ed., by William
H. Saunders, B.A., M.D.; William H.
Havener, B.A., M.S. (Opth.), M.D.;
Carol J. Fair, R.N., M.S., and Joseph-
ine T. Hickey, R.N.. M.S. 402 pages.
Saint Louis, Mosby, 1968.
Reviewed by Marcella MacDonald and
Eileen Burgoyne, Eye, Ear, Nose, and
Throat Department, Camp Hill Hospi-
tal, Halifax, N.S.
Section one contains 1 5 chapters on
ocular disorders. Anatomy and physio-
logy are discussed and an account of
clinic examinations of eyes is given. The
significance of various eye symptoms is
particularly well covered and is followed
by a brief account of drugs commonly
usedJn the treatment of eye disease.
The chapter on nursing care is good
and certainly outlines current ideas of
postoperative nursing care and the use of
ophthalmic preparations. Refractive errors,
injuries, infections, strabismus, glaucoma,
cataract, and retinal detachments are each
given a chapter, and all the conditions are
adequately explained and the treatment
principles described.
A few of the less common eye diseases
are described in Chapter 13. The last two
chapters are devoted to the problems of
blindness and attempts to dispel common
misconceptions about eyes.
This section is easily read and well
illustrated, and represents an excellent
basic text for any nurse caring for eye
patients. It is higlily recommended and
should be in every eye ward.
Section two is devoted to disorders of
the ear, nose, and throat.
Anatomy and physiology, old and
modern methods of medical and surgical
therapy, and measures of prevention are
explained clearly and logically.
The authors' extensive use of illus-
THE CANADIAN NURSE 41
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yellow Caduceus. Lifetime "Fix-it-Free" Guarantee
No. 1610 Lighter 6.O0 ea. ppd.
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^^lg.u..M. Waterproof NURSES WATCH
Swiss made, raised silver full numerals, lumtn. mark-
ings. Rvd-tippcd sweep second hand, chrome /stainless
case. Stainless expansion band plus FREE black leather
strap. 1 )rr. guarantee.
No. 0»9a» IZ95 M. ppd.
"SENTRY" SPRAY PROTECTOR
Protects you against violent man or dog . . .
instantly disables without permanent injury.
Handy pressurized cartridge projects irritating
stream.
No. AP-16 Sentry 2,00 ea. ppd.
sterling HORSESHOE KEY RING
Clever, unusual design- one knob unscrews for In-
serting keys. Fine sterling silver throughout, wiHi
sterling sculptured caduceus cliann.
No. 96 Kay Rins 3.79 a«. ppd.
Nurses ENAMELED PINS
Beautifully sculptured status insignia: 2-color keyed,
hard-fired enamel on gold plate. Dime-siied; pin-bacli.
Specify RN. LPN. PH. LVN. HA. or RPh. on coupon.
No. 205 Enameled Pin 1.2S ea. ppd.
FISHER Finest sculptured cfiarms for Nurses. Check squares
CHARMS below and enclose with coupon right.
Caduceus CUFF UNKS
Sim. Mother-Df-Pearl set into (otd finish link,
spring arm. Sculptured gold fin. caduceus with
Of without RN, Gift-boxed.
No. 40300 LINKS (plain caduceus) i
No. 403RN LINKS (R. N. caduceus) {
3.9S pr. ppd.
PRINCESS GARDNER® Nurse Accessories
Famous matching Imported Pigskin, with narrow band Genuine Rep-
tile, all in Red. Blue or Brown. Sculptured gold-fin caduceus. For
hot-stamped gold initials, add $1.00 per item
_ A. SECRETART. holds cveryttilni: cirdt,
cith, ramovabla 14 ptrato'ctrd win.
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^^ n 1 cash, ramovabK
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-■--' |b3 y M. aoHiscBiih
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temo», winOowj.
s.30a>. ^a.
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Cath, cirdt, bill dlvldar, ram.
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pockati tor cards, cash. etc.
Ma. SOP PIcluraM J.SO ••. n*-
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M. IMAM Nay Guard 3.M aa, RRi.
. CIBAMTTE CASE, fits kinc or r*f.
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i. Na. SOL LlgNter 3.90 aa. »d.
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Gold fin., gift-boied. Specify RN. LVN or LPN.
No. 3240 Pin Guard 2.95 ppd.
Shears/ Pen POCKET KIT
Plastic Pocket Saver (see below) with 5Vi" prof,
forged bandage shears, plus handy chrome "tri-color"
pen (writes red, black or blue at flip of thumb).
No. 291 Pocket kit 3.50 ppd.
No. 292-R Pen Refills (all 3 colors) ..50 ppd.
Etched initials on shears add .50
Uniform POCKET SAVERS
Protects against stains and wear. Pliable white
plastic with gold stamped caduceus. Two com-
partment^ for pens, shears, etc. Ideal token gitb
or favors.
Ho. 210-e ( 6 for 1.50, 10 for 2.25
Seven } Zi or more, ,20 oa., all ppd.
Lindy Nurse STICK PENS
Slender, white barrels with tops colored to match
ink. Fine points; colors for charts, notes. Adj, silver
pocket clip. Blue, black, red or lavender.
Nr. 4S7-F Stick Ptns ) 6 pens 2.89, 12 pens 5.29
(cheese colorassort.) ] 24 or more 39 ea., all ppd.
TO REEVES COMPANr. Allleboro. Mass, 02703
When ordering CHARMS, check choices in boxes
at left and enclose with coupon.
DESMieriON
Nurtt'. C.P
Baby Sho.1
lliidualion tr.
Lucky Cn.rm
HtCOtnt Rini Bell
He.ri a Key
Oipiom. w flitbon
Al.im Clock
Cockl.il Giaii
Churcii * Vi.*
F.itn. Hop* a cri.r
Bo.l.r M.I. or Fern
Sowlmi Pin Bill
Book of Knowl.dg.
CupiO
RounO Pnolo cn.rm
Use separate sheet for additional items
LETT. COLOR! D Black n Blue FINISH: G Gold D Silver
LETTERING
2nd Line
INITIALS PROF.LETTERS-
STICK PEN COLORS
I enclose $ {Mass. residents add 3% S.T.)
Send to
Street
City
State .
.Zip..
42 THE CANADIAN NURSE
trations effectively clarifies and comple-
ments their pertinent information. It
seems a pity, however, that Frank
Netter's beautiful illustrations taken from
Clinical Symposia have not been repro-
duced in color.
A glossary and a list of suggested and
reference readings are also included.
Particular emphasis is placed on nurs-
ing procedures, patient teaching, and the
physiological and emotional changes that
the individual patient undergoes.
This text provides an authoritative
background to enhance nursing per-
formance and maintain it at a high level
of clinical competence, which, as stated
in the preface, is the authors' aim.
Storage of Blood by B.A.L. Hurn. 167
pages. New York and London, Acade-
mic Press, 1968.
Reviewed by Dr. D.M. Wrobel, Medical
Director, Canadian Red Cross Blood
Transfusion Service, Toronto.
This book brings a renewal of promise
that the consolidated efforts of many
scientists will establish long-term blood
storage as a routine practice. As yet, there
is no substitute for blood, and until there
is it will always be regarded as a life-giving
fluid. To fulfill its biological expec-
tations, the red cells must be kept viable
during storage.
In this book, the author gives precise,
up-to-date information with many in-
valuable references and his own practical
views on this fascinating subject. Each
chapter opens yet another aspect of the
blood transfusion. The author discusses
with clarity the complexities of blood
metabolism under various storage con-
ditions, the effect of different anti-
coagulants and purine nucleosides in re-
lation to biological and biochemical de-
gradation. Even under ideal storage con-
ditions the limited life of blood creates
acute shortages from time to time; this
reflects the urgent need for long-term
storage. The author evaluates the differ-
ent methods and techniques of freezing
and thawing blood for transfusion
purposes, together with its practical im-
plications in clinical medicine. The last
chapters of the book deal with methods
of red cell preservation for routine as well
as research laboratory.
A short review of the storage of other
blood components - platelets, leuco-
cytes, and plasma constituents - com-
pletes the book. Anyone who is in any
way connected with blood transfusion, be
he clinician, pathologist, technician, or
nurse, should read this excellent book. It
MARCH 1969
is well-written, with enofigh clear details
that the uninitiated reader will feel no
stranger in this field. □
accession list
Publications on this list have been
received recently in the CNA library and
are listed in language of source.
Material on this list, except Reference
items, including theses, and archive
books, that do not circulate, may be
borrowed by CNA members, schools of
nursing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List"
and should be addressed to: The Library,
Canadian Nurses' Association, 50 The
Driveway, Ottawa 4,
No more than three titles should be
requested at any one time.
BOOKS AND DOCUMENTS
1 . Adolescent psychiatry. Proceedings
of a conference held at Douglas hospital,
Montreal. Quebec, June 20, 1967, edited
by S.J. Shamsie. Montreal, Schering Corp.,
1968. 84p.
2. L'affrontement de I'inquietude par
Guy Delpierre. Paris, Editions du Cen-
turion, c. 1968. 302p.
3. Aids and adaptations; a collection
of designs compiled by the Canadian
Arthritis and Rheumatism Society, Oc-
cupational Therapy Department, Van-
couver, B.C. Toronto, The Canadian
Arthritis and Rheumatism Society, 1968.
Iv.
4. American universities and colleges.
edited by Otis A. Singletary and Jane P.
Newman. 10th edition. Washington,
American Council on Education, cl968.
1782p.
5. Annual report of the Order of the
Hospital of St. John of Jerusalem. Ot-
tawa, 1967. 58p.
6. Associated corporations in Canada.
3d edition. Don Mills, CCH Canadian
Ltd., 1965. 51p.
7. Cavalcade in white; the story of
nursing in Canada by Douglas H. Murray.
(Play written for the Canadian Nurses'
Association, 1958, Golden Jubilee). 64p.
8. Clear writing by Leo Kirschbaum.
Cleveland, World Publishing Company,
1961,cl950. 376p.
9. Deliberations; Conference cana-
dienne du vieillissement, Toronto, 20-24
Janvier 1966. Ottawa, Conseil canadien
du Bien-etre, 1967. 114p.
1 0. Effective revenue writing by Calvin
D. Linton. Washington, U.S. Treasury
Dept., 1962.2V.
11. Exchange of ideas; 1966-196 7
Conference of Nursing Advisory Service
of NLN-NTRDA. New York, National
League for Nursing, 1968. 1 14p.
12. Experiments in second-language
learning by Edward Crothers and Patrick
Suppes. New York, Academic Press,
1967. 374p.
13. Facts about nursing; a statistical
summary. New York, American Nurses'
Association, 1968. 247p.
14. Florence Nightingale. 1820-1910
by Cecil Woodham-Smith. London, Con-
stable, 1951, 1950. 61_5p.
15. Guide for instructors; care in the
home, rev. by National Nursing Services,
Canadian Red Cross Society. Toronto,
1967. 150p.
16. Handbook of recovery room nurs-
ing by Lucille 1. Betschman. Philadelphia,
Davis, c 1967. 308p.
17. Incorporation and income tax in
Canada. 4th edition by Gordon W. Riehl.
Don Mills, CCH Canadian Ltd., 1965.
196p.
\8. An introduction to the analysis of
educational concepts, by Jonas F. Soltis.
Reading, Mass., Addison-Wesley, cl968.
lOOp.
19. Learning and society, edited by
James Robbins Kidd. Toronto, Canadian
Association for Adult Education, cl963.
414p.
20. Man deserves man; CUSO in
developing countries, edited by Bill
• •I like the challenge
of working in the vi-
brant atmosphere of
Houston's Methodist Hos-
pital — let me tell why
t^ nurse
Let"s tell it like it is. Most nurses who are free to locate
anywhere they wish, want to be where medical history is
being made. Nurses at Houston's Methodist Hospital have
this sense of history being made — here and now. One nurse
said, "... the research and well-known physicians, pa-
tients from all over the world are interesting."
"I consider the most exciting thing about working at
Methodist Hospital the feeling that I'm in the middle of
a place that is making medical history." says a Cardiovas-
cular Nurse Specialist.
Ten Basic Nurse Services. Methodist Hospital nurses do
not rotate shifts and often improve their salaries and posi-
tions by entering our Nurse Specialist program. Excellent
openings are available in all ten basic nurse services, in-"
eluding Cardiovascular. Orthopedic. ICU, Surgical, Med-
ical. OB-GYN, Psychiatry, OR, Neuro, Eye and ENT.
Send for our colorful brochure today.
THE
FULLER
SHIELD:
NAME
ADDRESS-
CITY
Keeps dressings firmly in place
Prevents soiling of clothing, bed linen
The ideal post-operative dressing for patient
comfort, nursing convenience. The FULLER
SHIELD, designed on undergarment lines, is a
protective dressing especially made to maintain
anal, perianal or sacral dressings comfortably
in place without binding, without use of tapes.
Surgeons order two FULLER SHIELDS
for each patient. (One on and one off.)
Nurses are glad they do.
-STATE_
I'm interested in this nursing service
-ZIP.
Request samples through your hospital
purchasing agent.
interested in this nursing service: •
THE METHODIST HOSPITAL W
WINLEY-MORRIS
CO.
LTD.
Texas Medical Center Houston, Texas 77025
MARCH 1969
THE CANADIAN NURSE 43
accession list
(Continued from page 43)
McWhinney and Dave Godfrey. Toronto,
Ryerson Press, 1968. 461p.
21. Management and Machiavelli by
Antony Jay. London, Hodder and
Stoughton,cl967. 223p.
22. Pioneering in public health nursing
education; the history of the University
Public Health Nursing District
1917-1962, by Eleanor Farnham. Cleve-
land, Ohio, Press of Western Reserve
University, 1964. 104p.
23. Probings; a collection of essays
contributed to the Canadian Mental
Health Association for its golden jubilee
1918-1968. Ottawa, Canadian Mental
Health Association, 1968. 94p.
24. A profile of physicians in the city
of New York before medicare and
medicaid by Nora Piore and Sandra
Sokal. New York, Hunter College, 1968.
208p.
25. Psychiatric de I'adolescence; Con-
ference tenue le 20 juin 1967 a ITjdpital
Douglas, Montreal, P.Q., par S.J. Shamsie,
redacteur. Montreal, Sobering Corp.,
1968. 91p.
26. Research and investigation in adult
education - 1918 annual register, edited
by Roger DeCrow and Stanley Gro-
bowski. Washington, Adult Education
Association of the U.S.A., 1968. 79p.
27. Sante et equilibre de I 'enfant, ■
guide des infirmieres et puericultrices,
parente et educateurs par Florence Blake.
Paris, Centurion, cl968. 202p.
28. A study of a patient classification
system by Wayne Reavely Moon. Ann
Arbor, 1964. 90p. Thesis (M.H.A.) -
Michigan. R
29. Target 2067; Canada's second
century by Leonard Berlin. Toronto,
Macmillan,cl968. 297p.
30. Towards collective bargaining in
non-profit hospitals: impact of New York
Law by Sara Gamm. Ithaca, N.Y., New
York State School of Industrial and
Labor Relations, 1968. 1 12p.
31. What are the pay-offs from our
federal health programs? a progress
report on the Johnson administration,
1963-1968. New York, National Health
Education Committee, 1968. 71 p.
32. Working with others for patient
care by Grace Peterson. Dubuque, Iowa,
Brown, cl 968. 140p.
PAMPHLETS
33. Collective bargaining techniques.
Montreal, Montreal Board of Trade, Em-
ployee Relations Section, 1967. lOp. R
34. Folio of reports, forty-seventh
annual meeting, Oct. 22, 1968. Charlotte-
town, Association of Nurses of Prince
Edward Island, 1968. 47p.
35. Fundamentals of good plaster
technique. Lachine, Smith & Nephew
Ltd., 1966. lip.
36. Guide for assessing nursing services
in long term care facilities. New York,
National League for Nursing, cl968. 24p.
37. Guidelines for cyclical scheduling
by John P. Howell. Ann Arbor, Com-
munity Systems Foundation, 1965. 12p.
38. The implementation of a hospital
occupational health service by the Royal
College of Nursing and National Council
of Nurses of the United Kingdom, Lon-
don, Royal College of Nursing, 1968.
14p.
39. Occupational health for hospital
staff. Excerpts from the papers read
before the Health Congress of the Royal
Society of Health at Eastbourne, 29 April
to 3 May 1968 London, 1968. 5p.
40. Operation retrieval; list of phy-
sicians and biomedical scientists training
or working abroad and available for em-
ployment in Canada, 1968. Ottawa, As-
sociation of Canadian Medical Colleges,
1968. lip.
4\. A position paper on nursing in
Manitoba. Winnipeg, Manitoba Associa-
tion of Registered Nurses, 1968. 17p.
42. Progress report, first, March 1966.
London, The Commonwealth Foun-
dation, 1967. 24p.
Alitalia gives you
Portugal & /Madeira
just $341.
15 days in Portugal and Madeira, hotels,
breakfasts, sightseeing, plus your Alitalia jet
there and back. Just one of our great Extra-
Value Vacations !
Where leould you like to go? Send for brochures to:
TOUR DIRKCTOK, ALITALIA,
2055 PEEL ST., MONTREAL 110, P.Q.
E.ctrn-Valtie Vacations: D Portugal-Madeira, $341 Q
Spain-Portugal, $464 D Italy $540 D Portugal-Spain-
Moroeco, $626.
Bargain-Hunter's Holidays: D Israel, $525 D Italy By
Car, $389 D Italy Jet/Rail, $389 D Iberian Holiday By
Car, $325 O London & Britain, $325 D Ski D Sun & Fun
NAME_
ADDRESS PHONE
CITY PROV
MY TRAVEL AGENT IS
MUTMUM^
CN
Prices based on 14/21 day round-trip jet economy ^roup
toiii-ba.sinK fares from Montreal or N.Y.
44 THE CANADIAN NURSE
ALL MAKES
OF BROKEN
INSTRUMENTS
REPAIRED QUICKLY
AND EXPERTLY
Our skilled technicians perform fast, guaranteed
repairs on all makes of domestic and imported
instruments:
BLOOD PRESSURE APPARATUS D SCISSORS
D STETHOSCOPES D OTOSCOPES D FORCEPS
D RETRACTORS D NEEDLE HOLDERS
D OSTEOSCOPES D OSTEOTOMES D GOUGES
D MENISCUS KNIVES D BONE RONGEURS
D CURETTES D STERILIZERS D SIGMOIDO-
SCOPES DANASCOPES DOPHTHALMOSCOPES
D EXAMINING SETS, ETC.
Free advice and a quotation supplied on request.
A chrome plating and sharpening service Is also available.
Instruments accepted from individuals.
(Minimum charge is $5.00)
Send your instruments, with a purchase order to:
WINLEY-MORRIS SURGICAL DIVISION
c/o W&W Precision Company
745 St. Maurice Street
Montreal 3, Que.
MARCH 1969
accession list
48.
Occupational Research
(Continued from page 44)
43. Public health nursing officers and
administration. Excerpt from papers read
by Yvette E. Buckoke before the Health
Congress of the Royal Society of Health
at Eastbourne, 29 April to 3 May 1968.
London, 1968. 4p.
44. Reports presented during the
forty-eighth annual meeting. Montreal.
October 31, November 1, 1968. Montreal
Association of Nurses of the Province of
Quebec, 1968. 22p.
45. La responsabilite civile, medicale
et hospitaliere; evolution recente du droit
quebecois; par Paul A. Crepeau. Montreal,
Editions Intermonde, 1968. 38p.
COVhRNMENT DOCUMENTS
Canada
46. Bureau of Statistics. Hospital sta-
tistics: hospital beds, 1966. Ottawa,
Queen's Printer, 1968. 94p.
47. Dept. of Manpower and Im-
migration. Operation retrieval; Canadian
University Service Overseas (CUSO) re-
turning volunteers who will be available
for employment in Canada, 1968-69.
Ottawa, 1968.lv.
Section. Career information publications.
Ottawa, Queen's Printer, 1968. 2v.
49. Dept. of National Health and
Welfare. Research projects, 1968-69.
(Research under the National Health
Grants). Ottawa, 1968. Iv.R
50. . Research under the
National Health Grants; general in-
structions. Ottawa, 1968. 19p.
51. . Research and Statistics
Directorate. Social security in Canada.
Ottawa, 1968. 165p.
52. Medical Research Council of Can-
ada. Reference list of medical research
projects in Canada 1968-69. Ottawa,
Medical Research Council, 1968. 276p. R
53. National Research Council of
Canada. NRC Review, 1968. Ottawa,
Queen's Printer, 1968. 237p.
54. Parliament. Senate. Special Com-
mittee on Science Policy. Proceedings;
phase 1, 2d session of the 27th Parlia-
ment, 1967-1968. Ottawa, Queen's
Printer, 1968. 328p.
U.S.A.
55. Dept. of the Army. Improve your
writing. Washington, 1959. 28p.
56. Dept. of Health, Education and
Welfare. Getting your ideas across
through writing. Washington, U.S. Gov't.
Print. Off., 1950. 44p.
57. . Public Health Service.
List of journals indexed in Index
Medicus, National Library of Medicine.
Washington, U.S. Gov't. Print. Off.. 1968.
97p.
58. Environmental Radiation Ex-
posure Committee. Report on environ-
mental contamination bv radioactive
substances, Dec. 1, 1967. Rolleville. Md.,
National Center for Radiological Health.
1968. 24p.
59. National Center for Health Sta-
tistics. Design and methodology for a
national survey of nursing homes. Wash-
ington, U.S. Dept. of Health, Education
and Welfare, 1968. 37p.
STUDIES DEPOSITED IN
CNA REPOSITORY COLLECTION
60. An exploratory study of the pro-
fessionalization of registered nurses in
Ontario and the implications for the
support of change in basic nursing edu-
cational programs, by Dorothy Jean
Kergin. Ann Arbor, Mich., 1968. 244p.
Thesis — Michigan. R
61. Rapport du projet de recherche
no. 1, par M.L. Gingras. Toronto, Conseil
Canadien d'accreditation des hopitaux,
1968. 148p. R
62. The use of a conceptual model to
evaluate psychiatric nursing therapy by
Dorothy May Pringle. Denver, Col., i968.
89p. Thesis (M.Sc.N.) - Colorado. R
63. A view from the top of the hill;
decentralization of a state hospital by
Beatrice Biron. Brainerd, Minn.. 1968.
56p.R n
Request Form
for "Accession List"
CANADIAN NURSES'
ASSOCIATION LIBRARY
Send this coupon or facsimite to:
LIBRARIAN, Canadian Nurses' Association,
SO The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in the
issue of The Canadian Nurse,
or add my name to the waiting list to receive them when
available.
Item Author Short title (for Identification)
No.
Request for loans will be filled in order of receipt.
Reference and restricted material must be used in the
CNA library.
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Registration No
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SPEAK FRENCH THE FUN WAY
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business and travel.
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lary and accent that will be the envy
of an your friends.
Carefully planned by accredited linguistic
experts to bring you the most practical
course possible. Each side of every re-
cord is a complete lesson— read once
in English and twice in French so you
can check your progress and pronun-
ciation. All in a handsome presentation
case. Complete with printed instructions
for vocabulary, simplified rules of
grammar, hints on current idiom and
usage. Yours for the whole family to
enjoy and profit from — right in the
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NAME
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^
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^^^^
MARCH 1969
THE CANADIAN NURSE 45
classified advertisements
ALBERTA
ALBERTA
BRITISH COLUMBIA
Opportunity for team teaching in nursing in o Junior
College setting. INSTRUCTORS (3) to be appointed in
1969 - - one with Psychiatric Nursing preparation;
ond one with Pediatric or Maternal Child preporo-
tion; and one other with either preparation. Qualif.-
cation is Master's degree in clinical specialty pre-
ferred. Bachelor's degree accepted for temporary
oppointment. Active and auxiliary hospital proviides
clinical experiences. Total student enrollment of 70.
Total staff of seven for nursing. Apply for further "*'
details to; Director, Department of Nursing Educo-*'
tion. Red Deer Junior College, Red Deer, Alberta.
REGISTERED NURSES FOR GENERAL DUTY in a 3d-
bed hospital. Salary 1968 $405-$485. Experienced
recognized. Residence available. For particulars con-
tact: Director of Nursing Service, Whitecourt General
Hospital, Whitecourt, Alberta. Phone: 778-2235.
GENERAL DUTY NURSES (2) for a 21-bed hospital
in Northern Alberto. Separate Nurses' residence.
Uniforms laundered. Salary presently $420 to $490
per month pending 1969 negotiations. Apply to: Mrs.
Evelyn Forbes, Administrator, Berwyn Municipal
Hospital, Berwyn, Alberta.
General Duty Nurses for ccrive, accredited, well-
equipped 65-bed hospital in growing town, popula-
tion 3,500. Salaries range from S405 — S485 ccm-
mensL'rate with experience, other benefits. Nurses' re-
sidence. Excellent personnel policies and working
conditions. New modern wing opened in 1967. Good
communications to large nearby cities. Apply: Di-
rector of Nursing, Erooks General Hospital, Brooks,
Alberto.
GENERAL DUTY NURSES (2) for small modern Hos-
pital on Highway No. 12. East Central Alberto,
Salary range $430 to $510 including Regional
ADVERTISING
RATES
FOR ALL
CLASSIFIED ADVERTISING
$11.50 for 6 lines or less
$2.25 for each additional tine
Rates for display
advertisements on request
Closing date for copy and cancellation Is
6 weeks prior to 1st day of publication
month.
The Canadian Nurses' Association does
not review the personnel policies of
the hospitals and agencies advertising
in the Journal. For authentic information,
prospective applicants should apply to
the Registered Nurses' Association of the
Province in which they are interested
in working.
Address correspondence to:
The
Canadian
Nurse
50 THE DRIVEWAY
OTTAWA 4. ONTARIO.
Differential. Residence available. Personnel policies
as per AARN and A.M. A Apply: Director of Nursing,
Coronation Municipal Hospital, Coronation, Alberto.
GENERAL DUTY NURSES for 94-bed General Hos
pital located in Alberta's unique Badlands. $405
$485 per month, approved AARN and AHA per-
sonnel policies. Apply to: Miss M. Howkes, Direcio
of Nursing, Drumheller General Hospital, Drumhel
ler, AlberlG. 1-31-2A
Gvnaral Duty Nursas for 64-bed active treatrr^eni
hospital, 35 miles south of Calgary. Salary range
$405 - $485. Living accommodation available in sep-
arate residence if desired. Full maintenance in
residence $50.00 per month Excellent Personnel
Policies and working conditions. Please apply to:
The Director of Nursing, High River General Hos-
pital, High River, Alberto. J-46-1A
GENERAL DUTY NURSES for 200-bed active treatment
hospital. Credit for past experience and postgrad-
LOte training. Employer-employee porticipation in
medicol coverage and superonnuoton. Apply: D rec-
tor of Nursing Service, St. Michael's General Hos-
pital, Lethbridge, Alberta.
General Duty Nurses required by 150-bed general
hcsoital presently expanding to 230 beds. Salary
1967, S380 to $450; 1968 — S405 to $485. Experi-
ence recognized. Residence available. For particulars
contact Director of Nursing Service, Red Desr
Generol Hospital, Red Deer, Aibertc.
Ganeral Duty Nursing positions are available in c
100-bed convalescent rehabilitation unit forming
part of a 330-bed hospital complex. Residence
available. Salary 1 967 — $380 to $450. per mo.
1968 — $405 to $485. Experience recognized. For
full particulars contact Director of Nursing Service,
Auxiliary Hospital, Red Deer, Alberta.
BRITISH COLUMBIA
OPERATING ROOM ASSISTANT SUPERVISOR required
with preparation and experience, must be eligible
for B.C. Registration. For further information apply
to: Director of Nursing, Royal Jubilee Hospital,
Victoria, British Columbia.
OPERATING ROOM INSTRUCTOR w/ith University
preparotion, for a 450-bed hospital with a school of
nursing, 145 students. Apply: Associate Director,
School of Nursing, St. Joseph's Hospital School of
Nursing, Victoria, British Columbia.
COME TO PACIFIC NORTHWEST — Gateway to
Alaska, Friendly community, enjoyable Nurses' Resi-
dence accommodation at minimal cost. RNABC con-
tract in effect. Salories — Registered $508 to $633,
Non-Registered $483, Northern differential $15 a
month. Travel allowance up to $60. refundable
after 1 2 months service. Apply to: Director of
Nursing, Prince Rupert General Hospital, 551-5th
Avenue East, Prince Rupert, British Columbia.
B.C. R.N. for General Duty in 32 bed General Hospi-
tal. RNABC 1969 salary rate $508 - $633 and fringe
benefits, modern, comfortable, nurses' residence in
attractive community close to Vancouver, B.C. For
applicaion form write: Director of Nursing, Fraser
Canyon Hospital, R.R. 2, Hope, B.C. 2-30-1
Generol Duty Nurses for active 30-bed hospital.
RNABC policies and schedules in effect, also North-
ern allowance. Accommodations availoble in res-
idence. Apply: Director of Nursing, General Hospital,
Fort Nelson, British Columbia. 2-23-1
GENERAL DUTY NURSES (two). Fully accredited 25-
bed hospital Rogers Pass Area Trans Canada High-
way. Comfortable Nurses' Residence. RNABC Agree-
ment in effect. 3 months allowed to gain B C. Regis-
tration. Apply: Mrs. E. Neville, R.N., Director of
Nursing, Golden & District General Hospital, P.O.
Box 1260, Golden, B.C.
General Duty Nurses for new 30-bed hospital
located in excellent recreational area. Salary and
personnel policies in occordonce with RNABC. Com-
fortable Nurses' home. Apply: Director of Nursing,
Boundary Hospitol, Grand Forks, British Columbia.
GENERAL DUTY NURSES for 63-bed active hospital
in beautiful Bulkley Valley. Booting, fishing, skiing,
etc. Nurses' residence. Salary $466. -$490., main-
tenance $70., recognition for experience. Apply:
Director of Nursing, Bulkley Valley District Hospital,
Smithers, British Columbia.
General Duty Nurse for 54-bed active hospital in
norttiwestern B.C. Salaries: B.C. Registered $405, B.C.
Non-Registered, $390, RNABC personnel policies
in effect. Planned rotation. New residence, room and
board: S55/m. T.V. and good social activities.
Write: Director of Nursing, Box 1297, Terrace, British
Columbia. 2-70-2
GENERAL DUTY AND PRACTICAL NURSE needed for
70-bed General Hospital on Pacific Coast 200 miles
from Vancouver. RNABC contract, $25. room and
board, friendly community. Apply: Director of Nurs-
ing, St. George's Hospital, Alert Bay, British Colum-
bia.
GENERAL DUTY, OPERATING ROOM AND EXPERI-
ENCED OBSTETRICAL NURSES for 434-bed hospital
with school of nursing. Salary: $508-$633, these
rates are effective January 1969, plus shift differ-
ential. Credit for post experience and postgraduate
training. 40-hr. wk. Statutory holidays. Annual incre-
ments; cumulative sick leave; pension plan; 20
working days annual vacation; B.C. registration re-
quired. Apply; Director of Nursing, Royal Columbian
Hospital, New Westminster, British Columbia.
GRADUATE NURSES for 24-bed hospital, 35-mI. from
Vancouver, on coast, salary and personnel prac-
tices in accord with RNABC. Accommodation availa-
ble. Apply: Director of Nursing, General Hospital,
Squcmish, British Columbia. 2-68-1
GRADUATE NURSES FOR GENERAL DUTY (urgently
needed) in United Church frontier hospitals in
Western Canada and Newfoundland. This Is good
experience in all phases of general nursing. Room
and board supplied in staff residence ot nominal
cost; salary and working conditions as in agree-
ment with Reg. Nurses' Assoc, of the province con-
cerned. Please contact: W. Donald Wott, M.D.,
Superintendent of hospitals, 6762 Cypress Street,
Vancouver 14, B.C.
MANITOBA
GENERAL DUTY REGISTERED NURSES for 36-bed hos-
pital. Starting salary $460 per month with an addi-
tional basic raise of $10 Sept. 1st. For particulars
and personnel policies contoct: Director of Nurses,
Sour is District Hospitol, Souris, Manitoba.
NOVA SCOTIA
GENERAL DUTY NURSES: Positions available for
Registered Qualified General Duty Nurses for 138-
bed active treatment hospital. Residence accom-
modotion available. Applications and enquiries will
be received by: Director of Nursing, Blanchard-Fraser- :
Memorial Hospital, Kentvllle, Nova Scotia. 6-19-1'
ONTARIO
46 THE CANADIAN NURSE
DIRECTOR OF NURSING required for District Health
Unit. Good personnel policies. Apply to: Dr. A.E.
Thorns, Medical Officer of Health, 70 Charles St.,
Brockville, Ontario.
SENIOR SUPERVISOR PUBLIC HEALTH NURSING —
Required to direct nursing services in Genera I izerJ
Public Heolth program. Salary to be negotioted.
Employer shared OMERS, O.H.S.C. and Windsor
Medical. One month vacation. Cumulative sick leave.
Liberal car allowance. APPLY: stating qualifications
and experience to: E.G. Brown, M.O.H. and Director,
MARCH 1969
April 1969
The
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Only two months to go to the
INTERNATIONAL COUNCIL OF NURSES'
14th OUADRENNIAL CONGRESS
Place Bonaventure, Montreal, Canada,
22 to 28 June, 1969.
PROGRAM HIGHLIGHTS:
Sunday, 22 June
3.00 p.m. Interfaith Service
8.00 p.m. Opening Ceremony
Monday and Tuesday, 23 and 24 June
Open meeting of Council of National
Representatives (CNR)
Wednesday, 25 June
"Focus on the Future"
a.m. Plenary session —
Forecasting the Future
p.m. Plenary session —
Implications of Change
Thursday, 26 June
"Focus on the Future"
a.m. Plenary session —
Education for Today and To-
morrow. Basic Programs
p.m. Plenary session —
Education for Today and To-
morrow. Post Basic and Post-
graduate Programs
5.00 p.m. Voting for ICN Officers by
CNR
8.00 p.m. Students' Congress
Friday, 27 June
"Focus on the Future"
a.m. Plenary session —
Security for Tomorrow
p.m. Plenary session —
Leadership in Action
8.00 p.m. Closing Ceremony
Admission of new member
associations to ICN
New ICN Officers
announced
Saturday, 28 June
Canada Hospitality Day.
N.B.
Special Interest Sessions — 19 topics in English and French, will be
running Monday through Friday
International Nursing Exhibition — runs Monday through Wednesday
FOR FURTHER IN FORMA T/ON, INCL UDING R EG 1ST R A TION
KITS, PLEASE WRITE TO:
ICN Congress Registration,
50, The Driveway,
Ottawa 4, Ontario.
N. B. —Daily registration fee at Congress now $10.00
APRIL 1%9
THE CANADIAN NURSE 1
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The
Canadian
Nurse
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 4
^^^
April 1%9
33 Nursing Assistants Are Here to Stay D.J. Kergin
34 And Now Your Income Tax F.S. Mallett
37 Medicolegal Problems Can Arise in the
Coronary Care Unit G.G. Crotin
40 Smoking Habits of Canadian Nurses and Teachers A.J.Phillips
42 Hemodialysis in the Home S. Wood
45 Idea Exchange
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
7 News
22 Names
24 Dates
28 New Products
30 In a Capsule
46 Books
50 Accession List
Executive Director: Helen K. iMussallem •
Editor: Virginia A. Lindaburv • Assistant
Editor: Eleanor B. Mitchell • Editorial Assist-
ant: Carol A. KoUarsky • Circulation Man-
ager: Ber>l Darling • Advertising Manager:
Ruth H. Baumel • Subscription Rales: Can-
ada: One Year, S4.50; two years, $8.00.
Foreign: One Year, S5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Four weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, VNhere applicable. Not responsible for
journals lost in mail due to errors in address.
® Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on vvhite paper)
are welcomed with such articles. The editor
is not committed to publish all articles sent,
nor to indicate definite dates of publication.
.Authorized as Second-Class Mail by the Post
Office Department, Ottawa, and for payment
of postage in cash. Postpaid at Montreal.
Return Postage Guaranteed. 50 The Driveway,
Ottawa 4, Ontario.
PRIL 1969
Editorial
The strike of 18 nurse educators employed
by the Hamilton and District School
of Nursing (News, page 7) will probably be
ended and the main issues settled — in one
way or another — by the time this editorial
is read. Even so, we believe that certain
aspects of this strike and the negotiations
that preceded it need to be examined,
because they have implications for all nurses.
Let it be understood that we support
these nurse educators in their efforts to
obtain fair wages, benefits, and working
conditions. We are convinced that they
had no other alternative but to take the
action they did. They went on strike as a
last resort, after they had met again and
again with an employer who remained
inflexible.
The experiences of these teachers raise
several questions. First, how can
collective bargaining be considered
anything but a farce, when an agency such
as the Ontario Hospital Services
Commission — a government commission
that is responsible to the minister of
health — is in a position to pull strings so
effectively that employers of nurses and
nurse educators refuse to budge an inch
from the salary directives it lays down?
Second, why, in this instance, does
the employer say "We cannot meet
their demands," and yet offer to
submit the grievances to a government-
appointed arbitrator, whose findings would
be binding on both parties? The
arbitrator might well recommend that the
teachers be paid the salaries they are
asking; it is even conceivable that he
would recommend higher salaries than they
are demanding.
This offer on the part of management
is difficult to fathom. It gives the
impression that the arbitrator — who is
supposed to be impartial — might see
things their way.
Our third question is this: Why did
2 of the 18 instructors, one of whom
definitely voted in favor of strike
action, become turncoats and return
to work? If they didn't favor strike
action, they should have voted against it;
having declared their intention,
they should not have abandoned their
colleagues and their principles.
Our fourth question concerns the
nursing students who, as future members
of the profession and as future
employees, may one day be faced with
similar grievances. According to a
Globe and Mail report, the students
"took no side in the dispute," although
"many students were friendly to the
strikers."
We understand the concerns of these
students who wish to see an immediate
settlement. Is it not possible, however,
that the students' support of their
instructors might hasten this settlement?
And is it not possible that the profession
might progress further — in every way
— if more of its members and future
members were willing to take a stand
on an issue, instead of remaining
neutral? — V.A.I.
THE CANADIAN NURSE 3
letters {
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Brighter lives for the old
It isn't too many years ago that
geriatric care was carried out in "asy-
lums" where patients were treated as
incurable and hopeless. Many of these
institutions were called Hospitals for
Incurables.
Today, old people are no longer for-
gotten and neglected in old folks' homes.
The attitude of the general public has
changed and so has that of nurses. No
longer are old people considered to be a
chore, their care uninteresting and boring.
Thanks to our enterprising and thought-
ful nursing leaders, geriatric treatment has
become known as "extended care"; here,
good nursing programs work wonders for
our aged ones who otherwise might have
become a real burden.
This improved attitude to the old has
led to the rehabilitation of paraplegics,
many leading useful and busy lives from
their wheelchairs. Cars are designed
especially for them, and ramps are built
for their convenience in hospitals or in
their own homes. Physiotherapy and
hydrotherapy is put into practice in
swimming pools especially designed for
easy entrance.
This type of work takes dedication on
the part of the nurses involved. It can
become tedious and very uninteresting
unless the nurse takes a sincere interest in
each patient as an individual with indi-
vidual needs. The care of these people can
prove rewarding when even a little
progress is made by a seemingly helpless
person after many exercises and attempts,
perhaps over a long period of time.
In this field, "room number so and so"
or "case number such and such" must be
put aside and nurses must try to treat the
patient as an individual personality with
specific needs entirely his own. - Isobel
Simpson, Prince Rupert, B.C.
The unsigned letter
The letter in the November 1968 issue
entitled "A paid president? ", signed
"B.C. Nurse", annoyed me. In their vis-a-
vis in the August 1968 issue, Mary
Richmond and Monica Angus had the
courage to present their opposing points
of view on the issue of a paid president
for our consideration. Surely we must
have the courage to identify ourselves
with issues we feel strongly about, if we
are going to make progress in our pro-
fessional association.
The unsigned letter, the mumbing in
the back row at chapter or provincial
Registered Nurses' Association meetings,
4 THE CANADIAN NURSE
the beefing at coffee break, may meet the
needs of the individual but they certainly
do not meet the needs of the group. I
realize that the explanation for these
kinds of activities is embedded in our
tradition, but Mary Richmond and
Monica Angus have made a breakthrough.
Let's not slip back. — Patricia M. Wads-
worth, Vancouver.
Books needed overseas
I am writing to you with regard to a
problem faced by the Canadian Council
for International Co-operation, in its pro-
gram of sending educational books to
schools, libraries and training centers in
developing countries.
Several months ago, we received an
urgent appeal from the Nirmala Hospital
in Calicut (Kerala), India, for books on
nursing science and practice and nursing
journals for its training program. As our
book centers have not received such
books or journals for some time, we have
been unable to meet this request.
We would appreciate any donations of
such material, which can be sent to: the
Overseas Book Centre, 207 Queen's Quay
West, Toronto 1, Ont.; the Overseas Book
Center, 4130 Verdun Ave., Montreal 19,
Que.; or the Canadian Council for Inter-
national Co-operation, 75 Sparks St.,
Ottawa 4, Canada. Anyone in another
part of the country wishing to help could
write to Ottawa for instructions on where
to send the books.
We will undertake the cost of sending
the books to the Nirmala hospital. If we
receive more books than this hospital can
use, we will have them sent to similar
deserving institutions. - W.A. Teager,
Ottawa.
Ostomy rehab — a necessity
In May 1962, after having had ulcer-
ative colitis for five years, I underwent
surgery that left me with a transverse
colostomy. On my surgeon's instructions,
a nurse attempted to teach me to irrigate;
we thought we were following the in-
structions on the box, but did everything
wrong. How easy it would have been to
become discouraged; instead, as I recuper-
ated, I became determined to become a
self-taught enterostomal therapist dedi-
cated to the idea that patients undergoing
this surgery should have the support and
guidance of a fellow 'ostomist.
My qualifications include an RN
degree, extensive reading throughout my
five-year illness, and the best teacher of
all — living, coping, accepting. I was
determined to convince the hospitals and
doctors concerned that I was capable of
offering a new service, not duplicating
anything being done for 'ostomy patients.
I approached four surgeons in Victo-
ria. They seemed interested in using the
service I offered: a complete counseling
service for 'ostomy patients and their
families, preoperative care, postoperative
care, fitting of apphances, and teaching of
irrigation — in short, anything needed to
accustom a patient to hfe with an
'ostomy.
It is four years since 1 was called to see
my first patient — a frightened young
woman facing an ileostomy after years of
ulcerative colitis. I have just finished
teaching irrigation procedure to my 67th
patient — an elderly man fully accepting a
colostomy. I have a good working re-
lationship with most Victoria surgeons
and full acceptance in the hospitals and
with the local surgical supply house. My
satisfaction comes from seeing frightened,
depressed patients become cheerful,
accepting people.
As I enter my fifth year of 'ostomy
rehabilitation, 1 hope to expand the
services I can offer to include more
lecturing and teaching to hospital staff as
well as the individual instruction of
patients. There is a real need for stomal
therapists and visiting members from
'ostomy clubs. Happy, accepting patients
are a hving testimonial to the necessity to
continue this work. - Aileen E. Barer,
R.N., Stomal Therapist, Victoria, B.C.
Uniforms create invisible barriers
I was interested in the letter entitled
"Caps and uniforms - proud insignia" in
the December 1968 issue. Perhaps the
main reason that nursing is giving up its
uniform and cap is that nurse-patient
relationships are improved when nurses
wear civies. This has been proven on psy-
chiatric wards in the United States and
Canada and it is being proven on general
wards in various areas; Winnipeg's Victoria
General Hospital is one example. As for
"proud insignia," I believe that the school
pin outranks the school cap!
Some nurses do look "handsome" and
"imposing" in their white uniforms.
However, there is no reason why the
nurse cannot carry herself with pride and
dignity minus a cap and in a dress of
another color; she need not look "ordi-
nary" or "dowdy" in civies.
Many nurses hide behind their uni-
(Continued on page 6)
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6 THE CANADIAN NURSE
(Continued from page 4)
forms, believing that they are more
authoritative when wearing them. So be
it. But let's think of patients oriented
over the years not to argue with or
question that figure in white, but to do
what she says. In some hospital wards the
patient is relegated to the status of a child
unable to think for himself at all.
Public health nurses who, in Winnipeg
at least, wear civies, meet the patient in
his environment on an equal footing and
as a friend. In my experience with public
health nurses, I saw nothing that detract-
ed from their knowledge, ability, bearing,
or acceptance by patients because they
wore civies.
Take the hospital nurse out of uni-
form, put her in a washable dress, and an
invisible barrier is removed. Authority
remains but friendship develops.
Let us put and keep our patients first.
Our image will not be tarnished by what
we wear. - Bonnie Kerr, Reg.N., 1968
graduate, Victoria General Hospital,
Winnipeg.
December issue
I congratulate the circulation manager
and the editors on the very nice format of
the December 1 968 issue.
As a librarian, it is very satisfying to
me to see The Canadian Nurse join the
group of journals publishing their yearly
index in the December issue. Journals
that do not follow this procedure cause
librarians more headaches than enough,
because we must wait so long for the
index before we can have the journal
bound. Congratulations! -Pauline Cum-
mer, Librarian, Misericordia Hospital
School of Nursing, Bronx, New York.
Prices compare favorably
1 wish to commend the wide and
excellent coverage given in the January
1969 issue of The Canadian Nurse to the
Registered Nurses' Association of Onta-
rio's Regional Conference on the Use of
Audio-Visual Aids in Nursing held in
Toronto from November 11-14, 1968.
However, in the interest of nurses who
may attend future RNAO conferences,
and possibly at the same hotel, may I
correct the impression of an excessive
price range as stated on page 24, and state
that we have always experienced ex-
cellent service and quality, and that prices
compare favorably with other hotels of a
similar class across the province.
With the current cafeteria and dining
room menus as my reference, I found
that meals described in the article were
being offered at approximately 40-50
percent less than prices quoted on page
24. Also, two city bus stops to the center
of Toronto are within 75 yards of the
main entrance, with service every 20
minutes. - Eleanor Trutwin, Secretary,
Planning Committee, RNAO, Toronto.
Nursing scholarships
The Regina General Hospital School of
Nursing Alumnae makes available a
scholarship of five hundred dollars ( $500)
to active members of the Alumnae who
are presently engaged in nursing. This
scholarship may be used in any university
school of nursing for post-graduate study.
Completed applications must be received
by June 1, 1969.
Application forms and further in-
formation may be obtained from: (Mrs.)
Nora M. Kitchen, Chairman, Scholarship
Committee, Suite 301, 2536 Parliament
Avenue, Regina, Saskatchewan.
The Royal Canadian Army Medical
Corps Fund announces an annual bursary
of $300.00 for dependants of: (a) non-
commissioned members of the RCAMC,
Canadian Forces, who have been accepted
for career status; (b) non-commissioned
members or former members of the
RCAMC, Canadian Forces, or CA(R),
who have served a minimum of five years
subsequent to 1950; (c) former RCAMC
non-commissioned members of the
CASF(Korea).
The bursary is an award to a de-
pendent who has achieved satisfactory
scholastic standing in the entrance, first,
second or third year of a recognized
Canadian university, teachers' college,
school of nursing, or institute of technol-
ogy course requiring a minimum of 2400
hours of instruction.
Further details may be obtained from
the Secretaiy, RCAMC Bursary, Surgeon
General Staff, Canadian Forces Head-
quarters, Ottawa 4, Ontario. - Lt. G.H.
Rice, Secretary, RCAMC Bursary.
Alumnae wish to correspond
Members of the Alumnae Association
School of Nursing, Jewish General Hospi
tal, Montreal, are interested in corres-
ponding with other nursing alumnae
groups to exchange program ideas and
projects.
Please write to: The Alumnae Associa-
tion, Jewish General Hospital School of
Nursing, 3755 Cote Ste-Catherine Road,
Montreal. - Eileen Shalit, Montreal.
Journal needed
We are trying to find a copy of the
February 1962 issue of Nursing Outlook.
If any of The Canadian Nurse readers can
supply this issue, please write to: Mrs,
P.A. Whitaker, School Librarian, Royal
Victoria Regional School of Nursing, 61
Wellington St.W., Barrie, Ontario. C
APRIL 1969
news
Nurse Educators Go On Strike P^
Hamilton. -Members of the faculty of
the Hamilton and District School of ~--^
Nursing, with the exception of the direc-
tor and assistant director, went on strike
March 4 when they were unable to reach
agreement with their employer.
The strike followed 1 1 months of
unsuccessful negotiations with the em-
ployer. The 18 instructors, organized as
the Nurses' Association Hamilton and
District School of Nursing and certified as
a collective bargaining unit by the Labour
Relations Board on February 12, 1968,
had met three times with management
before asking the provincial minister of
labor to appoint a concihation officer last
July. When the conciliation officer's
attempts to effect a settlement were
unsuccessful, a conciliation board was
appointed in November. This board met
with the two parties in January, but did
not submit any recommendations to the
minister of labor, apparently because
the two parties were so far apart in their
demands.
Areas of Disagreement
The chief areas of disagreement are:
transportation expenses, educational
leave, benefit plans, hours of work, work
load, and salaries.
The Nurses' Association is asking for a
flat rate of S15 per week to cover travel
expenses and/or travel time involved,
since teachers travel to the five outlying
hospitals, where students receive their
clinical experience, three or four days a
week. Management has offered a cash
allowance of three dollars a day "when
no other transportation is available": the
Nurses' Association points out, however,
that '"available" often means taking a bus
as early as 6: 15 a.m. and arriving one and
one-half to two hours before their start-
ing time. No compensation for this incon-
venience and loss of time is provided.
The Nurses' Association has also- re-
quested a maximum of 16 hours a week
of teaching and a minimum of 16 hours a
week for lecture preparation, with at least
three hours required for other duties. The
school board agreed to a 38 1/2 hour
week, but made no concession for over-
time work. Overwork is apparently a vital
issue in the present impasse.
Salary demands by the teachers are
related to the academic qualifications
required by the school (Reg.N. with a
university degree); the actual qualifica-
tions held by the present staff (all staff
are registered nurses - some have a
APRIL 1%9
bachelor's degree, others have- a master's
degree); and current rates for teachers in
secondary schools or colleges requiring
equivalent education (for example, the
1 9 68 salary range for instructors in
Teachers' Colleges in the province was
$11,218 to 513,279).
The Nurses' Association is asking for a
minimum of S8,200 and a maximum of
512,400, achieved by 7 increments of
5600 for teachers with a baccalaureate
degree; and a minimum of 510,200 and a
maximum of 514,400, with the same
increments, for teachers with a master's
degree. Management has offered 57,632
- 58,950 for teachers with a bachelor's
degree, achieved by 5 annual increments
of 5264; and 58,112 - 59,432. with the
same increments, for teachers with a
master's degree.
Areas of Frustration
The 18 instructors list four areas of
frustration in their negotiations:
• The employer's refusal to equate the
instructors with other educators when
deciding on salary and other benefits;
• The employer's refusal to bargain "in
good faith," and the delaying tactics used
since the instructors were certified as a
collective bargaining unit.
• The impossibility of bargaining with
"the ghost of the Ontario Hospital Servi-
ces Commission," which has set wage
scales for nurses in the province, but is
not represented at the conciliation hear-
ings.
• The suggestion by a management
representative that the jobs of the nurse
educators were more similar to instruc-
tors of welding apprentices than to secon-
dary school teachers.
In a telephone interview with The
Canadian Nurse, Jack Lowes, personnel
director for the Hamilton and District
School of Nursing, stated that salaries are
the main stumbling block as far as mana-
gement is concerned. "We just can't meet
their salary demands," Mr. Lowes said.
When asked to comment on the teachers'
complaint that it is impossible to bargain
with the ghost of OHSC, Mr. Lowes said
"No comment." He did say, however,
that the School cannot "get out of line
THE CANADIAN NURSE 7
with what other nurse educators are being
paid."
Mr. Lowes said that management refu-
ses to equate the nurse educators' salaries
with those paid to other educators,
because "they [the nurse educators] are
nurses, and are certified as nurses by the
department of labor." He added that the
nurse educators are really clinical instruc-
tors, and that they receive salaries com-
parable to those paid to other clinical
instructors in the province.
Commenting on Mr. Lowes' statement,
Anne Gribben, director of employment
relations at the Registered Nurses' Asso-
ciation of Ontario, said: "We have two
arguments against Mr. Lowes' reasoning.
First, although these nurse educators are,
indeed, certified as a Nurses' Association,
they are required by management to
have at least a bachelor's degree. Second,
these nurse educators are more than
'clinical instructors.' They teach in the
classroom, as well as in the clinical area,
and are responsible for the counseling
program for all students."
Mr. Lowes said that the School Board
is doing its best to keep the school open.
When asked whether there was a danger
that the College of Nurses of Ontario
might cease to approve the school becau-
se of the altered curriculum, Mr. Lowes
sounded surprised, but admitted that the
College did have this right.
He added that management was willing
to submit the differences to an arbitrator
appointed by the government. He agreed,
however, that the teachers had the right
to strike and did not have to submit to
compulsory arbitration. According to
Anne Gribben, the teachers believe they
would be most unwise to submit their
grievances to compulsory arbitration.
"Past experience has shown that arbitra-
tors do not always look at the facts," she
said, "and have not awarded on the basis
of what could have been obtained had the
party involved had the right to strike."
The Registered Nurses' Association of
Ontario, which greylisted the School
when the instructors went on strike,
expressed concern for the 156 students
who are enrolled in the two-year course
offered by the Hamilton and District
School, but pointed out that the inflexi-
bility of the employer leaves the teachers
with no alternative other than to take
"the only legal action open to them."
RNAO has worked closely with the
instructors, helping them to organize for
certification and to draw up proposals,
and appearing with the Nurses' Associa-
tion's representatives at the bargaining
table.
8 THE CANADIAN NURSE
CNA's 1968-70 Goals Approved
The goals of the Canadian Nurses'
Association for the 1968-70 biennium
were approved by the CNA Board of
Directors at its meeting February 11-14.
They will be published shortly as a
separate document for members.
The goals call for CNA to:
1. Prepare and arrange for the 14th
Quadrennial Congress of the International
Council of Nurses, Montreal, June 22-28,
1969, and welcome the nurses of the
world.
2. Support and promote the program
of ICN and other international organi-
zations concerned with world-wide health,
education and welfare.
3. Continue to make representations
on behalf of Canadian nurses to the
federal government, its departments and
commissions in the interests of nursing
and related national and international
health services.
4. Promote continuing improvement in
communications and cooperation
between CNA and related national and
international health services.
5. Advocate support of the Canadian
Nurses' Foundation.
6. Establish a national testing service
to prepare tests that may be purchased
and used by the provincial registering
bodies for the licensing and/or regis-
tration of nurses.
7. Study national and provincial
nurses' association relationships, func-
tions, membership, fee structure, and
legislation.
8. Continue to develop standards for
nursing service and nursing care in order
to provide systems for evaluation of
quality of nursing service and nursing
education programs.
9. Continue to work toward the pro-
vision of systems for improving standards
of nursing service and nursing education
programs.
10. Encourage the development of
nursing diploma programs in educational
institutions within the general system of
education at the post-secondary level.
1 1. Promote continuing education pro-
grams, particularly those directed by
educational institutions, for the two iden-
tified categories of nurse practitioners.
12. Reflect the beliefs and policy of
CNA in a revised statement on the nurse's
social and economic welfare.
1 3. Reassess national goals for salaries,
social welfare and conditions of work for
nurses graduating from the baccalaureate
and diploma programs.
14. Provide consultation services to
the 10 provincial nurses' associations as
feasible.
15. Encourage research in relevant
areas, especially in clinical nursing prac-
tice, to improve nursing care.
16. Promote continuing improvement
in communications between CNA and its
individual members and between the
Association and the Canadian people.
1 7. Publish material on selected topics
that will help to meet CNA's goals.
1 8. Initiate dialogue with allied health
professions on the proliferation of cate-
gories of health workers with a view to
formulating policies in this area.
Daily Registration Fee
For ICN Congress Reduced
Ottawa. —The daily registration fee for
the XIV Quadrennial Congress of the
International Council of Nurses, to be
held June 22-28 in Montreal, has been
reduced from $ 15 per day to $ 10.
Daily registration will take place
Monday June 23 to Friday June 27 only.
Daily registrants will not receive the kit
containing the official program, and will
not be allowed to attend the special
interest sessions or the opening and clo-
sing ceremonies.
Three Nurses Appointed
To Federal Task Forces
Ottawa. -IhxQQ nurses are among the
40 members of seven task forces on
health costs announced by Health and
Welfare Minister John Munro in late
February.
They are: Louise Miner, president-
elect, Canadian Nurses' Association,
appointed to the task force on public
health services; Margaret McLean, CNA
second vice-president, task force on sala-
ries and wages; and Myrna Sherrard,
Moncton City Hospital, N.B., task force
on operational efficiency.
In addition, one task force — on
methods of delivery of medical care — has
asked the CNA to present its official
current views on the future role of the
nurse in delivery of medical care. Four
representatives of the association came
before the task force March 3 for this
purpose.
The seven task forces will prepare
reports for the federal-provincial commit-
tee on costs of health services. Members
include federal and provincial representa-
tives as well as professional persons from
related health fields.
Membership in the task forces was
determined by the secretariat established
for the national study, following consul-
tation with task force chairmen, federal
and provincial' health authorities, and
related health associations. None of the
10 chairmen and co-chairmen are nurses.
The extensive study into health costs
will cover three major areas: hospital
services, medical care, and public health
services. Four task forces will look at
factors involved in the provision of hos-
pital care and services; two groups will
examine areas pertinent to the provision
of medical care; the seventh will investi-
gate costs of public health services.
(Continued on page 12)
APRIL 1969
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APRIL 1969
THE CANADIAN NURSE 9
Leadership identified.
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Consider the responsibilities of leodership in products for intravenous therapy
...Quality standards must be the highest attainable. And these standards
must be maintained through constant testing ... checking, and re-testing...
every step of the way. Making the finest products available is where our
leadership begins. And so that the finest is readily identified, we've changed
the names to make them more descriptive.
Identify with the leader ...C.R. RARD, INC.
BARDIC Inside needle catheter
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from inside the bore of the non-coring needle. The needle is then withdrawn leaving only
the catheter in the patient's vein.
BARDIC Around needle catheter
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P'ound the sharp, non-coring needle. The Around needle catheter placement technique
allows complete removal of needle leaving only the soft, pliant catheter in the vein.
INTEGRITY
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(Continued from page 8)
CNA Asks Government
For A Million Dollars More
Ottawa.-l\ie Canadian Nurses' As-
sociation, in a brief presented this month
to the Commission on Relations between
Universities and Governments, re-
commends that the federal government
appropriate a minimum of one million
dollars per year for the preparation of
nurses at the baccalaureate and master's
levels, and $100,000 for doctoral study.
This amount would be in addition to the
present Professional Training Grant
Bursaries now being offered. The Bursa-
ries, CNA recommends, should be used
only for study at the university level.
The brief, prepared on behalf of CNA
by Shirley R. Good, the Association's
consultant in higher education, noted
that in 1967-68 the federal government
allotted $807,247.31 to nursing students
through the Professional Training Grant
Bursaries fund. This figure represents a
decrease of more than $100,000 per
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Naturalizers also have the famous Wonder-
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12 THE CANADIAN NURSE
annum in federal grants to nursing stu-
dents since 1966-67, and a decrease of
$152,452.53 compared to the bursaries
given in 1965-66. The brief noted also
that in 1967-68, only 8.5 percent of
nurses studying for baccalaureate degrees
and 23.2 percent of those enrolled in
master's studies received financial assis-
tance from the federal government. No
figures were available for nurses studying
at the doctoral level.
In the brief. Dr. Good pointed out
that there is an "absolute famine" of
university-prepared nurses in Canada. The
CNA's national objective of one nurse
with a bachelor's degree to three diploma
nurses has not been reached; the 1968
ratio was 1:18. Only .5 percent of Can-
adian nurses hold a master's degree; the
CNA's objective is 14-15 percent.
The CNA submission to the Commis-
sion on Relations between Universities
and Government also recommends that
the federal government give an explicit
and accurate account of monies appro-
priated to nursing. This would include a
breakdown of the provinces, institutions,
and numbers of people involved.
Professional Institute
Is Bargaining Agent
For Federal Nurses
Ottawa.-lht Professional Institute of
the Public Service of Canada became the
certified bargaining agent March 3 for
2,200 nurses employed by the federal
government.
The bargaining unit contains virtually
all federally employed nurses at the gener-
al duty, head nurse, and supervisory
levels. Anne Gribben, employment rela-
tions director, Registered Nurses' Associa-
tion of Ontario, said this step "exempli-
fies just what we're trying to do: create
unity in the profession. We are nurses
first — our job classifications are secon-
dary.
"It's an idealistic type of composi-
tion," she continued. It's broad and
gives all employees the right to bargain."
Ethel Gordon, consultant for health
service groups with the PIPS, said the
Institute is at present working on con-
tract demands for nurses for the two-year
period starting July 1, 1967, so the work
is urgently needed.
The nursing group is in the scientific
and professional category of public
servants. The defence, health and welfare,
and veterans' affairs departments are the
prime employers of the nurses.
Professional Liability Insurance
Available to ANPQ Members
Montreal. —kn insurance plan to pro-
tect professional nurses in the case of
costly malpractice suits is now available
to members of the Association of Nurses
APRIL 1969'
news
of the Province of Quebec, after months
of investigation and study by provincial
office. This information appeared in the
January issue of News and Notes, a
publication of the ANPQ.
The ANPQ Committee of Management
recently approved the plan for profes-
sional liability insurance proposed by the
Reliance Insurance Company of Canada.
Although the ANPQ has approved the
plan, it does not administer it. Nurses
wishing to avail themselves of this protec-
tion have been advised to apply directly
to the insurance company.
The ANPQ study of professional liabi-
lity insurance vi'as conducted following
many requests for information by ANPQ
members, who were anxious to know if
such insurance plans were available and
how they could be obtained.
AARN Presents Brief To Cabinet
Edmonton -The Alberta Association
of Registered Nurses presented its annual
brief outlining the Association's activities
and concerns to Alberta Premier Harry E.
Strom and members of his cabinet Jan-
uary 10.
The brief highlighted AARN's progress
and development during 1968 in the areas
of nursing service, nursing education, and
social and economic welfare. Items were
included on membership statistics,
developments in nursing education, and
research programs in which AARN is
involved.
The following nursing service items
were included:
•• The Alberta Medical Association, the
Alberta Hospital Association, and AARN
have endorsed "Guidelines for Medical-
Nursing Responsibilities" which are now
being used by medical, nursing, and
administrative personnel in the develop-
ment of local policy.
I AARN's nursing service committee is
working on guidelines for administrative
oersonnel in determining hospital staff
issignments. Registered nurses are per-
'orming many duties which cannot be
;lassed as nursing functions, and AARN
ecommended these non-nursing duties be
eallocated as far as possible to the
iepartment involved. Where the nurse
nust carry some of these duties, a more
ealistic computation of nursing care
lours should be carried out.
• AARN recommended a hospital in-
dices program, including: study of each
lospita! as to the influence of variables in
he staffing pattern; consideration of the
arious services offered by the hospital
nd its geographic location; examination
>f the number of graduate nurse per-
onnel and their position in each institu-
APRIL 1969
tion; and study of the use of registered
nurses in relation to the activities and
responsibihties they assume.
• The brief suggested that "Good Sama-
ritan" legislation, which would protect
people from liability for any civil
damages for acts or omissions at the scene
of an accident, would be in the public
interest. Premier Strom requested the
AARN to submit an outline for proposed
legislation on this subject to Manitoba's
Attorney General and Health Minister.
• AARN has agreed to set down for the
Hospital Services Division of the Depart-
ment of Health a definition of nursing in
terms of goals, in a project "to define
basic nursing care at the acute, sub-acute,
chronic and rehabilitative levels."
• AARN endorsed the recommendations
of Manitoba's Special Legislative and Lay
Committee inquiring into Preventive
Health Services that all the necessary
health services already in existence be
invited to participate in an organized
home care scheme.
• AARN feels the role of the certified
nursing aide requires close examination to
ensure that this role reflects present
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THE CANADIAN NURSE 13
hospital requirements.
The brief was presented by AARN
President Geneva Purcell, accompanied
by members of AARN's provincial
council and standing committee chair-
men.
RNAO Plans Programs
For ICN Visitors
Toronto. -The Registered Nurses'
Association of Ontario has invited nurses
from other countries who are attending
the International Council of Nurses'
Congress in Montreal this June to partici-
pate in the many visits and study pro-
grams being planned by RNAO.
RNAO sent a letter, through CNA, to
each ICN member country, giving infor-
mation about the programs that will be
available during either of the two weeks
preceding or the week following the
Congress. These include specialized study
programs, visits to hospitals and health
agencies; and a symposium on nursing
service and nursing education to be held
at RNAO headquarters each of the three
Mondays preceding the observation visits.
F. Lillian Campion, RNAO's interna-
tional secretary on the staff of the Pro-
fessional Development Department, is in
charge of the planning.
Provincial Associations Help
With ICN Congress
Ottawa. -Three more provincial nur-
ses' associations have presented cheques
to the Canadian Nurses' Association to
aid in the costs of the XIV Quadrennial
Congress of the International Council of
Nurses, June 22 to 28 in Montreal.
The Saskatchewan Registered Nurses'
Association has given CNA $3,000; the
Registered Nurses' Association of Nova
Scotia has donated $2,000; and the Mani-
toba Association of Registered Nurses has
presented $800.
In addition, six provinces are sending
their public relations officers to assist at
the Congress. They are: Claire Marcus,
from the Registered Nurses' Association
of British Columbia; Don LaBelle, Alber-
ta Association of Registered Nurses; Pearl
Morcombe, MARN; Isabel LeBourdais,
Registered Nurses Association of Ontario;
Nancy Rideout, New Brunswick Asso-
ciation of Registered Nurses; and Gertru-
de Shane, Registered Nurses Association
of Nova Scotia.
In the March issue of The Canadian
Nurse it was erroneously stated that
Norma Fieldhouse was RNABC's public
relations officer. She is public relations
committee chairman.
14 THE CANADIAN NURSE
The Presidents Go For A Ride
Dr. H.D. Dalgleish, president of the Canadian Medical Association, pulls a
toboggan-full of CMA-CHA-CNA Conference delegates during time off at the
Second Canadian Conference on Hospital-Medical Staff Relations in Quebec City.
Left to right: Sister Mary Felicitas, president of the Canadian Nurses' Association;
Alan Hay, president of the Canadian Hospital Association; Juliette Pilon, director
of nursing, Rosemount Hospital, Montreal: Ola Robitaille, director of nursing at
Jean-Talon Hospital, Montreal; and Helen K. Mussallem, executive director of the
Canadian Nurses' Association.
CNA, CMA, CHA Discuss
Hospital-Medical Staff Relations
Quebec Ofy. -Doctors, nurses, hospi-
tal administrators and trustees were
subject to a sound drubbing at the first
day of the Second Canadian Conference
on Hospital-Medical Staff Relations,
February 17 to 19. Dr. E.W. Barootes,
chief urologist at Regina General Hospital
and keynote speaker, accused nurses of
losing their nursing sense and replacing it
with a "demoniacal devotion to adminis-
trative bureaucracy," and administrators
and other hospital groups of trying to run
illnesses on a nine to five daily basis.
Doctors were attacked for keeping pa-
tients in hospital only because it is easier
to care for them there than at home.
The conference was sponsored jointly
by the Canadian Hospital Association, the
Canadian Medical Association, and the
Canadian Nur§es' Association to improve
communication among hospital person-
nel. Alan Hay, president of the CHA,
presided over the conference.
Dr. Barootes' address was supple-
mented on the final day of the confe-
rence by an address by Dr. A.B. Powell,
director of medical services for the Onta-
rio Workmen's Compensation Board, enti-
tled "Effective Medical Services."
The participants of the conference
were divided into four study groups of
approximately 100. Before beginning
their discussions, the groups were addres-
sed by Russell J. Porter, principal asso-
ciate of Willson Associates, Limited on
"Conference Goals."
At the conclusion of the conference,
the four group leaders presented reports
on the progress of their groups. The first
report, delivered by W.C. Gardner, listed
several recommendations, including:
regionalization of conference workshops
with regard to size and areas of problems;
circulation of agenda prior to conferences
and the discussion of questions and topics
of each group present.
Group II, represented by Dr. P.M.
Christie, recommended that regional con-
ferences run by the three sponsoring
associations be established, and that the
national conference be less frequent.
Group III made one recommendation,
presented by Dr. K.H. MacKay: that the
Canadian Hospital Association, the Cana-
dian Medical Association, and the Cana-
dan Nurses' Association approach the
proper authorities so that research funds
will be increased to attract medical and
nursing teachers of the highest calibre.
The fourth group, which was conduc-
ted in French, made several recommen-
dations, including the following: that Dr.
Barootes' speech be translated into
French and distributed in either language
APRIL 1969
to participants; that the participants be
given a choice of groups; and that French
and English groups be intermingled, with
simultaneous translation.
The third conference will be held in
Banff, Alberta, next year.
CNF Board Meets
And Appoints New Officers
Ottawa. -The Canadian Nurses' Foun-
dation's board of directors elected Hester
J. Kernen, associate professor in public
health nursing, University of Saskatche-
wan, as president, and Albert Wedgery,
associate director. College of Nurses of
Ontario, as vice-president at its meeting at
National Office March 10.
The CNF board also appointed mem-
bers to the nominating and selections
committees of the Foundation. Names of
members will be released on their accept-
ance of the appointments.
Concern about the low membership in
CNF was expressed by the board mem-
bers. They agreed that a letter should be
sent to former CNF scholars, asking for
their support in promoting the Foun-
dation. Because of the present financial
situation of CNF, the board agreed that
priority must continue to be given to
scholarships, rather than to research, to
help prepare nurses for positions of re-
sponsibility.
To date, approximately $35,000 is
available for 1969 fellowship awards, as
compared to 557,000 awarded in 1968.
Membership in CNF can be obtained by
sending a cheque for two dollars to: CNF,
50 The Driveway, Ottawa 4. Fees and
donations are tax deductible.
Two Students Selected
To Attend ICN Congress
Sudbury. -Two students at Laurentian
University School of Nursing will be given
financial assistance to attend the XIV
Quadrennial Congress of the International
Council of Nurses to be held June 22 to
28 in Montreal.
Louise Picard and Rosemary Boyle
were selected to receive the award. It is
given in memory of Wilda Sims, a former
faculty member at Laurentian University,
who died in December 1968. During her
25 years as nurse educator, over 600
students graduated under her adminis-
tration.
"NBARN Sponsors Inservice
Education Workshop
Memramcook, N.B. -"Better Patient
Care with Inservice Education" was the
APRIL 1%9
theme of a two-day workshop held here
in March. Sponsored by the nursing servi-
ce committee of the New Brunswick
Association of Registered Nurses, the
workshop was expected to attract nurse
representatives from some 30 hospitals
and agencies in the province.
Workshop leader was Mona Callin,
lecturer in nursing. McGill University,
Montreal. Miss Callin's background is in
the area of adult education and inservice
coordination.
Purpose of the workshop was to assist
in improving patient care in New Bruns-
wick by improving inservice education
programming for nursing service staff.
Topics included: inservice education
philosophy and objectives; obstacles to
effective inservice programming; adult
versus youth learning; philosophy of
adult education; types of leadership;
effective group efforts; planning an in-
service project.
NLN Conference To Consider
Health in Community
New Forfc -"Partners for Health -
Nursing and the Community" is the
(Continued on page 18)
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bw its
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THE CANADIAN NURSE 15
Quick-change
artist
The new Uromatic
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Sets-up fast, changes fast. That's uromatic plastic irrigating con-
tainer. The new plastic irrigation solution container that stops
irrigation procedures from becoming irritation procedures. They're
lighter, easier to handle, and safer to hong than conventional
gloss bottles. Now every procedure is a safe procedure.
The UROMATIC container changes everything
but the technique.
Three special ports let you use familiar
techniques. But there is one big differ-
ence. No troublesome metal closures
or cops. Set-ups and change-overs
ore faster and more aseptic
than ever before. As you
insert the set, the spike com-
'pletely occludes the admin-
istration port opening before it
punctures on internal safety seal.
No fluid escapes. No air enters.
It's automatic. The second port
lets you add supplemental solu-
tions when required. Or may be
used for series hook-ups. A third,
middle port may be clipped for
use as a convenient pouring spout.
From set connection through
bottle change-over, it's the smoothest procedure available.
And the safest. You'll wonder where the vent went. And why. The
UROMATIC container doesn't need it. Atmospheric pressure produces
flow. A dependable, continuous flow. There's no vent to clog or
leak and disrupt the entire procedure. And no vent, no air. Air-
borne contaminants are locked out. Safety is locked in.
These are just some of the features you should know about.
Discover them all. A complete brochure is available at
your request.
^The UROMATIC plastic irrigation container.
Irrigation without irritation.
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{Continued from page 15)
theme of the National League for Nursing
Convention to be held in Detroit, May
19-23. Keynote speaker will be Dr. Philip
M. Hauser, director of the Population
Research Center and professor of sociol-
ogy at the University of Chicago, who
will speak on "Urban USA - A Chaotic
Society? "
The convention participants will con-
sider the theme in large general sessions,
in "think-ins and talk-backs," at luncheon
meetings, and at seminars throughout the
convention. Other speakers include L.
Ann Conley, president of NLN; Dwight
L. Wilbur, president of the American
Medical Association; Margaret B. Dolan,
head of the department of public health
nursing at the University of North Caro-
lina; and Richard Magraw, deputy assist-
ant secretary for health manpower, US
Department of Health, Education, and
Welfare.
Panel discussions will consider
"Mobilizing for Community Health," and
will take a new look at the people who
make up today's health team. During the
week, other programs designed to bring
information to members on new methods
of health care are scheduled. All NLN
councils of agency members will meet
during convention week, and the annual
convention of the National Student
Nurses' Association will take place in the
week preceding the conference in Chi-
cago.
ICN Nominations Announced
Geneva, Switzerland -~ Nominees for
elected positions in the International
Council of Nurses for 1969-1973 were
announced early in 1969 in Geneva.
Elections will take place during ICN's
14th quadrennial congress in Montreal,
June 22-28. Votes may be cast by the
Council of National Representatives,
composed of the presidents of the 63
national nurses' associations in member-
ship with ICN.
To be elected for the four-year term
are a president, three vice-presidents,
board of directors, and members of the
standing committees on membership and
professional services. Each nominee has
been certified as a nurse who is an active
member in a member association.
Two nurses have been nominated as
ICN president: Margrethe Kruse, chair-
man of ICN's Professional Services Com-
mittee 1965-69 and executive secretary
of the Danish Nurses' Organization: and
Dame Muriel Powell. DBE, member of
the ICN Board of Directors 1965-1969
and matron at St. George's Hospital,
London, U.K.
18 THE CANADIAN NURSE
There are three nominees for the three
posts of first, second and third vice-
president: Dorothy A. Cornelius, pre-
sident, American Nurses' Association;
Ruth Elster, ICN second vice-president,
1965-1969, and president, German Nur-
ses' Federation; and Alice Girard, ICN
president. 1965-1969, of Canada.
Nominees for the Board of Directors
are: Nicole F. Exchaquet, Switzerland;
Barbara Fawkes, U.K.; Nelly Goffard,
Belgium; Jadwiga Izycka, Poland; Docia
A.N. Kisseih, Ghana; Jane Martin, France;
Joyce C. Rodmell, Australia; Julita V.
Sotejo, Philippines; Gerd Zetterstrom
Lagervall, Sweden.
Sixteen nurses have been nominated
for membership on the ICN Membership
Committee, including Lyle Creelman, a
member of the Canadian Nurses' Associa-
tion and formerly chief nurse. World
Health Organization. Among the 23
nominees for the Professional Services
Committee is Laura W. Barr, executive
director of the Registered Nurses' Asso-
ciation of Ontario and member of this
committee in I965-I969.
Hospital Personnel Relations
Bureau Set Up
Toronto. Any hospital in Ontario can
now turn to the Hospital Personnel Re-
lations Bureau for help in dealing with
labor problems.
By the end of January, the bureau's
first month of full-time operation, 56
Ontario hospitals had joined this inde-
pendent organization. Ontario is the fifth
province to form such a "self-help''
central bargaining body.
The bureau concept developed
through several meetings of the Ontario
Hospital Association. At a meeting of
OHA representatives in March 1968, a
basic bargaining problem was seen in
negotiations carried out by management
representatives of an individual insti-
tution who were sometimes less knowl-
edgeable than their union counterparts.
OHA representatives believed that such a
situation tended to expose hospitals to:
one institution "playing off another.
and similar and separate negotiations
occurring in one hospital industry in a
given time, thus making invidivual nego-
tiations very time-consuming.
The main function of the bureau is to
coordinate the labor relations efforts of
its member hospitals for their mutual
advantage. The bureau emphasizes, how-
ever, that it has no intention of inter-
fering with the autonomy of any hospital,
and will act only when authorized by a.
hospital.
D. Alan Page, manager of the bureau,
says that the bureau's services are design-
ed to help hospitals with or without
unions.
The objectives of the bureau include:
• Development of uniform contracts in
regions of the province.
APRIL 1969
news
• Acting as a source of information on
hospital labor matters.
• Maintenance of fair salary scales for all
hospital employee classes.
• Interpretation of contracts and assis-
tance in gaining settlement of disputes.
• Investigation of salaries for nurses and
other paramedical people.
• Establishing relations with other
similar bodies in Canada.
Quebec Male Nurses
Seek Legal Recognition
MontreaL -"Mile nurses in the pro-
vince of Quebec are not losing hope even
though their grievances were not discuss-
ed at the last session of the Quebec
parliament," said Jean Robitaille, pre-
sident of the Graduate Male Nurses of
Quebec in an interview with L 'infirmiere
canadienne.
Male nurses at present do not have any
legal status in Quebec and cannot legally
be hired to practice as nurses in the
province. There are 525 male nurses in
Quebec, many of whom hold a bachelor's
or even a master's degree in nursing,
despite the fact that they do not possess
legal authorization to practice in Quebec.
The Association of Nurses of the Province
of Quebec fully supports the principle
that male nurses should be authorized to
practice; however, the Association cannot
grant them registration until the present
nursing act is amended by the Quebec
parliament.
"In 1966 the legal right of male nurses
to practice in Quebec was included in an
amendment to the Quebec Nurses' Act
and scheduled to be discussed in the
Quebec parliament," continued Mr. Robi-
taille. "Since that time, there has been a
provincial election and a change in the
government. The late Premier Daniel
Johnson promised to consider our pro-
blem, and at the last session, the dis-
cussion on Bill 85 - which concerns the
'ights of minorities in Quebec - took
oriority over discussion of our proposed
amendments to the Nurses' Act. We
iincerely hope that the amendment will
le discussed and approved during the
Parliamentary session that began Febru-
iry 25."
Maurice Jacques, the lawyer represent-
ng the Quebec male nurses, plans to meet
n the near future with Jean-Paul Clou-
ier, Quebec's minister of health, to im-
)ress upon him the urgency of the pro-
'lem.
"led Cross Bursary
Dffered to Ontario Nurses
Toronto.- A SI, 000 bursary is being
'ffered to graduate nurses registered in
KPRIL 1969
^^gt^
mm
&iOLBROOK
REEVES NAME PINS
Largest-selling among nurses ! Superb lifetime quality .
smooth rounded edges . . . featherweight, lies flat . . .
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Choose lettering in Black, Blue, or White (No. 169 only).
I SAVE: Order 2 identical Pins as pre-
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Personalized ^/'tP/rPJ
SHEARS
6" professional, precision sliears. forged
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No. 1000 Shears (no initials) 2.50 ppd.
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1 Name Pin only
2 Pins (Sana name)
No. 510
1 Name Pin only
2 Pins (same namt)
1.65* 1.95
2.50* 3.00
1.25* .1.85
75* 1.05*
^ IMTORTUtT: Please add 25c per order handlini cl>ar|e on all orders of
3 pins or less CHOUP DISCOUNTS: 25-99 pins, 5%; IX or more. 10*.
"Cap
Shears/ Pen POCKET KIT
Plastic Pocket Saver (see below) with 5^" prof,
forged bandage shears, plus handy chrome "tri-color"
pen (writes red. black or blue at flip of thumb).
No. 291 Pocket kit 3.50 ppd.
No. 292-R Pen Refills (all 3 colon) . .50 ppd.
Etched initials on shears add 30
Uniform POCKET PALS
Protects against stains and wear. Pliable white
plastic with gold stamped caduceus. Two com-
partments for pens, shears, etc. Ideal token gifts
or favors.
No. 210-E ( 6 for 1.50, 10 for 2.25
Savers / 25 or more, .20 ea., all ppd.
1
Scripto NURSES LIGHTERS
Famous Scripto Vu-Lighters with crystal-
clear fuel chamber. Choose an array of
colorful capsules, pills and tablets in
chamber, or a sculptured gold finished
Caduceus. Novel and unique, for yourself
or for unusual gifts for friends. Guaranteed
by Scripto.
No. 300-P Pilt Lighter /,^
No. 300-C Caduceus Lighter ( *'25 ea. ppd.
i
RN/Caduceus PIN GUARD
Dainty caduceus fine<hained to your professional
letters, each with pinback, saf. catch. Wear as is
... or replace either with your Class Pin for safety.
Gold fin., gift-boxed. Specify RN, LVN or LPN.
No. 3240 Pin Guard 2.95 ppd.
P
sterling HORSESHOE KEY RING
Clever, unusual design: one knob unscrews for In-
serting keys. Fine sterling silver throughout, with
sterling sculptured caduceus chann.
No. 96 Key Ring 3.75 U. ppd.
"SENTRY" SPRAY PROTECTOR
Protects you against violent man or dog . . .
instantly disables without permanent injury.
Handy pressurized cartridge projects irritating
stream.
No. AP-16 Sentry 2.00 ea. ppd.
Remove and refasten cap n^„
band instantly for launder-
ing or replacement! Tiny
molded plastic tac, dainty
caduceus. Choose Black. No. 200
Blue, White or Crystal with j^ Cap C-l
Gold Caduceus. or all Black U Tact^l
(plain). 6TacsPerSet U aniy I
SPECIAL! 12 Sets (72 Tacs) $9- total
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Sei-FIx NURSE CAP BAND
Black velvet band material. Self-adhe-
sive: presses on. pults off, no sewing
or pinning. Strip %■ x 36" for two or
more caps, trims to desired widths or
lengths. Reusable many times.
No. 3436 Band 1.25 ea~ 3 for 3.00,
6 or more ,85 ea.
Nurses ENAMELED PINS
Beautifully sculptured status insignia; 2<olor keyed,
hard-fired enamel on gold plate. Oime-sized; pin-back.
Specify RN, LPN. ?H, LVN. NA. or RPh. on coupon.
No. 205 Enameled Pin 1.25 M. ppd.
5^.,5™w. Waterproof NURSES WATCH
Swiss made, raised silver full numerals, iumin. mark-
ings. Red-tipped sweep second hand, chrome /stainless
case. Stainless expansion band plus FREE biKk leather
strap. 1 yr. guarantee.
No. 06-925 lZ95M.ppd.
Lindy Nurse STICK PENS
Slender, white barrets with tops colored to match
ink. Fine points; colors for charts, notes. Adj. silver
pocket clip. Blue, black, red or lavender.
Ns. 467-F Stick Perrs \ 6 pens 2.89, 12 pans 5.29
(chtasecoler assort) } 24 or more 39 ea., all ppd.
f
Reeves AUTO MEDALLIONS
Lend professional prestige. Two colors baked enamel on
gold background. Resists weather. Fused Stud and
Adapter provided. Specif* letters desired: RN, MO, 00.
RPti. DOS. DMD or Hosp. Staff (Plain).
No. 210 Auto Medallion 4.25 ea. ppd.
Professional AUTO DECALS
Your professional insignia on window decal.
Tastefully designed in 4 colors. 4V'4" dia. Easy
to apply. Ctioose RN, LVN, LPN or Hosp. Stall.
No.6210eul...l.OOea.,
3 for 2.50, 6 or more .60 ea.
TO: REEVES COMPANY. Attleboro. Mass 02703
CROSS Pen and Pencil
World famous Cross writing instruments with
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No. 6603 $8.00 No. 3503 $5.00
No. 6602 8.00 No. 3502 5.00
Set No. 660116.00 No.3501 laOO
8511 Pen Refills (blue med.), 2 for 1.50 ppd.
Of foil nnw enrntd m taipt on barrti Initisis sM 7S u
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STETHOSCOPE
Nationally advertised Littman' diaphragm-
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collapse concealed spring, non-chilling dia-
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No. 216 Nursescope 12.95 ppd.
12 or mora 10.95 ppd.
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INITIALS PROF. LETTERS
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I enclose $ (Mass. residents add 3% S.T.)
Send to .
City
.State..
.Zip..
THE CANADIAN NURSE 19
f..
THE SECRET
IS IN THE
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it moulds itself to the shape of your
foot curve for curve, giving evenly
distributed buoyant support w/here it
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Conventional Insoles
Cradle Arch Insole
But that's not all:
Until nov\^, shoes were made to fit
only the length and width of the
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ASSOCIATION OF
ONTARIO
ROYAL YORK HOTEL
TORONTO, ONT.
. MAY 1-2 69
At better shoe stores across Canada.
news
Ontario by the Volunteer Nursing
Committee of the Canadian Red Cross
Society. The award is to enable the
recipient to take further studies in nurs-
ing at the degree level.
The successful candidate will be select-
ed on the basis of training, nursing
experience, and leadership qualities; con-
sideration is also given to the applicant's
anticipated contribution to nursing in
Ontario.
Butterfly With a Broken Wing
20 THE CANADIAN NURSE
Montreal -The Quebec Society for
Crippled Children has adopted a new
emblem — a butterfly with a broken
wing. The symbol will appear on the
Society's stationary, its cars, and on all
materials used in this year's fund-raising
campaigns.
According to a brochure sent out by
the Society, last year $103,914 was
spent on orthopedic appliances, wheel-
chairs, special shoes, braces, and other
equipment necessary for young handi-
capped children. The society also pro-
vided speciahzed medical and nursing
care for handicapped youngsters and
provided camps and treatment centers
for nearly 500 physically handicapped
children.
Naegeie Fund Trustees Report
On Progress Of Children
Vancouver. — Trustees of the Kaspar
Naegeie Educational Trust Fund have
reported on the progress of Dr. Naegele's
three children. Dr. Naegeie, formerly
Dean of Arts at the University of British
Columbia, was preparing a study of nurs-
ing education in Canada at the time of his
death in 1965.
The Educational Trust Fund was set
up shortly after Dr. Naegele's death to
provide for the education of his three
children. Helen K. Mussallem, executive-
director of CNA, is one of the trustees,
CNA donated the remaining money set
aside for Dr. Neagele's report, some
APRIL 1969
news
SI, 200, to the Fund. Several nurses
donated individually.
The report says that Janet and Tim-
othy, the younger children, have rejoined
their mother in Vancouver after a stay
with their uncle in Northampton,
Massachusetts. They are now in school in
Vancouver. Barbara, the eldest child, is in
her final year of science at UBC.
Health & Welfare Department
Marks 50th Anniversary
Ottawa. -This year the Department of
National Health and Welfare marks the
achievement of 50 years of service to the
people of Canada.
Specials events are taking place during
April to mark this anniversary, plus
publication of a commemorative issue of
the Department's magazine Canada's
Health and Welfare.
The Department was first formed as
the Department of Health in 1919. In
1929 it was renamed the Department of
Pensions and National Health. Its broad
purpose has been to provide all Canadians
with the highest standards of personal
and collective health, and to provide
assistance to the many who cannot or
only partially can assist themselves in the
i business of daily living.
The activities of the Department
during the first half of these 50 years
were of a curative nature, devoted to
attempts to solve problems that had
grown beyond the capabilities of pro-
vincial and private organizations.
Considering the present-day concern
with water pollution, it comes as a
surprise to realize that as early as 1923 a
division for its control was established
within the Department.
The second 25 years, however, have
been marked by the assumption of a
preventive task. Much more effort has
been devoted to allaying the cause of
illness, and much new legislation has been
geared to provide security and health
benefits for the young, the old and the
infirm. This new direction was demon-
strated in 1944 when the Department was
given its present title.
This reorganization drew together
activities that had been the responsibi-
lities of other departments. Divisions
directing their efforts to new areas of
national health and welfare were started.
Things have happened thick and fast
during the last decade, most recently the
Canada Pension Plan of 1965, the sub-
sequent Guaranteed Income Supplement,
ind the Canada Assistance Plan. These
Tiany social legislations are either a total
ederal responsibility or operated jointly
■vith the provinces.
APRIL 1969
Charge Made For
Study Tours To UK
London. England. -A charge of 10 to
15 pounds will now be made for study
tours in the United Kingdom for overseas
nurses arranged by the Royal College of
Nursing and National Council of Nurses
of the United Kingdom. A charge of one
pound will also be made for work under-
taken by RCN's international department
on behalf of foreign nurses wishing to
work in the UK.
This new ruling took effect April 1,
1969. The decision was taken to offset to
some extent the heavy administrative
expenses of the international department
rather than to curtail the facilities offered
by the department for nurses from
abroad. There may be exceptional cir-
cumstances when this general ruling
should be waived.
The charge for a study tour will vary
depending on its length and complexity.
A charge is also made for work under-
taken by the international department for
RCN members wishing to work or study
overseas. Q
For nursing
convenience...
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TUCKS
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Soothing, cooling TUCKS provide
greater patient comfort, greater
nursing convenience. TUCKS mean no
fuss, no mess, no preparation, no
trundling the surgical cart. Ready-
prepared TUCKS can be kept by the
patient's bedside for immediate appli-
cation whenever their soothing, healing
properties are indicated. TUCKS allay
the itch and pain of post-operative
lesions, post-partum hemorrhoids,
episiofomies, and many dermatological
conditions. TUCKS save time. Promote
healing. Offer soothing, cooling relief
in both pre-and post-operative
conditions. TUCKS are soft
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TUCKS — the valuable nur-
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MWINLEY-MORRIS ^6.
MONTREAL CANADA
TUCKS Is a trademark of the Fuller Laboratories Inc.
THE CANADIAN NURSE 21
names
Eleanor Mitchell
joined the staff of
The Canadian Nurse
as assistant editor in
March 1969. A
graduate of the To-
ronto General Hospi-
tal School of Nurs-
ing. Miss Mitchell
received a postgradu-
ate diploma in neurological nursing from
the Montreal Neurological Institute, and a
Bachelor of Nursing Degree from McGill
University.
The new assistant editor has had ex-
perience on the neurosurgical unit at
Toronto General Hospital and for several
years was assistant director of nursing
education in charge of a nursing assis-
tants' program at Peel Memorial Hospital
in Brampton. Ontario. Before coming to
Ottawa, she taught students at the Credit
Valley School of Nursing in Mississauga.
Ontario.
Edna L. Moore, a pioneer in public
health nursing, died in Toronto February
25 at the age of 77.
Dr. Moore's active, 44-year nursing
career began in 1913 when she graduated
from the Toronto General Hospital
School of Nursing. After working two
years at TGH. Dr. Moore spent four years
overseas as a Nursing Sister with the
Canadian Army Medical Corps. She re-
turned to Canada to work as a social
service nurse with the Department of
Soldiers Civil Re-establishment.
Dr. Moore first worked for the Ontario
Department of Health as a social service
nurse with the Division of Preventable
Diseases from 1 920-24. She then went to
New York State, first as a supervisor of
social hygiene and two years later as the
assistant director of the national organiza-
tion for public health nursing. While in
the United States. Dr. Moore studied
maternal and child hygiene, venereal
disease control, social work, and tubercu-
losis control. From 1927 to 1929 she was
a field worker with the Canadian Tuber-
culosis Association in Ottawa.
In 1931 Dr. Moore joined the Ontario
Department of Health as chief public
health nurse. She became the first direc-
tor of the Public Health Nursing Division
when it was formed in 1944, the position
she held until her retirement in 1957.
Dr. Moore's leadership extended to
many professional associations. She ser-
ved on the editorial board of the Can-
adian Journal of Public Health; was a vice
22 THE CANADIAN NURSE
president of the Canadian Public Health
Association from 1956-57: was first vice
president and then president of the Onta-
rio Public Health Association from
1953-54; and was elected first vice pre-
sident of the Registered Nurses" Associa-
tion of Ontario in 1946. After retirement,
she conducted a study of nursing regis-
tries for the RNAO. From 1940 to 1947,
Dr. Moore served as chairman of the
Public Health Committee of the Inter-
national Council of Nurses. She was also
active in the Canadian Red Cross. Ontario
Society for Crippled Children. Canadian
Cancer Society, and the Nursing Council
of the University of Toronto School of
Nursing.
In recognition of her leadership, Dr.
Moore received the Associate Royal Red
Cross in 1919, the George V Jubilee
medal, and was made a Fellow of the
American Public Health Association. In
1956 the University of Western Ontario
honored Dr. Moore for her public health
service with an honorary Doctor of Laws
degree. In 1968 at Laurentian University
in Sudbury, Ontario, she presented the
first Dr. Fdna L. Moore scholarship -
awarded, most fittingly, for excellence in
the practice of nursing.
Mother Virginie
Allaire, founder of
L'Institut Marguerite
d'Youville. the first
school of higlier
education for
French-speaking
nurses, died in Jan-
uary at the mother-
house of the Grey
Nuns of Montreal.
Born in Grafton, Massachusetts,
Mother Allaire joined the Order of the
Grey Nuns of Montreal in 1904. Later,
she returned to the U.S. to complete her
nursing education at Morristown Hospital
in New Jersey. Her professional career
included: director of nurses at St. Peter's
Hospital in New Brunswick. New Jersey;
provincial superior at St. Boniface:
business manager of the Grey Nuns of
Montreal community: and director of
L'Institut Marguerite d'Youville, which
she founded in 1934.
During her lifetime. Mother Allaire
received recognition from many organiza-
tions for her outstanding contributions to
nursing and to various professional as-
sociations. In 1936, she was awarded an
honorary doctoral degree by the Univer-
sity of Montreal: in 1940, she received
the silver medal of the Canadian and U.S.
hospital associations for distinguished
service: she was made a Fellow of the
American College of Hospital Adminis-
trators; and in 1960 she was made an
honorary member of the Canadian
Nurses' Association.
Elaine Audrey
McEwan (B.N., U.
New Brunswick:
M.Sc.N., Cert.
N u rse-Midwifery,
Yale U., Mass.) has
been appointed
lectu rer at the
/I ^ A school of nursing,
Jm m jM University of New
Brunswick. Miss McEwan assumed her po-
sition in July 1968.
Annetta L.
Landon (Reg.N., To-
ronto General; Dipl.
Teach. & Superv..
McGill U.) recently
retired from her
position as director
of nursing services at
w»'| ^m Ottawa Civic Hospi-
'«t| H tal after 22 years ol
service at the Civic. Before coming tc
Ottawa. Miss Landon worked at Toronto
General Hospital for 1 6 years as operating
room nurse, supervisor of the radiology
department, and operating room super-
visor.
Throughout her nursing career. Miss
Landon has been active in the Registerec
Nurses' Association of Ontario.
Sixteen new instructors joined thi
staff of the school of diploma nursing a
the Saskatchewan Institute of Appliet
Arts and Sciences, Saskatoon, in Septem
ber 1968.
Charlotte A. Annable (B.S.N., U
Saskatchewan) formerly worked as a gen
eral duty nurse at The Winnipeg Genera
Hospital. Rose-Aline Begalke (R.N., Sas
katoon City H., Dipl. Teach. & Superv.
U. Saskatchewan) tauglit pediatrics fo
one year at Medicine Hat General Hospi
tal. Alberta, and orthopedics and urologj
for two years at St. Paul's Hospital ii
Saskatoon.
S. Maureen Campbell (R.N., Misericor
dia General, Winnipeg; Dipl. P.H.N,
McGill U.) formerly was employed by th'
Saskatchewan government as a publii
health nurse in Unity, Saskatchewan an(
APRIL 196«
names
Meadow Lake. Saskatchewan. Miss Camp-
bell has also worked as a general duty
nurse in Germany, Maryland, California,
and Saskatchewan.
K. Anne Harris (Reg.N,, Ontario H.,
Brockville: Dipl. Nurs. Educ. U. Western
Ont.) comes to Saskatchewan from
Brockville where she was an instructor at
the Ontario Hospital. Joyce M. Klingman
(R.N., Yorkton Union H., Sask.: Dipl.
Teach. & Superv., U. Alberta) previously
spent a year at Yorkton Union Hospital
as a general duty nurse.
Phyllis E. McElroy (R.P.N.. Saskat-
chewan H., Weyburn; Dipl. Teach. &
Superv., U. Saskatchewan) has had 10
years experience as an instructor for the
Saskatchewan department of health at
Yorkton Psychiatric Centre and in
Weyburn.
Donna C. Miller ( B.S.N. , U. Saskat-
chewan) previously taught for a year at
the school of nursing. University of
Saskatchewan. Patricia A. Meyer (R.N..
Regina Grey Nuns' H.; B.Sc.N.. U. Wind-
sor) formerly worked as a general duty
I nurse at Regina Grey Nuns' Hospital.
Stella Pankratz (R.N., U. Saskatche-
wan; B.Sc.N.. U. Alberta) has worked as a
staff nurse at St. Margaret's Hospital,
Biggar, Saskatchewan, and at Rosthem
Union Hospital, Saskatchewan. From
1967 until her present appointment, she
has been head nurse at Glenrose Pro-
vincial Hospital in Edmonton. Sheila E.
Perry (R.N.. The Winnipeg General Dipl.
Teach.. U. Saskatchewan) has worked as
a general duty nurse at The Winnipeg
General Hospital, St. Joseph's General
Hospital in Estevan. Saskatchewan, and
University Hospital. Saskatoon.
Blondina F. Peters (R.N., B.Sc.N., U.
Saskatchewan) previously worked at
Kingston General Hospital. Ontario and
University Hospital. Saskatoon as a staff
nurse. Olivia M. Sane (R.N., Regina Grey
Nuns' H.: Dipl. Teach. & Superv.. B.ScJ^i..
U. Saskatchewan) formerly worked as
jn instructor in Moose Jaw, Regina.
Dttawa, and Hamilton.
Judith M. Scanlan (R.N., Regina Gen-
eral; B.N.. U. Manitoba) comes to Sas-
;atoon from Winnipeg where she taught
!t The Children's Hospital of Winnipeg,
ihe had previously worked as a general
iuly nurse in North Vancouver and
Vinnipeg. Catherine M. Seymour ( B.Sc.N.,
J. Saskatchewan) formerly worked for a
ear as an instructor at Holy Cross Hospi-
al in Calgary.
Nevin N. Surring (R.P.N.. Saskat-
hewan H.. Weyburn: Dipl. Teach. &
)Uperv.. U. Saskatchewan) has experience
s an instructor at Yorkton Psychiatric
entre. Saskatchewan and Saskatchewan
iPRiL 1969
Hospital in Weyburn. Mary A. Symon
(R.N.. Regina Grey Nuns' H.; Dipl. P.H.,
U. Manitoba) previously worked in Sas-
katoon's St. Paul's Hospital as a staff
nurse, head nurse, and instructor, and in
Calgary's Holy Cross Hospital as a health
nurse.
Joyce O. Shack
(Reg.N., Victoria H..
London. Ont.; Dipl.
Nurs. Educ.,
B.Sc.N., U. Western
Ont.) has been
named director of
nursing service at
Plummer Memorial
Public Hospital in
Sault Ste. Marie, Ontario. Miss Shack
leaves her position as director of nursing
service at St. Joseph's Hospital, Sarnia,
Ontario. She has also held positions as a
general duty nurse at Victoria Hospital.
London, Ontario; head nurse at Syden-
ham District Hospital, Wallaceburg, Onta-
rio; and instructor at Sarnia General
Hospital, Ontario.
M. Colleen Stain-
ton (R.N., The Van-
couver General;
B.Sc.N., U. British
Columbia) has been
named instructor in
maternal and child
care at Mount Royal
Junior College, Cal-
gary.
Miss Stainton previously was an in-
structor in medical-surgical nursing at
Foothills Provincial General Hospital,
Calgary. From 1963 to 1966, she was an
instructor in obstetrical nursing at Holy
Cross Hospital in Calgary.
Ethel M. Gordon
(R.N.. The Winnipeg
General . ; Dipl.
P.H.N., U. Toronto)
former chief nursing
advisor in the Public
Service Health Di-
\ ision of the Depart-
ment of National
Health and Welfare
has retired after 21 years service. Miss
Gordon has now taken a new position
with the Professional Institute of the
Public Service of Canada as nursing con-
sultant.
Miss Gordon joined the former Civil
Service Health Division as assistant super-
visor of nursing councellors in 1947. In
1953, she became chief nursing advisor,
which involved directing the nursing
counsellor service for public servants in
the national capital area.
Following graduation, Miss Gordon
was nursing supervisor at The Winnipeg
General Hospital and at the same time
engaged in studies at Manitoba Med-
ical College.
In 1937, she joined the Victorian
Order of Nurses and remained on their
staff until she came to the Department of
National Health and Welfare.
Corazon Ignacio (B.Sc.N., U. Santo
Tomas. Manila. Philippines) has been
named inservice education coordinator at
St. Elizabeth Hospital in North Sydney,
Nova Scotia. Mrs. Ignacio comes to St.
Elizabeth's after one-and-one-half years as
head nurse at Ottawa General Hospital.
She had previously worked in hospitals in
Cincinnati and Cleveland, Ohio, as staff
nurse and operating room nurse.
Helen Cunning-
ham (Reg.N., Ot-
tawa Civic H.; B.N.,
McGill U.) recently
was appointed direc-
tor of nursing servi-
ces at Ottawa Civic
Hospital. Miss Cun-
ningham has spent
most of her nursing
career at Ottawa Civic Hospital. Previous
to her present appointment, she was
associate director of nursing service. She
has also worked at the Civic as a staff
nurse, assistant head nurse, head nurse,
chnical instructor, and executive assistant
to the assistant director of nursing.
M a rgaret C.
Cahoon (Reg.N.,
Women's College H.,
Toronto; B.A.,
Queen's U.;Cert.Ph.,
B.Ed., M.Ed., U.To-
ronto; Ph.D., U.
Michigan) has been
appointed associate
professor in the
school of nursing and the school of
hygiene at the University of Toronto. Dr.
Cahoon had been assistant professor in
the School of Hygiene, University of
Toronto since 1963 and visiting lecturer
to the School of Nursing, University of
Toronto since 1961.
She began her nursing career as a
public health nurse for the Board of
Health in Picton, Ontario. She then work-
ed as a public health nurse for the
Ontario Cancer Research and Treatment
Foundation in Kingston, Ontario. Dr.
Cahoon then moved to Toronto to be-
come a fellow in public health and
subsequently an associate in health educa-
tion at the School of Hygiene, University
of Toronto.
Dr. Cahoon has been active through-
out her nursing career in the Registered
Nurses' Association of Ontario, serving on
various executive committees. She was a
Worid Health Organization Fellow from
1963 to 1964. n
THE CANADIAN NURSE 23
April 14 - May 9, 1969
May 12 - June 6, 1969
Rehabilitation Nursing Workshops,
University of Toronto. Four-week
course for R.N.s employed in acute
general and chronic illness hospitals,
nursing homes, public health agencies,
and schools of nursing. Tuition fee:
$150. Apply to: Division of University
Extension, Business and Professional
Courses, 84 Queen's Park, Toronto 5.
April 20, 1969
Second Annual Dialysis Symposium
for Nurses, held in conjunction v^^ith
annual meeting of American Society
for Artificial Internal Organs, at Chal-
fonte-Haddon Hall, Atlantic City, New
Jersey. Organized by the US Public
Health Service's Kidney Disease Con-
trol Program. For further information
write: Michael A. Byrnes, Information
Services Section, Dept. of Health, Edu-
cation, and Welfare, Public Health
Service, Health Services and Mental
Health Administration, 4040 North
Fairfax Dr., Arlington, Virginia 22203.
April 28 - May 2, 1969
Final workshop of the Extension
Course in Nursing Unit Administra-
tion, Regina, offered in English and
French to registered nurses in adminis-
trative positions who are unable to
attend university. Sponsored by the
Canadian Nurses' Association and the
Canadian Hospital Association. Write
to: Director, Extension Course in Nurs-
ing Unit Administration, 25 Imperial
Street, Toronto 7.
May 1-3, 1%9
Registered Nurses' Association of On-
tario, annual meeting. Royal York
Hotel, Toronto.
May 5-7, 1969
Workshop for teachers on test cons-
truction, conducted by Professor V.
Wood, School of Nursing, The Univer-
sity of Western Ontario. Theme: Task-
oriented work sessions on essay ques-
tions, models for marking essay ques-
tions; objective examinations and
item-writing practice sessions; and
final assessment of student nurses.
Send applications to: Miss Angela Ar-
mitt. Summer School and Extension
Department, The University of West-
ern Ontario, London, Ont.
24 THE CANADIAN NURSE
May 5-7, 1969
Association of Registered Nurses of
Newfoundland, annual meeting. Au-
ditorium, Nurses' Residence, Western
Memorial Hospital, Cornerbrook.
May 12, 1969
Alumnae Association of the Toronto
General Hospital School of Nursing,
75th anniversary. Events for the week
of May 12 include tours of the new
school and residence, graduation exer-
cises, and dinner at the Royal York
Hotel. For dinner tickets ($8.50) and
further information write: Mrs. Grieg
Brown, 27 Thorncliffe Park Drive, Apt.
301, Toronto 17.
May 12-14, 1969
St. Boniface School of Nursing, Mani-
toba, class of 1944 will hold its 25-
year reunion. For information write
Mrs. M. Gyde, 13 Pawnee Bay, St.
Boniface 6, Man.
May 13-16, 1%9
Alberta Association of Registered
Nurses, annual convention, Macdo-
nald Hotel, Edmonton, Alberta.
May 19-23, 1%9
National League for Nursing, 1969
convention. To be held in Cobo Hall,
Detroit, Michigan. Fee: NLN members,
$15; non-members, $25. Write to:
NLN, 10 Columbus Circle, New York,
N.Y. 10019.
May 20-23, 1969
Canadian Public Health Association
annual meeting. Hotel Nova Scotian,
Halifax. Theme: The child in contem-
porary society. Write to: Canadian
Public Health Association, P.O. Box
2410, Halifax, N.S.
May 21-23, 1%9
Saskatchewan Registered Nurses' As-
sociation, annual meeting, Bessbor-
ough Hotel, Saskatoon.
May 21-23, 1969
Registered Nurses' Association of Brit-
ish Columbia, annual meeting, Bay-
shore Inn, Vancouver. Write: RNABC,
2130 W. 12th Ave., Vancouver 9.
May 23-25, 1969
Reunion of Moose Jaw Union Hospital
Alumnae Association, Moose Jaw,
Sask. Members of all classes 1909-69
are welcome. Write to: Alumnae Reu-
nion Committee, c/o Mrs. A. Kitts, 870
Stadacona St., W., Moose Jaw, Sask.
May 28-29, 1969
Registered Nurses' Association of
Nova Scotia, annual meeting, Yar-
mouth.
May 28-30, 1969
The New Brunswick Association of
Registered Nurses, annual meeting.
New Brunswick Hotel, Moncton.
May 29-30, 1%9
Manitoba Association of Registered
Nurses, annual meeting, Brandon
General Hospital School of Nursing
Building, Brandon.
lune 1-13, 1969
8th Annual residential summer course
on alcohol and problems of addiction,
Trent University, Peterborough, Onta-
rio. Cosponsored by Trent University
and the Addiction Research Founda-
tion of Ontario. Enrollment is limited
to 80 persons. The $250 fee includes
meals, tuition and accommodations.
Write to: Summer Course Director,
Education Division, Addiction Research
Foundation, 344 Bloor St. W., To-
ronto 4.
lune 16-18, 1969
Conference on nursing education for
visitors to the International Council of
Nurses Quadrennial Congress. Spon-
sored by the school of nursing and
alumni association. University of To-
ronto. June 19-20: tours in Toronto
and environs to be arranged at re-
quest of persons attending conference.
Apply to the Secretary of the School,
University of Toronto School of Nurs-
ing, 50 St. George St., Toronto 5.
lune 22-28, 1969
International Coun-
cil of Nurses' Qua-
drennial Congress,
Montreal. Fee: $60.
Write to: ICN Con-
gress Registration,
50 The Driveway,
Ottawa 4, Ont. D
APRIL 1969-
your
Own
hands:
■%,
soft testimony to your patients' comfort
Your own hands are testimony to Dermassage's effectiveness. Applied by your
soft, practiced hands, Dermassage alleviates your patient's minor skin irritations
and discomfort. It adds a welcome, soothing touch to tender, sheet-burned
skin ; relieves dryness, itching and cracking . . . aids in preventing decubitus
ulcers. In short, Dermassage is "the topical tranquilizer". . , it relaxes the patient
. . . helps make his hospital stay more pleasant.
You will like Dermassage for other reasons, too. A body rub with it saves your time
and energy. Massage is gentle, smooth and fast. You needn't follow-up with
talcum and there is no greasiness to clean away. It won't stain or soil linens or
bed-clothes. You can easily make friends with Dermassage— send for a sample!
Now available in new, 16 ounce plastic container with convenient flip-top closure.
^An^AM -^U^Ki^ a^LAO'tWL'thu cUUtn.i.y^.tt^
^iHtjM.
APRIL 1%9
LAKESIDE LABORATORIES (CANADA) LTD.
64-Colgate Aven ue • Toronto 8, Ontario
THE CANADIAN NURSE 25
New 11th Edition! Bergersen-Krug
PHARMACOLOGY
IN NURSING
The most widely adopted pharmacology text in Schools of Professional
Nursing, this classic maintains its reputation for excellence in its new 1 1 th
edition. Stressing that the good nurse must understand drug action, the
authors present physiological foundations of drug action, dosages, methods
of administration, abnormal reactions, and other vital information in a
logical, coherent format. This new 11th edition includes sound current
clinical and theoretical findings, the latest drugs accepted for general use, and
an entire new section on psychotropic drugs.
By BETTY S. BERGERSEN, R.N., M.S., Ed.D., Associate Professor of Nursing, College
of Nursing, University of Illinois at the Medical Center in Chicago; and ELSI E S. KRUG,
R.IM., M.A., Instructor in Pharmacology and Anatomy and Physiology, St. Mary's
School of Nursing, Rochester, Minn. In collaboration with ANDRES GOTH, M.D.
Publication date: June, 1969. Approx. 672 pages, 7"x 10", 50 illustrations and 7
color plates. About $9.75.
The cap
is the
symbol
of your
commitment... the book is
A New Book!
Williams New 6th Edition !
Smith
NUTRITION
AND DIET
THERAPY
Consider this new patient-centered
text for your course in "Nutrition
and Diet Therapy"! Clear,
understandable discussions relate
the chemistry of foods, human body
functions, and physiological and
emotional needs to each other and to
overall nursing care. Sections cover
scientific principles and their clinical
applications, the role of nutrition in
public health, in the basic nursing
specialties, and in clinical
management of disease.
By SUE RODWELL WILLIAMS,
M.R.Ed., M.P.H., Instructor in Nutrition
and Clinical Dietetics, Kaiser Foundation
School of Nursing; Nutrition Consultant
and Program Coordinator, Health
Education Research Center, Permanente
Medical Group, Oakland, Calif.
Publication date: March, 1969. Approx.
684 pages, 7"x 10", 117 illustrations.
Price, $9.85.
PRINCIPLES OF MICROBIOLOGY
Choose an important text for this important course — Principles of
Microbiology is the most widely adopted book in "Microbiology"
courses in Schools of Professional Nursing. Clear, logically oriented
discussions communicate the microbiological foundation your students
will use in their clinical experience: concepts of infection, sepsis,
immunity and many other aspects of the disease process. This new 6th
edition includes such timely topics as DNA and RNA, and the body's
protective mechanisms.
By ALICE LORRAINE SMITH, A.B., M.D., F.C.A.P., F.A.C.P., Associate
Professor of Pathology, The University of Texas Southwestern Medical School,
Dallas, T-ex. Publication date: May, 1969. Approx. 672 pages, 7"x 10", 207
illustrations. About $10.20.
New 2nd Edition!
Smith
MICROBIOLOGY LABORATORY
MANUAL AND WORKBOOK
An effective sequence of 29 practical exercises, this manual, correlated
with Principles of Microbiology, follows the popular framework of its
previous edition: (1) time, (2) reference sources, (3) intention, (4) tools
(5) technique, and (6) observations. The convenient punched and
perforated format now incorporates an increased number of
illustrations and tabulations.
By ALICE LORRAINE SMITH, A.B., M.D., F.C.A.P., F.A.C.P., Publication date:
May, 1969. Approx. 168 pages, 7'^"x ^QW, 11 illustrations. About $4.25.
A New Book!
Kaluger-Unkovic New 6th Edition'
Griffin-Griffin
PSYCHOLOGY & SOCIOLOGY:
An Integrated Approach to
Understanding Human Behavior
This unique new book can meet your need for
an interdisciplinary approach to the
individual and his behavior in society,
specifically nursing-oriented. The
well-rounded presentation considers man as a
social and psychological whole. Eight realistic
case studies point out that it is often more
important for the nurse to know what kind of
patient has a disease than what disease the
patient has. A complementary Teacher's
Guide and Test Manual will be supphed to
instructors adopting this text.
By GEORGE KALUGER, Ph.D., Professor of
Psychology and Education, Shippensburg State
College, Shippensburg, Pa.; and CHARLES M.
UNKOVIC, Ph.D., Chairman and Professor of
Sociology, Florida State Technological University,
Orlando, Fla. Publication date: May, 1969. Approx.
496 pages, 7" x 10", 42 illustrations. AboutS10.85.
Jensen's HISTORY AND TRENDS
OF PROFESSIONAL NURSING
The new 6th edition of the most widely adopted text
for "History of Nursing" courses presents the latest
trends and factual information in historical
perspective. Focusing on the relationship of
contemporary events and historical fact, it covers such
timely events as: recent uniting of nurses for higher
wages and economic security; new role of the nurse
clinician; and place of the community college in
nursing education.
By GERALD J. GRIFFIN. R.N.,
Dept. of Nursing, Bronx
Community College of the City
University of New York; and H.
JOANNE GRIFFIN, R.N., B.S.,
M.A., Instructor, Oiv. of Nurse
Education, New York University.
Publication date: March, 1969.
Approx. 360 pages, 7" x 10", 62
illustrations. About $8.75.
B.S., M.A., Former Head,
the symbol of ours
New 2nd Edition!
WORKBOOK AND STUDY GUIDE FOR MEDICAL-
SURGICAL NURSING-A Patient-Centered Approach
This carefully revised workbook correlates with the number one text on
Medical-Surgical Nursing, Medical-Surgical Nursing by Shafer, Sawyer,
McCluskey and Beck. Use it to help your students develop essential clinical skills^
communication arts, and problem -solving techniques.
By ALMA L. JOEL, R.N., B.S.N.; MARJORIE BEYERS, R.N., B.S., M.S.; LOIS S
CARTER, R.N., B.S.N.; BARBARA PURAS, R.N., B.S.N.; MARY ANN PUGH
RANDOLPH, R.N., B.S.N.; and DOROTHY SAVICH, R.N., B.S. Publication date: April
1969. Approx. 320 pages, 7%" x 10%", 13 illustrations. About $5.45.
New 2nd Edition! Lerch
WORKBOOK FOR
MATERNITY NURSING
The leading workbook for "Obstetric
Nursing" courses, this new edition
presents facts of conception and birth
and techniques and procedues of
maternal care. Punched, perforated
format is convenient for both
instructor and student. Answer book
supplied free to instructors adopting
this workbook.
By CONSTANCE LERCH, R.N., B.S. (Ed.),
Philadelphia, Pa. Publication Date: April,
1969. 2nd edition, 303 pages plus FM
l-VIII, 7V4" X 10>4", 33 illus. Price, $5.40.
A New Boo/<! Young-Barger
INTRODUCTION TO
MEDICAL SCIENCE
This unusual new book for your
practical nursing students and
paramedical trainees explains disease
in basic concepts of cause and effect,
in a semi-programmed format.
By CLARA GENE YOUNG, Technical
Editor and Writer (Medical), retired, U.S.
Civil Service; and JAMES D. BARGER,
M.D., F.C.A.P., Pathologist, Sunrise
Medical Center, Las Vegas, Nevada.
Publication date: March, 1969. 295 pages
plus FM l-XII, 7" X 10", 11 illustrations.
Price, $8.75.
... a commitment to provide
you, the dedicated nursing
instructor, with a complete line
of quality nursing textbooks,
continually revised, expanded, and
improved to meet YOUR needs,
YOUR high standards.
Before you choose textbooks
for next semester, examine these
. . . see how they can help you
fulfill your commitment to
the future of nursing.
86 Northline Road • Toronto 16, Ontario
new products {
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
Video Monitor / Recorder
This new line of video monitoring and
tape recording systems is intended espe-
cially for hospital installations.
Applications include monitoring of
several intensive care patients by a single
nurse; personnel training; closed circuit
microscopy (in conjunction with special
microscopes); evaluation or training in
operating room procedures; playback of
religious services into patients' rooms;
and children's visits to patients via closed
circuit television.
The system includes camera, video
monitor, video recorder, and a supply of
magnetic tape. The higli quality solid-
state closed circuit camera operates under
normal room ligliting and is completely
transistorized for simple, reliable opera-
tion and superior picture pickup capabili-
ties. It can be held in one hand, or
mounted on a tripod.
The 9-inch monitor is compact and
liglitweight. It is designed for panel or
wall mounting, and has operating controls
conveniently situated in front.
The solid state tape recorder receives
or records broadcasts through a conven-
tional TV set, its own TV.monitor, or the
video camera.
More information may be obtained
from Dallons Instruments, a division of
International Rectifier Corporation, 120
Kansas Street, El Segundo, California
90245.
Pediatric Respirator
This pediatric respirator is designed to
ventilate newborn, premature, and very
young children suffering from respiratory
distress.
The new Bourns Model LS-104-150
Pediatric Respirator is a volume limited,
positive pressure device, and offers a wide
range of adjustable respiratory functions,
including breathing and flow rates. Preset
28 THE CANADIAN NURSE
volume is adjustable from 5 to 150 ml,
maximum pressure is adjustable from 15
to 70 cm H2O, and variable flow is
adjustable from 50 to 200 ml per second.
Continuous readouts indicate volume,
breathing rate, and line pressure to pa-
tient.
Two modes of operation are
provided: 1. In the controlled mode,
ventilation is fully machine controlled at
an adjustable rate of 20 to 110 breaths
per minute. 2. In the assist mode, deli-
very of a preset volume of oxygen is
triggered within milliseconds by the in-
fant's respiratory effort. In this mode, the
respirator automatically provides con-
trolled respiration if the infant's own
respiratory effort stops or falls below a
predetermined rate for 12 seconds. It
returns to the assist function as soon as
spontaneous breathing is resumed.
Safety features include: apnea alarm
system, adjustable maximum pressure
relief valve, and low-pressure alarm to
indicate system leaks.
For additional information write:
Bourns, Inc., Life Systems, 300 Airport
Road, Ames, Iowa 50010, U.S.A.
Spoon Holder
This spoon holder is especially design-
ed for the patient who cannot close his
hand to hold a spoon. The holder is
adjustable to fit all hand sizes. When not
in use, the spoon is easily removed from
holder.
Inquiries or orders regarding this item
should be directed to your local hospital
equipment dealer or to Posey Products
stocked in Canada, B.C. Hollingshead
Ltd., 64 Gerrard St. E., Toronto 2.
Silver Swaddler
The Silver Swaddler is a device for
preventing hypothermia in the newborn.
It consists of a simple swaddling-suit of
polyester plastic film coated with a thin
layer of aluminum. It is a garment with a
hood and is supplied with an adhesive
strip for sealing. Convective and evapo-
rative heat loss are prevented because the
material is impermeable; the polyester is a
poor conductor of heat and the alumi-
num laminate acts as a silver surface
preventing radiant heat loss.
At the time of birth, a baby usually is
exposed to moderately severe cold stress
when he emerges naked and wet from the
warm environment of the uterus. A lusty
term infant can respond with an abrupt
fall of his body temperature by tripling
his heat production. However, in very
cold conditions or in babies who are
small, premature, Ul, or asphyxiated, the
results of cold exposure may be di-
sastrous. In certain circumstances, some
degree of cold exposure is almost inevi-
table, such as during transportation or
minor surgical procedures. This simple,
cheap device is useful for keeping babies
warm when more sophisticated apparatus
such as an incubator is unavailable or
inappropriate.
The Silver Swaddler is available from
Down Bros, and Mayer & Phelps Ltd.,
410 Dundas St., W., Toronto 2B. C
APRIL 1969-
The
disposable
diaper
concept
What are its advantages?
In providing greater comfort and safety for
the infant:
More absorbent than cloth diapers, "Saneen"
FLUSHABYES draw moisture away from baby's skin, thus
reducing the possibility of skin irritation.
Facial tissue softness and absence of harsh laundry
additives help prevent diaper derived irritation.
Five sizes designed to meet all infants' needs from
premature through toddler. A proper fit every time.
Single use eliminates a major source of cross-infection.
Invaluable in isolation units.
In providing greater hospital convenience:
Polywrapped units are designed for one-day use, and
for convenient storage in the bassinet. Also, Saneen
Flushabyes do not require autoclaving — they contain
fewer pathogenic organisms at time of application
than autoclaved cloth diapers.*
Prefolded Saneen disposables eliminate time spent
folding cloth diapers in the laundry and before
application to the infant. Easier to put on baby.
Constant supply. Saneen Flushabyes eliminate need
for diaper laundering and are therefore unaffected by
interruptions in laundry operations.
Elimination of diaper misuse, which may occur with
cloth diapers. *The leRlche Bacteriology Study— 1963
More and more hospitals are changing to Saneen Flushabyes disposable diapers.
Write us and we will be glad to supply you with further information on clinical studies, cost analysis, and disposal techniques.
Use these and other fine Saneen products to complete your disposable program:
MEOICAL TOWELS, "PERIWIPES" TISSUE. CELLULOSE WIPES. BED PAN DRAPES. EXAMINATION SHEETS AND GOWNS.
aneen
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M-H4 "Saneen". •■Flushabyes". "Peri-Wipes" Reg'd T.Ms, Facefle Company Limited
in a capsule
Safety Not In Numbers
A good Samaritan is most likely to be a
single Samaritan, rather than one of a
crowd, according to an American study
reported in The Homer Newsletter.
People in public are afraid to "lose
their cool." particularly when they are in
a crowd. Also the attitude: Nothing can
be wrong, otherwise someone would try
to stop it. was given as a reason for
increased violence occurring without
anyone nearby trying to stop it.
Patients Became Gourmets
A Russian proverb that goes "Drink a
glass of wine after your soup, and you
steal a ruble from your doctor," has the
support of doctors, as well as patients, at
San Francisco's St. Luke's Hospital. An
article in the Bulletin of the Society of
Medical Friends of Wine reports the
success of an experiment that began at
the hospital in 1961, with the arrival of a
chef from a famed restaurant. The
purpose: to tease the patients' appetites
with the "arts of haute cuisine developed
by great culinary artists." The results:
"Impressive therapeutic benefits to the
patients, as testified to by their physi-
cians."
Women and Water
Women use water in many places for
many things - but not to drink, says Dr.
William F. Mengert, commenting on day-
to-day problems of obstetrics and gyne-
cology in the Practical Ob. Gyit
The reason for this, says Dr. Mengert,
is that in our culture it is easier for the
male to find a place to empty his bladder
than for the female. Consequently, a
woman has learned to be sparing in her
water intake.
Dr. Mengert insists on liis private
patients drinking a minimum of 12 glasses
(3 quarts) of water a day.
Among the many feminine ills that can
be cured by this "cheap and excellent
medicine," is cystitis, a frequent com-
plaint of many women.
The conclusion of this watered-down
version of Dr. Mengert's article, in his
own words is: Sell it to her, doctor, sell it
to her!
Noisy shoes
How many hospital personnel realize
they are guilty of wearing noisy shoes?
Harriet Faulkner of Mission, B.C., who
30 THE CANADIAN NURSE
was a recent daily visitor for six weeks in
a large hospital, found it interesting to
notice the number of noisy shoes worn
by hospital personnel.
Some of the offenders were student
nurses, thougli the visitor didn't blame
them. She asks if the manufacturers of
white duty shoes are not aware of the
need for soft leather soles and heels. And
surely, she says, schools of nursing do not
advocate hard-soled shoes!
It is to be hoped that the kicks will go
to the guilty parties, so that future
hospital visits will be more pleasant to the
ear.
Talking back
"Talking back" is a term loaded with
connotations of unruly behavior and
smart alecky, disobedient children; "feed-
back," on the other hand, connotes the
sterile, efficient, controlled world of the
computer. Both words mean essentially
the same, however, and psychology and
art students at the University of Cincin-
nati are benefitting from an electronic
device in their classroom that enables
them to "talk back" to their lecturer.
The students let their feelings be
known by signalling to their instructor
with red and green lights. A monitoring
device with blinking colored lights, called
a communicator, is located at the front of
the classroom. Wires lead from the mon-
itor to switches controlled by the stu-
dents.
"Wlien students become frustrated
with a lecture or feel 'lost' or just plain
bored," a psychology instructor at the
University of Cincinnati, Dorelle Heisel,
explained, "they can indicate theit
anxiety by signaUing me on the monitor."
An instructor can determine the mood
of his class and ultimately the effective-
ness of his teaching by specified combina-
tions of blinking lights, Mrs. Heisel con-
tinued. "It has been found that only
about 20 percent of a lecture class is
listening at any one time. The lecture,
however, is a valuable medium for com-
municating information. This 'communi-
cator' can increase its effectiveness by
permitting students to influence an ex-
planation while it is in progress."
As she sees it, the communicator will
sensitize instructors to student reactions
and involve students in the class, since
they've helped shape it.
David Cox, a specialist in training
development at Proctor & Gamble, devel-
oped the communicator. C
APRIL 1969
a little knowledge is not enough . . .
give teen-agers the facts about menstruation
Some teen-agers have heard they shouldn't bathe
or wash their hair during their menstrual periods.
Some think unmarried girls should n't use tampons.
Others say exercise brings on "cramps." No
wonder they call it the "curse."
Give them the facts . . . with the help of the
illustrations in charts like the one above prepared
by R. L. Dickinson, M.D. and available to you free
from Canadian Tampax Corporation Ltd. These
81/2" X 11" colored charts are laminated in plastic
for permanence and are suitable for marking with
grease pencil. Social myths can be exploded, too,
by giving teen-agers either of the two booklets we
will be glad to send you in quantity fordistribution.
One bookietiswrittenfortheyounggirl just begin-
ning menstruation and the other for the older
teen-ager. The booklets tell them what menstrua-
tion is, how it will affect them, and how easily they
can adjust to it normally and naturally.
Unmarried girls, of course, can use tampons. And
they have many good reasons to do so. Tampax
tampons are easy to insert— comfortable to wear.
APRIL 1969
Because they're worn internally there's no irrita-
tion or chafing; no menstrual odor.
Tampax tampons are available in Junior,
Regular and Super absorbencies, with explicit
directions for insertion enclosed in each package.
TAMPAX
tAmponA
SANITARY PROTECTION WORN INTERNALLY
MADE ONLY BY CANADIAN TAMPAX CORPORATION LTD., BARRIE, ONT.
FREE CHARTS IN COLOR
Canadian Tampax Corporation Ltd., P.O. Box 627, Barrie, Ont.
Please send tree a set of the Dickinson charts, copies of the
two booklets, a postcard for easy reordering and samples of
Tampax tampons.
Name_
Address.
THE CANADIAN NURSE 31
OPINION
Nursing assistants are here to stay
Dorothy J. Kergin, Reg.N., Ph.D.
Society has granted to nursing the
right to determine the conditions for
attaining and retaining membership in the
profession, through control of the con-
ditions for registration as a nurse. To be
identified as a profession also implies that
nursing exerts a measure of control over
the manner in which its services are
rendered. In return for both, nursing is
responsible to society for providing its
services as effectively and as efficiently as
possible. Whenever a profession proposes
a change in its educational standards for
entry, in the conditions for remaining, or
in the manner in which its services are
rendered, it must ask itself if these
changes are in the best interests of
society as a whole.
Nursing is not fulfilling its responsibi-
lity to society if it advocates that educa-
tional programs to prepare practical
nurses or nursing assistants be discon-
tinued. At the Canadian Nurses' Associa-
tion's 34th general meeting in July 1968,
delegates approved a recommendation of
the Committee on Nursing Education
that "all programs which prepare prac-
titioners, who, upon graduation are not
eligible for licensure as registered nurses,
be phased out," adding only the word
"gradually" to the original recom-
mendation.*
Since the proposal is directed toward
nursing assistant programs, it must be
considered ill-conceived and poorly
timed. A decision such as this, which has
profound social and economic effects for
society and for nursing, should be based
upon a scientific study, or at least upon a
careful assessment of all the factors in-
volved. There is no real evidence that the
CNA has done this.
The proposal lacks rationality for the
following reasons:
1 . // (Joes not address itself to the
problem of more effective utilization of
the nurse. All individuals who are in-
capacitated by illness, injury, or senes-
* Identity and Destiny - in Saskatoon, Canad.
Nurs.. 64 33, Aug. 1968.
APRIL 1969
cence do not require personal care from a
registered nurse. Many patients confined
by disability to the home, hospital, or
nursing home can be maintained and
moved toward rehabilitation through the
ministrations of someone with lesser
preparation than that required for regis-
tration as a nurse. This assumes, of
course, that a professional registered
nurse assesses the patient's needs for
nursing care, formulates a plan for this
care indicating the level of skill re-
quired to expedite it - and periodically
evaluates the progress made by patient
and family.
Let us not try to eliminate a category
of personnel, but, rather, let us refine the
criteria with which a professional nurse
can judge what level of skill is required to
provide therapeutic nursing care.
2. The proposal does not recognize
the public 's concern for the rising costs of
medical care services, for both iu-hospital
and extra-hospital care. A major part of
the nursing profession's responsibility for
insuring that its services are rendered
efficiently as well as effectively is con-
cerned with the optimal utilization of
lesser skilled personnel. Can the public
afford to pay, or will it pay, for high cost
professional nursing services when lower-
priced non-professional services can
adequately meet many of their require-
ments for nursing service? Indeed, how
well have we documented the need for
professional nursing care at the patient's
bedside?
3. The proposal does not appear to
recognize that the health care industry is
one of the largest industries in Canada. At
a time when many occupational fields
require individuals to have preparation
beyond secondary school, the health field
continues to offer opportunities for those
who have not attained this level. Dis-
continuing nursing assistant programs
would mean that a satisfying work role
was denied a number of Canadians who
Dr. Kergin is Associate Director, McMaster
University School of Nursing, Hamilton, Ont.
had not had full educational opportu-
nities.
The Canadian Nurses' Association has
forthrightly spoken out against recruiting
nurses to Canada from countries where
there is a real shortage of nursing person-
nel. Instead of recruiting nurses, why
cannot this nation recruit individuals who
lack the educational prerequisites to enter
nursing but who would qualify to enter a
nursing assistant program'.' These indi-
viduals would thereby enter a useful
occupation and share the pleasures of life
in our democratic society.
4. The elimination of the formal edu-
cational programs that prepare nursing
assistants would fail to do away with this
level of nursing personnel The responsi-
bility for educating nursing assistants
would be left to the institutions that
employed them. Not only would this
contribute to the costs of patient care but
it would also lead to educational pro-
grams planned by institutions to meet
their unique and present requirements for
staff
What is the answer? Where should the
Canadian Nurses' Association be directing
its influence? Let us, as Association
members, encourage projects that at-
tempt to define more clearly the roles
and responsibilities of all levels of nursing
personnel, to examine present nursing
practice and identify what functions the
nurse should legitimately perform in the
changed world of tomorrow, and to
consider how nursing can contribute most
effectively to the delivery of health care.
We cannot turn back time - the nursing
assistant is here to stay. If we do not
determine how best she can be utilized,
others will do it for us.
The Canadian nursing profession has a
right to expect that the Canadian Nurses'
Association policies will be loudly pro-
claimed and broadly interpreted to in-
fluence health policies and practices. Any
proposal such as this one that contravenes
the realities of today and tomorrow may
well weaken the profession's influence
among employers and in society at large.
THE CANADIAN NURSE 33
And now your income tax..
A few general rules of the game and some specific details that are of
interest to nurses.
By April 30, 1969 over seven million
Canadians are expected to file personal
tax returns for the year 1968. The federal
government has estimated that these re-
turns will produce personal income tax
revenue, including old age security tax, of
approximately $4.2 billions. In addition,
the federal government will collect over
$1 bilhon in income taxes on behalf of
the provinces other than Quebec. (All
provinces impose a personal income tax
on its residents; Quebec alone administers
and collects its own provincial income
tax.) Although these rough figures may
be too large to convey any personal
impact, most taxpayers have found that
their share of this total represents a
significant personal sacrifice.
Qver the years, the Canadian tax sys-
tem has been amended many times to
correct obvious inequities and to provide
a number of special incentives. Taxpayers
who wish to take advantage of these
provisions to minimize their tax liability
or to defer the payment of tax until some
future time should, therefore, have some
understanding of these rules and plan
their financial affairs accordingly.
It is not possible to outline here all of
the rules applicable to every individual
taxpayer. There are, however, a number
that are of general application and these,
together with more specific details of
particular interest to members of the
nursing profession, are the subject of this
article.
34 THE CANADIAN NURSE
Frederick S. Mallett, C.A.
Who is taxable?
Generally, Canadian income tax is
imposed upon the world income of per-
sons resident in Canada at any time in the
year. Citizenship is not a determining
factor in establishing liability for Canadi-
an tax and, in this respect, Canadian
practice differs from that of the United
States, which imposes tax on all US
citizens, wherever resident. The first
problem that may face a taxpayer, there-
fore, is whether or not he is resident in
Canada and, if so, for what period.
Since the solution to this question
frequently requires reference to a mass of
court decisions, legal advice may be re-
quired. In the simple case, however, a
person is normally resident in the place
where he has his usual home and where
he is employed or carrying on a business
or profession. Canadian citizens who are
living and employed in Canada are, there-
fore, subject to Canadian tax. Immi-
grants, however, are subject to Canadian
tax on their world income earned only in
the period of their residence in Canada.
Similarly, persons giving up their Canadi-
an residence, although not necessarily
their Canadian citizenship, are subject to
Canadian tax only on income received
during the period prior to their departure.
Persons subject to Canadian tax for
Mr. Mallett is a partner in the Ottawa office of
Clarkson, Gordon & Co., Chartered Account-
ants.
part of a year only are not entitled to the
full personal exemptions provided in the
Income Tax Act, but rather to a pro rated
exemption based upon number of days'
residence in Canada. It is beyond the
scope of this article to deal further with
the complex problems that may face
non-resident taxpayers. The following dis-
cussion is therefore aimed at the great
majority who are resident and employed
in Canada throughout the year.
Two classes of personal taxpayers
There are two distinct classes of tax-
payers and the rules determining income
are somewhat different for each class.
Most taxpayers are classed as employees,
and generally the determination of their
income subject to tax is fairly simple.
Normally employees may use the abbrevi-
ated tax return form Tl Short provided
they are not engaged in other business
activities or earn over $2,500 in invest-
ment income.
Self-employed persons, and this class
would include private duty nurses, are
subject to tax on their net income after
deducting expenses necessary to their^
business or profession. These persons
must use the Tl General return. All
taxpayers are subject to the same rules
with respect to investment income, per-
sonal exemptions, medical expenses, and
charitable donations, and, of course, to
the same rates of tax.
The task facing employees in comput-
ing their liability for tax is simplified by
APRIL 1969'
the reporting requirements of the Income
Tax Act, which imposes upon the
employer an obhgation to furnish each
employee with a summary of earnings for
the year, the amount of tax deducted at
source, and the amounts of contributions
to registered pension plans and to the
Canada or Quebec Pension Plan. Each
employee should receive two copies of
this report (form T4) before the end of
February. Other copies are provided by
the employer to the Department of Na-
tional Revenue for checking purposes.
Self-employed persons must maintain
■their own accounting records to establish
income received in the year and expenses
incurred in earning income that may be
deducted for tax purposes. Generally,
individual taxpayers must compute in-
come and expense on a cash basis, that is,
on cash actually received or actually
disbursed during the year.
Income from employment that is sub-
ject to tax includes salary as well as the
value of board, lodging, or any other
oenefit received by virtue of employ-
;Tient. There are. however, certain bene-
fits that are specifically excluded, such as
employers' contributions to pension
ilans. group sickness or accident insur-
mce plans, medical plans, and payments
inder group term life insurance policies.
Employees are entitled to very few
leductions in computing their income
ither liian minor amounts for annual fees
5aid to professional associations. This
general restriction prevents, for example,
1 nurse employed in a hospital from
leducting the cost of uniforms that she
las been required to purchase herself,
iowever. if a nurse is provided with
iniforms by her employer without char-
;e, the Department does not require that
he value of this benefit be included in
ncome. A self-employed nurse is entitled
o deduct the cost of uniforms in com-
•uting her professional income.
Employees generally may not deduct
VPRIL 1969
automobile expenses or other transporta-
tion costs, since it is assumed that the
cost of getting to and from work is a
personal responsibility. If an employee is
required to use an automobile in the
performance of his or her duties and is
reimbursed on a mileage basis, the reim-
bursement is not included in income
unless the amount received is obviously
excessive.
Some employers prefer to give lump
sum car allowances that are not directly
related to actual business use. In these
cases the allowance can be included in
income but a deduction may be claimed
for actual expenses incurred. However, it
is unlikely that expenses could be claimed
significantly in excess of the allowance
given, since the allowance was probably
determined by the employer to be reason-
able in the circumstances.
Self-employed taxpayers, on the other
hand, may deduct transportation costs
related to the earning of income. A
private duty nurse, for example, should
be able to deduct the cost of driving from
her home to the places where she renders
professional services. In such cases, auto-
mobile expenses would include gas and
oil, maintenance, tires, insurance, licence
fees, and capital cost allowance (deprecia-
tion). Depreciation may be claimed at a
normal rate of 30 percent of the unde-
preciated cost of the automobile.
Since automobiles are rarely used en-
tirely for business or professional pur-
poses, taxpayers wishing to claim auto-
mobile expenses are required to maintain
a mileage log recording the date, mileage,
destination, and purpose of each business
trip. Business mileage for the year may be
determined and expressed as a percentage
of total mileage driven. This percentage
must then be applied to the total of
automobile expenses incurred to deter-
mine the amount deductible for tax
purposes. Taxpayers must be able to
support automobile expenses, as well as
other expenses claimed with invoices,
cancelled cheques or receipts, although
these need not be filed with the tx\
return.
Income from other sources
In addition to employment or profes-
sional income, income from other
sources, such as interest, dividends, estate
or trust income, the income portion of
annuities, and alimony or separation
allowances, must be included. Although
all amounts are taxable, no matter how
small, many taxpayers have apparently
failed to report bank interest or dividends
unless they have received a T5 slip from
the paying source. This year the Depart-
ment of National Revenue has extended
its reporting requirements so that all
interest or dividend payments over SIO
must be reported. Previously the lower
limit had been SI 00. As a result, many
taxpayers may have received T5 slips,
which report such minor items as bank
savings account interest, for the first time
this year.
Taxpayers should not forget to include
the value of bond coupons cashed during
the year, whether or not a T5 slip has
been received, particularly if an informa-
tion slip (form T600) was filled out as
required at the time the coupon was
cashed.
The following additional points should
be kept in mind when calculating tax on
investment income.
1. Interest: Interest on bank bor-
rowings may be deducted if the borrowed
money was used to purchase income-
producing investments or property.
Interest may be deducted in such cases
even if the amount of interest paid in the
year exceeds the amount of income re-
ceived.
2. Other Carrying Costs: Other costs
applicable to investment income are
deductible, such as safety deposit box
rentals, one-half of the fees charged by
investment counsel, and, if necessary,
professional accounting fees paid during
the year.
3. Depletion Allowances: Dividends
received from companies engaged in
extra-active industries, such as mining, oil
and gas. may be reduced by depletion
allowances at various rates. In most cases,
the depletion allowance rate is shown on
the T5 slip; if not, the rate may be
obtained by calling the local office of the
Department of National Revenue.
4. Twenty Percent Dividend Tax
Credit: Taxes may be reduced by 20
percent of the net dividend income
received (that is after deducting appli-
cable carrying costs and depletion) from
THE CANADIAN NURSE 35
taxable Canadian corporations. This
credit is intended to offset in part the tax
paid by the corporation on its earnings
prior to the dividend distribution. But it
also serves as an incentive to invest in
Canadian equity securities.
Personal exemptions
Every taxpayer is entitled to personal
exemptions of varying amounts com-
mencing at $ 1 ,000 (unless reduced in the
case of part-year residents). Although
these exemptions are described in some
detail on the return itself, some further
explanations may be useful.
Although working wives whose income
is over $1,250 may not be claimed as
dependents by their husbands, it should
be remembered that this limitation
applies only to income received after
marriage. Thus, a working girl earning
$400 per month who was married on
October 15, 1968, could be claimed as a
dependent by her husband. In this case
the exemption would be $250 ($1,250
less $1,000 earned after the wedding).
This newly married woman must also file
her own return for the year, reporting
income of $4,800 and claiming the basic
exemption of $1,000.
When both parents are working, the
question is sometimes asked as to which
parent may claim the children as depen-
dents. Normally it is advantageous for the
spouse with the larger income — usually
the husband - to claim the children;
because of the progressive tax rate struc-
ture, the exemption would result in a
greater tax saving. It is, however, a
question of fact as to which parent is
financially responsible for the children's
support and, therefore, in some cases the
wife may claim the exemption.
Medical expenses and charitable dona-
tions may be claimed subject to certain
limitations. Every taxpayer may claim
either (a) a standard deduction of $100
36 THE CANADIAN NURSE
or (b) actual medical costs incurred on
behalf of the taxpayer and his depen-
dents, less 3 percent of net income, plus
donations made to registered Canadian
charities.
Medical expenses may be claimed if
they were paid during any 12-month
period ending in the year, provided, of
course, that they were not claimed
previously. Medical expenses include
amounts paid on behalf of the taxpayer
by medical or hospital insurance plans,
except amounts paid by provincial hospi-
tal insurance plans. In Ontario, for
example, supplementary hospital benefits
paid by Blue Cross may be claimed, but
not amounts paid by the Ontario Hospital
Services Commission.
To be deductible, charitable donations
must be paid to registered Canadian
charities and must be supported by
receipts showing the registration number
of the organization. There are, however,
minor exceptions to this rule covering
donations made to certain US charities, if
the donor commutes to work in the US
or has income from US sources.
After completion, tax returns must be
filed on or before April 30 along with a
cheque payable to the Receiver General
of Canada for any unpaid tax. Many
prefer to complete their tax returns as
quickly as possible so that they will be
processed early. If tax is payable,
payment may be deferred until April 30,
even though the return has been submitt-
ed earlier. If a refund is due, the sooner
the return is filed the sooner the refund
cheque will be received. Any tax unpaid
after April 30 is subject to a 5 percent
penalty plus interest.
A look at the future
What can be done to reduce tax in
1969? Many taxpayers are unaware of
the tax savings (more properly a deferral
of tax to some future date) that may be
achieved through Registered Retirement
Savings Plans. These plans are generally
available through insurance companies,
trust companies, and mutual funds, and
provide a wide variety of investment
objectives and other features. Contribu-
tions are deductible for tax purposes up
to certain prescribed limits. The fund
itself is exempt from tax so that the
growth rate of the portfoUo is higher than
would otherwise be possible. Following
retirement, benefits in the form of an
annuity will be subject to tax, but pre-
sumably at a lower rate than would have
been paid had the contributions been^
taxed as earned.
These Registered Retirement Savings
Plans are of particular interest to self-
employed persons who may not enroll in
registered employee pension plans;
however employees who wish to set aside
more than permitted under their pension
plan may wish to use a Registered Retire-
ment Savings Plan as a supplement.
Although further tax saving measures
may be applicable in certain circum-
stances, the reader should understand
that the federal government is now in the
process of completing a review of the
substantial and challenging recommenda-
tions made by the Carter Royal Commis-
sion on Taxation in 1966. There is some
indication that many of the Commission's
recommendations may be adopted, a1
least in modified form, but no precise
details are expected to be available unti!
June 1969 at the earliest. In all probabil-
ity we will have a new Income Tax Act ir
effect by 1970.
At this stage one can only speculate as»
to how the new Act will affect tht
individual taxpayer, other than to suggesi
that income tax will continue to absorl
an increasing proportion of persona
income. Therefore, awareness of th('
impact of taxation remains an importan'
first step in financial planning. C
APRIL 196'
Medicolegal problems can arise
in the coronary care unit
A nurse working in a coronary care unit should be aware of all the medicolegal
implications involved in the care of her patients, and take measures to protect
herself from charges of malpractice.
Gloria G. Crotin, B.N., M.N.Ed.
In carrying out a nursing procedure in
any clinical area, a nurse can be sued if
damage results to the patient. The action
against her would be successful if the
damage were caused by negligence on her
part. In the coronary care unit, the
possibility of the nurse being sued for
malpractice is increased, since she often is
called on to perform functions that can
mean life or death for the patient.
In some coronary care units, particu-
larly those in small community hospitals,
there is a danger that the nurse may be
required to make emergency decisions
and to perform functions that are not
entirely nursing in nature. In this event,
she could be in difficulty in three
areas: 1. She is vulnerable to legal action
taken by the patient for malprac-
tice; 2. She is vulnerable to legal action
taken by the medical profession in that
she carried out an unauthorized prac-
tice; 3. If she carries out an unauthorized
practice, she could be guilty of profes-
sional misconduct within the regulations
of the nursing profession.
Problems facing the nurse
A patient is admitted to the coronary
care unit with a diagnosis of myocardial
infarction, coronary thrombosis, or a
suspected heart problem. While in the
Mrs. Crotin, a graduate of McGill University
and the University of Pittsburgh, is now Direc-
tor of Nursing at York Central Hospital, Rich-
mond Hill. Ontario.
unit he may or may not develop com-
plications, such as a major cardiac ar-
rhythmia.
A major arrhythmia presents the
greatest problem, since it may lead to
ventricular standstill or ventricular fibril-
lation. In either event, someone — prefer-
ably the doctor, but all too often the
nurse — must intervene.
If the doctor is not available when
such an emergency arises, the nurse is
forced to make an immediate decision
concerning her patient's treatment; her
decision will depend on her assessment of
his condition. Does he have cardiac stand-
still or cardiac fibrillation?
In this crisis, the nurse may decide to
apply external thoracic compression or
apply an electrical defibrillator to the
heart. She may make a wrong assessment
and thus apply an incorrect treatment,
such as giving an electrical countershock
when it is not indicated, or failing to
apply external thoracic compression
when it is indicated.
The nurse is faced with another
dilemma if the patient goes into cardio-
genic shock or cardiac decompensation. If
the physician is unavailable, she then has
to decide whether vasopressor drugs are
required and when. She also has the task
of administering these drugs intrave-
nously if a doctor is not present.
Even if the nurse selects the correct
course of treatment, damage to the
patient may follow. External thoracic
THE CANADIAN NURSE 37
38 THE CANADIAN NURSE
compression may be accompanied by
damage to the heart, such as a contusion
of the myocardium, rupture of the heart
or hver, or fractured ribs with possible
lung penetration. The use of vasopressor
drugs, such as metaraminol bitartrate can
lead to severe tissue damage if the med-
ication inadvertently extravasates.
Protective measures
A review of law cases reveals few
charges against nurses who have expanded
their functions into the area of general
medical practice, and few charges against
physicians who have delegated to nurses
functions that are beyond the education
of a nurse. However, this does not lessen
the importance of the nurse being pro-
tected against lawsuit.
Many of the protective devices used in
the past are outdated and need to be
revised, if they are to provide legal
protection. For example, some provincial
nursing acts do not define nursing prac-
tice; in addition, few medical or hospital
associations have issued statements of
policy in conjunction with the provincial
nurses' association to support the nurse's
activities in the coronary care unit.
Nursing Practice Act: Every province
in Canada has its own nursing act. These
acts, which are designed to protect the
public by demanding certain respon-
sibilities from the nurse, usually provide a
definition of professional nursing; a few,
however, do not. The acts grant minimal
rights to the nurse, such as the placement
of the initials RN following her name.
Most of the acts permit the nurse to do
almost anything in the medical area as
long as it is prescribed by a physician or
done under his direction or control.
A definition of professional nursing
practice is essential, for it limits the area
of professional nursing and protects the
nurse from the charge of unlicensed
practice of medicine, if she performs only
those functions that are defined by the
act.
The statutory definition of nursing
within any province may determine a
nurse's responsibility for injury to a
patient. For example, questions of relia-
bility for damages may relate to the
nurse's power of observation of symp-
toms, such as the observation of a patient
going into cardiogenic shock. Reliability
questions may arise from the recording of
facts. The nurse may record a wrong
pulse rate or electrocardiographic reading.
She also runs into problems if she fails to
carry out prescribed treatments and med-
ications, such as those suggested forr
ventricular fibrillation. The nurse is also
responsible for safeguarding the patient's
safety.
The tendency for the courts is to
follow past issues or similar ruhngs in
other provinces for malpractice suits
brought against a nurse. These com-
parable rulings may persuade a judge, but
any decisions in the future that involve a
nurse in a coronary care unit will
probably be based on the nurse's edu-
cational background and preparation,
how she carried out a given procedure,
and whether this procedure was within
the framework of the hospital's policies
and the physician's instructions.
Joint Statements: Further protectioi
for the nurse working in a coronary can
unit may be provided by the issuing of a
joint statement on the nurse's functions
by various professional associations. Foi
example, the California Medical Associa-
tion, California Nurses' Association, and
the California Hospital Association issued
a joint policy statement as follows:
"We recognize the propriety of registere
nurses to use monitoring, defibrillation, and
resuscitative equipment and to institute im-
mediate life-saving corrective measures, if a
licensed physician is not immediately available
to do so and the following conditions
exist: 1. The registered nurse has had special
competent instruction in the tech-
niques. 2. The registered nurse performs the
authorized procedures upon: (a) the direct
order of a licensed doctor of medicine, oi
(b) pursuant to standing procedures established
as set forth in item 4. following. 3. Where a
hospital has determined that a registered nurse
may perform the techniques, then the tech-
niques to be performed within the framework
of designated preparation and practice of the
nurse shall be established for the hospital by 5
committee composed of representatives from
the medical staff, the department of nursing.
and the administration. Thus the framework ol
preparation and practice shall be reproduced in
APRIL 1969
writing and made available to the total medical
and nursing staffs. 4. Such criteria shall make
provision that in case of a cardiac emergency, a
licensed physician and other designated catego-
ries of personnel are to be immediately
summoned to assist the registered nurse who is
carrying out the physician's orders or is carry-
ing out standing procedures established by the
medical staff of the hospital, and contained in
the adopted criteria."^
Malpractice Insurance: The nurse in a
coronary care unit should purchase a
malpractice insurance policy. The usual
policies provide her with two benefits.
First, the insurance company bears the
cost of defending and representing her in
court. Second, most liability policies state
that the insurance company will pay for
all losses incurred by the nurse, including
settlements made out of court, up to the
face value of the policy.
In some countries registered nurses can
purchase professional liability insurance
through their professional nurses' associa-
tion. The maximum limit is from one to
two hundred thousand dollars payable on
each claim, with a limit on the number of
claims in one year.
Future problems
It is quite likely that nurses may soon
be involved in establishing the time of
death of a patient. Clinical death occurs
when there are no observable or percepti-
ble vital signs of life, such as heart beat,
respiration, and, in rare instances, brain
wave activity. Within an interval of time
after clinical death, usually three or four
minutes, it is possible in some instances
to restore respiration and heart beat
through the use of external heart mas-
sage, artificial respiration, and drugs. This
all must be done before irreversible brain
damage occurs. The nurse now records
the time of clinical death (cardiac stand-
still) and the physician records the time
of medical death.
The mechanical failure of any of the
various monitoring devices that assist in
sustaining life, such as the deliberate
interruption of a pacemaker or a negli-
gent interruption of the pacemaker that
results in death, may present legal prob-
lems. Failure to provide competent resus-
citative procedures after clinical death
APRIL 1969
may lead to further legal problems.2
While nurses are becoming familiar
with external cardiac massage and the use
of cardiac defibrillators, physicians and
researchers are busy developing new heart
drugs and advanced equipment. What
problems these will bring is not known,
but some surmises can be made.
For the treatment of cardiogenic
shock, an intra-aortic balloon is already
being tested.3 The balloon, which con-
tains helium, assists the heart by acting as
a pump. It is predicted that future coro-
nary artery disease patients may have this
balloon inserted immediately upon admis-
sion to the coronary unit. There is a
major hazard with the balloon: if it
bursts, it may cause an embolus.
Another device is the solo hyperbaric
chamber or unit." This is a single bed unit
capable of delivering high concentrations
of pure oxygen. Physicians believe they
can halve the death rate from acute
myocardial infarctions with the use of
this apparatus. It, too, is not without
hazards.
A safe environment
When working in a coronary care unit,
the nurse should assure herself that she is
practicing within an environment that is
safe for herself as well as for the patient.
• Each registered nurse should have her
own liability insurance policy.
• Records showing monthly equipment
checks for conductivity and correct
grounding should be kept by the engi-
neering department.
• Nurses' notes should be descriptive and
frequent. The time of observations,
treatments, and electrocardiograph read-
ings is extremely important.
• There should be written policies on the
procedures to be followed when cardiac
arrest or any other problem occurs. The
policies should be developed by means of
a coronary unit committee with register-
ed nurses represented. The committee
should meet on a regular basis to discuss
current problems and to assure con-
tinuing education of physicians and
nurses.
• The advanced education and pre-
paration of the nurses who work in the
unit should be recorded for future refer-
ence. Any additional continuing educa-
tion should be recorded also.
• The nursing practice act for each
specific province should be reviewed to
find out if the nurse is practicing within
the definition of nursing practice or if she
is practicing medicine.
• The nurse should look for the support
of various professional organizations and
joint statement policies by these organ-
izations and joint statement policies by
these organizations on cardiopulmonary
resuscitation and other life-saving
measures she may be confronted with in
the unit.
References
1. Acute Cardiac Care; The Role of the Regis-
tered Nurse. (Joint statement by the Cali-
fornia Medical Association, California Hospi-
tal Association, California Nurses' Associa-
tion.) California Medicine CIV, March 1966,
p.228.
2. Houts, M. and Haul, l.H. Death: Courtroom
Medicine. New York, Matthew Bender and
Company, 1966, p.3.
3. Balloon lightens heart's workload. Medical
World News 9:43, May 24, 1968.
4. Hyperbaric Unit puts pressure on heart
deaths. Medical World News 9:65, May 24,
1968.
Bibliography
Caswell, .I.E. A brief history of coronary care
units. Public Health Reports 82:1105-1107,
Dec. 1967.
Downs, F.S. Technical innovation and the
future of the nurse-patient relationship.
ANA Clinical Sessions American Nurses'
Association. New York, Appleton-Century-
Crofts, 1966.
Ferrigan, M. A new nursing horizon. Int. Nurs.
Rev.. 13:19-20, March-April, 1966.
Jones, B. The patient and his responses. Amer.
J. Nurs. 67:2313-2320, Nov. 1967.
Nite, G. and Willis, F.N. The Coronary patient:
Hospital Care and Rehabilitation. New
York, The Macmillan Co., 1964.
Phibbs, B. The Human Heart. St. Louis. The
C.V. MosbyCo., 1967.
Pinneo, Rose. Nursing in a coronary care unit.
Cardio- Vascular Nursing 3:1-4, Jan.-Feb.,
1967.
Linger, P.N. and Jenkins, A.C. Guidebnes for
planning a coronary intensive care unit.
Hospital Progress 57:89-96, August, 1966.
Whalen, R.E. and Starmer, C.F. Electric shock
hazards in clinical cardiology. Modern Con-
cepts of Cardiovascular Disease 36:7-12,
Feb. 1967. Q
THE CANADIAN NURSE 39
Smoking habits of
Canadian nurses and teachers
Although the proportion of nurses and teachers who smoke habitually is lower
than that of the national average, those who do have the habit smoke more
heavily than other Canadians.
A.J. Phillips, Ph.D.
"I don't smoke. Top speed requires
top condition," says Al Pease, Canadian
racing driver. "Smoking and sports don't
mix," says Elaine Tanner, one of Can-
ada's top swimmers. Nancy Greene,
Olympic and World Champion skier, says
simply: "I don't smoke."
Personality posters displaying testi-
monials such as these along with a photo
of the star in action are distributed by the
Canadian Cancer Society as part of their
campaign against smoking. They are
aimed particularly at young people, who
are known to be greatly influenced by
persons they respect or admire.
Whether doctors, nurses, and teachers
live up to the expectations of the general
public or not, there is no doubt that
Canadians think that these persons should
be above reproach in matters of health
and morals. The example shown by a
single doctor, nurse or teacher can make
the difference between a nonsmoker
starting to smoke or not and a seasoned
smoker giving up the habit or continuing
it. As far as smoking is concerned, how-
ever, doctors certainly do not act as
examples to the rest of the population. A
recent survey of doctors' smoking habits
revealed that about one out of three
smoke cigarettes regularly and that doc-
tors smoke, on the average, considerably
more cigarettes per day than cigarette
smokers among the rest of the Canadian
population. ■"
The following study of Canadian
40 THE CANADIAN NURSE
nurses and teachers was carried out to
discover how their smoking habits com-
pare with those of other Canadians.
Fewer nurses and teachers smoke
Each provincial registered nurses' as-
sociation was invited to select every
thirtieth name from the mailing list,
beginning with the seventh name. All 10
provinces agreed to participate. A cover-
ing letter, questionnaire, and self-address-
ed envelope were sent to 3,557 nurses,
and 1,901 (53 percent) submitted com-
pleted questionnaires.
Each provincial teachers' association
was invited to select every 100th name
from its mailing list, beginning with the
seventh name. All provinces with the
exception of British Columbia agreed to
participate. The necessary materials were
sent to 1,227 teachers, and 792 (64
percent) submitted completed question-
naires.
The first question asked was, "Would
you classify yourself as a smoker, ex-
smoker, or nonsmoker? " The results as
shown in Table 1 were: 28.7 percent of
nurses and 29.2 percent of teachers
classified themselves as smokers; 14.9
percent of nurses and 12.2 percent of
teachers classified themselves as ex-
smokers; and 56.4 percent of nurses and
Dr. Phillips is Assistant Executive Director
(Statistics) at the National Cancer Institute of
Canada in Toronto.
58.6 percent of teachers were non-
smokers.
A study conducted by the Dominion
Bureau of Statistics for the Department
of National Health and Welfare revealed
that 35.6 percent of Canadian women
and 59.6 percent of Canadian men over
20 years of age smoke cigarettes. 2 It
would appear, therefore, that the pro-
portions of nurses and teachers who are
cigarette smokers are below that for
Canada.
Of the 545 nurses who classified them-
selves as smokers, 504 or 92.6 percent
reported smoking cigarettes regularly, and
257 (90.8 percent) of the 283 who
classified themselves as ex-smokers, said
that they used to smoke regularly.
Among teachers, 207 (89.6 percent) of
231 smokers smoked cigarettes regularly,
and 89 (91.8 percent) of the 97 ex-
smokers had done so.
Of nurses who smoked at one time,
34.2 percent had given up smoking, and
29.6 percent of teachers who smoked at
one time had given up the habit. As
shown in Table II, approximately one-
quarter of nurses and teachers have de-
creased their daily consumption. Offset-
ting this, however, is 24.7 percent of
teachers and 14.8 percent of nurses who
have increased their daily consumption.
More heavy smokers
Table III shows an analysis of th&
average number of cigarettes smoked pei
APRIL 196^
day and indicates that heavy smoking -
over 20 cigarettes per day — is more
common among nurses and teachers than
among the rest of the Canadian popu-
lation. Whereas 9.9 percent of Canadian
men and 4.3 percent of Canadian women
smoke more than 25 cigarettes daily, 30.3
percent of teachers and 31.7 percent of
nurses smoke more than 20 cigarettes per
day. 3
As shown in Table IV, a little more
than one-third of nurses and teachers gave
up smoking because of scientific evidence
that smoking is injurious to health; about
one out of eight nurses and one out of
five teachers gave up smoking to relieve
respiratory ailments; and about one out
of 12 nurses and teachers stopped
smoking because of illness.
Not setting example
This study of a random sample of
nurses and teachers in Canada revealed
that 28.7 percent of nurses and 29.2
percent of teachers smoke cigarettes. In
view of the mass of scientific evidence
relating cigarette smoking to cardio-
vascular and bronchopulmonary disease.
and the unique position of members of
these professions as examples to others, it
is difficult to understand why such high
proportions continue to smoke cigarettes.
The continuance of the habit indicates
that many are not fulfilling their roles as
models to their patients and students.
There is evidence also that heav\
cigarette smoking is more common
among both nurses and teachers than
among the general population. In the
present study, only 20.7 percent of
nurses who smoke and 21.6 percent ot
teachers who smoke consume fewer than
10 cigarettes daily; the Canadian study
showed that this figure is 27.8 percent for
the population at large. Conversely, 31.7
percent of nurses who smoke and 30.3
percent of teachers who smoke consume
over 20 cigarettes per day, compared to
7.8 percent in the Canadian study (based
on more than 25 cigarettes per day).
The study shows a decrease in ci-
garette smoking among both groups; 34.2
percent of nurses and 29.6 percent of
teachers who smoked cigarettes at some
time have stopped. Approximately 40
percent of the participants said that they
stopped smoking because of the scientific
evidence that cigarette smoking is hazard-
ous to health. However, about 22 percent
of nurses and 30 percent of teachers were
under some pressure to give up the habit,
as refiected by those who mentioned
relief from respiratory symptoms or
illness.
Although a proportion of nurses and
APRIL 1969
TABLE I
Classification of Nurses and Teachers
by Smoking History
TABLE III
Daily Cigarette Consumption
by Amount Smoked
1
t.
Nurses
Teachers
Canada
Smoking
History
1
No.
%
No.
%
Amount
Smoked
per Day
Nurses
7c
Teachers
%
Males Females
% %
' Smoker
Ex-smoke
Nonsmoker
545
283
1,073
28.7
14.9
56.4
231
97
464
29.2
12.2
58.6
Under 10
cigarettes
10-20
More than 20
No Data
20.7
31.9
31.7
15.7
21.6
34.2
30.3
13.9
21.8
68.3
9.9
37.9
*57.8
**4.3
Total
1,901
100.0
792
100.0
1
*11 - 25 cigarettes per day
**over 25 cigarettes per day
^^^^^^TABl^^^
^^1
^^^^tlassification of Smokers ^^^H
f by Change in Habit ^|
[' Nurses
Teachers
Change in Habit
No.
%■
No.
%
Decreased daily
consumption
156
28.5
58
25.1
Increased daily
consumption
81
14.8
57
24.7
No change
237
43.9
99
42.8
Data omitted
71
12.8
17
7.4
'Total
545
100.0
231
100.0
L»
teachers has given up cigarette smoking,
out of every three nurses and teachers
who still smoke, one smokes more than
20 cigarettes a day. It is clear that neither
of these professions can hope to influence
other Canadians to give up smoking.
References
1. Phillips, A.J. and Taylor, R.M. Smoking
habits of physicians in Canada. Canad. Med.
Assoc. J. 99:19:955-957, Nov. 16, 1968.
2. Canada. Department of National Health and
Welfare. Smoking habits of Canadians. Ot-
tawa, Queen's F^nter, 1964, p.l2.
3. Ibid., p. 14- 15. n
^^^
TABLE IV
Classification of Ex-Smokers
by Causative Factor
Nurses
Teachers
Causative
No.
%
No.
%
Factor
(a) BeHef in
scientific
evidence
112
39.6
37
38.1
(b) ReUef of
respiratory
symptoms
36
12.7
21
21.6
(c) Illness
25
8.8
8
8.2
Combination of
(a) and (b)
28
9.9
14
14.4
Combination of
(a) and (c)
3
1.0
4
4.3
Combination of
(b) and (c)
1
0.4
-
-
No data
78
27.6
13
13.4
Total
283
100.0
97
100.0
THE CANADIAN NURSE 41
Hemodialysis in the home
Artificial kidney treatment in the home offers a new lease on life to many
patients with chronic renal failure.
Sheila Wood, S.R.N., S.C.M.
For many patients with chronic renal
failure, use of the artificial kidney has
meant a definite prolongation of life.
Even so, this method of treatment is not
without its problems.
First, the cost of operating dialysis
units is prohibitive; second, a limited
number of beds are available for treating
these patients, even though there are now
many hospital-based dialysis centers; and
third, few trained staff are available to
operate these units. Fortunately, these
problems are being solved to a certain
extent by teaching the patient and at
least one member of his family to carry
out dialysis in the home.
Program al MCH
Such a program has been in effect at
The Montreal General Hospital since
August, 1966. We have 21 patients,
whose ages range from 14 to 62 years,
carrying out their own dialysis in their
homes. Four of these patients live in the
United States, and three in New Bruns-
wick; the remainder are Quebec residents.
The patient selected for home dialysis
is one who has a capable spouse, parent,
or other relative willing to undertake the
responsibility of working the machine.
Ideally, the patient should be in reason-
able health apart from the renal failure -
Miss Wood, a graduate of The Queen Elizabeth
School of Nursing, Birmingham, England, is on
the staff of the dialysis unit at The Montreal
General Hospital.
42 THE CANADIAN NURSE
although we have found that vascular
disease, such as angina, is not contraindi-
cated - be in his own home, preferably a
house, and have a job that he can retain
even after many absences; in other words,
he has to be a useful member of society.
After admission to the dialysis unit at
MGH, the patient has an arteriovenous
shunt (AV shunt) inserted. When possi-
ble, the shunt is inserted into the leg as
this gives the patient a greater degree of
independence when he begins and com-
pletes dialysis. He is in hospital for about
three weeks, during which time hemo-
dialysis is begun and a regular routine of
twice-weekly treatments established, to
give a total dialysis time of about 30
hours weekly.
The patient and his relative are taught
to take and record blood pressure and
temperature, to observe the shunt for
clotting, and to give catheter care. If the
patient is well enough at this time, he
then learns how to begin his dialysis. The
dietitian helps him to make the most of
his restricted diet, which usually allows
him 60 mg. of protein, 20 Gm. sodium,
and 60 mEq. potassium. Fluids are
restricted to 400 ml. daily, or free fluids
according to the urinary output.
As soon as the patient is mobile, he
and his relative come to the unit every
day except Sundays for about six weeks.
It must be remembered that few patients
or their relatives know anything about
medical matters, and learning to take and
APRIL 1969
record a blood pressure is a feat for them.
We are fortunate to have three registered
nurses among the wives of our patients,
and one patient is a doctor. The length of
time for patient teaching also depends on
the intelligence and confidence of the
people concerned.
Every aspect of patient care is taught,
from the sterile technique necessary for
beginning dialysis to the giving of blood
and saline into the venous drip chamber.
During the first two weeks, the patient
and his relative learn to prepare the tank
that contains the dialysate fluid, and to
build and sterilize the artificial kidney.
The relative observes the nurses on the
unit and how they deal with situations as
they arise.
At this stage, the patient is usually
beginning and ending dialysis himself.
Routine monitoring is then taught, and
the patient learns what to do when one of
the alarms rings. Emergencies, such as a
blood leak through the cuprophane
membrane or shock due to excessive
weight loss, are covered. Each section is
repeated as many times as necessary.
During the last two weeks, the patient
and his relative carry out the treatment in
a completely separate room located three
floors from the dialysis unit. This gives
them the feeling of being independent,
although they are still linked to the unit
by telephone and can call a nurse on the
unit, if necessary.
Before going home, the patient and his
APRIL 1969
relative are given a multiple-choice ques-
tion test; after they have successfully
passed this test, they return home,
accompanied by the nurse who has been
teaching them. She stays with them for
the first dialysis, after which they are on
their own unless they have any special
problems.
The patient keeps in touch with the
dialysis unit by telephone. He sends
specimens of serum, taken before and
after his weekly dialysis, to the unit,
along with dialysate fluid and whole
blood for hematocrit determination.
Analysis of these specimens is made at
the hospital, and any abnormality is
noted by the doctor, who immediately
calls the patient.
Every two months the patient returns
to the hospital and visits the renal clinic,
where he is examined. Here, he has an
opportunity to discuss any problem he
might have encountered during dialysis.
Patient histories
One of our youngest patients, CD., is
a 1 5-year-old boy with hereditary
nephritis, which resulted in chronic renal
failure. There was a strong family history
of the disease, so CD. was discovered
early and followed for several years. For
two years he was managed on a low
sodium diet, fluid restrictions, and drugs,
such as Amphojel, calcium, Apresoline
Hydrochloride, Aldomet and gua-
nethidine sulphate. He was usually hyper-
tensive (BP 160/100) but managed to feel
fairly well. CD. was followed carefully at
clinic; when his blood urea nitrogen
(BUN) reached 200 mg./lOO ml. and his
creatinine 20 mg./lOO ml., he was
brought into hospital for initiation of
hemodialysis. (Normal BUN: 10-20
mg./lOO ml.; normal creatinine level:
0.7-1.5 mg./100 ml.).
Peritoneal dialysis was done first for
57 hours, and this brought his BUN down
to 60 mg./lOO ml. and removed six
pounds of fluid. An AV shunt was in-
serted and hemodialysis begun. His
mother came to learn to run his artificial
kidney, and CD. lumself learned to
manage the equipment and begin and end
dialysis. He is now at home with his
dialysis equipment and managing well,
after a few initial problems concerning
the family's water supply. He goes to
school and is showing good progress.
Mrs. P.M., of Vermont, a 55-year-old
business woman, has chronic glomeru-
lonephritis. As her disease progressed, it
became necessary to begin hemodialysis.
Mrs. P.M. is a widow and lives with her
elderly, incapacitated mother. The
problem was, who would look after her
and stay with her while she was dialyz-
ed?
Fortunately, she has a daughter and a
daughter-in-law, both with young fam-
ilies, who arranged to learn together and
to take turns to help with Mrs. P.M.'s
dialysis. The three cooperated well and
learned quickly, so that after 10 weeks of
THE CANADIAN NURSE 43
Mr. L. on dialysis in his own home. Everything needed for his comfortis at hand: he can
sit and read, watch television, or sleep, safe in the knowledge that his alarm system will
warn him of any irregularity.
Home Dialysis Equipment. This complete unit shows: 1. the heparin pump; 2. the
dialyzer;3. the flow restrainer; 4. the venous pressure line; and 5. the control unit with
alarms.
traveling to and from Montreal twice a
week, they were ready to go home.
Mrs. P.M. has now been home for 16
months; her blood chemistry is well-
controlled by twice-weekly dialysis, she
works full time, and has only returned to
the unit on one occasion for dialysis.
Program successful
Home dialysis has proven very success-
ful; the rate of infection is virtually nil,
and problems over dialysis and equipment
are few. The patient likes to be at home
with his family, and, with a little intelli-
gent organization, there need be only a
small amount of disruption to the family
routine. The patient on home dialysis
does not have to worry about traveling to
and from the hospital, and persons who
would otherwise be too far from a dia-
lysis unit to make hospital dialysis prac-
tical, can benefit.
Each month a "Newsletter" is sent to
each patient with news and views from
the medical and nursing staff and from
the patients themselves. A favorite in-
clusion is salt-free recipes and a list of
restaurants that serve salt-free meals.
One major problem, the cost, is being
adequately met by some provincial
governments; however, patients in other
provinces have to rely on insurance,
kindly firms, or wealthy relatives.
The cost of the basic equipment is:
Tank, pump & control box $ 837.
Kiil dialyzer and stand $ 905.
Heparin pump $ 160.
Centrifuge $ 86.
Total $1,988.
The annual cost of thrice-weekly dia-
lysis in the home is $3,500, after an
initial cost of $2,500 for the basic equip-
ment and alterations in the home. This is
approximately one-quarter of the cost for
each patient on dialysis in hospital.
At present, the dialysis unit at The
Montreal General Hospital is the only
unit in Eastern Canada that has patients
receiving dialysis in the home. Similar
programs are being started in Ottawa and
Hamilton, Ontario, and in Vancouver,
British Columbia; there are, of course,
many hospitals that offer hemodialysis in
the hospital.
Home dialysis makes it possible to give
a new life to many more people than
would otherwise be possible. We believe it
is a practice that will increase rapidly in
the near future. D'
THE CANADIAN NURSE
APRIL 1969
idea
exchange
Communal
Dining
Patients in nursing homes or homes for
the aged frequently are apathetic about
feeding themselves, and this apathy
follows a set pattern. The indifference is
more pronounced where the resident eats
in his own bed. or alone at the bedside
from a tray, without social interaction.
He begins to toy with his food, eating less
and less. When this persists, the nurse
often gives help to provide a sufficient
caloric intake. This, of course, does not
improve the situation; the resident lacks
the appetite, or is too weak, or enjoys the
attention of the nurse too much to make
the effort. He now enters in the down-
ward spiral toward total dependency —
that of being fed.
Since this indifference to eating often
takes so much time, the nurse may resort
to minced or pureed food. The resident
has now reached a low ebb with the loss
of dignity and worth. This usually com-
pletes the picture of total regression.
The road back to self-feeding is a
difficult one, because pride and self-
esteem must first be restored. The indivi-
dual must be handled delicately, and with
tact. A habit has to be broken.
APRIL 1%9
The nurse begins by setting goals that
can be reached, so as not to discourage an
already indifferent person. Once the
patient starts to accept the change in
routine, he can be introduced to fellow
diners and the dining room.
In spite of careful introduction, some
residents are confused when they face the
change, but they do adjust under the
guidance of a helpful nurse. First at-
tempts at feeding can be just as painful as
they were long ago, but just as rewarding.
Residents slowly graduate to a higher
level, step by step. Plates are introduced
with minced, then solid food; later the
patient releams how to manage knife and
fork. Patience is required during the
releaming stage.
The indifference pertains to other
activities of daily living as well as eating.
Eating cannot be divorced from these
other activities because the whole picture
has to improve. One of our residents was
extremely reluctant to leave her room
and refused to eat in the dining room.
She was encouraged tactfully and pa-
tiently to try crafts. One day, six months
later, after a busy afternoon of work and
socializing, she demanded her right to eat
at the table with the rest of the ladies.
If possible, the dining area should be
subdivided into two or three smaller
areas. This can be achieved with shoul-
der-high, moveable screens or plant
dividers, or even just larger separations
between tables. The reason: eating habits
or the ability to manage utensils varies
among patients; some patients are ill at
ease in the presence of less able eaters.
It is a good idea to precede mealtimes
with brief entertainments, to set the
mood for sociability. At our hospital,
grace is said by a resident and a short
lesson is read. Low background music
also improves the atmosphere.
Mealtime should be a special event.
Tables must be attractively set, and a
gracious dining room atmosphere should
prevail. Much is gained by this step.
Results speak for themselves. In
August 1967, 30 percent of our patients
had to be fed by staff; in May 1968, only
14 percent needed to be fed; and in July
1968, only 11 percent. - Mrs. Vera
Mclver, Director of Hospital Services, St.
Mary's Priory Hospital, Victoria, B.C. D
THE CANADIAN NURSE 45
books
Countdown 1968. 151 pages. Ottawa,
Canadian Nurses' Association, 1968.
Reviewed by Mary L. Richmond, Di-
rector of Nursing, The Vancouver Gen-
eral Hospital, Vancouver. B. C.
"What happens to all the statistical
data I send the CNA each year about
myself and our agency? Does anyone
ever do anything with them? "
Yes! Their collection and orderly
arrangement in Countdown 1968 makes
very interesting and provocative reading.
It also provides a base for trend pre-
diction, which is fundamental to both
personal and agency planning.
How does your turnover rate compare
with that of other places in your pro-
vince? How does your province compare
with the rest of Canada? Is there a way
of estimating turnover rates that makes it
possible to compare one setting with
another? You will find answers to some
of these questions in Countdown 1968.
How does the percentage increase in
auxihary personnel compare with the
increase in registered nurses?
Compare your percentage of head
nurses having baccalaureate degrees with
that of other hospitals your size.
Also find out the answers to these
questions: Are we, as a country, progress-
ing far toward improving the educational
standing of our service and teaching
personnel? How many of our nursing
supervisors have academic degrees? How
do our salaries from province to province
compare among various categories of
nurses? Is there a place for male nurses in
Canada? How many are there?
Countdown 1968 is the sequel to
Countdown 1967 and is a publication of
the Canadian Nurses' Association. It is a
compilation of a great deal of statistical
information about nursing personnel in
Canada. Its 151 pages contain 133 tables
with well-worded headings; the contents
and text are evidence of the cooperation
between individuals and data-gathering
agencies.
There is little text, but a brief back-
ground note and an identification of
highlights and trends emerging from the
tables introduce each section.
While the tables have obviously been
prepared by a statistician, one need not
46 THE CANADIAN NURSE
be a statistician to understand and
appreciate them, or to have one's
curiosity aroused. The explicit titles and
headings of the tables, plus the brief
notes in the text, make the data meaning-
ful to both the nurse who is not a
statistician and the non-nurse. The back-
ground material explains our "universe of
professional discourse." This explanation
is essential both to the non-nurse and the
nurse not particularly familiar with the
vocabulary or the peculiarities of the
nursing world. For example, there is an
explanation of postbasic programs in
nursing and of educational programs for
nursing assistants.
The publication serves both as a source
book for locating specific data and as
thought-provoking reading - preferably
taken in not-too-large doses.
Countdown 1968 provides essential
data for those engaged in long-range
planning. For those who like to "wonder
why," it opens up vast areas of further
inquiry.
The real value of this publication will
derive from what we as a profession and
we as a nation do with it!
Read, wonder, and perhaps, with me,
thank our national office for providing
one more tool in helping to construct
health services for Canadians.
Textbook for Midwives, 6th ed.. by
Margaret F. Myles. 792 pages. Edin-
burgh & London, E. & S. Livingstone
Ltd., 1968. Canadian Agent: Macmil-
lan Co. of Canada, Toronto.
Reviewed by Molly Evans. Clinical
Instructor in Obstetrics, Royal Colum-
bian Hospital, New Westminster, B.C.
The 6th edition of Miss Myles' text-
book of midwifery is testimony to her
profound interest and sound knowledge
of the art and practice of all facets of
midwifery, and to her ability to teach.
This fascinating subject is presented
under eight headings and approached
from basic female anatomy, the physiolo-
gy of the reproductive cycle, the develop-
ment of the fertilized ovum, the placenta,
and fetus.
The major sections of pregnancy,
labor, and the puerperium are subdivided
from normal physiological changes to the
clinical application of such change for the
protection of the mother and baby. The
role of the midwife in caring for the
family is carefully elucidated; she prac-
tices only within the law and limit of the
Midwives Act. Therefore the normal sec-
tion of each subject is immediately
followed by deviations from the normal,
and the early recognition of such devia-
tions is emphasized.
The major asset of this text is the
presentation of the subject matter; it is
clear, concise, in logical sequence, and,
consequently, provides easy reference.
This new edition contains up-to-date
information on the "high risk" group of
mother and babies and the Saling method
of amnioscopy and fetal blood sampling
along with other research projects that
have been perfected in the past two years.
A suggested outline of an educational
program for parents in preparation for
parenthood is interesting. The first dis-
cussion group is to be held at six to eight
weeks gestation, subsequently at 20
weeks, and then each two weeks until 36
weeks gestation. Actual techniques of
preparation for labor are astutely sum-
marized as a wise precaution against
emphasis of "method" as opposed to
education as a basis for sound pre-
paration.
Illustrations and diagrams are ex-
cellent. Some photographs unfortunately
are sadly out of date and do little to
enhance the image of the midwife.
Canadian nurses working on the
obstetrical team would find the book an
excellent, if selective, reference.
Introduction to Human Embryology by
James Blake Thomas, Ph.D. 348 pages.
Philadelphia, Lea & Febiger, 1968.
Canadian agent: Macmillan Co. of
Canada Ltd., Toronto.
Reviewed by Carol L. Mc William,
Instructor, The University of New
Brunswick, Fredericton, N.B.
In this book, the author has met his
objective of "describing human prenatal
development within a broad frame of
reference." Using this as a criterion, the
book might be considered a success.
(Continued on page 48)
APRIL 1969
In Press Now - Ready Soon
The most widely used textbook of pediatric nursing in the United States — now thoroughly revised and
updated
Marlow: Textbook of Pediatric Nursing New 3rd Edition
As nursing instructors throughout the country know, Dr. Marlow's text is unex-
celled for its connprehensive treatment of the growth, development, and nursing
care needs of the sick and well child from birth through adolescence. For each
stage of development, Dr. Marlow discusses physical and emotional growth,
normal behavior patterns, health requirements, the functions of the nurse, con-
ditions requiring immediate, short term, or long term care and their nursing
requirements. Throughout the book, the author gives special attention to the
nurse's role in dealing with the emotional problems of the child patient and his
parents. This New (3rd) Edition maintains and even increases the all-around
excellence that has earned this text its position of leadership in the field.
By Dorothy R. Marlow, R.N., Ed.D., Deon ond Professor of Pediatric Nursing, College of Nursing,
Villanova University.
About 730 pages with about 350 illustrations. About $9.50 Just ready.
A new workbook that teaches as it tests your knowledge
Bleier: Workbook in Bedside Maternity Nursing
A new book by the author of the well known textbook of Maternity Nursing,
this workbook asks challenging questions that teach maternity nursing at the
same time that they evaluate learning. From the anatomy and physiology of
the reproductive organs. Miss Bleier proceeds in a logical order through units
on Development of the Baby, The Expectant Mother, Labor and Delivery, The
Puerperium, and Care of the Newborn. An unusual feature of this book is a
thorough treatment of contraception and family planning. The role of the
family is emphasized throughout and there is a valuable discussion of family
adjustments to the new baby. An Answer Key will be available to instructors.
By Inge J. Bleier, R.N., B.S., M.S., Maternal and Child Health Instructor, College of Nursing, University
of Illinois.
About 160 pages, illustrated. About $4.25 Just ready.
A well-known textbook for practical nurses, now revised and enlarged
Keane: Essentials of Nursing, A Medical-Surgical Text for Practical Nurses
New 2nd Edition
This clearly written, patient-centered textbook has been used in hundreds of
courses for practical nurses. It covers every aspect of medical and surgical
nursing, from the causes and symptoms of disease to the specific disorders of
each of the body systems. This new Second Edition is one-third larger than
the first, because it incorporates numerous suggestions from teachers and
students who used the first edition. Many new topics ore covered and there is
expanded coverage of many standard ones. To help moke learning swift and
sure, the author has added to each chapter a vocabulary list and an outline
summary. Throughout the text she has given new questions for study and
review, and she has provided a comprehensive glossary.
By Claire Brackman Keane, R.N., B.S., former Director, Athens (Go.) General Hospital School of
Practical Nursing.
About 500 pages with about 150 illustrations. About $8.25 Ready May.
W. B. SAUNDERS COMPANY Canada Ltd., 1835 Yonge Street, Toronto 7
please reserve my copies to be sent and billed when ready, of:
n AAarlow: Pediatric Nursing (about $9.50)
n Keane: Essentials of Nursing, 2nd Ed. (about $8.25)
n Bleier: Workbook of Maternity Nursing (about $4.25)
Zone:.
Province:
CN 4-69
APRIL 1969
THE CANADIAN NURSE 47
Next Month
in
The
Canadian
Nurse
• Unit Manager m Action
• Psychodrama
• Do Your Own Thing In Montreal
^^P
Photo credits for
April 1969
Julien LeBourdais, Toronto, p. 7
Photo Moderne, Quebec, p. 14
The Montreal General Hospital p. 44
Robin Clarke Photographer,
Victoria, B.C., p. 45
(Continued from page 46)
Dispensing with the classical approach to
the subject, he has included material on
the psychological impact of pregnancy on
the family, signs and symptoms of preg-
nancy, labor and delivery, physiological
adjustment of the fetus to the extra-uter-
ine world, and the puerperium. Repro-
duction, normal embryological and fetal
development, and abnormal development
are all discussed more extensively.
The writing style is clear and the
content well organized. Avoiding the
systemic approach, which tends to ignore
the fact that no organ or system develops
independently, the author has divided his
text into chapters outlining weekly, and,
later, monthly, development. These he
has consistently subdivided into sections
on external body form, body systems,
placenta and fetal membranes, and mater-
nal signs and symptoms. However, poor
placement of illustrations in sections
throughout the text makes it difficult to
follow these in conjunction with descrip-
tive content.
This book would best be used as a
reference text by nurse clinicians and
obstetric instructors who are already
familiar enough with the subject to dis-
pense with illustrative material. Its use as
a text for students of nursing will be
limited unless the illustrations are re-
arranged in future editions.
The CNA Librarian
would like to know of any library that
has sets of the following journals:
American Journal of Nursing, vol. 1 -
vol.40, 1901-1940.
Nursing Mirror, vol. 1 - vol. 91
1888-1950.
Also, anyone having sets of Amer. J.
Nurs. vol. 1 - vol. 68 that she wishes to
dispose of is requested to write:
Librarian, CNA Library, 50 The Drive-
way, Ottawa 4. It is requested that this
information be in list form and that the
issues should not be sent to the librarian
in advance.
48 THE CANADIAN NURSE
Psychiatric Nursing, 8th ed., by Margue-
rite Lucy Manfreda, R.N., M.A. 474
pages. Philadelphia, F.A. Davis Compa-
ny, 1968. Canadian agent: The
Ryerson Press, Toronto.
Reviewed by Agnes Herd, Associate
Director of Nursing Education, Moose
Jaw Union Hospital, Moose Jaw, Sask.
The 8th edition of this text continues
to reflect the author's belief that psychia-
tric nursing is both a specialty and an
integral part of all nursing. The primary
emphasis of the text is upon medical and
nursing aspects in a psychiatric treatment
center.
All the chapters have been updated to
include modern developments and trends
in social psychiatry. The chapters on
somatic therapies and therapy with tran-
quilizing and antidepressant drugs have
been completely rewritten. The chapters
on group nursing and social, recreational,
art, and music therapies would be helpful
to persons who are learning as well as
those who are interested in and responsi-
ble for expanding a social activity pro-
gram.
Chapters 13 through 18 deal with
basic fundamentals of nursing. This topic
is discussed more fully in any good
fundamentals of nursing text.
Fifteen of the 43 chapters are devoted
to behavior and nursing care of patients.
The title of each of these chapters combi-
nes classification terminology with the
most outstanding characteristic of the
individual disorder discussed, making it
possible to locate readily subject matter
in this area of the text.
The last two chapters provide a brief
summary of the prevailing attitudes
toward mental illness throughout the
history of civilization and the emergence
in America of the current emphasis on
preventive community psychiatry.
The references at the end of each
chapter are current and well-chosen, and
many of them are readily available.
The writing style tends to be didactic
and somewhat dogmatic. For this reason,
students in a basic nursing program might
not find this comprehensive text either
interesting or stimulating.
Determinants of The Nurse-Patient Rela-
tionship by Gertrud Ujhely. 271 pages.
New York, Springer Publishing Com-
pany, Inc., 1968.
Reviewed by Thelma MacLeod, Super-
visor, King's County Memorial Hospi-
tal, Montague, P.E.I.
This book deals with the many vari-
ables that affect the nurse-patient re-
lationship. It is easily read and compre-
hended by the practicing nurse. The
beginning nurse-student may find it
bewildering when reading it for the first
time, but will probably be able to refer to
it mentally when she encounters one of
the situations outlined.
Part 1 , "What the Nurse Brings to the
Relationship," effectively explores the
many facets of an individual's personali-
APRIL 1969
ty, values, professional and personal ex-
pectations and attitudes, and the conflicts
encountered when theory meets reahty in
the health field.
Part 2. "The Context Within Which
the Relationship Takes Place," is at times
heavy reading, but the author's examples
of actual cases help to keep the reader in
touch with the situation.
In the chapter entitled "Hospital and
Long-Term Institution." the patient's
problems and the nurse's problems are
considered. The nurse is remonstrated not
to feel too defeated or resigned when she
realizes that she cannot solve all patients'
problems. Some patients could neither
function without their problems nor do
they wish to have them solved.
The chapter entitled "The Patient's
Home" affords insight into what the visit-
ing nurse might encounter in a home.
Part 3, "Wliat the Patient Brings to the
Relationsliip," emphasizes that the pa-
tient, whether unconcious, blind, shy,
cantankerous, or overly pliable, should be
treated with the same regard for dignity,
compassion, and respect that one would
expect for oneself.
I thorouglily enjoyed reading this
book and would advocate its inclusion in
nursing schools and hospital hbraries as
an introduction for beginners to the
social aspects of nursing and as a compul-
sory review for working nurses who find
that their lamps are dimming and their
great expectations are somewhat jaded.
The Medical Secretary as a Word Tech-
nician by Anne Hadley. 260 pages.
Toronto, J.B. Lippincott Company,
1968.
Reviewed by Helen O'Connor. Medical
Secretary Course, Algonquin College
of Applied Arts and Technology,
School of Business, Ottawa, Canada.
The author has approached the subject
of medical terminology for the medical
secretary in a most unusual fashion. She
has departed from the customary review
of the systems and the related medical
terminology. Her book is based on a
series of actual case histories - consulta-
tions, physical examinations, and surgical
procedures.
Phonetic spelling has been used
throughout as an aid to pronunciation.
This could have been more effective if it
had been used only in a vocabulary
preview, or, as in the case of this book, in
a breakdown after each lesson, and not
included as part of each case history.
Simple, precise, nontechnical drawings
that illustrate the various explanations are
interesting and informative.
Definitions generally are simple, but
much time has been spent giving a break-
down of the origin of the various terms:
e.g., "anesthesia = no or not + feeling:
cyanosis: blue, a state of being (looking)
blue - finger nails or lips can be blue."
This appears to be an over-simplification
and might have been replaced by a
simple, straightforward definition of the
word.
Although there may have been a plan
for presentation of the material in its
present form, it is difficult to follow. The
subject has not been approached through
an explanation of a system of the body
nor on the basis of medical specialty, but
for the most part is a series of unrelated
case histories.
The author says that the book was
written to train the medical secretary.
However, this book seems to assume that
the girl being trained for this career
already has a basic knowledge of anatomy
and medical terminology. It might be of
value as a reference text for persons
employed as medical secretaries, who
possess a knowledge of medical terms.
Three thousand years of testing
by a highly qualified panel of experts
endorses the value of sugar in baby formulae
it's a controllable weight-builder and energy
source. It's easily digested, inexpensive, pure,
readily available and easy to use. In reason-
able quantities it is good for babies.
They have liked it for three thousand years
and still do. If you'd like to know more about
sugar send for an illustrated copy of our
brochure, "The Story of Sugar":
Canadian Sugar Institute
408 Canada Cement Building, Phillips Square, Montreal, P.O.
APRIL 1969
THE CANADIAN NURSE 49
accession list
Publications on this list have been re-
ceived recently in the CNA library and are
listed in language of source.
Material on this list, except Reference
items, which include theses and archive
books that do nol circulate, may be bor-
rowed by CNA members, schools of nurs-
ing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List" and
should be addressed to: The Library, Cana-
dian Nurses' Association, 50 The Drive-
way, Ottawa 4, Ontario.
No more than three titles should be re-
quested at any one time. If additional titles
are desired, these may be requested when
you return your loan.
BOOKS AND DOCUMENTS
1. Album-aimuaire. 1968. Grenoble, Fran-
ce, Maisons d'enfants et d'alolescents de Fran-
ce, 1968. 309p.
2. Atlas international Larousse politique et
economique. Paris, Librairie Larousse, 1965.
45p. R
3. Australasian hospital, directory, and
nurses' year hook. 1968/1969, Sydney, N.S.W.
Nurses' Association, 1968. 192p. R
4. Cadet nurse of the White Cross by
Marguerite Lees. London, Max Parrish, c.1962.
143p.
5. Canadian Almanac <& directory for 1969.
Vancouver, Copp Clark, 1969. 881p. R
6. Canadian Nurses' Association Biennial
Convention, July 8-12. 1968. Saskatoon, Sask.
Special interest sessions, Ottawa, Canadian
Nurses' Association, 1968. 140p.
7. Code for safety to life from fire in
buildings and structures. Twentieth edition.
Boston, National Fire Protection Association,
1966. 208p.
8. Collective bargaining: the power to des-
troy: new and better ways to industrial peace
by Merryle Stanley Rukeyser. New York, Dela-
corte, C.I 968. 220p.
9. Compendium des produits et specialites
pharmaceutiques (Canada) 1968. Toronto,
L'Association Pharmaceutiquc canadienne,
1968. 580p. R
10. Countdown: Canadian nursing statistics
1968. Ottawa, Canadian Nurses' Association,
1968. I5Ip.
11. Dictionnaire de statistique par E.
Morice avec la collaboration de M. Bertrand.
Paris, Dunod.cI967. I96p.
1 2. Extending the boundaries of nursing
education; the preparation and role of the nurse
scientist: papers presented at the second con-
ference of the Council of Baccalaureate and
Higher Degree Programs, Cleveland, Ohio,
March 27-29, 1968. New York, National
League for Nursing. Dept. of Baccalaureate and
Higher Degree Programs, 1968. 64p.
13. Health services administration: policy
cases and the case method, edited by Roy
Penchansky. Cambridge, Harvard Univ.. 1968.
460p.
14. Hospital libraries and work with the
disabled, edited by Mona E. Going. London,
Library Association, 1963. I98p.
15. Hospital safety and sanitation with
special reference to patient safety: proceedings
of an Institute on Hospital Safety and Sani-
tation, Feb. 15 and 16, 1962. Ann Arbor, Mich.
Univ. of Michigan, School of Public Health;
distributed by Continued Education Service,
C1962. 208p.
16. The human side of enterprise by
Douglas McGregor. New York, McGraw-Hill.
1960. 246p.
17. Hygiene, sante et bien-etre par Fran-
^oise Savard. Rev.ed. Montreal, Editions du
Renouveau pedagogique, cl968. 255p.
18. RN hospital school survey, 1968. Ora-
dcU, N.J., RN magazine, 1968. 46p.
19. Report of the Kellogg Foundation,
1968. Battle Creek, Mich., 1968. I28p.
20. Improving employee-management com-
munication in hospitals: a special study in
management practices and problems. New
York, United Hospital Fund of New York,
I965.lv. (various paging).
21. Marital breakdown by Jack Dominian.
Middlesex, England, Penguin Books, cl968.
I72p.
22. Memoirs of a bird in a gilded cage by
Judy LaMarsh. Toronto, McClelland and Ste-
wart, cI968. 367p.
HAMILTON CIVIC HOSPITALS
operating the
HAMILTON GENERAL HOSPITAL HENDERSON GENERAL HOSPITAL
with 650 beds, Medical, Surgical
and Paediatric.
with 1000 beds. Medical, Surgical
and Obstetric.
Require Registered Nurses or nurses eligible for registration in Ontario.
Excellent wages, working conditions and benefit programme.
Employee-run ski and golf clubs.
Our two hospitals have excellent facilities, are fully accredited, and
are affiliated with McMaster University.
Please submit applications to:
Personnel Department
HAMILTON CIVIC HOSPITALS
296 Victoria Ave. N.
Hamilton, Ontario
50 THE CANADIAN NURSE
APRIL 1%9
accession list
23. Monographs in the management library,
edited by David S. Brown. Washington, Leader-
ship Resources, 1968.lv. (various paging).
24. Nurse career - pattern study pt. I
practical nursing programs by Barbara L. Tate
and Lucille Knopf. New York, National League
for Nursing, 1968. 182p.
25. Nurse's guide to common surgical
operations by R. Gordon Cooke. London,
Faber, 1967. 71 p.
26. Principles of hospital plamiing, edited
by Robert Jefford, London, Pitman Medical,
1967. 83p.
27. Repertoire de vedettes - matiere.
Quebec, P.Q., Universite Laval. Bibliotheque,
1968. 1458p.
28. Secourisme de la Croix Rouge. 1st ed.
Toronto. La Societe Canadienne de la Croi.x-
Rouge, 1968. 91p.
29. Select bibliography in higher education.
A quarterly list. July to September 1968,
October to December 1968, Ottawa, Associa-
tion of Universities and Colleges of Canada,
1968. 2v.
30. Statesman's year-book; statistical and
historical annual of the states of the world for
the year, 1968-69. London, MacMillian, 1968.
1727p. R
31. Techniques of analyzing a professional
service department. New York, United Hospital
Fund of New York, 1966. 49p.
PAMPHLETS
32. Care of the aged at home by Anne
Jordheim. Wisconsin, University of Wisconsin,
1966. 41p.
33. Community health care in a technically
advanced society by Thomas McKeown. New
York, American Nurses' Association, cl968.
20p.
34. Continuing education for nursing;
tools and techniques. New York, American
Nurses' Association, 1968. 32p.
35. Extending campus resources: guide to
using and selecting clinical facilities for health
technology programs. Washington, American
Association of Junior Colleges, 1968. 28p.
36. Guide to the syllabus of subjects for
examination for the certificate of general nurs-
ing. London, General Nursing Council for En-
gland and Wales, London, 1962. 14p.
37. Guidelines for establishment of an em-
ployee grievance procedure. Chicago, American
Hospital Association, cl968. 8p.
38. Influencing nursing practice in changing
hospital settings by Anna T. Baziak. New York,
American Nurses' Association, 1968. 9p.
39. Knock before entering personal space
bubbles by Myra E. Levine. New York, Ameri-
can Nurses' Association, 1968. 2pts in 1.
(Excerpted from Bulletin Chart vol. 65, no.3,
March 1968).
40. Nursing and long-term carejthe research
program of the American Nurses' Foundation
by Eleanor C. Lambertsen. New York, Ameri-
can Nurses' Association, cl968. 16p.
41. Paid vacations and how they are grant-
ed by Pascal Ingenito. Ottawa, 1968. 26p.
42. Proposal for a uniform plan for hospital
statistics by Florence Nightingale, London, Her
Majesty's Stationery Office, 1860. p.63-71.
(Reprint from Programme of the Fourth Ses-
sion of the International Statistical Congress to
be held in London on July 16, 1860.) R
43. Report submitted to the Minister of
Health, 1967/68. London, General Nursing
Council for England and Wales, 1968. 54p.
44. Research and experimentation in the
delivery of nursing services. New York, Ameri-
can Nurses" Association, cl968. 36p.
45. Syllabus of subjects for examination for
the certificate of general nursing. London,
General Nursing Council for England & Wales.
London, 1962, reprinted 1967. 12p.
GOVERNMENT DOCUMENTS
Canada
46. Annuaire du Canada; ressources, histoi-
re, institutions et situation economique et
sociale du Canada par Bureau federal de la
statistique. Division de I'annuaire du Canada, et
de la Bibliotheque, 1968. Ottawa, Imprimeur
delaReine, 1968. 1393p. R
47. Bureau of Statistics. Annual report of
notifiable diseases. Ottawa, Queen's Printer,
JEWISH
GENERAL HOSPITAL
MONTREAL, QUEBEC
A modern 650-bed non-sectarian hospital with a School of Nursing. Planned Orientation Programme.
In-Service Education Programme. Excellent personnel policies. Bursaries for post-basic courses in Teaching
and Administration.
Interested in applications for all services: Supervisors, Head Nurses, Assistant Head Nurses, General Staff
Nurses, Certified Nursing Assistants.
For further information, please write:
DIRECTOR, NURSING SERVICE
JEWISH GENERAL HOSPITAL
3755 COTE ST. CATHERINE ROAD
MONTREAL, QUEBEC
APRIL 1969
THE CANADIAN NURSE 51
accession list
1968. 43 pages.
48. Bureau of Statistics. Labour Division.
Benefit periods established and terminated
under the unemployment insurance act.
Report. 1967. Ottawa, Queen's Printer, 1968.
51p.
49. . Estimates of families in Can-
ada, 1967. Ottawa, Queen's Printer, 1968.
50. . Hospital statistics: v. 4 balance
sheets, 1966. Ottawa, Queen's Printer, 1968.
51p.
51. . Hospital statistics; V. 6 hospita]
expenditures, 1966. Ottawa, Queen's Printer,
1968. 89p.
52. . Hospital statistics; V. 7 hospital
indicators, 1966. Ottawa, Queen's Printer,
1968. I54p.
53. . Mental health statistics, 1965;
V.2 patients in institutions. Ottawa, Queen's
Printer, November 1968. 527p.
54. — . Survey of vocational educa-
tion and training, 1965-1966. Ottawa, Queen's
Printer, 1968. 88p.
55. Dept. of Labour. Women in the public
service; their utilization and employment by.
Stanislaw Judek. Ottawa, Queen's Printer,
1968. 142p.
56. Dept. of National Health and Welfare.
Characteristics of the population covered under
the guaranteed income supplement of the old
age security program Canada. 1961. Ottawa,
1968. 14p. (Research and Statistics memo).
57. . Reference reading list on
nutrition an annotated bibliography on nu-
trition, food and related subjects. Ottawa,
1968. 64p.
58. . Report on cigarette smoking
and health; presented to the Health, Welfare
and Social Affairs Committee of the House of
Commons by the Honourable John Munroe,
Minister, Department of National Health and
Welfare on December 19, 1968. Iv. (various
paging).
Quebec
59. Office du Film. Catalogue permanent
des films distribues par I'office du film du
Quebec, 1968. Iv. (loose-leaO.
U.S.A.
60. Dept. of Labor. Report of a Consulta-
tion on Working Women and Day Care Needs,
Washington, June 1, 1967. Washington, 1968.
86p.
61. U.S. National Center for Health Statis-
ics. Migration, vital and health statistics; a
report of the United States National Committee
on Vital and Health Statistics. Washington, U.S.
Public Health Service, 1968. 17p.
62. U.S. National Center for Health Statis-
tics. Physician visits. Washington, U.S. Public
Health Service, 1968. 60p.
63. . Selected impairments. Wash-
ington, U.S. Public Health Service, 1968. 78 p.
64. . Variations in birth weight.
Washington, U.S. Public Health Service, 1968
35p.
STUDIES DEPOSITED IN
CNA REPOSITORY COLLECTION
65. Approach to the phases of nurse-patient
relationships by Marjorie A. WaUington.
66. Census of nursing personnel employed
for public health work in Ontario by position
and highest academic qualification on Novem-
ber 30, 1966. Toronto, Dept. of Health, 1968.
57p. (principal investigator: Isabel Black). R
67. Etude documentaire des besoins de la
mere et des membres de la famille durant le
cycle maternel par Sister Rachel Rousseau.
Montreal, 1968. 108p. Thesis (M.Nurs.) -
Montreal. R
68. Non-professional male worker as a part
of the patient care team by S. Arthur H. Craig.
Toronto, 1967. Ann Arbor, University Micro-
films 1968. 62p. Thesis - Toronto. R
69. Study of the routine taking of tem-
perature, pulse and respirations on hospitalized
patients by Pamela E. Poole. Ottawa, Dept. of
National Health and Welfare, 1968. 21p. R
70. Study to compare the nursing care
given by professionally and technically pre-
pared nurses on a medical unit by Betty Louise
Sellers. Washington, 1968. 59p. Thesis (M.N.) -
Washington. R
7 1 . Survey of graduates of the University of
Toronto baccalaureate course in nursing by
Nora I. Parker. Toronto, School of Nursing,
University of Toronto, 1968. 66p. R Q
Alitalia gives you
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52 THE CANADIAN NURSE
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ASSOCIATION LIBRARY
Send this coupon or facsimile to:
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50 The Driveway, Ottawa 4, Ontario.
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APRIL 1%9
May 1969
t*RS M ^'ELLCN
2368 MCNRCE AVE
OTTAKA 5 ONT 00511096
The
Canadian
Nurs^.
&
.O r>X
■-v*V
iVil^^
psychodrama in action
too little, for too long,
from federal government
do your own thing
in Montreal
^^^f-n^clmi^q uou^ to ^tau a^btea^t
'T aJi\
vance^ i^ titc
axcal ^cu^ce—
Sutton: BEDSIDE NURSING TECHNIQUES
IN MEDICINE AND SURGERY New 2nd Edition
By Audrey Latshaw Sutton, R.N., formerly of Edgewood General
Hospital, Berlin, N.J., and Wilmington (Del.) General Hospital.
Used by more than 80,000 nurses, "Sutton" is one
of the most widely used books of its type ever pub-
lished. The new, revised Second Edition, just ready,
is a completely up-to-date source book of clinical
nursing procedures. In clear, simple language sup-
plemented by more than 850 drawings, the author
tells precisely how to perform hundreds of nursing
functions — from intramuscular injection to care of
the patient in hyperbaric oxygen therapy. You'll find
new data on such topics as: reverse isolation. IPPB
respirators, hypodermoclysis, tubeless gastric anal-
ysis, heart transplants, and fluid and electrolyte
balance.
398 pages with about 870 illustrations. About $8.95
Just ready.
DORLAND'S POCKET MEDICAL DICTIONARY
21st Edition
This pocket-size reference has proved its value to
generations of nurses. Now in its 21st edition, it gives
the correct spelling, pronunciation, and meaning of
more than 40,000 terms in the medical arts — hun-
dreds of them found in no other pocket dictionary.
More than 7,000 words are new in this edition, many
of them from such rapidly expanding fields as psychi-
atry, pharmacology, and genetics. Convenient tables
list arteries, bones, muscles, nerves, and veins with
the latest nomenclature, and there ore 16 pages of
anatomical plates in full color.
699 pages, plus color plates. $6.25. Published April 1968.
The NURSING CLINICS of North America
The Nursing Clinics fill an urgent need by providing
a single, continuing source of information on the
latest nursing concepts and techniques. The forth-
comirrg June issue carries two important symposia:
"Neurologic and Neurosurgical Nursing," with Imo-
gene M. King, R.N., as Guest Editor, and "The Nurse
in the Community," with Leah Hoenig, R.N., as Guest
Editor. You'll find 17 articles, each by a recognized
authority. Such coverage is typical of the Nursing
Clinics; each issue contains about 175 pages, with no
advertising, bound between hard covers for permanent
reference use.
By annual subscription (4 issues) only. $13.
Student rote $10.80.
Frobisher, Sommermeyer & Fuerst:
MICROBIOLOGY IN HEALTH AND DISEASE
New 12th Edition
By Martin Frobisher, Sc.D., formerly of USPHS, Johns Hopkins Univ.,
Emory Univ. and the Univ. of Georgia; Lucille Sommermeyer, R.N.,
Ed.M., and Robert Fuerst, Ph.D., both of Texas Woman's Univ.
This up-to-the minute text for all in the health pro-
fessions emphasizes biochemical processes in micro-
bial physiology and the technical and clinical aspects
of microbiology. It uses the latest terminology and
classifications, and gives the student a firm under-
standing of microbiology in relation to patient care.
An accompanying Laboratory Manual gives exercises
coordinated with the text.
549 pages with about 180 illustrations. About $9.45.
Just ready.
Lab Manual: 178 pages, illustrated. $4.60.
Published February 1969.
W. B. SAUNDERS COMPANY Canada Ltd., 1835 Yonge Street, Toronto 7
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CN 5-69t
nmimiiiiiN ID OMESS
Only one month to go to the
INTERNATIONAL COUNCIL OF NURSES'
14th OUADRENNIAL CONGRESS
Place Bonaventure, Montreal, Canada,
22 to 28 June, 1969.
PROGRAM HIGHLIGHTS:
Sunday, 22 June
3.00 p.m. Interfaith Service
8.00 p.m. Opening Ceremony
Monday and Tuesday, 23 and 24 June
Open meeting of Council of National
Representatives (CNR)
Wednesday, 25 June
"Focus on the Future"
a.m. Plenary session —
Forecasting the Future
p.m. Plenary session -
Implications of Change
Thursday, 26 June
"Focus on the Future"
a.m. Plenary session —
Education for Today and To-
morrow. Basic Programs
p.m. Plenary session —
Education for Today and To-
morrow. Post Basic and Post-
graduate Programs
5.00 p.m. Voting for ICN Officers by
CNR
8.00 p.m. Students' Congress
Friday, 27 June
"Focus on the Future"
a.m. Plenary session —
Security for Tomorrow
p.m. Plenary session —
Leadership in Action
8.00 p.m. Closing Ceremony
Admission of new member
associations to ICN
New ICN Officers
announced
Saturday, 28 June
Canada Hospitality Day.
N.B. * Special Interest Sessions - 19 topics in English and French, will be
running Monday through Friday
International Nursing Exhibition — runs Monday through Wednesday
FOR FURTHER IN FORM A TION, INCLUDING REGISTRATION
KITS, PLEASE WRITE TO:
ICN Congress Registration,
50, The Driveway,
Ottawa 4, Ontario.
MAY 1969
N.B. -Daily registration fee at Congress now S 10.00
THE CANADIAN NURSE 1
FUNDAMENTALS
of
NURSING
The Humanities
and
The Sciences in Nursing
Extensively revised and expanded, the Fourth Edition
reflects greatly increased emphasis upon the independent
functions implicit in the nursing role.
Highlighted are nursing responsibilities that include
care of man as a human being
as well as a biological organism.
The nursing process is analyzed as a scientific discipline
involving definition of nursing problems,
use of the problem-solving approach,
and formulation of care plans based on priorities of needs.
Extensive reorganization has been effected for
increased logic and appropriateness for modern curricula.
Instructors will find that this edition
allows maximum flexibility in teaching.
Elinor V. fuerst, R.N., M.A. and LuVerne Vl/olff, R.N., M.A.
671 Pages • 170 Illustrations • 4th Edition, 1969
About S8.25
Lippincott
PHILADELPHIA • TORONTO
2 THE CANADIAN NURSE
MAY 196!"
The
Canadian
Nurse
&
^^p
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 5
May 1%9
29 Too Little, For Too Long, From Federal Government S.R. Good
31 Do Your Own Thing in Montreal V. Foumier and A. Legault
36 Nurses For Nursing H. Palmer
40 Cytology Screening — A Program That Works M.A. MacLean
44 Psychodrama D.M. Burwell
47 The Amputee and Immediate Prosthesis .. M. Shewchuk and Z. Young
50 Medication Errors Can Be Prevented S Thomas
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
9 News
18 Names
22 Dates
24 New Products
25 In a Capsule
52 Research Abstracts
54 Books
60 Accession List
88 Index to Advertisers
Executive Director: Helen K. MussaUem •
Editor: Virginia A. Lindabun • Assistant
Editor: Eleanor B. Mitchell • Editorial Assist-
ant: Carol A. Kodarsky • Circulation Man-
ager: Ber>l Darling • Advertising Manager:
Ruth H. Baumel • Subscription Rates: Can-
ada: One Year, $4.50; two years, $8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies; 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Six weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
* Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on white paper)
are welcomed with such articles. The editor
is not committed to publish all articles
sent, nor to indicate definite dates of
publication.
Postage paid in cash at third class rate
MONTREAL, P.Q. Permit No. 10,001.
50 The Driveway, Ottawa 4, Ontario.
MAY 1%9
Message From
The Executive Director
The most. significant happening of the
century in diploma nursing education is
taking place today: of the 209 diploma
schools of nursing programs. 26 are now
in educational institutions within the
post-secondary educational system. Last
year 1,901 students were admitted to
these programs, representing 19.3 percent,
or about one-fifth, of the total
admissions. Five years ago there were
none. Ten years ago, though the literature
of three decades documented the need,
the dawn of change was not yet on the
horizon.
How and why did it happen? This
happening is the saga of a few committed
to the belief that only through improved
nursing education could nurses be
prepared to function in health care
systems of foreseeable complexity. These
innovators knew that nursing preparation
should embrace a broad, general educa-
tional experience. They knew that exper-
ience should develop creativity and
adaptability for practice in an expanding
spectrum of health services. They knew
that their goal was a difficult one that
would often be obstructed by the champ-
ions of specializations.
This movement has begun in five
provinces. Others will follow, finding
it is difficult to justify a system of
nursing education suited to an era already
past, or rapidly passing. Many hurdles
remain to be taken by those with the
prowess to clear them and to join the
vanguard of reform in diploma nursing
education.
The graduates of these new diploma
programs, working in concert with the
graduates of university schools of
nursing, will use their knowledge and
skills to contribute to a higher standard
of nursing care on the health teams of
Canada. Helen K. Mussallem.
THE CANADIAN NURSE 3
letters
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Error
I would like to bring to your attention
a mistake that was made in the February
1969 issue of The Canadian Nurse. In the
article "Clinical Laboratory Procedures,"
page 46, 1 found the following statement:
CO2 is "increased in alkolis (respira-
tory obstruction, vomiting, ingestion
of bicarbonate); decreased in acidosis
(diabetes, over breathing, etc.)."
Respiratory obstruction should be an
example for acidosis of respiratory origin
where the CO2 is increased. On the other
hand, over breathing (hyperventilation)
will bring about alkalosis of respiratory
origin where the CO2 is decreased. There-
fore 1 suggest that the above quoted
statement should be corrected and the
reference concerning acidosis and alkalo-
sis should be divided since the CO2
behaves differently in respiratory and
metabolic acidosis and alkalosis. In fact
the total CO2 content in the plasma
increases in the case of respiratory acido-
sis and metabolic alkalosis and decreases
in the case of respiratory alkalosis and
metabolic acidosis. - Zoltan Lipcsey,
RITT(C), Charge Inhalation Therapist,
Ottawa General Hospital.
Mr. Lipcsey is correct. See "erratum" at
bottom of this page. - Editor.
Caps and uniforms
In her letter to the editor in the
December 1968 issue. Dr. Black gives the
impression that a nurse must wear a
uniform to be a nurse. We disagree.
What is a nurse? Is a nurse a uniform'.'
What is the purpose of a uniform? We
feel that a nurse should choose her
clothing according to her working situa-
tion.
Does a uniform give a nurse a sense of
authority? Is this "sense of authority" a
feature of a good patient-nurse relation-
ship? We think not. We think the basis of
a good nurse-patient relationship is em-
pathy, not authority.
By wearing a white starched uniform,
the nurse does not necessarily assure the
patient of the necessary standards of
hospital cleanliness. By a poor technique
she may have contaminated her white
uniform with a multitude of invisible
microorganisms.
We do not agree that "a uniform can
transfigure a woman who looks ordinary
or even dowdy in civilian clothes into a
handsome, imposing person." First, a
woman does not become "handsome"
4 THE CANADIAN NURSE
just by wearing a white uniform. Second,
we feel that an "imposing" nurse is an
unapproachable nurse.
Next, we do not agree that "nurses
[are] discarding their uniform because
they fear they will be degraded by cur-
rent methods of improving working con-
ditions and salaries, i.e., threats of strikes
and demands for arbitration, which the
newspapers so delight in reporting." Nor
do we believe that the intelligent youth
of today choose a profession by its
uniform. If they do, they do not know
what a profession is. We do not see the
relationship between the ritual of a
"thrilling capping ceremony" and "tan-
gible appreciation for endeavors."
Dr. Black was unable to identify a
nurse in the nursing administration area
because no one wore a uniform. We
believe that knowledge and skill identify
a nurse - not a uniform. - Wilda
Michaluk, Eileen Ateah, Dianne Coutts,
Sharon Bateman, RNs, Winnipeg, Man.
British Health Service
I was particularly interested, as an
English hospital administrator now work-
ing at The Hospital For Sick Children in
Toronto, to read the book review of A
Unified Health Service in the February
edition of your magazine.
Your reviewer fell into a common trap
when considering the British National
Health Service, of failing to perceive
anything beyond an apparently im-
possibly complex bureaucratic adminis-
trative organization. Admittedly, this can
be much improved, and it is to be hoped
that some structural change will follow
the report of a recent government paper.
The failure is in the absence of any
acknowledgement of the comprehen-
siveness of the medical and nursing care
available to patients. - D.J. Knowles,
Toronto, Ont.
Erratum
An error was made in the "Clinical
Laboratory Procedures" article in the
February 1969 issue. On page 46, the
information given under the heading
"clinical significance" for carbon
dioxide should read:
"CO2 is increased in respiratory aci-
dosis (respiratory obstruction) and in
metabolic alkalosis (ingestion of
bicarbonate, vomiting); decreased in
respiratory alkalosis (over breathing)
and in metabolic acidosis (diabetes)."
Two-year program
I am writing about the article in the
February issue concerning the two-year
program versus the three-year program.
I was disappointed to see that you
failed to mention the two-year programs
that are in progress in Ontario. I ami
thinking of the program at the Nightin-
gale School of Nursing in Toronto, intro-
duced in 1960.
The comparison in this article, which
involved the Grey Nuns' School, did not
make clear that both programs were in
progress at the same hospital and that, in
fact, the school was changing from a
three-year to a two-year program. I felt
this article was trying hard to find fault
with the two-year program.
I am a graduate of the Nightingale-
School of Nursing's two-year program,
and in no way feel less capable than my
three-year counterparts. I received a wide
variety of experience, with a good
academic background. We learned to
adapt quickly to new settings since we
went to several different hospitals during
our training. We also learned that when
we encountered new nursing situations
there were always books to consult. You
can learn anything, as long as you kno\w
the principle behind it.
We have graduates in every field of
nursing. Most of them are doing well. It is
true that some graduates are not up td
par - but we are dealing with human
beings.
I am sorry you allowed such a narrow-
minded article to be published. Oui
magazine should be used to enlighten
nurses. - Ann Gregg, R.N., Winnipeg
Man.
We, the faculty of St. Joseph's Schoo;
of Nursing, Toronto, strongly questior
the conclusions set forth in the article
"Two-Year Versus Three-Year Programs'
(February 1969). In many instances th&
conclusions set forth by the authors are
either not substantiated by factual evi,
dence or appear to be in direct opposition
to the evidence.
When rated in the simulated nursinjj
situations, the differences in favor of the
control students were significant in onl>'
one out of three situations; this does no>
warrant the authors' conclusions (p. 64
that the control students "showed mort
of the expected behaviors and performec
them more quickly in a simulated nursinj
situation."
In the State Board examinations, onl)
MAY 196
the difference in child nursing was signif-
icant in favor of the control students. In
the school of nursing examinations, only
the obstetric and psychiatric nursing re-
sults were significant in favor of the
control students; of these, only the ob-
stetric nursing results appear to be signif-
icant, since all control students did not
write the psychiatric nursing examina-
tion. In the National League of Nursing
examinations, none of the differences in
results were statistically significant. Yet
the authors state, "In the three written
examinations. . . the control students did
better than the experimental students."
When an instrument is reliable, differ-
ent raters should be able to use the
instrument with the same subjects and
obtain similar results. Since, in this study,
the outside raters did not agree, we
question the reliability of both the instru-
ment and the raters.
We question the validity of results that
are based on different numbers of partici-
pants in the study, e.g. ". . . some of the
comparisons between the experimental
and the control group are made on only
24 pairs, rather than 40 pairs, of stu-
dents" (p.63).
The lists of critical incidents by which
the nurses were evaluated at 3 and 12
months following graduation were not
identical in length; we therefore query
the validity of this, as well as the criteria
by which it was determined to eliminate
certain critical incidents.
Our concern over this report is height-
ened by the fact that St. Joseph's School
of Nursing has a two-year program and
that this report does not present an
accurate picture of the differences be-
tween students in two- and three-year
programs.
We question the authors' statements
that this study was carried out in a
"systematic and objective" manner. Ac-
curate analyses of the data do not provide
the "conclusive evidence" claimed by the
authors.
Because this report was published in
The Canadian Nurse, many nurses will
read the article and, without delving into
it too deeply, will assume this was a valid
study; in spite of the authors' cautions,
decisions will be made about two-year
programs on the basis of the results of
this study. Therefore, we strongly urge
The Canadian Nurse to peruse research
articles with greater care in the future,
with a view to publishing only accurate
interpretations of data. - (Mrs.) Olga E.
Chapchuk, R.N., B.Sc.N., First Year
Teacher.
It was with pleasure that I began to
read the report of the study of graduates
lof the two- and three-year nursing pro-
(grams at Regina Grey Nuns' Hospital
KFebruary, 1969). By the time I had
^finished reading it, however, my pleasure
MAY 1%9
had turned to disappointment and dis-
may.
In the first place, in spite of the
authors' confidence in the power of
statistical procedures to offset the unreli-
ability of small samples, 24 pairs of
subjects seems a very small number from
which to obtain "conclusive evidence."
That the two outside raters differed from
one another "to quite an extent" makes
one wonder how much error variance,
attributable to individual differences or
idiosyncrasies between raters, was intro-
duced. This, coupled with the extremely
difficult task of providing similar ward
experience for all subjects, certainly made
testing conditions far from ideal.
It was surprising to note that the
researchers used a simulated nursing situa-
tion as a criterion of effective nursing; the
validity of such an artificial situation
could well be questioned. Hence, the
methodological faults of this study may
be at least as serious as some of those
cited in the authors' review of previous
evaluative research on two-year programs.
The most glaring weakness of the
report is the manner in which the authors
interpreted their findings. In reporting
the results of ward performance ratings,
the authors noted that the difference in
favor of control students was significant
(i.e., greater than that which could have
occurred by chance) for one of the raters.
Does this mean that the difference for the
other rater was non-significant (i.e. that
there was no real difference)! If such is
the case, the evidence is hardly conclu-
sive. That there was no difference be-
tween groups on intermediate tasks in the
simulated nursing situations casts doubt
on the overall superiority of three-year
students. One could query the impor-
tance of speed in this setting.
The authors reported real (significant)
differences between groups on only one
State Board Examination and only two
school of nursing examinations. Is this
what the authors call conclusive evidence
of the superiority of three-year students?
The report states that three months
after graduation, there were no significant
differences between two- and three-year
graduates on seven out of ten aspects of
nursing performance; again, such findings
are hardly conclusive of control group
superiority. Although the details on the
12-month evaluations are obscure, the
authors claim significant differences in
favor of three-year graduates.
It is amazing that the researchers chose
to label non-statistical differences "con-
clusive evidence" of superiority of one
group over another. Even more amazing is
that The Canadian Nurse chose to print a
report which is so misleading to members
of the profession and the public, who, in
spite of the authors' pleas for caution,
will make decisions on the basis of
findings of this report. Surely your sub-
scribers deserve better treatment than
this! - M. Josephine Flaherty, Reg.N.,
Ph.D., Toronto.
