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f '  « 


S.-''J 


I  ^ 


I 


DO   NOT  TAKI 
OUT   OF   UBRAftV 


January  1975 


Nurse 


UNIVERSITY  OF  OTTAVJA 
NURSING  LIBRARY 
OTTAWA.  ONT. 

KIN  bN5 

12-7t-FAX-ll-74-CN-PD 


Drug  administration  times  should  be  reexamined 


9 


^ 


See  our  new  line 

of  Whites  and  Water  colours 


^ABPP^      A*%««AP»^B 


.^  X 


New...readytouse... 
"bolus"  prefilled  syringe. 

Xylocaine'100  mg 

(lidocaine  hydrochloride  injection,  USP) 

For  'Stat'  I.V.  treatment  of  life 
threatening  arrhythmias. 


D  Functions  like  a  standard  syringe. 

D  Calibrated  and  contains  5  ml  Xylocaine 


« 


D  Package  designed  for  safe  and  easy 
storage  in  critical  care  area 


V 


n  The  only  lidocaine  preparation 
with  specific  labelling 
information  concerning  its 
use  in  the  treatment  of  cardiac 


arrhythmias 


an  original  from 

ASTItA 


Xylocaine"  100  mg 

(Itdocaine  hydrochloride  injection  USP  ) 

INDICATIONS-X\locaine  ddministered  intra- 
venouslv  is  specifically  indicated  in  the  acute 
management  of  t  It  ventricular  arrhvthmias  occur- 
ring during  cardiac  manipulation,  such  as  cardiac 
surgcn,:  and  (2)  life- threaiening arrhythmia*.,  par- 
ticularly those  which  arc  ventricular  in  origin,  such 
as  iKcur  during  acute  myocardial  infarction. 

CONTRAINDICATIONS  Xylocaine  is  contra- 
indicated  (U  in  patients  with  a  known  history-  of 
hypersensitivity  to  local  anesthetics  of  the  amide 
type;  and  (2)  in  patients  with  .Adams-Stokes  syn- 
drome or  with  severe  degrees  of  sinoatrial,  atrio- 
ventricular or  intraventricular  block. 

WARNINCS-Constant  monitoring  with  an  elec- 
trocardiograph is  essential  in  the  proper  adminis- 
tration of  Xvlocaine  intravenously  Signs  of  exces- 
sive depression  of  cardiac  conducttvitv.  such  as 
prolongation  o(  PR  interval  and  QRS  complex 
and  the  appearance  or  aggravation  of  arrhythmias, 
should  be  followed  by  prompt  cessation  of  the 
intravenous  infusion  ofthis  agent.  It  is  mandatory 
to  have  emergency  resuscilative  equipment  and 
drugs  immediaieiy  available  to  manage  possible 
adverse  reactions  involving  the  cardiovascular, 
respiratory  or  central  nervous  systems. 

Evidence  for  proper  usage  in  children  is  limited. 

PRECACTIONS-Caution  should  be  employed 
in  the  repeated  use  of  Xylocaine  in  patients  with 
severe  liver  or  renal  disease  because  accumulation 
may  t>ccurandmav  lead  to  toxic  phenomena,  since 
Xylocame  is  metaboii/ed  mainly  in  the  liver  and 
e.xcretcd  bv  the  kidnev  The  drug  should  also  be 
used  with  caution  in  patients  with  hypovolemia 
and  sht^Kk.and  all  forms  of  heart  bKx-k(seeCON- 
TRAINDK  ATIONS  AND  WARNINGS! 

In  paltent:>  with  smus  bradycardia  the  adminis- 
tration of  Xvlocaine  intravenously  for  the  elimina- 
tion of  ventricular  ectopic  beaLs  without  prior 
acceleration  in  heart  rate  (e.g.  by  isoproterenol 
or  by  electric  pacing)  may  proyoke  more  frequent 
and  serious  ventricular  arrhythmias. 

ADVERSE  REACTIONS-Systemic  reactions  of 
the  following  types  have  been  reporied 

(1)  Central  Nervous  System:  lightheadedness, 
drowsiness:  dizziness:  apprehension:  euphoria; 
tinnitus;  blurred  or  double  vision:  vomiting:  sen- 
sations of  heal,  cold  or  numbness,  twitching, 
tremors:  convulsions:  unconsciousness;  and  respi- 
ratory depression  and  arrest. 

(2)  Cardiovascular  System:  hypotension:  car- 
diovascular collapse:  and  bradycardia  which  mav 
lead  to  cardiac  arrest 

There  have  been  no  reports  of  cross  sensitivity 
between  Xylocame  and  procainamide  or  between 
Xvlocaine  and  quinidine. 

DOSAGE  AND  ADMINISTRATION-Single 
Injection:  The  usual  dose  is  50  mg  to  100  mg 
administered  intravenously  under  tCG  monitor- 
ing. This  dose  may  be  administered  at  the  rate 
of  approximately  25  mg  to  50  mg  per  minute. 
Sufhcient  time  should  be  allowed  to  enable  a  slow 
circulation  to  carrv  the  drug  to  the  sue  of  action. 
If  the  initial  inieciion  of  50  mg  to  100  mg  does 
not  produce  a  desired  response,  a  second  dose  may 
be  repeated  after  10-20  minutes. 

NO  MORE  THAN  200  MG  TO  300  V1G  OF 
XYLOCAINE  SHOULD  BE  ADMINISTERED 
DURING  A  ONE  HOUR  PERIOD 

In  children  experience  with  the  drug  is  limited. 

Continuous  Infusion:  Following  a  single  injection 
in  those  patients  in  whom  the  arrhythmia  tends 
to  recur  and  who  are  incapable  of  receiving  oral 
antiarrhythmic  therapy,  intravenous  infusions  of 
Xylocaine  may  be  administered  at  the  rate  of  I 
mgio  2  mg  per  minute  (20  to  25  ug/kg  per  minute 
in  the  average  70  kg  man).  Intravenous  infusions 
of  Xylocaine  must  be  administered  under  constant 
ECG  monitoring  to  avoid  potential  overdosage 
and  toxicity  Intravenous  infusion  should  be  ter- 
minated as  soon  as  the  patient's  basic  rhythm 
appears  to  be  stable  or  at  the  earliest  signs  of 
toxicity  It  should  rarely  be  necessary  to  continue 
intravenous  infusions  bevond  24  hours  .As  soon 
as  possible,  and  when  indicated,  patients  should 
be  changed  to  an  oral  antiarrhythmic  agent  for 
maintenance  therapy 

Solutions  for  intravenous  infusion  should  be 
prepared  by  the  addition  of  one  50  ml  single  dose 
vial  of  Xylocaine  2^  or  one  5  ml  Xylocaine  One 
Gram  Disposable  Transfer  Synnge  to  1  liter  of 
appropnate  solution.  This  will  provide  a  0.1% 
solution:  that  is.  each  ml  will  contain  I  mg  of 
Xylocaine  HCl.  Thus  I  ml  to  2  ml  per  minute 
will  provide  I  mg  to  2  mg  of  Xylocaine  HCl  per 
minute. 


New  style 


I 


Clinical  studies  have  sliown  that  SELSUN  controls  up  to 
95%  of  simple  dandruff  cases^  and  87%  of  cases  of 
seborrheic  dermatitis". 

Controlling  seborrhea  is  vital  to  best  results  in  treating  such 
skin  conditions  as  acne,  blepharitis  and  otitis  externa. 

Precautions  and  side  effects:  Keep  out  of  the  eyes;  burning 
or  irritation  may  result.  Avoid  application  to  inflamed  scalp 
or  open  lesions.  Occasional  sensitization  may  occur. 


'    H.'rZnm'^.jM-.H^'^A^".''*''''.'*'  Po'  '^'^^'^Tt"'  <"  Scborrheic  Dermatitis  with  a  Shampoo  con.»rWng 
belenium  Sulfide.  AM  A    Arch.  Dermal.  &  Syph.,  6441,   1951  ►■        -  '    s) 

^     ?954^'°"'    ^^  '    "^^^   °'    ^^'*""""    Sulfide    Shampoo    in    Seborrheic    Dermalilis     JAMA.    156  1246, 


selenium  sulfide  lotion,  Abbott  Standar 

No  more  reliable  dandruff 
treatment  anywhere 


I    PfWIAC    I 


RD.  T.M. 


437450 


The 

Canadian 
Nurse 


^^17 


A  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  by  the  Canadian  Nurses'  Association 


Volume  71,  Number  1 


January  1975 


Editorial 


17    Drug  Administration  Times 

Should  Be  Reexamined!  B.B.  Moggach 

20   An  Experiment  with  the  Ladder  Concept   J. A.  Hezekiah 

23    Nursing  in  the  Sky M.  Hill,  M.  McLean,  E.  Sherwood 

27    What  Do  Nurses  Do  to 

Help  Patients  Who  Attempt  Suicide? R.  Cunningham 

30   A  Nutrition  Course  for  Nurses G.  Lapointe 

34    Idea  Exchange S.  Pearson,  C.  Roseli,  M.  Hitch 


The  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

9  News 

36  Names 

43  New  Products 


44  Dates 

45  Books 

46  Accession  List 

64  Index  to  Advertisers 


Executive  Director:  Helen  K.  Mussallem  • 
Editor:  Virginia  A.  Lindabury  •  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Dorothy  S. 
Starr  «  Production  Assistant:  Mary  Lou 
Downes  •  Circulation  Manager:  Beryl  Dar- 
ling •   Advertising    Manager:    Georgina    Clarke 

•  Subscription  Rates:  Canada:  one  year 
$6.00;  two  years,  $11.00.  Foreign:  one  year, 
$6.50;  two  years,  $12.00.  Single  copies: 
$1.00  each.  Matse  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  registration  number  in  a  pro- 
vincial nurses'  association,  where  applicable. 
Not  responsible  for  journals  lost  in  mail  due 
to  errors  m  address. 


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  rale 
MONTREAL.  P.Q.  Permit  No.  10,001. 
50    The    Driveway,    Ottawa,    Ontario,    K2P1E2 

®    Canadian  Nurses'  Association  1^75, 


\NUARY   1975 


This  past  week,  10,000  persons 
around  the  world  died  of  starvation ;  this 
coming  week,  another  10,000  will  die 
from  the  same  cause.  To  find  out  how 
many  will  be  dead  by  this  date  next 
year,  just  multiply  10,000  by  52  and 
you  will  reach  a  fairly  accurate  count. 

Ten  thousand  deaths  weekly  from  a 
lack  of  food!  Unbelievable.  Yet,  we 
know  it  is  true,  as  we  have  seen  films 
on  our  television  screens  of  the  dead 
and  dying. 

Few  of  us  have  escaped  feeling  an 
overwhelming  sense  of  rrustration  over 
this  catastrophe.  Part  of  our  frustration 
is  a  reaction  to  the  disappointing  re- 
sults of  the  World  Food  Conference, 
where  most  nations  were  unwilling  to 
shed  their  political  differences  long 
enough  to  come  to  grips  with  this  crisis. 
As  one  writer  put  it,  the  conference  was 
an  exercise  in  moral  abdication. 

Our  frustration  —  and,  indeed,  guilt 

—  also  results  from  a  personal  feeling 
of  helplessness.  Here  we  are,  in  an 
affluent  society,  with  an  abundance  of 
food  on  our  table  each  day.  In  fact,  a 
major  concern  in  Canada  is  our  life- 
style, which  includes  —  for  many  of  us 

—  the  problem  of  overeating. 
What,  then,  can  we  do  to  help  feed 

the  one-half  billion  hungry  people  in  the 
world?  Two  things:  First,  send  money 

—  even  as  little  as  $1  will  help  —  to 
UNiCEF  Canada,  443  Mount  Pleasant 
Rd.,  Toronto,  Ontario,  M4S  2L8. 

Second,  we  can  send  an  avalanche 
of  letters  to  the  federal  government  in 
Ottawa.  If  each  member  of  the  Cana- 
dian Nurses'  Association  were  to  write 
a  letter  to  the  Prime  Minister  of  Can- 
ada, stating  that  this  country  should 
pledge  even  more  tons  of  gram  than 
was  promised  at  the  World  Food 
Conference,  this  would  mean  that  the 
P.M.'s  office  would  be  deluged  with 
over  97,000  letters  —  a  number  that 
can  not  be  ignored.  Although  Canada's 
record  at  the  conference  was  better 
than  most  countries,  it  can  still  be  im- 
proved.* 

As  members  of  the  CNA  —  the 
largest  group  of  professional  health 
workers  in  the  country —  we  have  an 
obligation  to  lead  the  way.  Let  no 
one  accuse  us  of  moral  abdication. 

—    V.A.L. 


*  Canada  pledged  1 ,000,000  tons  of  grain 
a  year  as  food  aid  over  ttie  next  three  years 
and  later  promised  anotlier  600,000  tons  if 
the  money  can  be  found  to  pay  for  it. 

THE  CANADIAN  NURSE     3 


letters    { 


Letters  to  the  editor  are  welcome. 

Only  signed  letters,  which  include  the  writer's  complete  address, 

will  be  considered  for  publication. 

Name  will  be  withheld  at  the  writer's  request. 


Value  of  nursing  research 

The  article  ■"Nursing  research  is  not  every 
nurse's  business"  by  Marjorie  Hayes  (Oc- 
tober 1974)  was  ofparticular  interest  to  me 
because  I  have  been  introducing  senior 
students  to  basic  concepts  of  nursing  re- 
search for  several  years,  although  I  cannot 
claim  to  be  a  nurse  researcher.  Our  goals 
are  to  create  an  awareness  in  students  of 
the  need  for  nursing  research,  and  of  the 
nurse's  role  in  contributing  to  it. 

The  fact  that  bona  fide  research  requires 
a  specially  trained  person  does  not  negate 
Lucille  Nirtter's  contention  that  "" nursing 
research  is  every  nurse's  business,"  as 
quoted  by  Hayes. 

Research  depends  on  the  collection  of 
data,  and  every  nurse  practitioner  provides 
data  in  her  daily  reporting  and  recording. 
The  validity  of  such  data  depends  on  con- 
sistency and  accuracy. 

It  therefore  seems  reasonable  to  assume 
that  every  nurse  who  has  made  nursing 
research  her  business  can  better  appreciate 
the  value  of  her  records  as  a  potential 
source  of  data  for  the  nurse  researcher;  she 
is  also  better  prepared  to  identify  problems 
that  can  be  researched,  which  could  be 
overlooked  by  the  specially  trained  nurse- 
researcher-practitioner  herself. 

Hayes  believes  that  nurses  ought  to  be 
"provided  with  the  opportunity  to  learn 
about  research."  This  seems  to  imply  that 
every  nurse  should  make  nursing  research 
her  business,  at  least  to  some  degree.  I 
assume  then  that  the  meaning  of  her  title  is 
based  on  her  belief,  which  I  accept,  that 
not  every  nurse  can  be  or  should  be  a 
researcher. 

The  clarification  of  this  point  prompted 
my  letter.  It  is  not  intended  as  a  criticism  of 
Hayes"  summary  of  nursing  research  and 
its  needs,  so  succinctly  expressed  by 
her.  —  Joyce  Neviti.  Associate  Professor 
of  Nursi/i^.  Memorial  University  of 
Newfowidlund.  St.  John's. 


The  author's  thesis,  that  not  all  nurses  are 
adequately  prepared  to  conduct  formal 
research,  has  merit.  But  this  postulate 
cannot  be  a  license  to  state  that  research  is 
not  every  nurse's  business. 

As  nursing  moves  more  toward  a 
professional  stature,  it  becomes  impera- 
tive that  all  nurses  be  familiar  with  the 
benefits  as  well  as  the  limitations  of 
research  in  nursing.  Unless  we  can  apply 
the  knowledge  gleaned  through  research 
to  our  practice,  our  research  is  for  naught. 
4     THE  CANADIAN  NURSE 


Perhaps  not  every  nurse  should  be  a 
producer  of  research,  but  every  nurse 
should  be  an  intelligent  consumer  of 
research. 

I  support  wholeheartedly  Hayes" 
statements  that  nurses  must  be  provided 
opportunities  to  learn  about  research. 
Educators  and  administrators  must  recog- 
nize that  they  possess  a  responsibility  to 
those  they  lead  to  provide  a  climate 
conducive  to  learning  about  research. 
Students  of  nursing,  on  the  other  hand, 
must  be  prepared  to  avail  themselves  of 
this  climate. 

The  intelligent  use  of  research  in  the 
process  of  caring  for  people  is  every 
nurse's  business  —  James  D.  Parsek. 
R.N..  M.A.  (NSA),  Assistant  Professor. 
School  of  Nursing,  Northern  Michigan 
University,  Marquette,  Michigan.  U.S.A. 


In  her  article  "Nursing  research  is  not 
everv  nurse's  business"  (October  1974. 
p.  17).  Marjorie  Hayes  incorrectly  para- 
phrases Lucille  Notter.  Notter  contends 
that  the  use  and  dissemination  of  research 
is  a  professional  responsibility,  whereas 
Hayes  argues  that  not  every  RN  should 
become  a  nurse  researcher.  These  are  two 
entirely  different  ideas.  1  would  agree 
with  the  author  that  not  every  nurse  may 
desire  or  be  capable  of  doing  research  at 
the  level  she  describes;  however,  must 
research  be  so  large-scale  or  grandiose  to 
qualify  as  worthy  of  report,  discussion,  or 
use? 

Research,  a  form  of  problem-.solving. 
is  vital  to  the  development  of  nursing 
practice.  To  be  informed  of  research 
findings,  new  ideas,  ways  to  solve  sys- 
tematically the  client's  problems,  and  the 
data  needed  for  valid  conclusions  is  an 
integral  part  of  the  practitioner's  respon- 
sibility. 

Surely  nurses  have  a  commitment  to 
develop  skills  and  knowledge  if  they  wish 
to  serve  clients  adequately.  If  nursing 
research  is  not  every  nurse's  business, 
and  if  we  abdicate  our  responsibility  to 
the  development  of  our  discipline,  we 
have  no  right  to  call  ourselves  a  profes- 
sion or  to  offer  our  services  to  others. 
— Jan  Given,  London.  Ontario. 


Marjorie  Hayes  replies: 
1  thank  Joyce  Nevitt  for  her  comments 
that  so  well  restate  my  basic  concerns. 
Her  statement.   ""Every  nurse  who  has 


made  nursing  research  her  business  cai 
better  appreciate  the  value  of  her  records 
..."  surely  restates  my  concern  tha 
nurses  need  to  be  better  informed  abou 
research  and  the  ways  it  can  assist  ihei 
practice  b\  understanding  how  it  can  b[ 
interpreted.  One  way  of  creating  a  poiil  o 
better  prepared  nurses  is  to  providi 
research  concepts  in  nursing  educatioi 
concepts,  and  I  was  pleased  to  hear  o 
Nevitt's  efforts. 

I  agree  wholeheartedly  with  Janie 
Parsek  that  every  nurse  should  be  ai 
intelligent  consumer  of  research.  Unfor 
tunatelv ,  however,  the  nursing  professioi 
has  not  provided  avenues  for  nurses  t( 
become  intelligently  informed  about  re 
search  methodology,  statistics,  and  thei 
implication  for  nursing  care.  It  is  true  tha 
educators  and/or  administrators  must  ac 
cept  the  responsibility  to  provide  not  onl; 
a  climate  conducive  to  learning  but.  als( 
the  means  of  learning  about  research 
Students  must  expect  and  even  demam 
expert  teaching  in  research  design,  am 
that  involves  more  than  mere  '"problem 
solving"  techniques.  It  is  alright  to  kee| 
saying  that  every  nurse  should  use  re 
search  in  the  process  of  caring  for  people 
but  how  can  she  if  she  does  not  know  hov 
to  use  if.'  Intelligent  use  of  anythin; 
requires  informed  learning.  Surely,  th 
cliches  have  to  stop  and  actions  neC' 
to  start! 

I  am  sorry  that  Jan  Given  misinterprele 
what  I  wrote.  She  states  that  I  was  arguin 
that  every  nurse  should  become  a  nurs 
researcher.  What  I  was  attempting  to  stat 
clearly  was  that  nurses  cannot  be  expecte 
to  do  research  or  even  to  interpret  researc 
results  unless  adequate  provision  is  mad 
to  provide  learning  facilities,  climate.' 
and  role  models.  Surely  we  do  not  want  t 
abdicate  our  responsibility;  we  just  wantt; 
be  allowed  the  opportunity  to  be  well  irj 
formed.  'Assuming  one's  responsibilit' 
also  means  assuming  consequences  for  ac 
tions  demanded  as  a  result  of  those  respor 
sibilities.  Perhaps  there  are  not  enoug 
adequately  trained  and  informed  person 
to  call  ourselves  a  profession  at  this  timt 
if  you  assume  ability  to  do  and  make  use  c 
research  data  as  part  of  reaching  profei 
sional  stature  I 


Photos  wanted 

From  September  29  to  October  7.  1974. 
was  on  a  tour  of  Russia,  as  organized  b 

(CiiiirimictI  im  page  t 
JANUARY    197 


ENDORSED  For  SPRING 

By 
ESIGIMER'S  CHOICE 


V      A)  STYLE  No.  44250 
\       Sizes  3-15 
\      ROYALE  SPICE 
\     100%  POLYESTER  KNIT 

\  White, 
\\  pink  .  .^  about  $33.00 


B)  STYLE  No.  44725 

Sizes  5-15 
ROYALE  DIAMOND 
POLYESTER/NYLON    KNIT 

White 

only  .  .  .  about  $22.00 


C)  STYLE  No.  44744 

Sizes  3-15 

ROYALE  DIAMOND 

TRICOT  KNIT 

White 

only  .  .  .  about  $33.00 


lesigiier's 
n?s  cnoice 


\ 

AT  YOUR  FAVOURITE  CAREER  APPAREL  STORE 


{('nnrimtt'it  front  pilVf  ^t 

Professional  Seminars.  Ltd.  Like 
everyone  else.  I  took  many  photographs 
during  this  tour.  However,  they  did  not 
turnout. 

I  would  be  pleased  if  any  nurse  who 
was  on  that  tour  would  loan  nie  her  color 
slides  or  negatives  so  thai  1  could  have  my 
own  prints  made.  1  would  even  be  willing 
to  pay  for  these  slides  or  negatives.  — 
Tanva  Stauhin.  2155  W  1st  Ave.. 
Vancouver,  B.C.V6K  I E7. 


Stand  up  and  be  tested 

On  behalf  of  Recreation  Canada.  I  wish  to 
take  this  opportunity  to  thank  the  Cana- 
dian Nurses"  Association  and  the  host 
delegation  from  Manitoba  for  inviting  us 
to  the  recent  annual  meeting  in  Winnipeg. 
Display  representatives  were  heartily  en- 
couraged by  the  enthusiastic  reception  to 
and  participation  of  delegates  in  the 
fitness  appraisal  program. 

Unfortunately,  the  cardiovascular  step 
test,  now  commonly  referred  to  as  the 
Canadian  Home  Fitness  Test,  will  not  be 
available  this  year  as  anticipated.  It 
should  be  ready  for  distribution,  how- 
ever, during  the  spring  of  1975.  The 
formal  debut  of  the  Canadian  Home 
Fitness  Test  will  be  preceded  by  an 
appropriate  promotional  campaign.  We 
would  request  that  nurses  who  are  in- 
terested in  receiving  copies  delay  their 
requests  until  that  time.  —  Richard  R.J. 
Lauzon.  Fitness  Consultant,  Recreation 
Canada,  Health  and  Welfare  Canada, 
Ottawa. 


Down  under 

We  are  a  group  of  7  Canadian  RNs  who 
recently  came  to  work  in  Brisbane, 
Queensland.  Australia.  The  purpose  of 
this  letter  is  to  inform  fellow  Canadian 
nurses  who  are  considering  employment 
here  of  the  difficulties  and  inconsistencies 
they  may  meet  with  the  Nurses"  Registra- 
tion Board  upon  arrival  here. 

(Our  qualifications  are  varied.  Four  of 
us  have  a  bachelor  of  science  in  nursing 
degree,  and  three  are  graduates  from  a 
two-year  program,  with  an  additional  one 
to  two  years"  experience.  Previous  cor- 
respondence with  the  Nurses"  Board 
informed  the  university  graduates  that 
they  could  not  be  registered  if  they  had 
graduateil  from  a  two-year  program, 
unless  they  had  an  additional  one  year  of 
experience.  However,  the  two-year 
graduates  were  not  informed  of  this 
matter.  The  seven  of  us  have  all  met  these 
stated  qualifications. 

6     THE  CANADIAN  NURSE 


Upon  arriving  in  Brisbane,  we  found 
the  requirements  for  nurse  registration  to 
have  suddenly  become  more  difficult. 
The  first  2  Canadian  nurses  who  arrived 
were  able  to  become  registered:  however, 
the  next  5  nurses,  with  similar  qualifica- 
tions, were  not  registered  and  are  now 
required  to  work  as  third-year  students  for 
varying  lengths  of  time.  These  times 
range  from  three  to  six  or  eight  months. 
The  reasons  given  for  the  additional 
training  varies  from  the  need  for  addi- 
tional hours  to  the  need  for  experience  in 
a  specific  area. 

We  understand  that  a  large  number  of 
Canadian  nurses  have  been  recruited  for 
the  State  of  Queensland.  It  is  important 
that  they  realize  there  is  a  distinct 
possibility  they  will  not  be  registered,  but 
will  be  employed  and  paid  as  third-year 
student  nurses.  We  advise  anyone  seri- 
ously considering  employment  in  this 
state  to  have  their  Queensland  registration 
before  leaving  Canada  —  or  be  prepared 
to  work  as  third-year  student  nurses!  — 
Deborah  A.  Cooper,  B.N.,  R.N;  Janet 
DeRoche  R.N.:  Christine  Duffield 
B.Sc.N.,  R.N.:  Lvnn  McNamara  R.N.: 
Karen  Murdoch  B.ScN.,  R.N.,  B.A.; 
Beverley  Preston  B.Sc.N.,  R.N.:  and 
Christine  Rothera  R.N. 

Any  RN  planning  to  work  in  a  foreign 
country  should  contact  the  Canadian 
Nurses'  Association  for  information 
about  registration  requirements  and  de- 
tads  about  working  abroad.  Write  to: 
Nursing  Coordinator.  CNA,  50  The 
Drivewav.  Ottawa  K2P  1E2  -  The  Editor 


New  programs  have  advantages 

A  letter  in  the  October  1974  issue,  written 
by  -RN,  Quebec""  (page  7).  has  prompted 
my  first  letter  to  any  publication. 

The  writer  stales  that  the  2-year  pro- 
gram in  nursing  should  never  have  been 
started.  She  bases  her  opinion  on  15  years 
of  nursing  experience. 

My  reply  is  based  on  .'56  years  of  nursing 
experience,  17  of  which  were  in  nursing 
education  in  4  provinces.  I  have  found  just 
as  many  poor  nurses  who  graduated  from 
.1-year  programs  as  from  2-  or  4-year  prog- 
rams. Poor  products  are  not  necessarily  the 
fault  of  the  program,  but  rather  of  the  qual- 
ity of  the  teaching. 

Students  absorb  teacher  attitudes  far 
more  readily  than  factual  data.  If  the 
teachers  are  disinterested,  careless,  snob- 
bish, or  smug  in  their  positions,  the  stu- 
dents will  frequently  reflect  the  same  at- 
titudes. Too  often  the  staff  send  students 
who  are  poorly  prepared  to  a  health  agency 
and  expect  the  agency  to  teaeh  the  stu- 
dents. The  instructors  have  never  visited 
the  agency  to  see  what  kinds  of  experience 
it  offers  and  to  establish  rapport  and  coop- 
eration with  the  agency  staff. 

Sometimes,  too.  selection  of  staff  for 


teaching    positions    is    based    solely 
academic  achievement,  rather  than  oi' 
balance  of  academic  level  and  practi 
experience.  A  basic  principle  of  empioN- 
ment  practice  is  to  check  references  from 
former  employers  and  instructors.  Maybe 
there  should  also  be  a  check  of  the  opin-I 
ions  of  former  students. 

One  great  disadvantage  of  the  3-\ 
hospital-based  programs  was  the  segrci 
tion  of  the  students  in  a  totally  woi^x- 
oriented  environment.  The  great  advan- 
tage of  the  new  programs  is  the  contact 
with  students  in  other  disciplines  and  ex- 
posure to  nonnursing  instructors. 

Emphasis  in  programs  today  is  placed 
on  nursing  action  based  on  principles  fn 
many  fields  —  the  ""why""  of  action,  v.  . 
merely  the  "hows".  When  I  hear  nurses 
complain  about  how  much  the  new 
graduates  cannot  do,  I  am  tempted  to  ask; 
"How  perfectly  prepared  were  you  when 
you  began  your  nursing  career?"" 

It  has  been  proven  that  the  2-year  pro- 
gram of  instruction  for  nursing  is  ade- 
quate, given  enthusiastic,  interested. 
instructional  staff  who  have  demonstrated 
nursing  competence  and  academic 
achievement. 

We  must  all  accept  our  responsibilities 
as  mentors  to  the  newer  members  of  our 
profession,  and  stop  expecting  new 
graduates  to  function  as  though  they  ha\e 
been  in  active  nursing  for  5  or  more  yeai^. 
It  is  necessary  to  find  out  what  things  the 
students  have  not  had  a  chance  to  do  and  to 
give  them  the  opportunity  to  do  these 
things  with  interested  guidance,  not  criti- 
cal supervision.  —  O.  Bernice  Donaldson, 
Assistant  Director  of  Nursint;. 
Weta.ikiwin  General  Hospital,  Wetaskiwin, 
Alberta. 


Graduates  must  keep  up-to-date 

I  am  writing  in  reference  to  the  article  h\ 
Moira  MacDougall,  "A  diploma  is  not  an 
oil  painting"'  (February  1974),  in  which 
the  author  presents  an  unflattering  analoy  \ 
between  a  graduate  nurse  and  her  diploma, 
and  a  housewife  and  an  oil  painting. 

I  agree  that  in  many  eases  this  analogv  is 
correct.  Although  it  is  not  feasible  to  ex- 
pect every  graduate  to  seek  higher  educa- 
tion, it  is  reasonable  to  expect  graduates  to 
maintain  their  level  of  education  by  read- 
ing journals,  attending  conferences,  and 
participating  in  their  own  inservice  educa- 
tion programs. 

Our  society  is  experiencing  rapid 
change  and  advancement.  Attaining 
knowledge  cannot  be  left  to  the  next  nurs- 
ing generation,  but  must  be  achieved  by 
practicing  nurses. 

Why  are  nurses  not  meeting  their  re-' 
sponsibility  to  acquire  new  knowledge?^ 
One    reason,    as    pointed    out    by    Mac-' 
Dougall,  is  the  lack  of  inservice  programs. 
In  hospitals  where  such  programs  exist, 
however,    staff  shortages   often   prevent 
JANUARY   1975 


irc  than  one  nurse  per  unit  from  atlend- 
I.  Nurses  who  work  evening  or  night 
ifts  are  at  a  disadvantage,  as  most  educa- 
n  programs  are  given  during  the  day. 
Despite  these  barriers,  it  is  still  the  re- 
Misihility  of  the  professional  nurse  to 
nntain  her  level  of  education  and  seek 
w  information.  It  is  also  the  employer's 
ty  to  provide  opportunities  to  facilitate 
:  staffs  learning  needs. 
I  agree  with  MacDougall  that  inservice 
ucalion  programs  should  become  an  in- 
;raled  part  of  the  working  day.  S- 
irpt'r.  fourth-year  nursing  student.  Uni- 
'■sity  of  Calgary.  Calgary.  Alberta. 


fice  nurses'  work  is  degrading  to  them 

ter  reading  VVilinia  B.  Garbe's  letter 
ugust  1974.  page  4).  I  find  I  cannot 
ree  with  many  of  the  statements  she 
ikes. 

1  am  being  educated  in  a  four-year,  m- 
^rated  basic  baccalaureate  program, 
lich  stresses  individualized  patient- 
ntered  care  and  the  nurse  practitioner 
ncept.  Having  had  numerous  contacts 
th  physicians"  offices,  both  as  a  learning 
perience  and  as  a  consumer.  I  strongly 
ieve  that  what  most  nurses  do  in  an 
fice  is  degrading  to  them,  to  their  educa- 
>nal  preparation,  and  their  profession, 
lerefore.  I  cannot  be  horrified  by  a  doc- 
r  hiring  a  non-professional  to  do  the 
irk  for  a  registered  nurse 
Duties  such  as  typing,  filing,  filling  out 
idicare  forms,  answering  the  phone  and 
aying  the  message  to  the  physician, 
loking  appointments,  and  cleaning  the 
fice  can  be  carried  out  competently  by  a 
lined  medical  secretary.  They  do  not 
;ed  the  attention  of  an  educated  nurse;  no 
le  requires  two.  three,  or  four  years 
eparation  to  learn  how  to  clean  examin- 
g  tables  and  wash  specula.  Do  such  tasks 
quire  the  knowledge  and  skill  for  which 
e  nurse  was  prepared?  Are  these  tasks 
ftisfying  to  her'^ 

If  these  tasks  are  being  taken  over  b) 
inprofessionals.  what  is  going  to  happen 
I  our  role  in  the  physician's  office?  Un- 
ss  we.  as  nurses,  use  our  assets,  sell  our 
"oduct,  and  deliver  a  high  standard  of 
ire.  neither  the  physician  nor  the  patient 
ill  buy  our  product.  If  this  occurs,  we 
ave  a  right  to  be  horrified.  But  what 
roduct  are  we  trying  to  sell? 
An  educated  nurse,  who  is  prepared  to 
>e  the  knowledge  and  skill  she  has  and  is 
illing  to  gain  more  expertise  —  thereby 
inctioning  in  what  many  leaders  call  the 
<panded  role  concept  —  must  change  her 
)cus  from  one  of  serving  the  physician  to 
ne  of  serving  the  ci)nsumer. 
The  nurse  must  be  willing  to  work  not 
nly  in  the  office,  but  also  in  the  commun- 
y.  visiting  the  family  at  home  and  seeing 
le  interaction  and  coping  that  occurs  at 
lis  level.  Such  a  nurse  will  be  unique.  She 
ill  act  as  a  change  agent,  creating  her 
NUARY    1975 


own  individualized  program,  which  will 
meet  the  needs  of  the  community  more 
economically.  The  physician  will  also  be 
freer  to  carry  out  his  role.  In  assuming  an 
expanding  role,  many  nurses  are  finding 
the  need  to  iipelate  anti  further  their  skills 
—  thus,  the  emphasis  on  continuing  edu- 
cation and  obtaining  degrees. 

Yes.  the  nurse  does  belong  in  the 
physician's  office.  By  being  released  from 
her  managerial  tkities,  she  could  use  her 
knowledge  and  skill  more  effectively  and 
better  serve  the  consumer,  who  is  turned 
off  by  waiting  long  hours  in  a  stuffy, 
germ-laden  room  for  a  five-minute  contact 
with  a  physician. 

The  expanded  role  concept  is  Utopian  to 
many,  but  it  must  start  somewhere  if  we 
are  to  remain  a  viable  profession.  What 
better  place  is  there  to  begin  than  in  a 
doctor's  office,  by  a  doctor  who  frees  the 
nurse  from  managerial  duties  by  hiring  a 
nonprofessional  to  do  them?  —  Nancy 
Connors,  fourth-year  nursing  student. 
University  of  Calgary.  Calgary.  Alherta. 


RN  and  assistant  are  needed 

I  concur  with  Wilinia  B.  Garbe's  letter. 
■■RNs  belong  in  doctors"  offices""  (Aucust 
1974.  page  4). 

Lay  and  auxiliary  staff  have  a  place  in 
doctors"  offices,  but  it  is  not  performing 
nursing  procedures.  These  persons  are 
needed  for  the  many  clerical  and  house- 
keeping responsibilities  of  a  busy  office 
practice. 

Physicians  who  hire  office  personnel 
have  to  consider  the  priorities  and  ramifi- 
cations of  economics  versus  quality  pa- 
tient care.  Nurses  in  physicians"  offices 
have  to  consider  the  challenge  of  expanded 
role  nursing,  coming  changes  in  primary 
health  care,  and  the  role  they  are  prepared 
to  accept. 

In  addition  to  having  technical  skills  and 
knowledge,  as  nurses  we  must  anticipate 
patients"  needs  and  do  health  teaching. 
These  cannot  be  taught  to  an  office  assis- 
tant. They  are  gained  in  those  three  years 
of  nursing  education  and  years  of  practice 
afterward. 

1  hope  that  physicians,  nurses,  and  other 
health  professionals  w  ill  see  the  many  ad- 
vantages of  working  together  as  a  team  in 
giving  the  consumer  better  patient 
care.  — Eleanor  Hallman.  RN. 
Nanaimo.  British  Columbia. 


Less  helpful  lately 

1  have  found  the  magazine  to  be  less 
interesting  and  helpful  lately.  I  am  sure 
economics  are  a  big  part  of  the  problem. 

The  sections  I  like  best  are  books, 
research  abstracts,  news,  and  articles  on 
nursing  care  problems.  The  sections  I  like 
least  are  names,  articles  on  conventions, 
and  new  products.  —  Marie  Tovell 
Walker.  Edmonton.  Alberta. 


The  Professional 
Psychiatric  Nurse 
Is  Changing. 

We 
Are 
Too! 


Psychiatric  Nursing,  the  official  publi- 
cation    of    the     Psychiatric     Nurses 
Association  of  Canada,  is  chunfjinfj. 
Naturally,  we're  excited,  but  we  want 
to  emphasize  it's  our  job  keepinjj  the 
professional  up  to  date. 
Today's  psychiatric  nurses  are  part  of 
a   dynamic   profession.   C^ontmuinH   re- 
search  is  produt:ing  an  e^er  fjrowinfi 
volume  of  information   and.  hand   in 
hand,  an  ever  growing  need  to  make 
it    known   to   those   working   in    the 
profession. 

But  we  also  realize  thiil  there  are  many 
demands  on  a  nurse's  time.  That's  why 
the  new  Psychiatric  Nursing  has  geared 
each  issue  to  the  busy  professional  by 
using  timely  articles,  presented  in  a 
style  intended  to  inform  and  stimul.ite 
If  you're  a  nurse  in  psychiatry,  we  think 
the  two  of  us  should  get  together  Wiu'e 
both  changing. 


wmmmim 

NURSING 


I 


['ublished  bi-monthly  by  the  Psychiatrir 
Nurses  Association  of  Canada 
SUBSCRIPTION  S5  PER  YEAR 


Please  enter  my  subscription  In 
Psychiatric  Nursing. 

Cheque  enclosed  Q     Bill  me  Q 


N.A.Ml-: 


ADDRESS 

CITY 

POST.-XLCODE 


PROV 


Mail  to; 

Psychiatric  Nursing. 
871  Notre  Dame  Ave.. 
U1\\1P1-;C.  Manitoba   R3E  0M4 


THE  CANADIAN  NURSE 


for  relief  of  oostoortum  discomforts 

only  Tucks  babies 
tender  tissues  two  ways 

QS  Q  scx5thing  wipe...QS  q  cooling  compfess...Qnd  os  often  qs  she  likes 


Tucks  medicated  pads  give  your  postpartum 
patient  more  relief,  more  often  than  ointments  or 
aerosols  because  pads  can  be  used  more  ways. 
Cooling  Tucks  medication  can  be  applied  by 
using  the  pad  as  a  compress.  Or  the  pad  can  be 
used  as  a  wipe  to  both  soothe  and  cleanse.  As  a 
wipe,  if  lets  her  avoid  the  mechanical  irritation  of 
harsh,  dry  toilet  paper.  A  Tucks  pad  under  her 
sanitary  pad  prevents  chafing  too. 

Tucks  medication  gives  prompt,  temporary 
relief  from  postpartum  discomforts — the  itching, 
burning  and  irritation  of  episiotomies  and  simple 
hemorrhoids.  Its  active  ingredients  are  witch  hazel 
and  glycerine — there  Is  no  "caine"  type  anesthetic 


in  it.  Your  patient  can  have  her  own  supply  of 
Tucks  at  bedside  for  self-administered  relief  with 
minimum  risk  of  over-treatment  or  sensitization. 

In  addition,  Tucks  rriedication  is  buffered  to  an 
approximate  pH  of  4.6.  This  helps  tissues  maintain 
their  normal  acid  defenses.  Prescribe  Tucks  pads 
at  bedside  for  soothing,  cooling  comfort  from  the 
first  postpartum  day  on. 

Order  a  trial  supply  on  your  FJx.  Write  to: 

ID 


1 


ra 


r\ 


1956  Bourdon  Street,  Montreal,  P.O.  H4M  1 VI 


news 


Between  annual  assemblies,  any 
member  or  group  of  members  has  the 
right  to  present  a  recommendation  to  the 
bureau.  These  recommendations  are  dis- 
cussed at  its  next  regular  meeting. 

As  a  professional  corporation,  protec- 
tion of  the  public  is  our  raison  d'etre. 
Nicole  Du  Mouchel.  executive  director 
and  secretary  of  the  Order,  told  the  annual 
assembly.  To  respond  to  this  expectation, 
the  Order  must  encourage  the  profes- 
sional growth  of  its  members,  and  inter- 
pret to  the  government,  the  public,  the 
members,  and  other  disciplines  what  the 


eneral  Assembly  of  ONQ  Members 
o  Longer  Makes  Most  Decisions 

)n!real.  Quebec  —  Important  changes  in  the  structure,  a  slight  rise  in  fees,  and  long- 

J  short-term  priorities  were  among  the  chief  items  of  business  at  the  54th  annual 

neral  assembly  of  the  Order  of  Nurses  of  Quebec  (ONQ),  held  in  Montreal  4-6 

vember  1974. 

Some  important  changes  in  the  struc- 

e  and  responsibilities  of  the  Quebec 

jfessional  association  became  apparent 

ONQ  members  at  the  annual  general 

embly .  They  were: 

the  general  assembly  of  members  is  no 

nger    the    decision-maker    except    on 

rtain  points; 

the    chief    purpose    of    the    ONQ    is 

otection  of  the  public;  and 

the  ONQ  bureau  (board)  is  now  made  up 

28  directors  elected  or  appointed  for  a 
year  term. 

lese  changes  were  made  when  the  new 
jebec  Nurses"  Act  and  the  Quebec  code 
the  professions  came   into  effect  in 
ibruary  1974. 

The  September  1974  issue  of  the  ONQ 
illetin.  News  and  Notes,  explains: 
Faking  as  a  basis  the  administrative 
ganization  of  large  companies,  where 
.ickholders  elect  directors  to  manage 
leir  affairs,  the  Professional  Code  has 
isigned  new  responsibilities  to  the 
ireau's  directors.  Formerly,  the  annual 
meral  meeting  was  sovereign  and  the 
sociation  was  called  on  to  implement  its 
quests.'" 

Now.  the  bureau  exercises  all  the  rights 
id  powers  of  the  corporation  except  for 
e  following,  which  remain  with  the 
meral  assembly  of  members: 

to  determine  the  method  of  electing  the 
•esident; 

to  approve  any  resolution  passed  by  the 
rectors  to  fix  the  fee  that  members  must 
ly,  except  if  it  is  an  increase  necessary 
pay  expenses  due  to  the  indemnity 
ind,  to  the  procedure  of  recognizing 
}uivalent  diplomas  conferred  outside 
uebec,  or  for  applicatiojis  of  the  code  of 
e  professions  respecting  professional 
scipline  or  inspection;  and 

to  elect  the  auditors. 

The  general  assembly  now  has  the 
3wer  to  make  only  recommendations  to 
e  bureau,  which  may  or  may  not 
iplement  them.  The  bureau  must  ex- 
ain  the  reasons  for  refusal  to  implement 
commendations  and  inform  members  of 
:tion  taken  on  each  recommendation. 
NUARY   1975 


practice  of  nursing  is  and  the  roles  it 
includes,  she  said. 

The  ONQ  bureau  is  now  composed  of 
28  directors;  24  are  elected  for  2  years  by 
members  of  the  13  sections  of  the 
province,  and  the  Quebec  Professions 
Board  appoints  4  directors  to  represent 
the  public. 

Under  new  regulations,  the  administra- 
tive committee  is  reduced  to  5  members. 
In  1974-6,  members  of  this  committee 
are:  Jeannine  Tellier-Cormier,  ONQ  presi- 
dent; Rachel  Bureau,  vice-president; 
Claire  Loyer,  treasurer;  Raymond  Boulay 
and  Louise  Way  land,  councilors. 

Among  the  18  proposals  presented  at 
the  general  assembly,  the  one  that  drew 
the  most  attention  concerned  a  $5  raise  in 
annual  fee,  effective  1  January  1975.  The 
Order's  increased  responsibilities  for  pro- 
fessional inspection  and  discipline  neces- 
sitated the  increase. 

The  assembly  decided,  on  recommen- 
dation from  the  directors,  that  the  direc- 


ONQ  Priorities  Are  Explained  Graphically 


Nicole  Du  Mouchel.  executive  director  and  secretary  of  the  Order  of  Nurses  of 
Quebec,  left,  explains  the  priorities  of  the  Order  for  the  coming  year  during  the 
annual  meeting.  She  is  assisted  by  Sheila  O'Neill,  one  of  the  members  of  the  ONQ 
Bureau,  representing  the  Montreal  region. 


THE  CANADIAN  NURSE     9 


tors  would  elect  the  ONQ  president  by 
secret  ballot.  This  is  one  of  two  methods 
provided  by  the  code  of  the  professions. 
The  other  method  —  election  by  all  the 
members  —  would  entail  complicated 
and  expensive  procedures,  because  of  the 
large  onq  membership. 

The  Professional  Code  permits,  but 
does  not  oblige,  the  bureau  to  ""impose 
upon  its  members  an  oath  of  secrecy. '" 
Members  at  the  annual  assembly  re- 
quested the  bureau  to  refrain  from  impos- 
ing such  an  oath  of  secrecy  on  its 
directors;  they  said  that  section  members 
must  be  informed  of  the  bureau's  objec- 
tives, to  be  able  to  elect  representative 
directors. 

Members  also  recommended  to  the 
bureau  that  ONQ  ""vigorously  promote  the 
organization  of  professional  development 
courses  within  reach  of  nurses  in  isolated 
centers,  taking  into  account  regional 
needs."  And  the  general  as.sembly  asked 
that  ONQ  provide  its  members  with 
information  on  family  planning,  so  they 
can  play  their  role  in  promoting  health. 

Priorities  of  the  Order,  which  were 
established  more  than  one  year  ago.  form 
a  long-term  plan,  made  up  of  many 
interrelated  research  projects.  The  pro- 
jects are  divided  into  6  main  sectors: 
definition  of  nursing  practice;  establish- 
ment of  standards  of  nursing  care;  work 
on  various  pieces  of  legislation,  including 
formulation  of  regulations  concerning  the 
general  administration  of  the  Quebec 
Nurses'  Act  and  planning  professional 
inspection  programs;  basic  education; 
continuing  education;  and  public  rela- 
tions. 


CNA  Response  To  Health   Paper 
Stresses  Nursing  Participation 

Ottawa  ~  The  Canadian  Nurses" 
Association's  response  to  the 
government's  working  document,/!  New 
Perspective  on  the  Health  of  Canadians. 
says  there  are  4  main  areas  in  which 
■"nurses  can  and  should  play  a  particu- 
larly valuable  role  in  program  develop- 
ment and  implementation."  The  response 
was  presented  to  the  Minister  of  National 
Health  and  Welfare  6  November  1 974. 

The  4  main   areas   in   which   nursinc 
participation  is  stressed  are: 
■  •  reduction    of    .self-imposed    and    en- 
vironmental health  risks; 

•  development  of  alternative  modes  of 
health  care  for  chronically-ill  and  aged 
individuals; 

•  full  use  of  the  education  and  experi- 
ence of  nurses  in  treatment,  prevention, 
and  promotion  programs;  and 

10     THE  CANADIAN  NURSE 


•  critical  evaluation  of  the  cost-effective- 
ness of  health  care  interventions. 

CNa's  response  says  that  health  promo- 
tion strategies,  which  are  intended  to 
bring  about  an  awareness  of  self-imposed 
and  environmental  health  risks  and  to 
increase  mental  and  physical  fitness,  are 
an  integral  part  of  all  nursing  care, 
including  the  immediate  treatment  of 
persons  with  existing  illness. 

Nurses  and  other  health  workers  must 
actively  adhere  to  the  principle  that 
accessibility  to  ambulatory,  institutional, 
and  home  care  must  be  based  upon  actual 
public  need,  not  upon  professional  and/or 
bureaucratic  convenience,  the  CNA  re- 
sponse says. 

Under  the  heading,  "Full  Utilization  of 
Nurses."  the  response  says  "...  if  the 
traditional  view  of  the  health  field  is  to  be 
expanded  to  include  the  philosophy  of  the 
New  Perspective ,  nurses  should  be 'given 
the  psychological  and  financial  support 
they  need  to  function  in  new  modes  of 
practice  in  either  traditional  or  new  set- 
tings. Implicit  in  this  is  the  necessity  of 
viable  educational  programs,  permissive 
legislation  reflecting  changing  health  care 
needs  and  resources,  and  "untraditional' 
career  opportunities." 

The  respon.se  states:  ""The  Association 
will  welcome  opportunities  for  participa- 
tion in  the  planning,  development,  and 
evaluation  of  new  modes  of  care." 


Notice  of  Annual  Meeting 

of  the 

Canadian  Nurses'  Association 

In  accordance  with  Bylaw  Section  44, 
notice  is  given  of  an  annual  meeting  to 
be  held  April  3,  1975,  commencing  at 
0900  hours.  This  meeting  will  be  held 
at  the  Chateau  Laurier  Hotel,  Ottawa, 
Ontario.  The  purpose  of  the  meeting  is 
to  conduct  the  business  of  the  Associa- 
tion. 

The  meeting  will  be  asked  to  consi- 
der and  approve  a  resolution  passed  by 
the  Board  of  Directors  authorizing  an 
application  for  Supplementary  Letters 
Patent  amending  paragraph  (D)  of  the 
Letters  Patent  by  substituting  for  the 
words.  ""The  Association  of  Nurses  of 
the  Province  of  Quebec,"  the  words, 
"The  Order  of  Nurses  of  Quebec." 

Ordinary  members  of  the  Canadian 
Nurses'  As.sociation  are  eligible  to  at- 
tend the  annual  meeting.  Presentation 
of  a  current  provincial  membership 
card  will  be  required  for  admission. 
Nursing  students  are  welcome  to  attend 
the  meeting  as  observers.  Proof  of  en- 
rollment in  a  school  of  nursing  will  be 
required  for  admission.  —  Helen  K. 
Mussallem,  Executive  Director,  Cana- 
dian Nurses'  Association. 


Employee  Physical  Fitness 
Topic  Of  National  Conference 

Ottawa  —  Delegates  to  the  National  Co^ 
ference  on  Employee  Physical  Fitness  re( 
'ommended  that  regular  exercise  brcali 
replace  TV  commercials  and/or  serve  i 
fill-ins  during  regular  television  pr< 
gramming.  The  invitational  confercnc( 
sponsored  by  Health  and  Welfare  Canadi 
was  held  at  the  government  conferen^ 
center,  Ottawa,  2-4  December  1974.     j 

Huguette  Labelle.  principal  nursing  aH 
ficer.  Health  and  Welfare  Canada,  wasj 
member  of  the  conference  planning  con 
mittee.  Canadian  Nurses"  Associatid 
President  Labelle  and  Jean  Everar( 
Canadian  Nurses'  Association  project  ol 
ficer.  were  among  the  19  workshop  leac 
ers. 

Some  200  persons,  representing  labc 
unions,  industry  management,  and  healt 
and  physical  education  professionals,  al 
tended  the  conference.  Among  them  wei 
about,  10  nurses  from  occupational  healt 
departments  of  industries  and  hospitals 
provincial  health  departments,  and  a  ho^ 
pital  health/safety  committee.  ' 

The  conference  set  a  new  style  in  meel 
ings:  nutrition  breaks  offered  fruit  juice 
milk,  bran  muffins,  and  apples  in  additio 
to  coffee;  exercise  breaks  had  conferene 
attenders  relieving  tension  by  rotatin 
their  shoulders,  shaking  their  arms,  am 
swinging  their  legs  in  time  to  music;  am 
luncheon  and  dinner  menus  showed  ih 
caloric  value  of  each  dish. 

Recommendations  on  which  most  al 
tenders  agreed  included: 

•  quality  and  quantity  of  physical  educa 
tion  in  schools  should  be  improved; 

•  physical  fitness  program  guidelines  an 
needed  on  such  aspects  as  medical  clear 
ance.  legal  implications,  facilities,  pro- 
gram administration,  motivation,  and  .statis 
tical  data  on  participation  levels;  and 

•  inservice  training  is  needed  to  updaK 
and  upgrade  potential  leaders  of  employe( 
physical  fitness  programs,  such  as  occupa- 
tional  health  nurses. 

The  group  did  not  reach  con.sensus  oJ 
suggestions  that:  1 

•  the  Olympic  lottery  should  be  retained 
and  the  proceeds  allocated  to  a  wide- 
ranging,  national,  physical  fitness  pro 
gram;  i 

•  federal  and  provincial  government^ 
should  allocate  sizeable  portions  of  their 
health  budgets  to  industrial  fitness,  provid- 
ing industry  would  cooperate  and  savings 
from  traditional  medical  care  are  feasible; 

•  workmen's  compensation  boards 
should  allocate  funds  for  physical  fitness 
programs,  recognizing  that  prevention  of 
unfitness  is  good  business;  and  i 

•  labor  and  management  should  not  view 
physical  fitness  programs  as  a  negotiable 
item  in  union  contracts,  but  as  ""a  deter- 
minant in  the  quality  of  life  of  the  indi- 
vidual for  which  they  must  take  combined! 

iContimiCil  an  pa^e  12}'. 
JANUARY   1975 


Where  can  you  turn  when 
you  need  up-to-date  answers 
towhafsnew- 


•in  coronary  and  intensive  care? 

•in  obstetrics  and  gynecology? 

•in  emergency  treatment  and  diagnosis? 

•in  chemotherapy  and  pharmacology? 


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news 


{Continued  from  piif^e  10) 

responsibility  for  providing  the  education 
and  the  opportunity."" 

At  the  closing  luncheon  on  4  December, 
conference  attenders  asked  that  Health  and 
Welfare  Minister  Marc  Lalonde  send  a  let- 
ter to  the  presidents  of  companies  rep- 
resented at  the  conference,  asking  top 
management's  support  of  suggestions  and 
recommendations  for  employee  physical 
fitness,  which  are  brought  back  to  the 
company  by  its  representatives  at  the  con- 
ference. 

They  also  asked  that  conference  pro- 
ceedings be  published  '"no  later  than  24 
December  1974."  Conference  Chairman 
Cor  Westlund,  director  of  Recreation 
Canada,  a  department  in  Health  and  Wel- 
fare Canada,  said  this  recommendation 
could  not  be  implemented,  because  gov- 
ernment documents  must  be  issued  simul- 
taneously in  English  and  French.  He  esti- 
mated the  recommendations  will  be  avail- 
able in  3  months  and  the  final  report  in  6 
months. 

ECC  Uses  Social   Indicators 
To  Monitor  Canadian  Society 

Ottawa  —  The  Economic  Council  of 
Canada  (F.CC),  which  was  set  up  to  monitor 
the  state  of  Canadian  society,  has  offi- 
cially recognized  health  as  one  statistical 
measure  of  the  quality  of  life.  In  its 
Eleventh  Annual  Review,  released  re- 
cently, the  ECC  presents  ""first  approxima- 
tions"" of  some  principal  social  indicators 
for  health,  housing,  and  natural  environ- 
ment. 

CNA's  executive  director,  Helen  K. 
Mussallem,  is  one  of  the  24  members  of 
the  Council.  Other  members  include  rep- 
resentatives of  business.  labor,  and  gov- 
ernment. 

There  is  general  agreement  on  the  de- 
sirability of  a  healthy  society,  the 
Council's  report  points  out.  "Health, 
being  intimately  linked  with  survival,  has 
always  been  one  of  society's  major  con- 
cerns." It  says  that,  in  spite  of  advances  in 
the  health  field  and  increases  in  expendi- 
ture, there  remain  considerable  problems 
concerning  the  treatment  and  prevention 
of  disease  and  the  organization  and  dis- 
tribution of  health  and  medical  care. 

Three  mortality-oriented  measures  of 
health  —  life  expectancy,  infant  mortal- 
ity, and  prime-age  mortality  —  have  been 
chosen  to  assess  the  health  of  Canadian 
society.  Although  the  Council  recognizes 
that  it  would  be  preferable  to  employ  both 
morbidity-  and  mortality-oriented  meas- 
ures, necessary  data  are  not  available  at 
this  time.  It  is  not  yet  possible,  either,  to 
state  objectives  in  terms  of  positive  health, 
12     THE  CANADIAN  NURSE 


Cuban  Nurses  Visit  Canada 


Four  Cuban  nurses,  who  visited  Canada  under  a  Canada-Cuba  nursing 
exchange  agreement  recently  concluded  between  the  two  governments,  spent 
22  November  1974  at  CNA  House.  Seated  in  the  foyer  of  the  Canadian  Nurses" 
Association  building  are.  left  to  right,  Silvia  Gomez,  nursing  officer.  Ministry  of 
Public  Health,  Cuba:  Dora  Rodriguez,  chief  nurse,  Ministry  of  Public  Health; 
Maria  Fenton,  director  of  nursing.  National  Hospital.  Havana:  and  Nilda  Bello, 
nurse-teacher.  National  School  of  Health  Sciences.  The  4  Cuban  nurses,  who  are 
responsible  for  the  planning  and  implementation  of  the  first  postbasic  university 
nursing  program  in  Cuba,  visited  selected  universities  and  health  institutions  in 
Canada.  A  return  visit  by  three  Canadian  nurses  is  planned  for  early  1975. 


although  this  approach  would  be  prefera- 
ble. 

As  an  indication  of  the  measure  of 
health  of  Canadians,  the  Council  came  up 
with  the  following  findings  in  the  three 
chosen  areas  of  study.  Life  expectancy  at 
birth  has  risen  steadily  over  the  years,  to 
71.4  years  for  males  and  77.3  years  for 
females  in  1971.  according  to  Council 
tabulations,  but  the  disparity  between  life 
expectancy  for  men  and  women  has  con- 
tmued  to  widen. 

Infant  mortality  rates  have  dropped  by 
more  than  50%  from  1951  to  1972.  but 
Canada  ranked  1 2th,  just  above  the  United 
States  and  behind  such  nations  as  Sweden, 
the  Netherlands,  Norway.  Denmark, 
France,  and  Australia  in  a  1970-71  compa- 
rison of  these  rates.  About  40  thousand 
persons  aged  35  to  64  die  each  year  in 
Canada,  representing  a  considerable  social 
and  economic  loss,  ihe Review  points  out. 
The    prime-age    mortality    rate    dropped 


about  l(37c  from  1951  to  1972,  butthedrc 
for  men  was  only  79( ,  and  that  for  wome 
28%. 

The  Council  stressed  the  need  to  begi 
development  of  morbidity-oriented  ind 
cators  of  health.  It  recommended  "th 
effort  be  made  by  the  federal/provinci 
conference  of  deputy  ministers  of  health  1 
ensure  that  the  data  produced  by  the  o 
ganizations  responsible  for  the  administr; 
tion  of  the  provincial  medical  care  an 
hospital  insurance  plan  are  consisten 
comparable,  and  efficient  for  the  d( 
velopment  of  national  morbidity-base 
health  indicators."" 

The  Council  describes  the  developniei 
of  social  indicators  as  "the  measuremei 
and  analysis  of  aspects  of  social  welfai 
that  enhance  our  understanding  of  a  give 
area."  It  states  that  it  has  been  necessary  I 
take  preliminary  steps  toward  a  system  ( 
■"social  accounting""  because  econom 
{Continued  on  page  I- 

JANUARY    19: 


iftHi  should 

beo^ieofour 

pin-ups. 


These  sheets  list  the  jobs  avail- 
able from  employers  in  the  area. 
We  pin  them  up  on  our  boards  for 
potential  employees  to  find  the  jobs 
they're  most  qualified  for 

That  way  employers'  jobs  get 
filled  faster. 

Boards  like  these  are  going  into 
over  400  Canada  Manpower 
Centres  across  Canada.The  jobs  you 
have  to  offer  could  be  on  these 
boards  All  you  have  to  do  is  let  us 
know  about  them. 

But  Canada  Manpower  Centres 
are  much  more  than  just  placement 
offices. Were  helping  Canadian  em- 
ployers and  employees  in  many 
different  ways. 

We  provide  labour  market 
information  to  help  you  in  the  planning 
of  your  manpower  needs  both 
short  and  long-term  We  can  help  you 
get  the  right  people  for  specific 


jobs;  we'll  arrange  advertising, 
screen  applicants  or  assist  you  to 
interview  candidates  on  the  spot. 

And  while  the  employer  has 
primary  responsibility  for  training  his 
staff,  we  may  well  be  able  to  lend 
him  a  hand  through  the  Canada 
Manpower  Industrial  Training  Pro- 
gram. This  program  can  help 
Canadian  businesses  increase  pro- 
ductivity and  reduce  unemployment 
by  assisting  in  the  development 
or  expansion  of  their  employee 
training  programs. 

Through  the  Canada  Manpower 
Consultative  Service  we  can  help 
you.  as  an  employer,  smooth  the 
upheaval  caused  by  a  technological 
change  in  your  business  or  a  plant 
relocation 

In  addition,  our  counselling 
services  provide  guidance  to  people 
with  special  problems  so  that 


they  can  again  become  productive 

members  of  society. 

If  you  have  questions  about  any 
aspect  of  Canada  Manpower's 
services,  just  give  us  a  call:  we'll  be 
happy  to  give  you  further  infor- 
mation. 


I* 


C»n»da 

Manpower  Centre 

Manpower 

and  Immigration 

Robert  Andras 

Minister 


Centre  de  Matn-d'c 
du  Canada 
Main-d  oeuvne 
et  Immigration 
Robert  Andras 
Ministre 


Canada  Manpower. 
Let's  work  together. 


THE  CANADIAN  NURSE     13 


news 


(CoiUiiuicd  from  pane  12) 

indicators,  which  have  been  used  in  the 
past,  do  not  fully  or  adequately  reflect  the 
broadening  concerns  of  society  in  recent 
years. 

A  system  of  '"social  accounting"  that 
would  permit  a  simultaneous,  comprehen- 
sive examination  of  all  aspects  of  the  so- 
cial system  is  still  a  long  way  off.  the 
Council  cautions.  Housing,  health,  and 
natural  environment  were  chosen  for  this 
initial  assessment  of  the  quality  of  life  be- 
cause they  are  essentially  quantitative 
measures  and  do  not  involve  subjective 
judgements  to  the  same  extent  as  qualita- 
tive indicators,  such  as  individual  rights 
and  responsibilities. 

Self-Actualization  Is  Theme 
Of  McGill  Nursing  Conference 

Montreal.  Quebec  —  On  II  October 
1974.  the  psychiatric  units  of  the  teaching 
hospitals  affiliated  with  McGill  Univer- 
sity held  an  all-day  conference  on  the 
theme  of  self-actualization,  entitled 
""Transition  and  Metamorphosis."' 

Speakers  at  the  third  annual  psychiatric 
nursing  conference  were  Dr.  Margaret 
Kiely.  a  clinical  psychologist  at  the 
Mental  Health  Institute.  University  of 
Montreal;  Dr.  Lionel  Tiger,  professor  of 
anthropology  at  Rutgers  University.  New 
Jersey,  and  author  of  Men  in  Groups: 
Lorine  Besel.  director  of  nursing.  Royal 
Victoria  Hospital.  Montreal;  and 
Margaret  Atwood.  Canadian  poet  and 
novelist,  author  oiThe  Edible  Woman. 

The  entire  conference  was  videotaped. 
The  tapes  are  available  for  borrowing  by 
any  agency  or  group,  for  a  nominal  fee. 
To  borrow  the  tapes,  write  to:  Gillian 
Cargill.  Inservice  Supervisor.  Allan 
Memorial  Institute.  1025  Pine  Avenue 
West,  Montreal,  Quebec.  H3A  lAl. 


Quebec  Minister  Supports 
Expanded  Role  For  Nurses 

Montreal.  Quebec  —  Lise  Bacon. 
Quebec  Minister  of  Social  Affairs,  told 
the  annual  general  assembly  of  the  Order 
of  Nurses  of  Quebec  (ONQ)  that  rational 
use  and  expansion  of  the  nursing  role  will 
help  make  health  care  more  accessible 
and  humane.  Areas  in  which  she  said  the 
nurse's  role  might  be  expanded  included 
care  of  a  pregnant  woman  before,  during, 
and  after  delivery;  care  of  newborn  and 
well  babies;  and  emergency  care. 

Bacon  endorsed  the  view  that  a  nurse 
with  special  training  in  obstetrics  is 
competent  to  follow  women  through  the 
course  of  their  pregnancy.  It  is  equally 
important  to  give  nurses  larger  responsi- 
14     THE  CANADIAN  NURSE 


bility  for  preventive  measures,  especially 
in  prenatal  classes,  she  said. 

Without  stating  explicitly  that  the 
Ministry  of  Social  Affairs  endorses  the 
principle  of  nurse-midwifery.  Bacon  sug- 
gested that  a  nurse  specialized  in  obstet- 
rics could  play  a  more  important  role  in 
labor  and  delivery.  She  also  expressed  the 
hope  that  the  expanded  role  of  the  nurse 
in  emergency  care  would  be  carefully 
studied. 

Huguette  Labelle.  president  of  the 
Canadian  Nurses"  Association,  speaking 
to  ONQ  members  at  the  general  assembly, 
said  that  nurses  should  turn  to  promotion 
and  maintenance  of  health.  But  a  good 
deal  of  research  needs  to  be  done  to  learn 
how  to  educate  the  public,  how  to 
measure  the  state  of  an  individual's 
health,  and  how  to  measure  the  effects  of 
nursing  intervention  on  clients'  health, 
she  said. 

Acknowledging  that  certain  questions 
are  dealt  with  on  the  provincial  level. 
Labelle  said  that  the  time  is  past  when 
problems  can  be  solved  in  a  single  way. 
The  breadth  of  the  questions  requires  a 
multifaceted  and  flexible  approach,  she 
said.  The  answers  we  ought  to  use  will  be 
the  result  of  such  an  approach. 


Remove  Discrimination  Against 
Married  Women,  Quebec  Nurses  Ask 
Quebec.  Que.  —  The  officers  of  La 
Federation  des  Syndicats  Professionels 
d'infirmieres  et  d'infirmiers  du  Quebec 
(FSPllQ)  are  about  to  request  the  Quebec 
Council  on  the  Status  of  Women  to  re- 
commend an  amendment  to  the  Profes- 
sional Syndicates  Act  of  Quebec  (R.S.Q. 
1964,  Chapter  146). 

Ratified  in  1964  and  amended  in  1972, 
the  act  contains  a  clause  that  discriminates 
against  married  women.  Item  7  reads: 
■"Minors  of  sixteen  years  of  age  and  mar- 
ried women,  except  when  the  husbands 
object,  may  be  members  of  a  professional 
syndicate."' 

The  act  applies  to  the  1  1 .000  members 
of  FSPliQ.  They  are  8,000  full-time  and 
3,000  part-time  nurses,  of  whom  45  to  50 
percent  are  married  women. 

Although  the  clause  in  question  does  not 
seem  to  have  caused  prejudice  against  its 
members,  the  FSPllQ  is  taking  this  stand  as 
it  is  convinced  that,  in  any  area  of  concern 
to  the  federation,  all  forms  of  discrimina- 
tion should  disappear. 


Resolutions  for  Annual  Meeting 

Persons  who  wish  to  submit  resolutions 
to  the  Canadian  Nurses"  Association 
annual  general  meeting  (3  April  1975) 
are  asked  to  send  the  resolutions  to  CNA 
House  as  soon  as  possible,  to  assure 
distribution.  —  Helen  K.  Mu.ssallem. 
E.xecutive  Director.  CSA.  Ottawa. 


RNABC   Proposes  Pilot   Project 

In   Psychiatric   Nursing  Consultation 

Vancouver.  B.C.  —  The  Register^ 
Nurses'  Association  of  British  Coluin 
(RNABC)  will  ask  B.C.  Minister  of  Hea 
Dennis  Cocke  to  assign  a  registered  nud 
consultant  to  conduct  a  pilot  project  [ 
psychiatric  nursing  consultative  service 
The  decision  was  made  at  a  meeting  of  t| 
RNABC  board  of  directors  on 
November. 

The  directors  requested  that  the  pi 
be    conducted    in    cooperation    wiiii 
RNABC.  They  proposed  that,  following  i 
sessment  of  the  need  for  consultative  s( 
vices  in  psychiatric  nursing,  the  nur 
would  formulate  and  implement  the  s( 
vice  in  general  hospitals  and  communi 
mental  health  centers  in  British  Colunibi 
The  nurse  consultant  and  the  RNABC  w ouli 
also  explore  the  need   for  a  multidisci 
plinary  consultative  service.  ! 

The  RNABC  provides  a  consultative  se( 
vice  to  nursing  service  departments  oi 
B.C.'  hospitals.  The  total  cost  of  thj 
heavily  used  service,  designed  to  impro\^ 
nursing  care  in  hospitals,  is  covered  by  thi 

RNABC. 


Third  Pulmonary  Nursing  Course 
Meets  Fellowship  Requirements 

Tucson,  Arizona  —  The  University  c 
Arizona  now  offers  a  nursing  specialii 
degree  in  pulmonary  nursing.  This  is  th 
third  course  to  meet  the  requirements  fc 
study  as  a  nursing  fellow  of  the  Canadia 
Tuberculosis  and  Respiratory  Diseas 
Association. 

The  two  other  programs  approved  fc 
study  under  the  fellowship  are  the  Uni 
versity  of  California  at  San  Francisco  an 
the  University  of  Cincinnati,  Ohio.  Th 
Association's  nursing  fellowship  o 
$6,000  per  year,  for  2  years  minimum,  i 
given  for  study  at  the  master's  level  in 
clinical  nursing  specialty  in  respirator 
disease. 

The  University  of  Arizona  program  i 
cosponsored  by  the  colleges  of  nursin 
and  medicine.  Two  options  are  available 
There  is  a  graduate  program  leading  to 
master  of  science  degree  with  a  major  i 
medical-surgical  nursing,  and  a  nursin 
specialist  degree  in  pulmonary  nursins 
which  is  one  and  one-half  calendar  year 
in  length. 

For  those  with  a  master's  degree  i 
medical-surgical  nursing,  a  program  leac 
ing  to  the  nursing  specialist  "degree  i 
pulmonary  nursing  is  available  in  on 
lO-week  summer  session  and  one  semes 
ter  of  full-time  study. 

The  nursing  specialist  program  pre 
pares  a  nurse  to  function  as  a  clinician 
educator,  and/or  clinical  researcher.  Fc 
information  on  the  program,  contaci 
Gladys  Sorensen.  Dean,  College  of  Nurs 
ing,  Universitv  of  Arizona,  Tucson 
Arizona,  85721'.  U.S.A. 

JANUARY    197 


St   Northeast  Canada/U.S. 
•alth  Seminar   Planned 

i  iiureal.  Quebec  —  Some  500  partici- 
its  are  expected  to  attend  the  first 
irtheast  Canadian/American  health 
ninar  to  be  held  1^-22  March  1975.  at 
•  Queen  Elizabeth  Hotel.  Montreal, 
e  seminar  will  involve  five  Canadian 
ivinces  —  Quebec.  New  Brunswick, 
na  Scotia.  Prince  Edward  Island,  and 
:svfoundland  —  and  6  New  England 
tes.  It  is  expected  that  those  attending 
il  represent  nearly  all  the  health-related 
'tossions. 

The  seminar  w  ill  study  a  broad  range  of 
blems  arising  from  the  migration  of 
tionals  between  Canada  and  New  Eng- 
id.  and  particularly  the  complications 
icemed  with  such  health  matters  as 
iiiniunicable  diseases  and  emergency 
alth  care. 

Chairpersons  for  the  seminar  are  Dr. 
rtrude  T.  Hunter,  New  England  reg- 

mal  health  administrator  for  the  U.S. 
partment  of  health,  education  and 
Ifares  public  health  service.  Boston, 
d  Dr.  Raymond  Robillard.  president  of 
c  Federation  of  Medical  Specialists  of 
ucbec.  Montreal. 

Included  among  speakers  on  the  pro- 
am  for  the  seminar  are  Denise  Lalan- 
iio.  clinical  nurse  sjjecialist.  University 
ospiial.  Sherbrooke.  Quebec,  and 
aine  .McCarty.  family  nurse  associate, 
land  Medical  Center.  Deer  Island, 
aine. 

For  further  information  about  the  first 
ortheast  Canadian/American  health 
•minar.  contact:  Lili  de  Grandpre. 
anadian  .Medical  Association,  Room 
no.  1350  Sherbrooke  Street  West, 
lontreal.  Quebec.  H3G  IJI. 

ree  Nursing  Groups  Form 
ouncil  Of  Nurses  In  Manitoba 

innipeg,  Munitobii  —  The  three  Mani- 
iba  associations  representing  registered 
urses,  registered  psychiatric  nurses,  and 
censed  practical  nurses  have  formed  a 
ouncil  of  Nurses  in  Manitoba.  The  presi- 
ent  and  two  members  from  each  associa- 
on  comprise  the  Council,  which  held  its 
rst  organizational  meeting  in  October 
974  and  a  second  meetinsz  on  28  Novem- 
ei   1974. 

The  .Manitoba  As.sociation  of  Register- 
d  Nurses  (.MARN)  approved  participation 
1  the  Council  at  its  annual  meeting  m  May 
974.  (News,  September  1974,  page  13.) 


1974  Index  Available 

The  1974  index  for  The  Canadian 
\tirse.  vol.  70.  is  available  on  request. 
\\  rite  to  the  Circulation  Manager.  The 
Canadian  Murse.  50  The  Drive wav, 
Ottawa.  Ontario,  K2P  1 E2. 


MARN  representatives  on  the  Council  are 
M.ARN  President  Greer  Black.  Executive 
Director  Louise  Tod.  and  Margaret 
Bicknell.  chairman  of  the  MARN  legisla- 
tion committee. 

.'According  to  the  November  1974  issue 
of  Nursvene.  marns  bulletin,  the  two 
major  tasks  of  the  Council  are  "to  act 
as  a  means  of  liaison  between  the  three  as- 
sociations, and  to  act  in  an  advisory 
capacity  in  the  development  of  a  unified 
Nurses"  Act." 


Internationa!  Nursing  Review 
Publishes  75th  Birthday  Issue 

Geneva.  Switzerland  —  International 
Nursing  Review,  the  otTicial  publication 
of  the  International  Council  of  Nurses 
(ICN).  published  a  special  64-page  issue  in 
September  1974  in  honor  of  iCN's  75th 
anniversary. 

Included  in  the  issue  are  an  article  on 
ICN's  most  significant  achievements  over 
the  years,  a  report  on  current  projects  of 
ICN's  standing  committees,  and  a  conver- 
sation with  ICN's  officers  and  executive 
director,  who  share  their  views  on  iCN — 
past,  present,  and  future.  Vema  Huffman 
Splane.  Vancouver,  is  third  vice- 
president  of  ICN.. 

The  issue  also  includes  100  photos 
from  ICN  archives,  showing  events  and 
nurse  leaders  in  ICN's  history.  A  personal 
view  of  significant  milestones  is  given 
by  former  ICN  presidents,  including  Alice 
Girard,  Montreal,  who  was  president 
1965-9. 

Nursing  libraries  and  schools  of  nurs- 
ing who  want  a  copy  of  this  special 
document  for  historical  purposes  may 
order  it.  at  a  price  of  U.S.  $2.25,  from: 
International  Council  of  Nurses.  Publica- 
tion Sales  Department,  P.O.  Box  42. 
ZH-  1211  Geneve  20.  Switzerland. 


Committee  Advising  NBARN  Council 
Holds  Its  First  Meeting 

Fredericton.  N.B.  —  An  Advisory  Com- 
mittee on  Regulation  and  Professional 
Practice,  set  up  to  study  evaluation  of  nurs- 
ing practice  and  make  recommendations  to 
the  council  of  the  New  Brunswick  Associ- 
ation of  Registered  Nurses,  held  its  first 
meeting  early  in  October.  It  is  acting  in  an 
advisory  capacity  in  matters  including  re- 
gistration and  discipline  policies,  ad- 
ministration of  RN  examinations,  and 
standards  of  nursing  practice. 

At  the  October  meeting,  hospital  ad- 
ministrator Elizabeth  Murray  was  named 
chairman.  There  are  6  nurse  members  on 
the  committee  so  far:  Geraldine  Pelletier, 
Edmundston:  Anne  Thorne.  Saint  John: 
Jean  Sillars,  Campbellton:  Elizabeth  Beat- 
teay .  Saint  John:  Mary  Wheeler,  Bathurst; 
and  Eva  O'Connor,  Fredericton.  The  gov- 
ernment still  has  to  appoint  one  nonnurse 
member,  who  will  represent  the  public 


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THE  CANADIAN  NURSE      15 


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HEELBO"  and  the  new  "supercushioned"  HEELBO  FLAIR 
are  the  only  protection  for  decubitus  ulcers  that  allow  your 
patients  to  walk  in  comfort  and  safety. 

The  slim,  natural  shape  gives  patients  a  firmer  footing,  so 
that  during  late  hours  and  on  weekends  they  can  man- 
age better  alone. 

Like  the  original  HEELBO,  the  FLAIR  has  a  patented, 
warm,  comfortable  lining  of  brushed  Acrilan.'"  Heal- 
ing is  more  rapid,  because  there  are  no  straps  or 
bindings  to  restrict  blood  circulation. 

But  only  the  new  FLAIR  has  an  extra  deep  "arm- 
chair" of  foam  with  higher  sides  for  an  important 
extra  edge  of  protection. 

Leading  institutions  have  given  HEELBO 
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HEELBO   comfort  and   protection   to 
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After  all,  it  shouldn't  be  just  the  doctor 
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HEELBO  and  the  new  FLAIR  are 
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Hospital: 

Address: 

City: 

State: 

Zip: 

Preferred  Dealer: 

Heelbo  Corporation    P.O.  Box  950    Evanston,  Illinois  60204 


OPINION 


Drug  administration  times 
should  be  reexamined! 

The  pharmacy  staff  of  a  370-bed  general  hospital,  in  cooperation  with  the  pharmacy  and  therapeutics 
committee,  and  the  nursing  staff,  revised  the  time  schedules  for  administering  drugs.  The  new  times  went 
into  effect  after  a  through,  personalized  inservice  program,  reinforced  by  a  videotape. 

Ben  B.  Moggach 


i.d.  docs  not  have  to  be  translated  into 
XK).  1400.  and  1800  hours!  Optimum 
mes  tor  administering  one  drug  are  not 
3timun).  or  even  moderately  effective, 
mes  for  a  different  medication,  although 
,nh  ha\e  been  ordered  to  be  given  l.i.d. 

There  is  a  proper  time  to  administer 
rugs:  this  is  not  new.  Evidence  of  this 

ncern  may  be  seen  in  ancient  prescrip- 
on  writing  and  in  pharmacy  texts.  A 
andbook  of  materia  medica  and  therapeu- 
cs.  published  in  1^03,  mentions,  among 
thcr  things,  that  intervals  between  doses 
nd  lime  of  administration  arc  conditions 
lat  modify  the  actions  of  medications.* 

M\  career  in  hospital  pharmacy  began 

ih  ii'spcct  for  proper  administration 
mes.  I  was  eager  to  pass  on  to  nursing 

iff  information  1  fell  necessary  for  the 
roper  timing  of  drug  administration. 

I  also  knew  that  there  was  a  time 
chcdule  for  drugs,   which  was  hospital 

ilicy  initiated  by  the  pharmacy  and 
ncrapcutics  committee  and  sanctioned  b\ 


the  medical  advisory  committee.  But.  I  did 
not  realize  that  it  was  in  no  way  flexible. 
Even  if  a  drug  i)rdered  t.i.d.  would  be  best 
administered  q.  8  h..  it  would  still  be  ad- 
ministered according  to  the  schedule: 
IO(K).  l40U.and  1 800  hours.  My  efforts  to 
assist  were  seldom,  if  ever,  successful. 

Awareness  of  this  situation  gradually 
became  more  acute.  On  one  occasion,  in 
my  efforts  to  conuiiunicate  with  a  physi- 
cian who  had  written  an  exceptionally 
large  dose  l.i.d.  (no  time  specified).  I 
asked  the  head  nurse  how  she  had 
scheduled  the  drug  and.  to  my  horror,  she 
replied  1000,  1400.  and  1800  hours. 

This  compelled  me  to  declare  to  the 
pharmac)  and  therapeutics  committee  that 
1000.  1400.  and  1800  hours  were  seldom, 
if  ever,  a  rational  administration  schedule. 
The  motivation  was  further  strengthened 
during  the  RNAo's  interaction  conferences 
for  phamiacists  and  nurses,  when  I  discov- 
ered that  l.i.d.  in  most  Ontario  hospitals 
meant   1()(K).   14(M).  and  1800  hours,  and 


FIGURE  1 
Former  Policy  on  Drug  Scheduling 
To  reduce  the  likelihood  of  error,  the  following  interpretations  will  be  followed  with 
regard  to  the  physician's  orders: 

q.i.d.  (uns|3etified)  means  to  be  given  at 

q.i.d.  a.c.  &  h.s.  "       "    ' 

q.i.d.p.c.&  h.s.  

t.i.d.   (unspecified)  ' 

b.i.d.  (unspecified) 

q.  6  h.  

q.  8h.  

q.  12  h. 


1000  — 

1400  — 

1800  — 

2200 

0730  — 

1130  — 

1630  — 

2200 

0900  — 

1300  — 

1800  — 

2200 

1000  — 

1400  — 

1800 

1000  — 

2200 

1000  — 

1600  — 

2200  — 

0400 

0600  — 

1400  — 

2200 

1000  — 

2200 

that  many  nurses  fell  compelled  to 
schedule  this  time  even  though  they  knew 
it  was  not  necessarily  in  the  best  interest  of 
the  patient. 

I  also  began  to  see  other  defects  in  the 
schedule  policv  {Fi\(iire  I).  In  our  hospi- 
tal, q.i.d.  meant  1000.  1400.  1800.  and 
2200  hours.  If  the  drug  were  an  antibiotic, 
for  example,  the  patient  received  no  dose 
for  12  hours,  from  2200  hours  to  KXJO 
hours  the  following  day.  Our  q.  6  h. 
schedule  was  1000,  1600.  2200.  and  0400 
hours:  there  was  a  possible  conflict  with 
food  at  1600  hours  and  the  need  to  waken 
the  patient  at  04(X)  hours. 

The  pharmacy  and  therapeutics  commit- 
tee began  to  look  more  closely  at  the  drug 
groupings  set  out  by  Murrav  Shore**.  We 
conceived  the  idea  of  grouping  drugs  into 
A.B.C.D.  and  t-:  categories  and  setting  up  a 
specific  schedule  for  each  group 
(Figure  2). 

Drugs  were  arranged  in  alphabetical 
order  by  both  proprietary  and  generic 
names,  indicating  their  particular  group- 
ing (Figure  J).  Only  a  partial  list  is  in- 
cluded in  this  article,  since  manv  druizs 


S.O.L.  Poller.  MaU'iia  Mctluii  miJ 
Therupculii  s.  9cd.  Philadclphiu.  P. 
Blakislonv  Son  and  Co..  1903.  p  73 

**  Murrav  F.  Shore.  A  time  for  drugs.  C"(i//<((/. 
Plunin.J..  1 04:4: 5/W.  .Apr.  I*)7I 

Ben  Mogiiach  (Phiii.  B..  Ontario  Collc!:<:  of 
Pharniac) .  L'ni\crsit>  (>r  Toronto)  is  Jircclor 
of  phannacv  al  Si.  \l,ir\'s  General  Hospital. 
Kilehener.  Ontario 

THE  CANADIAN  NURSt     17 


FIGURE  2 
Guide  to  Administration  Schedules 

CROUP     A       Drugs  to  be  taken  on  an  empty  stomach  —  about  one  hour  a.t .  or  about  two  hrs.  p.c. 


o.d. 

b.i.d. 

q.12.h. 

f.i.d.  0600  —  1400 

q.i.d. 

q.e.h. 


1000 

— 

1000 

— 

1000 

— 

0600 

— 

0600 

1100 

0600 

1100 

— 

2200 

— 

2200 

— 

2200 

1600 

2200 

1600 

2200 

GROUP     B       Drugs  to  be  taken  immediately  a.c,  immediately  p.c,  or  with  food  or  milk 


o.d. 
b.i.d. 
q.  12.h. 
I.i.d. 


q.i.d. 
q.6.h. 


0800  or  w 

ith  food 

0800 

— 

— 

— 

0800 

— 

— 

— 

0800 

— 

1400 
with  food  or  milk 

— 

0800 

1200 

— 

1700 

0800 

1200 



1700 

2000  with  food  or  milk 
2000  with  food  or  milk 
2200  with  food  or  milk 

2200  with  food  or  milk 
2200  with  food  or  milk 


CROUP  C 

Drugs  to  be  taken 

1/2  hour 

before  food. 

o.d. 

0730  or  1/2  hour  before  food 

b.i.d. 

0730 

—         — 

1630  j 

— 

t.i.d. 

0730 

1130        — 

1630 

— 

q.i.d. 

0730 

1130        — 

1630 

2200 

q.6.h. 

0730 

1130        — 

1630 

2200 

CROUP     D      Long-acting  (slow  release)  drugs,  and  drugs  whose  effect  is  required  during  waking  hours. 


o.d. 

b.i.d. 

q.  12.h. 

t.i.d.  0730  —  1400 

q.i.d. 

q.6.h. 


0900 

— 

0900 

— 

0600 

— 

0730 

— 

0600 

1100 

0600 

1100 

1800 

— 

1800 

— 

— 

2000 

1600 

2200 

1600 

2200 

CROUP     E        Drugs  whose  maximum  benefit  is  not  dependent  upon  dosage  intervals  and  may  be  taken  with  or  without  food 


o.d. 

b.i.d. 

q.12.h. 

t.i.d. 

q.i.d. 

q.6.h. 


1000 
1000 
1000 
1000 
1000 
0600 


1400 
1400 


1100 


1800 

1800 
1800 
1600 


2200 

2200 
2200 


18     THE  CANADIAN  NURSE 


lANUARY    197 


FIGURE  3 
Example  of  Drug  Groupings 


)rug  Group 

mpicillin  (Penbritin) A 

S.A.  and  compounds  B 

tropine  sulphate  C 

elladonna;  phenobarbital 

nd  belladonna C 

eminal E 

entylol  C 

uftazone    B 

uscopan C 

utagesic B 

utazolidin   B 

utone B 

hlordiazepoxide  hydrochloride  (Librium) D 

hlopromazine  (Largactil) B 

hlorpropamide  (Diabinese) B 

loxacillin  (Orbenin)  A 

)echolin  (also  with  belladonna)  C 

)iazepam   D 


Drug 

Fersamal    

Furadantin 

hydrochlorothiazide  (HydroDiuril) 

hydrocortisone   

indomethacin  (Indocid) 

Lasix  (b.i.d.=  0700  &  1600)    

Librax 


Group 

B 
B 
B 
B 
B 
E 
C 


Dicoumarol  (same  time  daily) 
ligoxin  (b.i.d.  =  1000  &  2200  hours) 

;)onnatal   

•rythromycin 

errous  gluconate   

errous  sulphate   


E 
E 
C 
A 
B 
B 


Mobenol    . ' B 

multivitamins    E 

nalidixic  acid  (NegGram)  B 

nitrofurantoin    B 

phenformin  hydrochloride  (DBI)   B 

phenylbutazone  B 

prednisolone B 

prednisone B 

Pro-Banthine C 

Salazopyrin  B 

Serpasil    B 

sulfonamides  (with  large  amounts  of  fluid)    A 

Tandearil B 

tolbutamide B 

trimeprazine  tartrate  (Panectyl)    ^ B 

(Adapted  from  Murray  Shore,  "A  Time  for  Drugs.") 


id  to  be  arbitrarily  placed  for  lack  of 
formation. 

Pharmacy  staff  members,  on  recom- 
endation  of  the  pharmacy  and  therapeu- 
;s  committee,  conducted  a  survey  on  all 
jrsing  units  to  determine  the  present 
ork  load  placement.  We  rescheduled  ac- 
)rding  to  our  proposed  system  and  found 
ime  interesting  and  encouraging  infor- 
ation.  h  appeared  that  the  work  load  in 
edical  and  surgical  areas  could  be  more 
.enly  distributed  throughout  the  day. 

A  2-month  project  on  medical  and  sur- 
ical  floors  was  authorized  by  the  phar- 
lacy  and  therapeutics  committee. 


service  program 

We  began  to  work  immediately  with  the 

aff  development  persons  to  prepare  an 

diovisual  inservice  program.  We  made  a 

lor  movie  with  sound,  showing  nurses 

d  pharmacists  preparing  the  Kardex  and 

ledication  tickets,  using  the  alphabetical 

ug  grouping  list  and  the  schedules. 

Two  pharmacists  discussed  the  new  sys- 

:m  with  personnel  on  each  shift  until  we 

ere    certain    everyone    understood    the 

reject's    aims    and    how    the    system 

orked.  We  assured  the  head  nurses  that  a 

harmacist  would  assist  on  the  first  day  of 

•VNUARY   1975 


the  project  and  would  be  at  her  beck  and 
call  throughout  the  project  period.  The 
pharmacy  is  routinely  open  56  hours  a 
week  and  offers  24-hour,  "on  call'"  ser- 
vice, using  a  paging  system. 

Meetings  were  held  with  the  head 
nurses  and  the  area  coordinators  at  least 
once  a  week  to  monitor  progress  and  deal 
with  problems.  Problems  were  rare,  and 
usually  preexisting,  and  were  solved  to 
everyone's  satisfaction.  Nurses  expressed 
a  sense  of  well-being  about  giving  medica- 
tions at  times  that  were  best  for  the  patient: 
they  became  more  aware  of  the  impKirtance 
of  administration  times. 

The  project  was  extended  an  extra 
month  before  final  approval  was  given  by 
members  of  the  pharmacy  and  therapeutics 
committee  and  sanction  from  the  medical 
advisory  committee. 

Then  it  was  pharmacy  personnel's  task 
to  introduce  the  system  throughout  the 
hospital.  We  followed  the  same  procedure 
of  personal  inservice,  reinforced  by  a  vid- 
eotape. 

Conclusion 

We  still  have  a  drug  administration  time 
schedule  authorized  by  medical  advisory 
committee,   but   it   is   much   broader   in 


scope,  permitting  scheduling  with  respect 
to  food,  time,  and  desired  effect.  The 
grouping  for  each  drug  has  been  carefully 
scrutinized  by  the  pharmacy  department 
and  will  be  revised  as  more  information 
becomes  available.  Pharmacy  staff  have 
an  opportunity  for  input  as  new  drugs  are 
ordered;  our  information  is  being  applied 
and  our  efforts  in  medication  scheduling 
are  seldom  frustrated. 

Nurses  have  a  new  sense  of  well-being 
in  knowing  patients  are  receiving  better 
care.  Doctors  have  complimented  our  ef- 
forts, none  has  been  critical,  and  we  hope 
they  use  the  information  in  community 
prescribing.  Pharmacy  personnel  see  this 
experience  as  an  opening  door  to  patient 
education  via  the  nurse  or  directly  or  both. 

It  is  our  hope  that  this  shared  experience 
will  encourage  nurses  to  look  more  closely 
into  an  area  of  patient  service,  controlled 
by  a  policy  that  may  be  interfering  with  the 
safe  and  proper  scheduling  of  drug  ad- 
ministration. 


THE  CANADIAN  NURSE     19 


An  experiment  with 
the  ladder  concept 


A  description  of  an  experiment  with  core  courses,  specifically  designed  for 
students  in  the  nursing  diploma  and  nursing  assistant  programs. 


Jocelyn  A.  Hezekiah 


Although  much  has  been  written  about  the 
concept  of  vertical  mobility  in  education, 
so  far  in  nursing  there  is  little  evidence  that 
this  concept  has  been  put  into  practice.  A 
few  experiments  are  now  being  tried.  In 
the  United  States,  for  example,  practical 
nurses  at  the  State  College  of  Arkansas  can 
move  to  the  baccahuircatc  level  with 
credit  given  for  past  educational 
achievement.' 

Another  way  of  facilitating  vertical  mo- 
bility is  to  use  the  core  curriculum.  The 
concept  of  a  common  core,  either  in  one 
subject  or  in  a  variety  of  subjects,  is  not 
radically  new.  Within  the  past  four  or  five 
years,  reports  at  the  federal  and  provincial 
levels,  addressing  themselves  to  the  health 
care  system,  have  recommended  that 
common  courses  for  students  in  various 
health  disciplines  should  be  introduced  in 
universities  and  in  colleges  of  applied  arts 
and  technology.  This,  it  was  hoped,  would 
not  only  maximize  learning  opportunities 
and  share  costs,  but  would  also  help  stu- 
dents understand  each  other's  roles  and 
responsibilities,  thus  facilitating  com- 
munication and  coordination  between  the 
various  health  disciplines.  ^.^•'* 

Cognizant  of  the  needs  of  the  health  care 
system,  the  faculty  of  the  Health  Sciences 
Division,  HumberCollegeof  Applied  Arts 


Jocelyn  Hezekiah  (B.N.,  McGill:  M.til..  On- 
tario Instilutc  for  Studies  in  Kducation)  is 
Chairman,  Nursing  Programs,  North  Campus. 
Humbcr  College  of  Applied  Arts  and  Technol- 
ogy, Rcxdalc.  Ontario. 
20     THE  CANADIAN  NURSE 


and  Technology,  decided  to  experiment 
with  core  courses  for  nurses  and  allied 
health  workers.  We  believed  that  much 
innovation  and  experiinentation  could  and 
should  take  place  in  the  college  setting.  A 
key  component  in  our  philosophy  was  to 
provide  an  opportunity  for  potential  health 
workers  to  be  educated  in  common  courses 
and  in  similar  settings  to  facilitate  func- 
tioning of  the  health  care  team. 

It  seemed  appropriate  that  we  should 
attempt  to  experiment  in  this  area  by  or- 
ganizing a  curriculum  that  would  facilitate 
career  mobility  and  possible  transfer  from 
one  nursing  program  or  allied  health  prog- 
ram to  another. 

An  experiment 

The  following  is  a  description  of  an  ex- 
periment with  core  courses,  specifically 
for  students  in  the  nursing  diploma  and 
nursing  assistant  programs. 

A  number  of  factors  precipitated  this 
experiment; 

D  The  College  of  Nurses  of  Ontario,  in  its 
■"white  paper'"  that  was  circulated  provin- 
cially,  reaffirmed  that  the  functions  of 
both  the  registered  nurse  and  the  registered 
nursing  assistant  constituted  a  single  dis- 
cipline, namely,  nursing,  with  identified 
levels  of  skills  and  application  of  know- 
ledge in  clinical  practice.' 
n  Humber  College,  at  that  time,  was  the 
only  community  college  in  Ontario  with  a 
nursing  diploma  program. 
n  The  phasing  out  of  a  nursing  assistant 
training  center  within  the  region  that 
Humber  College  served,  created  the  op- 


portunity for  the  transfer  of  such  a  school 
into  the  college  setting. 

It  is  a  well-known  fact  that  many  regis- 
tered nursing  assistants  have  entered 
schools  of  nursing  to  become  registered 
nurses,  but  have  been  given  no  credit  foi 
their  past  knowledge  and/or  experience. 
When  credit  was  given,  it  was  in  a  hap- 
hazard fashion.  Furthermore,  these  two 
groups  work  closely  together  on  the  health 
care  team. 

Too  often,  one  group,  which  is  prepared 
differently  from  the  other,  tends  to  feel 
superior  or  inferior,  rather  than  recogniz- 
ing that  each  fills  a  well-needed  role  on  the 
team.  Consequently,  one  group  feels 
threatened  by  the  other;  instead  of  a 
cooperative,  complementary  relationship 
transpiring,  a  competitive  one  occurs.  We 
hope  that  a  more  positive  appreciation  ol 
each  other's  role  will  be  fostered  in  oui 
educational  program. 

The  curriculum 

Final  approval  of  the  curriculum  to  meet 
the  College  of  Nurses'  requirements  was 
granted  in  June  1972.  Commencing  in  the 
fall  of  1972,  both  nursing  diploma  and 
nursing  assistant  students  shared  a  com- 
mon initial  semester.  (September  to  De- 
cember.) 

The  curriculum  content  for  both  group; 
is  comprised  of  bioscience.  developmenta 
psychology,  sociology,  communit) 
health,  nursing  I  theory,  nursing  I  prac 
tice,  and  first  aid  and  accident  prevention 
The  total  number  of  hours  in  theory  aiK 
practice  per  week  is  29. 

JANUARY   197; 


Behavioral  objectives  are  identical  for 
II  courses.  Students  explore  common 
ends  in  the  provision  of  health  care,  learn 
asic  skills  of  nursing  care,  and  take  clini- 
al  practice  and  theorv'  classes  together. 
^'e  make  no  distinction  in  terms  of  assign- 
ig  students  to  the  clinical  setting;  each 
roup  of  10  to  12  comprises  both  nursing 
nd  nursmg  assistant  students. 

dmlsslon  requirements 

Grade  12  is  required  of  all  students.  In 
ddition,  diploma  nursing  students  need 
n  overall  average  of  60  percent  in 
cademic  subjects  and  in  each  of  two  sci- 
nces.  Science  courses  are  not  required  of 
ursing  assistant  students. 

Students  who  contemplate  upgrading  to 
^le  nursing  diploma  program  are  advised 
hat  they  require  two  sciences.  Mature 
ursing  assistant  applicants  who  do  not 
lave  Grade  12  can  write  a  Humber  College 
ilulure  .Applicant  test  and.  on  successful 
ompletion.  are  admissible  to  the  prog- 
am. 

Interviews,  group  and  individual,  are 
arried  out  for  both  groups  with  estab- 
i^hed  criteria  to  assess  students"  suitabil- 
ty  for  the  nursing  programs. 

andidates 

Fifty-five  students  enrolled  in  the  dip- 
oma  program,  and  1 8  in  the  nursing  assis- 
ant  program  in  the  class  commencing  Sepv 
ember  1972.  .All  nursing  assistant  applic- 
ints  had  the  requirement  of  Grade  12  and 
nany  had  one  or  two  sciences. 

During  the  first  semester,  four  students 
Aithdrevv  from  the  nursing  assistant  prog- 
am  and  one  transferred  to  the  nursing  dip- 
oma  program:  one  student  was  unable  to 
omplete  the  nursing  component  satisfac- 
torily and  was  given  the  option  to  reenter 
the  program  in  September  1973.  As  a  re- 
sult, 12  students  remained  from  the  origi- 
nal enrollment. 

In  addition  to  these  12  remaining  stu- 
dents. 4  students  in  the  nursing  diploma 
program  of  September  1 97 1  were  admitted 
to  the  second  semester  of  the  nursing  assis- 
tant program,  at  their  request.  Five  stu- 
dents who  were  experiencing  some  diffi- 
culty in  the  1 972  nursing  diploma  program 
transferred  to  the  nursing  assistant  prog- 
ram in  the  second  semester.  The  numberof 
JANUARY   1975 


Students  thus  enrolled  in  semester  II  was 
2 1 .  All  successfully  completed  the  prog- 
ram. 

Results 

The  evaluation  of  the  common  semester 
and  the  program  as  a  whole  involved  stu- 
dents, faculty,  and  nursing  service  agen- 
cies. It  took  place  in  several  stages.  A 
questionnaire  pertaining  to  nursing  con- 
tent and  role  perception  was  distributed  to 
students  at  the  end  of  the  first  semester, 
second  semester,  and  again  after  the  sum- 
mer session. 

After  the  first  semester.  50  percent  of 
the  respondents  stated  they  were  attracted 
to  the  program  because  "the  opportunity 
for  transferability  to  other  health  programs 
is  possible."  Fifty  percent  stated  that  the 


teachers  had  similar  expectations  of  nurs- 
ing diploma  and  nursing  assistant  students 
during  the  common  semester  and  that  the 
teachers  did  not  make  distinctions  in  their 
relationships  with  students  from  either 
group.  Twenty-five  percent  commented 
on  the  advantages  of  studying  with  other 
health  workers  in  semester  I. 

By  the  end  of  the  second  semester,  most 
students  perceived  the  registered  nurse  as 
the  person  responsible  for  the  administra- 
tive side  of  nursing  and  for  medications. 
They  saw  her  as  team  leader  and  as  the 
person  who  supervises  the  registered  nurs- 
ing assistants.  Most  perceived  the  nursing 
assistant  as  the  bedside  nurse,  the  one  in 
close  contact  with  the  patient. 

The  faculty  as  a  total  group  gave  verbal 

evaluation  on  both  nursing  content  and 

THE  CANADIAN  NURSE     21 


their  perception  of  iiaving  combined  nurs- 
ing and  nursing  assistant  students  together 
in  the  chnical  practice  and  classroom  set- 
ting.. TJiey  felt  they  had  treated  both 
groups  similarly,  forgetting  that  students 
were  either  nursing  diploma  or  nursing 
assistant.  It  must  be  noted  that  the  role 
perception  questionnaire  was  designed  by 
faculty  and  was  by  no  means  a  precise 
instrument. 

An  outside  researcher  was  hired  to 
document  findings  on  the  performance  and 
career  plans  of  the  first  graduates  of  the 
nursing  assistant  program.  In  addition,  a 
refined  role-perception  instrument  was  de- 
signed. 

The  questionnaire  with  regard  to  work 
performance  was  issued  to  both  the 
graduates  and  their  employers,  whereas 
the  refined  role-perception  questionnaire 
was  issued  to  the  graduates  only.  From  the 
data  obtained,  it  appeared  that  the  first 
graduates  were  considered  by  their  emp- 
loyers to  function  about  the  same  as  other 
nursing  assistants  of  equal  work  experi- 
ence. Four  indicated  that  they  intended  to 
continue  what  they  were  doing  at  the  time 
the  questionnaire  was  completed.  Four 
others  indicated  a  desire  to  complete  re- 
quirements for  the  diploma  program.  One 
intended  to  take  up  a  different  career,  and 
one  to  take  a  postbasic  course.* 

Problem  areas 

With  the  first  class,  a  major  problem 
experienced  was  in  communication,  that 
is,  unclear  interpretation  of  the  purpose  of 
the  common  semester.  Because  of  this, 
many  students  entered  the  nursing  assis- 
tant prograin  as  a  ""back  door""  approach 
to  the  nursing  diploma  program,  either  be- 
cause the  diploma  program  was  filled,  or 
because  they  did  not  meet  the  admission 
requirements.  Consequently,  in  the  first 
semester  there  were  many  requests  for 
transfer  to  the  diploma  program. 

Perhaps  this  problem  bears  a  relation- 
ship to  the  outside  researcher's  findings, 
which  indicated  that  at  least  one-half  of  the 
group  planned  to  become  registered  nurses 
and  wished  they  had  done  so  in  the  first 
place.  Further  follow-up  studies  of  subse- 
quent classes  have  been  recommended  by 
the  researcher  to  negate  or  validate  this 
finding. 
22     THE  CANADIAN  NURSE 


Summary 

Having  a  common  initial  semester  not 
only  facilitates  vertical  mobility  for  nurs- 
ing assistants  —  should  they  desire  to  con- 
tinue their  studies  toward  diploma  nursing 
—  but  it  also  provides  a  way  for  the  dip- 
loma students  to  transfer  to  the  nursing 
assistant  program  when  they  are  unable  to 
cope  with  the  requirements  of  the  nursing 
program.  In  the  past,  these  students  left  the 
nursing  diploma  program  and  went  into 
nursing  assistant  programs,  where  they 
often  had  to  repeat  their  entire  year.  With 
the  common  semester,  they  receive  credit 
for  the  entire  first  semester,  and  they  have 
to  pick  up  only  from  semester  two. 

We.  the  nursing  faculty,  have  worked 
hard  to  revise  the  curriculum,  based  on  the 
evaluative  tools.  We  are  enthusiastic  about 
the  common  semester  and  its  implementa- 
tion, and  hope  that  students  will  pick  up  a 
more  positive  outlook,  understanding,  and 
appreciation  of  the  other  health  care  team 
members"  roles  and  functions.  Our  find- 
ings indicate  on  a  small  scale  that  the  be- 
ginning of  such  appreciation  is 
engendered.^ 

For  too  long,  registered  nurses  in  bac- 
calaureate programs  have  complained 
about  this  need  to  repeat  courses  they  took 
as  diploma  students.  Various  proficiency 
tests  are  being  designed  to  exempt  students 
from  particular  courses.*  We  have  started 
with  such  tests  for  the  nursing  assistant 
student  who  moves  to  the  diploma  level  in 
nursing. 

There  is  an  urgent  need  to  look  at  other 
levels  of  nursing.  With  the  transfer  of  dip- 
loma programs  to  community  colleges,  the 
time  is  ripe  for  us  to  work  closely  with 
faculty  of  university  nursing  programs. 
We  need  to  develop  a  variety  of  models 
and  inethods  so  the  diploma  nurse  can  re- 
ceive credit  toward  the  baccalaureate 
level.  In  this  way,  each  level  can  contri- 
bute fully  to  the  development  of  the  pro- 
fession and  provide  optimum  care  to  our 
society. 

Nursing,  if  it  is  to  go  forward  and  not 
become  obsolescent,  must  be  prepared  to 
take  risks  —  risks  in  innovation,  risks  in 
pioneering. 


References 

1.   "Cone" 


Career    options    in    niirsin^^ 


eiliiccition.  Conwav.  ArkanMis.  .State  Cc 
lege  of  Arkansas.  1971.  (Unpuhlishc 
document.) 

2.  Ontario.  Deparliiient  ot  He.illh.  Cniulin; 
principles  for  the  revtihilion  <iiicl  ih' 
ediiccilion  of  the  health  disciplines 
Thomas  Wells,  Health  .Miiiisicr.  1 97 1 . 

?i.  Ontario  Council  '.'•i  Health.  Future  ar 
ruHiieinenls  for  health  education.  TorontOi 
Ontario  Depl.  of  Health.  1971.  (Mono- 
graph no.   I ) 

4.  Canada.  Committee  iw  Costs  of  Health 
.Services.  Task  Force  report  on  the  cost  o) 
health  services  in  Canaila.  Ottawa,  c  1969, 
(Draft) 

5.  College  of  Nurses  of  Ontario.  Statements 
of  education  and  functions  for  the  bac- 
calaureate nurse,  diploma  nurse,  nursinii, 
assistant.  Draft.  Toronto.  1971. 

6.  Smith.  1.  A  study  of  the  first  class  of  nurs 
ing  assistants  to  )>raduale  from  Huiiihei 
Colleiie  of  Applied  Arts  and  Technoloif) 
t97i.  Rexdale,  Humber  College  of  .^ppliei 
Arts  anil  Technology.  1974. 

7.  Ibid. 

8.  Schmidt.  Mildred  S..  and  Lyons.  William 
Credit  for  what  you  know  .  Amer.  J.  Xurs 
69;  1: 101-4.  Jan.  1969. 

Bibliography 

Brunet.  Jacques,  and  Gagnon.  Claire.  Lava 
University  accepts  a  challenge.  Canad 
Nurse  65:8:44-5.  Aug.  1 969. 

Canada.  Committee  on  Costs  ^-tt  Health  Ser 
vices.  Task  force  report  on  the  cost  o 
health  .wrvices  in  Canada.  Ottawa.  el969 
(Draft). 

College  of  Nurses  of  Ontarii).  Statements  o 
education  and  fuiutions  for  the  hac 
calaureate  nurse,  diploma  nurse,  iiursiiii 
assistant.  Draft.  Toronto.  1971. 

Ontario.  Department  of  Health.  Guidinf-  prin 
ciples  for  the  regulation  and  the  educatioi 
of  the  health  disciplines.  Thomas  Wells 
Health  Minister.  1971. 

Ontario  Council  of  Health.  Future  arranve 
ments  for  health  education,  loronlo.  On 
tario  Depl.  of  Health.  1971.  ( Monograpl 
no.  I) 

Schmidt.  Mildred  S.  and  L\i>ns.  VVilliam 
Credit  tor  what  yi)u  know.  .Amer.  J.  .\i{rs 
69: 1: 10 1-4.  Jan.  1969. 

Uprichard,  .Muriel.  The  education  of  nurses 
Canad.  .\nr.se  68:6:.^0-6.  Jun.  1 972.         '^^ 

JANUARY   197 


The  three  pilot-nurse  crews  of  the  Saskatchewan  Air  Ambulance  Service  assure 
continuity  of  patient  care  for  even  the  remotest  community  of  the  province. 


\n  unexpected  prairie  dust  storm  had  low- 
red  visibility  to  almost  zero.  Approach- 
ng  the  airport  with  the  aid  of  instruments, 
he  pilot  received  clearance  to  attempt  a 
anding  directly  into  the  80  niile-an-hour 
vmd. 

Our  patient  was  to  be  a  kidney  recipient 
nd.  as  the  donor  kidney  was  in  Saska- 
oon,  a  detour  to  an  alternate  airport  would 
iiean  losing  valuable  time. 

Two  landing  attempts  were  unsuccess- 
ul  as  we  strained  lo  see  any  identifying 
andmarks:  these  were  obscured.  On  our 


Mary  Hill,  Marlyn  McLean,  Erna  Sherwood 

third  approach,  the  wind  shifted  suffi- 
ciently to  attempt  landing  on  the  longer 
runway.  We  landed  safely  with  the  aid  of 
approach  lights.  The  patient,  seemingly 
unaware  of  the  problems  encountered, 
thanked  us  for  a  pleasant  trip! 


Mar>'  Hill  (R.N..  University  Hospital  School 
el  Nursing.  Saskatoon;  dipl.  public  health 
nursing.  U.  of  Saskatchewan).  Marlyn 
McLean  (R.N..  Saskatoon  City  Hospital 
school  of  nursing),  and  Erna  Sherwood  (R.N.. 
Moose  Jaw  Providence  school  of  nursing)  are 
the  nursing  staff  of  the  Saskatchewan  Air 
\nibulance  Service  in  Saskatoon  and  Regina. 
lANUARY   1975 


Air  ambulance  service 

The  Saskatchewan  Government  Air 
Ambulance  Service  was  formed  in  1946. 
Since  then  it  has  flown  more  than  23.000 
nights  and  logged  nearly  7  million  miles, 
without  injury  or  fatal  accident  to  passen- 
gers or  crew.  There  are  three  pilot-nurse 
crews,  four  aircraft  engineers,  and  five 
aircraft. 

The  principal  function  of  the  service  is 
totransport  patients  quickly,  safely,  and  as 
comfortably  as  possible  from  the  rural  cen- 
ters of  the  province  to  hospitals  where 
specialized  medical  care  is  available. 

Requests  to  transfer  a  patient  are  usually 
received  from  the  doctor  in  the  rural  com- 
munity or  from  the  receiving  doctor  in  the 


city.  In  the  absence  of  a  doctor,  calls  may 
be  made  by  any  responsible  person  of  the 
comntunity.  such  as  a  member  of  the 
clergy  or  Royal  Canadian  Mounted  Police. 

The  service  reaches  all  areas  of  the  pro- 
vince where  there  are  adequate  landing 
strips,  and  even  where  they  are  less  than 
adequate.  For  example,  in  one  small 
community  the  landing  strip  is  outlined  by 
a  public  school  at  one  end  and  a  dugout  at 
the  other,  bordered  by  a  curling  rink  on  the 
right  side,  and  a  stone  monument  on  the 
left.  Here,  it  seemed  the  whole  town  came 
to  greet  us  on  arrival ,  no  doubt  amazed  that 
we  had  missed  all  obstacles. 

Most  patients  transported  fall  into  the 
categories  of  medical  emergencies,  such 
as  cardiac  failure  or  respiratory  distress: 
accidental  injuries,  such  as  head  injuries  or 
fractures;  or  complications  of  pregnancy 
and  premature  babies. 

The  flight  nurse  is  responsible  for  the 

continuation  en  route  of  medical  treatment 

as  prescribed  by  the  physician  or,  in  the 

THE  CANADIAN  NURSE     23 


absence  of  such  orders,  on  her  personal 
initiative.  The  aim,  as  in  any  field  of  nurs- 
ing service,  is  to  provide  the  best  possible 
patient  care  in  any  given  situation,  and  to 
anticipate,  recognize,  and  cope  with 
emergencies  that  may  arise. 

Besides,  we  must  give  consideration  to 
the  effects  of  turbulent  air  and  confined 
space  on  the  patient,  his  psychological 
reaction  to  flying,  and  the  physiological 
reaction  of  the  body  to  changes  in  altitude. 
Reduction  in  air  pressure  during  flight  will 
expand  a  collection  of  air  within  body 
cavities  by  20  percent  at  5.000  feet  above 
sea  level.  Areas  most  affected  are  the  ab- 
domen, chest,  ears,  and  sinuses. 

Patients  usually  will  already  have  re- 
ceived considerable  definitive  treatment 
prior  to  their  transfer  to  the  aircraft  from 
the  rural  hospital.  However,  there  are 
some  instances  where  there  can  be  little 
previous  preparation.  One  such  was  on  a 
typical,  bright  sunmicrday.  when  we  took 
off  from  a  small  northern  conmiunity  with 
two  patients  on  board. 

Mrs.  C.  was  diagnosed  as  possibly  hav- 
ing a  brain  tumor,  yet  was  able  to  sit  up. 
Our  other  patient,  Mrs.  U.,  was  a  multi- 
para with  placenta  praevia.  Ten  minutes 
prior  to  our  arrival  at  Saskatoon,  our  pa- 
tient count  increased  to  three,  as  a  healthy 
baby  boy  had  arrived  on  the  scene. 

There  have  been  several  births  while 
airborne  and  many  ""almosts""  during  the 
28-year  history  of  the  air  ambulance  ser- 
vice. One  grateful  mother  named  her  new- 
born son  after  the  pilot  and  the  aircraft's 
registration  letters,  which  happened  to  be 
CFSAM. 

Since  space  is  at  a  premium  in  a  small 
aircraft,  deliveries  are  often  hard  to  man- 
age. Equipment  must  be  within  arm"s 
reach,  and  as  clean  and  sterile  a  fleld  as 
possible  must  be  maintained,  while  reas- 
suring the  mother  —  who  may  not  care  to 
have  her  child  delivered  3,000  feet  in  the 
air  —  and  coping  with  the  complications 
of  labor,  since  most  pregnant  patients  are 
being  flown  because  of  maternal  or  fetal 
emergency.  Basically,  the  flight  nurse 
must  be  able  to  anticipate,  improvise,  ob- 
serve, and  initiate  treatment  when  neces- 
sary. 

Equipment 

Eiquipped  to  operate  on  a  year-round 
basis,  the  service  provides  coverage  24 
hours  a  day,  with  crews  prepared  for  im- 
24    THE  CANADIAN  NURSE 


mediate  departure  from  the  airport  office 
from  09:00  to  17;00  hours,  and  providing 
standby  coverage  at  night. 

All  equipment  is  portable,  except  forthe 
oxygen  supply,  which  is  permanently  lo- 
cated within  the  aircraft.  Therefore,  it  is 
important  that  the  nurse  obtain  as  much 
information  as  possible  about  the  patient's 
condition  prior  to  leaving  base  in  order  to 
have  available  en  route  the  equipment  she 
will  need. 

Each  nurse  has  a  medical  bag  containing 
basic  supplies.  These  include  dressings, 
needles  and  syringes,  catheters  (suction 
and  oxygen),  oxygen  masks  and  nasal 
cannulas,  airways,  tape,  clamps  and  scis- 
sors, sterile  gloves,  and  a  small  supply  of 
drugs,  such  as  analgesics  and  cardiac  and 
respiratory  stimulants. 

Our  portable  equipment  includes  infant 
and  adult  resuscitators  (kept  on  the  aircraft 
at  all  times),  an  automatic  resuscitator 
(used  when  we  know  in  advance  that  a 
patient  needs  constant  resuscitation),  in- 
cubator, croupette,  blood  pressure  cuff, 
pressure  infusion  cuff,  cardio-beeper.* 
fracture  boards,  sandbags,  suction,  and 
maternity  bundles. 

Nursing  duties,  apart  from  direct  patient 
care,  include  maintenance  and  cleaning  of 
equipment,  keeping  stock  supplies  up-to- 
date,  recommending  purchase  of  new 
equipment,  recording  information  about 
each  patient  carried,  and  arranging  for  and 
attending  refresher  programs  on  nursing 
care. 

Weather  or  not 

Environmental  factors  obviously  play  a 
major  role  in  aeromedical  nursing. 
Weather  conditions,  as  well  as  the  im- 
mediate physical  environment  of  the  air- 
craft, are  definite  considerations  in  provid- 
ing nursing  care. 

During  winter,  stretchers  are  made  up 
with  extra  blankets  and  "bunny  bags" 
(heavy  zippered  covers),  as  the  tempera- 


*  A  cardio-beeper  is  a  portable  battery- 
operated  heart  monitor  approximately  4  "  x6". 
It  can  be  used  either  by  attaching  a  small  dia- 
phragm to  the  patient's  finger  by  means  of  a 
Veicro  strip,  or  by  attaching  the  beeper  to  elec- 
trodes placed  on  the  palicnts  chest  or  wrists. 
The  monitor  tells  the  heartbeats  per  minute  on  a 
meter,  and  indicates  the  heart  rhythm  by  way  of 
a  "beep"  and  flashing  light. 


ture  inside  the  aircraft  is  often  not  miicf 
higher  than  outside  the  craft,  especially  ir 
30-degree-below  weather.  Providing  nins 
ing  care  when  both  patient  and  nurse  art 
heavily  bundled  in  layers  of  blankets  oi 
clothing  is  cumbersome  and  can  be  frus- 
trating. All  procedures  are  carried  out  a.* 
quickly  as  possible.  Intravenous  solutions 
sometimes  freeze  during  stretcher  tc 
stretcher  transfer  and  on  very  cold  days 
can  take  the  duration  of  the  flight  to  thaw. 

An  unusual  and  atypical  responsibility 
used  to  fall  to  the  nurse  during  winter  when 
our  smallest  aircraft  was  on  skis.  The 
plane  often  refused  to  turn  around  in  the 
soft  siiow .  so  the  nurse  was  asked  to  take  t 
rope  —  conveniently  located  next  to  hei 
seat  —  and  loop  it  through  a  ring  on  the 
outer  edge  of  the  wing,  dig  her  heels  into 
the  deep  snow,  and  hang  on  for  dear  life 
while  the  pilot  roared  the  engine  to  swinj 
the  aircraft  around.  Shock  and  disbeliel 
can  best  describe  our  initial  reaction  ir 
such  a  situation. 

In  summer,  problems  include  motior 
sickness  due  to  turbulent  air  and  heat. 
Muddy  flelds,  masses  of  grasshoppers, 
mosquitoes,  and  blowing  dust  are  often 
additional  hazards. 

The  patient's  diagnosis  largely  deter- 
mines the  altitude  in  flight.  For  instance, 
patients  with  head  injuries  are  flown  al 
lower  altitudes  to  lessen  a  possible  in- 
crease in  pressure  on  the  injured  brain, 
Conversely,  patients  with  fractures  are 
often  transported  at  higher  altitudes  tc 
avoid  turbulence,  which  would  add  to  dis- 
comfort and  pain. 

Although  the  primary  concern  during 
any  flight  is  patient  comfort,  the  overall 
safety  in  flight  operations  as  determined 
by  the  pilot  takes  precedence  over  flight 
levels  or  routes  that  may  be  preferred  by 
the  flight  nurse.  The  pilot  does,  however, 
comply  with  reasonable  requests  by  the 
flight  nurse  when  they  do  not  constitute  a 
real  or  potential  flight  hazard.  A  pilot  and 
nurse  simply  work  as  a  team,  while  retain- 
ing a  mutual  respect  for  each  other's  re- 
sponsibilities. 

Willing  hands 

A  pilot's  licence  is  not  a  requirement  for 
employment  as  a  nurse  w  ith  the  air  ambul- 
ance service.  However,  it  was  decided  one 
summer  that  the  nurses  should  learn  some- 
thing about  flying,  or  at  least  become 
familiar  with  landing  procedures  and  in- 
JANUARY    197 


The  nurse  was  asked  to  take  a  rope  and  loop  it  through  a  ring  on  the  outer  edge  of  the  wing,  dig  her 
heels  into  the  deep  snow,  and  hang  on  for  dear  life  while  the  pilot  revved  the  engine  to  swing  the 
aircraft  around. 


experience  is  to  land  at  a  small  airstrip  and 
be  met  by  smiling  faces  and  willing  hands. 
No  matter  how  tiring  the  day  or  how 
■"bumpy"  the  flight  has  been,  a  friendly 
welcome  from  those  awaiting  our  arrival 
makes  air  ambulance  nursing  a  particu- 
larly gratifying  experience. 

Minutes  count 

Time  is  an  important  factor  for  many  of 
the  patients  transported,  especially  in 
terms  of  the  total  lime  they  are  out  of  reach 
of  the  care  of  a  physician  and  hospital 
facilities. 

This  was  illustrated  when  we  received  a 
request  late  one  afternoon  from  a  rural 
hospital  approximately  200  miles  away  to 
transport  two  patients  who  were  in  critical 
condition  and  in  urgent  need  of  specialized 
medical  care  in  an  urban  center.  Treatment 
that  had  been  initiated  prior  to  transpon 
was  continued  en  route.  The  total  time 


expended  between  medical  centers  was 
one  hour,  a  shaip  contrast  to  four  or  even 
five  hours  had  they  gone  by  road. 

In  some  cases,  patients  require  little 
physical  care  but  need  a  great  deal  of  emo- 
tional support  and  reassurance.  Relatives 
accompanying  the  patient  may  also  need 
support  and  advice  during  w  hat  is  usually  a 
stressful  time  for  them  also. 

On  occasion,  the  air  ambulance  service 
flies  specialists  and  blood  supplies  to  the 
rural  centers.  This  was  the  case  when  Mrs. 
R.  gave  birth  and  began  to  hemorrhage. 
Two  specialists  were  flown  out  to  assist 
the  rural  doctor  with  emergency  surgery, 
since  the  patient's  condition  would  not 
allow  her  to  be  moved.  Blood  supplies  had 
been  transported  earlier  in  the  evening. 
Local  residents  turned  out  to  light  the  air- 
strip w  ith  car  lights  to  enable  the  aircraft  to 
land  safely. 

Mrs.  R.  not  only  survived  the 
THE  CANADIAN  NURSE     25 


Loading  patient  into  aircraft  at  Hudson 
Bay,  Saskatchewan. 


emergency  surgery,  but  also  the  transfu- 
sion of  42  pints  of  blood.  32  of  Iheni  do 
nated  that  evening  by  local  residents.  Just 
such  coniniunity  involvement  and  spirit  is 
often  in  evidence. 

Although  the  service  is  available  only  to 
residents  of  Saskatchewan,  flights  are  not 
all  confined  within  provincial  boundaries. 
Trips  have  been  made  to  Texas,  Califor- 
nia, Ontario,  and  many  other  Canadian 
provinces.  For  such  extended  flights,  addi- 
tional preparation  is  needed  to  ensure  ade- 
quate supplies  for  the  entire  trip. 

One  interesting  flight  was  to  California 
to  bring  a  9 1 -year-old  man  and  his 
86-year-old  wife  back  to  Saskatchewan. 
Mr.  M.  had  become  ill  while  visiting  rela- 
tives. The  diagnosis  was  cerebrovascular 
accident,  pneumonia,  and  diabetes. 

Mr.  M.  was  unconscious  and  required 
continuous  oxygen  and  frequent  oral  suc- 
tioning. He  was  to  have  tube  feedings 
every  three  hours,  important  because  of 
26     THE  CANADIAN  NURSE 


Transferring  patient  from  air  ambulance  to  road  ambulance. 


his  diabetic  condition.  However,  due  to  air 
turbulence  and  the  consequent  increased 
danger  of  vomiting  and  aspiration,  the 
tube  feedings  were  given  at  refueling  stops 
only. 

For  this  kind  of  trip,  the  nurse  must 
consider  the  amount  of  oxygen,  feedings, 
linen,  and  so  on.  to  have  sufficient  sup- 
plies, but  not  too  many,  in  the  liniited 
space  available  on  the  aircraft. 

Conclusion 

The  aeromedical  branch  of  nursing  of- 
fers a  dimension  of  nursing  service  that 
differs  from  most  other  fields  of  nursing 


practice.  Although  some  training  in  avic 
tion  medicine  is  available,  most  know 
ledge  is  gained  through  experience  ob 
tained  in  actual  flight  situations.  Becaus 
the  service  is  unique,  there  are  few  prect 
dents  for  many  of  the  nursing  situatior 
that  arise.  This  makes  air  ambulance  nur; 
ing  interesting,  at  times  exciting,  and  se 
dom  "routine."' 

Although  we  have  patients  in  our  car 
for  only  a  short  time,  we  derive  satisfac 
tion  from  the  knowledge  that  the  service  : 
an  important  link  in  the  provision  of  healt 
care.  Our  personal  reward  is  a  simp! 
■"thank  you""  at  the  end  of  each  flight. 
JANUARY   19: 


what  do  nurses  do 

to  help  patients 

who  attempt  suicide? 


A  description  of  an  exploratory  study  that  was  undertaken  to  look  at  public 
health  nursing  activities  in  relation  to  patients  who  had  attempted  suicide. 

Rosella  Cunningham 


tie  number  of  suicides  and  the  suicide 

ate  in  Canada  has  increased  alarmingly 
n  recent  years.  In  1921  there  were  496 

eported  suicides,  with  a  rate  of 
i. 7/ 100.000  population;  in  1970  there 
vere  2.413  suicidal  deaths,  with  a  rate  of 

1.3/100.000  population.' 
Unquestionably,    a    large    number   of 

potential"  suicides  exist.  Many  persons 
Aho  are  subject  to  overwhelming  fits  of 
depression  make  repeated  attempts  at 
iuicide;  some  of  these  attempts  are 
^erious.  intended  to  succeed,  and  some 
ire  merely  gestures  or  appeals  for  help.  It 
las  been  found  that  those  who  make  one 
ittempt  are  likely  to  make  another,  and 
that  up  to  10  percent  of  persons  who 
attempt  suicide  kill  themselves 
:\entually.- 

What  do  public  health  nurses  do  to  help 
these  people?  With  this  question  in  mind, 
an  exploratory  study  was  undertaken  to 
look  at  public  health  nursing  activities  in 
relation  to  such  patients  in  the  Borough  of 
Scarborough  during  the  period  1  Mav  to 
8  June  1973. 

It  was  decided  that  the  investigator 
would  accompany  Scarborough  nurses 
participating  in  the  study  on  their  first 
visits  to  patients  who  had  attempted 
suicide.  One  week  after  the  first  visit  by 


Rosella  Cunningham  (B.Sc.N..  University  of 
Toronto.  Toronto,  Ontario:  M.P.H..  Univer- 
sity of  Michigan.  Ann  Arbor.  .Michigan)  is 
Associate  Professor.  University  of  Toronto 
School  of  Nursing. 
JANUARY   1975 


the  public  health  nurse  and  the  inves- 
tigator, the  nursing  record  was  reviewed. 
Some  2  to  5  weeks  later,  this  process  was 
repeated,  that  is,  a  second  visit  was 
observed,  the  record  reviewed,  and  data 
recorded.  Finally,  each  nurse  was  inter- 
viewed. 

Before  a  visit  was  made,  permission 
for  the  patient  to  participate  in  the  study 
was  obtained  from  the  psychiatrist  in- 
volved, and  the  family  physician  was 
notified  of  the  project  by  a  letter  from  the 
Scarborough  Health  Department.  The 
liaison  nurse,  who  is  employed  by  the 
health  departinent,  arranged  for  the  public 
health  nursing  follow-up,  and  briefly 
explained  the  study  to  the  patient.  When 
the  patient  was  receptive  to  participating 
in  the  study,  she  asked  for  his  signature 
on  the  consent  form.  Fifteen  patients 
agreed  to  take  part. 

The  participating  patients  consisted  of 

14  women  and  I  man,  ranging  in  age 
from  18  to  73  years,  with  6  under  the  age 
of  30.  The  mode  of  the  suicide  attempt  for 
13  patients  had  been  overdose  of  drugs 
(mainly  soporifics),  and  8  patients  had 
also  consumed  alcohol.  One  patient  had 
slashed  her  arms  and  another  had  deliber- 
ately walked  into  heavy  traffic.  Six  of  the 

15  had  previously  attempted  suicide. 
Although  economic   status   appeared   to 


A  selected  bibliography  is  available  on  request 
from  the  Library,  Canadian  Nurses"  Associa- 
tion, 50  The  Driveway.  Ottawa,  Ontario. 


vary,  all  patients  had  multiproblems; 
severe  marital  strife  was  evident  in  9 
families. 

The  patients  were  assigned  by  the 
health  department  in  its  usual  way  to  12 
nurses  (6  of  these  had  a  certificate  in 
public  health  nursing,  and  6  had  a 
baccalaureate  degree).  During  the  study 
period,  the  15  patients  received  62  visits. 
The  investigator  accompanied  the  12 
nurses  on  28  of  these  visits. 

Analysis  of  Home  Visits 

To  focus  observation  of  activities,  the 
aspects  of  a  visit  were  broken  down  into 
the  following  categories:  entry  to  the 
home;  content  of  the  visit,  including  the 
nurse's  assessment  of  the  problem,  her 
plan  for  dealing  with  it,  and  its  implemen- 
tation: and  conclusion  of  the  visit. 

Entry 

Showing  an  awareness  that  the  entry 
into  a  home  paves  the  way  to  the  visit  and 
that  the  initial  communication  is  basic  to 
the  establishment  of  a  helping  relation- 
ship between  nurse  and  patient,  each 
nurse  made  a  friendly  entry  into  the 
home,  introducing  herself  by  name  and 
profession  and  also  introducing  the  ob- 
server in  the  same  manner.  In  a  sentence 
or  two  she  stated  in  general  why  she  was 
there,  leaving  the  specific  plan  for  the 
visit  until  she  was  able  to  assess  the 
situation  and  establish  priorities. 

For  the  most  part,  nurses  emphasized 
that  they  did  not  have  answers  to  prob- 
lems, but  that  they  were  there  to  help  seek 
THE  CANADIAN  NURSE     27 


solutions,  usually  beginning  with  such 
remarks  as: 

D  "I  came  to  see  if  there  was  anything  I  could 
do  to  help  solve  your  problems.  What  hap- 
pened that  caused  you  to  go  into  hospital?'" 

n"We  can  try  to  sort  out  how  you  are 
feeling,  and  maybe  later  on  we  can  talk  with 
your  mom  about  it.  and  help  her  to  under- 
stand." (This  was  to  an   18-year-old  student 


n  "I  look  at  the  patient's  ability  to  cof)e  with 
everyday  things  —  her  apartment,  her  chil- 
dren, the  meals,  etc.  I  especially  listen  to  her 
plans." 

D  "By  sitting  around  the  table  and  having  a 
cup  of  tea,  I  note  the  family  interaction.  I  was 
aware  which  problems  made  Mrs.  X  tense,  but 
I  wasn't  sure  at  first  whether  this  was  anger  or 
fear." 


In  no  visit  was  the  word  "suicide"  used  by  eitiier 
the  patient  or  the  nurse.  The  nurses  often  referred  to 
these  patients  as  "O.D.s"  (overdoses),  which  gives 
some  indication  of  the  frequency  of  this  type  of  visit. 


who  sought  the  nurse  at  school,  and  who 
obviously  saw  the  nurse  as  a  helping  person.) 

n  "I  wondered  if  it  would  help  to  talk  over 
your  problems."  (This  nurse  had  known  the 
patient  for  some  time.) 

n  "I  came  to  see  you  so  that  we  can  discuss 
your  problems  and  together  look  for  solu- 
tions." 

Content 

1 .  Assessment 

It  was  evident  that  the  nurses  were  in 
agreeinent  with  the  point  of  view  expres- 
sed by  Shneidman  and  Farberow: 
"Suicide  is,  of  course,  not  only  the 
individual's  problem.  It  is  the  family's 
problem  and  it  is  the  community's 
problem."^  These  nurses  looked  not  only 
at  the  patient,  but  also  at  the  immediate 
family,  the  extended  family,  and  the 
environment.  They  were  very  aware  of 
the  background  of  existing  problems  in 
some  of  the  Ontario  Housing  units  —  the 
problems  of  poverty,  multifamily  dwel- 
lings with  shared  facilities,  and  the 
interwoven  sexual  problems  that  seemed 
to  occur  frequently. 

When  the  nurses  were  asked  in  inter- 
views how  they  assessed  and  planned  care 
for  the  patient  and  family,  several  de- 
scribed their  way  of  observing  the  patient 
and  the  family  interaction: 

D"!  especially  observe  the  nonverbal  com- 
munication —  the  posture,  facial  expression, 
and  method  of  talking  (response  or  no 
respon.se)  —  and  1  especially  look  at  their 
eyes.  Their  eyes  seem  to  show  anger  or  fear 
very  quickly." 
28     THE  CANADIAN  NURSE 


2.  Plan 

Following  the  assessment,  the  nurse 
made  a  plan  and  a  record  of  the  approach 
and  the  progress  made  in  each  case. 
Usually  she  established  short-term  goals 
for  immediate  problems  and  long-term 
goals  for  behavioral  changes.  These  goals 
were  frequently  discussed  with  the  pa- 
tients or  families.  In  planning  for  care, 
most  nurses  worked  closely  with  the 
social  worker  who  had  known  the  patient 
in  hospital. 

3.  implementation 

(a)  Approach: 

Two  main  approaches  were  used  in 
offering  care  on  these  visits.  One  was 
referred  to  as  the  " "confrontation"  or 
"contract"  approach;  the  other  was  much 
more  indirect,  a  ""listening"  type  of 
approach.  Perhaps  the  value  of  the  first 
approach  is  to  help  the  patient  face 
reality,  to  accept  the  outcome  of  his 
behavior,  and  to  be  accountable  for  his 
actions. 

The  value  of  the  second  approach  is 
outlined  by  Fallon,  who  reminds  nurses 
that  they  must  listen  to  their  patients,  and 
convey  real  concern  for  their  well-being, 
while  appreciating  them  as  valuable 
persons. ■•  Most  nurses  emphasized  one  or 
other  approach,  but  .some  elements  of 
both  methods  were  observed  in  most 
visits. 

The  "confrontation  "  approach  tries  to 
get  families  to  look  at  their  interaction,  as 
may  be  seen  in  the  following  instances: 
D  In  talking  with  a  young  couple  with  marital 
difficulties,  the  nurse  said:  "What  has  been 
going  on  between  you  two?  Do  you  really 


want  to  get  together  again?  And.  directly  t( 
the  patient,  "How  do  you  feel  about  it 
Barb?"  Later,  she  asked  the  husband  the  sam( 
question. 

n  In  talking  with  another  family:  "Wha 
happens  when  your  mother  comes  home  am 
blows  her  top  about  what  is  going  on?' 
Teenage  boy  replied.  "We  try  to  keep  he 
from  knowing  what  has  been  going  on."  Th( 
daughter  said,  "I  get  mad  back  and  I  yell  a 
her.  "  The  nurse  went  on  helping  them  to  se( 
how  these  interactions  build  on  one  another 
that  all  the  family  must  change  and  develoj 
better  ways  of  coping  with  situations,  and  iha 
they  must  be  open  with  their  feelings  so  the; 
would  understand  each  other. 

When  ""setting  contracts,"  the  nurs< 
and  the  patient  together  plan  a  course  o: 
action.  If  the  patient  repeatedly  does  no 
keep  his  part  of  the  contract,  the  nurs< 
may  discontinue  visiting  because  she  i; 
not  accomplishing  any  of  the  goals.  Sh« 
makes  it  clear  to  the  patient  that  she  is 
willing  to  return  any  time  he  is  willing  tc 
cooperate . 

Having  assessed  the  situation  and  e.s- 
tablished  a  helping  relationship,  the  nurse 
frequently  breaks  the  problems  down  into 
parts.  Together,  the  patient  and  nurse 
then  establish  priority  of  action.  Foi 
example: 

n  One  nurse  told  a  young  couple.  "I  can't 
solve  your  problems.  What  is  to  happen  will 
be  up  to  you.  and  it  will  take  a  long  time  to 
talk  all  your  problems  through.  In  the  mean- 
time, let's  deal  with  those  we  can  and  get  them 
out  of  the  way."  She  went  on  to  explain  three 
possible  arrangements  for  a  pregnancy  test. 
The  patient  then  decided  the  course  of  action 
and  kept  her  part  of  the  contract  by  dealing 
with  the  problem  of  a  possible  extra-marital 
pregnancy. 

How  the  "listening  approach"  is  based 
on  establishing  personal  rapport  with  the 
patients  was  clearly  observed  in  the 
following  visit  and  the  discussion  after- 
ward. 

D  One  nurse  visited  a  woman  who  had 
attempted  suicide  with  an  overdose  of  Elavil 
(Amitriptyline  HCL)  and  alcohol.  The  nurse 
praised  the  patient  for  small  accomplishments 
in  everyday  living.  On  the  second  observed 
visit  this  patient  appeared  to  be  coping  with 
her  depression;  she  was  interested  in  her 
appearance  and  in  the  care  of  her  apartment, 
and  she  was  seeking  employment.  Following 
this  visit,  the  investigator  asked  if  consump- 
tion of  alcohol  had  been  discussed.  The  nurse 
replied,  "No,  if  the  patient  wishes  to  talk 
about  it  she  will  bring  it  up.  In  the  meantime,  1 
think  there  is  inore  accomplished  by  praise 
than  blame.  It  is  important  to  try  to  find  a 
JANUARY     1975 


ason  to  live,  noi  to  dwell  on  what  happened 
the  past . "  ■ 

Nurses  appeared  quite  confident  and 
tablished  a  helping  relationship  quickly 
1  using  their  own  approach.  However, 
lis  does  not  mean  that  they  were  not 
illing  to  discuss,  observe,  and  evaluate 
ther  approaches.  Since  every  situation  is 
ifferent,  they  are  quite  willing  to  adapt 
nd  modify  their  approach  and  to  try  a 
ompletely  different  one.  Several  of  the 
ur.ses  discussed  this  with  the  inves- 
gator.  It  appears  that  each  nurse's 
pproach  is  unique  to  her  and  not  just  a 
jchnique  to  be  adopted  mechanically, 
he  nurse  must  be  herself. 

(b)  Problem-Solving: 

The  basis  of  all  approaches  was 
iroblem-solving.  Since  hospitalization 
ad  been  relatively  short  for  patients  in 
he  present  study,  the  public  health  nurse 
isually  came  into  the  picture  when  there 
vas  a  felt  need  to  restore  equilibrium, 
'erhaps  because  of  this,  the  nurse  was 
nost  welcome.  Her  task  seemed  to  be  to 
issist  the  patient  to  seek  out  and  use  the 
)alancing  factors. 

The  following  exainple  of  this  type  of 
:risis  intervention  was  observed: 

The  nurse  encouraged  the  patient,  a  young 
mother,  to  tell  what  happened  that  caused 
her  to  be  admitted  to  hospital.  In  relating 
the  specific  events  that  led  to  hospitaliza- 
tion, this  mother  told  of  many  problems. 
Her  husband  had  been  having  psychiatric 
treatment;  previously,  he  had  molested  her 
8-year-old  daughter.  The  patient  had  been 
advised  by  the  psychiatrist  never  to  allow 
the  husband  and  her  daughter  to  be  alone  in 
the  house.  This  was  a  difficult  recommen- 
dation, because  financially  it  was  neces- 
sary for  this  mother,  who  had  two  other 
small  children,  to  be  employed.  The 
situation  fostered  guilt  feelings,  fear,  and 
hostility.  These  feelings,  along  with  her 
financial  problems,  became  unbearable. 

To  assess  the  adequacy  of  "the  situational 
support."  the  nurse  next  visited  in  the 
evening  to  talk  with  both  parents.  She 
encouraged  the  mother  to  develop  a  closer 
relationship  with  the  8-year-old  child  and 
also  with  an  aunt  who  lived  nearby  and 
who  seemed  able  to  offer  additional  sup- 
port. The  husband  seemed  angry  and  rather 
patronizing  with  the  patient. 

When  the  problem  of  incest  occurred  the 
next  time,  the  patient  and  aunt  sought  the 
assistance  of  the  nurse  and  accepted  legal 
aid.  Instead  of  attempting  self-destruction, 
the  patient  was  ready  to  face  the  court 
proceedings.  Welfare  assistance  was  ar- 
ranged, which  permitted  her  to  have 
JANUARY   1975 


necessary  medical  and  dental  treatment. 
She  also  showed  evidence  of  an  ability  to 
budget,  and  was  beginning  to  plan  for  a 
future  with  her  children. 

The  nurse  had  helped  this  patient  gain  a 
realistic  perception  of  the  events,  to  seek 
and  use  adequate  situational  support,  and 
to  use  more  adequate  coping  mechanisms 
to  try  to  find  a  resolution  for  her  problem. 

(c)  Family-Centered  Care: 

Nurses  welcomed  the  opportunity  to 
talk  with  the  whole  family.  When  this 
was  not  possible  during  the  usual  working 
hours,  arrangements  were  made  for  even- 
ing visits.  Two  evening  visits  were 
observed  by  the  investigator,  but  nurses 
made  others  to  the  patient  population 
during  the  study  period. 

Evans  reminds  us  that  ■■  .  .  .  all  family 
members  and/or  significant  others  need 
help  to  come  to  terms  with  their  feelings 
about  suicide  Being  available,  being 
undemanding,  and  assisting  in  practical 
ways  all  help.  Emotional  support  from  the 
nurse  may  be  the  decisive  factor  between 
adaptation  and  maladaptation.""'  These 
nurses  were  concerned  with  the  numerous 
problems  that  contributed  to  the  depres- 
sion and  to  the  defeated  attitude  of  the 
patient. 

(d)  Interviewing  and  Counseling: 
Although  nurses  frequently  express  a 
need  for  more  preparation  in  counseling, 
it  was  observed  that  some  were  continu- 
ally analyzing  their  interviews  and  de- 
veloping much  skill.  They  appeared 
aware  of  the  setting  of  the  interview,  the 
importance  of  easy  eye  contact,  the  use  of 
direct  and  indirect  questions,  and  the  need 
for  mutual  trust. 

It  was  interesting  to  note  that  in  no  visit 
was  the  word  "suicide"'  used  by  either 
the  patient  or  the  nurse.  The  nurses  often 
referred  to  these  patients  as  "O.D.s" 
(overdoses),  which  gives  some  indication 
of  the  frequency  of  this  type  of  visit.  The 
use  of  first  names  seemed  acceptable  for 
both  patients  and  nurses. 

4.  Conclusion  of  Visit 

All  the  observed  visits  were  completed 
in  about  one  hour.  The  nurses  concluded 
the  visits  with  specific  directions  as  to 
how  they  could  be  contacted  and  with 
plans  for  the  next  visit.  This  ensured 
continuity  of  care. 

Summary 

What  do  nurses  do  to  help  patients  who 
attempt  suicide?  During  these  28  visits, 
many  nursing  skills  were  observed  in 
action,  reflecting  the  words  of  Dr.  Laura 


Simms:  "Nursing  nurtures  people  and 
their  coping  behaviors.  Nurses  diagnose 
and  treat  human  responses."* 

It  was  apparent  that  the  nurse"s  help, 
based  on  an  understanding  of  illness  and 
social  situations,  did  assist  the  patient  and 
his  family  to  gain  insight  into  problems 
and  actions.  The  family-centered  care 
given  by  the  public  health  nurse  provided 
continuity  of  service  between  home  and 
hospital.  She  was  the  only  worker  who 
knew  the  family  in  many  settings  — 
school,  hospital.  doctor"s  office,  clinic, 
and  especially  his  home.  Her  broad 
knowledge  of  community  resources  and 
her  ability  to  coordinate  them  provided 
direct  support.  Using  skillful  interviewing 
techniques,  the  nurses  directed  the  pa- 
tients toward  reality,  toward  attainable 
goals,  and  toward  decisions  for  future 
actions. 

References 

1 .  Canada.  Statistics  Canada.  Suicide  mortal- 
ity. 1950-1968.  Ottawa.  Information 
Canada,  1972.  p.  68.  (This  volume  in- 
cludes some  statistics  beyond  the  period 
indicated  by  the  title.) 

2.  Burton,  Lloyd  E.  and  Smith.  Hugh  H. 
Public  health  and  community  medicine. 
Baltimore,  Williams  and  Wilkins,  1970,  p. 
391. 

3.  Shneidman.  Edwin  S.  and  Farberow. 
Nomian  L.  The  Los  Angeles  suicide 
prevention  center:  a  demonstration  of  pub- 
lic health  feasibilities.  Amer.  J.  Pub. 
Health  55:  \:26.idn.  1965. 

4.  Fallon.  Barbara.  "And  certain  thoughts  go 
through  niy  head..."  Amer.  J.  Nurs. 
72:7:1257.  July  1972. 

5.  Evans.  Frances  Monet  Carter.  Psychoso- 
cial nursing:  theory  and  practice  in  hospi- 
tal and  conununirs-  mental  health.  New 
York.  Macmillan.  c  1 97 1 .  p.  289. 

6.  Simms.  Laura.  Clinical  nurse  specialist 
In  Report  of  the  Clinical  Nurse  Specialist 
Conference.  Sponsored  by  Faculties  of 
Nursing  and  Medicine,  and  the  School  of 
Hygiene  of  the  University  of  Toronto.  June 
4.  1973.  Toronto.  Faculty  of  Nursing, 
University  of  Toronto.  1973.  s2? 


THE  CANADIAN  NURSE     29 


A  nutrition 

course  for 

nurses 


Practical  training  in  nutrition  for  nurses  is  now  available  on  the  Loyola  Campus, 
Concordia  University,  Montreal.  In  this  article,  which  has  been  translated  from 
the  French,  the  instructor  of  the  course  explains  its  aims  and  justifies  its  existence. 


In  spite  of  their  close  relationship,  the  art 
of  cooking  and  the  science  of  nutrition 
have  become  virtual  adversaries.  Fine  liv- 
ing emphasizes  the  attractions  of  one, 
while  good  health  depends  upon  the  other. 
It  is  hard  to  understand  why  the  two  cannot 
be  reconciled;  why  the  efforts  of  organiza- 
tions devoted  to  health  care  are  held  in 
such  slight  regard;  and  why  members  of 
the  public,  in  the  face  of  a  multiplicity  of 
recipe  books,  indulge  in  those  foods  most 
likely  to  insult  their  stomachs. 

Besieged  with  demands  for  their  ser- 
vices, doctors,  nutritionists,  and  dietitians 
are  harassed  and  overworked.  Nurses, 
con.scious  of  their  close  relationships  with 
patients,  would  like  to  throw  some  light 
into  the  dim  corridor  leading  from  the  din- 
ner table  to  the  hospital ,  but  have  to  endure 
certain  restraints. 

A  nutrition  course  for  nurses 

Three  years  ago,  in  support  of  her  own 
convictions,  Gladys  Lennox  —  the  direc- 
tor of  health  education  programs  at  Loyola 
Campus,  Concordia  University,  Montreal 
—  introduced  a  course  in  nutrition  for 
nurses  working  in  industry,  schools,  and 


The  author  is  assistant  editor  of  L' infirmiere 
canadieime,  the  French- language  magazine 
published  by  the  Canadian  Nurses"  Associa- 
tion, Ottawa. 


Gertrude  Lapointe 


community  health  centers.  She  believes 
the  course  is  needed,  as  most  nurses  are  in 
no  position  to  act  as  intermediaries  in  mat- 
ters related  to  nutrition.  Lennox  also  be- 
lieves that  the  basic  course  in  nursing  does 
not  prepare  the  nurse  to  help  others  with 
their  nutritional  needs,  although  she  con- 
cedes that  graduates  from  some  of  the 
newer  programs  in  basic  nursing  are 
somewhat  better  prepared  than  graduates 
from  earlier  pi'ograms. 

Knowledge  of  foods  that  nourish  the 
body  is  essential  to  everyone,  but  has  par- 
ticular significance  for  health  educators, 
Lennox  says.  They  are  expected  to  give 
advice  to  those  who  seek  it.  She  em- 
phasizes this  in  justification  of  Loyola's 
nutrition  course.  Nurses  involved  in  com- 
munity health  programs  cannot  sidestep 
issues  related  to  diets  for  the  sick,  nor 
absolve  themselves  of  the  responsibility  to 
discuss  dietary  regimens  intelligently. 

The  course,  "Nutrition  in  the  70"s,"  is 
a  requisite  for  any  Loyola  student  who 
wishes  to  obtain  a  bachelor  of  arts  degree 
with  a  major  in  community  nursing.  In- 
cluded in  this  nutrition  course  is  a  study  of 
dietary  regimens  in  relation  to  health  prob- 
lems such  as  obesity,  heart  disease,  poor 
eating  habits,  and  malnutrition.  The  ef- 
fects of  socioeconomic  forces  on  the  nutri- 
tional status  of  individuals  is  examined,  as 
well  as  the  relationships  beween  food  cus- 
toms  and   various   social,   cultural,   and 


psychological  aspects  of  life.  Students  are 
required  to  draw  up  budgets  for  consumers 
at  all  socioeconomic  levels. 

As  part  of  this  nutrition  course,  students 
learn  to  estimate  individual  food  require- 
ments in  relation  to  age  and  activity.  They 
must  also  be  able  to  recognize  and  deal 
effectively  with  nutritional  problems  ex- 
perienced by  persons  in  the  community, 
home,  or  hospital.  Graduates  are  prepared 
to  counsel  others  concerning  proper  nutri- 
tion within  their  budgetary  limits,  and  to 
teach  them  how  to  shop  economically  as 
well  as  wisely.  In  short,  the  course  pro- 
vides application  of  the  principles  of  nutri- 
tion to  everyday  living.  The  student  is  also 
introduced  to  available  literary  resources 
and  taught  how  to  use  them. 

Gladys  Lennox  is  both  practical  and 
foresighted.  Developing  the  interest  of 
nurses  in  nutrition  is  only  the  first  step  in 
her  ultimate  objective  to  teach  the  public 
how  to  use  food  to  improve  growth  and 
maintain  health.  As  she  sees  it,  the  nurse 
occupies  an  enviable  position  between  the 
dietitian,  the  doctor,  and  the  community  at 
large.  Preparing  her  to  meet  the  needs  of 
the  latter  in  regard  to  nutrition  is  preven- 
tive work  of  the  highest  order. 

Consequently,  the  course  has  been  or- 
ganized along  pragmatic  lines  so  that  stu- 
dents may  emerge  better  prepared  to  act 
efficiently  within  the  community  or  as 
members  of  a  multidisciplinary  team.  In  a 


30     THE  CANADIAN  NURSE 


JANUARY   1975 


vorld  where  poverty  and  affluence  live 
ide  by  side,  nurses  have  an  important 
ontribution  to  make  through  their  ability 
o  integrate  various  health  aspects,  includ- 
ng  proper  nutrition. 


V  question  of  ability 

Graduates  of  the  nutrition  course  are 
prepared  to  counsel  individuals  about  diet- 
ir\  habits,  physical  condition,  and  exer- 
ise  —  that  is.  about  good  health  and  its 
maintenance.  Even  in  our  affluent  society, 
iuch  advice  is  a  necessity.  The  well-to-do 
suffer  from  malnutrition  too,  not  because 
they  lack  the  necessities,  but  because  their 
:hoices  are  poor. 

Lennox  believes  that  the  nurse  is  still  the 
best  health  educator  available  to  teach 
people  how  to  balance  their  diets.  This  is 
not  a  situation  involving  the  hierarchical 
position  of  nurses  and  dietitians.  It  is  sim- 
pi>  a  question  of  who  is  prepared  to  do  the 
job.  The  one  who  has  the  infonnation 
should  give  it. 

""Nurses  are  prepared  to  counsel," 
Lennox  says,  ""but  they  are  not  prepared  in 
diet  therapy.  Therefore,  the  community 
nurse  will  find  many  opportunities  to  help 
people  develop  good  eating  habits  and  ul- 
timately improve  health  standards.  We  do 
not  foresee  that  qualified  nutritionists  will 
be  available  on  a  one-to-one  basis  in  the 
community .  and  therefore  we  see  the  nurse 
as  someone  who  knows  when  to  counsel 
and  when  to  refer  nutritional  problems  to 
others." 

In  a  nation  where  soft  drinks,  hot  dogs, 
french  fries,  and  chocolate  bars  are  staples 
in  so  many  diets,  Lennox  sees  her  effort  as 
an  attempt  to  bring  about  a  general  change 
in  dietary  habits.  Encouragement  is  forth- 
coming. At  the  moment,  interest  is  being 
shown  by  school  nurses.  Audiovisual  in- 
struction, school  health  programs,  and 
projects  directly  related  to  cafeteria  ser- 
vice are  in  full  swing.  There  has  been 
support  from  provincial  and  municipal 
bodies,  as  well  as  from  school  boards. 

Various  industries  are  beginning  to  in- 
dicate interest  in  projects  of  a  nutritional 
nature.  Nurses  employed  by  industries  and 
business  are  able  to  demonstrate  what  con- 
stitutes a  nutritious  box  lunch,  to  show  low 
and  high  energy  points  in  a  worker's  da)S 
and  to  teach  workers  the  elements  of  a 


nourishing  food  intake.  Naturally,  the 
nurse  must  be  assured  of  management's 
support  if  she  is  to  supervise  effectively 
the  well-being  of  staff. 

The  summer  course 

Loyola  Campus  offers  a  summer  course 
called  '"Hunger  in  the  Classroom"  for 
teachers  wishing  to  obtain  credits.  There 
were  6  students  the  first  year,  and  150  in 
the  second  (summer,  1 974) .  No  attempt  is 
made  to  develop  nutritionists  or  dietitians 
out  of  teachers  who  want  only  to  improve 
their  general  knowledge.  The  aim  is  to 
help  teachers  to  know  when  to  direct  stu- 
dents to  the  specialists  —  nurses,  doctors, 
and  dietitians  —  before  it  is  too  late.  Al- 
though there  will  never  be  enough  experts 
in  nutrition,  this  group  may  be  able  to 
guide  their  students  to  professional  help. 


The  courses  in  nutrition  are  also  open  to 
student  nurses  enrolled  in  basic  programs, 
and  applicants  from  other  provinces  are 
welcome.  However,  the  director  suggests 
that  interested  persons  should  register  in 
advance,  as  applications  are  flowing  in 
from  all  areas. 

Conclusion 

The  course  "Nutrition  in  the  70's"  is  an 
innovation.  Nothing  similar  existed  previ- 
ously in  Quebec  and  possibly  not  in  other 
provinces.  It  is  now  a  requisite  for  regis- 
trants in  the  community  health  program, 
but  can  be  taken  as  an  elective  by  other 
students.  Like  ""Hunger  in  the  Class- 
room," it  responds  to  an  urgent  need. 


Gladys  Lennox,  director  of  health  education  programs  at  Loyola  Campus, 
Concordia  University,  Montreal,  says  the  basic  course  in  nursing  does  not 
prepare  the  nurse  to  help  others  with  their  nutritional  needs. 


JANUARY   1975 


THE  CANADIAN  NURSt     31 


LIPPINCOTTS  NO-RISK  GUARANTEE: 

Books  are  shipped  to  you  ON  APPROVAL;  if  you  are  not 
entirely  satisfied  you  may  return  them  within  30  days 
for  full  credit. 


NURSING  MANAGEMENT  OF  THE  PATIENT  WITH 
PAIN  — McCaffery 

This  brilliantly  researched  text  presents  sociologic, 
psychologic  and  physiologic  concepts  within  a 
problem-solving  framework.  The  patient  Is  viewed  as 
a  total  human  being  with  a  variety  of  physical,  emo- 
tional and  Intellectual  needs  and  experiences. 
LIPPINCOTT  248  Pages 

PRICE:  $5.25  Paperbound/1972 

THE  LIPPINCOTT  MANUAL  OF  NURSING  PRACTICE 
—  Brunner  and  Suddarth 

Designed  to  be  the  most  useful 
single  volume  ever  published 
for  the  nursing  profession,  The 
LIpplncott  Manual  will  provide 
all  nursing  practitioners  with 
instant  information  for  immedi- 
ate application  to  patient  care. 


NURSES'  HANDBOOK  OF  FLUID  BALANCE 
2nd  EDITION  — 


LIPPINCOTT 
PRICE:  $21.50 


1473  Pages 
Illustrated/1974 


PERSPECTIVES  IN  HUMAN  DEVELOPMENT  — 
Sutterly  and  Donnelly 
Nursing  Throughout  the 
Life  Cycle 

An  entirely  new  approach  to  the 
study  of  human  development, 
designed  to  prepare  nurses  to 
meet  the  challenges  of  the 
present  and  future,  and  to  apply 
recent  findings  in  the  physical 
and  social  sciences  to  the  care 
of  patients. 


LIPPINCOTT 
PRICE:  $8.75 


331  Pages 
Diagrams  and  Charts/ 1973 


Cf*^, 


CRITICAL  CARE  NURSING  —  Hudak,  Gallo  and  Lohr 

A  comprehensive  course  in  the 
area  of  critical  care  nursing,  un- 
excelled in  depth  and  content. 
Material  for  the  text  evolved 
from  the  authors'  four  years 
experience  in  teaching  intensive 
care  nursing  content  In  continu- 
ing education  courses.  The 
approach  is  holistic,  based  on 
the  Interrelatedness  of  the  four 
major  body  systems  —  respira- 
tory, cardiovascular,  renal  and 
nervous  —  with  man's  hierarchy 
of  needs  as  a  framework. 
LIPPINCOTT  351  Pages 

PRICE:  $9.95  1973 


S^^^giSict 


LIPPINCOTT 
PRICE:  $8.75 


Metheny  and  Snively 

The  expanded  responsibilitie 
of  the  nurse  in  the  areas  c 
physical  diagnosis,  treatmen 
and  evaluation  of  laborator 
findings  are  reflected  in  thi 
thoroughly  revised  edition.  A 
chapters  have  been  revised  t> 
include  the  latest  findings  ij 
types  of  Imbalances,  treatments; 
and  medication,  and  each  ele 
ment,  deficit  and  excess  is  dis 
cussed  in  greater  depth  aD( 
clarity. 

Illustrated  325  Page: 

Paperbound/197' 


A  GUIDE  TO  PHYSICAL  EXAMINATION  —  Bates 


LIPPINCOTT 
PRICE:  $18.75 


Expertly  illustrated,  this  "how-to' 
text  bridges  the  gap  betweer 
anatomy  and  physiology  anc 
their  application  to  the  physica 
examination.  Within  each  bod^ 
region  or  system,  three  topics 
are  dealt  with:  1)  anatomy  anc 
physiology  basic  to  the  examin- 
ation, 2)  examination  techni- 
ques, 3)  examples  of  selectee 
abnormalities. 

375  Page; 
Illustrated/ 1974 


NURSING  OF  FAMILIES  IN  CRISIS  —  Hall  and  Weaver 

This  unique  book  provides  an  introduction  to  crisis 
theory  as  a  conceptual  approach  to  nursing  of  families 
The  authors  include  numerous  case  studies  of  families 
who  have  experienced  maturational  or  situationa 
crises. 

LIPPINCOTT 
PRICE:  $6.50 


250  Pages 
197-! 


ABOUT  BEDSORES  —  Miller  and  Sachs 
What  You  Need  to  Know  to  Help  Prevent  and 
Treat  Them 

In  simple  language  and  with  many  full  color  photo- 
graphs and  drawings,  this  unique  manual  effectively 
presents  what  the  nurse  needs  to  know  to  prevent  anc 
treat  bedsores. 

LIPPINCOTT 
PRICE:  $5.40 


Many  full  color  Illustrations  —  50  Pages 
Paperbound/1974 


CARING  FOR  AND  CARING  ABOUT  ELDERLY 

PEOPLE  — Long 

A  Guide  to  the  Rehabilitative  Approach 

The  content  Is  centered  around  concepts  and  skills 
fundamental  to  the  rehabilitative  process,  including 
such  concepts  as  the  dynamics  of  independence,  the 
hazards  of  immobility,  the  age  continuum,  the  value 
system  and  life  style,  and  the  dynamics  of  role  in  the 
rehabilitative  team  relationship. 

LIPPINCOTT  127  Pages 

PRICE;  $3.90  Paperbound/1974 


nsure  clinical  ccmpeteiice 


i 

MEDICAL  CARE  AND  REHABILITATION  OF  THE 

'  -      CHRONICALLY  ILL 

^•^T^^'     3rd  Edition  —  Bonner 


Frequently,  various  members  of 
the  health  team  have  not  known 
what  can  be  done  to  help  the 
aged  and/or  chronically  III.  This 
new  edition  of  this  unique  book 
answers  the  need. 


ITTLE.  BROWN 
RICE:  $16.50 


311  Pages 
1974 


'ATIENT  CARE  SYSTEMS  — 

Kraegel,  Arora,  Mouseau,  and 
Goldsmith 


Based  on  a  project  which  won 
the  1972  Lambert  Award,  this 
new  book  extends  the  science 
of  design  to  the  rational  planning 
of  complex  health  care  systems. 
Administrative  principles  are 
applied  to  the  hospital  setting; 
patient,  environmental  and  nur- 
sing needs  are  examined;  case 
studies  are  used  to  explore  and 
implement  patient  care  plans. 

1 50  Pages 
1974 


IPPINCOTT 
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:LINICAL  geriatrics  —  Rossman 

'his  timely,  cross-disciplinary  work  provides  a  com- 
)rehensive  account  of  the  diagnosis  and  treatment  of 
he  older  patient  within  the  framework  of  the  biological 
)rocess  of  aging.  All  organ  systems  and  their  diseases 
ire  completely  covered  from  the  preventive,  diag- 
lostic,  and  therapeutic  aspects. 

IPPINCOTT  525  Pages 

f'RICE:  $26.00  171  Figures  1971 


3UICK  reference  TO  PEDIATRIC  EMERGENCIES 
—  Pascoe  and  Grossman 

Here  is  an  unusual  reference  for  the  health  team  faced 
with  pediatric  emergencies.  It  provides  quick  access 
0  the  information  needed  to  "do  the  best  thing  at  the 
right  time."  The  organization  of  material  and  the 
chapter  heading  have  been  structured  with  speed  of 
accessibility  always  in  mind. 

-IPPINCOTT  421  Pages 

=RICE:  $17.00  Illustrated/1973 


[CURRICULUM  AND  INSTRUCTION  IN  NURSING  — 

Donley 

rhis  text  carefully  examines  nursing  education  and 
he  process  of  change  in  relation  to  the  nature  and 
sbjectives  of  curriculum  and  instruction. 
:'TTLE,  BROWN  673  Pages 

'RICE:  $16.50 Illustrated/1 973 


METHODS  OF  CLINICAL  EXAMINATION: 

A  PHYSIOLOGIC  APPROACH  —  3rd  edition  — 

Judge  and  Zuidema 

Extensively  revised  and  updated  to  include  new 
diagnostic  techniques  such  as  the  problem-oriented 
approach  to  medical  history-taking.  Methods  of 
Clinical  Examination  helps  the  student  to  develop  early 
experience  in  the  differentiation  of  normality  and 
abnormality  over  a  broad  diagnostic  range,  and  to 
correlate  preliminary  diagnostic  findings  with  special 
techniques  for  the  further  evaluation  of  any 
physiologic  system. 

LITTLE,  BROWN  439  Pages 

PRICE:  paper  $11.50  cloth  $17.50  Illustrated/1974 

SEX  AND  THE  INTELLIGENT  WOMAN  —  De  Martino 

Is  high  intelligence  in  women  compatible  with  an 
active  and  enjoyable  sex  life?  This  question  has 
particular  relevance  today  as  the  conventional  image 
of  woman  gives  way  to  a  broader  view  of  women's 
mental  powers  and  right  to  personal  fulfillment. 
SPRINGER  320  Pages 
PRICE:  $8.95      1974 

PROBLEM-ORIENTED  NURSING  — 
Woolley,  Warnick,  Kane  and  Dyer 

A  comprehensive  text  and  how-to  book,  introducing 
the  theory  and  application  of  the  problem-oriented 
medical  record  system.  The  presentation,  based  on 
actual  hospital  situations,  details  the  incorporation  of 
the  nurse  into  a  functioning,  decision-making  medical 
care  team. 


SPRINGER 

PRICE:  paper  $5.25  cloth  $8.50 


1 76  Pages 
1974 


MANUAL  OF  PEDIATRIC  THERAPEUTICS  — 
Children's  Hospital  Medical  Center,  Boston 

This  book  provides  specific,  up-to-date  information  on 
current  pediatric  therapy,  including  administration  and 
dosages  of  new  drugs.  In  clear,  outline  form,  it  offers 
a  sound  approach  to  the  diagnosis  and  management 
of  most  of  the  major  syndromes  and  diseases  of 
infants,  children,  and  adolescents,  and  presents 
I  '  ional  therapeutic  procedures  for  all  of  the  common 
(  '.diatric  emergencies. 

LITTLE,  BROWN  525  Pages 

PRICE:  $8.95  1974 

RESPIRATORY  INTENSIVE  CARE  NURSING  — 
Bushnell 

Presenting  current  interdisciplinary  practices  in  res- 
piratory and  intensive  care,  this  book  is  a  necessity  for 
nurses  and  nursing  instructors  involved  in  the  treat- 
ment of  critically  ill  patients  as  well  as  for  those  nurses 
organizing  intensive  care  facilities. 

LITTLE,  BROWN  354  Pages 

PRICE:  $10.95  Illustrated/1973 

Lippincott 

J.  B.  LIPPINCOTT  COMPANY  OF  CANADA  LIMITED 

SERVING  THE  HEALTH  PROFESSIONS  IN  CANADA  SINCE  1897 
75  HORNER  AVE.    TORONTO.  ONTARIO      M8Z  4X7     (416)252-5277 


idea 
exchange 


Nursing  grand  rounds 

Cheryl  Rosell 


Nursing  Grand  Rounds  is  a  vital  and 
important  educational  tool.  On  24  Jan- 
uary 1974,  the  nursing  education  staff  of 
Sunnybrook  Medical  Centre  initiated  the 
Rounds  to  involve  the  nursing  staff  in 
their  own  professional  development. 

Rounds  are  held  once  a  month,  each 
time  given  by  a  different  .service  among 
our  33  nursing  units.  Three  to  six  staff 
nurses  do  the  presenting.  Nurses  who 
give  the  care  should  be  the  ones  discus- 
sing such  care.  A  patient  may  be  cared  for 
in  more  than  one  area.  For  example,  a 
patient  who  is  admitted  to  a  medical  unit 
may  be  transferred  to  a  surgical  ward  after 
his  initial  workup.  In  such  an  instance, 
we  try  to  involve  each  of  the  units 
associated  with  the  patient's  care,  in  some 
aspect  of  the  presentation  at  Rounds.  The 
learning  that  is  the  end  product  of 
preparing  for  these  presentations  benefits 
similar  patients  in  the  future. 

The  Rounds,  although  not  interdisci- 
plinary in  presentation,  are  open  to  all 
departments.  Attendance  has  ranged  from 
45  to  60,  including  staff  from  pharmacy, 
physiotherapy,  occupationel  therapy,  and 
social  service.  Other  departments  report 
benefits  from  their  attendance.  Local 
public  health  nurses  also  have  attended. 

About  four  weeks  ahead  of  the  date, 
the  nursing  staff  begin  to  prepare  for 
Rounds  by  selecting  their  patient  for 
presentation.  Then,  weekly  meetings  are 
held  to  discuss  the  patient's  progress  and 
the  nursing  care  to  be  emphasized. 

Response  from  the  nursing  staff  has 
been  excellent.  They  find  this  a  stimula- 
ting way  of  keeping  up  with  new  ideas  in 
nursing  care  that  are  being  implemented 
in  various  parts  of  the  hospital . 

The  role  of  the  nursing  education  staff 
has  been  one  of  guidance  and  resource. 
The  style  of  the  presentation  is  decided  by 
the  unit  presenting.  There  is  a  question 
and  answer  period  at  the  end  of  each 
presentation.  This  has,  perhaps,  been  our 
weakest  area:  nurses  are  still  hesitant  to 
be  critical  of  each  other. 

34     THE  CANADIAN  NURSE 


^»S:«.-^^»KC-!!aK 


The  nurses  have  a  practice  session  to  get  used  to  talking  and  handling  the  microphone 
The  nurse  pictured  here  is  Joan  Smith. 


We  find  the  Rounds  to  be  a  valuable 
method  of  education.  We  also  see  it  as  an 
important  tool  in  bringing  pride  to  the 
staff  nurses  presenting.  Successes  and 
failures  are  discussed  at  the  Rounds,  and 
it  is  this  evaluation  of  one's  professional 
ability  that  justifies  saying  that  nursing  at 
Sunnybrook  is  done  professionally  — 
by  professional  nurses. 


Cher>l  Reinholz  Rosell  graduated  from  Thi 
Johns  Hopkins  Hospital  School  of  Nursing 
Baltimore,  Maryland.  She  has  worked  ii 
Canada  since  1970  and  was  responsible  to 
instituting  nursing  grand  rounds  at  Sunny 
brook.  Ms.  Rosell  is  nursing  education  in 
slruclor  al  Sunnybrook  .Medical  Centre.  To- 
ronto. 

JANUARY    197 


roducts  festival 


elanie  Hitch 


iMinces  in  orthopedic  nursing  require 
ongoing  education  program  if  RNs  and 
!As  are  to  i^eep  abreast  of  new  products 
d  procedures.  With  this  in  mind,  the 
)ronto  chapter  of  the  Orthopaedic 
irses  Association  iTONAi  recently  spon- 
red  a  "products  festival""  at  Sunny- 
3ok  Medical  Centre.  Toronto. 
The  goals  of  the  evening-long  program 
;re  fivefold;  to  acquaint  rns  and  RN.'\'., 
10  are  interested  in  orthopedic  nursing, 
th  TONA:  to  introduce  them  to  new 
oducts:  to  make  available  new  educa- 
mal  material:  to  introduce  them  to  other 
irses  interested  in  orthopedics:  and  to 
change  ideas  on  this  interesting  area  of 
irsing. 

The  evening  was  definitely  a  success. 
)uneen  Toronto-area  distributors  of  or- 
jpedic  and  orthotic  products  each  ex- 
ited 6  of  their  latest  products,  provi- 
ig  educational  material  on  each.  More 
n  100  persons  attended,  which  made  it 
warding  for  the  organizers. 
Most  attenders  considered  it  an  infor- 
ative  evening,  and  expressed  consider- 
ile  interest  in  the  educational  programs 
fered  by  TONA.  It  is  equally  important  to 
)te  that  many  expressed  interest  in 
ining  the  Orthopaedic  Nurses  Associa- 
)n. 

How  was  the  evening  organized? 
olor-coded  name  tags  were  distributed 
an  effort  to  get  a  cross  section  of 
thopedic  nursing  in  each  tour  group.  A 
am  leader  was  appointed  for  each 
oup.  Over  a  period  of  some  2  hours, 
ich  group  was  given  6  minutes  at  each 
x)th  to  examine  material,  ask  questions, 
id  exchange  ideas. 

Among  the  products  exhibited  were  a 

w  fiberglass  casting  method,  a  variety 

;  new  prosthetic  joint  implants,  several 


braces,    plus   the    latest   in   soft   goods,  education  and  team  conferences, 

traction,  and  operating  room  equipment.  Finally,  a  questionnaire  was  circulated. 

Several     companies    also    provided  asking  guests  what  they  thought  of  our 

brochures    containing    information    on  products  festival.  Their  positive  reaction 

movies  and  educational  programs  that  are  made  the  entire  effort  worthwhile, 
available   free   of  charge    for   inservice 


Corridor  Playroom 

Sally  Pearson 


What  do  you  do  with  the  little  ones  in  the 
pediatric  ward  when  you  do  not  have  a 
playroom? 

At  Kootenay  Lake  District  Hospital, 
we  put  chalkboards  on  the  corridor  walls 
and  got  our  best  maintenance  man  to 
build  a  gate  across  the  hallway  in  the  end 
of  the  corridor.  We  then  got  a  play  lady 
and  a  nurse,  the  little  patients  and  some 
toys,  a  table  and  chairs,  a  stroller  and  a 


rocking  horse  —  we  had  all  the  ingre- 
dients for  a  makeshift  playroom. 

The  gate  swings  back  flat  against  the 
wall  when  the  corridor  playroom  is  not  in 
use. 