Dr. Costello replies
The number of subjects (24 in each
group) is not a small one, particularly in
view of the fact that these are matched
subjects. What is always far more danger-
ous is the obtaining of small significant
differences by the use of very large
samples. Dr. Flaherty and some of your
readers may be interested in a book by
P.O. Davidson and myself, which will
appear in May, entitled "N = 1." Even
samples of this size can permit one to
draw conclusions with considerable confi-
dence.
Dr. Flaherty tries to make a lot out of
the fact that not all the differences
between the groups were significant. The
important thing, however, is that in just
about every comparison the control stu-
dents did better than the experimental
students. Of course, it is because of the
great inter-subject variability that they
did not all come out significant, but the
very consistency of the direction of the
differences enables us to have consid-
erable confidence in those findings that
are significant. To accept the null hypo-
thesis of no real difference between the
groups in the case of these data would be
quite unwarranted.
Of course ward experience was not
identical for all subjects; however, there is
no reason to think that there is any
systematic difference in the ward expe-
rience of the experimental and control
students so that it cannot be used to
account for our findings. All that one can
say is, despite differences between the
raters, the findings consistently showed
the control student to be better. Simu-
lated situations have generally been of
value for testing model ships, model
rockets, model astronauts, and model
soldiers; I see no reason why they should
not be of value to assess model nurses.
Dr. Flaherty says there was no differ-
ence between the groups on intermediate
tasks in the simulated nursing situation.
Our article reports that there was a
significant difference between the groups
on the intermediate tasks. She suggests
that one could query the importance of
speed in this setting. At the age of 38 I
have been blessed with good health and
have never been hospitalized. When I am,
I hope the nurses attending me will not
be the lethargic type.
To suggest that the methodological
faults of this study may be at least as
serious as those reviewed is quite ridicu-
lous.
Finally, we have not suggested that the
nonsignificant differences provide conclu-
sive evidence of differences. We have said,
to repeat, that the significant differences
among findings that go consistently in
one direction can be accepted with a
THE CANADIAN NURSE 5
considerable degree of confidence. I do
not want to be ungentlemanly, but I
really do feel that it is not so much that
the subscriber to The Canadian Nurse
deserves better treatment, but that The
Canadian Nurse deserves more careful
reading. - C.G. Costello, Ph.D., Profes-
sor, Department of Psychology, The
University of Calgary.
Subscriptions
This is a good time, as postal rates
increase, to end the strange phenomenon
of a professional group being forced to
subscribe to a magazine.
I am strongly against paying for The
Canadian Nurse. I do not read it, nor do
my two roommates. We are all nurses
who are forced to receive three journals
in one apartment! We live in a large
apartment house - and the day the
journal arrives, you can find half a dozen
copies of the current issue piled up near
the incinerator.
Nurses in Nova Scotia do not receive
the same rate of salary as do nurses in
Ontario, so any increase in subscription
rates dreamed up by the board of direc-
tors of the CNA would be a burden to us.
Anti-perspirant
is usually
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6 THE CANADIAN NURSE
We receive other medical journals and
have resource to our hospital libraries,
where all new trends in medicine are
available. Let us not force nurses to
receive periodicals they do not want.
Others will subscribe if they choose to do
so. - E. Sutherland, R.N., Halifax, N.S.
The subscription-through-fees plan was
not decided by the Canadian Nurses'
Association. The membership of each
provincial nursing association voted in
favor of this plan in the 1950s. Actually,
it is not a "strange phenomenon." Most
professional associations, including the
Canadian and American Library' associa-
tions, the Canadian Medical Association,
The Canadian Adult Education Associa-
tion, Engineering Institute of Canada,
Canadian Public Health Association, Insti-
tute of Aeronautical Science, and the
Canadian Pharmaceutical Association in-
clude a journal with the members ' pro-
fessional fees. - Editor.
Do we care enough?
The question that bothers me is not
new. I have long wondered what kind of
leadership nurses give in the community,
and whether they show the concern for
social problems that is rightly expected of
professionals. For example, what have
nurses done to change a system that
condemns to inactivity many elderly
persons who could contribute to society
by continuing to work at a job that they
enjoy? Virtually nothing.
Why have nurses remained aloof from
this issue? First, most nurses probably
have not thought of compulsory retire-
ment as an issue within the realm of
nursing interest. Second, those who are
concerned about the problem feel help-
less to do anything about it. Finally,
some nurses do not see anything amiss
about compulsory retirement at 65.
If people wanted to spend their last 10
or 20 years in leisure activities and were
prepared to use this leisure, there would
be no problem. We know that this is not
generally so; a walk through a home for
the aged is convincing. We hear and read a
great deal about the need of education
for leisure. The trouble is, we do next to
nothing about it. Surely this is a nursing
responsibility.
An even more basic problem is that of
attitude. It is Western society's attitude
toward the aged that condemns them to a
life apart. Our scale of values gives prio-
rity to youth, and attitudes are extremely
hard to change. To get people in our
society to look forward to old age would
take a revolution.
There are good reasons for old age to
be a desirable period of life. The indivi-
dual has acquired knowledge and experi-
ence, and has usually learned to live
harmoniously with others, to cope with
frustrations, to accept knocks without
bitterness, and to press on, day after day,
MAY 1969*
no matter how hard the going. If we do
not look to these people who have
"weathered the storm," are we not by-
passing a rich source of help in the art of
living?
Think of the difference it would make
to the aged person if sons and daugh-
ters — not only his own — regularly
asked for advice on how to handle the
perplexing situations of daily life.
Wouldn't this make the elderly person
feel needed?
As nurses, we have a responsibility to
change the public's attitude toward the
aged. We have the knowledge, we know
the problem. Do we care enough? — Sis-
ter Muriel Gallagher, Moose Jaw, Sas-
katchewan.
Bursary for nursing students
In the fall of 1962, under the leader-
ship of Miss Dorothy Hart and Mrs.
Maxine Thomson, many students of Miss
Mildred 1. Walker contributed to a fund
to establish a bursary for nursing students
at The University of Western Ontario in
Miss Walker's name. Miss Walker, herself,
left $5,000 in her will for this fund and,
at the time of her death, many friends
and associates made a contribution in her
memory.
The capital of this fund is now $8,848,
which earns an estimated annual income
of S500. Nurses who contributed to this
fund will be interested in this informa-
tion.
The faculty and students at The
University of Western Ontario School of
Nursing are grateful that this bursary was
established. It is a very fitting tribute to
Miss Walker, whose interest in students
was outstanding. - R. Catherine Aikin,
Dean, School of Nursing, UWO, London,
Ont.
Second class citizens?
Thank you for the articles on Clinical
Laboratory Procedures and Hyperbaric
Oxygen Units (February 1969). I am an
R.N. from the Netherlands and was
pleased when you mentioned Amsterdam.
Gas gangrene is a real danger in certain
parts of Holland.
Also, as a midwife from Holland, I
know that many hospitals appreciate our
training. Why do midwives here not get
any recognition from official bodies in
the nursing field? If a Canadian nurse
takes postgraduate training in obstetrics
and gets rewarded, why not the foreign
nurse? How long will we be treated as
second-class citizens in this respect?
It is not my intention to take the place
of the doctor; the understanding of a
woman in labor and the ability to recog-
nize abnormalities are often far more
important than the delivery itself. 1 must
admit, however, that I am proud I am
also thoroughly trained for this, as are my
colleagues from England. Perhaps it
would be valuable to assess the abilities of
MAY 1%9
foreign nurses and reward them rather
than use their extra training and tell
them, at the same time, that it is not any
more than the Canadian R.N. learns
during her basic training. - Susanna J.D.
Meyer, R.N., Cochenour, Ontario.
Take a dive
For the past two years I've been
working as a Canadian University Service
Overseas volunteer in Barbados and now
in Jamaica. At the present time, I'm
keeping more than busy as a staff nurse in
the premature baby unit of the children's
hospital here in Kingston.
During the year I spent at the
Montreal Children's Premature Nursery, I
would have chuckled at anyone who said
I'd be doing half the things I'm doing
now. But I will never regret having joined
CUSO. I hope that far more nurses will
take the dive out of our warm, neat,
sterile, well-organized life in Canada and
come for a swim with most of the world's
nurses in a much less pampered life. I've
loved it!
At the moment, there are about four
CUSO nurses in the Caribbean. We could
use at least 10 more. There is no age
limit.
Any volunteers? —Wendy Craster, King-
ston, Jamaica. □
Just Press the Clip and It's Sealed
It takes but a moment to identify your pa-
tient, positively and permanently, with
Ident-A-Band. Then just a glance is all you'll
need to be sure that this is the right patient.
fcfent-A-Bcincr'
Write today for free
samples and literature.
|_HoLList€r;^
160 BAV ST.. TORONTO 1
THE CANADIAN NURSE 7
We want
a special kind
of nurse*#
We want a nurse who can handle
two jobs: one who can nurse the
men of the Canadian Armed
Forces and who can accept the
responsibilities of being a com-
missioned officer. That's why
we're offering a salary of more
than $590.00 a month. It's inter-
esting work. You could travel to
bases all across Canada and be
employed in one of several
different hospitals.
It's challenging.You'll never find
yourself in a dull routine. And, in
addition, you have the extra pres-
tige of being made a commis-
sioned officer when you join us.
If the idea intrigues
you, you're probably
the kind of special
person we're looking
for. We'd like to have
«you with us.
Write: The Director of
Recruiting, Canadian
Forces Headquarters,
Ottawa 4, Ontario.
^ J
THE CAIMADIAIU ARMED FORCES
V80413
8 THE CANADIAN NURSE MAY 1%9
news
CNA's Journals Reclassified
As Third Class Mail
Ottawa. - The Canadian Nurses' As-
sociation's application to have The Can-
adian Nurse and L 'infinniere canadienne
remain classified as second class mail by
the Canada Post Office was rejected in
February.
Under the terms of the "Post Office
Act as amended by chapter 5 of the
Statutes of Canada 1968," the CNA
journals do not qualify as second class
mail because they are "published prima-
rily for the benefit of the members of a
particular profession."
The new postal rates, which came into
effect April 1, raise the annual costs of
mailing the journals by approximately
SI 35.000.
More Nursing Schools Move
'Within Framework ... Education
Ottawa. - Twenty-six diploma
schools of nursing and nursing courses
were in operation within the general
education system at the post-secondary
level in Canada, at the end of December
1968. These programs were in five pro-
vinces: Alberta, British Columbia, Onta-
rio, Quebec, and Saskatchewan.
Total admission to these schools of
nursing in 1968 was 1,901; total enroll-
ment in these nursing programs in 1968
was 2,349. In Quebec and Saskatchewan,
slightly more than half the admissions
were to programs within the general
education system.
The most recent figures on these two
provinces have been supplied by Lois
Graham-Cumming, director of research
and advisory services for the Canadian
Nurses' Association. In Quebec, 2,521
students were admitted to diploma
schools of nursing in 1968. Of these,
1 ,402 were enrolled in the 20 general and
vocational colleges (CEGEP) with nursing
options. The CEGEP system was set up
following the Royal Commission Inquiry
on Education in the Province of Quebec
(Parent Report), which recommended the
integration of nursing schools into the
general system of education and the
integration of nursing courses at the
post-secondary level. The first nursing
courses within the general system were
offered in 1967.
In Saskatoon, 244 of the 454 admis-
sions to schools of nursing in 1968 were
to the Institute of Applied Arts and
Sciences. Nursing education in Saskatch-
ewan came under the ministry of educa-
tion in 1966. The first school of nursing
under these auspices was opened in the
MAY 1969
fall of 1967.
In Ontario there were 37 admissions to
the school of nursing at Toronto's
Ryerson Polytechnical Institute in 1968.
(This was the first school of nursing in
Canada to be set up under the general
education system.) In British Columbia,
99 nursing students were admitted to the
British Columbia Institute of Technology.
Alberta admitted 57 nursing students to
the Mount Royal Junior College, 34 to
Red Deer Junior College, and 28 to St.
Jean's College. New Brunswick is conti-
nuing to press for all nursing education to
be under the jurisdiction of educational
institutions.
The idea of establishing schools of
nursing under the system of general
education is not new. A report by Dr.
Weir in 1932 said that the educational
principles governing the preparation of
nurses did not differ fundamentally from
those underlying the education of other
disciplines. In 1952, the CNA recom-
mended that nursing education should be
provided in institutions whose primary
objective is education. Since then, the
Association has maintained the belief that
nursing education should be developed
within the educational systems of the
country and has pressed for this change.
Newfoundland Donates $1,840
To CNA For ICN Costs
St. John's. - The Association of
Registered Nurses of Newfoundland
donated one dollar per member (SI, 840)
to the Canadian Nurses' Association in
March, for the 14th Quadrennial Congress
of the International Council of Nurses to
be held in .Montreal June 22-28. The
ARNN will also donate 10,000 pamphlets
about Newfoundland and Labrador.
Newfoundland is the fifth province to
make a financial contribution to CNA for
ICN. The others are: New Brunswick,
Quebec, Alberta, and British Columbia.
RNABC Contributions
To ICN Reach $8,400
Ottawa. - An additional gift of
S2,900 has been made by the Registered
Nurses' Association of British Columbia
to the 14th Quadrennial Congress of the
International Council of Nurses, to be
held June 22-28 in Montreal.
A gift of S5,500 was reported in the
news section of the March issue.
RNABC has requested that the funds
be used as follows:
• S5.000 for the CNA to use in any way
needed.
• S500 to provide music for the Congress.
Whoo-fur - ICN's Furry Mascot
Ottawa. - Whoo-fur, the furry
creation of the Saskatchewan Plains
Indians, has been chosen official mascot
for the International Council of Nurses'
XIV Quadrennial Congress in Montreal
in June. Whoo-fur is a strip of rabbit fur
with two large owlish eyes. He will be
given to each registrant at the Congress
and will be worn on her lapel to help
identify her as a member of ICN.
• SI, 500 to provide entertainment tickets
for guests from abroad who have limited
funds in Canadian currency.
• S 1 .400 to assist with living expenses for
guests from abroad who have limited
funds in Canadian currency.
Lester Pearson Cancels
ICN Commitment
Ottawa. Lester B. Pearson, origi-
nally scheduled to be the keynote speaker
at the 14th Quadrennial Congress of the
International Council of Nurses to be
held in Montreal June 22-28th, will be
unable to attend.
Harriet J.T. Sloan. ICN Congress Coor-
dinator, received word that Mr. Pearson
THE CANADIAN NURSE 9
has a European commitment at the same
time, and this necessitates his change in
plans.
As yet, a replacement for Mr. Pearson
has not been named.
Western Region of CCUSN
Holds Annual Meeting
Vancouver. - The annual meeting of
the Canadian Conference of University
Schools of Nursing, Western Region, took
place at the University of British Colum-
bia February 8-9, 1969.
The theme of the meeting was con-
tinuing education. Dr. Donald Williams,
professor and head of the Centre for
Continuing Education in the Health
Sciences, University of British Columbia,
was keynote speaker. He discussed three
main points: 1. What is continuing
education for health professionals?
2. Why is there such urgency - why so
much interest? and 3. What is the role of
the university in continuing education?
Margaret Neylan, head. Continuing
Nursing Education, University of British
Columbia, outlined the purpose of con-
tinuing education in nursing as an oppor-
tunity for nurses to keep abreast of the
times. Mrs. Neylan said that educational
experiences must be flexible, meet needs
of persons with varying levels of educa-
tion, and be stimulating.
Another speaker, Rita Darragli, assis-
tant director of the school of nursing at
Montana State University, Montana,
discussed regional planning for continuing
education. She pointed out that the
Western Interstate Commission on Higher
Education (WICHE) is attempting to
equalize educational opportunities among
the states. The council on higher educa-
tion in nursing of WICHE is concerned
with upgrading the education of persons
who hold leadership positions in nursing
education and nursing service. The coun-
cil agreed that baccalaureate preparation
should be basic education for leaders,
but, in reality, this was not possible.
Miss Darragh said that pilot demons-
trations in leadership have been held by
WICHE since 1957. These demonstrations
were one week in length and extended
over a three-year period. Extensive eval-
uation indicated that the demonstrations
led to improved leadership and patient
care. Twice yearly seminars for leaders
and consultants were also held. Miss
Darragh said, and were sponsored by the
Kellogg Foundation and later by federal
traineeships. Results indicated a greater
understanding of nursing service problems
and nursing education goals, and greater
interest in continuing education as a
means to improve patient care.
Following the addresses, members of
the CCUSN formed small groups to dis-
cuss the implications of the conference
presentation and to consider ideas that
might be promoted.
The following officers were elected for
the remaining part of the two-year term,
1968-70: Hazel Keeler, past president;
Alice Baumgart, president; Peggy Ann
Field, vice-president; and Jessie Hibbert,
secretary-treasurer. Members at large are;
Margaret Street, B.C.; Grace Tannehill,
Alta.; Jean Pipher, Sask., and Joy Wink-
ler, Man.
CCUSN is a national organization
whose purpose is to promote the advance-
ment of nursing education in universities.
The annual CCUSN meeting will coincide
with the International Council of Nurses'
Congress in Montreal in June.
Nurses Discuss Future
of Nursing Education
Nova Scotia. - The future of nursing
education in Nova Scotia was discussed
April 1 at a meeting at the Victoria
General Hospital Nurses' Residence. The
session focused on the two-year nursing
education program. It was cosponsored
(Continued on page 12)
Some Thoroughly Modern Millies
Here they are - those gay, daring debs of the roaring 20's,
with their scandalously short skirts, fivrolous beads, and
bobbed hair.
These are some of the nurses from countries 'round the
world who flocked to the swinging city of Montreal in 1929 to
attend the first Congress of the International Council of
Nurses to be held in Canada. According to stories featured in
the Montreal Gazette, they deluged the ICN's information
desk with questions such as: "Which restaurant in Montreal
has the most 'atmosphere'? " "Can one get a ferry from
Quebec to the United States? " "I have a friend from England
who is at the convention; could you find me her address? "
And the crucial issues at stake in the nursing world of
1929? Would you believe protecting student nurses from
"measureless possibilities" of exploitation by hospital nursing
schools? A paper given by Professor M. Adelaide Nutting from
Teachers College, Columbia University, New York, made the
headlines in the Montreal newspapers. Professor Nutting said
that nursing schools must be taken out of hospitals and put
into institutions concerned wholly with the education of
nurses. She suggested establishing schools of nursing within
universities, since students in hospital schools were looked
upon as "sources of profit."
Times haven't changed all that much.
10 THE CANADIAN NURSE
MAY 1%!
now
o!9« tampons offer inlprnal
rotef.lion with a dllferpncB:
-foiiruled ll|) l<n oasy insertlrin, '
■ unique t)loti(l of highly .ihsorbent
llbret which mnpand to the natural
body contour, a «oll fabric covvrlng to
prevent nhpcfdlng, a doubl« rontovat
airing that's m(>l"itur«>-rr><ist»nt
V. and B go' d«
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<vAlL^<
by Kimb«rly>Ct«rk of Canada ItvS
news
Commuting Students Study En Route
(Continued from page 10)
by the Nova Scotia Hospital Insurance
Commission and the Registered Nurses'
Association of Nova Scotia.
The meeting took the form of an
instructional program for those concern-
ed with nurse education programs in
hospital and the products of those pro-
grams. Attending were hospital adminis-
trators and directors of nursing service
and of nursing education in hospital
schools of nursing.
The pattern of Canadian nurse educa-
tion in two-year programs was presented,
and the effect of application of this
change in the hospital and other health
services was reviewed.
Nova Scotia has accepted the concept
of a two-year program for hospital
schools of nursing. This program will be
introduced in two schools of nursing in
September 1969, and by 1971 will be the
pattern for all hospital nursing schools in
the province.
The day-long meeting was opened by
Richard A. Donahoe, provincial minister
of health.
University Nurses Present Brief
To Castonguay Commission
Montreal. - A brief presented Febru-
ary 4 on behalf of the Canadian Confer-
ence of University Schools of Nursing,
Quebec region, to the Castonguay Com-
mission on Health and Welfare in Quebec,
recommends ways to meet the need for
higher education of nurses in Quebec,
new nursing categories, and nursing re-
search.
The brief was presented in a public
hearing by Claire Gagnon, director, and
Olive Goulet, assistant professor, Laval
University School of Nursing; Sister Marie
Bonin, who is responsible for the bacca-
laureate program, and Sister Marie-Claire
Rheault, lecturer in the nursing faculty.
University of Montreal; Elizabeth Logan,
director, and Helen Moogk, assistant
professor of nursing, McGill University
School for Graduate Nurses.
The brief recommends:
• That university schools of nursing al-
ready offering a baccalaureate program
receive funds that will permit them to
accept larger numbers of students.
• The establishment of baccalaureate pro-
grams, particularly in Quebec's French-
language universities.
• Increased study grants, divided equally
across the province, for nurses wishing to
pursue higher education.
In the brief, a table of statistics for
1967, compiled by the Association of
Nurses of the Province of Quebec, shows
that only 5.7 percent of staff nurses, 10.6
percent of supervisors, and 20.6 percent
12 THE CANADIAN NURSE
Montreal - Commuting time is not wasted time for this group of senior nursing
students from the State University of New York in Plattsburgh. The buses that
carry the students once a week to Douglas Hospital, Verdun, near Montreal, have
headphones installed in each seat for lectures and discussion en route. Two groups
of 40 students make the trip once a week, accompanied by four instructors, for
psychiatric experience. Seats in the fire-engine red buses are arranged in three
groups for easier discussion. On the way to the hospital the discussion centers on
the plans for the day, and on the return trip it centers on the results of the day's
work. The photo shows Mary Christie, director of nursing at Douglas Hospital,
welcoming a group of students.
of teachers practicing in Quebec hold a
bachelor's degree; .5 percent of Quebec
nurses hold a master's degree; and three
nurses a doctoral degree.
• That competent authorities systemati-
cally review the categories of health
workers required to meet the needs of the
people of Quebec.
• That two classes of nurses be officially
recognized: the university-trained nurse
and the nurse technician or technologist;
and that male candidates become legally
integrated into these two classes.
According to the brief, Quebec now
prepares one university-trained nurse for
10 nurse technicians.
• That a large number of well-trained
guidance counselors be available to guide
secondary school students, according to
their aptitudes, either toward the CEGEP
nursing option [General and Vocational
Colleges throughout Quebec will replace
all hospital schools of nursing by 1970]
or toward the pre-university option
necessary for entrance to the university
school of nursing.
• That the department of education make
it compulsory, after a certain time, for
nurses teaching at the CEGEP level to
hold at least a bachelor's degree; and that
measures be taken to allow these nurse
access to master's programs.
• That organizations in charge of plan
ning research in Quebec take account o
the need for developing research in th-
field of nursing.
• That the hiring policies of the depart
ment of education favor nurses preparei
at the university level for positions ii
public health nursing.
• That research funds be set aside ti
allow for publication of nursing books ii
French.
MARN Surveys Staffing Patterns
Winnipeg. - A province-wide surve
of staffing patterns just completed by th
Manitoba Association of Registered Nun
es has netted a 95 percent return. Th
material is now being analyzed.
One area of concern has been th
competence of out-of-country nurses
this survey shows they are satisfactory i
small rural hospitals; the smaller th
hospital, the greater satisfaction reported
The incidence of continuing educatio
programs and their efficacy has also bee
investigated; the survey indicates snia
rural hospitals do not have formalize
(Continued on page 1
MAY 19ft'
Now available
THE SECOND EDITION OF
COUNTDOWN
CNA'S YEARBOOK OF CANADIAN NURSING STATISTICS
One-third larger than last year's edition, COUNT-
DOWN 1968 contains commentary and 133 sta-
tistical tables updated to present the latest
available data on nursing manpower, education, and
salaries.
An exciting addition this year is the inclusion of
salaries paid to nurses employed in public general
hospitals throughout Canada.
A cross-reference between COUNTDOWN and
FACTS ABOUT NURSING, published by the
ANA, is available from CNA.
Act now. Continue your collection of COUNT-
DOWN with the 1968 edition by clipping and
mailing the coupon below.
TO: Canadian Nurses' Association
50 The Driveway
Ottawa 4, Ontario
Please send
per copy, to:
Name
(no. of copies) of Countdown 1968, at $4.50
Address
City
Province
Position
Money Order D
Cheque D
For$
Enclosed
MAY 1969
fcOUNTDOW
196!
NURSES' ASSOCIATION
THE CANADIAN NURSE 13
news
(Continued from page 12)
programs other than doctors' lectures.
It is anticipated that MARN will give
more leadership in the area of inservice
education in the next year and will
conduct workshops on this subject.
Hamilton Nurse Educators
Return To Work
Hamilton. - The 18 faculty members
of the Hamilton and District School of
Nursing who went on strike March 4
returned to work on March 25, after
reaching agreement with their employer
over salaries, transportation expenses,
benefit plans, and hours of work.
The contract, effective March 2, 1969
to March 1, 1970, provides a salary
increase of 8-1/2 percent, 2 percent high-
er than salaries set by the Ontario Hospi-
tal Services Commission. The new salary
range for instructors with a bachelor of
nursing science degree is S7,800 to
S9,120, with 5 yearly increments of S22;
for instructors with a master's degree, the
TECH
$18
suggested Retail Prices
At last/ perspiration
damage meets its match.
Naturalizer now brings you duty shoes of
genuine Servotan* leather, specially treated
to resist drying, cracking and discoloration
from perspiration.
With Servotan, Naturalizers stay softer, more
comfortable and are so easy to clean with
soap and water.
Naturalizers also have the famous Wonder-
sole (See illustration at right).
n
Wondersole is contoured to
match the shape of your foot.
Your body weight is distrib-
uted evenly along its entire
length for complete support.
WITH SERVOTAN AND WONDERSOLE*
*Trademarl<s of
BROWN SHOE COMPANY OF CANADA LTD.
Naturalizer Division, Perth, Ontario
14 THE CANADIAN NURSE
new range is $8,280 to $9,600. Salaries
include a monthly educational bonus of
$80 for instructors with a bachelor's
degree, and SI 20 for instructors with a
master's degree. In lieu of retroactive
increases, the nurses received a lump sum
of $200.
Other provisions in the contract are:
• A 10 cent per mile travel allowance
from the school to the destination and
return.
• The supplying of teachers' textbooks
by the school.
• A 38-3/4-hour work week, including 12
hours a week for lecture preparation.
• Time off for overtime.
• Payment by the school of 66-2/3 per-
cent of a hospital, medical, and group
insurance plan.
• The hiring of a substitute teacher if an
instructor is absent more than a week.
• Vacation pay based on the current
salary rate.
• A S24 per month allowance for
"leaders when required by the school."
(The term "leader" refers to the two
senior teachers in the school who help to
coordinate the first- and second-year pro-
gram and instructors.)
• Three working days off at Christmas
and four at Easter. (These days are in
addition to the usual holiday time allow-
ed for Christmas, New Year, and Easter.)
The Registered Nurses' Association of
Ontario worked closely with the instruc-
tors, helping them to organize for certifi-
cation and to draw up proposals. Anne
Gribben, RNAO's director of employ-
ment relations, told The Canadian Nurse
that the contract achieved certain goals,
even though there was no great monetary
gain.
"The principle of comparing these
teachers with other educators when
deciding on salaries was not accepted,''
Miss Gribben said. "However, other gains
were made. First, the contract recognized
the teachers' need to have time to prepare
lectures. It is a good thing to have this
spelled out. Second, recognition was
given to the senior teachers [called "lead
ers" in the contract] who have additional
responsibilities. This recognition is a real
breakthrough," Miss Gribben said.
Extension Courses Continue
To Be Popular
Toronto. - The five hundred and
seventeen nurses enrolled in the 1968-69
extension course in Nursing Unit Admi-
nistration completed spring workshops in
May.
To date, 537 nurses are enrolled in the
1969-70 class; 11 of these nurses are in
the French program. Fall workshops fo!
this class have been planned for August
25-29 in Vancouver and Ottawa, Septem
her 8-12 in London, Halifax, and Mont
real (French), and September 15-19 ir
Toronto and Winnipeg.
(Continued on page 16
MAY 1%V^
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^^p
to hasten healing
when the lesion is
infected...infiamed
Elase
[fibrinolysin and desopbonuclease, combined, (bovine) Parke-Davis]
Elase (powder tor solution)
Elase Ointment
Eiase-Chioromycetin' Ointment
Ulcerative lesions, contaminated lacerations and un-
healed burns contain fibrinous exudates and necrotic
tissue elements that support bacterial growth-a major
factor in delayed healing. Through its enzymatic de-
briding action ELASE helps remove this nutritive base
on which bacteria thrive . . thus it supports and hastens
healing.
ELASE is supplied in ointment form and as dry material for
solution. Each gram of ointment contains 1 unit (Loomis) of
fibrinolysin and 666 units of desoxyribonuclease. Each vial of
ELASE for solution contains 25 units (Loomis) of fibrinolysin
and 1 5,000 units of desoxyribonuclease.
ALSO AVAILABLE: ELASE-CHLOROMYCETIN Ointment con-
tains 1% CHLOROMYCETIN (chloramphenicol, Parke-Davis) in
combination with ELASE Ointment.
INDICATIONS: To lyse fibrin and liquefy pus in order to aid
removal of necrotic debris. Useful in the removal of exudate from
skin surfaces as in wounds, ulcers, burns, vaginitis, cervicitis:
also used to irrigate abscess cavities, superficial hematomas,
sinus tracts, and fistulas.
ELASE-CHLOROMYCETIN Ointment provides effective
enzymatic debridement plus direct antibacterial action
to assist healing of infected surface lesions. May be
used topically and intra-vaginally when both a debriding
agent and a topical antibiotic are indicated.
APPLICATION: Skin surface /esions—appW topically as oint-
ment or solution as indicated, one or more times a day. After
application, enzymatic activity becomes progressively less and
IS probably exhausted for practical purposes at the end of 24
hours. Remove necrotic debris between applications. M//d to
moderate vaginitis and cervicitis-deposn 5 cc. of ointment deep
in the vagina once nightly after retiring for 5 applications; re-
examine for possible need of further therapy.
PRECAUTIONS: Observe usual precautions against allergic
reactions, particularly in persons sensitive to materials of bovine
origin, antibiotics or thimerosal. With respect to ELASE-
CHLOROMYCETIN Ointment, following topical use of chloram-
phenicol, the patient may become sensitized to the drug. ELASE-
CHLOROMYCETIN should be used only for serious infections
caused by organisms which are susceptible to the antibacterial
action of chloramphenicol.
WARNINGS: ELASE should not be used parenterally. ELASE-
CHLOROMYCETIN should not be used as a prophylactic agent.
Chloramphenicol, when absorbed systemically from topical
application, may have toxic effects on the hemopoietic system.
Prolonged use may lead to an overgrowth of non-susceptible
organisms including fungi.
ADVERSE REACTIONS: Side effects from ELASE have been
minimal, consisting usually of local hyperemia. Allergy to the
chloramphenicol portion of ELASE-CHLOROMYCETIN Oint-
ment may show itself as angioneurotic edema or vesicular and
maculo-papular types of dermatitis.
SUPPLY: ELASE Ointment in 10-Gm and 30-Gm tubes'
ELASE-CHLOROMYCETIN Ointment in 30-Gm. tubes; V-Ap-
plicators for use with the 30-Gm. tube for intravaginal applica-
tion, in packages of 6; dry material for solution, in rubber-
diaphragm-capped vials of 30 cc.
Detailed information available on request. cp-mnM
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16 THE CANADIAN NURSE
(Continued from page 14)
The Nursing Unit Administration
Course, which is sponsored jointly by the
Canadian Nurses' Association and the
Canadian Hospital Association, provides
an organized program on the principles of
administration and leadership, with the
goal of more effective patient care. It is
intended for nurses who are working in
administrative positions and who are
unable to attend a university to upgrade
their skills.
The course consists of an initial five-
day work.shop held in the fall, followed by
1 2 correspondence lessons and another
workshop in the spring. Workshops are
held in seven locations on a regional basis.
RNABC Loans Offered
Vancouver. - The Registered Nurses'
Association of British Columbia is offer-
ing a number of bursary/loans for assis-
tance in nursing study.
RNABC members undertaking full-
time post-basic study and students in the
final year of a basic baccalaureate degree
program in nursing are eligible for the
awards. A commitment of one year of
service in a nursing position in British
Columbia must be given by each recipi-
ent.
Completed application forms must be
in to RNABC by June 15.
Nurses' Christian Fellowship At ICN
Toronto. ~ The Nurses' Christian
Fellowship of Canada, in collaboration
with Nurses' Christian Fellowship Inter-
national, will have a Friendship Lounge in
Place Bonaventure, near Concordia Hall,
during the 1 4th Quadrennial Congress of
the International Council of Nurses in
Montreal June 22-28. Here, delegates may
relax between sessions, meet old friends,
and make new ones.
NCF hostesses, conversant in the four
main languages of the Congress, will be
present to welcome delegates and answer
questions about Canada and Montreal.
Two Scholarships Offered in Quebec
Montreal. Two scholarships of S300
each are being offered this year by
District Nine of the Association of Nurses
of the Province of Quebec. They are open
to nurses of the district who will be
studying for a baccalaureate degree.
Candidates must have at least two
years' experience in nursing and must be
accepted at a university school of nursing.
Preference will be given to those who
intend to make a career out of nursing.
Candidates will be chosen by a selec-
tion committee of five or six experts in
nurse education from District Nine. Dead-
line for applications is August I . D
MAY 1969
ELI LILLY AND COMPANY (CANADA) LIMITED, TORONTO, ONTARIO
For four fenerations
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'iDENTi CODE'" (formula identification code. Lilly) provides quick, positive product identification.
names
Grace M. Fairley, a pioneer in Can-
adian nursing, died in Vancouver March
15 at the age of 87. She came to Canada
in 1912 from her native Scotland where
she held several nursing positions.
Miss Fairley began her career in Can-
ada as superintendent of nurses, first at
Montreal's Alexandra Hospital from 1912
to 1919, then at The Montreal General
Hospital from 1919 to 1924, and later at
the Victoria Hospital in London, Ontario,
from 1924 to 1929.
As director of nursing and principal of
the School of Nursing at The Vancouver
General Hospital from 1929 until her
retirement in 1943, Miss Fairley intro-
duced many progressive changes. Actively
concerned about nurses' working condi-
tions, she saw the eight-hour day for
nurses become a reality. She strongly
supported higher education for nurses.
Under her leadership. The Vancouver
General Hospital School of Nursing in-
creased its number of graduates to be-
come one of the largest schools in Can-
ada.
Through the important offices she
held in Canadian and international as-
sociations, Miss Fairley increased the
stature of Canadian nursing. She was
vice-president of the American Hospital
Association from 1916 to 1917. In 1941,
she was appointed third vice-president of
the International Council of Nurses, a
post she held until 1953.
As chairman of the nursing education
section of the Canadian Nurses' Associa-
tion from 1930 to 1934, she laid the
foundation for many recent educational
developments. As president of the CNA
from 1938 to 1943, one of her objectives
was to help develop nursing throughout
Canada, rather than think "in terms of
east or west."
Miss Fairley was active on the execu-
tives of the provincial registered nurses'
associations of Quebec, Ontario, and
British Columbia. She also served as
president of the Canadian Association of
Nursing Education.
In 1943 Miss Fairley received the
Agnes Snively memorial medal, awarded
to leading members of the nursing pro-
fession in Canada.
One of her former students, Dr. Helen
K. Mussallem, executive director of the
CNA, recalls Miss Fairley's belief that the
nurse had a great responsibility to the
community - as a professionpl and as a
citizen. "Miss Fairley saw the nurse's role
extending beyond the hospital, and in-
18 THE CANADIAN NURSE
New Zealand Nurse Visits CNA
mmmM
Jean Sutherland, acting assistant director of the Division of Nursing, Department of
Public Health in Wellington, N.Z., is touring Canada — one of four countries she
chose to visit on her four-month World Health Organization fellowship. At a news
conference at CNA House March 28, Miss Sutherland said she had visited the
University of British Columbia's school of nursing where she was interested in the
multi-discipline approach to the teaching of public health nursing. Also on her study
tour are the United States, England, and Finland.
troduced into her nursing education pro-
gram many types of clinical experiences
that were real innovations at that time,"
Dr. Mussallem said. "She was a very
courageous person, and when convinced
of the need for change, she was not afraid
to take the difficult road. For example, in
1942 she was successful in having Japa-
nese and North American Indian students
admitted into The Vancouver General
Hospital's School of Nursing."
"Miss Fairley was one of the real
giants in Canadian nursing."
Anne Gribben
(Reg.N., Toronto
Western H., B.A., U.
Toronto; Cert. Nurs.
Service Admin., U.
Toronto) is the new
director of em-
ployment relations
for the Registered
Nurses' Association
of Ontario. Previously Miss Gribben was
associate director of RNAO's em-
ployment relations department.
Miss Gribben was born in Brantford.
She graduated from Toronto Western
Hospital in 1945, then worked there as a
staff nurse, head nurse, and for 13 years
as supervisor of the emergency and emer-
gency observation wards.
She has also worked on committees
for the Canadian Nurses' Association and
the RNAO.
L||^^ I Margaret M.
^■■■k Lonergan (Reg.N.,
^C_^» St. Joseph's H.;
Jm^Wf B.Sc.N.Ed., Seattle
U.; M.N., U. Wash-
ington) has been
appointed full-time
nursing consultant
with the Mental
Health Branch, Brit-
ish Columbia Department of Health Servi-
ces and Hospital Insurance, Victoria.
Miss Lonergan was formerly director
of nursing in the B.C. Mental Health
Branch in Essondale. In Vancouver, Miss
Lonergan was a science instructor, and
(Continued on page 20)
MAY 1%9»
Johnson & Johnson recommends eight departments
where J CLOTH* Hospital Towels have important advantages
-and can reduce expenses
Operating Room.Use J CLOTH*
Hospital Towels as a prep
sponge, vaginal wipe and to catch
overflow of prep materials. Ex-
cellent as surgeon's hand towel
and for drying his forehead. Avail-
able in three colours. Green is
recommended for O.R. use.
Recovery Rooms. Protect your
pillows with a large size (14" x
24") J CLOTH* Hospital Towel.
Use the medium size (12!/4" x 19")
as a personal towel for patients,
and the small size (12'/4" x I21/2")
as a patient face cloth.
Out-patients Department.
J CLOTH* Hospital Towels are
very absorbent. Use them to clean
wounds of accident victims, for
minor surgery, as a hand towel
for doctors, as a pillow case pro-
tector and as a cover for carts,
counters and scales.
MAY 1969
Obstetrical Department.
J CLOTH* Hospital Towels are
sterilizable which makes them
ideal to receive baby during de-
livery—and as a hand towel for sur-
geons and nurses. Also can be used
as a perineal wipe and prep towel.
They won't fall apart when wet.
Orthopaedic Department, Use
them as a hand towel for sur-
geons and cast room technicians.
They are surprisingly durable and
retain shape after many dryings.
Low unit cost makes them more
economical than rental towels.
Central Supply Room.
J CLOTH* Hospital Towels have
no lint drop out. They won't leave
a trace of lint: ideal for polishing
and wrapping syringes and surg-
ical instruments. Incidentally, the
fact that there are 100 towels per
package ensures portion control.
Isolation Wards. J CLOTH*
Hospital Towels cost so little they
can be thrown away after a single
use. No wonder so many hospitals
are using them in their isolation
wards as a sterile, single-use face
cloth or hand towel. They're far
better than paper.
^ J
Nursery. Nurses find J CLOTH*
Hospital Towels very good as a
burp cloth. Other uses: face cloth
for newborn babies, as a mattress
cover for bassinets and for clean-
ing babies' buttocks. They're far
softer than terry cloth or paper.
4o4H*OHc+^i>Ww?n
CLOTH
hospital towels
Available in white, blue or green in
these three convenient sizes:
Order
Small
Medium
Large
Codas
12'/4'«12!4"
Uy.'x\9'
14'«24'
White
CI 640
CI 630
CI 620
Blue
CI 641
CI 631
CI 621
Green
CI 642
CI 632
CI 622
'Trademark of Johnson & Johnson or Affiliated Companies. O J&J 1968
THE CANADIAN NURSE 19
Whenyourddy
starts at
6 a.m... you re oji
charge duty... ^
you've skimped
on meals...
and on sleep.,
you haven't had^
time to hem
a dress...
makeana^pplepie..,
washyourhair..
evenpowder ^M.
your nose ^
m comfort.^
it's time for a change. Irregular hours and meals on-the-
run won't last. But your personal irregularity is another
matter. It may settle down. Or it may need gentle help
from DOXIDAN.
use
DOX I DAN*
most nurses do
DOXIDAN is an effective laxative for the gentle relief of
constipation without cramping. Because DOXIDAN con-
tains a dependable fecal softener and a mild peristaltic
stimulant, evacuation Is easy and comfortable.
For detailed information consult Vademecum
or Compendium.
HOECHST
PHARMACEUTICALS
3400 JEAN TALON W . MONTREAL 301
DIVISION OF CANADIAN HOECHST LIMITED
names
(PMAC i
20 THE CANADIAN NURSE
(Continued from page 18)
later associate director of nursing educa-
tion at St. Paul's Hospital School of
Nursing.
An active member of the Registered
Nurses' Association of British Columbia,
Miss Lonergan has worked on various task
committees, and has been on the Board
of Nurse Examiners and the Committee
on Nursing Education.
Lydia Wiebe
(R.N., B.N.) has
been appointed di-
rector of nursing ser-
vice for Grace Gen-
eral Hospital, Winni-
peg.
Miss Wiebe gradu-
ated from St. Boni-
face Hospital, Mani-
toba. She received her bachelor of nursing
degree from McGill University, Montreal.
She was formerly supervisor of a medi-
cal nursing unit at the Winnipeg General
Hospital.
^gMMj^ Winnifred M.
^■^ Reid (R.N., B.Sc.N.,
^^\^m U. Alberta H.) has
^®|SW been appointed di-
»..». W rector of nursing at
^ -.ji^j^^^ Burnaby General
^^^^^^^^H Hospital. She began
^^^^^^^^^1 her on
^^^^^^H to
i^^^H^^^^I the retirement of
Mrs. Ruth Laird from that position.
Mrs. Reid was formerly assistant di-
rector of nursing at Edmonton General
Hospital in Alberta. She studied post-
graduate psychiatric nursing at Alberta
Hospital, Ponoka, Alberta.
Named medical-surgical instructor at
the school of nursing, University of
British Columbia, is Caroline Domke
(R.N., Hinsdale H., 111.; B.Sc, Walla Walla
College, Washington).
Mrs. Domke previously worked as staff
nurse, head nurse, and instructor at
Hinsdale Hospital, Illinois, and as head
nurse at Walla Walla General Hospital,
Washington.
Jean M. Hill, dean of the school of
nursing at Queen's University, Kingston,
has announced two new appointments to
the faculty. Mary Elizabeth Johnson
(B.Sc.N., U. Western Ont.; M.Ed.N.,
Columbia U., N.Y.) has been named
assistant professor and Patricia S.B. An-
derson (B.Sc.N., U. British Columbia;
M.Sc.(Appl.), McGill) has been named
lecturer.
Miss Johnson, a native of Manitoba,
comes to Queen's from Rutgers Uni-
versity, New Jersey, where she was ins-
tructor in public health nursing. Before
her appointment to Queen's, Miss Ander-
son was teacher and supervisor of in-
service education at The Hospital for Sick
Children, Toronto; inspector of schools
of nursing in Ontario; and, most recently,
assistant director of the College of Nurses
of Ontario.
Three staff members recently joined
the faculty of the school of nursing,
Lakehead Oniversity.
Liny E. Lyss
fl^ (R.N., Switzerland;
^k B.Sc.N., Chico State
1^^ College, California;
^^ M.Sc.N., U. CaUfor-
.. f nia, San Francisco)
-"" - was appointed as-
sistant professor.
She will be teaching
psychiatric nuning.
Mrs. Lyss went to CaHfomia in 1955
from Switzerland. In her homeland she
had had several years experience as a staff
nurse, head nurse, and supervisor.
She spent some time as assistant pro-
fessor in nursing at Sacramento State
College and came to Lakehead University
from Madison, Wisconsin, where she or-
ganized and implemented an inservice
education program financed by a Nation-
al Institute of Mental Health Grant. The
written report of this program will be
published early in 1 969.
Margaret L Boone
(Reg.N., Mack Train-
ing School for
Nurses, St. Cather-
ines, Ont.; B.Sc.N.,
Lakehead U.) has ac-
cepted an appoint-
ment as lecturer.
After graduation,
Miss Boone worked
as a general staff nurse at The Hospital
for Sick Children, Toronto.
Carole J. Aalto
Faulkner (Reg.N.,
St. Joseph's H., Port
Arthur, Ont.; Cert.
Nurs. Educ, U. To-
ronto; B.Sc.N.
Lakehead U.) was
appointed lecturer.
Following gradu-
ation in 1955, Mrs.
Faulkner spent one year as staff nurse at
Lakehead Psychiatric Hospital, returning
there as instructor in psychiatric nursing
in 1957. In 1965 she joined the staff of
the school of nursing. General Hospital of
Port Arthur, as a teacher in pediatric
nursing, a position she held until accept-
ing her present appointment. C
MAY 1%i'
THIS MESSAGE WILL BE OF SPECIAL INTEREST TO:
ADMINISTRATORS
DIRECTORS OF NURSING SERVICES
IN-SERVICE TRAINING DIRECTORS
NURSING PERSONNEL
UTENSIL PROCESSING i
EQUIPMENT and TECHNIQUES...^
Clean, uncontaminated patient utensils are
essential to any hospital or nursing home's
patient care program. In developing and
improving these programs, most institutions
look to Amsco . . . for we offer the most
complete range of UTENSIL PROCESSING
equipment and techniques available.
Whether your technique involves a simple,
direct processing of individual patient
utensils on the nursing floor . . .
semi-automated or fully automated
processing . . . even terminal sterilization
in Central Service, Amsco has the
equipment to implement it.
We consider patient comfort too.
For example, our Patient Core Console is a
practical method of rinsing and storing
utensils right in the patient's bathroom . . .
ond it warms them to a comfortable
temperature.
Amsco will help you institute the utensil
technique of your choice . . . we have
the full range of equipment and know-how
to do it.
Write for UTENSIL PROCESSING literature.
AMSCO
-BRAMPTON. ONTARIO-
MAY 1%9
AMSCO PRODUCTS ARE MADE IN CANADA . . . FOR THE ADVANCEMENT OF THE WORLD HEALTH SCIENCES
THE CANADIAN NURSE 21
May 14-16, 1969
A continuing education course for
nurses, University of British Columbia.
Theme: Pre-Operative nursing care.
Course fee: $23. Non-registrants may
attend the keynote lecture May 14. For
further information write: Division of
Continuing Education in the Health
Sciences, University of British Columbia,
Task Force Building, Vancouver 8, B.C.
May 21-23, 1969
Canadian Hospital Association, 2nd
national convention and 26th assembly
meeting, Civic Centre, Ottawa.
May 20-23, 1969
Canadian Public Health Association an-
nual meeting. Hotel Nova Scotian, Hali-
fax. Theme: The child in contemporary
society. Write to: Canadian Public Health
Association, P.O. Box 2410, Halifax, N.S.
May 21-23, 1969
Saskatchewan Registered Nurses' Associa-
tion, annual meeting, Bessborough Hotel,
Saskatoon.
May 23-25, 1969
Reunion of Moose Jaw Union Hospital
Alumnae Association, Moose Jaw, Sask.
Members of all classes 1909-69 are wel-
come. Write to: Alumnae Reunion
Committee, c/o Mrs. A. Kitts, 870 Stada-
cona St. W., Moose Jaw, Sask.
May 28-29, 1969
First national institute on Tuberculosis
and Respiratory Disease, Christmas Seal
Auditorium, Vancouver. Sponsored by
the Nursing Section of the Canadian
Tuberculosis and Respiratory Disease
Association, British Columbia branch.
Theme: What's Ahead in Nursing Care of
Respiratory Diseases. For hotel reser-
vations write: Mrs. C.G. LaRiviere,
Willow Chest Centre, 2647 Willow Street,
Vancouver 9.
May 29-30, 1969
Manitoba Association of Registered
Nurses, annual meeting, Brandon General
Hospital School of Nursing Building,
Brandon.
22 THE CANADIAN NURSE
May 28-29, 1969
Registered Nurses' Association of Nova
Scotia, annual meeting, Yarmouth.
June 2-3, 1969
Refresher Course for Inactive Public
Health Nurses, School of Nursing, Univer-
sity of Toronto. Residence accommo-
dation available. Write to: University of
Toronto, Division of Extension, 84
Queen's Park, Toronto 5.
lune 6-7, 1969
Conference for dialysis personnel. Park
Plaza Hotel, Toronto. Sponsored by the
Ontario Dialysis Association. For further
information, write to: Miss Bernadette
Plaus, 280 Wellesley Street, No. 2603,
Toronto 5.
lune 10, 1969
Annual meeting. Association of Nurses of
Prince Edward Island, Charlottetown.
June 9-13, 1969
The Catholic Hospital Association annual
convention, Minneapolis auditorium,
Minneapolis, Minnesota. Theme: The
Evolving Health Care System.
June 9-20, 1969
Seminar for senior nursing executives.
School of Nursing, University of Western
Ontario, London. For application forms
and further information, write to: Miss R.
Catherine Aikin, Dean, School of Nurs-
ing, The University of Western Ontario,
London, Ontario.
June 13, 1969
Annual dinner meeting. Nurses Alumnae
Association of the University of Ottawa
and Ottawa General Hospital Schools of
Nursing, Skyline Hotel, Ottawa. A new
slate of the executive and officers will be
elected.
June 16-18, 1969
Conference on Nursing Education for
visitors to the ICN Congress, University
of Toronto School of Nursing. On June
19 and 20, the School will try to meet
individual requests for special activities,
such as small group conferences, visits to
nursing schools and community agencies.
Write to: The Secretary of the School,
University of Toronto School of Nursing,
50 St. George Street, Toronto 5. Send
name and address, dates of arrival and
departure, and whether there are any
financial problems.
June 21, 1969
50th anniversary celebration. The alum-
nae association of the Women's College
Hospital School of Nursing, Toronto.
Jubilee Dinner and Dance, Inn-on-the-
Park, Toronto.
June 25-27, 1969
Final reunion of The Children's Hospital
Alumnae Association, The Children's
Hospital of Winnipeg School of Nursing.
Held to coincide with the graduation of
the last class from the School of Nursing.
In future, a 10-week program in the
nursing of children will be offered to
students in Manitoba diploma schools.
June 22-28, 1969
International Coun-
cil of Nurses' Qua-
drennial Congress,
Montreal. Fee: $60.
Write to: ICN Con-
gress Registration,
50 The Driveway,
Ottawa 4, Ont.
August 8-10, 1969
Reunion of Moncton Hospital School of
Nursing Alumnae, New Brunswick. Mem-
bers of all classes, 1909-1969, welcome.
Write to: Alumnae Reunion Committee,
c/o The Moncton Hospital, Moncton,
N.B.
October 3-5, 1969
Second Annual Postgraduate Course for
Emergency Room Nurses. Given by the
Chicago Committee on Trauma of the
American College of Physicians and
Surgeons at John B. Murphy Auditorium,
50 East Erie Street, Chicago. The course
will be open to graduate nurses employed
in hospital emergency rooms, industrial
health, and schools.
October 23-25, 1969
Association of Nurses of the Province of
Quebec, annual meeting. Convention
Floor, Queen Elizabeth Hotel, Montreal.
MAY 1969
EVEREST & JENNINGS
Aids to Independence
SAFETY GRIP BATH SEAT
No. C409 — Elevation of seat
permits personal washing in
bath tub. Constructed of
chrome-plated tubing and
fitted with non-slip rubber
tips for extra safety. 6"
high; width at base 14"
%
r
PORTABLE PATIENT HELPER
No. C704 — Mounted on a
strong base, yet easily
moved about. Upright is
adjustable and has a bed
end locking clamp for '
complete stability. Durable
nylon chain and moulded
hand grip designed for
patient comfort.
BEDSIDE COMMODE
No. 11BCS20-91 7 — Simple,
sturdy and inexpensive. Lid
and seat in hygenic white
plastic, frame in easy to
clean chrome-plated steel
tubing. Non-slip rubber tips
on feet. Adjusts from 171/2
to 211/2" ^
1
ALUMINUM LIGHTWEIGHT WALKING AID No. C435NA — Balanced design,
sound construction and non-slip rubber tips assures strength and
stability. Standard model as illustrated, 33" high. Adjustable model,
from 33" to 37".
PREMIER RAISED TOILET
SEAT No. C404 — Increases
toilet height by approx.
51/2". Easily installed and
fits all standard toilets.
Chrome-plated brackets fix
seat to bowl. Seat has
matching white plastic
sanitary shield.
POLYPROPYLENE RAISED -^
TOILET SEAT No. C457 —
Soft and comfortable, this
seat increases height at
front by 5" and 6" at back
Designed for all standard
toilets. Easily cleaned
with boiling water.
With more than 30 years experience in the design and manufacture of wheelchairs, Everest
& Jennings now offers a complete range of equipment for the physically disabled. Every
item is carefully designed and thoroughly tested for maximum patient satisfaction. Only a
few items are shown here. Ask for more details on our full line of AIDS TO INDEPENDENCE.
^.^^'1
EVEREST & JENNINGS
P.O. BOX 9200 DOWNSVIEW. ONT. (416)889-9251
MM 1%9
THE CANADIAN NURSE 23
new products I
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
Vacutainer Needle
This needle simplifies and speeds the
taking of multiple blood samples. Design-
ed for use with B-D Vacutainer blood
sampling system, the needle permits
drawing several tubes of blood from a
patient, using a single venipuncture, with-
out needless loss of blood.
The syringe-like Vacutainer system
also consists of a sealed, evacuated glass
tube that receives a precise measurement
of blood equal to the size of its vacuum,
and a plastic holder for the needle and
specimen tube.
The Multiple Sample Needle is dis-
tinguished from its predecessor by a tiny
shutoff valve on the distal end. The valve
opens with the forward push of the
Vacutainer tube after the venipuncture
and closes as the filled tube is removed.
Additional samples can then be taken
with other tubes using the same needle.
The needles, which come in individual,
sterile blister packages, can be used with
the more than 400 existing types of
Vacutainer specimen tubes, with and
without anticoagulants.
For further information write: Becton,
Dickinson & Co., Canada Ltd., Clarkson,
Ont.
Hospital Communications System
A new hospital communications sys-
tem, called Teleskom, uses a central
operator and a single graphic control
panel to handle all internal communi-
cations linking patients, nurses, nurses'
aides, doctors, and personnel of key
staffs.
Teleskom can reduce patient calls up
to 50 percent by allowing nursing per-
sonnel to spend more time in patient
care.
In addition to permitting direct voice
communications, the control panel in-
stantly shows the location of each patient
calling and then enables the operator to
pinpoint the locations of all nurses and
aides through "presence lights." When the
nurse or aide enters a room she presses
her presence button, which records her
location at the central panel and on a
corridor dome light; she cancels it upon
leaving. The presence lights, shown on a
schematic layout of the hospitals' floors,
enable the operator to spot at a glance
personnel closest to the patient so that
assistance can be provided promptly.
A single operator can handle all inter-
nal calls for a hospital of up to 500 beds,
and can handle approximately 60 percent
24 THE CANADIAN NURSE
Child uses the internal hospital communications system.
of patient requests without disturbing the
nursing staff.
For further information: Tele Tracer
International, Inc., 16 East 40th St., New
York, N.Y. 10017.
Myambutol Tablets
Myambutol (Ethambutol) Lederle is
an oral chemotherapeutic agent that is
specifically effective against actively
growing microorganisms of the genus
mycobacterium, including M. tuberculo-
sis.
It is indicated for the treatment of
pulmonary tuberculosis. It should not be
used as the sole antituberculous drug, but
in conjunction with at least one other
antituberculous drug.
Myambutol is contraindicated in pa-
tients known to be hypersensitive to this
drug and in patients with known optic
neuritis, unless clinical judgment de-
termines that it may be used.
Patients with decreased renal function
must be on a reduced dosage as deter-
mined by serum levels of Myambutol
since the main path of excretion of this
drug is by the kidneys.
The drug may produce decreases in
visual acuity, which appear to be due to
optic neuritis and to be related to dose
and duration of treatment.
For further information write to:
Cyanamid of Canada Limited, Medical
Products Department, 5550 Royalmount
Avenue, Town of Mount Royal, Quebec.
Electronic Stethoscope And Amplifier
This new Electronic Stetho-
scope/Amplifier System is a lightweight,
compact, battery-operated unit ideal for
teaching applications and consultation
purposes.
The Medetron unit can be used sepa-
rately as an Electronic Stethoscope. It
provides both high and low level ampli-
fication (up to several thousand times) of
heart or other chest sounds, fetal heart-
beats, etc. The Medetron permits easier
examination of elderly, obese and coma-
tose patients, and of children. It extends
the normal hearing range and com-
pensates for hearing loss.
The Medetron Amplifier (Model M-5)
permits up to six persons to participate in
the stethoscope examination either as
students or consultants. Used by the
attending nurse, it facilitates close
cooperation with the physician and sim-
plifies verbal description by liim
For further information, write to: Mr.
Marshall Benson, Manager, Sales and Ser-
vice, Eraser Sweatman Ltd., 77 Grenville
Street, Toronto 5, Ont. C
MAY 196 I
in a capsule
Parlez-vous franfais?
Espanol?
Deutsche?
Heading for the ICN next month?
You still have time to brush up (even if
it's for the first time) on one — or
more — of the four official languages. It
always seems friendlier to greet a foreign
visitor in his own language, even if the
sailing after the first "Hello" is not
exactly smooth.
Everything is being done to make the
visitors feel at home in Montreal (al-
though home was never like this! ) There
will be a large, multi-language group of
hostesses, who will add bright splashes to
the Congress with their colored shoulder
sashes: blue for English, green for French,
red for German, and yellow for Spanish.
Hostesses who speak Swahili and
Cantonese - among the many languages
that will be represented by 63 coun-
tries — will meet national groups at
transportation centers, assist delegates in
registering at hotels, hold orientation
meetings for the group, distribute Con-
gress kits, and will be available through-
out the week for help.
You, too, will have many chances to
befriend a bewildered visitor. Perhaps the
guide below will help. Bon Voyage!
r^
-Itai/a
G®^ £n&iis
Brush up on your languages for the ICN Congress.
ENGLISH
FRENCH
SPANISH
GERMAN
book
livre
llbro
Buch
building
edifice
edificio
Bavwerk
church
eglise
Iglesia
Kirche
city
ville
cludad
Stadt
country
pays
pais
Land
good-bye
au revoir
adios
auf wiedersehn
hello, good day
bonjour
buenos dfas
guten tag
hospital
hopital
hospital
Krankenhaus
how are you?
comment allez-vous?
como esta Usted
WIe Geht's
1 am hungry, thirsty
j'al falm, soif
tengo hambre, sed
Ich bin hungrig, durstig
interpreter
interprete
interprete
Dolmetscher
luggage
bagage
equlpaje
Gepack
map
carte
mapa
Landkarte
meal
repas
comlda
Mahl
night
nult
noche
nacht
nurse
inflrmlere
enfermera
Krankenschwester
price
pnx
preclo
preis
room (hotel)
chambre
cuarto
ZImmer
street
me
calle
Strasse
subway
metro
metro
Untergrundbahn
thank you
merci
graclas
danke
today
aujourd'hui
hoy
heute
tomorrow
demain
manana
morgen
yes, no
oui, non
si; no
ja; nein
what time Is it?
quelle heure est-ll?
que hora es
was 1st die uhr
where Is...?
ou est...?
donde esta
wo ist...
woman, Mrs...
femme, Madame...
mujer, senora...
Dame, Frau...
MAY 1969
THE CANADIAN NIIB<:f 9>:
New 11th Edition! Bergersen-Krug
PHARMACOLOGY
IN NURSING
The most widely adopted pharmacology text in Schools of Professional
Nursing, this classic maintains its reputation for excellence in its new 1 1 th
edition. Stressing that the good nurse must understand drug action, the
authors present physiological foundations of drug action, dosages, methods
of administration, abnormal reactions, and other vital information in a
logical, coherent format. This new 11th edition includes sound current
chnical and theoretical findings, the latest drugs accepted for general use, and
an entire new section on psychotropic drugs.
By BETTY S. BERGERSEN, R.N., M.S., Ed.D., Associate Professor of Nursing, College
of Nursing, University of Illinois at the Medical Center in Chicago; and ELSIES. KRUG,
R.N., M.A., Instructor in Pharmacology and Anatomy and Physiology, St. Mary's
School of Nursing, Rochester, Minn, in collaboration with ANDRES GOTH, M.D.
Publication date: June, 1969. Approx. 672 pages, 7"x 10", 50 illustrations and 7
color plates. About $9.75.
The cap
is the
symbol
of your
commitment... the book is
A New Book!
Williams f^ew 6th Edition I
Smith
NUTRITION
AND DIET
THERAPY
Consider this new patient-centered
text for your course in "Nutrition
and Diet Therapy"! Clear,
understandable discussions relate
the chemistry of foods, human body
functions, and physiological and
emotional needs to each other and to
overall nursing care. Sections cover
scientific principles and their clinical
applications, the role of nutrition in
public health, in the basic nursing
specialties, and in clinical
management of disease.
By SUE RODWELL WILLIAMS,
M.R.Ed., M.P.H., Instructor in Nutrition
and Clinical Dietetics, Kaiser Foundation
School of Nursing; Nutrition Consultant
and Program Coordinator, Health
Education Research Center, Permanente
Medical Group, Oakland, Calif.
Publication date: March, 1969. Approx.
684 pages, 7"x 10", 117 illustrations.
Price, $9.85.
PRINCIPLES OF MICROBIOLOGY
Choose an important text for this important course - Principles of
Microbiology is the most widely adopted book in "Microbiology"
courses in Schools of Professional Nursing. Clear, logically oriented
discussions communicate the microbiological foundation your students
wOl use in their clinical experience: concepts of infection, sepsis,
immunity and many other aspects of the disease process. This new 6th
edition includes such timely topics as DNA and RNA, and the body's
protective mechanisms.
By ALICE LORRAINE SMITH, A.B., M.D., F.C.A.P., F.A.C.P., Associate
Professor of Pathology, The University of Texas Southwestern Medical School,
Dallas, Tex. Publication date: May, 1969. Approx. 672 pages, 7"x 10", 207
illustrations. About $10.20.
New 2nd Edition!
Smith
MICROBIOLOGY LABORATORY
MANUAL AND WORKBOOK
An effective sequence of 29 practical exercises, this manual, correlated
with Principles of Microbiology, follows the popular framework of its
previous edition: (1) time, (2) reference sources, (3) intention, (4) tools
(5) technique, and (6) observations. The convenient punched and
perforated format now incorporates an increased number of
illustrations and tabulations.
By ALICE LORRAINE SMITH, A.B., M.D., F.C.A.P., F.A.C.P., Publication date:
May, 1969. Approx. 168 pages, T/t'ii 10>i", 11 illustrations. About $4.25.
A New Book!
Kaluger-Unkovic New 6th Edition!
Griffin-Griffin
PSYCHOLOGY & SOCIOLOGY:
An Integrated Approach to
Understanding Human Behavior
This unique new book can meet your need for
an interdisciplinary approach to the
individual and his behavior in society,
specifically nursing-oriented. The
well-rounded presentation considers man as a
social and psychological whole. Eight realistic
case studies point out that it is often more
important for the nurse to know what kind of
patient has a disease than what disease the
patient has. A complementary Teacher's
Guide and Test Manual will be supplied to
instructors adopting this text.
By GEORGE KALUGER, Ph.D., Professor of
Psychology and Education, Shippensburg State
College, Shippensburg, Pa.; and CHARLES M.
UNKOVIC, Ph.D., Chairman and Professor of
Sociology, Florida State Technological University,
Orlando, Fla. Publication date: May, 1969. Approx.
496 pages, 7" x 10", 42 illustrations. About $10.85.
Jensen's HISTORY AND TRENDS
OF PROFESSIONAL NURSING
The new 6th edition of the most widely adopted text
for "History of Nursing" courses presents the latest
trends and factual information in historical
perspective. Focusing on the relationship of
contemporary events and historical fact, it covers such
timely events as: recent uniting of nurses for higher
wages and economic security; new role of the nurse
cUnician; and place of the community college in
nursing education.
By GERALD J. GRIFFIN, R.N.,
Dept. of Nursing, Bronx
Community College of the City
University of New* York; and H.
JOANNE GRIFFIN, R.N., B.S.,
M.A., Instructor, Div. of Nurse
Education, New York University.
Publication date: March, 1969.
Approx. 360 pages, 7" x 10", 62
illustrations. About $8.75.
New 2nd Edition! Lerch
WORKBOOK FOR
MATERNITY NURSING
The leading workbook for "Obstetric
Nursing" courses, this new edition
presents facts of conception and birth
and techniques and procedues of
maternal care. Punched, perforated
format is convenient for both
instructor and student. Answer book
supplied free to instructors adopting
this workbook.
By CONSTANCE LERCH, R.N., B.S. (Ed.),
Philadelphia, Pa. Publication Date: April,
1969. 2nd edition, 303 pages plus FM
l-VIII, TA" x 10'/4", 33 illus. Price, $5.40.
■FSW^IFe?
86 Northline Road • Toronto 16, Ontario
B.S., M.A., Former Head,
the symbol of ours
New 2nd Edition!
WORKBOOK AND STUDY GUIDE FOR MEDICAL-
SURGICAL NURSING — A Patient-Centered Approach
This carefully revised workbook correlates with the number one text on
Medical-Surgical Nursing, Medical-Surgical Nursing by Shafer, Sawyer,
McCluskey and Beck. Use it to help your students develop essential clinical skills,
communication arts, and problem -solving techniques.
By ALMA L. JOEL, R.N., B.S.N. ; MARJORIE BEYERS, R.N., B.S., M.S.; LOIS S
CARTER, R.N., B.S.N.; BARBARA PURAS, R.N., B.S.N.; MARY ANN PUGH
RANDOLPH, R.N., B.S.N.; and DOROTHY SAVICH, R.N., B.S. Publication date: April,
1969. Approx. 320 pages. 7%" x 1054", 13 illustrations. About $5.45.
A New Boo/(! Young-Barger
INTRODUCTION TO
MEDICAL SCIENCE
This unusual new book for your
practical nursing students and
paramedical trainees explains disease
in basic concepts of cause and effect,
in a semi-programmed format.
By CLARA GENE YOUNG, Technical
Editor and Writer (Medical), retired, U.S.
Civil Service; and JAMES D. BARGER,
M.D., F.C.A.P., Pathologist, Sunrise.
Medical Center, Las Vegas, Nevada.
Publication date: March, 1969. 295 pages
plus FM l-XII, 7" X 10", 11 illustrations.
Price, $8.75.
... a commitment to provide
you, the dedicated nursing
instructor, with a complete line
of quality nursing textbooks,
continually revised, expanded, and
improved to meet YOUR needs,
YOUR high standards.
Before you choose textbooks
for next semester, examine these
. . . see how they can help you
fulfill your commitment to
the future of nursing.
SUGGESTION TO NURSING SUPERVISORS:
Why not a ^UM\:t7®
portable aspirator at
every nursing station!
when time is more important than anything else
in providing positive, safe aspiration to a patient,
this proven Gomco Portable Aspirator is a friend
indeed to patient and nurse.
Be sure you have it when you need it. Keep at
least one on hand at every nursing station. Then
you can get a replacement from Central Supply
for the next emergency.
The Gomco No. 789 "Portable Aspirator" weighs
only 16 pounds, is easily carried, requires less
than 1 sq. ft. of space, provides up to 20" of vacuum.
Ask yaur nearby Surgical Supply dealer for com-
plete information and demonstration or write:
GOMCO SURGICAL MANUFACTURING CORP.
828 E. Ferry Street, Buffalo, New York 14211 D.pi. c-z
OPINION
Too little, for too long,
from federal government
Shirley R. Good, B.S.N., M.Ed., Ed.D.
There is lethargy, bordering on anti-
pathy, on the part of the federal govern-
ment about the education of the mem-
bers of the largest occupational group in
the health professions - nurses. Proof of
this lethargy can be found in the minimal
sums of money that the government now
provides through its National Health
Grants to nurses studying at the bacca-
laureate, master's, and doctoral levels.
Federal funds 1964-68
In 1968, the Department of National
Health and Welfare reported that a total
of S6,3 1 7,3 1 3.30 was granted for nursing
programs between 1964-68.'' (Table 1).
Contrary to usual appropriations, less
money was given for capital grants and
more for bursaries. Excluding monies
allocated to National Health and Welfare
nursing research, over one-half of the
research funds were granted to non-
nurses, presumably for research about
nurses; and faculty salaries listed in Table
1 are not solely for nurse faculty.
In its 1968 report, the Department
stated: "Since 1964 there has been a
noticeable increase in the number of
bursaries granted by provinces for study
at the baccalaureate and graduate level. "2
The report then listed the figures shown
■in Table 2.
From these figures, it is apparent that
there has, indeed, been an appreciable
increase in the number of bursaries
awarded from 1964-65 to 1967-68. How-
MAY 1969
ever, the 304 people who received grants
at the baccalaureate level in 1967-68
represent only 8.5 percent of the total
number of 3,565 nurses enrolled in Can-
adian university schools of nursing bacca-
laureate programs at that time; the 13
nurses who received grants at the master's
level represent only 23.2 percent of the
56 nurses enrolled in master's programs.
Since most Canadian nurses studying for
doctoral degrees are enrolled in depart-
ments other than nursing in Canada or in
U.S.A. programs, no enrollment figures
are available for them.
Student nurses in hospital schools of
nursing and university programs are, of
course, eligible for the Canada Student
Loans that come under the Department
of Finance. However, in view of the
actual cost to the student and her family,
it is questionable whether the amount
provided is sufficient. These loans have
other deterrents: authorization of awards
is dependent on family or guardian in-
come; and there is no "forgiveness"
clause relative to repayment of principle
and interest for those entering a vital
social service profession.
Why this lethargy?
For some reason, government has been
unable, or unwilling, to recognize that
monies granted to nursing education and
Dr. Good is Consultant in Higher Education
with the Canadian Nurses' Association, Ottawa.
research would ultimately benefit the
public. In ignoring pleas for additional
financial support, government has failed
to equate quality preparation of health
personnel with quality health care.
The government cannot explain away
this indifference by pleading that it is
unaware of the nursing profession's needs
for funds for education and research. It
has been kept well informed by the
elected officers and professional staff of
the Canadian Nurses' Association, who
have presented numerous briefs and
appeared personally to point out the need
for financial assistance.
If the government had doubts about
CNA's credibility, it had only to read the
reports of T}\e Royal Commission on
Health Service, 1964, and The Second
Annual Report of the Economic Council
of Canada, 1965, to learn that these
august bodies strongly advocated in-
vestment in human educational resources
at the university level.
Money available for hockey
In briefs presented to the federal
government in February 1968 and Jan-
uary 1969, CNA requested a minimum of
2.2 million dollars for nursing. Included
in these briefs was a request that a
minimum of 5100,000 of this money be
designated exclusii'ely for nursing re-
search in Canadian university schools of
nursing.
The CNA representatives were given a
THE CANADIAN NURSE 29
TABLE 1
Major Areas
Total Amounts
Appropriated in
a Four-Year Period
Capital Grants $1,309,968.96
Professional Training Grant Bursaries
(degree and short courses exclusive
of hospital nursing programs) 3,606,393.13
Nursing Research
To Nurses 92,204.00
To Other Than Nurses 57,927.00
Recruitment Programs 79,428.46
Faculty Salaries in Schools of Nursing 700,891.75
National Health & Welfare
Nursing Research 200,000.00
*Exlucational leave with financial
assistance to nurses of National
Health and Welfare 240,500.00
$6,317,313.30
♦Federal employees are not eligible for assistance under the National Health Grant
Program.
TABLE 2
Number of Bursaries Provided Through National Health Grants to Canadian
Nurses for Study at the Baccalaureate, Master's and Doctoral Levels, 1%4-65
and 1%7-6«*
Fiscal Year
Total
Level of Preparation
Baccalaureate
Master's
Doctoral
1964-65
1967-68
21
328
17
304
4
13
0
1
*Source: Health Insurance and Resources, Health Grant Program, Department of
National Health and Welfare, October, 1968.
polite hearing. To date, no positive action
has been taken by the government, and
there is no indication that it intends to
take action.
However, eight months following
CNA's hearing, the Minister of Health and
Welfare, The Honorable John Munro,
somehow found $200,000 for the 45
members of Canada's national hockey
team to improve their game in the last
half of the 1968-69 season.
No one would deny that it is better to
settle international differences and gain
prestige on the hockey rink or playing
fields than on the intercontinental ballis-
tic missile firing ranges. But there may be
more truth than fiction in what Reyn-
olds, a character in Hugh Atkinson's book
The Games says about international
sports:
"You know what the Olympics are? A
scoreboard for the State Department . . .
it's war in track shoes, and everybody
makes out except the athlete . . . You
know how much they spent on the games
30 THE CANADIAN NURSE
at Tokyo? Six hundred million dollars
— who do you think got it? The politi-
cians, the contractors, the officials, the
chambers of commerce, or some boy
jumping over a bar? . . . You don't eat
medals, boy. All 1 want out of a medal is
a pro football contract ..." 3
This kind of federal investment for the
few does not fit our concept of a "Just
Society." On the other hand, invest-
ment - or the lack of it - in nursing
education and research could affect the
health of thousands of Canadians.
Compare with U.S.
Some may say that comparisons
between Canadian and U.S. government
policies cannot be made because of the
differences in government financing, i.e.,
indirect aid versus direct aid in areas such
as education. There is some validity in
this argument. Even so, one fact cannot
be denied: the U.S. federal government
considers nurses and nursing education to
be vital national resources; to date, the
Canadian government has given little indi-
cation that it shows the same concern.
The most recent evidence of the U.S.
federal government's concern about
nursing can be found in the January-
February 1 969 issue of Capital Commen-
tary. " Former President Johnson request-
ed the U.S. Congress to include in its
1970 fiscal budget $47,730,000 for five
program categories for nurse education.
Of this, $7 million would be allotted for
special project grants to schools of
nursing; $9,610,000, for the student loan
fund; $12 million, for the scholarship
program; $11,120,000, for traineeships
for professional nurses; and $8 million,
for construction grants to schools of
nursing. It is estimated that some 42,000
nursing students will receive educational
financing, 13,000 will receive scholar-
ships, and 29,000 will receive loans.
In comparison to U.S. efforts, the
Canadian federal government has made a
poor showing. In four years it has provid-
ed 13.2 percent of the amount that the
U.S. government is considering for one
year.
More realistic funding needed
How can we persuade the federal
government that more realistic funding is
needed for nursing education and re-
search? One way would be for each of
the 120,186 nurses in this country to
write to her member of parliament and to
the minister of health, requesting that
positive action be taken. Another way is
for the CNA to continue its efforts, as it
undoubtedly will, at the national level.
If we fail to persuade government, we
will fail to have properly prepared nurse
practitioners and leaders for the future.
References
1. Letter from Principal Nursing Officer, Dept
of National Health & Welfare, November,
1968.
2. Ibid.
3. Atkinson, Hugh. The Games. New York,
Simon & Schuster, 1967. p.ll.
4. Capital Commentary. New York, American
Nurses' Association, January-February,
1969. pp.4-5. II
MAY 1%V
do your own thing in
For those of you going to the ICN Congress in June, we present
a very special tourist's guide, which we hope will unveil a Mont-
real you might never have seen — its hidden charms and delights.
You might never go home!
Valerie Fournier and Agathe Legault
;*
The world of Montreal is worlds within worlds; a night world
and a day world, a world of people or of things, of art or of
food. In fact, it is a different world for each person who wishes
to explore and find it.
You can discover a quaint old street in Vieux Montreal; take
a gastronomic tour: sail the vast seas of art in bookshops, art
galleries, theatres; or live dangerously and sample the night life.
Which is your world?
I Food!
The whole world of food awaits you in Montreal. The city is
cosmopolitan in its taste buds, and the delights of cooking from
many countries await you. Each Montrealer has his favorite
restaurants. We asked a few of them to give us their choices.
A Montrealer by adoption, Mme Leon Dussault, loves to
discover intimate, cosy restaurants where the cuisine is excellent
and the price is reasonable. She knows the little places not
frequented by tourists.
Mme Dussault recommends Le Plat d' Argent (1790 boule-
vard des Laurentides 668.6874), where you can order a
complete meal - including veal kidneys, a specialty of the
house - for $3.50. Or, she says, try a charming Httle place
called Le Moli^re (5870 Decarie Boulevard - 739.7970),
where the decor is scarlet: the rich, warm color does wonders
for the digestion, not to mention the spirit!
But above all Mme Dussault loves Le Paesano, a typically
Italian restaurant, (5192 Cote des Neiges - 731.8221) and its
Da Vinci Room with stained glass windows and frescoes of the
great towns of Italy. Again, the price is reasonable, the music
soft, the coffee deUcious. And you'll be served by waiters and
waitresses in the national colors of Italy - white, green, and
MAY 1%9
red. There's an excellent bar in the basement, and in the
summer you can sit outside on one of the two terraces.
A true lover of Montreal is M. Marcel Pare, a businessman
who enjoys good food and wine. He knows the best restaurants
in the city, and he knows many restauranteurs personally.
In the area in which M. Pare does most of his business,
bounded by Bleury, Guy, Sherbrooke and Dorchester Streets,
you will find a profusion of excellent restaurants. Many say this
is the gastronomic center of the city. Here M. Pare will direct
you to Chez Tonneau (1445 Crescent Avenue - 849.9086), a
restaurant specializing in Belgian cuisine, where you'll find a
copy of the famous "Mannekenpis" statue, which draws the
tourists to Brussels' main square. If you want something
different, try the white Belgian sausage, or the eels served on a
bed of greens (anguilles au vert).
But M. Pare would not want you to miss sampling the cuisine
of Vieux Montreal. In this part of the city he takes pleasure in
dining at Les Filles du Roy (415 St. Paul Street
East - 849.6556), whose proprietor, M. Jacques Trottier, is a
friend of his schooldays. You will find superb French-Canadian
cuisine, and picturesque, old-world French-Canadian decor.
French-Canadian satirist Jacques Normand suggests the
Castel du Roy (2070 Drummond Street - 842.8106), where
you're likely to find a varied clientele of artists and business-
men. The "in" people sit downstairs, and it's a fascinating place
in which to eavesdrop. The chefs are skilled in the art of French
cooking.
For a dramatic evening of dining out. La Barre-500 is
recommended (2019 Taschereau Boulevard - 677.0101).
Mrs. Fournier is Public Relations Officer, Canadian Nurses' Association.
Mile Legault is Assistant Editor, L 'infirmiere canadienne.
THE CANADIAN NURSE 31
Mountain Street, with its Jumble of
facades and signs, is one of the liveliest
parts of the city.
Here everything - but everything - comes flambe, so watch
yourself. In the middle of it all stands the maitre d'hotel,
Monsieur Rene; with the flames flickering on his face he looks
like a proud Corsican pirate. He really is Corsican, too, and
knows the secrets of two magnificent salads with Corsican
names: the Santiago and the Bonifacio. He is also master of the
steak au poivre, filet mignon, and shish-kebab — all flaming, of
course.
And if you really feel like living it up, you should try La
Saulaie, on the road to Boucherville. Here the top men in the
city meet to talk business and sometimes even bring their wives.
The decor is sumptuous, and so is the bill.
Shellfish, men, and high altitudes
For lovers of shellfish and all the riches of the sea, the Cafe
Desjardins or Chez Son P^re are often recommended. But the
restaurant with the oldest tradition for these delicacies is Chez
Pauze (1657 Ste-Catherine Street West - 935.9137). The
decor is old-world, with much warm wood panelling.
M. Roger Poitras, printer for The Canadian Nurse, swears
by a sea-food restaurant to the north of the city called Les
Mouettes (1280 Laurentian Boulevard - 744.2845). During
working hours he is continually worried about correct punc-
tuation marks appearing on the pages of this journal, so when
relaxing he loves to eat the dehcious commas made by the
shrimps in his favorite restaurant.
Returning to Catherine Street (1812 Ste-Catherine West)
youTl find Le Paris, gay with its curtains covered with bright
polka dots. It's a small restaurant with a faithful clien-
tele - always the sign of good food. If it's to your taste, try a
specialty: brains in black butter. The prices are modest, but be
warned: if your waiter suggests a small endive salad with your
meal, be prepared to add an extra dollar to your bill!
Another Uttle restaurant that is inexpensive and has a
pleasant atmosphere is Le Caveau (2363 Victoria
Avenue - 844.1624). It's handy to the business hub of
Montreal, and businessmen in the know like to spend their
U THE CANADIAN NURSE
lunch-hours here.
But Agathe Legault, assistant editor of L'infirmiere canadien-
ne, finds the best place for businessmen-watching is the Jardin
du Ritz, Ritz-Carlton Hotel, on Sherbrooke Street West. She
says the handsomest men of this breed are to be found here at
noon in the summer, where little ducklings swim around a
murmuring pool, freshly starched tablecloths flap in the breeze,
and scarlet and black clad waiters perform a ballet while
whisking silently around the tables. Here sit these wealthy men,
oozing culture and maturity, graying at the temples but still in
their prime. The prices, naturally, are high. But in the
afternoon, at tea-time, the atmosphere changes completely, as
the handsome men are replaced by dignified ladies, charming as
they discourse from under flowered hats while picking at
French pastries or cinnamon toast.
For a somewhat more exciting atmosphere, go and drink a
Volcano at the Kon-Tiki (1455 Peel Street) - a Polynesian
restaurant within the Mount Royal Hotel. It's very different.
The Volcano is an extremely expensive drink, but it will take
you a long time to drink it - or it should - as you gaze
fascinated at the strange white fog that pours out of the drink
itself, hypnotized by the exotic decor.
If you care to leave the ground, hop on the nearest
high-speed elevator at Place Ville-Marie. It will transport you to
the top of the world of Montreal, to Altitude 737 - that's how
many feet you are from the city streets. The midday buffet, at
about $5.00, is a feast, and the whole place smells of the sauces,
herbs, and fresh vegetables. And the view! The whole city is at
your feet. By day pulsing with life, by night, when the city
lights up, it becomes a fairyland for adults.
Fashion
In Montreal's world of fashion and of shimmering fabrics,
Raoul-Jean Foure is the prince of Canadian Haute Couture
designers (1390 Sherbrooke Street West - 845.8841). If your
stars are lucky and you ask him nicely, he may invite you to
view part of his collection. But the haute couture comes at a
MAY 1%^
At right: M. Marcel Pare enjoys the
good food and good service of Les
Filles du Roy on Saint Paul Street
with Jacques Trottier, (left), the pro-
prietor.
The delicate steeple of Notre-Dame de
Bon Secours pierces the sky above
Saint Paul Street in Vieux Montreal.
The domed building used to be an
indoor market.
haute price!
If you prefer to make your own clothes, and love the feel of
good cloth, M. Joseph Ascher will welcome you at his fabric
boutique (1448 Sherbrooke Street West - 288.4624). He
supplies fabrics to the best houses of fashion in Montreal, those
of Foure, Mario DiNardo, Lillian Farrar, Marie-Paule. He is
carrying on the tradition of his brother Zika Ascher, who
supplies London and Paris fashion houses. M. Ascher has mills in
Scotland that produce the two great specialties of the house of
Ascher: woollens and prints. For more beautiful fabrics you
might visit France-Couture (Maison Ducharne, 1431 Mountain
Street).
Art, Books, and Hidden Worlds
The worid of art is fascinating and exciting in Montreal. You
will see many different styles of painting, by the famous and
about-to-be famous, and here you might even be lucky enough
to find your picture, the one you always dreamed of for your
living room, at a reasonable price.
Several art galleries are scattered along Sherbrooke Street,
especially on the south side between Peel and Guy. But if you
have the time, go further north near the intersection of Park and
Laurier Avenues, and youll find the gallery L'Art Fran9ais (370
Laurier Avenue West - 277.2179). This gallery is very special,
because it seems to have the knack of discovering painters
before they become famous. Long before people had heard of
Ottawa Painter Henri Masson, L'Art Fran^ais had hung his
works. Vidal, the painter from the south of France, was
introduced to Canada through the gallery. A staircase from a
side door leads to the second floor, which is a treasure trove for
art lovers.
Hidden away in this area of town are other treasures. Nearby
vlAY 1%9
are the coffees and dehcious pastries of Van Houtte. Across the
road you can browse at leisure in the bookshop of Lemeac.
There's plenty of reading matter and your hosts don't mind how
long you take. Right next door is a florist who features rare
plants and a range of African violets. And round the corner on
Park Avenue, M. Lalonde has a fantastic assortment of carpets
on display in his shop.
Talking of bookshops, you should drop in to Flammarion's
at 1243 University Street, near the Place Bonaventure, where
you'll find a wide choice of books reasonably priced. The little
bookshop in Central Station has an exceptional collection of
paperbacks. And the people who live around Cote des Neiges
will tell you nothing can beat the bookshop owned by Renaud
and Bray (5210 Cote des Neiges) for its wide selection,
ultra-modern fittings, and its helpful clerks, who are all
booklovers. We should also mention a little shop called Montreal
Picture Frame (1076 St. Lawrence) where you can sometimes
come up with a real find, since some painters who do excellent
work have their paintings on sale here.
There's a small Italian community well worth visiting in the
North of Montreal, around the intersection of St-Dominique
and Jean-Talon. Its hub is, of course, an excellent Italian
restaurant, Bianca and Franco. Inside you'd think you were in
Italy. On Sundays you even see long tables set up where at least
three generations of an Italian family will gather to celebrate an
anniversary or a first communion.
During the week people from all over the city visit this
restaurant. It has red and white checkered tablecloths, good
wines, more than modest prices; try the delicious escalopes de
veau, the soupe aux pois romaine — a meal in itself - or even
octopus, if you feel daring. The espresso coffee is black and
strong, and cheaper than usual.
Close by is a charming boutique specializing in Italian
porcelain. You should also visit Bianca and Franco's
bakery - try some "Spanish bread" a fine pastry, straight from
the oven. You might also be surprised to see lovely little gifts
for sale at the bakery - delicate cups and saucers, vases, and
THE CANADIAN NURSE 33
Montreal as I see it . . .
Valerie Fournier lives in Ottawa, but often drives to
Montreal for a weekend or even an evening with her Swiss
husband Pierre, who knows Montreal well. This is her
Montreal:
"Mountain Street is the street. Close to the heart of
Montreal, it fairly throbs with the spirit of the city. Chic
boutiques are side by side with discotheques, art shops,
and small, intimate restaurants. It's a place to see and be
seen, a small world of its own.
"One place we always visit for a real French flavor is
Le Bistro. The waiters sport handlebar moustaches and
long white aprons as they serve Pernod and sandwiches
made with crusty French bread and Camembert. Just up
the street is Le Drug, a discotheque which you enter
through (!) a crazy metal sculpture.
"Go the other way and you'll find La Guillotine — ve-
ry dark, with a postage-stamp dance floor and lots of
French music. Within a block of Mountain Street is
perhaps the craziest disco of them all: the Mousse
Spacth^que, where zebra-skin booths, flashing hghts, and
tailors' dummies are part of the decor. But there are
plenty more discos to choose from: Le Crash, the
Whiskey-a-Go-Go, Don Juan, and so on.
"Leaving Mountain Street, I love to have a cocktail at
the lounge atop the hotel Chateau-Champlain. Through
the huge windows Montreal is sprawled below you, and
delicious canapes are served free during the cocktail hour.
If you'd rather drink underground, try the several small
bars sprinkled through the shopping area of Place Ville-
Marie. Each has its own atmosphere; but my favorite is
the Club-Car. It really does look like the inside of an
overgrown train, and there's lots of popcorn at each table.
"For food, we go to the William Tell (2055 Stanley
Street - 288.0139), which makes the best cheese or beef
fondue outside of Switzerland wlule you sit and count the
cow-bells. And for the best — and quickest — smoked
meat sandwich I've ever tasted go to Dunn's Dehcatessen
(892 Ste-Catherine Street West - 866.4377). The food is
cheap, delicious, and it's open all night! "
34 THE CANADIAN NURSE
brightly-colored bon-bons. An Italian woman with skillfu
fingers sits and sews these gifts in tulle; they'll be presented tc
ushers or guests at Italian weddings or christenings. Also in thii
area you can buy wine in bottles of all sizes and shapes, in thai
raffia cradles, or pick up fresh vegetables at a bargain in tlu
market.
History
Much of the history of old Montreal is concerned with
the Church. For instance, take the tiny church of Notre-Dame
de Bonsecours on St. Paul Street, one of the first churches to bt
built in Montreal. If you don't suffer from vertigo you car
climb up inside the steeple for a panoramic view of the port o
Montreal and of the island of Ste-Helene.
In the basement of this ancient church there's an exhibitior
depicting the Hfe of Marguerite Bourgeoys, who founded th(
congregation of Notre-Dame in Canada. The scenes of her life
from her cliildhood in France to her death in New France, are ;
marvellous reconstruction of the past. The church itself is full o
little nuggets of iiistory; you can pick out here and there th(
names of the pioneering clergy who came to the New Woric
centuries ago, or you can marvel at the workmanship of age;
past.
Right at the east end of Sherbrooke Street is a place tha
most Montrealers themselves do not know. Called the Chapeih
de la Reparation, it's run by the Capucin fathers. In the ground:
you will find a copy of the stations of the cross, a peacefu
wooded grove, and a baroque-style chapel, where several masse:
are celebrated on Sundays. There's also a restaurant and an ini
with rooms for pilgrims (3650 49th Avenue - 642.5391 ).
In the heart of Montreal there is a Carmelite monastery
situated in a quiet residential street lined with trees (351 Carme
Avenue - 271.6957). The grounds of the monastery an
peaceful and beautiful, the chapel itself is impressive, ant
MAY 196
Far left: She could be in Paris, but Valerie's actually in Le
Bistro, on Mountain Street, being sen'ed by a waiter clad in the
uniform of the house - moustache and long white apron. Be
turned - you 'II have to practice your French here!
At left: It's not Montmartre, but Place Jacques Cartier in Vieux
Montreal, with its flower market and cobbled streets.
Above: Monsieur Rene, the Corsican maitre d', ducks to avoid
the massive flame that illuminates La Barre-500, a restaurant
where everything comes jlambe.
contains many objects of art. Admittance is from 8.00 a.m. to
10.00 p.m., and vespers are sung eacli day at 4.30 p.m. from
behind the grille.
Sixteen nuns live enclosed in these cloisters. They used to
come from all parts of Canada and from the United States, but
now are mainly from Montreal. They have designed cards for all
occasions that you can buy at a little shop, as well as plaques
made out of leather or plastic and mounted on wood or jute.
Flowers and night life
Montreal is filled with parks and gardens, but the one that
stands out is the Botanical Garden (4101 Sherbrooke Street
East). At the end of June the gardens are a riot of lilacs and
peonies and petunias. Above all, you must see the greenhouses
with their magnificent permanent collection of exotic and
tropical plants. The garden is open in tiie summer from 9.00
a.m. to sunset and there is a restaurant if you're hungry.
Night-clubs are well advertized in the newspapers, but we'd
like to recommend two very different, very French, "boftes a
chanson" that feature good singers. The first is Chez Clairette
(1456 Mountain Street H45.0690), where there are always a
couple of singers, and where Clairette herself - whom every-
one calls "'Motiier Superior" infects the whole audience with
joie de vivre. Le Patriote (1474 Ste-Catherine Street
East - 522.0626) is equally well-known for the quality of its
entertainers, but you should make reservations to be sure of a
place, as it's always popular.
And, of course, there are many cinemas and thea-
tres you'll easily be able to find information on what's
playing at such places as La Poudriere. the Rideau-Vert, and the
Place des Arts.
Montreal is a fabulous world, wide open for exploration,
which you will never quite finish discovering.
MAY 1%9
Montreal as I see it . . .
Mile Eliane LacroLx, translator for the Canadian Nurs-
es' Association, is an Ottawan, New Yorker, Quebecker
and Montrealer - in other words, she loves cities. She
talks of the Montreal she loves:
"For me, Montreal is the mountain that surveys the
city, from where you can see the port, and even
Mont-Beloeil and the mountains of Saint-Hilaire and
Rougemont. It is the mountain with its footpaths, where
it's pleasant to walk on a Sunday morning before it
becomes too crowded; the mountain with its Beaver Hill
Lake where the children, and sometimes even the grow-
nups, launch their little sailing ships, just as in New York's
Central Park or in some of the pubhc gardens in Paris.
You'll find many sculptures adorning the park on the
mountain: they are a legacy of an international sympo-
sium of sculpture organized by Montreal's Mayor Jean
Drapeau some years ago.
"Montreal is listening to the open-air summer concerts
given on the mountain by the Montreal Symphony
Orchestra. There are also concerts in the Maurice Richard
arena, where you can listen to your favorite arias sung by
local talent, while you eat cheese and sample the wines of
the well-stocked cellars of the Hel^ne de Champlain
Restaurant, owned by the City of Montreal.
"Montreal is also the International Festival of Music,
which takes place for two weeks each summer. One year
this festival is devoted to the piano, the next to the violin,
the next to song. And then it's the piano's turn again.
"It is the Dominion Park with its exhibitions of
paintings in the open air and its cafe Guinguette where, in
summer, you can sit outside and snack at tables covered
with checkered tablecloths.
"It is the Dow Planetarium with its awesome spec-
tacles, the Hotel-Dieu Hospital founded by Jeanne-Mance.
the Montreal Seminary flanked by its two pillars on
Sherbrooke Street.
"Montreal is also a visit to the locks of Saint-Lambert
de la Voie Maritime, opposite the city, where you can
watch ocean-going vessels being lifted up before your eyes
and sent on their way to sea," rn
THE CANADIAN NURSE 35
Nurses for nursing
Everybody agrees — patients, doctors, administrators, trustees, and particularly
nurses themselves: the nurse belongs at the bedside. Nurses must be freed,
then, from duties that take them away from the bedside. One new concept —
that of ward manager — is being tried at The Hospital for Sick Children, Toronto.
It permits head nurses, too, to return to patient care.
Helen Palmer
The hospital head nurse faces a
seemingly impossible variety of roles:
personnel manager responsible for morale
and development of staff under her admin-
istration; chief nurse responsible for the
overall quantity and quality of care of a
number of patients; coordinator of physi-
cian-ordered treatments administered by
the many members of the medical team;
and general arbitrator for everybody's
problems. Too often she has no time for
her nursing role.
The smooth functioning of the pre-
sent-day wards depends on the head
nurse's administrative ability and physical
stamina. She must be the pivotal link in
the health team, yet she may be frequent-
ly interrupted in her duties. One study of
head nurse activities showed that she is
interrupted an average of once every 30
seconds to answer innumerable questions
and solve the problems that arise on an
active ward.
A few years ago, the Massachusetts
General Hospital tried to solve the pro-
blem by delegating non-nursing ward
administrative functions to a unit man-
ager; this freed the head nurse for her
primary function - care of the patient.
The concept of the unit manager is
based on the recognition that the hospital
functions smoothly with a separation of
administrative and medical functions. The
hospital administrator coordinates the
functions of the hospital and allows
medical personnel to concentrate on their
36 THE CANADIAN NURSE
primary function — care of the sick.
This system has worked well. The
assumption, then, is that a ward would
benefit in a like manner by extending
management into the ward system, thus
relieving the head nurse of her non-
nursing functions.
The validity of such a plan was tested
at The Hospital for Sick Children, Toron-
to, as a pilot project October 1966 to
October 1967.
Pilot project carefully planned
The experimental project for a ward
manager system was set up and im-
plemented by the medical nursing depart-
ment. The project itself was tried with
one ward manager for two adjacent wards
during the day for eight hours, five days a
week. The ward manager was directly
responsible to the hospital's coordinator
of medical nursing.
The ward manager worked as a partner
with each of the two head nurses. It was
important in the beginning that she
cooperate with departments such as
pharmacy, diet kitchen, and laboratory.
The housekeeping department, being
autonomous, allowed the ward manager
no direct control over housekeeping staff
within the two wards; cooperation, how-
Miss Palmer is Coordinator of the Medical
Nursing Department of The Hospital for Sick
Children, Toronto. This article is based on the
official report of research into the use of a ward
manager at that hospital.
ever, was excellent.
A job description outlined the main
functions and suggested a way to cate-
gorize duties: managerial and nursing.
The managerial duties were described in
more detail than were nursing duties. The
analysis attempted only to show how to
avoid overlapping.
The ward manager was responsible for
nursing aides and clerical personnel. At
The Hospital for Sick Children, the nurs-
ing aide is a non-professional worker, who
is trained on the job and who carries out
selected routine duties under the direc-
tion of the ward manager. She does not
give direct patient care.
The duties of the ward manager were:
• To cooperate with the head nurse and
her staff in providing a clean, tidy,
pleasant environment as economically as
possible.
• To handle the budget for the floor and
to consider carefully all expenditures.
• To maintain all ward supplies, equip-
ment, and furnishings and to supervise
their use.
• To coordinate the departments of
housekeeping, pharmacy, diet kitchen,
laboratory, and x-ray to facilitate good
patient care.
The qualifications of the ward man-
ager are important because she must be
able to adapt to and cooperate with the
head nurse. She must be intelligent, have
above average initiative, and be able to
organize. She must be firm courteous,
MAY 1%^'
pleasant, consistent, and skilful in com
municating with people. Previous training
or experience in management skills is a
valuable asset. Whether the ward manager
is a man or woman seems unimportant.
The salary for a ward manager probably
should be on a par with that of the head
nurse.
A threat to the nurse?
The person most affected by the ward
manager system is the head nurse. She
loses many of her daily routine duties and
is required to change the emphasis in her
functions.
In the past, her administrative role has
tended to take precedence over patient
care and personnel supervision. Although
the responsibility of housekeeping and
clerical duties has to some extent been
taken over by auxiliary staff, the head
nurse was still left with so many adminis-
trative duties that her position was fre-
quently dubbed "nursing the desk" rather
than "nursing the patient."
A curious status has been attached to
"nursing the desk." Nurses were rewarded
for managerial functions so they naturally
gravitated toward this role.
Reorientation of responsibility may
prove difficult during the transition
period. Obviously, duties and responsibi-
lities of both head nurse and ward man-
ager need to be carefully defined so that
the head nurse does not feel that the loss
of desk responsibilities has lowered her
prestige and status. She must clarify her
position in her own mind. Rather than
dissipate her newly found time on such
minor duties as transporting a patient to
x-ray, delivering specimens to labora-
tories, or making empty patient beds, the
head nurse must use the time she gains by
planning and directing the nursing func-
tions of her ward.
In establishing this system in The
Hospital for Sick Children, the head nurse
was asked first of all to differentiate
between the functions related to nursing
and the purely administrative ones. In
this way she became involved in assessing
her own role as a nurse. Because she was
MAY 1969
now able to concentrate on this aspect of
her job, she began to see the possibihties
for improved patient care.
In the pilot project, fortunately, both
head nurses believed in nursing; both
welcomed the opportunity to become
involved in improving team nursing, to
promote better team conferences, and to
develop nursing care plans that would
provide individualized, personalized, and
coordinated care.
Involvement of all staff
The coordinator of medical nursing
held meetings with unit staff to interpret
the ward manager system and to give the
nursing staff an opportunity to express
their feelings. Throughout the entire plan-
ning stages, nursing staff expressed am-
bivalence; although they looked forward
to the change, many nurses doubted the
feasibility of the project. Most nurses
regretted that there had not been more
time in the past to concentrate on quality
nursing care and on the smooth operation
of the nursing teams on the floor; if the
ward manager system met these needs,
then it would be welcome. It was under-
stood from the beginning that the role of
the assistant head nurse would become
redundant with the new program
Before the system was begun, it was
absolutely essential that interpretative
sessions be held for all department heads
with whom the ward manager would be
in direct liaison in her managerial func-
tions. Memoranda were sent to other
departments informing them of the new
experiment and requesting appointments
to discuss it. In this way the ward
manager could personally meet each
department head; all displayed interest
and enthusiasm.
The medical physician-in-chief present-
ed the project to the medical staff as a
group and enlisted their support for the
study. More detailed discussion was held
individually with the physicians respon-
sible for the floor involved in the experi-
ment.
A resource manual was prepared; it
included the outline of projected duties
of the ward manager, the ward clerks, and
the nursing aides, and a copy of all
available literature on ward manager pro-
grams. Quotas were established for
central supply room supplies, and surgical
and stationery supplies. Changes were
made in the handling of linen supplies,
and in the set-up of utility rooms, nursing
station, and head nurse's office.
Problems of transition
In the beginning, daily conferences
were held for the ward manager, the head
nurses, and the coordinator. After the
program was underway, conferences were
held weekly. Eventually, conferences
were called only as necessary. Short daily
sessions between the head nurses and the
ward manager maintained the program.
Doctors as well as nursing staff were
affected by the introduction of the ward
manager. The doctor was required to
relate to two people, the head nurse and
the ward manager. For this reason, some
hospitals have placed the ward manager
under the supervision of the head nurse;
other hospitals have made them equal.
Medical staff had suggested that the
scheme might produce a two-boss ward if
they were made equal, but it was decided
that only if the head nurse was comple-
tely relieved of responsibility for non-
nursing functions would she in the final
analysis be allowed to carry out her real
function - nursing. The ward manager
was, therefore, placed in partnership with
the head nurse. If there were conflict, it
was clearly understood that any final
decision affecting the patient in any way
was to be left to the head nurse.
It would be unrealistic not to acknowl-
edge that there were problems during the
transition period. Probably the most
acute problem related to doctor's
orders - a point of comnmnication
regarding the patient. It was difficult for
the head nurse to adjust to the fact that
the responsibility for transcribing doc-
tors' orders now came under ward man-
agement; the nurse's function was now to
review, to interpret, to implement, and to
follow through.
THE CANADIAN NURSE 37
A lesser problem presented itself when
the ward manager was ill or on vacation
and her activities were taken over by the
nursing staff. On the other hand, when
the ward clerk was ill or on vacation, the
ward manager picked up the clerical
duties. Before the ward manager system
came into being, the head nurse routinely
filled all gaps.
immediate results
Results of our pilot project have been
encouraging. We have proven that many
non-nursing activities, which had original-
ly occupied too much of the head nurse's
time, can be successfully transferred to
the ward manager. There are many ex-
amples:
• The ward manager now supervises the
use of laundry and adjusts the quotas.
• Before the advent of the ward manager,
the head nurse often delegated the order-
ing of pharmacy supplies to one of the
nurses; her supervision, however, was
frequently necessary to ensure adequate
but not overstocked suppHes.
• The laboratory departments are now so
extensive that in the past as much as one
hour of the head nurse's time has been
required to trace the particular laboratory
specializing in a certain test and then
arrange for the test to be done. Now the
ward manager finds the correct labora-
tory, books the test, and follows through
by seeing that the specimen reaches the
correct laboratory, and finally by filing
the results in the patient's chart.
• Strictly clerical work involving booking
of x-rays or operations was extensive and
time-consuming, often requiring more
than one phone call. The ward manager
now arranges bookings, records them in a
book, and checks them off as they are
completed. This provides a fast check for
both doctors and nurses.
• All maintenance repairs, such as
requests for the repair of blinds, curtains,
plumbing, or lights had to be channelled
through the head nurse. Now the ward
manager routinely checks all such items
and requests repairs when necessary.
• Although items from central supply are
38 THE CANADIAN NURSE
TTie unit manager works closely with the head nurse on the unit.
used only by nursing personnel, it does
not require nursing skill to order them; a
specific quota exists and no judgment
under ordinary circumstances is required
to order them These supplies are now
maintained by the ward manager.
• The supervision of the work of ward
clerks and nursing aides, although it was
housekeeping and clerical and not nurs-
ing, was time-consuming. Supervision is
necessary, however, if these people are to
work at full capacity. The head nurse was
not always available to provide this es-
sential supervision. This, also, is now the
responsibility of the ward manager.
The head nurse, relieved of these
onerous tasks, is better able to con-
centrate on her primary duty of planning
and supervising nursing care. This may
best be illustrated by the following ex-
amples.
First, the greater part of nursing care
requiring supervision is done in the morn-
ing. The preparation of patients for tests
medications, treatments, and genera
organization that sets the tone of the da>
is done in the first two to three hours o)
the day. This had been the time of da>
when the head nurse found herself check
ing pharmacy, supplies, and supervising
clerical work. Now, this time of day i:
relatively free for her to supervise nursin§
care.
Second, all calls are screened by tht
ward manager during doctors' rounds anci
interruptions are kept to a minimum
This allows the head nurse to give un
divided attention to the discussion o
plans for the care of patients as outlinet •■
by the doctor.
Third, rather than spending timt
stamping requisitions, making bookings
MAY
jngs
19M
and transcribing orders, the head nurse
needs only to oversee the orders. The
remaining time is spent in supervising the
nursing care required by the new orders.
Fourth, patients and parents have
come to know the head nurse as a person,
a factor that has increased their confi-
dence in the nursing care. The head nurse
now has time to keep both the patient
and his relatives informed about his con-
dition. The psychological benefits of this
rapport cannot really be estimated.
Fifth, the head nurse can now leave
^her ward for meetings with the knowl-
edge that the general staff nurse left in
charge would not become overladen with
paperwork. She is free to supervise pa-
tient care; the ward manager is available
for all other activities, and the organ-
ization of the ward does not disintegrate.
The results also have been shown in
improved team nursing, better team con-
ferences, and the development of a plan
for personalized care. Nurses participating
in the pilot project have shown approval.
Many doctors have said that they have
gained from the ward manager system.
They have the undivided attention of a
head nurse uninterrupted now by routine
matters of ward administration.
Another group who believed they
.profited were those who supplied the
auxiliary services. Their association with
the ward was made more efficient be-
cause all communication was now
channelled through one person, the ward
manager.
I Long-term results
It is hard to evaluate quality nursing
care objectively. We would like to be able
to say the nurses did spend the time
gained in improved patient care. How-
ever, in physical care, such as bed baths,
intravenous administration, and med-
ication, little change was noticed. The
emotional, social, and mental needs of
the children, however, were much better
met.
In addition, the nursing care plan
improved the services of the occupational
therapist, the physiotherapist, the med-
MAY 1%9
ical social worker, the school teacher, the
nursery school personnel, and the public
health nurse. Prior to the project, full use
had never been made of the facilities they
offered. For instance, the school teacher
had in the past often identified an indivi-
dual cliild's problem, but no team meet-
ings were arranged routinely for dis-
cussion. This lack of communication
precluded comprehensive nursing care, so
vital to the child's recovery, psychologi-
cally as well as physically.
At the end of the year's experiment,
the nursing department concluded that
the project justified its extension into all
wards. It is being introduced in stages. At
present the ward manager system is auto-
nomous within nursing, under the direc-
tion of an administrative assistant of the
hospital who is responsible to the director
of nursing.
Perhaps not for all
The ward manager system is not
necessarily suited to all hospitals or all
hospital situations. For instance, the
Frieson type of hospital with a built-in
system for keeping the wards supplied
with everything needed for patient care
probably would not benefit from this
system, nor would a small hospital unsuit-
ed to unit operation.
Within a single hospital, all areas might
not benefit equally from the ward man-
ager system. The type of care required
and the size of the ward involved are
factors to be considered. Economics is
also a factor. At The Hospital for Sick
Children, it was found that one ward
manager can handle two wards, obviously
a financial saving.
This is a changing world in a computer
age. We must be aware of the weaknesses
in our particular hospital system, the
necessity of continually reexamining and
reassessing methods of delivering nursing
care. We must take steps toward construc-
tive change. What was satisfactory and
perhaps efficient 20 years ago may not be
so today. It behooves us, as nurses, to be
aware of modern trends, of possible
improvements not only in nursing tech-
niques but also in ward management.
To predict the continuing success of
this program is difficult. Problems such as
staff turnover have not been solved. Like
all other systems, success or failure
depends on the enthusiasm or lack of it
shown by the people involved. Resistance
to change is one of the major hurdles to
be overcome. Continuing education is
needed to make this transition easier and
more effective. The head nurse who is
thoughtfully involved in nursing takes
advantage of her new found time to
stimulate nurses to return to nursing that
focuses on the patient and his needs. The
ultimate success of the ward manager
system lies in the creating of a balance of
trust between the head nurse and the
ward manager.
Bibliography
A Study of the Functions and Activities of
Head Nurses in a General Series -
Memorandum No. 5, Research Division,
Department of National Health and Welfare,
Ottawa, 1954.
Brody, N.A., Herman, J.J. and Warden, A. The
unit manager. Hosp. Manag., June, 1966,
pp. 30-36. D
THE CANADIAN NURSE 39
Cytology screening —
a program that works
In 1949, an intensive campaign to detect early cases of carcinoma of the cervix
was begun in British Columbia. That province now has the lowest incidence
of invasive carcinoma of the cervix in the world. This article will help nurses
to be well-informed about the value of screening programs so that they can help
to reduce further the incidence of cervical cancer.
Margaret A. MacLean, B.N.
Cancer of the cervix has a long latent
period; it may take 10 to 15 years to
progress from the pre-invasive stage of
carcinoma to the clinical disease of inva-
sive carcinoma of the cervix. Statistics
indicate the average age of onset of
cervical cancer - as carcinoma in
situ - is 37.7 years. The average age of
all cases found with in situ carcinoma is
42.3 years; microscopic invasion of cer-
vical tissue, found between onset of in
situ and the invasive stage is at 46.2 years;
the occult stage of invasive carcinoma is
found in women at 49 years; and the
clinical invasive stage is 52.1 years. This
indicates an average 1 5-year difference
between onset and clinical disease.
A free cytology screening program
aimed at early detection and control of
cancer of the cervix was begun in British
Columbia in 1949. BC now has the lowest
incidence of invasive carcinoma of the
cervix in the world.
The theory was that in situ carcinoma
of the cervix is a precursor of invasive
carcinoma and that its removal would
Miss MacLean is Supervisor, Inservice Kduca-
tion. Department of Nursing, The Vancouver
General Hospital. She is a graduate of the
Providence Hospital, Moose Jaw, Saskatchewan;
served with the RCAMC in Canada and over-
seas', received her B.N. degree from McGill
University, Montreal. Prior to her present posi-
tion she was the Gynecological Clinical Instruc-
tor at Toronto Western and Vancouver General
Hospital Schools of Nursing.
40 THE CANADIAN NURSE
result in a significant lowering of mor-
bidity and mortality from carcinoma of
the cervix. i
During the early years, growth of the
program was slow; by 1955 only 3
percent of the population had been
screened. Since then, the program has
expanded steadily. By the end of 1966,
approximately 75 percent of all women
20 years of age and over, within the
province, had been tested at least once
for carcinoma of the cervix. At present
(Dec. 1968), approximately 1,300 smears
arrive in the clinic daily.
Screening procedure
Most specimens to be examined are
"Pap" (Papanicolaou) smears. These are
prepared by scraping cells from the
cervix, placing the scrapings on two glass
slides, and fixing the smear with an
aerosol, water-soluble fixative (Figure 1).
The slides are then sent to the Central
Cytology Laboratory of The Vancouver
General Hospital and The British Colum-
bia Cancer Institute for processing and
interpretation. Ninety percent of speci-
mens are submitted by private doctors.
The slides are examined and a notifi-
cation is sent back to the doctor. The
classification is:
Class I ishowing normal cells.
Class II : shows some atypical or
inflammatory cells.
Class III: shows suspicion of malig-
nant change.
MAY 1969
TIlis photograph shows the Cytette, a
cytological specimen collection pipette,
capped, ready for insertion into the
nmiling container. The Cytette is a
method of collecting cells from the
vagina and cervix - a technique that can
be carried out by the patient at home.
Class IV: shows malignant cells.
Class V : is conclusive for malig-
nant cells.
Classes I and II require no further
investigation. Class III calls for a repeat
cytology smear. Should the repeat smear
verify the first report, then a cone biopsy
is recommended. Classes IV and V call for
investigation - either a cone biopsy or a
punch biopsy - and treatment.
Cone biopsy is diagnostic, but in early
stages may also be sufficient treatment as
well. In a cone biopsy, a cone shaped
section of the cervix is removed (Figure
2). Examination of sections (microscopic)
of the cone biopsy indicates whether the
lesion is on the surface (pre-invasive) or
has penetrated the surface (invasive).
Complete examination of the sections
will provide a map giving an accurate
picture of the extent of the lesion.
When the disease penetrates beyond
the vaginal portion covered with squa-
mous epithelium, it is no longer pre-
invasive or in situ carcinoma. At this
stage, the cone biopsy is not only a
diagnostic measure but also a surgical
cure.
Records obtained from cytology
smears and cone biopsies are kept on case
cards in the Cytology Department of The
British Columbia Cancer Institute. Each
subsequent examination is recorded.
There, a complete follow-up is carried out
on each case. There is correlation bet-
MAY 1969
TABLE 1
Incidence of Clinical Invasive Squamous Carcinoma of |
Cervix in Women Over age 20
Population
in
Thousands
Clinical Invasive Carcinoma
Year
Total Cases Incidence
1955
422.9
120
28.4
1956
436.7
119
27.2
1957
460.9
120
26.0
1958
473.0
112
23.7
1959
478.8
108
22.6
1960
486.4
96
19.7
1961
496.0
115
23.2
1962
503.0
78
15.5
1963
513.0
98
19.1
1964
526.8
86
16.3
1965
543.2
80
14.7
1966
566.5
77
13.6
Correct at J
an. 1968.
ween cytology and tissue diagnosis as all
biopsy and surgical specimen reports are
reviewed.
Source sheets detailing the age and
cytological history have been made out
on all cases since 1958. These are submit-
ted to the Provincial Division of Vital
Statistics for collation of population
screening data. The data from all positive
cases are kept on punch cards in the
statistical research department and eval-
uated separately and in more detail.
It is most important that the private
doctor is responsible for a follow-up on
these cases. A letter is written by the
cytologist to the patient's doctor request-
ing an annual repeat examination on
those who have positive cytology. If
smears are not received by the date
requested, two subsequent letters are sent
at two-monthly intervals. If there is still
no response, the public health nurse
contacts the patient directly to ask her to
go to her doctor for a repeat cytology
smear.
All new cases of invasive carcinoma
have been kept in a separate registry since
1955. This register is compiled from
province-wide lists submitted by the Di-
vision of Vital Statistics, as cancer is, by
law, a reportable disease. These Usts are
obtained from all pathologists in the
province who diagnose carcinoma of the
cervix by biopsy or autopsy and also
from lists from the treatment centers. By
these means, recurrent disease, errors in
notification, name changes and other
causes of duplication can be detected.
Effects of program
These registries provide a reasonably
reliable annual incidence rate for invasive
carcinoma. This is important as the in-
cidence rate is the first that one might
expect to be affected by the screening
program [Table 1).
In 1965, an article of mine reported
that the drop was from 28.4 cases per
100,000 in 1955 to 15.5 cases per
100,000 in 1962 - a drop of 45.5 per-
cent in seven years. I called it "statis-
tically significant" then. 2
The incidence rate has now dropped to
13.6 per 100,000, or 48 percent of the
basic rate in 1955!
The second or the ultimate goal is a
reduction in the mortality rate. In the last
four years, there has been a drop, which,
if maintained, will be significant (Table
II.
A more effective way of measuring the
results of a screening program is to
compare the annual incidence of invasive
disease in the segment of population that
has been screened with the unscreened
segment (Table III). These figures in-
dicate that the numbers of women devel-
oping invasive carcinoma of the cervix are
six to seven times greater among those
who have not had screening tests done.
Table III also shows that the popu-
lation previously screened is generating
THE CANADIAN NURSE 41
TABLE II
Crude and Refined Mortality Rates for Squamous Carcinoma of
the Cervix in the Province of British Columbia
Population CRUDE REFINED
in Thousands No. of Rate No. of Rate
Year over Age 20 Deaths 1/100,000 Deaths 1/100,000
1958
473.0
65
13.5
54
11.4
1959
478.8
65
13.6
51
10.6
1960
486.4
50
10.3
48
9.9
1961
496.0
66
13.3
51
10.25
1962
503.0
81
16.1
65
12.9
1963
513.0
60
11.7
57
11.0
1964
526.8
65
12.3
56
10.6
1965
543.2
56
10.3
42
7.7
1966
566.5
66
11.7
44
7.8
1967
592.4
52
8.8
38
6.4
Correct as at June, 1968.
CRUDE rate— from the Division of Vital Statistics.
REFINED rate— each case is reviewed and evaluated by the Cytologist. He
has investigated to determine if the cause of death was carcinoma of the cervix.
The reports, both hospital records and the B.C.C.I. records are thoroughly
investigated. There have been cases where the original diagnoses were not
carcinoma of the cervix. The B.C.C.I. Registry has been kept since 1950.
new disease at a rate of about 4.5 per
100,000 whereas the rate in the unscreen-
ed population is about 29 per 100,000
which is very close to the basic incidence
rate in 1955.
Cases were detected at an earlier clini-
cal stage in the screened than in the
unscreened and also the mortality rate is
less. At present, it is 22 percent compared
to 39 percent.
One important fact is that, as a result
of the screening program, 3,667 cases of
pre-clinical squamous carcinoma of the
cervix have been detected that would not
have been detected without a screening
program as they were found mainly by
cone biopsies on clinically negative but
cytologically positive cervixes.
Some problems encountered
The cytology program, to be effective,
must involve all women in the area. This
is always difficult in any large-scale,
voluntary-population study, when the
participation depends, in part, on the
socio-economic and educational levels in
the community.
In one study on the British Columbia
program it was found that the better
educated and informed women were the
ones being reached. 3 The woman who
takes advantage of a screening program is
the same one who would present herself
to the doctor with very early symptoms
of the clinical disease. Conversely, the
woman who would ignore symptoms as
42 THE CANADIAN NURSE
long as possible (hoping they would go
away), would also ignore the screening
program. For this reason the nurse, as a
community health teacher, must use
every opportunity to reach and teach all
women. To be effective, the nurse herself
must be very well informed.
Only about 75 percent of the female
population in British Columbia has been
reached; the aim is to reach all women.
Cytology is not a perfect diagnostic
tool; it is estimated that there is at least a
10 percent false negative error. Because
of the spectrum of this disease there is a
difficult zone of atypicality between
dysplasia and in situ carcinoma which is
reflected in cytology, so it is often
impossible to know when in situ carci-
noma actually begins. Also, smears can be
badly taken and miss the disease.
New developments
The screening program so far has
depended mainly on the results of only
the Papanicolaou smear taken by the
doctor during a vaginal examination.
Currently there is another method (still
unknown and somewhat controversial)
being introduced to obtain cells. In this
test, a "Cytette" is used. The Cytette is a
cytological specimen collection pipette
containing 6 cc. of pink, isotonic, cyto-
logical irrigation solution, which also
fixes the cells until they can be examined.
This method is carried out by the
patient at home, and there is no need for
a vagina] examination procedure in the
doctor's office. The patient is told to
obtain the specimen at least one week
after menstruation, and to avoid douch-
ing or sexual intercourse for 24 hours
prior to obtaining the specimen. She is
instructed to obtain cells by inserting the
stem of the Cytette into the vagina,
squeezing the bulb, and injecting the
solution into the vagina. Then, by moving
the bulb from side to side and releasing
the pressure on the bulb, the solution can
be aspirated back into the bulb. It is very
important that almost all solution is
collected back into the Cytette. When it
is removed from the vagina, the solution
in the bulb will now appear yellow (or
amber) in color. The cap is replaced
firmly and the Cytette is returned to the
mailing container with the completed
requisition and mailed, as quickly as
possible, to the Cytology Laboratory.
This procedure may be one way to
obtain specimens from those women we
are not reaching. The specimen can now
be obtained in the privacy of the
woman's home without visiting the doc-
tor and at no cost to the patient. At
present we do not know how valid this
method is. The majority of physicians I
have talked to believe it will not replace
the cytology smear, which is definitely
considered the method of choice.
One can envision the advantages of a
"well-lady" Cytology Clinic staffed by
nurses where "follow-up" could be done.
Some of the advantages might be that it
would relieve the pressure in the doctor's
office and be less time-consuming for the
patient. This way, a small segment of the
population who will not see a doctor
might be reached.
References
1. [idler, H.K. cl al. Carcinoma cancer detec-
tion in Britisli Columbia. 7. Ohstet. Gynaec.
Brit. Cwllh. 75:4:392-404, April, 1968.
2. Mac Lean, M.A. Carcinoma of the cervix.
Canad. Nun. 61:968-71, Dec. 1965.
3. Worth, A.J. et al. The acceptance of cervical
cytology screening programme in the pro-
vince of British Columbia. J. Ohstet.
Gynaec. Brit. Cwlth. 75:4:79, Aug. 1967.
The author acknowledges with thanks the
assistance of Dr. D.A. Boyes, Radiotherapist
and Associate Director of the Cytology Labora-
tory, The British Columbia Cancer Institute,
Vancouver, B.C.
MAY 1969
TABLE III
Incidence of Clinical Squamous Carcinoma of Cervix in Women over age 20— Screened and V
nscreened Segments
of Population
Those screened
Clinical
Those unscreened
Clinical
to previous vear
Invasive
Rate per
to previous year
Invasive
Rate per
Year
(in 1,000s)
Carcinoma Cases
100,000
(in 1,000s)
Carcinoma Cases
100,000
1961
120.9
5
4.14
375.1
110
29.33
1962
164.2
7
4.26
338.8
71
20.96
1963
214.9
ID
4.65
298.4
88
29.52
1964
260.0
12
4.6
266.8
74
27.8
1965
310.0
13
4.2
233.2
67
28.8
1966
357.0
17
4.8
209.5
60
28.6
Correct Dec.
1967.
Figure L- The diagram shows the
Ayre's (or Papanicolaou) spatula in posi-
tion for removing cells from the most
vulnerable part of the cervix, the
squamous-cohtmnar junction.
Cervical gland
Columnar epithelium
Epithelial junction
Squamous epithelium
CERVICAL CONE BIOPSY
f-r?*riTf^ ^
\
"^ ^
Incision Line
VI AY 1%9
Figure 2. ~ In a cone biopsy, the point
of the cone is directed toward the
internal os but does not include it. The
biopsy leaves the cervix intact and does
not usually interfere with the potential
for pregnancy and normal delivery. Q
THE CANADIAN NURSE 43
Psychodrama
Description of n form of group therapy that permits patients to work out
feelings and conflicts through the medium of spontaneous drama.
Dorothy M. Burwell, Reg.N., M.A.
Two persons, a man and a woman, are on
stage. The lights are dim. At first, the
man speaks to the woman in subdued
tones, as though he is afraid of revealing
his true feelings. Then, gradually, his
voice becomes louder as he forgets his
audience and directs his anger toward the
woman His voice subsides again. He
begins to sob openly. Later, he will try to
describe his feelings and reactions to his
"audience. "Now, he just weeps.
This "actor," who was reenacting a
scene that in actual life had been disturb-
ing to him, is one of many persons
presently being helped by psycho-
drama - a group psychotherapeutic
technique that encourages individuals to
act out their conflicts in life situations. In
this "play," the person portrays himself,
and, in the medium of the group, reveals
and shares his feelings of anger, fear, and
frustration.
Psychodrama was brought to North
America by a Viennese-trained psychia-
trist. Dr. J.L. Moreno, in the 1930s. As a
young medical student in Vienna, Dr.
Moreno had been impressed by the
spontaneity of plays enacted by children.
Mrs. Dorothy (DL\) BurweU, a graduate of
Toronto General Hospital School of Nursing,
The University of Western Ontario, and
Teachers College, Columbia University, is Direc-
tor of Nursing at the Oarke Institute of
Psychiatry, Toronto, and Associate Professor of
Psychiatric Nursing, the University of Toronto.
44 THE CANADIAN NURSE
Later, while studying psychiatry, he
began to realize that the play medium
could be used to help patients resolve
their problems. Today, Dr. Moreno has
two centers in the United States where
psychiatrists, nurses, psychologists, social
workers, and clergymen meet to study
group psychotherapy and psychodrama.
In Canada, at least two centers use
psychodrama as a form of therapy. At the
Clarke Institute of Psychiatry in Toronto,
psychodrama is used as an adjunct to
individual psychotherapy. Only patients
who have been referred by a psychiatrist
take part in the group.
Spontaneity of action
Two major problems of patients with
psychiatric disorders are: a lack of inner
spontaneity and creativity in behavior,
and a break in human relationships with
significant others - family, friends, and
co-workers. In the medium of the group,
with spontaneity as the key, the patient's
feelings begin to emerge. All his anger,
frustrations, fears, longings, loneliness,
and confusion are shared with the group.
In psychodrama, the patient reenacts
scenes that have bothered him. The group
is kept small - 1 0 to 1 2 persons - and
intimate. The therapist acts as the direc-
tor of the drama. At the Clarke, the only
director is a registered nurse. The patient
who reenacts the scenes (usually only one
person is selected for each meeting) is the
"protagonist" for the meeting.
MAY 1969
Tlie director of the psychodrama session,
Dorothy Burwell (second from left),
interviews the protagonist "Mary, " while
the group listen attentively. For this
photo, staff members posed as patients.
In a typical session, the director has a
short interview with the protagonist; then
the lights are lowered. The director might
say. Show us what happened, Bill.
Where > id it take place? What was the
room like? Where are the windows,
where is the television set? Where are the
chairs, the couch? Where were you
sitting? Where was your wife sitting?
Who started the argument, and how was
it started? "
To reenact the scene, other members
of the group are drawn into the action as
significant others" in the life of Bill to
represent mother, father, wife, and child-
ren. These members are called the "auxil-
iary egos" {not alter egos). As the scene
unfolds, Bill may not feel free enough to
express his thoughts or innermost feel-
ings. We then have a staff member or
another patient play the role of the
"double."
The double moves and acts as Bill
does, expressing what he (or she) thinks
Bill would like to say but cannot. Bill
does not have to agree with his double; he
may even turn and have an angry encoun-
ter with him. The double supports the
protagonist as he expresses his inner
world to the group, acts as a catalyst, and
encourages the protagonist to bring out
his feelings of anger, fear, or warmth, joy,
and love.
Several scenes that have bothered Bill
are reenacted in one meeting. In the final
scene, or "closure," the director helps the
VI AY 1%9
protagonist and the group to experience
positive feelings. These positive feelings
will give the protagonist courage to try
new patterns of behavior to help release
his fears, anxieties, and frustations, and
to cope with life's crises. Thus, the
director might ask Bill to replay a scene
as Bill would like to see it happen if the
same circumstances were to occur in the
future.
The lights are then raised, and a
discussion on "how we can support and
help Bill," follows. At this time, patients
relate similar experiences they have
encountered, or offer suggestions on ways
Bill could handle the situation in future.
Two techniques used
Two techniques used within the drama
are the "soliloquy" and "role reversal."
The soliloquy finds the protagonist
moving slowly around the room with his
double, speaking about his feelings as he
approaches the scene. For example. Bill is
on his way home. He speaks aloud: "How
do I feel, as I come closer to the time
when I shall meet the barrage of anger
that my wife no doubt will have ready for
me?"
The role reversal usually takes place
during a scene where there is a significant
encounter that indicates lack of under-
standing on Bill's part. The director then
would say, "Bill, reverse roles with your
wife. For a few minutes you sit where she
is sitting, and the auxiliary ego playing
her part will sit where you are sitting."
Then the director might ask, "Now, Mary
[Bill's wife] . what do you think about
Bill? Do you love him? "
At this point. Bill must try to see
himself through his wife's eyes. As a
consequence, he may begin to understand
his wife's feelings.
Often a husband and wife are in the
same group, each playing his or her own
role. In this event the "masks" come
down - the real person within him
meets the real person within her, perhaps
for the first time. And the "1-Thou
relationship," as Martin Buber calls it, is
strengthened.
Lighting effects can be helpful. People
who are sensitive to color respond better
when blues and greens are used for the
sad scenes, and when a rosy glow is cast
over the group for the more joyful scenes.
The lights are lowered as the drama
begins and often are not raised again until
the discussion starts. Tears are expressed
more openly in the darkened room, and
those who are self-conscious or anxious
are more relaxed when not seen so
openly.
Value of psychodrama
A study I conducted recently with one
of the psychiatrists from a neighboring
Ontario Hospital and with two groups at
Clarke Institute of Psychiatry, reveal sev-
eral positive effects of psychodrama.
THE CANADIAN NURSE 45
Ttie protagonist, "Mary, "and the double,
standing behind her, reenact a scene that
in actual life had disturbed Mary. For this
photo staff members posed as patients.
1 . The drama has an abreactive effect
(a means of opening up and expressing
feelings) that often continues for the day.
Frequently, the patient's "frozen anger"
is melted by this acting out process, and
the patient responds better to his psycho-
therapy. Other members of the group also
experience this abreactive effect as they
listen to another person's story, which
may "hit home."
2. Communication is enhanced, not
only between patients and staff, but also
among patients - who become more
open with each other — and among staff
members.
3. Staff begin to understand the
patient better as he expresses his inner
feelings, and attitudes often change. For
example, the manipulative patient may
no longer be regarded as an uncooperative
patient, but as a person who has under-
lying fears of rejection and loss, who
must continually test staff relationships.
4. Psychodrama offers a way of reliev-
ing anxiety within patients. Even the
most psychotic patient can often be
reached if a staff member assumes the
role of the "double," and helps him to
express his thoughts and feelings.
5. A closely knit group is developed
more quickly than with other kinds of
group therapy. The action helps patients
to talk, and the tele, or the reaching out
to others, helps to cement the group. The
result is more than group cohesiveness; it
seems that a deeper feeling, as within a
family, exists. Many patients have said,
"This is the first time that I have ever felt
an important part of a family."
46 THE CANADIAN NURSE
6. A reintegration of personaUty
begins. During one role revensal, patients
played "staff and staff played "pa-
tients." A patient who had required
considerable persuasion from staff to
attend the workshop rose slowly to her
feet as the session began. Pointing to the
nurse, she said, "'You go to the workshop
today. I'm boss here just now." That
afternoon the same regressed patient -
now with a new feeling about the
workshop - put on her best clothes,
made up her face, and, without any
further assistance or encouragement,
went to the occupational therapy bazaar
and had a wonderful time selling things to
patients and staff.
7. Psychodrama teaches patients new
ways of coping with their panic. One boy,
Joe, trembled and perspired, his fist
clenched, while he watched a drama
unfold. I went to him, touched him
lightly, and quietly suggested, "Joe, you
are frightened. Take three deep breaths,
relax, and drop your anger." He did, and
immediately burst into tears. The next
week, Joe stopped a scrap on the ward by
going between the boys and telling them
to take deep breaths, relax, and drop
their anger - which they did. The out-
burst stopped, everyone laughed. Frank,
who was involved in the fracas, claimed
that Joe had hypnotized the two, "just as
Mrs. Burwash had done."*
*"Biirwash" (the farm belonging to the Ontario
Department of Reform Institutions), has
become Mrs. Burwell's nickname on the loren-
sic Unit at the Clarke Institute.
Summary
Psychodrama has proved to be a suc-
cessful supplement to the one-to-one rela-
tionship that the patient has with his
psychiatrist. In portraying himself, the
patient has a "second chance" to relive
and reenact situations in his life that have
been disturbing to him. As part of a
group, the patient is able to discuss and
examine his reactions and ways of coping
with stressful situations. In most in-
stances, both the patient and his "audi-
ence" benefit from this acting out of
repressed feelings.
With psychodrama, the patient's
psychotherapy progresses much better. In
addition, the patient begins to be enrich-
ed by his encounters with others in the
group, and may even feel tiiat tiiis group
has become similar to a new family.
Often, psychodrama helps to stimulate
and reawaken the patient's spontaneity
and creativity as he relives his unpleasant
experiences.
Finally, I have found this to be one of
the best techniques for changing staff
attitudes toward patients, patients toward
patients, and patients toward staff. Now
we become real to each other, as we see
through the eyes of the other and sense
the inner world of the other. The staff
ineeting following each session is particu-
larly helpful, as the staff, too, become
involved and feelings are siiared. And
learning in psychiatry cannot take place
without involvement. C
MAY 196S'
The amputee and
immediate prosthesis
Postoperative fitting of a prosthesis, early ambulation, and weight-bearing
allow a patient with a below-knee amputation to walk with relative ease.
M. Shewchuk, B.Sc.N., and Z. Young
Until recently, many patients with
amputation of the lower extremity have
had to wait from three to five months for
stump shrinkage before being fitted for a
prosthesis. As a result of this immobility
of the stump, muscle weakness, joint
contractures, and soft tissue wasting have
occurred, often preventing the patient
from wearing a lower extremity prosthe-
sis.
In the past, this problem has been
particularly true for persons in the older
age group, who are prone to conditions
such as peripheral vascular disease and,
gangrene, which may require lower limb
amputation. Too often, because of loss of
functional use of the leg stump, these
elderly persons have been unable to wear
a prosthesis. Many today are confined to
crutches or wheelchairs for the remainder
of their lives.
Recent developments
During the past decade, much research
and experimentation have been focused
on the patient with a lower limb amputa-
tion, bringing to light the need for earlier
ambulation and progressive weight
bearing. It has been found, too, that in
the past, legs were amputated above the
knee with little consideration given to the
Mrs. Shewchuk is Assistant Director of Nursing
Service, Special Services, The University of
Alberta Hospital. Mr. Young is Chief Remedial
Gymnast (Prosthetics), Dept. of Physical Medi-
cine and Rehabilitation, at the same hospital.
function of the stump. The need for
saving and retaining use of the knee joint
and muscles at the site of amputation
has only recently been recognized by all
surgeons.
Departments of physical medicine and
rehabilitation, prosthetists, and intensive
physical therapy programs in large, well-
equipped hospitals have developed new
and extremely valuable programs to pre-
pare the stump for functional prosthesis;
the objective is to train the amputee for
an optimal gait after fitting him with a
prosthesis. As a result of advances in
prosthetics and amputee training, imme-
diate fitting of a temporary prosthesis
following amputation has been started.
This procedure may be carried out at a
number of different anatomical levels;
however, this article will deal essentially
with below-knee amputations.
Preoperative care
All patients who are to have amputa-
tion should be advised by the surgeon of
their chance for prosthetic replacement.
Psychological preparation of the patient
who will be fitted immediately after
surgery remains essentially the same as
for conventional forms of amputation.
However, if the patient realizes that he
will ambulate with a prosthesis the first
day after surgery and will have considera-
ble independence, he is more reassured
and comforted than if he were faced with
a long waiting period.
THE CANADIAN NURSE 47
Patient standing on scales to determine poundage of weight-bearing.
Patient wearing plaster socket with adjustable wedge-disc unit and Sach
foot attached.
The therapist or prosthetist visits the
patient at least one day before the opera-
tion to explain the rehabilitative treat-
ment plan. He teaches the patient the
required active range of motion, with
emphasis on exercises for the hip and
knee on both sides.
The prosthetist measures the patient's
leg length and calf circumference to
determine the most suitable size of Knit-
Rite* stump sock. The patient's shoe is
fitted with a Sach foot (a soft, cushion-
like prosthesis). A one-half inch lift is
glued to the heel to obtain more accurate
alignment to compensate for the tempo-
rary absence of a shoe. An adjustable
prosthesis is assembled, consisting of a
one and three-quarter inch aluminum
tube with an adjustable wedge-disc unit
on both ends ready to incorporate into
the cast (socket) immediately after sur-
gery.
Operative procedure
After the limb is amputated below the
knee, the surgeon performs a myodesis,
suturing the fascia and muscles to distal
bone stumps with fixation through drill
holes. Special surgical flaps for surgical
closure have been developed to enhance
the success of the procedure. A one-half
inch rubber drain is left in the suture line
*Thc "Knit-Rite" stump sock is manufactured
by the Knit-Rite Company, 1121 Grande Ave-
nue, Kansas City.
48 THE CANADIAN NURSE
to prevent pooling under the skin flaps.
The drain is not secured as it is removed
within 48 hours through a small cast
window.
A thin, non-adherent dressing and a
layer of fluffed 4" x 8" gauze cover the
wound, followed by the stump sock.
Commercially-prepared, tapered, one-
quarter inch felt pads are secured to the
stump over sensitive areas and bony
prominences, such as patella, head of
fibula, anterior tibia, and lateral femoral
condyle.
A specially prepared elastic plaster
Orthoflex** - which has the tension
of a top quality elastic bandage, is applied
and allowed to set. Care is taken to allow
at least 5° flexion in the knee joint so
that a near normal position for walking is
retained. The previously prepared flanged
upper component prosthesis is attached
to the socket and secured with plaster. A
buckle is also incorporated into the cast
to be secured to the waist belt to prevent
slippage. Under the care of qualified
personnel, the patient obtains "total
contact" of the stump immediately fol-
lowing surgery. "Total contact" means
that the total area of the stump receives a
certain degree of pressure that is kept up
continuously. This pressure helps to de-
crease phantom pain.
**Orthonex is a product of Johnson & Johnson
Ltd., 2155 Pic IX Blvd., Montreal, Quebec.
Postoperative care
Vital signs are observed for any evi-
dence of shock and blood loss. Considera-
ble bleeding may occur before it becomes
visible on the cast. Excessive edema is
reported immediately as it may result in
tissue damage or circulatory impairment;
extreme pain may be evidence of edema.
The cast must remain secure; if it comes
off, the limb is wrapped immediately
with an elastic bandage and a new cast is
applied. No attempt is made to replace
the old cast.
First postoperative day
On the morning of the first postopera-
tive day, the patient is taught to stand at
the bedside in a secure walker, "feather-
ing weight" only. This means he rests the
weight of the prosthesis on the floor. The
lower component of the prosthesis is
carefully aligned for optimal weight-
bearing and function.
In the afternoon, the patient is taken
to the physiotherapy department where
he stands and walks between parallel bars,
bearing a weight of usually no more than
30 pounds on the prosthetic foot. This
measurement is obtained by the patient
standing on the scales. We limit weight-
bearing to what the patient can tolerate
and do not prolong it unduly.
Successive days
Decisions about each step of the
procedure are made by the physician.
MAY 1969
Below knee stump, following myodesis,
showing anterior skin flap.
prosthetist. and therapist.
Usually walking with progressive
weight-bearing is carried out two to three
times daily, and any necessary adjust-
ments in alignment are made if necessary.
The sutures are removed 12 to 14 days
postoperatively, and a new Orthoflex cast
is applied to remain on a further two
weeks. Following removal of the second
socket, it is usually possible for the
patient to be fitted with a permanent
prosthesis. A bivalved cast may be worn
at night to prevent edema and continue
total contact for a limited period of time
after the prosthesis is fitted.
With the permanent limb and its acti-
I'ated knee joint, the patient needs a
further period of practice training for one
to two weeks. The myodesis with the
functioning muscles in the stump makes
this period of training considerably easier
;han in former types of amputation. The
Mtient and his prosthesis are checked
Jeriodically by physician and prosthetist
0 make certain the the prosthesis fits
veil and is functional.
"atient histories
A I 7-year-old male, victim of severe
electrical burns, had a conventional
■)elow-knee amputation of the right leg.
light weeks after surgery he was fitted
•vith a temporary socket. With partial
•veight-bearing, his stump shrank enough
n the next three weeks to allow fitting of
1 more permanent prosthesis. One year
*1AY 1%9
later, he was still having difficulty obtain-
ing a proper fitting socket.
Eight months following injury, after
attempts to save the left leg had been
unsuccessful, a below-knee amputation
with an immediate prosthesis was carried
out. In 10 weeks, the patient was dis-
charged, walking well on both prostheses,
ready for employment. He reported that
the prosthesis that was fitted immediately
after surgery was much more satisfactory
than the earlier one.
A 48-year-old male with extensive
atherosclerotic peripheral vascular disease
that had resulted in gangrene of both
feet, required bilateral below-knee ampu-
tation; a prosthesis was applied immedi-
ately to each limb. The patient was
discharged six weeks after surgery, walk-
ed very well with one cane, and was able
to return to his former employment.
An 81-year-old male required below-
knee amputation for diabetic gangrene
resulting from arteriosclerotic obliterative
disease of the left leg. On the first
morning after the operation he stood at
the bedside, "feathering weight"" for four
minutes. In the afternoon he stood with
30 pounds weight and walked 20 feet
with a 3-point gait. Ten days postopera-
tively, he was able to tolerate 60 pounds
weight and walk with crutches 50 feet. In
19 days he was walking 300 feet.
He was discharged 36 days postopera-
tively, able to carry on living alone.
Because of his age and medical condition,
it is quite possible that he would never
have come to prosthetic fitting if there
had been the usual delay of two to three
months after a conventional amputation.
Summary
The contraindications of this proce-
dure are few when proper facilities and
experienced surgeons and prosthetists are
available. Without a thoroughly trained
team of physicians, prosthetists. surgeons,
and nurses, the procedure is not success-
ful. Early ambulation and weight-bearing
are essential if the patient is to walk with
relative ease and live independently.
References
1. Burgess, E.M., Traub, J.E., and Wilson, A.B.
Immediate Postsurgical Prosthetics in the
Management of Lower Extremity Amputees.
Washington, D.C.. Veterans Administration,
April 1967.
2. Warren, R. Surgical Clinics of North Ameri-
ca. 48:4:807, August 1968. D
THE CANADIAN NURSE 49
Medication errors
can be prevented
Despite new methods of dispensing medications in hospitals, errors continue
to occur. Inadequate education, poor communication, and disorganization
ail contribute to this problem.
New systems of dispensing med-
ications in hospitals are continually being
developed and tested. Yet drug errors still
occur. One expert estimates that 99
percent of errors that occur are never
reported, and that the nurse involved may
not even realize that the wrong patient
received the wrong drug at the wrong
time.''
Mismanagement and disorganization
The problem lies in inadequate educa-
tion, faulty communication among doc-
tors, pharmacists, and nurses, and just
plain mismanagement and disorganization
in the hospital.
Too often, the nurse does not keep
up-to-date with the new drugs that are
ordered for her patient; unaware of the
correct dosage, use of the drug, and
contraindications, she may fail to recogn-
ize signs of overdosage or side effects.
The physician, too, is frequently at fault:
his writing may be illegible; he may order
medications verbally, instead of taking
the time to write the order on the
patient's chart.
In a study conducted in the United
States, the researchers reported two main
causes of drug errors: mismeasurement or
miscalculation of the dosage of the drug
by the nurse (31 percent), and selection
and administration of the wrong drug (18
percent). The third most common cause
of error (15 percent) was confusion about
standing orders and when a certain drug
was to be discontinued. This confusion
30 THE CANADIAN NURSE
Sharon Thomas, B.Sc.N.
was thought to be the result of doctors'
unwillingness to abide strictly by the
rules. This research team estimated that
an error of some kind was made in 15
percent of all drugs administered. 2
To reduce errors
How can a nurse prevent drug errors?
First, she can suggest to the nurse repre-
sentative on her hospital's drug com-
mittee ways to improve or alter the drug
dispensing system. Second, she must
make certain that she understands the
uses, dosage, and effects of the drugs she
administers. Third, she must take parti-
cular care to select the correct drug and
measure it accurately. She should double
check the drug and dosage before and
after preparation.
The conscientious nurse may be frus-
trated by incomplete or out-of-date re-
ference materials, or by an overcrowded,
noisy medicine room located in a busy
area. Obviously, she must press for
change. In the meantime she should
compensate by increasing her efforts to
concentrate, or suggest that the number
of nurses preparing and giving med-
ications at the same time be decreased.
Technical details of preparation are
also important. These include: thorough
dissolving of tablets before withdrawing
the solution into the syringe; complete
withdrawal of all the solution in single-
Mis. Thomas, a graduate of the Calgary General
Hospital and Queen's University, now lives in
London, Ontario.
dose vials; and the labeling of mixed
solutions with strength and date.
The correct patient
To eliminate possible errors, the nurse
must know her patient and understand
his illness. She must compare the med-
icine ticket with the identification band
on the patient's wrist, as well as with the
name on the patient's door or bed. Many
nurses feel rather silly when they check a
patient's wristband, particularly if the
patient has been on the ward for some
time. Even so, this final check must be
made, because medications frequently are
administered to the wrong patient -
even though the staff know the patients.
Besides checking to make sure that th&
correct drug is given to the correct
patient, the nurse must observe her pa-
tient for any untoward condition that
might make her administration of the
drug dangerous. For example, she should
check the patient's pulse rate before
giving digitalis, and question the frequent
administration of a tranquilizer to a
patient who appears extremely drowsy.
Most medications should not be left at
the patient's bedside. The nurse is respon-
sible for making sure that the patient
takes his prescribed medication. This is
not merely a moral responsibility; the
hospital and its employees are legally
responsible for the complications that
could result from a patient not receiving
medication or from a patient who ac-
cumulates a number of pills and take;
them all at one time.
MAY 1%
High rate of error
None of these suggestions is new;
every nurse has been taught these pre-
cautions plus many more. Why, then, the
high rate of error?
The U.S. study mentioned previously
came to three conclusions on why drug
errors continue to be made: 3
1. The modern hospital has not kept
pace with the rapidly increasing
demands of modern drug therapy.
2. There appears to be a serious lag in
the effective and accurate distri-
bution of drugs within the hospital.
3. Many errors seem to suggest faulty
training in nursing schools in mat-
ters of drug preparation and/or lack
of emphasis on the importance of
performing these tasks accurately;
others suggest a lack of proper
equipment and facilities: most sug-
gest need for greater systemization
and controls.
The third conclusion is of most in-
terest to nurses, mainly because it is
within their sphere of influence.
Summary
Too often, the administration of med-
ications becomes merely a routine. Also,
in situations where doctor-nurse commu-
nication is minimal, the nurse is unaware
of the doctor's specific goals for a pa-
tient, and therefore does not understand
why a certain medication is ordered. In
too many hospitals, questions about
drugs and their dosage are not en-
couraged. The result is illustrated by this
story, which appeared in Medical Econo-
mics:
The operation was being performed
with spinal anesthesia. The surgeon, no-
ting that the patient was getting restive,
decided a sedative was indicated. So he
said to the circulating nurse, a student on
her first O.R. tour; "Give 15 milligrams
of morphine to the anesthetist, please."
The young nurse eagerly loaded the hypo-
dermic, took it over to the preoccupied
anesthetist, and gave it to him - in the
upper arm. Soon the man became
euphoric and had to be replaced. By then,
the nurse already had been. "
Unfortunately, most drug errors are
not brought to our attention in such and
amusing fashion.
I References
1. Barker, K.N., Kimbrough, W.W., and Heller,
W.M. A study of medication errors in a
hospital. Arkansas, University of Arkansas,
Nov. 1966, p. 11.
2. Ibid.
3. Barker, et al,, op. cit., p.272.
4. Rutley, R.J. Medical Economics. Dec. 1968.
D
MAY 1%9
To eliminate possible error, the nurse compares the medicine ticket with the name
band on the patient's wrist.
Tlie nurse makes certain that she understands the use, dosage, and effects of the
drugs she administers.
1^ '^^ilk^.
research abstracts
Bailey, A. Joyce. Relationships between
attitudes to nursing, job satisfaction
and professioiml organization member-
ship. Cleveland, Ohio, 1968. Thesis
(M.Sc.N.) Western Reserve.
This study was done to determine
nurses' attitudes to their profession,
image of nursing, and level of job satisfac-
tion, and to determine the relationship of
these variables to professional organ-
ization membership. The stimulus for this
study emanated from the continuing
decline in numbers of nurses who were
members of their professional organ-
ization in Ontario (Registered Nurses'
Association of Ontario) and the lack of
compulsory membership for nurses in
that province. Contlicting opinions re-
garding the desirable pattern for educa-
tion of nurses in Ontario was also a
stimulus.
It was thought that a complex vari-
able - general positive attitude to nurs-
ing - existed and was composed, in
part, of attitude to the profession, image
of nursing, job satisfaction, and member-
ship in the professional organization.
Hypotheses were formulated that predict-
ed positive relationships among the
aforementioned variables.
The method used was that of mailed
questionnaires to registered nurses em
ployed full-time in the province of On-
tario. A total of 361 questionnaires were
mailed; 151 returns were usable. Re-
lationships among variables were explored
and member and nonmember subgroups
were compared with .01 selected as the
level for significance.
A general positive attitude to nursing
was not demonstrated. The hypotheses
formulated about relationships among the
attitudes, satisfaction, and organization
membership variables were not accepted
No differences were found between
members and nonmembers on the major
variables. The groups also did not differ
with respect to age, marital status, res-
idence, nursing education (basic and
post-basic), or place of employment varia-
bles.
Differences between members and
non-members were found to exist regard-
ing present enrollment in educational
courses and mean salary obtained. The
groups also differed in distribution by
level of positions held when positions
were dichotemized at the head nurse
level.
Differences between members and
52 THE CANADIAN NURSE
non-members were found as to whether
membership in the RNAO was required
or not by employers. No relationship was
demonstrated between salary levels and
employer expectations of membership.
Membership does not appear to re-
present more professional commitment or
job satisfaction. Whether a nurse is a
member or not, she tends to hold much
the same view of nursing and derive much
the same satisfactions from it. Lack of
demonstrable differences between mem-
ber and nonmember subgroups should
stimulate a change of thinking by profes-
sional organizations with regard to
recruitment of members.
Currently, membership may represent
primarily attitudes and expectations of
employers and employing agencies.
Unless there is a change in the future, the
professional association may function
solely for the economic security of
nurses.
Purushothain Devamma.r/je relationship
between continuity of nurse-patient
assignment and the patient's knowl-
edge of self-care. Montreal, 1968.
Thesis. (M.Sc.N.(A)). McGill.
This research study examined the
relationship between continuity of nurse-
patient assignment and the patient's
knowledge of self-care. The study, ex-
ploratory in nature, was carried out in
three general teaching hospitals. Thirty
patients with colostomy were selected for
the purpose of the study. A special
instrument was devised, based on a set of
criteria for optimum colostomy care, to
measure the patient's knowledge of self-
care. The number of nurses who cared for
each patient over a 15-day period was
determined from the unit nursing assign-
ment sheets.
The data were analyzed using Spear-
man's coefficient of rank correlation and
analysis of variance.
A significant association between con-
tinuity of nurse-patient assignment and
the patient's knowledge of self-care was
found, r(rho)= .744.
The findings support the hypothesis.
Shantz, Shirley )ean. A study to deter-
mine who, in the opinion of nurses
and physicians, should be responsible
for teaching the hospitalized patient.
Seattle, Wash., 1968. Thesis (M.N.)
Washington.
Studies have shown that while many
patients desire health information, and its
provision may positively influence their
response to therapy, nurses and physi-
cians show little agreement in their de-
finition of their teaching role.
The purpose of this study was to
compare the responses of a group of
nurses and physicians who work together
in a Canadian active treatment hospital to
a questionnaire that asked them to select
who they felt should be responsible for
teaching in 20 hypothetical situations.
The options allowed the respondent to
indicate that he felt the responsibility
should belong to the physician, the nurse,
or be shared by both.
The 102 nurses chose the "nurse's
responsibility" option most frequently,
and the 64 physicians selected the
"shared responsibility" option most
often. A significant difference in these
responses was found when they were
submitted to the chi-square test. Neither
the nurse's position, the physician's
specialization in practice, nor the indivi-
dual's affiliation with a particular nursing
unit were found to have significantly
infiuenced the responses.
The majority of the respondents varied
their responses, indicating that each
situation must be assessed individually,
but consistently selected a more inde-
pendent teaching role for the nurse in
situations where the patient or his family
needed to learn specific skills, than when
understanding of the illness or therapy
was required.
Williams, Marguerite C. A comparison of
the perceptions of public health nurses
and their alcoholic patients regarding
the priority ranking of nursing needs.
Boston, 1968. Thesis (M.Sc.N.) Boston
University.
The plan authorized by the Ontario
government to combat alcoholism called
for greatly expanded education of mem-
bers of the health professions to increase
their skill in helping alcoholics. In an
effort to contribute to the improvement
of a developmental factor of the nursing
care plan, this study was undertaken by
mail to determine how the perceptions of
public health nurses vary with the percep-
tions of their patients dependent on
alcohol with respect to the priority rating
of nursing needs. The sample consisted of
five public health staff nurses employed
in two public health departments and
MAY 1969-
their five patients who were dependent
on alcohol.
From statements submitted by a group
of alcoholic patients and a group of
public health nurses, 14 nursing needs
were identified Based on these needs, 14
statements were developed and printed
on individual cards. Each patient, provid-
ed with one set of 14 cards, was asked to
place them in rank order according to the
relative importance of the statements for
him. Two sets of cards were provided for
each nurse participant; the nurse was
asked to place the cards in rank order
twice: as she believed her patient would
rank them and as she perceived their
tlierapeutic importance for him.
Data analysis revealed no statistical
correlation between individual patient
rankings and corresponding nurse
opinions of patient preferences or nurse
perceptions of the therapeutic impor-
tance of the statements. Two nurse res-
ponses, however, showed statistical
correlation between the nurse's own two
rankings. Such correlation could indicate
the possibility that the nurse's opinion of
her patient's perceptions was a projection
of her own beliefs about his therapeutic
needs.
The findings and conclusions of this
study led to the recommendation that
further study be undertaken to refine the
tool in an effort to gain more valid
comparisons of patient-nurse perceptions
of nursing needs.
I Richard, Sister Huberte. A study of the
attitudes of nurse faculty members in
a selected Canadian province in rela-
tion to their educational functions.
Washington, D.C., 1963. Thesis (M.S.)
The Catholic U. of America.
The purpose of this study was to
identify the attitudes of nurse faculty
members in a selected Canadian province
in relation to three educational functions,
namely: teaching, curriculum develo{>-
ment, and research related to the educa-
tional program Thirty-six full-time nurse
faculty members from 10 schools of
nursing in a selected Canadian province
constituted the sample for this study.
The descriptive survey method was
used. The instrument designed for the
collection of the data was an attitude
inventory constructed after the Likert
technique for the construction of attitude
scales. This was coupled with general
information relating to the length of time
participants spent in teaching positions.
The 103 statements on the attitude in-
ventory were classified under 3 cate-
gories - social environment, personal
dimension, and role dimension - in re-
lation to the 3 educational functions.
Before sending the inventory to the
selected schools, it was submitted to a
trial study after which the responses were
MAY 1969
scored and a critical evaluation for relia-
bility was done by using the split-half
method: the reliability of the tool was
found to be .72 for the half; when
correlated for the whole inventory, it was
.84. The criterion of internal consistency
was applied to determine the discri-
minative powers of the statements by
using the upper and lower four partici-
pants: the results showed that some state-
ments did not discriminate. After
revision, the inventory consisted of 97
statements.
An attitude rating scale was construct-
ed on which the attitudes of participants
and of faculty from the schools could be
located on the attitude continuum -
highly favorable, favorable, less favorable,
unfavorable, and higlily unfavorable.
The analysis of the data obtained from
the inventory revealed that the majority
of the participants considered indivi-
dually had a liighly favorable attitude
toward social environment relative to
teaching, a favorable attitude toward
social environment relative to curriculum,
and a less favorable attitude toward social
environment relative to research. The
majority of participants had a favorable
attitude toward personal dimension and
role dimension relative to teaching, curri-
culum, and research.
Faculty from the majority of the
schools had a favorable attitude toward
teaching, curriculum, and research as in-
dicated by the total score. Faculty from
the majority of schools had a favorable
attitude toward social environment, per-
sonal dimension, and role dimension
relative to teaching, curriculum and
research as indicated by the sub-scores.
The number of schools with highly
favorable attitude toward social environ-
ment, personal dimension, and role
dimension relative to teaching were four,
two, and five respectively. No highly
favorable attitudes toward research were
shown by faculty from any schools.
Faculty from one school had a highly
favorable attitude toward social environ-
ment relative to curriculum
The coefficient of rank correlation
showed no significant relationship at the
5 percent level between the attitudes of
faculty members and their experience in
the present teaching position.
The writer is aware that numerous
factors could infiuence the attitudes of
individuals. In this study, however, only
one variable, the length of time partici-
pants spent in teaching and in present
teaching position, was considered. The
number of statements for each category
and for each function varied greatly. This
variation might have had an influence on
the findings of the study. The negative
statements in the inventory seemed to
have been interpreted with difficulty by
some of the participants. The size of the
sample would not permit generalization
from the findings outside the province
selected for the study.
Administrative tasks, such as budget
and annual report preparation, may be
perceived as prestige functions by many
directors of nursing, whereas the acquir-
ing of equipment for a patient unit may
be seen as a low prestige job. In univer-
sity-centered hospitals it may be expected
that there is more stratification in the
nursing service hierarchy than in the
community hospital. This is due to asso-
ciate and assistant directors of nursing.
This stratification may prevent the nurs-
ing supervisor from sharing in budget and
annual report preparation.
McEwan, Elaine A. Women's feelings
about the figure change in pregnancy.
New Haven, Conn.. 1968. Thesis
(M.Sc.N.) Yale U.
The purpose of this study was to
discern what feelings women had about
figure changes in pregnancy, to see if
those feelings were a problem to her and,
further, to see what factors might be
related to those feelings.
There were 40 married women in the
sample, 20 clinic patients, and 20 private
patients. The sample was distributed over
4 gestational periods: early (18-24
weeks); middle (28-32 weeks): late (38-40
weeks); and within 48 hours postpartum
Data were collected by the use of an
interview and measurement scales. The
responses obtained from the interview
concerning the figure change in preg-
nancy were rated and. as a result, each
woman was placed along a 5-point con-
tinuum from dissatisfied to satisfied.
Four women were rated as dissatisfied, 17
as somewhat dissatisfied, 10 as neutral, 9
as somewhat satisfied, and none as satis-
fied. The expression of neutral feelings
was greatest at 18-24 weeks and. as the
gestation progressed, expressed feelings of
dissatisfaction increased
Feelings of dissatisfaction seemed to
be related to such factors as lower social
class, youth, negative feelings about
menstruation, and a less than normal
weight gain. Feelings of satisfaction seem-
ed to be related to age (30-39), planned
pregnancy, higher social class, and posi-
tive feelings toward menstruation.
The measurement scales were useful as
research tools but. in practice, one or two
of the questions from the interview that
were very discerning should be sufficient
to give the nurse cues as to whether a
mother has dissatisfied, neutral, or satis-
fied feelings about the way she looks. The
amount and kind of support each woman
received from her husband appeared to
influence the way she viewed herself.
The results of this study seem to
indicate that body image during pre-
gnancy may be a problem area, and that
mothers need moral support so they do
not feel unattractive during pregnancy. D
THE CANADIAN NURSE 53
Behavioral Science, Social Practice, and
the Nursing Profession by Powhatan J.
Wooldridge, James K. Skipper Jr. and
Robert C. Leonard. 108 pages, Cleve-
land, Ohio, The Press Of Case Western
Reserve University, 1968. Canadian
agent: Burns & MacEachern Ltd., Don
Mills, Ont.
Reviewed by Anna Gupta, Associate
Professor, School of Nursing, Univer-
sity of Windsor, Windsor, Ont.
To many professional nurses, this
book would be an eye-opener to the facts
about the present status of nursing
theories, nursing guidelines, and nursing
practices.
The book raises the fundamental issue
of the responsibilities of the nursing
profession in developing guidelines and
theories in the areas of its "independent"
functions. The authors attempt to dif-
ferentiate nursing duties carried out
under medical guidelines to meet the
biophysical needs of the patient from
independent nursing duties that meet the
situationally-derived needs or the
psycho-social aspects of patient care.
They point out that nurses are solely
responsible for meeting such situation-
ally-derived needs of the patient, indepen-
dent of the physician or his guidelines.
The authors define the role and unique
functions of nurses as those of social
practitioners.
The book's essential purpose is to
show the way in which the "accumulated
theoretical and methodological knowl-
edge of the behavioral sciences can be
used to improve the effectiveness of
nursing." However, the authors caution
against blindly applying principles of
social sciences, and stress the need for
experimental nursing research to be con-
ducted in actual nursing practice so that
the principles of social interaction and
human behavior that will be useful in
formulating theories of nursing practice
can be identified. The authors say that
such research will also help to test general
proposals about human behavior and,
quite possibly, new theories in sociology
and psychology will be developed from
studying nurse-patient interaction.
Though the book seems brief and of a
simple format, the thoughts expressed
therein are rather complex and of grave
importance to the nursing profession.
One needs to read the book two or three
times to appreciate its purpose and the
approach of the writers, and to realize the
challenges of the issues revealed.
54 THE CANADIAN NURSE
Problems in Child Behavior and Develop-
ment by Milton J.E. Senn, M.D., and
Albert J. Solnit, M.D. 268 pages.
Toronto, Macmillan Co. of Canada,
1968.
Reviewed by Jean Jenny, Inservice
Education Director, Riverside Hospital
of Ottawa, Ottawa, Canada.
Many changes have taken place in
pediatric practice during the past few
decades. A favorable shift downward in
the frequency of childhood disease has
not been paralleled by a decrease in the
number of people emotionally disturbed
to a degree where they need professional
help. This text was written to assist the
general practitioner and pediatrician to
update their present practice by present-
ing to them the newest methods of
approaching the problems in child and
family behavior. The initial education of
medical and nursing staff is often inade-
quate in the fields of general psychology
and emotional disturbances, and this
book will be of distinct value to anyone
engaged in pediatric health care and
family counseling.
The authors describe the philosophy
and methods used at the Yale Child
Study Centre in dealing with parents and
children in distress. The newest concepts
in child development, psychiatry, and
psychoanalysis are presented. The selec-
tion of theoretical and clinical concepts is
eclectic, including the most popular
theories of Freud, Piaget, and Erickson.
The book characterizes the developmen-
tal phases as they appear chronologically
and as they evolve qualitatively in the
growing child. The dominant character-
istics portraying each stage, with their
accompanying affective and cognitive fea-
tures, are discussed and the behavioral
aspects of the child's development are
viewed longitudinally.
The breadth of the book encompasses
pregnancy, the newborn, premature, and
young infant, the toddler, the school age
and preadolescent youngster, and the
young adolescent. Pediatric evaluation
and therapeutic management are dis-
cussed in depth and a large chapter on
special problems includes various psychia-
tric disorders, rape, suicide, adoption,
fatal illness, and preparation for hospitali-
zation. The depth of the material makes
it of worth to a professional person and it
would contribute greatly to the nurse's
postbasic cHnical knowledge. There is an
excellent index at the back but no biblio-
graphic references are included. The
authors' style is crisp and authoritative
and the book, as a whole, is eminently
readable.
The philosophy of the text stresses
that psychologic pediatrics encompasses
comprehensive medical care of the child
in the context of his family and com-
munity, and underlines the need for
embracing the whole person and the
whole family. The sick child, rather than
the disease itself, occupies the authors'
attention. I would recommend this
volume for all pediatric nursing libraries.
A striking feature of this text is the
grouping together of seemingly different
conditions that are basically the same
from the surgeon's point of view. For
example, one chapter entitled "obstruc-
tion" lists obstructing agents and con-
ditions in which the free flow of fluids
and impulses is hampered, thus requiring
surgical intervention. Cardiac arrest and
respiratory failure are presented in a clear
and concise manner in this chapter.
The chapter on iatrogenic conditions is
recommended reading to nurses who play
an important role in prevention of disease
and the safety of the patient. The authors
outline a variety of disorders, most of
which can be prevented by the vigilant
and skillful nurse. Although not mention-
ed in this book, there are serious legal
problems involved in iatrogenesis of
which the nurse should be constantly
aware.
This text would be a valuable, up-to-
date, quick reference in the ward library
of both an adult and children's ward. As
it presupposes basic preparation in surgi-
cal nursing, it would be of most value to
the senior student and graduate nurse.
The Knife Is Not Enough by Henry H
Kesler. 295 pages. New York, W.W
Norton & Co. Inc., 1968. Canadiar
agent: George J. MacLeod Limited
Toronto.
Reviewed by Valda Law ford. Infor-
mation Service Officer, Manpowei
Utiltation Branch, Dept. of Man-
power & Immigration, Ottawa, Canor
da.
The title of this book conveys the
philosophy that has guided the authoi
through a medical career in which the
emphasis has been not so much on the
excellence of his technique as an ortho-
pedic surgeon but on his dedication tc
the principles of rehabilitation. He con-
MAY 196'
tinues to demonstrate his belief that it is
not enough for the surgeon or physician
to provide optimum medical or surgical
care: that his work is not done until he
sees that his patient has received all the
other services - physical and occupa-
tional therapy, prosthetic devices, voca-
tional counseling, training and place-
ment - that will enable him to resume
his former place in society or assume a
new role that is productive and satisfying.
The author emphasizes this belief
through his distress when, as a naval
surgeon, he had to perform many am-
putations without the opportunity of
seeing that his patients got satisfactory
follow-up services. His reassignment to
the Naval Hospital at Mare Island was a
relief to him for he was able to develop a
rehabilitation program for his amputee
patients.
As Dr. Kessler recounts his experiences
with the Workmen's Compensation Pro-
gram, The New Jersey Rehabilitation
Commission, and later at the Kessler
Rehabilitation Center, the reader sees
some of the problems of ignorance, mis-
conception, prejudice, and public apathy
that have to be overcome in developing a
rehabilitation program in any commu-
nity.
Dr. Kessler has traveled widely and a
large part of his book concerns his experi-
ences on the international scene. In early
years, he sought out leaders in surgery
and prostheses, always on the alert for
new techniques and advances that would
help his own patients. From 1950 on he
acted as a United Nations expert on
rehabilitation to help countries establish
or develop their rehabilitation programs.
As a representative of the International
Society for Rehabilitation of the Di-
sabled, he visited many countries, pro-
moting the value of rehabilitation and
helping many handicapped individuals.
The reader, through Dr. Kessler's ex-
periences and travels, will meet many
world leaders in the field of rehabili-
tation. He will also get glimpses of the
effects of war and the struggles of coun-
tries to care for their handicapped citi-
zens at the same time that they are faced
with other problems of reconstruction.
The book is enlivened with personal
experiences, character sketches, and
anecdotes that make for interesting and
entertaining reading.
Principles and Methods of Sterilization In
Health Sciences, 2nd ed., by John J.
Perkins. 560 pages. Springfield, Illi-
nois. Charles C, Thomas, 1968. Can-
adian agent: Ryerson Press, Toronto.
Reviewed by Frances Howard, Consul-
tant, Nursing Service, Canadian Nurs-
es' Association, Ottawa.
Ten years, for some, is a short span of
life. Technological change has made the
MAY 1%9
\Wm
Esjjolbrook'
Personalized ^*It.°*"
SHEARS
6" professional, precision shears, forged
in steel Guaranteed to stay sharp 2 years.
No. 1000 Shears (no initials) 2.50 ppd.
SPECIAL! 1 Doz. Shears $24. total
Initials {up to 3} etched add 50c per pair.
WmmS
imm
f,^
REEVES NAME PINS
Largest'Selling among nurses ! Superb lifetime quality . . .
smooth rounded edges . . , featherweight, lies flat . . .
deeply engraved, and lacquered. Snow white plastic will
not yellow. Satisfaction guaranteed. GROUP DISCOUNTS.
Choose lettering in Black, Slue, or White (No. 169 only).
I SAVE: Order 2 identicai Pins as pre-
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No. 169
No. 100
1 Namt Pin only
2 Pins (same name)
1 Name Pin only
2 Pins (same nama)
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2.50* 3.00
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Shears/Pen POCKET KIT
Plastic Pocket Saver (see twiow) with 5^" prof,
forged bandage shears, plus handy chrome "trixolor"
pen [writes red, black or blue at nip of thumb).
No. 291 Pocket kit 3.50 ppd.
No. 292-R Pen Refills (atl 3 colors) . .30 ppd.
Etched initials on shears add 30
Uniform POCKET PALS
Protects against stains and wear. Pliable white
plastic with gold stamped caduceus. Two com-
partments for pens, shears, etc. Ideal token gifts
or favors.
N0.210-E ( 6 for 130, 20 for 2.25
Savers / ZS or more, 20 ea.. all ppd.
^
Scripto NURSES LIGHTERS
Famous Scripto Vu-lighters with crystal-
clear fuel chamber. Choose an array of
colorful capsules, pills arKl tablets in
chamber, or a sculptured gold finished
Caduceus. Novel and unique, for yourself
or for unusual gifts for friends. Guaranteed
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N0.300-P Pill Lighter f -„„, „„^
No. 300-C Caduceus Lighter { 4^ ea. ppd.
i
RN/Caduceus PIN GUARD
Dainty caduceus fine<hained to your professional
letters, each with pinback. saf. catch. Wear as is
... or replace either with your Class Pin for safety.
Gold hn.. gifWMxed. Specify RN, LVN or LPK.
No. 3240 Pin Guard 2.95 ppd.
sterling HORSESHOE KEY RING
Clever, unusual design: one knob unscrews for in-
serting keys. Fine sterling silver throughout, with
sterling sculptured caduceus charm.
No. 96 Key Ring 3.7S ea. ppd.
"SENTRY" SPRAY PROTECTOR
Protects you against violent man or dog . . .
instantly disables without permanent injury.
Handy pressurized cartridge projects irritating
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No. AP-16 Sentry 2.00 ea. ppd.
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Black velvet band material. Self-adhe-
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or pinning. Strip H" x 36" for two or
more caps, trims to desired widths or
lengths. Reusable many times.
No. 3436 Band 1.25 0a.. 3 for 3.00, 6 or more 35 e
Nurses ENAMELED PINS
Beautifully sculptured status insi^ia; 2-color keyed,
hard-fired enamel on gold plate. Dime-sized; pin-tieck.
Specify RN. LPN, PN. LVN, NA, or RPh. on coupon.
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Swiss made, raised silver full numerals, lumin. mark-
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No. 06-925 12.95 ta. ppd.
Lindy Nurse STICK PENS
Slender, white barrels with tops colored to match
ink. Fine points; colors for charts, notes. Adj. silver
pocket clip. Blue, black, red or lavender.
Na. 467-F Stick PtM j 6 pens 2.89, 12 pens 5.29
(chfltsicglDratsort) } 24 or more .39 ea., all ppd.
f
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Lend professional prestige. Two colors baked enamel on
gold background. Resists weather. Fused Stud and
Adapter provided. Specify letters desired: RN, MO, DO,
RPti, DOS, DMD or Hosp. Staff (Plain).
No. 210 Auto Medallion 4.25 ea. ppd.
Professicnal AUTO DECALS
Your professional insignia on window decal.
Tastefully designed in 4 colors. 4V4" dia. Easy
to apply. Choose RN, LVN, LPN or Hosp. Staff,
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World famous Cross writing instruments with
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BSll Pen Refilli (blue med.), 2 for 1.50 ppd
or full Mm. tngrntt in icript on bami initijls odd 75 o.
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Nationally advertised Liftman^ diaphragm-
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collapse concealed spring, non-chilling dia-
phragm. U. S. made Choose from 5 jewel-
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LETT.COLOR: Q Black DBtue D White (No. 169only)
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Send to
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City
State.,
.Zip.
THE CANADIAN NURSE 55
past 10 years but a brief and explosive
interlude in the history of health sciences.
Personnel, charged with the preparation
and sterilization of medical supplies, will
welcome, therefore, the second edition of
Principles and Methods of Sterilization in
Health Sciences,
Whether the student or practitioner
requires theoretical background on the
nature of hfe and death of micro-
organisms or practical information on the
techniques and modes of sterilization, the
text provides an adequate reference on
the most recent developments in these
fields. Its value as a reference book is
enhanced by the inclusion of numerous
illustrations. For those who wish to
pursue the subject further, the author has
appended extensive bibliographic refer-
ences to most chapters.
The text is written for use in hospitals,
clinics, laboratories, allied institutions,
and services. Personnel in hospitals will
find additional help from the chapter on
the organization and function of the
central service department.
Basic Psychiatry by Myre Sim and E.B.
Gordon. 262 pages. London, E. & S.
Livingstone Ltd., 1968. Canadian
agent: Macmillan Company of Canada,
Toronto.
Reviewed by Karen V. Walker, Assis-
tant Director of Nursing Education,
Clarke Institute of Psychiatry, Toron-
to.
This small, easy-to-handle book con-
sists of short summaries of definitions,
etiology, theories, and therapies, covering
a great breadth. Some of the sections are:
psychology, psychopathology, psych-
opharmacology, genetics, specific dis-
orders, social psychiatry, child psychia-
try, physical treatments, and legal
aspects.
As a nurse educator, I do not hesitate
to recommend it as a reference book for
beginning student nurses. It gives them a
summary of the field of psychiatry, from
which further depth study may be pur-
sued. It presents information in a factual,
unbiased and concise manner, which is
commendable in such an abstract field.
This book would also be of use to
graduate nurses beginning work in a
psychiatric setting. If it were available on
the wards, these nurses could quickly
obtain basic information that would assist
them in understanding the patients and
the communication of other disciplines.
This book could also serve a useful
purpose in the general hospital setting.
Nursing is growing in its ability to view
the total person, rather than separate
aspects. If this book were available to
nurses in obstetric, pediatric, I.C.U. and
medical-surgical settings, it could serve as
a quick reference in any area in which
psychiatry has contributed to the under-
standing of the total person.
56 THE CANADIAN NURSE
In summary, this book offers all the
health professions a reference work on
basic psychiatry. It provides breadth but
not depth, and is a useful aid for this
purpose.
Chemistry: Inorganic, Organic and
Biological by Philip S. Chen. 263
pages. New York, Barnes & Noble,
Inc., 1968.
Reviewed by Shirley W. Stephens,
Instructor, Nursing Program, British
Columbia Institute of Technology,
Burnaby, B.C.
Prepared for the "College Outline
Series" published by this company, this
book is intended to be a study guide for
students taking a course including three
broad areas of chemistry - inorganic,
organic, and biological. It would also be
of value to graduate nurses for reviewing
basic chemistry material and to members
of the paramedical professions for refe-
rence.
In each chapter the author presents a
comprehensive summary of the topic
discussed. The beginning chapters review
basic concepts including radioactivity,
radioisotopes, electrolytes, and ioniza-
tion. In the chapters on organic chemis-
try, the author discusses the chemical
nature of carbohydrates, lipids, and pro-
teins, and includes numerous tables classi-
fying commonly used com-
pounds - with many applications to
medicine. The remaining chapters sum-
marize the metabolism of the nutrients
and the chemistry of blood, urine, vita-
mins, and hormones. However, there is
insufficient material included on body
fluids, electrolytes, and acid-base balance
to be of optimum use for nurses.
In addition, there is a reference table
keyed to standard textbooks, a detailed
glossary, and a self-test for review pur-
poses.
This book would be a valuable refe-
rence source for students and graduates
of health professions.
Health Visiting Practice by Mary Saun-
ders. 1 1 2 pages. Toronto, Pergamon
Press, 1968.
Reviewed by Ruth E. Aiken, Director
of Nursing, Department of Public
Health. Borough of York, Weston,
Ont.
This book was written for the prac-
ticing health visitor and in particular for
mature women who are beginning field
work. The author has found that the
mature nurse entering the health visiting
field has need of practical detail to give
her confidence.
The book begins with an outline of the
organizational structure of public health
services in Britain, The author admits that
one of the difficulties in writing about
health visiting is the variation in patterns
of organization. Therefore she has tried
to choose a "happy medium" in describ-
ing the lines of authority and responsibi-
lity.
The book describes an interesting
concept of health visiting, which is still
largely in the pilot stage in Canada. The
health visitor works attached to or in
liaison with the general practitioner,
either in a single or a group practice. An
absorbing chapter is devoted to methods
of developing this service.
Two chapters are devoted to methods
of writing reports and keeping records.
These chapters are detailed, elementary,
and the methods are useful parochially.
The chapters dealing with infant and
child care, the school health service, and
the after-care of patients discharged from
hospital, offer useful advice to the begin-
ning health visitor about planning her
work and setting priorities. Some routine
procedures are described in detail.
A perceptive discussion about geriatric
work and related welfare services that
concern the health visitor hints at the
frustration frequently felt by the health
visitor when she attempts to interest
others in the care of the aged.
The author discusses briefly the health
visitor's Haison with workers of other
disciplines and outlines the legal frame-
work on which child protection in Britain
is based. She describes some of the
differences in viewpoints of the social
worker and the health visitor in dealing
with situations involving child protection.
Since this book deals at length with
material that most Canadian health agen-
cies provide in their local or provincia-
procedure manuals, its use is limitec
except for purposes of comparison.
Psychiatry For Nurses, Social Workers
And Occupational Therapists by C,P
Seager, 231 pages. London, Williaii
Heinemann Medical Books, Ltd.
1968. Canadian agent: Burns Sr
MacEachern Limited, Don Mills., Ont
Reviewed by James B. Birley, Psychia
trie Nursing Instructor, The Saskat i
chewan Training School, Moose Jaw. I
Dr. Seager has designed this book "ti
introduce the newcomer to psychiatry t(
those aspects of the subject which an
more important in helping her to dea
with the many problems that she is likel)
to meet in her work." He hopes that i '
will be of value "to the psychiatric nurse
to the occupational therapist, the socia
worker and to all others who come int( j
this field of medicine." |
For three main reasons, Seager's boot
would be of questionable value to Can
adian psychiatric personnel: 1. A largi
portion of his text is distinctly British
Canadians might read, for interest only
about the General Nursing Council, thi
MAY 196.1
Mental Health Act of 1959. the British
legal and administrative aspects of marria-
ge, divorce, sterilization, and abortion, or
of criminal responsibility or drug depen-
dency. 2. Treatment and rehabilitation
of the emotionally ill and the mentally
retarded in Saskatchewan and in many
other parts of Canada are a step or two
aiiead of that reported in Dr. Seager's
book. 3. The author has condensed too
many topics into one small book. In 225
pages he includes an introduction, a
history of psychiatric nursing, and chap-
ters devoted to human development,
admission and examination of the pa-
tient, development of intelligence, the
emotions, thinking, personality and its
disorders, psychiatric treatment, legal and
administrative aspects, psychiatric emer-
gencies, and special psychiatric units.
The Treatment of Mental Disorders in the
Communify, edited by Gerald S.
Daniel, and Hugh L. Freeman. 83
pages. London, Bailli^re, Tindall and
Cassell, 1968. Canadian agent: Macmil-
lan Co. of Canada, Toronto.
Reviewed by Lois Kirkland, Public
Health Nurse, Ottawa, Canada.
This book contains papers presented at
a symposium held at the Royal Society of
Medicine. London, in November 1967.
The purpose of the symposium was to
present basic problems in providing
community services in the treatment of
mental disorders and to illustrate the
successful developments of certain units
in Great Britain.
The movement toward treatment of
the mentally ill outside hospitals seems to
be the common purpose of each writer.
One writer discusses the integration of
mental health services within the commu-
nity; another indicates the value of day
care units in relieving the general hospital
psychiatric inpatient unit. The value of
keeping elderly paranoid patients out of
hospital is reported by a doctor who
organized community services for aged
persons. The use of drugs in keeping
patients out of hospital is reviewed. One
author outlines an organization of
domiciliary psychiatric nursing care,
which proves successful to the main
purpose of the symposium. Another
writer, who was a pioneer of industrial
therapy, examines the value of essential
ingredients for setting up a useful service.
Finally, the principal medical officer,
ministry of health, discusses in general
terms methods of increasing the efficien-
cy of mental health services.
The book indicates that community
health care does not mean care and
services "outside the hospital." The
hospital must be considered an integral
part of the community service - a part
providing one aspect of health care.
Comprehensiveness, coordination, and
continuity with other services are shown
as basic ingredients of community care.
The writers' reports of their work de-
monstrate the use of these ingredients in
providing community mental health care.
It seems logical that these applications
could well be ones to bring about changes
in health care in general.
This book is a series of reports from
men who have worked closely with units
that provide progressive community servi-
ce in the care of the mentally ill. As such,
the book has little practical value for
nurses, except perhaps for nursing admi-
nistrators who are organizing special servi-
ces of this nature. However, the contents
broaden the reader's concepts and under-
standing of the trends in mental health
care. Trends of this type could become
established practice in total health care in
the future.
Wanted
April 1968 issue of the Journal of
Nursing Education. Please send to: CNA
Library, 50 The Driveway, Ottawa 4.
Surgical Principles by James Moroney and
Francis E. Stock. 371 pages. Edin-
burgh and London, E. & S. Living-
Three thousand years of testing
by a highly qualified panel of experts
endorses the value of sugar in baby formulae
It's a controllable weight-builder and energy
source. It's easily digested, inexpensive, pure,
readily available and easy to use. In reason-
able quantities it is good for babies.
They have liked it for three thousand years
and still do. If you'd like to know more about
sugar send for an illustrated copy of our
brochure, "The Story of Sugar":
Canadian Sugar Institute
408 Canada Cement Building, Phillips Square, Montreal, P.O.
MAY 1969
THE CANADIAN NURSE 57
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Address all inquiries to:
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ay. Otiawa 4, Canada
stone Ltd., 1968. Canadian agent: The
Macmillan Company of Canada, Ltd.,
Toronto.
Reviewed by Helen T. Nightingale,
Supervisor, Queen Elizabeth Hospital,
Toronto.
The authors of this book are English
surgeons who are addressing chiefly the
student surgeon. On browsing quickly
through the pages, one is impressed by
the simplicity of presentation. That a
picture is worth a thousand words is
certainly evident in this profusely illus-
trated text. The photographs and color as
well as black-and-white sketches facilitate
easy, rapid reading.
Being a medical text, this book would
be better reviewed by a surgeon. But
being a colleague profession, nursing can
be enhanced by a knowledge of the
principles by which the surgeon is guided.
This review in no way implies sophistica-
tion in the practice of surgery, but is
concerned with the implications the text
has for surgical nursing.
Just three pages long. Chapter 1 deals
with the cell, its structure, and environ-
ment. The indication for surgery is suc-
cinctly stated at the end of this short
chapter: "The need for surgery arises
from changes whose ultimate impact is on
the life of the cell which may be de-
formed, deprived or poisoned." The next
chapter provides a wealth of material on
congenital anomalies and includes abnor-
mal development due to maternal prob-
lems, such as rubella and the use of
thalidomide in early pregnancy. Up-to-
the-minute information is presented in aU
chapters; the nurse who is familiar with
this information could understand the
patient better and work more effectively
with the surgeon.
Human Sexual Behavior and Sex Educa-
tion: Perspectives and Problems, 2nd
ed., by Warren R. Johnson. 235 pages.
Philadelphia, Lea & Febiger, 1968.
Canadian Agent: Macmillan Company
of Canada, Toronto.
Reviewed by Doris S. Thompson,
formerly Nursing Instructor, The
Children's Psychiatric Research Insti-
tute, London, Ont.
In an era preoccupied with sex, chan-
ging morals, and demands for sex educa-
tion, it is rewarding to read a frank,
realistic, but somewhat shocking book on
human sexual behavior and sex educa-
tion.
The subject material is presented in an
organized and interesting manner. Refe-
rences at the end of each chapter support
the material presented.
Next Month
in
The
Canadian
Nurse
• Welcome to ICN Congress
• Nursing in Japan
• Nursing in Columbia
^^P
Photo credits for
May 1969
Bob Pichette Studio,
Lasalle, P.Q. p. 12
Crombie McNeill Photography,
Ottawa, p. 18
Ashley & Crippen, Toronto, p. 29
Graetz Bros., Montreal,
pp. 32, 34 (left)
City of Montreal, pp. 33 (left),
34 (right)
Armour Landry, Montreal,
pp. 33 (right), 35
The Hospital for Sick Children,
Toronto, p. 38
University of British Columbia,
Vancouver, pp. 41, 43
The Clarke Institute of Psychiatry,
Toronto, pp. 45, 46
University of Alberta Hospital,
Edmonton, pp. 48, 49
Riverside Hospital, Ottawa, & Dept.
Health & Welfare, p. 5 1
58 THE CANADIAN NURSE
MAY 19W
The author is concerned with helping
people gain greater understanding of
themselves and others through increased
awareness of the dynamics of sex in
modern life. With this understanding the
educator may find directions that will
lead humanity to relationships of mean-
ing and fulfillment.
The book opens with a description of
sex education, its nature, and the scope
of the challenge. This first chapter out-
lines the problems of sex education and
closes with a list of personal qualities the
author believes teachers of sex education
should possess: these include an under
standing of one's own sexuality.
Sexual attitudes, morality, and laws
are traced throughout history, and in-
clude old Testament Jewish patterns and
the Puritan influence. The author des-
cribes the dilemma of rearing children in
a sex-centered society, which is at the
same time antisexual.
Misconceptions related to sexual
behavior, such as masturbation resulting
in insanity, impotent men being less
masculine, and "frigidity" being evidence
of low femininity, are presented. Recent
studies are quoted to support the author's
views.
A full chapter is devoted to sex and
the law. The author points out the
inconsistency of laws related to sexual
behavior from state to state. He considers
many laws to be outdated.
In an effort to develop a better under-
standing of human sexual behavior in a
"natural state," the author includes
studies on primitive societies and their
sexual behavior. He also examines sexual
behavior in modern societies.
Seven theories of sex education are
outlined. The author does not outline a
curriculum on sex education, but tries to
develop in the reader a better under-
standing of human sexual behavior by
discussing the biological-psycho-
developmental, historical-linguistic, legal,
moral, and cultural aspects.
This book will help mothers under-
stand their children, nurses understand
their patients, teachers understand their
students, and adults understand one an-
other.
Inservice Education by Russell C.
Swansburg. 339 pages. New York, GJ'.
Putnam's Sons, 1968. Canadian agent:
Macmillan Company of Canada,
Toronto.
Reviewed by Lynsia Hylton, Coordi-
nator, Inservice Education Program.
The Princess Margaret Hospital, Toron-
to.
This is the first book on programmed
instruction for inservice education that I
have seen. It presents the basic concepts
of inservice education for directors and
MAY 1%9
instructors of inservice education sys-
tems, as well as for supervisors, charge
nurses, and team leaders in agency set-
tings.
The author defines inservice education
as education designed to retrain people to
improve their performance and their com-
municative ability, and to introduce them
to the never-ending continuum of educa-
tion.
The book contains ideas about what
inservice education is and who should
receive it: why we need inservice educa-
tion: how to get inservice education off
the ground: what the program should be:
and the responsibility people have for
continuing their own education. The
appendix includes ideas for inservice pro-
grams, an inservice quiz, and a biblio-
graphy.
Each chapter is broken into sections
beginning with an overall view of the
topic to be discussed, followed by a series
of short questions and answers. Program-
med instruction gives the learner in-
centive to proceed with the task, through
the gratification received by turning to
the next page for the results of his effort.
In this respect, the book is not at all dull
reading. The questions become progres-
sively more complex. Real-life situations
are introduced in the form of case studies
and each chapter ends with a summary of
concepts that should have been learned.
This book is written by a nurse in the
United States Armed Forces. The USAF
spends much more time and money than
a genera] hospital on a person's health
and self-development. The reader should
bear this in mind when reading about
some of the ideal conditions mentioned
in the book.
This book will be useful to persons
already employed as inservice educators,
as it may be used to evaluate and help
improve existing methods. It puts inservi-
ce education into a frame of reference
incorporating orientation, skill training,
on-the-job training, and continuing educa-
tion. In this book, a wealth of in-
formation is provided for persons about
to become inservice educators or about to
assume any position of leadership in
nursing.
Continuing Education in Action by Ha-
rold J. Alford for the W.K, Kellogg
Foundation. 153 pages. New York,
John Wiley & Sons Inc., 1968.
Reviewed by Derek Pest ell. Associate
Director of Nursing. The Princess
Margaret Hospital, Toronto.
The subject of this book is organized
in a logical manner, starting with an
over-view of adult learning, and progress-
ing through the conception, planning, and
building of the Kellogg-aided centers.
Problems of design, function, and cost
are discussed and experiences relating to
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Victoria, British Columbia
THE CANADIAN NURSE 59
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these problems are described. This infor-
mation would be valuable for anyone
planning a building with both a resident
and day-to-day populace.
One chapter illustrates the need for
teamwork among a center's staff and
members of the adjacent community, and
the need for specialists in program coordi-
nation.
Emphasis is placed on the need for
constant reevaluation of programs, in-
service education, and research to find
ways to improve existing programs. It is
comforting to find that Dr. Alford and
liis peers at other Kellogg-aided centers
are not without their problems in these
areas.
An excellent chapter on the adminis-
trative aspects of an educational center
such as this provides insight into the
many problems that face such an institu-
tion.
The final chapter asks the question
"Where do we go from here? " and herein
lies the main purpose of Dr. Alford's
book. The Kellogg Foundation has given
financial aid to others to show what can
and must be done in the field of conti-
nuing education; however, theirs is not a
bottomless financial pit. Others must take
up the challenge, if we are to be able to
utilize man's ever-increasing mass of
knowledge.
This is not a book to be read lightly or
rapidly. The reader must ignore any
initial response that all he is reading is a
book pubHcizing the Kellogg Foundation.
Some of the points Dr. Alford makes
are obvious - so obvious that many
people forget them! 1 recommend this
book to any educator or administrator
who "knows where education is at," D
accession list
Publications on this list have been
received recently in the CNA library and
are listed in language of source.
Material on this list, except Reference
items, which include theses and archive
books that do not circulate, may be
borrowed by CNA members, schools of
nursing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List"
and should be addressed to: The Library,
Canadian Nurses' Association, 50 The
Driveway, Ottawa 4, Ontario.
No more than three titles should be
requested at any one time. If additional
titles are desired, these may be requested
when you return your loan.
Stamps to cover payment of postage
from library to borrower should be in-
cluded when material is returned to CNA
library.
60 THE CANADIAN NURSE
BOOKS AND DOCUMENTS
1. Canadian source book of free educational
materials. 1st ed. Cranberry Portage, Manitoba,
Cert. Co. 1968. 166p.
2. Developpement biologique de Venfant
par Stanislau Tomkiewiez. Paris, Presses Univer-
sitaires, 1968. 234p.
3. Developpement de la personalite; initia-
tion a la comprehension du comportement
humain et des relations interpersonnelles par
Paul Bernard. Paris, Masson, 1968. lOOp.
4. Doctors, patients and health insurance;
the organization and financing of medical care
by Herman Miles Somers, and Anne Ramsay
Somers. Washington, Brookings Institution,
1961. 576p.
5. Encadrement des eleves infirmieres en
stage hospitaller. Paris, Association Nationale
Fran^aise des Infirmieres et Infirmiers Diplomes
d'Etat, 1967. 148p.
6. Fundamentals of biostatistics by Stanley
Schor. New York, Putnam's, 1968. 312p.
7. Good uniform; the St. John story by
Joan Clifford. London, Robert Hale, 1967.
190p.
8. Hospital career information. Toronto,
Ontario Hospital Association, 1969.
9. How to use your time to get things done,
by Edwin B. Feldman. New York, Frederick
Fell, 1968. 273p.
10. Inservice education by Russell C.
Swansburg. New York, Putnam, 1968. 340p.
11. Leadership and the nurse; an introduc-
tion to the principles of management by Marga-
ret Schurr. London, English Universities Press,
1968. 116p.
1 2. Man, medicine and environment by
Rene Dubos. New York, Praeger, 1968. 125p.
1 3. Nurses can give and teach rehabilitation.
2d ed. by Mildred J. Allaire. New York,
Springer, 1968. 93p.
14. Nursing education and research; a report
of the regional project 1962-1966 by Helen C.
Belcher. Atlanta, Ga., Southern Regional Edu-
cation Board, 1968. 124p.
15. Nursing education in North Carolina;
today and tomorrow. Raleigh, N.C., North
Carolina Board of Higher Education, 1967.
126p.
16. Nursing observation by Virginia B.
Byers. Dubuque, Brown, 1968. 113p. (Founda-
tions of nursing series.)
17. Office employee; a national study of
work practices and labour law. Toronto, Cana-
da Labour Views Company Ltd., 1968. 272p.
1 8. Ophthalmic assistant; fundamentals and
clinical practice by Harold A. Stein, and Ber-
nard J. Slatt. St. Louis, Mosby, 1968. 406p.
1 9. Part-time employment; its extent and its
problems by Jean Hallalre. Paris, Organization
for Economic Co-operation and Development,
1968. 108p. (Employment of special groups no.
6.)
20. Pears cyclopaedia I96S/69; a book oj
background information and reference for
everyday use. 77th edition. London, Pelham
Books, 1968. R
21. Philosophy and ethics of medicine by
Michael Gelfand. Edinburgh, Livingstone, 1968.
174p.
22. Practice nurse; further development o]
MAY 196'
her role in general practice and its effect on the
doctor's work. Report of Royal College of
General Practitioners. Edinburgh, Livingstone,
1968. 49p. (Reports from General Practice No.
10).
23. Promoting psychological comfort by
Gloria M. Francis and Barbara Munjas. Du-
buque, Brown, 1968. 105p. (Foundations of
nursing series).
24. Rapport de I'Institut sur la personne
dgee, 5ieme. 1-3 mai 1968, Chateaiiguay. P.Q.
St. Jean, P.Q., Federation des services sociaux a
la Famille du Quebec, 1968. 151p. (La FamiUe,
VoL 5 no. 49, 25 juin 1968).
25. Research proposal on the study of
visiting homemaker services by Georges-Heiui
Belleau. Ottawa, Canadian Welfare Council,
August, 1968. 24p.
26. Study of some effects of sensitivity
training on the performance of students in
associate degree programs of nursing education
by Doris Arlene Geitgey. New York, National
League for Nursing, 1968. 71 p. (League
exchange no. 86).
27. Teaching function of the nursing practi-
tioner by Margaret Pohl. Dubuque, Brown,
1968. 121p. (Foundations of nursing series).
28. Television in education by Roderick
MacLean. London, Methuen Educational, 1968.
151p. (Modern teaching series).
29. The U.S. and us, edited report of 37th
Couchiching Conference, J 968 by Gordon
McCaffrey. Toronto, Canadian Institute on
Public Affairs, 1968. 139p.
PAMPHLETS
30. Assignment report nursing education in
Lebanon. 20 April- 1 9 July, 7^66' by Dorothy
G. Riddell. Alexandria, World Health Organiza-
tion, Regional Office for the Eastern Mediterra-
nean, 1968. 15p.
31. Educational television in U.S.S.R. by
Lev Shatrov. Toronto, Convergence, 1968. 5p.
32. Licensure to practice nursing. New
York, American Nurses' Association, 1968.
33. Occupational wage differentials in Cana-
da 1939-1965; a new look at relative occupa-
tional differentials by Stephen G. Peitchinis.
Calgary, University of Calgary, 1965. 40p.
34. Mental health film library sponsored by
the Rotary Clubs of Toronto, rev. ed. Toronto,
The Onadian Mental Health Association, 1 966.
30p.
35. Policies and procedures of accreditation
for programs in practical rnirsing. First Edition.
New York, National League for Nursing, 1968.
18p.
36. Recyclage des infirmieres en service
hospitaller. Memoire a I'Association des infir-
mieres de la province de Quebec. Quebec,
I'Association des infirmieres de la province de
Quebec, District no. IX, Comite d'education,
1968. lOp.
37. Resume of the report of the Royal
Commission on Bilingualism and Bicultiiralism;
Education. By Canadian Association for Adult
Education in co-operation with the Citizenship
Branch, Dept. of the Secretary of State. Toron-
to, Canadian Association for Adult Education,
1968. 16p.
38. Training syllabus and record of practical
instruction and experience (general) for admis-
sion to the Roll of Nurses. London, General
Nursing Council for England and Wales, 1964.
31p. R
GOVERNMENT DOCUMENTS
British Columbia
39. Dept. of Health Services and Hospital
Insurance. Report on Hospital statistics and
administration of the hospital act for the year
ended 1964. Victoria, Queen's Printer, 1966.
48p.
Canada
40. Bureau of Statistics. Canada; the official
handbook of present conditions and recent
progress, 1968. Ottawa, Queen's Printer, 1968.
311p. R
41. .. Salaries and qualifications of
teachers in universities and colleges, 1965-1966.
Ottawa, Queen's Printer, 1969. 75p.
42. . Survey of education finance,
1965. Ottawa, Queen's Printer, 1969. 51p.
43. Commission des relations de travail dans
la Fonction publique. Premier rapport annuel.
Ottawa, Imprimeur de la Reine, 1968. 73p.
44. Canada Council Report, 1967-1968.
Ottawa, Queen's Printer. 167p.
45. Dept. of Consumer and Corporate
Affairs. Policies for price stability. Ottawa,
Queen's Printer, 1968. 34p.
46. Dept. of Indian Affairs and Northern
Development, Indian Affairs Branch. The Cana-
THE
FULLER
ISHIELD:
Keeps dressings firmly in place
Prevents soiling of clothing, bed linen
The ideal post-operative dressing for patient
comfort, nursing convenience. The FULLER
SHIELD, designed on undergarment lines, is a
protective dressing especially made to maintain
anal, perianal or sacral dressings comfortably
in place without binding, without use of tapes.
Surgeons order two FULLER SHIELDS
for each patient. (One on and one off.)
Nurses are glad they do.
Request samples through your hospital
purchasing agent.
tf
MAY 1%9
WIN LEY- MORRIS .5??i
MONTREAL CANADA
ALL MAKES
OF BROKEN
INSTRUMENTS
REPAIRED QUICKLY
AND EXPERTLY
Our skilled technicians perform fast, guaranteed
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BLOOD PRESSURE APPARATUS D SCISSORS
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D OSTEOSCOPES D OSTEOTOMES D GOUGES
D MENISCUS KNIVES D BONE RONGEURS
D CURETTES D STERILIZERS D SIGMOIDO-
SCOPES DANASCOPES DOPHTHALMOSCOPES
D EXAMINING SETS, ETC.
Free advice and a quotation supplied on request.
A chrome plating and sharpening service is also available.
Instruments accepted from individuals.
(Minimum charge is $5.00)
Send your instruments, with a purchase order to:
WINLEY-MORRIS SURGICAL DIVISION
c/o W&W Precision Company
745 St. Maurice Street
Montreal 3, Que.
THE CANADIAN NURSE 61
dian Indian: a reference paper. Ottawa, Queen's
Printer, 1966. 13p.
47. Dept. of National Health and Welfare.
Nursing with medical services. Ottawa, Queen's
Printer, 1968. 12p.
48. Dept. of National Health and Welfare.
Emergency Health Services. Disaster nursing in
student nurse curricula: guidelines for instruc-
tors. Ottawa, 1967. various paging.
49. Economic Council of Canada. Effective
protection in the Canadian economy prepared
by James R. Melvin and Bruce W. Wilkinson.
Ottawa, Queen's Printer, 1968 (Special study
no. 9)
50. Ministere de la Sante nationale et du
Bien-etre social. Division de I'Hygiene maternel-
le et infantile. Normes et recommandations
pour les soins a la mere et nouveau-ne. Ottawa,
Imprimeur de la Reine, 1968. 185p.
51. Ministeres des Affaires exterieures. Le
Canada et les Nations Unies, 1966. Ottawa,
Imprimeur de la Reine, 1968. (Recueil de
conferences) 152p.
52. Ministere du Travail. Collaborateur
essentiel des travailleurs et des employeurs.
Ottawa, Imprimeur de la Reine, 1968. 16p.
53. . Direction de I'economique et de
recherches. Les femmes dans I'administration
federale; les emplois qu'elles occupent et I'utili-
sation de leurs competences par Stanislau
Judek. Ottawa, Imprimeur de la Reine, 1968.
171p.
54. Public Service Staff Relations Board.
First Annual report J 96 7-1 968. Ottawa,
Queen's Printer, 1968. 73p.
55. Science Council of Canada. Towards a
national science policy for Canada. Ottawa,
Queen's Printer, 1968. 56p. (Report No. 4)
Great Britain
56. Ministry of Health Scottish Home and
Health Department, Central and Scottish
Health Services Councils. The care of the health
of hospital staff: report of the joint committee.
London, Her Majesty's Stationery Office, 1968.
45p.
Quebec
57. Office d'information et de publicite. Le
gouvernement du Quebec et la constitution.
Quebec. 101 p.
U.S. A.
58. National Center for Health Statistics.
Comparison of the classification of place of
residence on death certificates and matching
census records. United States, May-August
I960. Washington, Public Health Service, 1969.
60p.
5 9. . Health resources statistics:
health manpower and health facilities, 1968.
Washington, U.S. Govt. Print. Off., 1968. 260p.
60. . Hearing status and ear examina-
tions: finding among adults: United States
1960-1962. Washington, Public Health Service,
1968. 28p.
61. . Infant and perinatal mortality in
England and Wales. Washington, Public Health
Service, 1968. 77p.
62. . Patients discharged from short-
stay hospitals by size and type of ownership.
United States ~ 1965. Washington, Public
Health Service, 1968. 29p.
63.
Pseudoreplication further evalu-
ation and application of the balanced half-
sample technique. Washington, Public Health
Service, 1969. 24p.
64. . Use of special aids in homes for
the aged and chronically ill. United States -
May-June 1964. Washington, Public Health
Service, 1968. 32p.
AUDIO VISUAL AIDS
65. The maternal cycle. Toronto, Canadian
Red Cross Society, 1965. 32 col. slides with
commentary in English and French. (May be
purchased from Canadian Red Cross Society,
Toronto.)
66. Posture and body mechanics for you
and your patient. Toronto, Canadian Red Cross
Society, 1966. 38 col. slides with commentary
in English and French. (May be purchased from
Canadian Red Cross Society, Toronto.)
STUDIES DEPOSITED IN
CNA REPOSITORY COLLECTION
67. Evaluation of a two-year experimental
nursing program by C. Costello, and Sr. T.
Castonguay. Regina, Regina Grey Nuns' Hospi-
tal, School of Nursing, 1968. 92p. R
68. Prediction of College level academic
achievement in adult extension students by
Josephine M. Raherty. Toronto, 1968. 24 2p.
(Thesis - Toronto) R
69. Women's feelings about the figure
change in pregnancy by Elaine Audrey
McEwan. New Haven, Conn., 1968. 107p.
(Thesis (M.Sc.N.) ~ Yale.) R
Request Form for "Accession List"
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Send this coupon or facsimile to:
LIBRARIAN, Canadian Nurses' Association, 50 The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in the
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62 THE CANADIAN NURSE
MAY 1%
June 1969
The
Canadian
Nurse
international issue
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to our ICN guests
nursing in Colombia
and japan
ICN - its origin
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Style 5061 Retails about $1 5.98
Sizes 6 to 18
This and other styles available at uniform shops
and department stores across Canada.
PROFESSIONAL UNIFORMS
For a copy of our latest catalogue and
for the store nearest you, write :
La Cross Uniform Corp.
4530 Clark St.,
Montreal, Quebec
Tel: 845-5273
LOOK at the all -new 11th edition of
nursing's most popular pharmacology text ever I
By Betty S. Bergersen, R.N., M.S., Ed.D., and Elsie E. Kruq, R.N., M.A. ^^^^^^B
In consultation with Andres Goth, M.D.
Look at the qualities which instructors have ad-
mired about this text through 10 previous editions
... its emphasis on not only knowing but under-
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troduction of the student to this sometimes be-
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Take a good long look at this new 11th edition,
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the new 11th edition of Bergersen-Krug, PHAR-
MACOLOGY IN NURSING?
By BETTY S. BERGERSEN, R.N., M.S., Ed.D., Associate Professor
of Nursing, College of Nursing, University of Illinois at the Medical
Center In Chicago; and ELSIE E. KRUG, R.N., M.A., Instructor In
Pharmacology and Anatomy and Physiology, St. Mary's School of
Nursing, Rochester, Minn. In consultation with ANDRES GOTH,
M.D., Professor of Pharmacology and Chairman of the Department,
The University of Texas Southwestern Medical School, Dallas. Pub-
lication date: June, 1969. 11th edition, approx. 672 pages, 7"x ICT,
with 51 illustrations and 8 color plates. AI>out $9.90.
Look at WHY it can meet your needs better than any other pharmacology text
Totally up-to-date content includes current clinical and research
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not so oversimplified that it lacks scientific basis
Inviting new two-column, two-color format emphasizes l<ey points,
helps students locate information quickly
New chapter on psychotropic drugs explores every aspect of this
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Expanded discussions of physiology and physiological foundations
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• Fresh facts on drugs affecting the central nervous system . . .
caffeine, amphetamines, new analeptics, analgesics, hypnotics and
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• Meaningful new material on drugs affecting the circulatory system
includes a discussion of cardiac electrophysiology, ganglionic
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• Timely new information on drugs that affect the reproductive
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• Tables, review questions, glossaries and current references aid
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M«f r,
The C.V. MOSBY Company, Ltd. • Publishers
86 Northline Road • Toronto 16, Ontario
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rule
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WHITE^
UNIFORM
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The
Canadian
Nurse
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 6
^^P
lune 1969
31 International Forum in Montreal S. Quinn
32 The Growth and Development of a Profession D. Bridges
35 Nursing in Japan S. Nagano
37 Nursing in Colombia L.A. Restrepo and B.C. de Garzon
40 Medical Photography — A Century of Progress J. Doyon
42 Medical Illustration — An Art and a Science M. Gagnon
45 Nurses are Not Neurotic A. Cohen
46 Rooming-In Brings Family Together B. Coome
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
9 News
20 Names
24 Dates
26 New Products
28 In a Capsule
48 Research Abstracts
49 Books
51 Accession List
80 Index to Advertisers
Executive Director: Helen K. Mussaliem •
Editor; Virginia A. Lindaburv • Assistant
Editor: Eleanor B. Mitchell • Editorial Assist-
ant: Carol A. Kodarsky • Circulation Man-
ager: Beryl Darling • Advertising Manager:
Ruth H. Bauniel • Subscription Rates: Can-
ada: One Year, $4.50; two years, $8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Six weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
® Canadian Nurses' Association 1969.
Manuscript Information: The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on white paper)
are welcomed with such articles. The editor
IS not committed to publish all articles
sent, nor to indicate definite dates of
publication.
Postage paid in cash at third class rate
MONTREAL, P.Q. Permit No. 10,001.
50 The Driveway, Ottawa 4, Ontario.
WELCOME ABOARD
Flight 1969 ICN Rocket Service
to Montreal.
For your comfort and
enjoyment, we suggest
that you:
Fasten your money belt
2. Extinguish all cares
and avoid gravity.
3. Lower tray in
front if you
wish moonshine
en route.
4. Do your own
thing in
Montreal.
5. Get back in
orbit and
down to
earth again
after the
Congress.
BON
VOYAGE!
JNE 1%9
THE CANADIAN NURSE 3
letters
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Thought and action
I hope that all CNA members, both
active and inactive, have read "Thought
and Action" by Mr. E. Van Raaite (March
1969). He is to be congratulated on his
report of the economics of the Canadian
Nurses' Association.
At the same time, we cannot ignore
the "News" section from which we can
draw our own conclusions. Any provin-
cial association that decides not to pay a
CNA membership fee of S 10 per member
should realize the effect this decision will
have on the national association.
The publication of French and English
journals is commendable and should be
continued, even though extra mailing
charges strain the CNA budget. Also, we
should acknowledge the fact that we
cannot purchase very much today in
quality and service for SIO. We have to
agree that since 1940 our association has
gained in quality and stature as a result of
better qualified personnel. In my opinion,
there is greater strength in centralization
than in decentralization.
If we have any pride in our profession,
we owe it to our association to express
our views on this issue.
It was my privilege to be elected as a
representative of our district at the meet-
ing of the Association of Nurses of the
Province of Quebec last fall. I found it a
most rewarding experience to see our
provincial association in action, and to
note the enthusiasm of the younger
nurses present. - Gladys McDonald.
Reg.N., Occupational Health Nurse, East
Angus. Quebec.
The message so succinctly put forth by
Mr. Van Raaite in the article "Thought
and Action" (March 1969) explained the
financial position of the Canadian Nurses'
Association, but it would appear some
basic facts are not spelled out and their
absence is noticeable.
The breakdown of the $10.00 fee paid
to CNA by each nurse who is a member
of her provincial association incorporates
the unknown cost of owning, operating
and maintaining CNA House, total sala-
ries paid, and travel expenses. Would it
not be prudent for Mr. Van Raaite to
reveal these possible large expenditures
rather than apportion them to various
areas? Perhaps knowing the hidden costs
would take some of the wonderment
away from "what happened to the
SI 0.00 for CNA'.'
Advertising revenue from The Cana-
dian Nurse would be interesting to know,
4 THE CANADIAN NURSE
coupled with the cost of producing the
publication and its actual total mailing
list.
It would appear from this article that
CNA survival is based on members taking
action. How can we realistically do so
when so much is nebulous? - (Miss)
Jacqueline P. Robarts, Reg.N., B.Sc.N.,
Principal, Osier School of Nursing,
Weston, Ont.
The article "Thought and Action" by
Ernest Van Raaite, and the February
editorial reported that the CNA requires a
fee increase.
Many nurses think it is most unfair
that nurses who work on a casual basis or
part-time pay the same registration fee as
nurses who work full-time. The salary
differences are too great to have registra-
tion fees the same for all. Perhaps regis-
tration fees should be in proportion to
income.
If registration fees were in proportion
to income, it would be necessary to have
a separate licence fee. A nominal licence
fee, such as Ontario has, seems fair and
reasonable.
The Canadian Nurse is a wonderful
journal and well worth the true costs to
those who read it. Subscription to the
journal could be voluntary. With the
licence and journal subscription separate,
registration fees in proportion to income
would be feasible.
Perhaps the CNA's Ad Hoc Committee
on Fee Structure would consider the
above suggestions. - Beverley B. Barr,
Winnipeg, Man.
Two-year vs. three-year programs
The undersigned members of the Com-
mittee on Research in Nursing of the
Registered Nurses' Association of Ontario
herewith register concern about the arti-
cle "Two-Year Versus Three-Year Pro-
grams" by C.G. Costello and Sister T.
Castonguay (February 1969).
This Committee believes: 1. that the
theoretical rationale suggested by the
authors' review of the literature is inade-
quate; 2. that the design of the study is
not without serious methodological
faults; for example, the assumed rela-
Letters Welcome
Letters to the editor are welcome. Be-
cause of space limitation, writers are
asked to restrict their letters to a
maximum of 350 words.
tionship between the educational objec-
tives of the nursing programs and the
student behaviors assessed in this study,
and the inconsistency between the two
outside raters and the implications drawn
from their ratings; and 3. that the report
of the study contains statements that give
cause for serious concern; for example,
this Committee questions the authors'
interpretation of statistically non-
significant differences between groups as
"conclusive evidence" of the superiority
of one group over another. Thus readers
are misled into believing that the per-
formance of the three-year students in
this study was significantly better than
that of the two-year students.
At a time when nursing is looking
more and more to research for direction,
it is imperative that it be reported accu-
rately and meaningfully for members of
the profession. Therefore, the Committee
recommends that, prior to publication in
the journal, research articles be reviewed
by researchers who are competent to
assess soundness of the design, implemen-
tation, and reporting of the research. It
also recommends that Tlie Canadian
Nurse invite critiques of articles and
research reports for publication, prefera-
bly in the same issue or closely following
the initial publication of the article,
study, or report. Lucille C. Peszat.
Secretary for Committee on Research in
Nursing, RNAO; Margaret Allemang, Isa-
bel Black, Margaret Cahoon, Rosemary
Coombs, M. Josephine Flaherty. Amy
Griffin, Lois Powell, Albert W. Wedgery.
Right no to strike
1 am writing to express concern over
the editorial (April 1969) that is so biased
toward those nurse educators who chose
to exercise their right to strike in Hamil-
ton.
A good number of us, both in nursing
service and education, have strong feel-
ings about the use of the strike in our
profession. Some of us are neither old nor
particularly old-fashioned. Nor do we
appreciate that the two teachers who
exercised their right not to strike should
be the brunt of derogatory comments in
your editorial. We feel, in fact, that they
should be entitled to an apology and a
retraction of the term ■"turncoats."
The strong support of the strikers and
of their view of the situation - and their
view only has been widely publicized
by our national professional journal. We
fCoiitiinicil on paKC ('.
JUNE 1%
"Core" Texts in Nursing Education
^^^
BOOKS
New Texts New Editions
Distinguished Reference Works
VISUAL AIDS
TO TEACHING
Film Loops (motion pictures
demonstrating basic nursing
skills)
Transparencies (illustrating
nursing subjects vio overhead
projection)
See the above at the
Lippincott booth (54)
during the Fourteenth
Quadrennial Congress
of the I.C.N. in
Montreal.
New
(4th)
Edition!
FUNDAMENTALS OF NURSING:
THE HUMANITIES AND THE SCIENCES IN NURSING
By Elinor V. Fuerst, R.N., M.A.. and LuVerne Wolff. R.N.. M.A.
Extensively revised and expanded, the Fourth Edition reflects
greatly increased emphasis upon the independent functions implicit
in the nursing role. Nursing responsibilities are highlighted, includ-
ing core of man as a human being as well as a biological organism.
The nursing process is analyzed as a scientific discipline involving
definition of nursing problems, the use of the problem-solving
approach and formulation of core plans based on priorities of
needs. Extensive reorganization of content has resulted in increased
logic and appropriateness to modern nursing curricula. Instructors
will find that this edition allows maximum flexibility in teaching.
446 Pages 170 Illustrations 4th Edition, 1969 $8.25
New!
NURSING CARE PLANNING
By Dolores E. Little, R.N., M.N., and Doris L. Carnevali, R.N., M.N.
Realistic in approach and modern in concept, this entirely new book
presents the rationale for systematically planned nursing care,
based on priorities of patients' needs and the best utilization of
personnel in meeting these needs. Examples of core plans, using
a variety of patients, are included in the first section to demonstrate
the dynamics of the planning process. The concept of planned
nursing care as an ongoing process is introduced in the last half
of the book. Chapter-end summaries, study questions and projects
highlight the major points and invite creative thought on the part
of the student.
245 Pages
1969
Paperbound, $3.80
Clothbound, $5.50
J.B. LIPPINCOTT COMPANY OF CANADA LTD., 60 Front St. W., Toronto, Ont.
Lippiyicott
Please send me the following books:
Z FUNDAMENTALS OF NURSING (4th Edition $8.25
U NURSING CARE PLANNING D Paperbound S3.80
D Clothbound $5.50
Name
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City Province
n Payment enclosed
n Charge
CN-6-69
UNE 1969
THE CANADIAN NURSE 5
Whenyourday
startsat __
6 a.m. ..you re oji
charge duty... ^
you \/e skimped
onmea/s...^
and on sleep...
you haven't had^
time to hem
a dress... ^
mal(e an apple pie...
washyourhair.
evenpowder «
your nose,
m comforts
It's time for a change. Irregular hours and meals on-the-
run won't last. But your personal irregularity Is another
matter. It may settle down. Or it may need gentle help
from DOXIDAN.
use
DOXIDAN"
most nurses do
DOXIDAN is an effective laxative for the gentle relief of
constipation without cramping. Because DOXIDAN con-
tains a dependable fecal softener and a mild peristaltic
stimulant, evacuation is easy and comfortable.
For detailed information consult Vademecum
or Compendium.
HOECHST
PHARMACEUTICALS
3400 JEAN TALON W . MONTREAL 301
DIVISION OF CANADIAN HOECHST LIMITED
I PMAC I
6 THE CANADIAN NURSE
(Continued from page 4)
are particularly worried to find that the
students, who remained quiet and non-
committal, should be almost reprimanded
for this in your editorial and encouraged,
even incited, to support the striking
teachers. The consequences of all of this
are grave.
We want to express disapproval of the
lack of fairness in the reporting and in the
editorial of The Canadian Nurse on this
issue. We also wish an apology to the two
non-striking teachers (some of us even
admire their courage and we know that
not a few students do also). Next, we
object to the encouragement of student
involvement when the students had
chosen, for their own reasons, not to
support the strike.
Finally, we wish to express sadness
and regret that a great lady and nursing
leader, in the person of Miss Nightingale,
should have been posthumously insulted
by the use of the disrespectful nickname
on the placard and the implication that
she would have supported the strike
action. It might do some persons consi-
derable good to re-read their history of
nursing and a biography of Miss Nightin-
gale. Many of us feel she would have
responded as a lady, an educator and a
nurse practitioner whose primary concern
would have been those in need of better
nursing care, not her own remuneration.
We are not, in this letter, objecting to
the strike action. We recognize the right
of the strikers to act this way, if they
wish. Whether we agree or approve is
largely irrelevant. When those who disa-
gree, however, for their own reasons are
either not allowed to do so (and remain
in good standing in our professional
organization), and/or are ridiculed for
their stand, it is our business. It has been
erroneously assumed that all of us either
are, or should be, in favor of the strike
and of strike action for nurses.
We have been assured by several peo-
ple that our views will be considered
unimportant, non-representative, dan-
gerously narrow, and out of date. There-
fore, they will not be published. We feel
that there are still honest attempts to air
all sides of any situation in nursing in our
professional journal. - Catherine Smith,
Owen Sound, Ont.
Nursing assistant programs
It was very encouraging to read Doro-
thy Kergin's reasoned argument in favor
of continuing nursing assistant programs
(April 1969). I agree with Dr. Kergin that
the CNA committee on nursing education
policies, which include the gradual phas-
ing out of all programs "that prepare
practitioners, who, upon graduation, are
not eligible for licensure as registered
nurses," are not only "ill-conceived and
poorly timed," but are out of touch with
what is happening in the world around us.
Ten, or perhaps even five years ago, it
might have been possible to move in the
direction suggested by the committee on
nursing education, i.e., to define only two
nursing roles, differentiated by their basic
educational preparation, but with both
retaining eligibility for licensure as re-
gistered nurses. At that time the bounda-
ries between the functions and the res-
ponsibilities of the diploma graduate
nurse and the nursing assistant were less
blurred, and their future roles appeared
to be more easily differentiated.
What appears to have gone unre-
cognized has been the steady growth over
the past decade in programs to prepare
practical nurses for licensure. In British
Columbia alone there are now over 3,500
practical nurses with current licensure; in
the latest B.C. report on hospital statis-
tics, it was noted that the non-
professional nursing staff comprised over
43 percent of the total nurse force in
hospitals. This group of nurse practition-
ers is most involved in direct patient care.
It is interesting to speculate about which
of the two nursing groups is actually
having the greater impact on patients
today.
It seems to me that to continue to
deny the existence of this viable nursing
force will only perpetuate a vacuous
nursing predicament that has gone on too
long. Undeniably, the nursing assistant is
here to stay, and the time has come for us
to accept this reality instead of looking to
the past in an attempt to find the answers
for the future. Dr. Kergin's prediction
that unless we determine how best to
utilize the nursing assistant, others will
decide this for us, has already begun to
come true. These decisions often have
been made with only a polite acknowl-
edgement of nursing's inherent right for
self-determination.
I suggest that the nursing assistant
programs should not only be continued
but be strengthened. We know that gra-
duates from these programs are continual-
ly being faced with responsibilities for
which they have not been adequately
prepared, and it is highly probable that in
the future the demands upon their capa-
bilities will increase. Attempts to impose
unrealistic ceilings on practical nursing
functions, or to consider shortening or
eliminating these programs, can only be
viewed as a defensive reaction against the
inescapable changes occurring in the nurs-
ing and medical worlds.
If we are to grow as a profession, we
must begin to assume a greater responsibil-
ity for the practice of nursing and its
practitioners. We can do so by negotiating
with the leaders of the non-professional
nursing groups to find a mutual agree-
ment on the best course for the future ofi
JUNE 1969
nursing. Together we should begin to
explore our existing roles in the hope that
through a joint reexamination of our
similarities we can arrive at a clearer
definition of our differences. We can only
start to define these differences when we
stop being rivals and stop worrying about
our overlapping roles.
The practice of nursing will remain
challenging only as long as nursing leaders
constantly seek and promote new chal-
lenges, with each practioner being encour-
aged to develop to her fullest human
potential. Nursing assistants have long
proven their worth in providing patient
care, and it is now the responsibility of
professional nursing to give them the
opportunity to make an even greater
contribution.
I forsee the professional nursing role as
primarily one of leadership and guidance,
and of increased concern, not only for
patient care, but for all those who are
committed to patient care. To be effec-
tive leaders we must first put our own
house in order. Only then can we know
with reasonable clarity the full extent of
nursing's contribution to the future
health needs of our society. - Mrs. Car-
olee Bailey. R.N., Victoria, B.C.
Advances in nursing
The letter by M.H. Rajabally (March
1969) was rather galling, certainly to all
degree nurses, and most probably to the
majority of diploma nurses.
The query on the future trends of
nursing reveals some lack of percep-
tiveness on the part of the writer. It is
quite correct that a nurse at present
cannot prescribe medication. Legally it is
not tolerated. This in no way. however,
implies that a nurse is incapable of minor
diagnosis. Most practicing nurses, whether
degree or diploma, have always diagnosed
ills, then forwarded their opinion to the
attending physicians who have usually
:orroborated their analysis and prescribed
the remedies. The services of the physi-
;ian, in many cases, could conceivably be
aerfornied by most highly qualified
lurses. In 10 years perhaps hospital ad-
ministrators will realize this fact.
"Nursing is becoming more and more
heoretical because many nursing experts
lave left the hospital setting and disasso-
;iated themselves completely from pa-
ients." Nonsense!
Because nursing is becoming more
heoretical, many educators have found it
lecessary to disassociate themselves from
he patient. Advances in nursing, medi-
ine, and administration techniques are
onstantly being made. Someone must
ccumulate and process this data for the
lenefit of students. The average profes-
ional nurse has not the time to handle
he deluge of new knowledge. This is the
orte of the educator; in most cases, but
lot always, this is a degree nurse who has
■een trained to acquire and process infor-
UNE 1969
mation as efficiently as possible.
Higher education is not intended to
equip educators with manual dexterity,
but to allow them to acquire knowledge,
then forward this information to their
students who, through practice, will ac-
quire the dexterity to nurse patients
adequately.
"1 want - rather the patient
wants - practice." How true! What
nurse Rajabally fails to realize is that the
ill person is the responsibility of the staff
nurse, while the student is the responsibil-
ity of the educator-degree nurse. Both
must acquire perfection in handling their
respective patients. That the professional
should adequately administer to the edu-
cator's patients or vice versa is simply not
possible in this dynamic science.
Science has always been the mainstay
of medicine and the applications today
are subtle. Tomorrow's vistas appear fan-
tastic - patient monitoring from a mas-
ter situation, as in the space program, and
diagnosis by computer. Today's student
nurse is tomorrow's diploma (and I hope
eventually degree) nurse. The patient, the
doctor, and the profession will need her
and her knowledge. 1 can only hope she
obtains it through practice or education
before it is needed. - Joan MacDonald,
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THE CANADIAN NURSE 7
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CCHA Rejects CNA
Bid For Representation
Ottawa. - For the eighth time in
four years, the Canadian Nurses' Associa-
tion's appeal for representation on the
Canadian Council of Hospital Accredita-
tion has been rejected. The executive
director of CNA, Dr. Helen K. Mussallem,
received this news in February from the
Council, whose membership consists of
the Canadian Hospital Association, the
Canadian Medical Association, the Royal
College of Physicians and Surgeons of
Canada, and I'Association des Medecins
de Langue Fran^aise du Canada.
Since May 1965, the CNA has corres-
ponded frequently with Dr. W.I. Taylor,
executive director of the CCHA, express-
ing the association's deep concern about
the lack of a representative from the
organized nursing profession.
In July 1968, the Council again defer-
red CNA's request for representation
until CCHA had received the report of its
special structure study. This study, pub-
lished by CCHA in December 1968 as the
Report of Research Project No. 1, recom-
mended that:
I* Fifteen seats be provided on the board
Df the Council and that two of these be
given to CNA.
t» The executive office include three full
time surveyors (one physician, one ad-
Tiinistrator, and one registered nurse.)
w Future surveys be conducted by a team.
To date, the Report's recom-
Tiendations have been ignored.
The need to evaluate the quality of
lursing in hospitals has been a matter of
concern to CNA for a number of years.
Several provincial nurses' associations
lave also expressed concern that not
;nough attention has been given to the
;valuation of nursing care when hospitals
ire being assessed for accreditation. Rep-
esentation on the CCHA would be one
vay for the CNA to meet this need.
In an interview with The Canadian
Vurse, Frances Howard, CNA consultant
n nursing services, suggested several
easons why the CCHA has not made the
:hanges recommended in the Report.
'The CCHA is a 'closed shop,' " she said,
'and if nursing is represented on the
'ouncil, other hospital departments
night also ask to be represented. CCHA
lelieves that if the quality of medical care
5 good, patient care will be good," she
ontinued. Miss Howard said that CNA
hould continue to press for membership
in the CCHA; she believes that in the
neantime there should be nurse represen-
UNE 1969
Sister Mary Felicitas, president of the Canadian Nurses' Association, pins
Whoo-fur - the furry mascot of the ICN Congress - on lapel of Laura W. Barr,
executive director of the Registered Nurses' Association of Ontario. Miss Barr is on
the ICN Professional Services Committee.
tation on the standards committee and
nurse participation on the survey team.
She suggested, in addition, that the nurse
surveyors be selected from a roster of
nurses prepared by the CNA.
Margaret McLean, consultant in hospi-
tal nursing, Department of National
Health and Welfare, and chairman, CNA
committee on nursing service, told The
Canadian Nurse that she supports CNA's
bid for representation on the CCHA.
"The CNA is committed by its objects to
improve the quality of nursing services in
Canada," Miss McLean said. "Many proj-
ects have been undertaken in carrying out
this responsibility.
"The request for the CNA to be
consulted when criteria for the assess-
ment of hospital nursing service is being
developed or revised in the accreditation
program, and the request for a seat on the
Council are two avenues through which
the association would hope to maintain
standards and improve the quality of
hospital nursing service," Miss McLean
said. "Since the majority of registered
nurses are employed in hospitals," she
continued, "participation in the develop-
ment of criteria for evaluation of hospital
nursing services and representation on the
Council could be expected to forward the
objectives of the CNA."
At the board of directors' meeting in
February 1969, CNA suggested that the
provincial nurses' associations send letters
to their provincial hospital associations
and the Canadian Hospital Association to
interpret the merit of CNA's represen-
tation on CCHA. "Of all the professional
services in the hospital, nursing is the
only one that is continuous," Dr. Mus-
sallem reminded the board members.
ICN Receives $8,000
From AARN
Edmonton, Alta. - The Alberta As-
sociation of Registered Nurses has made a
gift of $8,000 to the 14th Quadrennial
Congress of the International Council of
Nurses, to be held June 22-28 in Mont-
real. Seven thousand dollars are to assist
CNA with the expenses of the Congress
(reported in May 1 969) and an additional
$1,000 to purchase tickets to "Man and
His World" for international guests who
are not residents of North America.
THE CANADIAN NURSE 9
Library Display
At ICN Congress
Ottawa. - All available library refer-
ences and other library tools for nursing
will be displayed at the 14th Quadrennial
Congress of the International Council of
Nurses in Montreal June 22-28.
Virginia Henderson, author of ICN
Basic Principles of Nursing Care and
co-author of Principles and Practice of
Nursing, is responsible for the exhibit and
will be at the booth to answer questions.
Miss Henderson will take part in a panel
discussion on libraries in schools of nurs-
ing on June 24.
Team Nursing Workshops
Held In Alberta
Ottawa. - Frances Howard, con-
sultant in nursing service at the Canadian
Nurses' Association, conducted work-
shops in Alberta in April. In Edmonton,
more than 100 attended the workshop
held April 8 and 9 in the auditorium of
the school of nursing residence. Royal
Alexandra Hospital. Over 75 were present
in Calgary April 10 and 1 1 at the Univer-
sity of Calgary. The workshop was a
"problem-solving" clinic on team nursing.
A group discussion was held by those
nurses who had practiced team nursing,
followed by a lecture on the philosophy
and development of team nursing. A
second group discussion centered on how
to improve the team nursing already in
practice related to the three basic aspects
of team nursing: 1. the conference;
2. assignment of patients; and 3. the
nursing care plan.
The final session included the role of
inservice education in the implementation
of team nursing, and the preparation of
personnel for team nursing.
CCUSN Atlantic Region Assesses
Need for Master's Program
Fredericton, N.B. - Challenges, cur-
riculum, faculty selection, and the me-
chanics of setting up a master's program
in nursing were topics presented by Dr.
Shirley R. Good, consultant in higher
education, Canadian Nurses' Association,
at the Canadian Conference of University
Schools of Nursing, Atlantic Region,
meeting held April 21-22 in Fredericton.
"Since there are no specific Canadian
guidelines for graduate education, we will
have to continue to use USA material and
modify it to meet our needs," Dr. Good
told nurses from Newfoundland, Nova
Scotia, and New Brunswick. Baccalaure-
ate programs should be general in content
with no major offerings in either basic or
postbasic curricula," she said. Master's
programs that are superficial or a makeup
10 THE CANADIAN NURSE
Tardivelle
Redman
Eight staff members of the International Council of Nurses, Geneva, will be in
Montreal June 22-28 to attend the 14th Quadrennial Congress of the ICN.
Sheila Quinn, ICN executive director. Born in England, she is a nursing graduate
from Royal Infirmary, Lancaster, and holds a B.Sc. in Economics from the
University of London. She was nurse tutor at Prince of Wales Hospital, London,
prior to joining the ICN in 1 96 1 . Marjorie Duvillard, ICN deputy executive director.
Born in Argentina, she attended secondary school and Le Bon Secours school of
nursing in Geneva, where she was director prior to her recent appointment to the
ICN in 1969. Martha (Biddy) Shout, ICN nurse advisor. Born in Great Britain, she is
a graduate of Mildmay Memorial Hospital and Metropolitan Hospital, London. Prior
to joining ICN in 1966, she was principal nursing tutor and registrar, Nurses Board
of Ghana. Mrs. Margaret Pickard, ICN nurse advisor. Born in New Zealand, she is a
graduate from Wellington Hospital School of Nursing and New Zealand Post-
graduate School of Nursing. Prior to joining ICN in 1968, she was national
secretary. New Zealand Registered Nurses Association. Alice Thompson, Editor,
International Nursing Review. Born and educated in England, she was librarian at
Royal College of Nursing and National Council of Nurses, London, prior to joining
ICN in 1968. Dr. Mary Seivwright, ICN nurse advisor. Born in Jamaica, Dr.
Seivwright attended Montego Bay and Kingston Public Hospital Schools in Jamaica,
and holds a B.Sc, M.A. and Ed.D. from Columbia University. She joined ICN in
1969. Mrs. Merren Tardivelle, ICN editorial assistant. Born in Manitoba, she is a
graduate of Portage Collegiate Institute, Portage la Prairie, and holds a B.A. from
the University of Manitoba. She joined the ICN in 1966 after two years with the
League of Red Cross Societies in Geneva. Christine Redman, ICN congress
secretary. Born and educated in England, she was production assistant at the BBC
in London prior to joining ICN in 1968.
for weak or questionable baccalaureate
programs, she explained, can only end in
disaster at the first hurdle - rejection by
the committee of graduate faculties.
Dr. Good stressed that preparation for
both the nurse educator and the clinical
specialist should include nursing content,
functional preparation, and research in
each year of the master's program. She
pointed out that the teacher needs the
ability to impart knowledge accurately
and imaginatively, and the clinical special-
ist needs abilities in teaching and "human
organization." The level of knowledge
(cognitive), skills, and attitudes (affec-
tive) to be attained as the educational
outcome of the program must be deter-
mined, she said.
"Faculty selection is extremely im-
portant," Dr. Good continued. "The crit-
eria for faculty include preparation to a
level one degree higher than the students:
scholarship and creative ability; an excel-
lent teacher; professional experience for
which she is sought for consultation; and
demonstrated abihty in research."
Dr. Good cautioned directors to have a
heterogenous faculty, make provision for
present faculty to become more produc-
tive, and recognize that the initiation of a
master's program will not alleviate faculty
shortage. Dr. Good beUeves that the
faculty should develop the educational
program in cooperation with other uni-
versity departments that will contribute
(Continued on page 12,
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to the curriculum.
To establish a master's program, long
range planning is vital, Dr. Good said. An
effective graduate program will not
happen overnight; frank and serious eval-
uation, both internal (including philoso-
phy and purposes) and external (includ-
ing societal needs and clinical and finan-
cial resources), is needed. "You must
recognize," Dr. Good said, "that the
ultimate purpose is quality education for
the practice and/or teaching of nursing."
Students Discuss Pros and Cons
Of Own Provincial Association
Toronto, Ont. - The pros and cons
of setting up a provincial student nurses'
association were discussed in some detail
by students attending a special student
session at the annual meeting of the
Registered Nurses' Association of Ontario
in May.
Over 200 students listened as a five-
member panel outlined some of the acti-
vities of various student groups already
established in the province. These groups
include the Student Nurses' Association
of Windsor, the Toronto Student Nurses'
Association, the Eastern Ontario Student
Nurses' Association, and the Student Nur-
ses' Association of Southwestern Ontario.
A lively discussion followed, and at
least 25 students in the audience pre-
sented arguments against or in favor of
setting up a provincial, and eventually a
national, student association. A major
problem, as seen by several students,
would be the difficulty in organizing a
provincial association in a province as
large as Ontario. Finances, too, were seen
as an obstacle, as well as the problem of
interesting students in an organization of
this size. Several speakers believed that
efforts should be made to strengthen the
groups at the local level before at-
tempting to organize on the provincial
level.
An equal number of students spoke in
favor of setting up a provincial associa-
tion as soon as possible, and chastised
their colleagues for being apathetic about
the idea. One student said that students
should have more say in curriculum and
examination planning, and that a pro-
vincial student nurses' association could
conceivably act as a pressure group in
effecting change. Another student
pointed out that Ontario was the only
province without a provincial student
nurses' association.
The student delegates approved several
resolutions: 1. that RNAO be asked to
compile a mailing list of student council
presidents in schools of nursing in the
province, and that students provide this
information annually to RNAO; 2. that
the mailing list be distributed to all
schools of nursing and student nurses'
associations in the province to facilitate
communication among students; 3. that
the pro tern committee already in exis-
tence be expanded and be given the
responsibility of examining proposals dis-
cussed by the students at the RNAO
meeting.
Line-up at the microphones. RNAO members wait their turn to express opmions about
collective bargaining methods. The discussion centered on resolutions presented on the
final day of the RNAO annual meeting held in Toronto in May.
12 THE CANADIAN NURSE
Three of the five student nurse pa-
nelists who spoke at a special students'
session at the RNAO annual meeting in
May. Left to right: Valerie Bassett, presi-
dent of the Toronto Student Nurses'
Association; Michael Roland, chairman of
the Student Nurses' Association of South-
western Ontario; and Carolyn Coates,
publicity convener of TSNA.
RNAO Delegates Approve
Affiliate Status
Toronto, Ont. - Voting delegates at
the annual meeting of the Registered
Nurses' Association of Ontario held May
1-3 approved a change in the association's
bylaws to permit specific categories of
registered nurses to become "affiliates"
of the association.
A registered nurse would qualify for
this designation if she is: I. a resident in
Ontario and not working in the practice
of nursing; 2. a resident outside Ontario,
and not working in the province; 3. a
full-time postbasic student enrolled at a
recognized university. The annual fee for
the first category of affiliate and for the
"postbasic affiliate" is $18; the fee for
the "out-of-province affiliate" is $12.
Unless the bylaws of the association
specifically require regular membership
standing, affiliates and postbasic student
affiliates will be entitled to the rights and
privileges of a regular member. An out-
of-province affiliate will receive the
[INAO News and will be allowed to
participate in the RNAO income protec-
tion plan. However, this affiliate will not
otherwise be entitled to any rights or
privileges in the association.
The affiliates will not be considered
members of RNAO, but affiliates of the
association.
A proposed bylaw to permit a grad-
uate nurse who is not a registrant of the
College of Nurses of Ontario, but who is a
member of a local collective bargaining
(Continued on page 14
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(Continued from page 12)
association to become an "associate" of
the RNAO, was defeated. Delegates ex-
pressed concern that this category would
make it possible for a graduate nurse who
had registration revoked by the College to
become an associate. Other delegates
pointed out that the association is for
registered nurses only.
The following resolutions were also
approved by the delegates;
• That advertising be included in the
RNAO News to help offset financial
difficulties faced by the association.
• That RNAO recommend to the College
of Nurses of Ontario that an optional
psychiatric nursing test be made available
to candidates writing national tests and to
all registered nurses in Ontario. If the test
is introduced, the RNAO will assess the
results of these options in 1972, and may
at that time recommend to the College
that the psychiatric nursing test be a
requirement for registration in Ontario.
• That RNAO take appropriate steps to
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14 THE CANADIAN NURSE
modify provincial fiscal policy to permit
abolition of the internship year in schools
of nursing. Basic nursing education would
then be financed in the same way as other
post secondary professional educational
programs.
• That the RNAO recommend that the
1967 Public Health Act of Ontario
Section 1 be amended to include a
definition of "Public Health Nurse."
There is no definition in the 1 967 Act.
Collective bargaining and the methods
used by nurses under existing provincial
legislation continue to be debatable issues
among Ontario nurses. Delegates approv-
ed a resolution to allow RNAO to seek
legal recognition to represent all nurses in
the province at the bargaining table. They
defeated a resolution asking for a survey
of membership to ascertain the degree of
member satisfaction with collective bar-
gaining under the Labour Relations Act.
Delegates also defeated a resolution to
recommend that a nurse be appointed as
an official member of the Ontario Hospi-
tal Services Commission, because they
believed that nurses could have more
influence on the Commission when not
officially a part of it.
RNAO Recommends $7,000
As Minimum Salary For RN
Toronto, Ont. - Delegates at the Re-
gistered Nurses' Association of Ontario
annual meeting May 1-3 approved a min-
imum salary of $7,000 for a registered
nurse in 1970. This represents a six
percent increase over the 1969 recom-
mendation. A registered nurse with uni-
versity preparation would receive an addi-
tional $600 for a diploma, $1,200 for a
bachelor's degree, and $1,800 for a
master's degree.
Other new standards include:
• at least 1 1 paid statutory holidays
• at least 24 hours off when tours of duty
change
• safe transportation provided by the
employer for all female nurses coming
on or off duty between 12:00 midnight
and 6:00 a.m.
• no loss of salary when a nurse is
transferred from one position level to a
higher position level
• $33.65 a day for a part-time nurse
• graduates from outside Ontario whose
registration is granted without examina-
tion to be paid the registered nurse
salary retroactive to the date of em-
ployment
The Canadian Nurses' Association's
1970 salary goal for the beginning practi-
tioner from a basic diploma nursing pro-
gram is $7,200 per annum, and for the
beginning practitioner from a baccalaure-
ate program, no less than $8,640 per
annum.
CNA Representatives Meet
With Minister of Health
Ottawa. - Sister Mary Fehcitas, pres-
JUNE 1969
ident of the Canadian Nurses' Associa-
tion, Dr. Helen K. Mussallem, executive
director of CNA, and Mrs. Lois Graham-
Cumming, CNA's director of research and
advisory services, met for one hour April
25 wath the Minister of Health, John
Munro, and other federal health officials.
The meeting was arranged to apprise
the Minister of the objectives, activities,
and concerns of the association and to
give him an opportunity to ask questions.
Minister Announces
National Nurse Week
Ottawa, - John Munro, Minister of
National Health and Welfare, has declared
June 22 to 28 "National Nurse Week" in
Canada to honor the nursing profession
and to mark the 14th Quadrennial Con-
gress of the International Council of
Nurses in Montreal.
"On behalf of our country, may I
extend our hospitality to our visitors,
along with that of the host organization,
the Canadian Nurses' Association," he
said.
The minister noted the role of nurses
in the changing pattern of health care
throughout the country, and lauded the
;ontribution Canadian nurses have made
to international organizations and techni-
;al assistance programs. He termed the
:ongress "an event of importance to the
nternational health community and to
:anada."
Mr. Munro will be present at the
Congress June 25 to open the plenary
iessions.
VON Holds 71st Annual Meeting
Ottawa. - The variety of ways in
vhich the Victorian Order of Nurses for
lanada contributed to the health care of
Canadians in 1 968 was outlined by Jean
^ask, director in chief of VON, at the
'1st annual meeting May 8-9.
In her report Miss Leask said that
nore than 109,000 patients had received
are from the 104 branches of VON
cross Canada. The VON is striving to
nsure continuity of patient care by
nstituting referral programs; last year 75
■ranches worked with local hospitals to
Tovide continuing care. Miss Leask ex-
'lained. She also reported that maternal
nd child care, night care during acute or
erminal illness, and health counseling
ervices for adults and industries were
Tovided by the VON in 1968.
Miss Leask referred to the efforts of
'ON to adapt its services to meet the
hanging demands for health services and
he delivery of these services.
A project to study the team nursing
oncept was undertaken by VON in
968. The report of that study is now in
reparation. Miss Leask said.
With the increasing emphasis on reha-
ilitation and home care, the physiothe-
ipisf plays an important role with VON;
JNE 1%9
she not only gives direct patient care but
also acts as consultant to nursing person-
nel.
In 1968 more than 1,500 homes
received housekeeping services that have
become an important part of home care
for some patients, Miss Leask said. In
addition, the Hamilton branch of VON
reported a successful pilot year with its
new "meals on wheels" service that provi-
ded over 16,000 meals to 224 persons.
This success prompted a similar project in
Edmonton that recently got under way.
The national office of VON coordi-
nates activities to reach common stand-
ards and goals and is responsible for
maintaining the quality and an adequate
number of personnel. Miss Leask report-
ed. In 1968 there were 765 registered
nurses on staff. Twenty-two percent held
baccalaureate or master's degrees and 60
percent had preparation in public health
nursing.
Miss Leask believes that it is becoming
increasingly important for the public to
participate actively in the planning, finan-
cing, and delivery of the service they will
use. Inherent in the structure of the VON
is the partnership between the public and
professional health workers. To the pre si-
TO PLAN FOR A LIFETIME
Marriage is a responsibility that often re-
quires both spirituol and medical ossistance
from professional people. In many instances
a nurse may be called upon for medical
counsel for the newly married young wo-
mon, mother, or a mature woman.
"To Plan For A Lifetime, Plan With^Your Doc-
tor" is a pamphlet that was written to assist
in preparing a wemon for patient-physician
discussion of family planning methods. The
booklet stresses the importance to the indi-
vidual of selecting the method that most
suits her religious, medical, and psychological
needs.
Nurses are invited to use the coupon below
to order copies for use as an aid in coun-
selling. They will be supplied by Mead John-
son Laboratories, a division of Meod John-
son Canada Ltd., as a free service.
MeadjiJiTiMn
LABORATORIES
ORDER FORM
Please send
Name
To: Meod Johnson Laboratories, '
95 St. Clair Avenue West, I
Toronto 7, Ontario. I
copies of "To Plon For A lifetime, Plon With Ye«i j
Doctor" to: '
I
Address
l_
THE CANADIAN NURSE 15
news
dent of VON falls the task of providing
leadership for both segments of this
partnership, Miss Leask explained.
Mrs. C.H.A. Armstrong of Toronto
was elected president of the Victorian
Order of Nurses for Canada at the
opening session May 8, attended by 200
delegates. She has a B.A. degree in
modern history from the University of
Toronto, and for 10 years wrote a weekly
cooking column for the magazine Satur-
day Night under the name Janet March.
Mrs. Armstrong, who succeeds Dr.
G.D.W. Cameron, is the first woman
president of VON since the founder Lady
Aberdeen in 1897.
Three new staff members were ap-
pointed to national office in September.
Eleanor MacDougall is regional director
for Alberta and Saskatchewan and
Marlene Line and Ruby Cuthbert are
regional supervisors.
Index Of Canadian Nursing
Studies Available
Ottawa. - The Canadian Nurses'
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16 THE CANADIAN NURSE
Association has two continuing projects
related to Canadian studies on nursing:
the CNA Repository Collection of
Nursing Studies and the CNA Index of
Canadian Nursing Studies. Both these
projects are concerned with studies about
nursing in Canada or by Canadian nurses.
A preliminary Index was issued in
1964. A revised copy has now been
prepared and will be distributed to
schools of nursing libraries and research
libraries.
The Index includes all completed
studies to which reference can be found,
as well as those in the Repository Collect-
ion of Nursing Studies in the CNA Libra-
ry. Studies in the collection are available
for research in the library or on inter-
library loan for faculty or graduate study.
Mature Students To Be Admitted
To BC Schools Of Nursing
Victoria, B.C. - Bill 63, an act to
amend the Registered Nurses' Act of
British Columbia, became effective April
2.
The Act was amended by the provin-
cial government at the request of RNABC
to allow post secondary educational insti-
tutions, such as regional colleges and
technological institutes, to exercise their
judgment as to whether the educational
background of an applicant is such that
he or she can succeed in the nursing
program. Under the terms of the amend-
ment, a candidate for admission to a BC
school of nursing may be a "mature
student without the necessary academic
qualifications."
Previously, the minimum educational
requirements were: (a) a graduate of a
secondary school in an academic-
technical program or (b) a graduate of a
program certified by the registrar of the
Department of Education or the registrar
of a post-secondary public educational
institution in the province to be equiva-
lent to the qualifications under clause (a).
Although the RNABC cannot legally
prevent a university or college from oper-
ating any kind of program, Section 13 of
the Nurses' Act gives the RNABC the
authority to deny registration to a gradu-
ate of any nursing program that it has not
approved.
Less Paperwork And Bureaucracy
If Nursing Is To Survive
Winnipeg, Man. - Non-involvement is
a lonely, superficial road, a well-known
nurse educator told 300 nurses at the
annual meeting of District 1, Manitoba
Association of Registered Nurses April
24.
Marguerite Schumacher, director of
nursing at Red Deer Junior College in
Alberta and first vice-president of the
(Continued on page 18
JUNE 196S
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(Continued from page 16)
Canadian Nurses' Association, said that
involvement with patient care means
taking risks, but that the end result is
worth it, for without involvement one
only exists. "Involvement is not haphaz-
ard," Miss Schumacher said. "It is caring
for and sharing the feelings of the patient
as a person. If the nurse really cares, her
attitudes and expressions will reflect this
care," she told the MARN nurses.
Miss Schumacher warned her audience
that nursing must stop revolving around
bureaucracy and paperwork, if it is to
survive. "Otherwise," she said, "persons
with lesser preparation will take over
patient care and will do a better job than
professional nurses."
Student Nurses Debate
Role of the Supervisor
Ottawa. - Is the traditional role of
the supervisor no longer relevant to good
nursing care?
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18 THE CANADIAN NURSE
This question provided an evening of
heated debate March 18 by six students
in the Certificate Program of Nursing
Education at the University of Ottawa.
The three students arguing for the
affirmative advocated removing the super-
visory level - a role that is "confusing
and self-limiting." This role was referred
to as a "dichotomy," because of con-
flicting administrative functions. In place
of the "traditional" supervisor, they pro-
posed a reorganization of nursing service
to relieve key personnel of non-nursing
duties.
This aim was shared by both sides. The
three students on the negative, however,
argued that changes in attitude toward
supervision were required, not removal of
the supervisor. They compared this role
with a valuable piece of machinery that
has not functioned properly and "would
not be discarded without first attempting
to have it repaired."
The students' preparation for the
debate involved interviewing staff mem-
bers at Ottawa's Civic, General, and
Riverside hospitals.
The winning side, chosen by the
judges - three Ottawa educators — was
the affirmative. Some 100 fellow students
and faculty provided an enthusiastic audi-
ence.
Harder Bargaining Ahead
For Canadian Nurses
Vancouver, B.C. — "As collective bar-
gaining becomes the accepted means of
improving salaries and working conditions
for nurses across Canada, hospital associa-
tions are becoming ... more united in
their efforts to keep nurses in line." This
statement was made by M. Louise Tod,
employment relations officer for the Al-
berta Association of Registered Nurses, in
an address to 100 nurses from 67 staff
groups attending the Registered Nurses'
Association of British Columbia's Staff
Representatives Conference in the Hotel
Vancouver, April 21 and 22.
Miss Tod, who is chairman of the
Canadian Nurses' Association's commit-
tee on social and economic welfare, pre-
dicted harder bargaining ahead for Cana-
dian nurses and said they could no longer
work in isolation. She called for greater
communication between the provinces to
ensure successful collective bargaining
programs. Miss Tod said that nurses could
not represent nursing effectively in col-
lective bargaining unless they were well
informed in the area of nursing service
and nursing education. She pointed out
that close liaison was needed between
provincial staff nurse committees or their
equivalents and provincial committees on
nursing service and education. I_
JUNE 196¥
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CYANAMID OF CANADA LIMITED. Montreal
names
A Canadian nurse has again been ap-
pointed chief nursing officer of the World
Health Organization.
Lily M. Turnbull (R.N., Regina Gen-
eral H.; B.N., McGill U.; M.P.H., Johns
Hopkins U.) assumed this top nursing
position in WHO in April. She replaces
Lyle Creelman, who returned to Canada
in 1968 after 14 years as WHO chief
nursing officer.
Miss Turnbull joined WHO in 1952
after holding head nurse and nursing
supervisory positions in Canadian hospi-
tals. Until 1957 she worked in Malaysia as
nurse educator, assisting in the develop-
ment of nursing education programs.
From 1957 until her present appoint-
ment, Miss Turnbull was regional nursing
adviser for the Western Pacific region of
WHO.
Two new appointments have been
made at St. Paul's Hospital, Vancouver.
Marie Whitney(B.S.N., U. British Colum-
bia) is assistant director, school of nurs-
ing. Before joining the teaching faculty at
St. Paul's Hospital, Mrs. Whitney was a
clinical instructor in psychiatric nursing
at the Provincial Government Education
Centre, Riverview Hospital, Essondale,
B.C.
Audrey Murray
(R.N., Gait H., Leth-
bridge; B.S.N., U.
Washington, Seattle)
is director of nursing
service. She was for-
merly assistant direc-
f» "''im:. tor of St. Paul's
School of Nursing,
and has been at the
hospital since 1956.
Margaret A. Mo-
tiuk (R.N., Miseri-
cordia H., Edmon-
ton; B.N., School for
Graduate Nurses,
McGill U., Montreal;
Dipl. Nurs. Service
Admin., U. Saskat-
chewan) has been
appointed assistant
director of nursing, Rockyview Hospital,
Calgary.
Miss Motiuk has been a head nurse,
assistant director, and deputy director of
nursing service at the Misericordia Hospi-
tal, and a supervisor at the Royal Inland
Hospital, Kamloops, B.C.
20 THE CANADIAN NURSE
RNAO Elects New Officers
Albert W. Wedgery, president of the Registered Nurses' Association of Ontario since
1967, gives a few words of advice to the new RNAO officers, Laura E. Butler (left),
president, and Josephine Flaherty, president-elect. Over 1,900 RNAO members
attended the association's annual meeting in Toronto in May.
Shirley M. Stin-
son (R.N.; B.Sc.N.,
U. Alberta; M.N.A.,
U. Minnesota) has
received a dual ap-
pointment on the
faculty of the Uni-
versity of Alberta,
Edmonton, effective
July 1. She will be
responsible for teaching and research in
the School of Health Services Adminis-
tration and will work in the School of
Nursing.
For the past year Miss Stinson has
been completing the doctor of education
program at Teachers College, Columbia
University in New York. She received the
Dr. Katherine McLaggan fellowship from
the Canadian Nurses' Foundation in
1967.
Miss Stinson was associate director of
nursing service at The Hospital for Sick
Children, Toronto, from 1961 to 1965.
Following this, she was an assistant pro-
fessor in the University of Alberta School
of Nursing.
Mary fane Seivw-
right (B.Sc, M.A.,
Ed.D., Columbia U.,
New York) has been
appointed Nurse Ad-
viser on the staff of
the International
Council of Nurses.
Dr. Seivwright, a
native of Jamaica,
lias worked as a public health nurse in
Kingston, Jamaica, and in Toronto. Her
varied nursing experience in New York
included work with the Visiting Nurse
Service, City Department of Hospitals,
nursing supervisor at the Hebrew Hospital
for Chronic Sick, chief project nurse at
the Albert Einstein College of Medicine,
and project director at the Institute of
Research, Teachers College, Columbia
University.
Irma Butz (R.N., Royal Victoria H.,
Montreal; degree in public health admin.,
McGill U.) has been appointed assistant
(Continued on page 22)
JUNE 1969
New and Recent Books from Collier-Macmillan
The Emergence of Modern Nursing, Second Edition
By Vern L. Bullough, B.A., M.A., Ph.D., Professor
of History, San Fernando Valley State College; and
Bonnie Bullough, R.N., M.S., M.A., Ph.D., Assist-
ant Professor, School of Nursing, University of
California, Los Angeles
The Second Edition of this popular text describes the evolution of modern
nursing, with unusual sensitivity to nursing problems of the past and pres-
ent. Especially interesting is new material on nursing practice in Europe
and In the less developed areas of the world. A new bibliographic essay is
included. 1969, approx. 288 pages, $7.70
Management of Nursing Care
By Elma L. Rinehart, B.S., M.A., Assistant
Director, Nursing Service, Cincinnati General
Hospital
Microbiology in Nursing Practice
By Marlon E. Wilson, M.A., Ph.D., Chief Micro-
biologist, New York City Department of Health,
Bureau of Laboratories, and Helen Eckel Mizer,
R.N., A.B., M.S., Instructor, Department of Nurs-
ing Education, Western Connecticut State College
The Cardiac Surgical Patient
Pathophysiologic Considerations and Nursing Care
By Maryann E. Powers, B.S., Head Nurse, Cardiac
Recovery Room, University of Oregon Medical
School Hospital; and Frances Storlie, R.N., M.S.,
Instructor for Cardiac Care, Nursing Inservice,
Providence Hospital, Portland, Oregon
Written for all members of the nursing team, this book focuses on the pa-
tient care unit and explores the possibilities for effective nursing manage-
ment in the progressive hospital. The author provides an intimate study of the
nursing team, with emphasis on the role of the head nurse and the working
relationships which contribute to productive nursing. 1969, 243 pages, $7.70
This comprehensive book provides the practicing or prospective nurse with
basic information on the principles of microbiology and the epidemiology
of microbial diseases. Nursing applications are consistently emphasized.
Excellent illustrations, chapter outlines, bibliographies, and appendices
enhance the self-study aspects of the book.
1969, approx. 704 pages, $10.25
This text is the first physiological, patient-centered approach to the cardiac
emergencies encountered by medical-surgical nurses. Congenital cardiac
defects and acquired cardiac diseases are discussed in terms of physiology,
clinical profile, prognosis, and surgical correction.
1969, approx. 256 pages, prob. $8.80
Pharmacology and Therapeutics, Fourth Edition
By Ruth D. Musser, A.B., M.S., formerly Assistant
Professor in Pharmacology, School of Medicine,
and formerly Chairman of Pharmacology, School
of Nursing, University of Maryland, Baltimore,
and John J. O'Neill, Ph.D., M.S., B.S., Associate
Professor, Department of Cell Biology and Phar-
macology, School of Medicine, University of Mary-
land, Baltimore
In the Fourth Edition of this widely-used text a new co-author adds to the
preparation of this book his significant experience in cell biology and
related molecular pharmacology. New material is included on drug abuse
and control, pituitary hormones, reproduction and contraception, vaccines
and serums, water and electrolytes, the management of severe burns, and
the use of drugs for diagnostic purposes.
1969, approx. 896 pages, prob. $12. 10
Clinical Nursing
Pathophysiological and Psychosocial Approaches
By Irene L. Beland, B.S., M.S., R.N., Professor
of Nursing, College of Nursing, Wayne State Uni-
versity
A pioneering book. Clinical Nursing is oriented in the sciences — physical,
biological, and social— to help the nurse view the patient as a whole indi-
vidual, an individual whose illness is affected by a variety of factors.
1965, 1398 pages, $14.25
Anatomy and Physiology, Fifteenth Edition
By the late Clifford Kimber, the late Carolyn E.
Gray, and the late Caroline E. Stackpole; Revised
by Lutie C. Leavell, M.A., M.S., Emeritus, Teachers
College, Columbia University; and Marjorie A. Mil-
ler, M.S., Cornell University; with the assistance
of Florence M. Chapin, M.A., M.S., University of
Pennsylvania School of Nursing
Obstetric Nursing, Fifth Edition
By Erna Ziegel, B.S., M.H., R.N., Associate Pro-
fessor of Obstetric Nursing, The University of Wis-
consin, and the late Carolyn Van Blarcom, A.M.
"This excellent textbook has become a classic The authors have Incor-
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clarify the information Two distinct improvements are: the placement
of discussion of sensations and the sensory organs with the material on
the nervous system and adding information on the nerve and blood rela-
tions of specific muscles to the discussion of muscles."
-American Journal of Nursing
1966, 805 pages, $10.00
(A Test Manual and Teacher's Guide are available, gratis)
"The author has been most successful in presenting detailed technical
procedures associated with nursing care of mother and infant."
—American Journal of Nursing
1964, 795 pages, $9.35
Write to: Collier-Macmillan Canada, Ltd. 1125B Leslie Street, Don Mills, Ontario
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Swiss made, raised silver full numerals, lumin. mark-
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strap. 1 yr. guarantee.
No. 06-925 1^95 ta. ppd.
Lindy Nurse STICK PENS
Slender, wtiite barrels with tops colored to match
ink. Fine points; colors for charts, notes. Adj. silver
pocket clip. Blue, black, red or lavender.
No. 467-F SUck Pens ) 6 pens 239, 12 pens 5.29
(chease color assort.) ) 24 or more 39 ea., all ppd.
f
Reeves AUTO MEDALLIONS
Lend professional prestige. Two colors baked enamel on
gold background. Resists weather. Fused Stud and
Adapter provided. Specify letters desired: RN, MD, DO,
RPh, DOS. DMD or Hosp, Staff (Plain).
No. 210 Auto Medallion 4.25 ea. ppd.
Professional AUTO OECALS
Your professional Insignia on window decal.
Tastefully designed in 4 colors. 4V4'' dia. Easy
to apply. Choose RN, IVN, LPN or Hosp. Staff.
No. 621 Dacal... 1.00 ea.,
3 for 2.50, 6 or more .60 la.
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CROSS Pen and Pencil
World famous Cross writing mstruments with
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Set No. 6601 16.00 No. 3501 10.00
8511 Pen Refills (blue med.), 2 for 1.50 ppd.
or tull umi engrtwd in script on twril. Inititli add .75 ti.
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3m
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Personalized
NURSES
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Nationally advertised Littman* diaphragm-
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nurses. Weighs less than 2 on., fits in uni-
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collapse concealed spring, non-chilling dia-
phragm, U, S. made. Choose from 5 jewel-
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No. 216 Nursescope 12.95 ppd.
12 or more 10.95 ppd.
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names
22 THE CANADIAN NURSE
(Continued from page 20)
director of nursing, Douglas Hospital,
Verdun, Quebec.
Mrs. Butz was formerly director of
nursing education at the Albert Prevost
Institute, Montreal.
Gladys Sharpe, who retired last year
after 42 years in nursing, received an
honorary life membership in the Re-
gistered Nurses' Association of Ontario at
the RNAO annual meeting in May. The
honorary membership was presented to
Miss Sharpe "for service to the cause of
nursing and the betterment of humanity
far beyond the course of duty."
Miss Sharpe, a well-known figure in
Canadian nursing, is a past president of
the RNAO and the Canadian Nurses'
Association.
Ethel Horn, associate professor at the
School of Nursing, The University of
Western Ontario, was in Scotland in April
for a month's study tour of Family
Practice Units and Community Mental
Health Centers in England and Scotland.
On arrival in Scotland she spent several
days at the University of Edinburgh in
the World Health Organization Research
Studies Unit. The tour was supported by
a research travel grant from the Ivey
Foundation.
Jean W. Forrest
(Reg.N., Toronto
General H.; B.N.,
McGill U.; B.A.,
Laurentian U., Sud-
bury; M.S., Boston
U.) has been appoin-
te(l assistant profes-
sor of the School of
Nursing, The Univer-
sity of Western Ontario.
Miss Forrest has had extensive experi-
ence in public health nursing in Ontario,
most recently as a supervisor with the
Sudbury and District Health Unit.
Dorothy E. Rajcsanyi (R.N., Montreal
General H.; Dipl. P.H., McGill U.; B.N.,
McGill U.) has been named associate
director in charge of education, Victorian
Order of Nurses, Greater Montreal
branch.
Mrs. Rajcsanyi, a native of Montreal,
has been on the nursing staff of The
Montreal General Hospital. Her experi-
ence with the Montreal branch of the
VON has included administrative work;
she has been VON liaison for the Royal
Victoria and Jewish General Hospitals. □
lUNE 1969
soft testimony to your patients' comfort
Your own hands are testimony to Dermassage's effectiveness. Applied by your
soft, practiced hands, Dermassage alleviates your patient's minor skin irritations
and discomfort. It adds a welcome, soothing touch to tender, sheet-burned
skin; relieves dryness, itching and cracking . . . aids in preventing decubitus
ulcers. In short, Dermassage is "the topical tranquilizer". . . it relaxes the patient
. . . helps make his hospital stay more pleasant.
You will like Dermassage for other reasons, too. A body rub with it saves your time
and energy. Massage is gentle, smooth and fast. You needn't follow-up with
talcum and there is no greasiness to clean away. It won't stain or soil linens or
bed-clothes. You can easily make friends with Dermassage— send for a sample!
Now available in new, 16 ounce plastic container with convenient flip-top closure.
M'-mA; -p^^fuyjiay (2.<uo""te£L~tlo JLUJkAJyy^^ce^
Wieaiy.
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lUNE 1%9
LAKESIDE LABORATORIES (CANADA) LTD.
64- Colgate Avenue • Toronto 8, Ontario
THE CANADIAN NURSE 23
Next Month
in
The
Canadian
Nurse
• Needed: A Lobbyist
for CNA
• Private Duty
— Private Choice
0 Health Sciences Complex
at Laval
^^^
Photo credits for
June 1969
Julien LeBourdais, Toronto,
pp.9, 12,20
Bomac Photo Studio, Geneva, p. 10
Tara Dier, Ottawa, p. 12
Agence Internationale Actualit,
Brussels, p. 33
Japanese Embassy, Ottawa, p. 36
Colombian Embassy, Ottawa,
pp. 38, 39
St. Michael's Hospital,
Toronto, pp. 46, 47
dates
June 9-20, 1969
Two-week seminar for senior nursing ex-
ecutives. School of Nursing, University of
Western Ontario, London. Fee with resi-
dence — $250; without resi-
dence — $125.
lune 11, 1969
Reunion of graduates and friends of
Guy's Hospital, London, England, Royal
York Hotel, Toronto, 5 p.m. Further
information may be obtained from the
Canadian Tuberculosis Association, 343
O'Connor Street, Ottawa.
June 11-14, 1969
19th annual meeting of the Canadian
Psychiatric Association, King Edward
Hotel, Toronto. A $5 registration fee for
non-members must be paid in advance to
The Montreal Children's Hospital, Dept.
of Psychiatry, and should be sent to: Dr.
K. Mende, Dept. of Psychiatry, The
Montreal Children's Hospital, 2300 Tup-
perSt., Montreal 108.
June 13, 1969
Ophthalmic Assistants' Association of
Ontario Symposium, Royal York Hotel,
Toronto.
June 18-20, 1969
Conference on pediatric nursing, The
Hospital for Sick Children, Toronto.
June 19-20, 1%9
Two-day program for nurse educators,
McMaster University School of Nursing,
Hamilton.
June 24, 1969
Meeting of nurses interested in continuing
education, McGill University, School for
Graduate Nurses, Montreal.
June 9-13, 16-20, 1%9
June 30 - July 4, 1969
Registered Nurses' Association of Ontario
programs for visitors to the Congress of
the International Council of Nurses.
Symposiums on nursing service, public
health, and nursing education, with visits
to cooperating hospitals and health agen-
cies.
July 3 - August 15, 1969
Six- week course for ophthalmic assis-
tants. Centennial College of Applied Arts
and Technology, 1651 Warden Ave., Scar-
borough, Ont. Fee: $75. Candidates must
be sponsored by an ophthalmologist.
24 THE CANADIAN NURSE
August 1968 - June 1969
The National League for Nursing is
sponsoring a series of 12 two-day work-
shops in several U.S. cities for persons
involved in administration, planning, and
evaluation of hospital nursing services.
The first workshop was held in San
Francisco August 9, 1968, and the last
will be held in Miami Beach, June 26-27,
1969.
The workshops are designed for nurses
and others interested in nursing audits,
new staffing patterns, and hospital staff
development programs.
Further information and application
forms for registration may be obtained
from the Department of Hospital Nurs-
ing, National League for Nursing, 10
Columbus Circle, New York, New York
10019.
September 18-20, 1969
Annual conference on obstetrics, gyneco-
logic, and neonatal nursing, Sheraton-
Brock Hotel, Niagara Falls, Ontario.
Sponsored by District V of the American
College of Obstetricians and Gynecolo-
gists.
September 23-25, 1969
10th annual meeting and convention of
Associated Nursing Homes, Inc., Shera-
ton-Connaught Hotel, Hamilton.
September 25-27, 1969
3rd annual postgraduate course for emer-
gency room nurses. Palmer House Hotel,
Chicago. Tuition fee: $60. Write to: Dr.
Anast, 55 East Washington Street, Chica-
go, Illinois 60602.
September 28 - October 3, 1%9
13th annual Registered Nurses' Associa-
tion of Ontario Conference on personal
growth and group achievement, Delawana
Inn, Honey Harbour.
Ocfober 6-8, 1969
Annual conference on obstetrical and
gynecological nursing, sponsored by
District VI of the American College of
Obstetricans and Gynecologists. To be
held in the Marlborough Hotel, Winnipeg.
Nurses from all over Canada are welcome.
October 24, 1969
Catholic Hospital Conference of Ontario
Nursing Committee meeting, Westbury
Hotel, Toronto.
October 27-28, 1%9
Ontario Hospital Association 45th annual
convention. Royal York Hotel, Toronto,
JUNE 196
OUR 1969 UNIFORM
CATALOGUE
IS NOW AVAILABLE
TO YOU AT NO CHARGE
Just fill in your name and address
and send to:
BLAND UNIFORMS
LIMITED
1435 St. Alexandre Street
Montreal, Que.
Name
Address
new products |
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
NEW!
The eleventh edition of
TABER'S
CYCLOPEDIC
MEDICAL
DICTIONARY
PUBLICATION: JUNE 1st, 1969
This outstanding work includes
many important revisions and
offers vital new knowledge in
every section. Price $8.00
SEE IT!
at The Ryerson Press booth No.
W-4 at Place Bonaventure during
the meeting of the International
Council of Nurses, June 23-25.
THE
RYERSON PRESS
299 Queen St. West
Toronto 2B
Surgical Prep Blade
The new ASR Surgical Prep Blade is a
disposable, stainless steel, single-edge
blade with a unique coating. The 2-1/4-
inch blade is used primarily for preparing
patients for surgery.
Because it is of more durable steel and
has an electro-coated finish, tests show
that the new ASR Surgical Prep Blade has
a sharper shaving edge and lasts two to
seven times longer than conventional
blades.
The extra length of the new prep blade
provides greater area coverage. Its longer-
lasting, sharper shaving edge prevents the
lost time and inefficiency of changing
blades.
The new Surgical Prep Blade is sup-
plied with a protective cardboard cover
over its shaving edge, and is packaged five
to a small sulfide cardboard box. The
blade itself bears the "Personna Super
Stainless" imprint.
For information write: Mr. Gilles Mi-
chaud, ASR Medical Industries Super-
visor, 555 Royal Mount Ave., Montreal.
Sterile Disposable Aspirating Tube
This disposable aspirating tube is made
of tough, transparent plastic (polysty-
rene) and individually packaged sterile in
special peelable envelopes. Aspirating
tubes are used in bronchoscopy proce-
dures as a collecting tube for cell wash-
ings and collection of purulent materials.
The new Lukenstype tube comes with
stopper and latex tubing ready for im
mediate use. It is destroyed when auto-
claved, preventing any possible reuse and
eliminating valuable nurse time now spent
resterilizing and preparing reusable tubes.
Four step directions are printed and
illustrated on the special envelope
package, with spaces for entering the
patient's name, room number, and the
doctor's name.
Further information is available from;
Davis & Geek Products Department,
Cyanamid of Canada Limited, P.O. Box
1039, Montreal 101, Quebec.
Unit-Pack
New packaging called Unit-Pack is now
available for Hoechst Pharmaceuticals'
oral antidiabetic agents, Orinase R (tolbu-
tamide) and Chloronasef^ (chlorpropa-
mide). The products are dispensed in the
manufacturer's original package; a tear-
off label allows the pharmacist to apply
his own. Tablets are sealed in foil and
vinyl trays to ensure a hygienic product.
In addition, Unit-Pack protects against
product degradation, prevents medication
contamination, and eliminates exposure
to sensitizing medications in the dispen-
sary.
Each tablet is now coded for the
patient's protection, and each tray is
stamped with the manufacturer's lot
number. This provides positive identifi-
cation for dispensing and administering
the drug. Unit-Pack reduces dispensing
costs by saving time and by eliminating
prescription vials, cotton batting, and
caps.
For further information write;
Hoechst Pharmaceuticals, 3400 Jean
Talon W., Montreal 16.
26 THE CANADIAN NURSE
Hydraulic Stretcher
This Hydraulic Emergency and Re
covery Room Stretcher stresses comfort
safety, and ease of operation. A foot
powered hydraulic system provides th(
stretcher with a range of heiglit fron
37-1/4 inches in the elevated litter posi
tion to 27-1/4 inches when fully lower
ed, allowing the paUent to be transferrec
safely and comfortably from the over
sized 28 by 80 inch litter to the lowerec
bed position. Fingertip control levers car
be used to activate the unit for eithe
Trendelenberg or reverse-Trendelenberj
positions.
Stainless steel side-rails that telescopi
into the litter frame, interchangeabli
chrome end-rails, vinyl non-markin]
bumpers, manual back rest, and quie
conductive chrome-plated casters foun(
in the standard Colson line of stretcheri
have been retained in the new model. /
conductive 4-inch pad, stainless steel I\'
rod, and Fowler back rest are also in
eluded as standard.
For additional information write Th'
Colson Corporation, 39 South LaSall'
Street, Chicago, Illinois 60603. [
JUNE 196
when teen-agers want to know about menstruation
one picture may be worth a thousand words
Never are youngsters more aware of their own
anatomy than when they begin to notice the changes
of adolescence. And never are they more susceptible
to misinformation from their friends and schoolmates.
To negate half-truths, give teen-agers the facts —
using illustrations from charts like the one pictured
above. They'll help answer teen-agers' questions about
anatomy and physiology. These SVa" x 11" colored
charts of the female reproductive system were pre-
pared by R. L. Dickinson, M.D. and are supplied free by
Canadian Tampax Corporation Ltd. Laminated in
plastic for permanence, they are suitable for grease
pencil marking. And to answer their social questions
on menstruation, we also offer two booklets — one
for beginning menstruants and one for older girls —
that you may order in quantities for distribution.
Tampax tampons are a convenient — and hygienic
— answer to the problem of menstrual protection.
They're convenient to carry, to insert, to wear, and
to dispose of. By preventing menstrual discharge from
exposure to air, Tampax tampons prevent the embar-
rassment due to menstrual odor. Worn internally, they
JNE 1%9
cause none of the irritation and chafing associated
with perineal pads.
Tampax tampons are available in Junior, Regular
and Super absorbencies, with explicit directions for
insertion enclosed in each package.
TAMPAX
SANITARY PROTECTION WORN INTERNALLY
«*0E ONLY BY CANADIAN TAMPAX CORPORATION LTD.. BARRIE, ONT.
FREE CHARTS IN COLOR
I I
Canadian Tampax Corporation Ltd.. P.O. Box 627, Barrie, Ont.
Please send free a set of the Dickinson charts, copies of the
two booklets, a postcard for easy reordering and samples of
Tampax tampons.
Name_
Address_
THE CANADIAN NURSE 27
in a capsule
Black Friday
"Oh no," was one of the milder
reactions of The Canadian Nurse editorial
staff when Whoo-fur, the white, furry
mascot of the ICN Congress, returned
from the printer with a black beard
(News, May 1969, page 9).
What had our former blonde done
to deserve such treatment? It just shows
that you never know how dangerous a
trip to the printer can be!
Poor Whoo-fur. We're all waiting to see
the real you in Montreal.
Nurses make high-status marriages
A study conducted by two American
sociologists has found that girls from
low-status families who become nurses
are much more likely to marry men of
high status than are girls who do not
enter nursing.
According to the study, reported in
Nursing Times, this applies whether the
girls are college-educated or not.
Although girls from rural communities
were found less likely to marry high-
status men than were urban girls, the
rural girls' chances increased if they be-
came nurses.
Chiid's-eye view of surgery
The Grey Vine, published by the
Regina Grey Nuns' Hospital, recently
wrote about the following nurse's experi-
ence.
"In my years of nursing I thought I
had seen every item that a patient could
bring to the hospital. But a paper cup
filled with dirt, brought by a little girl
facing major surgery, had me mystified.
The child had been ill for several years
and I wondered if she still had the spirit
she would need during the next few days.
My doubts vanished as she explained,
"That's the bean I planted before I came.
We're going to have a race to see who gets
his head up first."
Surgery was successful, and she beat
the bean."
Relatives found
For two Australian sisters - an assis-
tant nursing matron and a hospital
business administrator - the 14th
Quadrennial Congress of the International
Council of Nurses will be an extra special
event.
The long trip from Joondanna, West-
Roll Out The Red Carpet!
ern Australia, to Montreal will be their
first to Canada. The emotional part of the
journey, however, will be their visit to
Toronto following the congress.
In January, Miss Elaine Greger wrote
to the Canadian Red Cross national head-
quarters and made a special request. She
sought help in locating her aging mother's
relatives with whom the family had lost
contact in Canada 25 years ago. Over the
years a series of letters to Toronto ad-
dresses had been returned with the
disappointing marking, "Moved, left no
address."
Dr. Helen G. McArthur, national direc-
tor of Red Cross nursing services, took a
special interest in the case. On receipt ol
the request, the Enquiry Bureau took up
the search. Within a few days, Toronto-
Central Branch had reached the relatives
The Toronto relatives plan a happ>
reunion this summer for the two dele
gates from down under.
Wear maple leaf at ICN
A well-traveled nurse from Toronto
A. Cecilia Pope, has suggested a good wa)
for us to identify ourselves as Canadiar
nurses at the ICN Congress: wear a mapl(
leaf pin, and perhaps give one to a visito
as a distinctive Canadian souvenir.
The nose knows?
Osmics is becoming big business, be
cause of man's extraordinary sense o
smell.
This finding is explained in a speed
reported in the April Ontario Newslettet
published by the Consumers Associatioi
of Canada.
According to the vice-president L
charge of market planning for Mattei
Inc., marketing should encourage a cus
tomer to: open bags of freshly roastd
coffee, packages of linens and towels witl
the "clean wash smell" built into th
package, and packaged grass seed tha
smells like freshly cut grass. Marketers ar
already wrapping bread in waxed pape
impregnated with "freshly baked" odoi
wafting synthetic strawberry scents ove
the frozen strawberry section of th
supermarket, impregnating nylon rope
with the odor of tarred hemp, putting th
scent of cheddar cheese on mousetrap
and unfortunately - blendin
banana oil, glue, leather, rubber, gasolint
and plastic to make a "new car smell,
which can be hidden behind the seat of
"back row beauty." [
28 THE CANADIAN NURSE
JUNE 19(
Used by over 80,000 nurses
Sutton's Bedside Nursing Techniques
in Medicine and Surgery
iNow completely revised in a New 2nd Edition
A valuable source of advanced clinical nursing techniques, this popular
text has now been made even more valuable in the new revised Second
Edition — just off press. The newest concepts of hospital care, the latest
equipment, currently preferred medications and diets, and the most recent
diagnostic and therapeutic methods in medicine and surgery — all are
explained in this new edition. In clear, precise language, supplemented by
nore than 850 explicit drawings, Mrs. Sutton tells precisely how to perform
'lundreds of nursing functions — from intramuscular injection to caring for
he patient in hyperbaric oxygen therapy. Among the new material in this
'evised edition are sections on:
Reverse Isolation Tubeless Gastric Analysis
IPPB Respirators Fluid and Electrolyte Balance
Hypodermoclysis Heart Transplants
Controlling Hemorrhage from Esophageal Varices
Intra-arterial Infusion of Anticancer Agents
n the first part of the book, Mrs. Sutton describes the basic techniques
hat are common to all areas of clinical nursing. Then she takes up the
nore specialized techniques used in disorders of each of the body systems.
This arrangement provides a natural division that corresponds to that of the
lursing specialties. Each of these chapters is subdivided under such
leadings as Diagnostic Procedures, Therapeutic and Rehabilitative Proce-
lures. Additional Procedures to Review, Diets to Review, and Medications
0 Review.
Curses by the tens of thousands have found "Sutton" unparalleled as a
•ource of current information. It is ideal for the recent graduate who seeks
'lelp on how to perform specific clinical techniques... for the nurse
eturning to practice after an interruption ... for the nurse who wants to
ransfer from one area of practice to another. Order your copy now!
^Y AUDREY LATSHAW SUTTON, R.N., formerly Director of Nursing
'Crvice, Edgewood General Hospital, Berlin, N.J.
R98 pages. 871 line drawings. $8.95. Published March, 1969.
Stop in and see Saunders Nursing Books at Booth W-6 during the
international Council of Nurses 14th Quadrennial Congress, June
23-25, in Montreal.
AND DON'T FORGET
THESE FINE BOOKS:
Asperheim: PHARMACOLOGIC BASIS
PATIENT CARE. 417 pp. S7.60.
OF
Bookmiller. Bowen & Carpenter: OB-
STETRICS AND OBSTETRK NUfiSMG.
5th ed. 574 pp. S8.65.
Davis & Rubin: DelEE's OBSTETRICS
FOR NURSES. IBIli ed. 535 pp. S8.65.
Borland's POCKET MEDICAL
ARY. 716 pp. S6.25.
DICTION
Gillies & Alyn: SAUNDERS TESTS FOR
SELF EVALUATION OF NURSING COM-
PETENCE. 326 pp. S7.30.
Hymovich: NURSING OF CHIIDREN - A
Guide for Study. S5.95. 389 pp. Just off
press.
Kron: COMMUNKATION
244 pp. S4.05.
Kron: NURSING TEAM
2nd ed. 172 pp. $3.00.
IN NURSING.
LEADERSHIP.
leifer: PRINCIPLES AND TECHNIQUES
IN PEDIATRIC NURSING. 210 pp. $5.15.
leMaitre & Finnegan: THE PATIENT IN
SURGERY. 399 pp. $5.15.
Marlow: PEDIATRIC NURSING. 3rd
687 pp. $9.20. Just off press.
ed.
NURSING CLINICS OF
Publistied Quarterly,
subscription, S13.00.
NORTH AMERICA.
Sold by yearly
Sarner: THE NURSE AND THE LAW.
219 pp. S7.05.
Stryker: BACK TO NURSING. 312 pp.
S6.25.
W. B. SAUNDERS COMPANY Canada Ltd., 1835 Yonge Street, Toronto 7
PiMise send on approval and bill me:
Author: Book fifle:
Zip:
CN 6-69
THE CANADIAN NURSE 29
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Smith and Nephew products are sold in 80 countries
on six continents around the world— under the mark
that means quality in any language. You'll find the
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GUEST EDITORIAL
It would be interesting to know if any
of the founder members of the Inter-
national Council of Nurses had a vision of
the great organization they had set in
motion when they first put forward the
"international idea" in 1899, and gather-
ed for the first Congress in Buffalo, New
York, in 1 90 1. If they could be present in
Concordia Hall in Montreal this June,
^ould they recognize ICN as it is today,
ind would they feel it is meeting the
leeds or fulfilling the purposes for which
t was intended?
In 1901, travel to Buffalo was slow
ind costly. Sixty-eight years later, nurses
Tom more than 70 countries who con-
verge on Montreal will still find it costly.
3ut even in these days of space travel,
here is still something exciting about the
vay in which thousands of nurses come
ogether so quickly, and as rapidly scatter
igain to the four quarters of the globe.
Vliatever else those early nurses might
hink of ICN as it is today, they would
igree that it is fulfilling magnificently one
)f its primary objectives of providing an
nternational forum for nursing.
Several major issues, based on pro-
blems facing the profession and their
)0ssible solutions, will be discussed at the
msiness sessions of the 14th Quadrennial
"ongress. Since these issues affect all
lurses, we hope that these sessions will be
veil attended.
Decision-making can be a lengthy
•rocess, even at local and national levels.
Jurses are often accused of being a
onservative profession, but do other
nternational bodies, even intergovern-
aental ones, move any faster? True, the
uestion of auxiliary nursing personnel
/as under discussion at the Stockholm
ongress in 1949, and 20 years later it is
gain on the agenda.
There is, however, a change of em-
hasis. We are beginning to talk in terms
f a "second level nurse," prepared in a
efinite way and awarded a certificate or
ther recognition on completion. We are
iso talking about this person in relation
3 his or her national association. When
le Royal College of Nursing and the
lational Council of Nurses of the United
angdom raised the subject of the
second level nurse" at the last meeting
JNE 1969
International forum in Montreal
Sheila Quinn
of the ICN Council of National Repre-
sentatives (CNR) in 1967, the delegate
spoke of "the position, of the enrolled
nurse internationally. ". It is a burning
question, and one on which there will be
much discussion relating to the care of
the patient and the quality of this care.
The profession must think and act wisely
for the future.
One of the features of recent years has
been the formation of regional groups of
national nurses' associations. This could
be a trend of the future. We need to
assess the relationship of such groups to
ICN, and the future role of international,
regional, and national associations.
In the future, ICN will become in-
creasingly concerned with all aspects of
legislation, since sound legislation is the
basis for both preparation of the nurse
and quality patient care; without it,
nursing education and practice are
threatened. The document Principles of
Legislation for Nursing Education and
Practice, A Guide to Assist National
Nurses' Associations is the first part of a
project undertaken with funds from the
Florence Nightingale International Foun-
dation Trust, administered by ICN. Plans
are now being made for an international
seminar based on this document.
Menfion the International Labor
Organization (ILO) and nurses, and most
people immediately think of the 10-year-
old report Employment and Conditions
of Work of Nurses. But a new project is
,underway. In 1967 the CNR asked the
fLO to consider, with World Health
Organization cooperafion, the pre-
paration of an international instrument
on the status of nurses for the improve-
ment of nursing services. The CNR will be
brought up-to-date with the progress of
ICN's efforts in this respect. For several
years discussion on ICN's relations with
ILO has brought conflicting opinions, but
the importance of this relationship is
becoming more evident. Such an instru-
ment could have a lasting influence on
the continuing development of the nurs-
ing profession.
Miss Quinn is Executive Director of the Inter-
national Council of Nurses, Geneva, Switzer-
land.
The "right to strike" is guaranteed to
have every ICN delegate on her feet. This
issue was under fire in 1967, at which
time the ICN Professional Services Com-
mittee was asked to study the possibility
of preparing guidelines on economic
welfare. This committee has been work-
ing with the executive staff throughout
the quadrennium on statements in the
major areas of nursing education, service,
and social and economic welfare of nurs-
es. Any professional association should be
able to set down its philosophy on these
vital areas. Statements from ICN would
not be only a statement of its own
beliefs, but also could give leadership and
inspiration to many small and developing
nurses' associations throughout the
world.
The popular and much used ICN Ex-
change of Privileges Programmes for nurs-
es has been under careful scrutiny, and
suggestions will be put forward for
revision at the 14th Quadrennial Congress
in June. This program, now 20 years old,
has helped many nurses to travel abroad,
putting their professional qualifications
to good use, and giving them valuable
experience for use in their own countries.
Times change, so do the needs of ICN
member associations; ICN programs must
adapt to meet these needs.
Every nurse in Montreal should be
thinking in the future tense. We will not
find all the solutions; many things will
remain in discussion until the next meet-
ing, and others may drop and lie fallow
for several years until they become a
matter of urgency to the profession. Each
participant at the Congress will see a
world turned - slowly, perhaps imper-
ceptibly, but positively.
A Congress is not just a means of
coming together, of meeting old friends,
making new ones, and traveling to a new
country. It is an international forum that
can have a resounding effect throughout
the world. If the minds of participants are
not stretched to new dimensions, then
ICN could be said to be losing its role in
the world of today. We dare to prophesy
that the "international idea" expressed
by Mrs. Bedford Fenwick in 1899 will
become reality for many thousands of
nurses in June 1969 in Montreal. D
THE CANADIAN NURSE 31
The growth and development
of a profession
The 14th Quadrennial Congress of the ICN in Montreal will be yet another
landmark in the history of international nursing. The question is: "Where do
we go from here?" We are moving faster and faster toward unknown horizons
and a future dimly seen. We cannot stop the trend.
"Every nurse should give her support
to the work of the International Council
of Nurses and use all the influence she
can command to make this body an
instrument of a world community and
not a mere device for calling pleasant
conferences. " These words were spoken,
not by a member of the ICN, not even by
a nurse, but by a member of a university
faculty. He was addressing a meeting of
nurses on the subject 'The nurse as
citizen." The words are singularly apt
since an ICN Congress, with Canada as
hostess, is once more approaching. Inter-
est in the Council is always more
apparent when such plans are in progress.
It should be remembered, however, that
this is only one of ICN's activities. Much
routine work is carried on from head-
quarters during the intervening years.
in the beginning
In a short article it is difficult to do
justice to the story of an international
organization whose origin dates back to a
previous century. Nurses can feel justi-
fiably proud that their profession has
been organized internationally longer
than any other professional group. A
British general addressing his troops once
said: "A collection of soldiers is no more
an army than a collection of bricks is a
house." The same could be said of nurses.
Individually they may do good work, but
organization is needed to ensure that the
best service is offered to the community.
32 THE CANADIAN NURSE
Daisy C. Bridges
Our pioneers foresaw that a profession
organized was a profession strengthened;
that nurses as individuals could never
accomplish what they were capable of
doing as a unified body.
The idea of an international nursing
organization was first conceived by Mrs.
Ethel Gordon Fenwick. In 1899 she
proposed the foundation of a federation
composed of "nursing councils" from
every country. She visualized that this
federation would unite the profession in
its demands for necessary reform and
would help to establish nursing councils
in countries that had no form of nursing
organization. Mrs. Fenwick's proposal
was addressed to a meeting of the Ma-
tron's Council of Great Britain. It took
the form of a simple resolution: "That
steps be taken to organize an Inter-
national Council of Nurses."
It is probable that no more far-
reaching decision has ever been made at
any meeting of nurses. Nursing leaders
from Australia, Canada, Denmark, Hol-
land, New Zealand, South Africa, and the
Miss Bridges, who was executive secretary of
the ICN from 1948 to 1961, is a distinguished
world nursing leader. In 1954, she was awarded
the decoration of Commander of the Order of
the British Empire by Queen Elizabeth. The
Canadian Nurses' Association awarded an
honorary membership to Miss Bridges in 1958.
A recent accomplishment (1967) is her book: A
History of the International Council of Nurses
1899-1 964: the first sixty-five years.
USA joined with those from Great Britain
in forming a provisional international
committee to draw up a draft consti-
tution that eventually signalled the birth
of the ICN. Under this constitution,
which was formally accepted in 1900
with revisions and amendments from time
to time, the Council has developed it;
work and widened its influence through
succeeding years.
The objectives of the ICN are simple
and have remained unchanged:
• To help in maintaining the highes:
standards of nursing in member countries
• To assist nurses in countries when
there is no association, or where the
association is not yet ready for member
ship, to achieve a form of organizatioi
that would enable it to join.
There is another objective, whicl'
althougli not included in the forma
constitution, is equally important - tb
promotion of friendship and fellowshi)
among the nurses of the world. Through
out more than half a century this spirit o
international cooperation has been bull
up. It is a priceless heritage to be cherish
ed and handed on to succeeding genera
tions, and it is our contribution, a
nurses, to the cause of worid peace.
Throughout its long history, th
routine work of the ICN has been carrie
on from headquarters temporarily locate
in a number of cities. From 1900 t
1923, Lavinia Lloyd Dock of the USi*
the ICN honorary secretary, travelle
JUNE 19(
between New York and London main-
taining, first from one side of the Atlantic
and then from the other, a close relation-
ship with nurses in all countries where
there was interest in supporting the new
federation.
From 1900 to 1904, Mary Agnes
Snively (at that time Lady Super-
intendent of the Toronto General Hospi-
tal) held the office of honorary treasurer,
(n 1901 she presented what was described
IS "a very satisfactory balance sheet."
The cash balance, when all expenses had
3een paid, amounted to SI 4. 18.
In 1925 the first permanent headquar-
ers was established in Geneva. Here, the
"irst executive secretary, Christiane
^eimann of Denmark, placed the work of
the Council on a firm footing. She was
succeeded in 1934 by Anna Schwarzen-
berg of Austria. In 1937 headquarters
moved from Geneva to London. Follow-
ing the outbreak of war in 1939, all
essential documents were transferred to
the USA. As much work as circumstances
permitted under war conditions was car-
ried on, first in New Haven and later in
New York. During these difficult years
the Canadian Nurses' Association was one
of the few member associations with
which the ICN president, Effie J.Taylor,
could continue to correspond. This con-
tact was a source of great support and
encouragement to her.
In 1 94 1 , Miss Taylor had written to all
member associations, recording the death
of Jean Gunn, Lady Superintendent of
the Toronto General Hospital, who had
been first vice-president of the ICN since
1937. The president wrote: "Few of our
members have occupied so deep a place in
the hearts of international nurses as Jean
Gunn: her name will be placed among
those to be remembered always as out-
standing figures in international nursing."
In 1948 headquarters returned once
again to London. After six years of war,
the staff were faced with many diffi-
culties. Temporary offices were found in
a bomb-damaged building with broken
windows and cracked walls. Total office
furniture and equipment consisted, at
first, of two tables, a few chairs (on loan),
and a portable typewriter brouglit from
lie founder of ICN - Mrs. Bedford Fenwick - seen in center of photo, taken in
933 in the Royal Palace Grounds, Brussels. Front row, left to right: Mile Chaptal,
resident, ICN; Queen Elizabeth of Belgium: and Mrs. Fenwick.
JNE 1969
Mary Agnes Snively: a Canadian nurse
who held the office of ICN honorary'
treasurer from 1900 to 1904.
THE CANADIAN NURSE 33
Ethel OurduN J^ en wick ~ wku proposed
the creation oflCN in 1899.
New York and damaged in transit. Final-
ly, when repairs and decorations were
completed, the offices were accommo-
dated on three floors. A further move
took place in 1956 and the headquarters
finally had "a house and home of its
own." Here, in a new building situated in
the most historical part of London, the
work continued to grow and expand. In
1948 Daisy Bridges of Great Britain
succeeded Anna Schwarzenberg as execu-
tive (later general) secretary. In 1961
Helen Nussbaum of Switzerland took
over the office.
When the 13th Quadrennial Congress
was held in Frankfurt in 1965, the
question of a future location for ICN
Headquarters was again discussed. This
gave rise to the following recommen-
dation: "That in the interest of providing
the continued effectiveness and develop-
ment of headquarters' services to member
associations, and to the nursing profes-
sion throughout the world, more com-
modious and suitable premises must be
obtained."
This recommendation was accepted by
the majority of member associations
present. Accordingly, headquarters re-
turned once more to Geneva where, since
1966, it has been established in a new
office building. The accommodation is
spacious and dignified. Under the direc-
tion of Sheila Quinn, who succeeded
Helen Nussbaum as general secretary,
(later executive director) the staff carry
on the routine work and meet many and
varied demands for assistance.
A moment of climax
It can truly be said that the found-
ation of the Council was the culminating
professional event of a century that had
seen the rise of nursing from "suitable
employment for women in the lowest
class" to an honorable and scientific
34 THE CANADIAN NURSE
Effie J. Taylor - a U.S. nurse who was
ICN president from 1937 to 1947.
profession for persons of education and
culture. The establishment of nursing
schools, the advent of the "trained nurse"
as a product of these schools, a growing
insistence on educational reform, and the
registration of nurses to safeguard the
community — these were some of the
legacies of the nineteenth century to the
twentieth.
The increasing impetus toward profes-
sional organization, both national and
international, was an inevitable conse-
quence of progress in nursing and a
growing consciousness of its obligations
to the community. In all these develop-
ments the ICN has been in the forefront.
It has witnessed the rapid growth of
national nursing organizations, infusing
the whole profession with strength and
vitality; the gradual recognition by
government of its responsibility for the
preparation of nurses; the development of
advanced programs of professional educa-
tion designed to prepare and equip nurses
for administration, teaching, and all
spheres of leadership; the advancement of
knowledge and understanding of the
social implications of all sickness, mental
and physical; the greater consciousness of
the profession's obligations in the work
of preventive medicine; and the need for
an international standard of nursing servi-
ce and nursing education, and a code of
ethics pertaining to both.
In 1948 the ICN was admitted into
official relationship with the World
Health Organization. It was thus recogn-
ized as a body capable of representing the
views and furthering the purposes of
professional nursing throughout the
world. Friendly relations with all inter-
national organizations in the fields of
health and social welfare have conferred
on ICN both privileges and responsibi-
lities. These are the rewards for the vision
and foresight of our founders, and the
Jean Gunn: first vice-president of ICN
from 1937 to 1941.
climax of more than half a century of
progress in nursing service and profes-
sional organization.
Milestones and landmarks
At every Congress, plans have been
initiated and decisions made that have
anticipated and precipitated events, later
recognized as landmarks of progress. The
names of the cities of Buffalo, Berlin,
London, Cologne, Copenhagen, Helsinki,
Montreal, Paris, Brussels, Atlantic City,
Stockholm, PetropoUs, Rome, Mel-
bourne, Frankfurt — have become
monuments to nursing achievements that
have been the result of perseverance and
united action. Only the future will show
what outstanding event in nursing history
owes its inspiration and impetus to the
14th Quadrennial Congress to be held in
Montreal in June, 1969.
In 1901, nurses gathered in Buffalo for
the first Congress of the International
Council of Nurses. Here is a description
of the scene: "Delegates surrounded the
President, all in most tasteful toilettes. In
the auditorium and gallery were over 400
bright-faced eager women, bristling with
energy and expectation." In her closing
address, Mrs. Fenwick said: "The time
has come when nurses need their educa-
tional schools, their endowed colleges,
their Chairs of Nursing, their University
degrees and State Registration." Inspired
words indeed when they were uttered in
1901!
This year many thousands of nurses
will gather in Montreal. There is no doubt
that we shall hsten to pronouncements as
inspiring and as far-reaching to guide us
through the next half century. At the
same time we shall be obeying the com-
mand contained in an old Sanscrii
proverb: "Walk together, talk together all
ye peoples of the earth; then and only
then, will ye have peace." C
JUNE 196'
Nursing in Japan
Japanese nurses have the same goals as Canadian nurses and seem to be faced
with similar problems.
Japan is a country with four main
islands in the north-eastern extremity of
Asia, with an area slightly smaller than
the State of California. The country is
370,000 km. wide and has a population of
over 100 miUion; it is divided into 46
prefectures (districts), and Tokyo is the
capital.
History of nursing
The midwife, known as the "birth
attendant," was the first nurse to appear
on the scene in Japan, around the 17th
century. The independent regulation of
midwifery was established in 1899, 25
years after the enforcement of the medi-
cal system.
Around 1 880, several schools of nurs-
ing were established by foreign nurses.
These schools were the Sakurai Girls'
School in Tokyo; the Tokyo Kyoritsu
Hospital Nursing School; the Doshisha
Nursing School; and the Tokyo Imperial
University Hospital Nursing School. Un-
fortunately, these nursing schools were
dissolved within a short time.
From 1917 to 1947, the educational
requirement for admission to a nursing
school was six years of elementary educa-
tion, plus two years junior high school.
During this time, nurses earned certifi-
cates as nurses, midwives, or public health
nurses after graduating from an approved
training school or after one year of
practice and the successful completion of
lUNE 1969
Sada Nagano
separate perfectural examinations in each
category.
The Public Health Nurse Midwife and
Nurse Law was passed in 1948. This law,
administered by the Ministry of Health
and Welfare, prescribes the qualifications,
training, practice, registration require-
ments, national examination, and status
for both nurses and assistant nurses.
The Nursing Section, Medical Affairs
Bureau of The Ministry of Health and
Welfare, is responsible for general control
and supervision of nursing affairs includ-
ing the regulation of supply and demand
of nurses, the keeping of statistics, the
provision of scholarships and money for
the construction and maintenance of
nursing schools. The budget of the Nurs-
ing Section in the 1969 fiscal year (April
1969-March 1970) will be 275 miUion
yen - approximately $763,888.
At the national level, the Nursing
Section assists the 69-member nursing
council. The council approves schools of
nursing, prepares the national examin-
ation, and authorizes the practice of
public health nurses, midwives, and
nurses.
Nursing service
The demand for an increasing number
of nursing personnel comes from all areas
Mrs. Sada Nagano is Chief of the Nursing
Section, Medical Affairs Bureau, Ministry of
Health and Welfare, Tokyo, Japan.
of medical services, especially from hospi-
tals. A standard number of nursing per-
sonnel for each hospital was established
by the Medical Service Law, enacted in
1948, which states as a requirement:
"Every 4 inpatients to one nurse and
every 30 outpatients to one nurse and
add one for any fraction beyond." Ac-
cording to this standard figure, there was
a shortage of 31,800 hospital nurses in
1967.
One reason for the shortage of nurses
in the past has been the regulations
affecting night duty. In 1965, three years
after the Government Medical Workers'
Union took action, the National Person-
nel Authority recommended that condi-
tions of nurses' night duties at the nation-
al hospitals be improved. The improve-
ments included: 1. no more than eight
days a month on night duty; 2. no more
single night duty within a nursing unit;
3. a period of six months free of night
duty for any nurse who has given birth to
a baby - this is in addition to the
Labour Standards Law that permits vaca-
tion with pay for six weeks before and six
weeks following delivery; 4. a clear ex-
planation of "rest hour" and "recess
hours." With these improvements, it is
hoped that the shortage of nurses will
soon be reduced.
Professional associations
There are recognized professional
THE CANADIAN NURSE 35
nurses' and midwives' organizations in
Japan, both incorporated associations.
The Japanese Nursing Association has
more than 110,000 members, including
12,000 public health nurses, 3.000 mid-
wives, and 95,000 clinical nurses, of
whom 40,000 are assistant nurses. The
Japan Midwife Association has a member-
ship of 35,000. The President is also a
member of the House of Councillors
(similar to the Senate in the US Con-
gress).
Conclusion
To meet the need, in quantity and
quality, for nursing personnel in the
future, the Nursing Section and the entire
Medical Affairs Bureau are reexamining
the supply and demand for the next 10
years, and are formulating policies to
recruit more nursing students and to train
larger numbers of nurses. Plans will be
made to reduce the attrition rate in
nursing, and to attract unemployed
nurses back to nursing. D
Top left: a street scene in Tokyo. Japan.
Bottom left: "danchi, " or apartment areas, are now being erected on the outskirts of
towns. In such a community of apartment residents, most middle-income housewives
share common interests and pleasures.
Top right: great progress has been made to bring the benefits of modem medical
developments to alL Under various welfare programs, nearly every Japanese is able to
receive medical treatment free or at a reasonable charge.
Middle right: a Japanese housewife in front of her home.
Bottom right: Supermarkets are relatively new in Japan, but their appearance has won
wide popularity with housewives. Many modem supermarkets, like the one pictured
here, can now be found in the large cities of Japan
36 THE CANADIAN NURSE
JUNE 1969
Nursing in Colombia
Colombia, similar to other developing countries, faces the problem of providing
quality nursing care with limited nursing personnel.
Lucia A. Restrepo, M.S.N., and Elvia C. de Garzon
Colombia is a republic on the north-
west coast of South America. Most of its
17 million inhabitants live in the interior
cities, isolated from the coast by ranges
of mountains. The country is divided into
1 6 departments, similar to provinces, and
each department has its own capital.
In recent years, Colombia has suffered
from an alarming shortage of nurses. The
most recent information on the nursing
situation is reported in the 1 965 Study of
Human Resources for Health and Medical
Education in Colombia. i Althougli the
figures have changed in the past four
years, they give an idea of the nursing
resources in Colombia for that period.
The ratio to population in the capitals
was 22.5 nurses per 100.000 inhabitants
(1:444), in contrast to the rest of the
country where the ratio was 1.5 nurses
per 100,000 inhabitants (1:6667).
Nursing personnel
There are two types of personnel
giving nursing care in Colombia: profes-
sional nurses and auxiliary personnel.
University schools of nursing, established
in 1903, provide basic education for
nurses - a great benefit to the advance-
ment of nursing in Colombia. Faculty and
graduates from the six schools, although
small in number, are well prepared.
In 1963 the admission requirements
for students to all nursing schools were
consolidated and included high school
lUNE 1969
completion. The academic university
system was adopted, placing nursing stu-
dents on the same level, and giving them
the same privileges, as students in other
faculties within the university. The nurs-
ing program was extended to four years
to grant the degree of Licentiate in
Nursing Sciences.
Study plans were modified to provide
students with opportunities to acquire
knowledge in the natural and social sci-
ences and the humanities. Theoretical as
well as practical experience is provided in
administration, supervision, and teaching.
Nursing education in the past stressed
the development of skills for bedside
care. Graduates, however, were required
to occupy supervisory or teaching posi-
tions — a situation that compelled nurs-
ing educators to consider the need for a
new orientation in basic studies. Facts
concerning this reorientation were pres-
ented by the members of the National
Association of Nurses of Colombia, Sec-
tion of Cundinamarca in 1967. 2
With these changes in the basic educa-
tion, supplementary programs were initi-
ated to allow general nurses (graduates of
three-year programs) to continue their
studies and to obtain the degree of
Miss de Garzon and Miss Restrepo, each hold
the Licentiate in Nursing Sciences from the
National University, Bogota, D.E., Colombia.
Currently, they are assistant professors. Faculty
of Nursing, National University of Colombia.
Licentiate in Nursing Sciences. A high
percentage of nurses returned to universi-
ty to undertake these studies, despite the
great effort and expense involved.
In an effort to prepare more capable
nursing auxiliaries to help relieve the
nursing shortage, the Ministry of Public
Health provided financial assistance and
scholarships to students in the 30 schools
for nursing auxiliaries. Approximately
900 graduate each year, and are then
required to work in Colombian health
institutions. Between 1915 and 1965
there were 3,957 nursing auxiliaries.
However, there is no infomiation avail-
able on the general characteristics of age,
sex, civil status, inactivity, or geographi-
cal distribution.
A problem must be faced
The general opinion among Colombian
nurses seems to be that there should be
only these two types of nursing workers.
This avoids fragmentation in patient care,
as well as the confusion that arises among
the public, medical personnel, and nurses
themselves when there are too many
types of personnel. Other countries have
experienced this problem when there is a
proliferation of personnel.
Nevertheless, Colombia, similar to oth-
er developing countries, has and will
probably continue to use for some time
the nursing aide, even though her role in
the overall system has not yet been
THE CANADIAN NURSE 37
studied in detail. The main reason is
economical: patient care given by the
nursing aide is less costly. There is
growing belief among administrators of
health services that nursing aides should
be trained and supervised directly by
nurses.
The creation of a new type of nurse to
relieve the shortage has been suggested.
However, the paper presented before the
Third National Congress of Nurses in
1967 outlined in detail the economic and
administrative aspects that impede the
creation of a new type of nursing person-
nel. 3 More difficulties than solutions
would arise.
Where the nurses are
In 1965 there were 1,616 professional
nurses in Colombia, of whom 1,177 (72.8
percent) were actively practicing in the
country. Lay nurses constituted 77.3
percent and religious nurses 22.7 percent.
One hundred and three (6.5 percent) of
Colombia's nurses were attracted to other
countries by better employment opportu-
nities, opportunities to study, and reli-
gious orders. The remaining 336, consti-
tuting the group of inactive nurses, had
left the profession because of marriage or
other personal reasons. More nurses were
practicing in the departmental capitals
than in the rest of the country.
The data in the Study also showed
that the official (government controlled)
hospitals and the semi-official (religious
order) hospitals employed 41.7 percent
of the active nurses. The social security
institutions employed a considerably
smaller proportion, more or less equal to
the private sector. About one-half of the
remaining nurses were employed in
university teaching, the other half, in
public health service.
Although the number of nurses has
increased in the past few years, the
Ministry of Public Health plans to provide
more nurses for the rural areas through
better work incentives for health pro-
fessionals in these areas.
Continuing education
The faculty of nursing of the National
University has developed programs of
continuing education in psychiatry,
administration of nursing services, and
public health nursing. The nursing school
of the University of el Valle offers
courses for specialization in psychiatry
and in maternal-chUd health. The faculty
of the Javeriana University has under-
taken courses in nursing equipment and
leadership.
Graduate education is a project that
shows many possibilities for realization,
38 THE CANADIAN NURSE
A general view of Bogota, Colombia,
once well-qualified nurse teachers are
available, and the necessary arrangements
that permit the development, continuity,
and evaluation of these programs have
been made.
The University of el Valle offers pro-
grams of graduate education for nurses by
means of a provisional licence. This is a
temporary measure and will probably be
phased out when the masters' programs in
the country are officially organized and
the minimum requirements for this type
of nursing program are determined. Since
1965, courses have been offered in
psychiatric nursing, medical and surgical
nursing, and maternal and child health
nursing. The National and Antioquia
Universities are planning masters' pro-
grams for nurses occupying positions in
teaching and administration. In the future
these programs will help solve the
shortage of highly qualified teaching
personnel, in Colombia as well as in other
Latin American countries. For economic
and language reasons Colombian nurses
cannot take advantage of these studies in
other countries.
Perspectives for the future
Basic nursing education has developed
positively and rapidly during the past few
years, offering new perspectives for
Colombian nurses and for nurses coming
from other countries of Latin America.
We believe that our efforts must con-
centrate on strengthening these basic pro-
grams, endeavoring constantly to improve
the preparation of nurse teachers. In
future we plan to: establish new programs
of continuing education; raise the scholas-
tic requirements for candidates entering
the schools for nursing auxiliaries in such
a way that the preparation gap between
the registered and the' auxiUary nurse is
JUNE 1969
A main street in Colombia.
narrowed: improve the quality of instruc-
tion received by the auxiliary nurse so
that she is able to carry out effectively
her functions in the health institutions;
carry out research studies to determine
the functions of the two types of nursing
personnel, the actual and future demands
of such personnel, and the means of
supplying these.
Professional associations
Colombian nurses belong to one of six
branches of the Asociacfon Nacional de
Enfermeras de Colombia (ANEC). ANEC
is a member of the International Council
of Nurses and the Federation of Profes-
sionals of Colombia, FEDERPROCOL.
The Association publishes a magazine for
members, called ANEC, through which
the nurses receive information and
express their opinions and ideas on
various professional topics.
UNE 1969
The Permanent Committee on Nursing
is part of the Colombian Institute for
Advancement of Superior Education,
formerly the Colombian Association of
Universities -National University Fund.
It is composed of directors of nursing
schools and representatives of the main
nursing sectors in the country. It has
performed important work in the pre-
paration of standards for the accredita-
tion of university programs, description
of the role of the registered nurse, and
characteristics of the licentiate programs.
Conclusion
The development of nursing in Colom-
bia has been aided by members of the
nursing profession who are motivated to
change and to effect change. Various
international organizations, such as the
World Health Organization, WJC. KeUogg
Foundation, the Agency for international
Development, the Rockefeller Found-
ation, and other institutions have provid-
ed valuable and efficient assistance. In
addition, universities have made a con-
tinuous and organized effort to study and
solve the outstanding aspects of the
present problems in nursing education.
References
1. Ministry of Public Health of Colombia,
Columbian Association of Medicine Facul-
ties. Study of Human Resources for Health
and Medical Education in Colombia, Bogota
D.E. 1967, pp. 17-22.
2. Paez de Reyes, Fanny. Sister Aiacelly, et at.
Planning for the Future of Nursing Educa-
tion. Medellih, 1967, p.4.
3. Ministry of Public Health of Colombia, op.
cit. p. 14. □
THE CANADIAN NURSE 39
Photographing an operative field is proba-
bly the most challenging task that the
medical photographer encounters. This is
a job for the expert. It involves both
knowledge of surgical asepsis and mastery
of photographic techniques. Ninety
percent of medical photography is in
color. In this picture, the author is using a
35 mm. camera with a 105 mm. lens.
Medical
photography
a century of
progress
Camera at the alert, the medical photographer has joined the ranks of those who
make up the health team. He has won his spurs as a participating and
contributing member of hospital personnel.
Jacques Doyon
One hundred years have gone by since
the first hospital department of medical
photography was launched in France by
two doctors, Hardy and de Montmeja,
members of the staff of Saint Louis
Hospital in Paris. This was in 1869. The
value of photography io the medical field
seems to have been almost immediately
recognized. Actually, its success had been
predicted almost 30 years earlier by
another physician, Dr. A. Donne, who
had himself succeeded in producing
microscopic slides. Today, thousands of
highly specialized photographers are at
work in hospitals the world over. Medical
photography has become a recognized
and respected discipline, exciting the in-
terest of many young persons who will be
the leaders of the future in this area.
Doctors are particularly aware of the
role of photography in medical edu-
cation. For many years, medical students
Mr. Doyon is the Director of the Department of
Medical Photography, Hopital Sainte-Justine,
Montreal. He is a member of the Association
des photographes professionnels, and of the
Photographes medicaux de la province de Que-
bec.
40 THE CANADIAN NURSE
have benefited from the countless num-
bers of photographs used to illustrate
their textbooks. Many a lecture has been
brightened and clarified through the use
of slides. Audio-visual aids have become
indispensable means of communication.
The student absorbs ideas more readily
and has a greater depth of understanding
because he is able to see the total picture.
Preparation of visual aids
Faced with a persistent need for visual
aids, doctors have turned to those who
can offer professional help in this field.
Artists and photographers assume the
responsibility for the creation of all
materials required for projection, and
consequently have become essential mem-
bers of hospital personnel. Working
together, the medical artist and medical
photographer form a highly specialized
team, producing thousands of items each
year.
There are still many people who ques-
tion the need for the hospital photo-
grapher. In the department that I direct,
15,000 photographs and slides are pro-
cessed annually, as well as numerous 16
mm. films, both silent and with sound
JUNE 196'
All of this is necessary because of the
importance of maintaining permanent
photographic records for use in scientific
research, medical practice, and teaching.
Obviously, the job must be in the
hands of qualified personnel. The photo-
grapher works under the guidance of the
physician, and is concerned with any
aspect of hospital activity that has photo-
graphic significance.
The medical photographer
Those who enter the profession must
be expert practitioners of photography
generally and, in addition, must possess
special attributes that will gain their
acceptance as photographic experts in
medical work. The medical photo-
grapher's success depends on the con-
fidence he is able to inspire in his
colleagues, and his reputation as a skilled
worker.
The prospective candidate must com-
plete secondary school, acquire a diploma
in photography, and engage in additional
study in human anatomy and physiology.
Coarctation of the aorta prior to surgery,
in the operating room the pliotographer's
clioice of subject material must be appro-
oriate to tlie surgical specialty and must
meet the surgeon's approval Speed is
essential, and usually there is no going
hack for a second attempt.
lUNE 1969
He is required to serve an apprenticeship
in a hospital under the supervision of a
qualified medical photographer.
Continuous study is a necessity since
he must keep abreast of new develop-
ments in the field of photography and in
medical science. He must have a sensitive
professional conscience, exhibited in the
scrupulous care and precision with which
each item is prepared. His ability to select
photographic material wisely, his in-
tegrity, and his initiative are effective
factors in winning the confidence of
others. In photographing patients, he
must be able to display sympathy, tact-
fulness, and devotion to duty. He must be
knowledgeable about the hygienic measu-
res required in the prevention of disease
transmission, since his duties carry him to
the autopsy room the operating room,
and many other hospital areas.
In addition to scientific knowledge,
the medical photographer must have
exceptional powers of observation and
considerable dexterity in the use of the
camera, particularly when taking photo-
graphs of an operation.
He must maintain an interest in med-
ical matters generally, although he will
never be called upon to care for patients
nor to take scalpel in hand. His daily
routine brings him into contact with
medical personnel at all levels, as an
active participant in hospital life.
In the province of Quebec alone there
are, at the moment, some 50 medical
photographers. They share in common a
high degree of expertise in technique.
These photographers are able to make a
contribution when they sense that it is
their special skills, experience, and ability
that are needed to place important
records in the hands of the physician:
otherwise they drop to the level of simple
technicians who press a button, develop
film, and mount slides. The medical
photographer must believe that his work
is the answer to a real need ~ that
through it a doctor is enabled to visualize
a lesion more precisely, and teach others
about it more effectively.
Scientific value
Photography is especially helpful in
following the course of an illness. We can
watch the patient's progress or his
deterioration. For example, in orthopedic
surgery a good photograph can effectively
demonstrate the results of surgical inter-
vention. Also, patients with rare diseases
can be photographed; their pictures be-
come permanent records of the particular
syndrome or lesion.
From a legal point of view, photo-
graphy offers protection both to the
doctor and to the hospital, since the
courts accept pictures that originate from
an official source, such as the hospital's
photographic department.
Types of medical photographs
The medical photographer's subject
material is varied. In addition to actual
patients and disease conditions in general,
he photographs anatomical specimens,
cultures, chemical reactions, medical
documents of all types, drawings, graphs,
electrical tracings, such as one finds in
EEC and ECG, electrophoresis and im-
munoelectrophoresis.
In conclusion I extend my thanks and
gratitude to all nurses who have assisted
us, particularly when we have had to
work in the operating room or in the
patient's room. Their help and their
cooperation have enabled us to produce
better pictures in the interest of both
patients and doctors. □
THE CANADIAN NURSE 41
Medical illustration
- an art and a science
Medical illustration has become an indispensable feature of scientific life.
Through it, the printed or written word takes on life and meaning; the obscure
becomes clear; the incomprehensible gains meaning.
Madeleine Gagnon
Medical illustration - what is it, art
or science? Probably it is both an art,
because skill in drawing is a prerequisite;
a science, since the artist must com-
plement his artistic ability with a body of
scientific theory.
There are two distinct types of med-
ical illustration: medical art and medical
photography. In this article we are con-
cerned with the former, although the one
profession complements the other, and
maintenance of cooperation between the
two is essential.
History
Through the ages, man has continued
to record his progress through his art. Bits
of sculpture, paintings of humans, of
animals or of geometric forms adorned
the walls of the caves that housed primi-
tive peoples. Each civilization, in turn,
has contributed to a growing body of
artistic knowledge that has presently
reached impressive proportions.
Around the end of the fourth century,
artists were exhibiting an amazing degree
of skill both in painting and in sculpting
either the whole human form or parts of
it. At the same time, the developing
professions of medicine and surgery
Miss Gagnon, a graduate of Hopital Sainte-
Justine, Montreal, and a former operating room
nurse, obtained her certificate as a medical
illustrator in 1956 from the Association of
Medical Illustrators.
42 THE CANADIAN NURSE
began to use illustrative material to pro-
vide greater depth of knowledge about
human anatomy. These illustrations,
while fairly well executed, were based on
the results of animal dissection and the
artist's powers of imagination.
Leonardo da Vinci, working in the
fifteenth century, was one of the first to
produce highly successful anatomical art.
Delia Torro, von Calcar, and Andreas
Vesalius followed. The latter has been
called "the father of medical illustra-
tion." His knowledge of art and of
anatomy made his contribution particu-
larly outstanding. The publication of his
De hiimani corporis fabrica in 1543 mark-
ed the beginning of scientific medical art.
Between the sixteenth and nineteenth
centuries, medical illustrations dealt
mainly with physical anomaly or deform-
ity and were of fairly good quality.
Although there was no attempt to con-
centrate specifically on medical topics,
these particular works had both artistic
and scientific value and were carefully
preserved.
On the North American continent,
medical art was introduced by Herman
Faber in 1853. In 1894, Max Broedel
immigrated from Germany to the United
States. He settled in Baltimore and, in
1911, founded the first school of medical
illustration at Johns Hopkins University
School of Medicine. He trained medical
artists of great promise who subsequently
carried on his work. At the present time
JUNE 1969
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fev
/
^^fe
fv
/ / /
/
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/fc^~5
Inguinal hemia repair - closure of the incision
Resection of an aortic aneurysm in a child.
Inguinal hemia repair ~ resection of the hernial sac.
Primary cancer of the liver in a child. Dissection of
the hepatic pedicle. Cutting and tying of the cystic
duct, cystic artery, the right hepatic artery, the right
branch of the portal vein, and the right hepatic duct.
)NE 1%9
THE CANADIAN NURSE 43
there are several schools of medical illus-
tration in the United States, one in
London, England, and one in Toronto. It
is hoped that another such school may
open in the near future in the province of
Quebec.
Value of medical art
Medical art has become a connecting
link between medical teaching and prac-
tice. Through its use, theoretical prin-
ciples are made more comprehensible
both to medical and nursing students.
The design and preparation of scientific
exhibits, television productions, and
movie films all fall within its range of
interest. Literary works of various
types - books, journals, pamphlets —
benefit from the skill of the medical
artist, as do the advertising materials of
pharmaceutical and other manufacturing
firms. Last, but not least, medical art has
even found a place on the walls of
institutions in the form of murals.
The medical artist
The field is open to both women and
men, but the percentage of male artists is
presently higher, probably due to a
steady increase in salary over the past few
years. This is especially true of the United
States.
The prospective student should be a
high school graduate with additional
preparation in the fine arts, including
study of the human body - nude and
clothed; artistic composition; sketching;
color theory; design; and history of art.
Among other personal attributes, he must
possess exceptional powers of observation
and be capable of intense concentration.
Finally, he must have general knowledge
pertaining to medical science.
The medical artist receives his training
in a school specializing in this field. The
course extends over a period of three
years and the curriculum includes study
of embryology, histology, anatomy and
pathology. These lectures are taken with
first- and second-year medical students,
and the same sets of examinations must
be passed.
Attendance at autopsies and surgical
operations is a necessity, and the student
must become generally familiar with
44 THE CANADIAN NURSE
hospital routine. He is expected to com-
plete black and white, as well as colored,
drawings of various anatomical and
pathological specimens, surgical proce-
dures, and clinical subjects from the
different medical specialties.
He learns how to design and set up
scientific exhibits and how to illustrate
books. He studies the history of medicine
and is introduced to the basic principles
of photography as related to the use of
medical art in the production of audio-
visual aids of all types.
His goal is the ability to produce
illustrations that are clear, exact, stripped
of unnecessary detail, and which, at one
and the same time, possess scientific value
and exhibit artistic ability. The artist does
not copy, he creates through his own
personal and original efforts. Part of his
success will depend on his diligence in
keeping up-to-date with new discoveries
in medicine and in art.
Future prospects
Since most medical artists are without
predecessors in their present jobs, there
will be a continuing need for their servi-
ces in universities, hospitals, research cen-
ters, and pharmaceutical firms. Generally
speaking, there is a shortage in numbers,
with the result that some institutions
have found it necessary to employ artists
who lack specialized preparation.
The work of the medical artist is
well-known throughout the medical
world and its value is undeniable in the
scientific community. D
Textbook illustration is
one aspect of the medi-
cal illustrator's role.
The subject matter is
not necessarily patholo-
gical or anatomical
0a^
JUNE 1%
^otses are not neuroV^^
The author wonders, however, how many imaginary diseases the nurse suffers
during her career.
Anthea Cohen
The public, as a general rule, are under
the impression that nurses are not afraid
of catching infections from the patients
they nurse or of contracting similar
diseases. How wrong they are!
On the medical ward, for example, the
nurse assiduously reads all the notes so
that she knows all about the patient she is
nursing, and, bingo! she has got the lot.
"I've got an awful pain in my chest,"
ihe says, darkly, to one of her companion
nurses, while they are engaged in the
nevitable task of testing the urines. "Do
/ou think I'm going to have a coro-
nary? "
Or she surreptitiously tests a specimen
if her own urine in order to see whether
ihe's got diabetes, kidney trouble, or
A-hether anything has happened to her
iver function. With trembling fingers she
irops a Clinitest tablet into her specimen
ind, joy of joy, it remains blue. Then, she
^ets shifted to a surgical ward.
Promptly, she gets a pain in the right
■ide of her tum and thinks; "Here it is.
t's my appendix."
But she waits a couple of hours and
he pain disappears, only to be replaced
iy one in the region of the gall bladder,
ihe is caught by the sister examining the
vhites of her eyes tentatively in a hand
nirror, trying to see if she has become
aundiced.
"You should not wear mascara on
luty. Nurse" says sister crisply, and our
leurotic one shambles off, wondering
low many times during a training you
an be misunderstood.
iverything except nappy rash
In the children's ward she is afflicted
/ith imaginary worms, German measles,
nlarged tonsils, pyloric stenosis and. in
act, everything with the exception of
appy rash, and when she leaves the
hildren's ward she gives a sigh of relief to
hink she didn't catch anything from the
ttle darlings, but this time she gets
lonked on the orthopedic ward.
Here, she contracts in rapid succession,
steo-arthritis of hip. a slipped disc,
artilage trouble in both knees, wry neck
nd a tendency to fallen arches.
Get a case of measles in the middle of
le ward, and all the nurses will become
JNE 1969
^
^o^
Holding their breath as they pass the measley patient . .
very bright about how they "couldn't
care less," but you watch 'em when they
are passing the bed before the patient is
moved out of the ward! They're all
holding their breath in case the measley
germ takes a quick, jet-propelled dive and
goes up their nose in passing. Oh, they'll
nurse him faithfully enough, but not
without being sure that they have got
measles too. because they get a sore
throat, or think they see a rash on
themselves.
The experienced and older ward sister,
of course, has the roughest time, because
she knows it all and has had, in her
imagination, every kind of dreaded
"lurgy" known to the doctors and some
that aren't. If she has a headache she
thinks she's suffering from: a brain
tumor: that she's going to have a stroke;
or she's got typhoid coming on.
After all, she knows the symptoms. If
Reprinted from Nursing Minor and Midwives
Journal, February 7, 1969 issue, with the kind
permission of the editor and the author.
she gets a pain in her chest, it's never just
indigestion, it's: a coronary; an aortic
aneurism; or a hiatus hernia.
A quick stab of pain on one side of her
face and she's got Trigeminal neuralgia
coming on, or osteomyelitis of the jaw;
nothing, in any circumstances, that is
simple.
Of course, these neuroses aren't at-
tached only to herself but they can be
superimposed on her mother, her father,
her sister, her brother or her husband.
They usually have a great deal more sense
and say something like:
"Oh, get off, I've only got the stom-
ach-ache" and leave her to her dark
mumblings of "diverticulitis" or "duo-
denal ileus" and all those gay little
prognosticisms.
However, among all this sea of diseases
there is one comforting thought which
will take the average nurse successfully
through her training and help her to cope.
No matter how many diseases she meets
she can't die of them all! D
THE CANADIAN NURSE 45
1. Roomin^-in is a plan whereby mother and
infant share the same room and are cared for
together. It permits the mother to begin to care
for her baby during the early days of life under
supervision of a nurse. The father, when he
visits, also participates in the care of his newborn.
2. At St. Michael's Hospital, Toronto, a young
couple may arrange with their obstetrician during
the prenatal period for the young woman to be
admitted to a unit that allows rooming-in.
Starting the first day after delivery if the mother
is ready, a special baby-care cart is taken to the
mother's room during the day; at night it is
returned to a special unit nursery so the mother
will get adequate rest.
46 THE CANADIAN NURSE
3. As soon as the mother feels able, she begins tc-
care for her infant — with supervision and health
teaching. Those who benefit most from rooming-
in are those with their first baby. It helps provide
a sense of confidence in their ability to care for tht
babe and to ease anxiety and fear before having
to cope alone at home.
JUNE 1%V-
Rooming-in is not a new idea. Many Canadian hospitals have
adopted this kind of family-centered care for parents who
want it. The student who provided this photo-article recog-
nizes one important point, however: nurses must be con-
vinced of the value and be willing to participate in parent-care
as well as baby-care, if rooming-in is to work.
Rooming -in
brings family together
Barbara Coome
Miss Coome is a third-year nursing
student at St. Michael's Hospital
School of Nursing in Toronto.
*4. The mother has the satisfaction of being able
to observe her baby during the day, and to learn
how he reacts. She can also practice her care
under supervision and ask questions about things
that trouble her. The baby can have his needs
met as soon as they are expressed — and babies
don't understand delay.
lUNE 1%9
5. The father participates in the care of his baby
early, rather than just seeing him through glass.
The parents can learn, together, the essentials of
baby care. Specialists believe this may lead to a
closer and more natural family relationship.
6. The nurse on a rooming-in unit must be pro-
ficient in both postpartum care and nursery care.
It is much more demanding for the nurse than on
conventional units. She must be able to support
and guide the new parents, and her skills must
include a sound understanding of human rela-
tions. Often the success or failure of the rooming-
in concept depends on the nurses' attitudes.
THE CANADIAN NURSE 47
research abstracts
Crotin, Gloria C. Nursing supervisors'
perception of their functions and
activities. Pittsburgh, 1968. Thesis
(M.N.Ed.) University of Pittsburgh.
This study was conducted in six gen-
eral, short-term care hospitals varying in
size from 301-600 beds. Four hospitals
were defined as community hospitals and
the remaining two as university-centered.
Eighteen day nursing supervisors acted as
the sample participants.
A structured, fixed-alternative ques-
tionnaire was the tool selected for this
descriptive study. The method employed
in the construction of the questionnaire
was designed following the collection of
job descriptions from the study hospitals
for the day nursing supervisors. Four
major categories were established for sort-
ing the functions: (a) Administrative
tasks of a non-nursing nature, such as
planning staff hours, vacation time,
absenteeism, obtaining equipment and
supplies; and administrative tasks of a
nursing nature, such as the development
of nursing care procedures, job descrip-
tions, review of nursing research,
(b) Coordination of services, patient-care
and personnel, (c) Evaluation of patient-
care and personnel, (d) Teaching and
development of self, staff, and patients.
From these categories, new reconstructed
statements of functions were prepared
consisting of 37 functions.
The findings indicated the following:
1. The nursing supervisors in the sample
had limited education following gradua-
tion from a diploma nursing program.
Only 38.9 percent of the sample had
baccalaureate preparation. 2. More than
80.0 percent of the supervisors' responses
indicated they performed the functions
listed in the questionnaire. 3. All respon-
dents stated that they performed the
following two functions and they also
agreed that supervisors should perform
these tasks. The tasks pertained to de-
termining the adequacy of nursing
personnel, qualitatively and quantita-
tively, on specific patient units, and
participating in the evaluation of profes-
sional and non-professional nursing
personnel. 4. In the category of coordi-
nation of services, patient-care and per-
sonnel, as well as in the category of
teaching and development of self, staff,
and patients, there was not one function
about which total agreement was reached
by the subjects. 5. The supervisors regis-
tered their greatest opposition to tasks in
48 THE CANADIAN NURSE
the category of administration. These
were the tasks of acquiring special equip-
ment, supplies, and drugs for a patient
unit and approving requisitions for new
materials and equipment. 6. All func-
tions in the teaching and development
category received two or more negative
responses from the supervisors, indicating
that they did not wish to carry out the
described functions, except for the func-
tion of providing individual instruction to
nursing personnel. 7. The university
hospital supervisors indicated that they
performed more of the functions listed in
the questionnaire than their counterparts
in the community hospitals. 8. The study
revealed contrasting views between the
two groups of supervisors. Supervisors in
the community hospitals showed a
greater willingness to perform the stated
functions than did the university-centered
supervisors. However, among the func-
tions checked not performed, the univer-
sity-center supervisors expressed a higher
level of agreement that they should be
performing the stated functions, than did
those employed in community hospitals.
The major conclusion indicated that
there seems to be a confusion of roles or
lack of clarity in the job descriptions of
supervisors and other nursing personnel.
Responsibility for teacliing staff members
appeared to be a neglected function
unless it was done on an individual basis.
Group confrontation may be threatening
to a nursing supervisor who does not
possess the skills required for group
leadership in conducting patient-centered
conferences.
Proulx, Yolande. A study to determine
the influence of selected factors in
choosing a head nurse's position
Boston, 1968. Thesis (M.S.) Boston
Univ.
This study was undertaken to identify
some selected critical factors that would
deter or attract nurses to head nursing.
The data were gathered by means of
questionnaires administered to a total
group of 45 participants working in one
hospital and enrolled in one university
school of nursing, both located in a
southeastern city of Canada. The partici-
pants consisted of 1 1 prospective clinical
teachers and 21 potential head nurses
who were currently enrolled in a post-
basic program, and of 4 head nurses and 9
clinical teachers who were presently em-
ployed in one hospital.
The data were tabulated and analyzed
to identify the participants' work back-
ground, personal attributes, forces that
attracted nurses to iiead nursing, factors
that would deter clinical teachers from
head nursing, and outside motivational
factors that influenced their occupational
choice.
On the basis of the findings of this
study, the following conclusions were
drawn in relation to the participants from
one university and one hospital located in
a selected city of southeastern Canada.
l.The clinical teachers graduated more
recently from a diploma program than
did the head nurses. 2. There were more
head nurses functioning without educa-
tional preparation in their field than there
were clinical teachers without formal
preparation. 3. Personal qualities and
abilities required of the prospective head
nurse were the same as those desired for
the potential clinic teacher. 4. Com-
munication skills and knowledge in the
assigned clinical area were qualities that
were perceived as vital to success for both
head nurses and clinical teachers.
5. Working opportunities were the most
influential factors in attracting nurses to
head nursing. 6. The bureaucratic aspects
of head nursing were indicated as forceful
factors in deterring clinical teachers from
head nursing. 7. Directors of schools of
nursing have been more active in recruit-
ing educationally qualified clinical
teachers than their colleagues in nursing
service administration have been in
recruiting formally prepared head nurses.
8. Teachers have been attracted to teach-
ing by the example of a competent
faculty member; head nurses were in-
fluenced in their choice by a situation
whereby they were made aware of the
need for educationally qualified head
nurses as a condition to the improvement
of nursing care. 9. Advertisements in pro-
fessional magazines were the least influen-
tial source of recruitment for both groups
of clinical teachers and head nurses.
In view of the findings, it was recom-
mended that three separate studies be
undertaken, utilizing more refined or
standardized tools to: 1. determine the
personality traits that are most conducive
to success in head nursing; and 2. deter-
mine if there is a correlation between the
head nurses' perception of the working
conditions and the actual working situa-
tion. D
JUNE 1%9
Infectious Diseases by Carl C. Dauer,
Robert F. Korns, and Leonard M.
Schuman. 262 pages. Cambridge,
Mass., Harvard University Press, 1968.
Canadian Agent: W.B. Saunders Ltd.,
Toronto.
Reviewed by Dorothy M. Mumby,
Director, Public Health Nursing, City
of London, Board of Health, London,
Ont.
This book is a record of a series of
vital and health statistics monographs
sponsored by the American Public Health
Association. It is a sequel to a similar one
on Accidents and Homocide.
This volume is divided into three
sections: infectious and parasitic diseases;
other specified infectious diseases; and
respiratory diseases.
Statistics presented for the years 1949
to 1961 compare morbidity and mortali-
ty rates by age, sex, color, and geographi-
cal division of the lunited States. The
reasons given for limitations of the mor-
bidity and mortality data are inadequate
reporting and inaccuracy of diagnosis.
A short history and factors relating to
an increase or decrease of a disease are
discussed as each disease or group of
diseases is presented. Diseases with a high
incidence rate and death rates are present-
ed, as well as those seen infrequently in
the US.
The tables and figures are well present-
ed. A 40-page appendix of incidence,
incidence rate, and numbers of deaths by
geographic division and states is a handy
reference. References and a detailed in-
dex are also included.
This book would be valuable as a
reference for statistical data on infectious
diseases in the United States. It does not
give up-to-date information of the infec-
tious disease picture in 1969. It is under-
standable but unfortunate that this type
of data cannot be collected and presented
within a shorter time.
The Ophthalmic Assistant by Harold A.
Stein and Bernard J. Slatt. 406 pages.
Saint Louis, Mosby, 1968.
Reviewed by Dr. S. Y. Shirley, Ottawa.
Demand for highly skilled ophthalmic
assistance has led to a new paramedical
technician, the "ophthalmic assistant."
These assistants have joined the growing
ranks of paramedical personnel, which
include x-ray technologists, laboratory
lUNE 1%9
technologists, inhalation therapists, etc.
This book was written for the ophthal-
mic assistant who assists the ophthalmo-
logist in the day-to-day care of eye
patients. The role of the ophthalmic
assistant is to provide reliable and compe-
tent eye care prior to and following
regular visits to offices and clinics.
The text is well illustrated and covers
the technical aspects of ophthalmology,
ocular instrumentation, diagnostic meth-
ods, procedures regarding sterility, and
supervision of ocular instruments. It des-
cribes the common ocular diseases and
the nature of emergency eye patients.
One chapter deals in simple, easily under-
stood terms with the common refractive
disorders and optics of the lens required
for correction. Another section deals with
community ocular problems, with a chap-
ter on eye screening programs, which
would be of particular interest to the
industrial and school nurse.
This book is of tremendous value to
the nurse working in an eye clinic or an
ophthalmologist's office. It covers the
practical field of eye diseases better than
any nursing textbook I have seen on this
ubject. For this reason. I would recom-
mend it to nursing schools as a text and
certainly it should be in all nursing school
libraries.
Handbook of Diseases of the Skin, 9th
ed., by H.O. Mackey. 424 pages. New
York, St. Martins Press, 1968. Cana-
dian agent: Macmillan Co. of Canada,
Ltd. Toronto.
Reviewed by Dr. Robert Jackson,
Ottawa.
This book is reported to be for "stu-
dents as a practical guide to the clinical
study and treatment of the diseases of the
skin." Actually it is an out-of-date (by at
least 30 years) abbreviated encyclopedic
textbook of dermatology with a few dibs
and dabs of modern cutaneous medicine.
The first part on anatomy and physiol-
ogy is too brief to be of any value. The
stratum lucidum has been known not to
exist for at least 15 years, yet it is still
described.
In discussing methods of examination,
no mention is made of the use of a hand
lens, nor is mention made that the hair
and nails must be examined, as should the
lymph nodes.
The chapters on treatment read like
Alice in Wonderland. It is recommended
that diseases for which there is now
specific treatment should still be treated
by arsenic, e.g., syphilis, pemphigus and
pellagra. To use "ichthyolated yellow
paste" for impetigenized eczema would
almost amount to malpractice. No men-
tion is made of the not uncommon
neomycin contact dermatitis or to the
yellow pigmentation of the teeth follow-
ing the administration of tetracycline to
pre-pubertal children.
At least 150 diseases are described by
very short, inadequate descriptions. Some
of the common skin conditions that the
student should learn are dealt with in a
cursory manner (e.g. contact dermatitis
1/2 page, acne vulgaris 2-1/2 pages, stasis
dermatitis 1-3/4 pages).
Almost all the photographs are out of
focus, are far too dark to show anything,
or show rare diseases that the average
busy practicing dermatologist might see
once a year (e.g., there are three poor
chemical photographs and six poor pho-
tomicrographs of sarcoidosis). The value
of these to the student is nil. There are no
color photographs, and no references.
There are numerous proofreading er-
rors, e.g.. p. 44, lupus erythematosis (for
erythematosus), and p. 28, "it is unusual
for patients who present with allergies
due to food not to have a family history
of atrophy" (for atopy).
There are excellent, practical, up-to-
date, short textbooks on dermatology
with excellent black and white and color
photographs (e.g.. Stewart, Danto, and
Maddin, Synopsis of Dermatology, 1 966).
It is difficult to know to whom this book
will prove useful. It is certainly not
recommended for nurses.
The CNA library urgently requires
the following issues of the Journal of
Nursing Education, published by the
Blackston Division of McGraw-Hill.
If you can spare any or all of these
issues, please inform the Librarian, Ca-
nadian Nurses' Association, 50 The
Driveway, Ottawa 4, Ont.
v.l, no. 3 - Aug. 1962
no. 4 -Nov. 1962
v.2, no. 1 -Jan. 1963
no. 3 -Aug. 1963
no. 4 -Nov. 1963
v.3, no. 1 -Jan. 1964
V.4, no. 2 - Apr. 1965
no. 3 - Aug. 1965
no. 4 - Nov. 1965
1966, 1967, 1968 -complete
THE CANADIAN NURSE 49
Microbiology and Pathology, 9th ed., by
Alice L. Smith. 723 pages. Saint Louis,
Mosby, 1968.
Reviewed by Heather Blair, Instructor,
School of Nursing, Ottawa Civic Hos-
pital. Ottawa, Ont.
This textbook would be a valuable
addition to the library of any nursing
school. The author provides a comprehen-
sive study of microbiology and an outline
of the principles of pathology, including
1 1 chapters on the pathology of the
major body systems.
The assets of this book include the
well-chosen illustrations that give added
meaning to the text, and the convenient
summary charts that give easy access to
important facts. The questions at the end
of each chapter serve as a guide to
important concepts.
In Part 1, chapter two, dealing with
"The Cell," and chapter three, "The
Bacterial Cell," are too detailed in places
for the use of nursing students. For
example, although it is valuable for the
student to know the basic shapes and
names of bacteria, it is unnecessary to
demand that she should have a knowledge
of the structure of the bacterial cell.
Excellent chapters within Part 1 in-
clude chapter 14 on antibiotics and chap-
ter nine dealing with specimen collection.
In both chapters the clinical relevance of
microbiology is clearly evident. The chap-
ter on viruses is up-to-date and provides
complete coverage of an area of micro-
biology that seems to arouse the curiosity
of nursing students. The existence of
both non-pathogenic and pathogenic mi-
croorganisms is made evident by the
chapter on "The Microbes Daily Contri-
bution." I feel it is important that the
student be aware of this balance. Again,
clinical references are made; for example,
the roles of the normal flora of the bowel
in vitamin K synthesis.
Chapter 34 on recommended immu-
nizations is a useful and important re-
ference for health-teaching purposes. The
weiglit given to preventative measures in
Part I of this textbook is admirable. Unit
five, "Microbes, Pathogens and Parasites,"
is thoroughly, yet simply, explained. 1
would recommend it as a reference for
intermediate students studying communi-
cable diseases.
Part 11 of the text, which deals with
pathology, describes clearly and concisely
the major disease processes of the body
systems. It is useful as a reference for
senior students. 1 would not recommend
this section of the book for junior or
beginning intermediate students, howev-
er, since pathology and nursing care are
not correlated. A senior student should
not have difficulty making this connec-
tion.
Disease in Infancy and Childhood,6th ed.
by Richard W.B. ElUs and Ross G.
Mitchell. 687 pages. Edinburgh and
London, E. & S. Livingstone Ltd.,
1968. Canadian agent: Macmillan Co.
of Canada Ltd., Toronto.
Reviewed by Dr. Helen tvans Reid,
Dept. of Medical Publications, The
Hospital for Sick Children, Toronto,
Ont.
This comprehensive, well organized
book provides senior medical students
with an introduction to the study of the
diseases of infancy and childhood.
The text is not concerned with specific
therapy. It presents, with well-illustrated
examples, conditions the doctor will
encounter in various systems, such as the
disorders of metabolism and storage, dis-
orders of the blood, and disorders of
growth and development. Prognosis and
treatment are only briefly mentioned.
Nurses and general practitioners who
need to recognize the unusual conditions
considered, but who are unlikely to be
v.j.p.
of the Medical World
Welcome to i II lontreal , . .
and the International Council of Nurses'
14th Quadrennial Congress
Montreal is proud to host the council for the second time.
On behalf of La Cross Uniform Corp., welcome to our beautiful city. Best
wishes for a successful congress and we hope you enjoy every moment
of your visit with us.
P.S. While attending the congress in Place Bonaventure you may wish to see our styles.
La Cross uniforms will be on display at the Mr. Uniform booth, number E 5. And, of
course, are available at the following St. Catherine Street stores: Dupuis Freres, Eaton,
Salon Fantasia, Simpsons.
50 THE CANADIAN NURSE
JUNE 1%9
called upon to treat them, should find
this book invaluable. It is no surprise that
this text is already in its sixth edition.
The Psychoanalytic Approach, edited by
John D. Sutherland. 77 pages. Lon-
don. Bailliere. Tindall & Cassell Ltd.,
1968. Canadian agent; Macmillan Co.
of Canada Ltd.. Toronto.
Reviewed by Dorothy M. Phngle,
Lecturer in Nursing, McMaster Univer-
sity School of Nursing, Hamilton. Ont.
This small book comprises five lectures
sponsored in 1967 by the British Psycho-
analytic Society. The purpose of the
lectures was to help those people inter-
ested in psychoanalysis become more
aware of how the analyst works and how
his knowledge and research can provide
insight into human behavior. On a small
scale the book accomplishes this aim.
The five papers recorded are different
in content and value. Robert Gosling's
discussion of transference is excellent. He
uses case material to illustrate this com-
plex concept and discusses the relation-
ship between patient and analyst in terms
of everyday experience. Elliott Jacques'
treatment of guilt, conscience, and social
behavior is equally enlightening. He traces
the child's development of these charac-
teristics through positive and negative
learning experiences. Sidney Crown's pa-
per on psychoanalysis and science is
concise and well-presented. He defends
the psychoanalytic position of not dis-
torting a patient's analysis in order to
obtain data, but he presents alternate
ways of conducting psychoanalytic re-
search.
Two other papers included in the
collection do not meet the objective of
the series as well as do the others. Martin
James' "Psychoanalysis and Childhood
1967," is a rambling affair that attempts
to cover a wide spectrum of topics but
leaves the reader to wonder about child-
hood in 1967. Elizabeth Botts' "Psycho-
analysis and Ceremony" is, in fact, a
detailed anthropologic study of the Kava
ceremony of the Kingdom of Tonga. The
writer claims her objective is not to show
how a knowledge of unconscious mental
processes helps in the understanding of
social behavior, but only to understand
this particular ceremony. The objective of
the series of articles would have been
better reached if Dr. Botts had made the
understanding of social behavior, as illus-
trated by this ceremony, her main objec-
tive, and had then explicitly referred to
this objective throughout her paper.
This book would make interesting
reading for those nurses concerned with
broadening their understanding of the
application of psychoanalysis. Graduate
students in psychiatric nursing would find
it helpful in understanding present-day
analytic thought. Its usefulness for under-
graduate teaching, however, is question-
able.
accession list
Publications on this list have been
received recently in the CNA library and
are listed in language of source.
Material on this list, except reference
items, which include theses and archive
books that do not circulate, may be
borrowed by CNA members, schools of
nursing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List"
and should be addressed to: The Library,
Canadian Nurses' Association, 50 The
Driveway, Ottawa 4, Ontario.
No more than three titles should be
requested at any one time. If additional
Three thousand years of testing
by a highly qualified panel of experts
endorses the value of sugar in baby formulae
It's a controllable weight-builder and energy
source. It's easily digested, inexpensive, pure,
readily available and easy to use. In reason-
able quantities it is good for babies.
They have liked it for three thousand years
and still do. If you'd like to know more about
sugar send for an illustrated copy of our
brochure, "The Story of Sugar":
Canadian Sugar Institute
408 Canada Cement Building, Phillips Square, Montreal, P.O.
UNE 1%9
THE CANADIAN NURSE 51
This hand
was bandaged
in just
34 seconds
with
Tubegauz
SEAMLESS
TUBULAR
GAUZE
It would normally take over 2 minutes.
But the Tubegauz method is 5 times
faster— 10 times faster on some
bandaging jobs. And it's much more
economical.
Many hospitals, schools and clinics
are saving up to 50% on bandaging
costs by using Tubegauz instead of
ordinary techniques. Special easy-
to-use applicators simplify ev'e/'K type
of bandaging, and give greater patient
comfort. And Tubegauz can be auto-
claved. It is made of double-bleached,
highest quality cotton. Investigate
for yourself. Send today for our free
32-page illustrated booklet.
Surgical Supply Division
The Scholl Mfg. Co. Limited
174 Bartley Drive, Toronto 16, Ontario
Please send me "New Techniques
of Bandaging with Tubegauz".
NAME
ADDRESS
THE SCHOLL MFG. CO. LIMITED
69H9
52 THE CANADIAN NURSE
accession list
(Continued from page 51)
titles are desired, these may be requested
when you return your loan.
Stamps to cover payment of postage
from library to borrower should be in-
cluded when material is returned to CNA
library.
BOOKS AND DOCUMENTS
1. Annual congress on medical education,
64th Chicago. February 11-12, 1968, selected
papers. Reprints from JAMA. Chicago, Ameri-
can Medical Association, 1968. Iv.
2. Basic documents. Nineteenth edition.
World Health Organization, Geneva, 1968.
196p.
3. Behavioral science, social practice, and
the nursing profession by Powhatan J. Wool-
dridge and James K. Skipper and Robert C.
Leonard. Oeveland, Press of Case Western
Reserve University, 1968. 108p.
4. Canadian Medical Directory. Compiled
from the daily medical service bulletins, Toron-
to, 1969. 704p. R
5. Developing behavioral concepts in
nursing by Loretta Zderad and Helen C.
Belcher. Atlanta, Southern Regional Education
Board, 1968. 121 p.
6. Ecole d'infirmieres de I'hopital Notre-
Dame, Montreal, 1898-1968. Montreal, Hopital
Notre-Dame, Ecole d'infirmieres, 1968. 67p.
7. Future patterns of health care with
emphasis on utilization of nursing personnel;
the report of a conference held on March
24-26, 1968 at Williamsburg, Virginia,
Richmond, Governor's Committee on Nursing,
1968. 69p.
8. Health labor and productivity. Washing-
ton, World Health Organization. Pan American
Sanitary Bureau, 1969. 9 pts. in 1. (Press
releases for World Health Day April 7, 1969.)
9. Media Canada: guidelines for educators
edited by J.D. Miller. Toronto, Pergamon,
1969. 59p.
10. A multiple assignment model for
staffing nursing units by Harvey Wolfe. Balti-
more, 1964. Ann Arbor, Michigan, University
Microfilms, 1969. 306p. (Theses-Johns Hop-
kins.)
11. Non-degree research in adult education
in Canada 1967-1968; an annotated bibliogra-
phy by Canadian Association for Adult Edu-
cation and Department of Adult Education,
Ontario Institute for Studies in Education and
Institut canadien d'Education des Adultes. To-
ronto, 1969. 76p.
12. Organisation des services pour arrieres
mentaux; quinzieme rapport du Comite OMS
d'experts de la Sante mentale. Geneve, Organ-
isation Mondiale de la Sante, 1968. 61p.
13. La recherche au Canada fran^ais par
Louis Baudouin. Montreal, Les Presses de I'Uni-
versite de Montreal, 1968. 164p.
14. Preparation for retirement booklets.
Ann Arbor, Michigan, University of Michigan,
moving?
married?
wish an adjustment?
All correspondence to THE CA-
NADIAN NURSE should be ac-
companied by your most recent
address label or imprint (Attach
in space provided.)
Are you
D Receiving duplicate copies?
n Actively registered with more
than one provincial nurses'
association?
Permanent reg. no.
Provincial association
Permanent reg. no.
Provincial association
n Transferring registration from
one provincial nurses' asso-
ciation to another?
From:
Provincial association Permanent reg. no.
To:
Provincial association Permanent reg. no.
other adjustment requested:
jT
\
ATTACH CURRENT LABEL
or IMPRINT HERE to be
assured of accurate,
fast service
Print New Name and or
Address Below
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Mrs
Sister/ Mr. Name (please print)
Street address
City Zone Province
Please allow six weeks for
processing your change
The Canadian Nurse cannot
guarantee back copies unless
change or interruption in de-
livery is reported within six
weeks!
Address all inquiries to:
Th^Canadian Nurse '^^
Cifculilion Depl.. SO The Dnvewar. On»w» *. Cin»(>«
JUNE 1%?
Division of Gerontology, 1965. (Reprinted:
Detroit, Michigan, U.A.W. Older and Retired
Workers Department 1965.) 10 pts. in 1.
15. A study of three concepts in team
nursing by Sister Mary Barbara Anderson.
Berkeley, 1967. Ann Arbor, Michigan, Universi-
ty Microfilms, 1969. 18p.
16. Report of First Nursing Research Con-
ference, April 5-7, 1965, New York. New York,
American Nurses' Association, 1965. 153p.
17. Report of Second Nursing Research
Conference, February 28, March 1-2, J 966,
Phoenix Arizona. New York, American Nurses'
Association, 1966. 169p.
1 8. Report of Third Nursing Research Con-
ference, February 27-28, March 1, 1967,
Seattle Washington. New York, American
Nurses' Association, 1967. 301p.
1 9. Social policies for Canada; a statement
by the Canadian Welfare Council. Ottawa,
Canadian Welfare Council, 1969. 78p.
20. Vocabulary of medicine and related
sciences; English, French and French-English by
W.J. Gladstone. New York, 1968. 169p. R
21. Vocational choice and satisfactions of
licensed practical nurses: excerpts from a thesis
submitted at the University of Minnesota in
partial fulfillment of the requirements for the
degree of Doctor of Philosophy by Eleanor Mae
Walters Treece. New York, National League for
Nursing, 1969. 61p. (League exchange no. 87.)
PAMPHLETS
22. Brief to the Commission of Enquiry on
Health and Welfare of the Government of
Quebec. Montreal, P.Q., Association of Nurses
of the Province of Quebec, 1969. Iv.
23. Catalogue of films and film strips.
Toronto, Canadian Red Cross Society, 1968.
25p.
24. Emergency health preparedness and
your nursing service; an action program for
hospitals, community agencies and nursing
homes. New York. American Nurses' Associa-
tion, 1969. Iv.
25. The fundamentals of joint statements
on nursing practice. New York, American
Nurses' Association, Nursing Practice Depart-
ment, 1968. 6p.
26. List of major I.L.O. instruments and
documents concerning women workers.
Geneva, International Labour Office, 1968.
20p.
27. Nurse and closed-chest cardio pulmo-
nary resuscitation. New York, American Nurs-
es' Association Committee on Nursing Practi-
ces, 1965. 5p.
28. The Rand report; summary, comment,
analysis, recommendations. Submitted by the
Executive Board of the Ontario Federation of
Labour to the 12th annual convention of the
Ontario Federation of Labour in London,
Ontario - November 1968. Don MUls, Onta-
rio. Ontario Federation of Labour, 1968. lOp.
29. Submission to the Commission on Re-
lations Between Universities and Governments
prepared by Shirley R. Good. Ottawa, Canadian
Nurses' Association, 1969. 15p.
30. Submission to the Special Committee
on Science Policy. OtUwa, Canadian Nurses'
Association, 1969. 18 + 3p.
lUNE 1%9
THE SECRET
IS IN THE
Buoh
it moulds itself to the shape of your
foot curve for curve, giving evenly
distributed buoyant support where it
is needed.
.^,
But that's not all:
Until now, shoes were made to fit
only the length and width of the
foot. Now White Cross scientific
3-WAY FIT ensures perfect
fit around the girth too.
All White Cross Shoes are
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and protection.
Up to 6 FITTINGS are avail-
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A BEAUTIFUL WAY TO BE COMFORTABLE
SEE US
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INTERNATIONAL
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MONTREAL, QUE.
JUNE 23-25
^
n
I
I
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At better shoe stores across Canada.
THE CANADIAN NURSE 53
accession list
GOVERNMENT DOCUMENTS
Alberta
31. Bureau of Statistics. Alberta salary and
wage rate survey, report, 1968. Edmonton,
Alberta Bureau of Statistics, 1968. 123p.
Canada
32. Bureau of Statistics. Federal govern-
ment employment in metropolitan areas 1967.
Ottawa, Queen's Printer, 1969. 27p. (D.B.S.
catalogue no. 72-205).
33. Department of Labour. Economics and
Research Branch. Wage rates, salaries and hours
of labour, 1967. Ottawa, Queen's Printer, 1968.
432p.
34. Department of National Health and
Welfare. Report on the operation of agreements
with the provinces under the hospital insurance
and diagnostic services act for the fiscal year
ended March 31, 1968. Ottawa, 107p.
35. Department of the Secretary of State,
Canadian Citizenship Branch. The Canadian
family tree prepared by. . .and published in
cooperation with the Centennial Commission.
Ottawa, Queen's Printer, 1967. 354p.
36. Economic Council of Canada. Canadian
income levels and growth: an international
perspective by Dorothy Walters. Ottawa,
Queen's Printer, 1968. 277p. (Staff study no.
23)
37. Humanities Research Council of Cana-
da. «epo« 1967-1968. Ottawa, 1969. 32p.
38. Ministere du travail. Direction de I'^co-
nomique et des recherches. Organisations de
travailleurs au Canada. 57th ed. Ottawa, Impri-
meur de la reine, 1968. 1 12p.
39. Social Science Research Council of Can-
ada. Report 1967-1968. 35p.
USA
40. Department of Labor. Wage and Labor
Standards Administration. Continuing educa-
tion programs and services for women, rev.
Washington, U.S. Government, Print. Off.,
1968. 104p.
41. Department of State. Bureau of Public
Affairs. Background roles on countries of the
world. Washington, U.S. Government Print.
Off., 1968. (loose-leaf)
42. National Center for Health Statistics.
Socioeconomic characteristics of deceased
persons. United States, 1962-1963 deaths.
Washington, Public Health Service, 1969. 38p.
43. Post Office Department national zip
code directory. Washington, U.S. Government
Print. Off., 1968. 1652p. R
44. Public Health Service. Medical Care in
transitions: vol. 3. Reprints from the American
Journal of Public Health 1962-1966. Wash-
ington, U.S. Government Print. Off., 1967.
454p. (Publication no. 1 1 28)
AUDIO VISUAL MATERIAL
45. Uniforms of Royal Columbian Hospital,
School of Nursing, 1901-1967. New West-
minster, B.C., 1967. 10 color slides, 35mm.
STUDIES DEPOSITED IN
CNA REPOSITORY COLLECTION
46. L'avenement de I'infirmiire clinicienne
- speciatiste. Montreal, Universite de Montreal,
Institut Marguerite d'Youville, 1967. 17p. R
47. Comment revaluation est-elle pergue
par I'infirmiere dans un hopital regional? Mont-
real, Universite de Montreal, Institut Marguerite
d'Youville, 1967. 13p. R
48. A comparison of the perceptions of
public health nurses and their alcoholic patients
regarding the priority ranking of nursing needs
by Marguerite Catherine Williams. Toronto,
1968. 59p. R
49. Le concept de la communication dans
le nursing. Montreal, Universite de Montreal,
Institut Marguerite d'Youville, 1967. 9p. R
50. L'hopital d'aujourd'hui offre-t-il la se-
curite necessaire aux alcooliques? Montreal,
Universite de Montreal, Institut Marguerite
d'Youville, 1967. 13p. R
51. L 'infirmiere et la continuation des soins
hopital-domicile par une equipe infirmiere,
Montreal, Universite de Montreal, Institut Mar-
guerite d'Youville, 1967. 22p. R
52. L 'infirmiere et la resocialisation du
malade mental par le travail; resume. Montreal,
Universite de Montreal, Institut Marguerite
d'YouviUe, 1967. 18p. R
53. Pourquoi I'enfant ne peut-il jouir du
soutien maternel lors de son hospitalisation?
Montreal, Universite de Montreal, Institut Mar-
guerite d'Youville, 1967. 12p. R [J
THE CANADIAN
RED CROSS
SOCIETY
Welcomes nurses attending the I.C.N.
Congress. Visit the Red Cross booth for
information on all aspects of Red Cross
and meet the Red Cross Youth and nurses
who will be in attendance.
Request Form
for "Accession List"
CANADIAN NURSES'
ASSOCIATION LIBRARY
Send this coupon or focsimiJe to:
LIBRARIAN, Canadian Nurses' Association,
50 The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in the
issue of The Canadian Nurse,
or add my name to the waiting list to receive them when
available.
Item
No.
Author Short title (for identification)
Request for loans will be filled in order of receipt.
Reference and restricted material must be used in the
CNA library.
Borrower
Registrotion No.
Position
Address
Date of request
54 THE CANADIAN NURSE
JUNE 1%9
July 1969
The
o - v>
Canadian
Nurse
CNA needs a lobbyist
on Parliament Hill
private duty - private choice
unit assignment
- a new concept
some allergens
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PRECAUTIONS: May cause drowsiness. Hypnotics,
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sible additive effect. Diphenhydramine has an
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when prescribing BENADRYL.
ADVERSE REACTIONS: Side effects, generally mild,
may affect the nervous, gastrointestinal, and cardio-
vascular systems. Ivlost frequent reactions reported
are drowsiness, dizziness, dryness of the mouth,
nausea, and nervousness.
DOSAGE; Oral - adults, 25 to 50 mg. three or four
times daily; Children, 1 or 2 teaspoonfuls of Elixir
three or four times daily. Parenteral -adults, 10 to 50
mg. intravenously or deeply intramuscularly, not to
exceed 400 mg. daily.
SUPPLY: Kapseals'"' of 50 mg.; Capsules of 25 mg.;
Elixir containing 10 mg. per 4 cc; Steri-Vial*, 10 mg
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John Kennedy
2750 Slough Street
Malton, Ontario
of Bio-Dynamics
Warsaw,
Indiana 46580 U.S.A
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Partial Contents of June Issue
NEUROLOGIC AND NEUROSURGICAL NURSING
Guest Editor, Imogene M- King
A Patient-Centered Approach to Neurologic Nursing — Patricia A. Regan
Nursing Care of Patients in a Neurologic Intensive Care Unit — Margaret
Clipper
Recognition, Significance, and Recording of the Signs of Increased Intra-
cranial Pressure — Jessie F. Young
Observations and Care for Patients with Head Injuries — Jeanne Holman
Quesenbury and Pamela Lembright
Parkinson's Disease — Martha E. Haber
The Public Health Nurse and the Long-Time Neurologic Patient —
Kathryn A . Christensen and Marylou Kiley
Advanced Teaching in Neurological and Neurosurgical Nursing at the
National Hospital, London — Christine Rubin
THE NURSE IN THE COMMUNITY
Guest Editor. Leah Hoenig
Assessment and Planning for Continuity of Care from Hospital to Home —
Sylvia R. Peabody
The Public Health Nurse as a Member of the Interdisciplinary Team —
Beth M. Hohle, Jane K- Mclnnis and A Imyra C. Gates
A Nurse in School — Why? — Margaret J . O'Brien
The Nursing Audit as a Learning Tool for Undergraduates in a Community
Nursing Service — Irene Cam
Education for Family Living — What is it? — Bernice Milburn Moore
The Public Health Nurse and Research — Helen M. Simon
SPECIAL FEATURE: Insights into Interpersonal Relations
MOTIVATING PEOPLE TO STOP SMOKING — John Rimberg
AND DON'T FORGET —
Asperheim: PHARMACOLOGIC BASIS
OF PATIENT CARE, 417 pp. S7.60
Bookmlller, Bowen & Carpenter:
OBSTETRICS AND OBSTETRIC
NURSING 5th ed. 574 pp. S8.65
Davis & Rubin: DelEE'S OBSTET-
RICS FOR NURSES 18th ed. 535 pp.
$8.65
Dorland's POCKET MEDICAL DICTION-
ARY. 716 pp. $6.75
Gillies & Alyn: SAUNDERS TESTS FOR
SELF-EVALUATION OF NURSING COM-
PHENCE. 326 pp. $7.30
Hymovich: NURSING OF CHILDREN-A
Guide for Study. 389 pp. S5.95
Kron: COMMUNICATION IN NURSING
244 pp. $4.05
Leiier: PRINCIPLES AND TECHNIQUL^
(N PEDIATRIC NURSING 210 pp
$5.15
LeMaitre & Finnegan: THE PATIENl
IN SURGERY 399 pp. $5.15
Marlow: PEDIATRIC NURSING 3r(
ed. 687 pp. About $9.45
Sarner: THE NURSE AND THE LAW
219 pp. $7.05
Stryker: BACK TO NURSING 312 pp
$6.25
Sutton: BEDSIDE NURSING
TECHNIQUES IN MEDICINE AND SUR
GERY 2nd ed. 398 pp. $8.95
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2 THE CANADIAN NURSE
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JULY 196'
The
Canadian
Nurse
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 7
^^P
July 1%9
21 Needed: A FuU-Time Lobbyist
22 A Look at ANA's Legislative Program V.A. Lindabury
25 Private Duty — Private Choice C. Hacker
29 Unit Care — A New Concept K. Skjoberg
32 Insulin Injection — a New Technique P. St. James
34 Lady Mary Wortley Montagu —
Eighteenth Century Crusader D. Grant
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
7 News
16 Names
17 New Protiucts
18 Dates
19 In a Capsule
37 Books
39 Films
Executive Director: Helen K. Mussallem •
Editor: Virginia A. Lindabury • Assistant
Editor: Eleanor B. Mitchell • Editorial Assist-
ant: Carol A. KoUarsky • Circulation Man-
ager: Beryl Darling • Advertisine Manager:
Ruth H. Baumel • Subscription Rates: Can-
ada: One Year, $4.50; two years, $8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Associadon. • Change of Address:
Six weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
® Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on w'hite paper)
are welcomed with such articles. The editor
is not committed to publish all articles
sent, nor to indicate definite dates of
publication.
Postage paid in cash at third class rate
MONTREAL, P.Q. Permit No. 10,001.
50 The Driveway, Ottawa 4, Ontario.
JLY 1969
In this column in August 1967, we
suggested that the Canadian Nurses' Asso-
ciation's methods of petitioning the
federal government and of informing govern-
ment personnel of the association's
activities, objectives, and policies
were less than satisfactory. We suggested
that the federal government's increasing
involvement in affairs that directly or
indirectly affect nurses, nursing, and
the health of the people of this country
demanded a more formal type of lobbying
than presently being used by CNA.
At that time we had scant information
on which to base our opinion: we had not
conferred with other associations about
their efforts to lobby government ; we had
not interviewed any members of parliament
to get their opinions on the value of lobby-
ists and lobbying; and we had read little
about lobbying in Canada, mainly because
of the dearth of material on the subject.
Now, we have done our homework: we
have compared notes with professional
associations that employ lobbyists (in
Canada, associations with lobbyists on
staff are reluctant to label them lobbyist,
even in private conversation, and refer
to them as "public relations officers,"
"information officers," or some other
innocuous title); we have interviewed two
members of parliament and have spoken to
several others informally; and we have
read as much as we could find on lobbying
in Canada, although it is a subject that
has been surprisingly neglected by the
news media.
Our conviction that CNA needs a
lobbyist on staff has not changed; if any-
thing, it has been strengthened. We
believe that a full-time lobbyist would
benefit both parties - the association
and the government. v A L
THE CANADIAN NURSE 3
letters
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Letters Welcome
Letters to the editor are welcome. Be-
cause of space limitation, writers are
asked to restrict their letters to a
maximum of 350 words.
Parents — members of the team
During the past year I have been part
of a community team active in the field
of mental retardation. Although em-
ployed by an institution for the mentally
retarded, my role has been primarily in
the community. 1 met and learned much
from team members active in the com-
munity — family physicians, public
health nurses, social workers, teachers,
psychologists, and clergy. I also talked
with the other important team mem-
bers — the parents of the mentally re-
tarded.
Only a parent of a mentally retarded
child can fully understand the feeling of
any parent when he first learns his child is
retarded: shock, disbelief, anger, re-
jection, and guilt are all experienced in
greater or lesser degrees. Most parents
report getting much professional support
at this time. As the initial crisis passes
with time, the parent and child begin the
day-to-day task of living; and as the
family becomes more adept, the profes-
sional moves into the background. This is
as it should be. Care should be taken,
however, that the family knows this
support is not completely withdrawn,
oidy less active.
Parents also need to be encouraged to
use their initiative, as many are afraid
that if they are "too good" or "too
imaginative" in caring for their child,
professional help will disappear. They
need to know this is not so.
Parents - good parents - fre-
quently express feelings of guilt because
"sometimes we wish we didn't have this
child." I think this is normal. Parents of
normal children also say there are times
vAien they feel this way. Parents who feel
guilty about these feelings toward their
retarded child admit to the same feelings,
without guilt, toward their normal chil-
dren. These parents need the opportunity
to express their feeUngs; once out in the
open, they fall into proportion.
A legitimate worry of parents rests
with the future of their child. They need
to know that if anything happens to
them, their child will not be alone, that
other team members will be able and
willing to help. At the same time, they
need to be encouraged to make some
4 THE CANADIAN NURSE
provisions. Many parents might be sur-
prised to find that the solution to their
problem is within their own reach.
I would encourage all workers to take
full advantage of contact with parents of
the mentally retarded. Everybody can
learn. Many times a parent has offered me
more than I could offer him. - Lois
Patchell, R.N., Smiths Falls, Ontario.
The changing role of the nurse
The article by Helen K. Mussallem,
"The Changing Role of the Nurse" (No-
vember 1968), has been widely read in
Israel. It was required reading and the
focal point for group discussion in our
baccalaureate program. The article was
photostated by the Nursing Department
of Kupat Holim (the health insurance
division of the federation of labour) and
distributed to its key nurses in nursing
schools, hospitals, public health agencies,
and clinics. At a staff meeting of the
Kupat Holim, the directors and supervi-
sors of nursing were so stimulated by the
Have you a Christmas
Story Or Message
To Share?
The
Canadian
Nurse
invites readers to submit original articles
about Nursing at Christmas for possible
publication in the December 1969 issue.
Manuscripts should be typed dou-
ble-space on one side of unruled paper,
leaving wide margins. The usual rate will
be paid for accepted material.
Suggested length: 1 000-2500 words.
Deadline date: September 1, 1969.
Send manuscript to: Editor, The Cana-
dian Nurse, 50 The Driveway, Ottawa 4,
Ontario.
author's approach that they decided to
circulate the article among a wider au-
dience.
This article has now been translated
into Hebrew. It will be distributed to
nurses, doctors, and other key staff in the
services. Within the next few months,
discussion of the role of the nurse, using
this article as a base, will be on the
agenda of staff and/or inservice meetings.
I am sure that the article has received
equal interest in many countries. We are
all acutely aware of the need to redefine
our role, and are moving toward this goal
in many ways. "The Changing Role of the
Nurse," through its clarity and vision, is
serving as a stimulus for group thought
and action. — Rebecca Bergman, R.N.,
Ed.D., Acting Head of Department, Fa-
culty of Continuing Medical Education,
Nursing Department, Tel-Aviv University,
Ramat-Aviv, Tel-Aviv, Israel.
Names and addresses required
The Payzant Memorial Hospital School
of Nursing, Windsor, Nova Scotia, will
celebrate its diamond jubilee in the fall of
1969.
In late July or August (the date will be
announced later) the Alumnae association
will hold a week-end of events, when
graduates can get together to celebrate
the 60th anniversary.
The alumnae association would like
the names (maiden and married) anc
addresses of graduates with whom the)
have lost contact. The lending of ok
uniforms and pictures would also b(
appreciated.
Please send information to: Mrs. Clar
ence Boyd, Secretary, Box 3, Windsor
N.S. - (Mrs.) Geneva M. Sanford, R.N.
Publicity Chairman.
Willing to share knowledge
In her letter to the editor (May 1969)
Sister Muriel Gallagher suggests tha
nurses should start a revolution to ge
people in our society to look forward t(
old age. We heartily concur.
In Victoria we started a little re
volution of our own by drawing attentioi
to the deteriorating effect, both mentall;
and physically, that results when onl;
custodial care is given to the aged, am
also to the fact that when activity pre
grams are added to meet the psychosocis
needs, deterioration is reversed.
One example where this "revolution
is carried out is at St. Mary's Prior
(Continued on page •
JULY 196 ,
a little knowledge is not enough , . .
give teen-agers the facts about menstruation
Someteen-agers have heard they shouldn't bathe
or wash their hair during their menstrual periods.
Some think unmarried girls shouldn't use tampons.
Others say exercise brings on "cramps." No
wonder they call it the "curse."
Give them the facts . . . with the help of the
illustrations in charts like the one above prepared
by R. L. Dickinson, M.D. and available to you free
from Canadian Tampax Corporation Ltd. These
SVa" X 11" colored charts are laminated in plastic
for permanence and are suitable for marking with
grease pencil. Social myths can be exploded, too,
by giving teen-agers either of the two booklets we
will be glad to send you inquantityfordistribution.
One booklet is written for the young girl just begin-
ning menstruation and the other for the older
teen-ager. The booklets tell them what menstrua-
tion is, how it will affect them, and how easily they
can adjust to it normally and naturally.
Unmarried girls, of course, can use tampons. And
they have many good reasons to do so. Tampax
tampons are easy to insert— comfortable to wear.
lULY 1969
Because they're worn internally there's no irrita-
tion or chafing; no menstrual odor.
Tampax tampons are available in Junior,
Regular and Super absorbencies, with explicit
directions for insertion enclosed in each package.
TAMPAX
tampcmi
SANITARY PROTECTION WORN INTERNALLY
MADE ONLY BY CANADIAN TAMPAX CORPORATION LTD., BARRIE, ONT.
FREE CHARTS IN COLOR
Canadian Tampax Corporation Ltd., P.O. Box 627, Barrie, Ont.
Please send free a set of the Dickinson charts, copies of the
two booklets, a postcard for easy reordering and samples of
Tampax tampons.
Name_
Address.
THE CANADIAN NURSE 5
Whenyourday
starts at _
6 a.m... you re oji
charge duty.. ^
you \/e skimped
onmea/s...^^
and on sleep...
you haven't ha^
time to hem
a dress...
makeanapp/epie..
wash your hair..^
evenpowder w.
yournose
m comfort:^
il's time for a change. Irregular hours and meals on-lhe-
run won't last. But your personal irregularity is another
matter. It may settle down. Or it may need gentle help
from DOXIDAN.
use
DOXIDAN
most nurses do
®
DOXIDAN is an effective laxative for the gentle relief of
constipation without cramping. Because DOXIDAN con-
tains a dependable fecal softener and a mild peristaltic
stimulant, evacuation is easy and comfortable.
For detailed information consult Vademecum
or Compendium.
HOECHST
PHARMACEUTICALS
3400 JEAN TALON W. MONTREAL 301
DIVISION OF CANADIAN HOECHST LIMITED
6 THE CANADIAN NURSE
(Continued from page 4)
Hospital. Here it is common to see a
mentally regressed, immobile person be-
come lucid and active.
Recently, the administrator of the
Royal Jubilee Hospital presented a bou-
quet to the nurses at St. Mary's, which
appeared in the Victoria Times: "We have
the highest regard for the Priory concept
of extended care and wish it could be
developed throughout British Columbia.
The work they are doing at the Priory
must spread."
Much has been written about our
experiences in caring for the aged. We
would be pleased to share this knowledge
upon request. - Sister Mary Elizabeth,
O.S.B., Director of Nursing, St. Mary's
Priory Hospital, Victoria, B.C.
Wear uniform with pride
I read with interest Dr. E. Black's
comments about nurses, uniforms, and
caps (December, 1968). Today 1 read a
reply from four R.N.s (May 1969). For
the first time in some 30 years of active
nursing, I feel compelled to write to the
editor.
Initially, 1 would hke to acknowledge
that part of my interest was aroused
because Dr. Black is one of those doctors
who was never too busy to teach, and a
great many nurses learned a great deal
from her. 1 feel a sense of resentment to
the tone of the R.N.s' letter.
A uniform has been a part of my life
since I first wore the awful probationary
style. Then we received our caps, not in a
ceremony, but in our classroom and from
the hands of our clinical instructor. At
that point we were nurses - a proud and
happy group.
It is true that a uniform does not make
a nurse, nor does a degree make a nurse,
teacher, or doctor. One has to have a
great deal more than a superficial cover-
ing to make her a successful "anything."
A uniform, though, does distinguish the
nurse who, because she is wearing it on
duty, is recognized as a skilled, profes-
sionally-equipped individual. It is an indi-
cation to a certain important person,
namely the patient, that the person in
this uniform - and the color really isn't
all that important - is his nurse. This is
the person who is especially prepared to
meet his total needs.
Having recently experienced a lengthy
hospitalization, 1 perhaps have more po-
sitive feelings than 1 might have had
otherwise in regard to uniforms. I knew
by her cap and uniform when a nurse
came into my room. I felt secure with
her, and our relationships were on a
different level than the other individuals
concerned with some phase of caring for
patients in hospital. I especially enjoyed
the bright young student in her pinks
who was usually responsible for waking
me each morning. It wasn't a trial to be
aroused so cheerfully by a pleasant, well-
groomed young lady in an attractive
uniform, with her cap and band indicat-
ing her experience.
In the muddle of people who are
included in the patient's daily routine, it
is reassuring to be able to recognize who
is what; at times it's difficult, but I feel
from a patient's point of view, uniforms
and caps are symbols of those who are
prepared to give nursing care.
In our profession, as in others, we have
faced many changes. We have accepted
them well and appreciated the im-
provements they brought with them.
Styles in uniforms are more practical and
laundries have made us aware that bibs
and aprons are expensive and impractical
in this "swinging age." However, can we
not wear our uniforms and caps with
pride in the setting for which they were
designed? Can we not recognize that
there are times and places where uniforms
are indicated, and other times and places
where they may not be necessary? Can
we not demonstrate that we are members
of an intelligent profession in our to-
lerance and consideration for what is
most fitting and suitable for the nurse in
her professional activity? - Lorraine F.
Miller, R.N., P.H.N., Saskatchewan.
Tribute to Grace Fairley
The May issue contains an excellent
tribute to the late Grace M. Fairley. As a
graduate of the Hamilton General Hos-
pital, I regret that an error was made in
stating that Miss Fairley was "Super-
intendent of Nurses of the Montreal
General Hospital from 1919 to 1924."
She held this position at the Hamilton
General Hospital during that period.
I consider it a privilege to have been
one of Miss Fairley's graduates. I presume
that others share my wish that her con-
nection with "our" school is not omitted,
and concur with Dr. Mussallem's state-
ment that "Miss Fairley was one of the
giants in Canadian nursing." - Mrs. Al-
berta Creasor, London, Ont.
Directory available
St. Boniface General Hospital Nurses'
Alumnae has prepared an up-to-date di-
rectory of almost 2,000 former St. Boni-
face School of Nursing graduates. A copy
may be obtained for $1.50 plus 20 cents
to cover postage. Please direct requests tc
St. Boniface School of Nursing and make
money orders payable to "Secretary, St
Boniface Nurses' Alumnae, St. Boniface
School of Nursing. Proceeds will go to aic
the scholarship fund. - Mrs. M. Isbell
St. Boniface General Hospital. C
JULY 1%^
news
Ad Hoc Committee Completes
Draft For Standards For
Nursing Service
Ottawa. - The Canadian Nurses' As-
sociation's ad hoc committee or stand-
ards for nursing service met at CNA
House June 4-6 to complete the draft for
standards on nursing service. The com-
mittee produced a guide for evaluating
nursing service, incorporating many of
the suggestions offered by the parti-
cipating health agencies.
Eight hospitals, ranging from 170 to
1,000 beds; three extended care facilities;
four public health centers; four Victorian
Order of Nurses' agencies; and three
occupational health units took part in
testing the draft. Directors of nursing,
selected in areas where a member of the
ad hoc committee was available for inter-
pretation, received the drafts in April.
Included in the draft were: philo-
sophy, objectives, functional structure of
the nursing department, personnel, ma-
terial resources, and the nursing depart-
ment within the total organization. Parti-
cipants in the study evaluated each of the
standards in terms of clearness and con-
ciseness, relevancy, flexibility, measurabi-
lity, and attainability. Results of the draft
testing indicate that the terms are general-
ly applicable in all areas where nursing
care is given.
The guide will be presented to the
CNA Board of Directors for approval at
the November meeting. Early in 1970 the
nursing service evaluation guide will be
available to CNA members.
Fran Howard, CNA consultant on
nursing service, told The Canadian Nurse
that the next phase of the study will be
the development of standards for nursing
care. The board of directors will be asked
to restructure the ad hoc committee to
include more people from the clinical
area and nursing education, Miss Howard
added.
The ad hoc committee on standards
for nursing service was set up by the
Doard of directors in March 1967. Two
factors influenced its formation: 1. the
results of a study conducted by Lillian
Campion at that time director of the
CNA project for the evaluation of the
quality of nursing service - that CNA
Jiitiate a program to assist those with
administrative responsibility to study and
evaluate their own departments; and
2. CNA's efforts to obtain representation
on the Canadian Council of Hospital
Accreditation and the need for CNA to
lave nursing service standards.
lULY 1969
Gold Chain Honors Nurses
Charlotte Whitton presented a presidential gold cham of office to Sister Mary
Felicitas, president of the Canadian Nurses' Association, in a special ceremony June
6 at CNA House. The medalhon is engraved with the raised leaf and lamp symbol of
CNA with "Canadian Nurses' Association des Infirmieres canadiennes" printed
around the edge. At Dr. Whitton's request, these words are engraved on the back of
the medallion: "Given to honor the profession and three fine women and great
nurses: Jean I. Gunn, Gertrude M. Bennett, Agnes J. Macleod."
The presidential chain has 25 links engraved with the names of the 25 presidents of
CNA from its inception in 1908 to the present. A special case for the chain bears
the plaque: "Presented by Charlotte Whitton, CBE, SM, 1969." In the presentation
Dr. Whitton pointed out that the chain could be readily adapted to meet any
anatomical variation in presidents.
RNABC Elects New Officers
Vancouver, B.C. - Results of the
mail balloting for officers were an-
nounced at the 57th annual Registered
Nurses' Association of British Columbia
meeting in Vancouver May 21-23. Monica
D. Angus of Port Coquitlam, B.C. was
elected president of the 1 2,000-member
organization.
In her acceptance speech Mrs. Angus
said that the public is bringing increasing
pressure upon governments to provide
better health services and that the govern-
ments are making decisions regarding the
provision of services. Mrs. Angus went on
to say that this had implications for
associations. "Governements are not
equipped to make proper decisions regard-
ing the quality and quantity of health
care without the expert knowledge that
only groups like ours can provide," she
said.
Mrs. Angus is a graduate of St. Paul's
Hospital, Vancouver, and holds a ba-
chelor of science in nursing degree from
the University of B.C. She recently com-
pleted requirements leading to a master
of arts degree at UBC.
Other officers elected were: first vice-
president - Roberta Cunningham, edu-
cational director at St. Paul's Hospital
School of Nursing; second vice-presi-
dent - Alice Baumgart, associate pro-
fessor, UBC School of Nursing; honorary
secretary -Sister Kathleen Cyr, su-
THE CANADIAN NURSE 7
perior, trustee, and general duty nurse,
St. Joseph's Hospital, Victoria; and ho-
norary treasurer - Thomas J. McKenna,
medical technician, Riverview Hospital,
Essondale.
Nurses Negotiations
With NBHA Deadlocked
Fredericton, N.B. - The New Bruns-
wick Association of Registered Nurses'
negotiation committee announced June 5
that negotiations with the New Bruns-
wick Hospital Association had broken
down. The committee has had six meet-
ings with the labor relations committee of
the NBHA since March 10 to negotiate
salaries and working conditions for 1 969.
Marilyn Brewer, spokesman for the
nurses' committee, said that the break-
down resulted from NBHA's refusal to
make a realistic offer to the nurses.
Current 1 969 salaries for registered nurses
in New Brunswick are $373 per month,
the lowest in Canada.
At a meeting held June 2, it was
apparent that the NBHA committee had
not given any consideration to the nurses'
proposals made May 5, according to Mrs.
Brewer. "Negotiations have been futile,"
she said, "because of constant changes in
management representatives and lack of
preparation on the part of management
between meetings."
It is the committee's opinion that
NBHA has not been bargaining in good
faith, Mrs. Brewer explained. "We can
only conclude that the Hospital Asso-
ciation and the government are not in-
terested in improving the working condi-
tions of nurses, which ultimately affect
patient care," she added.
The nurses were willing to submit to
compulsory arbitration in the event of a
deadlock, but the hospital association
would not agree. Arbitration is not com-
pulsory since the Public Service Labor
iielations Act of New Brunswick, passed
in December 1968, has not yet been
signed into law by the Lieutenant Go-
vernor-in-Council. The Act would give
nurses the right to bargain collectively. In
the meantime, nurses have been forced to
accept an interim negotiating procedure
with the NBHA as directed by the minis-
ter of health, Mrs. Brewer said.
"Today's nurses are dedicated peo-
ple," Mrs. Brewer said, "but they will no
longer meekly accept low scale salaries
and working conditions for their servi-
ces."
Letters registering disappointment and
concern with the method and conduct of
negotiations to date were sent to the
president of the NBHA and the New
Brunswick minister of health and welfare.
8 THE CANADIAN NURSE
RNANS Considers Principles
Of Curriculum Building
Halifax, N.S. - The graduate of a
two-year nursing program has learned to
generalize and is prepared for a beginning
position in nursing, Kathleen Arpin, con-
sultant to schools of nursing, College of
Nurses of Ontario, advised the executive
committee and the curriculum council of
the Registered Nurses' Association of
Nova Scotia, April 24-25. The curriculum
council is a new group established to set
standards and evaluate two-year diploma
programs.
Miss Arpin discussed some principles
of curriculum building. The blueprint
should focus on horizontal and vertical
progress with principles organized from
the simple to the complex. Miss Arpin
explained. A philosophy leading to ob-
jectives forms the foundation, she con-
tinued. The student should then be
placed in an integrated situation. Miss
Arpin suggested, with the incorporation
of growth and development, communica-
tions, and legal aspects.
Montreal To Close English
Language Hospital
Schools of Nursing
Montreal, P.Q. - Montreal's five
English-language hospital schools of
nursing will admit their last classes of
students in 1969. In 1970, nursing educa-
tion in the province will be within the
College d'enseignement general et profes-
sionnel (CEGEP) for nursing and pre-
university schooling. The General and
Vocational College is the English equiva-
lent to CEGEP.
Under the CEGEP plan, students with
a high school leaving certificate or equiva-
lent will choose between a three-year
program at a CEGEP to obtain an RN,
and a two-year program of biological
sciences at a CEGEP, followed by three
years of arts, science, and professional
courses at a university to obtain an RN
plus "what will probably be a B.Sc.N.,"
Mary Barrett, director of nursing educa-
tion at the Jewish General Hospital,
explained.
Teaching hospitals will continue to
play an important role in nursing educa-
tion and provide clinical experience for
CEGEP students. It is expected that a
hospital will become specialized in a
chnical field such as obstetrics or neuro-
surgery. Miss Barrett said.
She referred to the good teaching job
that hospital schools of nursing have done
in their time. They are not equipped to
teach the sciences and other subjects now
increasingly important in the curriculum.
Miss Barrett said. Nurses will be free to
teach nursing because sociology and bio-
logy will be taught by CEGEP professors,
she explained.
The Association of Nurses of the
Province of Quebec will continue to
control the CEGEP curriculum, and to set
and administer registration examinations.
Miss Barrett pointed out.
Dawson College, the first of the En-
glish-language general and vocational col-
leges will admit approximately 400 stu-
dents in 1970, the number now admitted
to hospital schools of nursing.
Twenty French-language CEGEPs have
attracted many students. In 1968, 1,402
students were enrolled in CEGEP nursing
programs. The first nursing courses within
the general system of education were
offered in 1967.
The quality of nursing care should be
better, Miss Barrett believes, because CE
GEP students will receive a more liberal
education and will mingle with students
from other disciplines.
Miss Barrett reminded nurses who feel
threatened by the CEGEP system that
over 100 years ago Florence Nightingale
recommended that nursing schools and
nursing care should function under dif-
ferent budgets and administrations.
AARN Membership
Increases In 1968
Edmonton, Alta. ~ Active member
ship in the Alberta Association of Re
gistered Nurses in 1968 was 8,391, a 1(
percent increase over 1967, according t(
Doris J. Price, AARN registrar. Associat(
membership increased from 1,718 ii
1967 to 2,100 in 1968.
In her report to the association's annu-
al convention May 13-16, Mrs. Price said
that 866 nurses were registered by reci
procity, exceeding initial registrants bj
262. Thirty-seven percent of these nurse
came from outside Canada, as comparec
to 36 percent in 1967.
Mrs. Price said that the rapidly increas
ing membership is refiected in an improv
ed supply of nurses, chiefly in the cities^
"With the trend to urban living," she said
"it continues to be very difficult fo
many hospitals in the rural areas t( ■
attract adequately prepared staff."
First Nurses Graduate
From Memorial University
St. John 's, Newfoundland. ~ Four re
gistered nurses became the first bacca
laureate graduates of Memorial Universi
ty's School of Nursing on May 24. The;
were also the first to wear the cora
velvet-edged hoods signifying the degre
of bachelor of nursing.
Memorial University admitted its firs
class of nursing students to the five-yea
basic, integrated degree program in Sef
tember 1966. Since the average age of
high school graduate is 16 years, car
didates for admission to the school c
nursing are required to complete one yea
lULY 1%
news
of study at the university before being
formally admitted to the professional
program. This plan permits the student to
enter the nursing program with the neces-
sary academic prerequisites - English,
psychology, biology, chemistry, and a
language course -plus "a certain degree
of maturity."
The decision to admit registered nurses
to the school of nursing arose from the
faculty's concern that there were many
capable nurses in Newfoundland who
desired higher education but who did not
find ready access to mainland universities.
Admission is limited to resident re-
gistered nurses who entered hospital
schools of nursing prior to the opening of
the university school. The course in
nursing is designed to ensure that all
graduates from the school of nursing have
met the same requirements. Registered
nurses must complete the same require-
ments in arts and science courses as
students in the basic program.
At the convocation exercises the se-
nate of Memorial University awarded the
honorary degree of D.Sc. to Helen K.
Mussallem, executive director of the Ca-
nadian Nurses' Association. Dr. Mussal-
lem is the first nurse to be honored by
the university.
CMHA Approves Volunteer
Services For Emotionally
Disturbed Children
Toronto. - Approval in principle of a
Jroject providing school volunteer servi-
;es for emotionally disturbed children
vas given by the National Scientific
Planning Council of the Canadian Mental
health Association at its 2 1st annual
neeting March 13.
The CMHA will also establish a special
rommittee on the study and possible
mplementation of this project, and will
onsider methods of training, selection,
upervision. and control of volunteers.
In a submission to the CMHA, Mrs.
ohn Wickett described the volunteer
'rogram which has been operating in
Ottawa since 1963. Volunteers are re-
ruited to work on a one-to-one relation-
hip with disturbed children. They visit
he school at least twice a week and take
he children out of the regular classroom,
he volunteer aims to win the child's
onfidence. to restore his self-respect, and
o assist with school work to the extent
le is capable of learning.
Several other reports were presented at
he annual meeting, including:
A report on a study to find out whether
icotinic acid is useful in treating schi-
ULY 1969
zophrenics. Although the study will not
be completed for six years, enough evi-
dence for or against the use of nicotinic
acid will be available within three years
for doctors to make up their minds
whether or not to use it.
• The report of the Commission on
Emotional and Learning Disorders of
Children. The Commission recommends
multi-disciplinary centers to focus on the
individual, his needs, and ways to meet
them. The Commission will be publishing
its report within a year.
The CMHA also voted to commend
the federal government for estabhshing a
task force to study the mental health
needs of Eskimos and Indians in the
Yukon and Northwest Territories, and to
offer to participate if requested.
A long discussion on the question of
student unrest ended when it was decided
the real need was to study the process of
change and how people react to it in a
university setting, rather than to study
student unrest per se.
The Canadian Nurses' Association
representative at the annual meeting was
A. Isobel MacLeod who is director of
nursing at The Montreal General Hospital
and a past president of CNA.
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THE CANADIAN NURSE 9
news
"Too Many Supervisors"
RNABC Meeting Told
Vancouver, B.C. - "The bedside
nurse needs more freedom to practice as a
professional. Get rid of the needless brass
at the top and let the pure gold of our
nursing practitioners shine through."
These were the concluding remarks of
the keynote speaker at the 57th annual
meeting of the Registered Nurses' Asso-
ciation of British Columbia, May 21-23.
Speaking on structure of nursing servi-
ces in the hospital, Margaret D. McLean, a
nursing consultant for the federal govern-
ment, told the audience that hospital
nursing staffs were top heavy with brass.
In the pre-Second World War period,
when most nursing care was given by
student nurses, there was a need for
several levels of supervisory personnel,
she said. However, she added that nursing
education and service have changed and
that now bedside care is the responsibility
of the well-prepared, general duty staff
nurse.
"But the same structure still exists in
the nursing service hierarchy," she added.
Miss McLean, who is senior consultant,
health insurance. Department of National
Health and Welfare, described projects at
several hospitals that have started to look
at the structure of nursing service so that
it can be streamlined.
During the three-day meeting, dele-
gates passed a resolution calling for the
RNABC to establish criteria for the stand-
ardization of courses on intensive care
and coronary care.
Another resolution called for the
RNABC to investigate the need to raise
the annual registration fee and to revise
fee rebates to chapters and districts.
Registration for the meeting was 363.
CHA To Study
Nursing Education
Ottawa. - Provincial delegates to the
second national convention and assembly
of the Canadian Hospital Association
meeting, May 21-23, adopted a resolution
to conduct a study of the results being
achieved in nursing education.
A lively discussion among the dele-
gates followed the reading of the resolu-
tion before it was finally accepted by the
assembly. A debate developed concerning
whether or not there should be a study.
An Ontario delegate expressed concern
about the cost of a study. Dr. H. Dal-
gleish, president of the Canadian Medical
Association, spoke in opposition to the
resolution. "The study is too soon," he
said. "We must move very cautiously in
this area."
10 THE CANADIAN NURSE
Time out at the Canadian Hospital Association convention in Ottawa in May. Pamela
Poole, nursing consultant Department of National Health and Welfare, chats with a
Health and Welfare colleague. Dr. Roger-B. Goyette, director of Hospital Insurance
and Diagnostic Services. Earlier they heard Dr. Bernard Snell discuss The Teaching
Hospital and Research.
An Ontario delegate, herself a nursing
director, also questioned the validity of
the study. "How can you get a just
evaluation when there is dissension
between nursing education and nursing
service? "
A delegate from Saskatchewan com-
mented that her province would not be in
a position to help evaluate nursing pro-
grams because nursing education there is
now under the department of education.
Chaiker Abbis, Q.C., chairman of the
assembly, pointed out that the intent of
the study is not to tell nursing what to
do, but to offer comments and evalua-
tion. R. Alan Hay, CHA president, re-
minded the assembly that the CHA "eval-
uates as an employer."
Several delegates supported the
nursing education study because of their
concern about the effectiveness of a
graduate from a two-year program as
compared to the graduate from a three-
year program.
The structure of the committee that
will conduct the study also was discussed.
Sister Raymond Marie, an Ontario dele-
gate, asked if there would be a nurse
represented on the committee. She re-
ceived a negative reply from the chair-
man.
Several delegates supported the view
that the study should be conducted inde-
pendently of doctors and nurses. Other
delegates said that the study should be
conducted in collaboration with the Ca-
nadian Nurses' Association. Dr. H.J. War-
wick, a delegate from Newfoundland,
spoke in support of CNA representation
on the study committee. He said, "The
CHA should include CNA and other allied
groups, but we are against CNA official
representation."
A nurse delegate from British Colum-
bia and a delegate from Quebec expressed
the opinion that CNA would appreciate
CHA's opinion. L.R. Adshead, installed as
the new CHA president May 22, made his
views known on CNA participation. "The
CNA supposedly represents 80,000
nurses," he said. "CNA is poppycock."
This will not be the first study on
nursing education conducted by CHA. A
previous study resulted in the publication
in 1 967 of Viewpoint on Nursing Educa-
tion, in which CHA stated that new
programs in nursing education should be
developed on an experimental basis only.
In addition the statement said that any
attempt to phase out existing nursing
education programs before an acceptable
substitute had been developed could
jeopardize the quantity and quality of
nursing care and constitute a serious
threat to the hospital care of the sick.
Following the issuance of CHA's state-
ment in 1967, Sister Mary Felicitas,
president of the Canadian Nurses' Asso-
ciation, said, "The CNA is amazed that
the Canadian Hospital Association could
arrive at such a statement without a single
registered nurse on the committee res-
ponsible for drawing it up."
"Organize Resources"
Minister Tells CHA
Ottawa. - Health Minister John
JULY 1969
Munro cautioned delegates at the second
national convention of the Canadian Hos-
pital Association May 21, that if hospitals
and other health facilities did not get
together to coordinate their services, then
he and his provincial colleagues would
give serious thought to the selective use
of government funds to reach that goal
themselves.
The team principle is coming into
more general operation, Mr. Munro said,
and hospitals have a crucial role to play.
"Perhaps we should be thinking in terms
of the hospital as a community care
center," he suggested. The first step
would be a counseling service that should
stretch into the community where people
could discuss their health problems and
decide if they needed care, Mr. Munro
advised.
Active treatment is important, Mr.
Munro said, but community care centers
should have intensive rehabilitation units
as well. Mr. Munro believes that there
should be a variety of types of treatment:
continued hospital care; convalescent
care; skilled nursing care; and coordinated
home care. Since not all illnesses are
physical in nature, health workers must
consider establishing comprehensive com-
munity mental health services, the minis-
ter pointed out.
We need integrated facilities efficiently
planned on a broad scale, Mr. Munro said.
Competition among hospitals is senseless
and often harms the overall community
health picture, he warned his audience.
We must plan so that existing facilities are
used to the best advantage, thus avoiding
excesses on the one hand and shortages
on the other.
He added that in his view we must
provide the same standard of health care
for all Canadians — the poor, the dis-
advantaged, and the Indians - "instead
of simply pyramiding and sophisticating
what the haves of our society already
possess."
Mr. Munro referred to the work of the
student health organization of the Univer-
sity of Toronto (SHOUT), a group that
attempts to unite students from the
various health sciences in a team project.
These students have established a center
to send workers into the community for
follow-up visits to people who have been
to their center. Mr. Munro said that
SHOUT is an attempt to create a mean-
ingful society in miniature.
The minister challenged his audience
by asking if the requirements for certain
health care occupations and service
groups were too rigid.
In conclusion, Mr. Munro recom-
mended that if part of the hospital's
responsibility includes a poverty area in a
lULY 1969
major city, then representatives of the
poor should sit on that hospital's board.
"After all, who knows the health pro-
blems of our urban slums and ghettos
better than those who have had to live
there? " he asked. "Trusteeships should
not be allocated on the basis of whose
name would add the most status to a
letterhead," the minister said.
Health Care For
Remote-Area Indians
Toronto, Ont. - Doctors from the Fa-
culty of Medicine at The University of To-
ronto will provide health care for 15,000
Indians who live in the Sioux Lookout
Zone. This informal undertaking is spon-
sored by the federal government.
The program will be coordinated by
Dr. Harry W. Bain, chairman of the
department of pediatrics. University of
Toronto, and chief of pediatrics at The
Hospital for Sick Children. It should
increase the number of general practi-
tioners and specialists available to the
area.
The current project has its origins in a
letter, written by Dr. Bain last May on
behalf of The Hospital for Sick Children,
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THE CANADIAN NURSE 11
news
which offered to the federal government
the assistance of the staff and resources
of the hospital in providing care for
Indians and Eskimos. The response of
Federal Health and Welfare Minister, the
Hon. J.C. Munro, was immediate and
enthusiastic.
"It is hoped," Dr. Bain said, "that
nursing, whether from hospital training
schools or the university department, will
look carefully at this project with a view
to providing not only service to Indians
of the area but also training for their
undergraduates and research into the
need for training doctor-nurse associ-
ates."
Emergency Hospital Institute
Displays Instant Hospital
Ottawa. - An Emergency Hospital
Institute held April 21-23 to familiarize
professional health personnel with the
kinds of emergency equipment available,
attracted nearly 2,000 health workers and
students. It was the ninth Institute in a
series sponsored by the Emergency
Health Services branch of the Ontario
Hospital Services Commission. The emer-
gency hospital in operation was the cen-
tral theme of the institute.
The emergency hospital is prepackaged
and contains sufficient supplies and
equipment to care for 200 persons in-
jured during explosions, floods, torna-
does, fire, or nuclear warfare. It re-
inforces the casualty care services provid-
ed by an existing hospital.
The hospital was displayed as it would
be used in an emergency situation. Sup-
plies and equipment are provided for
seven days and, with additional supplies
from the national medical stockpile, ex-
tend a hospital's function to 30 days.
Each of the eight general wards are
equipped to care for 20 patients. In
addition, two wards are available for
preoperative and postoperative care.
Twenty nurses and 51 nursing assistants
would provide nursing care for these
patients. All personnel would be prepared
to accept responsibilities beyond ordinary
practice.
The lightweight folding beds have
decks of nylon and cotton coated with
plastic. Two wool and synthetic fiber
blankets, a patient's effects bag, and a
pillow covered with a plastic pillow slip
are provided for each bed.
Other aspects of the display included
x-ray equipment, central supply with
special autoclaves, oxygen and suction
equipment, and pharmacy.
In 1966, the emergency hospitals were
put to practical use when 20 were sup*-
plied under the auspices of the Colombo
12 THE CANADIAN NURSE
Plan to South Vietnam. Dr. W.J. Con-
nelly, medical consultant emergency
health services. Department of National
Health and Welfare, and Mr. M.J. Corbeil,
packaging officer, health supplies section,
emergency health services. Department of
National Health and Welfare, made se-
veral visits as consultants to the Vietnam-
ese Ministry of Health to discuss the
installation and operation of the emergen-
cy hospital units.
Fear Of Malpractice Suits
Reaches Canadian Nurses
Toronto, Ont. - "Nurses and doctors
are infected with fear from the U.S. as far
as lawsuits are concerned," Dr. T.L.
Fisher, secretary-treasurer of the Cana-
dian Medical Protective Association in
Ottawa, told 1,100 members of the Re-
gistered Nurses' Association of Ontario at
the first day session of the annual
meeting at the Royal York Hotel, May
1-3.
"Canadians are sensitized to American
thinking and this is wrong," Dr. Fisher
said. "Much of the advice to U.S. profes-
sional persons is inapplicable and mislead-
ing." Dr. Fisher said that to the best of
his knowledge no nurse in Canada has
ever been held personally and solely
responsible in legal action without the
employer being included.
Although nurses in the U.S. are ad-
vised to carry malpractice insurance, Dr.
Fisher does not believe this is necessary
for all Canadian nurses. Most hospitals in
Canada carry malpractice liability insur-
ance that covers all their employees in-
cluding nurses, he explained. The case of
the "too hot hot water bottle" was cited
as an example for which both the nurse
and the hospital can be held responsible
in legal action.
Today, nurses are being pushed into
new fields of work by a variety of forces.
Dr. Fisher explained. There are new
medical procedures and doctors must
now delegate new responsibilities to
nurses, he said. The nurse can be guilty of
negligence if she allows others to think
that she has been taught to carry out a
particular procedure, carries out the pro-
cedure, and makes an error. Dr. Fisher
cautioned.
The nurse's duties in the recovery
room and the intensive care unit are more
onerous since she is working under condi-
tions of urgency and stress. Dr. Fisher
believes. Here, nurses need more training
and some legal reasoning. "The nurse
should make sure that she has adequate
training and experience and subject her-
self to testing by a qualified person," Dr.
Fisher said. "She has a duty to acquire
sufficient skill and to use knowledge with
reasonable care."
In a legal action the nurse must show
that "knowledge and skill were used with
reasonable care," Dr. Fisher explained.
"Canadian courts do not demand perfec-
tion, but they do insist on competence." I
Dr. Fisher said that the courts are about '
as sensible as the rest of us. "They will
not penalize merely because the outcome
of treatment was poor; not all treatment
can cure and Canadian courts do not
demand the impossible," Dr. Fisher as-
sured his audience.
Under special circumstances a nurse
must use discretion. Dr. Fisher gave admi-
nistration of medication as an example: a
nurse knows or should know when a dose
is too high and the effects of the drug she
is giving. "The nurse has a right and a
duty to confirm a dose or to say that she
prefers not to administer the drug be-
cause her knowledge is too slight," Dr.
Fisher advised. In this case the nurse is
"simply avoiding something that was ill-
advised," he explained.
Although Dr. Fisher did not support
malpractice insurance for all nurses in
Canada, RNAO voting delegates approved
the resolution "that the Association en-
gage in a group policy for malpractice
insurance with voluntary participation by
RNAO members." The cost was es-
timated at $2.50 for each participating
member per year.
A Moral And Legal Look
At Organ Transplants
Ottawa. - Moral and legal problems
that face organ transplant donors and
recipients, their families, and the medical
team are not isolated issues. This was
illustrated vividly by two speakers who
addressed the final session of the Cana-
dian Hospital Association's second na-
tional convention and assembly May 23.
The Reverend Dr. Paul McCleave, di-
rector of the department of medicine and
religion for the American Medical Asso-
ciation, warned delegates that organ
transplants are always a risk and "are not
something for society, in its emotion, to
praise or reject."
Dr. McCleave expressed his concern
about the publicity that surrounds per-
sons involved in heart transplants. He
pointed out that there is no moral issue in
the heart transplant that is any different
from any other organ transplant. "One
reason why the press has taken over on
heart transplants," he explained, "is that
for so long the heart has been used as a
symbol of compassion, mercy, etc. It is
necessary to change society's attitude
toward the body, which is not sacred."
Destroying privileged communication
is immoral. Dr. McCleave said. He ex-
pressed concern about the growing prac-
tice of making public information about
heart transplant patients and donors. As
an example of this, he told the audience
about a man who, suddenly faced with
the news that his daughter had irreversi-
ble brain damage, said "no" to having her
lULY 1969
heart transplanted; immediately his name,
as well as the disappointment of the
transplant team, was known across the
United States. "It was nobody's damn
business," Dr. McCleave said. "I don't
know what I would say in a moment of
emotion."
H. Allan Leal, Q.C., chairman of the
Law Reform Commission, Toronto, out-
lined proposed South African legislation,
which, if enacted, would be the first law
to prevent disclosure of the identity of
the transplant donor or recipient, unless
authorized by the families involved. "This
legislation," Mr. Leal said, "would plug
loopholes that exist in our legislation."
Mr. Leal explained that the South African
bill also deals with the difficult problem
of avoiding conflict of interests in de-
termining the time of death. This would
be determined by two medical practi-
tioners who are not part of the subse-
quent medical team.
Dr. McCleave beUeves there are three
stages of death: 1. cellular death;
2. physiological death; and 3. the loss of
"meaningfulness" that does not necessari-
ly take place at the time of physiological
death, but when the individual "as a
being" no longer exists.
Public Health Nurses
Return To Work
Toronto, Ont. - The 18 public
health nurses of the Grey-Owen Sound
Health Unit who went on strike for
higher salaries April 1 8 returned to work
June 2. They agreed on a one-year con-
tract effective from January 1969 to
December 1969 with the right to re-
negotiate three months prior to the end
of that contract.
Compromises concerning salaries were
made on both sides. If the contract is
ratified by Grey County Council, pubUc
health nurses will receive a salary ranging
from $6,000 to $7,250. This represents
an 11 percent increase over the salary
range previously in effect.
At issue was Grey County's share of
the increase in salaries asked by the
nurses and approved by the province of
Ontario and the City of Owen Sound,
who, with Grey County, share the costs
for the Grey-Owen Sound Health Unit.
Grey County, whose share represents less
than one-fifth of the total, had insisted
that the 1968 scale continue for another
two years into 1971.
The public health nurses, who are
required to have the minimum of a
university diploma, had been paid at a
rate $240 a year less than the Ontario
Hospital Service Commission's approved
salary rate for newly graduated registered
nurses.
At press time the Grey County Coun-
cil had not yet ratified the contract with
the nurses.
JULY 1%9
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pen (writes red, black or blue at flip of thumb).
No. 291 Pocket kit 3.50 ppd.
No. 292-R Pen Refilts (all 3 colore) . ..50 ppd.
Etched initials on sheare add .50
Uniform POCKET PALS
Protects against stains and wear. Pliable white
plastic with gold stamped caduceus. Two com-
partments for pens, shears, etc. Ideal token gifts
or favors.
No. 220-E ( 6 for 130, 10 for 2.25
Savors J 25 or more, ^0 ea., all ppd.
w
Scripto NURSES LIGHTERS
Famous Scripto Vu-Lighters with crystal-
clear fuel chamber. Choose an array of
colorful capsules, pills and tablets in
chamber, or a sculptured gold finished
Caduceus. Novel and unique, for yourself
or for unusual gifts for friends. Guaranteed
by Scripto.
N0.300-P Pill Lighter \ .„„ „„^
No. 300-C Caduceus Lighter ( 4^ a*. PPd-
i
RN/Caduceus PIN GUARD
Dainty caduceus fine-chained to your professional
letters, each with pinback. saf. catch. Wear as is
... Of replace either with your Class Pin for safety.
Gold fin., gift-boxed. Specify RN. LVN or LPN.
No. 3240 Pin Guard 2.95 ppd.
Sterling: HORSESHOE KEY RING
Clever, unusual design: one knob unscrews for in-
serting keys. Fine sterling silver throughout, with
sterling sculptured caduceus charm.
No. 96 Key Ring 3.75 aa. ppd.
"SENTRY" SPRAY PROTECTOR
Protects you against violent man or dog . . .
instantly disables without permanent mjury.
Handy pressurized cartridge projects irritating
stream.
No. AP-16 Sentry 2.00 ea. ppd.
SAVE: Order 2 identic]! Pins as pre-
caution afainst loss, less dianging.
With 1 line
lettennE
Wtlh 2 lines 1
^etter.ngj
No. 169
No. 100
k 1 Name Pin only
' 2 Pins (same nami)
1.65*
1.95*
2.50*
3.00*
No. 510
k 1 Name Pin only
' 2 Pins (same name)
.75*
1.05*
1.25*
.1.85*
^ilMPORTANT Please add 2Sc per order harvjiing charge on all orders of
3 pros or less, CROUP DISCOUNTS: 25 99 pins. 5%. lOO or mote, 10%. _
Remove and refasten cap i,^>,
band instantly tor launder-
ing or replacement! Tiny
molded plastic tac, dainty
caduceus. Choose Black. No. 200
Blue, White or Crystal with f\ Cto C'4
Gold Caduceus. or all Blxk k Taci^l
(plain). STacsPerSet U only I
SPECIAL! 12 Sets (72 Tacs) $9. total
tap
No. ■"
6:
•Iks
Sel-Fix NURSE CAP BAND
Black velvet band material. Self-adhe-
sive: presses on. pulls ofT, no sewing
or pinning. Strip *4" x 36" for two or
more caps, trims to desired widths or
lengths. Reusable many times.
No. 3436 Band 1.25 ea.. 3 for 3.00,
6 or more .85 ea.
®
Nurses ENAMELED PINS
Beautifully sculptured status insignia; 2-color keyed,
hard-fired enamel on gold plate. Dime-sized; pinback.
Specify RN, LPN, PN. LVN, NA, or RPh. on coupon.
No. 205 Enameled Pin 1.25 aa. ppd.
^^i,,-,^.^ Waterproof NURSES WATCH
Swiss made, raised silver full numerals, lumin. nurk-
ings. Red-tipped sweep second hand, chrome/ stainless
case. Stainless expansion band plus FREE black leather
strap. 1 yr. guarantee.
No. 06-925 12.950*. ppd.
Lindy Nurse STICK PENS
Slender, white barrels with tops colored to match
ink. Fine points; colors for charts, notes. Adj. silver
pocket clip. Blue, black, red or lavender.
Na. 4fi7-F Stick Pens j 6 pens 2.89, 12 pens 5.29
(cheese color assort) / 24 or more 39 ea., all ppd.
f
Reeves AUTO MEDALLIONS
Lend professional prestige. Two colors baked enamel on
gold background. Resists weather. Fused Stud and
Adapter provided. Specify letters desired: RN, MO, DO,
RPh. ODS, DMD or Hosp, Staff (Plain).
No. 210 Auto Medallion 4.25 ea. ppd.
Professional AUTO DECALS
Your professional insignia on window decal.
Tastefully designed in 4 colors, 4"/*" dia. Easy
to apply. Choose RN, LVN, LPN or Hosp. Staff.
No.621 Decal... 1.00 ea.,
3 for 2.50, 6 or more .60 ea.
TO: REEVES COMPANY. Attleboro, Mass 02703
CROSS Pen and Pencil
World famous Cross writing instruments with
Sculptured Caduceus Emblem. Lifetime guarantee
i; nr coco Fuitp lustrous cwrom^
Pencil. , . No. 6603 $&00 No. 3503 S5.00
Pen No. 6602 aOO No. 3502 5.00
Set No. 6601 16.00 No. 3501 laOO
8511 Pen Refills (blue med.), 2 for 1.50 ppd.
or full naiM (nirned in script on btrrti Initials mM .75 aa.
tr Mt). Full Nama add l.M ea (300 p*r sat) to abovt pricai
3IYI
Personalized
NURSES
STETHOSCOPE
Nationally advertised Littman" diaphragm-
type Nursescope* especially designed for
nurses. Weighs less than 2 ozs., fits in uni-
form pocket. High acoustic sensitivity,
ideal for blood pressures, general auscul-
tation. Flexible 23" vinyl tubing with anti-
collapse concealed spring, non-chiiltng dia-
phragm, U S. made. Choose from 5 jewel-
like colors: Goldtone, Silvertone, Blue.
Green, Pink. Up to 3 Initials etched on dia-
phrain FREE, prevents loss Indicate on
coupon.
No. 216 Nursescope . 12.95 ppd.
12 or more 10.95 ppd.
I
I
I
I
%
I
I
I
I
I
I
I
A
O one Name Pin D two, same name
LETT.COLOR: Q Black DBlue D White (No. 169 only)
METAL FINISH (Nos. 169 or 100): DGold DSilvef
LETTERIN6
INITIALS
Name Engraved
(Cross Pens)
PROF. LETTERS.
t enclose S (Mass. residents add 3% S.T.)
City.
SUte.
Zip.
THE CANADIAN NURSE 13
For nursing
convenience...
patient ease
TUCKS
offer an aid to healing,
an aid to comfort
Soothing, cooling TUCKS provide
greater patient comfort, greater
nursing convenience. TUCKS mean no
fuss, no mess, no preparation, no
trundling the surgical cart. Ready-
prepared TUCKS can be kept by the
patient's bedside for immediate appli-
cation whenever their soothing, healing
properties are indicated. TUCKS allay
the itch and pain of post-operative
lesions, post-partum hemorrhoids,
episiotomies, and many dermatological
conditions. TUCKS save time. Promote
healing. Offer soothing, cooling relief
in both pre-and post-operative
conditions. TUCKS are soft
flannel pads soaked in witch hazel
(50%) and glycerine (10%).
TUCKS — the valuable nur-
sing aid, the valuable patient
comforter.
Specify the FULLER SHIELD® as a protective
postsurgical dressir)g. Holds anal, perianal or
pilonidal dressings comfortably in place with-
out tape, prevents soiling of linen or cloth-
ing. Ideal for hospital or ambulatory patients.
w
WIN LEY- MORRIS Si
AA MONTREAL CANADA
TUCKS is a trademark of the Fuller Laboratories Inc.
14 THE CANADIAN NURSE
Orderly Training Program
To Open In BC In Fall
Vancouver, B.C. - British Columbia
will open its first training program for
orderlies tliis September. The new pro-
gram, which will be held at a technical
school in Victoria, was announced at the
annual meeting of the Registered Nurses'
Association of British Columbia meeting
in Vancouver in May.
According to Helen Saunders, one of
two RNABC representatives on the plan-
ning council for the new program, the
new nursing orderly course will be rough-
ly equivalent to BC's one-year practical
nurse program, although the new program
will take only 10 months. It is expected
that the orderlies' program will place less
emphasis on maternity care and will stress
male genitourinary treatments, orthope-
dic care, and inhalation oxygen therapy.
Miss Saunders told The Canadian
Nurse that the RNABC has long sup-
ported some kind of training program for
orderlies. "We wanted a pre-service
training, not an inservice training," she
said.
She thought that the new program
would be a valuable beginning.
"The RNABC would like to see the
orderlies' program and the practical
nurses' program basically parallel because
of the similar nature of the work of the
two in hospitals," she added. "We do not
see any reason to add a new category of
health worker only on the basis of sex."
Hospitals will have no legal pressure to
hire only the trained nursing orderlies,
but the program is supported by the BC
Hospital Association and the BC Hospital
Insurance Scheme; the local unit of the
orderlies union has also promoted the
idea.
Miss Saunders said she thought that
many young men might enter the order-
lies' program even though they had the
background for entrance to a school of
nursing. "If the pay remains as good, and
the separate categories continue, why
not? " she asked. She said that in many
instances orderlies' pay is comparable to
that of an RN.
Male Student Wins
Recruitment Poster Contest
Vancouver, B.C. ~ Who'd know more
about how to recruit students into
nursing than students themselves? At
least, that's what the Registered Nurses'
Association of British Columbia must
have thought when it decided to sponsor
a poster contest with a $50 prize for the
best poster aimed at recruitment of stu-
JULY 1%9
moving?
married?
wish an adjustment?
All correspondence to THE CA-
NADIAN NURSE should be ac-
companied by your most recent
address label or imprint (Attach
in space provided.)
Are you
'~ Receiving duplicate copies?
" Actively registered with more
than one provincial nurses'
association?
Pefmanent reg. no. Provincial association
Permanent reg. no. Provincial association
''' Transferring registration from
one provincial nurses' asso-
ciation to another?
From:
Provincial association Permanent reg. no.
To:
Provincial association Permanent reg. no.
Other adjustment requested:
/
\
ATTACH CURRENT LABEL
or IMPRINT HERE to be
assured of accurate,
fast service
Print New Name and or
Address Below
AAiss
Mrs.
Sister/Mr. Name (please print)
Street address
City Zone Province
Please allow six weeks for
processing your change
The Canadian Nurse cannot
guarantee back copies unless
change or interruption in de-
livery is reported within six
weeks!
Address all inquiries to:
^^^Canadian Nurse ^
Cocuiation Dcpt . SO Th« Dn.ewar Ot!«*i 4. Csnada
dents into nursing programs.
Grant Dickinson, 23, a preliminary
student at The Vancouver General Hospi-
tal School of Nursing, won first prize in
the contest. Contest winners were an-
nounced by Margaret H. Lunn, RNABC's
retiring president, at the 57th annual
meeting May 21-23. Mr. Dickinson won
the $50 prize for submitting the best
poster aimed at recruitment of stu-
dents — male and female into
nursing. He received a bachelor of arts
degree in anthropology from Simon Fra-
ser University last year, prior to entering
the nursing program.
The second prize of S25 was won by
Elizabeth Maria Ottens, 21, a student in
the class of 1970 at the Royal Inland
Hospital School of Nursing in Kamloops.
Honorable mention was awarded to
Gerdina Tolen, a student in the class of
1970 at St. Joseph's Hospital School of
Nursing in Victoria, for one of two
posters she entered in the contest.
Contest judges were Peter Small, a
Vancouver artist; Lisa Goscoe, represent-
ing the Student Nurses' Association of
British Columbia; and Claire Marcus, di-
rector of communication services for the
RNABC.
Canadian Red Cross
Establishes Nursing Fellowship
Toronto, Ont. - The Canadian Red
Cross Society has announced the estab-
lishment of a Red Cross National Nursing
Fellowship. It will award S3, 500 an-
nually, or may accumulate to $7,000.
The resolution was passed unani-
mously by the Central Council of the Red
Cross May 6, after studying a report
prepared by Helen M. Carpenter, hono-
rary adviser in nursing. The report, pre-
sented May 4, recommended the esta-
blishment of a 33,500 fellowship. The
Central Council changed the motion to
allow the fellowship to accumulate to
$7,000.
Royal College Of Nursing
Against Voluntary Euthanasia
London, England. - The Council of
the Royal College of Nursing adopted a
policy in April that opposes proposed
legislation to permit voluntary euthana-
sia. The Ren believes that the practice of
euthanasia is contrary to the ethical
principles of the medical and nursing
professions.
The British Medical Association and
the World Medical Association both agree
"that the practice of euthenasia is con-
trary to the public interest and to medical
ethical principles as well as to natural and
civil rights." D
nw mm\ mmm
POSEY SIT'N SAFETY BELT
(Patent Pending)
Holds patient upright on commode, straight-
bock, or wheelchair; prevents slumping for
word. Secures patient to commode with
safety, privacy and without nurse's constant
supervision. Shoulder straps may be used in
the front, straight over the shoulders or
criss-crossed. Adjusts to fit virtually oil pa-
tients. Cot. No. 4220. $14.85 each.
POSEY VELCRO WHEEL CHAIR
SAFETY STRAP
Keeps patient from foiling out of his wheel
choir. Fits virtually any size patient. Self-
odhering surface provides eosy, quick ad-
justment. Easily attached; strap remoins at-
tached to chair when not being used; for
added safety, if desired, choir may be equip-
ped with one strap across waist and one
across lop. Made of 2- inch wide Velcro
covered, webbing. No. 4188 (2-piece), $6.30
each.
WRIST OR ANKLE RESTRAINT
A friendly restraint available in infant, smoll,
medium and large sizes. Also widely used for
holding extremity during intravenous injection
.Mo. P-450, $6.00 per pair, $12.00 per set. With
DECUBITUS padding. No. P-450A, $7.00 per
pair, $14.00 per set.
POSEY PRODUCTS
Stocked in Canada
ENNS & GILMORE LIMITED
1033 Rangeview Road
Port Credit, Ontario, Canada
JULY 1969
THE CANADIAN NURSE 15
names
Judith Whitaker, executive director of the
American Nurses' Association, visited
CNA House May 12. Mrs. Whitaker (left)
and Dr. Helen Mussallem, executive di-
rector, Canadian Nurses' Association,
took a few minutes after a press con-
ference at CNA House to read the article
"Do Your Own Thing in Montreal" in the
May issue of The Canadian Nurse.
Marjorie Duvil-
lard, an internation-
ally known Swiss
nurse, has been ap-
pointed deputy ex-
ecutive director of
the International
Council of Nurses.
She has special re-
sponsibilities for co-
ordinating the professional activities of
nurse advisers.
Born in Argentina, Miss Duvillard re-
ceived her basic nursing training at Le
Bon Secours Hospital school of nursing in
Geneva. She obtained a diploma in public
health nursing from Geneva's Ecole d'E-
tudes Sociales, and took postbasic nursing
education in the United States at Western
Reserve University, Cleveland, Ohio, and
at the University of California, San Fran-
cisco.
Throughout her career Miss Duvillard
has taken an active interest in nursing in
many countries. She was the Latin Amer-
ican representative for two years for the
International Union for Child Welfare in
Geneva. For three years she was nurse
adviser for Latin America at the League
of Red Cross Societies.
Miss Duvillard has worked closely with
the World Health Organization. She is a
member of the board of the International
School of Advanced Nursing Education in
16 THE CANADIAN NURSE
Lyon, France, and a member of the
International Committee of the Red
Cross.
Marjorie Duvillard was formerly direc-
tor of Le Bon Secours school of nursing
in Geneva. Before assuming her new
position, she visited several Latin Amer-
ican countries as an ICN consultant.
One year after receiving an honorary
Doctor of Laws degree from the Univer-
sity of New Brunswick, Helen K, Mussal-
lem, executive director of the Canadian
Nurses' Association, was back on the east
coast to receive an honorary Doctor of
Science degree from Newfoundland's Me-
morial University.
The citation that was read for Dr.
Mussallem, noting that the first degrees in
nursing were being awarded at the univer-
sity, called this a fitting occasion to
honor "one who contributed with her
vision and her energy to the foundation
of our School of Nursing and who, in her
own career, has set a model to the
profession."
In the citation, tribute was paid to Dr.
Mussallem's doctoral thesis on Nursing
Education in Canada, published in 1962,
that "has become a basic handbook in
Canada, along with her Spotlight on
Nursing Education published in 1960.
Spotlight is a report of a pilot project for
evaluating nursing schools, and in com-
piling it Helen Mussallem traveled thou-
sands of miles by incredibly various and
unpredictable transportation, visited un-
heard of places . . . travehng in darkest
Canada. . . .
"A measure of her effectiveness may
be seen in the statistics on Canadian
nursing: the spectacular growth of recent
years in the number of nurses with
bachelor's degrees, with M.A.'s, and doc-
torates."
lean C. Leask
(B.A., Reg.N., U. of
Toronto; M.A., U. of
Chicago) is the 1969
recipient of the R.D,
Defries Award. The
award is given by the
Canadian Public
Health Association
for outstanding con-
tributions in the field of public health.
Miss Leask is director in chief for Canada
of the Victorian Order of Nurses.
Miss Leask was born in Moose Jaw,
Saskatchewan, and on graduating from
nursing she joined the VON in Toronto.
She was transferred to Regina as nurse in
charge in 1940, when she was given a
traveling fellowship by the Rockefeller
Foundation. She traveled through the
United States and Canada, observing of-
ficial agency programs for a year.
In 1942, Miss Leask returned to To-
ronto as supervisor, and was promoted to
assistant district director in 1943. She
remained until 1952.
After receiving her M.A. degree in
1953, she returned to Toronto as staff
nurse and assistant director of the City of
Toronto's Department of Health. In 1960
she returned to the VON as director in
chief for Canada, the position she now
holds.
Miss Leask has earned other awards
during her career. In 1965 she was ad-
mitted as Officer Sister of the Order of
St. John; in 1967 she was awarded the
Centennial Medal. She is a member of the
commission to study the structure of the
Canadian Public Health Association.
Jean L. Church,
former president of
the Registered
Nurses' Association
of Ontario, died in
Ottawa May 30.
Miss Church gra-
duated from the To-
ronto General Hos-
pital in 1925, and
went to the Homeopathic Hospital in
Montreal (now the Queen Elizabeth Hos-
pital) as night supervisor in 1928, later
becoming floor supervisor. Then she turn-
ed her interests toward private duty
nursing.
Miss Church's contributions to RNAO
began when she became chairman of its
private duty section, and later chairman
of the Canadian Nurses' Association's
private duty section. She was second,
then first vice-president of RNAO, before
becoming president in 1940. She held
that position for two years.
During Miss Church's term as presi-
dent, the community nursing registry
program was started and a registry super-
visor appointed. Special studies were
made of private duty nursing. It was also
during her term that RNAO began an
experiment in the training of nursing
assistants by sponsoring eight courses of
six-month periods. The Ontario govern-
ment continued the programs at the end
of the eight experimental courses, and the
result is the nursing assistant program as
it is today. □
lULY 1%9
new products {
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
Improved Facemask
The Bardic facemask now features an
adjustable nose band that is easily shaped
to conform and hold to individual facial
contours, effectively reducing breathing
leakage. The improved cloth tie strings
provide a more comfortable fit and are
easier to tie.
The facemask is made of a filter
material of fine fibers that capture and
hold 96 to 99 percent of aerosol bacteria
and effectively remove viral particles. The
deep fold across the mask helps provide a
snug fit and forms an air chamber to
contain breath until filtered. The soft,
nonwoven fabric covering is smooth and
non-irritating, and the OR green color
reduces glare and reflection.
This facemask is available in a 50-mask
dispenser that permits removal and don-
ning of the mask with minimal handling.
For literature, write C.R. Bard (Can-
ada) Ltd., 22 Torlake Cres., Toronto 18,
Ont.
Gas Aerator
This gas aerator, which removes ab-
sorbed ethylene oxide gas from heat and
moisture sensitive materials following
sterilization, reduces to one-third the
time established for ambient temperature
aeration.
Thermostatically controlled heating
elements, bacteria-retentive filter, and
dual blower fan provide four complete
heated chamber air changes every 60
seconds. The unit operates automatically.
The operator sets the timer; presses the
power switch; and the gas aerator auto-
matically times the cycle, heats the cham-
|:^*i|
Baxter's Disposable Biopsy Tray.
Gas Aerator
ber to 120°F, and aerates the load with
heated, filtered air.
The aerator, when mounted adjacent
to a gas sterilizer, forms an efficient
installation for fast, safe, gas sterilization.
This gas aerator is for use principally in
central supply, inhalation therapy, and
urology departments - wherever heat-
and-moisture sensitive materials are gas
sterilized.
Address inquiries to: American Steri-
lizer Co. of Canada, Ltd., Brampton,
Ont., for Catalog SC-347.
"Niftee" Toothbrush
"Niftee," a toothbrush with tooth-
paste in the bristle, eUminates problems
for patients who enter hospital without
toothbrushes. Each Niftee is individually
cello wrapped with the toothpaste im-
pregnated in the professionally approved
nylon bristles. The brush is full size,
disposable or reusable with regular tooth-
paste.
For further information write to: Lind
Equipment Ltd., 37 Colonsay Road,
Thomhill, Ont.
Disposable Biopsy Tray
This completely disposable biopsy tray
contains all the necessary equipment to
perform a biopsy procedure.
The components of the tray are ar-
ranged according to the sequence in
which they are used. A special inner and
outer wrap ensure the sterility of the
tray.
JULY 1969
The prep dish in the tray is divided
into two halves: the smooth side is used
for macroscopic investigation and, if nec-
essary, the serrated half is used for
cutting specimen.
A featured item in the biopsy tray is
the "Tru-cut" biopsy needle; it penetrates
like a needle and cuts like a scalpel. The
needle's 20mm notch holds the specimen,
which is cut from surrounding tissue,
rather than torn. The specimens obtained
in this manner tend to be clean and
precise.
Further information is available from:
Baxter Laboratories of Canada, Limited,
6405 Northam Drive, Malton, Ont.
Raised Toilet Seats
A raised toilet seat has been intro-
duced to help the handicapped for whom
a standard height toilet is too low. This
seat fits all standard toilets. The normal
lid and seat are lifted and the raised toilet
seat is fixed to the bowl by heavily
chrome-plated bracket clamps. A fifth
support bracket provides stability by pre-
venting the seat from tilting forward.
This polypropylene raised toilet seat
can be cleaned with boiling water. It is
comfortable and increases the seat height
by five inches at the front and six inches
at the back. This lightweight unit can be
lifted off when not in use. It is suitable
for all standard toilet pedestals.
For further information write to:
Everest & Jennings Canadian Ltd., P.O.
Box 9200, Downsview, Ont. □
THE CANADIAN NURSE 17
Next Month
in
The
Canadian
Nurse
• ICN Congress Report
• Private Practitioner
and the Public Health Nurse
• Health Sciences Complex
at Laval
"^^
Photo credits for
July 1969
Murray Mosher, Ottawa,
pp. 7, 10
Julien LeBourdais, Toronto,
pp. 26, 27, 28
University Hospital, Saskatoon,
p. 31
August 1968 - lune 1%9
The National League for Nursing is
sponsoring a series of 12 two-day work-
shops in several U.S. cities for persons
involved in administration, planning, and
evaluation of hospital nursing services.
The first workshop was held in San
Francisco August 9, 1968, and the last
will be held in Miami Beach, June 26-27,
1969.
The workshops are designed for nurses
and others interested in nursing audits,
new staffing patterns, and hospital staff
development programs.
Further information and application
forms for registration may be obtained
from the Department of Hospital Nurs-
ing, National League for Nursing, 10
Columbus Circle, New York, New York
10019.
August 18-21, 1969
American Hospital Association, Interna-
tional Amphitheater, Chicago.
September 18-20, 1%9
Annual conference on obstetrics, gyneco-
logic, and neonatal nursing, Sheraton-
Brock Hotel, Niagara Falls, Ontario.
Sponsored by District V of the American
College of Obstetricians and Gynecolo-
gists.
September 23-25, 1%9
10th annual meeting and convention of
Associated Nursing Homes, Inc., Shera-
ton-Connaught Hotel, Hamilton, Ont.
September 25-27, 1969
3rd annual postgraduate course for emer-
gency room nurses. Palmer House Hotel,
Chicago. Tuition fee: $60. Write to: Dr.
Anast, 55 East Washington Street, Chica-
go, Illinois 60602.
September 28 - October 3, 1969
13th annual Registered Nurses' Associa-
tion of Ontario Conference on Personal
Growth and Group Achievement, De-
lawana Inn, Honey Harbour, Ont.
October 6-8, 1969
Annual nurses' convention, sponsored by
the American College of Obstetricians
and Gynecologists, Marlborough Hotel,
Winnipeg. For further information write
to: Mrs. Jordan, c/o Women's Pavilion,
Winnipeg General Hospital, 700 William
Avenue, Winnipeg 3, Man.
October 6-8, 1%9
Annual conference on obstetrical and
gynecological nursing, sponsored by
District VI of the American College of
Obstetricans and Gynecologists. To be
18 THE CANADIAN NURSE
held in the Marlborough Hotel, Winnipeg.
Nurses from all over Canada are welcome.
October 16-17, 1969
Continuing Nursing Education Course in
Nursing the Adult with Long Term Ill-
ness. The University of British Columbia,
School of Nursing, Vancouver, B.C.
October 24, 1969
Catholic Hospital Conference of Ontario
Nursing Committee meeting, Westbury
Hotel, Toronto.
October 25-26, 1969
Catholic Hospital Conference of Ontario,
annual convention, Westbury Hotel,
Toronto, Ontario.
October 27 28, 1969
Ontario Hospital Association, 45th an-
nual convention. Royal York Hotel, To-
ronto.
October 30-31, 1969
Continuing Nursing Education Course in
Pediatric Nursing. The University of
British Columbia, School of Nursing,
Vancouver B.C.
November 10-14, 1969
Course in occupational health for nurses,
New York University Medical Center.
This course, for registered nurses in indus-
try, is pffered by the department of
environmental medicine of New York
University, in cooperation with the Amer-
ican Association of Industrial Nurses.
Tuition: $175. The course is limited to
nurses with five years or less experience
in occupational health. Write to: Qffice
of the Recorder, New York University
Post-Graduate Medical School, 550 First
Avenue, New York, N.Y., 10016.
November 11-13, 1969
Quebec Operating Room Nurses' Group,
annual convention. Skyline Hotel, Mon-
treal.
November 13-14, 1969
Continuing Nursing Education Course in
Nursing the Adult with Acute Illness. The
University of British Columbia, School of
Nursing^ Vancouver, B.C.
November 19-21, 1969
Second Manitoba Health conference, Fort
Garry Hotel, Winnipeg. This was formerly
the Manitoba Hospital and Nursing Con-
ference.
November 24-27, 1969
Conference for directors of nursing, To-
ronto. Sponsored by Ontario Hospital
Association and Registered Nurses' Asso-
ciation of Ontario. D
JULY 1969
in a capsule
Study needed?
Delegates at the Canadian Hospital
Association's annual convention in May
approved a resolution that directs CHA to
conduct its own study of the results being
achieved in nursing education. Perhaps
the time has come for the Canadian
Nurses' Association to conduct a study to
assess the results being achieved in hospi-
tal administration and in programs that
prepare hospital administrators.
I.Q. deters smoking
Here is good news for those who are
about to stop smoicing. A new product to
help break the smoking habit has been
developed by the Chemway Corporation,
Wayne, New Jersey.
Called "I.Q." - for I Quit the
smoking deterrent is a lozenge that comes
in different flavors and is contained in a
cigarette-like package. According to the
manufacturer, a lozenge "popped into the
mouth when the smoker feels the urge to
light up" reduces the desire to smoke.
Laugh and live longer
The German Society for Dental Health
has discovered a good reason for laugh-
ing: the increased oxygen intake results in
a more lively metabolism, more intensive
breathing, and a relaxation of the dia-
phragm.
The society supports its theory with
the evidence that women live longer than
men - and women laugh more. It be-
lieves there is a correlation between these
two facts.
On the basis of the above study, some
practical advice to those suffering from
laugh inhibition is: take in some big gulps
of air (as in laughing) and relax the
diaphragm (without collapsing) which re-
duces tension and increases sociability
(moderation is advised).
Thus a laugh = a more lively metabo-
mism = a more lively day (or evening).
Telephone visiting chain
The Victorian Order of Nurses in
Kingston, Ontario, has helped launch a
telephone visiting chain to check daily on
elderly people living alone. Five or six of
these people, with a captain in charge,
make up the chain. Each member of the
"cham gang" is given a schedule of names
and phone numbers in the order and time
of calls. If a member cannot reach a
number, he calls the captain. The member
then calls the next person on the list, so
that the chain isn't broken.
Another chain has been successful in
lULY 1969
Leaside, Ontario. The VON gives Sweden
credit for the idea.
Equality for men
The traditional women's auxiliary at
York-Finch General Hospital, Downs-
view, Ontario, is being replaced by a
Volunteer Service Organization (VSO).
Members of the other sex will be encour-
aged to join and will be able to supply
transportation services, visiting services
for men, and may help out in a planned
translation service.
The VSO also hopes to attract mem-
bers who are retired but still active.
Apart from providing services, the
VSO will be a link between the hospital
and community. Mrs. Lorraine Deane,
VSO chairman, explains that hospitals are
vital to their communities and everyone
has a stake in them.
Volunteers already number 150 at
York-Finch, although more are needed.
Pastels are "in"
Nurses in the pediatric ward at the
Prince George Regional Hospital in Brit-
ish Columbia are working toward devel-
oping a warmer rapport with their young
patients ~ by wearing pastel-colored
uniforms.
The psychology behind this colorful
move was well summarized in the Prince
George Citizen: "A lot of kiddies develop
a terrible fear of white, coming to asso-
ciate it with pain," explained Mrs. Tom
O'Hearn, supervisor of the pediatric ward.
To a sick child in the hospital, nurses
become associated with their painful stay.
The resulting fear of the nurse can be
transferred later in life to others wearing
similar uniforms.
The swing from the white starched
look to color has also taken place in the
pediatric department of the Vernon Jubi-
lee Hospital, Vernon, B.C.
Are nurses dressed in colored uniforms
really friendlier or is it just the appear-
ance that counts?
How to enjoy retirement
You can now go to school to learn
"how to retire - and enjoy it." The
Collegiate Institute Board of Ottawa
sponsored this 10-week evening program.
Among the topics covered were housing,
leisure, hobbies, pension and insurance
benefits, increasing income, personal
investments, physical and mental health.
With this type of education, perhaps
such expressions as "killing time" will
disappear. Yet how many people would
love to find out what it means to "kill
time! " □
"Dick Tracy uses a bedpan, Batman uses a bedpan ..."
THE CANADIAN NURSE 19
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20 THE CANADIAN NURSE |ULY 1969
Needed: a full-time lobbyist
• Item: In February, seven task forces on
health care costs were set up by the
minister of national health and welfare.
Three nurses were among the 40 mem-
bers appointed to these task forces.
However, none of the chairmen and
co-chairmen are nurses. A U are doctors
or hospital administrators.
• Item: To commemorate the 14th
Quadrennial Congress of the Inter-
national Council of Nurses in Montreal
this June - the first time since 1929
that this body, representing the largest
group of health workers in the world,
will hold its meeting in Canada - the
Canadian Nurses' Association asked the
postmaster general to issue a special
stamp on nursing. After repeated re-
quests the postmaster general advised
CNA that a special stamp would, in-
deed, be released: it will hm>e Dr.
William Osier's picture on it.
• Item: In briefs presented to the federal
government in February 1968 and Jan-
uary 1969, CNA documented the need
for 2.2 million dollars for nursing
education and research. No positive
action has been taken. Yet eight
months after CNA 's initial hearing, the
minister of health found $200,000 for
the 45 members of Canada's national
hockey team to improve their game in
the last half of the 1968-69 season. i
What do these items indicate? One
thing: the nursing profession does not
have a significant image in the eyes of
the federal government.
How important is it for the nursing
profession to become "significant" to
government? Extremely important. We
contend that the public is ill-served
when the largest health profession in
the country, whose members have con-
siderable expertise in giving and plan-
ning patient care, is virtually ignored by
government when it is planning, enact-
ing, and implementing health legis-
lation.
Some success in the past
The Canadian Nurses' Association, as
spokesman for its 80,000 members at
the national level, uses various means to
keep the federal government informed
of its objectives, policies, and activities.
In addition, the association recognizes
its role in attempting to influence
government on matters that concern
nurses, nursing, and health.
In the past, CNA has communicated
its views to government in several
ways: 1. through meetings with minis-
JULY 1969
ters and other government
personnel; 2. through the submission
of briefs; and 3. through its informa-
tion services. This lobbying — and,
whether we like it or not, it is
lobbying - has generally been of an
informal nature. It has met with success
in certain areas and failure in others.
One instance of CNA's success in
lobbying was in 1966, when the execu-
tive director met with the associate
minister of national defence to inter-
pret the association's views about the
policy that withheld commissions from
male nurses in the Armed Forces. A
year and one-half after this meeting, the
first male nurse received his com-
mission.
There are several reasons for the
success of this lobbying: 1. Persis-
tence: although previous efforts to
have male nurses commissioned as offi-
cers had failed, CNA, prompted by the
Registered Nurses' Association of On-
tario, continued to press for change. 2.
Unity: the demand for change was
backed by a determined membership of
over 74,000 nurses at a CNA biennial
meeting in 1966. 3. Personal ap-
proach: CNA's argument was presented
by the executive director in a personal
interview with the associate minis-
ter. 4. Timing: there was a shortage of
nurses in the 1960s, and probably a
more tolerant attitude toward men in
nursing.
CNA has not been as successful in
convincing the government of the pro-
fession's needs for increased federal
funds for nursing education and re-
search. And, despite its efforts, it has
had only moderate success in making
the profession "significant" in the eyes
of government.
Full-time lobbyist needed
CNA's methods of lobbying are no
longer good enough to present the
association's views to a government
whose involvement in health and wel-
fare is increasing yearly by leaps and
bounds. The association now needs a
full-time lobbyist on staff to maintain a
constant, continuous liaison with go-
vernment.
A lobbyist, or a "CNA government
relations representative," would keep
the association informed of pending
legislation and government policies, and
would inform the government of CNA's
views and objectives; in addition, the
lobbyist would work closely with the
association's elected officers, com-
mittees, and staff in determining the
issues that require action and the strat-
egy needed.
There are two reasons why CNA's
lobbyist should be a nurse on staff,
rather than a lawyer or public relations
person from an outside agency: 1. A
nurse-lobbyist would be accepted more
readily than a professional lobbyist by
government personnel. 2. An outside
agency usually has several clients to
satisfy and could not always devote
enough concerted effort to CNA inter-
ests. Also, conflicts of interest among
the various clients of the same agency
could arise and might be resolved to the
disadvantage of CNA. 2
Strategy
The CNA government relations rep-
resentative would undoubtedly develop
her own tactics or approach. However,
certain basic ingredients are essential
for effective lobbying.
First, where there is unity there is
strength. If nurses are speaking as mem-
bers of CNA, they should support its
representations to government, which
are based on decisions made by the
elected delegates at each CNA biennial
meeting.
Second, both the elected and em-
ployed personnel of government should
be kept apprised of CNA's views. It is
no secret that senior civil servants are
influential in the decision-making pro-
cess.
Finally, opposition parties should
also be kept informed of CNA's views,
and should be given copies of the
association's statements or briefs to
government. As Mrs. Grace Maclnnis,
M.P., told us, "The government's back-
benchers will certainly not oppose go-
vernment legislation: the opposition
members, on the other hand, are under
no such inhibitions."* V.A.L,
References
1. Good, Shirley R. Too little, for too long,
from the federal government. Canad. Nurs.
65:5:29.
2. Hutchison, G. Scott. Reactions to the
"latent lobby." Han: Bus. Rev. 45:167
July/Aug. 1967.
*The editor expresses her appreciation to Mrs.
Grace Maclnnis (NDP) Vancouver-Kingsway,
The Honorable Waldo Monteith (PC) Perth, and
Dr. William Wigle, President, Pharmaceutical
Manufacturers Association of Canada, for their
helpful comments concerning lobbying. D
THE CANADIAN NURSE 21
A look at ANA'S
legislative program
Increasingly, the goals of national associations — including the Canadian Nurses'
Association — are intertwined with federal government legislation. To find out
how nurses in the United States keep government informed and influence
legislation at the federal government level, the editor of The Canadian Nurse
interviewed staff in the New York and Washington D.C. offices of the American
Nurses' Association, and attended a House of Representatives health committee
meeting, where ANA presented testimony.
V.A. Lindabury
It was 12:30 p.m., and all seats but
one were empty behind the large, semi-
circular table at the front of the commit-
tee room in the U.S. House of Repre-
sentatives building. Seven of the eight
The author expresses her appreciation to the
staff of the American Nurses' Association, who
so willingly answered her many questions about
ANA and its legislative program, and to the
librarian at the Canadian Nurses' Association,
for her valuable assistance and unending pa-
tience.
22 THE CANADIAN NURSE
congressmen on the health committee
had left shortly before, presumably to
attend a general session in the House.
Only a handful of journalists, lobby-
ists, and observers remained as two indivi-
duals presented their organization's testi-
mony before the lone committee mem-
ber, who had moved into the chairman's
seat.
A few minutes later, the acting chair-
man banged the gavel and declared the
session adjourned until 2:00 p.m. There
was a groan from the second row, where I
lULY 1969
sat with Julia Thompson, director of the
American Nurses' Association's Washing-
ton Office, and Jean MacVicar, chairman
of ana's committee on legislation who
was slated to present testimony that
morning.
"Is something wrong? Can't the
nurses return this afternoon? " the chair-
man asked with some concern.
"We'll be here, Mr. Chairman," Miss
Thompson replied politely and firmly.
And at 2:00 p.m. on March 27, Mrs.
MacVicar, with Miss Thompson beside
her, faced a committee of five and pre-
sented ana's views on the two hospital
and medical construction bills being scru-
tinized by the health committee.
The American Nurses' Association's
efforts to influence legislation at the
federal government level date back to
1901, when it was instrumental in having
a bill enacted to create the "Army Nurse
Corps, Female." 1 Since then, ANA, as
spokesman for its 204,704 members, has
taken a stand on many issues that affect
nurses, nursing, and health, from social
security to gun control.
I asked Judith Whitaker, executive
director of ANA, and Margaret Carroll,
deputy executive director, how ANA's
legislative program had evolved.
They explained that the problems of
state nurses' associations to obtain man-
datory licensing laws had catapulted ANA
into action in the early 1900s. In 1914,
the association created a central bureau
of legislation and information to facihtate
the legislative programs of the state
nurses' associations.2 Later, two commit-
tees on legislation were set up by ANA,
one to deal with legislation that came
under state jurisdiction, the other, with
legislation that came under federal juris-
diction.
"A good part of this first committee's
time was spent developing tools and
techniques for influencing state govern-
ments," Mrs. Carroll said, "whereas the
committee on federal legislation was pri-
marily concerned with federal aid to
education, although it became involved
with other issues. For example," she
continued, "in the 1930s and 1940s ANA
was successful in getting professional clas-
sification for nurses in the civil service,
supported the setting up of a national
department of health and welfare, and
pushed for a food and drug act."
Eventually the two committees were
dissolved and replaced by one, called the
ANA committee on legislation. This com-
mittee, composed of nurses appointed by
the ANA board of directors, was origi-
nally set up as a policy-making body for
JULY 1969
the association's total legislative needs.
According to Mrs. Whitaker and Mrs.
Carroll, the role of this committee has
changed somewhat since ANA set up its
commissions on service, education, and
economic and general welfare in 1966.
(The commissions are similar to the Cana-
dian Nurses' Association's three standing
committees.) The business of formulating
legislative policies in these areas is now
the prerogative of the commissions. The
policies they enunciate are, of course,
vkithin the framework of ANA's platform
as decided biennially by the house of
delegates, the voting body of the associa-
tion.
"However," Mrs. Carroll said, "it
appears that the committee on legislation
is still needed, mainly to pull together the
total legislative concerns of the associa-
tion and to arrive at priorities in terms of
what is feasible in the present political
chmate and in terms of the association's
resources. "Actually," she continued,
"this committee is becoming less of a
policy-forming committee and more of
the 'committee of pohticians.' "
Lobbyist appointed
Mrs. Whitaker said that much of
ANA's lobbying efforts in the early days
was carried on by nurses employed by the
federal government - "quite an illegal
way of lobbying," she added with a
chuckle. "Later, the chairman of the
original committee on federal legislation,
who was also executive director of the
District of Columbia's nurses' association,
served in a voluntary capacity as lobbyist,
testified at hearings, and occasionally
called on congressmen."
Although this informal type of lobby-
ing had been fairly effective in the past, it
was obvious to ANA that more forceful
and concentrated efforts would be need-
ed in future as the federal government
was becoming increasingly involved with
health legislation. Two issues, in parti-
cular, were of concern to ANA and
required immediate attention: the need
for more federal aid for nursing educa-
tion; and the need to press for changes in
the existing labor legislation (Taft-Hartley
Act, 1947), which excluded non-profit
hospitals from collective bargaining.
"We realized that if we hoped to
influence government, we needed some-
one on the scene who could keep a
constant watch on legislation that was
before Congress," Mrs. Whitaker said.
"We needed someone who would estab-
hsh relationships with the congressmen,
their administrative staffs, and the federal
agencies that are involved in developing
and implementing legislation for both the
legislative and executive branches of go-
vernment."
In 1951, ANA appointed its first
full-time lobbyist - Julia Thompson, a
registered nurse who had been a member
of the committee on legislation - to its
staff as "Washington representative." To-
day, the association's department of gov-
ernment relations has five full-time staff
members, two at ANA's headquarters in
New York City, and three in Washington.
"In the future," Mrs. Whitaker said,
"we plan to have enough staff in the
Washington office to deal with legislation
that affects the major areas of service and
practice, education, and economic and
general welfare. This would be in addition
to the director in Washington, whose
main job would be to coordinate activi-
ties."
Action program at federal level
Helen Connors, director of ANA's
government relations department, ex-
plained that the association's legislative
program is one of action at the national
level and consultation at the state level.
"Nationally," she said, "we try to keep
the federal government and the bureau-
cracy informed about ANA's stand on
health matters, and attempt to have
certain legislation enacted or amended.