Sally  Pearson  is  director  of  patient  services  at 
Kootenay  Lake  District  Hospital.  Nelson. 
British  Columbia. 

THE  CANADIAN  NURSE     35 


names 


I  :-^ftMMMmMr::i<,?jiyfei^ 


Irene  Norton  (R.N..  Massachusetts 
Memorial  Hospital,  Boston;  B.S.N. Ed., 
M.  Ed..  Boston  University)  has  been 
appointed  acting  chairman  of  the  nursing 
department,  Ryerson  Polytechnical  Insti- 
tute, Toronto.  Roslyn  Klaiman,  former 
chairman,  is  currently  on  sabbatical  leave 
for  further  study. 

Ms.  Norton  was  an 
army  nurse  during 
World  War  II.  Later, 
she  was  assistant 
principal,  Faulkner 
Hospital  school  of 
nursing,  Jamaica 
Plain.  N.Y.  She  was 
in  teaching  and  ad- 
ministration at  the 
Massachusetts  General  Hospital  school  of 
nursing  before  coming  to  Toronto  in  1957 
to  be  director  of  nursing  education. 
Women's  College  Hospital. 

Suzanne     Brazeau 

(Reg.  N.,  Ottawa 
General  Hospital 
school  of  nursins;  B. 
Sc.N.  Ed..  B.aT,  B. 
Th.,  M.A.  Th..  Ot- 
tawa University)  has 
been  appointed 
health  education  and 
->'  nursing    consultant 

for  the  Canadian  Tuberculosis  and  Re- 
spiratory Disease  Association. 

She  was  formerly  a  public  health  nurse 
with  the  Ottawa-Carleton  Regional  Area 
Health  Unit  and  is  currently  studying 
toward  a  doctorate  in  ethics  and  society  at 
the  University  of  Chicago. 


The  Council  of  the  College  of  Nurses  of 
Ontario  announced  two  new  appoint- 
ments, effective  September  4,  1974. 

Helen  Evans  (Reg.N.,  Toronto  General 
Hospital  school  of  nursing;  B.Sc.N., 
University  of  Western  Ontario;  M.S., 
Boston  University)  is  assistant  director  — 
professional  standards.  She  was  formerly 
assistant  chairman,  nursing  department. 
Ryerson  Polytechnical  Institute,  Gerrard 
Campus  (Hospital  for  Sick  Children), 
Toronto. 

lanice  Legg  (R.N.,  Saskatoon  City 
Hospital  school  of  nursing;  B.N.,  McGill 
University)  has  accepted  the  position  of 
inspector.  She  was  formerly  chairman, 
nursing  division,  Doon  Centre,  Cones- 
toga  College  of  Applied  Arts  and  Tech- 
nology. Kitchener,  Ontario. 
36     THE  CANADIAN  NURSE 


Margaret  Ann  Cock- 
man   (Reg.    N..    St. 
Michael's 
school    of 
Toronto; 
Health 
versity 


Hospital 
nursins, 
PublTc 
Cert.,  Uni- 
of  Toronto) 


has  been  appointed 
to  the  health  services 
recruitment  staff  of 
Canadian  University  Services  Overseas 
in  Ottawa. 

Her  nursing  experience  has  included  a 
tour  of  volunteer  duty  with  CU.SO  in 
India;  surgical  nursing  at  St.  Michael's 
Hospital,  Toronto;  nursing  in  the  coronary 
care  unit  of  St.  Joseph's  Hospital,  Hamil- 
ton; and  community  health  nursing  with 
the  St.  Elizabeth  Visiting  Nurses'  Asso- 
ciation, Hamilton. 

The  Marjorie  Hiscott  Keyes  Medal  (1974) 
of  the  Canadian  Mental  Health  Associa- 
tion has  been  awarded  to  Dorothy  Burwell, 
director  of  nursing  education,  Clarke  In.sti- 
tute  of  Psychiatry  in  Toronto,  Ontario,  as  a 
recognition  of  and  in  tribute  to  her  deep 
concern  for,  and  her  interest  in,  the  men- 
tally troubled. 

Ms.  BurwelKReg.  N.,  Toronto  General 
Hospital  .school  of  nursing;  B.Sc.N.,  Uni- 
versity of  Western  Ontario;  M.A.,  Col- 
umbia University)  has  been  .staff  nurse, 
head  nurse ,  instructor  and  supervisor  at  the 
Toronto  General  Hospital;  lecturer  and  as- 
sistant professor  of  mental  health  and 
psychiatric  nursing  at  the  University  of 
Toronto.  She  has  given  courses  on  coun- 
seling the  mentally  and  emotionally  dis- 
turbed, and  has  led  a  number  of  workshops 
and  conferences  on  communications, 
psychodrama,  and  counseling.  She  has 
been  chairman  of  the  National  Committee 
of  Mental  Health  Professions  and  a 
member  of  the  National  Scientific  and 
Planning  Council. 


AnneGribben  (Reg.  N..  Toronto  Western 
Hospital  school  of  nursing;  B.A.,  Univer- 
sity of  Toronto)  has  become  the  chief  ex- 
ecutive officer  of  the  Ontario  Nurses  As- 
sociation (ONA).  She  was  formerly  direc- 
tor of  employment  relations  of  the  Regis- 
tered Nurses  Association  of  Ontario  and 
was  chief  negotiator  for  ONA  and  10,000 
nurses  with  their  respective  hospital  emp- 
loyers when  Ontario  registered  nurses' 
starting  salaries  were  increased  in  July 
1974.  She  besan  her  new  duties  October  1. 


Marguerite  (Dick)  Richards  was  presenti 
with  a  silver  tray  on  her  retirement  aft 
more  than  30  years  of  nursing.  She  h 
for  many  years  been  head  nurse  of  tl 
obstetrical  department  of  the  Blancha 
Eraser  Memorial  Hospital  in  Kentvill 
Nova  Scotia. 


Ann    Hilton    and    Olive   Wilson   Simpsc 

have  been  appointed  assistant  professo 
at  the  school  of  nursing.  University 
British  Columbia,  Vancouver. 

Hilton  (B.S.N.,  University  of  Briti; 
Columbia;  M.Sc.N.,  University  of  T 
ronto)  was  a  Canadian  Nurses'  Found 
tion  fellow,  and  has  been  a  team  leader 
Sunnybrook  Hospital  in  Toronto  and 
lecturer  at  the  University  of  Toronto. 

Simpson  (Reg.  N.,  Victoria  Hospit 
school  of  nursing,  Renfrew;  B.Sc.N 
M.Ed.,  University  of  Ottawa)  has  been  < 
instructor  at  the  schools  of  nursing  i 
Victoria  Hospital  and  of  the  Ottawa  Civ 
Hospital.  Prior  to  her  current  appoir 
ment,  she  was  director  of  nursing  at  tl 
Regional  Medical  Centre,  Abbotsfon 
B.C. 


Dr.  Arnold  L.  Swanson  has  been  appointe 
executive  director  of  the  Canadian  Coui 
cil  on  Hospital  Accreditation,  Toront( 
Ontario.  He  assumed  his  duties 
January,  1975,  on  the  retirement  of  D 
L.O.  Bradley.  Dr.  Swanson  was  former) 
administrator  of  the  Queen  Street  Ment; 
Health  Centre,  Toronto,  prior  to  which  h 
was  executive  director  of  the  Victon 
General  Hospital,  London,  Ontario. 

(Conlimieil  on  page  M 
JANUARY   19: 


What  the  well-bandaged 
patient  should  wean 


Bandafix  is  a  seamless  round 
woven  elastic  "net"  bandage, 
composed  of  spun  latex 
threads  and  twined  cotton. 

Bandafix  has  a  maximum  of 
elasticity  (up  to  10-fold)  and 
therefore  makes  a  perfect 
fixation  bandage  that  never 
obstructs  or  causes  local 
pressure  on  the  blood  vessels. 

Bandafix  is  not  air-tight, 
because  it  has  large  meshes ;  it 
causes  no  skin  irritation  even 
when  used  for  the  fixation  of 
greasy  dressings.  The  mate- 
rial is  completely  non-reactive. 


Bandafix  stays  securely  in 
place ;  there  are  eight  sizes, 
which  if  used  correctly  will 
provide  an  excellent 
fixation  bandage  for 
every  part  of  the 
body. 


Bandafix  does  not  change  in 
the  presence  of  blood,  pus. 
serum,  urine,  water  or  any 
liquid  met  in  nursing. 

Bandafix  saves  time  when 
applying,  changing  and 
removing  bandages;  the  same 
bandage  may  be  used  several 
times ;  it  is  washable  and 
may  be  sterilized  in  an 
autoclave. 

Bandafix  is  an  up-to-date 
easy-to-use  bandage  in  line 
with  modern  efficiency. 

Bandafix  replaces  hydrophilic 
gauze  and  adhesive  plaster, 
is  very  quick  to  use  and 
has  many  possibilities  of 
application.  It  is  very  suit- 
able for  places  that  otherwise 
are  diflficult  to  bandage. 

Bandafix  is  economical  in  use, 
not  only  because  of  its  rela- 
tively low  price  but  because 
the  same  bandage  may  be 
used  repeatedly. 


Bandafix  does  not  fray, 
because  every  connection 
between  the  latex  and  cotton 
threads  is  knotted;  openings 
of  any  size  may  be  made  with 
scissors  or  the  fingers. 


Bandafix'' 


Distributed  by 


1956  Bourdon  Street.  Montreal.  P.Q  H4M  1 VI 


Now  available 

■Ready  to  Use 
Bandafix 

•  Pre-measured 
•  Pre-cut 
14  different  applications 
•  Individually  illustrated 
peel-open  packages 


*Reoi8tered  trademark  of  Corttinental  Pharma. 


ANUARY   1975 


THE  CANADIAN  NURSE     37 


names 


iConlinuecl  friim  pane  ^6) 

Recent  appointments  to  the  faculty 
of  the  University  of  Alberta  school  of 
nursing  have  been  announced: 

)oyce  Benders  (R.N..  Royal  Alexandra 
Hospital  school  of  nursing.  Edmonton: 
B.Sc.N,,  University  of  Alberta,  Edmon- 
ton) is  a  part-time  clinical  instructor 
in  the  basic  degree 
program.  She  has 
previously  taught 
obstetrics  at  the 
Royal  Alexandra 
Hospital  school  of 
nursing  and  nursing 
fundamentals  at  the 
Misericordia  Hospi- 
tal school  of  nursing 
in  Edmonton.  Alta. 
Margaret  Brackstone  (Reg.  N..  Public 
General  Hospital  school  of  nursing. 
Chatham,  Ontario:  Dipl.  Nurs.  Educ. 
B.Sc.N.,  University  of  Western  Ontario) 
is  a  lecturer  (nursing  for  mental  health). 
She  has  been  a  teacher  at  the  Hamilton 
Psychiatric  Hospital  and  at  the  Hamilton 
Civic  Hospital  school  of  nursing:  assistant 
director  of  the  Public  General  Hospital 
school  of  nursing,  Chatham:  a  lecturer  in 
psychiatric  nursing  at  the  University  of 
Ottawa  school  of  nursing;  and  Year  II 
coordinator  at  Mohawk  College.  Hamil- 
ton Campus. 

ludith  Friend  (Reg.  N.,  Kitchener- 
Waterloo  School  of  Nursing:  Cert. 
Nurse-Midwifery,  Frontier  School  of 
Nurse  Midwifery,  Hyden,  Kentucky: 
B.Sc.N.,  University  of  Alberta,  Edmon- 
ton) is  lecturer  in  the  advanced  practical 
obstetrics  program.  Her  nursing  experi- 
ence has  included  general  duty  nursing  at 
Bella  Bella  Church^Hospital,  Bella  Bella, 
B.C.;  public  health  and  family  planning 
in  India,  under  the  auspices  of  the 
Canadian  University  Services  Overseas; 
and  being  in  charge  of  the  Health  and 
Welfare  Canada  nursing  station  at  Tuk- 
toyaktuk.  N.w.T. 

Barbara  Kerr  (R.N.,  University  of  Al- 
berta Hospital  school  of  nursing,  Edmon- 
ton; B.Sc,  University  of  Alberta)  is  a 
lecturer.  She  has  nursed  at  the  University 
of  Alberta  Hospital  and  has  been  a 
nursing  instructor  at  the  Royal  Alexandra 
Hospital  school  of  nursing,  Edmonton. 

Elaine  Parfitt  (Reg.  N.,  Calgary  Gen- 
eral Hospital  school  of  nursing:  Dipl. 
Teach,  and  Supervision,  B.Sc.N.,  Uni- 
versity of  Alberta,  Calgary)  is  a  lecturer. 
Her  career  assignments  have  included 
those  of  staff  nurse,  clinical  instructor, 
and  coordinator  of  the  first-year  program 
at  the  Calgary  General  Hospital;  instruc- 
tor at  Mount  Royal  College.  Calgary;  and 
38    THE  CANADIAN  NURSE 


evening  supervisor.  University  of  Alberta 
Hospital.  Edmonton. 

Patricia  McKillip  (B.S.  in  Nursing. 
University  of  Nebraska  Medical  Center. 
Omaha;  M.A.Ed..  Idaho  State  Univer- 
sity. Pocatello)  is  assistant  professor  of 
nursing.  She  has  been  an  instructor  and 
chairman  of  the  department  of  nursing  at 
Idaho  State  University;  director  of  nurs- 
ing service  at  Bannock  Memorial  Hospi- 
tal. Pocatello;  and  nursing  instructor  at 
Solano  Community  College,  Fairfield, 
California. 

Margaret  E.  Steed  (Reg.  N..  Toronto 
Western  Hospital  school  of  nursing;  B.N.. 
McGill  University.  Montreal;  M.A. 
(Nurs.  Educ),  Columbia  University,  New 
York)  is  director  of  continuing  education 
in  nursing.  During 
her  career,  she  has 
been  a  nursing  sister 
with  the  Royal  Cana- 
dian Medical  Corps: 
nursing  instructor, 
Toronto  Western 
Hospital;  asssitant 
director  of  nursing. 
Kitchener- Waterloo 
Hospital,  Kitchener;  consultant  with  the 
Canadian  Nurses"  Association,  Ottawa: 
and  adviser  with  the  Universities  Coor- 
dinating council  in  Alberta.  Steed  has 
also  served  on  various  provincial  and 
national  nursing  committees  and  has  been 
a  member  of  panels  presented  at  the 
International  Council  of  Nurses. 


Phyllis  Bluett  (Reg.N.,  Toronto  General 
Hospital  school  of  nursing:  B.Sc.N.,  Uni- 
versity of  Western  Ontario,  London)  re- 
tires Jan  31,1 975  as  director  of  nursing  of 
the  Woodstock  General  Hospital.  She 
began  her  association  with  that  hospital  in 
1934,  but  following  her  university  gradua- 
tion in  1946  she  was  for  a  few  years  in- 
structor of  nurses  at  the  Victoria  Hospital 
in  Londt)n. 


Dorothy  Kergin  is  one  of  four  members 
reappointed  to  the  Medical  Research 
Council.  She  is  director  of  the  school  of 
nursing  at  McMaster  University.  Her  re- 
search interests  are  directed  toward  the 
development  of  educational  programs  for 
nurse-practitioners  and  the  nursing  ac- 
tivities in  primary  care  settings. 


leannine  Tellier-Cormier  was  elected  pres- 
ident of  the  Order  of  Nurses  of  Quebec  at 
its  annual  meeting  in  November.  She 
succeeds  Rachel  Bureau.  Tellier-Cormier 
(R.N.,  Hopital  St. -Joseph  des  Trois- 
Rivieres,  Three  Rivers,  Que.)  is  responsi- 
ble for  the  obstetrical  team  and  is 
professor  at  the  CEGEP  in  Three  Rivers. 
She  has  done  outpost  nursing  among  the 
Indians  of  Northern  Alberta;  has  been  in 
charge    of  trauma,    operating    room    at 


Hopital  St. -Joseph  in  Three  Rivers; 
has    taught    obstetrical    nursing    at 
school  of  nursing  of  Hopital  St.-Joscf 
Her  professional  activities  have  includ! 
three  years  as  president  of  District  No 
two  terms  as  treasurer,  and  member 
on  several  committees  of  ONQ. 


Elizabeth  M.  Butler  (S.R.N. ,  Hanu 
smith  Hospital,  London,  Engl. 
O.H.N.C,  D.N.,  London)  has  ! 
appointed  occupational  health  nurse 
sultant  in  the  Alberta  Department 
Health  and  Social  Development  (Indi 
trial  Health  Services  Division). 

On       coming 
Canada  in  1967.  s! 
joined    the    depai 
ment    of   health 
Saskatchewan-.    I  ; 
er,  she  worked  ai  ti 
University  of  Alhji 
Hospital  and  then 
a    full-time    occup 
tional  health  nurse 


"^'WP' 


Jean  G.  Church  (R.N..  Royal  Vici  i 
Hospital  School  of  Nursing,  Monirc; 
B.Sc,  Dalhousie  U.;  Dipl.  teaching 
schools  of  nursing,  McGill  U.;  M.A  (  i 
umbia  University,  New  York)  has  i 
signed  as  associate  professor  and  cm 
dinator  of  the  B.N.  program  for  registcn 
nurses  at  Dalhousie  University  school 
nursing.  She  had  been  with  the  faculty  f 
22  years. 

An  untiring  member  of  the  Registert 
Nurses  Association  of  Nova  Scotia,  si 
was  president  from  1967  to  1969,  an 
later,  chairman  of  the  board  of  examiner 

Dollene  Diane  Rampersaud  (Reg.  N.,  5 
Joseph's  School  of  Nursing,  Londo 
P.H.N.  Cert;  B.Sc.N,,  University 
Western  Ontario,  London)  has  been  a 
pointed  nursing  supervisor,  Oxfo 
Health  Unit,  Woodstock,  Ontario. 

During  her  nursii 
career,  she  has  bet 
staff  nurse  at  tl 
London  Psychiatr 
Hospital  and  tl 
Addiction  Resean 
Foundation,  T( 
ronto;  instructor  ai 
inental  health  coo 
^  wr^  /  dinator  at  the  Wooi 

stock  General  Hospital;  and  supervisor 
the  Oxford  Mental  Health  Center.         ■; 


JANUARY   19 


AUTONOMY. 

AUTHORITY. . . 
ACCOUNTABILITY.. 
'        nursing 
leadership 
defined. 


Mclnnes 


NewMosby  texts 

help  toddy  5  students 

become  tomorrow's 
tedders. 


New  2nd  Edition! 

THE  VITAL  SIGNS,  WITH  RELATED  CLINICAL 

MEASUREMENTS:  A  Programmed  Presentation 

Covering  more  than  basic  vital  signs,  this  new  edition  includes 
all  aspects  of  measurement  of  body  temperature  and  cardiac 
activity.  The  authors  provide  the  student  with  the  scientific 
concepts  that  permit  understanding  and  assessment  of 
vital  signs.  Fetal  heart  rate  and  venous  pressure  are  also 
incorporated,  along  with  reorganized  bibliographies. 

By  BETTY  MclNNES,  R.N.,  B.Sc.N.,  M.Sc.  (Ed.).  January,  1975. 

Approx.  144  pages,  7"  x  10",  45  illustrations.  About  $6.55. 

New  3rd  Edition!  Anthony 

BASIC  CONCEPTS  IN  ANATOMY  AND  PHYSIOLOGY: 

A  Programmed  Presentation 

This  manual  teaches  the  facts  necessary  for  developing  a 

clear  understanding  of  the  human  body.  Material  has  been 

totally  reorganized  to  focus  on  functions  of  the  body. 

The  endocrine  chapter  has  been  enlarged,  and  a  new 

chapter  discusses  the  respiratory  system. 

By  CATHERINE  PARKER  ANTHONY,  R.N.,  B.A.,  M.S.  July,  1974. 
182  pages  plus  FM  l-VIII,  7"  x  10',  54  illustrations.  Price,  $6.60. 

3rd  Edition!  Labunski  et  a! 

WORKBOOK  AND  STUDY  GUIDE  FOR  MEDICAL-SURGICAL 

NURSING-A  Patient-Centered  Approach 

Realistic  exercises  encourage  students  to  develop  problem- 
solving  techniques  and  communication  skills  as  they  identify 
and  solve  nursing  problems.  The  authors'  flexible  approach 
shows  students  how  to  integrate  the  information  from  their 
general  education  courses  to  improve  the  quality  of 
patient  care. 

By  ALMA  JOEL  LABUNSKI,  R.N.,  B.S.N.;  MARJORIE  BEYERS,  R.N., 
B.S.,  M.S.;  LOIS  S.  CARTER,  R.N.,  B.S.N.;  BARBARA  PURAS  STELMAN, 
R.N.,  B.S.N.;  MARY  ANN  PUGH  RANDOLPH,  R.N.,  B.S.N.;  and 
DOROTHY  SAVICH,  R.N.,  B.S.  1973,  331  pages  plus  FM  l-Vill, 
7V4"  X  lOVz".  Price,  $6.70. 


\NUARY   1975 


MOSBV 

TIMES  MIRROR 

THE    C    V    MDSBY  COMPANY.  LTD 

86   NORTHLINE    ROAD 

TORONTO.  ONTARIO 

M4B   3E5 


THE  CANADIAN  NURSE     39 


AUTONOMY 
AUTHORITY. 


ACCOUNTABILITY.. 


A  New  Book!  Dreyer-Bailey-Doucet 

NURSING  MANAGEMENT  OF  THE  PSYCHIATRIC 
PATIENT:  A  Workbook 

Based  on  actual  clinical  cases,  this  unique  workbook  is  a 
practical  guide  for  the  application  of  psychiatric  nursing 
techniques.  Topics  covered  include:  legal  aspects;  patients 
with  problems  related  to  alcohol  and  drug  abuse;  behavior 
disorders  in  children;  and  more.  Each  chapter  concludes  with 
useful  questions  similar  to  those  found  on  State  Board  exams. 

By  SHARON  DREYER,  R.N.,  M.S.;  DAVID  BAILEY,  Ed.D.;  and  WILLS 
DOUCET,  M.Ed.  January,  1975.  Approx.  208  pages,  7Vi~  x  10%". 
About  S6.25. 

A  New  Book!  Kneisl-Ames 

MENTAL  HEALTH  CONCEPTS  IN  MEDICAL-SURGICAL 
NURSING:  A  Workbook 

This  new  text  offers  a  practical  way  to  help  students  apply 
mental  health-psychiatric  nursing  concepts  when  caring  for 
adult  patients  with  medical  and/or  surgical  problems. 
Holistic  in  approach,  this  workbook  can  aid  in  assessing 
needs,  planning  care,  and  evaluating  effectiveness  of 
nursing  actions  with  medical  or  surgery  patients. 

By  CAROL  REN  KNEISL,  R.N.,  M.S.;  and  SUE  ANN  AMES,  R.N.,  M.S. 
September,  1974.  160  pages  plus  FM  l-X,  7V4"  x  10y2',  23  illustrations. 
Price,  $5.80. 

A  New  Book!  Davis  et  a! 

NURSES  IN  PRACTICE:  A  Perspective  on  Work  Environments 

This  new  text  is  a  collection  of  articles  which  consider  the 
work  of  nurses  in  a  variety  of  settings.  As  R.N.'s,  two  of  the 
authors  present  special  Insight  into  the  nurse's  lack  of 
autonomy;  the  attitudes  concerning  the  role  of  women  today; 
and  the  care  components  of  other  health  professionals. 

By  MARCELLA  Z.  DAVIS,  R.N.,  Ph.D.;  MARLENE  KRAMER,  R.N.,  Ph.D.; 
and  ANSELM  L.  STRAUSS,  Ph.D.;  with  11  contributors.  February,  1975. 
Approx.  272  pages,  6%"  x  9%".  About  $7.30. 


nursing  leadership  dejined. 


New  3rd  Edition!  lorio 

CHILDBIRTH:  FAMILY-CENTERED  NURSING 

This  new  edition  presents  the  nursing  concepts  necessary 
for  nursing  intervention  in  childbirth.  Well-grounded  in 
physiology,  the  text  considers  the  psychologic  implications 
of  growth  and  maturation  of  all  family  members;  abortion; 
trends  in  maternal-health  services;  and  more.  The  author 
covers  the  normal  maternity  cycle  in  full  detail. 

By  JOSEPHINE  lORIO,  R.N.,  B.S.,  M.A.,  M.Ed.  January,  1975. 

468  pages,  plus  FM  l-XII  6^4'  x  9Va\  199  illustrations.  Price  $9.40. 

A  New  Bool(!  Waring-Jeansonne 

PRACTICAL  MANUAL  OF  PEDIATRICS: 

A  Pocket  Reference  for  Those  Who  Treat  Children 

This  pocket-size  book  is  a  ready  source  for  information 
necessary  for  "on-the-spot '  treatment  of  children.  The 
information  is  highly  accessible  through  the  use  of  charts, 
tables,  and  outlines.  It  includes  forgettable  facts  and  figures 
of  drug  dosages,  nutrition,  standard  measurements, 
conversion  tables,  etc. 

By  WILLIAM  W.  WARING,  M.D.;  and  LOUIS  O.  JEANSONNE  III,  M.D. 
April,  1975.  Approx.  360  pages,  4V4  '  x  6',  213  illustrations.  About  S6.25. 

A  New  Boold  Saxton-Hyland 

AN  INTEGRATED  APPROACH  FOR  PLANNING  AND 
IMPLEMENTING  NURSING  INTERVENTION 

This  unique  new  text  explores  the  concepts  of  stress  and 
adaptation,  problem  solving,  and  21  nursing  problems. 
Emphasis  is  on  the  levels  of  adaptation  and  their  relationship 
to  nursing  intervention.  In  an  integrated  approach,  the 
authors  present  the  development  of  an  assessment  graph 
for  use  in  planning  nursing  intervention. 

By  DOLORES  F.  SAXTON,  R.N.,  B.S.,  M.A.,  Ed.D.;  and  PATRICIA 

A.  HYLAND,  R.N.,  B.S.,  M.S.,  M.  Ed.  January,  1975.  Approx.  192  pages, 

6*  X  9',  46  illustrations.  About  S6.05. 

r 


kNUARY   1975 


M05BY 


TIMES  MIRROR 

THE    C    V    MOSBY  COMPANY,  LTD 

86   NQRTHLINE    ROAD 

TORONTO,  ONTARIO 

M4B   3E5 


THE  CANADIAN  NURSE     41 


AUTONOMY. 

AUTHORITY... 
ACCOUNTABILITY.. 

nursing  leadership  de/ined. 


A  New  Book!  Schreck 

ORGANIC  CHEMISTRY:  Concepts  and  Applications 

Presenting  the  essentials  of  organic  chemistry,  this  new 
text  offers  students  a  comprehensible  treatment  of  the 
basics.  Written  from  a  functional  approach,  it  blends 
chemistry  basics  and  relevant  examples  to  relate  chemistry 
to  the  real  world.  Energy  considerations  and  profiles  of 
common  reactions  appear  throughout  the  text.  Each 
chapter  contains  a  summary  of  important  concepts,  a  list  of 
new  terms,  and  a  problem  set  which  reinforces  pertinent 
concepts. 

By  JAMES  O.  SCHRECK.  May,  1975.  Approx.  448  pages, 
7'  X  10",  93  illustrations.  About  $13.60. 


New  3rd  Edition!  Guthrie 

INTRODUCTORY  NUTRITION 

The  new  edition  of  a  popular  text  presents  relevant 
nutrition  information  in  a  direct  and  extremely  readable 
style.  It  is  organized  into  3  parts:  part  1  -Basic  Principles 
of  Nutrition  — includes  discussions  of  all  major  nutrients. 
Part  2-Applied  Nutrition-deals  with  the  application  of 
basic  principles  to  various  nutritional  situations. 
Part  3— Appendices— includes  a  glossary,  prefixes  and 
suffixes,  and  a  multitude  of  tables. 

By  HELEN  ANDREWS  GUTHRIE,  B.Sc,  M.S.,  Ph.D.  March,  1975. 
Approx.  576  pages,  7'  x  10',  159  illustrations.  About  $11.50. 


MOSBV 

TIMES  MIRROR 

THE    C    V    MOSBY  COMPANY,  LTD 

86   NORTHLINE    ROAD 

TORONTO.  ONTARIO 

M4B   3E5 


new  products     { 


Descriptions  are  based  on  information 
supplied  by  the  manufacturer.  No 
endorsement  is  intended. 


ubilus  ulcer  cushions 

Hcclbo  and  Heelbo  "Flair"'  provide 
iitortable  protection  for  patients  with 
ubitus  ulcers. 

Vhen  used  as  a  heel  protector.  Heelbo 
vides  senii-anibulatory  patients  with 
ler  footing,  allowing  greater  freedom 
I  security.  The  Heelbo  slays  comforta- 

in  place  without  straps,  so  blood 
:ulates  freely  to  promote  tissue  granu- 
on  and  rapid  healing, 
fhe  Heelbo's  brushed  acrilan  interior 
vides  patients  with  gentle  warmth 
hout  pressure.  The  cushion   itself  is 


de    of   stain-resistant    urethane    foam 

h  a  tricot  finish.  The  Heelbo  ""Flair" 

a  deeper  cushion  to  protect  more  of 

elbow  or  the  area  around  the  ankle 

le. 

Dne  size  fits  all  adults  and  can  be  used 
either  elbows  or  heels  without  adjust- 
nt.  They  are  washable  in  autoclave  or 
chine.  Exclusive  Canadian  distributor 
Hartz-Standard  Ltd..  34  Metropolitan 
ad.  Aeincourt.  Ontario. 


becomes  available  for  appro .ximately 
1 2-hour  sustained  release . 

Drixoral  is  indicated  for  the  relief  of 
upper  respiratory  mucosal  congestion  in 
seasonal  and  perennial  nasal  allergies. 
acute  rhinitis  and  rhinosinusitis.  acute  and 
subacute  sinusitis,  eustachian  tube  block- 
age, and  secretory  otitis  media. 

The  product  is  supplied  in  bottles  of  .SO 
tablets.  Information  is  available  from 
Schering  Corporation  Limited.  3535 
Trans  Canada  Highway.  Pointe  Claire. 
Que.  H9RIB4. 

Urine  meter 

The  Bard  urine  meter  of  molded  transpar- 
ent plastic  is  a  completely  sealed,  closed 
system.  Its  shape  allows  accurate  meas- 
urement from  2cc  to  400  cc.  Graduations 
are  raised  to  facilitate  reading  and  record- 
ing of  measurements. 

A  molded  drip  chamber,  bonded  to  a 
9/32"    drainage    tube,    minimizes    the 


danger  of  retrograde  infection  from  the 
urine  meter  to  the  bladder.  The  urine  meter 
is  air-vented  for  uninterrupted  flow. 

Drainage  is  through  a  bottom  outlet 
valve.  Each  unit  is  supplied  individually 
packaged  with  sterile  fluid  path,  in  a 
snap-open  poly  bag. 

For  details,  write  C.R.  Bard  (Canada) 
Ltd.,  1  Westside  Drive.  Etobicoke,  Ont. 
M9C  1B2. 


1L.        "^' 


^ 


Aseptic  scrub  station 

The  Market  Forge  Surgical  Scrub  Station 
Model  SSIO  is  designed  to  provide  max- 
imum convenience,  comfort,  and  assur- 
ance of  proper  techniques  for  the  surgeon 
and  the  OR  staff.  Water  temperature  and 
volume  are  pre-set.  Each  bay  of  the  Mar- 
ket Forge  SSIO  Scrub  Station  is  isolated 
with  a  Plexi-glas  divider  and  high  sides, 
minimizing  the  danger  of  cross- 
contamination  from  bacterial  aerosols.  Di- 
rect shadowless  illumination  is  provided 
within  the  scrub  area.  Sink  and  faucet  are 
designed  to  eliminate  splashing  of  floor  or 
operator. 

The  SSIO  accommodates  a  wide  varia- 
tion in  operator  heights.  It  offers  an  unob- 
structed view  of  the  operating  room  while 
scrubbing.  Its  "no  touch"  press  and  re- 
lease knee  controls  turn  soap  and  water  on 
and  off.  Unsanitary  soap  dispensers  are 
eliminated.  The  scrub  station  is  wall- 
mounted,  with  pipes  concealed.  It  is  avail- 
able with  one.  two.  or  three  bays.  For 
information,  write  .Market  Forge  Hospital 
Equipment    Division.     Everett,     Mass. 

Complete  infusion  system 

The  LaBarge  Infusion  System  will  elec- 
tronically pump,  regulate,  and  monitor  the 
intravenous  flow  of  fluids  and  drugs  to  a 
patient.  It  contains  specially  designed 
safeguards  against  variations  in  the  flow 
rate.  It  is  also  designed  not  to  infuse  air  or 
interfere  with  the  sterility  of  the  fluid. 

The  unit  can  be  used  in  intensive  care 
therapy,  neonatal  units,  labor  and  delivery 
units,  coronary  care,  and  other  general 
areas  where  present  infusion  sets  are  em- 
ployed. 

For  information  write:  LaBarge,  Inc., 
500  Broadway  BIdg..  St.  Louis.  Mo. 

THE  CANADIAN  NURSE     43 


Next  Month 


in 


The 

Canadian 
Nurse 


n  U-lOO  Insulin: 

A  Challenge  for  Nurses 


D  Guidelines  for  Quality  of  Care 
in  Patient  Education 


D  Critique:  Nursing  Research 
is  Not  Every  Nurse's  Business 


D  Ostomy  Skin  Barriers 

Used  to  Treat  Decubitus  Ulcers 


^^^ 


Photo  Credits 
for  January  1975 

Graetz  Bros.  Limited. 
Montreal,  Quebec,  p.  9 

Photo  Features  Ltd., 
Ottawa,  Ontario,  p.   12 

Field  Aviation  Company  Limited, 
Ottawa.  Ontario,  p.  23 

Saskatoon  Star  Ptioenix 
Saskatoon,  Sask..  p.  26 

Canada  Wide, 

Montreal,  Quel)ec,  p.  31 

Sunnybrook  Medical  Centre, 
Toronto.  Ontario,  pp.  34,35 


dates 


February  17-18, 1975 

Seminar  on  budgeting  in  health  care 
administration,  Chateau  Halifax,  Nova 
Scotia,  sponsored  by  Ottawa  University 
School  of  Health  Administration.  For  in- 
formation write:  Barbara  Schulman,  Coor- 
dinator Continuing  Education  Program, 
School  of  Health  Administration,  University 
of  Ottawa,  Ottawa,  Ontario,  KIN  6N5. 

March  26-28,  1975 

A  three-day  intensive  course  on  au- 
diometry and  hearing  conservation  in 
Industry  will  be  held  at  Rensselaer 
Polytechnic  Institute,  Troy,  New  York.  For 
information  write:  Office  of  Continuing 
Studies,  Rensselaer  Polytechnic  Institute, 
Communications  Center  209,  Troy,  New 
York  12181,  U.S.A. 

April  21-23,  1975 

Ninth  annual  conference  of  Operating 
Room  Nurses  of  Greater  Toronto  to  be 
held  at  Skyline  Hotel,  Toronto.  Address 
inquiries  to:  Dixie  OSulllvan,  Convener, 
Publicity  Committee,  orngt,  624  Tedwyn 
Drive,  Misslssauga,  Ontario,  L5A  1K2. 

May  6-9,  1975 

Alberla  Association  of  Registered  Nurses 
annual  convention  to  be  held  at  the 
Calgary  Inn,  Calgary,  Alberta.  The  theme 
Is  "Nursing  Power." 

May  26-.30,  1975 

Canadian  Public  Health  Association  66th 
annual  conference,  MacDonald  Hotel, 
Edmonton,  Alberta.  Theme  is  "Priorities 
for  Prevention."  Address  inquiries  to:  cpha, 
55  Parkdale  Avenue,  Ottawa,  Ontario, 
K1Y1E5. 


June  1975 

St.  Josephs  School  of  Nursing  Alumnae, 
Victoria,  B.C.,  75th  anniversary  reunion. 
For  further  Information,  write  to:  Ms.  Phyllis 
Fatt,  4253  Dieppe  Rd.,  Victoria,  B.C.. 

)une4-6,  1975 

Canadian  Hospital  Association  national 
convention  and  32nd  annual  meeting  will 
be  held  in  Saskatoon,  Sask. 


June  9  and  10, 1975 

Fifteenth  annual  meeting  of  the  Ambula- 
tory Pediatric  Association,  to  be  held  at  the 


44     THE  CANADIAN  NURSE 


Royal  York  Hotel,  Toronto,  Canada.  A 
stracts  are  invited  for  consideration  f 
presentation  at  the  scientific  sessions  ai 
must  be  postmarked  no  later  than  Janua 
31,  1975.  Papers  on  pediatric  educati( 
and  health  care  research  in  ambulato 
facilities  are  particularly  encouraged.  F 
information,  write:  George  D.  Comer 
M.D.,  Department  of  Pediatrics,  Univers 
of  Arizona  College  of  Medicine,  Tucso 
Arizona,  85724,  U.S.A. 

June  11-14,  1975 

The  annual  meeting  of  the  Register 
Nurses  Association  of  Ontario  will  coinci^ 
with'  RNAO's  50th  birthday.  The  meet! 
and  anniversary  celebrations  are  to  be 
the  Royal  York  Hotel,  Toronto,  Ontario. 

August  11-16,  1975 

World  AssemDIy  oi  War  Veterans, 
commemorate  the  30th  anniversary  of  t 
end  of  World  War  II,  Sydney,  Austral 
Pre-  and  post-convention  tours  availab 
Registration  fee:  SA.  30.00.  For  furtt^ 
information,  write  to:  Assembly  Secret! 
iat,  G.P.O.  Box  2609,  Sydney.  N.S.V 
2001 ,  Australia. 

August  14  -  17,  1975 

The  Moncton  Hospital  school  of  nursii 
homecoming  reunion  and  the  last  gradu 
tion  of  the  school  of  nursing.  For  mo 
information  write  Harriett  Hayes,  Cha 
man,  Reunion  Committee,  43  Wah 
Street,  Moncton,  N.B.,  E1C  6W6. 

August  17-18,  1975 

American  Academy  of  Medical  Admini 
trators  18th  annual  convocation  and  met 
Ing,  Continental  Plaza  Hotel,  Chicag 
Illinois.  For  information  write:  agma, 
Beacon  Street,  Boston,  Mass.,  02108. 

August  29-31,  1975 

Hotel-Dleu  St.  Joseph  school  of  nursln 
Campbellton,  N.B.,  final  graduation  ai 
grand  reunion  of  graduates.  Write:  Clai 
C.  Doucet,  Director,  School  of  Nursin 
Hotel-Dieu  St.  Joseph,  Campbellton,  N.E 

'Jovember  24-26, 1975 

Conference  for  nurse  administrators  to 
held  at  gha  Centre  Auditorium.  Toron 
For  information,  write:  Educational  S 
vices  Division,  Ontario  Hospital  Assoc 
tion,  150  Ferrand  Drive,  Don  Mills,  Ontai 
JANUARY    IS 


books 


ex  of  Canadian  Nursing  Studies.  Com- 
piled by  Canadian  Nurses'  Association 
Library,  under  the  direction  of 
Marearet  L.  Parle  in.  Librarian.  184 
page's.  Ottawa.  CNA.,  1974. 

IS  addition  of  the  Index  of  Canadian 
rsing  Studies  is  a  cumulation  of  the 
S9  edition,  the  Addenda  for  1970-72. 
1  the  data  collected  through  1973  to  31 
y  1974. 

The  Index  is  in  two  parts:  Part  I  —  a 
inj:  by  author,  or  responsible  agency, 
h  full  bibliography  description.  Part  II 
subject  listings  by  author  or  agency. 
Studies  in  the  Index  are  done  by  Cana- 
,n  nurses  or  are  concerned  with  nursing 
Canada.  They  range,  therefore,  from 
;cific  investigations  to  major  research 
ijects,  and  include  master's  and  doc- 
al  theses  as  well  as  reports  by  institu- 
ns.  associations,  and  government  de- 
rtnients.  The  Index  includes  all  studies 
v^hich  reference  could  be  found. 
Those  studies  not  in  the  CNA  Repository 
llection  of  Nursing  Studies  are  indi- 
cd  by  an  asterisk.  Inquiries  concerning 
;ir  availability  must  generally  be  di- 
:ted  to  the  author  or  source. 
Studies  in  the  CNA  Repository  Collec- 
n  are  available  for  consultation  in  the 
A  Library  or  may  be  borrowed  on  inter- 
rary  loan. 


ilical  Incidents  in  Nursing,  edited  by 
Loretta  Sue  Bermosk  and  Raymond 
Corsini  Jr.  369  pages.  Toronto, 
Saunders.  1973. 

Reviewed  hy  Helen  Niskalu.  Coor- 
dinator. Undergraduate  Programs. 
School  of  Nursing,  University  of 
Alherta.  Edmonton.  Alberta. 

ihis  book,  the  editors  have  arranged  for 
liberation  38  situations  or  critical  inci- 
nts.  dealing  with  current  controversial 
ues  in  nursing  service,  nursing  educa- 
n.  and  nursing  research.  The  everyday 
man  relations  incidents  or  problems 
ve  been  sectioned  into  six  areas  of 
rse  interactions:  with  the  patient,  with 
peers,  with  the  doctor,  with  the 
mily.  with  her  supervisors,  and  with  the 
stem. 

The    presentations    might    have    been 

engthened  by  reordering  of  chapters, 

that  patient-   and   family-related  sit- 

tions    appear    in    sequence    and    those 

NUARY   1975 


related  to  the  nurse's  interactions  with  her 
professional  colleagues,  supervisors,  and 
the  system  were  together. 

The  incidents,  selected  from  a  pool  of 
situations  reported  to  the  editors  by 
nurses,  deal  with  such  timely  topics  as 
euthanasia,  patient  rights,  drug  abuse  by 
health  professionals,  ethics  in  research, 
and  difficult  intra  and  interprofessional 
relations. 

Each  incident  includes  relevant  back- 
ground information  a'oout  the  event,  a 
description  of  the  situation  as  reported  by 
the  nurse  involved,  and,  finally,  opinions 
solicited  from  concerned,  experienced, 
knowledgeable  persons  from  a  variety  of 
disciplines.  Inclusion  of  opinions  of 
specialists  from  other  disciplines  should 
enrich  the  reader's  appreciation  of  how 
others  consider  the  ethics  and  profes- 
sionalism involved  in  each  incident. 
Although  some  of  the  reactions  seem  to 
reflect  professional  biases  or  lack  of 
understanding  about  nursing,  they  are 
nonetheless  provocative  observations  that 
should  lead  the  reader  to  review  her  own 
feelings  and  beliefs  about  the  topics  under 
consideration. 

The  text  is  a  useful  reference  for  senior 
nursing  students,  regardless  of  the  pro- 
gram, and  for  all  those  who  are  concerned 
about  dealing  with  the  complex  human 
situations  that  confront  the  nurse  of 
today . 


Patient  Care  Systems  by  Janet  Kraegel  et 
al.  219  pages.  Philadelphia,  Lippin- 
cott,  1974.  Canadian  agent:  Lippincott, 
Toronto. 

Reviewed  by  Marvel  Seeley.  Lecturer, 
Faculty  of  Nursing,  University  of  Sas- 
katchewan, Saskatoon,  Sask. 

This  book  is  based  on  the  outcome  of  a 
3-year  research  project  on  patient  care  sys- 
tems. Illustrations,  appendixes,  pictures, 
and  results  of  the  study  fill  84  of  the  219 
pages.  For  the  most  part,  these  are  mean- 
ingful and  may  serve  as  a  guide  in  setting 


+  R0II  up 
your  sleeve 
to  save  a  life... 


up  such  a  system.  There  are  2  pages  of 
mathematics  and  formulas  that  deserve  a 
more  adequate  explanation:  however,  this 
in  no  way  detracts  from  the  usefulness  of 
the  book. 

The  system  described  focuses  on  patient 
needs  and  is  patient-centered.  The  practi- 
cal analogies  u.sed  by  the  authors  make 
reading  easy  and  meaningful  to  a  wide 
variety  of  health  care  planners.  The  book 
is  well  organized  and  follows  a  logical 
sequence  from  beginning  to  end,  with  a 
comprehensive  summary  at  the  end  of 
each  chapter. 

The  chapters  are  short;  the  contents  of 
each  are  adequately  defined  at  the  begin- 
ning for  quick  and  easy  reference.  How- 
ever, to  be  totally  appreciated  the  book 
must  be  read  from  cover  to  cover,  as  it 
follows  a  continuum. 

The  book  begins  with  a  historical  ap- 
proach, showing  the  fragmentation  of 
health  care  systems  to  date,  and  discusses 
their  detrimental  effect  on  the  patient.  It 
identifies  the  lack  of  a  unifying  philosophy 
and  clearly  indicates  the  necessity  for 
change  to  meet  the  needs  of  society  and  to 
keep  abreast  with  the  rapid  growth  of  the 
medical  and  nursing  professions.  An  in- 
tegrated approach  based  on  patient  needs 
is  proposed. 

The  authors  show  how  a  design,  based 
on  patient-centered  care,  brings  the  patient 
to  light  and  makes  him  an  integral  part  of 
the  health  care  system.  They  suggest  the 
type  of  environment  necessary  to  meet  the 
patient's  needs.  This  environment  is  ideal 
and  would  be  most  useful  to  health  care 
planners  involved  in  hospital  design. 

I  doubt  whether  existing  hospitals  could 
be  modified  or  renovated  without  consid- 
erable cost  to  create  such  an  environment. 
The  authors  are  explicit  in  their  approach 
to  decentralization  and  show  how  such 
systems  cannot  rely  on  mere  chance  for 
their  interrelationship. 

The  book  brings  out  the  necessity  for 
health  care  system's  components  to  oper- 
ate as  a  unified  whole  based  on  a  common 
purpose:  patient  needs.  The  book's  sequel 
effect  shows  the  implications  of  designing 
patient  care  systems  to  meet  patient  needs 
and  how  they  can  be  implemented  with  no 
undue  rise  in  the  cost  of  operating  ex- 
penses of  increase  in  personnel. 

This  modern  book  would  be  an  asset  to 
any  hospital  library.  It  is  an  excellent  re- 
ference book  for  colleges  that  conduct 
programs  for  health  care  planners. 

THE  CANADIAN  NURSE     45 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses"  Association  library  are 
available  on  loan  —  with  the  exception  of 
items  marked  R  —  to  CNA  members, 
schools  of  nursing,  and  other  institutions. 
Items  marked  R  include  reference  and 
archive  material  that  does  nor  go  out  on 
loan.  Theses,  also  R.  are  on  Reserve  and 
go  out  on  Interlibrary  Loan  only. 

Requests  for  loans,  maximum  3  at  a 
time,  should  be  made  on  a  standard  Inter- 
library  Loan  form  or  on  the  "Request 
Form  for  Accession  List"". 

BOOKS  AND  DOCUMENTS 

1 .  L'ameliDratioii  ile  I' enseiftnemenr  des  personnels 
de  same.  Geneve.  Organisation  Mondiale  cie  la 
Sante.  1974.  1 1  Ip.  (Cahiers  de  same  publique  no. 
52) 

2.  Basic  concepts  in  anatomy  and  physiology;  a 
programmed  presentation,  by  Catherine  Parker  An- 
thony. 3ed.  St.  Louis,  Mosby,  1974.  181p. 

3.  Cardiac  arrest  and  resuscitation,  by  Hugh  E. 
Stephenson.  4ed.  St.  Louis.  Mosby,  1974.  181p. 

4.  C«.v/  reduction  for  special  libraries  and  informa- 
tion centers,  edited  by  Frank  Slater.  Washington, 
American  Society  for  Information  Science,    1973. 

5.  Costs  of  education  in  the  health  professions.  Re- 


port of  a  study  by  Instilule  of  Medicine,  Washington. 
Parts  I  and  II.  Washington.  National  Academy  of 
Sciences.  1974.  284p. 

6.  Current  index  to  journals  in  educatiim:  annual 
cumulation.  Vol.  5.  1973.  New  York.  Macmillan. 
1974.  4pts.  R. 

7.  The  dyin^i  patient:  a  nursing  perspective.  Com- 
piled by  .Mary  H.  Browning  and  bdilh  P.  Lewis.  New 
York,  American  journal  of  nursing.  cl972.  27,'ip. 
{Contemporary  nursing  series) 

8.  The  expanded  role  of  the  nurse.  Compiled  by 
Mary  H.  Browning,  and  Edith  P.  l^wis.  New  York, 
American  journal  of  nursing,  cl973.  32.'i  p.  (Con- 
temporary nursing  .series) 

9.  Histophysiolofiie  de  Tappareil  genital  feminin. 
par  Marc  Maillet.  et  al.  Montreal,  Gaulhier-Villars. 
CI974.  2.'i2p. 

10.  Human  sexuality:  nursing  implications.  Com- 
piled by  Mary  H .  Browning  and  Edith  P.  Lewis.  New 
York.  American  journal  of  nursing,  cl973.  276p. 
(Contemporary  nursing  series) 

1  1 .  Maternal  uiul  newborn  care:  nursing  inten-en- 
tions.  Compiled  by  Mary  H.  Browning  and  Edith  P. 
Lewis.  New  York,  American  journal  of  nursing, 
cl973.  2.'i8p.  (Contemporary  nursing  series) 

1 2 .  Modern  management  methods  and  the  organiza- 
tion of  health  services.  Geneva.  World  Health  Or- 
ganization, 1974.  lOOp.  (WHO  Public  health  papers 
no.  55) 

13.  The  nurse  in  community  mental  health.  Com- 
piled by  Edith  P.  Lewis  and  Mary  H.  Brow  ning.  New 
York,  American  journal  of  nursing.  cl972.  298p. 
(Contemporary  nursing  series) 

14.  Nurses'  alumnae  journal .  Winnipeg,  Winnipeg 


General  Hospital.  School  of  Nursing.  Alumnae  i 
sociation.  1974.  248p.  R 

15  ,\ursini;  anil  the  cancer  patient.  Compiled 
Mary  H  Browning  and  Edith  P.  Lewis  New  Yo 
.'American  journal  of  nursing.  cl973.  354p.  (O 
temporary  nursing  series) 

16.  Nursing  in  respiratorv  diseases.  CtJmpiled 
Edith  P.  Lewis  and  Mary  H.  Browning  New  Yo 
American  journal  of  nursing.  cl972.  275p.  (C 
temporary  nursing  series) 

17.  Nursing  papers  V. 6.  no. 2.  The  expanding  roU 
the  nurse:  her  preparation  and  practice.  Montrs 
McGill  University,  Schtiol  for  Graduate  Nurs 
1974.  64p.  R 

18.  Office  and  association  directory.  Toror 
Canadian  Hospital  Association.  1974.  73p.  R 

\^  Perspectives  in  bioavailability  of  dru, 
therapeutic  and  toxicological  significance .  Proce 
ings  of  Canadian  Association  for  Research  in  T 
icology.  Annual  Symposium.  Fifth.  1971 .  Montn 
LesPressesderUniversitede  Montreal,  1973.  18! 

20.  Planning  for  cardiac  care.  A  guide  to  the  pi 
ning  and  design  of  cardiac  care  facilities,  by  Colin 
Clipson  and  Joseph  J.  Wehrer.  Ann  Art 
.Michigan.  Health  Administration  Press,  cl9 
407p. 

2 1 .  Practical  nursing;  a  textbook  for  students 
graduates,  by  Dorothy  R.  Meeks,  et  al.  5ed. 
Loms,  Mosby.  1974.  720p. 

22.  Primer  of  epidemiologx.  by  Gary  D.  Friedni 
New  York.  McGraw-HiM,'cl974.  2.^()p. 

23.  Recherche  en  organisation  sanitaire  et  tech 
ques  de  management .  par  F.  Grundy  ct  W.A.  Rein 
Geneve,  Organisation  mondiale  de  la  Sante,   19 


NURSING     EMPLOYMENT 
OPPORTUNITY 


COORDINATOR  OF 

PROFESSIONAL 

INSPECTION 

THE  ORDER  OF  NURSES  OF  QUEBEC 


$ 


RESPONSIBILITIES 

Plans  professional  inspection  program  as  prescribed  by  the  Professional 
Code  and  according  to  regional  disparities  and  availability  of  resource  per- 
sons. 

Participates  in  the  development  of  standards  and  necessary  instruments  of 
measure. 

Responsible  for  the  Professional  Inspection  Committee. 
Prepares  plans  for  visits,  develops  grids  with  the  help  of  other  consultants  and 
submits  reports  to  the  chairman  of  the  Professional  Inspection  Committee,  the 
Secretary  of  the  Order  and  the  Bureau  depending  on  circumstances  and  the 
provisions  under  the  Act. 

QUALIFICATIONS 

Candidates  must  be  bilingual  and  possess: 

•  a  university  degree 

•  knowledge  of  Professional  Code,  Nurses  Act,  Act  Respecting  Health 
Services  and  Social  Services,  labour,  etc. 

•  varied  nursing  experience. 

Applications  containing  full  Information  must  be  received  before 
February  15.  7975, 

The  Executive  Director  and 
Secretary  of  ttie  Order 
4200  Dorchester  Blvd.  West 
Montreal  H3Z  1V4,  Que. 


NURSING     EMPLOYMENT 
OPPORTUNITY 


ASSISTANT  REGISTRAR 


AND 


PERSON  RESPONSIBLE  FOR 

THE  LEGISLATION  SECTOR 

OF  THE  ORDER 

THE  ORDER  OF  NURSES  OF  QUEBEC 


$ 


RESPONSIBILITIES 

Assists  the  registrar  to  carry  out  registration  procedures. 

Works  closely  with  the  legal  advisors  on  all  questions  of  legislation  raised  by  a 

memtier,  an  organization,  a  committee  or  the  Bureau. 

Informs  ONQ  members  on  the  nursing,  social  and  health  laws. 

Studies  all  legal  documents  concerning  the  nursing  profession,  health  and 

health  services,  and  education,  at  the  provincial,  national  and  international 

level. 

QUALIFICATIONS 

Candidates  must  tie  bilingual  and  possess: 

•  a  university  degree 

•  nursing  experience  (administration  and  education) 

•  knowledge  of  Qu6bec  legislation  in  the  fields  of  health  and  nursing. 

Applications  containing  full  information  must  be  received  befori 
February  15,  1975. 

The  Executive  Director  and 
Secretary  of  the  Order 
4200  Dorchester  Blvd.  West 
IVIontreal  H3Z  1V4,  Que. 


46     THE  CANADIAN  NURSE 


JANUARY   1' 


p  (Orgunisalion  mondiale  de  la  Sante.  Cahiers  de 
le  Publique  no.  51 ) 

Slatfing:  a  journal  of  nursing  administrmian 
ler.  Selected  by  Mary  Ellen  Warstler.  Wakefield. 
,>  .  Conlemporary  publishing:  for  American 
sc-.'  Association.  \914.  51p. 

Slate-iipproveil  schools  of  nursing  — 
..v.//,. '-'..v..  meeting  minimum  requirements  set 
on-  und  hoard  rules  in  the  various  jurisdictions. 
New  Yoik.  National  League  for  Nursing.  Di- 
on of  Research.  1974.  120p. 

State-approved  schools  of  nursing  —  R..\'.: 
ling  minimum  requirements  set  hy  law  and  hoard 
s  in  the  various  jurisdictions.  New  York.  Na- 
al  League  for  Nursing.  Division  of  Research. 
4    1.^6p. 

Teaching  the  mentally  handicapped  child,  edited 
Ralph  Hyall  and  Norma  Rolnick.  New  York, 
lavioral  Publications.  cl974.  337p. 

Tcle-clinique  Montreal -Lyon.  Bilan  de  la  prc- 
re  teleconference  medicale  par  satellite  entic  la 
nee  et  le  Quebec.  14  juin  1973.  Quebec,  P.Q.. 
versiie  du  Quebec.  Vice-Presidence  aux  Com- 
licalions.  1973.   185p. 

Three  orfourday  work  week.  Edited  by  S.M.A. 
need  and  G.S.  Paul.  Edmonton.  Faculty  of  Busi- 
s  Administration.  University  of  Alberta.  cl974. 
:>. 

Wrigley' s  hotel  directory:  official  directory  of 
el  .Association  of  Caiuida.  1974.  Vancouver, 
iglev  Directories  Ltd.  for  Hotel  Association  of 
lad.i.  1974.  339p.  R 

flPHLETS 
Memorandum  to  the  federal  law  reform  commis- 
I  in  respect  to:  Working  paper  no.  I .  the  family 
ri.  Ottawa.  Vanier  Institute  of  the  Family,  1974. 

Nursing  skills  and  techniques.  A  series  of  126 
jle  concept  silent  film  loops  (Super  8mm  tech- 
nlor  motion  pictures;  catalogue)  Englewood 
ffs.  N.J..  Prentice-Hall.  1970.  28p. 

Proposals  for  prison  reform,  by  Norval  Morris 
James  Jacobs.  New  York.  Public  Affairs 
iimiitee,  cl974.  28p.  (Public  Affairs  Pamphlet 
510). 

Wonum's  changing  place:  a  look  at  se.xism.  by 


* 
^ 


LOVi  «//«// 


V 


On 
fAce 


NOW  IIAIMM  :   I 

liitd  iigl\  siipcrnuoiis  hair  .  .  .  was 
unloved  .  .  .  discoiiragcii.  I  ricii  main 
liiings  .  .  .  even  razors.  Nothing  was 
salistaclory  .  Then  I  developed  a  sim- 
ple, painless,  inexpensive,  noneleetrie 
method.  It  has  helped  thousands  win 
heautv.  love,  happiness.  M\  I  RKI- 
book.  ■What  I  Did  Aboul  .Supcr- 
lliious  Hair"  explains  method.  Mailed 
in  plain  envelope.  Also  Trial  Otter. 
Wrile  Mme  Annette  Lanzelte.  P.O. 
Box  610.  Dept.  C-504  Adelaide  St. 
P.O..  Toronto  210.  Ont. 


Nancy  Doyle.  New  York.  Public  .Affairs  Commit- 
tee 1974.  28p.  (P"blic  Affairs  Pamphlet  no.  509). 

GOVERNMENT  DOCUMENTS 

35.  Commission  de  reforme  de  droit.  Documents 
prelimiiuiire  preparee  par  la  section  lie  recherche  sur 
la  procedure  penale.  OltavKa.  1973.   I  v. 

36.  Health  and  Welfare  Canada  Pilot  survev  of  hos- 
pital therapeutic  ahortiim  committees.  British 
Columbia.  1971-1972.  Ottawa.  Informalion 
Canada.  1974,  44pp. 

37.  Quad  review  2:  a  publication  of  the  drug  quality 
assessment  program,  hy  the  Health  Protection 
Branch.  Dept.  of  Natioiud  Health  and  Welfare. 
Ottawa.  Information  Caiuida.  1974.  240p. 

38.  Report  on  the  operation  of  agreements  with  the 
provinces  under  the  hospital  insurance  uiul  diagnos- 
tic services  act  for  the  fiscal  sear  ended  March  i  I . 
\97i.  Ottawa.  67p. 

39.  Information  Canada.  Photos  Canada.  Ottawa, 
c  1 965- 1974.  4v. 

40.  Travail  Canada.  Direction  des  Recherehes  sur  la 
Legislation.  Les  normes  du  travail  Canada.  1973. 
Ottawa.  1974.   I04p. 

41 .  Northwest  Territories.  Laws  and  Statutes.  Ordi- 
nances 1973.  3rd  session.  Ottawa.  Information 
Canada.  1974.  37p. 

Ontario 

42.  Ministry  of  Health.  Directory  of  nursing  per- 
soniu'l  in  charge  of  official  public  health  nursing 
services  in  Ontario:  listed  according  to  counties  and 
districts.  1974.  Toronto.  1974.  4p.  R 

43.  Ministry  of  Labour.  Women's  Bureau.  Lou  uhJ 


the  W(mian  in  Ontario.  1974.    foronio.   19p. 

United  States 

44.  US,  Division  ol  Nursing. ,-1  refresher  lourse  for 
registered  nurse:  a  gidde  for  instructors  and  stu- 
dcms.  Bethesda.  Md,.   1974, 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLECTION 

45.  Index  of  Canadian  nursing  studies  compiled  hy 
CNA  library.  .August  1974.  Oiiaua.  Can.idian 
Nurses'  .\ssocialion.  1974.  2pts   in  I.  R 

46.  L' influence  du  salaire  sur  la  satisfaction 
generale  au  travail  des  infirmieres  I  Milieu  hos 
pitalier    quehecois).    pur    Jacque^    SaiiU-Ciermain, 

Montreal.  1974,  238p,R 

47.  Stiitlies  in  nursing:  reports  submiited  in  partial 
fulfillment  of  the  requirements  for  the  degree  of  mas- 
ter of  science  in  nursing.  1974.  .New  Haven.  Conn.. 
Yale  University.  School  of  Nursing.  1974.  1  Kip,  R 

48.  A  study  of  the  neeih  for  continuing  education  for 
nurses  in  the  tricounty  area  ofl\sse.<:.  Kent  and  l.amh- 
ton.  by  Margaret  Wilson  and  .Anna  Gupta,  Windsor. 
Ont..  School  of  Nursing.  University  of  V\indsor. 
1974.  2.sp,  R 

AUDIO-VISUAL  AIDS 

49    Sonomed.  serie  2.  no.  2.   Cole  .\.  Diabete  el 

grossesse.  par  Dr.  Pierre  Guimond.  Cote  B.  Car- 

diopathie  el  grossesse.  par  Dr.  Jacques  Desrosiers. 

Montreal.   Association   des   Medecins   de   Langue 

franyaise  du  Canada,  1974.  I  cassette. 

50.  Principau-x   objeclifs   du  programme   medics. 

Quebec.  Minisiere  des  Affaires  sociales.  Direction 

de  la  recherche,  1973.  l9diaposilives.35mni.coul. 


JOHN  ABBOTT  COLLEGE  (CEGEP) 

Ste  Anne  de  Bellevue 

(Suburban  Montreal) 

THREE-YEAR  NURSING  PROGRAMME 

requires 

ADDITIONAL  TEACHING  STAFF 
for  September,  1975. 

Applicants  should  possess  an  R.N.  or  eligibility  for  licensure  in  Quebec,  a  Bachelor's  Degree 
in  nursing  and  a  minimum  of  two  years  general  nursing  experience. 

John  Abbott  College  is  a  community  college  serving  the  West  Island  of  Montreal. 
It  offers  a  park-like  setting,  close  to  the  city,  on  campus  sports,  recreation,  and  the 
possibility  of  residence  close  to  the  campus. 

Teaching  salaries  according  to  Quebec  teacher's  scale,  excellent  fringe  benefits, 
group  insurance,  pension  plan,  health  benefits,  and  two  months  paid  vacation. 

Address  application  and  completed  curriculum  vitae  to: 

DIRECTOR  OF  PERSONNEL 

JOHN  ABBOTT  COLLEGE 

P.O.  BOX  2000 

STE  ANNE  DE  BELLEVUE,  QUEBEC 

H9X  3L9 


THE  CANADIAN  NURSE     47 


classified  advertisements 


ALBERTA 


BRITISH  COLUMBIA 


NEW  BRUNSWICK 


REGISTERED  NURSES  required  tor  30  bed  Accredited  Gen- 
eral Hospital  Apply  to  Adminislraior,  Our  Lady  of  the  Rosary 
Hospital,  P  O  Box  329,  Castor.  Alberta.  TOC  0X0 


REGISTERED  NURSES  required  toi  70  bed  accredited  active 
ireatment  Hospital  Full  time  and  summer  relief  All  AARN  per- 
sonnel policies.  Apply  in  writing  to  the  Director  of  Nursing, 
Drumheller  General  Hospital  Drumheller.  Alberta 


2  R.N.'s  wanted  tor  immediate  employment  at  the  Two  Hills 
Municipal  Hospital.  Two  Hills,  Alberta  We  follow  salary 
schedule  as  set  forth  by  the  AARN  Must  be  willing  to  stay  at  this 
location  a  minimum  of  one  year  Apply  to  Administrator.  Two 
Hills  Municipal  Hospital,  Two  Hills.  Alberta 


GENERAL  DUTY  NURSES  required  for  50-bed  hospital  m  cen- 
tral Alberta,  half  way  between  Calgary  and  Edmonton  on  main 
highway  Salanes  and  personnoi  policies  as  set  by  AARN 
agreement  Residence  accommodation  available  Contact.  Mrs 
E  Harvie  R  N  Administrator  Lacombe  General  Hospital. 
Lacombe,  Alberta,  TOC  ISO 


REGISTERED  and  GRADUATE  NURSES  and  an  O.R. 
NURSE  required  for  new  4l-bed  acute  care  hospital,  200  miles 
north  of  Vancouver,  60  miles  from  Kamloops.  Limited  furnished 
accommodation  available.  Apply  Director  of  Nursing,  Ashcrofi  & 
District  General  Hospital.  Ashcrofi,  British  Columbia 


Applications  are  invited  for  a  very  interesting  and  challenging 
new  position  We  require  a  B.C.  REGISTERED  NURSE  to  assist 
the  Nurse  Admmislraior  to  be  classified  at  a  Head  Nurse 
Preference  will  be  given  one  with  prior  Emergency  or  Obstetric 
Nursing  experience  and  having  successfully  completed  the 
Nursing  Unit  Administration  course  The  hospital  is  a  newly 
opened  one  situated  on  the  Yellowhead  Highway,  80  miles  north 
of  Kamloops,  E  C  The  area  is  a  vacationers  paradise  both  in 
Summer  and  Winter  RNABC  salary  scale  and  fringe  benefits 
applicable  Please  reply  to.  Mix.  K.  Rice.  Nurse  Administrator, 
Dr.  Helmcken  Memonal  Hospital.  Clearwater,  Bntish  Columbia. 


REGISTERED  NURSES  and  LICENCED  PRACTICAL 
NURSES  for  27  bed  hospital.  Salary  and  personnel  policies  m 
accordance  with  RNABC  Accommodations  available  in  resi- 
dence Apply  to  Director  of  Nursing,  Queen  Charlotte  Islands 
General  Hospital  Queen  Charlotte  City  British  Columbia,  VOT 
ISO 


THREE  FACULTY  MEMBERS  needed  July  1.  1975,  to  rep 
faculty  members  going  on  one-year  sabbatical  and  iwo- 
study  leaves  Preparation  and  experience  desirable  in  mate 
infant  and  m  medical-surgical  nursing.  Increasing  enroimen 
permit  retention  of  nght  persons  at  end  of  these  periods  Ei 
we  have  to  offer  are  an  exciting  new  curnculum  approachJ 
well-equipped  self-instruclional  laboratory,  a  new  hospid 
the  advantages  of  living  in  a  beautiful,  small  city  Addresslf 
Faculty  of  Nursing,  The  University  of  New  Brunswick.  Fn 
Ion,  New  Brunswick 


Is  E) 

i 


t 


NOVA  SCOTIA 


REGISTERED  NURSES  and  PSYCHIATRIC  NURSES.  Ger 

Staff  positions  available  in  this  modern.  270-bed  psychiatric 
pital.  located  m  the  Annapolis  Valley  Orientation  and  insef' 
provided  Excellent  personnel  policies  Salary  according  tost 
For  further  information  direct  inquiries  to:  The  Director  of  Nun 
Kings  County  Hospital.  Waterville.  Nova  Scotia 


BRITISH  COLUMBIA 


OPERATING  ROOM  NURSES  required  Dy  a  SBO-bed  active 
teaching  hospital  Applicants  v^ith  experience  and  or  post 
graduate  course  preferred  Salaries  and  benefits  as  per  RNABC 
contract  Apply  to  Assistant  Director  of  Nursing  Service.  St 
Paul  s  Hospital  1081  Burrard  Street,  Vancouver  British  Colum- 
bia V6Z  1Y6 


EXPERIENCED  NURSES  (eligible  for  B  C  registration)  required 
tor  dOQ-bed  acute  care  teaching  hospital  located  in  Fraser 
Valley,  20  minutes  by  freeway  from  Vancouver,  and  within 
easy  access  of  varied  recreational  facilities  Excellent  Onenta- 
Iion  and  Continuing  Education  programmes  Salary  S850  00  to 
S1020  00  Clinical  areas  include:  Ivledicine,  General  and  Spe- 
cialized Surgery  Obstetrics  Pediatrics  Coronary  Care,  Hemo- 
dialysis. Rehabilitation.  Operating  Room.  Intensive  Care  Emer- 
gency PRACTICAL  NURSES  (eligible  lor  B.C.  Licensel  also 
reqi/ireo  Apply  to  Nursing  Recruitment.  Personnel  Department. 
Royal  Columbian  Hospital  New  Westminster  Bnlish  Columbia 
V3L  3W7 


ONTARIO 


DIRECTOR  OF  NURSING  required  by  expanding  accrea 
300-bed  Chronic  Illness  and  Convalescent  Hospital,  f 
Northwest  Metropolitan  Toronto  Please  reply  in  conf; 
Director  of  Nurses.  The  Toronto  Hospital    Weston 
IVI9N  3M6 


ADVERTISING 
RATES 

FOR   ALL 

CLASSIFIED    ADVERTISING 

$15.00   for   6   lines   or   less 
$2.50  for  each  odditiorxil   !ii>e 

Rates    for    display 
advertisements    on    request 

Closing  dale  for  copy  ond  cancellation  is 
6  weeks  prior  to  1st  day  of  publicotion 
month 

The  Canodion  Nurses'  Association  does 
not  review  the  personnel  policies  of 
the  hospitals  and  agencies  advertising 
in  the  Journo!.  For  authentic  information, 
prospective  opplicants  should  apply  to 
the  Registered  Nurses'  Association  of  the 
Province  in  which  they  are  interested 
in    working. 


Address  correspondence  to: 

The 

Canadian  .su 
Nurse 


W 


50  THE  DRIVEWAY 
OTTAWA,  ONTARIO 
K2P  1F2 


GRADUATE  NURSES  for  21-bed  hospital  preferably 
with  obstetiical  expenence  Salary  in  accordance 
with  RNABC  Nurses  residence  Apply  to  fvlatron. 
Totino  General  Hospital.  Totino.  Vancouver  Island, 
British  Columbia 


EXPERIENCED  GENERAL  DUTY  NURSES  AND 
LICENSED  PRACTICAL  NURSES  required  lor  small 
uPcOHSl  hospital  Salary  and  personnel  policies  as 
per  RNABC  contract  Salanes  start  at  S672  00  tor 
Registprea  Nurses.  S57  7  76  lor  Licensed  Practical 
Nurses  Residence  accommodation  S25.00  per  month 
Transportat.„n  paid  from  Vancouver  Apply  to 
Director  of  Nursing  St  George  s  Hospital  Alert  Bay 
British  Cnlumbia 


GENERAL  DUTY  NURSES  AND  LICENSED  PRACTICAL 
NURSES  for  modern  130-bed  accredited  hospital  on  Vancouver 
Island  Resort  area  —  home  of  the  Tyee  Salmon  Four  hours 
travelling  lime  to  city  o(  Vancouver  Collective  agreements  with 
Provincial  Nursing  Association  and  Hospital  Employees  Union. 
Residence  accommodation  available  Please  direct  inquines  to: 
Director  of  Nursing  Services.  Campbell  River  4  Distnct  General 
Hospital.  375  —  2nd  Avenue  Campbell  River.  British  Columbia. 
V9W  3V1 


WANTED:  GENERAL  DUTY  NURSES  for  modern  70- 
bod  hospital.  (48  acute  beds  -  22  Extended  Care) 
located  on  the  Sunshine  Coast.  2  hrs.  from  Vancou- 
ver Salaries  and  Personnel  Policies  in  accordance 
with  RNABC  Agreement.  Accommodation  available 
(female  nu'ses)  in  residence.  Apply  The  Director 
of  Nursing.  St.  Marys  Hospital,  PO  Box  678.  Se- 
chell.  British  Columbia 


GENERAL  DUTY  NURSES  lor  modern  41 -bed  hospital  located 
on  the  Alaska  Highway  Salary  and  personnel  policies  in 
accordance  with  RNABC  Accommodation  available  in  resi- 
dence Apply  Director  ol  Nursing.  Fort  Nelson  General  Hospital, 
Fort  Nelson,  British  Columbia 


NEWFOUNDLAND 


J 


HEAD  NURSE  required  for  the  NewlXDrn  Nursery  and  Neonatal 
Inlensive  Care  Units  Applicants  must  have  clinical  experience 
and'or  poslgraduate  training  in  the  care  uf  high-risk  infants. 
Apply  In  Director  of  Nursing  Service.  St  Clare  s  Mercy  Hospital 
St.  John  s.  Newfoundland  A1C  5B8. 


OPERATING  ROOM  STAFF  NURSE  required  lor  fully  accri 
ted  75-bed  Hospital.  Basic  wage  $689  00  with  consideration 
experience:  also  an  OPERATING  ROOM  TECHNICIAN,  bi 

wage  $526  (X)  Call  time  rates  available  on  request  Write 
phone  the  Director  of  Nursing.  Dryden  District  General  Hospi 
Dryden.  Ontario 


REGISTERED    NURSES    for    34-bed    General    Hosp 
Salary  $850.00  per  month  to  $1,020.00  plus  experience 
lowance      Excellent     personnel     policies.     Apply 
Director    of    Nursing,     Englehart    &    District    Hosp 
Inc.,  Englehart,  Onlano.  f^J  IHO. 


REGISTERED  NURSES  required  lor  107-bed  accredited  Ge 
rat  Hospital  Basic  salary  comparable  to  other  Ontario  h 
with  remuneration  lor  past  experience    Yearly  mere 
progressive  hospital  amidst  the  lakes  and  streams  of  N' 
tern   Ontario    Apply   to    Director   of   Nursing.    LaVeiencj 
Hospital    Fort  Frances,  Ontario,  P9A  2B7. 


REGISTERED  NURSES  required  for  our  ultramodern  7^ 

General  Hospital  in  bilingual  community  of  Northern  (" 
French  language  an  asset,  but  not  compulsory  Salary  is^ 
to  $1030  monthly  with  allowance  for  past  experience  j 
weeks  vacation  alter  l  year  Hospital  pays  lOO'o  of  U.J. 
Life  Insurance  (1 0.OOO).  Salary  Insurance  (75°^  of  wages  ^ 
age  of  65  with  U  I  C  carve-out),  a  35(t  drug  plan  and  a  ( 
care  plan.  Master  rotation  in  effect  Rooming  accommo ' 
available  in  town  Excellent  personnel  policies  Applij 
Personnel  Director.  Notre-Dame  Hospital,  PO  Box 
Hearst,  Ontario. 


REGISTERED  NURSES  AND  REGISTERED  NURSll 
ASSISTANTS  lor  45-bed  Hospital  Salary  ranc 
include  generous  experience  allowances  R  ^ 
salary  $915  to  $1  085  and  R  N  A.  s  salary  $650.  to  $7 
Nurses  residence  -  private  rooms  with  bath  —  $60  per  mor 
Apply  to  The  Director  of  Nursing,  Geraldton  District  Hospii 
Geraldlon,  Ontario,  POT  1M0 


48     THE  CANADIAN  NURSE 


REGISTERED  NURSES  FOR  GENERAL  DUTY 
C.C.U.  UNIT  and  OPERATING  ROOM  requi 
fully  accredited  hospital  Starting  salary  $850 
regular  increments  and  with  allowance  tor 
ence  Excellent  personnel  policies  and  le' 
residence  accommodation  available.  Apply 
Director  ol  Nursinq.  Kirkland  &  District  H 
Kirkland  Lake.  Cnlano.  P2N  1 R2 


I.e. 

red 
00    1 
evor 


JANUARY 


I 

id 


QUEBEC 


UNITED  STATES 


UNITED  STATES 


TERED  NURSE  required  for  co  ed  children  s  summer 

he  Laurenlians  (seventy  miles  north  of  MonlresI)  from 

.^  .0    1975  10  AUGUST  20,  1975   Call  (514)  688  1753  or 

CAMP  MAROMAC,  4548    8th  Street.  Chomedey,  Laval. 

Ibec.  H7W2A4 


SASKATCHEWAN 


ilSTERED  NURSES  urgently  needed  for  active  47-bed 
iiern  hospital  Especially  interesting  to  those  who  like  variety 
iemergency  care  in  nursing  Apply  to.  Director  of  Nursing,  St 
Iph's  Hospital,  He  ^  La  Crosse   Saskatchewan,  SOI^  1C0. 


UNITED  STATES 


ERANT  PUBLIC  HEALTH  NURSE  POSITIONS  —  Open  in 
>ral  areas  of  Alaska  Reguire  travel  to  group  of  villages  to 
ide  primary  health  care  services  Accredited  public  health 
ing  preparation  required;  preference  given  to  public  health 
iing.  outpost  nursing,  or  nurse  practitioner  experience.  High 
jries;  liberal  fringe  benefits  Contact:  Edna  Crawford,  Chief, 
5ing  Section,  Div.  of  Public  Health.  Pouch  H-06E.  Juneau, 
;ka,  USA,  99811, 


-  Openings  now  available  m  a  vanety  of  areas  of  a  458 
Iteaching  and  research  hospital  affiliated  with  the  school  of 
Jicine  of  Case  Western  Reserve  University  New  facility 
lung  in  the  spring.  Personalized  orientation  excellent  salary, 
iDaid  benefits  and  housing  available  m  hospital  residence 
■assist  you  with  H  1  visa  for  immigration  A  license  in  Ohio  to 
Itice  nursing  is  necessary  for  employment  For  further 
imation  write  or  phone:  Mrs  Mary  Hernck,  Personnel 
artment,  Saint  Luke  s  Hospital,  1 131 1  Shaker  Blvd.,  Cleve- 
:)hio.  44104.  Phone:  Monday  -  Friday.  9  A.M.  -  4  P.M.. 
I  6  368-7440. 


and  LPN's  —University  Hospital  North,  a 
;hing  Hospital  of  the  University  of  Oregon  Medical 
ooi,   has  openings   in   a  variety   of   Hospital    ser- 

We  offer  competitive  salaries  and  excellent 
ge  benefits  Inquires  should  be  directed  to  Gale 
utrecior  of  Nursing.  3171  S  W  Sam  Jackson 
k  Road.  Portland.  Oregon,  97201 , 


SISTERED  NURSES:  Excellent  opportunities  in  a  large 
anding  &  progressive  hospital  Located  in  the  heart  of 
(ofnia  near  the  finest  educational  and  recreational  activities 
re  the  climate  is  mild  the  year  round  Good  starting  salaries 
liberal  employee  benefits.  Write;  Personnel  Dept..  Sutter 
pitals,  282C   L   St.,  Sacramento,  California  95816 


■RATING  ROOM  NURSE  EDUCATORS  —  positions  im- 
Balely  available  with  Project  HOPE  m  Tunisia  Duties  include 
ihing  and  supervision  of  practical  experience  of  Tunisian 
iterparts  Requirements  two  years  OR,  exp  ,  formal  or 
'mai  teaching  exp  ,  French  lang  ability.  18  mo.  commitment, 
tact:  Protect  HOPE,  2233  Wisconsin  Ave  ,  N.W.,  Washing- 
D.C- 20007(202)  338-61 10 


^MNSH^WE 
#^C01LEGE 

LONDON,  ONTARIO 

tnvites  applications  for  the  position  of 

NURSE  TEACHER 

Location:  School  o(  Nursing,  Victoria  Campus.  London, 

Ontario, 
Duties:  To  teach  in  the  3  year  Diplonia  Nursing  Program, 
Qualifications   B  Sc  N,  and  at  least  two  years  nursing 

experience 

Please  submit  applications  to: 

The  Personnel  Officer, 

Fanshawe  College, 

P.O.  Box  4005, 

Terminal  C, 

London,  Ontario.  NSW  5H1, 


TEXAS  iwants  you!  if  you  are  an  RN.  experienced  or 
a  recent  graduate  come  to  Corpus  Chnsti  Sparkling 
City  by  the  Sea  ,  a  city  building  for  a  better 
future  where  your  opportunities  for  recreation  and 
studies  are  limitless  Memorial  Medical  Center  500- 
bed,  general,  teaching  hospital  encourages  career 
advancement  and  provides  in-service  orientation 
Salary  from  4682  00  10  S940  00  per  month,  com 
mensurate  with  education  and  experience  Differential 
for  evening  shifts  available  Benefits  include  holi- 
days,  sick  leave,  vacations  paid  hospitalization 
health,  life  insurance,  pension  program  Become  a 
vital  part  of  a  modern  up-to-date  hospital  write  or 
call  collect  John  W  Gover,  Jr  Director  of  Per 
sonnet  Ivlemorial  Medical  Center,  PO  Box  5280 
Corpus  Christi,  Texas.  78405. 


VOLUNTEER  WORK  OVERSEAS  —  Specialists  in  the  areas  of 
NURSING.  PUBLIC  HEALTH.  NUTRITION.  I^AMILY  PLAN- 
NING. MIDWIFERY,   MEDICAL  TECHNOLOGY  and  RURAL 

HEALTH  needed  for  two-year  assignments  on  multi-national 
teams  m  Bangladesh,  Papua  New  Guinea.  Yemen  and 
Ecuador  Single  preferred  Modest  salary,  living  allowances  and 
transportation  provided.  Send  resume  to.  International  Volun- 
tary Services,  Inc,  1555  Connecticut  Avenue,  North  West, 
Washington.  D  C.  20036.  U,  S,  A, 


FREE  SERVICE  BY  AUTHORIZED  HOSPITAL  REPRESEN- 
TATIVE FOR  QUALIFIED  H.N.'s  WANTING  USA.  OR  CANA- 
DIAN NURSING  POSITIONS.  VISA.  TRAVEL  AND  ACCOM- 
MODATION ASSISTANCE  ALSO  CONTACT:  PHILCAN  PER- 
SONNEL. THE  MEDICAL  PLACEMENT  SPECIALIST,  5022 
VICTORIA  DRIVE,  VANCOUVER,  B  C  ,  CANADA,  V5P  3T8, 
TEL  .  (604)  327-9631,  TELEX   0455333, 


Get  what  you've 

always  wanted 

from  nursing 


Like,  for  a  change,  working  the  way  you  want  to 


Medox  cant  make  you  a  better  nurse 

Only  you  can  do  that. 

But  we  can  help  you  see  to  it  you're 
working  under  the  kind  of  conditions 
that  allow  i^ou  to  make  the  most  of 
your  talents  and  experience 

With  Medox,  you  get  a  flexibility 
that  lets  you  direct  your  own  career. 

For  instance,  did  you  know  that 
Medox  can  help  you  find  a  permanent 
nursing  position''  That's  right 

It's  part  of  the  service  Or  you  can 
work  at  teiTiporary  assignments  on  a 
permanent  basis  Another  interesting 
possibility. 


Or  you  can  pick  and  choose  from  a 
wide  range  of  temporary  positions  in 
just  about  any  nursing  field  to 
broaden  your  professional  experience. 
Permanent.  Permanent/temporary. 
Temporary.  With  Medox.  it's  up  to  you. 

And,  since  it's  up  to  you.  better 
come  to  Medox. 


Word  of  our  "Travel  Canada  and  U.S.  A" 
program  is  getting  around  Enquire  how  you 
can  participate,  write  MEDOX  Travelling 
Nurse  Co-Ordinator,  Plaza  37,  4  Place  Ville 
Marie.  Montreal,  Quebec. 


r 


MedoX 


a  DRAKE  INTERNATIONAL  company 

CANADA  •  USA  •  UK  •  AUSTRALIA 


NUARY   1975 


THE  CANADIAN  NURSE     49 


NURSING 
FELLOWSHIP 

(Two  (2)  Years  -  Minimum 
S6,000.00  per  annum) 

To  study  at  Master's  level 
in  a  clinical  nursing  speci- 
ality in  respiratory  disease 
at  a  recognized  University. 
Application  process  to  the 
University  must  have  been 
started    by    February    1st. 
1975. 
For  further  information  and  appli- 
cation  form  please   write,   before 
February  1st,  1975,  to: 
The  Nursing  Consultant, 
Canadian  Tuberculosis  and 
Respiratory  Disease  Association, 
345  O'Connor  Street, 
Ottawa,  Ontario,  K2P  1V9 


GENERAL  DUTY  NURSES 

Required  immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit. 

Clinical  areas  include:  msdicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R.N.A.B.C.  contract: 

SALARY:  $850  —  $1 020  per  month 
(1974  rates) 
SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


GENERAL  DUTY  NURSES 

MEDICINE 

PAEDIATRICS 

CHRONIC  &  REHABILITATION 

REQUIREMENTS: 

Current  Ontario  Registration  as  a  Regis- 
tered Nurse. 

Inquiries  may  be  d/rected  to: 

Mrs.  J.  Stewart 
Director  of  Nursing 
Oshawa  General  Hospital 
24  Alma  Street 
OSHAWA,  Ontario 
L1G2B9 


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  hospital  is 
presently  expanding  from  126  beds 
to  400  and  is  fully  accredited. 
Nursing  is  a  profession  we  respect 
and  we  were  the  first  to  plan  and 
develop  a  unique  nursing  audit 
system.  There  are  opportunities  for 
gaining  wide  experience,  for  get- 
ting to  know  patients  as  well  as 
staff.  R.N.  salaries  range  from 
S850.  to  $1020.  per  month.  Credit 
allowed  for  relevant  previous  hospi- 
tal experience. 


Situated  in  Richmond  Hill,  all 
the  cultural  and  entertainment  faci- 
lities 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  Personnel. 


YORK 
CENTRAL 
HOSPITAL 


RICHMOND  HILL. 
O   N    T   A    R    I   O 

L4C  4Z3 


DIRECTOR 
OF  NURSING 


A  Director  ot  Nursing  is  needed  as  the  incunibent  Direcl 
ot  Nursing  is  retiring  in  1975  Will  have  the  supervisic 
direction  control  and  overall  planning  responsibilities  I 
realizing  the  hospital  s  patient  care  objectives  This  r€ 
ponsibilily  includes  a  237-bed  active  treatment  hospit 
as  well  as  facilitating  the  integration  of  100  chron 
rehabilitation  beds  and  230  nursing  home  beds  A  ma] 
renovation  and  expansion  program  of  all  facilities  n 
been  granted  approval 

Education  should  include  (raining  at  the  Masters  levi 
but  a  Bachelor  of  Nursing  Science  degree  in  a  person  wi 
progressive  leadership  qualities  will  be  considered  Pr 
fessional  nursing  experience  is  also  required.  Salary 
negotiable. 

The  hospital  places  considerable  emphasis  on  contmi 
ing  education  programs  for  all  staff,  and  has  estabiishc 
relationships  with  many  community  agencies  to  proviC 
specialized  types  of  services  on  a  contractual  basis. 

Medicine  Hat  is  the  energy  capital  of  the  West,  ai 
offers  excellent  swimming,  skiing,  twating,  etc..  on  i 
doorstep  A  Communtty  College  and  other  education 
and  cultural  facilities  abound  in  the  community 


Repty  In  confidence,  giving  full  details,  re 
garding  education,  experience,  job  related  ac 
complishments  and  references  to: 


Executive  Director 

Medicine  Hat  General  Hospital 

5th  Street  SW 

Medicine  Hat,  Alberta 

T1A4H6 


GENERAL  DUTY 
REGISTERED  NURSES 

CERTIFIED  NURSING  AIDES 


Required  for  a  135-bed  active  treatmen 
Hospital  located  in  a  modem  city  of  som^ 
6500  people,  just  forty  miles  south  of  Ed 
monton  and  with  easy  access  to  lake  am 
mountain  resort  areas  such  as  Banff  am 
Jasper. 

Salaries  presently  under  negotiations.  E) 
cellent  personnel  policies  and  fringe  b« 
nefits  available. 


Kindly  apply  to: 

Director  of  Nursing 
Wetasklwin  General  Hospital 
5505  -  50  Avenue 
WETASKIWIN,  Alberta 
T9A  0T4 


50     THE  CANADIAN  NURSE 


JANUARY    1? 


tOBOKTO 


Ag 

place  tD 

work«««a 

fun  place 

to  live* 


Many  girls  will  tell  you  Toronto 
IS  a  fun  place  to  live.  But  have 
you  heard  about  the  new 
Northwestern  General  Hospital? 

We'll  soon  be  opening  a  new 
1  20-bed  facility  designed  to 
the  Friesen  concept. 

Besides  ideal  nursing 
conditions,  the  benefits  we 
provide  are  what  you  would 
expect  fronn  a  progressive 
expanding  hospital. 

We  have  openings  for  RN's  in 
all  areas  and  are  particularly 
interested  in  applicants  for  our 
intensive  care  units. 

Our  Director  of  Nursing 
will  gladly  give  you  all  the 
information  you  want  to  know. 
About  our  hospital  and  even 
about  our  city. 


NORTHWESTERN  GENERAL  HOSPITAL 
2175  Keele  St.  Toronto.  Ont 


Public  Service      Fonction  publique 
Canada  Canada 


THIS  COMPETITION  IS  OPEN  TO  BOTH  MEN  AND  WOMEN 

NURSING  OPPORTUNITIES  IN  THE  NORTH 
Starting  salary  up  to  $9,488 

(UNDER  REVIEW) 
(Plus  Northern  Allowance) 

HEALTH  AND  WELFARE  CANADA 
Medical  Services 

Various  locations  in  the  Yukon  and  N.W.T. 

An  opportunity  to  see  parts  of  Canada  few  Canadians  ever  see  and  to  utilize  all  your  nursing 
skills.  Nurses  are  required  to  provide  healtfi  care  to  the  inhabitants  located  in  some  settlements 
well  north  of  the  Arctic  Circle.  Radio  telephone  communication  is  available.  Join  the  Northern 
Health  Service  of  the  Department  of  Health  and  Welfare  Canada  and  discover  what  northern 
nursing  is  all  about. 

Candidates  must  be  registered  or  eligible  for  registration  as  a  nurse  in  a  province  of  Canada, 
be  mature  and  self-reliant.  For  some  positions,  mid-wifery.  obstetrics,  pediatrics  or  Public 
Health  training  and  experience  is  essential.  Proficiency  in  the  English  language  is  essential. 
Salary  commensurate  with  expenence  and  education. 

Transportation  to  and  from  employment  area  will  t)e  provided;  meals  and  accommodation  at 
a  nominal  rate. 

HOW  TO  APPLY: 

Fonward  "Application  for  Employment"  (Form  PSC  367-4110)  available  at  Post  Offices. 
Canada  Manpower  Centres  or  offices  of  the  Public  Service  Commission  of  Canada  to  the: 

DEPARTMENT  OF  HEALTH  AND  WELFARE  CANADA 

MEDICAL  SERVICES  —  NORTHWEST  TERRITORIES  REGION 

1401  BAKER  CENTRE  —  10025  -  106  STREET  EDMONTON,  ALBERTA  T5J  1H2 

Please  quote  competition  number  74-E-4  in  all  correspondence. 

Appointments  as  a  result  of  this  competition  are  subject  to  the  provisions  of  the  Public 

Service  Employment  Act. 


Nursing  Education  Positions 

Division  of  Continuing  Education 

University  of  Victoria 

Applications  are  invited  for  tvuo  Nursing  positions  associated  with  a  new  six  month 
program  entitled  "Post  Basic  Course  in  Psychiatric  Nursing  for  Registered  Nurses" 
beginning  In   1975  —  exact  date  is  to  be  announced. 

1.  Psychiatric  Instructor  —  Coordinator  -  9  month  appointment 
Major  duties  include: 

a.  orientation  to  the  sponsoring  educational  Institution  and  the  clinical  facilities  to  be 
used  for  student  experience. 

b.  planning  of  courses,  learning  objectives,  and  student  evaluation  techniques. 

c.  development  of  appropriate  clinical  learning  experiences. 

d.  participation  in  student  selection. 

e.  Implementation  of  the  course. 

f.  completion  of  necessary  reports  and  records.  Including  follow-up  svaluation. 

2.  Psychiatric  Clinical  Instructor  -  Half-time  -  7  month  appointment 
Major  duties  include: 

a.  orientation  to  the  program  and  to  the  clinical  facilities  to  tDe  used  for  student  experience. 

b.  helping  develop  appropriate  learning  experiences  with  cooperating  clinical  facility. 

c.  assisting  with  course  planning  and  Implementation,  as  required. 

Nursing   Instructors  must  be  eligible  for   registration   in   B.C.        Positions  -  available 
immediately        Salary  -  competitive 
Direct  applications  with  complete  resume  to: 

Mrs.  F.B.  Collins,  Program  Officer 

Division  of  Continuing  Education 

University  of  Victoria 

P.O.  Box  1700,  Victoria,  B.C.   V8W  2Y2 


THE  CANADIAN  NURSE     51 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from 

REGISTERED  NURSES 

54-bed  accredited  general  tiospi- 
tal.  Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to: 

MISS  E.  LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  ICO 


PUBLIC 
HEALTH 
NURSES 


Required    for   the    Sudbury    and 
District  Health  Unit. 

Apply  to: 

The  Director  of  Nursing 
Sudbury  and  District  Health  Unit 
1300  Paris  Crescent 
Sudbury,  Ontario 
P3E  3A3 


ST.  MICHAEL'S  HOSPITAL 

Toronto,  Ontario 

invites  applications  from 

REGISTERED  NURSES 

for 

INTENSIVE    CARE 
and  "STEP-DOWN"  UNITS 


Planned  orientation  and  in-service  programme  will  ena- 
ble you  to  collaborate  in  the  most  advanced  of  treatment 
reg^nens  for  the  post-operative  cardio-vascular  and 
other  acutely  ill  patients.  One  year  of  nursing  experience 
a  requirement. 


for  details  apply  to: 

The  Director  of  Nursing, 
St.  Mictiael's  Hospital, 
Toronto,  Ontario, 
M5B1W8. 


NORTH  NEWFOUNDLAND  &  LABRADOR 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

International  Grenfell  Association  provides 
medical  services  for  Northern  Newfoundland 
and  Labrador.  We  staff  four  hospitals,  eleven 
nursing  stations,  eleven  Public  Health  units. 
Our  main  180-bed  accredited  hospital  is 
situated  at  St.  Anthony.  Nevi/foundland.  Active 
treatment  is  carried  on  m  Surgery.  Medicine. 
Paediatrics.  Obstetrics,  Psychiatry.  Also. 
Intensive  Care  Unit.  Orientation  and  In-Service 
programs.  40-hour  week,  rotating  shifts.  Living 
accomodations  supplied  at  low  cost.  PtJBLIC 
HEALTH  h.is  challenge  of  large  remote  ireas 
Excellent  personnel  benefits  include  liberal 
vacation  and  sick  leave.  Salary  based  on 
Government  scales. 

Apply  to: 

INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services, 
St.  Anthony,  Newfoundland. 


CHALLENGING  POSITION 

FOR  A 

CREATIVE  PERSON 


Educational  Co-ordinator  to  be  responsible  fc 
inservice  education  and  program  developmen' 
Ttiis  is  a  new  senior  position  within  the  nursin' 
division  of  an  agency  covering  a  rural  and  urba 
population  of  neariy  300,000.  Applicants  shouli 
have  a  minimum  of  five  years  nursing  experience 
—  Bachelor's  degree  considered,  Master's  da 
gree  preferred.  Salary  competitive. 

Apply  to 

(Mrs.)  Dorottiy  M.  Mumby,  B.Sc.N.,  M,A. 
Director  of  Public  Health  Nursing 
lUiddlesex-London  District  Health  Unit 
346  South  Street,  London,  Ontario 
N6B  1B9 


UNIVERSITY  HOSPITAL 

SASKATOON 

SASKATCHEWAN 

Positions  are  available  for 

REGISTERED  NURSES 

for    the    Psychiatric    v^rard,    also    othei 
specialized  and  general  areas. 


Apply  to: 


Employment  Officer,  Nursing 
University  Hospital 
SASKATOON,  Saskatchewan 
S7N  0W8 


REGISTERED  NURSES 


Registered  Nurses  required  for  large 
metropolitan  general  hospital. 
Positions  available  in  all  clinical  areas. 
Salary  Range  in  effect  until  December 
31,  1974- 

$665.00  —  $830.00.  Starting  rate  de- 
pendent on  qualifications  and  experi- 
ence. 


Apply  to: 


Staffing  Officer-Nursing 
Personnel  Department 
Edmonton  General  Hospital 
Edmonton,  Alberta 
T5K  0L4 


52     THE  CANADIAN  NURSE 


REGISTERED  NURSES 

Required 

For  fully  accredited  recently  expanded  200-bed 
hospital,  situated  on  beautiful 

LAKE  OF  THE  WOODS 

starting  salary  $850,  increasing  to  S915  January 

1,  1975and$945Aphl  1,1975. 

Allowance  given  for  past  hospital  experience. 

Shift  differential  and  annual  increments. 

Vacancies  in  medical,  obstetrics  and  progressive 

coronary  care  units. 

37V2-hourweel<. 

Excellent  personnel  policies. 

Apply  in  writing  to: 

Mrs.  B.G.  Schottroff 

Director  of  Nursing 

l^l<e  of  the  Woods  District  Hospital 

Kenora,  Ontario 


WEST  COAST  GENERAL  HOSPITAL 
PORTALBERNI,  BRITISH  COLUMBIA 


requires  the  following  qualified  Nursing  Person- 
nel: 


OPERATING  ROOM  SUPERVISOR 
INTENSIVE  CARE  UNIT  NURSE 
OPERATING  ROOM  NURSE 


Personnel  policies  as  per  RNABC  Contract 
This  is  a  139  Acute,  30  Extended  Care  Fully 
Accredited  Hospital  on  Vancouver  Island.  Excel- 
lent recreational  facilities  and  within  easy  reach  of 
Vancouver  and  Victoria. 


Apply. 


Director  of  Nursing 
West  Coast  General  Hospital 
814  -  8th  Avenue  North 
Port  Alberni,  B.C.,  V9Y  481 


JANUARY    19 


Whatls  a  bis  company 
like  Upjolm  doing 
in  nursing  services? 

( Simple.  We're  in  it  to  help  you  and  here's  how.) 

If  you're  a  Nursing  Supervisor  we  can  complement  your  staff 
when  shortages  occur  by  providing  competent  R.N.'s, 
R.N.A./C.N.A./  L.P.N.'s  or  Nurse  Aides. 

If  you're  a  nurse  interested  in  working  part-time  to  supple- 
ment your  family's  income,  we  offer  you  the  opportunity  to 
select  hours  and  assignments  convenient  to  your  schedule, 
not  ours. 

If  you're  a  Discharge  Planning  Officer  or  Home  Care  Co- 
ordinator, we  are  a  reliable  source  for  home  health  care 
with  whom  you  can  trust  your  outgoing  patients. 

If  you're  an  inactive  nurse  temporarily  out  of  touch  with 
nursing,  we  can  offer  patient  care  opportunities  which  will 
enable  you  to  re-enter  your  profession. 


We  think  that  it  is  important  for  you.  the  Registered 

Nurse,  to  understand  why  The  Upjohn  Company's 

subsidiary.  Health  Care  Services  Upjohn  Limited, 

has  become, involved  in  nursing.  Our  concept  of 

part-time  nursing  services  has  proven  to  be  an 

important  adjunct  to  the  delivery  of  health  care. 

Our  interest  is  in  assisting  the  Medical  and  Nursing 

Professions  by  providing  additional  qualified 

R.N.'s,  R.N.A./C.N.A./L.P.N.'s  and  Home 


Health  Care  Personnel  to  serve  the  commu- 
nity. If  you  would  like  more  information  about 
the  work  that  we  are  doing  across  the  country 
and  how  we  can  help  you,  contact  the  Health 
Care  Services  Upjohn  office  nearest  you. 
Ask  for  the  Service  Director.  She  is  an  R.N.. 
and  you'll  both  be  speaking  the  same  lan- 
guage. Look  for  us  in  the  white  pages  and  in 
the  yellow  pages  under  "Nurses  Registries." 


HEALTH  CARE  SERVICES  UPJOHN  LIMITED 


With  16  offices  to  serve  you  across  Canada 


ictoria 

388-6639 

Winnipeg 

943-7466      St.  Catharines 

688-5214 

Montreal 

288-4214 

ancouver 

731-5826 

Windsor 

258-8812     Toronto  East 

445-5262 

Trois  Rivieres 

379-4355 

dmonton 

423-2221 

London 

673-1880     Toronto  West 

239-7707 

Quebec  City 

687-3434 

algar> 

264-4140 

Hamilton 

525-8504     Ottawa 

238-4805 

Halifax 

425-335 1 

(Operating  in  Ontario  as  HCS  Upjohn) 

NUARY   1975 

THE  CANADIAN  NURSE 

53 


McMASTER  UNIVERSITY 
SCHOOL  OF  NURSING 


Co-ordinator,  Basic  Sciences  Program 

(not  necessarily  a  nurse)  required  as  soon 
as  possible  for  a  School  of  Nursing,  witfiin  a 
Faculty  of  Health  Sciences.  The  School  is 
an  integral  pan  of  a  newly  developed  Health 
Sciences  Centre  where  collaborative  rela- 
tionships are  fostered  among  the  various 
health  professions. 

Requirements:  Ph.D.  or  equivalent,  includ- 
ing a  broad  understanding  of  bionnedical 
sciences,  experience  in  teaching  (including 
small  group  tutorials,  use  of  instructional 
media).  Coordination  and  leadership  of 
biomedical  faculty  resources,  supervision 
of  technicians  and  demonstrators,  contribu- 
tion to  curriculum  development. 


Application,  with  a  copy  of  curriculum  vitae 
and  two  references  to: 


Dr.  D.J.  Kergin,  Associate  Dean  (Nursing) 

Faculty  of  Health  Sciences, 

McMaster  University, 

Health  Sciences  Centre, 

1200  Main  Street  West, 

HAMILTON,  Ontario. 

L8S  4J9 


COLLEGE  OF 
NEW  CALEDONIA 

A  comprehensive  regional  College  in 
Prince  George,  British  Columbia,  re- 
quires 

NURSING 
FACULTY 

Positions  available  as  of  April,  1 975  to 
help  develop  a  new  two  year  R.N.  Dip- 
loma Program,  This  program  will  begin 
in  September  1 975.  Applicants  should 
be  prepared  to  teach  basic  nursing 
concepts  and  skills  at  the  diploma 
level. 
We  offer: 

Excellent  fringe  benefits 

Relocation  allowances 

Excellent  salary  commensurate 

with  qualifications 
Qualifications: 

Masters  or  Baccalaureate 

Degree  in  Nursing. 

Experience  in  Bedside  Nursing. 
Applicants  should  submit  a  curriculum  vltae 
and  names  of  three  references  to: 

Dr.  F.J.  Speckeen,  Principal 
College  of  New  Caledonia 
2001  Central  Street 
Prince  George,  B.C. 
V2N  1P8 


DIRECTOR 
OF  NURSING 


The  Darmouth  General  Hospital  and  Com- 
munity Health  Centre,  Dartmouth,  Nova 
Scotia  is  scheduled  for  opening  in  the 
spring  of  1 976.  and  requires  a  Director  of 
Nursing  immediately. 

The  hospital  will  open  in  phase  1 .  with  1 1 4 
beds  and  a  large  ambulatory  care  facility. 

The  candidate  should  possess  training  at 
the  baccalaureate  level  with  registration,  or 
eligibility  for  registration  in  Nova  Scotia. 

The  candidate  should  possess  a  minimum 
of  five  years  administrative  experience  at  a 
senior  level,  in  an  active  treatment  hospital. 

This  position  offers  a  great  challenge  to  the 
candidate  seeking  an  opportunity  to  be  a 
member  of  a  team  developing  an  innovative 
approach  to  patient  care. 

A  curriculum  vitae  along  with  required  sal- 
ary should  be  submitted,  in  confidence,  to: 

THE  ADMINISTRATOR 
DARTMOUTH  GENERAL  HOSPITAL 
AND  COMMUNITY  HEALTH  CENTRE 
P.O,  BOX  1016 
DARTMOUTH 
NOVA  SCOTIA 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  IVIed- 
ical  or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound    in   our  clinics  and 

their  numbers  increase  daily  in  our 

Emergency. 

If   you   do   not   like   working  with 

children    and   with   their   families, 

you  would  not  like  it  here. 

If,  you  do  like  children  and  their 
families,  we  would  like  you  on  ouf 
staff. 

Interested  qualified  applicants 
should  apply  to  the: 

DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tapper  Street 
Montreal  108,  Quebec 


OKANAGAN  COLLEGE 

Kelowna,  British  Columbia 

POSITION: 

Coordinator  of  Nursing  Education 
DUTIES: 

To  plan,  organize  and  develop  a  two  year  Registered  Nursing  program.  The  first 
class  is  tentatively  scheduled  to  begin  training  in  September,  1976.  Duties  tc 
commence  as  soon  as  possible. 
QUALIFICATIONS  DESIRED: 
M.Sc.N.  or  equivalent.  Experience  in  several  nursing  fields;  curriculum  planning 
training  and/or  experience:  supervisory  experience.  Capable  of  developing  anc 
maintaining  good  relationships  with  students,  staff,  cooperating  hospitals  and  othei 
agencies. 

SALARY  AND  WORKING  CONDITIONS: 

in  accordance  with  academic  faculty  scales  and  agreements. 
OKANAGAN  COLLEGE 

is  a  multi-discipline  institution  offering  technical,  vocational  and  academic  programs 
in  several  centres  throughout  the  Okanagan  area  of  British  Columbia.  The  R.N 
program  will  be  located  at  the  Kelowna  Centre  of  the  College:  close  liaison  with  othe* 
College  Centres  will  be  required. 

APPLICATIONS: 

The  Principal, 

Okanagan  College,  1000  K.L.O.  Road, 

Kelowna,  B.C.  V1Y  4X8 

CLOSING  DATE: 

15  February,  1975 


54     THE  CANADIAN  NURSE 


JANUARY    1 


DIRECTOR 
OF  NURSING 


lequired  effective  March  1 . 1 975.  This  pos- 
ion  carries  responsibility  for  the  coordina- 
on  of  all  facets  of  nursing  services  within  a 
'5bed  accredited  hospital.  Preference 
liven  to  applicants  with  University  prepara- 
on  in  Nursing  Administration  or  successful 
upervisory  and  nursing  administration  ex- 
lerience. 


pply  in  writing,  stating  experience,  qualifica- 
ons.  references  and  date  available  to: 


Administrator 
St.  Therese  Hospital 
St.  Paul.  Alberta 
TOA  3A0 


Refresher  Course  (in  French) 
TB?  .  .  .  TODAY? 

and 

RESPIRATORY  DISEASES 

March  8- 14,  1975 
Chateau  du  Lac  Beauport,  Quebec 

Joint  proiect  of  CTRDA  &  QUEBEC  CHRISTMAS 
SEAL  SOCIETY.  Uval  University 


'/ease  contact; 


Mrs.  Femande  Hamel 
Library  Pavilion 

Room  2417 
l^val  University 
Ste-Foy,  Quebec 


QUEEN'S  UNIVERSITY 
SCHOOL  OF  NURSING 

Faculty  Openings 

July  1975  for  Lecturers.  Assistant  or  Asso- 
ciate Professors  for  basic  undergraduate 
programme  In  nursing  of  adults,  maternity 
nursing  and  community  health.  Master's 
degree  in  clinical  nursing  and  successful 
experience  required.  Preference  given  to 
preparation  as  a  family  nurse  practitioner. 
Salary  commensurate  with  preparation. 


i^pply  to: 


Dean,  School  of  Nursing 
Queen's  University 
Kingston,  Ontario 
K7L  3N6 


.j,'^- 


n 


Some  nurses  are  just  nurses. 
Our  nurses  are  also 
Commissioned  Officers. 


iMLifses  are  very  special  people  in  the  Canadian  Forces 

Thev  earn  an  Officer  s  salary  enpy  an  Officers  privileges 
and  live  in  Officers'  Quarters  (or  m  civilian  accommodation  it  ttiey 
prefer)  on  Canadian  Forces  bases  all  over  Canada  and  in  many 
other  parts  of  the  world 

If  they  decide  to  specialize,  they  can  apply  tor  postgraduate 
training  with  no  loss  of  pay  or  privileges  Promotion  is  based  on 
ability  as  well  as  length  of  service  And  they  become  eligible  for 
retirement  benefits  (including  a  lifetime  pension)  at  a  much  earlier 
age  than  in  civilian  life 

If  you  were  a  nurse  in  the  Canadian  Forces,  y.  j  would  be 
a  special  person  doing  an  especially  responsible,  rewarding  and 
worthwhile  job 

For  full  information,  write  the  Director  of  Recuiting  and  Seiec- 
tion.  National  Defence  Headquarters.  Ottawa.  Ontario  KIA  0K2 


Get  involved  with  the 
Canadian  Armed  Forces. 


"MEETING  TODAY'S  CHALLENGE  IN  NURSING" 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGIII  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 

Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


THE  CANADIAN  NURSE     55 


WE  CARE 


M 


4>? 


D^ 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 
Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 
Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


UNIVERSITY  OF  BRITISH  COLUMBIA 
SCHOOL  OF  NURSING 


Rapidly  growing,  well  funded  School  requires  a  senior 
faculty  member  to  fill  the  newly  established  position  of 


ASSISTANT  DIRECTOR 


Functions  will  be  to  assist  in  the  over  all  operation  and 
development  of  the  School  and  the  Faculty. 

A  doctoral  degree  desirable.  Masters  degree,  and  suc- 
cessful experience  in  administration  and  nursing  education 
are  essential. 


APPLY  TO: 

DR.  MURIEL  UPRICHARD 
PROFESSOR  AND  DIRECTOR 
SCHOOL  OF  NURSING 
UNIVERSITY  OF  BRITISH  COLUMBIA 
VANCOUVER,  B.C. 
V6T  1W5 

Call  collect  604-228-2595. 


UNIVERSITY  OF  BRITISH  COLUMBIA 
SCHOOL  OF  NURSING 

Requires 

ASSOCIATE 

or 

FULL  PROFESSOR 


To  take  complete  charge  of  a  large  and  successful  pro- 
gramme of  Continuing  Education  in  Nursing. 

Candidates  must  be  nurses  with  at  least  a  Master's  degree 
and  successful  experience  in  the  direction  of  continuing 
education  essential. 

Generous  salary  and  fringe  benefits. 

Apply  to: 

Muriel  Uprichard,  Ph.D. 

Director 

School  of  Nursing 

University  of  British  Columbia 

2075  Wesbrook  Place 

Vancouver,  B.C. 

V6T  1W5 


SCHOOL  OF  NURSING 
UNIVERSITY  OF  BRITISH  COLUMBIA 

Vancouver,  B.C. 


Rapidly  growing,  well  funded  school  requires  FACULTY  at 
all  levels  from  Instructor  1  to  Full  f^rofessor  for  Bac- 
calaureate and  Masters  programmes.  Applications  are  in- 
vited from  male  or  female  nurse  specialists  in  all  clinical 
fields  but  especially: 

CHILD  AND  MATERNAL  HEALTH 
NURSING  SERVICE  ADMINISTRATION 
NURSING  CONSULTATION 
CONTINUING  EDUCATION 
COMMUNITY  HEALTH  NURSING 

Master's  degree  and  successful  nursing  experience  essen- 
tial, Doctoral  degree  desirable. 
Salaries  and  fringe  benefits  excellent. 


Apply  to: 


MURIEL  UPRICHARD,  PH.D. 
PROFESSOR  AND  DIRECTOR 
SCHOOL  OF  NURSING 
UNIVERSITY  OF  BRITISH  COLUMBIA 
VANCOUVER,  B.C. 
V6T  1W5 


56     THE  CANADIAN  NURSE 


JANUARY   1' 


THE  SCARBOROUGH 
GENERAL  HOSPITAL 

invites  applications  from: 
Registered  Nurses  and  Registered  Nursing  Assis- 
tants  to   worl<    in   our   650-bed    active   treatment 
hospital  and  new  Chronic  Care  Unit. 

;e  oiler  opportunities  in  Medical,  Surgical.  Paedialnc   and  Obstetrical  nursing 
ur  specialties  include  a  Burns  and  Plastic  Unit.  Coronary  Care.  Intensive  Care  and 
eurosurgery  Units  and  an  active  Emergency  Department. 

Obstetrical  Department  —  participation  in  "Family  centered"  teaching 

program. 

Paediatric  Department  —  participation  in  Play  Therapy  Program. 

Orientation  and  on-going  stafi  education. 

Progressive  personnel  policies. 
tie  tiospital  is  located  in  Eastern  Metropolitan  Toronto. 
or  further  information,  write  to: 

The  Director  of  Nursing, 
SCARBOROUGH  GENERAL  HOSPITAL 
1050  Lawrence  Avenue,  East,  Scarborough,  Ontario 


ORTHORAEDIC    tc    ARTHRITIC 
HOSR|-rAU 

43  WELLESLEY  STREET,  EAST 

TORONTO,  ONTARIO 

M4Y1H1 

Enlarging   Specialty   Hospital   offers   a   unique 
opportunity  to  nurses  and  nursing  assistants 
interested  in  the  care  of  patients  with  bone  and 
joint  disorders. 
Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  all 
units 

Clinical  specialists  for  Operating  Room,  Intensive 
Care,  Patient  Care  and  Education. 


Serve  Canada's 
native  people 


in 

awell 
equipped 
hospital. 


i« 


Hearth  and  Welfare       Sante  et  Bien-etre  social 
Canada  Canada 


Medical  Services  Branch 

Department  of  National  Health  and  Welfare 

Ottawa,  Ontario   K1 A  0K9 


Please  send  me  information  on  hospital 
nursing  witti  this  service. 


Name: 

Address: 

City: 


Prov: 


NUARY     1975 


THE  CANADIAN  NURSE     57 


HEALTH 

SCIENCES  CENTRE 

INTENSIVE  CARE  NURSING 

■Myocardial  infarction 


(Arrhythmias 
I  Renal  Failure 
[Respiratory  Failure 


%Pacemakers 
■Trauma 
■  Shock 


24  BED  INTENSIVE  CARE  UNIT 

in  a 

1 ,400  BED  UNIVERSITY-AFFILIATED  HOSPITAL 

OFFERS 

A  12  MONTH  CLINICAL  COURSE 

IN  INTENSIVE  CARE  NURSING  FOR  ALL 

REGISTERED  NURSES  ON  STAFF  IN  THE 

INTENSIVE  CARE  UNIT 

Opportunities  To  Learn  — 

—  Nursing  care  of  critically  ill 

—  Resuscitative  measures 

—  Use  of  monitoring  and  other  advanced  equipment 

—  Multidisciplinary  approach 

Through  — 

—  Four  weeks  of  planned  orientation 

—  Supervised  clinical  experience 

—  Continuing  In-service  program 

—  Series  of  comprehensive  lectures 

—  Concentrated  study  and  hard  work 

For  further  information  write  to: 

Course  Co-ordinator 
Intensive  Care  Nursing 
Health  Sciences  Centre  GH601 
700  William  Avenue 
Winnipeg,  Manitoba,  R3E  0Z3 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 
invites  applications  from  general  duty  nurses 


Opportunities  for  Professional  development  m 
general  and  specialty  areas  of  Medical  and  Sur- 
gical Nursing.  Paediatrics,  Obstetrics.  Psychiatry. 
Operating  Room.  Renal  Dialysis  Unit,  and  Extend- 
ed Care. 

Planned  Orientation  Program. 
In-service  Education  Program. 

Salary  commensurate  with  education  and  expe- 
rience. 

For  further  information  write  to: 

EMPLOYMENT  SUPERVISOR  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
84  Avenue  &  11 2  Street 
Edmonton,  Alberta 


CARIBOO 
COLLEGE 

KAMLOOPS 

BRITISH 
COLUMBIA 


requires 


Nursing  Instructors 

Qualifications: 

1)    An  M.A,  degree  is  preferred  but  consideration  will  be  given  to  persons^ 
with  a  Baccalaureate  degree 

a)  Service  and  teaching  expenence  in  Psychiatry 

b)  Service  and  teaching  experience  in  Medical-  Surgical  Nursing 

c)  Eligibility  for  registration  m  British  Columbia. 

Duties:  (to  commence  April  1 ,  1975) 

1 )  Classroom  teaching 

2)  Clinical  teaching  and  supervision 

3)  Participation  in  curriculum  planning,  and  other  faculty  activities 

Mail  applications  together  with  curriculum  vitae  and  letters  of 
reference  to:  The  Principal,  Cariboo  College,  Box  860, 
Kamloops,  British  Columbia,  V2C  5N3. 


i8     THE  CANADIAN  NURSE 


JANUARY    1' 


REGISTERED  NURSE 

have  opportunities  here  for  an  expen- 
ded registered  nurse.  Our  nursing 
taries  are  established  through  agree- 
int  with  the  A.A.R.N. 


have  a  very  active  230-bed  hospital  in 
Intra!  Alberta,  If  you  are  interested  in 
j)re  information  regarding  Red  Deer  and 
h    Red    Deer    Health    Care    Complex, 

sase  write  or  call: 

Personnel  Director 
Red  Deer  General  Hospital 
Red  Deer.  Alberta 
Tel.:  (403)  346-3321 


REGISTERED  NURSE 

CRITICAL  CARE  PROGRAM 

le  St  Michael  s  Hospital  Campus  of  the  George 
own  College  s  Nursing  Division  announces  the 
'enng  of  an  indepth  program  utilizing  an  holis- 
approach  lo  the  care  of  the  crilically-ill  patient. 
Ivanced  theory  is  closely  correlated  with  ad- 
nced  clinical  practice 

le  program  —  5  months  in  duration  —  is  offered 
ice  annually,  in  February  and  August. 
ie  years  recent  nursing  practice  and  current 
gistration  as  a  nurse  is  mandatory  Enrolment 
lited 

r  further  Information,  contact: 
The  Registrar 

St.  Michael's  Hospital  Campus 
The  George  Brown  College 
P.O.  Box  1015,  Station   B' 
Toronto.  M5T  2T9 
Phone:  (416)-967-1212-local  269 


The  Brome-Missisquoi-Perkins 
Hospital 

requires 

1  Day  Supervisor 
1  Night  Supervisor 
Registered  Nurses 


write  to: 

Director  of  Nursing 
Brome-Uissisquol-Perklns  Hospital 
950  Main  Street 
Cowansville,  Quebec 
J2K1K3 


A^^^"^^/ 


'^n/^m^^' 


Quebec's  Health  Services  are  progressive! 


So  is  nursing 


at 


The  Montreal  General  Hospital 

a  teaching  hospital  of  McGill  University 


Come  and  nurse  in  exciting  Montreal 


r~ 

M^. 

^^H  BJ^*                                 The  Montreal  General  Hospital 
^^ACHit*^'                                               1^50  Cedar  Avenue,  Montreal,  Quebec      H3G  1A4 

Please  tell   me  about  hospital   nursing   under  Quebec's   new   concept  of   Social   and 

Preventive  Medicine. 

Name 

Address 

Quebec  language  requirements  do  not  apply  to  Conadian  appliconts. 

1 

<V\R\     1975 


THE  CANADIAN  NURSE     59 


BRANDON  GENERAL  HOSPITAL 
SCHOOL  OF  NURSING 

NURSE  TEACHER 

FOR 

TWO  YEAR  DIPLOMA  PROGRAM 

POSITION  AVAILABLE  FEBRUARY  1,  1975 
IN 

OBSTETRICAL  NURSING 

QUALIFICATIONS: 

Baccalaureate  Degree  in  Nursing  is  required.  Preference  given  to 
applicants  with  experience  in  Nursing  and  Teaching. 

Apply  in  writing  stating  qualifications,  experience,  references  to: 

PERSONNEL  DIRECTOR, 
Brandon  General  Hospital, 
150  McTavish  Avenue  East, 
Brandon,  Manitoba, 
R7A  2B3. 


NURSE  CLINICIAN 

(Clinical  Nurse  Specialist) 

for  the  area  of  medical-surgical  nursing  is  required  at: 

TRAIL  REGIONAL  HOSPITAL 

an  active  238  bed  referral  hospital  located  in  the  heart  of  the  West 
Kootenay  skiing  country.  This  is  an  area  noted  for  the  accessibility 
of  all  forms  of  outdoor  activity. 

JOB  SUMMARY 

A  non-supervisory  position  with  direct  responsibility  to  the  Director 

of  Nursing. 

The  successful  applicant  will  work  closely  with  the  Charge  Nurses 

to 

•  Assist  staff  in  determining  priorities  of  care 

•  Develop  therapeutic  nurse-patient  interaction 

•  Co-ordinate  nursing  inservice  programmes 

•  Orientate  new  nursing  personnel 

This  is  a  day-duty  position  with  weekends  off.  however,  some 
flexibility  in  hours  of  work  is  anticipated. 

QUALIFICATIONS 

•  Clinical  expertise  and  teaching  skills 

•  Ability  to  develop  interpersonal  relationships 

•  Preparation  at  University  level  preferred 

•  Registrability  in  B.C.  is  required 

SALARY:  {commencing  January  1975)  $1350.00  per  month 
Apply  In  writing  to: 

DIRECTOR  OF  NURSING 
Trail  Reqional  Hospital 
TRAIL,  B.C.  —  V1R4M1 


HEALTH 

SCIENCES 

CENTRE 

WINNIPEG, 
MANITOBA 


THIS  1345  BED  COMPLEX  WITH  AMBULATORY  CARE  CLINICS.  AFFILIATE: 
WITH  THE  UNIVERSITY  OF  MANITOBA.  CENTRALLY  LOCATED  IN  A  LARGE 
CULTURALLY  ALIVE   COSMOPOLITAN   CITY. 

INVITES  APPLICATIONS  FROM 

REGISTERED  NURSES  SEEKING  PROFESSIONAl 
GROWTH,  OPPORTUNITY  FOR  INNOVATION,  AND  JOE 
SATISFACTION. 

ORIENTATION  -  Extensive  two  week  program  at  full  salary 
ON-GOING  EDUCATION    Provided  tfirough 

—  active  in-service  programmes  in  all  patient  care  areas 

—  opportunity  to  attend  conferences,  institutes,  meetings  of  professional 
association 

—  post  basic  courses  in  selected  clinical  specialties 
PROGRESSIVE  PERSONNEL  POLICIES 

—  salary  based  on  experience  and  preparation 

—  paid  vacation  based  on  years  of  service 

—  shift  differential  for  rotating  services 

—  10  statutory  holidays  per  year 

—  insurance,  retirement  and  pension  plans  j 

—  contractundernegotiation  effective  March.  1975  \ 

SPECIALIZED  SERVICE  AREAS  include  orthopedics,  psychiatry,  post 
anaesthetic,  emergency,  intensive  care,  coronary  care,  respiratory  care,  dialysis, 
medicine,  surgery,  obstetrics,  gynaecology,  rehabilitation,  and  paediatrics. 

ENQUIRIES  WELCOME 

FOR  FURTHER  INFORMATION  PLEASE  WRITE  TO: 

PERSONNEL  DEPARTMENT.  NURSING  SECTION 
HEALTH  SCIENCES  CENTRE, 

/OO  WILLIAM  AVENUE,  WINNIPEG.  MANITOBA    R3EOZ3 


60     THE  CANADIAN  NURSE 


JANUARY    1^ 


i"     REGISTERED  NURSES 

are  Invited  to  apply  for  positions  in 

INTENSIVE 
CARE  UNITS 

•  MEDICiNEAND 
GENERAL  SURGERY 

at 

Toronto 
General  Hospital 

University 
Teaching  Hospital 


•  located  in  heart  of  downtown  Toronto 

•  within  walking  distance  of  accommodation 

•  subway  stop  adjacent  to  Hospital 

•  excellent  benefits  and  recreational  facilities 

apply  to  Personnel  Office 

TORONTO  GENERAL  HOSPITAL 

67  COLLEGE  STREET,  TORONTO,  ONTARIO,  M5G  1L7 


NURSING 
INSTRUCTOR 
MENTAL 
HEALTH 

The  DEPARTMENT  OF  HEALTH  AND  SOCIAL  DEVELOP- 
MENT, inter-regional  Operations/Selkirk  Mental  Health 
Centre,  Selkirk.  Manitoba  requires  a  person  to  plan  and 
implement  instructional  courses  within  the  general 
framework  of  programs  offered  by  the  School  of  Nursing. 
Responsible  for:  Carrying  out  a  theoretical  instructional 
program;  clinical  supervision  and  instruction  of  students 
within  a  clinical  or  community  setting;  evaluation  and 
counselling  of  students,  and  the  administering  of  examina- 
tions and  maintenance  of  records.  Incumbent  will  partici- 
pate in  curriculum  development. 

R.N.  and/orR.P.N.  plus  at  least  two  years'  experience  asa 

Nursing  Instructor,  Bachelor  of  Nursing  or  other  additional 

education  plus  experience  preferred. 

SALARY:  $9,336  —  $11,904  per  annum. 

Apply  In  writing,  immediately,  referring  to  No.  1325, 

MANITOBA 

CIVIL  SERVICE  COMMISSION 

ROOM  154,  LEGISLATIVE  BUILDING, 

440  BROADWAY.  WINNIPEG.  MANITOBA  R3C  0V8 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 

teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

1974  Salary  Scale  S850.00  —  $1,020.00  per  month 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 

VANCOUVER  GENERAL  HOSPITAL 

855  WEST  12TH  AVE. 

VANCOUVER,  B.C. 


MUARY     1975 


THE  CANADIAN  NURSE     61 


We  invite  applications  from 

REGISTERED  NURSES 
FOR  GENERAL  DUTY 

in  all  patient  services  areas  including  I.C.U./C.C.Unit.  This  is  an 
opportunity  to  be  on  staff  wfien  we  move  to  this  new  138  bed 
General  Hospital,  which  will  be  early  in  1975. 

Successful  applicants  will  be  paid  prevailing  Ontario  salary  rates  as 
well  as  other  generous  fringe  benefits  and  in  addition  you  will  have 
the  opportunity  to  work  in  a  brand  new  building  with  modern  equip- 
ment and  beautiful  surroundings. 

Apply  in  writing  to 

The  Director  of  Nursing 
Kirldand  and  District  IHospital 
Kirltland  Lal<e,  Ontario 
P2N  1R2 


MJRSES 

for 

OV^RSEi\S 


Experienced  nurses  needed  to  wori<  in  Bangladesh,  Latin 
America,  and  Africa.  Become  involved  in  preventive, 
curative  and  training  health  programmes. 

Two  year  contracts  with  CUSO. 

Transportation  costs  paid. 


Contact: 


CUSO  HEALTH  - 
151  Slater  Street 
Ottawa  KIP  5H5 


13 


POST  GRADUATE 
COURSES 


The  following  courses  in  this  modern  1 200  bed  teach- 
ing hospital  will  be  of  interest  to  registered  nurses 
who  seek  advancement,  specialization  and  profes- 
sional growth. 


•  Cardiovascular-Intensive  Care  Nursing.  This 
is  a  22  week  clinical  course  with  classes 
commencing  in  February  and  September. 

•  Operating  Room  Technique  and  Manage- 
ment. This  24  week  clinical  course  commences 
in  March  and  September. 


For  further  Information  and  details,  contact: 

Recruitment  Officer  -  Nursing 
University  of  Alberta  Hospital 
Edmonton,  Alberta  T6G  2B7 


MEMORIAL  UNIVERSITY 

OF  NEWFOUNDLAND 

SCHOOL  OF  NURSING 


is  expanding  its  B.N.  program,  extra  mural  courses  an( 
continuing  educational  program.  Positions  are  availabk 
August  1,  1975  for  faculty  wtio  are  expert  in  teaching,  cur 
riculum  development  and  one  of  the  following  areas. 

NURSING  OF  ADULTS 
MATERNAL-CHILD  NURSING 
NURSING  OF  CHILDREN 
MENTAL  HEALTH  NURSING 
COMMUNITY  NURSING 
NURSING  RESEARCH 
CONTINUING  EDUCATION 
CO-ORDINATOR  FOR  POST-R.N. 


B.N.  PROGRAM 


Applicants  should  direct  enquiries  to: 

Miss  lUlargaret  D.  McLean 
Director,  School  of  Nursing 
Memorial  University  of  Nfld. 
St.  John's,  Newfoundland  A1C  5S7 


62     THE  CANADIAN  NURSE 


JANUARY    1 


City  of  Regina 

HOME  OF  THE  1975 
WESTERN  CANADA  SUMMER  GAMES 

REQUIRES 

PUBLIC  HEALTH  NURSES 

i)UTIES:  Carry  out  a  variety  of  duties  relating  to 
generalized  community  health  nursing  program 
/ithin  a  designated  district  of  the  City. 

tUALIFICATIONS:  Must  possess  a  Degree  in 
lursing  with  a  major  in  Public  Health  Nursing  or  a 
;ertificate  in  Public  Health  Nursing.  This  employee 
lust  be  eligible  for  registration  with  the  Saskat- 
hewan  Registered  Nurses'  Association. 

lALARY:  R.N.  with  Certificate  in  Public  Health 
Jursing;  $767.00  to  $940.00  per  month.  R.N.  with 
Degree  in  Nursing;  $821 .00  to  $1,006.00  per  month. 

MOTE:  The  incumbent  in  this  position  must  pos- 
;ess  a  valid  operator's  license  and  a  car  and  will  be 
lompensated  by  a  monthly  car  allowance. 

Applications  and  inquiries  should  be  directed  to 
The  Personnel  Department, 
City  Hall, 
P.O.  Box  1790, 

Regina,  Saskatchewan,  S4P  3C8 
or  Phone  522-1621  extension  248 


City  of  Regina 

HOME  OF  THE  1975 
WESTERN  CANADA  SUMMER  GAMES 

Requires 

ASSISTANT  DIRECTOR  OF 
PUBLIC  HEALTH  NURSES 

DUTIES:  Required  to  assist  the  Director  of  Nurses  in  the 
promotion  of  the  quality  of  Public  Health  nursing  in  the 
community  and  the  development  of  staff.  Assists  in 
planning  and  directing  the  activities  of  nursing  staff  m 
designated  areas.  Orientates  new  staff  and  keeps  them 
informed  of  standards  and  policies  of  the  organization 

QUALIFICATIONS:  A  Baccalaureate  Degree  with  pre 
paration  in  Public  Health  Nursing,  supervision  and  ad 
ministration.  Thorough  knowledge  of  the  pxinciples, 
practices  and  techniques  of  Public  Health  Nursing, 
supervision  and  administration.  Minimum  of  three  (3) 
years  experience  in  Public  Health  Nursing  including  ex 
perience  in  a  Supervisory  Capacity. 

SALARY:  From  $939.00  to  $1,154.00  per  month. 

Applications  and  inquiries  should  be  directed  to 

The  Personnel  Department,  City  Hall, 

P.O.  Box  1790,  Regina,  Saskatchewan,  S4P  3C8 

Or  Phone  522-1621  extension  248 


SCHOOL  OF  NURSING 

DALHOUSIE  UNIVERSITY 


Halifax,  N.S. 

FACULTY  POSITIONS 

A  number  of  positions  will  be  available  in  1975  for  well-qualified  faculty  to  participate  in  a 
progressive  undergraduate  and  graduate  program. 

The  baccalaureate  program  for  basic  and  R.N.  students  is  integrated  around  an  holistic 
developmental  concept  of  human  beings  in  health  and  illness.  A  graduate  program  is 
planned  to  start  in  September,  1975. 

Other  plans  for  the  development  of  the  School  make  Dalhousie  a  challenging  place  for 
faculty  committed  to  the  continual  improvement  of  nursings  contribution  to  health  care, 
and  wanting  opportunity  to  develop  their  own  professional  interests, 
fvlinimum  requirement  —  Masters  degree 
Apply  to: 

Ms.  Muriel  E.  Small 

Acting  Director 

School  of  Nursing 

Dalhousie  University 

Halifax.  N.S. 

B3H  3J5 


MUARY     1975 


THE  CANADIAN  NURSE     faj 


«/ 


^,  -,..;!;;::'  •'{ 


GENERAL  STAFF  NURSES 

required  for 

RECINA  GENERAL  HOSPITAL 

openings  in  all  departnnents 

Salary  -  $775.  -  $900. 

Recognition  Given   For  Experience 
Progressive  Personnel  Policies 

Apply: 

Personnel  Department 
REQINA   GENERAL    HOSPITAL 

Regina,  Saskatchewan 
S4P  0W5 


R.N.'S 


The  Royal  Alexandra  Is  a  friendly  place  to  work;  a  modern 
progressive  1000  bed  teactiing  hospital  in  the  "just-right- 
size"  city  of  Edmonton.  Alberta. 

Fully  accredited,  the  Royal  Alexandra  offers  challenging  ex- 
perience, on-going  in-service  programs,  generous  fringe 
benefits  and  competitive  salaries.  All  previous  experience  is 
recognized.  You  may  skate,  ski  and  curl  inexpensively.  Ed- 
montorMS  within  easy  driving  distance  of  many  lakes  where 
you  may  enjoy  the  sunny  Alberta  summer. 


Vacancies  exist  in  most  areas  including  ICU,  O.R.  &  Psy- 
chiatry. 

Salary  Range  for  General  Duty:  $900.  -  $1075. 


For  Information  plane  writ*  to: 

Director  of  Nursing 
Royal  Alexandra  Hospital 
10240  Kingsway  Ave. 
EDMONTON,  ALBERTA 
T5H  3V9 


Index 

to 

Advertisers 

January  1975 


Abott  Laboratories 2 

Astra  Pharmaceuticals  Canada  Ltd 1 

Canada  Manpower  Centre 13 

Department  of  National  Defence 55 

Health  Care  Services  Upjohn  Limited   53 

Heelbo  Corporation   16 

I  C  N  Canada  Limited 8  &  37 

Lanzette  Products 47 

J.B.  Lippincott  Co.  of  Canada  Ltd 32  &  33 

MedoX  49 


64     THE  CANADIAN  NURSE 


The  C.V.  Mosby  Company,  Ltd 

.  .39,  40,  41,  42 

The  Nurses  Book  Society 

11 

Psychiatric  Nursing   

7 

Posey  Company 

15 

W.B.  Saunders  Company  Canada,  Ltd. 

Cover  IV 

White  Sister  Uniform,  Inc 5, 

Covers  II  &  III 

Advertising  Munugcr 
Gcorgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  1E2  (Ontario) 

A  dvertising  Rcprcsentati ves 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore,  Penna.  19003 

Iclcphonc.  (21,^)  Midwas  9-1497 

GordiMi  Tiffin 

2  Tremont  Crescent 

Don  Mills,  Ontario 

Telephone.  (416)  444-4731 

Member  of  Canadian 
Circulations  Audit  Board  Inc. 

iron 

JANUARY   19 


i    • 


FEB  27  tsn 


DO    HOT 
OUT   OF    LIBRARY 


I 


Nurse 


r-D-nflT»H.     uni.        

10-75-10-74-CN-INV. 

UNIVERSITY  OF  CTTA'.VA 
NURSING  LIBRARY 
OTTAWA,  ONT-. 


February  1975 


WELCOME  SPRING 


in  beautiful  new  WATER  COLORS 


by 


A.      Style  No.  44477 

Sizes  3-15 
Royale  Corded  Tricot 
White,  Blue 
bout  $20.00 


B.     Style  No.  44956 

Sizes  5-15 
Royale  Supreme 
Plain  Tricot  Knit 
White         about  $27.00 
Royale  Corded  Tricot 
Blue  about  $27.00 


C.       Style  No.  44761 

Sizes  12-20 

Royale  Corded  Tricot 

White,  Blue 

About  $26.00 


^ 


IfWHITE 
SISTER 


See    our   new    line    of   Whites    and   Water   Cnlniirs   at    fine    stnre<;    flnrnc;<;    Han? 


Use  of  the  MINI-BOTTLE  drug  delivery 
system  eliminates  several  preparation  steps  and 
some  equipment.  The  MINI-BOTTLE  can  in 
itself  be  the  KEFLIN  I.V.  delivery  system,  or  can 
be  utilized  with  most  I.V.  administration  sets 
presently  in  use. 

The  KEFLIN  MINI-BOTTLE  drug  delivery 
system  is  available  at  no  increase  in  cost  over 


regular  ampoules  of  KEFLIN. 

Your  Lilly  representative  will  be  pleased  to 
supply  you  with  full  details.  Your  inquiry  is 
invited. 

Call  or  write: 


Eli  Lilly  and  Company  (Canada)  Limited, 
P.O.  Box  4037.  Terminal  "A", 
Toronto,  Ontario,  M5W  ILl 


:    PMAC 


■sodium  cephalothin 


SOME  S:  3LE  IN  COLORS        SOME  STYLES  3'  ?  -  12  AAAA-E.  about  23  95  to  29  95      ' 

For  a  complimentary  pair  of  white  shoelaces,  folder  showing  all  the  smart  Clinic  styles,  and  ilst  of  stores  selling  them,  write: 

THE   CLINIC   SHOEMAKERS    •    Dept.  CN  2,  7912  Bonhomme  Ave.   •    St.  Louis,  Mo.  63105 


The 

anadian 
Nurse 


^^7 


\  monthly  journal  for  (he  nurses  of  Canada  published 

n  English  and  French  editions  bv  the  Canadian  Nurses'  Association 


Volume  71,  Number  2 


February  1975 


19   Guidelines  for  Quality  of  Care 

in  Patient  Education    B.K.  Redman 

22    Insulin  Goes  Metric:  A  Time  for  Review  E.  Laugharne 

25    Project  Alternative: 

The  Road  Away  From  Isolation    M.D.  Jones 

28  Critique:  Nursing  Research 
Is  Not  Every  Nurse's  Business J.  Ramsay 

29  The  Author  of  "Nursing  Research  Is 
Not  Every  Nurse's  Business"  Replies  M.  Hayes 

30  The  Nurse  and  the  Grieving  Parent H.  Elfert 

34   Ostomy  Skin  Barriers  for  Decubitus  Ulcers   R.  Greene 


The  views  expressed  in  the  articles  are  those  ot  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

9  News 

36  Names 

38  Books 


43  Research  Abstracts 

44  Dates 

46  Accession  List 

64  Index  to  Advertisers 


Executive  Director:  Helen  K.  Mussallem  • 
Editor:  Virginia  A.  Lindabury  •  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Dorothy  S. 
Starr  •  Production  Assistant:  Mary  Lou 
Downes  •  Circulation  Manager:  Beryl  Dar- 
ling •   Advertising    Manager:    Ceorgina    Clarke 

•  Subscription  Rates:  Canada:  one  year 
$6  00:  two  years.  Sll.OO.  Foreign:  one  year. 
$6.50:  two  years,  $12.00.  Single  copies: 
$1.00  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  registration  number  in  a  pro- 
vincial nurses  association,  where  applicable. 
Not  responsible  tor  journals  lost  in  mail  due 
toerrorsinaddress. 


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,    Ontario,    K2P  1 E2 

®   Canadian  Nurses'  Association  1975. 


SRUARY  1975 


Ed  iorial 


During  the  past  months,  TV  and  ws- 
papers  have  recorded  severe  in- 
stances of  prominent  individuals  ho 
faced  health  threats  with  courage  nd 
forthrightness.  The  wives  of  the  prt  ■!- 
dent  and  vice-president  of  the  Unitei 
States  have  spoken  openly  abou- 
breast  cancer;  Canada's  governor- 
general  has  resumed  his  duties  while 
still  recovering  from  a  cerebral  acci- 
dent; the  prime  minister's  wife  has 
been  frank  about  her  need  for  psychiat- 
ric help.  These  individuals,  and  many 
others  known  personally  to  nurses,  are 
examples  of  courage. 

We  require  the  same  qualities  of 
courage  and  honesty  to  evaluate  per- 
sonal ways  of  living  that  risk  our  pres- 
ent state  of  health,  and  to  take  action  to 
reduce  these  risks.  Fear  of  ill  health  is  a 
gloomy  sort  of  motivation.  How  about 
professional  pride  as  a  motivator? 

Nurses  are  health  teachers.  In  this 
issue,  Barbara  Redman  writes  about 
nursing  care  standards  for  patient  edu- 
cation (page  1 9).  We  know  the  value  of 
the  teacher  as  an  example,  a  role 
model  of  health.  Is  this  the  push  each  of 
us  needs  to  examine  her  life-style  and 
decide  where  it  needs  improvement? 

Disregard  the  superficial  goal  of 
youthfulness  and  beauty:  are  you 
overweight  in  terms  of  good  health? 
Are  you  of  normal  weight  but  flabby 
and  out-of-condition?  Are  you  dead 
tired  every  night?  Do  you  puff  on  the 
second  flight  of  stairs?  Fatigue  and  de- 
pression are  a  cycle;  one  feeds  the 
other.  Exercise  and  weight  control  lead 
iO  an  alternate  cycle:  energy  and  op- 
timism. 

It  takes  guts  to  cut  down  on  eating 
the  sweets,  pizza,  or  cream  sauce  you 
enjoy;  to  stop  smoking  after  years  of 
depending  on  the  comfort  of  nicotine; 
or  —  somehow  —  to  find  time  to  exer- 
cise more.  A  calendar  that  will  help  you 
carry  out  your  decisions  about  a  health- 
ier life-style  has  recently  been  pub- 
lished by  Health  and  Welfare  Canada. 

Sprinkled  through  the  days  and 
months  of  1975  are  reminders  about 
less  smoking,  drinking,  and  eating; 
buckling  up  seat  belts;  swimming  and 
boating  safety;  exercise;  and  house- 
hold accident  prevention. 

Over  5  million  copies  of  the  fold-out, 
poster-type  calendar  were  distributed 
in  the  magazine  supplement  of  Cana- 
dian newspapers  the  last  week-end  of 
1974.  If  you  want  a  free  copy,  write  to: 
Information  Directorate,  Health  and 
Welfare  Canada,  Ottawa,  K1A  0K9. 

Raise  your  consciousness  of  health. 
■You  can  have  easier  breathing,  freer 
movement,  a  trimmer  waist,  and  a 
great  feeling  of  well-being.    —  D.S.S. 

THE  CANADIAN  NURSE     3 


letters    { 


Letters  to  the  editor  are  welcome. 

Only  signed  letters,  which  include  the  writer's  complete  address, 

will  be  considered  for  publication. 

Name  will  be  withheld  at  the  writer's  request. 


Guidance  for  health 

I  was  delighted  to  read  the  article,  "Lum- 
bar Pain  Linked  to  Hypokinesia"  (No- 
vember 1974).  To  me,  it  was  another  en- 
couraging note  in  the  process  of 
consciousness  raising  and  strengthening  of 
the  nurse's  role  as  a  health  promoter.  It 
was  also  practical  guidance  to  the  nurse  to 
move  toward  this  goal,  because  it  encou- 
raged her  to  examine  the  effects  that  her 
work  has  on  her  own  health. 

If  you  as  a  nurse  are  trying  to  strengthen 
your  role  as  a  health  promoter,  tell  others. 
It  is  a  great  coffee  time  topic.  Share  with 
your  peers  the  creative  ways  you  have 
found  to  promote  your  own  health  and  ask 
for  their  ideas.  We  need  to  talk  over  with 
each  other,  not  only  the  physical  effects 
our  work  has  on  our  health,  but  also  the 
psychological  consequences. 

The  public  does  not  allow  the  physical 
educator  to  forget  his  need  to  be  a  role 
model.  Who  would  listen  to  a  fat,  inflexi- 
ble, uncoordinated,  physical  education 
teacher?  People  believe  what  they  see,  so 
we,  too,  must  earn  the  right  to  be  heard. 

There  is  still  hope  for  us  to  solve  some 
of  the  large  problems  facing  us  in  nursing, 
such  as  the  lack  of  job  satisfaction  and  the 
stress  of  modern  hospital  work  with  its 
increasingly  dehumanizing  effects. 

It  is  simplistic  to  think  in  terms  of  one 
solution  to  these  problems.  We  need  to  try 
a  variety  of  approaches.  Emphasizing  the 
nurse's  own  health  will  strengthen  her  role 
as  a  health  promoter  and  should  free  her  to 
move  with  more  conviction  in  both  her 
professional  and  personal  environments  of 
health-related  matters. — Elite  Robson. 
Vancouver,  B.C. 


Nurses  "baby"  patients 

After  reading  the  article:  "Poor  Baby;  the 
nurse  and  feminism"  by  Dorothy  Starr  in 
the  March  1974  issue  oi  The  Canadian 
Nurse ,  I  was  forced  to  make  an  observa- 
tion on  the  attitudes  of  nurses  here  toward 
their  patients.  Most  nurses  in  our  hospital 
"baby"  their  patients,  making  them 
spoiled  and  totally  dependent  on  them  for 
their  physical  and  emotional  needs. 

I  am  thankful  to  Starr  for  pointing  out  a 
mistake  that  we  as  nurses  are  committing 
unconsciously.  I  entirely  agree  with  the 
remedies  she  has  prescribed  to  help  us 
avoid  "poor  babying"  another  person. 

As  a  junior  nursing  student,  I  feel  the 
need  to  improve  the  quality  of  nursing  care 
we  nurses  are  giving  our  patients.  I  re- 
commend that  all  nurses,  student  nurses 
4    THE  CANADIAN  NURSE 


especially,  should  read  the  above- 
mentioned  article,  for  I  believe  they  would 
learn  and  benefit  from  it.  — Areli  R.  de 
Vera,  Philippine  Union  College  School  of 
Nursing,  Manila  Sanitarium  and  Hospi- 
tal, Manila. 


Author  disagrees  with  reviewer 

I  noted  with  interest  the  review  of  my 
book.  Maternity  Nursing,  in  the  Novem- 
ber 1974  issue. 

The  statement  made  by  Genevieve 
Appleby,  that  I  failed  to  discuss  the  con- 
troversy regarding  sodium  intake  during 
pregnancy,  is  incorrect.  Please  refer  to 
page  126  in  my  book,  where  the  subject « 
discussed.  Appleby  should  be  requested  to 
retract  her  statement.  — Constance  Lerch. 
R.N..  B.S.Ed..  Runnemede,  N.J. 


Nurses'  job  satisfaction 

I  feel  compelled  to  respond  to  Ms. 
Dufour's  article  "The  System  Needs  to  be 
Changed!"  (Nov.  1974).  She  appears  to 
perceive  job  satisfaction  in  a  simplistic 
manner.  Her  recommendations  state  "job 
satisfaction  can  result  from  a  change  in  the 
time  periods  of  the  present  shifts  and  from 
an  improvement  in  the  patient  assignment 
and  staff  patterns."  I  do  not  believe  this  is 
the  crux  of  the  problem,  nor  that  these 
changes  will  achieve  job  satisfaction. 

Herzberg's  theory  indicates  that  two  in- 
dependent sets  of  factors  influence  job  sat- 
isfaction and  performance.  The  motiva- 
tional factors  are  related  to  job  satisfac- 
tion. These  are  achievement,  recognition, 
the  work  itself,  responsibility,  and  ad- 
vancement. The  second  set  of  factors  — 
the  maintenance  ones  —  are  company  pol- 
icy and  administration,  supervision,  sal- 
ary, interpersonal  relations,  and  working 
conditions.  Deficiencies  in  these  are  re- 
lated to  dissatisfaction  on  the  job.  How- 
ever, improvement  in  these  latter  areas 
does  not  produce  job  satisfaction;  it  merely 
reduces  some  of  the  dissatisfiers. 

Dufour's  article  focuses  on  mainten- 
ance factors.  Such  improvements  as  she 
outlines  may  reduce  the  dissatisfiers,  but 
will  not,  in  themselves,  produce  job  satis- 
faction. 

A  system  is  a  series  of  interrelated  parts, 
coordinated  to  achieve  a  set  of  goals.  The 
goal  of  the  nursing  department  is  patient 
care.  Nursing  activities  are  the  interrelated 
parts.  The  nurse,  therefore,  is  the  system, 
and  only  when  she  recognizes  this  total 


involvement  and  develops  appropriai 
responsibility  will  there  be  change  or  ir 
provement. 

"The  work  itself"  is  one  of  the  motiv 
tional  factors.  In  nursing,  the  work  itself 
nursing  practice.  Dufour  states,  "Ear 
awakening  of  patients  may  not  be  the  pel 
icy  in  all  institutions,  but  personnel  ! 
many  hospitals  still  feel  the  patient  must  Ij 

tiven  the  opportunity  to  wash  befol 
reakfast."  This,  to  me,  is  a  revealiij 
statement.  Hospitals  rarely  have  polici 
of  this  nature;  this  is  a  practice  or  ritual  thi 
nursing  staff  sustain  and  perpetuate.  It 
one, of  the  many  rituals  nursing  staff  pe' 
form  that  may  have  little  relation  td  t 
patient's  actual  needs.  Progressive  nursiij 
administrators  who  attempt  to  change  sui' 
rituals  rarely  achieve  the  active  suppc 
and  cooperation  of  their  nursing  staff,  i 

I  do  not  believe  job  satisfaction 
occur  for  the  nurse  until  she  learns  to  i    . 
on  the  patient's  actual  nursing  needs  ai 
determines  priorities  accordingly.  Profei 
sional  persons  aim  for  excellence  in  mail 
taining  professional  standards  and  in  pe| 
forming  meaningful  work.  When  the  nur 
functions  as  a  professional  and  critical! 
examines  her  practice,  work  will  becor' 
more  meaningful.  The  resultant  impr 
work,  based  on  activities  determine 
the  patient's  needs,  may  then  provid. 
satisfaction. 

This  type  of  nursing  practice  may  th 
produce  changes  in  patient  assignment  a ; 
scheduling,  and  ultimately  changes  in  t' 
system.  I  do  regret,  however,  that  I  s 
little  evidence  of  such  critical  examinati', 
and  action  taking  place  by  nurses  in  hos]: 
tals.  — D.  Wylie,  Assistant  Executive  L' 
rector.  Patient  Care,  Sunnybrook  Medu 
Centre,  Toronto,  Ont.  ,■ 


RNs  in  doctors'  offices 

I  have  been  following  with  much  int. 
the  letters  to  you  in  recent  issues  conccr, 
ing  the  RN  in  a  doctor's  office.  f 

I  suppose  I  have  not  been  too  obser^ 
before  now.  but  I  was  shocked  to  L 
that  many  "nurses"   in  offices  are  ni 
nurses  at  all,  although  they  give  iniel 
tions,  do  other  nursing  treatments, 
constantly  give  information  and  me^.. 
direction  over  the  telephone.  On  questn' 
ing  others  on  the  subject,  I  have  four 
this  is  frequently  the  case.  i' 

I  did  not  realize,  until  I  started  workiiji 
for  a  general  practitioner,  how  much  n 
nursing  knowledge  would  be  used.  Th 

(Continued  on  page 
FEBRUARY  195 


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(Conliniieil  from  page  4) 

knowledge  is  essential  whert  sorting  out 
the  urgent  from  the  non-urgent,  helping 
the  new  mother  with  a  problem,  explain- 
ing slowly  what  the  doctor  has  just  told 
the  patient,  giving  directions  for  tests  and 
explaining  why  the  test  is  necessary,  and 
handling  emergencies  in  the  office.  The 
list  is  endless. 

We  should  be  working  toward  improv- 
ing these  office  situations.  I  hope  all 
doctors  will  soon  realize  the  value  of  the 
RN  in  the  office.  Perhaps  the  government 


health  departments  should  be  looking  at 
this  as  a  means  of  better  patient  care. 

As  RNs,  we  should  ask  our  associations 
to  help  keep  our  standards  on  a  high  level 
in  this  field.  I  don't  believe  that  untrained 
personnel  doing  nursing  tasks  are  part  of 
this  standard. 

I  would  be  most  interested  in  hearing 

from  anyone  who  has  some  ideas  on  how 

this    matter    could     be     pursued. 

—  Marjorie    E.     Payne,     RN,     1943 

Nicholas  Rd..  R.R.  #3.'  Victoria,  B.C. 


Agrees  with  Quebec  RN 

I  am  writing  in  response  to  the  letter  from 
the  nurse  in  Quebec,  in  which  she  remarks 
on  the  situation  there  that  requires  a  nurse 


t^ 


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great  snow  and  supenor  grooming! 


GUEST  HOUSES . . .  HOTELS . . .  MOTELS :" 
PRIVATE  CHALETS . . .  APARTMENTS . . . 
SKI  DORMS... 


SUTTON 
TOURIST 
INFORMATION 
Mrs.  Lamb 
P.O.  Box  418 
Sutton,  Quebec 
Reservations; 
514/538-2646 
514/538-2537 


1200  accommodations 
within  12  miles 

Package  deals  including  nneals, 
ski  lessons  and  lift  tickets.  Let  us 
know  the  kind  of  accommodation 
you  wish  and  rest  assured  of  our 
full  cooperation  for  a  pleasant 
stay. 


6     THE  CANADIAN  NURSE 


to  belong  to  the  registered  nurses'  assoc 
tion  before  she  can  practice  as  an  RN  (L 
ters,  Nov.  1974,  p.  4). 

I  fully  agree  with  her  remarks  and  fee 
is  high  time  that  nurses  got  together  I 
right  the  deplorable  situation  existini:' 
many  parts  of  Canada,  which  forces 
join  our  professional  association  befi ' 
can  practice  as  registered  nurses. 

Here  in  Nova  Scotia,  we  are  in  the  sai 
boat.  We  must  pay  the  Registered  Nursi 
Association  of  Nova  Scotia  $50  yearly  ji 
to  call  ourselves  RNs.  I  feel  strongly  ih 
after  studying  and  working  for  two,  thrc 
or  even  five  years  as  the  case  may  be.  a 
successfully  passing  the  RN  exams,  ue 
not  owe  anyone  $50  yearly  to  practice 
RNs.  This  situation  works  a  particu 
hardship  on  nurses  moving  from  provin 
to  province,  as  in  the  case  of  a  friend 
mine  who  has  paid  $100  already  this  yt 
just  for  the  right  to  work  as  an  RN  ($50 
Alberta  in  January,  then  another  $50 
Nova  Scotia  in  May). 

When  I  worked  in  Ontario  and  was  re 
istered  for  $5  in  1969  and  1970.  I  enjoy 
every  benefit  that  I  do  in  Nova  Scotia  1 
$50.  If  our  provincial  association  we 
required  to  convince  us  that  thr 
deserve  our  support,  perhaps  the 
would  be  some  incentive  for  them  to  i 
something  for  us. 

The  Canadian  Nurse  would  probably 
a  much  better  magazine  if  it  had  to  car 
paign  for  our  subscriptions,  rather  th; 
enjoy  a  captive  audience  of  nurses  whoi 
not  have  a  choice  about  belonging  to  tht 
associations  and  receiving  the  maga/in 

I  hope  you  will  print  my  letter,  and  th 
any  RNs  in  Nova  Scotia  who  are  interest! 
in  seeing  membership  in  the  RNANS  mat 
voluntary  will  write  to  me.  —  Mar<;(ir 
MacCahe.  R.N..  Bo.x  162.  River  ' 
Nova  Scotia. 


Journal  not  meeting  needs 

We  find  that  The  Canadian  Nurse  is  n< 
meeting  our  needs. 

There  are  a  number  of  good  things  aboi 
The  Canadian  Nurse.  It  is  a  way  of  kee| 
ing  up-to-date  with  new  publications  an 
also  with  any  research  that  is  being  doni 
We  believe  there  should  be  more  articl* 
covering  the  broad  aspects  of  nursing  froi 
the  point  of  view  of  both  education  ar 
practice.  We  would  also  like  to  see  moi 
variety  in  each  issue. 

The  Nursing  Times  from  Britain  has  c 
cellent  nursing  articles.  We  suggest  ih 
The  Canadian  Nurse  seek  more  adve 
tisements  as  a  source  of  increased  income 

If  we  were  not  forced  to  buy  Th 
Canadian  Nurse  through  our  annual  n 
gistration  dues,  we  would  not  subscribe  I 
it  voluntarily.  We  hope  these  commcni 
are  helpful  to  you  in  upgrading  oi 
professional  journal.  —  Walter  Coh 
President,  Yarmouth  Branch.  Registera 
Nurses'  Association  of  Nova  Scotia.  \ 
FEBRUARY  197 


Because  youVe 

*^^yserious 

about your 
profession, 


. . .  you  know  how  important  it  is  to  stay  on  lop  of  advances  in  nursing  care — 
especially  as  nurses  assume  more  and  more  responsibility.  Easier  said  than  done? 
Even  if  your  schedule  hardly  lets  you  pick  up  anv  other  journal  than  the  one  you're 
reading  now,  wed  like  to  suggest  another  that  can  provide  a  better  balance  to  your 
regular  reading. 

The  Nursing  Clinics  of  North  America  combine  the  best  features  of  books  and 

lournals,  making  them  unlike  dn\  other  clinical  periodical: 

•  Each  issue  is  devoted  to  only  one  or  two  central  topics.  Leaders  in  nursing 
practice  and  education  are  selected  as  guest  editors  to  oversee  each  symposium. 

•  All  articles  are  written  expressly  for  the  Nursing  Clinics.  Contributors  are  chosen 
lor  Iheir  expertise  and  acliv  il\  in  the  subject  at  hand. 

•  The  Nursing  Clinics  carry  no  letters,  columns  or  advertising.  We  offer  a  welcome 
change  of  pace  from  other  professional  journals. 

•  Each  issue  is  published  hardbound.  With  ils  symposium  format,  each  volume  is  a 
monograph  that  takes  a  (X'rmanent  place  in  your  nursing  library. 

•  The  Nursing  Clinics  are  published  only  four  times  a  year.  That  way  issues  don't 
pile  up — or  compete  w  ilh  monthly  journals  for  your  attention.  We  keep  you 
informed  of  changes  in  nursing  with  each  change  of  season. 

•  They're  a  trusted  source  of  continuing  education.  Since  their  inception  in  1  966, 
thousands  of  nurses  have  come  to  relv  on  the  Clinics  for  accurate  and  timely 
information.  They  keep  you  as  informed  as  today's  graduate. 

This  year's  issues  will  feature  the  following  symposia: 

March:  Intensive  Care  of  the  Surgical  Patient 

June:  The  Handicapped  Nurse  '  Maternitv  tuning 

September:  Kidney  and  Urologic  Nursing  i  Human  Sexuality 

December:  Operating  Room  Nursing  I 

Communitv  Health  Nursing  in  Canada 
It  takes  more  than  just  texts  and  journals  to  keep  the  serious  nurse  fully  informed. 
Enter  your  subscription  to  the  Nursing  Clinics  for  1  975  and  find  out. 


C\    .'75         ' 

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^   833  0xfordStreel,  Toronto  18,  Ontario  M8Z5T9 

Yes!  Enter  m\  subscription  to  the  Nursing  Clinics  of  North  America  for 
one  year  beginning  with  the  March  1975  issue. 

D  I  enclose  check  for  $15.1 5. 
n  Please  bill  me. 

Name 

Address  


City Prov. Zone  . 


Parnpas 


you  both 
abeak 


CeepvS 
lim  drier 

Instead  of  holding 
moisture.  Pampers 
hydrophobic  top  sheet 
allows  it  to  pass 
through  and  get 
"trapped"  in  the 
absorbent  wadding 
underneath.  The  inner 
sheet  stays  drier,  and 
baby's  bottom  stays 
drier  than  it  would  in 
cloth  diapers. 


SavCvS 
voii  time 

Pampers  construction 
helps  prevent  moisture 
from  soaking  through 
and  soiling  linens.  As  a 
result  of  this  superior 
containment,  shirts, 
sheets,  blankets  and 
bed  pads  don't  have  to 
be  changed  as  often 
as  they  would  with 
conventional  cloth 
diapers.  And  when  less 
time  is  spent  changing 
linens,  those  who  take 
care  of  babies  have 
more  time  to  spend  on 
other  tasks. 


PROCTER  a  gamble: 


news 


Vomen's  Status  Is  Issue 
li   Nursing:   ICN   Director 


neva,  Switzerland  —  "The  status  of  women  is  not  only  a  social  issue;  it  is  a 

rsing  issue,  too."   said  Adele  Herwitz,  executive  director  of  the  International 

luncil  of  Nurses  (ICN). 

She  made  the  statement  in  announcing 

It  International  Nurses  Day  1975,  cele- 

ited  in  most  countries  on  May  12,  the 

niversary    of   the    birth    of    Florence 

ghtingale,    will    focus   on    the   theme 

ntemational    Women's    Year."    The 

lited    Nations    has    declared     1975 

temational  Women's  Year. 

"There  are  exceptions,  of  course,  but  in 
ost  countries  the  nursing  profession  is 
rgely  female."  iCNs  executive  director 
)inted  out.  "Another  reason  for  nurse 
volvement  in  the  issues  that  will  receive 
tention  in  1975  is  the  recognition  by 
irses  of  their  responsibility  as  citizens  for 
pponing  action  to  meet  both  health  and 
cial  needs  of  the  public.  The  question  of 
omen's  role  in  modern  society  comes 
to  ICNs  position  On  human  rights  in  2en- 
aJ. 

"Many  of  the  nursing  profession's  con- 
luing  problems  are  a  reflection  of  the 
ile  traditionally  accorded  to  women." 
jclared  Herwitz.  This  has  affected,  for 
lample,  the  salary  levels  in  nursing,  and 
is  made  it  difficult  to  achieve  recognition 

the  need  for  university  education  for 
jrses.  and  the  need  for  nurse  participa- 
?n  in  policy-  and  decision-making  in 
;alth  matters,  she  said. 

"The  action  that  will  be  taken  by  iCNs 
1  member  associations  on  International 
urses  Day.  and  throughout  1975.  will 
ary  according  to  the  particular  social 
snditions  of  each  country.  ICN  s  focus 
ill  be  the  promotion  of  equality  in  every 
:spect  between  men  and  women  as  this 
ffects  the  nursing  profession  and  as  this 
ffects  the  nursing  and  health  care  availa- 
e  to  all  members  of  society."  concluded 
erwitz. 


(uebec  Nurses  Say  Membership 
>n  Hospital  Boards  Is  Worthwhile 

rtawa  —  Following  the  election  or  ap- 
Dintment  of  more  than  160  nurses  to 
:iards  of  public  hospital  centers  in 
uebec.  L'infirmiere  canadienne  sur- 
EBRUARY  1975 


veyed  them  to  find  out  whether  these 
nurses  believed  such  experience  was 
worthwhile.  Three-quarters  of  the  nurses 
responding  to  the  questionnaire  said  they 
would  accept  board  responsibility  again,  if 
the\  had  it  to  do  over. 

The  survey  questionnaire  was  sent  by 
L'infirmiere  canadienne  to  137  of  the 
nurse-board  members.  77  replies  were  re- 
ceived, about  a  56  percent  retum.  In  an 
article  in  the  February  1975  issue  of 
L'infirmiere  canadienne.  staff  members 
Nicole  Blais  and  Diane  Groulx  sunmiarize 
the  77  questionnaire  replies  and  draw  a 
profile  of  the  nurses  who  served  on  hospi- 
tal boards  1973-4. 

Most  of  the  nurse-board  members  oc- 
cupied administrative  positions  in  nursing 
at  the  time  of  their  election  or  appointment 
to  the  board.  In  most  cases,  they  were 
elected  by  the  professional  council  of  the 
hospital,  and  they  believed  they  were  sup- 
ported by  nurses  in  the  election.  Nurses  are 
less  well  represented  on  hospital  boards  in 
large  centers,  such  as  Montreal  and 
Quebec  City,  and  in  the  eastern  townships, 
than  in  the  Sud  de  Montreal  or  Saguenay- 
Lac-Sl-Jean  regions. 

Respondents  said  they  fit  easily  into  the 
new  administrative  structure:  they  said 
their  professional  experience  had  prepared 
them  to  assume  this  kind  of  responsibility  . 
They  participated  in  board  discussions  and 
estimated  that  their  point  of  view  was  well 
respected. 

Half  of  the  respondents  believed  the 
board  structure  was  effective  and  demo- 
cratic, and  others  thought  it  was  more 
or  less  effective  and  more  or  less  demo- 
cratic. In  general,  respondents  said  the 
doctors  on  the  board  did  not  have  more 
influence  than  other  board  members. 

The  nurses  expressed  some  ambival- 
ence about  their  rapport  with  the  groups 
they  represented.  They  were  not  sure  for 
whom  they  spoke.  However,  they  said 

(Continued  on  page  16) 


International  Women's  Year  1975 


The  United  Nations'  logo  for  Interna- 
tional Women's  Year  1975  is  a  dove, 
symbolizing  peace.  The  genetic  sign 
for  woman,  a  sphere  that  represents 
the  world,  and  the  mathematical  sign 
for  "equal"  are  integral  parts. 


ONQ  Makes  37  Recommendations 
On  Community  Health  Nursing 

MontreaL  Que.  —  A  brief  from  the  Order 
of  Nurses  of  Quebec  (ONQ)  to  the  provin- 
cial Ministry  of  Social  Affairs  contains  37 
recommendations  for  improving  commu- 
nity health  nursing.  The  brief  was  made 
public  at  the  ONQ  annual  meeting  in 
November  1974. 

The  50-page  document  details  the  func- 
tions of  community  health  nurses  in  the 
care  of  5  population  groups:  mothers,  in- 
fants and  preschool  children,  school  age 
children,  adults,  and  aged  persons. 

The  proclamation  of  the  Quebec  Health 
and  Social  Services  Act  in  1971  placed 
departmenLs  of  community  health  within 
3 1  hospital  centers  in  Quebec.  Directors  of 
nursing  service  in  these  hospitals  were, 
thus,  made  responsible  for  community 
health  nursing,  including  maternal  and 
well-baby  care,  and  school  nursing. 

Some  of  the  recommendations  in  the 
ONQ  brief  refer  to  the  supervision  and  di- 
rection of  community  health  nursing.  In- 
cluded in  them  are: 

•  Programs  in  nursing  care  in  community 
health  should  be  directed  by  a  coordinator 
of  community  health  nursing  who  is  di- 
rectly responsible  to  the  director  of  nursing 
care: 

•  Each  nursing  program  [  that  is,  the  five 
groups  mentioned  above  ]  should  be  di- 

THE  CANADIAN  NURSE     9 


reeled  by  a  nurse  who  is  directly  responsi- 
ble to  the  community  health  nursing  coor- 
dinator; 

•  The  coordinator  and  the  chief  of  the  de- 
partment of  community  health  should  be  at 
the  same  level  in  the  hierarchy;  and 

•  The  nursing  care  programs  in  commun- 
ity health  should  be  adapted  to  the  needs  of 
the  population  in  the  socio-health  region. 

Approval  of  the  brief  by  the  ONQ  bureau 
(board  of  directors),  which  was  given  in 
October,  1974,  makes  it  the  official  posi- 
tion of  ONQ.  A  copy  of  the  brief,  in  French, 
is  available  from  CNA  Library.  The  brief  is 
not  yet  available  in  English. 


Ontario  Nurses'  Union  Ups  Fee, 
Sets  Up  2  New  Regional  Offices 

Toronto.  Out.  —  At  its  annual  meeting  on 
14  December  1974.  the  Ontario  Nurses' 
Association  (ONA)  approved  a  dues  in- 
crease from  $5.50  per  month  to  $9,  the 
immediate  establishment  of  2  new  re- 
gional offices  in  Thunder  Bay  and  Ottawa, 
and  the  enlargement  of  staff  in  Hamilton. 
London,  and  Toronto. 

By  mid-January  1975,  the  ONA  had  a 
staff  of  20  persons.  The  ONA's  annual 
meeting  approved  the  appointment  of 
Anne  S.  Gribben  as  its  chief  executive 
officer. 

Jean  Lowery,  Etobicoke  department  of 
Health,  was  re-elected  president  for  a  sec- 
ond term;  Berenice  Hicks,  St.  Mary"s 
General  Hospital,  Kitchener,  was  cho.sen 
president-elect;  and  Sharon  Thompson, 
Porcupine  Health  Unit,  was  named 
secretary-treasurer  for  a  second  term. 

The  O.NA  now  comprises  132  local  as- 
sociations, representing  16,400  registered 
and  graduate  nurses.  It  was  sponsored  by 
the  Registered  Nurses  Association  of 
Ontario  to  assume  the  collective  bargain- 
ing function. 

ONA  was  certified  as  a  labor  union  in 
January  1974  and  represented  nurses  in 
province-wide  negotiations  with  the 
Ontario  Hospital  Association  during  the 
spring  and  summer  of  1974.  (News, 
August  1974,  page  11,  and  September 
1974.  page  12.) 


5  Nurses  Named  To  Committee 
On  Nursing  Manpower  in  N.B. 

Fredericton.  N.B.  —  Five  nurses  have 
been  named  by  the  provincial  department 
of  health  to  serve  on  a  9-member  subcom- 
mittee on  nursing  manpower.  The  sub- 
committee will  report  to  the  provincial 
Coordinating  Committee  on  Health  Man- 
power. 

Nurse  members  of  the  subcommittee  are 
My  ma  Sherrard.  who  is  chairman  of  the 
subcommittee;  Eva  O'Connor.  Claudette 
Redstone;  Gail  Dennison;  and  Lorraine 
Mills.  Other  subcommittee  members  are 
Inez  Smith.  RNA;  Dr.  Carl  Trask.  adminis- 
trator; Dr.  T.L.  Creamer,  physician;  and 
Bryan  Ferguson,  department  of  health 
10     THE  CANADIAN  NURSE 


employee  and  coordinator  for  all  sub- 
committees. 

The  subcommittee's  objectives  are: 

•  To  examine  the  underlying  causes  of 
shortages  of  nurses  in  hospitals  in  New 
Brunswick  and  to  recommend  solutions  to 
overcome  these  shortages.  Possible  fac- 
tors to  be  examined  include  employing 
situation,  remuneration,  social  conditions, 
and  innovative  programs. 

•  To  examine  the  projected  requirements 
for  nursing  manpower  necessary  to  meet 


needs  over  the  next  3  to  5  years; 

•  To  examine  the  projected  supply  of  nur 
ing  manpower  over  the  next  3  to  5  yeai 

•  To  review  the  policies  and  practices 
the   use   of  nursing   manpower   in   Ne 
Brunswick  hospitals. 

To  assist  the  subcommittee,  the  Ne 
Brunswick  Association  of  Registere 
Nurses'  nursing  committee  has  set  up 
task  committee  to  look  into  the  use  ( 
nurses  and  the  nonnursing  functions  pe 

formed  by  RNS .  (Continued  on  page  h 


Official  Notice 

of 

Annual  and  Special  General  Meeting 

of  the 

Canadian  Nurses'  Foundation 


In  accordance  with  Bylaw  Section  36. 
notice  is  given  of  an  annual  and  special 
general  meeting  to  be  held  April  2, 
1975,  commencing  at  2000  hours  at 
CNA  House.  50  The  Driveway,  Ot- 
tawa, Ontario.  The  purpose  of  the 
meeting  is  to  receive  and  consider  the 
income  and  expenditure  account,  bal- 
ance sheet,  and  annual  reports,  and  to 
propose  changes  required  to  reduce 
costs,  giving  particular  attention  to  the 
membership  structure,  board  of  direc- 
tors structure  and  activities,  and  ad- 
ministrative policies  and  procedures.  In 
this  regard,  the  meeting  will  be  asked  to 
consider  and  approve  the  following  re- 
solution passed  by  the  board  of  direc- 
tors. 

"BE  IT  RESOLVED  That  the  By- 
laws of  Canadian  Nurses'  Foundation 
be  amended  as  follows: 

(a)  Section  6(a)  of  the  Bylaws  is  hereby 
amended  to  read: 

6.  The  prescribed  membership  fee 

for  each  class  of  member  shall  be  as 

follows: 

(a)  Regular  Members:  An  annual 

fee  of  $10.00  per  member; 

(b)  Section  9  of  the  Bylaws  is  hereby 
amended  to  read: 

The  affairs  of  the  coporation  shall  be 
directed  by  a  Board  of  five  (5)  Direc- 
tors who  shall  be  members  of  the 
corporation.  A  majority  of  the  Di- 
rectors shall  constitute  a  quorum. 

(c)  Section  lO(ii)  of  the  Bylaws  is 
amended  to  read: 

10  (ii)  Only  the  Regular  Members 
shall  vote  on  the  election  of  Direc- 
tors. 

(d)  Section  13  of  the  Bylaws  is  amen- 
ded to  read: 

13.  Meetingsof  the  Board  of  Direc- 
tors may  be  held  at  any  time  and 
place  on  a  direction  by  the  Chairman 
of  the  Board  or  on  a  requisition  in 


writing  by  any  three  (3)  members  of 
the  Board.  The  secretary  shall,  upon 
receipt  of  such  a  direction  or  requisi- 
tion, summon  a  meeting  of  the 
Board  by  notice  served  upon  the  se- 
veral members  of  the  Board  at  the 
address  in  Canada  provided  by  each 
for  this  purpose.  At  least  fourteen 
(14)  days  notice  shall  be  given  of 
any  such  meeting  of  the  Board  of 
Directors. 

(e)  Section   5 1  (a)   of  the   Bylaws   is 

amended  to  read: 

5 1 .  The  following  shall  be  Standing 
Committees  of  the  Corporation.  The 
Chairman  and  members  of  each 
Standing  Committee  shall  be  mem- 
bers of  the  Canadian  Nurses'  Foun- 
dation appointed  by  the  Board  of 
Directors  at  the  first  meeting  of  the 
Board  of  Directors  following  each 
Annual  General  Meeting  of  the 
members. 