We work closely with the state nurses'
associations, as it is most important that
they be kept informed of what we are
doing. Furthermore," she added, "we
depend on the state nurses' associations
and nurses within each state to support
our efforts by writing to their congress-
men on various issues."
I asked Miss Connors if ANA ever
found it necessary to obtain the state
nurses' associations' approval before
taking a stand on a specific issue.
She said that a referendum vote of
approval is seldom necessary, mainly be-
cause the association has become quite
sophisticated in identifying the legislation
likely to come before Congress, and has
been able to get a broad platform from its
house of delegates every two years to
cover most exigencies. "Occasionally,"
she added, "the ANA board of directors
will refer a recommendation of the com-
mittee on legislation about a controversial
issue to the House of Delegates for
approval.
As an example of controversial legisla-
tion. Miss Connors cited the medicare
bill, introduced in 1958, which recom-
mended health care coverage for persons
over 65 years. "Presumably," she said,
"ANA could have supported this bill
without referring it to the House of
Delegates for approval, because of the
THE CANADIAN NURSE 23
association's previous endorsement of so-
cial security improvements. However, we
recognized that there was not unanimity
on this bill - in fact, one state nurses'
association later went to Congress and
testified in opposition to ANA's posi-
tion — so the ANA board of directors
referred the issue to the association's
House of Delegates, in which every state
in the union is represented. At the next
ANA biennial meeting, the House of
Delegates approved the principle of sup-
porting the medicare bill," Miss Connors
added, "and our department was then
charged with working out the strategy for
presenting the association's views to Con-
gress."
Miss Connors admitted that ANA had
"gone out on a limb" last summer, when
it supported former U.S. President John-
son's bill to tighten gun legislation. "This
proved to be a very controversial issue,"
she said, "and we had a lot of opposition
from our members. We didn't refer this to
the state nurses' associations for approval,
mainly because we felt we had a right to
support meaningful gun legislation, as it is
the nurse's role to help preserve life.
"As a citizen in a democratic country,
any nurse has the right to disagree with
the association on any issue," Miss Con-
nors said. "However, we point out to our
members that if they are speaking for the
association, they should present the asso-
ciation's position, regardless of their own
feehngs. Otherwise," she added, "we
merely confuse the legislators and get
nowhere."
Miss Connors feels strongly that nurses
should present their viewpoints to govern-
ment without making compromises first.
"Go to the legislators with your pure,
unadulterated demands," she said firmly.
"Let the legislators, who are faced with
many pressures, make the compromises."
How ANA lobbies
"Be firm, friendly, and femi-
nine - that's my motto," Julia Thomp-
son said with a conspiring wink as we sat
in her Washington office the day before
she and Mrs. MacVicar presented ANA's
statement to the congressional health
committee. And judging by ANA's suc-
cesses in lobbying since Miss Thompson
was appointed in 1951, this 3F strategy
seems to work.
According to Miss Thompson, ANA
has a good reputation with Congress,
mainly because it supports issues that are
socially oriented and concerned with
people, rather than issues that benefit
only the profession. She said that ANA
has a somewhat different approach than
other organizations to lobbying in that
24 THE CANADIAN NURSE
the Washington staff rarely entertain con-
gressmen or senators, mainly because it is
unnecessary and they do not want to be
accused of 'buying support.'
Miss Thompson explained that ANA's
lobbying activities are mostly directed to
three areas within government: 1. the
committees of the Senate and House of
Representatives, where most of the work
of Congress is carried on; 2. the execu-
tive branch, including the cabinet mem-
bers and their agencies; and 3. the bu-
reaucracy.
"We have several ways to present our
views to personnel in these three areas,"
Miss Thompson explained. "First, we can
appear in person and testify at a commit-
tee hearing. Second, we may decide not
to appear in person before a committee,
but to file a statement with the commit-
tee chairman. Third, we may visit a
committee member or a civil servant in
his office, and explain our point of view
directly. Fourth — and this is a very
important part of our program — we
often ask state nurses' associations and
their members to write to the senator or
representative from their state or dis-
trict."
1 asked Miss Thompson about the
effectiveness of testimony presented at
committee hearings. Did an organization's
testimony really influence legislators?
She said yes, she believed it did, even
though some cynics maintain that most
committees have a predetermined notion
of what they are going to do. "We feel we
have an opportunity to become known,"
Miss Thompson said, "and to present our
point of view, which is then pubhshed for
public information. "After all," she
added, "it is just as important to get this
information out for public consumption
as it is to get the congressmen to pay
attention to it."
What about letters to congressmen
from their constituents? Are these effec-
tive in convincing them that ANA's de-
mands are worthy of consideration?
"It depends on the letter," Miss
Thompson answered. "If it's a form letter
or postcard, it's not too meaningful.
"When we decide that an issue requires
support from ANA members, we send a
memo to the state nurses' association,
school of nursing, or individual nurse
requesting that a letter be sent to the
congressman involved who represents the
state or area. We ask the person writing
the letter to be specific in outlining the
reasons why the enactment or amend-
ment of the legislation under study is
important to the nurses in that area. We
find that congressmen do pay attention
to this kind of letter," she said.
Breakthrough on education
ANA's most successful instance of
lobbying, according to all the ANA staff I
interviewed, was in getting legislation
enacted for federal aid to nursing educa-
tion. "We had been trying for years to
secure federal assistance for graduate edu-
cation," Miss Thompson said, "and we
were finally successful in 1956."
EarUer, when I had spoken to Mrs.
Whitaker and Mrs. Carroll in New York,
they had pointed out that the passing of
this legislation represented the first real
breakthrough in federal assistance. This
success, they said, had been due, in no
small part, to the concerted and constant
attention of their Washington representa-
tive, Miss Thompson. (A comparison of
the U.S. federal government's annual ap-
propriations to nursing education with
the Canadian federal government's appro-
priations can be found in "Too little, for
too long, from the federal government,"
by Dr. Shirley R. Good, in the May 1969
issue of The Canadian Nurse).
Miss Thompson hastened to point out
that not all of ANA's lobbying efforts
have been successful. To date, she ad-
mitted, ANA has been unable to get the
government to amend a clause in the
national labor relations act that excludes
non-profit hospitals from collective bar-
gaining.
"Each year we ask a congressman to
introduce an amendment to the Taft-
Hartley Act to remove that clause," she
said. "We can always find someone to
introduce this bill, but then it just dies in
committee. We've been told that it's
useless, until the two major forces - la-
bor and management — decide they
want the labor relations act opened for
amendments.
"We've been trying to get this changed
since 1937, and still no luck," Miss
Thompson said ruefully. "But everything
takes time," she added with a twinkle,
"and we'll keep plugging away."
This writer has no doubt that the 4F
strategy — firm, friendly, and feminine,
with a large dash of fortitude - will
ultimately take Taft-Hartley apart suc-
cessfully.
References
1. Gerds, Gretchen. Every nurse a lobbyist.
Amer. J. Nurs. 60:9:1242-5, Sept. 1960.
2. Roberts, Mary M. American Nursing, Histo-
ry and Interpretation. New York, Mac-
millan, 1954, p.98.
Bibliography
The ANA and the legislators. Amer. J. Nurs.
46:9:615-16, Sept., J 946.
Thompson, Julia C. White caps on capitol hill.
Amer. J. Nurs. 55:10:1204-5, Oct. 1955. D
JULY 1%9
Private duty — private choice
To find out why nurses are attracted to private duty nursing and some of the
pleasures and problems inherent in this type of nursing. The Canadian Nurse
asked the author, a freelance writer and researcher, to interview several
private duty nurses whose home base is Toronto.
Carlotta Hacker, M.A.
Why do registered nurses choose to
become private duty nurses, rather than
staff nurses in a hospital? The income is
uncertain and many young nurses find
they have to do a high proportion of
night duty to bring in a reasonable salary.
In the winter months, work is not always
available.
Private duty nurses receive no pay
during holidays or times of sickness, and
no insurance schemes are provided for
them: if they wish to have a pension plan,
medical insurance, or malpractice in-
surance, they have to organize it them-
selves — an expensive business, as there
is no employer to contribute to the
payments. Similarly, if a patient does not
pay a bill, it is up to the private duty
nurse to pursue the bad debt and, when
necessary, hire a lawyer. They are very
much out on their own.
Yet each year a small proportion of
nurses continues to sign on at the regis-
tries.
"I like it for the freedom," says one.
"I like it because 1 can work when 1
want, have what days off I want, and
have what holidays 1 want," was another
opinion.
"It's far more interesting than being a
staff nurse. More interesting and more
stimulating."
This last explanation has been expres-
sed in a variety of ways, but it was the
chief reason given by private duty nurses
at Toronto General Hospital for their
attraction toward their work. The inde-
pendence of it appeals to them too,
JULY 1%9
because they are independent people by
nature. You have to have a certain self-
confidence and self-sufficiency to cope
with the insecurities inherent in "spe-
cialing" — but the basic appeal is the
work itself.
"I used to be on staff in the respirato-
ry unit," says Elizabeth Sanmiya, who
has been doing private duty since 1965.
"I think that's the main reason why I
started 'specialing': because I liked
working there, and I liked the idea of
going to all the different parts of the
hospital and looking after seriously ill
patients."
Miss Sanmiya prefers the night shift
because it fits in well with her evening
classes. Since starting private duty she has
taken Japanese and Grade 13 French, and
she is now enrolled in a course in mas-
saging. Continual night duty has made
this possible.
Beverly Bell, who has done private
duty for a year now, also started on staff.
She began private duty as a temporary
measure after returning from a year in
England, and she liked it so well, parti-
cularly the intensive care, that she stayed
at it.
"1 think I have learned as much during
this last year of 'specialing' as I did in my
The author, an English and History graduate of
St Andrews University in Scotland, is a fre-
quent contributor to The Canadian Nurse. Her
book . . .And Christmas Day on Easter Island
was recently published by Michael Joseph Ltd.
of London, England.
three years of training," she says. "You
get such a variety of cases."
Like most of the private duty nurses
who were interviewed at Toronto Gener-
al, both girls feel that they have gained
more experience and kept more up-to-
date than they would have done in a staff
position. This seems to be one of the
strong attractions to private duty.
And the general opinion seems to be
that the pay is approximately equivalent
to that of a staff nurse, although income
is certainly one of the insecurities. You
may be lucky and have the chance of
earning a high salary for a short period,
but there are also the lean times to take
into account.
Some of the private duty nurses have
experienced antagonism from regular
staff because they are thought to earn
more for equal work. Certainly a special's
pay packet for a week's work is fatter,
but tax has not been deducted at source,
and she receives no pay packet at all
during holidays and sickness, or when she
can't get work.
Antagonism has also occasionally been
experienced when the staff are busy and
the private duty nurses are not.
"But the patient is paying us," said
one special. "So he is entitled to our full
care and attention. That's why we're
there."
The author of the article and the editor of The
Canadian Nurse express their sincere appre-
ciation to the staff at Toronto General Hospital
and to the director of the Central Registry of
Nurses in Toronto for their valuable assistance.
THE CANADIAN NURSE 25
Elizabeth Sanmiya and Beverly Bell relax with the author over coffee before going on duty.
"Envy enters the picture quite a lot,"
was another opinion. "Some members of
staff resent our freedom because we
aren't part of the hierarchy."
But on the whole the private duty
nurses can see few disadvantages in their
work. There are not, by any means,
always personality difficulties with staff.
And many obstacles, which the less in-
trepid might consider to be disadvantages,
are brushed aside with slight surprise that
they could present any problem.
No . . . there's nothing terrifying about
moving into a new ward or unit, or even a
different hospital. It's interesting to meet
new people and tackle a new job ... In-
come tax? That's not much of a pro-
blem. It may be a bit difficult to work
out the first year, but you learn by
experience and organize it properly from
then on.
Even non-payment by a patient gives
no particular cause for worry. If he
doesn't pay his bill (and this is a rare
occurrence) then you simply send a re-
minder and, if necessary, a lawyer's letter.
Most private duty nurses present their
bills weekly on a long case so that the
patient is aware of how much the special
care is costing liim. Margaret Kellough,
also of the Toronto General, makes a
habit of doing this.
"Because I know what it costs! " she
says. "I've been a patient myself with a
special nurse."
Miss Kellough has been in private duty
a long time. It appeals to her because, as
she says, "I enjoy people," and she feels
26 THE CANADIAN NURSE
that private duty gives her the opportu-
nity to nurse her patients single-mind-
edly. She can get to know them, and give
them the encouragement and personal
attention that a staff nurse seldom has
time for. Because of this close contact
with the patient, Margaret Kellough
prefers private duty to any other form of
nursing.
She has had considerable experience in
other fields. She gave up private duty in
1939 at the outbreak of war in order to
volunteer and, within three days of
writing to the Red Cross, found herself in
the army. She worked in England during
the Battle of Britain, in North Africa with
the 15th Canadian General Hospital (a
tent hospital: lanterns, fiashliglits, and
outdoor plumbing) and then landed with
the troops in Italy where she took charge
of a casualty clearing station.
"We were only a few miles from the
German lines, with the big guns shooting
over us."
Miss Kellough was decorated A.R.R.C.
for her African service, and after the war
she continued nursing the military for a
while at Malton. Then, after running the
hospital at Port Hope for six years and
taking on a crippled children's camp, she
made an attempt to resume private duty.
This attempt was soon foiled when a
doctor persuaded her to organize and run
an eye surgery clinic for him: a four-
teen-bed private nursing home. But in
1956 she did at last succeed in returning
to private duty.
"A lot of people thought I was very
foolish going back to it after all that
experience," she says. "But, you see, I
really enjoy private duty nursing."
Miss Kellough considers that it gives
her far more job satisfaction than she is
likely to find in a staff position, because
each of her assignments is an entity that
she can give all her attention to and
follow through. And she feels strongly
that personal attention by a special nurse
can hasten recovery.
"1 truly believe that people get out of
hospital faster," she says. "1 don't spoil
patients, but 1 can give them the confi-
dence to do the things they should do.
Like early ambulation. If you're there
with them, you can suggest it to them
gradually. You can take a lot of worrying
from them too, so that they relax. And
you can listen to their complaints and
generally make things run smoothly."
And things do run smoothly, with
both staff and patients, when she is on
duty.
When it is possible, Miss Kellough gets
her patient into a wheelchair and does a
tour of the hospital, showing him the
swimming pool, the occupational
therapy, the physiotherapy, the carpen-
ter's shop and the ceramics shop.
"It makes it more interesting for the
patients," she says. "I don't want them
lying there in bed just tliinking of their J
operations." '
Not surprisingly, many patients who
have been under Miss Kellough's care ask
for her as their nurse if they have to
return to hospital for another operation.
JULY 1969
T^
^^^^w^l^ ^^^^^^^K
Elizabeth Sanmiya, a private duty nurse since 1965, prefers the
night shift since it allows her to take evening classes.
But she will not always guarantee to
nurse them because she does not like to
start a new assignment, however attrac-
tive, if it means leaving the previous
patient while he still needs a special
nurse.
Her patients vary widely. Obstetrics
and intensive care units are the only areas
where she prefers not to work now,
although of course she had experience of
intensive care when it was being given in
the general wards. She enjoys the diversi-
ty and finds it far more interesting than
working on the floors, where nurses are
more likely to care for many patients
who have had similar operations.
But she does consider the lack of
security a strong disadvantage. She has
taken out her own pension and sickness
policies. She feels this is a sensible move.
"Because you don't make money at
private duty," she says.
She considers that she has to work
longer hours to earn the equivalent of a
staff nurse's salary.
Margaret Kellough generally has to
wait a few days between finishing one
case and starting another, partly because
she only takes the most popular eight to
four shift now. She likes to live a normal
life and see her friends in the evenings,
and it is impossible to do so if she is
working at night. As it is, a regular
routine is difficult for her, because a
patient may require care longer than
anticipated - perhaps for 10 or 14 days
at a stretch - which may mean can-
celling a weekend in the country or being
JULY 1969
on duty at Christmas,
Miss Kellough does not insist on a
five-day week. Her own life is fitted
round her patients' requirements, rather
than the other way round. In a long
assignment, she will find a reliable deputy
to give her a few days' break every week
or so, but she sees a shorter case through
to the end, without any break, for she
considers it upsetting for a patient to
have to adapt to a change of nurse.
So, because of her principles, she is
not entirely a free agent. However, like all
private duty nurses, she has the opportu-
nity to work when she wants to (pro-
viding work is available) and she can take
the hohdays she wants. Eight years ago
she was able to attend the International
Congress of Nurses in Melbourne and
include a holiday in the Far East. The trip
lasted nearly two months. Four years
later she was able to attend the Congress
in Frankfurt.
Such extended holidays would be dif-
ficult for a staff nurse. But the ability to
take these long vacations is only a
pleasant sideline to Margaret Kellough's
work. The true reason why she returned
to private duty is because of her empathy
vkdth people and because of the great
satisfaction the work gives her.
She is slightly worried that private
duty work may diminish or even cease in
the future, not because there will be no
need for it, but because she thinks it
holds less appeal for younger graduates
who like a regular five-day week. How-
ever, younger graduates are still recruiting
Beverly Bell began private duty as a temporary measure after
returning from a year in England, and liked it so well that she
stayed at it.
as specials and one of their reasons is the
same as Miss Kellough's: job satisfaction.
But the job tends to be different.
Valerie Braden, who graduated in
1961, has done most of her special duty
in intensive care units. She finds this
stimulating, challenging, and extremely
interesting. Like Miss Kellough, she has
an independent nature and, when neces-
sary, has no fear of speaking out. Like
Miss Kellough, she is absorbingly inter-
ested in her work. But, unlike Miss
Kellough, it is the intensive care units
that appeal to her, rather than the less
dramatic forms of nursing.
Her first taste of intensive care was at
the Toronto General Hospital where she
worked on the respiratory unit for several
months.
"It was very good experience," she
says, "because I completely overcame my
fears of respirators and acutely ill
people."
Then the Toronto General set up a
unit for coronary patients and applied to
the registry for graduate nurses to help
staff it. So Miss Braden did special work
there. But the private duty she most
enjoyed was the 10 months she worked
on the intensive care unit at The Hospital
for Sick Children in Toronto.
"There was a wonderful sense of cama-
raderie," she says. "Everyone pitched in
to help everyone else. It was hard work,
and we were doing quite irregular shifts,
but it was fantastically stimulating. And
it was a good learning experience too,
because nothing was ever static. We had
THE CANADIAN NURSE 27
^#^',-j"n
Private nursing appeals to Margaret Kellough because she finds she has time to give her
patients the personal attention and encouragement they need.
Valerie Braden, a 1961 graduate, prefers private nursing in the intensive care units. She
is seen here (left) with Mrs. E. Tyer, a head nurse at the Toronto General Hospital
all the open heart cases, a lot of neurosur-
gery, and lots of the acutely ill medical
cases."
Inevitably, when Miss Braden was
woricing on intensive care, a schedule had
to be made out and she kept to it, but
generally she can work or take a hoHday
as she desires. Like so many other
specials, she appreciates this aspect of
private duty nursing.
In spite of the longish holidays she
takes periodically, she considers that,
with effort, her income can be as much or
even more than that of a staff nurse.
Uniforms and transport can be claimed
against tax, because she is self-employed.
And, although she receives no salary
during long vacations, she can work extra
hard while saving to go for six weeks to
Hawaii, for instance. She can do a spell of
night duty, which is easier to come by
than the eight to four shift that she
usually works. Quite often there has been
the opportunity to make extra income by
doubling and nursing two hospital
patients in the same shift.
"But when I earn more, it's probably
because I work more," she says. "I'm sure
I work more days per month than the
average staff nurse."
She is not particularly concerned
about the insecurity of her employment.
She sees insecurity as a necessary com-
panion to independence. Maybe there are
periods in winter when she would like to
be on duty and isn't, but there is often
the night shift to fall back on. If this also
fails, then she remains on call, fretting
28 THE CANADIAN NURSE
slightly, but aware that being out of work
is sometimes an unpleasant corollary to
the freedom of private duty nursing.
Like Miss Kellough and other special
nurses, Valerie Braden enjoys the variety
of experience that private duty brings.
Like them, she feels that she keeps more
up-to-date than a nurse who stays in one
area. She is prepared to tackle anything,
so even when not working on intensive
care she has had a cross-section of inter-
esting patients. However, she has also had
a proportion of assignments that have
largely been "hand-holding," and she
does not enjoy these after the first couple
of days: she feels that they are often a
waste of the patient's money and her
time.
"There's no challenge or stimulus,"
she says. "I feel I'm not fulfilling my
potential."
Recently the Toronto General
Hospital has stopped employing special
nurses from the registries, and other
Ontario hospitals are also having to cut
down. This means that private duty work
in the province is likely to involve far
more "hand-holding" assignments. So
Miss Braden is considering some other
form of employment. She could, of
course, sign on as a member of staff, but
she has grown accustomed to her freedom
and can't see herself fitting in comfort-
ably with a hospital routine.
"I'm thinking quite seriously of going
into public health," she says. "It would
mean going back to school, but I could
work in the vacations. I'm very interested
in organizations like World Health, and
would like to be contributing in that
area."
So it looks as if private duty may lose
Miss Braden - except in the college va-
cations of the next two or three years.
Because of the cuts in hospital charge
patients, it has already lost a number of
nurses. Some have gone on staff, some
have gone on relief nursing. Others have
left nursing altogether.
But it also looks as if a proportion of
graduate nurses of all age groups will
continue to be interested in signing on
with the registries for private duty. Their
reasons will vary. Some may see it as a
convenient temporary job, while others J
will be drawn to it because of the close "
relationship it offers with the patient.
Some may find it stimulating and ob-
sorbing, while some may use it only as a
useful and uninvolved form of income.
But most graduates who sign on with a
registry in a regular manner are private
duty nurses because they find satisfaction
in this form of work. Although private
duty nursing has decreased considerably
over the last 50 years — partly because
there is so little graduate nursing in the
home nowadays - it is likely to con-
tinue to some extent, since there will
always be patients willing to pay for the
extra care.
And it looks as if there will continue
to be nurses willing to give this type of
care. D
lULY 1969
Unit assignment —
a new concept
A different staffing pattern could create greater nurse satisfaction and
improve patient care.
The University Hospital in Saskatoon
has implemented a new staffing system
on its 47-bed research ward. This ward is
organized into six units of care — one
three-bed intense care unit, two five-bed
above average care units, and three aver-
age care units.
A unit is defined as the number of
patients that can be effectively cared for
by a registered nurse who is given ade-
quate nursing assistance and supply ser-
vices. The size and staffing of each unit
depends on the care category of the
patients assigned to the unit. The ward
consists of the number of properly staf-
fed units that can be managed by a head
nurse who is given adequate clerical and
service coordinating support.
Each unit has a mobile station, located
in close proximity to the patients, which
houses the charts, doctors' orders, medi-
cations, sterile and unsterile supplies,
stationery, and a telephone intercom-
munication system. The unit station is
thus the center for communications and
supply delivery.
Unit assignment
The new staffing pattern, known as
the unit assignment system, developed
from a recommendation of the first phase
of a nursing study completed at the
University of Saskatchewan in 1967. The
second phase of this study was designed
to implement and evaluate this staffing
pattern and to conduct a feasibility study
JULY 1969
Kay Sjoberg, B.Sc.N.
on measurement of the quality of patient
care.
On admission, patients are categorized
according to their need for care and are
assigned to the appropriate unit —
intense care, above average, average, or
minimal care. This four-level patient clas-
sification system was also developed in
the first phase of the study.
In May 1968 the system was compared
with the patient classification model
developed by Dr. Asa MacDonell at Deer
Lodge Hospital, Winnipeg. Simul-
taneously, both systems were compared
with the head nurses' independent evalu-
ation of the level of care required by the
patient. This further study assured the
research team that the phase I catego-
rization system is a valid tool to classify
patients quickly into levels of care de-
pending on the amount of nursing care
they require.
Since the prime objective of the unit
assignment system is to deliver personal-
ized patient care effectively, the head
nurse assesses daily all patients on the
ward. If the patient's care category has
changed and is expected to remain stable
for approximately two days, the head
nurse initiates the patient's transfer to the
unit that is staffed and equipped to meet
his needs. Patients are moved within the
Mrs. Sjoberg, a graduate of the University of
Saskatchewan School of Nursing, is currently
Project Leader of the Nursing Study, University
Hospital, Saskatoon, Saskatchewan.
ward approximately twice during their
hospital stay.
The head nurses' role
What is unique about this system?
The head nurse on the ward remains
responsible for providing nursing service,
but she delegates the administration of
each of the units to her unit nurses. She
also delegates clerical functions, the or-
dering of suppUes, and service secural to
her service coordinator. This gives the
head nurse time to apply her knowledge,
experience, and clinical competence di-
rectly to patient care.
The head nurse is the key person in
creating a therapeutic environment for
patient care. She guides, supervises and
assists her unit nurses to meet the goals of
personalized patient care; supervises
patient care; teaches patients and nurses;
orientates new nursing staff; evaluates
staff performance; and conducts the mul-
ti-disciplinary patient care conference.
Staffing patterns
The unit assignment system permits a
certain degree of flexibility in staffing.
Each unit nurse is a registered nurse
responsible for total patient care. She
works with her assistant, directing and
supervising patient care. There is no
formal assignment for a unit assistant.
Unit nurses and unit assistants are
assigned by the head nurse daily to a unit;
continuity of assignment is promoted
THE CANADIAN NURSE 29
through a weekly assignment plan. The
size of the unit varies, depending on the
numbers and needs of the patients. The
key is to establish a unit of appropriate
size to permit the unit nurse to supervise
patients' care, work with her assistants,
and be in control of the situation.
An evening nurse in the above average
care unit assumes responsibility for two
day-shift units; a night nurse in the
average care unit assumes responsibility
for as many as three day-shift units. The
number and level of staff assigned to the
intense care unit remains constant. Every
attempt is made to match the nursing
staff to meet the patients' needs and to
equalize the nurses' assignments from day
to day.
The unit assignment system uses exact-
ly the same budgeted staff as the team
method of assignment. Floats are still
required, although less frequently.
Nursing assistants and orderlies may
assume the role of unit assistant. They
expect direction, supervision, guidance,
and teaching from their unit nurse. They
work with her and are never in complete
charge of any patient's care. Orderlies
find their new role rewarding, although
they are still responsible for performing
male procedures in other units.
Student nurses enjoy their assignment
to the research ward for senior surgical
experience. They function as observers
and unit assistants. The role model set by
the unit nurse should enrich the students'
experience. We have found it wise to limit
the number of observers. For this reason,
only two students are assigned for experi-
ence on each day shift.
Communication
Doctors and all other members of the
health team communicate directly with
the unit nurse who has up-to-date infor-
mation on each patient's condition and
progress. The patient's treatment plan,
needs, reactions, and preparation for dis-
charge may be discussed. The unit nurse
plans with the other health disciplines to
schedule the patient's activities, such as
physiotherapy, occupational therapy,
social service, x-ray, and speech therapy.
This direct communication helps main-
tain continuity of care.
30 THE CANADIAN NURSE
AU departments in the hospital coop-
erate to allow the patients to rest from
1:00 to 2:00 p.m. daily. During this
period, the nursing staff discuss plans for
patient care, participate in patient care
conferences, and revise charts or kardex
as necessary.
Two formal patient care conferences
are held each week, and are attended by a
doctor and other members of the health
team. These conferences are conducted
by nurses and center on the patient's
illness, progress, needs, nursing inter-
vention, teaching, and preparation for
discharge.
When shifts change, each day unit
nurse reports verbally to the evening unit
nurse and her unit assistant. This method
of reporting encourages two-way dis-
cussion of the patient's progress, treat-
ment, and nursing care. Continuity of
care is aided and some communication
problems are resolved because each unit
nurse is expected to relay information
from the doctor, social worker, and
physiotherapist.
Service staff
Our service staff includes a coor-
dinator, clerks and aides. The service
coordinator provides the continuing servi-
ces required to meet the environmental
needs of the patients. In securing sup-
phes, she works closely with many de-
partments: laundry, central supply,
oxygen therapy, pharmacy, dietary,
housekeeping, maintenance, admitting,
and purchasing. She supervises and main-
tains all clerical and receptionist func-
tions of the ward and assigns and super-
vises the aides' duties. The service clerks
take care of the clerical needs of the units
and the ward.
The service coordinator meets with the
housekeeping team leader to plan for the
housekeeping of the patients' rooms. This
is done daily when the head nurse com-
pletes the patient categorization.
Supply standards have been deter-
mined for each portable unit station.
These standards are replaced each shift by
the service staff. Aides take supplies to
the units when required. Other responsi-
bilities are included in a detailed job
description. The service staff play a vital
role in the unit assignment system of
staffing and an indirect though important
role in patient care.
Conclusion
The unit assignment system of staffing
progressed through the cooperative
support of hospital administration, me-
dical staff, nursing staff, and the support-
ing hospital service departments. Its effec-
tiveness can be partly measured by staff
response.
Nurses on the unit have found that
communications have improved among
members of the health team. Also, be-
cause nurses spend less time performing
non-nursing activities, they have found
that they know their patients as people
and can provide more individual care.
There is time, too, for professional
growth and learning. Nurses are encou-
raged to experiment with their own ideas
to improve patient care. They use their
professional talents and are given re-
cognition by both staff and patients. As a
result, organization improves and time is
used more effectively. These comments
came from nurses involved in the unit
care system.
In the coming months the unit assign-
ment system of staffing will be evaluated
by the research team, using activity
studies, gross quality of patient care
studies, cost studies, and a staff satisfac-
tion questionnaire. The nursing service
research study will assess its overall
effect.
Does the unit assignment system lead
to more effective personalized patient
care with greater job satisfaction for
nurses without increasing costs? We are
still looking for the answer.
Bibliography
Holmlund, B.A. Nursing Study - Phase I,
University Hospital, Hospital Systems Study
Group, University of Saskatchewan, Sas-
katoon, Saskatchewan. September, 1967.
Sjoberg, K. and Bicknell, P. Patient Classifi-
cation Study, (unpublished report), Univer-
sity Hospital, Hospital Systems Study
Group, University of Saskatchewan, Sas-
katoon, Saskatchewan. September 1968. O
JULY 1969
Top right: Above Average Care Unit.
Because the nurse is serviced close to
the patient, her main focus can remain
on the patient.
Middle: service staff - coordinator,
clerk, and aide.
Bottom right: Supply section separate
from desk. Supply cart is easily wheeled
from patient to patient.
Top left: Stationery file.
Bottom left: Medication and sterile sup-
ply section of unit station
U^i"i-*L
)ULY 1%9
THE CANADIAN NURSE 31
Insulin injection —
a new technique
Description of a method that the author claims is easier, more effective,
and painless.
Peter St. James
In woricing with diabetics for over 10
years, I became concerned about the
method used to inject insulin by the
patients themselves, nurses, medical staff,
and anyone else responsible for the injec-
tion, such as parents of diabetic children.
The injection seemed to be one of the
greatest obstacles to both the new and
the "experienced" diabetic.
I set out to develop a method that
would be painless, effective, easy to
perform, and that might eliminate the
disfiguring hollows on the diabetic's
body. I have found great success with this
method, both in its ease of technique and
in the resulting disappearance of the
insulin atrophy and hypertrophy marks,
which were very evident in some cases.
I have used this method with both
male and female patients, who range in
age from 8 to 41 years. Their dosages
range from 6 to 80 units in each injec-
tion.
Rotate area
Insulin should always be injected to
reach the loose space under the skin
between the fat and the underlying
muscle. If the dose is injected too close to
the surface, it enters the fat or the skin
and causes a painful stretching and swell-
ing.
The author is indebted to Pam Morgan for her
invaluable assistance and to all the other dia-
betic patients who have tried and found success
with this method.
32 THE CANADIAN NURSE
The site of injection must be rotated
through as many areas as possible, chan-
ging the location each day by at least two
inches. If given in the same area, the
tissue becomes hard, lumpy, and discolor-
ed and the insulin may not be properly
absorbed.
Occasionally there will be a little
bleeding at the point where the needle is
withdrawn. This means that a small blood
vessel close to the surface has been
penetrated; this is harmless, and no cause
for alarm.
The actual pain of an injection is
caused by passing the needle through the
nerve endings of the dermis layer of the
skin. If the needle is inserted quickly, the
pain is minimal and of short duration; if
it is inserted slowly, the pain is drawn
out. By actually "darting" the needle into
the skin, there is no pain at all.
It is common to pinch the skin before
inserting the needle, but there is no need
to do this as it only brings together more
and more nerve endings. If you pass a
needle through this gathering of nerve
endings, there is sure to be some dis-
comfort.
Technique
• Wipe the site of injection with an
alcohol swab.
• Dart the needle straight into the skin to
the hilt of the needle.
• Gently pinch a large fold of skin and
underlying fat. This brings the point of
lULY 1969
the needle into the loose space under
the skin.
• Slide the plunger fully down to inject
the insulin.
• Withdraw the needle.
• Apply slight pressure with the alcohol
swab over the area for a minute or two.
The second step must be done quickly,
which may require practice at first. With
this method there should never be any
discomfort from the needle, nor should
there ever be any mark or hollow in the
skin — provided the site is changed every
day. Do not use the same site more than
may be lifted up to assure that the point
of the needle is in the proper space and
not resting in muscle tissue.
Teaching technique
In teaching my diabetic patients, I
have them first push down with the
alcohol swab; this leaves a small white
spot that disappears in a matter of
seconds. The idea is to have them insert
the needle before the white spot dis-
appears, which is just a method of getting
them to overcome their hesitation and to
learn to insert the needle quickly.
to perform by himself.
With this method there is no need to
aspirate the syringe, as the tip of the
needle is in a space under the skin and
cannot be in a blood vessel. No matter
how many thousand times a diabetic is
told to aspirate the syringe, he always
seems to forget. In using this method, he
can "forget" and not worry about it. D
— Epidermis
— Dermis
— Subcutaneous
fat
— Muscle
once every three weeks. Rotate the site
daily.
The object is to get the insuUn into the
space between the skin proper and the
underlying muscle tissue. By inserting the
needle perpendicular to the skin, the
point of the needle penetrates deeply
enough to pass through all the layers of
skin.
1 have found that when the skin is
pinched and the point of the needle is
about to pass through the first layer of
skin, it folds in the center, making the
injection difficult to perform. This is
particularly evident when the patient has
tough skin. By not pinching the skin, but
allowing it to remain flat against the
muscle, the penetration of the needle
becomes a much simpler task. Once the
needle has penetrated all layers, the skin
JULY 1969
1 explain that it is the nerve endings
that cause the discomfort and that pinch-
ing the skin only brings more nerve
endings together. I tell them that the
nerve endings are separated when we push
down with the alcohol swab. In reality it
is the speed with which the needle is
inserted that minimizes the discomfort.
1 have found this method particularly
rewarding when teaching children the
technique. After a few successful at-
tempts, the diabetic convinces liimself
that insulin injection is painless and easy
Mi. St. James, a graduate of Woodstock General
Hospital, is presently employed at the Clarke
Institute of Psychiatry in Toronto. He is an
active member of the Canadian Diabetic As-
sociation, and has written several articles on
diabetes.
THE CANADIAN NURSE 33
Lady Mary Wortley Montagu
eighteenth century crusader
The story of one woman's crusade to control smallpox.
Dorothy Metie Grant
Years ago, when I was a student nurse,
I was anything but impressed with my
classes on the lives of the early pioneers
of preventive medicine. To me, men Hke
Pasteur and Jenner were only paper-thin
characters imprisoned in the dull, ponder-
ous chronicles of nursing textbooks.
Looking back, it seems to me that the
problem rested with the writers: few had
put into words the incredible drama
underlying the early struggles of countless
men and women in their fight to control
infectious diseases.
Recently I discovered one of these
fascinating stories as I browsed through
several history books. My detective
instincts were aroused when a woman's
name - Lady Mary Wortley
Montagu - kept appearing in connec-
tion with smallpox control. Further read-
ing provided me with a picture of a truly
outstanding character.
Lady Mary, the daughter of an English
aristocrat, was one of those rare women
whose intelligence and determination
make then unique in any era. She was
destined to become one of the leading
social satirists of her century, and her
numerous letters are now considered to
be among the best sources of information
on English life and politics during the
1700s.
Mrs. Grant, a graduate of Halifax Infirmary
School of Nursing, lives in Halifax, Nova Scotia,
where she is a freelance writer.
34 THE CANADIAN NURSE
Early in life she experienced the cruel
effects of smallpox, first by her mother's
death, then by the death of her only
brother.
Although smallpox had first shown its
lethal disposition in England during the
reign of James I,i it was a relatively new
disease in the early 1 700s. But from that
period on, it began to rake the country
with ruthless vengeance.
Lady Mary contracted smallpox in
1715, three years after she was married,
when she was cultivating a prestigious
position at the court of George 1. Under
the care of the royal physicians, she
recovered, but was left with deeply pitted
skin and the permanent loss of her
eyelashes. Her famed beauty had been
destroyed by a disease that would take
the lives of 60 million people before the
century was over. 2
Lady Mary was an embittered woman
during her convalescence, but she was
extremely fortunate to have survived an
attack of smallpox. All over Europe
people were dying from the plague, or
were left deformed. Portrait painters
could remove pock marks from their
canvases, but contemporary females had
to rely on heavy make-up and artfully
applied beauty spots to cover badly scar-
red faces.
Servants who contracted the disease
were thrown into the street to die. 3
Those who had not had the disease found
it difficult to get employment.
JULY 1969
Doctors prescribed strange treatment
for smallpox victims. Usually they were
crowded into small, windowless rooms
where they lay for days in filthy clothing.
Sometimes a regimen of fresh air and
frequent changes of clothing were pres-
cribed. Because freshly laundered cloth-
ing was considered unhealthy, a relative
or friend first wore it.^
One doctor recommended that pa-
tients be given a spoonful of a mixture of
white wine and sheep dung.^ Men and
women wore "sachets antivarioliques"
around their necks for protection. With
the sachets came precise instructions:
men were to allow the sachet to rest over
one breast, and women were to place it
over the navel for best results. 6
Smallpox, like most infectious dis-
eases, did not respect social barriers. In
the seventeenth century, Charles I of
England lost two children to the disease. ^
Peter II of Russia died from it in 1730,
on his wedding day. 8 In the United
States, George Washington, the first pre-
sident, owed his pock-marked face to
smallpox, and Benjamin Franklin's four-
year-old son died during an epidemic in
the New England colonies.9 (Franklin
became one of the colonies' most out-
spoken advocates of inoculation.)
A year after Lady Mary's recovery, her
husband was appointed ambassador to
Turkey. There she heard about a strange
practice.
Every fall, when the weather was cool,
people gathered to have "the smallpox."
An old woman would arrive at a home
"with a nutshell full of the matter of the
best sort of smallpox. "io Each person
was asked to decide which veins he
wanted opened. Usually they were on the
arms and legs where scars would be
hidden. The woman made a scratch on a
vein and inserted enougli pus to cover the
head of the needle. She then bound the
wound with a hollow piece of shell. This
procedure was usually repeated on three
or four other veins.
Within a week of this inoculation, the
patient began to display symptoms of
JULY 1969
smallpox; usually on the eighth day he
spiked a high temperature that seldom
lasted more than three days. Although
pustules erupted on the skin, they rarely
resulted in permanent scarring. 1 1
This lack of scarring convinced Lady
Mary that it was her duty to introduce
the English public to the medical benefits
of inoculation. She made a courageous
decision to have her three-year-old son
inoculated, and asked Dr. Charles Mait-
land, the embassy physician, to witness
the procedure.! 2
The old Greek woman who was asked
to perform the inoculation caused the
boy so much pain that the doctor took
the needle away from her and injected
the pus into the child's veins himself. In
March 1718, Lady Mary wrote the fol-
lowing letter to her husband:
"The boy was engrafted last Tuesday,
and is at this time singing and playing and
very impatient for his supper. I pray God
my next (letter) may give as good an
account of him."i3
Little Edward Wortley completely re-
covered from the mild case of smallpox
that followed and was left without any
scarring.
The English medical world received
the news of this inoculation with amused
interest and skepticism. As one doctor
later wrote, "It was an experiment prac-
ticed only by a few ignorant women
amongst an illiterate and unthinking peo-
ple."! ^
Lady Mary believed that inoculation
was a Turkish discovery: however, the
practice had been used in some parts of
the world for centuries. Since early times
the Chinese had been inoculating the
virus into the skin or drying smallpox
matter into a powder that was blown into
the nostrils.! 5 African tribes had been
known to inoculate themselves against
the disease.! 6 In Northern Scotland it
was common to allow children to sleep in
bed with members of the family who had
smallpox, or to soak material with small-
pox matter and tie this on the arms of
small children.! 7 Doctors there consider-
ed it so important to contract smallpox in
early childhood that they often took
their young children to homes of patients
convalescing from a "favorable kind" of
smallpox.! 8 Most English doctors knew
about inoculation but rejected the idea.
When Lady Mary returned to England,
another smallpox epidemic struck. Be-
cause her son's inoculation had been
dismissed as inconclusive, she decided
again to bring the procedure to the
attention of laymen and the medical
world. She asked Dr. Maitland to inocu-
late her daughter who had been born in
Turkey. Maitland at first refused, but
later, with three doctors as witnesses, he
inoculated the little giri.
Once again, news of the successful
inoculation created widespread interest
and comment. One of those most in-
terested was Princess Caroline, daughter-
in-law of George I, who had long feared
that her three daughters might die of
smallpox. Not convinced of the safety of
inoculation, she chose six condemned
convicts in Newgate prison and offered
them full pardon if they submitted to the
"Turkish invention."! 9 The now famous
Dr. Maitland acted as their physician.
For days after their inoculation, news-
papers carried extensive reports, and hun-
dreds of people flocked to stare at the
prisoners. One man, who already had had
smallpox, did not show any signs of the
disease. The others, who developed mild
cases, recovered without any ill effects.
They left Newgate as happy testimonials
to the relative safety of inoculation.
But Princess Caroline was still not
ready to allow her daughters to be inoc-
ulated. To test its safety further, she
ordered the inoculation of 1 1 orphans,
including five infants. Their complete
recovery from mild cases of smallpox
provided the proof she needed. Later, Dr.
Claude Amyand, the royal physician,
inoculated two of her children. 20
Almost immediately, English society
began to debate the wisdom of this Royal
approval of inoculation. Many of Lady
Mary's family and closest friends refused
THE CANADIAN NURSE 35
to be inoculated. One of these skeptics,
Lady Mary's sister, lost a son to the
disease two years later.
Nevertheless, more and more people
began to ask to be inoculated. Between
1721 and 1728, 897 people were inocu-
lated; 17 died as a result. During the same
period, 18,000 people died from active
cases of smallpox. 21
Some historians believe that inocu-
lation resulted in more cases of smallpox
in England. This may have happened
occasionally because many doctors did
not reahze that inoculated patients were
as infectious to others as were people
with active cases of the disease. 22 At a
time when sterile technique was un-
known, deaths sometimes occurred when
doctors used filthy, blood-encrusted
needles for inoculations. Some patients
were weakened from bleeding before the
inoculation was performed. 2 3 Matter
taken from a recently inoculated indivi-
dual was sometimes used, usually result-
ing in mild cases of smallpox that did not
provide permanent immunity. 24
As inoculation became increasingly po-
pular, hospitals were built where people
could be inoculated and convalesce under
the watchful eyes of physicians. Patients
were asked only to make a deposit of one
pound, sixpence, to cover burial ex-
penses, a sign that there were still mis-
givings about the safety of inoculation.
Smallpox hospitals were frequently for-
ced to move because of local citizens'
complaints. Between 1746 and 1750,
almost 4,000 people were inoculated at
these hospitals.25
After her daughter's inoculation. Lady
Mary spent several years defending the
procedure she had helped to introduce
into England. To answer critics of inocu-
lation, she wrote an anonymous essay, "A
Plain Account of the Inoculating of the
Smallpox by a Turkish Merchant." It was
only recently that Lady Mary was proven
to be the author of this controversial
essay. 26
Lady Mary died in 1 762 of cancer of
the breast. Only a small monument in a
36 THE CANADIAN NURSE
quiet English churchyard serves as a
memorial to her. The inscription on the
monument reads: "Sacred to the Memory
of The Right Honourable Lady Mary
Wortley Montagu who happily introduced
from Turkey The Salutary Act of Inocu-
lating The Smallpox."27
Did inoculation play a part in the
famous experiment that was to earn
Jenner immortality?
Perhaps, for in recent years some
scientists have suggested that cowpox
may have been inoculated smallpox. 28
What may have happened was that inocu-
lated farmers and milk maids scratched
itchy pustules on their arms, and the
infectious matter beneath their fingernails
was transmitted to cows' udders. This
accidental infection of human smallpox
may have been the accident that provided
Jenner with vaccination. The infected
cows developed a milder, related type of
disease resulting in a live virus that
stimulated the production of antibodies
capable of defending the body against an
attack of a deadlier organism.29
Women like Lady Mary exist in any
century. They are the people who accept
the risks others are afraid to take. Nurses
meet them often during their careers - a
patient who undergoes a kidney trans-
plant, well aware of the hazards involved;
a mother who agrees to have her child,
suffering from leukemia, receive new,
experimental drugs. Without the fortitude
of these pioneers, medical progress would
be impossible, for people Uke these are
the real heroes in the continuing battle
against disease.
References
1. Steams, Raymond P. Remarks upon in-
troduction of inoculation for smallpox in
England. Bull, of the Hist, of Med.
24:103-22, Mar./Apr. 1950.
2. Beilin, Adolph. Edward Jenner,
1749-1823; great pioneer physician who
conquered scourge of smallpox. Hygeia
14:37-8, Jan. 1936.
3. Green, F.H.K. An eighteenth century
smallpox hospital. Brit. Med. Jr. 1:1 245-7,
17 June 1939.
4. MiUer, Genevieve. The Adoption of Inocu-
lation for Smallpox in England and France.
Philadelphia, Univ. of Pennsylvania Press,
1957, p.40.
5. Loc. cit.
6. Loc. cit.
7. Stearns, op. cit., p. 106.
8. Tobey, James A. Some famous victims of
smallpox. Hygeia 12:620-2, July 1934.
9. Ibid., p.dll.
10. Halsband, Robert, editor. The Complete
Letters of Lady Mary Wortley Montagu.
Oxford, aarendon Press, 1965. pp.338-9.
11. Loc. cit.
12. Halsband, op. cit. p.392.
13. Loc. cit.
14. Halsband, Robert. New light on Lady Mary
Montagu's contribution to inoculation. Jr.
of the Hist, of Med. & Allied Sciences. 7 &
8:390-405, 1953.
15. KJebs, Arnold C. The historic evaluation of
variolation. Bull, of the Johns Hopkins
Hosp. 24:69-83, March 1913.
16. Ibid., p.70.
17. Miller, op. cit., p.42-3.
18. Loc. cit.
19. Halsband, Jr. of the Hist, of Med. 4 Allied
Sciences, op. cit., p. 397.
20. Ibid., p.398.
21. Halsband, Jr. of the Hist, of Med. & Allied
Sciences, op. cit., p.404.
22. Williams, John Hargraves Harley. The Con-
quest of Fear. London, Jonathan Cape,
1952, p. 30.
23. Ibid., p.29.
24. Green, op. cit., p. 1245.
25. /Wd. p. 1246-7.
26. Halsband, Jr. of the Hist, of Med. & Allied
Sciences, op. cit., p.400-03.
27. Cove, Joseph Walter, (Gibbs, Lewis,
pseud.) The Admirable Lady Mary. Lon-
don, Dent, 1949, p.l32.
28. MiUer, op. cit., p.18-19.
29. Loc. cit. □
lULY 1969
Comprehensive Cardiac Care. A hand-
book for nurses and other paramedical
personnel, by Kathleen G. Andreoli,
Virginia K. Hunn, Douglas P. Zipes,
and Andrew G. Wallace. 153 pages.
Saint Louis, Mosby, 1968.
Reviewed by Mary Alexander, Lec-
turer in Medical-Surgical Nursing,
McMaster University, Hamilton, Ont.
This text describes the essentials of
comprehensive cardiac care with which
nurses and other paramedical personnel
should become familiar in order to
recognize the warning signs of cardio-
vascular emergencies and to implement
appropriate therapy promptly.
The text begins with a brief review of
the anatomy and physiology of the heart.
Each structure and its function are given
side by side with illustrations, which
facilitates easy review of the subject.
Following is a section on physical exami-
nation of the cardiovascular system; with
each method of diagnosis, the normal
manifestations, followed by the abnor-
mal, are explained. In describing coronary
heart disease and its complications, the
pathological manifestations according to
the type of blood vessel involved are
detailed, and a brief but complete des-
cription of clinical syndromes, such as
angina pectoris, myocardial infarction,
congestive heart failure and cardiogenic
shock is included. Related topics that
need to be reviewed (but an elaborate
description of which seems beyond the
scope of the book) are indicated in tables;
for example, the treatment of acute
pulmonary edema.
Basic electrocardiography is ably des-
cribed, perhaps in greater detail than
seems necessary for nurses and other
paramedical personnel. An understanding
of leads I, II, and III, as well as cardiac
arrhythmias, would have sufficed. Cardiac
arrhythmias are described with figures
according to their place of origin in the
heart. Prior to a description of this, the
electrical pattern of the cardiac cycle,
time lines of the electrocardiogram, the
method of calculating heart rate, and the
conduction of normal sinus rhythm are
well elaborated. The purpose, indications,
methods, and complications of temporary
as well as permanent cardiac pacemakers
are specified. The final chapter gives a
clear and comprehensive picture of the
care of the cardiac patient.
There are four appendices in this
book. Appendix A presents some of the
significant drugs in cardiac disorders.
JULY 1%9
Electrocardiogram tracings showing the
normal as well as toxic effects of digitalis
and quinidine are given. Appendix B
describes disorders other than myocardial
infarction and compares the nature of
chest pain in these, enabling one to
differentiate myocardial ischemia from
other clinical problems. Finally, appen-
dices C and D are two test selections that
are invaluable for a review of arrhythmias
and electrocardiography.
This book on the whole is an excellent
manual on cardiac care and a good source
for a quick review of the subject. A
reader with some background knowledge
of the cardiovascular system and its dis-
orders could well understand the subject
matter due to its clarity of style and
lucidity of expression, as well as the
illustrations and electrocardiogram
tracings that are included. Although brief,
the text is exhaustive and has definite
continuity from one chapter to the other.
Each chapter concludes with extensive
references. These features make it a
valuable reference book for nurses and
paramedical personnel.
Antibiotic and Chemotherapy,2nd ed. by
Lawrence P. Garrod and Francis
O'Grady. 475 pages. Edinburgh and
London, E. & S. Livingstone Ltd.,
1968. Canadian agent: Macmillan Co.
of Canada Ltd.. Toronto.
Reviewed by Dean M. J. Huston,
Faculty of Pharmacy, University of
Alberta, Edmonton, Alberta.
The preface to the first edition of this
book states that it is "mainly about
antibiotics, sulphonamides and other
synthetic drugs employed in the chemo-
therapy of microbic infections." This
welcome second edition is much more
than a textbook on materia medica or a
pharmacopoeia as that statement might
suggest.
The book is divided into two parts.
Part one, dealing with the properties and
uses of the antimicrobial drugs, has been
revised and brought up-to-date with the
addition of many newer antibiotics and
other synthetic antimicrobial drugs
currently in use. In addition, current
knowledge concerning the development
of drug resistance by various pathogenic
microorganisms and the mechanisms of
antimicrobial activity of many of the
drugs is presented concisely in tables and
figures.
Part two consists of a discussion of
current concepts in the treatment of most
of the common microbial infections. This
part of the book is an excellent source of
up-to-date information on causative
microorganisms and secondary invaders in
microbial infections. The various infec-
tions are grouped according to anatomical
location, which should facilitate use of
the book by clinicians. The information
presented in this section has been taken
from recent publications. Only the perti-
nent facts have been selected, condensed,
and compiled in a form that provides a
maximum yield of information in a mini-
mum reading time.
Laboratory workers will find the
second part of this book particularly
useful. It provides a compendium of
bacterial sensitivity tests and antibiotic
assay procedures, some of which may not
be found elsewhere.
At this time when the influence of 25
yean of antibiotic chemotherapy is being
reflected in unpredictable alterations in
what may be called the "traditional"
etiology and treatment of infectious
diseases, an up-to-date source of informa-
tion regarding current trends and con-
cepts is essential to all who treat infected
patients, work in pharmaceutical or clini-
cal laboratories, or advise clinicians.
History, School of Nursing, Toronto Gen-
eral Hospital, vol. 2, 1932-1%7, by
Mary E. Macfarland. 59 pages. Toron-
to, McGaw-Jordan Ltd., 1968.
Reviewed by Mrs. H.G.M. Colpitis,
President, Ottawa Chapter, Toronto
General Hospital Alumnae.
This soft-cover book recounts the his-
tory of the TGH School of Nursing,
providing the reader with a clear picture
of the progress and development during
the years 1932-1967.
A brief reference is made to the
inception of the training school. Of par-
ticular interest is the information that the
two nurses responsible for the training of
the first class of students were "to receive
each one hundred dollars a year for their
services in connection with the school."
The year was 1881.
It is refreshing to read a textbook
written by someone dedicated to her
work, who can transmit this enthusiasm
to the reader.
The book speaks of problems that
existed during the depression and war
years, and points out the dramatic and
rapid change of the last 20 years. It
clearly reflects the modern attitude
THE CANADIAN NURSE 37
books
toward nurses and nursing, and is almost
a chronicle of nursing itself.
While education of the student has
been broadened in scope and has under-
gone innumerable changes, social and
cultural activities have been recognized as
important aspects of development of the
person.
Included in the history, although not
part of it, are descriptions of new build-
ings, refurbishing, and refurnishing, which
vitally affect the School's functions. Trib-
ute is paid to many of the "history-
makers," whose record of service and
devotion is unparallelled.
The book is well and liberally
illustrated. Many of the pictures will
evoke a "do you remember? " from the
readers, particularly those who graduated
a few years ago.
Since both chronological and topical
approaches are used, the reader must
remain alert. The author has avoided
boring detail; she has condensed a proud
record of achievement into a fascinating
and very readable narrative.
Anyone who is charged with the task
of compiling a history of a school of
nursing will greatly benefit from this
volume. All TGH graduates and those
associated with the hospital will find the
book interesting and nostalgic.
Swift, effective
care in
life-threatening
situations!
1 iVt'M^ Book !
' INTENSIVE
NURSING CARE
Bv Zeb L. Burrell, Jr., M.D.
and Lenette O. Burrell, R.N., B.S.
• Essentials of intensive care for
diseases of all body systems!
• Logical explanation simplifies
highly technical material!
• Complete clinical guidance-
plus vital background
information!
The C. V. Mosby Company, Ltd.
86 Northline Road
Toronto 374, Ontario
Please send me a copy of Burrell-Bur-
rell, INTENSIVE NURSING CARE,
priced at about $9.65, on 30 day
approval.
□ bim me QPayment enclosed. (Same
return privilege.)
R N
Ar1r1rRS<i
r.ity
?nne
CN 769
Essentials of Communicable Disease With
Nursing Principles, by Dorothy F.
Johnston. 400 pages. Saint Louis,
Mosby, 1968.
Reviewed by Sally Tretiak, Red Deer
Junior College, Red Deer, Alberta.
The value of this smoothly written,
easy-to-read book lies in its comprehen-
siveness. It would be excellent for overall
teaching purposes.
The content is divided into six sec-
tions. The introduction deals with histori-
cal events, scope of control, immunology,
social, psychologic and economic factors,
and nursing patients with communicable
diseases. The remainder of the book
classifies diseases according to the causa-
tive factors, including bacteria, viruses,
arthropod vectors, fungi and helminths.
Each chapter has a list of references and
each section contains review questions, a
bibliography, and a listing of films that
could be used in conjunction with the
book.
The sections on nursing care give a
clear description of procedures. However,
the student would need a good back-
ground of physiology and microbiology
and a pathology reference at hand to
understand the specific disease processes.
For a comprehensive listing of commu-
nicable diseases in man and for methods
of their control, one would have to go to
official publications. No textbook can do
this, and this one rightly concentrates on
the nursing care of the patients.
The Operating Room Technician, 2nc
ed., by Sister Mary Louise. 282 pages
Saint Louis, Mosby, 1968.
Reviewed by Miss K.L, Cook, Heac
Nurse, Operating Room, Whitehorse
General Hospital, Whitehorse, Yukor,
Territory.
In the fore ward, the author stresses
the fact that, as a text, this book shoulc
be used in conjunction with a plannec
curriculum of training in practical operat
ing room duties.
The book, centered wholly on the
patient's welfare, is written in a clear anc
understandable way. Each chapter is
headed by a summary, or Hst of subject;
it contains and new terms that are in
troduced, making it easier for the studeni
to look up any reference. There are
questions at the end of each chapter.
The first chapter, which briefly out
lines hospital management, illustratec
with a graph, gives all the positions anc
services in a hospital and stresses the role
of the operating room technician in the
structure.
All the salient points of patient care
before, during, and after surgery are
covered. One excellent chapter, "essen-
tials for the procedure," covers sponges
their composition and uses, dressings
syringes, needles, connectors, and adap-
tors.
The book is well illustrated, anc
shows, step by step, such procedures ai
the "closed glove method," and opening
V-l VADEMECUM INTERNATIONAL V-l
Pharmaceutical Specialties and Biologicals
During the past years we have received many orders from Registered Nurses for VADEMECUM
INTERNATIONAL. We have not been able to fill some of these orders due to the limited
number of books available. If you w/ould like a copy of the 1970 edition, please order it
immediately to enable us to order an adequate supply from our printer to insure delivery
of your copy. There will be no other solicitation for your order. November delivery.
I 1
J. Morgan Jones Publications, Ltd.
6300 Park Avenue,
Montreal 8, P.Q.
Y-1 1970
I
Enclosed you will find my check or postal money order at the special R.N. rate of
$5.00. Please send to me the 1970 □ English or □ French (check language choice)
edition of VADEMECUM INTERNATIONAL as soon as printed.
I NAME
I ADDRESS
I CITY PROV.
38 THE CANADIAN NURSE
JULY 196'
suture packs and dressings. Sutures and
different types of needles are shown.
There are also illustrations of instruments
divided into group types, e.g., holding
forceps, clamps, retractors, and speculi.
Instead of interrupting the trend of a
chapter, the author has included 25
appendices that cover such subjects as the
objectives of each person in the operating
room, room clean-up routine, electro-
surgery in the operating room (including
an interesting short history), topical out-
lines of microbiology, pharmacology,
psychology, operating room funda-
mentals, and techniques. These would be
excellent guides for the operating room
instructor or supervisor who teaches stu-
dent technicians. D
Immediate Post-Surgical Prosthesis - 16
mm., 30 minutes, color and sound.
Available without charge on loan from
Miss Anne Gilbert, c/o Johnson &
Johnson, 2155 Boulevard Pie IX,
Montreal 403, P.Q.
Several case histories are described
that concern the management of lower
extremity amputees at the Prosthetic
Research Study in Seattle, Washington.
The psychological and economic advan-
tages of immediate post-surgical fitting
technique are illustrated effectively.
This film would be of special interest
to nurses working in the field of rehabili-
tation.
Overcoming Resistance to Change 16
mm., 28 minutes, black and white or
color, sound. Produced 1962. Sale
Price b/w $185, color $315. Available
on loan from Canadian Film Institute,
1762 Carling Ave., Ottawa, for a small
rental fee.
This film outlines how various people
react to proposed change and how each
one is taught to deal with it effectively.
Employees in a business situation are
unhappy about moving to a new plant.
Their manager is shown gaining sudden
insight into their problems and then
presenting specific ways to deal with
each. Although this film is not new, it
demonstrates well the fundamental prin-
ciples that are applicable to any situation
involving change.
It is well-organized and clearly present-
ed, and would be a good training film for
nursing personnel.
JULY 1969
Robin, Peter, and Darryl: Three to a
Hospital - a new 16 mm., 53-minute,
black and white motion picture devel-
oped by the multidisciplinary faculty
of the Department of Nursing, Faculty
of Medicine at Columbia University.
Available on loan from the Canadian
Film Institute, 1762 Carling Avenue,
Ottawa, for a small rental fee.
Events in the film are not staged.
Rather, the camera captures the fears,
tears, and frustrations of the three chil-
dren as they express them during their
hospital stay. The film would be useful to
teach nursing students about effects of
maternal separation and children's reac-
tions to hospitalization. Content and
technique are designed to stimulate the
student's imagination and eHcit classroom
discussion.
Emergency 77 - 16 mm., 14 minutes,
black and white, sound. Available
without charge on loan from Metropo-
litan Life Insurance Company, 180
Wellington St., Ottawa 4.
This film presents several emergency
situations faced by individuals, their fa-
milies, and their doctor in a typical
community. The importance of knowing
what to do quickly in an emergency
requiring medical attention is well docu-
mented and is based on actual emergen-
cies. Emphasis is placed on avoiding panic
through knowledge, planning, and prac-
tice. As a teaching tool it is suitable for
anyone concerned with his own health
and safety and the well-being of family
and community.
The Way I See It - 16 mm., 23 minutes,
black and white, sound. Available on
loan from Canadian Film Institute,
1762 Carling Ave., Ottawa, for a small
rental fee.
This is an open-ended film designed to
stimulate thought and discussion on such
questions as:
1. To what extent do perceptual differ-
ences influence job performance?
2. Why do people see themselves so
differently from the way others see
them?
3. How can a manager know what his
people think of him?
May be useful for preparing head
nurses to function in managerial posi-
tions, or supervisors to evaluate per-
sonnel.
Hyperbaric Fire Control — Fire Behavior
and Extinguishment in Hyperbaric
Chambers - 16 mm., 20 minutes,
color, sound. Prepared in 1965 by
Roman L. Yanda, M.D., Los Angeles,
in cooperation with the Los Angeles
City Fire Department, California State
Fire Marshals Office. Indicate desired
and alternate showing dates. Available
on loan from: Film Library, USAF
School of Aerospace Medicine, Brooks
AFB, Texas 78235.
Hyperbaric oxygen therapy is a new
technique being developed for the treat-
ment of certain disease conditions. Al-
though it is still experimental, the techni-
que is being utilized in this country and
in Europe on an increasing scale. One of
the serious problems associated with
hyperbaric oxygenation is the fire hazard.
Anything that burns in air ignites more
readily and burns more rapidly in oxygen
or in compressed air.
This film depicts graphically the fire
hazards associated with the use of a
hyperbaric chamber. Mannequins dressed
in conventional hospital clothing are set
afire in atmospheres of compressed air to
demonstrate vividly how rapidly cotton
fabrics will burn and how difficult the
fires are to extinguish. Smothering with
blankets is ineffective. Large volumes of
water are required. Shown and discussed
are extinguishment techniques, methods
of mitigating fire hazards, and suggestions
for fire safety programs in hospitals in
which hyperbaric facilities are in use.
This motion picture is directed at all
levels of personnel involved in hyper-
baric-facility design, operation, and main-
tenance. Physicians, nurses, chamber
technicians and operators, and hospital
engineers and architects who are concern-
ed with the use of a hyperbaric chamber
will find much valuable information. It is
not recommended for showing to lay
groups in general since a potential candi-
date for hyperbaric therapy might refuse
needed treatment were he to view the
vivid fire scenes. D
accession list
Publications on this list have beenre-
ceived recently in the CNA library and
are listed in language of source.
Material on this list, except reference
items, which include theses and archive
books that do not circulate, may be
borrowed by CNA members, schools of
nursing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List"
and should be addressed to: The Library,
Canadian Nurses' Association, 50 The
Driveway, Ottawa 4, Ontario.
No more than three titles should be
requested at any one time. If additional
titles are desired, these may be requested
when you return your loan.
Stamps to cover payment of postage
from library to borrower should be in-
cluded when material is returned to CNA
library.
THE CANADIAN NURSE 39
accession list
BOOKS AND DOCUMENTS
1. Abregi de psychiatric; a I'usage de I'iqui-
pe medico-psychologique par Michel Anty. Pa-
ris, Masson, 1968. 247p.
2. Accreditation - a cooperative function;
report of the 1968 regional workshops of the
Council of Diploma Programs. New York,
National League for Nursing, Dept. of Diploma
Programs, 1969. 54p.
3. Actualites cardio-vasculaires midico-
chirurgicales publiees sur la direction de R.
Froment, A. Gonin, et P. Michaud. 4ieme serie.
Phonomecano-cardiographie correlations hemo-
dynamiques. Paris, Masson, 1968. 365p.
4. American Nurses' Association clinical ses-
sions, 1968, Dallas. New York, Appleton-
Century-Qofts, 1968. 357p.
5. Anatomy and physiology; 1500 multiple
choice questions and referenced answers edited
by Marguerite C. Holmes and Marvin I. Gott-
lick. Flushing, N.Y., Medical Examination
Publishing, cl 966. 155p.
6. Association dues structure: theory and
practice. Washington, American Society of As-
sociate Executives, cl969. 64p.
7. Basic sciences; 1800 multiple choice
questions and referenced answers edited by
Marguerite C. Holmes et ai. Flushing, N.Y.,
Medical Examination Publishing, cl964. 183p.
8. Bedside nursing techniques in medicine
and surgery by Audrey Latshaw Sutton. 2d ed.
Philadelphia, Saunders, 1969. S'JSp.
9. A bibliography of nursing literature
1959-1960 with an historical introduction
edited by Alice M.C. Thompson. London,
Library Association for the Royal College of
Nursing and National Council of Nurses of the
United Kingdom in association with King Ed-
ward's Hospital Fund for London, 1968. 132p.
10. The Canadian Centenary Council,
1959-1967 hy Anne Hanna. Ottawa, 1968. 60p.
11. Communicating nursing research; the
research critique edited by Marjorie V. Batey.
Boulder, Co., Western Interstate Commission
for Higher Education, 1968. 170p.
12. Community planning for nursing by F.
Robert Paulsen and Barbara L. Tate. New York,
National League for Nursing, 1969. 49p.
13. Comprehensive cardiac care; a hand-
book for nurses and other paramedical person-
nel by Kathleen G. Andreoli et al. St. Louis,
Mo., Mosby, 1968. 153p.
14. La croix-rouge Internationale par Henri
Coursier. Paris, Presses Universitaires de France
1962. 128p.
15. Directory of special collections in Cana-
dian libraries by Janet Fyfe and Raymond H.
Deutsch. Ottawa, Canadian Library Associa-
tion, 1968. (Its Occasional Paper no. 68).
16. Essentials of communicable disease with
nursing principles by Dorothy F. Johnston.
Saint Louis, Mo., Mosby, 1968. 400p.
17. Frontiers of collective bargaining edited
by John T. Dunlop and Neil W. Chamberlain.
New York, Harper & Row, 1967. 318p.
40 THE CANADIAN NURSE
18. Guidebook for the hospital patient by
Herman Schwartz and Michel Lipman. North
Hollywood, Brandon House, cl968. 178p.
19. Howarth & Smith's new standards for
the printed word; a guide to better typographic
communication. Toronto, Howarth & Smith
Monotype, 1968. 5 2p.
20. L 'hygiine des voyages par Francois Pa-
ges. Paris, Presses Universitaires de France,
1968. 124p. (Que sais je? no. 1307).
21. The logic of collective action; public
goods and the theory of groups by Mancur
Olson. New York, Schocken, cl965. 176p.
22. Looking ahead to retirement; discussion
guide. Washington, United Steelworkers of
America. Committee on Retired Workers, 1960.
369p.
23. Management of nursing care by Elma L.
Rinehart. New York, Macmillan, cl969. 243p.
24. Maternal and child health nursing; 1500
multiple choice questions and referenced
answers edited by Joanne K. Griffen et al. 2d
ed. Rushing, N.Y., Medical Examination Pub-
lishing, cl968. 256p. (Nursing examination
review book, no. 3).
25. Medical-surgical nursing; 1500 multiple
choice questions and referenced answers edited
by Marguerite C. Holmes and Harriet Levine. 2d
ed. Flushing, N.Y., Medical Examination Pub-
lishing, cl967. 216p. (Nursing examination
review book, no. 1).
26. Nursing challenges in cardiovascular and
metabolic disease edited by Beatrice Marino.
(In Nursing clinics of North America
4:1:121-189, March, 1969).
27. Nursing of mother and child edited by
Reva Rubin and Florence Erickson. (In Nursing
cUnics of North America 4:1:1-120, March,
1969).
28. Nutrition and diet therapy by Sue
Rodwell Williams. Saint Louis, Mo., Mosby,
1969. 686p.
29. Pharmacology; 1500 multiple choice
questions and referenced answers edited by
Maurice B. Feinstein and Harriet Levine.
Flushing, N.Y., Medical Examination Publish-
ing, cl966. 182p. (Nursing examination review
book, no. 6).
30. The photography of H. Armstrong Ro-
berts, vol. 14. Philadelphia, 1969. 96p.
31. Precis de contraception par Pierre Si-
mon avec la collaboration de J.-P. Goiran. Paris,
Masson, 1968. 271 p.
32. Principles and methods of sterilization
in health sciences by John J. Perkin.s. 2d ed.
Springfield, lU., Charles C. Thomas, cl969.
560p.
33. Proceedings of the American Nurses'
Association, House of Delegates, 1968. New
York, 1969. 103p.
34. Proceedings of the California Nurses'
Association Institute on the Medico-Legal As-
pects of Nursing Practice, Nov. 3-4, 1961, Santa
Monica, Calif San Francisco, Calif., California
Nurses' Association, 1962. 163p.
35. Psychiatric nursing; 1500 multiple
choice questions and referenced answers edited
by Frances B. Arje, Charlotte H. Martin, and
L-ene N. SeU. 2d ed. Flushing, N.Y., Medical
Examination Pubhshing, cl967. 199p. (Nursing
examination review book, no. 2).
36. Reeducation musculaire a base de re-
flexes posturaux par W. van Gunsteren, O. de
Richemont, et L. van Wermeskakon. Paris,
Masson, 1968. 25 3p.
37. The report of the Task Force on Cana-
dian Industrial Relations, the Woods Report.
Don Mais, Ont, Canadian Labour Law Reports,
1969. 83p.
38. The second 20 years; papers delivered at
a regional convocation on higher education in
the South. Atlanta, Ga., Southern Regional
Education Board, 1968. 84p.
39. Sociology in hospital care by Emily
Mumford and James K. Skipply, Jr. New York,
Harper & Row, cl967. 228p.
40. Special libraries in Canada; a directory
compiled by Beryl L. Anderson. Rev. ed.
Ottawa, Canadian Library Association, 1968.
21 7p. (Its Occasional paper no. 73).
41. Toward collective bargaining in non-
profit hospitals: impact of New York law by
Sara Gamm. Ithaca, N.Y., New York State
School of Industrial and Labor Relations, 1968.
112p.
42. Trends in health and hospital care; chart
book 1968; a Joint program of the Canadian
Hospital Association and the Dominion Bureau
of Statistics. Toronto, Canadian Hospital Asso-
ciation, 1969.
43. Urology for nurses by J.P. Mitchell.
Bristol, Wright, 1965. 324p.
PAMPHLETS
44. Associate degree education for nursing.
New York, National League for Nursing. Dept.
of Associate Degree Programs, 1969. 6p.
45. Collective bargaining progress report,
1945-1968. Toronto, Registered Nurses' Asso-
ciation of Ontario, 1969. 125p.
46. College and university audio-visual cen-
tres by Eleanor Barteaux Haddow. Ottawa,
Canadian Library Association, 1960. 28p. (Oc-
casional paper no. 25).
47. Film catalogue. Montreal, Canadian Red
Cross Society. Quebec Provincial Division. 15p.
48. Local union handbook; older and re-
tired workers plans, programs and services in
the field of the Aging. Washington, United
Steelworkers of America. Committee on Older
and Retired Workers, 1960. 31p.
49. Looking ahead to retirement; manual
for discussion leaders. Washington, United
Steelworkers of America. Committee on Re-
tired Workers, 1960. 43p.
50. Master's education; route to opportu-
nities in modern nursing. New York, National
League for Nursing. Dept. of Baccalaureate and
Higher Degree Programs, 1969. 15p.
51. Pensioners in search of a Job; what
prospects are there of part-time employment?
by F. Le Gros Clark. London, Pre-Retirement
Association, 1968. 31 p.
52. Principles of legislation for nursing edu-
cation and practice; a guide to assist national
nurses associations. Basel, Switzerland, S.
Karger for International Council of Nurses,
1969. 40p.
53. Report of the study on home care
services submitted to the advisory planning
lULY 1969
committee on home care services. Regina,
Saskatchewan Registered Nurses' Association.
Study Committee on Home Care Services,
1961. 30p.
54. Selected bibliographies on long term
care facilities effective September 25, 1968.
New York, National League for Nursing. Dept.
of Hospital Nursing, 1968. 18p.
55. Summary of a survey of library techni-
cian training courses in Alberta, British Co-
lumbia, Manitoba and Ontario. 1967-1968 by
Marion C. Wilson and June Munroe. Ottawa,
Canadian Library Association, 1968. 4p. (Occa-
sional paper no. 71).
56. Toronto, Home Care Program report
1967-1968. Toronto, 1968. lip.
57. Towards an unambiguous profession? A
review of nursing by Odin W. Anderson. Chica-
go, Center for Health Administration Studies,
1968. 38p. (Health administration perspectives
no. 46).
GOVERNMENT DOCUMENTS
Canada
58. Dept. of Labour. Economics and Re-
search Branch. The collective agreement in
Canada; the study of its contents and of its role
in a changing industrial environment, 1967.
Ottawa, 1967. 115p.
59. . Labour organizations in Carui-
da. 57th ed. Ottawa, Queen's Printer, 1968.
112p.
60. Dept of Manpower and Immigration.
Canada's manpower requirements in 1970 by
Noah M. Metz and G. Peter Penz. Ottawa,
Queen's Printer, 1968. 68p.
61. Dept. of National Health and Welfare.
Research and Statistics Directorate. far/iiVigxo/
dentists in Canada, 1959-1965. Ottawa, 1968.
42p. (Its Health care series memorandum no.
22).
62. Dominion Bureau of Statistics. Hospital
morbidity, 1960. Ottawa, Queen's Printer,
1964. llOp.
63. . Hospital morbidity, 1961. Ot-
tawa, Queen's Printer, 1966. 123p.
64. . List of Canadian hospitals and
related institutions and facilities, 1969. Ottawa,
Queen's Printer, 1969. 64p.
65. Ministere du Travail. Direction de I'eco-
nomique et des recherches. Greves et lock-out
au Canada, 1966. Ottawa, Imprimeur de la
Reine, 1968. 84p.
66. National Film Board of Canada. Film
catalogue 1969. Ottawa, Queen's Printer, 1968.
108p.
67. Task Force in Canadian Industry Rela-
tions. Canadian industrial relations; report of
the Task force on Labour Relations. Ottawa,
Queen's Printer, 1969. 250p.
USA
68. Dept of Health, Education and Welfare.
Public Health Service. Progress against cancer
1969; a report by the National Advisory Cancer
Council. Washington, U.S. Gov't. Print. Off.,
1969. 83p.
69. National Center for Health Statistics.
Chronic conditions causing activity limitations.
United States, July 1963- June 1965. Washing-
ton, U.S. Public Health Service, 1969. 48p. (Its
Vital and Health Statistics, series 10, no. 51).
70. Public Health Service. Psychological and
social aspects of human tissue transplants; an
annotated bibliography by Jacquelyn H. Hall
and David D. Swenson. Washington, U.S. Gov't.
Print. Off., 1968. (U.S. Public Health Service
publication no. 1838).
STUDIES DEPOSITED IN
CNA REPOSITORY COLLECTION
71. Effects of interpersonal difference, so-
cial distance, and social environment on the
relationship between professionals and their
clientele by Ruth C. MacKay. Lexington, 1969.
146p. Theses - Kentucky. R
72. Evaluative research in nursing education
by Moyra Allen. (In McGill University, School
for Graduate Nurses. Nursing papers. Montreal,
April 1969. p.9-16). R
73. Learning to nurse patients in labor by
Helen Moogk. (/n McGill University. School for
Graduate Nurses. Nursing papers. Montreal,
April 1969. p.6-8). R
74. The role of the nurse midwife in family
planning by Ruby Norma Eliason. Seattle,
1968. 82p. Theses (M.N.) - Washington. R
75. Sensory deprivation as demonstrated by
loneliness in the patient who is isolated because
of a communicable disease by M. Marguerite
Hornby, Virginia M. Dondero, and Patricia A.
Creniins. Boston, 1968. Theses (M.N.) - Bos-
ton. R □
Request Form for "Accession List"
CANADIAN NURSES' ASSOCIATION LIBRARY
Send this coupon or facsimile to:
LIBRARIAN, Canadian Nurses' Association, 50 The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in the issue of The
Canadian Nurse, or add my name to the waiting list to receive them when available:
Item Author Short title (for identification)
No.
Requests for loans will be filled in order of receipt.
Reference and restricted material must be used in the CNA library.
Borrower Registration No.
Position
Address
Date of request
JULY 1969
THE CANADIAN NURSE 41
classified advertisements
ALBERTA
ALBERTA
BRITISH COLUMBIA
DIRECTOR OF NURSING required for
modern 30-bed General Hospital in Central
Alberta. Applications to include experience,
qualifications and references. Salary negotiable.
Suite available in modern residence. Apply to:
Administrator, General Hospital, Bashaw, Al-
t>erta.
DIRECTOR OF NURSING SERVICE for
70-bed hospital (accredited). Preparation for
nursing administration required. Salaries com-
mensurate with qualifications and preparation.
Apply to: Administrator, St. Joseph's General
Hospital, Vegreville, Alberta.
REGISTERED NURSES required for GENER-
AL DUTY in 22-bed active treatment hospital.
Established personnel policies and pension plan.
Salary range $425 — $495. Adjustments made
for previous experience. Residence accommoda-
tion available. Apply to: IVIatron-Administrator,
Consort Municipal Hospital No. 22, Consort,
Alberta^
REGISTERED NURSES FOR GENERAL
DUTY in a 34-bed hospital. Salary 1968,
$405-$485. Experienced recognized. Residence
available. For particulars contact: Director of
Nursing Service, Whitecourt General Hospital,
Whitecourt, Alberta. Phone: 778-2285.
GENERAL DUTY NURSES for active, ac-
credited, well-equipped 65-bed hospital ingrow-
ing town, population 3,500. Salaries range from
$405— $485 commensurate with experience,
other benefits. Nurses' residence. Excellent per-
sonnel policies and working conditions. New
modern wing opened in 1967. Good communica-
tions to large nearby cities. Apply: Director of
Nursing, Brooks General Hospital, Brooks. Al-
berta.
ADVERTISING
RATES
FOR ALL
CLASSIFIED ADVERTISING
$11.50 for 6 lines or less
$2.25 for each additional line
Rates for display
advertisements on request
Closing date for copy and cancellation is
6 weeks prior to 1st day of publication
month.
The Canadian Nurses' Association does
not review the personnel policies of
the hospitals and agencies advertising
in the Journal. For authentic information,
prospective applicants should apply to
the Registered Nurses' Association of the
Province in which they ore interested
in working.
Address correspondence to;
The
Canadian ^o.
Nurse ^^'
50 THE DRIVEWAY
OTTAWA 4, ONTARIO.
GENERAL DUTY NURSES (2) for small mod-
ern Hospital on Highway No. 12. East Central
Alberta. Salary range $430 to $510 including
Regional Differential. Residence available. Per-
sonnel policies as per AARN and A. H. A. Apply:
Director of Nursing, Coronation Municipal Hos-
pital, Coronation, Alberta.
GENERAL DUTY NURSES for 94-bed General
Hospital located in Alberta's unique Badlands.
$405— $485 per month, approved AARN and
AHA personnel policies. Apply to: IVliss M.
Hawkes, Director of Nursing, Drumheller Gene-
ral Hospital, Drumheller, Alberta.
GENERAL DUTY NURSES required for
140-bed active treatment hospital located in the
Peace River Country. Usual employment bene-
fits and residence available. 1968 salary
$405 — $485, 1969 being negotiated. Experi-
ence recognized. For particulars contact: Di-
rector of Nursing, Grande Prairie Municipal
Hospital, Grande Prairie, Alberta.
GENERAL DUTY NURSES for 64-bed active
treatment hospital, 35 miles south of Calgary.
Salary range $405— $485. Living accommoda-
tion available in separate residence if desired.
Full maintenance in residence $50.00 per month.
Excellent Personnel Policies and working condi-
tions. Please apply to: The Director of Nursing,
High River General Hospital, High River, Alber-
ta.
GENERAL DUTY NURSES for summer relief
or permanent positions required for 50-bed
active treatment hospital with six practicing
doctors. 1968 salary, $405 to $485. Past
experience recognized. 1969 salary under re-
view. Residence accommodation available. Lo-
cated on main highway between Calgary and
Edmonton. Apply to: Mrs. E. Harvie R.N.,
Administrator, Lacombe General Hospital, La-
combe, Alberta.
GENERAL DUTY NURSES are required by a
230-bed, active treatment hospital. This is an
ideal location in a city of 27,000 with summer
and winter sports facilities nearby. 1968 salary
schedule $405 — $485. 1969 schedules present-
ly under negociation. Recognition given for
previous experience. For further information
contact: Personnel Officer, Red Deer General
Hospital, Red Deer, Alberta.
GENERAL DUTY NURSING POSITIONS are
available in a 100-bed convalescent rehabilitation
unit forming part of a 330-bed hospital complex.
Residence available. Salary 1967 — $380 to
$450 per mo. 1968 — $405 to $485. Experience
recognized. For full particulars contact Director
of Nursing Service, Auxiliary Hospital, Red Deer,
Alberta.
BRITISH COLUMBIA
EVENING COORDINATOR required for a
New Modern Hospital designed with the Friesen
Concept of Supply — Distribution. Acute Unit
75-beds. Extended Care Unit 35-beds. Bachelor
Degree in Nursing and previous supervisory
experience desirable. Apply to: Director of
Patient Care, Cranbrook and District Hospital,
Cranbrook, B.C.
COME TO PACIFIC NORTHWEST — Gateway
to Alaska, Friendly community, enjoyable
Nurses' Residence accommodation at minimal
cost. RNABC contract in effect. Salaries — Re-
gistered $508 to $633, Non-Registered $483,
Northern differential $15 a month. Travel allow-
ance up to $60 refundable after 12 months serv-
ice. Apply to: Director of Nursing, Prince Rupert
General Hospital, 551-5th Avenue East, Prince
Rupert, British Columbia.
B.C. R.N. FOR GENERAL DUTY in 32 bed
General Hospital. RNABC 1969 salary rate
$508— $633 and fringe benefits, modern, com-
fortable, nurses' residence in attractive com-
munity close to Vancouver, B.C. For application
form write: Director of Nursing, Fraser Canyon
Hospital, R.R. 2, Hope, B.C.
GENERAL DUTY NURSES (2) required for
New Modern Hospital designed with the Friesen
Concept of Supply — Distribution. Acute Unit
75-beds. Extended Care Unit 35-beds. RNABC
policies in effect. Hospital located in the
beautiful East Kootenays. Apply to: Director
of Patient Care, Cranbrook and District Hos-
pital, Cranbrook, B.C.
GENERAL DUTY NURSES for active 30-bed
hospital. RNABC policies and schedules in ef-
fect, also Northern allowance. Accommodations
available in residence. Apply: Director of Nurs-
ing, General Hospital, Fort Nelson, British
Columbia.
GENERAL DUTY NURSES for new 30-bed hos-
pital located in excellent recreational area. Salary
and personnel policies in accordance with
RNABC. Comfortable Nurses' home. Apply: Di-
rector of Nursing, Boundary Hospital, Grand
Forks, British Columbia.
GENERAL DUTY NURSES for 37-bed Acute
Hospital in Southwestern B.C. Salary: $508 —
$633 plus shift differential. Credit for past
experience. RNABC Personnel Policies in
effect. Accommodation available in Residence.
Apply to: Director of Nursing, Nicola Valley
General Hospital, P.O. Box 129, Merritt, B.C.
GENERAL DUTY NURSES for 63-bed active
hospital in beautiful Bulkley Valley Boating,
fishing, skiing, etc. Nurses' residence. Salary
$498—523, maintenance $75; recognition for
experience. Apply: Director of Nursing, Bulkley
Valley District Hospital, Smithers, British
Columbia.
GENERAL DUTY AND PRACTICAL NURSE
needed for 70-bed General Hospital on Pacific
Coast 200 miles from Vancouver. RNABC
contract, $25 room and board, friendly com-
munity. Apply: Director of Nursing, St. George's
Hospital, Alert Bay, British Columbia.
GENERAL DUTY, OPERATING ROOM AND
EXPERIENCED OBSTETRICAL NURSES for
434-bed hospital with school of nursing. Salary:
$508— $633, these rates are effective January
1969, plus shift differential. Credit for past expe-
rience and postgraduate training. 40-hr. wk.
Statutory holidays. Annual increments; cumula-
tive sick leave; pension plan; 20 working days
annual vacation; B.C. registration required.
Apply: Director of Nursing, Royal Columbian
Hospital, New Westminster, British Columbia.
GENERAL DUTY and OPERATING ROOM
NURSES for modern 450-bed hospital with
School of Nursing. RNABC policies in effect.
Credit for past experience and postgraduate
training. British Columbia registration is re-
quired. For particulars write to: The Associate
Director of Nursing, St. Joseph's Hospital,
Victoria, British Columbia.
GRADUATE NURSES required for 30-bed
hospital in interior B.C. Salaries and conditions
in accordance with RNABC agreement. Excel-
lent accommodation available at an attractive
rate. Apply: Director of Nurses, Lady Minto
Hospital, Ashcroft, B.C.
GRADUATE NURSES FOR GENERAL DUTY
in modern 225-bed hospital in city (20,000) on
Vancouver Island. Personnel policies in accor-
dance with RNABC policies. Direct inquiries
to: The Director of Nursing, Regional General
Hospital, Nanaimo, B.C.
GRADUATE NURSES for 24-bed hospital,
35-mi. from Vancouver, on coast, salary and
personnel practices in accord with RNABC.
Accommodation available. Apply: Director of
Nursing, General Hospital, Squamish, British
Columbia.
MANITOBA
42 THE CANADIAN NURSE
DIRECTOR OF NURSES for a 17-bed General
Hospital located in southeastern Manitoba.
Residence available, 4 weeks vacation after 1
year of service. Salary negotiated. For further
information, write to: Director of Nurses, Vita
District Hospital, Vita, Man.
JULY 1969
August 1969
''o^J'or ,
Of
tie
OF
4 /; .
i.
12-
69-
*4C.
il-6
The
Canadian
Nurse
the nursing world
meets in Canada
team work: the way
to play the game
mind your own business
jSsa^>^B&s,^ffiu-^^
Use Abbott's Butterfly Infusion Set
in an adult arm?
Certainly. The fact is, today more Abbott
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arms and hands, etc., than in infant
scalps.
Good reason.
Abbott's Butterfly Infusion Set simplifies
venipuncture in difficult patients. It has
proved fine in squirming infants. But it has
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and in oldsters with fragile, rolling veins.
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ultraflexible tubing, and stabilizing wings
tend to prevent needle movement, and to
avoid vascular damage.
Folding Butterfly Wings
The Butterfly wings are flexible. Like a
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ing. They let you manoeuver the needle
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Then, once the needle is inserted, the
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Five Peel- Pack Sets
To accommodate patients of various ages,
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The sets are supplied m sterile "peel-
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436Y
E ■
1 PERSONAL AND VOCATIONAL
RELATIONSHIPS IN PRAHICAL
NURSING - New (3rd) Edition!
By Carmen F. Ross, R.N., M.A.
Extensively reorganized, expanded, and with a new format, this text
Is ideal for either the basic course in relationships, or programs
where the subject is integrated into the curriculum. A t°ble of
chapter-by-chapter references to major textbooks in the field adds
increased flexibility. New or expanded material is included on
reading assignments and the PQRST method; modifications in nursing
organizations; and such current socio-culturol problems as the
battered child, drug abuse, alcohol consumption and cigarette smoking.
A new Instructor's Guide provides answers to all questions in the
text, and numerous suggestions ore offered for course enrichment.
266 Pages llhiitrafed 3rd Edition, 1969 (Ready) Paperbound, $3.50
2 TEXTBOOK OF BASIC NURSING
By Ella M. Thompson, R.N., B.S., and
Constance Murphy, R.N., B.S.
For clarity and comprehensive coverage this book has no peer. In-
corporating recent concepts in nursing care, the text includes the life
sciences, pharmacology and drug administration, conditions of illness
maternity-child nursing and the family. Interpersonal relationships and
psychological considerations are interwoven throughout.
752 Pages
204 Illustrations
1966
$8.00
5. PRAaiCAL NURSING WORKBOOK
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By Claire P. Hoffman, R.N., M.A., and
Gladys B. Lipkin, R.N., B.S.
An entirely new workbook that covers concepts and procedures basic
to patient care. Chapter-by-chapter page references to five major
practical nursing texts permit extreme latitude in the use of literature.
Questions include: body structure and function; fundamentals of nurs-
ing; conditions of illness; maternal and child care; geriatric nursing;
nutritional requirements; personal and vocational relationships; family
living; the hospital and the community health team. A separate book-
let, available to instructors, supplies the answers to every question
in the book.
306 Pages 48 Illustrations 1969 (Ready) Perforated and DrHled
Paperbound, $4.00
6 PRACTICAL NURSING STUDY GUIDE
AND REVIEW
By Zella von Gremp, M.A., R.N., and
Lucile Broadwell, R.N., M.S.
This combination review-workbook has been substantially broadened
to include a review of general nursing content; personal and voca-
tional relationships; administration of medications; principles and con-
cepts of rehabilitation. Patient-centered material is supplemented by
over 1000 questions. Perforated answer sheets are bound in.
333 Pages 66 Illustrations 2nd Edition, 1965 Paperbound, $5.00
3 INTRODUCTORY MAMNITY NURSING
By Doris C. Bethea, R.N., M.S.
The responsibilities of the practical nurse in caring for mothers and
infants are thoroughly covered in this sensitively-written book. Included
ore current concepts of obstetrical management, as well as funda-
mental nursing procedures. The what and why of nursing core ore
explained in addition to the how.
1968 Paperbound, $4.00
223 Pages
83 Illustrations
^ PRACTICAL NUTRITION
By Alice B. Peyton, M.S.
Ideal OS a basic text for practical nursing students, this popular book
provides a wide range of information on both normal and therapeutic
nutrition as well as food economics. The Appendix includes numerous
tables, a carefully-selected list of references, and a section on prob-
lems and questions for chapter-by-chapter review.
434 Pages Illustrated
2nd Edition, 1962
Paperbound, $3.75
4 THE HUMAN BODY IN HEALTH
AND DISEASE
By Ruth Lundeen Memmler, M.D.
A text and reference, fusing the basic sciences, that meets the needs
of practical nurses. To support the nurse's understanding of structure
and function, the body as a whole is explained by contrast under
normal and abnormal conditions. Each new term is carefully defined,
and the interrelationships of anatomy, physiology, pathology, and
elements of microbiology ore graphically presented.
372 Pages Illustrated 2nd Edition, 1962 Paperbound, $3.50
8 SIMPLIFIED NURSING
By Claire P. Hoffman, R.N., M.A., Gladys B. Lipkin,
R.N., B.S., and Ella M. Thompson, R.N., B.S.
Full coverage of pertinent material from anatomy and physiology
through specific nursing measures in the major clinical areas is
offered in this revised version of a favorite text. This book is ideal
for use in intensive courses for nursing assistants, home health aides,
psychiatric technicians — and as a suitable "shorter" text for practical
nursing. Not only how to give nursing core is explained, but the
reasons behind each step.
692 Pages
112 Illustrations Plus on 8-Page Color Insert
8th Edition, 1968 Paperbound, $5.25
ffta
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60 FRONT ST. WEST
TORONTO, CANADA
Please send me the books I have circled: 12 3 4
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Lippincott books are on approval and are returnable
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CNJ 8-69
2 THE CANADIAN NURSE
AUGUST 1969
The
Canadian
Nurse
^
^^p
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 8
August 1%9
29 Team Work: The Way To Play The Game F. Howard
30 ICN Congress Report
40 A Challenge That Confronts Us Hon. John Munro
44 Laval University Accepts A Challenge J. Brunet and C. Gagnon
46 Mind Your Own Business C. Dutrisac
The views expressed in the various articles are the views of the authors and do not
necessarily represent the poHcies or views of the Canadian Nurses' Association.
4 Letters
7 News
21 Names
23 Dates
24 New Products
26 In a Capsule
49 Research Abstracts
50 Books
54 Accession List
80 Official Directory
Executive Director: Helen K. Mussallem •
Editor: Virginia A. Lindabiu^ • Assistant
Editor: Eleanor B. Mitchell • Editorial Assist-
ant; Carol A. Kodarsky • Circulation Man-
ager: Beryl Darling • Advertising Manager:
Rnth H. Baomel • Subscription Ra^es: Can-
ada: One Year, $4.50; two years, $8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Six weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
© Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in india ink on white paper)
are welcomed with such articles. The editor
is not committed to publish all articles
sent, nor to indicate definite dates of
publication.
Postage paid in cash at third class rate
MONTREAL, P.O. Permit No. 10,001.
50 The Driveway, Ottawa 4, Ontario.
The bang of the gavel that officially
closed the 14th Quadrennial Congress of
the International Council of Nurses in
Montreal on Friday June 27 brought mixed
feelings to many: relief that the event -
so long planned for — was over; and
regret that it had ended so quickly.
The amount of detailed planning and
work that went into this congress is un-
believable. That the congress was a
success is due to the efforts of hundreds
of persons.
We got a fair amount of feedback from
nurses at the congress. These nurses
found the church service at Notre-Dame
Cathedral to be the most inspiring event.
Although it was extremely hot and crowdec
they sensed a real feeling ot oneness.
The opening ceremony on Sunday night wa
listed by these nurses as the most color-
ful event. They were particularly impress-
ed by the dignity, warmth, and humor of
the Governor-General.
Canada's Minister of Health, the
Honourable John Munro, received the most
votes from these nurses as best speaker of
the week. Also high in their estimation
were the special interest sessions.
We would be departing from our usual
practice of editorial frankness if we
ignored the criticisms voiced by these
nurses. They complained about the registra-
tion lineups; the mediocre acoustics in
Concordia Hall, particularly for those who
had to rely on earphones for translation;
the problems they had in seeing the speak-
ers when the dias on the platform was not
revolving; and the impossibility, because
of the number of persons attending the
congress, of feeling a sense of "imity"
with others.
These nurses agreed, however, that
the congress had been a tremendous success.
As evidence, they expressed the hope that
they could find the time and funds to
attend the 1 5th Quadrennial Congress in
Mexico in 1973. - V.A.I.
THE CANADIAN NURSE 3
letters {
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Two-year vs. three-year programs
I am gratified to see the active think-
ing going on in the minds of Canadian
nurses in reading our article "Two-Year
Versus Three-Year Programs (Feb. 1969).
However, while we might be to blame for
not having used block letters in printing
some of the key points in this report, I
believe the readers would do well to get
used to small print as well. For example,
the sixth paragraph notes: "Both the
experimental and the control stu-
dents ..." followed a similar program,
except that one was one year longer. And
as part of the conclusion: "... the dif-
ference in favor of the controls is not so
marked as to justify an extra year of
education."
1 would like to reaffirm that even if
some results were in favor of a program
similar, but one year longer, I am firmly
convinced that the hypothesis stated in
the first paragraph proved to be true in
this experiment. Nursing students can be
adequately prepared for the demands of
the profession and society in less than
three years providing the whole program
is geared toward that goal. The fact that
the graduates of this experimental pro-
gram have met the registration re-
quirements and the employers' expecta-
tions speak in favor of this shorter pro-
gram. This voice, we hope, will be heard
by many and should be encouraging for
all who are engaged in the "renewal" of
nursing education.
In conclusion, may I assure the readers
that we are not suggesting that our
research project and report were flawless.
On behalf of the faculty and students
who participated in this five-year ex-
periment, we would like to thank all
those who showed some interest in it and
see some credit in an effort that we
believe should have some bearing on the
advancement of the nursing profession in
Canada. - Sister T. Castonguay, St.
Louis, Mo.
Nursing director can evaluate
In her letter entitled "Smug Disrespect
toward doctors" in the January issue,
Carole Stafford has pointed out the
dilemma present in the nursing profession
today.
She asks, "Does the nurse interviewer
assume that the director of nursing from
her office can better assess the nurse's
capabilities than the surgeon to whom she
passes the instruments? "
4 THE CANADIAN NURSE
The fundamental issue here, of course,
is whether nursing as a profession is able
to plan, assess, and evaluate its services in
the health field. I, for one, do not believe
that the surgeon is better qualified to
evaluate the nurse than is the director of
nursing.
The director has among her staff,
people who are accountable to her for the
evaluation of nursing personnel. She does
not glibly evaluate "from her office." -
A. Joyce Bailey, Reg.N., Toronto.
Students' association
With reference to the item "Students
Discuss Pros and Cons of Own Provincial
Association" (News, June 1969), I would
like to give a few observations of my own
that might be of interest to those who
plan to organize such an organization on
the provincial level and those whom the
organization will represent.
Have you a Christmas
Story Or Message
To Share?
The
Canadian
Nurse
invites readers to submit original articles
about Nursing at Christmas for possible
publication in the December 1969 issue.
Manuscripts should be typed dou-
ble-space on one side of unruled paper,
leaving wide margins. The usual rate will
be paid for accepted material.
Suggested length: 1000-2500 words.
Deadline date: September 1, 1969.
Send manuscript to: Editor, The Cana-
dian Nurse, 50 The Driveway, Ottawa 4,
Ontario.
As a student nurse in England, I was,
during my three years of training, chair-
man in my own hospital unit, of the
Student Nurses' Association of Great
Britain, and eventually the representative
of all the Western Counties and a member
of the executive council at the national
level.
At that time there were some 20,000
members of the SNA with units at each
hospital. The Council consisted of 26
elected members with a paid secretary, a
non-practicing registered nurse. It was
organized as an independant body under
the auspices of the Royal College of
Nurses.
In the two years that I served at the
national level I really had an eye opener. I
found that there were many enthusiastic
people in our organization, anxious to be
heard and help effect changes for the
general good. But for every one enthusias-
tic member, 20 or more were apathetic
and uninterested. The few who were
enthusiastic endeavored to make the
organization a viable, meaningful insti-
tution, sometimes against overwhelming
odds and many frustrations. It was un-
fortunate, as the students were often the
people who really had knowledge of
situations that could be improved.
Although the executive council fought
bravely, their enthusiasm and energy was
drained and strangled in a red tape jungle.
Many of the senior members of the
profession were only prepared to en-
courage the SNA if all it did was have
afternoon teas or sponsor outings for the
local Old Folks Home. The blame was not
with these people entirely. Worst of all
were the students themselves, who sat
apathetically in their hospitals and never
worried about what became of their 1
professional association, in spite of re- I
peated efforts of the SNA national coun-
cil and the enlightened members of the
Royal College to stir up a thinking,
meaningful group to make recommenda-
tions for reform in areas where it was
needed.
Yes, student nurses of Ontario, do
have an organization, you have much to
contribute and I wish you well. But
remember, every student has the onus to
contribute something to the endeavor; or,
like the Student Nurses' Association of
Britain, you will fail in spite of the valiant
efforts of those who wanted to do so
much for the students' benefit. - Mar-
garet Side, Lieutenant, Canadian Armed
Forces. D
AUGUST 1%9
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6 THE CANADIAN NURSE AUGUST 1%9
news
students Want Voice At ICN
iBegin To Speak Out On Issues
Montreal, P.Q. - By far the largest
number of students ever to have attended
an ICN Congress — 700, compared with
300 in Germany in 1965 — were in
Montreal June 22-28 as invited observers.
Their varied program, organized by the
Association of Nurses of the Province of
Quebec, began on a Ught note Monday
evening with colorful folklore dances, but
ended with a panel discussion Thursday
night that aroused heated debate among
the students.
It was Thursday's panel discussion,
"Students on the March," that brought
out many voices of dissent and focussed
on issues that will have to receive more
attention in the future — if students
have their way.
In his introduction to the keynote
speaker. Dame Muriel Powell, Jean-Pierre
Ruest, president of Montreal's Associa-
tion of Student Nurses of the Province of
Quebec, began the discussion of student
protest. The brightest young people, he
said, are involved in protest against wars,
assassination, military takeovers, and the
injustices of the South African govern-
ment. It is up to young people to reject
whatever breaks down humans, he told
the student audience.
Dame Muriel Powell, matron and chief
nursing officer of St. George's Hospital in
London, England, said that the satisfac-
tion inherent in the job of the nurse may
be responsible for the failure of nurses as
a whole to organize themselves as a
professional group, for slowness in re-
forming nursing education, and for the
acceptance by nurses of poor remunera-
tion and long hours of work. But this
situation is changing, she pointed out.
Issues such as transplant surgery, birth
control, and the legalization of abortions
concern the nursing profession, and
nurses must be able to play their part in
any public debate and discussions, she said.
Dame Muriel, quoting George Bernard
Shaw, told her audience, "all that the
young can do for the old is shock them
and bring them up to date."
Following this speech student panel
members from Switzerland, New Zealand,
and the United States spoke. Ariane
Randell from Geneva explained how the
150 students at Le Bon Secours Hospital
participate in decision-making through a
student council and through student
evaluations of their teachers and the
program. The goal, she said, is for stu-
dents to plan their own programs in the
AUGUST 1%9
ICN Congress Breaks All Registration Records
Montreal, P.Q. - A record number of nurses came from 85 countries to attend
the quadrennial Congress of the International Council of Nurses June 22-28.
Canada had the highest registration with 2,800 nurses attending, followed by the
United States with 1,870, and the United Kingdom with 740. Total daily
registration came to slightly more than 1 ,000.
Twenty-seven national associations sent observers to the Congress. Of these
associations, 1 1 had applied for ICN membership and all were successful. Argentina,
Bermuda, Bolivia, Costa Rica, Ecuador, Lebanon, Morocco, Nepal, Portugal,
Salvador, and Uganda are new members of ICN.
The eight nurses here catch some of the international flavor created by the
colorful variety of national costumes that were worn throughout the week. These
representatives (clockwise from front center) from Switzerland, Ceylon, Canada,
Japan, England, United States, and Zambia, are admiring a floral replica of the
Congress symbol. The flowers red sweetheart roses on a background of white
chrysanthemums — were a salute from Interflora, an association of florists from
90 countries.
Full congress reports are carried throughout the journal.
future, with teachers only to guide.
Florence Huey, a recent graduate of
Louisiana State University's school of
nursing, asked why there has not been
more student nurse protest. The audience
applauded when she said that nursing
education has perpetuated the isolation
of nursing students from other students.
The nursing student movement is 10
years behind, she added. She concluded
that the future will be determined by the
ability of nurses not to be content with
the status quo, always to grope for
change, and to question.
Then the audience made their views
known. One student nurse from the
United States said that the students at the
Congress had been served a grave in-
justice. In each plenary session in which
the role of the student was discussed, no
one invited a student to express her
viewpoint. It is only tonight that we have
the opportunity to discuss our views
(Continued on page 8)
THE CANADIAN NURSE 7
Hospital Nurses In NB Submit Mass Resignation
Fredericton, N.B. - The New Brunswick Association of Registered Nurses'
negotiation committee announced that on July 15,1 ,369 registered nurses employed
in public hospitals offered resignations to take effect August 15. This is 90 percent of
those nurses in the hospital nureing force in a bargaining unit.
"We expect the number to increase, because we were unable to contact 118 nurses
now on vacation," said Marilyn Brewer, spokesman for the nurses' negotiation
committee. Mrs. Brewer also said that the nurses are prepared to provide emergency
services and will discuss these with management.
The decision to withdraw services per month basic remuneration for a reg-
istered nurse.
Resignation was the only course open
to the nurses because the Public Service
Labour Relations Act of New Brunswick,
although passed in December 1968, has
not yet been proclaimed. This move is
necessary before nurses could strike.
In an interview with Glenna Rowsell,
the newly appointed Employment Rela-
tions Officer of the New Brunswick As-
sociation of Registered Nurses, she said:
"I think the government and the Hospital
Association got a shock when they
realized how well prepared the nurses
were for collective bargaining. The quali-
ty of the counter proposal by NBHA did
not reflect the quality and worth of the
registered nurse," she added.
came at a meeting of the provincial
collective bargaining committee July 4.
The 10-member committee, representing
the five provincial regions, has three of its
members on the negotiation committee.
The committee brought the results of a
poll conducted among hospital nurses
during the last week in June to determine
nurses' willingness to resign if necessary.
As reported in the July issue of The
Canadian Nurse negotiations with the
New Brunswick Hospital Association
broke down in June when the NBHA
refused to make a realistic offer to nurses.
Current 1969 salaries for registered nurses
in New Brunswick are $373 per month,
the lowest in Canada. The Canadian
Nurses' Association recommends S500
(Continued from page 7)
- but with each other, she continued.
"If we must financially support this
Congress, we're entitled to more partici-
pation." She recommended that at the
next Congress a student session be held
earlier in the week to allow students to
voice their opinions strongly in the plena-
ry sessions.
"Marvellous, you're getting a bit angry
now," Dame Muriel replied. "I'm sure
that at the next Congress they will be
listening."
A recent U.S. graduate said that the
students had been letting him down. At
the open sessions many questions were
nebulous and pointless, he said. "Where
were the students? " "Too often you're
told you're the leaders of tomorrow.
You're the leaders of today! "
Dame Muriel said that only ICN mem-
bers were allowed to speak at the open
sessions. It was only in 1961 that the first
students were invited to attend the ICN
Congress, she reminded the audience.
"Things take a long time." She strongly
advised the students to press through
their national associations to get into the
ICN. It would be very helpful to have the
student point of view, she said.
Association's Aims Too Remote
Says MARN President
Brandon, Man. - "Aims were too far
removed from the immediate problems
facing the [association's] provincial board
and office to be realistic," said Dorothy
Dick, president of the Manitoba Associa-
tion of Registered Nurses. She was speak-
8 THE CANADIAN NURSE
ing at the annual meeting of MARN in
Brandon, May 29-30, 1969.
Miss Dick went on to discuss other
problems facing the association, including
the shortage of professional staff and the
difficulties she encountered as president,
having had no experience in the board in
the previous biennium. She traced the
actions of the association over the past
four years, identifying the problems and
discussing possible solutions to them. The
opening of the new MARN headquarters
was one of its greatest accomplishments,
said Miss Dick, providing more office
space for staff and better facilities for
membership. The problem of apathy in
the association was attacked by visits to
local groups, often by the social and
economic welfare committee, she report-
ed.
Other speakers at the annual meeting
included O.A. Schmidt, president of the
Manitoba Medical Association, and G.E.
Chapman, administrator of the Brandon
General Hospital, speaking for the Mani-
toba Hospital Association. The Hon. Sid-
ney J. Spivak, Manitoba minister of in-
dustry and commerce, was the keynote
speaker. His address was titled "Health
needs in Manitoba in the second centu-
ry."
A panel presentation moderated by
Shirley Jo Paine discussed "Where is
nursing going in 1970? "
No Salary Increases Offered
Toronto, Ont. - The Nurses' Associa-
tion of the Clarke Institute of Psychiatry
has not reached an agreement with the
Institute over salary increases. After six
months of meetings there has been very
little progress, according to a release
issued by the Association June 23.
The negotiating committee of NACIP
has been meeting regularly with re-
presentatives of the Clarke Institute since
January. Some progress has been made on
non-monetary items.
The Institute offered no salary in-
creases at a conciliation meeting in May,
although NACIP claims its employees are
"the most poorly paid psychiatric nurses
in the province."
NACIP feels the Ontario Hospital Serv-
ices Commission is limiting the Clarke
Institute at the bargaining table whenever
monetary items are discussed.
In late June NACIP notified the Ins-
titute of its nominee to a board of
arbitration. The employer's nominee is
still to be named.
Dame Muriel Powell (center), keynote speaker at Thursday evening's panel discussion,
"Students on the March," talks with two of the student nurse participants. This
was the final event of the four-day student program at the Congress of the
International Council of Nurses in Montreal held June 22 to 28.
AUGUST 1%9
Off Press this Summer
Culver:
New 7th Edition
MODERN BEDSIDE NURSING
(formerly titled The Practical Nurse)
By Vivian M. Culver, R.N., B.Ed., formerly Florida State Department
of Education.
This comprehensive textbook of practical nursing is
centered on the patient and the patient's needs
rather than on procedures. Each chapter has study
aids and an Appendix gives concise, illustrated
descriptions of common nursing procedures.
About 850 pages, about 350 illustrations. About $10.55.
Ready August.
King & Showers: New 6th Edition
HUMAN ANATOMY AND PHYSIOLOGY
By Barry G. King, Ph.D., U.S. Public Health Service, and
Mary Jane Show/ers, R.N., Ph.D., Hahnemann Medical College.
The completely revised new 6th Edition of this v*^eil
known text features a magnificent 8-page series of
full<olor plates on transparent overlays, which show
the muscles, veins, arteries, viscera and skeleton
in successive layers, making their anatomical
relationships clear.
About 430 pages, about 330 illustrations. About $9.50.
Ready August.
Simmons: A New Book
THE NURSE-PATIENT RELATIONSHIP
IN PSYCHIATRIC NURSING
By Janet A. Simmons, R.N., M.S., University of Massachusetts.
This unique workbook helps the student nurse
establish a therapeutic relationship with mental
patients during her institutional affiliation in psychiatric
nursing. Each section describes one aspect of the
process and asks questions for the student to answer.
About 200 pages. About $4.00. Ready August.
W., B. SAUNDERS COMPANY CANADA LTD., 1835 Yonge Street, Toronto 295
Please reserve my copy, to be sent and billed when ready:
D Culver: Modem Bedside Nursing (about $10.55)
n King & Showers: Human Anatomy and Physiology (about $9.50)
Q Simmons: Nurse-Patient Relationship (about $4.(X))
AUGUST 1%9
Nome
Address
City
Zone
CN 8-69
THE CANADIAN NURSE 9
news
(Continued from page 7)
3M Donates Fellowship
Montreal, P.Q. - The 3M Company
has offered an annual grant of $6,000 to
continue education of nurses chosen from
among the members of national nursing
associations affiliated with the Interna-
tional Council of Nurses.
The grant, to be called the 3M Nursing
Fellowship, will be awarded annually to a
nurse selected by the ICN. The money
may be used at his or her discretion for
formal study in the nurse's chosen field
of interest.
The award will be made to a nurse
who is a member of her own national
nursing association, who has had at least
two years nursing experience after gradu-
ation and is active in nursing. Each
national association will submit the name
of one candidate to the selection com-
mittee, which will consist of the ICN
president, three vice-presidents, and the
executive director.
Roy W. Keeley, executive vice-
president and general manager of 3M,
Canada, presented a scroll confirming the
3M Fellowship to Alice Girard, president
of ICN, at the Quadrennial Congress of
ICN. "We hope and expect that the 3M
Fellowship will assist the development of
nursing knowledge on an international
basis," Mr. Keeley said. "The ICN, as the
international body of professional nurses,
is the logical organization to administer
these funds."
The 3M Company is a world-wide
manufacturer of numerous products, in-
cluding surgical and various cellophane
tapes. They also produce photocopy
machines and donated services of two 3M
Photocopiers during Congress sessions.
White Sister Donates
$30,000 Scholarship
Montreal, P.Q. - A $30,000 scholar-
ship fund for Canadian nurses has been
donated to mark the 14th Quadrennial
Congress of the International Council of
Nurses, June 22-28. White Sister Uniform
Inc. announced the donation during the
Congress in Montreal.
The fund will be donated in 10 yearly
installments of $3,000 to the Canadian
Nurses' Foundation by the Montreal-
based company. It will be awarded to one
or divided among two or three graduate
nurses for continuation of their studies.
Norman Lupovich, president of White
Sister, said the fund is being donated to
commemorate the magnificent scope and
magnitude of the Congress and to re-
cognize the superb effort of the Canadian
Nurses' Association, host of the Congress.
A commemorating certificate and medal
of honor will be awarded with each
presentation.
White Sister intends to reestablish the
scholarship after 10 years. The company
has asked that the scholarship be awarded
provincially on a rotating basis.
"Nurse In Society" Is
AARN Convention Theme
Edmonton, Alta. - Pediatric nursing,
drug addiction, alcoholism, and mental
health were some of the topics that fell
under the theme "Society — the Nurse's
Role" at the annual convention of the
Alberta Association of Registered Nurses.
The convention was held May 13-16 in
Edmonton.
Loretta D. Ford, professor of public
health nursing at the University of Co-
lorado in Denver, spoke to some 600
nurses following a luncheon on the topic
of pediatric nurse practitioners. She des-
cribed an experiment taking place at the
University of Colorado in which nurses
are trained to assume part of the pediatri-
cian's role in examining children, and to
refer only those requiring medical atten-
tion to the doctor. She stressed that they
were not producing another type of
health worker, but training the nurse to
assume more responsibility.
Other speakers included Albert Rosen-
tein, a psychologist from California, and
Howard Levitt, a probation officer with
the Los Angeles county probation depart-
ment, who discussed drug addiction; Fil
Eraser of the Alberta division of al-
coholism, who spoke on alcoholism; and
Dr. W.N. Blair, who reported on recent
findings of his study on mental health in
Alberta.
The speakers were brought together
after the presentations to answer ques-
tions from the audience.
Geneva Purcell, president of AARN,
reminded members in her address that the
AARN must speak for the profession as a
whole, yet allow the individual nurse to
express assent or dissent. "The effective-
ness of an organization is dependent upon
the active participation of its members,"
she said. "The association needs the
vision, intellect, the will and cooperative
effort of each individual."
Brief reports were also presented on
the new two-year nursing program by
Marguerite Schumacher, director of
nursing at Red Deer Junior College, and
members of the AARN advisory commit-
tee to the study.
During the convention, the Board of
Directors reelected Miss Purcell as pre-
sident for a two-year term. Roseanne
Erickson was elected to the new position
of president-elect.
ANPEI Holds Annual Meeting
Charlottetown, PEL - One-hundred-
twenty-three nurses from across the prov-
ince attended the 48th annual meeting of
the Association of Nurses of Prince Ed-
ward Island held June 10.
(Continued on page 12)
Roy W. Keeley, executive vice-president and general manager
of 3M Canada, presents to Alice Girard, president of ICN, the
scroll confirming the 3M fellowship to ICN at the 14th
Quadrennial Congress in Montreal.
10 THE CANADIAN NURSE
Norman Lupovich, president of White Sister, discusses the
$30,000 scholarship donated by his company to CNF with
Rita Lussier, analyst at the center for evaluation of positions
in Quebec Hospitals at the ICN Congress in Montreal.
AUGUST 1%9
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In providing greater hospital convenience:
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news
(Continued from page 10)
Main resolutions passed were:
• Every member and former member of
ANPEI will be asked to write something
for inclusion in a history of the associa-
tion, to be published for the 50th an-
niversary of ANPEI in 1971.
• ANPEI is to organize workshops for
doctors and nurses to discuss team health
care.
• The Association is to approach the local
medical association regarding the es-
tablishment of a pilot project in home
care.
• The four branches of ANPEI will plan
to raise at least a dollar per member for
the Canadian Nurses' Foundation as an
annual project.
A panel discussion on team health care
was a highlight of the meeting. Chairman
for this panel was Dr. Burton Howatt,
assistant deputy minister of health for
PEL
"Things take time" was the theme
chosen for an address by ANPEI Pre-
sident Bemice Rowland. She related this
to changes taking place in the province in
the areas of nursing education and labor
relations.
Miss Rowland mentioned three schools
of nursing are about to be replaced by
one in the province as a result of studies
and workshops. Nurses have also improv-
ed health care practices in their individual
work units, she added.
Miss Rowland then discussed the new
nurses' bill, which has not yet been
passed by the provincial government. This
bill includes clauses on future nursing
education programs and on collective
bargaining.
Provincial Health Minister Bruce
Stewart also spoke at the meeting. He
mentioned his department's interest in
the bill, and offered his aid in presenting
it to the government at the next sitting of
the provincial legislature.
Changes in nursing education in Cana-
da were discussed in a speech by Sister
Mary Felicitas, president of the Canadian
Nurses' Association. She also talked on
the goals of CNA and of the International
Council of Nurses.
ICN Reports And Papers
Available From Geneva
Montreal, P.Q. - Reports and
papers given at the International Coun-
cil of Nurses 14th Quadrennial Congress
in Montreal will be issued in two pub-
lications by ICN before the end of the
year.
These may be ordered from ICN
headquarters, Box 42, 1211 Geneva 20,
Switzerland. There will be a charge for
these publications.
CNA Presents Painting To ICN
Ottawa. - ICN headquarters moved to Geneva, Switzerland at the end of July
1966 after 19 years in London, England. At the Canadian Nurses' Association's
board of directors' meeting in September 1967 a suggestion was made that CNA
present a gift to ICN in honor of the new location. By March 1968, the 10
provinces had contributed $385 toward the gift.
The gift that was chosen is a needle painting worked in silk on a theme of
Canada's autumn coloring. Anne-Marie Matte of St. Hyacinthe, Quebec was
commissioned to do this work. Sister Felicitas, president of CNA, describes "Le
Pont" as unique and artistic. MUe Matte's paintings hang in Buckingham Palace, the
White House, and several European Embassies.
CNA's gift was formally accepted during the ICN Congress in Montreal by Dr.
Alice Girard, ICN president. It will hang in the ICN boardroom in Geneva.
ANPEI Donates $225
To ICN Congress
Charlottetown, PEI, - The Associa-
tion of Nurses of Prince Edward Island
donated $225 to assist the 14th Quadren-
nial Congress of the International Council
of Nurses in Montreal, June 22-28.
The gift was announced June 1 1 in a
letter to the Canadian Nurses' Association
from Mrs. Vernon Bolger, executive secre-
tary registrar of ANPEI.
Congress News
Goes World-Wide
Montreal, P.Q. - The June Congress
of the International Council of Nurses
received world-wide coverage from the
news media and from nurse journalists.
Highlights of sessions and interviews
with registrants and speakers were broad-
cast to all six continents in 1 1 languages
through the International Service of the
Canadian Broadcasting Company.
12 THE CANADIAN NURSE
Axel Thogerson, head of CBC Outside
Broadcasts, said the Congress was a uni-
que opportunity to gather material on the
world of nursing in several languages.
Daily reports in English were sent by
the International Service to Europe, Afri-
ca, USA, Australasia and the Caribbean.
Also, special items with interviews were
shipped to Nigeria, Jamaica, Barbados
and Trinidad for relay over local stations
there.
A special report and round-table dis-
cussion was sent in English to 60 overseas
stations in USA, the Caribbean area,
Africa, Australia, New Zealand, Ceylon,
Cyprus, Malta, Malaysia, Singapore, Bur-
ma, and Thailand, and to the Canadian
Armed Forces Network in Europe.
Daily French-language reports were
included in I.S. transmissions to Europe,
Africa, Antilles and USA. Special reports
were shipped to French-language stations
in Africa and Europe.
AUGUST 1969
news
Daily reports in German were also sent
to Europe. And daily reports and inter-
views were sent to Europe and Latin
America in the following languages:
Czech, Slovak, Polish, Spanish, Russian,
Portuguese, Hungarian, and Ukranian.
More than 40 nursing press, represent-
ing journals from as far away as Australia,
Ghana, and Sweden, covered the Con-
gress.
To give an idea of Canadian coverage,
some 220 special interviews were arrang-
ed during the congress for members of
the press, radio, and television. The Cana-
dian Press carried stories before and
during the Congress to most papers across
Canada, and both national television net-
works featured the event in their news.
SRNA Meets Challenge,
President Reports
Saskatoon. - "Nursing in Saskatche-
wan has been successful in meeting all the
challenges thrust upon it by rapid social
changes," said Agnes Gunn. president of
the Saskatchewan Registered Nurses' As-
sociation, speaking at its 52nd annual
meeting May 21-23 in Saskatoon.
"Change is always an opportunity to
advance and make progress, and those of
us who are flexible in mind will welcome
new experiences." Miss Gunn continued.
She cited as an example the first grad-
uating class of the two-year nursing pro-
gram at the Institute of Applied Arts and
Sciences in Saskatoon this year, a move
encouraged by SRNA.
Miss Gunn also noted the achieve-
ments of the provincial bargaining com-
mittee, which has been responsible for
contract negotiations with the Saskat-
chewan Hospital Association.
Grace Motta, retiring registrar of the
Saskatchewan Registered Nurses' As-
sociation, reported that the number of
registered nurses in the province had
increased by 151 to 5,979. Saskatchewan
had gained 201 nurses from other provin-
ces, and 94 from other countries. Miss
Motta said. Linda Long, advisor to
schools of nursing for SRNA, said 150
nurses had enrolled in refresher courses,
which are compulsory for nurses wishing
to return to practice after an absence of
five years.
Miss Long also reported that eight
hospital schools of nursing are closing, six
after graduating this year's class, and two
more next year. The University of Saskat-
chewan will discontinue its diploma
nursing program and retain only the
four-year baccalaureate program. Miss
Long said.
Keynote speaker at the annual meeting
was Margaret F. Myles, speaking on
"Modem aspects of obstetrical practice."
Greetings were brought to the meeting
by S.L. Buckwold, mayor of Saskatoon,
Louise Miner, president-elect of the Cana-
dian Nurses' Association, and Hester
Kernan. president of the Canadian
Nurses' Foundation.
US Air Force Nurses
Discuss Space Age Nursing
At ICN Interest Session
Montreal, P.Q. - Perhaps not too
many nurses think of themselves as be-
coming moon mates, but this space age
role is nearing reality, at least for some
adventurous United States Air Force
nurses. Four of these women attended
the Congress of the International Council
of Nurses June 22-28 where they gave
Major Dorothy Novotny (left) and Capt.
C. Corrado, United States Air Force
Nurses, participated in a special interest
session on space age nursing at the Con-
gress of the International Council of
Nurses.
nurses from around the world a many-
sided look at the U.S. aerospace program
and the important place of the nurse in it.
Col. Florence Deegan, Commander
and chief nurse for the mihtary air lift
command at Scott Air Force Base in
Illinois, traced the U.S. history of aero-
medical evacuation of patients, with the
help of colored sUdes. She gave a detailed
description of the latest C-9 Nightingale
twin-engine jet which can hold 18 litter
and 20 ambulatory patients and has room
for 40 patients if necessary. Its basic crew
consists of two flight nurses and two
medical technicians.
Among the C-9's many unique features
is a special carrier area for care of the
seriously ill or those with contagious
diseases; it has a window through which
the nurse can watch the patients. All
controls are in easy reach of the medical
crew. Patient enjoyment, comfort, and
convenience are also taken care of with
the most modern devices.
Capt. C. Corrado, an aerospace nurs-
ing-course graduate, explained the six-
week course in aerospace nursing, the
longest course of its kind available, given
at Brooks Air Force Base in Texas.
Major Dorothy Novotny, an aerospace
nursing supervisor, described the 52-
week, post-graduate nursing aerospace
program conducted at Cape Kennedy,
Florida. It is open to U.S. air force nurses
with a bachelor's degree in nursing, who
are not over 35, are graduates of the
six-week flight nursing course, and have
been on active duty three years before
they apply for this course.
The three areas of study are bioastro-
nautics, the "application of life sciences
in support of man in space," occupational
health services, and research. Capt. Cor-
rado said that this program is going to be
extended to two years. "In the second
year the nurse will go out into the field to
apply her knowledge."
Improvement In Quality
Theme Of NBARN Meeting
Moncton, N.B. - Improvement in the
quahty of nursing care was the theme of
the 53rd annual meeting of the New
Brunswick Association of Registered
Nurses in Moncton May 28-30.
Irene Leckie, president of NBARN,
addressed the meeting on the role of the
nurse in assisting the patient in activities
he would perform unaided if he had the
strength. She urged nurses to establish
priorities and goals in planning care for
each patient.
"If we believe that the many complex
aspects of direct nursing care should be
done by qualified nurses, then we need to
reorganize our work so that this patient
care is given by those who are qualified
and not by unquahfied personnel." Miss
Leckie said. "We will have only ourselves
to blame if we find we can no longer gain
satisfaction from our work because we
are not nurse practitioners."
The second day of the conference was
"program day." with the theme PRO-
JECT: P.L.A.N. (Patients - Let's Assess
Needs). Huguette LaBelle, director of
nursing at the Vanier School of Nursing,
Ottawa, was keynote speaker and leader
of the program. She placed strong em-
phasis on the needs of the patients,
saying. "We have been serving the needs
of the doctor and hospital for too long."
On the final day of the meeting
members passed a resolution that the
council consider obtaining a nursing servi-
ce consultant to promote better patient
care. During the same session the finance
committee outlined a deficit budget for
1969, and it was decided to call a special
general meeting before November 30 to
discuss an increase in fees to be effective
January 1, 1970.
Irene Leckie was reelected president of
NBARN at the meeting. First vice-pre-
sident is Harriet Hayes; second vice-pre-
sident, Apolline Robichaud; honorary se-
cretary is Margaret MacLachlan; and the
past president is Katherine Wright.
THE CANADIAN NURSE 13
news
Internationally-Known Nurses
Debate Practice Of Nursing
At ICN Interest Session
Montreal, P.Q. - Margaret McLean,
senior nursing consultant, Hospital Serv-
ices Division, Department of National
Health and Welfare, says that provision of
nursing service in the quantity and qual-
ity needed is the major problem faced by
nurses in the practice of nursing. During
an interest session at the 14th Quad-
rennial Congress of the International
Council of Nurses, June 22-28, she made
several suggestions how this need can be
met. All discussion was based on the fifth
World Health Report in Nursing issued in
1966 and accepted by the ICN,
Reward staff for excellence of service
and for nursing care rather than for
service time, Miss McLean urged. Have
the best qualified nurses with leadership
ability as the team leader and allow
creativity in nursing by reducing the
number of "bosses," she suggested.
Nursing assistants have a role to play,
Miss McLean believes. They can carry out
specific nursing procedures and tasks for
the patient, that do not require the
judgment of a registered nurse.
"What kind of education can be pro-
vided to ensure good nursing? " Ruth
White of Australia asked. The WHO re-
port suggests that nursing education move
into the field of general education, with
curriculum content controlled by nurses
and established in a legislative framework.
Nursing education needs to be part of
general education if nureing is to meet the
changing needs of the future. Miss White
said. In the United States 85 percent of
health care is provided outside the hospi-
tal; in Great Britain it is 95 percent, she
pointed out.
Ayodele Tubi of Nigeria reported
who's suggestions concerning postbasic
education. There is a need for postbasic
education in every country, but courses
should be planned and developed accord-
ing to the individual need on the national
level. Mrs. Tubi said that the aim of these
courses should be to teach the nurse how
to find the answers, not to know all the
answers.
Grace March, inservice education of-
ficer for the Ministry of Health in Jamai-
ca, referred to three types of continuing
education: formal study leading to a
degree; short term study at an advanced
level not necessarily referring to a degree;
inservice education provided by the prof-
essional organization and the employing
^ency.
Discussion from the floor followed Dr.
J.C. Bacala's comments on nursing re-
search. A medical practitioner in Cotts-
burg, Indiana, he said he had noticed that
14 THE CANADIAN NURSE
Birgit Tauber, Margaret Parkin, Virginia Henderson, Alice Thompson, and Luther
Christman discuss topics related to the effective functioning of libraries in nursing
schools and professional associations during a panel presentation at interest sessions
during the ICN Congress in Montreal.
nursing research consisted of questionnai-
res for gathering information but really
only gathered opinions. Care of the sick is
the purpose of research in nursing, Dr.
Bacala said, but bedside nursing is seldom
researched.
He expressed concern that the more
highly educated the nurse, the farther she
is from nursing practice. He concurred
with Miss McLean that we should reward
the bedside nurse financially so that we
can accept reports on patients' condi-
tions, from the best qualified observer.
If postgraduate nursing courses were
more like medical residency perhaps more
nurses with advanced degrees would stay
at the bedside, Dr. Bacala suggested.
Clinical specialist courses are the most
valuable for good bedside nursing, and
will bring the nurse back to the bedside,
Dr. Bacala beUeves.
Library Issues Discussed
By ICN Panelists
Montreal, P.Q. - A small but select
group of nurses attended the special
interest session on libraries in schools of
nursing and in professional associations
held during the 14th Quadrennial Con-
gress of the International Council of
Nurses June 22-28.
Panelists Luther Christman, dean of
the school of nursing, Vanderbilt Univer-
sity, Nashville, Tennessee; Virginia Hen-
derson, director, nursing studies index
project, Yale University School of
Nursing, New Haven, Connecticut; Mar-
garet L. Parkin, librarian, Canadian
Nurses' Association; Birgit Tauber, nurs-
ing officer. National Health Service of
Denmark, Copenhagen; and Alice Thomp-
son, editor of International Nursing Re-
view, Geneva, Switzerland, presented sev-
eral questions for consideration:
1 . What organizational structure
within a country might effectively pro-
mote library resources, facilities, and serv-
ices?
2. How can present resources and
needs be determined within a given area?
3. Where might nursing look for funds
to provide needed library resources? '
4. What types of space, equipment,
and materials should be considered as
comprising library resources for nurses?
What are the criteria for acquiring and
withdrawing library materials?
5. To what extent are the library
needs of nurses different from those in
other health professions?
6. Would a Ubrary of integrated facili-
ties for several health professions be
feasible?
7. What types of library tools are
needed in nursing and who should be
responsible for them?
8. How can the effective use of library
resources be promoted?
9. Who should staff libraries in
schools of nursing?
Members of the audience contributed
answers to these questions based on their
experiences in library work.
Continuity Of Patient Care
Discussed By ICN Panelists
Montreal, P.Q. - More than 500
nurses attended a special interest session
on the continuity of patient care, held
during the 14th Quadrennial Congress of
the International Council of Nurses, June
22-28.
Constance Swinton, a nurse with the
Victorian Order of Nurses, defined conti-
nuity of patient care as "the right care at
the right time in the right place." Today,
home care is a complex, highly organized
institution. Miss Swinton said. In many
areas of Canada, a hospital referral pro-
gram has made it possible for the chro-
nically-ill, the long-term, and the acutely-
ill patient to be cared for at home, she
reported. This helps to reduce hospital
costs, she added.
Good nursing care depends on a
nurse's assessment of the patient's pre-
and post-hospital care requirements; that
necessitates close cooperation between
hospital and community. Miss Swinton
explained.
As an illustration of the effective use
(Continued on page 16)
AUGUST 1969
Fleet
ends ordeal by
Enema
for you and
your patient
Now in 3 disposable forms:
* Adult (green protective cap)
* Pediatric (blue protective cap]
* Mineral Oil (orange protective cap)
Fleet — the 40-second Enema* — is pre-lubricated, pre-mixed,
pre-measured, individually-packed, ready-to-use, and disposable.
Ordeal by enema-can is over!
Quick, clean, modern, FLEET ENEMA will save you an average of
27 minutes per patient — and a world of trouble.
WARNING: Not to be used when nausea,
vomiting or abdominal pain is present.
Frequent or prolonged use may result in
dependence.
CAUTION: DO NOT ADMINISTER
TO CHILDREN UNDER TWO YEARS
OF AGE EXCEPT ON THE ADVICE
OF A PHYSICIAN.
Full information on request.
•Kehlmann, W. H.: Mod. Hosp. 84:104, 1955
FLEET ENEMA® — single-dose disposable unit
In dehydrated or debilitated
patients, the volume must be carefully
determined since the solution is hypertonic
and may lead to further dehydration. Care
should also be taken to ensure that the
contents of the bowet are expelled after
administration. Repeated administration
at short intervals should be avoided.
CEUTICAL*
AUGUST 1%9
THE CANADIAN NURSE 15
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(Continued from page 14)
of coordinated home care involving sever-
al health disciplines, a panel composed of
physician, hospital-based nurse, social
worker, physiotherapist, speech therapist,
and VON nurses conducted a team con-
ference based on their approach to the
home care of a two-year-old boy with
mandibular facial dystosis. Panel partici-
pants were members of the Montreal
Children's Hospital Home Care Program.
The home care program set up for a
man and his wife was the basis for a
second panel discussion presented by the
greater Montreal branch of the Victorian
Order of Nurses. Panelists discussed plans
made for this couple. The liaison nurse
first assessed the patients' suitability for
home care — in consultation with the
attending physician and the head nurse.
The VON nurse who cared for the pa-
tients made her assessment and arranged
for the assistance of a physiotherapist and
a homemaker. During the entire home
care program, the team members met
regularly to evaluate the patients' prog-
ress in preparation for their return to
independent living.
Too Much Treatment A Danger
Warns ICN Psychiatry Panelist
Montreal, P.Q. - Too comprehensive
a nursing program could rob the mental
patient of the opportunity to function
independently in the modem hospital
setting, warned Lorine Besel, chairman of
a special interest session on psychiatric
nursing at the Quadrennial Congress of
the International Council of Nurses in
Montreal, June 22-28.
The therapeutic community, said Miss
Besel, is a concept in which the whole of
the patient's time in hospital is thought
of as treatment. This is a sharp change
from an earlier view that medication,
physical treatments, and an hour with a
psychiatrist was treatment. Miss Besel
added that an effort must be made to
reproduce an environment in which the
patient will take as much responsibility as
he is able to handle.
Miss Besel also said that nurses' per-
sonal conflicts increase their difficulties
in dealing with psychiatric patients. Often
nurses cannot work within a group
setting; they feel inadequate in a group
and are not prepared to cope with their
own feelings, let alone the patients' feel-
ings, she said.
Authority is another difficult area
because the nurse learns to accept a
passive role in general nursing, and must
learn to be an equal in psychiatric nurs-
ing. Team participation and negotiation
must also be learned, said Miss Besel.
Miss Besel's opening remarks were
16 THE CANADIAN NURSE
followed by panel presentations by Mary
Christie, John Greene, Mrs. Noel Robin-
son, S.M. Bohn, and A.M. Dneppe.
ICN Interest Session Speakers
Examine Nursing Legislation
Montreal, P.Q. - Nurses attending a
special interest session of the ICN Con-
gress June 26 learned the pitfalls involved
in framing nursing legislation from three
specialists who have been active in this
field in their home countries.
Mary Henry, registrar of the General
Nuning Council for England and Wales,
outlined fundamental issues in seeking
such legislation. First, she said this legisla-
tion is the foundation on which the
profession must be built if it is to grow in
stature. Second, nursing legislation must
be framed to meet the needs of the
country. It must be realistic and not set
its si^ts too high or too low; the
legislation must be capable of implemen-
tation. Third, it should be framed so that
it does not need frequent revision. With
the constantly changing pattern in nurs-
ing needs in the community, regulations
should not be too detailed. Miss Henry
warned, for changes take a long time. She
emphasized that the freedom to experi-
ment is essential. Overall change should
be gradually introduced and should prove
successful before being generally accepted
throughout the country, she said.
Both Miss Henry and Laura Barr,
executive director of the Registered
Nurses' Association of Ontario, stressed
the necessity of having social and eco-
nomic legislation for nurses remain dis-
tinct from nursing legislation.
Miss Barr compared nursing legislation,
whose focus is on the protection of the
public, with socioeconomic legislation,
which is highly motivated by the self-
interest of the nursing profession. It is
difficult to believe that a reasonable
balance of interests could be maintained
if one piece of legislation were to serve
two such distinct purposes. Miss Ban-
said.
Speaking of the administration of
nursing legislation. Miss Barr referred to
two points of view - external and in-
ternal. The external involves the machin-
ery estabUshed within the government to
support the legislation it creates.
"In looking at government depart-
ments, shouldn't we be assessing each to
determine where the greatest expertise
lies to help us achieve our goals in
nursing? " she asked. She pointed out the
opportunity to participate in the ad-
ministration of nursing legislation should
be available to all nurses.
On the other hand. Miss Ban explain-
ed, it is customary to administer legisla-
tion for socioeconomic welfare through a
group of members a majority of whom
might be involved in collective bargaining.
The time has come, said Miss Barr,
when we must show that the programs we
AUGUST 1%9
conduct as associations are influenced
more equally by three sources: 1. the
individual nurse and her needs that are
basic to her being an effective health
worker; 2. the profession as a whole;
3. the public we serve.
Julie Symes, registrar of the nursing
council in Jamaica, pointed out the im-
portance of lobbying when nurses are
seeking legislation. They must explain
their need for legislation to all parties and
should approach leaders of other groups
in the community. Nurses must also
study the laws of other countries to guide
them, Miss Symes said. She warned that
when nursing legislation is drafted, it
should be worded so that nurses who are
already trained can be registered, and that
anything making it too difficult for
nurses from abroad to register should be
avoided.
Where there is provision for dis-
ciplinary action to be taken against
nurses, there must be the right of appeal,
she said.
ICN Interest Session Debates
Role Of Rehabilitation Nurse
Montreal, P.Q. - The role of the
rehabilitation nurse in fulfilling the
special needs of her patients was dis-
cussed at a special interest session at the
International Council of Nurses' Congress
in June.
Specialists from the Rehabilitation In-
stitute of Montreal outlined their func-
tions in relation to the handicapped
patient. After each had spoken, Elizabeth
Epp, a nurse from the Institute, discussed
the inpUcations of that role for the
nurse.
Areas under discussion included phy-
siotherapy, social service, speech therapy,
ergotherapy, psychology, and prosthetics.
Dr. Gustave Gingras, director of the
Rehabilitation Institute and co-chairman
of the session, emphasized that it is vital
for the nurse to maintain constant rap-
port with the specialist.
"It is possible for the nurse and a
therapist to work in a complete vacuum,"
he said, "but I see no reason for an
amputee not to walk on weekends be-
cause his therapist is off duty."
Miss Epp said the nurse must be aware
of the underlying principles and techni-
ques of all the disciplines of rehabilita-
tion. The nurse provides valuable backup
work in physiotherapy, she said, by assist-
ing a patient with braces, shngs and other
aids for ambulation and manipulation. To
do this she must know about the care,
function, and application of these ap-
pliances.
Miss Epp advised the rehabilitation
AUGUST 1%9
nurse to observe the patient's perform-
ance and progress during sessions with the
therapist. This will make her more aware
of the problems of other patients under-
going the same kind of surgery, she said,
and also will aid in the nurse's supervision
of the patient on the ward.
Miss Epp commented on the strong
bond of cooperation between nurse and
social worker, adding that it provides "a
more positive, more productive outlook
for the patient, not only with an eye on
his residence at the hospital, but with a
particular accent on his return to the
community."
Chairman of the session was Miss MJB.
Whitton, vice-chairman of the Royal Col-
lege of Nursing and National Council of
Nurses of the United Kingdom.
Liberian Government Doubtful
Of Family Planning Clinics
Montreal, P.Q. - In Liberia, men, not
women, are the obstacle to family
planning, said Jeannette King, one of
several paneUsts on the special interest
session on outpost nursing at the 14th
Quadrennial Congress of the International
(Continued on page 18)
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THE CANADIAN NURSE 17
news
(Continued from page I 7j
Council of Nurses in Montreal. She said
many husbands of women coming to the
clinics in her country suspected that their
wives simply wanted no more children,
rather than that they were planning to
space the family for health reasons.
"From top to bottom, the government
men opposed giving such advice because
they feared a drop in the birthrate," she
said. "We agree that we are an un-
populated country, but we had to explain
that we favor spacing pregnancies, not
cutting the number of children bom," she
added. She said that it took two years to
get government permission to run the
clinics.
Miss King was on a panel chaired by
Electa MacLennan, director of the school
of nursing at Dalhousie University. Panel-
ists included Catherine Keith, Ruth May,
Carolyn Banghart, E. Holdgate, Kapelwa
Sikota, and Pilar D. Pacifica.
Nurses Reluctant To Write
ICN Delegates Told
Montreal, P.Q. - Nurses are un-
accustomed to being vocal and therefore
are reluctant to write articles, a U.S.
educator told about 225 nurses at an
interest session on "The Printed Word" at
the 14th Quadrennial Congress of the
International Council of Nurses.
Responding to a comment from panel
chairman Richard Newcombe that it is
difficult to get nurses to write articles.
Dr. Ruth V. Matheney of the department
of nursing at the Borough of Manhattan
Community College in New York, said
that in the past nurses have refrained
from expressing their opinions - verbal-
ly or in writing — partly because they
have equated criticism with disloyalty.
Dr. Matheney said that she doubted that
special courses in writing for nursing
students would stimulate greater debate.
Other panelists at 'The Printed Word"
session included Enid Meehan, editor of
the Irish Nurses' Journal; Gertrude
Swaby, secretary of the Jamaica Nurses'
Association; Isabel LeBourdais, PR of-
ficer, RNAO; Yvonne Cross, editor of
Nursing Mirror and Midwives Journal; and
Gordon Henderson, legal consultant to
CNA.
"Design, Then Build,"
Renowned Consultant Tells CHA
Ottawa. - Define the problem,
design facilities for the total concept, be
flexible, and don't forget the patient,
were ideas presented by Gordon A.
Friesen, the well-known hospital con-
sultant, to delegates at the Canadian
Hospital Association's second national
convention and assembly May 21-23.
Mr. Friesen, president of Gordon A.
Friesen International Inc. Washington,
D.C., a firm of hospital consultants, held
his audience entranced while with ges-
tures and vocal spurs he talked about his
concept of the modern hospital.
Twentieth century medicine is prac-
ticed in nineteenth century facilities, he
said, and hospitals are 25 years old when
they open their doors for the first time.
Mr. Friesen urged that better use be
made of the health workers we now have.
The Kitchener-Waterloo hospital in Onta-
rio gave him the first opportunity to put
some of his ideas into practice and his
colored sUdes portrayed effectively many
of these. More than 40 hospitals have
been designed using Friesen concepts. His
concept of central dispatching frees the
nurse to nurse. An aide brings supplies for
each patient through an outside corridor,
and places them in a dispensary accessible
from two sides, Mr. Friesen explained.
The nurse receives supplies directly into
the patient's room.
"Why duplicate facilities? " he asked.
"Doctors' offices should be within the
hospital." Put the administrative core in
the center and build what you need to
operate efficiently around it, he said.
One hundred and eighty-four interrup-
tions in a 24-hour period for one patient
surely indicate that we need the team
approach, Mr. Friesen said. But motiva-
tion and inservice education are needed
to make it work, he continued.
Patient units should be flexible, con-
verting easily from single rooms to groups
of rooms, and from obstetrics to surgery
as the need indicates, he advised. On the
subject of separate nurseries, Mr. Friesen
quipped, "All husbands don't hate their
wives, and children their parents."
McGill Student Nurses
Contribute To CNF
Montreal, P.Q. - The Graduate
Nurses' Students' Society of McGill Uni-
versity has contributed $200 to the Cana-
dian Nurses' Foundation. The money was
collected from members during elections
for the 1969-70 executive, and forwarded
Isabel LeBourdais, public relations officer for the Registered
Nurses' Association of Ontario and editor of RNAO News, talks
about editorial freedom at a special ICN interest session held at
McGill. Chairman Richard Newcomb, editor of y?A^ magazine, is
at left ; Yvonne Cross, editor of the Nursing Mirror and Midwives
Journal, and Gordon Henderson, legal consultant to the
Canadian Nurses' Association, were fellow panelists.
18 THE CANADIAN NURSE
It was standing room only at the special ICN interest session on
nursing journalism Tuesday June 24. PaneUsts included, left to
right: Barbara Schutt, editor, AJN; Daisy C. Bridges, chairman;
Philip E. Day, executive director, American Journal of Nursing
Company; Donald Williams, Rapid Grip and Batten - the firm
responsible for layout for The Canadian Nurse; and Nancy J.
Kinross, Health Department, Wellington, New Zealand.
AUGUST 1969
news
to the Foundation in June.
"We hope that, through our efforts,
other students in schools of nursing and
universities could be made aware of this
fund, and could plan future contribu-
tions," said Kathleen Kennedy, president
of the Society. "As postbasic students,
we recognize the importance of assisting
in furthering the education of nurses in
Canada," she said.
Despite the interest of student groups,
membership in CNF has dropped from
1,482 in September 1968 to 920 in June
1969. A CNF spokesman pointed out
that at least part of the drop was due to a
changeover in fiscal years. "September
was the end of the fiscal year in 1967-68"
she said. "We hope that at the end of this
fiscal year, in December, that member-
ship will be comparable to last year's."
The record high for membership was
1965, when there were 1,697 members.
Breakdown of membership is as fol-
lows: British Columbia 99; Alberta 78;
Saskatchewan 104; Manitoba 51; Ontario
282; Quebec 66; New Brunswick 143;
Nova Scotia 46; Prince Edward Island 4;
Newfoundland 8; outside Canada 27;
sustaining 1 1 . There is one patron,
making a total of 920.
McMaster Student Nurses
Request Financial Aid
iJamihon, Ont. - Students of the
school of nursing at McMaster University
presented a report to Ontario health
minister Matthew B. Dymond May 30.
requesting that the Ontario government
make bursaries available for students in
the basic degree program in universities.
The five-page brief included a table
comparing the costs to students in the
McMaster school with those to students
in St. Joseph's Hospital. Hamilton and
District Hospitals, and Hamilton Civic
Hospitals schools of nursing. Costs were
S7,300, $1,210, $1,275. and $990 res-
pectively for the total training period.
Pay differential after graduation was $80
per month.
The report pointed out the difficulty
in acquiring financial assistance for basic
degree program students. Assistance is
offered to registered nurses by the Onta-
rio government, but the Victorian Order
of Nurses was cited as the major source of
aid to basic degree program students. The
brief also pointed out that the Canadian
Nurses' Association's Submission to the
Royal Commission on Health Services
had suggested that funds be made avail-
able for loans to these students, and that
the Royal Commission has called the
integrated course the only educationally
sound one.
AUGUST 1%9
ICN Election Results
Elected to office in the International
Council of Nurses at the closing session
Friday, June 27, were:
President: Margrethe Kruse - execu-
tive secretary of the Danish Nurses'
Association since 1945.
First Vice-President: Dorothy A. Corne-
lius - executive director of the Ohio
Nurses' Association and President of the
American Nurses' Association.
Second Vice-President: Alice Gi-
rard -immediate past president of the
ICN and dean of the Faculty of Nursing
at the University of Montreal.
Third Vice-President: Ruth Elster -
president of the German Nurses' Fede-
ration.
Board of Directors: Nicole F. Ex-
chaquet, Switzerland; Barbara Fawkes,
United Kingdom; Nelly Goffard, Bel-
gium; Mrs. Jadwiga Izycka, Poland;
Docia A.N. Kisseih, Ghana; Jane Martin,
France; Joyce C. Rodmell, Australia;
Julita V. Sotejo, Philippines; Catherine
Verbeek, Netherlands; Mrs. Gerd Zetter-
strom-Lagervall, Sweden.
Membership Committee: Lyle M. Creel-
man, Canada; Jo Eleanor Elliott, United
States of America; Phyllis Friend,
United Kingdom; Mrs. Kofoworola A.
Pratt, Nigeria; E. Beatrice Salmon, New
Zealand; OUve E. Anstey, Australia;
Julie Symes, Jamaica.
Professional Services Committee: Ingrid
Hamelin, Finland; Laura W, Ban, Cana-
da; Dr. Rebecca Bergman, Israel; Adele
Herwitz, United States of America; Re-
nee de Roulet, Switzeriand; Gertrude
Swaby, Jamaica; Grace M. Westerbrook,
United Kingdom.
Two-Year Program's Discussed
At RNANS Annual Meeting
Yarmouth, N.S. - Education was the
highlight of the 60th annual meeting of
the Registered Nurses' Association of
Nova Scotia in Yarmouth, May 27-28.
The 1 50 nurses attending the meeting
heard Sister Ann Gill of the Halifax
Infirmary discuss the needs of the gradu-
ate of the two-year program, saying that
the basic need of such a graduate was an
organized inservice program. Sister's talk
was followed by a panel discussion on the
implications of the two-year program.
This September at least three schools
in Nova Scotia will move into the two-
year program, and several of the smaller
schools will be phased out.
Reports presented at the meeting also
noted:
• the annual fee for membership in
RNANS has increased from $25 to $35;
• educational requirements for entrance
to schools of nursing in the province will
be Nova Scotia grade 12;
• the association's bulletin will be pub-
lished quarteriy rather than monthly.
Joan Fox was elected president at the
meeting.
Visiting Homemaker Services
In Short Supply
Ottawa. - The Canadian Welfare
Council hopes to discover why the visit-
ing homemaker service is in short supply.
The Council has begun a study of selected
homemaker agencies in seven provinces.
The study, supported by a grant from the
Welfare Grants Division of the Depart-
ment of National Health and Welfare, is
expected to cost over 528,000 and take
one year to complete.
Visiting homemaker services are re-
cognized by home economists, nurses,
and social workers as a necessary commu-
nity service for people of all incomes, in
time of need.
In Canada there is only one home-
maker for every 30,000 persons. Home-
maker services in Canada operate under
the auspices of family service associa-
tions, the Canadian Red Cross Society,
the V.O.N. , and others.
Areas for study by a committee of the
council include: the structure of these
agencies and their financing; the recruit-
ment, training, hours of work, duties, and
salaries of the homemakers; and the types
of families that are served. Policy re-
commendations will then be formulated
in an effort to relieve the shortage of
visiting homemakers and meet commu-
nity needs.
In the past the "extended family"
took the place of the visiting homemaker.
Today the role of the extended family
has dwindled and the visiting homemaker
must assume this role.
Interim Executive Director
Appointed By ANA
New York, USA. - Hildegard Peplau
has been appointed interim executive
director of the American Nurses' Associa-
tion, Dorothy Cornelius, ANA president,
announced in JxJy.
Dr. Peplau will assume her duties in
September. She is now professor and
director of the graduate program in
psychiatric nursing at Rutgers, the State
University of New Jersey, and will be on
leave of absence from Rutgers during her
temporary appointment.
She will succeed Judith Whitaker, who
has been ANA executive director from
1958 to the present.
Dr. Peplau, who holds a doctor of
education degree in curriculum develop-
ment from Teachers College, Columbia
University, has served on many com-
(Continued on page 1 9)
THE CANADIAN NURSE 19
news
(Continued from page 19)
mittees and advisory groups of both the
ANA and the Nationd League for Nurs-
ing. She is currently chairman of ANA's
division of psychiatric-mental health prac-
tice; a member of the Congress on nursing
practice; and she is ANA consultant to
the advisory council of the National
Institute of Mental Health.
First Licence Granted
For Rubella Vaccine
Montreal, P.Q. - The world's first
licence for a vaccine to prevent rubella,
commonly known as German measles,
was granted by Switzerland April 3.
Recherche et Industrie Therapeutiques
(RIT), a Belgian subsidiary of Smith,
Kline & French Laboratories, was granted
the licence for a vaccine using the live
"Cendehill" virus strain, developed by
RIT. The Cendehill vaccine, a live at-
tenuated strain of the wild rubella virus,
is grown in primary rabbit kidney culture.
Of more than 60,000 persons vacci-
nated in large-scale studies, 97.5 percent
became immune to the disease. A single
subcutaneous injection of the Cendehill
vaccine provides immunity against rubel-
la. But it will require years of retesting
vaccinated persons to determine whether
this vaccine or any rubella vaccine gives
lifelong immunity.
The studies also showed that the vac-
cine is well tolerated and attenuated
enough that it does not spread the virus
from the vaccinates to susceptible unvac-
cinated persons. Used largely in children,
young girls, and adult women the vaccine
has caused no significant clinical symp-
toms and no significant reactions.
The most recent North American ep-
idemic of rubella, a relatively minor
disease in children but serious in women
during early pregnancy, occurred in
1964-65 when there were some 20,000
birth abnormalities and fetal deaths in the
United States alone. Another epidemic is
expected in 1970-71.
The vaccine is being reviewed in Cana-
da by the Food and Drug Directorate.
Two Workshops At UWO
London, Ont. - iwo seminars on
test construction were held for teachers
recently at the University of Western
Ontario. The workshops, conducted by
Vivian Wood, assistant professor of
nursing, UWO, were cosponsored by the
school of nursing and the extension de-
partment of the university.
The workshops consisted of task-
oriented work sessions on essay ques-
tions, models for marking essays ques-
tions, objective examinations and item-
20 THE CANADIAN NURSE
writing practice sessions, and final assess-
ment of student nurses.
The first workshop was held May 5-7,
and was attended by 28 teachers from
Ontario, New Brunswick, and Nova
Scotia. The second was held June 15-18,
and was attended by 35 teachers from
Ontario, British Columbia, Alberta. Que-
bec, New Brunswick and Nova Scotia.
D
An Unlikely Author
Victoria, B.C. - A nurse married to an Armed Forces lawyer, who has raised three
children while following her husband through 1 8 moves in 25 years, would hardly
be a likely author of a Doubleday Crime Club choice. But Marion Rippon, the
unlikely author, sold The Hand of Solange to Doubleday and Company a year ago,
and the book will be on sale by September.
"It's a sort of psychological mystery," Mrs. Rippon explained. 'The murders and
sex aren't very important; it's the psychological process leading up to the murders
that I have tried to trace." Experience with mental patients in the Canadian Forces
Hospital in Halifax helped her understand the workings of mental patients, she said.
The story is set in France, where Mrs. Rippon's husband was posted for four years.
It tells the story of Solange, a schizophrenic who is a compulsive eater. "She
switches from the world of reality, which is intolerable to her, to her own world of
fantasy where she sits and eats chocolate bars," Mrs. Rippon said. "1 haven't used
any real cases, but I have tried to keep it as authentic as possible. Most of the other
characters are perfectly ordinary Frenchmen."
Mrs. Rippon is working on a sequel to her novel - Behold the Druid Weeps for
Thee. It has also been bought by Doubleday.
AUGUST 1%9
names
Glenna Rowsell
(R.N., St. John's
General H., St.
John's, Nfld.; dipl.
in clinical super-
vision, dipl. in nur-
sing education and
administration, U. of
Toronto; dipl. in
Public Health Nur-
sing. U. of Ottawa) leaves the Canadian
Nurses" Association in July to become
employment relations officer of the New
Brunswick Association of Registered
Nurses.
Miss Rowsell remained in her native
Newfoundland until 1 96 1 , as a staff nurse
in the operating room, assistant instructor
at the General Hospital in St. John's,
nursing arts instructor, and finally^ as
associate director of the same school of
nursing. In 1961 she joined CNA as
director of the association's school impro-
vement program, and in 1966 she became
consultant in social and economic wel-
fare.
Miss Rowsell has traveled throughout
Canada in her position as consultant. Last
October she conducted educational work-
shops throughout New Brunswick on
social and economic welfare, sponsored
by the New Brunswick Association of
Registered Nurses. In February and
March 1969, she conducted workshops
on collective bargaining in Manitoba.
Dorothy S. Starr
(B.A., Simpson Col-
lege, Iowa; M.N.,
Yale U. School of
Nursing, New Haven,
Conn.) left her post
as principal of the
.^^^^^ Ottawa Civic Hospi-
L ^"''j^^^,^ t^l school of nursing
^ ^■■H in July.
Mrs. Starr began her experience in the
Lord Dufferin Hospital in Orangeville,
Ontario, then joined the psychiatric unit
of the Institute of Human Relations at
Yale University as a staff nurse. A year in
Pakistan with the American Friends Servi-
ce Committee followed, during which she
served as a "nurse-of-all-trades" with the
Quaker mobile medical team. She then
joined the Ottawa Civic Hospital school
of nursing, first as a teacher, later be-
coming administrative assistant, assistant
director, and principal of the school.
Mrs. Starr leaves to become assistant
professor of nursing at Ottawa University.
AUGUST 1%9
New ICN Executive
The Council of National Representatives elected a new executive for the next
quadrennium during the Congress of the International Council of Nurses in
Montreal June 22-28. From left to right are Ruth Elster, Germany, third
vice-president; Alice Girard, Canada, second vice-president; Dorothy Cornelius,
United States, first vice-president; and Margrethe Kruse, Denmark, president,
wearing the Presidential Chain of Office.
Miss Kruse has just completed four years as chairman of ICN's Professional Services
Committee, a position in which her knowledge of social and economic welfare was
very important. She has been executive secretary of the Danish Nurses Association
since 1945.
At a press conference held following the announcement of her election as ICN
president, Miss Kruse said she hoped ICN would remain non-political. "We can't
interfere with the political systems of countries," she said, answering a question
about countries that practice racial discrimination. "We must show that we can live
in peace and love each other."
Dorothy Cornelius is executive director of the Ohio Nurses' Association and
president of the American Nurses' Association. She has been president of the
American Journal of Nursing Company and chairman of her national association's
employee relations committee.
Alice Girard, immediate past president of the ICN, is dean of the faculty of nursing
at the University of Montreal. Dr. Girard is a member of the World Health
Organization's Expert Committee on Nursing. She is a past president of the
Canadian Nurses' Association and the Canadian Nurses' Foundation.
Ruth Elster, who was second vice-president of ICN in the past quadrennium, has
been president of the German Nurses' Federation and the Agnes Karll Association,
one of the federation's member associations, since 1957. She has served on the ICN
Finance and Administration, and Economic and Welfare Committees. Miss Elster is
a member of the WHO Expert Advisory Panel on Nursing.
THE CANADIAN NURSE 21
names
Laura W. Barr, executive director of the
Registered Nurses' Association of Ontario
since 1961, was elected to the seven-
member Professional Services Committee
at the Congress of the International
Council of Nurses in Montreal. Miss Ban-
was a member of this committee during
the past ICN quadrennium.
During the time she has been executive
director of the RNAO, active programs
have been developed in all fields relating
to the welfare of nurses.
At the ICN Congress, Miss Barr was
one of three panel members at a special
interest session on nursing legislation (see
News, p. 16).
Nora Paton (Reg.N.,
Toronto General H.;
Dipl. in Neurological
and Neurosurgical
Nursing, Montreal
Neurological Insti-
tute; B.N., McGill
U.) has been ap-
pointed director of
personnel services
for the Registered Nurses' Association of
British Columbia. She joins RNABC on a
half-time basis in September, and in June
1970 will take over this position from
Evelyn E. Hood, who is retiring.
Miss Paton is studying toward a mas-
ter's degree in education at the University
of British Columbia.
Miss Paton left The Vancouver General
Hospital in May, after nine years as a
general duty nurse and head nurse of the
neurosurgical unit. She has done general
duty nursing at St. Luke's Hospital in
Denver, Colorado, and the Montreal Neu-
rological Institute, where she became
director of nursing education.
Eight former Saskatchewan nurses
were awarded honorary memberships in
the Saskatchewan Registered Nurses'
Association at the 52nd annual meeting
in Saskatoon, May 21-23: They are:
Margaret F. Myles; the well-known
author of A Textbook for Midwives, is a
graduate of Yorkton Union Hospital
School of Nursing, and was director of
nursing there from 1928 to 1931. Audrey
M. Shattuck was director of nursing at
Meadow Lake Union Hospital from 1959
to 1967, and was active in SRNA. Sister
Armande Ste-Croix was director of nur-
sing of St. Paul's Hospital, Saskatoon,
from 1942 to 1955, and supervisor of the
obstetrical unit from 1965 to 1967.
Mary Elizabeth Keyes was director of
nursing at Maple Creek Union Hospital
from 1951 to 1967.Elizabeth H. Mitchell
22 THE CANADIAN NURSE
formed the first SRNA chapter in Wey-
burn and was its first president. She has
held several positions at Weybum Union
Hospital. Alberta Normandin does relief
work at Buffalo Narrows Outpost Hospi-
tal. She has also done relief nursing at
Sandy Bay Outpost Hospital, and was
public health nurse, supervisor, then offi-
cer in charge of medical health for the
Assiniboia-Gravelbourg health region
from 1935 until 1966.
Kate Chapman of Saskatoon has been
president, secretary, and chairman of
several committees of the Humboldt
Chapter of SRNA. Jean S. Harry was
director of nursing at Winnipeg General
Hospital, Victoria Union Hospital, Prince
Albert, from 1933 to 1959.
Edith G. Stevenson
^ a (R.N., Butler H.,
^ Providence, Rhode
Island; Certificate
Public Health Nurs-
ing, U. Toronto) has
retired as a nursing
counselor with the
Ottawa Branch of
Medical Services, De-
partment of National Health and Welfare.
Miss Stevenson held this position for 20
years.
Before she joined the government.
Miss Stevenson worked with the Vic-
torian Order of Nurses in Montreal, North
Bay, and Preston, Ontario.
p ^^^ Hazel B. Keeler
^^^^^^^ (R.N., The Vancou-
^^^HB^^^ ver General H.; dipl.
^^B^^^^^' in teaching and su-
■■.^ _J^k pervision. School for
Hf^^""^ W Graduate Nurses,
' ■ McGill U.; B.A., U.
of Saskatchewan;
M.A., Teachers Col-
lege, Columbia U.) is
retiring as director of the school of
nursing at the University of Saskatchew-
an.
Miss Keeler began nursing as an obste-
trical supervisor at the Kootenay Lake
General Hospital, Nelson, British Colum-
bia. She has held the positions of clinical
supervisor at the University of Alberta
Hospital in Edmonton, associate profes-
sor of nursing education at the University
of Buffalo, director of nurses at the
Women's College Hospital in Toronto,
and science instructor at The Vancouver
General Hospital. She was the organizer
and first director of the department of
nursing education at the University of
Manitoba.
Miss Keeler became director of the
school of nursing at the University of
Saskatchewan in 1950. She reorganized
the work in the school to provide for
specialized training in public health nur-
sing in the five-year degree course.
4^\
education
Also active in the Canadian Nurses'
Association, Miss Keeler served as a vice-
president and chairman of the CNA
committee on nursing education.
Karen Walker
(Reg.N., Victoria H.,
London, Ont.; Dipl.
Psych. Nursing, Al-
lan Memorial Insti-
tute, Montreal;
B.Sc.N., U. Western
Ontario) has been
appointed assistant
director of nursing
Clarke Institute of
Psychiatry in Toronto.
Prior to her appointment, Mrs. Walker
was an instructor at the Clarke Insti-
tute - a University of Toronto teaching
hospital and research center.
For the past two years she has been a
member of the Toronto-Hamilton area
educators in psychiatric nursing.
Two New Brunswick nurses were
honored at the 53rd annual meeting of
the New Brunswick Association of Regis-
tered Nurses in Moncton, May 28-30.
Lois Smith , formerly director of nur-
sing at the Provincial Hospital in Saint
John, and M. Jane Stephenson, formerly
director of nursing at the Saint John
General Hospital, were awarded honorary
membership in NBARN at the annual
banquet. The memberships were present-
ed in recognition of long and outstanding
service to the Association.
Ma rilyn Barras
(Reg.N., St. Joseph's
H., Toronto;
B.Sc.N., U. of West-
em Ontario; post-
graduate course in
pediatric nursing,
Washington Child-
ren's Hospital,
Washington, D.C.)
has been appointed director of nursing,
Humber College of Applied Arts and
Technology in Toronto.
Mrs. Barras spent one year as an
assistant nursing arts teacher, four years
as a pediatric nursing teacher, and two
years as nursing education coordinator at
St. Joseph's school of nursing in Toronto.
Honorary memberships were awarded
to two nurses at the annual meeting of
the Registered Nurses' Association of
Nova Scotia in Yarmouth, May 27-28.
E.A. Electa MacLennan, director of Dal-
housie University school of nursing, and
Hope Mack, director of nursing at the
Nova Scotia Sanatorium, Kentville, N.S.,
were honored by the 150 nurses attend-
ing the meeting. D
AUGUST 1%9
September 17-19, 1%9
Annual Convention, Alberta Certified
Nursing Aide Association, Calgary, Al-
berta.
September 18-20, 1%9
Annual conference on obstetrics, gyneco-
logic, and neonatal nursing, Sheraton-
Brock Hotel, Niagara Falls, Ontario.
Sponsored by District V of the American
College of Obstetricians and Gynecolo-
gists.
September 22-24, 1%9
Annual Convention, Alberta Medical As-
sociation, Calgary, Alberta.
September 23-25, 1969
10th annual meeting and convention of
Associated Nursing Homes, Inc., Shera-
ton-Connaught Hotel, Hamilton, Ont.
September 25-27, 1%9
3rd annual postgraduate course for emer-
gency room nurses. Palmer House Hotel,
Chicago. Tuition fee: $60. Write to: Dr.
Anast, 55 East Washington Street, Chica-
go, Illinois 60602.
September 28 - October 3, 1%9
13th annual Registered Nurses' Associa-
tion of Ontario Conference on Personal
Growth and Group Achievement, De-
lawana Inn, Honey Harbour, Ont.
October 6-8, 1969
Annual nurses' convention, sponsored by
the American College of Obstetricians
and Gynecologists, Marlborough Hotel,
Winnipeg. For further information write
to: Mrs. Jordan, c/o Women's Pavilion,
Winnipeg General Hospital 700 William
Avenue, Winnipeg 3, Man.
October 9-10, 1969
Annual Convention, Catholic Hospital
Conference of Alberta, Edmonton, Al-
berta.
October 16-17, 1969
Continuing Nursing Education Course in
Nursing the Adult with Long Term Ill-
ness. The University of British Columbia,
School of Nursing, Vancouver, B.C.
October 24, 1969
Catholic Hospital Conference of Ontario
Nursing Committee meeting, Westbury
Hotel, Toronto.
October 25-26, 1969
Catholic Hospital Conference of Ontario,
annual convention, Westbury Hotel,
Toronto, Ontario,
AUGUST 1%9
October 9-10, 1969
Ontario Hospital Association, 45th an-
nual convention, Royal York Hotel, To-
ronto.
October 30-31, 1969
Continuing Nursing Education Course in
Pediatric Nursing. The University of
British Columbia, School of Nursing,
Vancouver B.C.
October 2-9, 1%9
Second symposium on the use of comput-
ers in clinical medicine. Executive Motel,
Buffalo, N.Y. Workshops include "The
Nurse in a Computerized Hospital In-
formation System." A Canadian work-
shop is under consideration. For more
information write to: Continuing Medical
Education, State University of New York
at Buffalo, 2211 Main St., Buffalo, N.Y.
14214.
October 6-31, 1%9
Advanced program in Health Services
Organization and Administration, Uni-
versity of Toronto School of Hygiene.
This is the first of two parts of the
course. Fee: $200 for each part. Write to:
Dr. R.D. Barron, Secretary, School of
Hygiene, University of Toronto, Toronto
5, Ont.
November 11-13, 1%9
Quebec Operating Room Nurses' Group,
annual convention. Skyline Hotel, Mon-
treal.
November 13-14, 1969
Continuing Nursing Education Course in
Nursing the Adult with Acute Illness. The
University of British Columbia, School of
Nursing, Vancouver, B.C.
November 17-21, 1969
World Mental Health Assembly, spon-
sored by the World Federation for Mental
Health and the National Association for
Merital Health, Washington, D.C. Theme:
Mental Health In The Community. Write
to: Dr. Paul V. Lemkau, Chairman, World
Mental Health Assembly, 615 N. Wolfe
St., Baltimore, Md. 21 205, USA.
November 19-21, 1%9
Second Manitoba Health conference. Fort
Garry Hotel, Winnipeg. This was formerly
the Manitoba Hospital and Nursing Con-
ference.
November 24-27, 1%9
Conference for directors of nursing, To-
ronto. Sponsored by Ontario Hospital
Association and Registered Nurses' Asso-
ciation of Ontario. D
Next Month
in
The
Canadian
Nurse
• professional nursing associations
- are they coming or going?
• a look at inservice in a school
of nursing
• film crews at work
&
^^P
Photo credits for
August 1%9
Gazette Photo Service, Montreal,
pp. 10, 12
Malak, Ottawa, p. 7
Julian LeBourdais, Toronto,
pp.8, 10,14,18,21,30-38
THE CANADIAN NURSE 23
new products {
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
Infant Immobilizing Board
The new infant immobilizing board
has Velfoam covering and Velcro restrain-
ing bands. Padded for comfort, the infant
immobilizing board permits well-
positioned x-rays without holding the
child.
Also useful for venesection, exchange
transfusion, or umbilical vessel catheter-
ization, the 14" by 23" board, made in
Canada, will fit most incubators and will
withstand autoclaving.
For more information contact: Down
Bros, and Mayer and Phelps Ltd., 261
Davenport Road, Toronto 5, Ontario.
Net-Back Mitt
This mitt is designed with a rigid palm
to prevent the patient from using his
fingers for grasping himself or other
objects. The reach of the patient can be
limited further by attaching the extra
strap provided to the bed spring or rail.
The mitt can also be worn without this
strap.
The mitt is constructed of long-
wearing nylon, and is available in small,
medium and large sizes.
For more information on this Posey
product, write to: Enns & Gilmore
Limited, 1033 Rangeview Road, Port
Credit, Ont.
of a durable, high-dielectric material that
sterihzes well by any method; the unit
disassembles quickly into four pieces. For
easy handling, the power cord swivels and
also enters the handle at a right angle.
For full details, write Gene Lamb, The
Birtcher Corporation, Medical Division,
4371 Valley Blvd., Los Angeles, Califor-
nia 90032.
Rubber Implant
Silastic finger joints are designed for
metacarpophalangeal and proximal inter-
phalangeal joint arthroplasty. The im-
plant functions as an interpositional ma-
terial, helping to maintain normal joint
relationship. The intramedullary stem and
flexible hingelike construction provide
normal joint alignment, good lateral sta-
bility, and a minimum restriction of
flexion-extension.
The intramedullary implants are made
of a heat vulcanized medical grade sili-
Duatrol Antacid
Duatrol, a new antacid/antiflatulent,
provides buffering action, acid-consuming
effectiveness, and relief from gas. It com-
bines three antacid ingredients (calcium
carbonate, aluminum hydroxide, and
glycine) with the antiflatulent dime-
thylpolysiloxane.
Formulated to relieve both hyper-
acidity and the discomfort caused by
excess gas in the gastrointestinal tract,
Duatrol is recommended for the effective
treatment and relief of symptoms of
peptic ulcers, gastritis, hyperacidity and
those gastrointestinal disorders accom-
panied by excessive gas.
Duatrol is available as a suspension in
12 fl. oz. bottles, and as monogrammed
tablets, strip-packed in boxes of 50.
For further information, write to:
Smith Kline & French, Montreal 379,
Quebec.
Electrosurglcal Handle
This new electrosurglcal handle allows
quicker, simpler changing of electrodes.
The Model 779 handle uses a new
chuck design that eliminates threads and
the problems caused by jamming threads.
Insertion and removal of electrodes is
almost instantaneous. The handle is made
24 THE CANADIAN NURSE
cone elastomer. Test joints have been
flexed more than 45 million repetitions
without breaking, indicating that the elas-
tomeric material possesses excellent flex
characteristics. The implant is unlikely to
cause necrosis or stimulate bone absorp-
tion and can be trimmed and shaped to
some degree at surgery. Because of this
combination of properties, the prosthesis
is expected to last the lifetime of a
patient.
For further information write: Medical
Products, Dow Corning Silicones, Downs-
view, Ontario. LJ
AUGUST 1%9
when teen-agers want to know about menstruation
one picture may be worth a thousand words
Never are youngsters more aware of their own
anatomy than when they begin to notice the changes
of adolescence. And never are they more susceptible
to misinformation from their friends and schoolmates.
To negate half-truths, give teen-agers the facts —
using illustrations from charts like the one pictured
above. They'll help answer teen-agers' questions about
anatomy and physiology. These SVi" x 11" colored
charts of the female reproductive system were pre-
pared by R. L. Dickinson, M.D. and are supplied free by
Canadian Tampax Corporation Ltd. Laminated in
plastic for permanence, they are suitable for grease
pencil marking. And to answer their social questions
on menstruation, we also offer two booklets — one
for beginning menstruants and one for older girls —
that you may order in quantities for distribution.
Tampax tampons are a convenient — and hygienic
— answer to the problem of menstrual protection.
They're convenient to carry, to Insert, to wear, and
to dispose of. By preventing menstrual discharge from
exposure to air, Tampax tampons prevent the embar-
rassment due to menstrual odor. Worn internally, they
AUGUST 1969
cause none of the irritation and chafing associated
with perineal pads.
Tampax tampons are available in Junior, Regular
and Super absorbencies, with explicit directions for
insertion enclosed in each package.
TAMPAX
SANITARY PROTECTION WORN INTERNALLY
MADE ONLY BY CANADIAN TAMPAX CORPORATION LTD.. BARRIE, ONT.
FREE CHARTS IN COLOR
Canadian Tampax Corporation Ltd.. P.O. Box 627, Barrie. Ont.
Please send tree a set of the Dickinson charts, copies of the
two booklets, a postcard for easy reordering and samples of
Tampax tampons.
Name_
Address_
THE CANADIAN NURSE 25
in a capsule
Maple leaves from Japan
One generous donation for the ICN
Congress that the Canadian Nurses' As-
sociation received from a provincial
nurses' association was a gift of 10,000
souvenir-size Canadian flags.
What better reminder of Canada, along
with Whoo-fur, could foreign nurses take
home from Montreal?
We hear that a slight problem faced
the donors before they could present
these Canadian souvenirs, however. How
do you erase "Made in Japan" when it is
carved on the wooden stick that holds the
maple leaf?
Hire a Canadian Indian to carve
around the problem?
Alive and kicking
"What's this man's name - Hitler? "
was the stormy reaction of one 83-year-
old. "The doctor clearly is not old
enough to know better," said the
96-year-old philosopher Bertrand Russell.
These were two of the reactions to the
suggestion by British doctor Kenneth
Vickery that an age be set beyond which
doctors should no longer strive to keep
patients alive. "About 80," was his guess
at the right time to allow a person to die.
Dr. Vickers said that elderly persons
are demanding so much attention that
younger persons were no longer getting
the attention they needed. He said he
realized that euthanasia is unthinkable in
a Christian society, but the question
could no longer be ignored in a society
with insufficient nurses and hospital beds.
Ernest Melling, general secretary of the
National Federation of Old Age Pen-
sioners and author of the comment
above, said bluntly that he had no faith in
doctors. "Who does this man think he is
to decide on life and death? "
Dr. Robert McClure, moderator of the
United Church of Canada, said "The
answer is obvious: get more beds. A
nation that can afford its whiskey and
beer should be able to afford more beds."
Timeless valley
Ihe Horner Newsletter has a brief
report on the Vilcabamba Valley in
Ecuador in the June 9 issue. Census
figures show that many persons living in
the valley, at an altitude of 4,500 feet,
live to the age of 130. About 10,000
26 THE CANADIAN NURSE
people live a quiet, rustic existence, with
heart ailments non-existent in the 628
persons interviewed by investigators.
Other ailments were rare as well. Title of
the item: Valley of the Elderly Dolls.
A wardrobe of artificial limbs
An entire wardrobe of artificial limbs
might be the answer to the problem of
realistic-looking, but inefficient artificial
limbs, according to a Scottish bioengi-
neer. Robert M. Kenedi, director of re-
search for the bioengineering unit of the
University of Glasgow, said there was
little difference between modern artificial
limbs and limbs designed in the sixteenth
century. Old and modern limbs both were
designed to look natural, and therefore
have severe limitations because they do
not have the normal muscle movements.
Professor Kenedi said that he has
always felt that one of the major aspects
of rehabilitation should be to overcome
disability by giving supranatural ability.
But when he asked a group of amputees
to accept a highly functional limb, such
as a telescopic leg, the response was a
little uncertain. Most said they would
wear such a device for working condi-
tions, but when they took their wives out
for an evening they wanted to look
natural.
"So why not a wardrobe of limbs? "
asks Professor Kenedi.
"There's a song In my heart"
So, at least, was the situation recently
at a hospital in Leicester, England during
a delicate heart operation. As the pace-
maker machine was switched on, thump-
ing rock and roll music poured out,
picked up from a local radio station 400
yards away. Plugs were pulled out to
silence the din and surgery continued
without the pacemaker. The patient sur-
vived. An investigation is now under way
in Britain of all hospitals where radio
interference might occur. - From The
Homer Newsletter, volume 6, number 12.
The focal point
Concordia Hall was the scene of many
interesting events during the International
CouncU of Nurses Congress in June, but
we disagree strongly with the opinion
given in the report of the Congress
Arrangements Committee. "The fecal
point" it was not. D
AUGUST 1%9
EVEREST & JENNINGS
Aids to Independence
SAFETY GRIP BATH SEAT
No. C409 — Elevation of seat
permits personal washing in
bath tub. Constructed of
chrome-plated tubing and
fitted with non-slip rubber
tips for extra safety. 6"
high; width at base 14"
PORTABLE PATIENT HELPER
No. C704 — Mounted on a
strong base, yet easily
moved about. Upright is
adjustable and has a bed
end locking clamp for •
complete stability. Durable
nylon chain and moulded
hand grip designed for
patient comfort.
BEDSIDE C0I4M0DE
No. 11BCS2D-917 — Simple.
sturdy and inexpensive. Lid
and seat in hygenic white
plastic. Frame in easy to
clean chrome-plated steel
tubing. Non-slip rubber tips
on feet. Adjusts from 17V2
to 21'/2" ^
ALUMINUM LIGHTWEIGHT WALKING AID No. C435NA — Balanced design,
sound construction and non-slip rubber tips assures strength and
stability. Standard model as illustrated, 33" high. Adjustable model,
from 33" to 37".
PREMIER RAISED TOILET
SEAT No. C404— Increases
toilet height by approx.
5V2". Easily installed and
fits all standard toilets.
Chrome-plated brackets fix
seat to bowl. Seat has
matching white plastic
sanitary shield.
POLYPROPYLENE RAISED >
TOILET SEAT No. C457 —
Soft and comfortable, this
seat increases height at
front by 5" and 6" at back
Designed for all standard
toilets. Easily cleaned
with boiling water.
With more than 30 years experience in the design and manufacture of wheelchairs, Everest
& Jennings now offers a complete range of equipment for the physically disabled. Every
item is carefully designed and thoroughly tested for maximum patient satisfaction. Only a
few items are shown here. Ask for more details on our full line of AIDS TO INDEPENDENCE.
EVEREST & JENNINGS
P.O. BOX 9200 DOWNSVIEW, ONT. (416)889-9251
Frankly,
we'd
rather
you didn't
notice us
It has been said that the measure of
truly effective background music is
the degree to which it goes un-
noticed.
A contradiction? Perhaps. Yet, con-
sider how little thought you give to
anything while it is fulfilling its
functional obligations smoothly. An
electric shaver. A radio. A lawn
mower. Even the ubiquitous light
bulb.
We like to think that our hospital
specialty products are somewhat in
the background of your professional
activities, and also go unnoticed. For
experience has shown that when a
surgeon is very much aware of the
materials with which he is working,
something is not working right. And
this is the kind of awareness we
don't want.
It's just one of the reasons we have
been striving for over 60 years to
produce sutures, needles, and a
variety of other surgical products
that perform the way you want them
to — and striving as well to anticipate
the rush of progress in surgery
through creative research and in-
novation.
Along with you, we think that
patients should be subjected to the
least trauma possible under the cir-
cumstances, and be afforded every
possible opportunity for successful
recovery.
Sothe nexttimethe untoward behav-
iour of a product causes you to look
twice at the package, look carefully.
Itprobablywon'tsay DAVIS &GECK.
That time, incidentally, might be an
ideal time to call us. You'll discover
that DAVIS & GECK can provide you
with products and services that
perform so well you'll hardly notice
them.
Even if you feel there's an area in
which we can improve, please don't
CYAN AMID OF CANADA LIMITED, Montreal
wait for us to call you — write us or
call collect.
We may not want to be noticed, but
neither do we want to be ignored.
ATRAUMATIC® Needled sutures •
predictably absorbed Gut suture •
silicone-treated Silk suture • braided
Dacron* and TYCRON® sutures •
DERMALON® nylon suture •Linear
Polyethylene suture • Cotton suture
. FLEXON® multistrand Stainless
Steel suture • PRE-OP® disposable
surgical scrub sponge •VIRO-TEC®
disinfectant/deodorant spray •
FLEXITONE® surgical binders •
OWENS* surgical dressings •
AUREOMYCIN® dressings •
©Registered Trademark
•Trademark
Team work:
the way to play the game
OPINION
Frances Howard, B.N.
Radical changes in health care in our
society and the rapidity with which these
changes are occurring leave the nursing
profession only one course of action, if it
is to keep apace: it must, through its
members and in cooperation with other
health disciplines, reexamine and redefine
its role. In addition, its members must
decide what their functions should be and
how they wish "to play the game."
Are we, as nurses, to manage
"things"? Are we to act as pseudo
doctors? Or are we to practice nursing? 1
believe there is Httle argument that our
prime purpose is to give nursing care as
we ourselves have described it at our
professional associations.
Have we been playing the game as we
have described it? Probably not, if we are
to believe the many criticisms about
nursing that abound, both from within
and without the profession.
Within the profession we admit that a
shortage of personnel has forced us to
delegate a large part of nursing care to
less qualified persons; we admit, too, that
the auxiliaries giving this care are not
receiving adequate guidance and super-
vision; and we admit that the best practi-
tioners of nursing often leave the pa-
tient's bedside, because they are pro-
moted to administrative positions, where
management of "things" has somehow
achieved a higher status than management
of "care."
Outside the profession, the criticisms
are similar, although often a little more
bitter. Probably the complaint most fre-
quently voiced by the patient is that his
care is so fragmented that he seldom
knows who his nurse is or from whom he
can seek advice, information, comfort,
and support.
I believe that nurses are both willing
and able to give good nursing care. Where,
then, does the fault lie? In the system, or
the means by which the functions of
nursing is carried out. How do we im-
prove the system? By adopting the team
method of nursing.
Why team nursing?
Success, satisfaction, and reward are
dependent on the degree of judgment and
AUGUST 1%9
decision allowed the practicing nurse. Yet
our present system of organization has
vested such responsibilities in those per-
sons holding administrative and super-
visory positions. The nurse who gives
direct patient care has responsibility only
for carrying out functions assigned by
someone higher up the ladder.
Nursing students are being prepared to
give patient-centered care. Regrettably,
the work environment tends to decrease
initiative and motivation to the point
where competency either reaches a pla-
teau or is diminished. Too often the
individual adopts the "if you can't beat
them, join them" attitude.
Organizations for nursing service
should be based on human behavioral
principles that recognize both patient and
nurse as human beings. Team nursing was
designed for this purpose: it is a reorgani-
zation of nursing service by which people
(nurses) work with and through other
people (nurses and patients) to give
nursing care.
The primary concern of the nursing
team is what is best for the patient. The
capabilities of all members of the team
are used to their fullest to provide the
best possible care. Thus the maximum
number of patients benefit from the most
skilled care. Moreover, the responsibility
for planning and giving nursing care is
decentralized and, for the most part, rests
with the nurse who is caring for the
patient.
Team members have the advantage of
immediate supervision and guidance.
Face-to-face communication is enhanced,
thus increasing the probability of the
patient receiving the care he requires.
Team nursing encourages individual ini-
tiative in the planning and giving of care.
Miss Howard, a graduate of St. John General
Hospital, SL John, N.B., the University of
Toronto School of Nursing, and the School for
Graduate Nurses, McGill University, is Con-
sultant in Nursing Service, Canadian Nurses'
Association, Ottawa. Miss Howard leaves CNA
next month to begin work toward her M.Sc.N.
degree at the University of Western Ontario in
London, Ontario.
Also, a system of checks and controls
inherent in team nursing allows the team
collectively to establish goals and evaluate
the care given.
There is better opportunity, too, to
provide continuity of care. Although indi-
vidual members may be absent, the team,
as a group, know and understand the
patient and his needs; the patient, in turn,
knows "his" team and has confidence in
its members.
The hub of nursing
It has recently been suggested that the
average organization is designed "to mini-
mize the opportunity for participants at
the lower level to perform work from
which they can experience a sense of
challenge, a meaningful contribution,
control over work activities, and opportu-
nities to make decisions count."* Team
nursing is a cure for such an illness. When
in operation, it becomes the hub around
which all supporting spokes are joined.
Yet, after more than 20 years, its effec-
tiveness is still being questioned.
Three reasons probably can be found
for this neglect of team nursing: 1. lack
of planning for change; 2. lack of prepa-
ration of personnel for change; and 3. in-
appropriate supporting structures. If team
nursing is to be successful, all personnel
must accept the method. Nursing staff
should be prepared through staff develop-
ment programs to function in their new
roles. Team nursing is a clinically-oriented
system and, therefore, requires a clinical-
ly-oriented supporting structure. Too
often team nursing has been superim-
posed on a structure defined around the
work to be done, rather than on the
patient, his needs, and his problems.
Team nursing is the answer to the
nurse's desire to return to her original
role of providing nursing care. It also
provides the nucleus for a more clinical-
ly-oriented organizational structure. In
effect, team nursing is the most satis-
factory and satisfying way - for both
patients and staff - to play the game.
*Chris Argyris, Organizational illness: an ana-
lysis, Toronto, Canadian Imperial Bank of
Commerce, Commercial Letter, October, 1968.
THE CANADIAN NURSE 29
ICN CONGRESS REPORT
For a week in June, Canada was the
center of the world of nursing. Ten
thousand nurses from 85 countries met in
Place Bonaventure in Montreal June 22 to
27 to deliberate on both unique and
common concerns of nurses and nursing
at the 14th Quadrennial Congress of the
International Council of Nurses.
A nurse was still a nurse that week in
Montreal; however, instead of being
identified by a cap and uniform, she was
known by the white "Whoo-fur" she
wore on her lapel and the special blue-
and-white ICN tote bag she carried.
Whoo-fur, the furry mascot of the con-
gress, was the Canadian Nurses' Associa-
tion's gift to every registrant.
Language differences proved no barrier
at either the formal or informal sessions.
Although English is the official language
of ICN, simultaneous translation was
provided for all major sessions into
French, German, and Spanish. As well,
hostesses were on hand to give assistance
to those who spoke no English. The
hostesses were easily recognized in their
white dresses with colorful ribbon sashes
designating by color the languages they
spoke: green for French, yellow — Span-
ish; red — German; and blue — English.
When nurse met nurse over coffee, sign
language often served as a fifth language.
Another aid to communication was the
ICN Bulletin, published daily in the four
languages.
Music, the universal language, was also
part of the congress. The red-jacketed
30 THE CANADIAN NURSE
members of the Royal Canadian Mounted
Police Band entertained a large audience
on Monday evening. Wednesday evening,
the Montreal Symphony Orchestra pre-
sented a special congress concert - a gift
of the Province of Quebec — featuring
combined selections from composers of
many nations.
"Man and His World" — the grandson
of Expo 67 - helped to perpetuate the
international flavor. A pass was given by
the CNA to any nurse wishing to visit the
fair, and special trips were arranged on
the Saturday following the congress.
The swinging success of the congress
represented a personal success for Cana-
dian nurses; the time, effort, and money
spent at the local, provincial, and national
levels paid off in an exciting event in
which all Canadians could take pride.
Opening Ceremonies
The first official function of the Con-
gress was an interfaith service held on
Sunday afternoon. Montreal's 140-year-
old Notre-Dame Church opened its doors
to more than 5,000 nurses and friends.
Three ethnic groups provided music for
meditation prior to the service, which was
conducted by representatives from
Hindu, Buddhist, Jewish, Moslem, and
Christian faiths.
The address was given by Archbishop
Paul Gregoire of Montreal, who said that
the service of many denominations helps
us to rise above our differences - prog-
ress is only possible by acting together.
For the occasion, a responsive prayer
and the recessional hymn were spoken in
four languages. Father Francois DeRuijte
of St. Joseph Convent, Father Robert
Vachon, and Father Jacques Langlais of
Monchainin Center, Montreal, created the
words.
In honor of Montreal's first nurse
Jeanne Mance, ICN president Alice Girard
and Goldie Green, representing the As-
sociation of Nurses of the Province of
Quebec which arranged the service,
placed flowers at a stained glass window
to commemorate nursing's contributions
to mankind.
Varicolored sights and sounds distin-
guished Sunday evening's formal opening
ceremonies of the ICN 14th Quadrennial
Congress. Thousands of nurses - many
dressed in elegant national costume
— watched the dignified, colorful pro-
cessions of observer associations, ICN
board of directors and committee chair-
men, ICN Council of National Represent-
atives (CNR), and presidential procession
make their way to the revolving stage in
the center of the vast Concordia Hall. The
flag of each country represented was
carried by a Canadian student nurse.
In her welcome, ICN president Alice
Girard spoke of the many values of an
ICN Congress. "I believe that nothing has
yet been found to replace the warm
feeling of a spontaneous handshake, the
pleasure of watching someone's face light
up with interest when captivated by a
good speaker, and above all the bond of
AUGUST 1%9
friendship that often starts with a friend-
ly smile," she said.
The Governor General of Canada, The
Right Honourable Roland Michener, de-
clared the congress and meeting of the
Council of National Representatives of-
ficially open.
The roll call of the 63 ICN member
associations, 58 of whom were present,
climaxed a ceremony that brought to-
gether what Sheila Quinn, ICN executive
director, had earlier called a "huge inter-
national family."
Business Sessions
Business of the Congress actually start-
ed in closed session of the CNR on
Saturday, June 20. During that time,
financial reports and details that were not
considered to be of general interest to the
thousands of nurses at the six-day con-
gress were discussed. CNR is the voting
body of ICN and is composed of the
president of each national association in
membership with ICN.
The first open session of the CNR
began Monday morning in Concordia Hall
of Place Bonaventure. About 5,000
nurses observed this first business session.
"I doubt whether ICN can go on much
longer without drastic changes and still be
fulfilling worthwhile goals and objec-
tives," Alice Girard, president of ICN and
chairman of the board of directors, said
in her report to the CNR. "What are the
strengths of ICN, what are its weak-
nesses? " she continued. "Is it attempting
to provide assistance or services which
could be found elsewhere? Is it trying to
be all things to all people? " she asked. "I
do not have the answers," she said, "but
answers can be found."
In her report, Sheila Quinn, executive
director of the ICN, spoke of the move of
ICN headquarters from London to Gene-
va in 1966, adoption of the new ICN
Constitution, and changes in head-
quarters' staff. The move to Geneva has
made possible closer cooperation with
other international organizations, Miss
Quinn explained. This has been de-
monstrated by informal inter-organiza-
tion staff conferences with ICN, the
World Health Organization, and the Inter-
national Labor Organization, she said.
Despite the continued shortage of ex-
ecutive staff, ICN has provided advice and
assistance to several nurses' associations
seeking to qualify for membership. Miss
Quinn pointed out. "Difficult though this
quadrennium has been, it has not been
without the satisfaction of having faced
considerable challenge and somehow
having achieved the near impossible," she
concluded.
Miss Quinn also read the report on
ICN publications - the International
Nursing Rex'iew and ICN Calling. In the
first year that the Review was published
in Switzerland, subscriptions almost
doubled. The ICN is supporting a heavy
financial loss with ICN Calling, she said.
Miss Quinn also provided information
on a nursing legislation project authorized
by CNR in 1967. This project, part of a
two-stage program recommended by the
professional services committee, resulted
in the 70-page document, Principles of
Legislation for Nursing Education and
Practice Funds from the Florence Night-
ingale International Foundation are fi-
nancing the project. The plan of the
second stage of the program, originally to
hold a regional seminar for nurses, was
expanded to an international seminar on
nursing legislation, with possible follow-
up regional seminars during the coming
quadrennium.
Dr. Helen Mussallem, executive direc-
tor of the Canadian Nurses' Association,
reported on the planning for the Montreal
Congress. She said that a manual based on
Canada's experiences will be given to ICN
for future reference.
Several items came before the CNR for
its consideration. One that sparked the
longest discussion centered on a recom-
mendation in the report of the member-
UGUST 1%9
Members of the Council of National Representatives are received by
Archbishop Gregoire at the interfaith service.
Montreal's 140-year-old Notre-Dame Cathedral opened its doors to more
than 5,000 nurses at the interfaith sen>ice on Sunday.
THE CANADIAN NURSE 31
ship committee, one of the two standing
committees of ICN under the new cons-
titution. This resolution concerned the
"second level nurse" and her membership
in both the national and international
association.
"Second level nurse" is defined as one
with the next to the highest preparation
to that of "nurse" as defined in the ICN
constitution. The second level nurse is
prepared in a preservice course with a
definite curriculum, on completion of
which a certificate or other recognition of
competence is given. A national associa-
tion has the right to define its own
membership at national level.
"If the second level nurse is accepted
into national membership, she should also
be afforded the privileges of ICN mem-
bership," said Virginia Arnold, committee
chairman, in proposing the recommenda-
tion. This statement brought delegates
from 32 countries to their feet. The
majority were opposed to the resolution
in any form. Concern was expressed that
in some countries the number of auxiliary
personnel exceeds the number of nurses
and that recognition of the auxiliary
nurse might be detrimental to the nurse.
On the other hand, some delegates said,
when second level nurses have no associa-
tion with the national nurses' association,
their only alternative is to join a union.
Australia proposed an amendment to
the main resolution to admit auxiliaries
to ICN membership, but without voting
privileges. In the discussion on the a-
mendment, the Netherlands pointed out
that without voting privileges, auxiliaries
would not benefit from ICN membership.
Australia withdrew the proposed amend-
ment after matters of parliamentary pro-
cedure became involved.
As the discussion progressed, Ruth
Elster, second vice-president of ICN, ex-
plained that auxiliaries could not be
admitted to the ICN without changing
the constitution.
After much discussion, the U.S. dele-
gate moved that the main motion to
admit auxiliaries to ICN be postponed for
four years for further study by the ICN
on the issues concerned. Ghana seconded
the motion, and it was approved by the
CNR.
Held over for consideration at the next
quadrennium was a resolution calling for
reopening some form of associate or
Hmited membership in ICN for associa-
tions that at present either do not qualify
for full membership or are of a size that
makes full membership impossible. Dis-
cussion concerned problems of member-
ship encountered by small countries with
a small number of nurses - only three
or four in some countries. One way to get
around this, it was suggested, would be
for these countries to enter into ICN
membership as part of a regional group.
The resolution for reopening associate or
limited membership involved a question
settled at the last congress in Frankfurt,
Germany.
The report of the seven-member pro-
fessional services committee was read by
chairman Margrethe Kruse of Denmark.
The report proposed that the exchange of
privileges program for nurses be replaced
by a service called "Nursing Abroad" and
defined as "a service offering nurses from
ICN member associations arrangements
for salaried employment and/or study
abroad"; and that ICN produce a leaflet
including general information and guid-
ance. This recommendation was adopted
by the CNR after brief discussion.
The second recommendation concern-
ed the recruitment of nurses to foreign
countries. The resolution as amended by
South Africa and approved by the CNR
read: "That ICN believes in the right of
free movement of individuals but de-
plores the tendency of certain govern-
ments and employment agencies to use
undesirable methods of recruiting large
numbers of nurses from one country to
another." Canada pointed out that its
objection was not against nurses working
in foreign countries, but against travel
32 THE CANADIAN NURSE
Governor-General Roland Michener, who opened the Congress, chats with
ICN presiden t A lice Girard and CNA presiden t Sister Mary Felicitas.
Eighty-five countries were represented at the Congress. Here, the
procession of member nations is led by Canada.
AUGUST 1%9
Sheer concentration. Simultaneous translation was provided for all major
sessions into French, German, and Spanish.
ICN vice-president confer Left to right: K. Pratt, 3rd vice-president,
Nigeria; Ruth Elster, 2nd vice-pres., Germany; and Alice Clamageran, 1st
vice-pres.. France.
agencies that entice nurses to work in
countries where they may be exploited.
The third recommendation of this
report proposed the adoption of a state-
ment on nursing education, nursing
practice and service, and social and eco-
nomic welfare of nurses. It was carried
with one amendment: "In those countries
where a Trades Union has been accorded
the exclusive rights of negotiation, the
National Nurses' Association should seek
to achieve a situation where it can ac-
tively influence the negotiations conduct-
ed on behalf of nurses." This amendment
was substituted for a paragraph which
maintained that the national nurses' asso-
ciation was the proper representative of
nurses, although "in some countries this
is undertaken by a trade union or labor
organization." The statement is intended
as a guide for national associations in
developing their own policies in greater
detail.
Two items brought forward by mem-
ber associations were approved. Australia
recommended that ICN member organiza-
tions that correspond on nursing matters
with organizations other than the ICN
member body in any country should
send a copy of the correspondence to the
national association concerned. Australia
also called for the adoption of a universal
record of professional education and serv-
AUGUST 1%9
ice for nurses. This record, intended as a
document that would be issued once and
added to as necessary, would be the
property of the individual nurse who
could get photostat copies when register-
ing in another country or state, and
would be accepted by licensing bodies all
over the world.
A motion put forward by the Royal
Council of Nursing, England, was adopt-
ed. It requests the board of directors to
set up a study group to review ICN
objectives and functions. The study group
would confirm or redefine ICN's role and
assess the achievements of its present
structure and organizational pattern in
relation to the role as confirmed or
redefined. The board will decide whether
an ICN committee or an outside group
makes the study. A report is to be
submitted in time for the next CNR
meeting.
The final items on the business agenda
were selection of sites for future meet-
ings. The next CNR closed meeting will
be in Dublin, Ireland, June 26-30, 1971.
The next ICN Congress will be held in
Mexico City in the summer of 1973 — a
bright note on which to close the heavy
business sessions.
Plenary Sessions
Few, if any, platitudes were heard
during the plenary sessions held Wednes-
day, Thursday, and Friday.* The speakers
were refreshingly frank in presenting their
concerns about issues affecting nurses,
nursing, and health, and the audience's
response showed that they appreciated
this frankness.
The tone was set by Canada's Minister
of National Health and Welfare, the
Honourable John Munro, who spoke
candidly about obstacles that must be
overcome if an efficient, personalized
health care delivery system is to be
provided to all people. His remarks
— many of which could be considered
controversial - showed a keen under-
standing of the problems that appear to
exist in all countries. (Mr. Munro's speech
is printed on page 38).
Following the Minister's address, The
Honourable Milton Gregg, president of
the Canadian Council for International
Cooperation and a former federal cabinet
ministe', gave a prediction of health care
for the future. He suggested that illness in
future will result from the expenditure of
nervous energy, rather than from over-
work of the body, as machines continue
to take over and life's complexities in-
*Plenary sessions are planned as educational
days for nurses attending the congress. Inter-
nationally known persons present papers.
THE CANADIAN NURSE 33
A member of the ICN Council of National Representatives casts her ballot
for ICN officers, board and committee members.
Delegates from Iran study the agenda for the business sessions, which were
held Monday and Tuesday.
crease daily for each person.
Mr. Gregg predicted that cooperation
among countries will grow. "In this co-
operation," he said, "nurses will have a
vital part and add the humanitarian touch
to international and governmental pro-
jects as they are more widely developed."
Technological change in nursing
Dr John D. Wallace, executive director
of Toronto General Hospital, minced no
words in telling the assembly that both
nursing and medicine place too much
emphasis on art, rather than science, in
their educational programs. Forecasting
that technological developments in the
next 20 years will be even more spectacu-
lar than in the past. Dr. Wallace said that
he is not sure that the health professions
are prepared to advance with them. "I
fear," he said, "that medicine and nursing
will, through default, suffer the fate of
the dodo bird that could not, or would
not, adapt to a changing environment."
Dr. Wallace questioned whether the
staff nurse should be expected to rotate
freely through all departments of the
hospital and be proficient in all special-
ties. This, he said, is impossible in this age
of electronics and specialization.
In summary. Dr. Wallace pointed out
the need for postgraduate educational
programs for nurses; recognition of the
34 THE CANADIAN NURSE
role of the clinical specialist in nursing;
and economic and status incentives to
attract capable nurses who are more
interested in giving direct patient care
than in administration or teaching.
Nelida Lamond, a senior lecturer in
nursing at the University of Natal in
Durban, South Africa, reiterated Dr. Wal-
lace's belief that nursing is not keeping
up-to-date with technological change. To
remedy this situation, she suggested that
the fear of the "black box" of technology
must be removed from the collective
mind of the nursing profession and that
pressure must be brought to bear on the
authorities in each country to insist on
facilities for formal education at relevant
levels.
Technological change in administration
Lucy D. Germain, associate ad-
ministrator of the Pennsylvania Hospital,
Pa., said that modem technology en-
hances both the efficiency and effective-
ness of management at all levels. More-
over, she said, it disturbs and pricks
complacency, and challenges the work-a-
day world to be ever aware of human
values and human performance. However,
she pointed out, technology is not a
cure-all, and while enthusiasm for it runs
high, it should not be permitted to
overbalance its relationship with man.
On the same subject, Sheila lu, matron
of a hospital in Hong Kong, said that the
full potential of modern technology will
be realized only when administrative
practices are improved. And the key to
better administration, she suggested, rests
on good personnel poUcies.
Technological change and the law
Two speakers - a lawyer and a
nurse - told the assembly how advances
in technology have solved some problems,
but have created new ones for medicine
and nursing. Claude Tellier, a Montreal
lawyer, explained that the nurse's present
role in working closely with the physician
and in carrying out extremely complex
functions has created legal entanglements.
"One of the problems facing hospitals
today stems precisely from this sharing of
functions and responsibilities by physi-
cians and nurses," he said. "Although
certain duties can easily be delegated to
nurses, the law on the other hand remains
the yardstick by which to assess the
prerogatives of both physicians and
nurses."
Speaking of legal problems that could
result from organ transplantation, Mr.
Tellier expressed the hope that new legis-
lation will soon be enacted to define the
procedure to be followed.
Julita Sotejo, dean of the College of
AUGUST 1%9
The many exhibits around Concordia Hall were a big attraction for the 10 000
nurses who attended the congress.
Speakers could be seen from all points in the hall as they stood on a revolving dias
Dr John Wallace, shown here, spoke at a plenary session.
Nursing at the University of the Phil-
ippines and a lawyer, pointed out that the
law is always "catching up - the law
follows society and does not precede it."
Technological change has affected
nursing in five major ways, said Dean
Sotejo. It has relieved nurses of many
tasks, enabled administration to make
better use of nurses' time, instigated
studies of nursing functions, stimulated
the international flow of nurses to more
advanced countries, and brought new
problems that have new legal implica-
tions.
By way of example. Miss Sotejo hsted
eight actions normally taken in heart
emergencies using technological equip-
ment routinely operated by nurses assist-
ing doctors. "Where a physician is not at
once available, the nurse, seeing the need,
may act," she suggested, but "because
these are medical procedures, the nurse
becomes Uable for illegal practice of
medicine unless otherwise authorized by
law."
Miss Sotejo pointed out that techno-
logy has created areas in wliich the nurse
needs legal protection on a personal basis.
"What are the rights of a nurse who
becomes incapacitated in the course of
her work, say, from oxygen toxicity,
from exposure to x-ray or radio-
isotopes? " she asked.
AUGUST 1%9
"As technology advances, more res-
ponsibilities, more problems, more risks
and newer ways are forced on nurses. Our
profession should discern emerging trends
and forces and keep nursing abreast of
the times."
Technological change, human relations
Dr. Leo Dorais, rector of the Univer-
sity of Quebec, Montreal, reminded the
audience that technological changes are
not unique to the twentieth century. It is
only in more recent times, he said, that
technological changes have meant, or
have been associated with, a "de-skiUing"
of the individual.
According to Dr. Dorais, negative at-
titudes develop because society has not
devised social techniques to cope with
technological changes. In applying this
concept to nursing. Dr. Dorais cited team
nursing as an example. He said that team
nursing has developed rapidly because of
demands for health services in institu-
tional settings, but that little adaptation
and foresight has been applied.
In summary. Dr. Dorais stressed that
good human relations can be maintained,
even in the face of rapid technological
change, when personnel are kept inform-
ed, and when changes are planned,
thought about, talked about, and master-
ed by all those concerned.
Education for today and tomorrow
Philippe Garigue, dean of the faculty
of social, economic, and political scien-
ces. University of Montreal, compared the
nursing profession with the family unit.
The nurse traditionally has been seen as
an assistant to the physician, now she is
seen helping to put health policies into
effect, he said. The patient is not only an
individual with a disease, but a member
of a family, all of whom are important to
the patient's treatment and recovery.
"The nurse's role has changed," Dr.
Garigue said, "she must understand the
different levels of behavior patterns and
the relationship between biological, so-
cial, cultural, and physical factors." "The
effects of the nurse's actions extend to
future generations and to the shaping of
tomorrow's society," he continued.
Nurses must also take another look at the
reasons behind their actions "because the
tensions and frustrations created by tech-
nological changes will have to be counter-
balanced without making the tendency
toward dependability worse than it is at
present."
Nursing leaders from Finland, Canada,
and the United States, spoke on the
theme of basic programs in education for
today and tomorrow. They agreed that
methods used to prepare nurses at the
diploma level should be updated to prov-
THE CANADIAN NURSE 35
ide the quality and quantity of profes-
sional nurses required. Ingrid Hamelin, a
nursing officer from Helsinki, Finland,
reviewed patterns of basic nursing educa-
tion - nonacademic hospital schools of
nursing, independent schools of nursing,
and academic university-based programs.
She outUned a more recent development
in the pattern of nursing education: the
vocational school that prepares various
categories of health workers in addition
to nurses. In the vocational school, all
students meet the same entrance require-
ments, and part of the theoretical pro-
gram is the same for all, she said. In
practical areas, each group concentrates
on its special field.
"Since we are expected to provide the
health services demanded by society in a
changing time, are the present patterns of
nursing education the right ones to pre-
pare nurses for today and tomorrow? "
Miss Hamelin asked.
Florence MacKenzie, associate director
of nursing education, The Montreal Gener-
al Hospital, continued on a similar note
when she said, "It would seem that the
hospital school of nursing has become an
anachronism as nursing education in Ca-
nada begins a new era. Change is needed,"
she said, "but there is resistance. The
resistance arises out of a lack of under-
standing that new programs can prepare a
student to nurse in less than three years if
her program is controlled by the school."
In the future, two types of nurses will
be prepared - one in the university
schools of nursing and the other in
post-secondary institutions of learning,
continued Miss MacKenzie. We need
well-qualified teachers and expert nurses
who can accept the challenge to meet the
exciting and difficult task to prepare an
adequate number of nurses for the nurs-
ing needs of tomorrow, she said.
Mildred Montag, professor of nursing
education, Columbia University, New
York, outlined the junior college program
or associate degree program of nursing in
the United States begun in 1952 as part
of a five-year research project to develop
and test a new type of nurse practitioner.
"Because the colleges admit students re-
gardless of age, sex, or marital status, the
programs attract students of a much
wider range than is usually found in the
nursing programs," Dr. Montag said.
There are now 413 approved programs of
this type in the U.S., she added.
The most significant aspect of the
associate degree program, according to
Dr. Montag, is its ability to attract and
graduate persons able to carry on the
functions in the program. "It seems
clear," she said, "that the associate degree
36 THE CANADIAN NURSE
nursing program will not only continue,
but will become increasingly important in
the preparation of nursing personnel."
In a panel discussion on university
level programs, six nurse educators agreed
that the university offers the best setting
for nursing education. Chairman Rozella
Schlotfeldt, dean of the school of nursing
at Case Western Reserve University in
Cleveland, Ohio, pointed out that nursing
education should focus on people, not
things. "Caring is indeed therapeutic; we
must consider man and the social system.
Nursing is nursing and not technical
doctoring," she added.
Sheila Collins, principal tutor in a
London, England, school of nursing,
agreed that good education is possible no
matter where the budget comes from.
The university, however, has something
to offer nursing, she said. The method of
teaching, the opportunity for inde-
pendent work and research, and the
quality of teacher are unparalleled, she
added.
Mohammed Abdul Ahad, principal.
School of Nursing, Victoria Hospital,
Bangalore, India, observed that even in
the poorest countries, physicians, clergy-
men, and lawyers are educated in the
university. Why not nurses? he asked. If
nursing lags for another two decades it
will be 50 years behind, he said.
Luzmila Arosemana de Ilueca, director
of the school of nursing. University of
Panama, said there is a tendency in Latin
America for nursing schools to move into
universities, some on equal status with
other schools in the university. The uni-
versity provides increased relationships
with other disciplines, she said.
All agreed that university education
for nurses was essential, and that it is
nursing's duty to gain public support and
to establish nursing as a self-determining
profession.
Aims for tomorrow
Jane Martin, director of nursing in the
French Red Cross Society in Paris, said
that higher education should define the
specific service nurses are expected to
render to society and lead to the creation
of a group conscience.
"What do we hope to achieve through
improved selection into nursing pro-
grams? " asked Rebecca Bergman, head
of the nursing department at Tel Aviv
University, Israel. She suggested that se-
lection through research in nursing educa-
tion would help reduce the attrition rate
and help graduate nurses who are prepar-
ed to meet the needs of our changing
world.
"Research findings have shown that
high school grades and intelligence tests
are reliable predictions of academic suc-
cess," Dr. Bergman explained. Only 10
percent of high school students are in-
terested in nursing and only five percent
actually enter.
Education is a life-long experience for
all human beings, pointed out Dr. Gerald
Nason, secretary -treasurer, Canadian
Teachers' Federation, Ottawa, during a
panel discussion on 'Teaching Tomor-
row's Nurses." "Progress at the individ-
ual's own rate must replace lock-step
systems run on mass examinations," he
advised. "The limitations now hampering
education are dying slowly but irrevoca-
bly," Dr. Nason predicted. "Under-
developed countries are unhampered by
the very traditions of which they have
been deprived - they may well be able
to take giant steps into tomorrow."
Jacqueline Demaurex, head of Le Bon
Secours School of Nursing in Geneva,
Switzerland, suggested that the educa-
tional program for tomorrow's nurses
should take into account what the
student already knows and teach her how
to learn, organize, and transfer learning,
and to cultivate attitudes of true research.
"Clinical teaching," said Miss De-
maurex "is an essential element in a
nurse's education, and must complement
the formal teaching of physical, biologi-
cal, and social sciences." Clinical teaching
is most effective where people are: in
families, in schools, in industries, in hos-
phals, and in homes for the aged. Miss
Demaurex believes.
Principal Winnifred Hector, St. Bar-
tholomew's Hospital London, England,
urged nurses to copy from national net-
work shows in producing effective audio-
visual aids for nursing education. She
cautioned teachers that a lesson does not
become good just because it comes via
TV, however. "Nurse-teachers have to
impart to their students factual informa-
tion, technical and social skills, methods
of thought, and penonal attitudes," she
said, "and the methods they use should
be as varied as these aims."
Security for tomorrow
Health care economics, socialized
medicine, and the professional associa-
tion's responsibility for the economic
security of the nurse were topics dis-
cussed Friday morning.
Speaking of the nurse and her profes-
sional security, Elizabeth Cantwell, di-
rector of the American Nurses' Associa-
tion's economic security department, said
emphatically that nursing must "deliver
the goods or face annihilation." Miss
Cantwell urged nurses to be as aggressive
AUGUST 1%9
It wasn 't all work. Joyce Nevitt (in wheelchair). Director of the School
of Nursing at Memorial University, Newfoundland, talks to a U.S. friend
at a reunion of the Nursing Education Alumni Association, Teachers
College, Columbia University.
At the same reunion are, left to right: Marie Loyer, faculty. University of
Ottawa; Virginia Lindabury, editor of The Canadian Nurse - a guest at
the reunion; and Dorothy Mumby, director of public health nursing in
London, Ontario.
AUGUST 1%9
Harriett Sloan (left), the Canadian Nurses' Association 's coordinator
for the ICN Congress Committee, confers with Sheila Quinn, ICN
executive director, during a break.
With 10.000 nurses hungry and ready to eat at the same time, you
bought your box lunch and ate it where you could.
THE CANADIAN NURSE 37
in their demands to speak on policies that
determine the quality of nursing care as
they are in pressing for full professional
status and freedom from economic want.
Gerd Zetterstrom-Lagervall, a member
of the ICN board of directors and pre-
sident of the Swedish Nursing Associa-
tion, spoke about the professional asso-
ciation and economic security for the
nurse. She listed 16 points considered
most important for a nurse's economic
security, and said that the professional
association can help nurses to achieve
these goals through negotiations with the
employer. The negotiable items she listed
included provision for salary during preg-
nancy and childbirth, illness, injury on
duty, leave of absence for study, and
military service; compensation for over-
time service and for inconvenient working
hours; group insurance and pension plans;
and vacation time.
To be of use to its members, a
professional organization must keep itself
informed of what is going on in society,
Mrs. Lagervall said. Moreover, she added,
the organization, which is nonpolitical,
has to make contact with members of
parliament who belong to different
parties to give them information, to
obtain information, and to try to in-
fluence their decisions.
Leadership in action
Leadership was examined — from
every angle — by a well-known socio-
logist and four nurses Friday afternoon
during the final plenary session.
Dr. Robert K. Merton, Giddings pro-
fessor of sociology and associate director
of the Bureau of Applied Social Research
at Columbia University, New York, told
the assembly that at least one thing is
clear about the subject of leadership: it
has not suffered from neglect. He added
that there are still individuals who be-
lieve, as Aristotle believed, that from the
hour of their birth, some are marked out
for subjection, others for rule.
More recently. Dr. Merton said, social
science has changed many of its concepts
about the so-called leadership traits.
Leadership does not result merely from
the individual traits of leaders, he said. It
must also involve attributes of the tran-
sactions between those who lead and
those who follow. Dr. Merton noted a
basic distinction between authority and
leadership which is "fundamental to
understanding that leadership can be
found at every level of an organization.
The leaders, the influentials, sometimes
hold formal offices of authority; some-
times they do not."
What makes for the joint exercise of
authority and leadership? According to
Dr. Merton, four conditions must be met:
the person receiving a communication
must be able to understand it; he must be
able to comply with the directive; he
must believe it is in some degree con-
sistent with his personal interests and
values; and he must perceive the directive
as consistent with the purposes and values
of the organization.
Leadership is not simply a mystique,
concluded Dr. Merton. "Slowly our un-
derstanding of leadership grows and
sometime, perhaps, it will emerge from
the sociological twilight into the full light
of day."
Discussing leadership and the ad-
ministrative process, an Australian nurse
told the assembly that nurses on the
whole are narrow in vision, apathetic, and
at times petulant. Joyce Rodmell, pre-
sident of the Royal Australian Nursing
Federation, blamed much of this rigidity
on the outdated, autocratic methods
being used by administrators. "Of all the
occupations, nursing has surely been the
last to see the need for change in this
field," she said.
The trend in school, in the home, and
in the community is to encourage greater
individual freedom and initiative. Miss
Rodmell remarked, and young people
today are less willing to be seen and not
heard, or to accept the old saying, often
The red-jacketed members of the Royal Canadian Mounted Police
band entertained an appreciative audience in Concordia Hall.
38 THE CANADIAN NURSE
This young lady was so absorbed in her reading at the "Library Toot
Exhibit " that she didn 't even notice the photographer.
AUGUST 1969
ICN president Alice Girard (left) and CNA executive director Helen K.
Mussallem (right) congratulate newly-elected ICN president Margrethe
Kruse of Denmark.
New associations admitted to ICN membership include: Argentina,
Bermuda. Bolivia, Costa Rica, Ecuador. Lebanon, Morocco, Nepal,
Portugal. Salvador, and Uganda.
heard in nursing, "You are here to do,
not to thirdc." The nurse administrator
must change, she said, and accept and
practice modem administration based on
leadership, not autocracy. Otherwise her
status will deteriorate further and, more
important, fewer students will be re-
cruited to nursing, she warned.
Speaking about education for leader-
ship, Antje Grauhan, director of a univer-
sity school of nursing in West Germany,
said that most nursing education is com-
pulsory and leaves little discretion to the
student. She finds that the students'
initial enthusiasm is often dampened and
creativity squelched by the tightly re-
gulated hospital.
A "systems approach" to hospital
nursing was suggested by Jytte Kiaer,
director of the division of nursing ad-
ministration at Aarhus University in Den-
mark, in her discussion of leadership for
technological advance in nursing.
Mrs. Kiaer views the hospital as com-
posed of two major subsystems: medical
service and nursing service. Only by a
systematic analysis of nursing functions
can a hospital make the best use of
technological sciences, she said, and allow
the nurse to devote more time and effort
to human relations — the most indis-
pensable ingredient of nursing.
Analysis of nursing services might be
AUGUST 1%9
based on such things as physical environ-
ment, methods, patients, nurses, re-
porting methods, Mrs. Kiaer suggested.
Systematic analysis miglit show that
much information on patients could
easily be transferred in a more concrete
way. This would ease communication and
make such information adaptable for
automatic equipment, she suggested.
Charlotte Searle, head of the depart-
ment of nursing at a university in South
Africa, said that nursing leadership must
ruthlessly remove basic causes of weak-
ness within the profession, most of which
result from inadequate educational pre-
paration.
Dr. Searle said nursing leaders need
courage to meet opposition of govern-
ments, hospital authorities, and others,
and also to meet opposition from mem-
bers of their own profession. "But no
matter what forces have to be contend-
ed with, the quality of nursing leadership
will be the real determinant in shaping
the future of nursing," she said.
"Unity" is watchword
The formal meetings of the congress
came to a close on Friday evening. Each
of the several thousand nurses attending
the closing ceremony took home with her
a word that will become the password to
the next congress to be held in Mexico
City in 1973. four years from now.
Ahce Girard, retiring president, said
that unity is a guideword that has been
part of her personal philosophy for many
years. "It seems essential to our survival
as an association to preserve unity," Dr.
Girard said.
Unity represents a loyal and conti-
nuous search for the truth in our goals
and a union of faith in our methods, she
continued. Failure to meet our objectives
does not mean that we have lost faith in
one another or our methods, but only
that we have encountered the inevitable
obstacles from which may come better
understanding. "Intelligent compromise is
often the evidence of courageous wis-
dom," she pointed out. "We seek an
association of good will, mutual respect,
reciprocal confidence, and unselfish
cooperative endeavor," she said.
Dr. Girard left her audience with a
thought that vividly illustrates how futile
efforts can be without unity and a sense
of brotherhood: "What is the sound of
only one hand clapping? " she asked. D
THE CANADIAN NURSE 39
A challenge that confronts us
Mr. Munro presented this speech at the opening plenary session of the 14th
Quadrennial Congress of the International Council of Nurses in Montreal
on June 25. Because of the important issues and possible solutions raised by
Mr. Munro in this paper, we present it in its entirety.
The Honorable John Munro,
Minister of National Health and Welfare
In opening my remarks, I would like
to say that I am truly impressed at th?
size and the nature of this gathering. I
suppose that if any time is appropriate to
get sick, today is the right day for it.
But this is no time to discuss sickness.
Rather it is a time to discuss health -
the health of our people, and the health
of the nursing profession. I see that your
theme - Focus on the Future - reflects
this outlook.
I should, at this time, convey on
behalf of the Canadian government our
best wishes for your meeting's success.
We are honoured that such an important
multi-national organization, in such a
significant field of human endeavour, has
chosen to come to our country for its
conference. I would also add that we have
an interest far surpassing that of mere
courtesy in the subjects you will be
tackling, and will be looking forward to
the benefit of your internationally con-
certed thoughts on reforms of the health
delivery system.
We are interested in these views, not-
withstanding the apparent economic
strength and vigour of our young coun-
try. We are considered, I know, as one of
the richest of the western nations, and
some of our affluence, especially in
medical personnel, must seem like
extreme opulence to places that have very
large disparities in doctor-to-population
and nurse-to-population ratios.
40 THE CANADIAN NURSE
Yet we are far from perfect. We have a
small population, spread over the second
largest area of any country in the world.
Obviously, this creates enormous prob-
lems in getting care to the people. Thus,
we must concern ourselves as much with
the distribution of our medical resources
as with the raw amounts of them.
And, I must confess, we have not yet
reached Utopia on this important ques-
tion of distribution. We have very serious
gaps in the total framework of health
care. If, in Vancouver, it's a feast com-
parable to the banquet of Balthazar, then
in some of our urban slums. Maritime
towns and villages, and Indian settle-
ments, it's truly a famine.
Not that either the feast or the famine
are inexpensive. The Canadian taxpayer is
spending a sizable chunk of public money
for hospital insurance, and soon the full
impact of the medicare program will be
dropped on top of this. This gives rise to
a fundamental point: for all the money,
shouldn't we be able to expect that all
our citizens are more or less equal in
terms of access to necessary health
care? — an access that we have come to
accept as a fundamental human right,
after all.
So, the challenge is two-fold. The first
is to reform the delivery system to extend
treatment and services to all corners of
our vast land and all segments of our
highly diverse population. The second is
AUGUST 1%9
to avoid bankrupting the common trea-
sury in the process.
This may sound contradictory. It isn't.
I make that as a flat statement because I
know what can be done if we really care
about seeing that it is done. And, in the
meeting of this double challenge, the
nursing profession has a definite and an
expanded role to play.
I know that you want to play such a
greater role. For one thing, 1 know that
you care deeply about returning the
practice of health work to the most
meaningful basic unit - the human
being, the individual, the present or
potential patient. There has been an
erosion of this recently. Many of your
colleagues feel frustrated within a system
that seems to be turning you more and
more into bureaucrats ~ paper-pushers,
red tape merchants. It may seem, at
times, as if you have escaped the bedpan
era only to graduate into a mindless
round of tramping painfully through a
swamp of administrative detail. You too
are becoming part of the depersonaliza-
tion process of modern life, that process
which tends to reduce men to a role of
computer card digits, whether on the job
or in the hospital. It is this depersonaliza-
tion that leads to the alienation which, as
we have seen, can cause the most violent
social eruptions in the streets of our
so-called enliglitened affluent western
democracies.
For this reason, I support your view-
point on care. I think it's high time to get
the nurse back into nursing. And, with
your sufferance, I'd like to throw out a
few suggestions on how that can be done.
An important opening step would be
to cut the chain that tends to bind the
The honorable John Munro. Minister of Health and \vetjare. chats with Alice Girard jleji/, Jurmer president oj the International
Council of Nurses, and Vema Huffman (center), principal nursing officer. Department of National Health and Welfare.
AUGUST 1%9 THE CANADIAN NURSE 41
modern nurse to the hospital. Don't get
the impression that I am against nursing
in hospitals. If, when I leave the meeting
this morning, 1 were to be struck by a car,
you can be sure I'd want to have some
nursing services in a hospital context, and
rather quickly too.
What I am suggesting though is that
the nursing profession as a whole
shouldn't be dependent on hospital work
in the same way as an infant depends
upon the umbilical cord. The figures do
show a rather high correlation between
nursing and hospitals. There are over
130,000 registered nurses in Canada, and
I note that only about five percent of
them are in public health work. Yet, to a
large extent, I believe that the latter
direction is where the future lies. 1, and
many health officials, at any rate, feel it
lies to a greater extent outside the active
care hospital than at present.
Unfortunately, public health work has
tended to pick up a bad name. Perhaps
that is a fault of restriction in terms and
areas of practice. So I'll make my defini-
tions clear. Public health should mean
health care provided to the public at
large.