(a)  Selections  Committee.  There 
shall  be  three  (3)  members  of  the 
Sections  Committee  including  the 
Chairman,  all  of  whom  may  be  se- 
lected from  the  Board  of  Directors . 
The  Selections  committee  shall  re- 
ceive and  consider  all  applications 
for  bursaries,  scholarships,  and  fel- 
lowships for  graduate  study  in  nur- 
sing. After  considering  such  appli- 
cations, the  Selections  Committee 
shall  report  to  the  Board  of  Directors 
with  its  recommendations  as  to 
whom  bursaries,  scholarships  and 
fellowships  should  be  awarded,  and 
the  suggested  amount  of  each  such 
award. 

All  members  of  the  Canadian  Nurses'J 
Foundation  are  eligible  to  attend  and^ 
participate  in  this  annual  and  special 
general  meeting  —  Helen  K.  Mussal- 
lem,  Secretary  — Treasurer,  Canadian 
Nurses'  Foundation. 


FEBRUARY  197.' 


How  come  you're  probably 
paying  a  lot  more  income  tax 
than  a  man  who  makes  the 
same  money  you  do? 


You're  probably  paying  a  lot  more  tax  because  he's  putting  his  money  into  a  Registered 
Retirement  Savings  Plan  and  you're  not 

The  sad  fact  is  that  too  many  bank  and  trust  company  managers 
think  that  women  don't  understand  financial  matters. 
As  a  result,  most  working  women  simply  don't  realize 
that  probably  the  best  thing  they  can  do  with  their  money 
taxwise  is  to  put  it  into  an  RSR 

Depending  on  your  taxable  income  and  what  kind  of 
pension  plans  you  have,  you  can  end  up  paying  as  much 
as  30%  less  income  tax  with  an  RSP  deduction.  You  can 
get  up  to  a  $1,000  or  more  tax  refund  cheque  from  the 
government. 

Even  if  you  don't  have  any  ready  cash  to  put  into  an  RSP, 
you  can  use  whatever  qualified  stocks  and  bonds 
or  trust  and  deposit  certificates  you  have 
to  get  a  big  tax  refund. 
You  can  probably  even  borrow  the 
money  to  get  into  an  RSP  from 
Guaranty  Trust.  And  wind  up 
earning  a  good  deal  more  than 
the  after-tax  cost  of  your  loan. 
Most  important,  when  you  finally 
stop  working  or  need  money  for  something  really  important,  you'll 
have  the  money  put  away. 

It's  all  fully  explained  in  a  comprehensive, 
yet  delightfully  simple  new  book  that's  free 
from  Guaranty  Trust. 

There's  one  catch  though.  After  March  1, 
the  government  won't  let  you  into  an  RSP 
that  will  do  you  any  good  on  your  1974 
income  tax  return. 

So  drop  into  your  local  Guaranty  Trust 
branch  or  send  in  the  coupon  and  we'll  get  an 
RSP  book  off  to  you  right  away. 

It  could  be  the  difference  between 
thinking  about  what  you're  going  to  give  the 
government,  or  looking  forward  to  what  the 
government  is  going  to  give  you. 


I  don't  want  to  pay  more  tax 

than  a  man  who  makes  the  same  money 

Please  send  me  the  free  book. 


Name: 
Streets 
City:_ 


Province; 


Code:, 


Mail  to:  RSP  Information  Centre, 

Guaranty  Trust,  RO.  Box  328, 
Richmond  Hill,  Ontario  L4C  4Y6 

OuarantyABL 


New  9th  Edition! 


Anthony-Kolthoff       New  6th  Edition! 


Shafer  et  a 


TEXTBOOK  OF  ANATOMY 
AND  PHYSIOLOGY 

A  tradition  of  excellence  has  been  estab- 
lished through  8  editions  of  this  leading  text. 
The  9th  edition  is  no  exception,  for  it  adds 
fresh  features  and  a  wealth  of  new  informa- 
tion based  on  recent  findings.  As  in  previous 
editions,  outline  surveys  introduce  each 
chapter;  outline  summaries  and  review 
questions  conclude  each  chapter.  Diagrams 
and  tables  appear  in  nearly  all  chapters  with 
suggested  readings,  abbreviations,  prefixes, 
and  glossary.  New  material  includes:  altered 
states  of  consciousness  and  the  "emotional 
brain";  biofeedback  training;  physiological 
changes  that  occur  during  meditation  (yoga); 
and  more.  In  conveying  ideas,  the  authors 
hope  to  "help  students  see  science  for  what 
it  is — a  continual  asking  of  questions  and 
searching  for  answers,  not  merely  a  collec- 
tion of  facts  and  final  answers."  Once  again, 
Mr.  Ernest  W.  Beck  has  enriched  the  text 
with  a  number  of  new  drawings. 

By  CATHERINE  PARKER  ANTHONY,  R.N.,  B.A., 
M.S.;  with  the  collaboration  of  NORMA  JANE 
KOLTHOFF,  R.N.,  B.S.,  Ph.D.  April,  1975.  Approx.  624 
pages,  8"  x  10",  335  figures  (144  in  color),  including 
239  by  ERNEST  W.  BECK,  and  an  insert  on  human 
anatomy  containing  15  full-color,  full-page  color  plates, 
with  six  in  transparent  Trans-Vision®  (by  ERNEST  W. 
BECK).  About  $13.15. 


New  9th  Edition!  ANATOMY  AND  PHYSI- 
OLOGY    LABORATORY     MANUAL.     By 

CATHERINE  PARKER  ANTHONY,  R.N.,  B.A., 
M.S.  April,  1975.  Approx.  224  pages,  8"  x  10", 
115  drawings,  69  to  be  labeled.  About  $6.55. 


MEDICAL-SURGICAL  NURSING 

The  latest  edition  of  one  of  the  field's  leading 
texts  features  a  new,  larger  format,  new 
easy-to-read  type,  new  information  on  ecol- 
ogy and  health,  and  much  more!  This  revisior 
includes: 

•  an  important  new  chapter  on  ecology  anC 
health  that  reflects  current  thought  on  this 
vital  issue 

•  an  extensive  new  chapter  (the  largest  ir 
the  text)  on  neurologic  diseases 

•  a  new  chapter  on  musculoskeletal  dis- 
orders and  injuries 

•  an  expanded  chapter  on  reproductive  dis- 
eases 

•  a  revised  chapter  on  urinary  diseases  in- 
cluding cardiovascular  physical  assessmen 

Greater  depth  in  physiology,  pathophysi- 
ology, and  nursing  assessment  is  noted 
throughout  the  text.  New  illustrations  stress 
this  greater  depth. 

By  KATHLEEN  NEWTON  SHAFER,  R.N.,  M.A.;  JANET 
R.  SAWYER,  R.N.,  Ph.D.;  AUDREY  M.  McCLUSKEY, 
R.N.,  M.S.,  Sc.M.Hyg.;  EDNA  LIFGREN  BECK,  R.N., 
M.A.;  and  WILMA  J.  PHIPPS,  R.N.,  A.M.  April,  1975. 
Approx.  1,056  pages,  8V2"  x  11",  608  illustrations. 
About  $17.35. 

WORKBOOK  AND  STUDY  GUIDE  FOR 
MEDICAL-SURGICAL  NURSING:  A  Patient- 
Centered  Approach.  By  ALMA  JOEL 
LABUNSKI,  R.N.,  B.S.N.;  MARJORIE 
BEYERS,  R.N.,  B.S.,  M.S.;  LOIS  S.  CARTER, 
R.N.,  B.S.N.;  BARBARA  PURAS  STELMAN, 
R.N.,  B.S.N. ;  MARY  ANN  PUGH  RANDOLPH, 
R.N.,  B.S.N.;  and  DOROTHY  SAVICH,  R.N., 
B.S.  1973,  331  pages  plus  FM  l-VIII,  7Va"  x 
^0V^".  Price,  $6.70. 


New  6th  Edition! 


Matheney-Topalis, 


PSYCHIATRIC  NURSING 


1 


This  carefully  revised  edition  provides  stu- 
dents with  clear  insights  into  the  very  latest 
thoughts  in  this  vital  area  of  nursing.  Using 
a  behavior-centered  theme,  the  authors  fo- 
cus on  community  involvement  and  examine 
the  role  of  the  psychiatric  nurse  as  both  a 
hospital  practitioner  and  an  integral  mem- 
ber of  society.  Expanded  chapters  on  crisis 


management,  drug  dependency  and  suicide 
(both  in  and  out  of  the  hospital  setting)  fur- 
ther emphasize  this  role. 


By  RUTH  V.  MATHENEY,  R.N.,  Ed.D.;  and  MARY 
TOPALIS,  R.N.,  Ed.D.  Guest  contributor:  JEANETTE 
A.  WEISS,  R.N.,  M.A.  July,  1974.  440  pages  plus  FM 
l-XiV,  7"  X  10",  illustrated.  Price,  $10.00. 


iJew  9th  Edition!  Mereness-Taylor 

ESSENTIALS  OF 
PSYCHIATRIC  NURSING 

Carefully  reorganized  and  updated,  this  new  edition 
presents  a  complete  overview  of  the  field  of  psychi- 
atric nursing  to  help  students  gain  the  background 
they  need  to  work  effectively  in  this  field.  The  open- 
ing section  provides  a  foundation  for  understand- 
ing the  development  of  personality,  the  cause  and 
prevention  of  mental  illness,  and  communication 
theory.  Section  II  incorporates  the  principles  of 
Dsychiatric  nursing  and  provides  a  basis  for  the 
nurse  to  act  as  therapeutic  agent  in  a  variety  of 
situations.  In  Section  III,  frequently  encountered 
psychiatric  entities  are  discussed  including  the 
cause  and  treatment  of  withdrawal,  depression, 
elation,  suspicion,  neurosis,  personality  disorders, 
toxic  and  organic  brain  disorders  and  behavior  dis- 
orders. Section  IV  surveys  community  psychiatry 
and  includes  new  material  on  suicide  prevention 
centers,  outreach  clinics  and  walk-in  clinics.  The 
final  section  traces  the  historical  development  of 
psychiatric  nursing  and  considers  the  legal  aspects 
of  work  in  this  field. 

By  DOROTHY  A.  MERENESS,  R.N.,  Ed.D.;  and  CECELIA 
MONAT  TAYLOR,  R.N.,  M.S.  July,  1974.  356  pages  plus  FM 
l-XII,  7  "  X  10  ",  26  illustrations.  Price,  $10.00 


A  New  Bool<! 


UNDERSTANDING 
INHERITED  DISORDERS 


Whaley 


Basic  concepts  of  inherited  diseases  are  introduced 
in  this  book  by  first  presenting  general  principles 
and  then  outlining  their  applications  and  excep- 
tions. Comprehensive  coverage  includes;  the 
physical  basis  of  inheritance;  gene  transmission 
n  families;  single  gene  disorders;  chromosome 
aberrations;  genes  and  immunity;  genetic  equi- 
librium; heritability  of  common  diseases  and  dis- 
orders; etc.  A  glossary  of  terms  facilitates  use  of 
the  text,  and  the  appendices  include  the  genetic 
code,  blood  group  systems,  and  dermatoglyphics. 
Since  many  inherited  disorders  are  indistinguish- 
able from  those  due  to  environmental  causes,  the 
effects  of  environment  of  the  individual  through- 
out a  lifetime  are  included — particularly  those 
which  affect  the  developing  organism. 

By  LUCILLE  F.  WHALEY,  R.N.,  M.S.  June,  1974.  220  pages 
plus  FM  l-XII,  eVs"  X  9V2 ",  121  illustrations.  Price,  $11.50. 


Saxton-Wai 


PROGRAMMED  INSTRUCTION 

IN  ARITHMETIC,  DOSAGES, 

AND  SOLUTIONS 


This  updated  review  of  basic  arithmetic  includes 
"old"  and  "new"  math,  as  well  as  newer  logarithms 
for  division  and  subtraction.  The  text  describes 
Centigrade  and  Fahrenheit  temperature  scales, 
apothecaries,  metric  and  household  systems  of 
measurement  and  the  problems  encountered  in 
conversion  from  one  system  to  another.  The  stu- 
dent is  introduced  to  mathematical  problems  in- 
volved in  administ,ering  medication;  for  added 
relevance,  these  incorporate  both  new  and  com- 
monly used  drugs.  New  material  has  been  added 
on  ratio  and  intravenous  solutions.  Sufficient  cov- 
erage of  each  topic  is  provided  for  the  student  to 
determine  if  he  needs  more  time  with  the  material 
at  hand. 


By  DOLORES  F.  SAXTON,  R.N.,  B.S.,  M.A.,  Ed.D.;  and  JOHN' 
F.WALTER,  Sc.B.,  M.A.,  Ph.D.  June,  1974.  66  pages  plus  FM  l-X,i 
7"  X  10".  Price,  $5.00. 

Berni-Reade> 

PROBLEM-ORIENTED  MEDICAL 

RECORD  IMPLEMENTATION 

(Allied  Health  Peer  Review) 

This  new  text  provides  a  clear  and  direct  methoc 
for  effective  use  of  the  patient's  records.  A  "how- 
to-do-it"    manual    using    the    "Problem-Orientecl 
Medical  Record"  method  organizes  patient  infor- 
mation according  to  a  patient's  data  base:  problerr' 
identification  worksheet;  a  written  plan  for  each' 
proposed  problem  solution;  a  continuous  written' 
evaluation  of  each  problem;  flow  sheets  or  graphs;! 
and   an  automatic,   updated   index.   This  process' 
obligates  the  present  health  care  team  to  docu- 
ment objective  data  and  to  clearly  describe  infor- 
mation from  all  sources,  e.g.,  previous  physicians, 
family  members,  and  agencies.  It  details  system 
implementation    in    hospitals    (private,    university, 
and    psychiatric),   episodic   care  facilities,   physi- 
cians' offices  and  community  services  including 
nursing  homes  and  extended  care  facilities. 

By  ROSEMARIAN  BERNI,  R.N.,  M.N.;  and  HELEN  READEY, 
R.N.,  M.S.  October,  1974.  183  pages  plus  FM  l-XIV,  7"  x  10",  14 
Illustrations.  Price,  $6.25. 


mmm 


,v  Book' 


Davis-Kramer-Strauss       New  2nd  Edition! 


Brunner 


NURSES  IN  PRACTICE: 
A  Perspective  on  Work  Environments 

IIS  new  book  fortifies  students  with  some- 
ing  that's  vitally  important:  a  sense  of  per- 
)ective.  Rather  than  presenting  nursing  as 
should  be,  the  authors  discuss  the  way  it 
,  pointing  out  all  the  "externals"  along  the 
ay:  lack  of  autonomy,  society's  attitudes 
ward  the  role  of  women  .  .  .  and  the  care 
)mponents  offered  by  other  health  profes- 
onals,  since  the  nurse's  key  value  is  her 
ility  to  coordinate  these  components.  An 
jtstanding  feature  of  this  collection  of  arti- 
es  (12  original,  5  previously  published)  is 
5  abundant  use  of  field  notes— a  traditional 
isearch  tool,  but  a  new  teaching  strategy. 
\}\s  empirical  approach  allows  students  an 
^ewitness  vantage  point  to  a  wide  range  of 
jrsing  situations,  and  the  actions  and 
tteractions  which   affect  them. 


MARCELLA  Z.  DAVIS,  R.N.,  Ph.D.;  MARLENE 
)AMER,  R.N.,  Ph.D.;  and  ANSELM  L.  STRAUSS, 
I.D.;  with  11  contributors.  February,  1975.  Approx. 
2  pages,  G'A"  x  9^/4".  About  $7.30. 


ORTHOPEDIC  NURSING: 
A  Programmed  Approach 

The  primary  objective  of  this  book  is  to  assist 
the  student  in  learning  principles  of  ortho- 
pedic nursing  care.  The  text  assumes  basic 
knowledge  in  anatomy,  physiology,  medical 
terminology,  and  nursing  skills.  Material  is 
included  on  joint  motion,  basic  body  me- 
chanics, classification  of  fractures,  stages 
of  bone  healing,  complications  of  fractures, 
treatment  of  orthopedic  conditions,  princi- 
ples of  nursing  care  of  both  surgical  and  of 
non-surgical  orthopedic  patients.  Revisions 
include:  increased  emphasis  on  the  nursing 
process:  expansion  of  the  section  on  pre  and 
post-operative  care  of  the  orthopedic  patient 
to  include  greater  depth  on  techniques;  in- 
creased material  on  care  of  the  surgical  ortho- 
pedic patient  to  include  more  emphasis  on 
care:  greater  emphasis  on  pathophysiology 
in  the  section  on  arthritis:  and  a  new  section 
on  total  hip  replacement. 

By  NANCY  A.  BRUNNER,  R.N.,  B.S.N.,  M.S.  February, 
1975.  Approx.  208  pages,  7"  x  10",  126  illustrations. 
About  $7.10. 


New  Book!  Hilt-Schmitt 

»EDIATRIC  ORTHOPEDIC  NURSING 

his  comprehensive  text  presents  thorough 
overage  of  areas  relevant  to  pediatric  ortho- 
edic  nursing,  including:  the  history  of  pedi- 
tric  orthopedic  nursing;  anatomy  and 
hysiology  of  the  musculoskeletal  system; 
ommon  pediatric  orthopedic  diseases  and 
isorders;  nursing  care  of  children  in  casts; 
actions  used  in  care  and  treatment  of  chil- 
ren;  use  of  restraints;  the  immobilized  child; 
laintenance  of  muscle  function;  activities: 
races,  crutches,  and  prosthetic  devices; 
nd  more.  Specific  emphasis  is  placed  on 
16  use  of  Bradford  Frames,  nursing  care  of 
16  child  in  traction,  and  emotional  support 
f  the  child  and  parents.  Other  highlights 
iclude  nursing  ca'e  plans,  home  care  in- 
tructions,  and  more  than  270  illustrations. 


New  8th  Edition!  Larson-Gould 

ORTHOPEDIC  NURSING 

This  new  edition  presents  a  comprehensive 
resource  on  orthopedics  applicable  to  nurs- 
ing at  all  levels.  It  has  been  completely  re- 
vised and  updated  to  include  current 
information  on  body  mechanics,  behavioral 
aspects  of  rehabilitation,  metabolic  disorders 
of  bone,  and  total  hip  and  knee  joint  replace- 
ment. Other  areas  discussed  include:  care  of 
patients  in  casts,  traction,  and  braces;  sur- 
gical patients;  trauma  to  bones,  joints, 
and  ligaments;  arthritis;  bone  tumors;  in- 
fections of  bones;  congenital  deformities; 
developmental  diseases;  cerebral  palsy; 
neuro-muscular  affections;  operative  pro- 
cedures: and  legal  liability  of  nurses. 


y  NANCY  E.  HILT,  R.N.;  and  E.  WILLIAM  SCHMITT, 
M.D.  January,  1975.  Approx.  224  pages.  7"  x  10", 
91  illustrations.  About  $11.55. 


By  CARROLL  B.  LARSON,  M.D.,  F.A.C.S.;  and 
MARJORIE  GOULD,  R.N.,  B.S.,  M.S.  April,  1974.  488 
pages  plus  FM  l-XII,  7"  x  10",  672  illustrations.  Price, 
S12.55. 


news 


(Conlimied  from  page  10) 

RNABC  Adds  Four  Non-Nurses 
To  Its  Board  Of  Directors 

Vancouver.  B.C. —  The  first  4  non-nurse 
directors  of  the  Registered  Nurses'  As- 
sociation of  British  Columbia  took  up  their 
appointments  at  the  January  1975  meeting 
of  the  board  of  directors  at  provincial 
headquarters  in  Vancouver.  They  are: 
Valeri  Laxton,  executive  director  of 
Action  B.C.,  representing  the  provincial 
government;  Clive  Lytle,  assistant 
secretary-treasurer  of  the  B.C.  Federation 
of  Labour:  Ada  Brown,  president  of  the 
B.C.  Branch,  Consumers"  Association  of 
Canada:  and  Dolores  Holmes,  a  Van- 
couver lawyer,  appointed  from  among 
nominees  suggested  by  rnabc  districts 
and  chapters. 

The  appointment  of  non-nurse 
directors  was  made  possible  by 
amendment  of  the  Registered  Nurses 
Act,  approved  by  the  provincial  gov- 
ernment at  the  request  of  the  RN.ABC, 
and  subsequent  amendment  of  the 
association's  constitution  and  bylaws. 

Other  members  of  the  board  of  directors 
are  the  association's  6  elected  officers  and 
the  12  elected  district  presidents. 


Anthropologist  Named  to  ONQ 
Administrative  Committee 

Montreal,  Quebec  —  The  sixth  member  of 
the  administrative  committee  of  the  Order 
of  Nurses  of  Quebec  (ONQ)  is  Guy 
Dubreuil,  professor  of  anthropology 
at  the  University  of  Montreal.  Dubreuil 
was  named  by  the  government  to 
represent  the  public  on  the  ONQ's 
administrative  committee,  formerly 
called  the  executive  council. 

Names  of  the  five  other  committee 
members  were  included  in  news  of  the 
ONQ  annual  meeting  (Jan.  1975,  page  9). 


Alberta  Universities  Unite 
On  Degree  Program  For  RNs 

Calgary.  Alberta  -—  The  University  of 
Calgary  and  the  University  of  Alberta  have 
established  a  cooperative  program  that 
will  allow  practicing  registered  nurses  in 
Calgary  to  pursue  a  U  of  A  nursing  degree 
at  the  U  of  C  campus. 

The  program  commenced  with  one 
course  in  the  fall  session  1974  and  con- 
tinued in  the  winter  session  with  2  courses 
being  offered.  Most  of  the  courses  will  be 
in  the  evening,  although  some  may  be 
scheduled  in  the  day,  depending  on  the 
response. 

To  obtain  a  U  of  A  nursing  degree  under 
the  guidelines  of  the  new  program,  appli- 
cants must  complete  12  full  courses, 
16     THE  CANADIAN  NURSE 


which  normally  requires  2  calendar  years. 
Several  courses  presently  offered  by  the 
University  of  Calgary  may  be  accepted  for 
transfer  of  credit  to  the  degree  program. 
Courses  that  are  not  offered  by  U  of  C  will 
be  taught  by  U  of  A  instructors  in  Calgary 
on  a  part-time  basis. 

Marguerite  Schumacher,  director  of 
University  of  Calgary's  school  of  nursing, 
stresses  that  the  continuing  education 
program  with  the  U  of  A  is  being  provided 
on  an  interim  basis  only,  and  does  not 
eliminate  the  need  for  the  U  of  C  to  de- 
velop a  similar  program  of  its  own. 


CNAs  Win  Human  Rights  Decision 
On  Equal  Pay  With  Orderlies 

Edmonton.  Alberta  —  The  Alberta  Human 
Rights  Commission  has  decided  in  favor 
of  a  group  of  certified  nursing  aides,  who 
claimed  they  were  not  receiving  the  same 
pay  as  certified  nursing  orderlies,  although 
their  jobs  were  essentially  the  same.  The 
claims  were  filed  by  the  certified  nursing 
aides  in  April  1973,  and  the  Human  Rights 
Commission's  decision  was  reported  in 
The  Edmonton  Journal  of  2  December 
1974. 

The  certified  nursing  aides  who  filed  the 
complaints  were  employed  at  the  Royal 
Alexandra  Hospital,  Edmonton,  but  the 
Alberta  Hospital  Association  has  recom- 
mended that  all  hospitals  in  the  province 
pay  nursing  aides  at  the  orderlies'  rate  of 
pay. 

The  predominant  rate  of  pay  in  Alberta 
for  nursing  orderlies  ranges  from  $590  to 
$635  a  month,  while  nursing  aides  were 
paid  $480  to  $560  a  month .  Since  the  nurs- 
ing aides  who  filed  the  complaint  were 
employed  at  the  Royal  Alexandra,  they 
will  be  paid  at  that  hospital's  rate  for  nurs- 
ing orderlies,  which  is  $626  to  $681  a 
month. 

The  certified  nursing  aides  belonged  to 
a  collective  bargaining  unit  and  were 
locked  in  to  a  contract  with  differential  pay 
scales,  so  they  went  to  the  Human  Rights 
Commission  to  plead  for  equal  pay  for 
equal  work.  The  case  is  believed  to  set  a 
precedent  for  Canada. 


Year  of  Advanced  Clinical  Studies 
Begins  at  Univ.  of  Manitoba 

Winnipeg.  Man.  —  Eight  registered 
nurses  with  experience  in  community 
health  nursing  began  a  year  of  advanced 
clinical  studies  1  November  at  the  Univer- 
sity of  Manitoba. 

This  program  is  intended  to  extend  the 
nurses'  knowledge  and  skills  so  they  can 
work  confidently  in  a  primary  care  setting; 
for  example,  they  will  have  primary  con- 
tact with  persons  who  come  with  medical 
complaints  to  clinics,  and  will  follow  the 
health  of  special  groups  in  the  community, 
who  need  above  average  attention. 

During  the  first  five  months  of  this  prog- 


ram, the  nurses  attend  lectures  at  the  uni  1 
versity  and  gain  practical  experience 
primary  care   in  hospital  outpatient  > 
partments,  geriatric  centers,   psychiai 
and  rehabilitation  clinics.  , 

The  last  seven  months  will  consist  of  i 
supervised  field  experience  in  the  setti' 
in  which  the  nurses  are  employed,  lli 
are  being  supported  financially  by  varii 
health  agencies,  and  have  agreed  to  pra 
tice  their  expanded  skills  in  a  specified 
community  for  at  least  a  year  after  gradua- 
tion. 

This  program,  which  is  being  coordi- 
nated by  Professor  Mary  Peever  of  the 
school  of  nursing,  is  intended  to  be 
interim  program  until  its  content  is  in^t 
porated  into  the  university's  bachelor  oi 
nursing  program. 


HSC  Women's  Auxiliary  Puts  Out 
Italian  Primer  for  Medical  Use 

Toronto.  Ont.  —  The  women's  auxiliary 
of  the  Hospital  for  Sick  Children  (HSC). 
Toronto,  has  sponsored  preparation  of  a 
booklet  "Perche  Siete  Qua?"  ("Why  Arc 
You  Here?"),  an  Italian  primer  for  medi- 
cal personnel. 

The  book  provides  basic  vocabulary  and 
key  expressions  that  the  health  profes- 
sional will  need  to  conduct  a  medical  ex- 
amination .  There  are  also  personal  phrases 
of  reassurance,  such  as  ""Don't  worry,  we 
will  take  good  care  of  you." 

A  single  copy  of  the  booklet  is  available 
on  request,  free  of  charge,  to  any  doctor  oi 
medical  professional  in  the  hope  that  it  will 
help  Italian-speaking  Canadians  com- 
municate their  health  needs  and  avert  po- 
tentially dangerous  misunderstanding  of  1 
medical  instructions. 

Address  requests  to:  Department  of 
Public  Information,  The  Hospital  for  Sick 
Children,  555  University  Ave.,  Toronto, 
Ont. 


(Continued  from  page  9) 

they  had  obtained  some  changes  in  the 
organizational  plan  of  the  hospital. 

Application  of  the  new  Quebec  law 
governing  health  and  social  services, 
which  was  effective  December  1971,  re- 
sulted in  reconstruction  of  the  manage- 
ment boards  of  health  institutions.  The 
new  structure  assures  board  representation 
of  groups  of  individuals  and  institutions, 
such  as  universities,  local  health  and  social 
centers,  consumers,  professionals,  non- 
professionals, and  doctors,  in  the  man- 
agement of  hospitals. 

However,  it  does  not  guarantee  partici- 
pation of  nurses,  unless  they  are  elected  by 
the  hospital's  consultative  council  of  pro- 
fessionals, or  are  appointed  by  one  of  the 
other  groups  mentioned.  The  Order  iif 
Nurses  of  Quebec  has  strongly  urged  its 
members  to  inform  themselves  and  to 
ganize  for  these  board  elections. 

FEBRUARY  197S 


mture 

shock 


The  biggest  thing  you're 
up  against  in  business  isn't 
your  nearest  competitor  It's 
the  future.  And  your  future 
in  business  depends  on  many 
things.  Not  the  least  impor- 
tant of  which  is  people. 
People  planning  is  your  job. 
And  a  very  important  one. 
It's  also  a  job  that  any  one  of 
over  400  Canada  Manpower 
Centres  can  help  you  do. 

The  people  on  our  Canada 
Manpower  planning  staff  pos- 
sess a  variety  of  skills  and 
abilities  and  have  been  care- 
fully selected  and  trained 
to  help  you  cushion  your 
future. 


By  helping  you  plan  for  it 
now. They'll  provide  you  with 
information  on  labour  market 
conditions.The  demand  and 
supply  of  specific  types  of 
labour  Regional  and  national 
industrial  trends.  In  short 
everything  you'll  need  to 
know  to  help  keep  your  busi- 
ness growing. 

Then  they'll  work  with  you. 
Forecasting  future  needs, 
establishing  on-going  pro- 
grams of  recruitment, 
training  and  retraining.  And 
also,  helping  you  make 
better  use  of  the  people  you 
already  have.  Because  the 
future  starts  now. 


"People  Planning".  A 
feature  of  the  new  improved 
Canada  Manpower.  And 
a  very  useful  idea  in  helping 
you  make  your  business 
run  better  Now  and  in  the 
future. 


I* 


Canada 

Manpower  C«ntrc 

Manpower 

and  Immigration 

Robert  Andraa 

Minister 


Centre  de  Msin~d'aeuvr« 

du  Canada 

Main-d'cau«ra 

et  Immigration 

Rol>cr1  Andras 

Miniatre 


Canada  Manpower. 
Let's  work  together. 


BRUARY  1975 


THE  CANADIAN  NURSE     17 


fact,  more  than  that.  A  team's  function 
depends  on  some  common  definition  of  an 
area  of  care.  Without  more  clarity  than 
now  exists,  it  is  difficult  to  see  how  educa- 
tion therapy  will  become  a  professional- 
level  service. 

Gross  errors  in  health  teaching  can  now 
exist,  probably  more  by  omission  than 
commission,  although  neither  has  been 
adequately  studied.  A  humorless  example 
is  that  the  Patient's  Bill  of  Rights,  which  is 
meant  to  represent  a  reformulation  of  the 
contract  between  health  professionals  and 
institutions  and  patients,  is  probably  not 
understandable  to  someone  with  less  than 
a  post  high  school  reading  level!' 

Definitions  and  standards 

For  purposes  of  professional  practice, 
patient  education  ought  to  be  defined  as 
learning  (change  in  behavior)  brought 
about  by  contact  with  a  health  care  worker 
or  agency.  As  a  therapeutic  tool,  teaching 
is  aimed  at  individuals  with  normal  contact 


be  accomplished  by  the  patient,  a  task  that 
could  not  be  accomplished  in  the  time  and 
with  the  expertise  of  the  usual  client-health 
professional  relationship. 

Expertise  is  really  the  crux  of  the  matter; 
without  it,  all  the  time  in  the  world  is  of  no 
use.  Yet  virtually  no  one  has  systemati- 
cally tested  the  limit  of  the  amount  and 
kind  of  patient  education  that  can  be  pro- 
vided as  part  of  the  usual  care  given  by  a 
staff  adequately  prepared  to  educate,  sup- 
ported by  a  well-developed  institutional 
policy  and  program. 

Guidelines  in  terms  of  patient  care  out- 
comes are  rare.  Perhaps  the  most  explicit 
has  been  Green,  who  proposed  cost  benefit 
measures  for  health  education,  and  sug- 
gested that  50  percent  success  rates  are  the 
mode,  if  not  the  mean,  for  serious  health 
education  programs.* 

Process  criteria 

Meanwhile,  process  criteria  seem  use- 
ful, at  least  as  a  focus,  for  describing  the 


The  age  of  patient  education  is  upon  us,  and  we're  not 
ready. .  ■  •  Recent  changes  in  nurse  practice  acts  in  sev- 
eral locations  have  made  more  explicit  the  inclusion  of 
patient  or  health  education. 


with  reality,  and  its  goal  is  not  reconstruc- 
tion of  personality. 

The  common  ploy  of  limiting  the  defini- 
tion to  those  learning?,  intended  by  the  pro- 
fessional clearly  eliminates  responsibility 
for  the  often  potent  informal,  unintended 
learnings  that  occur.  But  what  difference 
does  it  make  to  the  patient  if  learning  was 
or  wasn't  intended? 

Of  course,  not  all  this  service  ought  to 
be  included  in  the  definition  of  separately 
reimbursable  patient  education.  Influence 
is  an  inevitable  part  of  the  professional- 
client  relationship:  the  time  and  influence 
of  that  relationship  must  be  used  as  part  of 
a  consciously  planned  therapeutic  pro- 
gram. But,  it  is  also  possible  to  define  those 
times  in  which  a  major  learning  task  must 
20     THE  CANADIAN  NURSE 


full  range  of  needs  for  the  patients  an  in- 
stitution serves  and  for  setting  priorities 
for  practice. 
The  following  process  is  suggested: 

1 .  Document  the  need  for  teaching  for  all 
rational  patients  and  for  families  of. 
nonrational  patients. 

2.  Develop  a  priority  system  for  meeting 
patient  education  needs. 

3.  Ensure  that  all  patients  and/or  their 
agents  have  adequate  understanding 
and  skill  to  carry  out  prescribed  treat- 
ments safely,  including  medications 
that  will  be  self-administered. 

Medical  regimens  often  introduce  power- 
ful therapeutic  agents  that  are  new  to  pa- 
tients. Many  have  no  reasonable  way  of 


learning  how  to  avoid  the  dangers  of  such 
agents,  unless  they  are  provided  with  in- 
struction (not  just  information). 

4.  Ensure  adequate  skill  and  understand- 
ing in  doing  self-care  activities,  to  the 
extent  that  the  contract  with  the  patient 
requires. 

Adults  are  largely  responsible  for  the 
health  aspects  of  their  daily  living  func- 
tions. Illness  often  requires  aid  with  those 
functions.  But  the  goal  is  to  return  that 
responsibility  to  the  individual.  He  retains 
the  right  to  perform  those  functions  as  he  I 
wishes,  unless  affected  by  law  or  by  a 
contract  with  a  health  professional  for  ser-i 
vices. 

5.  Demonstrate  evidence  of  adequate  skill 
in  the  process  of  teaching: 

•  obtaining  and  using  assessment  of 
client  readiness  (motivation  and  al-i 
ready  existing  skills  and  knowledge); 

•  articulation  of  clear  goals  that  reflect 
client  readiness  and  desired  medical 
outcomes; 

•  facility  with  a  range  of  instructional 
methodologies  and  ability  to  match | 
them  to  the  kind  of  learning  to  be  ac-l 
complished;  and 

•  obtaining  and  interpreting  evaluative  j 
data  with  ability  to  make  correction  in 
the  teaching  process,  suggested  by  the- 
data.  ! 

Category  of  needs  i 

To  develop  a  priority  system  for  meet-f 
ing  patients'  needs  for  education  (the  sec-: 
ond  step),  needs  might  be  categorized  in 
the  following  way: 

Acute  educational  needs  exist  when  a 
lack  of  understanding  is  causing  psycho- 
social anguish  and/or  physical 
danger. 

Preventive  educational   needs  exist' 
when  a  condition  of  some  threat  isi 
likely  to  occur  to  an  individual  or  group' 
who  has  little  skill  for  handling  it.  The 
seriousness  of  the  threat  and  the  proba- 
bility of  its  occurring  both  vary. 
Maintenance  educational   needs  c^ 
for  those  living  with  medically  deri\ 
alterations  in  their  living  patterns,  who 
will  need  more  or  less  frequent  reteach- 
ing,  and  those  for  whom  a  deficit  of 
FEBRUARY  197; 


understanding  and  skill  is  causing  diffi- 

.  iilty  with  normal  developmental  tasks. 

'  ■  'iigh  not  inclusive,  some  brief  patient 

pies  may  help  to  clarify  this  category 

1.  111.  An  acute  educational  need  caus- 
l:  psychosocial  anguish  can  be  seen  in 
c  explosive  tension  that  can  build  in  the 
m\\y  of  a  patient  who  is  at  home  after 
Micardial  infarction,  if  neither  the  pa- 
■11!  nor  the  family  understands  the  nature 

the  disease  or  the  physician's  instruc- 
'iis  An  acute  educational  need  causing 
i\sical  danger  can  be  present  when^a 
i!!ent  who  is  on  anticoagulants  has  a  seri- 
is  bleeding  episode  and  doesn't  know 
n\  to  handle  it  or  how  to  dist  r;uish  it 
oni  minor  bleeding  episodes. 

Pieventive  needs  vary  in  their  predicta- 
'lit> ,  but  obvious  examples  include  those 
;rsons  who  rate  very  high  on  risk  factors 
ir  cardiovascular  disease  or  diabetes  and 
ho  can  be  taught  to  reduce  these  risks  and 
i  recognize  the  disease  at  its  early  stages, 
he  maintenance  category  of  educational 
;eds  recognizes  that  many  persons  with  a 
ironic  disease,  who  are  on  a  long-term 
edical  regimen,  will  decrease  their  de- 
■ee  of  compliance.  Reteaching,  usually 
imbined  with  screening  for  complica- 
ons,  can  boost  that  compliance.  A  person 
hose  social  competency  and  understand- 
ig  is  minimal  (such  as  a  mentally  retarded 
lult)  may  well  need  periodic  education  at 
mes  of  change  and  stress,  such  as  becom- 
g  a  parent. 

These  categories  are  quite  fluid  and 
)metimes  not  mutually  exclusive.  But 
ich  a  system  allows  priority  setting  ac- 
jrding  to  an  estimate  of  the  seriousness  of 
le  difficulty .  It  should  also  allow  analysis 
f  the  nurse's  pattern  of  responding  to 
eeds.  For  example,  are  maintenance  and 
reventive  needs  too  often  allowed  to  be- 
ame  acute? 

esired  and  undesired  effects 

Among  health  professionals,  the  most 
bvious  goal  of  patient  education  is  com- 
liance  with  treatment  regimen  and  with 
ther  desirable  health  behavior.  The 
eakness  of  this  goal  can  be  its  closed 
oor  attitude  toward  incorporation  of  the 
atient's  goal,  even  though  (his  incorpora- 

BRUARY  1975 


tion  frequently  constitutes  an  important 
element  for  motivated  learning.  The  no- 
tion of  ■"intelligent"  compliance  needs  to 
be  further  articulated.  Such  compliance 
includes  the  client's  goals  and  leeway  in 
which  he  makes  decisions.  Training  of  pa- 


is to  document  evidence  of  a  core  of  prac- 
titioners able  to  practice  patient  education 
according  to  standards.  And  a  third  is  pro- 
vision of  high-quality,  effective  health 
educational  services  to  persons  of  all 
socioeconomic  status,  educational  level. 


Gross  errors  in  health  teaching  can  now  exist,  proba- 
bly more  by  omission  than  commission,  although 
neither  has  been  adequately  studied. 


tients  for  home  hemodialysis,  home  trans- 
fusions for  hemophiliacs,  and  so  on  have 
reminded  the  medical  community  that  pa- 
tients can  be  taught  to  take  a  great  deal  of 
responsibility. 

Patient  education  can  serve  as  a  cost 
containment  measure.  Its  effect  on  psycho- 
social well-being,  including  comfort,  has 
been  fully  debated  but  not  supported  with 
much  empirical  evidence. 

Some  undesired  effects  seem  to  have 
been  overestimated,  and  others  seriously 
underestimated  or  ignored.  There  is  con- 
cern about  the  ability  of  patients,  who  have 
additional  information  and  skills,  to 
evaluate  the  services  of  health  care  givers; 
it  is  feared  that  they  will  judge  from  super- 
ficial knowledge  of  the  full  complexity  of 
the  situation. 

Simple  learning  failure  implies  that  the 
learning  goal  was  not  reached,  and  so  the 
problem  to  which  it  was  a  solution  is  left 
unresolved.  But  it  is  indeed  possible  to  exit 
from  an  education  program  in  worse  shape 
than  one  entered,  by  the  development  of 
incapacitating  confusion  or  severe  conflict 
between  what  one  was  taught  and  how  one 
or  one's  significant  others  believe  in  liv- 
ing. The  patient  can  become  a  victim  if 
members  of  a  health  team  vary  signific- 
antly in  their  expectations  and  demands  of 
him.'' 

Tasks  before  us 

Health  professionals  have  several  tasks. 
One  is  further  development  and  validation 
of  standards  of  care.  A  closely  related  task 


cultural  background,  and  place  of  resi- 
dence. 

References 

1.  Pohl,  M.L.  Teaching  activities  of  the 
nursing  practitioner.  N'urs.  Res.  14:4-11, 
Winter  1965. 

2.  Duff,  Raymond  S.  and  Hollingshead, 
August  B.  Sickness  and  society.  New 
York.  Harper  and  Row,  1968. 

3.  Korsch,  B.M.  and  Negrete.  V.F.  Doctor- 
patient  communication.  Sci.  Amer.  227: 
66-74,  Aug.  1972. 

4.  United  States.  Department  of  Health,  Edu- 
cation and  Welfare.  National  High  Blood 
Pressure  Education  Program.  E.xecuiive 
summary  of  the  Task  Force  Reports  to  the 
Hypertension  Information  and  Education 
Advisory  Committee.  Washington,  U.S. 
Govt.  Print.  Off..  1973.  (DNEW  Publica- 
tion No.  (NlH)  74-592) 

5 .  lepson.  H.  A  study  of  the  comparison  of  the 
education  level  of  patients  to  the  readability 
level  of  the  patients'  bill  of  rights.  Min- 
neapolis. University  of  Minnesota.  School 
of  Nursing,  1974.  (Unpublished  Plan  B. 
paper.) 

6.  Green,  L.  Toward  cost-benefit  evaluations 
of  health  education:  some  concepts, 
methods  and  examples.  Health  Educ. 
Mono.  2  Supp.  1 .  1974.  (In  press) 

1 .  De-Nour,  A.K.  et  al.  A  study  of  chronic 
hemodialysis  teams  —  differences  in  opin- 
ions and  expectations.  J.  Chron.  Dis. 
25:8:441-8,  Aug.  1972.  ■§ 


THE  CANADIAN  NURSE     21 


1^  m  it 

Of  m 


For  most  diabetics,  a  concentration  of  1 00  units  of  insulin  per  cc  (U-1 00  insulin)  is 
the  simplest  and  safest  concentration.  It  is  compatible  with  the  metric  system  and 
reduces  the  volume  of  the  injection.  The  introduction  of  U- 1 00  gives  the  nurse  an 
opportunity,  not  only  to  review  her  own  knowledge  of  insulin  use  in  diabetes,  but 
also  to  assess  the  diabetic  individual's  understanding  of  it. 


Elizabeth  Laugharne 


Few,  if  any .  nurses  do  not  know  the  date  of 
the  great  breakthrough  by  Banting  and 
Best  that  provided  us  with  an  injectable 
insulin.  It  has  been  estimated  that 
25,000,000  lives  have  been  saved  since 
insulin  was  discovered.'  Diabetics  now 
live  full  lives  with  a  life  span  almost  equal 
to  the  nondiabetic.-^ 

The  first  insulin  was  crystalline  insulin, 
which  had  a  short  action  of  approximately 
4  to  6  hours.  It  is  obvious  what  difficulties 
this  presented,  and,  although  diabetics  in 
1921  were  quite  prepared  to  take  more 
than  one  injection  daily,  the  advent  of  the 
longer-acting  insulins  was  welcomed. 

In  the  past  50  years,  medical  research 
has  made  greater  progress  than  in  the  past 
1 ,000  years.  With  the  development  of  the 
electron  microscope,  we  have  learned  the 
structure  of  the  insulin  molecule.^  We 
know  that  proinsulin  is  a  precursor  to 
insulin. "*  With  this  additional  understand- 


Elizabelh  Laugharne  (R.N.,  Toronto  General 
Hospital  school  of  nursing)  is  nurse- 
coordinator  of  the  Tri-Hospital  Diabetes  Edu- 
cation Centre  for  New  Mount  Sinai  Hospital. 
Toronto  General  Hospital,  and  Women's  Col- 
lege Hospital  in  Toronto.  She  is  chainnan,  pro- 
fessional health  uorkers'  section,  Canadian 
Diabetic  Association,  and  a  member  of  the  Al- 
lied health  professional  section,  American 
Diabetes  Association. 


22     THE  CANADIAN  NURSE 


ing  and  knowledge,  we  are  able  to  make 
much  better  insulins  today,  resulting  in 
fewer  problems  and  better  control  of  dia- 
betes. 

A  time  for  review 

The  difficulties  inherent  in  assuring 
adequate  instruction  to  ensure  a  proper  un- 
derstanding of  the  unit  strength  of  insulii 
are  well  documented.^-*  To  teach  that  "i! 
unit  is  a  unit  is  a  unit"  has  been  one  of  th( 
greatest  challenges  to  the  nurse  teachinji 
the  diabetic.  We  have  had  confusion  n* 
suiting  from  different  unit  strengths,  sucH 
as  20  units  per  cc,  40  units  per  cc,  and  8( 
units  per  cc.  Now,  in  1974,  wehaveU-10< 
insulins  (100  units  per  cc).  Nurses  mav' 
well  ask:  "Who  needs  another  kind  oi 
insulin?"  I 

Perhaps  this  is  an  appropriate  time  t( 
review  the  kinds  of  insulin  available  it 
Canada  and  their  mode,  peak,  and  dura 
tion  of  action.  (Figure  1 .)  This  is  a  goo< 
starting  point.  Many  diabetics  and  nurse: 
are  found  lacking  when  asked  the  ques 
tions:  "Is  timing  of  insulin  important'?' 
and  "Is  it  necessary  to  eat  breakfast  im 
mediately  after  taking  insulin?"  The  an- 
swers to  these  questions  lie  in  a  good  un 
derstanding  of  insulin  action. 

Nurses  should  also  know  the  meaning  o 

unit  strength  of  insulin.  Oneunitof  insulir 

is  a  measurement  of  weight  —  24  mg.  o 

insulin  crystals.  The  type  of  solution  ii 

FEBRUARY  1975 


FIGURE  I 
insulins  Available  in  Canada,  and  Their  Action 


Insulin 


Type 


Duration  of  Action 


Regular  (Toronto) 

fast 

Up  to  8  hours 

Neutral 

fast 

Up  to  8  hours 

Semilente 

fast 

12-16  hours 

NPH 

medium 

18-24  hours 

Lente 

medium 

18-28  hours 

Protamine  Zinc 

long 

36  hours 

Ultralente 

long 

36  hours  or  more 

Peak  Period  of  Insulin 
if  injected  at 
8  A.M.  6  P.M. 

9  a.m. — 1p.m.  7  p.m. — 11p.m. 

9  a.m.— 1  p.m.  7  p.m.— 11p.m. 

10  a.m. — 2  p.m.  8  p.m. — Midnight 

4  p.m. — 8  p.m.  12  mid. — 6  a.m. 

4  p.m. — 8  p.m.  12  mid. — 6  a.m. 

10  p.m. — 4  a.m.  8  a.m.— 2  p.m. 

10  p.m. — 2  a.m.  8  a.m. — 12  noon 


.hich  the  crystals  are  dissolved  provides 
b.'rt-.  medium-,  or  long-acting  insulins. 

hic  unit  strength  is  the  concentration  per 
uhic  centimeter. 

A  study  by  the  American  Diabetes  As- 
iKiation  and  insulin  manufacturers  in  the 

iiited  States  and  Canada  concluded  that, 
or  most  diabetics,  a  concentration  of  100 
nits  per  cc  (U-100  insulin)  would  be  the 
iniplest  and  safest  concentration.  It  would 
111  be  compatible  with  the  metric  system 
lu!  would  reduce  the  volume  of  the  injec- 
\on.  In  April  1974,  Connaught 
-alioratories  sent  out  information  regard- 
nj  these  insulins  to  every  pharmacist, 
!ii,pital,  and  physician  in  Canada.''  Man- 
uacturers  of  syringes,  such  as  Becton- 
3i  Vinson  Co.  Ltd..  began  to  prepare  for 
he  changeover  with  production  of  U-100 
ii^posable  and  reusable  syringes. 

roblems 

Despite  careful  planning,  this  change 
las  been  fraught  with  problems.  U-80  and 
J-40  insulins  are  still  available.  Health 
)rofessionals.  hospitals,  and  manufactur- 
rs  of  syringes  have  admitted  that  avail- 
bility  of  other  unit  strengths  has  made 
hem  slow  to  change  over.  There  has  been 
ittle  information  for  the  lay  person,  and  it 
las  been  generally  agreed  that  the  hoped- 
or  impact  of  U- 100  insulins  did  not  occur. 

Press  reports  concerning  a  shortage  of 
nsulin  have  only  made  the  situation 
vorse,  because  of  some  panic  buying  of 
nsulin  by  diabetics.  Syringes  have  been 
lifficult  to  obtain .  This  has  been  partly  due 
■EBRUARY  1975 


to  drug  wholesalers  wanting  to  move  exist- 
ing stocks  before  buying  U-100  syringes. 

The  challenge  for  nursing 

A  great  deal  of  effective  patient  educa- 
tion can  and  should  be  carried  out  by  indi- 
vidual nurses.  The  challenge  of  U-100 
gives  the  nurse  an  opportunity,  not  only  to 
review  her  own  knowledge  of  the  use  of 
insulin  in  diabetes,  but  also  to  assess  the 
understanding  of  the  diabetic.  All 
insulin-dependent  diabetics  should  have 
their  equipment  checked  at  least  once  as 
they  change  over  to  U-100  insulin. 

This  provides  nurses  with  the  opportu- 
nity to  review  such  aspects  as: 

D  Does  the  diabetic  understand  unit 
strength?  The  author  has  found  that  few 
lay  people  and  some  health  professionals 
have  difficulty  grasping  the  fact  that  the 
unit  dose  will  not  change  with  U- 100.  For 
example,  an  intelligent,  well-educated 
diabetic  who  is  taking  45  units  of  U-80 
asked,  ■•Will  I  take  45/80  of  100  as  my 
new  dose?"  The  unit  dose  remains  the 
same;  this  should  be  stressed  to  health  pro- 
fessionals and  nurses. 
n  Has  the  diabetic  a  good  understanding 
of  injection  technique,  that  is,  angle  of 
injection  and  rotation  of  sites?  Ideally,  in- 
sulin should  be  injected  into  any  sub- 
cutaneous fatty  tissue  at  an  angle  of 
60-90  degrees  for  an  adult.* 

In  making  this  assessment  the  nurse  is 
afforded  an  opportunity  to  observe 
whether  the  proper  equipment  has  been 


obtained  and  to  watch  the  diabetic  drawing 
up  his  insulin.  It  also  gives  a  chance  to 
inquire  whether  old  equipment  has  been 
discarded.  Many  diabetics  have  been 
hesitant  to  do  this. 

n  Do  the  diabetic  and  the  nurse  know  how 
to  mix  insulins?  The  new  U-100  insulins 
have  a  neutral  pH  and  are  more  stable,  thus 
making  mixing  insulins  less  problematic. 
Mixing  insulins  can  be  readily  taught  and 
easily  understood,  if  it  is  necessary  to  mix 
them.  However,  many  nurses  are  unaware 
of  the  mixing  techniques  and  should  re- 
view this  before  attempting  to  teach  any- 
one the  technique. 

Usually  the  practice  is  to  draw  up  the 
cloudy  insulin  first,  followed  by  with- 
drawal of  the  clear  insulin.  Contamination 
of  insulin  should  be  avoided  at  all  costs. 
One  or  two  practice  sessions  seem  to  be  all 
that  is  necessary. 

n  Does  the  diabetic  understand  the  mode, 
peak,  and  duration  of  action  of  his  insulin? 
Can  he  identify  his  insulin  by  name?  Does 
he  read  the  label  when  purchasing  his  insu- 
lin? Has  he  ever  made  a  mistake?  The 
labeling  on  the  new  U-100  insulins  makes 
it  imperative  that  each  person  read  the 
label  prior  to  the  use  of  any  insulin.  Color 
coding  of  insulins  will  be  discontinued:  the 
new  labels  will  be  black  and  white.  Nurses 
must  stress  the  importance  of  label  read- 
ing. 

n  Does  the  diabetic  understand  the  impor- 
tance of  dietary  balance  and  timing  of 
meals?  Again,  this  gives  the  nurse  an  op- 
portunity to  review  with  every  diabetic  the 
THE  CANADIAN  NURSE     23 


understanding  of  the  use  of  insulin  and 
point  out  that  insulin  should  be  given  each 
day  at  the  same  time,  give  or  take  an  hour. 

By  and  large,  it  is  recommended  that 
breakfast  be  eaten  after  injection.  How- 
ever, in  some  home  situations  when  nurs- 
ing service  is  not  available  early  in  the 
morning,  it  is  quite  possible  for  the 
insulin-dependent  diabetic  who  takes  lente 
insulin  to  have  breakfast  first,  while  await- 
ing the  arrival  of  the  teaching  nurse. 
Medium-acting  insulins,  such  as  lente  in- 
sulin, do  not  begin  to  act  until  approxi- 
mately 2  hours  after  injection. 

Summary 

Inservice  programs  on  U-100  insulin 
have  been  set  up  in  many  hospitals,  de- 
partments of  public  health,  and  visiting 
nurse  agencies.  When  U-100  has  been 
suggested  to  the  physician  or  diabetic, 
there  has  been  no  resistance.  U-40  and 
U-80  insulins  will  be  phased  out  of  produc- 
tion in  the  coming  months.  It  would  be 
uneconomical  for  the  Connaught 
Laboratories  to  continue  producing  all 
three  unit  strengths. 

Patient  education  can  and  should  take 
place  whenever  and  wherever  there  are 
encounters  between  nurses  and  patients.  In 
this  way,  nurses  can  assist  the  health  team 
in  making  the  changeover  as  smooth  as 
possible.  At  no  time  in  the  past,  perhaps, 
have  nurses  had  such  an  opportunity  to 
coordinate  efforts  with  other  health 
professionals.  We  can  assist  local  pharma- 
cists, physicians,  and  diabetics  to  under- 
stand the  need  for  and  benefits  of  U- 1 00 
insulin.  There  is  no  doubt  that  a  diabetic 
can  function  well  if  given  an  explanation 
of  control  that  is  straightforward  and 
meaningful. 

References 

1 .  Liebel.  B.S.  and  Wrenshall.  G. A. .Insulin. 
Toronto,  Canadian  Diabetic  Association. 
1971, p.  15. 

2.  Ibid. 

3.  Steiner,  D.F.  et  al.  Isolation  and  properties 
of  proinsulin,  intermediate  forms,  and 
other  minor  components  from  crystalline 
bovine  insulin.  Diabetes  17:12:725.  Dec. 
1968. 

4.  Ibid. 

5.  Watkins,  J.D.  et  al.  A  study  of  diabetic 
patients  at  home.  Amer.  J.  Pub.  Health 
57:3:452-9.  Mar.  1967. 

24     THE  CANADIAN  NURSE 


U-100  insulin  is  clearly  labeled  in  black  and  white. 


sterile  Disposable  PLASTIPAK  Insulin  Syringe- Needle  Unit  1  cc.  (100  Unit) 


4 


Reusable  Syringe 

1  cc.  (100  unit)  YALE  Reusable  Glass  Syringe  with  2-unit  grariuations 

.  .,     10    20  30  *o  »o  6t>^o  ao  90  roo  unh 

— *-^  lull  liiiiiin  I  liitii  111!  hill  hull  iiiiliuilijiil  ice 


i-.| 


Reusable  Syfn'  jt,- 

0  35  cc  (35  unit;  VALE  Reusable  Glass  Syringe  with  l-unit  graduations 


3»Ljf 


— ^'     5    ra — IS   20  u  ss  3s —7 

•-        ^1  llUlllllllllllillMllllilllltllllli 

Becton,  Dickinson  &  Co.  .Canada,  Ltd 

Disposable  and  reusable  syringes  for  100-unit  insulin  are  compared  with  the  size  of  a 
35-unit  syringe. 


6.  Watkins.  J.D.  and  Moss,  Fay  T.  Confusion 
in  the  management  of  diabetes.  Amer.  J . 
Nurs.  69:3:52 1-4,  .Mar.  1969. 

7.  Romans,  R.G.  Something  new  —  lOO-imit 
insulins.  Toronto,  Connaught 
Laboratories.  1974. 

8.  Tri-Hospital  Diabetes  Education  Centre.  A 
manual  for   diabetics.    Toronto,    Tridec, 

1974. 


'Q 


FEBRUARY  1975 


Project  Alternative: 

the  road  away 
from  isolation 


The  author  describes  why  therapeutic  social  groups  for  long-term  psychiatric 
patients  sometimes  don't  work,  and  what  makes  them  successful  when  they  do. 
Project  Alternative  resulted  in  reduced  rehospitalization,  and  staff  were  excited 
with  the  new  life-style  their  clients  adopted. 


Moyra  J.D.  Jones 


Project  Alternative  is  a  therapeutic 
XMjp,  conceived  and  put  into  action  by 
:cupational  therapists,  to  help  women, 
ho  are  isolated  by  long-standing 
lychiatric  problems,  move  slowly  into 
>mmunity  activities.  What  sort  of  person 
Sally  Brown,  a  typical  member  of  Proj- 
ct  Alternative?  Sally  is  not  unlike  our- 
:lves  in  many  ways.  She  lives  in  a  mid- 
le-class  residential  area  with  her  husband 
f  many  years  and  their  two.  three,  or  four 
lildren.  She  struggles  with  the  same 
roblems  of  food  prices,  laundry,  and  car 
ools.  She  appears  somewhat  flustered, 
tigued,  poorly  organized,  and  generally 
bit  of  a  wreck.  But  don't  we  all.  at  one 
me  or  another? 

No,  there  is  a  difference.  After  years  of 
pparently  successful  marriage,  Sally  has 
ecome  paralyzed  by  guilt,  emptiness,  and 
5ar.  The  children  have  their  own  special 
Jterests  and  friends.  Her  husband  seems 
tally  absorbed  by  his  job.  She  cries  a  lot 
nd  is  afraid  to  leave  the  house  or  answer 


loyra  J.  D.  June.',  (P.O.T.,  University  of 
oronto)  was  director  of  the  department  of 
ccupational  therapy  and  speech  therapy  at 
>ttawa  Civic  Hospital  when  Project  Alterna- 
ve  began.  She  now  lives  with  her  family  in 
iorth  Vancouver.  British  Columbia. 
EBRUARY  1975 


the  phone.  Every  task  —  even  the  simplest 
domestic  chore  —  seems  fantastically  dif- 
ficult. Sally  is  more  miserable  than  she  had 
ever  believed  possible. 

The  cast  of  Project  Alternative  changes, 
of  course.  The  group  often  includes  the 
single  parent  whose  economic  dilemmas 
add  a  special  dimension  to  the  problem. 
Many  unmarried,  middle-aged  women 
suddenly  feel  their  lives  lack  purpose  and 
gratification. 

Occupational  therapists  and  other  health 
care  workers  have  frequently  seen  Sally 
Brown.  She  waits  anxiously  in  the  outpa- 
tient psychiatric  clinic.  Perhaps  she  is 
familiar  because  we  know  her  from  many 
short  admissions  to  an  inpatient  facility. 


needs  or  to  interact  with  others  as  an  in- 
teresting human  being  in  her  own  right. 
She  is  visited  regularly  by  her  family,  who 
seem  helpless  to  understand  her  needs. 
She  is  desperately  anxious  to  go  home. 
With  medication  and  scheduled  visits  to 
return  to  see  her  doctor  as  an  outpatient, 
she  does  go  home. 

Hospital  —  home  —  hospital  —  home: 
The  tragic  cycle  repeats  itself  with  devas- 
tating regularity,  consuming  Sally,  her 
family,  and  the  health  care  workers  in 
costly  frustration. 

Rehabilitation 

What  can  Project  Alternative  do  for 
Sally  Brown?  The  theory  inherent  in  the 


Unless  our  patients  are  functionally  prepared  —  not 
intellectually,  but  functionally  prepared  —  for  the 
goals  we  suggest,  they  will  fail,  and  as  therapists  we 
have  failed  them. 


On  the  psychiatric  unit.  Sally  Brown  is  a 
model  patient,  quiet,  trying  desperately  to 
please,  just  "in  for  a  rest."" 

She  relates  to  staff  members  in  a  super- 
ficial manner  and  is  unable  to  articulate  her 


use  of  a  social  club  as  therapy  revolves 
around  the  significance  of  the  social  ad- 
justment of  the  psychiatric  patient  as  a 
component  of  the  rehabilitation  process. 
The  program  must  be  relevant  to  the 
THE  CANADIAN  NURSE     25 


patient's  needs  of  that  moment,  and  must 
have  validity  from  the  patient's  point  of 
view. 

The  good  intentions  of  countless  social 
activities  have  been  wrecked  on  this  criti- 
cal shoal.  The  best  of  bingos,  picnics, 
bowling  parties,  and  dances  have  failed  — 
and  failed  miserably  —  because  staff 
members  responded  to  their  conception  of 
the  patient's  needs.  If  he's  busy  and  doing 
fun  things,  he  will  feel  meaningful  as  a 
person.  This  is  not  only  an  outdated  and 
erroneous  concept,  but  a  cruel  one. 

The  patient's  integration  with  the  family 
and,  ultimately,  into  the  social  community 
is  a  desirable  goal  of  therapy.  However,  it 
is  not  unusual  for  therapists  and  public 
health  nurses  to  see  very  ill  clients  going 
through  the  motions  of  homemaking. 
When  asked  by  their  doctors  if  they  can 
manage  to  care  for  their  homes  and 
families,  and  participate  in  social  ac- 
tivities, many  women  will  reply  affirma- 
tively. Their  ability  to  persevere  with 
domestic  tasks  often  masks  the  degree  of 
their  psychological  problems  from  family 
members  and  medical  teams  for  long 
periods.  Through  appropriate  therapeutic 
intervention,  social  undertakings  can  be 
attempted  with  some  degree  of  success  as 
the  patient  begins  to  function  more  nor- 
mally. 

Consideration  of  the  patient's  priorities 
for  her  life  is  important.  For  example, 
when  we  talk  to  a  patient  about  returning 
home  after  hospitalization,  do  we  really 
consider  what  this  means?  When  we  refer 
a  client  to  a  community  facility,  are  we 
aware  of  its  location,  its  programs,  and  its 
attitudes  toward  persons  with  psychiatric 
problems'?  Do  we  remember  our  feelings 
when  we  last  enrolled  in  a  sports  club, 
attended  a  convention  or  reunion,  or  ap- 
plied for  a  new  job'.'  Unless  our  patients  are 
functionally  prepared  —  not  intellectually, 
but  functionally  prepared  —  for  the  goals 
we  suggest,  they  will  fail,  and  as  therapists 
we  have  failed  them. 

Anne  Cronin  Mosey,  opting  for  a  tiio- 
psychosocial  model  of  treatment  for  pa- 
tients as  an  alternative  to  the  medical 
model,  .states:  'Man  has  the  right  to  a 
meaningful  and  productive  existence.  This 
includes  the  right  not  only  to  be  free  of 
disease  but  to  participate  in  the  life  of  the 
community.  General  aims  of  rehabilitation 
26     THE  CANADIAN  NURSE 


need  to  be  translated  into  clearly  defined 
and  concrete  knowledge,  skills  and 
attitudes."' 

If  patients  are  encouraged  to  participate 
in  activities  and  programs  where  they 
know  no  one,  trust  no  one,  and  do  not  feel 
secure,  they  will  be  frightened  and  resis- 
tive. The  raison  d'etre  for  the  program  is 
destroyed.  Development  of  the  therapist  as 
a  significant  person  in  the  patient's  view  is 
critically  important  to  the  therapeutic  pro- 
cess. This  is  equally  true  of  personnel  in- 
volved in  community  programs  with  less 
overtly  therapeutic  objectives. 

The  health  professionals  on  the 
psychiatric  inpatient  unit  saw  Sally  Brown 
come  back  into  hcspital,  go  home,  and 
then  come  back  as  a  patient  again.  She 
lacked  the  skills,  knowledge,  and  attitudes 
to  participate  in  the  life  of  the  community. 
We  asked  ourselves  how  we  could  help 
Sally  Brown  use  the  community  facilities 
available  to  her,  how   she  could  make 


•  Deviations  in  psychosocial  developi 
ment  can  be  altered  with  time; 

•  Subskills     fundamental     to    matui 
adaptive   skills    must    be   acquired   in 
sequential  manner; 

•  Mature  psychosocial  skills  can  be  ac| 
quired  through  participation  in  situation 
that  simulate  normal  interactions  betweei 
individual  and  environment;  and 

•  Community-based  developmenta 
groups  could  provide  the  most  socially  ac 
ceptable,  financially  feasible,  and  long 
term, forum  for  change. 

Project 

Project  Alternative  was  designed  U 
serve  a  female  clientele;  these  womei 
were,  on  the  average,  about  42  years  ok 
and  had  long  histories  of  depression  as : 
primary  or  secondary  diagnosis.  All  pa 
tients  were  a  high  rehospitalization  risk 
Most  of  them  were  functioning  at  a  lower 
than-average    level,    and    were    experi 


Project  Alternative  was  designed  to  serve  a  female 
clientele;  these  women  were,  on  the  average,  about  42 
years  old  and  had  long  histories  of  depression  as  a 
primary  or  secondary  diagnosis.  All  of  them  had  a 
high  risk  of  rehospitalization. 


friends  and  ease  her  extreme  isolation.  She 
needed  a  selected  social  group,  one  that 
could  provide  mutual  support  and  learn- 
ing. 

Therapeutic  social  clubs  are  not  new 
and,  in  fact,   proliferate  in  most  com- 
munities, so  it  was  important  to  discover 
why  they  had  not  proven  successful  in  the 
rehabilitation  of  the  long-term  psychiatric 
patient.  We  identified  3  deficits: 
n  After  referral  of  the  client,  there  rarely 
appeared  to  be  sustained  medical  input  to 
the  community  group; 
n  Clients  refused  to  participate  or  discon- 
tinued attendance  after  a  few  .sessions;  and 
D  Emphasis  was  usually  placed  on  the 
activity  offered. 

In  considering  Project  Alternative, 
treatment  was  planned  around  the  follow- 
ing theoretical  base: 


encing     difficulty     interacting     with; 
others.  All  complained  of  isolation,  fear, 
and    hopelessness.    Most    of   them    had 
participated    in    regular    medical    pro-' 
grams  for  many  years.   They  had  little' 
insight,     were    poorly    motivated,    and 
were  considered  by  few  staff  members 
to  be  challenging,  or  to  have  good  re- 
covery or  improvement  potential. 

Preliminary  discussions  with  personnel  - 
from  the  local  YM  YWCA  indicated  their 
interest  in  a  socialization  project,  and  their 
ability  to  provide  facilities,  equipment, 
and  personnel.  They  had  experienced  a 
high  failure  rate  in  involving  this  type  of 
client  in  their  traditional  programs.  They 
were  excited  about  liaising  with  personnel 
from  the  hospital  on  an  ongoing  basis. 
Special  funding  for  transportation, 
lunches,  appropriate  clothing,  and  other 
FEBRUARY  1975 


usual  expenses  was  provided  by  the  aux- 
ary  organization  of  the  hospital. 
Choice  of  personnel  was  undoubtedly 
;  deciding  factor  in  ensuring  success  of 
i  project.  Social  group  leaders  must 
ve  a  high  degree  of  flexibility  and  be 
per  organizers.  This  organizational  abil- 
must  be  extremely  subtle  in  terms  of  its 
iviousness  and  its  timing.  Most  readers 
I  e  familiar  with  fantastically  planned 
ents  in  which  no  patient  involvement 
as  evidenced. 

Leaders  must  have  a  consistency  in  their 
i)proach  to  therapy,  and  they  must  be 


as  a  client-centered  therapy.  A  high  degree 
of  permissiveness  was  built  into  the 
project.  In  Carl  Rogers'  view,  the  per- 
missive attitude  "rests  on  the  propo- 
sition that  the  client  has  basic  poten- 
tialities within  him_for  growth  and  de- 
velopment. The  main  function  of  thera- 
py IS  to  provide  an  atmosphere  in  which 
the  client  feels  free  to  explore  himself, 
to  acquire  deeper  understanding  of  him- 
self, and  gradually  to  reorganize  his 
perception  of  himself  and  the  world 
about  him.""^ 

Program  flexibility  was  important  to 


Patients  saw  themselves  in  a  pattern  of  behavior 
based  on  actual  experience.  This  felt  more  comfort- 
able, realistic,  and  in  keeping  with  the  person  the 
patient  felt  or  perceived  herself  to  be.  They  became 
ex-patients. 


illing  to  be  involved  in  the  experience  on 

continuing  basis.   They  must  have  a 

nuine  regard  and  concern  for  the  patient. 

upled  with  an  awareness  of  the  patient's 
oint  of  view .  They  must  have  the  ability 
)  evoke  trust  in  the  patient.  They  are  op- 
mists  with  infinite  patience.  And  they  are 

ry.  very  rare! 

The  project  originally  consisted  of  10 
weekly  sessions.  As  the  group  developed. 
lis  was  increased  to  2  meetings  per  week. 
jr  a  total  of  20  sessions  for  each  segment 
f  the  program.  The  group  met  for  approx- 
nately  two  to  two  and  one-half  hours, 
icluding  transportation  to  and  from  ac- 
vities  and  lunch  periods.  Transportation 
nd  lunch  were  considered  critical  points 

the  program  and  were  given  special  at- 
sntion  from  staff  members. 

Maximum  attendance  for  each  group 
vas  10  members.  Each  segment  of  the 
(fogram  was  open-ended:  that  is.  mem- 
lers  continued  in  the  program  for  addi 
ional  sessions  if  this  seemed  desirable. 
nd  new  members  joined  at  the  beginning 
f  each  new  segment.  No  changes  in  staf- 
ing  occurred  until  the  program  was  well 
stablished. 

Project  Alternative  functions  primarily 
EBRUARY  1975 


allow  the  clients  to  develop  the  therapeutic 
situation  to  meet  their  own  needs.  There- 
fore, although  a  wide  variety  of  activities 
were  explored,  there  was  no  overt  pressure 
on  patients  to  acquire  skills  or  even  be- 
come involved  in  an  activity  per  se. 

Swimming,  yoga,  slim  and  trim,  folk 
dancing,  luncheons,  discussions,  and 
tours  formed  parts  of  the  program.  No 
particular  attention  was  paid  to  how  well  a 
group  member  swam,  for  example,  but 
great  care  was  given  to  preparation  of  the 
facility,  transportation  arrangements, 
explanation  of  the  day's  activities,  and 
continuity  of  the  presence  of  significant 
figures.  Frequently,  this  involved  hours 
on  the  telephone,  in  face-to-face  con- 
tact, and  accompanying  participants  to 
the  facility. 

It  did  not  take  long  to  discover  that  pa- 
tients like  Sally  Brown  knew  almost  no- 
thing of  their  community's  resources. 
They  hadn't  the  faintest  idea  how  to  go 
about  traveling  by  bus.  and  almost  none 
had  their  own  transportation.  They  were 
terrified  of  becoming  lost,  of  approaching 
strangers  for  advice,  and,  generally,  of 
appearing  out-of-step  or  inappropriate. 
This  fear  caused  them  to  decline  social 


opportunities,  making  it  all  too  easy  for 
staff  and  group  members  to  feel  they  didn't 
care  or  were  poorly  motivated. 

As  the  project  proceeded,  positive  at- 
titudes predominated  over  negative  feel- 
ings as  each  success  was  experienced.  Pa- 
tients saw  themselves  in  a  pattern  of  be- 
havior based  on  actual  experience.  This 
felt  more  comfortable,  realistic,  and  in 
keeping  with  the  person  the  patient  felt  or 
perceived  himself  to  be.  They  became 
ex-patients. 

Participants  began  comparing  their 
thoughts  and  feelings  with  others.  Much 
time  was  spent  telephoning  back  and  forth 
to  confirm  dates,  attendance,  dress,  and  so 
on.  They  began  accepting  responsibility 
for  how  they  spent  their  time  together,  and 
became  aware  of  the  wealth  of  community 
resources.  Senior  members  telt  com- 
fortable in  helping  new  members  adjust. 
Some  group  members  began  participat- 
ing in  activities  outside  the  confines  of 
their  home  and  family.  Incredibly,  some 
developed  " "friends  for  the  first  time"  — 
their  description  of  a  successful  social 
interaction. 

Summary 

Project  Alternative  is  a  joint  hospital- 
community  social  club  offering  therapy  to 
women  with  long-term  psychiatric  disor- 
ders. It  has  proven  successful  due  to  con- 
joint planning  and  implementation. 
Infinite  attention  has  been  lavished  on 
support  of  the  clients  until  psychosocial 
changes  in  behavior  were  achieved. 
Emphasis  has  been  on  development  of 
information,  abilities,  and  values  neces- 
sary for  productive  living  in  the  commu- 
nity. Project  Alternative  has  given  these 
women  a  health  model  to  consider  as  an 
alternative  to  continuing  hospital  de- 
pendency and  isolation  in  their  homes. 

References 

1.  Mosey.  Anne  Cronin.  An  alternative:  the 
biopsychosocial  model.  Amer.  J.  Occup. 
Therapy  2^3  A ?J  40.  Mar.  1974. 

-■  Rogers.  Carl  R.  Client  ceniered  iherapy. 
Boston.  Houghton  .\1itflin.  1951.  <^ 


THE  CANADIAN  NURSE     27 


A  rebuttal  to  Marjorie  Hayes'  article  "Nursing  research  is  not  every  nurse's 
business,"  which  appeared  In  the  October  1974  issue  of  The  Canadian  Nurse. 


Critique:  nursing  research  is  not 
every  nurse's  business 


Janice  Ramsay 


Hayes  argued  that  research  is  not  the  busi- 
ness of  every  nurse,  but  only  of  those  who 
have  methodological  and  statistical 
sophistication.  Her  point  was  well  made. 
In  fact,  the  strongest  support  for  that  point 
comes  from  the  errors  about  methodology 
within  the  text  of  her  paper.  In  view  of  the 
increasing  significance  of  research  within 
nursing,  it  is  essential  that  the  misconcep- 
tions produced  by  Hayes  be  clarified. 

Hayes  stated  that  research  within  nurs- 
ing was  first  the  domain  of  other  discip- 
lines and  that,  "as  a  result,"  this  led  to  a 
time  of  highly  ■"controlling"  experimenta- 
tion, which  progressed  to  every  nurse  be- 
coming a  researcher.  This  may  be  an  error 
in  syntax,  for  otherwise  Hayes  was  di- 
rectly attributing  to  the  scientists  this 
period  of  highly  controlled  research  by 
nurses,  followed  by  every  nurse  being  ex- 
pected to  be  a  researcher. 

This,  of  course,  is  pure  conjecture.  No- 
where has  it  been  established  that  there 
ever  was  a  time  of  highly  controlled  ex- 
perimentation within  nursing,  nor  that  a 
sizable  number  of  nurses  believe  that  all 
nurses  should  be  researchers,  nor  that 
these  scientists  could  alone  be  responsible 
for  such  a  sequence. 

Hayes  also  stated  that  nurses  believe 
research  is  the  means  to  separate  nursing 


Janice  Ramsay  (RN,  Winnipeg  General  Hospi- 
tal School  of  Nursing;  B.A.,  University  of 
Manitoba,  is  currently  a  student  in  the  faculty 
of  graduate  studies.  University  of  Manitoba. 
28     THE  CANADIAN  NURSE 


from  all  other  fields.  If  this  is  indeed  the 
view  of  nurses,  it  is  naive.  Research  is  a 
tool  used  by  a  profession  to  explore  prob- 
lems and  to  answer  questions.  It  provides 
the  opportunity  to  grow  toward  indepen- 
dence. However,  in  the  scientific  world, 
independence  is  not  synonomous  with 
isolationism. 

History  has  demonstrated,  again  and 
again,  how  one  discipline  has  developed 
out  of  another.  For  example,  psychology 
came  into  being  because  of  specific  ad- 
vances within  physiology.  Furthermore, 
each  discipline,  if  it  hopes  to  make  any 
headway,  must  use  knowledge  of  current 
advances  in  several  other  disciplines.  A 
good  example  is  medicine's  use  of  the 
achievements  from  physiology,  anatomy, 
and  cheinistry.  So,  given  that  indepen- 
dence is  achieved,  nursing  cannot  be  iso- 
lated from  all  other  disciplines  and  still 
expect  to  remain  viable. 

Hayes  stated  that  there  are  two  types  of 
research.  One  is  basic  or  pure  and  the  other 
applied.  It  is  at  this  point  that  the  greatest 
departure  from  convention  exists.  A  great 
many  researchers  do  pure  research,  but 
would  be  unable  to  identify  with  the  de- 
scription of  pure  scientists  given  by 
Hayes.  These  researchers  do  not  see  them- 
selves as  frivolous  scientists  doing  re- 
search for  pleasure,  with  no  regard  for  the 
current  state  of  the  world. 

On  the  other  hand,  Hayes  portrays  ap- 
plied researchers  as  those  industrious  sci- 
entists pursuing  "real"  problems.  In  real- 
ity, the  applied  researcher  examines  a 


specific  problem,  and  the  resulting  con-1 
elusions  are  usually  limited  to  those 
specific  conditions  under  which  that  prob- 
lem occurs. 

An  applied  problem  would  be  to  deter-i 
mine  what  conditions  produce  depression 
in  Jane  Smith.  It  inight  be  found  that  rainy 
weather  on  weekends  is  invariably  fol- 
lowed by  depression  in  Jane.  This  is  cer- 
tainly not  the  only  condition  that  produces 
all  depression  in  all  other  persons.  So  the 
finding  that  bad  weather  produces  depres- 
sion is  relevant  only  in  a  limited  context. 

The  pure  scientist,  on  the  other  hand, 
approaches  a  problem  with  the  goal  of 
finding  general  principles  that  can  be  ap- 
plied to  a  large  number  of  situations.  In  the 
example,  the  pure  scientist  might  seek  to 
determine  all  conditions  and  combinations 
of  conditions  that  could  produce  depres- 
sion. These  findings  would  then  be  relev- 
ant for  a  wide  range  of  situations  and  indi- 
viduals. 

Another  example  is  that  of  an  applied 
researcher  who  might  try  to  determine 
what  happens  to  a  specific  object  as  it  falls 
from  a  specific  height.  A  Newtonian  pure 
researcher  would,  however,  look  for  a  law 
of  gravity. 

Once  the  true  difference  between  pure 
and  applied  research  has  been  established, 
it  is  easy  to  see  the  absurdity  of  the  state- 
ment that  "the  pure  scientist  has  no  obliga- 
tion to  produce  useful  findings  that  would 
allow  him/her  to  end  up  with  true,  reliable 
data;  the  applied  researcher,  on  the  other 
hand,  is  committed  to  concrete,  applicable 
FEBRUARY  1975 


ngs."  The  difference  between  pure 
i  applied  research  cannot  be  expressed 
terms  of  reliability  of  data.  Every  re- 
archer,  whether  pure  or  applied,  strives 
•  reliability  of  results. 
Unless  results  occur  consistently,  the 
Wnomenon  is  the  result  of  a  combination 
errors  rather  than  the  planned  experi- 
ental  manipulation.  As  a  hypothetical 
ample,  consider  how  little  faith  there 
'ould  be  in  an  experiment  that  found  con- 
tions  A  +  B  produced  cancer,  if  those 
me  results  could  never  be  reproduced 
ter  the  initial  experiment. 
If  pure  scientists  were  not  obligated  to 
)me  up  with  useful,  reliable  data,  we 
ould  be  at  the  technological  level  of  the 
ark  Ages.  If  we  waited  for  the  applied 

1  searcher  with  his  concrete  or  reliable 
ndings.  we  would  be  little  more  ad- 
_jnced  and  would  be  completely  occupied 
(Iving  specific  problems  without  for- 
ulating  the  many  laws  and  principles  by 
hich  we  live. 

For  Hayes  to  suggest  that  nurses  restrict 
lemselves  to  applied  research  is  to  im- 
ose  limits  that  would  soon  stifle  scientific 


growth.  There  is  not  and  never  will  be  any 
reason  why  nurses  cannot  become  in- 
volved in  pure  research. 

As  nurses  must,  according  to  Hayes,  be 
involved  in  applied  research,  then  they 
must  "produce  only  usable  data,"  that  is, 
data  that  can  be  applied  to  solve  a  problem . 
Therefore,  nurses  have  confined  them- 
selves to  "descriptive  studies"  to  avoid 
failure  in  doing  applied  research.  If  this  is 
true,  they  have  failed  to  avoid  failure,  as 
the  descriptive  method  —  or,  as  it  is  cor- 
rectly called,  the  case  history  method  — 
has  the  least  reliability  and  generality  of  all 
methods  of  experimentation.  It  seems 
more  likely  that  nurses  have  used  this 
method  so  rigorously  because  they  lack  the 
knowledge  to  do  otherwise. 

Nurses  must  recognize  those  problems 
that  are  not  testable  and  those  that  must 
wait  until  technology  has  advanced.  For 
example,  it  might  be  interesting  to  ex- 
amine a  unit  of  memory,  but  curiosity  will 
have  to  wait  on  advances  in  neurophysiol- 
ogy and  psychology. 

Hayes  said  that  nurses  also  must  know 
when  they  can  relax  scientific  rules  to 


solve  a  problem.  Relaxation  of  the  scien- 
tific method  leads  to  unreliable  results  and 
this,  as  we  have  seen,  is  quite  undesirable. 
It  is  not  possible  to  relax  scientific  rules  of 
experimentation  and  still  have  good  re- 
search. This  is  analogous  to  relaxing  asep- 
tic technique  in  the  operating  room  and  yet 
still  striving  for  good  operative  technique. 
Some  problems  just  cannot  be  solved,  and 
relaxing  experimental  technique  does  not 
make  them  more  solvable.  It  just  produces 
unreliable  results  with  no  advances  in  sci- 
ence. 

According  to  Hayes,  nurses  with  the 
skills  for  doing  research  should  be  offered 
special  programs  in  faculties  of  nursing. 
Hence,  a  selected  number  of  nurses  will 
become  researchers,  having  been  taught 
methodology  and  statistics  by  the  nursing 
faculty.  But  who  will  teach  the  teachers? 

So  far,  nursing  has  demonstrated  only 
the  beginnings  of  willingness  to  do  re- 
search but  not  yet  the  capacity  for 
methodologically  and  statistically  sound 
research .  C: 


\rifKfi'<r<'<f<'><"><f<f<f<r<r<f<'<'<f'>^^<'<'<'<'<">'V<<"><-^'^<f'>'><'<-<":-'>'>'><"^^^ 


Marjorie  Hayes,  the  author  of  "Nursing  research 
is  not  every  nurse's  business/'  replies: 


Having  an  opinion  and  being  willing  to  examine  it  in  the 
public's  eye  is,  I  would  hope,  an  objective  of  the  "Opinion 
page"  of  The  Canadian  Nurse.  I  appreciate  J.  Ramsay's 
thorough  review,  even  if  1  continue  to  assert  my  belief. 

I  could  not  agree  more  with  Ramsay  that  I  was  trying  to 
prove  that  research  is  a  tool  that  could  provide  the  opportun- 
ity for  independence .  However,  I  accept  that  independence  is 
not  synonymous  with  isolation,  and  it  was  not  my  intent  to 
imply  the  latter. 

Unfortunately,  Ramsay  and  I  are  to  stay  at  odds  on  the 
difference  between  pure  and  applied  research.  Research  is 
being  done  every  day  in  laboratories  and/or  other  isolated 
settings  that  continue  to  produce  useless  data  for  the  sake  of 
simply  producing  information.  "Milking"  health  insurance 
data  for  the  sole  ambition  of  ascertaining  possible  correla- 
tions, without  a  concrete  hypothesis  or  model,  is  producing 
data  without  an  associated  obligation  to  society  at  large. 


Perhaps  Ramsay  would  assert  that  this  concern  is  unrelated  to 
"pure"  or  "applied"  research  but,  in  relation  to  my  defini- 
tions, it  is. 

Ramsay  states  I  implied  that  nurses  should  restrict  them- 
selves only  to  applied  research.  In  the  context  of  providing 
data  related  to  sound  hypotheses,  I  still  argue  it  would  be 
better.  But  I  would  rather  use  the  entire  concept  and  state  that 
nurses  must  collect  data  in  a  sound  methodological  way.  I 
strongly  agree  that,  "it  is  not  possible  to  relax  scientific  rules 
of  experimentation  and  still  have  good  research." 

Unfortunately,  there  is  a  widespread  idea  that  anyone  can 
go  into  research  on  nursing  as  long  as  she/he  is  a  good  and 
intelligent  nurse.  The  whole  reason  for  my  article  was  to  put 
before  the  nursing  public  my  concern  that  everyone  cannot 
even  make  use  of  research  data,  let  alone  do  research,  unless 
more  avenues  are  provided  to  learn  research  methodology 
and  use  research  data. 


* 

FEBRUARY  1975 


THE  CANADIAN  NURSE 


<• 
* 


29 


The  nurse  and  the 
grieving  parent 

When  a  child  has  a  fatal  illness,  parents  must  come  to  terms  with  their  anticipated 
loss.  One  cannot  provide  a  happy  ending  for  such  an  episode.  But,  if  we  can  help 
parents  cope  so  they  can  provide  the  love  and  care  their  child  needs,  we,  too,  may 
feel  less  helpless  and  more  fulfilled  in  our  role. 


Helen  Elfert 


WORKING  WITH  THh  PARENTS  OF  A 
child  who  has  an  illness  that  will 
probably  be  fatal  can  be  disturbing  for 
nurses.  To  many  nurses,  the  ideal  parent  is 
one  who  is  calm,  rational,  helps  in  the 
therapeutic  process,  supports  the  child, 
and  does  not  show  excessive  grief.  Most 
nurses  have  no  difficulty  working  with  such 
parents,  and  feel  the  parents  are  a  part  of 
the  team  caring  for  the  child;  good  rela- 
tions between  parents  and  staff  ensue. 

When  parents  demonstrate  anger,  de- 
nial, or  acute  grief,  nurses  may  respond 
with  anger  or  hostility.  Understanding  of 
the  process  of  anticipatory  mourning  can 
help  us  to  work  in  a  more  supportive  way 
with  parents. 

Donna  was  1 8  months  old  when  she  was 
admitted  to  hospital.  After  several  days  of 
tests,  a  malignant  growth  was  diagnosed. 
When  her  mother  was  informed  of  the 
diagnosis,  her  response  was  to  say,  in  a 
voice  tense  and  controlled,  that  she  had 
lost  a  previous  child  and  she  wasn't  going 


The  author  (R.N.,  The  Hospital  for  Sick  Chil- 
dren School  of  Nursing,  Toronto;  B.N., 
McGill  University;  M.A.,  New  York  Univer- 
sity) is  Assistant  Professor,  School  of  Nursing. 
The  University  of  British  Columbia.  Van- 
couver. British  Columbia. 
30     THE  CANADIAN  NURSE 


to  go  through  that  again.  She  stated  she 
was  going  home  and  would  never  return  to 
see  the  child  again.  The  nurses"  immediate 
response  to  this  mother  was  one  of  anger, 
and  a  belief  that  she  was  an  unnatural 
mother  who  cared  more  about  herself  than 
her  child. 

THEORIES  AND  RESEARCH  ABOUT  pa- 
rental grieving  may  assist  us  to  under- 
stand parental  behavior,  and  help  us  pro- 
vide what  parents  need  in  these  situations. 
Futterman  et  al  suggest  5  sequential  steps 
in  the  process  of  anticipatory  mourning:' 
D  Acknowledgment:   becoming  progres- 
sively convinced  that  the  child's  death 
is  inevitable. 
n  Grieving:  experiencing  and  expressing 
the  emotional  impact  of  the  anticipated 
loss  and  the  physical,  psychological, 
and  interpersonal  turmoil  associated 
with  it. 
n  Reconciliation:  developing  a  perspec- 
tive on  the  child's  expected  death, 
which  preserves  a  sense  of  confidence 
in  the  worth  of  the  child's  life  and  in  the 
worth  of  life  in  general. 
D  Detachment:   withdrawing  emotional 
investment  from  the  child  as  a  growing 
being  with  a  real  future. 
D  Memorialization:  developing  a  rela- 
tively fixed  conscious  mental  represen- 


tation of  the  dying  child  that  will  endure 

beyond  his  death. 
Initially,  one  might  feel  that  the  mother 
described  was  already  at  stage  four,  de- 
tachment. But,  in  fact,  the  person  who  is 
coping  relatively  well  with  the  grieving 
process  balances  detachment  with  con- 
tinued emotional  investment  in  the  dying 
child,  and  participation  in  his  care.  The 
total  denial,  even  of  the  child's  existence 
and  bond  to  mother,  suggests  the  mother  is 
running  away  from  the  pain  that  acknow- 
ledgement of  the  diagnosis  would  create. 

Previous  experience  with  loss  of  a  loved 
one,  and  especially  loss  of  another  child, 
makes  it  likely  that  the  new  experience 
will  revive  all  the  anxiety  and  grief  of  the 
previous  experience.  One  writer  described 
what  he  called  the  "vulnerable  child 
syndrome."^  According  to  this  writer,  one 
type  that  fits  this  pattern  is  the  child  who 
represents  to  the  parent  a  figure  from  the 
past  who  died  prematurely. 

One  might  hypothesize  that  the  mother 
described  above  had,  throughout  the 
child's  short  life,  been  fearing  just  such  an 
event  —  that  is,  that  this  child  too  would 
die.  The  diagnosis  of  a  fatal  illness  caused 
all  the  previously  subinerged  fear  and 
worry  to  surface,  and  the  mother's  initial 
reaction  was  to  escape  from  feelings  with 
which  she  could  not  cope. 

FEBRUARY  1973 


Nurses,  too,  suffer  anxiety  and  grief  in 
iring  for  dying  children.  They  lack  the 
me  emotional  investment  in  the  child 
at  a  parent  has,  but  there  is  still  a  prevail- 
g  feeling  of  sadness  at  a  child's  dying. 
ur  feeling  of  anger  at  a  parent .  such  as  the 
le  described,  may  be  a  reflection  of  our 
ivn  feeling  of  hopelessness  in  the  face  of 
ath. 

•S  IT  POSSIBLE  TO  PROVIDE  HELP  to  a 
.parent  who  is  unable  to  face  the  impend- 
(g  death  of  a  child?  Can  we  help  the 
went  come  to  terms  with  grief  suffi- 
lently  to  be  able  to  continue  to  provide 
)ve  and  emotional  support  to  the  child? 
i'ould  it  be  better  if  some  mothers  were  to 
o  away  and  never  return? 

With  our  knowledge  of  child  develop- 
lent,  we  can  assume  it  is  best  for  the  child 
have  continued  support  and  love  from 
er  parents.  If  this  is  accepted,  then  a  first 
m  would  be  to  help  the  parent  come  to 
rms  with  her  overwhelming  feelings,  to 
alk  about  her  fear,  anger,  and  anxiety, 
nitially,  this  means  letting  her  know  that 
ou  recognize  her  inability  to  face  her 
hild"s  impending  death. 

Parenthood  at  any  time  includes  some 
iegree  of  anxiety,  and  in  healthy  parent- 
lood  this  anxiety  is  used  to  motivate  the 
)arent  to  care  for  and  protect  the  child.  In 
iddition ,  parenthood  is  fraught  w  ith  poten- 
ial  or  actual  guih  feelings  that  one  is  not 
ioing  all  the  things  one  should,  and  that 
iometimes  parents  are  short  tempered  or 
lack  knowledge,  resources,  and  time  to 
Tieet  all  their  children's  needs.  Normally, 
these  feelings  are  kept  in  perspective  and 
parents  recognize  that  they  have  needs  of 
their  own  and  limitations  in  their  child- 
rearing  abilities  —  and  that  the  children 
are  doing  quite  well  anyway. 

When  a  child  becomes  ill,  the  anxiety 
and  guilt  can  easily  surface  and  distort 
parental  functioning.  One  task  of  nurses 
and  others  working  with  parents  of  dying 
FEBRUARY  1975 


children  is  to  avoid  any  behavior  that 
might  increase  the  parents'  guilt  feelings. 
In  times  of  crisis,  parents  may  be  hypersen- 
sitive to  any  suggestion  of  inadequacy  oi 
omissions  in  the  present  or  past  care  of  the 
child;  since  they  are  already  accusing 
themselves,  they  are  only  too  ready  to  pick 
up  implied  criticism  from  others.  It  is  un- 
helpful to  dwell  on  past  behaviors  when 
what  is  needed  is  development  of  func- 
tional, helpful  behavior  for  the  pre.sent. 

To  get  back  to  the  situation  described: 
anger  and  accusation  will  not  help  either 
mother  or  child.  Letting  the  mother  know 
that  you  understand  how  overwhelmed 
and  helpless  she  feels  may  help  her  ac- 
knowledge the  child's  prognosis.  The  nurs- 
ing staff,  too,  need  a  chance  to  say  how 
they  feel,  to  discuss  their  anger  and  dis- 
quiet, and  to  learn  how  to  cope  with  their 
feelings. 

WHEN  A  CHILD  H.AS  A  FATAL  ILLNESS, 
parents  must  be  helped  to  come  to 
terms  with  their  anticipated  loss.  Their 
coping  abilities  inay  be  severely  strained 
by  this  crisis.  We  have  all  seen  some  of  the 
ways  parents  try  to  regain  some  sense  of 
control  in  this  situation:  by  searching  far 
and  near  for  other  medical  opinions,  by 
participating  in  the  child's  care  by  helping 
with  treatments,  and  by  becoming  in- 
volved in  other  hospital  activities.  For 
many,  it  is  a  time  for  reassessing  values 
and  thinking  about  the  meaning  of  their 
lives.  Futterman  and  Hoffman  have  writ- 
ten about  some  of  these  processes  as  they 
saw  them.^ 

The  mother  described  was  able  to  come 
to  terms  with  her  feelings  sufficiently  to  be 
able  to  return  and  help  care  for  her  child. 
As  she  grieved  for  this  child,  she  also 
mourned  for  the  child  she  had  lost  earlier 
and  finally  began  to  come  to  terms  with 
that  loss. 

One  cannot  provide  a  happy  ending  for 
such  an  episode.  But  if,  when  working 


with  parents  who  are  suffering  the  loss  of  a 
child,  we  can  help  them  cope  and  reestab- 
lish equilibrium  so  they  can  provide  the 
love  and  care  their  child  needs,  we,  tcxi, 
may  feel  less  helpless  and  more  fulfilled  in 
our  role. 

References 

1 .  Fulternian.  B.H.  et  al.  Parental  anticipatory 
mourning.  In  Schoenberg.  B.  Psychosocial 
aspects  of  terminal  care .  edited  by  Schoen- 
berg etal.  New  York.  Columbia  University. 
197^2. 

2.  Green,  Morris.  Reactions  to  the  threatened 
loss  of  a  child:  a  vulnerable  child  syndrome. 
Pediatric  management  of  the  dying  child. 
Part  .V  Pediatrics  34: 1:58  -66  .  Jul.  1964. 

.3.  Futlemian,  E.H..  and  Hoffman.  I.  Crisis 
and  adaptation  in  the  families  of  fatally  ill 
children,  /n  Anihonv .  E.  James.  The  impact 
of  disease  and  death,  edited  by  E.J.  An- 
thony andC.  Koupemik.  vol.  2.  New  York, 
Wiley,  1973.  ^ 


THE  CANADIAN  NURSE     31 


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meet  a  variety  of  learning  needs 


'HYSICAL  EXAMINATION  FILMS 

A  series  of  12  sound  motion  pictures  in  color  with 
physical  examination  procedures  correlated  with  the 
content  of  Dr.  Bates'  book,  A  Guide  to  Physical  Exami- 
nation. (Films  may  be  used  to  supplement  any  text  on 
the  physical  examination.)  Average  running  time:  10 
minutes. 

•  Examination  of  the  Head  and  Neck 

Examination  of  the  Thorax 

Examination  of  the  Heart 

Examination  of  Pressures  and  Pulses 

Examination  of  the  Breasts  and  Axillae 

Examination  of  the  Abdomen 

Examination  of  the  Male  Genitalia,  Anus  and  Rectum 

Examination  of  the  Female  Genitalia,  Anus  and 
Rectum 

Examination  of  the  Peripheral  Vascular  System 

Examination  of  the  Musculoskeletal  System 

Examination  of  the  Neurological  System  (Part  I  and  II) 

Special  Procedures  of  the  Pediatric  Physical 
Examination 

Produced  under  the  supervision  of  Barbara  Bates,  M.D. 
(Special  procedures  of  the  Pediatric  Physical  Exami- 
nation supervised  by  Robert  A.  Hoekelman,  M.D., 
Associate  Professor  of  Pediatrics,  University  of  Roches- 
ter, School  of  Medicine  and  Dentistry.) 

Each  title  is  available  in  16mm  sound,  or  Super  8mm 
(magnetic  and  optical)  for  Fairchild,  Kodak  and  Techni- 
color cartridges,  or  on  reels. 

Instructor's  manual  available:  "A  Visual  Guide  to  Physi- 
cal Examination:  A  Motion  Picture  Film  Series." 


MULTIPLE  BIRTHS:  TWINS 

New  in  the  Human  Birth  Films  Series 

In  dramatic  live  action  .  .  .  this  close-up,  full-color 
(sound  or  silent)  film  of  the  delivery  of  twins  offers 
students  an  opportunity  for  a  rare  learning  experience. 
(Running  time:  about  5  minutes.) 

Available  in  16mm  sound,  or  Super  8mm  sound  (mag- 
netic or  optical)  for  Fairchild,  Kodak  and  Technicolor 
reels.  Also  available  in  a  silent  version  with  superim- 
posed titles  in  2  Technicolor  silent  cartridges  or  1  Kodak 
cartridge. 

Other  available  Human  Birth  Films:  Vertex  Delivery, 
with  Forceps.  Vertex  Delivery,  Spontaneous.  Breech 
Delivery,  Assisted.  Breech  Delivery,  with  Forceps. 
Breech  Delivery,  Extraction.  Cesarean  Delivery. 

Available  in  separate  Super  8mm  film  loops  (sound  or 
silent),  or  on  one  16mm  sound  film  showing  all  presen- 
tations. 


^v^       y  ' 


LIPPINCOTT 

SUPER-8MM  FILM  LOOPS  (Silent) 

Procedures  in  Patient  Care:  Wound  Care  (8  loops). 
Urinary  Catheterization  and  Care  (9  loops).  Injection 
Technic  (9  loops).  Drainage,  Suction,  Irrigation:  Pul- 
monary and  Gastric  (15  loops).  Lifting  and  Moving  Pa- 
tients (6  loops).  Positioning  and  Exercise  (3  loops). 
Hygiene  (3  loops).  Asepsis:  Medical  and  Surgical  (9 
loops).  Bedmaking  (6  loops)  Each  Film  Loop:  $21.50 
Lippincott  film  loops  can  be  displayed  with  the  Techni- 
color Super/8  Movie  Projector,  or  with  similar  projectors. 


For  additional  information  on  LLS,  dmi  Experiences  in 
Clinical  Nursing,  Physical  Examination  Films, 
Human  Birth  Films,  or  Lippincott  Film  Loops, 
please  write: 

Lippincott 

J.  B.  LIPPINCOTT  COMPANY  OF  CANADA  LIMITED 

SERVING  THE  HEALTH  PROFESSIONS  IN  CANADA  SINCE  1897 
75  HORNER  AVE.   TORONTO.  ONTARIO     M8Z  4X7     (416)252-5277 


Ostomy  skin  barriers 
for  decubitus  ulcers 


A  specialized  treatment  for  one  condition  can  sometimes  be  adapted  for  others. 
Karaya  powder  and  other  skin  barriers  used  in  enterostomal  therapy,  are  finding 
a  rightful  place  in  the  treatment  of  decubitus  ulcers. 


Ruth  Greene 


«! 


Many  new  skin  barriers  are  available  to 
treat  the  excoriated  skin  around  colos- 
tomies, ileostomies,  and  so  on.  Although 
used  primarily  to  protect  the  skin  around 
stomas  and  to  promote  healing  of  reddened 
areas  underneath,  these  barriers  can  be 
successfully  applied  to  decubitus  ulcers. 
We  are  not  far  enough  along  in  our  pro- 
gram of  healing  decubitus  ulcers  with 
karaya  to  have  gathered  much  data,  but  the 
results  at  our  hospital  so  far  have  been 
encouraging. 

Karaya  procedure 

Prior  to  the  actual  treatment,  the  fol- 
lowing are  important; 

1 .  Culture  of  infected  areas,  subse- 
quently done  every  two  weeks  until  the 
area  is  clear  of  infection. 

2.  Measurement  of  the  lesions,  to  pro- 
vide a  base  for  comparison  and  for  setting 
a  goal  for  complete  healing.  Measure- 
ments are  then  done  periodically  to  en- 
courage patient  and  staff. 

3 .  Provision  of  a  high  protein  diet,  to 
rebuild  cells  systematically. 


Ruth  Greene  (R.N..  Royal  Victoria  Hospital 
school  of  nursing.  .Montreal;  E.T.  —  Enteros- 
tomal Therapist  —  Cleveland  Clinic,  Cleve- 
land. Ohio)  is  assistant  director  of  the  inservice 
education  department.  Saint  John  General 
Hospital.  Saint  John.  New  Brunswick. 
34     THE  CANADIAN  NURSE 


The  treatment  itself  follows  the  karaya 
procedure  outlined  in  box,  on  page  35. 

Once  treatment  has  begun,  and  as  new 
epithelial  tissue  forms  around  the  wound 
edge,  we  advance  the  karaya  gum  ring  to 
surround  the  unhealed  portion  of  the  le- 
sion. Karaya  rings,  with  various  inside 
diameters,  can  be  obtained,  or  large  rings 
can  be  cut  to  fit  and  the  ends  pressed  to- 
gether to  seal  them. 

John 

Our  first  patient  was  a  30-year-old  male 
with  multiple  sclerosis  who  had  deep  ul- 
cers on  his  buttocks  and  hips  and  smaller 
lesions  on  his  inner  knees. 

John  S.  was  not  a  good  candidate,  as  it 
was  difficult  to  set  goals  and  be  enthusias- 
tic about  healing.  He  knew  his  condition 
was  deteriorating.  He  was  very  depressed 
and  really  did  not  care  if  his  ulcers  healed, 
as  their  healing  would  not  make  him  well. 

A  high  protein  diet  was  ordered  for  him 
but  John  just  picked  at  his  tray  and  insisted 
his  wife  bring  him  root  beer  and  french 
fries.  She  did  this  almost  daily. 

Even  under  these  circumstances,  im- 
provement has  been  noted  in  the  lesions. 

The  procedure  was  started  22  June 
1974,  when  the  lesions  were  measured. 
They  were  again  measured  18  September, 
and  the  treatments  were  continued.  The 
following  measurements  in  inches  show 
the  improvement  that  had  taken  place 
during  those  three  months. 


X  2.75" 
X  I.25" 
X  1. ()()■' 
X    .75" 


22  June 
Right  hip  3. ()()■■ 

Left  hip  l.iy 

Coccyx  \.5(y 

Right  Imee  \ .%)" 

Left  knee  .75"" 

18  September 
Riglil  hip  2.75'"  X  2.25" 

Left  hip  2.25""  x  1.5()"" 

Coccyx  l.OO""  X     .75" 

Right  knee  .75""  x     .50"" 

Left  knee  healed 

No  record  of  depth  of  ulcers  was  made, 
but  they  were  deep  and  are  filling  in  well. 

John  is  reluctant  to  be  turned  and  will 
work  himself  onto  his  right  hip,  which  has 
been  slow  to  heal. 

Culture  reports  showed  infection  in  the 
large  deep  areas  on  his  hips  and  buttocks 
and,  although  reports  have  varied,  they 
still  show  some  moderate  growth  of 
staphylococcus  aureus. 

None  of  the  barriers  used  is  sterile,  nor 
is  the  karaya  powder;  but  aseptic  technique 
is  important  nevertheless. 

Karaya  sheets  (8"  x  8"")  were  used  on 
John's  buttocks  as  he  had  smaller  open 
areas  surrounding  the  large  one,  and  red 
skin  in  between  the  areas. 

Elaine 

Our  second  patient,  a  55-year-old  fe- 
male, was  admitted  after  it  became  increas- 
ingly difficult  to  look  after  her  at  home. 
Elaine  B.  was  obese,  crippled  with  arthri- 
FEBRUARY  1975 


s,  confused,  and  belligerent  when 
imed.  There  were  multiple  breakdown 
reas  on  her  body  but  few  deep  ulcers. 

She  had  two  large  raised  areas  on  the 
ack  of  her  head,  which  were  partly  necro- 
c  tissue  and  partly  oozing  pus.  These, 
hen  debrided,  were  1/2""  deep  and  3/4'" 
:ross.  After  three  weeks  of  treatment  they 
re  now  pin-head  size.  We  discontinued 
sing  karaya  rings,  as  they  melted  too 
uickly ,  but  did  use  two  pads  of  Reston. 

One  breast  fold  was  red  and  oozing, 
fith  a  large  necrotic  area  on  the  lower  part 
f  the  breast  which,  when  debrided,  was 
/4"  deep.  We  used  karaya  rings  and  Re- 
ton  to  try  to  keep  the  fold  surfaces  apart. 
ifter  six  weeks,  pink  and  healthy  tissue 
overs  the  area. 

Elaine's  groin  areas  were  raw,  but  not 
leeply  excoriated.  We  discontinued 
araya  rings  as  they  melted  also  but.  with 
ontinued  treatment  and  Saran,  the  area  is 
low  healed.  We  just  sprinkle  it  with 
araya  powder  to  prevent  further  break- 
low  n. 

Saran  Wrap  has  been  taped  with  1 ""  3M 
Micropore  tape  on  those  areas  where  it 
nded  to  come  loose.  Skin  Prep  was  used 
is  a  preventative  on  normal  and/or  red- 
lened  skin  to  form  a  protective  coating. 
Caraya  powder  was  sprinkled  on  small, 
ipen,  red  areas.  We  applied  Skin  Prep  on 
op  and  allowed  it  to  dry. 

All  areas  originally  open  are  now 
lealed.  after  one  to  two  months,  but 
ilaine"s  general  condition  is  so  poor  that  if 
1.2h.  turnings  are  not  scrupulously  carried 
)ut,  new  areas  start  breaking  down. 

Treatment  has  been  applied  to  three 
ither  patients  who  had  ulcers  on  coccyx. 
leels,  and  ankles.  These  lesions  have  been 
smaller  in  diameter  and  depth  than  those  of 
John  and  Elaine,  and  have  healed  quickly . 


n  Karaya  rings  or  wafers,  with  various 
inside  and  outside  diameters,  10  to  a  pack- 
age; karaya  sheets  8'"  x  8"";  or  karaya 
powder  in  a  2.5  oz.  .squeeze  bottle.  These 
are  available  from  United  Surgical 
Co. /Canadian  Howmedica  Ltd.,  90 
Woodlawn  Road  West,  Guelph,  Ontario, 
or  from  Atlantic  Surgical  Co. ,  1834  Lans- 
downe  Avenue,  Merrick,  New  York. 

We  are  trying  skin  barriers  other  than 
karaya  rings  on  those  areas  where  the  rings 
melt: 

n  Stomahesive  (E.R.  Squibb  &  Sons, 
Ltd.)  3"  X  4"  or  4"  x  4".  This  is  thin, 
has  a  shiny  surface,  will  not  readily  melt, 
and  is  not  softened  by  the  irrigation  fluid. 
Although  more  expensive  than  most  bar- 
riers, it  can  be  left  on  longer  provided  the 
seal  is  not  broken  between  it  and  the  skin. 
The  center  needs  to  be  cut  to  the  exact  edge 
of  ulcer,  but  a  paper  pattern  of  the  hole  size 
could  b>e  made  to  eliminate  measuring 
each  time  it  is  changed. 
D  Colly-.seels  (Mason  Laboratories  — 
Willowgrove,  Pennsylvania,  U.S.A.). 
These  are  thick,  blue,  and  come  10  to  a 
package  in  various  outside  diameters  2" "  to 
6"".  Again,  the  center  requires  cutting  to 
exact  size  of  ulcer.  They  adhere  to  damp 
skin,  so  should  be  dampened  on  both  sides 
and  allowed  to  become  tacky  before  apply- 
ing. 

D  Skin  Prep  (United  Surgical  Co.)  is  a 
collodion-like  substance  that  leaves  a 
shiny,  protective  film.  This  is  meant  for 
reddened  areas  only,  and  is  used  alone  or 
on  top  of  karaya  ptiwder.  It  stings  on  raw 
skin,  but  is  not  harmful.  Must  be  allowed 
to  dry.  Do  not  use  under  other  skin  bar- 
riers. Skin  Prep  comes  in  spray  can  or  a 
bottle  with  applicator. 
n  3M  Micropore  Tape,  in  1"  and  2" 
widths,  is  easy  to  apply  in  that  it  rips  eas- 
ily, leaves  no  irritation  on  skin,  peels  off 
easily,  yet  gives  a  good  seal.  It  was  used 
on  areas  where  the  Saran  was  apt  to  come 
off. 

Summary 

In  the  short  time  we  have  been  using  this 
procedure,  we  have  found  it  worthwhile. 
It  takes  time  to  do  the  treatment,  but  it  is 
done  only  once  a  day.  compared  with  the 
conventional  q.4h.  treatments. 

We  shall  concinue  to  u.se  skin  barriers  in 
treating  patients  with  skin  ulcers  and  rec- 
ommend that  nursing  personnel  institute 
the  procedure  on  their  patients  with  similar 
problems.  "^ 


THE  KARAYA  PROCEDURE* 

Surgical  debridement,  if  indicated,  is  done 
first.    Strict    aseptic    technique    is    used 
throughout  the  karaya  procedure.   While 
adaptations  are  made  for  each  patient,  the 
basic  steps  are  these: 
I.  Irrigate   ulcer  and  surrounding   skin 
gently   with   approximately   250   cc. 
pHisoHex  solution  (2  oz.  pHisoHex  to 
4  oz.  normal  saline)  using  an  Asepto 
syringe.  Gently  cleanse  surrounding 
skin  with  a  gauze  sponge,  using  a  cir- 
cular motion. 

2.  Irrigate  with  approximately  250  cc. 
normal  saline  solution.  It  is  important 
to  irrigate  sufficiently  to  remove  all  of 
the  pHisoHex  solution. 

3.  Irrigate  twice  with  39c  hydrogen 
peroxide  solution.  Completely  dry  the 
surrounding  skin  with  sponge,  taking 
care  not  to  touch  the  surface  of  the 
ulcer.  Leave  ulcer  site  moist. 

4.  Apply  karaya  gum  ring  to  skin,  mold- 
ing it  to  fit  closely  around  edge  of 
ulcer. 

5.  Sprinkle  karaya  powder  on  ulcer,  cov- 
ering the  entire  surt'ace  with  powder. 

6.  Cut  a  hole  in  the  middle  of  a  sheet  of 
Reston  (polyurethane  foam  pad  with 
adhesive  backing)  the  size  of  the  karaya 
gum  ring.  Apply  Reston  to  the  skin 
around  wound  so  that  Reston  fits 
around  the  karaya  gum  ring.  This  pad- 
ding prevents  pressure  on  the  ulcer  and 
distributes  body  weight  around  the 
site.  For  very  large  wounds,  more  than 
one  sheet  of  Reston  may  be  necessary 
to  relieve  pressure.  If  so,  place  one 
sheet  directly  on  top  of  another. 

7.  Cover  opening  in  Reston  with  Saran 
wrap  to  contain  drainage  from  ulcer, 
and  to  provide  a  window  through 
which  ulcer  can  be  visualized. 

Repeat  steps  I  through  7  every  24  hours. 
Lift  the  Saran  wrap  every  8  hours  and  add 
karaya  powder  to  the  wound.  Extensive 
oozing  can  be  expected  during  the  first  few 
days.  Since  karaya  swells  with  moisture, 
drainage  may  seem  profuse.  Daily  irriga- 
tions wash  off  most  of  the  karaya.  Do  not 
attempt  to  remove  any  karaya  that  adheres 
to  the  wound  following  gentle  irrigation. 


*  Wallace,  Gladys;  Hayier,  Jean;  "Karaya 
for  Chronic  Skin  Ulcers,' "  American  Jour- 
nal of  Nursing,  volume  74  #6,  June  1974, 
p.  1097. 


THE  CANADIAN  NURSE     35 


names 


Canadian  nursing  has  lost  one  of  its  best 
known  and  most  respected  nurses.  Helen 
McArthur  Watson,  a  former  president  of 
the  Canadian  Nurses' Association  (1950- 
54)  and  national  director  of  the  nursing 
service  of  the  Canadian  Red  Cross 
Society,  died  in  Guelph,  Ontario,  17 
December  1974. 

Dr.  Watson  was  the  first  nurse  to  re- 
ceive an  honorary  citation  from  the 
CN.A.  in  1971.  She  had  received  in 
1957  the  highest  international  nursing 
award,  the  Florence 
Nightingale  Medal, 
from  the  International 
'■  -3.  ggi     Committee    of    the 

■^^    «>   W      Red  Cross.  In  1958, 

f^l^^'V     '  »      '^^^     received     the 

f  1^7-»  Coronation    Medal, 

and    in     1964    had 

conferred  on  her  an 

honorary   degree   of 

Doctor    of   Laws    from    the    University 

of  Alberta. 

A  pioneer  from  the  beginning  of  her 
nursing  career.  Dr.  Watson  was  a  public 
health  nurse  in  rural  Alberta  and,  many 
years  later,  was  relief  coordinator  for  the 
League  of  Red  Cross  Societies  in  war-torn 
Korea.  Before  becoming  national  director 
of  nursing  service  of  the  National  Red 
Cross,  Dr.  Watson  had  been  director  of  the 
University  of  Alberta  school  of  nursing 
and  director  of  the  public  health  nursing 
division  of  the  Alberta  provincial  depart- 
ment of  health. 

In  the  words  of  Louise  Miner,  who  was 
president  of  CNA  when  the  honorary  cita- 
tion was  conferred,  Helen  McArthur 
Watson  was  "a  person  whose  country  is  the 
world  and  whose  religion  is  to  do  good."" 


Glenna  Rowsell  (R.N.,  St.  Johns  General 
Hospital  school  of  nursing;  Dipl.  Clin. 
Supervision,  Dipl.  Nurs.  Educ.,  and 
Admin..  University  of  Toronto;  Dipl.  Pub- 
lic Health  Nursing,  University  of  Ottawa) 
has  resigned  as  part- 
time  consultant  in 
social  and  economic 
welfare  for  the 
/q;^  ^g  New  Brunswick 
Association  of 
Registered  Nurses. 
She  now  devotes  full 
time  to  her  position 
*  ^        of   employment    re- 

lations officer  with  the  Provincial  Collec- 
tive    Bargaining     Councils    of    New 
Brunswick. 
36     THE  CANADIAN  NURSE 


Rowsell  was  formerly  director  of  the 
school  improvement  program  of  the  Cana- 
dian Nurses  Association  (CNA),  prior  to 
which  she  had  been  associate  director  of 
the  school  of  nursing  of  St.  John's  General 
Hospital.  Active  in  association  work,  she 
is  currently  member-at-large  of  the  cna 
board  of  directors,  representing  social  and 
economic  welfare. 


The  Montreal  Children "s  Hospital  Centre 
has  announced  two  appointments: 

Margaret  lreton(R.N.,  B.S.N. ,  Univer- 
sity of  British  Columbia  school  of  nursing) 
as  assistant  director  of  nursing,  staff  edu- 
cation. Prior  to  her  current  appointment, 
she  was  inservice  coordinator  for  Glendale 
Lodge,  Victoria,  British  Columbia. 

Elizabeth  M.  Kannon  (R.N..  St.  Marys 
Hospital  school  of  nursing,  Montreal; 
B.N.,  McGill  University;  M.Sc.N.,  Uni- 
versity of  Colorado,  Boulder,  Colo.)  as 
associate  director  of  nursing,  division  of 
ambulatory  services.  Until  recently,  she 
had  been  in  charge  of  emergency  at  the 
Boston  Children's  Medical  Centre. 


Helen  Gemeroy  (R.N.,  Provincial  Hospi- 
tal school  of  nursing,  Ponoka,  Alberta; 
B.A.,  Sir  George  Williams  University, 
Montreal;  M.A.,  Columbia  University, 
New  York)  associate  professor,  school  of 
nursing,  and  director  of  nursing  — 
psychiatry.  Health  Sciences  Centre  Hospi- 
tal, University  of  British  Columbia,  has 
added  to  her  responsibilities  those  of  as- 
sociate professor  in  the  faculty  of  medicine 
at  UBC. 

According  to  Gemeroy,  because  the 
UBC  school  of  nursing  is  under  the 
faculty  of  applied 
science,  and  the  di- 
rection of  the  Health 
Sciences  Centre 
Hospital  comes 
largely  through  the 
faculty  of  medicine, 
communication  be- 
tween nursing  and 
medicine  is  com- 
plex Her  honorary  appointment  to  the 
faculty  of  medicine  has  served  to  sim- 
plify this  situation  and,  thus,  indirectly 
benefit  nursing. 


Nora  J.  Earle(Reg.  N.,  Hamilton  General 
Hospital  school  of  nursing;  B.N.,  McGill 
University)  has  been  appointed  advisor  in 


nursing  in  the  Ontario  Ministry  of  Correc- 
tional Services.  She  was  formerly  as- 
sociate director  of  nursing,  ambulatory 
services,  at  the  Montreal  Children's  Hos- 
pital. 


The  Memorial  University  of  Newfound- 
land school  of  nursing  has  announced  the 
appointment  of  several  faculty  members: 
Marilyn  Avery  (B.Sc,  Memorial  U; 
M.S.N..  New  York  Medical  School)  is 
assistant  professor.  She  has  been  on  the 
nursing  staff  of  Flower  and  Fifth  Avenue 
Hospital,  New  York,  and  Stanford  Uni- 
versity Hospital,  Stanford,  California. 
More  recently,  she  has  been  a  nurse- 
instructor  at  the  Brockville  Regional 
School  of  Nursing,  Brockville,  Ontario. 


M.  Avery 


'K..^    Fill 
P.  Bruce-Lockhart 


lursing,  Kingston;  M.S.,  Boston  Univer- 
ty  school  of  nursing)  is  assistant  profes- 
ir.  Her  nursing  career  has  been  chiefly 
£voted  to  public  health  and  has  brought 
r  to  Toronto,  Moose  Factory,  Hamil- 
)n.  and  Kenora  in  Ontario,  and  to 
'arbonear  in  Newfoundland. 

Mary   Victoria  Tiffin 
(B.Sc.N..     Univer- 
sity of  Toronto.  To- 
ronto, Ont.)  is  a  lec- 
turer. Her  prior  ex- 
perience   has    been 
that  of  staff  nurse, 
Grace  General  Hos- 
pital.    St.     John's, 
Newfoundland. 
Laura    Hope    Toumishey    (S.R.N. , 
aiinus    Nursing    College    and    Groote 
ctiuur    Hospital,    Cape    Town,    South 
virica;    S.C.M.,    Robroyston    Hospital, 
ilasgow,     Scotland;     B.N.,     Memorial 
iiversity   of  Newfoundland)    is   a   lec- 
.irer.  Since  coming  to  Canada,  she  has 
een  on  the  nursing  staff  of  the  Montreal 
!|jencral  Hospital,  Victoria  General  Hos- 
(jiilal  in  Halifax.  Toronto  General  Hospi- 
jjal.  and  St.  John's  General  Hospital.  She 
las  also  been  an  instructor  at  the  Grace 
Jospital.  St.  John's. 

DVce  Zadroga  (R.N..  Crouse-lrving  Hos- 
ital  school  of  nursing.  Syracuse,  New 
'ork;  B.S..  M.S..  Syracuse  University 
chool  of  nursing)  is  assistant  professor, 
ihe  has  been  a  staff  nurse  and  a  clinical 
nslructor  at  the  Crouse-lrving  Hospital  in 
yracuse  and  an  instructor  at  Boston 
Jniversity  school  of  nursing. 


4elena  Friesen  Reimer  (R.N.,  Winnipeg 
jeneral  Hospital  school  of  nursing; 
P.N..  McGill  University;  M.A..  Uni- 
ity  of  Chicago;  LL.D..  Uni- 
versity of  Win- 
nipeg) has  been 
conferred  the 

medal  of  the  Order 
of  Canada,  the  high- 
est    of     Canadian 
honors.  In  October. 
1974,    she    received 
.^       an    honorary   doctor 
rXl      of    laws    degree    at 
he  University  of  Wmnipeg. 

Rcimer's  nursing  career  has  been  a  truly 
lucrnational  one:  first  with  UNRRA  and 
hen  with  v\H<).  she  has  worked  in  Egypt 
iiid  Palestine,  in  Formosa  (then  a  province 
>l  China),  in  Cambodia,  and  once  again  in 
i.i;>pt.  In  1938  she  became  secretary- 
registrar  of  the  Association  of  Nurses  of 
he  Province  of  Quebec  (now  ONQ).  a  post 
she  held  until  her  retirement  in  1970. 

Now  living  in  Winnipeg.  Reimer  has 
beeome  a  member  of  the  Manitoba  Citi- 
zenship Council  and  the  Winnipeg  Senior 
C  iii/ens  Council.  She  also  attends  univer- 
Mi>  to  enrich  her  knowledge  of  art  and 
puliiical  science. 

FEBRUARY  1975 


New  appointments  to  the  faculty  of  the 
nursing  program  of  Grant  MacEwan 
Community  College,  Edmonton,  Alberta, 
have  been  announced; 

Jeanette  Boman  (R.N.,  University  of 
Alberta  Hospital,  Edmonton;  B.S.N., 
University  of  Alberta)  has  had  experience 
in  general  duty  nursing  in  medicine, 
surgery,  and  intensive  care.  She  teaches  in 
the  areas  of  medicine  and  surgery. 

Isabelle  Darrah  (R.N.,  Edmonton  Gen- 
eral Hospital.  B.S.N.,  University  of 
Alberta)  has  had  experience  in  clinical 
nursing.  After  working  as  a  head  nurse, 
she  taught  psychiatric  nursing  and  nursing 
fundamentals. 

Mary  Dawson  (R.N.,  Misericordia 
Hospital.  Edmonton;  B.A.  in  Social 
Work,  Utah  State  University,  Logan)  has 
had  experience  in  clinical  nursing,  includ- 
ing two  years  of  volunteer  work  in  the 
West  Indies,  and  in  psychiatric  social 
work. 

Sheila  Cravelle  (R.N.,  University  of 
Alberta  Hospital,  Edmonton;  B.S.N. , 
University  of  Alberta)  has  had  experience 
in  medical-surgical  nursing  and  has 
studied  cardiovascular  intensive  care  nurs- 
ing. 


M.  Dawson 


S.  Gravelle 


S.  Whytock 


Marilyn  Meyer  (R.N.,  Calgary  General 
Hospital;  B.S.N.,  University  of  Alberta) 
has  had  experience  in  clinical  nursing  and 
has  taught  obstetrics  and  gynecology. 

Camille  Romaniuk  (R.N.,  Edmonton 
General  Hospital;  B.S.N. ,  University  of 
Alberta)  has  had  experience  in  general 
duty  nursing,  nursing  administration,  and 
public  health  nursing. 

Sandra  Whytock  (R.N.,  Wellesley 
Hospital,  Toronto;  B.S.N.  University  of 
Alberta)  has  had  experience  in  clinical 
nursing  and  has  taught  nursing  fundamen- 
tals, medical-surgical  nursing,  and  inter- 
mediate surgery. 


Jennifer  MacPhee  (S.R.N. ,Radcliffe  In- 
firmary, Oxford,  England)  has  been  ap- 
pointed provincial  nursing  consultant  with 
the  St.  John  Ambulance  Association  in 
Nova  Scotia.  She  will  travel  through  the 
province  to  promote  teaching  of  both  pa- 
tient care  and  child  care  in  the  home,  as 
well  as  encourage  groups  to  take  an  in- 
terest in  this  training  as  a  service  to  their 
communities. 

MacPhee  has  worked  at  the  Grenfell 
Mission  Hospital  in  St.  Anthony, 
Newfoundland,  and  at  the  Halifax  Civic 
hospital. 


The  Saskatchewan  Registered  Nurses' 
Association  has  announced  two  new  ap- 
pointments, effective  1  November  1974: 

Catherine  O'Shaughnessy  (R.N..  St 
Mary's  Hospital  school  of  nursing. 
Montreal;  B.Sc.N.,  St.  Francis  .Xavier 
University,  Antigonish,  N.S.)  is  executive 
assistant  in  the  .srn.a  office.  She  is  cur- 
rently completing  thesis  requirements  for 
the  master  of  education  degree  at  Univer- 
sity of  Regina. 

O'Shaughnessy  has  for  several  years 
been  associated  with  the  Regina  Grey 
Nun's  Hospital  school  of  nursing,  as  in- 
structor, assistant  director,  and  director. 
Most  recently,  she  was  a  research  officer 
with  the  Saskatchewan  department  of 
health,  research  and  planning  branch. 

Norma  Hopps  (R.N.,  Regina  General 
Hospital  school  of  nursing;  B.S.N.,  Uni- 
versity of  British  Columbia)  is  nursing 
consultant  with  the  association.  She  has 
worked  at  the  Regina  General  Hospital  as  a 
medical  instructor  and  head  nurse,  and  as 
assistant  director  of  nursing  at  the  South 
Saskatchewan  Hospital  Centre,  Wascana 
Division,  Regina. 

Hopps  has  recently  returned  from 
Nigeria,  where  she  served  with  Canadian 
University  Service  Overseas  as  nurse  tutor 
and  nurse  administrator. 


Marie  Anne  Toupin  (R.N.,  Pasqua  Hospi- 
tal, Regina;  B.N.,  McGill  University; 
M.S.  Denver  Medical  Center  of  the  Uni- 
versity of  Colorado,  Denver)  has  been  ap- 
pointed director  of  nursing  at  Bumaby 
General  Hospital.  She  has  held  supervis- 
ory positions  in  the  Royal  Victoria  Hospi- 
tal, Montreal,  and  University  cf  Alberta 
Hospital,  Edmonton. 


Marielle  Lalonde  (Reg.  N.,  Ottawa  Uni- 
versity school  of  nursing)  has  been  ap- 
pointed director  of  a  demonstration  project 
for  Planned  Parenthood  of  Ottawa  that  is 
designed  to  reach  the  French-speaking 
population  of  Ottawa  and  neighboring 
eastern  Ontario  communities.  She  will 
work  with  executive  director  Mary  Mills 
and  Planned  Parenthood  Ottawa's  board  of 
directors.  >? 

THE  CANADIAN  NURSE     37 


books 


Scientific  Principles  in  Nursing,  led.,  by 
Shirley  Hawke  Gragg  and  Olive  M. 
Rees.  563  pages.  St.  Louis,  Mosby. 
1974.  Canadian  Agent:  Mosby. 
Reviewed  hy  Shirley  Bartley.  Teacher. 
Misericordia  General  Hospital  School 
of  Nursing.  Winnipeg.  Manitoba. 

The  authors  suggest  a  variety  of  selected 
physiologic,  psychologic,  and  sociologic 
concepts  that  will  supply  the  nursing 
student  and  practitioner  with  a  rational 
approach  to  planning  patient  care  to  meet 
the  needs  of  the  individual  as  he  responds 
holistically  to  his  environment.  It  is 
intended  that  the  student  will  be  led  to 
apply  scientific  principles,  through 
problem-solving  activities,  in  using  the 
modified  adaptation  model  described  in  a 
beginning  chapter.  The  book  covers  the 
concepts  well  and  provides  a  sound  basis 
for  problem  solving. 

In  attempting  to  define  nursing,  the 
authors  expound  on  Henderson's  defini- 
tion, then  conclude  that  no  one  has  yet 
adequately  described  how  and  why  nurs- 
ing is  specifically  unique  and  different 
from  other  human  services.  Adaptation 
and  Selye"s  "stress  of  life'"  is  discussed 
briefly  in  chapter  1 ,  and  these  concepts 
are  related  to  the  nursing  process  and 
personal  and  community  health.  The 
organizational  charts  provided  and  the 
agencies  for  health  care  described  are 
those  existing  in  the  U.S  A  ,  but  know- 
ledge of  the  basic  setup  of  hospital 
departments,  and  their  relationship  is 
helpful  for  beginning  health  workers. 

Unit  two  begins  with  a  discussion  of 
adaptation  as  a  basis  for  patient  care;  at 
this  point  the  authors  touch  briefly  on 
both  Helsen's  adaptation-level  theory  and 
Roy's  four  modes  of  adaptation,  which 
seem  pertinent.  Chapter  13  in  this  unit, 
■"Planning  Nursing  Care.""  is  easy  to 
understand;  it  has  basic  definition  of 
nursing  process,  where  to  find  pertinent 
information,  and  a  well-developed  case 
study  on  which  a  sample  plan  of  care  is 
based. 

In  units  three  to  six,  an  attempt  to 
present  the  independent  nursing  roles, 
followed  by  the  dependent  and  collabora- 
tive roles,  has  been  made  at  the  cost  of 
organization.  The  beginning  student  may 
find  it  difficult  to  follow  the  text,  as 
information  on  a  particular  topic  is  spread 
throughout  the  book.  For  example.  Chap- 
ter 4.  ""Rehabilitation.'"  deals  briefly 
38    THE  CANADIAN  NURSE 


with  positioning  in  illness:  coping  with 
musculoskeletal  deterioration  (range  of 
motion  exercises,  with  illustrations)  is 
covered  in  chapter  19.  followed  by 
chapter  20  where  adaptation  to  dying  is 
discussed:  long-term  illness  is  singled  out 
in  chapter  33. 

The  authors  have  fulfilled  their  objec- 
tive: a  text  that  will  provide  ways  of 
translating  concepts  into  nursing  be- 
haviors through  problem-solving  ac- 
tivities. This  book  would  be  useful  for 
supplying  nursing  students  and  prac- 
titioners with  a  rational  approach  to 
planning  patient  care  that  meets  the  needs 
of  the  individual  as  he  responds  to  his 
environment. 


Understanding    Inherited    Disorders    by 

Lucille  F.  Whaley.  219  pages.  St. 
Louis,  Mosby,  1974.  Canadian  Agent: 
Toronto.  Mosby. 

Reviewed  by  Peggy-Anne  Field,  As- 
sociate Professor.  School  of  Nursing, 
University  of  Alberta,  Edmonton, 
Alberta. 

This  book  is  intended  as  a  resource  for 
health  professionals  who  are  not  geneti- 
cists, but  who  work  with  families  who 
have  members  with  an  inherited  defect  or 
disease. 

The  first  part  of  the  book  deals  with  the 
fundamental  mechanisms  of  heredity  and 
the  application  of  the  principles  to  defects 
and  diseases.  Following  this  general 
introduction,  specific  instances  of  single 
gene  disorders  and  chromosomal  aberra- 
tions are  discussed.  The  last  section  deals 
with  genetic  inheritance  and  equilibrium, 
interuterine  diagnosis  of  defects .  and 
genetic  counseling,  including  the  prob- 
lems of  ethical  management. 

In  the  early  chapters,  each  new  term 
introduced  is  italicized  and  a  definition  of 
the  term  given.  In  later  chapters,  when 
less  common  terminology  is  employed,  a 
cross-reference  to  the  original  definition  is 
supplied.  Explanations  are  simple  and  are 
linked  to  clinical  examples. 

Diagrams  are  well  chosen  and  com- 
plement the  written  text.  For  example,  in 
discussing  gene  inheritance,  the  Punnett 
square  and  a  diagram  of  genes  during 
meiotic  division  are  both  used.  This  aids 
in  interpreting  information  presented  in 
the  Punnett  square.  Similarly  the  dia- 
gram    illustrating    the    metabolism    of 


phenylalanine  shows  clearly  how  blocks 
at  different  points  in  the  metabolic  pat' 
way  produce  different,  but  related,  clii: 
cal  syndromes. 

The  symptoms,  diagnosis,   and  treat 
ment  of  inherited  diseases  are  outlined 
Obscure  conditions  are  dealt  with  brietl\ : 
more  commonly  seen  diseases  and  defect^ 
are  discussed  in  some  detail. 

The  section  on  counseling,  ethics,  and 
construction  of  a  family  pedigree  pro- 
vides a  useful  overview,  but  not  sufficient 
detail  for  those  persons  engaged  in  these 
activities. 

The  book  is  highly  readable.   Inht 
itance  can  be  understood  without  a  stroi 
mathematical  background.   It  provides 
simple,   but   sufficiently   detailed,    intro- 
duction to  inherited  disorders  for  those 
who  have  contact  with  affected  children 
and   their  families.    It   is   to   be   recom- 
mended for  those  who  seek  a  relativel\ 
simple  explanation  of  a  complex  subject . 


Special  Needs  of  Long-Term  Patients  by 

Carolyn  B.  Stevens.  288  pages. 
Philadelphia,  Lippincott,  1974.  Cana- 
dian Agent:  Lippincott,  Toronto. 
Reviewed  by  Sybil  Markowitz, 
Teacher,  Nursing  program,  Georgian 
Community  College.  Orillia.  Ontario. 

The  author,  who  is  a  licensed  practical 
nurse,  has  aptly  stated  her  purpose  in  the 
preface:  "This  book  was  written  with  one 
purpose  in  mind  —  to  promote  a  better 
understanding  of  long-term  patients  and  to 
(hopefully)  give  an  insight  into  their  prob- 
lems and  their  needs."" 

The  book  has  little  new  material  on  ac- 
tual nursing  care,  but  what  is  presented  is 
done  in  a  different  manner  than  is  usual. 
This  is  particularly  noticeable  in  the  first 
two  chapters,  which  deal,  primarily,  with 
interpersonal  relationships.  The  personal 
descriptions  of  long-term  patients  may  be 
felt,  by  some,  to  be  framed  in  rather 
■"familiar"  language.  However,  they  ap- 
pear to  be  written  with  much  love  and 
understanding  of  each  individual  patient 
and  his  family. 

Throughout  the  chapters,  this  personal 
approach  covers  all  aspects  of  nursing  care 
necessary  for  the  extended  care  patient. 
What  may  be  more  important,  nursing  at- 
titudes, both  positive  and  negative,  are 
discussed. 

(Conlinued  on  ptn>i'  40) 

FEBRUARY  1975 


OUT 


FRONT 


CONCEPTS  BASIC  TO  NURSING 

Pamela  Mitchell 

Focuses  on  [he  inlerpersonai  and  iniellectuat  sKiHs  basic  to  making  decisions  about  Ilie  nursing 
care  needed  by  patients  to  cope  witti  ttie  changes  in  daily  living  brougrit  at30ut  by  Iheir  stale  ot  tiealtli  or 
illness 

384  pages  —  $10.95 

THE  NURSE'S  GUIDE  TO  DIAGNOSTIC  PROCEDURES,  3/e 

Ruth  French 

Ihe  purpose  ot  ttiis  bool(  is  to  explain  the  data  used  and  procedures  carried  out  in  the  clinical 
laboratory  and  in  departments  of  radiology  and  nuclear  medicine,  relating  tnem  to  nursing  care  It 
contains  the  latest  materia^of  particular  significance  in  the  rapidly  changing  fields  of  chemistry  and 
imrnunohematology 

358  pages  —  soft  cover  —  S   6.55 

DYNAMIC  ANATOMY  &  PHYSIOLOGY,  4/e 

L.  L.  Langley.  Ira  Telford  &  John  Christensen 

Revision  ot  a  popular  superbly  written  and  illustrated  two-color  text  for  the  combined  anatomy  and 
physiology  course  Anatomy  and  physiology  are  integrated  throughout  to  highlight  and  clarity  their 
interrelationship  This  book  has  greater  depth  than  most  texts  in  this  market  yet  difficult  concepts  are 
explained  m  a  comprehensible  manner 

900  pages  —  SI  5.35 

IT'S  YOUR  BODY 

Lawrence  M.  Bison 

.  Pfesents  an  overview  of  the  organization  of  Ihe  body,  basic  terminology,  and  an  introduction  to 
cells  and  tissues,  this  book  proceeds  to  the  study  of  body  structure  through  the  regional  approach  in 


addition  to  numerous  line  drawings  and  diagrams,  the  book  is  illustrated  with  an  atlas  of  x-rays 
including  contrast  media  to  demonstrate  visceral  structure 

645  pages  —  SI  3.60 

PREGNANCY  AND  FAMILY  HEALTH  —  Vol.  1  The  Child- 
bearing  Family 

Betty  Anderson.  Mercedes  Camacho  and  Jeanne  Stark 

This  pfOQfdfTimed  book  is  the  first  ot  a  two-volume  series  on  the  cnildbearing  family  This  volume 
covers  the  normal  maternity  cycle  The  programmed  material  is  a  mixture  of  linear  and  branch-type, 
supplemented  by  some  straight  text  General  concepts  related  to  family  health  are  integrated  with 
material  on  the  maternity  cycle, 

450  pages  —  $    7.15 

MATERNITY  NURSING  TODAY 

Jay  Clausen.  Margaret  Flock,  Bernie  Ford,  Marilyn  Green  and  Elda  Popiel 

Discusses  maternity  nursing  from  a  family  approach  and  gives  coverage  to  such  current  social 
issues  and  phenomena  as  abortion  communes,  and  the  single  parent  family  Themes  throughout  the 
book  are  the  nursing  process  nursing  care  of  the  famdy  as  a  whole,  the  use  of  seit  in  nursmg  the 
normal  mother  and  newborn,  and  high  risk  mothers  and  infants 

950  pages  — SI  4.25 

CYCLOPEDIC  MEDICAL  DICTIONARY,  12/e 

Clarence  W.  Tatter 

This  amazing  reference  work  with  over  40,000  entries  has  been  praised  lor  its  convenient  size,  the 
completeness  of  its  definitions,  and  the  broad  range  of  medical,  nursing  and  allied  scientific  fields  which 
are  covered  It  gives  more  nursing  procedures  than  are  usually  found  m  nursing  handbooks  and 
individual  diseases  are  covered  in  terms  of  etiology,  symptoms,  laboratory  findings,  treatment  ant) 
nursing  care. 

1.754  pages  —  S10.25 


Spring  will  be  a  little  greater  this  year 


INTERRUPTIONS    IN    FAMILY    HEALTH    DURING    PRE- 
GNANCY —  Vol.  II  The  Childbearing  Family 

Betty  Anderson.  Mercedes  Camac/io  and  Jeanne  Stark 

This  IS  the  second  of  a  two-volume  programmed  series  on  Ihe  chilUuearmg  family  and  covers  the 
high  risk  pregnancy  All  the  material  has  been  class  tested  and  includes  behavioural  obiectives, 
glossaries,  and  pre-  and  post-tests  which  make  Ihe  books  ideal  as  supplements  reviews  or  for 
self-study 

480  pages  (tent.)  —  S   8.75 

NURSING  CARE  OFTHE  ALCOHOLIC  AND  DRUG  ABUSER 

Pamela  Burkhalter 

This  unique  book  provides  the  nurse  with  in-depth  material  covering  the  dynamics  and  characteris- 
tics of  alcohol,  alcoholism,  drug  abuse  and  drug  abusers,  as  well  as  the  nursing  care  interventions 
which  are  applicable 

384  pagas  (tent.)  —  $  8.25 

MATERNAL  AND  INFANT  CARE 

Elizabeth  Dickason.  Martha  Schult 

Emphasizes  the  rote  ot  the  nurse  as  educator  in  Ihe  field  of  malernal/infanf  care  f^uch  attention  is 
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576  pages  (tent.)  —  $13.25 


DERMATOLOGY  AND  SKIN  CARE 

John  Parrish 

Provides  knowledge  about  the  skin  m  an  inlereslmg.  readable,  and  simple  manner  The  book 
begins  at  a  simple  level  assuming  little  or  no  medical  background  It  builds  vocabulary  and  explains 
basic  medical  concepts  as  it  progresses  Inflammation,  immunology  healing  allergy  and  other 
concepts  are  introduced 

224  pages  (tent.)  —  $   7.65 

COMPREHENSIVE  PEDIATRIC  NURSING 

Gladys  Scipien.  Martha  Barnard.  Marilyn  Chard.  Jeanne  Howe  and  Patricia  Phillips 

-  To  meet  the  extensive  changes  m  pediatrics  and  in  nursmg.  the  editors  of  this  new  book  have 
designed  its  content  m  Ihe  firm  belief  that  comprehensive  pediatric  nursmg  must  be  derived  from  art 
understanding  of  child  and  family  development,  a  knowledge  of  normal  and  pathological  embryology 
anatomy,  and  physiology;  and  the  application  of  the  nursing  process  m  the  care  of  children 

1.156  pages  (tent.)  —  SI  8.65 

Prices  are  subject  to  change  without  notice. 


For  more  information,  contact  — 

College  Division 

McGRAW-HILL  RYERSON  LIMITED 

330  Progress  Avenue 

Scarborough,  Ontario 

M1P2Z5 


iVnl 


Representing  In  Canada: 

McGraw-Hill  Book  Company 
F.A.  Davis  Company 


1975 


THE  CANADIAN  NURSE     39 


(Coiuinued  from  pu^e  .^S) 

The  chapter  on  "Common  Treatments" 
is  particularly  well  written  and  covers 
clearly  and  concisely  such  diverse  subjects 
as  fecal  impaction,  decubiti,  and  bandag- 
ing of  legs. 

As  well  as  writing  about  the  geriatric 
patient,  the  author  provides  a  chapter  on 
"Youth  and  Chronic  Illness."  This  chap- 
ter not  only  covers  the  physical  and 
psychological  problems  of  the  young,  but 
also  discusses  the  patient  as  a  sexual  being 
—  a  point  many  nurses  and  doctors  do  not 
consider  in  caring  for  these  patients. 

Again,  the  last  chapter,  which  is  on 
death,  does  not  say  anything  particularly 
new,  but  rather  states  simply  how  each 
individual  patient  and  nurse  approaches 
this  inevitable  part  of  life. 

This  book  may  not  be  of  any  particular 
interest  to  those  nurses  in  a  university  set- 
ting: it  is  written  for  the  basic  practitioner. 
It  could  be  recommended  as  a  resource 
book  for  first-year  diploma  nurse  students, 
and  those  in  registered  nursing  assistant 
programs. 

It  may  be  of  particular  use  to  nurses  who 
are  instituting  inservice  programs  in 
homes  for  the  aged  and  nursing  homes, 
and  who  are  working  with  nonregistered 
nurse  aides.  The  basic  nursing  care  is  in- 
formative, and  attitudes  toward  patients 
and  their  families  are  presented  (both  posi- 
tively and  negatively)  in  an  open,  forth- 
right manner. 


About  Bedsores:  What  You  Need  to  Know 
to   Help   Prevent  and   Treat  Them   by 

Marian  E.  Miller  and  Marvin  L.  Sachs. 
45  pages.  Philadelphia,  Lippincott, 
1974.  Canadian  Agent:  Lippincott,  To- 
ronto. 

Reviewed  by  Walter  E.  Bohonis.  Nurs- 
ing Instructor,  Misericordia  General 
Hospital  School  of  Nursing,  Winnipeg, 
Manitoba . 

This  book  is  directed  to  all  members  of  the 
health  team  who  come  in  direct  contact 
with  the  patient.  Basic  concepts  that  are 
essential  in  the  prevention  and  treatment  of 
bedsores  are  well  presented. 

The  first  half  of  the  book  defines  bed- 
sores and  discusses  the  physiological 
changes  that  cause  them.  The  photo- 
graphic presentation  is  excellent;  it  helps 
the  nurse  better  understand  why  the  patient 
gets  a  bedsore. 

The  remainder  of  the  book  deals  with 
the  prevention  and  treatment  of  bedsores. 
This  section  stresses  nursing  knowledge 
that  is  essential  to  prevent  them.  Once 
again,  the  illustrations  are  excellent  in 
40    THE  CANADIAN  NURSE 


stressing  the  essential  concepts,  which 
other  texts  have  done  with  words  alone. 

How  often  have  we  assumed  that  an 
alternating  pressure  pad  is  the  key  to  treat- 
ing bedsores'?  The  authors  explain  that  this 
device  is  likely  to  increase  the  time  needed 
to  care  for  the  patient  and  is  not  as  suitable 
as  a  good  mattress  and  bed  surface. 

The  material  in  this  text  is  presented  in  a 
simple  and  easily  understood  manner,  and 
is  valuable  as  a  reference  in  both  the  class- 
room and  clinical  area.  Good  nursing  care 
is  the  essential,  underlying  key  to  the  pre- 
vention of  bedsores.  The  authors  do  an 
excellent  job  of  telling  us  what  nurses  need 
to  know  to  prevent  and  treat  bedsores. 


Smoking:  Behavior  Modification  Pro- 
gramme by  G.J.  Kleisinger.  33  pages. 
Regina,  Prairie  media  and  resource  sys- 
tems, 1973. 

Reviewed  by  Mary  Lou  Downes,  Pro- 
duction Assistant,  Canadian  Nurse. 

The  author  states,  "This  program  has  been 
designed,  by  using  the  basic  principles  un- 
derlying human  behavior,  to  maximize 
your  chances  of  changing  your  smoking 
habit.  .  .  .One  of  the  goals  of  this  pro- 
gram is  to  separate  your  smoking  behavior 
from  those  unconscious  actions  which 
accompany  your  smoking  habits." 

The  technique  of  this  "stop-smoking" 
program  differs  from  others  more  widely 
known  in  that  the  smoker  does  not  stop 
"cold  turkey,"  but  gradually  decreases 
his  cigarette  consumption  while  altering 
his  behavior.  The  smoker  is  allowed  one 
cigarette  per  hour  on  Day  1  of  the  pro- 
gram. This  amoung  gradually  decreases  to 
0  consumption  on  Day  2 1 .  A  cigarette  may 
be  smoked  only  on  the  hour.  If  the  hour  is 
missed  for  any  reason,  the  smoker  must 
wait  until  the  next  hour.  The  effect  of  this 
is  to  change  cigarette  use  from  -d  desirable 
time  to  'dpermissihle  time,  thereby  making 
cigarettes  a  task  rather  than  a  pleasure. 

The  pamphlet  is  clearly  laid  out  and  is 
quite  easily  understood.  The  reviewer 
tried  the  program  with  two  other  smokers. 
The  reviewer's  habit  has  not  ended,  but 
consumption  has  decreased  from  20  to  10 
cigarettes  per  day.  The  second  person 
trying  the  program  abandoned  it  after  a 
week  to  try  another  method. 


Correction 

Under  the  title  "Literature  Available" 
in  the  New  Products  section  of  the  October 
1974  issue.  The  Canadian  Nurse  told 
readers  about  a  61 -page  booklet  entitled 
Recipes  for  Controlled  Fat  Diets.  We 
neglected  to  add  that  this  booklet,  publish- 
ed by  the  Ontario  Hospital  Association, 
costs  $.75  per  copy.  We  regret  any  in- 
convenience this  has  caused  our  readers 
and  the  Ontario  Hospital  Association. 


The  third  person  was  successful  in 
eliminating  cigarette  consumption  com 
pleteiy.  She  reports  no  withdrawal  symp 
toms,  and  no  desire  for  a  cigarette,  despite 
being  exposed  to  smokers  on  a  regular 
basis.  She  reports  that  she  had  previously 
tried  several  other  methods  with  no  suc- 
cess and  says  this  is  an  almost  painless  wa 
of  ridding  oneself  of  the  cigarette  habit 

This  pamphlet  should  be  of  value  u 
anyone  who  seriously  wishes  to  discoi 
tinue  smoking. 


i 


Interpersonal  Change:  A  Behavioral  Ap 
proach  to  Nursing  Practice,  by  Maxinc 
E.  Loomis  and  Jo  Anne  Horsley.  182 
pages.  New  York,  McGraw-Hill, 
1974.  Canadian  Agent:  McGraw-Hill 
Ryerson,  Scarborough. 
Reviewed  by  Merina  Dobson  Hilton, 
Senior  Instructor,  Psychiatry,  School 
of  Nursing,  Vancouver  General  Hospi- 
tal, Vancouver,  B.C. 


This  is  a  practical  guide  for  professionals  I 
interested  in  the  clinical  application  of  op-i 
erant  theory,  especially  in  the  practice  of 
nursing.  The  book  is  theoretically  based 
on  a  sound  researchable  framework  from 
which  to  develop  a  practical  application. 
Each  aspect  of  the  theory  is  followed  by 
concise  guidelines  with  apt  and  detailedi 
examples. 

The  book  successfully  implements  the 
theory  of  behavior  modification  by  a  skil 
ful  presentation  of  practical  problems.  It 
begins  by  outlining  the  philosophical  con 
siderations,  and  then  deals  with  the  oper- 
ant pattern  of  discriminative  stimulus,  re- 
sponse, and  their  consequences.  The  au- 
thors deal  effectively  with  the  issues  of 
control,  how  to  do  it,  and  the  rationale  for 
using  the  outlined  techniques.  They  also 
carefully  and  successfully  deal  with  the 
application  of  the  problem-solving  process 
to  ensure  safe  and  therapeutic  application. 

The  book  offers  a  comprehensive  ap- 
proach for  two  categories  of  behavior  fre- 
quently confronted  by  professionals:  the 
depressed,  self-destructive  and  the 
bizarre.  The  section  on  the  application  of 
this  method  with  groups  is  informative  for 
informal  psychiatric  or  formal  non- 
psychiatric  groups,  but  unfortunately  it 
fails  to  offer  anything  on  formal  psy- 
chiatric groups. 

However,  the  section  on  the  application 
within  a  "token  economy"  is  basic,  con- 
cise, and  adequate.  The  book  concludes 
with  an  interesting  chapter  on  promotion 
of  mental  health  and  primary  prevention  in 
family,  work,  and  social  settings. 

The  book  is  a  must  for  anyone  genuinely 
interested  in  involvement  with  interper- 
sonal change.  Its  only  drawback  is  that  it  is 
too  complex  for  basic  students.  Although 
the  theoretical  presentation  is  somewhat 
complex,  the  book  is  informative,  interest- 
ing, and  vital.  ^ 
FEBRUARY  1975 


Elastic  hosiery 


Now  nobody  need  know  she's  wearing 
support  hosiery.  Bauer  and  Black  make  a 
complete  line  of  attractive  and  fashionable 
Elastic  Panty  Hose  and  Cosmetic  Sheer  Stock- 
ings. All  provide  firm,  medically  correct  "grad- 
uated compression",  the  kind  of  support  she 
needs  for  improved  circulation. 

Ver\'  simply,  "graduated  compression"  is  con- 
trolled compression  at  the  ankles,  with  diminish- 
ing pressure  up  the  leg.  Because  Bauer  and  Black 
Elastic  Hosiery  is  made  with  stronger,  tougher 
yarns,  your  patient  will  get  up  to  twice  the  com- 
pression that  ordinary  support  hosiery  would 
provide  her.  And  that's  important. 

So  now  that 
you've  helped  get 
her  back  on  her 
feet,  you  can  hon- 
estly tell  her  that 
Bauer  and  Black 
Elastic  Stockings 
and  Panty  Hose 
will  allow  her  to 
feel  much  better- 
without  detract- 
ing one  bit  from 
her  appearance. 

Just  because  her 
legs  need  a  little 
support  doesn't 
mean  they  have 
to  look  like  they're 
bandaged! 


s  her  secret. 


i 


BAUCR  &  BLACK 

Supports  your  patients 


Also  available  in  Surgical  Weight. 


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NURSES  PERSONALIZED 
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Mrs.  R.  F.  JOHNSON 

SUPERVISOR 


CHARLENE  HAYNES 

TohnTlpn 


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CAP  TOTE    keeps   your   caps   crisp   and   clean  '^ 

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WHITE   CAP  CLIPS       Holds  caps 
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No.  2100  Combo  Stetti . . .  29.70  ea.  Duty  free 

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Handiest  for  busy  nurses.  Includes  white 
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finished.  Change  compartment,  key  chain 

No.  291  Pal  Kit 6.50  ea. 

3  Initials  engraved  on  shears,  add  SOc  per  kit 


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No.  1093  Nurses  Watcti 19.95  ea 


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■^ 


research  abstracts 


arns,  Patricia.  Changes  in  the  amount 
and  nature  of  contacts  of  cardiac  surgi- 
cal patients  following  transfer  from  an 
intensive  care  unit.  Toronto.  Ontario, 
1974.  Thesis  (MSc.N.)  U.  of  Toronto. 


le  problem  posed  for  this  study  was  the 
ffcrences  that  occurred  in  the  amount 
d  nature  of  contacts  of  cardiac-surgical 
itienis  following  transfer  from  an  inten- 
e  care  unit  ilCU)  to  a  general  care  ward. 
C  w  I.  and  the  patients"  reactions  to  these 
ffcrences. 

The  objectives  iif  the  study  were  to  iden- 

\  the  following:  the  changes  in  the  total 

nount  of  patients"  contacts  in  the  ICL  and 

GCW ;  differences  in  the  nature  of  the 

intacts  in  these  two  areas;  with  whom 

iiients  had  contacts:  length  of  time  con- 

cls  were  maintained;  and  by  whom  and 

Aw  contacts  were  initiated. 

■  Patient  contact  was  defined  as  an  overt. 

.   isiiy  observable  interaction  between  the 

.itient  and  other  persons  (including  other 

iiients  and  various  categories  of  hospital 

.Tsonnel). 

Sixteen    patients    undergoing    aortic- 

ironary    bypass   surgery    were   studied. 

onparticipant   observation    was   carried 

'Vtr  designated  periods  on  inpatients  in 

'  u  and  GCW  s  and  on  another  6  patients 

on  the  GCW    Interviews  were  held 

i  all  16  patients  after  the  ob.servation 

>ds.  Data  were  analyzed  according  to 

icdelermined  categories  of  care. 

Results  indicated  the  following  differ- 
nces  between  the  ICL  and  the  GCWs:  total 
ontact  lime  and  number  of  contacts  were 
;duced  for  most  patients  following  trans- 
jr:  the  nature  of  the  contacts  changed 
from  mainly  for  technical  procedures  and 
asic  care  in  the  icu  to  mainly  for  basic 
are  and  social  contacts  on  the  GCVV);  con- 
icts  for  supportive  care  constituted  a 
mall  percentage  of  the  contacts  in  both 
reas;  hospital  personnel  with  whom  pa- 
lents  were  in  contact  changed  from  mostly 
Tofessionnal  in  the  icu  to  mostly  non- 
•rofessional  persons  after  transfer;  con- 
acts  with  other  patients  increased  on  the 
}CW.  and.  in  the  ICL .  patients  were  better 
ble  to  use  nonverbal  clues  to  attract  the 
taffs  attention. 

The  follow  ing  similarities  existed:  con- 
acts  with  personnel  were  predominantly 
rief  in  both  units,  usually  under  5  min- 
Jtes.  although  a  small  number  of  contacts 
jf  slightly  longer  duration  occurred  in  the 
CU.  Conlacis  were  initiated  mainly  by 
taff  in  both  units.  During  observation. 

EBRUARY  1975 


patients  reacted  to  the  difference  in  assis- 
tance available  following  transfer  by  pas- 
sive compliance.  They  made  few  requests 
for  more  contacts  with  personnel  than 
were  provided,  even  when  experiencing 
considerable  discomfort. 

Certain  needs  for  further  contacts  were 
identified  on  the  GCWs.  These  were  mainly 
for  the  relief  of  pain  and  tiredness:  assis- 
tance w  ith  activity;  hygienic  and  technical 
procedures;  and  information  about  activ- 
ity, available  medications,  and  the  regime 
to  follow  after  discharge  from  hospital.  In 
addition,  patients  needed  opportunities  to 
discuss  the  experience  of  heart  surgery  and 
its  social  implications. 

The  conclusions  suggested  by  the  data 
are: 

•  certain  barriers  to  communication  be- 
tween patients  and  staff  exist  as  a  result  of 
the  organization  of  patient  and  slaff  con- 
tacts: 

•  brief  contacts  on  the  GCWs  allow  staff 
only  limited  opportunities  for  assessment 
of  patient  needs,  resulting  in  much  patient 
discomfort  that  might  possibly  be  al- 
leviated: 

•  increased  awareness  of  pain  and  fatigue, 
accompanied  by  decreased  assistance  fol- 
lowing transfer,  increases  negative  emo- 
tional reactions,  such  as  depression: 

•  lack  of  opp<^munities  for  patients  to  dis- 
cuss the  experience  of  heart  surgerv  also 
results  in  undesirable  emotional  reactions; 
and 

•  more  specific  patient  teaching  is  re- 
quired on  GCWs. 


Cillis,  Sr.  Loretla.  The  effects  of  an  automa- 
tic and  deliberative  process  of  nursing 
activity  on  patients'  inability  to  sleep. 
Boston.  Mass..  1972.  Clinical  paper 
(M.S.  (Nursing))  Boston  U. 

This  study  focuses  on  the  kinds  of  ac- 
tivities carried  out  by  nurses  in  response  to 
the  verbal  and  nonverbal  liehavior  of  pa- 
tients who  are  unable  to  sleep.  It  is  de- 
signed to  explore  the  invesiigalor"s  belief 
that  deliberative  kinds  of  nursing  activiiies 
are  more  effective  than  automatic  kinds  of 
activiiies  in  relieving  patients"  inability  to 
sleep. 

One  medical  and  two  surgical  units  of  a 
general  hospital  comprised  the  study  area. 
The  study  was  conducted  between  24:00 
hours  and  4:00  hours.  .411  patients  who 
summoned  a  nurse  during  the  previously 


mentioned  times  and  nights  comprised  the 
study  sample.  All  sample  members  were 
assigned  to  the  control  and  experimental 
groups.  Nineteen  patients  were  included  in 
the  study:  10  in  the  control  group  and  9  in 
the  experimental  group. 

In  the  experimental  group,  the  inves- 
tigator ascertained  the  meaning  of  the  pa- 
tients" distress,  then  carried  out  an  activity 
to  relieve  the  distress.  In  the  control  group. 
the  investigator  observed  the  interaction 
betw  een  the  patients  and  the  nurses  and  the 
initial  results  of  the  interaction.  At  stan- 
dard intervals  in  both  control  and  experi- 
mental groups,  the  investigator  checked 
the  patients  for  signs  of  sleen.  All  interac- 
tions and  observations  w  ere  later  analyzed 
to  determine  which  kinds  of  nursing  ac- 
tivities relieved  patients"  inability  to  sleep 
most  effectively. 

To  determine  if  there  were  any  relation- 
ship betv^een  the  kinds  of  nursing  ac- 
tivities and  relief  from  sleeplessness,  the 
following  data  were  examined: 
1 .  observation  of  patient  w  hen  nurse  en- 
tered patient's  room  after  call  light 
sounded.  2.  the  activity  carried  out  by  the 
nurse  in  response  to  patient's  complaints 
of  sleeplessness.  3.  the  results  o\  the  ac- 
tivity carried  out  in  response  to  patient's 
inability  to  sleep. 

The  data  were  then  analyzed  for  any 
correlation  between  the  kinds  of  nursing 
activities  carried  out  and  the  effects  of 
these  activities  on  the  patients'  ability  to 
sleep.  All  10  patients  in  the  control  group 
were  given  medication.  3  patients  were 
ob.served  to  be  sleeping  in  one-half  hour, 
and  no  additional  patients  were  asleep  in 
one  hour.  Two  patients  in  the  experimental 
group  were  given  medications.  9  were  ob- 
served sleeping  in  one-half  hour,  and  all  9 
were  still  asleep  at  the  one-hour  check. 

The  findings  of  this  study  indicate  that 
patients"  complaints  of  inability  to  sleep 
were  considered  to  be  indications  for  the 
giving  of  medications  by  the  nurses  in- 
volved with  the  control  group  of  patients. 
The  findings  further  indicate  that  when  the 
specific  meaning  of  a  patient's  inability  to 
sleep  was  not  ascertained  by  the  nurse,  the 
patient  did  not  experience  relief  from  his 
sleeplessness,  even  when  medication  was 
given. 

However,  w  hen  the  specific  meaning  of 
the  palieni"s  inability  to  sleep  was  ascer- 
tained and  an  activity  carried  out  to  relieve 
his  sleeplessness,  as  in  the  experimental 
group,  the  findings  show  that  the  patient 
was  relieved  and  slept.  Q 

THE  CANADIAN  NURSE     43 


Next  Month 
in 


The 

Canadian 
Nurse 


D     The  Canadian  Nurses"  Foundation 
Is  Its  Members 


D     The  Administrator: 
the  Real,  the  Ideal 


n     Write  for  the  Reader 


n    Control:  Cigarettes 
and  Calories 


dates 


Photo  Credits 
for  February  1 975 


Miller  Services, 
Toronto,  Ontario,  Cover  I 


Women's  College  Hospital, 
Toronto.  Ontario,  p.  24 


44     THE  CANADIAN  NURSE 


February  17-21,  1975 

Occupational  Health  Nursing  course.  Uni- 
versity of  Toronto,  Toronto.  Further  infor- 
mation from:  Dorothy  Brooks.  Chairman. 
Continuing  Education,  Faculty  of  Nursing, 
University  of  Toronto.  50  St.  George  Street, 
Toronto  (Tel.  928-8559). 

April  2-4,  1975 

Pediatric  Intensive  care  nursing  conference 
at  the  Hospital  for  Sick  Children.  Toronto. 
Emphasis  on  cardiac  surgery,  neurosur- 
gery, respiratory  problems,  and  other 
stressful  situations.  For  Information  write: 
Directorof  Nursing  Education,  The  Hospital 
for  Sick  Children,  555  University  Avenue. 
Toronto,  Ontario,  M5G  1X8, 

Aprils,  1975 

Canadian  Nurses  Association  will  hold  its 
annual  meeting  at  the  Chateau  Laurler, 
Ottawa,  Ontario. 

April  11-12,  1975 

Workshop  — •  Education  for  Childbirth  —  for 
health  professionals  and  interested  citi- 
zens. Featured  speaker  —  Dr.  Murray 
Enkln.  McMaster  University.  Further  Infor- 
mation from  Dr.  Shirley  Alcoe,  Faculty  of 
Nursing,  University  of  New  Brunswick, 
Frederlcton,  New  Brunswick, 

April  17-18,  1975 

Family  centered  maternity  care  sym- 
posium, Foothills  Hospital,  Calgary,  For 
further  information  write:  Brian  Wright, 
Coordinator  inservlce  education.  Foothills 
Hospital.  Calgary,  Alberta. 

April  17-18,  1975 

National  League  for  Nursing  regional  as- 
sembly, Chicago,  Illinois.  Theme:  "Con- 
sumer concerns  for  the  delivery  of  health 
care  —  reality  or  fantasy?"  For  Information 
write:  Convention  Services,  National 
League  for  Nursing,  Ten  Columbus  Circle, 
New  York,  N.Y,,  10019, 

April  21-23, 1975 

Ninth  annual  conference  of  Operating 
Room  Nurses  of  Greater  Toronto  to  be 
held  at  Skyline  Hotel,  Toronto,  Address 
inquiries  to:  Dixie  OSulllvan,  Convener, 
Publicity  Committee,  ORNGT,  624  Tedwyn 
Drive,  MIsslssauga,  Ontario,  L5A  1K2. 

May  6-9, 1975 

Alberta  Association  of  Registered  Nurses 
annual    convention    to    be    held    at    the 


Calgary  Inn.  Calgary,  Alberta.  The  theme] 
Is  "Nursing  Power. 

May  7-9,  1975  j 

Registered  Nurses'  Association  of  British 
Columbia  annual  meeting,  Peach  Bowl 
Pentlcton.  B.C. 

May  7-9,  1975 

Cardiology  '75,"  an  advanced  program  fa 
nurses  and  doctors  Interested  In  cardial 
care.  Humber  College  of  Applied  Arts  and 
Technology,  Highway  27  and  401 ,  Toronto 
Information  available  from:  Conferencf 
and  Seminar  Office.  Humber  College.  P.O 
Box  1900,  Rexdale,  Ontario.  M9W  5L7,   j 

May  22-23,  1975 

Seminar  on  principles  of  sterilization,  car( 
of  Infectious  materials,  chemical  disinfec 
tants,  and  care  of  surgical  Instruments,  t( 
be  held  In  Oshawa,  Ontario,  For  informa 
tion  write:  Gail  IV  cDonald,  The  Doctor  J, 0 
Ruddy  Hospital,  Whitby,  Ontario. 

May  26-30,  1975 

Canadian  Public  Health  Association  66tl- 
annual  conference,  MacDonald  Hotel 
Edmonton,  Alberta.  Theme  Is  "Prloritle! 
for  Prevention."  Address  Inquiries  to:  cpha 
55  Parkdale  Avenue,  Ottawa,  Ontario. 


June  1975 

St.  Josephs  School  of  Nursing  Alumnae 
Victoria,  B.C.,  75th  anniversary  reunion 
For  further  information,  write  to:  Ms,  Phyllis 
Fatt,  4253  Dieppe  Rd.,  VIctona,  B.C.. 

June  3-6,  1975 

Canadian  Hospital  Association  nationa 
convention  and  32nd  annual  meeting  wil 
be  held  In  Saskatoon,  Sask. 

June  11-14,  1975 

The   annual   meeting  of  the   Register 
Nurses  Association  of  Ontario  will  coinc 
with  RNAOs  50th  birthday.  The  nieeti  .^ 
and  anniversary  celebrations  are  to  be  ai 
the  Royal  York  Hotel,  Toronto,  Ontario.       1 

August  10-16,  1975 

World  Federation  of  Mental  Hea 
congress  In  Copenhagen,  Denma 
Theme  Is  "Mental  Health  and  Economic 
Growth."  For  Information  write:  WFMH 
World  Congress  —  Copenhagen  1 975.  The 
Congress  Secretariat:  Danish  Association 
for  Mental  Health,  15.  Frederlciagade,  DK 
1310  Copenhagen,  Denmark.  .§. 

FEBRUARY  1975 


New...readytouse... 
"bolus"  prefilled  syringe. 

XylocainelOO  mg 

(lidocaine  hydrochloride  injection,  USP) 

For  'Stat'  I.V.  treatment  of  life 
threatening  arrhythmias. 

D  Functions  like  a  standard  syringe. 

D  Calibrated  and  contains  5  ml  Xylocaine. 

D  Package  designed  for  safe  and  easy 
storage  in  critical  care  area 

n  The  only  lidocaine  preparation 
,   -^^  with  specific  labelling 

1^0^         information  concerning  its 
^r  use  in  the  treatment  of  cardiac 

arrhythmias. 


Xyl( 


an  original  from 

ASTirA 


locaine "  100  mg 

(lidocaine  hydrochloride  miection  U  S  P  ) 

INDICATIONS-Xylocaine  administered  intra- 
vcnousiv  IS  5pccificailv  indicated  in  the  acute 
management  of  ( \ )  ventricular  arrhythmias  occur- 
ring dunng  cardiac  manipulation,  such  as  cardiac 
surgery,  and  ( 2 )  life- threatening  arrhythmias,  par- 
ticularly those  which  are  venincular  in  origin,  such 
as  occur  during  acute  myocardial  infarction, 

CONTRAINDICATIONS- Xylocaine  is  contra- 
indicated  (I)  in  patients  with  a  known  history  of 
hypersensitivity  to  local  anesthetics  of  the  amide 
tvpe;  and  (2)  in  patients  with  .Adams-Stokes  syn- 
drome or  with  severe  degrees  of  sinoatnal.  atrio- 
ventricular or  intraventricular  block. 

WARNINGS-Conslant  monitoring  with  an  elec- 
trocardiograph is  essential  in  the  proper  adminis- 
tration of  Xylocaine  intravenously.  Signs  of  exces- 
sive depression  of  cardiac  conductivity,  such  as 
prolongation  of  PR  interval  and  QRS  complex 
and  the  appearance  or  aggravation  of  arrhythmias, 
should  be  followed  by  prompt  cessation  of  the 
intravenous  infusion  of  this  agent.  It  is  mandatory 
to  have  emergency  rcsuscilative  equipment  and 
drugs  immediately  available  to  manage  possible 
adverse  reactions  involving  the  cardiovascular, 
respiratory  or  central  nervous  systems. 

Evidence  for  proper  usage  in  children  is  limited. 

PRECAL'TIONS-Caution  should  be  employed 
m  the  repeated  use  of  Xylocaine  in  patients  with 
severe  liver  or  renal  disease  because  accumulation 
mav  occur  and  may  lead  to  toxic  phenomena,  since 
Xviocaine  is  metabolized  mainly  in  the  liver  and 
excreted  by  the  kidney.  The  drug  should  also  be 
used  with  caution  in  patients  with  hypovolemia 
and  shock,  and  all  forms  of  heart  block  ( see  CON- 
TRAINDICATIONS AND  WARNINGSl. 

In  patients  with  sinus  bradycardia  the  adminis- 
tration of  Xviocaine  intravenously  for  the  elimina- 
tion of  ventricular  ectopic  beats  without  prior 
acceleration  in  heart  rate  (e.g.  by  isoproterenol 
or  by  electric  pacing)  may  provoke  more  frequent 
and  serious  ventricular  arrhythmias. 

ADVERSE  REACTIONS-Systemic  reactions  of 
the  following  ivpes  have  been  reported. 

(1)  Central  Nervous  System:  lightheadedness, 
drowsiness;  dizziness:  apprehension;  euphoria; 
tinnitus;  blurred  or  double  vision:  vomiting;  sen- 
sations of  heat,  cold  or  numbness:  twitching: 
tremors:  convulsions:  unconsciousness;  and  respi- 
ratory depression  and  arrest. 

(2)  Cardiovascular  System:  hypotension:  car- 
diovascular collapse:  and  bradycardia  which  may 
lead  to  cardiac  arrest. 

There  have  been  no  reports  of  cross  sensitivity 
between  Xviocaine  and  procainamide  or  between 
Xviocaine  and  quinidine. 

DOSAGE  AND  ADMINISTRATION  Single 
Injection:  The  usual  dose  is  50  mg  to  100  me 
administered  intravenously  under  ECG  monitor- 
ing. This  dose  may  be  administered  at  the  rale 
of  approximately  25  mg  to  50  mg  per  minute. 
Sufficient  time  should  be  allowed  to  enable  a  slow 
circulation  to  carrv  the  drug  to  the  site  of  action. 
If  the  initial  injection  of  50  mg  to  100  mg  does 
not  produce  a  desired  response,  a  second  dose  may 
be  repeated  after  10-20  minutes. 

NO  MORE  THAN  200  MG  TO  300  MG  OF 
XYLOCAINE  SHOULD  BE  ADMINISTERED 
DURING  A  ONE  HOUR  PERIOD 

In  children  experience  with  the  drug  is  limited. 

Continuous  Infusion:  Following  a  single  injection 
in  those  patients  in  whom  the  arrhythmia  tends 
to  recur  and  who  are  incapable  of  receiving  oral 
antiarrhythmic  therapy,  intravenous  infusions  of 
Xviocaine  mav  be  administered  at  the  rale  of  1 
mgto2  mgper  minute  (20  to  25  ug/kg  per  minute 
in  the  average  70  kg  man).  Intravenous  infusions 
of  Xviocaine  must  be  administered  under  constant 
ECG  monilonng  to  avoid  potential  overdosage 
and  toxiatv-  Intravenous  infusion  should  be  ter- 
minated as  soon  as  the  patient's  basic  rhythm 
appears  to  be  stable  or  at  the  earliest  signs  of 
toxicity.  It  should  rarely  be  necessary  to  continue 
intravenous  infusions  beyond  24  hours  As  soon 
as  possible,  and  when  indicated,  patients  should 
be  changed  to  an  oral  antiarrhythmic  agent  for 
maintenance  therapy. 

Solutions  for  intravenous  infusion  should  be 
prepared  by  the  addition  of  one  50  ml  single  dose 
vial  of  Xviocaine  2*t  or  one  5  ml  Xylocaine  One 
Gram  Disposable  Transfer  Syringe  to  I  liter  of 
appropriate  solution.  This  will  provide  a  0.1% 
solution;  that  is.  each  ml  will  contain  I  mg  of 
Xylocaine  HCl.  Thus  I  ml  to  2  ml  per  minute 
will  provide  I  mg  to  2  mg  of  Xylocaine  HCl  per 
minute. 


accession  list 


Publicatidns  recently  received  in  the 
Canadian  Nurses'  Association  library  are 
available  on  louii  —  with  the  exception  of 
items  marked  R  —  to  CNA  members, 
schools  of  nursing,  and  other  institutions. 
Items  marked  R  include  reference  and  ar- 
hive  material  that  does  not  go  out  on  loan. 
Theses,  also  R .  are  on  Reserve  and  go  out 
on  Interlibrary  Loan  only. 