Let there be no doubt that such care is
needed. There are the gaps I have already
cited. In addition, a little rule of thumb
that I have mentioned to other groups
before is perhaps instructive. We estimate
that of 1,000 people who need medical
attention, 275 actually get to see a
doctor, and only 10 ever get assigned to a
hospital. Now not all of the other 990
not admitted need hospital treatment.
But the 725 who don't see a physician
should see somebody who knows some-
thing about sickness and its correction.
Many of these people, of course, are
unaware that they may need attention —
that is, until they are carted off to that
unexplored land that Hamlet talked
about. I think I should add that not many
of the 725 tend to be in any of the high
income tax brackets.
Somehow or other, this ratio has got
to be set into a better balance. One of the
best ways that it can be is through greater
public health work, not only by nurses,
but by all types of physicians, as well as
other health personnel.
But if public health has too much of
the connotation of immunization clinics
and even more staggering amounts of
paper work, we could call the process:
community care. This means leaving the
active bed ward to go out into the field
and discover cases of need, perhaps in
time to treat them before they wind up in
these very active-care beds.
Right now, I am talking about expand-
42 THE CANADIAN NURSE
ed services. Very well, some may say, but
how do you reconcile that with the need
for cutting costs?
Let me set it up this way. The earlier
sickness is detected, the less expensive the
treatment tends to be. Moreover, public
health is more than broader discovery and
diagnosis; it's preventive medicine as well.
One of its essential functions is educa-
tion. To point out one example, educa-
tion on proper nutrition can avoid a lot
of subsequent disease - of the bones, of
the heart, of the liver, and so on. In
another field, early education on fluorida-
tion can cut down a lot of future expen-
sive cavities and extractions.
Alright then, the critics will say, you
can cut expenses in the long run - but
what about the here and now? The more
you go out into the community at large,
the more you will find people who do
need to see a doctor, and more people
who will be hospitalized. How are our
doctors and hospitals ever going to cope
with this increased demand?
The answer to that is, very bluntly,
that we can probably accompUsh it by
reducing the dead wood in our present
facilities. That may sound harsh, but I
feel it's true. Hospitals often seem to be
erected more as municipal monuments
than as realistic treatment centres. Pa-
tients who could be treated just as well at
home, or in institutions of special care,
such as convalescent and chronic care
homes, are frequently left in enormously
expensive active-care beds. This some-
times seems to happen just to satisfy
convenience, or to increase the "take" of
medical personnel who are far from
starving at the present time.
Let me also point out that giant
hospitals are often built, or often expand-
ed, simply to satisfy civic pride, or add to
professional points of status. As I men-
tioned to the Canadian Hospital Associa-
tion in May, what is the sense of a process
that results in three hospitals, located in
the same city, under one university juris-
diction, within a mile of each other,
performing three separate heart trans-
plants in the same month.
Greater planning, I am convinced,
would show that in many areas facilities
are far outstripping real demand, and
what's worse, are blocking expenditures
in places of true, and often desperate,
need.
There is one point of extreme impor-
tance to Canadian nurses and other
non-physician hospital personnel. Hospi-
tal costs are escalating so rapidly at
present that provincial treasuries are
reaching the bursting point. Unless we
can stop this escalation, and unless we
can effect some real economies in this
field, and in the field of the costs of
physicians" services, then there is going to
be very little left short of bankrupt-
cy - or even higher taxes - to improve
the salary conditions of those at the
lower ranks on the scale.
So hospital dependence and its high
expense can and must be reduced. They
can be reduced by moving out into the
general community. But this move cannot
be accomplished without the active parti-
cipation of the nurses.
There are a host of ways that this can
be done. More nurses can be trained in
the specialized field of home care and
home nursing. That doesn't just mean
holding hands with the bedridden child
who has mumps. With more aggressive
home treatment programs, it can mean
preliminary investigation visits, follow-up
visits on treatment prescription, specia-
lized medicinal supervision, and other
responsible tasks. They can be at least as
meaningful, and should be even more
meaningful, than the treatment of similar
patients who are now in hospitals - and
they are less costly. As an example, I
would cite an experiment in the Ottawa
area which showed that patients now
being treated in hospitals at $42 a day
and more could just as easily and just as
adequately be treated at home - with
probably a far better personal apprecia-
tion of the reception of care - at a cost
of $12 a day or less.
Another alternative is joining in the
formation and operation of community
health clinics. These places, as part of the
anti-poverty work of the Office of Econo-
mic Opportunity in the States, have been
shown to be capable of transformation
into neighbourhood health "drop-in"
centres. They can be more than just pill
dispensaries; they can be integral parts of
social development programs and overall
community regeneration. They should
involve doctors, social workers, dieticians,
and psychiatrists as well as nurses. In
other words, they should be the mobile
out-patient clinic - not just putting out
fires through emergency treatment, but
stopping fires before they start. They
bring the remote white-coated, cold, and
impersonal world of organized medicine
down to an understandable, available, and
friendly people-to-people basis.
There are places where these centres
are urgently required. I am contemplating
the often appalling lack of facilities in our
urban slums and ghettos. I am thinking of
enclaves of the alienated drop-outs of
society - such as the youthful drug
communities like Yorkville. 1 am thinking
of every location where we have failed as
AUGUST 1%9
a society to prove that we have something
to offer - something of value that can
be shared.
Health care is only part of the job that
such centres can dispense. They can
dispense hope and counsel that can revi-
talize the lives of our depressed, our
disadvantaged, and our down-trodden.
Even disregarding the impact on current
health costs, I think that the benefit of
such operations in social rehabilitation
alone can save our population untold
amounts - and what's more, can help
conserve our most precious resour-
ce - people by bringing them back
to productive lives. One thing we do
know: someone who's sick and feels
cut-off has little incentive to struggle
back into the mainstream. Community
health care can correct this waste of
human lives and human talent.
Team practice in the family care field
is another opportunity to bring the nurse
back into touch with the patient. As we
realize more and more that increasing
physician concentration on more abstruse
specialities reduces to a greater and
greater extent the scope of medical prac-
tice, a counter trend is taking hold. There
are some doctors - a growing number, I
believe - who really care about the total
man, just as I am told that there are some
doctors who know how to work with a
nurse, without assuming that she is their
personal servant. Such doctors, on an
interdisciplinary basis, are moving back
into the field of direct family care
through the formation of large practice
units. In such units the nurse should play
a vital part.
In all those roles I have outlined, the
nurse becomes a far more important
member of the health team. She accepts
greater responsibility and more inde-
pendence. But I do not think that those
trained to follow in the footsteps of
Florence Nightingale shrink from proving
that they are 100 percent capable of
using their God-given intelligence for
more significant tasks than filling in
forms.
As a matter of fact, I know personally
that this is not the case. I have seen
young girls carry a health load that would
stagger many doctors. Where I saw this
was in our own Canadian northland.
The North is a land of promise, or as
the expression there has it, the Big
Tomorrow Country. It is potentially rich,
it is exciting, it is beautiful. It is a land as
big as the men and women who are
carving out its future right now. But it is
also, at present, a monstrous health pro-
blem. Particularly among our isolated
native people, disease rates are higher,
AUGUST 1%^
accident rates are higher, both children's
and adults' mortality rates are
higher - much higher - than they are
in our southern climes.
Facing up to the job square-on are our
Indian and Northern Health Service
nurses. In the Yukon and the Northwest
Territories, roughly 1 50 of them tackle
the burden of 50,000 people spread over
one and one-third million square miles.
Added to those who work in the remote
Indian settlements in the northern areas
of our provinces, you can see that these
women are bucking up to a Herculean
task - and they are doing a fantastic job
of meeting it. The nurse in an outpost
health station isn't just a 9-to-5 bureau-
crat. She's a 24-hour nurse, public health
worker, dentist, midwife, and even doc-
tor. Without these nurses, I shudder to
think what might happen to the people
north of the 60th parallel.
Unfortunately, I must confess that not
all are Canadian. In fact, far fewer than a
majority of them are. So I am afraid I
must apologize to many of the delegates
here for the fact that we're draining off
their scarce resources to look after our
North. However, I am hopeful that the
Canadian delegates, representing leaders
of the profession from coast to coast, will
carry the message back to their homes of
the task and the opportunity of northern
services. I am not issuing a call of the
Wild; I am issuing an appeal of the heart
that our girls recognize that there are
more worthwhile aspects to life than
settling down to a dull middle class
existence, with a suburban mortgage, 1.2
automobiles, and 2.2 children. All these
can come in time - but I think our
young students would want to be able to
say, before this happens, that they have
done something truly constructive and
essential in their career.
But I wish to draw more from this
illustration than a recruiting pitch. I wish
to point out that it is silly to draw an
artificial geographic barrier on a nurse's
capability. Is there some magical power a
nurse possesses that she suddenly loses
when she crosses the border of our
Northern Territories? I hardly think so.
I think that a nurse in the south of our
country can be fully trusted, with proper
training, to handle at least half the tasks
her northern sister does routinely. In this
process, I think she can take a good deal
of the volume load off our doctors,
freeing them for jobs that their extended
educations qualify them to do.
Let's look at infant care as an exam-
ple. Why should normal deliveries and
well-baby care be the exclusive preserve
of someone who's spent up to 12 years
mastering the most complex techniques
of modern medicine? In Europe and the
rest of the world, this is not the case.
Thus it is said that the North American
obstetrician is the most expensive mid-
wife on earth. Why not cut his expensive
caseload by instructing nursing students
in such fields? That way, the obstetrician
could use his or her talents to their full
potential.
There are many other categories of
medical care where the same thing
applies. Therefore, we should not wonder
why we have under-serviced regions, and
waiting lists for needed treatment. But if
routine could be cut. our doctors could
become more mobile, and move where
their services were called for.
Take hospitals. How much of prelimi-
nary examination work, application of
splints and dressings, and simple respira-
tory treatment really needs a doctor's
attention? If the nurse carried more of
this burden, not only would overall hos-
pital costs and physician's costs be
lessened, but the patient would benefit
from a closer relationship with those
most active in his daily care. We could
evolve a nursing care plan that is a true
reflection of the patient's need.
At this point I must confess a shortfall
of expertise. I do not know exactly how
the health professions could be reorga-
nized properiy to utilize better existing
talent without a drop in the quality of
care. But 1 do feel that reform of health
education is possible, is feasible, is prac-
tical, and is necessary.
There is talk of a new category of
super-nurse; there is talk of a Feldsher
system. Which avenue is best is a fact I do
not pretend to know. But reform and
reorganization must come, not only in
education, but in patterns of practice. We
owe it to the Canadian population.
Therefore, I call on you to devote
serious thought to this question. I call on
you to consider our challenge as your
challenge. I call on you to come up with
ways in which the nurse has the greater
independence and responsibility she
needs to live up to her potential. I call on
you to upgrade the role of nursing in the
care of the sick and the improvement of
society. In other words, I call on you to
join in the total restructuring of the
health care delivery system. □
THE CANADIAN NURSE 43
Laval University
accepts a challenge
Laval University recently launched an exciting new educational project. The
ultimate goal is to prepare a harmonious body of professional health workers,
rather than a variety of specialists. The program of studies offers both pragmatic
learning and empirical knowledge, general scientific information, and specific
professional preparation at one and the same time.
Jacques Brunet, M.D., F.R.C.P. (C) and Claire Gagnon, M.Sc.lnf.
For many years, students in the var-
ious health disciplines have received their
educational preparation either in profes-
sional schools or in universities with
distinctly separate faculties. Only re-
cently has thought been given to the need
for a more comprehensive program that
would provide students in the health
professions with a common body of basic
knowledge.
This new approach has already been
demonstrated by educational institutions
in other countries as well as in several
provinces in Canada. Within the universi-
ty, this structure has come to be known
as the "health sciences complex." The
university carries a heavy load of res-
ponsibility with respect to the prepara-
tion of health workers - total responsi-
bility for some groups, partial for others.
The limits of its role and responsibility
must be set by the institution itself.
Traditionally, the health team includes
doctors, dentists, pharmacists, and nurses.
To these must be added teachers and
research workers, such as anatomists,
physiologists, biochemists, microbiol-
ogists and others. New groups, such as
clinical psychologists, medical social
workers, dietitians, speech and hearing
specialists, and physiotherapists have
joined the ranks more recently. There is a
growing demand for the services of these
new groups, but as yet their numbers are
rather limited. Generally speaking, these
persons hold university diplomas, bacca-
laureate, masters' or doctoral degrees.
44 THE CANADIAN NURSE
Finally, there are the technicians in such
areas as radiology, medical laboratory
work, medical electronics, electroen-
cephalography, physiotherapy, social
work, dentistry, and many other depart-
ments.
In 1967, Laval University recognized
the importance of the comprehensive
approach and created the environment
necessary to facilitate development of a
health sciences complex. A vice-rector
responsible for the health sciences and a
permanent committee were appointed. In
September 1968, a new study program
was set up under the guidance of the
faculty of medicine. The first stage is a
three-year block of studies leading to a
baccalaureate in health sciences. The
courses offered are of a general nature,
while at the same time they open the
door to the pursuit of more specific goals.
Dr. Brunet, Associate Professor, Faculty of
Medicine, L^val University, is a graduate of
College St-Charles Gainier and I-aval University.
He interned at Hopital St-Sacrement, Quebec
Qty, then went to the University of Pennsyl-
vania for postgraduate medical experience. He
carried out research in endocrinology at Jeffer-
son Hospital, Philadelphia, and later took ad-
vanced study in internal medicine and endocri-
nology at Guy's Hospital, London, England.
Qaire Gagnon, a graduate of the University of
Montreal and Teachers College, Columbia Uni-
versity, is Nursing Consultant to the minister of
health for Quebec, and Director of the School
of Nursing, Laval University.
Objectives
The first objective is to help the
student attain scientific and intellectual
growth. Like any other undergraduate
program, the baccalaureate program in
health sciences is designed to give the
student the intellectual background ne-
cessary to foster independent thought. He
learns to study by himself, develop
insight, and find the solutions to a given
problem through his ovm efforts. Per-
sonal study habits are developed through
the use of self-directed projects, such as
seminars and occasional written assign-
ments. Practical experience in scientific
or analytical method is provided through
individual, in depth study of certain
material. Each student enrolled in this
program chooses a particular group of
related subjects for intensive study.
The second objective, "orientation and
personal development," is the result or
consequence of the first. Sufficient flexi-
bility has been built into the course of
studies to permit its adjustment to indi-
vidual needs and thus encourage personal
development. Consideration has been
given to the differences that exist in
regard to previous education, individual
interests, and ambitions.
The baccalaureate program in health
sciences attempts to improve communica-
tion among health workers and to help
them develop a sense of unity through
common interests. As a result of ex-
periences and courses shared during their
university years, graduates should have a
AUGUST 1%9
greater appreciation of the unity of pur-
pose that binds them together. This parti-
cular aspect will be of prime importance
for those who eventually become in-
volved in patient care.
The fourth objective is to assure a
uniform quality of teaching, and is
achieved through the regrouping and
coordination of teaching programs. Good
use is made of university teaching resour-
ces, and a uniform quality of instruction
is assured.
To meet more specific objectives, ma-
terial basic to an understanding of the
functioning of the human being is taught.
This includes physiology, biochemistry,
microbiology, pharmacology, anatomy
and histology, psychology, sociology, an-
thropology, and economics.
To achieve the various general and
specific objectives of the new baccalau-
reate program, the committee on the
health sciences substantially reduced the
amount of material to be committed to
memory so that the student could devote
more time to study and reflective think-
ing. Each course is divided into periods of
theoretical teaching alternated with prac-
tical experience and supervised personal
projects. In addition, study courses are
arranged so that clinical, social, and
psychological aspects are presented in
conjunction with more theoretical detail
in the biological and behavioral sciences.
This plan goes into effect in the first year
of study and is intended to make the
student more aware of the close relation-
ship that exists among the different fields
of interest.
Flexibility in course choices
The program includes a certain num-
ber of courses designed to equip each
student with a body of knowledge basic
to all branches of the health sciences.
Other subjects or blocks of selected sub-
jects provide for indepth investigation of
specific areas or complement the general
program.
General courses
All students enrolled in the health
sciences program are required to take
subjects such as physiology, anatomy,
and so on. These subjects have been
selected to provide basic knowledge re-
lated to general principles in the basic
sciences. Interdepartmental cooperation
has made coordination of several of these
courses possible.
Selected courses
Selected courses fall into two catego-
ries, complementary or intensive. Com-
plementary courses are courses chosen by
AUGUST 1%9
the student from areas other than those
that constitute his main field of interest.
They contribute to his general and profes-
sional education.
Intensive courses are related to fields
of special concentration and are grouped
accordingly. This type of course has a
bearing on the fundamental ideas of the
health sciences and on the scientific
content by reason of its intellectual in-
terest for the student, rather than its
value on a strictly professional or utilitari-
an basis. In other words, such courses
allow for exhaustive study in an area that
has some special appeal for a student.
Appropriate combinations of courses,
either in the molecular, biological,
psychological, or social sciences, form the
chief areas of concentration during the
last two years of the baccalaureate pro-
gram.
School of nursinj sciences
Since its opening in September 1967,
the School of Nursing Sciences, which is
affiliated with the faculty of medicine at
Laval, has depended on professors in the
biological sciences for assistance with its
teaching program. The first students en-
rolled in the school studied physiology
with the medical students. Courses in
biochemistry, anatomy, and bacteriology
also formed part of the study program,
but were taught by lecturers from the
faculty of medicine.
During the 1 967-8 university year, the
rector appointed the permanent com-
mittee of the health sciences. Its members
were drawn from the faculty of medicine
and affiliated schools. The committee is
chiefly concerned with the organization
of the health sciences complex and with
the preparation of study programs in
accordance with stated objectives. The
School of Nursing Sciences is represented
by two professors, thus assuring commu-
nication between the school and the
faculty of medicine.
In September 1968, 33 new students
enrolled in the school and became an
integral part of the new body of health
science students. They study the same
courses, share the same laboratory work,
and must write the same examinations as
their colleagues in medicine, pharmacy,
and physiotherapy. An introductory
course in nursing care provides the stu-
dents of nursing science with an introduc-
tion to their future professional career.
During the second and third years, the
course of study focuses more directly on
the student's preparation for nursing.
Nevertheless, she continues to follow
certain intensive courses in company with
the other health sciences students.
University hospital
For a university to become a center
for both education and research in the
health sciences, it must be closely af-
filiated with a hospital. Students of all
disciplines use the hospital's facilities for
clinical experience, and team work-habits
soon develop.
The staff members of a university
hospital center have a responsibility to
participate in advanced programs for all
health professionals in accordance with
the specified objectives of the university
teaching program; establish standards of
care; promote exchange of ideas and
foster good relationships among the va-
rious members of the health team; and
carry out medical and multidisciplinary
research that promotes advances in know-
ledge in the health sciences.
The first step in this project was taken
in September 1 968 when Hopital Ste-Foy
became the Medical-Hospital Centre for
Laval Uhiversity, under the jurisdiction of
the minister of health for Quebec. This
hospital was previously owned by the
federal government and used for the care
of war veterans. When the official cere-
mony took place in December 1968, the
Quebec government handed over the
ownership of the hospital to the board of
the University's Medical Hospital Centre.
Administrators, doctors, nurses, and
other health professionals are presently
striving to make this hospital a center
where the quality of clinical teaching and
patient care will be assured, and research
programs will be developed.
Conclusion
The team spirit should develop more
readily in the health science workers who,
throughout their university experience,
have had an opportunity to become
familiar with the principles and proce-
dures underlying the work of various
health disciplines. Each profession has its
role to play, a role that is always com-
plementary to that of others; each dis-
cipline contributes to the fulfillment of
the total therapeutic plan for the patient.
The initiative shown by Laval in the
field of the health sciences clearly proves
that institutions of higher learning can
take a tangible interest in the welfare of
the general public. The ultimate result of
improved teaching programs and support
for research will undoubtedly result in
better patient care. D
THE CANADIAN NURSE 45
Mind your own business
Nurses need to be aware of laws governing themselves and the other health
professions. In fact, nurses and their professional associations need to make it
their business to be in on the law-making processes. This article reviews new
additions to the Quebec Hospitals Act with respect to nursing.
Claire Dutrisac
As the result of an Act passed in 1963,
the Quebec government was empowered
to exert a certain degree of control over
hospitals. The Act was very general in
nature and required additional detail in
some areas. For example. Articles 20 and
21 delegated the responsability for draft-
ing medical regulations to the Quebec
Hospital Association and the College of
Physicians and Surgeons. The government
was to draw up administrative guidelines.
When the QHA and the College found
themselves unable to agree, an order-in-
council relieved them of their privilege to
draft the regulations and the privilege
reverted to the government.
Now, after years of procrastination,
the Quebec government has finally releas-
ed the medical and administrative regula-
tions anticipated by Articles 20 and 21 of
the Hospitals Act. On the whole, they are
excellent, and should bring some order
into the confusion that has resulted from
lack of direction.
The main emphasis in the new Articles
is on medical practice, which is as it
should be. Administrative practices have
been considered from a qualitative rather
than a quantitative viewpoint. However,
much emphasis has been put on nursing
care as an integral part of adequate
medical care. This area appears to have
been poorly investigated and is therefore
worthy of our concern.
Fundamentally, all services are essential
to good hospital function. The patient
46 THE CANADIAN NURSE
needs a proper diet, clean clothing, and so
forth. However, all services cannot be
compared on an equal basis; their impor-
tance is relative. Nurses are treated as
ordinary employees in those sections of
the regulations devoted specifically to
them. The effect of these regulations
should be considered, especially from the
point of view of the director of nursing,
Qaire Dutrisac is a journalist with La Presse,
Montreal, and specializes in matters related to
health and welfare. Her report of the heart
transplant performed on Mr. Gaetan Paris at the
Institut de cardiologie de Montreal won for her
one of the most coveted journalistic prizes in
Canada under the National Newspaper Awards.
the Staff nurse, and nursing personnel in
general.
A few preliminary remarks are in
order. Article 3 stipulates that every
hospital will be classified; the implication
is that this has not been done. Such
classification should precede any state-
ment of general regulations as it may be
impossible to impose such regulations on
all hospitals indiscriminately. A teaching
hospital is administered differently from
any other; the specialized hospital varies
as to form of organization; a 50-bed
institution cannot be compared with the
400-bed hospital. Surely it would have
been easier to draw up regulations accord-
ing to hospital categories.
Moreover, the provision of nursing
care is a special factor to be considered in
classification. The nursing care standards
issued by the minister of health for
Quebec have already created numerous
problems in application, especially in
smaller institutions.
The definition for paramedical person-
nel could readily encompass nurses: "All
persons other than doctors and dentists
who, by reason of their qualifications and
at the request of the physician, share in
diagnosis and carrying out of treatment."
In another section, nursing personnel are
specifically described as all persons quali-
fied to give nursing care to the ill. We can
only assume that somewhere a distinction
has been made.
What constitutes nursing care has not
AUGUST 1%9
been specified. Does it include giving a
bed pan, collecting urine, changing a bed,
administering a bed bath? The definition
is faulty. A further reference to the
present nursing care standards laid down
by the Minister of Health would also be
appropriate.
Hospital boards
Why are nurses not asked more often
to be a part of the boards of manage-
ment, which, under the Act, run hospi-
tals? Or has this been done and nurses
have refused to cooperate? Certainly
when a public hospital is operated by a
religious order, nursing representatives of
the order often sit on the governing body,
but I do not know of any lay nurses to
whom this applies. It seems to me that
they would have as much right to do so as
doctors, lawyers, businessmen, notaries,
pharmacists, accountants, dentists, and so
on.
Apart from private hospitals, are there
any boards that include nurses in their
ranks? If so, it is a well-guarded secret.
Under the terms of the Act, hospital
employees can be represented on the
board of management so long as their
number does not exceed one-third of the
total membership.
The Act also states that a member who
is a physician shall be appointed by the
medical board of the hospital. In addi-
tion, there must be a doctor on the
executive committee. Is it completely
Utopian to hope for similar representation
for nursing? I think nurses would have to
present a united front, similar to that of
the doctors, to make their participation
in the control of the quality of nursing
care absolutely necessary.
Staff turnover may make it difficult
for nurses to become as unified a group as
the doctors. On the other hand, such
unification has a stabilizing effect and
might help prevent such rapid turnover of
nursing staff.
Another factor must be consid-
ered - the possibility of union objec-
tions to such internal organization. Mod-
ern nursing is assuming ever-increasing
AUGUST 1%9
importance in diagnosis and treatment. Is
it inconceivable to suppose that if nurses
were organized as democratically as doc-
tors, they could manage their own af-
fairs?
Under the Act, unless the board of
management decides otherwise, the hospi-
tal administrator and the medical director
attend meetings, but have no voting
privileges. Since nursing is so closely
linked to medical procedure, why is the
same courtesy not extended to the direc-
tor of nursing?
The following note was placed on my
desk on day by my city editor:
"A tearful mother told me that her
little girl had had a kidney transplant and
died. She said that the doctor had ex-
plained that there were not enough nurses
ai2d they were not trained to cope with
such highly specialized operations. "
If the mother's statements were accu-
rate, these are serious accusations by a
doctor against nurses. If there was a
mistake, who was at fault? To whom can
the nurse turn under such circumstances?
Should the medical committee be respon-
sible for investigating such cases?
A Toronto urologist recently declared
publicly that lack of communication be-
tween nursing personnel and himself was
the basic cause of death of one of his
patients.
The respective responsibilities of
nurses and doctors cannot be settled here.
I am simply attempting to prove that the
nurse carries too heavy a load to be
treated on the same level as other em-
ployees.
The director of nursing
The director of nursing, along with the
hospital administrator and the medical
director, belongs to the administrative
group. The administrator holds the ulti-
mate authority for what goes on in the
hospital by delegation from the board of
management. Even the medical director
submits to his control.
Usually there are five departments -
including the medical department - un-
der the administrator. The director of
nursing, as chief nurse, wields consider-
able power. In fact, her power is so great
that one wonders what recourse the nurse
who displeases her has, apart from union
protection. Since not every hospital in
the province has a nurses' staff associa-
tion, there are still some personnel at the
mercy of arbitrary authority.
A doctor accused of a breach of
professional ethics can defend himself
before his peers. The nurse is not given
such as opportunity. Her only alternative
is to leave with a slightly tarnished
reputation.*
Each hospital is free to establish regu-
lations amphfying those passed by gov-
ernment. Thus, each hospital is free to
develop some system of appeal against
arbitrary judgment. One of the functions
of the director of nursing is to set up the
committees necessary to ensure good
nursing service.
The suggested pattern is as vague as
one could hope for. It is so vague that an
enterprising director could readily devel-
op a truly democratic committee on
nursing. This body, in addition to investi-
gating ways and means of improving
nursing care, could be given the responsi-
bility of studying accusations made against
nurses by doctors, patients, or the public.
Article 75 gives the hospital medical
board - the doctors - the freedom to
include in its membership representatives
from other health professions. This means
that the director of nursing could be
invited to attend meetings. But are nurses
really looked upon as "health profes-
sionals? " I doubt it, although it would
seem desirable that they should be.
At the present time, most medical
boards would certainly not permit the
director of nursing to be present, al-
though Article 8 1 provides another open-
ing. Anyone can sit in on meetings of the
medical board or its executive by invita-
tion. Have the doctors ventured to make
such a gesture toward nurses as yet?
*In some provinces, an individual nurse can
ask her provincial nursing association to investi-
gate conditions on her behalf.
THE CANADIAN NURSE 47
Article 76-g puts control of paramedi-
cal and nursing activities in the hands of
the medical board. This alone should
justify the presence of the director of
nursing at meetings of this group. The
hospital administrator, who is not always
a doctor, sits in on meetings of the
executive committee of the medical
board; the director of nursing deserves
these rights also.
Staff nurses
This group is without protection of
any kind in the hospital hierarchy. Even
the majority opinion of its members need
not prevail against the wishes of the
director of nursing nor of the administra-
tor. What alternatives does she have but
to submit or to resign?
The Act recommends a joint com-
mittee on nursing with equal representa-
tion from both nursing service and medi-
cine, in addition to the administrator and
the director of nursing. One of its func-
tions is to investigate any complaints
related to nursing. Could it not also act as
a sort of court of appeal for staff nurses?
Its make-up, however, leaves something
to be desired. Three doctor members in
addition to the administrator would seem
to balance three nurses plus the director
of nursing. We forget that this committee
is under the control of the hospital
administrator who frequently sides with
the doctors when, to put it bluntly, the
director of nursing does not balance the
scales, but serves as a representative of
administration.
It is a vicious circle. Committees form-
ed for the purpose of overseeing nursing
care are controlled by doctors, and nurses
can do little except not assent. If, at their
peril, they oppose the doctors, it is
without hope of a hearing.
Although I believe that doctors have a
place in this area, nurses should play a
much greater role in the control of
nursing.
Nurses have little protection in the
practice of their profession. However,
through force of circumstances, they are
being called on with increasing frequency
to carry out more and more complex
medical procedures. Article 245, as an
example, startled me somewhat. It states
that in an emergency a verbal order can
be given by telephone to an authorized
person. The latter must record it on the
chart along with the doctor's name, date,
and time of the call, and then sign it. The
attending doctor must countersign this
order within 24 hours. The "authorized
person" is often the nurse!
There is always the possibility of error
under such circumstances. In most cases,
48 THE CANADIAN NURSE
the telephone treatment is successful. In
other instances, unless the patient is
examined by a doctor, he may die. The
"authorized person" finds herself in an
awkward situation if, in the face of a
serious or fatal outcome, the doctor
refuses to countersign his order or claims
to have prescribed something different.
The only possible solution is to require
the presence of at least one doctor in the
hospital at all times.
Although taking a new and daring
approach in several areas, the new regula-
tions are weak with respect to emergency
services. Article 228 says only that each
hospital must have a doctor available at
all times. There is no indication of where
he is to be located, nor of what "avail-
able" means. Various nurses have com-
plained about this, particularly those
from non-teaching hospitals without
intern services.
On behalf of the patient
Whether nurses like it or not, all of the
foregoing considerations have a bearing
on hospital classification. The duties and
obligations of an institution are neces-
sarily limited by its bed capacity, facili-
ties and equipment, personnel, the area
served, and the number of doctors on its
staff. The nurse is also affected. Her
responsibilities are likely to be propor-
tionately greater in the hospital with
more limited facilities than in the univer-
sity teaching hospital where she is sur-
rounded by medical personnel. On the
other hand, since the latter provides more
complex types of care, the nurse must be
more highly specialized.
The newly-amended Act, as far as
nursing is concerned, sums up a code of
procedure concerning the organization of
nursing service. In the overall picture,
there is little concern with nurses. They
are considered as nothing more nor less
than hospital employees, although touch-
ing discourses on their calling are fre-
quently directed to them. The role and
functions of the director of nursing are
clearly specified, which is one good point.
In Quebec, nursing personnel in gen-
eral - nurses, nursing assistants, and
nursing aides — have no other alternative
than unionism. Even here there are limita-
tions. Should the union stick to its
traditional role of ensuring bread and
butter for its members, or must it be
concerned about their professional stand-
ing?
The doctors have decided on divorce.
In Canada, control over medical practice
is in the hands of the College of Physi-
cians and Surgeons of each province. In
Quebec, fees and collective bargaining are
in the hands of physicians' unions.
To summarize, the following questions
have been raised and would appear to be
good material for discussion.
• Should nurses take a greater interest in
hospital corporations and participate in
them more frequently and in greater
numbers?
• Should the director of nursing enjoy
the same privileges and prerogatives as the
medical director, including a seat on the
board of management, and on the exe-
cutive committee of the medical board
with the right to be present, if not to
vote, at meetings of this board?
• Could nurses be invited, at least oc-
casionally, to membership on the board
of management?
• Could nurses in a given hospital be
organized in such a way that they might
have a representative on the board of
management?
• Could the control of nursing be placed
in the hands of nurses, if so organized,
with representation from medical person-
nel?
• Is there a place for some sort of system
of appeal when the competence of a
nurse is questioned, or when the value of
a specific nursing procedure is disputed?
A lay person cannot settle these ques-
tions for nurses. However, if nurses them-
selves do not take the initiative, others
will do so for them. In the name of the
patient, mind your own business, but for
goodness' sake, do mind it! D
Translated and adapted from an article that
appeared in the May issue of L 'infirmiere
canadienne.
AUGUST 1%9
research abstracts
Smith, Dorothy (McPhail), Survey of
follow-up of visual defects in grade
one school children in central Alberta
health units. 1958-59. Ann Arbor,
Mich., 1960. Thesis (M.P.H.) Univer-
sity of Michigan.
The investigation was confined to the
possible influence of the attendance of a
parent at the physical examination and of
the size of the family upon the correction
of referrable visual defects among grade
one school children in three central Al-
berta health units.
The investigation showed that the cor-
rection of visual defects among grade one
school children was not significantly in-
fluenced either by the attendance of the
parent at the physical examination, or by
the size of the family. One wonders,
therefore, whether other factors, such as
the socio-economic status of the family,
the content of the interview with parents
at the time of the physical examination,
or the frequency and method of follow-
up might have some bearing on the
correction of visual defects.
A significantly higher percentage of
school children had referrable visual de-
fects corrected in a city of approximately
15,000 people than among those in a
rural health unit where there was no
center of population over 6,000 people.
This distinct difference might suggest that
the proximity of facilities for ophthalmic
advice may have been an important factor
in determining parental response to a
recommendation for referral.
Flaherty, M. Josephine, The prediction of
college level academic achievement in
adult extension students. Toronto,
1968. Thesis (Ph.D,) Univ. of Toronto.
The purpose of the study was to
identify factors - cognitive and non-
cognitive - that account for the
common variance among 43 psycho-
logical and biographical measures on
adult college students, and to assess the
relative importance of each factor for
predicting academic achievement. Psycho-
logical variables included measures of
verbal and non-verbal intellectual ability,
intellectual speed, persistence, as well as
orientations toward learning, study
habits, and attitudes toward study. Bio-
graphical variables included data on age,
number of years since leaving school,
number of college subjects taken to date,
and number of hours of study per week.
AUGUST 1%9
The first-order cognitive factors
hypothesized to underlie the 43 measures
were the fluid and crystallized general
intellectual factors of Cattell. The non-
cognitive factors that were expected in-
cluded five orientation factors: learning
orientation, sociability, personal goal,
societal goal and need fulfillment, a study
habits factor and an age factor.
Subjects for the study were 296 ma-
ture (adult) students enrolled in credit
courses in the Division of Extension of a
large metropolitan university. Analyses of
data were carried out separately for three
groups: the total group, males only, and
femies only. Analyses were done also on
similar sub-groupings of students for
whom high school grades were available.
An iterative factor analysis was perform-
ed for each group of students and 12
first-order orthogonal factors were ex-
tracted. An oblique rotation was applied
to the factor structure and, from the
matrix of intercorrelations of first-order
factors, second-order factors were ex-
tracted.
The obtained first-order cognitive fac-
tors were intellectual-educational ability,
non-verbal reasoning ability, and intellec-
tual speed. Non-cognitive factors included
six orientation factors — learning orien-
tation, sociability, societal goal, personal
goal, need for acceptance by others, and
relief from boredom-frustration. An age
factor and a factor that was not named
were also obtained for each group. A
study habits and attitudes factor was
obtained for all groups except females;
for one group of females, an educational
achievement factor was obtained.
At the second order, there was a
general intellectual factor and three fac-
tors representing the learning, activity,
and goal orientations. A fifth second-
order factor, obtained for one group of
females, was interpreted tentatively as
educational orientation.
The results of the factor analysis did
not provide evidence to distinguish the
Cattell-Horn theory of fluid and crystal-
lized intellectual abilities from Vernon's
hierarchical model of abilities; this
suggests that the two theories are not
necessarily dissimilar as they apply to the
behavior of adults. The findings did sup-
port an earlier conclusion that adults can
be classified according to their orien-
tations toward learning. It is suggested
that further investigation be made of
adult orientations toward learning, and,
in particular, the two need-related orien-
tations that were not identified m earlier
studies.
To determine which factors best pre-
dict university performance, scores on the
1 2 orthogonal factors were computed for
each student and used in a multiple
regression analysis. Criteria for prediction
were overall numerical grade average, and
final grades in language, science, mathe-
matics, humanities, and social science
courses.
The intellectual-educational ability
factor was the most effective predictor of
overall grade average, science and social
science grades, and made substantial con-
tributions to the prediction of grades in
humanities and languages; statistically
significant contributions of this factor to
the total criterion variance ranged from 3
percent to 18.87 percent. Study habits
and attitudes were the most effective
predictors of grades in the humanities
(contributing from 7.35 to 22.44 percent
of the total variance) and made large
contributions to variance (ranging from
2.35 to 9.51 percent) in grade average,
languages, and social science grades.
Need for acceptance by others was a
useful predictor of humanities grades for
females (10.07 to 10.54 percent of the
variance), and made contributions, rang-
ing from 1.58 to 5.29 percent of criterion
variance, to prediction of grade average,
humanities, social science, and science
grades for other groups. Age made useful
contributions to the prediction of science
(3.50 to 5.80 percent) and mathematics
grades (3.77 to 7.65 percent) for males
and for the mixed groups. Societal goal
orientation (6.18 to 15.07 percent) and
non-verbal reasoning (3.81 to 10.23 per-
cent) were the most effective predictors
of mathematics grades. All the other
orientation factors made substantial con-
tributions to the prediction of grades.
The multiple regression analyses in-
dicate that although the intellectual-
educational factor was the best predictor
of overall grade average, non-cognitive
factors made substantial and sometimes
larger contributions to the prediction of
grades in specific course areas. There was
evidence of marked differences in the
predictive validity of some factors for
males and females, it is suggested that
prediction of academic achievement be
done separately for males and females
and that further investigation be carried
out to determine the usefulness of non-
cognitive factors in the prediction of
academic achievement in adults. □
THE CANADIAN NURSE 49
The Psychology of Play by Susanna
Millar. 288 pages. Don Mills, Long-
mans Canada Limited, Penguin Divi-
sion, 1968.
Reviewed by Elinor Burwell, Assistant
Professor, Dept. of Psychology, Carle-
ton University, Ottawa, Ont.
The subject of play has been treated
by the author, a psychologist, in a thor-
ough, scholarly fashion. Dr. Millar states
that her book is intended mainly for the
general reader, and that she has tried to
present her material at a level that will be
readily comprehended by non-
psychologists. The scholar who is interest-
ed in play will not be displeased with this
book, however.
Over 400 references to scientific books
and journal articles are given in the
bibliography; many were published as
recently as 1967. Findings from observa-
tional and experimental studies are skil-
fully integrated, gaps in our knowledge
are pointed out, and questions that re-
quire further exploration are brought to
our attention.
There are two chapters on theories
about play; theorists from Plato to Piaget
are presented. The third chapter surveys,
with many examples, the play of animals
at various positions in the evolutionary
scale. The remainder of the book deals
with the variety of forms of children's
play: exploring and movement play,
phantasy and make-believe play, imitative
play, social play. There is a thorough
discussion of the influence on play of a
number of individual difference variables:
sex, intelligence, social class, culture.
There is even a chapter on play therapy!
Dr. Millar writes in a clear, lucid style.
This reviewer found the book highly
readable and fascinating. However, the
statement in the editorial foreword that
the book "can be commended to all
parents and to teachers as well as to
students engaged in advanced studies in
psychology and the social sciences"
should be taken with a grain of salt. In
the reviewer's opinion, the reader with no
background in psychology will find parts
of this book tough sledding.
Human Labor & Birth, 2nd ed. by Harry
Oxorn and WiUiam R. Foote. 538
pages. New York, Appleton-Century-
Crofts, 1968.
Reviewed by Phyllis Van Troyen, In-
service Director, and Sharon Benko,
50 THE CANADIAN NURSE
Head Nurse, Obstetrics, St. Mary's
Hospital, Camrose, Alberta.
This text is an excellent handbook for
obstetrical nurses and doctors. The infor-
mation is presented in a concise point-
form manner. Diagrams are in close prox-
imity to the information. In this way the
reader can use them as visual aids to the
written information without having to
refer to another part of the book. They
are excellent in content, especially those
describing position and presentation of
the fetus.
The emphasis of the book is on anato-
my and the practical application of ob-
stetrics in labor and delivery. This is a
refreshing change from most textbooks,
in which the main concern seems to be
physiology and psychology.
The information presented in point
form permits the reader to find exactly
what he is looking for without wading
through reams of irrelevant words. A
good background knowledge of obstetrics
is required, but the book does provide an
excellent source for reference and guid-
ance to obstetrical personnel. This book
should be kept close at hand on every
obstetrical unit.
Fundamentals of Biostatistics by Stanley
S. Schor. 312 pages. New York, G.P.
Putnam's Sons, 1968. Canadian agent:
Macmillan Co. of Canada Limited,
Toronto.
Reviewed by Vivian Wood, Assistant
Professor, School of Nursing, The Uni-
versity of Western Ontario, London,
Ont.
This text, directed toward the clinical
investigator, medical student and physi-
cian, begins with a general discussion of
statistics. The clinical trial, an experiment
designed to assess the value of a particular
treatment, is examined in the second
chapter. Other techniques and concepts,
such as the double-blind study, the pla-
cebo effect and systematic versus experi-
mental error, are included here.
The author then explores the design of
the epidemiological study, which is usual-
ly a retrospective analysis of certain
characteristics in selected populations.
Examination and discussion of descriptive
measures, probability, random sampling,
and statistical inference follow in separate
chapters. Both types of studies, the cli-
nical trial and the experimental study, are
completed with a discussion of the mean-
ings and limitations of their results. Fol-
lowing a comprehensive examination of
correlations and multiple sample tests,
the author explores the use of non-
parametric statistics and illustrates their
use.
The last chapter discusses the Bayesian
Theory of selecting the alternative that
gives the greatest expected gain or small-
est expected loss.
This text is written clearly, with sum-
mary statements and problems con-
cluding each chapter. It would be useful,
however, for students to have the answers
either at the end of the text or in a
supplemental workbook. Another minor
fault is the repetition of previously des-
cribed basic concepts.
This text could be used for courses in
medical statistics and fundamentals of
biostatistics.
The Pharmacologic Basis of Patient Care
by Mary Kaye Asperheim. 417 pages.
Toronto, W.B. Saunders, 1968.
Reviewed by Beth Davis, Assistant
Supervisor, Inservice Education,
Obstetrics, Kingston General Hospital,
Kingston, Ont.
This book gives an excellent discussion
of how drugs are administered, the effects
they have on the body, and the nurse's
responsibility to her patient.
The author introduces pharmacologic
patient care by defining pharmacology,
briefly describing the source of drugs, and
explaining the various forms of these
drugs. Also important is the interesting
detail on Canadian and American legisla-
tion regarding all drugs and narcotics and
the dispensing of these drugs.
The chapters on the mathematics of
drug therapy, the administration of drugs,
and the action of drugs on the body
follow the introduction. The author then
goes into detail about vitamins and miner-
als, antihistamines and immunizing
agents, anti-neoplastic agents, radioactive
drugs, and drug addiction. Each body
system is dealt with separately. The
author describes the system briefly, some-
times with the help of informative dia-
grams; she then discusses the drugs that
affect each particular system.
In writing about drugs, the author uses
both the generic and trade name and gives
detailed but brief information about the
(Continued on page 52)
AUGUST 1%9
Now available
THE SECOND EDITION OF
COUNTDOWN
CNA'S YEAR BOOK OF CANADIAN NURSING STATISTICS
One-third larger than last year's edition, COUNT-
DOWN 1968 contains commentary and 133 sta-
tistical tables updated to present the latest
available data on nursing manpower, education, and
salaries.
An exciting addition this year is the inclusion of
salaries paid to nurses employed in public general
hospitals throughout Canada.
A cross-reference between COUNTDOWN and
FACTS ABOUT NURSING, published by the
ANA, is available from CNA.
Act now. Continue your collection of COUNT-
DOWN with the 1968 edition by clipping and
mailing the coupon below.
TO: Canadian Nurses' Association
50 The Driveway
Ottawa 4, Ontario
Please send
per copy, to:
Name
(no. of copies) of Countdown 1968, at $4.50
Address
City
Province
Position
Money Order D
Cheque D
For$
Enclosed
TTTTTTTTTd o w N
1968
^T I S T I C S
CANADIAN NUnSES' ASSOClATri
AUGUST 1%9
THE CANADIAN NURSE 51
(Continued from page 50)
drug, its uses, toxicity, and dosage.
In the table of contents, chapter head-
ings are arranged according to parts of the
body. For example, one chapter is on
drugs that affect the respiratory center;
another is on diagnostic agents. Each
chapter is introduced by a brief preview
of the important concepts to be discussed
and ends with a few pertinent questions
for review.
The index, consisting of 21 pages,
makes it possible to find specific detail.
Because of the format used by the
author, the book could be useful to
instructors as well as to students; howev-
er, it would not be too useful for quick
reference.
Social Competence & Mental Handi-
cap — An Introduction To Social
Education by H.C. Gunzburg. 225
pages. London, Bailliere, Tindall &
Cassell, 1968. Canadian Agent: Mac-
millan Co. of Canada, Toronto.
Reviewed by Mary Macaulay, Director,
Social Work Department, Rideau Re-
gional Hospital School, Smiths Falls,
Ont.
Tliis book should be of great interest
and help to those engaged in education
and rehabilitation of the retarded.
Dr. Gunzburg speaks with authority
and understanding. His approach to the
assessment, evaluation, and development
of social skills in the mentally retarded is
thoroughly practical. He groups social
skills under four sections: self-help, com-
munication, socialization, and occupa-
tion. Each of these contains sub-sections
referring to particular areas of social
development.
1. Self-help includes skills such as
good table habits, mobility, good toilet
habits, washing, dressing, use of clothing,
and personal health.
2. Communication includes all abili-
ties relating to the use and understanding
of the ordinary means of communication
(language, reading, writing, and arith-
metical work).
3. Socialization deals with the skills
and ability to work with others, not just
next to others.
4. Occupation refers to the skills that
make a person useful, help to occupy
him, and enable him to contribute to his
own support. The training for occupation
begins early, with the development of
motor skills that are learned in a variety
of ways, and which give a certain degree
of physical competence for work tasks.
Dr. Gunzburg discusses the place of
52 THE CANADIAN NURSE
the Intelligence Quotient and the Social
Quotient, and emphasizes that these two
alone do not complete the assessment
necessary for programming for the de-
velopment of social skills. It is important
to note the retardate who falls below
others who are similar to himself, but
have developed a higher degree of social
competence than he has. In other words,
take a look at the "retarded retardate"
and find out what he needs to plan a
better way of functioning for him. The
assessment and planning will, hopefully,
provide the child or adult with the
"intellectual vitamins" he needs.
Dr. Gunzburg refers to the socially
incompetent retardate as a "stranger in
his ovm country," because he is often
"ignorant of its customs, imperfect in his
command of the language, deficient in his
understanding, suspicious of the in-
tentions of others, and bewildered by the
demands of changing situations." He sug-
gests a first aid program for him in the
areas already mentioned.
The case for systematic observation
and assessment is very strong, because Dr.
Gunzburg sees the retarded as an individ-
ual with special needs, rather than a
problem case to be measured. With help
such as he prescribes, the retardate may
be "at home" rather than a "stranger" in
his own country.
Nutrition and Diet Therapy by Sue
Rodwell Williams. 686 pages. Saint
Louis, Mosby, 1969.
Reviewed by S.J. Slinger, Professor
and Chairman, Department of Nutri-
tion, Ontario Agricultural College,
Guelph, Ont
The author is well qualified to write
this text, and obviously is dedicated to
the field of nutrition in health and
disease. The book is easy to read, well
organized, and presents a wealth of up-
to-date information of value to the nurse
in any area of work.
The first several chapters deal with the
foundations of nutrition, including the
roles of the various broad classes of
nutrients, the importance of water and
electrolytes, and digestion, absorption,
and metabolism. In these chapters the
author places nutrition on a chemical
Correction
In the February "Books" section,
Health Services Administration: Policy
Cases and the Case Method, edited by
Roy Penchansky, was listed as a publica-
tion of Harvard University Press. The
Canadian distributor is Saunders of To-
ronto, 1885 Leslie St., Don Mills, Ont.
Saunders of Toronto also distributes
Infectious Diseases, by Dauer, Koms,
and Schuman, which was incorrectly
listed as a W.B. Saunders publication in
the June issue of CNJ.
basis and relates the nutritive needs in
terms of basic chemical compounds
rather than in terms of food. Great care is
taken, however, to show how the indivi-
dual nutrients are interrelated for the
total physical and psychological needs of
the individual. With this background the
student is in a position to understand the
applied chapters that follow.
The section on applied nutrition
presents valuable information on the
dangers of food faddism, the necessity
and means of protecting the community
food supply, and the methods of teaching
nutrition to the community and the
family.
The section on nutrition in nursing
emphasizes such areas as nutrition during
pregnancy and lactation, during various
stages of the life cycle, in rehabilitation,
the importance of nutrition in relation to
psychiatric nursing, and nutritional the-
rapy in disease.
Also of particular interest is the sec-
tion on nutrition in medical-surgical
nursing, which describes in detail the
application of sound nutrition principles
to the care of patients with specific
diseases.
The presentation of glossaries of terms
and useful questions throughout the book
will be of considerable value to the
student. A large number of references
that are also included will help the
interested student enrich her knowledge.
The science of nutrition is in a conti-
nuous state of flux, with new information
being uncovered at a rapid rate. The nurse
must have an adequate understanding of
this science if she is to fulfil her obliga-
tions to the patient and the public at
large. This book is recommended not
only to the nurse, but to all other persons
concerned with health and disease as they
relate to nutrition.
Principles of Medicine, 4th ed. by James
Vemey Cable. 685 pages. Christ-
church, New Zealand, N.M. Peryer
Limited, 1969.
Reviewed by Irene MacMillan, Assist-
ant Director of Nursing, Montreal Neu-
rological Hospital, Montreal, Que.
The author recognizes the contribu-
tion of the nurse to the total care of the
patient, and shares with her his knowl-
edge to help make the treatment of the
patient more meaningful. He draws on
such related disciplines as pharmacology,
bacteriology, and psychology to present a
comprehensive study of the conditions
discussed.
His clear-cut style simphfies the ex-
tremely complex subjects. Examples are
frequent and specific, illustrations are
helpful, cross references are generously
used, and excellent summaries are pro-
vided.
The result is a book that is particularly
useful to the student as an outline to
AUGUST 1%9
consolidate information received from
other courses and from experience; to the
graduate nurse who has elected to special-
ize in one type of nursing but who wishes
to keep abreast of new developments in
medicine as a whole; and to lay readers
who will appreciate its readable style and
the general information presented. Al-
though prepared especially for nurses in
New Zealand, the book should prove to
be a valuable addition to any nursing
library.
The Young Handicapped Child, 2nd
ed.,by Agatha H. Bowley and Leslie
Gardner. 167 pages. Edinburgh and
London, E. & S. Livingstone Ltd.,
1969. Canadian Agent: Macmillan Co.
of Canada, Toronto.
Reviewed by Dr. Helen Evans Reid,
Dept. of Medical Publications, The
Hospital for Sick Children, Toronto,
Ont.
This book deals with four types of
handicaps: cerebral palsy, deafness, blind-
ness, and autism. The authors discuss
recognition of the handicap and outline
the problems involved in the care and
education of children who have these
handicaps.
Agencies that provide assistance for
handicapped children are Usted at the end
of each chapter, although those referred
to are in Britain.
This book is recommended for health
care workers, including social workers
and nurses, and specialist teachers of the
handicapped. It is less suitable for parents
w4io might find the discussion of other
conditions too discouraging.
Pediatric Surgery for Nurses, edited by
John G. Raffensperger and Rosellen
Bohlen Primrose. 327 pages. Boston,
Little, Brown and Company, 1968.
Canadian agent: J.B. Lippincott Co. of
Canada, Toronto.
Reviewed by Roselyn Smith, Director
of Nursing, Montreal Children 's Hospi-
tal, Montreal, P.Q.
With the recent advances in pediatric
medicine and the stress on prevention,
many of the children's conditions re-
quiring medical treatment have practical-
ly disappeared. At the same time, ad-
vances in surgery are now able to save
children who would not have survived
because of congenital anomalies, disease,
trauma, and malignancies. As surgery
advances, surgical nursing must keep
pace. To date, pediatric surgical nursing
textbooks have been few and the need for
them is great.
AUGUST 1%9
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No. 216 Nursescope 12.95 ppd.
12 or more 10.95 ppd.
D one Name Pin D two, sarrw narrw
LETT. COLOR: D Black DBlue D White (No. 169 only)
METAL FINISH (Nos. 169 or 100): GOoW OSilver
LETTERING.
2nd Line .
INITIALS
Name Engraved
(Cross Pens)
PROF. LETTERS -
I enclose S (Mass. residents add 3% S.T.)
City
Zip.
THE CANADIAN NURSE 53
The text is concise, easy to read, and
should be useful to nurses at all levels. It
would be a valuable addition to any ward
library. □
This reviewer is particularly impressed
with the breadth of approach to pediatric
surgical nursing in this volume. The text
deals with most pediatric surgical pro-
blems that nurses see in hospitals. Pre-
and postoperative care are discussed and
many of the illustrations are most
helpful.
Emphasis is placed on the role of the
nurse in the pediatric surgical team and
on the kinds of situations in which she
must take knowledgeable and prompt,
independent action.
Such areas as the newborn infant,
trauma, and malignancies are well cover-
ed. The book also deals with such special-
ties as neurosurgery, orthopedics, plastics,
and cardiac surgery, as well as abdominal,
eye, ear, nose and throat surgery, and
surgery of the genitourinary tract.
Of note throughout the text is the
comprehensive approach to the needs of
the child and his family. The section on
burns recognizes the effect of nursing this
type of injury on morale of the staff and
makes useful suggestions.
At the end of each section, pertinent
nursing care problems are posed and some
answers to these problems are provided at
the back of the book.
accession list
Publications on this list have been
received recently in the CNA library and
are listed in language of source.
Material on this list, except reference
items, which include theses and archive
books that do not circulate, may be
borrowed by CNA members, schools of
nursing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List"
and should be addressed to: The Library,
Canadian Nurses' Association, 50 The
Driveway, Ottawa 4, Ontario.
No more than three titles should be
requested at any one time. If additional
titles are desired, these may be requested
when you return your loan.
Stamps to cover payment of postage
from library to borrower should be in-
cluded when material is returned to CNA
library.
BOOKS AND DOCUMENTS
1. American Association of Junior Colleges.
Junior college directory, Washington, American
Association of Junior Colleges, 1969. 109p. R
2. Bases et Umites physiologiques du con-
trdle des naissances par C. Thibault et M. C.
Levasseur. Paris, Doin, 1968. llOp.
3. Basic microbiology by Margaret F.
Wheeler and Westley A. Volk. Philadelphia,
Lippincott, C1969. 410p.
4. Canadian Hospital Association office and
association directory. Toronto, Canadian Hospi-
tal Association, 1969. 47p. R
5. The construction and use of teacher-
made tests by Maiy R. Shields. 2d ed. New
York, National League for Nursing, Test Con-
struction Unit, 1965. 116p. (The Use of Tests
in Schools of Nursing, pamphlet no. 5)
6. Educational television and radio in Brit-
ain: present provisions and future possibiUties.
Papers prepared for a national conference or-
ganized jointly by the BBC and the University
of Sussex and held at the Conference Centre,
the White House, Chelwood Gate, Sussex 1 3 to
17 May 1966. London, cl966. 292p.
7. Exposes schematiques de soins pri et
postopiratoires par Claude Bomet. Paris, Ma-
loine, 1965. 287p.
8. Forces affecting nursing practice edited
by Dorothy D. Petrowski and Margaret T.
PartheymuUer. Washington, Catholic University
of America Press, cl 969. 11 7p.
9. Fundamentals of nursing; the humanities
and the sciences in nursing by Elinor V. Fuerst
and LuVeme Wolff. 4th ed. Philadelphia,
Lippincott, cl969. 446p.
10. Fundamental skills in the nurse-patient
Three thousand years of testing
by a highly qualified panel of experts
endorses the value of sugar in baby formulae
It's a controllable weight-builder and energy
source. It's easily digested, inexpensive, pure,
readily available and easy to use. In reason-
able quantities it is good for babies.
They have liked it for three thousand years
and still do. If you'd like to know more about
sugar send for an illustrated copy of our
brochure, "The Story of Sugar":
Canadian Sugar Institute
408 Canada Cement Building, Phillips Square, Montreal, P.O.
54 THE CANADIAN NURSE
AUGUST 1969
relationship: a programmed text by Uanne S.
Mercer and Patricia O'Connor. Philadelphia,
Saunders, cl 969. 192p.
\\. A guide for the development of
refresher courses for professional nurses by
Rachel B. Westmoreland and Kenneth S.
Oleson. Ralei^, Dept of Community Colleges,
State Board of Education, 1967. Iv. (various
paging).
\2. A guide for health technology program
planning by American Association of Junior
Colleges and National Health Council, 1967.
52p.
13. Health manpower: factors of crisis.
North Miami, Fla., North Miami General Hospi-
tal; reprinted from Medical Tribune, New York,
N.Y., March-July 1968, cl968. 78p.
14. Health service delivery to the commu-
nity. Papers presented at the Council of Hospi-
tal and Related Institutional Services, October
10-11, 1968, Dallas, Texas. New York, National
League for Nursing, 1969. 58p.
15. The hospitals yearbook and directory
of hospital suppliers, 1969. London, Institute
of Hospital Administrators, 1%9. 1384p. R
16. How to make money writing short
articles and fillers by Marjorie M. Hinds. New
York, Fell, cl 968. 127p.
n. An introduction to the physical aspects
of nursing science by O.F.G. Kilgour. London,
William Heinemann, cl969. 292p.
1 8. Job descriptions: how to write and use
them by Conrad Berenson and Henry O.
Ruhnke. 1969 ed. Swarthmore, Personnel Jour-
nal, 1969. 4 5p.
19. Measuring faculty performance by
Arthur Cohen and Florence B. Brawer. Wash-
ington, American Association of Junior Col-
leges, 1969. 81p.
20. Medical-surgical nursing workbook for
practical nurses by Dorothy F. Johnston. 2d
edL, Saint Louis, Mo., Mosby, 1969. 146p.
21. Microbiology in health and diseax by
Martin Frobisher, Lucile Sommermeyer and
Robert Fuerst 1 2th ed. Philadelphia, Saunders,
1969. 549p.
22. Nursing of children: a guide for study
by Debra P. Hymovick. Philadelphia, Saunders,
cl969. 389p.
23. Pidiatrie par M. Poitout et C. Joly.
Paris, Malrane, 1967. 432p.
24. Preparation for retirement by Woodrow
W. Hunter. Ann Arbor, Mich., Division of
Gerontology, University of Michigan, 1968.
108p.
25. Proceedings of ANA Conference for
Members and Professional Employees of State
Boards of Nursing and ANA Advisory Council,
Dallas, Texas, May 9-10, 1968. New York,
American Nurses' Association, 1969. 46p.
26. Social policies for Canada, part 1. Ot-
tawa, Canadian Welfare Council, 1969. 78 p.
27. State approved school of professional
nursing, 1969. New York, National League for
Nursing. Research and Studies Services. 112p.
28. A study of 1543 women 21 years of age
and over at the University of Manitoba, Sep-
tember 196 7-May 1968 by Shirley A. Smith,
Winnipeg, University of Manitoba, 1%8. 70p.
29. Work attitudes and retirement ad-
justment by Jean E. Draper, Earl F. Lundgren
and George B. Strother. Madison, Univ. of
Wisconsin, Graduate School of Business, Bureau
of Business Research and Service, 1%7. 91p.
30. Workbook for maternity nursing by
Constance Lerch. 2d ed. Saint Louis, Mosby,
C1969. 303p.
PAMPHLETS
31. ARNN, what it is, what it does. St.
John's, Association of Registered Nurses of
Newfoundland, 1969. 15p.
32. Esquisses: I'Hotel-Dieu de Quebec. Que-
bec, P.Q., 1939. Iv. (not paged) R
33. Guidelines for the development of
post-basic education for nurses. Geneva, World
Health Organization, 1%9. 17p.
34. A national occupational health service
by Royal College of Nursing and National
Council of the United Kingdom. London, 1969.
15p.
35. On using and being a consultant. Wash-
ington, American Associations of Junior Col-
leges, cl%7. 33p.
36. Organization of University Health
Centre Administrators by John F. McCreary.
Vancouver, British Columbia, 1968. lip.
37. Principles of organization, management
and community relations for hospitals. Chicago,
American Hospital Association, cl964. 13p.
38. Public health nursing activity study;
report to the CPHA (Alberta Division) Conven-
tion 1969 by Beryl Ebert. Edmonton, 1969.
lip.
NOTICE
On February 8, 1969, a Regulation made under
The Public Health Act respecting X-Ray safety,
known as O.Reg. 29/69, was published in the
Ontario Gazette.
X-RAY OWNERS
must register
"Every person who is the owner of an X-Ray machine, or who
hereafter becomes the owner of an X-Ray machine, is required
by this Regulation to register with the Department of Health."
Copies of the Regulation and of the prescribed Ownership
Registration Form may be had on request from:
The Ontario Department of Health,
Radiation Protection Service,
1 St. Clair Avenue West,
P.O. Box 425, Postal Station Q,
Toronto, Ontario.
ONTARIO DEPARTMENT OF HEALTH HON. MATTHEW B. DYMOND, M.D., Minister
R N
rity
7nnK
CN 869
An important
first i
for nursing j
instructors! !
ASSOCIATE
^DEGREE NURSING
A Guide to Program
and Curriculum Development
By Ann N. Zeitz. R.N., M.A.:
Lelia Delores Howard, R.N., M.S.:
Elva Christy. R.N.. Ed.M.:
fond Harriette Simington Tax, R.N., M.S.
• Describes course content and prac-
tical application for each course in
curriculum
• Provides complete course outlines j
• Explores team teaching, its
advantages, problems and
solutions
• Includes list of
film sources
The C. V. Mosby Company, Ltd.
86 Northline Road
Toronto 374, Ontario
Please send me a copy of ASSOCIATE
DEGREE NURSING, priced at $10.75,
on 30-day approval.
QBill me nPayment enclosed. (Same
return privilege.)
AUGUST 1%9
THE CANADIAN NURSE 55
39. Rounded development of the human
personality by F.F. Korolei. Toronto, Conver-
gence, 1968. Sp.
GOVERNMENT DOCUMENTS
Canada
40. Btireau of Statistics. Salaries and quali-
fications of teachers in universities and colleges,
1967-68. Ottawa, Queen's Printer, 1969. 75p.
41. Dept. of Finance. Canada student loans
plan, report, 1965-1967. Ottawa, Queen's
Printer, 1969. 3v.
42. Dept. of Labour. Canada and the Inter-
national Labour Organization; 50 years of
social progress. Ottawa, 1%8. Iv. (various
pagings).
43. . Labour and industrial relations
research in Canada: progress report, December
1968. Ottawa, Queen's Printer, 1969. 32p.
44 — ' . Report 1968. Ottawa, Queen's
Printer, 1969. 58p.
45. ■. Women's
Bureau and Eco-
nomics and Research Branch. Maternity leave
policies; a survey. Ottawa, Queen's Printer,
1969. 137p.
46. DepL of National Health and Welfare.
Canada Assistance Plan, report, 1966-67. Ot-
tawa, 1968. Iv.
47. — — . Emergency Welfare Services Di-
vision. Emergency clothing operations, Ottawa,
Queen's Printer, 1969. 82p.
48. . Division de I'hygiene dentaire.
Manuel d'hygiine dentaire. Ottawa, 1969. 48p.
49. Minist^e de la Sante nationale et du
bien-etre sociaL Rapport, 1967. Ottawa, Impri-
meur de la Reine, 1968. 279p.
50. National Science Library. Scientific and
technical societies of Canada. Ottawa, Na-
tional Research Council of Canada, 1968.
69p. R
Ontario
51. Dept. of Labour. Research Branch.
Negotiated wage rates in Ontario hospitals,
March 1969. Toronto, 1969. 98p.
52. Provincial Committee on Aims and
Objectives of Education in the schools of
Ontario. Living and learning; the report of
the Provincial Committee . . . Toronto, On-
tario, Department of Education, 1968. 221p.
Quebec
53. Gouvernement Ministere de I'Educa-
tion. Direction ginirale de I'enseignement
colUgiaL Quebec, 1968. 28p.
USA
54. Bureau of Labor Statistics. Middle
Atlantic Region. Some facts relating to
changing patterns of costs and structure in
the health sector by Hubert Bienstock. New
York, 1969. 12p.
55. Dept. of Health, Education and Wel-
fare. National Institutes of Health. Pain.
Washington, U.S. Govt. Print. Off. 1968. 16p.
STimmS DEPOSITED IN
CNA REPOSITORY COLLECTION
56. Care approaches to the dying patient
and his family by Michelle Marion Brideau.
London, 1968. 61 p. R
57. Continuing education for nurses; a
study of the need for continuing education
for registered nurses in Ontario by School of
Nursing, University of Toronto and Division
of University Extension. Toronto, 1969. 63p.
R
58. Correlates of approval and disapprov-
al received by students at selected schools of
nursing by Margaret L. Hayward. Pittsburg,
1969. 11^. (Thesis - Pittsburg) R
59. Family doctor, public health nurse
teamwork, a report of a study by Phyllis E.
Jones. Toronto, School of Nursing, Univer-
sity of Toronto, 1969. 58p. R
60. A guide for the public health nurse to
assist elderly patients in the achievement of
selected functional tasks at home by Phyllis
Margaret (Baird) Wilson. Seattie, Wash. 1968.
96p. (Thesis (M.N.) - Washington) R
61. Guilt: an operationally defined con-
cept by Pauline Annette (Peters) Kliewer,
Washington, 1969. 97p. (Thesis (M^.) -
Washington) R
62. One year follow-up survey of the
1 968 re-entry program for inactive registered
nurses. Halifax, Registered Nurses Associa-
tion of Nova Scotia, 1969. 8p. R
63. A study of the activities of nursing
personnel in ten health units and one city
health department in the province of Alberta.
Edmonton, Dept of Health, Alberta. 1968.
40p. R
64. Supervisor activities and the clinical
specialist by Sister Carmen Wolfe and Marcie
M. Richmond. Boston, 1969. 44p. (Thesis
(M.ScN) - Boston) R Q
REPORT OF THE COMMISSION
OF INQUIRY ON HEALTH
AND SOCIAL WELFARE
(CAST0H6UAY mm
Volume I — Health Insurance — $2.50
Volume II — Interns and Residents — $1.00
THE ENGLISH^ANGUAGE EDITION is already ON
SALE at the Commission's Offices, 360, McGill Street,
Montreal, and at the office of the Quebec Official
Publisher, Parliament Buildings, Quebec.
Each order must be accompanied by a money order
or certified cheque, payable to the Minister of
Finance.
cx)l;vernemen'i"
du quebec
56 THE CANADIAN NURSE
Request Form
for "Accession List"
CANADIAN NURSES'
ASSOCIATION LIBRARY
Send this coupon or facsimile to:
LIBRARIAN, Canadian Nurses' Association,
50 The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in tiie
issue of The Canadian Nurse,
or add my name to the waiting list to receive them when
available.
Item Author Short title (for identification)
No.
Request for loans will be filled in order of receipt.
Reference and restricted material must be used in the
CNA library.
Borrower
Registration No
Position
Address
Dote of request
AUGUST 1%9
September 1969
UNTVERSTTY OF OTTAWA,
SCHOOL OF NURSING
OTTAWA, ONT.
12-69-MAC-11-68
The
OUT OF LIBRARY
Canadian
Nurse
health needs are met
when PHN and GP
work together
nursing associations
- are they coming
or going?
a Peruvian adventure
IF YOU'RE GOING TO HAVE A FIT.. . MAKE IT A GOOD ONE!
Here, at White Sister, the most important thing built into every uniform is the kind of perfect fit that
no one else even comes close to! Our famous "Scientific Fit" is legend in the apparel industry . . .
and we're improving on it every single day of the week! You see, we're of the firm belief that no
matter how beautiful a uniform looks . . . it's no good unless it fits just as beautifully. Try one and see!
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SISTER
Featured: In an 8O0/0 Kodel and SOo/o Cotton "Flopence"-style-#0694 in short sleeves at: $15.98, #4694 in long sleeves at: $16.98, sizes 8 to 20, regular length.
Available at all fine retail and department stores. For the name of the store nearest you, and for your free copy of our Fall style book, please write:
WHITE SISTER UNIFORM INC., 70 Mt. Royal West, Montreal, Quebec.
This Smith and Nephew mark
spells quality in almost every language
Smith and Nephew products are sold in 80 countries
on six continents around the world— under the mark
that means quality in any language. You'll find the
Smith and Nephew mark on Elastoplast, Gypsona,
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SMITH AND NEPHEW LIMITED
2100-52nd Avenue. Lachine, P.Q., Canada
i
. 1
ii
BY...
Dolores E. Little, R.N., M.N.
Professor, School of Nursing,
University of Washington
Doris L. Carnevali, R.N., IVI.N
Associate Professor,
School of Nursing,
University of Washington
CONTENTS . . .
Planning Pafient Care —
Current Concepts and Rationale
Philosophy of Patient Care —
Its Relationship to Nursing Care Plans
Overview of Processes Used in
Planning Patient Core
The Nursing History
Skills and Technics
of Nursing History Taking
Nursing Care Plans,
Variations and Modifications
Revised Nursing Care Plans
The Nursing Care Plan Forms:
Guidelines for Development and Usage
Communicating by Means of
Nursing Care Plans
Activating the Nursing Care Plan System
Teaching the Planning of Nursing Care
Nursing Care Plans —
A System for Implementing Professional Caret
245 Paget • 1969 • Paperbound, $3.80 • Clothbound, $5.50)
NURSING CARE PLANNING
JL i^ooL DLt J4ad Oo Be Written !
Realistic in objectives and modern in concept, this helpful
new book presents the rationale for patient care planning
as a key process inherent in the professional nursing role.
The authors are fully aware of the critical need to provide
a growing population with both quantity and quality
nursing care. Knowledge about the patient is expanding —
the pathology that afflicts him and his response not only to
the disease and its treatment, but to the total experience
of illness. Nursing knowledge and skills have kept pace in
helping the patient to cope with these physiologic and
psychosocial disturbances. Unfortunately, the nurse's added
responsibilities do not allow a commensurate increase in
nurse-patient contacts. Therapeutic plans must often be
carried out with the assistance of other personnel.
How then con the nurse assure continuity of good patient
care — twenty-four hours a day, seven days a week?
The solution offered by this book is systematically planned
assessment and intervention, based on priorities of patients'
needs, and the most effective use of available personnel.
The first section presents ideas and guidelines for planning
patient core in any setting — hospital, clinic, or doctor's
office. Examples of care plans, using a variety of patients,
are included to demonstrate the dynamics of the planning
process. The balance of the book introduces the concept of
planned nursing care as an ongoing process, including
development of nursing care plan tools, activating and
teaching the care plan system, and the rationale for sys-
tematized planning as a means of providing optimal
patient core.
Educators will find this text extremely useful throughout the
curriculum — in fundamentals of nursing where orientation to
objectives is stressed; for team nursing seminars; in all
clinical areas; and for senior courses in principles of
administration, supervision and leadership.
Graduates will find concrete suggestions for overall improve-
ment of patient care predicated upon a realistic approach
to today's problems.
Lippincott
J.B. LIPPINCOTT COMPANY OF CANADA, LTD./60 Front Street West/Toronfo 1, Ontario
2 THE CANADIAN NURSE SEPTEMBER 196i1
The
Canadian
Nurse
^
^^p
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 9
September 1%9
29 Inservice For Teachers, Too? S. Post
31 Nursing Associations — Are They Coming Or Going? G. Zilm
36 Peruvian Adventure D. Daveluy
38 Family Health Service: The PHN
and the GP P.E. Jones and D.M. Bondy
41 Helping The Patient Face Reality G.A. Arnold
43 It's Depressing C.G. Costello
46 Idea Exchange
48 Come With Me, Lori L.E. Warwick and J. Wilting
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
9 News
17 Names
20 Dates
22 New Products
26 In a Capsule
50 Research Abstracts
54 Books
60 Accession List
80 Index to Advertisers
Executive Director: Helen K. MussaUem •
Editor: Virginia A. Lindaburv • Assistant
Editor: Eleanor B. Mitcliell • Editorial Assist-
ant: Carol A. Kotlarsky • Circulation Man-
ager: Beryl Darling • Advertising Manager:
Rath H. Bamnel • Subscription Rates: Can-
ada: One Year, $4.50; two years, $8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Six weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
(S> Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in india ink on white paper)
are welcomed with such articles. The editor
is not committed to publish all articles
sent, nor to indicate definite dates of
publication.
Postage paid in cash at third class rate
MONTREAL, P.O. Permit No. 10,001.
50 The Driveway, Ottawa 4, Ontario.
SEPTEMBER 1%9
We're not wagging our editorial
fingers at anyone this month. For one
thing, it's summer as we write this and —
well, you know the feeling one gets two
days before vacation. Beside - and more
to the point - those non-wagging fingers
have poison ivy on them. Yes,
POISON IVY.
Now we know, dear readers, that there
are those among you who undoubtedly
will say "It serves those fingers
right! They deserve to suffer from this
type of Rhus dermatitis. Long may they
itch! " Others, of course, will "tut tut" in
sympathy - or empathy, as you will —
recalling with less than nostalgia their
own experiences with this three-leafed
monster. Still others will ask, "How could
anyone be so stupid . . .? "
Well, it was like this. We (not the
entire staff, just the "editorial we")
recently tip-toed through a juicy patch of
this vermin of the plant kingdom,
assuming that we were immune. How
the malady got from bottom digits to
top digits is anyone's guess.
Believing in the theory that one should
make the best of a bad "learning
experience," we did a little research on
the subject, which we hereby present for
your future safety. Now research is
difficult at the best of times. But when
one is forced to rely on only the
unaffected parts of one's body - namely
the eyes - it can be extremely
frustrating. So we know you will overlook
any overgeneralizations in our conclusion.
First - and get this poison ivy
isn't really poison ivy at all. It's Toxico-
dendron radicans. Had we known that,
we'd have given it a much wider berth.
Second, 77? grows in every province
but Newfoundland. The Newfies
probably shooed it off to the mainland
by spraying it with Screech.
Third, only 10 percent of persons
who have had this disease retain their
immunity to it. (It's a blow to one's
pride to know that one belongs with 90
percent of the population).
Fourth, and last, the treatment for
relief of the discomfort is the same today
as it was 30 years ago: good old Calamine
lotion.
Well, as the boys in the backwoods
say, "Leaves three - let it be."
V.A.I.
THE CANADIAN NURSE 3
letters
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Lobbyist needed
1 was very pleased and excited to read
the editorial "Needed: A Full-Time
Lobbyist" (July, 1969). 1 endorse your
proposal wholeheartedly.
We have witnessed tremendous chan-
ges and advances in many areas of nursing
in recent years, but in other areas nursing
has barely progressed beyond the early
evolutionary stages.
Government relations officers must
and will become a reality. The question
is, when?
I would be grateful to receive any
further information on this matter, in-
cluding preparation, qualifications and
requirements of such a lobbyist should
the position ever be created. - Margaret
Becker, Reg. N., B.N.Sc:
I would like to express my support for
the idea of the Canadian Nurses' Associa-
tion having a lobbyist as a bridge between
the association and the federal govern-
ment.
We do not generally hear about or
from nurses in public reports, unless it is
pertaining to extraordinary events such as
a strike. What do the nurses working in
public health among the Indians feel
about new legislation concerning the
future of the Indians? Are their views
expressed to the committees dealing with
the subject? What do nurses feel about
the legislation that still allows lashing of
prisoners in our jails? Laws such as these
are as outdated as the hedonistic philoso-
phy of the 18th century on which they
are based.
I think nurses should be heard on
subjects like these. Our concept of health
must be broad and include social as well
as physical, mental, and emotional inter-
pretations. A lobbyist should let nurses'
concerns be known to the legislators. If
such a position is to be created, my
application will probably be in the
mail. ~ Dorothy Fulford, Ottawa, Ont.
I felt you might be interested in our
response to your mini-editorial in the
July issue of The Canadian Nurse. We
were contacted by radio station CFNB,
Fredericton, and I made the following
statement on behalf of the New Bruns-
wick Association of Registered Nurses.
"We would agree with the editor of
The Canadian Nurse that there is a need
for improved communication with gov-
ernment, both national and provincial.
We believe that if there were a "govern-
4 THE CANADIAN NURSE
ment relations representative" nationally,
a desirable result would be a better
informed public. There is a need for a
greater understanding of the services
given by the actively employed Canadian
nurses.
"All too often studies are done or
boards set up to study some aspect of
health care in Canada or one of our
provinces, and nursing is not involved.
"We believe the recipient of health
care is interested in the standards of care
which is to be offered to him, but
communication with government at na-
tional level would benefit government,
the Canadian nurses, and most important
each Canadian citizen." - M. Jean An-
derson, B.S.R.N., Executive Secretary,
NBARN.
In your editorial "Needed: a full-time
lobbyist" you point out that the nursing
profession is the largest health profession
in Canada, and it is therefore extremely
important that it be heard by government
on matters concerning nurses, nursing,
and health. A substantial budgetary allo-
cation is now made toward health pro-
grams and services, and will likely con-
tinue to be made no matter what political
party holds the power in Ottawa. As
citizens, and as health professionals,
nurses ought to help insure that political
decisions on health-related matters are
based upon information that is as accu-
rate and as complete as possible.
A professional nursing association has
a responsibility to serve the public in-
terest with respect to nursing and matters
related to nursing. Surely the Canadian
Nurses' Association can only fulfill this
responsibility if it makes available to
government a tuned ear and an informed
voice to identify matters of concern to
nurses, and to provide to both govern-
ment and opposition party members the
data regarding health care, health needs
and health resources that only nurses can
provide. The tuned ear and the informed
voice logically must belong to a profes-
sional nurse who fulfills the role of
lobbyist or government relations re-
presentative. Dorothy J. Kergin, Reg.
N., Ph.D., associate professor. School of
Nursing, McMaster University, .Hamilton.
Two-year program
In reply to the letters (May, June,
1969) regarding the article "Two-Year
Versus Three-Year Programs" (February,
1969), the faculty of the Grey Nuns'
School of Nursing wish to indicate that
we see merit in speaking with each other
through The Canadian Nurse. Con-
troversy is often an indication of profes-
sional growth, and on this basis we wish
to utter our concerns about the concerns
of the writers of these letters.
What do you, as researchers, consider
an adequate theoretical rationale for re-
view of literature?
Ratings of the two independent raters
were consistent over a three-year period.
The ratings of the two independent raters
were not equivalent.
Regarding the design of the study
having limitations, we wondered why you
did not mention the obvious point that
the two groups of students followed a
revised curriculum, and that the con-
clusions might well have been different
had the control group come from another
school of nursing following a three-year,
service-oriented program taught by dif-
ferent teachers. At no point was the
statement of "superiority" of one group
over another made.
That readers might have interpreted
that the performance of the three-year
students was significantly better than that
of the two-year students would be an
inference, as the summary statement
made was that the control students per-
formed generally better than the two-year
students. We would anticipate that you.
as researchers, would avoid the pitfall of
making inferences or jumping to con-
clusions.
Since this study was done, the Grey
Nuns' School of Nursing has improved
the two-year program, phased out the
three-year program, and will soon move
into a multi-disciplinary post-secondary
educational institution. Faculty, Grey
Nuns' School of Nursing, Regina, Sask.
New Brunswick resignations
I am concerned about the mass resig-
nation of registered nurses employed by
public hospitals in New Brunswick. The
resignation becomes effective August 15,
1969, after three years of negotiations.
First, these nurses are making great
personal sacrifices. They will be without
pay and will face difficulty in financing a
move and obtaining employment else-
where. They have volunteered their serv-
ices for emergency care, but they must
take a stand to protect their profession
and the patient, whom they serve.
Second, in some provinces, because of
(Continued on page 6)
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6 THE CANADIAN NURSE
(Continued from page 4)
existing labor laws, mass resignation is the
final recourse nurses can use to improve
their working conditions. The provincial
associations representing registered nurses
often cannot act on behalf of their
members, resulting in many groups acting
on their own behalf with their employing
agency.
What can nurses who are genuinely
committed to nursing do about poor
working conditions, such as staff short-
ages, that threaten the safety of the
patient, and exhaust and frustrate staff?
Some employing agencies have allowed
nurses' organizations within the agency to
discuss working conditions, salaries, etc.
But many will not.
If a recurrence of this situation is to be
prevented, improved communication, un-
derstanding, and a review of existing
labor laws are not only essential, but
overdue! — Donna Roe, Ottawa, Onta-
rio.
Diploma versus degree
The many fine articles in The Cana-
dian Nurse are commendable. However, I
question some of the proposals made by
the university educated leaders.
Why should the new graduate of a
university program receive $1,440 per
year more than a new graduate from a
diploma program? Is the university de-
gree being used as a status goal?
Is the phasing out of programs for
psychiatric nurses and nursing assistants
not being proposed too soon? I cannot
foresee the replacement of these valuable
assistants by registered nurses or universi-
ty graduates.
Two categories of nurses have been
proposed: the university graduate and the
registered nurse technician. Who will
teach techniques? The university grad-
uate has knowledge of theory, but is she
proficient in the nursing arts?
Statistically speaking, university
educated nurses are in a small minority,
particularly those with advanced theoreti-
cal and practical knowledge. Is it not time
to reassess the problem?
There is a human element involved
too. The desires of the few should not be
achieved by overlooking the needs of the
many nurses who have struggled over the
years against impossible barriers.
The nursing profession is showing the
aspects of pride and prejudice originally
reserved for the medical elite. Progress is
fine, but let us not replace the doctor
who considers the nurse his handmaiden
by university educated nurses with similar
delusions of grandeur. - Rita Carroll,
R.N., MaxvUIe, Ont. D
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news
CNF Announces
Scholarship Winners
Ottawa, - The Canadian Nurses'
Foundation has awarded 544,000 to
17 Canadian nurses to pursue graduate
studies in the 1969-70 academic year.
Helen P. Glass of Winnipeg. Mani-
toba, assistant professor University of
Manitoba School of Nursing since
1962, has been awarded the Dr. Kathe-
rine E. MacLaggan Fellowship of
S4,000 to continue her study for a
Doctor of Education degree at Teach-
ers College, Columbia University, New
York.
The 16 CNF awards to candidates
for masters' degrees range from SI ,300
to S3,000. The recipients, selected for
their leadership potential as well as
scholastic ability are:
• Mrs. Anita Cabelli of Montreal, Que-
bec, a fellowship to study for a Master
of Science (A) degree in Nursing at
McGill University, Montreal.
• Mrs. Teresa M. A. Davis of Edmon-
ton, Alberta, a fellowship to study for
a Master of Education degree at the
University of Alberta.
• Miss Frances Howard of Saint John,
New Brunswick, former nursing service
consultant, Canadian Nurses' Associa-
tion, a fellowship to study for a
master's degree in nursing service ad-
ministration at the University of West-
em Ontario, London, Ontario.
• Miss Hisako Rose Imai of Pierre-
fonds Quebec, a fellowship to study
for a Master of Public Health degree at
Johns Hopkins University, Baltimore,
Maryland.
• Miss June Fumiko Kikuchi of Toron-
to, Ontario, a fellowship to study for a
Master of Nursing Education degree at
Federal Government
Contribution To ICN Congress
The federal government informed
the Canadian Nurses' Association in
May, 1969, that it would contribute
$25,000 toward the costs of the Inter-
national Council of Nurses' 14th
Quadrennial Congress held in June.
This amount was allocated "... to
assist with the translation service so as
to permit Canadian nurses to benefit
from all the presentations at the Con-
gress.'
This information was received by
The Canadian Nurse early in June, but
was inadvertently omitted. The editor
regrets this omission.
the University of Pittsburgh, Pitts-
burgh Pennsylvania.
• Mile Rita J. M. Lussier of Lafleche,
Quebec, a fellowship to study for a
Master of Science degree in Nursing at
Boston University, Boston, Massa-
chusetts.
• Miss Kathleen R. Miller of Victoria,
British Columbia, a fellowship to
study for a Master of Science degree in
Nursing at Yale University, New Haven,
Connecticut.
• Miss T. Rose Murakami of Salt
Spring Island, British Columbia, a
fellowship to study for a Master of
Science (A) degree in Nursing at
McGill University, Montreal.
• Mrs. Margaret L. Mrazek of Ed-
monton, Alberta, a fellowship to study
for a master's degree in health service
administration.
• Miss Diana D. Pechiulis of Calgary,
Alberta, a fellowship to study for a
master's degree in nursing service ad-
ministration or supervision at the Uni-
versity of Colorado, Denver, Colorado.
• Mr. Ronald S. Reighley of Red Deer
Alberta, a fellowship to study, for a
Master of Science (A) degree in Nurs-
ing at McGill University, Montreal.
• Miss Marilyn S. Riley of Windsor,
Nova Scotia, a fellowship to study for
a Master of Science in Nursing degree
at the University of Western Ontario,
London, Ontario.
• Miss Judith A. Ritchie of Saint John,
New Brunswick, a fellowship to study
for a Master of Nursing degree at the
University of Pittsburgh, Pittsburgh,
Pennsylvania.
• Miss Sheila M. Ryan of Edmonton
Alberta, a fellowship to study for a
master's degree in health service ad-
ministration at the University of Al-
berta. Edmonton, Alberta.
• Miss Julia E. Shannon of Vancouver,
British Columbia, a fellowship to
study for a Master of Science degree in
Nursing at the University of Michigan,
Ann Arbor Michigan.
• Mrs. Ethel M. Smith of Vancouver,
British Columbia, has been awarded
the W.B. Saunders Company Canada
Fellowship and a CNF fellowship to
study for a Master of Science in
nursing degree at the University of
British Columbia, Vancouver, British
Columbia.
Health Manpower Conference
To Be Held In Ottawa
Ottawa. - Some 200 representatives
Presence
The history of Canadian nursing was
given some extra publicity in June when
Presence, the French edition of the
Canadian Nurses' Association's The Leaf
and the Lamp, was published. Shown
here by Agathe Legault, assistant editor
of L'infirmiere canadienne, the book
was translated by Madeleine Wermenlin-
ger-DeRopero, and is available for $3.00
on request from CNA, 50 The Drive-
way, Ottawa, Ontario.
SEPTEMBER 1%9
of the health and health-related profes-
sions will meet in Ottawa October 7 to 10
at a national health manpower conferen-
ce.
The conference will be sponsored join-
tly by the Department of National Health
and Welfare and the Association of Uni-
versities and Colleges of Canada. It will
bring together persons familiar with the
problems that exist in the health services
field to formulate suggestions for a pro-
gram to improve the human resources of
Canada in the health and health related
fields. Papers will be presented on several
topics, including society's health expec-
tations, planning and delivery of com-
prehensive health services, and education-
al trends and objectives. Panel discussions
will be held throughout the four-day
conference, and during two days partici-
pants will discuss specific topics in dis-
THE CANADIAN NURSE 9
news
cussion groups of smaller numbers.
Conference planners hope agreement
can be reached on guidelines for: plan-
ning the delivery of total health services
during the next decade; determining the
numbers and quality of health manpower
required for these services; and planning
the education of the required manpower.
"This National Health Manpower Con-
ference will be the first of its kind to be
held in Canada," the Honorable John
Munro, minister of national health and
welfare, explained. "We hope that this
conference will aid in the attainment of
the goal of equality in health care for all
Canadians."
Co-chairmen of the conference are
Jacques Gelinas, deputy minister of
health for the province of Quebec, and
Professor L.-P. Bonneau, vice rector of
Laval University. Speakers include Mr.
Munro; J.F. McCreary, dean of medicine
at the University of British Columbia;
Warren J. Perry, dean of the school of
health related professions at the State
University of New York; and others from
various related professions.
Among the 12 panelists is Lois Gra-
ham-Cumming, director of research and
advisory services for the Canadian Nurses'
Association. CNA was among seven pro-
fessional associations invited to partici-
pate in the conference.
ANPQ To Study
Nursing Profession In Quebec
Montreal, P.Q. - Madeleine Jal-
bert, president of the Association of
Nurses of the Province of Quebec,
recently announced that the ANPQ is
conducting a study to evaluate the
nursing profession in the province.
Miss J albert told L'infirmiere cana-
dienne some of the reasons why the
study was undertaken. "We have
noticed that nurses are not involved in
their professional association," she
said, "and as a result chapter meetings
are often a failure. Secondly, nursing
must function within a rapidly chang-
ing society and we must adapt to meet
new needs," she said.
To meet these needs the ANPQ has
formed an ad hoc committee to
conduct an opinion poll among nurses
in Quebec. Moyra Allen, associate
professor. School for Graduate Nurses,
McGill University, and Jacqueline Ga-
gnon-Audet, a member of the advisory
committee of ANPQ, have been ap-
pointed to this ad hoc committee and
will submit their report in 1970. Ques-
tionnaires have been distributed to
ANPQ districts, to the general and
vocational colleges, and to several
individual nurses in Quebec.
10 THE CANADIAN NURSE
The Hellenic Nurses' Association presented the bust of Hygeia to the Canadian
Nurses' Association during the Congress of the International Council of Nurses in
Montreal in June. Dr. Helen K. Mussallem (right), executive director of CNA,
accepted the gift on behalf of the Association. The original Hygeia is housed in the
Archeological Museum in Athens.
The ANPQ has also obtained the
services of "Cadres Professionnels In-
corpores," a firm of consultants, to
conduct a scientific study of the asso-
ciation's problems and to make an
objective evaluation. From a sample
population of nurses, the consultants
- economists, psychologists, and
sociologists - will survey their activi-
ties to determine, among other things,
the image and role of the nurse in
relation to the profession, the ad-
ministrative structure of the hospital,
and the public. Groups outside the
nursing profession will be approached
to determine how they view the role
of the nurse as compared to other
professionals.
Miss J albert said that the main
purpose of a professional association is
to establish good relationships among
nurses and between nurses and the
public. She said that the association
has an obligation to protect the public
by maintaining high educational stand-
ards for nurses and nursing service. To
meet this obligation, good public rela-
tions and communication within the
profession are needed, she said.
New Brunswick Nurses
Withdraw Resignations
Frederic ton, N.B. - One thousand
four hundred New Brunswick hospital
nurses have withdrawn their resignations.
They had threatened to leave their jobs
August 15 because of a contract dispute.
Negotiations between the New Bruns-
wick Association of Registered Nurses
and the New Brunswick Hospital Associa-
tion resumed July 24 after the NBHA
president approached the NBARN presi-
dent for a "communications meeting."
"NBHA conceded to all our demands
regarding procedure," said Marilyn
Brewer, spokesman for the nurses.
Among other things the NBHA has agreed
to establish a committee to meet with the
nurses, she explained. Previous negotia-
tions had been unsuccessful because of
constant changes in management repre-
sentatives.
"If negotiations break down, both
parties shall apply to the minister of
labour to appoint a conciliation officer. If
for any reason the above step does not
resolve the deadlock, a three-member
board of mediation will be established."
(Continued on page 13)
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THE CANADIAN NURSE 11
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news
(Continued from page 10)
Mrs. Brewer explained that the minister
of health has guaranteed the cooperation
of the minister of labour in this matter.
The NBHA also guaranteed that those
nurses who submitted resignations would
not be subject to any reprisals, Mrs.
Brewer said.
Mrs. Brewer also said that the staff
association presidents would meet at
NBARN headquarters on August 12 to
discuss the proposals of the new contract.
At press time no information on contract
terms was available.
Canadian Neuro Nurses
Form Association
Montreal, P.Q. A desire to improve
communications among specialist nurses
and to share and increase knowledge has
prompted more than 40 nurses to organ-
ize a Canadian Association of Neurologi-
cal and Neurosurgical Nurses. The organ-
izational meeting was held at the Chateau
Champlain hotel in Montreal on June 20.
Annual meetings will be arranged to
coincide with the Canadian Congress of
Neurological Sciences, an organization of
physicians in that field. The nurses will
meet at the same time and place.
Any nurse interested in neurological or
neurosurgical nursing who wishes to join
the nurses' association is invited to con-
tact a member of the executive for more
information.
Elected to the executive were: Jessie
Young, Toronto General Hospital, chair-
man; Anne Carney, Montreal Neurologi-
cal Hospital, vice-chairman; Olga Thies-
sen, University of Alberta Hospital,
secretary-treasurer; and Paula Hopkins,
Calgary Foothills Hospital, membership
chairman.
Trends Reversing
In Nursing Education
Ottawa. - 1968 was a year for chan-
ges in nursing education programs in
Canada. "For the first time no students
entered non-integrated basic baccalaurea-
te degree programs," said Lois Graham-
Cumming, director of research and ad-
visory services for the Canadian Nurses'
Association.
Baccalaureate degree programs that
prepare students to qualify as registered
nurses may be either integrated or non-
integrated. In 1963,221 students entered
integrated programs that are organized
and controlled in the same way 3s other
units in the university; and 269 entered
non-integrated programs, part of which
are conducted outside the control of the
degree-granting institutions. In 1965 the
trend reversed - 340 students entered
SEPTEMBER 1%9
integrated, and 226, non-integrated pro-
grams. All admissions were to the inte-
grated basic degree programs in 1968.
The officers and executive committee
of CNA in 1965 endorsed the concept of
an integrated degree program in response
to recommendation 131 of the Royal
Commission on Health Services (Hall Re-
port).
Two types of postbasic baccalaureate
programs in nursing are available to
nurses who are graduates of diploma
schools of nursing. One offers a major in
a clinical area such as psychiatry, or a
functional area such as administration;
the other (general) type does not include
a specialization within the nursing pro-
gram. Five students graduated from the
general postbasic program in 1963, and
178 graduated in 1968. Although the
numbers have increased in the general
program, three-quarters of all postbasic
degree graduates in 1968 had a major.
From 1963 to 1967, more students
completed a one-year diploma/certificate
program than graduated with a postbasic
baccalaureate degree. In 1968, however,
the trend reversed and 60 percent of the
students graduated with degrees.
(Continued on page 14)
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THE CANADIAN NURSE 13
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14 THE CANADIAN NURSE
news
Ontario Supreme Court To Settle
Terms Of Nurses' Contract
Toronto, Ont. - For the first time,
the Registered Nurses' Association of
Ontario and a nurses' association have
taken a contract issue to court.
The RNAO Newsette reports that on
December 17, 1968, an arbitration board
made an award to settle contract terms
between the Nurses' Association of St.
Joseph's General Hospital, Peterborough,
and their employer, retroactive to Janua-
ry 1, 1968.
On January 23, 1969, the arbitration
board interpreted its own earlier decision
as applying only to nurses who were
employed at the hospital at the time the
agreement took effect. Assisted by
RNAO's employment relations depart-
ment and legal counsel, the nurses' asso-
ciation appeared before Ontario Supreme
Court Judge J.H. Osier, claiming that the
arbitration board had exceeded its juris-
diction in issuing a second order purport-
ing to interpret its own previous award.
Pay retroactive to January 1, 1968
ought to apply to all nurses who worked
on the hospital staff during 1968, the
report continued. The amount involved is
about $6,000 for 17 nurses who left the
hospital staff during the year. N.B.: Word
received at press time that Court ruled in
favor of nurses and awarded costs to the
nurses ' association
College of Nurses
To Close Waiver Clause
Toronto, Ont. - For the past two
years, state registered general nurses from
the United Kingdom and Eire, have been
allowed to write the Ontario registration
examination in pediatric and/or obstetric
nursing without preparation in the par-
ticular area of nursing. Effective Septem-
ber 30, 1969, this practice will cease.
The director of the College of Nurses
of Ontario, Joan C. Macdonald, explained
this change in policy to The Canadian
Nurse.
A waiver policy was established for a
two-year period, which allowed nurses
from the United Kingdom and Eire, who
had not had courses in pediatric or
obstetric nursing to write the registration
examinations in these subjects. If they
passed these examinations, they were
registered in Ontario. Although this po-
licy made supplemental courses no longer
mandatory for admission to the two
examinations, it did not negate the provi-
sion of courses for those who wished to
take courses before writing the examina-
tions.
The special conditions were set up to
give an opportunity for registration to ai
SEPTEMBER 1%9
group of nurses who had come to Ontario
and who were employed as graduate
non-registered nurses.
The decision of the Council of the
College is to close the waiver and to apply
the policy which was applicable prior to
the waiver. That policy was to require
supplemental courses in obstetric and/or
pediatric nursing to make up for deficien-
cies in the applicant's preparation to meet
regulations in Ontario legislation.
Nurses from the United Kingdom and
Eire who apply for registration without
preparation in obstetric and/or pediatric
nursing will be advised by the College of
the kind and amount of supplemental
preparation required. Miss Macdonald
said that it would be advisable for these
nurses to determine their eligibility
before coming to Ontario. "If short-term
preparation in either or both of these
areas of nursing is available to them at
home, it would be wise to obtain this
preparation in advance," she said.
Miss Macdonald said that all nurses in
Ontario will be required to meet the same
requirements for registration and be sub-
ject to College discipline.
Alberfa Nurses
Accept New Contract
Edmonton, Alta. - A conciliation
board award in the dispute between
the Alberta Association of Registered
Nurses and the Alberta Hospital Asso-
ciation on behalf of 2,500 nurses
working in 28 hospitals in the province
was accepted in May. The AARN
Newsletter also reported the new
contract provides a 20.9 percent in-
crease in salary over two years. Retro-
active to January 1, 1969, registered
nurses in the province received S440
per month. Effective September 1,
1969 salaries increased to $465 per
month. On May 1, 1970 nurses will
receive S490 per month.
The agreement also provides an
educational allowance of $25 per
month for a university diploma, $60
for a baccalaureate, and $100 for a
master's degree. After four years con-
tinuous service, nurses will have 20
working days vacation.
Summer Workshop
For Nurse-Teachers
Charlottetown, F.t.L - Thirty-two
teachers from three hospital schools of
nursing attended a three-day workshop
here, August 6-8. Shirley R. Good, con-
sultant in higher education, the Canadian
Nurses' Association, conducted the ses-
sions at the request of the Association of
Nurses of Prince Edward Island.
Workshops were planned to assist the
teachers as they prepared to change from
a three-year to a "two plus one" curricu-
lum. The three existing hospital schools
are phasing out, and will be replaced
SEPTEMBER 1%9
START
USING NEW STERILE/DISPOSABLE
TEXTURED SURGICAL SCRUB SPONGE
FROM DAVIS & GECK
Now contains
HEXACHLOROPHENE
or
lODOPHOR
CYANAMID OF CANADA LIMITED, Montreal
THE CANADIAN NURSE 15
news
shortly by one diploma school.
"Effective teaching requires a
thorough knowledge of content," Dr.
Good said. "Then you need a plan to
direct the level of knowledge, skills, and
attitudes you hope the students will
achieve," she continued. Dr. Good de-
monstrated several teaching methods
during discussions on the development of
philosophy, objectives, learning theories,
criteria for effective teaching, and
content guidelines. She suggested the
teachers try various teaching methods,
but cautioned that there must be content
to make any teaching method exciting.
During the workshops, the teachers
worked in small interest groups and deve-
loped a plan for philosophy, objectives,
and learning experiences.
Summer Camp Holiday
For Douglas Hospital Patients
Verdun, P.Q. — Fifty long-term pa-
tients from the Douglas Hospital left
August 6 for a summer camp in the
Laurentians. They were accompanied by
11 staff members. Another 100 patients
went later as part of a rehabilitation
Just Press the Clip and It's Sealed
it takes but a moment to identify your pa-
tient, positively and permanently, with
Ident-A-Band. Then just a glance is all you'll
need to be sure that this is the right patient.
Ident-JK-Band
Write today for free
samples and literature.
16 THE CANADIAN NURSE
fj-IoLLisrei^
160 BAY ST.. TORONTO
program to help them learn how to use
leisure time.
Dr. Henry B. Durost, executive direc-
tor at the hospital, said the unusual
project recognized that inability to use
leisure time constructively is a source of
emotional stress. Last year a few long-
term patients were sent to camp as an
experiment, and they responded so well
to the change that the hospital now hopes
to have a permanent camping program.
David Taube, recreational therapist
and director of the camp, said boating,
hiking, swimming, and overnight trips
with campfire cooking were among the
activities arranged for the patients.
A day camp on the hospital grounds is
provided for young patients of the child-
ren's services. Some children are sent
away to regular camps each year by
community organizations.
"Canadian Hospital" Attacks
New Postal Rates
Toronto, Ont. - "Canadian Hospital
like many sister publications in the health
field and other professional journals, is
being forced to subsidize commercial
profit-making publishing firms through an
arbitrary ruling by the Post Office De-
partment," says an editorial in the June
issue of Canadian Hospital, the publica-
tion of the Canadian Hospital Associa-
tion.
The editorial, signed by Dr. B.L.P.
Brosseau, executive director of the CHA,
accuses the department of favoring publi-
cations of commercial firms over publica-
tions of organizations "responsible to the
profession they represent."
The editorial was protesting the in-
creased postal rates that have affected
most organizational journals in Canada,
while leaving profit-making publications
at lower postal rates. The Canadian
Nurses' Association has faced an increase
from S750 per month to $11,000 per
month for The Canadian Nurse and L 'In-
firmiere canadienne,
"Prior to rulings by the Post Office
Department," the editorial continued,
"we understand that the giant publication
monopolies of MacLean-Hunter and
Southam Business PubHcations approach-
ed many of the successful organization
publications in an effort to take over
these magazines."
The editorial also argued that the CHA
was not an organization "in the truest
sense," because it did not represent a
single profession but "a total of 18
organizations." Therefore, it continued, it
would not faU under the definition used
to make the ruling forcing it to pay
increased rates.
"We have no quarrel with increased
postal rates because we do not expect to
be subsidized at the expense of the
public. But we want the government to
play fair ball," it concluded. D
SEPTEMBER 1%9
names
Frances M. Howard
(R.N., Saint John
General Hospital,
Saint John, N.B.;
post-graduate course
in obstetrics, Boston
Lying-in Hospital,
Boston, Mass.; certi-
ficate in nursing edu-
cation, U. of Toron-
to; B.N.. School for Graduate Nurses,
McGill U.) left the staff of the Canadian
Nurses' Association in August. She will
continue studies toward a master's degree
in nursing service administration at the
University of Western Ontario in London.
As CNA consultant in nursing service
since 1963, Miss Howard traveled across
the country to direct regional workshops
in problem solving for hospital directors
of nursing service, and acted as CNA
consultant to the association's standing
committee on nursing service and the ad
hoc committee on standards for nursing
service.
Before she joined CNA staff in 1958,
Miss Howard had worked as obstetrical
supervisor and instructor at the General
Hospital in Port Arthur, Ontario; nursing
arts instructor at the Oshawa General
Hospital, Oshawa, Ontario; assistant
supervisor of the delivery room at Boston
Lying-in Hospital; and had done general
duty nursing at the Saint John General
Hospital, Saint John, New Brunswick.
Miss Howard was recently awarded the
St. John Ambulance SI, 000 Margaret
MacLaren bursary for graduate study. She
has also received a SI, 000 bursary from
the Ontario Red Cross Society, and a
Canadian Nurses' Foundation fellowship
for her master's studies.
Helen T. Stevenson
(R.N., School of
Nursing, Johns
Hopkins Hospital,
Baltimore, Md.;
B.SC.N., U. of Utah,
Salt Lake City,
Utah; M.N., U. of
Washington, Seattle,
Wash.) has been ap-
pointed director of the School of Diplo-
ma Nursing, Saskatchewan Institute of
Applied Arts and Sciences, Saskatoon.
Mrs. Stevenson has held a variety of
positions in nursing service and nursing
education. She was teacher and coordina-
tor of a diploma nursing program at Holy
Cross Hospital, Salt Lake City, Utah, and
SEPTEMBER 1%9
was an instructor and assistant professor
at the College of Nursing, Brigham Young
University, Provo, Utah. She has also
worked as a public health nursing super-
visor with the Seattle-King County Health
Department, Washington.
There was much excitement among
the staff of The Canadian Nurse when the
news was received from Carleton Univer-
sity in Ottawa that Glennis N. Zilm,
former assistant editor of this journal,
had been awarded the university medal in
journalism. This means she has the high-
est standing of all the students graduating
in journalism this year.
Miss Zilm left The Canadian Nurse in
January to complete her final year at
Carleton. She had been assistant editor
since October 1 964.
Her colleagues at the Canadian Nurses'
Association had the opportunity of work-
ing with her again in June, when she
rejoined the staff temporarily as part of
CNA's public relations team at the ICN
Congress. Shortly afterward she left for
Edmonton, Alberta, and a position with
The Canadian Press.
Lucille C. Peszat
(Reg.N., St. Joseph's
School of Nursing,
Chatham, Ont.;
B.Sc.N., U. Western
Ontario; M.Ed., Ont.
Institute for Studies
in Education, U. of
Toronto) has been
appointed coordina-
tor of formal continuing education pro-
grams. Registered Nurses' Association of
Ontario.
Miss Peszat was formerly a curriculum
consultant with the Quo Vadis School of
Nursing in Toronto. She has held posi-
tions as lecturer at the University of
Ottawa; nursing adviser in the External
Aid Department to the government of
Trinidad and Tobago; hospital careers
consultant for the Ontario Hospital Asso-
ciation; and instructor at St. Joseph's
Hospital School of Nursing, Chatham,
Ont.
Margaret E. Harper (Reg.N., Guelph
General H.; clinical supervision, U. of
Toronto) has been appointed assistant
director of nursing. Peel Memorial Hospi-
tal, Brampton, Ont.
Miss Harper was formerly director of
inservice education at the same hospital.
Nicole Dion
(R.N., Oldchurch H.,
Romford, Essex, En-
gland; dipl. nurs.
admin., U. of Mont-
real) has been ap-
pointed executive
coordinator, United
Nurses of Montreal.
Miss Dion has
held the positions of staff nurse, head
nurse, and nursing supervisor at The
Montreal General Hospital.
The nursing consult-
ant in highereduca-
tion for the Cana-
dian Nurses' Associa-
tion leaves CNA
House in August for
Calgary. Shirley R.
Good, (Reg.N.. Wo-
men's College Hospi-
tal, Toronto; Certifi-
cate. Clinical Supervision, Medical-Sur-
gical Nursing, U. of Toronto; B.S.N. ,
M.Ed., Drury College, Springfield, Mo.;
Ed.D., Teachers College, Columbia U.)
has been appointed the first director of
the school of nursing at the University of
Calgary.
In her position at CNA for the past
two years. Dr. Good visited universities
across the country, providing consulta-
tion services for the establishment of new
schools of nursing and the improvement
of existing baccalaureate and master's
programs. She also advised individuals on
matters of university education for nurses
in Canada.
Dr. Good has conducted numerous
nursing studies, submitted briefs to the
government, and has written articles for
Canadian and International journals.
In 1964 and 1965 she was awarded the
Canadian Nurses" Foundation fellowship
for doctoral study.
Dr. Good has held varied nursing
positions at New Mount Sinai Hospital,
Toronto; Lady Dunn Hospital, Wawa,
Ontario; Women's College Hospital, To-
ronto; School of Nursing, Toledo Hospi-
tal, Toledo. Ohio; Springfield Baptist
Hospital. Springfield, Mo.; and the school
of nursing. University of Western Ontario,
where she was an assistant professor,
lecturing in nursing service administra-
tion.
As director of the University of Calga-
ry's school of nursing. Dr. Good plans to
"educate practitioners of nursing who
THE CANADIAN NURSE 17
names
(Continued from page 17)
will give leadership in the delivery of
patient care." She is strongly opposed to
including administration or teaching
majors at the baccalaureate level and
would like to see a bachelor of nursing
degree conferred.
The first students will enter the school
in September 1970. Initially, the program
will be designed for high school grad-
uates, with plans for post-basic baccalau-
reate education in September 1972.
After 34 years of
service to the Toron-
to department of
public health, Eileen
Cryderman (Reg.N.,
Toronto Gen. H.,
Cert, in public
health nursing, U. of
Toronto; B.Sc,
Columbia U.) retired
as director of the division of public health
nursing.
Miss Cryderman left the TorontQ
General Hospital soon after graduation to
go to Kirkland Lake, nursing at the
Ontario Red Cross Outpost Hospital. She
then joined the Toronto department of
public health as a staff nurse, later be-
coming a district supervisor. After return-
ing to University, she joined the East
York-Leaside Health Unit, guiding the
unit until 1952. When she returned to the
Toronto department of public health as
assistant director of public health nursing.
She became director in 1954, remaining
in the position until her retirement during
the summer.
Replacing Miss
Cryderman as direc-
tor of the division of
public health nursing
for the Toronto de-
partment of health is
Myrna Slater
(B.Sc.N., U. of To-
ronto; M.Sc.N., U.
' of Minnesota).
Miss Slater, a primary school teacher
before entering nursing, joined the Toron-
to department of health in 1951 as a staff
nurse, later becoming assistant supervisor,
educational consultant, and assistant di-
rector. She is currently president of the
Ontario Public Health Association.
Kalhleen M. Clark (B.Sc.N., U. of To-
ronto) has been appointed an instructor,
University of British Columbia School of
Nursing.
Mrs. Clark was formerly an instructor
18 THE CANADIAN NURSE
at the Clarke Institute of Psychiatry,
Toronto. She was awarded the Ontario
Mental Health Association Scholarship
for the fourth year of the baccalaureate
program.
Virginia D. Leves-
que B.Sc.N., U. of
Santo Tomas,Manila,
P h i 1 i p i n e s ;
M.Sc.(A), McGill U.)
. ».. J has been appointed
W^ 4 director of nursing
jL-.'' ' w at Oromocto Public
^^ \ ^^ Hospital, Oromocto,
^™ -^^B New Brunswick.
Mrs. Levesque has worked as a super-
visor at Victoria Public Hospital in Fred-
ericton, N.B., a head nurse at the Jewish
General Hospital in Montreal, and a staff
nurse at Hamilton General Hospital.
Before coming to Canada, Mrs. Leves-
que worked for two years as part of an
exchange program in the intensive care
unit for open heart surgery at St. Mary's
Hospital, Rochester, Minnesota.
The Saskatchewan Registered Nurses'
Association has announced the retirement
of Grace Molta(R.N. Winnipeg Gen. H.;
dipl. in teaching and supervision, U. of
Toronto) after 13 years as registrar of
SRNA.
Miss Motta's experience includes gen-
eral and private duty nursing in Winnipeg,
a year as clinical instructor at the Winni-
peg General Hospital, and 13 years as
superintendent of nurses and director of
nursing at Moose Jaw Union Hospital,
Moose Jaw, Saskatchewan. She joined
SRNA as registrar in 1956, having served
as president from 1952 to 55. She was
acting executive secretary -treasurer twice:
1957-58, and 1966-67.
■*>
Replacing Miss Motta as registrar of
SRNA is Edna Dumas(R.N., Moose Jaw
Union H., Moose Jaw, Sask.; dipl. in
teaching and supervision, and B.Sc.N., U.
of Sask.). After nine years away from
nursing to raise her four children, Mrs.
Dumas joined the staff of the Saskatoon
Sanatorium. She moved to the Saskatoon
Geriatric Center for two years, then
became director of nursing education at
Saskatoon City Hospital. Two years later
she became associate director of nursing
service at the same hospital, then deputy
director of nursing service.
Sheila Mclver, (R.N., Grey Nuns' Hos-
pital, Regina) was awarded the Good
Citizenship award in Victoria, B.C., for
her work in geriatrics. The award was
given by the Native Sons of British
Columbia. Mrs. Mclver described part of
her work in the April, 1969 issue of The
Canadian Nurse.
The University of Ottawa has an-
nounced the appointment of three nurses
to the position of lecturer.
Basantl Bhaduri
(B.Sc.Nsg., College
of Nursing, New
Delhi, India; M.N.,
U. of Delhi; dipl. in
coronary care. Over-
look Hosp., Summit,
New Jersey) joined
the University July
I 14. Miss Bhaduri has
worked as head nurse and sister tutor in
India. From 1966 until last year she
worked as staff nurse, team leader, and
assistant to an instructor at Overlook
Hospital in Summit, New Jersey. For the
past year she has taught nursing at the
Ottawa General Hospital.
Marjorie Carroll
(R.N., Ottawa Civic
^U^ IM Hospital; B.Sc.N.
S »** ?QW ^'^•' ^- °^ Ottawa)
M '"^ worked at the Pro-
' "* vincial Hospital in
Campbellton, N.B.,
as head nurse and
psychiatric instruc-
tor for five years,
then spent two years as nursing tutor in
Emekuru, Nigeria. From 1967 to 1969
she was a clinical instructor at the Royal
Victoria Hospital in Montreal.
Purification Barron
(R.N., Hopital
St- Luc, Philippines;
dipl. in pediatric
nursing. Mount Sinai
Hosp., New York;
B.Sc.N., Columbia
U., New York; M.N.,
Philippines Women's
University) had 1 5
years of experience as a staff nurse and
instructor in the Philippines before
coming to North America in 1965. Mrs.
Barron spent two years as an instructor at
Lorrain School of Nursing in Pembroke,
Ontario, and another year at the Ottawa
General Hospital.
Dorothy Kannp
(R.N., St. Paul's
Hosp., Saskatoon;
dipl. in nsg. admin.,
B.Sc.N., U. of Wind-
sor) joined the Met-
ropolitan General
Hospital in Windsor,
Ont., as director of
nursing service in
May.
Mrs. Kamp's nursing experiences in-
clude five years as operating room super-
visor at the Union Hospital in Melfort,
Saskatchewan, and II years as general
duty and instructor for inservice educa-
tion at Metropolitan Hospital, Windsor. D
SEPTEMBER 1%9
••»'■.
Does Jane Cowell know the facts
about dandruff?
Probably not!
The facts are dandruff is a medical prob-
lem and requires medical treatment. Ordinary
shampoos cannot control dandruff.
New formula Selsun can!
The doctors you know are undoubtedly
familiar with Selsun. And they prescribe it
because it's medically recommended. And
proven effective in 9 out of 10 severe dan-
druff cases.
Our new formula Selsun is as effective as
the old. We use the same efficient anti-
seborrheic — selenium sulfide. We've simply
improved the carrier. A more active deter-
gent produces foamier lather — a finer
suspension gives smoother consistency.
To top off new formula Selsun we added
a fresh clean fragrance and put it in an at-
tractive unbreakable white plastic bottle.
If you know someone with a dandruff prob-
lem tell them to ask their doctor about
Selsun. And if dandruff worries you — ask
your own doctor.
selsun
(Sefenium Sulfide Detergent Suspension U.S.P.)
A PRODUCT OF ABBOTT LABORATORIES, LIMITED
nw nuMin producis
POSEY HEEL PROTECTOR
(Patent Pending)
The Posey Heel Protector serves to protect
the hee! of the foot and prevents irritation
from rubbing. Constructed of slick, pliable
plastic, lined with synthetic wool. Can be
washed or outocloved. No. HP-63ALW.
$3.90 ea. — $7.80 pr. (w/out plastic shell)
$5.25.
NO. 66
POSEY SAFETY
BELT
(Patent Pending)
&uckl« und«r ud
Okil of paiienU
This new
Posey Belt
provides safe-
ty to o bed
patient yet
permits him
to turn from side to
side. Also allows sitting
up. Made of strong, re-
inforced white cotton
webbing; with flannel-lined canvas reinforced
insert. Strap passes under bed after a turn
around spring roil to anchor. Friction-type
buckles. Buckle is under side of bed out of
patient's sight and reach. Also available
in Key-Lock model which attaches to each
side of bed. Small, medium and large
sizes. No. 66. $8.25. Key-Lock Belt. No.
K66, $1 3.95. No. 66-T. (ties on sides of
bed) $8.10.
POSEY SAFETY BELT
(Patented)
Allows maximum freedom with safe re-
straint. An improvement over sideboards,
the Posey belt is designed to be under the
patient and out of the way. Belt and bed
strop ore of heovy white cotton webbing;
loop and pod of cotton flannel. Friction-type,
rust-resistant buckles. Small, Medium ond
Large sizes. Safety Belt, No. S-141, $6.90.
(Extra heavy construction with key-lock
buckles. No. 453, $19.80)
POSEY PRODUCTS
Stocked in Canada
ENNS & GILMORE LIMITED
1033 Rangeview Road
Port Credit, Ontario, Canada
September 18-20, 1969
Annual conference on obstetrics, gyneco-
logic, and neonatal nursing, Sheraton-
Brock Hotel, Niagara Falls, Ontario.
Sponsored by District V of the American
College of Obstetricians and Gynecolo-
gists.
September 22-24, 1969
Annual Convention, Alberta Medical As-
sociation, Calgary, Alberta.
September 23-25, 1969
10th annual meeting and convention of
Associated Nursing Homes, Inc., Shera-
ton-Connaught Hotel, Hamilton, Ont.
September 24-27, 1969
Canadian Association for the Mentally
Retarded, National Planning Symposium,
Hotel London, London, Ont. For in-
formation write: CAMR, 149 Alcorn
Ave., Toronto, Ont.
September 28 - October 3, 1969
13th annual Registered Nurses' Associa-
tion of Ontario Conference on Personal
Growth and Group Achievement, De-
lawana Inn, Honey Harbour, Ont.
October 6-8, 1969
Annual nurses' convention, sponsored by
the American College of Obstetricians
and Gynecologists, Marlborough Hotel,
Winnipeg. For further information write
to: Mrs. Jordan, c/o Women's Pavilion,
Winnipeg General Hospital, 700 William
Avenue, Winnipeg 3, Man.
October 6-31, 1969
Advanced program in Health Services
Organization and Administration, Uni-
versity of Toronto School of Hygiene.
This is the first of two parts of the
course. Fee: $200 for each part. Write to:
Dr. R.D. Barron, Secretary, School of
Hygiene, University of Toronto, Toronto
5, Ont.
October 7-9, 1969
Operating Room nurses of Nova Scotia
study group, fall convention, Halifax
Infirmary Hospital, Halifax
October 9-10, 1969
Annual Convention, Catholic Hospital
Conference of Alberta, Edmonton, Al-
berta.
October 9-10, 1969
Ontario Hospital Association, 45th an-
nual convention. Royal York Hotel, To-
ronto.
20 THE CANADIAN NURSE
October 10, 1969
Homecoming 69, for all graduates of any
nursing programs at the University of
Ottawa. For information contact: Miss M.
Olsiak, pro tern chairman. School of
Nursing, University of Ottawa, 30
Stewart St., Ottawa, Ont.
October 16-17, 1969
Continuing Nursing Education Course in
Nursing the Adult with Long Term Ill-
ness. The University of British Columbia,
School of Nursing, Vancouver, B.C.
October 24, 1969
Catholic Hospital Conference of Ontario
Nursing Committee meeting, Westbury
Hotel, Toronto.
October 25-26, 1969
Catholic Hospital Conference of Ontario,
annual convention, Westbury Hotel,
Toronto, Ontario.
October 25, 1969
Fraser Valley District Registered Nurses'
Association of British Columbia Educa-
tion Day, Chilliwack, B.C., Evergreen Hall
Auditorium. Fee: S5.00. Write: Mrs.
Mary McCallum, 127 Princess Ave. E.,
Chilliwack, B.C.
October 30-31, 1969
Continuing Nursing Education Course in
Pediatric Nursing. The University of
British Columbia, School of Nursing,
Vancouver B.C.
November 10-14, 1969
American Public Health Association
meeting, Philadelphia, Pa. For informa-
tion write: American Public Health As-
sociation, 1740 Broadway, New York,
N.y.
November 11-13, 1969
Quebec Operating Room Nurses' Group,
annual convention. Skyline Hotel, Mon-
treal.
November 13-14, 1969
Continuing Nursing Education Course in
Nursing the Adult with Acute Illness. The
University of British Columbia, School of
Nursing, Vancouver, B.C.
November 19, 1969
Symposium of Operating Room Study
Group of Manitoba in conjunction with
the Manitoba Health Conference. Fort
Garry Hotel, Winnipeg, Man. Contact:
Mrs. Diane Aboud, Corresponding Secre-
tary, St. Boniface General Hospital, St.
Boniface, Manitoba. D
SEPTEMBER 1%9
BANISH
PINWORM
INFECTION
WITH A
SINGLE
DOSE
Van@uiii
(pyrvinium pamoate)
• Convenient, economical single-dose oxyuricide • Single-dose
elimination of pinworm infection in 90-100% of cases • Notable
freedom from serious and other side effects • Especially valuable for
institutional and family use • Available as a pleasant-tasting
suspension or as sugar-coated tablets • Dosage: Children and adults,
a single oral dose equivalent to 5 mg. per Kg. body weight. This is
approximately equivalent to one 5-cc. teaspoonful of Vanquin
Suspension or one Vanquin Tablet for each 22 pounds of body weight.
Precautions: Tablets should be swallowed whole to avoid staining
teeth. Pyrvinium pamoate will stain most materials. Stools may be
coloured red. Side Effects: Infrequent nausea and vomiting and
intestinal complaints have been reported. How Supplied: Vanquin is
available as a pleasant-tasting, strawberry-flavoured suspension in
1-oz. and 2-oz. bottles; and as sugar-coated tablets in packages of 12,
and bottles of 25 and 100. Vanquin Suspension contains the pamoate
equivalent of 10 mg. pyrvinium base per cc. Each Vanquin Tablet
contains the pamoate equivalent of 50 mg. pyrvinium base. Detailed
prescribing information available on request.
PARKE-DAVIS
Parke, Davis & Company, Ltd., Montreal 9
(&
I/.
$Afi
new products
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
Quick-Switch Parallel Bars
A team of working physical therapists
has designed new motorized parallel bars
that can be adjusted in seconds. The fast
adjustment to height and width for each
patient is made possible by four switches
and two push buttons in the activation
and control mechanism.
The average adjustment per patient
with the motorized parallel bars takes
about eight seconds, compared with
about three minutes for manually adjust-
ed bars. This saving amounts to more
than SI, 000 a year for a single unit.
By adjusting height from 25 to 40
inches and width from 16 to 25 inches,
this device can easily accommodate chil-
dren or adults. Chromium plated steel
handrails assure rigidity and long life; an
optional tapered steel base allows easy
access for wheelchairs.
For further information contact: Pre-
sentation of Canada Limited, 74 Victoria
Street, Suite 616, Toronto 1 , Ontario.
Erratum
The June issue of The Canadian Nurse
gave an incorrect address for information
concerning the Surgical Prep Blade. The
manufacturer has informed us the correct
address is: Mr. Gilles Michaud, ASR
Medical Industries, 5555 Royalmount;
Avenue, Montreal, Quebec.
Underwater Chest Drainage
Sterile underwater chest drainage sets
are available in one, two, or three bottle
setups. A rack is provided with each
bottle to prevent accidental tipping. Each
bottle is calibrated to 1500 cc. and is
labeled. The screw top eliminates glass
rods, cork and tape; on the tubing to the
patient are two clamps making a tight
closure.
For further information write: Hos-
pital Products Division. Chesebrough-
Pond's (Canada) Ltd., 150 Bullock Drive,
Markliam, Ontario.
Automatic Infusion Pump
An automatic infusion pump requiring
a simple "dialing in" for the desired
infusion rate in ccs per hour has been
developed by the IVAC Corporation.
The pump needs no reference to charts
in setting up; instrument never requires
calibration, nor readjusting during in-
fusion. It will accept any size intravenous
tubing, and the rate desired is independ-
ent of tube inside diameter.
The instrument will shut itself off
when the last drop leaves the bottle and
signal the nurse at her station, thus
eliminating air infusion.
For further information contact:
Standard Hospital Supply, 2276 Dixie
Rd., Cooksville, Ontario.
\
Disposable Electrodes
These disposable electrodes are to be
used with electronic monitoring equip-
ment in hospitals. They are lightweight,
with sturdy, one-piece construction elimi-
nating the need for heavy ECG cables and
metal plate or needle electrodes.
Each disposable electrode has a
36-inch lead and a positive adhesion to
provide maximum patient-electrode
contact. They are designed for long-term
monitoring without discomfort to the
1
/■
i
22 THE CANADIAN NURSE
patient. Tlieir flexible construction and
application are designed to avoid skin
irritation, as well as the time-consuming
need to relocate continually electrodes
from one portion of the body to another.
They are available in dispenser packages
containing 50 individually wrapped elec-
trodes connected in a roll.
For further information contact: Bax-
ter Laboratories of Canada, 6405 North-
am Drive, Malton, Ontario.
Tinactin Cream
Tinactin (tolnaftate), a fungicide for
treatment of fungus infection of the skin,
including athlete's foot, is now available
in a new cream form.
Available in 15 Cm. tubes, this cream
kills tinea organisms with speed and
convenience, while showing virtually no
side effects. Non-sensitizing, non-irri-
tating, and not active systemically,
Tinactin is odorless and non-staining.
This product is also available as a
solution in 15cc. bottles or as a powder in
40 Gm. tubes.
For further information, write to;
Schering Corporation Limited, Pointe
Claire, Quebec.
SEPTEMBER 1969
Ethylene Oxide Sterilizers
Automatic, portable ethylene oxide
sterilizers are designed for the steriliza-
tion of virtually any article used in
hospitals.
Using disposable "'Steri-Gas" car-
tridges, the units feature simple, auto-
matic unattended operation for sterilizing
surgical, diagnostic and optical instru-
ments, plastic and rubber materials, pa-
tients" personal effects, and other items
sensitive to the effects of heat and mois-
ture.
All units have anodized aluminum
chambers and a case finish of silver-gray
hammertone enamel.
For further information, write to: 3M
Company. P.O. Box 5757. London, Ont.
Magnetic Tape Recorder
The Dallons Automatic Memory Tape
Loop Recorder is designed for use in
coronary and intensive care units. The
unit features two separate recording chan-
nels, one for EKG signals and the other
for voice information, permitting a des-
criptive or analytical voice track to be
recorded either simultaneously with the
EKG pattern, or at a later time.
The equipment is designed to record a
patient's EKG information continuously,
erasing older information and recording
new information on the same tape. The
unit automatically shuts off at a preset
length of time after onset of an alarm
condition. This provides several minutes
of data showing the heart action pre-
ceding, during, and immediately follow-
ing the emergency. Tapes in easily loaded
cartridges are available in lengths from 70
seconds to 10 minutes.
A built-in speaker and a microphone
for recording on the voice track are
provided with the unit. A safety interlock
switch prevents inadvertent loss of pre-
viously recorded information. Either 1 15
volt, 60 cycle: or 220 volt, 50 cycle units
can be provided, permitting the recorder
to be operated from standard hospital
wall outlets.
For further information contact:
Bionetics Ltd.. 6420 Victoria Avenue,
Montreal 26. Quebec.
SEPTEMBER 1%9
A Chemical Disinfection Unit
Market Forge has developed a chema-
tic control chemical disinfection unit that
provides control over the chemical disin-
fection process.
The chematic control is designed for
use in the hospital's central sterile service,
the operating room cystoscopy, anesthe-
sia, and inhalation therapy areas. In addi-
tion to providing all facilities to observe
proper technique, chematic control auto-
matically assures that all items are expos-
ed for the correct amount of time.
Chematic control is available as a com-
plete unit that can be placed on an
existing counter or cart or as a self-
contained chemical disinfection work sta-
tion. Features include dial timers; inter-
locked covers; transfer baskets: indicator
lights; covers, trays, and transfer baskets
removable for autoclaving; tray syphon;
soak and rinse trays: and transfer baskets
of inert material to be used with all
generally used chemical disinfectants
without chemical reaction; and stainless
steel construction for durability and
cleanliness.
For further information contact:
Gordon G. Brown & Co., Ltd., Suite 23,
1875 Leshe Street, Don Mills, Ontario.
Anti-pcrspirant
is usually
a
Now it*s
a shoe.
MEDIC
$18
Perspiration is no longer one of a
shoe's worst enemies. NowAirStep
brings you a shoe made of genuine
Servotan* leather, specially treated
to resist drying, cracking and dis-
coloration due to perspiration. The
shoes stay unbelievably soft. So
easy to clean, too, with soap and
water.
AndAirStephasthefamousWonder-
sole. (See illustration below.)
WONDER
TIE
$18
Suggetted Rttail Pricts
*Wondersole fits your
sole, dip for dip,
rise for rise.
WITH SERVOTAN AND WONDERSOLE*
*Tradetndrl<s of
Brown Shoe Company of Canada Ltd. Ait Step Division, Perth, Ontario
1
THE CANADIAN NURSE 23
For nursing
convenience...
patient ease
TUCKS
offer an aid to healing,
an aid to comfort
Soothing, cooling TUCKS provide
greater patient comfort, greater
nursing convenience. TUCKS mean no
fuss, no mess, no preparation, no
trundling the surgical cart. Ready-
prepared TUCKS can be kept by the
patient's bedside for immediate appli-
cation whenever their soothing, healing
properties are indicated. TUCKS allay
the itch and pain of post-operative
lesions, post-partum hemorrhoids,
episiotomies, and many dermatological
conditions. TUCKS save time. Promote
healing. Offer soothing, cooling relief
in both pre-and post-operative
conditions. TUCKS are soft
flannel pads soaked in witch hazel
(50%) and glycerine (10%).
TUCKS — the valuable nur-
sing aid, the valuable patient
comforter.
Sinee^
Specify the FULLER SHIELD^ as a protective
postsurgical dressing. Holds anal, perianal or
pilonidal dressings comfortably In place with-
out tape, prevents soiling of linen or cloth-
ing. Ideal for hospital or ambulatory patients.
w
CO.
LTD.
WIN LEY- MORRIS .^^
^A MONTREAL CANADA
TUCKS is a trademark of the Fuller Laboratories Inc.
new products
Garamycin Ophthalmic
Garamycin ophthalmic is effective
against most common pathogens, includ-
ing penicillin-resistant staphylococcus,
pseudomonas and proteus. It is recom-
mended for the treatment of superficial
bacterial infections of the eye and for the
prevention of infection resulting from
injury to the eye or adjacent areas.
Garamycin ophthalmic is available in
0.3 percent solution or ointment. Each
cc. of solution or gram of ointment
contains 5 mg. of gentamicin sulphate,
equivalent to 3 mg. of gentamicin base.
The solution is a stable (2 years),
sterile form, ready for immediate use.
The ointment form, in a 1/8 oz. tube
with applicator tip, is suggested where
lubrication or sustained medication is
desirable.
For further information contact: Cor-
poration Ltd., Pointe Claire, Quebec.
24 THE CANADIAN NURSE
Blood Analyzer
The Blood Analyzer 11 is designed to
permit the physician's own office staff to
perform a variety of blood chemistries or
for a group practice or clinical laboratory
already engaged in volume blood-testing.
A direct-reading, photoelectric colori-
meter, the new blood analyzer offers
savings in the time and the cost of blood
testing. Average elapsed time per test is
less than 1 5 minutes, with a total average
operator time of two minutes. Average
cost per test can be as low as 19 cents
using bulk reagents.
Ten different blood chemistries are
presently available: albumin, alkaline
phosphatase, bilirubin, B.U.N. , cholester-
ol, cyanmethemoglobin, oxymethemo-
globin, total protein, true glucose, and
uric acid. New chemistries are in the final
prerelease test stage and others are being
developed to be added to the blood
analyzer's operation.
For additional information write: Mr.
H. Court, 879 Warwick Drive, Burlington,
Ontario. D
SEPTEMBER 1%9
Fleet
ends ordeal by
Enema
for you and
yoiir patient
Now in 3 disposable forms:
* Adult (green protective cap)
* Pediatric (blue protective cap)
* Mineral Oil (orange protective cap)
Fleet — the 40-second Enema* — is pre-lubricated, pre-mixed,
pre-measured, individually-packed, ready-to-use, and disposable.
Ordeal by enema-can is over!
Quick, clean, modern, FLEET ENEMA will save you an average of
27 minutes per patient — and a world of trouble.
WARNING: Not to be used when nausea,
vomiting or abdominal pain is present.
Frequent or prolonged use may result in
dependence.
CAUTION: DO NOT ADMINISTER
TO CHILDREN UNDER TWO YEARS
OF AGE EXCEPT ON THE ADVICE
OF A PHYSICIAN.
In dehydrated or debilitated
patients, the volume must be carefully
determined since the solution is hypertonic
and may lead to further dehydration. Care
should also be taken to ensure that the
contents of the bovi/el are expelled after
administration. Repealed administration
at short intervals should be avoided.
Full intormat'ion on request.
'Kehlmann, W. H.: Mod. Hosp. 84:104, 1955
FLEET ENEMA® — single-dose disposable unit
SEPTEMBER 1%9
Knu>NONONn<Auc*rMOA /
TOMOrO m CMua* mm— J
THE CANADIAN NURSE 25
in a capsule
Plugged in
Language difficulties at the ICN con-
gress in June were minimized by the use
of simultaneous translation facilities into
the four official languages of the ICN.
Unfortunately for two Spanish-speaking
nurses, the translation facihties did not
extend to outside activities leading to
various interesting incidents.
The two nurses entered a Montreal
restaurant one evening, still carrying the
portable headphones that plugged into
the translation service. After several mo-
ments of fruitless sign language, one of
the nurses excitedly motioned to the
waitress to don the headphone, and seiz-
ed the plug to speak into.
Whether or not the nurses ever were
served is still in doubt.
Nursing at its best
Recently, a nursing educator friend of
ours returned from a year's postmaster's
studies in California. During the time she
was there she worked as a general duty
graduate in a rehabilitation hospital "to
keep a hand in patient care." That's a
commendable sentiment from today's
educators, we think.
One of the interesting stories she has
to tell concerns the use of wine with the
afternoon and evening meals, a custom
rapidly growing in California's hospitals.
There were several patients of Italian
origin on the ward, and one small glass of
wine merely whetted the appetite. So the
enterprising nurses made rounds of the
ward and kept a list of all the teetotalers.
Then as they passed out the trays, they
whipped the glasses off those of the
abstainers and onto those of the Italians.
Everybody was happy.
Catnip confusion
Readers of The Journal of the Ameri-
can Medical Association enjoyed pointing
out an error in the article "Catnip and the
Alteration of Consciousness" (February
17, 1969).
26 THE CANADIAN NURSE
The error - the labeling of Cannabis
sativa (marihuana) for Nepeta cataria
(catnip) and vice versa - resulted in
some of the following reader comments
(JAMA, April 14):
"One of my hippied patients noted,
with a pardonable snicker, that the labels
for Cannabis and catnip had been inter-
changed. He confirmed the descriptions
of the psychedelic effects, calHng them
'low high.'"
"A short time ago an elderly gentle-
man in Grand Rapids, Michigan, was
arrested for collecting marihuana. To
their chagrin, the police discovered that
he had a bag of catnip for his cat.
Apparently the police had used the same
botanist who labeled the illustrations in
the article."
"One exposing his pet cat to what is
termed Cannabis might get the false
impression that he was sheltering a feline
junkie."
"Being a bit of a catnip and mint
chewer myself, it is shattering to learn I
was denied the pleasures I might have
had, had I known I was nibbling at the
edge of psychedelia."
Extendible shoes
A Canadian doctor has come up with
an idea for a shoe that no manufacturer
will touch according to a Canadian Press
story from Edmonton. Harold England
has invented a child's shoe which can be
extended one size by a simple operation
requiring only a screwdriver.
"It's a tremendous idea" said the
inventor, "but I'm living in the wrong
society. No manufacturer is going to take
on a shoe that could replace the sale of
two pairs of shoes."
Drink "hard," live longer
The London School of Hygiene and
Tropical Medicine reports that drinking
hard water seems to keep people alive
longer. The school conducted a survey of
61 county boroughs in England and Wales
where the population was 80,000 and
over. The survey showed that the harder
the water and the more calcium it con-
tained, the lower the death rate - espe-
cially in cases of cardiovascular disease
and bronchitis. It appears that perhaps
calcium, magnesium, and sodium are res-
ponsible for keeping hard-water drinkers
alive longer. If not, then hard water's
trace metals such as boron, iodine, fluo-
rine, and silica may be the reason. - The
Homer Newsletter, iune 1 , 1968. D
SEPTEMBER 1%9
Postgraduate Publications
Secor: PATIENT CARE in Respiratory Problems
By Jane Secor, R.N., MA., Syracuse University.
A new series, Saunders Monographs in Clinical Nursing, begins with this volume.
The series will make available to the practicing nurse and advanced nursing student
individual studies of significant specialized topics in clinical nursing.
Secor's Patient Care in Respiratory Problems is the first book specifically designed
for use by the clinical nursing specialist in respiratory diseases. It presents, on an
advanced level, a comprehensive discussion of respiratory physiology, diagnostic
techniques, signs and symptoms, complications, individualized nursing care and
special treatments. Then the author gives studies in depth of six common respira-
tory disorders and their total care.
Miss Secor points out that technologic innovations in patient care demand from the
nurse flexible manipulative skills and reliable interpretive skills. "Effective nursing
in an equipment-dominated environment requires constant and intensified attention
to the special needs of the individual patient. Nursing specialization is an inseparable
blending of technical expertise and personalized patient care." This book will be
valuable for independent study and for reference by nursing specialists, nurse
educators and advanced nursing students.
229 pages, illustrated. About $9.25. Just Ready.
The NURSING CLINICS of North America
The Nursing Clinics are widely known and valued as a continuing source of infor-
mation on the latest nursing concepts and techniques. These unique harbound
periodicals are almost like a postgraduate seminar, designed and written specifically
to meet the needs of practicing nurses. The forthcoming September issue, for exam-
ple, contains two symposia. Patient Care in Kidney and Urinary Tract Disease, with
Barbara J. Fulton as Guest Editor, examines the nursing aspects of hemodialysis
and renal transplantation. New Ways of Providing Nursing Service, with Laurence
E. Souza as Guest Editor, discusses some of the new roles, new settings, and new
adjuncts that may foretell future nursing care.
There are fourteen articles in the two symposia, each of them illuminating a
specific facet of the subject, each of them written by a leading nursing authority.
Such coverage (and such timeliness) is typical of the Nursing Clinics. Each issue
(there are four per year) contains about 185 pages, with no advertising, bound
between hard covers for permanent reference use. Sold only by annual subscription
(4 issues) $13.
W.B. SAUNDERS COMPANY CANADA LTD., 1835 Yonge St., Toronto 7
D Please reserve my copy of Secor's Palient Care in Respiratory Problems to be sent and
billed when ready. (About $9.25)
n Please enter
my
subscription
to
the Nursing Clinics,
to start with the September
issue ($13)
Name:
Address*
City:
Zone:
Province:
CN 9-69
SEPTEMBER 1969 THE CANADIAN NURSE 27
ahead
soften
With
dermassage,
you'll rub
every
patient the
right way.
'V
Dermassage cools and soothes.
Softens and smooths. Refreshes and
deodorizes without leaving a scent.
Protects with antibacterial and
antifungal action. Dermassage forms
a greaseless film to cushion ^/^^^
your patients against linens, ^Eai
helping to prevent sheet
burns and irritation.
Just think of the
welcome comfort a
Dermassage rub can be
to a patient's tender,
sheet-scratched skin.
And when you give
back or body rubs with
Dermassage, you never U -^.tiiasd
have to worry about
rough, scratchy hands.
So go ahead... soften
them up.
xiUi
Lakeside Laboratories (Canada) Ltd.
64 Colgate Avenue • Toronto 8, Ontario
•Trade marl<
Inservice for teachers^ too?
No professional nurse can function well without continuing to learn. And nurse
educators are no exception.
Shirley Post, B.Sc.N.Ed.
Any educational administrator who
wants a high quality educational program
is obliged to find, select, and retain the
finest faculty possible. She looks for
quaUfied, competent faculty and con-
siders each individual teacher's academic
qualifications, clinical experience, clinical
depth, teaching ability, attitudes, philo-
sophy, and character. As well, she must
consider the teacher's potential for pro-
fessional development.
Once the administrator has obtained
well-qualified faculty members, she must
accept a certain responsibility for helping
to increase their effectiveness as teachers
and as professional nurses, if the school is
to maintain this "quality" aspect.
No professional nurse can function
well or for long without continuing to
leam. A nurse who graduated five years
ago and has not studied in her field since
is out of date. Nursing educators are not
exceptions.
Schools of nursing can no longer toler-
ate the kind of teacher who has not
changed her lecture content or method of
presentation since she prepared her
course 10 years ago. If administration
fails to recognize and help this staff
member, today's students will call atten-
tion to her.
Mrs. Post, a graduate of the Toronto Western
Hospital and the University of Ottawa, is
Assistant Director, School of Nursing, Ottawa
General HospitaL
SEPTEMBER 1%9
Each teacher must continue to leam.
If she stops learning, she slips behind;
new knowledge and technology does not
wait for the laggard, but passes by.
Nursing educators are, in a sense,
nursing leaders. They cannot know every-
thing, but must be aware of trends, of
changes, of where to look for knowledge.
They must keep pace with the times if
they are to motivate, stimulate, and guide
student nurses of today and tomorrow.
Blueprint needed
The director of a school of nursing can
help faculty members to grow. She must
believe in the philosphy of continuing
education. She must provide incentives
and stimulation to encourage improve-
ment of faculty competence. As direc-
tor, she must provide leadership in
planning programs with her staff, or
delegate this function to a member of her
faculty. She must consider inservice needs
when plaiming her budget. In short, she
must remember that the faculty of a
school of nursing needs a planned in-
service program too.
An inservice program does not just
happen. To make any program a reality,
we must have a blueprint. We must know
what we want to do, why we want to do
it, and how we will achieve it. This means
a written philosophy and objectives.
The objectives may be very flexible;
they may even change from year to year.
However, they should be comprehensive
THE CANADIAN NURSE 29
and include personal, emotional, ana so-
cial aspects as well as professional con-
cerns of the faculty.
There are nine considerations for a
faculty inservice program:
• It must be carefully planned.
• It must be flexible enough to take
advantage of unforeseen educational
opportunities.
• It must be comprehensive
• It must meet the needs of the faculty
members.
• It must meet the needs of the institu-
tion.
• It must be supported by administration.
• It must be supported by faculty.
• All faculty must actively participate.
• A budget must be established.
Four areas of concern
Inservice programs for faculty should
cover four areas: orientation; group edu-
cation; individual growth opportunities;
and counseling.
Orientation is planned by the school
administration. It introduces the new
faculty member to the school and to the
hospital and staff. It gives her written
philosophy, objectives, and organizational
patterns. Personnel policies, faculty by-
laws, committee structures, and job des-
criptions are discussed.
The new teacher needs an overview of
the total curriculum, as well as an intro-
duction to her own area. Student evalua-
tions, student guides, and other forms
must be understood.
At the Ottawa General Hospital
School of Nursing, orientation is planned
for new teachers by the assistant directors
and the medical-surgical coordinator. One
week is spent at the school with a
planned program, one week in the clinical
area with an instructor, and one week
with nursing service orientation program.
Each teacher receives a loose-leaf manual
containing all policies and a sample of all
records used. A loose-leaf binder is used
to make additions of material simple; it
also serves as a file for the minutes of
future faculty meetings.
30 THE CANADIAN NURSE
Group education permits every faculty
member to continue to learn, to improve
her teaching effectiveness, to keep up
with current trends, and to broaden her
horizons. At our hospital we try to create
an atmosphere whereby each faculty
member wants to continue to learn. To
provide stimulation, the administration
has planned group programs twice
monthly, on Wednesday afternoons, from
1:30 to 3:30 p.m.
When planning first began, faculty
members were asked about their interests
and needs. Following this discussion, the
assistant director, whose function is to
act as inservice coordinator, listed a num-
ber of possibilities. Priorities were set at
the following faculty meeting, and ar-
rangements left with the assistant direc-
tor.
Individual growth opportunities need
to be provided for an inservice program.
A keen, participating faculty member,
with an evident interest in continuing
education opportunities, provides an ex-
cellent role model for students. Planning
for these opportunities is the responsibili-
ty of the faculty member, but administra-
tion can offer encouragement and often
financial assistance. Two members of our
faculty are on the executive of the
Ottawa East Chapter of the Registered
Nurses' Association of Ontario. We have
had members of the faculty at seminars,
workshops, and conventions in Detroit,
Toronto, Kingston, Ottawa, and Montreal
this year — 20 different functions in all.
Four faculty members went to the pro-
vincial annual meeting in May and five
attended the International Council of
Nurses Congress in June.
In her article in the February '69 issue
of Nursing Outlook, Eleanor Muhs in-
cludes counseling as part of an inservice
education program. This is a good idea.
Every director of a school of nursing
needs to spend time listening to her staff,
encouraging them to try new methods,
discussing plans for going on with their
own education, and supporting them in
efforts to provide quality nursing educa-
tion for their students.
A beginning — not an end
Faculty improvement is a term that is
neither clear nor explicit. At our hospital,
the inservice program for teachers has
created a happy, friendly atmosphere, has
helped keep our teachers motivated and
interested. They participate. They try
new methods. They ask to go to confer-
ences, and are even willing to spend their
own money to go because they believe it
is important and they will learn. They
share their experiences with colleagues.
This is only the begiiming of course.
What of the future for inservice in schools
of nursing?
I believe that in the future we shall see
more programs planned between service
and education. We shall also see sharing
of programs between schools of nursing,
especially in terms of human and finan-
cial resources. Plaiming together cuts
costs and provides everyone with better
programs.
I also foresee continuing education
programs being planned, not only within
the confines of one or two schools, but
locally and regionally. Perhaps university
schools of nursing will provide leadership
by offering continuing educational oppor-
tunities for graduates in the community
through evening courses or workshops.
Other community resources also could be
utilized for educational programs.
I see broader content areas with pro-
grams including nurses, doctors, adminis-
trators, and other health care workers.
I believe the day is not far off when
nursing schools will offer sabbatical
leaves, perhaps a year, or even a term, so
faculty members have an opportunity to
keep pace with the times. D
SEPTEMBER 1%9
Nursing associations
— are they coming or going?
If a professional organization fails to grow and change as times dictate, it will
decline and gradually fade out of a useful role. In which direction are the
professional nursing associations going?
They're coming, according to Laura Barr,
executive director ofRNAO.
SEPTEMBER 1%9
Glennis Zilm, B.Sc.N., B.).
Every association, if it is to survive and
be successful, must periodically reex-
amine its goals, structure, functions, and
ways of carrying out its duties. It must be
prepared to change if that examination
reveals that it is not meeting the needs of
its members and the needs of the society.
During the present biennium, the Ca-
nadian Nurses' Association has appointed
a special committee to examine its goals
and functions. During the past five years,
six of the provincial nursing associations
have undertaken a comprehensive review
of their roles, goals, structure, and func-
tions. Two more are planning such
studies.
Because many nurses are interested in
this topic, The Canadian Nurse sent a
reporter to interview the executive direc-
tor of a provincial nursing association
which, in 1964, initiated some radical
changes to try to make itself more dyna-
mic, more effective, and more progres-
sive.
Laura W. Barr, executive director of
the Registered Nurses' Association of
Ontario, has an impressive record in
association work. She has been active in
chapter and district levels of her provin-
cial association. In 1960 she joined the
Registered Nurses' Association of Ontario
as assistant executive director and became
executive director in 1961. She was
instrumental in getting an outside study
of the RNAO in 1964 and has been
concerned with implementing the re-
commended changes in the structure of
that association.
As a provincial executive director, she
attends the board of directors' meetings
of the national nurses' association, and
she is Canada's representative to the
International Council of Nurses' Profes-
sional Service Committee. She is extreme-
ly competent to talk about the problems
and pressures in the growth of a profes-
sional association.
Here are some of her responses to
questions on the professional nursing
associations and their present and future
roles.
What are the roles and purposes of a
voluntary association?
I believe there are three general pur-
poses in a nursing association. It is a
professional association, so one compo-
nent is to see that the member becomes
most effective as a practitioner. Part of
the programming has to be concerned
with the development of the individual
member and with provision of services for
the individual that can be better supplied
through a group. Then the second em-
phasis must be the" promotion of the
profession itself to mak6 it a realistic
contributor to society. The association
Nfiss 2aim, now a reporter for The Canadian
Press, was formerly assistant editor for The
Canadian Nurse, and before that a nursing
instructor.
THE CANADIAN NURSE 31
sets standards in excess of those currently
in practice, interprets the profession, and
attempts to change the course as indicat-
ed. The third element is the responsibility
to the community at large. The associa-
tion is the liaison between community
needs and professional service. The key to
any association has to be balance. Asso-
ciations sometimes forget to emphasize
balance in their programming. To create a
balance between these three is difficult,
but I believe it is the secret to a useful
organization.
One of the difficulties in interpreting
the association's role to the membership
is the need to interpret the balanced
program. There may be a large segment of
the membership who are quite young in
the profession and really have a lot of
personal needs that they want met. They
would want the association to put greater
emphasis on the first role. Then there are
other members who have become quite
job-centered; these may be the 25- to
40-age group. They are highly career-
oriented and they see a need for a
different emphasis. And then there are
the ones who have moved out of the
profession a little bit and are much more
aware of what is going on in society.
They see the emphasis as being on com-
munity needs. So, an association has to
be conscious of the stages of individual
development in membership depending
on career opportunities, career plans, and
age.
Would you say that the third /unc-
tion - responsibility to the commu-
nity - is what separates a professional
association from a union?
Union leaders would say that they also
have the interest of the community in
mind, but I do think that the professional
association has a greater responsibility or
commitment to this balance of activity.
Especially in relation to this third
fiinction of associations - that of res-
ponsibility to the community - isn V the
government really the responsible body?
Doesn't it act for the community through
legislation and health departments?
The government responds to the needs
of the people, and it has a variety of ways
of having legislation administered. I
suppose its main responsibility related to
nursing is the legislation of registration,
which takes in the approval of schools of
nursing, the registration itself, and the
discipline. Governments provide legisla-
tion for these things.
In most provinces the government has
32 THE CANADIAN NURSE
"Members, through the association, set goals for the profession "
said to the professional nursing associa-
tion, "You administer these regulations."
In Ontario there is a separate body set up
to administer the regulations. Ultimately,
the responsibility is the government's; it
has merely delegated the administration
of nursing legislation to a council of
nurses which is elected by nurses.
But, don't associations have higher
standards than the ones governments
legislate?
What we find is that the legislation sets
minimum standards and the profession,
through its association, tries to increase
the standards. Many schools of nursing
require more than the minimum entrance
requirements, give much more than the
minimum in the curriculum, and require
much more during the nursing program
than the minimum registration examina-
tion results. Members, through the asso-
ciation, set goals for the profession to
work toward.
This explains one of the binds that
occurs when the association also adminis-
ters the regulations. When RNAO did this
it was really difficult to be in a meeting
for registration one day and be talking
about the minimums and then the next
day coming along to a member's meeting
and talking about maximums. You were
almost battling with yourself.
The whole process of registration is to
ensure that the public has someone who
can be designated as a registered nurse. It
is really a protection for the public.
The association says what standards it
thinks can be attained in the foreseeable
future! The legislative body says what is
essential here and now. And somewhere
in between the members are working
from one to the other - and you have
them in all stages of commitment in
working toward the goals.
What are nursing's goals right now?
In our province, and I would think this
is true right across Canada, there is a great
SEPTEMBER 1%9
deal of concern about how associations
set goals for nursing. This is because the
picture of the whole system of health
services is unclear. We attempt to put out
feelers about where nursing should be
going, who the practitioners should be,
and what their role should be. It seems to
we have not worked enough with other
groups. We need to be involved in de-
veloping a comprehensive system of
health services, of health care.
In Ontario, our association has re-
cently had one conference with other
groups to try and come up with proposals
for government that will be incorporated
into a whole system of health care.
I can remember when I first joined
RNAO. As nurses, we were so bent on
devising a strong identity for ourselves
that we refused to entertain approaches
from other groups - except on our
terms. For my money we are now making
a beginning in interdisciplinary coopera-
tion, but there is still a long way to go.
Social workers, physiotherapists, archi-
tects, even engineers are coming in to see
if they can talk with us at the association
level. We even have approaches from the
medical profession.
At this conference I mentioned, I met
an optometrist. We were talking together
and he said, "For me at this conference
the eye-opener is that nursing and medi-
cine do not talk the same language. I
thought you people were hand in glove
and our health care needs were piloted by
these two groups in close cooperation.
Yet now I see that there is much that you
do not understand about each other." He
was most disappointed.
If we are going to utffize-£ully the
contribution of the profession, we must
work with the allied professions. We can
not be clamped into a comer in the way
we function. We really can not be ef-
fective workers unless we do work in
cooperation.
In the past, nurses first joined together
in associations to get registration - legis-
lation to protect the patient and the
nurse. We were a long time in getting it.
After that, the associations stressed the
development of nursing education pro-
grams, and that has been a long hard haul.
As a member of the profession I am
awfully disappointed that we failed to do
more work on nursing service prior to the
time we introduced the general duty
nurse or general practitioner in nursing. I
think we have a great deal to undo in the
way this group of practitioners has devel-
oped and the attitudes they have about
themselves and other's attitudes about
them. Our present goal must be in the
SEPTEMBER 1969
area of the practitioner.
In the past the associations have had a
great deal of concern about the public
and the student, but this was not offering
the balanced program either. Now we
must concentrate to a greater degree on
the practitioner. The primary goal must
be to make her the most effective health
worker she can possibly be. I see associa-
tions as really zeroing in on nursing
practice and assisting those in nursing
service to develop an appropriate design
for the delivery of care.
Studies of voluntary organizations
show that membership is usually lower
among younger age groups - those that
you have indicated would be primarily
concerned with the individual
I think when we are talking about
nursing organizations there are some
other factors to be taken into considera-
tion. When it has come to looking at the
needs of the organization, I have found a
tremendous change in the way new grad-
uates look at the profession in the eight
years I have been with the Registered
Nurses' Association of Ontario. Histori-
cally, we are very much geared to our
own school of nursing, our own hospital.
I question that in the past nurses had
strong professional realizations.
Our association is terribly encouraged
this year with the high degree of interest
and commitment in the newly graduating
students. Whether they will all be mem-
bers or not remains to be seen, but they
are tremendously concerned with what
the profession should be doing for itself.
They have certainly explored RNAO's
roles and whether they decide they are
effective enough remains to be seen.
Over the years, I have seen a tremen-
dous change in the professional identifica-
tion of the graduate. Instead of identify-
ing with an individual school, she identi-
fies with the profession.
How do you feel about voluntary and
compulsory membership?
I have some ambivalent feelings about
this issue. If I have a bias it is toward
voluntary membership in an association.
I question the idea that if an associa-
tion represents all the nurses it has a
stronger voice. This concept carries no
weight with our provincial government. If
membership is compulsory, the govern-
ment questions whether or not nursing is
a profession. One of the responsibilities
of a professional is to be organized, to
establish standards for his work in con-
junction with others of his profession. If
we legislate that nurses have to belong to
the professional association, then no one
will ever know whether our members are
responsible professionals, whether there is
a core of integrity. If an association
cannot maintain membership without
being compulsory, does it really represent
professionals?
Conversely, 1 become extremely con-
cerned when there are people who want
to be called registered nurse but who
divorce themselves from any contact with
the profession. Also, an association to be
effective needs money, and compulsory
membership provides money.
Why would or should nurses join a
voluntary association?
When a nurse has taken her two-to-
four years of nursing education, when she
has committed herself to this field, she
has made an investment in nursing. She
has made a considerable personal contri-
bution to her career as well as a real
financial outlay. Membership in the asso-
ciation is a kind of protection for that
investment.
Another reason — although it may be
a hard row to hoe - is that through her
association the individual nurse can get
group pressure brought to bear on con-
cepts that she wants to see developed.
How does a nurse who holds a minori-
ty opinion get the whole large association
to listen to her? How can one tnirse
challenge the "establishment" in an asso-
ciation?
One change I have seen in my 10 years
with the RNAO, and one that encourages
me very much, is the development of the
art of debate. In the past we have often
had very passive annual meetings; in the
last couple of years we have really seen a
group of people coming forward to
propose and defend new points of view.
These new "debaters" can also accept a
view put forward by others and still
discuss the merits or demerits. We are
learning that one or two persons can
persuade a large group if they use logic.
Another way the individual now chal-
lenges the establishment is through the
use of resolutions. Ten years ago there
would be one resolution — the courtesy
resolution thanking the hotel and speak-
ers. Now at annual meetings our associa-
tion has 30 and 40 and even 50 resolu-
tions coming forward from members,
from individuals who want to question a
point, or raise a new idea.
The third way is to raise a matter at
the chapter or district level and see it
THE CANADIAN NURSE 33
filter up to the board of directors through
the elected members and even to the
annual meeting. Election of the board
must be handled in such a way that it
reflects members' wishes. A good "mix"
of members will ensure that the interests
of most are considered.
Associations have become much better
about seeing that there is two-way com-
munication, because this is one of the
essentials if an organization is to survive.
What about the "passive" member as
opposed to the "active" member?
I think we will always have people
who will be strong, silent supporters. Our
province recognizes and awards the title
"Member Emeritus" to anyone who has
been a member for 40 years. Often these
poeple will say "Oh, but I've never done
anything. I've just been a member." Yet
think what a fantastic contribution this
person has made! Moral and financial
support for 40 years! All though the
depression! It is a problem for me to
consider these persons as "passive" mem-
bers.
What about other ways to contribute?
Belonging to an association gives the
individual nurse an opportunity to take
her turn to contribute by being a leader.
Associations have a structure, like the
chapter executive and so on. In a strong
organization, these positions will be
rotated through the membership so that
many people can take a turn at giving an
extraordinary amount of themselves for a
short period.
In the past, organizations sometimes
made the mistake of letting the same
persons take the leadership positions for a
long period of time and made no allow-
ance for change and sharing of responsi-
bility. People felt hurt if they were not
reelected or reappointed. This gave the
idea of the establishment. Several provin-
ces, Ontario included, have new struc-
tures that encourage rotation through the
positions. We are trying to draw many
more people in.
However, we still need those strong
silent supporters, those who come to
meetings, who are warm and receptive,
who welcome new ideas. There is a place
for everyone in the Association; each one
has a special role and a special time.
There is a role for the agitator, the
activist, the non-verbal supporters, the
extraordinary leader . . .
What about the person who does not
become a member?
34 THE CANADIAN NURSE
"// / have a bias, it is toward voluntary
membership in an association. "
One of the things associations have to
recognize is that people have different
priorities at different times in their lives.
Most nurses are females and it is therefore
to be expected that at certain times, as
during the time they are having children
and the children are very young, that the
professional association may be low on
the list of priorities.
Associations may have to take a more
realistic approach to the young members
and not expect them to become leaders
right away. These young women may
need time to find a job to their liking, to
become proficient practitioners, to gain
confidence in themselves, to take that
trip to Europe. But I hope that they will
be enough committed to their profession
to contribute non-verbally and financial-
ly. They should at least allow themselves
the opportunity to participate if some-
thing about which they have strong feel-
ings comes up.
The young mother, depending on the
circumstances, may not see the profes-
sional association as a high priority either.
She may not even be able to contribute
financially - although S35 a year - 10
cents a day — does not seem like very
much. We have to accept the priorities set
by the individual.
However, associations are noticing
quite a different attitude among today's
new graduates. Professionalism is of high-
er priority now than I have ever seen it.
The new graduate, even if she leaves her
career for travel or motherhood, sees
herself as someday returning to the pro-
fession and she recognizes the need to
build her profession for her future. And
when she comes back to the profession
today it is with a different attitude.
Perhaps our society is changing its atti-
tude toward the working woman, and the
working woman's attitudes toward her
career are also changing.
There are a lot of contributing factors.
One is that women no longer see them-
selves as withdrawing from the job as
they used to do. Then there is the new
emphasis in nursing education programs:
present curricula expose students to the
profession, its liistory and trends, and
current problems. There is a real effort to
talk about the present influences on
nursing and the student finishes her edu-
cation aware that there are threats to the
profession if she is not involved. Too,
there is less emphasis on the student's
school of nursing as the total identity and
more on nursing itself. Finally, today's
students have many more skills in orga-
nization; they are much more used to
associations in their school years.
i believe the association also has a
responsibility toward the "non-profes-
sional." The RNAO has extended many
services to non-members. They are wel-
come to come to meetings, for example.
We hope they will see some of the
benefits of membership. We try to com-
municate with them about the needs of
the profession.
What about associate fees or reduced
fees for those who place a "low priority"
on association membership?
A good many people have expressed a
need for this kind of fee. Those who
place RNAO on a low priority do not
mind that their privileges from the asso-
ciation might be less if they pay a
reduced fee, but they want to be part of
the profession. The RNAO discontinued
its associate member fee in 1964, but this
year at the annual meeting, we reinstated
it.
Are professional fees that high? Are
reduced fees necessary for those who are
not working?
No, I do not believe so. I think we
have an attitude toward the income of
the nurse that is left over from the past.
You still hear nurses talking about being
so badly underpaid that you would doubt
that they could support themselves. This
no longer is true. When our association
raised the fees, it raised them from $20 to
$35 a year. At that time, mainly through
the association's efforts at collective
bargaining, salaries had increased by $ 1 25
a month. Does it seem unreasonable that
out of a salary raise of $1,500 a year a
nurse must pay $ 1 5 a year more to her
association?
A look at membership fees for other
SEPTEMBER 1%9
professional associations shows that
nurses' fees tend to be low — especially
when you consider national and interna-
tional affiliation fees are included. At the
salaries nurses are earning now — some-
thing in the neighborhood of SI 25 a
week — I wonder if SI a week is too
much? Personally, 1 think it is not too
much to invest in your professional asso-
ciation.
But Just what does the professional
association do for its members?
Sociologists point out that professions
have three responsibilities: to enlarge the
body of knowledge that the profession is
based on; to press for higher standards of
personnel, education, research, and
practice; and to formulate goals. I can
only answer this question by saying why I
join and support my professional associa-
tion.
First of all, 1 believe in nursing. I want
it to go on. 1 see the professional associa-
tion as the group identity or image for
the professional.
As well, professional associations
provide the means whereby leaders are
brought forward. Professional associa-
tions are concerned with promotion of
the profession, protection of the mem-
bers, and policing of the standards. The
association speaks with authority for the
profession, it can take stands on public
issues and provide cohesiveness in actions.
The professional association also provides
a sense of identity for its members; it
gives a sense of accomplishment, a his-
tory.
I also see that it may serve as a kind of
pressure group to allow us to bring
pressure on governments and other
groups. The professional association
should set the goals based on the under-
standing and the knowledge of members
and unless I participate in the group, it
cannot know how I believe.
1 want to belong because a profes-
sional nursing association today provides
many services to the members — special
interest groups so that nurses in one
specialty can meet with others of the
same interest, legal services to members,
special kinds of insurance, professional
development and collective bargaining
services, to mention just a few.
1 joined my professional association
because to me it is important and mean-
ingful to demonstrate that I care about
nursing and nurses. Nursing is important.
Nurses are important. The fact that we
care is important.
In talking about the association you
SEPTEMBER 1%9
noted that professional nursing associa-
tions'goals have changed from 10 years
ago. What do you see for the future?
First of all, today the emphasis is
much more balanced. In the past, the
individual member of the profession was,
to a high degree, ignored. Now, associa-
tions are concentrating on this area so
that there will be a more effective practi-
tioner.
New goals for the future should be, 1
think, short term goals. The first, as I
have already mentioned, is to help the
individual member be a more effective
member of her profession. We need to
examine how she will be able to articu-
late, be involved, contribute, and gain.
1 also believe that associations are
going to have to look at education for the
practitioner. We are going to need to go
into this whole question of increasing the
competence of the individual nurse and
of offering continuing education in spe-
cialized areas. 1 see nurses with different
competences being developed in three- to
six-month postgraduate courses. Some
nurses are very fearful of this trend and
say that we are developing separate cate-
gories. I see it as a need. How are nurses
going to keep updated in everything
between now and 1 990 - when the first
hospital will go into space — unless we
provide special educational opportu-
nities? We have said that 80 percent of
our practitioners will come from the
diploma programs. Well, unless this diplo-
ma person is kept updated in the special
skills that make her an expert in giving
direct ongoing care, she is going to cease
being useful.
I also think our emphasis in the next
10 years is going to be on nursing
practice - affecting the quality of nurs-
ing care delivery, increasing the compe-
tence of nurses in specialized areas,
attempting to help nursing education and
nursing service communicate in a mean-
ingful way.
Maybe my other concern about the
nursing practitioner has been included in
these goals, but 1 also think that associa-
tions will have to help the total profes-
sion see a meaningful role for the general
practitioner. The general duty nurse has
moved into a field that 20 years ago was
staffed by students. Many of the attitudes
that we had about students giving patient
care were transferred to this new, well-
prepared practitioner. We did nothing to
evaluate the structure in which she work-
ed. This structure is even tighter today,
even more binding than it was. There are
more head nurses, more supervisors; we
have got our practitioners boxed in so
much that it is hard to see their role. At
present, the individual nurse can in-
fluence her environment very little and
yet we know that a professional person
should be able to influence her environ-
ment, to change the plan of care if it does
not meet the needs of the individual
patient.
I get concerned about the way the
staff nurse is involved in providing learn-
ing situations for students. We are critical
of the bedside nurse because she fails to
develop nursing care plans or set up
long-term goals for patients. I really
wonder how she can, when any day of
the week an instructor can come along
and say to the head nurse, "1 need these
kinds of experiences for my students so 1
will take this patient and that patient! "
The next day that general practitioner is
reassigned and loses contact with a partic-
ular patient.
Rarely do you find an instructor talk-
ing to a general duty nurse about her
plans for a particular patient. Rarely do
you find an instructor asking the graduate
which of three ways might be best for the
care of the patient: allowing the student
to have the patient on her own; allowing
the student to work with the graduate
while the graduate is giving care; or
recognizing that it is not appropriate for
the student to give care to the patient at
this time because of his particular needs.
A change in the attitude toward the
bedside nurse would raise her practice to
levels at which we almost do not believe
she can function - but she would sur-
prise us. We really need to see her as a
professional practitioner. She needs the
recognition. This is one area where pro-
fessional associations are just beginning to
work.
1 also think that the nursing association
are going to become more involved in
establishing a system of health care in
collaboration with other health profes-
sions and governments. This will also
involve an assessment of the role of the
nurse and how she relates to the other
health workers. Under what circum-
stances will she provide the direct care
and under what circumstances will she
provide supportive aid to other members
of the team? Associations will have a
major role in relating to the other mem-
bers of the health team in establishing the
roles and functions of the members. We
can no longer plan unilaterally. D
THE CANADIAN NURSE 35
Peruvian adventure
Each year many young Canadians travel to remote areas of the world to share
their knowledge and talents with those in less fortunate circumstances. A graduate
nurse provides a glimpse of life in the Peruvian sierras and explains the
philosophy that led her to embark on this adventure in living.
Many months have gone by since that
frosty February morning when I left
Montreal, feeling both excited and anx-
ious about the future toward which the
big DC -8 plane carried me. As a Canadian
University Service Overseas volunteer, I
had embarked on a new kind of life.
That evening we reached Lima, bask-
ing in the heat of mid-summer. I had
come to this city to study Spanish - a
language that I would have to use for the
next two years. The Peruvian govern-
ment, acting through CUSO, had chosen
me for this assignment. I was to be posted
to the Centro de Salud in Abancay, the
capital of the province of Apurimac in
the heart of the sierras.
A journey to remember
Six weeks later, although still far from
fluent, I set out with another Canadian
nurse on the Journey to our little corner
of the Andes. To reach it we had to go
through Cuzco, the archeological head-
quarters of Latin America. Historically,
this city goes back to the age of the Incas.
Relics of a civilization that continues to
excite admiration still remain; at the same
time the beauty of the present-day
Cuzco - its architecture, sculpture, and
handicrafts - fascinate the visitor. We
would have liked to collect samples of
everything we saw - colorful ponchos,
vicuna wool carpets, little statues of Inca
gods, tiny silver llamas.
What a trip we had from Cuzco! It
was the rainy season and during the night
36 THE CANADIAN NURSE
Danielle Daveluy
a large rock, loosened by the downpour,
crashed down the mountainside and com-
pletely blocked the one and only road.
To get around it we had to go on foot,
carrying our luggage, almost to the
bottom of a ravine, across a little river
and up a slope to the road where a
bus from Abancay had come out to meet
us to take us to the hospital.
Cuzco is only about 125 miles from
Abancay, but it took 12 hours to com-
plete the journey! We reached our desti-
Miss Daveluy is a 1967 graduate of Maisonneu-
ve Hospital, Montreal.
Peruvian mother nurst-i lu-t uai> v.
nation at 9:30 p.m. in pitch-darkness. We
were to go to the hospital at the other
end of the town, but the bus driver
refused to take us and there were no
taxis. So there we stood - two strangers
surrounded by 10 pieces of luggage, in
the middle of a poorly lighted street, in
an unfamiliar town, and with only a
meagre knowledge of the language.
A little boy watching us pointed out a
telephone just opposite to where we were
standing, and we went over to it. About
20 Indians sitting in a little house nearby
watched in complete astonishment. On
the phone, we tried in vain to explain our
A street in A bancay, capital of the province of Apurimac in Peruvian Andes.
'J
SEPTEMBER 1%9
arrival, but no one could understand our
gibberish. Finally a young girl who had
been listening to us came to the rescue
and helped us explain our predica-
ment — with success. Five minutes later
the hospital ambulance arrived with a
flourish to collect us.
A valley high in the Andes
Abancay is a small town situated in a
deep valley, 7,000 feet above sea-level. It
has a population of 15,000. Houses are
built of adobe bricks with red tile or
corrugated iron roofs. The people are
half-breeds — the offspring of unions
between the conquering Spaniards and
the native Indians. The Indians them-
selves live in the mountains, far enough
away that sometimes a two- to three-day
walk is necessary for them to come into
town.
The 1 50-bed hospital is new and com-
pletely furnished with German equip-
ment. It has a medical staff of eight
doctors and six nurses — four of whom
are members of a German rehgious order.
About 20 auxiliary workers, men and
women, complete the personnel.
I was assigned to the surgical
ward - a 40-bed unit that rarely has
more than 30 patients. In addition to
general surgery, we also care for patients
admitted to neurosurgery, ophthalmolo-
gy, otorhinolaryngology, and pediatric
surgery. There are many bum cases and
dermatological conditions here also.
Sometimes we even have mothers who
have to have Caesarean section, or women
with gynecological conditions. There is
much to be done, not only as far as
patient care is concerned, but also in
relation to educational programs for
patients and auxiliary workers. Occa-
sionally I must take my turn in the
operating room when major surgical
procedures are scheduled.
Beautiful black-eyed children
Generally the patients are peasants
- impoverished, dirty, and illiterate. On
admission the children look terrified and
defiant but in about two days time you
can win their confidence and their smiles.
They are lovely youngsters with big,
black eyes, tanned skins, and thick black
hair. When they smile at you, it can make
your day. Unfortunately, the dialect that
they speak, which was inlierited from
their Incan ancestors, is hard to learn
- which makes communication with
them rather difficult.
For the first few days I found life
rather discouraging. Every time I gave an
intramuscular injection, I broke the
needle. The Indians have very tough
SEPTEMBER 1%9
skins! Now, however, I am used to this
and the results are better. Quite often we
are short of drugs. As a rule the hospital
supplies them as few patients can afford
to purchase their own. Even solutions are
lacking once in awhile, and as for intrave-
nous equipment, when there are no more
sterilized sets, we boil used ones and
make the best of a bad situation.
On the evening of my arrival in the
hospital, I had been intrigued to read a
sign on one door: "banco de sangre." I
opened the door and there was the blood
bank — an undraped stretcher, an empty
refrigerator, a tourniquet, and some al-
cohol sponges. And that tells the story of
blood donations in this country.
Upper class patients have no problem.
Auxiliary workers and even the doctors
will happily part with a pint of their
blood since they receive $15 per transfu-
sion. Alas, when a poor penniless Indian
needs blood, all of the auxiliary workers
disappear. Fortunately, about 90 percent
of the persons on whom blood grouping
is done are universal donors.
A fatalistic outlook
These people are extremely fataUstic
in their outlook. Many die alone in their
little cabins, without coming to the hos-
pital or seeking medical attention because
they feel that if their number has been
called, no one can help. They believe that
it is their fate to be poor, ignorant, and
sick and so they do nothing to try to
overcome their disadvantages. This fatalis-
tic mentality is carried on from genera-
tion to generation.
My friend was put in charge of the
maternity service, which included both
obstetrics and gynecology. Indian women
of all ages, some barely 1 5 years old, have
their babies easily without anesthesia or
midwife assistance. In cases of home
delivery, several mothers usually appear
at the hospital about a week later with
complete or partial placental retention.
Almost all curettages are performed with-
out anesthesia.
A great many children are admitted
suffering from a type of malignant hepati-
tis peculiar to Abancay. The cause is
unknown. All of these children die after
one or two days of delirium and convul-
sions.
Other children are hospitalized with
malnutrition - qualitative and quantita-
tive - of varying degrees of severity.
Since they eat only soup and rice, pro-
tein, vitamin, and mineral deficiencies are
common. Mothers breast-feed the child-
ren until they are one-to-two years old
(or until another baby comes along); the
mothers, too, are undernourished.
Tuberculosis in all forms is prevalent
in the sierras, affecting adults and chil-
dren alike. I have encountered two pa-
tients with tetanus already. One man was
brought in with an open fracture of the
leg that was simply crawling with mag-
gots. I have seen children following ap-
pendectomy vomit tape-worms about 10
inches long. I have seen a man come to
visit his dying father accompanied by a
tailor who proceeded to take measure-
ments for the burial suit.
On a less serious note, I have tasted
beef stomach and tripe soup (which we
have once a week at the hospital) and,
believe me, our good old pea soup then
looks like food fit for a king.
In contrast to this rather sombre
picture, many patients leave hospital
cured and with a smile on their face.
They are the majority.
Pros and cons
Even after all these months, it is hard
for me to define the motives that prompt-
ed me to leave friends, work, and country
to come to an environment so different
from everything I had known, and to
work under frequently difficult condi-
tions. What has been accomplished during
the past two years will not be lost, but
what of the future after I leave?
As soon as I turn my back, the
auxiliary workers will forget all about
asepsis and even ordinary cleanliness.
They will become negUgent, impatient
with the Indians, as soon as I am no
longer there to supervise them.
I know, too, that the patients whom
we have cured through faithful care will
return again suffering from something
else, or they will die in their homes
because they failed to return. For what or
for whom has the past two years of effort
been made?
One answer to this was provided by a
volunteer worker in the mission. He
pointed out that those whom 1 had cared
for, helped, and loved would, in all
probability, not have received such atten-
tion otherwise. Perhaps they believe now
in the brotherhood of man. If even a
handful of people are warmed by this
thought, my time in Peru will not have
been in vain.
Another answer is found in the CUSO
motto: "Volunteers learn while serving."
They learn that man, regardless of cli-
mate, color, financial standing, or learn-
ing is still man, sharing the same great
emotions — love, hate, fear, anxiety.
Wherever he may be in the world, what-
ever may be his culture, the color of his
skin, or his mentality, he is worthy of
being loved. ^
THE CANADIAN NURSE 37
Family health service:
the PHN and the GP
In January 1967, a special research project began in which public health nurses
worked with private doctors to provide better care for patients. In |uly 1968,
an article in The Canadian Nurse described this project. This article reports
on how the project has developed.
Phyllis E. tones and Doreen M. Bondy
A private practitioner was having a
problem with a family under his care. A
20-year-old, multi-handicapped girl in a
wheelchair was living with her parents
and two younger brothers. All were de-
pressed by the situation and many were
the visits and phone calls made by the
doctor.
The parents of the young girl said they
wanted her placed in a suitable institu-
tion; the girl herself agreed this would be
best. However, all were troubled. Was this
the best solution? And, besides, just
what kind of facilities were available?
This doctor turned for help to a public
health nurse who worked with him. She,
too, began visiting the family.
The doctor and the public health nurse
pondered the question together. They
discussed various possible solutions.
Finally, they decided that, because the
family had previously attended the
Mental Health Clinic, the clinic personnel
should be consulted about this new crisis.
A clinic psychiatrist visited the home.
Although the nurse was not able to go to
the home with the psychiatrist, she met
him shortly afterward to discuss the
patient's situation. During the discussion,
she invited him to come with her to see
the family doctor.
As a result, the family doctor and the
nurse did the counseling of the parents
and the girl under the guidance of the
psychiatrist.
Eventually, the young lady was ad-
mitted to a hospital for the chronically
38 THE CANADIAN NURSE
ill. The nurse visited her there after she
was admitted and found her happy and
animated, enjoying the companionship of
her roommates, and interested in her
occupational therapy program. She met
the mother, too, during that visit and
scarcely recognized her without the one-
time haggard look. All this was achieved
through the guidance and support of a
team of private doctor, public health
nurse, and community psychiatrist.
No fairy tale
This kind of cooperation really exists.
It is just one example of the coordinated
effort facilitated by the presence of the
research project nurse.
The project,* jointly undertaken by
the Borough of East York Health Unit,
the University of Toronto School of
Nursing, and six general practitioners, was
designed to use existing public health and
*The project was assisted by a Public Health
Research Grant
Miss Jones, a graduate of the University of
Toronto School of Nursing, is Associate Pro-
fessor of Nursing at the University of Toronto
and Director of the "Special Public Health
Nursing Project" in East York.
Mis. Bondy, a graduate of the Royal In-
firniary, Aberdeen, Scotland, is a public health
nurse with the Borough of East York Health
Unit.
private medical practice arrangements
with only minor modifications. Public
health nurses employed by the local
health unit were assigned to work with
designated private physicians and to pro-
vide public health nursing service to
families receiving medical care from these
physicians.
This project was designed to explore
one way to close the gap in communica-
tions between two community health
workers the public health nurse and
the general practitioner. Both have the
same focus of interest: the health of the
family. The overall aim was to examine
the feasibility of seconding public health
nurses employed by a local health depart-
ment to work with designated general
practitioners. To achieve this aim, three
objectives were stated: to determine the
cost to the agency of assigning public
health nurses to private medical practice,
to examine requirements for nursing serv-
ice of patients receiving medical care
through private general practitioners, and
to identify factors contributing to com-
munication between private practitioner
and public health nurse.
A previous article included some pre-
liminary observations and posed some
questions about the project. ■" This article
updates some of the findings and observ-
ations and discusses some of the implica-
tions - such as the relative responsibili-
ties of the family doctor and the com-
munity nurse within the framework of
present conditions.
SEPTEMBER 1969
The elderly account for a high number of
Evaluating the project
During the two years the project has
been underway, three general practi-
tioners and one public health nurse have
been involved full time and an additional
three general practitioners and one other
public health nurse have participated for
shorter periods of time. These variations
resulted from changes in personnel during
the life of the project.
Sources of data include the referral
form completed by the physician for each
request for nursing service; the nursing
service record for each family; an analysis
of a sample of nursing time and activity;
and comment from participants.
During the two years, 484 persons
were referred by the doctors for nursing
service. This represents an average of 60
referrals per year per doctor. Analysis of
this total by selected age groupings re-
veals that more than three-quarters were
adults over 20 years of age, and only 14
percent were under school age. (Table I).
Medical findings associated with refer-
rals for nursing service were classified
using the International Classification of
Diseases.2 This revealed that the largest
number of total referrals, 38 percent,
were related to maternity; 26 percent
prenatal and 1 2 percent postnatal teach-
ing. This explains the large proportion of
patients in the 20- to 44-year-old group in
the table. It also means that there was a
much greater nursing contact with infants
than the table suggests, since mothers
referred during the prenatal period had
SEPTEMBER 1%9
referrals, and often are most in need of care.
nursing supervision postnatally for as long
as required.
The prenatal and well baby referrals
were a source of great satisfaction to the
public health nurse. Knowledge of the
doctor's routines and expectations made
her teaching more meaningful. The pa-
tients were very accepting of their "doc-
tor's nurse" and frequently called her
directly. One of the earliest referrals for
nursing service was to an expectant mo-
ther who was failing to keep her appoint-
ments. She has become a "regular cust-
omer" and recently even called the nurse
when she was bleeding heavily following
insertion of an intrauterine contraceptive
device. The nurse reassured her, then
hastily called the doctor for her own
reassurance!
Twenty-two well preschool children
were referred to the public health nurse
for guidance in normal development and
behavior. If these are added to the group
of expectant and new mothers, it means
that 43 percent of referrals were for
nursing service to essentially well indivi-
duals; it also means that a large group of
young families had access to nursing
supervision over a period of weeks or
months while learning new roles and skills
in family life.
The elderly also accounted for a high
proportion of referrals. As will be seen in
the table, 27 percent of patients were
over 65 years. It is not surprising, there-
fore, to find that the medical findings,
other than maternity and preschool, show
relatively large proportions classified as
mental and personality disorders (II
percent), circulatory diseases (8 percent),
diabetes (6 percent) and senility (6
percent), all commonly associated with
aging.
Reasons for referral of the elderly
varied from short term needs, such as
making arrangements for homemaking
services and supervision of medications in
acute illness, to long term needs, such as
helping prepare the patient for more
sheltered care in a nursing home, chroni-
cally ill hospital, or home for the aged.
Discussions between doctor and nurse
fostered close collaboration, not only in
the approach to the patient who so often
is unaware and unaccepting of the need
for more care, but also in making appro-
priate arrangements for care.
TABLE I
Referrals For Nursing Service, 1967-68:
According To Selected Age Groups
Age Group
Number of
Referrals
Percentage
Under 1 year
1 - 4 years
5—14 years
15 - 19 years
20 - 44 years
45 - 64 years
Over 65 years
35
34
18
22
196
49
130
484
7.23
7.02
3.72
4.55
40.50
10.12
26.86
100.00
THE CANADIAN NURSE 39
Other types of referrals included those
to newly diagnosed diabetics (about 6
percent of total referrals) and to pre- and
postoperative patients. These people have
been well counseled by the doctor, but
because of their emotional turmoil often
experience further confusion and anxiety
at home. This anxiety is alleviated by an
early nursing visit during which needs can
be anticipated and questions answered.
Liked by all participants
In the opinion of the majority of
participants, the greatest value of the
project to patients has been the teaching
and counseling function of the nurse; this
has led to greater assurance on the part of
the patient in carrying out his medical
regime. Participating doctors found that
these functions were also of value in their
management of medical care. Also noted
by the majority of doctors as useful was
the increased knowledge of the family
and home situation brought to them by
the project nurse through her skills in
assessment of health and related prob-
lems.
An important part of the project
nurse's function could be classified as
liaison or coordinative. Her knowledge of
community resources and how to mobil-
ize them was constantly used; in fact,
about 7 percent of project nursing time
was devoted to consultation with other
agencies and with co-workers on behalf of
patients. The case story of the multi-
handicapped girl given at the beginning of
this article is but one example of coordi-
nated effort.
Referrals such as mental retardation in
children, alcoholism, mental health or
marital problems were likely to require
the service of other agencies. The doctor
might want more detail about the agen-
cy's policies or the nurse might suggest an
alternative service or arrange to gather
more information.
Because of these discussions the doc-
tor and nurse sometimes decided that a
home visit was not indicated at that time.
Alternatively, such as with the elderly
person who had called the doctor's office
confused about the taking of prescribed
medication, a visit from the public health
nurse was frequently more appropriate
than the doctor's house call.
Although the project was not designed
to measure the effectiveness of the result-
ing service, in the judgment of all partici-
pants the closer working relationship bet-
ween these two personal health care
workers was of value to patient care. The
consistent communication between the
physician and the nurse allowed an ex-
change of ideas and a pooling of their
assessments of the patient, the family,
and the social situation. This led to a
more concerted approach to the manage-
ment of health problems.
Joint planning activity, together with
the nurses' skills in teaching, assessing
health needs, and mobilizing and coor-
40 THE CANADIAN NURSE
dinating community resources, permitted
the doctor to extend his treatment of
patients. In the words of one doctor: "In
certain areas, the quality of medical care
has been improved because of better
continuity and because of an increased
emphasis on social and preventive aspects
of medical care as provided by the visits
of the public health nurse."
The interchange between doctors and
nurses necessary for this joint planning
activity was readily achieved through
regular weekly face-to-face discussions,
through ready doctor-nurse accessibility
at other times, and through sharing of
medical and nursing records. Approxi-
mately 10 percent of project nursing time
was spent in these activities of relating to
the doctor and his office and records.
Doctors estimated that conferences with
nurses required about 45 minutes to one
hour per week; they believed that this
was more than made up by the efficiency
with which certain problems could be
handled.
Other factors indicated that this in-
vestment of time may have resulted in an
overall saving of time for doctor, nurse,
and patient: doctors noted that telephone
calls from anxious patients decreased
when there was contact with the nurse;
house calls or home visits by doctor and
nurse could be planned to complement
one another; and, when families had the
doctor's orders explained and reinforced,
they were better able to accept these and
take action sooner.
Implications of the project
These observations, selected from the
findings of this demonstration, suggest
that a significant part of private general
practice can benefit from appropriate
public health nursing skills. No new tasks
were added to the public health nurse's
function except that of working as a
colleague of the doctor. All participating
doctors employ office staff with varying
background; this office staff continued to
assume responsibility for managing the
office and assisting the doctor just as they
had done prior to the project. Relation-
ships between office staff and public
health nurses were constructive and help-
ful. The one dimension that was added by
this project was the closer doctor-nurse
working relationship.
The nursing functions of teaching,
counseling, assessing, and coordinating
were judged to be of value to the patient
and family and to their medical manage-
ment. For definitive answers to the
vexing question of relative effectiveness
and resulting costs, much more study is
required. However, in the light of present
knowledge and conditions, it seems likely
that increased collaboration between
private doctor and community nurse is
both possible and highly desirable.
The findings that the public health
nurse's skills were most used in dealing
with the expectant and new mother and
in the management of illness of a long-
term nature are not inconsistent with the
findings from other sources .3 -6 These
two groups make up a large proportion of
the population and account for a large
part of the utilization of health care
services. Since much of the management
of the health problems of these two
groups involves measures aimed at main-
taining health and preventing further ill-
ness and complications, public health
nursing skills seem very appropriate for
this aspect of ambulatory or out-of-
hospital care. It seems likely, too, that
the public health nurse's "family advisor"
functions and her knowledge and prevent-
ive approaches can be most effective if
closely aligned with the family doctor's
skills in clinical medicine.
The change made by the health
unit — that of assigning one public
health nurse to work with the patients of
a number of doctors rather than to a
territory - was the largest factor in
making communication easier between
the private practitioner and the public
health nurse. It is equally clear that the
consistent contact between these workers
has vastly improved their communication.
Whether or not formal arrangements
exist for these closer working relation-
ships between the private doctor and
community agencies such as the health
department, better communication bet-
ween individual nurses and doctors
obviously can do much to complement
their work in providing health care in the
community.
References
1. Jones, Phyllis E. The public health nurse and
general practice. Canad. Nurs. 64:7, July,
1968, p.43-44.
2. World Health Organization. International
Classification of Diseases. Geneva, World
Health Organization, 1955.
3. Ford, P.A., Seacat, M.S., and Silver, G.A.
The relative roles of the public health nurse
and the physician in prenatal and infant
supervision. Amer. J. Public Health. 56:7,
July 1966, p.1097-1 103.
4. Lindberg, H.G. and Carlson, B.V. A public
health nurse in the private physician's office.
Nurs. Outlook, 16:4, April, 1968, p.46-48.
5. Rogers, K.D., Mally, M., and Marcus, F.L. A
general medical practice using non-physician
personnel. JAMA 206:8, November 18,
1968, p.1753-57.
6. Seacat, M. and Schlacter, L. Expanded
nursing role in prenatal and infant care.
Amer. J. Nurs. 68:4, April, 1968,
p. 822-824. n
SEPTEMBER 1%9
Helping the patient
face reality
How ridiculous to assume that a nurse can don the cloak of a psychiatrist, social
worker, or psychologist and intensively counsel patients with emotional conflicts
related to their illness. However, recently an opportunity to work with a medical
patient helped this student see this grey area of nursing a bit more clearly.
Preparing to live with a medical condi-
tion, or facing the prospect of a short-
ened life expectancy, forces patients to
undergo varying degrees of psychological
stress as they struggle to cope with the
reality of their altered health status. In
this situation, it is most definitely a
nurse's responsibility to help patients
make this difficult adjustment.
I was working on a medical floor
where hospitalization is lengthy and
where doubts, fears, and anxieties almost
invariably affect an individual's health.
This opportunity helped me to realize my
role as a therapist intensely involved with
the emotional conflicts as well as the
physical aspects of patient care.
My patient was a 53-year-old Irishman
who had had tuberculosis 30 years ago
and a recurrence one year ago. He had a
history of bronchiectasis, and his more
recent condition was emphysema.
The present hospitalization was ini-
tiated by a severe dyspneic attack and
while in hospital he had undergone a
glomectomy (carotid body excision).
Although the reason is unclear, removal
of this chemoreceptor respondent to oxy-
gen, carbon dioxide, and pH blood levels
has, in some instances, been known to
relieve dyspnea. In this situation, how-
ever, no positive results followed. When I
was assigned to Mr. Smith,* it was five
days after his operation and he was
waiting for transfer to a chronic hospital.
*Pseudonym
SEPTEMBER 1%9
Gail A. Arnold
Observing
Before 1 ever met my new patient, a
picture had begun to be formed. Most
certainly, we should rely on the patient
himself for our perceptions, but often the
concepts that contribute to the picture
begin with the observations at the desk.
How does one observe? I suppose that
our eyes see and our minds make little
notations; often the notation does not
reach our conscious thinking until further
evidence is brouglit to support it.
My observations of Mr. Smith's case
went something like this.
Reading the Kardex: emphy-
sema — could be caused by allergy, in-
fection, emotional factors; unsuccessful
glomectomy - a serious disappointment
for the patient; Staff doctor - no family
doctor, is he alone? ; occupation writ-
er - intelligent, emotional, sensitive.
In the hall: stopped by staff member
before reaching room: "You'll be lucky if
he lets you make the bed. Best to leave
him alone." - I had no thought, just
two raised eyebrows.
//; the room: "no visitors" sign on
door - but he was five-days post-
operative; clothes on chair (bright greens
and blues to be worn together) — hardly
the conservative type. . .; clock on table
Miss Arnold, a second-year student at the
Nightingale School of Nursing, Toronto, pre-
pared this article as a patient care study on
support for a patient with a long-term illness.
(small white with little red flow-
ers) - hardly a 'Brutus' either; type-
writer on overbed table - still interested
in his work.
On seeing the patient: lying in bed
with no clothes on - I've never had a
patient who didn't wear a gown or
pajamas.
During the day the picture of Mr.
Smith became clearer. He was a short,
rather effeminate-looking man with
straight, quite long hair that seemed to
have been dyed - possibly for acting; he
appeared indifferent to company and
stated he would rather be alone. He did
not want to get up from a "sleeping"
position, lying on his left side, curled
slightly, his hands under the pillow and
his exposed ear always covered with a
radio speaker. Whenever I entered the
room he seemed to be asleep, but my
suspicions asked if he were not merely
avoiding personal contact.
He seemed disinterested in his ap-
pearance, with no desire to dress, wash,
or shave, and refused to be assisted with
these. When he spoke, he used affected
tones; every statement was dramatized
and dashed with a pinch of humor that
kept the conversation a breezy distance
from serious reality. For each little pro-
cedure I carried out (not mucii more
involved than passing him his medication)
I was overly thanked, and whether I was
speaking or being spoken to, Mr. Smith
never looked at me.
THE CANADIAN NURSE 41
Responding
The most effective way one can relate
to another person is to be natural; then
genuine interest and honesty are easily
conveyed. The natural response to Mr.
Smith's "put-off was to be somewhat
annoyed. This then was the basis for my
reaction; I was more firm and matter-of-
fact, and just as persistent as he was. I
thought that in this way he could not
help but see that I was not as much
interested in his wit as I was in him as a
person.
According to Fiedler, the elements
that characterize a good therapeutic re-
lationship are an ability to understand
another's meanings and feelings, a sensi-
tivity to his attitudes, and a warm interest
without emotional overinvolvement.**
Interacting
Since relationships are built upon in-
teraction, I shall try to give you a few
significant snatches of our conversation in
which I think Fiedler's three elements can
be identified.
During my first afternoon with Mr.
Smith, I sat by his bedside for about
seven minutes while he "slept," then
softly said, "I don't disappear until mid-
night." He alertly opened his eyes and
muttered "Bloody leprechaun! "
We talked briefly and he began to
continue with "thanking." I said, "Mr.
Smith, someday I will discover what you
mean when you say 'thank you'."
The next morning we had the same
difficulty establishing contact. I reminded
him of our bargain from the day before:
"I'll find you a hot cup of tea - you let
me make your bed," but he "slept" in
silence. Snatching the back of his menu, 1
tried to imitate his prosaic phraseology:
Arise good sir.
Pay tribute to your liege lord nurse.
She maketh tea to come at ten.
Get thee hence upon thy chair
I will anew thy linen fair!
I placed this in his hand with his
glasses and walked out of the door
commenting, "I'll be back here in ten
minutes." On my return he was sitting on
the chair. "You don't stand for much
nonsense, do you, Miss Dragonfly? I
hope you don't have any ideas about a
great future in poetry writing."
Gradually he made it known to me
that he feared being "shipped off to a
chronic hospital. He showed little factual
knowledge of his condition other than it
♦♦Fiedler, F.E. Quantitative studies on the role
of therapeutists' feelings toward their pa-
tients. In Mowrer, O.H. ed. Psychotherapy:
Theory and Research. New York, Ronald
Press, 1953, ch. 12.
42 THE CANADIAN NURSE
being "incurable." Related to this was his
frustration at having to be dependent
upon the medical profession. He seemed
frightened and alone.
Relating
As we got to know each other he still
tried testing me periodically. Two morn-
ings he asked me to phone physiotherapy
and say he was "not up to going" that
day; I did this for him. On the third day
when he asked, I showed my unwilling-
ness by asking him to verbalize his rea-
sons. "Okay, okay. I'll go to the damn
place! " Thereupon, I picked up the
phone and said, "Hello, this is eighth
floor calling to say Mr. Smith will not be
down for physio today."
"What? I just said I'd go! " he inter-
jected.
"Mr. Smith, I don't need physio-
therapy. You don't have to do anything
for my sake," I replied as 1 left the room.
The next week he went without a
reminder.
Relationships, both personal and
professional, are never formed at one
given time. Unless they continue to grow
and change, they cease to develop and fail
to be of any value to either person.
To provide the necessary nutrients for
this developing process, there have to be
various degrees of interaction on both
sides. This is not always 50-50; some-
times, as in a helping relationship, it is
85-15.
Looking back at the physiotherapy
incident, I think that for me to have
unquestioningly complied with Mr.
Smith's wishes would have kept us fur-
ther away from our goal, to help him take
a positive approach to his condition.
Although prior to this we had made big
steps, it was only a beginning; we were
not relating but we had provided a
channel by which we could both view our
common goal and together try to achieve
it. In other words, we were communicat-
ing.
It was not until we were both on this
road that Mr. Smith could accept a more
concrete form of support. This took the
form of working out a regime with which
he could familiarize himself while in
hospital. At a chronic hospital he would
most likely be given a more elaborate
plan of exercise, activity, postural drain-
age, and other treatments. The important
thing while he was in my care was the
establishment of positive goals that he
could take with him.
In the apparent trivia of our daily
relationships lay the determinent of
whether Mr. Smith would be "shipped
off to a chronic hospital, or whether he
would instead be going with the desire to
make the most of his life within the realm
of his capacities.
One afternoon, Mr. Smith accepted
my invitation for a walk down the hall.
To my knowledge he had not been out of
his room for three weeks. He walked the
hall twice without dyspnea, visited ano-
ther patient briefly, and suggested we sit
in the lounge. I left him in an armchair
with a cup of tea and a magazine and
returned an hour later to find him con-
versing with another patient. Had he not
taken a big step from his apathetic
attitude of several days ago?
Moving on
Between this time and his discharge,
Mr. Smith was given some literature on
his condition and his doctor discussed
emphysema with an approach relevant to
his oncoming plans for entering another
hospital.
The morning he was to leave, Mr.
Smith was somewhat dyspneic and obvi-
ously frightened, but he left with a smile
to my wave. I hope he was equipped with
a foundation firm enough for him to
make a healthy physical and mental
adjustment. D
SEPTEMBER 1%9
It's depressing!
There is considerable evidence that being in hospital may cause depression.
In this article, a psychologist speculates on the nature of depression occurring in
patients in hospital.
C.G. Costello. Ph.D.
It is generally accepted that hospital-
ization - especially hospitalization for a
serious illness - may produce consider-
able depression in a person. However, the
ways in which such depressions may be
understood and modified seem to have
been neglected in research.
Research has centered on the more
severe forms of depression, but, unfor-
tunately, the conclusions of investigations
into these severe depressions cannot be
extrapolated to mild depressions. Both
clinicians and researchers have assumed
that there is something qualitatively dif-
ferent between "normal" depression and
the depressions of psychiatric patients.
Severe depressions have been considered
to be due to a disease process of some
sort, and emphasis has been placed on
somatic treatments. As a result, little
work has been done on the behavioral
analysis of depression.
Studies of severe depression - of
psychiatric depression - are therefore of
little use to nurses in understanding the
mild forms of depression common among
patients on general wards. But it is hoped
that the following discussion - of neces-
sity a speculative one - of two theories
in psychology might help us to under-
stand the nature of these mild forms of
depression.
Dr. Costello is a professor in the Department of
Psychology, University of Calgary. Other of
Professor Costello's articles - mainly on
nursing education - have appeared in The
Canadian Nurse.
SEPTEMBER 1%9
Sarbin's theories
The first theoretical system to be
discussed is the one described by Sarbin.i
He is concerned with the effects of a
person's social status and his role per-
formance in that status on his behavior,
both adaptive and maladaptive. (The term
"status" is used in the sociological sense
of being equivalent to a person's position
in a social structure.) He distinguishes
between ascribed statuses and achieved
statuses. Examples of ascribed statuses
are: mother, adult, male, female; exam-
ples of achieved statuses are: Member of
Parliament, pop singer, voter.
The most important difference be-
tween these two types of status is that
one does not choose to occupy an ascrib-
ed status - or at least the element of
choice is small; in achieved statuses there
is a considerable element of choice. A girl
cannot choose her female status and may
have only a small element of choice over
her status as a housewife; she can, how-
ever, choose whether or not she will
occupy the status of a pop singer or an
athlete.
A second important difference follows
from this one. This difference concerns
the evaluations placed on the role per-
formance. The evaluations placed on per-
formances in ascribed statuses tend to
vary from neutral to negative. For in-
stance, the housewife, occupying an
ascribed role, can be severely criticized if
she does not perform her role adequately.
On the other hand, she receives very little
in the way of praise or reward for good
performance of the role. This, of course,
THE CANADIAN NURSE 43
may explain the frustrations experienced
by many women occupying the house-
wife status and seems to be far more
likely than the usual one suggested that
"her work never finishes." If the intermi-
nable nature of the work were the impor-
tant factor, then one could not explain
why many housewives will both hold a
job outside the home and also fill the
housewife position, and in so doing be
much happier.
We can explain this greater happiness
of the working wife, if we consider the
evaluations placed on role performance in
achieved statuses. Here they tend to go
from neutral to positive. Because one
chooses, for instance, to be a member of
a committee (in this heyday of commit-
tees the choice even in this regard is
becoming increasingly smaller - but
that is another matter), poor performance
or even absence from some committee
meetings receives very little in the way of
criticism. Good performance, on the
other hand, can receive considerable
praise.
There is a third important difference
between the two kinds of statuses. An
ascribed status involves a considerable
period of time. One is always male or
female, always a mother or a father. An
achieved status, on the other hand, need
only occupy us some of the time. Being a
committee member may involve only a
small portion of our time. Being a nurse is
not a full-time job. As a result, one can
move from one achieved status to another
if things are not going too well. One can
also simply pull out of an achieved status
for a time as on a holiday. This cannot be
done in the case of ascribed statuses.
Occupancy, then, of an ascribed status
is something from which we can get little
if any relief and also something which
brings us little or nothing in the way of
reward or praise, but may bring us blame
and punishment.
Sarbin has not discussed the relevance
of his system for depressive states. His
purpose has been mainly to use the
theory in an attempt to understand why
poor, deprived people have a tendency to
have more serious psychiatric diagnoses.
He suggests that the cognitive strain
involved in occupying only ascribed sta-
tuses may be the most important factor.
For instance, it is because the youth in
the slum does not have a job and there-
fore never receives praise or reward for an
achieved status that he is likely to engage
in socially unacceptable behavior.
Implicitions of the theory
for patients
This theory might have relevance in
44 THE CANADIAN NURSE
relation to the depression that occurs in
people entering hospital. The hypothesis
would be that there is a transformation of
their social identity. More specifically,
the person loses his achieved statuses -
at least temporarily - and occupies
only the ascribed status of patienthood.
It may be argued that a person chooses to
enter a hospital, but since admission into
hospital is the logical outcome of certain
illnesses, in practice there is very little
choice.
A person, then, who might have oc-
cupied a number of achieved statuses
with their potential for rewarding conse-
quences now finds himself occupying one
full-time ascribed status with no opportu-
nity for any real reward. Comments by
the nurse to an adult patient that he or
she is the "best patient she has ever had"
are not likely to be considered particu-
larly rewarding. It is likely that comments
or indications from the nursing staff that
the patient is not behaving as he should
are hkely to be far more impressive.
It is true, of course, that there can be
some maintenance of achieved statuses in
hospital. The businessman may still be
able to make some decisions concerning
his business. One would expect that to
the extent that this can be done, the less
the probability of the development of
depression. The little-rewarding, ascribed
status of patienthood is still likely to be
predominant in the person's awareness,
however. This is particularly so, of
course, on terminal wards, when relatives,
friends, and business colleages begin to
pull away from the dying person.
It miglit be expected that the depres-
sion occurring due to the transformation
of social identity would be less for those
patients who, before admission to hospi-
tal, occupied only ascribed statuses such
as the unemployed or aged. Evidence
presented by Glaser and Strauss,2 sug-
gests that nurses are far more disturbed
when a person occupying highly-valued
achieved statuses is dying. This disturb-
ance seems to be due to awareness of the
social loss involved.
Application to the dying patient
The occupancy of a social status
implies certain expectations on the part
of the occupant and of others concerning
the behavior of the person in the status.
These are what are known as role expect-
ancies. It is generally known by adminis-
trators that confusion concerning the
status of individuals in an insti-
tution - which in turn results in confu-
sion concerning the behavior expected of
the individuals - can present one of the
biggest administrative headaches. It might
be expected, therefore, that similar prob-
lems would result when there is confusion
on the part of either patient or nursing
staff concerning whether or not the pa-
tient is dying.
We have suggested that the ascribed
nature of patienthood is particularly clear
when the patient is dying. Here there is
no choice at all and inevitably one faces
termination of all achieved statuses. For-
tunately, man is able to adapt to his
circumstances. It would seem hkely that
most people can adapt to the thought of
dying. Hinton's^ review of the literature
indicates that people, whether or not
they are terminal patients when inter-
viewed, would generally prefer to know if
they are dying; 80 to 90 percent of the
persons interviewed expressed this wish.
Where there is no clear awareness on
the part of the patient as to whether or
not he is dying and when the nurse is
struggling to prevent imparting cues to
him about his dying status, not knowing
herself just how aware he may be, there is
no opportunity for adaptation to any
status. This lack of opportunity for adap-
tation, plus the strain for both patient
and nurse and the suspicion and mutual
pretense, would seem to provide most
undesirable circumstances for a person's
last period of time on earth. Nevertheless,
Hinton's study also indicates that 80 to
90 percent of physicians are against tell-
ing the patient that he is dying. It does
not seem that a study has been done on
nurses' feelings with regard to this. This,
of course, is something that should be
done because it is the nurse, spending far
more time with the terminal patient, who
must bear the brunt of any ambiguities in
the situation.
Ferster's theories
There is a second theoretical system,
proposed by Ferster, on the way in which
depression may occur.^ His theory also
suggests ways in which the depression of
a patient may be modified.
Ferster suggests that reduction in a
person's performance is one of the most
characteristic aspects of the depressed
condition. He notes that animal experi-
mentation shows three conditions under
which performance may be reduced:
1 . When a large expenditure of effort
is needed to produce any change in the
environment. Ferster gives as an example
the salesman who has to visit many, many
customers to get even a few sales. When
the ratio of selling behavior to sales gets
too large, he will soon stop trying. Simi-
lariy, any attempt of a patient to con-
tinue performing his roles in an achieved
status after entry into hospital will in-
SEPTEMBER 1%9
volve very much more effort and perhaps
so much effort that the person will stop
trying.
This principle may also help us to
understand how depression may result
from the illness itself rather than from
the status of patienthood. For instance,
the person who becomes handicapped
through amputation will probably have to
put considerably more effort to perform
satisfactorily certain behaviors than he
had to do previously. Once again the
effort may be so great that the person
will give up trying.
Certainly it would seem to give us
more understanding of the disturbance of
the handicapped person to think in terms
of greater expenditure of effort required
than to think in terms of distorted body
images. Seeing the problem as due to a
distortion of body image does not pro-
vide either the patient or the nurse with
the means of alleviating the disturbance.
Recognition that increased effort is the
important factor enables them both by
proper spacing of activities and by maxi-
mizing feedback of success to offset the
problem to some extent.
2. When conditioned aversive stimuli
precede an aversive event. It may be
worthwhile to consider how this principle
can be demonstrated in the animal labora-
tory. First of all. the animal learns to
press a lever to obtain food. When this
behavior has become firmly established,
the animal in another situation then
experiences the association of a buzzer
and an electric shock, the buzzer always
preceding shortly the onset of the electric
shock. In this way. the buzzer soon
becomes a conditioned aversive stimulus.
If now the animal is put once again into
the bar-pressing situation, and the buzzer
is sounded, the animal will not press the
bar even though it is very hungry. It can
be shown that the animal has not for-
gotten the response of bar-pressing be-
cause it will begin to press the bar if the
buzzer is not sounded.
It is likely that many of the stimuli for
a patient in hospital are conditioned
aversive stimuli. These may be stimuli
such as hypodermic needles that have
been associated with painful sensations.
For the terminal patient many of the
stimuli may be associated with the ap-
proaching death. It is not surprising then
that many of the learned behaviors, such
as eating, reading, talking, may be sup-
pressed by the presence of these aversive
stimuli.
So that these well-learned behaviors
can once more be performed, it would
seem necessary to reduce as far as possi-
ble the presence of any conditioned
SEPTEMBER 1%9
aversive stimuh associated with the ill-
ness. This, of course, is a good argument
for the absence of nursing uniforms and
any rituals that may serve as reminders of
the aversive events.
2. When there is a sudden major
cliange in the environment. Ferster re-
ports that under certain conditions a
sudden change may virtually denude an
individual of all his past learned behavior.
"The secluded elderiy spinster lady, for
example, may lose her entire repertoire
on the death of her close companion
because each person's behavior was nar-
rowly under the control of the other."
There are obvious links between this
principle and Sarbin's ideas concerning
the transformation of social identity. It
may be expected, for example, that the
businessman who has chosen to occupy
his achieved status as an executive for
most of his waking life will find himself
at quite a loss on entering hospital. This is
so because his behavior has been deter-
mined almost completely by stimuh asso-
ciated with his position as an executive.
Generally, it may be said that the more
restricted the stimuli are that control
behavior, the greater the loss of behavior
on removal of the stimuli.
We can also use this principle in the
understanding of the depressions recur-
ring from the illnesses themselves. In the
case of an amputee, for instance, we not
only have the loss of effective stimuli
from those parts of the body now lost,
we also have the loss of the stimuli-
maintaining behavior in those situations
which the handicapped person can no
longer enter.
Implications for nursing care
Depression occurring in patients on
entering hospitals thus may be best un-
derstood as a drastic reduction in per-
formance as the result of changes in the
patient's environment. To alleviate the
depression, the nurse needs to establish
new behaviors in the patient or to elicit
old behaviors once more. This may be
done by encouraging relatives and col-
leagues to maintain for the patient some
of his achieved statuses.
A patient's skills may be used in
relation to a problem in the ward or in
the hospital. For instance, the legal skills
of a sick lawyer may be used. Stimuli that
were previously effective in eliciting
strong behaviors should, as far as possible,
be introduced into the situation. For
instance, the patient who read a lot of
history should have available history
books rather than novels. The woman
who did a considerable amount of knit-
ting should have appropriate materials
available. As far as possible, conditioned
aversive stimuli should be removed from
the situation.
Initially, the development of either old
or new behaviors will be slow. The
problem is to introduce new stimuli and
new positive reinforcers (rewards) to
build up behaviors.
Drugs cannot be expected to result in
the development of new behaviors though
they may influence to some degreee the
existing repertoire of behaviors of the
person. Ferster has commented, "The
effects of drugs on behavior suggest a
situation much as with the effects of a
drug on cell or organ physiology. A drug
can make a cell do more or make it do
less, but it cannot make the cell do what
it does not do anyway. A kidney will
excrete more or less urine under the
influence of drugs, but it is unlikely that
the drug will make the kidney produce
thyroxin."
Conclusions
It would seem that a useful addition to
the educational curriculum of the student
nurse would be training in a behavior
modification laboratory. Whether or not
depression is more likely to occur in
those previously occupying achieved sta-
tuses than in those previously occupying
ascribed statuses, is, of course, something
that could readily be investigated in the
hospital. The nurse, perhaps more than
anyone else, finds herself spending long
periods of time with people going
through perhaps the most stressful period
of their lives.
The more that the nurse can learn
about the close observation of behavior,
its antecedants, and its consequences, the
more she can learn about the way in
which she could manipulate environmen-
tal stimuli to reduce or increase behav-
iors. Thus the greater her beneficial ef-
fects on the patient would be and the
more comfortable he would be. In all
probability it would follow in many
instances that his chance for recovery
from his physical illness would also be
greater.
References
1. Sarbin. T.R. Notes on the transformation of
social identity. In Comprehensive Mental
Health, edited by L.M. Roberts, N.S. Green-
field and M.H. Miller. Madison, Wise, Univ.
of Wisconsin Press. 1968.
2. Glaser, B.C. and Strauss, \.L. Awareness of
Dying. Chicago, Aldine Publishing Compa-
ny, 1965.
3. Hinton, J. Dying. London, Penguin, 1967.
4. Ferster. C.B. Animal behaviour and mental
illness. Psychological Record. 16:345-356,
1966. D
THE CANADIAN NURSE 45
idea
exchange
Nancy Dolan, a student nurse at St. The stars of "Where It's At" - students
Michael's School of Nursing, is shown at and faculty of St. Michael's School of
the animation stand, illustrating one Nursing - were invited to the premiere
method of doing title shots. of their own production.
Mary I'm Byrne (left) is using the "editor" and Maureen McAlpine is preparing to use
the "splicer" in the final editing phase of "Where It's A t. "
46 THE CANADIAN NURSE
Film Crew At Work
Students at St. Michael's School of
Nursing in Toronto wanted to make this
year's Education Week — an annual
event at the school - "different." The
result was Where It's At, an 18Vi-minute
film made by and about student nurses.
The students were eager to see the
school's new Super 8mm camera in ac-
tion - not a small factor in deciding on
this medium.
Objectives of the film production were
to:
• present a realistic concept of the role
of the student nurse;
• illustrate pictorially the activities and
environment of a student nurse;
• promote a deeper understanding of the
school by introducing ourselves to
others;
• provide an interesting and meaningful
audiovisual aid for those recruiting
nurses;
• gain knowledge of film production
through experimentation.
The subject matter was divided into
roughly 50 percent educational and 50
percent social scenes. Included in the
educational scenes were three types of
classroom situations — role playing,
lecture, and anatomy lab; a consultation
of a head nurse and staff doctor with
students at a busy nursing station; stu-
dents learning to dress for the operating
room which provided some more
humorous moments; and the library re-
source center.
To show a lighter, social side of
student life, shots were taken of residence
"happenings" and a favorite athletic
activity - skating.
Filming sessions were followed by
numerous, question-filled meetings to de-
cide on editing cuts, titles, and music
background. The final job was the sound
track. For this, records that seemed to fit
the mood and objective of each scene
were used. The tempo was kept mainly
fast and gay, but there were some serious
moments.
Not only were students involved in the
film, but patients also enjoyed partic-
ipating by painting the background for
the credits and title. - Marilynne Se-
guin, Reg. N., librarian and director/
producer of Where It's At, St. Michael's
School of Nursing, Toronto.
SEPTEMBER 1%9
Orientation to Hospital Careers
Toronto General Hospital is taking
part in a new high school work study
program that gives grade 12 and 13
students an opportunity to spend two
weeks in a hospital work setting where
they can learn more about the realities of
hospital careers.
The program was instigated by the
North York Board of Education (Toron-
to) as a pilot project, and has proved to
be a successful recruitment mechanism
for nursing and allied professions.
On their first day in the hospital,
students receive an orientation to facili-
ties and to general behavior and ethics.
Then they are assigned to departments
such as nursing units, inhalation therapy,
laboratories, and physiotherapy. Students
work from 9:00 a.m. to 4:00 p.m. during
the two week period.
Since the students work under the
guidance of the volunteer department,
additional responsibility is removed from
the nursing staff. A volunteer smock with
a student volunteer name pin identifies
each student.
The nursing staff cooperates extremely
well. Students who express interest in
nursing are given the opportunity to
observe procedures and to attend occa-
sional lectures. They respond with eager-
ness and a willingness to learn.
About 85 percent of the students who
share this experience make formal ap-
plication for entrance into a nursing
school or university to further a hospital
career. Although all students find it a
rewarding experience, some realize that a
hospital career is not for them. - Mrs.
Maureen Moody, Director of Volunteers,
Toronto General Hospital. [j
Student volunteer Sonfa McKibbon (left)
hears about the advantages of a pocket
watch from third-year TGH student nurse
Carol Goldman.
Mrs. Harlan Wilson, a Toronto General
Hospital head nurse (left) shows student
volunteers Phyllis Orton and Carol Wong
how to make a hospital bed.
SEPTEMBER 1%9
j^^^.
THE CANADIAN NURSE 47
ii',' ,1,1, :L'/ir/i''j/'J J7ij
48 THE CANADIAN NURSE
^;i^'
Come with me, Lori
Almost every nurse has experienced anxiety in her first contact with a psychiatric
patient. This anxiety is normal and helpful. In this article, a student nurse examines
her own feelings as well as her patient's feelings and tries to discover how these
influenced both her own and her patient's behavior.
Lorraine E. Warwick and (ennie Wilting
What do I say or do to help a
44-year-old bachelor who has never had a
stable home, steady job, or steady girl-
friend, and who is now on a psychiatric
ward with a diagnosis of schizophrenia?
How do I meet and get to know a person
who has Httle or no desire to live and
little or no motivation or drive to try and
regain a level of mental health so he can
go back into the community?
I'm new here. I'm only a student. Why
did they assign me to this patient? I
don't know anything! How am I going to
help a person like that? What will I say
to him?
Getting acquainted
It was my second week on the psychi-
atric unit. I was assigned to a patient with
whom I would be working during my
entire psychiatric experience.
My patient, whom I will call Mr.
Evans, was the oldest son in a family of
six born to a farmer and his wife. His
parents were Ukranian. Mr. Evans had a
high school education. While obtaining
this education, he lived alone in a cold,
uncomfortable, discarded granary.
Miss Warwick is a third-year student in the
tour-year basic program leading to the degree of
Bachelor of Science in Nursing at the University
of Alberta. Her report on her ward experience
in psychiatry was condensed into this article by
Mrs. Jennie Wilting, an instructor on the staff at
the University of Alberta.
At age 20, he was admitted to a
mental hospital and had been in and out
of psychiatric hospitals and under psy-
chiatric care ever since. Sometime during
his life he learned the carpenter trade and
built two houses. A brother lives in one
of them. After being a patient at Alberta
Hospital for five years, Mr. Evans was
transferred to the psychiatric unit of the
University of Alberta Hospital.
Mr. Evans looks his age: his hair is
beginning to gray at the temples, he has a
few forehead wrinkles, and his shoulders
sag. He dresses in older styled clothes and
the few that he owns were purchased at
the Salvation Army. He is a quiet man,
but not shy and looks directly at people
when conversing with them.
Our personalities were so different. I
am an active, fast-moving individual, who
talks readily. When under stress or anx-
ious, I tend to relieve my anxiety and
tension by talking and increased activity.
Mr. Evans, on the other hand, is an
inactive, slow moving individual. He
speaks slowly and uses short sentences.
When under stress or anxious, he tends to
relieve his anxiety and tension by silence
and withdrawal. He didn't socialize in
hospital and spent all his time in bed,
unless someone specifically told him to
go to some activity.
During the first week that I worked
with Mr. Evans, I was anxious and lacked
confidence in myself and in my ability to
care for him. I looked to Mr. Evans for
SEPTEMBER 1%9
reassurance - a nod, a smile, or an
invitation to accompany him to certain
activities - any sign whatever that
would reassure me that I was doing well.
I am sure that some of my anxiety was
communicated to Mr. Evans. However,
with support and guidance from my team
leader, my instructor, the patient's
doctor, and other members of the health
team, I gained self confidence and was
able to look more objectively at my
work.
A nursing care plan
Throughout the relationship, 1 noted
and studied my feelings and behavior, as
well as Mr. Evans' behavior. I tried to see
how his behavior influenced my feelings
and behavior and how mine affected his.
As well, I wanted to see how my feelings
influenced my observations and inter-
pretations. When necessary, I tried to
modify my behavior to meet the needs of
Mr. Evans.
Space does not permit me to relate
day by day interactions or progress, but,
over the weeks and with the help of the
health team, I formulated and carried out
a nursing plan. My nursing plan included
the following:
• establish a therapeutic nurse-patient re-
lationship
• progress at the patient's pace
• gradually increase time spent together
• slowly direct conversation more and
more toward his illness and problems
SEPTEMBER 1%9
• tactfully increase his social and self-
awareness
• learn about his past experience and his
present behavior, feelings and thoughts
• observe his behavior in various areas of
the hospital (dining room and re-
creational areas) and watch his reaction
to different people (patients, doctors,
and nurses)
•join him in planned activities (swim-
ming, bowling, billiards, and discussion
groups).
After working with Mr. Evans for five
weeks, I tried to assess the progress we
had made. I felt our relationship was
growing steadily in trust and value as each
day progressed. I was enjoying the chal-
lenge of working with him.
On looking back over the week's
events, I noted that Mr. Evans had made
many spontaneous contributions and in-
dications of his trust and desire of our
relationship. He showed me pictures of
his niece; he showed concern for me and
my time - "You have to get home" and
"You'd better go" - which could be
generalized to others eventually; he
reached out and touched my shoulder, a
very positive sign of friendship.
His appearance improved in that he
bought some new clothes and shaved
more often. The staff gently teased me
about the fact that although Mr. Evans
did not shave every day, he always shaved
on the days I was scheduled to be on
duty. He began to interact with the other
patients and on one occasion invited a
patient to join him in activities. He took a
more active interest in his environment
by commenting on various things going
on around him.
Mr. Evans had developed a trust in me
and he could share with me his thoughts
and feelings about his niece, an old
girl-friend, music, and past life. I felt
rewarded that he revealed his trust in me.
His mood had also improved. He was
more spontaneous in conversation,
happier, and more active.
Leaving the unit .
Now we were ready to concentrate on
formulating plans for Mr. Evans' return to
the community, his living accommoda-
tions, and employment. It was very dif-
ficult for him to think about and plan his
reentry into the community.
Several times his anxiety was so great
that he could only cope with it by
regressing; he would become withdrawn,
non-communicative, and depressed. This I
found very discouraging. However, as the
days went by, his regression was less
frequent.
Shortly after, when 1 had completed
my psychiatric experience, Mr. Evans was
discharged and went to live with his
brother. He had been in the University of
Alberta Hospital for seven months.
Now living with his brother, Mr. Evans
is attending the day care program at the
hospital. Under this program, he worked
in the hospital's carpentry repair shop for
eight weeks. Later, for more challenging
work, he was transferred to the occupa-
tional therapy department. Here he has
designed and made a coffee table and
record holder, and is assisting with other
articles, such as sewing machine cabinets.
He seems to enjoy being a hard worker.
We both learned
I saw a great change in Mr. Evans
during the 10 weeks that I worked with
him. There was also a great change in me.
No longer was 1 the frightened, insecure,
unskilled student nurse of two months
ago. I had lost my fear and gained
self-confidence and skills in psychiatric
nursing. I believe that both Mr. Evans and
I benefited greatly from working to-
gether. D
THE CANADIAN NURSE 49
research abstracts
The following are abstracts of studies select-
ed from the Canadian Nurses' Association
Repository Collection of Nursing Studies.
Abstract manuscripts are prepared by the au-
thors.
Saunders, Peggy, A descriptive study of
the behavior mothers exhibit, in res-
ponse to each other during the early
puerperium, in matters of family living
with a newborn infant, Montreal 1 969.
Thesis (M.Sc.N.(A)). McGiU.
Based on the problem of preparedness
of parents for family living with a new-
born infant, the investigation describes
how mothers respond to each other dur-
ing the early puerperium in hospital. Two
types of information were collected by
means of observation and use of a check
list. One was the frequency with which
certain items of behavior were exhibited
when two or more mothers responded to
each other; the second was the frequency
of different topic areas noted in conversa-
tions between mothers. Two hundred
10-minute observations were made of 96
mothers in hospital, varying in age,
parity, and days postpartum. The results
suggested that mothers respond to each
other through conversing, smiling and
watching. Also, that the behavior is con-
tinued by the majority of mothers be-
yond initial contact; and that some items
of behavior vary significantly with age,
parity, days post-partum, and the mo-
ther's country of birth. Findings indicate,
too, that some topics of conversation
occur more frequently than others, and
vary with parity of the mother.
Kliewer, Pauline Annefte.Cur7^• an opera-
tionally defined concept. Seattle,
Wash., 1969. Thesis (M.A.) U. of
Washington.
Guilt is a factor that constantly in-
fluences both nursing performance and
patient reaction, but has as yet been little
researched in nursing. It was the purpose
of this study to develop an operational
definition of the concept of guilt.
The study was based on the observa-
tions made concerning guilt by five
authors from psychiatry and five authors
from the social sciences who specifically
dealt with the problem of guilt. These
observations were then tabulated accord-
ing to the following categories: what guilt
is, what causes guilt, how guilt is ex-
50 THE CANADIAN NURSE
perienced, and what effects of guilt on
behavior can be observed. This tabulation
made it possible to trace the interrela-
tionships of the various observations and
delineate the general operations that
make up the concept of guilt.