Request  for  loans,  maximum  3  at  a 
time,  should  be  made  on  a  standard  inter- 
library  Loan  form  or  on  the  "Request 
Form  for  Accession  List"  printed  in  this 
issue. 

If  you  wish  to  purchase  a  book,  contact 
y(Ui  local  bookstore  or  the  publisher. 


BOOKS  AND  DOCUMENTS 

I.  Aninitiirc  de  I'lissiHialiiiii.  Tdronlo,  AsMicialliin 
.de^  Hopilaux  du  Canada.  1974.  h.  73  p.  R 
Z.  Hiciiiiiul  ri'/xiri  1972-7J.  New  York.  American 
Jdurnal  of  Nursing  Co..  1474.  47p. 
.^.  Ciiiuidum  hospiuil  law  ii  pnuticul  ftiiide.  b\ 
l,orne  KIkin  Rozovsky.  Toronlo.  Canadian  Hospital 
Assoeialinn.  1974.    lOOp. 

4.  Caiuuliiin  iinivcrsilics  and  ivj/Zcifcv.  1974. 
Ollaua.  pub.  joinlly  hy  .Association  of  Universities 
and  Colleges  of  Canada  and  Statistics  Canada.  1974. 
.57.'Sp.  R 

."i.  CitmniLiniculini;  iniisini;  rcseiirch:  ciilUihoniiion 
and  ciinipcniiim.  (:diled  hy  Marjorie  V.  Balev . 
Boulder.  Colorado.  Western  Interstate  Commission 
for  Higher  tiducation.  197,1.  22(ip 

6.  Cnirenl  diiia  handhniik.  1974-76.  hv  .Mars  W  . 
Falconer  and  H.  Roherl  Patterson  and  Edward  A. 
Gusiafson.  Philadelphia.  .Saunders.  1974    257p. 

7.  Fluids  and  cleclralytes:  a  pracrical  approach.  h\ 
Violet  R.  Stroot.  et  al.  Philadelphia.  Davis.  cl974. 
244p. 

5.  Fundinncnial  .\kilh  in  ilw  nursc-palicnl  rehiliiw- 
ship:  a  prin'iannncd  icxi.  b\  Lianne  .S.  Mercer  and 
Patricia  O'Connor  Philadelphia.  Saunders.  1974. 
:if)p. 

9.  Ijihoialcis  maimed  and  warl^haak  in  niiirohial- 
(),i;v.  .Applications  In  palicni  care,  by  Marion  l-], 
Wilson,  cl  al.  New  "lork.  Maonillan.  cl974.  24.1p. 

10.  Lcxiipic  dc  Icrincs  incdicau.x  a  liisa.tfe  dcs  infir- 
niicrcs.  par  J. P.  .Monceaux.  Paris.  Lamarre-Poinat. 
cl97l.  7Xp, 

1  I .  Mcdicid-snntual  niirsan;:  a  ps\(lu>physii)liif;i( 
approach,   by  Joan  l.uckmann  and  Karen  Creason 
Sorcnsen.  Toronto.  Saunders.  1974.   l(i.'*4p. 
12.  ;V<Mi7v    iniliaicil   and   cuniplcwd    rc\carch    in 
WCHFS  schools  of  luirsinf-  June  l970-.hil\   /y7,i. 
Boulder.  Colorado.  Western  Council  on  Higher  tdu- 
cation  for  Nursing,  1974.  Iv.  (Loose  leaf) 
\'S.  Nurses'  aliinwac  journal.  Winnipeg.  Winnipeg 
General  Hospital.  1974.  Iv.  248p.  R 
14.  .\ursinf;    in    conieinporary    society,     by     I'na 
Maclean.  London.  Routledge  &  Paul.  1974.   172p, 
l.'i.  \ursini;  research  in  the  south:  a  survey.    b\ 
Lucille  L    Notter  and  .'Audrey  F    Spector    .■\tlanla. 
Ga..   Southern   Regional   Itducation    Board,    1974. 
1  ISp 

46     THE  CANADIAN  NURSE 


16  Quality  .Assurance  for  Nursing  Care  Institute. 
Oct.  2V-.U .  I97S.  Kansas  City.  Mo.  Proceedings. 
Kiinsas  City,  Mo..  American  Nurses'  Association. 
1974.  I48p. 

17.  .Nutrition  and  diet  therapy :  reference  dictionary. 
2ed..  by  Rosalinda  T.  Lagua  and  Virginia  S.  Claudio 
and  Victoria  F.  Thiele.  Saint  Louis.  Mosby.  1974. 
.129p. 

IS.  Office  and  association  directory.  Toronto. 
Canadian  Hospital  Association.  1974.  7.'ip.  R 
1 9  Organization  and  provision  of  community  itiedi- 
cal  services.  The  proceedings  of  a  symposium  held  at 
the  Winnipeg  Clinic.  Oct.  30.  1967.  Winnipeg. 
Winnipeg  Clinic.  1968.  Il9p. 
2(1  Parliamentary  procedure,  by  James  Dowell. 
Otiavsa.  Canadian  Union  of  Public  tmployces.  1974. 
6lp 

2  1 .  Perceived  need  for  technical  specialists  in  nurs- 
inf!  care  of  hospitalized  patients,  by  Helen  H. 
Burnside.  New  York.  National  League  for  Nursing. 
cl972.   1974.  70p. 

22.  Planification  el  organisation  des  services  de 
geriatric:  rapport  dun  coinite  d'  experts  de  I'OMS. 
Geneve.  Organisation  niondiale  de  la  sante.  1974. 
49p.  (Serie  de  rapports  techniques  no.  .'i48) 
2^.  Planning  for  health:  development  and  applica- 
tion of  social  change  theory,  by  Henrik  L.  Blum. 
New  York.  Human  Sciences  Press.  cl974.  622p. 
24  Precis  de  sohis  aux  malades  de  chirurgie.  par  M . 
Lacombc  et  J.Vi.  Desmonts.  2ed.  Paris,  Laniarre- 
Poinal.   1972.  cr967.  44lp. 

2.S.  Proceedings  of  l>lh  Quadrennial  Congress.  In- 
ternatiinial  Council  of  Nurses.  Mexico  Citv.  I.^-IH 
May  1973.  Geneva.  International  Council  of  Nurses. 
1974.   192p. 

26.  Universiie    el    lolleges    du    Canada.    1974. 
Ottawa,  publiee  conjoinlement  par  Association  des 
Universites  el   Colleges  du   Canada  et   Statislique 
Canada.  1974.  575p.  R 

PAMPHLETS 

27.  Basic  procedures  for  taking  stimulation 
threshold  measurements  and  sensitivity  threshold 
measurements  with  a  .Medtronic  T.M.  model  5840. 
.s<VW)  or  ''USD /A  external  demand  pacemaker. 
Malton.Onl.,  Medtronic  of  Canada  Ltd..  1970.  revi- 
sion A.  197.1.  24p. 

28.  .A  brief  to  the  Minister  of  Public  Health.  The 
Nova  Scotia  Council  of  Health,  and  the  Nova  Scotia 
Health  Services  and  Insurance  Commission  concern- 
ing the  health  needs  of  the  aged.  Halifax,  Registered 
Nurses  Association  of  Nova  Scotia.  1974.  ^p. 

29.  La  feinine  et  le  loisir:  aujourd'hui  et  deinain.  par 
France  Govaerts.  Bruxelles,  197,1.  42p. 

.1(1.  Pood  fin-  the  world's  hungry,  by  Maxwell  S. 
Slewan,  New  '^'ork.  Public  Affairs  Committee, 
cl967.  24p.  (Public  affairs  pamphlet  no.  ,'i  1!  ) 


Registered  Nurses 

Your  community  needs  the  benefit 
of  yourskillsand  experience,  Volun 
teer  now  to  teach  Patient  Care  in 
The  Home  and  Child  Care  in  The 
Home  Courses.  — 


1 


contar 


in  Ambulance 


31 .  Le.xique  ctymologique  des  lermes  medicaux.  pa 
M.  Lacombc.  Paris,  Lamarre-Poinat.  1971 
p.  85- 104 

32.  Ninth  report  of  World  Health  Organization  / 
pert  Committee  onTuherculosis .  Geneva.  1974  i 
(Technical  report  series  no.  552) 

33 .  Standards  of  nursing  for  nursing  homes  in  \  • 
Scotia  as  recommended  by  Registered  Nurses 
sociat'ton of  NovaScot'ia.  Halifax.  Registered  Nui 
Association  of  Nova  Scotia.  1974.  26p. 

GOVERNMENT  DOCUMENTS  1 

Canada 

34.  Advisory  Council  on  the  Status  of  Women  fl-  ' 
port  1973174.  Ottawa,  1974.  I  v.  n.p. 

35.  Health  and  Welfare  Canada.  Analysis  ofdau, 
nursing  personnel  ICCDO  3 13 1  from  the  job  vacm 
survey.   1st  quarter  1971   —  4th  quarter  1973 
HisakoRose  Imai.  Ottawa.  1974.  27p.  (Health  i; 
power  report  no. 9-74) 

36.  — .  Development  in  biomedical  engineerin.:  , 
Canada,  manpower  and  government  activities,  b\  B 
Leung.  Ottawa.  1974.  24p.  (Health  manpower  repon 
8-74) 

37.  — '  Education  and  regulation  of  selected  health. 
occupations  in  Canada:  nursing  manpower,  by  B. 
Leung.  Ottawa.  1974.  16p  (Health  manpowerrepon 
no.  7-74) 

38 .  — .  Pilot  survey  of  hospital  therapeutic  abortion 
committees.  British  Columbia.  1971-1972.  Ottawa, 
Information  Canada.  1974   44p. 

39.  — .  Supply  projections  to  I9HI :  selected  health 
manpower  categories.  Ottawa.  1974.  I9p.  (Health 
manpower  report  no. 4- 74) 

40.  Labour  Canada.  Women's  Bureau.  The  law  re- 
lating to  working  women.  2ed.  Ottawa.  Information 
Canada.  1973.  27p. 

41.  Post  Office.  Rc/jw/.  1973.  Ottawa,  1974.  1 

42.  — .  Revue  quad  2 :  lute  publication  prepare! 
le   Programme   d' appreciation   de   la   qualite 
medicaments.  Ottawa.  Information  Canada.    19'-( 
237p. 

43.  Secretary  of  State.  Education  Support  Branch. 
The  organization  and  administration  of  education  in 
Canada,   by   David  Munroe.   Ottawa.   lnform;ir 
Canada.  1974.  219p. 

Quebec 

44.  Ministerc  des  Affaires  socialcs.  Nutrition  en 
milieu  scolaire.  Quebec  (ville).  1974    Iv.  v. p. 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLECTION  I 

45.  Comporiements  therapeuliques  de  T infirini'ere: 
perception  du  malade  mental,  par  Denise  Paul. 
Montreal.  1973.  91p.  R 

46.  Intermediate  care.  A  research  and  demonstra- 
tion project.  Kelowna  and  district.  Compiled  by 
Elise  Clark.  Kelowna.  B.C..  1974.   I  1  Ip    R 

47.  Literature  review:  maintaining  the  competence 
of  health  professionals.  1970-73.  bv  Margaret  S. 
Neylan.  Vancouver.  University  of  British  Columbia, 
Division  of  Continuing  Education  in  the  Health  Sci- 
ences. 1974.  20p.  R 

48.  Report  on  findings  if  a  national  survey  concern- 
ing the  Canadian  Nurses'  Finindation.  by  Barbara 
.Archibald  Ottawa.  Canadian  Nurses'  Foundation. 
1974.  42p.  R 

49.  A  study  of  the  first  class  of  nursing  assistants  to 
graduate  from  Number  College  of  Applied  Arts  and 
Technology,  by  tola  Smith.  Rexdale.  Ont..  Health 
Science  Division.  Humber  College  of  Applied   \ 
and  Technology.  1974.  49p.  R 

FEBRUARY  1975 


NURSING  AND  PLANNING 
OFFICER 


Securtty 
UciiiKet 

SKIN-CONFORMING  KARAYA  BLANKET 

PROTECTS  SKIN  AROUND  WOUND  SITE  . . .  DIRECTS 

DISCHARGE  INTO  AHACHED  COLLECTOR. 


\pplications  are  invited  for  the  position  of  Nursing  and  Planning  Officer  for  tfie 
^-  Tiergency  Health  Services  Division,  Nova  Scotia  Department  of  Public 
alth,  Halifax,  Nova  Scotia, 

ivIINIMUM  QUALIFICATIONS: 

B  Sc.  (Nursing)  or  R.N.  with  post  graduate  training  in  Education,  Admlnlstra- 
von  or  Public  Health  and  three  years  experience. 

DUTIES: 

To  assist  in  the  development  and  maintenance  of  emergency  health  planning 
and  training  in  Nova  Scotia. 

SALARY: 

Commensurate  with  qualifications  and  experience. 
Full  Civil  Service  Benefits. 

Competition  open  to  both  men  and  women. 

Applications  may  be  obtained  from  the  N.S.  Civil 
Service  Commission,  P.  0.  Box  943.  Johnston  Building, 
Halifax,  N.  S.,  B3J  2V9,  and  from  the  Provincial 
Building,  Sydney,  Nova  Scotia. 


FOOTHILLS  HOSPITAL 
Calgary,  Alberta 

Advanced  Neurological- 
Neurosurgical  Nursing 

for 
Graduate  Nurses 

a  five  month  clinical  and 

academic  program 

offered  by 

The  Department  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

(Department  of  Surgery) 

Beginning:    March,  1975 
September,  1975 

Limited  to  8  participants 
Applications  now  being  accepted 

For  further  information,  please  write  to: 

Co-ordinator  of  In-service  Education 

Foothills  Hospital 

1403  29  St.  N.W.    Calgary,  Alberta 

T2N  2T9 


THE  HOLLISTER  DRAINING-WOUND 
MANAGEMENT  SYSTEM 

KEEPS  FLUIDS  AWAY  FROM 

PATIENT'S  SKIN  AND  GUARDS  AGAINST 

IRRITATION  AND  CONTAMINATION. 

Odor-kx3rrier,  translucent  Drainage  Collector  holds  exu- 
date for  visual  assessment  and  accurate  measurement. 
Tt^ere  are  no  messy,  wet  dressings  to  handle. 

View  wound  through  Access  Cap.  Rennove  cap  tor 
wound  examination  and  drain  tube  adjustment.  There  is 
no  need  for  painful  dressing  removal. 

Supplied  sterile,  for  application  In  O.R.  or  patlenf  s  room. 


g 


The  better  alternative 
to  absorbent  dressings. 

Write  for  more  intormalion 

HOLLISTER 

Holiiste.'   Ltd  ,  332  Consumers  Rd  ,  Willowdale,  Ont.  M2J  1P8 


EBRUARY  1975 


THE  CANADIAN   NURSE     47 


classified  advertisements 


ALBERTA 


BRITISH  COLUMBIA 


ONTARIO 


REGISTERED  NURSES  required  for  30  bed  Accredited  Gen- 
eral Hospital  Apply  to:  Administrator,  Our  Lady  of  the  Rosary 
Hospital.  P  O  Box  329.  Castor.  Alberta.  TOC  0X0 


REGISTERED  NURSES  required  for  70  bed  accredited  active 
treatment  Hospital  Full  time  and  summer  relief  All  AARN  per- 
sonnel policies  Apply  in  writing  to  the-  Director  of  Nursing, 
Drumheller  Genera!  Hospital,  Drumheller,  Alberta 


GENERAL  DUTY  NURSES  required  for  50-bed  hospital  in  cen- 
tral Alberta,  half  way  between  Calgary  and  Edmonton  on  mam 
highway  Salanes  and  personnel  policies  as  set  by  AARN 
agreement  Residence  accommodation  available  CWJacl  Mrs 
E  Harvie,  RN,  Administrator.  Lacombe  General 'Hospital, 
Lacombe,  Alberta,  TOC  ISO 


BRITISH  COLUMBIA 


Applications  are  invited  for  a  very  interesting  and  challenging 
new  position.  We  require  a  B.C.  REGISTERED  NURSE  to  assist 
the  Nurse  Administrator  to  be  classified  as  a  Head  Nurse 
Preference  will  be  given  one  vvith  prior  Emergency  or  Obstetric 
Nursing  expenence  and  having  successfully  completed  the 
Nursing  Unit  Administration  course.  The  hospital  is  £  newly 
opened  one  situated  on  the  Yellowhead  Highway,  80  miles  north 
of  Kamloops.  EC  The  area  is  a  vacationers  paradise  both  m 
Summer  and  Winter  RNAEC  salary  scale  and  fringe  benefits 
applicable  Please  reply  tc:  Mrs.  K.  Rice,  Nurse  Administrator, 
Dr  Helmcken  Memorial  Hospital,  Clearwater,  British  Columbia 


ADVERTISING 
RATES 

FOR    ALL 
CLASSIFIED    ADVERTISING 

$15,00    for    6    lines    or    less 
$2.50  for  each  additionol   line 

Rates    for    display 
advertisements    on    request 

Closing  dale  for  copy  and  cancellation  is 
6  weeks  prior  to  1  st  day  of  publication 
month. 

The  Canadian  Nurses'  Association  does 
not  review  the  personnel  policies  of 
the  hospitals  and  agencies  advertising 
in  the  J  our  no  I.  For  outhentic  information, 
prospective  applicants  should  opply  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,  ONTARIO 
K2P  1E2 


EXPERIENCED  GENERAL  DUTY  NURSES  AND  LICENSED 
PRACTICAL  NURSES  required  for  small  upcoast  hospital  Sal- 
ary and  personnel  policies  as  per  RNABC  and  H  E  U  contracts 
Residence  accommodation  S25.00  per  montti  Transportation 
paid  from  Vancouver  Apply  to  Director  of  Nursing,  St  Georges 
Hospital,  Alert  Bay,  British  Columbia.  VON  lAO. 


GENERAL  DUTY  NURSES  for  modern  41-bed  hospital  located 
on  the  Alaska  Highway  Salary  ar>d  personnel  policies  m 
accordance  with  RNABC.  Accommodation  available  in  resi- 
dence Apply:  Director  of  Nursing,  Fori  Nelson  General  Hospital, 
Fort  Nelson,  British  Columbia 


GENERAL  DUTY  NURSES,  for  modern  35-bed  hospital  located 
in  southern  B.C  s  Boundary  Area  with  excellent  recreation  faci- 
lities Salary  and  personnel  policies  in  accordance  with  RNABC. 
Comfortable  Nurses  s  home.  Apply  Director  of  Nursing.  Bound- 
ary Hospital.  Grand  Forks.  British  Columbia 


EXPERIENCED  NURSES  (eligible  for  B.C  registration)  required 
for  409-bed  acute  care,  teaching  hospital  located  in  Fraser 

Valley,  20  minutes  by  freeway  from  Vancouver,  and  wilhm 
easy  access  of  varied  recreational  facilities  Excellent  Onenla- 
ton  and  Contmyng  Education  programmes  Salary  S985  00  to 
51,163  00  Clincal  areas  include  Medicine  General  and  Spe- 
cialized Surgery.  Obstetrics,  Pediatrics.  Coronary  Care.  Hemo- 
dialysis. Rehabilitation,  Operating  Room.  Intensive  Care  Emer- 
gency PRACTICAL  NURSES  (eligible  for  B-C,  License)  also 
requ'tred.  Apply  to  Nursing  Recruitment.  Personnel  Departmen- , 
Royal  Columbian  Hospital.  New  Westminster.  British  Columbia 
V3L3W7 


NEW  BRUNSWICK 


: 


THREE  FACULTY  MEMBERS  needed  July  l,  1975,  tc  replace 
faculty  members  going  on  one-year  sabbatical  and  two-year 
study  leaves  Preparation  and  experience  desirable  in  maternal- 
infant  and  in  medical-surgical  nursing  Increasing  enrolment  will 
permit  retention  of  right  persons  at  end  of  these  periods.  Extras 
we  have  to  offer  are  an  exciting  new  curnculum  approach,  a  new. 
well-equipped  self-inslructional  laboratory,  a  new  hospital,  and 
the  advantages  of  living  in  a  beautiful,  small  city  Address;  Dean, 
Faculty  of  Nursing.  The  University  of  New  Brunswick.  Frederic- 
ton.  New  Brunswick. 


NOVA  SCOTIA 


REGISTERED  NURSES  and  PSYCHIATRIC  NURSES,  General 

Staff  positions  available  m  this  modern  270-Ded  psychiatric  hos- 
pital located  m  the  Annapolis  Valley  Oneniaiion  and  Inservice 
provided  Excellent  personnel  policies  Salary  according  to  scale 
For  further  information  direct  inquiries  to  Tne  Director  of  Nursing. 
Kings  County  Hospital,  Waterville  Nova  Scotia 


ONTARIO 


DIRECTOR  OF  NURSING  required  Dy  expanding  accredited 

300-bed  Chronic  Illness  and  Convalescent  Hospital,  iocated  in 
Northwest  Metropolitan  Toronto  Please  reply  m  confidence  lo 
Director  of  Nurses,  The  Toronto  Hospital  Weston,  Ontario 
MSN  3M6 


OPERATING  ROOM  STAFF  NURSE  required  for  fully  accredi- 
ted 75-bed  Hospital  Basic  wage  S689  00  with  consideration  for 
experience:  also  an  OPERATING  ROOM  TECHNICIAN,  basic 
wage  S526  00.  Call  time  rates  available  on  request  Wnte  or 
phone  the:  Director  ot  Nursing,  Dryden  District  General  Hospital. 
Dryden,  Ontario. 


REGISTERED  NURSES  for  34-bed  General  Hospital 
Salary  S850,00  per  month  to  Si, 020  00  plus  expenence  al- 
lowance Excellent  personnel  policies  Apply  to 
Director  of  Nursing,  Englehart  &  District  Hospital 
Inc  ,  Englehart.  Ontario,  POJ  1HQ 


REGISTERED  NURSES  required  for  1 07-bed  accreditee; 
ral  Hospital  Basic  salary  comparable  to  other  Ontario  Ho 
with  remuneration  for  past  experience.  Yearly  mcrem'. 
progressive  hospital  amidst  the  lakes  and  streams  of  No- 
tern  Ontario  Apply  to  Director  of  Nursing,  LaV'^r. 
Hospital,  Fort  Frances.  Ontario.  P9A  2B7. 


REGISTERED  NURSES  required  for  our  ultramodern  "~ 

General  Hospital  in  bilingual  community  of  Northern  C 
Krench  language  an  asset,  but  not  compulsory  Salary  - 
to  $1030  monthly  witti  allowance  for  past  experience 
weeks  vacation  after  1  year  Hospital  pays  lOCo  of  o 
Life  Insurance  (10.000),  Salary  Insurance  (75°o  of  wageb 
age  of  65  with  U.I  C  carve-out),  a  35it  drug  plan  and  a 
care  pian  Master  rotation  m  effect  Rooming  accommi 
available  in  town  Excellent  personnel  policies  A| 
Personnel  Director.  Notre-Dame  Hospital.  PO  Bo: 
Hearst.  Ontario. 


eb  •:.  ■ 


REGISTERED    NURSES    AND    REGISTERED    NURSIKl. 
ASSISTANTS     tor     45-bed     Hospital       Salary     rang  | 
include      qenerous      expenence      allowances.       RN|_ 
salary  ,S915    10  S1.085,  and   RNA  s  salary  S650    tc 
Nurses  residence  —  private  rooms  with  bath  —  S60  per 
Apply  to   The  Director  of  Nursing   Geraldton  District  He 
Geraldton.  Onlano.  POT  1M0  l. 


REGISTERED  NURSES  FOR  GENERAL  DUTY,  I  C  i 
ecu.     UNIT    and     OPERATING    ROOM    required    i 

lully  accredited  hospital.  Starting  salary  $850  00  w 
regular  increments  and  with  allowance  tor  expe 
ence  Excellent  personnel  policies  and  tempore 
residence  accommodation  available  Apply  to  Tl 
Director  of  Nursing,  Kirkland  &  District  Hospili 
Ki-Vland  Lake,  Cnla-io.  P2N  1R2 


QUEBEC 


REGISTERED  NURSE  required  for  CO  ed  children  £  Eumm 
camp  in  the  Laurentians  (seventy  miles  north  of  Montreeli  frc 
JUNE  20,  1975  to  AUGUST  20,  1976  Call  (514)  688  1753 
write  CAMP  MAROMAC.  4548  8th  Street.  Chomedey,  Lav 
Quebec.  H7W  2A4, 


SASKATCHEWAN 


REGISTERED  NURSES  urgently  needed  lor  active  47-b» 
northern  hospital  Especially  interesting  to  those  who  like  varie 
and  emergency  care  in  nursing  Apply  to  Director  of  Nursing,  E 
Josephs  Hospital,  lie  a  La  Crosse,  Saskatchewan,  SOM  tCC 


UNITED  STATES 


48     THE  CANADIAN  NURSE 


R.N.'s  —  Openings  now  available  m  a  variety  of  areas  of  a  41 
bed  teaching  and  research  hospital  affiliated  with  the  school 
medicine  of  Case  Western  Reserve  University  New  facil* 
opening  in  the  spring  Personalized  orientation,  excellent  salai 
full  paid  benefits  and  housing  available  m  hospital  residenc 
Will  assist  you  with  H  l  visa  for  immigration  A  license  m  Ohio 
practice  nursing  is  necessary  for  employment  For  furtti 
information  write  or  phone:  Mrs  Mary  Hernck.  Personn 
Department,  Saint  Luke  s  Hospital  11311  Shaker  Blvd..  Clev 
land  Ohio  44104.  Phone  Monday  -  Friday,  9  A.M.  -  4  PN 
1-216-368-7440 


REGISTERED  NURSES:   Excellent  opportumttes  in  a  lart 

expanding  &  progressive  hospital  Located  in  the  heart " 
California  near  the  finest  educational  and  recreational  activiti* 
where  the  climate  is  mild  the  year  round  Good'slarting  salaric 
and  lilDeral  employee  benefits.  Write  Personnel  Dept  Sut^ 
Hospitals,  2820   L   St  .  Sacramento.  California  95816 


FEBRUARY  197. 


NUMBER 
COLLEGE 


Requires 

TEACHERS  OF  NURSING 

"  teach  nursing  theory  and  practice  for  the  nursing  dip- 
""a  program  Expertise  and  teaching  experience  m  any 
■  'le  (ollowing  areas  would  be  a  definite  asset,  paediat- 
rics, mental  neatlh,  obsletncs  and  medical -surgical  nurs- 
ing Applicant  should  have  BSCN  with  at  least  two  years  of 
njfsing  practice 

Please  repty  in  writing  with  resume  and  other  required 
information  to: 

Personnel  Relations  Centre 

Number  College  ol  Applied  Arts  and  Tectinology 

P  0.  Boi  1900.  Rexdale.  Ontario 

.Ve  are  interested  m  Male  and/or  Female  applicants 


R.N.'s.  NURSING  AHENDANT. 
O.T.  AIDES,  C.N.As. 
PSYCHIATRY  AIDES 


Newly  established  Day  Hospital  in 
Community  Mental  Health  Centre. 
Emphasis  placed  on  Therapeutic 
Community.  Unique  opportunities.  No 
shift  work.  Mondays  through  Fridays, 
hours  9:00  a.m.  to  5:00  p.m. 


Please  apply  to: 

Dr.  EOMOND  RYAN 

Executive  Director 

Cumberland  Mental  Health  Centre 

88  Charles  Street 

Amherst.  Nova  Scotia 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from 

REGISTERED  NURSES 

j4-bed  accredited  general  hospi- 
tal. Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to: 

MISS  E.LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  1  CO 


UNITED  STATES 


UNITED  STATES 


RNs  and  LPN's  -  University  Hospital  Norm,  a 
teaching  Hospital  ol  the  University  of  Oregon  Medical 
School,  has  openings  in  a  variety  ol  Hospital  ser- 
vices We  ofler  competitive  salaries  and  excellent 
fringe  benefits  Inquires  should  be  directed  to  Gale 
Rankin  Director  of  Nursing.  3171  8  w  Sam  Jackson 
Park  Road.  Portland  Oregon  97201 


STATE  OF  ALASKA  —  PUBLIC  HEALTH  NURSE  with  MCH 
expenence  to  direct  Maternal  and  Infant  Care  Project  in  Juneau, 
Alaska  Competitive  salary  An  Equal  Opportunity  Employer, 
Contact  Margaret  Crawford,  MCH  Nursing  Consultant.  Depart- 
ment of  Health  &  Social  Services,  Pouch  H-06B,  Juneau,  Alaska. 
99811 


TEXAS  wants  youf  if  you  are  an  RN.  experienced  or 
a  recent  graduate  come  to  Corpus  Chnsti  Sparkling 
City    by    the    Sea  a    city    building    for    a    belter 

future  where  your  opportunities  for  recreation  and 
studies  are  limitless  Memorial  Medical  Center  500 
bed  general  teaching  hospital  encourages  career 
advancement  and  provides  in-service  orientation 
Salary  from  i682  00  to  59-10  00  per  month  com- 
mensurate with  education  and  experience  Differential 
for  evening  shifts  available  Benefits  include  holi- 
days sick  leave  vacations  paid  hospitalization 
hnalth  life  insurance  pension  program  Become  a 
vital  part  of  a  modern  up  to-date  fiospital  write  or 
call  collect  John  W  Gover  Jr  Director  of  Per 
sonnel  Memorial  Medical  Center  P  O  Box  5280 
Corpus  Chnsti  Texas.  78405, 


Get  what  youVe 

always  wanted 

from  nursing 


&; 


Like  a  wealth  of  professional  experience 
to  enrich  your  career. 


Nursing  has  a  lot  to  offer  Remember' 
But  sometimes  you  can  get  so  stuck  in 
a  rut  you  almost  forget  those  exciting 
challenges  that  made  you  choose  a 
nursing  career  in  the  first  place 

With  Medox.  you  can  revive  those 
challenges 

Since  Medox  serves  almost  the 
entire  spectrum  of  nursing  services, 
you  can  get  more  variety  of 


assignments  in  a  month  than  you 
could  in  a  year  back  in  that 
comfortable  rut  Operating  room. 
Intensive  Care  Cardiac  Unit   Pediatric 
care 

There's  more  to  nursing  than 
punching  a  time  clock 

With  Medox.  there  can  be  a  lot 
more. 


r- 


MedoX 


a  DRAKE  INTERNATIONAL  company 
CAISIACA .  USA .  UK .  AUSTRALIA 


BRUARY  1975 


THE  CANADIAN  NURSE     49 


REGISTERED  NURSES 


required  for 

•  modern  45  bed  acute  care  general  hos- 
pital in  Southwestern  B.C. 

-  R.N. A. B.C.  Contract  in  effect 
1975    Salary    S942.00    —    SI. 112. 00 
(Cost  of  Living  Adjustment  to  be  applied 
March  1.  1975) 

Recognition  for  previous  experience 
Residence  available 


Please  Contact: 

Director  of  Nursing 

Nicola  Valley  General  Hospital 

Merritt,  B.C. 

VOK  280 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

Staff  nurses  for  St,  Antfiony,  New  hospital  of 
150  beds,  accredited.  Active  treatment  in  Surgery, 
Medicine,  Paediatrics.  Obstetrics.  Psychiatry. 
Large  OPD  and  ICU.  Onentation  and  In-Service 
programs.  40-hour  weel<.  rotating  shifts.  PUBLIC 
HEALTH  has  challenge  of  large  remote  areas. 
Furnished  living  accommodations  supplied  at  low 
cost  Personnel  benefits  include  liberal  vacation 
and  sick  leave,  travel  arrangements.  Staff  RN 
S637  - S809.  prepared  PHN  $71 2  —  $903.  steps 
lor  expenence. 


Apply  to: 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Anthony.  Newfoundland 

AOK  4S0 


FISHERMEN  S  MEMORIAL  HOSPITAL 

requires 

OPERATING  ROOM 

AND 

OBSTETRICAL 

UNIT  NURSES 

IN-SERVICE  EDUCATION  DIRECTOR 
SHIFT  SUPERVISOR 

Apply  to 

The  Director  of  Nursing 

Fishermen's  Memorial  Hospital 

Lunenburg,  Nova  Scotia 


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  hospital  is 
presently  expanding  from  1 26  beds 
to  400  and  is  fully  accredited. 
Nursing  is  a  profession  we  respect 
and  we  were  the  first  to  plan  and 
develop  a  unique  nursing  audit 
system.  There  are  opportunities  foi 
gaining  wide  experience,  for  get- 
ting to  know  patients  as  well  as 
staff.  R.N.  salaries  range  from 
S850.  to  SI 020.  per  month.  Credit 
allowed  for  relevant  previous  hospi- 
tal experience. 


Situated' in  Richmond  Hill,  all 
the  cultural  and  entertainment  faci- 
lities 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  Personnel . 


YORK 
CENTRAL 
HOSPITAL 


RIC  HMOND  Hll  I  . 
O  N     1    A    R    1    () 

L4C  4Z3 


GOOD  THINGS 

HAPPEN 

WHEN  YOU  HELP 

RED  CROSS 


Refresher  Course  (in  French) 
TB?  .  .  .  TODAY? 

and 

RESPIRATORY  DISEASES 

March8-14, 1975 
Chateau  du  Lac  Beauport,  Quebec 

Joint  proiect  ot  CTRDA  &  QUEBEC  CHRISTMAS 
SEAL  SOCIETY.  Laval  Universitv. 


Please  contact: 


Mrs.  Fernanda  Hamel 
Library  Pavilion 

Room  2417 
Laval  University 
Ste-Foy,  Quebec 


HEAD  NURSE 
INTENSIVE  CARE  UNIT 

REQUIRED  IMMEDIATELY 

Baccalaureate  degree  preferred 
with  broad  nursing  experience. 

Remuneration  will  be  consistent  with  ex- 
perience. 

Present    salary    range    $11,976.00    - 
$14,040.00  per  year 

January     1st     1975     -     $12,756.00    - 
$15,180.00  per  year 
Generous  fringe  benefits. 

Apply  in  writing  sending  complete  re- 
sume to: 

Director  of  Personnel 
Stratford  General  Hospital 
Stratford,  Ontario,  N5A  2Y6 


50     THE  CANADIAN  NURSE 


FEBRUARY  19; 


Career  opportunities  as 

lurse  practitioners 

n  primary  care 


WcMASTER  UNIVERSITY 
IDUCATIONAL  PROGRAMME 
OR  FAMILY 
PRACTICE  NURSING: 


lext  Program:  Session  Beginning  Fall  1975  — 
'rospective  Candidates  may  apply  until  June  30, 
975 

lequirements:  Current  Canadian  Registration. 
Iponsoring  by  a  medical  co-practitioner.  One 
ear  work  experience  in  nursing. 

For  further  irtformatiori  and  application  forms 
write  to: 

Ms  E.  Mary  Buzzell.  Director, 
Family  Practice  Nurse  Programme, 
Faculty  of  Healtti  Sciences, 
McMaster  University. 
Hamilton,  Ontario,  L8S  4J9. 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Dur  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
;urned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  IVIed- 
ical  or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound    in   our  clinics   and 

:heir  numbers  increase  daily  in  our 

Emergency. 

f   you   do   not   lil<e   working  with 

children    and   with   their   families. 

/ou  would  not  like  it  here. 

If  you  do  like  children  and  their 
families,  we  would  like  you  on  our 

staff. 


Interested     qualified 
should  apply  to  the: 


applicants 


DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108.  Quebec 


POST-DIPLOMA  NURSING  PROGRAMS 


Ryerson's  Post-diploma  Nursing  programs  in  Pediatric  Nursing,  Psychia- 
tric Nursing,  and  Adult  Intensive  Care  offer  graduate  nurses  the  opportu- 
nity to  become  more  effective  professionals  in  these  branches  of  nursing 
practice.  Each  program  is  endorsed  by  the  O.H.A..  O.M.A..  and  R.N.A.O. 
and  is  comprized  of  approximately  1 5  weeks  of  full-time  study.  The  curricu- 
lum structure  provides  for  a  unique  balance  of  clinical  experience,  and 
classroom  instruction  —  highlighting  courses  in  nursing,  pathology,  and 
the  humanities  and  social  sciences. 


Applicants  must  have  obtained  the  Ryerson  diploma  in  Nursing  (or  equiva 
lent)  and  be  registered  or  eligible  for  registration  in  Ontario.  An  additional 
prerequisite  to  the  Psychiatric  program  is  experience  in  this  phase  of 
nursing  during  diploma  studies. 

For  detailed  program  information,  please  contact: 


RYERSON  POLYTECHNICAL  INSTITUTE 

Office  of  Admissions 

50  Gould  Street,  Toronto  MSB  1E8  Ontario 

Telephone:  595-5027 


JIBissiffnmen(^ 
Oifcrscas 


^J'CP^ 


Experienced  nurses  are  need- 
ed to  work  in  Africa,  Asia, 
Latin  America,  and  the  South 
Pacific. 

Become  involved  in  public 
health,    primary    care,    and 
training  programmes. 
Two  year  contracts. 
Contact:    CUSO  -  Health  -14 
151  Slater  Street 
Ottawa,  Ontario 
K1P5H5 


GENERAL  DUTY 
REGISTERED  NURSES 

CERTIFIED  NURSING  AIDES 


Required  for  a  135-bed  active  treatment 
Hospital  located  in  a  modern  city  of  some 
6500  people,  just  forty  miles  south  of  Ed- 
monton and  with  easy  access  to  lake  and 
mountain  resort  areas  such  as  Banff  and 
Jasper. 


Salaries  presently  under  negotiations.  Ex- 
cellent personnel  policies  and  fringe  be- 
nefits available. 


tOndly  apply  to: 

Director  of  Nursing 
Wetaskiwin  General  Hospital 
5505  -  50  Avenue 
WETASKIWIN,  Alberta 
T9A  0T4 


<BRUARY  1975 


THE  CANADIAN  NURSE     51 


UNIVERSITY  HOSPITAL 

SASKATOON,  SASKATCHEWAN 

Requires 

REGISTERED  NURSES 

for 

PEDIATRICS  and  other  services. 

Policies  according  to  S.U.N,  contract  which  inclu- 
des a  cost  of  living  clause. 

Apply  to: 

Employment  Officer,  Nursing 
University  Hospital 
SASKATOON,  Saskatchewan 
S7N  0W8 


QUEEN'S  UNIVERSITY 
SCHOOL  OF  NURSING 

Faculty  Openings 

July  1975  for  Lecturers,  Assistant  or  Asso- 
ciate Professors  for  basic  undergraduate 
programme  in  nursing  of  adults,  maternity 
nursing  and  community  healtfi.  Masters 
degree  in  clinical  nursing  and  successful 
experience  required.  Preference  given  to 
preparation  as  a  family  nurse  practitioner. 
Salary  commensurate  with  preparation. 


Apply  to: 


Dean,  School  of  Nursing 
Queen's  University 
Kingston,  Ontario 
K7L  3N6 


REGISTERED  NURSES 


Registered  Nurses  required  for  large 
metropolitan  general  hospital. 
Positions  available  in  all  clinical  areas. 
Salary  Range  in  effect  until  December 
31,1975. 

$900.  —  $1,075.  Starting  rate  de- 
pendent on  qualifications  and  experi- 
ence. 


Apply  to: 


Staffing  Officer-Nursing 
Personnel  Department 
Edmonton  General  Hospital 
Edmonton,  Alberta 
T5K  0L4 


ST.  MICHAEL'S  HOSPITAL 

Toronto,  Ontario 

invites  applications  fron-i 

REGISTERED  NURSES 

for 

INTENSIVE    CARE 
and  "STEP-DOWN  "  UNITS 


Planned  orientation  and  in-service  programme  will  ena- 
ble you  to  collaborate  in  the  most  advanced  of  treatment 
regimens  for  the  post-operative  cardio-vascular  and 
other  acutely  ill  patients  One  year  ot  nursing  experience 
a  requirement. 


For  details  apply  to: 


The  Director  of  Nursing, 
St.  Michael's  Hospital, 
Toronto,  Ontario, 
M5B1W8. 


REGISTERED  NURSE 


We  have  opportunities  here  for  an  exper 
enced  registered  nurse.  Our  nursjn- 
salaries  are  established  through  agree 
ment  with  the  A. A. R.N. 

We  have  a  very  active  230-bed  hospital  ii 
Central  Alberta.  If  you  are  interested  ii 
more  information  regarding  Red  Deer  am 
the    Red    Deer    Health    Care    Compley 

please  write  or  call: 

Personnel  Director 
Red  Deer  General  Hospital 
Red  Deer,  Alberta 
Tel.:  (403)  346-3321 


Director 
of  Nursing 


Applications  are  invited  for  this  position  in  a  100 
bed  fully  accredited  hospital.  Expansion  of  Attn 
bulant.  Rehabilitative  Care  and  diagnostic  areas 
to  be  undertaken  in  the  near  future. 


Individuals  possessing  a  BSc  in  Nursing  and  ex- 
perience in  Nursing  Administration  preferred 
Qualified  interested  persons  are  requested  tc 
supply  a  resume  containing  details  of  education 
training  and  expenence,  and  date  of  availabilit) 
for  employment  to: 

Administrator, 

Dawson  Creek  and  District  Hospital, 

11100-13th  St., 

Dawson  Creek,  B.C. 

V1G  3W8 


GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit. 

Clinical  areas  include:  medicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R.NA.B.C,  contract: 

SALARY:  $850  —  $1 020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


REGISTERED  NURSES 

Required 

For  fully  accredited  recently  expanded  200-bed 
hospital,  situated  on  beautiful 


LAKE  OF  THE  WOODS 

Starting  salary  $850,  increasing  to  $915  January 
1 ,  1 975  and  $945  April  1 .  1 975. 
Allowance  given  for  past  hospital  expenence. 
Shift  differential  and  annual  increments. 

Vacancies  in  medical,  obstetrics  and  progressive 

coronary  care  units. 

37'/2-hour  week. 

Excellent  personnel  policies. 

Apply  in  writing  to; 

Mrs.  B.G.  Schottrotf 

Director  of  Nursing 

Lake  of  the  Woods  District  Hospital 

Kenora,  Ontario 


The  Brome-MJssisquoi-Perkins 
Hospital 

requires 

1  Day  Supervisor 
1  Night  Supervisor 
Registered  Nurses 


Please  write  to: 

Director  of  Nursing 
Brome-MJssisquoi-Perkins  Hospital 
950  Main  Street 
Cowansville,  Quebec 
J2K1K3 


52     THE  CANADIAN  NURSE 


FEBRUARY  19 


Whatls  a  big  company 
like  Upjolin  doing 
in  nursing  services? 

( Simple.  We're  in  it  to  help  you  and  here's  how.) 

If  you're  a  Nursing  Supervisor  we  can  complement  your  staff 
when  shortages  occur  by  providing  competent  R.N.'s, 
R.N.A./ C.N.A./ L.P.N,  s  or  Nurse  Aides. 

If  you're  a  nurse  interested  in  working  part-time  to  supple- 
ment your  family's  income,  we  offer  you  the  opportunity  to 
select  hours  and  assignments  convenient  to  i;our  schedule, 
not  ours. 

If  you're  a  Discharge  Planning  Officer  or  Home  Care  Co- 
ordinator, we  are  a  reliable  source  for  home  health  care 
with  whom  you  can  trust  your  outgoing  patients. 

If  you're  an  inactive  nurse  temporarily  out  of  touch  with 
nursing,  we  can  offer  patient  care  opportunities  which  will 
enable  you  to  re-enter  your  profession. 


W'e  think  that  it  is  important  for  you.  the  Registered 

Nurse,  to  understand  why  The  Upjohn  Company's 

subsidiary.  Health  Care  Services  Upjohn  Limited. 

has  become. involved  in  nursing.  Our  concept  of 

part-time  nursing  services  has  proven  to  be  an 

important  adjunct  to  the  delivery  of  health  care. 

'ur  interest  is  in  assisting  the  Medical  and  Nursing 

Professions  by  providing  additional  qualified 

R.N.'s.  R.N.A./C.N.A./L.P.N.'s  and  Home 


Health  Care  Personnel  to  serve  the  commu- 
nity, if  you  would  like  more  information  about 
the  work  that  we  are  doing  across  the  country 
and  how  we  can  help  you,  contact  the  Health 
Care  Services  Upjohn  office  nearest  you. 
Ask  for  the  Service  Director.  She  is  an  R.N.. 
and  you'll  both  be  speaking  the  same  lan- 
guage. Look  for  us  in  the  white  pages  and  in 
the  yellow  pages  under  "Nurses  Registries." 


HEALTH  CARE  SERVICES  UPJOHN  LIMITED 


With  16  offices  to  serve  you  across  Canada 


Victoria 

388-6639 

Winnipeg 

943-7466 

St.  Catharines      688-5214 

Montreal             288-4214 

Vancouver 

731-5826 

Windsor 

258-8812 

Toronto  East        445-5262 

Trois  Rivieres     379-4355 

Edmonton 

423-2221 

London 

673-1880 

Toronto  West      239-7707 

Quebec  City        687-3434 

Calgary 

264-4140 

Hamilton 

525-8504 

Ottawa                238-4805 

Halifax               425-3351 

(Operating  in 

Ontario  as  H  C  S  Upjohn) 

BRUARY  1975 

THE  CANADIAN  NURSE 

53 

Nursing  Education  Positions 

Division  of  Continuing  Education 

University  of  Victoria 

Applications  are  invited  for  two  Nursing  positions  associated  with  a  new  six  month 
program  entitled  "Post  Basic  Course  in  Psychiatric  Nursing  for  Registered  Nurses" 
beginning   in   1975  -  exact  date  is  to  be  announced. 

1.  Psychiatric  Instructor  -  Coordinator  -  9  month  appointment 
Major  duties  include: 

a.  orientation  to  the  sponsoring  educational  institution  and  the  clinical  facilities  to  be 
used  for  student  experience. 

b.  planning  of  courses,  learning  objectives,  and  student  evaluation  techniques. 

c.  development  of  appropriate  clinical  learning  experiences. 

d.  participation  in  student  selection. 

e.  implementation  of  the  course. 

f.  completion  of  necessary  reports  and  records,  including  follow-up  evaluation. 

2.  Psychiatric  Clinical  Instructor  -  Half-time  -  7  month  appointment 
Major  duties  include: 

a.  orientation  to  the  program  and  tothe  clinical  facilities  to  be  used  for  student  experience. 

b.  helping  develop  appropriate  learning  experiences  with  cooperating  clinical  facility. 

c.  assisting  with  course  planning  and  implementation,  as  required. 

Nursing    instructors   must   be  eligible  for   registration    in    B.C.        Positions 
immediately        Salary  —  competitive 
Direct  applications  with  complete  resume  to: 

Mrs.  F.B.  Collins,  Program  Officer 

Division  of  Continuing  Education 

University  of  Victoria 

P.O.  Box  1700,  Victoria,  B.C.    V8W  2Y2 


available 


"MEETING  TODAYS  CHALLENGE  IN  NURSING" 

QUEEN     ELIZABETH     HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGill  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 
Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


CARE 


CANADA 


THE 
WORLD   OF    CARE: 

Providing  nutritious 
food  for  school  chil- 
dren and  pre-schoolers, 
health  services  for  the 
sick  and  handicapped, 
facilities  and  equip- 
ment for  basic  school- 
ing and  technical  train- 
ing, tools  and  equip- 
ment for  community 
endeavours.  Your  sup- 
port of  CARE  makes 
such  things  possible  for 
millions  of  individuals 
around  the  world. 


One  dollar   per   person; 
each  year  would  do  it!) 

I 

63  Sparks  OTTAWA  (Ont.)  K1  P  bf- 


54     THE  CANADIAN  NURSE 


FEBRUARY  1 


A  brand-new  Appointment... 

Senior 
Lecturer  in  Chss^- 
EKploma  of  Nursing 

An  exciting  new  challenge... 


In  1976  the  Preston  Institute  of  Technology 
will  pioneer  a  new  facet  of  nurse  education  in 
Victoria.  Working  with  the  full  endorsement 
and  support  of  two  of  Victoria's  larger  general 
hospitals  the  Institute  will  establish  a  three 
year  Nursing  Diploma  Course  on  its 
new  Campus. 

This  Appointment  represents  a  real 
challenge  to  a  University  or  College  Graduate, 
either  male  or  female  who  will  develop  the 
course  with  full  support  from  leading  nursing 
interests  in  Victoria,  administer  the 
programme  and  assume  the  duties  of  Senior 
Lecturer  in  Charge  of  the  Department  of 
Nursing. 

The  Institute 

The  Preston  Institute  of  Technology  Is  one  of 
the  well-established  Colleges  of  Advanced 
Education  in  Victoria,  with  Degree  and 
Diploma  courses  in  Applied  Science,  Art  & 
Design,  Business  Studies,  Engineering, 
Physical  Education  and  Social  Work,  and 
Certificate  courses  including  Occupational 
Health  Nursing. 

Today,  having  outgrown  the  original  facilities, 
It  now  occupies  a  new  location  in  the 
"green  belt'    some  20  kilometres  from  the 
Capital  City  of  Ivlelbourne  —  population  in 


••• 


excess  of  two  and  a  half  million.  The 
Institute  now  has  the  most  up-to-date 
facilities  and  equipment  available  and  is 
situated  in  approximately  40.5  hectares 
(100  acres)  of  bushland  setting  —  magnificent 
tor  study  yet  only  minutes  from  the  bustling 
suburbs  and  supporting  hospitals. 

Remuneration... 

A  permanent  appointment  is  desired  with  a 
salary  range  envisaged  between  SAI 5,361 
to  SA17,890  annually. 
The  Institute  is  prepared  however,  to 
consider  a  two  or  three  year  teaching 
contract;  in  this  instance  Citizens  of  the 
United  States  could  be  eligible  for  exemption 
from  both  U.S.  and  Australian  income  tax. 
The  salary  for  an  overseas  appointee  will  be 
calculated  from  the  agreed  date  of 
embarkation. 

Relocation  assistance... 

The  Institute  has  established  allowance 
schemes  covering  relocation  expenses  for 
your  family  and  your   household  goods,  an 
immediate  superannuation  insurance  cover, 
and  assistance  with  accommodation  and 
housing  loans. 


For  more  information  about  the  Institute,  the  Course,  working  and 
living  conditions  please  write  to  the  Staffing  Officer. 

A  Senior  Member  of  the  Institute  will  be  travelling  overseas, 
early  in  March,  1975  to  meet  interested  people,  who  should  apply 
for  an  interview  before  February  21,  1975. 

PRESTON  INSTITUTE  of  TECHNOLOGY 

Plenty  Road,  Bundoora, 
Victoria,  Australia  3083 


IBRUARY  1975 


THE  CANADIAN  NURSE     55 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 

Furnished  ■  shared. 

Swimming  Pool,  Tennis  Cou'ft, "Recreation  Room, 

Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital. 
NEWMARKET,  Ontario, 
L3Y2R1. 


'% 


"^•"••wiiii^^        Jim 


THE  SCARBOROUGH 
GENERAL  HOSPITAL 

invites  applications  from: 
Registered  Nurses  and  Registered  Nursing  Assis- 
tants  to   work    in    our   650-bed    active   treatment 
hospital  and  new  Chronic  Care  Unit. 

We  "offer  opportunities  in  Medical.  Surgical.  Paediatric,  and  Obstetrical  nursing 
Our  specialties  include  a  Burns  and  Plastic  Unit,  Coronary  Care,  Intensive  Care  and 
Neurosurgery  Units  and  an  active  Emergency  Department. 

•  Obstetrical  Department  —'participation  In  "Family  centered"  teactiing 
program. 

•  Paediatric  Department  —  participation  In  Play  Therapy  Program. 

•  Orientation  and  on-going  stall  education. 

•  Progressive  personnel  policies. 

The  hospital  is  located  in  Eastern  Metropolitan  Toronto. 
For  further  information,  write  to: 

The  Director  of  Nursing, 

SCARBOROUGH  GENERAL  HOSPITAL 

3050  Lawrence  Avenue,  East,  Scarborough,  Ontario 


POST  GRADUATE 
COURSES 


The  following  courses  in  this  modern  1 200  bed  teach- 
ing hospital  will  be  of  interest  to  registered  nurses 
who  seek  advancement,  specialization  and  profes- 
sional growth. 


•  Cardiovascular-Intensive  Care  Nursing.  This 
is  a  22  week  clinical  course  with  classes 
commencing  in  February  arnl  September. 

•  Operating  Room  Technique  and  Manage- 
ment. This  24  week  clinical  course  commences 
in  March  and  September. 


For  further  Information  and  details,  contact: 

Recruitment  Officer  -  Nursing 
University  of  Alberta  Hospital 
Edmonton,  Alberta  T6G  2B7 


<i/ 

»  .  -\  ■  '  .  .-  ,•_        ---_-. 

'^^~""-^'*4>^ 

fy      '    ^rT:;1^|;;;.l^..; 

'     -.S-i-'^fN.-,  ••••^^^•" 

GENERAL  STAFF  NURSES 

required  for 

RECINA  GENERAL  HOSPITAL 

openings  In  ail  departments 

Salary  -  $775.  -  $900. 

Recognition  Given  For  Experience 
Progressive   Personnel   Policies 

Apply: 

Personnel   Department 
REGINA   GENERAL    HOSPITAL 

Regina,   Saskatchewan 

S4P  0W5 


56     THE  CANADIAN  NURSE 


FEBRUARY  197 


PAEDIATRIC 
SUPERVISOR 


.  ;ellenl  opportunity  in  a  fully  accredited  333-bed 
iive  treatment  hospital  located  in  the  Toronto- 
■amilton  area. 

Responsible  for  administration  and  nursing  care 
n  a  45-bed  mixed  medical-surgical  paediatric 
mit.  Good  clinical  background  in  Paediatric  Nur- 
;ing  is  essential. 

■xcellent  salary  and  working  conditions  Further 
iformation  will  be  forwarded  on  receipt  of 
omplete  resume  of  education  and  experience. 


fpfyto: 

PERSONNEL  MANAGER 
Oakville-Trafalgar  Memorial  Hospital 
327  Reynolds  Street 
Oakville.  Ontario 
L6J3L7 


GENERAL  DUTY  NURSES 

MEDICINE 

PAEDIATRICS 

CHRONIC  &  REHABILITATION 

REQUIREMENTS: 

Current  Ontario  Registration  as  a  Regls- 
:ered  Nurse 


Inquiries  may  be  directed  to: 

Mrs.  J.  Stewart 
Director  of  Nursing 
OEhawa  General  Hospital 
24  Alma  Street 
OSHAWA,  Ontario 
L1G  2B9 


DIRECTOR 
OF  NURSING 


Required  effective  March  1 , 1 975.  This  pos- 
ition carries  responsibility  for  the  coordina- 
tion of  all  facets  of  nursing  services  within  a 
75-bed  accredited  hospital.  Preference 
given  to  applicants  with  University  prepara- 
tion in  Nursing  Administration  or  successful 
supervisory  and  nursing  administration  ex- 
perience. 


Apply  in  writing,  stating  experience,  qualifica- 
tions, references  and  date  available  to: 


Administrator 
St.  Therese  Hospital 
St.  Paul.  Alberta 
TOA  3A0 


Some  nurses  are  just  nurses. 
Our  nurses  are  also 
Commissioned  Officers. 


Nurses  are  very  special  people  m  the  Canadian  Forces 

They  earn  an  Officers  salary,  enpy  an  Officer s  privileges 
and  live  in  Officers'  Quarters  (or  m  civilian  accommodation  if  they 
prefer)  on  Canadian  Forces  bases  all  over  Canada  and  m  many 
other  parts  of  the  world 

If  they  decide  to  specialize,  they  can  apply  for  postgraduate 
training  with  no  loss  of  pay  or  privileges  Promotion  is  based  on 
ability  as  well  as  length  of  service  And  they  become  eligible  for 
retirement  benefits  (including  a  lifetime  pension)  at  a  much  earlier 
age  than  m  civilian  life. 

If  you  were  a  nurse  in  the  Canadian  Forces,  you  would  be 
a  special  person  doing  an  especially  responsible,  rewarding  and 
worthwhile  |0b. 

For  full  information,  write  the  Director  of  Recuiting  and  Selec- 
tion. National  Defence  Headquarters.  Ottawa.  Ontario  KIA  0K2 


^^0^  Get  involved  With  the 
W'  Canadian  Armed  Forces. 


Public  Service      Fonction  publique 
Canada  Canada 


THIS  COMPETITION  IS  OPEN  TO  BOTH  MEN  AND  WOMEN 

NURSING  OPPORTUNITIES  IN  THE  NORTH 
Starting  salary  up  to  $9,488 

(UNDER  REVIEW) 
(Plus  Northern  Allowance) 

HEALTH  AND  WELFARE  CANADA 

Medical  Services 
Various  locations  in  the  Yukon  and  N.W.T. 

An  opportunity  to  see  parts  of  Canada  few  Canadians  ever  see  and  to  utilize  all  your  nursing 
skills.  Nurses  are  required  to  provide  health  care  to  the  inhabitants  located  in  some  settlements 
well  north  of  the  Arctic  Circle.  Radio  telephone  communication  is  available.  Join  the  Northern 
Health  Service  of  the  Department  of  Health  and  Welfare  Canada  and  discover  what  northern 
nursing  is  all  about. 

Candidates  must  be  registered  or  eligible  for  registration  as  a  nurse  in  a  province  of  Canada, 
be  mature  and  self-reliant.  For  some  positions,  mid-wifery,  obstetrics,  pediatrics  or  Public 
Health  training  and  experience  is  essential.  Proficiency  in  the  English  language  is  essential. 
Salary  commensurate  with  experience  and  education. 

Transportation  to  and  from  employment  area  will  be  provided:  meals  and  accommodation  at 
a  nominal  rate. 

HOW  TO  APPLY: 

Fon^fard  Application  for  Employment"  (Form  PSC  367-4110)  available  at  Post  Offices, 
Canada  Manpower  Centres  or  offices  of  the  Public  Service  Commission  of  Canada  to  the: 

DEPARTMENT  OF  HEALTH  AND  WELFARE  CANADA 

MEDICAL  SERVICES  —  NORTHWEST  TERRITORIES  REGION 

1401  BAKER  CENTRE—  10025  -  106  STREET  EDMONTON.  ALBERTA  T5J  1H2 

Please  quote  competition  number  74-E-4  in  all  correspondence. 

Appointments  as  a  result  of  this  competition  are  subject  to  the  provisions  of  the  Public 

Service  Employment  Act. 


BRUARY  1975 


THE  CANADIAN  NURSE     57 


BRANDON  GENERAL  HOSPITAL 
SCHOOL  OF  NURSING 

NURSE  TEACHER 

FOR 

TWO  YEAR  DIPLOMA  PROGRAM 

POSITION  AVAILABLE  FEBRUARY  1,  1975 
IN 

OBSTETRICAL  NURSING 

QUALIFICATIONS: 

Baccalaureate  Degree  in  Nursing  is  required.  Preference  given  to 
applicants  with  experience  in  Nursing  and  Teaching. 

Apply  in  writing  stating  qualifications,  experience,  references  to: 

PERSONNEL  DIRECTOR, 
Brandon  General  Hospital, 
150  McTavlsh  Avenue  East, 
Brandon,  Manitoba, 
R7A  2B3. 


SCHOOL  OF  NURSING 

Assistant  Director 

and 

Instructors 

required  for  August,  1975 
in  a  2  year  Nursing 
diploma  program. 


Qualifications 

Assistant  Director  —  Master  degree  In  Nursing  Education,  prefer- 
red, with  experience  in  Nursing  Education  Administration  and  teach- 
ing and  at  least  one  year  in  a  Nursing  Service  position.  Eligible  for 
registration  in  New  Brunswick. 

Instructors  —  Bachelor  of  Nursing  with  experience  in  teaching  and 
at  least  1  year  in  a  Nursing  Service  position.  Eligible  for  registration 
in  New  Brunswick. 

Apply  to: 

Harriett  Hayes 

Director 

The  Miss  A.  J.  MacMaster  School  of  Nursing 

Postal  Station  A,  Box  2636 

Moncton,  N.B. 

E1C8H7 


MATER  PUBLIC  HOSPITAL 

SOUTH  BRISBANE,  AUSTRALIA 


COME  TO  SUNNY  QUEENSLAND 


NURSE  TEACHERS  WANTED 


FOR  THEORETICAL  &  CLINICAL  AREAS: 

IN  GENERAL  AND  PAEDIATRIC  NURSING; 

At  Basic  &  Postbasic  levels. 


Apply 


Director  of  Nursing  Services, 
Mater  Misericordiae  Hospitals, 
South  Brisbane,  Qld.  4101, 
Australia. 


McMaster  University 
IVIedical  Centre 


We  would  like  to  discuss  a  senior  nursing  position  with  you. 
Our  Patient  Care  Co-Ordinators  have  clinical  and  adminis- 
trative responsibility  for  their  own  units.  They  are  directly 
accountable  for  staff  performance  and  development,  in- 
service  education  and  for  the  quality  of  patient  care  through 
the  implementation  of  nursing  standards.  Resource  people 
are  available  as  these  responsibilities  are  not  usually  within 
the  scope  of  the  traditional  "head  nurse". 

If  you  are  looking  for  an  added  challenge  and  dimension  in 
your  work,  write  us  with  details  of  your  past  experience  and 
your  interests.  For  qualified  candidates  cross  appointments 
in  the  School  of  Nursing  at  McMaster  University  may  be 
recommended. 


Send  your  letter  to: 

Manager,  Employment  &  Staff  Relations 
McMaster  University  Medical  Centre 
1200  Main  Street  West 
HAMILTON,  Ontario 
L8S  4J9 


58     THE  CANADIAN  NURSE 


FEBRUARY  19; 


NURSING     EMPLOYMENT 
OPPORTUNITY 


SYNDIC 


THE  ORDER  OF  NURSES  OF  QUEBEC 


$ 


RESPONSIBILITIES 

Responsible  for  the  application  of  the  law  concerning  the  Committee  on 

Discipline 

Conducts  enquines. 

Prepares  official  complaint. 

Informs  the  public,  organizations,  members  and  other  corporations  according 

to  established  procedures  and  legal  requirements. 

Verifies  that  members  have  taken  the  oath  of  office. 

QUALIFICATIONS 

Candidates  must  be  bilingual  and  possess: 
•  broad  nursing  experience 
■  knowledge  of  psychokjgy.  interviewing  methods  and  allied  skills 


Applications   containing   full  information   must  be   received  before 
February  28.  T975. 


The  Executive  Director  and 
Secretary  of  tlie  Order 
4200  Dorctiester  Blvd.  West 
Montreal  H3Z  1V4.  Que. 


WELCOME 


to 


"THE  NEURO" 


A  Teaching  Hospital 
of  McGill  University 

Positions  available 

for  nurses  in  all  areas 

including  Operating  Room 

Individualized  orientation 

On-going  staff  education 


(Quebec  language  requirements 
do  not  apply  to  Canadian  applicants) 


Apply  to: 

The  Director  of  Nursing, 

Montreal  Neurological  Hospital. 

3801  University  Street. 

Montreal  H3A  2B4. 

Quebec,  Canada. 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEUROSURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  f^anagement. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 

BRUARY  1975 


^M^ 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


THE  CANADIAN  NURSE     59 


R.N.'S 


The  Royal  Alexandra  is  a  friendly  place  to  work;  a  modern 
progressive  1000  bed  teaching  hospital  in  the  "just-right- 
size"  city  of  Edmonton,  Alberta. 

Fully  accredited,  the  Royal  Alexandra  offers  challenging  ex- 
perience, on-going  in-service  programs,  generous  fringe 
benefits  and  competitive  salaries.  All  previous  experience  is 
recognized.  You  may  skate,  ski  and  curl  inexpensively.  Ed- 
monton is  within  easy  driving  distance  of  many  lakes  where 
you  may  enjoy  the  sunny  Alberta  summer 

Vacancies  exist  in  most  areas  including  ICU,  O.R.  &  Psy- 
chiatry. 

Salary  Range  for  General  Duty:  $900.  -  $1075. 


For  Information  please  write  to: 

Director  of  Nursing 
Royal  Alexandra  Hospital 
10240  Kingsway  Ave. 
EDMONTON,  ALBERTA 
T5H  3V9 


NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  tor  all  Nursing  Units 
Intensive-Coronary  Care,  Psychiatry,  Med.-Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservice  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries    Reg.  N.  Jan.  1st,  1975—915.-1,115. 
April  1st,  1975  —  945.  —  1,145. 

R.N.A.  Jan.  1st.  1975  —  686.  —  728. 
July  1st,  1975  —  738.  —  780. 

Contact 
Director  of  Nursing 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 

teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

1974  Salary  Scale  $850.00  —  $1,020.00  per  month 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 
VANCOUVER  GENERAL  HOSPITAL 
855  WEST  12TH  AVE. 
VANCOUVER,  B.C. 


60     THE  CANADIAN  NURSE 


FEBRUARY  1 


REGISTERED  NURSES 

are  invited  to  apply  for  positions  in 

MEDICINE  AND 
GENERAL  SURGERY 


at 


^ 


Toronto 
General  Hospital 

University 
Teaching  Hospital 


•  located  in  heart  of  downtown  Toronto 

•  within  wall<ing  distance  of  accommodation 

•  subway  stop  adjacent  to  Hospital 

•  excellent  benefits  and  recreational  facilities 


apply  to  Personnel  Office 

TORONTO  GENERAL  HOSPITAL 

67  COLLEGE  STREET,  TORONTO,  ONTARIO,  M5G  1 L7 


Ji- 


I 


i 


We  invite  applications  from 

REGISTERED  NURSES 
FOR  GENERAL  DUTY 

in  all  patient  services  areas  including  I.C.U./C.C.Unit.  This  is  an 
opportunity  to  be  on  staff  when  we  move  to  this  new  138  bed 
General  Hospital,  which  will  be  early  in  1975. 

Successful  applicants  will  be  paid  prevailing  Ontario  salary  rates  as 
well  as  other  generous  fringe  benefits  and  in  addition  you  will  have 
the  opportunity  to  work  in  a  brand  new  building  with  modern  equip- 
ment and  beautiful  surroundings. 

Apply  in  writing  to 

The  Director  of  Nursing 
Kirkland  and  District  Hospital 
Kirkland  Lake,  Ontario 
P2N  1R2 


HEALTH 

SCIENCES 

CENTRE 

WINNIPEG, 
MANITOBA 


THIS  1345  BED  COMPLEX  WITH  AMBULATORY  CARE  CLINICS,  AFFILIATED 
WITH  THE  UNIVERSITY  OF  MANITOBA,  CENTRALLY  LOCATED  IN  A  LARGE. 
CULTURALLY  ALIVE  COSMOPOLITAN  CITY 

INVITES  APPLICATIONS  FROM 

REGISTERED    NURSES    SEEKING    PROFESSIONAL 

GROWTH,  OPPORTUNITY  FOR  INNOVATION,  AND  JOB 

SATISFACTION. 

ORIENTATION  -  Extensive  two  week  program  at  full  salary 

ON-GOING  EDUCATION    Provided  through 

—  active  in-service  programmes  in  all  patient  care  areas 

—  opportunity  to  attend  conferences,  institutes,  meetings  of  professional 
association 

—  post  basic  courses  in  selected  clinical  specialties 
PROGRESSIVE  PERSONNEL  POLICIES 

—  salary  based  on  experience  and  preparation 

—  paid  vacation  based  on  years  of  service 

—  shift  differential  for  rotating  services 

—  lOstatutory  holidays  per  year 

—  insurance,  retirement  and  pension  plans 

—  contract  under  negotiation  effective  March,  1975 

SPECIALIZED  SERVICE  AREAS  include  orthopedics,  psychiatry,  post 
anaesthetic,  emergency,  intensive  care,  coronary  care,  respiratory  care,  dialysis, 
medicine,  surgery,  obstetrics,  gynaecology,  rehabilitation,  and  paediatrics. 

ENQUIRIES  WELCOME 

FOR  FURTHER  INFORMATION  PLEASE  WRITE  TO: 

PERSONNEL  DEPARTMENT.  NURSING  SECTION 
HEALTH  SCIENCES  CENTRE, 

700  WILLIAM  AVENUE,  WINNIPEG.  MANITOBA    RJE0Z3 


BRUARY  1975 


THE  CANADIAN  NURSE     61 


NORTH  YORK  GENERAL  HOSPITAL 

INVITES  APPLICATIONS  FROM: 

REGISTERED  NURSES  AND 
REGISTERED  NURSING  ASSISTANTS 

FULL  AND  PART-TIME  POSITIONS 

N.Y.G.H.  is  a  585-bed.  fully  accredited,  active  treatment  hospital 

located  in  Nortti  Metropolitan  Toronto  ottering  opportunities  in  all 

services. 

The  Hospital  embraces  the  full  concept  of  Progressive  Patient 

Care  featuring  a  Self  Care  Unit  and  a  Psychiatric  Day  Care 

Program. 

Our  Nursing  Philosophy  focuses  on  the  patient  as  an  individual  and 

recognizes    the    importance    of    continuing    education    for    the 

improvement  of  patient  care. 

An  active  Staff   Development  program  focusing  on   individual 
learning  needs  is  maintained. 

Apply  to: 

Personnel  Department 
North  York  General  Hospital 
4001  Leslie  Street 
Willowdale,  Ontario 
M2K1E1 


ORTHOPAEDIC    U    ARTHRITIC 
HOSRIT-AL- 

43  WELLESLEY  STREET,  EAST 

TORONTO,  ONTARIO 

M4Y1H1 

Enlarging   Specialty   Hospital   offers   a   unique 
opportunity  to  nurses  and  nursing  assistants 
interested  in  the  care  of  patients  with  bone  and 
joint  disorders. 
Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  all 
units 

Clinical  specialists  for  Operating  Room,  Intensive 
Care,  Patient  Care  and  Education. 


SCHOOL  OF  NURSING 

DALHOUSIE  UNIVERSITY 

Halifax,  N.S. 

FACULTY  POSITIONS 

A  number  of  positions  will  be  available  in  1 975  for  well-qualified  faculty  to  participate  in  a 
progressive  undergraduate  and  graduate  program. 

The  baccalaureate  program  for  basic  and  R.N.  students  is  integrated  around  an  holistic 
developmental  concept  of  human  beings  in  health  and  illness.  A  graduate  program  is 
planned  to  start  in  September,  1975. 

Other  plans  for  the  development  of  the  School  make  Dalhousie  a  challenging  place  for 
faculty  committed  to  the  continual  improvement  of  nursing's  contribution  to  health  care, 
and  wanting  opportunity  to  develop  their  own  professional  interests. 
Minimum  requirement  —  Masters  degree 
Apply  to: 

Ms.  Muriel  E.  Small 

Acting  Director 

School  of  Nursing 

Dalhousie  University 

Halifax,  N.S. 

B3H  3J5 


62     THE  CANADIAN  NURSE 


FEBRUARY  19: 


CARIBOO 
COLLEGE 

KAMLOOPS 

BRITISH 
COLUMBIA 


requires 


Nursing  Instructors 

Qualifications: 

I)    An  MA.  degree  Is  preferred  but  consideration  will  be  given  to  persons 
with  a  Baccalaureate  degree. 

a)  Service  and  teaching  experience  in  Psychiatry 

b)  Service  and  teaching  experience  in  Medical-  Surgical  Nursing 

c)  Eligibility  for  registration  in  Bntlsh  Columbia. 

Duties:  (to  commence  April  1 , 1 975) 

'^ )    Classroom  teaching 
j2)    Clinical  teaching  and  supervision 
3)    Participation  In  curriculum  planning,  and  other  faculty  activities. 

Mail  applications  together  with  curriculum  vitae  and  letters  of 
eference  to:  The  Principal,  Cariboo  College,  Box  860, 
Kamloops,  British  Columbia,  V2C  5N3. 


UNIVERSITY  OF  ALBERTA 
SCHOOL  OF  NURSING 


FACULTY  POSITIONS 

Faculty  members  required  for  positions  in  four  year  basic 
and  two  year  post-basic  baccalaureate  programs.  Applic- 
ants should  have  graduate  education  and  experience  in  a 
clinical  area  and/or  in  curriculum  development,  evaluation  or 
research.  Must  be  eligible  for  Alberta  registration. 

Personnel  policies  and  salaries  in  accord  with  University 
schedule  based  on  qualifications  and  experience. 

Apply  In  writing  to: 

RUTH  E.  McCLURE,  M.P.H. 
Director,  School  of  Nursing 
Clinical  Sciences  Building 
University  of  Alberta 
Edmonton,  Alberta 
T6G  2G3 


Dr  Welby  is  a  . . . 
NURSE 


It  seems  clear  from 
watching  this  program 
that  poor  Dr  Welby  is 
spending  2/3  of  his 
time  NURSING. 

The  nursing  profession  at 

the  ROYAL  VICTORIA  HOSPITAL 

is  concerned  about  this. 
We  are  reviewing  nursing 
roles  in  depth  in  this 
teaching  hospital  center, 
and  we  feel  that  we  can 
relieve  Dr  Welby  of  his 
non-doctoring  functions. 

You  are  invited  to  join 

an  extensive  change 

program  in  the  nursing 

profession  at  the 

ROYAL  VICTORIA  HOSPITAL. 

Areas  wnere  you  can  be  a 
part  of  the  change  program 
are,  Medical  and  Surgical 
Specialties,  Intensive  Care 
Areas,  Operating  Room, 
Psychiatry,  Obstetrics, 
Emergency  and  Ambulatory 
Services. 

No  special  language 
requirement  for  Canadian 
Citizens,  but  the  opportunity 
to  improve  your  French  is 
open  to  you. 

For  Information,  Write  To: 

Anne  Bruce,  R.N., 
Nursing  Recruitment  Officer 
Royal  Victoria  Hospital 
687  Pine  Avenue  West 
Montreal,  Quebec,  Canada 
H3A  1A1. 


IBRUARY  1975 


THE  CANADIAN  NURSE     63 


^■'^Y 


of  providing  liealth 
core  forthQ 
Indian  people, 
of  Canada 


1^ 


Health  Sante  et 

and  Welfare       Bien-etre  soci 
Canada  Canada 


'^'  /    y.\  \ 


Medical  Services  Branch 

Department  of  National  Health  and  Welfare 

Ottawa,  Ontario   K1A0K9 


Please  send  me  more  information  on  career 
opportunities  in  Indian  Health  Services. 


Name: 

Address: 

City: 


Prov: 


Index 

to 

Advertisers 

February  1975 


Astra  Pharmaceuticals  Canada  Ltd 45 

Baxter  Laboratories  of  Canada Cover  IV 

Canada  Manpower  Centre 17 

The  Clinic  Shoemakers   2 

Colgate-Palmolive  Limited    41 

Department  of  National  Defence 57 

Guaranty  Trust  Company  of  Canada 11 

Health  Care  Services  Upjohn  Limited 53 

Heelbo  Corporation   18 

Hollister  Limited    47 

Eli  Lilly  and  Company  (Canada)  Ltd 1 

J.B.  Lippincott  Co.  of  Canada  Ltd 32  &  33 

McGraw-Hill- Ryerson  Limited  39 

MedoX   49 

Mont  Sutton   6 

The  C.V.  Mosby  Company,  Ltd 12,  13,  14,  15 

Preston  Institute  of  Technology 55 

Procter  &  Gamble    8 

Reeves  Company   42 

Ryerson  Polytechnical  Institute 51 

W.  B.  Saunders  Company  Canada,  Ltd 7 

White  Sister  Uniform,  Inc 5,  Covers  II  &  III 


Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  1E2  (Ontario) 

A cherrising  Representatives 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore,  Penna.   19003 
Telephone:  (215)  649-1497 

Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills.  Ontario 
Telephone:(416)  444-4731 


Member  of  Canadian 
Circulations  Audit  Board  Inc. 


n^B 


64     THE  CANADIAN  NURSE 


FEBRUARY  1< 


March  1975 


Nurse 


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PROMINENT  DEALERS  listed  alnhahetinallv  hv  nennranhlr  Inratinn 


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THE   CLINIC   SHOEMAKERS    •    Oept.  CN-3,  7912  Bonhomme  Ave.    •    St.  Louis,  Mo.  63106 


The 

Canadian 
Nurse 


^^? 


A  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  bv  the  Canadian  Nurses'  Association 


Volume  71,  Number  3 


March  1975 


9 
2 
24 
19 


18 


The  Case  of  the  Warm 

Moist  Compress J.  Moore,  M.  Weinberg 

The  Canadian  Nurses'  Foundation 

Is  Its  Members H.D.  Taylor 

Write  for  the  Reader,  He  May  Need  to  Know 

What  You  Have  to  Say E.K.  O'Farrell 

CNA  Financial  Statement 

Control:  Cigarettes  and  Calories D.  Birch 

The  Administrator:  the  Real,  the  Ideal    R.  Bureau 

I  Can't  Quit  Now! C.G.  Klute 


The  views  expressed  In  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

9  News 

14  Dates 

16  In  A  Capsule 

42  New  Products 


44  Names 

49  Research  Abstracts 

51  Books 

58  A.V.  Aids 

59  Accession  List 


Executive  Director:  Helen  K.  Mussallem  • 
Editor:  Virginia  A.  Llndabury  •  Assistant 
Editors:     Liv-Ellen     Lockeberg,     Dorothy    S. 

Starr  •  Production  Assistant:  Mary  Lou 
Downes  •  Circulation  Manager:  Beryl  Oar- 
ling  •   Advertising    Manager:    Georgina    Clarke 

•  Subscription  Rates:  Canada:  one  year 
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>(>.50:  two  years.  $12.00.  Single  copies: 
S 1 .00  each.  Mal<e  clieques  or  money  orders 
payable   to  the   Canadian    Nurses'    Association. 

•  Change  of  Address:  Six  weel<s'  notice;  the 
old  address  as  well  as  the  new  are  necessary. 
Sogether  with  registration  number  in  a  pro- 
Miicial  nurses'  association,  where  applicable. 
Not  responsible  tor  iournals  lost  in  mail  due 
ti)  errors  in  address. 


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  tndia  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. 
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®    Canadian  Nurses'  Association  1975. 


HRCH  1975 


Editorial 


When  a  new  method  of  preparing 
warm  moist  compresses  was  intro- 
duced recently  at  Glenrose  Provincial 
General  Hospital  in  Edmonton,  the 
nursing  staff  had  mixed  reactions: 
some  preferred  it  to  the  traditional 
method,  others  believed  it  to  be  in- 
ferior. This  difference  of  opinion 
prompted  the  hospital's  nursing  proce- 
dure committee  to  conduct  a  study  to 
find  out  just  which  method  was  more 
effective  and  efficient. 

Our  feature  article  this  month,  "The 
Case  of  the  Warm  Moist  Compress," 
by  Jannice  Moore  and  Maureen  Wein- 
berg, describes  how  this  study  was 
carried  out,  and  reports  the  findings.  As 
well  as  determining  which  method  is 
superior,  the  investigators  found  suffi- 
cient evidence  to  warrant  their  ques- 
tioning the  length  of  time  compresses 
should  be  applied. 

This  study  shows  the  importance  of 
questioning  and  evaluating  new 
methods  or  equipment  that  may  be  in- 
troduced into  the  clinical  setting.  And, 
as  the  authors  say,  it  also  shows  the 
value  of  reexamining  time-honored 
procedures  to  make  sure  our  nursing 
practices  provide  maximum  effective- 
ness. Too  often,  procedures  become 
sacred  cows  that  seem  to  defy 
scrutiny. 

Described  by  the  authors  as  a  "small 
study, "  this  nursing  research  has  all 
the  components  necessary  for  suc- 
cess: it  was  initiated  by  staff  nurses 
who  questioned  which  procedure  was 
more  effective;  it  was  conducted  in  a 
setting  conducive  to  research;  it  was 
carried  out  by  RNs  in  the  practice  set- 
ting; and  its  actual  focus  was  the  pa- 
tient —  the  chief  beneficiary  of  the 
study's  results. 

Authors  Moore  and  Weinberg  note 
that  their  study  involved  a  small  sample 
of  patients.  Other  investigators  should 
replicate  this  research,  they  say,  to  find 
out  if  the  results  are  similar  in  other 
settings. 

Their  point  is  well  taken.  If  studies 
are  not  repeated  as  often  as  they 
should  be,  they  tend  to  remain  isolated 
examples  of  what  can  be  done.  Con- 
sequently, as  one  U.S.  researcher 
commented,  we  do  not  yet  see  exam- 
ples of  clinical  nursing  research  that 
have  compelled  some  widely  adopted 
improvement  in  patient  care. 

So,  RNs  are  needed  to  repeat  this 
study.  How  about  you?  Underneath  it 
all,  are  you  really  a  frustrated  gum- 
shoe? If  so,  collect  your  curiosity,  your 
desire  to  improve  patient  care,  and 
your  magnifying  glass  and  get  going. 
Happy  sleuthing  I  —  V.A.L. 

THE  CANADIAN  NURSE     3 


letters    { 


Letters  to  the  editor  are  welcome. 

Only  signed  letters,  which  include  the  writer's  complete  address, 

will  be  considered  for  publication. 

Name  will  be  withheld  at  the  writer's  request. 


Comments  on  "Lumbar  Pain" 

1  certainly  enjoyed  reading  the  article, 
■"Lumbar  Pain  Linked  to  Hypokinesia"" 
(November  1974).  I  am  an  active  phy- 
siotherapist presently  lecturing  in  a 
"back  education  unit""  for  back  patients. 
I  felt  the  material  was  well  written  and 
researched.  Being  a  physiotherapist  and  a 
specialist  in  therapeutic  exercise,  I  would 
like  to  make  a  few  comments  on  the 
authors'  choice  of  exercises. 

Exercise  #3,  in  which  a  person  alterna- 
tively arches  his  back  and  then  makes  it 
hollow,  is  one  in  which  the  second  part  or 
hollowing  is  detrimental  to  a  person's 
back.  The  hollowing  promotes  excessive 
hyperextension  of  the  lumbar  spine,  in 
which  the  posterior  intervertebral  joints  of 
the  spine  are  being  jammed  together;  this 
gives  increased  back  pain. 

Also,  all  the  abdominal  exercises 
should  have  first  incorporated  #  1 ,  or  the 
pelvic  tilt,  in  them.  This  puts  the  back  in  a 
better  position  to  increase  abdominal 
strength.  I  stress  pelvic  tilt  in  all  postures, 
sitting,  walking,  and  activity. 

The  bilateral  leg-lifting  exercise,  #5, 
places  a  tremendous  strain  on  the  back. 
Anyone  doing  this  exercise  will  automati- 
cally hyperextend  his  back  to  keep  his 
legs  elevated.  I  personally  do  not  give  any 
exercise  to  my  back  patients  or  anyone 
else,  which  increases  the  lumbar  curve 
that  is  seen  so  often  in  bad  posture  with 
weak  abdominals. — Iris  Weverman, 
M.C.P.A.,  Toronto.  Ontario. 

The  nurses  of  the  corrective  orthopedic 
unit  at  the  Centre  hospitalier  de 
rUniversite  Laval  reply:  We  appreciate 
the  comments  made  by  Weverman  and 
agree  with  the  points  she  mentions.  We 
failed  to  stress  that  the  back  should  touch 
the  floor  before  exercises  I,  2.  3.  and  4 
(p.  30-1).  This  is  almost  as  important  in 
exercise  5  (p.  31). 

Weverman  says  that  she  never  recom- 
mends exercise  5,  and  we  agree  that 
persons  with  pain  in  the  hack  region 
should  not  do  this  exercise.  The  abdomi- 
nal muscles  must  be  strong  and  active  to 
be  able  to  do  it. 

As  for  exercise  3  {p.  29),  Weverman 
says  she  doesn't  recommend  the  hollow 
position  of  the  back.  She  is  teaching 
exercises  for  persons  with  back  pain .  We 
agree  that  persons  with  back  problems 
should  not  do  this  exercise  as  we  de- 
scribed it;  they  should  do  the  arching  and 
return  the  back  to  aflat  position,  but  not 
do  the  hollowing. 
4     THE  CANADIAN  NURSE 


We  were  writing  about  primary  preven- 
tion, not  secondary  prevention.  We  thank 
her  for  drawing  these  points  to  our 
attention  and  to  that  of  readers  of  The 
Canadian  Nurse. 


Case  of  the  missing  rungs 

As  a  retired  nurse  of  many  years'  experi- 
ence, I  look  forward  to  my  issue  of  The 
Canadian  Nurse  every  month.  There  is  at 
least  one  article  per  issue  that  provides 
much  food  for  thought  in  my  leisure  hours. 

I  feel  I  must  comment  about  the  article 
■"An  Experiment  with  the  Ladder  Con- 
cept"" by  J.  A.  Hezekiah(Jan.  "75),  since  it 
has  occupied,  to  date,  more  of  my  leisure 
time  than  I  am  willing  to  spend! 

Like  most  people,  I  usually  read 
through  paragraphs  on  numbers  and  statis- 
tics rather  quickly,  skimming  to  the  con- 
clusions; however,  with  Hezekiah's  arti- 
cle, I  became  entranced  with  the  numbers. 
I  kept  turning  them  over  in  my  mind  and 
finally  resorted  to  a  paper  and  pencil.  Al- 
though I  have  read  widely  on  the  ladder 
theory,  Hezekiah's  ladder  would  appear  to 
have  built-in  landings,  missing  rungs, 
people  walking  backward  up  the  ladder, 
and  some  dark  areas  at  the  top  of  the  stairs. 

Perhaps  Hezekiah  could  comment  on 
my  rough  calculations.  Of  the  21  graduat- 
ing RNAs,  9  students  (43%)  fell  off  the 
ladder  somewhere  above  the  landing  re- 
served for  RNAS.  This  type  of  career  mobil- 
ity is  surely  not  what  is  meant  by  "vertical 
career  mobility." 

According  to  my  calculations,  rough  as 
they  may  be,  more  than  these  nine  students 
fell  off  the  ladder.  Although  the  numbers 
given  by  Hezekiah  are  perhaps  incom- 
plete, I  am  missing  at  least  one  student  and 
possibly  more  who  "missed"  the  landing 
reserved  for  rnas.  If  this  is  not  so,  then 
approximately  99%  of  the  students  who 
began  as  RNs  graduated  as  RNs.  This  is  a 
rather  startling  (but  pleasing)  retention  rate 
—  or  did  more  RNs  fall  off  the  ladder?  This 
would  again  tend  to  negate  the  belief  that 
this  is  "vertical  career  mobility." 

The  third  result  of  my  playing  with 
Hezekiah's  numbers  is  that  I  am  unable  to 
find  one  student  who  began  as  an  RNA  and 
went  on  to  RN  studies.  If  this  is  so,  is  this 
career  mobility? 

Although  I  find  the  concepts  outlined  in 
the  article  interesting,  progressive,  and 
worthy  of  future  study,  I  feel  that  the 
"pioneering  and  risk-taking"  was  done  by 
the  hand-picked  group  of  students  who 
began  (backward  or  forward)  to  climb  a 


i 


ladder  with  missing  rungs  and  secret  Ian 
ings  at  such  a  high  risk  of  falling  off!  j 
Of  course,  I  do  not  have  the  full  resul! 
of  Hezekiah's  study,  and  1  look  forward 
her  comments.  — Isabel  Hamilton  Smit, 
Ontario. 

The  author  replies 

It  was  most  rewarding  to  me  that  my  artic 
merited  so  much  of  Isabel  Hamilti 
Smith's  leisure  time. 

There  appears  to  be  some  confusic 
with  the  interpretation  of  the  statistics  pr 
vidcd.  A  significant  question  is  also  raisi 
with  regard  to  reclarification  of  the  coi 
cept  of  vertical  mobility. 

The  project  (acknowledging  its  limit^ 
tions),  examined  only  the  first  class  i 
nursing  assistants  who  shared  a  commcl 
semester  with  nursing  diploma  students' 

Eighteen  students  enrolled  in  the  initi 
class.  Six  withdrew  for  a  variety  > 
reasons.  One  of  the  6  transferred  to  tl 
nursing  diploma  program,  thus  leaving  I 
students.  Nine  diploma  students  transfe 
red  to  the  nursing  assistant  program,  brin 
ing  the  total  to  2 1 .  Attrition  in  the  diplon 
program  was  not  the  object  of  the  projec 
thus,  data  regarding  this  were  not  pp 
vided. 

The  9  students  (43%)  transferred  fro 
the  nursing  diploma  program  were  a 
cepted  as  respected  and  creditable  pa 
ticipants  in  the  nursing  assistant  progran 
This  is  consistent  with  our  philosophy. 

Vertical  mobility  provides  for  mov 
ment  up  and  down.  It  is  not  meant  to  I 
restrictive  to  any  one  group.  Although  oi 
experiment  was  partially  motivated  by  tl 
idea  of  upward  mobility,  from  the  outs 
we  facilitated  movement  in  either  dire 
tion.  This  permitted  students  to  achie' 
realistic  learning  goals,  without  the  net 
for  unnecessary  repetition. 

As  a  point  of  interest,  2  nursing  assista 
students  (class  of  '73)  are  cuirently  enrc 
led  in  the  nursing  diploma  program;  ' 
addition,  6  to  1 2  nursing  assistant  studen 
from  other  programs  enroll  each  year 
the  nursing  diploma  program,  and  credit 
given  to  them  for  nursing  theory  ar 
practice.  — Jocelyn  A.  Hezekiah,  Chai. 
man.  Nursing  Programs,  Health  Scienci 
Division,  Humber  College  of  Applied  Ar 
and  Technology,  Rexdale,  Ont. 


Help  wanted 

The  alumnae  of  St.  Joseph's  Hospit. 
School    of    Nursing    in    Peterboroug: 

(continued  on  page  ' 
MARCH  19/ 


There  are  plenty  of  'look-alikes'  but  only  one 
BUTTERFLY    infusion  set- Abbott  makes  it! 


1.  Ultrasharp  siliconed  stainless  steel  needle 

with  siiort  double  bevel.  Glides 
through  tissue. 

2.  Patented  grooves  automatically  align 
wings,  with  needle  bevel  up.  No  slip 
or  roll. 

3.  Slim  design  eliminates  hub  drag  when 
making  venipuncture.  Furthermore, 
there  is  no  bulky  hub  connection  to 
tape  down,  causing  possible  pressure 
irritation. 

4.  Wings  lie  flat  against  patient's  skin  after 
venipuncture.  Large  anchor  surfaces 
permit  extra  secure  tapedown. 

5.  Specially-selected,  soft,  flexible  tubing 

resists  kinks.  Ample  length  for  full- 
size  safety  loop. 

6.  Full-line  colour  coding  makes  identification 
easier  than  ever.  Each  size  has  its  own 
distinctive  colour.  Adapter  of  set, 
Tyvekt  cover  of  clear  semi-rigid 
pocket-size  tray,  and  handy  dispenser 
carton  all  carry  same  colour.  Also, 
gauge  size  is  printed  on  each  adapter 
and  stamped  on  left  wing  of  set. 

7.  Transparent  cap  provides  extra  protection 
for  outer  and  inner  surfaces 

of  female  adapter.  Guards  sterility  of 
areas  most  likely  to  contact  male 
adapter  of  administration  set. 

8.  Intermittent  (INT)  and  Short  Tubing  (ST) 
sets  available  for  specific  I.V. 
requirements. 


•RD.  T.M. 

tT.M.  of  Dupont  of  Canada,  Limited 


THE  VENIPUNCTURE  SPECIALISTS 


(Continued  from  page  4) 

Ontario,  are  attempting  to  locate  current 
addresses  of  former  graduates  to  assist 
in  compiling  material  for  the  school  ar- 
chives. A  committee  is  presently  working 
to  prepare  a  publication  of  school  annals  to 
include  memorable  events  of  the  history  of 
our  school. 

Graduates  are  asked  to  contact:  Annals 
and  Archives,  c/o  Sister  Margaret 
McDonald,  Box  566,  Mount  St.  Joseph, 
Peterborough.  Ontario,  K9J  6Z6.  —M. 
Colleen  Shaughnessy.  Co-Chairman, 
Annals  &  Archives  Committee. 
Peterborough,  Ontario. 


Proposed  timetable  not  realistic 

I  would  like  to  comment  on  Nan-Michelle 
Dufour's  views  in  "The  system  needs  to 
be  changed!"  (Nov.  p.  13) 

Dufour  says,  "If  shifts  were  to  begin  at 
0900,  1700,  and  0100,  think  of  the  pos- 
sibilities." My  endeavors  in  this  sense 
have  been  in  vain.  Without  being  pes- 
simistic, I  can  think  of  many  disadvan- 
tages. 

According  to  the  author,  patients  not 
booked  for  early  morning  procedures 
could  be  awakened  at  a  reasonable  hour. 
Ridiculous!  Patients  in  our  hospital  are 
working  people  who  are  used  to  getting  up 
around  0700  to  start  work  at  0800. 

Even  in  hospital,  they  are  hungry  about 
0700  or  0800.  Once  awake,  the  patient 
waits  for  the  nurse  and  his  breakfast.  As 
soon  as  his  hunger  is  satisfied,  he  can  rest, 
and  dress  later  if  he  wishes. 

Think  of  the  nurse,  perhaps  a  married 
woman  and  mother  of  two.  Her  children 
will  not  shut  off  their  "music  box"  be- 
cause mother  wants  to  sleep  late.  And, 
would  her  husband  eat  his  breakfast  alone 
while  he  gets  his  son  ready  for  school 
about  0830?  Or,  should  we  rather  change 
the  husband's  and  school's  timetables? 
What  about  the  baby's  schedule? 

If  the  afternoon  shift  begins  at  1700,  the 
day  shift  is  over  then .  The  nurse  who  stops 
work  at  this  hour  would  have  to  get  home 
(1720),  prepare  dinner  ( 1740),  and  shower 
and  dress  (1820),  before  eating  with  her 
family. 

After  the  meal  is  finished  and  the  dishes 
are  done,  the  sitter  arrives.  It  is  almost  too 
late  to  enjoy  a  social  evening  out.  Is  this 
race  against  time  ever  finished? 

If  work  begins  at  0100  —  at  last,  a 
reasonable  hour.  However,  to  end  night 
duty  at  0900  would  be  discouraging.  The 
nurse  who  is  free  at  that  hour  could  always 
shop  before  going  home  to  rest. 

In  conclusion,  the  advantages  do  not 
outweigh  the  disadvantages.  If  we  do  want 
6     THE  CANADIAN  NURSE 


other  timetables,  let  us  suggest  something 
else.  —  Mireille  Vachon.  Relief  Team. 
Hotel-Dieu  Notre-Dame  de  Beauce.  St. 
Georges.  Quebec. 


Book  review  ending  misplaced 

I  was  disappointed  when  I  saw  that  the 
summarizing  paragraph  to  my  review  of 
Technical  Nursing  of  the  Adult  (Nov. 
1974)  was  misplaced.  Unfortunately,  the 
paragraph  was  included  at  the  end  of  the 
following  book  review,  which  made  both 
reviews  somewhat  confusing.  — Kathrxn 
Revell.  Edmonton,  Aha. 


Office  nurse  gains  understanding 

I  am  writing  in  answer  to  the  article, 
"Registered  nurses  in  office  practice," 
(November  1974,  page  18).  I  have  been  an 
office  nurse  for  almost  25  years  and  be- 
lieve that  a  nurse  working  in  this  capacity 
greatly  contributes  to  mankind  through  her 
professional  skills  and  medical  know- 
ledge. If,  through  office  nursing,  I  have 
lost  some  knowledge  of  hospital  proce- 
dures and  skills,  I  have,  on  the  other  side 
of  the  picture,  gained  tremendously  in 
medical  knowledge  and  in  understanding 
of  human  relationships. 

Perhaps    nurses    do    not    realize    the 


MOVING? 
BEING  MARRIED? 

Be  sure  to  notify  us  six  weeks  in  advance, 
otherwise  you  will  likely  miss  copies. 


Attach  the  Label 
I  From  Your  Last  Issue 

p>  OR 

Copy  Address  and  Code 
Mumbers  From  It  Here 


< 


NEW  (NAME) /ADDRESS: 


Street 


City 


Zone 


Prov. /State  Zip- 

Please  complete  appropriate  category: 

I I     I  hold  active  membership  in  provincial 

nurses'  assoc. 


reg.  no. /perm,  cert./  lie.  no. 
I     I    I  am  a  Personal  Subscriber. 
MAILTO: 

The  Canadian   Nurse 

50  The  Driveway 

OTTAWA,  Canada  K2P  1E2 


number  ot  nursing  procedures  that  are  c 
ried  out  in  a  doctor's  office  —  apply; 
dressings,  giving  injections,  taking  \ 
nous  blood,  doing  hemoglobins  a 
urinalysis,  taking  blood  pressures,  assi 
ing  the  doctor  with  minor  office  surgt 
and  the  application  of  plaster  casts  to  fr;i 
tured  limbs.  Many  times  a  prelimina 
medical  history  is  taken  by  the  nurse.  7 
office  nurse  must  also  draw  on  her  medii 
knowledge  to  give  advice  to  patien 
either  in  the  office  or  over  the  telephoiu 

An  office  nurse  works  long  and  arduoij 
hours,  many  times  without  having  a  coff 
break  or  a  full  hour  lunch  period. 

Hospital  nurses  have  the  help  of  ce; 
tified  nursing  aides  who  do  much  of  tl! 
nursing  care  for  the  patient,  while  the  re 
istered  nurses  does  more  in  the  administr. 
tive  field.  | 

I  am  KW'/r  in  favor  of  a  doctor  emplo' 
ing  a  registered  nurse  in  his  office  to  gi\! 
to  patients  her  nursing  skills  and  kno 
ledge  in  an  area  of  "out  of  ho.spital"  nui 
ing.  a  most  important  field  c 
medicine.  — Anne  Jensen.  RN.  Edmontor. 
Alberta. 


In  reply  to  the  concern  of  Margart 
Fredeen  of  Saskatoon,  ("More  Aboi 
Office  Nurses,"  Letters,  Dec.  1974)  aboi 
the  placement  of  nonregistered  nurses  i{ 
doctors'  offices  and  other  responsible  po; 
itions  such  as  nursing  homes,  I  can  onlj 
think  that  the  registered  nurse  is  a  dyinj 
species! 

Our  problem  is  that  we  have  no  unifoi' 
mity  in  defining  our  duties,  which  ma| 
vary  from  province  to  province.  If  1  have 
plumber  in  my  house  doing  a  job  and  1  as 
him  to  attach  two  wires  for  me,  which  hei! 
well  equipped  to  do,  he  reacts  in  honro 
and  states  that  the  electrical  union  wouUl 
have  his  neck! 

Unfortunately,  the  nursing  profession  i 
mainly  composed  of  women .  Our  sisters  ii: 
other  activities  are  consolidating  thei 
forces,  but  we  are  lagging  behind  badl 
while  our  profession  is  insidiously  take:' 
over  by  the  stronger,  but  less  qualified 
unions  and  associations. 

What  we  need  is  a  simple  job  descrip 
tion  of  the  things  we,  and  we  alone,  art 
qualified  to  do.  The  registered  nurse  is  no 
only  taught  procedures,  but  also  under 
goes  exhaustive  study  of  the  backgroum 
and  implications  of  anatomy  and  physiol : 
ogy  —  not  to  inention  pharmacology' 
chemistry,  biology,  and  allied  subjects 
We  are  not  mere  mechanics  with  a  few' 
months  of  superficial  training! 

Using  our  education  as  background,  i' 
guideline  of  duties  could  be  prepared  anc' 
any  infringement  be  reported  to  a  govern' 
ing  body.  Threats  to  our  profession  shoulc| 
incur  the  wrath  of  every  registered  nurse  irl 
the  province.  If  effective  protests  could  btj 
organized,  these  incidents  would  eventu- 
ally be  few  and  far  between,  and  our  pre 
fession  would  have  a  chance  of  survival,  j 

MARCH  197.'i 


-  for  our  medical  allies,  the  doctors,  I 

iJer  every  one  "the  enemy."  espe- 

.   where  money  is  concerned.  With 

and  highly  technical  procedures,  and 

and  highly  dangerous  drugs,  the  pub- 

jmust  be  protected  from  inadequately 

Ined  personnel.  In  the  final  instance. 

"duty  and  loyalty  is  to  the  public.  Who 

jetlerable  than  we  to  judge  the  harm  that 

I  result  from  an  untrained  hand?  —  Enid 

rris,  RN.  Toronto.  Ontario. 

I  image  is  too  "all-knowing" 

I  of  all.  1  v\(iuld  like  to  thank  you  for 
January  editorial.  I  am  sending  my 
T  to  Mr.  Trudeau  and  my  money  to 
[CEF  right  away. 

"'  le  reason  for  this  letter  though  is  my 
icism  of  your  magazine.  Why  do  I  feel 
Tustrated.  guilty,  and  (already)  obso- 
when  I  read  your  articles?  They  are,  on 
whole,  good  pieces  of  writing  and  re- 
rch,  and  many  interest  me  in  an  abstract 
y.  But  I  am  a  young  nurse  with  three 
its"  experience  w  ho  has  chosen  to  marry 
I  am  now  expecting  my  first  baby. 
[Tie  dcwr  to  postgraduate  education  is 
nly  closed  against  me  for  an  indefinite 
le,  since  my  husband  is  just  beginning 
career  and  we  may  never  be  able  to 
Old  my  postgraduate  education.  I  want 
experience  the  career  of  a  wife  and 
Iher  and  yet  you,  and  many  nurses  I 
/e  spoken  to,  make  me  feel  guilty.  1  love 
rsing.  Am  1  wasting  my  talents,  my 
ining,  the  great  potential  I  once  had? 
More  and  more,  your  magazine  is  filled 
th  articles  that  cater  to  BNs  and  instruc- 
■s  in  every  level  of  education  in  nursing. 
)u  are  missing  most  of  your  readers. 
hat  about  the  hospital-trained  nurses 
10  are  slogging  away  in  miserable 
utines,  in  mismanaged  hospitals,  faced 
th  those  seemingly  insoluble  people 
oblems  and  administration  problems 
ery  day?  What  about  the  part-time 
irses  and  full-time  mothers?  What  about 
e  ones  who  don't  work  and  see  nursing 
id  education  sliding  past  them  and  leav- 
g  them  behind? 

Are  nurses  not  interested  in  other  things 
sides  nursing?  Don't  they  participate  in 
orts,  in  the  arts,  in  religious  activities,  in 
)Iitics?  Aren't  there  any  philosophers, 
iture  lovers,  health  nuts?  Aren't  there 
ly  nurses  who  fail,  who  feel  over- 
helmed,  who  make  mistakes? 
The  Canadian  Murse  image  is  too  all- 
lowing,  too  infallible,  and  narrow. 
)mehow.  Could  we  soften  it  up  a  bit?  And 
in  some  of  those  RN  mothers  out  there 
nd  a  little  support  to  someone  who  is 
cling  very  left  out?  —  Dorothy 
cFarkme.  R.N..  Quebec.  %^ 

ARCH  1975 


POSEY  SAFETY  VESTS 


The  Posey  Patient  Restrainer  is  one 
of  the  many  products  which  com- 
pose the  complete  Posey  Line. 
Since  the  introduction  of  the 
original  Posey  Safety  Belt  in  1937, 
the  Posey  Company  has  specialized 
in  hospital  and  nursing  products 
which  provide  maximum  patient 
protection  and  ease  of  care.  To  in- 
sure the  original  quality  product, 
always  specify  the  Posey  brand 
name  when  ordering. 

The  Posey  Patient  Restrainer  with 
shoulder  loops  and  extra  straps  keeps 
the  patient  from  falling  out  of  bed 
and  provides  needed  security.  There 
are  eight  different  safety  vests  in  the 
complete  Posey  Line.  #5163-3737 
(with  ties),  $9.45. 


The  Posey  Disposable  Limb  Holder 

provides  desired  restraint  at  low  cost. 
This  is  one  of  fifteen  limb  holders  in 
the  complete  Posey  Line.  #5163-2526 
(wrist),  $  3.T5  pr.   36.00  dz  pr. 


The  Posey  Keylock  Safety  Belt  is  de- 
signed with  a  revolutionary  new  key- 
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an  exact  fit  and  snap  locked  in  place. 
This  belt  is  one  of  seventeen  Posey 
safety  belts  designed  for  patient  com- 
fort and  security.  #5163-7333  (with 
snap  ends),  $19.80. 


The  Posey  Retractable  Stretcher  Belt 

can  be  adjusted  to  fit  eyery  stretcher, 
guerney  or  operating  table.  This  is 
one  of  seventeen  safety  belts  in  the 
complete    Posey    Line.    ^5163-5605 

(non-conductive),  $24.00  set. 


The  Posey  Footboard  fits  any  stan- 
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Helps  prevent  foot  drop  and  foot  ro- 
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THE  CANADIAN  NURSE     7 


for  relief  of  postpartum  discomforts 

only  Tucks  babies 
tender  tissues  two  ways 

OS  Q  soothing  wipe...Qs  o  cooling  compress...Qncl  os  often  os  she  likes 


Tucks  medicated  pads  give  your  postpartum 
patient  more  relief,  more  often  than  ointments  or 
aerosols  because  pads  can  be  used  more  ways. 
Cooling  Tucks  medication  can  be  applied  by 
using  the  pad  as  a  compress.  Or  the  pad  can  be 
used  as  a  wipe  to  both  soothe  and  cleanse.  As  a 
wipe,  it  lets  her  avoid  the  mechanical  irritation  of 
harsh,  dry  toilet  paper.  A  Tucks  pad  under  her 
sanitary  pad  prevents  chafing  too. 

Tucks  medication  gives  prompt,  temporary 
relief  from  postpartum  discomforts — the  Itching, 
burning  and  irritation  of  episiotomies  and  simple 
hemorrhoids.  Its  active  ingredients  are  witch  hazel 
and  glycerine — there  is  no  "caine"  type  anesthetic 


in  it.  Your  patient  can  have  her  own  supply  of 
Tucks  at  bedside  for  self-administered  relief  with 
minimum  risk  of  over-treatment  or  sensitization. 

In  addition,  Tucks  medication  is  buffered  to  an 
approximate  pH  of  4,6.  This  helps  tissues  maintain 
their  normal  acid  defenses.  Prescribe  Tucks  pads 
at  bedside  for  soothing,  cooling  comfort  from  the 
first  postpartum  day  on. 

Order  a  trial  supply  on  your*  Rx.  Write  to: 

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1956  Bourdon  Street,  Montreal.  P.O.  H4IVI 1V1 


news 


: 


tawa,  Ontario  —  An  "Ordinance  Respecting  the  Nursing  Profession  in  the 
jrthwest  Territories"  (nwt).  which  was  proposed  by  the  Northwest  Territories 
;gistered  Nurses'  Association  (nwtrna).  was  approved  by  the  Territorial  Council 
2!  January.  "The  executive  met  soon  after  the  ordinance  was  passed  and  wrote 
apply  for  membership  in  the  Canadian  Nurses'  Association,"  Leone  Trotter. 
VTRNA  president,  told  The  Canadian  Nurse  in  a  telephone  interview. 

Trotter  said  that,  in  April  1974.  the  gen 


WT  Nurses'  Ordinance  Passed, 
WTRNA  Applies  To  Join  CNA 


1  membership  of  nwtrna  directed  the 
jcutive  committee  to  apply  for  CNA 
:mbership  as  soon  as  legislation  was 
ssed.  At  the  June  1974  board  meeting. 
.'A  directors  voted  to  assist  the  nwtrna 
th  a  grant  of  $15,000.  (News.  Sep- 
nber  1974.  page  7.) 
The  new  legislation  gives  nwtrna 
;  authority  to  grant  or  revoke  certif- 
ies of  registration  to  nurses  practic- 
!  in  the  Territories  and  the  right  to 
icipline  members  of  the  profession, 
irses  in  the  Northwest  Territories  are 
*  first  professional  group  north  of  the 
th  Parallel  to  gain  control  over  the 
sistration  of  members. 
"We  will  certainly  be  issuing  nwt 
irses'  registrations  in  1975,  perhaps  by 
mmer."  Trotter  told  The  Canadian 
irse.  "We  will  begin  registering  as  soon 
the  machinery  is  ready."  All  members 

the  association's  executive  committee 
e  practicing  nurses,  she  said,  so  associa- 
)n  work  has  to  be  done  in  off-duty  time, 
le  NWTRNA  is  advertising  for  a  part-time 
gistrar,  using  News  of  the  North,  a 
wspaper  that  is  distributed  all  over  the 
•rritories. 

There  are  approximately  250  nurses 
nployed  in  the  Territories,  about  150  of 
hom  are  employees  of  the  federal  gov- 
nment.  The  majority  of  nwt  nurses  are 
ready  members  of  the  nwtrna.  Trotter 
id.  Nurses  in  the  Territories  are  pres- 
itly  registered  with  one  of  the  10  provin- 
al  registering  bodies. 
When  the  ordinance  was  passed. 
iVTRN.A  received  congratulatory  tele- 
anis  from  CNA  and  the  Registered 
urses'  Association  of  Ontario,  and  tele- 
lone  calls  from  the  Alberta  Association 

Registered  Nurses  and  from  Harriet 
Trari,  nwt  regional  nursing  officer 
r  the  federal  government.  Trotter 
pressed  appreciation  for  the  support 
WTRNA  received  from  the 
ommissioner   for   the    nwt   and   from 


Health    and    Welfare    Minister    Marc 
Lalonde. 

"We  certainly  received  support  from 
Territorial  Council  members,  too,"  she 
said.  "The  councillor  for  Yellow  knife 
brought  our  ordinance  forward  on  the 
order  paper,  so  it  was  considered  in 
January.  And  from  the  beginning  of  the 
current  session  of  Council,  Lena 
Pederson,  the  Eskimo  councillor  from 
CopperiTiine.  asked  questions  about 
when  the  ordinance  would  be 
presented." 

After  the  nurses'  ordinance  had  re- 
ceived first  and  second  reading.  Trotter 
and  Jeanette  Plaami,  secretary  of 
NWTRNA.  appeared  on  the  witness  stand  to 
answer  questions  from  the  Council,  which 
met  as  a  committee  of  the  whole.  "One  of 
the  councillors  questioned  the  amount  of 
responsibility  given  to  the  nurses'  associa- 
tion in  the  ordinance,  with  only  the  ap- 
proval of  the  Commissioner  required," 
Trotter  said.  "But  nurses  became  the  first 


in  the  Territories  to  have  a  professional 
Act." 

The  NWTRNA  held  its  founding  meeting 
in  April  1974.  (News,  June  1974,  page  8.) 
Since  that  time.  Bob  Creasy,  a  social 
worker  w  ho  is  assistant  director  of  the  nwt 
Department  of  Social  Welfare,  has  rep- 
resented the  public  on  the  association's 
board  of  directors. 

The  ordinance  provides  that  nwtrna 
shall  conduct  business  under  the  bylaws 
approved  by  its  general  members  in  April 
1974  until  regulations  under  the  ordinance 
can  be  drafted  and  approved  by  the  nwt 
commissioner.  Because  of  extremely  high 
travel  costs,  nwtrna  proposes  to  hold  a 
general  meeting  every  2  years,  but  it  may 
be  necessary  to  hold  one  sooner  for  the 
purpose  of  presenting  draft  regulation  to 
general  membership  for  approval.  Trotter 
told  The  Canadian  Nurse. 

ONQ  Teleconference  Discusses 
Delegation  Of  Medical  Acts 

Hull,  Quebec  —  More  than  2.500  Quebec 
nurses  participated  in  a  province-wide 
information  day.  held  simultaneously  in 
10  centers  across  the  province  by  a 
telephone  hookup.  The  topic  of  the 
conference,  held  on  24  January  1975  by 
the  Order  of  Nurses  of  Quebec  (onq), 
concerned  medical  acts  delegated  to 
nurses. 

Although  the  list  of  medical  acts  to  be 

delegated  to  nurses  in  Quebec  will  not  be 

(continued  on  page  12) 


CNA  Membership 

Grows 

By  Nearly 

7,000  Last  Year 

In  mid-January  1975,  the  Canadian  Nurses'  Association  had  more  than 

104.000 

members.  Membership  figures 

for  4  years,  1971-4,  are 

compared  below. 

listed  by 

provincial  associations. 

1971 

1972 

1973 

1974 

British  Columbia 

1 1 ,905 

12,530 

13,389 

14.646 

Alberta 

9,754 

10,216 

10,060 

10.698 

Saskatchewan 

6.075 

6,253 

6,470 

6.617 

Manitoba 

5,466 

5,719 

6,007 

6.284 

Ontario 

11,579 

11,829 

13,183 

14,534 

Quebec 

32,198 

33,391 

35,196 

38,084 

New  Brunswick 

3,856 

4.145 

4.339 

4.540 

Nova  Scotia 

5.072 

5,273 

5.263 

5,360 

Prince  Edward  Island 

725 

755 

803 

842 

Newfoundland 

2,243 

2.204 

2.442 

2.519 

88,873 

92.315 

97.152 

104,124 

THE  CANADIAN  NURSE     9 


Nurses  Submit  Resignations 
To  Protest  Pay  Inequities 


Fredericton,  N.B.  —  By  31  January  1975,  over  90  percent  of  New  Brunswick's 
registered  nurses  had  submitted  their  resignations,  effective  on  dates  between  I  and  15 
February.  The  nurses  had  requested  the  provincial  treasury  board  to  reopen  their 
contracts,  which  expire  March  1976  and  August  1976,  and  bring  RNs"  salaries  into  line 
with  those  of  nonprofessional  hospital  workers. 
Although  the  nurses"  contracts  allow  for 


indjl 


renegotiation  of  salaries  with  the  consent 
of  both  parties,  treasury  board  refused  to 
consent  to  it.  Premier  Richard  Hatfield 
told  the  nurses  that  he  would  not  appoint  a 
special  conciliation  board  for  their  dis- 
pute. 

A  staff  member  of  the  nurses'  collective 
bargaining  councils  told  The  Canadian 
Nurse,  "It's  like  a  kick  in  the  face.  The 
Premier  today  announced  an  interest-free, 
$7.5  million  loan  to  Bricklin  Industries 
[makers  of  an  experimental  sports  car]. 
There  is  money  for  cars,  but  not  for 
nurses." 

In  the  fall  of  1974,  the  Canadian  Union 
of  Public  Employees  negotiated  a  contract 
that  gave  nonprofessional  hospital 
workers  a  65  percent  increase  over  2  years . 
According  to  a  brief  submitted  to  the  trea- 
sury board  by  the  New  Brunswick  Nurses' 
Provincial  Collective  Bargaining  Councils 
in  December  1974,  nonprofessional 
workers,  such  as  some  orderlies,  will  earn 
more  than  some  registered  nurses  by  July 
1975. 

In  their  brief,  the  N.B.  nurses  asked  for 
salary  adjustments  of  32  percent  plus  a 
$500  cost-of-living  bonus,  to  provide  rela- 
tivity between  nurses'  and  nonprofes- 
sional workers'  salaries. 

With  nurses'  resignations  effective  the 
next  day,  a  Fredericton  hospital  declared  a 
state  of  emergency  on  31  January. 

{continued  on  page  12) 

Que.  Nurses'  Union  Celebrates 
IWY  With  Monthly  Contests 

Montreal.  Quebec  —  1  he  United  Nurses 
Inc.,  a  professional  union  that  has  over 
6,000  female  nurse  members,  is  conduct- 
ing monthly  contests  during  1975  to  cele- 
brate International  Women's  Year  (IWY). 
Members  of  the  United  Nurses  Inc.  and 
other  nurses  in  Quebec  are  invited  to  enter 
the  contests. 

Union  officers  have  selected  a  theme  for 
each  month,  related  to  equality,  develop- 
ment, and  peace  in  social,  cultural,  and 
economic  affairs,  as  set  forth  in  the  IWY 
goals.  January's  contest  topic  was  the 
hobby  least  related  to  nursing;  February 
was  sports;  and  March's  topic  is  dis- 
coveries and  innovations  to  improve  care 
of  the  sick.  In  succeeding  months,  themes 
will  include  music,  social  laws,  and  plastic 

Each  month  a  4-member  jury  will 
select  the  entry  that  is  most  original, 
10     THE  CANADIAN  NURSE 


interesting,  and  appropriate  to  the  theme 
of  the  month.  A  memorial  plaque  will 
be  awarded  to  the  winner,  who  will 
compete  with  the  other  1 1  monthly  contest 
winners  for  a  grand  prize  to  be  awarded  in 
December  1975. 


Fed.  Nurses  Reject  Contract 
In  "Nurse  Help  Nurse"  Vote 

Ottawa.  Ont.  —  Nurses  employed  by  the 
federal  government  overwhelmingly  re- 
jected a  2-year  contract  offered  by  the 
treasury  board.  The  nurses  voted  in  a  amil 


ballot  that  was  completed  on  31  Jano 
1975. 

Ruth  Sear,  Ottawa,  who  is  p 
chairman  of  the  federal  nurses  of  Cam 
and  chief  negotiator  during  contract  tal 
called  the  vote  a  "nurse  help  nun 
movement. 

According  to  Sear,  the  1 ,600  nurses 
jected  the  contract  offer  because 
were  not  at  all  satisfied  to  be  tied  u 
2-year  contract  in  depressed  areas  wh 
nurses  have  not  had  a  chance  to  have  th 
salaries  reassessed  and  to  catch  up."  S 
told  The  Canadian  Nurse  that  fed 
nurses'  salaries  are  depressed  in 
Atlantic  provinces,  Manitoba,  ; 
Saskatchewan. 

"This  is  the  first  time  that  federal  nui 
across  Canada  have  united  to  support  th 
colleagues  who  receive  smaller  salaries 
doing  exactly  the  same  work.  If  we 
cepted  the  2-year  contract  offered, 
would  depress  their  salaries  even  moi 
she  said. 

The  contract  that  was  rejected  by 
nurses  continued  the  regional  rate  stn 
ture  present  in  the  1973-4  contract  t 


Nurse  Who  Sculpts  Wins  Prize 


Lucienne  Chevalier,  a  nurse  from  Montreal,  makes  sculpture  as  a  hobby.  She 
submitted  some  of  her  pieces  in  the  January  contest  of  the  United  Nurses  of 
Montreal  and  won  first  prize.  Chevalier  is  shown  with  two  of  the  more  than  1 ,000 
pieces  of  sculpture  she  has  made. 


MARCH  19' 


e^ired  29  December  1974.  The  rejected 

!ract  contained  salary   increases  be- 

jti  10.5  and  36  percent  in  the  first  year, 

between  8  and   17.5  percent  in  the 

•lid  year. 

ite  in  1973.  federally  employed  nurses 

csted  an  arbitration  award  that  failed  to 

nurses  financial  parity  with  their  pro- 

jial    counterparts.     The    Canadian 

ses"     Association    and    provincial 

es'  associations  supported  them  in  the 

est.  (News,  December  1973,  page  7.) 

hat  time,  a  spokesman  for  the  federal 

cs   told   The  Canadian   Nurse.    "'In 

aration  for  future  negotiations,  it  can 

iticipated  that  federal  nurses  will  be 

^lde^ing  the  strike  route  in  preference 

t  arbitration."" 

\tter   they    rejected    the    contract    in 

ary  1975,  federal  nurses  faced  a  prob- 

their  employers  designated   up  to 

ihirds   of   the    nurses    as    essential. 

ncs  designated  essential  do  not  have 

right  to  strike. 

\t  press  time,  talks  were  going  on  in 

:  .tings  between  representatives  of  the 

cs  and  their  employers  —  treasury 

\\  and  federal  departments,  such  as 

;h   and   welfare,   penitentiaries,   and 

lans  affairs.  When  mutually  satisfac- 

lesignations  of  essential  nurses  have 

!  worked  out,  an  application  for  con- 

-aiion  procedure  will  go  to  the  staff  rela- 

ns  department  of  the  federal  govem- 

:nt. 

It  is  expected  that  conciliation  will  be 
tup  by  mid-March.  A  maximum  time  of 
weeks  is  allowed  for  the  complete  con- 
iation  procedure.  Nurses  not  designated 
essential  would  be  legally  able  to  strike 
iays  after  the  conciliation  report  is  re- 
ised  —  approximately  the  second  week 
April. 


berta  Task  Force  Studies 
rsing  Skills,  Programs 


monton.  Alberta  —  A  task  force  on 
rsing  education  in  Alberta  has  been  es- 
ished  and  its  13  members  appointed, 
nounced   Advanced    Education    Minis- 
Jim  Foster  on  21  January  1975.  Six  of 
:  task  force"s  13  members  are  nurses. 
Formation  of  the  task  force  follows  a 
licy  announcement  last  year  that  prep- 
tion  of  health  manpower  was  trans- 
red  from  the  department  of  health  and 
cial  development  to  the  department  of 
vanced  education,  which  is  concerned 
th    all    post-secondary    education    in 
berta. 

The  purpose  of  the  task  force,  Foster 

id,  is  to  examine  nursing  education  in  a 

oad  context.  More  specifically,  the  task 

rce  will  identify  (he  competencies  and 

ills  required  by  nursing  graduates,  and 

late  these  to  program  considerations  for 

■  levels  of  nursing  preparation.  It  will 

^o  examine  issues  associated  with  man- 

liwer  supply  and  demand,  standards,  and 

JARCH  1975 


the  preparation  of  nurse  educators. 

The  task  force  met  for  the  first  time  on 
28  January.  The  members  are  expected  to 
complete  deliberations  by  30  June  and 
bring  forward  their  report  by  31  August 
1975. 

Chairman  of  the  13-member  task  force, 
which  is  representative  of  institutions  and 
associations  concerned,  is  Dr.  Walter 
Johns.  f«rmer  president  of  the  University 
of  Alberta.  Nurse  members  appointed  in- 
clude: Ruth  Palfrey,  nurse  clinician. 
Foothills  Hospital,  Calgary:  Lillian 
Rutherford,  director.  Mount  View  and 
Foothills  Health  Units,  and  Dr.  Joanne 
Scholdra.  chairman  of  the  School  of 
Health  Sciences.  Lethbridge  Community 
College.    Lethbridge.    Other  nurses   ap- 


pointed to  the  task  force  are:  Marguerite 
Schumacher,  director  of  the  School  of 
Nursing.  University  of  Calgary.  Calgary; 
Betty  Sellers,  nursing  service  consultant. 
Alberta  Association  of  Registered  Nurses, 
Edmonton;  and  Doris  Stevenson,  director. 
Holy  Cross  School  of  Nursing,  Calgary. 
Nonnurse  task  force  members  are:  Pat 
Frederickson,  Alberta  Certified  Nursing 
Aide  Assoc.  Wetaskiwin;  Ethel  Marliss. 
CBC  consumer  affairs  commentator, 
Edmonton;  Dr.  Arnold  Murray.  Grande 
Prairie;  Dr.  Bernard  Snell,  executive 
director.  University  of  Albena  Hospital, 
Edmonton;  Bert  Briens,  Alberta  Assoc,  of 
Registered  Nursing  Orderlies;  and  Dr.  Joe 
Woodsworth,  department  of  educational 
psychology.  University  of  Calgary. 


^ 


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Package  deals  including  meals, 
ski  lessons  and  lift  tickets.  Let  us 
know  the  kind  of  accommodation 
you  wish  and  rest  assured  of  our 
full  cooperation  for  a  pleasant 
stay. 


THE  CANADIAN  NURSE     11 


news 


ONQ  Teleconference 

(continued  from  page  9) 

available  before  March,  nurses  at  the 
information  day  learned  about  the 
principles  guiding  discussions  between  the 
ONQ  and  the  Corporation  of  Physicians  of 
Quebec  (CPO). 

Jules  O.  Duchesneau,  legal  counsel  for 
the  ONQ,  reviewed  the  legal  responsibility 
of  the  nurse  in  relation  to  delegated 
medical  acts.  He  said  that  the  two  criteria 
by  which  she  can  judge  whether  to  perform 
delegated  acts  are  knowledge  and 
competence. 

Sister  Anicet  Guay,  a  member  of  the 
joint  ONQ-CPQ  committee  on  delegation  of 
medical  acts,  said  that  the  discussions  be- 
tween doctors  and  nurses  about  the  dele- 
gated acts  are  not  negotiations  between 
two  professions;  the  preoccupation  of  the 
joint  committee  is  to  assure  the  public  of 
efficient  care  of  high  quality.  She  said 
that,  for  each  of  the  acts  studied,  the  ques- 
tion has  been;  do  nurses  have  the  prepara- 
tion to  do  it? 

Dr.  Andre  Lapierre,  presenting  the 
physician's  point  of  view,  spoke  of  the 
conditions  under  which  the  acts  should  be 
delegated:  the  education,  knowledge, 
competence,  and  experience  of  the  nurse, 
and  environmental  factors,  such  as  suffi- 
cient security,  adequate  equipment,  and  a 
back-up  system. 

Nova  Scotia  Nurses'  Association 
Establishes  Placement  Service 

Halifax.  N.S.  —  Placement  Service,  a 
new  service  to  members,  was  initiated  in 
February  by  the  Registered  Nurses" 
Association  of  Nova  Scotia  (RNANS).  E. 
Margaret  Bentley,  RNANS  employment 
relations  officer,  who  is  directing  the 
placement  service,  says  that  this  new 
service  fills  a  long-felt  need  in  the 
province  and  will  be  of  benefit  not  only  to 
RNANS  members,  but  to  all  who  employ 
nurses. 

Placement  Service  lists  all  known 
nursing  vacancies  in  all  clinical  areas  of 
nursing  in  Nova  Scotia,  and  in  all  parts  of 
the  province.  Professional  credentials, 
including  references,  of  nurses  listed  with 
Placement  Service  are  assembled  and  kept 
up-to-date.  This  record  can  be  sent  to  the 
prospective  employer  at  the  nurse's 
request,  saving  repeated  requests  to 
previous  employers  or  schools  of  nursing 
for  references  and  records. 

Another  feature  of  the  service  will  be 
offering  assistance  to  nurses  in  evaluating 
their  qualifications,  in  relation  to  the 
requirements  of  nursing  positions  in  which 
they  might  be  interested.  Counseling  on 
professional  problems  is  available. 
12     THE  CANADIAN  NURSE 


Sunnybrook  Medical  Centre,  Toronto,  opened  its  5-bed  acute  stroke  unit  in  January 
1975.  Designed  to  provide  intensive  observation  of  stroke  patients  for  both  diagnosis 
and  therapy,  the  unit  has  sophisticated  equipment,  such  as  intracranial  pressure 
monitors.  Through  the  acute  stroke  unit,  specialists  from  many  disciplines  hope  tc 
provide  new  knowledge  and  insight  into  one  of  the  commonest  causes  of  chronic 
disability.  Shown  in  the  unit's  central  nursing  station  are,  left  to  right.  Dr.  Vladimii 
Hachinski,  department  of  neurology;  Barbara  Doughty,  staff  nurse;  and  Dr.  John  W 
Norris,  department  of  neurology,  Sunnybrook  Medical  Centre,  Toronto. 


(connnued  from  page  10) 

Resignations  withdrawn 

At  press  time  —  Most  nurses  had  with- 
drawn their  resignations  and  gone  back 
to  work  under  orders  from  the  New 
Brunswick  Supreme  Court. 

The  Court  issued  a  2-day  injunction  or- 
dering nurses  from  the  Victoria  Public 
Hospital,  Fredericton,  and  the  Hotel  Dieu 
Hospital,  Campbellton,  to  return  to  work. 
After  a  hearing,  a  second  injunction  with- 
out a  time  limit  was  issued;  nurses  were 
told  that  other  injunctions  would  follow  if 
other  resignations  were  implemented. 

Glenna  Rowsell,  employment  relations 
officer  of  the  Provincial  Bargaining  Coun- 
cils of  New  Brunswick,  told  The  Canadian 
Nurse:  "The  nurses  are  very  discouraged. 
We  will  be  surprised  if  we  retain  the  pres- 
ent quota  of  nurses  in  this  province,  and 
we  may  not  attract  nurses  from  other  pro- 
vinces where  salaries  are  higher  this 
year." 

Rowsell  said  that  the  provincial  treasury 
board  has  promised  to  start  negotiations 
eariy  for  the  1976  contract  and  to  go  to 
binding  arbitration  if  necessary.  New 
Brunswick  labor  law  says  that  if  the  em- 
ployer doesn't  want  to  go  to  arbitration, 
there  is  no  arbitration. 


"But  they  have  already  promised  us  tl 
the  arbitration  procedure  will  be  used  t 
the  nurses,  if  necessary  in  1976.  Tl 
would  be  the  first  time  treasury  board  h 
gone  to  arbitration,  if  we  use  the  prot 
dure,"  she  said. 

Rowsell  also  said  that  treasury  boi 
has  indicated  that  they  are  willing  to  t; 
after  the  nurses  have  gone  back  to  wo 
"But  we  don't  know  what  this  v 
mean,"  she  told  The  Canadian  Nurse ^ 


Four  Representatives  Of  PubIS 
Appointed  To  Bureau  Of  ONI 

Montreal.  Quebec  —  Four  persons  ha 
been  named  by  the  Quebec  Professic 
Board  to  represent  the  public  on  the  bure 
(board)  of  the  Order  of  Nurses  of  Quet 
(ONQ).  They  are:  Guy  Dubreuil,  profes! 
of  anthropology  at  the  Universite 
Montreal;  Pierre-Paul  Paquin,  president 
the  Quebec  Bakers  Association;  Sim 
Beaulieu,  chartered  accountant;  a 
Louise  Savard,  Office  of  the  Secretary 
State,  Government  of  Canada. 

Dubreuil  is  also  a  member  of  the  Oi 
administrative  committee.  (News,  Ft 
ruary  1975,  page  16.) 

MARCH  19 


At  the 

nursing 

station 

and  on 

the  floor; 


in  the 

ER,  ecu, 

and  ICU; 


and  in 

school  or 

office 

work. 


Wood:  NURSING  SKILLS  FOR  ALLIED  HEALTH  SERVICES, 

Volume  III 

Just  published,  this  self-study  guide  outlines  "level  11"  skills  for  the  LPN/LVN  and  RN: 
aseptic  technique,  preparation  and  administration  of  medications,  urinary  catheterization, 
hot  and  cold  compresses,  pharyngeal  suction,  tracheostomy  care,  tourniquets,  smears  and 
cultures,  skin  tests,  immunizations,  and  more.  A  complete  unit  for  each  skill  includes 
performance  objectives,  vocabulary,  step-by-step  instructions,  illustrations,  a  |x>st-test, 
preparation  for  a  performance  test,  and  a  performance  checklist  Volumes  I  &  II  contain 
"level  11"  skills  for  the  beginning  practitioner.  By  Lucile  A.  Wood,  RN,  MS.  Volume  III:  449 
pp.  336  ill.  Soft  cover.  About  $7.75.  Just  Ready.  (Teacher's  Guides  available  for  all  three 
volumes.)  Order  #9602-3. 

Volume  I:  394  pp.  281  ill.  Soft  cover.  $5.15.  May  1972.  Order  #9600-7. 

Volume  II:  374  pp.  279  E  Soft  cover.  $5.15.  May  1972.  Order  #9601-5. 


Mercer  &  O'Connor:  FUNDAMENTAL  SKILLS  IN  THE 
NURSE-PATIENT  RELATIONSHIP:  A  Programed  Text, 

New  Second  Edition 

A  unique  learning  guide  for  developing  interpersonal  communication  skills.  A  sequence  of 
241  situations  teaches  you  what  to  say  and  do  when  similar  instances  arise  on  the  job.  The 
program  and  concluding  test  can  be  completed  in  8  to  1 0  hours.  By  Lianne  S.  Mercer,  RN, 
BSN,  MS;  and  Patricia  O'Connor.  PhD.  216  pp.  Illustd.  Soft  cover.  $4.90.  July  1974. 
(Teacher's  Guide  available.)  Order  #6266-8. 


Luckmann  &  Sorensen:  MEDICAL-SURGICAL  NURSING: 
A  Psychophysiologic  Approach 

This  massive  text  scrutinizes  all  aspects  of  modem  nursing  practice.  Step-by-step  specifics 
for  nursing  measures  are  described,  and  their  rationale  explained.  Pathophysiology  and 
preventive  care  are  emphasized.  By  Joan  Luckmann,  RN,  MA;  and  Karen  Crcason 
Sorensen,  RN,  MN.  1634  pp.  422  Ul.  $20.35.  Sept.  1974.  Order  #5805-9. 

Phillips  &  Feeney:  THE  CARDIAC  RHYTHMS:  A  Systematic 

Approach  to  Interpretation 

After  examining  the  dynamics  of  the  normal  heartbeat,  the  authors  then  analyze  the  more 
complex  abnormal  rhythms.  The  effects  of  the  autonomic  system  and  cardiac  drugs  are 
described.  By  Raymond  E.  Phillips,  MD;  and  Mary  Kay  Feeney,  RN,  BSN.  354  pp.  928  ill. 
$12.40.  Oct.  1973.  Order  #7220-5. 


Frederick  &  Kinn:  THE  MEDICAL  OFFICE  ASSISTANT: 

Administrative  and  Clinical,  Fourth  Edition 

Here's  valuable  insight  into  the  most  effective  ways  of  handling  the  administrative  and 
clinical  responsibilities  of  nurses  and  office  assistants,  including  even,'thing  from  diets  to 
letter  writing  to  diagnostic  laboratory  procedures.  By  Portia  M.  Frederick,  CMA-AC;  and 
Mary  E.  Kinn,  CPS,  CMA-A.  740  pp.  215  ill.  16  color  plates.  $14.20.  Sept.  1974. 
(Teacher's  Guide  available.)  Order  #3862-7. 


Nemir&Schaller:  THE  SCHOOL  HEALTH  PROGRAM, 

New  Fourth  Edition 

The  chOd's  health  problems;  the  importance  of  health  services,  health  instruction,  and 
healthy  environment;  and  physical  and  emotioneJ  development  are  covered — along  with 
discussion  of  nutrition,  mental  health,  allergies  and  skin  problems.  By  the  late  Alma 
Nemir,  MD;  and  Warren  E.  Schaller,  HSD.  569  pp.  Illustd.  $11.85.  Jan.  1975.  (Teacher's 
Guide  avaUable.)  Order  #6748-1. 


lW.B.  SAUNDERS  COMPANY  CANADA  LTD. 


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April  2-4,  1975 

Pediatric  intensive  care  nursing  conference 
at  the  Hospital  for  Sicl<  Children,  Toronto. 
Emphasis  on  cardiac  surgery,  neurosur- 
gery, respiratory  problems,  and  other 
stressful  situations.  For  information  write: 
Director  of  Nursing  Education,  The  Hospital 
for  Sicl<  Children,  555  University  Avenue, 
Toronto,  Ontario,  M5G  1X8. 

Aprils,  1975 

Canadian  Nurses  Association  will  hold  its 
annual  meeting  at  the  Chateau  Laurier, 
Ottawa,  Ontario. 

April  6-10,  1975 

American  Association  of  Neurosurgical 
Nurses  annual  meeting,  Hyatt  House, 
Miami  Beach,  Florida.  For  information 
write:  Kathleen  Redelman,  Secretary, 
American  Association  of  Neurosurgical 
Nurses,  428  East  Preston  Street 
Baltimore,  Md.,  21202,  U.S.A. 

April  18-20,  1975 

Five-year  reunion  of  Saskatchewan  dip- 
loma nursing  graduates  of  1969.  For  infor- 
mation, contact  Ms.  S.  Carlson,  2314  East 
Hill,  Saskatoon,  Saskatchewan,  or  phone 
306-374-3023. 


April  21-22, 1975 

Budget  workshop  for  administrators  and 
directors  of  nursing,  Calgary  Inn,  Calgary. 
For  information  write:  Alberta  Hospital 
Association,  10025-  108th  Street,  Edmonton, 
Alta. 


April  22,  1975 

"First  Forum"  on  basic  issues  in 
Emergency  Medical  Services,  Chicago, 
Illinois.  Sponsor:  Public  Safety  Officers 
Foundation.  Contact:  Sharon  Sparacino, 
PSOF,  Suite  2024,  307  North  Michigan 
Ave.,  Chicago,  III.  60601 . 

April  25,  1975 

Renfrew  County  Chapter  of  rnao  presents 
Dr.  Hans  Selye  at  Pembroke  Senior  Public 
School,  Pembroke,  Ontario.  Further  infor- 
mation from:  Olive  Poff,  133  Morris  St., 
Pembroke,  Ontario.  Phone:  613-732-9496. 
14     THE  CANADIAN  NURSE 


April  29— June  1 7,  1 975 

Workshop:  Human  sexuality  and  family 
planning  (8  consecutive  Tuesday  even- 
ings) at  University  of  Toronto,  Faculty  of 
Nursing.  For  information  write:  Dorothy 
Brooks.  Chairman,  Continuing  Education 
Program  for  Nurses,  50  St.  George  St., 
Toronto,  Ont.,  M5S  1A1. 


May  5-16,  1975 
May  26-)une6,  1975 

Workshop:  Analysis  of  the  process  of 
psychiatric  nursing.  Sunnybrook  Hospital, 
2075  Bayview  Avenue,  Toronto.  For  infor- 
mation, write:  Dorothy  Brooks,  Chairman, 
Continuing  Education  Program  for  nurses, 
50  St.  George  St.,  Toronto,  Ont.,  M5S  1 A1 . 


May  7-9,  1975 

Registered  Nurses'  Association  of  British 
Columbia  annual  meeting.  Peach  Bowl, 
Penticton,  B.C. 


May  10,  1975 

Seminar  on  problems  of  relationships 
within  the  medical  field,  to  be  held  at 
Queen's  University,  Kingston,  Ontario. 
Sponsored  by  Nurses'  Christian  Fellowship 
in  Kingston.  For  information  write:  Sandy 
Stewart,  289  MacDonnell  Street,  Apt.  5, 
Kingston,  Ontario. 


May  14-17,  1975 

Association  for  the  Care  of  Children  in  Hos- 
pitals annual  conference,  Sheraton-Boston 
Hotel,  Boston.  Theme:  Listening  to  children 
and  their  families.  For  information  write: 
Anita  Giovannetti,  Publicity  Chairperson, 
1975  ACCH  Conference,  Instructor, 
Boston  University  school  of  nursing,  635 
Commonwealth  Avenue,  Boston,  Mass. 
02115,  U.S.A. 

May  15-16,  1975 

Conference  at  McMaster  University 
Medical  Centre,  Hamilton,  Ontario.  Theme: 
"Issues  in  interprofessional  education  for 
health  care  practice  —  interdisciplinary  or 
undisciplined?"  For  information  write:  Anne 
Myers,  Master  of  Health  Sciences  (Health 
Care  Practice)  Programme,  McMaster 
University,    Faculty    of    Health    Sciences, 


1200  Main  Street  West,  Hamilton,  Ontan 
L8S  4J9. 

May  18-21,1975 

National  League  for  Nursing  Convention 
New    Orleans,    La.    Theme:    Operatic 
Update.  For  information  write:  Conventi( 
Services,  National  League  for  Nursing, 
Columbus  Circle,  New  York,  N.Y.,  lOOIC 

June  2-4,  1975 

Posfgraduate  refresher  course  in  pediatr 
rehabilitation  for  nurses,  physiotherapist:, 
occupational  therapists.  For  informatio 
write:  L.  Hamilton,  Education  Departmer 
Ontario  Crippled  Children's  Centre,  35 
Rumsey  Road,  Toronto,  Ontario,  M4 
1R8. 

June  5-6,  1975 

Seminar  on  obstetrical  and  neonatal  cor 
plications.  School  of  Physiotherapy  ar 
Occupational  Therapy,  McGill  Universit 
Montreal,  Ouebec.  For  information  writ 
Valmai  Elkins,  315  Victoria,  Montrea 
Quebec,  H3Z2N1. 

June  10-12,  1975 

Final  reunion  of  graduates  of  the  Hotej 
Dieu  St.  Joseph  School  of  Nursin;; 
Bathurst,  N.B.,  to  coincide  with  Bathurs 
Festival  Week.  For  information  writ! 
C.  Morrison,  Chairman,  Reunion  75  Comm'i 
tee,  School  of  Nursing,  Chaleur  Gener^ 
Hospital,  Bathurst,  N.B.  ' 

September  24-26, 1 975 

Institute  on  progressive  extended  can 
Calgary  Inn,  Calgary.  For  informatic 
write:  Alberta  Hospital  Associatioi 
10025-108th  Street,  Edmonton,  Alta.        | 

October  19-24,  1975 

Institute  on  health  care  administratior 
Banff  Springs.  For  information  write 
Alberta  Hospital  Association,! 0025-1  OSti 
Street,  Edmonton,  Alta. 

December  3-5, 1975  { 

Alberta  Hospital  Association  annual  meet 
ing  and  convention,  Edmonton.  For  infor 
mation  write:  Alberta  Hospital  Association 
1 0025-1 08th  St.  Edmonton,  Alta.  i 

MARCH  197! 


I! 


Also  custom-made 


Q 


im 

A  Sut>s.ciiafyoiin!erndiKjfiaiCMemica}4  Nucieaf  Cc-fD-Jfatson 


675  M^^tee  i3e  Liesse 
Morii'eai377  Quebec 


in  a  capsule 


Champagne  cork  may  be  hazardous 

You're  celebrating  during  the  holidays, 
and  —  (Kip  —  out  flies  the  champagne 
cork.  Well,  just  make  sure  it  isn't  pointed 
toward  yourself  or  someone  else.  That 
cork  is  a  dangerous  missile,  according  to  a 
report  in  the  Jounuil  of  the  American 
Medical  Association  (Dec.  23,  1974). 

Sherwin  H.  Sloan,  MD,  an  ophthal- 
mologist, said  he  began  noticing  a  series  of 
serious  eye  injuries  at  the  Jules  Stein  Eye 
Institute  at  the  University  of  California  at 
Los  Angeles  Medical  School.  All  the  vic- 
tims had  been  struck  in  the  eye  by  cham- 
pagne corks. 

"All  but  one  were  men  —  men  seem  to 
do  most  of  the  champagne-opening  —  and 
most  had  been  struck  in  the  left  eye,"  said 
Dr.  Sloan.  He  believes  that  the  left  eye  is 
struck  most  often  because  of  the  bottle's 
position  while  being  opened  by  a  right- 
handed  person. 

The  results  were  severe:  Of  14  cases 
treated  at  the  institute  in  a  recent  3-year 
period,  3  patients  lost  the  sight  of  the  in- 
jured eye.  Three  others  have  considerable 
permanent  vision  loss  due  to  injuries  to 
cornea  or  macula.  All  14  had  corneal  abra- 
sions, 10  had  hyphemas,  3  developed 
permanent  macular  damage,  1  had  recur- 
rent hyphemas,  and  2  sustained  severe  ret- 
inal detachments. 

In  1967,  two  British  investigators  re- 
ported nine  similar  eye  injuries.  They  es- 
timated that  a  champagne  cork  may  be 
backed  by  pressures  of  up  to  100  atmos- 
pheres. 

All  the  California  victims  had  been 
struck  by  the  newer  plastic  "corks,"  but 
the  injury  with  a  genuine  cork  would  be 
similar.  Dr.  Sloan  said.  He  offers  two 
.safety  suggestions.  The  first  is  for  caution- 
ary labeling  on  all  champagne  bottles. 
The  second  suggestion  is  for  greater  care 
while  opening  champagne  bottles,  f/1  third 
suggestion  would  be  to  give  up 
champagne.  —  Eds.) 


Adverse  reactions  to  Lomotil 

Children  may  have  adverse  reactions  to 
the  antidiarrheal  agent  Lomotil 
(diphenoxylate  hydrochloride  with  at- 
ropine sulfate),  and  relatively  small  doses 
may  be  toxic.  This  comment  was  made  by 
Dr.  Gary  Wasserman,  a  Kansas  City 
pediatrician,  in  an  interview  published  in 
the  7  October  1974  issue  of  ihe  Journal  of 
the  American  Medical  Association . 

Dr.    Wasserman   does   not   berate   the 
agent,  which  he  calls  a  "fine  drug,"  but 

16     THE  CANADIAN  NURSE 


he  does  advise  caution.  He  also  suggests 
that  physicians  prescribing  the  drug  for 
adults  should  limit  the  number  of  tablets 
to  lessen  chances  of  accidental  ingestion 
by  children.  In  one  instance,  a  child 
swallowed  150  tablets,  and  "that's  far 
more  than  would  be  needed  to  treat  an 
episode  of  diarrhea  in  an  adult,"  he  said. 
Dr.  Wasserman  added  that  parents  should 
be  warned  not  to  play  doctor  and  give  the 
drug  to  an  ailing  child. 


Liver  tumor  linked  to  the  pill 

Benign  liver  tumors  have  been  found  in  I  I 
women  at  the  University  of  Louisville  who 
were  taking  oral  contraceptives.  Six  of  the 
women  presented  with  hemorrhaging  from 
a  ruptured  tumor;  one  died.  The  other 
tumors  were  detected  incidentally  during 
abdominal  surgery.  Six  additional  deaths 
have  been  reported  throughout  the  world. 
This  information,  which  appeared  in  the 


January  1975  issue  of  aorn  (official  joui 
nal  of  the  Association  of  Operating  Roor 
Nurses),  was  reported  at  the  America 
College  of  Surgeons  meeting  recently  b 
E.T.  Mays,  M.D. 

The  1 1  women  were  between  the  ages 
22  and  47  and  had  been  taking  the  pill . 
average  of  five  years.  There  was  no  corr 
lation  established  between  length  of  tin 
on  the  pill  and  the  tumor  mass .  One  patio 
had  been  on  the  pill  only  six  months. 

Dr.  Mays  advised  women  taking  the  pi 
who  experience  persistent,  severe  abdon 
inal  pain  to  consult  their  physician.  Ar 
lump  or  mass  in  the  abdomen  in  the  rig 
upper  quadrant  should  be  reported. 

He  suggested  that  the  oral  contracc 
lives  that  cause  thickening  of  the  veins  ai 
arteries  in  some  women  might  restn 
blood  flow  to  the  liver,  resulting  in  li\ 
damage.  He  stressed  that  there  is  no  sol 
evidence  that  oral  contraceptives  cau: 
iver  cancer. 


MARCH  19 


Use  of  the  MINI-BOTTLE  drug  delivery 

system  eliminates  several  preparation  steps  and 
some  equipment.  The  MINI-BOTTLE  can  in 
itself  be  the  KEFLIN  I.V.  delivery  system,  or  can 
be  utilized  with  most  I.V.  administration  sets 
presently  in  use. 

The  KEFLIN  MINI-BOTTLE  drug  delivery 
system  is  available  at  no  increase  in  cost  over 


regular  ampoules  of  KEFLIN. 

Your  Lilly  representative  will  be  pleased  to 
supply  you  with  full  details.  Your  inquiry  is 
invited. 

Call  or  write: 


Eli  Lilly  and  Company  (Canada)  Limited,  ^le-uBCR 

P.O.  Box  4037,  Terminal  "A",  ^  pmacI 

Toronto,  Ontario,  M5W  ILl  »  ' 


I  'sodium  cephalothin 


ass;r 


-t9»^i-<'dt-<. 


■<Jni^3SXSSS7. 


^  Ahhh...thafs  nice 

HEELBO™  and  the  new  "supercushioned"  HEELBO  FLAIR 
are  the  only  protection  for  decubitus  ulcers  that  allow  your 
patients  to  walk  in  comfort  and  safety. 

The  slim,  natural  shape  gives  patients  a  firmer  footing,  so 
that  during  late  hours  and  on  weekends  they  can  man- 
age better  alone. 

Like  the  original  HEELBO,  the  FLAIR  has  a  patented, 
warm,  comfortable  lining  of  brushed  Acrilan.™  Heal- 
ing is  more  rapid,  because  there  are  no  straps  or 
bindings  to  restrict  blood  circulation. 

But  only  the  new  FLAIR  has  an  extra  deep  "arm- 
chair" of  foam  with  higher  sides  for  an  important 
extra  edge  of  protection. 

Leading  institutions  have  given  HEELBO 
excellent  evaluations.  Now  you  can  give 
HEELBO   comfort  and   protection   to 
your  patients. 

After  all,  it  shouldn't  be  just  the  doctor 
who  can  make  your  patients  say 
"Ahhh." 


HEELBO  and  the  new  FLAIR  are 
made  of  washable  Acrilan  with  a 
stain-resistant  foam  cushion,  and 
can  be  autoclaved.  One  size  fits  all 
adults,  heels  or  elbows.  In  blue  or 
yellow,  3  dozen  pairs  per  case. 


FLAIR  on  elbow 


FLAIR  inside-out 


Heelbo 

Heelbo  Corporation       P.O.  Box  950      Evanston,  Illinois  60204 


r- 


Please  send  me  a 
Name: 

free  sample  and 

price 

list. 

Title: 

Hospital: 

Address: 

City: 

State: 

Zip: 

Preferred  Dealer: 

Heelbo  Corporation    P.O.  Box  950    Evanston,  Illinois  60204 


The    case 
of  the  warm 
moist  compress 


Are  nursing  procedures  based  on  tradition  or  clinical  evidence?  The  nursing 
procedure  committee  at  Glenrose  Provincial  General  Hospital,  Edmonton, 
Alberta,  compared  the  efficiency  and  effectiveness  of  the  traditional  method  of 
preparing  warm  moist  compresses  with  a  new  method,  using  prepackaged 
compresses  heated  by  an  infrared  bulb.  Their  study  raised  questions  about 
nurses'  methods  of  doing  procedures. 


Jannice  Moore  and  Maureen  Weinberg 


A  new  method  of  preparing  warm  moist 
compresses,  using  an  infrared  bulb  to  heat 
water  or  saline  compresses  prepackaged 
in  aluminum  foil  (the  Curity  Thermal 
Pack  System)  was  recently  introduced  at 
our  hospital.  Comments  by  staff  who 
used  the  new  system  indicated  a  variety  of 
opinions  on  how  it  compares  to  the 
traditional  method  that  uses  a  compress 
tray  to  which  a  solution  and  dressings  are 
added.  The  nursing  procedure  committee 
agreed  to  conduct  a  study  to  determine 
which  of  these  two  methods  was  more 
effective  and  efficient. 

Review  of  the  literature 

From  a  review  of  the  literature,  it 
appeared  that  no  study  of  this  nature  had 
been  previously  done.  There  were  several 


Jannice  Moore  (B.Sc.N.,  University  of 
Saskatchewan)  was  a  supervisor  at  the 
Glenrose  Provincial  General  Hospital, 
Edmonton,  at  the  time  this  study  was  done. 
She  is  presently  enrolled  in  the  Master's 
program  in  health  .services  administration. 
University  of  Alberta.  Maureen  Weinberg 
(S.R.N,  and  S.C..M.,  Walton  Hospital, 
Liverpool,  England)  is  a  supervisor  at  the 
Glenrose  Provincial  General  Hospital. 


l^RCH  1975 


studies  involving  warm  moist  com- 
presses, but  they  compared  various 
methods  of  application,  ail  within  the 
method  we  have  called  traditional.  These 
studies  indicated  wide  variations  in 
methods  of  heating  the  solution,  materials 
used  for  the  compress,  and  methods  of 
maintaining  the  temperature. i'^ 

Another  study,  comparing  the  effec- 
tiveness of  various  insulating  materials  in 
maintaining  compress  temperature,  found 
aluminum  foil  to  be  the  most  satisfactory 
insulator.  Heat  retention  was  positively 
affected  by  the  addition  of  an  external 
heat  source,  such  as  a  hot  water  bottle.-^  A 
number  of  sources  were  consulted  to 
determine  what  temperature  was  adequate 
to  produce  the  desired  therapeutic  effect 
without  causing  injury  to  the  skin.^"' 
None  of  these  indicated  an  optimum 
temperature  for  compresses.  The  Petrello 
study-'  considered  the  lower  limit  of  an 
adequate  compress  to  be  98.6  degrees  F. 
Most  sources  cited  111.2  degrees  F.  as 
the  lowest  temperature  that  might  cause 
injury  to  the  skin. 

Hypotheses  and  limitations 

We  selected  the  following  variables  for 

study:    temperature,    moisture    content, 

sterility,    nursing    time,    and    cost.    We 

THE  CANADIAN  NURSE     19 


I 


assumed  that  Curity  prepackaged  dress- 
ings contain  a  standardized  amount  of 
moisture.  We  did  not  attempt  to  measure 
the  physiological  effects  of  the  two  types 
of  compresses. 

Only  selected  variable  costs,  such  as 
supplies,  labor,  and  maintenance  of 
equipment,  were  measured.  Fixed  costs, 
such  as  the  Thermal  Pack  machine, 
reusable  equipment  on  trays,  autoclave 
operation,  and  transportation  of  supplies 
within  the  hospital,  were  not  measured. 

We  hypothesized  that  the  traditional 
method  would  sustain  heat  longer, 
contain  more  moisture,  be  less  sterile, 
more  time  consuming,  and  more  costly 
than  the  Curity  method. 

Study  method 

One  registered  nurse  performed  all 
compresses  to  minimize  the  differences  in 
working  speed  that  might  have  been 
encountered  if  several  nurses  were  used. 
To  eliminate  time  discrepancy,  a 
standardized  procedure  was  developed  for 
each  type  of  compress. 

Although  the  Curity  literature  states 
that  the  compresses  will  reach  140-150 
degrees  F.  in  5  minutes,  we  found  in  our 
pretrials  that  in  5  minutes  the  temperature 
did  not  exceed  106  degrees  F.  For  the 
purpose  of  this  study,  we  found  that 
heating  compresses  8  minutes  resulted  in 
an  adequate  temperature. 

There  was  some  variability  among 
compress  heat  lamps.  This  is  a  drawback 
of  the  Curity  system;  it  is  difficult  to 
determine  the  exact  temperature  of  the 
compress  in  an  actual  practice  situation. 
If  left  too  long,  the  compress  could 
become  too  hot;  there  is  no  alarm 
indicator  on  the  equipment.  In  the 
interests  of  safety,  we  recommend  use  of 
a  timer  with  a  buzzer  and  suggest  that  the 
nurse  plan  her  work  so  she  is  occupied  in 
the  patient's  room  while  the  compress  is 
heating. 

After  initial  trials,  compresses  were 
done  twice  daily  on  2  patients  for  a  period 
of  3  days,  using  each  method  once  every 
day.  Both  patients  received  saline 
compresses.  A  thermometer  was  inserted 
into  the  center  of  each  compress,  and  the 
20     THE  CANADIAN  NURSE 


FIGURE  1 

Temperature  Maintenance  of  Curity 
and  Traditional  Compresses* 


0      1      2     3     4     5     6     7     8     9    10    11     12    13    14 
Minutes  from  initial  contact 


15     If 


_Curity 
.Traditional 


each  temperature 
indicated  is  the  mean 
of  six  trials. 


temperature  was  recorded  to  the  nearest 
degree  F.  on  initial  application  and  at 
I -minute  intervals  until  the  reading  was 
less  than  98  degrees  F. 

Moisture  content  was  measured  by 
weighing  a  wet  compress,  heating  it  to 
evaporate  the  liquid,  weighing  it  dry,  and 
calculating  the  percentage  of  total  weight 


due  to  moisture.  Sterility  was  determine^ 
by  obtaining  a  culture  just  prior  to  placin 
the  compress  on  the  patient. 

The  procedure  was  divided  into  severe 
parts,  and  nursing  time  for  each  part  wa 
recorded  to  the  nearest  second.  The  tim 
required  to  heat  the  compress  or  solution 
and  the  actual  time  the  compress  was  lei 

MARCH  197 


the  patient  were  not  included  in  total 
me.  because  in  actual  practice  the  nurse 
nuld  be  otherwise  occupied  during  these 

criods. 

indings 

The  data  that  we  obtained  indicated 
lat  the  traditional  method  maintained  a 
eat  ranging  from  107.6  degrees  F.  to 
"3  degrees  F.  for  8.7  minutes,  while  the 
"uiity  method  maintained  a  range  of 
(19.8  degrees  F.  to  97.7  degrees  F.  for 
^v7  minutes,  as  shown  in  Figure  1 .  The 
aJitional  compress  has  a  mean  moisture 
'  1  ntent  of  8 1 .  36%  compared  to  the  Curity 
aUne  compress  at  72.88%  and  the  Curity 
lain      compress      at      66.48%.       All 

11  presses  of  both  types  showed  no 
..^terial  growth. 

Nursing  time  was  broken  down  as 
howri  in  Figure  2.  FYeparation  and 
leanup  times  specified  whether  or  not  a 
Irjssing  tray  was  required  to  cleanse  the 
irca  prior  to  application  of  the  compress. 
-or  an  area  requiring  no  cleansing,  the 
Turity  method  saved  5  minutes  and  15 
CLonds  of  nursing  time.  When  a  dressing 
r  ty  was  needed,  the  Curity  method  saved 
I  minute  24  seconds. 

The  total  variable  cost  of  one  traditional 
I  impress,  including  the  dressings,  labor 
'St  of  preparation,  laundry'  cost,  and 
abor  cost  of  administration,  was  $1.50. 


The  total  variable  cost  of  one  Curity 
compress,  including  dressings,  labor  cost 
of  preparation,  laundry  cost,  machine 
maintenance.  and  labor  cost  of 
administration,  was  SI. 28  for  a  saline 
compress.  $1.60  for  a  saline  compress 
requiring  a  dressing  tray  for  cleansing, 
S 1 .08  for  a  plain  compress,  and  $  1 .40  for 
a  plain  compress  requiring  a  dressing 
tray. 

In  summary,  our  findings  indicated  that 
the  Curity  method  sustains  more  heat  for 
a  longer  period  of  time,  is  less  time  con- 
suming, and  less  costly  in  most  cases  than 
the  traditional  method.  The  methods  are 
equally  aseptic.  The  traditional  compress 
contains  more  moisture. 

We  concluded  that  the  Curity  method  is 
more  effective  and  efficient  than  the 
traditional  method  of  applying  warm 
moist  compresses.  Because  the  study  was 
conducted  with  a  small  sample  of  patients, 
it  should  be  replicated  to  determine  the 
findings  in  other  settings. 

Discussion 

An  important  question  is  raised  by  this 
study.  Nurses  have  traditionally  applied 
compresses  for  15  to  20  minutes.  Because 
the  purpose  of  a  warm  moist  compress  is  to 
increase  circulation  to  promote  healing, 
the  effect  of  the  compress  is  counteracted 
when  the  compress  temperature  drops  be- 


Activity 


FIGURE  2 

Nursing  Time  for  Compresses 

Traditional  Curity 


with 
dressing  tray 


without 
dressing  tray 


Set  up  tray 

5  min. 

1 1  sec. 

4  min. 

1  min. 

23  sec. 

Prepare  patient 

2  min. 

39  sec. 

2  min. 

21  sec. 

2  min. 

21  sec. 

Prepare  and 

apply  compress 

1  min. 

3  sec. 

0  min. 

49  sec. 

0  min. 

49  sec. 

Remove  compress  and 

reapply  dressing 

1  min. 

43  sec. 

1  min. 

27  sec. 

1  min. 

27  sec. 

Clean  up 

2  min. 

n  sec. 

2  min. 

46  sec. 

1  min. 

32  sec. 

12  min. 

47  sec. 

1 1  min 

23  sec. 

7  min. 

32  sec. 

low  body  temperature.  This  study  showed 
that  with  the  traditional  method  the 
temperature  falls  below  body  temperature 
after  8.7  minutes. 

If  the  compress  is  continued  beyond  8.7 
minutes,  evaporation  occurs  and  actually 
cools  the  body  surface,  thus  negating  the 
purpose  of  the  procedure.  This  effect  can 
be  avoided  by  changing  the  compress 
every  8  minutes  to  maintain  adequate  heat. 
However,  the  nursing  time  required  then 
increases,  and  the  cost  of  the  procedure,  as 
we  have  defined  it.  increases  correspond- 
ingly. This  study  ptiints  out  the  impor- 
tance of  questioning  and  reexamining  time- 
honored  procedures  to  be  certain  that  our 
nursing  practices  maintain  maximum  effec- 
tiveness. 


Sterile    warm     wet 
Nurs.  59:982-4.  Jul. 


^tARCH  1975 


References 

1.  Sheldon.  Nola  S. 
compresses.  Amer.  J. 
1959 

2.  Glor,  Beverly  A.K.  and  Estes,  Zane  E. 
Moist  soaks:  a  survey  of  clinical  practices. 
Nurs.  Res.  19:5:463-5.  Sept. /Oct.  1970. 

3.  Petrello.  Judith  .M.  Temperature  mainten- 
ance of  hot  moisi  compresses.  Amer  J. 
Nurs.  73:6: 1050- l.Jun.  1973 

4.  Fuerst.  Elinor  V.  and  Wolff.  LuVeme. 
Fundamentals  of  nursing:  the  humanities 
and  the  sciences  in  nursing.  3ed. 
Philadelphia.  Lippincott.  1964.  p.  519 

5.  Brunner,  Lillian  S.  et  al.  Te.xtlyook  of 
medical-surgical  nursing.  Philadelphia.  Lip- 
pincott. 1964.  p.  26. 

6.  Moritz.  A.R.  and  Henriques.  F.C.  The 
relative  importance  of  time  and  surface 
temperature  in  the  causation  of  cutaneous 
bums.  Amer.  J.  Pathology  23:695-720. 
Dec.  1947. 

7.  Fraser.  Robin.  Radiant  heat  bums  and 
operating  theatre  lamps:  a  study  of  the  heat 
required  to  cause  tissue  necrosis.  Med.  J. 
Aust.  I:  1 199-1202.  Jun.  17.  1967. 

8.  Quinones.  C.A.  and  Winkelmann.  R.K. 
Changes  in  skin  temperature  with  wet 
dressing  therapy.  Arch.  Derm.  97:708-1 1. 
Dec.  1967. 

9.  Watemian  N.G.  el  al.  Effects  of  various 
dressings  on  skin  and  subcutaneous 
temperatures.  A  comparison.  Arch.  Surg. 
95:464-71.  Sep.  1967.  C^ 

THE  CANADIAN  NURSE     21 


The  Canadian  Nurses' 

Foundation 

is  its  members 

Increasing  numbers  of  nurses  are  seeking  advanced  study  to  prepare  for  new 
nursing  roles.  The  membership  and  support  of  Canadian  nurses  are  needed  to 
help  the  Canadian  Nurses'  Foundation  fulfill  its  purposes  of  providing 
scholarships  and  grants  for  nursing  research.  The  president  of  CNF's  board  of 
directors  outlines  the  bylaw  changes  proposed  to  conserve  existing  funds  and 
provide  new  revenues. 


Helen  D.  Taylor 


Are  you  a  member  of  the  Canadian 
Nurses"  Foundation?  Your  personal  mem- 
bership and  support  are  needed  if  the  CNF 
is  to  fulfill  its  purposes  of  providing  schol- 
arships for  nurses  to  undertake  study  for 
academic  degrees  and  grants  for  research 
in  nursing  science.  Increasing  numbers  of 
nurses  are  needing  and  seeking  advanced 
study  to  adequately  prepare  themselves  for 
new  nursing  roles;  a  record  number  of  re- 
quests for  fellowship  applications  and  in- 
formation has  been  received  this  year. 

In  1973,  a  national  survey  was  con- 
ducted by  questionnaires  on  CNF's  pur- 
poses and  effectiveness,  which  were  di- 
rected to  nurses  across  the  country.  Re- 
spondents said  that  CNF  is,  indeed,  playing 
a  significant  role  in  providing  scholarships 
to  nurses  undertaking  advanced  education. 
Reasons  given  in  support  of  this  belief  can 
be  grouped  in  three  main  categories: 

•  CNF  scholars  are  making  important  con- 
tributions to  the  nursing  profession  in 
Canada; 

•  CNF  demonstrates  nurses"  belief  in  fund- 
ing their  colleagues  and  strengthens  the 

Helen  D.  Taylor  (R.N..  The  Montreal  General 
Hospital  school  of  nursing:  B.N..  McGill  U.)  is 
director  of  nursing,  Jewish  General  Hospital, 
Montreal.  She  is  1st  vice-president.  Canadian 
Nurses"  Association,  and  president.  Canadian 
Nurses"  Foundation  board  of  directors. 


22     THE  CANADIAN  NURSE 


grounds  for  future  solicitation  of  fundi 
from  other  sources;  and 
•  CNF  is  important  in  influencing  the  nurs 
ing  profession  to  consider  the  educations 
needs  of  its  members. 

CNF  directors  accept  these  reasons  an 
are  endeavoring  to  assure  a  viable  futur 
for  the  Foundation.  Federal  and  provincia 
funding  is  limited  and,  even  if  funds  fron 
these  sources  become  more  available  ii' 
future  years,  still  more  will  be  needed.  T(' 
date,  the  CNF  has  given  $468,000  in  schol  j 
arships  to  nurses  for  advanced  academi«' 
degrees.  j 

The  Canadian  Nurses"  Foundation  is  <! 
nonprofit,  charitable  organization  incor' 
porated  under  Letters  Patent  of  the  Canada 
Corporations  Act.  As  such,  CNF  is  permit' 
ted  to  issue  receipts  for  income  tax  pur 
poses  to  members  and  donors.  Under  th< 
Act,  expenditure  of  revenue  must  be  di 
reeled  toward  fulfillment  of  the  purpose:! 
of  the  organization;  for  this  reason,  schol 
arships  must  be  allocated  each  year  a: 
long  as  the  cnf  remains  viable.  ' 

The  CNF  is  not  bankrupt,  as  some  nurses 
might  have  believed.  However,  the  Foun- 
dation will  only  be  able  to  continue  tc 
respond  to  its  purposes  if  present  and  fuv 
ture  members  offer  greater  support  thar! 
they  have  in  the  past.  In  1974.  provincia 
associations  —  Alberta,  Saskatchewan 
Manitoba,  New  Brunswick,  Nova  Scotia 
and  Prince  Edward  Island  —  gave  gener 

MARCH  1975 


lonations  to  the  Foundation.  Without 

tl  support  of  these  associations,  and  that 

hers  who  have  made  previous  dona- 

.  the  CNF  might  well  have  ceased  to 

.  ;ie  imptirtance  of  membership  to  our 
Fiiidation  cannot  be  overemphasized:  in 
f  I.  CNF  revolves  around  its  membership, 
[rectors  are  nominated  from  CNF  mem- 
bship.  Members  ultimately  determine 
\io  shall  serve  as  directors.  Elected  direc- 
I  s,  in  turn,  stand  accountable  to  mem- 
trs  for  their  decisions  and  overall  man- 
nent  of  corptirate  affairs.  In  short,  the 
bers  are  the  Foundation. 

fur  funds 
hi  addition  to  the  S468.000  awarded  in 
larships,  CNF  has  received  fees  and 
tions  in  excess  of  $  1 50.000  that  have 
retained  by  the  Foundation  for  future 
itions.  This  amount  was  allocated  to 
s  four  funds:  general,  scholarship,  re- 
:arch.  and  capital  trust,  according  to  CNF 
I  licies  and  contributor  stipulations.  The 
szation  of  funds  is  essential  if  revenue 
iji  located  by  donors  to  specific  funds  and 
i  iherefore.  not  available  for  the  general 
ises  of  the  organization.  Donations 
ated  to  CNF"s  scholarship  fund  or  re- 
h  fund  are  devoted  specifically  to  the 
a!   scholarship  program  and  to  re- 
h  grants  respectively.  Due  to  the  cost 
adertaking  research,  grants  for  re- 
.i;v.h  have  yet  to  be  awarded. 
Revenue  to  cnf's  general  fund,  com- 
bed of  membership  fees  and  donations 
'    ilated  for  this  fund,  is  used  for  the 
lal  purjxise  of  the  organization,  that 
'perational  costs  such  as  staff  salaries 
Id  cost  of  meetings.  Money  given  to  CNF 
at  is  not  stipulated  is  deposited  to  the 
ipital  trust  fund,  according  to  policies  set 
-   ihe  CNF  directors.  This  capital  trust 
inJ  is  des-gned  to  accumulate  donations. 
hat  its  income  will  eventually  provide 
ne  needed  money  for  administrative 
penses.    scholarships,    and    research 
'■nts  on  a  yearly  basis.  The  capital  trust 
has  grown  to  approximately  $70,000; 
l^  growth  is  most  encouraging. 
.iARCH  1975 


The  directors  are  committed  to  improv- 
ing the  operational  efficiency  of  the  Foun- 
dation by  decreasing  expenditures  and  in- 
creasing revenues.  It  is  anticipated  that 
improved  operations  will  conserve  exist- 
ing funds  and  provide  new  revenue  for 
CNF's  annual  scholarship  program  and  fu- 
ture operations.  A  new  application  proces- 
sing procedure,  designed  to  reduce  ad- 
ministrative costs,  was  implemented  I 
November  1974. 

Bylaw  changes 

The  directors  will  present  bylaw 
changes  to  membership  for  approval  at  the 
annual  general  meeting  in  April  1975.  It  is 
proposed  that  the  cnf  selections  commit- 
tee be  reduced  to  3  members  from  7.  and 
the  board  of  directors  be  reduced  to  5  from 
9.  The  CNF  board  of  directors  will  be 
nominated  from  cnf  membership  only  and 
the  requirement  for  cna  representation  on 
the  CNF  board  will  be  eliminated.  It  is 
anticipated  that  this  w  ill  circumvent  prob- 
lems pertaining  to  cnf  elections. 

CNF  directors  will  propose  that  fees  be 
increased  from  $5  to  S 10,  in  the  belief  that 
members  will  understand  the  rationale  for 
this  proposal.  A  further  reduction  in  ex- 
penditures is  expected  through  holding  the 
cnf  annual  general  meeting  in  conjunction 
with  the  CN.i^  annual  meeting  each  year. 
This  should  also  enable  more  nurses  from 
across  Canada  to  attend  and  participate  in 
each  Foundation  annual  general  meeting. 

All  nurses  are  urged  to  support  the 
Canadian  Nurses"  Foundation  by  becom- 
ing members.  In  recent  years,  memorial 
and  honorarium  donations  have  been  in- 
creasing. Individual  contributions  from 
nurses  and  nonnurses  given  "in  memory 
of.  .  ."■  represent  a  more  lasting  memorial 
than  flowers  and  are  an  appropriate  and 
constructive  form  of  remembrance.  Hon- 
orarium gifts  to  CNF  in  recognition  of  indi- 
vidual nurses'  participation  in  public  ap- 
pearances and  lectures  are  also  a  construc- 
tive form  of  tribute. 


THE  CANADIAN  NURSE     23 


wRite  fOR  the  Readec, 
he  may  nee6  to  know 
what  you  have  to  say 


Elizabeth  Kinzer  O'Farrell 


The  how-to  aspects  of  developing  a  meaningful  manuscript  and  the  publishing 
process  for  a  journal  article  are  described  for  should-be  nurse  authors. 


Writing  for  publication  has  become  a 
necessary  and  increasingly  important  con- 
sideration for  the  professional  nurse  in 
modem  nursing  practice  for  two  distinct 
and  important  reasons.  First,  if  nursing  is 
to  achieve  its  long-range  goals  and  objec- 
tives in  the  struggle  for  recognition  as  an 
independent  health  profession,  a  current 
and  expanding  body  of  knowledge  specific 
to  nursing  and  developed  by  nurses  is  es- 
sential to  meet  the  criteria  for  such  recog- 
nition. Second,  and  perhaps  more  perti- 
nent to  immediate  nursing  objectives, 
sharing  new  nursing  knowledge  in  a 
rapidly  changing  health  care  system  is 
mandatory  to  the  delivery  of  quality  pa- 
tient care.  While  the  mandate  to  share  new 
nursing  knowledge  is  not  new  and  has  long 


Elizabeth  Kinzer  O'Farrell,  R.N.,  formerly 
Editor  of  the  Journal  of  Nursing  Administra- 
tion, is  a  freelance  editor  and  writer  working 
from  her  home  in  Tucson,  Arizona.  Prior  to 
Joining  yOA'/l,  Mrs.  OTarrell  was  Managing 
Editor  and  Business  Manager  for  The  Journal 
of  Nursing  Education.  This  article  is  adapted 
from  a  paper  presented  September  26.  1973. 
Tele-Conference  Series  in  Continuing  Educa- 
tion, cosponsored  by  the  Colleges  of  Nursing. 
University  of  Arizona.  Tucson,  and  Arizona 
State  University,  Tempe.  It  is  reprinted,  with 
permission,  from  the  Journal  of  Nursing  Ad- 
ministration. September-October,  1974. 
24     THE  CANADIAN  NURSE 


been  recognized  by  most  professional 
nurses,  writing  skill  and  the  how-to  as- 
pects of  developing  a  meaningful  manu- 
script have  not  usually  been  included  in  the 
nurse's  preparation  for  practice.  The  result 
all  too  often  is  readily  apparent  not  only  to 
the  editor  or  publisher  working  with  nurs- 
ing manuscripts,  but  also  to  many  capable 
and  experienced  nurses  who  fail  to  share 
their  knowledge  and  experiences  with 
their  colleagues  simply  because  the  task 
seems  too  great  or  because  they  do  not 
know  where  to  begin  or  how  to  proceed 
with  a  writing  project. 

Is  writing  for  publication  really  as  dif- 
ficult as  many  should-be  nurse  authors 
tend  to  make  it?  Certainly  there  is  no  de- 
bate even  among  experienced  authors. 
Writing  effectively  is  not  easy,  and  a  writ- 
ers" workshop  specifically  designed  to  de- 
velop writing  skill  is  a  worthwhile  project 
for  any  continuing  education  program  for 
nurses  or  as  a  senior  seminar  for  nursing 
students.  Perhaps  more  important  for  busy 
practitioners,  a  practical  discussion  on  the 
how-to  aspects  of  developing  a  publish- 
able  manuscript  may  b)e  rewarding  and  need 
not  require  more  than  a  one-  or  two-hour 
classroom  discussion  period.  Such  a  dis- 
cussion, prepared  as  a  paper  and  presented 
during  a  one-hour  continuing  education 
program,  is  presented  in  this  article.  While 
the  article  is  necessarily  brief  and  the  re- 
marks apply  primarily  to  developing  the 


manuscript  for  a  journal  article,  much 
what  has  been  said  also  applies  to  develo 
ing  a  book  manuscript  or  writing  a  coil 
prehensive  and  meaningful  report. 

Preplanning  a  writing  project 

How  does  one  begin  a  writing  projci 
Certainly   a   writing   project,   like   ni( 
worthwhile  projects,  requires  a  great  di 
of  time,  thought,  and  careful  preplannii 
if  the  desired  result  is  to  be  achieve 
Perhaps  the  best  place  for  the  writer 
begin  is  to  ask  himself  a  difficult  but  ii , 
portant  question  to  answer  honestly.  Dei 
have  something  to  say  that  a  reader  mig 
need  to  know?  In  their  eagerness  to  i 
published,  many  writers  either  fail  to  a;; 
themselves  this  important  question  or  f;, 
to  answer  it  honestly ,  with  the  unfortuna 
result  that  they  devote  a  great  deal  of  tin 
and  energy  to  a  project  that  may  never  g 
off  the  ground.  Fortunately,  they  usual 
have  not  wasted  their  time  or  energy,  sim 
good  writers  are  rarely  born  that  wa; 
Good     writers     become    good    write 
through  writing  experience,  and  a  secor 
or  third  attempt  to  be  published  may  I 
more  rewarding. 

The  second  question  the  writer  shou. 
ask  himself  in  the  preplanning  stage 
equally  important.  Who  needs  to  kno 
what  I  have  to  say?  The  success  or  failui 
of  a  writing  project  may  depend  on  tt 
writer's  careful  analysis  of  his  answer  ll 

MARCH  19?| 


I  ^  question.  Who  is  the  intended  reader? 

at  specifically  is  his  orientation,  and 

'  ;\  is  the  topic  to  be  discussed  likely  to  be 

I   interest  or  important  to  him?  When 

A.'  questions  have  been  answered,  the 

I  question  follows  logically;  What piib- 

,  r  serves  the  intended  audience? 

\  hile  it  may  seem  premature  to  explore 

matter  of  a  possible  publisher  in  the 

(.planning  stage  for  a  writing  project,  the 

'  sc  writer  will  do  a  little  research  on  this 

I  liter  before  he  begins  to  develop  his 

uiscript.  The  format  and  nature  of  the 

Jes  regularly  published   in  a  target 

nal  or  periodical  provide  a  valuable 

le  for  the  wnter  and  may  spare  him 

^iderable  grief  as  well.  Forexample,  a 

^lng  journal  by  name  obviously  serves 

irsing  audience,  but  it  does  not  neces- 

l\  serve  everv  nurse.  The  trend  in  mod- 

•  II  nursing  is  toward  specialization  in 

•  le  area  of  nursing  practice.  Nursing  jour- 
lis  are  following  this  trend,  and  their 
ihlishers  have  established  their  editorial 
i]cctives  accordingly.  The  nurse  author 
ho  assumes  that  her  article  is  suitable  for 
i\  nursing  journal  bearing  the  name  is 

cly  to  wait  weeks  for  a  publishing  deci- 

1  only  to  be  rew  arded  by  a  typical  mes- 

.  from  the  editor:  ""We  appreciate  your 

rest  in  submitting  the  enclosed  manus- 

!  to  us,  but  ...."■ 

:  is  sad,  but  unfortunately  it  is  also  true 

at  not  just  a  few  well-written  manu- 

.ripts   spend   many    weeks   on   a  busy 

iitor's  desk  pending  a  publishing  deci- 

1    This  is  particularly  true  of  manu- 

.pts  of  a  professional  or  highly  technical 

iiure.  Such  manuscripts  usually  are  re- 

•  ed  by  a  panel  of  advisors  qualified  to 

aiate  the  validity  and  potential  value  of 

ic  content  to  the  audience  to  be  served 

re  a  publishing  decision  is  made.  Oc- 

>nally,  if  a  manuscript  is  particularly 

written  but  deemed  inappropriate  for 

audience  served  by  the  publisher,  the 

>r  will  take  time  to  suggest  a  suitable 

iisher  or  to  explain  in  detail  why  the 

uscript  is  deemed  unacceptable.  But 

editors  usually  are  not  so  inclined, 

iarily  because  authors  are  expected  to 

ct  an  appropriate  publisher  to  reach 

:  intended  audience.  Sampling  a  few 

les  in  recent  issues  of  a  target  journal 

ally  will  reveal  the  nature  and  orienta- 

of  the  audience  served,  and  noting  the 

lat  customarily  used  by  the  publisher 

presenting  bibliographies,  footnotes, 

similar  material  provides  a  useful  and 

saving  guide  for  the  writer  in  prepar- 

his  own  manuscript.  If  still  in  doubt 

r  such  a  sampling,  the  wise  writer  will 

aie  step  further  and  write  to  the  editor, 

ly  describing  his  topic  and  inquiring 

^^    -KCH  1975 


about  the  editor's  interest  in  the  project.  A 
favorable  response  provides  additional  in- 
centive and  the  writer  is  ready  for  the  next 
step  to  be  taken. 

Organizing  the  material 

The  importance  of  preparing  a  working 
outline  can  hardly  be  news  to  should-be 
authors.  They  have  been  hearing  about 
working  from  a  detailed  outline  dating 
back  to  their  first  English  composition 
course  in  junior  high  school  or  earlier.  Yet 


so  many  manuscripts  submitted  to  pub- 
lishers reflect  so  little  organization  of  the 
content  and  continuity  in  the  discussion 
that  the  matter  of  preparing  and  working 
from  a  detailed  outline  bears  repeating. 
Little  purpose  is  served  in  dwelling  on  this 
subject,  however,  and  perhaps  a  more 
practical  discussion  might  be  to  describe 
an  organizational  structure  that  works  for 
an  effective  article  or  report  and  why. 

If  the  project  is  intended  for  a  profes- 
sional audience  and  the  writer  has  ans- 
wered the  first  question  honestly,  he  prob- 
ably is  writing  about  the  results  of  a  re- 
search project  or  describing  a  new  method 
of  accomplishing  an  objective  based  on  his 
experience  with  that  method.  In  either 
case,  reponing  the  results  of  a  study  is  by 
no  means  the  same  thing  as  making  the 
study.  The  reader  is  unlikely  to  have  either 
the  time  or  the  inclination  to  follow  a  wri- 
ter through  a  step-by-step  or  blow-by- 
blow  discussion  of  the  details.  A  reader 
wants  to  know  what  the  writer  thinks  he 
should  know  at  the  outset  of  the  discus- 
sion. He  will  be  interested  in  the  details 
and  the  writer's  analysis  of  them  only  in 
direct  proportion  to  his  interest  in  the  re- 
sults and  their  potential  value  to  him  in  his 
own  particular  work  environment. 

An  organizational  structure  that  works 
in  making  and  reporting  a  study  might  be 
described  by  comparing  the  process  to 
building  a  pyramid.  The  foundation  or 
base  of  the  pyramid  is  the  research  and 
cataloguing  of  relevant  details  supporting 
the  study  objectives.  The  middle  section  or 
body  of  the  pyramid  is  a  step-by-step 


analysis  of  the  details  and  data  gathered, 
and  the  apex  is  the  result  or  conclusion 
drawn  from  the  analysis.  The  researcher, 
like  a  builder,  identifies  his  objective  and 
begins  with  the  foundation  —  with  the 
details  and  facts  supporting  his  objective. 
He  then  works  stone-upon-stone  through  a 
comprehensive  analysis  of  the  data 
gathered  to  the  conclusions  to  be  drawn 
from  them.  In  reporting  the  study,  he  de- 
scribes his  objective  and  reverses  the  pro- 
cess. He  begins  at  the  apex,  with  the  con- 
clusions drawn,  and  works  back  through 
the  analysis  of  the  data  to  the  details  or 
foundation  supporting  the  study  objective. 
While  it  may  be  stretching  the  point  a 
bit,  the  reader  might  be  compared  to  a 
tourist  viewing  a  pyramid  for  the  first 
time.  The  tourist's  initial  reaction  is  why. 
Why  was  it  built;  what  purpose  did  it 
serve?  Only  if  the  tourist  is  genuinely  in- 
terested orarcheologically  inclined  will  he 
bother  to  explore  further  to  learn  how  it 
was  built,  and  the  wi.se  writer  will  recog- 
nize this  very  human  reaction  to  a  new  idea 
and  develop  his  working  outline  accord- 
ingly. He  first  describes  his  objective 
briefly  and  lists  the  reasons  his  report  may 
be  important  to  the  reader.  Next  he  lists  the 
results  or  conclusions  drawn  from  the 
study  or  experience.  He  follows  this  with 
the  supporting  data  and  his  analysis  of 
them,  keeping  the  orientation  of  the  target 
audience  in  mind  (e.g.,  charts  and  tables 
reflecting  voluminous  statistical  data  and 
research  terminology  have  little  value  or 
interest  to  a  nonresearch-oriented  audi- 
ence). The  relevant  details  and  nitty-gritty 
information  likely  to  be  useful  to  a  reader 
seeking  additional  information  come  next, 
and  the  conclusion  once  again  refers  to  the 
study  objective  and  the  writer's  rationale 
for  reporting  the  study.  A  working  outline 
prepared  in  this  manner  provides  a  logical 
presentation  of  the  discussion  material. 
More  important,  it  serves  to  clarify  the 
writer's  thinking,  and  the  next  step  is  to 
develop  the  manuscript  using  the  outline 
prepared  as  a  guide. 

Developing  the  subject 

As  mentioned  earlier,  writing  effec- 
tively is  not  easy.  It  is  not  as  difficult, 
however,  as  many  inexperienced  writers 
tend  to  make  it.  The  effective  writer  ob- 
serves and  follows  three  basic  but  impor- 
tant rules  in  developing  a  publishable 
manuscript.  First,  he  develops  his  discus- 
sion logically,  always  keeping  his  in- 
tended reader  in  mind.  Second,  he  gets  his 
main  points  across  promptly  and  force- 
fully. Third,  he  keeps  his  language 
natural .  The  writer  who  has  done  his  or  her 
preplanning  carefully  and  is  working  from 
THE  CANADIAN  NURSE     25 


a  well-organized  and  detailed  outline  is 
well  on  the  way  to  observing  the  first  two 
rules.  The  third  rule,  however,  deserves 
further  discussion.  If  there  is  a  single  mes- 
sage more  important  than  all  others  for  the 
would-be  author,  it  can  be  summed  up  in 
one  .sentence:  Write  for  the  reader:  he  may 
need  to  know  what  you  are  trying  to  say. 

Not  just  a  few  writers,  perhaps  in  an 
attempt  to  appear  scholarly,  tend  to  garble 
their  message  with  polysyllabic  words, 
with  research  jargon  that  means  nothing  to 
the  nonresearch-oriented  reader,  and  with 
complex  or  overlong  sentences  well 
sprinkled  with  commas  and  parenthetical 
phrases.  Such  manuscripts  impress  no 
one.  Far  worse,  they  fail  to  communicate 
worthwhile  ideas  unless  the  reader  has  the 
patience  to  extract  the  ideas  from  the  wel- 
ter of  words  that  surround  them.  Unfortu- 
nately, some  of  the  worst  offenders  are 
graduate  students,  particularly  doctoral 
candidates,  and  library  shelves  in  univer- 
sity settings  are  lined  with  dissertations 
rarely  used  as  resource  material  simply 
because  they  are  unreadable.  This  situa- 
tion in  nursing  obviously  reflects  countless 
hours  of  invaluable  research  literally  lost 
to  a  profession  in  which  none  can  be 
spared  if  its  members  are  to  achieve  their 
professional  goals.  Although  it  is  true  that 
writing  for  one"s  own  edification  has  some 
reward,  writing  for  publication  is  writing 
for  the  reader,  and  the  author  who  writes 
for  rhetorical  display  usually  has  only 
himself  for  an  audience. 

Much  might  be  said  in  this  discussion 
about  grammar,  punctuation,  spelling, 
etc.,  but  these  topics  might  better  be  dealt 
with  in  a  writers'  workshop.  Perhaps  all 
that  need  be  said  in  this  area  is  to  avoid 
words  and  phrases  of  obscure  meaning 
and.  when  in  doubt  about  spelling,  use  a 
good  dictionary.  There  is  no  disgrace  in 
being  unable  to  spell,  but  the  writer  who  is 
unaware  of  the  problem  and  repeatedly 
misspells  words  in  common  usage  has  a 
serious  handicap.  A  good  dictionary  is  an 
essential  tool  for  any  writer,  and  the  wise 
writer  uses  it  often  in  preparing  his  manu- 
script. 

Preparing  the  manuscript 

The  next  step  in  a  writing  project,  of 
course,  is  the  actual  preparation  of  the 
manuscript.  Fortunately  the  desirable  way 
to  prepare  and  submit  a  manuscript  is  no 
more  difficult,  time  consuming,  or  expen- 
sive than  a  haphazard  way.  The  margin  of 
difference,  however,  is  enormous  when 
considered  from  the  publisher's  point  of 
view.  A  poorly  organized  and  carelessly 
prepared  manuscript  on  an  important  topic 
may  become  a  source  of  considerable  extra 
26    THE  CANADIAN  NURSE 


work,  worry,  and  frustration  for  the  author 
as  well  as  the  publisher  when  and  if  such  a 
manuscript  is  accepted.  For  this  reason,  it 
is  usually  a  good  practice  to  prepare  a  first 
draft  of  the  manuscript  and  to  put  it  aside 
for  a  few  days  before  preparing  the  manu- 
script to  be  submitted  to  the  publisher 
selected.  Although  this  practice  is  obvi- 
ously time  consuming  and  a  few  experi- 
enced authors  may  find  it  unnecessary, 
most  writers  are  well  advised  to  pause  in 
their  project  and  to  carefully  review  and 
edit  a  first  draft  of  the  manuscript  to  be 
certain  that  the  material  is  logically  or- 
ganized and  presented  and  that  nothing  has 
been  left  to  the  reader's  imagination. 

Although  not  all  publishers  subscribe  to 
the  same  set  of  rules  for  preparing  a  manu- 
script, there  are  certain  rules  basic  to  the 
publishing  industry  that  all  writers  should 
know  and  observe  in  preparing  their  manu- 
script. The  first  and  perhaps  most  impor- 
tant rule  is  that  all  material,  including 
footnotes,  quotations  from  the  published 
works  of  others,  case  reports,  legends  for 
illustrations,  bibliographies,  and  reference 
lists,  be  typed  in  double  space  and  on  one 
side  of  the  paper  only.  Margins  of  no  less 
than  one  inch  all  around  should  be  allowed 
for  the  editor's  and  the  printer's  markings. 
The  paper  used  should  be  the  standard  8V2 
x  1 1  size  and  of  an  opaque  quality  that  will 
take  ink  or  ink  eradicator. 

The  second  rule  is  that  manuscript  pages 
be  numbered  consecutively  throughout  the 
manuscript  and  preferably  in  the  upper 


right-hand  comer  of  the  page.  Handwrit- 
ten corrections  in  the  copy  are  acceptable 
if  limited  to  a  few  words  on  the  page  and 
legibly  made  in  ink,  but  if  additional  mat- 
erial is  to  be  inserted,  the  pages  on  which 
the  insertions  are  to  be  made  should  be 
retyped  and  the  additional  pages  numbered 
and  inserted  so  that  all  copy  reads  consecu- 
tively. 

Manuscripts  that  include  illustrations, 
charts,  or  graphs  should  cleariy  indicate  in 
the  text  where  such  material  is  to  be  in- 
serted. The  type  for  most  tabular  material 
must  be  set  separately,  and  it  is  usually 
best  to  clearly  identify  and  prepare  such 


material  on  a  separate  page.  Photograph 
particularly  require  special  handling  in  th 
reproduction  process,  and  care  should  b 
taken  to  identify  and  protect  prints  fror 
damage  in  transit.  Photographs  should  b 
glossy,  black  and  white  prints  for  best  re 
production  results.  Paperclips  usuall 
leave  an  imprint  and  should  never  be  ap 
plied  directly  over  a  photograph.  Whei 
more  than  one  photograph  is  to  be  used, 
is  usually  best  to  identify  them  lightly  0 
the  back  with  a  soft  pencil  or  felt  tip  pen  I 
prevent  errors  in  matching  the  photograp 
with  the  appropriate  legend  during  tli 
production  process. 

The  matter  of  selecting  an  appropriai 
format  was  mentioned  earlier,  but  a  b 
more  might  be  said  regarding  preparin 
the  manuscript  for  bibliographies  and  re 
erence  lists.  The  correct  spelling  of  authc 
names  and  titles  of  books  or  articles  shoul 
be  checked  carefully  and  the  complei' 
publishing  data  included.  Inexperience 
authors  frequently  omit  page  numbers  ft 
references  cited,  and  this  requires  extil 
time  and  effort  to  supply  such  informatic 
later  when  queried  by  the  editor. 

Finally,  one  further  matter  might  t 
mentioned.  Quoting  extensively  from  th 
published  works  of  others  is  a  poor  prai 
tice  and  is  seldom  recommended.  When 
is  deemed  necessary  or  desirable  to  do  s 
rather  than  paraphrase  such  material,  it 
mandatory  for  the  author  to  obtain  writte 
permission  from  the  original  publisher  ar 
to  submit  such  permission  with  the  mam 
script.    Publishers,   in   compliance   wit| 
copyright  laws,  seldom  accept  a  man 
script  without  the  necessary  permission  k 
ter  in  hand  or  without  some  indication  th 
the  permission  letter  has  been  requesti 
and  will  be  forthcoming  in  the  foreseeab 
future.  The  belated  handling  of  this  matt 
is  likely  to  result  in  prolonged  delays  whi 
the    author    waits    for    the    origin 
publisher's  permission  to  use  the  materi; 
The  number  of  words  that  may  be  quoti 
verbatim  from  published  works  will  va 
from    publisher    to    publisher,    but    ll 
number  likely  to  be  unchallenged  is  2( 
words  or  less.  It  should  be  rememberc 
however,  that  the  source  of  all  quoted  11 
terial  should  be  indicated  in  the  text  a 
documented    with    complete    publishi 
data  in  a  footnote  or  reference  list. 

The  publishing  process 

One  might  reasonably  expect  that  li 
author  whose  manuscript  has  been  a 
cepted  can  relax  at  last  and  begin  to  enji 
the  fruits  of  his  labor,  but  this  is  seldom  ti 
case.  The  author  usually  knows  his  subjc 
matter  too  well  or  has  lived  with  his  proje 
too  long  to  be  completely  objective  abo 

MARCH  19 


work.  A  discussion  that  seems  per- 
;  1  y  clear  to  an  author  may  not  be  so  clear 
lis  less  well-informed  reader,  and  the 
si  step  in  a  vs riling  project  is  the  editing 
cess.  Who  is  the  editor;  what  does  he 

The  editor's  primary  function,  of 
iise.  is  to  generate  and  select  appro- 
ite  material  in  keeping  with  the  journal's 
lurial  objectives.  After  selecting  a  suit- 
:Die  manuscript,  the  editor  works  with  the 
Uthor  on  an\  further  development 
teemed  necessary  to  clarify  the  discussion 
If  to  improve  the  general  organization  and 
(resentation  of  the  subject  matter.  Unfor- 
nateh  many  writers  who  have  prepared 
vhat  thev  believe  to  he  a  well-organized 
nd  well- written  manuscript  are  annoyed 
nd  even  angrv  when  the  manuscript  is 
etumed  to  them  heavily  edited  and  with 
nany  changes  recommended.  While  this 
nay  be  understandable,  it  is  seldom  wise 
or  the  author  to  quarrel  with  his  editor,  not 
>ecause  the  editor  is  ah^avs  right  hut  be- 
■ause  the  editor  is.  or  should  be.  regarded 
IS  the  author's  mentor  and  partner  in  a 
lublishing  project.  The  editor  serves  both 
luthor  and  reader,  and  his  task  is  to  assist 
he  author  in  presenting  the  discussion  so 
hat  it  mav  be  readilv  understood  by  the 
ntended  reader. 

Certainis  the  editor  is  not  always  right. 
^e  also  mav  be  a  bit  more  heavy  handed 
vith  a  blue  pencil  than  is  absolutely  neces- 
iary.  but  the  w  ise  w riter  carefully  reviews 
lis  editor's  notes,  queries,  and  recom- 
Tiended  changes  with  a  view  to  developing 
polished  and  highlv  readable  final  manu- 
icript.  Equally  unfortunate,  many  inex- 
jerienced  w  riters.  perhaps  in  fear  that  their 
nanuscripl  might  still  be  rejected,  accept 
iny  and  all  changes  recommended  by  the 
ditor  w  ithout  question.  This  loo  is  under- 
itandable  perhaps,  but  it  is  as  foolish  for  an 
luthor  to  accept  all  recommended  changes 
kvithout  question  as  it  is  to  arbitrarily  ac- 
ept  none  of  them.  In  the  final  analysis  the 
luthor  is  responsible  for  what  he  says. 
^ow  well  or  clearly  he  says  it  for  the 
jartieular  audience  to  be  served,  however, 
s  the  editor's  resptmsibility.  and  the  edit- 
ng  process  essentially  is  a  service  both  to 
:he  author  and  to  his  intended  reader. 

The  next  step  in  the  editing  process  is  to 
prepare  the  final  manuscript  for  the 
printer.  This,  of  course,  is  done  by  the 
sditor.  and  the  author  at  last  can  relax.  A 
Jrief  discussion  or  overview  of  the  produc- 
:ion  process,  however,  may  be  useful  and 
perhaps  explain  why  the  final  manuscript 
For  a  journal  article  submitted  in  January 
may  not  be  published  until  June  or  July. 
Surely  it  must  seem  to  the  author  that  his 
manuscript  could  be  set  in  type  and  pub- 
MARCH  1975 


lished  in  a  matter  of  weeks  rather  than 
months.  What  happens  next,  and  why  does 
it  take  so  long? 

The  production  process 

The  lead  time  required  in  the  production 
process  for  most  journals  is  approximately 
four  months.  While  the  process  is  not  es- 
sentially different  from  that  used  by  most 
newspapers,  the  various  steps  to  be  taken 
in  the  production  process  for  a  journal  re- 
quire considerably  more  time  and  attention 


to  details.  After  the  final  editing  and 
printer  instructions  have  been  specified  on 
the  manuscripts  scheduled  for  a  given 
issue  of  the  journal,  the  work  must  be 
gathered  and  sent  to  the  compositor.  Ap- 
proximately one  month  must  be  allowed 
for  the  type  to  be  set.  proofread,  and  cor- 
rected as  needed.  The  artwork  for  illustra- 
tions and  designs  to  be  used  throughout  the 
issue  must  be  prepared  for  reproduction 
and  collated  with  the  appropriate  text. 
Next,  the  layout  for  the  issue  must  be  plan- 
ned and  sample  pages  made  up.  The  sam- 
ple pages  in  turn  must  be  proofread  and 
checked  for  details  before  the  printing 
forms  are  prepared.  The  presswork.  cut- 
ting, and  binding  complete  the  production 
process,  but  mailing  labels  must  still  be 
affixed  to  individual  copies  and  the  journal 
distributed  to  subscribers  in  the  time  allot- 
ted for  the  production  process.  Since  most 
journals  have  an  established  publishing 
date  for  each  issue,  the  publisher  also  must 
build  in  a  one-  to  two-week  buffer  time 
period  in  any  or  all  of  these  steps  for  un- 
foreseen delays,  not  the  least  of  which 
might  be  a  labor  strike  by  any  one  or  more 
of  the  service  groups  involved.  Thus,  the 
three-  to  four-month  lead  time  for  the  pub- 
lishing process  is  both  realistic  and  neces- 
sary if  deadline  dates  for  each  step  of  the 
process  are  to  be  met.  But  there  are  other 
reasons  for  publishing  delays  as  well. 

A  successful  journal  usually  has  articles 
scheduled  for  publication  several  issues  in 
advance.  The  final  manuscripts  for  such 
articles  are  held  in  the  publisher's  article 
bank,  and  new  manuscripts  are  scheduled 
in  turn  as  space  becomes  available.  Occa- 


sionally a  particularly  timely  article  may 
be  published  out  of  turn,  but  this  is  seldom 
done,  for  obvious  reasons.  The  publisher's 
authors  are  as  important  to  him  as  are  his 
subscribers,  and  the  author  whose  manu- 
script has  been  waiting  too  long  for  space  is 
likely  to  look  elsewhere  for  a  publisher  for 
the  next  manuscript  developed.  It  will  be 
obvious  to  readers  that  the  publisher  has  a 
substantial  investment  in  his  authors  and 
that  he  is  likely  to  be  more  than  a  little 
anxious  to  accommodate  them  with  the 
earliest  publishing  date  possible.  The 
space  available  in  any  one  issue  of  most 
journals,  however,  is  necessarily  limited 
by  cost  factors  and  a  predetermined  format 
for  the  publication.  Scheduling  an  article 
for  a  specific  issue,  therefore,  may  not  be 
feasible  or  possible  for  several  months 
after  the  final  manuscript  has  been  submit- 
ted, and  the  four-month  lead  time  for  the 
production  process  is  compounded  by  ad- 
ditional delays  in  scheduling  the  article  for 
the  issue  in  which  it  is  to  appear. 

Conclusion 

Is  the  end  result  for  a  writing  project 
worth  the  time  and  effort  involved  —  is  the 
author  compensated  for  his  efforts?  Most 
professional  journals  pay  their  authors  a 
small  honorarium  based  on  a  predeter- 
mined price  per  word  or  printed  page. 
Monetary  compensation  for  authors,  how- 
ever, will  vary  from  journal  to  journal,  and 
the  writer  primarily  interested  in  such 
compensation  is  well  advised  to  inquire 
about  this  matter  prior  to  submitting  a 
manuscript  to  the  publisher  he  has 
.selected. 

Perhaps  in  concluding  this  discussion  a 
better  question  might  be  posed:  Is  the  con- 
siderable time  and  effort  required  of  the 
writer  in  a  publishing  project  justified  for 
the  busy  nurse  in  modern  nursing  prac- 
tice? Undoubtedly  there  are  still  many 
nurses  who  would  say  no.  But  the  nurse 
whose  well-written  and  informative  article 
has  recently  appeared  in  her  professional 
journal  thinks  it  is.  The  editor  and  pub- 
lisher working  with  nursing  manuscripts 
think  it  is.  and  certainly  the  reader  who 
needs  to  know  what  the  nurse  author  has  to 
say  thinks  so  too.  <^ 


THE  CANADIAN  NURSE     27 


The 

Canadian 
Nurse 

50  The  Driveway,  Ottawa  K2P  1E2,  Canada 


^JP 


Information  for  Authors 


Manuscripts 


The  Canadian  Nurse  and  L'infirmiere  canadienne  welcome 
original  manuscripts  that  pertain  to  nursing,  nurses,  or 
related  subjects. 

All  solicited  and  unsolicited  manuscripts  are  reviewed 
by  the  editorial  staff  before  being  accepted  for  publication. 
Criteria  for  selection  include  :  originality;  value  of  informa- 
tion to  readers;  and  presentation.  A  manuscript  accepted 
for  publication  in  The  Canadian  Nurse  is  not  necessarily 
accepted  for  publication  in  L'infirmiere  Canadienne. 

The  editors  reserve  the  right  to  edit  a  manuscript  that 
has  been  accepted  for  publication.  Edited  copy  will  be 
submitted  to  the  author  for  approval  prior  to  publication. 

Procedure  for  Submission  of 
Articles 

Manuscript  should  be  typed  and  double  spaced  on  one  side 
of  the  page  only,  leaving  wide  margins.  Submit  original  copy 
of  manuscript. 

Style  and  Format 

Manuscript  length  should  be  from  1,000  to  2,500  words. 
Insert  short,  descriptive  titles  to  indicate  divisions  in  the 
article.  When  drugs  are  mentioned,  include  generic  and  trade 
names.  A  biographical  sketch  of  the  author  should  accompa- 
ny the  article.  Webster's  3rd  International  Dictionary  and 
Webster's  7th  College  Dictionary  are  used  as  spelling 
references. 

References,  Footnotes,  and 
Bibliography 

References,  footnotes,  and  bibliography  should  be  limited 
28     THE  CANADIAN  NURSE 


to  a  reasonable  number  as  determined  by  the  content  of  thi 
article.  References  to  published  sources  should  be  numberec 
consecutively  in  the  manuscript  and  listed  at  the  end  of  thf 
article.  Information  that  cannot  be  presented  in  forma 
reference  style  should  be  worked  into  the  text  or  referred  t( 
as  a  footnote. 

Bibliography  listings  should  be  unnumbered  and  placec 
in  alphabetical  order.  Space  sometimes  prohibits  publishinj 
bibliography,  especially  a  long  one.  In  this  event,  a  note  i: 
added  at  the  end  of  the  article  stating  the  bibliography  i: 
available  on  request  to  the  editor. 

For  book  references,  list  the  author's  full  name,  boo! 
title  and  edition,  place  of  publication,  publisher,  year  o 
publication,  and  pages  consulted.  For  magazine  references 
list  the  author's  full  name,  title  of  the  article,  title  of  mag 
azine,  volume,  month,  year,  and  pages  consulted. 

Photographs,  Illustrations,  Tables, 
and  Charts 

Photographs  add  interest  to  an  article.  Black  and  whiu 
glossy  prints  are  welcome.  The  size  of  the  photographs  i: 
unimportant,  provided  the  details  are  clear.  Each  photc 
should  be  accompagnied  by  a  full  description,  including 
identification  of  persons.  The  consent  of  persons  photo 
graphed  must  be  secured.  Your  own  organization's  fom 
may  be  used  or  CNA  forms  are  available  on  request. 

Line  drawings  can  be  submitted  in  rough.  If  suitable,  the) 
will  be  redrawn  by  the  journal's  artist. 

Tables  and  charts  should  be  referred  to  in  the  text,  bu 
should  be  self-explanatory.  Figures  on  charts  and  table 
should  be  typed  within  pencil-ruled  columns. 

The  Canadian  Nurse 

OFFICIAL  JOURNAL  OF  THE  CANADIAN  NURSES'  ASSOCIATION 

MARCH  I975I 

i 


CNA  Financial  Statement 


CANADIAN  NURSES'  ASSOCIATION 

STATEMENT  OF  INCOME  AND  SURPLUS 

Year  Ended  December  31,  1974 
(with  comparable  figures  for  year  ended  December  31,  1973) 


X 


1974  1973 


888,904 

$  830.736 

40.820 

43,978 

299,264 

264,594 

8,127 

1 1 ,934 

evenue: 

Membership  fees     $ 

Subscriptions     

Advertising    

Sundry  income    

Government  grant  re  National  Conference  on 

Nurses  for  Community  Service  —  net    —  2,552 

1,237,115  1,153,794 

penditure: 

Operating  expenses: 

Salaries    

Printing  and  publications    

Design  and  graphics      

Postage  on  journal     

Computer  service    

Committee  meetings     

Translation  services     

Commission  on  advertising  sales      

Affiliations  fees  —  I.C.N 

—  Canadian  Council  on  Hospital 

Accreditation     

Professional  services     

Staff  travel     

Office  expense     

Books  and  periodicals     

Legal  and  audit     

Building  services     

Sundry     

Furniture  and  fixtures     

Landscaping  and  improvements     

Insurance      

Depreciation  —  C.N. A.  House      


568.306 

529.808 

222,422 

212.666 

7,943 

11.708 

113,175 

116.170 

25,658 

18.489 

23,176 

21.281 

2,319 

1,309 

20,663 

25,714 

47.130 

40,464 

5,000 

5,000 

9,725 

7,825 

12,061 

16,547 

35,387 

30,574 

6,645 

8,108 

8,747 

5,030 

70,256 

67,974 

5,320 

7,929 

602 

6,970 

948 

345 

367 

— 

31,867 

31,867 

1,217,717  1,165.778 


Non-operating  expenses: 

1974  convention    18.869  — 

Canadian  Nurses"  Foundation  —  administration     1 ,954  4,334 

—  grant  to  Research  Fund      22  2.000 

20.823  6,334 

1,238.540  1,172.112 


Loss  before  items  below     1.425  18,318 

C.N. A.  Testing  Service  —  per  statement     8.693  40,397 

Investment  income    66,475  51,968 

75,168  92,365 


Net  income  for  year 73,743  74,047 

Surplus  at  beginning  of  year    948,074  874,027 

1,021,817  948,074 
Less:  reserved  for  Northwest  Territories  Registered 

Nurses'  Association                                                      15,000                — 

Surplus  at  end  of  year    $1,006,817  $     948,074 

MARCH  1975  THE  CANADIAN  NURSE     29 


CANADIAN  NURSES'  ASSOCIATION 

BALANCE  SHEET 

as  at  December  31,  1974 

(with  comparable  figures  for  year  ended  December  31,  1973) 

ASSETS 


1974 


Current  Assets 

Cash  in  bank     

Short  term  deposits  plus  accrued  interest     .  . .  . 

Accounts  receivable     

Membership  fees  receivable    

Prepaid  expenses    

Sundry  Assets 

Marketable  securities  —  at  cost  (quoted  value 

$9,957;  1973:  $15,170) 

Loans  to  member  nurses  plus  accrued  interest 

Fixed  Assets 

C.N. A.  House  —  land  and  building  —  at  cost 

less  accumulated  depreciation  on  building 
Furniture  and  fixtures  —  at  nominal  value    .  .  . 


$  97.132 

712,593 

51,280 

10,852 

10,292 

882,149 

S  6,85' 

720,461 

47,18- 

16.93( 

9,66( 

801,09: 

3.77' 
6,75' 

3,779 
9,088 

12,867 

10.53f 

519,932 
1 

551,80C 

1 

519,933 
$1,414,949 

551,801 
$1,363.43: 

Approved  on  behalf  on  the  Board: 
HUGUETTE  LABELLE  President 

HELEN  K.  MUSSALLEM  Executive  Director 


30     THE  CANADIAN  NURSE 


i 


CANADIAN  NURSES'  ASSOCIATION 

BALANCE  SHEET 

as  at  December  31,  1974 

(with  comparable  figures  for  year  ended  December  31,  1973) 

LIABILITIES  AND  SURPLUS 

1974  1973 

rent  Liabilities 

Accounts  payable  and  accrued  liabilities    S     20,863  S     23.654 

Deferred  subscription  revenue       27.500  28.000 

48.363  51.654 


jrtgage  Payable  —  6  3/4^^;  due  1976  — 

payable  in  monthly  instalments  of 

$3,548  to  include  principal  and 

interest    344.769  363,704 

;serve  for  support  to  Northwest  Territories 

Registered  Nurses"  Association     15,000  — 

irplus     1,006,817  948.074 

SI, 4 14,949  $1,363,432 


We  have  examined  the  balance  sheet  of  Canadian  Nurses'  Association  as  at  December  31. 
1974.  and  the  statement  of  income  and  surplus  for  the  year  then  ended.  Our  examination 
included  a  general  review  of  the  accounting  procedures  and  such  tests  of  accounting 
records  and  other  supporting  evidence  as  we  considered  necessary  in  the  circumstances. 

In  our  opinion,  these  financial  statements  present  fairly  the  financial  position  of  the 
Association  as  at  December  3 1 ,  1974,  and  the  results  of  its  operations  for  the  year  then 
ended,  in  accordance  with  generally  accepted  accounting  principles  applied  on  a  basis 
consistent  with  that  of  the  preceding  year. 


GEO.  A.  WELCH  &  COMPANY,  OTTAWA, 
CHARTERED  ACCOUNTANTS 
February  3,  1975 


1\RCH  1975  THE  CANADIAN  NURSE     31 


CANADIAN  NURSES'  ASSOCIATION 

BALANCE  SHEET 

as  at  December  31,  1974 

(with  comparable  figures  for  year  ended  December  31,  1973) 

ASSETS 


Current  Assets 

Cash  in  bank     

Short  term  deposits  plus  accrued  interest     .  . .  . 

Accounts  receivable     

Membership  fees  receivable    

Prepaid  expenses    

Sundry  Assets 

Marketable  securities  —  at  cost  (quoted  value 

$9,957;  1973:  $15,170)   

Loans  to  member  nurses  plus  accrued  interest 

Fixed  Assets 

C.N.  A.  House  —  land  and  building  —  at  cost 

less  accumulated  depreciation  on  building 
Furniture  and  fixtures  —  at  nominal  value    . . . 


1974 


$     97.132 

712,593 

51,280 

10,852 

10.292 

882,149 

$     6,85^ 

720.461 

47.18- 

16.931 

9.661 

801.09: 

3,779 
9,088 

3.771 
6.7.V 

12,867 

519,932 
1 

10,538 

551,801 

519.933 
$1,414,949 

551.801 
$1,363.43: 

Approved  on  behalf  on  the  Board: 
HUGUETTE  LABELLE  President 

HELEN  K.  MUSSALLEM  Executive  Director 


30     THE  CANADIAN  NURSE 


CANADIAN  NURSB'  ASSOCIATION 

BALANCE  SHEET 

as  at  December  31,  1974 

(with  comparable  figures  for  year  ended  December  31,  1973) 

LIABILITIES  AND  SURPLUS 

1974  1973 

irrent  Liabilities 

Accounts  payable  and  accrued  liabilities    S     20,863  S     23.654 

Deferred  subscription  revenue       27.500  28.000 

48.363  51.654 


Ktgage  Payable  —  6  3/4't  due  1976  — 
payable  in  monthly  instalments  of 
$3,548  to  include  principal  and 
interest    344,769  363,704 

iserve  for  support  to  Northwest  Territories 

Registered  Nurses'  Association     1 5,000  — 

irplus     1.006.817  948.074 

SI. 4 14,949  $1,363,432 


We  have  examined  the  balance  sheet  of  Canadian  Nurses"  Association  as  at  December  31 . 
1974.  and  the  statement  of  income  and  surplus  for  the  year  then  ended.  Our  examination 
included  a  general  review  of  the  accounting  procedures  and  such  tests  of  accounting 
records  and  other  supporting  evidence  as  we  considered  necessary  in  the  circumstances. 

In  our  opinion,  these  financial  statements  present  fairly  the  financial  position  of  the 
Association  as  at  December  3 1 .  1974.  and  the  results  of  its  operations  for  the  year  then 
ended,  in  accordance  with  generally  accepted  accounting  principles  applied  on  a  basis 
consistent  with  that  of  the  preceding  year. 


GEO.  A.  WELCH  &  COMPANY.  OTTAWA. 
CHARTERED  ACCOUNTANTS 

February  3,  1975 


1ARCH  1975  THE  CANADIAN  NURSE     31 


CANADIAN  NURSES'  ASSOCIATION  TESTING  SERVICE 

STATEMENT  OF  INCOME  AND  SURPLUS 

Year  ended  December  31,  1974 

(with  comparable  figures  for  year  ended  December  31,  1973) 


Revenue: 

Examination  fees    

Interest  earned    

Expenditure: 

Salaries      

Board  and  committee  meetings     . .  .  . 

Item  writing    

Operations  (data  processing,  printing, 

warehousing)     

Consultants     

Rent     

Translation    

Office  supplies  and  stationery     

Postage  and  express     

Telephone  and  telegraph    

Staff  travel    

Equipment  maintenance  and  rental 

Books  and  periodicals    

Furniture  and  fixtures    

Miscellaneous     

Net  income  for  year     


1974 

197 

$303,703 

$287,95 

5,691 

2,8' 

309,394 

290.84 

142,656 

115,4^ 

37,834 

26,0 

19,123 

18,8: 

70,326 

62,9 

— 

4: 

7,869 

7,8( 

705 

3,3' 

4,765 

3,8. 

2,472 

3,9' 

2,737 

2,4 

1,628 

2,2( 

866 

1,0! 

467 

7: 

7,700 

- 

1,553 

1,2. 

300,701 

250,4 

$  8,693 

$  40,3' 

32     THE  CANADIAN  NURSE 


control: 


cigarettes  &  calorie 


The  key  to  prevention  of  weight  gain  when  you  stop  smoking  is  careful  monitoring 
of  calorie  levels.  The  author  warns:  make  sure  you  don't  increase  food 
consumption  to  make  up  for  cigarettes. 


Diane  Birch 


).  you  want  to  stop  smoking,  but  you 
)n't  want  to  get  fat.  Many  smokers  hide 
:hind  the  idea  that,  if  they  give  up 
noking,  they  will  gain  weight,  which  is 
st  as  bad  for  them.  But  it  is  estimated 
ai  smoking  20  cigarettes  daily  is  as  hard 
1  your  body  as  being  100  pounds 
,/erweight! 
For  ex-smokers,  the  key  to  prevention 
weight  gain  is  careful  monitoring  of 
dorie  levels;  make  sure  you  don't 
1  crease  food  consumption  to  make  up  for 
Igarettes.  Most  smokers  who  give  up  the 
ibit  find  themselves  battling  not  only  the 
-sire  to  smoke  but  a  powerful  desire  to 
It.  Here  is  a  5-step  approach  to  weight 
Imtrol  for  those  who  want  to  stop 
noking  without  gaining  weight. 

ep  1 :  Analyze  your  body 

I  The  body  is  so  individual  that  it  is 
ifficult  to  establish  a  ■"right"  size  for 
host  people.  Calipers  are  probably  the 
lost  careful  way  of  determining  your 
egree  of  fatness.  These  tools  to  measure 
'  dy  fat  are  generally  available  in  univer- 
ties,  YM  and  YWCAs.  and  health 
udios. 

It  is  also  necessary  to  examine  your 
ody  build.  The  stocky  muscular 
nesomorph  will  never  be  a  slender,  bony, 
ctomorph,  nor  will  the  rounded,  plump 
■URCH  1975 


endomorph  ever  achieve  ectomorphic 
status.  Nothing  short  of  actual  starvation 
will  achieve  such  drastic  changes;  even 
then,  body  build  will  remain  the  same.  In 
working  with  overweight  persons,  I  have 
often  found  that  their  goal  was  unrealis- 
tic. Sophia  Loren  could  never  resemble 
Cher  Bono,  despite  all  the  diets  in  the 
world.  Be  realistic  in  your  weight  evalua- 
tion. 

Figure  /  is  a  chart  of  approximate 
desirable  weights.  A  quick  rule  of  thumb 
in  determining  frame  size  for  women  is  to 
measure  your  wrist.  Six  to  six  and 
one-half  inches  is  average;  below  that, 
small;  and  above  that,  large.  The  height  is 
in  2-inch  heels.  The  weight  is  with 
clothes.  Perhaps  an  even  better  way  to 
judge  ideal  weight  is  to  recall  the  weight 
at  which  you  felt  most  comfortable  in  the 
past. 


Diane  Birch  (B.Sc.  (nutrition).  Marianofxilis 
College.  University  of  Montreal:  R.P.Dt.)  has 
worked  as  a  therapeutic  dietitian  at  Ottawa 
General  Hospital,  and  nutritionist  for  the 
Eastern  region  of  the  Milk  Foundation  of 
Ontario  and  for  the  Ottawa  Carleton  Regional 
Area  Health  Unit.  She  is  presently  a  free-lance 
nutritionist  carrying  out  several  community 
projects  in  the  Ottawa  area. 


Now  that  you  have  a  good  idea  of 
yourself,  start  asking  yourself  how  you 
look  to  the  world.  Are  you  overweight, 
living  only  to  eat?  Or  perhaps  you  had  no 
weight  problem  while  you  were  smoking. 
Do  you  remain  sleek  and  slender  while 
munching  a  chocolate  bar  or  gain  pounds 
just  passing  the  cake  counter?  With  this  in 
mind,  place  yourself  on  the  following 
vertical  axis. 


Step  2:  Analyze  your  food  personality 

Are  you  a  junk  food  fan  who  would 
rather  have  dessert  than  dinner,  or  french 
fries  and  a  cola  rather  than  a  well- 
balanced  meal?   Are  you  an  individual 

THE  CANADIAN  NURSE     33 


who  must  have  nulritious  meals  and 
snacks,  never  skipping  breakfast,  drink- 
ing soft  drinks  or  eating  chocolate  bars? 
Place  yourself  on  the  fitllowing  horizontal 
axis. 


Eat 

V 

Junk 

A 

Well 

F(H)d 

Step  3 :  Find  your  partner 

Place  the  twii  axes  together  and  find 
your  quadrant. 


Have  several  friends  go  through  Steps 
1  and  2,  and  find  a  partner  in  the  same 
area  of  the  quadrant  in  which  you  fall. 
Now  you  can  really  help  each  other. 
There  is  nothing  quite  as  fnistraiing  as 
trying  to  lose  weight  with  someone  who  is 
in  a  different  quadrant.  Junk  (ood  eaters 
may  dislike  the  pious  attitudes  of  those 
who  eat  well;  a  fat  person  is  upset  by  the 
slim  ones  who  claim  to  need  diet  help. 

The  slim  ex-smoker,  who  eats  a  ehoco- 
34     THE  CANADIAN  NURSE 


late  bar  and  enjoys  it.  assumes  that  the  fat 
ex-smoker  should  not  want  a  chocolate 
bar  and,  above  all,  should  not  break  down 
and  eat  it.  The  key  concept  in  this  buddy 
system  is  empathy  and  total  understand- 
ing. '"Slim"  will  never  understand  the 
temptation  "Fat"  is  facing  or  the  hunger 
she  feels. 

Step  4 :  Find  your  calorie  needs 

Why  do  smokers  who  kick  the  habit 
gain  weight?  Why  do  individuals  claim 
that  they  eat  the  way  they  have  for  years 
and  yet  are  now  gaining  weight?  A 
smoker  who  adds  even  one  apple  per  day. 
to  compensate  for  the  change  in  smoking 
habit,  is  adding  70  calories  per  day.  In  50 
days,  this  adds  up  to  35(X)  calories  and 
becomes  one  extra  pound  of  body  weight. 

Five  candies  per  day  add  up  to  100 
extra  calories:  a  gain  of  one  pound  per 
month,  12  pounds  a  year.  If  an  ex-smoker 
who  is  gaining  weight  eliminates  the 
apple  at  70  calories,  then  she  stops 
gaining  and  maintains  her  present  weight. 
To  elicit  a  weight  loss,  another  70 
calories  must  be  eliminated.  It  is  twice  as 
hard  to  lose  weight  as  it  is  to  gain  it! 

No  particular  calorie  level  will  guaran- 
tee to  reduce  weight.  The  calories  needed 
for  each  individual  vary  greatly.  A  quick 
rule  of  thumb  is  to  establish  your  basal 
metabolic  needs. 

Multiply  your  present  weight  by  1 1 
and,  if  a  woman,  decrease  this  by  10  per 
cent.  This  is  the  number  of  calories 
required  just  to  maintain  normal  body 
function.  Men  have  higher  basal 
metabolic  needs  than  women,  due  to  their 
greater  amount  of  muscle  tissue.  Mus- 
cles hum  more  energy  than  do  fat  cells. 

If  you  are  in  gotxl  physical  condition, 
you  burn  up  calories  more  quickly.  This 
is  why  exercise  is  imperative  for  the 
dieter.  As  we  age,  we  require  less,  so  cut 
5  calories  for  each  year  from  25  to  45, 
then  1 5  calories  for  each  year  up  to  65 . 
Men  must  take  off  10  calories  for  each 
year  over  25 . 

Now  add  calories  according  to  activity 
level:  .^O*^  if  you  are  sedentary;  50'7f  for 
light  work;  7595-  for  moderate  work;  and 


lOO^f  for  strenuous  work.  Most  peopi 
fall  into  the  light  work  or  totally  sedcntar, 
category.  Do  not  fool  yourself  int 
thinking  you  do  moderate  activities  unie? 
you  spade  the  garden  weekly  or  polis 
floors  a  couple  of  times  per  week.  Sittin 
at  the  main  desk  or  taking  temperatures 
light  work.  Lifting  patients  is  moderai 
activity. 


Now  calculate  your  needs,  tollowir 
this  example. 

Jane  Jones  ST 'tall  1 25  lbs      ^ 

37  years  old     light  activity 

125  lbs.  X  11  =  1375 
minus  10%  137 


1238  calories 

decrease  by  1 2  years  x  5  calories 
=      60  calories 


Add  507f  for 
activity 


1 1 78  calories 
589  calories 


Total  need  —         1767  calories 

To  reduce  10  lbs.  in  10  weeks  or  1 
per  week  she  needs  500  fewer  calories  p 
day. 

1767 
-  500 


1 267 is  Jane's  reducin 


level. 


Some  people  claim  to  gain  on  anythin 
over  800  calories.  Probably  they  don 
really  see  what  they  are  eating:  they  ma 
also  rely  on  caloric  tables  that  are  plus  i 
m  i  n  us  1 0  perce  nt  correct .  | 

In  addition,  one  portion  of  meal  in 
caloric  table  is  3  to  4  ounces.  One  portir 
to  an  individual  may  mean    12  ounce 
Restaurants  usually  overfeed  us,  and 
steak  may  be  10  or  12  ounces,  which 

MARCH  197 


Hid  1,000  calories.  One  restaurant 
nam's  hamburger  has  1.000  calories  by 
self. 

tep5:  Start  losing 

]  For  3  days,  eat  normally  and  record  all 
ic  food  you  eat. 

Analyze  the  record  to  determine  where 
can  cut  calories. 
^  IJiminate  only  the  determined  number 
f  calories;  everything  else  should  remain 
le  same. 

J  Develop  a  pattern  of  eating  at  regular 
nervals  with  the  same  basic  foods 
uiuded,  for  instance,  a  sandwich  and 
lilk  every  day  at  lunch.  (This  makes  it 
asier  to  be  sure  of  your  approximate 
itake.) 

H  Do  not  count  calories  daily. 
]  Do  not  weigh  yourself  daily.   Daily 

lings  only  exhibit  water  loss,  not  fat 
Weighing  yourself  once  a  week  is 
iufficient. 

11  Increase  energy  expenditure  by  walk- 
ni:  20  minutes  extra  per  day  or  increase 
xercise  or  sport  activity.  Don't  overdo 
he  exercise  or  you  will  be  ravenously 
iungry. 

'^  If  you   are   consuming   under    1,500  ' 
ilories  per  day,   use  a  good  multiple 
iiin   and    mineral    preparation;    it   is 

iicult  to  consume  all  the  necessary 
iiamins  and  minerals  in  less  than  1,500 
alories. 

Keep  in  constant  touch  with  your  diet 
lanner  (Step  3)  and  seek  his/her  help 
viore  it's  too  late. 

Remember  this  technique  leads  to  a 
u'w.  steady  weight  loss.  Great  losses  are 
lien  due  to  water  loss.  You  should  lose  1 
o  2  pounds  each  week. 

lummary 

The  5  steps  to  control  weight  gain 
A  hen  you  stop  smoking  are:  define  your 
x'Jy  type,  analyze  your  food  personality, 
ind  a  diet  partner,  identify  your  caloric 
lecds,  and  lose  the  desired  weight.         'i^ 


FIGURE  I 
Desirable  Weights  for  Persons  Aged  25  or  Over 

Women  * 


Height 

Small 

Medium 

Large 

(with  shoes  on)                 Frame                         Frame                         Frame 

2-inch  heels 

Feet        Inches 

4              10 

-1 

92—  98         r 

"1        96     107 

~ 

104—119 

4              11 

94—101 

98     110 

106     122 

5                0 

96—104 

101-113 

109—125 

5                1 

99     107 

104—116 

112—128 

5                2 

102—110 

107-119 

115      131 

5                 3 

105—113 

110—122 

118     134 

5                 4 

108—116 

113—126 

121—138 

5                 5 

111-119 

116—130 

125      142 

5                6 

114—123 

120—135 

129—146 

5                7 

118     127 

124—139 

133      150 

5                8 

122—131 

128—143 

137—154 

5                9 

126—135 

132—147 

141—158 

5              10 

130     140 

136^151 

145—163 

5              11 

134_144 

140—155 

149—168 

6                0 

138—148 

144—159 

153      173 

Men 


Height 

Small 

Medium 

Large 

(with  shoes  on)                 Frame                         Frame                         Frame 

1-inch  heels 

Feet        Inches 

5                2 

112-120 

— 

118—129 

- 

126—141 

5                3 

115     123 

121  —  133 

129     144 

5                4 

118     126 

124     136 

132—148 

5                5 

121—129 

127—139 

135     152 

5                6 

124—133 

130     143 

138     156 

5                 7 

128—137 

134—147 

142—161 

5                 8 

132—141 

138—152 

147—166 

5                9 

136—145 

142-156 

151—170 

5              10 

140—150 

146^160 

155     174 

5              11 

144—154 

150—165 

159     179 

6                0 

148     158 

1 54     1 70 

164—184 

6                1 

152—162 

15&— 175 

168     189 

6                 2 

156—167 

162—180 

173      194 

6                 3 

160     171 

167—185 

178—199 

6                 4 

164—175 

172—190 

182—204 

*  For  women  between  1 8  and  25,  subtract  one  pound  for  every  year  under  25. 
1    (Reprinted  with  permission  from  the  Metropolitan  Life  Insurance  Company.) 


HARCH  1975 


THE  CANADIAN  NURSE     35 


The  i 

administrator; 

the  real^  the  ideal 


This  article  is  translated  and  adapted  from  an  address  presented  by  the  author  t( 
the  annual  meeting  of  the  Association  of  Health  and  Social  Service  Administrator 
of  Quebec.  She  describes  how  nurses  perceive  the  administrator  and  what  rol 
they  expect  him  to  play. 


Rachel  Bureau 

Of  the  nearly  20.000  male  and  female 
nurses  currently  practicing  in  Quebec  hos- 
pitals, all  have  their  own  perception  of  the 
role  of  the  hospital  administrator,  and  have 
definite  expectations  of  him/her. 

When  visiting  nurses  in  the  s.iiious  re- 
gions of  the  province.  1  questioned  ihcni  on 
their  perceptions  of  the  role  of  the  admin- 
istrator. Sonic  of  their  comments  v^crc: 

•  The  administrator  is  an  important  and 
remote  person. 

•  The  administrator  has  to  be  fair  in  select- 
ing priorities. 

•  The  administrator  is  important  for  nurs- 
ing. 

•  The  administrator,  in  spite  of  his 
numerous  functions,  is  concerned  with  the 
ordinary  employee. 

•  The  administrator  is  a  person  who.  too 
often,  works  for  the  gallery  —  for  pres- 
tige. 

•  The  administrator?  I  don't  know  the  per- 
son. 


Rachel  Bureau  (R.N.,  Hopital  St.  Frun(,ois 
d" Assi.se,  Quebec)  is  public  health  nurse 
educator  with  the  Quebec  Christmas  Seal  Soci- 
ety, Inc.  and  was  president  of  the  Order  of 
Nurses  of  Quebec  1971-4. 


36     THE  CANADIAN  NURSE 


These  diversities  in  perception  could,  i 
many  instances,  be  due  to  the  personalit 
of  the  administrator.  I  should  like  to  shar 
certain  themes  that  recurred  during  thes 
conversations. 

An  ear  less  than  attentive 

First,  the  ears  of  the  administrator  ar 
not  always  as  responsive  to  the  requests  o 
the  nursing  staff  as  to  those  of  the  physi 
cians  or  the  "big  boss,"  the  Quebec  De 
partment  of  Social  Affairs.  Many  illustra 
tions  of  this  were  related  to  me. 

For  example,  in  some  institutions  i 
seems  almost  impossible  for  a  nurse  to  ge 
an  appointment  with  the  administrator  h 
discuss  an  important  subject,  yet  it  appear 
to  be  easy  enough  for  a  physician  to  do  so. 

In  the  case  of  research  projects,  it  wouK 
seem  that  medicine  has  priority  when  i| 
comes  to  available  resources.  Nurse 
rarely  benefit  from  such  funds,  evei 
though,  more  and  more,  they  want  to  un 
dertake  the  research  that  must  be  done  ii 
improve  quality  of  nursing  care.  Perhap 
this  is  the  field  where  the  ear  of  the  ad 
ministrator  is  least  attentive. 

The  competition,  if  indeed  it  exists,  i 
an  unequal  one.  On  the  one  hand,  physi 
cians  can  threaten  to  leave  if  they  do  no 

MARCH  197  1 


in  their  case.   On  the  other,  salaried 

urses.  unaccustomed  to  such  tactics,  cannot 

,1  the  same  to  defend  their  rights.  This  is 

^  here  the  administrator's  ability  to  be  im- 

nial  is  so  important. 

ietvveen  budget  and  patient  care 

Another  source  of  irritation,  perhaps  a 

lor  one.  exists,  and  it  is  one  that  the 

.Jministrator  cannot  avoid.  For  nurses. 

he  budget  seems  too  often  to  have  prece- 

Icnce  overthe  care  of  the  sick.  They  find  it 

litficult  to  accept  the  budget  as  a  reason 

or  refusing  to  hire  enough  competent  staff 

o  meet  the  needs  of  patients,  or  for  not 

^mining  appropriate  material  to  facilitate 

;r  work  (even  to  such  a  small  item  as  an 

V trie  fan  for  a  nursing  station  where  the 

ii  is  unbearable).  On  the  other  hand. 

.\(uipment    worth   thousands   of  dollars 

lids  idle  every  day. 

\nother  pxjint  having  to  do  with   fi- 
ices  frustrates  members  of  the  nursing 
tession.  This  is  the  difficulty  some  of 
n  have  in  being  released  from  work  to 
panicipate  in  professional  activities  of  the 
'Order  of  Nurses  of  Quebec  or  to  attend 
professional  seminars.  Nurses  do  not  wish 
to  be  cloistered:  they  want  to  keep  up-to- 
date  and  acquire  new  knowledge.  To  do 
^o.  they  have  to  get  approval  from  their 
employer  who.  unfortunately,  does  not 
always  see  merit  in  their  case. 

I  believe  that  nurses  want  more  than 

an\  thing  else  to  have  the  administrator  un- 

^'Jcrstand  the  area  of  expertise  of  each 

health  professional  and  to  ensure  that  each 

respects  the  independence  of  the  other. 

Nursing  service  director  expects. . . 

The  nurse  with  the  most  realistic  percep- 
;ion  and  the  most  clear-cut  expectations  of 
the  administrator  is  the  director  of  nursing 
^ersices.  She  administers  a  service  repres- 
enting about  70  percent  of  all  staff  in  a 
hospital  center,  which  includes  almost  85 
percent  of  the  professionals  who  work 
there. 

The  director  of  nursing  services  has 
high  expectations  of  the  administrator  — 
perhaps  even  wishes  he  were  a  superman! 
She  would  like  to  be  assured  of  his  "'pres- 
ence" in  temis  of  both  quantity  and  qual- 
!i> ,  and  of  his  awareness  of  the  problems 
MARCH  1975 


that  confront  her  daily.  For  example,  in 
institutions  with  no  interns,  residents,  or 
doctors  on  call,  nurses  are  obliged  to  make 
medical  decisions  in  certain  situations 
where  it  is  impossible  to  reach  a  physician . 

In  too  many  institutions,  the  nurse  must 
fill  the  role  of  pharmacist  after  5:00  P.M.  or 
on  weekends.  If  she  were  to  make  a  mis- 
take, where  would  the  responsibility  lie? 

Quite  often,  too.  a  nurse  is  confronted 
with  the  following  dilemma  after 
5:00  P.M.:  to  do  either  the  work  of  a  dieti- 
tian, a  physiotherapist,  or  an  inhalation 
therapist,  or  to  penalize  the  patient. 

The  supervising  nurse  sometimes  ad- 
mits patients  in  the  evenings  or  at  night  and 
even  has  to  look  for  a  chart  in  the  record 
room.  This  basic  nursing  dilemma  is  dealt 
w  ith  b\  Mar\  Brackett.'  who  speaks  of  the 
overavailability  of  the  nurse. 

The  nursing  service  is  fortunate  if  it 
dc^s  not  have  to  plug  a  leaking  pipe  or 
keep  poorly  operating  heating  equipment 
functioning  after  regular  office  hours. 
These  are  minor,  everyday  problems,  yet 
they  often  prevent  members  of  the  nursing 
profession  from  fulfilling  their  real  func- 
tion of  restoring  the  sick  person  to  the 
condition  where  nature  can  do  its 
work.-^ 

A  presence  that  seems  to  hover  some- 
where between  nursing  service  and  the 
administrator  is  the  provincial  department 
of  social  affairs.  The  administrator  who 
waits  too  long  for  direction  from  that  de- 
partment before  acting  seems  too  indeci- 
sive. He  should  be  more  independent 
where  the  welfare  of  the  sick  is  concerned. 

The  members  of  the  nursing  profession 
expect  even  more  of  the  administrator. 
They  want  the  administrator,  who  under- 
stands the  real  role  of  the  director  of  nurs- 
ing services,  to  have  the  department  of 
social  affairs  make  her  salary  match  those 
of  other  directors.  Naturally,  it  would  not 
be  a  question  of  a  salary  matching  that  of 
the  medical  director! 

Could  it  be  that,  in  spite  of  equal  compe- 
tence and  often  heavier  responsibilities 
than  those  of  other  directors,  the  director 
of  nursing  services  earns  a  salary  lower 
than  theirs  because  of  the  female  character 
of  the  profession? 

Above  all ,  the  director  of  nursing  wants 


the  administrator  to  be  a  real  head:  one 
who  plans,  directs,  and  controls  the  work 
of  his  subordinates,  and  who  has  the 
capacity  to  motivate  the  management 
team . 

If  the  director  of  nursing  services  ex- 
pects all  these  talents  in  one  person,  she  is 
also  conscious  of  the  heavy  respon- 
sibilities placed  on  the  administrator.  His 
most  faithful  colleague  probably  is  the  di- 
rector of  nursing  services,  for  her  attention 
most  directly  focuses  on  the  ultimate  goal 
of  the  institution.  She  has  no  ambitions  to 
take  his  place  but,  rather,  wants  to  become 
a  full  partner  in  the  management  team. 

Administrators  should  be  alert  to  prob- 
lems that  may  arise  concerning  acts  dele- 
gated to  members  of  the  nursing  profes- 
sion by  the  Professional  Corporation  of 
Physicians  of  Quebec.  Physicians  and 
nurses  have  worked  together  for  several 
months  to  establ  ish  a  1  ist  of  these  acts ,  and 
they  have  succeeded  in  defining  the  area  of 
independence  and  competence  of  the  pro- 
fessions concerned. 

In  summary,  nurses  expect  the  hospital 
administrator  to  be  responsive  to  the  needs 
of  all  his  employees.  He  should  be: 
«  a  leader  who  is  receptive  to  the  express- 
ed needs  of  nursing  staff: 

•  a  negotiator  on  their  behalf  with  the  de- 
partment of  social  affairs  and  the  board  of 
directors; 

•  an  arbitrator  between  the  nursing  and 
medical  professions:  and 

•  an  informed  spokesman  for  nursing  in 
the  multidisciplinary  and  administrative 
communications  network. 

References 

1 .  Brackett,  Mary  E.  The  nursing  priority  in 
the  hospital  nurse's  role.  In  National 
League  for  Nursing.  Dept.  of  Hospital 
Nursing.  Blueprint  for  progress  in  hospital 
nursing.  Proceedings  of  the  1962  Regional 
conferences  sponsored  by  the  Dept.  of  Hos- 
pital Nursing.  .National  League  for  Nursing 
and  the  Regional  Councils  of  State  Leagues 
for  Nursinc.  New  ^'ork.  el%3.  p.  2,^-7. 

2.  Nightingale.  Rorence.  Notes  on  nursing: 
what  it  is.  and  what  it  is  not.  I  ed.  London, 
Harrison.  1859.  ■£; 


THE  CANADIAN  NURSE     37 


I  can't  quit  now! 


In  a  matter  of  life  and  death,  it  may  already  be  too  late  to  help.  Resuscitation  may  be  futile.  The 
author  shares  her  sense  of  frustration  and  futility  with  those  who  may  face  a  similar  situation. 

Carolyn  C.  Kiute 


This  personal  experience  deals  with  the 
attempted  resuscitation  of  a  person  very 
close  to  me  and  my  reactions  and  feelings, 
as  a  human  being  and  as  a  nurse,  during 
and  after  the  crisis.  In  recounting  it.  I  hcipe 
to  show  others  the  feelings  of  inadequacy, 
the  indecision,  and  ambivalence  as- 
sociated with  facing  a  medical  crisis  with  a 
loved  one. 

My  life  changed  so  abruptly  and  com- 
pletely that  I  doubt  1  will  be  able  to  forget 
that  day.  which  started  off  as  a  very  happy 
one  in  our  lives.  .My  fiance  and  !  had  just 
bought  a  small  cabin  in  the  woods  of 
northern  Quebec.  We  had  spent  this  day 
clearing  the  land  and  planning  our  future. 
We  were  working  deep  in  the  bush,  with 
no  other  person  within  miles.  There  was  a 
magnificent  sense  of  togetherness  between 
John  and  me.  and  between  us  and  nature. 

I  can  remember  how  delighted  John  was 
at  my  exuberance  when  I  was  chopping 
down  my  first  tree.  It  was  an  experience  1 
had  never  had  in  New  York,  and  I  was 
thrilled.  We  spent  long  hours  that  day 
chopping  down  trees  and  cutting  down  the 
overgrown,  waist-high  weeds.  Finally,  we 
took  a  coffee  break,  during  which  we  dis- 
cussed our  many  plans  for  our  hideaway  in 
the  woods. 

I  was  physically  exhausted  and  sug- 
gested that  we  quit.  John  wouldn't  hear  of 
it.  1  can  remember  him  saying  that  we  had 
to  do  as  much  as  possible  before  winter 
settled  in.  Those  were  John's  last  words. 

After  a  few  minutes,  I  felt  guilty  about 


Carolyn  G.  Klutc  (R.N.,  Jersey  City  Medical 
Center  Hospital  school  of  nursing.  Jersey  City, 
N.J.;  B.S..  Richmond  College.  Staten  Island. 
N.Y.)  is  employed  at  Mount  Sinai  Hospital. 
Ste.  Agathe.  Quebec. 
38    THE  CANADIAN  NURSE 


resting  while  he  was  working,  so  I  forced 
myself  to  gii  back  to  work.  I  waved  to  him 
as  I  came  out  of  the  cabin.  I  wanted  him  to 
know  I  wasn't  a  quitter.  John  was  cutting 
down  the  weeds  on  the  far  side  of  the  cabin 
with  a  scythe.  He  smiled  and  waved  back. 
He  uas  happy  that  I  wasn't  quitting. 

I  set  to  work  chopping  a  path  to  the 
outhouse  on  the  near  side  of  the  cabin.  It 
was  so  peaceful  and  silent  —  all  1  could 
hear  was  the  sound  of  my  clippers  and  the 
swish  of  his  scythe. 

Premonition 

Less  than  five  minutes  later.  1  had  an 
inexplicably  bad  feeling.  I  didn't  know 
what  was  wrong,  but  somehow  I  knew  that 
something  was. 

I  dropped  my  clippers  and  ran  to  the 
other  side  of  the  cabin.  I  saw  a  flash  of 
John's  red  shirt  on  the  ground.  I  called 
him.  He  didn't  answer. 

Initially.  I  was  terrified.  What  had  hap- 
pened? Had  be  been  attacked  by  a  wild 
animal,  shot  by  a  hunter.  .  .'.'  I  could  feel 
my  heart  beating  very  hard  and  fast  as  I  ran 
to  John.  He  was  just  lying  there  with  one 
hand  still  gripping  the  scythe.  A/v  God.  no 
— he's  dead!  It  can't  he.  I  Just  saw  him  five 
minutes  ago.  and  he  was  fine.  Now  he's 
dead'.'  This  can '  I  happen  to  John .  not  to  my 
John . 

In  an  instant,  I  was  kneeling  beside  him, 
feeling  for  a  pulse,  looking  at  his  dilated 
pupils.  Cardiac  arrest! 

The  nurse  in  me  took  over  without  my 
having  to  think  about  it.  A  sharp  blow  to 
the  chest,  tilt  the  head  back,  pinch  the 
nostrils,  two  quick  breaths,  begin  cardiac 
compression.  Repeat  cycle. 

On  the  first  cardiac  compression  I  felt 
the  sickening  crack  of  ribs  breaking.  Calm 
down,  get  hold  of  yourself .  You  must  keep 


your,  mind  thinking  clearly  —  John  neec 
your  help.  The  cracking  ribs  unnerved  mil 
more  than  it  should  have .  Shortly  after  th  ' 
it  hit  me  —  what  really  was  happening 

There  I  was,  alone,  miles  from  m 
where,  trying  to  save  John's  life  with  noth 
ing  but  my  two  hands  and  my  breat^ 
How  I  wished  we  were  in  a  coronary  cai 
unit,  instead  of  here  in  the  woods.  Th 
desperation  of  the  situation  broke  dow 
my  defenses.  I  started  to  cry.  to  sob  i 
between  breathing  for  John.  I  kept  vvorl- 
ing.  and  tried  to  think  clearly.  j 

What  was  the  proper  ratio,  anyway'?  ■ 
couldn't  remember  for  sure.  I  had  alwa\ 
resuscitated  with  a  team,  but  soniewhert 
sometime.  I  had  learned  the  compressioi 
respiration  ratio  for  one  person  workin 
alone.  I  decided  on  5: 1.  and  stayed  wit 
that;  at  least.  I  think  I  did. 

Ten  minutes  passed.  Why  wasn't  he  ri 
sponding  yet?  Could  he  still  hear  me.' 
kept  calling  him.  begging  him  to  wake  up 
Please.  John,  please  wake  up.  There  j 
was.  an  experienced,  crisis-orienteij 
nurse,  and  I  could  not  comprehend  wha 
was  happening.  I  had  seen  death  .so  man'j 
times;  but  when  I  saw  it  that  day.  I  couldn' 
and  wouldn't  accept  it.  Prett}-  soon,  he't 
come  around.  I  know  he  will.  Have  to  keef 
trying.  I  can't  quit  now. 

By  now .  I  had  worked  up  a  good  sweat 
It  was  getting  cold  and  starting  to  drizzlei 
In  between  breaths.  I  had  been  screaming 
for  help.  There' s  no  one  within  miles,  hon 
can  anyone  hear  me '.'  What  if  no  one  comes 
until  tomorrow'.'  Should  1  stop'^  Can  i 
really  let  John  die?  What  if  he  lives  ana 
he's  nothing  more  than  a  vegetable'.'  Oh 
God.  .wmeone,  please  hear  me! 

A  thousand  thoughts  and  questions 
raced  through  my  mind.  I  was  losing  con- 
trol of  my.self.  1  went  on  like  this  for  nearly 

MARCH  1975 


hour.  1  guess.  I  had  not  been  able  to 
0  the  decision  that  John's  life  had 
.J  here  and  now.  I  could  not  be  the 


lelp  at  last 

I  Finally.  I  heard  the  sound  of  a  car  ap- 

iching  from  a  distance.  I  intensified 

^creams.  Help  is  coming  —  now  we 

^aveJohn.  As  the  sound  drew  closer.  I 

.u  I  had  been  heard. 

Next.  I  saw  tv\o  young  men  running  up 

c  hill  to  vshere  we  were.  I  screamed  to 

em  that  John  had  had  a  cardiac  arrest  and 

please  help  me.  The  young  men  neither 

loke  nor  understood  English,  and  my 

louiedge    of   French    was    limited.    I 

anted  them  to  take  over,  to  help  me,  but 

,\\  Just  stood  there  looking  at  this  hyster- 

i!  girl  working  on  a  dead  man.  Right 

^ .  I  knew  they  couldn't  help,  so  I  beg- 

...  them  to  get  a  doctor.  One  stayed,  one 

■fi. 

In  my  limited  French.  I  told  this  young 

I  an  how  to  do  artifical  respiration  while  I 

iJ  cardiac  massage.  He  tried,  but  he  sim- 

i\  had  no  idea.  It  wasn't  effective  —  the 

hcsi  wasn't  rising.  I  shoved  him  out  of  the 

a\  and  took  over  again.  1  didn't  even 

pologize  for  my  rudeness.  After  all.  he 

.1^  trying.  He  stepped  back  and  watched. 

eelmg.  I'm  sure,  completely  inadequate. 

Perhaps   15  minutes  later,  the  ambul- 

nct  came.  I  saw  three  men  running  up  the 

nil.  one  carrying  a  small  oxygen  tank. 

hank  God,  now  I  have  help.  Now  it  will 

i  alright.  Again.  I  wanted  these  people  to 

ake  over,  but  1  said  nothing. 

1  kept  working.  I  watched  one  man  slap 
he  oxygen  mask  over  John's  face.  Don't 
hcv  know  anything?  What  good  will  that 
>  he's  not  breathing  or  circulating?  I 
^eiit  back  to  work  —  now  close  to  being 
iN'Nterical.  but  1  didn't  have  the  time  for 
hat  1  kept  on  resuscitating,  while  two  of 
he  men  got  the  stretcher.  As  well  as  I 
-ould.  I  kept  working  as  we  moved  slowly 
Jown  the  hill. 

The  driver,  who,  fortunately,  spoke 
Hnglish,  told  me  to  get  in  the  front.  I  did. 
The  other  man  got  in  the  back  with  John.  I 
:hi>ught  he  would  now  take  over,  but  I 
li'oked  and  he  was  doing  nothing.  I  begged 
hini  to  please  breathe  for  John  —  please. 
So  he  did.  Then  1  begged  him  to  do  cardiac 
massage.  I  don't  know  what  ratio  he  was 
uMng,  if  any.  Could  it  be,  as  it  seemed, 
ih at  he  had  never  done  this  before? 
\1ARCH  1975 


Thank  God,  there's  the  hospital.  Now, 
finally,  we  can  save  John.  The  code  team 
will  he  waiting  —  defibrillator.  IV,  ad- 
renalin, endotracheal  tube,  monitor  — fi- 
nally, we'll  have  it  all.  We  rolled  the 
stretcher  into  the  hospital  —  I  kept  on 
resuscitating  as  we  went.  We  went  to  an 
elevator  and  stopped.  An  elevator!  What 
for?  Weren't  all  emergency  rooms  on  the 
ground  floor?  Not  this  one.  (I  later  learned 
it  was  a  psychiatric  hospital.) 

V^earr'ived.  Hang  on,  John,  it's  O.K.  — 
we're  here.  The  code  team  is  waiting  be- 
hind those  doors.  They  will  do  everything 
they  can.  They  will  save  you,  /  know  they 
will.  I  half  expected  to  be  stopped  firmly 
by  a  nurse  saying  that  I  would  have  to  wait 
outside,  please.  I  wasn't  stopped. 

The  doors  flew  open.  No  code  team,  no 
nurses,  one  doctor,  not  even  a  crash  cart! 
What  kind  of  hospital  is  this,  anyway? 
This  doctor  in  his  starched  white  coat  took 
his  stethoscope  from  his  pocket.  He  didn't 
start  screaming  orders,  or  push  the 
■■panic"  button,  or  get  excited  —  he  just 
took  out  his  stethoscope.  He  didn't  even 
ask  me  how  long  ago  this  had  happened, 
whether  there  was  a  history  of  heart  dis- 
ease, how  old  is  the  patient  —  nothing.  He 
put  the  scope  to  John's  chest  and  listened. 

He  looked  up  at  me.  took  the  scope  from 
his  ears,  and  said.  "■I'm  sorry."  You're 
sorry!  What  do  you  mean?  Is  this  all  there 
is?  A  ren '  t  we  going  to  try  ?  Can't  we  please 
at  least  try?  You're  sorry! 

Suddenly,  my  knees  felt  weak  with  the 
finality  of  his  ■"I'm  sorry^"  I  nearly  col- 
lapsed. My  God.  for  nearly  two  hours  I 
had  worked  on  John,  to  bring  him  here  to 
hear  this  doctor  say  he  was  sorry! 

I  wanted  to  scream  and  throw  things.  I 
wanted  to  wrap  the  stethoscope  around 
■"I'm  sorry 's"  neck.  Instead.  I  walked  out  of 
that  room  and  this  time  I  was  hysterical. 
Now ,  at  least  I  had  the  time  to  be.  John  really 
was  dead. 

1  went  to  the  lobby  —  I  sat,  I  walked.  I 
sobbed.  I  thought.  One  of  the  young  men 
offered  me  a  cigarette.  Hand  rolled  and 
strong,  it  burned  my  throat.  It  felt  good.  I 
was  so  upset  and  frustrated  at  this  point 
that  I  did  not  know  what  to  do.  1  blamed 
the  doctor  for  everything,  but  esp)ecially 
for  giving  up  on  John.  He  didn't  even  try! 
He  was  sorry! 

I  sat  in  that  lobby  —  soaking  wet.  dirty. 
sobbing,  alone.  Someone  had  called  my 
friends.  Maddy  and  Eddy.  Oh,  please 


hurry.  I  really  need  to  see  your  familiar 
faces.  I  waited  about  another  hour  for  my 
friends. 

I  can  remember  thinking  that  I  must  not 
upset  these  friends  who  were  close  to 
John.  How  should  I  tell  them?  What  can  I 
say?  I  didn't  know.  As  I  saw  them  coming 
toward  me.  I  lost  control.  I  embraced  them 
both  and  blurted  out  that  John  was  dead. 
Very  subtle.  Eddy  went  to  see  the  doctor, 
and  Maddy  and  I  hugged  each  other  and 
cried  and  cried.  It  hurt;  no  pain  can  ever  be 
worse. 

A  policeman  came.  Through  a  trans- 
lator, he  asked  me  so  many  stupid  ques- 
tions. Please  leave  me  alone.  We  were  in 
the  same  room  where  John,  covered  with  a 
red  blanket ,  lay  on  a  stretcher.  Caw'r  we  go 
somewhere  else?  I  don't  want  to  see  John 
covered  with  a  red  blanket.  Finally,  we 
started  the  long  drive  home.  It  was  still 
raining. 

Acceptance 

This  all  happened  just  over  a  year  ago. 
When  I  think  back  on  it  now .  one  thing  has 
.become  clear  to  me.  John  was  beyond 
help,  anyone's  help,  when  I  found  him. 

There's  no  question  in  my  mind  about 
that  anymore.  Maybe  I  should  have  just 
accepted  that  and  sat  down  and  cried.  But  I 
didn't.  I  had  to  try  to  save  him.  Had  I 
known  what  would  happen  at  the  hospital, 
honestly.  I  don't  know  if  I  would  have 
tried  so  hard.  Had  I  not  been  trained  in 
resuscitation.  I  would  have  been  spared  an 
enonnous  amount  of  frustration.  I  felt 
guilty  for  awhile  —  guilty  because  I  had 
failed,  guilty  because  I  didn't  find  John 
soon  enough,  guilty  because  I  reacted  with 
more  heart  than  head. 

1  no  longer  feel  guilty.  I  think  that, 
given  the  impossibilities  of  that  day.  I  tried 
to  the  limit  of  my  abilities.  If  this  same 
thing  happened  tomorrow .  I  guess  I  would 
have  to  react  in  the  same  way. 

It  is  hard  to  give  up  on  someone  you 
love.  It  is  really  impossible  to  be  the  one 
who  says:  '"CK.,  that's  it.  he's  dead." 
Someone  else  must  do  this. 

I  learned  when  training  for  a  nurse  that  it 
is  not  a  good  idea  to  nurse  someone  close 
to  you.  I  never  really  understood  why. 
Now  I  know  what  was  meant,  because 
there  are  times  when,  no  matter  what  your 
training  or  experience  is,  you  realize  that 
you  are  a  human  being  first  and  a  nurse 
second.  '=i 

THE  CANADIAN  NURSE     39 


I 

The  Lippiueott 

Manual  of  ^ursang  Praetie 

A  unique,  ready  reference  for  safe,  effective  pati  ent  care 


This  is  the  one,  indispensable  reference  for  every 
nurse's  professional  library.  It's  the  book  that  presents 
the  facts  of  clinical  nursing  step-by-step,  in  concise, 
outline  form  .  . .  instant  information  you  can  use  im- 
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The  Lippincott  Manual  of  Nursing  Practice  puts  virtually 
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and  photographs.  In  three  major  units  .  .  .  medical/ 
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presents  in  outline  form  clinical  problems,  their  causes, 
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The  information  you  require  is  available  at  a  glance 


when  you  need  it  for  immediate  use! 

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1473  Pages/Profusely  Illustrated  $21.| 

By  LILLIAN  S.  BRUNNER,  R.N.,  M.S.;  DORIS  S.  SUDDAJ 
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gan,  R.N.,  M.S.N. ;  Donnajeanne  B.  Lavoie,  R.N.,  Ml 
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•     A  GUIDE  TO  PHYSICAL 
EXAMINATION 

i  ies 

Ir  each  body  system  this  "how-to"  text 
Jers  anatomy  and  physiology  basic  to  the 
(am.,  examination  techniques;  selected 
jnormalities. 

!0  pp.  ilius.  1974 

$18.75 

.     TEXTBOOK  OF  MEDICAL-SURGICAL 
'     NURSING 

,  unner.  et  al. 

(isigned  to  develop  clinical  competence, 

ts  text  emphasizes  the   pathophysiologi- 

jl/psychosocial  factors  of  expert  nursing 

as. 

•31  pp.    387  illus.    2nd  ed.    1970    $15.95 

CARE  OF  THE  ADULT  PATIENT 
Medical-Surgical  Nursing 

nith,  et  al. 

realistic  clinical  overview  of  patient  care 
nphasizing     individualized     nursing.     In- 
ddesAcute  Lite-Threatening  Crises. 
97  pp.    425  illus.    3rd  ed.     1971     $14.95 


CRfTlCAL 


CLINICAL  PHARMACOLOGY  IN 


'      NURSING 
>odman  and  Smitti 

luick,  easy  access  to  data  needed  for  ex- 
ert patient  care.  Drug  Digests  cover  dos- 
ge,   administration,   adverse   effects,   indi- 
atlons,  contraindications. 
00  pp.  1974  $11.75 

:      PROBLEM-ORIENTED  NURSING 

Woolley,  et  al. 
'resents     the     problem-oriented     medical 
ecord  system,  detailing  the  incorporation 
)f   the    nurse    into    a   functioning    medical 
:are  team.  Springer 

76  pp.  1974  paper,   $5.25 

cloth,   $8.50 

DRUGS  IN  CURRENT  USE  AND  NEW 
DRUGS  1974 

'Ode// 
irhe    1974    issue    of    this    indispensable, 
annual  drug  standby  for  nursing  and  medi- 
cal personnel.  Springer 
rt85  pp.  1974  paper  $4.75 


7      EMOTIONAL  CARE  OF  HOSPITALIZED 

CHILDREN 
An  Environmental  Approach 

'°etrillo  and  Sanger 

How  to   minimize   pediatric  trauma.   Deals 

with  growth   and  development;  family  and 

Cultural  variabels;  reaction  to  stress,  loss, 

separation. 

j259  pp.  illus.  1972  paper,  $6.25  cloth,  $8.50 


Work  Manual 

for 

Critical 


Q      CRITICAL  CARE  NURSING 

**     Hudak,  et  al. 

This   comprehensive  book   deals  with   the 

physiological/emotional    bases    of    illness; 

professional     practice     in     the     ICU;    the 

nurse's  role  and  responsibilities. 

351   pp.         illus.,  tables         1973         $9.95 

Q     Work  Manual  for 

^      CRITICAL  CARE  NURSING 

A  self-evaluation   tool   with   questions  and 
answers  to  major  units  of  the  text. 
108  pp.         perforated  &  punched         1973 

paper,  $3.75 


10 


NURSING  IN  THE  CORONARY  CARE 
UNIT 

Sharp  and  Rabin 

Covers    diagnosis,    interpretation    of    elec- 
tronic  monitoring  systems,  etiology,  treat- 
ment,    psychologcial     response,     nursing 
intervention. 
213  pp.  89  illus.  1970  $8.75 


■f  -I  PATIENT  CARE  SYSTEMS 

Kraegel,  et  al. 
The  science  ol  design  applied  to  planning 
of     health-care     systems.     Includes     case 
studies  of  patient  care  plans. 
150  pp.     flow-charts,  tables  1974 

$10.95 


■lO  CARING  FOR  PATIENTS  WITH 
'*■  CHRONIC  RENAL  DISEASE 
A  Reference  Guide  for  Nurses 

Hansen 

Helpful    information    covering    onset,    renal 
failure,  end-stage  dialysis  therapy  in   hos- 
pital or  home. 
120  pp.  1974  paper,  $4.75 


10  NURSING  OF  FAMILIES  IN  CRISIS 
''*  Hall 

Introduces   crisis   theory   as   a   conceptual 
approach,  includes  many  case  histories  of 
families  in  crisis. 
264  pp.  1974  paper,  $6.50 


New  Edition  — 
•iA  NURSES' 
'^  BALANCE 

Metheney  and  Snively 
This   updated   edition 
new  role  in  diagnosis, 
ation  of  lab  findings. 
325  pp.  illus. 


HAND-BOOK  OF  FLUID 


reflects  the   nurse's 
treatment  and  evalu- 

Spring   1974 
paper,  $8.75 


iC  THE  PRACTICE  OF  MENTAL  HEALTH 
'*'  NURSING 
A  Community  Approach 

Morgan  and  Moreno 

Clear,   jargon-free   presentation   of   psychi- 
atric nursing  practice  and   patient  care  in 
the  community  setting. 
211   pp.     1973     paper,  $5.95     cloth,  $8.25 


16 


COMMUNICATION  IN  NURSING 
PRACTICE 

Hein 

Presents    the    wide    variety    of    skills    that 
nurses    must    use    to    communicate    effec- 
tively with  their  patients.  Little,  Brown 
242  pp.       1973       illustrated       paper  $6.95 


■17  ABOUT  BEDSORES 
'  '    What  You  Need  to  Know  to  Help 
Prevent  and  Treat  Them 

Miller  and  Sachs 

How  to  deal  with  one  of  the  most  common 
problems  in  long-term  patient  manage- 
ment. 

50  pp.         Many  color  illus.  1974 

paper,  $5.40 


0^ 


iO  SPECIAL  NEEDS  OF  LONG-TERM 
'"  PATIENTS 

Stevens 

Informal  and  delightful,  with  a  wealth  of 
practical  information  not  tound  in  standard 
texts! 

288   pp.  illus.  1974 

paper,  $5.90 


new  products     { 


Descriptions  are  based  on  information 
supplied  by  the  manufacturer.  No 
endorsement  is  intended. 


I 

1 


Disposable  suction  collection  unit 

Economy,  combined  with  practicality,  are 
features  of  a  new  disposable  suction  col- 
lection unit  available  from  Da  vol.  Inc. 
Economy  is  achieved  by  the  canister's  de- 
sign, using  plastic  material,  thus  making 
more  efficient  use  of  raw  materials  and 
keeping  selling  price  low.  It  eliminates  the 
problems  of  reusables,  such  as  risk  of 
cross-contamination  and  cost  of  reproces- 
sing, and  wear-related  operational  prob- 
lems, such  as  vacuum  loss,  breakage,  and 
clogging. 


Special  stainless  steel  brackets  are  sup- 
plied for  adaptation  to  all  common  hospital 
suction  sources.  A  bracket  with  anti-tip 
floor  stand  is  also  available.  Large,  prom- 
inent calibrations  (to  2000  cc.)  on  the 
brackets  allow  readings  from  a  distance  of 
10  feet. 

For  information,  write:  Davol  Inc., 
Providence,  Rhode  Island  02901  or  Enns 
and  Gilmore,  1033  Rangeview  Road,  Port 
Credit,  Ontario. 


Biogastrone 

Biogastrone  is  indicated  as  specific 
therapy  for  patients  with  confirmed  be- 
nign gastric  ulcer.  Its  use  promotes 
healing  without  the  need  of  .special 
dietary  measures  or  bed  rest.  Evidence  of 
its  local  action  on  the  gastric  mucosa  is 
42    THE  CANADIAN  NURSE 


shown  by  increased  secretion  of  mucus 
and  favorable  modification  of  its  molecu- 
lar structure,  prolonged  life  of  gastric 
epithelial  cells,  and  prevention  of  back- 
diffusion  of  hydrogen  ions. 

Patients  must  be  carefully  evaluated  and 
monitored  while  under  Biogastrone 
therapy.  The  drug  should  not  be  pre- 
scribed for  patients  suffering  cardiac, 
renal,  or  hepatic  failure. 

Biogastrone  tablets  are  scored,  each 
containing  50  mg.  carbenoxolone  sodium 
B.P.  For  information  write:  The  Wm.  S. 
Merrell  Company,  2  Norelco  Drive, 
Weston.  Ontario,  M9L  IR9. 


Medication  carts 

A  new  series  of  medication  carts  feature 
cassettes  that  can  be  removed  from  either 
side  for  efficient  patient  bin  exchange. 
They  also  serve  as  organizers  in  the 
pharmacy,  by  keeping  bins  together  in 
one  stack  for  easier  filling. 


This  series  also  has  the  exclusive 
Macbick  locking  system,  a  7"'-deep  nar- 
cotics drawer  with  additional  independent 
lock,  a  7'"-deep  supply  drawer,  and  a 
pull-out  tray  for  Kardex  file  that  leaves 
the  work  surface  clear. 

For  details,  write  C.R.  Bard  (Canada) 
Ltd.,  1  Westside  Drive,  Etobicoke,  Ont. 
M9C  1B2. 


Draining-wound  management  system 

The  Hollister  draining-wound  managt 
ment  system  helps  protect  against  ski 
irritation  by  collecting  exudate  away  froi 
the  wound;  helps  isolate  wound  froi 
external  environment;  permits  immediai 
access  for  observation  and  treatment;  an 
permits  disposal  of  exudate  without  ha' 
ing  to  strip  away  adhesive-held  dressing,^ 


Components  are  in  sterile  peel-pack' 
for  operating  room  or  postoperative  ap 
plication.  ; 

The  supplier  is  Hollister  Limited.  33  | 
Consumers    Road,    Willowdale,    On 
M2J  1P8. 


Posey  turn-and-hold  decubitus  pad 

A  new  decubitus  pad,  designed  for  turning 
holding,  and  pulling  patients,  has  bee; 
developed  by  the  J.T.  Posey  Company. 
The  Posey  turn-and-hold  decubitus  pai 
can  be  used  to  turn  the  patient  on  his  sidi 
and,  when  secured  to  side  rails,  will  holi 
the  patient  in  that  position. 


The  pad,  made  of  72  ounces  of  Kodc 
per  linear  yard  for  effective  pile  and  den 
sity.  is  available  in  three  sizes:  No  I 
6325-24  X  30.  No.  6341-30  x  40.  and  No  ' 
6361-30  X  60.  For  further  information 
write:  Enns  and  Gilmore  Limited.  103; 
Rangeview  Road,  Port  Credit,  Ontario. 

MARCH  197 


/, 


■lattress  prevents  decubitis  ulcers 

he  Equi-Spension  Floatation  System 
lattress  is  a  combination  water  and  air 
nit  that  inflates  to  the  same  size  and  shape 
s  an  ordinary  mattress.  It  sets  on  top  of 
xisting  mattresses  and  takes  regular  or 
itted  contour  sheets.  It  has  3  separate  in- 
iependent  sections,  each  holding  about  6 
allons  of  water.  The  air  frame  surround- 
ng  it  is  inflated  by  using  a  vacuum  cleaner 
n  reverse,  or  by  any  small  hand  or  foot  air 
lump.  The  vinyl  covering  permits  easy 
leaning. 
For  information  write  Thermo- 
'yronics,  Inc,  275  Route  18.  East 
Jrunswick,  New  Jersey  08816. 


vlodular  weight  system 

Thick  Orthopedic"s  new  modular  weight 
ystem  for  lower  extremity  exercise  is  de- 
igned to  fit  any  patient.  It  is  ideal  for 
ingoing  physical  therapy  programs. 


Comprised  of  a  five-pound  weight  boot 
,and  five-pound,  modular,  add-on  weights, 
the  system  features  adjustable  Velcro 
'.insures  for  sure,  quick  fit.  The  sturdy 
\  inyl  boot  and  modular  weights  are  easy  to 
;lean.  The  components  are  interchange- 
able; thus,  large  inventories  are  not  neces- 
sary. The  boot  and  weights  are  durable 
enough  to  be  used  over  and  over  again. 

For  information,  write  J.  Stevens  and 
Son  Co.,  Ltd.,  2050  Kipling,  Toronto, 
Ontario. 
MARCH  1975 


Thorax  Cut-A-Way 

The  Thorax  Cut-A-Way  has  been  de- 
veloped as  an  aid  for  external  cardiac 
massage.  The  life-size  model  of  a  cross- 
section  of  the  lower  half  of  the  sternum 
closely  resembles  conditions  found  in  an 
adult.  It  shows  blood  flow  and  the 
corresponding  amount  ejected  from  the 
heart  when  the  correct  pressure  is  exerted 
on  the  heart.  When  pressure  is  relaxed, 
the  model  shows  the  return  of  venous 
blood  to  the  heart. 


The  training  of  correct  cardiac  arrest 
revival  procedures  and  other  related 
symptoms  is  effectively  conducted 
through  use  of  the  Thorax  Cut-A-Way.  It 
weighs  7  lbs. 

The  Thorax  Cut-A-Way  is  available 
from  Safety  Supply  Company,  214  King 
Street  East,  Toronto,  Ontario,  M5A  IJ8. 


Pre-gelled  disposable  electrode 

Monitrode,  Inc.,  has  developed  a 
chloride-free  gel  media  for  use  in  Mini- 
trode  electrodes,  which  eliminates  poten- 
tial irritation  during  normal  periods  of 
application  on  infants. 

The  Mini-trode  may  be  used  3-7  days 
without  removing  from  the  infant,  with 
continued  high  performance  as  the  low 
offset  potentials  permit  long-term  accu- 
rate measurement.  Pre-geliing  allows 
quick  application.  Mini-trode's  pad  adhe- 
sive is  strong  enough  to  resist  unusual 
turning  of  infant  or  tugging  on  lead  wires. 
The  pad  is  not  loosened  by  exposure  to 
water. 

Mini-trodes  electrodes  are  packaged  in 
a  moisture-proof,  high-vac  bag,  freshness 
guaranteed  for  a  year.  Mini-trodes  are 
designed  for  maximum  infant  comfort, 
simplicity  of  use  and  minimum  cost,  and 
are  readily  adaptable  to  all  types  of 
monitoring  equipment. 

For  information  write  Monitrode,  Inc.. 
782  Burr  Oak  Drive.  Westmont.  111. 
60559,  U.S.A. 


Next  Month 
in 


The 

Canadian 
Nurse 


Rape  Victims  — 
The  invisible  Patients 


How  The  Leukemic  Child 
Chooses  His  Confidant 


•    The  Hyperkinetic  Child 


How  Children  See  Nurses 


^Z? 


Photo  Credits 
for  March  1 975 


Sunnybrook  Medical  Centre 
Toronto,  Ontario,  P.  12 


THE  CANADIAN  NURSE     43 


names 


Frances  Moore  (R.N..  B.Sc,  University 
of  Alberta)  previously  assistant  director  of 
nursing,  was  recently  appointed  director 
of  nursing,  local  board  of  health,  Calgary 
Health  District,  Calgary,  Alberta. 

An  active  member  of  the  Alberta  Asso- 
ciation of  Registered  Nurses,  she  was  its 
president  from  1965  to  1967.  As  its  past 
president,  she  served  as  chairman  of  the 
liaison  committee  of  the  Alberta  Medical 
Association,  Alberta  Hospitals  Associa- 
tion, and  the  aarn.  She  was  chairman  of 
the  nursing  practice  planning  committee 
from  1971  to  1974.  and  is  currently  a 
member  of  this  committee. 


F.  Moore 


M.R.  Thompson 


M.  Ruth  Thompson  (R.N..  B.Sc.N.,  Uni- 
versity of  Alberta;  M.A.  Columbia  U., 
New  York),  died  in  Edmonton  15  January 
1975.  She  had  retired  in  1971  asdirectorof 
the  University  of  Alberta  Hospital  school 
of  nursing,  having  filled  that  post  since 
1954. 

During  her  professional  career,  Thomp- 
son had  been  instructor  in  nursing  at  the 
Archer  Memorial  Hospital,  Lamont,  and 
at  the  University  hospital,  Edmonton;  a 
nursing  sister  during  World  War  II,  serv- 
ing on  the  hospital  ships  Lady  Nelson  and 
Letitia;  and  director  of  nursing  at 
Belleville  General  Hospital  and  at  the 
Victoria  General  Hospital,  London, 
Ontario. 

At  the  time  of  her  death,  she  was 
on  a  committee  engaged  in  writing  the 
history  of  the  school  of  nursing  of  the 
University  of  Alberta  Hospital. 


Helen  Evans  (Reg.  N..  Toronto  General 
Hospital  school  of  nursing;  B.Sc.N.,  Uni- 
versity of  Western  Ontario,  London; 
M.S.,  Boston  University)  has  been  ap- 
pointed assistant  director  of  professional 
standards.  College  of  Nurses  of  Ontario. 
Ba.sed  in  Toronto  throughout  her  nurs- 
44     THE  CANADIAN  NURSE 


ing  career,  Evans  was  for  several  years 
director  of  nursing  education.  The  Hospi- 
tal for  Sick  Children,  before  becoming  as- 
sistant chairman,  nursing,  at  the  Gerrard 
Campus  of  the  Ryerson  Polytechnical 
Institute,  a  position  she  held  prior  to  her 
current  appointment. 


Jerry  Miller  has  been  appointed  director, 
communication  services,  the  Registered 
Nurses  Association  of  British  Columbia, 
succeeding  Claire  Marcus,  who  recently 
resigned  from  that  position. 

Miller  has  been  assistant  director,  cor- 
porate communications.  Occidental  Life 
Insurance  Company,  Los  Angeles,  and. 
since  coming  to  Vancouver,  has  been  in- 
formation officer  for  the  Electrical  Con- 
tractors As.sociation  of  British  Columbia 
and  for  the  Workmen's  Compensation 
Board. 


Jackie  Robarts  (Reg.  N.,  Hamilton  Civic 
Hospital  school  of  nursing;  B.Sc.N., 
University  of  Toronto)  has  been 
appointed  principal  of  the  North 
Campus  (Rexdale)  of  the  Humber 
College  of  Applied  Arts  and  Techno- 
logy. Formerly  director  of  the  Osier 
School  of  Nursing 
in  Weston,  Robarts 
has  worked  at  the 
Hamilton  Civic 
Hospital  and  has 
been  director  of 
nursing  of  the 
Public  General 
Hospital  in  Chatham, 
Ontario.  She  is 
currently  completing  studies  for  her 
master's  degree  in  education  at  the  Ontario 
Institute  for  Studies  in  Education. 


Mary  L.  Richmond  (R.N. ,  Vancouver  Gen- 
eral Hospital;  B.N.,  McGill  University. 
Montreal;  M.A.,  Columbia  University, 
New  York)  has  become  the  first  director  of 
educational  resources  at  Royal  Jubilee 
Hospital,  Victoria,  B.C. 

Earlier  in  her  career  she  was  educational 
director  and  then  director  of  nursing  at  the 
Royal  Jubilee  Hospital,  later  becoming  a 
member  of  the  faculty  of  the  McGill 
School  for  Graduate  Nurses  in  Montreal. 
In  1964  she  was  appointed  director  of  nurs- 


ing at  the  Vancouver  General  Hospita 
Prior  to  her  current  appointment.  Rid 
mond  had  been  in  New  Zealand  on 
traveling  scholarship  to  discuss  nursin 
service  with  professionals  in  the  heali 
field. 


Eleanor  MacDougall  (Reg.N..  Ottau 
Civic  Hospital  school  of  nursing;  Cer 
Clinical  Teaching.  University  of  Toronti, 
Dipl.  Publ.  Health.  University  of  Westeij 
Ontgrio)  has  been  appointed  assistant  d ' 
rector  of  the  Victorian  Order  of  Nurse: 
She  is  responsible  for  personnel. 

MacDougall  has  been  associate 
with  the  VON  for  many  year: 
first  as  staff  nur^ 
in  Gait.  Ontaric 
She  went  on  t 
Dundas  as  nurst 
in-charge.  then  t 
Calgary  as  distrii 
director,  later  bt 
coming  region: 
director  for  Albert; 
Saskatchewai 
Manitoba,    and    branches    in    Ontarii 


Pierrette  Levesque  (R.N..  Hopital  S 
Michel-Archange.  Quebec;  B.Sc.  Inf 
University  of  Montreal;  M.S.N.,  Catholi 
University  of  America.  Washingtor 
D.C.)  has  been  appointed  director  of  th 
schodi  of  nursing,  Laval  University 
Quebec.  Recentl; 
the  director  of  nurs 
ing  service,  Hopita 
St-Michel-Archang( 
in  Quebec,  she  wa 
eariier  an  assistan 
professor  at  thi 
Laval  Universit} 
school  of  nursing 
Levesque  is  presi 
dent  of  the  Women's  University  Club  ol 
Quebec. 


John  E.A.  Baker  (Reg.  N,  St.  Joseph's  Hos 
pital  school  of  nursing,  Peterborough 
B.Sc,  Trent  University,  Peterborough)  ha 
been  appointed  director  of  nursing  at  thi 
Douglas  Memorial  Hospital,  Fort  Erie.  Hi 
was  formeriy  coordinator  of  nursing  ser 
vices.  Addiction  Research  Foundation 
Toronto.  C 

MARCH  197 


TURNING  PROBLEMS  INTO  OPPORTUNITIES- 

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LEADERSHIP! 


A  New  Book!  Hoffman  et  al 

SPATIAL  ANALYSIS  OF  THE  ELECTROCARDIOGRAM:  A  Program 

Step-by-step  instructions  and  specific,  related  illustrations  make  this  new  text  a 

valuable  learning  tool.  In  programmed  form,  three  sections  provide  the  material 

necessary  for  spatial  analysis  of  any  electrocardiogram. 

By  IRWIN  HOFFMAN.  M.D.;  JULIEN  H.  ISAACS,  M.D.;  JAMES  V.  DOOLEY,  M.D.;  PHIL 
R.  MANNING.  M.D.;  and  DONALD  A.  DENNIS,  Ph.D.  March,  1975.  Approx.  160  pages, 
7" X  10",  199  illustrations.  About  S7.30. 


New  2nd  Edition! 

WORKBOOK  FOR  PEDIATRIC  NURSES 


Anderson 


This  workbook  examines  growth  and  development  in  general,  and  then  presents 

exercises  on   nursing  care  of  the  hospitalized  child   at  every  age   level,  from 

infancy   through    adolescence.    Emphasis    is   placed    on   the  effects  of  family, 

environment,  and  nurse  on  child. 

By  NORMA  J.  ANDERSON,  R.N.  June,   1974.  200  pages  plus  FM  l-X,  7%"  x  10'A",  21 
illustrations.  Price,  $6.05. 

New  3rd  Edition!  Ingalls-Salerno 

MATERNAL  AND  CHILD  HEALTH  NURSING 

This   new  3rd   edition   is  a  completely  unified   presentation   of  obstetric  and 

pediatric   nursing.   New  material    includes:    new  charts,  discussions  and  tables; 

three  methods  of  pelvic  measurement;  new  information  on  birth  control  and 

abortion;  and  more! 

By  A.  JOY  INGALLS,  R.N.,  M.S.;  and  M.   CONSTANCE  SALERNO,  R.N.,  M.S.;  with  2 
contributors.  June,  1975.  Approx.  704  pages,  7"  x  10".  About  $12.55. 

A  New  Book!  Ingalls-Salerno 

MATERNAL  AND  CHILD  HEALTH  NURSING  STUDY  GUIDE 

Directly  correlated  with  the  above  text,  this  new  workbook  provides  methods  of 

evaluation  and   review;  and   helps  to  stimulate  additional  reading  and  further 

investigation  by  students. 

By  A.  JOY  INGALLS,  R.N.,  M.S.;  and  M.  CONSTANCE  SALERNO,  R.N.,  M.S.  June,  1975. 
Approx.  225 pages,  7%"  x  10>i",  40  illustrations.  About  $4.70. 


THE 


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A  New  Book  I  Coerzen-Chinn 

REVIEW  OF  MATERNAL  AND  CHILD  NURSING 

In  question  and  answer  form,  this  new  text  presents  a  comprehensive  review  of 

the    elements    of    maternal    and    child    nursing.    The    authors    provide    lucid 

discussions  covering:  family  and  culture;  human  sexuality  and  family  planning; 

nursing  management  in  risk  situations;  etc. 

By  JANICE  L.  GOERZEN,  R.N.,  B.Sc.N.;  and  PEGGY  L.  CHINN,  R.N.,  Ph.D.  April,  1975. 
Approx.  256 pages,  7"  x  10".  About  $7.30. 

A  New  Book!  Kneisl-Ames 

MENTAL  HEALTH  CONCEPTS  IN  MEDICAL-SURGICAL 
NURSING:  A  Workbook 

This  workbook  offers  a  practical  way  to  help  students  apply  mental  health- 
psychiatric  nursing  concepts  in  the  care  of  medical  and  surgical  patients. 

CAROL  REN  KNEISL,  R.N.,  M.S.;  and  SUE  ANN  AMES,  R.N.,  M.S.  September,  1974.  160 
pages  plus  FM  l-X,  7M"  x  lOVi",  23  illustrations.  Price,  $5.80. 

New  2nd  Edition!  Given-Simmons 

GASTROENTEROLOGY  IN  CLINICAL  NURSING 

Emphasizing  the  "why"  and  "what"  of  nursing  actions,  this  new  text  provides 

the  student  with  a  practical  guide  for  care  of  the  patient  with  gastrointestinal 

disorders.  The  authors  offer  a  systematic  approach  to  each  condition  discussed. 

By  BARBARA  A.  GIVEN,  R.N.,  B.S.N.,  M.S.;  and  SANDRA  J.  SIMMONS,  R.N.,  B.S.N., 
M.S.  June,  1975.  Approx.  336  pages,  7" x  10",  70  illustrations.  About  $8.40. 

A  New  Book!  Dreyer  et  al 

A  GUIDE  TO  NURSING  MANAGEMENT  OF 
PSYCHIATRIC  PATIENTS 

Based  on  actual  clinical  cases,  this  unique  workbook  can  aid  students  in  the 

application   of   psychiatric    nursing   techniques.   Topics  covered   include:    legal 

aspects,   patients  with   problems  related  to  alcohol  and  drug  abuse,  behavior 

disorders  in  children,  and  more. 

By  SHARON  DREYER,  R.N.,  M.S.;  DAVID  BAILEY,  Ed.D.;  and  WILLS  DOUCET,  M.Ed. 
January,  1975.  246 pages  plus  FM  l-X,  7%" x  10'A".  Price,  $6.25. 

A  New  Book! 

APPLIED  BEHAVIOR  MODIFICATION 

In  a  variety  of  settings,  this  new  text  covers  the  application  of  various  behavior 
modification  techniques.  Each  chapter  considers  needs,  population,  and  appro- 
priate target  behaviors  for  that  particular  setting  (home,  school,  mental 
institutions,  mental  health  clinics,  etc.). 

Edited  by  W.  DOYLE  GENTRY,  Ph.D.;  with  8  contributors.  May,  1975.  Approx.  176 
pages,  6"  x  9",  4  illustrations.  About  $6.25. 

A  New  Book! 

PAIN:  Clinical  and  Experimental  Perspectives 

Presenting  research  material  from  many  disciplines,  this  unique  new  book  offers 
experimental  and  clinical  studies  in  the  area  of  pain.  The  text  emphasizes  the 
measurement  of  pain,  the  correlates,  and  variables  used  to  manipulate  pain 
reaction. 

Edited  by  MATISYOHU  WEISENBERG,  Ph.D.  June,  1975.  Approx.  472 pages,  7" x  10'/.", 
86  illustrations.  About  $1 1.00. 


THArS  NURSING  LEADERSHIP! 

r/losby  texts  provide  the  background. 


A  New  Book  I 

CLASSIFICATION  OF  NURSIIMG  DIAGNOSES 

This  new  text  presents  the  proceedings  of  the  First  National  Conference  on  the 

Classification  of  Nursing  Diagnoses.  It  represents  the  first  attempt  at  collectively 

classifying  health  problems  and  conditions  which  nurses  face  in  practice. 

Edited  by  KRISTINE  M.  GEBBIE.  R.N..  M.N.;  and  MARY  ANN  LAVIN,  R.N..  M.S.N.  Jan- 
uary, 1975. 172  pages  plus  FM  l-VIII.  6"  x  9".  Price.  S7. 10. 


A  New  Book! 

DECISION  MAKING  IN  NURSING:  Tools  for  Change 


Bailey-Claus 


This  new  text  offers  unique  approaches tosolving patient-care  and  management 
problems.  Actual  case  studies  are  presented  as  detailed  examples  of  how  to 
apply  concepts  of  problem-solving  and  decision  making  in  the  delivery  of 
health  care. 

By  JUNE  T.  BAILEY,  R.N.,  Ed.D.;  and  KAREN  E.  CLAUS,  Ph.D.;  with  4  contributors. 
June,  1975.  Approx.  168  pages,  7"  x  10",  63  illustrations,  including  29  drawings  by  BEE 
WALTERS.  About  $5.55. 

A  New  Book!  Davis  et  al 

NURSES  IN  PRACTICE:  A  Perspective  on  Work  Environments 

This  new  text  is  a  collection  of  articles  which  presents  the  work  of  nurses  in  a 
variety  of  settings.  The  authors  present  special  insights  in  the  nurse's  lack  of 
autonomy;  the  attitudes  concerning  the  role  of  women  today;  and  more. 

By  MARCELLA  Z.  DAVIS,  R.N.,  D.N.S.;  MARLENE  KRAMER,  R.N.,  Ph.D.;  and 
ANSELM  L.  STRAUSS,  Ph.D.;  with  11  contributors.  January,  1975.  274  pages  plus 
FM  l-XIV,  6%"x  9%".  Price,  $7.30. 


A  New  Book! 

COMMUNICATIONS  AND  RELATIONSHIPS  IN  NURSING 


O'Brien 


A  comprehensive  guide  to  common  factors  in  communication,  this  new  book 

offers  students  practical  discussions  on:  commonalities  of  human  nature  relevant 

to  communication;  basic  facets  of  communication  skills;  10  "communications 

interactions";  etc. 

By  MAUREEN  J.  O'BRIEN,  R.N.,  M.S.  May,  1974.  180  pages  plus  FM  l-XII.  5'A"  x  8V. 
Price,  $5.55. 


A  New  Book! 


Hilliard 


ORIENTATION  AND  EVALUATION  OF  THE 
PROFESSIONAL  NURSE 

This  new  book  presents  an  effective  alternative  to  the  high  cost  of  long  term 

orientation   programs  of   professional   nurses  to  clinical   areas  of  the  hospital. 

Content  is  designed  to  ease  transition  from  student  to  practitionerandto  provide 

easy  reference  to  hospital  procedu'es  and  policies. 

By  MILDRED  HILLIARD,  R.N.,  B.S.,  M.S.  August,  1974.  168  pages  plus  FM  IX,  7%"  x 
10'A",  31  figures.  Price,  $6.25. 

A  New  Book!  Bregman 

ASSISTING  THE  HEALTH  TEAM:  An  Introduction 
for  the  Nurse  Assistant 

Designed  to  help  the  student  understand  his  or  her  role  as  a  nursing  assistant, 
this  new  text  includes  basic  instruction  in  anatomy,  physiology,  vital  signs  and 
patient  needs. 

By  MARCIA  S.  BREGMAN,  B.S.,  R.N.  May,  1974.  200  pages  plus  FM  l-XIV,  7" x  10",  190 
illustrations.  Price,  $6.85. 


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A  New  Book!  Williams 

ESSENTIALS  OF  NUTRITION  AND  DIET  THERAPY 

Pertinent  to  health  workers  at  all  levels,  this  new  text  develops  basic 

concepts  of  nutritional  science  and  diet  therapy.  Its  broad  coverage 

includes  physiologic  as  well  as  sociological  factors  relevant  to  growth 

and  development.  The  first  section  provides  a  thorough  introduction  to 

human  nutrition.  Part  two  considers  the  food  environment  while  the 

third  section  provides  a  basic  manual  of  clinical  nutrition. 

By  SUE  RODiVELL  WILLIAMS,  M.R.Ed..  M.P.H.  May,  1974.  342  pages  plus  FM 
l-XII,  7"x  10",  33  illustrations.  Price,  $7. 10. 

A  New  Book!  Williams 

SELF  STUDY  GUIDE  FOR  NUTRITION  AND 
DIET  THERAPY 

Although  specifically  correlated  with  ESSENTIALS  OF  NUTRITION 
AND  DIET  THERAPY,  this  new  guide  can  be  used  with  nutrition  and 
diet  therapy  books  at  all  levels.  It  makes  use  of  a  combination  of  review 
quizzes,  multiple  choice  and  discussion  questions,  and  study  projects 
to  reinforce  understanding  and  application. 

By  SUE  RODWELL  WILLIAMS,  M.R.Ed.,  M.P.H.  May,  1974.  208 pages  plus  FM 
l-VIII,  7"x  10",  37  illustrations.  Price,  $5.55. 

New  5th  Edition!  Williams 

Mowry's  BASIC  NUTRITION  AND  DIET  THERAPY 

In  the  style  of  previous  editions, this  new  text  offers  current  nutrition 
and  diet  therapy  information.  Revisions  of  Recommended  Dietary 
Allowances  made  by  the  Food  and  Nutrition  Board  in  1973  are 
presented  here,  along  with  their  broad  implications.  The  Basic  Four 
Food  Groups  has  been  enlarged,  and  a  new  section  on  community 
nutrition  has  been  added  to  bring  this  edition  entirely  up-to-date. 

By  SUE  RODWELL  WILLIAMS,  M.R.Ed.,  M.P.H.  February,  1975.  216  pages  plus 
l-XII.  6'A"x  9'A",  5  illustrations.  Price,  $6.25. 

New  3rd  Edition!  Guthrie 

INTRODUCTORY  NUTRITION 

This    new    edition    of    a    popular    text    presents    relevant    nutrition 

information   in  a  direct  and  extremely  readable  style.  Part  I  —  Basic 

Principles  of  Nutrition  —  includes  discussions  of  all  major  nutrients. 

Part    2  -  Applied    Nutrition  -  deals    with    the    application    of    basic 

principles   of  various  nutritional  situations.     Part    3  —  Appendices  — 

includes  a  glossary  and  numerous  tables. 

By  HELEN  ANDREWS  GUTHRIE,  B.Sc,  M.S.,  Ph.D.  March,  1975.  Approx.  576 
pages,  7"  X  10",  159  illustrations.  About  $11.50. 


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research  abstracts 


ukerman,  Winona  Hulse  and  Lampart, 
Rhona  Eudoxie.  Guidelines  to  assist  in 
Jecision-making  by  health  agency  per- 
sonnel regarding  utilization  of  the 
cardio-puhnonary  resuscitation  team. 
Buffalo.  New  York.  1972.  Study 
(M.S.)  State  U.  of  New  York  at 
Buffalo. 

Registered  nurses  often  have  a  greater  role 
n  the  final  decision  to  call  or  not  to  call  the 
iikTgency  cardio-pulnionary  arrest  team 
luin  any  other  group  of  health  worker.  The 
Mohlem  investigated  was:  what  are  the 
jriables  that  affect  a  registered  nurse's 
Iccision  to  call  or  not  to  call  the  cardio- 
uilmonary  arrest  team  when  she  finds  that 
i  patient  is  without  obvious  vital  signs? 
Mirses  indicated  whether  or  not  they 
uiuld  consider  physician's  order, 
laiient's  age.  prognosis,  condition,  per- 
>nai  status,  family's  loss,  family's  wish. 
\iiient's  religion,  and  were  asked  to  indi- 
-iio  other  possible  variables. 
Hypotheses  were: 

1  Ihc  nurse  w  ill  generally  give  more  than 
ne  basis  for  her  decision  to  call  or  not  to 

.all  the  cardio-pulmonary  resuscitation 
cam  unless  the  reason  is  that  it  was  so 
M'dered  by  the  physician. 

2  In  most  instances,  nurses  will  consider 
>.>th  the  client's  age  and  prognosis  in  mak- 
iiiL!  their  decision  to  call  or  not  to  call  the 

\lio-pulmonary  resuscitaticin  team. 

The  nurse's  number  of  years  of  profes- 

lal  education  will  not  significantly  af- 
...i  her  decision  to  call  the  team. 
4  The  longer  the  years  of  practice,  the 
more  clearly  defined  are  the  bases  for  her 
Jecision-making  to  call  or  not  to  call  the 
-ardio-pulmonary  resuscitation  team. 
^  The  nurse's  perceptions  of  the  effec- 
iiNcness  of  the  procedure  itself  will  affect 
her  decision  to  call  the  team. 

A  sample  of  78  registered  nurses  in  a 
teaching  and  a  nonteaching  hospital  in 
Canada  and  a  teaching  and  a  nonteaching 
hospital  in  the  United  States  were  inter- 
\  lewed.  An  interview  schedule  was  used 
to  collect  information,  opinions,  and 
iuirses"  statements  about  their  beliefs  with 

ard  to  cardio-pulmonary  resuscitation. 
■  iie  first  three  hypotheses  were  substan- 
iiated.  the  fourth  was  not  substantiated. 
and  the  fifth  was  not  adequately  tested. 

As  a  result  of  the  study,  it  is  recom- 
mended that  nurses  increase  their  input 
into  policy-making  and  participation  in 
Jeeision-making  about  terminally  ill  pa- 
VURCH  1975 


tients,  so  that  individual  nurses  will  not  so 
often  face  problematic  decisions  about 
cardio-pulmonary  resuscitation  in  the 
practice  situation.  In  addition,  nurses 
should  attempt  to  ensure  that  teaching 
programs  on  cardio-pulmonary  resuscita- 
tion are  planned  and  implemented  so  that 
no  nurse  will  be  expected  to  function  in  the 
cardio-pulmonary  resuscitation  situation 
v\ithoui  sufficient  understanding  of  the 
procedure  and  skill  in  the  techniques. 

Further  studies  should  be  done  with 
larger  samples  and  in  more  varied  settings. 


Watts,  ludith  Mary  E.An  exploratory  study 
to  identify  preconception  contracep- 
tive patterns  of  abortion  patients. 
Vancouver.  B.C.  1974.  Thesis 
(M.Sc.N.)  U.  of  British  Columbia. 

The  purpose  of  this  study  was  to  add  to 
the  understanding  of  problems  with  con- 
traceptive use  by  describing  contraceptive 
practices,  attitudes,  and  knowledge  of 
abortion  patients..  Women  having  abor- 
tions were  selected  as  subjects  because  of 
their  apparent  contraception  difficulties. 
The  study  was  considered  of  value  to 
nurses,  who  are  in  a  good  position  to 
provide  contraception  services  to  people. 

Thirty  subjects  were  randomly  selected 
from  patients  having  D  &  C/  aspiration 
alx^rtions  as  in-patients  in  a  large  urban 
British  Columbia  hospital.  Data  were 
gathered  using  a  semi-structured  ques- 
tionnaire in  a  single  interview  held  the 
evening  before  the  abortion. 

A  large  amount  of  data  was  gathered  on 
contraceptive  use.  of  which  the  following 
items  are  of  particular  interest: 

1 .  The  women  having  abortions  to 
deal  with  unwanted  pregnancies  varied 
widely  in  terms  of  age.  marital  status, 
education,  and  occupation.  The  largest 
number  were  in  their  20s  and  many  (over 
half)  had  stable  relations  with  their  sexual 
partners. 


+  R0II  up 
your  sleeve 
to  save  a  life... 


BE  A  BLOOD  DONOR 


2.  Almost  all  subjects  had  used  con- 
traceptives at  some  time  and  many  (over 
halO  used  them  at  the  time  of  conception 
of  the  pregnancy  being  terminated.  Five 
subjects  experienced  contraceptive  failure 
with  lUDs. 

3.  Many  subjects  indicated  ambival- 
ence about  the  use  of  and  responsibility 
for  contraception.  They  frequently 
wished  to  share  responsibility  for  choos- 
ing contraceptives  with  their  partners,  but 
often  did  not  do  so. 

4.  Most  subjects  were  not  well  in- 
formed about  contraception.  Their 
sources  of  information  were  varied  and 
their  parents  tended  to  be  inconsistent  as 
sources. 

5.  Users  of  contraceptives  at  the  time 
of  conception  tended  to  be  older,  have 
more  stable  relations  with  their  sexual 
partners,  be  more  regular  and  effective 
contraceptive  users,  and  not  have  de- 
pended on  parents  as  sources  of  con- 
traception information.  Nonusers  tended 
to  be  younger,  have  less  stable  relation- 
ships with  their  sexual  partner,  be  less 
regular  and  effective  contraceptive  users, 
and  have  depended  on  parents  for  con- 
traception information. 

Some  implications  drawn  from  the  data 
follow: 

•  Women  having  contraceptive  problems 
come  from  many  settings  and  back- 
grounds. Therefore,  efforts  to  improve 
contraceptive  use  must  be  varied  and 
flexible  to  reach  all  people  with  con- 
traception needs. 

•  Effective  contraceptive  use  appears  to 
be  influenced  by  feelings  about  indepen- 
dence and  responsibility,  and  of  comfort 
with  tine's  sexuality.  Consequently,  con- 
traception services  need  to  include  oppor- 
tunities to  deal  w  ith  these  broader  issues. 

•  Contraception  knowledge  is  often  li- 
mited, and  effective  sources  of  informa- 
tion are  not  found  consistently  in  our 
society.  Professional  effort  is  needed  to 
ensure  good  contraception  education  that 
can  supplement  what  is  learned  from 
parents. 

Areas  recommended  for  future  study 
include  more  thorough  investigations  of 
attitudes  toward  and  knowledge  of  con- 
traception and  their  effects  on  practice. 
Also,  comparison  studies  of  contraceptive 
use  by  other  groups  of  women  are 
needed,  as  are  experimental  studies  to  test 
the  effectiveness  of  contraception  educa- 
tion and  services.  w 
THE  CANADIAN  NURSE     49 


fwdm  7^  'fi^  /kcHa4...^m  ^ea^ 


Mrs.  R.  F.JOHNSON 
SUPERVISOR 


wmmmmmmmmmmmmmm 


IT'S  EASY  TO  ORDER  REEVES  NAME  PINS  FOR  YOURSELF  OR  FRIENDS! 


Choose  Style  you  want,  shown  left .  Print  name  (and  2nd 
line  it  desired)  on  dotted  lines  below.  Check  other  info  in 
boxes  on  chart,  clip  this  section  and  attach  to  coupon 


bottom  left  Attach  extra  sheet  for  additional  pms. 
NOTE  SAVINGS  ON  2  IDENTICAL  PINS-. . .  more  coovtnient. 
spare  in  case  ol  loss. 


LETTERING: 2nd  LINE:. 


ISTYU 

NO. 


Plastic  I 
Laminate  | 
No.  559         I    169 


OESCRIPTION 


ALL  METAI Smooth,  rounded 

k  corners.  Choose  Polished,  Satin,  or 
'  new  Duotone  combining  satin 

background  with  polished  edges. 


DGold 

D  Silver 


PLASTIC  LAMINATE... slimmer. 
L  broader;  engraved  thru  surface  to 
r  contrasting  core  color,  Eieveled 

border  matches  lettering. 


f5HN.LPN. 


METAL  FRAMED.     Classic 
b  design;  snow-white  plastic  witti 
smooth,  polished  beveled  frame. 


MOLDED  PLASTIC  . . .  Simple,  smart. 
\  economical.  Will  never  discolor. 
'  Smooth  rounded  corners  and  edges. 


All  pinbacks  with  safety  catch 


MH/U. 

coim 


DGold 
n  Silver 


IKT«l 
FINISH 


□  Duotone 
D  Polished 
O  Satin 


Polished 
frame 
only 


BACKCIIMW 
COLOR 

(Tlasticl 


apply 


D  White 
D  Green 
DBlue 
D  Cocoa 


nrnite  «■  v- 

ein      E 

e    >V 

oaj         1 


White 
only 


White 
only 


LETTtRme 
COLOR 


D  Black 
D  Ok.  Blue 
D  White 


IP  Black 

Dk.  Blue 
^White 
Letters  only 


n  Black 
n  Dk  Blue 


D  Black 
DDk.  Blue 


races 

EararMIUM  EitrmlJllan 


□  1  Pin    2.49 

□  2  Pins  3.99 

(same  narne) 


D  1  Pin    1J5 
n  2  Pins  1.95 


D  1  Pin   2.49 

D  2  Pins  3.99 

(same  namel 


D  1  Pin    1.25 

D  2  Pins  1.95 

(same  name) 


n  1  Pin    3,25 

n  2  P.ns  4.95 

(same  name) 


D  1  Pin    l« 

n  2  Pins  2.90 

(same  name) 


D  1  Pin    3.25 
n  2  Pins  4.95 


D  1  Pin    \Xi 

D  2  Pins  2.90 

(same  name) 


NURSES  PERSONALIZED 
ANEROID  SPHYG. 

A  superb  instrument  especially  designed 

for  nurses  by  Reister  Exacta,  precision 

craftsmen  in  W.  Germany.  Easy-to-attach 

Velcro*cuff,  lightweight,  compact,  fits 

into  soft  Sim.  leather  zippered  case 

2'/^"  X  4"  X  7".  Dial  calibrated 

to  320  mm,,  10-year  accuracy 

guaranteed  to  ±3  mm.  Serviced 

by  Reeves  if  ever  required.  Your 

initials  engraved  on  manometer 

and  gold  stamped  on  case  FREE. 

A  wise  investment  for  a  litetime 

of  dependable  servicel 

No.  lOeSphyg....  39.95  ea 

BLOOD  PRESSURE  SET 


^ 


Duty 
free 


Duty  free 


An  outstanding  value'  Excellent  qual- 
ity Clayton  Aneroid  Sphyg.  from 
Japan  Meets  all  U.S.  Gov.  specs. 
±3mm  accuracy,  guaranteed  10 
years.  Black  and  chrome  manometer, 
cal.  to  300mm.  Velcro*  grey  cuff, 
black  tubing,  soft  leatherette  zipper 
case  measuring  IVi"  x  4"  x  7".  Serv- 
iced in  USA  if  ever  needed.  Clayton 
No.  4140  Nurses  Stethescope  (less 
initials)  and  Scope  Sack  included  (see 
photo  right),  FREE  gold  initials  on 
case  and  Scope  Sack.  Here  is  a  sensi- 
ble, practical,  dependable  kit  fust 
right  for  every  nurse! 
No.  41-10  B.P.  Set... 

32.95  set  complete 
Sphyg.  only  No.  108  . . .  25.95  with  case 


CAP  ACCESSORIES 


CAP  TOTE   keeps   your   caps   crisp   and   clean  • 
white  stored  or  carried.  Dexible  clear  plastic,  white 
trim,  zipper,  carrying  strap,  hang  loop.  Stores  flat.  Also  ; 
(or  wiglets,  curlers,  etc.  %W  dia..  6"  high. 
No.  333  Tote  . . .  2.95  ea.  Gold  init.  SOWTote 

WHITE   CAP  CLIPS       Holds  caps 
firmly  in  place!  Hard-lo-find  white  bobble  pins, 
enamel  on  fine  spring  steel.  Seven  2"  and  four 
3"  clips  included  in  plastic  snap  box. 
No.  529  Clips  85(  per  box  (min.  3  boxes) 

MOLDED  CAP  TACS 

Replace  cap  band  instantly.  Tiny  plastic  tac, 
dainty  caduceus  Choose  Black,  Blue,  White 
or  Crystal  with  Gold  Caduceus.  The  neater  j 
way  to  fasten  bands.  : 

Ns.  200  —  Set  of  6  Tacs ...  1.25  per  set 


Free  Initials  and  Sack  with  your 

Littmanri  Nursescope! 


BRAND 

Famous  Littmann  nurses' 
diaphragm  stethoscope  .  .  . 
a  fine  precision  instrument, 
with  high  sensitivity  for 
blood  pressures,  apical  pulse 
rate.  Only  2  ozs.,  fits  in 
pocket,  with  gray  vinyl  anti- 
collapse  tubing,  non-chilling 
epoxy  diaphragm.  28"  ovar- 
all.  Non-rotating  angled  ear 
tubes  and  chest  piece  beau- 
tifully styled  in  choice  of  5 
jewel-like  colors:  Goldtone, 
Silvertone,  Blue,  Green,  Pink.* 


FREE  INITIALS  AND  SACK! 

Your  initials  engraved  FREE  on 
chest  piece:  lend  individual 
distinction  and  help  prevent 
loss.  FREE  SCOPE  SACK  neatly 
carries  and  protects  Nurse- 
scope.  Heavy  frosted  vinyl,  with 
dust-proof  press-type  closure. 

No.  2160  Nursescope 
including  Free 
Initials  and  Sack 
16.50  ea. 


METAL  CAP  TACS  Pair  of  dainty 
jewelry-quality  Tacs  with  grippers,  holds  cap 
bands  securely.  Sculptured  metal,  gold  finish, 
approx.  H"  wide.  Choose  RN,  LPfJ,  LVN,  RN 
Caduceus  or  Plain  Caduceus.  Gift  boxed. 
No.  CT-1  (Specify  Initials),  No.  CT-2  (Plain 
Cad.)  or  No.  CT-3  (RN  Cad.)  .  .  .  2.9S  or. 


TO:  REEVES  COMPANY.  Box  C  .  Attleboro.  Mass.  02703 


'IMPORTANT:  New  "Medallion"  styling  includes  tubing  in  colors  to  match 
metal  oarts.  If  desired,  add  $1.  ea.  to  price  above;  add  "M"  to  Order 
No-  2160M)  on  coupon.  UwXy  free 

LITTMANN  COMBINATION  STETHOSCOPE 

Maximum  sensitivity  from  this  fine  professional  instrument.  Con- 
venient 22"  overall  length,  weighs  only  3'^^  oz.  Chrome  binaurals 
fined  at  correct  angle.  Internal  spring,  stainless  chest  piece,  I%" 
diaptiragm.  I'/i"  bell.  Removable  non-chill  sleeve.  Gray  vinyl  tubing. 
Two  initials  engr.  on  chest  piece.  FREE  SCOPE  SACK  INCLUDED. 

No.  2100  Combo  Steth  . . .  29.70  ea.         Duty  free 


Use  extra  sheet  for  additional  items  or  orders 
INITIALS  as  desirvd:    


TO  ORDER  NAME  PINS,  fill  out  all  information  in  t»x,  top 
right,  clip  out  and  attach  to  this  coupon. 


I  enclose  $_ 


S  Please  add  50e  handling/postage 
_/  on  orders  totalling  under  $5.00 


No  COD'S  or  billing  to  individuals.  Mass.  residents  add  3%  S.  T 


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CLAYTON   DUAL  STETHOSCOPE 

Lightweight  dual  scope  imported  from  Japan;  highest 

sensitivity  for  apical  pulse  rate.  Chromed  binaurals, 

chest  piece  with  m"  bell  and  Vk"  diaphragm, 

grey  anti-collapse  tubing.  4  oz.,  29"  long.  Extra 

ear  plugs  and  diaphragm  included.  Two  initials 

engraved  free.  FREE  SCOPE  SACK  INCLUDED. 

No.  413  Dual  Steth  . . .  17.95  ea.    Duty  free 

LIGHTWEIGHT  CLAYTON  STETHOSCOPE 

Our  lowest  cost  precision  stethoscope'  Single  diaphragm  d'/s"  dia.l 
Choose  Blue,  Green,  Red,  Silver  or  Gold  tubing  and  chestpiece,  silver 
binaurals,  only  3  oz.  Three  free  initials  engraved.  FREE  SCOPF  SACK 

No.  4140  Clay.  Steth  .  .  .  11.95  ea.     Duty  free 


EXAMINING  PENLIGHT 

White  barrel  with  caduceus  imprint,  aluminum 
band  and  clip.  5"  long,  U.S.  made,  batteries  included  (re- 
placement batteries  available  any  store).  Your  own  light,  gift  boxed. 
No.  007  Penljght .  .  .  4.69  ea.  Your  Initials  engraved,  add  50«  per  llgtiL 


^ 


CADUCEUS  KEY  RING 

Clever,    unusual    horseshoe    design,    with    sculptured 
caduceus  charm.  One  knob  unscrews  for  inserting  keys. 
Strong,  secure,  no  bead  chain  to  break.  Choose  gold  or 
silver  finish. 
No.  96  Key  Ring 2.98  ea. 


SCISSORS  and  FORCEPS 


inest  Forged  Steel. 
I  Guaranteed  2  years. 


For  engraved  initials  add  50c  per  instrument 


LISTER  BANDAGE  SCISSORS 

Vh"  Mini-scissor.  Tiny,  handy,  slip  into 
uniform  pocket  or  purse.  Choose  jewelers 
gold   or   gleaming   chrome   plate    finish. 

No.  3500  3V2"  Mini 2.75 


. .  2.95 
.  .  3.25 
. .  3.75 


No.  4500  4V2"  size,  Chrome  only 
No.  5500  5V2"  size,  Chrome  only 
No.    702  7V4"  size.  Chrome  only 

51/2"   OPERATING   SCISSORS 

Polished  Stainless  Steel,  straight  blades.    — ^^ 
No.  705  Sharp/ Blunt  points  . . .  2.95 
No.  706  Sharp/ Sharp  points  . . .  2.95 

No.  7104!6"  IRIS  Scis..  Stainless.  Straight 


KELLY   FORCEPS 

So  handy  for  every  nurse!  Ideal  for  clamping 
off  tubing,  etc.  Stainless  steel,  5'/i" 

No.  25-72  Straight,  Box  Lock 4.49 

No.  725  Curved,  Box  Lock 4.49 

No.  741  Thumb  Dressing  Forcep, 

Serrated,  Straight,  5Vi"  ....  3.75 
For  engraved  initials  add  50*  per  instrument 


MEDI-CARD   SET    Handiest  reference 

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vinyl  holder  with  gold  stamped  caduceus 
No.  289  Card  Set  .  .  .  1.50  ea. 
Your   initials  gold-stamped   on   holder, 
add  50#  per  set. 


ir»« 


NURSES  BAG  A  lifetime  of  service 
for  visiting  nurses!  Finest  black  W  thick 
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Water  repellant.  Roomy  interior,  with  snap- 
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Two  rugged  carrying  straps.  6"  k  8"  x  12", 
Your  initials  gold  embossed  FREE  on  top.  An 
outstanding  value  of  superb  quality. 

No.  1544-1  Bag  (with  liner) .  .  42.50  ea. 

Extra  liner  No.  4415 8.50 


14K  G.F.  PIERCED 

EARRINGS  Dainty,  detailed  1/20  12K  G.F.  Gold 
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No.  J3/03S...  5.95  per  pair 


CROSS  PEN 

World-famous  ballpoint,  1 

sculptured  caduceus  emblem  Full  name 

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PIN  GUARD  Sculptured  caduceus,  chained 
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ENAMELED  PINS  Beautifully  sculptured  status 
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No.  205  Enam.  Pin  1.95  ea.. 


BZZZ   MEMO-TIMER    Time  hot  packs,  heat    ^.. 
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No.  M-22  Timor 5.89 


COMPLETE   SATrSFACTION   GUARANTEED!   All   prices  pos 


aring  for   Patients   with   Chronic    Renal 
Disease:  a  Reference  Guide  for  Nurses 

■Jited  by  Ginny  L.  Hansen.  132 
ages.  Philadelphia,  J.B.  Lippincott. 
^)74.  Canadian  Agent:  Lippincott, 
oronto. 

iviewed  hy  Carmelita  S.  Tolentino, 
istriictor  in  Medical-Surgical  Nurs- 

'!i>.  Health  Sciences  Centre  School  of 
tirsing.  Winnipeg,  Manitoba. 

the  preface,  the  editor  states  that  the 
rial  in  this  book  is  from  an  intensive 
course  presented  to  nurses  caring  for 
nts  with  chronic  renal  disease,   in 

Lhester  in  the  fall  of  1971 .  The  editor's 

.nil  purpose  is  for  the  book  to  be  used 

^elf-instructional  material  and  as  a 

cnce  guide,  primarily  for  the  nurse  in 

iialysis  unit  and  the  new  nurse  being 

ited  in  the  unit.""  Her  main  objective 

hat   "nursing  care  of  patients   with 

nic  renal  disease  will  be  improved 

.\ill  become  high  quality. "" 

his    book    brings    together    material 

1  physiology  and  pathology;  it  is  well 

nized    and    easy    to    read.    It    has 

rniation  involving  all  aspects  of  care 

I  a  patient  with  chronic  renal  disease, 

'uding  diseases  leading  to  its  develop- 

t.   diagnosis,   conservative   manage- 

t.   dietary   or  nutritional   aspects  of 

apy,  and  dialysis  both  in  hospital  and 

'.  .lome. 

Several  writers  have  contributed  to  the 
N.  In  the  chapter,  "" Nursing  Care  in 
\sis,'"  the  author  of  this  particular 
(in  has  given  necessary  attention  to 
lesirable  traits  and  skills  a  nurse  must 

-CSS  to  work  in  this  highly  specialized 

Information  about  common  medical 

nursing  problems  that  arise  in  dialysis 

Aritten    in    graphic    form    for    easy 

^ing,    but    more    could    have    been 
1.  luded  on  the  pathophysiology. 

'he  material  on  ""Home  Dialysis"  and 
irsing  Management  of  Home  Dialysis 
ching""  provides  a  good  example  for 
reader,  especially  the  checklist  for 
nalysis  assessment  of  patients  and  the 
I  quizzes  to  evaluate  the  teaching  and 
earning  that  have  taken  place. 
1  the  chapter  on  ""Psychosocial  Prob- 

^  related  to  Chronic  Hemodialysis,'" 
luthor  describes  in  detail  the  problems 
patient  has  to  cope  with  and  four 
ir  stresses  arising  from  these  prob- 
-.  She  also  lists  some  principles  that 
he  used  by  the  nurse  as  guidelines  to 

ct  these  needs. 

\s  a  reference  book  for  any  nurse  who 
URCH  1975 


is  caring  for  patients  with  chronic  renal 
disease  or  who  is  working  in  a  dialysis 
unit,  it  is  excellent;  it  is  also  a  good 
resource  book  for  students. 


Intensive  and  Rehabilitative  Respira- 
tory Care,  2ed.,  by  Thomas  L.  Petty. 
404  pages.  Philadelphia,  Lea  & 
Febiger,  1974.  Canadian  Agent: 
Macmillan.  Toronto. 
Reviewed  by  Marjorie  C.  Anderson, 
Assistant  Professor,  School  of  Nursing. 
University  of  Calgary,  Calgary.  Alia. 

In  this  second  edition,  the  author  again 
aims  to  bring  to  those  health  care  profes- 
sionals interested  in  respiratory  care,  an 
up-to-date  approach  to  the  management  of 
the  patient  in  acute  and  rehabilitative 
phases  of  respiratory  failure.  A  section  on 
respiratory  problems  in  the  pediatric  and 
elderly  age  group,  and  their  management, 
increases  the  comprehensiveness  of  this 
edition. 

The  first  section  of  the  book  discusses 
methods  of  care  for  acute  respiratory  fail- 
ure. The  rationale  that  this  care  should  be 
carried  out  in  a  respiratory  intensive  care 
unit  is  backed  by  longitudinal  research 
studies  that  indicate  nearly  80  percent  sur- 
vival rate  for  victims  with  respiratory  fail- 
ure thus  cared  for. 

The  methods  of  acute  respiratory  care, 
including  care  of  the  tracheostomy  and  its 
ever-present  complications,  are  based  on 
the  model  developed  at  the  University  of 
Colorado  Medical  Center.  The  rationales 
for  the  interventions  chosen  are  physiolog- 
ically sound.  Further,  these  rationales  are 
backed  by  systematic  research  that  began 
nearly  10  years  ago. 

Discussion  in  two  successive  sections, 
"Clinical  Application"  and  "Special 
Problems  of  the  Young  and  Old"  is  di- 
rected mainly  to  the  physician.  Medical 
interventions  for  major  respiratory  dis- 
eases, such  as  chronic  airway  obstruction 
and  reversible  obstructive  airway  disease, 
are  discussed,  and  also  less  commonly 
seen  respiratory  problems. 

Throughout  the  text,  the  multidiscipli- 
nary  approach  to  respiratory  care  is  stres- 
sed. Thus,  the  role  of  the  nurse  in  both  the 
acute  and  rehabilitative  pha.ses  of  respira- 
tory care  is  strongly  emphasized  by  this 
author.  The  nurse  is  seen  to  be  actively 
involved  in  the  meticulous  tracheostomy 
care,  the  management  of  respiratory  sup- 
port systems,  and  the  chest  physiotherapy 
necessary  for  all  patients  in  the  acute  phase 


of  this  illness.  Her  major  role  is  continued 
in  the  rehabilitative  phase. 

A  systematic  home  care  program  has 
been  designed  and  tested  by  the  Colorado 
center.  The  program,  as  outlined  in  the 
fourth  section  of  the  book,  is  based  upon 
education,  breathing  retraining,  and  phys- 
ical conditioning,  with  the  use  of  portable 
oxygen  therapy  to  facilitate  the  latter.  The 
nurse  is  active  in  all  phases  of  the  inhospi- 
tal  teaching  program,  and  home  follow-up 
is  done  by  the  public  health  nurse. 

A  4-year  study  demonstrated  that  this 
rehabilitation  program  decreased  the  rate 
of  pulmonary  function  decline  and  the 
number  of  hospital  days,  while  increasing 
patients'  exercise  tolerance  and  level  of 
daily  activity. 

Because  chronic  airway  obstructive  dis- 
eases are  one  of  the  most  rapidly  growing 
health  problems  in  the  United  States  and 
Canada  today,  a  publication  that  deals 
practically  with  this  problem  is  timely. 
The  ultimate  goal  is  prevention  and  early 
identification  of  the  disease,  with  de- 
velopment of  effective  methods  of  care  for 
patients  before  advanced  disease  and  disa- 
bility develop.  However,  effective 
methods  of  care  to  bring  benefit  to  patients 
already  burdened  by  severe  degrees  of 
chronic  airway  obstruction  are  important. 
This  text  has  done  much  to  achieve  this 
end. 


Practical  Concepts   in   Human   Disease 

by  Harmon  C.  Bickley.  332  pages. 
Baltimore,  Williams  &  Wilkins, 
1974.  Canadian  agent:  Burns  & 
MacEachern,  Don  Mills. 
Reviewed  hy  Marilyn  Avery.  Assistant 
Professor,  School  of  Nursing,  Memor- 
ial University,  St.  John's.  Nfld. 

This  book  provides  a  new  approach  to  the 
subject  of  pathology.  Although  short,  it 
covers  a  wide  spectrum  of  common  dis- 
eases in  a  concise  and  factual  manner.  By 
stating  the  learning  objectives  of  each  sec- 
tion and  summarizing  content  in  tabular 
form,  the  book  enables  the  student  to  re- 
view quickly. 

As  the  author  states,  the  content  in- 
cludes "material  generally  considered 
"core"  in  the  subject  of  pathology,  with  a 
few  nontraditional  subjects  added  for  good 
measure."  These  nontraditional  subjects 
include  topics  pertinent  to  the  health  of 
today's  society,  such  as  smoking,  al- 
coholism, drug  abuse,  and  fluoridation  of 
public  water  supply. 

THE  CANADIAN  NURSE     51 


Although  it  assumes  that  the  reader  has 
a  good  grasp  of  medical  terminology,  this 
book  would  be  an  excellent  text  for  the 
serious  layman  who  is  concerned  about  the 
health  of  his  community.  For  the  health 
professional,  it  is  a  good  resource  and 
means  of  quick  review. 

However,  this  book  is  not  thorough 
enough  for  a  basic  nursing  text  on  pathol- 
ogy. From  it  we  can  learn  how  a  disease 
affects  the  internal  physiology  of  the  pa- 
tient, but  not  necessarily  the  presentmg 
symptoms  or  discomforts.  In  terms  of 
nursing  needs,  this  book  would  be  useful 
as  a  reference,  quick  review,  or  sup- 
plementary text. 


Psychosocial  Aspects  of  Maternal-Child 
Nursing,  by  Gladys  B.  Lipkin.  160 
pages.  St.  Louis,  Mosby,  1974.  Cana- 
dian Agent:  Toronto,  Mosby. 
Reviewed  by  Saria  Sethi,  Assistant 
Professor.  School  of  Nursing,  The 
University  of  Calgary,  Calgary, 
Alberta. 

This  book  is  written  to  enhance  the 
nurse's  understanding  of  psychosocial 
aspects  of  the  entire  maternity  cycle. 
Significant  portions  of  the  book  are 
devoted  to  a  discussion  of  growth  and 
development  from  the  newborn  to  the 
adolescent. 

The  historical  overview  in  the  first 
chapter  is  concise,  but  interesting  and 
informative.  In  reading  through  the  book, 
one  gets  the  feeling  of  involvement  with 
the  subject  matter  and  a  desire  to  improve 
services  for  the  mother  and  her  child. 

The  author  has  illustrated  the  steps  of 
the  nursing  process  by  the  use  of  case 
histories  to  define  nursing  diagnoses, 
goals,  actions,  and  outcomes  of  the 
situation.  This  approach  makes  the  sub- 
ject matter  more  meaningful  and  chal- 
lenging. 

Principles  from  various  theories,  such 
as  crisis  theory,  role  theory,  adaptation, 
and  developmental  tasks  are  well  integ- 
rated in  the  presentation  of  the  material. 
The  emphasis  throughout  the  book  is  on 
recognition  of  psycho-social  needs  and 
provision  of  nonjudgmental  care.  Another 
encouraging  aspect  in  this  book  is  the 
author's  emphasis  on  prevention  of  prob- 
lems by  providing  anticipatory  guidance, 
according  to  the  assessed  needs  of  the 
mother  and  her  child.  She  stresses  health 
teaching  and  guidance,  rather  than  the 
performing  of  certain  technical  tasks, 
during  the  nurse's  interaction  with  her 
patient. 

In  the  chapter,  "" Preparing  Couples  for 
Labor  and  Delivery,"  the  author  discus- 
ses psychoprophylaxis  (Lamaze  method) 
in  clear,  simple  language;  the  nurse 
should  find  it  easy  to  implement  in 
guiding  expectant  parents. 

The  book  also  briefly  discusses  such 
52     THE  CANADIAN  NURSE 


concepts  as  sex  education  and  the  school 
child,  maternal  deprivation,  and  the  ter- 
minally ill  child. 

Because  the  author's  ideas  are  clearly 
discussed,  reading  is  easy,  informative, 
and  interesting.  The  material  in  this  book 
is  pertinent  and  current. 

This  book  is  a  valuable  addition  to  the 
recommended  list  of  readings  for  students 
of  diploma  and  baccalaureate  programs. 
It  also  provides  a  wealth  of  information  to 
nurses  already  functioning  in  maternal 
and  child  nursing. 


Liaison  Nursing;  Psychological  Approach 
to  Patient  Care,  by  Lisa  Robinson.  238 
pages.  Philadelphia,  Davis,  1974. 
Canadian  Agent:  Scarborough, 
McGraw-Hill  Ryerson. 
Reviewed  by  Dorothy  Froman, 
Psychiatric  Nursing  Instructor. 
Misericordia  General  Hospital  School 
of  Nursing,  Winnipeg,  Manitoba. 

The  author's  purpose  is  to  present  and 
clarify  the  importance  of  the  role  of  the 
liaison  nurse  in  the  general  hospital 
setting.  The  author  defines  the  liaison 
nurse  as  one  primarily  trained  in 
psychiatry  who  "'.  .  .brings  her  expertise 
into  the  general  hospital  to  provide  care 
for  the  mentally  disturbed  patient  suffer- 
ing from  a  physical  illness  and  also  to  aid 
the  patient  who  develops  an  iatrogenic 
illness  brought  on  by  the  stress  of 
disability  and  hospitalization." 

The  book  is  divided  into  three  sections. 
Section  1,  Theoretical  Framework,  traces 
the  development  of  liaison  nursing 
through  the  author's  personal  clinical 
experiences  and  a  review  of  the  literature. 
The  theoretical  aspect  revolves  around  the 
concept  of  anxiety  and  how  it  surfaces  in 
fairiy  predictable  behavioral  patterns. 
These  concepts  form  the  basic  philosophy 
for  reduction  of  anxiety  through  the  use  of 
short-term  therapy. 

Section  2  deals  with  "Process  in 
Liaison  Service."  Dr.  Robinson  discus- 
ses the  hospital  as  a  social  system,  with 
reference  to  professional  and  nonprofes- 
sional workers,  the  patient,  and  the  ways 
in  which  these  numerous  individuals 
relate  to  one  another  on  an  interpersonal 
basis.  She  indicates  how  the  liaison 
service  can  provide  the  means  by  which 
more  meaningful  interaction  and  relation- 
ship can  be  developed  within  the  social 
system. 


St  John  Ambulance 

needs  Registered  Nurses  to  volun 
teer  their  services  to  teach  Patient 
Care  in  The  Home.  Will  you  help? 


conta' 


ti 


Section  3,  Clinical  Problems,  dei 
with  the  various  "problem"  patier 
commonly  referred  to  the  liaison  nurs 
Some  examples  of  these  are:  the  preoper 
tive  patient,  the  dying  patient,  the  chro 
ically  ill  patient,  and  the  patient's  famil 
Many  good  suggestions  for  helping 
tients  deal  with  their  feelings  are  ( 
sented  in  this  section.  Every  nurse  rea 
ing  the  book  will  recognize  "problen: 
patients  she  has  known. 

Dr.  Robinson  never  loses  sight  of 
humanity  of  people.  Her  style  of  writir 
is  clear  and  down-to-earth.  The  book 
sprinkled    with    clinical    examples 
bring  alive  the  concepts  she  is  presentin 
This    book    should    be    a    "must' 
everyone's  reading  list.  I  highly  recor 
mend  it. 


Medical-Surgical  Nursing: 

Psychophysiologic  Approach  by  Jo, 
Luckmann  and  Karen  C.  Sorense 
1,634  pages.  Philadelphia,  W. 
Saunders,  1974.  Canadian  Agei 
Toronto,  W.B.  Saunders. 
Reviewed  by  Margaret  Arklie.  Le 
turer  in  Nursing.  Dalhousie  Unive 
sity.  Halifax,  Nova  Scotia. 

The    authors'     stated    purpose    is    "I 
provide  a  textbook  of  medical-surgiL 
nursing  that  meets  the  requirements 
current    nursing    practice."    They    hu 
carried  out  this  purpose.  i 

The  book  is  divided  into  three  maj  | 
sections.  Sections  1  and  2  inclu 
material  on  stress,  adaptation,  theories 
disease,  illness,  homeostasis,  a 
disturbances  of  homeostasis.  The  authi 
have  covered  these  areas  well, 
particular  the  unit  on  stress  and  t 
chapter  on  immobility. 

Section  3,  the  major  focus  of  the  boo 
deals  with  "Specific  Problems 
Medical-Surgical  Nursing  Practice."  Tl 
units  on  cardiovascular  disease  ai 
respiratory  disease  are  excellent.  They  a 
comprehensive  and  include  anatomy  ai 
physiology,  drugs  used  in  clinical  car 
and  diagnostic  methods,  surgery,  nursii 
care,  and  patient  teaching.  A  strong  poi 
of  this  section  is  its  emphasis  on  tl 
psychosocial  impact  of  illness  on  tl 
patient. 

I  have  one  major  criticism  of  the  boo 
The  information  in  the  chapters  on  tl 
urinary  system,  burns,  and  the  reprodu 
tive  system  is  brief  and  limited  in  i 
scope. 

The  layout  of  the  book  is  good.  Tl 
method  of  marking  important  points 
remember  is  excellent.  An  introductio 
study  guide,  and  learning  objectives  ai 
included  at  the  beginning  of  each  uni! 
which  would  be  helpful  to  the  stude 
nurse.     Reference    material,    which 
included  at  the  end  of  each  unit,  is  curre 
and     comprehensive.      The      index 

(continued  on  page  i 
MARCH  19; 


Trcivenol 
Slove/ 

"The  Problem  Solver" 


Responding  to  your  needs 
with  new  and  better 
hospital  products 


Are  his  glove 
problems 
your 
problem? 


\ 


I 


With  all  your  other  concerns  in  the  O.R.  you  don't 
need  to  hear  glove  complaints,  too.  But  a  glove 
that  causes  excessive  hand  fatigue,  tears  too  easily  or 
does  not  provide  adequate  sensitivity  can  make 
a  long  procedure  seem  even  longer  for  the  surgeon. 

Help  him  solve  his  problems. ..and  yours. ..have  him  try 
TRAVENOL  Surgeon's  Gloves -the  "problem  solver." 

TRAVENOL  Surgeon's  Gloves  are  made  of  a  strong  but 
thin  latex  which  provides  dependable  durability 
and  strength,  without  sacrificing  sensitivity.  And  a 
unique  patented  TRAVENOL  mold  forms  gloves  that 
provide  improved  fit  and  comfort  with  reduced  stress 
across  the  palm  and  less  strain  on  the  thumb  joint. 

CAUTION:  After  donning,  remove  powder  by  wiping 
gloves  thoroughly  with  a  sterile  wet  sponge,  sterile 
wet  towel,  or  other  effective  method. 


BAXTER  LABORATORIES  OF  CANADA 

DIVISION  OF  TRAVENOL  LABORATORIES,  INC 
6405  Northam  Drive,  Malton.  Ontario  L4V1J3 


(continueii  from  page  52) 

extensive   and    there    is    frequent   cross- 
referencing  between  units. 

This  book  would  be  an  asset  to  any 
nurse.  It  is  an  excellent  basic  text  for 
baccalaureate  nursing  students.  At 
present,  this  is  one  of  the  best  books  in 
this  area  of  nursing. 


Theoretical  Foundations  for  Nursing  edited 
by  Margaret  E.  Hardy.  490 pages.  New 
York,  MSS  Information  Corporation, 
1973. 

Reviewed  by  S.  Joy  Winkler,  Associate 
Professor.  School  of  Nursing,  Univer- 
sity of  Manitoba,  Winnipeg,  Man. 

This  book  of  readings  presents  and  ex- 
amines theories,  theory  development,  and 
.several  concepts  generally  used  as  founda- 
tions for  nursing  courses.  The  readings  are 
drawn  from  a  wide  variety  of  sources,  and 
both  the  health  professions  and  social  sci- 
ences are  represented  among  the  con- 
tributors. Classic  articles  and  recent  re- 
considerations of  particular  theories  are 
included,  along  with  several  original  pa- 
pers. The  editor  provides  guidelines  for 
reading  the  articles,  a  way  for  a  reader  to 
evaluate  theories  commonly  used,  and  in- 
troductory evaluative  articles  to  3  of  the 
book's  6  sections.  The  compilation  overall 
is  thought-provoking  and  stimulating. 

Theories  in  varying  stages  of  develop- 
ment are  presented,  along  with  articles  on 
the  basic  concepts  of  stress,  adaptation, 
and  crisis.  The  article  delineating  the  prob- 
lems involved  in  using  stress  theory  as  a 
basis  for  nursing  intervention  is  particu- 
larly useful. 

The  apparent  intended  goal  of  this  selec- 
tion of  readings  is  to  assist  nurses  to  make 
Judgments  about  the  rationale  identified 
for  care,  so  they  may  "act  knowledgeably 
and  responsibly  in  their  everyday  work." 
An  example  of  critical  evaluation  of  one 
nursing  theory  is  provided.  However,  if 
the  author  is  referring  to  the  average  nurse 
currently  in  practice,  I  believe  it  would  be 
difficult  for  such  a  nurse  to  use  the  book  in 
the  way  intended. 

Implicit  in  the  editor's  approach,  as  pre- 
sented in  the  keynote  article,  is  the  belief 
that  any  theory  can  be  evaluated  by  a  simi- 
lar process  regardless  of  content,  if  one 
examines  the  underlying  assumptions. 
The  high  cognitive  level  evidenced  in  the 
keynote  article  and  its  tightness  and  com- 
pression of  ideas  would  make  it  difficult  to 
follow  without  a  sound  research  and 
theoretical  background,  and  even  more 
difficult  to  apply  the  approach  in  evalua- 
tive reading  of  theories.  The  lack  of  such 
background  could  lead  to  misconstruing 
54     THE  CANADIAN  NURSE 


certain  of  the  aspects  discussed,  such  as 
the  concepts  of  mental  illness,  given  as 
examples. 

Every  article  has  merit,  and  certain  arti- 
cles are  valuable  reference  sources  for  the 
average  practicing  nurse,  but  those  are 
readily  available  elsewhere.  This  book 
would  be  a  useful  reference  for  teachers  in 
baccalaureate  programs,  and  for  graduate 
students  focusing  on  the  study  of  different 
theoretical  frameworks. 

The  printing  of  the  book  itself  is  dis- 
tracting, with  various  formats,  sizes,  and 
quality  of  print  in  different  sections.  The 
price  asked  seems  disproportionate  to  the 
quality  of  production. 


Nursing  Leadership  In  Action;   Principles 
and    Applications   to   Staff   Situations, 

2ed.,  by  Laura  Mae  Douglass  and  Em 
Olivia  Bevis.  214  pages.  St.  Louis, 
Mosby,  1974.  Canadian  Agent: 
Toronto,  Mosby. 

Reviewed  by  Mary  War  nock,  Nursing 
Service  Director,  Royal  Victoria  Hos- 
pital. Montreal,  Quebec. 

The  first  chapter,  "Theoretical  framework 
for  the  nurse-leader,"  provides  the  key 
hypothesis  that  forms  the  premises  upon 
which  the  following  six  chapters  are 
based. 

Nurses  today  are  expected  to  be  leaders. 
Leadership,  to  be  effective  and  satisfying 
to  both  employer  and  employee,  is  a 
learned  behavior  pattern  and  not  a  simple 
matter  of  inadequate,  on-the-job  training. 

The  book  deals  in  depth  with  the  princi- 
ples of  teaching  and  learning,  and  covers 
assessment,  formulation  of  objectives, 
motivation  and  reinforcement,  establish- 
ing the  learning  environment,  learning  ac- 
tivities, and  evaluation. 

A  discussion  of  predictive  principles  of 
effective  communication  between  indi- 
viduals and  groups  deals  with  perception 
of  self  and  others;  reinforcement  and  feed- 
back; communication  strategies;  goal  set- 
ting, achievement,  and  evaluation;  effec- 
tive direction  giving;  patient-centered  con- 
tent; reporting;  and  general  problem- 
solving  conferences. 

Material  on  predictive  principles  for 
delegating  authority  covers  agency 
structure,  job  descriptions,  policies  and 
procedures,  investment  of  authority, 
assignment  making,  and  measuring 
results.  Predictive  principles  for 
evaluation  deal  effectively  with  com- 
mitment, standards  of  practice  and 
criteria  of  evaluation,  and  disposi- 
tional activities. 

Predictive  principles  for  changing  are 
covered  under  the  following  headings: 
basic  ground  rules,  conditions  necessary 
for  changing,  basic  organizational  patterns 
forchanging,  and  basic  planning  strategies 
for  changing. 

Predictive  principles  of  leadership  be- 
havior looks  at  the  fundamentals  of  leader- 


ship: awareness  of  self,  knowledge  of  thi 
job,   mutual   respect,   open  channels  o 
communication,    knowledge    of   partici 
pants' capabilities,  and  environment.  Asii! 
the  preceding  6  chapters,  application  oj 
principles  follow  the  pattern  of  problem!' 
principles,  and  prescription.  ] 

This  book  is  a  valuable  asset  to  ali 
nurses,  particularly  those  in  charge  of  staf 
development. 


3 


Clinical  Pharmacology  in  Nursing  by  Mori 

ton  J.  Rodman  and  Dorothy  W.  Smith; 
701  pages.  Philadelphia,  J.B.  Lippinj 
cott.   1974.  Canadian  Agent:  Lippinig 
cott,  Toronto.  1 

Reviewed  by  Aley  P.  Thomas,  LecM 
turer.  School  of  Nursing,  University  ow 
Manitoba,  Winnipeg,  Manitoba. 

The  main  aim  of  this  book  is  to  providel 
information  about  modem  medications  to. 
suit  the  needs  of  nurses  who  are  caring  foi 
patients  in  various  clinical  situations.  The 
authors  recognize  that  the  nurse's  respon- 
sibility does  not  end  with  administering 
drugs;  she  must  possess  the  necessarv 
knowledge  about  their  effects  on  the  pa- 
tient. Often  the  nurse  must  also  teach  the 
patient  and  his  family  the  proper  use  of 
drugs  to  produce  maximum  therapeutic 
benefits. 

With  this  lofty  conception  of  the  crucial 
role  that  the  nurse  has  to  play  in  the  health 
care  system,  the  authors  have  not  chosen 
to  present  detailed  data  about  individual 
drugs  of  each  class,  but  rather  to  enlighten 
the  nurse  about  the  reasons  for  the  use  of 
different  classes  of  drugs  in  treatment.  On 
the  whole,  the  authors  have  been  success- 
ful in  carrying  out  this  task. 

A  brief  historical  introduction  to  phar- 
macology is  followed  by  discussion  of 
general  principles  of  pharmacology;  drugs 
that  affect  mental  and  emotional  function 
and  behavior;  drugs  u.sed  in  musculo- 
skeletal disorders,  neurological  disorders, 
pain,  inflammation,  allergy  and  related 
disorders,  endocrine  disorders,  infections, 
diagnostic  tests;  and  drugs  acting  on  the 
autonomic  neuro-effectors,  the  heart,  and 
circulation. 

Discussion  of  drugs  used  for  diagnostic 
purposes  will  be  valuable  to  both  the 
graduate  and  student  nurse.  Discussion  of 
clinical  nursing  situations,  which  appear 
in  several  chapters,  are  presented  with 
clarity  and  insight  and  will  be  useful  for 
self-learning. 

At  least  some  readers  may  find  the 
lengthy  discussions  on  anatomy,  physiol- 
ogy, and  pathophysiology  —  sup- 
plemented with  diagrams  —  somewhat  re- 
dundant in  a  book  on  pharmacology,  as 
these  areas  are  fully  covered  in  other  nurs- 
ing texts. 

There  is  a  surprising  neglect  of  drug 

dosages  for  children.  There  is  no  mention 

of  children's  dosage  of  such  widely  used 

(continued  on  page  56) 

MARCH  1975 


New...readytouse... 
"bolus"  prefilled  syringe. 

Xylocaine'100  mg 

(lidocaine  hydrochloride  Injection,  USP) 

For  'Stat'  I.V.  treatment  of  life 
threatening  arrhythmias. 

n  Functions  like  a  standard  syringe. 

D  Calibrated  and  contains  5  ml  Xylocaine2%. 

D  Package  designed  for  safe  and  easy 
storage  in  critical  care  area 

n  The  only  lidocaine  preparation 
with  specific  labelling 
information  concerning  its 
use  in  the  treatment  of  cardiac 


an  original  from 

ASTirA 


Xylocaine*  100  mg 

(lidocaine  hydrochloride  injection  USP) 

INDICATIONS— Xylocaine  administered  intra- 
venously is  specifically  indicated  in  the  acule 
management  off  I )  ventricular  arrhvthmtas  occur- 
nng  during  cardiac  manipulation,  such  as  cardiac 
surgery;  and  (2)  life-threatening  arrhythmias,  par- 
ticularly those  which  are  ventricular  m  ongin.  such 
as  occur  during  acute  myocardial  infarction. 

CONTRAINDICATIONS-Xylocaine  is  contra- 
indicated  (I)  in  patients  with  a  known  hisior\  of 
hypersensitivity  to  local  anesthetics  of  the  amide 
type:  and  (2)  in  patients  with  Adams-Stokes  syn- 
drome or  with  severe  degrees  of  smoatrial.  atrio- 
ventricular or  intraventricular  block. 

WARNINGS-Conslant  monitonng  with  an  elec- 
trocardiograph is  essential  in  the  proper  adminis- 
tration of  Xylocaine  intravenouslv.  Signs  of  exces- 
sive depression  of  cardiac  conductivity,  such  as 
prolongation  of  PR  interval  and  QRS  c-omplex 
and  the  appearance  or  aggravation  of  arrhythmias, 
should  be  followed  by  prompt  cessation  of  the 
intravenous  infusion  of  this  agent.  It  is  mandatory 
to  have  emergency  resuscitative  equipment  and 
drugs  immediately  available  to  manage  possible 
adverse  reactions  involving  the  cardiovascular. 
respiratory  or  central  nervous  systems. 
Evidence  for  proper  usage  in  children  is  limited. 

PRECAUTIONS -Caution  should  be  employed 
in  the  repeated  use  of  Xylocaine  in  patients  with 
severe  liver  or  renal  disease  because  accumulation 
may  occur  and  may  lead  to  toxic  phenomena,  since 
Xvlocaine  is  metabolized  mainly  in  the  liver  and 
excreted  by  the  kidnev  The  drug  should  also  be 
used  with  caution  in  patients  with  hypovolemia 
and  shock,  and  all  forms  of  heart  block  (see  CON- 
TRAINDICATIONS AND  WARNINGS) 

In  patients  with  sinus  bradycardia  the  adminis- 
tration of  Xylocaine  intravenously  for  the  elimina- 
tion of  ventricular  ectopic  beats  without  prior 
acceleration  in  heart  rate  (eg  by  isoproterenol 
or  by  electnc  pacing)  may  provoke  more  frequent 
and  serious  ventricular  arrhythmias. 

ADVERSE  REACTIONS-Systcmic  reactions  of 
the  following  types  have  been  reported. 

(1)  Central  Nervous  System:  lightheadedness, 
drowsiness:  dizziness:  apprehension:  euphoria: 
tinnitus:  blurred  or  double  vision:  vomiting:  sen- 
sations of  heal,  cold  or  numbness,  twitching: 
tremors:  convulsions:  unconsciousness:  and  respi- 
ratory depression  and  arrest. 

(2)  Cardiovascular  System:  hypotension;  car- 
diovascular collapse:  and  bradycardia  which  may 
lead  to  cardiac  arrest- 
There  have  been  no  reports  of  cross  sensitivity 

between  Xylocaine  and  procainamide  or  between 
Xylocaine  and  quinidine. 

DOSAGE  AND  ADMINISTRATION-Single 
injectioa:  The  usual  dose  is  50  mg  to  100  mg 
administered  intravenously  under  ECG  monitor- 
ing. This  dose  may  be  administered  at  the  rate 
of  approximately  25  mg  to  50  mg  per  minute. 
Sufficient  time  should  be  allowed  to  enable  a  slow 
circulation  to  earn,  the  drug  to  the  site  of  action. 
If  the  initial  injection  of  50  mg  to  100  mg  does 
not  produce  a  desired  response,  a  second  dose  may 
be  repeated  after  10-20  minutes. 

NO  MORE  THAN  200  MG  TO  300  MG  OF 
XYLOCAINE  SHOULD  BE  ADMINISTERED 
DURING  A  ONE  HOUR  PERIOD 

In  children  experience  with  the  drug  is  limited. 

Continuous  Infusion:  Following  a  single  injection 
in  those  patients  in  whom  the  arrhythmia  tends 
to  recur  and  who  are  mcapable  of  receiving  oral 
antiarrhythmic  therapy,  intravenous  infusions  of 
Xylocaine  mav  be  administered  at  the  rate  of  I 
mgio2  mg  per  minute  (20  to  25  ug/kg  per  minute 
in  the  average  70  kg  man).  Intravenous  infusions 
of  Xvlocaine  must  be  administered  under  constant 
ECG  monitoring  to  avoid  potential  overdosage 
and  toxicity.  Intravenous  infusion  should  be  ter- 
minated as  soon  as  the  patients  basic  rhythm 
appears  to  be  stable  or  at  the  earliest  signs  of 
toxicity.  It  should  rarely  be  necessary  to  continue 
intravenous  infusions  beyond  24  hours.  As  soon 
as  possible,  and  when  indicated,  patients  should 
be  changed  to  an  oral  antiarrhythmic  agent  for 
maintenance  therapy. 

Solutions  for  intravenous  infusion  should  be 
prepared  by  the  addition  of  one  50  ml  single  dose 
vial  of  Xvlocaine  2*?  or  one  5  ml  Xylocaine  One 
Gram  Disposable  Transfer  Synnge  to  I  liter  of 
appropriate  solution.  This  will  provide  a  Q.\% 
solution:  that  is.  each  ml  will  contain  I  mg  of 
Xylocaine  HCI.  Thus  1  ml  to  2  ml  per  minute 
will  provide  I  mg  to  2  mg  of  Xylocaine  HCI  per 
minute. 


(continued  from  page  54) 

drugs  as  aspirin.  Although  there  is  a  brief 
discussion  of  drug  interactions  in  an  early 
chapter,  incompatibility  is  not  discussed  in 
any  systematic  way. 

Some  may  also  question  the  author's 
categorical  assertion  that  "no  medication 
should  ever  be  administered  without  a 
doctor's  order"  (p. 70).  Although  the 
nurse  should  not  usurp  the  doctor's  role, 
there  are  exceptional  circumstances  when 
the  nurse  may  be  called  on  to  administer 
medications  without  a  doctor's  order.  One 
might  also  take  exception  to  the  inter- 
changeable use  of  "antineoplastic  drugs" 
and  "anti-cancer  drugs"  (p.  635-40). 

The  statement  that  "estrogens  are  not 
known  to  cause  cancer  in  human  patients" 
is  likely  to  raise  Canadian  eyebrows  be- 
cause there  is  growing  scientific  evidence 
suggesting  involvement  of  estrogen  in 
cancer  causation.  The  Canadian 
government's  reluctance  to  import  DES- 
fed  U.S.  beef  into  Canada  is  the  direct 
consequence  of  the  growing  scientific 
knowledge    linking    DES    with    cancer. 

However,  these  are  minor  flaws  in  an 
otherwise  well-written  and  valuable  text- 
book. 


Basic  Psychiatric  Concepts  in  Nursing  3ed. 
by  Joan  Kyes  and  Charles  K.  Hofling. 
527  pages.  Philadelphia,  J.B.  Lippin- 
cott,  1974.  Canadian  Agent:  Lippin- 
cott.  Toronto. 

Reviewed  by  Gail  Gitterman.  Instruc- 
tor, Nursing  Department.  Ryerson 
Polytechnical  Institute,  Toronto, 
Ontario. 

The  authors'  objectives  are  to  present  a 
clear  description  of  psychiatric  theory  and 
to  present  nursing  care  material  that  will 
enable  the  reader  to  move  from  the  theoret- 
ical to  the  operational  level.  As  it  applies 
to  the  medical  model,  the  authors  have 
achieved  their  purpose. 

The  book's  contents  travel  from  simple 
to  complex  theory,  and  from  a  health  to 
illness  theme.  The  reader  is  introduced  to 
mental  health  concepts  and  personality 
theory,  and  then  proceeds  to  explore  the 
neuroses  and  the  psychoses. 

Information  is  presented  clearly,  and 
ample  opportunity  is  made  of  presenting  a 
case  study  to  relate  the  nursing  interven- 
tion to  psychiatric  theory.  For  example, 
the  dynamics  of  hysterical  neurosis  is  out- 
lined along  with  symptomatology  and 
nursing  principles.  A  case  study  follows  of 
a  young  girl  suffering  from  conversion 
neurosis,  which  indicates  the  nursing  care 
and  the  thinking  on  which  the  nurse  based 
her  actions.  As  well,  the  authors  use  case 
56     THE  CANADIAN  NURSE 


studies  liberally  to  help  the  reader  gain  a 
clear  understanding  of  the  dynamics  of 
various  psychopathologies. 

The  authors  have  earnestly  attempted  to 
display  the  importance  of  nursing  inter- 
vention in  the  psychiatric  setting,  and  also 
the  importance  of  applying  psychiatric 
principles  to  a  variety  of  nursing  environ- 
ments. The  impact  of  this  attitude  is 
somewhat  dissipated  within  the  context  of 
the  medical  model. 