It was found that a person has certain
standards and potentials; when these are
violated he experiences a complex
psycho-physiological reaction and begins
to manifest various behaviors to cope
with the experience of guilt. This re-
searcher believes that this information
about guilt can help nurses understand
the dynamics of guilt and consequently
deal with their own and patient guilt
more effectively.
Wilson, Phyllis Margaret..4 guide for the
public health nurse to assist elderly
patients in the achievement of selected
functional tasks at home. Seattle,
Wash. 1967. Thesis (M.N.) U. of
Washington.
Occupying a key position in the in-
creasing number of home care programs,
the public health nurse has an important
responsibility in giving nursing care and
coordinating allied professional and
volunteer services to promote independ-
ence of the elderly at home. The purpose
of the study was to develop a guide that
could be used by the public health nurse
to assist elderly patients in the achieve-
ment of selected functional tasks at
home.
The guide was designed by the writer
to include five areas of daily living:
mobility, self-care, food habits, house-
hold tasks, and pyschosocial adjustment.
For each of these areas five functional
tasks important in maintaining independ-
ence at home were selected, and aids to
achievement were suggested for each
functional task.
Employing the developmental method
of research, 55 public health nurses in 9
British Columbia Health Units each used
the guide with a patient who was 65 years
or over, lived in a house or apartment,
and had acute or chronic illness or
changes associated with aging. Evaluation
of the guide was made by the public
health nurses' completion of the ques-
tionnaires and by the writer's observa-
tions of the used guides.
As a result of the findings the guide
was revised with relatively minor altera-
tions to the format and content. Analysis
of the data was also helpful in confirming
that the guide would be helpful in de-
termining the patient's suitability for
home care, developing a nursing care plan
to focus on the patient's individual and
total needs in relation to achieving maxi-
mum independence, faciHtating liaison
with family and allied personnel, and
providing on-going evaluation of patient
progress. In addition, recommendations
have been made in relation to further
development of the guide and its extend-
ed use in other phases of geriatric care.
Wallington, Marjorie A. An approach to
the phases of nurse-patient relation-
ships. Boston, 1968. Thesis (M.Sc.N.)
Boston U.
This is a library study designed to
examine the development of trust as the
first phase of a nurse-patient relationship.
The assumption was made that when a
patient enters into a relationship with a
nurse, this relationship will follow an
orderly pattern that can be described in
terms of its phases. A second assumption
was made that the orderly pattern follow-
ed in a nurse-patient relationship is a
re-enactment of the phases of child devel-
opment. The child development stages
listed by Erikson were used as a proposed
pattern for the phases of a relationship.
The study dealt with one aspect of
phase 1 - trust. Trust was examined as
it exists in a nurse-patient relationship: its
meaning, how it is developed, factors that
inhibit and foster trust, and how trust is
demonstrated.
According to the definition of trust
presented in this study, three criteria
must be met before trust exists for the
patient in a relationship: 1. The patient
must recognize and understand the limits
which are set for his behavior. 2. The
patient must be assured of his own ability
to function within these limits. 3. The
patient must receive reciprocal trust from
the nurse.
A review of literature supported this
definition in principle, although the word
"limits" is rarely used in this context.
A suggested list of behaviors that may
demonstrate trust was presented. Recom-
mendations included: 1. The suggested
list of behaviors that demonstrate trust
should be tested in the clinical setting to
refine, add to, and test for reliability and
(Continued on page 52)
SEPTEMBER 1%9'
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research abstracts
(Continued from page 50)
validity. 2. Similar additional studies
should be made to examine the other
phases in the proposed orderly pattern of
the nurse-patient relationship. 3. When
the other phases in the proposed orderly
pattern have been examined and defined
in the context of the nurse-patient rela-
tionship, the total pattern should be
examined and tested in the clinical setting
to ascertain if the pattern does exist and
if it can be measured.
Hayward, Margaret. Correlates of ap-
proval and disapproval received by
students at selected schools of nursing.
Pittsburg, Pa., 1969. Thesis (Ph.D.). U.
of Pittsburg.
The basis for this study was the
concern many have expressed for the
nurse's gradual move from giving patient
care to becoming involved with adminis-
trative duties. Its purpose was to find if
the student nurse was influenced toward
moving in this direction through approval
and disapproval received by her for her
nursing behavior. These responses were
considered to be one informal method of
teaching which, according to reinforce-
ment theory, was one way one individual
infiuences the behavior of another. This
study attempted to describe the kinds of
behavior for which students remembered
receiving these responses and to find the
percent of approval and disapproval they
received. It attempted to find if either of
these variables correlated significantly
with the needs of the students, with the
persons from whom they received most
of their responses, or with the type of
nursing school in which they were enroll-
ed. Finally, the study sought to deter-
mine if the behavior it found was being
impressed on the students through this
informal method were supporting or neg-
ating the educational objectives of the
schools.
Two hundred and twenty-seven begin-
ning students from two university-related
and two hospital-related schools partici-
pated in this study. They submitted over
5,000 incidents through use of the critical
incident technique, each of which told of
a nursing behavior for which they had
been given approval or disapproval. When
categorized, these incidents fell into 15
minor categories which in turn were
grouped into three major categories called
"giving care to patients," "working with
others," and "grades and classroom activi-
ty." When the percent of incidents sub-
mitted by each student in each of these
categories and the percent submitted by
52 THE CANADIAN NURSE
them of approval and disapproval was
correlated with their needs as described
by their scores of the EPPS, and with the
percent of incidents they received from
patients, instructors, and ward staff, few
correlations of significance were found.
The schools in which they were enrolled
failed also to correlate with significance
to these variables.
The Pearson r, Tetrachoric r and In-
traclass correlation were the statistical
methods used. A rating scale was created
for use in this study but was dropped
from inclusion in it because of time being
insufficient for adequate testing. Its pur-
pose was to have been to contribute
another dimension by describing the stu-
dents skills in nursing, as seen by her
instructor. In each school these beginning
students reported their largest percent of
incidents as having been received for
"giving patient care." Since each of their
schools stated that one objective was to
teach students to give a high level of
patient care, these data suggest that this
informal means of teaching was being
used in these four schools to support this
objective.
Although many minor recommenda-
tions were made in conclusion to this
study, the dominant recommendation
made was that the critical incident techni-
que, used so effectively in a slightly
revised form in this study, be used again
as a way of studying the process of
education as it is experienced by the
student.
Trout, Margaret F. Criteria used by em-
ployers when selecting nursing staff in
varying sized hospitals. Toronto, 1964.
Thesis (H. Admin.) Univ. of Toronto.
The rapid changes in the health field
during and since World War II have
created many problems for those respon-
sible for supplying needed services. Popu-
lation increases, economic expansion, and
the changing values of society have in-
creased demands for more and improved
health and welfare services in all coun-
tries. Traditional staffing patterns of
health agencies had to be drastically
altered to cope with severe shortages of
personnel and expanding facilities. Educa-
tional methods had to be modified also
and new approaches used to keep up with
the advances in all technical and organ-
izational fields.
The hospital, staffed traditionally by
"the learn as you serve method," found
itself hard pressed to compete with other
more attractive and lucrative vocations.
The staffing pattern, set by Florence
Nightingale, consisted in the main of
graduate and student nurses assuming all
duties relative to patient care, with a
preponderance of students in hospitals
that operate schools of nursing. During
the war, shortages of both student and
graduate nurses first necessitated the in
troduction of unskilled or partially train-
ed workers into the nursing hierarchy
The role of the graduate nurse changed
appreciably - widening in scope and
with the emphasis shifting from direct
patient care activities to managerial and
supervisory functions. Breaking with
traditional ideology is always painful and
the confusion that naturally ensued
within the profession itself was com-
pounded by the interposition of changing
ideas from other and allied fields.
With needs pressing, the role of the
graduate nurse became of great moment.
Employers were faced with the problem
of utilizing these key people to best
advantage while being bombarded by
demands from the public, demands from
the medical profession, and demands
from the nursing profession, all of whom
regarded the nurse in the light of their
own needs and preconceived images.
This study endeavors to ascertain some
of the basic criteria upon which em-
ployers select graduate nurse staff. Be-
cause of the ramifications that relate to
the topic, it is limited in scope. Only
graduate nurse staff in general hospitals
have been considered and no breakdown
has been attempted between teaching and
non-teaching hospitals.
The balance between nursing service
and nursing education has not yet been
struck. Much clarification and inter-
pretation on both sides is needed and a
further study of the correlation between
preparation and function would be of
great value in promoting understanding
and a closer working relationship between
these two groups. It would require, how-
ever, quite extensive research and was
beyond the scope of this paper.
This study, therefore, is confined to
establishing basic criteria presently used
by employers when hiring nursing per-
sonnel and comparing differences, if any,
in hospitals of varying size. Any con-
clusions drawn can only be applied within
the framework of a changing picture, as
the factors contributing to the formation
of the opinions on which these con-
clusions are based are still in a state of
flux.
Kergin, Dorothy f. An exploratory study
of the professionalization of Register-
ed Nurses in Ontario and the implica-
tions for the support of change in
basic nursing educational programs.
Ann Arbor, Michigan, 1968. Thesis
(PhJD.) U. of Michigan.
The Canadian Nurses' Association has
published statements regarding basic nurs-
ing education that designate two catego-
ries of nurses, one prepared in a bacca-
laureate degree program and the other in
a two-year diploma program. The ob-
SEPTEMBER 1%9
research abstracts
jective of this study was to determine
what discrepancies in professional attri-
butes there were among Ontario nurses
that might affect their acceptance of the
proposed changes in basic nursing educa-
tion.
The survey approach was selected as
the research method and a questionnaire
was mailed to a probability sample of
female nurses, registered in Ontario in
1967. To insure that comparisons could
be made by educational groups, a variable
sampling fraction was utilized for each of
three strata, consisting of nurses with
1. no academic degress, 2. baccalaureate
degrees, and 3. graduate degrees. Ques-
tionnaire returns totaled 549, or 76 per-
cent. The chi-square statistic was used for
computer analysis of the data, supple-
mented by t tests of the differences
between uncorrelated means
Following a review of literature, 12
attributes of the highly professionalized
nurse were stated. These attributes were
related to a nurse's beliefs and attitudes
concerning professional nurses' associa-
tions, professional education, and profes-
sional status, and were employed as an
attitude universe of professionalism. Be-
lieved to be associated with these 12
characteristics were certain behavioral
outcomes, among them selected scholarly
activities and knowledge of the state-
ments of the CNA on nursing education
and the association's adoption of the
Code of Ethics of the International Coun-
cil of Nurses as the code for Canadian
nurses. Education, age, and professional
association membership were identified as
three antecedent variables, associated
with professionalism in nurses, and cons-
tituted the independent variables for the
analysis of the data.
For all except the final attribute,
related to satisfaction with career choice,
the general statement can be made that,
for Ontario nurses, as their level of
education increases, so does their level of
professionalization. The findings indicate
disparities in levels of professionalization,
particularly between respondents with
graduate degrees and those with little or
no university preparation, that is, be-
tween many present and future leaders of
the profession and its rank-and-file mem-
bers.
Among these disparities are differences
in attitudes and beliefs related to the
responsibilities of the professional nurses'
associations with respect to future nurs-
ing education, perceptions of nursing's
public service obligation, attitudes toward
new graduates of basic baccalaureate and
two-year diploma programs, and recogni-
tion of the research potential of a nursing
SEPTEMBER 1%9
problem. Most relationships that were
apparently attributable to age or associa-
tion membership may have been biased
by a spurious relationship to education.
The finding that as a nurse's age increases,
so does the tendency for her to belong to
a professional nurses' association, illus-
trates a deferred occupational commit-
ment that is more typical of women than
of men.
Based on the findings, the major con-
clusions and recommendations are direct-
ed toward the achievement of an informed
and supportive nurse population with
respect to educational change. One of the
recommendations is that committees be
established at the chapter level of the
provincial nurses' associations, to lead
discussions within the chapters of current
issues in nursing, including the need for
educational reform. It is suggested that
the profession's obligation to serve the
public interest with respect to expert
nursing care provide the rationale behind
these discussions. To clarify the nursing
profession's public service obligation
further, it is also suggested that the CNA,
in conjunction with its provincial cons-
tituents, initiate discussions of a Canadian
code of ethics for nurses. Q
TO PLAN FOR A LIFETIME
Morriaga is a responsibility that often re-
quires both spiritual and medicol assistance
from professional people. In many instances
a nurse may be called upon for medical
counsel for the newly married young wo-
man, mother, or a mature woman.
"To Plon For A Lifetime, Plan With^Your Doc-
tor" is a pamphlet that was written to assist
in preparing a woman for patient-physicion
discussion of family planning methods. The
booklet stresses the importance to the indi-
vidual of selecting the method that most
suits her religious, medical, and psychological
Nurses are invited to use the coupon below
to order copies for use as an aid in coun-
selling. They will be supplied by Mead John-
son Laboratories, a division of Mead John-
son Canada Ltd., as a free service.
Meadliliiiinn
LABORATORI ES
ORDER FORM
Pleose send
To: Mead Johnson Laboratories,
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Toronto 7, Ontario.
n
copies of "To Plan For A lifetime. Plan With Ye«l
Doctor" to;
Addraet
l_
THE CANADIAN NURSE 53
Basic Microbiology, 2nd ed. by Margaret
F. Wheeler and Wesley A. Volk. 410
pages. Toronto, J.B. Lippincott Com-
pany, 1969.
Reviewed by Moira L. O'Brien,
Science Instructor, St. Martha 's Hospi-
tal, Antigonish, N.S.
A good reason for choosing this text
for a diploma program is its easy, conver-
sational approach to the material covered.
It covers the material well, but avoids
unnecessarily deep language.
The second edition of this useful text
is larger, and includes the latest scientific
developments in microbial genetics, cell
structure, and immunology. DNA synthe-
sis, RNA synthesis, and protein synthesis
are presented in a clear and attractive
manner. More diagrams and illustrations
have been added to explain difficult
points.
In short, the book is excellent for a
diploma program.
Social Work In The Hospital Organization
by Margaret Gaughan Brock. 117
pages. Toronto, University of Toronto
Press, 1969.
Reviewed by Mrs. N. Nera, Director of
Social Services, Ottawa Civic Hospital,
Ottawa, Ont
Readers will find this book straightfor-
ward and comprehensive. It attempts to
define and describe social work within
the hospital setting and within the
broader context of health care. It is
informative and historical.
The author's attempt to make it com-
prehensive may make it somewhat dull
for many experienced social workers.
However, as the author points out, it
should serve as a basic text for such
groups as social work students, hospital
board members, hospital administrators,
nursing students, and especially for social
workers in the community and primary
agencies not too familiar with the hospi-
tal machinery.
The chapter on the role of the social
worker in the hospital is thorough. The
chapter discusses consultation and collab-
oration as two important functions, but
makes it obvious that the primary func-
tion is service to patients and their
families. Formal and informal teaching
are also discussed; definitions are handled
clearly.
54 THE CANADIAN NURSE
Chapters six and seven bring in the
"ingredients" of social work administra-
tion in a way that would be useful to
beginning administrators. The author
shares her years of experience, and man-
ages to mix learning and practice in an
interesting manner. She fails to mention,
however, anything about the costs of
social work service in a hospital, although
she deals with costs of social work record-
ing.
In chapter eight, the author illustrates
various situations where social work inter-
ventions in a hospital setting have helped
in total patient care. She is also able to
illustrate efforts that have failed.
The author finishes the book with a
discussion of social work as the "third
dimension." She explains that "illness has
many forms and undoubtably many
meanings. How the patient perceives his
illness can often only be understood in
relation to his culture, social class, reli-
gion ..." The author has done an excel-
lent job on this text. Any succeeding
texts perhaps could deal with the
changing role of the social worker in
hospitals.
Anatomy of the Newborn: An Atlas
Edmund S. Crelin, 256 pages. Philadel-
phia, Lea & Febiger, 1969. Canadian
agent: Macmillan Co. of Canada Ltd.,
Toronto.
Reviewed by Glennis Zilm, formerly
assistant editor of The Canadian
Nurse.
The author, a professor of anatomy at
Yale University School of Medicine, pre-
pared this atlas because he was disturbed
about the lack of suitable texts on anat-
omy of the newborn. In the preface to
this book, he points out that descriptions
of newborn anatomy are limited to scat-
tered passages in adult anatomy and
surgical texts.
The need for a specialized work on
this subject is best stated in the author's
introductory words: "The newborn is not
a miniature adult. Some of the differ-
ences between a structure of the newborn
and that of an adult are quite complex.
For example, the overall size of the adult
temporal bone is about twice that of the
newborn temporal bone. However, in the
temporal bone of the newborn the diam-
eter of the internal acoustic meatus, the
size of the inner and middle ear cavities,
the fenestra vestibuli, the fenestra co-
cleae, the malleus, incus, and stapes, and
the tympanic membrane, or eardrum,
equal the size of these same structures in
the adult temporal bone."
As might be gathered from the above,
this is not primarily a book for nurses; it
is, however, the kind of primary essential
reference that should be available in any
pediatric surgical department.
The atlas is comprised of 296 labeled
drawings prepared by the author. He
based the drawings on findings on dissec-
tion of newborn cadavers. The drawings
are shown in proportionate sizes to a
mean body size and shape representing
the average newborn of about nine
months gestation. Because the author did
all the dissection and all the drawings, he
was able to achieve a continuity of
illustration not usually found in an anat-
omical atlas.
The book is atlas-size (12-1/4" x
10-1/4"), beautifully printed and bound,
and well-indexed. It is also expensive, but
seems well worth the price.
Psychosocial Nursing,edited by Elizabeth
Barnes. 316 pages. London, Eng.,
Tavistock Publications, 1968. Cana-
dian Agent: Methuen Publishers, To-
ronto.
Reviewed by Barbara Hazlewood,
Credit Valley School of Nursing facul-
ty, Mississauga, Ontario.
This collection of papers, written
between 1946 and 1967, offers an ac-
count of the approach to the treatment
of psychiatric patients and the training of
psychiatric nurses developed at the Cassel
hospital in England.
The approach presented is based on
three concepts. First, the hospital is a
therapeutic institution within which the
patient is responsible to himself for him-
self. Second, all aspects of psychiatric
nursing are built on a foundation of
psychoanalytic principles. Third, the
psychiatric nurse is trained to see herself
and her patient as an individual who
remains a part of his family and com-
munity.
The papers are arranged in five sec-
tions. Part one discusses the development
of the hospital as a therapeutic institu-
tion. The third paper in this section
outlines the present methods employed in
the training of psychiatric nurses and
serves as a guide to the Cassel philosophy
of psychosocial nursing.
SEPTEMBER 1%9
LOOK at the all -new 11th edition of
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Take a good long look at this new 11th edition,
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PHARMACOLOGY
IN NURSING
By Betty S. Bergersen, R.N., M.S., Ed.D.,
and Elsie E. Krug, R.N., M.A.
In consultation with Andres Goth, M.D.
tioned just a few below. Can any other text meet
your course requirements and your students' level
of understanding so completely and effectively as
the new 11th edition of Bergersen-Krug, PHAR-
MACOLOGY IN NURSING?
By BETTY S. BERGERSEN, R.N., Ed.D., Associate Professor of
Nursing, College of Nursing, University of Illinois at the Medical
Center in Chicage; and ELSIE E. KRUG, R.N., M.A., Instructor
In Pharmacology and Anatomy and Physiology, St. Mary's
School of Nursing, Rochester, Minn. In consultation with
ANDRES GOTH, M.D., Professor of Pharmacology and Chair-
man of the Department, The University of Texas Southwestern
Medical School, Dallas. Publication date: June, 1969. 11th
edition, 695 pages plus FM l-MV, 7"x 10", with 51 illustrations
and 8 color plates. Price, $10.75.
Look at WHY it can meet your needs better than any other pharmacology text
Totally up-to-date content includes current clinical and research
findings on all the latest drugs accepted for general use
Written by experienced nursing Instructors in a stimulating, inter-
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not so oversimplified that it lacks scientific basis
Inviting new two-column, two-color format emphasizes key points,
helps students locate information quickly
New chapter on psychotropic drugs explores every aspect of this
right-now topic
Expanded discussions of physiology and physiological foundations
of drug therapy
• Fresh facts on drugs affecting the central nervous system . . .
caffeine, amphetamines, new analeptics, analgesics, hypnotics and
sedatives
• Meaningful new material on drugs affecting the circulatory system
Includes a discussion of cardiac eiectrophysioiogy, ganglionic
blocking agents, management of shock
• Timely new information on drugs that affect the reproductive
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• Tables, review questions, glossaries and current references aid
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THE CANADIAN NURSE 55
Whenyourday
starts at ^^
6 a.m.. .you re oji
charge duty... ^
you've skimped
onmeals...\^
and on sleep...
you haven thad^
time to hem
a dress...
mal(eanaWepie...
wash your hair.,
evenpowder %3ifi
yournose
in comfort.^
it's time for a change. Irregular hours and meals on-the-
run won't last. But your personal irregularity is another
matter. It may settle down. Or it may need gentle help
from DOXIDAN.
use
DOXIDAN*
most nurses do
OOXIDAN is an effective laxative for the gentle relief of
constipation without cramping. Because OOXIDAN con-
tains a dependable fecal softener end a mild peristaltic
stimulant, evacuation is easy and comfonable.
For detailed information consult Vademecum
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<!•»
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56 THE CANADIAN NURSE
(Continued from page 54)
The first two papers of part two
describe how the staff came to reahze
that the "mothering techniques" of nurs-
ing were doomed to fail with the emo-
tionally disturbed and how this realiza-
tion led to a reclassification of the nurses'
role. The remaining five papers discuss
the resulting experiences of the nursing
personnel.
To maintain the patient's contact with
his family, a program emphasizing family
involvement was developed. The papers in
part three are concerned with such issues
as children remaining with their mothers,
the involvement of all members of the
family with problems of the adolescent
patient, and visits by the nurse to the
patient's home before, during, and after
hospitalization.
Part four enlarges on the second of the
three major concepts. Psychoanalytic
techniques are utilized in the process of
selecting and educating psychiatric nurses
for their role as therapeutic agents. The
final part consists of a summary of the
changes that have evolved at the Cassel
hospital during the last two decades.
This book would not be useful as a
text. However, it is of value to the
student nurse examining the role of the
social sciences within her profession, and
to the graduate nurse involved in the care
of emotionally disturbed patients. All
three major concepts should be applied to
the nursing profession at large.
Bedside Nursing Techniques in Medicine
and Surgery, 2nd ed. by Audrey Lat-
shaw Sutton. 398 pages. Toronto,
W.B. Saunders Co. of Canada Ltd.,
1969.
Reviewed by Mrs. Mary Carr, Instruc-
tor, Nursing Assistant Program, South
Peel Hospital, Mississauga, Ont
This "handbook of practical reference
for the bedside nurse" is divided into two
sections. The first section is concerned
with general nursing techniques, which
include planning bedside nursing care,
hypothermia, radiotherapy, administra-
tion of oxygen, and the use of respirators.
The second section is divided into
chapters on diseases of the body systems.
Each chapter includes a description of
diagnostic tests, preparation of the pa-
tient for them, and the normal results of
the tests. Therapeutic and rehabilitative
procedures, such as types of suction and
drainage, stump dressings, care of casts,
and how to use equipment like the
CircOlectric bed, are also discussed. At
the end of each chapter is a list of
additional procedures, diets, and medica-
tions.
The author states that "although this
book is procedure-centred, nursing is cer-
tainly not." The procedures are presented
clearly, and in a logical sequence. The
detailed illustrations are invaluable. The
nursing care of a patient undergoing the
various tests and procedures is briefly but
adequately described.
The book contains a wealth of infor-
mation and is an excellent reference
book. It would be helpful to teachers and
students of nursing, to a hospital proce-
dure committee setting up new proce-
dures or revising old ones, and to nurses
returning to nursing practice after some
time away from it. It would be a valuable
addition to any nursing library. The only
drawback to its regular use by staff on a
nursing unit would be the small discrep-
ancies between the textbook and the
employing agency's own policies and pro-
cedures.
Basic Physiology and Anatomy, 2nd ed.,
by Ellen E. Chaffee and Esther M.
Greisheimer. 634 pages, Toronto, J.B.
Lippincott Company, 1969.
Reviewed by Mrs. Robin Gardner,
medical-surgical instructor. School of
Nursing, Women's College Hospital,
Toronto.
The study of physiology and anatomy
is basic to our understanding of the body
in health and disease. Knowledge in this
field is rapidly increasing. This revised
edition has been expanded and updated
to include new scientific knowledge. It
presents anatomy according to the vari-
ous systems of the body, and is "devoted
primarily to gross anatomy." Physiology
is studied in more detail than in most
anatomy and physiology books for
nurses.
The introductory chapter provides a
basis in descriptive terminology. The
second chapter is exceptionally good. It
discusses the organization of the living
body within the following framework:
the organization of the cell, cell division,
protein synthesis, maintaining home-
ostasis, the primary tissues, tissues as
building materials, and an introduction to
the systems. The many illustrations
clarify subjects from the structure of
DNA to the carrier system theory for the
active transport of sodium and potassium.
The remainder of the book is organiz-
ed by systems. The section dealing with
the nervous system is good, with detailed
explanations accompanied by diagrams
to aid the student. In the section on the
brain, cerebral lesions are related to
symptoms a patient would present. The
cardiovascular system is also explained
well, with much attention given to the
electrical activity of the heart and the
electrocardiogram.
SEPTEMBER 1%9
Each section relates the study of ana-
tomy and physiology to nursing. For
instance, in the study of the skin the
blood supply is related to the develop-
ment of decubitus ulcers; and in the
chapter on the kidneys, hemodialysis is
explained. Although this is not a text on
medical-surgical nursing, it does contain
enough of these "extras" to whet the
appetite of the beginning student.
There are several teaching aids. At the
end of each chapter, there is a summary
that defines and summarizes the contents
in concise terms, and a list of practical
questions pertaining to nursing which
would stimulate the student nurse and
remind her why she is studying anatomy
and physiology. A glossary and a small
bibliography are also included. There is
an insert of transparencies illustrating the
depth of the organs and systems in the
human body.
This text would be useful as a text-
book for the student nurse, or as a
reference book for the instructor or
graduate nurse.
An Introduction to the Physical Aspects
of Nursing Science by O.F.G. Kilgour.
292 pages. London, William Heine-
mann Medical Books Ltd., 1969. Cana-
dian agent: Burns &MacEachern Ltd..
Don Mills, Ont.
Reviewed by Jean Godard, Assistant
Professor of Nursing, McGill Univer-
sity School for Graduate Nurses,
Montreal, Que.
In this well-illustrated text, the author
has attempted to present in relatively
simple terms the areas of physics that
have special significance for nurses. He
begins with the study of measurement
and proceeds through 12 chapters on
such topics as dialysis, forces and ma-
chines, pressures, heat, light, and electric-
ity. There is sound and up-to-date mater-
ial on the laser, cryosurgery, ultrasonics,
gamma cameras, and the effects of gravity
on astronauts.
Frequent definitions are included and
experiments accompany each section.
There is a list of visual aids at the end;
however, these are largely obtainable
from Great Britain and may prove diffi-
cult to locate for Canadian instructors.
There is a need for this kind of text,
and although I might hesitate to have
some nurses follow the instructions on
"how to wire a 3-pin standard plug,"
nonetheless it is particularly well written.
This book would be a valuable refer-
ence source for the beginning student
who is being initiated into the mysteries
of physics in nursing, for the instructor
who might spend hours organizing labora-
tory sessions, and for the majority of
students and graduates in the health
professions. The reader will also find it a
source of enjoyment.
SEPTEMBER 1%9
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THE CANADIAN NURSE 57
Next Month
in
The
Canadian
Nurse
• Nurse and Architect
Work Together on
Hospital Design
• Check Your Image
— It's Slipping
• The Child with Leukemia
^^P
Photo credits for
September 1969
Tara Dier, Ottawa, p. 9
Julien LeBourdais, Toronto,
pp. 10,31,32,34,39
St. Michael's School of Nursing,
Toronto, p. 46
The Globe and Mail, Toronto, p. 47
Microbiology in Health and DiseaseJ2th
ed. by Martin Frobisher, Lucille Som-
mermeyer, and Robert Fuerst. 549
pages. Toronto, W.B. Saunders Com-
pany. 1969.
Reviewed by Sharon Chambers, Fac-
ulty, Royal Victoria Regional School
of Nursing, Barrie, Ont.
The twelfth edition of this text has
kept pace with the changes in the educa-
tion of health personnel. It is no longer
specifically for the nursing field, but has
been revised so that it can be used as an
introduction to microbiology for ail
branches of the health services.
The text is divided into five sections
with appendices. Each of the first four
sections is made up of four to six
chapters. Section one discusses the char-
acteristics of the various types of micro-
organisms (viruses and bacteria are indi-
vidually covered in separate chapters).
Section two deals with microorganisms in
their environment, methods of laboratory
study and their usefulness in sanitation,
industry, etc. Section three concerns prin-
ciples of destroying microorganisms and
outlines the various methods most com-
monly used. Infection, immunity (active
and passive) and allergy are the topics of
section four.
The last 20 chapters make up the fifth
section on pathogenic microorganisms,
which is divided into six parts. Five of'
these concern various diseases, divided
according to the system through which
the pathogen is transmitted. The sixth,
which consists of the final chapter, out-
lines the responsibilities of health per-
sonnel in relation to transmissible dis-
eases.
The above is a birds-eye view of the
contents of this text which may help you
compare the relative merits of this text
with others on the same topic. Those who
know the previous edition will find simi-
lar content with some additions and
deletions.
The illustrations and tables reflect the
authors' objective of removing obsolete
material and substituting it with updated
facts.
Because the authors have removed the
nursing orientation, this text's main ad-
vantage is its versatility. It is organized so
that a chapter (or a part of one) can be
read even if the reader has not covered
the preceding chapters. Public health
nurses, registered nurses, and health and
nursing educators can use this text as a
valuable reference to meet their specific
needs in this field.
Schools of nursing are looking for
integrated texts to include all the
58 THE CANADIAN NURSE
sciences, thus the usefulness of this text
for nursing students is limited. This book
could and will continue to be used as a
library reference to which students could
be referred. It also might be of some use
in assisting high school students to choose
a field related to the specific study of
microorganisms.
Screening for Health; Theory and Practice
by H.P. Ferrer. 212 pages. Toronto,
Butterworth & Co. (Canada) Ltd..
1968.
Reviewed by Sister Mary Irene. Direc-
tor, Prince Edward Island School oj
Nursing. Charlottetown, P.E.I.
In the foreword to this book, the
medical officer of health for the city of
Liverpool states that when the commu-
nity health field is undergoing considera-
ble change, a collection of knowledge on
screening for health provides a source of
useful information of general and techni-
cal nature. This book attempts to serve
that purpose.
The book is written for the British
National Health Service, and the facts
compiled on screening tests pertain al-
most solely to England. Some compara-
tive data on incidence of disease in other
countries is included, however. It is extre-
mely well documented with references,
and contains 89 tables that are highly
informative.
A chapter on screening is devoted to
each of the following areas: infancy and
childhood; tuberculosis: anemia: diabetes;
cancer; bacteriuria; miscellaneous screen-
ing for glaucoma, mental health, hyper-
tension, chronic bronchitis, and coronary
artery disease. A chapter on future pat-
terns of health screening for the promo-
tion of health expresses a view worth
consideration. There are five appendices
on various diagnostic aids used as screen- j
ing procedures. I
The book is factual and would make a
good reference, although its use as a
student's reference would be limited.
A Textbook for nursing assistants , 2ndl
ed. by Gertrude D. Cherescavich, 439'
pages. Saint Louis, Mosby, 1968.
Reviewed by M.A. Felix, Department
Head. Practical Nurse Training, Mani-
toba Institute of Technology, Winni-
peg, Manitoba
In the preface, the author mentionsi
that this textbook is written for the many
non-professional workers in the nursing
team who are employed to assist in giving
nursing care. It would also be useful,
however, as a guide for the professional
nurse who is instructing nursing assist-
ants, nurses' aides, practical nurses, and
orderlies in hospitals or in approved
schools.
The author stresses the principles in-
volved in nursing procedures and in-
SEPTEMBER 1%9'
dicates how the patient's needs can be
met with greater understanding and ef-
ficiency by a nursing assistant who knows
and applies these principles in giving
nursing care. The nursing assistant is
helped to identify her own role in nursing
care and to understand the effects of
physical and emotional illness on her
patients.
The text is divided into four sections.
An introduction gives a brief outline of
types of hospitals, team nursing, and the
role of the nursing assistant in the team.
The lack of conformity in the nursing
assistant's role from hospital to hospital is
mentioned. The second section is con-
cerned with meeting the patients" basic
needs: a comfortable bed, food and
water, cleanliness, movement, sleep, and
elimination. The procedures given in rela-
tion to these needs are comprehensive
and detailed, with the patient as the focal
point around which the team operates.
Some anatomy and physiology is includ-
ed, although the text is mainly concerned
with nursing care. The material is well
presented, with the procedures explicitly
explained in point form. The headings for
the procedures and relevant information
are frequent and descriptive. Numerous
diagrams and illustrations should help the
student in identifying various disease con-
ditions and in giving specific treatments.
The administration of medications is not
included in the text.
The third section deals with the partic-
ular needs of the patient. This section
covers a number of procedures that many
non-professional nurses can be taught:
admission and discharge of patients, vital
signs, collecting specimens, enemas,
colostomy care, and catheter irrigations.
In this section also, principles are given
and stressed. The needs of special patients
include caring for a patient with a com-
municable disease, caring for an emotion-
ally ill patient, preoperative and post-
operative care, and caring for the breath-
less patient.
The fourth section deals with the
needs of the special patient. The material
in this section is informative; however, a
few of the procedures would not likely be
the responsibility of the nursing assistant
or the practical nurse, such as throat
suctioning in postoperative care.
The vocabulary is not too technical
and the meanings of medical terms are
given at the end of each chapter. Summa-
ries and review questions are also includ-
ed at the end of each chapter.
This text could be of great value to
both the student and instructor in out-
lining modern accepted methods of
patient-centered care and the principles
involved in this care.
Forces Affecting Nursing Practice edited
by Dorothy D. Petrowski and Margaret
T. Partheymuller. 1 1 7 pages. Washing-
SEPTEMBER 1%9
ton, D.C., The Catholic University of
America Press, 1 969.
Reviewed by Ruby Cuthbert. Regional
Supervisor, Victorian Order of Nurses.
National Office, Ottawa. Ont.
Each spring the school of nursing of
The Catholic University of America has
sponsored a continuing education series.
These papers, given by members of the
faculty of the school of nursing, the
University of America, a local Visiting
Nurse Association, and a member of the
public health service, have been compiled
into book form.
Each lecture or chapter shows how the
nurse of the future will need to be
educated, not only in nursing procedures,
but also in the technological field. This
need will present a difficult task for
educational institutions. As the lecturer
dealing with automation points out, "The
nurse will need to be able to describe
what she does - the computer is only as
good as the thought processes used to
plan it."
These lectures must have been fasci-
nating to listen to, and to discuss with the
lecturers. A few of the lectures need the
personality of the lecturer, but not all.
This would make a handy reference
book for students and postgraduate
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THE CANADIAN NURSE 59
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NADIAN NURSE should be ac-
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Address all inquiries to:
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C>rculat>on Depi . SO Tti
veway. Ottawa 4, Canada
nurses alike. The nurses who attended the
workshop must be pleased to have the
lectures in book form. Even if some
chapters do not pertain to Canadian
nursing, others do, and it is therefore
worth putting on the reference shelf in
any library. Q
accession list
Publications on this list have been
received recently in the CNA library and
are listed in language of source.
Material on this list, except reference
items, which include theses and archive
books that do not circulate, may be
borrowed by CNA members, schools of
nursing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List"
and should be addressed to: The Library,
Candian Nurses' Association, 50 The
Driveway, Ottawa 4, Ontario.
No more than three titles should be
requested at any one time. If additional
titles are desired, these may be requested
when you return your loan.
Stamps to cover payment of postage
from library to borrower should be in-
cluded when material is returned to CNA
library.
Books and Documents
1. AHA nursing activity study; project re-
port Chicago, American Hospital Association,
1968. 83p.
2. Anatomy of the newborn: an atlas by
Edmund S. Crelin. Philadelphia, Lea & Febiger,
1969. 256p. R
3. Basic pharmacology for nurses, 4th ed.
by Jessie E. Squire. Saint Louis, Mo. Mosby,
1969. 329p.
4. Basic physiology and anatomy by Ellen
E. Chaffee and Esther M. Greisheimer, 2d ed.
Philadelphia, Lippincott, cl969. 634p.
5. A brief history of pharmacy in Canada.
Toronto, Canadian Pharmaceutical Association,
1967. 113p.
6. Cancer ward by Alexander Solzhenitsyn.
Translated from Russian by Nicholas Bethell
and David Burg. New York, N.Y., Bantam,
cl969. 559p.
7. Crisis at Columbia; report of the Fact-
Finding Commission appointed to investigate
the disturbances at Columbia University in
April and May 1968. New York, Vintage
Books, cl968. 222p.
8. Diplomacy in evolution; report of the
Canadian Institute on Public Affairs 30th
Couchiching Conference, 1961 edited by D.L.B.
Hamlin. Toronto, University of Toronto Press
for Canadian Institute on Public Affairs, cI961.
128p.
9. Dossier homosexuality par Dominique
Dallayrac. Paris, Laffont, 1968. 514p.
60 THE CANADIAN NURSE
10. Essentials of nursing: a medical-surgical
text for practical nurses, 2d ed. by Claire
Brockman Keane. Philadelphia, Saunders,
cl969. 491p.
11. History, School of Nursing, Toronto
General Hospital. Volume 2, ] 932-] 967 by
Mary E. MacFarland. Toronto, 1968. 60p. R
12. Index of Canadian Nursing Studies
compiled by CNA Library, Ottawa, Canadian
Nurses' Association, 1969. R
13. La loi et la maladie mentale; rapport du
Comite d'etudes sur la Loi et la Maladie
Mentale du Comite scientifique national de
Planification. Montreal, L'Association canadien-
ne pour la Sante mentale, 1969. 3v.
14. Management techniques for the hospital
executive housekeeper by the National Sanitary
Supply Association and Executive House-
keepers of America. Chicago, 1965. 72p.
\5. A manual for team nursing developed
by Mercy Hospital, Pittsburgh, Penn. St. Louis,
Mo., Catholic Hospital Association, cl968. 56p.
16. Manual of hospital housekeeping. Chi-
cago, American Hospital Association, 1959,
113p.
17. Medlars 1963-1967 by Charles J. Aus-
tin. Washington, U.S. Dept. of Health, Educa-
tion, and Welfare, 1968. 76p.
18. Mental hospitals join the community.
New York, Milbank Memorial Fund, 1964.
180p. (Milbank Memorial Quarterly, v.42, no.3
July 1964, pt.2)
19. Nurse participation in hospital product
selection: verbatim descriptions of the nurse's
role in supply and equipment selection. New
York, American Journal of Nursing. Advertising
Research Department, 1967. 4v.
20. Nursing in respiratory diseases; a
symposium edited by Mary G. Helming. Phila-
delphia, Saunders, reprinted from Nursing
Clinics of North America, Sep. 1968 for Na-
tional Tuberculosis and Respiratory Disease
Association, 1968. p.38M87.
21. Nursing trends; a book of readings by
M. Virginia Dryden. Dubuque, Iowa. Brown,
cl968. 327p.
22. Repertoire, 1969 des itudes et travaux
ridigis au Canada au portant sur des sujets
louchant le domaine infirmier au Canada
compilee par les soins de la bibliotheque de
I'AIC. Ottawa, Association des infirmieres Ca-
nadiennes, 1969. 2v. R
23. Report of the Nursing Conference on
the Care of Patients with Cardiac Involvement,
Inn on the Park, Toronto, May 13-17,1968.
Co-sponsored by Ontario Heart Foundation,
Ontario Hospital Association, Ontario Medical
Association, Registered Nurses' Association of
Ontario. Toronto, Registered Nurses Associa-
tion of Ontario, 1969. 132p. |
24. Soins infirmiers; precautions d prendre: \
elabores avec la collaboration de plusieurs
groupes de monitrices et de Mme Got ex-direc-
trice de I'Ecole d'infirmieres de I'Hopital Saint
Antoine, a Paris. Paris, Lamarre-Poinat, 1968. j
225p. I
25. Survey report on the wastage of general
trained nurses from nursing in Australia, Nov.
1960-Nov. 1967, by Royal Australian Nursing
Federation, National Nursing Education
Division and the National Florence Nightingale ]
SEPTEMBER 1%9'
^■■OB
Committee of Australia. Victoria, 1967. Iv.
(various pagings)
26. Syntaxe du franfais modeme, ses fon-
dements historiques et psychologiques par
Georges LeBidois et Robert LeBidois. 2d ed.
Paris, Auguste Picard, 1968. 2v.
27. Textbook of pediatric nursing, 3d ed.
by Dorothy R. Marlow. Philadelphia, Saunders,
C1969. 687p.
28. Workbook in bedside nursing maternity
nursing by Inge J. Bleiei, Philadelphia,
Saunders, cl969. 147p.
Pamphlets
29. Les cinquante premiires annies; une
esquisse d'histoire. Ottawa, Association des
Infirmieres Canadiennes, 1959? 17p.
30. History of the nurses official directory
of the Registered Nurses Association of Nova
Scotia, Halifax Branch by Anna (Robert)
Thorpe. Halifax, 1967. 7p. R
31. How to attend a conference by S. I.
Hayakawa. San Francisco, International Society
for General Semantics, 1969. 7p.
32. Nursing in Sweden prepared by Swedish
Nurses' Association, Stockholm; The Swedish
Institute, 1965. 8p.
33. Schoolgirls' interest in nursing as a
career by Robert Gillan. Kensington, N.S.W.,
School of Hospital Administration, University
of New South Wales. 1968. 38p.
34. Swedish Nurses' Association, Stock-
holm, 1969. 83p.
35. Social and economic welfare goals -
1970: approved by Board of Directors, Februa-
ry 1 969. Ottawa, Canadian Nurses' Association,
1969. 4p.
Government Documents
Canada
36. Dept. of National Health and Welfare.
Careers in Canadian medicine by . . . in co-
operation with the Canadian Medical Associa-
tion. Ottawa, 1969? Iv.
37. . Dental Health Division. Dental
Health manual. Ottawa, Queen's Printer, 1969.
46p.
38. . Health Insurance and Resour-
ces Branch. Health Grants Directorate. National
health grant manual, April 1. 1969. Ottawa,
1969. 6p.
39. Ministere de la Sante nationale et du
Bien-etre Social. Services de Sante d'urgence.
Plan de I 'evacuation des hopitaux. Ottawa,
L'Imprimeur de la Reine, 1960. 55p.
40. . Services de Sante nationale et
du Bien-6tre social. Plan hospitaller en cas de
sinistre. Ottawa, L'Imprimeur de la Reine,
1959. 33p.
41. . Projets de recherche et itudes
dans le domaine hospitaller, 1967. Ottawa,
1968. 121p.
42. National Library of Canada. Canadian
theses 1966/67. Ottawa, Queen's Printer, 1969.
234p.
43. National Research Council of Canada.
Report of the president, 1967-1968. Ottawa,
1969. 126p.
44. Science Council of Canada. The role of
the federal government in support of research
in Canadian Universities by John B. Macdonald
and the Canada Council with a minority report
by L.P. DugaL Ottawa, Queen's Printer, cl969.
361 p.
Quebec
45. Ministere de I'lndustrie et du Commer-
ce. Bureau de la Statistique du Quebec. Taux de
salaire et heures de travail. October 1967.
(Quebec, 1968. Iv.
46. . Centre d'information Statisti-
que. Annuaire du Quebec, Quebec yearbook,
1968-69. Quebec, Editeur official du Quebec,
1969. 840p.
Studies Deposited in
CNA Repository Collection
47. /I descriptive study of the behavior
mothers exhibit in response to each other
during the early puerperium, in matters of
family living with a newborn infant by Peggy
Saunders. Montreal, 1969. 42p. Thesis
(M.Sc.(App)) - McGill. R
48. Extended care and the general hospital
by R. K. McGeorge. Toronto, 1969. 120p.
Thesis (Dip.H.A.) - Toronto. R
49. La philosophic des soins organises a
domicile par Jean-Benoit Bunock. Ottawa, Mi-
nistere de la Sante Nationale et du Bien-etre
Sociale, 195? 31p. R
50. The philosophy of organized home care
by Jean-Benoit Bunock. Ottawa, Dept. of Na-
tional Health and Welfare, 195? 31 p.R □
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Please lend me the following publications, listed in the
issue of The Canadian Nurse,
or add my name to the waiting list to receive them when
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SEPTEMBER 1%9
THE CANADIAN NURSE 61
classified advertisements
ALBERTA
ALBERTA
BRITISH COLUMBIA
DIRECTOR OF NURSING required for a mod-
ern 45-bed hospital with duties to commence
November 1, 1969. Applicant must have the
postgraduate training and experience in Nursing
Service Administration. Please submit informa-
tion of experience, qualifications and references
to the: Administrator of the Athabasca Munici-
pal Hospital, Box 240, Athabasca, Alberta.
REGISTERED NURSES required for a 51-bed
active treatment hospital, situated in east central
Alberta. Salary range Jan 1 to Aug 31 — $450
to $535, Sep 1 to Mar 31, 1970 — $475 to
$555, with full maintenance in new nurses res-
idence for $50 per month. Sick leave, holidays
and working conditions as recommended by the
Alberta Association of Registered Nurses. For
further information kindly contact: W.N.
Saranchuk, Administrator, Elk Point Municipal
Hospital, Elk Point, Alberta.
REGISTERED NURSES FOR GENERAL
DUTY in a 34-bed hospital. Salary 1968,
$405-$485. Experienced recognized. Residence
available. For particulars contact: Director of
Nursing Service, Whitecourt General Hospital,
Whitecourt, Alberta. Phone: 778-2285.
GENERAL DUTY NURSES for active, ac-
credited, well-equipped 65-bed hospital ingrow-
ing town, population 3.500. Salaries range from
$465 - $555 commensurate with experience,
omer Denerits. iNurses' residence. Excellent per-
sonnel policies and working conditions. New
modern wing opened in 1967. Good communica-
tions to large nearby cities. Apply: Director of
Nursing, Brooks General Hospital, Brooks. Al-
berta.
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$2.25 for each additional line
Rates for display
advertisements on request
Closing dale for copy and cancellation is
6 weeks prior to 1st day of publication
month.
The Canadian Nurses' Association does
not review the personnel policies of
the hospitals and agencies advertising
in the Journal. For authentic information,
prospective applicants should apply to
the Registered Nurses' Association of the
Province in which they are interested
in working.
Address correspondence to:
The
Canadian ^
Nurse
50 THE DRIVEWAY
OTTAWA 4. ONTARIO.
^Z7
GENERAL DUTY NURSES for 94-bed General
Hospital located in Alberta's unique Badlands.
$405— $485 per month, approved AARN and
AHA personnel policies. Apply to: Miss M.
Hawkes, Director of Nursing, Drumheller Gene-
ral Hospital, Drumheller, Alberta.
GENERAL DUTY NURSES for new 50-bed
modern hospital. Salaries approved by AARN.
Apply to: Director of Nursing Service, St. John's
Hospital, Edson, Alta.
GENERAL DUTY NURSES (3) required for
32-bed active hospital. Starting salary $500 to
$600 per month, plus $25 northern allowance.
Room and board $50. Pleasant working condi-
tions. Apply to: Matron, St. Theresa Hospital,
Fort Vermilion, Alberta.
GENERAL DUTY NURSES for 64-bed active
treatment hospital, 35 miles south of Calgary.
Salary range $405 — $485. Living accommoda-
tion available in separate residence if desired.
Full maintenance in residence $50.00 per month.
Excellent Personnel Policies and working condi-
tions. Please apply to: The Director of Nursing,
High River General Hospital, High River, Alber-
ta.
GENERAL DUTY NURSES required for 50-bed
active treatment hospital with six practicing
doctors. 1969 salary effective September
1st — $465 to $555. Past experience re-
cognized. Residence accommodation available.
Located on main highway between Calgary and
Edmonton. Apply to: Mrs. E. Harvie, R.N., Ad-
ministrator, Lacombe General Hospital, Lacom-
Ije, Alberta.
GENERAL DUTY NURSES are required by a
230-bed, active treatment hospital. This is an
ideal location in a city of 27,000 with summer
and winter sports facilities nearby. 1968 salary
schedule $405 — $485. 1969 schedules present-
ly under negociation. Recognition given for
previous experience. For further information
contact: Personnel Officer, Red Deer General
Hospital, Red Deer, Alberta.
GENERAL DUTY NURSING POSITIONS are
available in a 100-bed convalescent rehabilitation
unit forming part of a 330-bed hospital complex.
Residence available. Salary 1967 — $380 to
$450 per mo. 1968 — $405 to $485. Experience
recognized. For full particulars contact Director
of Nursing Service, Auxiliary Hospital, Red Deer,
Alberta.
GENERAL DUTY NURSES and OPERATING
ROOM SUPERVISOR for 72-bed accredited
hospital. Salary as recommended by Provincial
Association. Apply to: Administrator, Provi-
dence Hospital, High Prairie, Alberta.
PUBLIC HEALTH NURSE for the Big Country
Health Unit, Hanna, Alberta. R.N. required
(P.H.N, preferred). Drivers license. Provincial
Salary Scale. Working days Monday to Friday.
Apply: Box 279, Hanna, Alberta.
BRITISH COLUMBIA
EVENING COORDINATOR required for a
New Modern Hospital designed with the Friesen
Concept of Supply — Distribution. Acute Unit
75-beds. Extended Care Unit 35-beds. Bachelor
Degree in Nursing and previous supervisory
experience desirable. Apply to: Director of
Patient Care, Cranbrook and District Hospital,
Cranbrook, B.C.
MEDICAL-SURGICAL NURSING INSTRUC-
TOR, with University preparation, fora450-bed
hospital with a school of nursing. Apply to:
Associate Director, School of Nursing, St. Jo-
seph's Hospital School of Nursing, Victoria, B.C.
REGISTERED NURSES for Intensive and Pro-
gressive Care Unit in new 150-bed hospital.
Knowledge and experience in the use of Heart
equipment essential. Also GENERAL DUTY
NURSES required. Salary in accordance with
RNABC agreement. Apply to: Director of
Nursing, Cowichan District Hospital, Duncan,
B.C.
62 THE CANADIAN NURSE
REGISTERED NURSE for operating room for
44-bed hospital. Experience preferred but not
essential. RNABC policies and schedules in
effect. Apply to: Director of Nursing, Creston
Valley Hospital, Creston, B.C.
COME TO PACIFIC NORTHWEST — Gateway
to Alaska, Friendly community, enjoyable
Nurses' Residence accommodation at minimal
cost. RNABC contract in effect. Salaries — Re-
gistered $508 to $633, Non- Registered $483.
Northern differential $15 a month. Travel allow-
ance up to $60 refundable after 12 monthsserv-
ice. Apply to: Director of Nursing, Prince Rupert
General Hospital, 551-5th Avenue East, Prince
Rupert, British Columbia.
B.C. R.N. FOR GENERAL DUTY in 32 bed
General Hospital. RNABC 1969 salary rate
$508— $633 and fringe benefits, modern, com-
fortable, nurses' residence in attractive com-
munity close to Vancouver, B.C. For application
form write: Director of Nursing, Eraser Canyon
Hospital, R.R. 2, Hope, B.C.
GENERAL DUTY NURSES (2) required for
New Modern Hospital designed with the Friesen
Concept of Supply — Distribution. Acute Unit
75-beds. Extended Care Unit 35-beds. RNABC
policies in effect. Hospital located in the
beautiful East Kootenays. Apply to: Director
of Patient Care, Cranbrook and District Hos-
pital, Cranbrook, B.C.
GENERAL DUTY NURSES for new 30-bed hos-
pital located in excellent recreational area. Salary
and personnel policies in accordance with
RNABC. Comfortable Nurses' home. Apply: Di-
rector of Nursing, Boundary Hospital, Grand
Forks, British Columbia.
GENERAL DUTY NURSES for 37-bed Acute
Hospital in Southwestern B.C. Salary: $508 —
$633 plus shift differential. Credit for past
experience. RNABC Personnel Policies in
effect. Accommodation available in Residence.
Apply to: Director of Nursing, Nicola Valley
General Hospital, P.O. Box 129, Merritt, B.C.
GENERAL DUTY NURSES for 45-bed active
General Hospital — expanding to 70 beds. Situ-
ated on the Sunshine Coast, 2-1/2 hours from
Vancouver, B.C. RNABC policies in effect. Ap-
ply to: Director of Nursing, St. Mary's Hospital,
Sechelt, British Columbia.
GENERAL DUTY NURSES for 63-bed active
hospital in beautiful Bulkley Valley Boating,
fishing, skiing, etc. Nurses' residence. Salary
$498—523, maintenance $75; recognition for
experience. Apply: Director of Nursing, Bulkley
Valley District Hospital, Smithers, British
Columbia.
GENERAL DUTY AND PRACTICAL NURSE
needed for 70-bed General Hospital on Pacific
Coast 200 miles from Vancouver. RNABC
contract, $25 room and board, friendly com-
munity. Apply: Director of Nursing, St. George's
Hospital, Alert Bay, British Columbia.
GENERAL DUTY, OPERATING ROOM AND
EXPERIENCED OBSTETRICAL NURSES for
434-bed hospital with school of nursing. Salary:
$508— $633, these rates are effective January
1969, plus shift differential. Credit for past expe-
rience and postgraduate training. 40-hr. wk.
Statutory holidays. Annual increments; cumula-
tive sick leave; pension plan; 20 working days
annual vacation; B.C. registration required.
Apply: Director of Nursing, Royal Columbian
Hospital, New Westminster, British Columbia.
GENERAL DUTY and OPERATING ROOM
NURSES for modern 450-bed hospital with
School of Nursing. RNABC policies in effect.
Credit for past experience and postgraduate
training. British Columbia registration is re-
quired. For particulars write to: The Associate
Director of Nursing, St. Joseph's Hospital,
Victoria, British Columbia.
GRADUATE NURSES required for 30-bed
hospital in interior B.C. Salaries and conditions
in accordance with RNABC agreement. Excel-
lent accommodation available at an attractive
rate. Apply: Director of Nurses, Lady Minto
Hospital, Ashcroft, B.C.
GRADUATE NURSES for 24-bed hospital,
35-mi. from Vancouver, on coast, salary and
personnel practices in accord with RNABC.
SEPTEMBER 1969
October 1969
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The
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Nurse
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CNJ 10-69
2 THE CANADIAN NURSE
OCTOBER 1%9
The
Canadian
Nurse
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 10
October 1%9
29 Making a Comeback B. Kowalchuk
30 The Child With Leukemia C. Cragg
35 Collecting Urine Specimens From Children E.G. Pask
38 The Coagulation of Harry T.L. Carter
39 How to Prolong a Hospital's Lifespan E.H. Zeidler
42 Hospital Design is a Nursing Affair N.A. Wylie
45 Check Your Image — It's Slipping! G. Zilm
49 The Nurse and the Sociopathic Personality A.M. Marcus
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
1 1 News
22 Names
24 Dates
26 In a Capsule
51 Books
52 Accession List
72 Index to advertisers
Executive Director: Helen K. Mussallem •
Editor: Virginia A. Lindabury • Assistant
Editor: Eleanor B. Mitchell • Editorial Assist-
ant: Carol A. Kodarsky • Circulation Man-
ager: Beryl Darling • Advertising Manager:
Roth H. Bainnel • Subscription Rates: Can-
ada: One Year, $4.50; two years, $8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Six weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
® Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of imruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on white paper)
are welcomed with such articles. The editor
is not committed to publish all articles
sent, nor to indicate definite dates of
publication.
Postage paid in cash at third class rate
MONTREAL, P.O. Permit No. 10,001.
50 The Driveway, Ottawa 4, Ontario.
Editorial
OCTOBER 1%9
"It would be entirely wrong for you to
give an impression of flashy opulence, of
course; but on the other hand you should be
ware of [your premises] becoming an eye-
sore."
These words of advice are addressed to
undertakers - that much maligned group
whose services everyone tries to avoid —
in an article in a British publication that
asks: "How Can the Funeral Director Im-
prove His Image? " (Public Relations, Augus
1969.) It seems that undertakers, as
everyone else in the community, are anxious
to be well regarded by the public. They
are, however, faced with a difficult PR
task, since they are often criticized un-
fairly for making a living out of others'
grief, even though they are providing an
essential service.
And funeral directors aren't the only
ones who are trying to improve their image
these days. Even the students are having
a go at it. An article in the July issue
of Public Relations Journal (U.S.A.) tells
how a group of university students in Florid
went to work to clean up their host commu-
nity for its annual Beautification Week.
The article was entitled, "Help to Town
Builds Student Image." These students were
apparently concerned about the negative
image that a minority of radical students
on campus were creating. They wanted to
change the student image and thus improve
campus-community relations, which were
somewhat strained.
There is a temptation to be cynical about
such efforts by groups to improve or change
their image. We may speak disparagingly of
these efforts, dismissing them as mere
propaganda dreamed up by a slick promoter.
In a few instances this may be true; but
for the most part, groups that attempt to
improve their image are sincere about it.
Obviously, the success of the image
improvement depends on action, not merely
words. It also depends on each member of
the group, who must recognize the need for
change and be determined to bring it about.
This month we present a strongly-worded
article that asks hospital nurses to check
their image, because it's slipping. Al-
though the gist of the message is about
personal appearance, the author makes it
clear that appearance tells much about
attitude. As she says, "... usually
the professional shows his commitment to
his calling by representing it well when
on public view."
V.A.L
THE CANADIAN NURSE 3
letters
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Reaction to Minister's speech
The statistics quoted by the Minister
of Health in the article "A challenge that
confronts us" (Aug. 1969) do not quite
tally with those published by the CNA
for 1968 - or it may be a matter of
interpretation. He stated that "there are
over 130,000 registered nurses in Cana-
da .. . and only about five percent of
them are in public health work." Count-
down tells us there are 120,186 registered
of which 84,431 are employed. More
than eight percent (not five percent) of
the employed nurses are working in pub-
lic health if you include school health and
occupational health in that category.
One can speculate that nurses from
other countries find employment in
northern Canada satisfying because their
basic preparation has included study of
midwifery and perhaps other services
which in Canada are not within the legal
realm of nursing. The programs for ad-
vanced obstetrics offered at the Universi-
ty of Alberta and for outpost nursing in
Dalhousie provide opportunities for
nurses to prepare for health services
needed in remote Canadian areas, yet
practice of those skills in urban Canada
would likely be questioned.
I agree with the Minister when he says
"reform of health education is possible, is
feasible, is practical, and is necessary." It
is time the gaps and duplications in
medicine, nursing, and other health serv-
ices were studied to redefine goals and
roles. There is a feeling that nurses should
be universal substitutes ready to fill in for
any health (or administrative) service; this
the nurse often does willingly but at
considerable risk because she is unprepar-
ed. Time spent in non-nursing often
means deletion or dilution of nursing
care - or delegation to an auxiliary
person whose nursing preparation is of a
technical nature.
The team approach to health care, for
example health clinics, is a more reasona-
ble answer. Hard and fast lines should
never be drawn between professional serv-
ices, yet a more realistic alignment should
be studied. - Dorothy Hibbert, Profes-
sor, Faculty of Nursing, The University of
Western Ontario, London, Ont.
The Honourable Mr. Munro, Minister
of Health, in his address has indeed
challenged nurses everywhere. The em-
phasis he placed on health services out-
side the hospital is significant. Nursing
educators have been deeply concerned
4 THE CANADIAN NURSE
about the need for educational programs
to be developed to include all aspects of
health. It is no longer adequate to focus
the student's learning experience only
with the hospital patient in the acute
phase of his physical or emotional crisis.
The direction the nursing educational
programs have taken is positive for the
challenge of expanded health care.
Mr. Munro seems to be embracing the
team approach to develop more effective
health service. The team has been broad-
ened to include government health and
welfare departments, community agencies
including hospitals, and the medical and
nursing professions.
There is every indication that nursing
has been challenged to make a contribu-
tion to the plan. In fact, Mr. Munro is
calling on nurses to join in the total
restructuring of health care services. Let
us hope this is true, and when the call is
made, Canadian nurses will respond to
this challenge with vigor. It is also hoped
the provincial governments, health
agencies including hospitals, and associa-
tions are listening. - M. Geneva Purcell,
Director of Nursing, University of Alberta
Hospital, Edmonton, Alberta.
The Honourable John Munro has cap-
tured our views on nursing and publicly
announced his support. Moreover, his
suggestions on the expansion of services
to encompass the total spectrum of
health care - prevention, cure, rehabili-
tation - have been supported and
promoted by nurses for some time. The
community comprehensive health pro-
gram is the only realistic approach to a
healthy and productive society.
The double standards under which
nurses practice, depending on the locale
in which they work, should be reconsider-
ed by both the medical and nursing
professions. However, let us not move too
quickly to transform nurses into pseudo-
doctors, even thougli there may be indi-
viduals with an educational background
in nursing who aspire to this role. Such a
change will not alleviate the problems
facing practicing nurses and the recipients
of their care.
A role similar to the Russian feldsher
system should not be encompassed whol-
ly by the nursing profession. Nurses have
a distinctive and unique function that
should continue to predominate in the
provision of health care. - Frances
Howard, formerly consultant in nursing
service, Canadian Nurses' Association.
In favor of lobbyist
I want to tell you that I agree whole-
heartedly with your assessment of the
association's need for a full-time lobbyist
in Ottawa. That this is a necessity and
possibly may become a reality does not
need further discussion.
However, there are numerous thoughts
that occur to me, and I would hke to
share them with you.
First, I wonder if there is much to be
learned from the experience of the Amer-
ican Nurses' Association - except
perhaps that by combining firmness,
friendliness, and femininity, it has even-
tually achieved a few of its aims, and
those only after what must have seemed
an interminably long interval. ANA is still
plugging away after 22 years trying to
amend the Taft-Hartley Act. Fortitude is
all very well and good, and so is pa-
tience ~ heaven knows a nurse has plen-
ty of that. But there comes a time when
patience wears thin, when firmness and
friendliness are of little avail, and when
femininity fails us. God forbid that we
should ever use our femininity as a
weapon. They would turn the tables on
us if we did. That is exactly what they
want: the opportunity to admire our hats
and tell us how lovely we are looking
today, and to graciously turn down our j
proposals, our briefs, our "pure, unadul-
terated demands."
No, there are lessons to be learned
from the lobbyists in the USA, but not
from the ANA lobbyists. I would not
minimize Miss Thompson's accomplish-
ments; they have been considerable. 1
would only say that in Canada we are
dealing with a different type of govern- '
ment, a different type of politician
and - despite some evidence to the con-
trary - a different society than our
neighbors to the south. Consequently our
tactics will necessarily differ, if they are
to be successful.
I think by now CNA has realized there
is no percentage in appealing to other
members of the health professions to
present with us a united front. I believe
we should quit trying, as it is a losing
battle and a periodic affront to the
dignity of every professional nurse in
Canada. Remember such remarks as L.R.
Adshead's "CNA is poppycock." (News,
July 1969, p. 10.)
Instead, I propose that we should turn
to big business for help in achieving our
goals. I am thinking in particular of those
(Continued on page 6,
OCTOBER 196
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(Continued from page 4)
who would have a vested interest in
seeing that we reach these goals: text-
book manufacturers; hospital suppliers
(we still do have no small part to play in
planning hospital budgets); teaching aid
manufacturers; builders and hospital and
school planning consultants. I propose
that we go to them begging - nurses
have always been good at that — for
help in the way of lobbying at Ottawa
and the provincial capitals, in the way of
moral support when our proposals are
presented, in the way of pressure of the
kind that only big businesses can apply to
governments. You may feel that this is a
cynical and opportunistic attitude. I sug-
gest that it is only realistic. It seems to
me that all else has failed to this point.
You must see that.
I propose that now it is time to strip
off our gloves, as quickly and efficiently
as only nurses can and cease being firm,
friendly, fair, feminine and fool-
ish. - Mary E. Hall, R.N., Chateauguay,
P.Q.
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6 THE CANADIAN NURSE
More reaction to article
I have been asked by the executive
Committee of the Registered Nurses'
Association of British Columbia to ex-
press its concern over the publication of
the article "Two- Year Versus Three-Year
Programs" (February, 1969). Our delay
in forwarding these comments was delib-
erate in order that a copy of the full
report might be obtained and studied in
conjunction with the article.
The question was first raised at a
school of nursing conference where sever-
al senior members of school faculties
reported conversations with both nurses
and non-nurses who had read the article
and drawn erroneous and ill-founded con-
clusions from it. The problem was re-
ferred to the RNABC executive commit-
tee.
The authors of the study had caution-
ed the reader: "The results of this
study . . . must be interpreted with care
and used with equal care as the basis for
practical decision-making." Nevertheless,
it was apparent that not all journal
readers followed this advice. Many of us
agree with Dr. Costello's statement (Let-
ters, May, 1969) that "... The Canadian
Nurse deserves more careful reading." We
recognize, however, that the majority of
nurses do not have Dr. Costello's facility
and experience in critically assessing re-
search reports. For these reasons, the
members of the RNABC committee on
nursing education and the RNABC execu-
tive committee are of the opinion that
The Canadian Nurse has a responsibility,
in reporting nursing research, to see that
the chances of misunderstanding and
misinterpretation are kept to a minimum.
The title of the article in question is,
in itself, misleading. The study did not
concern "Two-Year Versus Three-Year
Programs." It concerned a comparison of
a group of graduates from one specific
two-year program and one specific three-
year program. A further point that seems
to have been overlooked by many readers
is that the three-year program followed
by the control group was a unique one.
The article stated only that "both the
experimental and the control students
followed a program in which repetitions
in classes were eliminated, content was
enriched and concurrent teaching was
introduced."
The detailed report entitled The
Evaluation of a Two-Year Experimental
Nursing Program made it clear that the
curriculum of the three-year program
followed by the control group was one
that had been "subjected to major chan-
ge":
"The students in the first year of the
two-year and three-year programs follow-
ed essentially the same curriculum. Stu-
dents in the second and third years of the
three-year program benefited from curric-
(Con tinned on page 8)
OCTOBER 1969
Frankly,
we'd
rather
you didn't
notice us
It has been said that the measure of
truly effective background music is
the degree to which it goes un-
noticed.
A contradiction? Perhaps. Yet, con-
sider how little thought you give to
anything while it is fulfilling its
functional obligations smoothly. An
electric shaver. A radio. A lawn
mower. Even the ubiquitous light
bulb.
We like to think that our hospital
specialty products are somewhat in
the background of your professional
activities, and also go unnoticed. For
experience has shown that when a
surgeon is very much aware of the
materials with which he is working,
something is not working right. And
this is the kind of awareness we
don't want.
It's just one of the reasons we have
been striving for over 60 years to
produce sutures, needles, and a
variety of other surgical products
that perform the way you want them
to — and striving as well to anticipate
the rush of progress in surgery
through creative research and in-
novation.
Along with you, we think that
patients should be subjected to the
least trauma possible under the cir-
cumstances, and be afforded every
possible opportunity for successful
recovery.
Sothe nexttimethe untoward behav-
iour of a product causes you to look
twice at the package, look carefully.
It probably won't say DAVIS &GECK.
That time, incidentally, might be an
ideal time to call us. You'll discover
that DAVIS & GECK can provide you
with products and services that
perform so well you'll hardly notice
them.
Even if you feel there's an area in
which we can improve, please don't
wait for us to call you — write us or
call collect.
We may not want to be noticed, but
neither do we want to be ignored.
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8 THE CANADIAN NURSE
(Continued from page 6J
ulum reorganization in obstetric and
psychiatric nursing areas and nursing of
children. Their programs in these areas
were 12 weeks in length. They had in
addition 48 weeks of experience in
general bedside nursing in the service-
oriented pattern or it could be described
as work experience primarily in medical-
surgical nursing."
The authors further reported that,
"the same faculty members selected
learning experiences for both groups,"
and further explained,
"By . . . careful selection and reorgani-
zation of content, the student was provid-
ed with additional time for independent
study and library work. However, because
the experimental group was one year
shorter . . . additional time was given for
clinical experience to students in the
experimental program, thus reducing
their time available for study and library
work as compared with the control
group."
It can be seen from the foregoing
statements that the educational program
of the control group was in no way
representative of three-year programs of-
fered by the majority of hospital schools.
In their report the authors stated,
"... the findings in favor of the controls,
though not overwhelming, were unex-
pected." Why the findings should have
been unexpected was not explained.
Some nurses who have read the report
and noted the educational programs of
the experimental and control groups have
expressed surprise that the differences in
performance by the two groups were
found to be so minimal. Surely it is not
unexpected to find that an additional
year of training following two years in an
education-centered program should refine
and add to a student's nursing skills!
To assist readers to become more
knowledgeable in the assessment of re-
search methodology and the interpreta-
tion of research findings, the RNABC
executive committee would like to urge
the adoption of the recommendations
made by the RNAO Committee on Re-
search in Nursing in their letter published
in June, 1969, that "prior to publication
in the journal, research articles be re-
viewed by researchers who are competent
to assess soundness of the design, im-
plementation and reporting of the re-
search," and that "The Canadian Nurse
invite critiques of articles and research
reports for publication, preferably in the
same issue or closely following the initial
publication of the article, study or
report." - F.A. Kennedy, RN, Director
of Education Services, RNABC U
OCTOBER 1969
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news
CNA Associate Director
To Participate In
WHO Conference In New Delhi
Ottawa - Lillian Pettigrew. associate
executive director of the Canadian
Nurses' Association, has been invited by
the World Health Organization to take
part in a South East Asia Conference to
be held in New Delhi. India from Novem-
ber 3 to November 14. 1969. The Con-
ference, organized by WHO. will take the
form of a workshop on the control and
management of the nursing component of
health services.
In her presentation. Miss Pettigrew
plans to include a discussion of the role a
professional nurses' association can play
in influencing the improvement of nurs-
ing practice.
The other consultants are Mary Henry,
a registered nurse and registrar of the
General Nursing Council for England and
Wales, whose discussion will center on
nursing legislation; a medical administra-
tor, and a part time consultant in legisla-
tion for the health professions.
Selected participants have been invited
from WHO member countries
- Afghanistan. Burma. Ceylon. India.
Indonesia, the Maldive Islands (south
west of Ceylon). Mongolia, Nepal, and
Thailand. Other participants at the con-
ference will include WHO staff from
South East Asia, the Western Pacific, and
the Eastern Mediterranean region.
Observers have been invited from the
International Council of Nurses and the
United States Agency for International
Development (USAID).
McGill To Offer
Master Of Nursing Program
Montreal P.Q. - The School for
'Graduate Nurses. McGill University, will
offer a one-year program leading to the
degree of Master of Nursing beginning
September 1970. The course is designed
to prepare teachers of nursing for the new
educational programs across Canada.
Graduates of baccalaureate programs in
basic nursing, who have a superior record
of academic and professional achievement
and development, are eligible for admis-
sion.
Supporting the major in the Teaching
of Nursing are courses in psychology,
sociology, and education. In the field,
graduate students will participate in the
teaching of nursing by studying how
students learn to nurse and by relating
conditions for learning to the teaching
process.
OCTOBER 1%9
Closed-circuit T.V., showing video-
tapes of learning and teaching situations,
will provide accessible empirical data for
analysis and evaluation. A final internship
of two months will permit students a
continuous experience in which to exam-
ine and develop their teaching practices.
SI. John Ambulance
Announces Bursary Awards
Ottawa. - The bursary awards
committee of the St. John Ambulance
Association recently announced its
awards for the 1969-70 academic year.
Recipients of the Margaret Mac-
Laren bursary for study at the master's
level are:
• Miss Frances Howard, former con-
sultant in nursing service, Canadian
Nurses' Association, for study at the
University of Western Ontario. Lon-
don, Ontario;
• Mrs. Marion Estelle Kerr of Beacons-
field Quebec, for study at McGill
University. Montreal.
Recipients of The Countess Mount-
batten Bursary for postbasic study are:
• Miss Carol Ann Cooper of Toronto,
Ontario, to study for the Bachelor of
Nursing degree at McGill University,
Montreal.
• Miss Heather Lewis of Pointe Claire,
Quebec, to study for the Bachelor of
Nursing degree at McGill University,
Montreal.
• Mrs. Judy Minkus of Winnipeg, Ma-
nitoba, to study public health nursing
at the University of Manitoba, Winni-
peg, Manitoba.
• Mr. Andreas Papadopoullos of Brant-
ford, Ontario, to study for the Bache-
lor of Science in Nursing degree at the
University of Windsor. Windsor, Onta-
rio.
Recipients of The Countess Mount-
batten Bursary for students are:
• Miss Kathryn Grant, student nurse,
Kingston General Hospital.
• Miss Isabel Hemming, student nurse,
Ottawa Civic Hospital.
• Miss Brenda Hunter, student nurse,
Winnipeg General Hospital.
• Miss Theresa Hunter, student nurse,
St. Joseph's Hospital School of Nurs-
ing. Victoria, British Columbia.
• Miss Janice Leask, student nurse,
Orillia Soldiers Memorial Hospital.
• Miss Lynne Mannard, student nurse,
The Montreal General Hospital.
• Miss Joyce Riehl, student nurse,
two-year diploma course, Saskat-
chewan Institute of Applied Arts and
Science, Saskatoon.
New Look In CNA Library
This new browsing stand, donated to
the CNA library by an Ottawa book
agent, makes an eye-catching entrance
display. Here, two staff members exam-
ine some of the fare. I
Federal Government Nurses
Get More Pay
Ottawa. - The Professional Institute
of the Public Service of Canada and the
treasury board of the federal government
signed a new contract August 29 to give
the 2.200 federally employed nurses
more pay and four weeks vacation after
10 years of service.
Leslie W.C.S. Barnes, executive direc-
tor of the Institute, said this is the first
federal group to have obtained this vaca-
tion goal, as virtually all other contracts
call for four weeks annual leave after 18
years' service.
The contract is in effect from July I,
1967 to December 31, 1970. In July
1967, a general duty nurse (Nurse I)
earned S4,200 and with 1 2 increments a
maximum of S5.910. depending on the
regional area in which she worked. Effect-
ive January I. 1970. she will receive
$5,523 with fewer increments to reach a
maximum of S7,900. Half-yearly adjust-
ments will be made retroactive to July
1968.
Ethel Gordon. R.N. consultant with
the Professional Institute, said tliat the
government has agreed to phase out the
THE CANADIAN NURSE 11
news
regions that determine how much general
duty nurses are paid. Initially, the con-
tract consolidates the present five region-
al areas into three. "We will be working
toward getting a shorter range with higher
starting salaries and larger increments,"
Miss Gordon said. "If there is reason to
believe that salaries are not competitive
with those outside the government, there
is a reopener clause to allow renegotiation
before the end of the contract."
Miss Gordon pointed out that a nurse
employed at the Nurse I level will receive
one increment above the minimum for
each two years of recent relevant experi-
ence up to a maximum of three incre-
ments. In other words, someone with six
or more years' recent relevant experience
will be earning the fourth step in the
salary range on appointment.
Although there is no assistant head
nurse classification as such, an assistant
head nurse in a federal hospital will
receive an additional S380 per year retro-
active to January 1, 1968.
The head nurse (Nurse 2) who earned
from $6,043 to S6,640 in July 1967 wUl
earn from $7,157 to $8,422 by January
1970. The Nurse 2 level and above is paid
at the same rate regardless of the region
in which she is employed.
The first level supervisor (Nurse 3),
paid from $6,467 to $7,150 in July 1967,
will earn from $8,133 to $8,992 by
January 1970. Other levels will receive
comparable increases with the nurse con-
sultant earning a maximum of $15,720
during the contract period.
The new agreement also provides for
financial recognition of university degrees
and diplomas; reduced working hours;
and compensation for overtime and for
assuming responsibilities in remote areas.
The Professional Institute of the Pub-
lic Service of Canada became the certified
bargaining agent for the federally employ-
ed nurses on March 3, 1969. The Depart-
ments of National Health and Welfare and
Veterans Affairs employ most of these
nurses. Several nurses work in Canada's
northlands.
OR Technicians
Form Association
New York, N.Y. - A National Asso-
ciation of Operating Room Technicians
iwas formed in New York July 20. Repre-
sentatives of over 60 chapters throughout
the US voted the establishment of the
organization, and adopted bylaws, under
the sponsorship of the Association of
Operating Room Nurses.
Purposes of the AORT are: to unite
operating room technicians; to enable
them to study and discuss knowledge,
experience and ideas in their area; to
12 THE CANADIAN NURSE
Robert W. Eades, elected first president of the Association of Operating Room
Technicians, is congratulated by Ina L. Williams, president of the Association of
Operating Room Nurses, which sponsored the AORT. Betty Thomas, president-elect
of the AORT, looks on.
promote a higher standard of operating
room technician performance; to stimu-
late interest in ongoing education; and to
influence hospitals to employ qualified
OR technicians, through cooperative
efforts of the AORN and other profes-
sional organizations.
Robert W. Eades of Rochelle Park,
N.J., was elected president of the organi-
zation. Ina L. Williams, president of
AORN, was chairman of the first national
AORT advisory board, made up of AORT
members plus representatives of the na-
tion's health industry.
"Miles For Books"
Answer To Shortage
St. John's, Nfld. - The clinical areas
of the Grace General Hospital in St.
John's Newfoundland, were desperately
in need of reference books, so the nursing
staff found an answer - a long walk.
Almost $2,000 was raised by the 146
nurses who walked 1 1 miles, earning what
their sponsors had agreed to pay.
The director of nursing, Mrs. V.
Ruelokke, led the field by raising
$267.50, as she crossed the finish line.
Paul Caraca, a registered nurse in charge
of male nurse training, was runner-up by
raising $118, and several instructors each
raised over $50.
CNA Library
Wants Theses
Ottawa. - The library of the Cana-
dian Nurses' Association wants to make
its collection of masters' and doctoral
theses, prepared by Canadian nurses, as
comprehensive as possible.
Margaret L. Parkin, CNA librarian, said
that a Canadian nurse attending any
university regardless of location is invited
to inform her of the topic of the research
being conducted and then send a copy of
the final paper for the library collection.
By the end of August 1969, nearly
375 studies had been reported and 80
percent were in the CNA collection. The
collection is used extensively by nurses as
well as by government organizations, and
as resource for foreign countries prepar-
ing histories of nursing.
Studies may be borrowed on inter
library loan or for use in the CNA library.
Breakthrough For Nurses
At St. Joseph's Hospital Guelph
Toronto, Ont. - An arbitration
board award on September 4, 1969
makes the nurses at St. Joseph's General
Hospital in Guelph, Ontario, the highest
paid public hospital nurses in Ontario.
"The arbitration award leads to a
breakthrough in negotiations for nurses,"
said Anne Gribben, employment relations
director for the Registered Nurses' Asso-
ciation of Ontario. The award was 1 1 to
1 5 percent over the Ontario Hospital
Services Commission recommended
guidelines.
Miss Gribben explained that the origi-
nal parties for the 1968 negotiations used
OHSC guidelines for salaries; however
neither the nurses nor the hospital were
prepared to negotiate these for 1 969. The
contract was opened to negotiate salaries
for 1 969.
Under the terms of the new contract
that expires in December 1969, general
duty nurses will earn $525 per month
(Continued on page 15)
OCTOBER 1969
NEW IN 1969
King & Showers: HUMAN ANATOMY AND
PHYSIOLOGY 6th Edition
By Barry G. King, Ph.D., U.S. Public Health Service, and Mary Jone
Showers, R.N., Ph.D., Hahnemonn Medical College.
This well know text has been completely revised and
reorganized into six units: The Body as an Integrated
Whole, Integration and Control, Biomechanics, Ex-
change and Transport, Metabolism, and Reproduc-
tion of the Human Being, This arrangement puts
increased emphasis on physiology and provides o
logical framework for discussing structure and func-
tion on successively more complex levels — from the
cell to man. In this edition a magnificent eight-page
series of full-color plates on transparent overlays
show the muscles, veins, arteries, viscera, and skele-
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anatomical relationship clear. An Instructor's Man-
ual is available.
About 430 pages with about 330 illustrations, plus color plates.
About $9.50. Just ready.
Sutton: BEDSIDE NURSING TECHNIQUES IN
MEDICINE AND SURGERY New 2nd Edition
By Audrey Latshow Sutton, R.N., Blue Cross of Philadelphia, formerly
of Edgewood Generol Hospital, Berlin, N.J., and Wilmington (Del.)
General Hospital.
Used by more than 80,000 nurses, "Sutton" is one
of the most widely used books of its type ever pub-
lished. The new, revised Second Edition is a com-
pletely up-to-date source book of clinical nursing pro-
cedures. In clear, simple language supplemented by
more than 850 drawings, the author tells precisely
how to perform hundreds of nursing functions — from
intramuscular injection to care of the patient in hyper-
baric oxygen therapy. You'll find new data on such
topics as: reverse isolation, IPPB respirators, hypo-
dermoclysis, tubeless gastric analysis, heart trans-
plants, and fluid and eletroiyte balance.
398 pages with 871 illustrations. $8.95. Published March, 1969.
Marlow: TEXTBOOK OF PEDIATRIC NURSING
3rd Edition
By Dorothy R. Marlow, R.N., Ed.D., Villonova University.
The most widely used text in its field, "Marlow" has
been completely revised and brought up to date in its
new Third Edition. It remains an unexcelled presenta-
tion of the growth, development, and nursing care
needs of the sick and well child from birth through
adolescence. For each stage of development. Dr.
Marlow describes normal growth and behavior pat-
terns, health requirements, and conditions requiring
immediate, short term, and long term care. She
emphasizes the nurse's role in dealing with the emo-
tional problems of the child patient and his family.
687 pages with 572 illustrations. $9.20. Published May, 1969.
Simmons: THE NURSE-PATIENT RELATION-
SHIP IN PSYCHIATRIC NURSING
By Janet A. Simmons, R.N., M.S., University of Massachusetts.
This new workbook fills a need unmet by anything
previously available. It helps the student nurse estab-
lish a therapeutic relationship with a mental patient
during her institutional affiliation in psychiatric nurs-
ing. Each of the thirteen guides covers a specific
aspect of the process — from orientation and com-
munication to final evaluation. There are questions
for the student to answer and places for her to
record her observations. A problem-solving approach
is used throughout. This book has been thoroughly
tested in actual use by classes of nursing students.
189 pages. Soft cover. $4.05. Published August 1969.
W. B. SAUNDERS COMPANY CANADA LTD., 1835 Yonge Street, Toronto 7
Please send and bill me:
O Sutton: Bedside Nursing Techniques ($8.95)
n King & Showers: Human Anatomy and Physiology (about $9.50)
n Simmons: Nurse-Patient Relationship ($4.05)
n Marlow: Pediatric Nursing ($9.20)
Name:
Address:
City: Zip:
ON 10-69
THE CANADIAN NURSE 13
OCTOBER 1969
Johnson & Johnson recommends eight departments
where J CLOTH* Hospital Towels have important advantages
-and can reduce expenses
OperatingRoom.UseJCLOTH*
Hospital Towels as a prep
sponge, vaginal wipe and to catch
overflow of prep materials. Ex-
cellent as surgeon's hand towel
and for drying his forehead. Avail-
able in three colours. Green is
recommended for O.R. use.
Recovery Rooms. Protect your
pillows with a large size (14" x
24") J CLOTH* Hospital Towel.
Use the medium size (12'/4" x 19")
as a personal towel for patients,
and the small size (I21/4" x 12>/2")
as a patient face cloth.
Out-patients Department.
J CLOTH* Hospital Towels are
very absorbent. Use them to clean
wounds of accident victims, for
minor surgery, as a hand towel
for doctors, as a pillow case pro-
tector and as a cover for carts,
counters and scales.
14 THE CANADIAN NURSE
Obstetrical Department.
J CLOTH* Hospital Towels are
sterilizable which makes them
ideal to receive baby during de-
Hvery— and as a hand towel for sur-
geons and nurses. Also can be used
as a perineal wipe and prep towel.
They won't fall apart when wet.
Orthopaedic Department. Use
them as a hand towel for sur-
geons and cast room technicians.
They are surprisingly durable and
retain shape after many dryings.
Low unit cost makes them more
economical than rental towels.
Central Supply Room.
J CLOTH* Hospital Towels have
no lint drop out. They won't leave
a trace of lint: ideal for polishing
and wrapping syringes and surg-
ical instruments. Incidentally, the
fact that there are 100 towels per
package ensures portion control.
Isolation Wards. J CLOTH*
Hospital Towels cost so little they
can be thrown away after a single
use. No wonder so many hospitals
are using them in their isolation
wards as a sterile, single-use face
cloth or hand towel. They're far
better than paper.
Nursery. Nurses find J CLOTH*
Hospital Towels very good as a
burp cloth. Other uses: face cloth
for newborn babies, as a mattress
cover for bassinets and for clean-
ing babies' buttocks. They're far
softer than terry cloth or paper.
^oWifOHc*^4t>Ww?n
CL0TH
hospital towels
Available in white, blue or green in
these three convenient sizes :
Order
Codas
White
Blue
Green
Small
uy."tn'A"
CI 640
CI 641
CI 642
Medium
12VS"x19"
CI 630
CI 631
/CI 632
Large
CI 620
CI 621
CI 622
'Trademark of Johnson & Johnson or Afflliated Companies. @ J&J 1968
OCTOBER 1969
news
(Continued from page 12)
with a maximum of S650 based on
increments of S25 per month annually
for five years. A graduate non-registered
nurse will earn from S500 to S625, and
an assistant head nurse S563 to S688.
The daily rate for registered nurses work-
ing part-time will be S28 and for graduate
non-registered nurses, S25.50.
Professor Earl Palmer, associate dean
of the faculty of law at the University of
Western Ontario and head of the arbitra-
tion board, said in his report: "The board
wishes to note that we have paid no
consideration whatsoever to statements
of the Ontario Hospital Services Commis-
sion. In our opinion, the intentions of
this body are completely irrelevant to our
deliberations. We cannot accept the posi-
tion that the public is entitled to nursing
services by virtue of legislatively forcing
nurses to accept substandard wages."
CCUSN (A) Submits Brief
To Maritime Union Study
Halifax. N.S. - The Canadian Con-
ference of University Schools of Nursing.
Atlantic Region, submitted a brief to the
Maritime Union Study (a commission set
up by the three Maritime provinces to
study the feasibility of union) on Septem-
ber 3, to demonstrate the present and
future need for cooperation among the
university schools of nursing in the re-
gion.
CCUSN (A) believes that money, a
sufficient number of qualified teachers,
and planning and coordination are equal-
ly important.
In the brief, CCUSN (A) reviewed the
present and future needs of higher educa-
tion for nurses in the Region and tried to
indicate the support necessary to provide
the kind of higher education that today's
society requires.
Because there is an urgent need for
more highly qualified nursing personnel
on faculties of university schools of nurs-
ing, CCUSN (A) believes there should be
within each Maritime university support-
ing a school of nursing, salary scales,
status, and working conditions that are
competitive with university schools of
nursing in other areas of Canada and with
their colleagues in other faculties within
the university community. Plans should
be developed to enable nurses to obtain
higher degrees to qualify for university
appointments, the brief continued.
CCUSN (A) recommended the devel-
opment of pubUcity on a regional basis to
attract more students into the program,
and that present obligations required by
bursary recipients be made less restrictive.
CCUSN is a national organization sub-
divided into four regions, of which the
OCTOBER 1%9
Atlantic region is one. Each region is
organized with its own executive and
constitution to permit free exchange and
collaboration that provides a voice to
speak for nursing education within the
university.
"Good Samaritan" Act Passed
By Alberta Legislature
Edmonton, Alta. - The Emergen-
cy Medical Aid Act to give protection
from actions for damages to certain
persons rendering medical aid as a
result of an accident or in an emergen-
cy was passed into law May 7, 1969.
by the Alberta legislature.
According to the AARN News-
letter, full credit for such action goes
to the Pincher Creek Chapter of the
AARN. which requested the executive
to seek such legislation. Their brief
presented to the Alberta Cabinet in
January brought favorable results.
The Act reads as follows:
1. This Act may be cited as the
Emergency Medical Aid Act.
2. In this Act.
a) "physician" means a person
who is registered as a medical
practitioner under The Medical
(Continued on page 1 7)
$18
Suggested Retail Prices
At last/ perspiratbn
damase meets its match.
Naturalizer now brings you duty shoes of
genuine Servotan* leather, specially treated
to resist drying, cracking and discoloration
from perspiration.
With Servotan, Naturalizers stay softer, more
comfortable and are so easy to clean with
soap and water.
Naturalizers also have the famous Wonder-
sole (See illustration at right).
Wondersole is contoured to
match the shape of yourf oot.
Your body weight is distrib-
uted evenly along its entire
length for compleYe support.
WITH SERVOTAN AND WONDERSOLE"
BROWN SHOE COMPANY OF CANADA LTD.
Naturalizer Division, Perth, Ontario
THE CANADIAN NURSE 15
in Canada ifs
Stille
exclusively from
DePuy
There's no disputing the fine
quality of Stille Surgical
Instruments. As a matter of fact,
other instrument manufacturers use
Stille as a gauge. But there's no
duplicating the strength, precision
and perfect balance and the prime stainless
steel of Stille instruments. A Stille
instrument will not only outperform but
it will also outlast any other surgical instrument
and we have case histories that prove it.
Available only from
DePuy Manufacturing Company (Canada) Ltd.
For additional
information write:
Quebec and
Maritime Provinces
Guy Bernier
862 Charles-Guimowd
Boucherville. Quebec
Ontario and
Western Canada
John Kennedy
2750 Slough Street
Malton, Ontario
16 THE CANADIAN NURSE
DePuy, Inc.
A Subsidiary
of Bio-Dynamics
Warsaw,
Indiana 46580 U.S.A.
OCTOBER 1969
(Continued from page 15)
Profession Act;
b) "registered nurse" means a
person who is a registered nurse
under the Registered Nurses Act.
3. Where, in respect of a person who
is ill, injured or unconscious as the
result of an accident or other emergen-
cy.
a) a physician or registered nurse
voluntarily and without expecta-
tion of compensation or reward
renders emergency medical services
or first aid assistance and the serv-
ices or assistance are not rendered
at a hospital or other place having
adequate medical facilities and
equipment, or
b) a person other than a person
mentioned in clause (a) voluntarily
renders emergency first aid assist-
ance and that assistance is rendered
at the immediate scene of the
accident or emergency,
the physician, registered nurse or other
person is not hable for damages for
injuries to or the death of that person
alleged to have been caused by an act
or omission on his part in rendering
the medical services or first aid assist-
ance, unless it is established that the
injuries or death were caused by gross
negligence on his part.
Management Nurses Organize
In New Brunswick
Fredericton, N.B. - Directors, assist-
ant directors, and associate directors of
nursing have formed a Management
Nurses' Organization under the New
Brunswick Association of Registered
Nurses. The idea for the group's forma-
tion resulted from the Public Service
Labour Relations Act of New Brunswick,
which excludes nurses in managerial posi-
tions from collective bargaining. More
than 55 management nurses are members.
A core committee of five, representing
the five health regions of the province,
met September 26 to develop guidelines
for the new organization that is open to
all management nurses. The guidelines
referred to the group in each region for
consideration have not yet been released.
Quebec School Children
Suffer From Malnutrition
Quebec City, P.Q. - In 1968,
508,519 school children had physical
examinations in the province. Of these,
55,604 had deficiencies that could affect
physical maturity. The majority were
(Continued on page I9j
OCTOBER 1969
^Sfi^^^^^^^^ffl^^P
Personalized ^/''PA"
SHEARS
6" protessjonal. pfecrsion shears, forgsd
in steel- Guaranteed to stay sharp 2 yem.
No. 1000 ShMn (no initials) 2JaOf
SPECIAL! 1 Doz. Sliears $24.tl>tll
Initials {up to 3) etched add SOc per pair.
REEVES NAME PINS
Largest-selling among nurses ! Superb lifetime quality . . .
smooth rounded edges , . . featherweight, lies flat . . .
deeply engraved, and lacquered. Snow-white plastic wili
not yellow. Satisfaction guaranteed. GROUP DISCOUNTS.
Choose lettering in Black, Blue, or White (No. 169 onlyl
I SAVE: Onltr 2 identical Pins as pre
caution ifalnst loss, less changing.
No. 169
No. 100
1 Nama Pin only
2 Pins (same nama)
1 Name Pin only
2 Pins (same nama)
1.65*
2.50*
.75*
1.25* . 1.85'
1.95*
3.00*
1.05*
1^ IMPORT ANT Please Mi 2Sc per order handling ctiarge on all orders of
3 pins Of less GDOUP OISCOUHTS: 25^99 pins. 5%: IM of mora, 10\,
up
*+
Shears/Pen POCKET KIT
Plastic Pocket Saver (see t>elow) witti 5^' prof,
forged bandage shears, plus handy chrome "tri-color"
pen (writes red. black or blue at flip of thumb).
No. 291 Pocket Kit 330 ppd.
No. 292-R Pen Refills (all 3 colore) JSO ppd.
Etched initials on shean add SO
Uniform POCKET PALS
Protects against stains and wear. Pliable white
plastic with gold stamped caduceus. Two com-
partments for pens, shears, etc. Ideal token gifts
or favors.
No. 210-E
Savers
(6 for 1.50, 10 for 2^25
\ 25 or more, .20 ea., all ppd.
^£
Scripto NURSES LIGHTERS
Famous Scripto VuLighters with crystal-
clear fuel chamber. Choose an array of
colorful capsules, pills and tablets in
chamber, or a sculptured gold finished
Caduceus. Novel and unique, for yourself
or for unusual gifts for friends. Guaranteed
by Scripto.
No.300-PPiMLigtiter ( a9«« nnri
No. 300-C Caduceus Ligtiter \ *-^ "' ****"•
i
RN/Caduceus PIN GUARD
Dainty caduceus fine-chained to your professional
letters, each with pinback. saf. catch. Wear as is
... or replxe either with your Class Pin for safety.
Gold fin., gift-boxed. Specify RN. LVN or LPN.
No. 3240 Pin Guard 2.95 ppd.
i>
Sterling HORSESHOE KEY RING
Clever, unusual design: one knob unscrews for In-
serting keys. Fine sterling silver througttout, with
sterling sculptured caduceus charm.
No. 96 Key Rlnt 3.75 ea. ppd.
"SENTRY" SPRAY PROTECTOR
Protects you against violent man or dog . . .
instantly disables without permanent injury.
Handy pressurized cartridge projects irritating
stream.
No. AP-16 Sentry ZOO M. ppd.
CROSS Pen and Pencil
World famous Cross writing instruments with
Sculptured Caduceus Emblem Lifetime guarantee
Ij KT COID nilED LUSTBQuS ChHOM^
Pencil No. 6603 $8.00 No. 3503 $5.00
Pen No. 6602 8.00 No. 3502 5.00
Set No. 6601 16.00 . No. 3501 10.00
8511 Pen Refills (blue med.), 2 for 1.50 ppd.
Inrtlflt or Ml mm* tnfrtwed in wript on turrtl lnili«ls MM 7S u
n 50 ptr Mt). Full Nhw add I.SO «. C3.00 pw m() to ito** pricn
Remove and refasten cap tj?,^
band instantly for launder-
ing or replacement! Tiny
molded plastic tac, dainty
caduceus. Choose Black. No. 200
Blue, White or Crystal with m Cap C-I
Gold Caduceus. or all Black U Tact^ I
(plain]. 6TacsPerSet \J miy I
SPECIAL! 12 Sets (72 Tacs) $9. total
h(ii
^K
Sel-Fix NURSE CAP BAND
Black velvet band material. Self-adhe-
sive: presses on, pulls off, no sewing
or pinning. Strip %' x 36" for two or
more caps, trims to desired widths or
lengths. Reusable many times.
No. 3436 Band 1.25 08. 3 for 3.00,
6 or more .85 ea.
Nurses ENAMELED PINS
Beautifully sculptured status Insi^ia; 2-color keyed,
hard-fired enamel on gold plate. Dime-sized^ pin-back.
Specify RN, LPN, PN. LVN, NA, or RPh. on coupon.
No. 205 Enamelod Pin IJZS oa. ppd.
5^.«.,uu>- Waterproof NURSES WATCH
Swiss made, raised silver full numerals, lumin. mark-
ings Red-tipped sweep second hand, chrome 'stainless
case. Stainless expansion band plus FREE black leather
strap. ] yr. guarantee.
No. 06-925 12.95 oa. ppd.
Lindy Nurse STICK PENS
Slender, white barrels with tops colored to match
ink. Fine points; colors for charts, notes. Adj. stiver
pocket clip. Blue, black, red or lavender.
Ne. 467-F Stick Pees J 6 pens 2.89, 12 pons 5.29
(cheese color assort) ) 24 or more 39 ea^ all ppd.
f
»-=-T 7
Reeves AUTO MEDALLIONS
Lend professional prestige. Two colors baked enamel on
gold background. Resists weather. Fused Stud and
Adapter provided. Specify letters desired: RN. MO, DO,
RPh, DOS. DMD or Hosp. Staff (Plain).
No. 210 Aiito Medallion 4.25 ea. ppd.
Professional AUTO DECALS
Your professional insignia on window decal.
Tastetuily designed in 4 colors. 4V4" dia. Easy
to apply. Choose RN, vm, LPN or Hosp. Stan.
No.621 Decal... 1.00 u.,
3 for 2.50, e or mort .60 ea.
TO: REEVES COMPANY, Attleboro. Mass. 02703
Personalized
NURSES
STETHOSCOPE
Nationally advertised Littman* diaphragm-
type Nursescope" especially designed for
nurses. Weighs less than 2 ozs.. fits in uni-
form pocket High acoustic sensitivity,
ideal for blood pressures, general auscul-
tation. Flexible 23" vinyl tubing with anti-
collapse concealed spring, non-chilling dia-
phragm. U. S, made Choose from 5 jewel-
like colors: Goldtone. Silvertone , Blue,
Green, Pink Up ts 3 initials etched on dia-
pkragH FREE, prevents toss Indicate on
coupon
No. 216 Nursescope . . 12.95 ppd.
12 or more 10.95 ppd.
I
I
H
I
I
I
I
I
I
I
A
n one Name Pin Q two. same name
LETT.COLOR: Q Black DBlue O White (No. 169 only)
METAL FINISH (Nos. 169 Or 100): OGokJ DSilver
LETTERINS.
INITIALS
Name Engraved
(Cross Pens)
PROF. LETTERS.
I enclose %
(Mass. residents add 3% S.T.)
City
SUte.
.Zip.
THE CANADIAN NURSE 17
Fleet
ends ordeal by
Enema
for you and
your patient
Now in 3 disposable forms:
• Adult (green protective cap)
• Pediatric (blue protective cap)
• Mineral Oil (orange protective cap)
Fleet — the 40-second Enema* — is pre-lubricated, pre-mixed,
pre-measured, individually-packed, ready-to-use, and disposable.
Ordeal by enema-can is over!
Quici<, clean, modern, FLEET ENEMA will save you an average of
27 minutes per patient — and a world of trouble.
WARNING: Not to be used when nausea,
vomiting or abdominal pain is present.
Frequent or prolonged use may result in
dependence.
CAUTION: DO NOT ADMINISTER
TO CHILDREN UNDER TWO YEARS
OF AGE EXCEPT ON THE ADVICE
OF A PHYSICIAN.
In dehydrated or debilitated
patients, the volume must be carefully
determined since the solution is hypertonic
and may lead to further dehydration. Care
should also be taken to ensure that the
contents of the bowel are expelled after
administration. Repeated administration
at short intervals should be avoided.
Full intormation on request.
•Kehlmann, W. H.: Mod. Hosp. 84:104, 1955
FLEET ENEMA® — single-dose disposable unit
QUALITV PMARMAceUTICAUS
18 THE CANADIAN NURSE
OCTOBER 1969
Next Month
in
The
Canadian
Nurse
• How Hospitalization
Affects a Child
• The Bluebirds
Who Went Over
• Aging and Learning
^ZP
Photo credits for
October 1969
Photo Features, Ottawa,
pp. 11,45-48
Hospital for Sick Children, Toronto.
pp. 36, 37
Craig, Zeidler and Strong,
Architects. Toronto, pp. 40, 41
McMaster University, Hamilton,
p. 43
news
(Continued from page I 7)
malnourished or suffering from fatigue.
Visual difficulties centered on strabismus,
myopia, and hyperopia.
Doctors visited kindergarten classes,
diagnosed problems, and suggested treat-
ments to give the children a better chance
at school. They were particularly interest-
ed in the children's neuromotor systems,
their mental and emotional states, and
their social adjustments.
Family doctors and health unit person-
nel became more aware of physical,
mental, and social problems of the
school-aged child as a result of the school
program. Seven hundred nurses spent 30
percent of their time in elementary
schools and 56 nurses worked in second-
ary schools in 1968. Depending on the
number of students, from one to five
nurses worked in each of the 55 regional
school boards in Quebec.
The department of health is interested
in treating the very young child in the
hope that future physical or intellectual
problems based on neglect can be avoid-
ed.
Committee To Investigate
Nonmedical Use of Drugs
Ottawa. - The Honorable John Mun-
ro, minister of national health and wel-
fare, has announced the appointment of a
committee to investigate the nonmedical
use of drugs. The committee, composed
of M. Gerald Le Dain. Ian Lachlan Camp-
bell. Andre Lussier, J. Peter Stein, and
Dr. Heinz Lehmann. will gather informa-
tion from Canada and abroad.
They will prepare a report on the
extent of current knowledge about the
nonmedical use of drugs; the reasons
underlying the use of the drugs; the
social, economic, educational, and philo-
sophical influences of the use of drugs;
and suggest ways that the federal govern-
ment can reduce and remedy the prob-
lems caused by drug use.
A preliminary report will be made
after six months and the final report after
two years.
WHO Work In Africa Continues
Geneva, Switzerland. - The World
Health Organization has intensified its
efforts to train doctors, paramedical staff,
and auxiliaries in Africa. In his annual
report to the WHO Regional Committee
for Africa, Dr. Alfred Quenum, the re-
gional director, said the shortage of quali-
fied health staff, the unsatisfactory dis-
tribution of the small number available,
and their depletion owing to the brain
FOOD AND DRUG
EDUCATIONAL SERVICES
Food and Drug Educational Ser-
vices is the new name for the
Consumer Division of Food and
Drug Directorate (FDD). The
change in name indicates the
expansion of service to educa-
tors, schools, provincial health
departments and professional
groups — as well as consumers
in general.
The ROLE OF FDD
EDUCATIONAL SERVICES
In five regional offices in Hali-
fax, Montreal, Toronto, Winnipeg
and Vancouver, our consultants
— inform and explain food and
drug laws, why made and how
they benefit Canadians
— assist educators in consumer
and health education programs
on food and drug subjects
through distribution of informa-
tive materials, displays and talks.
To receive publications or make
enquires write to:
Educational Services
FOOD AND DRUG DIRECTORATE
DEPARTMENT OF NATIONAL
HEALTH AND WELFARE
Tunney's Pasture
Ottawa 3, Ontario
Name
Address
Affiliation
Check your interest:
— Regular foct sheet
— Food informotion
— Drug informotion
— English
— French
D
D
D
D
D
OCTOBER 1969
THE CANADIAN NURSE 19
When you [day
starts at §^
6 a.m... you re oji
charge duty... ^
you've skimped
onmeals...^^?^
andonsleep..^ M
you haven't had^
time to hem
a dress...
mal(eana])plepie...
wash your hair.,
evenpowder w/M
yournose
in comfort!^
it's time for a change. Irregular hours and meals on-the-
run won't last. But your personal irregularity is another
matter. It may settle down. Or it may need gentle help
from DOXIDAN.
use
DOXIDAN"
most nurses do
DOXIDAN is an effective laxative for tlie gentle relief of
constipation without cramping. Because DOXIDAN con-
tains a dependable fecal softener and a mild peristaltic
stimulant, evacuation is easy and comfortable.
For detailed information consult Vademecum
or Compendium.
HOECHST
PHARMACEUTICALS
3400 JEAN TALON W , MONTREAL 30T
DIVISION OF CANADIAN HOECHST LIMITED
I PMAC I
20 THE CANADIAN NURSE
news
drain are still the main obstacles to the
development of public health services.
Dr. Quenum said one important fea-
ture of the work done in education and
training was the orientation given to most
of the programs set up according to the
countries" needs and tasks to be accom-
plished. Educational objectives, curricula,
and teaching tnethods reflected these
tasks, and were applied at the postbasic
nursing education center in Dakar that
opened recently with 20 students from
various French-speaking countries. Dr.
Quenuin reported.
WHO has also extended help in the
establishment of the African Region's
first University Centre for Health Scien-
ces in Yaounde, Cameroon, he said. The
Centre will be a new type of training and
research institution, specially designed to
meet local health needs, provide a high
quality multi-professional program for all
members of the health team, and develop
new concepts of the function of auxilia-
ries. "We are placing great hopes in this
scheme, since if it succeeds the problem
of training nationals capable of taking
over responsibility for the medical serv-
ices of their countries will be partially
solved," he said.
Old Age Pension
To Increase In 1970
Ottawa. - The Honorable John
Munro, minister of national health and
welfare, announced in August that in-
creases in the Old Age Security Pension
and the Guaranteed Income Supplement
will take effect in 1970.
Mr. Munro and Revenue Minister J.-P.
Cote jointly announced similar increases
in Canada Pension Plan retirement pen-
sions, survivor's benefits and contribu-
tions effective next year. Cheques issued
in January will reflect these increases.
The 1970 OAS pension will be S79.58
per month. More than 1,600,000 Cana-
dians will benefit, including those whose
pensions will begin in January when the
eligible age will drop to 65 years. In
addition, 780,000 OAS pensioners will
benefit from an increase in the Guaran-
teed Income Supplement. The 1970 CIS
payment will be $31.83.
Mr. Cote announced that maximum
annual pensionable earnings under the
Canada Pension Plan will reach $5,300 in
1970, compared to $5,200 in 1969.
At the end of 1969, Mr. Munro esti-
mated that more than 140,000 Canadians
would be receiving monthly retirement
pensions and survivor's benefits under the
Canada Pension Plan. The maximum
death benefit payable under the Plan, for
deaths in 1970, will be $530. D
moving?
married?
wish an adjustment?
All correspondence to THE CA-
NADIAN NURSE should be ac-
companied by your most recent
address label or imprint (Attach
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OCTOBER 1969
ADD
NEW DIMENSION
TO YOUR NURSING CLASSES
new depth to your course material. . . new breadth
to your students' knowledge and skill...
RECOMMEND THESE NEW NURSING
SUPPLEMENTS FROM MOSBY
New Volume III
CURRENT CONCEPTS IN CLINICAL NURSING
Stimulate student interest by recommending this clinicaUy oriented reference which
explores the most up-to-date concepts of nursing care. Separate sections consider
medical-surgical, psychiatric, pediatric, and maternity nursing. Liberally illustrated by
case studies, examples and even typical nurse-patient conversations, it examines such
diverse topics as: trauma nursing, the psychedelic drug patient, brief episodes of pain
in children, pica during pregnancy and low-income motherhood.
Edited by Betty Bergersen, R.N., Ed.D.; Edith Anderson, Ph.D.; Margery Duffey, R.N., Ph.D.;
Mary Lohr, R.N., Ed.D.; and Marian H. Rose, R.N., M. A. With 34 Contributors. Publication date:
October, 1969. Approx. 416 pages, 7"x 10", 16 illustrations. About $13.20.
New 7th Edition!
Mosby's COMPREHENSIVE REVIEW OF NURSING
Recommend the new updated 7th edition of nursing's most popular review book to
your students, to help them prepare for class or Ucensing exams. This revision offers a
concise, patient-centered resume of current information in all basic areas of nursing. It
includes a new section, "Paraclinical Nursing"; and more than half the material in the
"Medical-Surgical" section is new. More than 2,000 up-to-date review questions and a
free 24-page answer book, heighten the value of this review.
By 12 Distinguished Contributors. Publication date: September, 1969. 7th edition, 590 pages plus
FM I-Xll, 7V4"x lOVi". 24 illustrations. Price, $9.75.
A New Book!
INTENSIVE NURSING CARE
An especially effective student aid, this new guide is the only book in print today to
lucidly present all aspects of effective nursing care for critically ill patients, including
an introduction to electrocardiography. Each succinct discussion presents typical
orders the nurse will receive, followed by important information on clinical findings,
pathogenesis, treatment and rationale for therapy.
By ZEB L. BURRELL, Jr., A.B., M.D., and LENETTE OWENS BURRELL, R.N., B.S. Publication
date: July, 1969. 298 pages plus FM l-X, 7"x 10". 75 illustrations. Price, $9.65.
MOSBY
TIM
MIRROR
THE C.V MOSBY COMPANY LTD
86 NORTHLINE ROAD
TORONTO 374. ONTARIO. CANADA
A New Book!
ASSOCIATE DEGREE NURSING
A blueprint for two-year nursing programs, this pragmatic guide to practical
details and theoretical concepts helps you construct a program which aids the
student's understanding of nursing fundamentals and their use in a patient-
oriented context. It examines the core curriculum in detail, and discusses
goals, typical curriculums and the relationship of physical and mental health
and behavioral patterns.
By ANN N. ZEITZ, R.N., M.A.; LELIA D. HOWARD, R.N., M.S.; ELVA M.CHRISTY,
R.N., Ed.M.; and HARRIETTE SIMINGTON TAX, R.N. Publication date: July, 1969.
207 pages plus FM l-XII, 6'/2"x 9Vi". Price, $10.75.
OCTOBER 1969
THE CANADIAN NURSE 21
names
Margaret E. Walsh (B.S.N., Catholic U.
of America; M.N., U. of Pittsburgh) has
been appointed general director of the
National League for Nursing. She suc-
ceeds Inez Haynes. Mrs. Walsh has held
nursing posts with veterans administra-
tion hospitals in Pittsburgh, Pa., Brook-
lyn, N.Y., Madison, Wis., and in Washing-
ton, D.C. She has been a clinical associate
in the department of medical nursing.
University of Pittsburgh, and has held a
position in nursing administration at the
Catholic University of America. Prior to
her new appointment, Mrs. Walsh was
president of the District of Columbia
League for Nursing.
Gladys Sharpe (Reg.N., Toronto
Western Hosp.; B.S., Columbia U.; cert, in
admin, in schools of nursing, London U.;
cert, in teaching, McGill U.) was awarded
an honorary doctor of laws degree by
McMaster University in May.
The degree was conferred in honor of
a "Tireless worker with global perspec-
tive, whose dedication and compassion
have been reflected in remarkable ac-
complishments during the varied stages of
her professional career," according to her
citation. Miss Sharpe has left nursing after
42 years in the profession to become a
nursery school teacher.
Sister Elizabeth Hur-
ley (R.N., St. Jo-
seph's Hosp., St.
John, N.B.; B.Sc.N.,
U. of Seattle) recent-
ly was appointed
director of nursing
service at St. Vin-
cent's Hospital in
Vancouver.
Previously Sister had been a general
duty nurse and supervisor at St. Joseph's
Hospital, Saint John, N.B.
A well-known Canadian nurse died
suddenly in August of injuries received in
a car accident. Dorothy Warner (R.N.,
The Montreal General Hosp.; cert, in
admin, in schools of nursing, McGill U.)
died August 9 in Kenora, Ont.
Miss Warner began her career as a
general duty nurse in Medicine Hat,
Alberta, and in Anson General Hospital,
Iroquois, Ont. During the Second World
War, she became principal matron at
National Defence Headquarters, and later
Matron-in-Chief, NDHQ. At the time of
her death she was chief nursing officer,
22 THE CANADIAN NURSE
Dr. Lossing Retires
Dr. E.H. Lossing, former Director General of Health Insurance and Resources
Branch of the Department of National Health and Welfare, was honored by friends
on his retirement at a reception and dinner. Here Margaret D. McLean, Senior
Nursing Consultant, presents a bouquet of roses to Mrs. Lossing as Dr. Lossing
looks on.
the St. John Ambulance Society, and
head of volunteers at the Ottawa Civic
Hospital.
^■|^_ Arlene Aish (B.S.N.,
^^^^^^ U. of British Colum-
■P^^m bia; M.N., U. of
m^ .— i^ Washington) has
w^ **" 3 joined the staff of
^ j^ ^r the school of nurs-
^^" ^L^ ing. Queen's Univer-
^jC^JI^ sity in Kingston as
^Bj^^B assistant professor.
" ilHilB Miss Aish spent a
year at The Vancouver General Hospital
as a staff nurse, then joined the City of
Toronto Health Department as a public
health nurse. She spent four years at the
University of Toronto as lecturer, and
two years at the University of Frederic-
ton as assistant professor. She joined
Queen's after a year of post master's
work at the University of California, San
Francisco.
Douglas Hospital, Verdun, Quebec, has
announced the retirement of its director
of nursing, Mary Christie (R.N. , Hamilton
General Hosp.).
Mrs. Christie nursed in Hamilton and
St. Thomas, Ontario, before joining the
Royal Canadian Army Medical Corps in
1942. She spent three years in South
Africa with the South Africa Military
Nursing Service.
After the war, Mrs. Christie worked at
the Shriners Memorial Hospital and the
Allan Memorial Institute in Montreal. In
1948 she went to Douglas Hospital as an
instructor, and became director of nurs-
ing in 1958.
Replacing Mrs.
Christie is Nessa
Leckie (R.N., St.
Paul's Hosp., Sas-
•t'.2UM. katoon; B.Sc.N.,
McGill U., Mont-
^ . real).
H J Miss Leckie has
■ jteH^H^H been affiliated with
m mHHH^I nursing education in
three large mental hospitals. After becom-
ing assistant director of the school of
nursing at Douglas Hospital in 1960, she
reorganized and enlarged the program for
psychiatric nursing assistants.
In 1966 Miss Leckie helped reorganize
nursing education at St. Ann's Hospital,
Port-of-Spain, Trinidad, as part of the
federal government's External Aid team
to the Caribbean. The school of nursing
at Douglas Hospital continues to accept
many students from the Caribbean.
Nora Earle (R.N., Hamilton General
Hosp.) has been made a member of the
Royal Society of Health.
Mrs. Earle is head nurse of school
health services, Lakeshore Regional
Board, Pointe Claire, Que. She is also a
Fellow of the American School Health
Association. D
OCTOBER 1969
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THE CANADIAN NURSE 23
This hand
was bandaged
in just
34 seconds
with
Tubegi
auz
SEAMLESS
TUBULAR
GAUZE
It would normally take over 2 minutes.
But the Tubegauz method Is 5 times
faster— 10 times faster on some
bandaging jobs. And it's much more
economical.
Many hospitals, schools and clinics
are saving up to 50% on bandaging
costs by using Tubegauz instead of
ordinary techniques. Special easy-
to-use applicators simplify ei/er/ type
of bandaging, and give greater patient
comfort. And Tubegauz can be auto-
claved. It is made of double-bleached,
highest quality cotton, investigate
for yourself. Send today for our free
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Please send me "New Techniques
of Bandaging with Tubegauz".
NAME
ADDRESS
THE SCHOLL MFG. CO. LIMITED
69H9
24 THE CANADIAN NURSE
October 14-15, 1969
Respiratory Care Conference, Tlie Win-
nipeg General Hospital, Winnipeg. Write
to: Mrs. Slessor, The Winnipeg General
Hospital, 700 William Ave., Winnipeg 3,
Manitoba.
October 15-17, 1969
Health Care for the Stroke Patient, a
continuing education course for health
professionals, sponsored by the Universi-
ty of British Columbia. Tuition: $20. The
course will be held at The Arthritis
Centre, 895 West 10th Avenue, Van-
couver, B.C. Address inquiries to:
Division of Continuing Education in the
Health Sciences, Task Force Building,
The University of British Columbia, Van-
couver 8, B.C.
October 16-17, 1969
Continuing Nursing Education Course in
Nursing the Adult with Long Term Ill-
ness. The University of British Columbia,
School of Nursing, Vancouver, B.C.
October 24, 1969
Catholic Hospital Conference of Ontario
Nursing Committee meeting, Westbury
Hotel, Toronto.
October 25, 1%9
Fraser Valley District Registered Nurses'
Association of British Columbia Educa-
tion Day, Chilliwack, B.C., Evergreen Hall
Auditorium. Fee: S5.00. Write: Mrs.
Mary McCallum, 127 Princess Ave. E.,
Chilliwack, B.C.
October 25-26, 1969
Catholic Hospital Conference of Ontario,
annual convention, Westbury Hotel,
Toronto, Ontario.
October 30-31, 1969
Continuing Nursing Education Course in
Pediatric Nursing. The University of
British Columbia, School of Nursing,
Vancouver B.C.
November 3-6, 1969
Operating room seminar, sponsored by
the American Sterilizer Co., Park Plaza
Hotel, Toronto. For more information
write to: American Sterilizer Co. of Cana-
da Ltd., 255 Queen E., Brampton, Ont.
November 4-7, 1969
American College of Hospital Administra-
tors, seminar on executive skills, Corn-
wallis Inn, Kentville, Nova Scotia. Write
to: American College of Hospital Admin-
istrators, 840 N. Lake Shore Dr., Chicago
60611, Illinois.
November 11-13, 1%9
Quebec Operating Room Nurses' Group,
annual convention. Skyline Hotel, Mon-
treal.
November 12-14, 1969
A continuing education course for nurses:
"nursing the adult with an altered state of
consciousness." University of British
Columbia School of Nursing. Fee: $20.
Write: Division of Continuing Education
in the Health Sciences, Task Force Build-
ing, University of British Columbia, Van-
couver 8, B.C.
November 13-14, 1969
Continuing Nursing Education Course in
Nursing the Adult with Acute Illness. The
University of British Columbia, School of
Nursing, Vancouver, B.C.
November 17-21, 1969
World Mental Health Assembly, spon-
sored by the World Federation for Mental
Health and the National Association for
Mental Health, Washington, D.C. Theme:
Mental Health In The Community. Write
to: Dr. Paul V. Lemkau, Chairman, World
Mental Health Assembly, 615 N. Wolfe
St., Baltimore, Md. 21205, USA.
November 19-21, 1969
2nd Manitoba Health conference. Fort
Garry Hotel, Winnipeg, Manitoba. The
theme of special sessions for November
20, planned by the Manitoba Association
of Registered Nurses, is Community
Health — Planning for Progress. Another
special session topic will be Providing
Continuity of Care — The Home Care
Program: Community Or Hospital Based.
For more information write: The Manito-
ba Association of Registered Nurses, 647
Broadway, Winnipeg 1, Manitoba.
November 24-28, 1969
Nurse educators' course on disaster nurs-
ing, Canadian Emergency Measures
College, Arnprior, Ontario. Nurse educa-
tors from English-speaking schools of
nursing are encouraged to enroll. Prefer-
ence will be given to representatives from
schools of nursing that have not incorpo-
rated disaster nursing in their student
nurse curriculum. For further informa-
tion write to the director of emergency
health services in your provincial depart-
ment of health.
November 26-28, 1969
Fourth annual convention of the Cana-
dian Society of Inhalation Therapy Tech-
nicians, Calgary. For information write:
Mr. E. Zaiss, Convention Chairman,
Rockyview Hospital, Calgary, Alta. D
OCTOBER 1%9
a little knowledge is not enough . . .
give teen-agers the facts about menstruation
Someteen-agers have heard they shouldn't bathe
or wash their hair during their menstrual periods.
Some think unmarried girls shouldn't use tampons.
Others say exercise brings on "cramps." No
wonder they call it the "curse."
Give them the facts . . . with the help of the
illustrations in charts like the one above prepared
by R. L. Dickinson, M.D. and available to you free
from Canadian Tampax Corporation Ltd. These
8y2" X 11" colored charts are laminated in plastic
for permanence and are suitable for marking with
grease pencil. Social myths can be exploded, too,
by giving teen-agers either of the two booklets we
will be glad to send you in quantity for distribution.
One booklet is written fortheyounggirl just begin-
ning menstruation and the other for the older
teen-ager. The booklets tell them what menstrua-
tion is, how it will affect them, and how easily they
can adjust to it normally and naturally.
Unmarriedgirls, of course, can use tampons. And
they have many good reasons to do so. Tampax
tampons are easy to insert — comfortable to wear.
OCTOBER 1969
Because they're worn internally there's no irrita-
tion or chafing; no menstrual odor.
Tampax tampons are available in Junior,
Regular and Super absorbencies, with explicit
directions for insertion enclosed in each package.
TAMPAX
SANITARY PROTECTION WORN INTERNALLY
MADE ONLY BY CANADIAN TAMPAX CORPORATION LTD.. BARRIE. ONT.
FREE CHARTS IN COLOR
Canadian Tampax Corporation Ltd., P.O. Box 627, Barrie, Ont.
Please send free a set of the Dickinson charts, copies of the
two booklets, a postcard for easy reordering and samples of
Tampax tampons.
Name
Address.
THE CANADIAN NURSE 25
in a capsule
Esso bee
The May issue of Ontario Medical
Review carried a clinical report dealing
with the habits of bees. At a particular
intersection on a highway with a service
station on each corner, it was noted that
swarms of bees swoop down each summer
to hover around the Shell station, with
one or two going across the highway to
the Esso station. The conclusion of the
research was that in every swarm there
was at least one Esso bee.
Spicy wrapping
It may not be long before those
infuriatingly secure packages won't have
to be removed from food for cooking.
The packages may soon become part of
the meal.
An Associated Press story from Chica-
go reports that Dr. J.F. Murphy, a vice-
president of Swift and Company, told the
National Restaurant Association that
scientists are working on proteins that
will dissolve at cooking temperatures.
"We may even offer a choice of
flavored boxes, wrappers, or bottles to
complement or spice up the rest of the
meal," he said.
Meal's no great shakes, but that
box - it's delicious.
Color conscience
Have you ever wondered why it is
some people go for colors that merely
seem frumpish, loud, or plain awful to
you? Everyone discriminates in color,
but there has been little research into the
reasons for the discriminations.
Extensive tests have convinced some
scientists, however, that there is a reason.
Colors on the red side of the spectrum,
they say, are warm and stimulating,
whereas their blue and green opposites
are cool and relaxing.
This is nothing new? Well, consider
the following evidence reported by the
June issue of Hospital World:
Muscular responses are faster under a
light shade of red; green retards reactions.
Many people tend to overestimate the
26 THE CANADIAN NURSE
passage of time under the influence of
strong colors of red and underestimate it
under equally strong influences of green
or blue.
Blue can be an emotional sedative, and
some hospitals have found that patients
recover more quickly in blue rooms.
Although yellow shades are believed to be
capable of producing a warm sensation,
just a slight change in shading can cause a
feeling of nausea. Commercial airlines
long ago abandoned interior decorations
in yellow because tests showed certain
shades seemed to encouraged air sickness.
Factory workers complained they
were straining their backs lifting black
metal boxes in one factory. The foreman
suggested repainting them a pale green.
After this, a number of men commented
on the ease of lifting those new light-
weight boxes!
Fitness is the ideal
The ideal woman, apparently, is the
physically fit woman. According to the
Reverend Thomas Boslooper of Closter,
N.J., "Most outstanding women are
physically active in one way or another.
They also tend to make the best wives
and mothers because they have the fewest
emotional problems."
The Reverend Boslooper conducted a
10-year study on the subject, interviewing
300 "women of accomplishment" and
150 husbands. He began his study be-
cause he was called upon to counsel
women with marital problems and decid-
ed to go to women who had been
successful to see how they did it.
"The general finding was that all mat-
ure, intellectually creative women were
tomboys when they were young," he
said. "Emotionally healthy women love
the competition a sport offers, while
emotionally distraught women cannot
cope with competition."
Uniform uniforms
A medical student spent his summer
working in a variety of jobs to finance his
education. One time he assisted a butcher
by day and was an orderly by night. Both
jobs required similar white uniforms. One
evening he was assigned to push a patient
on a stretcher into the operating room.
As he entered the room, the patient
looked at him and looking up again began
to scream: "Good heavens! It's my
butcher! " CHAC Bulletin. June
1968. D
OCTOBER 1%9
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Each 5 cc.of
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Aluminum Hydroxide
equivalent to 200 mg.
Dried Aluminum Hy-
droxide Gel; Simethi-
cone (activated methyl-
polysiloxane), 20 mg.
Each MYLANTA chew-
able tablet contains: Mag-
nesium Hydroxide, 200
mg.-, Aluminum Hydroxide,
Dried Gel, 200 mg.; Simethi-
cone (activated methylpoly-
siloxane), 20 mg.
Dosage: One or two teaspoon-
fulsof liquid, or one or two tablets,
between meals and at bedtime.
Dosage may be varied so as to sup-
ply the ulcer patient with the amount of
antacid needed to lower gastric acidity to
a level compatible with healing of the ulcer.
Precautions: Since magnesium salts may
cause central nervous system depression,
MYLANTA should be given with caution to patients
with any degree of renal insufficiency. Aluminum
Hydroxide may, by reacting with phosphates to form the insoluble
aluminum phosphate, cause phosphorus deficiency in patients
whose diet is low in phosphorus.
Side Effects: The usual side effects associated with antacid ther-
apy, constipation and/or diarrhea, have not been reported with
the use of MYLANTA. Side effects are negligible even during long-
term administration of MYLANTA.
Supply: Liquid in 12-oz. nonbreakable plastic bottles; tablets in
boxes of 24 and 100. Detailed information available on request.
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OPINION
Making a comeback
Believing that hospitals needed all the staff they could get, the author took a
refresher course so that she could return to nursing. However, it wasn't all that
simple. She began to think it might be easier to get a part-time job with
Office Overload.
"Come back to nursing - nursing
needs you! " In recent years this plea has
been directed to those of us who are
almost middle-aged and retired from
active nursing. Radio and television
broadcasts urged us to help reduce the
hospital nursing shortage by returning to
work. Even subway posters, showing the
older nurse pinning on her cap to return
to work, exhorted us to come back to the
fold. It seemed that we could no longer
enjoy a shopping excursion or a free
afternoon without a pang of conscience.
Eventually these appeals reached me. I
took one of the six-week refresher
courses offered by the Registered Nurses'
Association of Ontario, because I believed
all hospitals were short staffed and would
appreciate a few hours a week of my
time. Also, the thought of working in a
hospital again appealed to me.
The course gave me the opportunity to
update my theoretical knowledge and
practical skills. My self-confidence grew
as I realized I had not forgotten as much
as 1 feared, and everything was not as new
and different as I anticipated. In short, I
knew it would take me only a brief
period to readjust to active nursing and
don the uniform and cap to work as a
nurse. My husband gave his whole-hearted
support. "Go ahead and do what you
want," he said, "as long as it doesn't
interfere with my comings and goings."
With the refresher course behind me
and the certificate to prove it in hand, I
was ready to go back to hospital
work — I thought. But getting a job that
suited both the hospital and myself was
not easy. The hours I was able to work
were not the hours the hospital wanted
me to work. Apparently I was not alone
in this dilemma: most of my refresher-
course colleagues were facing similar
situations.
Some hospitals were willing to accept
us part-time but with a fair share of shifts
and weekends. We were caught in the
OCTOBER 1969
B. Kowalchuk
middle our families protested when
we were out working and they were at
home; the hospitals complained when we
wanted to work oi^ly days and certain
hours at that. "We'll put your application
on file and call you if we need you," was
the usual response.
I had thought we were needed. I began
to think, however, that it would be easier
to get a satisfactory part-time job with
Office Overload!
I don't blame either part involved in
this predicament. When a wife works all
day, the household may be rather frantic
by the time the husband gets home from
work. Hot dogs heated up by his young
daughter, and a somewhat frenzied at-
mosphere created when a teenage son has
been left in charge, are rarely a welcome
reward for providing the family with
necessities and luxuries.
On the other hand, most hospitals
appear overstaffed on the weekday 8:00
a.m. to 4:00 p.m. shift. I had noticed this
as a patient and from my observations
during clinical experience in the refresher
course.
Another fact is often overlooked. The
middle-aged married nurse may have a
multitude of household details to attend
to as well as her job. She may not be as
energetic as the 22-year-old unmarried,
new graduate. Eight hours of continuous
physical exertion can be rather grim
unless you can go home and relax for a
few moments. Along with many others in
my age group, I do not wish to be
exhausted and irritable half the time. I
would like merely to keep my mind alert,
and my nursing skills up-to-date, and be
of some assistance to people.
Mrs. Kowalchuk, a graduate of Brantford
General Hospital, was case room head nurse at
the Toronto East General Hospital for several
years. The mother of three children, she still
finds time to write short stories and articles for
publication.
I believe there is an answer to this
dilemma. The two peak periods in the
nursing day are from 8:00 to 12:00
morning and evening. In the morning,
baths are given, beds are changed, most
treatments and medications are given, and
patients are visited by their doctors.
Frequently the same treatments are re-
peated in the evening. Many things could
and should be done to ensure the patient
a good night's sleep. By comparison, 12
noon to 8:00 p.m. and 12 midnight to
8:00 a.m. are reasonably light in most
units.
I believe that only the peak hours
described above need extra nurses. These
hours would be best for the refresher
course graduate to make her reap-
pearance.
Let us look at it from both points of
view. If the nurse worked only four
hours, she would perhaps be less tired and
less irritable with her family. The majori-
ty of reasonable husbands would not
object to the occasional four-hour even-
ing or weekend morning. Theoretically,
hospitals should not complain because
they would be receiving extra help when
they needed it most during peak
hours.
The half-shift system for part-time
nurses is not new. A few of the smaller
hospitals still use it. Why is this system
not adopted by the larger hospitals?
Probably because it involves extra book
work for the nursing office staff.
However, hospitals exist only for
patients. And patients would benefit
from the extra care that additional, part-
time staff could give during peak hours.
In the meantime I am still looking for
the ideal job. It will keep my family
happy, benefit patients, give me mental
stimulation, and provide some pocket
money as well.
But perhaps I am searching for Utopia.
D
THE CANADIAN NURSE 29
The child
with
leukemia
Knowing that leukemia robs children of normal experiences, the nurse caring for
these children tries to make the most of the present. She attempts to alleviate
some of the problems faced by the child and his parents and make their time
together happier.
Catherine E. Cragg
"How can you stand to work on a
ward where the children have leukemia? "
"Don't you find it depressing? " These
questions are frequently asked by those
unfamiliar with our ward at The Hospital
for Sick Children, Toronto. Although
approximately half of our 23 patients
have leukemia, the ward is not gloomy.
Satisfactions for the nursing staff come
not from seeing our patients go home
cured, but from believing that our care
has helped affect the course of the illness.
If we can alleviate some of the problems
faced by the child and his parents and
make their time together happier, our
nursing care has been of value. We cannot
be depressed by that.
Admission usually difficult
We usually see the child at intervals
throughout his illness. After his first
admission for diagnosis and beginning of
treatment, the hematologists see him as
an outpatient until he is readmitted to
the ward for reassessment, chemotherapy,
or treatment of complications. Admis-
sions may last one night or several
months. The child may appear well or be
critically, even terminally, ill.
The first admission is difficult. Sud-
Miss Cragg is a graduate of McGill University.
She has worked as a general duty nurse in
Vancouver and at The Hospital for Sick Chil-
dren, Toronto, where she is now head nurse on
one of the medical units.
30 THE CANADIAN NURSE
denly, after a period of feeling unwell and
lethargic, of having persistent infection,
pain, or abnormal bleeding, the child is
admitted to hospital. Most of our patients
are between two and six years of age.
Hospitalization and separation are dif-
ficult for any preschool child. It can be
terrifying when the admission is sudden,
parents are obviously upset, and strangers
perform painful procedures such as bone
marrow aspirations. Some children
protest by crying, squirming, refusing
medications, avoiding ward personnel,
clinging to mother, and attempting to
climb out of bed to follow her. Others
withdraw into the lethargy the illness has
already produced. Older children may
show signs of depression if they guess the
seriousness of the illness. Life has sud-
denly changed; it will never be the same
again.
At the time of diagnosis, we begin a
lasting relationship with the child. The
more we know of him and his family, the
more we can help. We have to accept his
protests as understandable. We try to
draw him out and learn as inuch about
him as we can. First, we talk to his
parents and have them answer a question-
naire about his habits and behavior at
home. As we learn how he reacts to being
in hospital and being ill, we exchange
information so that all members of the
nursing staff are aware of his likes,
dislikes, and special needs. Changes in
assignment are kept to a minimuin so that
OCTOBER 1969
he can learn to trust a few nurses. We
want the child to feel that when he is
readmitted he will be known, welcomed,
and accepted.
Chemotherapy is used to induce remis-
sion of the disease. When relapse occurs
after treatment with one drug or a com-
bination of agents, other drugs are used.
As well as using the common anti-leuke-
mia drugs, the hematologists use research
drugs to determine their effectiveness.
Most of the anti-neoplastic agents are
highly toxic because they affect normal
cells as well as leukemic ones. Many of
the physical problems with which we
must deal are created by the treatment.
Because the disease interferes with the
production of normal red and white
blood cells and platelets, and because
therapy depresses the bone marrow's
production of blood cells, anemia, bleed-
ing, and infections are common. We
watch for nosebleeds, blood in stool or
urine, petechiae. and bruising. Hemor-
rhage is potentially fatal and must be
treated promptly. We apply firm pressure
to venupuncture sites to prevent hema-
tomas. We have a nasal packing tray on
hand in case simple pressure does not
stop a nose-bleed. Transfusions of packed
cells and platelet concentrate are used to
stop bleeding and treat low platelet levels.
Since patients who have had many trans-
fusions are more likely to have reactions,
they must be carefully observed during
transfusions.
Lack of normal white blood cells
reduces the patient's ability to combat
infections. Bacteria normally present in
the gastrointestinal tract can cause high
fevers, septicemia, and fulminating infec-
tions. High doses of antibiotics are given
intravenously to combat infection. Oc-
casionally the child is isolated to protect
him from the environment. Traffic
through the ward area is minimal and the
children with leukemia are placed in
rooms away from the main door and
from children who might be sources of
infection.
Intravenous infusions are important
OCTOBER 1969
for administering blood and its products,
anti-neoplastic drugs, antibiotics, and
sedatives. They are frequently difficult to
start in the child who has had many
intravenouses and venupunctures and
who has hematomas and thrombosed
veins. Once the doctor has started the
intravenous, it is the nurse's responsibility
to protect and maintain it. The children
dread the treatment room because start-
ing an intravenous can be a long, painful
procedure. The nurse supports the child
physically and emotionally during the
time of fear. He quickly learns to protect
his intravenous, and an armboard is
usually the only restraint necessary.
Life kept normal
During intravenous therapy, we keep
life as normal as possible. We dress the
child in up-patients' clothing during the
day and arrange for activities that are
possible with an intravenous running. We
attach a pole to a stretcher or wheel chair
so that the child can go into the hall and
to the ward playroom. We teach the
parents to pick up the child even with the
intravenous so that physical contact is
maintained. The parents quickly learn to
recognize and report signs of trouble.
Procedures such as bone marrow as-
pirations and lumbar punctures loom
large among the child's fears. We give him
little warning of a procedure so that
worrying about it will not ruin his day.
During the procedure he is the nurse's
main concern as she holds him firmly but
gently. She tells him what is happening
behind him and explains that keeping still
will speed the procedure and avoid repeti-
tion. Most of the children learn not to
move. They can cry as much as they
want; we encourage the quiet child to
protest. "Say 'ouch" when it hurts." lets
him know we expect tears. A Band-Aid is
important as proof the procedure is over
and as a badge of courage.
Pain is a frequent and serious problem,
especially in the terminal phase of leuke-
mia. As the disease progresses, it may
infiltrate bone, brain, abdominal organs,
and other areas. Headache and dull, wear-
ing, abdominal pain, or vague general
discomfort, make rest impossible. Move-
ment can make pain in bones and joints
excruciating. Frequently, the young child
will not say he has pain or cannot
identify it. He may be shy. fear needles,
or fear that pain will keep him from going
home. Often he will tell only his parents
or a nurse he trusts. Increased irritability,
restlessness, reluctance to move, and cry-
ing, holding, or guarding reveal that the
child is having pain.
The nurse must assess the degree of
pain. Sometimes the child complains be-
cause he needs more attention, and ap-
prehension can magnify pain. Changing
position, giving back care, providing a
restful environment, companionship, and
diversion can be as important in reducing
pain as giving drugs. Usually when anal-
gesics are required, narcotics are used.
The nurse must decide when medications
ordered p.r.n. are indicated and must
report to the doctors if the relief they
produce is inadequate.
The child with leukemia frequently
has a poor appetite. During relapse, he is
often too lethargic to eat. Anti-neoplastic
drugs, radiation, and central nervous
THE CANADIAN NURSE 31
system involvement can cause nausea and
vomiting. Medication can cause severe
ulceration of the mouth and gastroin-
testinal tract. Nasal bleeding, with its
clots and packing, makes eating difficult
and food unpalatable. When eating is
tiring and painful, it is easier simply to
stop.
Foods that tempt children, such as
soft drinks, sugared breakfast cereals,
potato chips, and hot dogs, are not
necessarily nourishing. The children
develop fads in eating; one week chicken
noodle soup will be the choice, and the
next, spaghetti. When an anorexic child
does want food, he wants it immediately.
Maintaining a balanced diet is almost
impossible. At each meal we present food
as attractively as possible and try to
persuade the child to eat as much as he
can. We provide drinks and snacks when-
ever he asks for them; he can have ginger
ale or hot dogs at all hours. We encourage
parents to bring nourishing foods the
child likes. Mummy's soup seems better
than the hospital's and the potato chips
she brings are better than nothing. As the
child's condition improves, so does his
appetite. It is a joy to see him look
forward to a meal. Then we face the
problem of reestablishing good eating
habits.
When he feels unwell, the child is
lethargic and tires easily. He sleeps long
periods and tends to be quiet and passive.
Frequently he is irritable, whiney, and
demanding. He regresses under the stress
of hospitalization and illness. Such
behavior can carry over into periods of
remission when the child feels well.
Adults tend to overprotect and overin-
dulge the child with a fatal disease. The
child, confused by the sudden change in
his parents' discipline, may learn that he
can use his illness to manipulate them and
satisfy his whims. He may become so
spoiled that sick or well he is unpleasant
to live with.
The nurses have to adapt their expec-
tations to the child's condition. We have
to accept his lethargy and plan long rest
32 THE CANADIAN NURSE
periods. We expect dependence and self-
concern. We try, however, to treat the
child as normally as possible and en-
courage his parents to do the same.
Misbehaving produces a reprimand, as we
have a stake in preserving the pleasant,
well-disciplined behavior the child had
before he developed leukemia. If we help
spoil him, we will have to live with him.
If we can help the family to treat him
normally, we may avoid some of his
confusion and fear and reduce the resent-
ment other members of the family feel
toward him.
Play must also be adapted to the
child's condition. When he feels ill, he
wants only quiet, passive amusement. He
may watch television and like to have
stories read, or he may color, paint, and
play with cars or dolls for short periods.
A member of the hospital recreation staff
comes to the ward each day to conduct
playroom periods, and helps children in
bed with toys and projects.
The child does not have to go to the
playroom. Recreation is one of the few
areas of his life he can control. Many of
the children have formed close attach-
ments with the "play-lady" and playroom
time is one of the happiest periods of the
day. Many insist on going even when
critically ill; they go on stretchers, intra-
venouses and all. Often they will play out
their hospital experiences, starting intra-
venouses on dolls, and using plastic
syringes to draw up red paint and squirt it
into little bottles. When they feel better,
the children enjoy more active games,
such as riding the ward tricycles.
Appearance may upset child
During the course of the illness, the
child's appearance may become grossly
distorted. Bleeding leads to huge bruises,
packed noses, and caked, oozing lips and
gums. Drugs and radiation can cause
baldness or loss of hair tone. High doses
of steroids produce "moon face" and
obesity. Emaciated limbs and protruber-
ant abdomens give an impression of "all
knees, elbows, and tummy." These
changes upset the parents and the patient.
The child worries about his looks and his
friends' reactions.
During remission, the child's ap-
pearance is usually fairly normal, but
during treatment and the terminal stages
of the disease, his looks may be dread-
fully changed. We do not hide the child
because of his appearance, but accept the
changes. If he wants to go into the hall,
OCTOBER 1969
he may. The children usually accept each
other, but we try to make sure no one is
teased. Cushingoid changes disappear
when steroids are reduced.
We encourage the child about his
appearance. Beautiful, thick hair grows
back in most cases of hair loss, and in the
meantime the Cancer Society can help by
providing an attractive wig. We try to
emphasize assets by finding pretty dresses
for girls without hair and clothes that
camouflage large abdomens and cover
bruises. If they want to, they are allowed
to wear their own clothes.
To provide continuing and consistent
care for each child, all members of the
nursing staff are involved in our planning
for him. Reports include not only
physical condition and doctor's orders,
but also details of the child's day, his
reaction to new medication, his newest
toy, and his behavior when his parents
visit. A nursing care plan for each child is
made at nursing team conferences and is
frequently reevaluated to keep it up to
date. We keep the plan when the child is
discharged so that we can use the same
approaches if problems recur during sub-
sequent admissions.
Eventually neither drugs nor medical
and nursing care are effective against the
disease. During the terminal stages, the
child needs highly skilled, gentle, cons-
tant nursing care, and must be kept as
comfortable as possible. At this time the
nurse's thorough knowledge of the child
and his family is most useful. She uses
medication liberally to combat pain, and
positions the child so that he is comforta-
ble and breathes easily. She tries to
prevent hemorrhage and trauma. She
provides a calm, quiet environment so
that the child can rest as much as
possible, but she also responds to any sign
of interest in activity or to expressions of
fear. She maintains the intravenous so
that blood and drugs can be administered
promptly and easily. As comforter and
protector, she attempts to make the
child's death as painless, fearless, and
peaceful as lies within her skill.
OCTOBER 1%9
Family fears
Even when leukemia has been suspect-
ed or feared, confirmation of the diag-
nosis is a terrible blow to the parents.
During the first admission, great adjust-
ments must be made. Parents need time
to accept the diagnosis; they need to
change their lives to cope with a fatally ill
child and his hospitalization. They may
feel ill at ease with their child because of
his disease and have trouble relating to
him. On the other hand, they may shower
him with expensive toys and treats.
The parents dread the effects of the
illness. They may be so upset that they
cry when they visit or leave, or they may
react with hostility toward the hospital,
the doctors, or the nurses. Each visit to
the doctor or the hospital renews fears
that death may be near. When the child is
in remission, it is hard to believe that this
healthy, apparently normal child has a
fatal illness. The parents learn to look for
bleeding, fever, pain, vomiting, and
lethargy. They see the suffering of other
children on the ward and fear for their
child.
The family lives through a prolonged
period of stress aggravated by periodic
crises. The mother is usually closest to
the child and bears the brunt of the
illness. Her other children may resent the
time she devotes to the child with leuke-
mia. The father may resent the concern
that is diverted from him to the child,
and the mother may feel that no one
understands her problems or gives her
enough support. Conflicts already present
in a marriage may be aggravated to the
breaking point, although many families
draw much closer together. Well-meaning
relatives and friends can provide great
emotional and practical assistance, but
they can also magnify fears and ac-
centuate the difficulties by prying or
offering misleading advice or news of
cures for leukemia.
Sometimes parents feel great guilt.
They may interpret the child's disease as
punishment for their own misdeeds, or
may feel they are not doing enough for
the sick child. They may worry about
disruption to work and normal family
and social life. Also, parents may feel
guilty for agreeing to submit the child to
unpleasant, painful procedures, or for
wishing that death will come soon to
release their child from suffering.
To establish a relationship of coopera-
tion, support, and trust with the parents,
the nurse must be available to talk to
them and provide an outlet for their
feelings. She must accept their worries,
hostility, or unrealistic hopes, and be
honest with them at all times. She an-
swers the questions she can and refers
questions she cannot answer to doctors.
She keeps the parents informed of the
child's condition on such details as how
he ate and slept, how he reacted to their
departure, or when a procedure will be
done.
If there are severe family or financial
difficulties, she makes sure the parents
are referred to psychiatrists, medical
social workers, clergymen, or groups such
as the Cancer Society to alleviate the
problem before the family reaches the
breaking point.
We encourage the parents to help with
the child's care. They change diapers, give
THE CANADIAN NURSE 33
bedpans, take temperatures, help with
mouth care, bathing, changing hnen, and
maintaining special routines and bedtime
habits. Frequently Mummy can persuade
the child to take food or medication he
would otherwise refuse. Parents provide
the supervision toddlers need and help
the children with play. Helping with the
child's care brings the parents closer to
him and overcomes their feeling of
strangeness. They become closely involv-
ed in their child's hospital life.
When the child is dying, the parents
usually want to be near. The nurse must
consider their needs and show both the
child and parents that they are not
abandoned. A rollaway bed or chaise-
lounge can be set up in the child's room.
The facilities are unfortunately suitable
only for short stays. We discourage
parents from staying for long periods
because a tired parent is under even
greater emotional strain. The nurse assign-
ed to the terminally ill child must include
his parents in her care. She must talk with
them during long periods of waiting and
worrying when they face difficult ques-
tions, grief, fear, and doubt. She has to
consider their physical comfort and provi-
de as calm and restful an environment for
them as she can. By remembering their
need for sleep and food, she can help the
parents spend time away from the child
when he is sedated or sleeping.
As the child slips into unconsciousness
and death, it is the parents who concern
her most. When the child dies, a nurse
who knows the parents takes them to a
quiet room, provides coffee, and gives
them an opportunity to express their
sorrow while others prepare the body so
that they may see their child again if they
wish. Everything possible is done to
prevent further worries before they leave
hospital.
Facing death
It is difficult to work with children
who will die, knowing leukemia deprives
them of normal experiences. Death from
an incurable illness may seem to mean
34 THE CANADIAN NURSE
failure, but it is often a release from
intense suffering.
The child with leukemia presents great
opportunities for skilled, concerned nurs-
ing care. With these children, we con-
centrate on the present; today's problems
and joys become our main concerns.
Today we are happy to see him show
interest in a new toy, walk for the first
time in weeks, spend a comfortable night,
or go home in remission. Today he needs
mouth and skin care, analgesia, or some-
one to hold him because he is homesick.
We cannot deny the child's prognosis, but
we do not have to dwell on it.
The child who asks about death and
his disease is a source of anxiety to the
nurse who is often afraid to discuss death
with him. Frequently it is the nurse the
older child will approach. He may simply
mention death as all children do at times,
but he may be seeking help which the
nurse may fear she cannot provide. We
try to anticipate when a child is likely to
ask about death, for example, at the time
of another's death. We may discuss how
to deal with the child's questions and
fears with parents and doctors. Often,
however, the nurse is left to rely on her
own skill and judgement in talking with
and helping a child who knows or guesses
he will die.
Although we are concerned about each
patient, over-involvement with one child
is a problem we must try to avoid in
caring for fatally ill children over long
periods of time. The nurse whose concern
for a child becomes too personal can be
deeply hurt and unable to be objective
enough to give professional help to the
child, his parents, or the other children
on the ward. Caring for less seriously ill
patients on the ward gives the nurse relief
from long periods of looking after dying
children and a chance to regain a more
normal perspective.
Nursing a dying child is a great
emotional strain. Each nurse must come
to a personal reconciliation with death,
but the nurses support one another. The
whole ward staff shares the nurse's con-
cern for her patient and spends time
helping her to plan and give care, relieves
her for breaks and meals, and gives her a
chance to express her feelings. We share
the experience so that no one is over-
whelmed.
Working on a leukemia ward has many
compensations. The patients do not know
they are different or tragic. We have a
chance to know them well and help their
families throughout the course of a
serious illness. We are involved in medical
research projects that one day may
produce a cure for leukemia. Nursing's
oldest skills are those of providing help
for the sick and comfort for the dying.
The challenge of renewing and perfecting
these skills leaves little time for depres-
sion, n
OCTOBER 1969
Collecting urine specimens
from children
Description of a method used at The Hospital for Sick Children in Toronto for
collecting quantitative urine specimens.
The collection of 24-hours urine
specimens is important in the investiga-
tion, diagnosis, and treatment of an in-
creasing number of children's diseases. At
The Hospital for Sick Children, Toronto,
the 12-bed clinical investigation unit
(CIU) is designed to admit patients of all
ages from the young infant to the adoles-
cent. Various methods of collecting urine
are employed on this unit, depending on
the child's age and capability.
The child is encouraged to feel that he
is part of the team responsible for his
care. His responsibilities - which de-
pend on his age - are explained to him,
and as much time as necessary is spent
helping him understand his disease and
the investigations he will have. By en-
couraging his participation in his investi-
gations we gain his cooperation. The
more he understands, the more he wants
to help.
Often, a trial run of 24 hours is found
helpful before actually starting the collec-
tion. During this time the child learns
about his new responsibilities. At no time
is he allowed bathroom privileges, hence
his activities and routines change little
when collections begin. An accurate
urinary output is recorded daily on each
child so that when the time comes to
collect urine, he is used to the method.
Often he is taken to the laboratory to
meet the technician and to see where his
specimens are sent.
The staff, nurses, doctors, dieticians
OCTOBER 1%9
Eleanor G. Pask
and technicians, work closely with the
children at all times. Children tend to
copy the attitudes and meticulous atten-
tion to measurement and timing display-
ed by those who care for them.
Timing
The timing of urine collections must
be accurate. In the past, a nurse had to sit
by the untrained child and wait for him
to void. Thus she established the precise
time at which the 24-hour period began.
An electric device to signal this time
has been developed by the Sinclair
Laboratories and aptly named an annun-
ciator. As the child voids, the urine comes
in contact with the ends of water sensi-
tive leads, thereby setting up an electric
current that activates a buzzer, which
does not stop until it is turned off by
hand.
The beginning of the collection occurs
at the exact time of voiding. This urine is
discarded, the bladder is then empty, and
all subsequent voidings are added to the
collection. The final voiding is added and
the time is recorded as the ending time of
the collection. Again the bladder is
empty.
The ending time may not occur at
exactly 24 hours after the beginning.
Mrs. Pask, a graduate of the Hospital for Sick
Qiildren, Toronto is head nurse in the clinical
investigation unit at the Hospital for Sick
Children.
However, it is important to remember
that the collection ends at the precise
time of voiding, even though it may be
shorter than the 24-hour period. All urine
from the initial emptying of the bladder
until the final voiding constitutes a
complete collection.
If another urine collection is to com-
mence when this one is completed, the
final ending time for the first collection
becomes, as well, the beginning time for
the second collection.
(1) (2)
A B C
For example, if collection ( 1 ) begins at
A and ends at B, the collection (2) begins
at B and ends at C. In this way no time is
lost and specimens are consecutive. This
method is used for shorter periods of
collections, such as clearances or consecu-
tive 24-hour collections. During a collec-
tion, all losses are recorded. It is best to
check with the laboratory doing the test
to determine whether or not it is feasible
to continue, or better to start another
collection.
Procedure for female infants
It is advisable to have two nurses
available to place a child on the urine
collection frame and apply the collector
correctly. The female infant is placed on
a Bradford frame with an aperture under
the buttocks. The canvas frame is covered
with a one-inch layer of foam rubber
THE CANADIAN NURSE 35
An electric annunciator, shown with the water sensitive lead and adaptor.
which is, in turn, covered with thin
plastic sheeting. The edges and seams of
the plastic are sealed with waterproof
tape. A cotton sheet with Velcro tapes
(Canadian Velcro Limited) is placed over
the whole frame. The infant appears
comfortable, and skin problems arising
from areas rubbing against the frame are
minimal. A jacket restraint keeps the
upper portion of her body still. Her legs
are abducted and restrained in a frog-like
position.
The collector is made of thin but
slightly pliable polyethylene and is at-
tached with soft plastic to a 150 cm.
length of plastic tubing. The tubing with
an added adapter fits into the collection
bottle. The bottle is surrounded by ice in
a double-chambered, stainless steel holder
that hangs on the end of the bed. The
collector comes in three sizes: No. 1 fits
an infant up to about six months; No. 2
fits up to two years; and No. 3 up to four
years.
A small air vent at the top of the
collector assists in drainage of the urine.
We insert a No. 25 needle into the tubing
near the collector and tape it in place to
allow more air to enter the system. This
prevents back-up into the collector and
avoids overflow.
The skin is cleansed with a Betadyne
solution (British Drug Houses) and dried
thorouglily. The area that will be in
contact with the collector is then sprayed
with Dow Corning Medical Adhesive
Type B, an aerosol contact cement. The
broad rim of the collector is also sprayed,
and when the adhesive becomes tacky in
both areas the collector is applied by
gently placing the lower end against the
36 THE CANADIAN NURSE
perineum and cautiously pressing it up-
wards.
As this is done, the labia majora are
separated so that the broad sides of the
collector rest against the inner aspect of
the labia majora. The collector is held
gently but firmly in place for a minute or
so. Although the appliance is now secure,
it is wise to add four strips of one-half
inch Elastoplast (Smith & Nephew) to
prevent the collector from coming loose
as the child moves about or defecates.
A collector applied in this manner
should be secure for three or four days.
At this time, even if it appears to be well
attached, it should be removed and, after
a thorough cleansing of the area, a new
collector applied. Reuse is not practical
since soaking or autoclaving softens the
plastic.
A 2" X 16" X 11" pyrex or stainless
steel tray, covered with Saran Wrap (Dow
Chemical of Canada Ltd.) is placed on the
bed under the aperture so that any loss of
urine or leakage from the collector will be
caught and can be syringed from the
Saran and added to the collection. If the
collector leaks, it should be reapplied
rather than re-taped.
A blanket pinned at top and bottom
covers the patient from the waist down.
This not only adds to her feeling of
security and comfort, but also prevents
her from pulling the collector off.
Procedure for male infants
The same frame is used for male
infants, but it is unnecessary to restrain
them so firmly. The use of Sterilon
24-hour Pediatric Urine Collectors has
proven satisfactory. The skin is prepared
the same way as for female infants.
Although the collector has an adhesive
surface, the addition of aerosol cement
greatly improves its efficiency and holds
it in place longer.
Occasionally the adhesive tape or
cement may irritate the child's skin under
either the male or female collector. Dis-
continuing the collection temporarily, al-
lows the area to heal quickly.
Female urine cuiit'tiurs, sues i, 2, and ji.
OCTOBER 1969
The male collectors are much less
restricting than those used for girls. The
male infant can be placed in a sitting
position, whereas the female can be only
slightly propped.
This method of urine collection can be
modified to facilitate stool collections
from children with profuse diarrhea.
Stool is collected in a plastic bag taped to
the aperture. About one inch of the
margin left at the front of the aperture
allows the tubing from the urine collector
to pass through to the bottle. In this way
uncontaminated stool and urine can be
obtained.
Nursing care
Generally, children are kept on the
frame for about 4 days. The longest
period we kept a baby girl on the frame
was for 16 days. During that time she
seemed comfortable and secure and suf-
fered no apparent physical or emotional
trauma.
Children restrained on the frame
during urine collections need more direct
physical nursing care and emotional sup-
port than children who are up. We spend
much time with these children, reading
and playing to keep them occupied and
happy. We consider this diversional care
to be a major nursing responsibility.
When they are on the frame girls wear
dresses and boys wear shirts. This helps to
keep up their morale and they accept
collections as a routine part of their
investigation.
These children enjoy the frequent
visits and attention of other children on
the ward. Parents are encouraged to visit.
We inform parents a day ahead about the
methods that will be used to collect
urine, so they will be able to give their
child the extra care and attention he will
require during their visit.
The amount the child eats during his
period of collection is important since
frequently the results of his biochemical
tests are dependent on a constant cal-
culated intake. Every effort is made to
encourage the child to eat everything put
before him. At meal-time, children on
frames are in the same room with other
children in the unit so they can enjoy
each other's company. D
OCTOBER 1969
v-^
A female infant having a urine collection, showing the equipment described in this
article and its proper application.
Correct application of the female collector, with the addition of four elastoplast strips
to increase its efficiency.
THE CANADIAN NURSE 37
The coagulation of Harry
A novel approach to the blood clotting process.
Once upon a time, there was a bloody
little fluid named Harry. He was a very
complicated little fluid, consisting of plas-
ma, in which he carried red and white
corpuscles, platelets, and fat globules.
Altogether he was 22 percent solids and
78 percent water.
Many times every day he chugged
merrily through the heart, arteries, veins,
and capillaries of the human he served.
He took pride in his job. The only part he
disliked was crawling through the capil-
laries. Some of those tubes were so small
that he had to hold his breath to squeeze
through; but every job has some draw-
backs.
Harry's main duties consisted of chug-
ging through the maze of tubes in the
body, carrying nourishment and oxygen
to the tissues and taking away waste
matter and carbon dioxide. It was a
routine and rather dull job, but Harry
pushed on. knowing deep within his little
bloody fluid, that someone had to do it.
Harry was chugging along as usual one
day when suddenly it happened. Up
ahead on Finger Vessel Avenue, disaster
had struck. Something sharp and shiny
had cut the route in two. Harry activated
his alarm system and started to organize
his defense. The vessel around him had
already started to contract.
A liquid of strength, Harry whistled
for his first team of action, the platelets,
to go to work. Running from every
direction, the platelets started to aggluti-
38 THE CANADIAN NURSE
Terry Lynn Carter
nate or clump together. They huddled
together, and on Harry's order released
serotonin to stimulate further vessel con-
traction.
Harry took a deep breath as he moved
into phase two of his defense. He sum-
moned fibrin to the scene of the accident.
Fibrin responded quickly - protein
fibers formed a meshwork to trap more
platelets and red blood cells. A clot began
to form, filling the whole vessel diameter;
the vessel then began to retract.
The clotting process had begun when
prothrombin activator was formed in
response to the ruptured vessel. Then
prothrombin activator converted pro-
thrombin into thrombin. Next, the en-
zyme thrombin converted fibrinogen into
fibrin threads to enmesh red blood cells
and form the clot.
But Harry wasn't interested in such
details. He had a fight on his hands; facts
could be left for historians to write
about. He looked over the scene with
pride. "Men at Work" signs were posted
and emergency lights flashed as platelets,
fibrin, and the clot worked furiously to
repair the vessel. Platelets sent out pro-
cesses and fibrin threads. Harry watched
as the processes contracted, pulled on the
threads, and made the clot even smaller.
"Not bad," he thought.
Miss Carter is a second year student at York-
Regional School of Nursing, WiUowdale, Onta-
A siren screamed and macrophages
raced to the scene to invade the clot and
to phagocytize the red blood cells. After
gobbling up the debris, the macrophages
released hemoglobin into the tissues.
Working through the night and into
the next day, Harry and his little crew of
emergency workers repaired the damage.
Wliat remained of the clot was invaded by
fibroblasts that produced collagen and
elastin to turn the clot into a fibrous
mass. Under enzyme influence, this fi-
brous mass was replaced by connective
tissue. New blood channels formed
through the clot and after recanalization
took place, Harry returned to his job.
He chugged through the new channels
with glee, wondering what his human had
been doing during the disaster. "Prob-
lably putting on a Band-Aid," he thought.
If only he knew all that had taken place!
The disaster signs came down and the
emergency team resumed its normal
duties. Harry filed his report and returned
to his job, wistfully recalling the excite-
ment that had gone before.
He spit out the carbon dioxide and
chugged oxygen and nourishment to the
tissues. It was dull, but if he got too fed
up, he could always donate himself to the
Red Cross; anyway, he was up for retire-
ment soon.
So, Harry, the bloody little fluid,
chugged on, doing his dull routine job,
knowing as his liquid filled with pride,
that he had had his day. D
OCTOBER 1969
How to prolong
a hospital's lifespan
The architect responsible for designing the Health Sciences Centre at Hamilton's
McMaster University discusses some of the concepts that have applied to this
new complex.
Eberhard H. Zeidler, Dipl. Ing., F.R.A.I.C.
The medical professions have extended
the lifespan of man, but their ever-accel-
erating progress has produced a creeping
disease that reduces the lifespan of hos-
pitals. The name of the killer is obsoles-
cence.
Today, hospitals have to decide
whether to operate in outdated facilities
that inhibit medical progress, or to
abandon them. If we consider that over a
period of three years hospital operational
costs may equal capital costs, we may
reach the conclusion that the only solu-
tion is to demolish these outdated facili-
ties. Yet what a waste of resources!
The specialized spaces that we have to
build for a hospital should be used for at
least 30 to 60 years to amortize its cost.
Yet we know that the function of this
space may change several times during its
lifespan. Present methods of providing for
this change retain little of the original
investment.
To demolish outdated facilities seems
like pulling up a whole plant, roots and
all, to pick one flower. We believed that if
we could develop a system that would
allow us to cut flowers on the plant, we
would solve this dilemma. In such a
system we had to distinguish those ele-
ments that belonged to the flower from
those that belonged to the plant. We
called the flower the "non-permanent"
parts of the building that would be lost
with each functional change of the space;
OCTOBER 1969
we called the plant the "permanent"
elements that would remain as a perma-
nent receptacle.
The "Servo System" became this per-
manent frame. It is an integration of the
structure with the primary electrical and
mechanical services, that is, heating,
plumbing, and air conditioning, forming a
frame into which the various space uses
may be "plugged in." None of the ele-
ments of this "Servo System" will change
even if the non-permanent elements chan-
ge. Such a system affords the maximum
retention of the original building invest-
ment, regardless of the changes that must
be made to the building during its life-
span. We used this system in designing the
Health Sciences Centre at McMaster
University.
Because this building is unlike any that
has preceded it, it will not have the
familiar look of a hospital, a school, or a
research institute. Instead, it will express
the unique qualities of its structural-
mechanical system, the "Servo System,"
and the unpredictable nature of its func-
tions. Thus the exterior shell of a nursing
unit may look the same as a research
laboratory because the function of the
space is interchangeable.
The Servo Shafts punctuate the faca-
de, expressing in their glassy transparency
Mr. Zeidler is an Architect with the firm of
Craig, Zeidler & Strong, Toronto.
their structural and mechanical purposes.
Spanning between them are the great
trusses clad in simple, unadorned panels
sandwiching each habitable floor. A pat-
tern of separate window and wall units
express in their forms and in their ran-
dom distribution the ability of functional
freedom.
Nursing unit
Is there really a need to have all
elements of the Health Centre framed in
one system? Would it not simplify our
design problem to treat the nursing units
as separate entities divorced from the
other components of the complex? In
such a structure we certainly would fulfill
all present requirements of the inpatient
unit.
We were aware, however, that present
needs might not suit future needs, that
our approach to health care might under-
go principle changes, and that some of
them would affect the inpatient unit.
Furthermore, it is possible that future
reorganization of the Health Centre could
make it advisable to replace the inpatient
function with another function. In some
of the centers we visited, tliis had happen-
ed.
We felt, then, that if we could use
the space frame throughout the structure,
including the inpatient unit, we would
gain future flexibility for the total com-
plex without loss of economy. Looking at
THE CANADIAN NURSE 39
fSijiiiii
' I
\mmi
»«Hln|
miii»M»lw^^"^P.l
niii
ICJlfiil
^^^^l^^^^^^l
r""?'^^!
•J.JM
l*Mltslv'^H
^^M
View of Health Sciences Centre atMcMaster University in Hamilton, Ontario.
the present trend of development in other
nursing units, we found that in layout
and organization these units were totally
administrative-oriented. Development was
geared toward better material handling
and better nursing organization, yet the
basic reason for the hospital's existence
— the patient and his human needs
— seemed to be neglected.
In the design of most nursing units,
the pendulum has swung from the Floren-
ce Niglitingale ward to the impersonal
isolation of a hotel corridor. This design
has created physical barriers that make
nursing care difficult. North America has
succumbed to the double corridor plan,
with privacy considered to be the main
requirement of a patient.
When intensive nursing care was need-
ed and the double corridor system made
this impossible, the intensive care unit
was developed which, in fact, was the old
Florence Nightingale ward revisited. This
probably explains the higher percentage
of ICU beds in a North American hospital
compared to a British hospital. The ICU,
by removing the barriers, created again
the all-important physical relationship
between nurse and patient.
At present, North America is develoj>
Model of Nurse Work Territory encompassing 18 beds. This picture shows four
additional beds that belong to the adjacent team, both forming the 36-bed unit. The
Nurse Work Area is in the geographic center of the territory, limiting the furthest
point from the Nurse Work Area to 36 feet. The center core contains the teaching
spaces.
40 THE CANADIAN NURSE
J ing the physical separation of nurse and
patient even further. The isolation of the
patient in secluded single rooms is hoped
V to be solved by science fiction television
monitoring and the expansion of the
intensive care unit. These remedies de-
stroy even more the nursing incentive of
the normal ward.
•J We believe that an inpatient unit must
be patient-oriented. This result will be
achieved only if major changes are made
in the physical environment of the unit
and changes occur in the medical and
nursing approach to the patient.
^ We found three major relationships
y that had to be balanced in this inpatient
unit. At first glance the requirements of
each seem to be contradictory to the
other. These are: 1. the relationship
between patient and nurse; 2. the rela-
tionship of the nurse to her team; and
3. the flexibility of the number of beds
assigned to each team.
The first relationship — nurse to
patient — is, of course, most ideally solv-
ed by a direct physical and visual relation
of a nurse to a patient, as with a private
nurse, or a restricted number of patients
in an intensive care unit.
The second relationship, that of the
nurse to her team, would require a totally
different physical setup, which would
remove the nurse from the bedside, at
least far enough that a large enough
number of nurses could be in a common
location to work and be controlled as a
team. The team concept is a hierarchical
working order. Since the number in the
team fluctuates during the three shifts, it
would appear advisable to move the
nurses' control and chart area further
from the bed.
Viewed from the concept of centraliz-
ed administration, it would also seem
preferable to combine in an 80-bed unit
OCTOBER 1969
all these stations under one floor super-
visor. The actual experience of these
nurses' administration areas has found
this centralization less than satisfactory.
The third relationship is the flexibility
of the nursing team and the related beds.
This is mainly a demand for economy in
services. It is obvious that during his stay
in a unit a patient will require varying
degrees of attention from the nurse, so
that the number of patients a team can
look after will change. The double cor-
ridor scheme seems to fulfill this require-
ment. Yet the result of this administrative
demand may be a 200-foot institutional
corridor, to which neither the nurse nor
the patient can relate.
If we accept the team as a working
unit, then it is important to relate this to
a territory in which a personal relation
between nurse and patient can develop.
This visual enclosure of the team territory
still could maintain an administrative
flexibility, as the changing of the number
of nurses belonging to a team related to a
fixed bedcount would do the same as a
fixed team relation to a variable bed-
count.
Teaching facilities also had to be con-
sidered when we were planning this hos-
pital. A large number of students will
eventually be in the unit, and sufficient
space had to be created for their move-
ments in small groups without inter-
ference with the nurses in service. To
provide conference areas for these stu-
dents too far away from the bedside
would turn the corridor into the con-
ference area and create traffic problems
for the proper working of the unit.
The construction method chosen
allowed us to change and reevaluate our
nursing units over the last 18 months,
while construction proceeded unhamper-
ed. Certain principles have been crystalliz-
ed and formed our nursing unit.
• The minimum bedroom size should be
increased in a teaching hospital for the
additional monitoring equipment and
teaching space needed to allow groups to
enter a bedroom.
• A proportion of one-third of the beds
in singles and two-thirds in two or conver-
tible to four-bed rooms is advisable to
maintain a balance between economy and
changing requirements.
• The organization of the nursing unit
should be set at a 36-bed level with the
head nurse related to two teams of 18.
The next organizational level would be
the total hospital without any other
intermediate level, at 72 beds.
• The flexibility of the staff-bed ratio
could be obtained by movement of staff
OCTOBER 1969
NUFBE VVC3FK AFEA
18- BEDS
flE-U&VBLES CART
SOLED UCN CART
TIWSH CART
rather than bed territory.
• A visual relation between nurse and
patient should be obtained so that it can
be broken if desired for patient privacy.
We realized that the motivation of the
nurse is made greater through a direct
patient relationship than from a constant
nursing supervisor control.
• A nurse walking territory of approxi-
mately 35 feet is ideal.
• The nurse-server allocated for one or
two beds should be replaced by a team
supply cart serving 18 beds, thus eliminat-
ing additional movements and allowing
materials to be handled more economical-
ly-
• A definite territorial and visual defini-
tion should be achieved for the nursing
team.
• A corridor articulation for student
"hesitation spots" should also be provid-
ed.
• A flexible conference area should be
formed in the center of the nursing unit
to eliminate undesirable corridor teach-
ing.
Summary
We are only now at the threshold of
understanding the relation of physical
environment to psychological reaction.
The works of anthropologists and social
scientists have improved our understand-
ing of this relationship and have helped us
realize that emotional reaction toward an
environment has a deeper meaning than
we used to think.
A hospital must provide an environ-
ment for meeting human needs
- physical, psychological, esthetic and
intellectual. The best of physical care
cannot properly succeed if the patient
lapses into apathy brought on by mono-
tonous surroundings and a physical plant
that recognizes efficiency as its only aim.
Attention to emotional and perceptual
needs must not be a hastily improvised
afterthought. In the planning of the
McMaster University Health Sciences
Centre, these concepts are vital parts of a
totally coordinated complex. D
THE CANADIAN NURSE 41
Hospital design
is a nursing affair
Too often the person who knows most about health care facilities and how they
help or hinder the delivery of patient care is ignored when such facilities are
being planned. Not at McMaster University, however. The author, a registered
nurse, has worked closely with the architect and medical staff in the overall
planning and design of the new Health Sciences Centre.
Norma A. Wylie, M.Sc.N.
At McMaster University, nursing has
had its say in the planning of the new
Health Sciences Centre. This participation
began early, when the newly appointed
executive director of the University Hos-
pital arranged for the director of nursing
to join the organization at the same time
as himself. Since then, I, as director of
nursing, have been involved in all phases
of planning, working closely with ad-
ministrators, members of the faculty of
nursing, medical staff, and architects.
Hospital acts as pivot
The three principal objectives of the
Health Sciences Centre are delivery of
health care, teaching, and research. The
University Hospital will become the pivot
around which these objectives revolve and
will be an integral part of the social and
medical organization. Its function will be
to provide complete health care, both
curative and preventive. The outpatient
services will reach out to the family and
Miss Wylie, a graduate of the City Hospital
School of Nursing, Saskatoon, the University of
Toronto, University of British Columbia, and
the University of California, was appointed
Director of Nursing at the University Hospital,
McMaster University in Hamilton, Ontario in
January, 1968 and Associate Professor,
McMaster University School of Nursing. Prior
to moving to Hamilton, Miss WyUc was with the
World Health Organization for eight years, first
in Singapore and later in Malaya.
42 THE CANADIAN NURSE
the community. The hospital will also be
a center for the teaching of health work-
ers, and for bio-social research.
Before attempting to design the com-
plex, the architects wanted to learn about
the objectives and needs for patient care
and student teaching. Consequently, they
met with the principal users of each
special area. 1 was present at most of
these meetings. The conversations were
recorded and the analyzed data formed
the basis for the initial drawings.
The design was also influenced by the
demands of our community. We believed
we could not plan in isolation from the
society in which we live, and that our
planning should reflect its aspirations,
technological abilities, and economic
needs. Thus, regional planning has evolv-
ed which has influenced our final plans.
The nurses in the community have made
a valuable contribution as resource per-
sonnel in the clinical areas.
Early discussions with our architects
focused on the human needs of the
patient - physical, psychological, es-
thetic, and intellectual. We spoke about
the danger of progressive depersonaliza-
tion of patients and, concomitantly, of
nurses, as a result of increasing technical
and scientific knowledge. We discussed
with the architects the demands that
automation places on nurses to acquire
new knowledge and develop new
mechanical, administrative, and human
relationship skills. The means by which
OCTOBER 1969
Key personnel involved in design of University Hospital: left to right: E.H. Zeidler,
architect: Norma A. Wylie. director of nursing, R.C. Walker, executive director.
these skills may be acquired formed a
basis for dialogue between our two
groups. \
The architects and I visited several '
hospitals to study their physical facilities
and to talk with patients and staff. Our
findings resulted in a patient-oriented
unit as opposed to the traditional ad-
ministrative-oriented one. Our nursing
unit is planned to provide the environ-
ment for a close nurse/patient relation-
ship, which should facilitate good quality
nursing care and effective learning op-
portunities for the students.
Patient care hours increased
The involvement of the nurse as a
permanent member of the planning team
has many advantages. She can help to
interpret to the architects the daily activ-
ities within patient care areas, and how
the relationship of supplies to patient
rooms can affect the efficiency of the
nursing unit. The principles that have
been applied to our nursing units are
described by the architect in the preced-\
ing article.
This design, combined with a realloca-
tion of many tasks traditionally perform-
ed by the nurse, should permit the
professional nurse to spend more time in
direct patient care, and less in ancillary
routines. The knowledge and experience
of nurses in our community helped us
develop a most efficient materials-i
handling system. This should minimize
OCTOBER 1969
movement within the patient care area,
and increase patient care hours.
The quantity and quality of patient
care are directly affected by the efficien-
cy of the hospital's communication
processes. Seeing, hearing, speaking, writ-
ing, doing, are means of communication
whose effectiveness is dependent upon
the architectural model.
As director of nursing, I was responsi-
ble for assisting in the development of a
communications model. This consistedjof
defining the pliilosophy and objectives of
the communication system in every area
throughout the Health Sciences Centre,
and analyzing needs withough reference
to equipment. My research was done in
collaboration with each of the principal
users, and I obtained considerable inform-
ation by visiting a number of hospitals
and talking with patients and staff. My
findings were submitted to the architects
for consideration by their electrical en-
gineers.
Specialized areas
Because of limited knowledge and lack
of resources, in-depth research has been
needed in some of the highly specialized
areas. One such area is our neonatal,
obstetrical unit. Visits to specialized units
with the architects gave us the opportuni-
ty to study the environment and patient
needs as to staffing requirements, equif>-
ment, and essential services. It also
permitted us to observe the activities
within the unit, and to talk with nurses,
perinatologists, and neonatologists who
have acquired special skills for the care of
the acutely ill infant. These visits, plus
meetings with consultants who were invit-
ed to attend special planning sessions,
enabled the architect to draw a most
imaginative design.
The concept of rooming-in, which is in
keeping with our philosophy of family-
centered care, was also discussed and
investigated during field trips. Our nurs-
ing unit design was changed as a result of
these visits, where we talked with mo-
thers and fathers, nurses and medical
staff.
The nursery is situated in close proxi-
mity to all patient rooms, which permits
rooming-in for any mother who requests
it. This also presents a challenge to the
nurse to develop special skills in family-V
centred care. Rooming-in permits the
father to participate in the care of his
baby early. His special needs, prior to the
birth of his child, have been considered in
the design of a most attractive fathers'
room.
To consider the concept of family-
centered care in its totality, some arrange-
ments need to be provided for the chil-
dren when mother is in hospital. A lounge
has been planned outside tiie nursing unit
in which the family can visit.
Therapeutic effect of environment
Studies have indicated that the
architectural environment evokes
emotional and psychological responses
and has important therapeutic potential.
We made numerous visits to study the
design, in both old and new hospitals,
with particular reference to the effects on
the patient.
Our pediatric areas have been especially
affected by these visits. We observed the
therapeutic effect of murals on the walls
and ceilings, of large play areas, ot a
children's zoo, and special furniture and
toys. Studies conducted locally reaffirm-
ed our plan to provide facilities for
mothers wlio wish to stay with and care
for their children.
Continuity of care is one of our
primary goals in planning the delivery of
health care. We recognized early that the
THE CANADIAN NURSE 43
design would greatly affect our ability to
meet this goal.
In recent years, the center of gravity
of a hospital has shifted more and more
from inpatient to outpatient depart-
ments. The outpatient area is the point of
contact between hospital and com-
munity, and the patient's first impression
of the hospital may be gained here. This
department has been appropriately des-
cribed as the hospital's "shop window."
Its layout, furnishings, and decor can
affect both patients and staff.
Continuity of care has been further
enhanced by designing the inpatient serv-
ices, teaching facilities, and outpatient
services of each department in close
proximity, horizontally to each other.
The organization of the hospital's
administrative setup affects design.
Within the organizational plan for hos-
pital administration is the department of
nursing. We believe that the senior nurs-
ing members, to be called assistant direc-
tors, should be where the action is. These
assistant directors will be responsible for
implementing the continuity of care, dis-
cussed earlier, between inpatient and out-
patient department. Thus, their offices
will be in an area closely related to their
major clinical responsibilities. In close
proximity to them will be offices for the
clinical nurse specialists. This arrange-
ment of the home base office for the
senior nursing staff should provide
maximum opportunity for exchange with
all members of the health care team.
Each nursing unit will have a patient
lounge to provide a therapeutic milieu for
nurse/patient/family/doctor interaction.
The situation of this lounge is important.
We have emphasized to our architects
that it is best placed within the heart of
the nursing unit to permit maximum
opportunity for the nurse to observe her
patients and their visitors, so that she can
give appropriate care when indicated.
This site will also be used for patient
teaching by members of the health team.
In planning the unit design, we kept
the family and its needs in strong pers-
pective. A dying patient, or a sudden
tragedy, require skillful understanding.
Often the nurse is the one who is present
to communicate with the family. We
44 THE CANADIAN NURSE
discussed with the architects these
matters of life and deatli. and encouraged
them to explore the effect of environ-
ment and the need for privacy during
difficult times.
Small quiet rooms have been designed
adjacent to the nursing units where rel-
atives may retreat or be joined by the
clergy or staff member, if requested.
Also, a special family room adjoins the
intensive care unit where relatives may
come and go as desired. An interdenomi-
national chapel, with offices for the
chaplains adjoining, is situated near the
special family room.
Teaching facilities
One of the primary objectives of the
planned Health Sciences Centre is to
provide teaching facilities that will create
an environment for learning. Conference
rooms are located in each unit immediate-
ly adjacent to patient accommodation.
This will allow students to pursue discus-
sions in small, medium, or large groups,
appropriately removed from patients and
families.
Collaboration with members of the
university's faculty of nursing during the
planning of the nursing unit has enhanced
the design of the laboratory to which
students come for clinical learning and
experience. Because the director of nurs-
ing of the University Hospital is a mem-
ber of the nursing faculty and of the
curriculum committee, a fair amount of
understanding has developed of both
patient care and student needs. The es-
tablishment of these relationships be-
tween nursing service and nursing educa-
tion at an early stage is vital for the
success of good quality patient care and
student education.
Research
Research is the third objective in
planning the design for the Health Scien-
ces Centre. Stress is being placed on the
expansion of nursing knowledge through
research and the translation of the find-
ings into improved health care. A project
is presently being conceived to study new
areas of nursing activities and responsibili-
ties to utilize the nurses' skills more
effectively. This study is specifically relat-
ed to the role of the nurse practitioner
and is being conducted in a family prac-
tice clinic in an affiliate hospital.
A nurse practitioner who has demons-
trated special skills and knowledge related
to family care was appointed in Septem-
ber, 1968 as director of the project. I
have been actively involved as a member
of this project committee. The findings
and deductions will be utilized to de-
termine patterns of staffing and differen-
tiation of skills in the organization of the
family practice unit, which will be an
integral part of the University Hospital.
More experimentation with staffing
patterns and the effect of design - in
inpatient and outpatient units - on
quality of care needs to be done. Because
we have been committed to much innova-
tion in this project, a great deal of
research and evaluation must be carried
out to corroborate the value of such a
design.
The wisdom, experience, knowledge,
and intuitive insight of many minds has
purposefully guided the planning for the
Health Sciences Centre. I have appreciat-
ed the privilege of being a member of the
planning team and being able to initiate
the involvement of nursing in all areas. It
has given us an opportunity to establish
good working relationships with re-
presentatives of many disciplines - not
only in the physical phase of planning,
but also in the operational and program
aspects for the total project. The Health
Sciences Centre will be an excellent
vehicle to carry out the delivery of a high
level of health care, student teaching, and
research. CH
OCTOBER 1969
Check your image
— it's slipping!
In Burns' poem, a fine l.idv put on glamorous airs, unaware that a wee louse was
giving away her true habits. Nurses are claiming — with some good reasons —
to be professionals, but their looks give them away.
Glennis Zilm
A
OCTOBER 1969
Professional? Nurses? Well, maybe.
But in their identifying uniforms, many
look about as professional as a doctor
making rounds in his bare feet or a lawyer
pleading his case in a bathrobe.
During the past few years. 1 visited
nearly 60 hospitals in six provinces. Al-
most without exception in these hos-
pitals, many nurses were rumpled, dirty,
and frumpy - so many that tiiis untidy
and. yes, unsanitary image is the one that
stays in the mind.
It is true that clothes do not make the
professional. But. being professional im-
plies that one has a pride in oneself and in
one's job; usually the professional shows
his commitment to his calling by rep-
resenting it well when on public view.
Being professional, too. implies that
the individual polices himself, not that
orders come from above. Yet. all too
often directors of nursing or supervisors
have to issue directives ("No rings."
"Uniform skirts must be below the
knee.").
Miss Zilm, now a reporter for The Canadian
Press, was formerly assistant editor for The
Canadian Nurse, and before that - obvious-
ly - a nursing instructor teaching nursing arts.
• There is nothing wrong with short
skirts - patients like their nurses to look
nice. But who would blame the man in
the next bed from thinking all sorts of
things?
THE CANADIAN NURSE 45
• The uniform on the nurse on the right has shrunk. If that good-looking graduate
really wanted to look right, she would chuck it out.
46 THE CANADIAN NURSE
Our patients have a right to expect
nurses to be appropriately and profes-
sionally dressed - after all, they pay for
it. A few years ago nurses may have been
able to claim that they could ill afford to
buy new shoes or replace a uniform that
had shrunk from too many washings. This
is no longer true; collective bargaining has
raised salaries out of the poverty range.
And nurses should realize that they can
pay less to look smart in uniforms than
teachers or secretaries must pay to
provide themselves with chic working
wardrobes.
True, administration deserves to share
some blame; most hospitals fail to pro-
vide adequate change rooms, for one
thing. Yet, when bargaining for nurses,
how many staff associations demand
- or even ask for - large, comfortable
change rooms and efficient, effective
laundry service? Every day you see pur-
portedly professional health teachers
walking into supermarkets on their way
home, having spent the day caring for
pneumonia patients or changing dressings
on draining wounds. If the public under-
stood more about health and knew the
story of Typhoid Mary, they would
probably label these nurses Pneumonia
Patty or Staphylococcus Sally.
This article does not argue that profes-
sionals need to avoid short skirts or
makeup or fashionable hair styles. Often
the most professional-looking nurse on
the ward has the shortest skirt, is attrac-
tively made-up, and has the latest hair
style.
But this nurse has other attributes,
too: She is clean. Her uniform fits and
she wears pantihose and moves gracefully
so that her skirt, though short, does not
ride up. Her shoes and stockings are clean
and whole - not holey. Her cap is fresh.
She owns a clean, washable, white sweat-
er to wear if it is cold on the ward. Her
hands and nails look lovely. Naturally,
anyone so charming and wise is engaged,
but she wears her diamond on a fine
chain around her neck to protect it and
to protect her patients.
Of course, she is most likely a student
nurse - not yet a "professional." As
soon as she graduates, she will probably
stop fighting the trend to untidiness.
The following photographs illustrate
the 10 most common dress faults that
nurses make. They were posed by student
nurses from the Ottawa Civic Hospi-
tal - where, incidentally, I saw fewer
untidy nurses than in any other hospital I
visited. There, the overall image was of a
clean, tidy, and professional health work-
er. D
OCTOBER 1969
• You do see hair like this on wards. How
would you like to be the newly-admitted
patient who opens up his fresh hospital
bed to find a long black hair on the
drawsheet' Or the diabetic who finds
one on his tray?
• Two faults together here: All nurses
liave seen shoes and stockings exactly like
these - and those are not new runs,
either. Surely, for our mental health, we
Imve a better self-image than that!
• The most unprofessional look of all
- wearing the uniform on the street, in
buses, at the beauty parlor, or while
shopping for groceries on the way home.
A fine health teacher this nurse makes!
OCTOBER 1969
THE CANADIAN NURSb 47
• She 's cuddling all that dirty linen
against her uniform; tonight will she
aiddle her baby daughter against that
same uniform?
• Of course it gets cool on the wards on night duty, so what • Tills graduate must be very proud of her cap - she has tossed
could be nicer - and more unprofessional- loo king - than it onto the top of her locker after work every day for four
a woolly red cardigan'.' months. It is stained, battered, and securely anchored with
those big, black bobbypins.
9 She's engaged, she's lovely, she's carry-
ing staphylococci around on her dia-
mond. And yesterday she gouged a huge
scratch on a patient's back while changing
the drawsheet.
48 THE CANADIAN NURSE
OCTOBER 1969
The nurse and
the sociopathic personality
Patients who are sociopathic are skillful in engaging in subtle interactions with
those around them. They attempt to undermine others, and may place the staff in
situations that endanger their roles.
Anthony M. Marcus, M.A., D. Psych., L.M.S.S.A.
Individual human functioning may be
examined by looking at the three inter-
relating components which, together,
comprise personality organization: the
psychological, the somatic, and the
behavioral. A patient who expresses his
symptoms in the psychological, somatic,
or psychosomatic spheres invariably com-
plains of some form of internal distress,
whether physical or psychological. This
patient states that he feels bad, that he
feels a pain, that he feels subjectively
disturbed in some way. He feels the pain
inside himself. He hurts. He is suffering,
requires help, and actively seeks it out.
When he is a patient on the ward, he is
willing to call for help from the nurse.
The nurse responds to this patient who
has a definite sick role and approaches
him, wrapped in her own mantle of
nursing. She approaches him feeling com-
fortable, knowing that her own role is
secure and that she is approaching an
individual who has a defined role as
patient. Thus, both patient and nurse are
reaffirmed in their role assignments and
approach each other with minimum
anxiety.
This is not the case, however, with the
patient who has a sociopathic personality.
This patient displays his symptoms in the
form of a malignant, behavioral reaction,
and does not feel the pain inside. The
pain is felt by others. The patient's
distress is directed externally on to those
who are trying to help him. Instead of the
OCTOBER 1969
patient suffering, it is the nurse who feels
uncomfortable, has a feeling of defeat, is
irritable, and somehow extremely frus-
trated, yet not always aware of the source
of these feelings. She leaves the ward at
the end of her shift with a headache, with
the symptoms of tension, and feeling very
confused.
By projecting his anxiety onto others,
the sociopathic individual makes them
less useful, less adequate to their task,
and undermines their self-confidence in
their roles. The nurse is made to feel she
cannot cope and, as her sense of unease
continues, the patient is only too aware
of her increasing discomfort and anxiety.
Often these individuals, who are highly
sensitive to the nuances of personal inter-
action with others, exaggerate the situa-
tion by taking advantage and manipulat-
ing those around them.
One patient encouraged a student
nurse by saying, "You know nurse, I have
never felt before with anyone the sort of
feeling I have that you can really help me.
I would really like the opportunity of
spending more time with you, because I
feel you have the capacity to bring me
out of myself." The nurse, fiattered that
she was being thought of this way and
Dr. Marcus is Assistant Professor, Department
of Psychiatry, and Head, Section of Forensic
Psyctiiatry, The University of British Columbia,
Vancouver, B.C.
appreciative of the patient's words, spent
more time with him and encouraged him.
That night, the patient went to the
nurse in charge and said, "I don't want
you to say anything, but when Miss Jones
gave me a needle, I got the impression
that she stabbed me with it a little more
harshly than necessary. In fact, this is the
second occasion it's happened and I really
think she has it in for me. I wouldn't like
you to say anything, but I feel this isn't
right."
The charge nurse called the student
into her office and asked her if something
about Mr. Smith upset her to the point
where she was unnecessarily or even
unconsciously causing him pain. The
student, expecting praise for her care of
this patient, was more than shattered and
left the ward that afternoon with a severe
tension headache, her confidence under-
mined.
These patients, skillfully able as they
are to engage in subtle interactions with
those around them, constantly attempt to
undermine others, to place the nurse in a
situation where her role is definitely
endangered, and her response is that of
increased signals pointing to her own
distress. It is therefore extremely im-
portant for her to be sensitive to her own
subjective feelings when interacting with
these patients. The feeling described
above will be the ones evoked in the
nurse when interacting with a sociopathic
personality
THE CANADIAN NURSE 49
Sociopalhic trait?
The following characteristics may help
to give a framework which enables the
nurse to understand those individuals
described as a sociopathic personality.
Tiiese individuals often have above
average intelligence. They are plausible,
may be extremely bold, and have con-
siderable superficial charm. One can
usually spot sociopathic individuals in a
ward in a mental institution because the
student nurses are sitting with them.
Their charm and brightness can be
captivating.
If a patient confronts the nurse with
such drama that she wonders how he can
think that way, she is more than likely
dealing with a sociopathic personality.
Usually this patient has a self-centered
callousness and capacity to exploit
others.
The frustration tolerance of these
patients is low. They are impulsive and
ruled more by pleasure than reality; they
cannot anticipate, wait, or look forward
to things, but need instant gratification.
They have a recklessness that may, on
occasion, endanger themselves and others.
Sociopathic persons do not profit by
experience. They do not appear to suffer
the social disgrace of the average law-
abiding person appearing before a court
of law on a charge.
Whenever there is an opportunity,
sociopathic persons form a delinquent
subculture. This is an attempt to under-
mine the program of the system in which
they find themselves. It is extremely
difficult to manage more than one of
these persons in the open ward of a
general hospital's psychiatric unit. If, for
example, individuals on a ward are receiv-
ing or trafficking in narcotics or alcohol,
the atmosphere of a therapeutic environ-
ment can rapidly deteriorate and chaos
result. The nurse must be aware of
patient interaction, of the more subtle
communications that go on between
patients, and of manipulations intended
to play off the staff one against the other
in order to create a sense of distrust and
tension between the staff members.
Why should the sociopathic person-
ality be regarded as a psychiatric disor-
der? Are not the characteristics of ruth-
lessness, energy, high intelligence, and
charm those necessary for being the
president of a large corporation?
The sociopath is chronically engaged
in a life style that may result in personal
disaster involving imprisonment and often
suicidal attempts. These individuals may
be termed self-drivers in reverse. Their
lives show an inbuilt tragedy and a will to
fail. The business man, on the other hand,
50 THE CANADIAN NURSE
is goal-directed and intends to stay at the
top, whereas the sociopath never seems to
be able to carry off the coup with success
and rarely escapes to South America to
live in luxury on the proceeds of his
activities.
It is said the sociopath has no cons-
cience. From my own clinical experience
and using a biblical analogy, it is my
opinion that self-mutilation or suicidal
attempts are examples of self-punish-
ment, that such punishment only occurs
when there has been self-conviction of a
crime, and this implies guilt and thus the
presence of conscience as an ever present
but perhaps highly concealed factor in
these cases.
Types of sociopath
Sociopathy may coexist with neurotic,
psychotic, or borderline psychotic pro-
cesses, these elements being defined on
psychiatric examination. Two major
types of sociopathic personality are:
• The dys-social individual, such as the
criminal narcotic addict, is a member of a
delinquent subculture, shows allegiance
to it, and conforms to its mores. Belong-
ing to the group and adhering to its value
system is important to him. The subcul-
ture may have its own methods of com-
munication and even language. It is
cohesive and careful with respect to
non-members.
• The anti-social individual is often rest-
less, furtive, and alienated, showing
allegiance to no one and to nothing, and
he can be dangerous. Because of his
marginality, he may be chronically
frustrated, revengeful, and inclined to
seek vengeance by harming others.
Interrelating with these two types are
sociopathic personalities who may be
regarded as inadequate in that they
maintain a low level of subsistence and
show persistent mediocrity in their
exploits, social, and vocational goals. The
aggressive sociopath, while possessing
most of the features already described, is
inclined to catastrophic, explosive out-
bursts under minimal stress. Many of this
group show electroencephalographic
disorders, and treatment with Dilantin is
a valuable method of maintenance
therapy for them. The creative sociopath
may have considerable intelligence or
artistic talent. In addition, he may possess
charismatic qualities that give him con-
siderable leadership potential and powers
of persuasion over others. Individuals in
this group can play important parts on
the world stage; with assistance and good
luck, they can become stable and resour-
ceful people.
It is important that the nurse learn to
use herself as a therapeutic instrument so
that in her encounters with her patients
she acts as an emotional barometer, per-
mitting herself to feel the effects the
patient may have on her. This permits her
to examine the subjective feelings evoked
in her, and acknowledge to herself what
the patient makes her feel or do. In this
way she can realize her own potential
with respect to her sensitivity in her
interaction with patients. This is partic-
ularly valuable in formulating a treatment
plan and deciding on the management of
the patient.
The following principles are important
if a nurse is to be able to cope with this
type of individual.
First, there is an absolute need for
extremely good communication among
staff members. Conferences with nurses,
doctors, and other health professionals
must be held where communication is
open and frank. Factors that would ren-
der these meetings covert and negative
must be brought to the surface and
examined by everyone.
Second, early and direct confrontation
with the patient about his behavior is
important. The patient must be faced in
an open, direct way with the standards
and limitations expected of him. He
needs to be made aware of the social
realities of the ward.
The sociopathic personality can spot a
phony a mile away. There is no place in
dealing with this type of person for
humbug or hypocrisy. Having been
through the rougher mills of life, he is
well aware of what human beings are
capable of in playing pseudo roles. It is
important that the nurse is a person and
not a stereotype where she plays out a
role that masks herself from her own
unique self. The nurse therefore must be
open and honest with the patient, and the
patient will respect such encounters. He
will often say such things as, "Well I
tried, but I couldn't get away with it," or
"Well I can see I can't put one over on
you."
A sense of humor, a tongue in cheek
attitude to statements of melodrama,
purple passion, or plain showing off must
be handled with warmth and a cool quiet,
for the nurse will be constantly confront-
ed by remarks intended to shock and
pierce her vulnerabilities. D
OCTOBER 1969
A Preliminary Report On The Attitudes
And Behaviour Of Toronto Students
In Relation To Drugs by tlie Addic-
tion Research Foundation. 176 pages.
Toronto, The Addiction Research
Foundation, 1969.
Reviewed by B. June Goldberg. Senior
Nursing Instructor. University of Al-
berta Hospital, Edmonton. Alta.
This is a preliminary report of a survey
which is part of a larger scale investiga-
tion of the character, distribution, and
consequences of psychoactive drug use.
The report covers a five-month investiga-
tion of drug use among students in
Metropolitan Toronto high schools. It
records the extent of drug use, how
students regard this use and the differ-
ency in drug usage and attitudes among
various age and social groups. Representa-
tive sample groups of students were cho-
sen for interviews, and 6,447 students
answered questionnaires.
The report covers, in detail, the meth-
od of selecting samples and the technique
of interviews. This will be of interest to
any reader who is a student of sociology.
The report findings will surprise some
readers. The study of students in grades
seven to 13 found 46.3 percent reporting
use of alcohol at least once in the
previous six months, 37.6 percent reports
use of at least one cigarette per week.
More serious perhaps were findings that
9.5 percent had used tranquillizers at
least once during the five month survey
period, 7.3 percent had used stimulants,
6.7 percent had used marijuana, 5.7
percent had used glue, 3.3 percent had
used barbiturates, 2.6 percent had used
L.S.D., 2 percent had used other halluci-
nogens and 1 .9 percent used opiates. The
vast majority were reports of single usage,
indicating that in most cases the drug use
is partly and probably experimental.
The report attempts to explore, in
some depth, the factors influencing use of
drugs. There was a significantly high
number of non-users in the A grade
achievers and many users reported D and
E grades. Similarly, drug users were not
achievers in non-academic activities. In-
fluence of parental and peer groups was
examined and correlated as to use. Stu-
dents expressed a need for more and
earlier education on drug use and effects.
The report analyzes and correlates many
interesting factors and the attitudes of
students toward these factors.
Two very interesting conclusions are
that students depend on and are influ-
OCTOBER 1969
enced greatly by their peer groups. How-
ever, home and school environment stress
achievement and this factor (achieve-
ment) is negatively correlated to drug use.
This report, with its extensive statisti-
cal tabulation will be interesting reading
for all concerned with young people, and
will perhaps help each individual to un-
derstand the factors leading to drug use
and, hopefully, lead to some positive
action in combating this problem.
Doctors and Doctrines by Bernard R.
Blishen. 202 pages. Toronto, Universi-
ty of Toronto Press, 1969.
Reviewed by Frances Howard, former-
ly consultant in nursing service, Cana-
dian Nurses' Association.
The medical profession's stand on
medicare has met with mixed public
reactions depending on the individual's
political affiliation, social values, and
interpretation of information derived
from the news media. This book clarifies
the profession's reluctance to endorse
government-sponsored insurance plans by
identifying the function of ideology in
the practice of medicine.
The author has gone to considerable
length in describing the education and
practice of physicians, which may appear
superfluous to some readers. The descrip-
tion, however, is important in that it
emphasizes and qualifies the degree of
professional independence and autonomy
exercised by the profession and its reluc-
tance to accept the inception of an
outside control - the federal medicare
plan.
The author proceeds to describe the
history of provincial medicare schemes, in
particular the Saskatchewan plan, the
findings of the Royal Commission on
Health Services, the action taken by the
Federal Government in adopting medica-
re and the subsequent developments in
the various provinces.
Finally, medical ideology is discussed
against a background of Canadian social
and political history. Stress is placed on
the belief of freedom of choice the
physician's freedom to practice according
to the standards and ethics of his profes-
sion, and the patient's freedom to choose
his own physician.
Both sides of the argument have been
amply illustrated by statistical reference
and by quotes from research studies.
The author makes no attempt to reach
a conclusion or to cast blame. Rather, he
has presented an unbiased, factual picture
of the situation and left the reader to
decide for himself.
Fundamentals of Immunology For Stu-
dents of Medicine and Related Scien-
ces by Russell S. Weiser. Quentin N.
Myrvik, and Nancy N. Pearsall. 363
pages. Philadelphia, Lea & Febiger,
1969. Canadian Agent: Macmillan Co.
of Canada, Toronto.
Reviewed by Janelyn G. Kotaska, Van-
couver. B. C.
This textbook is intended for students
of medicine and related sciences, such as
veterinary medicine and dentistry. It
would be useful as a reference book for
nurses at a university level of study,
although the material is of a highly
technical nature and the terminology is
not for a beginning student. The book
attempts to clarify and standardize the
confusion of varied and often faulty
terms that have developed with this rel-
atively new science, but the glossary must
be used constantly to understand much
of the material in the text.
Immunology is one of the most rapid-
ly advancing areas of biology, and the
authors have extracted from the wealth
of current research those findings which
are significant, employing the "core con-
cept" in medical teaching to stress the
fundamentals. Much of the material is
beyond the scope of nursing. However,
several selected topics would be of inter-
est and value in nursing study: immunolo-
gic injury of tissues and organs; mecha-
nisms of inflammation; anaphylaxis; de-
layed sensitivities; tests involving antigen-
antibody reactions; immunology of neo-
plasms; human blood groups and transfu-
sions; Rh disease; and principles of host-
parasite interaction and host immunity to
parasites.
The artificial grafting of tissues and
organs is dealt with extensively and
would help the nurse clarify her under-
standing of transplants in this area of
intense public interest. The discussion
includes autografts and allografts, im-
mune response to allografts, graft rejec-
tion, and graft versus host reaction.
This text is well-written, with detailed
but concise documentation of much data
involving all aspects of immunology. It
does, however, require that the reader
have considerable knowledge of basic
sciences, such as biology, physiology,
bacteriology, chemistry, bio-chemistry.
THE CANADIAN NURSE 51
accession list
Publications on this list have been
received recently in the CNA library and
are listed in language of source.
Material on this list, except reference
items, which include theses and archive
books that do not circulate, may be
borrowed by CNA members, schools of
nursing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List"
and should be addressed to: The Library.
Canadian Nurses' Association, 50 The
Driveway. Ottawa 4, Ontario.
No more than three titles should be
requested at any one time. If additional
titles are desired, these may be requested
when you return your loan.
Stamps to cover payment of postage
from library to borrower should be in-'
eluded when material is returned to CNA
Library.
Books and Documents
1. I. 'an dc rivre en bonne sante par Will'rid
LcBlond. Montreal, Editions de rHomnie,
tl968. 25 1 p.
2. Basei phvsiologiques des nornies d'hygie-
ne applkahles an logement par M. S. Goro-
mosov Geneve, Organisation Mondiale de la
Sante, 1968. 105p.
3. liasic human anatomy by Helen L. Daw-
FOR WOMEN ONLY
. . . LAXATIVE NEWS !
"When I think of the suffering I could
hove avoided if I'd known about COR-
RECTOL* sooner! A friend recommended
it and we've found it fine for every age
group from Grandma to ten-year-old
daughter." — Mrs. E.H.
CORRECTOL has been specially developed
for a woman's delicate system. Its secret
is a non-laxatiye regulator that simply
softens woste. And, CORRECTOL contains
just enough mild laxative to give regu-
larity a start. Working together, these
two gentle ingredients in CORRECTOL
give 0 woman effective relief, even fol-
lowing childbirth.
CORRECTOL
*reg'd. T.M., Pharmaco (Canada) Ltd.
son. New York, Appleton-Century-Crofis,
1966. 332p.
4. The bake of children: reprint Edinburgh,
Il&S Livingstone. 1965. 76p. Exact copy of a
specimen of the original ed. published 1553 in
the Medical Library, Univ. of Bristol, I n-
gland.R
5. Canadian adult basic education by
Michael W. Brooke. Toronto, Canadian Associa-
tion for Adult Education, 1969. 49p.
6. Catalog of the Florence Nightingale
collection. New York, Department of Nursing,
I'aculty of Medicine, Columbia University, Pres-
byterian Hospital, School of Nursing, 1956.
7. A check list for nursing service policy
manuals by Sister Jean Marie Braun. St. Louis,
Mo., Catholic Hospital Association, 1968. I3p.
8. Child guidance centres by D. Buckle and
S. Lebovici. Geneva, World Health Organiza-
tion, 1960. 133p.
9. The content and role of collective
agreements in Canada by Felix Quinet. Ottawa,
CCH Canadian Ltd. 1969. I v.
1 0. Corporate boards in Canada: how sixty-
four boards function by W. J. McDougall and
G. Eogelberg. London, Ont., University of
Western Ontario, 1968. 77p.
1 1 . Creative annual reports: a step-hy-step
guide by Frances A. Koestler. New York,
National Public Relations Council of Health
and Welfare Services, 1969. 71 p.
1 2. La croixrouge et la paix par Henri
Coursier. Paris. Spes 1968. I27p.
13. Current medical terminology edited by
Burgess L. Gordon. 3d cd., Chicago, American
Medical Association, 1966. 696p.R
14. Current procedural terminology edited
by Burgess J. Gordon, 1st. ed., Chicago, Ameri-
can Medical Association, 1966. l72p.R
15. The development of a nursing categori-
zation of burn patients and a burn patient
nursing care index by Sister Adrian Chutz. New
York, N.Y., National League for Nursing, 1969.
1 lOp. (League exchange no. 88)
16. Educational television across Canada.
The development and state of E.T. V. 1968. 5th
cd. edited by Earl Rosen and I'lizabcth Whelp-
dale. Toronto META, 1969. 95p.
17. The effective director: a monograph
arising out of a seminar held at the School of
Business Administration, University of Western
Ontario, May 14 & 15, 196S. edited by W. J.
McDougall. London. University of Western On-
tario, 1969. 114p.
18. Elements de genetique medicate par
J.M. Robert. Lyon, Simep., 1968. 255p.
19. Evolving responsibilities of the corpo-
rate director: a monograph arising out of a
seminar edited by W. J. McDougall. London,
Ont., 1966. 128p.
20. Extending the boundaries of nursing
education ~ the preparation and roles of the
clinical specialist: papers presented at the third
conference of the Council of Baccalaureate and
Higher Degree Programs. Phoenix, Ariz., Nov.
13-15, 1968. New York, National League for
Nursing, Dept. of Baccalaureate and Higher
Degree Programs, 1969. 79p.
21. Folio of reports: 55th annual meeting.
May 29-30, 1969. North Hill Motel, Brandon.
Manitoba, Winnipeg, Manitoba Association of
Registered Nurses. 1969. 47p.
22. How to do pasteups and mechanicals:
the preparation of art for reproduction by S.
Ralph Maurello. New York. Tudor. 1960. 160p.
23. Human rights: a study guide for the
International "tear for Human Rights 1968.
Toronto. Heinemann Educational Books for the
llnited Kingdom Comniiltec for Human Rights
Year 1968. 1967. 220p,
24. Index of opportunity in nursing. Prince-
ton. N.J.. G. & W. Resource Publications Inc..
1969. 92p.
25. Infection in hospital a code of prac-
tice prepared by a sub-committee. Northern
Ireland Hospitals Authority of the Control of
Infection Committee. Belfast. 1968. 68p.
26. Informe final: Congreso Interamericano
dc Enfermeras, 8. Guatemala C.A. 5 a 10 de
Die. 1966. Guatemala City, 1967. 90p.
27. Medical reference works 1679-1966: a
selected bibliography edited by John Ballard
Blake and Charles Roos. Chicago, Medical
Library Association, 1967. 343p.
28. Microbiology laboratory manual and
work book by Alice Lorraine Smith. 2d. ed. St.
Louis, Mo., Mosby, 1969. I66p.
29. Morphologic evolutive des chordes par
Paul Pirlot. Montreal, Les presses de Puniversite
de Montreal. 1969. 1068p.
30. National reports of member associa-
tions: an international statistical survey of
nursing. Geneva, International Council of
Nurses, 1969. 140p.
3 1 . /I national survey of associate degree
nursing programs, 1967 by Sylvia Lande. New
UNIVERSITY HOSPITAL
McMASTER UNIVERSITY
A new University Hospital is
under construction. The scope of
activity \n\\\ involve major clinics
in all departments in addition to
a 420-bed in-patient service. The
establishment of limited out-
patient clinics is expected to
take place in November 1970.
In-patients are expected to be
admitted by July 1971. Applica-
tions are invited for the follov/-
ing key positions:
ASSISTANT DIRECTORS
OF NURSING
CLINICAL NURSE SPECIALISTS
OPERATING ROOM SUPERVISOR
HEAD NURSES
Interested riurses are requested
to write to:
Director of Nursing
UNIVERSITY HOSPITAL
McMASTER UNIVERSITY
Hamilton 16, Ontario
52 THE CANADIAN NURSE
OCTOBER 1969
York. N.Y.. National League for Nursing, 1969.
139p.
32. Nurse's liability for malpractice; a
programmed course by Kli P. Bcrnzwcig. New
York, McGraw Hill, 1969. :66p.
33. Nursing care planning by Dolores I .
Little and Doris L. Carnevali. Philadelphia,
Lippincott, 1969. 245p.
34. Personal and vocational relationships in
practical nursing by Carmen I-. Ross. 3d ed.
Philadelphia, Lippincott, 1969. 266p.
35. Pharmacology in nursing by Betty S.
Bergersen and Llsie L. Krug. 1 1th ed. St. Louis,
Mosby, 1969. 695p.
36. Le planning familial dans le monde:
aspect demographique-realisations par A.-M.
Daurlen-Rollicr. Paris, Petite Bibliothei|ue
Payot, 1969. 1 29p.
37. Les plus belles histoires de medecine par
Marcel Berger . . .et al. Paris. SLGr.P. 1954.
247p.
38. La pratique des tests mentaux en
psychiatric infantile par L. Moor. 2d ed., Paris.
Masson&Cie, 1967. 271 p.
39. The physiological basis of health stand-
ards for dwellings by M. S. Goromosov. Geneva.
World Health Organization, 1968. 99p.
40. Presence: I'Association des infirmieres
canadiennes. ses origines. les influences qui
I'ont marquee durant soixante ans. ses perspec-
tives d'avenir. Ottawa, Association des Infirmie-
res canadiennes, 1969. 113p.
41. The quiet art: a doctor's anthology
compiled by Robert Coopc. 1 dinburgh, Living-
stone, 1952, reprint 1958. 283p.
42. Recommended reading about children
and family life. New York, The Child Study
Association of America. 1969. 74p.
4 3. Rehabilitation of the lower limb
amputee by W. Humn. London, Baillicre,
TindaU and Cassell, 1965. 78p.
44. Repertoire des services de sante menlale
de la province de Quebec. Montreal, Associa-
tion canadienne pour la Sante mentale, 1969.
205p.
45. Report of the Caribbean Nurses' Organi-
zation Sixth Biennial Conference, 24th July to
2nd August, I96S, Kingston, Jamaica. King-
ston, 1969. 82p.
46. Report of the Second Canadian Confer-
ence on Hospital Medical Staff Relations, Que-
bec, p. 2, February I 7-/9, 1969. Toronto, Cana-
dian Hospital Association, 1969. 47p.
47. Resume de pathologic chirurgicale par
Bibiane G. Breton. Montreal, Renouveau Peda-
gogique, 1968. 182p.
48. The second ten years of the World
Health Organization 1958-1967. Geneva, World
Health Organization, 1968. 413p.
49. State-approved schools of nursing; meet-
ing minimum requirements set by law and
board rules in the various jurisdictions. New
York, National League for Nursing, 1969. 76p.
50. A study of the Florence Nightingale
International Foundation by H. R. Hamley and
Muriel Uprichard. London, Florence Nightin-
gale International Foundation, 1948. 46p.
51. Teaching in a junior college; a brief
professional orientation by Roger H Garrison.
Washington, Amer. Assoc, of Junior Colleges,
1968. 28p.
OCTOBER 1969
52. The technology of teaching by B. F.
Skinner. New York, Appleton-Century-Crofts.
1968. 271p.
53. Today's health guide: a manual of
health information and guidance for the A meri-
can family edited by W.W. Bauer. Rev. ed.
Chicago, American Medical Association, 1968.
635p.
54. Traumatologic infantile par Paul Louis
Chigot et P. Esteve. 2. ed. entiriement refon-
due. Paris, Expansion scientifiquc fran(;aise,
1967. 425p.
55. Understanding medical terminology by
Sister Mary Agnes Clare Frenay. 3d ed. St.
Louis, Mo., Catholic Hospital Association,
1964. 246p.
56. La verite sur les bebcs par Marie-Claude
Monchau.x. Paris. Fditions Magnard, 1968. 87p.
57. Workbook and study guide for medical-
surgical nursing: a patient-centered approach by
.Alma L. Joel. 2d cd. Saint Louis, Mo., Mosby,
1969. 319p.
Pamphlets
5H. Annual report. 1969 Ottawa, Canadian
Welfare Council, 1969. 30p.
59. Brief review of nursing in Brazil by
Glete DeAlcantara. Rio de Janeiro, Depart-
mento de Imprensa Nacional, 1957. 22p.
60. Bylaws as amended May, 1969. New
York, National League for Nursing, 1969.
29p. R.
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THE CANADIAN NURSE 53
6 1 . Collection des cycles de la vie. Toronto,
The Lite Cycle Centre, Kimberly-Clark, 1969.
Iv.
62. Criteria for the appraisal of baccalau-
reate and higher degree programs in nursing.
Rev. ed., New • York, National League for
Nursing. Dept. of Baccalaureate and Higher
Degree Programs, 1969. lip.
63. Educating nurses for coronary care
paper by Alice Baumgart. Vancouver. School of
Nursing, University of British Columbia, 1969.
5p.
64. Employment standards for registered
nurses. Winnipeg, Manitoba Association of
Registered Nurses, 1968. lOp.
65. Health; Britain and the developing
countries. London, Central Office of Informa-
tion, Reference Division, 1969. 39p.
66. A library guide for school of nursing.
2d. cd. London, Royal College of Nursing and
National Council of Nurses of the United
Kingdom, 1967. 23p.
67. Library orientation: college of nursing.
Detroit, Mich., Wayne State University, Kresge
Science Library, 1968. 8p.
68. Masters education: route to opportu-
nities in modern nursing. New York, National
League for Nursing, Dept. of Baccalaureate and
Higher Degree Programs, 1969. 15 p.
69. 7Vie life cycle library. Toronto, The Life
Cycle Centre, Kimberly-Clark, 1969. Iv.
70. On record: policy statements 1968.
Ottawa, Canadian Nurses' Association, 1969.
7p.
71. Principles of legislation relating to
public funds for nursing education. New York,
American Nurses' Association, 1969. 2p.
72. Producing an employee handbook by
1 lizabeth McLeod. London, Industrial Society,
1968. 20p.
73. La reanimation cardiaque par Yves
Bouvrain. Paris, Lditions de I'Lpargne, 1967.
38p.
74. Rehabilitation in Sweden by Karl
Montan, Stockholm, The Swedish Institute,
1967. 40p.
75. Report. 196811969. Toronto, Canadian
Public Health Association, 1969. 41p.
76. Report, Pan American Health Organiza-
tion. Technical Advisory Committee on Nurs-
ing, first meeting, 18-22 Nov. 1968. Washing-
ton, 1969. 17p.
77. The story of Bart's: the mother hospital
of the empire by Herbert Bloye. 2d ed.,
London, Blades Last & Blades Ltd., 1924. 16p.
78. Visees Aic. Ottawa, Association des
Infirmieres canadiennes, 1969. 7p.
Government Documents
Canada
79. Dept. of Labour. Economic and Re-
search Branch. Part-time employment in retail
trade by . . .and Women's Bureau. Ottawa,
Queen's Printer, 1969. 66p.
80. . Legislation Branch. Judicial re-
view of decisions of labour relations boards in
Canada by Jan K. Wanczycki. Ottawa, Queen's
Printer, 1969. 37p.
81. . Women's Bureau. Women in the
labour force, facts, figures. Ottawa, 1969. 16p.
82. Dept. of National Health and Welfare.
Food and Drug Directorate. Guide for drug
manufacturers. Ottawa, 1969. 40p.
83. Ministere de la Sante nationale et du
Bien-etre social. Direction des Alements et
Droques. Guide des fabricants de produit phar-
maceutiques, Ottawa, 1969. 40p.
84. Secretary of State. Education Support
Branch. Federal expenditures on post-
secondary education 1966-67. 1967-1968.
Ottawa, Queen's Printer, 1969. 34p.
Quebec
85. Dept. of Health, Family and Social
Welfare. Information Division. Elements in a
policy for ill-adapted children. Quebec, 1969.
58p.
U.S.A.
86. Dept. of Health, Education and Welfare.
Public Health Service, Directory of state,
territorial and regional health authorities 1968.
Rev. ed., Washington, U.S. Gov't Print. Off.,
1968. 147pR
Studies Deposited in
CNA Repository Collection
87. An exploratory study of the relation-
ship between physical and social-psychological
distance and nurse-patient verbal interaction by
Claire Tissington. Montreal, 1969. 59p.R
8 8. Relationship between attitude and
person-centered nursing care by Susan Eliza-
beth Perry. Boston, 1969. 107p. Thesis
(M.Sc.N) - Boston. R D
STANFORD UNIVERSITY MEDICAL CENTER
Invites you to consider employment in one of the
nation's foremost Teaching hospitals. We would like
to tell you more about it and the opportunities of-
fered on the San Francisco Peninsula.
For additional information —
Name
Address:
City: State:
Service desired:
RHURN TO:
STANFORD UNIVERSITY HOSPITAL
PERSONNEL DEPARTMENT
300 PASTEUR DRIVE
PALO ALTO, CALIFORNIA 94304
Request Form
for "Accession List"
CANADIAN NURSES'
ASSOCIATION LIBRARY
Send this coupon or facsimile to:
LIBRARIAN, Canadian Nurses' Association,
50 The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in the
issue of The Canadian Nurse,
or add my name to the waiting list to receive them when
available.
Item
No.
Author Short title (for identification)
Request for loans will be filled in order of receipt.
Reference and restricted material must be used in the
CNA library.
Borrower
Registration No
Position
Address
Dote of request
54 THE CANADIAN NURSE
OCTOBER 1969
November 1969
i
"^
1
The
U^'IVERSITY OF OTTAWA,
SCHOOL OF NURSING
OTTAWA, ONT. '*' *#'
12-69-MAC-ll-6^ '^11^4
tr
Canadian
Nurse
the bluebirds
who went over
in World War I
c
staff-line conflict
in hospitals
aging and learning
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Use Abbott's Butterfly Infusion Set
in an adult arm?
Certainly. The fact is, today more Abbott
"Butterfly Infusion Sets" are used in adult
arms and hands, etc., than in infant
scalps.
Good reason.
Abbott's Butterfly Infusion Set simplifies
venipuncture in difficult patients. It has
proved fine in squirming infants. But it has
proved equally helpful in restless adults,
and in oldsters with fragile, rolling veins.
And, once in place, the small needle,
ultraflexible tubing, and stabilizing wings
tend to prevent needle movement, and to
avoid vascular damage.
Folding Butterfly Wings
The Butterfly wings are flexible. Like a
butterfly. They fold upward for easy grasp-
ing. They let you manoeuver the needle
with great accuracy, even when the
needle shaft is held flat against the skin.
Then, once the needle is inserted, the
wings spread flat. They conform to the
skin. They provide a stable anchorage for
taping. The needle can be immobilized so
securely and so flat to the skin that there
is little hazard of a fretful patient dis-
lodging or moving it.
Five Peel- Pack Sets
To accommodate patients of various ages,
Abbott supplies Butterfly Infusion Sets in
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INOVEMBER 1%9
435Y
THE CANADIAN NURSE 1
Most people first
heard about Nivea
from their nurse.
Thanks for spreading it around.
Among nurses, Nivea has been a longtime favorite as an aid to personal
skin care and beauty. When it's a question of keeping their skin smooth
and supple, they've found Nivea is the answer.
With its deep, moisturizing penetration, it rapidly replaces natural skin
oils. Prevents dryness. And keeps the hardest-working hands beautifully soft.
Doctors find Nivea useful for a wide variety of indications — skin
infections, burns, radiant heat therapy. For chafing, cleansing, and as a
lubricant. Patients are comforted by Nivea's soothing effect and pediatri-
cians recommend Nivea for keeping babies soft— all over.
But it's the nurses who can really take credit for spreading the word
about Nivea. So if you've had a hand in it, thanks.
I \
SMITH & T^EPHEW LIMITED, zioo, sznd Avenue, Lachine, Que. \SMj
^IViA
The
Canadian
Nurse
^
^^^
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 11
29 On the Delegation of Responsibility
31 The Bluebirds Who Went Over
35 Staff-line Conflict in Hospitals
38 Psoriasis — The Stubborn Malady
41 Aging and Learning
44 The Minis Have It!
46 Two- Year-Old Michael — 111 and in Hospital
50 Quality of Care Makes the Difference
November 1%9
J.L. Nance
C. Hacker
M.B. Delahanty
A. Silverthom
M.D. Angus
E.J.M. Hill
R. Burnie
C.J. Matthews
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
24 New Products
51 Books
54 Accession List
1 1 News
22 Dates
26 In a Capsule
72 Index to Advertisers
Executive Director: Helen K. Mussallem •
Editor: Virginia A. Lindabur>' • Assistant
Editor: Eleanor B. Mitchell • Editorial Assist-
ant: Carol .\. KoUarsky • Circulation Man-
ager: Beryl Darling • Advertising Manager:
Ruth H. Baiunel • Subscription Rates: Can-
ada: One Year, $4.50; two years. $8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Six weeks" notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
® Canadian Nurses' Association 1969.
Manuscript Inlormation: "The Canadian
Nurse" welcomes unsolicited articles. All
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on white paper)
are welcomed with such articles. The editor
is not committed to publish all articles
sent, nor to indicate definite dates of
publication.
Postage paid in cash at third class rate
MONTREAL, P.O. Permit No. 10,001.
50 The Driveway, Ottawa 4, Ontario.
Editorial
NOVEMBER 1%9
This month, the month of
Remembrance, we decided to look into
the past at military nursing. We
asked a free-lance writer to talk to
several nurses who had served overseas
in World War I and write about
their experiences. The accounts
of these nurses make fascinating
reading, filled as they are with pathos,
courage, adventure, and humor.
Some of these nursing sisters, who
were nicknamed "bluebirds" because of
their distinctive blue uniforms, served
in England, Belgium, and France.
There they saw considerable action,
and were in the thick of the battle and
the bombings. Many died from shrapnel
wounds and many were lost at sea.
Others soon found themselves in
remote places, such as Salonika and
the Island of Lcmnos. In Lemnos, they
were faced with more than battle and
bombings: heat, dust, flies, dysentry,
and malaria plagued the soldiers as
well as those caring for them. For the
nurses, Lemnos became, indeed, "the
Crimea of World War I."
Few service personnel escaped the
illness attributed to the unhygienic
conditions. The late Nursing Sister
M.B. Clint, in her book Our Bit.
describes how two sisters succumbed:
"Within a few days of each other,
the Matron and a sister fell victims to
the scourge. As the little cortege of
those well enough to attend followed
the flag-draped coffins . . . with the
Sister's white veil and leather belt laid
on them, across the dusty, brown track,
some of the patients in my ward were
moved to tears. It always seemed a
special tragedy to them that anything
should happen to the sisters. At that
date it was expected that other nurses
would die, and ... the order went
forth that extra graves must be ready
for eventualities. And, in addition to
the fifty [graves] already referred to, a
trench to hold six was dug in the
Officers' lines. A laconic notice-board
bore the legend: "For Sisters only."
But whether or not the hilarity with
which the premature preparation was
received cured our invalids I know not,
but no more deaths occurred in the
Canadian hospitals. Before we left the
area two stone crosses were erected for
the Sisters, and the men decorated the
mounds with designs in white pebbles.
So that there is in that desolate foreign
Island, close by the Greek church, a
comer that is forever Canada."
V.A.L.
THE CANADIAN NURSE 3
letters {
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
In favor of lobbyist
Your article "A Look at ANA's
Legislative Program" in the July issue is
very informative. I am in full agreement
with your opinions concerning a CNA
lobbyist in the federal system.
Nurses are the largest group of health
workers. The thinking of nursing on
health issues as well as some social issues
should be heard in committees and by
individual members of parliament. In
addition, I believe the work of a CNA
lobbyist would help those of us who tend
to be complacent to become involved in
fulfilling our duty as responsible profes-
sional people and citizens of a democra-
cy. - Reg.N., Hamilton.
Bring schools up to date
Is there any excitement remaining in
learning in schools of nursing? Did all
interest stop in public school?
With all the audiovisual aids available
to nurse educators, surely we can put
some life into the classrooms and libraries
to stimulate learning, and, eventually,
problem solving in the clinical areas.
I am attending a five-week summer
course in Learning Materials Methods.
Although it is aimed primarily at teachers
in elementary schools, there is much that
a nursing instructor could adapt for her
students' needs.
For example, suppose the students are
studying the basic needs, and are learning
to meet hygienic needs of the individual.