I  would  recommend  this  book,  as  it  is 
designed,  for  the  undergraduate  student  of 
nursing.  The  readings  included  at  the  end 
of  each  chapter  are  eclectic  and  valuable 
and.  therefore,  offer  the  student  much 
more  than  what  is  contained  between  the 
covers.  As  a  basic  textbook  for  a  course  in 
psychiatric  nursing,  it  has  much  merit. 
Along  with  it,  I  would  encourage  the  use 
of  material  that  would  expand  on  nursing 
theory. 


Operating  Theatre  Technique,  3ed.,  by 
Raymond  J.  Brigden.  698  pages. 
Edinburgh,  Churchill  Livingstone, 
1974.  Canadian  Agent:  Longman,  Don 
Mills. 

Reviewed  by  Paulette  Parker,  Teacher 
OR  and  RR.  Algonquin  College  Nurs- 
ing Program,  Parkdale  Campus, 
Ottawa.  Ontario. 

This  book  is  an  improvement  over  the  first 
and  second  editions.  It  is  a  comprehensive 
text  for  both  the  graduate  nurse  in  the 
operating  room  and  for  students  whose 
curriculum  includes  the  operating  room 
experience. 

Although  it  goes  into  detail  about  setups 
and  equipment  used  for  each  type  of 
surgery,  the  book  deals  essentially  with 
the  fundamentals  necessary  to  understand 
how  the  operating  room  functions.  It  cov- 
ers design  of  the  rooms  and  specialized 
equipment. 

The  text  outlines  safety  measures  for  the 
staff  and  the  patient,  which  are  of  particu- 
lar interest  to  the  student  in  her  understand- 
ing of  the  operating  room.  These  will,  of 
course,  help  to  influence  the  student's 
preoperative  care  of  the  patient. 

The  author  gives  a  brief  description  of 
the  surgery,  the  position  the  patient  is 
placed  in,  the  setup  used,  and  then  a  brief 
outline  of  the  procedure.  This  is  a  good 
quick  reference  for  the  student  going  to 
observe  the  surgery. 

The  chapter  on  anesthetics  is  of  benefit 
to  all  nurses:  it  covers  the  importance  of 
maintaining  a  good  airway,  and  gives  two 
methods.  This  section  also  explains 
clearly  the  importance  of  not  talking  while 
the  patient  is  being  anesthetized,  because 
it  is  felt  that  the  patient's  hearing  can  be- 
come more  acute  during  induction. 

The  section  defining  technical  terms  is 
good  and  will  benefit  all  who  coine  in 
contact  with  the  operating  room.  In  this 
edition,  there  is  a  new  section  on  cardiac 


arrest,  which  is  basic  but  concise  enouglj 
for  most  graduates  to  understand. 

The  author  certainly  has  updated  several 
aspects  of  this  text.  The  book  can  be  useoT 
by  both  students  and  staff  in  the  operating 
room . 


Essentials  of  Psychiatric  Nursing,  9ed..  t 

Dorothy  A.  Mereness  and  Cecel 
Monat  Taylor.  356  pages.  St.  Loui 
Mosby,  1974.  Canadian  agent:  Mosb 
Toronto. 

Reviewed  by  Dorothy  M .  Pringle, 
rector.  Laurentian  University,  Scf, 
of  Nursing,    Sudbury,    Ontario; 
merly        Clinical        Coordinatt 
Psychiatry,  Holy  Cross  Hospital,  C& 
gary. 

The  latest  revision  of  this  standard 
psychiatric  text  incorporates  few  change: 
from  the  1970  edition.  It  continues  to  bii 
oriented  largely  to  the  management  of  pa- 
tients who  are  hospitalized  for  severa 
months  in  large  psychiatric  institutions 
The  book  covers  the  waterfront  o) 
psychiatry  and  psychiatric  nursing  and,  as 
a  result,  is  superficial  in  many  areas,  par 
ticularly  those  related  to  personality  de 
velopment  and  current  psychiatric  treat 
ment  modalities. 

In  the  preface,  the  authors  explain  thai 
they  have  reorganized  and  updated  the 
content,  recognizing  that  much  present 
day  treatment  is  not  hospital  based.  In  real- 
ity, they  devote  141  pages  to  inpatient 
treatment  specifically  and  24  pages  to  the 
community.  For  instance,  insulin  shock 
therapy  is  described  in  4  pages  and  family  j 
therapy  in  less  than  a  page.  i 

A  statement  of  beliefs  basic  to  psychiat- 
ric nursing,  which  is  included  at  the  begin- 
ning of  the  text,  is  a  valuable  addition.  The 
philosophy  of  man  as  a  unified  system  and 
the  implications  of  this  for  psychiatric 
nursing  are  well  described.  In  this  section, 
nursing  is  described  as  a  process  through 
which  the  patient  develops  a  more  positive 
self-concept  and  better  interpersonal  rela- 
tionships. It  is  unfortunate  that  the  re- 
mainder of  the  book  is  not  built  upon  these 
statements.  Perhaps  future  editions  willi 
extend  this  approach  and  result  in  updated 
nursing  diagnoses  and  approaches. 
Beyond  the  first  chapter,  there  is  a  recur- 
rent theme  that  nurses  are  not  agents  of 
therapy  in  psychiatry,  but  rather  managers 
of  the  environment,  while  the  social  work- 
ers, psychiatrists,  and  psychologists  con- 
duct any  psychotherapy  in  which  the  pa- 
tient is  involved. 

The  chapters  on  mental  health  and  men- 
tal illness,  developing  self-understanding, 
the  therapeutic  use  of  self,  and  some  as- 
pects of  coinmunication  theory  and  skills 
contain  material  that  is  easily  com- 
prehended and  could  be  helpful  to  begin- 
ning students.  The  chapters  on  working 
(continued  on  page  58) 
MARCH  1975 


New  style 


Clinical  studies  have  shown  that  SELSUN  controls  up  to 
95%  of  simple  dandruff  cases'  and  87%  of  cases  of 
seborrheic  dermatitis^ 

Controlling  seborrhea  is  vital  to  best  results  in  treating  such 
skin  conditions  as  acne,  blepharitis  and  otitis  externa. 

Precautions  and  side  effects:  Keep  out  of  the  eyes;  burning 
or  irritation  may  result.  Avoid  application  to  inflamed  scalp 
or  open  lesions.  Occasional  sensitization  may  occur. 


Selsun 

selenium  sulfide  lotion,  Abbott  Standard. 

No  more  reliable  dandruff 
treatment  anywhere 


1.  Slinger,  W.N.  and  Hubbard,  D.M.,  Treatment  of  Seborrheic  Dermatitis  with  a  Shampoo  containing 
Selenium  Sulfide.  A.f^.A.  Arch.  Dermat.  &  Syph..  64:41,  1951. 

2.  Bereston,   E.S..   Use  of  Selenium  Sulfide  Shampoo   in   Seborrheic   Dermatitis,   J. A.M. A.,    156:1246, 
1954. 


*RD.  T.M. 


437450 


(continued  from  page  56) 

with  patients  in  hospital  settings  are  dis- 
guised with  behavioral  titles. 

In  fact,  they  are  oriented  to  traditional 
treatment  and  labeling  of  psychiatric  ill- 
ness, such  as  schizophrenia  or  manic  de- 
pressive psychoses.  There  are  useful  sug- 
gestions in  these  areas  but  nothing  new  or 
imaginative.  The  case  studies  are  of  ex- 
treme pathology  and  describe  only  etiol- 
ogy and  behavior,  not  nursing  care.  These 
chapters  contain  good  bibliographies  of 
past  and  current  journal  articles. 

In  summary,  this  text,  although  revised, 
is  still  outdated  in  many  aspects  of  its  pre- 
sentation. Nursing  students  could  use  parts 
of  it  as  a  reference,  but  it  is  not  recom- 
mended as  a  text  for  students  in  up-to-date 
psychiatric  nursing  courses. 


AV  aids 


SLIDE/SOUND  PROJECTION 

n  A  compact  slide  show,  which  is  com- 
pletely portable  and  lightweight,  is  avail- 
able from  Rutherford  Audio  Visual,  21 1 
Laird  Drive,  Toronto,  Ontario  M4G 
3W8. 

The  AVCOM  psS-812  slide  show  will 
accept  any  Ektagraphic  35mm  slide  pro- 
jector. It  is  available  with  or  without  an 
automatic  slide/sound  synchronizer,  and 
has  a  large  rear  screen  (8x12  inches)  that 
provides  a  clear  image  —  even  in  a 
brightly  lit  room.  Front  projection  is 
available  with  an  auxiliary  attachment. 

Easy  to  use  in  any  situation,  this  unit  is 
said  to  be  ideal  for  presentations  in 
classrooms  and  for  training  programs. 

PORTABLE  TAPE  SYSTEM 

n  Medical  Translator,  a  new  system  that 
enables  emergency  room  staff  to  com- 
municate immediately  with  Spanish- 
speaking  patients,  is  available  from  Teach 
'em  Inc.,  625  North  Michigan  Avenue. 
Chicago.  Illinois  6061  1 .  U.S.A. 

This  system,  which  features  an  addi- 
tional tape  loop  permitting  nurses  and 
doctors  to  ask  questions  and  give 
Spanish-speaking  patients  directions, 
eliminates  the  need  for  interpreters.  It  is 
operated  by  dialing  the  statement  or 
question  desired  and  pushing  a  button  for 
playback.  An  off/on  volume  control 
switch  is  the  only  other  control  on  the 
unit. 

The  Medical  Translator  system  in- 
cludes a  lightweight  tape  unit  and  case, 
long-life  battery,  two  pre-recorded  belts 

58     THE  CANADIAN  NURSE 


with  50  statements  and  questions  re- 
corded in  Spanish,  and  cue  cards  showing 
the  English  equivalents  of  the  statements 
and  questions. 

LITERATURE  AVAILABLE 

nWhat  You've  Wanted  to  Know  about 
Helping  the  Handicapped.  But  Were 
Afraid  to  Ask  is  a  pocket-and-purse-sized 
guide  that  answers  such  questions  as  what 
to  do  when  coping  with  dressing,  toileting, 
and  feeding  a  handicapped  person,  the  best 
and  easiest  method  for  geltmg  a  wheel- 
chair into  a  car  and  even  "how  to  over- 
come your  embarrassment.""  The  booklet 
to  help  volunteers  overcome  their  fear  and 
apprehension  is  available  free  of  charge 
from  the  March  of  Dimes,  12  Overiea 
Blvd.  Toronto  Ont. 

n  Metropolitan  Life  has  published  in 
French  and  English,  a  new  booklet 
Mothers  at  Work.  The  16-page  pamphlet 
covers  such  topics  as  shortcuts  to  lighten 
housekeeping  tasks,  parent-child  rela- 
tionships, effects  on  the  family  when 
mother  goes  to  work  outside  the  home, 
and  precautions  to  maintain  the  mother"  s 
health. 

The  back  page  of  the  booklet  has  space 
to  list  essential  telephone  numbers  and  the 
suggestion  that  children  should  be  taught 
how  to  telephone  for  help  in  an  emer- 
gency. 

The  booklet  is  available  free  of  charge 
from:  Metropolitan  Life,  180  Wellington 
Street,  Ottawa,  Ontario,  KIP  5A3. 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses"  Association  library  are 
available  on  loan  —  with  the  exception  of 
items  marked  R  —  to  CNA  members, 
schools  of  nursing,  and  other  institutions. 
Items  marked  R  include  reference  and 
archive  material  that  does  not  go  out  on 
loan.  Theses,  also  R,  are  on  Reserve  and 
go  out  on  Interiibrary  Loan  only. 

Requests  for  loans,  maximum  3  at  a 
time,  should  be  made  on  a  standard  Inter- 
library  Loan  form  or  on  the  "" Request 
Form  for  Accession  List'"  printed  in  this 
issue. 

If  you  wish  to  purchase  a  book,  contact 
your  local  bookstore  or  the  publisher. 

BOOKS  AND  DOCUMENTS 

1  Anticomulsani  therapy.  Pharmacological  basis 
and  practice,  by  Mervyn  J.  Eadie  and  John  H.  Tyrer. 
Edinburgh.  Churchill  Livingstone,  1974.  204p. 

2.  Basic  physiology  and  anatomy,  by  Ellen  E.  Chaf- 
fee and  Esther  M.  Greisheimer.  3ed.  Toronto,  Lip- 
pincotl,  cl974.  559p. 

3.  Becoming  a  nurse:  the  registered  nurses'  view  of 
general  student  nurse  education,  by  Nelida  L.amond . 


London,  Royal  College  of  Nursing  and  National 
Council  of  Nurses  of  the  United  Kingdom,  cl974. ' 
90p.  ! 

4.  Bowel  function  in  hospital  patients,   by   Leslie 
Wright.  London,  Royal  College  of  Nursing.  1974.  i 
124p.  (The  study  of  nursing  care  project  reports. 
Ser.l.no.4) 

5.  The  aba  Collection  of  medical  illustrations, 
Vol.6  Kidneys,  ureters  and  urinary  bladder,  by 
Frank  Henry  Netter.  Summit,  N.J..  Ciba  Phar- 
maceutical, cl973.  29.Sp.  R 

6.  Community  health  services  in  the  health  care  de- 
livery system.  Papers  presented  at  four  open  forums 
at  Biennial  Convention,  Minneapolis,  May  6-10. 

1973.  New  York,  National  League  for  Nursing. 
cl974.  86p. 

7.  Dietary  control  of  cholesterol:  low-saturated-fat 
meal  plans  for  the  entire  family  model 
menus /delicious  recipes/calorie-controlled  diets 
Montreal,  1973.  47p. 

8.  Documents  de  reference  de  la  Conference 
panamericaine  sur  la  Planification  du  Personnel  de 
la  Same  Here.  Ottawa.  10-14  sept.  1973,  Washing- 
Ion,  Organisation  panamericaine  de  la  Sante.  1974 
3v. 

9.  The  drug,  the  nurse,  the  patient,  by  Mary  W. 
Falconer  et  al  .Sed.  Toronto,  Saunders.  1974.  62  Ip. 
Bound  with:  Current  drug  handbook. 

10.  Essays  in  science  and  philosophy,   by   Alfred 
North  Whitehead.  New  York,  Philosophical  Library,  j 
cl947.  348p.  I 

1 1 .  The  fitness  myth:  a  new  approach  to  exercise,  by 
Fern  Labo.  Toronto,  Lester  and  Orpen,  c  1974.  1 52p. 

12.  Folio  of  reports.  1974.  Montreal,  Association  of 
Nurses  of  the  Province  of  Quebec.  50p. 

1 3 .  Gowland  and  Cairney's  anatomy  and  physiology 
for  nurses.  8ed.  rev.  and  ed.  by  WE.  Adams  and 

D.W.  Taylor.  Christchurch,  New  Zealand.  Peryer. 

1974.  528p. 

14.  Insects  and  disease .  by  Keith  R.  Snow.  London. 
Routledge  and  Kegan  Paul,  cl974.  208p. 

15.  ,4n  introduction  to  community  work,  by  Fred 
Milson.  London,  Routledge  and  Kegan  Paul,  1974. 
153p. 

16.  An  introduction  to  human  physiology,  by  David 
F.  Horrobin.  Philadelphia,  Davis,  cl973.   176p. 

17.  Laboratory  manual  in  physiology  and  anatomy, 
with  study  guide  questions  and  practical  applica- 
tions, by  Ellen  Chaffee.  3ed.  Toronto.  Lippincott, 
cl974.  236  p. 

18.  Labour  force  and  world  population  growth. 
Geneva.  International  labour  Office.  1974.  78p. 
(Bulletin  of  labour  statistics.  Special  edition) 

19.  Main  d'oeuvre  et  croissance  demographique 
mondiale.  Geneve,  Bureau  international  du  Travail, 
1974.  78p.  (Bulletin  des  statistiques  du  travail. 
Edition  speciale) 

20.  Manual  for  nurses  in  family  and  community 
health,  by  Helen  Cohn  and  Joyce  E.  Tingle.  2ed. 
Boston,  Little.  Brown.  1974,  99p. 

21.  Manuel  de  I'infirmier  en  psychiatrie.  par  Paul 
Bernard.  2ed.  Paris.  Masson,  1974.  434p. 

22.  Membership  director)-.  Chicago.  111..  American 
Library  Association,  1974.  272p. 

23 .  Mental  health  concepts  in  medical-surgical  nurs- 
ing: a  workbook,  by  Carol  Ren  KneisI  and  Sue  Ann 
Ames.  St.  Louis,  Mosby.  1974.  I59p. 

24.  Nurse  —  /  want  my  Mummy!  By  Pamela  J. 
Hawthorn .  London ,  Royal  College  of  Nursing ,  1 974. 

(continued  on  page  60) 

MARCH  1975 


Your  patients 
will  amaze 
you  . . . 


^ 
^ 


so  will  retelast  ''^ 

Your  patients  will  be  back  to  normal  in  no 
time  and  ready  to  start  their  activities  as  if 
nothing  happened. 

NOT  SURPRISING  .  .  . 

RETELAST  is  so  comfortable  and  gives 
such  fast  relief.  Moreover,  RETELAST 
costs  up  to  40%  less  than  any  other 
dressing  or  traditional  bandage. 


d? 


OCTO  LABORATORY  LTD  . 
Laval.  Quebec 

CANADA  PHARMACAL  CO   LTD  . 
Toronto.  Ontario 


JlA^iA. 


DEMONSTRATION 
AND  FOLDERS 
UPON  REQUEST 


accession  list 


(continued  from  page  58) 

22  i  p.  (The  slutly  of  nursing  care  project  rcpons.  Ser. 

I.  no.  3) 

25.  Le  nursing  en  same  communaulaire .  Memoire 
presente  cm  minisrre  iles  Affaires  sociales.  Montreal . 
L'Ordre  de>  Infiriiiieres  et  Intlrmiers  du  Quebec, 
1974.  5lp. 

26.  Le  nursing;  el  ia  loi  canaJienne.  par  Shirlc\  R 
Good  el  Janel  C.  Keer.  Traduit  par  Magdeleine 
Deland  Mailhiot  Montreal,  hditions  HRW.  cl974. 
I74p. 

27.  .VHrv/'/i,?  leadership  in  action:  principles  ami  ap- 
plication to  staff  situations,  by  Laura  Mae  Dougla.ss 
and  E.M.  Olivia  Bevi>.  2ed.  St.  Louis,  Mosby, 
1974.  2l4p. 

28.  Obstetrics  illustrated,  by  Matthew  M.  Garrey  et 
al.  2ed.  London.  Churchill  Livingstone.  1974.  538p. 

29.  Orientation  and  evaluation  of  the  professional 
nurse,  by  Mildred  Milliard,  .St.  Louis,  Mosby,  1974. 

I68p. 

30.  Precis  de  neriatrie,  par  Eric  Martin  et  Jean- 
Pierre  Junod.  Paris,  Masson,  1973.  4l.'ip. 

31.  The  process  of  staff  development:  components 
forchange.  by  Helen  M.  Tobin,etal.  St.  Louis,  Mo., 

Mosby,  1974.  174p 

32.  Rapport.  1974.  Montreal,  Association  des  In- 
firmieres  el  Infirmiers  du  Quebec.  5lp. 

33.  Report,  1973-4.  Ottawa  International  Develop- 
ment Research  Centre,  1974    80p. 

34.  Report  of  Council  on  Collegiate  Education  for 
Nursing  2 1  St  Meeting.  April  3-5.  1974.  Atlanta,  Ga., 
Southern  Regional  Education  Board,  1974.  134p. 
3.'i.  Response  to  changing  needs.  Papers  presented 
at  the  twelfth  conference  of  the  Council  of  Bac- 
calaureate and  Higher  Degree  Programs.  Denver. 
Colorado.  March  20-22,  1974.  New  York,  National 
League  for  Nursing,  cl974.  73p. 

36.  Rocaberant  ou  les  tribulations  d'  une  jeune  infir- 
mi'ere  chez  les pionniers  de  r.4bitibi,  par  Nicole  de  la 
Chevroliere.  (Berith)  Montreal,  Sondcc  cl974. 
208p. 

37.  Scientific  principles  in  nursing,  by  Shirley 
Ha\\ke  Gragg  and  Olive  M.  Rees.  7ed.  St.  Louis, 
Mo.sby,  1974.  56.3p. 

38.  Tender  loving  greed:  him  the  incredibly  lucra- 
tive nursing  home  "Industry"  is  exploiting 
America's  old  people  and  defrauding  us  all,  by  Mary 
Adelaide  Mendelson.  New  York,  Alfred  A.  Knopf. 
1974.  245p. 

39.  Your  future  in  nursing  careers,  by  Alice  M. 
Robinson  and  Mary  E.  Reres.  New  York,  Richards 
Rosen,  1972.   I13p.  (Careers  in  depth  m\  99) 

40.  Writing  for  results  in  business,  government  and 
the  professions,  by  David  W.  Ewing.  Toronto. 
Wiley.  1974.  466p. 

PAMPHLETS 

41.  Baccalaureate  education  in  nursing:  key  to  a 
professional  career  in  nursing  —  1974-75.  New 
York.  National  League  for  Nursing.  Dept.  of  Bac- 
calaureate and  Higher  Degree  Programs,  1974.  23p. 
R 

42.  Basic  education  of  nursing  personnel  in  Canada. 
Address  by  Helen  Kathleen  .Mussallem  to  King's 
Fund  Seminar  of  Nurses.  London.  England.  1974. 

60     THE  CANADIAN  NURSE 


Ottawa.  1974.  9p. 

43.  Board  members'  handbook.  Vancouver.  Regi.s- 
tered  Nurses  Association  of  British  Columbia.  1974. 
15p. 

44.  Constitution.  Toronto.  Ontario  Nurses  Associa- 
tion. 1974.  32p 

45  Continuing  education  programs  in  British 
Columbia.  Policies,  procedures,  criteria  for  ap- 
proval. Vancouver.  Registered  Nurses  Association 
of  British  Columbia.  1974.  8p. 

46.  How  to  conduct  better  performance  appraisal 
interviews,  by  Robert  L.  Noland  and  Joseph  J. 
Moyland.  Springdale.  Conn..  Motivation.  1970. 
cl967.  3lp. 

47.  The  nurse  in  primary  health  care:  a  review  of 
recent  literature,  by  Phyllis  E.  Jones.  Toronto.  1974. 

17p. 

48.  Nurses'  guide  to  Canadian  drug  legislation,  by 
David  R.  Kennedy.  Toronto.  Lippincott.  cl973. 
I7p.  Published  for  use  with  Rodinan.  Mortin  J.. 
Pharmacology  and  drug  therapy  in  nursing. 

49.  Recommendations  of  Joint  Committee  on  the  £v- 
panded  Role  of  the  Nurse  in  British  Columbia. 
Vancouver.  1973.  6p. 

50.  Recommendations  of  National  Conference  on 
School  Heahh.  Ottawa.  October  29-.?/,  1972.  Ot- 
tawa. .Metropolitan  Life  Insurance  Co..  1973.  8p. 

5 1 .  Selected  readings  from  open  curriculum  litera- 
ture. An  annotated  bibliography.  New  York.  Na- 
tional League  for  Nursing.  cl974.  I7p. 

52.  Summary  of  the  report  of  Commission  on  Educa- 
tion for  Health  Administration.  Ann  Arbor,  Mich., 
Health  Administration  Press.  1974.   16p. 

53.  Today's  conceptual  framework:  its  relationship 
to  the  curriculum  development  process,  by  Gertrude 
Torres  and  Helen  Yura.  New  York.  Dept.  of  Bac- 
calaureate and  Higher  Degree  Programs.  National 
League  for  Nursing.  cl974.   12p. 

GOVERNMENT  DOCUMENTS 

Canada 

54.  Dept.  of  Labour.  Measuring  the  quality  of  work- 
ing life.  Proceedings  of  Symposium  on  Social  Indi- 
cators of  Working  Life,  Ottawa,  March  19  and  20, 
1973.  Edited  by  Alan  H.  Ponigal.  Ottawa.  cl974. 
280p.  "New  Research  Initiatives.  Research  and 
Development  Program." 

55.  Health  and  Welfare  Canada.  Categories  of  dental 
au.xiliaries  in  Canada  by  province  —  1973,  by 
Beverly  Du  Gas  and  B.  Leung.  Ottawa,  1974.  23p. 
(Health  manpower  report  no.   10-74) 

56.  Report  of  Interdepartmental  Committee  on  the 
NursingGroup.  Ottawa,  1974.  44p.  Chairman:  D.B. 
Dewar. 

57.  Summary  record  of  Federal-Provincial 
Emergency  Health  Services  Directors  Conference . 
Oct.  3-5.  1973.  Ottawa,  Emergency  Health  Services. 
Health  and  Welfare.  Canada.  1973.  85p. 


Registered  Nurses 

Your  community  needs  the  benefit 
of  your  ski  lis  antj  experience.  Volun 
teer  now  to  teach  Patient  Care  in 
The  Home  and  Child  Care  in  The 
Home  Courses.  —^ 


contact 


58.  Metric  Commission.  How  to  write  and  type  Si , 
style  guide.  Ottawa.  Infomiation  Canada,  c  1 974.  5 1 

59.  National  Science  Library.  Health  Scienci 
Resource  Centre.  Conference  proceedings  in  (' 
health  sciences  held  by  the  National  Science  Librari 
vol.  I.  Ottawa.  1973.  656p.  R  \ 

60.  Recreation  Canada.  Progress  report  on  Nation'\ 
Conference  on  Fitness  and  Health.  Otian , 
December  4-6,  1972.  Ottawa.  1974.  17p. 

61 .  Science  Council  of  Canada.  Facts  and  figure' 
Ottawa.  1974.   17p. 

62.  —  Committee  on  Health  Sciences.  Science f' 
health  services.  Ottawa.  Information  Canada,  c  197 
I40p.  (Science  Council  of  Canada.  Report  no.  2 

63.  Secretary  of  State.  The  organization  and  a 
ministration  of  education  in  Cattada.  by  Da\ 
Munroe.  Ottawa.  Information  Canada.  1974.  2I9| 

64 .  Statistique  Canada .  Directives  et  definitions  po, 
le  rapport  d'activite  des  hdpitau.x  1972.  Ottaw 
Information  Canada.  41p. 

Quebec 

65.  Laws,  statutes,  etc.  Official  language  act:  h. 
no.  22.  Don  Mills.  Ont.  CCH  Canadian  Ltd..  197 
4lp.  , 

66.  Ministere  des  Affaires  sociales.  Dircctii 
d'Agrement  des  Etablissements.  Lisle  des  centr, 
hospitallers  detenant  un  permis  delivre  en  vertu  de 

'  'Loi  sur  les  services  de  same  et  les  services  social 
IL.Q.  1971,  ch.  48)".  Quebec,  ville.  1974    lOlp 

United  States 

67.  National  Institutes  of  Health.  Clinical  Centc 
Nursing  Department.  A  new  dimension  in  the  care 
hospital  patients  under  stress:  a  multldisciplinui 
patient  care  study.  US  Dept.  of  Health.  Educali< 
and  Welfare.  Public  Health  Service.  1974.  32; 
(U.S.  DHEW  publication  no.  (NIH)  74-621). 

68.  National  Library  of  Medicine.  Literatui 
searches.  Bethesda.  Md..  1974.  Literature  seari 
no.  74-20.  Adverse  effects  of  oral  contraceptive  i 
65p.  Literature  search  no.  74-22.  Nutrition  for  tt 
aged.  I4p.  R 

69.  Public  Health  Service.  The  health  consequenct 
of  smoking.  Bethesda.  Md..  1974.   137p. 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLECTIO 

70.  Priorite  au  nursing  dans  I'activite  de  Tinfirmiei 
de  chevet.  Montreal.  Universite  de  Montreal.  Instill 
Marguerite  d'Youville.  1967.  20p.  "Travail  de  n 
cherche  presente  k  llnstitut  Marguerite  d'Youvill 
affiliee  a  I'Universite  de  Montreal  comni 
complement  au  cours  qui  conduit  au  Baccalaureal  i: 
Sciences  Infirmieres."  R 

7 1 .  Resistance  in  the  psychotherapeutic  interview 
with  a  depressed  patient,  by  Norma  Stewart.  Sa 
Francisco.  1974.  23p.  Study  done  for  comprehensiv 
examination  MSN  degree  Univ.  of  California.  Sa 
Francisco.  R 

12.  A  unit-dose  drug  distribution  system  for  the  Ol 
tawa  General  Hospital:  a  cost-benefit  analysis,  b 
Parminder  Singh.  Ottawa.  1974.  53p.  .Managemc 
Engineering   Services.   General   Hospital.   Otiaw 
study  with  cooperation  of  Nursing  Department.  R 

AUDIO-VISUAL  AIDS 

73.  Sonomed  (serie  2,  no.  3)  Montreal.  Associatii' 
desMedecinsde  languefran(,"aisedu  Canada.  1974 
cassette  Cote  A  Pontages  coronariens  (table  rondc 
—  Cote  B.   I    Etude  de  la  fonction  hepatique. 
Thymoanaleptiques,  .- 

MARCH  19751 


What  the  well-bandaged 
patient  should  wean 


Bandafix  is  a  seamless  round- 
woven  elastic  "net"  bandage, 
composed  of  spun  latex 
threads  and  twined  cotton. 

Bandafix  has  a  maximum  of 
elasticity  (up  to  10-fold)  and 
therefore  makes  a  perfect 
fixation  bandage  that  never 
obstructs  or  causes  local 
pressure  on  the  blood  vessels. 

Bandafix  is  not  air-tight, 
because  it  has  large  meshes ;  it 
causes  no  skin  irritation  even 
when  used  for  the  fixation  of 
greasy  dressings.  The  mate- 
rial is  completely  non-reactive 

Bandafix  stays  securely  in 
place ;  there  are  eight  sizes, 
which  if  used  correctly  wi 
provide  an  excellent 
fixation  bandage  for 
every  part  of  the 
body. 


Bandafix  does  not  change  in 
the  presence  of  blood,  pus, 
serum,  urine,  water  or  any 
liquid  met  in  nursing. 

Bandafix  saves  time  when 
applying,  changing  and 
removing  bandages;  the  same 
bandage  may  be  used  several 
times ;  it  is  washable  and 
may  be  sterilized  in  an 
autoclave. 

Bandafix  is  an  up-to-date 
easy-to-use  bandage  in  line 
with  modern  efficiency. 

Bandafix  replaces  hydrophilic 
gauze  and  adhesive  plaster, 
is  very  quick  to  use  and 
has  many  possibilities  of 
application.  It  is  very  suit- 
able for  places  that  otherwise 
are  difficult  to  bandage. 

Bandafix  is  economical  in  use, 
not  only  because  of  its  rela- 
tively low  price  but  because 
the  same  bandage  may  be 
used  repeatedly. 


Bandafix  does  not  fray, 
because  every  connection 
between  the  latex  and  cotton 
threads  is  knotted ;  openings 
of  any  size  may  be  made  with 
scissors  or  the  fingers. 


Bandafix'' 


Disti^buted  by 

D 


HD 


m 


1956  Bourdon  Street.  Montreal,  RQ.  H4M  1V1 


Now  available 

■  Ready  to  Use" 
Bandafix 

•  Pre-measured 

•  Pre-cut 

•  1 4  different  applications 

•  Individually  illustrated 

peel-open  packages 


*R€gi9tered  trademark  of  Continental  Pharma. 


\RCH  1975 


THE  CANADIAN  NURSE     61 


VIEW  WOUND  SITE  THROUGH  ACCESS 

CAP.  REMOVE  CAP  FOR  EXAMINATION  AND 

DRAIN  TUBE  ADJUSTMENT, 


THE  HOLLISTER  DRAINING-WOUND 
MANAGEMENT  SYSTEM 


KEEPS  FLUIDS  AWAY  FROM 
PATIENT'S  SKIN  AND  GUARDS  AGAINST 
IRRITATION  AND  CONTAMINATION. 
Skin-conforming  Koraya  Blanket  protects  skin  around 
wound  site.  It  directs  discharge  into  odor-barrier,  translu- 
cent Drainage  Collector  wtiicti  holds  exudate  for  visual 
assessment  and  accurate  measurement. 

There  are  no  messy,  wet  dressings  to  handle  or  change 
, , .  no  need  for  painful  dressing  removal. 

Supplied  sterile,  for  application  in  0,R,  or  patlenf  s  room. 


B 


The  better  alternative 
to  absorbent  dressings. 

Write  for  more  information. 

HOLLISTER 

Holhster   Ltd  ,  332  Consumers  Rd  ,  Willowdale,  Ont   M2J  1  P8 


Request  Form 
for  "Accession  List" 

CANADIAN  NURSES' 
ASSOCIATION  LIBRARY 

Send  ttiis  coupon  or  facsimile  tO: 
LIBRARIAN,  Canadian  Nurses'  Association, 
50  The  Driveway,  Ottawa  K2P  1E2,  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 

No. 


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 , 


tmum 


62     THE  CANADIAN  NURSE 


classified  advertisements 


ALBERTA 


BRITISH  COLUMBIA 


BRITISH  COLUMBIA 


.ISTERED  NURSES  required  )or  70  bed  accredited  acdve 
lent  Hospital  Full  time  and  summer  relief  All  AARN  per- 
onnel  policies    Apply  in  wnting  to  the:  Director  of  Nursing 
iheller  General  Hospital.  Drumheller.  Alberta. 


lEGISTERED  NURSE  required  by  25-bed  active  treatment  hos- 
ital  full  time  All  A  A  R  H  personnel  policies,  nurse  s  residence 
vailable    Apply  to    Director  of  Nursing.  Raymond  Municipal 
spital.  Raymond.  Alberta 


1  71-bed  active  treatment  hospital  requires  NURSES  FOR 
lENERAL  DUTY,  OR.,  and  INTENSIVE  CARE  NURSING. 

light  member  medical  staff  Personnel  policies  per  AA.R.N. 
igreement  —  starting  at  S900  per  month  This  hospital  is 
)cated  in  the  southern  part  of  the  province  {30  miles  east  of 
gthbridge)  which  en)oys  a  fairly  moderate  winter  climate  Easy 
s  to  winter  and  summer  recreational  activities  Apply 
lor  of  Nursing.  Tatjer  General  Hospital.  Tat)er.  Alberta. 
■0K2G0 


BRITISH  COLUMBIA 


ERATING  ROOM  NURSE  wanted  for  active  mo- 
•rn  acute  hospital  Four  Certified  Surgeons  on 
ttending  staff  Experience  of  training  desirable 
lust  be  eligible  for  B.C  Registration  Nurses 
sidence  available  Salary  according  to  RNABC 
mlract.  Apply  to  Director  of  Nursing.  Mills  Mem- 
rial  Hospital,  2711  Tetraull  St..  Terrace.  British 
Ukmbia 


ADVERTISING 
RATES 

FOR   ALL 
CLASSIFIED   ADVERTISING 

$15.00   for   6   lines   or   less 
$2,50  for  each  odditiorxil   line 

Rotes   for    display 
advertisements    on    request 

Closing  dole  for  copy  and  cancellation  is 
6   weeks    prior    to    1  st   day    of    publicotion 

month. 

The  Canodion  Nurses'  Associotion  does 
not  review  the  personnel  policies  of 
the  hospitols  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  A? 
urse        ^ 

50  THE  DRIVEWAY 
OTTAWA,  ONTARIO 
K2P.1E2 


CLINICAL  COORDINATOR  required  for  an  87-bed  acute  care 
hospital  with  expansion  plans  to  include  120  beds.  Located  m 
the  Northwest  of  B  C  Thirty-seven  and  one-half  hours,  5  day 
week.  Living  accommodations  available  RNABC  contract  ts  in 
effect  Duties  to  commence  May  1 .  1 975  DUTIES:  Coordination 
of  all  ln-Sen»'ice  education  requirements  of  the  hospital, 
including  audio-visual  equipment  and  technician  The  regular 
updating  of  pottcy  and  procedure  manuals  m  the  hospital,  with 
the  assistance  of  the  supervisory  staff.  Planning  scheduled 
hours  of  work  Must  be  willing  to  continue  updating  herself 
through  attendence  at  offered  continuing  education  courses 
The  ability  to  work  well  with  hospital  personnel  and  the  public  is 
essential  Will  act  as  Director  of  Nursing  m  her  absence, 
QUALIFICATIONS;  Registered  Nurse  m  British  Columbia 
Administrative  and/or  University  training  m  this  field  is  essential 
A  sound  clinical  tiackground  in  the  hospital  field  is  essential 
Apply  in  writing  to:  Mrs.  S  Thompson,  Director  of  Nursing,  Mills 
Memorial  Hospital,  Terrace.  British  Columbia. 


REGISTERED  and  GRADUATE  NURSES  required  for  new 
41 -bed  acute  care  hospital,  200  miles  north  of  Vancouver,  60 
miles  from  Kamloops  Limrted  furnished  accomnx)datk>n  availa- 
ble Apply:  Director  of  Nursing.  Ashcrott  &  District  General  Hospi- 
tal, Ashcrott.  British  Columbia. 


Applications  are  invited  for  a  very  interesting  and  challenging 
new  position  We  require  a  B.C.  REGISTERED  NURSE  to  assist 
the  Nurse  Administrator  to  be  classified  as  a  Head  Nurse 
Preference  will  t>e  given  one  with  pnor  EmergerKy  or  Obstetnc 
Nursing  experier>ce  and  having  successfully  completed  the 
Nursing  Unit  Administration  course  The  hospital  is  a  newly 
opened  one  situated  on  ihe  Yellowhead  Highway.  80  miles  north 
of  Kamloops,  B  C.  The  area  is  a  vacationers  paradise  both  in 
Summer  and  Winter.  RNABC  salary  scale  and  fringe  benefits 
applicable  Please  reply  to;  Mrs.  K,  Rice.  Nurse  Administrator, 
Dr.  Helmcken  Memonal  Hospital,  Cleanwster.  British  Columbia. 


REGISTERED  NURSES  are  invited  to  apply  to  this  active 
Regional  Referral  Hospital  m  the  B  C.  Interior.  Ttie  hospital  has 
400-beds  and  an  expansion  programme  underway  All  clinical 
specialties  are  represented  and  provide  opportunities  for  varied 
nursing  experience  RNABC  contract  in  effect.  B.C.  registration 
is  required  1975  staff  nurse  rale  is  5985,00  to  $1,163,00  per 
month.  Rease  direct  all  correspondence  to:  Director  of  Person- 
r>el  Services,  Royal  Inland  Hospital,  Kamloops.  British  Colum- 
bia, V2C  2T1 . 


EXPERIENCED  NURSES  (eligible  for  B  C.  registration)  required 
for  409-bed  acute  care,  teaching  hospital  located  in  Fraser 
Valley,  20  minutes  by  freeway  from  Vancouver,  and  withm 
easy  access  of  varied  recreational  facilities  Excellent  Onenta- 
tion  and  Contnung  Educatton  programmes.  Salary  S985.00  to 
$1,163-00  Oincal  areas  ncJude:  Medtcme.  Generai  and  Spe- 
cialized Surgery.  Obstetrics,  Pediatrics,  Coronary  Care,  Hemo- 
dialysis, Rehabilitation,  Operating  Room,  Intensive  Care,  Emer- 
gency PRACTICAL  NURSES  (eligible  for  B.C  License)  also 
required  Apply  to:  Nursing  Recruitment,  Personnel  Department, 
Royal  Cotucnbian  Hospital.  New  Westminster,  British  Columbia, 
V3L  3W7 


REGISTERED  NURSES  AND  NURSING  SUPERVISORS  re- 
quired by  a  100-bed  acute  care  and  40-bed  extended  care 
accredited  hospital  Must  be  eligible  for  B.C.  registratkjn. 
Supervisory  applicants  must  have  experience  m  administrative 
Of  supervisory  nursing  R  N.  s  salary  S985  to  Si, 163  and 
Supervisors  salary  51,181.  to  51.391.  (RNABC  Agreement  — 
1975)  Apply  in  writing  to  the  Director  of  Nursing,  G  R  Baker 
Memonal  Hospital,  543  Front  Street,  Ouesnel,  British  Columbia. 
V2J  2K7 


GRADUATE  NURSES  —  Looking  for  variety  m  your  wofk^ 
Consider  a  modern  10-bed  hospital  located  on  a  beautiful  fiord- 
tyoe-nlel  of  Vancouver  Island  s  west  coast.  Apply:  Administrator, 
Box  399,  Tahsii  British  Columbia,  VOP  1X0 


EXPERIENCED  GENERAL  DUTY  NURSES  AND  LICENSED 
PRACTICAL  NURSES  required  tor  small  upcoast  hospttal  Sal- 
ary and  personnel  policies  as  per  RNABC  and  H  E  U  contracts 
Residence  accommodation  S25  00  per  month  Transportation 
paid  from  Vancouver  Apply  to:  Director  of  Nursing.  St.  George's 
Hospital.  Alert  Bay,  British  Columbia,  VON  1A0. 


GENERAL  DUTY  NURSES  AND  LICENSED  PRACTICAL 
NURSES:  For  modem  130-bed  accredited  hospital  on  Van- 
couver Island  Resort  area  —  home  of  the  Tyee  Salmon,  Four 
hours  travelling  time  to  city  of  Vancouver  Collective  agreements 
with  Provincial  Nursir>g  Association  and  Hospital  Employees 
Union  Restdence  accommodation  available.  Please  direct 
inquires  to:  Director  of  Nursing  Sen/ices,  Campbell  River  & 
District  General  Hospital.  375  —  2nd  Avenue,  Campbell  River, 
Bntish  Columbia.  V9W  3 V 1 . 


GENERAL  DUTY  NURSES  for  modem  4i-bed  hospital  located 
on  the  Alaska  Highway.  Salary  and  personr>el  policies  in 
accordance  with  RNABC  AccomrrxxJation  available  m  resi- 
dence. Apply:  Director  of  Nursing.  Fort  Nelson  General  Hospital, 
Fort  Nelson,  British  Columbia. 


GENERAL  DUTY  B.C.  REGISTERED  NURSES,  full  accredited 
39-bed  hospital  Comfortable  nurses  residence.  RNABC  Ag- 
reement m  effect  Apply:  Mrs  E  Neville.  RN..  Director  of  Nurses, 
Golden  and  District  General  Hospital,  P  0  Box  1260  Golden 
Brrttsh  Columbia.  VOA  IHO. 


GENERAL  DUTY  NURSES  required  for  35-bed  extended  care 
unit  in  N  W  B  C  Good  recreational  facilities  and  residence  avai- 
lable. RNABC  policies  in  effect  Apply  to:  Director  of  Nursing. 
Kitimat  General  Hospital,  Kitimat,  British  Columbia,  V8C  1E7, 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  care 
hospital  in  Northern  B  C.  residence  accommodations  available 
RNABC  policies  in  effect  Apply  to  Director  of  Nursing  Mills. 
Memonal  Hospital.  Terrace,  British  Columbia,  V8G  2W7, 


MANITOBA 


UNIVERSITY  FACULTY  —  Positions  available  for  a  baccalau- 
reate program  in  Primary  Care  Nursing.  (Nurse  Practitioner). 
Restoration  of  Health  in  Nursir>g,  Amelioration  of  Illness  and 
Disability  in  Nursing,  Conservation  of  Health  in  Nursing,  Preven- 
tion of  Illness  and  Disability  in  Nursing,  Pronrotion  of  Health  in 
Nursing  Qualifications  required  are  Masters  Degree  and/or 
Doctoral  plus  teaching  experience  Rank  and  Salary  to  commen- 
surate with  Education  and  Expenence,  Contact:  Dr.  Helen  P, 
Glass,  Director,  School  of  Nursing,  The  University  of  Manitoba. 
Winnipeg,  Manitoba,  Canada.  R3T  2N2 


NEW  BRUNSWICK 


THREE  FACULTY  MEMBERS  needed  July  l  1975  to  replace 
faculty  members  going  on  one-year  sabbatical  and  two-year 
study  leaves.  Preparation  and  experience  desirable  in  matemal- 
mfant  and  m  medical-surgical  nursing  Increasing  enrolment  wi' 
permit  retention  of  nght  persons  at  end  of  these  penods.  Extras 
we  have  to  offer  are  an  exciting  new  cumculum  approach,  anew, 
well-equipped  self-instructional  laboratory,  a  new  hospital,  and 
the  advantages  of  living  m  a  beautiful,  small  city.  Address  Dean. 
Faculty  of  Nursing,  The  University  of  New  Brunswick.  Frederic- 
ton,  New  Brunswick. 


NOVA  SCOTIA 


REGISTERED  NURSES  (4)  required  tor  55-bed  hospital  Salary 
commensurate  with  experience  and  established  rates  Usual 
fringe  benefits  Resider>ce  accommodations  available  Apply: 
Administrator  or  Director  of  Nursing.  Queens  General  Hospital, 
Box  370,  bverpool.  Nova  Scotia.  BOT  IKO. 


ONTARIO 


OPERATING  ROOM  STAFF  NURSE  required  for  fully  accredi- 
ted 75-bed  Hospital  Basic  wage  S689  00  with  consideration  for 
expenence;  also  an  OPERATING  ROOM  TECHNICIAN,  basic 
wage  S526 OO  Call  time  rates  available  on  request.  Wnte  or 
phone  the  Director  of  Nursmg.  Dryden  Distnct  General  Hospital. 
Dryden,  Ontario 


REGISTERED  NURSES  for  34-bed  General  Hospital 
Salary  591500  per  month  to  $1,11500  plus  experience  al- 
lowance. Excellent  personnel  policies  Apply  to- 
Director  of  Nursing,  Englehart  &  District  Hospital 
Inc..  Englehart, Ontario,  POJ  IHO. 


REGISTERED  NURSES  required  for  our  ultramodern  79-bed 
General  Hospital  m  bilingual  community  of  Northern  Ontano 
French  language  an  asset,  but  not  compulsory  Salary  is  5855. 
to  $1030.  monthly  with  altowance  for  past  experience  and  4 
weeks  vacation  after  i  year  Hospital  pays  I00°o  of  CHIP.. 
Life  Insurance  (10,0(X)).  Salary  Insurance  (75%  of  wages  to  the 
age  of  65  with  U  I.C  carve-out),  a  354  drug  plan  and  a  dental 
care  plan  Master  rotation  in  effect  Rooming  accommodations 
available  in  town.  Excellent  personnel  policies  Apply  to: 
Personnel  Director,  Notre-Dame  Hospital.  P.O.  Box  850. 
Hearst,  Ontario. 


ilARCH  1975 


THE  CANADIAN  NURSE     63 


ONTAR<0 


REGISTERED  NURSES  are  required  immediately  tor  our  fully 
accredited  thirty  two  bed  complex  and  active  treatment  hospital 
located  m  twautiful  northern  Ontario,  Our  starting  salary  is 
S856.00  monthly  with  allowance  for  past  experience  and  four 
weeks  paid  vacation  after  one  year  Hospital  pays  I00°b 
O.H.I. P.,  excellent  pension  plan  and  ten  statutory  holidays  per 
year.  Apply  to:  The  Director  of  Nursing,  Hornepayne  Community 
Hospital.  Hornepayne,  Ontario, 


REGISTERED  NURSES  AND  REGISTERED  NURSING 
ASSISTANTS  for  45-bed  Hospital  Salary  ranges 
include  generous  experience  allowances.  R.N. '5 
salary  $915.  to  $1.085.,  and  R.NA.'s  salary  $650.  to  $725 
Nurses  residence  —  private  rooms  with  bath  —  S60.  per  month. 
Apply  to:  The  Director  of  Nursing,  Geraldton  District  Hospital. 
Geraldlon,  Ontario.  POT  IMP, 


SASKATCHEWAN 


URGENTLY  REQUIRED — Two  full  lime  General  Duty 
Registered  Nurses.  Duties  to  commence  as  soon  as  possible. 
Salary  as  per  SRNA  agreement  Residence  available.  For  more 
particulars  please  contact:  Daisy  Frostad,  DON,  Kincald, 
Saskatchewan,  SON  2J0.  Telephone:  264-3233. 

R.N.  required  Immediately  —  Porcuptne  Carragana  Union 
Hospital  requires  General  Duty  Registered  Nurse  immediately 
Salary  scale  and  fringe  benefits  as  negotiated  by  S.UN  Modern 
20-bed  hospital.  Near  Provincial  Park,  Progressive  community 
Apply,  in  writing,  to:  Administrator,  Porcupine  Carragana  Union 
Hospital.  Box  70.  Porcupine  Plain,  Saskatchewan,  SOE  IHO. 


UNITED  STATES 


R.N.'s  —  Openings  now  available  in  a  variety  of  areas  of  a  458 
bed  teaching  and  research  hospital  affiliated  with  the  school  of 
medicine  of  Case  Western  Reserve  University  New  facility 
opening  in  the  spring.  Personalized  orientation,  excellent  salary, 
full  paid  benefits  and  housing  available  in  hospital  residence. 
Will  assist  you  with  H  1  visa  for  immigration.  A  license  in  Ohio  to 
practice  nursing  is  necessary  tor  employment.  For  further 
information  write  or  phone:  Mrs.  Mary  Herrick,  Personnel 
Department.  Saint  Lukes  Hospital,  1 131 1  Shaker  Blvd..  Cleve- 
land, Ohio.  44104.  Phone:  Monday  ■  Friday.  9  A.M.  -  4  P,M 
1-216-368-7440, 


REGISTERED  NURSES  FOR  GENERAL  DUTY.  I.C.U.. 
ecu.  UNIT  and  OPERATING  ROOM  required,  for 
fully  accredited  hospital.  Starting  salary  $850,00 -^ith 
regular  increments  and  with  allowance  for  experi- 
ence. Excellent  personnel  policies  and  temporary 
residence  accommodation  available.  Apply  to:  The 
Director  of  Nursing,  Kirkland  &  District  Hospital. 
Kirkland  Lake.  Ontario,  P2N  1R2. 


PUBLIC  HEALTH  NURSE  —  GREY-OWEN  SOUND  HEALTH 
UNIT  has  an  opening  for  a  qualified  PUBLIC  HEALTH  NURSE. 

If  you  are  interested  in  obtaining  more  information  about  this 
position  please  contact:  Miss  E.  Davidson,  BScN,.  Director  of 
Nursing,  Grey-Owen  Sound  Health  Unit,  County  Building,  Owen 
Sound,  Ontario.  N4K  3E3, 


PUBLIC  HEALTH  NURSE  required  for  generalized  programme 
in  combined  rural  and  urban  area  in  Southern  Ontario,  Allowance 
for  experience  and/or  degree.  Generous  fringe  benefits  and  car 
allowance.  Apply  to:  Supervisor  of  Nursing,  Miss  Marie  I,  Elson, 
Elgin-St.  Thomas  Health  Unit,  2  Wood  Street,  St.  Thomas,  On- 
tario. 


LAURENTIAN  UNIVERSITY  invites  applicants  for  1975-76 
session  to  teach  in  all  clinical  nursing  fields  including  primary 
care.  New  basic  B,Sc,N,  curriculum  and  open  curriculum 
approach  to  post-R.N.  degree  programme  Masters  degree  in 
clinical  speciality  and  bilingual  (French- English)  preferred. 
Opportunity  to  become  bilingual  provided.  Salary  and  rank 
commensurate  with  qualifications  and  experience.  Young 
friendly  university  serving  north-eastern  Ontario.  Apply  to:  Ms. 
Dot  Pringle,  Director.  School  of  Nursing,  Laurenlian  University, 
Ramsey  Lake  Road,  Sudbury,  Ontario- 

RN  for  family-type  coed  camp  in  Northern  Ontario,  Approx,  80 
campers;  ages  14  to  16;  June  23  to  Aug.  11;  private  room  and 
board  plus  salary.  Write/phone:  CAMP  SOLELIM,  588  Melrose 
Avenue.  Toronto,  Ontario,  M5M  2A6,  (AC  416)  781-5156, 


QUEBEC 


REGISTERED  NURSE  required  for  co  ed  children  s  summer 
camp  in  the  Laurentians  (seventy  miles  north  of  Montreal)  from 
JUNE  20.  1975  to  AUGUST  20,  1975.  Call  (514)  688  1753  or 
wnte:  CAMP  MAROMAC.  4548  8th  Street.  Chomedey.  Laval. 
Quebec,  H7W2A4, 


We  require  the  services  of  a  GRADUATE  NURSE  for  a  summer 
position  at  The  Quebec  Camp  tor  Diabetic  Children  Inc.  in 
Ste-Agathe-des-Monts.  for  the  perio_d  extending  from  June 
30th  to  August  I6th  1975  Salaries  are  based  on  current 
accepted  levels.  Only  bilingual  applicants  will  be  considered. 
Enquiry  should  be  made  to;  Dr.  Mimi  M,  Belmonte.  2300  Tupper 
Street.  Room  448,  Montreal,  Quebec,  H3H  1  PS- 


Montreal  Graduate  Nurses  Club,  1234  Bishop  Street,  Down- 
town Montreal-  Furnished  Single  Rooms  for  rent  with  kitchen 
privileges,  linen  supplied.  Reasonable  rates.  Telephone:  (514) 
866-9077, 


^Mc2l^®  ^°"  CHILDREN'S  SUMMER  CAMPS  IN 
uutBEC.  Our  member  camps  are  located  in  the 
Laurentian  Mountains  and  Eastern  Townships,  within 
100  mile  radius  of  Montreal,  All  camps  are  accred- 
ited members  of  the  Quebec  Camping  Association 
Apply  to:  Quebec  Camping  Association  2233  Bel- 
489-754^"^"''®'     "^""f'^^'    261.    Quebec,    or    phone 


SASKATCHEWAN 


TWO  REGISTERED  NURSES  required  immediately  for  a 
15-bed  General  Hospital  in  Southern  Saskatchewan,  Salaries 
as  per  S.U.N,  and  S.H.A.  contracts-  Residence  available  within 
the  hospital  Apply  Director  of  Nursing,  Fillmore  Union  Hospital. 
Fillmore,  Saskatchewan, 

64     THE  CANADIAN  NURSE 


Get  what  you've 

always  wanted 

from  nursing 


Like  a  wealth  of  professional  experience 
to  enrich  your  career. 


Nursing  has  a  lot  to  offer.  Remember? 
But  sometimes  you  can  get  so  stuck  in 
a  rut  you  almost  forget  those  exciting 
challenges  that  made  you  choose  a 
nursing  career  in  the  first  place. 

With  Medox,  you  can  revive  those 
challenges. 

Since  Medox  serves  almost  the 
entire  spectrum  of  nursing  services, 
you  can  get  more  variety  of 


assignments  in  a  month  than  you 
could  in  a  year  back  in  that 
comfortable  rut.  Operating  room. 
Intensive  Care.  Cardiac  Unit.  Pediatric 
care. 

There's  more  to  nursing  than 
punching  a  time  clock. 

With  Medox,  there  can  be  a  lot 
more. 


a  DRAKE  INTERNATIONAL  company 

CANIACA .  USA .  UK .  AUSTRALIA 


MARCH  1975 


1. 


UNITED  STATES 


i4's  and  LPN's  —University  Hospital  North,  a 
aching  Hospital  of  the  University  ot  Oregon  Medical 
;hool.  has  openings  in  a  variety  of  Hospital  ser- 
ies. We  offer  competitive  salaries  and  excellent 
nfle  benefits  inquires  should  be  directed  to  Gate 
inkin.  Director  of  Nursing,  3171  S  W  Sam  Jackson 
Road.  Portland.  Oregon.  97201 . 


XAS  wants  you!  if  you  are  an  RN,  experienced  or 

ecent  graduate,  come  to  Corpus  Chnsti,    Sparkling 
y    by    the    Sea  a    ctty    building    for    a    better 

,ure.  where  your  opportunities  for  recreation  and 
dies  are  limitless  Memorial  Medical  Center.  500- 
general,  teaching  hospital  encourages  career 
•ancement  and  provides  in-service  orientation, 
ary  from  S682  00  to  $9-10.00  per  month,  com- 
nsurate  with  education  and  experience  Differential 
evening  shifts,  available  Benefits  include  holi- 
sick  leave  vacations,  paid  hospitalization 
Uth.  life  insurance,  pension  program.  Become  a 
ri  part  of  a  modern,  up-to-date  hospital  write  or 
I  collect  John  W  Cover  Jr  .  Director  of  Per- 
nnel  Memorial  Medical  Center.  P  O  Box  5280 
rpus  Christi.  Texas.  78405. 


REGISTERED  NURSES 


Registered  Nurses  required  for  large 

metropolitan  general  hospital. 
Positions  available  in  all  clinical  areas. 
jSalary  Range  in  effect  until  December 
31.1975. 

!$900.  —  $1,075.  Starling  rate  de- 
pendent on  qualifications  and  experi- 
ence. 


opiy  to: 


Staffing  Officer-Nursing 
Personnel  Department 
Edmonton  General  Hospital 
Edmonton,  Alberta 
T5K  0L4 


SCHWEIZERISCHE  PFLEGERINNENSCHULE 
SCHWESTERNSCHULE  UND 
SPITAL,  ZUERICH,  SCHWEIZ 


We  are  looking  for  our  medium-sized  hospital  to 
complete  our  staff 

NURSES  WITH  DIPLOMA 

with  knowledge  of  German. 
We  offer  pleasant  team-work,  favourable  possibil- 
ity for  lodging  and  boarding  as  well  as  regular 
working  time. 

Applicants   should   submit   written   offers   with 
specification  about  education  and  activity  to: 


Sctiweiz.  Pflegerlnnenschule,  40  Car- 
menstr.,  z.  Hd.  Personalchef,  CH-8032 
Zuericti. 


L. 


"MEETING  TODAY'S  CHALLENGE  IN  NURSING" 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGIII  University 

requires 

REGISTERED  NURSES 

AND 
REGISTERED  NURSING  ASSISTANTS 

Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  popuJation  consists  of 
thie  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound    in   our  clinics   and 

their  numbers  increase  daily  in  our 

Emergency. 

If  you   do   not   like  working  with 

children    and   with   their   families. 

you  would  not  like  it  here. 

If  you  do  like  children  and  their 
families,  we  would  like  you  on  our 
staff. 

Interested  qualified  applicants 
should  apply  to  the: 

DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108,  Quebec 


This 
.  PublicatiQn 
IS  Available  in 

MICROFORM 

. . .  from 


NvRCH  1975 


Xerox 
University 
Microfilms 


300  Nortti  Zeeb  Road 
Ann  Arbor,  Mictiigan  48106 

Xerox  University  {Microfilms 

35  Mobile  Drive 
Toronto,  Ontario, 
Canada  M4A  1H6 

University  Microfilms  Limited 

St,  John's  Road, 

Tyler's  Green,  Penn, 

Buckingtiamshire,  England 

PLEASE  WRITE  FOR 
COMPLETE  INFORMATION 


THE  CANADIAN  NURSE     65 


REGISTERED  NURSE 

We  have  opportunities  here  tor  an  experi- 
enced registered  nurse.  Our'  nursing 
salaries  are  established  through  agree- 
ment with  the  A.A.R.N. 


We  have  a  very  active  230-bed  hospital  in 
Central  Alberta.  If  you  are  interested  in 
more  information  regarding  Red  Deer  and 
the    Red    Deer    Health    Care    Complex, 

please  write  or  call: 

Personnel  Director 
Red  Deer  General  Hospital 
Red  Deer,  Alberta 
Tel.:  (403)  346-3321 


UNIVERSITY  NURSING 
FACULTY  POSITIONS 

Maternity,  Paediatric, 

Medical-Surgical, 

Psychiatric 


Master's  degree  and  teaching  experience  re- 
quired. Excellent  personnel  policies  and  fringe 
benefits.  Rank  and  salary  commensurate  wilti 
education  and  experience.  Positions  available: 
Fall,  1975. 

Write  to: 

Dean 

Faculty  of  Nursing 

University  of  Toronto 

Toronto,  Canada 

M5S  1A1 


GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit. 

Clinical  areas  include:  medicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with  I 
R.N.A.B.C.  contract: 

SALARY:  $850  —  $1 020  per  month 
(1974rates) 

SHIFT  DIFFERENTIAL 


APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


y 


REGISTERED  NURSES 
GENERAL  DUTY 


Required  for  modern,  fully  equipped  28-bed 
hospital,  with  two  Medical  and  one  Dental 
staff.  Salary  per  Union  agreement. 

Excellent  personnel  policies.  Accommoda- 
tion available  in  residence. 

Apply  to: 

Administrator 

KIPLING  MEMORIAL  UNION  HOSPITAL 

Box  420 

KIPLING,  Saskatchewan 

SOG  2S0. 


Psychiatric 
Nurse  Co-Ordinator 

WOODSTOCK  GENERAL  HOSPITAL 

The  220  bed  acute  treatment,  Woodstock  General  Hospi- 
tal, is  in  the  process  of  establishing  a  Psychtatnc  Unit  to 
provide  services  for  Oxford  County,  and  requires  tfie  ser- 
vices of  a  senior,  experienced  nurse  co-6rdtnator  to  assist 
in  its  estaWishmenI  and  operation. 
Qualifications  required  are  registration  or  eligibility  for  re- 
gistration as  a  nurse  in  Ontario  —  a  number  of  years  of 
progressively  responsible  experience  in  a  psychiatric  hos- 
pital or  unit,  plus  post  graduate  training  to  at  least  tlie  B.Sc. 
N,  level. 

Salary  will  be  appropriate  to  qualifications  and  experience, 
a  liberal  fringe  benefit  program  including  opportunities  for 
further  tramir>g  will  be  available  to  the  successful  applic- 
ant. 

Appty  as  soon  as  possible  to: 

Personnel  Officer 

WOODSTOCK  GENERAL  HOSPITAL 
270  RIDDEL  ST.,  WOODSTOCK,  ONTARIO 


REGISTERED  NURSES 
GRADUATE  NURSES 

and 

REGISTERED    NURSING 
ASSISTANTS 

required  for 

FIVE  SUMMER  CAMPS 

Strategically  located  ttiroughout  Ontario 

and  near 

OTTAWA,    LONDON,    COLLINGWOOD, 

PORT   COLBORNE.  KIRKLANO  LAKE 

(accredited  members  —  Ontario  Camping  Association) 

Applications  invited  trom  Nurses  interested  in  supervisory, 
assistant  and  general  cabin  responsibilities  in  Itie  iield  ot 
rehabilitation  ot  ptiysically  handicapped  children. 

Apply  in  writing  to: 

Supenrjsor  of  Camping  and  Recreation 

Ontario  Society  tor  Crippled  Children 

350  Rums ey  Road 

Toronto.  Ontario 

M4G  1R8 


FLIN  FLON  GENERAL  HOSPITAL 
FUN  FLON,  MANITOBA 

Opportunities  are  available  in  tfiis  modern 
125  bed  hospital  in  the  summer  and  winter 
vacation  land  of  Northern  Manitoba  for 
suitably  qualified  nurses.  Vacancies  exist 
for: 

Night  Supervisor 

Nursing  In-Service  Instructor 

General  Duty  Nurses  —  all  services 

Good  salary  and  working  conditions,  ac- 
commodation available  in  the  residence. 

For  further  details  apply  — 

Personnel  Office 

Flln  Flon  General  Hospital 

Flin  Flon,  Manitoba 

R8A1N2 


DIRECTOR  OF  NURSING 


Applications  are  invited  for  this  position  in  a  new 
and  modern  50  bed  general  tiospilal  located  close 
to  the  Foothills  and  Rockies,  70  miles  south  of 
Calgary. 


Successful  supervisory  and  nursing  administra- 
tion experience  or  university  preparation  in  nurs- 
ing administration  is  desirable. 

Please  address  applications  or  enquiries  to: 


Administrator 

Claresholm  General  Hospital 

Box  610 

Clarestiolm,  Alberta 

TOL  OTO 


CONESTOGA  COLLEGE  OF 
APPLIED  ARTS  AND  TECHNOLOGY 

Ttie  College  invites  applications  for  Faculty  positions 
in  our  various  Nursing  Divisions  which  are  located  in 
Cambridge,  Guelph,  Kitchener-Waterloo  and  Strat- 
ford. We  have  an  immediate  opening  in  our  Guelph 
Nursing  Division  for  a  faculty  member  to  teach  first 
year  nursing  students. 

Candidates  must  have  a  B.Sc.N.  Degree  or  equival- 
ent, and  at  least  two  years  nursing  experience.  Salary 
will  be  commensurate  with  background  and  experi- 
ence. 

Applications,  In  writing,  should  be  forwarded 
to: 

Mr.  Pat  Mansfield 

Conestoga  College  of  Applied  Arts 

and  Technology 

299  Doon  Valley  Drive 

Kitchener,  Ontario 

N2G  3W5 


66     THE  CANADIAN  NURSE 


MARCH  1975 


ENJOY 
NURSING 

AT 

VICTORIA 

HOSPITAL 

LONDON 

ONTARIO 

Apply  To:  — 

Director  of  Nursing, 
Victoria  Hospital, 
London, 
Ontario, 
N6A  4G5. 

Name:   

Address:    

Reg.N.Lj  R.N. A.  I     I 

ARCH  1975 


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Quebec's  Health  Services  are  progressive! 


So  is  nursing 


at 


The  Montreal  General  Hospital 

a  teaching  hospital  of  McGill  University 


Come  and  nurse  in  exciting  Montreal 


i 

i  mw 

The  Montreal  General  Hospital 

1650  Cedar  Avenue,  Montreal,  Quebec      H3G  1A4 

1               Please 

1                Preven 

tell   me 
ive  Med 

about 
icine. 

hos 

pitol 

nursing   under  Quebec's   new 

concept  of  Social 

and 

1                Name 

1               Address 

1 

Quebec  language 

requirements  do  not  apply  to  Cane 

dion  applicants. 

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THE  CANADIAN  NURSE     67 


UNIVERSITY  HOSPITAL 
SASKATOON,  SASKATCHEWAN 

Requires 

REGISTERED  NURSES 

for 

Specialized  and  General  areas 
Policies  according  to  S.U.N,  contract 


Apply  to: 


Employment  Officer,  Nursing 
University  Hospital 
SASKATOON,  Saskatchewan 
S7N  0W8 


EXPERIENCED 
O.R.  TECHNICIAN 


Required  to  assume  charge  of  operating 
room  in  small  but  busy  acute-care  hospital. 
Duties  will  include  care  and  servicing  of 
anaesthetic  equipment  and  surgical  ins- 
truments, and  assisting  in  surgical  procedu- 
res. Some  general  duties  also  included.  Sa- 
lary in  accordance  with  Newfoundland 
rates 

Please  apply  to: 

Miss  M.  Leach 
Director  of  Nursing 
Paddon  Memorial  Hospital 
International  Grenfell  Association 
Happy  Valley,  Labrador 
AOP  1E0 


ST.  MICHAEL'S  HOSPITAI 

Toronto,  Ontario 

invites  applications  from 

REGISTERED  NURSES 

for 

INTENSIVE    CARE 
and  "STEP-DOWN"  UNITS 


Planned  orientation  and  tn-service  programme  will  ena- 
ble you  to  collaborate  in  ttie  most  advanced  of  treatment 
regimens  for  the  post-operative  cardio-vascular  ano 
other  acutely  ill  patients.  One  year  of  nursing  experience 
a  requirement. 


For  details  apply  to: 


The  Director  of  Nursing, 
St.  Michael's  Hospital, 
Toronto,  Ontario, 
M5B1W8. 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from 

REGISTERED  NURSES 

54-bed  accredited  general  fiospi- 
tal.  Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to: 

MISS  E.LOCKE 

Director  of  Nursing 

The  Lady  IVIinto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane.  Ontario 

POL  1  CO 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

staff  nurses  for  St.  Anthony.  New  liospital  of 
150  beds,  accredited.  Active  treatment  in  Surgery, 
filedicine,  Paediatrics,  Obstetrics,  Psychiatry. 
Large  OPD  and  ICU.  Orientation  and  In-Service 
programs,  40-hour  week,  rotating  shifts.  PUBLIC 
HEALTH  has  challenge  of  large  remote  areas. 
Furnished  living  accommodations  supplied  at  low 
cost.  Personnel  benefits  Include  liberal  vacation, 
and  sick  leave,  travel  arrangements.  Staff  RN 
$637  —  $809,  prepared  PHN  $71 2  —  $903,  steps 
for  experience. 


Apply  to: 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Anthony,  Newtoundland 

AOK  4S0 


QUEEN'S  UNIVERSITY 
SCHOOL  OF  NURSING 

Faculty  Openings 

July  1975  for  Lecturers.  Assistant  or  Asso- 
ciate Professors  for  basic  uncjergraduate 
programme  in  nursing  of  adults,  maternity 
nursing  and  community  tiealtfi.  Master's 
degree  in  clinical  nursing  and  successful 
experience  required.  Preference  given  to 
preparation  as  a  family  nurse  practitioner. 
Salary  commensurate  with  preparation. 


Apply  to: 


Dean,  School  of  Nursing 
Queen's  University 
Kingston,  Ontario 
K7L3N6 


DIRECTOR 
OF  NURSING 

Applications  are  invited  for  this 
position  In  the  62  bed  accredited 
Nipawin  Union  Hospital  in  a  progres- 
sive community  of  4,500  with  complete 
recreational  facilities  and  nearby 
resort  area.  Supervisory  experience  is 
essential,  Diploma  in  Nursing  Unit 
Administration  or  equivalent  Is  desira- 
ble. 

Apply  In  confidence  to: 

Administrator 
P.O.  Box  2104 
Nipawin,  Sask. 
S0E1E0 


The  Brome-Missisquoi-Perkins 
Hospital 

requires 

1  Day  Supervisor 
1  Night  Supervisor 
Registered  Nurses 


Please  write  to: 

Director  of  Nursing 
Brome-Missisquoi-Perklns  Hospital 
950  Main  Street 
Cowansville,  Quebec 
J2K1K3 


ROYAL  JUBILEE  HOSPITAL 
SCHOOL  OF  NURSING 

requires 

NURSING  INSTRUCTORS 

tor 

Medical  Surgical  Nursing 
Pediatric  Nursing 
Psychiatric  Nursing 

Qualifications: 

Baccalaureate  Degree  &  experience,  eligibility  for 
BC.  registraton. 

Apply  to: 

Director  of  Education  Reaourcss 
Royal  Jubilee  Hospital 
Victoria,  B.C. 
VSR  1J8 


68     THE  CANADIAN  NURSE 


MARCH  197 


I 


'A. 


Some  nurses  are  just  nurses. 
Our  nurses  are  also 
Commissioned  OfFicers. 


Nurses  are  very  special  people  in  the  Canadian  Forces. 

They  earn  an  Officer's  salary,  enjoy  an  Officer's  privileges 
and  live  in  Officers'  Quarters  (or  in  civilian  accommodation  If  they 
prefer)  on  Canadian  Forces  bases  all  over  Canada  and  in-many 
other  parts  of  the  world. 

If  they  decide  to  specialize,  they  can  apply  for  postgraduate 
training  with  no  loss  of  pay  or  privileges.  Promotion  is  based  on 
ability  as  well  as  length  of  service.  And  they  become  eligible  for 
retirement  benefits  (including  a  lifetime  pension)  at  a  much  earlier 
age  than  in  civilian  life. 

If  you  were  a  nurse  in  the  Canadian  Forces,  you  would  be 
a  special  person  doing  an  especially  responsible,  rewarding  and 
worthwhile  job. 

For  full  information,  write  the  Director  of  Recuiting  and.  Selec- 
tion. National  Defence  Headquarters.  Ottawa.  Ontario  K1A  0K2 


Get  involved  with  the 
Canadian  Armed  Fdrces. 


Public  Service 
Canada 


Fonction  publique 
Canada 


THIS  COMPETITION  IS  OPEN  TO  BOTH  MEN  AND  WOMEN 

NURSING  OPPORTUNITIES  IN  THE  NORTH 
Starting  salary  up  to  $9,488 

(UNDER  REVIEW) 
(Plus  Northern  Allowance) 

HEALTH  AND  WELFARE  CANADA 

Medical  Services 
Various  locations  in  the  Yukon  and  N.W.T. 

An  opportunity  to  see  parts  of  Canada  few  Canadians  ever  see  and  to  utilize  all  your  nursing 
skills.  Nurses  are  required  to  provide  tiealth  care  to  the  inhabitants  located  in  some  settlements 
well  north  of  the  Arctic  Circle.  Radio  telephone  communication  is  available.  Join  the  Northern 
Health  Service  of  the  Department  of  Health  and  Welfare  Canada  and  discover  what  northern 
nursing  is  all  about. 

Candidates  must  be  registered  or  eligible  for  registration  as  a  nurse  in  a  province  of  Canada, 
be  mature  and  self-reliant.  For  some  positions,  mid-wifery,  obstetrics,  pediatrics  or  Public 
Health  training  and  experience  is  essential.  Proficiency  in  the  English  language  is  essential. 
Salary  commensurate  with  experience  and  education. 

Transportation  to  and  from  employment  area  will  be  provided;  meals  and  accommodation  at 
a  nominal  rate. 

HOW  TO  APPLY: 

Forward  "Application  for  Employment"  (Form  PSC  367-4110)  available  at  Post  Offices, 
Canada  Manpower  Centres  or  offices  of  the  Public  Service  Commission  of  Canada  to  the: 

DEPARTMENT  OF  HEALTH  AND  WELFARE  CANADA 

MEDICAL  SERVICES  —  NORTHWEST  TERRITORIES  REGION 

1401  BAKER  CENTRE  —  10025  -  106  STREET  EDMONTON,  ALBERTA  T5J  1H2 

Please  quote  competition  number  74-E-4  In  all  correspondence. 

Appointments  as  a  result  of  this  competition  are  subject  to  the  provisions  of  the  Public 

Service  Employment  Act. 


The 

Executive 

Nurse 

A  Three-day  Seminar 

for 

Directors, 

Assistant  Directors, 
Supervisors, 
Head  Nurses 

and 

Team  Leaders 

Seminar  objectives  include: 

•  learning  fundamental  management  con- 
cepts. 

•  detecting  climate  on  a  unit. 

•  developing  a  plan  of  action  for  managing 
tfie  nursing  unit. 

1975  SCHEDULE 

Mar.  19-21  Montreal,  Que. 

April  2-4  Toronto,  Ont. 

Sept.  23-25  Sudbury,  Ont. 

Oct.  7-9  Toronto,  Ont. 

Nov.  18-20  Montreal,  Que. 

The  Educator- 
Manager 

A  Three-day  Workshop 

for 

Inservice 
Education 
Co-ordinators 

Seminar  objectives  include: 

—  defining  the  dual  role  of  educator  and 
manager. 

—  matcfiing  styles  of  managing,  teaching 
and  learning. 

—  gaining  skill  in  identifying  educational 
needs. 

—  developing  skill  in  designing  and  im- 
plementing educational  programs. 

1975  SCHEDULE 

May  7-9  Toronto,  Ont. 

Oct.  20-22  Toronto,  Ont. 

Tuition  of  $75.00  covers  class  materials, 

instruction  and  coffee  breaks  and  is  tax 

deductible. 

THE    EXECUTIVE    NURSE    and    THE 

EDUCATOR-MANAGER  are  available  on  a 

CONTRACTED  basis  in  English  and  French. 

For  more  information  write  or  call: 
R.M.  BROWN  CONSULTANTS 

1701  Kilborn  Ave.,  Suite  1115 
Ottawa,  Ontario  K1H  6M8 
telephone:  (613)  731-0978 


URCH  1975 


THE  CANADIAN  NURSE     69 


ST.  BONIFACE  GENERAL  HOSPITAL 


Invites  applications  from 

REGISTERED  NURSES 

for  tfie  following  areas: 

General  Medicine  —  shift  rotation  —  day  to  night. 

General  Surgery  —  All  shifts. 

Orthopedics  —  Permanent  evenings  —  day  to 

night. 

E.E.N.T.  —  All  shifts. 

Pediatrics  —  Day  to  Evening  and  day  to  night. 

Intensive  Care  Areas  —  Day  to  night  rotation. 


Please  apply  to: 


STAFFING  CO-ORDINATOR 

NURSING  SERVICE  DEPARTMENT 

ST.  BONIFACE  GENERAL  HOSPITAL 

409  TACHE  AVENUE 
WINNIPEG,  MANITOBA  —  R2H  2A6 


THE  SCARBOROUGH 
GENERAL  HOSPITAL 

invites  applications  from: 
Registered  Nurses  and  Registered  Nursing  Assis- 
tants  to   work    in    our   650-bed    active   treatment 
hospital  and  new  Chronic  Care  Unit. 

WetJtfer  opportunities  in  Medical,  Surgical,  Paedlatric,  and  Obstetrical  nursing. 

Our  specialties  include  a  Burns  and  Plastic  Unit.  Coronary  Care,  Intensive  Care  and 
Neurosurgery  Units  and  an  active  Emergency  Department, 

•  Obstetrical  Department  —  participation  in  "Family  centered"  teaching 
program. 

•  Paedlatric  Department  —  participation  in  Play  Therapy  Program. 

•  Orientation  and  on-going  staff  education. 

•  Progressive  personnel  poilcjes. 

The  hospital  Is  located  in  Eastern  Metropolitan  Toronto, 
For  further  information,  write  to: 

The  Director  of  Nursing, 
SCARBOROUGH  GENERAL  HOSPITAL 
3050  Lawrence  Avenue,  East,  Scarborough,  Ontario 


INTENSIVE 
CARE  NURSING 


We  are  now  accepting  applications  for  Registered  Nurse 
positions  in  our  Intensive  Care  Areas  which  comprise  the 
following: 

•  An  integrated  surgical  open  heart  team. 

•  Acute  coronary  care. 

•  Acute  respiratory  care. 

•  Intensive  neurological  care. 

•  Acute  renal  dialysis  program. 

A  12  month  clinical  course  in  Intensive  Care  Nursing  for 
Registered  Nurses  employed  in  the  Intensive  Care  Units  is 
available. 


Please  apply  to: 

STAFFING  CO-ORDINATOR 
ST.  BONIFACE  GENERAL  HOSPITAL 

409  TACHE  AVENUE 
WINNIPEG,  MANITOBA  —  R2H  2A6 


EXTENSION  COURSE  IN 
NURSING  UNIT  ADMINISTRATION 


Registered  Nurses  employed  full  tinne  In  managennent  positions  may  apply 
for  enrolment  In  the  extension  course  in  Nursing  Unit  Administration,  A 
limited  number  of  registered  psyctiiatric  nurses  may  also  enrol,  Ttie  program 
is  designed  for  nurses  wt)o  wisfi  to  improve  tfieir  administrative  skills  and  is 
available  In  Frencti  and  in  Englisti. 

The  course  begins  with  a  five  day  Intramural  session  in  late  August  or 
September,  followed  tiy  a  seven  month  period  of  home  study.  The  program 
concludes  with  a  final  five  day  wor1<shop  session  in  April  or  In  May,  The 
Intramural  sessions  are  arranged  on  a  regional  basis. 

The  extension  course  in  Nursing  Unit  Administration  Is  sponsored  jointly  by 
the  Canadian  Nurses'  Association  and  the  Canadian  Hospital  Association 

Registered  Nurses  interested  In  enrolling  in  the  1975-76  class  should  submit 
applications  before  May  15th.  Early  application  is  advised.  The  tuition  fee  of 
$200,00  is  payable  on  or  before  July  1  st. 


For  additional  Information  and  application  forms  direct  enquiries  to: 

Director, 

Extension  Course  in  Nursing  Unit  Administration, 

25  Imperial  Street, 

Toronto,  Ontario,  MSP  1C1. 


70     THE  CANADIAN  NURSE 


MARCH  19; 


What^  a  big  company 
like  Upjohn  doing 
in  nursing  services? 

(Simple.  We're  in  it  to  help  you  anci  here's  how.) 

If  you  re  a  Nursing  Supervisor  we  can  complement  your  staff 
when  shortages  occur  by  providing  competent  R.N.s, 
R.N.A./C.N.A./L.P.N.'s  or  Nurse  Aides. 

If  you're  a  nurse  interested  in  working  part-time  to  supple- 
ment your  family's  income,  we  offer  you  the  opportunity  to 
select  hours  and  assignments  convenient  to  your  schedule, 
not  ours. 

If  you're  a  Discharge  Planning  Officer  or  Home  Care  Co- 
ordinator, we  are  a  reliable  source  for  home  health  care 
with  whom  you  can  trust  your  outgoing  patients. 

If  you're  an  inactive  nurse  temporarily  out  of  touch  with 
nursing,  we  can  offer  patient  care  opportunities  which  will 
enable  you  to  re-enter  your  profession. 


We  think  that  it  is  important  for  you.  the  Registered 

Nurse,  to  understand  why  The  Upjohn  Company's 

subsidiary.  Health  Care  Services  Upjohn  Limited. 

has  become.involved  in  nursing.  Our  concept  of 

part-time  nursing  services  has  proven  to  be  an 

important  adjunct  to  the  delivery  of  health  care. 

Our  interest  is  in  assisting  the  Medical  and  Nursing 

Professions  by  providing  additional  qualified 

R.N.s,  R.N.A./C.N.A./L.P.N.S  and  Home 


Health  Care  Personnel  to  serve  the  commu- 
nity. If  you  would  like  more  information  about 
the  work  that  we  are  doing  across  the  country 
and  how  we  can  help  you,  contact  the  Health 
Care  Services  Upjohn  office  nearest  you. 
Ask  for  the  Service  Director.  She  is  an  R.N., 
and  you'll  both  be  speaking  the  same  lan- 
guage. Look  for  us  in  the  white  pages  and  in 
the  yellow  pages  under  "Nurses  Registries." 


HEALTH  CARE  SERVICES  UPJOHN  LIMITED 


With  16  offices  to  serve  you  across  Canada 


Victoria 

388-6639 

Winnipeg 

943-7466 

St.  Catharines      688-5214 

Montreal             288-4214 

Vancouver 

731-5826 

Windsor 

258-8812 

Toronto  East        445-5262 

Trois  Rivieres     379-4355 

Edmonton 

423-2221 

London 

673-1880 

Toronto  West      239-7707 

Quebec  City        687-3434 

Calgary 

264-4140 

Hamilton 

525-8504 

Ottawa                 238-4805 

Halifax               425-335 1 

i 

(Operating  in 

Ontario  as  H  C  S  Upjohn) 

lARCH  1975 

THE  CANADIAN  NURSE 

71 

WE  CARE 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 

Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 

Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


DIRECTOR  OF  NURSING 


Required  for  the  Charlotte  Eleanor  Englehart  Hospital, 
Petrolia,  Ontario  to  assume  duties  on  or  before  April  1, 
1975. 

This  is  a  63  bed  fully  accredited  acute  care  hospital  which 
prides  itself  on  its  ongoing  progressive  training  program- 
mes and  the  fact  that  it  provides  much  higher  than  average 
T.L.C.  to  its  patients.  The  successful  applicant  will  be 
expected  to  use  her  ingenuity  in  continuing  and  developing 
further  these  philosophies  despite  a  tightening  of  govern- 
mental monies  available.  This  position  should  be  of  interest 
to  nurses  with  several  years  experience  at  the  Head  Nurse 
or  Nursing  Supervisor  level.  Preference  will  be  shown  to 
applicants  with  further  formal  education  in  the  field  of 
nursing  administration. 

Applicants  must  be  eligible  for  registration  in  Ontario. 
Salary  commensurate  with  training  and  experience.  Appli- 
cations stating  experience,  education,  references  and 
salary  expected  should  be  directed  to: 


Robert  P.  Finlayson 

Administrator 

Charlotte  Eleanor  Englehart  Hospital 

Petrolia,  Ontario 


UNIVERSITY  OF  WINDSOR 
SCHOOL  OF  NURSING 

Faculty  Positions 

Available  for  1975-76 


School  of  Nursing  Offers: 

—  Four-year  B  Sc  N  Honors  Degree  for  Grade  13  graduates 

—  Three-year  B  Sc  N  Honors  Degree  tor  Registered  Nurses. 

—  One-year  Public  Health  Nursing  Diploma  lor  Registered  Nurses. 

—  (Also  have  plans  lor  Graduate  Programmes  in  Nursing) 


Due  to  expansion,  faculty  positions  are  available  In  ttie 
following  areas: 

—  Fundamentals  ol  Nursing 

—  Medical-Surgical  Nursing 

—  Parental  and  Child  Health  Nursing  (Obstetrics  and  Nursing  of  Children) 

—  Community  Health  Nursing 

—  Mental  Health  and  Psychiatric  Nursing 

—  Advanced  Nursing  and  Introduction  to  Research 

—  Introduction  to  Principles  and  Practices  ol  Teaching  and  Administration 

—  Continuing  Education 


Qualifications: 

—  Preferably,  Masters/Doctoral  Degree  in  Nursing 

Rank  and  Salary  commensurate  with  qualifications,  and  are  negotiable 


WrHe: 


Director,  School  of  Nursing 
University  of  Windsor 
Windsor,  Ontario,  N9B  3P4 


Post-Basic  Course 

In 

PSYCHIATRIC  NURSING 


for 


Registered  Nurses 


currently  licensed  in  Manitoba  or  eligible  to  be  so  licensed 


The  course  is  of  nine  months  duration  and  includes  theory 
and  clinical  experience  in  hospital  and  community  agen- 
cies, as  well  as  four  weeks  nursing  of  the  mentally  retarded. 
Successful  completion  of  the  program  leads  to  eligibility  for 
licensure  with  the  R.P.N.A.M. 


For  further  Information  please  write  no  later  than  June  15/75 
to: 


Director  of  Nursing  Education 

School  of  Nursing 

Box  9600 

Selkirk,  Manitoba,  R1 A  285 


72     THE  CANADIAN  NURSE 


MARCH  197; 


SPECIAL  NURSES 
FOR  SPECIAL  PATIENTS 


If  your  nursing  experience  has  become  just  a 
matter  of  daily  routine,  then  it's  time  to  think  about 
it. 

Maybe  you  feel  that  your  patients  are  just  num- 
bers. .  .  that  your  involvement  with  them  is  too 
limited.  .  .  that  you  are  ready  for  a  change  because 
you  no  longer  feel  the  same  sense  of  achievement 
and  personal  commitment  in  your  present  posi- 
tion. . . 


Now  it's  really  time  to  think  about  It! 


if  you  are  thinking  about  a  new  approach  to 
nursing,  then  you  are  ready  to  become  a  special 
nurse  tor  special  patients. 

The  patients  at  Department  of  Veterans  Affairs 
Hospitals  across  Canada  need  special  care. 
In  these  hospitals,  nurses  work  in  well-equipped 
surroundings  where  specialized  treatment  is  pro- 
vided in  a  pleasant  atmosphere.  They  are  special 
nurses. 

DVA  hospitals  offer  job  security  in  a  congenial 
climate  that  encourages  nurses  to  give  psycholo- 
gical as  well  as  physical  care  to  their  patients. 

The  nurses  are  employees  of  the  Public  Ser- 
vice of  Canada  which  provides: 

•  Excellent  pension  plan 

•  Favourable  working  hours 

•  Attractive  fringe  benefits 

•  Relocation  expenses 

If  you  are  ready  to  consider  this  new  approach  to 
nursing,  why  not  discuss  it  frankly  with  our  own 
people  who  have  been  specifically  assigned  to 
help  you. 


Right  now,  our  Nurse  Coordinators  in  Winnipeg, 
London  and  Halifax  are  standing  by  for  your  phone 
call.  They  will  be  pleased  to  give  you  further 
information  on  the  variety  of  distinctive  job  benefits 
and  they  can  even  look  into  specific  requests  you 
may  have.  .  .  such  as  having  working  hours 
arranged  to  suit  your  needs. 


Call  collect: 
Halifax: 

London: 

Winnipeg: 


Mary  Johnson 
Camp  Hill  Hospital 
Phone:(902)423-1371 
Helen  Conn 
Westminster  Hospital 
Phone  (51 9)  432-6711 
Ann  Bowman 
Deer  Lodge  Hospital 
Phone:(204)837-1301 


For  information  about  employment 

in  Department  of  Veterans  Affairs  Hospitals 

elsewhere  in  Canada,  call  collect: 

Susan  Champion 

Department  of  Veterans  Affairs,  Ottawa 

Phone:(613)992-3248 


All  positions  are  open  to  both  men  and  women. 


1^ 


Public  Service 
Canada 


Fonction  publique 
Canada 


^RCH  1975 


THE  CANADIAN  NURSE     73 


We  invite  applications  from 

REGISTERED  NURSES 
FOR  GENERAL  DUTY 

in  all  patient  services  areas  including  i.C.U./C.C.Unit.  This  is  an 
opportunity  to  be  on  staff  when  we  move  to  this  new  138  bed 
General  Hospital,  which  will  be  early  in  1975. 

Successful  applicants  will  be  paid  prevailing  Ontario  salary  rates  as 
well  as  other  generous  fringe  benefits  and  in  addition  you  will  have 
the  opportunity  to  work  in  a  brand  new  building  with  modern  equip- 
ment and  beautiful  surroundings. 

Apply  in  writing  to 

The  Director  of  Nursing 
Kirltland  and  District  Hospital 
Kirkland  Lake,  Ontario 
P2N  1R2 


NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  for  all  Nursing  Units 
Intensive-Coronary  Care,  Psychiatry,  Med.-Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservlce  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries    Reg.  N.  Jan.  1st,  1975  —  915.  —  1,1 15. 
April  1st,  1975  —  945.  —  1,145. 

R.N.A.  Jan.  1st,  1975  —  686.  —  728. 
July  1st,  1975  —  738.  —780. 

Contact 
Director  of  Nursing 


FOOTHILLS  HOSPITAL 
Calgary,  Alberta 

Advanced  Neurological- 
Neurosurgical  Nursing 

for 

Graduate  Nurses 

a  five  month  clinical  and 

academic  program 

offered  by 

The  Department  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

(Department  of  Surgery) 

Beginning:    March,  1975 
September,  1975 

Limited  to  8  participants 
Applications  now  being  accepted 

For  further  information,  please  write  to: 

Co-ordinotor  of  In-service  Education 

Foothills  Hospital 

1403  29  St.  N.W.    Calgary,  Alberta 

T2N  2T9 


UNIVERSITY  OF  TORONTO 
FACULTY  OF  NURSING 

BACHELOR  OF  SCIENCE 
IN  NURSING: 

The  Undergraduate  Programme  leading  to  a  B.Sc.N.  degree  involves  two 

curriculae: 

1      Four  year  course  —  the  majority  of  students  enrolled  in  the  course 

enter  direct  from  Grade  13.  but  a  number  with  post-secondary  education 

are  also  admitted. 
2.    Three  year  course  —  for  graduates  of  diploma  schools  of  nursing.  The 

first  and  second  year  of  this  course  are  also  available  on  a  part-time 

basis. 

Both  courses  provide  a  professional  preparation  which  includes  qualification 
for  nursing  in  both  the  hospital  and  public  health  field.  In  both  curriculae 
humanities  and  sciences  is  associated  with  the  study  of  nursing.  The 
four-year  programme  prepares  the  student  for  registi-ation  under  the  Nurses' 
Act  of  the  Province  of  Ontario. 


MASTER   OF  SCIENCE 
IN   NURSING: 

Offered  by  the  Faculty  of  Nursing  through  the  Sctiool  of  Graduate  Studies, 
this  programme  offers  opportunity  for  the  preparation  of  nurses  to  provide 
leadership  in  planning  and  giving  high  quality  care.  Three  areas  of 
specialization  are  offered  at  present:  medical-surgical,  community  health 
and  mental  health-psychiatric  nursing.  Each  candidate's  programme  is 
individually  planned:  electives  in  the  functional  areas  of  education  and 
administration  may  be  selected.  A  thesis  is  required  and  involves  the 
investigation  of  a  nursing  problem  in  the  area  of  the  student's  clinical 
specialization. 


74     THE  CANADIAN  NURSE 


MARCH  19 


CLINICAL  CO-ORDINATOR 
Permanent  Evening 


Post  Basic  Preparation  and 

Administrative  Experience  Required 

at 


Toronto 
General  Hospital 

University 
Teaching  Hospital 


•  located  in  heart  of  downtown  Toronto 

•  within  walking  distance  of  accommodation 

•  subway  stop  adjacent  to  Hospital 

•  excellent  benefits  and  recreational  facilities 


»pply  to  Personnel  Office 

TORONTO  GENERAL  HOSPITAL 
67  COLLEGE  STREET,  TORONTO.  ONTARIO,  M5G  1L7 


R.N.'S 


The  Royal  Alexandra  is  a  friendly  place  to  work;  a  modern 
progressive  1000  bed  teaching  hospital  in  the  "jusf-right- 
size"  city  of  Edmonton,  Alberta. 


Fully  accredited,  the  Royal  Alexandra  offers  challenging  ex- 
perience, on-going  in-service  programs,  generous  fringe 
benefits  and  competitive  salaries.  All  previous  experience  is 
recognized.  You  may  skate,  ski  and  curl  inexpensively.  Ed- 
monton is  within  easy  driving  distance  of  many  lakes  where 
you  may  enjoy  the  sunny  Alberta  summer. 


Vacancies  exist  in  most  areas  including  ICU,  O.R.  &  Psy- 
chiatry. 


Salary  Range  for  General  Duty:  S900.  -  $1075. 


For  Information  plaate  write  to: 


Director  of  Nursing 
Royal  Alexandra  Hospital 
10240  Kingsway  Ave. 
EDMONTON,  ALBERTA 
T5H  3V9 


ST.  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

We  offer  opportunities  in  Emergency,  Operating  Room,  P.A.R.,   Intensive  Care  Unit,  Orthopaedics,  Psychiatry, 

Paediatrics,  Obstetrics  and  Gynaecology,  General  Surgery  and  Medicine. 

We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Service  programs. 

We  offer  —  Toronto  —  with  some  of  Canada's  finest  Theatres,  Restaurants  and  Social  events. 

We  offer  progressive  personnel  policies. 

We  offer  a  starting  salary,  depending  on  experience,  of: 

effective  April  1, 1975     -  $945  to  $1,145  per  montli. 
•  We  offer  monthly  educational  allowances  up  to  $1 20.  per  month  in  addition  to  the  above  starting  salary. 

Appiyto:  Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1B5 


iRCH  1975 


THE  CANADIAN  NURSE     75 


SCHOOL  OF  NURSING 

Assistant  Director 

and 

Instructors 

required  for  August,  1975 

in  a  2  year  Nursing 

diploma  program. 


Qualifications 

Assistant  Director  —  Master  degree  in  Nursing  Education,  prefer- 
red, with  experience  in  Nursing  Education  Administration  and  teach- 
ing and  at  least  one  year  in  a  Nursing  Service  position.  Eligible  for 
registration  in  New  Brunswick. 

Instructors  —  Bachelor  of  Nursing  with  experience  in  teaching  and 
at  least  1  year  in  a  Nursing  Service  position.  Eligible  for  registration 
in  New  Brunswick. 

Apply  to: 

Harriett  Hayes 

Director 

The  IVIiss  A.  J.  IVIacMaster  School  of  Nursing 

Postal  Station  A,  Box  2636 

Moncton,  N.B. 

E1C8H7 


UNIVERSITY  OF  ALBERTA 
SCHOOL  OF  NURSING 


FACULTY  POSITIONS 

Faculty  mennbers  required  for  positions  in  four  year  basic 
and  two  year  post-basic  baccalaureate  programs.  Applic- 
ants should  have  graduate  education  and  experience  in  a 
clinical  area  and/or  in  curriculum  development,  evaluation  or 
research.  Must  be  eligible  for  Alberta  registration. 
Personnel  policies  and  salaries  in  accord  w/ith  University 
schedule  based  on  qualifications  and  experience. 
Apply  in  writing  to: 

RUTH  E.  McCLURE,  M.P.H. 
Director,  School  of  Nursing 
Clinical  Sciences  Building 
University  of  Alberta 
Edmonton,  Alberta 
T6G  2G3 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 

76     THE  CANADIAN  NURSE 


oMs 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


MARCH  19 


Government  of 
Newfoundland  &  Labrador 

MENTAL  HEALTH 
NURSING  CONSULTANT 

Applications  are  invited  for  a  new  post  as  Consultant  in  the  Mental 
Health  Division  of  the  Department  of  Health.  The  Nursing  Consul- 
tant will  work  with  a  multi-disciplinary  group  of  Consultants  in  the 
Division. 

The  duties  and  responsibilities  will  be  oriented  towards  the  clinical 
aspects  of  nursing  in  programs  relating  to  prevention,  treatment, 
rehabilitation  and  the  continuity  of  care.  The  Consultant  will  be 
concerned  with  existing  mental  health  services  in  hospitals,  and 
community  clinics  and  with  the  mental  health  components  of  other 
community  agencies,  the  schools  and  special  services  such  as 
programs  for  the  aged,  the  retarded  and  other  developmental  disor- 
ders. 

Opportunities  will  be  provided  for  involvement  in  university  tea- 
ching, and  research  and  in  the  development  of  new  mental  health 
services  throughout  the  province. 

Salary  within  the  range  $14,076  —  $17,966. 

Qualifications  —  eligibility  to  register  in  Newfoundland.  A  Masters 
degree  in  psychiatric  nursing  or  some  equivalent  combination  of 
education  and  experience. 

Full  public  service  benefits  apply  with  annual  and  sick  leave  with 
pay,  provincial  statutory  holidays  and  contributory  pension  plan. 
Financial  assistance  towards  re-location  is  available. 
Applications  and /or  requests  tor  Information  stiould  be  forwarded  to: 

C.H.  Pottle,  M.D.,  F.R.C.P.  (C.) 

Director 

Mental  Health  Services 

Department  of  Health 

Chimo  Building,  Crosbie  Road 

St.  John's,  Newfoundland 


SHERBROOKE  HOSPITAL 

SHERBROOKE.  QUEBEC. 
Invites  applications  from 

REGISTERED  NURSES 
GENERAL  DUTY 


138-bed  active  General  Hospital;  fully  accredited  with 
Coronary,  Medical  and  Surgical  Intensive  Care. 
Situated  in  the  picturesque  eastern  Toyvnships, 
approxinnately  80  miles  from  Montreal  via  autoroute. 
Friendly  community,  close  to  U.S.  border.  Good 
recreational  facilities.  Excellent  personnel  policies, 
salary  comparable  with  Montreal  hospitals. 


Apply  to: 
Director  of  Nursing 

SHERBROOKE  HOSPITAL 

Sherbrooke,  Quebec. 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 

teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

1974  Salary  Scale  $850.00  —  $1,020.00  per  month 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 
VANCOUVER  GENERAL  HOSPITAL 
855  WEST  12TH  AVE. 
VANCOUVER,  B.C. 


V.RCH  1975 


THE  CANADIAN  NURSE     77 


DIRECTOR  OF  NURSING 


Director  of  Nursing  is  required  immeciiately  for  The 
Provincial  Hospital  located  in  Saint  John,  New  Brunswick. 

The  Provincial  Hospital  is  a  614  bed  psychiatric  facility 
encompassing  an  Active  Treatment  Unit  and  an  Extended 
Care  Unit. 

Responsibilities  include  planning,  organizing  and  co- 
ordinating all  activities  of  the  Department  of  Nursing.  The 
Director  will  be  part  of  the  senior  management  team  involved 
in  the  planning  activities  of  the  hospital. 

The  Director  should  be  registered  with  the  New  Brunswick 
Association  of  Registered  t^urses,  or  eligible  for  registration. 
A  baccalaureate  degree  in  Nursing  with  post-graduate  study 
and  considerable  experience  in  Psychiatric  Nursing  is  es- 
sential. Progressive  experience  in  a  supervisory  position  is 
desirable. 
Salary  is  to  be  discussed. 

Interested  applicants  should  send  resume  to: 
W.J.  Holloway 
Administrator 
The  Provincial  Hospital 
P.O.  Box  3220,  Postal  Station  B 
Saint  John,  New  Brunswick 


ORTHOPAEDIC    tc    ARTHRITIC 
HOSPITAL. 


\J'\\\=/ 


43  WELLESLEY  STREET,  EAST 

TORONTO,  ONTARIO 

M4Y1H1 

Enlarging  Specialty  Hospital  offers  a  unique 
opportunity  to  nurses  and  nursing  assistants 
interested  in  the  care  of  patients  with  bone  and 
joint  disorders. 

Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  all 
units 

Clinical  specialists  for  Operating  Room,  Intensive 
Care,  Patient  Care  and  Education. 


HEALTH 

SCIENCES 

CENTRE 

WINNIPEG, 
MANITOBA 


THIS  1345  BED  COMPLEX  WITH  AMBULATORY  CARE  CLINICS.  AFFILIATED 
WITH  THE  UNIVERSITY  OF  MANITOBA,  CENTRALLY  LOCATED  IN  A  LARGE, 
CULTURALLY  ALIVE  COSMOPOLITAN  CITY. 

INVITES  APPLICATIONS  FROM 

REGISTERED  NURSES  SEEKING  PROFESSIONAL 
GROWTH,  OPPORTUNITY  FOR  INNOVATION,  AND  JOB 
SATISFACTION. 

ORIENTATION  -  Extensive  two  weel<  program  at  full  salary 
ON-GOING  EDUCATION    Provided  througti 

—  active  in-service  programmes  in  all  patient  care  areas 

—  opportunity  to  attend  conferences,  institutes,  meetings  of  professional 
association 

—  post  basic  courses  in  selected  clinical  specialties 
PROGRESSIVE  PERSONNEL  POLICIES 

—  salary  based  on  experience  and  preparation 

—  paid  vacation  based  on  years  of  service 

—  shift  differential  for  rotating  services 

—  1 0  statutory  holidays  per  year 

—  insurance,  retirement  and  pension  plans 

—  contract  under  negotiation  effective  March,  1975 

SPECIALIZED  SERVICE  AREAS  include  orthopedics,  psychiatry,  post 
anaesthetic,  emergency,  intensive  care,  coronary  care,  respiratory  care,  dialysis, 
medicine,  surgery,  obstetrics,  gynaecology,  rehabilitation,  and  paediatrics. 

ENQUIRIES  WELCOME 

FOR  FURTHER  INFORMATION  PLEASE  WRITE  TO: 

PERSONNEL  DEPARTMENT.  NURSING  SECTION 
HEALTH  SCIENCES  CENTRE, 

/OO  WILLIAM  AVENUE,  WINNIPEG,  MANITOBA    R3E0Z3 


78     THE  CANADIAN  NURSE 


MARCH  1< 


VACANCY 
SUPERVISOR  FOR  OPERATING  ROOM 

Qualification  Requirement:  RN  plus  four  years  Operating  Room  experience.  Operating 

Room  Post  Graduate  desirable  plus  administrative  ability. 
Hours:  Day  Shift,  however,  hours  are  not  necessarily  8:00  a.m.  —  4:00  p.m. 
Salary  Scale:  $9,440.00  —  $1 1 ,999.00  per  annum. 

Excellent  working  conditions  and  fringe  benefits  such  as  four  weeks  annual  vacation, 
Pension  Plan,  Group  Life  Insurance,  etc.  Residence  Accommodation  available  at  a 
nominal  cost  per  month.  Assistance  with  travel  expenses  available  depending  on  terms  of 
contract. 


Apply  to: 


(Mrs.)  SHIRLEY  M.  DUNPHY 

Director  of  Personnel 
Christopher  Fisher  Division 
Western  Memonal  Hospital 
Corner  Brook,  Newfoundland 
A2H  6J7 


VACANCY 

Instructor  for  Nursing  III  area  of  a  two  year  program 

Required  Qualification:  Baccalaureate  Degree  in  Nursing. 

Excellent  fringe  benefits  such  as  twenty  days  Annual  Vacation,  Pension  Plan,  Group  Life 

Insurance,  etc. 

Residence  accommodation  available  plus  transportation  allowance. 

Salary  negotiable  depending  on  qualifications  and  experience. 


Apply  to: 


(Mrs.)  SHIRLEY  M.  DUNPHY 
Director  of  Personnel 
Western  Memorial  Hospital 
CORNER  BROOK,  NEWFOUNDLAND 
A2H6J7 


AARCH  1975  THE  CANADIAN  NURSE     79 


Arctic- 
M^armth 


-  •  ■  ■Avhen 

somebody 

cares. 


if  you  care, 


'UA     send  t 


t\is 
coupon  today. 

^Tr^^'yf ' 

I       •■       I,       y-, : -''  .      Medical  Services  Branch 

I*    -    V      ^      Department  of  National 

I*       Please  send  me  more  information  on  nursing 
opportunities  in  Canada's  Northern  Health  Service 

I    Name:       

I    Address:    

■city:  


Health  and  Welfare 
Ottawa,  Ontario   K1  A  0K9 


Prov: 


1^ 


Health  and  Welfare       Sante  et  Bien-etre  social 
Canada  Canada 


Index 

to 

Advertisers 

March  1 975 

Abbott  Laboratories 

.5,  57.  Cover  4 

Astra  Pharmaceuticals  Canada  Ltd.   . .  . 

55 

Baxter  Laboratories  of  Canada 

53 

The  Clinic  Shoemakers 

2 

Department  of  National  Defence    

69 

Health  Care  Services  Upjohn  Limited  . 

71 

Heelbo  Corooration                 

18 

Hollister  Limited              

62 

ICN  Canada  Limited   

8,  15.  61 

Eli  Lilly  and  Company  (Canada)  Ltd. 

17 

J    B    Linnincott  Co    of  Canada  Ltd 

.  .40  &  4 1 

MedoX          

64 

Mont  Sutton 

11 

The  C.V.  Mosby  Company,  Ltd 

.45,  46,  47,  48 

Nordic  Biochemicals                      

59 

Posev  Comoanv           

7 

Reeves  Company 

50 

W.  B.  Saunders  Company  Canada  Ltd. 

13 

White  Sister  Uniform,  Inc 

1 ,  Covers  2  &  3 

Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  IE2  (Ontario) 

i 

Advertising  Representatives 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore,  Penna.  19003 
Telephone:  (215)  649-1497 

1 

Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills,  Ontario 
Telephone:(4l6)  444-4731 

Member  of  Canadian 
Circulations  Audit  Board  Inc. 

mm 
J 

80     THE  CANADIAN  NURSE 


MARCH  1< 


APR 


'3  19 ?s 


Nurse 


DO    N'OT    TAKl: 
OUT    OF    LliJRAilY 


UNIVERSITY  OF  OTTAWA 
NURSING  LIBRARY 
TTAWA,  ONT. 


Nursing  in  a  northern  Indian  settlement 


^  • 


A)  Style  No.  44934 

Sizes  5-15 

Royale  Supreme  Plain 
Tricot  Knit 

White 

About . . .  $25.00 

Royale  Corded  Tricot 
Cantaloupe 
About. .  .$25.00 


B)  Style  No.  44964 

Sizes  3-1 3 

Royale  Supreme  Plain 

Tricot  Knit 

White 

About .  .  .  $20.00 


C)  Style  No.  4460 

Sizes  12-20 
Royale  Corded  Tricot 
White,  Yellow 
About . . .  $20.00 


^ 


come  the  Spring  Season  with 
of  our  newest  cantaloupe  wa 

rs  or  our  sparkling  whites. 

White  Sister,  of  course. 


•c-l  ic-i  J^ 


CAREER  APPAREL      See   our  new   line   of  White?;   and  W^tpr  r.nlmirc   at   fino   ctoroc    o-^r/^co    r^onar 


New...readytouse... 
"bolus"  prefilled  syringe. 

Xylocaine'100  mg 

(lidocaine  hydrochloride  injection,  USP) 

For  'Stat'  I.V.  treatment  of  life 
threatening  arrhythmias. 


n  Functions  like  a  standard  syringe. 


® 


D  Calibrated  and  contains  5  ml  Xylocaine2% 

D  Package  designed  for  safe  and  easy 
storage  in  critical  care  area 

D  The  only  lidocaine  preparation 
with  specific  labelling 
information  concerning  its 
use  in  the  treatment  of  cardiac 
arrhythmias. 


an  original  from 

ASTKA 


Xy local ne"  100  mg 

(lidocaine  hydrochloride  in)ection  USP) 

INDICATIONS-Xylocaine  adminislered  intra- 
venously IS  specifically  indicated  in  ihe  acute 
management  of  ( I J  ventricular  arrhvthmias  occur- 
ring dunng  cardiac  manipulation,  such  as  cardiac 
surgery;  and(2)  life-threatening  arrhythmias,  par- 
ticularly those  which  are  ventricular  in  origin,  such 
as  occur  during  acute  myocardial  infarction. 

CONTRAINDICATIONS-Xylocainc  is  contra- 
indicated  (I)  in  patients  with  a  known  historv  of 
hypersensitivity  lo  local  anesthetics  of  the  amide 
type;  and  (2)  in  patients  with  Adams-Stokes  s\n- 
drome  or  with  severe  degrees  of  sinoatrial,  airio- 
ventncular  or  intraventricular  block. 

WARNINGS-Constant  monitoring  with  an  elec- 
trocardiograph is  essential  in  the  proper  adminis- 
tration of  Xylocaine  intravenously.  Signs  of  exces- 
sive depression  of  cardiac  conductivity,  such  as 
prolongation  of  PR  interval  and  QRS  complex 
and  the  appearance  or  aggravation  of  arrhvthmias, 
should  be  followed  by  prompt  cessation  of  the 
Intravenous  infusion  of  this  agent.  It  is  mandatory 
lo  have  emergency  resuscitative  equipment  and 
drugs  immediately  available  to  manage  possible 
adverse  reactions  involving  the  cardiovascular, 
respiratory  or  central  nervous  systems. 

Evidence  for  proper  usage  in  children  is  limited. 

PRECALTIONS-Caution  should  be  employed 
in  the  repeated  use  of  Xylocaine  in  patients  with 
severe  liver  or  renal  disease  because  accumulation 
may  occur  and  may  lead  to  toxic  phenomena,  since 
Xylocaine  is  metabolized  mainly  in  the  liver  and 
excreted  by  the  kidney  The  drug  should  also  be 
used  with  caution  in  patients  with  hypovolemia 
and  shock,  and  all  forms  of  heart  block  ( see  CON- 
TRAINDIC.ATIONS  AND  WARNINGS) 

In  patients  with  sinus  bradycardia  the  adminis- 
tration of  Xylocaine  intravenously  for  the  elimina- 
tion of  ventricular  ectopic  beaus  without  prior 
acceleration  in  heart  rate  (e.g.  by  isoproterenol 
or  by  electric  pacing)  may  provoke  more  frequent 
and  serious  ventricular  arrhythmias. 

ADVERSE  REACTIONS-Systemic  reactions  of 
the  following  types  have  been  rcponed- 

(1)  Central  Nervous  System:  lightheadedness, 
drowsiness;  dizziness:  apprehension;  euphoria; 
tinnitus:  blurred  or  double  vision;  vomiting;  sen- 
sations of  heat,  cold  or  numbness:  twitching: 
tremors;  convulsions:  unconsciousness;  and  respi- 
ratory depression  and  arrest. 

(2)  Cardiovascular  System:  hypotension;  car- 
diovascular collapse:  and  bradycardia  which  may 
lead  to  cardiac  arrest. 

There  have  been  no  reports  of  cross  sensitivity 
between  Xylocaine  and  procainamide  or  between 
Xylocaine  and  quinidine. 

DOSAGE  AND  ADMINISTRATION-Single 
Injection:  The  usual  dose  is  50  mg  to  100  mg 
administered  intravenouslv  under  ECG  monitor- 
ing. This  dose  may  be  administered  at  the  rate 
of  approximately  25  mg  to  50  mg  per  minute. 
Sufficient  time  should  be  allowed  to  enable  a  slow 
circulation  to  carry  the  drug  to  the  site  of  action. 
If  the  initial  injection  of  50  mg  to  100  mg  does 
not  produce  a  desired  response,  a  second  dose  mav 
be  repealed  after  10-20  minutes, 

NO  MORE  THAN  200  MG  TO  300  MG  OF 
XYLOCAINE  SHOULD  BE  ADMINISTERED 
DURING  A  ONE  HOUR  PERIOD 

In  children  experience  with  the  drug  is  limited. 

Continuous  Infusioo:  Following  a  single  injection 
in  those  patients  in  whom  the  arrhythmia  tends 
to  recur  and  who  are  incapable  of  receiving  oral 
antiarrhvthmic  therapv,  intravenous  infusions  of 
Xylocaine  mav  be  administered  at  Ihe  rate  of  I 
mgto  2  mgper  minute  (20  to  25  ug/kg  per  minute 
in  the  average  70  kg  man).  Intravenous  infusions 
of  Xylocaine  must  be  administered  under  constant 
ECG  monitoring  to  avoid  potential  overdosage 
and  toxicity.  Intravenous  infusion  should  be  ter- 
minated as  soon  as  Ihe  patient's  basic  rhythm 
appears  to  be  stable  or  at  the  earliest  signs  of 
toxicity.  It  should  rarely  be  necessary  to  continue 
intravenous  infusions  bevond  24  hours.  As  soon 
as  possible,  and  when  indicated,  patients  should 
be  changed  to  an  oral  antiarrhythmic  agent  for 
maintenance  therapy- 
Solutions  for  intravenous  infusion  should  be 
prepared  by  the  addition  of  one  50  ml  single  dose 
vial  of  Xylocaine  2%  or  one  5  ml  Xylocaine  One 
Gram  Disposable  Transfer  Syringe  to  1  hier  of 
appropriate  solution.  This  will  provide  a  0,1*?^ 
solution;  that  is.  each  ml  will  contain  1  mg  of 
Xylocaine  HCl.  Thus  1  ml  to  2  ml  per  minute 
will  provide  1  mg  to  2  mg  of  Xylocaine  HCl  per 
minute. 


Help  us  with  our  International  Women's  Year  Project! 


The  Canadian  Nurse  and  L'infirrniere  canadienne  want  to  docu- 
ment instances  of  sex  discrimination  in  health  care  so  that  action 
can  be  taken  to  correct  it. 

Are  women  discriminated  against  in  health  care?    As  patients? 
As  nurses? 

We  invite  nurses  to  send  us  examples  of  discrimination.  Use  the 
form  below,  and,  please,  sign  it.  Your  identity  will  not  be  revealed. 

Return  the  form  not  later  than  30  June  1975,  to: 
Canadian  Nurses'  Association 
Director  of  Information  Services 
50  The  Driveway 
Ottawa,  Ontario  K2P  1  E2 


Incident: 


In  your  opinion, how  does  this  incident  show  discrimination  against  women? 


Are  you:[ina  nurse, Q  a  patient,  Q  other  (specify). 


2     THE  CANADIAN  NURSE 


APRIL  19 


The 

Canadian 
Nurse 


^^^ 


A  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  by  the  Canadian  Nurses'  Association 


Volume  71,  Number  4 


April  1975 


21     The  Nurses  of  Brochet H.  Brigstocke 

25     A  LEAP  with  UP R-  Edmunds,  D.L.  Smith 

29     Rape  Victims  — 

the  Invisible  Patients   V.  Price 

35     Report:  CNA  Directors 

Meet  in  Ottawa N.  Blals 

39     Changing  Staff  Behavior   M.K.  Eriksen 

41     How  Children  See  the  Nurse   C.  Turcotte 

The  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

1 1  News 

44  Dates 

46  New  Products 


49  In  A  Capsule 

50  Research  Abstracts 
52  Accession  List 

72  Index  to  Advertisers 


Executive  Director:  Helen  K.  Mussallem  • 
Editor:  Virginia  A.  Lindabury  •  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Dorothy  S. 
Starr  •  Production  Assistant:  Mary  lou 
Downes  •  Circulation  Manager:  Beryl  Dar- 
ling •  Advertising    Manager:    Georgina    Clarke 

•  Subscription  Rates:  Canada:  one  year 
$6.00;  two  years,  $11.00.  Foreign:  one  year, 
$6.50;  two  years,  $12.00.  Single  copies: 
$1.00  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  registration  number  in  a  pro- 
vincial nurses'  association,  where  applicable. 
Not  responsible  tor  journals  lost  in  mail  due 
loerrors  in  address. 


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  detmite  dates  of  publication. 

Postage  paid  in  cash  at  third  class  rate 
MONTREAL.  P.Q.  Permit  No.  10,001. 
50    The    Driveway,    Ottawa,    Ontario,    K2P1E2 

®    Canadian  Nurses'  Association  1975. 


IIL1975 


editorial 

A  few  months  ago,  a  man  who  was 
already  on  bail  after  three  offences, 
was  charged  with  raping  a  young 
woman  after  breaking  into  her  apart- 
ment and  threatening  her  with  a  knife. 
The  Crown  attempted  to  obtain  a  court 
order  to  require  the  accused  to  stay  in 
jail  until  his  trial,  to  be  held  two  months 
later,  but  the  presiding  judge  allowed  a 
defence  bid  to  free  him  on  bail.  The 
Crown  was  unable  to  show  that  releas- 
ing the  accused  would  be  contrary  to 
the  public  interest.  (Globe  and  Mail  5 
Sept.  1974.) 

In  another  case,  a  man  who  was 
convicted  of  beating  and  indecently 
assaulting  a  9-year-(3ld  girl  was  given  a 
15-weekend  jail  sentence,  i.e.,  he  had 
to  spend  1 5  consecutive  weekends  in 
jail.  (Globe  and  Mail  10  Jan.  1974.) 

On  the  other  hand,  two  men  who 
robbed  a  man  of  $130  last  July  and 
struck  him  in  the  shoulder  with  a  small 
knife  were  each  sentenced  by  the 
judge  to  five  years  in  the  penitentiary. 
One  is  forced  to  ask,  after  noting 
these  court  decisions  and  others  that 
appear  with  increasing  frequency  in 
the  press,  just  how  serious  the  crime  of 
rape  is  held  by  the  courts  —  and,  in- 
deed, by  society  —  even  though  the 
offence  comes  under  the  Criminal 
Code.  There  seems  to  be  little  recogni- 
tion that  the  act  of  rape  is  so  psycholog- 
ically traumatic  for  most  victims  that 
they  seldom  recover  completely.  For  a 
woman,  rape  is  the  worst  act  of  vio- 
lence. 

And  there  are  other  legal  injustices 
for  rape  victims.  As  the  law  stands,  de- 
fence lawyers  are  free  to  harass  rape 
victims  by  interrogating  them  about 
their  past  sexual  experiences,  how 
they  felt  as  they  were  being  raped,  and 
so  on.  Realizing  that  they  will  be  sub- 
jected to  this  further  torture,  many  vic- 
tims refuse  to  testify. 

Also,  rape  victims  are  forced  to  sup- 
port their  testimony  with  medical  evi- 
dence to  show  the  existence  of 
bruises,  cuts,  and  semen.  As  an  editor- 
ial in  The  Globe  and  Mail  pointed  out 
recently,  at  least  three  U.S.  states  have 
amended  their  laws  to  prevent  this. 

Before  the  federal  election  last  July, 
federal  Justice  Minister  Otto  Lang  an- 
nounced that  he  was  considering 
amendments  to  the  Criminal  Code  to 
make  legal  proceedings  fairer  for  rape 
victims.  His  intentions  are  commend- 
able, but  his  nonaction  is  deplorable. 
The  Justice  Minister  is  presently 
being  pressured  by  the  federal  advis- 
ory council  on  the  status  of  women  to 
introduce  amendments  to  the  section 
of  the  Criminal  Code  that  deals  with 
rape  and  sex  offences.  I  hope  he  will  be 
further  pressured  by  the  readers  of  this 
column.  — V.A.L. 

THE  CANADIAN  NURSE     3 


letters    { 


Letters  to  the  editor  are  welcome. 

Only  signed  letters,  which  include  the  writer's  complete  address, 

will  be  considered  for  publication. 

Name  will  be  withheld  at  the  writer's  request. 


Disagree  with  editorial 

On  the  subject  of  world  nutrition  (Editor- 
ial. 7"/!eCa«a^(a/jA'ttrje,  January  1975),! 
would  like  to  bring  to  your  attention  that 
the  nutritional  survey  done  in  Canada  re- 
cently shows  malnutrition  among  man>|/. 

1  am  not  in  favor  of  Canadian  organiza- 
tions or  the  government  spending  money 
to  provide  food  for  other  nations  when  it  is 
unlikely  that  the  bulk  ever  reaches  the 
needy.  Governments  of  these  nations 
spend  money  on  arms  while  you  ask  Cana- 
dians to  feed  their  starving  masses.  Give- 
away foodstuffs  often  reach  the  black 
markets  because  there  is  poor  supervision 
of  distribution. 

Instead,  I  would  prefer  the  Canadian 
Nurses"  Association  to  promote  better 
food  habits  among  Canadians,  starting 
with  the  nurses.  Nurses,  who  are  either 
underweight,  overweight,  or  following 
faddish  diets,  lose  their  credibility  when 
teaching  patients  good  nutrition  that  they, 
themselves,  obviously  do  not  follow. 
Should  nurses  not  lead  by  good  example  at 
home?  —  C.R.  Ballantyne,  Burnaby, 
British  Columbia. 


I  feel  I  must  voice  some  criticism  about 
the  stand  you  took  in  your  editorial. 

As  so-called  professionals,  nurses 
should  at  least  attempt  to  understand  the 
consensus  arrived  at  by  other  professionals 
such  as  engineers,  physicists,  economists, 
or  statesmen,  concerning  world  food  prob- 
lems. Most  of  these  agree  that  the  earth  is 
being  depleted  very  rapidly  of  its  re- 
sources, and  unless  some  measures  are 
taken  immediately,  we  will  all  suffer  the 
consequences.  It  would  seem  more  ap- 
propriate for  nurses  to  work  toward 
economic  controls,  whether  it  be  family 
planning  or  curbing  of  hospital  expendi- 
tures, rather  than  to  attempt  to  feed  ever- 
growing populations  with  ever-dwindling 
food  supplies,  as  the  sensationalism  of 
radio  and  TV  reporting  would  have  us  do. 
—  Stella  Lawand,  Montreal,  Quebec. 


Your  editorial  in  the  January  issue  did  not 
stimulate  me  to  write  to  the  Prime  Minis- 
ter. Instead,  I  got  hot  enough  under  the 
collar  to  reply  to  you  with  the  following; 
Sending  grain  to  the  starving  nations  is 
just  like  putting  a  soother  in  a  baby's 
mouth .  We  are  not  getting  at  the  root  of  the 
problem.  I  place  sending  $  1 .  to  UNICEF  in 
the  same  category. 
4     THE  CANADIAN  NURSE 


Why  are  there  so  many  mouths  to  feed 
to  begin  with?  Is  there  any  more  we  can  do 
to  help  them  solve  this  basic  problem? 
Perhaps  these  millions  have  to  starve  to 
make  them  realize  the  need  for  birth 
control.  I  am  more  in  favor  of  supporting 
programs  such  as  cida  and  cuso,  which 
are  education-oriented.  Teach  them  to 
help  themselves. 

While  I'm  on  the  subject,  let's  look  at 
what  is  happening  in  our  own  country: 
Why  do  so  many  teenage  girls  have  to 
deliver  one  child  before  I,  as  a  public 
health  nurse,  can  get  to  them  to  talk  about 
birth  control?  With  all  the  restrictions  on 
sex  education  in  the  public  school  system, 
plus  the  limitations  on  birth  control  adver- 
tising, I  am  unable  to  reach  these  girls 
before  it  is  too  late. 

Occasionally  I'll  have  an  opportunity  to 
talk  to  a  girl  while  I'm  treating  her  for 
venereal  disease.  However,  I'm  usually 
too  late.  (I  have  several  records  to  prove 
this  statement.)  Who  is  teaching  their  male 
sex  partners  some  sexual  responsibility 
and/or  methods  of  birth  control?  I  have  not 
found  a  means  to  do  this. 

1  hope  that  this  may  not  be  as  great  a 
problem  in  all  parts  of  this  country;  how- 
ever, it  exists  in  this  community.  I  know 
from  previous  experience  that  it  exists  in 
other  communities  in  northern  Saskatche- 
wan. Is  this  a  problem  that  is  limited  to 
northern  Saskatchewan,  all  northern 
communities,  only  specific  provinces,  or 
does  it  exist  right  across  Canada? 

Another  thought;  What  is  Canada  doing 
to  encourage  its  citizens  to  use  birth 
control?  If  Canada  does  not  soon  develop 
some  specific  means  of  encouraging  birth 
control  in  all  sectors  of  our  society,  we  will 
eventually  be  faced  with  the  same  prob- 
lem; How  do  we  feed  our  starving  mil- 
lions? —  Mary  L.  Toews,  PHN  IV, 
Saskatchewan. 


I  applaud  the  sentiment  expressed  in 
Virginia  Lindabury's  January  editorial,  in 
which  she  summons  us  to  action  for  the 
world's  starving  people.  She  suggests  that 
we  each  send  $1.  to  UNICEF  and  write  a 
letter  to  the  Prime  Minister  demanding  an 
increase  in  foreign  aid  in  the  form  of  food. 
Unfortunately,  such  an  attitude  fails  to 
consider  the  scope  of  the  problem  and  the 
realities  of  the  present  global  situation. 

First,  such  action,  in  the  long  term,  does 
more  harm  than  good.  An  escalating  popu- 
lation size  increases  further  —  in  effect. 


more  people  suffer.  Second,  dependenc 
of  a  nation  on  an  external  food  supply  rob 
that  nation  of  motivation  to  exercise  th 
right  and  potential  to  problem  solve.  Th 
concepts  of  effective  helping  are  bein 
clearly  articulated  in  nursing.  How  is 
then,  that  when  considering  a  nation,  I  ai 
called  upon,  as  a  member  of  the  cna.  t 
ignore  those  concepts? 

My  major  concern,  however,  is  th; 
such  an  approach  reinforces  the  mentalil 
that  a  solution  merely  requires  giving 
little  more  of  the  "things"  we  posses; 
Consequently,  having  dealt  with  the  prot 
lem  'to  our  moral  satisfaction,  life  is  a 
lowed  to  carry  on  as  before.  A  stand  of  th; 
nature  is  nothing  less  than  selfish  an 
hypocritical. 

The  only  hope  rests  in  arousing,  not 
guilty  conscience  that  is  assuaged  by  gi 
giving,  but  in  arousing  critical  evaluativ 
thinking  about  a  life-style  with  values  thi 
create  situations  in  which  many  suffei 
With  such  analyses,  rationality  can  surel 
only  be  satisfied  by  a  global  conceptu; 
framework  in  which  we  must,  undoub 
edly,  change  our  criteria  for  wh; 
constitutes  a  quality  life.  —  Mauree 
Murphy,  Student  —  M.Sc.N.  Yr.  i 
University  of  Western  Ontario,  Londot 
Ontario. 


Editor' s  note: 

Certainly  long-range  solutions  are  n 
quired  to  help  solve  the  worid  food  shoi 
age.  But  does  that  mean  we  must  igno 
the  short-term  solution  of  providing  ; 
much  food  as  possible  to  those  who  a 
starving?  I  cannot  accept  this. 


Enjoyed  January  editorial 

Thank  you  for  your  good  editorial  ( 
January  1975.  I  was  so  happy  to  see  n" 
journal  showing  a  constructive  concern  fi 
the  starving  people  of  the  world. 

May  I  add  to  your  two  suggestions  as  j 
what  we  can  do?  Many  of  us  can  support 
child  (or  children)  through  an  agenc 
such  as  Foster  Parent' s  Plan ,  The  Christii 
Children's   Fund,   or   World   Vision  i 
Canada.    Those    already    involved    wi| 
children  in  this  way  can  assure  those  wl 
are  not  that  there  will  never  be  anything 
their  mail  boxes  that  will  bring  greater  j( 
than  do  the  letters  received  from  a  spo 
sored  child.  —  Margaret  E.  Pardy,  Rl 
Bamfield,  British  Columbia. 

(continued  on  page  i 

APRIL  197 


A  FRESH  NEW  LOOK  FOR  SPRING 


BY 
DESIGNER'S  CHOICE 


desigher's 
choice 


A 

LIMITED 
EDITION 


AT    VrM  ID    CA\/rM  ID1TC    r^ADCCD     AODADtri       OT/^DI 


(continued  from  page  4) 

To  the  "down  under"  RNs 

After  reading  the  letter  from  7  RNS  in 
Australia  (Letters.  Jan.  1975.  p.  6).  I  feel 
that  I  must  reply.  I  am  a  Bntish  nurse, 
now  working  in  Canada. 

Before  coming  to  Saskatchewan.  I  ap- 
plied for  registration  and  was  told  I  would 
have  to  take  an  examination,  but  only  on 
general  nursing.  It  turned  out  to  be  3  days 
of  exams  in  surgery,  medicine,  pediatrics, 
obstetrics,  and  psychiatry! 

I  had  never  studied  psychiatry  and,  un- 
fortunately, failed  this  subject  twice.  I  was 
then  informed  that  I  must  take  some  les- 
sons, but  had  to  make  my  own  arrange- 
ments for  this.  This  is  what  I  did,  and  I  am 
now  registered  in  Saskatchewan. 

I  suppKJse  I'm  one  of  the  lucky  ones, 
because  one  woman  I  know  lacks  obstet- 
rics, but  can't  get  into  a  center  to  take  it. 
No  room!  SheisanSRN,  with  postgraduate 
work  in  chest  and  OR  supervision.  She  now 
works  at  10  percent  less  than  other  RNs, 
but  is  doing  the  same  work,  if  not  more, 
due  to  her  postgraduate  experience. 

Fortunately,  the  Saskatchewan  Regis- 
tered Nurses"  Association  has  written 
regulations  that  list  the  requirements 
for  overseas  RNS  applying  for  registra- 
tion. Even  so,  why  should  British  nurses, 
many  with  extensive  postgraduate  expe- 
rience in  various  fields,  have  to  take  these 
exams,  plus  the  10  percent  cut  in  salary? 

To  those  7  Canadian  RNs  "down  un- 
der," I  would  say:  1  am  glad  that  you  now 
know  what  we  have  to  go  through  when  we 
come  to  Canada.  Welcome  to  the  club! 

We  know  that  the  provinces  don't  want 
just  anyone  coming  in.  but  surely  each 
individual  should  be  taken  on  her  own 
merits  and  then  go  on  from  there.  It  is 
certainly  something  to  think  about!  — 
Marilyn  Dearden.  R,\,  SRN,  SCM,  Director 
of  Nursing.  Chief  Executive  Officer,  Lady 
Minto  Union  Hospital,  Edam,  Sask. 


Insulin  goes  metric 

We  were  interested  in  the  article 
"Insulin  Goes  Metric:  A  Time  for 
Review"  by  E.  Laughame  (February 
1975,  p.  22).  In  our  hospital,  we  found 
this  same  lack  of  knowledge  about  the 
new  lOO-unit  Insulin  preparations. 

We  decided  to  have  a  seminar  on  the 
topic  at  Loyalist  College,  which  is  now 
the  major  health  science  teaching  facility 
in  the  Belleville  area.  The  seminar  was 
cosponsored  by  the  local  branch  of  the 
Canadian  Diabetic  Association  (CDA)  and 
the  area  hospitals. 

CDA  notified  all  known  diabetics  in  the 
area,  as  well  as  their  families  and  friends. 
6     THE  CANADIAN  NURSE 


We  notified  doctors,  pharmacists,  the 
public  health  unit,  the  Victorian  Order  of 
Nurses,  the  home  care  office,  and  the 
inservice  education  directors  of  each 
hospital.  Two  weeks'  notice  of  the 
semmar  was  given  in  advertisements  that 
appeared  in  all  local  newspapers.  The 
local  radio  station  gave  free  an- 
nouncements. 

We  decided  to  have  a  panel 
presentation,  as  this  would  enable  the 
audience  to  ask  questions  of  professionals 
or  nonprofessionals.  We  have  found  that 
it  is  effective  and  informative  to  have 
diabetics  and  parents  of  diabetic  children 
on  the  panel,  along  with  a  doctor  or 
dietician.  Diabetic  teenagers  are  also 
included,  as  they  have  their  own  set  of 
problems  and  are  great  at  helping  each 
other. 

The  response  to  the  seminar  was 
excellent,  and  revealed  a  real  concern  on 
the  part  of  public  and  professionals  alike. 
However,  some  diabetics  at  the  seminar 
were  still  not  entirely  convinced  about  the 
need  for  change  nor  the  continued  use  of 
the  same  dosage  in  units.  We  believed  it 
wise,  therefore,  to  follow  up  the  program 
with  a  catchy,  slogan-type  advertisement 
in  all  the  newspapers: 

Notice  to  Diabetics 

With  Your  New  lOO-Unit  Insulin 

And  Your  New  100- (J nit  Syringe 

Continue  Talcing  the  Same  Number 

Of  Units  of  Insulin 

This  does  not  ignore  the  fact  that,  from 
time  to  time,  some  patients  require  a 
change  in  dosage.  Most  diabetics  keep  in 
touch  with  their  doctors  for  needed 
verification  of  dosage. 

We  have  been  asked  to  present  this 
seminar  in  another  area,  and  there  is 
doubtlessly  a  real  need  for  something 
similar  to  be  undertaken  in  any  area 
where  there  are  diabetics.  We  have  a 
professional  responsibility  to  ensure  that 
the  public  understands  important  health 
care  changes.  — Josephine  Reddick,  RN. 
SRN.  SCM.  Nursing  Teacher,  Loyalist 
College  of  Applied  Arts  and  Technology, 
Belleville,  Ontario,  and  R.  Gordon 
Romans,  M.D.,  Consultant,  Insulin 
Division,  Connaught  Laboratories, 
Toronto. 


Laurels 

I  enjoy  receiving  and  reading  The  Cana- 
dian Nurse  each  month.  It  is  stimulating, 
informative,  and  up-to-date.  The  nursing 
staff  in  the  homes  for  the  aged  across  the 
province  are  encouraged  to  use  this 
magazine  as  reference  material  for  inser- 
vice training  programs  in  the  nursing  unit. 
I  wish  you  continued  success  in  such  a 
worthwhile  endeavor.  —  Muriel  J. 
Maxwell,  Nursing  Consultant,  Senior 
Citizens'  Bureau,  Ontario  Ministry  of 
Community  and  Social  Services,  Toronto. 


Be  considerate  to  nonsmokers 

Recently,  I  attended  a  meeting  of  ti 
Order  of  Nurses  of  Quebec,  where  mai 
persons  were  smoking.  The  committee  r 
sponsible  for  organizing  meetings  such 
this  goes  out  of  its  way  to  secure  an  attra 
tive  hall  that  has  proper  acoustics  and  coi 
fortable  seats.  But  the  committee  membei 
tend  to  forget  that  the  quality  of  the  air 
also  closely  related  to  the  comfort  of  t'f 
participants.  We  should  realize  that  mo: 
and  more  persons  have  developed  a  ser| 
sitivity  to  smoke  and  are  genuine!' 
bothered  by  it. 

I  realize  that  this  harmful  and  abusi\ 
habit  is  now  well  established;  nevertht 
less,  I  believe  that  a  profession  such  i 
ours,  which  is  dedicated  to  the  health  an 
well-being  of  people,  should  set  the  exan 
pie  and  show  some  consideration  to  il 
nonsmokers  until  our  governments  intr 
duce  legislation  to  ban  smoking  in  publ 
places.  — P. A.  Pare,  Public  Heali 
Nurse,  Quebec. 

Journals  available 

I  would  like  to  hear  from  anyone  intereste 
in  receiving  my  complete  set  of  T) 
Canadian  Nurse  journals  from  the  yea 
1970  to  1974  inclusive. 

I  am  willing  to  pay  the  require 
postage.  —  B.J.  Ford,  R.R.  #  . 
Moncton,  New  Brunswick. 


Where  Is  the  nurse  who  cares? 

In  "Caring  Begins  in  the  Teache 
Student  Relationship"  (Dec.  1974 
Daphne  Walker  Mesolella  asks,  "Wher 
is  she?  Where  is  the  nurse  who  feels,  an 
who  cares  about  me  as  a  person?"  I  woul 
like  to  know  the  answer  to  that  questior 
too.  On  a  gynecological  floor  where  I  wa 
a  patient,  the  patients  seemed  to  have  th 
same  conditions  as  we  encountered  when 
was  a  student,  but  there  the  similarii 
ended. 

When  nursing  education  started  to  brea 
from  the  three-year  basic  hospital  training 
we  were  assured  that  the  "new"  nurs 
would  be  aware  of  the  patient  as  a  "whol 
person."  For  a  few  years  I  believed  th; 
was  a  realistic  aim.  But  what  has  gor 
wrong  with  the  education  system?  In  n^ 
recent  experience,  to  the  head  nurse  I  w; 
a  name  on  the  bed,  to  the  RN  I  was  a  nan 
on  the  medicine  card,  and  to  the  nursin 
assistant  I  was  a  nuisance. 

Should  a  fourth-day  postoperative  hy 
terectomy  keep  two  students  busy  for  th 
day  because  they  were  assigned  to  "d 
whatever  she  wanted  them  to  do?"  Ho 
should  one  react  when  the  nursing  assi 
tant  contaminates  everything  on  the  steri 
tray  before  she  even  starts  to  do  your  al 
dominal  dressing?  Should  a  patient  V 
given  scissors  and  told  to  "clip  herself 
for  her  prep?  (She  became  an  abdomin 
surgery  case  and  had  her  operation  withoi 
further  preparation.) 

(continued  on  page  i 

APRIL  19 


1 

1 


You  should  know  about  a  new  concept  in  contraception 

Cu-7®(CopperSeven) 
intrauterine  copper  contraceptive 


How  does  Cu-7  work?  Copper  provides  the  major  con- 
traceptive effect,  not  the  inert  plastic  7- shaped  carrier 
The  effect  is  local  and  non-systemic.  The  minute  quantity 
of  copper  released  daily  by  Cu-7  is  only  2-3%  of  the 
usual  daily  dietary  intake  of  copper 

How  effective  is  Cu-7?  Simply,  Cu-7  is  virtually  as  effec- 
tive as  "The  Pill". 

Who  can  use  Cu-7?  Cu-7  can  be  inserted  into  most 
normal  women  whether  nulliparous  or  multiparous.  The 
small  diameter  of  the  inserter  usually  permits  insertion 
without  cervical  dilation  and  usually  with  little  or  no 
patient  discomfort.  The  flexible  7  shape  is  highly  com- 


patible with  the  uterine  environment,  ensuring  a  high 
retention  rate. 

What  are  the  future  effects  of  Cu-7?  Following  proper 
insertion,  Cu-7  is  immediately  active,  rarely  expelled  and 
usually  easily  removed.  Cu-7  is  unlikely  to  affect  future 
fertility.  Studies  have  shown  that  most  women  wishing  to 
become  pregnant  did  so  within  four  months  after  removal 
of  Cu-7 

Do  you  desire  further  information?  Further  information 
is  available  to  all  registered  nurses  by  writing  Searle 
Pharmaceuticals,  Oakville,  Ontario. 


SEARLE 


Searle  Pharmaceuticals 

Oakville,  Ontano 


Note;  This  space  is  paid  for  by  Searle  Pharmaceuticals  as  an 
educational  service  to  the  nursing  profession  and  does  not 
constitute  a  solicitation  or  recommendation  for  use  of  Cu-7. 


IIL  1975 


THE  CANADIAN  NURSE     7 


(continued  from  page  6) 

What  has  happened  to  the  basic  rules  of 
hygiene?  The  public  health  regulations 
would  not  permit  a  waitress  to  work  in  a 
restaurant  with  the  careless  hands  and  hair 
care  that  were  seen  in  the  nursing  staff. 

No  nurse,  even  of  the  old  school,  wants 
to  reverse  the  changes  in  nursing  educa- 
tion. I  believe  care  could  now  be  excellent, 
but  somewhere  along  the  way  the  em- 
phasis seems  to  have  been  misplaced. 

Most  patients  do  not  expect  hotel  ser- 
vice, which  was  once  the  criterion  of  care 
on  private  service.  If  that  type  of  service  is 
expected  now,  it  is  the  fault  of  the  profes- 
sion for  not  educating  the  lay  population 
about  good  hospital  care.  The  admission 
unit  at  the  Halifax  Infirmary,  described  in 
the  December  1974  issue  of  The  Canadian 
Nurse  seems  a  good  way  to  help  the  patient 
understand  the  hospital.  My  orientation 
was  done  by  another  patient  in  the  ward! 

When  we  were  paid  a  pittance  compared 
to  present-day  salaries,  we  were  proud  and 
responsible  members  of  our  profession. 
Now  nurses  are  receiving  the  well- 
deserved  remuneration  that  compares 
more  favorably  with  other  professions. 
But  what  has  happened  to  their  pride  and 
sense  of  responsibility?  Somewhere,  the 
pendulum  must  have  swung  too  far.  Nurse 
educators,  can  you  not  do  something  to 
balance  the  scale?  —  Gladys  Creelman 
Workman,  Yellowknife,  N.W.T. 


Response  to  Mustard  Report 

We  believe  that  public  health  nurses  play 
an  important  role  in  community  health. 
Their  role  is  largely  omitted  in  the  com- 
munity health  centers  outlined  in  the  report 
of  the  Task  Force  on  Health  Services  in 
Ontario,  the  "Mustard  Report." 

Community  health  centers  will  be  effec- 
tive for  those  families  who  appreciate 
good  health  and  the  importance  of  main- 
taining it.  However,  the  families  who  have 
neither  the  understanding  nor  motivation 
to  carry  out  good  health  practices  are,  for 
the  most  part,  overlooked. 

There  will  always  be  people  who, 
through  ignorance  or  lack  of  interest,  will 
not  turn  to  primary  care  centers  for  the 
purpose  of  maintaining  optimum  health.  It 
is  only  through  consistent,  conscientious 
contact  with  these  people  in  their  homes 
that  adequate  supervision  of  health  needs 
throughout  the  life  cycle  of  both  individu- 
als and  families  may  be  achieved. 

The  Mustard  report  recommends  that 
"provision  of  health  care  be  based  on  a 
continuing  health  professional/patient  re- 
lationship that  is  characterized  by  mutual 
confidence  and  understanding.  .  ."  We 
do  not  think  the  centralized  clinic  will  pro- 
8     THE  CANADIAN  NURSE 


vide  this  to  the  degree  already  attained  by 
public  health  nurses. 

The  introduction  to  the  Report  states 
".  .  .the  public  is  highly  critical  of  the  vir- 
tual disappearance  of  the  person-to- person 
element  in  the  practice  of  medicine" 
(p. 3).  We  do  not  see  that  the  new  center 
will  alleviate  this  problem.  The  PHN  has 
attempted  to  provide  the  security  of  a  one- 
to-one  relationship;  this  can  best  be 
achieved  in  the  person's  own  environ- 
ment. 

If,  as  proposed,  the  health  care  plan  "is 
to  evolve  from  existing  arrangements," 
we  strongly  recommend  that  public  health 
nursing  services  be  further  studied  to  en- 
sure that  we  do  not  lose  all  the  benefits  and 
strengths  presently  offered  by  the  existing 
structure. 

Individuals  in  the  geriatric  age  group 
often  need  a  nurse's  opinion  and  support 
before  they  will  seek  medical  help.  To 
persons  in  this  category,  the  community 
health  center  may  seem  distant,  and  even 
frightening. 

In  conclusion,  although  we  agree  with 
many  of  the  principles  in  the  report,  we 
feel  that  extensive  and  comprehensive 
public  health  home  visiting  must 
continue.  —  V.  Krmpotich,  President, 
Nurses'  Association  Algoma  Health  Unit, 
Local  62,  Sault  Ste.  Marie,  Ont. 

Editor' s  Note:  A  discussion  of  the  Task 
Force  report  by  its  chairman,  Dr.  Fraser 
Mustard,  and  3  nurses  was  reported  in 
News,  December  1974,  page  12. 


Against  two-year  program 

I  have  yet  to  read  a  convincing  article  on 
the  merits  ofthe  2-year  program  of  nursing 
instruction.  Bemice  Donaldson's  com- 
ments on  this  subject  (Letters,  January 
1975,  p.  6)  have  prompted  me  to  write  this 
letter.  I  found  all  her  defences  of  this  pro- 
gram shallow,  and  she  convinced  me  all  the 
more  that  the  3-year,  hospital-based  pro- 
gram is  better.  I  am  a  graduate  ofthe  latter 
program  and  feel  most  fortunate  to  be  so. 

I  disagree  with  Donaldson's  statement: 
"Poor  products  are  not  necessarily  the 
fault  of  the  program ,  but  rather  ofthe  qual- 
ity of  teaching."  Not  so.  If  the  program  is 
poor,  which  I  consider  the  2-year  plan  to 
be,  poorly  trained  students  will  result,  re- 
gardless of  how  good  the  teacher  is.  Two 
years  of  sitting  in  a  classroom,  be  it  in  a 
university  or  in  a  vocational  school,  can 
not  replace  the  valuable  practical  experi- 
ence gained  in  a  3-year,  hospital-based 
program,  as  there  is  no  replacement  for 
practical  experience. 

Two  days  a  week  at  a  hospital,  under 
ideal  conditions,  do  not  begin  to  teach 
these  girls  the  full  responsibility  of  nursing 
that  will  be  required  of  them  on  gradua- 
tion. Many  of  these  2-year  graduates  say 
they  do  not  feel  prepared  or  confident 
enough  to  take  on  these  responsibilities 
when  they  graduate.  The  patients,  too. 


sense  this  lack  of  confidence,  and  con 
plain  openly  about  it.  Is  this  not  pro( 
enough  that  the  new  program  is  poor? 

There  is  good  and  bad  in  both  systen 
and  with  the  products  turned  out  by  boi 
systems.  But  the  3-year,  hospital-base 
program  is  far  superior  to  the  2-year  pn 
gram.  Granted,  we  did  spent  a  lot  of  ext; 
working  hours  at  the  hospital;  at  the  time, 
begrudged  this,  but  I  realized  on  gradu: 
tion  that  these  were  valuable  learning  e; 
perience  hours.  There  is  no  replaceme; 
for  experience,  and  the  more  one  has 
graduation,  the  more  confident  one  feels' 
go  out  and  carry  on  one's  nursing  caree; 

To  Donaldson's  question,  "How  pn 
pared  were  you  when  you  began  your  nur 
ing  career?"  I  respond  —  "A  heck  of  a  I 
better  than  the  girls  of  today  are,  thar 
goodness!" 

How  can  these  educators  defend  the| 
2-year  programs  when,  after  the  end  of  i 
years  training,  some  of  these  RNs  ha\ 
never  catheterized  a  patient,  have  give 
only  a  few  needles,  have  never  suctioned 
tracheotomy,  and  so  on?  Do  they  call  th 
being  prepared  as  an  RN? 

It's    about    time    that    these    nur.'j 
educators  woke  up  and  saw  the  light  ai 
quit   defending   their   obviously    inferii 
2-year  nurse-training  programs.  — Catl 
Rathwell,  RN,  Masset,  British  Columbii 


Objects  to  nurse  on  TV  program 

Last  evening  my  TV  was  tuned  in  to  i 
episode  of  CBC's  Performance  Serie. 
called  "Last  of  the  Four  Letter  Words. 
After  the  first  act,  I  turned  it  off  becau: 
what  I  saw  made  me  mad! 

I  became  angry  because  of  the  crue 
heartless  way  in  which  nurses  and  oth 
hospital    employees     were    portrayc 
Example:  nurse  rips  covers  off  patient  ai 
stabs    her    with    a    50    cc.    syringe 
medication.  Patient  collapses  onto  flo 
only  to  be  dragged  unceremoniously  oH; 
stretcher  by  nurse  and   insolent-lookiij 
orderly,  who  lolls  against  stretcher.         i 

Although  I  realize  that  the  playwrigj 
was    probably    trying    to    portray    tl' 
emotions  and  impressions  of  a  terminal! 
ill  patient,  I  cannot  tolerate  the  portray ; 
of  such  shoddy  nursing  behavior  beii 
foisted   onto   a   naive   and   unsuspectii 
audience    who    may    not    be    able 
distinguish  fact  from  fantasy. 

Point:  Is  the  CNA  or  any  other  nursii 
association  ever  asked  for  technici 
assistance  or  advice  on  nursing  by  any  1 
show?  If  so,  somebody  goofed  on  th 
one! 

God  help  us  all  if  we,  as  nurses,  . 
really  as  crass  as  this  portrayal!  God  h^ 
us  even  more  if  this  is  the  impression  i 
general  public  has  of  nurses! — Lyd 
Ziola,  RN,  Surrey,  B.C. 

'The  Canadian  Nurses'  Association  h 
not  been  asked  for  assistance  or  advice : 
nursing  by  any  TV  station.  —  Ed. 

APRIL  19 


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They'll  look  it,  too. 


fibres  by  Monsanto. 
Suggested  retail  price:  $6.00 


We'd  like  to  make  you  feel  more  comfortable  about 
buying  a  pair.  So  here's  a  dollar  refund  offer. 


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Responding  to  your  needs 
with  new  and  better 
hospital  products 


Are  his  glove 
problems 
your 
problem? 


\' 


'i 


With  all  your  other  concerns  in  the  O.R.  you  don't 
need  to  hear  glove  complaints,  too.  But  a  glove 
that  causes  excessive  hand  fatigue,  tears  too  easily  or 
does  not  provide  adequate  sensitivity  can  make 
a  long  procedure  seem  even  longer  for  the  surgeon. 

Help  him  solve  his  problems...and  yours. ..have  him  try 
TRAVENOL  Surgeon's  Gloves -the  "problem  solver." 

TRAVENOL  Surgeon's  Gloves  are  made  of  a  strong  but 
thin  latex  which  provides  dependable  durability 
and  strength,  without  sacrificing  sensitivity.  And  a 
unique  patented  TRAVENOL  mold  forms  gloves  that 
provide  improved  fit  and  comfort  with  reduced  stress 
across  the  palm  and  less  strain  on  the  thumb  joint. 

CAUTION:  After  donning,  remove  powder  by  wiping 
gloves  thoroughly  with  a  sterile  wet  sponge,  sterile 
wet  towel,  or  other  effective  method. 


BAXTER  LABORATORIES  OF  CANADA 

DIVISION  OF  TRAVENOL  LABORATORIES,  INC. 
6405  Northam  Drive.  Malton,  Ontario  L4V1J3 


news 


British  Nurses  Vote 

3n  Withdrawal  From  ICN 


ondon,  England  —  The  Royal  College  of  Nursing  (Ren)  is  holding  a  special  general 
leeting  on  16  April  1975  to  consider  a  resolution  to  give  notice  to  the  International 

||-ouncil  of  Nurses  (lCN)of  its  intention  to  withdraw  from  membership  effective  31 

Ihecember  1975. 


I  The  College's  official  bulletin.  The 
en  Nursing  Standard,  says  the 
ithdrawal    is    recommended    by    the 

ouncil  of  Ren  " "because  it  [Ren] 
elieves  the  role  that  the  ICN  is  still 
triving  to  fulfill  is  unrealistic  in  the 
■  orld  of  today." 

The  Standard  says,  "To  fulfill  this  role 
le  ICN  must  make  financial  demands  on 
s  member  associations  that  divert,  to  the 
jpport  of  an  international  body,  money 

quired  to  advance  the  work  of  the 
ssociations  at  national  level,  and  to 
Ktend  services  and  facilities  for  their 
wn  members.  On  a  cost/benefit 
ssessment  the  Council  [of  the  Ren]  can 

0  longer  justify  the  dues  at  present  paid 
y  the  Ren  to  the  ICN,  nor  contemplate 
le  proposed  increase  in  these  dues." 

The  ICN  was  established  in  1899  under 

movement  headed  by  a  British  nurse, 
el    Gordon    Bedford-Fenwick.     At 

c^ent  a  British  nurse  is  second 
ice-president  of  ICN,  another  is  a 
lember  of  the  board  of  directors,  and  a 
lird  is  a  member  of  the  professional 
:rvices  committee.  These  nurses  will 
ave  to  resign  their  positions  if  the  Ren 

ithdraws  from  the  international 
trganization.  Withdrawal  from  ICN  would 

1  so  effect  the  Ren's  membership  in 
bgional  European  nursing  organizations 
|iat  have  membership  in  ICN  as  an 
jigibility  requirement. 

Voting  on  the  resolution  is  by 
tendance  at  the  special  meeting  or  by 
ving  a  proxy  vote  to  one  of  the  Ren's 
ficials.  President  of  the  Council  of  Ren 
Sheila  Quinn,  who  was  executive 
rector  of  ICN  from  1967  to  70. 


!NA  Urges  Health  Promotion 
Reduce  Cost  of  Cures 

tt(ma  —  One  long-term  method  of  cut- 
costs  in  the  health  care  industry  is 
■eater  emphasis  on  health  promotion  and 
*vention.  This  will  reduce  expenditures 
the  curative  system,  according  to 
uguette  Labelle,  president  of  the  Cana- 
an Nurses'  Association  (CNA). 
•RIL  1975 


CNA  was  one  of  6  representatives  of  the 
health  industry  invited  to  a  meeting  in- 
itiated by  the  federal  government  to  bring 
together  principal  groups  in  society  to  dis- 
cuss inflation  and  to  explore  ways  of  re- 
straining it. 

Labelle  and  Executive  Director  Dr. 
Helen  K.  Mussallem  represented  CNA  at 
the  meeting  at  the  Skyline  Hotel,  Ottawa, 
on  4  February  1975. 

The  CNA  president  pointed  out  that  nurs- 
ing is  a  responsible  profession  that  recog- 
nizes the  necessity  of  providing  the  best 
possible  health  care  at  the  lowest  cost.  In 
spite  of  this,  she  said,  it  is  unlikely  that 
nursing  salaries  will  remain  constant  in  the 
face  of  continued  increases  in  other  sectors 
of  the  economy,  since  recent  increases 
serve  mainly  to  close  the  gap  between 
nursing  and  comparable  groups. 

Other  long-term  methods  of  cutting 
costs,  according  to  the  CNA  president,  in- 
clude development  of  extended  care 
facilities  to  reduce  the  use  of  more  expen- 
sive acute  care  facilities,  and  more  effi- 
cient use  of  existing  manpower,  resulting 
in  increased  productivity  of  the  nursing 
profession.  Measures  intended  to  counter 
or  correct  inflationary  trends  in  health  care 
costs  were  suggested  by  the  CNA  president. 
One  of  these  was  a  system  of  "holding"  a 
number  of  beds  in  acute  and  extended  care 
facilities,  so  that  these  could  be  made  im- 
mediately available  during  an  emergency 
to  the  sick  or  aged,  who  wish  to  remain  in 
their  own  homes  as  long  as  possible. 

Labelle  also  suggested  that,  at  the  pres- 
ent time,  a  great  deal  of  nursing  manpower 
and.  therefore,  money  is  wasted  in  carry- 
ing out  nonnursing  tasks  that  could  be 
done  by  less  highly  qualified  personnel.  In 
addition,  she  suggested  hospitals  could  be 
planned  or  redesigned  to  include  labor- 
saving  features,  which  would  reduce  the 
workload  of  the  nursing  staff. 

Government  representatives  at  the 
meeting  were  Minister  of  Health  and  Wel- 
fare Marc  Lalonde,  President  of  the  Treas- 
ury Board  Jean  Chretien,  and  Minister  of 
Veterans  Affairs  D.J.  MacDonald. 
In  addition  to  CNA,  the  health  sector  was 


represented  by  the  president  and  chief  ex- 
ecutive officers  of:  the  Canadian  Medical 
Association,  the  Canadian  Hospital  As- 
sociation, the  Canadian  Pharmaceutical 
Association,  the  Canadian  Dental  Associ- 
ation, and  L' Association  des  medecins  de 
langue  fran^aise  du  Canada. 


Unusual  Risk  To  OR  Nurses, 
Anesthetic  Gases  Hazardous 

Ottawa  —  Operating  room  nurses  are 
among  3  categories  of  health  professionals 
subject  to  unusual  risk  because  of  repeated 
exposure  to  anesthetic  gases,  according  to 
a  report  prepared  for  Health  and  Welfare 
Canada.  The  report  is  the  work  of  a  3-man 
committee  set  up  to  investigate  possible 
occupational  hazards  faced  by  health  per- 
sonnel working  in  hospital  operating 
rooms . 

According  to  the  committee's  report, 
which  was  released  in  the  fall  of  1974, 
anesthetists  are  subject  to  the  greatest  risk, 
followed  by  operating  room  nurses,  and 
then  surgeons.  According  to  the  commit- 
tee, preliminary  studies  have  shown  that 
women  exposed  to  anesthetic  gases  are 
particularly  susceptible  to  a  higher  inci- 
dence of  spontaneous  abortion  and  of  fetal 
abnormalities.  No  one  gas  could  be  in- 
criminated: halothane,  nitrous  oxide, 
methoxyfluorane,  and  ethrane  all  carried 
an  occupational  risk  from  repeated  pro- 
longed exposure. 

Since  these  gases  will  probably  con- 
tinue to  be  used  extensively  for  some  time, 
the  committee  considered  various  alterna- 
tives that  could  be  employed  to  eliminate 
or  reduce  the  occupational  hazard  in- 
volved. It  concluded  that  direct  venting  of 
gases  to  the  outdoors  is  the  simplest  and 
most  effective  means  of  reducing  the  ex- 
tent of  exposure.  A  description  of  a  safe 
and  adequate  venting  system  is  included  in 
the  report. 

In  October  1974,  the  Canadian  Nurses' 
Association  was  informed  of  the  results  of 
the  committee's  investigations.  The  ex- 
ecutive committee  of  CNA.  which  met  on 
January  30  and  31,  1975,  discussed  the 
report  and  believed  it  should  be  brought  to 
the  attention  of  nurses. 

One  of  the  committee  members  was 
Abram  Ber,  M.D.,  Department  of  Anaes- 
thesia, Reddy  Memorial  Hospital, 
Montreal.  Dr.  Ber  was  the  author  of  an 
earlier  report  to  the  Committee  of  Stan- 
dards of  Practice,  Canadian  Anaesthetists' 
Society.  In  his  report.  Dr.  Ber  stated: 
THE  CANADIAN  NURSE     11 


news 


"Until  recently,  the  subject  of  pollution 
and  anesthetic  gases  has  received  little  at- 
tention, but  now  there  are  few  of  us  left 
who  would  deny  that  we  are,  indeed,  faced 
with  an  occupational  exposure  hazard." 
He  cited  studies  indicating  a  higher-than- 
average  incidence  of  the  following  health 
problems  among  anesthetists:  spontaneous 
miscarriage,  liver  damage,  chronic  renal 
failure,  and  immunosuppression. 


MARN  Covers  Active  Members 
For  Professional  Liability 

Winnipeg,  Man.  —  All  active  practicing 
members  of  the  Manitoba  As.sociation  of 
Registered  Nurses  (marn)  are  covered  by 
a  group  professional  liability  insurance 
plan  purchased  by  the  association,  marn 
directors  approved  purchase  of  the  insur- 
ance plan,  which  became  effective  1 
March  1975. 

A  resolution  passed  at  the  1974  annual 
meeting  of  marn  asked  that  members" 
needs  for  liability  insurance  be  assessed, 
with  a  view  to  providing  such  coverage  in 
1975.  Responses  to  a  questionnaire,  in- 


New   Racing  Model  Wheelchair 


Two  wheelchair  racers,  Lee  Martin,  right,  and  Randy  Reeves,  use  chairs  designed 
and  produced  by  The  Hospital  for  Sick  Children,  Toronto,  specially  for  patients  with 
muscular  dystrophy .  The  chair  is  a  brace  designed  to  prevent  spinal  curvature;  the  seat 
is  a  plastic  shell  shaped  to  the  desired  curvature  of  the  normal  spine.  A  two-layer  inner 
padding  is  fitted  to  the  body  of  the  individual  child.  The  wheelchair's  seat  can  be 
removed  and  used  as  a  car  seat.  There  are  1 3  patients  using  the  chair;  they  range  in  age 
from  8  to  14.  All  of  them  enthusiastically  endorse  the  new  chair  that  enables  them  to 
sit  comfortably  for  14  hours  at  a  time,  as  opposed  to  3  hours  in  the  old  type. 


12    THE  CANADIAN  NURSE 


eluded  in  the  December  1974  issue  of  the 
MARN  bulletin,  Nurscene,  indicated  thai 
members  were  overwhelmingly  in  favor  ol 
purchase  of  liability  insurance,  subject  tc 
the  board  of  directors'  approval  of  financ- 
ing from  general  funds.  The  directors  gave 
approval  at  the  board  meeting  on  1 1  Feb- 
ruary. 

The  insurance  will  be  in  the  name  of  the 
Manitoba  Association  of  Registerec 
Nurses,  and  any  registered  nurse  who  is  ar 
active  practicing  member  in  good  standing 
is  covered  under  the  blanket  policy.  The 
policy  will  protect  each  nurse  "for  hei 
legal  liability  for  bodily  injury,  sickness 
or  death  as  a  result  of  rendering  or  failing 
to  render  professional  services  in  her  prac- 
tice as  a  registered  nurse." 

The  coverage  is  24  hours  per  day  anc 
includes  legal  costs.  The  limits  providec 
are  $100,000  coverage  for  an  occurrence 
involving  one  person,  and  $300,000  wher 
more  than  one  person  is  involved.  Indi- 
vidual enrolment  in  the  MARN  insurance 
plan  is  not  required. 


Nursing  Service,  Education 

Aided  By  Joint  Appointments 

Ottawa  —  Joint  appointments  in  nursing 
service  and  nursing  education  enhance  re- 
lationships and  increase  interaction,  Dr 
Jannetta  MacPhail  told  some  1 15  Ottawa 
area  nurses  at  a  workshop  marking  th( 
50th  anniversary  of  the  Registered  Nurses 
\ssociation  of  Ontario. 

Dr.  MacPhail  is  professor  and  dean  ol 
Frances  Payne  Bolton  school  of  nursing 
Case  Western  Reserve  University,  am 
head  of  nursing  at  the  University  Hospi 
tals,  Cleveland,  Ohio.  She  spoke  oi 
promoting  collaboration  between  nursinj 
education  and  nursing  service  during  thi 
workshop  in  Ottawa  on  24  February  1 975. 

"Representatives  of  nursing  service  am 
nursing  education  organizations  canno 
learn  to  respect  and  trust  each  other  anij 
commit  themselves  to  common  goals,  i, 
they  do  not  have  opportunities  to  interac, 
and  get  to  know  each  other,"  MacPhai' 
said. 

She  described  3  types  of  joint  appoint 
ments  that  she  and  her  colleagues  de, 
veloped  during  research  on  the  problem  Oj 
collaboration.  They  are: 

•  Shared  appointment,  in  which  the  costi 
shared,  as  well  as  the  responsibility  fc 
education  and  service,  in  such  positions  a 
school  departmental  chairperson-directc 
of  a  clinical  nursing  division,  or  facult 
member-nurse  clinician; 

•  Clinical  appointment  or  a  "leadershif 
clinical"  appointment  in  nursing  educ; 
tion  held  by  leaders  in  nursing  service  whi 
are  paid  fully  by  the  service  agency  an! 
have  their  primary  responsibility  in  seij 
vice;  and  ' 

•  Associate  appointment  in  nursing  sc 
vice,  which  is  given  to  all  faculty  membt 

(continued  on  page  1 
APRIL  197 


IL  1975 


Follow 

the 

Leader 


"Follow  the  leader"  —  a  fun 
game  for  children!  The  spirit  of 
inquiry  sometimes  exhibited  in 
childhood  games  is  a  spirit  which 
carries  an  individual  as  far  in  life 
as  he  wants  to  go.  But  when  it's 
time  to  put  away  toys,  "Follow 
the  leader"  is  no  longer  a  game, 
but  a  key  to  success  in  a  grown- 
up world.  The  demands  on  both 
follower  and  leader  are  real  and 
intense. 

Leadership  bears  important  im- 
plications: understanding,  experi- 
ence, knowledge,  insight .   .   .and 
responsibility.  It  requires  that 
you  prepare  students  for  the  day 
when  they  too  will  lead.  You 
have  but  to  lend  them  your 
seasoned  experience  backed  with 
a  strong  curriculum.  For  years 
Mosby  books  have  been  leaders 
in  many  areas  of  nursing.  This 
year  heralds  an  exceptional 
selection  of  trend-setting  texts. 
Follow  the  leader  today— for 
continued  good  leadership 
tomorrow! 


THE  CANADIAN  NURSE     13 


New  9th  Edition! 

Textbook  Of 
Anatomy  And 
Physiology 

Anthony-Kolthoff 


This  new  9th  edition  of  a  popular  text  upholds  the  tradition  of  excellence 
and  adds  fresh  features  and  a  wealth  of  new  information  based  on  recent 
findings.  As  in  previous  editions,  outline  surveys  introduce  each  chapter; 
outline  summaries  and  review  questions  conclude  each  chapter.  Diagrams  and 
tables  appear  in  nearly  all  chapters  with  suggested  readings,  abbreviations  and 
prefixes,  and  glossary. 

New  material  includes:  brain  waves,  altered  states  of  consciousness,  and  the 
"emotional  brain";  biofeedback  training;  physiological  changes  that  occur 
during  meditation  (yoga);  and  more. 

In  conveying  ideas,  the  authors  hope  to  "help  students  see  science  for  what  it 
is  —  a  continual  asking  of  questions  and  searching  for  answers,  not  merely  a 
collection  of  facts  and  final  answers."  Once  again,  Mr.  Ernest  W.  Beck  has 
enriched  the  text  with  a  number  of  new  illustrations. 

By  CATHERINE  PARKER  ANTHONY,  R.N.,  B.A.,  M.S.;  with  the  collaboration  of 
NORMA  JANE  KOLTHOFF,  R.N.,  B.S.,  Ph.D.  April,  1975.  Approx.  624  pages.  8"  x 
10",  335  figures  (144  in  color),  including  239  by  ERNEST  W.  BECK,  and  an  insert  on 
human  anatomy  containing  15  full-color,  full-page  plates,  with  six  in  transparent 
Trans^Vision  ®    (by  ERNEST  W.  BECK).  About  $13.10. 


New  9th  Edition! 

Anatomy  And 
Physiology 
Laboratory 
Manual 

Anthony 


This  traditional  supplement  to  TEXTBOOk  OF  ANATOMY  AND  PHYSI- 
OLOGY, rewritten  to  reflect  up-to-the-minute  information  in  the  text,  retains 
the  flexibility  and  time-saving  effectiveness  teachers  have  appreciated  through 
eight  previous  editions.  It  still  provides  a  complimentary  answer  book  and  a 
generous  list  of  suggestions  for  films  to  show  as  supplements  to  lab 
experiments.  It  also  includes  new  experiments  that  explore: 

**       ABO  and  Rh  blood  typing 

**       Bleeding  time 

**       Change  in  arterial  pressure,  and  whether  or  not  it  is 
followed  by  a  change  in  heart  rate 

**       Estimation  of  normal  and  abnormal  blood  pressure 

**       Effect  of  Valsalva  maneuver  on  central  venous  pressure 
and  on  the  volume  of  blood  returning  to  the  heart 

By  CATHERINE  PARKER  ANTHONY,  R.N.,  B.A.,  M.S.  April,  1975.  Approx.  224 
pages,  8"  x  10",  115  drawings,  69  to  be  labeled.  About  $6.55. 


Newly  Revised! 

Slides 


These  color  slides  (reproductions  of  key  illustra- 
tions in  the  book)  fully  complement  and  clarify 
the  text.  Ten  new  slides  have  been  added  to  the 
set,  four  of  them  devoted  to  the  material  on  stress. 
(For  example,  one  of  the  new  stress  slides  clearly 
details  the  "fight  or  flight"  syndrome  observed  in 
alarm  reaction  responses).  For  easy  use,  each  slide 
is  titled  and  keyed  to  the  text  by  both  figure 
number  and  page  number. 


14     THE  CANADIAN  NURSE 


Forty  2x2  teaching  slides  in  color,  suitable  for  use  with  any  35mm  projector.  April, 
1975.  About  $42.00. 


New  6th  Edition! 

Medical- 
Surgical 
Nursing 

Shafer-Sawyer- 

McCluskey-Beck- 

Phipps 


With  continued  improvement  in  quality,  authority  and  relevance,  this  new 
6th  edition  offers:  a  new,  larger  format;  new  easy-to-read  type;  new  chapters 
on  ecology  and  health,  neurologic  diseases,  musculoskeletal  disorders  and 
injuries.  You'll  find  increased  emphasis  on  physiology,  nursing  assessment  and 
pathophysiology  —  all  enhanced  by  many  new  Illustrations. 

Instructors  who  have  used  previous  editions  of  this  text  know  why  it  rapidly 
became  the  leader  and  the  standard  by  which  other  texts  were  judged.  But  a 
constantly  changing  world  demands  new  answers  to  old  questions  and  to 
questions  yet  unasked,  and  leadership  must  be  continually  re-earned.  We  feel 
that  the  new  6th  edition  of  MEDICAL-SURGICAL  NURSING  measures  up 
better  than  ever  before.  You'll  see  why  when  you  take  a  closer  look  at  the 
book  itself. 

By  KATHLEEN  NEWTON  SHAFER,  R.N.,  M.A.;  JANET  R.  SAWYER,  R.N.,  Ph.D.; 
AUDREY  M.  McCLUSKEY,  R.N.,  M.S.,  Sc.M.Hyg.;  EDNA  LIFGREN  BECK,  R.N., 
M.A.;  and  WILMA  J.  PHIPPS,  R.N.,  A.M.  April,  1975.  Approx.  1,056  pages,  8%"  x  11", 
608  illustrations.  About  $17.30. 


Labunski  et  a! 


Workbook  And 
Study  Guide  For 
I  Medical-Surgical 
Nursing: 


A  Patient-Centered 
Approach 


This  patient-centered  workbook  encourages  use  of  problem  solving  tech- 
niques. Students  are  given  opportunities  to  apply  basic  science  principles  to 
patient  care,  to  make  nursing  diagnoses  and  plans  for  immediate  and 
long-term  care.  Designed  to  supplement  Shafer  et  al,  MEDICAL-SURGICAL 
NURSING,  it  is  equally  effective  with  any  up-to-date  medical-surgical  text.  A 
comprehensive  bibliography  provides  reference  for  further  study. 

By  ALMA  JOEL  LABUNSKI.  R.N.,  B.S.N.;  MARJORIE  BEYERS,  R.N.,  B.S.,  M.S.; 
LOIS  S.  CARTER,  R.N.,  B.S.N.;  BARBARA  PURAS  STELMAN,  R.N.,  B.S.N.;  MARY 
ANN  PUGH  RANDOLPH,  R.N.,  B.S.N.;  and  DOROTHY  SAVICH,  R.N.,  B.S.  1973,  331 
pages  plus  FM  l-VIII,  7%"  x  lO'/i".  Price,  $6.70. 


New  2nd  Edition! 

The  Vital  Signs, 
With  Related 
Clinical 
Measurements: 

A  Programmed  Presentation 
Mclnnes 


An  effective  programmed  format  explains  basic  concepts  and  scientific 
rationale  as  it  familiarizes  students  with  the  use  of  common  equipment  and 
teaches  them  the  manipulative  skill  they  need  to  accurately  measure  vital 
signs.  This  new  edition  incorporates  new  material  on  fetal  heart  rate  and 
measurement  of  central  venous  pressure.  Reorganized  bibliographies  to  be 
used  as  special  section  references  and  improved  programming  make  this 
edition  systematic  as  well  as  comprehensive. 


By  BETTY  MclNNES,  R.N.,  B.Sc.N.,  M.Sc.(Ed.).  January,  1975.  130  pages  plus  FM 
l-XIV,  7"  X  10",  45  illustrations.  About  $6.60. 


New  2nd  Edition! 

Essentials  Of 

Communicable 

Disease 

Mclnnes 


Updated  and  revised,  this  concise,  new  edition  presents  basic  information  on 
communicable  diseases  still  surrounding  us  in  the  world  today. Sections  cover 
bacterial  diseases,  enteric  diseases,  viral  diseases,  arthropod-borne  diseases, 
diseases  caused  by  fungi,  and  Helminth  infections.  Sections  on  "Treatment 
and  Diagnosis",  and  "Prevention  and  Control"  have  been  updated,  and  the 
section  on  "Nursing  Care"  has  been  clarified  and  enlarged.  15  organized 
tables,  with  both  revised  and  new  material,  are  included  for  quick  reference. 

By  MARY  ELIZABETH  MclNNES,  R.N.,  B.Sc.N.,  M.Sc.(Ed.).  June,  1975.  Approx.  416 
pages,  6>i"x9'/4",  53  illustrations.  About  $11.25.  THE  CANADIAN  NURSE      15 


Fi9.  8-8.  It  is  advis- 
able to  request 
parents  of  infants  to 
return  to  the  of- 
fice for  cast  removal 
with  the  child  hun- 
gry. A  bottle  may 
then  be  given  during 
removal  and  reappli- 
cation.  This  will 
usually  be  a  source 
of  comfort  to  the 
mother  as  well  as  to 
the  child!  (From 
PEDIATRIC 
ORTHOPEDIC 
NURSING.) 


A  New  Book!  PEDIATRIC  ORTHOPEDIC  NURSING.  This 
comprehensive  text  covers  nursing  care  requirements,  tech- 
niques, and  essential  background  knowledge  necessary  for 
this  specialty.  By  NANCY  E.  HILT,  R.N.  and E.  WILLIAM 
SCHMITT,  Jr.,  M.D.  January,  1975.  268  pp.,  301  illus. 
$13.60. 

New  2nd  Edition!  ORTHOPEDIC  NURSING:  A  Program- 
med Approach.  With  increased  emphasis  on  the  nursing 
process  and  greater  depth  in  techniques  of  pre  and 
post-operative  care,  this  programmed  text  offers  new  and 
updated  information  in  orthopedic  nursing.  By  NANCY  A. 
BRUNNER,  R.N.,  B.S.N. ,  M.S.  February,  1975.234  pp., 
126  illus.  $7. 10. 

A  New  Book!  PLANNING  AND  IMPLEMENTING  NURS- 
ING INTERVENTION.  This  unique  new  text  explores 
concepts  of  stress  and  adaptation,  problem  solving,  and  21 
nursing  problems.  By  DOLORES  F.  SAXTON,  R.N.,  B.S., 
M.A.,  Ed.D.  and  PATRICIA  A.  HYLAND,  R.N.,  B.S.,  M.S., 
M.Ed.  January,  1975.  200pp.,  46  illus.  $6.05. 

A  New  Book!  FUNDAMENTALS  OF  OPERATING  ROOM 
NURSING.  Designed  for  students  with  no  previous  OR 
experience,  this  text  covers  basic  principles  and  background 
material  —  from  the  patient's  initial  visit  to  the  physician's 
office,  preoperative  hospitalization,  basic  intraoperative 
care,  to  post-anesthesia  recovery.  By  SHIRLEY  M. 
BROOKS,  R.N.  July,  1975.  Approx.  240  pp.,  207  illus. 
About  $7.30. 

New  3rd  Edition!  SURGICAL  TECHNOLOGY:  Basis  for 
Clinical  Practice.  This  new  edition  presents  rudiments  of 
operating  room  technology,  from  broad  conceptual  aspects 
to  application  of  the  latest  technical  advances.  By  MARY 
LOUISE  HOELLER,  D.C.,R.N.,  B.S.N. Ed.;  with  5  contrib- 
utors.   August,  1974.  398  pp.,  295  illus.  $1 1.50. 

A  New  Book!  EMERGENCY  CARE:  Assessment  and 
Intervention.  This  comprehensive  presentation  offers  in- 
depth  coverage  of  related  physiologic  and  pathophysiologic 
considerations,  along  with  intervention  guidelines.  Edited 
by  CARMEN  WARNER  SPROUL,  R.N.,  P.H.N,  and 
PATRICK  J  MULLANNEY,  M.D.;  with  32  contributors. 
September,  1974.  420  pp.,  122  illus.  $13.15. 

New  3rd  Edition!  CHILDBIRTH:  FAMILY-CENTERED 
NURSING.  This  new  edition  presents  nursing  concepts 
necessary  for  nursing  intervention  in  childbirth.  By 
JOSEPHINE  lORIO,  R.N.,  B.S.,  M.A.,  M.Ed.  January, 
1975.  480  pp.,  199  illus.  $9.40. 
16     THE  CANADIAN  NURSE 


New  9th  Edition!  ESSENTIALS  OF  PSYCHIATRIC 
NURSING.  The  authors  cover  personality  development, 
communication  skills  as  a  therapeutic  tool,  and  use  of  self 
in  therapy  in  one-to-one  and  group  relationships.  By 
DOROTHY  A.  MERENESS,  R.N.,  Ed.D.  and  CECELIA 
MONAT  TAYLOR,  R.N.,  M.S.  July,  1974.  368  pp.,  26 
illus.  $10.00. 

New  6th  Edition!  PSYCHIATRIC  NURSING.  Using  a 
behavior-centered  theme,  the  authors  focus  on  community 
involvement  and  examine  the  role  of  the  psychiatric  nurse 
as  both  a  hospital  practitioner  and  an  integral  member  of 
society.  By  RUTH  V.  MATHENEY,  R.N.,  Ed.D.  and 
MARY  TOPALIS,  R.N.,  Ed.D.  Guest  contributor: 
JEANETTE  A.  WEISS,  R.N.,  M.A.  July,  1974.  454  pp., 
illustrated.  $10.00. 

A  New  Book!  HUMAN  SEXUALITY  IN  HEALTH  AND 
ILLNESS.  This  new  practice-oriented  text  will  assist  health 
professionals  in  helping  clients  cope  with  interferences  in 
sexuality  and  sexual  function.  By  NANCY  FUGATE 
WOODS,  R.N.,  M.N.  June,  1975.  Approx.  256  pp.,  7  illus. 
About  $6.80. 

New  9th  Edition!  SELF-TEACHING  TESTS  IN  ARITH- 
METIC FOR  NURSES.  This  new  edition  continues  to  help 
students  develop  a  strong  background  in  basic  applied 
arithmetic,  in  class  or  by  independent  study.  Effective 
organization  of  previous  editions  has  been  retained.  By 
RUTH  W.  JESSEE,  R.N.,  Ed.D.  and  RUTH  W.  McHENRY, 
R.N.,  M.A.  March,  1975.  228  pp.,  15  illus.  $6.25. 

New  3rd  Edition!  CLINICAL  NURSING  TECHNIOUES. 

This  new  edition  continues  to  provide  explanatory  text  and 
meaningful  illustrations  of  techniques  used  in  nursing.  By 
NORMA  DISON,  R.N.,  B.A.,  M.A.  May,  1975.  Approx. 
336pp.,  689  illus.  by  MARITA  BITANS.  About  $8.90. 

New  3rd  Edition!  BASIC  CONCEPTS  IN  ANATOMY  AND 
PHYSIOLOGY:  A  Programmed  Presentation.  This  manual 
teaches  the  facts  necessary  for  developing  a  clear  under- 
standing of  the  human  body.  By  CATHERINE  PARKER 
ANTHONY,  R.N.,  B.A.,  M.S.  July,  1974.  190 pp.,  54  illus. 
$6.60. 

A  New  Book!  UNDERSTANDING  INHERITED  DIS- 
ORDERS. The  author  introduces  basic  concepts  of  in- 
herited diseases  by  first  presenting  general  principles  and 
then  outlining  their  applications  and  exceptions.  By 
LUCILLE  F.  WHALEY,  R.N.,  M.S.  June,  1974.  232  pp., 
121  illus.  $11.50. 


MOSBY 


TIMES  MIRROR 

THE    C.  V    MOSBY  COMPANY,  LTD 

86   NORTHLINE    ROAD 

TORONTO,  ONTARIO 

M4B   3E5 


APRIL 


news 


(continued  from  page  1 2) 
who  guide  students  in  practice  or  research 
jin  the  clinical  setting. 
I  "it  is  important  that  a  shared  appoint- 
ment be  viewed  as  one  job  and  that  reason- 
able expectations  be  set,  to  prevent  role 
Dverload,  role  conflict,  and  role  am- 
biguity," MacPhail  said. 

One  of  the  major  contributions  made  by 
the  nursing  service  person  in  a  clinical 
appointment  is  to  ensure  that  the  quality  of 
;are  given  to  patients  is  desirable  for  stu- 
dents  to  observe   and  emulate.   The 
jrivileges  of  the  clinical  appointment  in- 
ji.'lude  participation  in  general  and  clinical 
ii'aculty  meetings,  gaining  knowledge  of 
I  ind  contributing  to  curriculum  develop- 
I'Tient,  serving  on  committees,  and  par- 
jiicipating  in  educational  and  social  ac- 
tivities for  the  faculty. 
'     The  major  responsibility  of  the  as- 
ilociate  appointment  in  nursing  service  for 
jhe  nursing  education  person  is  to  influ- 
I'nce  the  quality  of  care  and  attitudes  of 
iKgency  staff  to  promote  an  exemplary 
earning  climate.  The  privileges  afforded 
iire  for  practice  and  research,  and  to  par- 
'icipate  on  agency  committees  and  work 
■|;roups  that  are  designed  to  enhance  care. 
!    MacPhail  and  her  colleagues  in  the  Case 
iVestem  Reserve  project  tried  to  develop 
.jelationship  between  nurses  in  the  univer- 
||ity  school  of  nursing  and  the  university 
jliospitals  so  that  nurse  educators  could  in- 
ijluence  nursing  care  in  the  settings  used 
ior  students'  practice,  and  so  that  nursing 
|ducators  and  administrators  in  nursing 
lervice  could  work  together  toward  their 
|ommon  goals,  even  though  their  primary 
ioals  differed. 


onference  On  Child  Abuse 
attracts  150  Nurses  in  PEI 

harlottetown,  PEI  —  A  conference  on 
hild  abuse  attracted  150  Prince  Edward 
iland  nurses.  There  were  so  many  par- 
cipants  that  the  conference,  first  held  in 
ecember  1974,  had  to  be  repeated. 
Nurses  employed  in  hospital  pediatric 
jnits  and  outpatient  departments,  public 
alth  nursing  units,  and  other  health 
feencies  involved  in  child  care  attended 
le  2-day  conference.  It  was  planned  by  2 
service  coordinators:  Joanne  Burke, 
jiiblic  health  nursing,  and  Betty 
lacEachem,  Prince  Edward  Island  Hos- 
tal.  The  program  was  taped,  and  these 
pes  are  now  available  to  nurses  and  other 
ofessionals  on  request. 
Conference  participants  made  5  rec- 
mendations  for  nurses  in  PEI.  These 
eluded: 
Through    personal    involvement    and 


—  registered  nurses  are  there  in  Canada? 
. . .  are  practising  nurses? 
. . .  male  nurses? 


lU]fr^ 


—  work  in  hospitals? ...  in  private  practice? ...  in  public  health? . 
in  schools? 


The  answers  to  these  —  and  hundreds  of  such  questions — are 
all  contained  in  Countdown  '74. 

Countdown  was  a  project  undertaken  a  few  years  ago  by  the 
Canadian  Nurses'  Association  to  gather  and  publish  the  first 
comprehensive  statistical  survey  of  Canadian  nurses. 

Countdown  '74  is  the  updated  version  of  this  book  —  more 
than  100  pages  —  chock-full  of  valuable  and  interesting  nursing 
statistics.  A  must  for  all  libraries— an  invaluable  reference  for  all 
nurses  who  wish  to  be  knowledgeable  about  nursing. 

Only  $5.00  a  copy. 

To  receive  your  copy  as  soon  as  it  is  off  the  press,  just  fill  out 
and  mail  this  coupon. 


Yes,  I  would  like  to  receive  Countdown  '74.  Send 
copies  at  $5.00  each  to: 


Name- 


Address. 


.Code- 


Mail  to: 


A.  mail  w:  Payment  enclosed  D 

tf^      CANADIAN  NURSES'  ASSOCIATION 

^"^^      50  The  Driveway,  Ottawa,  Ontario  K2P  1E2 


THE  CANADIAN  NURSE     17 


news 


through  their  professional  organization, 
nurses  should  support  formulation  of  pro- 
vincial laws  for  the  protection  of  the 
abused  child,  and  for  the  rehabilitation  of 
his  parents. 

•  Hospital  liaison  nurses  should  visit 
high-risk  families  whose  children  are 
treated  in  the  outpatient  department  but  are 
not  admitted  to  hospital,  and  who  are 
missed  by  the  usual  referral  methods. 

•  Parents  of  hospitalized  children  should 
have  continued  opportunity  to  learn 
through  hospital-based  parents"  classes. 

•  Each  nurse  should  be  alert  to  the  prob- 
lem of  child  abuse  and  should  follow 
through  to  help  both  the  child  and  his  par- 
ents. 

Copies  of  the  full  recommendations 
were  forwarded  to  directors  of  nursing  in 
the  general  hospitals  and  agencies  rep- 
resented at  the  conference. 


Canada  Pension  Plan  Amended 

Ottawa  —  The  Canada  Pension  Plan  has 
been  amended  by  Parliament  (Bill  C-22)  to 
provide  equal  benefits  for  the  spouse  and 
children  of  a  deceased  contributor  male  or 
female.  Bill  C-22  became  law  when  it  re- 
ceived royal  assent  on  27  November  1 974. 

Nurses  joined  the  protest  against  the 
discriminatory  nature  of  the  previous  Pen- 
sion Plan  benefits  (Letters  page  5,  and 
editorials  pages  3  and  29,  October  1973). 
Several  provincial  nurses"  associations 
supported  the  changes  in  the  pension  plan. 

The  Canada  Pension  Plan  covers  Cana- 
dians in  all  provinces  and  territories  except 
Quebec.  The  Quebec  Pension  Plan  was 
similarly  amended,  effective  1  January 
1975. 


N.S.  Nurses  Recycle  Uniforms 

Halifax,  N.S.  —  Nurses  in  Nova  Scotia 
have  sent  1 ,  100  pounds  of  uniforms  to  the 
Unitarian  Service  Committee  (use)  during 
the  past  year,  in  response  to  a  plea  for 
used,  but  still  serviceable,  uniforms.  The 
Registered  Nurses"  Association  of  Nova 
Scotia  says  the  uniforms  are  still  arriving 
for  the  use. 

The  uniforms  are  shipped  by  use  to 
hospitals  in  Lesotho,  a  small,  developing 
country  in  Africa. 


Government  Drug  Study  Reveals 
1:2  Canadians  Pop  Pills  Daily 

Ottawa  — Approximately  1  out  of  every  2 
Canadians  uses  at  least  one  drug  daily, 
according  to  the  preliminary  report  of  a 
study  on  the  use  of  nonprescription  drugs 
in  Canada. 

18     THE  CANADIAN  NURSE 


The  report  describes  patterns  of  house- 
hold and  individual  drug  usage  measured 
during  the  spring  of  1974  on  a  national  and 
provincial  basis.  It  also  examines  patterns 
of  multiple  drug  usage.  Four  professors 
from  the  Faculty  of  Administrative 
Studies,  York  University,  Toronto,  are 
carrying  out  the  study  for  Health  and  Wel- 
fare Canada. 

Vitamins  accounted  for  the  vast  propor- 
tion of  daily  drug  usage  reported  by  re- 
spondents to  the  study;  37%  of  respon- 
dents report  using  vitamins  on  a  daily 
basis;  approximately  79c  use  cold 
medicines  daily,  and  approximately  10% 
use  cough  medicines  daily. 

Of  persons  responding  to  the  study, 
96%  reported  using  at  least  one  remedy 
within  the  preceding  year,  and  two-thirds 
used  3  or  more  of  the  9  remedy  types 
studied.  Virtually  the  entire  population 
sampled  makes  use  of  one  or  more  of  these 
remedies  during  the  course  of  the  year, 
with  the  majority  using  several  types. 

The  first  part  of  the  study,  designed  to 
identify  the  extent  of  use  of  nonprescrip- 
tion drugs,  was  conducted  by  a  mail  sur- 
vey to  which  nearly  3,000  households, 
comprising  approximately  10,000  indi- 
viduals, replied.  Data  is  provided  for  such 
drugs  as  laxatives,  analgesics,  cough  and 
cold  remedies,  nighttime  sedatives,  and 
vitamins. 

Further  studies  in  progress  include  an 
investigation  in  depth  of  the  reasons  for 
use  of  nonprescription  drugs  by  the  public, 
and  continued  study  of  the  use  of  drugs  by 
the  public. 

Pnase  2  of  the  study,  which  is  scheduled 
to  begin  shortly ,  is  designed  to  expand  and 
validate  statistically  the  knowledge 
gathered  in  phase  one  with  representative 
samples  of  the  population.  In  addition, 
phase  2  will  begin  investigation  of  the 
methods  of  promotion  associated  with 
these  products,  and  will  examine  their  im- 
pact on  use  and  reasons  for  use  of  these 
products  by  Canadians. 

Copies  of  the  first  report  are  available 
on  request  to  Information  Services,  Health 
and  Welfare  Canada,  Ottawa.  Canada, 
KIA  0K9. 


Acupuncture  Is  A  Medical  Act 
But  Ont.  Insurance  Doesn't  Pay 

Toronto,  Ont.  —  Ontario  Minister  of 
Health  Frank  Miller  said,  in  a  statement 
issued  in  January,  1975,  '"I  have 
concluded  that  the  intentions  of  the 
College  of  Physicians  and  Surgeons  of 
Ontario  to  enforce  strict  medical  control  of 
acupuncture  in  the  province  is  the  correct 
course  of  action.  " 

He  continued,  however,  "I  also  want  to 
reconfirm  that,  until  the  therapeutic  values 
of  acupuncture  have  been  conclusively 
established,  the  government  does  not 
intend  to  include  services  for  acupuncture 
as    insured    benefits    under   the    Ontario 


Health  Insurance  Plan." 

According  to  Miller,  the  College  of 
Physicians  and  Surgeons  of  Ontario 
designated  acupuncture  as  a  medical  act 
and  outlined  conditions  for  its  practice  in 
June  1974.  The  College's  conditions 
were,  briefly,  that  acupuncture  was  to  be 
practiced  only  by,  or  on  written  referral 
from,  a  physician  legally  qualified  and 
licensed  to  practice  medicine  in  Ontario. 

Miller  said,  ""Of  prime  concern  is  the 
danger  of  acupuncture  being  used  before  a 
medical  diagnosis  of  the  individuaFs 
condition  has  been  made.  There  seems 
little  doubt  that  acupuncture  can  have  the 
effect  of  blocking  off,  or  masking,  the 
painful  physical  symptoms  of  an  ailment. 
While  this  may  be  useful  and  desirable  in 
some  cases,  it  can  lead  to  an  ailment 
continuing  and  becoming  progressively 
worse .  ■ " 

He  also  spoke  of  "'reports  that 
elementary  rules  of  hygiene  have  been 
disregarded  by  acupuncturists,  with  the 
obvious  risk  of  infection,  such  as 
hepatitis."" 


Canadians'  Smoking  Habits 
Relatively  Unchanged 

Ottawa  —  Smoking  habits  of  Canadians 
remained  relatively  unchanged  from  1972 
to  1973,  according  to  statistics  recently 
released  by  Health  and  Welfare  Canada. 
The  latest  figures  show  that  nonsmokers 
outnumber  smokers  in  Canada:  53  percent 
of  the  population  1 5  years  of  age  and  over 
does  not  smoke  at  all  and  60  percent  of  the 
population  over  15  does  not  smoke  cigar- 
ettes regularly,  that  is  every  day. 

A  slightly  greater  percentage  of  Cana- 
dian Women  over  the  age  of  15  were 
smokers  in  1973  (36.3  percent)  than  inl 
1972  (35.7  percent)  continuing  a  trend 
evident  since  1965,  especially  in  the  age 
group  15  to  19  years.  Of  Canadian  mer 
over  the  age  of  15,  42.2  percent  were 
nonsmokers  in  1973,  compared  to  42.t 
percent  in  1972  and  34. 8  percent  in  1965. 

Statistics,  prepared  for  the  Non- 
Medical  Use  of  Drugs  Directorate  by 
Statistics  Canada  indicate  that  those  whc 
do  smoke,  however,  appear  to  be  smoking 
more  cigarettes  per  day.  There  has  been  i 
rise  in  the  percentage  of  smokers  having 
from  11  to  25  cigarettes  a  day  and  a  de- 
crease in  the  percentage  of  the  ones  smok 
ing  from  1  to  10  cigarettes  a  day.  Th( 
change  of  the  percentage  of  heavy  smoken 
(more  than  25  a  day)  was  negligible. 

The  increase  of  the  number  of  cigarette: 
smoked  every  day  by  regular  smokers  anc 
the  fact  that  few  smokers  are  able  to  stay  ii 
the  category  of  occasional  smokers  indi 
cate  the  strong  dependency  produced  b; 
nicotine. 

The  report  on  smoking  habits  of  Cana 
dians  (1973)  is  available  on  request  fron 
Health  and  Welfare  Canada,  Healtl 
Protection  Branch,  Ottawa  KIA  0L2.  <{ 

APRIL  1971 


Roots  make  a  very  comfortable 
shoe  for  the  hospital.  Admit  it 


Supported  arch. 

When  you  step  off  tfie  number  of 
miles  your  job  calls  for  on  hard  hos 
pital  floors,  your  arches  need  our 
support. 


Gently  recessed  heel. 

It  eases  you  into  a  slightly  straighter 
stance  to  give  you  a  more  natural, 
less  tiring,  way  to  walk. 


CV-" 


Rocker  sole. 

Body  weight  should  shift  from  the 
heel,  along  the  outer  foot  to  the  big 
toe  for  lift  off.  Curved  sole  means 
easier  lift-offs. 


Naturally  shaped  toes. 

Because  your  feet  are  less  crowded 
they're  more  comfortable.  Better 
circulation  of  air  keeps  your  feet 
cooler,  too. 


Top-grain  leathers. 

Naturally-finished  skins  with  no 
cosmetic  cover.  Pores  stay  free  to 
breathe;  one  more  benefit  for  cooler 
feet. 


y 


Craftsmanship. 

Two  generations  of  Canadian  shoe- 
makers (a  father  and  four  sons) 
guide  Roots  production,  much  of 
which  is  still  done  by  hand. 


natural  Sootwear 


City  feet  need  Roots. 

Vancouver,  Calgary,  Edmonton, 
London.  Toronto,  Ottawa.  Montreal. 
Check  the  White  Pages  or  ask 
Directory  Assistance  for  new  listings. 


Ahhh...thcifs  nice. 

HEELBO™  and  the  new  "supercushioned"  HEELBO  FLAIR 
are  the  only  protection  for  decubitus  ulcers  that  allow  your 
patients  to  walk  in  comfort  and  safety. 
The  slim,  natural  shape  gives  patients  a  firmer  footing,  so 
that  during  late  hours  and  on  weekends  they  can  man- 
age better  alone. 


wmmmm 


Like  the  original  HEELBO,  the  FLAIR  has  a  patented, 
warm,  comfortable  lining  of  brushed  Acrilan.'"  Heal- 
ing is  more  rapid,  because  there  are  no  straps  or 
bindings  to  restrict  blood  circulation. 

But  only  the  new  FLAIR  has  an  extra  deep  "arm- 
chair" of  foam  with  higher  sides  for  an  important 
extra  edge  of  protection. 

Leading  institutions  have  given  HEELBO 
excellent  evaluations.  Now  you  can  give 
HEELBO   comfort  and   protection   to 
your  patients. 

After  all,  it  shouldn't  be  just  the  doctor 
who  can  make  your  patients  say 
"Ahhh." 

HEELBO  and  the  new  FLAIR  are 
made  of  washable  Acrilan  with  a 
stain-resistant  foam  cushion,  and 
carTbe  autoclaved.  One  size  fits  all 
adults,  heels  or  elbows.  In  blue  or 
yellow,  3  dozen  pairs  per  case. 

UD 


FLAIR  on  elbow 


FLAIR  inside.out 


Heelbo 

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Please  send  me  a  free  sample  and  price  list. 
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_ast  March,  the  author  spent  two  days  at  the  nursing  station  in  Brochet,  one  of  the 
nost  isolated  in  Canada.  He  had  a  glimpse  of  how  two  young  nurses  cope  with  life 
|n  a  small  Indian  settlement. 

ilary  Brigstocke 


LYNN  LAKE.  LYNN  LAKE.  THIS  is 
Brochet    Nursing.    I    have    urgent 

iffic  for  you .  All  stations  stand  by .  We 
'ant  to  clear  the  line  to  speak  to  the  rcmp. 
wo  men  required.  Over." 

The  radio  crackled  and  hummed  with 
tatic  as  the  nurse  in  charge  of  this  remote 
tation  in  northwest  Manitoba, 
ancashire-bom  Christine  Johnson,  tried 

make  contact  w  ith  the  Royal  Canadian 
Counted  Police  detachment  at  Lynn  Lake. 
ome  150  miles  to  the  south.  It  wasnt  an 
asy  job.  Communications  were  bad  and 
lad  been  for  days.  Outside  the  station  it 


liiarv     Brigstocke     is     .Media    Coordinator 

tiealth).  Information  Directorate.  Health  and 
Welfare  Canada.  Ottawa. 
PRIL  1975 


was  blowing  a  blizzard  and  visibility  was 
down  to  a  couple  of  hundred  yards. 

Luckily,  no  violence  was  involved  in 
this  case.  The  two  hefty  constables,  who 
arrived  later  in  a  ski-equipped  Cessna 
when  the  weather  cleared,  had  merely  to 
escort  an  old  Indian  back  to  hospital. 

BROCHET  IS  A  SMALL  INDIAN  com- 
munity —  mostly  Chipewyan  and 
Crees  —  that  lies  about  750  miles  north- 
west of  Winnipeg  and  just  south  of  the 
Northwest  Territories  border.  In  the  old 
days  there  were  Eskimos  as  well,  but 
they  have  disappeared.  The  white  man 
came  here  in  the  late  1850s.  with  the  estab- 
lishment of  a  Hudson's  Bay  post.  The 
Roman  Catholic  church  founded  a  mission 
in  1861. 


The  Indians,  nearly  1 .000  of  them,  live 
by  and  large  by  fishing  and  trapping.  In  the 
winter  Brochet  is  accessible  only  by  air 
and  by  "cat"'  train.  There  are  no  roads  as 
such.  There  is  a  good  air  strip,  and  a 
"feeder"  link  from  Lynn  Lake  —  rejoic- 
ing in  the  name  of  Calm  Air  —  provides  a 
daily  service  for  connecting  flights  to 
points  south. 

In  late  March  last  year.  I  spent  two  days 
at  this  nursing  station,  which  is  one  of  the 
most  isolated  anywhere  in  Canada,  and  got 
a  glimpse  of  how  two  young  nurses  —  one 
English  and  the  other  Canadian  —  coped 
with  life  (some  of  it  very  much  in  the  raw) 
in  a  small  Indian  settlement.  Indeed,  one 
sometimes  feels  this  sense  of  isolation  in 
the  northern  parts  of  the  provinces  more 
than  in  the  Arctic  regions  where  com- 
THE  CANADIAN  NURSE    21 


munications.  by  and  large,  are  surpris- 
ingly good.  As  Chris  Johnson  said,  "We 
need  a  better  telephone  system,  not  only 
for  emergencies,  but  also  to  keep  us  in 
personal  contact  with  the  outside  world."" 

Communication  with  the  outside  world 
gives  these  nurses  a  feeling  of  security  as 
well,  for  today,  more  than  ever  before, 
there  is  a  restlessness  in  the  Indian  com- 
inunities  and  an  atmosphere  of  uncer- 
tainty. Violence  abounds,  sometimes  re- 
sulting in  death. 

The  Brochet  nursing  station  is  highly 
operational  with  no  frills,  reminding  one 
of  life  aboard  a  wartime  destroyer.  It  con- 
sists of  three  trailers  joined  together  in 
T-shape  formation.  One  trailer  holds  the 
nurses"  living  quarters,  which  consist  of 
two  bedrooms,  a  bathroom,  and  combined 
kitchen  and  living  area.  The  other  units 
hold  the  storeroom,  administration  sec- 
tion, waiting  room,  and  clinic.  At  the  back 
of  the  station,  a  few  yards  away,  is  a 
visitor's  trailer  that  is  well  equipped  and 
self-contained. 

In  comparison,  much  larger  and  more 
luxurious  nursing  stations  can  be  found  in 
the  north;  for  instance.  Fort  Resolution,  on 
the  southern  side  of  Great  Slave  Lake,  and 
Fort  Providence  on  the  Mackenzie  River. 

LIFE  IN  THESE  ISOLATED  STATIONS 
is  one  of  peaks  of  activity  and 
stretches  of  boredom  (and  lots  of  it). 
spiced  on  occasion  with  an  element  of 
danger.  A  few  days  before  we  arrived,  a 
young  Indian  was  brought  into  the  clinic  in 
the  early  hours  of  the  morning  with  severe, 
.self-inflicted  gunshot  wounds.  There  was 
nothing  that  could  be  done  for  him  except 
to  ease  the  pain  and  pray.  He  died  on  the 
station.  The  rcmp  flew  in  fully  armed,  as 
they  have  to  do  when  such  incidents  occur, 
to  remove  the  body  for  post-mortem  and 
inquest. 

This  is  not  the  kind  of  job  for  an  inex- 
perienced girl  with  a  couple  of  years" 
classroom  training  in  some  southern 
hospital.  It  demands  emergency  room 
experience  in  a  large  hospital,  an  ability 
to  make  decisions  quickly  and  correctly, 
and.  above  all,  an  ability  to  keep  a  cool 
head. 

Johnson,  who  was  in  charge  at  the  time, 
obviously  has  these  qualifications.  Born  in 
22    THE  CANADIAN  NURSE 


*  1 

•    >   » 

^4 

Christine  Johnson,  at  Brochet,  trying  to 
get  through  by  radio-telephone  to  her 
headquarters  at  Thompson,  Manitoba. 

1946.  she  received  all  her  education,  in- 
cluding midwifery,  at  large  hospitals  in  the 
United  Kingdom.  She  also  worked  among 
the  gypsies  in  the  Vale  of  Evesham  before 
coming  to  Canada  to  work  for  the  Grenfell 
Mission  in  Labrador  and,  subsequently, 
for  Medical  Services,  Department  of 
National  Health  and  Welfare,  in  northern 
Manitoba.  She  was  assisted  at  Brochet. 
by  24-year-old  Gwenda  Peters  from 
Winnipeg,  who  received  her  education  in 
nearby  St.  Boniface. 

As  we  accompanied  these  nurses  on 
their  visiting  rounds  in  the  community  — 
much  of  it  by  skidoo,  which  they  drive 
with  considerable  verve  —  we  caught  a 
glimpse  of  what  the  daily  routine  is  like  for 
these  nurses.  An  interpreter  is  brought 
along,  in  this  instance  the  Indian  janitor  of 
the  station  who  doubles  as  mayor  of  the 
community. 

Many  of  the  cases  we  saw  involved 
children  with  chronic  chest  colds  that  had 
been  neglected  and  were  developing  into 
bronchitis  and  even  pneumonia.  Infected 
ears  are  a  bit  of  a  problem,  especially  if 
there  is  resistance  to  penicillin.  Gastroen- 
teritis and  allied  illnesses  also  present  dif- 


ficulties because  of  poor  water  supplies, 
one  of  the  key  problems  in  the  north.  There 
are  eye  injuries  and  dental  emergencies; 
fortunately,  Johnson  has  had  some  train- 
ing in  dental  extraction  and  in  inserting 
temporary  fillings. 

In  dealing  with  patients  with  tuber- 
culosis, she  finds  it  is  the  older  persons 
v\ho  are  difficult  to  treat.  They  tend  to 
neglect  their  anti-tuberculosis  medication, 
particularly  if  they  are  out  on  trap  lines. 
■"We  try  to  get  them  x-rayed  once  a  year, 
and  Treaty  Day  is  a  good  time  as  they  are 
all  in  one  spot."'  she  said. 

Many  nurses  prefer  to  get  their  patients 
to  come  to  the  clinic,  but  '"house  calls"" 
are  essential  as  the  nurses  can  see  what  the 
domestic  situation  is  like  and  have  some 
"■feel""  of  what  is  going  on  in  the  commun- 
ity. Personal  contact  is  essential  even  if 
there  is  a  language  and  cultural  barrier 
among  many  of  the  older  generation. 

ONE  OF  THE  BIGGEST  PROBLEMS  for 
nurses  in  these  remote  settlements, 
particularly  in  the  northern  parts  of  the 
province,  is  violence  in  one  shape  or 
another.  A  combination  of  alcohol  and 
firearms  produces  lethal  situations.  Gun- 
shot wounds,  resulting  from  fights  after 
excessive  drinking,  are  high  in  the  casu- 
alty list,  particularly  at  weekends.  Some 
inhabitants  go  to  the  nearest  liquor  store 
and  bring  supplies  back  by  the  easeful  for 
the  rest  of  the  community. 

Brochet  went  ""dry""  this  past  summer, 
by  order  of  the  community  council.  How- 
ever, like  Prohibition  in  the  United  States 
in  another  era,  this  may  aggravate  the  situ- 
ation rather  than  improve  it.  Loopholes 
will  be  found,  and  local  stills  can  produce 
inferior  liquor,  perhaps  causing  blindness 
and  even  death. 

There  are,  of  course,  other  accidents < 
that  require  immediate  aid,  such  as  fingers 
cut  off  by  an  axe,  a  foot  caught  in  a  trap. I 
exposure,  and  broken  bones  and  facial  lac- 
erations caused  by  fighting  —  indeed,  the] 
kind  of  cases  one  would  find  in  an 
emergency  ward  of  a  large  city  hospital.  A 
patient  may  be  brought  in  with  stomach 
pain  and  must  be  diagnosed.  In  the  "book 
of  rules,"'  patients  with  ill-defined  symp- 
toms such  as  this  should  be  evacuated  to 
the  closest  hospital,  following  consulta- 

APRIL  1975 


This  patient  will  be  cared  for  in  the  well- 
equipped  clinic  in  the  nursing  station,    i 


The  living  quarters  of  a  modern  nursing  station  of 
the  non-trailer  type,  which  are  now  being  built  in 
the  north.  This  one  is  at  Fort  Resolution  on  the 
south  shore  of  Great  Slave  Lake  and  serves  a  large 
Indian  community.  Nurse  Joyce  Atcheson,  of 
Edmonton,  selects  music  for  the  radio  and  record 
player.  Outside,  the  temperature  was  -34.4   C. 


<  "Just  look  this  way,  now."  Johnson  examines  the 
eyes  of  an  old  woman,  during  her  daily  house  visits 
to  the  Indian  community.  With  her  is  an  Indian 
interpreter. 

THE  CANADIAN  NURSE     23 


Johnson  starts  her  house  rounds  with  a  pair  of 
crutches  for  an  Indian  woman.  In  the  background 
Is  the  nursing  station,  consisting  of  three  trailers. 
^  On  the  left  is  the  nurses'  living  quarters. 


Johnson  takes  a  pair  of  snowshoes  with  her  as  she 
makes  her  house  calls  in  case  the  machine  breaks 
down  and  she  has  to  make  her  way  back  to  the 
station  on  foot.  ' 


tion  with  the  nearest  medical  supervisor; 
however,  it  may  be  impossible  to  make 
radio  contact  and  the  weather  may  be  too 
bad  to  fly  in  a  plane  to  evacuate  the  patient . 
A  decision  has  to  be  made  and  the  right 
treatment  given. 

Expectant  mothers  about  to  give  birth  or 
with  prenatal  complications,  such  as 
bleeding  and  vomiting,  are  brought  to  the 
station  in  the  middle  of  the  night.  Many 
nurses  in  charge  of  northern  stations  are 
British,  Australian,  or  New  Zealanders 
because  they  have  the  qualifications. 
Canadian  nurses  are  acquiring  these  skills. 

THE  NURSING  STATION  IS  THE  back- 
bone of  the  northern  health  service, 
be  it  in  the  provinces  or  the  Yukon  and 
Northwest  Territories.  In  the  nwt  and  the 
Yukon,  for  instance,  there  are  about  40  of 
these  stations.  Many  of  the  trailer  units  are 
located  in  settlements  with  a  population 
range  from  150  to  1,000.  Over  the  whole 
of  Canada  there  are  212  stations,  with  41 
percent  of  them  in  remote  areas. 

The  turnover  rate  for  nurses  is  high,  as 
nurses  do  not  stay  more  than  two  years  on 
the  average.  The  stations  are  equipped 
with  outpatient  facilities,  inpatient  beds 
for  the  severely  ill,  and  living  quarters  for 
the  staff.  Generally,  they  are  staffed  with 
one  to  three  nurses,  depending  on  local 
conditions. 

As  for  the  nurse  herself,  she  must  wear 
many  hats  and  wear  them  proficiently. 
Among  other  things,  she  should  be  a  good 
diagnostician,  be  able  to  render 
emergency  treatment  (like  the  shooting  in- 
cident mentioned  earlier),  be  versed  in 
preventive  medicine,  be  skilled  in  mid- 
24    THE  CANADIAN  NURSE 


wifery ,  be  capable  of  extracting  teeth  if  the 
occasion  demands,  take  x-rays  and  be  able 
to  glean  infomiation  from  them,  perform 
minor  laboratory  procedures,  and,  most 
important,  possess  skills  and  aptitudes  in 
counseling  individuals  with  emotional 
problems. 

This  is  the  clinical  side.  Above  all,  the 
nurse  must  be  imbued  with  a  sense  of  dedi- 
cation, for  this  is  not  a  job  for  the  faint- 
hearted. These  nurses  have  much  respon- 
sibility thrust  on  their  shoulders,  as  can  be 
seen  at  remote  outposts  like  Brochet. 

Doctors  are  supposed  to  visit  the  sta- 
tions at  regular  intervals  and,  in  theory, 
they  are  always  at  the  end  of  the  radio- 
telephone (there  are  not  many  land  lines)  if 
consultation  is  required. 

In  practice,  however,  this  is  not  always 
the  case.  Weather,  which  is  so  changeable 
in  the  north,  can  preclude  a  doctor  flying  to 
a  station;  because  of  atmospheric  condi- 
tions, communications  can  be  difficult  and 
sometimes  completely  impossible  for  days 
on  end.  The  nurse  can  be  left  to  look  after  a 
desperately  ill  patient,  knowing  full  well 
there  is  no  chance  of  evacuating  the  patient 
by  air.  She  is  on  her  own,  sometimes  mak- 
ing life  or  death  decisions. 

The  outpost  nurse  has  to  deal  with  day- 
to-day  situations,  which  she  will  not  find 
in  any  job  description,  that  require  great 
tact  and  forbearance,  a  good  sense  of 
humor  (she  will  be  lost  if  she  hasn't  got 
that  attribute),  considerable  tolerance  of 
the  frailties  of  others,  and  an  understand- 
ing of  alien  cultures.  She  must  show  firm- 
ness to  those  who  would  test  strength  of 
character  and  resolve,  and  a  warmth  of 
personality  that  is  so  necessary  when  deal- 


ing with  people  who  are  shy  and  initially 
suspicious  of  her.  Above  all.  she  must 
have  common  sense  in  dealing  with  situa- 
tions that  don't  necessarily  demand  the 
"book"'  answer. 

THERE  IS  undoubtedly  a  challenge 
in  this  kind  of  work  for  the  right 
type  of  person;  however,  in  recruiting 
nurses  for  the  outposts,  there  is  a  need 
to  guard  against  the  type  of  salesmanship 
that  glosses  over  the  difficulties  and  in 
doing  so  paints  a  more  rosy  picture  than  it 
is,  a  kind  of  "Call  of  the  Wild"  picture.  It 
is  a  tough  job  in  tough  surroundings,  and 
only  those  who  believe  that  they  can  meet 
this  challenge  should  apply.  There  must  be 
proper  screening  of  candidates  by  qual- 
ified persons  who  have  worked  and  lived 
in  the  north  for  some  years.  The  full  facts 
should  be  given  to  applicants  as  to  what 
they  are  getting  into,  otherwise  the  whole 
object  of  the  exercise  is  defeated  from  the 
start.  False  impressions  can  do  irreparable 
harm. 

The  whole  question  of  salaries,  holi- 
days, and  allowances  must  remain  a  major 
consideration  in  recruiting  northern 
nurses.  Working  conditions  and  housing,  i 
especially  in  isolated  areas,  must  be  safe 
and  satisfactory.  Nurses  should  derive i 
professional  satisfaction  from  their  job, 
and  this  problem  is  fully  recognized.        | 

The  nurse's  position  should  be  a  pres-j 
tigious  one,  for  she  is  an  ambassador  in' 
the  north.  Her  relations  with  Indian  andj 
Eskimo  communities  may  well  govern  thei 
attitudes  of  these  people  toward  health! 
services  in  these  reinote  regions  of 
Canada.  - 

APRIL  1975: 


A  V®^/>  with  WP 


The  director  of  nursing  and  the  recreational  therapist  designed  a  Life  Enrichment 
and  Activation  Program  (LEAP)  for  patients  in  the  Lethbridge  Auxiliary  Hospital, 
an  extended  care  facility.The  LEAP  staff  position  was  funded  by  a  Local  Initiatives 
Program  (LIP)  grant.  The  LEAP  staff  member  helped  paraprofessional  staff  carry 
out  the  enriched  activities  she  devised. 

Rosemary  Edmunds  and  Donna  Lynn  Smith 


lean  is  an  attractive.  20-year  old  girl  with 
:erebral  palsy  whose  parents  cared  for  her 
It  home  until  a  year  ago.  As  they  ap- 
iroached  their  mid-60s,  they  could  no 
onger  care  for  their  daughter  at  home  on  a 
illl-time  basis.  So,  following  a  hospifaliz- 
ition  for  constipation  and  gastrointestinal 
ipset,  Jean  was  transferred  to  extended 
;are.  She  appeared  to  enjoy  the  activity  of 
he  hospital  and  the  companionship  of  staff 
ind  patients. 

Jean  had  been  in  hospital  almost  10 
nonths  when,  one  Monday  moming  after 
ler  usual  weekend  at  home  with  her  par- 
ints,  she  began  to  behave  in  an  unusual 
lanner:  refusing  to  eat,  crying,  kicking, 
ind  throwing  herself  about  on  the  floor. 
ler  speech  is  always  difficult  to  under- 
tand,  but  in  her  excitement  it  was  almost 


tosemary  Edmunds  (R.N..  Royal  Alexandra 
lospital.  Edmonton:  cert,  in  psychiatric  nurs- 
Bg,  Alberta  Hospital,  Ponoka,  Alberta)  was 
way  from  nursing  for  23  years.  After  her 
usband's  death  5  years  ago.  she  reentered 
ursing  and  worked  on  a  medical  unit  at  the 
Jniversity  of  Alberta  Hospital  before  joining 
le  staff  of  the  Lethbridge  Auxiliary  Hospital  to 
ssist  in  implementing  the  life  enrichment  and 
Ctivation  program.  Donna  Lynn  Smith  is  di- 
;ctor  of  nursing  at  the  Lethbridge  Auxiliary 
lospital.  She  wrote  ■"Wild  Land:  a  Mental 
lealth  Resource."  which  was  published  in  The 
'anadian  Nurse  in  June  1974. 
PRIL  1975 


unintelligible.  A  telephone  call  to  her  par- 
ents helped  to  shed  some  light  on  the  situa- 
tion. 

When  Jean's  behavior  was  described  to 
her  parents,  they  said  she  had  tantrums 
many  times  while  living  at  home.  When 
she  became  upset  or  frustrated  she  threw 
herself  out  of  her  wheelchair  onto  the  floor 
where  she  would  kick  and  flail  around, 
hurting  herself  or  anyone  in  her  path.  She 
would  sometimes  refuse,  or  become  un- 
able, to  void  and  would  have  to  be  taken  to 
the  hospital  for  catheterization.  Over  the 
past  few  months,  when  it  came  time  to 
return  to  the  hospital  on  Sunday  nights, 
Jean  would  have  a  tantrum;  the  night  be- 
fore, she  had  misbehaved  so  severely  that 
her  mother  told  her  she  could  no  longer 
come  home  every  weekend. 

Her  parents  said  they  controlled  this  be- 
havior at  home  by  taking  her  to  her  room;  it 
would  sometimes  take  several  hours  be- 
fore she  was  able  to  go  to  sleep  or  rejoin 
the  family.  This  had  been  the  case  the 
night  before,  and  when  she  finally  re- 
turned to  the  hospital,  she  was  sullen,  un- 
happy, and  worried.  The  tantrum  we  wit- 
nessed in  the  moming  was  our  first  en- 
counter with  this  behavior,  which,  for 
Jean,  had  become  a  habitual  means  of 
dealing  with  situations  in  which  she  felt 
out  of  control . 

We  were  grateful  for  the  information 
given  to  us  by  Jean's  parents  and  told  them 
that,  with  their  help  and  permission,  we 


would  like  to  help  Jean  learn  to  deal  with 
frustration  in  a  manner  that  would  not  be 
potentially  harmful  to  herself  or  others. 
Her  parents  agreed  to  meet  us  the  next 
evening  to  discuss  our  proposed  program. 
In  the  meantime,  being  exhausted,  they 
asked  that  Jean  not  be  allowed  to  phone 
them. 

We  had  dealt  with  Jean's  immediate  be- 
havior in  a  way  similar  to  that  used  by  her 
parents:  lowering  her  to  the  floor  where 
she  could  hurt  herself  least  and  offering  no 
positive  reinforcement,  such  as  additional 
attention,  until  she  had  calmed  herself. 
Afterward,  while  helping  her  to  wash  her 
face,  we  explained  that  we  had  spoken  to 
her  parents,  and  that  they  would  be  in  to 
see  her  the  next  day.  We  told  Jean  that  we 
would  talk  to  her  about  how  she  felt,  but 
that  the  tantrums  would  not  be  permitted. 

Jean  is  a  sensitive  and  thoughtful  girl, 
and  already  felt  badly  about  her  behavior: 
we  told  her  we  would  work  out  a  plan  with 
her  to  help  her  learn  a  "safer  way  of  get- 
ting mad."  After  taking  her  to  the  recrea- 
tion department  for  moming  coffee,  we 
began  to  formulate  a  care  plan,  using  a 
token  system. 

The  care  plan 

Jean  was  to  receive  tokens  to  encourage 
certain  behavior.  For  things  she  wanted  to 
do  or  for  misbehavior,  she  would  have  to 
pay  tokens.  We  hoped  this  would  encour- 
age her  to  save  tokens  as  she  increased 
THE  CANADIAN  NURSE     25 


FIGURE  1 

^ 

Tokens  were  earned  for: 

Tokens  were  paid  for: 

Drink  1  cup  fluid  in  room 

1  token 

1  phone  call  per  day 

5  tokens 

Void 

1  token 

Extra  phone  calls 

1 0  tokens 

Help  dress  herself 

1  token 

Break  rules  -Dining  room 

(panties  and  slacks) 

-Workshop 

2  tokens 

Complete  dusting 

1  token 

Hurt  self 

5  tokens 

(1  hall) 

Tantrum  (Needlessly 

10  tokens 

Strip  own  bed 

1  token 

disturbing  others. 

Help  prepare  for  bed 

1  token 

Complaining  about  phone 

(panties  and  slacks) 

calls  and  going  home.) 

Supper  at  home 

1 0  tokens 

Keep  mouth  wiped 

1  token 

Weekend  at  home 

20  tokens 

(in  workshop) 

Trip  to  Red  Deer 

100  tokens 

independent  activity  and  did  things  that 
were  required  of  her.  It  would  also  allow 
her  to  earn  time  at  home  and  a  trip  to  Red 
Deer  to  see  a  dear,  old  friend.  The  number 
of  tokens  for  the  trip  was  purposely  kept 
low  —  well  below  what  it  was  possible  to 
earn  —  so  she  would  not  be  discouraged. 

In  deciding  which  behavior  we  should 
reinforce  or  discourage,  our  goal  was  to 
help  Jean  work  toward  accepting  respon- 
sibility for  her  feelings,  actions,  and  as 
much  of  her  own  care  as  possible. 
(Figure  1.) 

We  used  picture  wheels  and  poker  chips 
as  tokens  and  placed  a  supply  of  them  in 
the  different  places  where  Jean  spent  most 
of  her  time  —  her  room,  the  office  on  her 
floor,  and  the  occupational  therapy  work- 
shop. Her  roommate  volunteered  to  help 
keep  track  when  necessary  and  to  tell  staff 
when  Jean  had  earned  tokens.  An  occupa- 
tional therapy  worker  gave  her  an  attrac- 
tive needlework  purse  to  keep  tokens  in. 
26     THE  CANADIAN  NURSE 


The  system  worked  well.  Jean"s  be- 
havior was  good  and  she  made  a  real  effort 
to  save  tokens.  She  even  volunteered  to 
stay  in  hospital,  rather  than  go  home  for 
the  weekend,  two  weeks  following  the 
start  of  the  program,  if  there  were  any 
chance  that  she  might  not  have  enough 
saved  for  the  trip  to  Red  Deer.  Monday 
morning.  2  weeks  after  the  system  started, 
she  looked  rather  dejected  and  we  knew 
that  something  was  wrong. 

When  Rosemary  talked  to  her,  Jean  said 
she  felt  the  token  system  was  childish. 
Between  them,  they  decided  that  the  sys- 
tem had  helped  give  Jean  the  self- 
discipline  to  adjust  to  not  going  home  each 
weekend,  and,  with  encouragement  and 
support,  she  could  carry  on  without  the 
system.  It  would  be  reinstituted  again  if 
Jean  needed  help. 

It  is  now  several  months  since  we 
started  the  program  with  Jean.  There  has 
been  no  further  problem  of  refusing  to 


return  to  the  hospital  after  a  weekend  or 
evening  out.  Jean  even  accepted  the  idea 
of  her  parents  leaving  the  city  for  a 
6-month  vacation. 

Her  most  difficult  periods,  as  with  any- 
one els,e.  are  when  she  has  her  feelings 
hurt,  or  people  treat  her  as  if  she  were  not 
intelligent. 

The  LEAP 

Rosemary's  work  with  Jean  is  one  ex- 
ample of  the  Life  Enrichment  and  Activa- 
tion Program  (leap)  in  our  hospital,  for 
which  a  Local  Initiatives  Program  (LIP) 
grant  was  used. 

Local  Initiatives  Programs  are  intended 
to  meet  community  needs  and  to  create 
new  employment  opportunities.  Like 
many  other  extended  care  facilities,  our 
hospital  has  a  high  ratio  of  nonprofessional 
nursing  assistants  to  registered  nurses. 

Active  physio,  occupational,  and  recre- 
ational therapy  departments  help  to  meet 
many  patient  needs,  but  the  leadership  to 
support  the  goals  of  these  special  therapies 
and  to  assume  the  full  nursing  role  in  life 
enrichment  and  activation  comes  from  the 
registered  nurse.  She  must  be  an  expert  in 
assessing  patient  needs  and  in  identifying 
health  potentials.  Our  life  enrichment  and 
activation  program  was  intended  to  pro- 
vide support  and  impetus  to  these  aspects 
of  the  nurse's  role. 

The  LEAP  was  designed  by  Donna,  the 
director  of  nursing,  in  cooperation  with  the 
recreational  therapist:  a  proposal  was 
submitted  to  the  Department  of  Manpower 
and  Immigration.  Once  the  program  had 
begun.  Donna  served  as  a  resource  person ^ 
in  helping  to  identify  priorities,  set  goals, j 
locate  necessary  reference  material,  inter- i 
pret  the  program  to  hospital  administration 
and  staff,  and  to  share  supportively  in  thej 
ups  and  downs  that  are  an  inevitable  part  of  i 
any  experimental  venture.  j 

At  first,  Rosemary,  the  leap  nurse. j 
found  the  unstructured  time  available  tOj 
her  not  only  unfamiliar,  but  worrisome.! 

APRIL  1975 


•  ^^  it  really  working  to  sit  down  with  a 
>atient  long  enough  to  have  a  meaningful 
'unersation,  particularly  when  the  other 
latf  were  busy?  Was  it  fair  to  spend  more 
inie  with  one  patient  than  another? 

One  goal  of  the  program  w  as  to  increase 
he  amount  of  professional  nursing  atten- 
un  available  to  patients.  The  LEAP  nurse 
ftered  life  enrichment  activities  to  pa- 
en  ts  who  were  unable  to  benefit  from 
j.reation  and  rehabilitation  programs  al- 
jady   offered,    especially    persons   who 

•  ere  severely  withdrawn,  confused,  con- 
med  to  bed,  or  depressed.*  Once  assess- 
lent  and  goal  setting  had  taken  place 

ugh  observation  and  interaction  with 
.L  patient,  nursing  care  approaches  were 
lught  and  delegated  to  nonprofessional 
;atf  members.  The  continuing  supervi- 
lon  of  the  professional  nurse  was  essen- 
ai.  so  the  effectiveness  of  these  ap- 
roaches  could  be  evaluated  and  modifica- 
ons  made  as  necessary. 
Planning  with  Jean  to  set  up  the  token 
^  vtem  and  explaining  to  other  staff  mem- 
ers  the  reasons  for  it  and  the  way  it  was  to 
ork  were  the  responsibility  of  a  profes- 
lonal  nurse.  Dispensing  the  tokens  and 
ncouraging  ind  praising  Jean  for  desir- 
ble  behavior  could  be  carried  out  by 
thers,  once  this  had  been  done.  Only  with 
jntinuing  supervision  and  involvement 
f  the  professional  nurse  could  the  deci- 
on  to  discontinue  the  token  system  at  the 
jpropriate  time  have  been  made. 


; 


is.  X. 

The  work  Rosemary  did  with  Ms.  X. 
rther  illustrates  this  point.  Ms.  X  was 
ignosed  as  having  multiple  sclerosis 
'er  4  years  ago.  She  managed  fairly  well 
home  until  problems  arose  with  urinary 


The  objectives,  activities,  and  means  of 
lasuring  progress  of  the  Life  Enrichment  and 
:tivaiion  Program  are  available  from  the  au- 

■s. 

ML  1975 


retention,  bladder  infection,  and  spasms 
that  did  not  respond  well  to  opium  and 
belladonna  suppositories.  At  the  time  of 
admission  to  the  general  hospital,  her  left 
leg  was  weaker  than  her  right;  she  was 
complaining  of  generalized  weakness  and 
difficulty  in  coping  at  home.  She  shuffled 
when  she  attempted  to  walk  with  the  help 
of  a  walker. 

Ms.  X.  is  a  small,  attractive,  55-year- 
old    woman,    who    has    become    accus- 


tomed to  attention  because  of  her  health 
problems.  She  had  developed  certain 
personal  routines,  which  were  difficult, 
sometimes  impossible,  to  carry  out  with 
available  staff  in  our  setting.  For  in- 
stance, she  was  to  walk  with  assistance, 
and  she  preferred  to  do  so  in  the  middle  of 
the  night. 

Relationships  between  Ms.  X.  and  staff 
members  were  breaking  down;  each  saw 
the  other  as  unreasonable  and  inconsider- 


FIGURE  2 
Ms.  X's  morning  self-care  program 

1 .  Detach  catheter  bag  from  bed  and  attach  leg  bag,  which  can 
be  left  on  until  bedtime. 

2.  Place  her  housecoat  and  shoes  where  she  can  slip  into  them 
by  herself.  Leave  clean  towels  for  her  in  the  bathroom.  Place 
wooden  arm  chair  and  overt)ed  table  In  such  a  position  that 
she  can  return  to  them  with  her  walker. 

3.  Leave  signal  cord  within  reach  at  all  times,  or  remind  her 
about  it. 

4.  She  will  then  get  up  by  herself,  put  on  her  housecoat  and 
shoes,  walk  to  the  door,  open  the  door  herself,  then  walk  at 
least  to  the  office  and  back.  (The  goal  is  to  increase  this 
distance). 

5.  She  will  return  to  her  room,  go  to  the  bathroom  where  she  will 
place  the  signal  cord  across  her  walker,  sit  down  on  a  straight 
chair  and  bathe  herself.  (Her  back,  feet  and  peri-care  can  be 
done  when  it  is  convenient  for  the  nurse  to  come.) 

6.  She  will  dress  and  return  to  the  wooden  arm  chair  in  her  room 
for  breakfast. 

7.  Check  to  see  if  the  signal  light  cord  is  within  reach.  This 
will  eliminate  a  lot  of  her  apprehension  and  tension. 
When  she  knows  what  to  expect,  what  is  expected  of  her,  and 
is  urged  to  be  independent  whenever  possible,  but  is  offered 
help  when  necessary,  she  will  probably  be  more  relaxed.  This 
will  make  her  less  demanding,  more  anxious  to  be  indepen- 
dent, and  help  to  decrease  bladder  spasms. 
Encourage  her  to  do  things  for  herself  Give  her  a  chance 
and  then  give  help,  if  needed. 

This  plan  is  intended  as  a  guide.  Whatever  variations  of  this 
routine  work  out  better  for  the  staff  and  for  Ms.  X.  would  be 
preferable. 


THE  CANADIAN  NURSE     27 


ate.  To  ease  the  situation,  she  and  her 
husband  were  asked  to  consider  a  program 
that  would  help  her  to  be  more  self- 
sufficient,  to  do  her  own  morning  care, 
and  to  get  her  walking  more.  They  were 
prepared  to  try  it. 

Rosemary  worked  with  her  for  10  days, 
for  an  hour  or  so  each  morning.  During 
that  time,  Ms.  X.  did  everything  she  could 
for  herself  or,  at  least,  tried  it  before  being 
helped.  Her  daily  schedule  and  activities 
were  studied,  and  the  easiest  ways  for  her 
to  move  from  place  to  place  were  worked 
out.  If  one  method  did  not  work,  another 
was  attempted  until  she  had  a  fairly  ac- 
ceptable routine.  The  main  thing  was  that 
Ms.  X.  learned  to  do  things  in  a  different 
way  or  in  a  different  sequence ,  if  she  found 
it  necessary  to  change  for  some  reason. 
Her  routine  became  more  flexible. 

A  detailed  self-care  plan  was  prepared, 
so  both  Ms .  X .  and  those  assisting  with  her 
care  could  refer  to  it.  The  portion  of  this 
plan  relating  to  morning  care  is  shown  in 
Figure  2. 

A  tendency  for  nursing  assistants  to  in- 
terpret the  self-care  instructions  rather 
rigidly  was  a  temporary  problem  that  left 
Ms.  X.  with  the  feeling  that  she  could  not 
ask  for  help  when  she  needed  it.  By  slight 
changes  in  the  wording  of  the  plan,  and 
through  discusssions  with  the  staff  mem- 
bers, Rosemary  was  able  to  interpret  the 
intent  of  the  plan  more  fully.  We  observed 
a  beneficial  change  in  the  attitude  of  both 
Ms.  X.  and  the  staff  members. 

Near  the  beginning  of  this  enrichment 
program,  Ms.  X's  book  club  came  to  the 
hospital  for  their  monthly  gathering,  to 
include  her.  At  that  time,  it  was  doubtful  if 
she  could  sit  up  for  more  than  an  hour.  In 
her  self-care  program,  the  goal  was  to  have 
her  ready  to  go  out  on  pass  for  her  next 
book  club  meeting. 

It  was  stressed  frequently  that,  before 
doing  something  or  going  someplace  with 
her  walker,  she  should  plan  it  out  so  she 
would  know  what  she  was  going  to  do  and 
how.  We  urged  her  to  be  prepared  for 
28    THE  CANADIAN  NURSE 


something  unforeseen  and,  instead  of  get- 
ting in  a  panic  about  trivial  things,  to  relax 
and  wait  for  help. 

Ms.  X.  progressed  well.  Time  was  ap- 
proaching for  the  next  book  club  meeting 
and,  although  she  had  fallen  and  hit  her 
head  a  week  previous  to  the  meeting,  she 
was  looking  forward  to  the  evening  out. 
Her  husband  brought  clothes  for  her  to 
wear,  she  had  her  hair  set ,  and  her  husband 
made  other  necessary  arrangements.  She 
went  to  the  book  club,  was  out  for  3  hours, 
and  thoroughly  enjoyed  herself.  The  com- 
pany was  pleasant,  the  food  was  delicious, 
and  the  evening  out  was  a  success.  Even 
before  that  evening  arrived,  she  and  her 
husband  had  been  making  plans  to  go  out 
two  evenings  later  to  a  stage  production, 
and,  the  following  day,  out  as  guests  for 
Sunday  dinner. 

Ms.  X.  continued  to  take  part  in  com- 
munity activities,  thus  increasing  her  po- 
tential for  health.  She  requested  the  re- 
moval of  her  catheter  and  has  managed 
satisfactorily  without  it.  The  continuing 
challenge  is  to  coordinate  community  re- 
sources and  assist  the  family  to  obtain  the 
services  of  a  live-in  housekeeper,  which 
would  allow  Ms.  X.  to  return  home. 

Ms.  X.  falls  occasionally,  or  bends 
down  for  something  and  cannot  get  up 
again.  She  feels  that  this  is  something  she 
can  overcome,  by  being  more  careful  and 
planning  ahead.  She  has  been  out  for  some 
long  weekends,  goes  out  every  Sunday  for 
church  and  dinner,  and  is,  on  the  whole, 
happier  and  more  self-sufficient.  The  time 
spent  in  planning  and  implementing  this 
self-care  program  was  a  good  investment. 

LEAP  activities 

As  the  weeks  passed,  Rosemary  logged 
her  activities.  Items  from  her  journal, 
which  illustrate  the  variety  of  activities 
that  were  part  of  our  enrichment  program, 
included: 

D  Took  3  patients  to  see  several  nursing 
homes  in  the  community.  One  saw  several 
friends   and  another  feels   better  about 


transferring    to   a    nursing   home,    after 
seeing  the  accommodation. 
D  Started  placing  calendars  at  each  bed- 
side table  to  help  patients  orient  them- 
selves. 

n  Another  group  of  5  patients  started.  We 
talke4  about  colors;  Ms.  M.  knew  most  of 
them,  Ms.  Q.  all  of  them,  Ms.  P.  seemed 
to  look  and  try  to  respond  but  didn't  quite 
make  it.  Ms.  A.  could  not  see  most  of  the 
colors,  and  Ms.  C.  identified  one  color  as 
"dark  red,"  but  did  not  recognize  orange 
or  brown. 

When  asked  their  favorite  foods,  Ms. 
M.  immediately  replied,  "lemon  pie, 
which  we  don't  get  here."  Ms.  P.  said 
something  like  "shoosh,"  Ms.  A. 
"sandwiches,"  and  Ms.  C.  did  not  reply. 
D  Mr.  N.  is  really  on  the  prowl,  needing 
someone  with  him  all  the  time.  We  hav£ 
designed  a  program  to  increase  his  abilit> 
to  concentrate  and  his  attention  span,  bu- 
I'm  not  sure  we  can  get  him  to  listen  lonj 
enough  to  get  his  cooperation. 
D  Catalogues  obtained  and  placed  in  the 
office  for  patients'  use. 

The  unstructured  time  of  the  leap  nurse 
had  rapidly  filled;  there  were  more  thar 
enough  demands  to  keep  one  nurse  busy 
The  problem  became  one  of  assigning 
priorities,  and  deciding  which  activities 
should  be  or  remain  the  responsibilit) 
of  the  nurse  in  the  program  and  which 
might  be  delegated  to  or  shared  with 
others. 

The  LEAP  provided  an  opportunity  t( 

identify  needs  and  resources,  and  to  exper 
iment  with  a  different  role  for  a  nurse  ii, 
our  hospital.  We  are  able  to  use  what  wi! 
learned  last  year  as  we  implement  our  sec 
ond  program  in  January  1975.  i; 


APRIL  197 


Rope  viclim/  — 
Ihc  invi/ible  pcilicnl/ 


Rape  crisis  workers  see  an  extensive  part  of  their  client's  ordeal.  In  this  article,  a 
worker  at  the  Calgary  Rape  Crisis  Centre  shares  information  on  rape,  rape  victims, 
and  the  legal  process,  and  some  concerns  about  medical  contributions  to  the 
victim's  recovery. 


vi>r  the  door  open  and  ran  down  the  hall, 
:  Liming  and  banging  on  doors.  He  tack- 
...  me  onto  the  floor  and  covered  my 
tuHtih.  Nobody  came.  He  dragged  and 
iirried  me  back.  I  thought.  "He'll  never 
rust  me .  He '  //  kill  me  now  for  sure  ."I  was 
11  frightened  I  wet  myself.  —  a  victim 
dentifies  the  worst  part  of  a  4- hour  ordeal . 

Rape  is  a  terrifying  experience.  It 
auses  the  victim  acute  mental  distress  and 
la-  long-term,  disruptive  effects  on  her 
lie  From  the  victim's  viewpoint,  report- 
ng  her  rape  commences  a  long  process 
nvolving  herself,  her  experience,  and  her 
apist;  it  is  exacerbated  by  her  gnawing 
nxiety  that  people  will  not  believe  her. 

The  woman  who  comes  to  the  hospital 
Ticrgency  room  to  establish  the  evidence 
ape  is  doing  a  courageous  thing.  She 
L.'ds  help,  and  deserves  respect. 

In  Calgary,   reported  rape  increased 

between    1973  and   1974,  and  has 

.vn  527%  since  1968.  Canadian  figures 


n  Price,  the  mother  of  daughters  aged  17 

18  years,  is  a  geological  technician.  She  is 

,  inberof  the  Calgary  Raf)e  Crisis  Centre,  an 

ciate  director  of  the  Calgarv  Birth  Control 

-  K'iation.  a  director  of  the  Alberta  Family 

ining  Association,  and  the  Alberta  board 

esentative  on  the  Family  Planning  Federa- 

of  Canada.  She  describes  herself  as  a 

rpetual  night  school  student"  and  is  in  a 

-ram  leading  to  a  B.Sc.  in  geology. 

RIL  1975 


Vern  Price 

show  a  slower,  but  steady  increase.  These 
statistics  reflect  increased  urbanization, 
transient  youth,  changed  attitudes  toward 
sex,  changed  life-styles  for  women,  and 
women's  increased  willingness  to  report 
rape.  An  apparent  change  in  the  nature  of 
rape  —  toward  greater  violence  and  more 
sexual  humiliation  of  victims  —  is  fright- 
ening. 

Fortunately  for  women,  medical  atti- 
tudes to  the  experience  of  rape  seem  to  be 
changing.  We  now  have  the  compassion 
expressed  by  persons  such  as  psychiatric 
nurse  Ann  Burgess  and  sociologist  Lynda 
Holmstrom:  "  "Three  assumptions  underlie 
the  theoretical  framework  of  counseling 
the  rape  victim:  a)  the  rape  represents  a 
situational  crisis  for  the  victim  that  is  dis- 
ruptive of  her  life-style:  b)  the  victim  is 
viewed  as  a  consumer  of  emergency  health 
services  —  medical  and  psychological; 
and  c)  crisis  management  of  the  rape  vic- 
tim is  actually  the  practice  of  primary  pre- 
vention of  psychiatric  disorders."' 

Contrast  the  above  with  a  medico-legal 
presentation  in  1958  by  Dr.  D.F. 
Sutherland,  which  begins  "Sexual  of- 
fences, including  rape,  give  rise  to  an  ex- 
tremely distasteful  situation  for  all  who 
become  involved.  This  distaste  is  shared 
by  the  medical  practitioner  who  is  called 
on  to  collect  and  interpret  the  physical 
evidence."^ 

Emerging  in  North  America  are  two 
compatible  attempts  to  aid  the  rape  victim 
in  her  crisis:  a  comprehensive  treatment 


and  counseling  protocol,  and  follow-up 
system  within  medical  facilities;  and  au- 
tonomous rajje  crisis  services,  providing 
long-term  support,  advocacy,  accompa- 
niment, and  referrals.  A  priority  of  the  sec- 
ond group  is  the  encouragement  of  and 
active  lobbying  for  the  first  type  of  service; 
this  includes  convincing  government  rep- 
resentatives that  funds  should  be  allocated 
for  this  work. 

Though  the  law  apparently  treats  rape 
seriously,  rape  may  now  be  called  "the 
safest  crime.""  Estimates  of  the  rate  of 
reported  rapes  vary  from  1  in  3  to  1  in  20. 
The  generally  accepted  figure  is  1  in  5. 
Police  classify  some  reports  as 
"unfounded,"  that  is,  not  genuine.  In 
others,  there  is  not  sufficient  evidence  for 
trial,  the  suspect  is  never  apprehended  or 
identified,  or  the  charge  is  reduced  to 
attempted  rape  or  indecent  assault.  When 
a  charge  is  laid  and  continues  through  to 
trial  without  the  witnesses  dropping  out, 
the  conviction  rate  varies  from  18% 
(Toronto)  to  42%  (Canada).^  In  Canada, 
few  convicted  rapists  are  given  suspended 
sentences. 

Therefore,  assuming  a  reporting  rate  of 
1  in  5,  an  "unfounded"'  rate  of  20%,  a 
charge  rate  of  30% ,  and  a  conviction  rate 
of  40%,  only  2  rapists  in  100  will  serve 
prison  sentences  for  their  crime.  Clearly, 
tightening  up  the  end  steps  of  this  process 
will  not  greatly  alter  this  ratio.  We  can 
affect  steps  1  and  2  by  encouraging  and 
supporting  women  who  report  rape,  by 
THE  CANADIAN  NURSE     29 


taking  more  of  these  women  seriously  and 
making  every  effort  to  record  their  evi- 
dence, and  by  extending  our  concept  of 
what  constitutes  rape .  If  we  do  this ,  we  can 
make  rape  a  vastly  more  dangerous  crime 
to  commit. 

Rape  crisis  centre 

The  Calgary  Rape  Crisis  Centre  began 
offering  services  a  year  ago.  The  first 
counselors  had  experience  in  peer  counsel- 
ing, crisis  intervention,  and  sexuality  in- 
volvement as  volunteers  with  the  Calgary 
Birth  Control  Association,  a  feminist- 
oriented  service  that  occasionally  saw 
sexually  abused  women. 

Our  first  year  in  the  Rape  Crisis  Centre 
was  a  learning  process.  We  owe  much  to 
the  sheer  guts  of  the  victims  who  allowed 
us  to  share  their  feelings  and  experiences. 
Often  we  didn't  know  answers,  but  we 
tried  faithfully  to  find  out.  By  now,  we 


are  social  work  students.  In  communities 
with  a  law  school;  women  students  may 
become  involved. 

We  have  one  male  volunteer  who  helps 
with  community  education.  He  doesn't 
want  to  counsel  clients,  and  we  would 
probably  require  that  a  male  counselor  be  a 
professional  —  discriminatory,  indeed!  In 
the  past,  we  learned  together,  sharing  re- 
search and  discussing  cases.  Now  that 
there  is  a  new  generation  of  volunteers,  we 
will  begin  training  sessions  in  peer  counsel- 
ing and  data  about  rape.  Anyone  planning 
to  work  with  victims  should  attend  a  trial. 

Principles  of  peer  counseling  are  hon- 
esty, confidentiality,  openness,  and  con- 
cern. The  counselor's  similarity  to  the 
client  in  sex,  age  background,  and  experi- 
ence let  them  share  a  common  data  base. 
The  counselor  has  a  special  store  of  infor- 
mation that  the  client  needs  to  make  deci- 
sions. Outside  of  her  problem  area,  the 


The  victim  perceives  rape  as  an  act  of  violence,  not  as 
a  sexual  act. 


have  a  sizable  body  of  knowledge  and  em- 
pathy to  give  our  clients.  We  are  involved 
primarily  with  victims,  but  we  are  also 
attempting  to  provide  community  educa- 
tion on  prevention:  self-protection  for 
women,  and  changing  attitudes  for  men. 

A  24-hour  answering  service  keeps  a 
duty  roster  of  pairs  of  volunteers.  We  an- 
swer phone  calls  at  any  time,  and  go  to  meet 
with  a  rape  victim  who  is  in  the  crisis 
stage,  in  a  public  place  of  her  choosing.  In 
a  noncrisis  situation,  we  encourage  the 
victim  to  come  to  our  office  to  talk.  One  of 
the  assets  of  a  rape  crisis  center  is  that  it 
can  relegate  to  secondary  importance 
whether  or  not  a  victim  was  "legally" 
raped,  and  treat  any  cry  of  rape  as  a  call  for 
help. 

The  Calgary  Rape  Crisis  Centre  now 
has  about  20  volunteers,  a  full-time  coor- 
dinator who  is  a  former  policewoman,  and 
a  social  work  student  doing  a  practicum. 
Volunteers  need  patience;  there  is  much  to 
learn,  and  there  are  long  waits  between 
clients.  Counselors  need  a  calm,  sym- 
pathetic, nonjudgmental  attitude,  and 
maturity.  Most  of  our  younger  volunteers 
30    THE  CANADIAN  NURSE 


client  is  probably  as  capable  and  loveable 
as  the  counselor,  perhaps  more  so. 

Making  contact  at  the  same  level,  the 
counselor  can  validate  the  client's  feelings 
by  showing  her  that  what  happened  to  her 
matters,  and  that  she  is  worth  taking  seri- 
ously. The  counselor  owes  her  honesty. 
Don't  let  her  kid  herself.  Gently  express 
concern  for  her  in  a  "  what  if '  question .  A 
critical  p)oint  occurs  in  recognizing  when 
the  client  should  be  referred  for  profes- 
sional counseling. 

The  victim's  choices 

A  counselor  must  help  a  victim  under- 
stand her  choices.  Decisions,  such  as 
whether  to  report  her  rape,  must  be  hers 
alone.  She  has  choices:  to  report  formally, 
report  informally  (so  that  police  have  in- 
formation for  their  file  on  sex  offenders), 
or  not  report  at  all.  Vancouver's  Rape  Re- 
lief says,  "We  can  assist  her  decision 
somewhat  by  giving  practical  information 
as  to  what  may  happen  if  she  does,  but  we 
cannot  provide  guarantees  or  promises. 
No  matter  what  she  decides,  remind  her 
that  she  has  your  support  in  her  decision 


and  that  any  decision  she  makes  is  the  righi 
one  for  her." 

Support  may  entail  emotional  support 
accompaniment,  and  advocacy.  We  ma) 
go  with  her  to  court,  police,  and  medica! 
appointments.  Especially  if  she  is  youn§ 
or  has  difficulty  understanding,  she  ma) 
want  us  to  ask  questions  for  her  and  gener- 
ally make  sure  she  is  treated  with  respecl 
and  faimess. 

/  avoided  men  and  neglected  my  appear- 
ance. For  a  long  time  I  was  so  afraid  oj 
appearing  provocative  that  I  changed  c 
lot.  —  This  woman  was  evicted  from  hei 
apartment  when  a  neighbor  claimed  tha 
the  police  arrival  was  a  drug  raid.  She  die 
not  argue  or  regain  her  damage  deposit. 
A  rape  counselor  should  be  able  tc 
spend  several  days  on  each  case,  in  bits  anc 
pieces.  This  is  another  reason  for  a  lean 
approach,  so  that  at  least  one  person  whc 
knows  her  is  available  to  the  victim  at  al 
times.  Psychological  support  includes  lis- 
tening to  her  feelings,  and  may  extend  tc 
other  areas  of  her  life  as  well.  Before  cour 
appearances,  we  make  sure  she  know; 
what  to  expect  and  we  review  her  story 
Because  the  crisis  goes  on  and  on,  client; 
and  counselors  become  friends,  anc 
follow-up  is  high. 

The  ordeal  of  rape 

There  are  3  or  more  stages  of  reaction  tc 
rape:  acute  distress  and  grief;  pseudoad 
justment  and  suppression,  a  troublec 
stage;  and.  finally,  resolution  and  Integra 
tion.  Although  little  research  was  dom 
before  1970,  a  number  of  recent  observa 
tions  support  these  findings. '*'5 

Because  of  the  availability  of  abortion 
and  new  preventive  medication,  preg- 
nancy from  rap)e  is  no  longer  the  terror  thai 
it  was  a  short  time  ago. 

/  could  not  believe  that  he  could  do  thing:, 
like  that  and  let  me  live  to  tell  about  it. 

Women  tell  us  that,  during  rape,  the; 
instinctively  fear  for  their  lives.  The  rapis 
appears  powerful,  irrational,  and  out  o 
control.  Surely  a  sex  act  that  rams 
woman's  tampon  into  the  rear  of  her  vag 
ina  can  be  called  "out  of  control."*  Th 
victim  perceives  rape  as  an  act  of  violence 
not  as  a  sexual  act.  If  her  family  an^ 
friends  focus  on  the  sex.  they  will  nc 
understand  her;  they  will  not  even  be  talk 
ing  the  same  language. 

One  of  her  concerns  will  be  that  the 
will  reject  her  because  she  is  "despoiled. ' 

APRIL  197 


n 


This  happens,  in  varying  degrees.  A  hus- 
band may  always  suspect  that  his  wife 

5  provoked  her  rape.  Young  women  have 
been  ordered  to  leave  home. 

Offences  that  are  classified  as  gross  in- 
decencies, such  as  oral  and  anal  sex.  are 

a  \PRIL  1975 


regarded  much  less  seriously  in  law  than 
rape,  although  at  one  time  they  were 
punished,  even  if  both  parties  consented. 
It  seems  that  anal  intercourse  with  a  male 
is  more  punishable  (14  years  maximum 
sentence)  than  it  is  with  a  female  (5  years). 


Yet.  subjection  to  acts  that  many  victims 
regard  as  perversions  may  be  more  trauma- 
tic than  rape. 

A  victim  we  saw  had  cried  and  choked 
through  a  long  period  of  fellatio,  while 
the  man  controlled  her  by  pulling  her  hair. 
This  man  first  had  vaginal  intercourse, 
then  ejaculated  in  her  mouth  and  hit  her  in 
the  face  when  she  spat  out  the  semen.  We 
saw  a  second  of  his  victims,  and  have 
reason  to  b)elieve  that  his  pattern  contained 
a  deliberate  attempt  to  make  the  victim 
swallow  the  evidence.  Pathologists  have 
speculated  that  "  "serious"  rapists  may 
have  vasectomies,  believing  this  will 
eliminate  the  evidence. 

Medical  care 

/  guess  I  expected  they  would  make  me  feel 
better. 

Rape  counselors  are  concerned  about 
the  medical  treatment  given  to  their 
clients.  We  feel  there  should  be  both  a 
forensic  examination  for  evidence,  and 
treatment  offering  care  and  comfort.  Three 
basic  issues  are:  who  should  provide  a 
sexual  assault  treatment  service,  and  how 
it  should  be  funded;  whether  police  should 
automatically  be  called  in;  and  what  sort  of 
services  should  be  provided. 

At  least  one  hospital  in  each  city  should 
provide  24- hour  special  services  for  sexual 
assault  victims.  A  salaried  doctor  seems 
the  best  answer  to  the  reality  that  giving 
medical  testimony  in  court  is  time- 
consuming  and  causes  a  doctor  in  private 
practice  to  lose  money.  An  alternative 
might  be  to  have  medicare  or  some  other 
plan  reimburse  a  realistic  amount  for  court 
apjjearances. 

Courts  are  more  impressed  by  the  evi- 
dence of  gynecologists,  but  these  men 
often  feel  that  their  time  could  be  used  for 
more  vital  reasons.  In  a  feminist  view,  a 
woman's  physical  integrity  is  a  vital  con- 
cern, and  a  man  who  makes  women  his 
lifework  and  livelihood  should  recognize 
this.  Certainly,  a  rape  victim  is  not  so 
deserving  of  help  as  a  woman  with  cervical 
cancer;  however,  she  is  more  in  need  than 
a  woman  having  a  healthy,  wanted  preg- 
nancy. 

Police  should  not  be  called  in  without 
the  victim's  full  understanding  and  con- 
sent ,  and  a  victim  should  never  be  made  to 
feel  that,  unless  she  reports  her  experi- 
ence, medical  personnel  will  do  nothing 
for  her.  A  hospital  that  puts  great  emphasis 
THE  CANADIAN  NURSE     31 


on  reporting  to  the  police  should  have 
something  in  addition  to  offer  the  victim. 
If  the  sole  medical  emphasis  involves  find- 
ing the  "mark  of  the  rapist'"  on  her  body, 
can  we  wonder  that  a  victim  thinks  of 
herself  as  dirtied  and  despoiled? 

These  are  questions  rape  crisis  workers 
ask  about  emergency  room  care:  ''•^ 
D  Does  a  victim  receive  supportive  coun- 
seling by  a  nurse,  social  worker,  chaplain, 
or  volunteer  specially  trained  to  be  sensi- 
tive and  informative? 
n  Does  she  receive  the  same  quality  of 
care  and  acceptance  that  other  ER  patients 
receive? 

D  Does  she  have  a  long  wait  because  she 
is  a  low  priority  patient?  Does  she  wait 
alone? 

D  The  chances  of  pregnancy  from  rape  are 
similar  to  those  from  other  unprotected 
intercourse;  the  chances  that  the  victim  is 


victim  who  isn't  injured  and  doesn't  want 
to  report?  Is  she  believed,  in  this  case? 
D  Do  staff  make  sure  that  she  knows  what 
to  expect  in  the  pelvic  exam?  Is  she  asked 
if  she  has  ever  had  a  pelvic  before? 
n  Are  victims  referred  to  another  hospi- 
tal? What  transportation  is  used,  and  who 
pays? 

D  Would  ER  nurses  be  willing  to  testify  in 
a  rape  case? 

D  Who  creates  the  attitude  in  the  ER  — 
doctors,  or  nurses? 

lane,  a  Rape  Victim 

Jane  was  what  police  call  a  "good 
rape."  Let's  look  at  her  experience  and  the 
seven  months  it  took  to  complete  the  legal 
processing  of  her  case. 

Jane,  age  22,  moved  to  Calgary  from 
another  province;  she  came  with  her  hus- 
band, who  deserted  her  13  months  before 


Jane  talked  to  the  rapist,  trying  to  get  him  to  hear  her  as 
a  person.  He  told  her  to  shut  up. 


already  pregnant  may  be  slightly  greater." 
Do  ER  staff  members  ask  her  about  men- 
strual cycle  and  birth  control?  Is  the  rape 
victim  asked  if  she  has  previously  taken 
"morning  after"  medication,  before  she  is 
given  it?  Does  she  receive  an  explanation 
of  its  side  effects? 

D  Is  a  follow-up  appointment  for  tests 
made  for  her,  if  she  has  no  doctor? 
D  Is  she  permitted  to  read  the  medical 
report  of  her  examination?  This  will  allow 
her  to  make  a  wiser  decision  about  legal 
process,  and  reassure  her  while  she  awaits 
the  trial. 

D  Is  the  patient  given  an  antiseptic 
douche?  Probably  she  wants  to  douche  and 
shower  more  than  anything  else.  Is  she 
offered  a  chance  to  wash  up?  Safety  pins? 
Mouthwash,  if  she  was  subjected  to  oral 
sex?  Water  or  coffee  to  drink? 
D  Is  it  ascertained  if  she  has  a  place  to  go 
after  she  leaves  the  ER?  Money  to  get 
there? 

D  Though  a  victim  should  not  wash, 
douche,  comb  her  hair,  or  fix  her  clothing 
before  examination,  is  the  er  staff  repelled 
by  her  appearance?  If  she  has  tidied  her- 
self, might  they  think:  "Her  hair  isn't  even 
mussed"? 

n  Does  the  ER  have  anything  to  offer  a 
32     THE  CANADIAN  NURSE 


she  was  raped.  When  her  husband  left  her, 
she  was  depressed;  she  lacked  job  skills  to 
support  herself  and  hertwo  small  children. 
She  received  tranquilizers  and  advice  from 
a  clinic  physician,  and  she  enrolled  in  a 
vocational  school,  which  placed  her  in  an 
office  job  in  a  large  department  store.  She 
left  her  children  with  a  neighbor  while  she 
worked. 

One  Friday  night  at  9:00  P.M.  as  she  left 
the  employee  entrance  of  the  store,  she 
saw  that  she  had  missed  her  bus.  Her 
neighbor  would  be  annoyed.  Jane  stuck 
out  her  thumb.  A  car  with  a  male  driver 
stopped. 

Ai  sne  was  climbing  in,  she  smelled 
liquor,  so  she  told  him  her  destination  was 
a  dozen  blocks  away,  instead  of  further 
out.  She  was  tired.  So  he  wouldn't  make  a 
pass,  she  turned  and  stared  out  her  win- 
dow. The  car  speeded  up  and  she  felt  pres- 
sure at  the  side  of  her  throat;  she  held  very 
still.  He  was  holding  a  knife. 

He  drove  to  an  area  she  didn't  know, 
where  dark  industrial  buildings  seemed  to 
be  under  construction.  The  car  stopped  on 
gravel. 

The  man  told  her  to  take  off  her  clothes , 
and  tied  her  hands  together  with  the  laces 
from  her  shoes.  She  talked,  trying  to  get 


him  to  hear  her  as  a  person.  He  told  her  to 
shut  up. 

She  lay  rigidly  on  the  ground,  and  he 
held  the  knife  blade  across  her  throat.  He 
threatened  to  hurt  her  if  she  didn't  spread 
her  legs.  He  couldn't  come,  and  ordered 
her  to  respond,  using  obscene  language. 
Jane  told  him  she  couldn't  respond  be- 
cause she  was  too  frightened  of  the  knife. 
If  he  would  take  it  away  from  her  throat, 
she  would  cooperate. 

Afterward,  he  drank,  and  let  her  sit  up 
with  her  jacket  around  her  shoulders.  He 
talked  a  great  deal,  sometimes  incoher- 
ently or  abusively.  Jane  heard  only  some 
of  it;  she  was  brooding  about  her  chances 
of  being  let  go.  At  one  point  he  cried,  and 
said  his  wife  had  left  him,  taking  their 
child.  She  told  him  she  understood,  that 
she  was  in  the  same  situation.  He  said  all 
women  were  alike,  that  it  didn't  have  to  be 
her,  any  cunt  would  have  done;  she  merely 
made  it  easy  for  him. 

He  now  made  fun  of  her,  telling  her  he 
had  seen  her  around  and  knew  where  she 
worked.  He  rap)ed  her  again,  then  let  her 
dress.  She  left  her  shoelaces  on  the 
ground. 

They  drove  to  where  she  could  see  the 
lights  of  an  all-night  grocery  store.  The 
man  told  her  he  knew  where  to  find  her  and 
that  he  would  kill  her  if  she  told  the  police. 
He  demanded  "You  liked  it,  didn't  you?" 
Jane  nodded.  He  let  her  out  of  the  car. 

Jane  tried  to  remember  the  car  licence, 
but  could  only  retain  the  last  two  numbers. 
She  tidied  her  clothing  and  combed  her 
hair,  then  walked  to  the  store ,  asked  to  use 
the  bathroom,  and  phoned  her  babysitter 
from  the  pay  phone.  She  apologized,  and 
said  there  has  been  some  trouble,  but  she 
would  come  for  her  kids  as  soon  as  she 
could.  The  neighbor  was  angry,  but  said 
the  children  were  in  bed;  Jane  could  leave 
them  until  morning.  Jane  didn't  have 
much  money  and  thought  the  rapist  might 
be  watching,  so  she  didn't  call  the  police. 
She  took  a  taxi  to  the  closest  hospital.  The 
time  was  after  midnight. 

She  told  the  triage  nurse,  "Please,  can 
you  help?  A  man  just  raped  me . "  This  was 
Jane's  "first  report,"  evidence  that  she 
took  the  first  reasonable  opportunity  to 
report  her  rape;  it  is  an  exception  to  the 
prohibition  against  hearsay  evidence.  The  i 
triage  nurse  will  be  asked  to  testify  to  what 
Jane  said  and  did.  If  the  nurse  had  asked: 
"Were  you  raped?"  and  Jane  said, 
"Yes,"  this  would  not  be  acceptable  evi- 
dence . 

APRIL  1975 


The  nurse  asked  if  she  was  hurt,  and 
asked  her  consent  to  call  the  police.  Jane 
had  always  assumed  that  in  an  emergency 
she  would  get  police  help.  She  waited  for 
the  police  to  arrive ,  alone  in  a  cubicle .  She 
had  never  been  a  crying  woman,  but  she 
started  to  shake.  She  felt  helpless  and  dirt- 
ied; she  blamed  herself  for  hitch-hiking. 
.She  also  felt  angry,  that  it  was  unfair  for 
her  to  have  such  a  terrible  life,  with  no  one 
ii   trust  and  rely  on. 

The  police  were  in  uniform;  they  were 
\oung  and  courteous.  Jane  told  them  her 
story,  and  they  expressed  approval  of  her 
reactions.  They  asked  several  times  if  she 
knew  the  man  previously.  The  nurse  took  a 
brief  history,  asking  the  time  of  Jane's  last 
period  and  her  last  intercourse.  Jane  was 
embarassed  to  reveal  that,  although  she 
v'.as  separated,  she  still  took  the  pill. 

Finally,  a  gynecologist  arrived  to  ex- 
anine  her.  He  appeared  to  be  in  a  bad 
irnH)d  as  he  asked  the  physical  details  of 
the  rape  as  a  guideline  in  looking  for  sub- 
stantiating evidence.  He  became  more 
svmpathetic  as  he  examined  her,  noting 
marks  on  her  wrists  and  a  break  in  the  skin 
of  her  throat,  which  agreed  with  her  story, 
of  a  knife.  Fortunately,  the  knife  could  not 
have  been  very  sharp;  the  mark  was  mostly 
from  pressure. 

There  were  small  contusions  on  her 
back  and  buttocks  from  lying  in  fine 
gravel,  and  there  was  dirt  in  her  vulva. 
There  was  a  red  mark  inside  her  right 
thigh;  her  labia  and  vagina  were  not  in- 
jured. The  doctor  took  a  sample  of  her 
vaginal  fluids  and  cervical  mucus;  he  and 
the  policeman  waiting  outside  identified 
,he  slide.  Jane"s  panties  were  taken  for 
;vidence,  and  her  pubic  hair  was  combed 
or  foreign  material. 

The  doctor  noted  that  Jane  occasionally 
ihook.  Her  emotional  condition  was  not 
Uood  evidence;  the  law  assumes  she  may 
Jake  this.  Jane  was  advised  to  have  a 
iheckup  for  vd  in  6  weeks,  but  didnt. 
^ally,  she  was  given  an  antiseptic 
ouche  and  a  basin  of  water  to  wash  in. 

The  police  took  her  home  at  3:00  A.M. 
Tiey  said  they  would  pick  her  up  again  at 
0:00  A.M.  and  take  her  to  the  station.  Jane 
St  the  alarm  and  went  to  bed;  she  was 
'orrying  about  having  to  tell  her  gossipy 
)abysitter,  because  she  needed  the 
woman's  services,  and  about  having  to 
diss  a  day  from  her  new  job.  Her  super- 
isor  especially  distrusted  employees  who 
nissed  Saturdays.  Under  this,  she  felt  ex- 
lausted,  numb,  and  despairing. 
PRIL  1975 


At  the  police  station  the  next  morning, 
she  met  the  morality  detectives  who  would 
investigate  her  case.  They  were  older,  ex- 
perienced, and  nice.  Again,  she  told  her 
story  and  answered  many  questions  — 
some  seemed  unfairly  personal,  and  she 
didn't  understand  the  reason  for  them.  She 
hesitated;  they  told  her  that  this  rapist 
might  repeat  and  the  next  girl  might  not  be 
so  lucky .  This  was  a  powerful  appeal  be- 
cause of  Jane's  own  fear  for  her  life.  She 


forget,  to  do  better  at  work,  and  pay  more 
attention  to  her  children,  who  were  acting 
neglected. 

The  legal  process 

A  month  passed.  Two  policemen 
brought  a  subpoena  to  Jane's  house,  for 
the  preliminary  hearing  in  Provincial 
Court.  Here,  the  Crown  presents  its  case 
before  a  judge,  who  decides  if  there  is 
sufficient  evidence  to  commit  the  case  to 


She  felt  helpless  and  dirtied;  she  blamed  herself  for 
hitchhiking .  She  also  felt  angry ,  that  it  was  unfair  for 
her  to  have  such  a  terrible  life,  with  no  one  to  rely  on. 


read  a  typed  statement  and  signed  it.  Now 
she  was  committed  to  testify  if  a  charge 
was  laid.  If  this  became  psychologically 
impossible,  she  might  have  to  appear  be- 
fore a  judge  and  ask  his  permission  to 
withdraw. 

Jane's  wrists  and  throat  were  photo- 
graphed. She  looked  at  pictures  of  known 
sex  offenders,  but  didn't  recognize  any. 
The  detectives  drove  her  to  the  industrial 
area,  with  a  dog.  After  a  long  search,  the 
dog  located  the  shoelaces.  A  few  days 
later,  they  drove  her  out  again,  to  see  if  she 
could  find  the  place  after  dark,  but  she 
couldn't. 

There  was  a  suspect  from  her  descrip- 
tion of  the  car  and  license  fragment,  but 
there  was  no  one  at  his  residence.  On 
Monday,  Jane  went  to  work  and  explained 
her  problem,  in  confidence,  to  her  super- 
visor. At  home,  that  night,  she  thought  the 
rapist  might  have  traced  her  from  work  to 
her  home.  She  didn't  go  to  bed  that  night, 
and  dozed,  fully  dressed,  the  next  nights. 

The  rapist  was  arrested,  and  she  picked 
him  out  of  a  lineup,  with  great  anxiety.  He 
was  charged  and  released  until  the  trial. 
Jane  thought  now  that  he  knew  her  name, 
and  she  was  listed  in  the  phone  book.  She 
did  not  want  to  move  from  her  house;  it 
would  be  expensive  and  would  mean  new 
babysitting  arrangements .  She  was  paid  by 
the  hour  and  was  penalized  for  the  time  she 
had  missed  from  work.  She  put  extra  locks 
on  her  doors.  She  imagined  him  talking 
about  her,  sneering.  She  made  an  effort  to 


trial  in  Supreme  Court.  The  defence 
lawyer  has  a  free  hand  in  cross-examining 
the  Crown's  witnesses. 

Jane  expected  this  to  be  a  bad  experi- 
ence .  She  knew  that  the  police  had  investi- 
gated her,  including  questioning  the 
babysitter  about  her  behavior.  If  the  ac- 
cused could  afford  it,  a  private  investigator 
might  have  done  the  same.  She  worried 
that  the  defense  lawyer  would  know  she 
was  pregnant  when  she  got  married,  had 
occasionally  gone  to  cabarets  with  her 
classmates,  and  had  one  brief  sexual  rela- 
tionship with  a  man  she  met  there. 

Her  assailant  was  defended  by  Legal 
Aid  but,  since  rape  trials  are  dramatic, 
newsworthy ,  and  relatively  easy  to  win,  he 
had  a  good  lawyer,  who  spent  about  60 
hours  on  his  case.  The  defendant  was  a 
presentable  man  without  a  criminal  rec- 
ord, so  he  took  the  stand  at  the  trial;  his 
lawyer  spent  several  hours  preparing  him 
for  this.  Jane  had  20  minutes  with  the 
Crown  Prosecutor,  a  notoriously  over- 
worked man. 

The  court  was  almost  filled  with  spec- 
tators; a  traffic  court  session  had  just 
finished.  If  Jane  were  a  juvenile,  or  if  the 
act  had  been  perverse  enough,  the  court 
would  have  been  closed.  Jane  was  glad 
that  this  was  not  her  home  town. 

At  the  hearing,  Jane  was  tense.  One 
person  in  the  courtroom  knew  exactly 
what  happened  —  the  rapist  —  and  he  was 
desperately  trying  to  prove  she  was  lying. 
She  was  on  the  witness  stand  for  almost  4 
THE  CANADIAN  NURSE    33 


hours,  over  a  period  of  2  days.  First,  she 
told  her  story,  and  the  Crown  Prosecutor 
asked  questions  about  areas  she  had  left 
unclear. 

Then  the  defence  lawyer  began  an  ag- 
gressive cross-examination,  probing  ran- 
domly at  her  story,  moving  back  and  forth 
in  time  to  confuse  her,  implying  that  she 
consented  to  the  sex.  Jane"s  memory  did 
funny  things;  some  of  the  time  the  experi- 
ence and  the  fear  that  went  with  it  came 
back  vividly,  sometimes  her  mind  went 
blank  and  she  had  to  say  she  didn't  re- 
member. She  forgot  how  to  pronounce 
vagina.  She  was  not  allowed  to  hear  the 
other  witnesses.  The  case  was  committed 
to  trial. 

Counseling 

Jane  knew  she  was  in  bad  shape.  She  got 
a  friend  to  spend  the  night  with  her,  and 


kept  on.  She  and  the  counselor  had 
checked  that  the  Crown's  evidence  would 
definitely  bear  out  her  story.  She  had  a 
better  understanding  of  what  to  expect  in 
court,  and  realized  that  a  rape  trial  is  not  a 
win-lose  situation.  Here,  nobody  wins, 
and  the  legal  principle  that  even  a  small 
amount  of  doubt  about  what  actually  hap- 
pened must  be  used  to  benefit  the  accused 
prepared  Jane  to  accept  without  humilia- 
tion a  verdict  of  not  guilty.  Her  counselor 
drove  her  to  court. 

The  trial  was  more  formal  and  con- 
trolled. A  judge  presided;  in  other  prov- 
inces, a  jury  is  customary.  There  were  few 
spectators.  Jane  had  a  chance  to  read  her 
previous  testimony  while  she  waited  to  be 
called,  and  she  resolved  to  do  better  this 
time.  On  the  stand,  she  spoke  directly  to 
the  judge,  and  felt  less  shame.  She  ex- 
plained clearly  that  intercourse  had  taken 


At  the  hearing ,  Jane  was  tense .  One  other  person  in  the 
courtroom  knew  what  happened  —  the  rapist  — 
and  he  was  desperately  trying  to  prove  she  was  lying. 


missed  more  time  from  work.  She  wanted 
to  go  home,  but  had  not  felt  close  to  her 
parents  since  her  marriage.  She  sought 
counseling,  and  heard  of  the  newly  formed 
Rape  Crisis  Centre.  Jane  spent  hours  with 
a  counselor  who  was  experienced  in  deal- 
ing with  other  types  of  crises,  but  new  to 
rape  concerns. 

The  counselor  acknowledged  Jane's 
negative  feelings  and  the  reality  of  her 
hurt.  She  asked  searching  questions,  in- 
tended to  bring  out  the  logic  in  Jane's 
actions;  she  reassured  Jane  that  her  sub- 
mission had  been  a  reasonable  act  and  that 
she  had  not  colluded  in  her  rape.  Jane's 
concerns  focused  on:  did  I  do  the  right 
things,  are  my  feelings  normal,  am  I  still  a 
lovable  person,  was  I  a  fool  to  report  it. 
and  why  don't  people  believe  I  am  inno- 
cent? 

The  trial  was  held  5  months  later.  Jane 
felt  much  anxiety,  telling  her  counselor 
she  would  not  testify,  but  eventually  she 
34    THE  CANADIAN  NURSE 


place,  and  the  nature  and  degree  of  force 
that  were  used. 

The  cross-examination  was  more  sys- 
tematic and  less  confusing,  and  it  didn't  go 
on  as  long.  The  lawyer  had  selected  her 
weak  points:  her  previous  sexual  experi- 
ence, and  her  hitchhiking.  Combing  her 
hair  and  drinking  coffee  while  waiting  for 
the  taxi  at  the  comer  grocery  store  were 
not,  in  his  opinion,  the  actions  of  a  rape 
victim.  She  held  up  better,  and  could  re- 
member more. 

She  could  sit  in  the  courtroom  and  hear 
the  rest  of  the  trial.  Like  the  other  wit- 
nesses, she  was  paid  $10  for  each  day  in 
court.  There  were  bad  moments,  when  the 
defendant  was  on  the  stand,  when  her  pan- 
ties were  held  up  before  the  court,  when 
the  defence  summation  painted  her  as  an 
immoral  person.  The  judge  convicted  the 
rapist  and  sentenced  him  to  3  years  for  the 
rape  and  1  year  for  possession  of  a  knife. 

Jane  said  she  was  glad  of  this,  although 


she  didn't  think  it  would  accomplish  any- 
thing. She  might  have  been  sympathetic  to 
her  rapist  if  he  had  admitted  his  act  and  not 
made  her  fight  so  hard  to  prove  it .  She  says 
she  will  move  to  another  city  before  he  is 
released. 

Jane  wishes  she  had  had  supportive 
counseling  sooner;  she  is  willing  to  share 
her  experience  with  other  victims,  both  to 
prepare  them  for  court,  and  to  help  them 
feel  that  ordinary  women  can  be  raped. 
Jane  now  feels  less  like  the  helpless  victim 
of  an  especially  unkind  fate,  and  is  return- 
ing to  her  dream  of  finding  a  man  who  will 
take  care  of  her,  but  she  is  warier  now.  She 
still  has  periods  of  depression. 

Jane  is  a  synthesis  of  four  women, 
whose  experiences  and  immediate  and 
later  reactions  were  similar.  Her  medical 
treatment  has  been  slightly  idealized;  the 
real  Janes  had  more  negative  impressions. 
Also,  if  a  suspect  is  picked  up  im- 
mediately, the  case  moves  faster,  and  the 
woman  may  go  directly  from  hospital  to 
the  police  station,  not  getting  home  until 
morning.  One  source  says  that  most  rapes 
occur  on  Friday  and  Saturday  nights,  be- 
tween 8:00  P.M.  and  2:00  a.m. 

References 

1.  Burgess,  Ann  W.  and  Holmstrom,  Lynda 
Lytle.  The  rape  victim  in  the  emergency 
ward.  Amer.  J.  Nurs.  73:10:1741-5,  Oct. 
1973. 

2.  Sutherland.  D.F.  Medical  evidence  of  rape. 
Canad.  Med.  Ass.  J.  81:407-8.  Sep.  I, 
1959. 

3 .  Brooks ,  Neil .  Presentation  to  ' '  Women  and 
the  Law."  Calgary.  (Unpublished). 

4.  Burgess  and  Holmstrom,  loc.  cit. 

5.  Alleged  rape,  an  invitational  symposium. 7. 
Reproductive  Med.    12:4:133-52,   Apr. 

1974. 

6.  Burgess  and  Holmstrom,  loc.  cit 

7.  Medical  protocol.  Sexual  Assault  Center. 
Harborview  Medical  Center.  325  Ninth 
Ave..  Seattle,  Washington  98104. 

8.  Lipton,  G.L.  and  Roth,  E.L  Rape:  a  com- 
plex management  problem  in  the  pediatric 
emergency  room.  J.  Pediat.  75:859-66. 
Nov.  1969. 

9.  Alleged  rape,  loc.  cit.  '^ 


APRIL  1975 


Report 


CNA  Directors  Meet 
in  Ottawa 

February  20-21,  1975 


In  keeping  with  the  tenor  of  several  resolutions  adopted  by  cna  membership  at  the  annual 
meeting  in  June  1 974,  the  major  thrust  of  the  association's  activities  and  programs  during  this 
biennium  will  be  on  the  evaluation  of  nursing  practice.  As  a  means  of  reaching  this  goal,  the 
association  will  examine  three  separate  but  related  aspects  of  nursing:  education,  practice, 
and  human  resources.  Several  projects  already  initiated  by  CNA  will  serve  as  stepping-stones 
to  the  development  of  standards  in  each  of  these  areas. 

Nicole  Blais 


National  Survey  of  Nurses 

A  proposal  for  the  funding  necessary  to  carry  out  a  cross-Canada 
pnstal  survey  of  nurses  was  submitted  by  CNA  to  the  National 
Health  Research  and  Development  Program  of  Health  and  Wel- 
fare Canada  on  31  January  1975.  The  project  is  designed  to 
provide  national  data  to  assist  in  making  decisions  concerning 
the  development  of  standards  for  preparation,  continuing  com- 
petence to  practice,  responsibilities,  legal  protection,  and  re- 
muneration for  the  nurse.  Specific  objectives  are  to  describe 
socio-demographic  characteristics  of  nurses  in  expanded  roles, 
including  age,  sex.  education,  experience,  geographic  distribu- 
tion, practice  setting,  position  title,  activities,  remuneration, 
and  legal  protection. 

National  Standards  for  Nursing  Education 

This  project  is  designed  to  yield  national  staiidards  for  nursing 
education.  Although  educational  jurisdiction  prevents  mandat- 
ory implementation  of  such  standards  on  a  national  basis,  it  is 
hoped  to  provide  guidance  to  provincial  jurisdictions  in  the 
improvement  and  coordination  of  educational  programs  for 
nurses.  The  project  will  be  the  responsibility  of  an  ad  hoc 
committee  on  standards  for  nursing  education,  which  has  held 
one  meeting  to  date. 

National  Health  Education  Program 

This  project  is  designed  to  prepare  nurses  for  multi-risk  counsel- 
ing through  increased  personal  awareness  and  sensitivity  to 
lisks  in  their  own  life-style  and  to  provide  nurses  with  ways  of 


Nicole  Blais  is  with  the  CNA  Information  Services,  Ottawa. 
APRIL  1975 


reducing  these  risks.  It  is  intended  specifically  to  increase 
nurses'  knowledge  concerning  education  for  health,  including 
regional  resource  persons  and  facilities,  and  to  provide  nurses 
with  simple  testing  devices  (teaching  kits  and  aids)  to  determine 
and  improve  levels  of  health. 

As  part  of  the  program,  a  model  seminar  will  be  developed, 
implemented,  and  evaluated.  Seminar  content  is  being  designed 
in  collaboration  with  practicing  nurses,  a  nutritionist,  and  a 
physical  fitness  expert,  as  well  as  an  expert  in  substance  abuse. 
The  target  population  consists  of  nurses  in  face-to-face  contact 
with  clients  in  health  settings,  i.e..  occupational  health,  school 
health,  and  hospital  health  services.  CNA  will  apply  for  federal 
funding  for  the  project. 

People  in  Nursing 

In  any  consideration  of  supply  and  demand  in  nursing  man- 
power, it  is  necessary  to  take  into  account  the  human  resources 
that  are  invested  in  nursing  practice  as  well  as  their  social  and 
economic  well-being.  Recognizing  its  responsibility,  the  CNA  in 
this  biennium  will  participate  in  the  planning  and  development 
of  a  national  nursing  manpower  study  being  launched  by  the 
federal  government.  In  addition,  the  association  plans  to  use 
data  collected  by  means  of  the  National  Survey  of  Nurses  to 
study  other  aspects  of  working  conditions. 

Association  Funding:  Deficit  Budget  in  1975 

Current  inflationary  trends  and  new  demands  for  association 
services  have  pushed  CNA  expenditures  to  an  expected 
$1,492,000  in  1975.  Spending  for  the  current  year  will  surpass 
income  by  $120,000.  To  realize  the  objectives  of  the  1974-76 
biennium,  the  association  will  be  forced  to  dig  deeper  into  its 
reserves  and  to  seek  additional  funding  from  outside  sources, 

(continued  on  page  38) 
THE  CANADIAN  NURSE     35 


Expanded  Respans$hilUie§ 


A  GUIDE  TO  PHYSICAL 
EXAMINATION 

Edited  by  Barbara  Bates,  M.D.,  Professor  of  Medicine, 
University  of  Rochester,  School  of  l\1edicine  and  Dentistry; 
with  a  section  on  Pediatric  Examination  by  Robert  A. 
Hoekelman,  M.D.,  assistant  Professor  of  Pediatrics. 

Designed  for  beginning  practitioners  of  physical 
diagnosis,  including  students,  nurse  practitioners  and 
members  of  other  health  professions,  this  new  book 
Is  a  comprehensive  text,  profusely  and  expertly  illus- 
trated, on  how  to  examine  patients.  It  bridges  the  gap 
between  the  sciences  anatomy  and  physiology  and 
their  application  to  physical  examination.  Within  each 
region  or  system  of  ,the  body,  the  Guide  deals  with 
three  essential  topics:  (1)  the  anatomy  and  physi- 
ology necessary  to  understand  the  examination,  (2) 
the  techniques  of  examination,  and  (3)  examples  of 
selected  abnormalities.  The  selected  abnormalities 
are  presented  both  in  parallel  to  the  techniques  and 
In  tabular  form  at  the  end  of  each  region  or  system. 
This  book  is  a  cornerstone  for  any  teaching  program 
in  primary  health  care. 


Lippincott  1974, 
375  Pages,  illustrated 


$18.75 


A  series  of  12  sound  motion  pictures  in  color  with 
physical  examination  procedures  correlated  with  the 
content  of  Dr.  Bates'   book,  A  Guide  to   Physical 
Examination.  (Films  may  be  used  to  supplement  any  I 
text  on  the  physical  examination). 


Average  running  time:  10  minutes. 


PLEASE  RUSH 

n  A  Guide  to  Physical  Examination     Bates      $18.75 

□  Information  about  Ptiysical  Examination  Films 

□  Physical  Appraisal  Methods  in  Nursing  Practice  Sana  and  Judge  paper  about  $  8.95 
n  Physical  Appraisal  Methods  in  Nursing  Practice  Sana  and  Judge  cloth  about  $14.50 
D  Methods  of  Clinical  Examination     Judge     paper     $11.50 

n  Methods  of  Clinical  Examination     Judge     cloth     $17.50 


Namo_ 


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CN-4-75 


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Patient  Assessment 


ij  PHYSICAL  APPRAISAL 
ji  METHODS  IN  NURSING 
I  PRACTICE 


Josephine  Sana,  R.N.,  M.A.  Professor,  School  of 
Nursing,  University  of  Michigan,  Ann  Arbor,  Michigan 

Richard  Judge,  M.D.  Professor,  School  of  Medicine 
University  of  Michigan,  Ann  Arbor,  Michigan 

18  contributors,  under  the  direction  of  Professor 
Sana  and  Dr.  Judge  have  prepared  a  comprehensive 
survey  of  all  aspects  of  physical  examination  and 
appraisal.  A  first  group  of  4  chapters  deals  with  the 
"expanded  nurse  role"  and  the  "nursing  process," 
providing  a  context  for  the  clinical  portions  of  the 
book,  and  the  basic,  practical  skills  such  as  the  use 
of  the  Problem-Oriented  Medical  Record.  The  core  of 
tho  text  discusses  each  of  the  body  systems  in  turn, 
giving  step-by-step  instructions  on  how  to  conduct 
the  exam  and  sufficient  diagnostic  information  to 
indicate  when  and  what  further  inspection  is  called 
for.  Each  of  the  chapters  in  this  section  opens  with  a 


glossary  defining  all  of  the  technical  terminology 
used,  and  vivid  impressionistic  descriptions  supple- 
ment the  extensive  illustrations  to  provide  the  nurse 
with  a  permanent  reference.  The  bibliography  at  the 
end  of  each  chapter  gives  sources  of  further  infor- 
mation about  specific  points,  especially  where  au- 
thorities differ  on  procedural  questions. 
The  third  section  of  this  text  presents  special  age 
group  considerations  in  physical  appraisal,  with 
chapters  devoted  to  the  newborn;  infants,  children, 
and  adolescents;  and  the  elderly. 


Little,  Brown  and  Company,  April  1975. 

416  pp.,  paperback  about  $8.95,  cloth  about  $14.50 


METHODS  (^^TION: 


,1        TW«B*"°" 

i     By  19*""*^ 


METHODS  OF  CLINICAL  EXAMINATION: 
A  Physiologic  Approach.  Third  Edition. 

By  19  Authors.  Edited  by  Richard  D.  Judge,  M.D.,  Clinical  Professor 
of  Postgraduate  Medicine,  University  of  Michigan  Medical  School, 
Ann  Arbor;  George  D.  Zuidema,  M.D.,  Professor  and  Director,  Depart- 
ment of  Surgery,  The  Johns  Hopkins  University  School  of  Medicine, 
Baltimore 

Extensively  revised  and  updated  to  include  new  diagnostic  tech- 
niques such  as  the  problem-oriented  approach  to  medical  history- 
taking.  N^ETHODS  OF  CLINICAL  EXAIVIINATION  helps  the  student  to 
develop  early  experience  in  the  differentiation  of  normality  and  ab- 
normality over  a  broad  diagnostic  range,  and  to  correlate  preliminary 
diagnostic  findings  with  special  techniques  for  the  further  evaluation 
of  any  physiologic  system. 

Many  of  the  innovative  features  of  the  two  previous  editions  have 
been  retained,  including  overall  organization  by  physiologic  system 
rather  than  by  anatomic  region,  emphasis  on  bedside  learning,  and 
illustrations  that  show  in  full  detail  the  various  techniques  of  physical 
examination.  A  new  chapter  on  the  problem-oriented  medical  system 
is  also  included. 

This  text  correlates  easily  with  the  traditional  organization  of  material 
in  medicine  and  surgery  and  yet  is  highly  adaptable  to  a  wide  variety 
of  programs.  Students  will  find  this  approach  to  physical  diagnosis 
both  refreshing  and  extremely  practical. 

Little,  Brown  and  Company  1974 

439  pages,  illustrated  paper  $11.50,  cloth  $17.50 


Lippincott 

J.  a.  LIPPINCOTT  COMPANY  OF  CANADA  LIMITED 

SERVING  THE  HEALTH  PROFESSIONS  IN  CANADA  SINCE  1897 
75  HORNER  AVE.,  TORONTO,  ONTARIO  M8Z  4X7      (416)  252-5277 


(continued  from  page  35) 

such  as  national  health  grants.  Under  existing  arrangements, 
close  to  70%  of  CNA  revenue  is  derived  from  membership  fees. 
The  fee  structure  formula  approved  by  the  CNA  board  of 
directors  at  the  October  1974  meeting,  was  circulated  to  provin- 
cial associations.  (See  7"/ieCana<^ianA'Mri'e,  December,  1974.) 
All  provinces  have  indicated  they  will  support  adoption  of  this 
formula  at  the  annual  meeting  in  April.  Directors  also  approved 
a  motion  that  the  unit  fee  remain  at  $10. 


New  Developments  in  Nursing  Researcl 


In  an  effort  to  provide  cna  with  the  information  it  needs  when  it 
is  needed,  members  of  the  Special  Committee  on  Nursing  Re- 
search at  their  last  meeting  concentrated  on  specific  issues 
requiring  immediate  action.  As  a  result,  the  Committee  pre- 
sented directors  with  three  recommendations: 

1.  Guidelines  for  preparation  of  research  contracts: 
Suggestions  for  drafting  research  contracts  were  presented. 
Directors  accepted  these  guidelines  and  requested  that  they  be 
made  available  to  provincial  nurses'  associations. 

2.  Evaluation  of  nursing  practice :  On  the  recommendation  of 
the  Committee,  the  board  of  directors  approved  a  "Statement  of 
Beliefs  on  the  Evaluation  of  Nursing  Practice."  Two  steps  to 
implement  the  statement  were  also  approved: 

(a)  that  CNA,  in  collaboration  with  other  professional  associa- 
tions, sponsor  a  conference  to  determine  what  research  needs 
to  be  undertaken  to  develop  and  test  health  status  indicators 
(social,  psychological,  and  physical)  and  to  attempt  to  en- 
courage a  group  of  research  projects  on  this  subject; 

(b)  that  CNA  convene  a  workship  of  nurse  researchers  to 
produce  new  information  and  a  plan  of  research  to  develop 
and  test  criterion  measures  of  outcomes  of  nursing  interven- 
tion. 

3.  Patients'  rights:  Nurses  can  make  a  significant  contribution 
to  the  protection  of  patients'  rights,  according  to  members  of  the 
Nursing  Research  Committee,  and  it  is  up  to  the  CNA  board  of 
directors  to  assume  leadership  in  this  area.  Since  the  task  of 
developing  guidelines  goes  beyond  any  one  health  profession, 
consumer,  or  social  policy  group,  the  Committee  recommends 
collaborative  action  with  other  representatives  of  the  health 
industry  and  consumers  on  a  national  level. 


Comprehensive  Exam  Program 


CNA  Testing  Service  received  authorization  from  the  CNA  board 
of  directors  in  June  1974  to  embark  on  a  program  to  develop  a 
comprehensive  exam  intended  to  replace  the  five  clinical  exams 
now  in  use.  Target  date  for  completion  of  the  project  is  1978. 
A  task  force,  which  has  been  studying  requirements  for  the 
new  exam  to  be  developed  simultaneously  in  both  French  and 
English,  has  identified  a  number  of  new  demands  the  program 
will  make  on  the  Testing  Service.  These  involve  additional  staff 
and  office  space.  As  a  result,  it  is  becoming  increasingly  clear 
38    THE  CANADIAN  NURSE 


that  the  Testing  Service  budget  originally  presented  will  not  be 
adequate.  CNA  directors  therefore  approved  a  budget  deficit  of 
$  104,000  to  permit  the  program  to  go  ahead.  At  the  same  time, 
they  requested  the  Testing  Service  to  investigate  supplementary 
funding  from  outside  sources. 

CNA  directors  also  asked  that  the  Testing  Service  reconsider 
the  dates  of  the  exams,  since  some  provinces  find  the  present 
schedule  awkward. 

CNA  Representatives 
Nurses  named  to  committees  and  other  agencies  include: 

Canadian  Mental  Health  Association  Scientific  Planning 
Council 

•  Helen  Gemeroy,  Assistant  Professor  and  Assistant  Director 
of  Nursing,  Health  Sciences  Centre  Hospital,  University  of 
British  Columbia. 

Canadian  Council  on  Smoking  and  Health 

•  Jane  E.  Henderson,  Associate  Executive  Director,  cna. 

•  Greer  Black,  President,  Manitoba  Association  of  Registered 
Nurses. 

Canadian  Council  on  Hospital  Accreditation 

•  Helen  Taylor,  First  Vice-President,  CNA. 

Health  League  of  Canada 

•  Helen  K.  Mussallem,  Executive  Director,  CNA. 

•  Isabel  Black,  Vice-President  of  the  Nursing  Advisory  Com- 
mittee, Canadian  Red  Cross  Society. 

Joint  Committee  on  Extension  Course  Nursing  Unit 
Administration 

•  Fernande  Harrison,  CNA  Member-at-large,  Nursing  Ad- 
ministration. 

•  Lorine  Besel,  CNA  Member-at-large,  Nursing  Practice. 

•  Roberta  Coutts,  Head  Nurse,  Royal  Victoria  Hospital, 
Montreal. 

•  Denise  Lalancette,  Centre  hospitaller  universitaire  de  Sher- 
brooke,  Sherbrooke,  Quebec. 

Working  Party  on  School  Health  Education,  Health  and  Wel- 
fare Canada. 

•  Doreen  Wallace,  Assistant  Professor,  Faculty  of  Education, 
University  of  New  Brunswick. 

Working  Party  on  Venereal  Disease  Control,  Health  and  Wel- 
fare Canada. 

•  Trudi  Ruiterman,  Division  of  Venereal  Disease  Control, 
Dept.  of  Health  Services  and  Hospital  Insurance,  Van- 
couver. 

Task  Force  on  Mental  Health  Units,  Health  and  Welfare 
Canada . 

•  Beverlee  Ann  Cox,  Professor,  School  of  Nursing,  University 
of  British  Columbia. 

CNA  Special  Committee  on  the  Testing  Service 

•  Thurley  Duck,  First  Vice-President,  Registered  Nurses'  As- 
sociation of  British  Columbia. 

APRIL  1975 


N 


Changing  staff  behavior 


A 


Staff  who  are  nursing  patients  in 
a  rehabilitation  unit  require  skills 
different  from  those  needed  in 
caring  for  acutely  ill  patients. The 
author  describes  how  one  group 
of  hospital  workers  were  taught 
to  develop  these  skills. 

,       Maria  K.  Eriksen       _ 


U 


Most  nurses  have  been  educated  to  re- 
spond to  physical  signs  and  symptoms  that 
pertain  to  an  underlying  pathology  which, 
with  treatment,  will  disappear.  Such  a 
premise  is  not  relevant  to  a  rehabilitation 
setting.  Instead,  therapy  must  help  the  pa- 
tient to  adapt  and  to  live  as  effectively  as 
possible  with  his  disabilities.  Nursing  per- 
sonnel, who  have  been  educated  to  re- 
spond in  ways  appropriate  to  the  acutely 
ill,  have  difficulty  learning  the  skills  ap- 
opriate  for  the  care  of  long-term  pa- 
ients. 

oject  begins 

Registered  nurses,  certified  nursing  as- 
sistants, and  orderlies  at  the  Calgary  Gen- 
eral Hospital  volunteered  to  participate  in 
an  educational  program  on  operant  condi- 
tioning techniques.  Their  participation,  in 
turn,  permitted  them  to  be  involved  in  a 
research  project  comparing  operant  condi- 
tioning techniques  to  the  more  typical 
lursing  skills. 

All  volunteers  were  removed  from  the 
unit  for  three  days  so  they  would  not  have 


to  attend  to  patients.  They  were  examined 
on  operant  conditioning  techniques  before 
and  after  the  course  to  determine  the  effec- 
tiveness of  instruction.  On  the  t-test  fol- 
lowing the  course,  the  level  of  significance 
was  0.001,  indicating  that  much  learning 
had  occurred. 

The  success  of  the  teaching  was  proba- 
bly due,  at  least  in  part,  to  the  fact  that  it 
was  taught  according  to  the  principles  of 
operant  conditioning.  The  objective  was 
that  each  student  would  become  a  be- 
havioral engineer,  the  prerequisites  of 
which  are  to  define  the  problem,  analyze  it 
into  its  components,  design  a  program  to 
deal  with  the  problem,  assess  the  effec- 
tiveness of  the  program,  then  carry  on  with 
the  program  or  change  it. 

If  the  student  passively  hears  a  lecture 
on  each  of  these  aspects,  not  much  is 
learned.  If  anything  is  learned,  it  is  that  the 
instructor  says  one  thing  and  does  another. 
In  such  a  situation  it  is  always  the  behavior 
that  is  attended  to! 

Basics  are  boring 

In  this  workshop,  lectures  were  kept 
short  and  students  were  kept  involved.  On 
the  first  day,  definitions,  principles,  and 
behavioral  laws  of  operant  conditioning 
were  discussed. 

The  basics  are  always  boring!  So  we 
made  a  game  out  of  it,  similar  to  the  spel- 
ling bees  of  elementary  school.  Although 
such  a  technique  may  seem  too  childlike,  it 


works.  Everyone,  regardless  of  age,  likes 
to  win  prizes.  Students  were  on  their  feet 
shouting  out  definitions,  and  they  actively 
learned  the  principle  of  positive  rein- 
forcement. 

This  method  makes  it  easy  for  the  in- 
structor to  reinforce  the  learning  and  to 
pick  out  problem  areas.  Another  positive 
aspect  is  that  learning  becomes  active  and 
fun,  making  it  easier  to  maintain  an  atten- 
tion span. 

The  second  session  was  spent  defining 
and  stating  the  problem,  then  gathering  the 
base-line  data.  To  define  target  behaviors 
sounds  simple.  However,  this  is  more  dif- 
ficult than  it  first  appears,  especially  in 
rehabilitation  nursing. 

A  student  may  define  a  target  behavior 
as  "the  patient  is  depressed";  but  when 
she  must  gather  base-line  data,  she  quickly 
finds  that  this  definition  is  poor.  Ter- 
minology that  is  not  specific  means  many 
things  to  many  people.  The  target  behavior 
must  be  stated  so  it  is  clear  to  all  staff  and 
must  be  defined  in  behaviorisms  that  can 
be  seen  and  counted. 

This  concept  was  taught  by  means  of  a 
film  portraying  an  older  woman  in  hospi- 
tal. During  the  first  screening,  the  students 
were  asked  to  determine  a  behavior  that 
could  be  modified.  Two  behaviors  were 
then  selected,  and  the  class  was  broken 
into  two  groups.  The  film  was  shown 
again  while  the  students  counted  the  as- 
signed behaviors.  This  is  a  quick  way  to 
THE  CANADIAN  NURSE     39 


illustrate  the  need  for  specific  definitions; 
unless  the  definitions  are  specific,  each 
person  in  a  group  sees  the  behavior  differ- 
ently. 

The  film  also  showed  that  behaviors 
cannot  be  recorded  continuously  in  a  hos- 
pital setting.  No  patient  in  a  rehabilitation 
unit  has  a  private  nurse!  Duration  record- 
ing, interval  recording,  and  time  sampling 
are  other  legitimate  and  more  feasible 
ways  of  counting  behaviors. 

Behavioral  objectives 

The  next  concept  to  be  taught  wasjhat 
of  determining  behavioral  objectives  that 
essentially  involve  "when,  where,  land 
how  much."  Again,  the  students  wepe  as- 
signed to  groups  to  work  on  the  task/  They 
learned  that  it  is  insufficient  to  say  that  the 
behavioral  objective  for  Mr.  Sam  is  to 
learn  to  transfer  from  bed  to  wheelchair. 
None  of  the  "when,  where,  or  how  often" 
questions  have  been  answered.  A  transfer 
involves  many  behaviors,  and  it  is  the 
specific  behaviors  that  should  be  desig- 
nated, as  well  as  determining  if  he  is  to  do 
it  only  in  the  morning,  when  getting  up  for 
each  meal,  or  every  time  he  gets  out  of 
bed. 

Behaviors  broken  into  small  compo- 
nents are  especially  therapeutic  for  the  pa- 
tient. Following  abdominal  surgery,  the 
patient  is  usually  told  by  the  therapist  that 
he  will  do  well  to  walk  from  bed  to  bath- 
room. This  is  a  well-defined  behavior 
which,  on  completion,  makes  the  patient 
feel  "reinforced."  Unfortunately,  we  do 
not  generally  use  the  same  small  steps  with 
long-term  patients. 

Breaking  behaviors  into  small  compo- 
nents is  as  important  for  staff  as  patients. 
Patients  attain  a  goal  and  this,  in  turn,  is 
reinforcement  for  the  staff. 

An  important  session  of  the  workshop 
was  spent  on  graphs.  We  must  never  as- 
sume that  all  staff  members  know  how  to 
draw  graphs!  In  a  treatment  program  as 
explained,  graphs  are  indispensible  to  staff 
40     THE  CANADIAN  NURSE 


and  to  patients.  Nothing  is  more  depres- 
sing than  no  feedback.  In  fact,  this  is  more 
depressing  than  negative  feedback. 

Patients  must  have  charts  at  their  bed- 
side on  which  daily  progress  can  be  re- 
corded. Throughout  the  workshop,  stu- 
dents were  encouraged  to  count  and  chart  a 
behavior  of  their  own  choosing,  again 
reinforcing  the  concept  that  one  can  learn 
only  by  doing. 

Reinforcers 

Much  time  was  spent  on  the  modifica- 
tion treatment  plan,  because,  as  behavioral 
engineers,  staff  members  are  especially 
interested  in  rehabilitating  the  patient  to 
the  point  where  he  can  be  discharged  from 
hospital.  We  discussed  varieties  of  rein- 
forcers,  placing  emphasis  on  social  rein- 
forcement. This  is  the  main  reinforcerthat 
staff  have  available  to  them,  and  the  one 
most  difficult  to  use  in  ways  that  are  effec- 
tive for  rehabilitation. 

Because  of  their  previous  education, 
staff  members  are  conditioned  to  respond 
to  illness  behaviors  (moaning,  grimacing, 
complaints  of  pain,  fatigue,  and  so  on). 
For  rehabilitation,  we  advocate  that  the 
social  reinforcement  be  applied  to  non- 
illness  behaviors. 

As  an  example,  a  patient  with  parkin- 
sonism had  deteriorated  to  the  point  where 
he  was  unable  to  feed  himself,  and  it  took 
one  hour  for  a  staff  member  to  feed  him.  A 
contract  was  established  with  the  patient: 
for  every  minute  under  an  hour  it  took  him 
to  eat,  he  could  spend  one  minute  playing 
cards  with  a  staff  member.  Very  quickly, 
he  completed  meals  in  the  ordinary  length 
of  time. 

A  second  contract  was  drawn  up 
whereby  he  bought  more  time  for  card 
playing  by  eating  unassisted.  Within  one 
week,  this  patient  was  on  his  own  at  meal- 
time and  enjoying  himself  enormously 
with  the  card  playing. 

The  problem  is  that  staff  members  typi- 
cally do  not  appreciate  the  value  to  the 


patient  of  their  contact,  and  inadvertently 
encourage  illness  behaviors  rather  than 
well  behaviors.  Staff  often  find  it  difficult 
to  attain  their  own  reinforcement  from  in- 
dependent patient  behavior.  They  must 
learn  that,  on  a  rehabilitation  unit,  inde- 
pendent behavior  is  more  appropriate  than 
the  dependent  behavior  of  the  acutely  ill 
patient. 

Perhaps  the  most  difficult  part  of  the 
workshop  was  dealing  with  unacceptable 
behavior  primarily  by  withholding  social 
attention.  Even  though  the  students  could 
understand  that  they  were  reinforcing  such 
behavior  by  attending  to  it,  they  found  it 
exceedingly  difficult  to  ignore.  They  in- 
troduced real  issues,  such  as  "one  cannot 
ignore  a  call  bell,"  or  a  patient  calling 
"nurse,  nurse,"  or  hospital  equipment 
being  tossed  onto  the  floor. 

Essentially,  what  seemed  to  be  coming 
from  the  students  was  their  own  feeling  of 
frustration:  they  realized  that  "to  attend" 
was  reinforcing  inappropriate  behavior, 
but  they  were  reluctant  to  change.  It 
seemed  a  positive  experience  for  staff  to  be 
able  to  exchange  their  own  feelings,  rather 
than  focusing  these  feelings  negatively  on 
patients.  Following  this,  compromises 
could  be  worked  out. 

For  the  patient  who  is  continually  on  the 
call  bell,  a  staff  member  can  check  his 
need  without  allowing  eye  contact.  Most 
important  is  the  need  for  staff  to  spend 
time  with  a  patient  when  he  is  involved  in 
an  appropriate  behavior.  This,  too,  is  dif- 
ficult as  staff  members  feel  they  are  so 
busy  "doing  what  must  be  done"  that 
there  is  no  time  left  to  spend  with  patients 
who  are  behaving  appropriately. 

And  here  we  have  gone  full  circle.  To 
spend  time  with  a  patient  exhibiting  illness 
behavior  is  to  impede  rehabilitation.      '-^ 


APRIL  1975 


How  children  see  the  nurse 


A  child's  concept  of  nursing  changes  from  year  to  year,  yet  is  stereotyped.  The 
author  came  to  this  conclusion  through  interviews  with  elementary  school 
students  in  grades  one  to  five. 


Catherine  Turcotte 


idren   in  grades  one  to  five  at  the 

_hview      elementary      school      in 

'ciiibroke.    Ontario,    were    asked    ques- 

ii>ns  relating  to  nursing  and  to  their  own 

\periences  with  nurses.  From  their  an- 

rs,  I  have  tried  to  evaluate  the  feelings 

h.e  younger  generation  toward  nursing 

'day. 

)me  of  the  questions  I  asked  them  in 

interviews  were: 
Z  What  do  you  think  a  nurse  is? 
:  What  is  her  job  and  some  of  the  duties 
ilated  to  it? 

I  Have  you  ever  met  or  known  a  nurse? 
I  What  are  some  of  the  qualities  that  a 
lurse  should  have? 

I  What  do  you  think  a  bad  nurse  is? 
I  What  would  you  wish  a  nurse  could  do. 
ml  doesn't? 

>ade  1 
The  students  in  grade  one  were  rather 
and.  perhaps,  even  a  little  afraid  of 
nc.  so  I  found  it  difficult  to  obtain  much 
■  irmation. 

A  hat  I  did  find  out  was  that  nurses  are 

women  who  wear  white  uniforms  and 

;iy  hats.  They  are  nice,  like  mothers, 

uuse  they  help  people  who  are  sick. 

lie  of  the  jobs  nurses  do  are:  take 

pie's  tonsils  out.  check  in  on  sick  peo- 

bring  men  out  on  beds  with  rollers, 

J  give  big  needles. 

From  this  we  see  that  children,  even  at 


lerine  Turcotte  is  a  first-year  student  in  the 
ing  program.  Algonguin  College,  Lorrain 
tre.    Pembroke,    Ontario.    This    article    is 
:ited  from  a  term  paper. 
^I'RIL  1975 


this  early  age,  have  the  nurse's  image  im- 
printed on  their  minds.  For  instance,  they 
are  "women."  (Note  that  they  have  never 
heard  of  male  nurses.  Would  this  be  be- 
cause our  society  has  stereotyped  all  of 
us?)  Even  the  uniforms  and  caps  of  the 
nursing  profession  have  a  strong  signifi- 
cance as  to  what,  and  who,  nurses  are  in 
the  health  care  system. 

I  was  disappointed  to  hear  the  children' s 
narrow  and  dim  outlook  on  nursing  jobs, 
such  as  "taking  people's  tonsils  out."  The 
children  said  this  with  a  tone  of  disgust, 
and  I  feel  it  could  be  caused  by  their  par- 
ents, brothers,  and  sisters  scaring  them, 
jokingly,  at  the  expense  of  the  nursing 
profession. 

Grade  2 

Grade  two  had  a  livelier  group  of  stu- 
dents, who  also  had  a  more  knowledgeable 
and  mature  attitude  toward  nursing. 

To  them,  nurses  are  once  again 
"women,"  and  nice  people.  Some  of  their 
jobs  consist  of  taking  and  giving  things  to 
the  doctor,  giving  food  to  people,  helping 
in  op)erations,  giving  medicines  and  nee- 
dles, and  making  people  feel  better.  Ac- 
cording to  these  children,  nurses  have  to 
be  nice,  smart,  happy,  and  well  educated, 
having  at  least  grade  twelve. 

A  bad  nurse  is  one  who  does  not  treat 
people  the  way  they  should  be  treated, 
who  does  not  help  old  people  walk  in  the 
halls,  who  is  mean  and  leaves  all  the  jobs 
for  the  doctor  to  do. 

These  young  boys  and  girls  already  are 
aware  of  the  physical  aspects  of  a  nursing 
job,  such  as  helping  people  walk.  Such 
clinical  abilities  as  dispensing  medications 


and  assisting  in  operations  have  also  made 
a  significant  impression  on  young  minds. 
What  I  find  most  striking  are  the 
children's  perceived  ideas  that  a  nurse 
must  have  a  bright,  pleasing,  personality, 
serve  the  mental  needs  of  the  patient,  and 
fully  carry  out  the  responsibility  of  her 
profession  with  her  co-workers  and  pa- 
tients. 

Grade  3 

Grade  three  students  were,  once  again, 
more  mature  in  their  ideas  than  those  in 
grade  two.  They  have  come  to  realize  the 
need  for  medical  and  surgical  asepsis,  and 
their  ideas  of  sickness  due  to  accidents 
have  broadened. 

To  these  children,  a  nurse  is  someone 
who  makes  broken  legs  better,  "fixes" 
deep  cuts,  and  tells  how  things  happen  in 
cuts  and  disease.  The  nurse  also  takes 
temperatures.  Whenever  they  think  of  a 
nurse,  they  visualize  a  white  uniform, 
scissors,  face  mask,  white  shoes, 
and  a  nurse's  kit.  The  nurse  should  have 
at  least  a  college  education. 

To  them,  a  bad  nurse  is  one  who  doesn't 
listen  to  you.  cuts  off  your  toe  instead  of 
your  finger,  gives  dirty  needles,  and  gives 
you  the  wrong  medicine  for  a  disease. 

These  young  people  finally  know  the 
meaning  and  reality  of  death,  because  their 
one  wish  is  that  nurses  could  bring  back 
the  dead. 

Grade  4 

The  grade  four  students  emphasized  that 
a  nurse  must  have  a  bright  and  happy  per- 
sonality, with  intelligence  behind  it.  They 
also  mentioned,  in  their  own  way,  that  a 

THE  CANADIAN  NURSE     41 


Nurses  have  to  sleep  a  lot  " 


nurse  has  to  be  sympathetic  to  a  patient's 
physical  and  mental  needs.  The  mechani- 
cal and  clinical  abilities  were  extended  to 
include  the  operating  room.  Most  of  all, 
these  children  now  understand  and  include 
the  need  for  proper  nutrition,  in  both  food 
and  drink,  to  enable  a  patient  to  get  well. 

When  interviewed,  these  students  said 
that  most  nurses  are  nice,  smart,  funny, 
happy,  and  never  angry.  They  help 
straighten  broken  limbs  and  exercise  the 
broken  limbs  so  they  will  become  strong. 
Nurses  help  doctors  in  the  operating  room 
by  handing  them  the  tools.  On  wards,  the 
nurse  brings  meals  and  liquids  to  patients 
and  makes  sure  they  do  not  throw  any  of 
them  away.  The  nurse  gives  baths  to  pa- 
tients who  are  not  able  to  get  out  of  bed 
and,  in  general,  makes  the  sick  feel  better. 

These  children  are  observant  because, 
to  them,  a  bad  nurse  is  one  who  does  not 
pay  attention  to  you,  does  not  give  direc- 
tions on  how  to  use  medications,  is 
grumpy  and  makes  you  feel  like  a  bother, 
and  always  puts  herself  first.  They  wish 
nurses  would  give  medicines  by  mouth, 
instead  of  by  needle. 

Grade  5 

When  interviewing  the  grade  five  stu- 
dents, I  was  struck  by  the  influence  the 
family  and  the  working  and  social  worlds 
have  on  them.  Although  these  children 
42     THE  CANADIAN  NURSE 


could  not  give  it  a  name,  they  have  a  great 
understanding  about  the  psychological  as- 
pects of  a  person:  the  need  for  a  social  life, 
an  active  and  mobile  life,  and  the  real  need 
for  a  family.  According  to  these  children, 
nurses  have  to  sleep  a  lot  so  they  can  work 
efficiently  at  night,  and  nurses  care  for  the 
next-door  neighbor  as  well  as  the  person  in 
the  hospital.  A  nurse  tries  to  make  the 
patient  happy  so  he  can  forget  about  the 
soreness,  and  also  gives  the  patient  things 
to  do,  such  as  a  puzzle,  so  he  will  not  be 
lonely.  If  a  person  is  exceptionally  lonely, 
these  children  know  that  a  nurse  should 
call  in  the  family. 

Efficiency  was  stressed  by  these  chil- 
dren, because  they  believe  that  it  is  impor- 
tant for  a  nurse  to  come  immediately 
whenever  someone  rings  the  buzzer.  The 
needles  and  medications  should  be  given 
on  time,  and  nothing  should  be  done 
wrong.  One  child  casually  mentioned  that 
a  nurse  should  have  to  go  to  school  for 
three  to  five  years,  but  only  two  to  three 
years  if  a  neighbor  has  told  her  a  lot. 

The  students  felt  that  a  bad  nurse  is  one 
who  does  not  help  the  dying,  will  not  let 
the  minister  in  to  see  you,  and  gives  you 
hot  foods  when  you  have  your  tonsils  out. 

Their  childhood  wishes  are:  you  should 
not  have  to  pull  your  pants  down  for  a 
needle,  the  nurse  should  not  awaken  you  in 
the  middle  of  the  night  to  go  to  the  wash- 


room, and  visiting  time  should  be  all  the 
time,  with  your  parents  sleeping  in  the 
hospital  with  you. 

Conclusion 

After  conducting  these  interviews,  1 
have  come  to  realize  that  children  are  not 
as  ignorant  of  the  nursing  profession  or, 
rather,  the  nursing  image,  as  I  thought  they 
were.  We  cannot  brush  their  feelings  and 
requests  off  as,  "He  does  not  know  the 
difference  or  understand,  so  why  should  I 
bother?""  I  think  that  children  are  adults 
where  their  needs  are  concerned,  and  that 
they  are  exceptionally  sensitive  to  the 
world  around  them. 

From  this  I  conclude  that  we  need  to 
promote  understanding  and  education 
among  children  concerning  nurses  and 
their  roles  in  our  society.  Q 


APRIL  1975 


Open  New  Vistas  in  Nursing 
With  These  Saunders  Titles. 


Miller  &  Keane 

ENCYCLOPEDIA  AND  DICTIONARY  ^S^ 

OF  MEDICINE  AND  NURSING  '^^^ 

Over  340.000  of  your  nursing  colleagues  are  now  using  the 
Miller-Keane  ENCYCLOPEDIA  AND  DICTIONARY  OF  MEDICINE 
AND  NURSING,  They  know  that  a  nursing  encyclopedia  is  the 
first,  the  basic  the  most  important  book  in  every  nurse  s  personal 
library.  They've  put  their  trust  in  Miller-Keane:  you  should  too. 

Clear-cut  definitions  fill  over  1000  pages  of  this  handy  reference. 
You'll  find  122  outstanding  illustrations,  including  photographs 
and  radiographs,  plus  16  pages  of  full-color  anatomical  plates. 
Special  sections  on  nursing  care  are  included  for  most  diseases, 
conditions  and  operations.  You'll  find  more  than  40.000 
definitions — all  succinct,  precise  and  understandable. 
Straightforward  information  is  provided  on  drugs,  treatments,  ■ 
equipment  and  types  of  therapy.  Vital  data  is  helpfully  condensed  ' 
in  quick  reference  tables  strategically  placed  throughout  the 
book.  By  the  late  Benjamin  F.  Miller,  MD:  and  Claire  B.  Keane, 
RN,  BS,  MEd,  1089  pp.  122  ill.  $11.95.  March  1972. 

Order  #6355-9. 

-/m  \  . —^^  . 


Gillies  &  Alyn: 
SAUNDERS  TESTS  FOR 
SELF-EVALUATION  OF  NURSING 
COMPETENCE,  Second  Edition 

An  easy  and  reliable  volume  for  review  and  examination  of  nurs- 
ing methods,  professional  skills  and  medical  facts  Presents  a 
collection  of  representative  clinical  situations,  each  with  a  series 
of  multiple  choice  questions  to  test  the  reader's  recall  of  facts  and 
her  ability  to  apply  those  facts  to  the  resolution  of  actual  problems 
encountered  in  practice.  Individual  sections  examine; 
maternal-gynecologic,  pediatric,  medical-surgical,  and 
psychiatric  nursing.  By  Dee  Ann  Gillies,  RN,  EdD;  and  Irene  8. 
Alyn,  RN.  PhD  392  pp.  plus  152  answer  sheets.  S7.75.  January 
1973.  Order  #4131-8. 


THE  NURSING  CLINICS 
OF  NORTH  AMERICA 

Relied  uf>on  by  both  practicing  nurses  and  students  for  in-depth 
examinations  of  the  most  important  and  most  rapidly  changing 
aspects  of  patient  care.  Topics  for  1975  include:  March 
— Intensive  Care  of  the  Surgical  Patient,  edited  by  Joan  D, 
Harrington.  RN;  June — Advances  in  Maternity  Nursing,  edited  by 
Elizabeth  S.  Sharp,  RN;  and  The  Handicapped  Child,  edited  by 
Elizabeth  J.  Worthy,  RN;  Septemtser — Human  Sexuality,  edited 
by  Fern  Mims,  RN:  and  Kidney  and  Urotogic  Nursing,  edited  by 
Mary  O'Neill.  RN:  December — Perspectives  in  Operating  Room 
Nursing,  edited  by  Mary  Gill  Nolan,  RN;  anri  Community  Health 
Nursing,  edited  by  Verna  Huffman  Splane,  RN.  Published  quar- 
terly; March.  June.  Sept..  Dec,  Yearly  subscription — 515,15.  Each 
issue  is  approximately  180  pages,  hardbound,  illustrated,  and 
contains  no  advertising.  To  begin  your  subscription  with  the 
March  1975  issue,  just  indicate  in  the  coupon — Order  #0003. 


Nave  &  Nave:  ^~  ;^^j^^ 

PHYSICS  FOR  THE  HEALTH  SCIENCES 

This  new  text  offers  nurses  and  students  of  the  allied  health  sci- 
ences the  physics  they  need  to  know — at  a  level  requiring  only  a 
high  school  math  background  for  complete  understanding. 
Coverage  of  motion,  pressure,  heat  and  electricity  is  geared  to  a 
better  understanding  of  medical  phenomena  and  instrumenta- 
tion. Electrical  safety  problems  are  especially  featured.  By  Carl  R. 
Nave,  PhD:  and  Brenda  C.  Nave,  RN.  300  pp.  169  ill.  Soft  cover. 
$8.25.  February  1975  Order  #6665-5. 

Harrington  &  Brener: 

PATIENT  CARE  IN  RENAL  FAILURE 

A  thorough  guide  to  treatment  of  patients  with  kidney  disorders. 
The  authors  review  basic  anatomy  and  physiology — including 
fluid  and  electrolyte  balance — and  build  to  a  detailed  coverage  of 
practical  methods  of  nursing  care.  They  then  descritie  treatment 
by  hemodialysis,  peritoneal  dialysis,  transplantation,  and  conser- 
vative methods  of  correcting  renal  failure.  Lastly,  they  look  into 
the  prevention  and  control  of  renal  diseases.  By  Joan  0. 
Harrington,  RN,  BSN,  MA,  and  Etta  Rae  Brener,  RN,  BSN,  MEd, 
277  pp.  Illustd.  $9.30.  October  1973.  Order  #4528-3. 


ON  4/75"! 

833  Oxford  Street, 

Toronto  18,  Ontario  M8Z  5T9 


1W.B.  SAUNDERS  COMPANY  CANADA  LTD. 


To  receive  titles  on  30-day  approval, 
please  fill  in  order  numbers  below: 


NAME 


ADDRESS 


CITY 


PROV. . 


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Prices  subject  to  change 


D  Please  bill  me  G  Check  enclosed — 

Saunders  pays  postage  &  handling  if  check  accompanies  order. 


Next  Month 
in 


The 

Canadian 
Nurse 


•  The  Hyperkinetic  Child 


•  How  the  Leukemic  Child 
Chooses  His  Confidant 


•  Opinion:  Canada  Needs 
a  Population  Policy 


•  Health  and  Social 

Services  Under  One  Roof 


'^ 


J  L*-, 


0 
^^7 


Photo  Credits 
for  April  1975 


April  30  — lune  18,  1975 

A  course  in  "Genetics  for  Nurses"  will  be 
offered  on  Wednesday  evenings  7:00  to 
9:30  P.M.  at  the  University  of  Toronto 
Faculty  of  Nursing.  The  course  fee  is  $50. 
For  further  information,  contact  Dorothy 
Brooks,  Chairman,  Continuing  Education 
Program,  Faculty  of  Nursing,  University  of 
Toronto,  50  St.  George  St.,  Toronto, 
Ontario,  M5S  1A1. 


May  1-3,  1975 

Catholic  Hospital  Association  of  Canada 
annual  meeting.  Chateau  Laurier,  Ottawa, 
Ontario.  For  Information  write:  chac,  312 
Daly  Avenue,  Ottawa,  Ontario,  KIN  6G7. 


May  7,  1975 

Conference  on  new  dimensions  in  mater- 
nity care,  Norton  Hall  Conference  Theater, 
Main  Street  Campus,  State  University  of 
New  York  at  Buffalo.  For  information,  write: 
Department  of  Continuing  Education, 
School  of  Nursing,  State  University  of  New 
York  at  Buffalo,  81 6  Kenmore  Avenue,  Buf- 
falo, New  York,  14216,  U.S.A. 


May  10,  1975 

100lh  anniversary  celebration.  The  Hospi- 
tal for  Sick  Children,  Toronto.  For  informa- 
tion, write:  The  Department  of  Nursing 
Education,  The  Hospital  for  Sick  Children, 
555  University  Avenue,  Toronto,  Ontario, 
M5G  1X8. 


May  10,  1975 

New  Brunswick  Operating  Room  Nurses 
Group  provincial  meeting  is  being  held  at 
the  1 0OF  Hall,  Brunswick  and  York  Streets, 
Fredericton,  New  Brunswick. 


May  25-27,  1975 

Annual  meeting  of  the  Manitoba 
Association  of  Registered  Nurses  to  be 
held  in  Dauphin,  Manitoba.  For  information, 
write:  warn,  647  Broadway  Avenue, 
Winnipeg,  Manitoba,  R3C  0X2. 

June  2— August  6,  1975 

Night  course,  "Nutrition  in  the  70s, '  on 
Monday  and  Wednesday  nights.  Write  to: 
Gladys  Lennox,  Director  of  Health  Educa- 
tion, Loyola  Campus,  Concordia  Univer- 
sity, 7141  Sherbrooke  St.  West,  Montreal, 
Quebec,  H4B  1R1. 


June  11-13,  1975 

66th  annual  meeting  of  the  Registered 
Nurses'  Association  of  Nova  Scotia,  to  be 
held  at  St.  Francis  Xavier  University,  An- 
tigonish.  Theme:  The  nurse's  role  in  the 
new  perspective  on  health. 


July  7-11,  July  14-18,  or 
July  21-25,  1975 

"Hunger  in  the  classroom:  the  school's 
role."  One-week,  all  day,  crash  course,  for 
one-half  credit.  Write  to:  Gladys  Lennox, 
Director  of  Health  Education,  Loyola 
Campus,  Concordia  University,  7141 
Sherbrooke  St.  West,  Montreal,  Quebec. 


October  19-22,  1975 

8th  International  Congress  on  Suicide 
Prevention  (and  Crisis  Intervention)  in 
Jerusalem,  Israel.  Theme  is  "Modern  Cul- 
ture in  Crisis."  Information  from:  Ruth 
Broza-Levin,  Organizing  Committee.  8th 
International  Congress  on  Suicide  Preven- 
tion, Ministry  of  Health,  Mental  Health 
Services,  2  Ben  Tabai  Street,  Jerusalem, 
Israel. 


Health  and  Welfare  Canada, 
Ottawa,  Ontario. 
Cover  I,  pp.  21,  22,  23,  24 


Lou  Scaglione, 

Hospital  for  Sick  Children, 
Toronto,  Ontario,  p.  12 


44     THE  CANADIAN  NURSE 


May  20-23,  1975 

First  Canadian  Regional  Conference  of  the 
International  Childbirth  Education 
Association  will  be  held  in  Hamilton, 
Ontario,  at  the  downtown  Holiday  Inn. 
Theme  of  the  conference  is  "Tomorrow's 
Family  —  the  Team  Approach. "  Speakers 
include  Drs.  Avinoam  and  Beryl  Chernick. 
Further  information  and  registration  kits 
are  available  from  Lynn  Gilbank.  149 
Woodview  Crescent,  Ancaster,  Ontario, 
L9G1G1. 


October  27-29,  1975 

The  four  Prairie  university  schools  of  nurs- 
ing have  applied  for  funding  and  are  solicit- 
ing papers  for  a  National  Conference  on 
Nursing  Research  to  be  held  in  Edmonton, 
on  'The  Development  and  Use  of  Indi- 
cators in  Nursing  Research. "  Active  nurse 
researchers  are  invited  to  submit  related 
papers  to  Margaret  E.  Steed,  Program 
Coordinator,  3rd  Floor,  Clinical  Sciences  i 
Building,  University  of  Alberta,  Edmonton,  \ 
Alberta.  T6G  2G3.  -^  j 

APRIL  1975 


Pampecs 


ives 


you  both 

ahieak 


(eejxs 
lim  drier 

Instead  of  holding 
moisture,  Pampers 
hydrophobic  top  sheet    % 
allows  it  to  pass 
through  and  get 
"trapped"  in  the 
absorbent  wadding 
underneath.  The  inner 
sheet  stays  drier,  and 
baby's  bottom  stays 
drier  than  it  would  in 
cloth  diapers. 


Saves 
you  time 

Pampers  construction 
helps  prevent  moisture 
from  soaking  through 
and  soiling  linens.  As  a 
result  of  this  superior 
containment,  shirts, 
sheets,  blankets  and 
bed  pads  don't  have  to 
be  changed  as  often 
as  thev  would  with 
conventional  cloth 
diapers.  And  when  less 
time  is  spent  changing 
linens,  those  who  take 
care  of  babies  have 
more  time  to  spend  on 
other  tasks. 

PROCTER   t  SAMBLE  CAR-32Z 


new  products     { 


Descriptions  are  based  on  information 
supplied  by  the  manufacturer.  No 
endorsement  is  intended. 


Medtronic' sXytron  pacemakers  are  smaller  and  lighter  than  previous  models  because  of 
the  use  of  hybrid  circuitry'  (foreground).  All  models  are  the  same  size  and  weight:  57.5 
mm  diameter,  23.5  mm  thickness,  and  135  g  maximum  weight.  By  comparison,  that  golf 
ball  has  a  42.6  mm  diameter. 


Eltor  120 

A  method  has  been  found  to  unplug  a 
stuffed-up  nose,  according  to  Dow  Phar- 
maceuticals, which  recently  introduced 
Eltor  120.  This  drug  contains  pseudo- 
ephedrine  hydrochloride  in  sustained- 
release  form.  Unlike  other  long-acting  de- 
congestants on  the  market,  it  has  no  anti- 
histamine ingredient. 

Eltor  120  was  evaluated  by  specialists, 
using  a  method  of  measuring  nasal  airway 
resistance  (NAR).  Patients  were  fitted  with 
face  masks  and  mouthpieces,  and  the  air 
pressure  was  measured  in  the  mask  and  in 
the  mouth,  the  data  being  fed  into  an 
analogue  computer.  The  Dow-sponsored 
tests  showed  definite  decreases  in  NAR, 
lasting  up  to  12  hours  when  one  Eltor  120 
capsule  was  administrated. 

Eltor  120  is  recommended  only  for 
adults  and  children  over  1 2  years ,  but  Eltor 
Liquid  is  designed  for  the  younger  child. 
It,  too,  has  no  antihistamine.  Eltor  Liquid 
is  not  a  time-release  drug  and  must,  there- 
fore, be  administrated  3  to  4  times  daily. 

Aside  from  their  effectiveness  in  provid- 
ing temporary  relief  from  stuffiness  due 
to  the  common  cold,  both  Eltor  120  and 
Eltor  Liquid  are  recommended  for  cases  of 
sinusitis,  vasomotor  rhinitis,  and  allergic 
rhinitis. 

The  Dow  Pharmaceuticals'  press  re- 
46    THE  CANADIAN  NURSE 


lease  slates  that  the  antihistamine  ingre- 
dient usually  included  in  oral  deconges- 
tants was  omitted  from  these  formulations 
because  recent  medical  evidence  suggests 
that  antihistamines  are  not  effective  in 
treating  the  common  cold. 

For  further  information,  write:  Dow 
Pharmaceuticals,  14  Dyas  Road,  Don 
Mills,  Ontario. 


Sterilizing  trays 

A  new  line  of  heavy  duty,  stainless  steel 
trays  for  cleaning,  handling,  and  steriliz- 
ing surgical  instruments  has  been  intro- 
duced by  Sparta  Instrument  Corporation. 
Heavy  gauge  stainless  steel  is  used  on  all 
parts.  The  bottom  portions  have  multiple 
perforations  for  steam  penetration  and 
prof)er  drainage.  Careful  attention  has 
been  given  to  smoothing  and  finishing  the 
edges  and  corners. 

Also  offered  is  a  special  model  with 
handles  mounted  on  the  inside,  so  the  tray 
can  fit  into  ultrasonic  cleaners.  Separate 
lifting  handles  for  grasping  hot  or  sub- 
merged trays  are  included  in  Sparta's  in- 
strument line. 

Additional  information  on  stainless 
sterilizing  aids  may  be  obtained  by  con- 
tacting Sparta  Instrument  Corporation, 
305    Fairfield.    Fairfield.    N.J.    07006. 


New  pacemaker 

Medtronic  of  Canada  recently  introduced 
the  new  Xytron  family  of  small,  implant- 
able heart  pacemakers  that  are  expected  to 
last  at  least  5  years.  The  new  devices  are 
5.75  cm  in  diameter  and  weigh  about  135 
g,  compared  with  6.3  cm  and  160  g  for 
previous  units. 

All  components  except  batteries  are 
hermetically  sealed  to  give  protection 
from  moisture-related  problems  while  the 
device  is  in  the  body. 

Mercury-zinc  batteries  have  been  used 
as  a  power  source  since  the  early  days  of 
pacemal^ing,  around  1960.  However,  the 
Xytron  pacemakers  are  powered  by  im- 
proved mercury-zinc  cells  that  eliminate 
most  premature  failures  and  deliver  nearly 
all  their  theoretical  energy  supply.  These 
improved  batteries,  coupled  with  recent 
advances  in  circuitry,  make  more  efficient 
use  of  the  available  power  and  further  ex- 
tend pacemaker  life. 

For  further  information,  write:  Medtro- 
nic of  Canada  Ltd.,  6271-2  Dorman  Rd., 
Mississauga,  Ontario,  L4V  IHl. 


Survit-Plus 

Pharbec  Inc.'s  new  product.  Survit-Plus, 
is  a  red,  film-coated  tablet  containing  the 
Decavitamins  U.S. P.  formula.  Each 
Survit-Plus  tablet  contains:  Vitamin  A 
4000  U. I.,  Vitamin  D 400  U. I.,  Vitamin C 
70  mg.  Vitamin  Bi  2  mg.  Vitamin  B2  2 
mg.  Vitamin  86  2  mg.  Niacinamide  20 
mg.  Calcium  d-pantothenate  10  mg.  Folic 
Acid  100  mcgm.  Vitamin  B12  5  mcgm, 
and  Vitamin  E(dl  Alpha  Tocopheryl  ace- 
tate) 15  mg. 

Survit-Plus.  available  in  bottles  of  30, 
100,  500.  and  1,000  tablets,  is  manufac- 
tured by  Pharbec  Inc.,  4012  Cote  Vertu, 
Montreal,  Que.,  H4R  1V4. 


Cyclobec 

Cyclobec  (Dicyclomine  HCl  N.F.  10  mg). 
is  an  antispasmodic  and  has  a  direct  relax- 
ant effect  on  smooth  muscle  as  well  as  a 
depressant  effect  on  parasympathetic  func- 
tion. These  dual  actions  produce  relief  of 
spasm  with  minimum  atropine-like  ad- 
verse effects. 

This  drug  comes  in  10  mg  blue  capsules 
with  "Pharbec"  printed  on  each  capsule, 
and  is  available  in  bottles  of  100  and 
1,000. 

For  further  information,  write:  Pharbec 
Inc . ,  40 1 2  Cote  Vertu ,  Montreal ,  Quebec 

APRIL  1975 


Ultrasound  reveals  vascular  disorders 

The  medical  group  of  Siemens  has  de- 
veloped a  noninvasive  ultrasonic  unit  that 

rovides  acoustic  information  on  blood 

low  in  veins  and  arteries. 
The  ultrasonic  waves  emitted  by  the 
nsmitter  are  reflected  by  the  blood 
Itreaming  through  the  vessels,  are 
jhanged  in  their  frequency  according  to 
he  flow  speed,  and  are  sent  back  to  the 
jeceiver.  The  resulting  mixture  of  fre- 
|uencies  can  be  made  audible  by  a  loud- 
ipeaker.  or  can  be  displayed  visually  on  an 
jscilloscope  as  an  ultrasonic  tone  pattern. 
^igh  frequencies  represent  high  flow 
jpeeds  and  low  frequencies  slower  flow. 
ihus.  stenotic  disorders  or  functional  in- 
mpetence  of  the  venous  valves  are  diag- 
losed  rapidly  without  invasion.  In  addi- 
ion,  the  accuracy  of  blood  pressure  meas- 
irements  by  means  of  the  cuff  method  can 

Iso  be  improved. 


a 

-• 


The  ultrasonic  vessel  indicator  is  small 
nd  easy  to  operate.  The  built-in  loud- 
peaker  allows  ""on-the-spot""  diagnosis. 
"he  ultrasonic  transmitter  and  receiver  are 
lOused  in  a  cigar-shaped  pickup  probe, 
thich  is  applied  under  slight  pressure  to 
le  skin  above  the  vessel  to  be  examined. 

magnetic  tape  recorder  and  a  strip  chart 
ecorder  can  also  be  connected  to  the  ul- 
■asonic  vessel  indicator. 

More  information  is  available  from: 
iemens  Canada  Limited.  P.O.  Box  7300. 
»ointe  Claire.  P.Q..  H9R  4R6. 


hyroid  testing  products 
'wo  new.  hemagglutination  thyroid  test- 
Ig  products  are  now  available  in  Canada. 
Manufactured  for  the  early  detection  of 
[ashimoto's  and  Graves'  diseases,  Sera- 
'ek  Thyroglobulin  Test  is  a  hemagglutina- 
on  test  for  thyroglobulin  antibodies,  and 
era-Tek  Microsome  Test  is  a  hemag- 
lutination  test  for  microsomal  antibodies. 
For  information  w  rite:  Ames  Company, 
Wvision  Miles  Laboratories  Ltd.,  77 
elfield  Road.  Rexdale.  Ont.  V 

!PRIL  1975 


PEOPLE 
ARE  SOFTER 
THAN  BEDS. 

Smith  &  Nephew  Hospital  Lotion  -  'Hand  &  Back'  — 

is  indicated  in  the  treatment  of  dry,  irritated  skin  due  to 

external  disorders.  The  lotion  is  effective  as  a  hospital 

body  rub  and  is  specially  formulated  for  this 

purpose.  Hospital      Lotion  contains  no 

aromatic  sensitisers. 


Smith  8<Nephew 
Patient  Recovery  Ptoducts 

Smith  &  Nephew  Ltd.  2100— 52nd  Avenue,  Lachine,  Quebec 


THE  CANADIAN  NURSE     47 


Elastic  hosiery 


Now  nobody  need  know  she's  wearing 
support  hosiery.  Bauer  and  Black  make  a 
complete  line  of  attractive  and  fashionable 
Elastic  Panty  Hose  and  Cosmetic  Sheer  Stock- 
ings. All  provide  firm,  medically  correct  "grad- 
uated compression",  the  kind  of  support  she 
needs  for  improved  circulation. 

Very  simply,  "graduated  compression"  is  con- 
trolled compression  at  the  ankles,  with  diminish- 
ing pressure  up  the  leg.  Because  Bauer  and  Black 
Elastic  Hosiery  is  made  with  stronger,  tougher 
yarns,  your  patient  will  get  up  to  tivice  the  com- 
pression that  ordinary  support  hosiery  would 
provide  her.  And  that's  important. 

So  now  that 
you've  helped  get 
her  back  on  her 
feet,  you  can  hon- 
estly tell  her  that 
Bauer  and  Black 
Elastic  Stockings 
and  Panty  Hose 
will  allow  her  to 
feel  much  better- 
without  detract- 
ing one  bit  from 
her  appearance. 

Just  because  her 
legs  need  a  little 
support  doesn't 
mean  they  have 
to  look  like  they're 
bandaged! 


s  her  secret. 


BAUeR  £.  BLACK 

Supports  your  patients        " "' " 


Also  available  in  Surgical  Weight. 


in  a  capsule 


liopsies  of  breast  under  "local" 

VIost  women  who  need  biopsies  of  the 
xtast  can  have  them  under  local  anesthet- 
thus  lowering  both  the  risk  and  the 
;ost,  according  to  a  recent  study  by  two 
California  surgeons.  Currently,  in  most 
:ommunities.  biopsies  are  done  under 
;eneral  anesthesia. 

Writing  in  the  January  issue  ofSurgery. 

jynecology  and  Obstetrics,   the  official 

ournal  of  the  American  College  of 

Jurgeons,  Hollis  Caffee,  md,  and  John  R. 

Jenfield,  MD,  report  that  it  is  possible  to 

Tjiredict  with  9 1  percent  accuracy  w  hether  a 

Hump  in  the  breast  will  be  benign  or  can- 

ltous.  This  makes  it  possible  to  designate 

'  >se  patients  with  a  probably  benign  le- 

n  for  local  anesthetic. 

Although  biopsy  remains  mandatory, 

he  preoperative  diagnosis  of  carcinoma  of 

he  breast  can  currently  be  made  with  suf- 

l.ient  accuracy  to  justify  restricting  rec- 

iiiiendations   for  general   anesthesia   to 

ise  patients  likely  to  have  carcinoma  of 

he  breast,""  the  authors  report. 

The  next  step  to  explore,  according  to 

he  authors,  is  the  efficiency  of  exicising 

;iign  lumps  on  an  outpatient  basis. 

Although  we  have  never  either  rec- 

niended  or  routinely  done  biopsies  of 

..  breast  for  presumed  benign  masses  on 

uipatients,  this  approach  is  clearly  the 

e\t  logical  step,""   the  authors  say. 

However,  our  data  should  not  be  used  as 

blanket  endorsement  for  biopsies  of  the 

■reast  performed  on  outpatients  as  office 

mcedures.  The  propriety  for  biopsies  of 

ie  breast  upon  women  who  have  not  been 

'litted  to  hospitals  needs  to  be  evaluated 

itically  in  each  individual  setting,  and  it 

^  clear  that  the  judgment  and  qualification 

!  the  surgeons  should  be  at  least  as  impor- 

int  a  consideration  as  the  quality  of  the 

utpatient  operating  facilities  which  are 

vailable." 


ry  it  for  size 

ipanese  doctors  have  devised  a  simple 
id  reliable  method  for  selecting  the  op- 
mum  endotracheal  tube  for  children.  Size 
etermination  is  based  on  the  width  of  the 
ttle  finger,  which  the  doctors  say  is  a 
lore  accurate  index  than  age  in  patients 
nder  six  years  old. 

In  this  new  method,  as  reported  by 
/illiam  Millar  in  the  3  September  1974 
sue  of  The  Medical  Post,  the  optimal 
liter  diameter  of  the  tube  in  millimeters  is 
)und  by  either  adding  1 .4  to  the  width  of 

•RIL1975 


the  little  fingernail  or  subtracting  1 .2  from 
the  width  of  the  tip  of  the  little  finger  of  the 
patient. 

Drs.  Yuko  Mukubo  and  Seizo  Iwai  of 
the  department  of  anesthesiology  at  Kobe 
University  school  of  medicine,  Japan,  de- 
veloped this  new  method. 


No  male  midwives 

The  Royal  College  of  Midwives  in 
England  believes  that  the  profession  of 
midwifery  should  consist  of  only  female 
practitioners.  Commenting  on  proposed 
government  legislation  to  promote  equal 
opportunities  for  men  and  women,  the 
Royal  College  states  there  are  too  many 
practical  difficulties  to  allow  men  to 
practice  successfully  as  midwives. 

In  an  editorial  in  Nursing  Mirror  and 
Midwives  Journal  (Nov.  21,  1974). 
Editor  Pat  Young  states:  "The  reasons  the 
College  gives  are  good,  sound  common 
sense.  If  they  were  to  practice  midwifery. 


men  should  not  be  restricted  to  certain 
aspects  of  the  work,  but  be  trained  in  its 
full  range.  This  entails  not  simply  per- 
forming or  assisting  at  deliveries,  but 
attending  mothers  from  the  beginning  of 
pregnancy  to  the  end  of  the  postpartum 
period.  Various  intimate  procedures  are 
involved,  such  as  preparing  the  mother 
for  breast  feeding,  and  even  if  women  did 
not  object  to  men  carrying  out  these 
procedures,  it  is  conceivable  that  their 
husbands  might.  Thus  it  would  be  neces- 
sary for  all  male  midwives  to  be 
chaperoned  —  and  what  an  unthinkable 
waste  of  manpower  that  would  be."" 

Editor  Young  says  that  the  controversy 
about  male  midwives  will  likely  start  all 
over  again,  and  that  the  RCM  will  undoubt- 
edly be  accused  of  taking  a  restrictive 
and  discriminatory  attitude.  But,  she 
adds,  the  College  is  looking  at  the 
problem  from  the  patient" s  point  of  view , 
and  "that  is  what  matters  most  in  the 
end.-"  ^. 


THE  CANADIAN  NURSE     49 


research  abstracts 


Pfisterer,  ]anet.  Learning  needs  of  the  car- 
diac patient  being  discharged  from 
hospital  as  seen  by  the  patient,  his  doc- 
tor, and  his  nurse.  London,  Ontario, 
1 973 .  Thesis  ( M .  Sc .  N . )  U .  of  Western 
Ontario. 

The  purpose  of  this  study  was  to  determine 
the  learning  needs  of  selected  cardiac  pa- 
tients being  discharged  from  hospital  as 
perceived  by  the  patient  himself,  his 
nurse,  and  his  doctor.  Secondarily,  the 
types  of  health  personnel  who  might  be 
involved  in  meeting  these  needs  were  iden- 
tified. 

The  sample  was  comprised  of  6  men  and 
4  women  who  were  discharged  to  their 
homes  following  hospitalization  for  any  of 
the  following  diagnoses:  angina,  myocar- 
dial infarction,  congestive  heart  failure,  or 
valve  problems.  Questionnaires  were 
completed  by  the  patient,  nurse,  and  doc- 
tor at  the  point  of  discharge;  on  his  fifth 
day  home,  the  patient  responded  to  a  sec- 
ond questionnaire.  Medical  and  personal 
data  were  obtained  from  the  patient's 
chart. 

There  was  rather  marked  disagreement 
among  the  patients,  their  doctors,  and  their 
nurses  as  to  the  numbers  and  kinds  of 
learning  needs  of  the  patient  at  discharge. 
Of  7  patients,  only  2  reported  unmet  needs 
for  information  at  discharge.  After  5  days 
at  home,  2  more  patients  had  unanswered 
questions.  Concerning  who  might  do  the 
teaching,  5  out  of  10  responses  from  doc- 
tors included  the  nurse;  all  5  nurses  re- 
sponding to  the  question  indicated  a  nurse 
should  be  involved.  Only  one  out  of  7 
patients  perceived  the  nurse  as  having 
taught  him. 


Buckley,  Nancy  Wong  (married  name, 
Poichuk ) ,  The  effect  of  role  conflict  on  the 
level  of  communication  of  empathy  in 
baccalaureate  nurses.  Ottawa,  Ont., 
1974.  Thesis  (M.A.Ed.)  U.  Of  Ottawa. 

In  this  study,  the  Getzcls  and  Cuba  theory 
of  administration  as  a  social  process  was 
used  to  predict  the  effect  of  role  conflict  on 
behavior.  The  institutional  dimension  was 
represented  by  the  role  expectations  of 
three  groups:  the  hospital,  the  public 
health  aeenc v .  and  the  nursing  school .  The 
ideographic  dimension  was  represented 
by  the  professional  needs  of  the  bac- 
calaureate nurse.  Behavior  was  examined 
in  terms  of  the  nurse's  level  of  communi- 
cation of  empathy  to  the  patient. 

50     THE  CANADIAN  NURSE 


The  specific  hypothesis  was:  bac- 
calaureate student  nurses  and  bac- 
calaureate graduates  employed  in  public 
health  would  each  exhibit  a  higher  level  of 
communication  of  empathy  than  bac- 
calaureate graduate  nurses  employed  in  a 
task-oriented  hospital. 

The  sample  was  chosen  from  6  Ontario 
university  schools  of  nursing.  Included  in 
the  3  groups  of  nurses  were  fourth  year 
nursing  students  of  the  basic  baccalaureate 
program,  1972  basic  baccalaureate 
graduates  presently  employed  in  official 
public  health  agencies,  and  1972  basic 
baccalaureate  graduates  presently  em- 
ployed in  hospitals. 

The  Barrett-Lennard  Relationship  In- 
ventory was  used  to  obtain  a  measure  of 
the  nurse's  level  of  communication  of  em- 
pathy to  the  patient. 

Differences  did  exist  in  the  level  of 
communication  of  empathy  for  the  3 
groups  of  nurses.  However,  the  direction 
of  the  scores  was  not  as  predicted. 
Hospital-employed  nurses  achieved  the 
highest  scores,  public  health  achieved  the 
lowest  scores,  and  student  nurses  achieved 
the  intermediate  scores.  A  one-way 
analysis  of  variance  found  the  3  groups  to 
be  significantly  different  at  the  5  percent 
level. 

As  a  follow-up  to  the  analysis  of  var- 
iance, the  Scheffe  test  was  used  to  deter- 
mine where  significant  differences  ex- 
isted. Significant  differences  were  found 
between  the  hospital-employed  nurses  and 
the  public  health  nurses.  No  significant 


SICKROOM 

EQUIPMENT 

LOAN  SERVICE 


differences  were  found  between  the 
hospital-employed  nurses  and  the  student 
nurses ,  or  between  the  public  health  nurses 
and  the  student  nurses. 

The  following  conclusions  were  drawr 
from  the  results:  1 .  baccalaureate 
graduates  employed  in  the  hospital  exhi- 
bited the  highest  level  of  communicatior 
of  empathy;  2.  baccalaureate  graduate; 
employed  in  public  health  exhibited  the 
lowest  level  of  communication  of  em 
pathy;  and  3.  baccalaureate  student  nurse; 
exhibited  an  intermediate  level  of  com 
munipation  of  empathy. 


Nicholson,  Billie  Patricia. /I  study  to  deter- 
mine the  type  and  frequency  of  inter- 
ruptions sustained  by  postcardiotom) 
patients  in  an  intensive  care  unit. 
Vancouver,  B.C.,  1974.  Thesi; 
(M.S.N.)  U.  of  British  Columbia. 

The  environment  of  the  intensive  care  uni 
is  cited  as  one  etiological  factor  of  post 
operative  psychosis  in  patients  followin; 
open-heart  surgery.  This  descriptive  stud; 
was  undertaken  to  document  the  type  am 
frequency  of  interruptions  sustained  b 
post-cardiotomy  patients  in  one  intensiv 
care  unit. 

The  study  was  designed  to  answer  thre 
questions:  1 .  How  frequent  are  the  inter 
ruptions  sustained  by  these  patients 
2.  How  long  are  the  blocks  of  unintei 
rupted  time?  3 .  What  are  the  types  of  in 
terruptions? 

A  checklist  of  interrupting  activities  we 
used  to  collect  the  data.  The  sample  ir 
eluded  108  hours  of  observation  that  co\ 
ered  the  first  56  postoperative  hour: 
These  hours  were  divided  into  early,  mic 
die,  and  late  postoperative  periods,  wit 
36  hours  of  observation  in  each  period.  T 
facilitate  continuous  observation,  the  o\ 
servation  periods  were  divided  into  4-hoi 
blocks.  A  random  sampling  of  the  4-hoi 
blocks  in  each  postoperative  period  ov( 
the  days  of  the  week  was  carried  out. 

A  descriptive  analysis  of  the  data  co 
lected  centered  around  the  3  question; 
Also,  to  facilitate  analysis  of  data,  th 
types  of  interruptions  were  organized  ini 
4  main  categories:  nursing  activitie;: 
patient-initiated  activities,  activities  < 
others,  and  environment.  | 

Basic  to  the  discussion  of  the  data  we:j 
the  following  findings  reported  in  the  litej 
ature:  1 .  adults  require  85  to  90  minutes ; 
complete  one  sleep  cycle,  2.  there  is 
close  resemblance  between  the  psychos 

APRIL  197 


f  sleep  deprivation  and  postcardiotomy 
sychosis.  and  3.  the  environment  of  the 
ostcardiotomy  intensive  care  unit  is  not 
onducive  to  giving  patients  time  for  rest 
nd  sleep. 