Several aspects of this would include
anatomy and physiology of the skin,
normal flora of the skin, perhaps anti-
septics that may be applied, and the
many nursing measures that can be em-
ployed to preserve skin's health. To link
all these aspects together, displays
- perhaps made by students working in
groups - could be set up showing the
relationship between different conditions
of the skin and its care.
The displays could include charts and
models of the structure of the skin; slides
showing normal flora; single concept
films on pressure areas and methods of
preventing decubiti; filmstrips, overhead
transparencies, and so on.
My experience in teaching has indicat-
ed that classrooms and libraries are sel-
dom used after hours except when an
assignment or examination is coming up.
Let's make them exciting places to be at
other times too. Let's bring nursing
education up-to-date! — Mrs. L.E.
White, R.N., Scarborough, Ont.
4 THE CANADIAN NURSE
Pen pal wanted
Several months ago, I began reading
The Canadian Nurse in our school of
nursing library. I especially enjoy the
letters.
I hope to visit Canada soon. In the
meantime I would like to correspond
with a young graduate nurse like myself,
with whom I could compare notes on
nursing and life in Canada and the United
States. - Janet S. Jenkins, Route 2, Box
382 A, Portland, Oregon 97231 .
More reaction to Minister's speech
All Canadian nurses who were unable
to participate in the 14th Quadrennial
Congress of the International Council of
Nurses in Montreal last June should be
grateful to The Canadian Nurse for print-
ing in its entirety the address given by the
Honourable John Munro, Minister of
National Health and Welfare. The views
expressed by Mr. Munro are worthy of
study and comment by every person who
is concerned about the health of Cana-
dians and the future role of nursing in our
health care delivery system.
In reaUty, Mr. Munro does not tell us
anything new and startling in his call "to
join in the total restructuring of the
health care delivery system." From one
source or another, in one form or anoth-
er, we have been hearing for some time
about the changes necessary in the prepa-
ration of nurses and in their patterns of
practice if they are to assume a more
important role in the future provision of
care. On the surface, Mr. Munro's speech
would appear to put, once and for all, a
national seal of approval on these propos-
ed reforms, even though all his solutions
would not find general acceptance within
the nursing profession. Nevertheless, the
challenge to Canadian nurses is direct and
unmistakable. Are we ready for the con-
frontation?
More important is whether others are
ready and willing to help us meet the
double challenge of reformation and
economy. For example, when Mr. Munro
suggests that "the nursing profession as a
whole shouldn't be dependent on hospital
work in the same way as an infant
depends upon the umbilical cord," do he
Letters Welcome
Letters to the editor are welcome. Be-
cause of space limitation, writers are
asked to restrict their letters to a
maximum of 350 words.
and others in his orbit support the trans-
fer of the bulk of nursing education from
its traditional link with hospitals into the
framework of general education? What
more immediate way to cut hospital costs
and, at the same time, provide a new
focus — i.e., moving out into a larger
community - for the preparation of
nurses? Mr. Munro is quite correct in
reminding us that all the proposed moves
"cannot be accomplished without the
active participation of nurses," but it is
equally vahd that others should not be
allowed to block the way to success.
Truly, as Mr. Munro puts it, "reform
and reorganization must come," and
having his address for future reference
should assist all Canadian nurses to judge
the rate and degree of our progress.
- (Mr.) Albert W. Wedgery, Reg.N.,
Associate Director, College of Nurses of
Ontario, Toronto.
The Honourable John Munro, in his
address reprinted in the August issue of
Tfie Carwdian Nurse, points clearly to the
need for change in Canadian health serv-
ice. The challenge to reform health serv-
ice delivery without bankrupting the
common treasury can be met by coopera-
tive planning among all groups of health
workers. For an expanded role for nurses
to increase the effectiveness of health
services, the role must fit into the total
picture of services and its usefulness must
be accepted by other health workers.
I believe we are ready to accept an
expanded role. This is not a new concept
in some of its aspects. For example, when
nurses began to take blood pressure
readings and conduct well-baby confer-
ences, our role expanded. Perhaps the
difference in the current proposal is that
the nurse would be accountable for the
patient during an acute phase of illness
with infrequent supervision or with mere-
ly a consultant relationship on the part of
the physician (Mr. Munro's exam-
ple — "follow-up visits on treatment
prescription.")
Mr. Munro said, "the nursing profes-
sion as a whole shouldn't be dependent
on hospital work in the same way as an
infant depends upon the umbilical cord"
and also, "more nurses can be trained in
the specialized field of home care and
home nursing." These two points, I be-
lieve, are related. I assume Mr. Munro is
not making a distinction between public
(Continued on page 6)
NOVEMBER 1%9
#
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Insertion is faster, easier for you; less unnerving for your
patient.
The Curity Foley Catheter's distinctive shape protects the
profile of the lumen for optimum drainage all during patient
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The Curity Foley line includes Retention, Hemostatic and
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When appUcation is necessary, Curity Foley Catheters put
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Whenyourday
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from DOXIDAN.
use
DOXIDAN*
most nurses do
DOXIDAN is an effective laxative for the gentle relief of
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stimulant, evacuation is easy and comfortable.
For detailed Information consult Vademecum
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6 THE CANADIAN NURSE
(Continued from page 4)
health nursing and home nursing. Home
nursing could mean giving private duty
care to one patient in his home. However,
this activity does not require the nurse to
"be trained in the specialized field." Thus
relating the two points above, one obvi-
ous reason for dependence on hospital
work is that the majority of nurses are
not prepared for the public health field.
Mr. Munro suggests that more nurses
should be trained in the specialized field
of home care and home nursing. Might it
not be advisable to prepare all nurses for
public health nursing in their basic educa-
tion? What other profession requires its
members to specialize in order to change
their locale of practice from an institu-
tion to the home and community? To
give professional service, the nurse caring
for the patient in the hospital must be
capable of evaluating the many forces
that affect the ability of each patient and
his family to cope with health problems.
Does the setting make much difference?
Perhaps the question of whether the
"expanded role" is different in kind from
previous additions to nursing practice is
academic. Perhaps a feldsher system,
mentioned by Mr. Munro, is the answer.
But, in any case, I believe our fundamen-
tal responsibility as individual nurses and
as a professional group is to be forthright
in our commitment to provide and direct
the provision of nursing care to all per-
sons who require it. The demonstration
baby bath; feeding of a helpless patient;
helping a family organize its members to
care for an invalid member; bathing and
changing the bed linen of an unconscious
patient; helping a patient talk out his
fears preoperatively, are examples of
nursing care.
These functions are not glamorous;
but they and other unglamorous activities
constitute nursing care. As we expand our
role, we as a profession must retain
responsibility for the provision of nursing
care. - Myrtle Kutschke, Reg.N., Hamil-
ton.
The Minister of Health's speech at the
opening plenary session of the Interna-
tional Congress ot Nurses revealed a
compassionate understanding and con-
cern for our nation's needs. Truths were
said throughout, albeit with political
overtones; yet it was evident his main
concern was not only in the reduction of
the animated dollar sign.
Mr. Munro seemed cognizant of the
social and health problems of our coun-
try, which are precipitated by the dis-
parities in availability of medical and
nursing service. Although there were
many platitudes in his talk, he did not
hesitate to remind the listener that some
selfish motives may underly the present
system of care.
His criticisms, kindly said, and his
solutions to the problems have provided
the nursing profession in Canada with the
biggest challenge any government has
asked of it. One cannot help but feel
honored that we are so highly regarded. It
also stimulates one to do a little soul
searching. Are members of the profession
ready to accept his challenge, or is the
"pew" too comfortable? Is it realistic to
believe that Canadian nurses are concern-
ed about society's needs and the "have
not" places? One has only to be in
charge of a nursing service department in
a hospital and contend with mobility of
staff, reluctance to do shift work, absen-
teeism, and summer resignations to be-
come a little cynical.
Mr. Munro's speech was so nationally
oriented that it may have held little for
the international visitor to the Congress.
It would seem more appropriate for the
Canadian Nurses' Association biennial.
Perhaps he will favor us again, and in a
setting where open discussion can take
place. His ideas are excellent, and his
support is what is needed to do some-
thing concrete about meeting his chal-
lenge. - E. MacLeod, M.S., Director of
Nursing, Prince Edward Island Hospital,
Charlottetown, P.E.I.
I agree wholeheartedly with the Hon-
orable John Munro's statement, "Hospital
dependence and its high expense . . . can
be reduced by moving out into the
community." Not only can the expense
be reduced, but we have demonstrated
many times during the past 10 years that
organized home care programs can give
"the right care at the right time in the
right place." Many patients are ready for
discharge from hospital as far as their
medical needs are concerned and should
be discharged to meet their emotional
needs.
Home care programs have demonstrat-
ed that the community nurse, working
with the physiotherapist, social worker,
speech therapist and homemaker - all
under the direction of the family physi-
cian - can accomplish miracles in keep-
ing patients out of hospital, preventing
readmissions, holding families together,
and helping older couples stay at home
together for the remainder of their marri-
ed lives. To try and estimate the savings
to the taxpayer by these "miracles"
would be impossible.
Necessary funds should be made avail-
able for new home care programs and for
expansion of existing ones. Thorough
investigation should be made of some
barely tapped sources of patients, such as
pediatric patients, short-term surgical pa-
tients, patients having minor surgery on
an outpatient basis, and some postnatal
NOVEMBER 1969
and newborn patients. Patients now in
nursing homes, convalescent homes, and
geriatric centers could eventually be dis-
charged to home care programs, if physio-
therapy were available in the nursing
home. For some, the nursing home could
then become a stopping off place en
route home, rather than the place where
hope dies.
This is clearly illustrated by a pilot
project conducted by the Saskatchewan
Division of the Canadian Arthritis and
Rheumatism Society. The project, "The
Provision of Physiotherapy Services to
Sherbrooke Nursing Home, Saskatoon,
Sask.," showed that many patients in this
nursing home needed physiotherapy but
were unable to pay for either the service
or the necessary transportation; nor did
they have the stamina to make the trip to
an outpatient clinic.
If this service could become a part of
these institutions, it would open up this
great source of patients for the home care
team, and help to reduce health care costs
to the taxpayer. As well, it would allow
many to live their lives within the dignity
of their own homes.
I am delighted that the minister of
health advocates "moving out into the
community." I hope that his vision will
become evident at both federal and pro-
vincial policy levels. - Ruth Crichton,
Co-ordinator, Saskatoon Home Care Pro-
gram.
One of the highlights of the Inter-
national Congress of Nurses was the
address by the Honourable John Munro.
Minister of National Health and Welfare.
His words warmed the hearts of those
nurses who recognize the need for greater
emphasis to be placed on the prevention
of disease and the provision of facilities
for rehabilitation and care of the disabl-
ed.
Many shared his beliefs concerning the
need for nurses to play a larger role in the
health services. Rather than introduce
new members to the team, we believe
there is need to examine the roles of
those presently contributing, to ascertain
if. with adjustments in education and
legislation, the existing members could
not be qualified and licensed to meet the
needs of the people in all parts of Canada.
To the nurses" traditional role could be
added the responsibility for planning and
coordinating health care, teaching pa-
tients and their families in hospitals and
in homes, methods for the prevention of
disease and the avoidance of coinplica-
tions arising out of an illness. Nurses
could be qualified to accept responsibility
for an expanded role in maternal and
child care, and in certain aspects of the
care of acute and long-term illness. To
take such responsibilities, the pattern and
content of nursing education would need
to be reexamined.
NOVEMBER 1%9
For years, nursing leaders have regret-
ted the expenditure of large sums of
money on single discipline schools of
nursing and nurses" residences attached to
hospitals. The barriers to change have, at
times, appeared to be insurmountable.
Now. reform is taking place in some
provinces, but is being delayed in others.
Student nurses should be educated in
multi-disciplinary schools with other
members of the health team, some of
whom should be prepared in universities
and some in diploma schools. They
should live, as other students do, in their
own homes or in residences shared with
students from other disciplines. The cost
of their education should be met on the
same basis as other post-secondary educa-
tion. Many of the existing nurses" resi-
dences should be shared with students in
related disciplines. Some could be con-
verted into long-term illness and rehabili-
tation centers, for which there is a press-
ing need in most communities. The
content of the curricula in schools of
nursing should reflect changes arising
from advances in knowledge and new
patterns for the delivery of health care.
Students in the health professions should
have the opportunity for appropriate
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THE CANADIAN NURSE 7
Next Month
in
The
Canadian
Nurse
• Christmas in the North
• Safe Care for
Mother and Baby
0 Nurses and
Educational Change
^
^^P
Photo credits for
November 1969
Photo Features,
Ottawa, p. 11
University of Alberta,
Edmonton, p. 30
Foothills Hospital,
Calgary, pp. 39, 40
shared educational experiences, including,
for example, some lecture courses, case
studies, and clinical practice.
The challenge placed before us by the
Minister of National Health and Welfare is
clear. We need to reform the system for
the delivery of health care, and to extend
essential services to all Canadians with
due consideration for economy and effi-
cient use of personnel. To achieve the
goal set by the Minister, we will continue
to need strong leadership in our own
profession and the commitment of each
of the health professions to this goal.
Coordinated effort will be needed. We
trust the professions will accept this
challenge and give leadership to construc-
tive measures to improve and expand the
health services, so that the education for
the health professions is attuned to the
times. - Helen M. Carpenter, Director,
University of Toronto School of Nursing.
It seems fitting that the journal pub-
lished the address by the Minister of
Health, the Honourable John Munro, in
its entirety (August 1969).
Health costs and distribufion of health
care are Mr. Munro's concern for the
Canadian people, but also more signifi-
cant is his concern for the different roles
played by the professions in the delivery
of health care. There is no doubt that
nursing could accept a broader role in
health care. However, lines of responsibil-
ity and authority need to be clearly
defined, and it is only by dialogue
between the medical and paramedical
groups that this can be accomplished.
Public health nursing and the philoso-
phy of prevention, education, and home
nursing as expressed by and through the
minister's address is reassuring to nurses
in the public health field. Public health
nursing can now hope for a larger share of
the public health budget. This would be
"a shot in the arm" to raise the ratio of
public health nurses in Canada beyond
the present five percent of the total
registered nurses working in this country.
Let us now hope for some action! —
ApoUine Robichaud, Director, Public
Health Nursing, Fredericton, N.B.
Nursing Outlook wanted
If anyone has the following editions of
Nursing Outlook and would be willing to
donate them for the new diploma nursing
program at Humber College of Applied
Arts and Technology, we would be most
appreciative: 1964 - July and Decem-
ber; 1965 - May and October;
1966 - July; 1967 - March, May, and
August; 1968 - January.
The address of the college is Humber
College Blvd., Rexdale, Ontario. - Mrs.
Marilyn Barras, Director, Department of
Nursing, Humber College of Applied Arts
and Technology.
Identification of staff
I was interested in the letters "Uni-
forms create invisible barriers" and "Caps
and uniforms" (April and May, 1969).
I do not agree that nurses should
discard their uniforms. The uniform of a
nurse is one of the outstanding uniforms
of the nation. It has been through two
wars and the peace between, and is
recognized throughout the world. I be-
Ueve that the nurses themselves should
guard the uniform which only they are
entitled to wear. However, I am happy to
know that nurses are concerned about it.
If the hospitals put nurses in civilian
clothes, the patients are going to wonder
what happened to the nursing profession.
A nurse's uniform assures the patient of
the necessary standards of hospital clean-
liness. I agree with Dr. Black (Letters,
December 1968) that a nurse must wear a
uniform to be a nurse, and 1 feel proper
identification of staff is very important.
In Alberta, the patient often cannot
recognize the graduate nurse now that the
nursing aides are allowed to wear the
traditional white uniform of the graduate
nurse. Knowledge and skill identify a
nurse, but so does a uniform, because she
wears it on duty and is recognized as a
skilled, professionally-equipped person.
Her cap and black band indicate the
experience she has earned. If we have any
pride in our profession we should fight to
keep our nursing uniform, and be aware
that white uniforms and caps belong in
hospitals - not a washable dress of any
color or style, which is a disgrace to the
nursing profession. - Mrs. Minard, R.N.,
Calgary, Alberta.
American journal of Nursing
Would anyone having copies of the
following issues of the American Journal
of Nursing please write to: Mrs. K.
Whatley, Librarian, Lakehead Regional
School of Nursing, P.O. Box 1165, Port
Arthur, Ontario: March, 1961; March,
April, 1962; February, July, October,
1967. D
Your
Blood is
Always
Needed
+
BE A .
BLOOD :
DONOR :
8 THE CANADIAN NURSE
NOVEMBER 1%9
Johnson & Johnson recommends eight departments
where J CLOTH* Hospital Towels have important advantages
-and can reduce expenses
Operating Room. Use J C LOTH *
Hospital Towels as a prep
sponge, vaginal wipe and to catch
overflow of prep materials. Ex-
cellent as surgeon's hand towel
and for drying his forehead. Avail-
able in three colours. Green is
recommended for O.R. use.
Recovery Rooms. Protect your
pillows with a large size (14" x
24") J CLOTH* Hospital Towel.
Use the medium size {12Va" x 19")
as a personal towel for patients,
and the small size (12 1/4" x 12 1/2")
as a patient face cloth.
Out-patients Department.
J CLOTH* Hospital Towels are
very absorbent. Use them to clean
wounds of accident victims, for
minor surgery, as a hand towel
for doctors, as a pillow case pro-
tector and as a cover for carts,
counters and scales.
NOVEMBER 1%9
Obstetrical Department.
J CLOTH* Hospital Towels are
sterilizable which makes them
ideal to receive baby during de-
livery—and as a hand towel for sur-
geons and nurses. Also can be used
as a perineal wipe and prep towel.
They won't fall apart when wet.
Orthopaedic Department. Use
them as a hand towel for sur-
geons and cast room technicians.
They are surprisingly durable and
retain shape after many dryings.
Low unit cost makes them more
economical than rental towels.
Central Supply Room.
J CLOTH* Hospital Towels have
no lint drop out. They won't leave
a trace of lint: ideal for polishing
and wrapping syringes and surg-
ical instruments. Incidentally, the
fact that there are 100 towels per
package ensures portion control.
Isolation Wards. J CLOTH*
Hospital Towels cost so little they
can be thrown away after a single
use. No wonder so many hospitals
are using them in their isolation
wards as a sterile, single-use face
cloth or hand towel. They're far
better than paper.
Nursery. Nurses find J CLOTH*
Hospital Towels very good as a
burp cloth. Other uses: face cloth
for newborn babies, as a mattress
cover for bassinets and for clean-
ing babies' buttocks. They're far
softer than terry cloth or paper.
^oWK3H«*flt>^mirOn
GUITH
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Available in white, blue or green in
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White CI 640 CI 630 CI 620
Blue CI 641 CI 631 CI 621
Green CI 642 >C1632 CI 622
'Trademark of Johnson & Johnson or Affiliated Companies. O J&J 1968
THE CANADIAN NURSE 9
The changing face
of modern
nursing...
Meet its challenge
with these outstanding
Mosby texts
New 6th Edition!
Jensen's HISTORY AND TRENDS OF PROFESSIONAL NURSING
The most popular text in "History of Nursing" courses takes a
contemporary view of the significant past and today's exciting
changes in this dynamic new edition. It features an expanded section
on Canadian nursing; reports on the International Nursing Index, the
fight for economic security, and the nurse clinician.
By GERALD JOSEPH GRIFFIN, B.S., M.A., R.N.; and JOANNE KING
GRIFFIN, B.S., M.A., R.N. With a special unit on legal aspects by ELWVN L.
CADY, Jr., J.D., B.S.Med., and a special unit on Nursing in Canada by MARY B.
MILLMAN, B.A., R.N. Publication date: April, 1969. 6th edition, 353 pages,
T'x 10", illustrated. $7.85.
New 6th Edition!
PRINCIPLES OF MICROBIOLOGY
The most widely used text in its field lets beginning students apply
microbiologic principles to actual situations. It explores the relation
of DNA and RNA to the cell; new culturing techniques; and aspects of
cell morphology and physiology. An all-new chart shows incubation
periods of important infectious diseases.
By ALICE LORRAINE SMITH, A.B., M.D., F.C.A.P., F.A.C.P. Publication
date: June, 1969. 6th edition, 681 pages, 7"x 10", 223 illustrations. $9.75.
New 2nd Edition!
MICROBIOLOGY LABORATORY MANUAL AND WORKBOOK
This totally revised new edition involves students more directly with
the 29 timely exercises. They determine their own blood type; isolate
dermatopliytes from their own feet: see for themselves, cells engaged
in phagocytosis. Up-dated bibliography ; perforated, punched pages. .'
By ALICE LORRAINE SMITH, A.B., M.D., F.C.A.P., F.A.C.P. Publication '
date: June, 1969. 2nd edition, 176 pages, 7V4"x 10V2".$3.95.
New. . . for instructors in two-year associate degree nursing programs
ASSOCIATE DEGREE NURSING A Guide to Program and Curriculum Development
!V»
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A blueprint for construction and operation of the two-year asso-
ciate degree program, this unique new book explores possible ed-
ucational innovations, such as team teaching and the concept of
"patient-side" rather than "bedside" nursing. It spells out the
core curriculum, course outlines and day-by-day projection for:
Fundamentals of Nursing; Parent and Child Health, Physical and
Mental Illness, and Mental Health and Mental Illness.
By ANN N. ZEITZ,
R.N., M.A.; lEllA D.
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219 pp., 6 1/2" X 9 1/2".
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news
CNA Special Committee
Will Report To Board
Ottawa. - The report of the special
ad hoc committee on functions, relation-
ships and fee structures will be presented
to the board of directors of the Canadian
Nurses' Association when it meets in
Ottawa November 4, 6 and 7, 1969.
Committee chairman Jeanie S. Tronnings-
dal will attend the meeting to give the
report and to answer questions from the
board.
The committee held its last meeting
September 25 to 27 in Ottawa. Mrs.
Tronningsdal said then that committee
members felt they had not had as much
time as they would have wished to
prepare the report. However, she said, the
committee decided it must have its report
available for distribution to the board in
November to give provincial nurses" asso-
ciations the required six months to study
the report before CNA's biennial meeting
in June 1970.
The committee was set up at the 1968
biennial meeting in Saskatoon to investi-
gate the questions of fees and the divi-
sions of labor and responsibilities be-
tween the provincial and national associa-
tions. Members of the committee include:
Mrs. Tronningsdal, Calgary; Madge McKil-
lop. Saskatoon; Marie Sewell, Toronto;
Madeleine Jalbert, Quebec; Marilyn
Brewer, Fredericton; Dorothy Wiswall,
Halifax; Sister Mary Irene, Charlotte-
town; Janet Story, St. John's.
Health Care Fragmented
Labor Leader Tells Assembly
Ottawa. - The present system of the
delivery of health care services is highly
fragmented, a professional trade unionist
told 200 delegates attending the first
National Health Manpower conference in
Ottawa October 4-7.
Speaking as a panel member at the
opening session of the conference, Andy
Andras, director of legislation, Canadian
Labour Congress, said that a comprehen-
sive system of health care is needed now,
but is not being provided and is not likely
to be provided with the present system of
organization. Mr. Andras questioned the
quality of health care now being provid-
ed, and pointed out that not all persons
in Canada are getting the care they
require.
"Territorial justice is needed," he said.
"By this 1 mean that all people - wheth-
er they live in British Columbia or New-
foundland, in the north or south, should
have access to medical services. "
NOVEMBER 1%9
Panelists Discuss Education For Health Workers
Lois Graham-Cumming, director of research and advisory services tor the Canadian
Nurses" Asociation, was one of four panelists who discussed "Health Manpower
Education - The Challenge to Educational Institutions'" at the National Health
Manpower Conference held in Ottawa October 7-10. Other panel members were:
Professor L.-P. Bonneau, vice-rector, Laval University, Que., chairman of the
session; Dr. H.M. Scott, assistant professor of medicine, McGill University; Dr. J.R.
Evans, dean of medicine, McMaster University, Hamilton; and Dr. J. Brunet,
professor, Laval University.
Mr. Andras said that in any develop-
ment of manpower, professional self-
interest that would create obstacles to
manpower supply must be avoided. He
warned the assembly against a too conser-
vative approach to the planning of health
services delivery for the future. "Most
people are prepared to pay for health
services through collective action," he
said, "but the costs must be borne equita-
bly.
Other panelists at the opening session
were: Bernard Blishen, dean of graduate
studies, Trent University, Peterborough,
Ont.; Charles E. Hendry, consultant, re-
search and planning. Department of
Social and Family Services for Ontario;
Dr. John Maloney, honorary treasurer,
Canadian Medical Association: and Mrs.
Beryl Plumptre, president, Vanier Institu-
te of the Family. Dr. Jacques Gelinas,
deputy minister of health for the Provin-
ce of Quebec, chaired the session.
The four-day National Health Confer-
ence was sponsored jointly by the De-
partment of National Health and Welfare
and the Association of Universities and
Colleges of Canada. Its objectives were to
secure agreement on guidelines for plan-
ning the delivery of total health services
during the next decade, determining the
numbers and quality of the health man-
power required for these services, and
planning the education of the required
health manpower. Persons attending the
conference and participating in its ses-
sions represented consumer groups, gov-
ernment planners, professional associa-
tions, universities and colleges.
Plans Underway
For CNA Convention
Ottawa. - Between 850 and 1,000
nurses from across Canada are expected
THE CANADIAN NURSE 11
STOP
BRUSHING/RESTERILIZING
MAINTENANCE/SKIN IRRITATION
r
y
12 THE CANADIAN NURSE
news
to attend the 35th biennial convention of
the Canadian Nurses' Association in Fred-
ericton, New Brunswick, June 15 to 19,
1970. And the host association, the New
Brunswick Association of Registered
Nurses, promises visitors warm hospitali-
ty, including plenty of accommodations.
Hotel space in Fredericton is limited,
but ample accommodations have been
arranged at the residences of the Universi-
ty of New Brunswick, according to CNA
business manager Ernest Van Raalte, who
attended planning sessions with NBARN
in Fredericton in September. Those
staying in the residences will have the
advantage of a pleasant parkland setting
minutes from the center of town, he said.
Specially scheduled public transportation
will be available morning, noon, and night
between residences and the Playhouse
theatre, with cafeteria facilities close by.
All main sessions of the convention
will be held at the Playhouse. Space for
clinical and special interest sessions will
be provided in the university's auditori-
um.
The chairman of NBARN's biennial
planning committee is Catherine Bannis-
ter; vice-chairman is Diane Flower.
CNS Works With DBS
To Publish Statistics
Ottawa. - A request for statistics on
nurses' salaries first made by the Cana-
dian Nurses' Association in 1967 to the
Dominion Bureau of Statistics has result-
ed in a recently published DBS survey for
1968, Annual Salaries of Hospital Nursing
Personnel.
This 47-page survey is an extension of
a study DBS conducted in February
1967. As stated in CNA's Countdown
1968, information on salaries of
full-time graduate nurses employed in the
public general and allied special hospitals
in Canada was collected and tabulated by
DBS in 1967, at CNA's request and with
the support of the Canadian Hospital
Association .
At CNA's suggestion, the 1968 DBS
survey was extended to include mental
hospitals and TB sanatoria. In addition,
the salaries of qualified nursing assistants
in these institutions, as well as in the
public general hospitals, were included.
CNA worked jointly with DBS to
design the questionnaire used in the 1968
survey, and to provide the definitions of
terminology. Beginning in October 1970,
DBS, at the request of CNA and the
Canadian Public Health Association, will
start a salary study of public health
nurses in official agencies. It is hoped that
this study will be expanded in 1971 to
include public health nurses in non-
official agencies in Canada.
NOVEMBER 1%9
Nurse Included
In Canadian Delegation
To WHO Assembly
Ottawa. - The Canadian delegation
to the Annual Assembly of the World
Health Organization this year included a
nurse member. Vema Huffman, principal
nursing officer, Department of National
Health and Welfare, was among a number
of public health leaders in the country
designated by the federal government to
represent Canada.
"The significance of the inclusion of
nursing officers in official delegations to
the assembly is recognition that nursing
has a place with other health personnel in
planning for the health of the world,"
Miss Huffman said in an interview with
The Canadian Nurse.
The 22nd World Health Assembly was
held in Boston in July at the invitation of
the United States' goverrunent on the
occasion of the 1 00th anniversary of the
Massachusetts Department of Public
Health. It was the fifth time an assembly
had been held outside WHO Headquarters
in Geneva, Switzerland.
The 1 3 1 delegations from WHO mem-
ber states included about 1 ,000 represent-
atives. Nurses from two countries were
official delegates: Miss E.M. Githae, the
chief nursing officer for Kenya, and Miss
Huffman.
Also attending the assembly, as observ-
ers, were representatives of non-govern-
mental organizations: Dr. Irene S. Palmer,
School of Nursing, Boston University,
represented the International Council of
Nurses; and Miss Anny Pfirter represented
the International Committee of the Red
Cross.
Plenary sessions, committee sessions,
and technical discussions were conducted
during the assembly. The technical discus-
sions provided an opportunity for dele-
gates and observers to speak as experts in
their respective fields rather than as re-
presentatives of member countries.
The theme of the technical discussions
was The Application of Evolving Technol-
ogy to Meet the Health Needs of People
and dealt with health manpower and the
changing roles; education and training to
meet the changing roles; and the adminis-
tration and organization of health service.
Other topics discussed during the assem-
bly were: 1. the use and effects of drugs;
2. population planning; and 3. ways to
reduce dental caries.
A debate was held concerning malaria
eradication. The assembly reaffirmed its
objective of global control, modifying its
approach to a regional rather than a
country basis. It was also recommended
that efforts be made to find a substitute
for DDT that has less residual effects.
Several delegates reported action to ban
its use in their countries.
(Continued on page 15)
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THE CANADIAN NURSE 13
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news
(Continued from page 13)
AARN Holds District Rallies
To Study Bill 119
Edmonton, Alta. - The Alberta
Association of Registered Nurses is hold-
ing rallies throughout the province so its
members can study in detail Bill 119, a
Bill tabled by the Alberta government
during its last session to set up a council
of nursing in the province.
Bill 1 19, designed to bring the control
of licensing, education, and discipline for
all types of nurses, nursing aides, and
orderlies under a provincial council, has
met stiff opposition from almost all
registered nurses in the province. The
main complaint of the nurses is that the
autonomy of the profession would be
reduced considerably if the Bill were
passed by the legislature, and that major
decisions would be made primarily by
persons outside the profession who are
unqualified to make such decisions.
Under the proposed Bill, only four of
the 16-member council would be register-
ed nurses; three of these RNs would be
appointed by AARN, and one, by The
University of Alberta's faculty of nursing.
Non-nurse members of the council would
include: four political appointees; one
person appointed by the Psychiatric
Nurses' Association of Alberta; one mem-
ber representing mental deficiency nurses;
an appointee of the Alberta Association
of Nursing Orderlies; an appointee of the
Alberta Certified Nursing Aide Associa-
tion; a member appointed by the College
of Physicians and Surgeons of the provin-
ce; two members appointed by the Alber-
ta Hospital Association; and one member
appointed by the Catholic Hospital Con-
ference of Alberta.
In an open letter to the former minis-
ter of health, J.D. Ross, the president of
the Lethbridge Chapter of AARN, L.
Laqua, objected strenuously to the struc-
ture of the proposed council. In particu-
lar, she expressed concern that four of
the 16 council members would be politic-
al appointees. "This is gross political
interference in a professional body," she
wrote, "unknown in a democratic socie-
ty." Miss Laqua pointed out that three
members of the council would be em-
ployers of nurses. "A fine setup where
employers licence their employees," she
commented. "An irritable thorn in their
side, from some crusading nurse, could
easily be removed at the stroke of a pen."
Bill 119 also calls for a nursing educa-
tion committee to be formed from the
16-member council. Nurse educators who
were not on the committee would be
excluded from acting on it.
Under the Registered Nurses' Act of
1966, the AARN is authorized to decide
NOVEMBER 1%9
who is eligible to become a registered
nurse in the province, and to discipline
nurses. Nursing education in the province
is the responsibility of the Nursing Educa-
tion Committee of the Universities Coor-
dinating Council - a responsibility given
to the University of Alberta by AARN.
In a telephone interview with The
Canadian Nurse, M. Geneva Purcell, presi-
dent of AARN, said that rallies have been
held across the province to interpret the
Bill and to get members' reactions. She
explained that AARN did not object to
the setting up of a council per se, but
believed that the council proposed by the
government would have far too much
control over the nursing profession.
AARN has set up a task committee to
prepare a composite report of the res-
ponses from its members concerning Bill
119. A brief from the association will be
sent to the Alberta governement.
Arbitration Award Angers
Ottawa Civic Nurses
Ottawa. - The Ottawa Civic Hospital
Nurses' Association signed a one-year
contract in October with the hospital,
following months of negotiations that
had ended in deadlock before an arbitra-
tion board was appointed.
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THE CANADIAN NURSE 15
news
Mary Lou Annable, head of the
510-member association — one of the
largest in the province - told The Cana-
dian Nurse that this arbitration award
contains more unmet demands than any
other nurses' settlement in the province.
The arbitration board's report, which
was not signed by the association's
nominee on the board, gives the hospital's
graduate nurses and nursing instructors a
6.7 percent salary increase. Head nurses
and supervisors are excluded from the
association. Under the new salary scale
at the Ottawa Civic, a general staff nurse
registered in Ontario earns a minimum of
$475 per month, with a maximum of
$575. In the last contract the starting
salary for a registered nurse was $445 per
month.
The nurses' association originally ask-
ed for $525, but agreed to settle for
$500. However, the hospital refused to
offer more than $470 per month, the
amount recommended by the Ontario
Hospital Services Commission. Efforts by
a conciliation officer failed, and an arbi-
tration board was then appointed.
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16 THE CANADIAN NURSE
"The patient will suffer in the end,"
Miss Annable said. This past summer at
the hospital was the worst ever because of
a serious shortage of nurses, she explain-
ed. Nurses at other Ottawa hospitals were
earning $470 per month, compared with
$445 at the Civic.
Looking ahead to next year. Miss
Annable said that the OHSC is calling for
an eight percent salary increase, or $510.
"Guelph nurses are already receiving
$525 this year," she said.
Other nurses' demands not granted by
the arbitration decision included: an
eight-hour work day - nurses will con-
tinue to work an eight and one-half-hour
day, which includes a half-hour lunch
break; uniform allowance; one and one-
half days sick leave per month - one
and one quarter days remains unchanged;
and time and one-half for working on a
statutory holiday when regularly schedul-
ed to do so.
One issue that the nurses particularly
could not understand, Miss Annable said,
concerned annual vacations. The hospital
asked that the vacation period remain the
same, she said, but the arbitration award
took one of the four weeks away from
nurse technicians - nurses who work on
a blood team, administering intravenous
infusions and giving intravenous medica-
tions and drugs - and refused to grant
staff nurses the four weeks vacation
requested.
In his dissenting brief to the arbitra-
tion board, the nurses' representative,
D.F.O. Hersey, said, "In the very impor-
tant monetary area of the dispute, the
majority ignored a 12.5 percent wage
increase . . .granted to other employees at
the Ottawa Civic Hospital, and have
adopted the Ontario Hospital Services
Commission rate, plus $5 . . . .
"It is only for nurses that the OHSC
pubhshes specific rates," he said. "The
other hospital occupations are apparently
controlled by general permissable per-
centage increases or operating budgets."
The arbitration board did not give
reasons for its refusal to meet the individ-
ual demands of the nurses' association.
According to arbitration board chairman
J.H. Brown, Q.C., and the hospital repre-
sentative, A.J. Clark, "Our award repre-
sents the balancing of many factors all in
the context of the entire collective agree-
ment."
The Registered Nurses' Association of
Ontario helped the nurses' association
throughout its contract negotiations. The
RNAO supplied data on other Ontario
hospitals that the association presented to
the arbitration board.
The contract is retroactive to January
I, 1969, and extends to December 31,
1969.
NBARN Awards Scholarships
Fredericton, N.B. - A total of
(Continued on page 1 9)
NOVEMBER 1%9
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THE CANADIAN NURSE 17
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18 THE CANADIAN NURSE NOVEMBER 1%9
news
(Continued from page 16)
S2,000 in scholarships has been awarded
by the New Brunswick Association of
Registered Nurses to four nursing stu-
dents undertaking university study lead-
ing to a baccalaureate degree in nursing.
Recipients of the annual NBARN
Scholarship are Marielle Bosse of St.
Jacques, and Mary Jane Scott, Bathurst.
The annual Muriel Archibald Scholarship
was awarded to Arleen Brawley, RN of
Saint John and Mary McSheffrey, RN,
Oromocto. The awards are for S500 each.
Miss Bosse is a student in the basic
nursing program at the University of
Moncton, and Miss Scott is enrolled in
the basic program at the University of
New Brunswick School of Nursing, Frede-
ricton. Miss Brawley and Miss McShef-
frey, both registered nurses, are undertak-
ing university study leading to a degree in
nursing. Miss Brawley is enrolled at the
University of Ottawa, and Miss McShef-
frey is attending the University of New
Brunswick.
RNABC Urges
Protection For Nurses
Vancouver, B.C. - The Registered
Nurses' Association of British Columbia
will ask the British Columbia Hospitals'
Association to review hospital policies
and procedures relating to the safety of
night workers in hospitals. The RNABC
has also offered to make S 1 ,000 available
for research to study the problem of
safety.
This action was prompted by the
recent fatal stabbing of a nurse from St.
Paul's hospital, as she returned home
from work after midnight.
Immediately after this tragedy, St.
Paul's established a continuous inservice
program on self-protection for all person-
nel, and has increased parking facilities
for the afternoon staff.
"Many public spirited citizens have
volunteered transportation," said Mrs. A.
Murray, director of nursing service at St.
Paul's hospital. "All have been carefully
screened and a transportation system has
been established under the direction of an
administrative assistant."
The RNABC has commended St.
Paul's Hospital for its prompt action and
has offered whatever services it can to the
hospital in finding solutions to the pro-
blem.
The association will urge the British
Columbia Hospital Insurance Service to
provide funds to educate hospital workers
in self-protection, especially when com-
muting to and from work. A letter has
been sent to the mayor and council of the
NOVEMBER 1969
City of Vancouver expressing RNABC's
concern about the inadequate police pro-
tection and lighting, particularly in the
west end of the city.
A covering letter with copies of these
expressions of concern will be sent to
Premier W.A.C. Bennett, Health Minister
Ralph Loffmark, and Attorney-General
Leslie Peterson, indicating the associa-
tion's view that the suggestions made are
palliative measures only.
The Labour Standards in Canada cites
two provinces, Ontario and Manitoba,
with laws that require an employer to
provide free transportation for all female
employees whose shift begins or ends
between midnight and 6:00 a.m. Laws in
Alberta, Saskatchewan, and Quebec ex-
clude nurses from this provision. In the
other provinces, no law governs night
work for women.
Following the release of information
from the RNABC, The Canadian Nurse
conducted a telephone survey of several
hospitals in major centers across Canada
to determine what provision they make
for the safety of nurses changing shift at
night. The results of that survey will be
reported in an article in a future issue of
Ttie Canadian Nurse.
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THE CANADIAN NURSE 19
Two Nurses' Associations
Certified To Bargain
In Nova Scotia
Halifax, N.S. - Two nurses' associa-
tions have been certified to bargain for 55
nurses in Nova Scotia. The staff nurses'
association of the Highland View Hospital
in Amherst, Nova Scotia became the
Labour Board of Nova Scotia. On Sep-
tember 1 6, the staff nurses' association of
the Sutherland-Harris Memorial Hospital
became the certified bargaining agent for
17 nurses. All nurses except the evening
and night supervisor were included.
Margaret Bentley, employment rela-
tions officer for the Registered Nurses'
Association of Nova Scotia, said the
Highland View certification was an im-
portant step for the RNANS. "Our own
Act did not permit us to be certified as an
association because we have all types of
members, so we had to decide whether to
amend our Act or try for certification
under The Trade Union Act," she ex-
plained.
Mrs. Bentley said that after much
thought and discussion they chose the
Trade Union Act. "We state our aims and
objectives in our staff association cons-
titutions and in this way we feel we are
not lowering our professional standing in
any way," she said.
Hospitals in Nova Scotia submit budg-
ets to the Hospital Insurance Commis-
sion, which recommends a salary guide.
Mrs. Bentley explained that most hospi-
tals pay the basic recommendation of
$425., although they do not always pay
increases.
On September 16, the staff nurses'
association of Highland View Hospital
began negotiating its first contract.
NBARN Holds Meeting
To Vote On Fee Increase
Fredehcton, N.B. - A special general
meeting of the New Brunswick Associa-
tion of Registered Nurses has been called
for November 20, 1969 in Fredericton.
The purpose of the meeting is to vote on
a fee increase from $30 annually to $40
annually, effective January 1, 1970.
The special meeting was called in
response to a resolution presented at the
association's annual meeting in May. The
resolution stated that all NBARN services
presently offered to the members and the
community are essential and that it
would be beneficial to both groups if
services were enlarged. Since the associa-
tion's income is not sufficient to support
all essential services, it was resolved to
call a special meeting to consider a fee
increase.
20 THE CANADIAN NURSE
NBARN's proposed budget for 1969 is
a deficit budget.
RNAO Survey Shows
Disparity In Salaries
Toronto. - A marked diversity in the
salaries and working conditions of occu-
pational health nurses was shown in a
recent Toronto area survey conducted by
the Registered Nurses' Association of
Ontario.
Of 35 occupational health nurses re-
ceiving questionnaires, 23 replied. Salaries
ranged from $5,100 to $8,100 a year, but
the four nurses whose years of service
with their present employer varied from
15 to 23 included one who had a salary
of only $5,400. This was $900 a year less
than the highest among those with less
than three years service and $204 less
than average among those with less than
three years service.
Also, the lowest paid nurse with three
to six years of service received $1,144
more than the lowest paid nurse with six
to nine years service, and the average
salary of those with three to six years
service was $1,183 more than the average
of those with from six to nine years
service.
Shortest service reported was six
months and the longest 23 years, with the
average being 7.7 years. The average
salary for all was $6,404.61. The number
of paid holidays varied from 8 to 11.
Employer contribution to medical,
surgicd, and hospital insurance plans vari-
ed from 33 percent to 100 percent. All
nurses replied that they had some provi-
sion for income protection during illness.
Most employers provided uniforms
and/or laundering of uniforms. Fourteen
nurses received two weeks holidays after
a year and nine received three weeks.
Hours of work varied from 35 to 40.
UNM Elects
New Officers
Montreal, P.Q. - The United Nurses
of Montreal elected Gloria A. Blaker as
president of the association at the annual
meeting in September. Mrs. Blaker, who
is fully bilingual, won over four other
candidates for the office. A recent deci-
sion of the association established the
presidency as a full-time, paid position.
In presenting her views to members of
UNM, Mrs. Blaker cited three areas of
concern: communications, money, and
professional and working programs. Call-
ing for a greater public understanding of
the changing role of the nurse, she stated,
"The role of nurses . . . must be defined
to include the right and the responsibility
of determining our own future in a
changing society."
The UNM, which represents over
3,000 nurses in Montreal hospitals, agen-
cies, and companies, has been negotiating
a new contract with the Association of
Hospitals of the Province of Quebec since
April 1968.
Other officers elected by the United
Nurses of Montreal are: Sandra Taylor,
second vice-president; Anne Raudsepp,
treasurer; and Barbara Richards, Loraine
Brazeau and Marjorie Iwamoto as direc-
tors of the executive board.
Elected from the associate members
were: C. Robertson, first vice-chairman;
K. Grant, secretary; and A. Mountjoy, F.
Vincent, and E J. Pearson, as members of
the board of directors.
Contracts Signed By
Saskatchewan Nurses
Regina, Sask. - Since the conclusion
of collective bargaining agreements be-
tween the Saskatchewan Registered
Nurses' Association and the Saskatche-
wan Hospital Association committees on
May 5, 1969, 14 hospitals have signed
contracts of employment with their staff
nurses' associations. Most of the remain-
ing hospitals have applied the terms of
the SRNA-SHA agreement as personnel
policies.
The collective bargaining carried out
under voluntary recognition sets out sa-
laries and working conditions for head
nurses, instructors, assistant head nurses,
and general staff nurses.
The Saskatchewan Hospital Services
Plan has agreed to honor the terms of the
SRNA-SHA agreement, except for the
four weeks' vacation demand. SHSP rec-
ognizes only three weeks' vacation.
The two-year term of the contracts
provides salary increases in stages. As of
September 1, 1970, the starting salary for
the beginning nurse will be $500.; for the
nurse with one year or more of experi-
ence, S550.
Student Enrollment Increases
In Nova Scotia
Halifax, N.S. - Information received
from the Registered Nurses' Association
of Nova Scotia shows that enrollment in
schools of nursing in the province has
increased considerably this year.
In September, 500 students entered
the six diploma schools of nursing and
the three degree-granting institutions.
This is an increase of 210 over last year.
The diploma schools of nursing in the
province are at: Victoria General Hospital
and Halifax Infirmary, Halifax; Sydney
City Hospital, Sydney; Yarmouth Region-
al Hospital, Yarmouth; Aberdeen Hospi-
tal, New Glasgow; and Saint Martha's
Hospital, Antigonish. Universities offering
degree programs in nursing are: Dalhousie
University, Halifax; Mount Saint Vincent
University, Halifax; and Saint Francis
Xavier University in Antigonish.
NOVEMBER 1%9
Ryerson Institute Offers
Short Courses For RNs
Toronto, Ont. - The nursing depart-
ment of Ryerson Polytechnical Institute
is now offering short courses for the
registered nurse who wishes to improve
her knowledge and skills in psychiatric
nursing, pediatric nursing, or adult inten-
sive care nursing.
Each of the courses offers a balance of
supervised clinical practice, nursing
classes, and classes in the related sciences
and humanities, taught by experts in their
area. At present the courses are all ap-
proximately 15 weeks (one semester) in
length, although the psychiatric nursing
program will be expanding to two semes-
ters, probably in September 1970.
Both the psychiatric and pediatric
nursing courses are now in progress.
Applications are now being received for
the adult intensive care nursing course,
which will commence in January 1970.
Applications for the pediatric and
psychiatric nursing courses in September
1970 will be accepted for processing after
January 1st, 1970.
Application forms and information for
these advanced courses are available from
the registrar, Ryerson Polytechnical Insti-
tute, 50 Gould Street, Toronto 2b, Onta-
rio.
RNABC Announces Awards
Vancouver. B.C. - The Registered
Nurses' Association of British Columbia
has made S6.000 available this year in
bursary-loans for nursing education.
A bursary-loan of S2,000 has been
awarded to Mrs. Ada Butler of Vancouver
for master's study at the University of
British Columbia. She is a graduate of
The Vancouver General Hospital's School
of Nursing and obtained her bachelor of
nursing degree at UBC.
Other recipients are Beverly O'Brien
for baccalaureate studies toward a degree
in science in nursing at UBC; Jennifer
Stone, Mrs. Gayle Colonel, Mrs. Hilda
Van Bergen, Mrs. Kathleen Lawley, and
Gladys Anne Zitko, all diploma program
students at UBC.
Carol Horton and Doris Ann Varco,
basic nursing program students at UBC,
have been awarded bursaries from the
Margaret Sinn Fund, which is administer-
ed by RNABC.
New Roles
For Social Workers
Ottawa. - Writing in Canadian Wel-
fare, Brian Wharf, associate professor,
McMaster University School of Social
Work, said that social workers should be
trained as advocates and reformers. He
pointed out that the former roles of case
worker, group worker, and community
organization specialist are not enough to
help people.
NOVEMBER 1%9
"Many students and professionals are
becoming more and more disenchanted
with the old idea of helping people to
adjust to their environment," Dr. Wharf
said, "and they are demanding that atten-
tion be given to changing the environ-
ment."
Professor Wharfs proposals for case
workers and group workers are that, with
their skills of diagnosis, interviewing
techniques, and knowledge of community
resources, they are ideally suited to iden-
tify needs in an area and therefore help in
the development of new services.
Case workers should be advocates,
because advocacy seeks to ensure that the
existing system treats clients fairly, he
believes. He supports the adoption of
advocacy as a principle of practice to
encourage the position of social worker as
an ally of the people. "There is no doubt
that we need radicals in residence who
don't mind and even relish throwing the
spotlight on gaps in service, on rigid rules
and practices, on inadequate allowances
and housing, and on comfortable profes-
sionals."
Dr. Wharf said social workers have a
unique contribution to make because
they are the only profession that reflects
a total concern for all aspects of people in
their social role. □
RX
WONDER
TECH
$18
Sijggested Retail Prices
At last/ perspiratbn
damage meets its match.
Naturalizer now brings you duty shoes of
genuine Servotan* leather, specially treated
to resist drying, cracking and discoloration
from perspiration.
With Servotan, Naturalizers stay softer, more
comfortable and are so easy to clean with
soap and water.
Naturalizers also have the famous Wonder-
sole (See illustration at right).
Wondersole is contoured to
match the shape of your foot.
Your body weight is distrib-
uted evenly along its entire
length for complete support.
WITH SERVOTAN AND WONDERSOLE*
ksof
emarks o
*Trad
BROWN SHOE COMPANY OF CANADA LTD.
Naturalizer Division, Perth, Ontario
THE CANADIAN NURSE 21
Pll!;[t QUMin PRODUtIS
POSEY SIT-'N SAFETY BELT
(Patent Pending)
Holds patient upright on commode, straight-
back, or wheelchair; prevents slumping for
word. Secures patient to commode with
safety, privacy and without nurse's constant
supervision. Shoulder straps may be used in
the front, straight over the shoulders or
criss-crossed. Adjusts to fit virtually all pa-
tients. Cat. No. 4220. $14.85 each.
POSEY VELCRO WHEEL CHAIR
SAFETY STRAP
Keeps patient from falling out of his wheel
chair. Fits virtually any size patient. Self-
odhering surface provides easy, quick ad-
justment. Easily attached; strap remains at-
tached to choir when not being used; for
added safety, if desired, choir may be equip-
ped with one strap ocross woist and one
across lap. Mode of 2- inch wide Velcro
covered, webbing. Mo. 4188 (2-piece), $6-30
each.
WRIST OR ANKLE RESTRAINT
A friendly restraint ovoiloble in infant, small,
medium and large sizes. Also widely used for
holding extremity during intravenous injection
No. P-450, $6.00 per pair, $12.00 per set. With
DECUBITUS padding. No. P-450A, $7.00 per
pair, $14.00 per set.
POSEY PRODUCTS
Stocked in Canada
ENNS & GILMORE LIMITED
1033 Rangeview Road
Port Credit, Ontario, Canada
November 17-21, 1%9
World Mental Health Assembly, spon-
sored by the World Federation for Mental
Health and the National Association for
Mental Health, Washington, D.C. Theme:
Mental Health In The Community. Write
to: Dr. Paul V. Lemkau, Chairman, World
Mental Health Assembly, 615 N. Wolfe
St., Baltimore, Md. 21205, USA.
November 19, 1969
Symposium of Operating Room Study
Group of Manitoba in conjunction with
the Manitoba Health Conference. Fort
Garry Hotel, Winnipeg, Man. Contact:
Mrs. Diane Aboud, Corresponding Secre-
tary, St. Boniface General Hospital, St.
Boniface, Manitoba.
November 19-21, 1969
2nd Manitoba Health conference, Fort
Garry Hotel, Winnipeg, Manitoba. The
theme of special sessions for November
20, planned by the Manitoba Association
of Registered Nurses, is Community
Health — Planning for Progress. Another
special session topic will be Providing
Continuity of Care — The Home Care
Program: Community Or Hospital Based.
For more information write: The Manito-
ba Association of Registered Nurses, 647
Broadway, Winnipeg 1, Manitoba.
November 24-27, 1969
Conference for directors of nursing, To-
ronto. Sponsored by Ontario Hospital
Association and Registered Nurses' Asso-
ciation of Ontario.
November 24-28, 1969
Nurse educators' course on disaster nurs-
ing, Canadian Emergency Measures
College, Arnprior, Ontario. Nurse educa-
tors from English-speaking schools of
nursing are encouraged to enroll. Prefer-
ence will be given to representatives from
schools of nursing that have not incorpo-
rated disaster nursing in their student
nurse curriculum. For further informa-
tion write to the director of emergency
health services in your provincial depart-
ment of health.
November 25-28, 1969
Annual Convention, Alberta Hospital As-
sociation, Calgary, Alberta.
November 26-28, 1969
Fourth annual convention of the Cana-
dian Society of Inhalation Therapy Tech-
nicians, Calgary. For information write:
Mr. E. Zaiss, Convention Chairman,
Rockyview Hospital, Calgary, Alta. D
moving?
married?
wish an adjustment?
All correspondence to THE CA-
NADIAN NURSE should be ac-
companied by your most recent
address label or imprint (Attach
in space provided.)
Are you
n Receiving duplicate copies?
□ Actively registered with more
than one provincial nurses'
association?
Permanent reg, no.
Provincial association
Permanent reg. no. Provincial association
Transferring registration from
one provincial nurses' asso-
ciation to another?
From:
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To:
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Other adjustment requested:
/ ^
ATTACH CURRENT LABEL
or IMPRINT HERE to be
assured of accurate,
fast service
\ f
Print New Name and or
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Please allow six weeks for
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The Canadian Nurse cannot
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Address all inquiries to:
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Circulat.on Dept . 50 Ife Diiveway, Ottawa 4, Ca
&
22 THE CANADIAN NURSE
NOVEMBER 1%9
Indispensable References
Munchausen's syndrome?
Heavy chain disease?
Shope papilloma?
Fairbank's disease?
Burkitfs lymphoma?
Branched chain ketoaciduria?
If you were reading a current journal and came across one of these names,
where would you look it up? The new Joblonski dictionary is the answer. With
this remarkable new reference you can quickly find information on nearly
10,000 eponyms and synonyms that designate 2500 syndromes and diseases.
You will find not just a definition, but a concise description including such items
OS signs and symptoms, etiology, pathology, metabolic and genetic factors, and
age, sex, and geographical distributions. In addition, you'll find a list of other
names for the same entity and references to the initial description and other
important publications about it. A much-needed book, and one you will want to
have on your reference shelf, next to your medical dictionary, is
Joblonski: ILLUSTRATED DICTIONARY OF EPONYMIC SYNDROMES AND
DISEASES and their Synonyms.
By Stanley Joblonski, Notionol Library of Medicine.
About $14.00. Just ready.
335 pages with about 125 illustrations.
In a compact, ready-reference medical dictionary, the first choice is the Pocket
Dorland. For 70 years, previous editions have been famous for comprehensive-
ness, authority, and usefulness. The latest (21st) edition puts at your finger-
tips the correct spelling, pronunciation, and meaning of more than 40,000
terms in the medical arts — those every nurse must know and those she may
occasionally need to look up. It has more than 7,000 new entries — hundreds of
them found in no other pocket dictionary — new tables of bones, muscles,
nerves, and veins using the latest approved nomenclature; sixteen pages of
plates in full color; latest drug names; tables of chemical elements and con-
version tables of weights and measures. The cornerstone of every nurse's
professional library is
DORLAND'S POCKET MEDICAL DICTIONARY 21st Edition
715 poges, including 16 pages of plates in full color. $6.75. Published April, 1968.
Used by more than 80,000 nurses, "Sutton" is one of the most successful books
of its type ever published. The new, revised Second Edition is a completely
up-to-date source book of clinical nursing procedures. In clear, simple language
supplemented by more than 850 drawings, the author tells precisely how to
perform hundreds of nursing functions — from intramuscular injection to care of
the patient in hyperbaric oxygen therapy. You'll find new data on such topics
as reverse isolation, IPPB respirators, hypodermoclysis, tubeless gastric
analysis, heart transplants, and fluid and electrolyte balance. The basic hand-
book of nursing technique is
Sutton: BEDSIDE NURSING TECHNIQUES IN MEDICINE AND SURGERY
2nd Edition
By Audrey Lotshaw Sutton, R.N., Blue Cross of Philadelphia, formerly of Edgewood Generol
Hospital, Berlin, N.J., and Wilmington (Del.) General Hospital. 398 poges with 871 illustrotions.
$8.95. Published March, 1969.
W. B. SAUNDERS COMPANY CANADA LTD., 1835 Yonge Street, Toronto 7
Please send on approval artd bill me:
□ Joblonski: Dictionary of Eponymic Syndromes (about $14.00)
D Dorland's Pocket AAedical Dictionary ($6.75)
D Sutton: Bedside Nursing Techniques ($8.95)
Nome:
Address:
City:
Zone:
NOVEMBER 1%9
Prov.:
CN 11-69
THE CANADIAN NURSE
23
new products
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
Electronic Pulse Monitor
The new SphygmoStat Electronic
Pulse Monitor is a compact instrument
that provides instant and accurate human
pulse rates for monitoring or display
purposes.
The instrument consists of a finger
pulse sensor which incorporates a cad-
mium-sulphide photo-electric cell. Varia-
tions in the cell's resistance, due to blood
flow impulses, are amplified by the solid-
state circuitry and displayed instantane-
ously on the ratemeter. For convenient
monitoring without visual observation,
the pulses are also used to operate a
variable-volume speaker system housed in
the instrument.
Power is supplied by long-life re-
chargeable nickel-cadmium batteries, 7.2
volts; the recharging cable is included
with the instrument. Maximum recharg-
ing time is eight hours.
This Electronic Pulse Monitor is a
practical instrument for routine health
examinations as well as for emergency
situations. It can be used in hospital
wards, operating, and recovery rooms;
physician's offices for routine examina-
tions; oral surgeon's offices for patient
monitoring; athletic events; and research.
The Pulse Wave Adaptor, available as
an optional accessory, is a simple and
convenient method for recording pulse
wave pressure forms. It may be used with
any standard electrocardiograph and the
Model P-75 SphygmoStat Electronic
Pulse Monitor, providing information in
the study of pressure pulses and circulato-
ry dynamics.
This instrument is available in Canada
through Starkman Surgical Supply, 1243
Bathurst St., Toronto, Ontario.
24 THE CANADIAN NURSE
Quad Cane
This new cane, for use in home or
hospital, functions as an aid for walking
stability for victims of a stroke or paraly-
sis. It is chrome-plated and equipped with
a plastic coated handle and non-slip rub-
ber-tipped legs. It can be used singly or in
pairs. It is light-weight and easily adjusted
and comes in adult or child sizes, small or
large bases.
For more information write: B.C. Hol-
lingshead Ltd., 64 Gerrard St. E., Toron-
to, Ont.
[
s
)
iiiiir
t
rliP
Disposable Soap Tissue
Disposable soap tissues made of wet-
strength paper containing soap and hex-
achlorophene are being introduced by
Davis & Geek. The new soap tissues are
designed to help reduce contamination in
public wash areas and in general nursing
procedures.
Soap tissues are suitable for pre-wash
prior to surgical scrub as well as for all
skin cleansing purposes including those in
nursing areas, patient care areas, nursery,
food service areas, rest rooms, and physi-
cian and dentist offices.
The tissues are pleasantly scented.
When dampened they become soft and
pliable and produce rich lather. They do
not fuzz or disintegrate and do not tear in
normal use.
For information write: Davis & Geek
Products Department, Cyanamid of Cana-
da Limited, P.O. Box 1039, Montreal
101, Quebec.
Unlisted Drugs Index-Guide
A new computer-produced Index-
Guide is one of the largest international
drug listings so far compiled, with over
45,000 drug entries in its name and
code-number sections. It not only permits
determination of earliest reference to
each of these drugs in any issue of 19
years of publication of Unlisted Drugs,
but also identifies the drug manufacturer
by a special mnemonic code.
Included in this new book is the Drug
Manufacturers' Directory, containing over
5,000 names and addresses, and termed
the most comprehensive such compilation
available. Other Index-Guide features are
a 400-item computer-derived index of
codes for research drugs (investigational
codes), and recent books on drugs, a
section containing analytical reviews des-
cribing latest major drug compendia,
directories, and other new books related
to drug research and pharmaceutical
marketing, published in 1 1 important
countries.
This 8-1/2 x 11 inch compendium is
sturdily and attractively bound in green
cloth. Single copies of the Index-Guide
are available at $95 directly from Unlist-
ed Drugs, Box 401, Chatham, New Jersey
07928.
Yankauer Suction Instrument
A new sterile-packed, disposable
Yankauer type surgical suction instru-
ment offers several added design features.
An optional suction control vent gives
the new Yankauer added efficiency, safe-
ty, and versatility. It is designed so that
suction occurs at the tip only when the
index finger is pressed onto the valve.
When the finger is lifted, suction at the
tip terminates completely.
NOVEMBER 1%9
Holes in the tip are large and smooth,
and assure highly efficient suction with a
minimum of clogging.
This instrument is constructed of a
non-glare, resilient plastic that is suf-
ficiently strong and supple to permit use
of the instrument as a retractor or depres-
sor during surgery. Since it will bend
slightly under pressure, it transmits a feel
of the amount of pressure being applied,
diminishing chance of tissue trauma. For
oral use, the plastic stem helps prevent
possible damage to teeth or gums.
The disposable Yankauer is sterile-
packed in see-through, peel-back pack-
ages. It is available with or without vent,
and with or without pre-assembled 1/4-
inch I.D. plastic suction tubing. The
hospital may specify 72" or 120" lengths,
in clear or conductive black.
This product is available through
surgical supply dealers in Canada. For
complete information and prices, write
to: Davol Inc., Providence, Rhode Island,
02901.
Simplified Apgar Score Recording
A new Apgar Score Timing Unit pro-
vides a simple technique for more accu-
rate recording of the Apgar score, the
newborn scoring system.
This timing unit consists of an anodiz-
ed aluminum clipboard, 17 x 9-1/2
inches, with a specialized timer designed
to ring accurately at one minute and at
five minutes after birth. The timer, cover-
ing a five-minute cycle and graduated at
one minute intervals, is started at birth. A
bell signals the two time intervals when
the signs should be recorded. An Apgar
score pad is provided to tabulate the
findings.
For further information, write to:
Resuscitation Laboratories, P.O. Box
3051, Bridgeport, Connecticut, 06605.
Electronic Thermometer
The new IVAC Electronic Thermo-
meter delivers temperature readings in
inch high numerals in a matter of sec-
onds. It is completely portable, weighs
one pound, and requires no special train-
ing to operate.
This thermometer is safe. The hy-
genically clean, inexpensive, probe cover
is disposable. It is dispensed from a
cassette and never needs to be touched by
hand. It eliminates the possibility of cross
infection, re-infection, or broken glass.
The solid state circuitry of the instru-
ment assures superb operating reliability,
accurate to .1 degree from 90 degrees to
108 degrees F. It holds the highest
reading until the operator resets it.
The thermometer comes in an attrac-
tive charger-base which keeps its nickel
cadmium batteries fully charged at all
times.
This product can be obtained from
Standard Hospital Supply, 2276 Dixie
Rd., Cooksville, Ontario. D
NOVEMBER 1969
For nursing
convenience...
patient ease
TUCKS
offer an aid to healing,
an aid to comfort
Soothing, cooling TUCKS provide
greater patient comfort, greater
nursing convenience. TUCKS mean no
fuss, no mess, no preparation, no
trundling the surgical cart. Ready-
prepared TUCKS can be kept by the
patient's bedside for immediate appli-
cation whenever their soothing, healing
properties are indicated. TUCKS allay
the itch and pain of post-operative
lesions, post-partum hemorrhoids,
episiotomies, and many dermatological
conditions. TUCKS save time. Promote
healing. Offer soothing, cooling relief
in both pre-and post-operative
conditions. TUCKS are soft
flannel pads soaked in witch hazel
(50%) and glycerine (10%).
TUCKS — the valuable nur-
sing aid, the valuable patient
comforter.
Specify the FULLER SHIELD'^ as a protective
postsurgical dressing. Holds anal, perianal or
pilonidal dressings comfortably in place with-
out tape, prevents soiling of linen or cloth-
ing. Ideal for hospital or ambulatory patients.
w
WIN LEY- MORRIS >^?.V
JVA MONTREAL CANADA
TUCKS is a trademark of the Fuller Laboratories inc.
THE CANADIAN NURSE 25
in a capsule
CHA says president misquoted
An item in the September issue of
Canadian Hospital News, published by
the Canadian Hospital Association, states
that The Canadian Nurse misquoted the
president of CHA, L.R. Adshead, in a
news item that appeared in the July issue
of cm.
The news item, based on discussion at
the CHA annual meeting in May, quoted
Mr. Adshead as saying, "The CNA sup-
posedly represents 80,000 nurses. The
CNA is poppycock." According to Cana-
dian Hospital News, Mr. Adshead did not
say this:
"The argument raised during the dis-
cussion was that only the Canadian
Nurses' Association, representing 80,000
nurses, could properly undertake such a
study. To this President Adshead replied,
Toppycock, this is an employer study of
the graduates of the two and three-year
programs. We want to know the quality
of the product and how the hospital can
assist to ensure both graduates achieve an
equal level of performance.'"
Our reporter at this meeting wrote
what she heard. We are, however, pleased
to learn that Mr. Adshead apparently did
not say that CNA is "poppycock." After
all, the ultimate goal of both associations
is to promote better patient care. To do
this, we must work together, with mutual
respect.
Psyche soother
Here are a few more good reasons why
you should enjoy that glass (or two) of
wine - although the pleasure principle
alone is usually reason enough.
We quote a quote from an article in
Hospital Economics, noted by the Wine
Institute of San Francisco: "Wine soothes
the psyche as it serves the heart, making
it a most effective adjuvant in the treat-
ment of cardiovascular disorders."
Dr. Salvatore Lucia, professor emeritus
of the University of Cahfornia School of
Medicine, San Francisco, writes in this
article that wine helps to open blood
vessels; reduce the amount of cholesterol
in the blood stream; quiet emotional
tension; and can help the heart regulate
its rate of beating.
26 THE CANADIAN NURSE
The use of wine to treat heart disease
dates back to at least the first century
A.D., the author says. Because it dilates
blood vessels, wine has long been used to
treat poor circulation in fingers, toes, and
other extremities. And doctors have even
been able to prevent the need for amputa-
tion in gangrene, with the use of wine.
For this reason, it has been recommended
as a treatment for stroke.
The fact that wine helps the heart by
reducing emotional tension "cannot be
too greatly emphasized," says Dr. Lucia.
We heartily agree.
Dawdling don'ts
The Department of National Health
and Welfare included the following advice
in its July and August Heahh Notes.
Time means nothing to a young child.
A lot of dawdling is actually concentra-
tion upon the thing most interesting at
the moment, says the federal health
department publication, "Up the Years
From One To Six." A hungry child may
become so fascinated by watching soap
bubbles burst while washing his hands
that it takes him ages to finish and come
to his waiting dinner. He isn't purposely
wasting his time. To him it's all part of
the process of learning everything about
everything.
Time does mean a lot to a busy
mother. But a child can turn deaf to a
torrent of words. And if you start prodd-
ing and scolding now, you'll be at it for a
long time. If you're giving your child
responsibility for his own eating, dressing,
going to the toilet, and washing, and if he
doesn't feel he's being bossed too much,
he will gradually speed up. Dawdhng for
him won't become a form of passive
resistance.
Hospital Administration
There are procedures both common and
special.
There are policies which apply to us all.
There are forms both in multi and single.
Oh how can 1 cope with them all?
Now committees work on them revising.
Reviewing, renewing all the while.
To delete one, because it's not used
any more.
Guarantees it will come back in style.
There's a problem, it's common to all of
us.
No memo's come through on it yet.
How can 1 remember wWch policies
Are the ones I'm supposed to forget? D
— Normina Brooks, Edmonton, Alta.
NOVEMBER 1969
'WW.
Hup.' Down! After 56 bends, man perspires, kling* Conform Bandage stays in place.
Gruelling knee-bend test shows why more
hospitals use KLING Bandage every day
We put this man through the torture of
50 deep knee-bends to show you one
thing. When you put a KLING bandage on,
it stays in place. If you look carefully at
the black stripe we painted on the band-
age, you'll see the layers of bandage
haven't shifted at all. KLING bandage held
the primary dressing in one spot all the
way through.
Twist-hook action
KLING bandage conforms to the most
difficult shapes. It stretches and recovers
better than any non-elasticated bandage.
And it clings to itself
The reason lies in the way it is made.
The threads are shrunk differentially. As
they twist, they form little hook-like
curls. These hooks hold successive layers
together.
Kiffisi
Little hooks in kling After 50 bends, black
bandage prevent slip line shows no movement
Easy to apply
Because KLING bandage conforms so well,
there's no need to tuck and fold when
bandaging. Because it clings to itself, one
can apply the bandage more quickly and
easily.
You can bandage any part of the body
with KLING bandage. A child's elbow—
an athlete's knee. And you can be sure
KLING Conform Bandage will stay in
place.
For more information, and trial samples
of KLING Conform Bandage, contact your
local Johnson & Johnson representative.
Or write to us direct:
n n LIMITED
HOSPITAL PRODUCTS DIVISION
21 55 Boulevard Pie IX, Montreal 403, P.Q.
•Tndamail nf .inHNSnN h .inmS.niUi Mlihalsil nnmnanliit AJLI 'RS
leads the \A/ay.
in styling and worltmanship. "Each and every
garment is painstakingly manufactured to assure
the finest value, style and wearability.
Front zipper opening on this "Skimmer". Action
sleeve gussets.
80% DACRON — 20% COTTON
Style 5038 Retails about $15.98
Sizes 6 to 18
This and other styles available at uniform shops
and department stores across Canada.
Pkofessionai. uniforms
For a copy of our latest catalogue and
for the store nearest you, write ;
La Cross Uniform Corp.
4530 Clark St.,
Montreal, Quebec
Tel : 845-5273
28 THE CANADIAN NURSE
NOVEMBER 1%9
On the delegation
of responsibility...
The author conducted an experiment in self-evaluation with students and
confirmed her belief that they can be responsible for their own learning.
J. Leith Nance
I wonder where and when nurse educa-
tors — or theii predecessors by any
other name — began to assume they
were responsible for the education of the
student.
Principles of management state clearly
that although you can delegate duties, the
responsibilities for those duties remain
with the person who will carry them out.
It follows, then, that teachers are respon-
sible for teaching, students are responsi-
ble for learning, and patients are responsi-
ble for getting well. Isn't is logical to
assume, further, that the teacher is res-
ponsible for continuous evaluation of her
skills as a teacher, the student for evalua-
tion of herself as a learner, and the
patient for evaluation of his level of
wellness?
Have you ever wondered why a patient
will lie in pain while an intravenous
solution slowly oozes into the tissues of
his arm? Is it possible that nurses have
implied they are responsible for assessing
his level of comfort and that the patient,
perhaps in this role for the first time,
assumes this because of a lack of orienta-
tion to his role? Does the nurse usurp
this responsibility because unwittingly
she has relinquished her own?
Miss Nance, a graduate of Altierta Hospital,
Ponoka, and McGill University School for
Graduate Nurses, Montreal, is a Lecturer in
psyctiiatric nursing at The University of Alberta
School of Nursing.
NOVEMBER 1%9
Did our predecessors assume the re-
sponsibility for student learning solely
because they were concerned with patient
safety? Or did they do so, and do we still
do so, because we fail to recognize that
the responsibility to learn lies with the
learner? When a person understands the
scope of his responsibility and is reinforc-
ed in his attempts to assess his progress,
he will strive to achieve the goals set
— whether in regard to teaching, learn-
ing or getting well.
If we examine our own school of
nursing experiences, most of us can iden-
tify times when we were frustrated to the
point of anger by certain incongruities:
we were held responsible for the welfare
of a patient, yet were not considered
responsible enough to determine our own
social behavior in residence.
University schools of nursing have
avoided some of the pitfalls of traditional
diploma programs by expecting the
student to assume responsibility for her
own conduct. On the other hand, it
appears that students in some baccalaure-
ate programs are not given responsibility
for their own learning. Faculty in these
schools are so concerned about turning
out a quality product that they push the
learners, rather than guide them.
For example, each student is expected
to read certain articles and books, per-
form procedures with at least minimal
skill, and possess a specified amount of a
particular type of predetermined know-
THE CANADIAN NURSE 29
Four students examine the self-evaluation form they used to determine personal
achievement.
ledge. She is seldom consulted about the
course content. When she is consulted,
she is so unprepared for this that she is
unable to identify her own needs. The
student identifies success in terms of a
"successful" examination, a "successful"
interview and a "successful" evalua-
tion — not as personal growth and satis-
faction. Students in most situations are
required to write self-evaluation reports,
but all too often their evaluation has little
bearing on their final record.
As a result, the student does not have
the responsibility for her own evaluation
and feels no responsibility to live up to it.
The instructor, having assumed this res-
ponsibility, must then take on the addi-
tional responsibility for the student's
continued learning and safe conduct.
Why should the student reach out for
a book that isn't on the list or offer to
cut her patient's flowers or to help the
kitchen maid clean up spilt milk? These
things aren't part of the requirements for
success! Why should she turn down a
date in favor of an assignment or an
opportunity to practice some technical
skill, if success is measured by someone
else, rather than by a personal feeling of
pleasure, certainty or, better still, a
hunger for more knowledge?
What happens when the student grad-
uates? Too often she stops learning,
develops methods of escape and avoid-
ance, and becomes hypersensitive to criti-
cism. Why should a graduate nurse at-
tempt to read nursing journals and attend
workshops unless she is told to do so?
30 THE CANADIAN NURSE
She has never before been required to
make decisions concerning her education.
I was prompted to write this paper as a
result of an experiment with third-year
students in a four-year degree program.
The experiment began after the students
had completed a 13-week guided learning
experience on an active treatment
psychiatric unit. They increased their
familiarity with the community through
home visits, but still lacked an apprecia-
tion of the extent and severity of prob-
lems in the community that intensify
emotional and intellectual disorders.
To increase this understanding, each
student was asked to select one of 12
topics or to suggest a topic she would like
to study in depth. The students were free
to set their own objectives, determine
their method of enquiry, go at their own
speed, evaluate their gain, and determine
their own score. They were asked to
present their findings in their own way to
the others in the class. We gave them a
week to collect information, to plan for
their presentation, and consult with us if
they wished.
Preliminary discussion with the
students eUcited some resistance in the
form of, "Well, I'd Uke to have some say
in the final mark, but I'd be happier if
you (the instructor) would mark me too
so I could see how our marks compare."
We countered this with, "Education is a
growth process, and a personal one at
that, hence we are ill-equipped to meas-
ure what you gain from the experience."
Students also suggested that the
teacher was responsible for marking
students. We replied that each individual
is responsible for her own growth and
goals and should likewise be responsible
for her own assessment. We concluded
the discussion by explaining that they
would be responsible for living up to their
evaluations. In the end they agreed to try
it with the understanding that if they
wanted to change their minds they could.
No one did.
During their unstructured week they
each worked independently - some
diligently, some not so diligently. They
arranged visits to agencies, industries, and
businesses; visited homes; masqueraded as
poor people; lived at an alcoholic rehabili-
tation hospital; got involved with teen
groups; interviewed children and their
parents; and other activities too numer-
ous to mention.
The knowledge and understanding
they conveyed to their instructors and
peers were beyond our expectations. In
every instance we learned more about
each topic and its related problems than
we could have hoped to present ourselves.
Marks for the experience were divided:
70 percent for the assignment and 30
percent for an oral examination. We
assured the students that their final mark
would not be questioned — whether it
was 0 or 70 percent. The scores ranged
from 48/70 to 64/70 with a mean of
56/70. A mean of 80 percent may seem
high, but is not, in our opinion, out of
line. But then our opinions don't count
because the mark was based on personal
growth! The only tool we have for the
measurement of personal growth is the
student herself - a tool which will get
rusty if we don't use it.
What did the students say? We asked
each of them to complete a questionnaire
designed to elicit feelings concerning the
assignment, what they found most valua-
ble, least valuable, most anxiety provok-
ing. The results, too lengthy to be enu-
merated here, were strongly positive. All
agreed it was difficult; most said they
applied themselves more to this task than
to most assignments; and all found it a
worthwhile experience that should be
repeated in this area and developed in
others. Only one student stated she
would have been happier if the instructor
had helped with the final mark and
evaluation.
This experience confirms my belief
that people usually live up to your
expectations of them. They can and will
assume responsibilities that are theirs to
assume.
NOVEMBER 1%9
The bluebirds who went over
In World War I, Canadian nursing sisters who served overseas were sent chiefly to
France, Belgium, and England, but some of the first to volunteer found themselves in
Cairo, Salonika, and the Isle of Lemnos. A few of these nurses talk to the author
about their experiences as "Bluebirds" who went over.
N/S Heath - now Mrs. W. MacDemiott.
NOVEMBER 1%9
Carlotta Hacker, M.A.
It was difficult to eat or drink without
swallowing flies: the tables swarmed with
them. When dressings were changed, a
nurse had to stand by, farming vigorously,
to prevent the flies settUng. Bandages
were in short supply and often a soiled
one had to be used again over a clean
dressing. Then, back clouded the flies
onto the bandage.
That was the picture in 1915 on the
Isle of Lerrmos, when two Canadian
Stationary Hospitals were first landed to
nurse the wounded from the Dardanelles.
The temperature was 100°F. in the shade
and, although medical supplies had been
landed with the two Canadian units, they
were not nearly adequate for the thou-
sands of wounded and dying who had
been brought to the island. Food was also
scarce to begin with, and so was water
until wells were sunk.
Miss Eleanor M. Charleson, who is now
95 and who was one of the matrons on
Lemnos, recalls that when she first arriv-
ed on the island she and her nurses had
nothing to eat except malted milk tablets.
They existed on these, chewing them up
drily, for something like two days. Then
the HMS Glory came into harbor, saw the
The author, a free-lance writer and researcher,
is a frequent contributor to The Canadian
Nurse. She and the editor express their ap-
preciation to Miss Dorothy Percy, who first
thought of the idea of writing about nurses in
World War I and who subsequently helped to
set up the interviews.
phght of the nurses, and brought in food
and all the boiled water they could lay
their hands on, rolling the heavy water
drums up the craggy, steep hill to the
camp.
"My nurses cried when they got the
cold water," Miss Charleson recalls.
Over half a century has passed now
since the War To End All Wars, yet a
number of the 3,000 Canadian nurses
who served overseas are still living. It is
strange to talk with them and to hear,
first-hand - vividly and simply stated
- their personal anecdotes and their
descriptions of events that long ago be-
came history.
The nurses experienced terror and
tragedies, yet not one of them considers
herself a heroine. "There was a job to be
done, so we did it," is the attitude. They
state the tragedies as facts, long-accepted
facts, and remember chiefly the purpose-
fulness of the period, the team spirit that
bound them together, and the happy
times - an afternoon picnic at Boulo-
gne, or a ridiculous fiasco about army
etiquette, or the day a visitor was whisk-
ed off in an ambulance in mistake for a
Portuguese soldier who had been found
to have leprosy.
The Canadian nursing sisters served
chiefly in France, Belgium, and England,
although some of the first to volunteer
found themselves in Cairo, Salonika, and
the bare Isle of Lemnos. Because of the
enthusiasm for the war effort and the fact
that brothers, sons, and fiances were all
THE CANADIAN NURSE 31
Nursing Sister Ethel BagnalL
joining up, most of the girls had family
approval for the step they were taking.
However, Mrs. W.B. MacDermott (then
Miss Miriam Heath) had strong family
disapproval. Her father considered her
application as no more than a fad and
managed to block it. But, like so many
other nurses, Mrs. MacDermott was de-
termined to play her part; within a few
months she had succeeded in becoming a
nursing sister in the Canadian Army
Medical Corps and was crossing the Atlan-
tic on the HMS Letitia.
Matron Charleson, a graduate of St.
Luke's, Ottawa, also experienced opposi-
tion from her father. She was one of the
first to enlist, taking the opportunity
when Margaret Macdonald, Matron-in-
Chief of the Canadians, was in Ottawa in
1914. Miss Charleson went home to break
the news to her father, who was then 80.
The encounter is best described in her
own words:
"I said to Father, 'If they'll take me,
I'll go,' and he said, 'No, I don't want you
to do that. Daughter.'
"But I said, 'Father, what would you
do if you were my age and you had the
profession that was most needed? ' . . .
"And he said, 'Well, I'd go.'"
So Miss Charleson went. By the time
she returned to Canada after the war she
had gathered a Mons Medal, a Mention in
Dispatches, and a Royal Red Cross, First
Class.
Matron Charleson first served with No.
32 THE CANADIAN NURSE
1 Canadian Stationary Hospital on the
Western Front. In 1915 a seasoned unit
was required in the Near East because of
the casualties in the Dardanelles, so she
and her nurses were posted to the Greek
island of Lemnos, only about 40 miles
from the Turkish coast.
"A folly! I don't think they could
ever have evacuated us in an emergency.
The ships were already full."
She vividly remembers her arrival on
Lemnos: the heat, the flies, the dust. The
nurses landed wearing white shoes and
stockings - which were dirty grey by
the time they had trekked up the hill to
the hospital site. The working uniform at
the time was a blue dress, with white
starched collar, but in that heat it wasn't
long before the Canadian nursing sisters
had removed their restricting collars and
had slung their veils round their necks as
more comfortable scarves.
"Trust the Canadian nurse to make
herself look glamorous! " said Miss
Charleson with a laugh. "But I didn't
care. My idea was the comfort of my
nurses. I'm very proud to say I never lost
a nurse."
No. 3 Hospital, the other Canadian
unit on Lemnos, suffered dreadfully from
sickness among its staff, and the matron
and one of the nurses both died of Asiatic
cholera. They are buried there in the
graveyard that also holds the bones of
Rupert Brooke, the First War poet.
Much of the nursing on Lemnos was
medical, for many of the ships of wound-
ed went straight to the hospitals on the
mainland of Egypt, so it was disease as
much as wounds that the nurses had to
overcome.
The hospitals consisted of tents, hold-
ing about 50 men each, and the nursing
sisters - "Bluebirds" as they were nick-
named - lived in smaller tents. In addi-
tion to the flies, a considerable amount of
wild Ufe succeeded in crawling or flying
into the tents - a centipede in the night
scared Miss Charleson far more than
German bombs ever did - and when the
weather changed and the rains burst upon
Lemnos, the rush of water rolled great
boulders into the tents, and beds and
patients were awash.
"It was a fitful cUmate," remarked
Miss Charleson calmly.
However, toward the end of her time
on the island the patients were moved
into more weatherproof quarters as a
result of some quick thinking on Miss
Charleson's part. One afternoon, when
Miss Charleson was out for a walk with
Colonel McKee, the CO of No. 1 Station-
ary Hospital, they suddenly came upon
some empty huts.
"Let's take them! " said the matron
immediately. "Squatter's rights."
So they moved their hospital into the
huts - much to the annoyance of an
Australian medical unit that arrived some
days later, and for whom the huts had
been built!
After Lemnos, Matron Charleson was
sent with her nurses to Salonika. Mrs.
M.C. Lynch, formerly Miss Mary Macin-
tosh, was also at Salonika, having particu-
larly appUed to go there. Like Miss
Charleson, she was an experienced nurse
before the war, for she had graduated
from St. Joseph's Hospital, Glace Bay, a
good 10 years earlier.
Salonika was hot, very hot. Flies and
mosquitoes abounded and dead donkeys
were left to decay in the streets. Here the
nurses were not too busy; in fact, for long
stretches they had little to do but wait
for a convoy.
"They also serve who only stand and
wait," Matron Charleson told her nurses.
"And that only should be left out be-
cause I know that the waiting is one of
the hardest parts."
When convoys did arrive from the
front, they brought chiefly patients with
dysentery and malaria. Mrs. Lynch re-
Matron Eleanor M. Charleson
NOVEMBER 1%9
members that brandy was one of the
chief medicaments given for malaria.
"And one day somebody got at the
brandy and finished it all off"
Fortunately her brother-in-law had
given her a flask of brandy when she
joined up. She had forgotten about it
until that moment, when it was hurriedly
brought out and issued to the malarials.
As at Lemnos, food was scarce.
"We were hungry," states Miss Charles-
on simply.
Mrs. Lynch can remember margarine
with streaks of green through it, and the
staple food - such as it was - seems to
have been cans of Australian rabbit.
On the Western Front, in France and
Belgium, food was plentiful and the
hospitals were well stocked. As in Lem-
nos and Salonika, the nurses often lived
in tents, but most of the wards were huts,
with 45 or 50 patients to a hut. However,
these huts were not always newly built.
Sometimes they were old barracks and, in
bad weather, a nurse walking the wards in
a raincoat might hear a plaintive cry:
"Sister! Will you move my bed a bit?
It's raining on my feet."
No. 3 Canadian General Hospital at
Boulogne, where Mrs. MacDermott served
with the McGill unit, used the semi-ruins
of an old abbey as well as some huts. In
this antique setting, Mrs. MacDermott
spent much of the war nursing Portuguese
and Jamaicans (the latter suffering chiefly
from pneumonia), for the Canadian
nurses were not specifically attached to
the Canadian Expeditionary Force: they
nursed whatever nationality needed their
services.
Even though the major hospitals in
France were situated on the coast, away
from the front line, here too the war was
ever present. There were frequent attacks
from the air. Mrs. W.A. Blue, a Canadian
who served in France with the U.S.
forces, can remember her alarm when she
first saw observation balloons, for she
thought they must be a fleet of zeppelins;
and Miss Ethel Bagnall, a graduate of
Montreal's Royal Victoria Hospital, still
relives the horror of the many air raids
she went through.
Her initial experience of bombs, as
well as shellfire, was at the forces hospital
at Ramsgate on the south coast of En-
gland, where they were regularly shelled
from across the channel and sometimes
bombed simultaneously. But that was
only the beginning. In 1918 Miss Bagnall
was stationed with No. I Canadian Gener-
al Hospital at Etaples, on the French
coast, during the terrible bombing raid
that caused 1 70 hospital casulties in one
night.
NOVEMBER 1969
I
■■■*;< > ■ I - ' j » i
Matron Charleson (center, first row) with nurses on the Isle of Lemnos.
"We were bombed for two solid
hours," she remembers. "We lost 60
orderlies and 3 Canadian nurses. I was on
night duty and my ward was struck.
Everything was riddled with shrapnel.
And there was one tent that was just
wiped out. The boys in it had arrived that
day, so we didn't even know who they
were."
After this experience she got her
patients and herself under the beds at
night when the planes came over. She
finally conquered her fear of raids when
she was moved to the front line in
Belgium. There she found herself playing
bridge with the colonel when the bom-
bers came over, and the colonel wouldn't
allow her to take cover under the table.
"So I sat down and continued the
game of bridge, and after that I was never
nervous of air raids again."
During air raids the nurses were often
on duty far longer than their 12-hour
shift. In a fairly light raid, some were
permitted to sleep (if they could), but
operating room nurses were expected to
be on duty even if they had already
worked their very full day.
"But the nurses never questioned that
there was a duty to be done," said
Matron Charleson. "You really cannot
beat the Canadian Nurse."
It wasn't only during air raids that
extra hours were needed and therefore
worked. Mrs. MacDermott can remember
being on duty at Boulogne for 72 hours
at a stretch when a convoy of gassed
soldiers arrived straight from the line.
"They were temporarily blinded," she
said, "and the whole hospital was on duty
day and night for two or three days. The
treatment was boric acid and castor oil.
And it cured them all! I don't think one
of them went blind."
During a major offensive, or a retreat,
convoys of wounded arrived continually.
The nurses stayed in the wards until the
casualties were cleaned up and until those
who were well enough to travel further
had been put on the ships to be taken
across the Channel to hospitals in "Bligh-
ty." But even at comparatively quiet
times the arrival of a convoy meant
intensive work. Often the hospital staff
was given little advance warning of a
convoy and the nurses would have
perhaps three hours to vacate as many as
150 beds and get them ready for the
arriving casualties.
It was up to the doctors to decide
which patients were well enough to trav-
el, but Mrs. M.C. Macdonnell, who served
in France with No. 2 Canadian General,
can remember an occasion when she
intentionally kept back two of her pa-
tients. They were well enough to move on
to a convalescent hospital in England, but
they had both been medical students
before they enlisted for active service in
the army, and were invaluable to Mrs.
Macdonnell helping her change dress-
ings of wounded in a hospital which, at
THE CANADIAN NURSE 33
Soldiers taking a few minutes of well deserved rest.
the time, was very short-staffed. So she
told them to get into bed before the
doctor came round. He entered the ward
almost immediately and, while Mrs. Mac-
donnell was explaining that these two
boys were far too ill to be moved, the
doctor was looking at their boots, which
they hadn't had time to remove and
which were sticking out from under the
covers.
"Much too ill," the doctor agreed. He
also knew what good work these medical
students were doing within the hospital.
Mrs. Macdonnell, a graduate of Vic-
toria General Hospital in Halifax, went
overseas because her doctor husband was
posted abroad and she wanted to be near
him. She says that she originally had no
intention of joining up: it was only
meeting Margaret Macdonald, the Cana-
dian matron-in-chief, at a party .> in Lon-
don that caused her to sign on as a
nursing sister. Mrs. Macdonnell maintains
that she had little choice: she was a nurse,
she was in England, and the matron-in-
chief desperately needed nurses. By the
following day she was in the army and
was rushing round London collecting
uniform, trunk, and other necessities and
marking them all: "Nursing Sister M.C.
Macdonnell, Canadian Army Medical
Corps."
In spite of this story, any lack ot
enthusiasm is hard to believe when one
talks with Mrs. Macdonnell who is
French-Canadian by birth and who even
34 THE CANADIAN NURSE
now, in her eighties, is bubbling with
enthusiasm; it is also hard to believe when
one considers that, in middle life, she
volunteered to nurse a smallpox patient,
who was one of her orderlies, and she was
isolated with him for nearly three months
before he fully recovered. She has the
same attitude that Miss Charleson states
so clearly when she says:
"I'm not a heroine. I haven't done
anything that any woman wouldn't have
done if she was of my profession."
Mrs. Macdonnell took several months
to recover from a wound she received
during an air raid; but the war brought
her a deeper wound that was far slower to
heal: her husband succombed to one of
the many deadly features of the Great
War, the influenza epidemic, and died on
Armistice Day.
Miss Bagnall had a similar tragedy.
Although she survived influenza -
though she weighed only 68 pounds
when she returned to Canada - and
survived bombs and shellfire, her fiance,
whom she met at Etaples, was killed in
action.
Yet both these ladies remember chief-
ly the pleasant and amusing times they
had overseas. Mrs. Macdonnell will tell a
delightful saga of how she refused to
curtsy to the Duke and Duchess of
Connaught, when they were visiting the
hospitals. Miss Bagnall still laughs when
she recalls how, after the raid on Etaples,
the nurses often slept in the woods for
safety and how one morning they woke
to find they had slept among a Chinese
labor unit. There is a lot of merriment
and a lot of nostalgia.
Mrs. MacDermott met her future hus-
band on the ship crossing the Atlantic, so
for her, too, the war is remembered with
a degree of warm nostalgia. Like Mrs.
Hagyard, a Hamilton graduate who served
with No. 16 Canadian General and who
also met her doctor husband during her
service overseas, she can say: "It was a
very happy time."
Yet the war years seem to have been
good years for all the nurses, whatever
the outcome.
"It was a marvellous, marvellous expe-
rience," Miss Charleson said. "I wouldn't
have been without it. And you keep it
with you all through life."
While remembering how happy they
were and how often they laughed -
though perhaps sometimes it was to hide
their private fears - these ladies don't
seem to recognize their own bravery.
What they particularly remember, and all
mentioned frequently, is the courage and
spirit they witnessed in the troops. Mrs.
Lynch synthesized this, when she said:
"When 1 think back, I think of the
boys mostly. They were so cheerful,
always ready with a joke, even when they
knew they were dying."
And Miss Charleson is still stating what
must have been the attitude that made
the Canadian nurses so very popular:
"We were where we were when we
were wanted. That doesn't mean to say
we were heroines. But it certainly is
something that any nurse would be proud
i\ot all the "boys" were badly injureu.' of."
D
NOVEMBER 1969
staff-line conflict in hospitals
Conflicts among hospital personnel are almost impossible to avoid. However,
they occur with less frequency when lines of authority are well understood and
are followed.
Margaret B. Delahanty, B.N.
We hear a great deal about delegating
authority along with responsibility. How-
ever, certain responsibilities in an organi-
zation cannot be transferred. For exam-
ple, the responsibilities of the chief ex-
ecutive, known in hospitals as executive
director or administrator, are in this
category. Vision, planning, and initia-
tive — so necessary for the efficient
functioning of the hospital — rest with
the executive director. These responsibili-
ties cannot be delegated to department
heads or to anyone else who is not part of
management.
The executive director cannot assign
management responsibilities to the chief
accountant; the latter is responsible only
for his activities as chief accountant.
Similarly, the functional responsibilities
of the chief accountant cannot be dele-
gated to the hospital cook or to anyone
else. Department heads are responsible
for what their employees in their depart-
Miss Delahanty, a graduate of the Toronto
Western Hospital and The School for Graduate
Nurses, McGill University, was awarded the
Montreal Women's Personnel Association Prize
for best essay by a woman student in 1969.
This article is based on her essay.
The author acknowledges the assistance of
Ixirine Besel, Assistant Director of Nursing,
Royal Victoria Hospital; K. Brady, I..ecturer in
Public Health Nursing. McGill University; and
S. Goldenberg, Department of Economics,
McGill University. Montreal.
NOVEMBER 1%9
ments do; however, they cannot avoid or
delegate their own specific responsibili-
ties.
Obviously a clear understanding of the
locus of authority and responsibility is
necessary if the hospital is to operate
smoothly.
Line and staff responsibility
Some kinds of responsibility can be
delegated from top to bottom. Such
"line" responsibility is found throughout
the hospital. For instance, the chief
housekeeper delegates responsibilities to
assistant housekeepers: the accountant
has assistants who represent him; and the
nursing supervisor has assistants who re-
present her. Throughout the hospital,
assistants exercise delegated authority.
As well as this "line" responsibility in
an organization, there is also "staff
responsibility. Applied to hospitals, this
could refer to an expert, or recognized
authority, who is called in to advise or
assist management in some special matter.
For example, a lawyer may be necessary
to advise in legal matters; a decorator, in
color schemes for patients' rooms; or a
specialist in group dynamics, for consul-
tation in group work on the wards.
Although professionally responsible for
the advice he gives, this "expert" is not in
the "line" authority of the organization.
In each hospital, then, there is custom-
arily a "line" of authority graded down
from the top of the department. This
THE CANADIAN NURSE 35
ladder of authority also goes above the
department head to the superior authori-
ty and to the public, who have certain
authority as patients, or potential pa-
tients. There is also the "staff type of
control, in which the staff departments
are advisory to the line executives or line
departments. As well, there is "function-
al" control, consisting of the functional
responsibilities of specialists, such as the
chief engineer, and there is "committee"
control.
Application of staff-line concept
In the hospital, the board of directors
is the chief decision-maker. The advisory
committee to the board is in a staff
relationship with it, hence advises, but
does not discipline.
The request for budget usually comes
from the administrator, who is in a line
relationship with the directors of the
various hospital departments. The board
of directors may believe it knows more
about the budgetary needs of the hospital
than the advisory committee, and may
resent the advice given.
As decision maker, the board is in a
position to tell the administrator what he
can expect in the way of budgetary
allowance. Conflict may result. The ad-
ministrator may resent the board's deci-
sion, because he believes he knows more
than the board about the hospital's
budgetary needs as he confers directly
with the heads of various departments on
a regular basis. The board of directors, in
turn, is pressed by the provincial govern-
ment to cut costs.
A conflict between two department
heads that cannot be resolved between
them must go up the line to the adminis-
trator. Since department heads are in
staff relationship and have no authority
to discipline each other, the administrator
makes the decision for them.
A case in point might be where the
dietary department puts a notice on the
wards saying that nurses can no longer
drink morning coffee with patients. The
nurses on the psychiatric ward consider it
therapeutic to join the patients for coffee
36 THE CANADIAN NURSE
in the morning and are disconcerted by
the notice. These nurses will probably
notify their head nurse about the sign.
She, in turn, will undoubtedly bring the
matter to her supervisor, who will bring it
to the attention of the director of nurs-
ing. The director of nursing will then
probably confer with the director of the
dietary department and ask why the sign
was put up.
The director of nursing may agree that
drinking coffee with patients has a thera-
peutic purpose and is a nursing function
on the psychiatric ward. She may there-
fore be annoyed because she was not
consulted about a decision that she be-
lieves affects nursing. The director of the
dietary department may believe she can
post signs regarding food and drink with-
out consulting the nursing department,
because food and drink are within her
domain.
Hence, conflict results. Neither party
has authority to discipline the other, but
each believes the area in question is partly
within her domain. The directors of the
two departments have to go up their line
of authority to the administrator of the
hospital, who will make the final deci-
sion.
Within the nursing department, the
director of nursing service, the director of
nursing education, and the director of
inservice education are in a staff relation-
ship with one another; all are directly
responsible to the director of nursing in a
line relationship. However, conflict may
arise. For example, the director of nurs-
ing service and the director of inservice
education may have different ideas about
the ongoing education of staff nurses. As
a staff nurse, I have had the experience of
one director telling me one thing concern-
ing patient care, and the other telling me
something different. One then said to the
other, in my presence, "I hope I haven't
contradicted you." Such conflicts should
be resolved in private and not in the
presence of the staff nurse.
If these directors cannot agree, they
must go up the line of authority to the
director of nursing who will, if necessary,
make the decision. She has the authority
to do this, but whether or not they
perceive her as having this authority is
another matter.
Other examples of conflict
The clinical instructor on a ward is in a
line relationship with the department of
nursing education, which can tell her
what she should teach the students, and
in a staff relationship with the head
nurse. The head nurse cannot teach the
students on the ward - that is the clini-
cal instructor's job. But the head nurse,
who is in a line relationship with the
department of nursing service, is responsi-
ble for the care of patients on the ward.
The clinical instructor is also in a line
relationship with the head nurse because
she is responsible to her for the care of
patients whom she — the instructor -
has assigned to students. Therefore, if a
student makes a mistake, the clinical
instructor is responsible to the head nurse
for the mistake. The staff relationship
between head nurse and clinical instruc-
tor is shown when, together, they assign
the patients whom the students will care
for.
The clinical instructor is responsible
for teaching students to give good patient
care. She may believe she has a responsi-
bility to discipline a staff nurse, who, in
her opinion, is setting a poor example.
The staff nurse, however, is under the
department of nursing service. The clin-
ical instructor must, therefore, go to the
head nurse and tell her what she thinks of
the staff nurse's patient care, even though
she may feel like going directly to the
staff nurse. The head nurse disciplines the
staff nurse, if she sees fit.
Naturally, things do not always take
place in this idealistic way and conflict
frequently results. The clinical instructor
often goes straight to the staff nurse, who
may be resentful. She knows that the
cHnical instructor has no right to give her
orders, because they are not in a line
relationship.
The staff nurse is in a difficult position
because she has a commitment to both
NOVEMBER 1%9
the clinical and administrative lines of
authority. She is responsible to carry out
the doctor's written orders for patients
and she is under the line of authority of
the director of nursing, that is, the
administrative line of authority.
The doctor, on the other hand, is
under the clinical line of authority, that
is, the medical board. He may perceive his
relationship with the nurse as a line
relationship and she may perceive it as a
staff relationship. Actually it is a staff
relationship, though this is difficuh for
some doctors to accept. The way the
nurse perceives her relationship with the
doctor determines the way she wiU relate
to him.
The goal of the staff nurse who is in
charge of a ward on evening duty is to see
that all patients on the ward receive good
nursing care. The supervisor's goal is to
see that all patients in the hospital receive
this care. The supervisor may take some
nurses from one ward and assign them to
another ward that is short-staffed. The
staff nurse may believe this reassignement
interferes with her goal of safe patient
care on her ward. The goals of the staff
nurse and the supervisor are the same, but
one is responsible for more patients. For
this reason, each perceives the other as
interfering with her goal.
The supervisor is in a line relationship
with the staff nurse while the latter is on
evening duty. But the supervisor may
believe she does not know the ward as
well as the staff nurse. She may therefore
see her role as advisory rather than
directory. The staff nurse may believe she
knows more about what is actually taking
place on the ward than the supervisor,
and may also see the supervisor's role as
advisory, even though, on the organiza-
tional chart, it is directory. As we have
seen, it is the way in which each perceives
the other's role that will influence her
reactions to the other.
The head nurse is part of management
in some hospitals. She has a responsibility
to implement directives from the director
of nursing, even though she may not
agree with them. As well, she has a
NOVEMBER 1%9
responsibility to her staff and patients.
The head nurse is in a line relationship
with her staff nurses, and can discipline
them. She may choose to assume the
helping role, and indeed may find it an
effective way to get things done. At the
same time both parties understand, or are
supposed to understand, that she has
authority to go back to the directing role.
Conflict may ensue if the staff nurse
has a degree in nursing and the head
nurse, who has authority over her, does
not have a degree. In this situation, the
staff nurse may feel she has the know-
ledge but not the title of head nurse, and
may resent the head nurse's authority.
Liaison nurses, such as those from the
Victorian Order of Nurses, are in a staff
relationship with the director of nursing
of the hospital where they are working
and in a line relationship with the direc-
tor of the VON. The director of nursing
of the hospital cannot discipline the
liaison nurse for poor relationships with
her head nurses; she must go to the
director of VON, with whom the liaison
nurse is in a line relationship, and ask her
to discipline the nurse. In actual practice,
however, the head nurse often does disci-
pline the liaison nurse.
Since line-staff conflict often leads to
one person giving orders to another —
when officially she is not permitted to
do so - some think the line-staff distinc-
tion should be discontinued. Others be-
lieve that the concept of line-staff is
essential to the proper organization of
any enterprise.
Conclusion
Even though the objectives of the line
relationship are in the long run the same
as those of the staff organization, the
concept of line-staff is often essential to
clarify exactly who can give orders to
whom. This is particularly true when a
situation reaches a crisis. Then it is
especially helpful to consult the organiza-
tional chart to see who has authority over
whom — even though in day-to-day,
non-crisis situations the strict concept of
line-staff relations is almost impossible to
observe and conflicts are difficult to
avoid.
Bibliography
Blau, Peter M. Bureaucracy in Modern Society.
New York. Random House, 1956.
Fisch, Gerald G. Line-staff is obsolete. Han:
Bus. Rev. Sept.-Oct., 1961.
Griffiths, Daniel E. Administrative Theory.
New York, Appleton-Century-Crofts, 1959.
Koontz, Harold, and O'Donnell, Cyril. Princi-
ples of Management. New YOrk, McGraw-
HUI, 1955.
Roethlisberger. F.J. A 'new look' for manage-
ment. General Management Series 191,
American Management Association.
Thompson, James D. Modern approaches to
theory in administration, in Andrew W.
Halpin, ed., Administrative Theory in Edu-
cation. Chicago, Midwest Administration
Center, 1958.
Conference Board Reports. Improving staff and
line relationships. Studies in Personnel Pol-
icy. No. 153. New York, National Industrial
Conference Board. 1956. CI
THE CANADIAN NURSE 37
Psoriasis —
the stubborn malady
This common skin disease has continued to baffle dermatologists throughout the
years. Its cause is unknown, and although treatment usually brings about a
remission, exacerbations are frequent.
Of the many skin diseases affecting
man, psoriasis is perhaps the most frustrat-
ing - to patients and staff - if for no
other reasons than it is extremely com-
mon, has an unknown etiology, and tends
to recur, even after successful treatment.
Neither sex is immune to this non-
contagious dermatological problem, al-
though men seem to be affected more
frequently than women. The disease can
occur at any age, but most lesions present
tliemselves between the ages of 10 and 50
years. Approximately 25 percent of per-
sons with psoriasis have a family history
of the disease.
The extent of an individual's psoriasis
varies from a single, relatively untrouble-
some lesion to multiple lesions that re-
quire intensive treatment in hospital. In
either case the person is justifiably dis-
turbed by the appearance of this unsight-
ly disease, and needs assurance that this
malady will respond to treatment.
What is it?
Essentially, psoriasis is a disease of
epidermal hyperplasia and is manifested
clinically by excessive production of
scale. This tliickened epidermis may re-
place itself six or seven times more
rapidly than the thinner epidermis of
normal skin.
Individual lesions consist of well-
circumscribed plaques of dry, scaly ery-
thema. Generally chronic patches of pso-
riasis have thick scales, whereas the acute
38 THE CANADIAN NURSE
Alida Silverthorn, B.S.N.
lesions tend to be more red, shiny, with
less scale.
The scales are distinctive, having a
silvery sheen and flaking off like pieces of
mica when the surface is rubbed. If scale
is gently removed by scraping, minute
bleeding puncta are often noted (Auspitz
sign).
Lesions may develop in a scratch
mark, surgical incision, or skin test site
(Koebner phenomenon). There is marked
predilection for certain areas of the body,
including scalp, regions over the elbows,
knees, and lower part of the back; how-
ever other parts of the body are often
affected and the disease may become
generalized.
Psoriasis is extremely variable in its
duration and course. A single lesion may
persist for a lifetime or many lesions may
be present, disappear, and recur. Some
patients are never completely free of the
disease, whereas others may experience
long remissions. Most patients are better
in summer, particularly if they expose
their lesions to sunlight. When individual
lesions disappear, they leave no scar.
Attacks and exacerbations may be pre-
cipitated by emotional stress, infection in
some other part of the body, injury to
the skin, and pregnancy.
Miss Silverthorn, a graduate of the University of
Saskatchewan School of Nursing, is Head Nurse
on a medical unit at the Foothills Hospital,
Gilgary, Alberta.
Artliritis is a complication that ac-
companies psoriasis in 5 to 10 percent of
patients; it may precede, follow, or occur
at the same time as the psoriasis. 1 This
complication resembles rheumatoid
arthritis, but tests for the rheumatoid
factor are usually negative.
Nail changes occur in the more severe
cases of psoriasis. These include pitting,
particularly in the fingernails; and ridging,
with thick, horny material under the nail
plate - found mostly in the toenails.2
Pruritis is usually slight, but occasionally
troublesome.
How psoriasis is treated
Individual patients vary in their res-
ponse to different types of treatment, but
on the whole therapy is usually satisfacto-
ry. External treatment, consisting of
crude coal tar and ultraviolet light
(Goeckerman therapy) has the most ef-
fect. Acute cases in which the lesions are
widespread and inflammatory are treated
with bland applications until the disease
has ceased to erupt, at which time routine
measures are started.
Local applications of cortisone creams
or ointments, with Saran Wrap used for
occlusive dressings, offer some relief. This
is often a treatment of choice for home
use.
Methotrexate, an antimitotic drug and
folic acid antagonist, can have a dramatic
effect in certain carefully-selected pa-
tients who have severe psoriasis that has
NOVEMBER 1%9
Application of occlusive dressing over previously applied
steroid cream.
Foothills nursing student applies a steroid solution to psoriatic
areas on the scalp.
not responded to other methods of treat-
ment. The rationale is to reduce the
mitotic activity of the psoriatic epiderm-
is, which is responsible for the scaling.
Another drug that interferes with normal
cell division, 6 mercapto-purine, is used in
some centers.
Goeckerman therapy
The Goeckerman regimen of crude
coal tar applications to all skin areas
followed by ultraviolet Ught radiation
(UVL) is still the basic treatment for
patients hospitalized with severe psoriasis.
This therapy, as employed at Foothills
Hospital in Calgary, Alberta, consists of
applications of 5 percent crude coal tar in
'Vaseline' petroleum jelly to the entire
skin two times daily, plus 0.25 percent
Anthralin to the plaques only. The oint-
ments are applied at bedtime after a
shower is taken, and the affected area is
thoroughly scrubbed with soap, water,
and brush.
In the morning the excess tar is remov-
ed from the skin by wiping it with a
gauze or cotton pad saturated in mineral
oil. The patient takes a bath or sliower,
then goes to physiotherapy where he
receives UVL. Two hours after UVL
treatment, tar and Anthrahn are again
applied. The patient wears the same
"Johnny" shirt and pyjama bottoms and
uses the same bed linen for a week at a
time.
Immediate or delayed complications
NOVEMBER 1%9
from this therapy are infrequent. Most
troublesome is the development of follic-
uhtis in a few patients, but this reaction
subsides promptly if the use of the tar is
discontinued.
Psoriasis also responds to both tar and
UVL therapy when each is administered
separately. The benefit achieved when
these treatments are employed together
may be that the tar acts as a photosen-
sitizer.
An average period of treatment is from
12 to 18 days. Generally, the longer the
period of hospitalization, the greater the
degree of clinical improvement. The
Goeckerman regimen is not proposed as a
cure for psoriasis.
Ultraviolet light therapy
Ultraviolet rays, when absorbed in the
skin, cause chemical actions that result in
irritation and destruction of cells. This
causes liberation of the "H" substance,
which produces the triple response in a
similar manner to histamine: 1. dilata-
tion of the capillaries; 2. dilatation of the
arterioles; and 3. exudation of fluid into
the tissues. Depending on the strength of
irradiation, reddening of the skin to
formation of blisters may result.
After several treatments of UVL, the
patient may appear very sunburned, even
to the point of blistering. Analgesics may
be required for discomfort.
The initial erythema tolerance to UVL
treatment can be determined by test dose
which is read after eight hours. Factors
that may alter the erythema response
include increase in melanin pigmentation,
increased thickness of the strateum cor-
neum, and concentration of urocanic acid
in the epidermis. A daily increase of 30
percent to 50 percent usually produces
the desired intensity.
AH affected parts of the body are
treated, and individual large plaques are
shielded from the normal skin. To mask
the areas of good skin, we use a barrier
cream of RV Plus (titanium oxide 30
percent in a petrolatum base).
In treating these patients, we use
mercury arc lamps. Neon lamps or mer-
cury arc lamps are common examples of
light production by an electrical discharge
through a gas or vap)or. Mercury is a
heavy metallic element, which is normally
liquid. When in an electric arc, its elec-
trons are easily raised to energy states
that permit the emission of line spectrum
with radiant energy concentrated mostly
in the ultraviolet. Since mercury is
comparatively inert and does not react
appreciably with electrode materials or
glass, it is ideally suited for use as a
source of ultraviolet.
The pressure of mercury vapor in
lamps is determined by the temperature.
A low pressure of the order of 0.001
atmosphere in "cold quartz lamps" has a
temperature of 60oC. In this lamp, the
lines are very sharp and more than 90
percent of the energy is concentrated in
THE CANADIAN NURSE 39
the two wavelengths, 2537 angstroms
(Au.) and 1849 Au. wavelength. If other-
wise transmitted, the 1849 Au. line is
absorbed by oxygen in the air to form the
toxic gases ozone and oxides of nitrogen.
Since the 2537 Au. line is near the peak
of maximal bactericidal activity, these
lamps are ideal for the purpose of des-
troying the airborne and surface bacteria,
viruses, yeasts, and molds.
Low pressure mercury lamps provide
the basic requirements upon which the
production of light by fluorescent lamps
depends. The phenomenon of fluores-
cence is due to the fact that certain
substances (phosphors) have the property
of absorbing light of comparatively high
frequencies and re-emitting it as light
within a limited range of lower frequen-
cies.
Through the proper selection and com-
bination of various phosphors, it has been
possible to develop a fluorescent sunlamp
that radiates energy in the 2800 to 3500
Au. wavelength band. (In the fluorescent
lamps employed for illumination, the
2537 Au. wavelength emitted by the low
pressure mercury arc is turned into visible
light by a fluorescent material that covers
the inner surface of the lamp wall). Initial
Ultraviolet light therapy. Note the barrier cream on the patient's leg. This is applied to
exclude the normal skin areas.
/
treatments for Goeckerman therapy may
be started out by using a fluorescent
lamp.
Therapy usually successful
Following this regimen, the patient
usually looks and feels considerably
better. He needs the nurse's help in
accepting his appearance and in realizing
that he may have a recurrence of the
disease. Usually he can face this when he
realizes that intensive therapy in hospital
will produce a remission.
References
1. Beeson, P. and McDermott, W., eds. Cecil
- Loeb Textbook of Medicine. Philadel-
phia and London, W.B. Saunders, 1963,
p. 1486-148'/.
2. Munro, D.D. Psoriasis. Nursing Times
64:26:867-71, June 28, 1968.
Bibliography
Borrie, P. Roxburgh's Common Skin Diseases,
13th ed. London, H.K. Lewis & Co. Ltd.,
1967.
Lewis, Wheeler. Practical Dermatology. 3rd ed.
Philadelphia and London, W.B. Saunders
Co., 1967.
Perry, H.O., Soderstrom, C.W., and Schulze,
R.W. The Goeckerman treatment for pso-
riasis, Rochester Minnesota. Archives Of
Dermatology. Aug. 1968, vol. 98, no. 2.
McGrae, J.D. and Perry, H.O. Physics of light
sources, Rochester, Minnesota. Dermato-
Venereologica, 1963, vol. 43.
Scott, P.M. Claytons Electrotherapy and
Actinotherapy. London, Bailliere, Tindall
and Cox, 1962. □
M~A .
40 THE CANADIAN NURSE
Aging and learning
Our youth-oriented western society seems to accept the idea that aging is
accompanied by intellectual deterioration. There is evidence, however, that
intellectual and manual skills may be learned and maintained well into old age.
Monica D. Angus, R.N., M.A.
Aging begins when a person has reach-
ed his growth potential, usually around
18 to 22 years. The process varies from
person to person, but is universal and
irreversible.
Our society generally assumes that as a
person's physical performance slows
down, his intellectual ability also deterio-
rates. However, there is now evidence
that adults can learn as well and as easily
as adolescents, given suitable conditions.
These conditions can be discovered
through a careful study of the adult, his
physiology, and his society.
We do not know exactly how aging
comes about. Most researchers in the
human biological field agree that the
potential duration of life probably is an
inherited trait. Some believe this trait,
possibly centered in one of the genes that
govern the development of the metabolic
process, determines which of us will
experience the various aspects of the total
process, and at what age.
To those concerned with adult learn-
ing and the bearing age has on learning,
the theories of aging, although interest-
ing, are not particularly important. The
important concerns are the physiological
changes that affect learning as the human
organism passes maturity. Some of these
can be established reasonably clearly,
although many of their causes cannot.
For example, we know that certain
changes do occur with age in the eyes,
bone, muscle, hair, ears, cells, and in the
■NOVEMBER 1%9
cholesterol level, sense of smell, respirato-
ry adaptation, and physical activity of the
individual. We know, too, that there is
some dulling of the senses of tactile and
painful stimuli as one grows older.
Physical changes
Some of the changes that take place
are visible to the naked eye, others are
not. We also must distinguish between the
changes that are the result of aging and
those that are the result of antecedent
disease process. Once these distinctions
are made, some attention can be given to
those changes that have some bearing on
the performance of the adult and his
learning ability.
Changes in sensory organs, particularly
the eye and the auditory apparatus, are
significant to the older person's ability to
learn. Both seeing and hearing become
less acute with advancing age.
The eye, unlike many other organs,
reaches full size early, at about two years
of age. Changes in the eye begin about
the age of 18 to 22. The eye appears to
grow smaller as a person ages, because of
loss of fat behind the eyeball. The lids
tend to droop because of the inelasticity
Mrs. Angus, a graduate of St. Paul's Hospital in
Vancouver and the University of British Colum-
bia, is President of the Registered Nurses'
Association of British Columbia. This article is
an adaptation of a research paper she wrote this
year while studying for her master's degree.
of skin of the folds above the eye. The
color of the iris fades and the size and
mobility of the pupil diminish.
The visual field gradually becomes
smaller and the power of adaptation to
dark is slowed. Farsightedness, or presby-
opia, may appear in the fifth decade or
later, but it is a universal affliction that
comes with age as a result of inelasticity
of the lens of the eye. Cataract and
glaucoma, chief causes of blindness in old
age, seem to have a hereditary base.
Welford concludes it is unlikely that
optical defects of the eye are the sole
cause of poorer differential sensitivity in
older people. 1 He suggests that extended
viewing time be given to adult students,
and that the educator must be prepared
to call the other senses into play when
teaching adults.
Hearing also becomes less acute with
age, although for most people no notice-
able changes occur until after 40. Some
believe that aging women lose hearing for
low tones, however all data collected
indicate that for both sexes aging brings
mainly a loss of ability to hear high tones.
There is evidence that changes in the
receptor nerves of the inner ear are
almost universal after 65.2 Nq cure has
been found for the loss resulting from
these changes. High levels of noise have
relatively little effect on hearing by peo-
ple with nerve deafness; therefore older
people may work better than persons
with normal hearing in situations where
THE CANADIAN NURSE 41
the noise level is high.
Another possible factor affecting
learning by adults is the "signal ratio,"
(the ratio of brain signals to noise level).
This theory is that in middle and old age
the number of functional brain cells is
substantially reduced as many cells die
and are replaced with non-nerve tissue,
with subsequent decrease in the weight of
the brain3. Obrist found a general lowering
of activity and slowing of the dominant
rhythms in electroencephalograms done
on older people. There was, however,
some increase in random activity. The
conclusion drawn is that anything done
to improve the signal to noise ratio will
improve the performance of the older
person, but not the younger person. Care
must be taken, however, to insure that
the subject's sensory mechanisms are not
overloaded.
Much of the research suggests that
illness and its consequences have a bear-
ing on the adult's ability to learn. Older
persons are much more subject to multi-
ple chronic conditions than younger per-
sons, and injuries that occurred earlier in
life add a tremendous burden as age
increases. Those concerned with the
problems of the older person cannot help
but be convinced that preventive health
measures are of paramount importance.
Psychological factors of aging
The psychological factors of aging
must also be taken into account. JustiU
proposes that the primary cause of the
characteristic psychological changes asso-
ciated with senescence — poor short-
term memory, pronounced conservatism,
diminished interest in new events, rigidi-
ty, reduced perception, and a good mem-
ory for distant events - lies in the pro-
gressive reduction in central excitability
that occurs with age.'* The consequence is
a domination of past events over current
behavior, together with marked limita-
tions in the amount of information that
can be handled by the brain. This does
not mean that there will be any differ-
ence in the modes of thought.
Reminiscing in the older person has
been found to be unrelated to the level of
intellectual competence. Levin and Kaha-
na beUeve that the function of reminisc-
ing in the old is to shorten the span
between the past and the present .5 They
point out that sick persons are not able to
reminisce.
42 THE CANADIAN NURSE
One of the accepted traits of adult-
hood is that as people grow older they
become more rigid. Chown, however,
claims that rigidity cannot be generalized
from one situation to another because
there are many components of rigidity. ^
There are positive qualities of adult
Ufe or maturity to consider as well. The
shift from adolescence to adulthood is
supposed to bring with it greater emo-
tional stability, more equilibrium in
mood, more integration of ego processes,
greater feelings of autonomy and stabili-
ty, and greater extroversion. Cattell
shows in his experiments that there is a
consistent improvement in adjustment to
life between ages 15 and 55,' and this
view does not conflict with experiments
done in the areas of man's view of
himself. When asked, adults consistently
say that 40 is the prime of life. We note
all of these admirable qualities of adult-
hood, but our youth-oriented society's
view of the aging person is not nearly as
complimentary.
Some medical experts believe that
various psychological factors, such as our
negative view of older persons and their
resulting loss of self-esteem, can have
profound effects on the person's physical
condition. This hnk between emotional
illness and physical pathology suggests
that psychological factors may speed up
the rate of physical decline in older
people. Certainly both physical pathology
and psychopathology have a pronounced
and detrimental effect on learning.
The suicide rate for older persons is
evidence of this loss of self-esteem. There
is a sharp inrease in suicide in middle age
and a further increase with advancing age,
the latter trend being more pronounced
in men than in women. Although crude
rates for suicide have decreased in most
nations in the past 50 years, the rates for
older persons, particularly women, have
NOVEMBER 1%9
increased. There has been no drop in
these rates since government-sponsored
welfare schemes for the aged have begun,
suggesting that economic factors are not
the only ones involved.
Data on suicide indicate that predis-
posing causes for suicide in the younger
age groups were largely in the area of
personal relations, particularly marital
and family quarrels. These causes became
less important in middle age, and much
less so in old age. The opposite occurred
in physical illness, which was judged by
one researcher to have contributed to 35
percent of cases of suicide of the elderly.
For older men, retirement seems to be an
important causal factor in suicide,
although for men of wealth it presents
less of a problem. Presumably they go on
to other hobbies and endeavors. The
socioeconomic factor associated with re-
tirement and suicide was apparent only
for the lower income groups.
Learning by adults
Considering the diminished physical
capacity of adults, is there a reduction in
the adult's intellectual or cognitive per-
formance? The evidence indicates a de-
cline in speed and flexibility of compre-
hension, but no decUne in the power to
perform intellectual exercises. The forma-
tion of new associations is slower, but the
power of reasoning and judgment, as well
as the area of general information and
vocabulary, do not decrease with
age - in fact, there is evidence they
increase.
Some intelligence tests given in adult-
hood indicate that, contrary to the find-
ings of Terman and others,^ intelligence
does not decrease after 16 years of age,
but rather increases.^ However, the test-
ers make it clear that researchers should
not present conclusions about the growth
of intelligence unless the type of intelli-
gence and the method of measuring it is
q)ecified.
Speaking specifically of intellectual
performance, Birren states: "One gathers
from existing evidence that there is no
gradual decline with age in general mental
abiHty. The only aspect of mental perform-
ance that seems to change in most
persons is that of slowing speed of re-
sponse."1° This researcher attempts to
tie in intellectual functioning with surviv-
al in the older person. His expectation is
that given good health and freedom from
NOVEMBER 1%9
cerebrovascular disease and senile demen-
tia, individuals can expect a high level of
mental competence beyond the age of 80.
All the evidence indicates that there is
increasing variability among individuals
with increasing age.
Reference is made repeatedly in the
literature to the pacing of adults. There is
considerable evidence that adults do not
perform well on timed tests. They prefer
to have time to mull over problems and
weigh evidence before reaching a conclu-
sion. However, when they perform on the
basis of accurate completion, they do as
well as, and sometimes better than,
younger subjects. The implications for
persons who teach adults should be ob-
vious: adults must be given time to
complete new tasks and must not be
evaluated on the basis of speed of re-
sponse. If this principle is followed, and
provided the task is not beyond the
capability of the subject, an adult's abili-
ty to learn should be as good as a young
person's.
McGeoch and Irion postulated the
theory that learning as a skill can itself be
learned and maintained by continued
exercise. 1 1 They believe the difficulties
of learning by older people are due to
disuse of this ability.
Interruptions in learning are also a
hindrance to adults. Indications are that
when learning a new skill, any disruption
of the process will slow the performance
of an older person, but not of a younger
person. However, when an adult has
acquired a particular skill, his perform-
ance at times may be greater than that of
a younger person working at the same
job, providing the job is not beyond his
physical capability.
Educators should keep in mind that
adults prefer to expand the sensory
stimuli when dealing with objects. They
need time to see, touch, smell, and hear.
Similarly, persons teaching adults
should keep in mind the diminished
eyesight and hearing of some adults. They
should compensate by using large letter-
ing on blackboards, speaking clearly,
making full use of visual aids, and avoid-
ing poor tapes, poor speakers, and, espe-
cially with elderly people, speakers with
high-pitched voices.
Summary
The greatest problem that adult educa-
tors must deal with is the negative cultur-
al view of aging in western society. AU
persons involved in teaching adults must
have a realistic and positive view toward
their students. When one considers that
the years left to an individual after
maturity are almost three-quarters of his
life-span, and that the years of decline are
long and protracted, it is easy to be
optimistic about the adult's ability to
learn. Scientific evidence indicates that
adults who continue to use their intellec-
tual and manual skills tend to preserve
performance, and those who do not
exercise these skills tend to lose their
ability. Barring physical illness, the adult
should be able to continue to learn until
debility sets in. Clearly, there is a case for
continuing adult education.
References
1. Welford, A.T. Aging and Human Skill. Lon-
don, Oxford University Press, 1958, p.l53.
2. Boas, Ernst and Boas, Norman F. Add Life
To Your Years. New York, The John Day
Co., 1963, p.204.
3. Ibid., p. 159.
4. Justill, W.A. The Electroencephalogram of
the Frontal Lobes and Abstract Behavior in
Old Age, in Medical and Clinical Aspects of
Aging, ed. Hermen T. Blumenthal. New
York, Columbia University Press, 1962,
pp.567-593.
5. Levin, Sidney, and Kahana, Ralph. Psycho-
dynamic Studies on Aging. New York, Inter-
national Universities Press Inc., 1967, p.68.
6. Chown, Sheila M. Rigidity - a flexible
concept. Psychological Bulletin
56:3:195-225, May 1959.
7. Cattell, R.B. Personality and Maturation
Structure and Measurement. New York,
World, 1957.
8. Terman, L.M., and Oden, M.H. The Gifted
Group at Mid-life. California, Stanford
University Press, 1959.
9. Birren, James E. Relations of Development
and Aging. Springfield, Illinois, Charles C.
Thomas, 1964, p. 148.
10. Birren, James E. Psychological aspects of
aging: intellectual functioning. The Geron-
tologist vol.8, no. 2, part 11, Spring 1968,
pp. 16- 19.
11. McGeoch, J. and Irion, A. The Psychology
of Human Learning, 2nd. ed. New York,
Longmans Green and Co., 1952, xxii p.596.
D
THE CANADIAN NURSE 43
The minis have it!
How micro-teaching was used to help prepare teachers of nursing.
E. Jean M. Hill, R.N., Ed.D.
At Queen's University, the fifth year
of the baccalaureate program in nursing
for post-RN students always has included
practice teaching. The amount of ex-
perience, however, has varied from teach-
ing one class in hygiene in a local high
school to teaching several classes in a
selected diploma school of nursing.
Because of the number of students and
the location of the cooperating schools,
little direct supervision has been provided
by the university faculty. Although some
of this practice teaching appeared valu-
able, the faculty in nursing believed that
all planned learning experiences should be
guided and evaluated by university teach-
ers.
Most of our post-RN students anti-
cipate appointments as junior instructors
on graduation. As the spring term pro-
gresses, they become increasingly moti-
vated to acquire technical skills in teach-
ing and to acquire a little "know how."
The faculty, too, want these students to
develop a beginning competence in teach-
ing. However, the heavy course load
carried by students has made concurrent
practice in teaching impractical.
Last year, a three-week workshop was
proposed and a joint committee of facul-
ty and student volunteers organized to
plan it. The goal of the workshop was to
develop confidence in the ability to
select, organize, and present content in a
small group or laboratory setting.
Since the workshop was to be stu-
dent-centered, considerable responsibility
was given to the student committee mem-
bers. Initially, they compiled Usts of
desired activities from which the faculty
helped them to state objectives in behav-
ioral terms and to select experiences
possible within the time available. A
tentative guide for evaluation of teaching
was composed by the faculty. Time was
allocated from the class schedule to
enable the student committee members
to present their plans for the workshop to
the total class; this presentation, well
organized and enthusiastically given, elici-
ted the desired support. At this point,
examinations were imminent and the
faculty assumed the administrative re-
sponsibility for implementing the plans.
44 THE CANADIAN NURSE
Micro-teaching*
The McArthur College of Education at
Queen's had been using micro-teaching in
the preparation of teachers for element-
ary and secondary schools for some time.
It seemed natural, therefore, to use a
similar experience in preparing teachers
for schools of nursing. With some assist-
ance from College personnel, the students
were able to use episodes or "mini-
episodes" taken from the teaching plans
they had developed during the spring
term.
Financial aspects had to be considered
too. Although some equipment could be
borrowed without cost, the budget was
insufficient to cover the expense of vi-
deo-tapes and the salaries of technicians.
Therefore, it was decided to use audio
tapes only, and portable recorders were
borrowed for each classroom. The usual
classroom equipment was available and
special equipment was borrowed as the
need arose. A further modification was
made in using classmates as learner-
evaluators, rather than recruiting and
paying students from diploma schools.
At this point, the class was divided
into four groups, with six students in
each group: one student-teacher, one
process evaluator, and four participant
learners. A faculty member in each group
acted as consultant, resource person, ad-
viser, and general morale booster. The
groups were left intact throughout the
three weeks while the faculty adviser
rotated on schedule.
Each student taught one cycle of
teach-reteach each week and each had
one experience as process evaluator each
week. Prior to each episode, the student-
teacher gave her objectives for the epi-
sode and the level of the learner for
whom the lesson was planned.
The cycle consisted of a 10- to 15-
minute episode followed by a 20- to
30-minute evaluation conference with the
learners, the student evaluator and the
faculty advisor participating. The tape
recordings were used diagnostically to
Dr. Hill, a graduate of Yale University School
of Nursing and Columbia University, is Dean of
the School of Nursing, Queen's University,
Kingston, Ontario.
identify the strengths as well as the
weaknesses in the teaching process and
the content organization. Suggestions for
revision were made, then the student-
teacher was given 30 minutes in which to
restructure her presentation before re-
teaching the episode. The reteaching epi-
sode also was critically evaluated in the
light of suggestions offered. The evalu-
ation guide was used for both teaching
and reteaching sessions.
The faculty advisers were impressed
with the poise of the students during
teaching episodes and the depth of in-
volvement of the student-learners and
evaluators. Although praise was given
freely by classmates, analysis was made of
factors contributing to both successful
and unsuccessful teaching. It was not
unsual to hear comments such as:
"Quite frankly, I don't know what
you wanted from your question." "You
mean, I didn't give you sufficient struc-
ture to answer that question? "
"Your introduction really set the stage
for the lesson - it really got us involv-
ed."
"Listen to all those convergent ques-
tions - Don't you want to involve us in
creative problem-solving? "
"Had you given us all that material in
your lesson plan before the demonstra-
tions, I'd have been bored."
With only 30 minutes for replanning,
the amount of improvement demonstrat-
ed was gratifying.
Favorable reaction
The reaction of the students to the
experience of micro-teaching was mixed,
but generally favorable. They were tired
at the end of the year and suffered from
the let-down feehng that accompanies
final examinations. They had feared bore-
dom with reteaching the same content to
*Micro-teaching, according to J. Fortune, J.
Cooper, and D. Allen an article "The Stanford
Summer Micro-Teaching Clinic, 1965" in
Teaching Methods and Materials vol. XVIII, no.
4, Winter 1967, is: "a scaled-down teaching
encounter... developed at Stanford University
to serve three purposes: 1. as preUminary
experience and practice in teaching; 2. as a
research vehicle to explore training effects
under controlled conditions; and 3. as an in-
service training instrument for experienced
teachers. In micro-teaching, the trainees are
exposed to the variables in classroom teaching
without being overwhelmed by the complexity
of the situation. They are required to teach
brief lessons ... to a small group of pupUs ....
These brief lessons allow opportunity for in-
tense supervision, video-tape recording for
immediate feedback, and the collection and
utilization of student feedback."
NOVEMBER 1%9
the same learners, but this did not occur
until the third week. Students expressed
pleasure in the self-confidence they gain-
ed through the experience; they looked
like teachers to their classmates and it
was possible for them to see themselves as
successful in a role they both desired and
feared. The anxieties and qualms so ap-
parent to the individual were not rec-
ognized by their classmates. The trust
developed within the small group enabled
the student-teachers to be innovative.
Perhaps the greatest value lay in the
immediate feedback. "You taught your
lesson and the evaluation occurred."
"The mini-episode facilitated review and
remodeling. It was easier to cope with a
15-minute episode than a total class, yet
the insight gained might enable one to
undertake the more complex activity."
The concrete experience in the teach-
ing workshop seemed to crystaUize the
theory studied during the academic year.
Students found that the workshop sharp-
ened their perception of the teaching
process; they developed a way of looking
at it, of analyzing and identifying acts
that were successful or unsuccessful. The
probability of transfer to full-scale team
planning and teaching was discussed.
Suggestions for the future were freely
offered. It might have been more effec-
tive to space practice over the spring term
rather than concentrate it into a few
weeks. On the other hand, a workshop
eliminates the distractions of other course
requirements. Since the workshop ac-
tivities were not graded, students felt free
to experiment, and anxieties about suc-
cess or failure were reduced. If the
practice were part of the course, this
value might be lost. The concentrated
experience in small groups seemed to
contribute to the development of trust
among class members, which enabled
them to offer and accept critical evalua-
tion as a means of promoting growth.
Was it worth while? The students and
faculty agreed wholeheartedly as to the
value of the experience. It had been
exhausting but stimulating, and students
felt they could face the future with a
greater degree of confidence. Although
practice with teaching whole lessons
would have increased the preparedness of
students, episode teaching had distinct
advantages over the previous practice. In
our opinion the minis have it!
Reaction of students who helped
plan workshop at Queen's . . .
lane Kirkpatrick
To understand our feelings as students
participating in the student-faculty plan-
ning committee of the teaching work-
shop, it is necessary to know something
of the teacher-learner working relation-
ship that developed during the school
year.
From the beginning we were encourag-
ed to express our own ideas on education.
The first question we were asked was,
"What do you expect to learn from this
course? " Much of the course was then
designed on the basis of our expectations.
At first we were frustrated by this
permissive atmosphere. It seemed we
lacked direction from our teachers and
had no inner resources to establish that
direction for ourselves. To alleviate these
feelings, some students grouped together
to set up a student-faculty committee "to
establish an efficient and organized chan-
nel of communication between the facul-
ty and students to promote optimum
learning."
Matters of student concern regarding
curriculum, student opinions, and ideas
were chaimeled to this committee and
discussed at length. Student members
freely expressed their ideas and the facul-
ty advisors accepted and used these ideas
when planning their classes. The work-
shop and its committee, therefore, had a
strong background for the subsequent
working relationship between faculty and
students.
It is difficult to summarize our reac-
tions to our involvement in the workshop
planning, since this was such a personal
experience for the six of us on the
committee. We all experienced a change
in our feelings, however, a change that
reflected itself in our mounting enthusi-
asm.
We were motivated to volunteer as
student members of this committee by
our increasing need to acquire some
practical skills in the application of our
educational theory and to gain an under-
standing of how to plan a workshop. By
participating, we hoped to gain in our
personal development and to overcome
some of our discontent with the theoreti-
cal orientation of the course.
NOVEMBER 1%9
During our first sessions with the dean
and faculty members, we felt constrained
to silence. This planning committee seem-
ed only a nominal one and what we said
was dominated by our instructors' ideas.
It was a two-way fault: our inability to
decide and express clearly what we want-
ed as students, and their inability to
understand our unstructured ideas.
This carried on for several weeks to
the point that our frustration, anxiety,
and hostility drove us to create a tenta-
tive plan. Our vacillating at the beginning
may have been due to our unclear goals
for the workshop. Although we resented
faculty domination, we wanted more
concrete guidance on how to set up
objectives and plan activities.
Despite the pressure of final exams,
the end of term, and lack of subsequent
time to devote to the planning, we finally
put our ideas into a tentative outUne. We
hoped that this plan would be acceptable
to our classmates and to the faculty. To
our surprise, it was adopted with little
opposition. At this point our planning
efforts ended, and faculty members were
left to implement some of the ideas.
Following exams and throughout the
workshop itself, the planning continued.
Committee meetings were more relaxed
and we felt confident about expressing
our own ideas. Most of the offerings
seemed to come from us, but at the same
time we did not reject faculty ideas.
Finally, our plans and ideas crystallized
into the workshop.
Being a part of this workshop in its
planning stages and as participating stu-
dents, we felt capable to evaluate it and
refine the plans. The other students seem-
ed to appreciate our efforts and openly
expressed their ideas in class as well.
From this experience we developed
insight into ourselves as we learned to
assume responsibility, a working know-
ledge of planning a workshop, and an
understanding of how to work with
others. Above all we became more con-
fident about our ability to express our
own ideas and to function within nursing
education. D
THE CANADIAN NURSE 45
Two-year-old Michael
— ill and in hospital
The pediatric ward has many faces: a swollen, tear-streaked face staring wide-eyed
from behind the crib bars; a blank, unsmiling face withdrawn to a corner of the
crib; a smilingly invulnerable face bouncing about the playroom. Almost every child
in hospital is one of these faces during his stay. Why? Is this pain of separation,
loneliness and fear necessary? What mark does it leave on a child and his parents
after discharge?
During a follow-up visit to the home
of a two-year-old I had cared for in
hospital, his mother commented to me:
"If you had walked in the door wearing a
white uniform, I'm sure Michael would
have run in the opposite direction." This
statement is revealing: how does a two-
year-old perceive a nurse? Are we nurses
doing everything within our power to
lessen the trauma of hospitalization?
Michael was admitted to hospital with
difficulty in breathing and an elevated
temperature. From his admission records,
I noticed that auscultation revealed a
marked decrease in air entry over the
complete right chest. Concordantly, ad-
mission chest x-rays showed an area of
consolidation involving the right middle
lobe. All facts pointed toward a provi-
sional diagnosis of obstructive emphyse-
ma due to aspiration of a foreign body.
On admission, it was learned that he had
been chewing peanuts just prior to his
respiratory difficulty. Michael had proba-
bly choked on the peanut and it had
become lodged in his right bronchus.
Nursing care consisted of close obser-
vation of respirations and vital signs. The
day following admission, Michael showed
signs of pneumonitis, characterized by a
continued elevated temperature, nasal dis-
charge, and persistent cough. Blood tests
indicated an elevation in sedimentation
rate and white blood cell count. A bron-
choscopy to remove the peanut was done.
It was on the day following this treat-
ment that I first met Michael.
46 THE CANADIAN NURSE
Robin Burnie
What a mournful looking little boy!
He sat at the far end of his crib, hugging
one of the rails. He was covered from
head to toe m cereal, and his eyes were
caked with "sleepy-dust." He was looking
around and seemed to be wondering why
the other children were getting washed
while he was being ignored.
I sensed that Michael's emotional
needs at this point far exceeded his
physical needs. He needed someone to
hold, someone to comfort him; he needed
his mother, but she did not come when
he called. Michael was alone in a strange
world where he was locked into a crib
and people pushed and poked and hurt
him; he could not understand why. The
way in which Michael dealt with the
stress of hospitalization could determine
his future response to stress in general. 1
Would he conquer it or would it conquer
him?
There had been a sequence of separa-
tions that compounded Michael's hurt.
His parents had gone away for a few days
and had left him with a friend. Just after
they returned, Michael had to be hospital-
ized. They could not find time to visit
him often because they lived some dis-
tance from the hospital. They had two
other small children, and Mr. D. worked
late hours. Once, when they did manage
Miss Burnie is a third-year student in the
baccalaureate program in nursing at McMaster
University, Hamilton, Ontario.
to visit Michael, they arrived 10 minutes
past visiting hours and were not allowed
to see him.
Small wonder Michael's world of love
and security had collapsed. His trust had
been betrayed and he mourned deeply for
his mother. Withdrawal, rejection, and
apathy became his defense mechanism as
he began to adjust to this new situation.
I realized that Michael was emotional-
ly and physically drained. It was up to me
to give to him and to expect Uttle in
return. By being with him as much as
possible, by withholding my desire to
reach out and hold him, by waiting until
he reached out to me for comfort, I
hoped to bridge this gap in the trust that
was so essential for his future growth and
development.
On his own terms
I tried to meet Michael on his own
terms. At first I did not touch him, but
merely talked to him, giving him time to
adjust to a new face, a new voice, a new
intruder. He said nothing and ignored me.
When I bathed him, he responded me-
chanically. But when I changed his diaper
his legs shot straight up. I had found an
act that provided comfort; it was a
familiar ritual associated with the memo-
ry of Mommy, warmth, dryness, and
cuddling. It was at this moment that I
realized how little I knew about Michael.
How 1 wished that there was back-
ground information on his chart! Did
Michael dress himself, feed himself, talk?
NOVEMBER 1%9
Was he toilet trained? Was the dog in his
crib his favorite toy? So many questions
were unanswered and each one could
have helped me to help Michael. As it
was, observations were my only guide.
During that first morning I observed
many situations characterized by Mi-
chael's seeming depression. When he sat
with the other cliildren in front of the
television, he was a passive observer.
When I took him for his x-ray, he sat in
his wheelchair tightly hugging his dog,
ignoring approaches by the personnel. All
these people came and went; there was no
constant person to unify his experiences.
They asked Michael to give of himself,
but then they left him, just like Mommy
had done.
I tried to counteract this negative
force by taking a long time in bathing
Michael that morning, playing "peek-a-
boo" and other games. At refreshment
time I helped Michael drink his juice and
then suggested we color a bunny rabbit
on the paper cup. Michael sat on my lap
while we colored. When the medication
nurse came to give him a tubercuhn test
needle, he stayed on my lap, and I held
him until he seemed to have forgotten the
hurt. Later, I held him for his chest
x-rays.
It was on our return from the x-ray
department that Michael spotted his
mother, grandmother, brother and sister
sitting in the hallway outside the ward.
His face lit up. I suggested we go to his
crib, but I made the mistake of turning
NOVEMBER 1%9
the wheelchair away from his mother.
Michael reacted to this visual separation
by screaming. I took him from his chair
and Mrs. D. carried him to his crib. She
held him close and he cried quietly,
expressing all his pent-up emotions in the
security of his mother's arms.
Mrs. D. seemed bewildered by Mi-
chael's reaction. She told me that he
talked non-stop at home: "I've never seen
him like this before — so quiet — it's
like the end of the world has come." I
hoped that by talking with her I could
help Mrs. D. feel more relaxed and make
the present experience less cold and
frightening. I explained to her that this
was his way of adjusting to hospitaliza-
tion; that it was a normal defense mecha-
nism used by many children in adapting
to stressful situations.
Meeting Michael's mother was benefi-
cial to both of us because, in turn, Mrs. D.
was able to give me some details about
Michael at home. I learned that he talked
in sentences; he was outgoing; that his
toy dog's name was Poochy. If there had
been a more suitable place to talk, I'm
sure we could have discussed many more
things.
Also, I think Michael was confused by
having his brother and sister in sight,
without being able to play with them.
They are both close to Michael's age and
are constant companions at home. A
meeting with them would have been
healthier for the whole family.
What a change in Michael the follow-
ing day! It was as though he had read a
book on separation anxiety and was
following the expected pattern of adjust-
ment. When I first noticed him, he was
sitting in his crib with his bib on, and he
was smiling. He set to his breakfast
readily, accepting any help given with a
smile. He was responsible to every act and
to every person. When spoken to, he
looked right at the person speaking, not
avoiding them as before. When the clean-
ing lady asked him to hold out his foot,
he stuck it out of the crib and giggled.
Some psychologists theorize that this
change from depression to apparent inter-
est and joy in surroundings is another
phase of a child's response to hospitaliza-
tion.2 Since Michael could no longer
tolerate the poignancy of his distress, he
apparently was repressing all feeling for
his mother. This could be true, for it
agreed with what Mrs. D. later told me.
She said that the last few times she had
visited, Michael had said, "no, no, no,"
and ignored her. At any rate, Michael was
gaining in strength and could now begin
to interact with his envirormient.
Limited by illness
Michael's world was greatly limited by
his illness. He was confined to his crib for
most of the day and was only allowed up
when his bed was being made. It was
during these short times that I was able to
see Michael at play along with other
children his own age. Whether coloring or
playing with blocks, they sat at the same
table, each engrossed in his own play, so
typical of the two-year-old. They had not
yet reached the age of social play.
Because of his limited environment,
Michael's innate desire to explore and
discover was cramped. He needed help to
be stimulated. I would bring him blocks
and crayons and paper, and then sit with
him while he played. He had mastered all
of the motor skills characteristic of a
two-year-old. 3 I saw him make fine pre-
cise movements in putting small blocks
together and holding a crayon. He turned
pages of his farm book one at a time and
identified the animals within it. He built
towers of blocks of three, filled a cup
with these blocks, and then hurled the
cup. He showed coordination when eat-
ing.
It was at mealtime that I was particu-
larly struck by Michael's independence.
He knew what he wanted and when he
wanted it. He would eat his food eagerly,
but would eat no more than he wanted.
Then he would push his tray aside and lie
down for his nap. By doing these things
he was still able to exercise his developing
sense of autonomy. Without such oppor-
THE CANADIAN NURSE 47
tunities he would have been very frustrat-
ed.
As Michael became more secure, he
showed his independence more and more.
For instance, one day he did not want his
bath, and responded to the bath by
shouting "Don't! " However, by turning
it into a game, we soon became friends
again.
"Don't! " was a frequently -used word
in Michael's vocabulary, along with "no,
no, no." This negativistic stage is com-
mon to two-year-olds.
Michael had quite an extensive vocabu-
lary. It consisted mainly of nouns, verbs,
and adjectives used separately or together
to express an entire thought. For exam-
ple, when he wanted me to pick him up,
he would say "Me up! " We worked
together on building his vocabulary. I
would carry Michael to the window and
when he pointed at something outside I
would tell him what it was and he would
repeat it. This was his way of learning to
enunciate and to make new associations.
Michael was a responsive, but quiet
little boy when feeling physically well.
However, at the first indication of stress
he would withdraw into himself for com-
fort. This seemed to be his developed way
of dealing with stressful situations. It was
best, I found, to respect this and to leave
him alone, because efforts to comfort
him led to frustration and complicated
the situation. During the acute phases of
his illness it was particularly difficult to
provide comfort for this child.
Dps and downs
Michael experienced several ups and
downs during the course of his illness.
Successive chest x-rays following the
bronchoscopy pointed to progressive
obstructive emphysema and finally to
atelectasis of the entire right middle lobe.
One week following admission, he awoke
from his nap in obvious respiratory dis-
tress. His expirations were grunting and I
noted chest retractions. He had changed
so quickly from feeling well to feeling
sick — an alarming ability of children
and typical for progressive respiratory
involvement.
I gave Michael an ordered suppository
for his elevated temperature and notified
his doctor. A repeat bronchoscopy was
done. A second half of the peanut,
surrounded by pus, was found lodged in
the opening of the right bronchus. It
obstructed in such a way as to allow air
to enter but acted as a valve in preventing
the outward flow of air. This accounted
for Michael's normal inspirations yet
grunting expirations. The peanut was
48 THE CANADIAN NURSE
removed, the pus aspirated, and Michael
recovered rapidly following this final
bronchoscopy.
Michael had one further upsetting inci-
dent when he vomited over his beloved
Poochy. He cried whenever Poochy was
brought near. I tried to help him by
pretending Poochy had been sick and by
coaxing him to help me help Poochy get
better. First, we washed him, dried him
with Michael's towel, and put him to dry
in the window where he could still see
him. Later, when Poochy had dried out, I
gave Michael his talcum powder and he
took great joy in putting it on the toy.
This form of play therapy helped him to
work out his adverse emotions.
I also found that Michael could work
out these overwhelming feelings on a peg
and hammer bench. The force with which
he hit the pegs was amazing! This play
served two purposes: he could take out
all the hurt that he felt on it, and it acted
as a type of "peek-a-boo" game. It gave
him some sense of permanence — what
disappeared did come back. He was also
able to exercise some degree of control
over his environment.
I feel that in nursing Michael I acted in
a role parallel to these pegs. I cared for
him, I left him, but 1 always came back.
This was a stable influence in an other-
wise fragmented experience. One nurse
commented: "Michael has adjusted so
well. I only hope that he adjusts as well
to being home again." What happens to a
sick child and what does not happen to
him determines, to a great extent, the
nature of his behavior, not only in hospi-
tal but for a long time after he has
returned home. I had the opportunity to
see this myself.
Follow-up visit
A few days after Michael's discharge, 1
visited him at home. How he had chang-
ed! He had thrived in the warm, familiar
surroundings. Now I understood what he
had missed in the hospital. There was
Joey the goldfish and Billy the Budgie;
there was his pet dog and his bunk bed.
The house was small and everything
about it exuded comfort, freedom, and
happiness.
When I first arrived, Michael was in his
high chair eating, and his brother and
sister were near him at the kitchen table.
Michael grinned shyly, in contrast to his
siblings' boisterous welcome. They
bounced from top bunk to floor to me,
full of fun and energy. Mrs. D. tried to
tame them, but to no avail, so she turned
to Michael instead. She told him to eat up
and he shpped out of the chair and joined
us. At first he stayed close to his mother,
but it did not take long for him to
respond to the others' antics.
Michael was just as rough in his play as
they were and he fought for what he
wanted. At one point they were fighting
over a stuffed giraffe. His sister tore it
away from Michael and he hit her as hard
as he could. Then he climbed to the top
bunk. It was obvious that Mrs. D. was
worried about Michael's safety, but she
did not stop him. When he reached the
top, he started to cry because he could
not get down again. His mother picked
him up, hugged him, and sent him on his
way with a pat on the bottom. It was
easy to see why Michael was so independ-
ent.
From Mrs. D. I learned that it was
only in the past few days that Michael's
behavior had returned to normal. She
described how the hospital experience
had changed him and in the course of
doing so expressed many of her fears.
She said that before Michael was hos-
pitalized he used to sit and eat all day;
now he refused to eat and had lost
weight. She felt perhaps he did not like
the food at home as well as the hospital
food. I suggested that perhaps Michael
was not hungry at present. He was too
wound up in playing with his dog and his
toys and too excited by being home
again. It is also natural for a two-year-old
to lose interest in eating when there is so
much of the world about him to discover.
Mrs. D. said that Michael was aloof at
times. Whereas he used to be friendly and
greet her with "Hi! Mommy" every
morning, now he would bite and kick her
for no reason at all. I explained the
feelings that Michael had experienced
during hospitalization. He was too young
to understand why she had left him. He
had felt deserted. He still loved her as
much as before, but this was his way of
telling her that she had hurt him deeply.
He would soon forget and return to his
loving self.
Michael's sleeping habits had also
changed. Before hospitalization he was
eager to go to bed when told, but now he
refused to sleep in his own bed and
wanted to be with Mommy and Daddy.
The D's understood Michael's fears of
loneliness and separation and his need to
be close to them.
Michael had been toilet trained and
had regressed in this habit during his stay
in hospital. Mrs. D. did not find this a
problem, and assisted Michael in a gradual
return to his previous schedule. This
problem might have been avoided if
Michael had been encouraged to use the
toilet in hospital. However, information
about his toilet training was lacking
NOVEMBER 1%9
during his hospital stay.
When Mr. D. came home from work
Michael was overjoyed and greeted him
with a big "Hi! " Mr. D. picked him up
and swung him around, indicative of
Michael's close relationship with his par-
ents.
Mr. D. said that he had missed Mi-
chael, too: "It's kind of hard on us you
know, because no one has ever been sick
before, let alone in hospital. When they
went after that second peanut we gave up
hope. Michael was in hospital longer than
we ever expected."
Michael's father had enough confi-
dence in me to share these feelings. By
listening, I was helping. The parents also
expressed feelings of guilt because they
had not been able to visit Michael often.
The D's felt Michael had rejected them
because of this. I related Michael's rejec-
tion of them to this general pattern of
reaction and adjustment. Mr. and Mrs. D.
were reheved to see that it had been a
necessary defense tool.
From this home visit I realized that
the D's were warm, responsive, giving
persons and parents, providing Michael
with the security he needed for his
growth and development. Seeing Michael
cuddling Poochy on the floor, made me
think of the times that I had seen him so
unhappy, so lost. What could be done to
make the hospital a happier place for
other Michaels?
Suggestions
A family participation unit where
rooming-in facilities for chUd, mother,
and close relatives are provided would
ease the strain on both parents and
child. 3 SibUngs of all ages should be
welcome visitors. Studies have shown that
chances of cross infection through such a
unit are negligible. In this unit the mother
would carry out the treatments under
supervision and would take care of her
child as she would at home. Visiting
hours would be unrestricted.
In a case such as Michael's, where
parents are unable to visit often, I believe
that it would be beneficial to assign the
child to the same nurses to gain his trust
and lessen his anxiety. They could prov-
ide in part the love and security that his
mother would normally give. In this way
his relationships in hospital would be less
fragmented and there would be some
degree of unity in his day-to-day ex-
perience.
Inservice education is needed to teach
personnel how to help the child emotion-
ally. A head nurse who has been trained
in the psychological aspects of nursing
care could train her staff nurses and aides
NOVEMBER 1%9
by example. She could encourage them to
rock their children as part of their daily
nursing care.
1 have worked on two contrasting
wards. On one, we were told not to pick
the child up any more than required as it
would spoil him; on the other, the head
nurse herself would pick a child up if she
had time. The latter ward was a far more
enjoyable and relaxing ward to work on,
and the children benefited accordingly.
An extensive admission history is ne-
cessary. This should include the degree of
toilet training, feeding and sleeping
habits, favorite foods, favorite games, pet
names, vocabulary. By knowing these
things nurses could help a child feel more
at home and, at the same time, encourage
an onward process of growth and devel-
opment.
The nursing care plan on the Kardex
could be more geared toward the specific
nursing problem at hand. As Michael got
better he needed more activity. The
care-plan needed updating and filling-in.
Special needs of the child and much of
the admission information could be in-
cluded in it. The Kardex should and
could be an effective nursing tool.
Effective team conferences are needed.
This is related to many of the above
points. These should involve more than a
mere report. If there is a specific problem
in the care of a patient, the team should
discuss it as a group and each member
contribute ideas as to how to cope with
the problem. It could serve as a channel
through which doctors and nurses could
exchange questions and answers.
Lounging facilities for parents could
encourage nurses to talk to parents and
help them understand exactly what is
happening to their child. Visual aids
would be of help in teaching parents.
Comfortable chairs and the facilities with
which to make coffee would give this
room a warm and relaxed atmosphere.
Here, the parents and nurse could give
and take, and learn.
Extended play facilities with prepared
staff would help children adapt to hos-
pital Uving. The play therapist could
attend team conferences and suggest to
the staff toys that are most suitable for a
specific child in a specific situation. For
instance, she could suggest that a peg and
hammer bench, such as Michael used,
would help a two-year-old vent his frus-
trations. Illustrated posters with the same
theme could be hung over the toy box or
in the playroom.
During a follow-up home visit, I was
able to help Michael's parents sort out
many fears and questions. Other parents
must have similar worries after their child
has been discharged from hospital. Could
interested nurses be given the freedom to
visit in the home after a child's dischar-
ge? This would round out the nursing
team and extend the continuity of care
into the home.
Michael gave much else. He is now the
model by which 1 assess other children's
stage of growth and development and
their corresponding needs. I learned to
look beyond physical needs to emotional
needs and to coordinate the two. I
learned to include the family in my
nursing care. Michael helped me expand
my concept of nursing and, in turn, I was
able to help him deal with the loneliness
and pain that colored a small but signifi-
cant part of his life.
References
1. Shore, Milton F. ed. Red is the Color of
Hurting. Bethesda, Maryland, National
Clearinghouse for Mental Health Informa-
tion, 1965.
2. Marlow, Dorothy R. Textbook of Pediatric
Nursing. Philadelphia and London, W.B.
Saunders Company, 1966.
3. Condon, Maryrosc. Family participation
unit. Amer. J. Nurs. 68:3:505-507, March
1968.
Bibliography
Blake, Florence G. The Child, His Parents and
The Nurse. Philadelphia and London, J.B.
Lippincott Company, 1954.
Bowlby, John. Child Care and the Growth of
Love. Middlesex, England, Penguin Books
Ltd., 1966.
Mussen, Paul H. et al. Child Development and
Personality. New York, Evanston and
London, Harper and Row. 1963.
Plank, Emma M. Working With Children in
Hospitals. Qeveland, Ohio, Press of Western
Reserve University, 1962. CI
THE CANADIAN NURSE 49
COMMENT
Quality of care makes the difference
Carol J. Matthews
In my job as a psychiatric caseworker I
have often heard patients speak both
positively and negatively of the nursing
care they received while in hospital, and
have been struck by the significant part it
plays in the patient's overall attitude
toward the hospital and his treatment.
Recently, while in hospital to deliver my
baby, I noticed how great indeed is the
nurse's role in reassuring a patient, and
how great the variation in the quality of
nursing care given by different nurses.
From conversations with other
mothers, I learned that I was not unique
in feeling that I was about to do some-
thing quite exceptional and that everyone
must be very impressed with me. It is my
thesis that this feeling is what takes the
edge off labor pains, and that the nurse
can play a most important role in sup-
porting and sustaining the mother's sense
of self-importance.
I went into hospital at 9:00 a.m., and
throughout the morning I was impressed
with the cheerful, competent, and sup-
portive manner of the several nurses who
were in and out of my room. However, I
had no clear idea of any one of them as
"my" nurse. I believe patients would
appreciate it if a nurse introduced herself
as "your nurse. Miss X." It is frustrating
to ask a question of one nurse and be told
that you must ask your own nurse, when
you don't know whom your own nurse is.
I found the daytime of my labor very
cheerful. I had a lot of attention, with
visits from my doctor, the nurse who
prepped me, the receptionist taking
admission information, and many others.
A particularly important visit was that of
the nursing instructor who came to ask if
I would like her to assign a student nurse
to me as a "mother-baby" nurse, and who
spent some time telling me about the care
both the baby and I would receive. Her
visit made the baby seem a reality, and
greatly increased my excitement and
anticipation. My husband, too, was with
50 THE CANADIAN NURSE
me all this time and shared my feelings of
enthusiasm.
My contractions were becoming more
definite by the time the shifts changed
and my new nurse arrived, and although 1
was suffering from httle discomfort, I was
reassured by the time and interest she
gave me. When my husband had to leave
for a few hours, the nurse stayed with me
almost constantly until his return. The
time passed quickly, and when my hus-
band returned the three of us chatted
about how well everything was going,
what a good doctor I had, and what a
wonderful thing it was to have a baby.
I was fortunate in having a pleasant
resident physician on duty throughout
my labor. He had a great capacity for
enthusiasm and, on examining me, would
say things like, "Well, would you believe
five centimetres? That's terrific, five
centimetres and you don't seem to be
even feeling it! You're terrific, you really
are! " This, of course, made me feel
proud of myself, and my nurse reinforced
this by repeating that it certainly was
wonderful that things were going so well.
I wonder if my lack of discomfort were
not partially due to the way in which the
resident and the nurse sustained my
excitement and supported my most posi-
tive feelings.
By 11:00 p.m. I was in heavy labor.
My nurse was going off duty and I was
told I would soon be taken into the
delivery room for the epidural. A new
nurse came in then, asked a few questions
and, on hearing that I had been there
since morning, said something like, "Oh
you poor dear. You must be exhausted."
Her sympathy suddenly deflated me. I
wanted people to be impressed with me,
not sorry for me!
The nurse who took me to the delivery
room was competent and pleasant
enough, but did not seem at all interested
in conversation. Later I heard her tell
another nurse that she had not slept at all
the night before and was simply dead
tired. Again I felt a sudden letdown. I was
only an ordinary patient, like all other
patients, and the nurse was not eagerly
awaiting the arrival of my baby; she was
eagerly awaiting 7:00 a.m., when she
could get some sleep.
Once the epidural was set up and my
blood pressure and contractions timed,
the nurse left me, saying that my husband
would soon be with me. The delivery
room seemed strange and both my hus-
band and I missed having a cheerful nurse
to talk to. Eventually, the resident, who
had been having a short and well-earned
nap, returned, examined me, and pro-
claimed that I was fully dilated. "Isn't
that great? You'll have your baby very
soon now! " Once again, with his enthusi-
asm, my spirits soared.
Time passed quickly until my doctor
was called. By the time he arrived the
room seemed to have filled with people.
At 4:55 a.m., my daughter was bom.
The whole experience of childbirth
was an enjoyable and exciting one. I am
grateful to the staff for the good care I
received. However, I believe it might have
been an even more wonderful experience
if all of the nursing care had been of the
same quality as that I received earlier in
the day, so that my excitement and high
spirits might have remained constant
throughout. D
NOVEMBER 1969
Leadership and the Nurse : An Introduc-
tion to the Principles of Management
by Margaret Schurr. 116 pages.
London, The English Universities Press
Ltd., 1968.
1 Reviewed by Glennis Zilm, former
assistant editor. The Canadian Nurse.
The dust jacket on this slim book says
that it is intended for "first-line and
middle-management nurses" and that it
was published as a kind of response to the
Salmon Report. This Report by the
Committee on Senior Nursing Staff Struc-
ture, released in Britain about a year ago,
strongly pointed out that nursing ad-
ministrators needed management training.
The author, a one-time matron of a
teaching hospital and now a nursing
officer in the ministry of health, under-
took to explore the necessary qualities of
leadership and efficient management in
relation to nursing.
"First-line and middle-management
nurses" are, presumably, charge sisters
(head nurses) and departmental sisters
(supervisors). Miss Schurr suggests, how-
ever, that the principles will apply for the
nurse-in-charge at any level.
Much of the material in this book is so
basic that many of the principles could be
found in high school self-improvement
and personality texts on leadership. The
book is part of the "Modem Nursing
Series," written specifically for students
in Britain's hospital schools. It is possible,
therefore, that it might be useful for
these students. In Canada and the United
States, however, students would likely
find the principles elementary and the
terms confusing.
The book is divided into three sec-
tions: policy planning and organization;
the art of communication; and meeting
the needs of the individual. Of these, the
section on communication is perhaps the
clearest and would be the most useful to
Canadian students. However, several
other texts, such as Florence Lockerby's
Communication for Nurses, offer more
complete material on the subject. The
Canadian Nurses' Association's Manual
for Head Nurses in Hospital would be
more useful on administrative principles.
Several times the author laments that
nurses have never learned to perform
management duties. For example, she
says:
"On the whole, experienced nurses,
however good they may be at their own
work, are not so efficient when they have
NOVEMBER 1%9
to perform duties such as dictation,
which are commonplace in the life of
most people in senior positions. This may
be because in the past sufficient emphasis
has not been laid on the need for nurses
to be articulate. However, this should
improve with modem nursing education,
which encourages nurses to put thoughts
and ideas forward for discussion."
Several places in the book readers will
recognize and recall experiences of poor
management techniques similar to those
Miss Schurr describes. But this reviewer
does not believe that this book will do
much to improve nursing management.
Nursing Care Planning by Dolores E.
Little and Doris L. Carnevali. 245
pages. Toronto, J.B. Lippincott Co. of
Canada, 1969.
Reviewed by Dorothy Wasson. Direc-
tor Nursing Education, Saint John
General Hospital, Saint John, N.B.
This book presents a large topic -
planning of patient care - in a well-
organized, easy-to-read manner. The
reader is introduced to some of the
philosophies that underly patient care. In
doing so, a number of questions are
raised: What has the public come to
expect as its right in health care? What
beliefs do nurses themselves hold toward
patients and toward nursing?
The processes involved in planning
patient care are presented in some detail.
Included are areas such as determining
priorities in care, obtaining a nursing
history, writing nursing care plans, and
revising and modifying existing plans. A
number of sample nursing care plans,
which cover a wide range of problem
situations, are presented.
The last five chapters are concemed
with the introduction and implementa-
tion of a system of nursing care planning.
Who is the logical person to introduce a
new system? How best can staff be
prepared to participate in planning
patient care? How can the nursing care
plan be used as a communication tool not
only among nurses, but also among other
members of the health team?
This is an enjoyable book to read as
the authors have succeeded in conveying
to the reader their interest in the topic
discussed. The table of contents is fairly
detailed, which is a help to persons
looking for specific areas of information.
A brief summary and a number of study
questions are included at the end of most
chapters. Not only are the study ques-
tions of value to the instmctor, or to
members of the inservice education de-
partment for student participation, but
they also offer a number of thought-
provoking ideas for the reader.
Because of the scope of the topic
presented, many areas are not covered in
depth in this book. This may limit its
usefulness as a reference book in relation
to a specific topic, i.e., use of the
interview in obtaining nursing history.
However, it should be a valuable aid to
nursing instructors, supervisors, head
nurses, team leaders, and others, both in
clarifying their own thoughts on the value
of systematic planning of patient care and
in communicating this to other personnel.
A Psychiatric Glossary, American Psy-
. chiatric Association, 3rd ed. 102
pages. New York, Springer Publishing
Co., Inc. 1969.
Reviewed by Micheline Montgomery,
Nursing Service Instructor, Lakeshore
Psychiatric Hospital, Toronto, Ont.
This small, soft covered book is the
third edition of the Psychiatric Glossary
presented by the American Psychiatric
Association. Since its first edition in
1957, 300 more entries have been added,
150 of these since the 1964 edition.
In this third edition terms on commu-
nity psychiatry and the behavioral
sciences are used, as well as terms on
some of the latest forms of psychiatric
treatment, e.g. aversive therapy and be-
havior therapy. Also, more terms on
psycho-pharmacology, biochemistry,
neurophysiology, and epidemiology have
been added. Many other definitions have
been reformulated to correspond with the
1968 revision of Diagnostic and Statistic-
al Manual of Mental Disorders, also pu-
blished by the American Psychiatric As-
sociation.
The explanation of each term is clear,
concise, and written in language easy for
a lay person to understand. Some words
are italicized to make it more convenient
for the reader to cross-check references.
This up-to-date, informative glossary
would be useful as a quick reference for
all concerned with the field of mental
health. Its basic quality and simplicity
would make it beneficial to schools and
public libraries. It could also be of special
value to nursing students and to all levels
of nursing staff, especially those working
in a psychiatric setting.
THE CANADIAN NURSE 51
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52 THE CANADIAN NURSE
Obesity And Its Management, by Denis
Craddock. 200 pages. Toronto, Mac-
millan Company of Canada Ltd.,
1969.
Reviewed by Virginia Rivard, Director
of Nursing, Queen Mary Veteran's
Hospital, Montreal, Quebec.
Obesity is rarely discussed as a separa-
te condition, but usually is considered in
association with other conditions. Here,
however, the author has presented a
universal expose of this timely problem.
The subject is treated in a logical se-
quence, beginning by outlining the prob-
lem and its complications. The causes are
then analyzed from the physical and
psychological viewpoints. The hereditary
factor is given a strong note.
A section on treatment includes a
descriptive section on diet, drugs, exer-
cise, and moral support. Other areas are
also explored: pregnancy, intractable
obesity, diabetes, and childhood obesity.
The final chapter, "The Future," is conci-
se and to the point.
For the nurse and layman, the simplic-
ity of style is excellent; the few more
scientific sections can be skimmed with-
out loss of the central idea. The pages on
food values are especially interesting and
complete: for example calories per ounce
and units of carbohydrates per average
serving are given for many foods. Empha-
sis is placed on the intake of sugar, which
the author considers a more significant
culprit than fats. The suggestions for diets
are sensible without the rigidity which
usually makes dieters feel guilty if they
lapse.
The book is intended for physicians,
although it could be helpful to anyone
interested in weight control. The extensi-
ve references will be a great source of
information to the physician.
Principles of Microbiology, 6th ed., by
Alice Lorraine Smith. 699 pages. C.V.
Mosby Company, Toronto, 1969.
Reviewed by M. Francis, Biological
Sciences Instructor, School of Nursing,
Regina Grey Nuns' Hospital, Regina.
This is an excellent text for the stu-
dent nurse and the instructor. It is well
illustrated, with subject headings and
subheadings printed in red. The many
tables, which are excellent summaries of
important facts, are printed on pink to
make them easier to locate. Most chapters
conclude with questions for review, and a
comprehensive reference section.
The author has divided the textbook
into six units. Unit 1, "The Introduction
to Microbiology" contains the usual clas-
NOVEMBER 1969
sification of microorganisms, but also
includes a concise, up-to-date section on
contributions to our knowledge of micro-
biology and a detailed discussion of the
cell, "The Basic Unit."
Unit II discusses the bacterial cell, its
biological needs and activities. Methods
of studying bacteria by culture and direct
examination are also outlined. The most
useful chapter in this section is Chapter
10 on specimen collection. It includes
precautions in collecting each type of
organism and a table of important patho-
gens that could be found in each speci-
men.
Unit III is titled "Microbes' relation to
infection and immunity." The normal
body microbial flora is outlined as the
course of infection and the body's de-
fenses. It is in this unit that we find a
chapter on allergies.
Unit IV, "Microbes destruction and
inhibition of growth," includes not only a
discussion on destruction by physical and
chemical action, but a useful section on
practical disinfection and sterilization.
Unit V is "Microbes, pathogens and
parasites." As the name implies, this
section discusses the pathogens and the
conditions they cause. Included are the
gram positive and gram negative organ-
isms, the rickettsiae, the viruses, the
fungi, animal parasites, and others.
Unit VI, "Microbes and the public
welfare," includes a discourse on the
usefulness of bacteria and the microbiolo-
gy of water, milk, and food. The author
has also included two chapters most
useful to both the student and graduate
in the community health program. These
chapters include information on biologi-
cal products from immunization and rec-
ommended immunizations.
The most outstanding and useful fea-
tures of this book, both to the instructor
and to the student, is the inclusion, at the
end of each unit, of a laboratory survey
pertaining to that unit and a unit test,
using objective questions.
A Nurse's Guide to Anaesthetics Resusci-
tation and Intensive Care by Walter
Norris and Donald Campbell. 164
pages. Edinburgh, E.& S. Livingstone
Ltd., 1969. Distributed by Macmillan
Co. of Canada Limited, loronto.
Reviewed by Sister Camillus, Supervi-
sor, Intensive Care Unit, St. Joseph's
Hospital, London, Ontario.
This is an excellent reference book for
nurses employed in the recovery room,
intensive care and surgical units. The
book's objective is to present the nurse's
responsibilities in caring for patients be-
fore and after surgery.
Special emphasis is placed on the
newer methods in anesthetics, analgesics,
and resuscitation. In preparing the prean-
esthetic patient, the important steps are
outlined, including the physical and
NOVEMBER 1%9
psychological aspects. The complications
of anesthesia in post recovery room care
of patients are outlined in three main
areas: gastrointestinal disturbances, res-
piratory difficulties, and circulatory
changes.
Oxygen therapy and its toxic effects
are dealt with effectively. One chapter
presents in detail the physiology of
patients with respiratory anomalies.
Special procedures pertaining to a respira-
tory unit are well explained. The impor-
tance of highly skilled nurses to observe
patients with respiratory problems and to
administer intensive therapy is emphasiz-
ed.
The appendix includes brief explana-
tions on: anesthetic machines and electri-
cal equipment; diets for uremic patients
and patients on ventilators; instructions
in physiotherapy and the necessity of
physiotherapy in the immediate posto-
perative period to prevent pulmonary and
vascular complications; care of the trache-
otomy patient; precautions and re-
commendations to prevent fires and ex-
plosions in the operating room, and a
detailed outline in the management of
cardiac arrest.
The author has presented a concise,
informative book on three extensive sub-
jects.
^ Essentials of Nursing, 2nd ed. by Claire
Brackman. 491 pages. Toronto, W.B.
Saunders Company, 1969.
Reviewed by Miss Bugayong, Inservice
Coordinator. Peel Memorial Hospital,
Brampton, Ont.
Although this book is titled as a
medical-surgical text, the book includes
many subjects that will help the student
comprehend her patient as an individual,
as a member of his family and of society.
The nursing care her patient needs for his
illness, the rehabilitative measures, the
preventive measures, and some of the
health teachings in her capacity as a
practical nurse are all treated as impor-
tant aspects of nursing.
Personal hygiene, microbiology, men-
tal hygiene, ethics, and anatomy and
physiology all have been inteUigently
integrated. They are presented in such a
way that the student appreciates and
understands the meaning of her care to
her patients.
The book is clear and easily under-
stood, partly because of the author's
awareness of the general need for knowl-
edge of the practical nurse. While keeping
the language simple, she has incorporated
enough terminology to enlarge the stu-
dents' general knowledge.
Illustrations and examples are frequent
and to the point. Many of the examples
are particularly pointed: the nurse who
tells a patient he is about to have a "g.i.",
and leaves him to puzzle and worry over
what that is; and the nurse who is so
accustomed to routine she gives the
80-year-old patient a daily bed bath,
pathetically ignorant of the principles
underlying her care.
The book's drawback lies in the fact
that it does not emphasize team nursing.
It also presents clinical case problems at
the end of each chapter, when a nursing
care plan could be more useful.
Textbook of Pediatric Nursing, 3rd. ed.,
by Dorothy R. Mariow. 687 pages!
Toronto, W.B. Saunders Company
1969.
Reviewed by Marilyn H. Clarke and
Hazel Binch, pediatric nurses. River-
side Hospital of Ottawa. Ottawa. Ont.
This up-to-date, readable pediatric text
places its main emphasis not on the
diseases of children, but on their growth
and development - physical, mental,
and emotional - in health and in illness.
The introductory chapter gives an
interesting concise history of child care
through various ages, countries, and
ethnic groups. It also gives a brief back-
ground history of some of the many laws
and organizations that have been institut-
ed for the protection and well-being of
children.
Chapters two, three, and four deal
with the general growth and development
of children within the family, as influenc-
ed by heredity, parental attitudes, and
illness. The nurse's changing role and her
influence and importance to the ill child
is well discussed.
The remainder of the book is divided
into six units, each describing a specific
age group and the diseases most prevalent
to it. Growth and development and the
reaction to illness and hospitalization
specific to each age group is discussed
meaningfully. Further information about
the diseases, divided into short and long-
term illnesses, could be obtained from the
list of reference books and periodicals at
the end of each chapter. This reference
material is well-defined, and most of the
material is available in nursing libraries.
Student nurses beginning pediatric
study, or indeed anyone working with
children for the first time, could use this
book to gain valuable knowledge and
understanding of the child as an individ-
ual in hospital and in the community. D
Don't Push Your Luck - 16 mm., 15
minutes, color and sound. Available
without charge on loan from: The
Canadian National institute for the
THE CANADIAN NURSE 53
Blind, 1929 Bayview Avenue, Toronto
350. Ontario.
The Canadian National Institute for
the Blind released this dramatic film in
March 1969. An industrial accident leads
to blindness of a 50-year-old man.
Throughout the film, the viewer sees the
physical and psychological effects blind-
ness has on the victim and his family.
Several valuable rules to safeguard
eyesight at home and on the job conclude
this thought-provoking film, which would
appeal to a wide variety of audiences. Q
accession list
Publications on this list have been
received recently in the CNA library and
are listed in language of source.
Material on this list, except reference
items, which include theses and archive
books that do not circulate, may be
borrowed by CNA members, schools of
nursing and other institutions.
Requests for loans should be made on
the "Request Form for Accession List"
and should be addressed to: The Library,
Canadian Nurses' Association, 50 The
Driveway, Ottawa 4, Ontario.
No more than three titles should be
requested at any one time. If additional
titles are desired, these may be requested
when you return your loan.
Stamps to cover payment of postage
from library to borrower should be in-
cluded when material is returned to CNA
library.
Books and Documents
1. Adolescence for adults. Chicago, 111., Blue
Cross Association, cl969. 96p.
2. Annual report of the Order of the Hos-
pital of St. John of Jerusalem 1 968. Ottawa,
1969. 59p.
3. An approach to the training of psychia-
tric nursing in diploma and associate degree
programs: final report on the project by Joan E.
Walsh. New York, National League for Nursing,
C1969. 113p.
4. Biennial reports to the membership
196 7/68. New York, National League for Nurs-
ing, 1969. 45p.
5. Canadian Hospital Association office and
association directory, July 1969. Toronto.
1969. 56p. R
6. Collective bargaining in Ontario 1968 by
Keith McLeod and Gerald Starr. Toronto, Dept.
of Labour, 1969. 16p.
7. Dermatologie par Carmelle C. Plourde.
Ottawa, Renouveau Pedagogique, cl968. 49p.
8. Diamond jubilee conference of the New
Zealand Registered Nurses' Association hand-
book. Wellington, April 15-17, 1969. WeUing-
ton, Percival Publishing Co., 1969. 96p.
9, Guide du journaliste. Montreal, La Presse
Canadienne, cl969. 1 27p.
y 1 0. Histoire de I 'obstetrique et de la gyneco-
logie par Martial Dumont et Pierre Morel. Lyon,
Simep, cl968. 87p.
11. L 'hygiene atimentaire de I 'enfant by P.
Mozzicanacci. 8e ed. Paris, Francois & Moret,
C1969. 95p.
.V 12. A manual of style for authors, editors
and copywriters. 12th ed. rev. Chicago, Univer-
sity Press, cl 969. 546p.
13. Medical history of Malta by Paul Cassar.
London, Wellcome Historical Medical Library,
1964. 586p. R
14. Neurophysiological and behavioural re-
search in psychiatry: report of a WHO scientific
group. Geneva, World Health Organization,
cl968. 3Jp.
15. New Guinea nurse by Elizabeth Bur-
chill. Adelaide, Australia, Rigby, cl967. 151p.
16. Obesity and its management by Denis
Craddock. Edinburgh, E. & S. Livingstone
cl969. 191p.
17. La parole et I 'enfant sourd par S.
Borel-Maisonny et al. Lyon. Simep, cl967. 92p.
k/l8. The planning of change. 2d ed. Edited
by Warren G. Bennis, Kenneth D. Benne and
Robert Chin. New York, Holt, Rinehart and
Winston, c 1969. 627p.
C 19. Practical nursing workbook by Claire P.
Hoffman and Gladys B. Lipkin. Philadelphia,
A GIANT STEP FORWARD!
A Major New Text On Clinical Nursing
Concepts and Practices of
INTENSIVE CARE
for nurse specialists
Edited by Lawrence E. Meltzer, M.D., F.A.C.C.; Faye Abdellah, R.N., Ed. D., LL.D;
J. Roderick Kitchell, M.D., F.A.C.C.
Fifteen nationally-known Physician-Nurse teams from major medical centers describe
in step-by-step detail how each team functions with reference to a specialized prob-
lem, which benefits from intensive care. Emphasis throughout the book is toward the
nurse specialist member of the team: why, when, how she performs each of her duties.
496 Pages, Illustrated, Case Bound, $10.25 (U.S. Funds - $11.25 Canadian Funds)
{Postage and Handling Included, if prepaid)
(B
The CHARLES PRESS Publishers Inc. • 236 So. 20th Street, Philadelphia, Pa. 19103
54 THE CANADIAN NURSE
NOVEMBER 1%9
Lippincott, cl969. 31 Op.
, 20. A psychiatric glossary. The meaning of
terms frequently used in psychiatry. 3d ed.
Washington, American Psychiatric Association,
C1969. 102p.
•^1. Psychotherapies de I 'enfant par Didier-
Jacques Duche. Paris. Editions Universitaires,
cl967. 263p.
22. Recherches en pediatric. Rapport d'un
groupe scientifique de I'OMS. Geneve, 28
nov. - 4 dec. 1967. Geneve, Organisation
Mondiale de la Sante, cI968. 27p.
23. Report of Expert Committee on the
Health Problems of Adolescence, Geneva, 3 to
9 Nov. 1964. Geneva, World Health Organiza-
Uon, 1965. 28p.
24. Report of Expert Committee on the
Midwife in Maternity Care, Geneva, 19 to 25
Oct. 1 965. Geneva, World Health Organization,
1966. 20p.
25 . Report of Expert Committee on Plan-
ning and Evaluation of Health Education Serv-
ices, Geneva, 28 Nov. - 4 Dec. 1967. Gene-
va, World Health Organization, 1969. 32p.
; 26. Report of Victorian Order of Nurses for
Canada 1968. Ottawa, 1969. 81 p.
27. Sante et equilibre de I'enfant; guide des
infirmieres et puericultrices, parents et educa-
teurs par Florence G. Blake. Traduction de
Janine Pazard. Paris, Le Centurion/Sciences
Humaines, cl969. 245 p.
28. Sante mentale de I'enfant et de I'adoles-
cent: elements du cours de sante mentale de
I'enfant organise par le Centre international de
I'enfance par Claude Kohler, redacteur. Lyon,
SIMEP, 1966. 155p.
29. Second report of the Expert Committee
on Medical Rehabilitation, Geneva. 12-18 No-
vember 1968. Geneva, World Health Organiza-
tion, cl969. 23p.
30. The second ten years of the World
Health Organization. 1958-67. Geneva, World
Health Organization, 1968. 413p.
^ 31. /I study of staffing patterns in psychia-
tric nursing by Kathleen Bueker and Helen K.
Sainato. Washington, Saint Elizabeth Hospital,
1968. 103p.
Pamphlets
32. A dialysis symposium for nurses; report
of Symposium for Nurses Specializing in Artifi-
cial Kidney Therapy, Philadelphia, 1968. Wash-
ington, U.S. Health Services and Mental Health
Administration, 1968. 37p.
33. Prevention of childhood accidents in
Sweden. Stockholm, Swedish Institute and the
Joint Committee for the Prevention of Child-
hood Accidents, 1968. 40p.
34. Report of Clarke Institute of Psychiatry
1968. Toronto. 19p.
35. Selected list of books and Journals for
the small medical library prepared by Alfred N.
Brandon. 1969/1970 edition. Chicago, Medical
Library Association, 1969. p. 130- 150.
Government Documents
Canada
36. Department of National Health and
Welfare. Research and Statistics Directorate.
Inventory of welfare research. 2d ed. Ottawa,
1969. 105p.
37. Department of National Revenue. Taxa-
tion statistics. 1969. Ottawa, Queen's Printer,
1969. 180p.
38. Ministere du travail. Direction de I'eco-
nomique et des recherches. Greves et lock-out
au Canada, 1967. Ottawa, Imprimeur de la
Reine. 1967. 81 p.
39. Science Council. Report. 1968/69. Ot-
tawa, Queen's Printer, 1968. 40p.
USA
,/40. Dept. of Health, Education and Welfare.
Public Health Service. Guidelines to radiological
health. Washington, U.S. Gov't Print. Off.
1968. 173p.
Studies Deposited In
CNA Repository Collection
41. y4 study to determine the opinions of
administrators and directors of nursing on five
selected recommendations concerning nursing
education included in the CNA submission to
the Royal Commission on Health Services;
March 1962 by Frances M. Howard. Montreal,
1963.45p. R
42. Who does the nursing student in a
baccalaureate degree program of nursing consid-
er to be her significant nurse model and why
did she make this choice by Williamina A.
Watson. Minneapolis, Minn., 1968. SJp. Thesis
(M.Ed.) ,- Minnesota. R D
Request Form for "Accession List"
CANADIAN NURSES' ASSOCIATION LIBRARY
Send this coupon or facsimile to:
LIBRARIAN, Canadian Nurses' Association, 50 The Driveway, Ottawa 4, Ontario.
Please lend me the following publications, listed in the
Canadian Nurse, or add my name to the waiting list to receive them when available:
■tern Author Short title (for identification)
No.
issue of The
Requests for loans will be filled in order of receipt.
Reference and restricted material must be used in the CNA library.
Borrower Registration No.
Position
Address
Date of request
NOVEMBER 1%9
THE CANADIAN NURSE 55
classified advertisements
ALBERTA
ALBERTA
BRITISH COLUMBIA
REGISTERED NURSES required for a 51-bed
active treatment hospital, situated in east
central Alberta. Salary range Jan 1 to Aug 31 —
$450 to $535, Sep 1 to Mar 31, 1970 — $475
to $565, with full maintenance in new nurses
residence for $50 per month. Sick leave, holi-
days and working conditions as recommended
by the Alberta Association of Registered
Nurses. For further information kindfy contact:
W.N. Sarachuk, Administrator, Elk Point Mu-
nicipal Hospital, Elk Point, Alberta.
ADVERTISING
RATES
FOR ALL
CLASSIFIED ADVERTISING
$11.50 for 6 lines or less
$2.25 for each additional line
Rotes for display
advertisements on request
Closing date for copy and cancellation is
6 weeks prior to 1st day of publication
month.
The Canadian Nurses' Association does
not review the personnel policies of
the hospitals and agencies advertising
in the Journal, For authentic information,
prospective opplicants should apply to
the Registered Nurses' Association of the
Province in which they are interested
in working.
NEW
ADVERTISING
RATES
EFFECTIVE JANUARY 1, 1970
FOR ALL
CLASSIFIED ADVERTISING
$15.00 for 6 lines or less
$2.50 for each odditiona! line
Address correspondence tOi
The
Canadian Ay
urse ^
50 THE DRIVEWAY
OTTAWA 4, ONTARIO.
DIRECTOR OF NURSING SERVICE required
for 100-bed hospital providing services in
Obstetrics and Gynecology. Experience and
preparation in Nursing Administration required.
Apply in writing to: Administrator, Salvation
Army Grace Hospital, Calgary, Alberta.
REGISTERED NURSES FOR GENERAL
DUTY in a 34-bed hospital. Salary 1968,
$405-$485. Experienced recognized. Residence
available. For particulars contact: Director of
Nursing Service, Whitecourt General Hospital,
Whitecourt, Alt>erta. Phone: 778-2285.
GENERAL DUTY NURSES for active, ac-
credited, well-equipped 65-bed hospital in grow-
Ina town, population 3.500. Salaries range from
$465 - $555 commensurate with experience,
omer oeneins. iNurses' residence, bxcellent per-
sonnel policies and working conditions. New
modern wing opened in 1967. Good communica-
tions to large nearby cities. Apply: Director of
Nursing, Brooks General Hospital, Brooks. Al-
berta.
GENERAL DUTY NURSES (2) for small,
modern hospital on Highway no. 12, East
Central Alberta. Salary range $477.50 to
$567.50 including regional differential.
Residence available. Personnel policies as per
AARN and A.H.A. Apply to: Director of
Nursing, Coronation Municipal Hospital,
Coronation, Alberta.
GENERAL DUTY NURSES for 94-bed General
Hospital located in Alberta's unique Badlands.
$405— $485 per month, approved AARN and
AHA personnel policies. Apply to: Miss M.
Hawkes, Director of Nursing, Drumheller Gene-
ral Hospital, Drumheller, Alberta.
GENERAL DUTY NURSES (3) required for
32-bed active hospital. Starting salary $500 to
$600 per month, plus $25 northern allowance.
Room and board $50. Pleasant working condi-
tions. Apply to: Matron, St. Theresa Hospital,
Fort Vermilion, Alberta.
GENERAL DUTY NURSES for 64-bed active
treatment hospital, 35 miles south of Calgary.
Salary range $405— $485. Living accommoda-
tion available in separate residence if desired.
Full maintenance in residence $50.00 per month.
Excellent Personnel Policies and working condi-
tions. Please apply to: The Director of Nursing,
High River General Hospital, High River, Alber-
ta.
GENERAL DUTY NURSES required for a
34-bed general hospital located in northern
Alberta. $465 to $555 per month, plus $15
differential. Experience recognized. Residence
available. For particulars, contact: Director of
Nursing, Manning Municipal Hospital, Manning,
Alberta. Phone: 836-3391.
GENERAL DUTY NURSES are required by a
230-bed, active treatment hospital. This is an
ideal location in a city of 27,000 with summer
and winter sports facilities nearby. 1968 salary
schedule $405 — $485. 1969 schedules present-
ly under negociation. Recognition given for
previous experience. For further information
contact: Personnel Officer, Red Deer General
Hospital, Red Deer, Alberta.
GENERAL DUTY NURSING POSITIONS are
available in a 100-bed convalescent rehabilitation
unit forming part of a 330-bed hospital complex.
Residence available. Salary 1967 — $380 to
$450 per mo. 1968 — $405 to $485. Experience
recognized. For full particulars contact Director
of Nursing Service, Auxiliary Hospital, Red Deer,
Alberta.
BRITISH COLUMBIA
SUPERVISORS and GENERAL DUTY
NURSES for 50-bed acute care hospital 60
miles west of Prince George, B.C. Intensive
care/emergency unit planned with correlated
Inservice program. New hospital approved for
1970-71. RNABC contract in effect. Residence
accommodation provided at minimal rate.
Friendly, informal atmosphere, with opportuni-
ty to advance professionally. Write to: Director
of Nurses, St. John Hospital, Vanderhoof, B.C.
56 THE CANADIAN NURSE
COME TO PACIFIC NORTHWEST — Gateway
to Alaska, Friendly community, enjoyable
Nurses' Residence accommodation at minimal
cost. RNABC contract in effect. Salaries — Re-
gistered $508 to $633, Non-Registered $483,
Northern differential $15 a month. Travel allow-
ance up to $60 refundable after 12 months serv-
ice. Apply to: Director of Nursing, Prince Rupert
General Hospital, 551-5th Avenue East, Prince
Rupert, British Columbia.
B.C. R.N. FOR GENERAL DUTY in 32 bed
General Hospital. RNABC 1969 salary rate
$508— $633 and fringe benefits, modern, com-
fortable, nurses' residence in attractive com-
munity close to Vancouver, B.C. For application
form write: Director of Nursing, Fraser Canyon
Hospital, R.R. 2, Hope, B.C.
GENERAL DUTY NURSES (2) required for
New Modern Hospital designed with the Friesen
Concept of Supply — Distribution. Acute Unit
75-beds. Extended Care Unit 35-beds. RNABC
policies in effect. Hospital located in the
beautiful East Kootenays. Apply to: Director
of Patient Care, Cranbrook and District Hos-
pital, Cranbrook, B.C.
GENERAL DUTY NURSES for new 30-bed hos-
pital located in excellent recreational area. Salary
and personnel policies in accordance with
RNABC. Comfortable Nurses' home. Apply: Di-
rector of Nursing, Boundary Hospital, Grand
Forks, British Columbia.
GENERAL DUTY NURSES for 37-bed Acute
Hospital in Southwestern B.C. Salary: $508 —
$633 plus shift differential. Credit for past
experience. RNABC Personnel Policies in
effect. Accommodation available in Residence.
Apply to: Director of Nursing, Nicola Valley
General Hospital, P.O. Box 129, Merritt, B.C.
GENERAL DUTY NURSES for 45-bed active
General Hospital — expanding to 70 beds. Situ-
ated on the Sunshine Coast, 2-1/2 hours from
Vancouver, B.C. RNABC policies in effect. Ap-
ply to: Director of Nursing, St. Mary's Hospital,
Sechelt, British Columbia.
GENERAL DUTY NURSES for 63-bed active
hospital in beautiful Bulkley Valley Boating,
fishing, skiing, etc. Nurses' residence. Salary
$498—523, maintenance $75; recognition for
experience. Apply: Director of Nursing, Bulkley
Valley District Hospital, Smithers, British
Columbia.
GENERAL DUTY AND PRACTICAL NURSE
needed for 70-bed General Hospital on Pacific
Coast 200 miles from Vancouver. RNABC
contract, $25 room and board, friendly com-
munity. Apply: Director of Nursing, St. George's
Hospital, Alert Bay, British Columbia.
GENERAL DUTY and OPERATING ROOM
NURSES for modern 450-bed hospital with
School of Nursing. RNABC policies in effect.
Credit for past experience and postgraduate
training. British Columbia registration is re-
quired. For particulars write to: The Associate
Director of Nursing, St. Joseph's Hospital,
Victoria, British Columbia.
Fully accredited, 100-bed General Hospital
requires the immediate services of GRADUATE
NliRSES for all clinical units, operating room
and intensive care. Challenging, rapidly
developing town of 12,000 on Alaska Highway,
with daily transportation facilities to
Edmonton or Vancouver. Starting salary $508
ranging to $633 with credit for past experience.
Write or phone collect to: Administrator, Saint
Joseph General Hospital, Dawson Creek, B.C.
GRADUATE NURSES (2) required about
November 15th, 1969 for 26-bed hospital in
the sunny Interior of British Columbia. 3-1/2
hours from Vancouver and 1-1/2 hours from
Okanagan points. Starting salary $536 per
month with annual vacation of 21 working days
and 10 paid statutory holidays. Full board and
room in TV equipped residence $60 per month
with free uniform laundry. Other usual
employee benefits. For further information,
apply to: Director of Nursing, Princeton
General Hospital, Princeton, B.C.
GRADUATE NURSES for 24-bed hospital,
35-mi. from Vancouver, on coast, salary and
personnel practices in accord with RNABC.
Accommodation available. Apply: Director of
Nursing, General Hospital, Squamish, British
Columbia.
NOVEMBER 1%9
December 1969
^^^VERSITY
The
^2-69-,.,e-n,,,
Canadian
Nurse
Christmas in the north
safe care for mother
and babe
the nurse is a specialist,
in the artificial kidney i^riit
Both are disposable. But it takes a lot more expensive
labor and special equipment to dispose of glass bottles.
VIAFLEX plastic containers, on the other hand, go right
into the wastebasket. VIAFLEX containers are lighter and
easier to handle, too. They need 30% less storage space
than glass bottles do. One nurse can easily carry several
units. Set-ups and change-overs are easier and faeter.
The system is completely closed for sterility; there's no
vent, so no room air can get in. VIAFLEX is the first and
only plastic container for I.V. solutions. Easy come. Easy go.
BAXTER LABORATORIES OF CANADA
DIVISION Of TRAVENOL LABORATORIES INC
6405 Northam Drive, Malton. Ontario
Viafl^
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After all, catheterization can be a traumatic experience.
That's why we designed the Curity Foley Catheter with
enough medical grade latex to make it both firm and
flexible at the same time. So it doesn't readily kink.
Insertion is faster, easier for you; less unnerving for yotu
patient.
The Curity Foley Catheter's distinctive shape protects the
profile of the lumen for optimum drainage all during patient
usage. And natural tissue rejection is minimal, because of
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The
Canadian
Nurse
^
^^^
A monthly journal for the nurses of Canada published
in English and French editions by the Canadian Nurses' Association
Volume 65, Number 12
December 1969
25 Home for Christmas H.E. Ferrari
28 Nurses and Educational Change D. Kergin
31 Safe Care for Mother and Baby K. Dicker
33 The Nurse is a Specialist in the Artificial Kidney Unit C. Frye
37 Parents Participate in Care of the Hospitalized Child E.M.MacDonald
40 Drug Adverse Reaction Program - and the Nurse's Role E. Napke
The views expressed in the various articles are the views of the authors and do not
necessarily represent the policies or views of the Canadian Nurses' Association.
4 Letters
9 News
18 Names
21 Dates
22 New Products
23 In a Capsule
44 Research Abstrats
47 Books
49 Accession List
I-XVlll Official Directory
Executive Director: Helen K. Mussallem •
Editor: Virginia A. Lindabury • Assistant
Editor: Eleanor B. Mitchell • Editorial Assist-
ant: Carol A. Kotiarsky • Circulation Man-
ager: Beryl Darling • Advertising Manager:
Rntli H. Banmel • Subscription Rates: Can-
ada: One Year, $4.50; two years, $8.00.
Foreign: One Year, $5.00; two years, $9.00.
Single copies: 50 cents each. Make cheques
or money orders payable to the Canadian
Nurses' Association. • Change of Address:
Six weeks' notice; the old address as well
as the new are necessary, together with regis-
tration number in a provincial nurses' asso-
ciation, where applicable. Not responsible for
journals lost in mail due to errors in address.
® Canadian Nurses' Association 1969.
Manuscript Information: "The Canadian
Nurse" welcomes unsolicited articles. AH
manuscripts should be typed, double-spaced,
on one side of unruled paper leaving wide
margins. Manuscripts are accepted for review
for exclusive publication. The editor reserves
the right to make the usual editorial changes.
Photographs (glossy prints) and graphs and
diagrams (drawn in India ink on white paper)
are welcomed with such articles. The editor
is not committed to publish all articles
sent, nor to indicate definite dates of
publication.
Postage paid in cash at third class rate
MONTREAL, P.Q. Permit No. 10,001.
50 The Driveway, Ottawa 4, Ontario.
Hay W ^P^^^'
of the season
and the v^armth ^
of Christmas ^eer
Fill your heart
and ^ 1^°"^^ ^^
v^ith happiness
That v^ill last
throughout^_3
►year
jIum*^
DECEMBER 1%9
THE CANADIAN NURSE 3
letters
Letters to the editor are welcome.
Only signed letters will be considered for publication, but
name will be withheld at the writer's request.
Check your image
The Canadian Nurse is in the difficult
position, by virtue of its "captive" au-
dience, to chart a course that many of its
readers would like to read. I don't know
if an easy solution could ever be found
for this problem: theoretically, this maga-
zine stands as the body giving quasi-
official thoughts on direction and pur-
pose to Canadian nurses, and yet this
kind of information is hardly what a
captive audience would choose to read,
one would think.
I believe that the October 1969 issue
will polarize the opinions of many who
read this journal. I am referring to the
article "Check your image - it's
slipping! " In it, the author attempts to
equate professionalism among nurses with
the tidy wearing of uniforms. In fact, she
even seems to define professionalism by
stating, "usually the professional shows
his commitment to his calling by repre-
senting it well when on public view,"
following this with a series of examples
and pictures of untidy nurses.
Nurses seem to have gotten themselves
into a bind: so indoctrinated with the
maxim that a professional appearance
betokes a professional, they feel that by
looking clean, crisp and competent, they
are a credit to the profession. As a result
of this, nursing service issues directives
about skirt lengths and sweaters; in many
places, a nurse with "time on her hands"
is expected to clean cupboards, or per-
form other such tasks.
But perhaps this is no longer a signifi-
cant issue. If nursing administrators
choose to make it an issue, they are
admitting, perhaps, that more relevant
criteria for establishing professional be-
havior do not exist. It's easy to see if a
nurse looks clean and to check off that
category on her work-performance sheet,
but it is significantly less easy to devise
standards for professional behavior, and
to figure out appropriate ways to measure
if a given nurse has those qualities.
Better that we should stick to the
image of the clean crisp nurse? Is it easier
for The Canadian Nurse to meet the
needs of those who would have issues
stay the same, who would deny that
issues of more vital importance for nurses
do, in fact, exist?
I am not denying the importance of
basic neatness. It is one means by which
we pass information to others about our
view of Hfe and ourselves. One would
suppose, though, that sloppy attire is one
way for a nurse to express her dissatisfac-
4 THE CANADIAN NURSE
tion about her job, or with nursing in
general. And it is the creative suggestions
for minimizing the roots of discontent
that should be given importance on your
pages. As it stands now. The Canadian
Nurse has lent an almost official support
to Miss Zilm's completely untested state-
ment that there is a correlation between
professional behavior and appearance of
the nurse in her uniform.
Is a doctor, in rumpled whites, any less
professional? And would the pages of his
professional journal tell him so? - Ros-
alind Paris, B.Sc.N., Montreal.
We received our October issue of The
Canadian Nurse today, and the director
of our school of nursing is so impressed
with the article "Check your image-it's
slipping! " that she has asked me to order
two additional copies so that she can
make a montage of the pictures to bring
the message vividly to the nursing stu-
dents. Mrs. Elizabeth J. Guilfoil, Direc-
tor of Medical Libraries, Sacred Heart
Hospital, Spokane, Washington, U.S.A.
1 thank Glennis Zilm for her article
"Check your image - it's slipping! "
(Oct. 1969). It certainly is time someone
took this problem in hand.
As I am retired now, I wonder who is
responsible for these particular matters.
We do not have the old-time matrons
now. There are so many directors, super-
visors, and such that I am appalled when I
meet nurses wearing uniforms around the
streets and stores.
Again, thank you for the arti-
cle. - Dorothy Sharp, Vanier City,
Ontario.
I enjoyed the article "Check your
image - it's slipping! "(Oct. 1969). The
photographs alone told the story.
The thing that concerns me is that the
nurse's image began slippmg a long time
ago, when waitresses, hairdressers, and
domestic help donned white uniforms,
nylons, and duty shoes.
Most persons cannot differentiate
between these people and nurses. There-
fore, I believe nurses are often unjustly
blamed.
I am not saying that we are not at
fault. We have all been guilty of one of
these errors sometime during our career.
However, if persons in other careers
would acquire some type of uniform that
does not so closely resemble nurses'
uniforms, we would look more closely
and proudly at our own image. - Mrs.
M. Cook, RN, Sarnia General Hospital,
Sarnia, Ontario.
Miss Zilm wrote an interesting article
in the October issue ("Check your im-
age - it's slipping! "), and I had to agree
with most of her points.
I say "most" because I noticed she
said "... collective bargaining has raised
salaries out of the poverty range." Too
bad Miss Zilm did not inspect the salaries
of Quebec nurses a little more closely. If
my pantihose, which are quite expensive,
have a run, or my uniform looks shrun-
ken or gray, or my shoes have a hole in
the arch, please don't criticize me until I
can afford to buy new ones. My shoes,
stockings, and uniforms may look worn,
but at least they are clean. - Michelle
Van Hinte, Montreal.
Defends telephone surveys
Editor's Note: In August 1968. an article
on the self-defense of women, "Defend
Yourself, " by Loral Graham - then edi-
torial assistant of The Canadian
Nurse - appeared in the journal. This
article was picked up by Tlie Canadian
Press and excerpts from it subsequently
appeared in newspapers throughout Cana-
da (as well as in The New York Times).
Tlie Winnipeg Tribune published this CP
item this past October, and it was
brought to the attention of ADCOM
Research Limited, whose headquarters
are in Toronto. The president of this
company comments:
Your interesting article outlining pre-
cautions wise women take to protect
themselves was sent to me by our field-
interviewing supervisor in Winnipeg. I
agree with the vast majority of the
comments.
The statement that really stung me to
the quick was this: "Reputable firms
rarely conduct surveys over the tele-
phone." This just is not true since we,
and a good many other research compa-
nies, are both reputable and conduct
many surveys over the telephone for
some of the largest and most well regard-
ed companies in Canada. We at least
always identify both our company and
the actual person conducting the inter-
view, and this is the general practice.
Certainly, it is the privilege of any
individual to refuse to be interviewed and
this is accepted. It is also their privi-
lege ~ though we hope it won't happen
much - to call back and speak to our
DECEMBER 1969
supervisor who is on the spot. Incidental-
ly, our interviewers are all women.
We are members of the Better Business
Bureau of Toronto and in this area we
have a bit of a problem in that there is at
present no way of belonging to one
Better Business Bureau and, by some sort
of extra payment, also being registered
with all the Bureaus.
Being interviewed on the telephone is
safer than being interviewed at the door.
How does one know that an unknown
woman at the door is not a karate expert
with an accomplice round the corner? At
least no one can be rendered hors de
combat by a telephone.
It may be of interest to your readers
to understand what marketing research
surveys are really about. They are. in one
way or another, all aimed at finding out
what our democratic society - and it is
still basically a free enterprise socie-
ty-is doing and thinking, wants to do
and think. In this way, we are working to
provide better ideas to make life a little
more pleasant. Even if you do not par-
ticularly like television commercials, the
eventual alternative is S 100.00 a year or
more each in taxes, and the option to see
only whatever the government chooses to
let you see.
I'm sure that there is one thing we can
agree on. There are people who pretend
to be conducting a survey, but who are,
in fact, trying to sell something, often
magazine subscriptions. We wish, as I
imagine you do, that this could be
stopped. Adrian T. Gamble, president,
ADCOM Research Limited, Toronto.
Timely and thought-provoking
1 compliment you on the array of
timely and thought-provoking articles in
the October issue. "The Child with
Leukemia" was so well presented, dwell-
ing as it did on the mental approach to
these children, the common-sense atti-
tude toward specialized nursing care, and
an optimistic atmosphere.
1 chuckled over the delightful word
picture of "The Coagulation of Harry,"
which intrigued and amused my teen-
agers.
1 appreciated "The Nurse and the
Sociopathic Personality," because I have
never seen material dealing with this type
of patient. This is a must for every
nursing student, as contact with individu-
als like these can severely shake an
inexperienced person's confidence.
An article like "Check your Image-
It s Slipping" was long overdue.
My only criticism is the opinion page
"Making a Comeback." by Mrs. B. Ko-
walchuk. This article does a disservice to
the recruiting of older nurses back to the
profession. If I had read it two years ago,
it would have destroyed my desire to
return to nursing and undermined my
confidence.
1 agree, however, with Mrs. Kowal-
DECEMBER 1969
chuk's suggestion of having part-time
nurses during peak hours. This would
eliminate much of the rushing about at
bath-time, would give the nurse time to
study her patient's condition and to give
assurance when needed.
Yet. because nursing has always been a
serving profession, it can never be subject
to regular employment hours. Married
women who have one paycheck should
not expect the "plums" of a job when
full-time staff must work shifts, week-
ends, and holidays.
There is a place in nursing for married
women who have been inactive in their
profession for some years. Most of us
know how it feels to be a patient and
suffer the physical indignities, the grating
on edgy nerves, and the feeUng that
maybe something is wrong. Thus, when a
patient complains that nothing is right,
we keep trying until we convince her that
we care what happens to her. How much
satisfaction there is in hearing a fractious
patient say with a smile, "That feels
good, nurse! " — Mrs. Mary Grant,
Islington, Ontario.
NLN note to nurse educators
You are undoubtedly aware that Cana-
da will have its own nurse licensing
examination service sometime in 1970,
and the provinces will no longer be using
the State Board Test Pool Examination
from the United States.
The foregoing information seems to
have been misinterpreted, so we are writ-
ing to assure Canadian nurse educators
that the selection and achievement test
services of the National League for
Nursing will continue to be available to
Canadian schools of nursing and boards
of nursing as they have been in the past.
We will be happy to supply more detailed
information on request.- NLN Evaluation
Service. 10 Columbus Circle, New York.
N.Y. 10019, U.S.A.
Making a comeback
I read with interest the article "Making
a Comeback" (October 1969) by B.
Kowalchuk.
St. Peter's Infirmary in Hamilton, On-
tario, has for many years hired part-time
RNA staff to work the hours of peak
activity in the morning. This suited the
hospital and employee to such an extent
that it was a surprise to find so little of it
elsewhere.
However, my reason for writing is not
to discuss hours, but to encourage Mrs.
Kowalchuk as she searches for her
"Utopia." It may take time before she
finds what she wants, but nursing is too
varied a field to admit defeat.
There are people in the community
who need her valuable services. I suggest
that she investigate the possibility of
nursing outside the hospital setting. - C.
Rorke, R.N., Industrial Nurse, Toronto.
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6 THE CANADIAN NURSE
I hope this letter will be only one of
many you receive in response to B.
Kowalchuk's article, "Making a Come-
back" (Oct. 1969). As I read it, her words
echoed as if I had written my story. Her
sentence, "I would like merely to keep
my mind alert, and my nursing skills
up-to-date, and be of some assistance to
people" is the essence of how so many of
us in our middle thirties feel.
This was what prompted me last year
to call the hospitals in my area for
part-time work. In those hospitals that
did have part-time staff, their quota was
filled and no increase was planned for the
near future. Some hospitals did not wish
part-time help because it was "hard on
the bookkeeping."
I accepted a full-time job and was soon
feeling fulfilled in my profession. But, as
Mrs. Kowalchuk noted, the multitude of
household duties and the care of a family
soon began to require more effort for me
to be efficient in both fields. It became
necessary to make a decision - full-time
nursing, or no nursing at all.
My family respected me as a working,
contributing member of society; my teen-
age daughter seemed to respect my opin-
ions more, and my husband was pleased
with my happiness. Thus the decision to
resign was a difficult one to make. I again
hoped to find part-time employment, but
this has proved unsuccessful.
Mrs. Kowalchuk's solution is an obvi-
ous one for the nurse: suitable hours for
family routine and the feeling of being
useful in giving the nursing care needed
between 8:00 and 12:00 in the mornings
and evenings. We are thwarted in this
need by lack of foresight on the part of
hospital organization.
It may be a cry in the wilderness, but
such an idea may finally be heard before
some of us are too old to contrib-
ute. - Joan Hodgson, Dartmouth, N.S.
It was with sympathetic interest that I
read Mrs. Kowalchuk's article "Making a
Comeback" (Oct. 1969).
I also took a refresher course as soon
as my youngest child started school. Then
I did some part-time nursing for three
years. The hours I was needed most were
during the evenings or nights and they
certainly do not fit in with the needs of a
growing family or a contented husband.
Consequently, the hours that I do have
free during the day are spent on volunteer
work or hobbies that are not nearly as
stimulating or as satisfying as nursing.
If there is this great need for nurses to
come back to work, where can we fit in
and still be good wives and moth-
DECEMBER 1969
ers? — Mrs. Shirley Tempest, New West-
minster, British Columbia.
Final comment on February article
1 am particularly glad of the opportu-
nity to try to clear up some of the
confusion caused by the article "Two-
year versus three-year programs" (Febru-
ary 1969) in view of the letter from my
colleagues at the Regina Grey Nuns'
School of Nursing (September, 1969).
It seems to me that the letter from the
Grey Nuns' School of Nursing is a face-
saving one when such is not needed. For
instance, addressing previous correspond-
ents, they wrote: "Regarding the design
of the study having limitations, we won-
dered why you did not mention the
obvious point that the two groups of
students followed a revised curriculum
and that the conclusions might well have
been different had the control group
come from another school of nursing
following a three-year, service-oriented
program taught by different teachers."
I believe what they should have said is
that the results would almost certainly
have been different, but that any conclu-
sions would have been well nigh imjxjssi-
ble. This is so because the results would
have been difficult to interpret when any
differences between the experimental and
control groups due to differences in
length of course would have been con-
founded with differences due to the two
nursing schools.
It was also noted in the Regina letter
that in the original report "At no point
was the statement of 'superiority' of one
group over another made." It is true that
the word "superiority" was not used, but
to attack the critics on this ground is to
confuse the issue. We certainly said, "This
study provides conclusive evidence that
the students in the three-year program
performed better generally than students
in the two-year program." We could very
well have said that they were generally
superior to the students in the two-year
program.
There are many other confusions to be
cleared up. I would quite happily address
any gathering of nurses, if my basic
expenses in attending such a meeting
could be covered. In the meantime, I
thank your readers for their inter-
est. - C.G. Costello, Ph.D., Professor,
Dept. of Psychology, University of Calga-
ry, Calgary, Alberta.
This is the final correspondence that will
be published about the article "Two-year
versus three-year programs. " - Editor.
Curses respond
The advertisement for nursing person-
nel that we placed in your September
ssue has been a wonderful means of
communication. We have received
ipplications from 1 1 nurses and all refer-
ed to the ad in The Canadian Nurse. It
DECEMBER 1%9
also points out to interested nurses that
the magazine is read and appreciated by
nurses in general. -Sister B. Knopic, Di-
rector of Nursing, St. John's Hospital,
Edson, Alberta.
Further response to minister's speech
I had two reactions to the speech given
by the Minister of National Health and
Welfare at the ICN Congress and pubUsh-
ed in the August issue of The Canadian
Nurse. The opening paragraph put me off
completely when I read the rather tired
and overused introduction of "appropri-
ate day to feel sick," and so on. As a
result, my reaction to the first section
was rather negative.
I wondered what kind of critical
speech I was about to read wherein we
were being warned about bankrupting the
treasury and being told medicare would
be for everyone if we — the profession-
als - would toe the line. But when I
reached the end I felt there had been an
impact, which, if nurses responded, could
create a challenge and some action.
As the Minister developed his point, it
became clear to me that he was criticizing
the nursing profession as having develop-
ed two stereotyped groups of nurses: the
hospital nurse and the pubhc health
nurse. Don't restrict yourself to these
areas, he seemed to be saying. Get into
areas where the need for nurses is great.
Reduce the deadwood; get rid of monu-
mental buildings; be realistic; use home
settings.
These words struck home. I agree that
the taxpayer will not be able to stand the
escalating costs, and that the total health
team must move into the community and
reduce costs through preventive programs
and the use of home settings.
Again, I agree with him that the
nursing profession must be aggressive in
regard to treatment programs. We verbal-
ize about "getting back to the patient,"
but we sit in traditional settings and
protect the old, acceptable ways, rather
than trying to promote something new. If
we are to play a role of greater impor-
tance in the health team, with more
responsibility and independence, we will
have to change.
I wonder what the reaction will be to
his suggestion that nurses can take a great
deal of the workload from the doctors?
Do we believe this? Are we afraid of
practicing nursing - or are we digging
our heels in and saying "this is not
nursing"?
I am pleased, too, to read that the
Minister says that he does not pretend to
know the best avenue for us to take and
that he points to us to initiate reform and
reorganization, not only in education, but
also in patterns of practice. — Norah M.
Stevens, Director of Nursing, Royal
Columbian Hospital, New Westminster,
British Columbia. D
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THE CANADIAN NURSE 7
Frankly,
we'd
rather
you didn't
notice us
It has been said that the measure of
truly effective background music is
the degree to which it goes un-
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A contradiction? Perhaps. Yet, con-
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CNA Special Committee Report
To Be Sent To Provinces
For Further Study
Ottawa. - Restatement of the objec-
tives of the Canadian Nurses' Association,
clarification of the role of CNA, and a
recommendation that the association be
financed on a per capita fee basis are
found in the report of the special ad hoc
committee on functions, relationships,
and fee structure. The report, presented
to the CNA board of directors at its
meeting November 7 by committee chair-
man Jeanie S. Tronningsdal, is based on
the responses of questionnaires sent to
the provincial nurses' associations, the
CNA board of directors, and CNA profes-
sional staff.
The committee's recommendation
concerning CNA objectives is essentially a
change in wording, rather than in mean-
ing. The recommendation that attempts
to clarify the role of CNA says, in part,
that the association should lead, coordi-
nate and advise; that CNA is the voice for
nursing on national and international
levels; and that CNA acts as a catalyst for
change by identifying trends and helping
to implement new programs in the health,
social, and welfare fields.
The committee report said that the
majority of provincial nurses' associations
favored a fixed per capita fee structure.
This, along with the complexities of
administering a sliding scale system for
payment of CNA fees and the necessary
curtailment of CNA activities that would
result from a lowering of the average fee
per member, convinced the committee
that the per capita fee basis should be
continued.
The report, which may still be revised
in its organization and wording by the ad
hoc committee, will be sent to the pro-
vincial nurses' associations for further
study this month. The full report will
be published in The Canadian Nurse in an
early spring issue so it can be examined
by CNA members prior to its presenta-
tion at the general meeting in Fredericton
in June 1970. At that time, members will
vote on the committee's recommenda-
tions.
The special ad hoc committee was set
up at the association's 1968 biennial
meeting in Saskatoon, on the direction of
CNA membership, to investigate the
question of fees and the roles and res-
ponsibilities of the national associations
in relation to the provincial associations.
DECEMBER 1969
CNA President And Committee Chairman Discuss Report
Sister Mary Felicitas, president of the Canadian Nurses' Association, with Jeanie S.
Tronningsdal, chairman of the ad hoc committee on functions, relationships, and
fee structure. Mrs. Tronningsdal presented the committee's report to the CNA
board of directors in Ottawa November 7.
The committee has held three meetings
since it was organized.
New CNA Bylaws Approved
At Special Meeting
Ottawa. - At a special meeting of the
Canadian Nurses' Association November
5, delegates from the 10 provincial
nurses' associations voted in favor of
adopting several new bylaws. The accept-
ed bylaw changes for CNA were required
to allow it to comply with the require-
ments of Letters Patent companies under
Part II of the Canada Corporations Act.
Most bylaw changes were of a formal
nature and were not commented on by
delegates. A major change that disturbed
delegates involved the required bylaw on
withdrawal from membership in CNA. As
presently worded and eventually accepted
by the delegates, this bylaw states that
any member may withdraw from the
association by giving written notice.
Several delegates expressed concern that
this could lead to considerable confusion
and weakening of CNA, as individual
members could, by law, elect to with-
draw from the national association.
Delegates from some provinces came
to the special meeting prepared to vote
on an amendment to the proposed bylaw
on withdrawal. The delegates from the
Association of Nurses of the Province of
Quebec had a mandate from their mem-
bers to vote only on the bylaws as
drafted, not on any amendments. To
avoid delay in the issuance of Letters
Patent, the decision was made to vote on
the bylaws as proposed.
The CNA's legal adviser, George
Hynna, told the delegates that there was
nothing to prevent them from amending
this controversial bylaw or any other
bylaw at the next CNA general meeting in
June 1970. He pointed out, however, that
as soon as CNA is issued Letters Patent
under the Canada Corporations Act,
changes in bylaw amendment must be
approved by the federal government's
minister of Consumer and Corporate
Affairs - the department charged with
administering the Corporations Act.
The CNA is presently incorporated
under the Special Act of Parliament.
After two years of unsuccessful attempts
THE CANADIAN NURSE 9
to get amendments to its Charter passed
by Parliament, the association's board of
directors decided in March 1968 to apply
for Letters Patent under the new Canada
Corporations Act.
Under this Act, CNA will be required
to have an annual, rather than biennial,
general meeting.
Provisional Board To Be Set Up
For CNA Testing Service
Ottawa. - An important step toward
the operation of the CNA Testing Service,
which will offer nurse registration exami-
nations to the provinces by August 1970,
was taken by the board of directors of
the Canadian Nurses' Association at its
meeting November 4-7.
The CNA board passed a motion to set
up a provisional administrative board to
inaugurate the national testing service. An
ad hoc committee, which the CNA board
agreed to establish immediately, will rec-
ommend to the executive by January
1970 the terms of reference and composi-
tion of the provisional board. This new
board will be responsible for the testing
service until a permanent board is named.
Although the testing service is being
set up under the auspices of CNA, the
CNA board agreed at an earlier meeting
that the service should eventually be set
up under an independent board.
At its November meeting, the CNA
board of directors considered proposals
submitted by the College of Nurses of
Ontario and several provincial associa-
tions on the structure, composition, and
frame of reference of the testing service
board. These recommendations wUl be
examined by the ad hoc committee and
by the provisional board when it is set up.
Since the CNA board decision in 1967
to use the Registered Nurses' Association
of Ontario examinations as a nucleus for
a Canadian, objective-type, machine-
scored testing service, CNA and RNAO
negotiating committees have been work-
ing out the details of the transfer of the
RNAO testing service to CNA. The nego-
tiations have reached the final contract
stage, and the official transfer will be on
May 1,1970.
The RNAO testing service has been
supplying Ontario and New Brunswick
with registration and licensing examina-
tions. Because of the need for French-
language examinations, Ontario, unlike
the other provinces, has not used the
National League for Nursing Test Pool
examinations. The NLN test papers will
not be available outside the United States
after the summer of 1 970.
Quebec has used the NLN papers for
10 THE CANADIAN NURSE
Helen K. Mussallem, executive director of the Canadian Nurses' Association, was
one of 26 Canadians who received the Medal of Service of the Order of Canada
October 28, 1969. The investiture took place at Government House, Ottawa.
Instituted during Canada's Centennial Year, the Medal of Service is given in
recognition of "excellence in all fields of endeavour in Canadian life, and is
indicated by the initials SM following the name and takes precedence over degrees.
its English-language candidates and has
developed its own French-language exam-
inations. The Association of Nurses of the
Province of Quebec has agreed to accept
nationally-prepared examinations as long
as the French-language papers are not
translated from the English but are pre-
pared by experts in the French language.
CNA Board Adopts
Educational Committee Motions
Ottawa. - The board of directors of
the Canadian Nurses' Association agreed
to adopt as a policy the statement that all
teachers in nursing education programs
should have as a minimal qualification a
bachelor's degree.
This statement was recommended to
the board by CNA's standing committee
on nursing education during the board
meeting November 4 to 7, 1969 at CNA
House. The policy statement also says
that in bachelor's and master's programs
the teacher's degree should be one level
above that for which the nursing student
is being prepared.
At present, according to statistics in
CNA's Countdown 1969. less than 50
percent of the faculty in both diploma
and baccalaureate degree nursing pro-
grams are so qualified.
During its last meeting October 1 5 and
17, 1969, the education committee
identified as a priority for research the
topic "how students learn to nurse." The
CNA Board accepted the committee's
recommendation that CNA stimulate,
encourage, and become involved in
projects in this area.
The board also passed the education
committee's motion that it believes the
learning needs of students can best be
met if opportunity for student involve-
ment in planning the educational program
is provided.
Committee chairman is Kathleen
Arpin. Members include: Nora Tennant;
Elizabeth M. Moore; Kathleen G. De-
Marsh; Alberta Crouse; Ruby Dewling;
Sister Clare Marie; Isabel A. Brown; Stella
DriscoU; Therese d'Aoust; Mirth A.
Doyle; and Jean Byam.
CNF To Receive CNA Funds
For Research In Nursing Service
Ottawa. - The Canadian Nurses'
Foundation will receive direct financial
support for nursing research from the
Canadian Nurses' Asociation.
This decision was made by the CNA
board of directors at its November 4-7
meeting, on a recommendation from the
standing committee on nursing service.
The board's motion calls for not less than
$2,000 and not more than $5,000 to be
contributed to CNF each year for the
DECEMBER 1%9
next five years. The exact amount is to be
considered in the preparation of the next
CNA budget.
The committee beheved that such
CNA action might encourage further
donations to CNF from individuals and
organizations. In its report to the CNA
board, the committee emphasized that
there is an "urgent need for research in
many areas of nursing practice."
The committee's report identified
certain areas in nursing that are in need of
study, and recommended that these areas
be brought to the attention of nurses
doing graduate study. These areas are:
• Evaluation of the quality of nursing
care.
• Job satisfaction of nurse practitioners.
• Performance of registered nurses gradu-
ated from baccalaureate and diploma
nursing programs, and performance of
Ucensed practical nurses.
• How nurses can improve their image to
the public, to other health professions,
and to other nurses.
• Research in areas of nursing practice.
• Delivery of nursing care: 1. ritualism
vs. judgement, and 2. system of adminis-
tration of medications.
• Use of ward managers.
• Turnover rates of nursing personnel:
1. causes; 2. relationship to job satisfac-
tion; and 3. relationship to the quality of
nursing care.
• Role of the registered nurse in out-
patient and emergency services.
• Staffing in the outpatient department
and emergency services.
• Staffing patterns in operating rooms.
The nursing service committee, under
the chairmanship of Margaret D. McLean,
held its last meeting of the 1968-70
biennium October 15-17.
Guide On Nursing Service
Standards To Be Published By CNA
Ottawa. - Final revision of the self-
evaluation guide on standards for nursing
service was approved for publication by
the board of directors of the Canadian
Nurses' Association at its meeting Novem-
ber 4 to 7, 1969.
The guide was drawn up by CNA's ad
hoc committee on standards for nursing
service for use as a tool to evaluate the
quality of nursing service.
Prior to final revision, the guide was
tested in 23 areas throughout Canada,
representing all areas where nursing serv-
ice is provided. These included nine hos-
pitals, three extended care facilities, four
public health nursing agencies, four
branches of the Victorian Order of
Nurses, and three occupational health
settings.
Results of the testing indicated that
the nursing service standards were gener-
ally applicable to all areas where nursing
care is given.
The self-evaluation guide will be avail-
DECEMBER 1969
able on demand from CNA. After it has
been in use for some time, further revi-
sions will be made if necessary.
The ad hoc committee will now move
into phase two of its activities, which
entails developing standards for nursing
care. The CNA board approved the com-
mittee's recommendation that it be res-
tructured for this phase to include re-
presentation from education (in the
university settting), from VON and public
health, and from clinical practitioners in
psychiatric nursing, medical-surgical
nursing, and maternal and child health.
Some members of the present com-
mittee will be retained to maintain
continuity. Present chairman is Irene
Buchan.
Clinical Nursing Statement
Revised By CNA Board
Ottawa. - Revision of the Canadian
Nurses' Association's policy statement on
the chnical nurse specialist was agreed to
by the CNA board of directors during its
meeting November 4 to 7, 1969.
Revision of the statement, which
currently appears in CNA's On Record
1968, was recommended by CNA's com-
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THE CANADIAN NURSE 11
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Photo credits for
December 1969
Photo Features, Ottawa, p.9
Dominion-Wide,
Ottawa, pp. 10,20
Graetz Bros. Ltd.,
Montreal, p. 18
Pye Telecommunications Ltd.,
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Ottawa Civic Hospital,
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mittees on nursing education and nursing
service at a joint meeting October 16,
1969.
The revised statement now reads:
"The clinical nursing specialist is an
independent nurse practitioner prepared
at the master's level with specialization
and expertise in a particular area of
clinical nursing.
"This individual should be responsible
to the nursing director of the health
agency and free of administrative duties.
The clinical nursing specialist will enrich
the quality of nursing care by demons-
trating excellence in nursing practice, by
utilizing available knowledge to effect
improvement in care, by initiating and
contributing to nursing research and by
functioning as a resource person."
Chairman of the morning session of
the joint committee meeting was Marga-
ret D. McLean, chairman of the co-
mmittee on nursing service; Kathleen
Arpin, chairman of the nursing education
committee, chaired the afternoon session.
CNA Executive Director Predicts
Change In Science Of Nursing,
Not In Art Of Nursing
Vancouver, fi.C- Educational systems
of the future must make it easier for
students to change the direction of their
careers without unnecessary loss of time,
Helen K. Mussallem, executive director of
the Canadian Nurses' Association, told a
large audience at the University of British
Columbia October 24. "The ultimate
choice of a career is usually the cumula-
tive result of many decisions. The educa-
tional processes of the future must permit
a student to upgrade his profession with-
out starting at the bottom again," she
said.
Presenting the Marion Woodward Lec-
ture at UBC, Dr. Mussallem used the
theme "Nursing Tomorrow" to range far
over the field of health and related
environments as it will exist 50 years
from now. Predicting vast changes in
medical knowledge, nursing science,
nursing environment, and nursing prac-
tice. Dr. Mussallem also forecast an ed-
ucational process that will be more flexi-
ble and permit easier upward mobility
within the profession.
"In the next century," she said, "stu-
dents bound for one of the health disci-
plines will first master a basic cluster of
generalized knowledge and skills designed
for health professionals. Specialization in
any health field, including nursing, will
take place at the postbasic level, and may
involve a variety of educational ap-
proaches, including work-study programs
and more intimate relationships between
12 THE CANADIAN NURSE
educational and service programs," she
said.
Dr. Mussallem predicted vast change in
the science of nursing but forecast little
change in the essential art of nursing.
"Human nature will not change," she
said. "Man will respond then as now to
the tender care and skilled competence of
the professional nurse. The art of nursing
will continue to be the application of
scientific knowledge to increase human
comfort and welfare."
Dr. Mussallem said that the rapidly
accumulating knowledge in the health
field will require a changing role for the
nurse in relation to other members of the
health team. "New skills, techniques, and
methods will be interwoven to produce a
new structure in terms of health care,"
she continued, "and in this new structure
the nurse will become the primary con-
tact professional. She will be responsible
for the coordination of health services
between the family, the hospital, and
other health agencies. Nurses of the fu-
ture will be more fully concerned with
total individual health care.
"The nurse has a triple role in life,"
Dr. Mussallem said. "A nurse is part of
the social structure, a member of the
health team and, in the ultimate exercise
of professional responsibilities, an individ-
ual alone with a patient. We cannot
therefore look at the future of nursing as
an isolated entity, but rather in the
context of the deUvery of health services
to a community of people.
"The nurse in the next century will
use the newest technological advances,
such as the computer programmed by
experts in the health field, to assist her
with developing a total health care plan
for patients in the community. Only
when the nurse has doubts about the
treatment prescribed or is confronted
with a more complex medical situation
will she consult one of the busy, highly
specialized medical practitioners. He will
probably be located in a modern health
center and will employ both the nurse's
description of the symptoms and the
computerized medical record of the pa-
tient in making a medical decision.
"Having utilized modern technology
and specialized medical knowledge, the
nurse will then be in a position to use her
nursing skills to prepare a total plan for
the care of the patient, including the
family's responsibilities."
A spectre that will haunt nursing for
many years is that advanced technology
in health centers will lead to a dehuman-
ized atmosphere. Dr. Mussallem said.
"Certainly no one predicts that there will
be a 'warm computer' to provide emo-
tional support to the frightened or con-
fused patient. It is here, as all through the
centuries past, that the nurse will main-
tain her unique and essential function of
providing support, comfort, and highly
skilled care to assist the ill to regain
DECEMBER 1%9
health as quickly as possible."
CNA Biennial Convention
To Open On A Sunday
Ottawa. - As a break with tradition
the official opening of the 35th biennial
convention of the Canadian Nurses' Asso-
ciation will take place on a Sunday. This
decision was made by CNA's board of di-
rectors, meeting November 4-7, 1969.
The convention will be held June 14
to 19, 1970 in Fredericton, N.B., and is
hosted by the New Brunswick Associa-
tion of Registered Nurses.
Other board decisions on the conven-
tion are:
• Fees are to be $25.00 for registered
nurses and SI 0.00 for students, with
S7.00 for daily registration.
• Business sessions will be held Monday
to Friday, with Wednesday left complete-
ly free and designated "Hospitality Day."
NBARN wUl arrange special tours and
entertainment for this day.
• Clinical interest sessions will be held
during the week.
• The convention theme has not yet been
chosen, but will center on nursing care.
Provincial associations have been asked to
send in suggestions.
• An interfaith service will precede the
official opening.
Metric Conversion Kits
Available From CHA
Ottawa. - In the September 1968
issue of The Canadian Nurse, an article
"Plan your change to metric," contained
information on Metric Conversion Kits
for Hospitals.
At that time these kits were available
from the Ontario Hospital Association at
a cost of SI. 00 for hospitals in Ontario
and S2.00 for purchasers outside the
province.
The Canadian Hospital Association is
now responsible for distributing these
kits. The CHA offers them to all hospitals
in Canada for $1.00. Hospitals outside
Canada can purchase a kit for $2.00.
For these kits, write to the CHA, 25
Imperial Street, Toronto 197, Ontario.
U of T School of Nursing
Celebrates 50th Anniversary
Toronto, Ont. - The University of To-
ronto School of Nursing is presently
marking its fiftieth anniversary.
Anniversary activities began with a
conference sponsored by the faculty and
the Alumni Association, held in the
School in June. The conference was
attended by nurses from many countries:
Australia, India, Hong Kong, Malaysia,
Turkey, Rhodesia, the United States, and
all provinces of Canada. There was discus-
sion of trends and developments in
DECEMBER 1%9
nursing education in Canada, and reports
were given of research and special pro-
jects by Canadian nurses.
AARN Rejects Bill 119
Will Meet With Health Minister
Edmonton, Alta. - Alberta's Bill
119, designed to establish a provincial
council of nursing, is unacceptable to
registered nurses throughout the province
as it now stands. This was the finding of a
task committee set up by the Alberta
Association of Registered Nurses to study
submissions of its members on the bill,
introduced during the last session of the
Alberta legislature.
The committee recommended that
new legislation should be introduced to
ensure protection of nurses' professional
prerogatives.
AARN representatives were to meet
with Alberta Health Minister James D.
Henderson in November to discuss the
proposed new legislation.
AARN has approved in principle the
estabhshment of a coordinated council of
nursing, but believes the government's
proposed council would have too much
control over the nursing profession. The
association believes coordination of
nursing services through government
legislation would be an important factor
in improving patient care to the pubUc.
PPA Answers Editorial
On Postal Rates
Toronto. Ont. - The Periodical Press
Association - an organization represent-
ing approximately 140 commercial and
non-commercial publications in Cana-
da — has expressed concern about an
editorial in the June issue of Canadian
Hospital, which referred to association
publications supporting commercial pub-
lications tluough postal rates. ("News,"
The Canadian Nurse, Sept. 1969, p. 16)
According to a press release issued by
PPA, the editorial is not factually correct,
nor is it even fair comment.
"Neither Maclean-Hunter nor Southam
Business Publications are being subsidized
at the present rates they are paying for
the mailing of their publications," the
press release states. "By Post Office's own
figures the new rates will more than cover
the cost.
"We do agree that the discriminatory
action of the Post Office to the associa-
tion or non-profit publications is com-
pletely unjust," the press release contin-
ues. "Association publications may or
may not be aware that as soon as we
realized that these proposals were apt to
become law, we alerted as many of the
association papers as we could, including
some of our own member publications.
We urged them to make special represen-
tations to Ottawa. Most of them seemed
to take the attitude 'It can't happen to
us, therefore we will take no action.' In
any event, little or no action was taken."
The press release continues: "When
the Periodical Press Association did pres-
ent a brief to Mr. Kierans, representatives
of both Maclean-Hunter and Southam
spoke on behalf of the association pub-
lications because the association publica-
tions did not feel they could make
representations for a variety of reasons.
We pointed out to Mr. Kierans the inequi-
ty of this particular clause dealing with
the non-profit publications. Mr. Kierans
did not seem concerned because he had
heard no word from the association pub-
Ucations protesting this move."
In the press release PPA denies that its
members lobbied for discrimination
against the non-profit publications. "We
have many valued association publica-
tions in our membership and we can
assure you that this would not be permit-
ted." PPA states that neither Maclean-
Hunter nor Southam approached associa-
tion pubUcations in an effort to take over
these magazines prior to the April 1st
change.
"Write It Down"
OHA Panel Suggests
Toronto, Ont. - "Write it down" was
the unofficial theme of the nursing ses-
sion on 'The Nurse and the Law" at the
Ontario Hospital Association's annual
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THE CANADIAN NURSE 13
convention in Toronto October 27-29.
Gordon Sullivan, a Hamilton lawyer,
emphasized that a written policy adopted
by individual hospitals and made available
to nurses and medical staff would prevent
many legal problems by making it clear to
staff what procedures the nurse is legally
able to perform. He also suggested that all
verbal and telephone orders from doctors
be written down by the doctor as soon as
possible. "Don't just take a doctor's
word," he warned, "because if a lawsuit is
filed the doctor will be nowhere to be
seen."
Mr. Sullivan reminded the nurses of
the importance of keeping accurate charts
for each patient. "These charts are admis-
sible in court as evidence, he said. "They
can also serve as a reminder to the staff
involved if the case gets to court some
time after the event being investigated."
Panelist J.W. Galloway, medical ad-
ministrator of St. Joseph's Hospital in
Hamilton, suggested that an up-to-date
manual of hospital policy could be of
considerable use to a nurse when she is
uncertain of the legality of a procedure a
doctor has asked her to perform. He also
suggested that nurses who have proved
themselves competent to perform certain
medical procedures should be certified by
the hospital, and their names kept on file,
as several hospitals are now doing. "This
would ease the problem of locating a
doctor in case of emergency, or when
doctors are not readily available, without
putting the nurse in a legally difficult
position."
All panelists reacted strongly to a
question from the audience on the legal-
ity of the written order "Do not resusci-
tate" on patients' cards. "If you see it on
mine, cross it out," said Mr. Sullivan,
then told the audience that the law would
be harsh if such a case ever came to court.
Louise Hall, director of nursing at Peter-
borough Civic Hospital, commented that
she had seen the notice "No code four"
on patients' cards, indicating that they
should not be resuscitated. "I've seen it
on cards but it still shakes me," she said.
"On checking, I always discover that the
patient has little hope of recovery, and
that by calhng staff from other jobs in
the hospital, the lives of other patients
with a good chance of recovery could be
endangered," she added.
Senior Civil Servant
Misquoted In Newspaper
Ottawa. - Dr. W.S. Hacon, Director
of Health Resources, Department of Na-
tional Health and Welfare, was recently
misquoted in an article in an Ottawa
14 THE CANADIAN NURSE
newspaper and presumably in other pa-
pers in the country. During the National
Health Manpower Conference held in
Ottawa Oct. 7-10, Dr. Hacon issued this
statement.
"I would like to correct a statement
appearing under a headline in the Ottawa
Citizen on Wednesday, October 8th that I
consider that nurses are over-educated.
The direct contrary is true.
"The statement was out of context
and due I believe to over-condensation of
interview material during the editorial
process. It was extracted from a broad
review of differing opinions held across
the country."
New Brunswick Nurses
Sign New Contract
Fredericton, N.B. — The New
Brunswick Hospital Association and the
New Brunswick Association of Registered
Nurses signed a collective agreement on
behalf of its public hospital staff associa-
tions on August 29, 1969.
Fourteen hundred New Brunswick
hospital nurses had threatened to leave
their jobs in August because of a contract
dispute. They withdrew their resignations
in early August.
In an earlier statement to The Cana-
dian Nurse, Marilyn Brewer, spokesman
for the nurses' negotiating committee,
said that early negotiations with the
NBHA had been futile because of con-
stant changes in management representa-
tives and lack of preparation on the part
of management between meetings.
In the new contract both parties
agreed that a management labor relations
committee should be maintained or estab-
hshed within 30 days of signing the
contract. The committee consists of a
specific number of members of the ad-
ministrative staff of the hospital named
by the administrator, and a specific num-
ber of members appointed by the staff
association and unions representing other
staff of the hospital.
A joint consultation committee, com-
posed of the president and one other
representative of the staff association,
and the administrator and director of
nursing or delegates wUl meet at least
twice yearly.
Salary was a main point of negotiation
between the NBHA and NBARN. No
longer will New Brunswick registered
nurses be the lowest paid in Canada.
Under the terms of the new contract,
they will receive $430 per month, retro-
active to January 1 , 1969.
Educational increments for registered
nurses with additional preparation are
also included in the agreement. A nurse
with a master's degree in nursing will
receive an additional $60. per month, and
a nurse with a baccalaureate degree will
receive an additional $50 per month.
Educational increments will also be a
warded to a registered nurse who has
completed an accredited oneyear universi-
ty course in nursing ($25. per month); a
registered nurse with special clinical prep-
aration of six months or more ($15. per
month); and a registered nurse with the
Canadian Hospital Association/Canadian
Nurses' Association Nursing Unit Admin-
istration Course ($5. per month).
Nurses authorized to work overtime
will be given the choice of payment at the
regular rate or time off at a mutually
acceptable time to the nurse and the
hospital. If the nurse chooses time off, it
must be within 30 days of the overtime
worked; otherwise she will be paid at the
regular rate. A nurse required to work on
a holiday will be given time off or
overtime pay at the regular rate.
Other terms of the agreement include:
recognition by a hospital that the
NBARN staff association in that hospital
is the sole bargaining agent for graduate
nurses, registered nurses, assistant head
nurses, head nurses, supervisors, instruc-
tors, full-time health nurses, full-time
clinical coordinators, and full-time
inservice coordinators.
Regarding retirement benefits, a nurse
retiring at normal retirement age who has
served continuously for five years or
more will receive a retirement allowance
by the hospital. The allowance will be
equivalent to five working days pay for
each full year of service, but may not
exceed 125 working days pay.
The contract also provides for 10
statutory hohdays and all other days
proclaimed as holidays by the Governor
General and the Lieutenant Governor of
the province.
All full-time nurses who have com-
pleted six months service are entitled to
annual vacation with pay, calculated at
the rate of 1 1/4 working days for each
full calendar month of service, that is, 15
working days per year. After 10 years'
service, a nurse is entitled to 20 working
days vacation.
A dispute between a hospital and a
staff association or a member of it on the
interpretation, application, or violation of
the agreement will be submitted to a
grievance procedure, if it cannot be re-
solved by the two parties.
Nursing Administration Course
Starts in Ontario
Toronto, Ont. - The first Canadian
program for nursing home administrators
was launched in October 1969 by the
Associated Nursing Homes Incorporated
Ontario.
The course uses a traveling faculty
format that ANHIO believes is unique in
North America. Sessions are now being
held in Toronto, Belleville, and Ottawa,
and further locations will be chosen.
The management development pro-
gram for nursing home administrators was
DECEMBER 1%9
F
established in recognition of the in-
creasing need for formal preparation of
nursing home administrators, according
to ANHIO.
The program includes lectures, student
presentations, case studies, group discus-
sions, practical application sessions, and
home study assignments. It is run by
Personnel Systems Associates, a firm of
management consultants retained by
ANHIO as educational coordinators.
Candidates who successfully complete
all the requirements of the program will
be awarded a certificate by ANHIO.
NBARN Submits Brief
On Maritime Union
Fredericton, N.B. - Mutual goals and
responsibilities of the nurses' associations
in the Maritime provinces as well as areas
of concern specific to New Brunswick
nurses were the subjects of a recent brief
to the Maritime Union Study by the New
Brunswick Association of Registered
Nurses.
The submission followed an earlier
meeting of representatives from the three
Maritime nurses' associations.
"We beheve that the services given by
members of this Association to the peo-
ple of New Brunswick constitute a pubUc
service," said the brief, "and that we have
a responsibility to reassess that service
within the scope of a Maritime Union
Study."
The submission also pxjinted out that
some 1 1 percent of NBARN's members
have French as their first language. If
Maritime Union were to become a reality,
the French-speaking component would
become a smaller minority within the
overall Maritime total. Thus, special con-
sideration would be needed to assure the
French-speaking group of personal and
professional rights.
The Maritime Union Study was au-
thorized by the governments of New
Brunswick, Nova Scotia, and Prince
Edward Island to investigate and examine
the possibility of increased goverimiental
cooperation among the three provinces.
First Quebec Hospital
Goes Metric
Montreal, P.Q. - St. Mary's Hospital
in Montreal became the first hospital in
Quebec to "go metric" in all areas of
patient care, with its complete conversion
October 6 to this scientific measurement
system.
Executive director Sister Mary Mela-
nie, who foresaw a trend to metric in
Canadian hospitals, proposed conversion
to this system two years ago.
"In this scientific era with men landing
on the moon and other great technologi-
cal achievements, it makes sense that we
should speak in the language of science,"
Sister Melanie said. "There is a need for a
DECEMBER 1%9
universal system of weights and measures
in the health sciences, especially in view
of the increased tempo of the computer-
ization of hospital data. Hospital applica-
tion to the computer requires use of the
metric system.
"Furthermore," she added, "if hospi-
tals are to continue to make valuable
contributions in the fields of medical
research, education, and health care Uter-
ature, they must be fluent in scientific
speech."
Sister Melanie believes that most Cana-
dian hospitals will convert to metric,
wholly or partially, within the next few
years. Several Quebec hospitals have al-
ready partially converted, but St. Mary's
is the only large general hospital to
convert everything and at one time.
NBARN Achieves
Record High Membership
Fredericton, N.B. - For the first
time, membership of the New Brunswick
Association of Registered Nurses has
exceeded 5,000.
The present membership of 5,095 in-
cludes 3,686 active members and 1,409
non-active members. Total membership
this time last year was 4,783.
These figures represent a 3.8 percent
increase in the number of active mem-
bers, a 14.4 percent increase in non-active
members, and a total increase of 6.5
percent over last year's figures.
Out of a total membership increase of
312, 135 or 43.3 percent are active
memberships.
Nine male nurses are now registered
with NBARN.
Conference Held
For Dialysis Nurses
Hamilton, Ont. ~ The third annual
conference for dialysis nurses was held in
Fontbonne Hall at St. Joseph's Hospital
September 27. The conference, chaired
by Anne Donovan, coordinator of the
dialysis center at St. Joseph's, was attend-
ed by dialysis nurses, technicians, doc-
tors, and other interested personnel from
Ontario and Quebec.
The morning session dealt with home
dialysis, which is rapidly being developed
in many areas in Canada. Dr. E.K.M.
Smith described the home dialysis setup
at Charing Cross Hospital, London, En-
gland, and Mrs. Lindsay Werden, a nurse
on the staff of the St. Joseph's dialysis
center, discussed nursing aspects. A movie
was then shown depicting a day in the life
of one of St. Joseph's home dialysis
patients. Commentary was by Dr. G.D.
Thompson and the patient concerned.
Mrs. M. Brock, director of the social
service department at St. Joseph's, spoke
on psycho-social aspects of dialysis. Her
speech was followed by Dr. G.D. Thomp-
son, who reviewed the hospital's three-
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THE CANADIAN NURSE 15
year experience with chronic peritoneal
dialysis. Dr. P.R. Knight concluded the
session with a detailed review of the
history and present status of kidney
transplantation.
The fourth annual conference for dialy-
sis nurses will be held again next year at
St. Joseph's Hospital.
NB Nurses Discuss
Trends In Diploma Programs
Fredericton, N.B. - Nursing educa-
tion representatives from schools of
nursing throughout New Brunswick met
here in October to explore trends in
nursing education at the diploma level
and to clarify the role of the diploma
program graduate in nursing service.
The two-day workshop was held at the
headquarters of the New Brunswick Asso-
ciation of Registered Nurses. It was led
by Anne Thome, director of the new
Saint John School of Nursing, which
expects to receive its first students in the
fall of 1970.
Among topics discussed at the work-
shop were: the product of the diploma
program in nursing; approaches to curric-
ulum development for diploma programs;
potential curriculum courses; use of the
laboratory for nursing; and evaluation of
the student and the program.
Miss Thome emphasized the impor-
tance of flexibility in curriculum plan-
ning, and noted that the inclusion of both
general and specialized education was
characteristic of newer programs in
nursing. "The nursing school faculty has
an obligation to keep in touch with
changing needs for nursing services and
for newer understandings related to
teaching and learning," she said.
MARN Awards Bursaries
The Manitoba Association of Register-
ed Nurses has awarded bursaries for
1969-1970 totaling $625.
Bursaries were awarded to Joan Mona
Davidson to complete her master's degree
at the University of Washington, and
Leslie Anne Tatham, to complete her
B.N. at the University of Minnesota.
A $500 bursary was awarded to Mrs.
Ena Whalley to complete her B.N. at the
University of Manitoba.
RN Internship Programs
Starts At Chicago U
Chicago, U.S.A. - The University of
Chicago Hospitals and Clinics have started
a three-month internship program for
registered nurses beginning employment
at the university.
16 THE CANADIAN NURSE
This program is to assist the new nurse
to understand her role and responsibilities
in the hospital environment, according to
Lorraine Fernbach, RN, program coordi-
nator.
"A relatively new idea, nurse intern-
ship has been estabUshed in several hospi-
tals throughout the country because of
the 'dynamics of science,'" said Mrs.
Fernbach. "The increasing knowledge and
rapid scientific changes now taking place
have heightened the complexity of
nursing duties and responsibilities to the
extent that such programs are needed to
give a practical orientation to what
nursing is today."
During the first two weeks of the
program, nurses are assigned to one of
three teaching units; medicine, car-
diovascular and thoracic, and medical
cardiology.
The program will give nurses experi-
ence in such specialty areas as emergency
rooms, coma unit, intensive care units,
and the outpatient department at all
hours of the day.
Special presentations, conferences, and
demonstrations are planned, including a
simulated cardiac arrest, a peritoneal dial-
ysis, and tracheotomy suction.
ANA Releases
Current RN Data
New York, N.Y. - A comprehensive
survey on registered nurses has been
published by the American Nurses' Asso-
ciation. The book, RN's - 1966, pro-
vides the most current detailed data on
registered nurses in the United States.
This study is the fifth inventory of
registered nurses compiled by the Ameri-
can Nurses Association. It shows that the
number of RNs employed in nursing
more than doubled from an estimated
299,000 to 613,000 between
1949 — the year of the first survey —
and 1966. Although this number has
grown steadily over the past few years,
the increasing emphasis on health care in
the US and advances in medical technolo-
gy have made more acute the need for
additional RNs.
^A^x - 1966 includes national and
state data on age and marital status,
educational preparation, employment set-
tings, and clinical practice areas of
909,131 registered nurses. Of this num-
ber, it was estimated that 295,943 nurses
were not practicing in 1966.
This inventory was conducted under
contract with the US Public Health Serv-
ice, which provided financial support for
data processing. The State Boards of
Nursing assisted in collecting the data.
The book shows that 66.9 percent of
the employed nurses worked in hospitals
or related institutions. Private duty nurses
constituted 9.9 percent, office nurses 8.2
percent, public health 4.5 percent,
schools of nursing 3.6 percent, school
nurses 3.5 percent, and industrial nurses
3.1 percent of the total employed.
The median age of employed nurses
was 40.3 years. Sixty-four percent of the
employed nurses were married, and 12
percent had been married.
The inventory also provides data on
male nurses and inactive nurses. Noting
recent efforts to attract more men into
nursing, the study reveals that there were
only 6,590 male nurses in 1966. The
inactive nurses were predominantly
young, married women, many of whom,
the study suggests, return to nursing and
represent a potential future supply.
Hospital To Keep
Drug Databank
Montreal, Quebec. - Following suc-
cessful testing at Man and His World over
the past two seasons, Notre Dame Hos-
pital has decided to maintain its databank
of drug information, which is to be open
eventually to doctors and druggists in
remote locations.
The databank is the result of a pilot
project carried out by Notre Dame at The
Man The Explorer pavilion. Information
stored in the hospitd's computer includes
drug type; when and how to use a dmg;
how the body uses it; how it is adminis-
tered; its effects and possible counter-
effects; its chemical structure and chem-
ical name.
"We have tried to integrate drugs into
a computer," said Dr. Jules Labarre,
chairman of Notre Dame's medical data
processing committee. "We aim at the
safest possible drug treatment for hospi-
talized patients, and we think we have hit
on a modern formula capable of giving
concrete results."
Remote information on drugs can be
obtained through an IBM typewriter ter-
minal, which can be used to add to,
delete from, or query the databank. A
simple typed statement will generate the
required information instantly.
Doctors at Notre Dame Hospital are
now using a drug directory that tells them
the drugs that should be prescribed. The
catalogue has been prepared by the com-
puter with the stored information. It can
be updated as new drugs arrive on the
market.
McGill University Project
In Baffin Zone
Ottawa. - The Department of Na-
tional Health and Welfare has entered
into an agreement with McGill University
whereby the university faculty of medi-
cine will assist in a program of support to
the health services of the Baffin Zone.
The agreement was announced at a press
conference in Ottawa in September by
the Honourable John Munro, Minister of
National Health and Welfare, and Dr. H.
Rocke Robertson, principal and vice-
DECEMBER 1969
chancellor of McGill University.
The DNHW has assumed financial res-
ponsibility for the project, under which
the university will provide needed me-
dical personnel on a continuing basis to
serve in the Baffin Zone, and will assist in
the reception and discharge of patients in
a major teaching hospital of the universi-
ty's medical center.
The Baffin Zone of medical services
comprises Baffin Island, the Melville Pen-
insula, and Southampton with a total
population of about 6,000, of whom
approximately 4,000 are Eskimos.
Mr. Munro said that this new develop-
ment of health services in the Baffin Zone
was based on two principles: "As far as
possible," he said, "illness should be
treated in or near the home of the
patient. Both the adverse sociological
consequences of evacuation to the south,
and the cost, increase with the distance
from home. These disadvantages can be
overcome to a considerable extent by
reinforcing the health team in the settle-
ment and at Frobisher Bay Hospital.
"The final objective," he said, "will be
to assist in the training of young Eskimos
in the health services in hope that in the
future they will themselves build a major
role in the health services of the north."
The main base for the project will be
Frobisher Bay, the largest settlement in
the zone. At the present time, medical
personnel for this area consist of the zone
director. Dr. D. Horwood, and two doc-
tors stationed at the Frobisher Bay Hospi-
tal. Each of the 12 settlements in the area
has one or two nurses or a lay dispenser.
McGill will assist in the recruitment of
general duty medical officers for the
Frobisher Bay Hospital. In addition, two
senior undergraduate medical students
and two residents from McGill postgradu-
ate training program will serve in continu-
ity of short rotations at the base hospital
in Frobisher or in the outpost stations.
Another feature of the agreement
provides for visits of small teams of
medical specialists as often as four times a
year. Patients requiring this sort of atten-
tion will be treated in the zone rather
than having to be evacuated to Montreal.
Dr. Douglas G. Cameron, professor of
Medicine of McGill University and phy-
sician-in-chief at The Montreal General
Hospital, has been appointed director of
the project.
Family Physicians Meeting Sees
Debut Of Convention T.V.
Toronto, Out. ~ At the recent meet-
ing of the College of Family Physicians of
Canada held in Toronto September 29 to
October 1, Hoffmann-La Roche Ltd.,
Montreal, presented for the first time
medical convention television to some
800 delegates. Broadcasting was carried
on throughout the three-day session and
consisted of a variety of telecasts on
medical and paramedical topics.
The important role of television in the
continuing education of the family physi-
cian was reflected in the raison d'etre for
the convention television: enlightening
features for the physician to enjoy, run
on a program schedule designed to com-
plement the College's regular scientific
sessions.
Operating Room Nurses Meet
Halifax, N.S. - Some 140 registered
nurses from the four Eastern provinces
attended the seventh annual conference
of the Nova Scotia Operating Room
Nurses Study Group held here in Octo-
ber.
A highlight of the two-day meeting
was a panel discussion called: "Aspect Is
Technique - Follow That Bug."
Other topics discussed included: oper-
ating room technicians and their place in
an operating room; reconstruction surgery
of the face; emergency care of patients
with head injuries; recent developments
in infertility; and renal transplants.
Donald Carruthers, operating room
supervisor at the Victoria General Hospi-
tal, Hahfax, opened the sessions. D
™*^
I
. Africa
.Asia
.Latin America
. Caribbean
WORK OVERSEAS FOR TWO YEARS
Improvement of health standards Is a major factor
in the economic growth of the 40 developing
nations v/here CUSO operates. The need for all
types of medical personnel Is great. By performing
and teaching your essential skills as a nurse, you
have the opportunity to participate in the vital pro-
cess of International development. Professional
competence alone is not enough. Applicants must
be prepared to adapt their living and working
patterns to those of their host country.
Two-year assignments. Most salaries paid at ap-
proximately counterpart, not Canadian, scale by
overseas employer. CUSO provides training, re-
turn transportation, medical and life insurance.
Married couples with not more than one child are
eligible if both are suitably qualified and child will
remain below school age for duration of assign-
ment.
INTERESTED? Write now stating age, qualifica-
tions, marital status, etc.. to CUSO. 151 Slater,
Ottawa 4, Ont. Quote: CN/1
DECEMBER 1969
THE CANADIAN NURSE 17
names
Helen D. Taylor (center) was elected president of the Association of Nurses of the
Province of Quebec at its annual meeting October 22-25. Miss Taylor, who succeeds
Madeleine Jalbert, (right) as president, is director of nursing at the Jewish General
Hospital in Montreal. Miss Jalbert, nursing consultant with the Quebec Hospital
Insurance Service, remains on the ANPQ committee of management as first
vice-president, French. Mrs. Ruth Atto, director of nursing education at Sherbrooke
Hospital, was elected first vice-president, English. Second vice-president, French, is
Rachel Bureau, (left) nurse educator with the Provincial Committee for the
Prevention of Tuberculosis, Inc., Quebec City. Second vice-president, English, is
Kathleen Rowat, assistant professor at the School for Graduate Nurses, McGill.
Because of several inaccuracies in the
death notice of Mrs. Dorothy Warner
(Names, October 1969), we are repeating
the item - Editor.
^^•^^~2JHB Dorothy Isabel
^^j^jrijj^Hj^H (MacRae) Warner, a
well-known Cana-
dian nurse, died in
August of injuries re-
ceived in a car acci-
dent.
Born in Storno-
way, Quebec, Mrs.
Warner received her
basic nursing education at The Montreal
General Hospital. After working as a staff
nurse at MGH, she taught nursing at the
Medicine Hat General Hospital for several
years before returning to her home hospi-
tal as surgical supervisor of the outpatient
department. Later, after some time spent
as a night supervisor and floor supervisor
at MGH, she became matron of Anson
General Hospital, Iroquois Falls, Ontario.
18 THE CANADIAN NURSE
In 1940, Mrs. Warner joined the
RCAMC and went overseas as Matron of
No. 1 General Hospital. In 1944 she was
appointed matron-in-chief of the RCAMC
Nursing Service in Canada, with head-
quarters in Ottawa.
After demobilization, Mrs. Warner
took postgraduate study at the McGill
School for Graduate Nurses and sub-
sequently was appointed director of
nursing at the Reddy Memorial Hospital.
After this she nursed at various times in
the General Hospitals of Montreal, Calga-
ry, and Vancouver.
In 1958 Mrs. Warner was appointed
chief nursing officer of the St. John
Ambulance in Canada, a position she held
until 1964. At that time she became head
of volunteers at the Ottawa Civic Hospi-
tal.
Mrs. Warner's outstanding contribu-
tion to nursing will be well remembered
by all those who worked with her in
Canada and abroad. Because of Mrs.
Warner's interest in and support of the
Canadian Nurses' Foundation, a special
memorial fund is being set up by her
friends. Those interested in contributing
to this fund are invited to send their
cheque or money order to CNF, 50 The
Driveway, Ottawa 4, Ontario.
Dr. John N. Crawford, deputy minister
of National Health, retired in August. Dr.
Crawford held this position in the Depart-
ment of National Health and Welfare
since 1965. Before this he was assistant
deputy minister in the Department of
Veterans Affairs.
Born in Wiimipeg, Dr. Crawford was
graduated from the University of Manito-
ba. He then joined the staff of The
Children's Hospital of Winnipeg, the St.
Boniface Hospital, and lectured in pediat-
rics at the University of Manitoba.
During World War II, Dr. Crawford
was appointed Senior Medical Officer of
the Canadian forces despatched to Hong
Kong. Taken prisoner, he established a
makeshift hospital in prison camp that
provided the only treatment for allied
prisoners until their release nearly four
years later. For this he was made a
Member of the Order of the British
Empire.
After the war, Lt. Col. Crawford was
director of medical research at army
headquarters, later becoming deputy di-
rector general of medical services, and
executive staff officer of the Canadian
Forces Medical Council.
Madge McKlllop
(R.N., Moose Jaw
General H.; B.N.,
McGill U.; Cert, in
hospital organization
and management,
C a n a dian Hospital
Association) has
been elected presi-
dent of the Sas-
katchewan Registered Nurses' Associa-
tion. Miss McKillop, SRNA first vice-
president for the past two years, succeeds
Agnes Gunn of Saskatoon.
Miss McKillop is nursing administrator
at University Hospital in Saskatoon. She
previously held the positions of clinical
instructor, associate director of nursing
education, and director of nursing at the
Royal Edward Chest Hospital in Mon-
treal. During World War II, she served as a
nursing sister in the Canadian Army in
(Continued on page 20)
DECEMBER 1%9
Hup! Down! After 36 bends, man perspires, kling* Conform Bandage stays in place.
Gruelling knee-bend test shows why more
hospitals use KLIIMG Bandage every day
We put this man through the tortute of
50 deep knee-bends to show you one
thing. When you put a kling bandage on,
it stays in place. If you look carefully at
the black stripe we painted on the band-
age, you'll see the layers of bandage
haven't shifted at all. KLING bandage held
the primary dressing in one spot all the
way through.
Twist-hook action
KLING bandage conforms to the most
difficult shapes. It stretches and recovers
better than any non-elasticated bandage.
And it clings to itself.
The reason lies in the way it is made.
The threads are shrunk differentially. As
they twist, they form little hook-like
curls. These hooks hold successive layers
together.
Little hooks in KLING After 30 bends, black
bandage prevent slip line shows no movement
Easy to apply
Because kling bandage conforms so well,
there's no need to tuck and fold when
bandaging. Because it clings to itself, one
can apply the bandage more quickly and
easily.
You can bandage any part of the body
with KLING bandage. A child's elbow—
an athlete's knee. And you can be sure
KLING Conform Bandage will stay in
place.
For more information, and trial samples
of KLING Conform Bandage, contact your
local Johnson & Johnson representative.
Or write to us direct:
n (J LIMITBO
HOSPITAL PRODUCTS DIVISION
2155 Boulevard Pie IX, Montreal 403, P.Q.
•Trailiimirk nf .inHlll<;nN H .inHNSnN m Atfilialsd Comnanlas C JU 'B9
(Continued from page 18)
England, western Europe, and North Afri-
ca.
Miss McKillop has been active on
nursing committees in Quebec and Sas-
katchewan. She has also been a member
of the Canadian Nurses' Association's ad
hoc committee to study functions and fee
structure, and a member of the Saskat-
chewan Board of Nursing Education.
Eleanor R. Earle (R.N., A. Barton
Hepburn Hosp., Ogdensburg, N.Y.; cert,
in pubUc health nursing, U. of Toronto;
cert, in admin, and supervision, U. of
Michigan) has retired as supervisor of
pubHc health nursing for the Leeds, Gren-
ville and Lanark District Health Unit,
Brockville, Ontario.
Miss Earle worked as a private duty
nurse in Ogdensburg, N.Y. for three years
after her graduation, then spent five years
as a public health nurse in Woodstock,
Ont. She then moved to Brockville as a
school nurse. She has spent a total of 22
years as a public health nurse in the
health unit.
The Manitoba Association of Registered
Nurses has announced three appoint-
ments to its professional staff.
Bente Cunnings is in-
terim executive di-
rector of MARN. A
native of Denmark,
Mrs. Cunnings (B.N.,
U. of Manitoba)
taught public health
nursing at St. Boni-
face General Hospi-
tal, Manitoba, and
served as director of nursing service for
the Sanitorium Board of Manitoba.
Laurel Rector is em-
ployment relations
officer of MARN.
Mrs. Rector (R.N.,
The Winnipeg Gene-
ral Hospital, B.N.Sc.,
Queen's U., King-
ston, Ont.) has had
experience in nurs-
ing in various fields,
including general duty, public health, and
supervision. She has also served as di-
rector and supervisor of nursing service at
Pinawa Hospital, Pinawa, Manitoba.
Mr. T.M. Miller is
i \ public relations offi-
1 I cer of MARN. A na-
■^li||^>.J tive of Scotland, Mr.
^y "'• " •,'• Miller, has long been
■P'*^ active in the commu-
^^P«" nity life of Winni-
WKk^tK^k peg- He is a former
HpE^^^i^^L president of the Ma-
»^ .^^^^Hl nitoba division of
the Canadian Cancer Society and a for-
mer president of the Manitoba Branch of
the Canadian Public relations Society.
20 THE CANADIAN NURSE
Pa Cartwrlght and Friend
Canadian-born actor Lome Green, of
"Bonanza" fame, and executive director
of the Canadian Nurses' Asociation,
Helen K. Mussallem, both received the
Medal of Service of the Order of Canada
at Government House in October. (See
News, page 10).
At the inaugural meeting of the third
Council of the College of Nurses of
Ontario on September 19, Elsbeth M.
Celgerwas elected president. Miss Geiger
is assistant administrator, nursing, at The
Hospital for Sick Children in Toronto.
She served on the previous Council from
1966 to 1969 and is a past president of
the Registered Nurses' Association of
Ontario.
Jean S. Dalziel, assistant professor of
the school of nursing. University of To-
ronto, was elected vice-president of the
Council.
Agnes Fleury (R.N.,
St. Boniface H.;
B.Sc.N., L'Institut
Marguerite d'Youvil-
le, U. of Montreal;
cert, in Hospital Or-
ganization and
Management, Cana-
dian Hospital Asso-
ciation) has been
appointed director of nursing service of
the Manitoba Rehabilitation Hospital and
the D.A. Stewart Centre in Winnipeg.
Miss Fleury, who joined the Sanatori-
um Board of Manitoba staff in July, has
had extensive nursing experience. Most
recently she was director of the school of
nursing and assistant administrator of the
Regina Grey Nuns' Hospital. Before this
Miss Fleury was supervisor of the pediat-
ric ward, night supervisor, and director of
the school of nursing at the St. Boniface
General Hospital, St. Boniface, Manitoba.
Miss Fleury has served as chairman of
the nursing committee of the Catholic
Hospital Conference of Manitoba, was a
member of the Manitoba Minister of
Health's Committee on the Supply of
Nurses, president of the Catholic Hospital
Conference of Saskatchewan, and a mem-
ber of the executive committee of the
Canadian Nurses' Association from 1964
to 1966.
Beatrice E. Stucker (R.N., The Mont-
real General Hosp.; B.N., McGill U.)
recently was appointed nurse consultant,
maternal and child health service, special
health services branch for Ontario.
She began public health nursing with
the Victorian Order of Nurses in Mont-
real, and has held positions as nurse-in-
charge in the Arctic for the Department
of National Health and Welfare, zone
supervisor of nurses for Southern Alberta,
and supervisor of VON in Scarborough,
Ontario.
The new director of
the Victoria Hospital
school of nursing,
London, Ontario, is
Beatrice Davis(R.N.,
Children's Hosp.,
Winnipeg, Man.;
B.Sc.N., U. of West-
ern Ontario, Lon-
don).
Miss Davis has held positions as teach-
er and supervisor at Children's Hospital,
Winnipeg, and superintendent of general
hospitals in Portage la Prairie, Manitoba,
and Kenora, Ontario, and was director of
the General Hospital, Parry Sound, Ont.
She joined the Victoria Hospital's school
of nursing in 1966.
Anne D. Thorne(R.N., Saint John Gener-
al H.; diploma in teaching and super-
vision, McGill U.; B.N., McGUl U;; M.Ed.,
Teachers College Columbia U., New
York) has been appointed the first direc-
tor of the new Saint John School of
Nursing, Saint John, New Brunswick.
The first class of students will be
admitted to the school's two-year pro-
gram in the fall of 1 970.
Miss Thome was previously an instruc-
tor and associate educational director at
the Saint John General Hospital School
of Nursing. She has also worked as a head
nurse in obstetrics at the Saint John
General Hospital.
An active member of various commit-
tees, Miss Thome has been on the Cana-
dian Nurses Association's nursing educa-
tion committee, and chairman of the
nursing education committee of the New
Bmnswick Association of Registered
Nurses. She is a member of the NBARN
advisory committee on schools of nurs-
ing.
In 1968 Miss Thome was awarded a
CNF fellowship. D
DECEMBER 1969
September 1969 — April 1970
Nine workshops, sponsored by the
National League for Nursing, will be held
across the U.S. They will explore new
techniques and problem-solving ap-
proaches to hospital nursing, and will be
conducted by nursing service administra-
tive and supervisory personnel. For infor-
mation and registration forms write:
National League for Nursing, 10 Colum-
bus Circle, New York, N.Y., 10019,
U.S.A.
February 18-22, 1970
Conference ob The Nurse's Reactions
and Patient Care, sponsored by the Re-
gistered Nurses' Association of Ontario,
Geneva Park, Lake Couchiching. Registra-
tion fee: RNAO members - $80; non-
members - $95. This fee includes meals,
double room accommodation, and gener-
al-conference expenses. For further in-
formation and application forms, write
to: Professional Development Depart-
ment, RNAO, 33 Price Street, Toronto
289, Ontario.
February 24-25, 1970
Institute on Nursing Home Care, Inn-on-
the-Park, Toronto. Sponsored by the
Registered Nurses' Association of Onta-
rio, Associated Nursing Homes Inc., the
Ontario Dental Association, and the
Ontario Medical Association. For further
information, write to the RNAO Profes-
sional Development Department, 33 Price
Street, Toronto 289, Ont.
March 20, 1970
Seminar sponsored by The Operating
Room Nurses of Greater Toronto, Royal
York Hotel, Toronto. Direct inquiries to:
Mrs. Jean Hooper, Chairman, Public Rela-
tions Committee, The Operating Room
Nurses of Greater Toronto, 43 Beaver-
brook Avenue, Islington, Ontario.
May 31-|une 12, 1970
Ninth annual residential summer course
on Alcohol and Problems of Addiction,
Brock University, St. Catharines, Ontario.
Co-sponsored by Brock University and
the Addiction Research Foundation of
Ontario. Enrollment is limited to 80.
Basic information and findings of current
research relating to the misuse of alcohol
and other drugs will be presented. Provi-
sion will be made for discussion of
prevention and treatment aspects of
addiction problems. Address enquiries to:
Summer Course Director, Education
Division, Addiction Research Founda-
tion, 344 Bloor Street West, Toronto 181,
Ontario. D
DECEMBER 1969
HE NEVER
' TASTED MILK
SOCRATES CHAVEZ, SOUTH AMER-
ICAN, AGE 4. Large family. Father dead.
Mother works as laundress. Earns $20 a
month- Struggles to feed family. No milk.
No meat. Clothes given by charity. Live in
smelly, dusty slum. No paving, street
lights, sewage system or garbage disposal.
"Home" is shack made of split bamboo
mats. Dirt floor. No electricity. Use
candles. No running water. No toilet.
Socrates sleeps with three brothers in bed
without mattress. Situation desperate-
Help to Socrates means help to entire
family.
Thousands of children as needy as Soc-
rates anxiously await "adoption" by you
or your group. Choose a boy or girl from
South Korea, Viet Nam, Hong Kong, the
Philippines, Bolivia, Brazil, Columbia,
Ecuador or Peru. □ A monthly cash
grant helps provide primary school educa-
tion for your Foster Child and his sisters
and brothers. In addition, PLAN gives
family counselling, medical care when
called for, supplementary new clothing
and household equipment. □ PLAN'S
emphasis on education helps its children
to become self-supporting citizens- Since
i ..._^ ^^^^' '"°''^ ^^^^ 110,000 children have
I "'•ttO "graduated" from PLAN'S program. □
* You receive a case history and photo-
graph. Each month you write and receive
a letter (original and translation). These letters will tell you how your "adop-
tion" benefits the entire family. Soon, through the regular letters and PLAN
progress reports, you and your child develop a warm, loving relationship.
CHECK YOUR CHARITY! We eagerly offer our financial statement upon
request. You will see that your contribution truly benefits the child for which
it was intended.
PLAN is a non-political, non-profit, non-sectarian, government-approved,
independent relief organization. Financial statements are filed with the
Montreal E>epartment of Social Welfare and other similar bodies.
Approved by Department of Revenue, Ottawa
Foster Parents Plan of Canada
Plan de Parrainage du Canada
PARTIAL LIST OF
SPONSORS ANT)
FOSTER PARENTS
Dr, R.P Baird.
Kiichener. Ont.
Mr. and Mrs. Peter D. Curry.
Winnipeg. Man.
Mrs. John Dicfenbakcr.
Onawa. Ont.
Hon and Mrs. George Hees.
Ottawa. Ont.
Mr. and Mrs. Marshall McLuhan,
Toronto. Ont.
Rt, Hon and Mrs. L.B. Pearson,
Ottawa, Ont.
Mr and Mrs. Robert L. Stanfield.
Ottawa. Oni.
Northern Electric C» Ltd.
Sir George Williams
University
FOSTER PARENTS PLAN,
Dept. CN 12-1-69,
P.O. Box 65, Station "B", Montreal, Que., Canada.
A. I wish to become a Foster Parent of o needy child for one
year. If possible, sex age
nationality | will pay $17 a
month for one year or more ($204 per year). Payments will
be made monthly □, quarterly Q- semi-annually D,
annually Q. I enclose herewith my first payment $
B. I cannot "adopt" a child, but I would like to help a child
by contributing $
Name
Address
City
Prov.
Dote Contributions Income Tox Deductible
THE CANADIAN NURSE 21
new products {
Descriptions are based on information
supplied by the manufacturer. No
endorsement is intended.
Scrub Station
This self-contained, stainless steel
scrub station provides maximum conven-
ience, comfort, and proper "no-touch,"
"no-splash" surgical scrub technique.
The sloping sink and knee operated
water control and soap dispenser signifi-
cantly reduce the cross-contamination
hazard of the splash back and bacterial
aerosol generated by the surgical scrub.
Water temperature and rate of flow are
preset; there is nothing to adjust at any
time. To start the water, a knee-controll-
ed switch is pressed.
All units, whether single or multiple
bay, require only one set of rough-in
connections. The Market Forge Series
SS-10 Scrub Station is available in Canada
from Gordon G. Brown Co., Ltd., Suite
23, 1875 Leslie St., Don Mills, Ontario,
or 25 Westminster Ave. S., Montreal 28,
Quebec.
Urinary Drainage Unit
This closed system permits irrigation
or specimen collection without dis-
connecting the catheter by means of a
plastic sleeve covering an entry port in
the drainage tubing. This closed irrigation
sleeve is a simple device that promotes
better technique and can mean big savings
in nursing time. The sleeve is slipped
back, revealing the entry port. When
irrigation or specimen collection is made,
the sleeve is slid back into the closed
position, resealing the system.
The large bore tubing promotes the
free flow of urine into the drainage bag
and virtually eliminates the possibility of
a fluid column forming in the drainage
tube. Elimination of this fluid column
22 THE CANADIAN NURSE
Irrigation Tray
The contents of this new irrigation
tray are combined to offer greater con-
venience, more versatility, and better
patient care.
The graduated 50 cc. syringe has a
soft, pliant, "rubber-like" bulb designed
to permit excellent fingertip control,
provide greater protection, and allow
more ease in use. The solution container,
which has a 600 cc. capacity, is designed
for tip-proof stability. The container may
be used as a graduate for emptying
bedside drainage units; the clearly marked
graduations permit accurate monitoring
of urinary output. The contour-shaped
emesis basin fits snugly against the pa-
tient's body, and has an ample 1,800 cc.
capacity in a spill-proof, easy-to-carry
design.
All items needed for the irrigation
procedure are included in the sterile,
sequence-packed tray. The unit is
compact, with contents enclosed within a
CSR wrap. The irrigation tray is also
available with 2 oz. piston syringe grad-
uated to 50 cc.
For more information write to: C.R.
Bard (Canada) Ltd., 22 Torlake Cres.,
Toronto 18, Ont.
minimizes the danger of retrograde infec-
tion.
The exclusive ball check valve, housed
in a rigid chamber inside the bag, sepa-
rates the sides of the bag, permitting free
entry of urine into the bag and eliminat-
ing the risk of blockage at the end of the
tube. If the bag is tilted or dropped, the
valve becomes a positive shut-off.
The shield at the end of the draw-off
tube protects it from inadvertent contam-
ination. The end of the draw-off tube
should be attached to the stabilizer of the
drainage bag, and the clamp left open.
This procedure adds a unique safety
factor: if the bag is not drained before it
is completely filled, the over-flow will be
automatically released out of the system,
rather than back up or cause patient
discomfort.
The drainage bag has an opaque white
backing, which permits visual monitoring
of the coloration and amount of urine
flow. It is available as a kit, with all items
needed for catheterization and closed
system drainage, or as a single unit, with
or without catheter.
This Macbick product is distributed in
Canada through the Stevens Companies in
Toronto, Calgary, Winnipeg, and Vancou-
ver. In Montreal, Compagnie Medicale &
Scientifique Ltee, and Quebec Surgical
Company are the distributors. D
DECEMBER 1969
Nurses protest in 1918
What did nurses protest about in
1918? Considering that the first World
War had just ended and nurses were
settling down to a normal life, problems
were not too great.
Yet, as shown from an editorial in the
December 1918 issue of the The Canadi-
an Nurse, nurses were quick to react
when they thought their dignity was
being compromised.
"When a recent hook-Canada in
Khaki-wns published, the frontispiece,
with an illustration showing one of 'our
boys' with his arm around a nursing
sister, was objected to by many nurses.
The president (of the Canadian National
Association of Trained Nurses, later the
Canadian Nurses' Association) Miss Jean
Gunn, wrote to the publishers, stating the
view taken by the nurses that the illustra-
tion was, to say the least, undignified and
did not in any way represent the wonder-
ful spirit of service with which our nurses
had met the difficulties of overseas work.
The publishers were most pleased to
change the offending illustration and
were most courteous in their attention to
Miss Gunn's request."
Surely publishers today would not
commit such a faux pas. But, if after half
a century they had not learned this
lesson, would today's nurses be offend-
ed?
Bouquet to The Canadian Nurse
This was the title of a very complimen-
tary item that appeared in the May 1969
issue of The Nursing Director, the news-
letter of the Nursing Administration Sec-
tion of the Ontario Hospital Association.
After quoting excerpts from various items
in The Canadian Nurse, the newsletter
stated:
"In this and other newsletters we have
referred to items which have originally
appeared in 'The Canadian Nurse," jour-
nal of the Canadian Nurses' Association.
Quite apart from the fact that its pages
have furnished us with material for
comment, we feel it deserves our plaudits
for another reason. It is quite evident that
the editors have no hesitation in printing
valid opinions even though they may be
in direct conflict with CNA philosophy or
stated policy. This is courageous journal-
ism, something that other groups could
well emulate. So to Dr. Mussallem and
the editorial staff we say; "keep up the
good work! We are certainly in favour of
hearing all sides to the issues! "
DECEMBER 1%9
And to the editor of The Nursing
Director we say, "Many thanks for that
most fragrant and welcome bouquet! It
brightens our editorial offices considera-
bly! "
A "Mess"
There have been various ways and
means of measurement in use throughout
history, but we came across an item
which makes us particularly grateful for
our array of measuring spoons, graduated
cups and eyedroppers, and carefully
weighed pills.
"Measurements for the early Canadian
homemaker included such dosages as a
'cup' of catnip, elderblossom or pepper-
mint leaf tea; a 'copious draft' of tonic
brewed from green celandine; a 'little'
pipissewa, green elder, and white henna; a
'bag' of tansy or asafetida; a 'pinch' of
powder; a 'capful' of medicament; a 'few
cloves' of garlic; and 'handful,' 'mouth-
ful.' 'goodly portion,' 'generous helping,'
'batch,' 'mess,' and 'nip,'" says a release
by the Council on Family Health in
Canada, in a warning to mothers about
administering medicine to their child.
It was the "mess" that stopped us
cold.
More widows than widowers
How many women would be happy to
know that they will continue to outlive
men at an even greater rate than is now
the case?
Now there are about 1 29 older women
for every 100 older men. By the year
2000 the ratio may be 148 to 100.
There are nearly four times as many
widows as widowers. But there is at least
one more encouraging fact: There are also
35,000 marriages a year in which one or
both partners are over 65.
These statistics, reported in the Globe
and Mail July 16, come from the United
States, however. The article reports that
doctors are interested in marital status of
the aged because unmarried patients go to
hospital more often and stay longer than
those married. D
'We three Kings of Orient are... "
THE CANADIAN NURSE 23
in Canada it's
Stille
exclusively from
DePuy
There's no disputing the fine
quality of Stille Surgical
Instruments. As a matter of fact,
other instrument manufacturers use
Stille as a gauge. But there's no
duplicating the strength, precision
and perfect balance and the prime stainless
steel of Stille instruments. A Stille
instrument will not only outperform but
it will also outlast any other surgical instrument
and we have case histories that prove it.
Available only from
DePuy Manufacturing Company (Canada) Ltd.
For additional
information write:
Quebec and
Maritime Provinces
Guy Bernier
862 Charles— Guimowd
Boucherville, Quebec
Ontario and
Western Canada
John Kennedy
2750 Slough Street
Malton, Ontario
24 THE CANADIAN NURSE
DePuy, Inc.
A Subsidiary
of Bio-Dynamics
Warsaw,
Indiana 46580 U.S.A.
DECEMBER 1969
I
■JL
Home for Christmas
A story of Christmas based on the experiences of Catherine W. Keith, who
worked at the Fort George Nursing Station in Quebec in the early 1950s.
:^ ^
'14^
Harriet E. Ferrari
As the entourage approached the Fort
George Nursing Station, the two nurses
peering out the cUnic window doubled up
with laughter.
"I knew it! It's Emmaline! That's her
brother CharUe beside the lead dog," Kay
chuckled.
Hazel giggled. "She's done it again! I
knew she'd be here for Christmas! "
Outside, Charlie, his dog team, and
several relatives had grown from a speck
on the northern Quebec horizon into a
lumbering mass of fur parkas and wind
pants at the station gate. With a final
lunge they drew their burden to an
abrupt halt in front of the steps.
From the komatik a ton of robes and
skins were thrown off with a dramatic
flourish - a flair perfected by repeated
performances — and Emmaline emerged.
She rose with an air of victory and
Mrs. Ferrari, a graduate of Moose Jaw General
Hospital, is presently employed with Medical
Services, Department of National Health and
Welfare, Edmonton, Alberta.
f ^
m
frl^
home-coming, then put her mukluked
feet gingerly into the snow.
"Queen of the North! " Kay grinned,
as she went to the door to meet the
Eskimos. "Wonder what her problem is
this time."
In the small waiting room Emmaline
solemnly shook the fur mitten of each
escort before turning triumphantly to
gain entrance to what she considered her
personal haven.
"Her very sick, nurse," Charlie ex-
plained as his sister headed for the small
two-bed ward that she had reluctantly
vacated just three weeks before.
Having delivered their charge, the men
turned and shuffled out. Weary from the
long trek through the night, their sleepy
eyes squinted at the sunlight shimmering
across the snow-laden valley. Fort Geor-
ge, a cultural junction of what officials
called "Indian, Eskimo and Others," was
starting to show life. Charlie could im^-
ine the heavily socked feet hitting the
bare boards, the linoleum or a fancy rug
depending on the status of the wearer.
With a nod, he directed his companions
toward a nearby oval-shaped canvas tent
where cousin Josee would be brewing tea
on the chubby wood-burning tin stove.
With luck there might even be a pot of
porridge thickening on the back burner.
Back in the station, Emmaline, with
patronizing patience, allowed her host-
esses to perform the various admission
procedures necessary to gain inpatient
status.
"Okay, you're officially in," Hazel
said, wrapping the long maroon house-
coat around the rotund guest, whose face
broke into a beaming smile.
"Thank you," Emmaline acknowl-
edged. She smoothed her still wet, newly
disentangled, black hair. Then, smacking
her government-slippered feet over the
hardwood floor to the door, she swung
into her role as station socialite.
Returning to the desk, Hazel watched
ih6 reunion. Head tossed back, Emmaline
paused momentarily. Like a hunter level-
ing a harpoon, she thrilled at the prospect
of the encounter; filled with self-assur-
26 THE CANADIAN NURSE
ance, she crossed the threshold of the
second ward. Solemnly she gave one
shake of the hand to both elderly Indian
women, rubbed her stomach in a gesture
of justified presence, and sank into the
beckoning luxury of the well-cushioned
maple wood armchair.
"She's home again," Hazel remarked
wryly. "Wish / were."
Kay's glance swept the ward. There
was Betsy, her skin like crinkled brown
paper with the seasons of 70 years etched
across her face, nodding and grunting her
pleasure at Emmaline's return. Perched
mid-bed, her wasting legs flopped under
her ever-diminishing body, she brightened
as a conversation took shape. The sparkle
in her dimming eyes turned intently on
Emmaline.
On the other bed sat Jane. Legs
wrapped in a Hudson's Bay Company
blanklet, she stared at her beloved moose-
hide moccasins resting on the chair. De-
spite intermittent kneading they still
pinched her swollen feet. But they wery
hers, one of the few prized possessions
left, and she would not exchange them
for a pair of department slippers offered
by the nurses. At each offer, Jane's face,
tightened already by time and the tenden-
cy to scowl, would harden and her
braided head would violently shake her
refusal to give up yet another custom.
Jane eyed EmmaUne suspiciously. She
had forgotten how Emmaline, by persist-
ent coaxing and friendly bossing, had
previously broken down her shell of
bitterness and apathy, and had drawn her
into cheerful helpfulness. The stacks of
dressings, neatly cut and folded, were still
not all used; the cotton balls, meticulous-
ly spun from long rolls of absorbent
cotton, still filled several jars in the
treatment room; the folded linen had
been used and folded again, but had never
been done with greater care. But that
was last month and now Jane again
drooped with lethargy and inner loneli-
ness.
Busily engaged in the cleaning and
wrapping of supplies, Kay and Hazel
listened to the cheerful exchange between
Emmaline and Betsy. Emmaline's choppy
version of Cree dialect and Betsy's true
Cree were bound together by freely dis-
jointed English and seemed to mesh into
a common tongue. Hoots of laughter and
grunts of agreement filled the air. Jane
hung her head, twisted her gnarled fin-
gers, and stared at her mocassins.
Emmaline and Betsy were discussing
the events of the previous evening, which
had initiated the usual round of Christ-
mas season festivities in the community.
Last night, the school children had come
to the nursing station for their annual
"carol sing." Like a flock of geese they
had fluttered in, excitement bubbling
over their natural reserve, voices rising
and falling in awe and anticipation at the
sight of the tali pine hung with tingling,
shimmering decorations.
Page by page they sang through the
Carols for Christmas books. Squinting
and bluffing, they got through the non-
familiar verses, then burst into full voice
at the choruses.
Nine- and six-year-olds, Brian and Ste-
phen, sons of the Hudson's Bay manager;
Mary, daughter of the Anghcan mission-
ary; and Charles and Harry, children of
the school teacher, interrupted the sea of
black hair with their bobbing blond and
reddish heads. Kevin, a 10-year-old Metis
who was unable to speak, contributed no
sound, but smiled like an angel. Robbie,
eight, who had a congenitally dislocated
hip, leaned against the wall and rolled a
beautiful soprano from his otherwise
sturdy body.
Between carols there was shuffling and
giggling, but each song was treated with
the respect it deserved. Emmaline's young
nephew, Billy, glowed with the rest, and
the long hours of rehearsal suddenly
seemed worthwhile.
When the last page was turned and
after several rousing choruses of "Jingle
Bells," Kay and Hazel plucked the lolli-
pops from the tree and gave one to each
child. Then the members of the chorus
were invited to the nurses' living
quarters — a not unexpected treat. The
popcorn balls from the nurses' tree smud-
DECEMBER 1%9
ged many a face but cleared the memory
of many a needle. Before the kettle of
hot chocolate was empty, many memo-
ries had been tucked away for reliving
during the long lonely winter nights
ahead.
On the way out, each child filed past
old Jane and older Betsy, shook their
frail, heavily-veined hands, and wished
them "Merry Christmas."
Emmaline's nephew, Billy, had gone
home all excited about the carol sing.
Jarred by the reminder of the warmth,
good food, and good compagny at the
nursing station, Emmaline had taken a
sudden "attack" early the next morning.
She now munched away on a leftover
popcorn ball, while her quick mind re-
viewed the possibilities of extending her
stay at least until all the festivities were
over.
Hazel gazed longingly at the picture on
the wall of her native Nova Scotia and
gave a long, hard sigh. "Do you think
they will ever have a mail plane before
Christmas at Fort George? " she asked.
"Don't know," Kay answered, "Hope
so." Kay tucked the thermometer case
and the stethoscope into the black field
bag and snapped it shut. "See you at
noon."
Home visiting this morning took on
a new dimension for Kay. The "HeUos"
were louder and warmer, the doors were
opened wider in welcome, parents spoke
with greater ease, and children smiled at
everything and everyone. Each injection,
each dressing, each word of health teach-
ing, was received gratefully and each
handshake projected a special "we're-all-
in-it- together" message.
Kay's mukluks scrunched along in the
frosty air as she made her way from
house to house. The cold teased her
cheeks and frosted her eyelashes, but one
of her fur-lined mittens returned each
wave as she plodded on. "See you to-
night," she said gaily as she left each
home.
Along the trails she hummed the age-
old carols that would be sung again
tonight. The non-native adults would do
DECEMBER 1%9
the honors, gathering in early evening and
caroling to the local inhabitants, stopping
at every door to visit briefly and shake
the hands of the people inside. It would
be an evening when goodwill and fellow-
ship - taken for granted during the
year - would be demonstrated. Kay
hurried, thinking of the preparations yet
to be made. The singing troupe would
return to the nursing station after for hot
punch and fruit cake in front of the
fireplace.
Throughout the week there would be
gatherings, the gaiety overlapping from
one day to the next. That unique com-
munity spirit of small northern settle-
ments would reach a new peak, to be
climaxed on the morning of New Year's
Day. That was the time the native people
chose to make their official response to
the offerings of friendship from the non-
native populace.
At 8:00 a.m., the Indian and Eskimo
men would group together to visit every
non-native establishment. With guns on
their shoulders they would stop at each
door, and one man would mount the
steps with a violin and play a favorite
dance tune. When the music stopped, the
others would shoot their guns into the
air, a wild crescendo of greeting; sweets
would be passed and hands shaken all
around. At the last house, when the final
shots echoed bluntly through the frost,
the new year would be considered proper-
ly greeted and committed to Peace on
Earth, Goodwill to Men - at least in
Fort George.
Such is commuity nursing, Kay
thought. It's not just the public health
program and the care of patients. Com-
munity activities vary with the seasons,
just as health problems vary, but over the
year all these activities and the involve-
ment of all the people add up to com-
munity well being. Every facet of com-
munity life - the mores that determine
the work, the fun, the games, and the
rituals - affects the health and happi-
ness of its people. And we, the nurses, are
a part of it. But only a part. We must lead
and be led, teach and be taught, give and
be given to, just like every other person
here.
To be a part of it all - that was it,
that's community nursing, Kay realized,
her footsteps quickening. That's what this
good feeling is. We shouldn't be home-
sick, even at Christmas. This is home —
for now, this year, perhaps next year
too.
Kay rushed up the nursing station
steps and into the hall. "Hazel! " she
called, looking around, "I'm home! "
Hazel looked up from the wild goose
freshly unwrapped on the kitchen table.
"Our Christmas dinner," she said, smiling.
"Jane's sons, back from the bush for
Christmas, brought it."
Kay turned her glance into the ward.
Jane's squeaky laugh rose from the hud-
dle around a small table in the middle of
the ward. One hooked finger shook
threateningly at her opponents. Emma-
line gathered in the cards for the next
deal and winked at Jane while Betsy
glowed with shared satisfaction.
"Well, I never! " Kay exclaimed and
went to the kitchen. She and Hazel
nodded knowingly at each other.
"So you're home, eh, Kay? " Hazel
teased. "Well, so am I, for now." D
THE CANADIAN NURSE 27
Nurses and
educational change
The author conducted a study to determine how effective Canadian nursing leaders
have been in getting nurses' support for changes in nursing education.
Dorothy Kergin, R.N., Ph.D.
In a changing world, no occupation
can consider itself to be a profession
unless it continuously submits its prac-
tices and educational programs to self-
scrutiny and self-evaluation, and modifies
both when these analyses show that it no
longer is serving the best interests of
society. Among the professions, scrutiny
and evaluation are generally done by
those who serve as the profession's lead-
ers.
To nursing's leaders belongs the res-
ponsibility for evaluating societal needs
and estimating how nursing practice and
nursing education should be modified to
maximize the impact of the nurse on
problems related to the effective delivery
of health services. To these leaders also
falls the task of enlisting the support of
the rest of the profession to further
necessary change. This paper considers
how effective Canadian nursing leaders
have been in obtaining the profession's
support of educational change.
There is, first of all, a need to identify
those who are the leaders of the nursing
profession. In a cross-national study, Gla-
ser identified the positions of those who
served as nursing leaders. ■■ His findings
are as applicable to Canada as to other
countries. He included the directors and
faculty of educational programs preparing
nurses; the interpreters of standards, the
regulators of schools, and the gatekeepers
for entry (that is, administrators of li-
cencing agencies and consultants employ-
ed by governmental and professional
Dr. Kergin, a graduate of the University of
British Columbia School of Nursing and the
University of Michigan, is Associate Director of
the School of Nursing at McMaster University
in Hamilton, Ontario.
28 THE CANADIAN NURSE
organizations); the nursing executives of
organizations employing nurses; and the
elected officials and salaried secretaries of
nursing associations. These are the nurses
who serve as the profession's spokesmen
in govenunental, inter-professional, and
public settings. One of the characteristics
that is increasingly associated with the
members of this group in Canada is the
possession of a graduate degree.
Study of professional attributes
An investigation completed by the
author in 1968 provides a few insights
into the effectiveness of charmels of
communication between those who serve
as the profession's leaders and those who
constitute a large proportion of the mem-
bership.2 This study was concerned with
professional attributes, including a few
related to education and educational
change. To carry it out, a random sample
was drawn of female nurses, registered
and employed in Ontario in 1967. In the
sampling process, a different proportion
was selected from each of three strata or
groups, from among registered nurses
with: 1. no academic degrees; 2. bacca-
laureate degrees; and 3. graduate degrees,
that is masters or doctoral degrees.
Data were collected through a mailed
questionnaire and questionnaire returns
totaled 549, or 76 percent of the number
mailed. For most of this discussion res-
ponses of nurses with graduate degrees
and those with no academic preparation
will be compared. These responses com-
prise, on the one hand, those of many
professional leaders in Ontario and, on
the other, responses of a representative
proportion of rank-and-file members.
Findings indicate that of 65 respond-
ents with graduate degrees, 86 percent
DECEMBER 1%9
(56) occupied a position that correspond-
ed to one of those identified by Glaser as
"leader." Of the 180 without academic
preparation, 66 percent (118) reported
positions as staff nurses; 19 percent (35)
stated they were head or assistant head
nurses; and only 11 percent (25) held a
position that fell into Glaser's category of
leader.
As well as tending to differ according
to position held, those with graduate
degrees were more likely to be older,
single, employed full time in nursing, and
to be members of the Registered Nurses'
Association of Ontario (RNAO) than
were those with no university degree or
certificate.*
One of the chief responsibilities of a
professional association is to set rigorous
standards for the profession and to help
enforce them. For nursing, this includes
the responsibility to promote standards
of educational preparation that will foster
the provision of a high quahty of patient
care.
For the Canadian profession, the
spokesman on matters of professional
concern is the Canadian Nurses' Associa-
tion (CNA), in conjunction with its 10
provincial affiliates. Among policy state-
ments issued by the CNA, several have
been on nursing education. One such
statement indicates that in future there
should be two types of programs to
prepare for nurse registration: the basic
baccalaureate program and the diploma
program, plaimed within the framework
of two years.3 A distinction in these
statements is between the preparation of
the professional nurse and that of the
diploma nurse.
To assess how receptive or accepting
registered nurses might be of CNA state-
ments that propose change in basic nurs-
ing education, two items were included in
the questionnaire relating to CNA's right
to state two specific positions. The first
item concerned the baccalaureate pro-
gram as preparation for professional nurs-
ing practice, and the second, the two-year
diploma program as preparation for tech-
nical nursing practice. For each item
respondents were queried about CNA's
right to take a stand and asked to indicate
whether they would agree with or oppose
the statements. Their responses, accord-
ing to level of education, are shown in
Table 1.
Results
As shown in Table I, those without
university degrees were less inclined to
•Membership in the Registered Nurses' Asso-
ciation of Ontario is voluntary.
DECEMBER 1%9
TABLE I
Support of Opposition Expressed by Ontario R.N.s to Statements
Regarding Professional and Technical Nursing Practice,
According to Educational Preparation
Statements
Educational Preparation
No Academic Masters or
Degree Doctorate
No. % No. %
1 . Baccalaureate degree as preparation
for professional practice.
a. CNA's right: support
undecided
opposed
74
31
75
41
17
42
53
4
7
83
6
11
b. Position itself: agree
undecided
opposed
51
32
94
29
18
53
43
9
12
67
14
19
2. Two-year diploma as preparation
for technical practice.
a. CNA's right: support
undecided
opposed
93
29
55
53
16
31
56
2
6
88
2
10
b. Position itself: agree
undecided
opposed
70
37
66
41
20
39
47
6
10
74
10
16
agree with both positions than were those
with graduate degrees. The data indicate
that, for the baccalaureate position, 29
percent of those without academic de-
grees expressed agreement, compared to
67 percent of the respondents with gradu-
ate degrees; and for the "technical" posi-
tion, 41 percent of the former expressed
agreement, compared to 74 percent of
those with masters or doctoral prepara-
tion.
In both cases a larger percentage said
they would support the CNA's right to
express the position than would actually
seem to support the position. It seems
that a few hold to a philosophy of "I
don't agree with what you say, but 111
defend your right to say it." For those
who serve as spokesmen, this says that
some members support the legitimacy of
their leadership, without being in com-
plete agreement with the stands they
take.
But do Canadian nurses know what
their professional association, the CNA, is
saying on their behalf? Do those who
serve as leaders know what those who
comprise the rank-and-file beUeve? To
assess this, items were included in the
questionnaire to determine what the res-
pondents knew about the CNA's policy
statements on basic nursing education
and what they themselves believed about
future basic nursing educational pro-
grams.
In the case of the first of these items,
the respondents were asked to indicate
what they thought the CNA had stated
about the types and numbers of future
basic nursing educational programs; for
the second, they were asked what they
believed had been proposed concerning
future basic diploma programs. Respond-
ents who had academic degrees** and
who were also members of the RNAO
were most likely to know what the CNA
had stated in both cases and to have
supporting beliefs. For respondents with-
out academic degrees, statistical analysis
using the chi-square statistic, suggested
that RNAO-CNA membership had little
**As well as 65 registered nurses with graduate
degrees, there were 250 respondents with bac-
calaureate degrees included among those with
academic degrees. The group without academic
degrees was comprised of 45 nurses with a
university certificate or some credits toward a
bachelor's degree and 186 who reported no
university courses.
THE CANADIAN NURSE 29
effect on either knowledge or beliefs.
Members and non-members without
academic degrees were equally ill-inform-
ed. Only about 20 percent knew that the
CNA had issued statements indicating
that in future there should be two types
of programs preparing for registration as a
nurse: the basic baccalaureate program
and the diploma program, planned within
the framework of two years. When asked
what they thought about diploma pro-
grams in the future, approximately 50
percent of the 213 respondents without
academic degrees expressed support for
the two-plus-one program and over one-
third thought that the CNA had proposed
it.
Ineffective communication
This brief look at some aspects of
intra-professional communication sug-
gests that our channels are rather ineffec-
tive, especially the channels between the
membership as a whole and those who
speak for the professional associations.
Certainly this seems to be true when one
considers how well the membership is
informed of proposals of the national
association regarding future educational
programs for nurses. Nor can those of us
who call ourselves nursing educators con-
sider that we have done a very thorough
job of communication. This latter state-
ment is supported by data pertaining to
two other questionnaire items.
The respondents were asked whether
they agreed, disagreed, or were undecided
with respect to the following two state-
ments:
1. Even with a sound theoretical back-
ground, the decreasing amount of prac-
tice in two-year diploma programs means
that their graduates will be of very
limited use at the bedside of patients
when they first graduate.
2. Increasing emphasis on theory and
decreasing amounts of practice in basic
baccalaureate programs mean that future
new graduates will be of little use at the
bedside of patients.
These two are rather strong state-
ments, since they both imply that new
graduates of these programs will not be
particularly useful in the area that nurses
consider to be the primary place in which
they carry out their nursing functions -
the patient's bedside. The higher a
nurse's educational level, the more likely
she was to disagree with both statements.
Of those who had no formal educational
preparation beyond a basic diploma,
three-quarters (121) agreed with the
statement regarding the two-year diploma
graduate, and two-thirds (114), with the
one concerning the future graduate of a
30 THE CANADIAN NURSE
basic baccalaureate program. Even among
those with masters or doctoral degrees,
18 percent (12) agreed with the first
statement and 8 percent (5) agreed with
the second. The sample of nurses without
academic degrees represented a fairly
substantial proporition of registered
nurses employed in Ontario in 1967.
It seems that those who provide lead-
ership for the profession have not yet
achieved wide acceptance of the need for
new concepts in nursing education to
meet the new demands placed upon
nursing practice. One wonders how the
graduates of these two programs feel
when they are placed in their first job
situations following graduation, among
work colleagues who consider them to be
of limited usefulness.
We can only speculate whether these
opinions about newly graduated nurses
are part of an attitudinal set that forms
the basis for a characteristic called by
Reinkemeyer "anti-educationalism."^ Or
do these opinions represent a resistance
to change, a resistance that is typical of
professions and other occupations when
behaviors, symbols, and norms begin to
change and the means for attaining pro-
fessional stature is revised. Like many
groups, nurses are slow to accept change
unless they are convinced that it is
necessary. This suggests there is a need
for a great deal of communication within
the profession.
The whole matter of basic nursing
education and the rationale for change
need to receive full discussion at all levels
within the nursing profession. In particu-
lar, this discussion must reach the local
chapters, where the association's life-
stream begins. One way in which this
might be done is to establish special
committees in the chapters, whose func-
tion would be to identify current issues
within the profession, to explore fully
and rationally the various positions that
have been or might be taken with respect
to these issues, and to lead discussions
within the chapters. Such a committee
ought to keep before it always the pro-
fessional aim of public service.
Examination should be made of the
health care needs of the Canadian people
and of the educational preparation requir-
ed to prepare practitioners who can han-
dle effectively those functions that are
within the prerogative of the nurse. It is
of little use to propose educational
change at the national level and attempt
to legislate it at the provincial level, if the
local environment forces graduates pre-
pared in new programs to fit into old
patterns, among work peers who question
their capabilities.
It is time that we recognize that there
are differences between the graduates of
various nursing programs. It is time, too,
for us to revise our expectations of their
performance in work settings. The time is
not far off when we must assign them
different titles that reflect different per-
formance expectations and educational
backgrounds. Whether these titles are
"professional nurse" and "technical
nurse," or "clinical nurse" and "staff
nurse," or something else, is not impor-
tant. What is important is that we develop
titles that are used consistently and which
reflect agreed upon performance expecta-
tions.
A few years ago, Mallory succinctly
identified the problem when she said:
"... difficult and perhaps costly,
though its accomplishment may be, fail-
ure to achieve an understanding, articu-
late, and actively supportive membership
may prove a serious stumbling block to
the attainment of desired goals, particu-
larly in the field of education.''^
We do not seem to have eliminated
this stumbling block. It is exciting and
stimulating to contemplate the future of
nursing education in this country and
throughout the world, but let us make
certain that this excitement is shared as
widely as possible throughout the profes-
sion.
References
1. Glaser, William A. Nursing leadership and
policy: some cross-national comparisons. In
Davis, Fred, ed. The Nursing Profession.
New York, John Wiley & Sons, Inc., 1966,
pp. 55-56.
2. Kergin, Dorothy J. An exploratory study of
the professionalization of registered nurses
in Ontario and the implications for the
support of change in basic nursing educa-
tional programs. (Ph.D. diss.. University of
Michigan, 1968).
3. Canadian Nurses' Association. On Record:
CNA Policy Statements, Ottawa, The Asso-
ciation, 1964, p.4.
4. Reinkemeyer, Sister Mary Hubert. A nursing
paradox. Nurs. Res. XVII, Jan.-Feb., 1968,
pp.6-8.
5. Mallory, Evelyn. Whither are we tending . . .
updated. Mimeographed. (Paper delivered at
the Executive Committee Meeting, Canadian
Nurses' Association, Ottawa, February
12-15, 1964.) D
DECEMBER 1%9
Safe care for mother
and baby
A British nurse looks at the pros and cons of home delivery in her country.
Canadian nurses may be surprised to
learn that in England some babies are still
delivered in the home. To some this may
seem a primitive, dangerous, and un-
hygienic practice, but in this article I
hope to show that in England there is still
a place for domiciliary confinement.
Forty years ago, most women here
would not have thought of going to
hospital to give birth, which was consider-
ed a simple domestic event. The fact that
a small minority lost their lives was not
questioned, for childbirth was known to
have its hazards.
But our doctors did not share this
attitude. Parturition, they reasoned, was a
natural process, and with adequate care
no mother or baby should be lost,
whatever complications occurred during
pregnancy and labor. Over the years they
sent an increasing number of women to
hospital, where all eventualities could be
dealt with quickly and effectively.
Advantages at home
Why, then, do we still consider the
home a suitable place for childbirth? One
practical reason is that there are not
enough maternity beds in hospitals to
accommodate every expectant mother,
and this will take some years to remedy.
Another reason is that the geography of
England makes it possible to have a safe
domiciliary maternity service. Our towns
and cities are never more than 15 miles
apart, and the rural areas between are
thickly populated, compared with a coun-
try such as Canada. Doctors and district
DECEMBER 1%9
Kathleen Dicker, S.R.N., R.S.C.N., S.C.M.
midwives are always within a few minutes
drive from their patients, and the services
of speciahzed maternity units in the
towns are easily available to them. It is
possible to transfer patients to these units
quickly at any stage of pregnancy or
labor.
Each maternity unit also provides an
obstetric emergency service, known as the
Flying Squad, which goes out to treat
mothers. When calls for help are sent via a
reserved telephone line, two doctors go
immediately by ambulance, bringing
equipment for transfusion, a supply of
Group 0 Rh negative blood, sterile packs
of gloves, and portable anesthetic appara-
tus.
The most common emergencies are
retained placenta and/or postpartum
hemorrhage. After dealing with the situa-
tion, the doctors remain with the patient
until her condition is satisfactory. Then
they leave her in the care of her own
doctor and midwife.
The Flying Squad also goes out to
treat patients with serious antenatal emer-
gencies. Severe antepartum hemorrhage
and fulminating eclampsia are treated in
the home, and the patients are transferred
to hospital for intensive care. At present,
an average of two Flying Squad calls per
week occur in an area with a population
of 125,000.
Miss Dicker, a graduate of King Edward VII
Hospital, Windsor, England; St. Giles Hospital,
London; and Victoria Hospital for Children,
London, is in charge of a prenatal clinic in
Stephney, East London.
No woman who is recognized during
the antenatal period as being likely to
develop complications is delivered in her
own home. These complications include
cardiac problems, women with Rhesus
antibodies, and those who have had diffi-
culties during previous labors.
Dangers of home delivery
When a research project into perinatal
mortality was carried out 1 1 years ago, it
revealed some dangers not fully realized
before.* Statistics gathered then showed
alarming mortality and morbidity figures
for the second of twins and single babies
born of multiparous women by the
breech, especially when these patients
were delivered in places where facilities
for treating complications were not im-
mediately at hand.
The study also showed that the dan-
gers to both mother and baby increased
considerably with the fourth and later
children in a family. One reason for this
was the unsuspected, unstable lie of the
fetus, with its possible sequelae of mal-
presentation, obstructed labor, and pro-
lapsed cord. Also, multiparous women are
more likely to have uterine inertia during
the third stage of labor, which can result
in dangerous bleeding. All these factors
*The Perinatal Survey 1958 was organized by
The National Birthday Trust, and its findings
were published in 1963. All births that took
place in the United Kingdom during the period
from March 3 to 9 were studied. Detailed
records were supplied by doctors and midwives.
A further survey is planned for 1970.
THE CANADIAN NURSE 31
Midwives in urban areas of England have walkie-talkies for calls.
can cause the death of either mother or
baby, and sometimes both. Even if trans-
fer to hospital can be made in time to
prevent this disaster, the delay involved
can result in brain damage to the infant.
The mother who had always had her
babies quickly, with no problems, was
thus recognized as one who possibly
faced the greatest risk. Even though the
risk of home delivery was remote, it was
too great to take. It was often difficult,
however, to convince these women that it
was necessary for them to leave their
families and go to hospital to be deliver-
ed. Now that we have a system that
permits them to return home 24 to 48
hours after the baby's birth to be cared
for by their district midwives, it is easier
to gain their cooperation.
Home requirements
The number of domiciliary deliveries
has declined over recent years and has
been further decreased because of the
housing shortage in England. The criteria
for home delivery are a separate room
where the woman can have her baby in
absolute privacy, even if the following
night, her husband returns to share the
double bed; an adequate water supply
and sanitary arrangements; and domestic
help from a relative or friend so that the
new mother can rest for at least a week
after the birth. Often the role of house-
keeper is filled by the husband who takes
32 THE CANADIAN NURSE
his vacation at this time.
Early in the patient's pregnancy her
doctor makes a careful medical, obstetric,
and social assessment to decide whether
she is more suitable for home or hospital
confinement; usually he considers the
patient's preference. If she is to have
home delivery, her district midwife and
doctor share her antenatal care. Natural-
ly, she can be referred at any time to the
specialized maternity unit if her progress
deviates from normal.
The midwife inspects her patient's
home to make sure it is suitable, and
advises about preparations and the time
to call her when labor starts. (Midwives in
urban areas now have walkie-talkie radios
for calls.) At delivery, the midwife sup-
plies sterilized disposable equipment,
analgesics, and oxytocic drugs.
Birth at home
The birth of a baby in the home is a
truly happy occasion. Possibly because
the mother is in a familiar place among
people she knows, she often seems to
have a more relaxed and rapid labor than
her less fortunate sister who, for one
reason or another, has to go to hospital.
Although Demerol is always offered in
labor, the patient frequently refuses it
and accepts inhalation analgesia — ni-
trous oxide with oxygen, or Trilene with
air - for the delivery only.
The patient's doctor is informed when
labor starts, and he is often present for
the birth. But delivering the baby is
considered to be the midwife's special
privilege; if, as a courtesy, she asks the
doctor if he wishes to do it, he usually
declines, saying that she is the expert.
One great advantage of complete do-
miciliary care is that mother and child are
safe from the possibility of cross infec-
tion. Delivery in the home is conducted
with all the aseptic technique used in
hospital. Patients assume either the dorsal
or left lateral position as they prefer and
their midwives find most convenient.
When working in the home, one must
be adaptable. Beds are often so low that
the midwife must kneel on the floor
when delivering the baby. Surprisingly,
perhaps, this kneeUng position is quite
comfortable.
It is common for the patient's husband
to be present at the birth. As soon as this
is safely accompUshed, the grandmother
and older children, if they are in the
home, are invited to meet the new arrival.
At this stage everyone takes time off to
drink tea and eat cookies or cake, for
labor can be hungry work for all concern-
ed. While the mother sips her second cup,
the midwife weighs and bathes the baby.
She remains in the house for at least one
hour, leaving when all the clearing up has
been done, provided that her two patients
are completely satisfactory.
The midwife visits twdce daily for the
first three days and then daily until the
baby is 10 days old. The mother gradual-
ly assumes complete care of her child,
and after the seventh day resumes her
household work.
Comment
Some persons in England believe that a
domiciliary maternity service, which in-
cludes deliveries, is too expensive in time
and personnel. They advocate that all
mothers be delivered in hospital, where a
high concentration of skilled staff is
already available. To ease the accommo-
dation problem, these women could be
sent home to the care of district midwives
24 to 48 hours after birth.
It seems unlikely, however, that a
system that has been successful for so
long and has become more efficient
throughout the years will be abandoned.
Those mothers who are able will continue
to give birth to their children in the
security and comfort of their own homes,
with the advantage of the personal care of
their own doctors and midwives. CH
DECEMBER 1%9
The nurse is a specialist
in the artificial kidney unit
An introduction to dialysis nursing, with emphasis on the criteria needed for
nurses who plan to work in an artificial kidney unit.
A friend and I were enjoying a late
lunch in the hospital coffee shop. Our
conversation inevitably turned to dialysis,
as he had spent many months as a patient
on our chronic hemodialysis program
before he had a successful kidney trans-
plant. While reminiscing about his experi-
ences on the unit, he gave me a valuable
tip to pass on to our stan : "Don't ever say,
in front of your patients, that you have
just had a deUcious ham sandwich! So
often I would be staring at my lunch
tray - which looked darned uninterest-
ing because of my diet - and the nurses
would start discussing the varied menu
available in the cafeteria that day. It was
terrible! "
My friend had a valid point. It seems
such a little thing, but it was important to
him. So often we forget that patients are
people with feelings, frustrations, and
unpleasant restrictions. This is true for all
patients, but his comment was especially
applicable to patients on the hemodialysis
(artificial kidney) unit. On this unit the
nurse has many added challenges and
frustrations not encountered on general
duty.
To the general staff nurse, hemo-
dialysis is vague and unfamiliar. As the
field expands, more and more skilled
nurses will be required, and most of them
will be transfers from other hospital
departments. It is my purpose to present
an introduction to dialysis nursing, with
the emphasis on criteria for nurses.
What is dialysis?
Glomerular and tubular function in
the normal kidney controls the excretion
DECEMBER 1%9
Christine Frye
of metabolic waste products and excess
fluid from the body. In renal failure,
these products accumulate in the blood
stream, resulting in the uremic syndrome
with its many varied complications. The
artificial kidney machine mimics the nor-
mal kidney, utilizing semipermeable
membranes for dialysis and filtration.
In hemodialysis, the patient's blood is
shunted from his body through a length
of plastic tubing and membranes of cello-
phane or other material, and back to his
body. Circulating around the membranes
is a bath solution, "dialysate," containing
the chemicals normally found in blood.
Any substance - other than blood cells
and most proteins - that has a higher
concentration in the blood than in the
bath will diffuse through the membrane
into the bath and be discarded. Water will
also be removed from the blood through
hydrostatic and osmotic pressure.
Hemodialysis is used primarily for
three different conditions. Most common
of these is chronic renal failure, caused by
kidney diseases, such as chronic glomerulo-
Miss Frye, a graduate of the Maiy Fletcher
Hospital School of Nursing, Burlington, Ver-
mont, U.S.A., is Head Nurse of the Artificial
Kidney Unit of the Ottawa Civic Hospital. She
is also chairman of the committee on training
and education of the Canadian Society of
Extra-Corporeal Circulation Technicians. She
expresses her thanks to Dr. Bernd Koch,
Nephrologist in charge of the Renal Laboratory
and Artificial Kidney Unit, Ottawa Civic Hospi-
tal, for his helpful criticism of this paper and
for his encouragement of his staff in research
and writing.
nephritis and pyelonephritis, polycystic
kidneys, and analgesic nephropathy. Dial-
ysis is also frequently the treatment of
choice in acute renal failure resulting
from surgery, trauma, acute kidney infec-
tions, and other causes. OccasionaUy a
patient may be dialyzed to remove toxins
in cases of drug overdose or poisoning.
Many types of dialyzers have been
used, but two basic kinds have become
most popular. They require different
techniques, buc produce comparable re-
sults. The Ottawa Civic Hospital uses the
twin-coil kidney, patterned after the de-
sign of Dr. W.J. Kolff, and modified by
Travenol (Baxter Laboratories) and King-
med Limited.
The actual work
Let us consider a typical dialysis in our
unit for a patient with chronic renal
failure. He is admitted, weighed, gets into
bed, and has his blood pressure recorded.
Dialysis is started, and he settles down to
read, sleep, or watch television. He is
questioned informally about his condi-
tion: how has he felt since his last
dialysis? Does he have any new com-
plaints? Are there problems with drugs
or diet?
The patient's blood pressure is record-
ed every 20 minutes, or more frequently
if it is above or below his normal reading.
He may require mild analgesics for a
headache or muscle cramps. He is served
his meal according to the diet he is
following. Blood is transfused through
the machine if his hematocrit is below 15
to 20 percent. An antihistamine may be
given before the transfusion, particularly
THE CANADIAN NURSE 33
A former patient and his wife (left) talk
to the head nurse of the dialysis unit,
Chris Frye, in the hospital coffee shop.
This patient had a kidney transplant in
1968 and returns to the outpatient clinic
every four to six weeks for a check-up.
if he has had previous blood reactions. A
high machine pressure may be used to
remove excess fluid from the patient's
system, or fluid may be given through the
machine to replace a loss. This need is
determined by his pre-dialysis weight and
the blood pressure readings.
If he is tense or anxious, he may be
given a tranquilizer, either as a routine
daily dose, or just as needed during
dialysis. We have written orders for these
routine drugs and treatments, so it is
unnecessary to call a doctor for each little
problem. However, a resident and staff
physician are on call at all times when
dialysis is in progress.
The dialysis runs for four to six hours,
after which the patient is allowed to get
up. If he feels well, he is weighed and
goes home. If he prefers to rest, or does
not feel well, his discharge is delayed
accordingly. Most patients are dialyzed
twice a week, during the day or the
evening, depending on their working
hours.
Criteria for dialysis nursing
What quaUties, attitudes, or interests
should the dialysis nurse possess? These
can be summarized briefly: a willingness
to specialize; an interest in chronic care
nursing; ability to care for acutely ill
patients; alertness; ability to work as a
member of a small team; a positive
attitude; and good health.
Willingness to learn a highly specialized
type of work. Most nurses tend to forget
all but the basics of anatomy and physiol-
ogy after they finish training. The dialysis
nurse must relearn this along with kidney
34 THE CANADIAN NURSE
function in health and disease. In addi-
tion, she must be aware of body chemis-
try, fluid and electrolyte balance, cardio-
respiratory function, blood pressure con-
trol, nutrition, and so on. She must
understand the principles and functions
of the kidney machines, the cardiac moni-
tor, and associated equipment and be
completely capable of running them. It is
to her advantage to spend her free time
reading, studying, and asking questions.
Interest in caring for the long-term,
chronically-ill patient. Chronically diseas-
ed kidneys do not recover. The only real
hope of a chronic dialysis patient is to
have a successful kidney transplant. While
waiting for a suitable donor kidney, or if
he is not a transplant candidate, his
week-to-week existence depends on ade-
quate dialysis. He is usually acutely aware
of the severity of his illness and requires
constant psychological support and en-
couragement.
The dialysis nurse must be prepared to
listen to the patient's problems and to
decide when they should be brought to
the doctor's attention. And she must
watch closely for changes in a patient's
condition, which he may be afraid to
mention, or which he may not notice
himself. The chronic dialysis patient re-
quires little actual nursing care and
should be encouraged to help himself as
much as possible, but this is never an
excuse for the nurse to refuse to help.
Ability to care for acutely ill patients
during a complex procedure. Whereas
chronic patients require little nursing
care, those with acute renal failure are
seriously ill. Intensive nursing care is
required and is complicated by the dial-
ysis procedure. Many types of equipment
may be in use and the nurse must
understand these. At the same time she
must be aware of the hemodynamic
changes that dialysis may cause, including
wide fluctuations in blood pressure, the
chance of clotting or hemorrhage, and the
danger of dehydrating the patient or of
over-loading the circulatory system, caus-
ing pulmonary edema and congestive fail-
ure.
If the patient is unconscious at the
start of dialysis, he may gradually become
more alert as his biochemical status im-
proves. Thus a quiet, comatose patient
may become a restless and frightened one
over a period of a few hours. Constant
observation is mandatory.
Alertness in the midst of routine. The
chronic dialysis program consists of many
routine procedures. When the nurse be-
comes familiar with them, she can relax
and be comfortable with her work. Weeks
may pass with little change in procedure
and with little to challenge the nursing
staff. However, they must at all times be
alert and aware of what is happening in
the unit. Mechanical failure of equip-
ment, an unexpected power failure, or a
sudden change in a patient's condition
must be noticed and treated without
hesitation.
One of the most common problems
associated with the equipment is a leak in
the dialysis membrane, allowing blood to
escape into the bath fluid. If not detected
immediately, this can result in a consider-
able blood loss from the patient. Many of
the newer models of artificial kidneys
DECEMBER 1969
Dr. Bernd Koch, director of the artificial
kidney unit, and head nurse, Miss Frye,
examine a patient's chart. Nurses and
doctors on the unit hold frequent infor-
mal conferences to deal with day-to-day
problems.
have built-in alarms that alert the staff to
any sudden change in the system.
The patient also can develop serious
problems with little or no warning, such
as a sudden fall in blood pressure, severe
muscle cramps, nausea and vomiting, or
dyspnea and shortness of breath. The
nurse must be able to initiate treatment
immediately, since there is seldom a
doctor in the room.
Ability to work as a member of a small
team. Most dialysis units in Canada are
still small, with few beds and few nurses.
The unit is under the direct supervision of
a staff physician, who may or may not
have interns and residents working with
him. There is usually a head nurse and a
varying number of staff nurses. There
may be technicians who are responsible
for the equipment but who are seldom
directly involved in patient care. Less
intimately involved with the team are
dietitians, social workers, and laboratory
technicians.
All these people, with varying back-
grounds and responsibilities, must be able
to work together efficiently and happily
to provide a safe and pleasant atmosphere
for the patients - and for themselves!
Thus, if a nurse does not like the work or
feels unable to cope with it, she would do
well to transfer to some other depart-
ment. Agreement on policies and pur-
poses and close cooperation are essential
for a smoothly functioning unit.
Positive, cheerful attitude and emo-
tional maturity. Caring for patients who
constantly face serious illness and death is
a difficult and demanding task. To deal
with chronic dialysis patients, a nurse
DECEMBER 1%9
must first understand her own feelings
about the value of the program, about her
role in it, and about illness and death. She
must be able to offer hope and encour-
agement, while recognizing that each pa-
tient requires a different approach.
Patients often need to talk out their
problems and concerns and may use
expressions or state ideas that are offen-
sive to those around them. A very real
example of this is the attitude of patients
who have waited a long time for a
transplant. They frequently "'joke" about
highway accidents, knowing full well that
a traffic fatality may produce a donor
kidney. The nurse can neither condone
nor condemn such comments. And a
quiet, cheerful atmosphere gives the pa-
tients confidence and helps them to relax
and to feel more "normal."
Good health and dependability. Al-
though last on the list, good health is by
no means the least important requirement
for a dialysis nurse. She is usually one of
a small team, as previously mentioned,
and if she is absent the others must add
her work load to their own. Relief is not
available from other sources because of
the need for specialized training.
An undependable nurse is never an
asset and may become a burden to others.
On the other hand, the staff must be
aware of certain health hazards encoun-
tered in this work, particularly the danger
of contracting hepatitis from contact
with contaminated blood. Certain precau-
tions are necessary in handling needles
and syringes, donor blood packs, and the
tubings and membranes of the artificial
kidney.
Unless it is run on a 24-hour basis, a
dialysis unit must have staff always on
call for emergencies. These emergencies
include patients with acute renal failure,
poisoning, and transplant rejection that
requires dialysis. Thus the nurses must be
prepared on occasion to work long hours
with little relief.
Staff illness also endangers the patient.
Uremic patients have httle resistance to
infection and recover poorly from added
illness. Therefore, a nurse with a cold or
with skin infections, for example, should
avoid contact with these patients or
observe reverse precaution technique
when near them.
Present trends in dialysis
In April 1969, there were 45 hemo-
dialysis centers in Canada, caring for 284
chronic patients. i Many of the smaller
centers are planning to expand in the near
future, and more hospitals are starting
dialysis programs. As in so many medical
specialties, there is a continuing need for
new, trained personnel. Since most
schools of nursing do not include dialysis
nursing in their curricula, it is the res-
ponsibility of each unit to train its own
staff. Some do this with on-the-job,
apprentice-type training; other hospitals
send their nurses to a larger center,
usually in the United States, for more
formal training. A committee of the
Canadian Society of Extra-Corporeal Cir-
culation Technicians (CanSECT) has been
assigned the task of setting up formal
training programs in English and in
French to provide adequate nursing and
technical personnel for Canada's dialysis
THE CANADIAN NURSE 35
Head nurse (right) helps Lynne Patterson,
a new nurse in the artificial kidney unit,
to hang up a unit of sedimented cells
during dialysis. Early in their orientation,
new staff learn to set up and monitor the
machines and to be responsible for the
technical aspects of dialysis.
centers.
The nurse who is interested in research
will find many challenges in this field.
Many centers are now doing transplanta-
tion as well as chronic dialysis, and
nephrologists and surgeons are actively
involved in transplant evaluation and re-
search. The nurse who is willing to spend
the time and effort to gather statistics
and to review patient files and profession-
al literature can be a great help to the
physician. At the same time she develops
new skills and interests of her own, which
make her work more interesting and
allow her to grow professionally. Her
perspectives broaden and she can take a
long-range look into the future, rather
than dwelUng on the day-to-day frustra-
tions and disappointments.
More and more dialysis-oriented litera-
ture is appearing in the scientific journals.
In addition, professional organizations,
such as CanSECT and the Ontario Dial-
ysis Association, have been set up to
provide information and service. These
will become more active and more in-
fluential as hemodialysis and kidney
transplantation become more common.
The future of hemodialysis is uncer-
tain. Almost every center operates at
capacity and many have patients waiting
for openings to go onto the program.
Some hospitals are setting up home dial-
ysis programs, where the patient is train-
ed at the center to perform his own
dialysis with the help of a relative and his
family doctor. A mini-unit is then set up
in his home, and the bed space in the
hospital becomes available to train an-
other patient. Because of the limitations
36 THE CANADIAN NURSE
of space and funds, this may prove the
most effective system. Transplantation
will become more common and more
successful as methods are found to pre-
vent the rejection of the graft. This too
will ease the strain on the hospital dialysis
center.
Summary
An introduction to hemodialysis nurs-
ing has been presented, describing the
procedure and outlining certain criteria
for the nurses. This is a relatively new
specialty in medicine and is expanding
rapidly. It provides opportunities that
general bedside nursing does not, but at
the same time it places many more
demands on the nurses. Maclean, Creigh-
ton, and Herman summarized the situa-
tion in an article written 1 1 years ago.
Chronic dialysis was not being carried out
then, but their words express what this
writer has tried to say.
"Ideally, the nurse who works on the
renal laboratory and artificial kidney unit
team should devote her full working time
to it. Many more nurses need to be
trained for this work .... Only in this
way will they gain the familiarity and
experience to work with maximum effi-
ciency, competence, speed, and ease as
team members. While the hours may be
long and somewhat uncertain . . . there is
a very real satisfaction in the work. "2
References
1. Survey conducted in April, 1969 by Baxter
Laboratories of Canada Ltd. Personal com-
munication.
2. Maclean, M.M., Creighton, H., and Herman,
L.B. Hemodialysis and the artificial kidney.
Amer. Jour. Nurs. 58:12:1672, Dec. 1958.
Bibliography
Albers, J. Evaluation of blood volume in
patients on hemodialysis. Amer. Jour. Nurs.
68:8:1677, Aug. 1968.
Baltzan, R.B. Glomerulonephritis. Canad. Nurs.
62:8:45, Aug. 1966.
Bois, M.S., Barfield, N.B., Taylor, C.E., and
Ross, CD. The patient with a kidney
transplant. Amer. Jour. Nurs. 68:6:1238,
June 1968.
Brand, L. and Komorita, N.I. Adapting to
long-term hemodialysis. Amer. Jour. Nurs.
66:8:1778, Aug. 1966.
Qunie, G.J. A. Intermittent hemodialysis in the
treatment of chronic renal failure. Nurs.
Mirror, 27 May 1966, p.i.
Dossetor, J.B. Present status of renal transplant-
ation. Canad. Nurse 63:10:32, Oct. 1967.
Fellows, B. Hemodialysis at home. Amer Jour.
Nurs. 66:8:1775, Aug. 1966.
Hampers, C.L. and Schupak, E. Long-Term
Hemodialysis. New York, Grune and Strat-
ton, 1967.
Maclean, M.M., Creighton, H., and Berman,
L.B. Hemodialysis and the artificial kidney.
Amer Jour Nurs. 58:12:1672, Dec. 1958.
Nesbitt, L. Nursing the patient on long-term
hemodialysis. Canad. Nurs. 63:10:40, Oct.
1967.
Shaldon, S. Chronic Renal Failure. Nurs. Mir-
ror, 13 Mar. 1964, p.i.
Schreiner, G.E. and Maher, J.F. Uremia: Bio-
chemistry, Pathogenesis and Treatment.
Springfield, 111., Charles C. Thomas, 1961.
Wood, S. Hemodialysis in the home. Canad.
Nurs. 65:4:42, April 1969.
D
DECEMBER 1969
Parents participate in care
of the hospitalized child
A study conducted at The Hospital for Sick Children in Toronto shows that the
amount of care a parent is willing to give the hospitalized child depends
on the age of the child, the nurses' attitude toward the parents' help, and whether
or not the parents were born in Canada.
E. Mae MacDonald
Recently an immigrant mother whose
son was a patient at The Hospital for Sick
Children, Toronto, was heard to say,
"When my other boy had operation here
five years ago, he cry every time I leave.
This boy no cry. For him I wash, feed,
bandage. He no cry. I like better." This is
the kind of conversation you hear as you
walk down some of the corridors of the
hospital.
Four years ago, members of the hospi-
tal staff realized that parents could share
in the care of their children. To allow
this, visiting time was increased from four
hours each afternoon to nine hours daily,
from 11:00 a.m. to 8:00 p.m.
The question then was, "What can
parents do to help? " There were other
questions we wanted answered: What did
nurses believe the parents could do for
their children? What did parents believe
they were capable of doing? What were
the differences of opinion between nurses
and parents? Was there any difference in
the response of Canadian-bom parents
and foreign-bom parents? How did the
age of the child affect the amount of
parental care offered?
To find the answers, we conducted a
study in which we interviewed and ob-
served 76 parents whose children had
Mrs. MacDonald, a graduate of the Atkinson
School of Nursing, Toronto Western Hospital,
was Assistant Surgical Coordinator of family-
centered care at The Hospital For Sick Chil-
dren, Toronto, at the time of writing.
been admitted to the cardiac, neurosur-
gical, and ear, nose, and throat units; to
the general surgical wards, including or-
thopedic, urological, and plastic surgery;
and to units where children were isolated
because of bums and surgical infections.
Fifty of these parents were Canadian-
bom; 26 were bom outside Canada. Of
the latter, 11 had lived in Canada less
than 10 years.
We hoped that our findings would
encourage the staff to accept the help of
parents and to realize that the parent is
the key to continuity in the child's care.
Methods used
To make sure the nursing staff under-
stood the study, 1 explained its purposes
and methods to the head nurses and
asked for their suggestions on family care
of the child in hospital. In conferences
with ward staff members, I encouraged
their cooperation and invited their opin-
ions.
I chose the parents for the study at
random. When I first met them, I explain-
ed the background and purpose of the
study, and how they could help. Al-
though they wished to help, many par-
ents believed their contribution would be
limited. As soon as parents agreed to
participate, 1 notified the nurses who
were caring for the children involved.
The information gathered from the
parents included whether the child had
been in hospital before, and if so, where;
THE CANADIAN NURSE 37
the father's occupation; where the family
lived; whether the mother worked outside
the home; how often the parents could
visit the child; the number and ages of
brothers and sisters; whether the parents
had ever been patients in hospital; what
they did when they visited their child;
and whether they knew how long their
child might be in hospital.
Nurses and parents answered question-
naires, stating what the parents would be
willing and able to do for their child and
what assistance they would require. 1
summarized the nurses' and parents'
answers and recorded relevant sugges-
tions.
Finally, I observed what the parents
did for their child when they visited; the
attitude of the nurse toward the parents;
what the nurse thought about the par-
ents' help; and how much the nurse
encouraged the parents to do for their
child.
Parent participation varies
Of the 76 questionnaires completed by
the parents, 62(81 percent) were answer-
ed by the mother alone; 2 (3 percent)
were answered by the father alone; and
12 (16 percent) were answered by both
parents. Seventy-one nurses replied to the
questionnaire. Five did not answer it
because they believed they did not know
the parents well enough.
All parents said they would comfort
their child. Over 90 percent agreed to
38 THE CANADIAN NURSE
encourage their child to drink, to help
feed him, to undress him on admission,
and to entertain or play with him.
Canadian-born parents were more will-
ing to help care for their child than
parents bom outside Canada. At least 10
percent more Canadian-bom parents were
willing to take the child's temperature,
pulse, respirations, and blood pressure,
feed or bathe him in a croupette, go with
him to x-ray, and make his bed.
Parents born outside Canada, but re-
siding here for more than 10 years,
appeared less willing to participate in the
care of the child than parents who had
lived here less than 10 years. This was
particularly tme when this care involved
disciplining the child; taking his tempera-
ture, pulse, and respirations; feeding or
bathing him while an intravenous was
mnning or while he was in a croupette;
going with him to the operating room;
obtaining a urine specimen and keeping a
record of elimination; and making his
bed.
The activities in which parents living in
Canada less than 10 years would partici-
pate were mainly those of a mothering or
protective nature, such as setting limits
on the child's behavior, encouraging him
to drink fluids, vmdressing him on admis-
sion, feeding or bathing him with ari
intravenous mnning or while he was in a
croupette, holding him for the doctor's
examination, going with him to x-ray,
and giving him oral medications.
A few nurses thought that parents who
had resided in Canada less than 10 years
could help more. When parents and child
shared another language, nurses left more
of the care to the parents. During the
study some nurses did not talk to the
parents if they beHeved, often incorrect-
ly, that they did not speak English.
Parents and nurses disagree
Nurses and parents differed in their
opinion on the care parents could give
their child. Of 320 disagreements that
arose between parents and nurses, 2.2
percent occurred with parents of children
up to the age of 23 months; 40.3 percent
in the two-to-five-year-old group; 34.4
percent in the six-to- 10-year-old group;
and 23.1 percent with parents of children
1 1 years and older.
Most parents were willing to help more
than nurses were wiUing to let them,
particularly with suctioning; percussing
the chest to facilitate drainage; changing
dressings; taking blood pressure, tempera-
ture, pulse, and respiration; and restrain-
ing the child during painful procedures.
The investigation showed that nurses
usually accepted help offered by parents,
and that the nurses believed parents of
children under five would do more for
their child if encouraged to do so. Howev-
er, although parents and nurses agreed
that these parents could do more in their
child's care, they disagreed on what du-
ties the parents of children under five
DECEMBER 1969
,r
"^
4
V'
>- V
could share. Parents of six- to 10-year-
olds were more reluctant to undertake
the tasks that parents of the younger
children were willing to do, except re-
straining the child when necessary.
More parents of children in all age
groups were willing to give oral medica-
tions than nurses were willing to let them.
More nurses than parents thought parents
could feed or bathe a child in a croupette
in all groups except 1 1 years and older.
More parents, except those of six- to
10-year-olds, wished to help feed their
child, bathe him even when intravenous
was running, take him to the operating
room, and set limits to his behavior.
Information collected on surgical
wards showed that a high percentage of
parents and nurses disagreed on the par-
ents' ability and willingness to change
dressings. Parents were not as willing to
change dressings as might be expected,
considering that many of them would
have to change these dressings at home. A
few said they did not want to see their
child's recent wound. However, more
parents were willing to change dressings
than were nurses willing to allow them to
carry out this procedure.
Disciplining the child caused disagree-
ment among parents and nurses. Some
parents said the hospital was no place to
discipline a child, and others disciplined
their child only if his behavior concerned
them directly. Nurses sometimes were
reluctant to set limits for the child
DECEMBER 1%9
'W
y
because of possible reproach from par-
ents. A few nurses thought some parents
were too anxious and doting to discipline
the child.
More than one mother said she would
not make the child's bed or take him to
the toilet because the child saw this as the
nurse's function. Occasionally a child
would say: 'The nurse is supposed to do
that," or "I want my nurse to help me."
Some parents said they would not make
the child's bed because they would be
unable to make the bed the way the nuise
did.
Results of Study
Findings of this study are being used
in a pilot project, and results will be
assessed again in another year.
The most notable result of the study is
a more positive attitude toward parent
participation that has developed among
the nurses, showing they are aware of the
need for the parent to maintain ties with
the child.
The study shows that most parents
seem unaware of the effect of separation
on the child and the effect of their
participation in his hospital care. Hospital
staff perhaps could discuss this in com-
munity-parent organizations.
The nurses learned from parents who
added touches of warmth, bringing pho-
tographs of the family or pets, or leaving
a precious treasure. One mother brought
an old clock, which never did run. Some-
At The Hospital for Sick Children in
Toronto, parents are encouraged to help
the nurses in the care of their children.
These photographs show a mother help-
ing her child who is on a Stryker frame.
times a mother helped her child write
letters to his friends or thank-you notes
for gifts. Often she shared her attention
with other children who had no visitors.
Some nurses are still hesitant about
parent participation. Recently, however,
one nurse said: "At first I was skeptical
about the study. I thought it would
increase and complicate our work - and
sometimes it does. But it is so much more
gratifying to nurse the child who is secure
because his parents share his care."
Another nurse said, "It gives me the
opportunity to learn more about family
influences on my patient and to under-
stand his reaction to being in hospital.
Having the parents here is a great advan-
tage for teaching child health. I feel I am
really nursing." D
THE CANADIAN NURSE 39
Drug adverse reaction program
— and the nurse's role
The Canadian drug adverse reaction program is unique in that it depends on
members of all health professions for its effectiveness.
E. Napke, M.O.
Early in 1965 the Food and Drug
Directorate of the Department of National
Health and Welfare initiated a program
designed to collect and evaluate reports
of suspected drug adverse reactions.* The
prime intent of the program was to
develop some method and alerting system
that would detect or prevent another
thalidomide tragedy.
From the beginning, this program in-
corporated the concept that all members
of the medical and paramedical team
should participate^in the program ; other-
wise it would be ineffective. This ap-
proach is contrary to that used in other
countries, which usually depends on only
the medical profession for the reporting
of adverse drug reactions.
The drug adverse reaction reporting
program consists of two systems: the
"drug alert system" and the "evaluation
and research system." The drug alert
system, which is probably the key to drug
surveillance, is devised to warn or alert
personnel of possible problem areas of
suspected drug adverse reactions. The
evaluation and research system is design-
ed to investigate specific problems identi-
fied in the drug alert system by retro-
I>r. Napke is Medical Officer in Charge, Drug
Adverse Reaction Program and Poison Control
Program, Food and Drug Directorate, Depart-
ment of National Health and Welfare, Ottawa.
*An adverse drug reaction is defined as any
action or lack of action that is not of therapeu-
tic, diagnostic, or prophylactic benefit to the
patient.
40 THE CANADIAN NURSE
spective and prospective techniques.
Six aspects of the Canadian drug ad-
verse reaction program make it unique:
1 . our definition of a drug adverse reac-
tion; 2. formulation or trade-name orien-
tation; 3. pigeon-hole alert system; 4. in-
volvement of the whole parameter of
personnel in the medical team, from the
physician to the nurse, including pharma-
cists, dentists, and veterinarians; 5. de-
velopment of a food adverse reaction
program; and 6. a tie-in with the poison
control program — in other words, the
program can pick up information on the
interplay between chemicals and humans
with special emphasis on those chemicals
known as drugs.
As soon as a problem area is identified,
the next steps are automatic.
The key to the problem of drug
adverse reactions is to know when a
suspected drug adverse reaction actually
becomes a drug adverse reaction. This is a
difficult problem to solve. Other than
using the "rechallenge procedure," which
involves giving the suspected drug again
after a reaction and getting the same
response, most other methods of ap-
proaching the problem are by guess and
opinion. This is especially true in the case
of a single reported incident. Obviously,
the opinion becomes stronger and more
certain as the number of incidents increase.
A drug adverse reaction may result
from a combination of the suspected drug
and the diet or disease, or other chemicals
and drugs. In these cases, however, the
likelihood of one person seeing such a
combination often enough to reinforce a
suspected reaction is smjdl. If, however, a
DECEMBER 1%9
number of observers have similar suspi-
cions of adverse reactions to a specific
drug or formulation, the chances of sus-
pecting a reaction are greatly increased.
Basic to the alert system is the simple,
easy-to-complete Food and Drug 123
series of reporting forms and the more
complicated F&D 122 form. (See Figure I
for sample of F&D 123 form) The F&D
123 was specifically designed to be as
simple as possible to encourage the re-
porting of suspicions by medUcal prac-
titioners and paramedical personnel. This
form is distributed periodically to doc-
tors, dentists, veterinarians, coroners,
pharmacists, and some nurses.
To gather data to show cause-and-
effect relationship in each specific case of
suspected drug reaction would be costly
and time-consuming and would require
highly-trained personnel and adequate
facilities. However, the Canadian drug
adverse reaction reporting program does
pick up trends and, epidemiologically,
may show a cause-and-effect relationship
For FDD use
IN CONFIDENCE
To:
Drug Adverse Reaction Program
Food and Drug Directorate
Tunncy's Pasture, Ottawa
•NOTIFICATION OF SUSPECTED OR PROVEN
ADVERSE EFFECTS OF DRUGS
•INCLUDING SIDE EFFECTS. TOXICITY. IDIOSYNCRASY.
INTOLERANCE. ALLERGY. INCOMPATIBILITY ETC.
SUSPECTED DKUG
(Trade Nam«) (Indudinf
vaccine, anti-sera, etc.) [
X>ate drag administered:
Route and daily dotace
Suspected reaction
(Including — allefgic,
anaphylactic, etc )
(brief description of iua-
pected toxic side etrccts,
frequency and data if
poasible)
Please use reverse side
for concomitant therapy
and comments
If no other drugs used
please state.
Age, sex, height and
weight of patient
Patient's name or ioitiala I
From:
Name
Street
City
Signed-
Tiiktr
F fc D IJ3 (R 6T)
DECEMBER 1969
when dealing with large numbers of re-
ports.
It is considered medically wise and
scientific for the physician to be aware of
the adverse reactions to any drug he
prescribes and to know the severity and
frequency of these reactions. Only then is
he in a position to equate the safety-
therapeutic equation. The safety-
therapeutic equation is usually defined as
the equation that balances the known
degree of safety of a drug against its
therapeutic benefit for a patient.
At present we do not know how
common the common reactions are, or
whether "common" in Halifax is the
same as "common" in Vancouver, either
in type of reaction or frequency. It is
important for us to know how common
the common reactions are and whether
these reactions are increasing or decreas-
ing. If they are increasing or decreasing,
we should know why.
This is one reason why we are collect-
ing all cases of suspected and proven drug
adverse reactions, whether common or
otherwise, to all drugs, new and old. We
must know how common "common" is!
Chronic drug adverse reactions
Up to this point, most participants in
the program are concerned primarily with
acute drug adverse reactions. Chronic
reactions are also important and data
must be collected on them. Is there an
early warning symptom, such as rash or
headache, that heralds a full-blown dis-
ease one, two, or ten years later? Individ-
ually, members of the healing professions
would be lost in this type of data study.
However, if everyone contributes to the
study, the problem may be solved more
easily.
Sometimes a flash of insight occurs to
an observer, but the next case with a
similar situation may not appear for some
months, so the original flash of insight is
forgotten. However, if, at the time, the
suspected reaction is reported, the like-
lihood of matching with similar reactions
is greatly increased. It is in the interest of
the patient, medical and paramedical pro-
fessions, and pharmaceutical industry
that all suspicions of drug adverse reac-
tions are reported.
In addition to the alert system describ-
ed, we are now developing an alert system
based on computerized programs. The
difficulties we have encountered are not
unique; a number of other countries have
been computerizing their data for a num-
ber of years and are still in various
degrees of development.
Examples of recent adverse reactions
Up to now we have talked about
suspected drug adverse reactions and have
defined adverse reaction. However this
does not really describe the chain of
events that leads to recognition of a drug
adverse reaction. The following are two
recent examples of the simplicity and
complexity of a drug adverse reaction.
Recently, reports came from New Zea-
land and Australia about the drug diphen-
ylhydantoin sodium. It was observed that
a number of patients were showing signs
of toxicity or overdosage of diphenylhy-
dantoin. On investigation it turned out
that an excipient** in the formulation
had been replaced by another exci-
pient - a sugar. It now turns out that
this substitution increased the rate of
absorption and perhaps the amount of
the active ingredient - diphenylhydan-
toin - absorbed. This resulted in the
patient receiving a toxic dose although, as
far as the prescribing doctor was concern-
ed, the patient was still being given what
the physician considered a therapeutic
dose of the active ingredient.
Of course the classic example is that of
the monoamine oxidase inhibitors
(MAO). These drugs were used to elevate
the mood in various depressions.
Several years ago, letters to the editor
appeared in the British medical journals,
first associating the monoamine oxidase
inhibitors with severe headaches, hyper-
tension, and cerebrovascular accidents.
The letters then began to indicate that in
addition to the monoamine oxidase in-
hibitors, certain types of cheese were also
involved.
Laboratory analysis of certain aged
cheese showed that they contained pres-
sor amines and that it was the combina-
tion of the monoamine oxidase inhibitors
and cheese containing pressor amines that
resulted in headaches and occasional cere-
brovascular accidents. It was not long
**An excipient is defined in Borland's Medical
Dictionary as: any more or less inert substance
added to a prescription in order to confer a
suitable consistency or form to the drug.
THE CANADIAN NURSE 41
Dr. E. Napke, Medical Officer in Charge of the federal government's Drug Adverse Reaction
42 THE CANADIAN NURSE
andFoison Control Program.
DECEMBER 1969
after this that certain wines, pickled
herring, chicken Hvers, and certain cold
remedies were found to contain pressor
amines in amounts to account for the
symptoms described.
Another typ>e of reaction involved
alcoholic patients and tolbutamide. It was
found that tolbutamide is metabolized
faster in alcoholic persons than in non-
alcoholics. Thus, there is a need for more
specific control of the alcohohc patient.
How many more chemicals are there
whose therapeutic value is modified by
the state of the patient, who might be
alcoholic, addicted, or a chronic smoker?
Then, again, several chronic diseases
are often treated concomitantly, so a
patient may be receiving tolbutamide for
one condition and receiving phenylbuta-
zone for another. Unfortunately, it was
found that somewhere and somehow in-
side the body these two chemicals inter-
react, resulting in an increased hypoglyce-
mic response to tolbutamide. Hence the
diabetic patient is out of control.
The list is ever increasing. The first
example was that of a drug adverse
reaction resulting from a formulation
change; the second, an interreaction be-
tween a drug and a food; the third, a drug
and the state of the patient; and the
fourth, an interreaction resulting from
specific therapy for two different diseases
within the same patient. The problem will
continue as each new chemical is added
to the environment of man.
Who discovers drug adverse reactions?
The first suspicion can come from any
source - nurse, physician, pharmacist,
nutritionist, veterinarian, or layman. Un-
fortunately, some time may elapse before
a definite cause-and-effect relationship is
proven.
The role of the physician in the
reporting of cases of suspected drug
adverse reactions is evident. The pharma-
cist can make two major contributions:
1 . He is possibly the only person who
has any knowledge of the sale, distribu-
tion, and medical complaints concerning
over-the-counter products and is in a
good position to ascertain whether the
patient is receiving drugs from a number
of physicians, or is self-medicating. This
type of situation is complicated, but he
should be able to report to us his suspi-
cions following the complaints of some of
DECEMBER 1%9
his customers. Also, he can relate his
suspicions to the prescribing physician.
2. The role of the hospital pharmacist
is dictated by the poHcy of the hospital
concerned. The pharmacist is in a unique
position to tabulate and collate the
amount and types of drugs prescribed for
any one patient, not only in the hospital
setting but also in the outpatient depart-
ment. In other words, he is aware of the
flow of drugs in and out of the hospital as
well as the specific patients involved with
these drugs.
The role of the veterinarian is unique.
Often identical drugs are used to treat
animals and man for diseases that are
similar as well as dissimilar. Because these
drugs may be used in a more heroic
manner in animals than in man, the
veterinarian can often pick up suspected
drug adverse reactions early.
Often a large number of animals are
treated at one time; this can lead to good
epidemiological evidence for cause-and-
effect relationships between the particu-
lar product, the animal, and the disease.
Role of the nurse
The previous outline gives some of the
background, philosophy, and hardware of
the system as well as the role played by
the nurses' coworkers in the reporting of
suspected adverse drug reactions. What,
then, is the role of the nurse?
The nurse is in a position to play an
important role, whether she works in the
physician's office or on the hospital ward.
She should take note of each prescription
change and find out why the change was
made. Was it because of some adverse
reaction, such as a rash, diarrhea, hiccups,
loss of appetite, change in personality,
failure of the drug to live up to its
therapeutic claims? Or was there some
other reason? She should then ask the
physician in charge whether she should
send a report to the pharmacy and
therapeutics committee in the hospital.
Sometimes the physician may wish to
make the report himself. In this case the
nurse can remind the physician at the
time of the patient's release from hospi-
tal.
Often the first signs or symptoms of a
drug adverse reaction are noted in the
nurse's reports, only to be overlooked by
the physician. A system should be set up
in hospitals to investigate nurses' suspi-
cions ot drug reactions. The occurrence
of a rash does not always mean that the
penicillin administered to the patient
caused it. On the contrary, it could be
due to any other drug given singly or in
combination, as well as the usual differen-
tial diagnosis for a rash. Drugs, excipients,
foods, fluids, and so on, are all chemicals
and can act with or in replacement of the
chemicals of the body on each other.
The nurse must be alert to suspected
drug adverse reactions. The hospital
nurse, in particular, should keep in mind
the possibility of drug adverse reactions
with any "happening" that does not go
with a particular patient and his disease.
These "happenings" can include; 1. a
change in signs or symptoms; 2. the
onset of new signs and symptoms;
3. laboratory findings; 4. psychic
changes and fetal abnormalities.
The most obvious "happenings" are
personality and mood changes, changes in
level of consciousness, skin changes, chan-
ges in appetite and gastrointestinal func-
tion, facial changes, and deviation from
the normal sleep pattern, energy, and so
on. The nurse informs the physician of
any change and then asks whether he
should forward the report of the suspect-
ed adverse reaction. These reports usually
are sent to the pharmacy and therapeutics
committee of the hospital, but if there is
not such a committee, either the nurse or
the physician should report directly to
the Food and Drug Directorate in Otta-
wa. It is hoped that the pharmacy and
therapeutics committees will forward all
reports that they receive to us.
Reports received are all reviewed at
the Food and Drug Directorate and cod-
ed. Then they are readied for a possible
alert concerning that particular drug.
Bibliography
Napke, E. Drug adverse-reaction alerting pro-
gram. Carwd. Pharm. J. 101:7:17-20, July
1968.
Napke, E. A drug adverse reaction alerting
program. Carwd. Fam. Phys. 14:5:65, May
1968.
Napke, E. and Bishop, J. The Canadian drug
adverse reaction reporting program. CMAJ
95:25:1307-1309, Dec. 17, 1966. D
THE CANADIAN NURSE 43
research abstracts
Tissington, F. Claire. An exploratory
study of the relationship between
physical and social-psychological dis-
tance and nurse-patient verbal interac-
tion. Montreal, 1969. Thesis
(M.Sc.(App.)), McGill University.
An exploratory study of the relation-
ship between physical and social-psy-
chological distance and nurse-patient ver-
bal interaction was carried out on the
maternity ward of a 265-bed general
hospital. Data was collected in 100 ob-
servations of nursery nurses interacting
with mothers during the infant feeding
period. The observer used interaction and
physical distance check lists to record
observations. Nurses completed question-
naires designed to measure theii percep-
tion of individual patients.
Findings indicated that the amount of
the nurse's verbal interaction was related
to the nurse's perception of the patient
and the patient's days postpartum, parity,
method of infant feeding, age, socio-
economic status, and nationality. Results
suggest imphcations for patient-assign-
ment and parent and nursing education,
as well as areas for further research.
loseph, Mary. Effectiveness of clinical
instructors as perceived by nursing
students. London, Ont., 1968. Thesis
(M.Sc.N.) U. of Western Ontario.
While evaluation of students is practic-
ed continuously in most educational pro-
grams, teacher evaluation is given little
consideration in many areas. This study
was designed to determine the effective-
ness of teachers in promoting the learning
of nursing students in the clinical area of
a hospital as perceived by their students.
A total of 11 instructors from two
university schools of nursing, one in
Ontario and the othe; in Quebec, was
rated by nursing students of the four-year
baccalaureate program. A rating scale for
clinical instruction, fashioned after the
Purdue rating scale for instruction,* was
used in obtaining student ratings and it
included 10 items from the Purdue rating
scale for instruction. A pilot study de-
monstrated the usability of the rating
scale for clinical instruction.
Wide variations were seen in the results
of individual teachers rated irrespective of
their age, educational background and
experience. Mean average of ratings on
each item was computed for schools A
and B. A definite correlation was observ-
ed between the rankings of the mean
44 THE CANADIAN NURSE
averages of schools A and B on items one
to 16 but a significant difference was
noticed between the two rankings for
items 17 to 30. The item which scored
the highest mean average for both the
schools was concern for patients' welfare,
and that which scored the lowest mean
average was presentation of subject mat-
ter. Interest in subject, personal appear-
ance, and knowledge of nursing practice
were the next items which scored higher
mean averages. Items such as fairness in
grading, liberal and progressive attitude,
sense of proportion and humor, personal
characteristics, stimulating intellectual
curiosity, and counselling scored compar-
atively lower mean averages.
The concept of teacher effectiveness
md the importance of teacher evaluation
are explored. Possible conclusions and
implications from the literature and from
this study, which might bear on the
practice of teacher evaluation and im-
provement of instruction in nursing edu-
cation are drawn. Certain ideas evolved
from the study for future research are
suggested.
Perry, Susan. Relationship between atti-
tude and person-centeredness of nurs-
ing care Boston, 1969. Thesis
(M.Sc.N.) Boston University.
This study was undertaken to identify
the relationship between nurses' attitudes
toward physically disabled persons and
the person-centeredness of their responses
to patients with a specific physical dis-
ability.
The sample consisted of 30 registered
nurses employed on surgical units in two
large general hospitals. The study tools
were a standardized attitudinal scale, atti-
tude toward disabled persons (ATDP) and
a modification of the response to patient
inventory. The inventory consisted of 15
simulated nurse-patient interaction situa-
tions in which a female patient who
recently had a mastectomy directed a
statement or question to the nurse. The
interaction situations were sub-divided
into three categories according to the
type of feeling expressed by the patient
in the situation. The nurses' written
responses were categorized along a con-
tinuum from person-centered, to person-
positive, to neutral, to non-person-center-
ed.
There was a significant relationship
between the nurses' attitude toward
physically disabled persons and the
person-centeredness of their responses to
the patients. The Spearman's coefficient
of rank order correlation between the
two scales was .65. The respondents were
consistent in their responses regardless of
the type of feeling expressed by the
patient. The nurses gave person-positive
responses most frequently. Most of the
respondents gave a disproportionately
large number of person-positive responses
to situations in which the patient express-
ed feeUngs of conflict or irritations over
enforced dependency or submission. Situ-
ations in which the patient expressed
feelings of danger for her self-regard,
self-esteem, or standing in the eyes of
significant others elicited the greatest
number of negative responses. The nurses
responded most positively to situations in
which the patient expressed feelings of
danger for her survival. The differences in
the responses to the three categories of
situations were related largely to the type
of feeling being expressed rather than to
the attitude of the respondents to phys-
ically disabled persons.
MacLeod, Ella, and Gill, Sister Catherine.
A study of the needs of graduates
from two year diploma nursing pro-
grammes in Canada. Boston, 1968.
Thesis (M.Sc.N.) Boston U.
The primary purpose of this study was
to gain some insight and knowledge into
the needs of graduates from two-year
diploma nursing programs in the first
three months of employment. An at-
tempt was made to determine the grad-
uates' needs specifically in the perform-
ance of nursing and management skills, as
general staff nurses. The basis for justifi-
cation of the study was an awareness that
nursing service personnel should be pre-
pared to meet the needs of these gradu-
ates when first employed.
The review of literature revealed a
trend toward shortened diploma nursing
programs in Canada. Though many arti-
cles have been written and studies done
on graduates of shortened programs in
the United States, the investigators found
only a limited number of studies on
graduates from Canadian programs. In
view of the trend toward shortened pro-
grams, it was thought advantageous to
conduct further research in this area.
A questionnaire was structured to elic-
it the amount of guidance 25 selected
graduates required in the performance of
certain nursing and management skills
during the first three months of employ-
DECEMBER 1%9
ment. Data were also obtained to deter-
mine the graduates' ability to transfer
knowledge of principles and meet emer-
gencies, and to determine their speed and
dexterity in carrying out nursing proce-
dures.
This questionnaire survey cannot be
considered a completely valid evaluative
tool because of the many intervening
variables. The most significant was the
length of time that elapsed between the
end of the third month of employment
and the time the head nurses completed
the questionnaires. The results of the
study, however, do reveal some signifi-
cant information regarding the amount of
guidance the graduates required for spe-
cific skills.
The findings in the section marked
"unknown," gave cause for considerable
reflection. One wonders why there was
such a high percentage of activities about
which the head nurses were ignorant of
the amount of guidance the graduates
needed. These unknown areas could con-
tain specific needs that were not revealed
in the study.
The analysis of data revealed that
two-thirds of the nurses required the
most guidance in management skills re-
lated to indirect care of the patients. The
skills with which the nurses needed the
most guidance were: organizing activities
on 3-11 shift, establishing priorities in
giving nursing care, interpreting doctors'
orders, and assuming the role of team
leader.
It was of interest to note that out of
25 nurses, only 3, or 12 percent, had not
had charge responsibilities on the 3-11
shift, or had not had experience as team
leaders. This would seem to indicate that,
at least in the hospitals employing the
nurses studied, the graduates of two-year
diploma programs are expected to assume
the role of team leader and are assigned
to the 3-11 shift within the first three
.months of employment.
Additional information obtained from
the study suggested that the nurses need-
ed help in the application of theory to
practice. This would seem to be a normal
need of a young practitioner in any field.
These nurses also exhibited another char-
acteristic common to most young practi-
tioners: they were slow in completing a
workload. The study also revealed that
over 50 percent of the nurses required
help in meeting emergencies.
MacKay, Ruth C. Effects of interpersonal
difference, social distance, and social
environment on the relationship be-
tween professionals and their clientele.
Lexington, 1969. Thesis (Ph.D.) U. of
Kentucky.
People in the helping professions must
invariably depend upon interpersonal
communication with their patients or
clients if they are to render appropriate
DECEMBER 1%9
assistance, and social distance is a crucial
element in this communication process. It
is the thesis of this study that social
distance in professional-client relation-
ships is determined by norms in the social
situation and by psychological variables
associated with the personalities of both
the professional and the client or patient.
Some social distance is assumed to be
functional in supporting the asymmetric
relationship typical of and necessary to
the helping professions. On the other
hand, too much distance may hamper the
relationship, obstructing the profes-
sional's assessment of the client's or
patient's condition, or impeding the re-
habilitative process.
Nine determinants of social distance
are examined in the nurse-patient rela-
tionship, as one example of profes-
sional-client relationships. Differences in
age, sex, race, and social class between
nurses and patients were studied as socio-
cultural factors. In addition, humanitari-
anism, professional motivation, and
opinionation (the chosen personality va-
riables) were measured in the nurse popu-
lation. The nurse-patient relationship was
studied both in a hospital and in an
outpatient clinic to determine the effects
of environmental variables; and the in-
fluence of time and duration was con-
trolled by limiting the study to the first
meeting of nurse and patient and to the
taking of a nursing history.
The study population consisted of
nursing students three months from grad-
uation in a collegiate nursing program and
regularly admitted patients in a university
medical center. Transcripts of 37 taped
interviews provided the data for measur-
ing social distance and effectiveness of
communication. Race had to be deleted
from the study as only five suitable Negro
patients were available. Multiple correla-
tion analysis failed to indicate any signifi-
cant correlations between differences in
age and in social class, humanitarianism,
opinionation, or professional motivation.
However, sex differences correlated
moderately and in some instances mark-
edly with social distance and with ef-
fectiveness of communication. There are
also distinct differences in social distance
and effectiveness of communication be-
tween the hospital and the cUnic setting.
In particular, social distance was greater
and the effectiveness of communication
less with opposite-sex participants in hos-
pital, but in the clinic the findings were
reversed. In addition, the length of the
interview, which ranged to a maximum
given limit of 30 minutes, correlated
inversely with social distance and positiv-
ely with the effectiveness of communica-
tion.
Two explanations of the sex difference
findings are offered. It is possible that the
nurses (all female) in general relate better
to males than to females, and it is the
awkward and intimate encounter with
hospitalized males who are in bed that
masks the more fundamental preference
female nurses demonstrate for males.
Secondly, it may be that the nurses
usually relate more closely to hospitalized
patients since they have been more fully
socialized into the role of the nurse in the
hospital than in other treatment environ-
ments, and it is the socially devalued
dependency of hospitalized males that
creates the reversal of findings in the
hospital situation.
Pringle, Dorothy M. The use of a concep-
tual model to evaluate psychiatric
nursing therapy. Colorado, 1968.
Thesis (M.S.) Univ. of Colorado.
This study was designed to construct a
conceptual model for short-term psychi-
atric nursing therapy to help the nurse
systematically identify and evaluate her
work with patients. Three central ques-
tions were examined in the study, name-
ly: 1. What are the strengths and limita-
tions of the model? 2. Is the model
helpful in identifying the phases and
process of nursing therapy? 3. Is the
model useful in evaluating the nurse's
work with patients?
A methodological research approach
was used in the study. The investigator
worked with three patients in a mental
health clinic. A conceptual model was
developed by the investigator to examine
systematically her work with these pa-
tients.
This model, which was constructed
through the process of study and revision
and under the guidance of a specialist in
psychiatric nursing therapy, has three
main phases of therapy, namely, the
initiating phase, the intensive treatment
phase, the concluding phase, and 10
sub-phases. Selected principles of cyber-
netics and concepts of short-term psycho-
therapy were used as a conceptual frame-
work in developing the model. After the
model was developed, it was independ-
ently tested by three clinical specialists in
psychiatric nursing in relation to the
three questions stated above. The special-
ists analyzed 21 hours of nursing therapy
by classifying the content of the therapy
into specific categories.
The major findings of the study were
that the model had many strengths, in-
cluding a high percent of reliability when
used by different analysts; an appropriate
sequence of phases and sub-phases; and it
was easy to use. The limitations of the
model revealed a need for definitions of
the categories and other minor factors .
that were easily corrected by a revision.
The model was especially helpful in iden-
tifying the phases and process of therapy.
It was useful in evaluating how systemat-
ically the nurse was working with the
patient, and helped to identify areas in
which there was concentration or in
which there were omissions. D
THE CANADIAN NURSE 45
The
disposable
diaper
concept
What are its advantages?
In providing greater hospital convenience:
Polywrapped units are designed for one-day use, and
for convenient storage in the bassinet. Also, Saneen
Flushabyes do not require autoclaving — they contain
fewer pathogenic organisms at time of application
than autoclaved cloth diapers.*
Prefolded Saneen disposables eliminate time spent
folding cloth diapers in the laundry and before
application to the infant. Easier to put on baby.
Constant supply. Saneen Flushabyes eliminate need
for diaper laundering and are therefore unaffected by
interruptions in laundry operations.
Elimination of diaper misuse, which may occur with
cloth diapers. *The leRiche Bacteriology Study— 1963
More and more hospitals are changing to Saneen Flushabyes disposable diapers.
Write us and we will be glad to supply you with further information on clinical studies, cost analysis, and disposal techniques.
Use these and other fine Saneen products to complete your disposable program:
MEDICAL TOWELS, "PERIWIPES" TISSUE. CELLULOSE WIPES. BED PAN DRAPES. EXAMINATION SHEETS AND GOWNS.
In providing greater comfort and safety for
the infant:
More absorbent than cloth diapers, "Saneen"
FLUSHABYES draw moisture away from baby's skin, thus
reducing the possibility of skin irritation.
Facial tissue softness and absence of harsh laundry
additives help prevent diaper derived irritation.
Five sizes designed to meet all infants' needs from
premature through toddler. A proper fit every time.
Single use eliminates a major source of cross-infection.
Invaluable in isolation units.
"An Facdle Company Liroittd, 1350 Jane Street, Toronto 15,Ontario, Subsidiary ol Canadian International Paper Company c.^
6a-H4 "Saneen", "Flushabyes", "Peri-Wipes" Reg'd T.Ms. Facelle Company Limited
aneen
comfort • safety • convenience
Intensive NursingCare by Zeb L. Bunell,
and Lenette Owens Burrell. 298 pages.
Saint Louis, Mosby. 1969.
Reviewed by Maureen Bennett, Bead
Nurse, Intensive Care Unit, The Mon-
treal General Hospital, Montreal, P.Q.
Nursing the intensive care patient re-
quires wide knowledge of medical condi-
tions that lead to the patient becoming
critically ill. On many intensive care
units, inservice education for nurses has
been introduced to help staff assimilate
this knowledge more quickly and to
understand treatments more intelligently.
This book is compiled from lectures
given by medical staff to nursing person-
nel who work in an intensive care unit.
The book's strength lies in its clear
organization of subject matter. There are
sections on anatomy, physiology, pathol-
ogy, and therapy of common conditions
afflicting each organ system. Familiar
problems of congestive heart failure and
pulmonary emboli, as well as the rare
addisonian crisis and thyroid storm are
discussed.
One serious omission is that of 'shock';
nowhere is it treated as a distinct entity,
although it is the most common reason
for a patient's presence in an intensive
care unit. Also, the widespread advocat-
ed use of prophylactic antibiotics and
anticoagulants needs to be clarified.
Although some techniques limited to
larger centers - open heart surgery,
hemodialysis, emergency and elective
surgery in pulmonary embolus, and treat-
ment of severe burns — are omitted, this
book is well worth reading by nursing
staff of small hospitals and teaching
centers.
Associate Degree Nursing: A Guide to
Program and Curriculum Development
by Ann N. Zeitz, Leila D. Howard,
Elva M. Christy and Harriette Siming-
ton Tax. 207 pages. Saint Louis,
Mosby, 1969.
Reviewed by Joyce Nevitt, Director,
School of Nursing, Memorial Universi-
ty of Newfoundland, St. John 's, New-
foundland.
Rarely does one find so comprehensive
an approach to nursing education in so
few pages. This book fulfills the purpose
stated in the preface in lucid and concise
language. Not only does it provide a guide
to those who are plaiming two-year pro-
DECEMBER 1%9
grams in nursing in Canada, but it could
serve as a stimulus to experienced teach-
ers who are seeking new approaches to
teaching nursing as a process in any
program in nursing.
New teachers would welcome the
guides to plaiming preparation. Various
methods and tools of teaching are illus-
trated with examples based on sound
rationale.
A chapter that discusses interpersonal
relationships within and outside the col-
lege, and between faculty and students,
could serve as a basis for new teachers in
their orientation to their role in the
college.
The concept of a core curriculum is
well illustrated. The philosophy and ra-
tionale of each part of the curriculum
clearly show how the authors conceptual-
ize coordination of the total program.
Learning experiences, including specific
readings and audiovisual aids, are describ-
ed. These are preceded by specific objec-
tives and concepts for each unit. Day-by-
day projections of nursing content and
experiences and samples of student assign-
ments, including evaluation forms,
follow each unit.
The authors suggested five approaches
to nursing education. This is an example
of the flexibility of the book as a guide to
teachers. Adaptations can be made ac-
cording to the particular orientation of
the teacher, without losing sight of the
objectives of the total program. The
scientific and humanistic principles learn-
ed in related courses are noted. Preventive
aspects of health are included through-
out, particularly with respect to com-
munity health, nutrition, and mental
health and mental illness. A separate
chapter deals with mental health and
mental illness as an aid to identifying the
objectives and learning experiences. Re-
ference readings are timely and pertinent
to each unit.
Discussion of the teacher's dress may
be considered irrelevant, but new teachers
may appreciate reading different ar-
guments on what the teacher should wear
in the clinical area.
The book reinforces a coordinated,
total concept of nursing. The curriculum
The author of the text Essentials of
Nursing 2nd ed. (Toronto, W.B. Saunders
Company, 1969), which was reviewed in
the November 1969 issue, is Claire Brack-
man Keane.
is planned to teach nursing, not hospital
nursing. This book, however, is only a
guide and its value will depend on the
quality of the teachers who use it.
Nurses Technical Manual 1968-69 by
W.E. Broome, 100 pages. London,
Butterworth & Co., 1968. Canadian
Agent: Butterworth & Co. (Canada)
Ltd., Toronto.
Reviewed by J.M. Dawes, Director of
Nursing, Prince George Regional Hos-
pital, Prince George, B.C.
This soft-cover, well-illustrated, con-
cise manual published in Great Britain is
intended to familiarize nurses with the
types and uses of hospital equipment
currently available. Some of the material
is organized in relation to systems, (e.g.
respiratory, digestive). The clinical notes
interspersed throughout help the reader
understand the basic principles of applica-
tion of the equipment discussed.
A section devoted to diagnostic pro-
cedures gives the indications for such
tests and the normal range of values.
Equipment used in the prevention of
cross infection, and in drainage and
suction is also discussed. A comprehen-
sive bibliography is included.
This manual would be a valuable re-
ference to nurses in Great Britain, but its
usefulness to Canadian nurses is question-
able. Much of the equipment discussed is
not used on this continent or is known by
another name, although the diagrams may
help the reader to identify the count-
erparts in use here. The color coding of
gas cylinders is different than that used in
Canada and could, therefore, be danger-
ously misleading. There are variations in
the normal results of diagnostic tests
from those given in "Clinical Laboratory
Procedures" in The Canadian Nurse (Feb.
1969).
It is this reviewer's opinion that the
manual is, at best, of limited value to
nurses practicing in Canada.
Toohey Medicine for Nurses, edited by
Arnold Bloom 9th ed. Edinburgh, E.&
S. Livingstone Ltd., 1969. Distributed
by Macmillan Co. of Canada Ltd.,
Toronto.
Reviewed by Myrna Sherrard, Nurse
Clinician, The Moncton Hospital,
Moncton, New Brunswick.
(Continued on page 49)
THE CANADIAN NURSE 47
Our family has
Deen giving hope to theirs
for over 30 years.
'^ ifi^
/
^
uv
Dilantin
Supplied in various forms including Kapseals 0.1 Gm. and
0.03 Gm. diphenylhydantoin sodium; Delayed Action Kapseals
0.1 Gm. diphenylhydantoin; Infatabs ,50 mg. diphenylhy-
dantoin; Dilantin-12S Suspension, 125 mg. diphenylhydantoin
per 5 cc; Dilantin-30 Suspension, 30 mg.
diphenylhydantoin per 5 cc.
"^ Dilantin
with phenobarbita
Supplied in Kapseals containing 0.1 Gm. diphenylhydantoin
sodium with 'A groin phenobarbital and 0.1 Gm. diphenyl-
hydantoin sodium with Vz groin phenobarbital.
« Phelantin'
Each Kopseol conloins 1 00 mg. Dilantin, V2 grain phe-
nobarbital, and 2.5 mg. methamphetomine hydrochloride.
Celontin'
Each Kopseol contoins 0.3 Gm. methsuximide.
Zarontin'
Each soft gelatin capsule contains 0.25 Gm. ethosuximide.
Syrup contoins 0.25 Gm. ethosuximide per 5 cc.
Milontin'
Each Kopseol contains 0.5 Gm. phensuximide. Fruit-flavored
aqueous Suspension contains 300 mg. phensuximide per 5 cc.
Steri-Viar Dilantin
or parenteral use
Vials of 250 mg. and 100 mg. diphenylhydantoin
with special solvent.
Brochure supplying details of dosage, administration and side
effects available on request.
The First Family
of Anti-epileptics
(Continued from page 4 7)
The basic facts needed to understand
the nature and treatment of most of the
medical diseases that the nurse may en-
counter are presented clearly and concise-
ly in this text.
The table of contents and index are
detailed and enable the reader to find
specific information quickly. At the end
of many chapters there is a summary of
the most significant points, as well as a
summary of important drugs used and
routine procedures undertaken in relation
to the diseases discussed.
One chapter discusses important
drugs: their actions, uses, dosage, and
toxic effects. At the end of the book
there is a comprehensive list of all drugs
mentioned, their approved or chemical
names, trades names, and action on dis-
eases in which they are used.
There is an interesting chapter on
psychological medicine. The author con-
siders topics such as the psychological
development of the individual, psychoso-
matic medicine, the psychological effects
of illness, and the psychological role of
the nurse.
Although the sections on obesity, drug
addiction, and organ transplantation are
brief, sufficient valuable information is
presented to make inclusion of these
topics worthwhile.
There is a section that includes points
to remember on subjects such as the
patient as an individual, the nursing of
elderly patients, rest, noise, and the prob-
lem of the bedpan, diet, and smoking.
Throughout the text there are over
200 illustrations, colored photographs,
and original diagrams that help the reader
understand and remember some of the
more important facts.
This is a valuable reference book for
students and graduate nurses. It is easy to
read and should be understood without
difficulty. Q
accession list
PARKE-DAVIS
ACCESSIONS
The CNA Library, like most libraries,
does not send out loan material during the
Christmas mailing season. For this reason
there is no accession list this month. We
look forward to welcoming back all our
borrowers-by-mail in the New Year, and
in the meantime, best wishes for a Happy
Holiday Season. □
THE CANADIAN NURSE 49
STANFORD UNIVERSITY MEDICAL CENTER
a*?
Invites you to consider employnnent in one of the
nation's foremost Teaching hospitals. We would like
to tell you more about it and the opportunities of-
fered on the San Francisco Peninsula.
For additional information —
Name
Address;
City: State:
Service desired:
RHURN TO:
STANFORD UNIVERSITY HOSPITAL
PERSONNEL DEPARTMENT
300 PASTEUR DRIVE
PALO ALTO, CALIFORNIA 94304
Have a
rewarding
career in
foreign lands
Take our special course in tropical diseases
and related subjects. Graduates enjoy special
status, gain valuable experience overseas
where the need is great.
Open to graduate nurses, nursing assistants
and paramedical personnel. Comprehensive
19-week course commences in February &
September, 1970. Train in modern, fully-
equipped centre with attractive accommodation
for living in, located in Metropolitan Toronto.
Opportunities to earn while you learn.
For more information write to:
World-wide Health Service Course,
international
heaKh institute
4000 LesUe Street, WUowdale,
Ontario, Canada.
DO YOU
WANT TO HELP
YOUR PROFESSION?
Then fill out and send in the form below
REMITTANCE FORM
CANADIAN NURSES' FOUNDATION
50, The Driveway, Ottawa 4, Ontario
A contribution of $ payable to
the Canadian Nurses' Foundation is enclosed
and is to be applied as indicated below:
IVIEMBERSHIP (payable annually)
Nurse Member — Regular $ 2.00
Sustaining $ 50.00
Patron
$500.00
Public Member — Sustaining $ 50.00
Patron $500.00
BURSARIES $ RESEARCH $
MEMORIAL $ in memory of
Name and address of person to be notified of
this gift
REMIHER
Address .
Position .
Employer
(Print name in full)
N.B. CONTRIBUTIONS TO CNF
ARE DEDUCTIBLE FOR INCOME TAX PURPOSES
50 THE CANADIAN NURSE
DECEMBER 1969
EXPERIENCED SENIOR NURSES
needed for
Hospitals and Public Health Positions
Department of National Health and Welfare
Various Locations
HOSPITAL POSITIONS - (Nurse 3 and 4)
Directors and Assistant Directors of Nursing for 15 to
100 bed Hospitals located in Prairie Provinces,
Ontario and the Yukon and Northwest Territories.
Care and treatment of all residents of the Yukon and
Northwest Territories (including Eskimos) and Indians
in the Provinces.
PUBLIC HEALTH POSITIONS - (Nurse 4)
Area and Zone Nursing Officers. Offices located in
various centres in oil Provinces and the Yukon and
Northwest Territories. Field establishments may
include Out-post Nursing Stations, Health centres and
clinics, for generalized treatment and Public Health
Programs for all residents of the Yukon and the
Northwest Territories (including Eskimos) and Indians
in the Provinces.
SALARIES -
Until anticipated upward revisions are announced.
Nurse 3 $8,133 to $8,992
Nurse 4 $8,901 to $10,062
Additional allowances ore paid in isolated locations.
GENERAL QUALIFICATIONS
• Current Registration as a Nurse in a Province
of Canada
• Post graduate education in the specialty.
• Certificate in Administration or Supervision and
Teaching in Nursing.
• Acceptable experience; personal suitability.
Performance of the duties of some of the positions
to be filled requires proficiency in English while the
performance of the duties of the remaining positions
requires proficiency in French.
For further informatiort regard'mg the work write to:
Public
Service
of
Canada
The Personnel
Administrator
Medical Services
Division
DEPARTMENT OF
NATIONAL HEALTH
AND WELFARE
Ottawa, Canada
Application forms and details of current vaconcies within the
region of interest can be obtained by writing to the REGIONAL
OFFICE of the PUBLIC SERVICE COMMISSION OF CANADA in
VANCOUVER, EDMONTON, WINNIPEG, TORONTO, OHAWA,
MONTREAL, QUEBEC, SAINT JOHN (N.B.), HALIFAX or ST. JOHN'S
(NFLD.).
Dermop
Better than a
feather pillow for relief
from postepisiotomy
discomfort
Soothing anesthetic spray relieves postepisiotomy
surface pain and itching in seconds — without the
need for touching sensitive, affected areas — while
promoting healing and fighting infection. Also
provides quick relief from pain of postpartum
hemorrhoids.
Composition: Benzocalne: Benzethonium chloiide: Menthol. S-Hydro-
xyquinoline benzoate. and Methylparaben. dissolved in oils. Other indi-
cations: For immediate use in relieving pain, preventing infection, and
coating burns, surface wounds, lacerations, abrasions, minor operation
sites Administration: Hold can in a convenient position at least 12
inches away from affected area. Point spray nozzle and press button
forward Use two or three times daily, or as directed by the physician. A
sterile gauze dressing, saturated with spray, may be applied if thought
necessary Contraindication: Allergy to benzocaine Nets: Chemical,
acid or alkali bums should be washed ana neutralized before applying
DERMOPLAST, If dirt is present, spray with DERfVIGPLAST. then gently
wash away dirt with mild soap solution, rinse thoroughly and respray with
OERti^OPtj^ST. Warning: Keep away from eyes and mouth. Do not
apply to face while using oxygen resuscitator. Stains on synthetic fabrics,
such as nylon or rayon, are removable by laundering with a detergent
that does not contain bleach Supply: No 1001. in containers of 3 avdp
oz (Prescription Size), and 11 avdp oz (Hospital Economy Size) full
information available on request.
T.M. Reg'd.
fVEIvlBER
AYERST LABORATORIES.
Division of Ayerst, McKenna & Harrison Limited
Montreal. Canada
H
DECEMBER 1969
M-2299/2/69
THE CANADIAN NURSE 51
classified advertisements
ALBERTA
ALBERTA
BRITISH COLUMBIA
REGISTERED NURSES required for a Sl-bed
active treatment hospital, situated in east
central Alberta. Salary range Jan 1 to Aug 31 —
$450 to $535, Sep 1 to Mar 31, 1970 — $475
to $565, with full maintenance in new nurses
residence for $50 per month. Sick leave, holi-
days and working conditions as recommended
by the Alberta Association of Registered
Nurses. For further information kindly contact:
W.N. Sarachuk, Administrator, Elk Point Mu-
nicipal Hospital, Elk Point, Alberta.
ADVERTISING
RATES
FOR ALL
CLASSIFIED ADVERTISING
$11.50 for 6 lines or less
$2.25 for eocli additional line
Rates for display
advertisements on request
Closing dale for copy and cancellation is
6 weeks prior to 1st day of publication
month.
The Canadian Nurses' Association does
not review the personnel policies of
the hospitals and agencies advertising
in the Journal. For authentic information,
prospective applicants should opply to
the Registered Nurses' Association of the
Province in which they are interested
in working.
NEW
ADVERTISING
RATES
EFFECTIVE JANUARY I, 1970
FOR ALL
CLASSIFIED ADVERTISING
$15.00 for 6 lines or less
$2.50 for each additional line
Address correspondence to;
The
Canadian ^
Nurse "^
REGISTERED NURSES FOR GENERAL
DUTY In a 34-bed hospital. Salary 1968,
$405-$485. Experienced recognized. Residence
available. For particulars contact: Director of
Nursing Service, Whitecourt General Hospital,
Whitecourt, Alberta. Phone: 778-2285.
BASSANO GENERAL HOSPITAL REQUIRES
NURSES FOR GENERAL DUTY. Active
treatment 30-bed hospital in the ranching area
of southern Alberta. Town on Number 1
trans-Canada Highway mid-way between the
cities of Calgary and Medicine Hat. Nurses on
staff must be willing and able to take
responsibility in all departments of nursing,
with the exception of the Operating Room.
Single rooms available in comfortable residence
on hospital grounds at a nominal rate. Apply
to: Mrs. M. Hislop, Administrator and Director
of Nursing, Bassano General Hospital, Bassano,
Alberta.
GENERAL DUTY NURSES for active, ac-
credited, well-equipped 65-bed hospital in grow-
Ina town, population 3.500. Salaries range from
$465 - $555 commensurate with experience,
other oeneiiis. I'gurses' residence, txcellent per-
sonnel policies and working conditions. New
modern wing opened in 1967. Good communica-
tions to large nearby cities. Apply: Director of
Nursing, Brooks General Hospital, Brooks. Al-
berta.
GENERAL DUTY NURSES (2) for small,
modern hospital on Highway no. 12, East
Central Alberta. Salary range $477.50 to
$567.50 including regional differential.
Residence available. Personnel policies as per
AARN and A.H.A. Apply to: Director of
Nursing, Coronation Municipal Hospital,
Coronation, Alberta.
GENERAL DUTY NURSES for 94-bed General
Hospital located in Alberta's unique Badlands.
$405— $485 per month, approved AARN and
AHA personnel policies. Apply to: Miss M.
Hawkes, Director of Nursing, Drumheller Gene-
ral Hospital, Drumheller, Alberta.
GENERAL DUTY NURSES (3) required for
32-bed active hospital. Starting salary $500 to
$600 per month, plus $25 northern allowance.
Room and board $50. Pleasant working condi-
tions. Apply to: Matron, St. Theresa Hospital,
Fort Vermilion, Alberta.
GENERAL DUTY NURSES for 64-bed active
treatment hospital, 35 miles south of Calgary.
Salary range $405— $485. Living accommoda-
tion available in separate residence If desired.
Full maintenance in residence $50.00 per month.
Excellent Personnel Policies and working condi-
tions. Please apply to: The Director of Nursing,
High River General Hospital, High River, Alber-
ta.
GENERAL DUTY NURSES required for a
34-bed general hospital located In northern
Alberta. $465 to $555 per month, plus $15
differential. Experience recognized. Residence
available. For particulars, contact: Director of
Nursing, Manning Municipal Hospital, Manning,
Alberta. Phone: 836-3391.
GENERAL DUTY NURSES are required by a
230-bed, active treatment hospital. This is an
ideal location in a city of 27,000 with summer
and winter sports facilities nearby. 1968 salary
schedule $405 — $485. 1969 schedules present-
ly under negociation. Recognition given for
previous experience. For further information
contact: Personnel Officer, Red Deer General
Hospital, Red Deer, Alberta.
GENERAL DUTY NURSING POSITIONS are
available in a 100-bed convalescent rehabilitation
unit forming part of a 330-bed hospital complex.
Residence available. Salary 1967 — $380 to
$450 per mo. 1968 — $405 to $485. Experience
recognized. For full particulars contact Director
of Nursing Service, Auxiliary Hospital, Red Deer,
Alberta.
50 THE DRIVEWAY
OTTAWA 4, ONTARIO.
BRITISH COLUMBIA
SUPERVISORS and GENERAL DUTY
52 THE CANADIAN NURSE
NURSES for 50-bed acute care hospital 60
miles west of Prince George, B.C. Intensive
care/emergency unit planned with correlated
Inservice program. New hospital approved for
1970-71. RNABC contract In effect. Residence
accommodation provided at minimal rate.
Friendly, informal atmosphere, with opportuni-
ty to advance professionally. Write to: Director
of Nurses, St. John Hospital, Vanderhoof, B.C.
"OBSTETRIC NURSING INSTRUCTOR — to
conduct a concurrent program in a school of
nursing in a 450-bed hospital with a family
centred maternity unit. Requirements: B.S.N. ,
degree; experience in obstetric nursing; registra-
tion in B.C. Attractive personnel policies.
Salary $643. - $788. Apply — Director of
Nursing, Royal Columbian Hospital, New West-
minster, B.C."
COME TO PACIFIC NORTHWEST — Gateway
to Alaska, Friendly community, enjoyable
Nurses' Residence accommodation at minimal
cost. RNABC contract in effect. Salaries — Re-
gistered $508 to $633, Non-Registered $483,
Northern differential $15 a month. Travel allow-
ance up to $60 refundable after 12 monthsserv-
ice. Apply to: Director of Nursing, Prince Rupert
General Hospital, 551-5th Avenue East, Prince
Rupert, British Columbia.
GENERAL DUTY NURSES (2) required for
New Modern Hospital designed with the Friesen
Concept of Supply — Distribution. Acute Unit
75-beds. Extended Care Unit 35-beds. RNABC
policies in effect. Hospital located in the
t>eautiful East Kootenays. Apply to: Director
of Patient Care, Cranbrook and District Hos-
pital, Cranbrook, B.C.
GENERAL DUTY NURSES for new 30-bed hos-
pital located in excellent recreational area. Salary
and personnel policies in accordance with
RNABC. Comfortable Nurses' home. Apply: Di-
rector of Nursing, Boundary Hospital, Grand
Forks, British Columbia.
GENERAL DUTY NURSES for 96-bed acute
hospital, fully accredited. RNABC personnel
policies and salary scale, plus $15 Northern
differential. Excellent recreational area, bowl-
ing, skiing, skating, curling and fishing. Hot
Springs swimming nearby. Nurses' residence
and cafeteria meals available. Apply to: Direc-
tor of Nursing, Kitimat General Hospital,
Kitimat, British Columbia.
GENERAL DUTY NURSES for 37-bed Acute
Hospital in Southwestern B.C. Salary: $508 —
$633 plus shift differential. Credit for past
experience. RNABC Personnel Policies in
effect. Accommodation available in Residence.
Apply to: Director of Nursing, Nicola Valley
General Hospital, P.O. Box 129, Merritt, B.C.
GENERAL DUTY NURSES for 63-bed active
hospital in beautiful Bulkley Valley Boating,
fishing, skiing, etc. Nurses' residence. Salary
$498—523, maintenance $75; recognition for
experience. Apply: Director of Nursing, Bulkley
Valley District Hospital, Smithers, Britlsn
Columbia.
GENERAL DUTY AND PRACTICAL NURSE
needed for 70-t>ed General Hospital on Pacific
Coast 200 miles from Vancouver. RNABC
contract, $25 room and board, friendly com-
munity. Apply: Director of Nursing, St. George's
Hospital, Alert Bay, British Columbia.
GENERAL DUTY and OPERATING ROOM
NURSES for modern 450-bed hospital with
School of Nursing. RNABC policies In effect.
Credit for past experience and postgraduate
training. British Columbia registration Is re-
quired. For particulars write to: The Associate
Director of Nursing, St. Joseph's Hospital,
Victoria, British Columbia.
GRADUATE NURSES for 24-bed hospital,
35-mi. from Vancouver, on coast, salary and
personnel practices in accord with RNABC.
Accommodation available. Apply: Director of
Nursing, General Hospital, Squamish, British
Columbia.
GRADUATE NURSES for active 21-bed hos-
pital, preferably with obstetrical experience.
Friendly atmosphere, beautiful beaches, local
curling club. Single room and board $40 a
month. Salary $508 for Gen. Duty Registered
Nurses; Salary $483 for non-registered nurses
DECEMBER 1969
DIRECTOR OF NURSING SERVICE
required
For 247-bed chronic illness and rehabilitation
geriatric hospital. Affiliated with outstanding Schools
of Nursing in nursing education progrann. Unusual
melieu therapy program. Bachelor's degree in nursing
administration preferred with extensive experience
in supervisory nursing positions. Salary open and
commensurate with qualifications.
Apply:
Administrator
MAIMONIDES HOSPITAL AND HOME
FOR THE AGED
5795 Caldwell Avenue
Montreal 268, Quebec
Applicatiorts are invited
for the position of
DIRECTOR OF NURSING SERVICE
in fully accredited 100-bed hospital. Applications
from Registered Nurses with degree or diploma in
nursing service administration or with 5 years
equivalent in related supervisory experience will be
welcomed.
Please address enquiries to:
The Admnistrator
PORTAGE DISTRICT GENERAL HOSPITAL
Portage La Prairie, Manitoba
there are over
200J00 more
who need your help!
REGISTERED NURSES • PUBLIC HEALTH NURSES
CERTIFIED NURSING ASSISTANTS
Have you considered a Career with the...
Indian Health Services of MEDICAL SERVICES
DEPARTMENT OF NATIONAL HEALTH AND WELFARE
for further information write to: MEDICAL SERVICES, DEPARTMENT OF NATIONAL HEALTH AND WELFARE. OTTAWA, CANADA
DECEMBER 1%9
THE CANADIAN NURSE 53
BRITISH COLUMBIA
ONTARIO
ONTARIO
plus recognition for postgraduate experience.
Shift differential. Apply to: Matron, Tofino
General Hospital, Tofino, Vancouver Island,
B.C.
MANITOBA
Registered Nurses required for 15-bed hospital
in Northern Manitoba, serving a small com-
munity and a Hydro construction site. Single
accomodation available at $45. per month.
Daily plane service and C.N.R. Starting salary
approximately $595. per month. Relocation
expenses paid from Winnipeg. For further
information apply to: Mrs. J. Davoren, Director
of Nursing, Gillam Hospital Inc., P.O. Box 130,
Gillam, Man.
REGISTERED NURSE for Doctor's office.
Please send application with references and
information regarding age, experience and ex-
pected salary to: Hanover Medical Clinic, Box
640, Stelnbach, Manitoba.
NOVA SCOTIA
GENERAL DUTY NURSES: Positions availa-
ble for Registered Qualified General Duty
Nurses for 138-bed active treatment hospital.
Residence accommodation available. Applica-
tions and enquiries will be received by: Director
of Nursing, Blanchard-Fraser Memorial Hos-
pital, Kentville, Nova Scotia.
ONTARIO
TEACHERS for September 1970. Regional
School program for classes of sixty students.
Teach patient-centered nursing in both clinical
and classroom setting. University preparation
essential. For school brochure and application
forms write to: Director, Algoma Regional
School of Nursing, 150 Conmee Avenue, Sault
Ste. Marie, Ontario.
FACULTY: Positions available January 1970
in maternal<hild or maternity and pediatric
nursing areas for new baccalaureate program.
Master's degree in clinical specialty required.
Rank and salary commensurate with
qualifications. Calendar year appointment.
Apply to: Dean, School of Nursing, Queen's
University, Kingston, Ontario, Canada.
REGISTERED NURSES for 34-bed General
Hospital. Salary $460 per month to 550 plus
experience allowance. Residence accommoda-
tion available. Excellent personnel policies.
Apply to: Superintendent, Englehart & District
Hospital Inc., Englehart, Ontario.
REGISTERED NURSES needed for 81-bed
general hospital in bilingual community of
Northern Ontario R.N.'s starting salary —
$500/m., with allowance for past experience,
4 weeks vacation, 18 sick leave days. Unused
sick leave days paid at 100 percent every year.
Master rotation in effect. Rooming accommo-
dation available in town. Excellent personnel
policies. Apply to: Personnel Director, Notre-
Dame Hospital, P.O. Box 850, Hearst, Ont.
REGISTERED NURSES. Applications and
enquiries are invited for general duty positions
on the staff of the Manitouwadge General
Hospital. Excellent salary and fringe benefits.
LIC>eral policies regarding accommodation and
vacation. Modern well-equipped 33-bed hospital
in new mining town, about 250-mi. east of Port
Arthur and north-west of White River, Ontario.
Pop. 3,500. Nurses' residence comprises individ-
ual self-contained apts. Apply, stating qualifica-
tions, experience, age, marital status, phone
number, etc. to the Administrator, General
Hospital, Manitouwadge, Ontario. Phone:
826-3251.
REGISTERED NURSES required for the Nipi-
gon District Memorial Hospital. New 37-bed hos-
pital opened on March 26, 1969. Attractivesala-
ry and fringe benefits. Residence accommoda-
tion available at $50 a month. For further infor-
mation, write to: Mrs. G. Gordon, Superintend-
ent, Nipigon, Ontario.
54 THE CANADIAN NURSE
REGISTERED NURSES for a 100-bed General
Hospital, situated 40 miles from Ottawa. Excel-
lent personnel policies. Residence accommoda-
tion available. Apply to: Director of Nursing,
Smiths Falls Public Hospital, Smiths Falls,
Ontario.
REGISTERED NURSES REQUIRED IMME-
DIATELY FOR 53-BED HOSPITAL. START-
ING SALARY $485. Three weeks vacation, pen-
sion plan, life and medical insurance, 9 statutory
holidays, 40-hour week. Air, rail and road facili-
ties. Northern hospitality. Apply to: Director of
Nurses, Porcupine General Hospital, South Por-
cupine, Ontario.
REGISTERED NURSES AND REGISTERED
NURSING ASSISTANTS are invited to make
application to our 75-bed, modern General
Hospital. You will be in the Vacationland of
the North, midway between the Lakehead and
Winnipeg, Manitoba. Basic wage for Registered
Nurses is $470/m and for Registered Nursing
Assistants is $329/m, with yearly increments
and merit increments for experience. Write or
phone: The Director of Nursing, Dryden
District General Hospital, DRYDEN, Ontario.
REGISTERED NURSES and REGISTERED
NURSING ASSISTANTS for 45-bed hospital.
R.N.'s salary $485 to $585 with experience
allowance and 4 semi-annual increments. Nurses'
residence — private rooms with bath — $20
per month. R.N.A.'s salary $330 to $405. Apply
to: The Director of Nursing, Geraldton District
Hospital, Geraldton, Ontario.
REGISTERED NURSES AND REGISTERED
NURSING ASSISTANTS for 160-bed ac-
credited hospital. Starting salary $485 and
$340 respectively with regular annual incre-
ments for both. Excellent personnel policies.
Residence accommodation available. Apply to:
Director of Nursing, Kirkland and District
Hospital, Kirkland Lake, Ontario.
Registered Nurses Urgently Required for Gene-
ral Staff — in 63-bed modern hospital in West-
ern Ontario situated near Sarnia and the Ameri-
can border. Basic salary for 1969, $470. per
month with annual increments, shift differen-
tial and allowance for past experience. Resi-
dence accommodation available at the present
time. Apply: Director of Nursing, Charlotte
Eleanor Englehart Hospital, Petrolia, Ontario.
REGISTERED NURSES FOR GENERAL
STAFF AND OPERATING ROOM, in well-
equipped 34-bed hospital. Gold mining and
tourist area, wide variety of summer and winter
sports. Modern nurses' residence, room and
board and uniform laundry $55. Cumulative
sick-time, 9 statutory holidays, 4 weeks vaca-
tion. Salary from $485— $595, with allowance
for past experience and ability. Shift differen-
tial $1. per evening or night shift. Apply to:
Matron, Margaret Cochenour Memorial Hos-
pital, Cochenour, Ontario.
REGISTERED NURSES FOR GENERAL
STAFF AND OPERATING ROOM, in modern,
accredited 235-bed General Hospital situated in
the Nickel Capital of the world. Good person-
nel policies. Recognition for experience and
post-l>asic preparation. Annual bonus plan.
Planned "in-service" programs. Assistance with
transportation. Apply — Director of Nursing,
Sudbury Memorial Hospital, Sudbury, Ontario.
GENERAL DUTY NURSES for 95-bed hos-
pital equipped with all electric beds through-
out. Starting salary $470 per month. Excellent
personnel policies. Pension plan, life insurance,
etc., residence accommodation. Only 10 min.
from downtown Buffalo. Apply: Director of
Nursing, Douglas Memorial Hospital, Fort Erie,
Ontario.
GENERAL DUTY NURSES for 145-bed
modern hospital. Southwestern Ontario, 32 mi.
from London. Salary commensurate with ex-
perience and ability; $470/m basic salary.
Pension plan. Apply giving full particulars to:
The Director of Nurses, District Memorial
Hospital, Tillsonburg, Ontario.
GENERAL STAFF NURSES AND RE-
GISTERED NURSING ASSISTANTS are re-
$tuired for a modern, well-equipped General
Hospital currently expanding to 167 beds.
Situated In a progressive community in South
Western Ontario, 30 miles from Windsor-
Detroit Border. Salary scaled to experience and
qualifications. Excellent employee benefits and
working conditions plus an opportunity to
work in a Patient Centered Nursing Service.
Write for further information to: Miss Patricia
McGee, B.Sc.N., Reg.N., Director of Nursing,
Leamington District Memorial Hospital,
Leamington, Ontario.
Nurses with l.C.U. training, O.R. training and
experience, and general duty nursing. Wanted
for 80-bed General Hospital recently enlarged,
located in summer and winter sport area.
Apply: Director of Nursing, Huntsville District
Memorial Hospital, Box 1150, Huntsville,
Ontario.
PUBLIC HEALTH NURSES required for gene-
ralized program in leading resort area. Team
Nursing has been in effect for one year. For full
details regarding personnel policies and program
please write to: W.H. Bennett, M.D., D.P.H..
Medical Officer of Health, Muskoka-Parry
Sound Health Unit, Box 1019, Bracebridge,
Ontario.
"Residential School Nurse required for Board-
ing School in Ontario, for particulars Apply:
Box No. A" Canadian Nurse, 50 The Driveway,
Ottawa 4, Ont.
Matron Supervisor to take charge of Elderly
Ladies Residence: downtown Montreal. Box
no: "B" — Canadian Nurses Association, 50
The Driveway, Ottawa 4, Ont.
QUEBEC
BILINGUAL GENERAL DUTY NURSES for a
modern 96-bed hospital, located 80 miles from
Ottawa and 180 miles from Montreal. Please send
application and r6sum6 to: Executive Director.
St. Joseph's Hospital, P.O. Box 1000, Manlwaki,
Quebec.
REGISTERED NURSES for modern 80-bed
General Hospital expanding to 150 t>eds,
located in an attractive, dynamic, sports orient-
ed community 50 miles south of Montreal,
Salaries and fringe benefits, comparable to
Montreal: Apply to: Director of Nursing,
Brome-Missisquoi-Perkins Hospital, Cowansvll-
le. Que.
REGISTERED NURSES for 30-bed General
Hospital. Huntingdon is 45 miles south west of
Montreal. Salaries as approved by Q.H.I.S. 4
weeks annual vacation. Accumulated sick leave.
Blue Cross partially paid. Full maintenance avail-
able for $43.50 per month. Apply to: Mrs. D.
Hawley, R.N., Huntingdon County Hospital,
Huntingdon, Quebec.
UNITED STATES
REGISTERED NURSES. Opportunities avail-
able at 415-bed hospital in Medical-Surgical,
Labor and Delivery, Intensive Care. Operating
Room and Psychiatry. No rotation of shift,
good salary, evening and night differentials
liberal fringe benefits. Temporary living accom-
modations available. Apply: Miss Dolores
Merrell, R.N., Personnel Director, Queen of
Angels Hospital. 2301 Bellevue Avenue, Los
Angeles 26, California.
REGISTERED NURSES for general duty and
speciality areas in expanding 350-bed general
teaching hospital located in prime southwest
beach community. California license required.
Excellent salaries and employee benefit pro-
gram. For further information, please contact:
Personnel Dept., St. Mary's Hospital, 509 E.
10th Street, Long Beach, California 90813.
REGISTERED NURSES — Immediate open-
ings in all services, medical, surgical, ICU-CCU,
pediatrics, maternity, psychiatry. J.C.A.H. Hos-
pital halfway between San Francisco and Lake
Tahoe. $660 base pay with shift differentials.
Apply: Director of Nursing Services, Woodland
Memorial Hospital, 1325 Cottonwood Street,
Woodland, California 95695.
STAFF DUTY POSITIONS (NURSES) in pri-
vate 403-bed hospital. Liberal personnel po-
licies and salary. Substantial differential for
evening and night duty. Write: Personnel Di-
rector, Hospital of The Good Samaritan, 1212
Shatto Street, Los Angeles 17, California.
GOOD CHOICE: Be a California-licensed Cotta-
ge Hospital nurse In Santa Barbara. Sunny
smog-free climate. Beaches and mountains. Col-
lege and resort town. Modern 350-bed hospital.
Accredited teaching programs for Interns, re-
sidents, nurses, medical and X-ray technicians.
DECEMBER 1%9
BROMLEY, STRAHON
HUNTER, GORE
KILLIN6T0N, HAYSTACK
OKEMO, SPECULATOR
WHITEFACE, JIMINY
Ski slopes. You name 'em, we've got 'em in our back-
yard. And, as a teaching medical center, we offer the
widest possible selection of positions for nurses. So, if
you're a skiing nurse, Albany is the place for you. For
more details, write for our free booklet, "Albany Medical
Center Nurse."
ALBANY MEDICAL CENTER HOSPITAL
Mrs. Helen F. Middleworth
Director, Nursing Service
Albany Medical Center Hospital
Albany, New York 12208
Please send me a free copy of your nursing
booklet.
NAME
ADDRESS
CITY
STATE ZIP 9*N
ONTARIO SOCIETY
FOR
CRIPPLED CHILDREN
requrres
• Camp Directors
• General Staff Nurses
• Registered Nursing Assistants
for
FIVE SUMMER CAMPS
located near
OTTAWA — COLLI NGWOOD
LONDON — PORT COLBORNE
KIRKLAND LAKE
Applications are invited from nurses in-
terested in the rehabilitation of physically
handicapped children. Preference given to
CAMP DIRECTOR applicants having super-
visory experience and to NURSING ap-
plicants with paediotric experience.
Apply in writing to:
Miss HELEN WALLACE, Reg. N.,
Supervisor of Camps,
350 Rumsey Road,
Toronto 17, Ontario
UNITED STATES
UNITED STATES
Obtain the facts! Top pay and benefits.
Housing allowance. Contact: Director of
Nursing, Cottage Hospital, Bath and Pueblo
Sts., Santa Barbara, California 93105.
GENERAL DUTY NURSES: 64-bed J.C.A.H.
fully accredited general tiospital. Salary range
$610— $742 with shift differential. Liberal per-
sonnel policies with retirement plan. Contact:
Personnel Dept. Physicians Hospital, 901 Olive
Or., Bakersfield, California, 93308.
NURSES for new 75-bed General HospitaL
TRAIN TO BE A REGISTERED
NURSE IN ENGLAND
ANNOUNCEMENT
THE ST. GILES' HOSPITAL, SCHOOL OF NURS-
ING will be joining with KING'S COLLEGE
HOSPITAL GROUP TRAINING SCHOOL from
JANUARY, 1970.
The King's College Group of Hospitals of
1,800 beds with experience available in all
specialities is situated 3 miles south of
Central London in an area with excellent
transport facilities to all ports of the country.
Training takes three years, four months with
o training allowance of £365 - £420 per
onnum, with 14 weeks' vocation during this
course. Uniform Is provided.
// you are interested and hove attained
Grade 12 in Bnglish Language and three
academic subjects, in the Canadian
matriculation, write fir further particulars
to:
Miss Girling, Senior Nursing Officer
ST. GILES' HOSPITAL
Camberwell, London, S.E.5, England
Resort area. Ideal climate. On beautiful Pacific
ocean. Apply to: Director of Nurses, South
Coast Community Hospital, South Ljguna,
California.
REGISTERED NURSES: Excellent opportunity
for advancement in atmosphere of medical excel-
lence. Progressive patient care including Inten-
sive Care and Cardiac Care Units. Finely equip-
ped growing 270-bed suburban community hos-
pital on Chicago's beautiful North Shore. Mod-
ern, furnished apartments are available tor single
professional women. Other fringe benefits in-
clude paid vacation after six months, paid life
insurance, 50 percent tuition refund and staff
development program. Minimum starting salary
$626 per month plus shift differential. Contact:
Donald L. Thompson, R.N., Director of Nursing,
Highland Park Hospital, Highland Park, Illinois
60035.
REGISTERED NURSES and CERTIFIED
NURSING ASSISTANTS — opening in several
areas, all shifts. Every other weekend off, in
small community hospital 2 miles from Boston.
Rooms available. Hospital paid life insurance
and other liberal fringe benefits. RN salary
$125 per week, plus differential of $20 for 3-11
p.m. and 11-7 a.m. shifts. CN Assts. $98 weekly
plus $10 for 3-11 p.m. and 11-7 a.m. shifts.
Must read, write, and speak English, be gra-
duated from accredited school, and have had
course in Pharmacology. Write: Miss Byrne,
Director of Nurses, Chelsea Memorial Hospital,
Chelsea, Massachusetts 02150.
REGISTERED NURSES — Excellent opportu-
nity for advancement in atmosphere of medical
excellence in 505-bed JCAH accredited hospi-
tal. New facilities including MEDELCO Total
Hospital Information System (which frees the
nurse from most paper work). Good In-service
orientation and training programs. Liberal
tuition refunds and opportunity to work on BS
degree on hospital premises. Up-to-date
personnel policies. Salary according to educa-
tion and experience. Minimum $7560 (U.S.
Dollars) plus differential for evenings and
nights. Write to William A. Davidson, Personnel
Manager, Deaconess Hospital, 6150 Oakland,
St. Louis, Missouri 63139.
STAFF NURSES: To work in Extended Care
or Tuberculosis Unit. Live in lovely suburban
Cleveland in 2-bedroom house for $55 a month
Including all utilities. Modern salary and ex-
cellent fringe benefits. Write Director of
Nursing Service, 4310 Richmond Road,
Cleveland, Ohio.
STAFF NURSES — Here is the opportunity to
further develop your professional skills and
knowledge in our 1,000-bed medical centei. We
have liberal personnel policies with premiums
for evening and night tours. Our nurses' residen-
ce located in the midst of 33 cultural and
educational institutions, offers low-cost housing
adjacent to the Hospitals. Write for our booklet
on nursing opportunities. Feel free to tell us
what type position you are seeking. Write
Barbara E. Hark, Assistant Director, Nurse
Recruitment, Room 600, University l-lospitals
of Cleveland, University Circle, Cleveland, Ohio
44106.
REGISTERED NURSE (Scenic Oregon vaca-
tion playground, skiing, swimming, boating &
cultural events) for 295-bed teaching unit on
campus of University of Oregon medical school.
Salary starts at $630. Pay differential for nights
and evenings. Liberal policy for advancement,
vacations, sick leave, holidays. Apply: Multno-
mah Hospital, Portland, Oregon. 97201.
SEATTLE GENERAL DUTY NURSES Experi-
enced, days, $630 to $650 dependent on experi-
ence. Additional shift differentials of $40 on
3-11 and 11-7 shift. Free medical and life insur-
ance. 270-bed regional referral center with inten-
sive care, new coronary care units. Postgraduate
classes available at two universities. Extensive
intern, resident teaching program. Free housing
first month. Please write to: Personnel Director,
Virginia Mason Hospital, 1111 Terry Avenue,
Seattle, Washington 98101.
STAFF NURSES: University of Washington
320-bed modern expanding teaching and re-
search hospital located on campus offers you an
opportunity to join the staff in one of the follow-
ing specialities; Clinical Research, Premature
Center, Open Heart Surgery, Physical Medicine,
Orthopedics, Neurosurgery, Adult and Child
Psychiatry in addition to the General Services.
Salary $580 for newly graduated nurses, $630
within first six months to $714. Salary com-
mensurate with experience and education.
Unique benefit program includes free University
courses after six months. For information on
opportunities, write to: Mrs. Ruth B. Fine,
DIRECTOR OF
OPERATING ROOM
NURSING
REQUIRED
BY
UNIVERSITY HOSPITAL
Saskatoon, Saskatchewan
To be responsible for
administration and management
of operating room nursing
service.
Qualifications: Preparation and
experience in adminisitration
and operating room nursing.
Please Apply:
Nursing Administrator
UNIVERSITY HOSPITAL
SASKATOON, Saskatchewan
UNITED STATES
Director of Nursing Services, University of
Washington, University Hospital, 1959 N.E.
Pacific Avenue, Seattle, Washington, 98105.
PROFESSIONAL NURSES — Harborview
Medical Center, an affiliate of the University of
Washington, will be opening a Coronary Care
Unit in October, 1969, and a Surgical Intensive
Care Unit in January, 1970. Plan now to join our
staff in preparation for the opening ot these
units. Salary commensurate with experience and
ability. Liberal personnel policies. For further
Information write to: Miss Elizabeth A. An-
drews, Director of Nursing Services, Harborview
Medical Center, 325 9th Avenue, Seattle,
Washington 98104.
YOUYILLE HOSPITAL
NORANDA (QUEBEC)
216-bed hospital expanding to 450 beds
invites applications from Registered Nurses
in
MEDICINE — SURGERY
GYNECOLOGY
Sola
y according to Quebec Hospitaliza-
tion
Insurance scale.
Please write:
The Director of Nursing
YOUVILLE HOSPITAL
Noranda (Quebec)
56 THE CANADIAN NURSE
DECEiVlBER 1%9
Of course, we have more of the other kind
at Methodist (female RNs, that is), but the
fact that men are entering the profession and
choosing Methodist Hospital as their base
of operation is quite significant.
The professionally-oriented man, just like a
woman, has an eye for opportunity and ad-
vancement. One look at Methodist's 1200-bed
progressive medical complex ... its excel-
lence in patient care, education and research
... its advanced clinical services in open-
heart surgery and post-operative care; kidney
dialysis; coronary intensive care ... its sup-
porting disciplines in pathology and nuclear
medicine ... its distinct separation of all
clinical services ... its salary schedules and
fringe benefits . . . one look at all of this
and what man OR woman in the nursing
profession wouldn't be tempted?
How about you? All the facts are laid before
you in 'Your Life At Methodist", the com-
prehensive and heart-warming story of your
personal participation in the rewarding ac-
tivities of one of the largest hospitals in the
nation. And you'll enjoy the companion book-
let "Metropolitan Indianapolis" which offers
the complete picture of your new home in
the city of warmth, friendship and opportunity.
Send for your copies today.
ethodist
ospital
p. Martin
Director of Recruitment
Methodist IHospital of Indiana, Inc.
1604 North Capitol Avenue
Indianapolis. Indiana 46202
AN
EQUAL
OPPORTUNITY
PROGRAM
Please send me my personal copies of "Your Life At Methodist"
and "Metropolitan Indianapolis" . . . and thank you.
D I'm an RN
D
I'm a student.
1 win graduate
Name
Address
City
State
Zip Code.
_Phone_
DECEMBER 1%9
THE CANADIAN NURSE 57
ST. MARY'S GENERAL HOSPITAL
SCHOOL OF NURSING
KITCHENER, ONTARIO
requires
TEACHERS FOR 2 + 1
PROGRAAAME
Affiliated with a modern, progressive,
400-bed fully-accredited hospital. Student
enrolment, 150. Salary commensurate with
preparation and experience.
For further details apply:
Director
ST. MARY'S SCHOOL
OF NURSING
Kitchener, Ontario
UNIVERSITY OF ALBERTA
SCHOOL OF NURSING
ADVANCED PRACTICAL
OBSTETRICS COURSE
A five month course in theory and practice
of obstetrical nursing open to Registered
Nurses. Next course commences March 30,
1970.
for further information write to:
Miss R.E. McClure
Director, School of Nursing
UNIVERSITY OF ALBERTA
Edmonton
NURSE TEACHER
To teach nursing in a well established
school which has a progressive two year
educational programme and a third year
is in hospitol nursing service.
Applicants must be eligible for registra-
tion in Ontario and have a baccalaureate
degree. A University certificate in nursing
education or Public Health Nursing may
be considered.
POSITION OPEN
Qualified applicants please apply to:
Sister M. McDonald, M.S.N.
Director
ST. JOSEPH'S
SCHOOL OF NURSING
Peterborough, Ontario
ST. JOSEPH'S HOSPITAL
HAMILTON, ONTARIO
Invites Applications for:
GENERAL STAFF NURSES
REGISTERED NURSING ASSISTANTS
and
ORDERLIES
Positions are available in:
MEDICINE
SURGERY
PAEDIATRICS
OBSTETRICS
PSYCHIATRY
CORONARY MONITOR
UNIT
INTENSIVE CARE UNIT
DIALYSIS CENTRE
for further information write to:
Director of Nursing
ST. JOSEPH'S HOSPITAL
Hamilton, Ontario
NURSING CONSULTANT
FOR
THE SASKATCHEWAN REGISMED
NURSES' ASSOCIATION
A master's degree in nursing and
staff and administrative experi-
ence in nursing service and/or
education are required.
The main responsibilities of this
position wil be to provide con-
sultation services to the general
membership of the Association
and to plan continuing education
programs for nurses.
for furtfier information and
application please write:
Miss A. Mills
Executive Secretary
SASKATCHEWAN REGISTERED
NURSES' ASSOCIATION
2066 Retallack Street
Regina, Saskatchewan
HEALTH NURSE
NEEDED
For 313-bed accredited hospital. Must be
Registered Nurse with Certificate in
Public Health.
Good salary and fringe benefits.
Accommodation available for gracious
living in the Festival City of Canoda.
Apply to:
Personnel Officer
STRATFORD GENERAL HOSPITAL
Stratford, Ontario
SANTA CABRINI HOSPITAL
Modern General Hospital of 350 beds,
requires:
— Supervisor with Bachelor degree
— Registered Nurses
— Nursing Assistants
Wishing to work on permanent shift, day
— evening or night.
Please apply to:
PERSONNEL OFFICE
5655 St. Zotique E.
Montreal 410, Qve,
HEAD NURSE
For a new PSYCHIATRIC UNIT
— Located in 360-bed acute General
Hospital
— Duties to commence approximately
August, 1970
— Personnel policies in accordance with
the current RNABC contract.
REQUIREMENTS:
— eligibility for B.C. registration
— post basic education in the field of
ward administration
— experienced or post-basic education in
psychiatric nursing.
Please address enquiries to:
The Director of Nursing
NANAIMO REGIONAL
GENERAL HOSPITAL
Nanaimo, B.C.
58 THE CANADIAN NURSE
DECEMBER 1961
'I'm sorry, but you can't give your Daddy
a Saint Barnabas Nurse for Christmas"
A typical reaction to a typical Saint Barnabas nurse.
At Saint Barnabas Medical Center we pride ourselves
on the quality of our nurses... people who care about
people who need care. To help them, and you, we have
the most modern devices for nursing care including
sophisticated electronic equipment, X-Ray department
the world's largest and most complete hyperbaric
medicine and research facility and more. What's
more we have installed the latest automated devices
to eliminate a great deal of hand record keeping. You
spend your time being what you're trained for, a nurse
not a part time clerk. Mail the coupon for the free
informative booklet on Saint Barnabas and see for
yourself how, when it comes to both your professional
and your personal life (we're 55 minutes from New York
40 minutes from the seashore, 45 minutes from skiing)
happiness is working with us.
Miss Anna E. Marks, Director of Nursinq Deot CN
SAINT BARNABAS Medical Center ^
Old Short Hills Road, Livingston, N.J. 07039
Please send full details on your
nursing program:
NAME-
ADDRESS-
01 TY
-STATE-
-2IP-
DECEMBER 1%9
Saint Barnabas
Medical Center
Old Short Hills Rd., Livingston, New Jersey 07039
An Equol Opportunity Employer
THE CANADIAN NURSE 59
NURSING SERVICE
CONSULTANT
Duties: To develop a nursing
service consultation program
aimed at assisting health agen-
cies to provide and maintain a
high quality of nursing care. The
successful applicant would be
expected to identify and assist
in finding solutions to problems
in nursing service, advise on
areas requiring research, and
suggest topics for workshops.
Qualifications: Master's degree
preferred with administrative
and clinical courses. Experience
in Nursing Service essential.
Salary commensurate with quali-
fications and experience.
Apply to:
Executive Secretary
ALBERTA ASSOCIATION
OF REGISTERED NURSES
10256-112 Street, Edmonton
Alberta
EMPLOYMENT
RELATIONS OFFICER
Duties: To conduct the employ-
ment relations activities of the
Association, promote the devel-
opment of staff nurses' associa-
tions, coordinate their activities
and act as liaison between their
associations and promote and
facilitate communication among
professional nurses in the Prov-
ince.
Qualifications: A minimum of a
Bachelor's degree in nursing.
Over two years specific work
experience or four to eight years
related work experience. A the-
oretical knowledge of nursing
plus a practical working know-
ledge of industrial relations.
Must be free to travel extensively
throughout the Province.
Salary commensurate with quali-
fications and experience.
Apply to:
Executive Secretary
ALBERTA ASSOCIATION
OF REGISTERED NURSES
10256 - 112 Street
Edmonton 12, Alberta
THE HOSPITAL
FOR
SICK CHILDREN
OFFERS:
1. Satisfying experience.
2. Stimulating and friendly en-
vironment.
3. Orientation and In-Service
Education Program.
4. Sound Personnel Policies.
5. Liberal vacation.
APPLICATIONS FOR REGISTERED
NURSING ASSISTANTS INVITED.
For detailed information
please write to:
The Assistant Director
of Nursing
AUXILIARY STAFF
555 University Avenue
Toronto, Ontario, Canada
L
PROVINCE OF BRITISH COLUMBIA
Has opening for
SUPERINTENDENT
OF NURSES
PEARSON HOSPITAL
VANCOUVER
SALARY: $626, rising to $755 per month
plus special courses bonus where applic-
able. Under direction, to be responsible
for the detailed administration of patient
care and personnel management within
a hospital ward dealing with Extended
Care patients or on a rotation basis, to
assume delegated responsibilities for
supervision of the entire hospital (3CX)
beds) on afternoon and night shifts.
Applicants must be Canadian citizens or
British subjects with registration, or
eligible, in the British Columbia Associa-
tion of Nurses; preferably with a diploma
or degree in teaching and administration
or a diploma for an approved related
clinical course; a minimum of one year's
experience in nursing of tuberculosis,
physically handicapped, progressive neu-
rological diseases patients; administrative
ability.
Obtain applications from the
CIVIL SERVICE COAAMISSION
OF BRITISH COLUMBIA
Valieyview Lodge, ESSONDALE
and return IMMEDIATELY
COMPETITION NO. 69-726 A.
ASSISTANT DIRECTOR
OF NURSING
Applications are invited for the
above position in a fully ac-
credited 163-bed General Hos-
pital in beautiful Northern On-
tario.
Desirable qualifications should
include B.S.N. Degree with ex-
perience in supervision.
For further information.
Write to:
Director of Nursing
KIRKLAND and DISTRICT HOSPITAL
Kirkland Lake, Ontario.
60 THE CANADIAN NURSE
DECEJMBER 1969
SELKIRK COLLEGE
DIRECTOR OF
NURSING EDUCATION
Selkirk College, in Castlegar, British Columbia,
requires a full-time Director for a two-year
Registered Nurses' Training Programme,
scheduled to begin in September, 1971.
DUTIES:
To assume primary responsibility for the
development of a successful nursing educa-
tion programme at the College, including
the following:
— advising on all matters of curriculum;
— making recommendations regarding
laboratory and other facilities,-
— developing library resources in nursing;
— assisting in the recruitment of faculty
and other staff necessary to the pro-
gramme.
QUALIFICATIONS:
At least a Master's degree in the field.
EFFECTIVE DATE OF APPOINTMENT:
July 1, 1970.
SAURY:
To be discussed. The College has an attrac-
tive salary scale and excellent fringe
benefits.
This is a challenging opening, offering consi-
derable scope for the right person to create
a first-rate programme in nursing education.
Those interested should contact:
A.E. Soles
Principal
SELKIRK COLLEGE
Box 1200
Castlegar, British Columbia
the word is
OPPORTUNITY
for Registered Nurses in the medical
centre of Atlantic Canada
Opportunity for professional growth
Opportunity for advancement
Opportunity for specialization
If you are a registered nurse looking for new
horizons where you can fulfill the aspirations of
your nursing profession in the challenging
atmosphere of a large, progressive, teaching hospital
• . join us at the Victoria General. Our need
is your opportunity. There are excellent general
staff openings in Medicine, Neuro-surgery, Surgery,
Recovery Room, Emergency and Operating Room
and Intensive Care Units. Excellent salary and
benefits with additional credit for experience and
skills learned in special units. You will enjoy
living in Nova Scotia with its almost unlimited
recreational opportunities and temperate climate.
We'll be glad to send you more information.
Write: Miss Florence Gass
Director of Nursing
VICTORIA GENERAL HOSPITAL
Halifax, Nova Scotia
DECEMBER 1%9
THE CANADIAN NURSE 61
IS THIS ANY PLACE
TO BE A NURSE ?
...YOU BET IT IS!
Sun-drenched tropical island . . . swaying
palms . . . breakers curling onto a golden
beach — Galveston Island, home of the
University of Texas Medical Branch, the
Southwest's leading medical school. Off
the Texas Gulf Coast, only minutes to
Houston with its Astrodrome and Manned
Spacecraft Center.
This 1200-bed hospital facility includes:
12-bed Clinical Research Center Coronary
Care and Intensive Care Units. Beautiful
new 175-bed hospital for Psychiatry,
Medicine and Neurology.
Plus:
Planned in-service education — Person-
alized orientation programs — Liberal
personnel policies — Excellent pay differ-
entials for evenings and nights Opportu-
nity for advancement.
STAFF NURSE SALARIES
$592 to $740
Based on background, educotion and
experience.
Write today to:
Assistant Administrator
for Nursing
UNIVERSITY OF TEXAS HOSPITALS
Galveston, Texas 77550
Equal Opportunity Employer
KIRKLAND AND
DISTRICT HOSPITAL
KIRKLAND LAKE, ONTARIO
REGISTERED NURSES
FOR
GENERAL DUTY
CORONARY CARE UNIT
REGISTERED NURSING ASSISTANTS
required for
162-bed accredited active Gen-
eral Hospital in beautiful North-
ern Ontario where you can enjoy
winter and summer sports.
Starting salary for Registered
Nurses $485. R.N.A. $340.
respectively with regular incre-
ments for both. Excellent person-
nel policies. Temporary residence
accommodation available.
For further information, write to:
Director of Nursing
KIRKLAND AND DISTRICT
HOSPITAL
Kirkland Lake, Ont.
NURSES !
ST. PAUL HOSPITAL
R.N.'s
LV.N.'s
489-bed Teaching Hospital in
Southwest Medical Center
Rewarding and challenging
opportunities in:
• Medical Surgical
• Intensive Core
• Coronary Care
• Special Units
Training programs for advance-
ment. Excellent starting salary,-
generous differential for evening
and night duty.
DALLAS
A good place to work and ploy.
Apply now!
Personnel Office
5909 Harry Mines
Dallas, Texas 75235
UNIVERSITY OF ALBERTA HOSPITAL
EDMONTON ALBERTA CANADA
A 1,200-bed modern teaching and research hospital with a School of Nursing of 360 students
* Opportunities for Professional development in:
MEDICINE
CORONARY CARE
RENAL DIALYSIS UNIT
ADULT & CHILD PSYCHIATRY
REHABILITATION
PAEDIATRICS
OBSTETRICS
SURGERY
OPERATING ROOM
NEUROSURGERY
ORTHOPAEDICS
CARDIAC SURGERY
INTENSIVE CARE UNIT
Planned Orientation Programme
Inservice Education Programme
Interested in applications from Supervisors,
Head Nurses, Assistant Head Nurses,
General Staff Nurses, Instructors for
School of Nursing, Certified Nursing Aides.
BENEFITS
* Salary commensurate with
education and experience
* Liberal personnel policies
APPLY TO DIRECTOR OF NURSING
62 THE CANADIAN NURSE
DECEMBER 1969
THE SCARBOROUGH
GENERAL HOSPITAL
— A 650-bed progressive, accredited hospital — located in Eastern
Metropolitan Toronto.
— Active and stimulating In-Service Educational Program including
videotape telecasts.
— A modern Management Training Program to assist the adminis-
trative nurse to develop managerial skills.
— Challenging opportunities in medical and surgical nursing,
including specialties such as Cardiology, Intensive Care, Burns,
Plastic Surgery, Ophthalmology, Paediatrics, Community Psychia-
try, and Emergency.
— An extensive clinical program of individual patient core plans.
— Experience and post-basic education are monetarily recognized.
There is a future for you in Scarborough where young moderns
live, work, and play.
For further information write to:
Director of Nursing
SCARBOROUGH GENERAL HOSPITAL
Scarborough, Ontario
HOSPITAL:
260 bed (expanding to 415) occredited, modern, general hos-
pital, with progressive patient care, including a 12 bed
I.C.U., 22 bed Psychiatric and 24 bed Self-care unit.
IDEAL LOCATION:
45 minutes from downtown Toronto, 15-30 minutes from ex-
cellent summer and winter resort areas.
SALARIES:
Reg. Nurses: $470.00 - $570.00 per month
(plus shift diff.)
Reg. Nursing Assistants: $349.00 - $394.00
FURNISHED APARTMENTS
Swimming pool, tennis courts, etc. (see above)
OTHER BENEFITS:
Medical and hospital insurance, pension plan, 40 hour week.
Please address all enquiries to:
Director of Nursing,
YORK COUNTY HOSPITAL
596 Davis Drive,
NEWMARKET, Ontario.
TORONTO GENERAL
HOSPITAL
1820-1968
UNIVERSITY TEACHING
AND RESEARCH CENTRE
(1.300 Beds)
PROFESSIONAL GROWTH
Planned Programmes in
— Orientation
— Staff Education
— Staff Developnnent
PERSONNEL POLICIES
Salaries:
— Comnnensurate with Qualifications, Experience
— 3 weeks vacation
— 8 statutory holidays
— Cumulative Sick Leave
— Pension Plan
— Hospitalization and medical insurance plan
— Uniforms Laundered Free
OPPORTUNITIES FOR
General Staff Nurses
Registered Nursing Assistants
in
Clinical Services:
— Medicine, Surgery, Obstetrics, Gynaecology
Specialty Units:
— Cardiovascular, Clinical Investigation, Coro-
nary, Neurosurgery, Psychiatry, Operating
Room, Recovery Room, Renal dialysis. Res-
piratory
Administrative and Teaching Positions:
— Consideration given to applicants with Uni-
versity preparation and/or experience.
Applicants' requests for any of the above positions
will be given careful consideration.
For additional information write:
Miss M. Jean Dodds,
Director of Nursing,
TORONTO GENERAL HOSPITAL
101 College Street
Toronto 2, Ontario.
)iECEMBER 1%9
THE CANADIAN NURSE 63
PROVINCE OF BRITISH COLUMBIA
has opening for
MENTAL HEALTH NURSES
CRANBROOK
SALARY: $674 rising to $820 per month
To function with mininnal guidance as the nurse mennber of o
Mental Health Centre team in the planning operation and evaluation
of a community mental health programme. The nurse provides direct
service to patients and families with complex problems where
sensitivity, symptom recognition and skilled techniques are manda-
tory; functions as a mental health educator on the development of
community programmes.
Applicants must be Canadian Citizens or British subjects and be
R.N. with B.Sc. in Nursing, and preferably Master's degree, and two
years' clinical experience in mental health practice.
NOTE: Non-degree R.N.'s with P.H.N, diploma and related experi-
ence may commence of salary range, $602, rising to $730 per
month.
Obtain applications from
the Personnel Officer
CIVH. SERVICE COMHISSION OF BRITISH COLlfMBIA
Valleyview Lodge, ESSONDALE, and return lAAMEDIATELY
COMPETITION NO. 69:1170
McMASTER UNIVERSITY
SCHOOL OF NURSING
Challenging positions will be
open July 1970 for well-prepar-
ed nurse practitioners as faculty
members of a progressive and
expanding School of Nursing.
The School, established in 1946,
is on integral part of a newly
developed Health Sciences'
Centre where collaborative rela-
tionships within nursing and
among the health professions are
fostered.
Minimum educational require-
ment is a Master's degree.
Applications are invited in the
following fields:
MEDICAL-SURGICAL NURSING
PUBLIC HEALTH NURSING
PSYCHIATRIC NURSING
NURSING SCIENCE
Apply sending curriculum vitae
and two references to:
Director, School of Nursing
McMASTER UNIVERSITY
Hamilton, Ontario
SUNNYBROOK HOSPITAL
UNIVERSITY OF TORONTO TEACHING CENTRE
OFFERS YOU
OPPORTUNITIES FOR DEVELOPMENT IN OUR NURSING DEPARTMENT
STAFF RESIDENCE ACCOMMODATION
PARKLAND SEHING
EXCELLENT TRANSPORTATION TO DOWNTOWN
EXPANDING PROFESSIONAL OPPORTUNITIES
THREE WEEKS VACATION
PAID SICK LEAVE
FOR MORE INFORMATION
ABOUT STAFF POSITIONS AND OUR DEVELOPING NURSING
RESEARCH UNIT WRITE TO:
CO-ORDINATOR OF PROFESSIONAL EMPLOYMENT
SUNNYBROOK HOSPITAL
2075 BAYVIEW AVENUE
TORONTO 12, ONTARIO
64 THE CANADIAN NURSE
DECEMBER 1969
ROYAL YiaORIA HOSPITAL
MONTREAL, P.O.
invites applications from
Registered Nurses for
GENERAL DUTY
Inservice Education Program
Progressive Personnel Policies
Inquiries from Nurses with
Special Preparation are welcome
for further information apply to:
The Director of Nursing
ROYAL VICTORIA HOSPITAL
Montreal 112, P.Q.
We invite you
to consider joining our Nursing Staff
1
r
OHAWA
This large, well equipped
CIVIC
and fully accredited Teach-
ing hospital offers a va-
HOSPITAL
riety of Clinical experience
for nurses motivated to
OHAWA 3
learn.
ONTARIO
OUR EMPHASIS IS ON:
Please write for further
Special Care Units.
information to:
Miss B. Jean Milligan M.A.
In Depth Orientation Pro-
Assistant Executive Director
gram.
OTTAWA CIVIC HOSPITAL
Development of Staff.
Ottawa 3, Ontario
JEWISH
GENERAL HOSPITAL
MONTREAL, QUEBEC
A modern 650-bed non-sectarian hospital with a School of Nursing. Planned Orientation Programme.
In-Service Education Programme. Excetlent personnel policies. Bursaries for post-basic courses in Teaching
and Administration.
Interested in applications for all services: Supervisors, Head Nurses, Assistant Head Nurses, General Staff
Nurses, Certified Nursing Assistants.
For further information, please v^rite:
DIRECTOR, NURSING SERVICE
JEWISH GENERAL HOSPITAL
3755 COTE ST. CATHERINE ROAD
MONTREAL, QUEBEC
DECEMBER 1%9
THE CANADIAN NURSE 65
REGISTERED NURSES FOR
GENERAL STAFF
REGISTERED NURSING ASSISTANTS
Peel Memorial Hospital is a 250-bed
accredited general hospital, presently
expanding to 450 beds, with our first
new ward opening projected for January
1970.
Brampton is a town of 38,000, 30 minutes
drive from the O'Keefe Centre in down-
town Toronto. Our nurses enjoy a 37 1/2
-hour week with excellent fringe benefits.
Please telephone or write for further
information, we shall be pleased to hear
from you.
Mrs. Freda Garden, R.N.
Personnel Assistant
PEEL MEMORIAL HOSPITAL
Brampton, Ontario
REGISTERED NURSES
Qualified or Interested in Qualifying for
Employment in Intensive Cardiac Care Unit
GENERAL STAFF NURSES
REGISTERED NURSING
ASSISTANTS
Modern 395-bed, fully accredited Generol
Hospital with School of Nursing.
Excellent personnel policies, O.H.A. pen-
sion plan.
Pleasant, progressive, industrial city of
23,000.
Apply:
Personnel Officer
ST. THOMAS-ELGIN
GENERAL HOSPITAL
St. Thomas, Ontario
WILSON MEMORIAL
GENERAL HOSPITAL
requires
REGISTEkED NURSES
FOR GENERAL DUTY
20-bed hospital. Locoted in Northwestern
Ontario community. Liberal fringe benefits
include pension plan, OHA group
insurance, paid vacation, 9 statutory
holidays. Residence accommodation avail-
able at nominal rate. Salary scale —
$460. to $550. with recognition for post
service. '
Apply:
Miss E.P. Hoffman
Administrator
AAARATHON, Ontario
HEAD NURSE
Required For
8-BED INTENSIVE CARE UNIT
in
313-Bed Accredited Hospital.
Must hove experience at Supervisory
level and/or Formal Training in I. CD.
Good Salary and Fringe Benefits.
Accommodation Available.
Pleasant Living in The Festival City.
Apply in writing to:
Personnel Officer
STRATFORD GENERAL HOSPITAL
Stratford, Ontario
BROMPTON HOSPITAL
LONDON, S. W. 3
ENGLAND
Good Canadian nurses are welcomed at
the above named hospital, which specia-
lises in diseases of the heart and lungs.
Post registration courses of six months
or or>e year. Staff nurses posts available
for short or long periods.
Whitley scale salary and holiday with
pay in all posts.
Additional unpaid leave for tours by
arrangement.
Please apply to:
AAATRON
OWEN SOUND GENERAL
AND MARINE HOSPITAL
Requires
REGISTERED NURSES
For all departments irKluding Intensive
Core Unit, Operating Room and Emer-
gency Department. This is a 250-bed fully
accredited hospital located in the vaca-
tion centre of Georgian Bay. Recognition
given for experience and post basic
education.
For information and application
Write to:
MISS W. BELL
Director, Nursing Service
RIVERSIDE HOSPITAL
OF OnAWA
Applications are called for Nurses for the
positions of:
ASSISTANT HEAD NURSES,
GENERAL STAFF NURSES
and
REGISTERED NURSING
ASSISTANTS
Address all enquiries to:
Director of Personnel
RIVERSIDE HOSPITAL
OF OTTAWA
1967 Riverside Drive,
Ottawa, Ontario
ST. JOSEPH'S
SCHOOL OF NURSING
HAMILTON, ONTARIO
requires
TEACHERS for 2 + 1 year program in a
well-equipped modern School of Nursing.
Progressive eHucational trends. Student
enrollment approx. 350. Affiliated with a
modern 800-bed Hospital. The applicant
must have a Bachelor of Nursing degree
or its equivalent.
for further details apply:
Director
ST. JOSEPH'S
SCHOOL OF NURSING
ASSISTANT DIRECTOR OF
NURSING - EDUCATION
SUPERVISORS
HEAD NURSES
CERTIFIED NURSING ASSISTANTS
Come and work in a psychiatric hospital
where individual interest and initiotVve
are encouraged. Ample opportunity for
advancement.
Apply:
Director of Nursing
DOUGLAS HOSPITAL
6875 Lasalle Blvd.
Verdun, Quebec
66 THE CANADIAN NURSE
DECEMBER 1969
ST. JOSEPH'S HOSPITAL
TORONTO, ONTARIO
Registered Nurses
700-bed fully accredited hospital
provides experience in Operating
Room, Recovery Room, Intensive
Core Unit, Pediatrics, Orthope-
dics, Psychiatry, General Surgery
and Medicine, Observation Unit.
Orientation and Active Inservice
Program for all staff.
Salary is commensurate with
preparation and experience.
Benefits include Canada Pension
Plan, Hospital Pension Plan. Af-
ter 3 months, cumulative sick
leave — Ontario Hospital Insur-
ance — Group Life Insurance —
P.S.I. (Blue Plan) — 66 2/3%
payment by hospital.
Rotating Periods of duty — 40
hour vk^eek, 9 statutory holidays
— annual vocation 3 v^eeks af-
ter one year.
Apply:
Assistant Director of
Nursing Service
ST. JOSEPH'S HOSPITAL
30 The Queensway
Toronto 3, Ontario
NUMBER MEMORIAL HOSPITAL
Positions for Registered Nurses and Registered Nursing Assistants are
available in the Nursing Department of this new 350 bed active, general
hospital.
A high quality of patient care is given and a friendly working environ-
ment exists for all personnel associated with the hospital.
• • •
Furnished apartments are available at subsidized rates.
Orientation and Inservice Educational programmes are provided.
Salary range for Registered Nurses — $470.00 - $570.00 per month.
Recognition is given for past experience.
You are invited to enquire concerning employment opportunities to:
Director of Nursing
NUMBER MEMORIAL HOSPITAL
200 Church Street, Weston, Ontario
Telephone 249-8111 (Toronto)
PROVINCE OF BRITISH COLUMBIA
has openings for
OCCUPATIONAL THERAPIST
HILLSIDE REHABILITATION UNIT
ESSONDALE
SALARY: $537 rising to $649 per month.
To carry on a programme of vocational assessment of psychiatric patients who are preparing to return to community living; to prepare
individual plans for patients; write reports; recommend vocational training or placement, arranging small sheltered workshops.
Requires a Registered Occupational Theropist with two years' experience, preferably in the psychiatric field; preferably some supervisory
experience; requires a mature individual with interest in practical work with individual patients ot the time of discharge, administrative
ability,
COMPETITION NO. 69:614B
STAFF NURSING INSTRUCTOR
RIVERVIEW HOSPITAL
SALARY: $649 rising to $785 plus special training bonus where opplicable. To develop and direct staff orientation and educotion pro-
grammes for several categories of nursing personnel; related duties.
Requires Registered R.N. in British Columbia; post-basic preparation in teaching and supervision; satisfactory experience in general and
psychiatric nursing essential.
COMPETITION NO. 69:824B
DIETITIAN
VALLEYVIEW LODGE
SALARY: $559 rising to $674 per month.
To assist the chief Dietitian in supervising dietary arrangements.
Requires University graduation in Home Economics specializir>g in food and nutrition with approved dietetic Training.
COMPETITION NO. 69:1120
Applicants must be Canadian citizens or British subjects.
Obtain applications from Civil Service Commission of British Columbia
Valleyview Lodge, ESSONDALE, AND RETURN lAAMEDIATELY
(DECEMBER 1%9
THE CANADIAN NURSE 67
AJAX AND PICKERING
GENERAL HOSPITAL
AJAX, ONTARIO
127-beds
Nursing the Patient as an individual,
Vacancies for Registered Nurses for all
areos. Full time and part time. Collective
bargaining. Consideration for experience
and education. Excellent fringe benefits.
Apply:
NURSING OFFICE PERSONNEL
Applications are invited for the
position of:
UNIT COORDINATOR
FOR
OPERATING ROOM
AND OBSTETRICS
This position carries responsibility for
organization and co-ordination of all
facets of these specialties v^ithin a fully
accredited 180-bed hospital.
Enquiries or applications stating
experience and qualifications should be
addressed to:
The Director, Nursing Service
ST. JOSEPH'S HOSPITAL
Sudbury, Ontario
COORDINATOR
NURSING STAFF
DEVELOPMENT PROGRAMME
REQUIRED
For 313-bed Accredited Hospital
Opportunity to exercise skill of leadership
and creative motivation in the orientation
and education of nursing personnel.
Good salary and fringe benefits.
Accommodation available.
Enjoy working in the Festival City
Conado.
of
Apply in writing to:
Personnel Officer
STRATFORD GENERAL HOSPITAL
Stratford, Ontario
nurses
who want to
nurse
At York Central you can join
an active, interested group of
nurses who want the chance to
nurse in its broadest sense. Our
126-bed, fully accredited hospi-
tal is young, and already talking
expansion. Nursing is a profes-
sion we respect and we were the
first to plan and develop a unique
nursing audit system; new mem-
bers of our nursing staff do not
necessarily start at the base salary
of $470 per month plus shift
differential. Added pay for prev-
ious years of work. There are
opportunities for gaining wide ex-
perience, for getting to know pa-
tients as well as staff.
Situated in Richmond Hill, all
the cultural and entertainment fa-
cilities of Metropolitan Toronto
are available a few miles to the
South . . . and the winter and
summer holiday and week-end
pleasures of Ontario are easily
accessible to the North. If you
are really interested in nursing,
you are needed and will be made
welcome.
Apply in person or by mail to the
Director of Nursing.
YORK
CENTRAL
HOSPITAL
RICHMOND HILL,
ONTARIO
NEW STAFF RESIDENCE
REGISTERED NURSES
For new 151 -bed General Hospital in the
beginning stages of an expansion pro-
gram, located on the beautiful Lake of
the Woods. Three hours' travel time from
Winnipeg with good transportation avail-
able. Wide variety of summer and win-
ter sports — swimming, boating, fishing,
golfing, skating, curling, toboggoning,
skiing.
Salary: Registered Nurse $485. — Shift
Differential $1.00, with allowance for
experience. Good personnel policies.
Apply to:
Director of Nursing
LAKE OF THE WOODS
DISTRICT HOSPITAL
Kenora, Ontario
WE DON'T LIKE TO BOAST ■
at DESERT HOSPITAL in
but
BEAUTIFUL SMOG FREE PALM SPRINGS,
CALIFORNIA
We ploy Golf in the Sunshine while YOU
wade in Snow. NOW — if that is not
enough — HOW ABOUT THIS ?
STAFF NURSES — $644.00 to $905.00
SUPERVISORS — $821.00 to $998.00
Interested? Call Collect — or write today:
JO SAYRE, R.N.
Assist. Director - Personnel
Drawer EE
P.S. Calif — 92262
Area Code 714 — 324-1417
PORT COLBORNE
GENERAL HOSPITAL
PORT COLBORNE, ONTARIO
STAFF NURSES
required
for 166-bed hospital within easy driving
distance of Americon and Canadian me-
tropolitan centres. Consideration given for
previous experience obtained in Canada.
Completely furnished apartment-style resi-
dence, including balcony and swimming
pool, adjocent to hospital.
Apply:
Diractor of Nursing
GENERAL HOSPITAL
Port Colborno.Ontorio
68 THE CANADIAN NURSE
DECEMBER 1969
THE MONTREAL GENERAL HOSPITAL
offers a
6 month Advanced Course in
Operating Room Technique and
Management to
REGISTERED NURSES
with a year's Graduate experience
in an Operating Room.
Classes commence in September and
March for selected classes of
8 students
For further information apply to :
The Director of Nursing
THE MONTREAL GENERAL HOSPITAL
Montreal 109, Quebec
ROYAL VICTORIA HOSPITAL
SCHOOL OF NURSING
MONTREAL, QUEBEC
POSTGRADUATE COURSES
1. (a) Six month clinical course in Obstetrical Nurs-
ing. Classes — September and March.
(b) Two month clinical course in Gynecological
Nursing. Classes following the six month
course in Obstetrical Nursing.
(c) Twelve week course in Care of the Premature
infant.
2. Six month course in Operating Room Technique.
Classes — September and March.
3. Six month course in Theory and Practice in Psy-
chiatric Nursing.
Classes — September and March.
For information and details of the courses, apply to:
Director of Nursing
ROYAL VICTORIA HOSPITAL
Montreal, P.Q.
UNIVERSITY OF BRITISH COLUMBIA
SCHOOL OF NURSING
DEGREE PROGRAAAMES
Baccalaureate — basic students
— registered nurses
This course for both groups of students leads to
the B.S.N, degree, and prepares the graduate for
public health as well as hospital nursing positions.
Master's
For qualified baccalaureate nurses leading to the
degree of M.S.N. This course, two years in length,
prepares the graduate for leadership roles in nurs-
ing with emphasis on clinical expertise.
DIPLOMA PROGRAMMES
— for registered nurses.
Public Health Nursing (Nursing B)
Administration of Hospital Nursing Units
(Nursing C)
Psychiatric Nursing (Nursing E)
for information write to:
The Director
SCHOOL OF NURSING, UNIVERSITY OF B.C.
Vancouver 8, B.C.
SCARBOROUGH CENTENARY HOSPITAL
(located Within Metropolitan Toronto)
Invites Applications For:
GENERAL STAFF R.N.
GENERAL STAFF R.N.A.
This modern 525-bed hospital is fully equipped with the latest
facilities to assist personnel in patent care and embraces the most
modern concepts of team nursing. Excellent personnel policies ore
available. Progressive staff and management development programs
offer the maximum opportunities for those who are interested.
Salary is commensurate with experience and ability.
Single Room Residence Accommodation Available.
For further information, please direct your enquiries to:
Personnel Department
SCARBOROUGH CENTENARY HOSPITAL
2867 Ellesmere Rd., West Hill, Ontario
)ECEMBER 1%9
THE CANADIAN NURSE 69
DO YOU
WANT TO HELP
YOUR PROFESSION?
Then till out and send in the form below
REMITTANCE FORM
CANADIAN NURSES' FOUNDATION
50, The Driveway, Ottawa 4, Ontario
A contribution of $ payable to
the Canadian Nurses' Foundation is enclosed
and is to be applied as indicated below:
(VIEMBERSHIP (payable annually)
Nurse Member — Regular $ 2.00
Sustaining $ 50.00
Patron $500.00
Public Member — Sustaining $ 50.00
Patron $500.00
BURSARIES $ RESEARCH $
MEMORIAL $ in memory of
Name and address of person to be notified of
this gift
REMIHER
Address
Position
Employer
(Print name in full)
N.B. CONTRIBUTIONS TO CNF
ARE DEDUCTIBLE FOR INCOME TAX PURPOSES
Index
to
advertisers
December 1969
Ayerst Laboratories 5 1
Baxter Laboratories of Canada Cover II
Canadian University Service Overseas 17
Clinic Shoemakers 2
Davis & Geek 8
De Puy Manufacturing Company (Canada) Ltd 24
Facelle Company Limited 46
Foster Parents Plan of Canada 21
Hoechst Pharmaceuticals 5
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70 THE CANADIAN NURSE
DECEMBER 1%9
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Can Love. Compassion, and
Involvement Be Scientific?
Anne H. Rohweder, M.N., discusses this timely question in the December Nursing Clinics
of North America, in one of seventeen vital articles. Among the others are "Nursing Care
of the Cardiac Surgery Patient," by Barbara Rogoz, M.S.N., and "Staffing and Staff Rela-
tions in Coronary Care Units," by Catherine A. Baden, B.S.N. Ad., and Jacquelyn A.
Huebsch, B.S. Each of the seventeen articles is written especially for the Nursing Clinics
by a leading authority, and each illuminates a specific facet of the subject of a symposium.
The two symposia in the forthcoming December issue are: "Care of the Cardiac Patient,"
with Adeline C. Jenkins, R.N., as Guest Editor, and "Compassion and Communication in
Nursing," with Grace Theresa Gould, M.S., as Guest Editor.
Widely known and valued as a continuing source of information on the latest nursing
concepts and techniques, these unique hardbound periodicals ore almost like a post-
graduate seminar, designed and written specifically to meet the needs of practicing nurses.
Each issue (there ore four per year) contains about 185 pages, with no advertising, bound
between hard covers for permanent reference use. Sold only by annual subscription.
Nursing Clinics of North America. Per year (4 issues) $13.
Selected 1 969 Reference Books
Nelson, McKay & Vaughan: Textbook of Pediatrics
In this standard text, 85 contributors discuss hundreds
of childhood disorders, giving etiology, pathology,
epidemiology, immunology, clinical manifestations,
diagnosis, prognosis, prevention, and treatment.
Edited by WALDO E. NELSON, M.D., D.Sc, R. JAMES McKAY, M.D.,
and VICTOR C. VAUGHAN III, M.D.. 1590 pages, 527 illustrations,
26 in full color. $23.25. Ninth edition published August, 1969.
Singer & Singer: Psychological Development in
Children
Instead of merely describing what children are like at
various ages, this new text emphasizes the processes
of development and presents a unified theory.
By ROBERT D. SINGER, Ph.D., and ANNE SINGER, 437 poges,
illustrated. $8.65. Just ready. Published October, 1969.
az3e
Jablonski: Dictionary of Eponymic Syndromes
This much-needed reference lists nearly 10,000 names
for 2500 diseases and syndromes, with concise clinical
descriptions and references.
By STANLEY JABLONSKI. 335 pages with 126 illustrations. About
$13.80. Just ready.
Morgan & Engel: The Clinical Approach to the Patient]
The basic skills of acquiring, analyzing, and reporting]
clinical data — skills that ore vitally important to the!
physician — ore presented in this book. Nurses, too,
will find it valuable as a sourcebook of techniques
and of the principles of understanding the patient's
experience with illness.
By WILLIAM L. MORGAN, Jr., M D., and GEORGE L. ENGEL, M.D. J
314 pages, illustrated. $10.55. Published May, 1969.
W. B. SAUNDERS COMPANY CANADA LTD., 1835 Yonge Street, Toronto 7
n Please enter my subscription to 'h^l'^^aR's!''*iF' °' North America, to start with the December issue, oncJ
bill me. 1 year (4 issues) $13
Please sencJ on approval a
n Nelson, McKay & Vau
□ Jablonski: Dictionary i
n Singer & Singer: Psych
D Morgan & Engel: Approad
Name:
obout $13.80)
about $8.65)
55)
AcJdress: Zone:
Province:
CN 12-69
La Blbtloth^qu^.
Universite d' Ottawa
EchSance
The, LlbAoAy
University of Ottawa
Date Due
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PR \ L ^^^^
IJAN 0 5 2CC5
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