Within  the  limits  of  the  small  sample, 
ie  findings  of  the  study  indicated  that 
atients  were  frequently  interrupted.  Sec- 
nd.  the  interrupted  time  blocks  are  not 
)ng  enough  for  patients  to  obtain  rest  and 
eep.  Finally,  nursing  activities  were  re- 
wnsible  for  50  percent  of  the  interrup- 
ons.  These  findings  supported  the  find- 
gs  of  other  studies  undertaken  in  the 
ostcardiotomy  intensive  care  unit. 
In  addition,  implications  and  recom- 
:ndations  for  nurses  regarding  manage- 
;nt  of  these  patients  were  discussed.  Fi- 
»lly.  recommendations  for  further  inves- 
;ation  were  suggested. 


Icock,  Louise.  Exploratory  study  of  the 
father-adolescent  relationship:  impli- 
cations for  family  life.  Ottawa, 
Ontario,  1974.  Thesis,  (M.A.  (Ed.)) 
U.  of  Ottawa. 

his  study  focuses  on  the  male  and  female 
lolescents'  perception  of  the  father's  re- 
tionship  with  them  as  measured  by  the 
arrett-Lennard  Relationship  Inventory, 
id  in  the  light  of  3  hypotheses  concerning 
tpected  differences  in  perception  of  the 
lationship  according  to  the  adolescent's 
»e,  sex,  and  family  size. 
The  259  adolescents  who  completed  the 
elationship  Inventory  randomly  fell  into 
■oupings  according  to  age  (modal  age  13 
16),  sex.  and  family  size.  A  multivariate 
lalysis  of  variance  showed  significant 
fferences  in  the  adolescents'  perception 
'  the  father's  relationship  with  them  for 
e  two  age  levels  and  the  two  sexes,  but 
significant  difference  was  found  be- 
'cen  the  two  levels  of  family  size. 
The  early  adolescent  scored  the  father 
ore  favorably  than  did  the  older  adoles- 
nt,  and  the  variable  that  contributed  sig- 
ficantly  to  this  result  was  the  father's 
vel  of  empathic  understanding.  The 
males  scored  their  fathers  higher  on  two 
riables  (level  of  regard  and  uncondition- 
ty  of  regard),  but  the  males  scored  their 
;hers  higher  on  level  of  empathic  under- 
inding. 

Therefore,  although  one  can  say  that,  on 
:  overall  score,  females  scored  their 
hers  more  favorably  than  did  the  males, 
:  significantly  different  scoring  of  these 
riables  must  be  taken  into  consideration 
ten  looking  at  the  father-adolescent  rela- 
nship. 

The  findings  of  this  study  present  areas 
■consideration  by  family  life  educators. 
*<  rent-adolescent  discussion  leaders,  and 
!lil  :rapists  helping  adolescents  in  crisis. 
Be  ggestions  have  been  offered  regarding 
:i  Iher  research  to  augment  the  present 
;!«  owledge  of  father-child  relationships. 
H  RIL  1975 


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THE  CANADIAN  NURSE     51 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses'  Association  library  are 
available  on  loan  —  with  the  exception  of 
items  marked  R  —  to  CNA  members, 
schools  of  nursing,  and  other  institutions. 
Items  marked  R  include  reference  and 
archive  material  that  does  not  go  out  on 
loan.  Theses,  also  R,  are  on  Reserve  and 
go  out  on  Interlibrary  Loan  only. 

Requests  for  loans,  maximum  3  at  a 
time,  should  be  made  on  a  standard 
Interlibrary  Loan  form  or  on  the 
"Request  Form  for  Accession  List"" 
printed  in  this  issue. 

If  you  wish  to  purchase  a  book,  contact 
your  local  bookstore  or  the  publisher. 

BOOKS  AND  DOCUMENTS 

1 .  ALA  handbook  of  organizations  1974-75. 
Chicago.  American  Library  Association,  1974. 
117p. 

2.  Bailliere' s  nurses'  dictionary.  18ed.  By  Barbara 
F  Cape  and  Pamela  Dobson.  London.  Baillere 
Tindall.cl974,  479p. 

3.  Bibliography  on  women:  with  special  emphasis 
on  their  roles  in  science  and  sociery.  by  Audrey  B. 
Davis.  New  York.  Science  History  Publications. 
cl974.  50p. 

4.  Determinants  of  the  nurse-patient  relationship, 
by  Gerlrud  Bertrand  Ujhely.  New  York.  Springer. 
C1968.  27  Ip. 

5.  Dictionary  of  Canadian  biography.  Volume  3. 
1741-1770.  Toronto,  University  of  Toronto  Press. 
cl974.  782p.R 

6.  U education  permanente  en  nursing  du  Quebec. 
Principe  s  de  developpement  d' un  systeme 
d' education  permanente  en  nursing.  Prepare  en 
collaboration  avec  Madeleine  Blais  et  Rita  J.  Lussier 
du  Service  de  leducation  permanente  en  nursing. 
Montreal.  Ordre  des  Infirmieres  et  Infirmiers  du 
Quebec,  1974.  45p.  ("Document  du  travail") 

7.  Elements  de  sociologie  hospitaliere ,  par  Paul 
Swertz.  Traduction  de  Andre  Metzger.  Preface  par 
Catherine  Mordacq.  Paris.  Centurion.  1974.  131p. 
(Infirmieres  d'aujourd'hui,  no.  8) 

8.  Encyclopedia  Britannica.  Book  of  the  year. 
Chicago,  Encyclopedia  Britannica.  Inc..  1974. 
8(X)p.R 

9.  Family  development,  by  Evelyn  R.M.  Duvall. 
4ed.  Philadelphia.  Lippincotl.  c  197 1 .  576p. 

10.  From  medical  police  to  social  medicine:  essays 
on  the  history  of  health  care,  by  George  Rosen. 
New  York.  Science  History  Publications,  1974. 
327p. 

1 1.  Health,  a  quality  of  life,  by  John  S.  Sinacope. 
2ed.  New  York,  Macmillan,  cl974.  524p. 

12.  How  to  get  results  from  interviewing:  a 
practical  guide  for  operating  management,  by 
James  Menzies  Black.  Toronto.  McGraw-Hill, 
cI970.  203p. 

13.  L' implantation  de  roles  nouveaux  en  nursing, 
par  Paul  N.  Bourque.  Document  de  travail.  Etude 
speciale  sur  les  conditions  et  les  modal  ites  de  la  mise 
en  oeuvre  de  nouveaux  roles  en  nursing,  effectuee 

52     THE  CANADIAN  NURSE 


pour  le  compte  du  Comite  directeur  de  lOperation 
Sciences  de  la  Sante.  Quebec.  Ministere  de 
I'Education.  Operation  Sciences  de  la  Sante.  1974. 
63p. 

14.  Lecture  notes  in  pharmacology  and  therapeutics 
for  nurses,  by  James  A.  Boyle.  2ed.  Edinburgh. 
Churchill  Livingstone,  1974.  234p. 

15.  Microbiology  for  health  careers,  by  Elvira  B. 
Ferris.  Albany,  Delmar,  cl974.  149p.  (Delmar 
Practical  Nurse  Series) 

16.  The  nurse's  materia  medica,  by  John  Gibson 
3ed.  Oxford.  Blackwell.  1973.  250p. 

17.  The  nursing  process,  report  of  Stewart 
Conference  on  Research  in  Nursing,  lOth.  Columbia 
University,  1972.  Edited  by  Marie  M.  Seedor,  New 
York,  Teachers  College  Pr.,  cl973.  51p.  (Annual 
Stewart  Nursing  Research  Conference  Papers) 

18.  Operation  sciences  de  la  sante  planification 
sectorielle  de  I'  enseignement  superieur. 
Sous-operation  i  assistance  medicale,  dossier 
principal,  par  Claude  A.  Lanctot.  Sherbrooke, 
P.Q..  Faculte  de  Medicine,  Universite  de 
Sherbrooke.  1974.  I63p. 

19.  The  national  list  of  advertisers.  Toronto. 
Maclean-Hunter.  1975.  51  Ip.  R 

20.  Nouvelles  approches  au  sein  des  services  de 
sante.  Texte  tire  de  la  conference  prononcee  par 
Jean-Guy  Hebert  et  le  Dr  Pierre  Duplessi  devant  les 
universites  canadiennes  le  28  juin  1974,  au  Congres 
de  CACUSS;  texte  presente  au  Ministere  de  la  Sante 
et  du  Bien-etre  social  du  Canada.  Montreal, 
Universite  de  Montreal.  1974.  76p. 

2 1 .  Papers  presented  at  Conference  on  the  Clinical 
Nurse  Specialist,  Toronto,  June  4  and  5,  1973. 
Toronto.  Faculties  of  Nursing  and  Medicine  and  the 
School  of  Hygiene.  University  of  Toronto.  1974. 
78p. 

22.  Planification  et  politique  au  Quebec,  par 
Jacques  Benjamin.  Montreal.  Presses  de 
I ' Universite  de  Montreal.  1974.  142p. 

23  Psychosocial  aspects  of  maternal-child  nursing. 
by  Gladys  B.  Lipkin.  St.  Louis,  Mosby,  1974. 
I60p. 

24.  Response  to  the  Minister  of  Health  on  the  report 
of  the  Health  Planning  Task  Force.  Don  Mills, 
Ont.,  Ontario  Hospital  Association,  1974.  45p. 

25.  Science  and  direct  patient  care.  Papers 
presented  at  Nurse  Scientist  Conference.  Fourth. 
Denver.  Col..  Apr.  2  and  3,  1971.  Denver,  Col.. 
University  of  Colorado  Medical  Center.  School  of 
Nursing.  1974.  81p. 

26.  Science  and  direct  patient  care:  IT  Papers 
presented  at  Nurse  Scientist  Conference.  Fifth, 
Denver,  Col.,  Apr.  14  and  15,  1972.  Denver.  Col., 
University  of  Colorado  Medical  Center,  School  of 
Nursing.  1974.  I89p. 

27.  Se.xo-jeunesse,  dossier  I.  Par  un  groupe 
d'etudiants  de  la  Polyvalente  Beloeil.  sous  la 
responsabilite  de   Michel   Berger.    Beloeil,   P.Q., 


w  — 


Comite  de  Recherche  et  de  Publication  e 
Sexologie,  1974.  123p. 

28.  Stress  without  distress,  by  Hans  Selyi 
Philadelphia,  Lippincott.  cl974.  171p. 

29.  Text  book  for  midwives.  by  Margaret  F.  Mylc: 
8ed.  Edinburgh.  Churchill  Livingstone,  1975.  796| 

30.  Vinaigre  ou  miel,  comment  eduquer  son  enfan 
par  Robert  Belanger.  Quebec,  cl974.  192p. 

3 1 .  The  way  your  body  works,  by  Bemai 
Slonehouse  et  al.  New  York,  Mitchell  Benzie) 
1974.  96p. 


PAMPHLETS 

32.  Address  listing  1974-75.  Ottawa,  Canadii 
Medical  Association,  1974.  40p.  R 

33.  Advice  on  making  a  college  orientatic 
video-tape,  by  Margaret  Guss  et  al.  Corvalli 
Oregon  State  University  Library,  1973.  7p. 

34.  Behaviour  modification.  (Bibliograph; 
Ottawa.  Canadian  Teachers'  Federation.  1974.  34( 
35  By-laws.  Ottawa,  Association  of  Canadii 
Community  Colleges,  1974.  31p. 

36.  A,  career  with  a  future.  Kansas  City,  Mi 
American  Nurses' Association,  1974.  12p. 

37.  La  formation  en  cours  d'emploi.  Guide  prepa 
en  collaboration  avec  Rita  J.  Lussier  et  Madeleii 
Blais  du  Service  de  TEducation  permanent 
Montreal.  Ordre  des  Infirmieres  et  Infirmiers  i 
Quebec.  1974.  41  p. 

38.  Guidelines  for  short-term  continuing  educatii 
programs  preparing  the  geriatric  nur: 
practitioner.  Kansas  City,  Mo.,  American  Nurse 
Association.  1974.  9p. 

39.  Initiating  a  baccalaureate  degree  program 
nursing:  asking  the  essential  questions,  by  DorotI 
Ozimek.  New  York,  National  League  for  Nursin 
1974.  lip. 

40.  Masters  education:   route  to  opportunities 
modern  nursing.   New  York.  National  League  f 
Nursing.  Dept,  of  Baccalaureate  and  Higher  Degr 
Programs,  1974.  21p. 

4 1 .  Memoire  au  sujet  de  '  'nouvelle  perspective  de 
sante  des  canadiens" .  Ottawa,  Association  d 
infirmieres  canadiennes,  1974.  4p.  R 

42.  L' orientation.  Formation  en  cours  d'emplc 
Guide  prepare  en  collaboration  avec  Madelei 
Blais  et  Rita  J.  Lussier  du  Service  de  I'Educati- 
permanente  en  .Nursing.  Montreal.  Ordre  d 
Infirmieres  et  Infirmiers  du  Quebec.  1974  26p 

43.  Position  paper  on  continuing  education  J 
re-registration.  Vancouver,  Registered  Nurst 
Association  of  British  Columbia.  1974.  2p 

44.  Proposed  model  for  the  delivery  of  home  heat 
services.  New  York,  National  League  for  Nursir, 
Council  of  Home  Health  Agencies  and  Commun 
Health  Services.  1974.  8p. 

45.  Reglements.  Ottawa.  Association  des  Colleg 
Communautaires  de  Canada.  1974.  3lp. 

46.  Report,  1973174.  St.  Louis,  Missouri,  Catho 
Hospital  Association,  1974.  36p. 

Al .  Report  1973-1974.  Ottawa,  Canadi 
Tuberculosis  and  Respiratory  Disease  Associatic 
1974.  I2p. 

48.  Report.  Toronto.  Canadian  lnic!-;f  Committi 
1974.  I4p. 

i9.  Review  of  C  ID  A  activities  1970-1974.  Ottav 
Canadian     International     Development     Ageni 
Communications    Branch.    Information    Divisit 
1974.  43p, 
50.  Sairaanhoidoa    vuosikirja.    (Research    repoi 

APRIL  19; 


:Mnki,  Federation  of  Nurses  of  Finland.   1974. 

^P  (Summaries  in  English) 

■  minor  for  the  development  of  nursing  care 
irds  in  the  area  of  the  Caribbean.  Bridgetown. 
.Jos.  Oct.  8-18.  1974.  Caracas.  Venezuela. 
\merican  Health  Organization.  1974.  23p. 
elected  bibliography  on  associate  degree 
•I?  education.  New  York.  National  League  for 
ng.  Dept.  of  Associate  Degree  Programs,  1974. 

Itort   experience   and  cooperative   education 
ams.  Onawa.  Canadian  Teachers'  Federation. 
^  26p. 


64.  The  effect  of  rote  conflict  on  the  level  of  com- 
munication of  empathy  in  baccalaureate  nurses,  by 
Nancy  C  Y.  Wong  Buckley.  Ottawa.  el974.  71p. 
(Thesis  (M.Ed.)  —  Onawa)  R 

65 .  The  effects  of  an  automatic  and  deliberative  pro- 
cess of  nursing  activity  on  patients'  inability  to  sleep. 
Clinical  paper,  by  Sister  Loretta  Gillis.  Boston. 
1972.  23p.  R 

66.  L'enseignement  au  malade,  etudes  en  soins  in- 
firmiers.   par  Marie  F.   Thibaudeau  et  Nicole 

Marchak.  Montreal.  Presses  de  TUniversite  de 
Montreal.  1974.  167p.  R 

67.  Exploratory  study  of  the  father-adolescent  rela- 
tionship: implications  for  family  life,   by  Denise 


Alcock.  Ottawa.  1974.  91p.  (Thesis(M.A.  (Ed.))  — 
Ottawa)  R 

bS.  An  exploratory  study  to  identify  preconception 
contraceptive  patterns  of  abortion  patients,  by  Judith 
Marv'  E.  Watts.  Vancouver.  1974.  94p.  (Thesis 
(M.S.N.)  —  British  Columbia)  R 

69.  Participation  by  nurses  in  independent  and  de- 
pendent continuing  learning  activities,  by  Kathleen 
M.Clark.  Vancouver,  1974.  I27p.  (Thesis(M.S.N.) 
—  British  Columbia)  R 

70.  Postoperative  cardiac  surgical  patients'  opin- 
ions about  structured  preoperative  teaching  by  the 
nurse,  by  Louise  Dumas.  Birmingham.  Alabama, 

1974.  35p.  (Thesis  (M.Sc.  in  Nurs.)  —  Alabama)  R 


;rnment  documents 
iniaJa 

4  Health  and  Welfare  Canada.  Report  of  cross- 
ariLida  survey  to  examine  the  emergence  of  the  nurse 
raKtnioner.  prepared  for  Federal/Provincial  Health 
Ijnpower  Committee  by  H.  Rose  Imai.  Ottawa, 
Irjith  and  Welfare  Canada.  1974.  84p.  R 
-  National  Research  Council  of  Canada.  Report. 
)t[awa.  National  Research  Council  of  Canada,  1974. 

h   National  Science  Library.  Health  Sciences  Re- 

■urce  Centre.  Canadian  locations  of  journals  in- 

exed  in  Index  Medicus.  Ottawa,  National  Research 

ncil  of  Canada,  1974.  204p.  R 

science  Council  of  Canada.  Knowledge,  power 

niblic  policy,   by  Peter  Aucoin  and  Richard 

jh.  Ottawa.  Information  Canada.  1974.  95p.  (Its 

■ground  Study  no.  31) 

^,^or;  Canada.  Get  fit  —  keep  fit:  a  physical 

i  and  training  guide  for  young  Canadians.  Pre- 

1  by  a  Joint  Committee  of  the  Canadian  Medical 

ciation  and  the  Canadian  Association  for 

uaiih.  Physical  Education  and  Recreation.  Ottawa, 

iforniation  Canada,  1972.  28p. 


\linistere  de  llndustrie  et  du  Commerce.  Bureau 
.  ..iStatistiquedu  Canada.  Service  del' information. 
nniiaire  de  Quebec.  Quebec,  Editeur  officiel  du 
luebec,  1973.  915p.  R 
0    Traitement     automatise     des     documents 

•media  avec  les  systemes  ISBD   UNIFIE, 

^  Rousseau  et  PRECIS,  par  Franjoise  Lamy- 
'Usseau.  Propositions  S.I. LP.  Quebec  (ville). 
Inistere  de  I'Education.   Service  general  des 

^ns  d'enseignement,  cl974.  214p. 

ruled  States 

i    Food  and  Drug   Administration.   Bureau  of 

idiological  Health.  A  practitioner's  guide  to  the 

:iiostic  X-ray  equipment  standard.    Rockville, 

.  1974.  lip. 
-   John  E.  Fogarty  International  Centre  for  Ad- 
jnced  Study  in  the  Health  Sciences.  China  medicine 
'  Hc  saw  it.  Edited  by  Joseph  R.  Quinn.  Bethesda, 
'     .  U.S.  Depanment  of  Health.  Education,  and 

tare.  Public  Health  Services.  National  Institutes 

Health.  1974.  430p.  (U.S.  DHEW  Pub.  No. 
-■IH)  75-684) 

Public  Health  Service.  Division  of  Nursing.  5.vj- 

:!ic  nursing  assessment,  a  step  toward  automa- 
Project  director.  Deane  B.  Taylor  and  Research 

>,iate,  Onalee  H.  Johnson.  Bethesda,  Md.  1974. 

p   (U.S.  DHEW  Pub.  No.  (HRA)  74-17) 

DIES  DEPOSITED  IN  CMA  REPOSITORY  COLLECTION 

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classified  advertisements 


ALBERTA 


BRITISH  COLUMBIA 


BRITISH  COLUMBIA 


JEGISTEHED  NURSES  required^or  70  bed  accredited  active 
eatment  Hospitai  Full  time  and  summef  reiiel.  All  AARN  per- 
innel  policies.  Apply  m  writing  to  the:  Director  of  Nursing, 
umtieller  General  Hospital.  Drumfieller.  Alberta. 


BRITISH  COLUMBIA 


iPERATING  ROOM  NURSE  wanted  for  active  mo- 
ern  acute  hospital.  Four  Certified  Surgeons  on 
ttendmg  staff  Experience  of  training  desirable. 
'ust  be  eligible  for  B  C  Registration.  Nurses 
isidence  available.  Salary  according  to  RNABC 
lontract  Apply  to  Director  of  Nursing.  Ivlills  Mem- 
irlil  Hospital.  2711  Tetrault  St..  Terrace.  British 
imbia. 


REGISTERED  NURSES  AND  NURSING  SUPERVISORS  re- 
quired by  a  100-t»ed  acute  care  and  40-t>ed  extended  care 
accredited  hospital.  Must  be  eligible  for  BO  registration 
Supervisory  applicants  must  have  experience  in  administrative 
or  supervisory  nursing  RN  s  salary  $985.  to  SI. 163  and 
Supervisors  salary  S1.181  to  S1.391  (RNABC  Agreement  — 
1975)  Apply  in  writing  to  the:  Director  of  Nursing.  OR.  Baker 
IVIemorial  Hospital.  543  Front  Street,  Ouesnel.  British  Columbia. 
V2J2K7. 


REGISTERED  NURSES  are  invited  to  apply  to  this  active 
Regional  Referral  Hospital  in  the  B.C.  Interior.  The  hospital  has 
40(>-beds  and  an  expansion  programme  underway.  All  clinical 
specialties  are  represented  and  provide  opportunities  for  varied 
nursing  experience.  RNABC  contract  in  effect  B  C  registration 
is  required  1975  staff  nurse  rale  is  $985.00  to  $1,163  00  per 
month.  Please  direcl  all  correspondence  to:  Director  of  Person- 
nel Services,  Royal  Inland  Hospital.  Kamloops.  British  Colum- 
bia, V2C2T1 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  care 
hospitai  in  Northern  B.C  residence  accommodations  available. 
RNABC  policies  in  effect  Apply  to:  Director  of  Nursing.  Mills. 
Memorial  Hospital.  Terrace.  British  Columtiia,  V8G  2W7 


NOVA  SCOTIA 


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REGISTERED  NURSE  (Full  Time)  required  lor  62-bed  active 
treatment  hospital  Permanent  night  duty  medical  unit  Salary  in 
accordance  with  R.N. A.N  S.  Apply,  giving  full  particulars  and 
references  in  first  letter,  to:  Director  of  Nursing.  All  Saints'  Hospi- 
tal. Spnnghill.  Nova  Scotia. 


ONTARIO 


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lications  are  invited  for  a  very  interesting  and  challenging 
position  We  require  a  B.C.  REGISTERED  NURSE  10  assist 
_  Nurse  Administrator  to  be  classified  as  a  Head  Nurse 
■elerence  will  be  given  one  with  pnor  Emergency  or  Obstelnc 
ursing  expenence  and  having  successfully  completed  the 
ursing  Unit  Administration  course.  The  hospital  is  a  newly 
jened  one  situated  on  the  Yellowhead  Highway,  80  miles  norm 

Kamloops,  BC,  The  area  is  a  vacationers  paradise  both  m 
iimmer  and  Winter,  RNABC  salary  scale  and  fringe  benefits 
jplicable.  Please  reply  to:  Mrs.  K,  Rice.  Nurse  Administrator. 

Helmcken  Memonal  Hospital.  Cleamvater.  British  Columbia. 


ADVERTISING 
RATES 

FOR   ALL 
CLASSIFIED    ADVERTISING 

$15.00   for   6   lines   or   less 
$2.50  for  each   odditiorxil   line 

Rotes   for    disploy 
odvertisements   on    request 

Closing  dole  for  copy  and  conceiiofion  is 
6  weeks  prior  to  1st  day  of  publicotion 
month. 

The  Canodian  Nurses'  Associotion  does 
not  review  the  personnel  policies  of 
the  hospitals  and  agencies  odvertising 
m  the  Journal.  For  authentic  information, 
prospective  applicants  should  apply  to 
the  Registered  Nurses'  Associotion  of  the 
Province  in  which  they  ore  interested 
in    working. 


Address  correspondence  to: 

The 

Canadian  Ai 
urse        ^ 

50  THE  DRIVEWAY 
OTTAWA,  ONTARIO 
K2P 1E2 


EXPERIENCED  NURSES  (eligible  for  B.C.  registration)  required 
for  409-bed  acute  care,  leaching  hospital  located  in  Fraser 
Valley.  20  minutes  by  freeway  from  Vancouver,  and  within 
easy  access  of  varied  recreational  facilities.  Excellent  Orienta- 
tion and  Continuing  Education  programmes.  Salary  SI  .026.00  to 
$1,212.00.  Clinical  areas  include  Medicine.  General  and  Spe- 
cialized Surgery.  Obstetrics,  Pediatrics,  Coronary  Care,  Hemo- 
dialysis, Rehabilitation  Operating  Room,  Intensive  Care.  Emer- 
gency PRACTICAL  NURSES  feliQible  for  B.C  License)  also 
required  Apply  to:  Administrative  Assistant.  Nursing  Personnel. 
Royal  Columbian  Hospital.  New  Westminster.  British  Columbia. 
V3L  3W7 


GRADUATE  NURSES  —  Looking  for  variety  in  your  work': 
Consider  a  modern  10-bed  hospital  located  on  a  beautiful  fiord- 
type  inlet  of  Vancouver  Islands  west  coast.  Apply:  Administrator, 
Box  399,  Tahsis,  Bntish  Columbia,  VOP  1X0, 


GRADUATE  NURSES  for  21 -bed  hospital  preferably 
with  obstetrical  experience.  Salary  in  accordance 
with  RNABC  Nurses  residence.  Apply  to.  Matron, 
Tofino  General  Hospital,  Tolino,  Vancouver  Island, 
Britisti  Columbia, 


EXPERIENCED  GENERAL  DUTY  NURSES  AND  LICENSED 
PRACTICAL  NURSES  required  for  small  upcoast  hospitai  Sal- 
ary and  personnel  policies  as  per  RNABC  and  H  E  U,  contracts 
Residence  accommodation  $25  00  per  month  Transportation 
paid  from  Vancouver,  Apply  to:  Director  of  Nursing,  St  George's 
Hospital.  Alert  Bay,  British  Columbia,  VON  1A0 


GENERAL  DUTY  NURSES  for  modern  41-bed  hospital  located 
on  the  Alaska  HigRway,  Salary  and  personnel  policies  in 
accordance  with  RNABC,  Accommodation  available  in  resi- 
dence. Apply:  Director  of  Nursing,  Fort  Nelson  General  Hospital, 
Fon  Nelson.  Bntish  Columbia. 


GENERAL  DUTY  NURSES,  for  modern  35-bed  hospital  located 
in  southern  B  C  s  Boundary  Area  with  excellent  recreation  faci- 
lities Salary  and  personnel  policies  in  accordance  with  RNABC 
Comfortable  Nurses  s  home.  Apply,  Director  of  Nursing,  Bound- 
ary Hospital,  Grand  Forks,  British  Columbia, 


WANTED:  GENERAL  DUTY  NURSES  for  modern  70- 
bed  hospital.  (48  acute  beds— 22  Extended  Care) 
located  on  the  Sunshine  Coast.  2  hrs.  Irom  Vancou- 
ver Salaries  and  Personnel  Policies  in  accordance 
with  RNABC  Agreement.  Accommodation  available 
(female  nurses)  m  resrdence.  Apply:  The  Director 
of  Nursing.  St.  Mary  s  Hospital,  P,0  Box  678,  Se- 
otielt,  British  Columbia. 


GENERAL  DUTY  B.C.  REGISTERED  NURSES,  full  accredited 
39-t)ed  hospitai  Comfortable  nurses  residence.  RNABC  Ag- 
reement in  effect  Apply:  Mrs.  E.  Neville.  R.N..  Director  of  Nurses. 
Golden  and  District  General  Hospital.  P.O.  Box  1260,  Golden, 
British  Columbia.  VOA  IHO. 


SUPERVISOR    IN    PUBLIC    HEALTH     NURSING    for    the 

Middlesex-London  District  Health  Unit  Challenging  position  in 
progressive  agency.  Excellent  fnnge  benefits  Position  available 
immediately  A  curriculum  vitae  should  be  submitted  to:  Mrs. 
Dorothy  M  Mumby.  Director  of  Public  Health  Nursing.  346  South 
Street,  London,  Ontario,  N6B  1B9, 


PUBLIC  HEALTH  NURSE  —  GREY-OWEN  SOUND  HEALTH 
UNIT  has  an  opening  (or  a  qualified  PUBLIC  HEALTH  NURSE. 
If  you  are  interested  m  obtaining  more  information  about  this 
position  please  contact  Miss  E,  Davidson,  B  Sc  N,,  Director  of 
Nursing,  Grey-Owen  Sound  Health  Unit,  County  Building,  Owen 
Sound,  Ontario,  N4K  3E3 


PUBLIC  HEALTH  NURSE  required  for  generalized  programme 
in  combined  rural  and  urtian  area  in  Southern  Ontario,  Allowance 
for  experience  and/or  degree  Generous  fringe  benefits  and  car 
allowance  Apply  to  Supervisor  of  Nursing.  Miss  Mane  I.  Elson. 
Elgin-Sl  Thomas  Health  Unit,  2  Wood  Street,  St,  Thomas,  On- 
tario, 


QUALIFIED  PUBLIC  HEALTH  NURSES  required  for 
generalized  public  health  nursing  program.  Health  Unit  located  in 
a  rapidly  developing  area  of  the  province.  Generous  fringe  be- 
nefits and  car  altowance.  For  application  form  and  further  infor- 
mation wrile  to:  Dr,  H,H,  Washburn,  Medical  Offcer  of  Health, 
Haldimand-Nortolk  Regional  Health  Unit,  Box  247.  Simcoe.  On- 
lano.  N3Y  4L1. 


OPERATING  ROOM  STAFF  NURSE  required  tor  fully  accredi 
ted  75-bed  Hospital  Basic  wage  S689  00  with  consideration  for 
experience  also  an  OPERATING  ROOM  TECHNICIAN,  basic 
wage  $526  00.  Call  time  rates  available  on  request.  Write  er 
phone  the  Director  of  Nursing,  Dryden  Distnct  General  Hospital, 
Dryden,  Ontario 


REGISTERED  NURSES  for  34-bed  General  Hospital 
Salary  S91d00  per  month  to  $1,115,00  plus  experience  al 
lowance  bxcelleni  personnel  policies.  Apply  to: 
Director  of  Nursing,  Englehart  &  District  Hospital 
Inc,  Englehart,  Ontario,  POJ  1H0- 


REGISTERED  NURSES  for  107-bed  General  Hospital  Salary 
range  $915  00  —  $1,1 15  00  plus  experience  allowance.  Yearly 
increments  Excellent  personnel  policies.  Rooming  accommoda- 
tions available  in  town.  Apply  to:  Director  of  Nursing,  La  Veren- 
-Irye  Hospital,  Fort  Frances,  Ontario,  P9A  2B7  or  call  collect  (807) 
274-3261 


Your 
Blood  is 
Always 
Needed 


+  i 

BE  A    I 
BLOOD  I 

^:  DONOR : 


III  1975 


THE  CANADIAN  NURSE     55 


ONTARIO 


REGISTERED  NURSES  required  lor  our  ullramodern  79-bed 
General  Hospital  in  bilingual  community  ol  Northern  Ontario 
French  language  an  asset,  but  not  compulsory  Salary  is  $945.  to 
$1 145.  monthly  (sub)ect  to  increase  July  1st)  with  allowance  tor 
past  experience  and  4  weeks  vacation  after  1  year.  Hospital  pays 
100%  ol  OHI.P.  Life  Insurance  (10.000)  Salary  Insurance 
(75%  ol  wages  to  the  age  ol  65  with  U  I  C.  carve-out),  a  35^  drug 
plan  and  a  dental  care  plan  Master  rotation  in  effect.  Rooming 
accommodations  available  in  town.  Excellent  personnel  policies 
Apply  to:  Personnel  Director.  Notre-Dame  Hospital.  P  O.  Box 
850,  Hearst.  Ontario. 


REGISTERED  NURSES  are  required  immediately  lor  our  tully 
accredited  thirty  two  bed  complex  and  active  treatment  hospital 
located  m  beautiful  northern  Ontario.  Our  starting  salary  is 
$856  00  monthly  with  allowance  tor  past  experience  and  four 
weeks  paid  vacation  after  one  year  Hospital  pays  100% 
0  HIP.,  excellent  pension  plan  and  ten  statutory  holidays  per 
year.  Apply  to  The  Director  of  Nursing.  Hornepayne  Community 
Hospital.  Hornepayne.  Ontario 


TWO  REGISTERED  NURSES,  preferably  friends,  for  girls  pri- 
vate camp,  ages  6  to  16.  Camp  located  at  Sundridge.  Ontario. 
175  miles  north  of  Toronto  Dates  ol  camp,  June  27  to  August  22 
Salary  for  season,  $81X1  00,  room  and  board.  Phone:  532-3403. 
Write  to  Mrs  John  W  Gilchnst.  6-A  Wychwood  ParV,  Toronto, 
Ontario,  M6G  2V5 


REGISTERED  NURSES  AND  REGISTERED  NURSING 
ASSISTANTS  lor  45-bed  Hospital  Salary  ranges 
include  generous  experience  allowances  R  N  s 
salary  S945  to  S1  115.,  and  RNA  s  salary  $650  to  $725 
Nurses  residence  —  private  rooms  with  bath  —  $60  per  month 
Apply  to.  The  Director  ol  Nursing.  Geraldton  District  Hospital. 
GeraWlon.  Ontaro.  POT  1  MO 


REGISTERED  NURSES  FOR  GENERAL  DUTY,  I.C.U., 
ecu.  UNIT  and  OPERATING  ROOM  required  for 
fully  accredited  hospital-  Starting  salary  $850.00  with 
regular  increments  and  with  allowance  for  experi- 
ence. Excellent  personnel  policies  and  temporary 
residence  accommodation  available  Apply  to:  The 
Director  of  Nursing.  Kirkland  &  District  Hospital. 
Kirldand  Lake.  Cntano.  P2N  1 R2. 


Overnight  camp  in  Ontario  (near  Ottawa)  requires  FULL-TIME 
NURSE  from  June  26- August  14.  1975  For  inlormation  contact: 
L  Hams  P  O  Box  5288.  Station  F  .  Ottawa,  Ontario,  K2C  3H5 
Telephone:  Office  (613)  232-7306  between  3-5  P  M.,  Mondays 
—  Thursdays:  Evenings:  (613)  225-6557 


TWO  NURSES  needed  for  girls  summer  camp  located  on  Eagle 
Lake  40  miles  north  ol  Kingston.  Ontario  June  24  to  August  22 
For  further  inlormatmn  contact.  Mrs  C.  Labbett,  3  Pine  Forest 
Road,  Toronto,  Ontario,  M4N  3E6 


Childrens  summer  Camps  in  Scenic  Areas  of  Northern  Ontario 
Require  Camp  Nurses  for  July  and  August  Each  has  resident 
M.D  Contact:  Harold  B.  Nashman.  Camp  Services  Co-op,  821 
Eglinton  Avenue  West,  Toronto,  Ontario.  M5N  1E6. 


PRINCE  EDWARD  ISLAND 


GENERAL  DUTY  REGISTERED  NURSES  required  lor  50-bed 
(Seneral  Hospital  in  Alberton.  PEL  Residence  accommodation 
available  Apply  Sister  Mane  Cahill,  Director  of  Nursing,  Western 
Hospital,  Alberton,  PEI 


QUEBEC 


ZJ 


REGISTERED  NURSE  required  lor  CO  ed  childrens  summer 
camp  in  the  Laurentians  (seventy  miles  north  ol  Montreal)  from 
JUNE  20,  1975  to  AUGUST  20.  1975  Call  (514)  688  1753  or 
write  CAMP  MAROMAC.  4548  8th  Street.  Chomedey.  Laval. 
Quebec.  H7W  2A4 


Montrsal  Graduate  Nurses  Club,  1234  Bishop  Street.  Down- 
town Montreal  Furnished  Single  Rooms  for  rent  with  kitchen 
privileges,  linen  supplied  Reasonable  rates.  Telephone:  (514) 
866-9077 


SASKATCHEWAN 


REGISTERED  NURSE  urgently  needed  for  Northern  15-bed 
outpost  hospital.  Salary  scale  as  set  forth  by  S.U.N.  Apply  to: 
Director  ol  Nursing.  St  Martin  s  HosprtaJ.  LaLoctie.  Saskatch- 
ewan or  phone  coiled:  822-201 1 

56     THE  CANADIAN  NURSE 


REGISTERED  NURSES 
GRADUATE  NURSES 

and 

REGISTERED    NURSING 
ASSISTANTS 

required  for 

FIVE  SUMMER  CAMPS 

Strategically  located  throughout  Ontario 

and  near 

OTTAWA.   LONDON.    COLLINGWOOD, 

PORT   COLBORNE.  KIRKLAND  LAKE 

(accredited  members  —  Ontario  Camping  Association) 

Applications  invited  Irom  Nurses  interested  in  supervisory, 
assistant  and  general  cabin  responsibilities  m  the  field  of 
rehabilitation  of  physically  handicapped  cfiildren 

Apply  in  writing  to: 

Supervisor  of  Camping  and  Recreation 

Ontario  Society  tor  Crippled  Children 

350  Rumsey  Road 

Toronto.  Ontario 

M46  1R8 


SASKATCHEWAN 


^00«E  Co, 

cfc 


Canadore  College 

Applied  Arts  and 
Technology 


TEACHER 
DIPLOMA  NURSING 

Responsibilities  will  include  classroom 
and  clinical  teaching  in  the  Diploma 
Nursing  Program. 

Applicants  must  possess  Ontario 
registration,    a  mininrium  of  a  baccalaureate 
degree  in  Nursing  and  a  minimum  of  two 
years  of  nursing  practice. 

Salary  commensurate  with  preparation  and 
experience  within  the  C.   S-    A.    O. 
agreement. 

Duties  to  commence  in  August.    1975. 

Applications,    stating  qualifications, 
experience,    references  and  other  pertinent 
information  should  be  addressed  to: 
Personnel  Officer,    Canadore  College  of 
Applied  Arts  and  Technology,   P.  O.    Box 
5001.    North  Bay.    Ontario.     P1B8K9 


FUN  FLON  GENERAL  HOSPITAL 
FLINFLON,  MANITOBA 

Opportunities  are  available  in  this  modern 
125  bed  hospital  in  the  summer  and  winter 
vacation  land  of  Northern  Manitoba  for 
suitably  qualified  nurses.  Vacancies  exist 
for; 

Night  Supervisor 

Nursing  In-Service  Instructor 

General  Duty  Nurses  —  all  services 

Good  salary  and  working  conditions,  ac- 
commodation available  in  the  residence. 

For  further  details  appfy  — 

Pet^onnel  Office 

Flin  Flon  General  Hospital 

Fiin  Flon,  Manitoba 

R8A1N2 


R.N.  required  Immediately  —  Porcupine  Carragana  Unio 
Hospital  requires  General  Duty  Registered  Nurse  immecliatel> 
Salary  scale  and  fringe  benefits  as  negotiated  by  SUN.  Moder 
20- bed  hospital  Near  Provincial  Park.  Progressive  communit) 
Apply,  in  writing,  to  Administrator  Porcupine  Carragana  Unio 
Hospital.  Box  70.  Porcupine  Plain,  Saskatchewan.  SOE  IHO. 


UNITED  STATES 


R.N. '8  —  Openings  nov**  available  in  a  variety  of  areas  of  a  45 

bed  teaching  and  research  hospital  affiliated  with  the  school  - 
medicine  of  Case  Western  Reserve  University.  New  facili 
opening  in  the  spring  Personalized  orientation,  excellent  salar 
full  paid  benefits  and  housing  available  in  hospital  residenc 
Will  assist  you  with  H  1  visa  for  immigration.  A  license  in  Ohc 
practice  nursing  is  necessary  for  employment  For  furthi 
information  write  or  phone:  Mrs  Mary  Hernck.  Personn 
Department,  Saint  Luke  s  Hospital,  11311  Shaker  Blvd..  Devi 
land.  Ohio,  44104,  Phone:  Monday  -  Friday.  9  A.M.  ■  4  P.V 
1-216-368-7440. 


RN's     and     LPN's  —  University     Hospital     North, 

teaching  Hospital  of  the  University  of  Oregon  Medic* 
School,  has  openings  m  a  variety  of  Hospital  sei 
vices  »  We  offer  competitive  salaries  and  exceller 
fringe  benefits.  Inquires  should  be  directed  to  Gai 
Rankin.  Director  of  Nursing.  3171  SW  Sam  Jackso 
Park  Road,  Portland.  Oregon,  97201 . 


TEXAS  wants  you!  if  you  are  an  HN.  experienced  o 
a  recent  graduate  come  to  Corpus  Christi  Sparklm 
City    by    the    Sea  a    city    building    for    a    bette 

future  where  your  opportunities  for  recreation  an 
studies  are  hmitiess  f^emorial  Medical  Center  60C 
bed  general  teach mg  hospital  encourages  caree 
advancement  and  provides  in-service  onentatior 
Salary  from  S682  00  to  S940  00  per  mpnth  corr 
mensurate  with  education  and  experience  Differenli; 
for  evening  shifts  available  Benefits  include  hoi 
days,  sick  leave  vacations,  paid  hospitalizatiot 
health,  life  insurance,  pension  program  Become 
vital  part  of  a  modern  up  to-date  hoSpital  write  i 
call  collect  John  W  Cover  Jr  Director  of  Pe 
sonnel  Memorial  Medical  Center.  PO  Box  528 
Corpus  Christi.  Texas.  78405. 


REMEMBER 

HELP  YOUR  RED  CROSS 

TO  HELP 


+ 


I 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from 

REGISTERED  NURSES 

54-bed  accredited  general  hospi^ 
tal.  Northeastern  Ontario.  Compel 
titive  salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to; 

MISS  E.  LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  ICO 


APRIL  19/ 


DURHAM      ""^^      COLLEGE 

OF  APPLIED  ARTS  &  TECHNOLOGY 

requires 

1.  A  DIRECTOR  OF  THE  NURSING  DIVISION 

The  School  of  Nursing  has  a  staff  of  28  faculty  and  about  300 
students  enrolled  in  RN  and  RNA  programmes.  The  Director  will 
have  had  several  years'  experience  in  education  and  management 
as  well  as  the  necessary  experience  in  clinical  nursing. 

2.  A  CLINICAL  DEPARTMENT  HEAD 

T"he  incumbent  will  be  responsible  for  the  planning  and  implementa- 
on  of  the  clinical  component  of  nursing  training  for  the  School  of 
■^iursing  in  area  hospitals  and  nursing  homes,  and  tor  the  supervi- 
sion of  the  teaching  staff  so  involved. 

Candidates  for  either  position  should  hold  at  least  a  Bachelor's 
Degree  in  Nursing  or  its  equivalent.  Duties  will  commence  not  later 
than  June  1 .  1975.  Salary  will  be  commensurate  with  qualifications. 

Pfaase  apply  In  writing  to: 

The  Personnel  Officer 

Durtiam  College  of  Applied  Arts  &  Technology 

P.O.  Box  385 

Oshawa,  Ontario,  L1H  7L7 

All  replies  will  be  treated  confidentially. 


FOOTHILLS  HOSPITAL 
Calgary,  Alberta 

Advanced  Neurological- 
Neurosurgical  Nursing 

for 
Graduate  Nurses 

a  five  month  clinical  and 

academic  program 

offered  by 

The  Department  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

(Department  of  Surgery) 

Beginning:  September,  1975 
March,  1976 


Limited  to  8  participants 
Applications  now  being  accepted 


For  further  information,  please  write  to: 

Cc-ordinator  of  In-service  Education 

Foothills  Hospital 

1403  29  St.  N.W.    Calgary,  Alberta 

T2N  2T9 


1976 

Announcement  —  Competition 
W.H.O.  Travel  Fellowships 


Each  year,  the  World  Health  Organization  allocates  a 
number  of  Travel  Fellowships  to  Canada  for  the  study 
abroad  of  health  care,  in  order  to  increase  Canadian 
knowledge  of  various  health  care  delivery  systems. 
The  Fellowship  is  granted  for  short-term  programs  of 
observation  or  training  of  approximately  one  to  three 
months  duration. 

Eligible  to  enter  the  competition  are  Canadian  citi- 
zens engaged  in  operational  or  educational  aspects  of 
public  health  and  health  care  in  a  professional  capac- 
ity. Ineligible  are  workers  in  pure  research,  persons 
who  wish  to  attend  international  meetings,  students  in 
the  midst  of  undergraduate  or  graduate  courses,  and 
applicants  more  than  55  years  of  age.  As  some  clas- 
ses of  health  workers,  for  example,  employees  of  the 
federal  government,  have  easier  access  to  other 
sources  of  training  assistance,  they  may  apply  but 
their  applications  will  be  given  a  low  priority. 

Candidates  will  be  rated  and  chosen  by  a  selection 
committee  on  the  basis  of  their  education  and  experi- 
ence, the  field  of  activity  they  propose  to  study,  and  the 
intended  use  of  the  knowledge  gained  during  the  fel- 
lowship upon  return  to  this  country. 

Employers  of  successful  candidates  are  expected  to 
endorse  applications  and  continue  salary  during  the 
Fellowship  because  the  WHO  award  will  cover  only 
per  diem  maintenance  and  transportation.  Because  of 
the  tourist  and  holiday  season,  WHO  will  not  entertain 
applications  which  feature  visits  to  Europe  and/or 
Scandinavia  between  June  15  and  September  15. 


Applications  should  be  submitted  before  September  30, 

1975. 


Information  and  forms  may  be  obtained  from: 

International  Health  Services 
National  Health  and  Welfare 
Brooke  Claxton  Building 
Ottawa,  Ontario 
K1A  0K9 


j^lL  1975 


THE  CANADIAN  NURSE      57 


The  Brome-MJssisquoi-Perkins 
Hospital 

requires 

1  Day  Supervisor 
1  Night  Supervisor 
Registered  Nurses 

Please  write  to: 

Director  of  Nursing 
Brome-Missisquoi-Perkins  Hospital 
950  Main  Street 
Cowansville,  Quebec 
J2K1K3 


HEAD  NURSE 

Emergency  Department 


Required  for  modern,  well-equipped.  250  bed  General 
Hospital,  centrally  located  in  Southwest  Ontano  University 
town  less  than  one  hour  from  Toronto/Hamilton, 


Applicants  should  be  registered  in  the  Province  of  Ontano. 
have  at  least  2  years  Emergency  nursing  expehence  and 
preferably  some  experience  in  a  senior  position.  Addi- 
tional preparation  such  as  Nursing  Unit  Administration 
diploma  and /or  Baccalaureate  degree  would  be  desira- 
ble 


Applications  should  tM  submitted  to: 

Personnel  Officer, 
Guelph  General  Hospital, 
115  Delhi  Street, 
Guelph,  Ont.  N1E  4J4. 


REGISTERED  NURSES 


Registered  Nurses  required  for  large 
metropolitan  general  hospital. 
Positions  available  in  all  clinical  areas. 
Salary  Range  in  effect  until  December 
31,1975. 

$900.  —  $1,075.  Starting  rate  de- 
pendent on  qualifications  and  experi- 
ence. ■ 


Apply  to: 


Staffing  Officer-Nursing 
Personnel  Department 
Edmonton  General  Hospital 
Edmonton,  Alberta 
T5K  0L4 


DIRECTOR 
OF  NURSING 

Applications  are  invited  for  this  position  in  a  53 
bed  accredited  hospital  located  in  south  eastern 
New  Brunswick. 

The  position  will  l3e  available  on  or  Ijefore  June 
1st  1975. 

The  successful  applicant  should  have  a  Bachelor 
of  Science  in  Nursing,  or  the  equivalent,  along 
with  experience  in  a  senior  nursing  administrative 
capacity. 

Reply  in  confidence,  giving  full  details  as  to  ex- 
perience, education  and  references  to: 

The  Administrator 
Sackville  Memorial  Hospital 
Sackville,  New  Brunswick 
EGA  3C0 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

Staff  nurses  for  St.  Anthony.  New  hospital  of 
150  beds,  accredited.  Active  treatment  in  Surgery. 
Medicine,  Paediatrics.  Obstetrics.  Psychiatry. 
Large  OPD  and  ICU.  Orientation  and  In-Service 
programs.  40-hour  weel<.  rotating  shifts.  PUBLIC 
HEALTH  has  challenge  of  large  remote  areas. 
Furnished  living  accommodations  supplied  at  low 
cost.  Personnel  benefits  include  liberal  vacation, 
and  sick  leave,  travel  arrangements.  Staff  RN 
S637  —  $809,  prepared  PHN  $71 2  —  $903,  steps 
for  experience. 


Apply  to: 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Anthony.  Newfoundland 

AOK  4S0 


UNIVERSITY  HOSPITAL 
SASKATOON,  SASKATCHEWAN 

Requires 

REGISTERED  NURSES 

for 
Specialized  and  General  areas 

Policies  according  to  S.U.N,  contract 
Apply  to: 

Employment  Officer,  Nursing 
University  Hospital 
SASKATOON,  Saskatchewan 
S7N  0W8 


A 


ST.  MICHAEL'S  HOSPITAI 

Toronto,  Ontario 

invites  applications  from 

REGISTERED  NURSES 

for 

INTENSIVE    CARE 
and  "STEP-DOWN"  UNITS 


Planned  orienlation  and  in-service  programme  will  ena- 
ble you  to  collaborate  in  the  most  advanced  ot  treatment 
regimens  for  the  post-operative  cardio-vascular  and 
other  acutely  iH  patients.  One  year  of  nursing  experience 
a  requirement. 


For  details  apply  to: 

The  Director  of  Nursing, 
St.  Michael's  Hospital, 
Toronto,  Ontario, 
M5B1W8. 


GENERAL  DUTY  NURSES 


Required  Immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit 

Clinical  areas  include:  medicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    v^^ith 
R.N.A.B.G.  contract; 

SALARY:  $850  —  $1 020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


ROYAL  JUBILEE  HOSPITAL 
SCHOOL  OF  NURSING 

requires 


* 


NURSING  INSTRUCTORS 

for 

Medical  Surgical  Nursing 
Pediatric  Nursing 
Psychiatric  Nursing 

Qualifications: 

Baccalaureate  Degree  &  experience,  eligibtiity  tor 
BC.  registration 

Apply  to: 

Director  of  Education  Resources 
Royal  Jubilee  Hospital 
Victoria,  B.C. 
VSR  1J8 


58     THE  CANADIAN  NURSE 


APRIL  19} 


EXTENSION  COURSE  IN 
NURSING  UNIT  ADMINISTRATION 


Registered  Nurses  employed  full  lime  in  management  positions  may  apply 
for  enrolment  in  the  extension  course  in  Nursing  Unit  Administration.  A 
limited  number  of  registered  psycl^iatric  nurses  may  also  enrol.  The  program 
is  designed  for  nurses  who  wish  to  Improve  their  administrative  skills  and  Is 
available  in  French  and  in  English. 

The  course  begins  with  a  five  day  intramural  session  in  late  August  or 
September,  followed  by  a  seven  month  period  of  home  study.  The  program 
concludes  with  a  final  five  day  wor1«shop  session  In  April  or  in  May.  The 
intramural  sessions  are  arranged  on  a  regional  basis. 

The  extension  course  in  Nursing  Unit  Administration  is  sponsored  jointly  by 
the  Canadian  Nurses  Association  and  the  Canadian  Hospital  Association. 

Registered  Nurses  interested  in  enrolling  in  the  1975-76  class  should  submit 
applications  before  May  1 5th.  Early  application  is  advised.  The  tuition  fee  of 
$200.00  is  payable  on  or  tjefore  July  1  st 


For  additional  Information  and  application  forms  direct  enquiries  to: 

Director, 

Extension  Course  in  Nursing  Unit  Administration, 

25  Imperial  Street. 

Toronto,  Ontario.  MSP  1C1. 


^ 

1^ 

m 

\      WELCOME 

1 

S 

© 

1       •" 

I  "THE  NEURO" 

4 

i 

^^ 

^^     ( ^         A  Teaching  Hospital 
^4J*G         of  McGill  University 

1 

^ 

1 

J            Positions  available 
!          for  nurses  in  all  areas 
1       including  Operating  Room 

*        Individualized  orientation 

N 

B 

BA'J' 

i^        On-going  staff  education 

1 

H 

i 

j      (Quebec  language  requirements 
do  not  apply  to  Canadian  applicants) 

fi 

S 

;                             ^pfi  to: 

1 

^M 

>i  "'-'^ri        ^^^  Director  of  Nursing, 
y^t^^jl^f  Montreal  Neurological  Hospital. 
Jr.jT-^          3801  University  Street, 
•^C^^             Montreal  H3A  2B4, 
ih-^%;^:,              Quebec,  Canada. 

FEATURES 


FOOTHILLS  HOSPITAL 

invites  applications  from  graduate  nurses  eligible  for  registration  who 
enjoy  nursing  and 
seek  opportunities  for  personal 
and  professional  growtf) 


Footlillls  is  a  new  766  bed  general  hospital  affiliated  with  the  University  of  Calgary  situated  in 
northwest  Calgary  fifty  miles  east  of  the  Rockies 


—  patient  and  family  -  centred  approach  to  health  care  by  all  team  members 

—  patient  care  departments  in  obstetrics,  paediatrics,  medicine,  surgery, 
neurosurgery,  reactivation,  psychiatry,  intensive  care 

—  Centre  for  southern  Alberta  In  neonatal  intensive  care,  renal  dialysis,  and 
treatment  of  glaucoma,  detached  retina. 

OPPORTUNITY 

—  for  individualized  orientation  program 

—  for  broad  range  of  learning  experiences  and  attendance 

at  in-sen/ice  educational  programs 

—  to  participate  in  planning  your  own  program  of  growth 

—  excellent  personnel  policies 


for  application  form  write  to: 

Mrs.  Claire  Ingles,  personnel  officer. 
Foothills  Hospttal,  Calgary.  Alberta,  T2N  2T9 


''RIL  1975 


THE  CANADIAN  NURSE     59 


REGISTERED 
NURSE 

required  for  the  staff  of  Birtle  District  Hospi- 
tal, Birtle,  t^anitoba. 

Duties  to  commence  March  1st  or  there- 
atx)uts. 

Salary  range  as  per  new  scale  set  by 
M.A.R.N.  as  of  March  1st,  1975.  Credit  for 
past  experience  allowed. 


Apply  to: 


The  Administrator 
Birtle  District  Hospital 
Birtle,  Manitoba 
ROMOCO 


POSITIONS  AVAILABLE 

REGISTERED 
NURSES 

Small  21  bed  modern  hospital.  Situated  in 
Canadian  Rockies,  100  miles  west  of 
Jasper,  Altjerta.  Residence  available.  Hik- 
ing, camping,  boating,  helicopter  skiing. 
Salary  range:  $1,005.00/month  starting. 


Contact- 


Mrs.  E.  Haan 

Director  of  Nursing 

McBride  and  District  l-lospitai 

Box  128 

McBride,  British  Coiumbia 


ST.  THOMAS  -  ELGIN 
GENERAL  HOSPITAL 

Invites  Applications  from 

REGISTERED  NURSES 


To  work  in  our  modern  fully  accredited  400  bed  General 
Hospital  located  in  Southwestern  Ontario. 

We  offer  opportunities  in  medical,  surgical,  paediatric, 
obstetrical  and  geriatric  nursing. 

Our  specialties  include  Coronary  Care,  Intensive  Care 
and  an  active  Emergency  Department. 
Orientation  Program. 
Progressive  Personnel  Policies. 

APPLY  TO: 

Personnel  Office 

St.  Thomas-Elgin  General  Hospital 

St.  Thomas,  Ontario 

N5P  3W2 


DIRECTOR 

of 
NURSING 


Applications  are  invited  tor  the  position  of  Director  of  Nurs- 
ing in  a  fully  accredited  50-bed  Acute  Care  Hospital  lo- 
cated in  the  beautiful  East  Kootenay  Industrial  and  Recre- 
ational area  of  British  Columbia. 

Successful  applicant  will  be  responsible  for  all  nursing 

services  including  In-Service  Education. 

Minimum  qualifications  include  registration  or  eligibility  for 

registration  in  the  Province  of  British  Columbia.  Previous 

training  and  expenence  in  a  senior  nursing  position  is 

required. 

Position  available  September  i,  1975 

P/M«e  apply  In  writing  to: 

ADMINISTRATOR 
Kimberiey  &  Dis'^rict  Hospital 
260  -  4th  Avenue 
Kimberiey,  British  Columbia 
V1A2R6 


LIVERPOOL  HOSPITAL 

NEW  SOUTH  WALES 

AUSTRALIA 

A  230  bed  hospital  —  expanding  to  334 
beds  in  1975.  Acute  Medical,  Surgical,  Ac- 
cident Trauma,  Maternity,  Paediatrics. 

GENERAL  TRAINED  NURSES 

Liverpool  is  situated  20  miles  from  the  heart 
of  Sydney  in  a  semi  rural  area. 

For  furthv  Information  wrlta  to: 

(Miss)  J.M.  Grauss  —  MATRON 
Liverpool  District  Hospital, 
P.O.  Box  103, 
LIVERPOOL,  N.S.W. 
AUSTRALIA 


SOUTH  WATERLOO  MEMORIAL  HOSPITAL 
CAMBRIDGE,  ONTARIO 

CO-ORDINATOR 

SPECIAL  CARE 

HEAD  NURSE 

PAEDIATRICS 

HEAD  NURSE 

MEDICAL-SURGICAL 

New  hosprtal  departments  are  nearing  completion  and 
these  positions  will  be  ot  interest  to  creative  individuals 
looking  for  challenge.  We  offer  a  pleasant  city,  an  oppor- 
tunity to  contribute  to  quality  care  and  a  progressive  nurs- 
ing service  in  a  community  of  oriented,  active  treatment 
hospital. 

If  you  feel  you  have  the  personal  qualifications,  ap-  j 
propnate    experience    and    educational    preparation, 
please  wrrte  to. 

Director  of  Nursing 

South  Waterloo  Memorial  Hoapttal 

Coronation  Blvd. 

Cambridge,  Ontario 

N1R3G2 


GENERAL  DUTY 
NURSES 


—  360-bed  acute  general  hospital 

—  personnel  policies  in  accordance  with 
RNABC  Contract 


Direct  Inqulrlaa  to: 

Director  of  Nursing 

Nanaimo  Regional  General  Hospital 

Nanaimo,  British  Columbia 

V9S  2B7 


ASSISTANT 
DIRECTOR  OF  NURSING 

Career  opportunity  to  assist  in  administration  and 
planning  of  patient  care  in  progressive  348  bed 
hospital.  The  position  will  present  a  challenge  tor 
a  person  with  a  desire  to  achieve  and  maintain  the 
highest  standard  of  excellence  within  the  Nursing 
Department. 

Candidate  should  have  a  minimum  of  a  B.Sc.N. 
Degree  as  well  as  progressive  experience  in 
Nursing  Administration. 

Salary  commensurate  with  experience.  Full  range 
of  benefits  and  excellent  working  conditions. 

Apply  In  conf/dance  to:  — 

DIRECTOR  OF  PERSONNEL 

Public  General  Hospital 

106  Emma  St. 

Chatham,  Ontario 

N7L  1A8 


HEAD  NURSE 
OPERATING  ROOM  SUITE 


For  a  276  bed  fully  accredited  hospital  in  a  uni- 
verse city  of  60,000  population  in  Southern  On- 
tario. We  require  someone  with  management  ex- 
perience and  advanced  preparation  in  Operating 
Room  technique  and  administration. 
Excellent  tjenefits  and  a  salary  commensurate 
with  experience  will  be  offered  plus  extra  for  ad- 
vanced preparation. 

Pl—M  apply  giving  full  reauma  to: 

Personnel  Manager 
St.  Joseph's  Hospital 
80  Westmount  Road 
GUELPH,  Ontario 
N1H  5H8 


60     THE  CANADIAN  NURSE 


APRIL  19 


PRINCE  EDWARD  HEIGHTS 

PICTON,  OhfTARIO 

HEALTH  SERVICES 
CO-ORDINATOR 


Salary: 

$14,80C  — $17,100  per  annum 

$15.200  — $17,600  per  annum.  (April  1,  1975) 

Dutias: 

To  administer  a  total  health  care  program  for  mentally  retarded  residents 
of  non-medical  units,  irrcluding  the  supervision  of  fifteen  staff 

Qualifications: 

Registration  as  a  nurse  in  Ontario.  A  degree  in  nursing  or  a  recognized 
certificate  in  Public  Health.  Several  years  progressively  responsible  ex- 
perience including  supervision  and  some  experience  in  public  health. 


Qua/m*d  applkantt  an  lnvlt»d  to  ttnd  a  rMum*  (o,  or  obtain  turthar 
Information  trom: 


Personnel  Officer 
Prince  Edward  Heights 
Box  440 
Picton,  Ontario 


R.N.'S 


The  Royal  Alexandra  is  a  friendly  place  to  work;  a  modern 
progressive  1000  bed  teaching  hospital  in  the  "just-right- 
size"  city  of  Edmonton,  Alberta. 


Fully  accredited,  the  Royal  Alexandra  offers  challenging  ex- 
perience, on-going  in-service  programs,  generous  fringe 
benefits  and  competitive  salaries.  All  previous  experience  is 
recognized.  You  may  skate,  ski  and  curl  inexpensively.  Ed- 
monton is  within  easy  driving  distance  of  many  lakes  where 
you  may  enjoy  the  sunny  Alberta  summer. 


Vacancies  exist  in  most  areas  including  ICU,  O.R.  &  Psy- 
chiatry. 

Salary  Range  for  General  Duty:  $900.  -  $1075. 

For  Information  plaata  writa  to: 

Mrs.  R.  Tercier 

Director  of  Nursing  Personnel  Administration 

Nursing  Office 

Royal  Alexandra  IHospltal 

10240  KIngsway  Ave. 

EDMONTON,  ALBERTA 

T5H  3V9 


if  Paris  appeals  to  you  . . . 


. .  .so  will  Montreal 


•  modern  700  bed  non-sectarian  hospital 

•  excellent  personnel  policies 

•  Registered  Nurses  and  Nursing  Assistants 
are  asked  to  apply 


•  active  In-Service  Education  program 

•  bursaries  available 

•  Quebec  language  requirements  do  not 
apply  to  Canadian  applicants 


Director,  Nursing  Service 
Jewish  General  Hospital 
3755  cote  ste.  Catherine  Road 
Montreal,  Quebec  H3T  1E2 


ARIL  1975 


THE  CANADIAN  NURSE     61 


RED  DEER  COLLEGE 

NURSING  MANAGEMENT 

OF 

PATIENT  CARE 

A  post-basic  certificate  program,  designed  to  assist  the 
nurse  develop  leadership  skills  in  the  management  of 
direct  patient  care  and  increase  nursing  expertise  m  a 
selected  clinical  area 

Students  may  complete  the  program  m  one-fifteen  week 
term  as  a  full-time  student,  or  register  as  a  part-time  stu- 
dent over  several  terms 

Arrangements  may  be  made  to  combine  fieldwork  with 
employment.  Each  term,  some  of  the  courses  are 
scheduled  m  the  evenings.  Entry  points  are  September 
and  January  each  year 

For  further  information,  contact: 

Red  Deer  College 
P.O.  Box  5005 
Red  Deer,  Alberta 
T4N  5H5 
Phone:  40^-346-3376 


RED  DEER  COLLEGE 

NURSING  FACULTY 

Positions  available  Summer  1975  for  the  fall  term. 
Academic  and  clmical  nursing  qualifications  essential. 

Opportunity  to  participate  m  challenging  and  progressive 
programs  and  new  program  development. 

Programs  currently  offered: 

Diploma  in  Nursing  —  two  year  integrated  program 

Supplemental  Program  in  General  Nursing  for  the  Regis- 
tered Psychiatric  Nurse  —  12  month  program 

Nursing  Management  of  Patient  Care  —  one  term  post 
basic  clinical  program 

For  further  information  write  to: 

Dr.  Gerald  Kelly 
Director  of  Academics 
Red  Deer  College 
Red  Deer,  Alberta 
T4N  5H5 
CANADA 


WEST  COAST  GENERAL  HOSPITAL 
PORT  ALBERNI,  BRITISH  COLUMBIA 


requires  the  following  qualified  Nursing  Person- 
nel: 


OPERATING  ROOM  HEAD  NURSE 
INTENSIVE  CARE  UNIT  NURSE 


Personnel  policies  as  per  RNABC  Contract. 
This  IS  a  139  Acute,  30  Extended  Care  Fully 
Accredited  Hospital  on  Vancouver  Island.  Excel- 
lent recreational  facilities  and  within  easy  reach  of 
Vancouver  and  Victoria. 


Apply: 


Director  of  Nursing 
West  Coast  General  Hospital 
814  -  8th  Avenue  North 
Port  Alberni,  B.C.,  V9Y  4S1 


"MEETING  TODAY'S  CHALLENGE  IN  NURSING  " 

QUEEN     ELIZABETH     HOSPITAL    OF     MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGill  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 
Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound   in   our  clinics  and 

their  numbers  increase  daily  in  our 

Emergency. 

If   you   do   not   like   working  with 

children    and   with   their  families, 

you  would  not  like  it  here. 

If  you  do  like  children  and  their 
families,  we  would  like  you  on  our 
staff. 


Interested      qualified 
should  apply  to  the: 


applicants 


DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108,  Quebec 


MOVING? 
BEING  MARRIED? 

ie  sure  to  notify  us  six  weeks  in  advance, 
otherwise  you  will  likely  miss  copies. 


> 


Attach  the  Label 
From  Your  Last  issue 

OR 
Copy  Address  and  Code 
Numbers  From  It  Here 


<^ 


NEW  (NAME) /ADDRESS: 


Street 


City 


Zone 


Prov. /State  Zip- 

Please  complete  appropriate  category: 

I I     I  hold  active  membership  in  provincial 

nurses'  assoc. 


reg.  no. /perm,  cert./  lie.  no. 
I     )    I  am  a  Personal  Subscriber. 
MAILTO: 

The  Canadian   Nurse 

50  The  Driveway 

OTTAWA,  Canada  K2P  1E2 


62     THE  CANADIAN  NURSE 


APRIL  193 


CHILDREN'S    HOSPITAL    OF 
EASTERN  ONTARIO 

DIRECTOR 
OF  NURSING 


A  new  300  bed  pediatric  teaching  hospital  in  the  Nation's 
capital  offers  a  challenging  opportunity  for  a  person  with 
experience  in  administration  and  pediatric  nursing.  The  can- 
didate must  be  bilingual  and  preferably  qualified  at  the  Mas- 
ters level. 

The  position  is  available  May  1,  1975 


Apply  In  confidence  to: 

The  Director  of  Personnel 

Children's  Hospital  of  Eastern  Ontario 

401  Smyth  Road 

Ottawa,  Ontario 

K1H  8L1 


i 


ORTHOPAEDIC    tC    AR-rHRlTIC 
HOSRI-TAl- 


\=/iw^ 


43  WELLESLEY  STREET,  EAST 

TORONTO,  ONTARIO 
M4Y1H1 

Enlarging   Specialty   Hospital   offers  a   unique 
opportunity  to  nurses  and  nursing  assistants 
interested  in  the  care  of  patients  with  bone  and 
joint  disorders. 
Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  all 

units 

Clinical  specialists  for  Operating  Room,  Intensive 

Care,  Patient  Care  and  Education. 


Dr  Welby  is  a  . . . 
NURSE 


It  seems  clear  from 
watching  this  program 
that  poor  Dr  Welby  is 
spending  2/3  of  his 
time  NURSING. 

The  nursing  profession  at 

the  ROYAL  VICTORIA  HOSPITAL 

is  concerned  about  this. 
We  are  reviewing  nursing 
roles  in  depth  in  this 
teaching  hospital  center, 
and  we  feel  that  we  can 
relieve  Dr  Welby  of  his 
non-doctoring  functions. 

You  are  invited  to  join 

an  extensive  change 

program  in  the  nursing 

profession  at  the 

ROYAL  VICTORIA  HOSPITAL. 

Areas  where  you  can  be  a 
part  of  the  change  program 
are.  Medical  and  Surgical 
Specialties,  Intensive  Care 
Areas,  Operating  Room, 
Psychiatry,  Obstetrics, 
Emergency  and  Ambulatory 
Services. 

No  special  language 
requirement  for  Canadian 
Citizens,  but  the  opportunity 
to  improve  your  French  is 
open  to  you. 

For  Information,  Write  To: 

Anne  Bruce,  R.N., 
Nursing  Recruitment  Officer 
Royal  Victoria  Hospital 
687  Pine  Avenue  West 
Montreal,  Quebec,  Canada 
H3A  1A1. 


PRIL  1975 


THE  CANADIAN  NURSE    63 


WE  CARE 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to 420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 
Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 
Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital. 
NEWMARKET,  Ontario, 
L3Y2R1. 


NORTH  YORK  GENERAL  HOSPITAL 

INVITES  APPLICATIONS  FOR  THE  POSITION  OF 

DIRECTOR  OF  NURSING 


N.Y.G.H.  is  a  586-bed,  fully  accredited,  active  treatment  teaching 
hospital  located  in  North  Metropolitan  Toronto  providing  a  full  range 
of  medical  services. 

Our  Nursing  Philosophy  focuses  on  the  patient  as  an  individual  and 
recognizes  the  importance  of  continuing  education  for  the  improve- 
ment of  patient  care. 

The  Position:  To  provide  creative  and  innovative  leadership  in  ail 
aspects  of  nursing  and  to  direct  the  education  programme  of  the 
training  centre  for  Registered  Nursing  Assistants. 

The  Applicant:  Should  be  eligible  for  registration  with  the  College  of 
Nurses  of  Ontario,  possess, 'as  a  minimum,  a  baccalaureate  degree 
and  have  sufficient  administrative  experience  to  anticipate  the  activi- 
ties essential  to  the  functioning  of  the  Nursing  Department. 


Apply  to: 


Executive  Director 

North  York  General  Hospital 

4001  Leslie  Street 

Willowdale,  Ontario 

M2K  1E1 


NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  for  all  Nursing  Units 
Intensive-Coronary  Care.  Psychiatry,  Med. -Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservice  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries    Reg.  N.  Jan.  1st,  1975  —  915.  —  1,115. 
April  1st,  1975  —  945.  —  1.145. 

R.N.A.  Jan.  1st,  1975  —  686.  —  728. 
July  1st,  1975  —  738.  —  780. 

Contact 
Director  of  Nursing 


Thi.$ 
Put^lkation 
isAiailaUein 

MICROFORM 


Xerox  University  Microfilms 

300  North  Zeeb  Road 
Ann  Arbor,  Michigan  48106 

Xerox  University  Microfilms 

35  Mobile  Drive 
Toronto,  Ontario, 
Canada  M4A  1H6 

University  Microfilms  Limited 

St.  John's  Road, 

Tyler's  Green,  Penn, 

Buckinghamshire,  England 

PLEASE  WRITE  FOR  COMPLETE  INFORMATION 


64    THE  CANADIAN  NURSE 


APRIL  19; 


MEMORIAL  UNIVERSITY 

OF  NEWFOUNDLAND 

SCHOOL  OF  NURSING 


is  expanding  its  B.N.  program,  extramural  courses  and 
continuing  educational  program.  Positions  are  available 
August  1,  1975  for  faculty  who  are  expert  in  teaching,  cur- 
riculum development  and  one  of  the  following  areas. 

PRIMARY  CARE  NURSING 
NURSE  PHYSIOLOGIST 
NURSING  OF  ADULTS 
MATERNAL-CHILD  NURSING 
NURSING  OF  CHILDREN 
MENTAL  HEALTH  NURSING 
COMMUNITY  NURSING 
NURSING  RESEARCH 

Appllcsnts  should  direct  enquiries  to: 

Miss  Margaret  D.  McLean 
Director,  School  of  Nursing 
Memorial  University  of  Nfld. 
,  St.  John's,  Newfoundland  A1C  5S7 


RN'S 


The  Royal  Alexandra  Hospital  offers  a  challenging  position 
to  interested  nurses  in  a  new  45  bed  neonatal  intensive  care 
unit  in  a  large  1000  bed  hospital. 

WE  OFFER: 

(1)  A  teaching  full  time  neonatologist. 

(2)  Formal  orientation  and  in-service  programs. 

(3)  Excellent  salaries  ($900.  —  S1075.)  plus  shift  diffe- 
rential. 

(4)  Three  weeks  holidays  after  one  year  employment 
and  many  other  fringe  benefits. 

Salary  commensurate  with  experience. 


Send  complete  resume  to: 

Mrs.  R.  Tercler 

Director  of  Nursing  Personnel  Administration 

Nursing  Office 

Royal  Alexandra  Hospital 

10240  Kingsway  Ave.  Edmonton,  Alberta 

T5H  3V9 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 
teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

1975  Salary  Scale  $1,026.00  —  $1,212.00  per  month  (subject  to  change) 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 
VANCOUVER  GENERAL  HOSPITAL 
855  WEST  12TH  AVE. 
VANCOUVER,  B.C. 


ARIL  1975 


THE  CANADIAN  NURSE     65 


REGISTERED  NURSES 
LICENSED  PRACTICAL  NURSES 

Salary  Under  Negotiation 
Nm  Rates  Effective  March  1,  1975 
QUALIFICATIONS 

—  Eligible  for  registration  or  license  m  Manitoba 

—  Experience  desirable  but  not  required 

ON-GOING  EDUCATION  AND  DEVELOPMENT 

—  Planned  two  week  onenlation  at  full  salary 

—  Dynamic  in-service  education  programs 

—  Opportunity  to  participate  in  workshops,  professional  association  meetings,  and  community 

activities 

PROGRESSIVE  PERSONNEL  POLICIES 

—  Salary  recognizes  preparation  and  experience 

—  Paid  vacation  based  on  years  ot  experience 

—  Differential  for  evening  and  night  shifts 

—  Life  insurance  and  retirement  plans 

CLINICAL  AREAS 

—  Including  medicine,  surgery,  obstetrics,  gynecology,  pediatrics,  emergency  and  ambulatory 
services,  operating  room,  intensive  and  coronary  care  unit,  and  a  rehabilitation  and  extended 
treatment  centre 

This  lully  accredited  433  bed  hospital  located  in  the  southwestern  region  ot  Manitoba  administers  to 
the  needs  ol  a  University  City  ot  40,000  people,  and  is  the  third  largest  hospital  complex  in  the 
Province  A  single  statf  residence  is  available 
/nteresteo  appiKants  may  write  to: 

Mr,  A.  Leako 

DIRECTOR  OF  PERSONNEL  (ACTING) 

Personnel  Department 

BRANDON  GENERAL  HOSPITAL 

150  McTavlah  Avenue  East 

Brandon,  Manitoba 

R7A  2B3 


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BRANDON  GENERAL  HOSPITAL 
SCHOOL  OF  NURSING 

For 

TWO-YEAR  DIPLOMA  PROGRAM 

POSITIONS  AVAILABLE  AUGUST  1975 

IN 

NURSING  CONTENT  AREAS 

Of 

"FUNDAMENTALS"  —  "MATERNAL  —  CHILD" 
"MEDICAL-SURGICAL"  —  "PSYCHIATRIC  NURSING- 


QUALIFICATIONS: 

Baccalaureate  Degree  in  Nursing  is  required. 

Preference  given  to  applicants  with  experience  in  Nursing  antj 

Teaching.  , 

Apply  In  writing  stating  qualifications,  axpurlunce,  rafarancaa  to: 

Director  of  Personnel 

BRANDON  GENERAL  HOSPITAL 

150  McTavish  Avenue  East 

Brandon,  Manitoba 

R7A  2B3 


Nursing  Care  Coordinator 

(Salary  Range  —  $12,480  —  $14,820) 
BRANDON  GENERAL  HOSPITAL 


Positions  Available  for: 

1.  Maternal  —  Child  Area 

2.  Active  Rehabilitation  and  Extended  Care  Area 

To  be  responsible  for  the  overall  management  of  Nursing  Care 
within  the  defined  area  reporting  to  the  Director  of  Nursing  Services. 

QUALIFICATIONS: 

—  Advanced  preparation  in  ttie  Clinical  Nursing  Specialty  witti  a  baccalaureate  nursing 
degree  preferred 

—  Candidates  with  progressive  experience  in  the  Clinical  Area  v^ho  have  functioned  in  a 
leadership  position  and  demonstrated  administrative  ability  will  be  considered, 

—  Eligible  for  Registration  in  Manitoba, 

Our  hospital  is  a  433  t>ed  complex  including  Intensive,  Acute.  Rehabilitation,  Extended  and 
Ambulatory  Services  where  the  philosophy  of  care  reflects  the  multidisciplinary  team 
approach  concept, 


Interestad  applicants  art  raquastad  to  submit  a  currant  rasuma  outlining 
axparlance  and  aducatlon  history  to: 


Mr.  A.  Lesko 

Acting  Personnel  Director 

BRANDON  GENERAL  HOSPITAL 

150  McTavish  Avenue  East 

Brandon,  Manitoba 

R7A  2B3 


Infection  Control  Nurse  (R.N.) 

Required  for 
BRANDON  GENERAL  HOSPITAL 


MAJOR  RESPONSIBILITIES: 

—  To  coorcJJnate  and  evaluate  hospital  infection  control  program. 

—  Surveillance,  investigation  and  reporting  of  hospital  infections. 

—  Record  and  compile  statistical  data  related  to  hospital  infections- 

—  To  act  as  a  resource  person  in  the  continuing  education  of  hospital  personnel  in 
infection  control 

QUALIFICATIONS: 

—  Eligible  tor  Registration  in  Manitoba. 

—  At  least  three  years  nursing  experience  required  preferrably  in  public  health  nursing  or 
surgical  nursing. 

—  Background  in  infection  control  and/or  epidemiology  an  asset. 

SALARY: 

—  Competitive,  based  on  preparation  and  experience 

Our  hospital  is  a  433  bed  complex  including  Intensive,  Acute,  Rehabilitation,  Extended,  and 
Ambulatory  Services  where  the  philosophy  of  care  reflects  the  multidisciplinary  team 
approach  concept 


Intaraaiad  applicants  are  raquaatad  to  submit  a  currant  reauma  outlining  j 
axparlanca  and  aducatlon  history  to: 

Mr.  A.  Lesko 

Acting  Personnel  Director 

BRANDON  GENERAL  HOSPPTAL 

150  McTavish  Avenue  East 

Brandon,  Manitoba 

R7A  2B3 


66    THE  CANADIAN  NURSE 


APRIL  1? 


REGISTERED  NURSES 

Immediate  Openings  in  all  Services 


Come  work  and  ptay  in  Newfoundland  s  second  largest  cily! 

Corner  Brook  has  a  population  of  approxtmatety  35.000  with  a  teniperate  climate  in 
comparison  with  most  of  Canada.  Outdoor  life  is  among  the  finest  to  be  found  in  North 
Amenca  The  airports  serving  Comer  Brook  are  at  Deer  Lake.  32  miles  away,  and 
Stephenviile  50  miles  away  Connections  with  these  airports  make  readily  available  air 
travel  anywhere  m  the  world 

—  Salary  Scale:  $7,652.  —  $9,715.  per  annum;  Contract  expires  March  31, 
1975. 

—  Service  Credits  —  One  step  for  four  years  experience;  two  steps  for  six 
years  experience  or  more. 

—  Educational  differential  for  B.N.  and  master's  degree  in  Nursing. 

—  $2.00  per  shift  for  Charge  Nurse. 

—  S50.00  uniform  allowance  annually. 

—  20  wording  days  annual  vacation. 

—  8  statutory  holidays. 

—  Sick  Leave  —  M/2  days  per  nx)nth. 

—  Accommodation  available. 

—  Two  week  orientation  on  commencenwnt 

—  Continuing  Staff  Education  program. 

—  Transportation  available. 

At  the  present  time  a  major  expansion  project  is  in  progress  to  provide  regional  hospital 
facilities  for  the  West  Coast  of  the  Province  The  Hospital  will  have  a  350  bed  capacity  by 
June.  1975,  Services  include  Medicine.  Surgery.  Paediatrics.  Obstetrics.  Psychiatry,  CCU 
and  ICU. 


Letters  of  apptication  should  be  aubmMod  to: 

Director  of  Personnel 
WESTERN  MEMORIAL  HOSPITAL 
CORNER  BROOK,  NFLD. 
k  A2H6J7 


THE  TORONTO  WESTERN  HOSPITAL 

"THE  HOME  OF  FRIENDLY  CARE 
AND  PROTECTION' 

invites  applications  for 

General 
Staff  Nurse  Positions 


An  800-bed  downtown  teaching  hospital  affiliated  with  the 
University  of  Toronto. 

Many  specialty  services,  also  general  medicine  and  surgery. 

Salaries  and  fringe  benefits  comparable  to  other  similar  hos- 
pitals. 


n««M  apply  to: 


Staff  Co-Ordinator 
Nursing  Service 
399  Bathurst  Street 
Toronto,  Ontario 
M5T  2S8 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 


^m^ 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


f  1L  1975 


THE  CANADIAN  NURSE     67 


TWO  COMMUNITY  HEALTH 
NURSES  REQUIRED 

The  Queen  Charlotte  Islands  Regional  Health  and  Human  Re- 
sources Council  invites  applications  from  registered  nurses  in- 
terested in  working  in  an  "expanded  role"  within  the  context  of  an 
integrated  community  health  and  social  services  program.  The  posi- 
tions are  for  the  towns  of  Sandspit  and  Port  Clements  in  the  Queen 
Charlotte  Islands  and  duties  will  involve  the  operation  of  clinics  with 
visiting  medical  and  social  services  personnel.  RN's  will  be  ex- 
pected to  have  or  obtain  training  in  industrial  first  aid  and  "expanded 
role"  functions. 

Qualifications  Desired: 

—  Registrability  in  British  Columbia. 

—  B.Sc  N  degree,  preferably  a  Masters  Degree. 

—  Minimum  requirements:  Diploma  graduate  with  successful  com- 
pletion of  a  course  of  study  to  equip  her  for  an  expanded  role. 

Experience: 

—  A  Minimum  of  three  years  of  supervised  experience  preferably  in 
a  community  health  setting. 

Salary  and  Benefits: 

—  Commensurate  with  educational  preparation  and  experience 
and  within  the  salary  structure  as  outlined  in  The  Community 
Services  Nurses  Component  Agreement  for  Provincial  Nurses. 

Apply  In  writing  to: 

Mr.  Jonathan  Howland 
Co-ordinator/Di  rector 
Queen  Charlotte  Island  Regional 
Health  and  Human  Resources  Council 
Box  346,  Masset,  B.C. 


MOHAWK  COLLEGE 
OF  APPLIED  ARTS  AND  TECHNOLOGY 

DIVISION  OF  HEALTH  SCIENCES 
DEPARTMENT  OF  NURSING 


invites  applications  for  faculty  positions  for  a  dynamic  pro- 
gressive nursing  program.  Applicants  possessing  Bachelor 
of  Nursing  degree  wWh  two  years  of  experience  In  nurs- 
ing practice  will  be  given  preference. 

Duties  to  commence  August  1,  1975 


Application  must  be  submitted  In  writing  to: 

Manager  of  Personnel  Relations 

Mohawk  College  of  Applied  Arts  and  Technology 

135  Fennell  Avenue  West 

Hamilton,  Ontario 

L8N  3T2 


VACANCY 


Instructor  for  Nursing  III  area  of  a  two  year  program 

Required  Qualification:  Baccalaureate  Degree  in  Nursing. 

Excellent  fringe  benefits  such  as  twenty  days  Annual  Vacation,  Pension  Plan,  Group  Life 

Insurance,  etc. 

Residence  accommodation  available  plus  transportation  allowance. 

Salary  negotiable  depending  on  qualifications  and  experience. 


Apply  to: 


(IVIrs.)  SHIRLEY  M.  DUNPHY 
Director  of  Personnel 
Western  Memorial  Hospital 
CORNER  BROOK,  NEWFOUNDLAND 
A2H  6J7 


5 


68    THE  CANADIAN  NURSE 


APRIL  1 


JUDY  HILL  MEMORIAL  SCHOLARSHIP 


Applications  are  being  received  for  this  annual  Scholarship, 
details  of  which  are  as  follows: 

VALUE  —  up  to  $3,500.00 

PURPOSE-  To  fund  post-graduale  nursing  training  (with  special  emphasis  on 
mtdwrtery  and  nurse  practitioner  training)  for  a  period  of  up  to  one  year 
commencing  July  1st.  1975- 

TENABLE-        In  Canada,  the  United  Kingdom.  Australia,  and  New  Zealand. 

APPLICANTS  should  possess  the  following  qualifications: 

Fluency  in  English; 
*  R-N   Diploma,  or  equivalent: 

A  desire  to  worU  for  the  Government  of  Canada  or  one  of  its  Provinces  at  a  fly-in  nursing 
station  in  a  remote  area  of  Northern  Canada  for  a  minimum  period  of  one  year 
following  completion  of  the  scholarship  year  (Details  of  this  work  will  be 
fonwarded  on  request  ) 

AND  SHOULD  SUBMrT: 

A  resume  of  their  academic  and  nursing  career  to  date; 

Copies  of  the  educational  qualifications  submitted  on  entry  to  nursing 

school; 

Verffication  of  their  R  N   Diploma,  or  equivalent; 

Their  proposed  course  of  study: 

Acceptances  and/or  preferences  for  place  of  study;  Two  character 

refererKes 


TO:  Philip  G.C  Kelchum. 

Chairman,  The  Board  of  Trustees. 

Judy  Hill  Memorial  Fund, 

829  Centennial  Building, 

Edmonton.  Alberta. 

Canada 
BY:  May  I5th.  1975 


The  Scholarship  is  contingent  on  the  successful  applicant  s  being  registrable  by  a 
nursing  association  in  one  of  the  Canadian  provinces  and  meeting  current  Canadian 
immigration  requirements  for  landed  immigrant  status  A  successful  applicant  from 
outside  Canada  will  be  assisted  by  the  Trustees  in  meeting  these  requirements. 


LECTURERS  IN  NURSING 
STURT  COLLEGE  OF  ADVANCED  EDUCATION 


South  Australia 

Sturt  College  ot  Advanced  Education  situated  m  Adelaide  has  begun  m  1975  the  first  tertiary-level 
Diploma  in  Nursing  Course  in  South  Australia  in  co-operation  with  Flinders  Medical  Centre,  a  new 
maior  teaching  hospital  and  medical  school  located  on  an  adjoining  campus  and  with  other  health 
agencies  in  the  area  It  will  also  Degin  in  1975  a  course  in  Speech  and  Hearing  Science  The  College 
enjoys  autonomy  under  the  governance  of  its  own  Council  and  is  currently  engaged  in  the  preparation 
of  primary  and  secondary  teachers  There  are  plans  to  diversify  into  other  areas  of  training  for  health 
professions  and  social  welfare 

Applications  are  invited  from  nurses  eligible  for  registration  in  South  Australia,  with  appropriate 
qualifications  as  indicated.  Each  lecturer  appointed  will  have  a  special  area  of  responsibility,  related  to 
his/her  particular  preparation  and  interests  Beyond  this,  the  lecturers  will  share  responsibility  tor  the 
general  activities  within  the  nursing  programme 

Position  1.  Nurse  wilti  a  degree  in  Sociology,  Social  Anthropology,  or  Social  Administ- 

ration to  assist  in  ttie  programme  of  Social  and  Behavioural  Sciences 
applied  to  nursing  and  relating  Itiese  studies  to  the  ttieory  and  practice  of 
nursing. 

Position  2.  Nurse,  preferably  with  a  degree,  with  posl-basic  training  and  eiperience  in 

Community  Health  Nursing,  to  plan  and  implement  in  conjunction  with 
ottter  members  of  staff,  a  community  health  module  consisting  of  theory 
and  practice.  Teaching  experience  in  Community  Healtli  would  be  an 
advantage 

The  Salary  Range  is  expected  to  be:— 

Lecturer  AJ11.2S0  —  AS15.100 

Assislant  Lecturer  AS  9.180  —  AS10.840 


Appointments  will  be  made  within  these  ranges  depending  on  qualifications  and  experience  The 
usual  CAE  conditions  of  appointment  and  staff  benefits  will  apply.  The  appointee  will  be  expected  to 
commence  duty  as  early  as  possible  in  1975 

The  closing  date  tor  appllcalions  is  April  30th ,  1 975.  Applicants  should  be  prepared  to  forward  a 

curriculum  vitae.  including  personal  details.  Qualifications  experience,  and  the  names  and 
addresses  of  three  referees  from  whom  confidential  information  may  be  sought.  Further  particu- 
lars and  application  forms  may  be  obtained  from  Ihe  ACADEMIC  REGISTRAR,  STURT  COUEGE  OF 
ADVANCED  EDUCATION.  STURT  ROAD,  BEDFORD  PARK.  SOUTH  AUSTRAUA  5042.  to  whom 
applications  marked  "Confidential"  should  be  addreued. 


ST.  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

We  offer  opportunities  in  Emergency,  Operating   Room.   P.A.R.,   Intensive  Care  Unit,  Orthopaedics,   Psychiatry, 

Paediatrics,  Obstetrics  and  Gynaecology,  General  Surgery  and  Medicine. 

We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Service  programs. 

We  offer  —  Toronto  —  with  some  of  Canada's  finest  Theatres,  Restaurants  and  Social  events. 

We  offer  progressive  personnel  policies. 

We  offer  a  starting  salary,  depending  on  experience,  of: 

effective  April  1, 1975     -  $945  to  $1,145  per  month. 
•  We  offer  monthly  educational  allowances  up  to  $1 20.  per  month  in  addition  to  the  above  starting  salary. 

Apply  to:  Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1 B5 


IIL  1975 


THE  CANADIAN  NURSE     69 


The 

Canadian 
Nurse 

50  The  Drivcwav,  Ottawa  K2P  1  E2,  Canada 


^^7 


Information  for  Authors 


Manuscripts 


The  Canadian  Nurse  and  L'inflrmiere  canadienne  welcome 
original  manuscripts  that  pertain  to  nursing,  nurses,  or 
related  subjects. 

All  solicited  and  unsolicited  manuscripts  are  reviewed 
by  the  editorial  staff  before  being  accepted  for  publication. 
Criteria  for  selection  include  :  originality;  value  of  informa- 
tion to  readers;  and  presentation.  A  manuscript  accepted 
for  publication  in  The  Canadian  Nurse  is  not  necessarily 
accepted  for  publication  in  L'infirmiere  Canadienne. 

The  editors  reserve  the  right  to  edit  a  manuscript  that 
has  been  accepted  for  publication.  Edited  copy  will  be 
submitted  to  the  author  for  approval  prior  to  publication. 

Procedure  for  Submission  of 
Articles 

Manuscript  should  be  typed  and  double  spaced  on  one  side 
of  the  page  only,  leaving  wide  margins.  Submit  original  copy 
of  manuscript. 

Style  and  Format 

Manuscript  length  should  be  from  1,000  to  2,500  words. 
Insert  short,  descriptive  titles  to  indicate  divisions  in  the 
article.  When  drugs  are  mentioned,  include  generic  and  trade 
names.  A  biographical  sketch  of  the  author  should  accompa- 
ny the  article.  Webster's  3rd  International  Dictionary  and 
Webster's  7th  College  Dictionary  are  used  as  spelling 
references. 

References,  Footnotes,  and 
Bibliography 

References,  footnotes,  and  bibliography  should  be  limited 
70    THE  CANADIAN  NURSE 


1 


to  a  reasonable  number  as  determined  by  the  content  of  th( 
article.  References  to  published  sources  should  be  numbere( 
consecutively  in  the  manuscript  and  listed  at  the  end  of  th« 
article.  Information  that  cannot  be  presented  in  forma 
reference  style  should  be  worked  into  the  text  or  referred  ti 
as  a  footnote. 

Bibliography  listings  should  be  unnumbered  and  place 
in  alphabetical  order.  Space  sometimes  prohibits  publishin 
bibliography,  especially  a  long  one.  In  this  event,  a  note  i 
added  at  the  end  of  the  article  stating  the  bibliography  i 
available  on  request  to  the  editor. 

For  book  references,  list  the  author's  full  name,  boc 
title  and  edition,  place  of  publication,  publisher,  year  ( 
publication,  and  pages  consulted.  For  magazine  reference! 
list  the  author's  full  name,  title  of  the  article,  title  of  maj., 
azine,  volume,  month,  year,  and  pages  consulted. 

Photographs,  Illustrations,  Tables, 
and  Charts 

Photographs  add  interest  to  an  article.  Black  and  whi 
glossy  prints  are  welcome.  The  size  of  the  photographs 
unimportant,  provided  the  details  are  clear.  Each  phoi 
should  be  accompagnied  by  a  full  description,  includi, 
identification  of  persons.  The  consent  of  persons  pholi 
graphed  must  be  secured.  Your  own  organization's  tot 
may  be  used  or  CNA  forms  are  available  on  request. 

Line  drawings  can  be  submitted  in  rough.  If  suitable,  th 
will  be  redrawn  by  the  journal's  artist. 

Tables  and  charts  should  be  referred  to  in  the  text 
should  be  self-explanatory.  Figures  on  charts  and  iii 
should  be  typ)ed  within  pencil-ruled  columns. 

The  Canadian  Nurse 

OFHCIAL  JOURNAL  OF  THE  CANADIAN  NtJRSES'  ASSOCIATI 

APRIL  T 


THE  SCARBOROUGH 
GENERAL  HOSPITAL 

invites  applications  from: 
Registered  Nurses  and  Registered  Nursing  Assis- 
tants  to   work   in   our   650-bed   active   treatment 
hospital  and  new  Chronic  Care  Unit. 

We  offer  opportunities  in  Medical,  Surgical,  Paedlatnc.  and  (JDsteirical  nursing. 

Our  specialties  include  a  Burns  and  Plastic  Unit,  Coronary  Care,  Intensive  Care  and 
Neurosurgery  Units  and  an  active  Emergency  Department. 

•  Obstetrical   Department  —  participation  in   "Family  centered"  teaching 
program. 

•  Paedlatric  Department  —  participation  In  Play  Therapy  Program. 

•  Orientation  and  on-going  stall  education. 

•  Prooressive  personnel  policies. 

The  hospital  is  located  in  Eastern  Metropolitan  Toronto. 

For  further  information,  write  to: 

The  Director  of  Nursing, 
SCARBOROUGH  GEIMERAL  HOSPITAL 
3050  Lawrence  Avenue,  Eas'.  Scarborough,  Ontario 


UNIVERSITY  OF  ALBERTA 
SCHOOL  OF  NURSING 


FACULTY  POSITIONS 

Faculty  members  required  for  positions  in  four  year  basic 
and  two  year  post-basic  baccalaureate  programs.  Applic- 
ants should  have  graduate  education  and  experience  in  a 
clinical  area  and/or  in  curriculum  development,  evaluation  or 
research.  Must  be  eligible  for  Alberta  registration. 

Personnel  policies  and  salaries  in  accord  with  University 
schedule  based  on  qualifications  and  experience. 

Apply  in  writing  to: 

RUTH  E.  McCLURE,  M.P.H. 
Director,  School  of  Nursing 
Clinical  Sciences  Building 
University  of  Alberta 
Edmonton,  Alberta 
T6G  2G3 


HEALTH 

SCIENCES 

CENTRE 

WINNIPEG, 
MANITOBA 


THIS  1345  BED  COMPLEX  WITH  AMBULATORY  CARE  CLINICS.  AFFILIATED 
WITH  THE  UNIVERSITY  OF  MANITOBA,  CENTRALLY  LOCATED  IN  A  LARGE, 
CULTURALLY  ALIVE  COSMOPOLITAN  CITY. 

INVITES  APPLICATIONS  FROM 

REGISTERED  NURSES  SEEKING  PROFESSIONAL 
GROWTH,  OPPORTUNITY  FOR  INNOVATION,  AND  JOB 
SATISFACTION. 

ORIENTATION  -  Extensive  two  week  program  at  full  salary 
ON-GOING  EDUCATION    Provided  through 

—  active  in-service  programmes  in  all  patient  care  areas 

—  opportunity  to  attend  conferences,  institutes,  meetings  of  professional 
association 

—  post  basic  courses  in  selected  clinical  specialties 
PROGRESSIVE  PERSONNEL  POLICIES 

—  salary  based  on  experience  and  preparation 

—  paid  vacation  based  on  years  of  service 

—  shift  differential  for  rotating  services 

—  10  statutory  holidays  per  year 

—  insurance,  retirement  and  pension  plans 

—  contract  under  negotiation  effective  March.  1975 

SPECIALIZED  SERVICE  AREAS  include  orthopedics,  psychiatry,  post 
anaesthetic,  emergency,  intensive  care,  coronary  care,  respiratory  care,  dialysis, 
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ENQUIRIES  WELCOME 

FOR  FURTHER  INFORMATION  PLEASE  WRITE  TO: 

PERSONNEL  DEPARTMENT,  NURSING  SECTION 
HEALTH  SCIENCES  CENTRE, 

700  WILLIAM  AVENUE,  WINNIPEG,  MANITOBA    R3E  0Z3 


A(iL  1975 


THE  CANADIAN  NURSE     71 


luorth 
looking 
into... 


occupotionol 

heoltii 

nursing 

with  Canada's 

federal  public 

servants. 


I* 


Health  and  Welfare        Sanie  ei  Bien-etre  social 
Canada  Canada 


Medical  Services  Branch 

Department  of  National  Health  and  Welfare 

Ottawa,  Ontario   K1A0K9 


Please  send  me  information  on  career 
opportunities  in  this  service. 


Name: 

Address: 

City: 


Prov: 


Index 

to 

Advertisers 

April  1975 


Abbott  Laboratories  Cover  4 

Astra  Pharmaceuticals  Canada,  Ltd 1 

Baxter  Laboratories  of  Canada 10 

Buriington  Industries  (Canada),  Ltd 9 

Canadian  Nurses'  Association 17 

Colgate-Palmolive,  Limited    48 

Heelbo  Corporation 20 

Hollister  Limited 54 

Imperial  Ventures  (Apple  Green  Park) 51 

J.B.  Lippincott  Co.  of  Canada,  Ltd 36,  37 

MedoX 53 

The  C.V.  Mosby  Company,  Ltd 13,  14,  15,  16 

Procter  &  Gamble 45 

Roots  Natural  Footwear 19 

W.B.  Saunders  Company  Canada,  Ltd 43 

Searle  Pharmaceuticals    7 

Seneca  College  of  Applied  Arts  and  Technology  .  .  .54 

Smith  and  Nephew,  Ltd 47 

White  Sister  Uniform,  Inc 5,  Covers  2,  3 


Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  1E2  (Ontario) 

Advertising  Representatives 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore.  Penna.  19003 
Telephone:  (215)  649-1497 

Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills,  Ontario 
Telephone:(416)  444-4731 


Member  of  Canadian 
Circulations  Audit  Board  Inc. 


EHELH 


72     THE  CANADIAN  NURSE 


APRIL  197 


MAY  1  3  1975 


ursp 


DO    I ;  V.  T    ;      ;;  E 
OUT   OF    il^RARW 


from  white  yi/ter^de/iqn /ho 

"""^  for  yum  me 


CAREER  APPAF 


S^:^^"^^"**"?*^. 

•'<« 


^ 


CAREER  APPAREL 


»EE  OUR  NEW  LINE 
)F  WHITES  AND 
COLOURS  AT 
INE  STORES 
kCROSS  CANADA 


,)  Style  No.  45957 

Sizes  5-15 

Royale  Supreme 
Plain  Tricot  Knit 

White  only 

about  $23.00 

«» 

)  Style  No.  45963 

Sizes  5-15 

Royale  Supreme 
Plain  Tricot  Knit 

White  only 

about $19.00 

«» 

)  Style  No.  45961 

Sizes  5-15 

Royale  Supreme 
Plain  Tricot  Knit 

White,  Navy 

about  $23.00 

IE  CANADIAN  NURSE  —  May  1975 


rui 


-registered  nurses  are  there  in  Canada? 
.  are  practising  nurses? 
.  male  nurses? 


¥o 


wmM 


—  work  in  hospitals? ...  in  private  practice? ...  in  public  health? . 
in  schools? 


The  answers  to  these — and  hundreds  of  such  questions  —  are 
all  contained  in  Countdown  '74. 

Countdown  was  a  project  undertaken  a  few  years  ago  by  the 
Canadian  Nurses'  Association  to  gather  and  publish  the  first 
comprehensive  statistical  survey  of  Canadian  nurses. 

Countdown  '74  is  the  updated  version  of  this  book— more 
than  100  pages  —  chock-full  of  valuable  and  interesting  nursing 
statistics.  A  must  for  all  libraries  — an  invaluable  reference  for  all 
nurses  who  wish  to  be  knowledgeable  about  nursing. 

Only  $5.00  a  copy. 

To  receive  your  copy  as  soon  as  it  is  off  the  press,  just  fill  out 
and  mail  this  coupon. 


Yes,  I  would  like  to  receive  Countdown  '74.  Send 
copies  ai  $5.00  each  to: 

Name 


Address - 


-Code^ 


Mail  to: 


^         iviaii  ro:  Payment  enclosed  D 

t;^^      CANADIAN  NURSES'  ASSOCIATION 
W       50  The  Driveway,  Ottawa,  Ontario  K2P  1E2 


for  relief  of  postportum  discomforts 

only  Tucks  babies 
tender  tissues  two  woys 

OS  Q  soothing  wipe...QS  o  cooling  compress...anci  os  often  os  she  like 


Tucks  medicated  pads  give  your  postpartum 
patient  more  relief,  more  often  than  ointments  or 
aerosols  because  pads  can  be  used  more  ways. 
Cooling  Tucks  medication  can  be  applied  by 
using  the  pad  as  a  compress.  Or  the  pad  can  be 
used  as  a  wipe  to  both  soothe  and  cleanse.  As  a 
wipe,  it  lets  her  avoid  the  mechanical  irritation  of 
harsh,  dry  toilet  paper.  A  Tucks  pad  under  her 
sanitary  pad  prevents  chafing  too. 

Tucks  medication  gives  prompt,  temporary 
relief  from  postpartum  discomforts — the  itching, 
burning  and  irritation  of  episiotomies  and  simple 
hemorrhoids.  Its  active  ingredients  are  witch  hazel 
and  glycerine — there  is  no  "caine"  type  anesthetic 


in  it.  Your  patient  can  have  her  own  supply  of 
Tucks  at  bedside  for  self-administered  relief  with 
minimum  risk  of  over-treatment  or  sensitization. 

In  addition.  Tucks  medication  is  buffered  to  an 
approximate  pH  of  4.6.  This  helps  tissues  maintain 
their  normal  acid  defenses.  Prescribe  Tucks  pads 
at  bedside  for  soothing,  cooling  comfort  from  the 
first  postpartum  day  on. 

Order  a  trial  supply  on  your  Rx.  Write  to; 


D 


1956  Bourdon  Street,  Montreal,  P.O.  H4M  1V1 


The 

Canadian 

Nurse 


^^:7 


editorial 


A  monthly  journal  lor  the  nurses  of  Canada  published 

in  English  and  French  editions  bv  the  Canadian  Nurses'  Association 


Volume  71,  Number  5 


May  1975 


17  Does  Canada  Need  a  Population  Policy? L.  Fouler 

22  How  the  Leukemic  Child  Chooses  His  Confidant    ).  Kikuchi 

24  Health  and  Social  Services  Under  the  Same  Roof C.  Rioux 

27  The  Hyperkinetic  Child D.C.  Anonsen 

30     The  Bicycle  Child-Carrier  Seat 

A  New  Hazard G.  Cooperman,  E.M.  Cooperman 

32     Promoting  Collaboration 

Between  Education  and  Service     J.  MacPhail 

39     Idea  Exchange     C.  Tench  and  E.  Bentley 

The  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

7  News 

40  In  a  capsule 

41  Names 

42  New  Products 


45  Dates 

46  Books 

52  A.V.  Aids 

52  Accession  List 

72  Index  to  Advertisers 


Executive  Director:  Helen  K.  Mussallem  ■ 
Editor:  Virginia  A.  Lindabury  •  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Dorothy  S. 
Starr  •  Production  Assistant:  Mary  Lou 
Downes  •  Circulation  Manager:  Beryl  Dar- 
lir»g  •   Advertising    Manager:    Ceorgina    Clarke 

•  Subscription  Rates:  Canada:  one  year 
$6.00:  two  years.  $11.00.  Foreign:  one  year, 
$6.50;  two  years,  $12.00.  Single  copies: 
$1.00  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  registration  nunit)er  in  a  pro- 
vincial nurses'  association,  where  applicable. 
Not  responsible  for  journals  lost  in  mail  due 
to  errors  in  address. 


Manuscript     Information:       The    Canadian 

Nurse  "  welcomes  unsolicited  articles.  All 
manuscripts  should  be  tvped.  double-spaced, 
on  one  side  ot  unruled  paper  leaving  wide 
margins.  Manuscripts  are  accepted  for  review 
lor  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,    Ontario,    K2P1E2 

®    Canadian  Nurses'  Association  1975. 


The  theme  of  change  runs  through 
several  articles  in  this  issue.  Use 
Fortier  writes  compellingly  of  Canada's 
need  for  a  population  policy.  Jannetta 
MacPhail  promotes  a  new  relationship 
between  nurses  who  administer 
nursing  care  and  those  who  educate 
entrants  to  the  profession;  she  details 
Ihe  need  for  changed  attitudes  to  foster 
a  new  spirit  of  collaboration.  Ceciie 
Rioux  describes  new  criteria  and  ad- 
ministration for  a  home  care  program. 

These  health  workers  write  of 
change  with  a  sense  of  urgency. 
Canadians  need  changes  in  nursing; 
some  nurses  are  dragging  their  feet. 
But,  change  is  threatening.  To  change 
requires  energy  that  we  sometimes 
feel  we  can  ill  afford;  our  daily  tasks  in 
nursing  take  all  our  strength.  Lewis 
Carroll,  in  Through  the  Looking-Glass, 
expressed  a  reaction  with  which  we 
can  identify:  ' . .  .It  takes  all  the  running 
you  can  do,  to  keep  in  the  same  place. 
If  you  want  to  get  somewhere  else,  you 
must  run  at  least  twice  as  fast  as  that! " 

However,  the  imperative  for  change 
in  nursing  is  clear.  It  is  change  or  else: 
the  number  of  alternatives  is  diminish- 
ing, and  they  grow  less  attractive.  In 
1867,  Disraeli  said,  "Change  is  inevit- 
able. In  a  progressive  country,  change 
is  constant," 

There  is  so  much  change;  we  get 
tired  of  waiting  for  the  changes  we  de- 
sire, and  tired  of  living  with  changes  we 
don't  understand  or  approve.  We  be- 
come wearied  of  the  demands  change 
makes  —  of  reassessing,  adapting, 
uncertainty,  and  new  roles.  On  the 
other  hand,  change  is  growth,  stimula- 
tion, development.  Effort  is  tiring,  but 
how  dull  a  life  without  change  would 
be! 

The  sea  is  described  as  ever- 
changing  —  change  is  like  the  ocean. 
We  can  let  change  wash  over  us  and 
go  down,  gasping  and  sputtering 
'They  don't  make  nurses  like  they 
used  to, "  and  "What's  the  matter  with 
the  old  way! "  Or,  we  can  judge  the 
waves  of  change  and  use  our  strength 
wisely,  swim  with  the  tides'  rise  and  fall, 
and  find  exhilaration  and  a  new  beauty. 

Let's  join  together  on  the  shores  of 
population  policy,  intraprofessional  re- 
lationships, new  modes  of  service  for 
our  clients  —  on  the  exciting,  changing 
edges  of  nursing!  —  DSS 


<E  CANADIAN  NURSE  —  May  1975 


letters 


Eliminate  the  laundry-list  approach 

1  wholeheanedly  agree  with  Jocelyn 
Hezekiah  (Jan.  1975.  p. 20)  that  nurs- 
ing educators  need  to  develop  ways  of 
facilitating  lateral  and  upward  mobility 
in  nursing.  If  we  agree  with  Toffler  that 
permanence  is  dead,  we  very  much 
need  to  get  our  curriculum  house  in 
order,  and  make  innovative  changes 
that  will  give  prospective  students  new 
choices. 

As  co-developer  of  the  core  cur- 
riculum at  Long  Beach  City  College 
and  author  of  two  texts  designed  for 
core  curricula  (First  Level  Nursing 
Workbook.  Second  Level  Nursing 
Workbook.  Wallcur,  Inc..  Seal  Beach, 
Califomia).  I  must  encourage  the  im- 
plementation of  learning  technics  that 
foster  inquiry  and  conceptualization  at 
all  levels  of  nursing  education.  We  are 
remiss  if  we  do  not  address  ourselves  to 
eliminating  the  traditional  laundry-list 
approach  to  course  content,  and  recog- 
nize the  need  to  become  enlightened 
risk  takers  in  curriculum  development. 

I  was  much  encouraged  by 
Hezekiah"s  article,  and  delighted  to 
know  that  the  gospel  is  spreading  — 
however  slowly.  — VennerM.  Farley. 
R.N.,  M.A.,  Chairwoman  and  Profes- 
sor of  Nursing,  Long  Beach  City  Col- 
lege. Long  Beach,  California. 

Let's  help  upgrade  the  product! 

I  noted  with  interest  the  letter  from 
Walter  Cole  in  the  February  1975  issue, 
stating  that  The  Canadian  Nurse  '  'does 
not  meet  our  needs." "  At  the  end  he 
states,  "We  hope  that  these  comments 
are  helpful  to  you  in  upgrading  our 
magazine." 

It  seems  to  me  that  we,  the  nurses  of 
Canada,  are  not  meeting  our  own 
needs.  We  should  be  the  ones  who  are 
helping  to  upgrade  our  magazine. 

People  usually  tend  to  focus  more 
intently  on  the  negative  aspects  of  any 
given  situation.  We  complain,  but 
don't  want  to  be  involved  in  remedying 
the  complaint.  I  would  be  interested  to 
know  when  Mr.  Cole  last  submitted  an 
article  to  the  journal.  In  other  words, 
Mr.  Cole.  "Put  your  money  (article) 
where  your  mouth  is." 

It  is  up  to  us  to  solve  our  problems.  It 


is  also  up  to  us  to  help  upgrade  the 
magazine.  —  Gail  Kelsall.  Clinical 
Instructor,  ICU.  Montreal  General 
Hospital.  Montreal,  Quebec. 


In  favor  of  day  care  units 

Recently.  I  was  involved  in  a  car  acci- 
dent and  had  my  collarbone  broken. 
Later,  because  of  complications  of  the 
fracture,  I  required  emergency  surgery. 
But.  as  usual,  there  were  no  beds 
available  —  for  two  weeks. 

My  doctor  finally  had  me  admitted  to 
a  day  care  unit,  where  the  surgery  was 
perfonned  shortly  after  my  admission 
at  6:15  A.M.  Although  I  was  a  little 
drowsy.  1  was  discharged  by  my  doctor 


MOVING? 

BEING  MARRIED? 

Be  sure  to  notif  v  us  six  weeks  in  advance , 

otherwise  you  will  likely  miss  copies 

Attach  the  Label 

From  Your  Last  Issue 
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Copy  Address  and  Code 

< 

Mumbers  From  It  Here 

NEW  (NAME) /ADDRESS; 

Street 

! 

City                                              Zone 

Prov. /State                                 Zip- 

Please  complete  appropriate  category: 

1 1     1  hold  active  membership  in  provincial 

nurses'  assoc. 

reg.  no. /perm,  cert./  lie.  no. 

1     J    1  am  a  Personal  Subscriber. 

MAILTO: 

The  Canadian   Nurse 

50  The  Driveway 
OTTAWA.  Canada  K2P  1E2 

around  4:00  P.M.  The  head  nurse  gave 
my  husband  instructions  for  my  care, 
and  1  was  sent  home  with  sufficient 
analgesics  to  relieve  my  pain. 

Actually.  I  preferred  being  home  and 
not  having  to  conform  to  the  usual  hos- 
pital routine.  Also,  this  undoubtedly 
saved  our  provincial  medical  care  plan 
a  fair  amount  of  money. 

I  believe  we  should  encourage  more 
use  of  day  care  units.  It  would  save 
many  patients  from  having  to  wait  days 
or  even  weeks  for  a  bed  in  an  active 
surgical  ward.  I'd  like  to  receive  opin- 
ions from  other  nurses  on  this 
subject.  — Alice  Tester,  rn.  15869 
Pacific  Ave..  White  Rock.  British  Col- 
umbia. V4B  IS8. 

Cancer  patients  needs  unmet 

What  is  the  nursing  profession  doing 
for  cancer  patients?  As  a  cancer  victim 
myself.  1  find  there  aren't  many 
changes  in  the  attitude  toward  this  dis- 
ease. 

Cancer  is  still  a  fatal  disease,  and  the 
emotional  needs  of  cancer  patients  are 
not  being  met.  Yes.  surgery,  radiation, 
and  chemotherapy  bring  some  cures, 
and  the  hopes  of  afflicted  victims  are 
somewhat  higher,  but  what  is  there  for 
incurable  cases  —  still  the  biggest  per- 
centage? Once  the  doctor  says,  "there 
isn't  a  thing  we  can  do  for  you."  the 
patient  is  left  to  fight  the  dreaded  dis- 
ease for  himself. 

Has  anyone  studied  the  emotional 
needs  of  cancer  victims  and  the  emo- 
tional factors  that  could  bring  about  the 
disease?  The  mind-body  relationship 
hasn't  been  researched  enough  yet. 

What  about  the  so-called  "quack"?  I 
am  sure  there  are  many  nurses  who 
have  friends,  relatives,  or  patients  who 
have  traveled  to  get  relief,  if  not  a  cure, 
to  Mexican  or  German  clinics,  which 
organized  medicine  in  Canada  has  re- 
fused to  recognize. 

Is  it  because  we  are  afraid  there 
might  be  something  of  positive  value 
that  we  haven't  found  here?  I  know  it  is 
hard  to  admit  that  we  don't  know  it  all. 

I  don't  find  it  unethical  to  promote 

such  clinics,  especially  to  patients  who 

are  considered  incurable.  Should  we 

(Continued  on  page  6) 


A  SuDSKJiafy  ot  injefnaio^af  C'Te^'cai&  Nuclear  GorcxsfaiiO.'^ 

675  ft^tfitee  Oe  Lfesse 
MenKeal377  Quebec 


m 


PEOPLE 
ARE  SOFTER 
THAN  BEDS. 

Smith  &  Nephew  Hospital  Lotion  — 'Hand  &  Back'  — 

is  indicated  in  the  treatment  of  dry,  irritated  skin  due  to 

external  disorders.  The  lotion  is  effective  as  a  hospital 

body  rub  and  is  specially  formulated  for  this 

purpose.  Hospital      Lotion  contains  no 

aromatic  sensitisers. 


Smith  S^Nephew 
r^ient  Recovery  Products 

Smitii  &  Nephew  Ltd.  2100- 52nd  Avenue.  Laciiine,  Quebec 


letters 


(Continued  from  page  4) 

apply  pressure  to  have  some  serious 
scientific  study  done,  or  let  the  public 
do  it?  As  a  predominantly  women's 
group,  shouldn't  we  take  more  interest 
in  the  welfare  of  our  sick?  ""Why  not""? 
—  Louise  Harrod,  R.N..  Dawson 
Greet:.  B.C. 


Research  is  every  nurse's  business 

The  article  "Nursing  research  is  not 
every  nurse's  business,"  by  Marjorie 
Hayes  (October  1974,  p.  17)  is  pre- 
sented convincingly.  She  quotes  in  her 
conclusion,  "Research  must  be  done 
by  individuals  who  possess  the  requis- 
ite qualifications  of  interest,  know- 
ledge and  skill,  and  the  ability  to  find 
their  own  role  model  and  create  their 
own  self-image."' 

I  agree  with  her,  and  believe  this 
should  be  read  by  all  nurses  so  they 
could  be  aware  of  these  skills  and  de- 
velop them.  Research  is  one  of  the 
functions  of  nurses,  and  who  would  be 
better  qualified  to  do  research  in  nurs- 
ing than  nurses  themselves?  I  still  be- 
lieve that  nursing  research  should  be 
every  nurse's  business. 

Thank  you  for  publishing  such  an 
article.  I  found  it  stimulating.  — Fer- 
nando Basil,  Student  Nurse,  Manila 
Sanitarium  and  Hospital,  Pasay  City, 
Philippines. 


Book  reviewer  replies 

Concerning  the  review  of  the  book 
Maternity'  Nursing  by  Constance  Lerch 
(Nov,  1974.  p.  43.  and  Feb.  1975.  p. 
4):  My  apology  to  Ms.  Lerch.  The  con- 
troversy regarding  the  intake  of  sodium 
during  pregnancy  is  discussed.  — 
Genevieve  Appleby,  Toronto,  Ontario. 


BiiiiiiiiiiiMMiiiiiniij 

Ibeapart    I 

[OF 


IBEAPART     I 
iOF  THE  ACTION  I 

niiiiiiiiiiiiiiiiiiiiiiid 


nevus 


Money  Has  Failed  To  Solve 
Health  Problems,  Seminar  Told 

Montreal.  Que.  —  Enomious  sums  of  money  invested  in  the  health  care  systems  of 
the  us  and  Canada  have  not  brought  about  coordinated  systems  of  health  care  or 
reduced  the  incidence  of  "diseases  of  choice"  related  to  life-style.  These  were 
among  the  concerns  expressed  during  the  first  conference  of  the  Northeast 
Canadian/American  Health  Seminar  held  in  Montreal.  19-22  March  1975.  The 
conference  was  attended  by  some  100  specialists  and  experts  in  the  health  field. 
some  of  them  nurses. 


Although  Canadian  and  American 
approaches  to  decision  making  within 
the  health  disciplines  are  different,  the 
two  groups  have  in  common  several 
serious  problems  that  neither  has  been 
able  to  solve.  For  example,  the  health 
care  system  has  not  provided  equal  ac- 
cess to  health  services  for  lower 
socioeconomic  groups  or  a  more  equal 
geographic  distribution  of  health  pro- 
fessionals. 

According  to  Yves  Martin,  president 
of  the  Quebec  Health  Insurance  Board. 
Canadians  could  benefit  from  the  com- 
petence and  experience  of  their  Ameri- 
can counterparts,  and  the  latter  could 
learn  from  Canadian  mistakes. 

The  most  obvious  difference  be- 
tween American  and  Canadian  health- 
care systems  is  found  at  the  decision- 
making level.  Dr.  E.  D.  Pellegrinotold 
the  conference.  Pellegrino  is  chairman 
of  the  board  of  Yale-New  Haven  Hospi- 
tal. Connecticut. 

In  Canada,  control  and  supervision 
of  the  health  system  is  in  the  hands  of  a 
government  authority  that  sets  the  goals 
and  priorities  of  the  system,  allocates 
available  resources,  studies  the  results, 
and  imposes  corrective  measures  when 
necessary.  Pellegrino  said.  The  use  of 
this  comprehensive  planning  strategy 
makes  it  possible  to  develop  a  rationale 
for  a  global  system,  w  hich  is  presumed 
to  meet  all  the  needs  of  the  population. 

In  the  United  States,  the  free  enter- 
prise system  is  at  the  heart  of  political 
and  economic  decisions.  The  health- 
care system  has  evolved  in  response  to 
specific  needs  as  they  become  evident. 
In  keeping  with  the  .^ITlerican  ideal  of 
individual  freedom,  this  system  en- 
courages the  search  for  solutions  based 
on  agreement  between  the  health-care 
consumer  and  the  health  professional. 
Government  intervention  is  confined  to 
critical  needs.  Pellesrino  said. 


Thomas  Boudreau,  assistant  deputy 
minister  for  long-term  health  planning. 
Health  and  Welfare  Canada,  said  that 
society  has  deprived  the  individual  of 
the  ability  to  control  his  immediate  en- 
vironment, of  his  autonomy  and  free- 
dom. According  to  Boudreau.  this  de- 
privation has  resulted  in  an  attitude  of 
psychological  dependence  on  the 
health-care  system,  a  belief  that  the  sys- 
tem will  "'mend  everything. ■■  Resump- 
tion by  the  individual  of  responsibility 
for  his  own  health  will  not  take  place  as 
the  result  of  changes  in  laws;  it  will 
require  a  complete  reform  of  the  social 
value  system. 

Boudreau  concluded  that,  since  in- 
dividuals are  surrounded  by  a  network 
of  systems,  it  will  be  necessary  to  go 
through  these  systems  to  reach  the  {peo- 
ple. Members  of  the  health  disciplines 
by  themselves  cannot  create  a  new  so- 
cial system.  The  answer  will  be  found 
outside  the  confines  of  health  care. 

During  a  panel  discussion.  Laurent 
Laplante.  associate  editor  of  a  Montreal 
newspaper.  Le  Jour,  said  that  we  are 
facing  a  widespread  opting-out  in  the 
health  field. 

Pointing  out  the  discrepancies  be- 
tween the  ethical  concepts  put  forward 
and  their  actual  practice,  he  said  that 
health  professionals  wish  to  remain  at 
the  top  of  the  social  ladder.  Their  mes- 
sage will  be  perceived  only  if  they 
coine  closer  to  the  lower  socio- 
economic groups  in  society. 

Jeannine  Tellier-Cormier  president 
of  the  Order  of  Nurses  of  Quebec,  said 
that  one  important  result  the  seminar 
might  have  for  nurses  was  to  give  them 
a  broader  perspective  on  health.  It 
would  also  encourage  nurses  to  think  in 
terms  of  health  care  for  the  general  pub- 
lic, rather  than  a  particular  group  of 
individuals,  she  said. 


Health  professionals  must  act  collec- 
tively to  plan  more  comprehensive 
strategy.  Tellier-Cormier  said.  But 
each  profession  must  first  achieve  unity 
within  itself. 

Although  cultural  differences  be- 
tween Ainericans  and  Canadians  result 
in  different  methods  of  planning, 
communication  between  the  two 
groups  makes  it  easier  to  solve  some  of 
the  comiTion  problems.  Tellier- 
Cormier  said  she  was  concerned 
primarily  with  the  failure  of  both  the 
US  and  Canada  to  deal  with  problems 
of  underprivileged  and  low  income 
groups. 


Annual  Meeting  Of  CUNSA 
Draws  366  Nursing  Students 

Toronto.  Ont.  —  Some  366  students 
from  22  university  schools  of  nursing, 
with  invited  faculty  members  and  re- 
source persons,  considered  the  theme 
of  interdisciplinary  health  education 
during  their  annual  conference.  The 
1975  meeting  of  the  Canadian  Univer- 
sity Nursing  Students"  Association 
(CUNS.A)  was  held  at  the  University  of 
Toronto  February  6  to  10. 

In  the  keynote  address.  Dr.  Doroth\ 
Kergin.  associate  dean  of  health  sci- 
ences (nursing).  McMaster  University, 
discussed  the  importance  of  intra- 
professional  educational  development, 
as  well  as  interprofessional  educational 
development,  in  the  framework  of  the 
isolation  of  schools  of  nursing. 

She  said  that  criteria  for  inter- 
disciplinary health  education  include 
interprofessional  role  models  in  re- 
search, education,  and  practice:  educa- 
tion related  as  closely  as  possible  to  real 
life,  that  is.  relevant  to  practice;  and 
education  suited  to  the  goals  and  learn- 
ing levels  of  students,  that  is.  readiness 
of  both  students  and  faculty. 

"if,  and  onK  if.  these  are  fulfilled, 
can  interdisciplinary  health  education 
proceed.""  Kergin  said. 

"A  unique  experience'"  was  the  stu- 
dent description  of  a  panel  discussion 
b\  Dr.  John  Evans,  president  of  the 
University  of  Toronto;  Dr.  Josephine 
Flaherty,  dean  of  the  University  of 
Western  Ontario  school  of  nursing;  and 
Horace  Krever.  professor  of  law  at  the 
Universitv  of  Toronto. 


THE  CANADIAN  NURSE  —  May  1975 


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Evans  discussed  trends  in  health  and 
health  education.  He  said  approaches 
developed  through  education  and  re- 
search would  include  selective  —  not 
comprehensive  —  shared  objectives, 
shared  resources  to  achieve  objectives, 
and  a  common  group  with  responsibil- 
ity for  the  objectives. 

Flaherty,  speaking  on  the  relevance 
of  interdisciplinary  health  educatien, 
emphasized  the  concept  of  accountabil- 
ity for,  rather  than  accountability  to. 
Effective  organization  of  the  nursing 
profession  is  a  prerequisite  for  the  de- 
velopment of  interdisciplinary  health 
education,  she  said. 

Krever  challenged  all  nurses  to  cease 
being  passive,  and  to  become  vocal  and 
active. 

Students  discussed  in  small  groups 
such  topics  as  how  and  where  interdis- 
ciplinary health  education  can  be  intro- 
duced into  the  health  education  system, 
legal  issues  related  to  the  health  team 
concept,  the  status  of  women  in  the 
health  care  team,  and  educating  the 
consumer  to  use  the  health  team. 


Nursing  Research  Conference 
Will  Consider  Indicators 

Edmonton,  Aha.  — The  1975  National 
Conference  on  Nursing  Research  will 
focus  on  the  development  and  use  of 
indicators  in  nursing  research.  The 
schools  of  nursing  at  the  Universities  of 
Alberta,  Calgary,  Manitoba,  and  Sas- 
katchewan have  applied  for  funding 
and  are  soliciting  papers  for  the  confer- 
ence to  be  held  in  Edmonton  27-29  Oc- 
tober 1975. 

Participation  at  the  conference  will 
be  limited  to  approximately  55  active 
nurse  researchers.  Papers  are  being  sol- 
icited on  nursing  research  that  pertains 
to  the  development  and  use  of  any 
criterion  measures  of  nursing  input, 
process,  and/or  outcome  variables, 
with  particular  preference  given  to 
physical,  psychological,  and/or  social 
indicators  as  they  relate  to  measuring 
nursing  interventions. 

Papers  should  be  submitted  by  12 
May  1975,  but  late  papers  will  be  ac- 
cepted until  15  July.  Conference  plan- 
ners would  welcome  nursing  research 
projects  at  any  stage  of  development  — 
initial  planning  phase,  ongoing,  or 
completed  research  —  and  from  any 
setting.  They  plan  to  follow  the  previ- 
ous conference  policy  of  excluding 
master's  degree  theses,  but  they  are 
prepared  to  reconsider  that  policy  in 
cases  of  current  or  completed  theses 


that  are  uniquely  relevant  to  the  confer- 
ence theme. 

The  conference  planners  include: 
Dr.  Shirley  Stinson,  University  of  Al- 
berta; Marguerite  Schumacher,  Uni- 
versity of  Calgary;  Dr.  Helen  Glass, 
University  of  Manitoba;  and  Myrtle 
Crawford,  University  of  Saskatch- 
ewan; plus  4  nursing  service  desig- 
nates, and  the  program  coordinator, 
Margaret  Steed.  The  full  planning 
committee  will  hold  its  first  meeting 
early  in  June  1975. 

Correspondence  about  the  1975  con- 
ference should  be  directed  to:  Margaret 
E.  Steed,  Program  Coordinator,  School 
of  Nursing,  Clinical  Sciences  Building, 
University  of  Alberta.  Edmonton,  Al- 
beila,  T6G  2G3. 

Elderly  Persons  Need 
Bright  Color,  Stronger  Light 

Toronto,  Ont.  —  Bright  colors  and 
good  lighting  stimulate  older  individu- 
als and  help  failing  eyes  see  better. 
These  are  some  findings  from  the  On- 
tario Nursing  Home  Association. 

"An  older  person  requires  8  times 
more  illumination  than  a  23-year-old," 
Dr.  L.Z.  Cozin  of  Oxford,  England, 
told  an  institute  on  long-term  care  held 
recently  in  Toronto.  The  institute  was 
co-sponsored  by  the  Ontario  Nursing 
Home  Association,  the  Ontario  Hospi- 
tal Association,  and  the  Ontario  Asso- 
ciation of  Homes  for  the  Aged. 

Bright  color  stimulates  children,  but 
it  is  even  more  important  in  the  daily 
life  of  older  persons.  Not  only  can  it  be 
used  to  motivate  them  and  lift  morale, 
but  correct  use  of  color  can  also  help 
them  distinguish  shapes  and  objects 
more  clearly. 

Variation  in  color  can  be  used  to  help 
orient  them  better  to  their  surround- 
ings. In  many  nursing  homes,  doors 
leading  to  residents"  rooms  are  painted 
in  different  colors.  It  helps  an  indi- 
vidual recognize  "his"  door  more 
quickly.  In  large  buildings,  corridors 
can  be  painted  in  different  colors  to  aid 
residents  in  knowing  where  they  are. 

Bold-colored  furniture  helps  older 
people  see  it  more  clearly  and  prevents 
accidents.  One  nursing  home  owner 
furnished  a  lounge  with  light-colored 
carpet  and  black  furniture.  This  lounge 
becaine  popular  because  residents  fell 
safer;  they  could  distinguish  the  furni- 
ture more  easily.  Color  experts  say  that 
wall  and  floor  coverings  should  be  in 
sharp  contrast  to  furniture  to  avoid  the 
problem  of  stumbling  over  objects. 

(Continued  on  page  1 1) 


TWO  IMPORTANT  TEXTS 


CLINICAL  NURSING:  Pathophysiological  and 
Psychosocial  Approaches,  3rd  edition 

I.  L.  Beland,  J.  Y.  Passes 

1 975/1 086pp./cloth,  $17.50/order  code  #02.307900.2 

This  new  edition  of  the  most  comprehensive  text  in  pro- 
fessional clinical  nursing,  continues  the  tradition  of  treat- 
ing the  patient  as  a  total  individual  rather  than  in  a  strict 
medical  model  construct.  The  text  thoroughly  familiarizes 
the  nurse  with  physiological  manifestations  of  an  individ- 
ual's impairment  and  presents  guidelines  for  understand- 
ing and  responding  to  the  patient's  needs  for  nursing. 
Emotional,  social  and  cultural  components  of  illness  are 
treated  along  with  the  physical  care  factors.  Changes  in 
this  edition  include  improved  organization  that  promotes 
a  concept  building  approach,  much  new  material  on  nurs- 
ing intervention  in  traumatic  injury,  pain  alleviation 
techniques,  infections,  expanded  chapters  on  cardiovas- 
cular and  respiratory  problems  and  a  new  section  on 
nursing  practice  and  spiritual  needs  of  the  patient. 


CONTENTS 

Introduction.  Historical  Perspectives.  The  Health-Illness 
Spectrum.  The  Effects  of  Injurious  Agents  on  Cells.  The 
Control  of  Infections.  Nursing  the  Patient  Having  a  Prob- 
lem Resulting  From  Disorders  in  Regulation.  Defenses 
Against  and  Responses  of  the  Body  to  Injury.  The  Psycho- 
social Aspects  of  Illness.  Relationship  of  Illness  to  the 
Maturational  Level  of  the  Individual.  Nursing  the  Patient 
Having  a  Problem  in  the  Removal  of  Carbon  Dioxide 
and/or  In  Maintaining  the  Supply  of  Oxygen.  Nursing  the 
Patient  with  a  Disturbance  in  Fluid  and  Electrolyte  Bal- 
ance. Nursing  the  Patient  Having  a  Problem  with  Some 
Aspect  of  Transporting  Material  to  and  from  Cells.  Nurs- 
ing the  Patient  Having  a  Problem  with  Some  Aspect  of 
Nutrition.  Nursing  the  Patient  in  Shock.  Nursing  the 
Patient  with  an  Alteration  in  Body  Temperature.  Nursing 
the  Patient  Having  a  Problem  Resulting  from  Failure  to 
Regulate  the  Proliferation  and  Maturation  of  Cells.  The 
Requirements  of  Patients  Treated  Surgically.  Nursing  in 
Rehabilitation.  Epilogue. 


DYNAMIC  ANATOMY  AND  PHYSIOLOGY 

B. Pansky 

1974/672pp./cloth,$14.25/order  code  #02.390740.1/ 

Teacher's  Manual  $1.10/order  code  #02.390690.1 

This  authoritative,  lavishly  illustrated,  textbook  of 
anatomy  and  physiology  is  designed  primarily  for  use  by 
undergraduate  students  of  nursing  and  allied  health  pro- 
fessions. Emphasis  is  placed  on  the  molecular  and  cellular 
basis  of  body  structure  and  function,  clinical  applications, 
and  developmental  aspects  of  the  subject.  The  author  is  a 
functional  anatomist,  physician,  researcher,  medical 
illustrator,  and  master  teacher. 

Review  questions  and  references  are  located  at  the  end  of 
each  chapter.  An  atlas  of  regional  anatomy  (seven  full- 
page,  four-color  halftone  illustrations)  and  a  listing  of 
prefixes,  suffixes,  and  combining  forms  appear  in  the  back 
matter. 


CONTENTS 

Preface.  THE  BODY:  ITS  STRUCTURE  AND  ORGANI- 
ZATION. Cell  Structure.  Cell  Development.  Cell  Func- 
tion. Tissues  of  the  Body.  BODY  FRAMEWORK  AND 
MOVEMENT.  Bony  Framework:  The  Skeletal  System. 
The  Body  in  Motion:  Joints.  The  Body  in  Motion: 
Muscles.  EXTERNAL  INTEGRATION,  CORRE- 
LATION, AND  COORDINATION.  Neural  Control 
Mechanisms.  Perception  of  a  Changing  Environment: 
Special  Senses.  INTERNAL  INTEGRATION,  CORRE- 
LATION, AND  COORDINATION.  Circulation:  The 
Cardiovascular  System.  Transfer  of  Gases:  The  Respira- 
tory System.  Digestion  and  Food  Absorption:  The  Diges- 
tive System.  Organic  Metabolism  and  Energy  Balance. 
Regulation  of  Extracellular  Water  and  Electrolytes:  The 
Urinary  System.  Chemical  Messengers:  The  Endocrine 
System.  Defense  Mechanisms  of  the  Body.  THE  LIFE 
CYCLE.  The  Male  Reproductive  System.  The  Female 
Reproductive  System.  DEVELOPMENT  AND  AGING. 
Human  Development.  Consciousness,  Behavior,  and 
Aging.  Atlas  of  Regional  Anatomy.  Prefixes,  Suffixes,  and 
Combining  Forms.  Index. 


For  further  information  write  to: 


COLLIER  MACMILLAN  CANADA,  LTD. 

1125B  LESLIE  STREET,  DON  MILLS,  ONTARIO 


THE  CANADIAN  NURSE  —  May  1975 


fl^me'  7^  1^  VicHd<f.,.^m  ^eem 


GENEROUS  NEW  GROUP  DISCOUNTS  on  an 

items  shown,  for  group  purchases,  graduation  gifts,  favors,  etc. 
6-11  Same  Items,  Deduct  10%;    12-24  Same  Items,  Deduct  15% 
25  or  More  Same  Items,  Deduct  20%  q 


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IT'S  EASY  TO  ORDER  REEVES  NAME  PINS  FOR  YOURSELF  OR  FRIENDS ! 

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bottom  left.  Attach  entra  sheet  for  additional  pin-; 
NOTE  SAVINGS  ON  2  IDENTICAL  PINS..  .  .  more  coavtnient. 
spare  in  case  of  loss. 


LETTERING: 2nd   LINE: 


Plastic  I 
Laminate  | 
No.  559         I    169 


ALL  METAL  , . ,  Smooth,  rounded 
coffiers.  Choose  Polished,  Satin,  or 
new  Duotone  combining  satin 
background  with  polished  edges. 


PLASTIC  LAMINATE  . . .  stinnmer. 
k  broader:  engraved  thru  surface  to 
F  contrasting  core  color.  Beveled 

txjrder  matches  lettering. 


METAL  FRAMED    ..Classic 
\  design;  snow-white  plastic  with 

'  smooth,  polished  beveled  frame. 


MOLDED  PLASTIC      .  Simple,  smart, 

\  economical.  Will  never  discolor. 

'  Smooth  rounded  corners  and  edges. 


Mn/u. 

CM.M 


ncow 

n  Silver 


QGold 
a  Silvei 


IKTU 


n  Duotone 
D  Polistied 
n  Satin 


Polistied 
frame 
only 


■ACKSIIIHHIO 
CUM 
Plaitk) 


DWtiite. 


D  GreeTTl         B 

D  Blue    J/ 

DCocoaJ  L 


White 
only 


White 

only 


liTTEIMC 
COIOR 


D  Black 
n  Dk  Blue 
n  White 


Black 
Dk.  Blue 

JWhite 

Letters  only 


D  Black 
n  Dk-  Blue 


D  Black 
D  Ok,  Blue 


nncB 

UinnOUM  b|ran<2lkM 


□  1  Pin    2.49 

□  2  Pins  3.99 


n  1  Pin    1.25 
D  2  Pins  1.95 


D  1  Pin   2.49 
D  2  Pins  3.99 


D  1  Pin    1J!5 
D  2  Pins  1.95 

(samensfflc) 


n  1  Pin    3.25 
□  2  Pins  4.95 


D  1  Pin    1.85 
D  2  Pins  2.90 

Isamenanw 


n  1  Pin    3  25 
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D  1  Pin    l.«5 
D  2  Pins  2.90 


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trim,  zipper,  carrying  strap,  hang  loop.  Stores  flat.  Also  '  „.,———  1 '. 
for  wiglets,  curlers,  etc.  %W  dia..  6"  high.  t.  i 

No.  333  Tote  . . .  2.95  ea.  Gold  init.  SOWTote  ^^ 

WHITE  CAP  CUPS     Holds  caps 

firmly  in  place!  Hard-to-find  white  bobbie  pins, 
enamel  on  fine  spring  steel.  Seven  2"  and  four 
3"  clips  included  in  plastic  snap  box. 
No.  529  Clips  85<  per  box  (min.  3  boxes) 


Replace  cap  band  instantly.  Imy  plastic  tac. 
damty  caduceus.  Choose  Black.  Blue,  White 
or  Crystal  with  Gold  Caduceus,  The  neater  i 
way  to  fasten  bands.  l ' 

No.  200  —  Set  of  6  Tacs  . . .  1.25  per  set     "' 


MOLDED  CAP  TACS 


Free  (nitidis  and 

Littmanri 

BRAND 

Famous  Littmann  nurses' 
diaphragm  stethoscope  .  .  . 
a  fine  precision  instrument, 
with  high  sensitivity  for 
blood  pressures,  apical  pulse 
rate.  Only  2  ozs..  fits  in 
pocket.  »<ith  gray  vinyl  anti- 
collapse  tubing,  non-chilling 
epoxy  diaphragm.  28"  over- 
all. Non-rotating  angled  ear 
tubes  and  chest  piece  beau- 
tifully styled  in  choice  of  5 
jewel  like  colors:  Goliltone, 
Silvertone,  Blue.  Green,  Pink.* 


Sack  with  your 

Nursescope! 

FREE  INITIALS  AND  SACK! 

Your  initials  engraved  FREE  on 
chest  piece:  lend  individual 
distinction  and  help  prevent 
loss,  FREE  SCOPE  SACK  neatly 
carries  and  protects  Nurse- 
scope.  Heavy  frosted  vinyl,  with 
dust-proof  press-type  closure. 


No.  2160  Nursescope 
including  Free 
Initials  and  Sack 
16.50  ea. 


METAL  CAP  TACS  Palr  of  dainty 
jeweiry^iuality  Tacs  with  grippers,  holds  cap 
bands  securely.  Sculptured  metal,  gold  finish, 
approx,  V  wide.  Choose  RN,  LPN,  LVN.  RN 
Caduceus  or  Plain  Caduceus.  Gift  boxed. 
No.  CT-l'(Specify  Initials),  No.  CT-2  (Plain 
Cad.)  Of  No.  CT-3  (RN  Cad.)  .  .  .  2.95  pr. 


TO:  REEVES  COMPANY.  Box  C    Attleboro.  Mass.  02703 


"IMPORTANT:  New  "Medallion"  styling  includes  tubing  in  colors  to  match 
metal  parts.  If  desired,  add  $1.  ea,  to  price  above;  add  "M"  to  Order 
No.  2160M)  on  coupon.  Duty  free 

LITTMANN  COMBINATION  STETHOSCOPE 

Maximuin  sensitivity  from  this  fine  professional  instrument.  Con- 
venient 22"  overall  length,  weighs  only  SVz  oz.  Chrome  binaurals 
fixed  at  correct  angle.  Internal  spring,  stainless  chest  piece,  IH" 
diaphragm,  IVi"  bell.  Removable  non-chill  sleeve.  Gray  vinyl  tubing. 
Two  initials  engr.  on  chest  piece  fREE  SCOPP  SACK   INCLUDED 

No.  2100  Combo  Steth  . . .  29.70 ea.     Duty  free 


COLOR 


QUANT. 


Use  extra  sheet  tor  additional  items  or  orders. 
INITIALS  as  desired:    


TO  ORDER  NAME  PINS,  fill  out  all  information  in  t)ox,top 
right,  clip  out  and  attacn  to  ttiis  coupon. 


I  enclose  $_ 


I  Please  add  50c  handling/postage 
_/  on  orders  totalling  under  $5.00 


No  COD'S  or  billing  to  individuals,  Mass.  residents  add  3%  S.  T 

Send  to 

Street  

City State Zip 


CLAYTON   DUAL  STETHOSCOPE 

Lightweight  dual  scope  imported  from  Japan:  highest 

sensitivity  for  apical  pulse  rate.  Chromed  binaurals 

chest  piece  with  \W  bell  and  Vk"  diaphragm, 

grey  anti-collapse  tubing,  4  oz.,  29"  long.  Extfa      M       (0,12 

ear  plugs  and  diaphragm  included.  Two  initials       I       V     ^ 

engraved  free.  FREE  SCOPE  SACK  INCLUDED 

No.  413  Dual  Steth  . .  .  17.95  ea,  ^^^^  ^ ^^^ 

LIGHTWEIGHT  CLAYTON   STETHOSCOPE 

Our  lowest  cost  precision  stethoscope!  Single  diaphragm  (H'g"  dia.) 
Choose  Blue,  Green.  Red.  Silver  or  Gold  tubing  and  chestpiece,  silvei 
binaurals,  only  3  oz.  Three  free  initials  engraved  FREE  SCOPE  SACK 
No.   4140   Clay.    Steth    .  .  .  11.95   ea.       Duty  free 


No.  149  Shoulder 
Bag  . .  .  32.95  ea. 


NURSES  SHOULDER  BAG 

Perfect  for  the  visiting  nurse'  Comt)ines 
convenience  and  smart  styling,  while 
avoiding  the  risky  "doctor's  bag"  look. 
Adjustable  shoulder  strap,  or  carry  in 
hand.  Generous  inside  and  outside  pockets 
for  records,  adjustable  and  fixed  loops 
inside  to  hold  bottles,  tubes,  instruments, 
etc.  In  rich  water  repellent  vinyl  sim, 
black  leather,  sturdy  stitching,  gold  fin- 
ished hardware,  lock  clasp  with  key.  Opens 
widely  for  easy  access,  ID  card  holder  on 
end.  FREE  initials  gold  embossed.  12 ''2" 
X  g'^i"  X  S'l".  OutsIantJing  value! 


SCISSORS  and  FORCEPS 


I  Finest  Forged  Steel. 
'  Guaranteed  2  years. 


For  engraved  initials  add  50c  per  instrument 

LISTER  BANDAGE  SCISSORS 

Vh"  Mini-scissor.  Tiny,  handy,  slip  into 
uniform  pocket  or  putse.  Choose  jewelers 
gold    or   gleaming   chrome   plate   finish. 

No.  3500  3V3"  Mini 2.75 

No.  4500  4'/;"  size.  Chrome  only  . . .  2.95 
No.  5500  5V2"  size.  Chrome  only  . . .  3.25 
No.    702  Tk"  size.  Chrome  only  .  . .  3.75 

5V2"   OPERATING   SCISSORS  . 

Polished  Stainless  Steel,  straight  blades.    — ^ 

No.  705  Sharp/  Blunt  points  .  .  .  2.95 

No.  706  Sharp/Sharp  points  . . .  2.95  ^^ 

No.  7IO4V2"  IRISScis..  Stainless,  Straight . . .  3.75^-.^ 

KELLY   FORCEPS 

So  handy  for  every  nurse!  Ideal  for  clamping 
off  tubing,  etc.  Stainless  steel,  SVi" 

No.  25-72  Straight,  Box  Lock 4.49 

No.  725  Curved.  Box  Lock 4.49 

No.  741  Thumb  Dressing  Forcep, 

Serrated,  Straight.  5Vi"....  3.75 
For  engraved  initials  add  50<  per  instrument 


MEDI-CARD  SET    Handiest  reference 

ever!  6  smooth  plastic  cards  OVg"  x  5^")  cram- 
med with  information,  including  Equivalencies  ot 
Apothecary  to  Metric  to  Household  Meas.,  Temp. 
""C  to  °F,  Prescrip.  Abbr.,  LJrinalysis,  Body  Chem., 
Blood 'Chem,,  Liver  Tests,  Bone  Marrow,  Disease 
Incub.   Periods,   Adult  Wgts.,   etc.  All   in  white 
vinyl  holder  with  gold  stamped  caduceus. 
No.  289  Card  Set  .  .  .  1.50  ea. 
Your  initials  gold-stamped  on   holder, 
add  50(  per  set. 


POCKET  SAVERS 


/ 


. Prevent  stains  and  wear! 

Smooth,  pliable  pure  white  vinyl.  Ideal 
low<ost  group  gifts  or  favors. 

No.  210-E  (right),  two  compartments    4 —    ' l 

with  flap,  gold  stamped  caduceus  . . .  /      T  ] 

Packet  of  6  for  $1.80 

Ne.  791  (left)  Deluxe  Saver,  3  comot.  , 

change  pocket  &  key  chain  .  .  .         L  j_        f 

Packet  of  6  for  $2.98 

Nurses'  POCKET  PAL  KIT 

Handiest  for  busy  nurses.  Includes  white 
Deluxe  Pocket  Saver,  with  ^W  Lister  Scissors 
(both  shown  above),  Tricolor  ballpoint  pen, 
plus  handsome  little  pen  light  ...  all  silver 
finished  Change  compartment,  key  chain 

No.  291  Pal  Kit 6-50  ea. 

3  Initials  engraved  on  shears,  add  50^  per  kit. 


EndUra  NURSE'S  WATCH  F.ne  Swiss  made 
waterproof  timepiece.  Raised  easy-to-read  white  numerals 
and  hands  on  black  dial,  luminoiis  markings.  Red  sweep- 
second  hand.  Chrome  finish,  stainless  t^ack.  Includes 
black  velvet  strap.  Gift-boxed,  with  1  year  guarantee 
Very  dependable  Includes  3  initials  engraved  FREE! 
No.  1093  Nurses  Watch 19.95  ea 


PIN  GUARD  Sculptured  caduceus,  chained 
to  your  professional  letters,  each  with  pinback 
safety  catch.  Or  replace  either  with  class  pin  for 
safety.  Gold  finish,  gift  boxed  Choose  RN,  LPN 
Of  LVN  No.  3420  Pin  Guard  ....  2.95  ea, 


ENAMELED  PINS  Beautifully  sculptured  status 
insignia,  2-cclof  keyed,  hard-fired  enamel  on  gold  plate. 
Dime-sized,  pm-back.  Specfy  RN,  LPN,.LVN,  or  NA  on  coupon. 

No.  205  Enam.  Pin  1.95  ea.. 


Bzzz  MEMO-TIMER 


Time  hot  packs,  heat 


give  medication,  etc.  Lightweight  compact  d^"  dia.), 
sets  to  buzz  5  to  60  min.  Key  ring.  Swiss  made. 
No.  fVl-22  Timer 6.95 


nevus 


(Continued  from  page  8) 


Canadian  Nurses  Visit  Cuba, 

Learn  About  Rural  Health 

Ottawa  —  Three  Canadian  nurses  spent 
13-26  March  in  Cuba,  returning  the 
visit  to  Canada  made  earlier  by  4  Cuban 
nurses.  (News.  January  1975.  page 
12). 

The  Canadian  nurses  who  were  ap- 
pointed by  Health  and  Welfare  Canada 
to  visit  Cuba  were:  Margaret  D. 
McLean,  second  vice-president  of  the 
Canadian  Nurses'  Association  and  di- 
rector of  the  Memorial  Universit\ 
school  of  nursing,  St.  John's.  Nfld.; 
Lisette  Arcand,  director  of  continuing 
education,  school  of  nursing,  Laval 
University.  Quebec,  Que.;  and 
Margaret  S.  Neyland.  assistant  direc- 
tor, educational  planning  —  nursing, 
B.C.  Medical  Centre,  Vancouver. 

The  purpose  of  their  visit  was  to 
learn  about  health  care  in  the  rural  areas 
of  Cuba,  and  how  consumers  partici- 
pate in  providing  health  care.  ""We  are 
satisfied  that  we  reached  both  these  ob- 
jectives," McLean  told  The  Canadian 
Nurse. 

In  Cuba's  capital.  Havana,  the 
Canadians  visited  general  and 
specialized  hospitals,  policlinics 
(health  centers  responsible  for  primary 
health  care),  a  day  care  center,  and  a 
maternity  home  that  provides  antenatal 
care  for  women  with  complications  of 
pregnancy.  They  also  visited  poli- 
clinics and  a  rural  hospital  in  the  coun- 
tryside about  100  miles  from  Havana. 

According  to  McLean,  the  Cana- 
dians did  not  succeed  in  finding  out 
what  Cuban  nurses  do.  "A  doctor  an- 
swered our  questions  about  the  nurses' 
role.  The  answer  was  always  that 
nurses  and  doctors  work  in  a  team.  We 
had  no  opportunity  to  observe  nurses  at 
work."  she  said. 

"If  I  were  to  go  again.  I  would  want 
to  spend  time  observing  in  a  hospital 
ward  and  in  a  policlinic,  to  see  how  the 
Cuban  system  functions,"  McLean 
said. 

There  are  certainly  health  workers  in 
the  rural  area,  she  commented.  The 
policlinics  in  rural  and  urban  areas  are 
staffed  by  nurses,  auxiliary  nursing 
personnel,  doctors,  a  dentist,  usually  a 
dental  assistant,  and  a  psychologist. 

Consumers  are  used  to  encourage  in- 
dividuals to  seek  health  care,  according 
to  McLean.  One  person,  usually  a 
woman,  on  every  block  in  Havana  has  a 
responsibility  for  health.  She  looks  for 
those  who  need  preventive  or  curative 
care,  and  makes  sure  they  continue  the 
prescribed  care.  "This  is  using  a  citizen 


Before  their  departure  for  an  official  visit  to  Cuba.  Margaret  S.  Neylan  and  Lisette 
Arcand  were  briefed  by  Rose  H.  Imai,  information  support  officer  to  the  principal 
nursing  officer.  Health  and  Welfare  Canada,  and  by  Dr.  Helen  K.  Mussallem, 
executive  director  ofthe  Canadian  Nurses"  Association.  Margaret  D.  McLean,  the 
third  nurse  visitor,  was  not  present  for  the  photograph.  Pictured  at  CNA  House  are: 
left  to  right.  Rose  Imai,  Dr.  Mussallem,  Margaret  Neylan,  and  Lisette  Arcand. 


instead  of  a  paid  professional  worker  to 
seek  out  individuals  needing  health 
care,"  McLean  said.  Citizen  health  ad- 
vocates also  work  in  the  rural  areas. 

An  article  by  Dr.  Helen  Mussallem, 
which  describes  Cuba's  health  care  sys- 
tem, appeared  in  The  Canadian  Nurse, 
September  1973,  pages  23-30. 


Fiji,  Swaziland  Join 
World  Nursing  Council 

Geneva,  Switzerland  —  The  national 
nurses'  associations  of  Fiji  and  Swazi- 
land have  been  accepted  into  member- 
ship with  the  International  Council  of 
Nurses  (ICN)  effective  1  January  1975. 
according  to  The  International  Nursing 
Review,  official  journal  of  ICN. 

The  two  new  member  associations 
will  be  seated  with  voting  rights  at  the 
meeting  of  iCN's  governing  body,  the 
Council  of  National  Representatives,  to 
be  held  in  Singapore  4-8  August  1975. 
The  ceremonial  admission  will  take 
place  at  the  ICN's  16th  quadrennial  con- 
gress in  Tokyo  in  1977. 

The  Fiji  Registered  Nurses'  Associa- 
tion, founded  in  1956,  has  668  mem- 
bers. The  Swaziland  Nursing  Associa- 
tion has  150  members;  it  was  founded 
in  1965. 


Calif.  Rape  Laws  Revised 

Sacramento,  Calif.  —  Legislation  re- 
forming California's  century-old  rape 
law  defines  more  sharply  what  a  judge 
may  or  may  not  do  in  a  prosecution  for 
rape.  He  may  not  instruct  the  jury  that  a 
victim's  previous  sexual  conduct  with 
persons  other  than  the  defendant  calls 
her  credibility  into  question. 

The  American  Journal  of  Nursing, 
which  reported  the  law's  revision,  said 
that  the  California  law  change  also  pro- 
vides that  the  cost  of  the  rape  victim's 
medical  examination  to  gather'  evi- 
dence for  possible  prosecution  of  a  sex- 
ual assault  is  not  charged  to  the  victim 
but  to  the  appropriate  local  governmen- 
tal agency.  Universal  medical  insur- 
ance coverage  is  not  provided  in  the 
U.S.A. 

California  also  adopted  resolutions 
calling  on  local  law  enforcement  agen- 
cies to  place  policewomen  in  positions 
to  respond  to  cases  of  reported  rape,  the 
AJN  said.  A  recommendation  was 
made  that  victims  who  receive  treat- 
ment in  public  or  private  emergency 
facilities  should  be  given  a  thorough 
examination  for  physical  and  emotional 
trauma,  and  be  informed  of  available 
services  for  venereal  disease,  preg- 
nancy, and  psychiatric  care. 

(Continued  on  page  13) 


THE  CANADIAN  NURSE  —  May  1975 


Help  us  with  our  International  Women's  Year  Project! 


The  Canadian  Nurse  and  L/inf irmiere  canadienne  want  to  docu- 
nnent  instances  of  sex  discrimination  in  health  care  so  that  action 
can  be  taken  to  correct  it. 

Are  women  discriminated  against  in  health  care?   As  patients? 
As  nurses? 

We  invite  nurses  to  send  us  examples  of  discrimination.  Use  the 
form  below,  and,  please,  sign  it.  Your  identity  will  not  be  revealed. 

Return  the  form  not  later  than  30  June  1975,  to: 
Canadian  Nurses'  Association 
Director  of  Information  Services 
50  The  Driveway 
Ottawa,  Ontario  K2P  1 E2 


Incident: 


In  your  opinion, how  does  this  incident  show  discrimination  against  women? 


Are  you:na  nurse, O  a  patient,  □  other  (specify). 


neu;s 

(Continued  from  page  1 1) 

Rape  Crisis  Services 

We  had  hoped  to  publish  a  partial  list  of  crisis  services  for  rape  victims  in 
the  April  issue,  to  accompany  the  article  on  "Rape  Victims  —  the  invisible 
Patients."  Interruptions  in  mail  service  frustrated  that  project. 

This  list  was  compiled  with  assistance  from  Vern  Price,  Calgary  Rape 
Crisis  Centre,  and  staff  members  of  the  Ottawa  Rape  Crisis  Centre.  Readers 
who  have  additions  to  the  list  are  invited  to  send  them  for  publication  in  the 
"Letters"  section. 


British  Columbia: 

Rape  Relief 

181  West  Broadway 

Suite  D 

Vancouver,  B.C. 

V5Y  1P4 

732-1613 

Women's  Centre 
1  306  -  7th  Ave. 
Prince  George,  B.C. 
V2L  3P1 
563-7305 

Alberta: 

Rape  Crisis  Centre 
223-12  Ave.  S.W. 
Calgary,  Alta. 
T2R  0G9 
261-9821 

Rape  Crisis  Centre 
10032  -  103  St. 
Edmonton,  Alta. 
T5J  0X4 
426-4252 

Manitoba: 

Klinic  Distress  Centre 
467  Broadway 
Winnipeg,  Man. 
R3C  0W4 
786-8686 

Ontario: 

Rape  Crisis  Centre 
322  Queens  Ave. 
London,  Ont. 
N6B  1X4 
432-8693 

Waterloo  Women's  Place 
25  Dupont  Street  E. 
Waterloo,  Ont. 
N2J  2C8 
884-9862 

Rape  Crisis  Centre 

P.O.  Box  6597,  Station  A 

Toronto,  Ont. 

M5W  1X4 

487-2345 


Rape  Crisis  Centre 
81  Albany  Ave., 
Hamilton,  Ont. 
L8H  2H4 
545-0773 

Rape  Crisis  Centre 
Box  3773,  Station  C 
Ottawa,  Ont. 
K1Y4J8 
238-6666 

Kingston  Women's  Centre 
346  1  /2  Princess  St. 
Kingston,  Ont. 
K7L  1B6 
542-5226 

Quebec : 

Montreal  Rape  Crisis  Centre 

P.O.  Box  1756,  Place  d'Armes  Stn. 

Montreal,  Quebec 

H2Y  3L5 

866-6666 

New  Brunswick: 

Women's  Information  Centre 

27  Wellington  Row 

St.  John,  N.B. 

E2L  3H4 

657-6366 

Les  Fam 

1 9  Morton  Ave. 

Moncton,  N.B. 

E1A  3H7 

854-3095 

Nova  Scotia: 

Women's  Place 
5683  Brenton  Place 
Halifax,  N.S. 
B3j  1E4 
423-0643 

Newfoundland: 

Women's  Centre 
P.O.  Box  6072 
St.  lohn's,  Nfld. 
A1C  5X8 
753-0220 

(Continued  on  page  14) 


CARE  is 
more  than 
just  a 
package. 

It's  people 
helping  people 

MEDICO,  a  service  of 
CARE,  provides  teams  of 
Canadian  trained  doctors  and 
nurses  throughout  the  de- 
veloping world.  These  MEDICO 
teams  work  to  spread  their 
Canadian  medical  knowledge  to 
their  counterparts  overseas  as 
well  as  to  relieve  immediate 
needs. 

You  can  help  upgrade 
medical  standards  in  Asia, 
Africa,  and  Latin  America  by 
supporting  MEDICO  volunteers. 
Five  dollars  supplies  a  CARE 
MEDICO  team  with  enough 
suturing  materials  for  20  simple 
operations. 

Send  your  dollars  to: 
CARE  Canada, 
Department  4 
63  Sparks  St. 
Ottawa, 
K1P5A6 


THE  CANADIAN  NURSE  —  May  1975 


neu;s 


(Continued  from  page  13) 


Nursing  Research  Workshops 
Attract  Nearly  100  Nurses 

Edmonton.  Aha.  —  Two  workshops  on 
■■Research  for  Practicing  Nurses. "" 
held  in  March  1975.  attracted  nearly 
100  nurses.  The  workshops  were  pre- 
sented by  nurse-researchers,  Dr. 
Shirley  Stinson  of  the  University  of 
Alberta,  Edmonton,  and  Dr.  Marlene 
Kramer,  University  of  California. 

Most  workshop  attenders  were  from 
Alberta,  but  some  15  nurses  came  from 
Newfoundland.  New  Brunswick. 
Quebec,  Ontario,  and  British  Colum- 
bia. ■■Over  half  the  nurses  attending  the 
workshops  had  no  previous  knowledge 
of  research,""  Stinson  told  The  Cana- 
dian Nurse. 

The  workshops  were  directed  to 
■■consumers  of  nursing  research,""  she 
said.  ■■Our  objective  was  to  improve 
their  ability  to  appraise  critically  re- 
search articles,  and  to  see  implications 
for  nursing  practice."" 

All  position  levels  from  general  staff 
nurse  to  director  of  nursing  service 
were  represented  among  the  attenders. 
who  were  employed  in  community  and 
hospital  nursing,  and  on  faculties. 

Nurses  were  asked  to  evaluate  what 
action  they  expected  to  result  from  their 
attendance  at  the  workshop  —  the  im- 
pact on  the  institution  from  which  they 
came,  on  their  immediate  work  situa- 
tion, on  their  own  attitudes  toward  re- 
search, and  on  their  professional 
careers.  In  3  months.  Stinson  and 
Kramer  plan  to  ask  the  nurses  what 
impact  the  workshop  has  actually  had 
in  these  4  aspects.  According  to  the 
initial  evaluation,  the  workshop  was 
enthusiastically  received. 

Included  in  the  workshop  were  exer- 
cises on  delineating  researchable  ques- 
tions in  nursing  problems  brought  up  by 
the  workshop  students.  "■It  was  an  im- 
mersion course,  and  I  was  delighted 
with  the  researchable  questions  iden- 
tified by  these  students,""  Stinson  said. 

Content  of  the  workshop  also  in- 
cluded: what  nursing  research  is.  the 
basic  elements  of  research  design,  ethi- 
cal considerations  in  research,  using  re- 
search results  in  nursing  practice,  and 
exercises  in  critiquing  historical,  ex- 
perimental, and  descriptive  research. 

The  two  workshops  were  cospon- 
sored  by  the  University  of  Calgary  de- 
partment of  continuing  education  and 
the  University  of  Alberta  school  of 
nursing's  continuing  education  com- 
mittee. One  workshop  was  held  in  Ed- 
monton 17-19  March,  and  the  other  in 
Calgary  24-26  March. 


Workers'  Mutual  Respect  Said 
Essential  To  Good  Health  Care 

Ottawa.  Ont.  —  "■Mutual  respect  be- 
tween health  professionals  is  the  only 
real  way  to  provide  good  health  care  to 
the  community.'"  said  Dr.  Richard 
Bann,  staff  member  of  St.  Anne"s 
Clinic  in  Ottawa.  He  was  speaking  at  a 
panel  presentation  to  University  of 
Ottawa  nursing  students  on  26  March 
1975.  The  topic  of  the  panel  was  the 
expanded  role  of  the  nurse  in  primary 
health  care. 

Gail  Pyne.  nurse-practitioner  at  St. 
Anne"s  Clinic,  said  that  the  4-month 
nurse-practitioner  course  she  took  at 
McMaster  University  gave  her  special 
skills  but,  in  her  daily  work  as  a  pro- 
vider of  primary  health  care,  she  used 
most  her  nursing  skills  gained  in  a  basic 
nursing  program.  ■■It"s  a  matter  of  car- 
ing for  people  and  looking  after  them."' 
Pyne  said. 

Health  education  has  been  poorly 
handled  by  health  professionals,  she 
said.  ""It  is  one  of  the  most  important 
aspects  of  the  nurse-practitioner's 
work." 

The  health  problems  seen  in  a  pri- 
mary care  setting  are  life-style  prob- 
lems. Pyne  said.  The  nurse  as  a 
generalist  is  valuable  as  a  health  asses- 
sor. In  addition,  nurses  generally  re- 
ceive more  empathy  training  in  their 
educational  programs  than  doctors. 

Some  200  nurse-practitioners  in 
Ontario,  graduates  of  3  programs 
(McMaster.  University  of  Toronto,  and 
University  of  Western  Ontario),  are 
forming  a  special  interest  group  to  be 
affiliated  with  the  Registered  Nurses" 
Association  of  Ontario,  Pyne  said. 
"The  nurse-practitioner  is  not  a  cate- 
gory to  be  set  apart;  she  is  not  a  super- 
nurse.""  As  basic  nurse-practitioner 
skills  are  introduced  into  educational 
programs,  it  will  be  interesting  to  see 
what  will  happen  in  hospitals,  Pyne 
said. 

Virginia  Brown,  nurse-practitioner 
at   the    Eccles   St.    Clinic,   a   newly- 


Correction 

The  date  of  the  final  reunion  of 
graduates  of  the  Hotel-Dieu  St. 
Joseph  School  of  Nursing,  Bathurst, 
N.B..  is  July  10-12,  1975.  For  in- 
formation write:  C.  Morrison. 
Chairman,  Reunion  75  Committee, 
School  of  Nursing,  Chaleur  General 
Hospital,  Bathurst,  N.B. 


formed  community  health  center  in  Ot- 
tawa, said  that  they  are  experimenting 
with  a  problem-oriented  family  record 
to  be  used  by  both  the  community  ser- 
vices and  health  care  components  of  the 
center. 

The  Eccles  St.  Clinic  is  also  involv- 
ing the  community  in  assessing  the 
health  needs  that  should  take  priority  in 
health  education  programs.  There  is 
community  representation  on  the 
committee  to  select  physicians  for  the 
clinic. 

.A  member  of  the  audience  asked 
how  the  public  accepted  the  programs 
of  nurse-practitioners.  Pyne  replied 
that  it  works  best  by  example.  ■■Most 
persons  want  health  care  from  someone 
who  is  honest  with  them  and  who  cares 
about  rhem."" 

Dr.  John  Aldis  said  his  group  in  the 
Ontario  Ministry  of  Health  supports  in- 
itiatives to  practice  health  care  in  a  dif- 
ferent way  that  is  appropriate  to  the  last 
quarter  of  the  twentieth  century.  He  is 
head  of  the  project  development  and 
implementation  group  in  the  Ontario 
Ministry  of  Health,  which  has  respon- 
sibility for  nurturing  community  health 
service  projects. 

■■prom  the  government's  point  of 
view,  nurses  are  a  resource  that  is 
grossly  underused:  they  are  not  making 
their  maximal  contribution  and  are 
even  losing  some  skills  through 
nonuse,"  Aldis  said. 

In  answer  to  a  question,  he  said, 
"The  government  is  going  to  have  to 
invest  money  now  to  save  money  in  the 
future."  Prevention  will  cost  money 
now  and  save  it  in  future  health  care. 

Discussion  of  how  the  nurse- 
practitioner  should  be  paid  did  not 
reach  a  conclusive  answer.  Aldis  said 
that,  in  Ontario,  the  only  health  care 
organization  in  which  the 
nurse-practitioner's  salary  is  not  an 
"add-on""  expense  is  a  community 
health  clinic,  which  has  a  global 
budget,  or  in  an  area  that  is  officially 
designated  as  medically  "■underser- 
viced,""  in  which  a  physician  is  given 
government  support  and  may  be  pro- 
vided with  a  nurse-practitioner's  salary 
as  well. 

Marie  Loyer.  dean  of  the  University 
of  Ottawa  school  of  nursing,  said  that  a 
nurse-practitioner  program  of  6  to  8 
months'  duration,  with  flexible  entr- 
ance requirements  to  admit  graduates 
of  both  diploma  and  baccalaureate 
programs,  has  been  developed  by  the 
University  of  Ottawa.  The  program 
will  begin  when  funding  is  available.^ 


Your  patients 
will  amaze 
you  . . . 


so  will  retelast 

Your  patients  will  be  back  to  normal  in  no 
time  and  ready  to  start  their  activities  as  if 
nothing  happened. 

NOT  SURPRISING  .  .  . 

RETELAST  is  so  comfortable  and  gives 
such  fast  relief.  Moreover,  RETELAST 
costs  up  to  40%  less  than  any  other 
dressing  or  traditional  bandage. 


//JiMU. 


&G©51©0©  FrSF" 


ACEUTIQUES  LTEE 

TICALS  LTD 

Canada. 


DEMONSTRATION 
AND  FOLDERS 
UPON  REQUEST 


■y.  t  ,^" : ii-yim'mi*>%   , '.;-^^t:;^iM 


Ahhh...thats  nice. 

HEELBO™  and  the  new  "supercushioned"  HEELBO  FLAIR 
are  the  only  protection  for  decubitus  ulcers  that  allow  your 
patients  to  walk  in  comfort  and  safety. 

The  slim,  natural  shape  gives  patients  a  firmer  footing,  so 
that  during  late  hours  and  on  weekends  they  can  man- 
age better  alone. 

Like  the  original  HEELBO,  the  FLAIR  has  a  patented, 
warm,  comfortable  lining  of  brushed  Acrilan.™  Heal- 
ing is  more  rapid,  because  there  are  no  straps  or 
bindings  to  restrict  blood  circulation. 

But  only  the  new  FLAIR  has  an  extra  deep  "arm- 
chair" of  foam  with  higher  sides  for  an  important 
extra  edge  of  protection. 

Leading  institutions  have  given  HEELBO 
excellent  evaluations.  Now  you  can  give 
HEELBO   comfort   and   protection   to 
your  patients. 

After  all,  it  shouldn't  be  just  the  doctor 
who  can  make  your  patients  say 
"Ahhh." 


HEELBO  and  the  new  FLAIR  are 
made  of  washable  Acrilan  with  a 
stain-resistant  foam  cushion,  and 
can  be  autoc laved.  One  size  fits  all 
adults,  heels  or  elbows.  In  blue  or 
yellow,  3  dozen  pairs  per  case. 


FLAIR  on  elbow 


FLAIR  inside-out 


Heelbo 

Heelbo  Corporation      P.O.  Box  950      Evanston,  Illinois  60204 


Please  send  me  a  free  sample  and  price 
Name: 

list. 

Title: 

Hospital: 

Address: 

City: 

State: 

Zip: 

Preferred  Dealer: 

Heelbo  Corporation    P.O.  Box  950    Evanston,  Illinois  60204 


OPINION 


Canada  needs  a  population  policy! 


I 


i 


Canada  must  have  a  population  policy  if  the  quality  of  life  is  to  be  maintained. 
Although  fertility  has  virtually  reached  replacement  level,  with  present  mortality 
conditions  it  will  take  approximately  70  more  years  before  zero  population 
growth  is  achieved  in  Canada.  At  its  presently  known,  sustainable,  carrying 
capacity,  Canada  is  already  overpopulated  in  the  strip  of  land  that  is  habitable. 

Use  Fortier 


Mo  one,  not  even  the  most  conservative 
person,  can  deny  that  there  is  a  population 
oroblem.  There  are  200.000  new  persons 
;achday  in  the  world,  for  a  total  of  75  to  80 
million  a  year.  In  20  years,  instead  of  the  4 
million  people  the  earth  is  supporting  now. 
there  will  be  more  than  6  billion. 

The  most  nightmarish  situation  is  taking 
place  in  Bengladesh.  Bengladesh  has  a 
population  of  75  million  and  it  is  increas- 
ing at  the  rate  of  3'7f  per  year!  It  has  525 
oersons  perkm^.  compared  to  2.4perkm'^ 
in  Canada  or  186  per  km^  in  India.  Re- 
;ently.  due  to  famine,  there  were  100.000 
dead  in  1  month  and  1.000.000  expected 
in  3  months.  The  more  pessimistic  foresee 
hat  the  people  of  Bengladesh  will  soon  be 
jrey  to  cannibalism. 

This  threat  of  cannibalism  cannot  be 
discarded  as  a  scarecrow  for  the  gullible: 
Tiore  and  more  reports  of  its  occurrence 
lave  come  to  the  W.H.O.  from  the  Sahel. 
A'here  there  has  been  an  acute  drought  in 
he  last  few  years.  One  reason  for  the 
ragic  Sahel  situation  has  been  identified 
IS  overgrazing  and  overcultivation  of  the 
and.  with  resulting  erosion  of  the  topsoil. 

A'orld  food  situation 

The  world  food  situation  took  a  sharp 
urn  for  the  worse  in  1972-73;  the  chief 
ause  was  widespread,  unfavorable 
veather,  particularly  drought.  As  they  re- 
'iew  the  bizarre  and  unpredictable 
veather  of  the  past  several  years,  a  grow- 
ng  number  of  scientists  is  beginning  to 
uspect    that    seemingly    contradictory 

HE  CANADIAN  NURSE  —  May  1975 


meteorological  fluctuations  are  actually 
part  of  a  global  climatic  upheaval.  This 
would  include  the  record  rain  in  1972  in 
Canada,  U.S.A..  Pakistan,  and  Japan,  and 
the  recent  rainy  springs  and  summers  in 
Canada. 

Since  1940,  the  mean  global  tempera- 
ture has  dropped  about  1 .5°C;  since  197 1 . 
the  snowcover  of  the  northern  hemisphere 
has  increased  by  12%,  an  increase  that  has 
persisted.  There  are  other  indications  of 
global  cooling,  such  as  the  expansion  of 
the  great  belt  of  dry,  high-altitude  polar 
winds  that  sweep  from  West  to  East, 
which  is  the  immediate  cause  of  Africa's 
drought.  This  cooling  trend  may  be  only 
temporary,  but  even  so  it  can  be  catas- 
trophic. 

A  change  of  temperature  and  rainfall  — 
even  a  very  slight  change  —  in  the  near 
future  in  one  of  the  3  major  grain  exporting 
countries  (U.S.A.,  Canada,  and  Australia) 
would  mean  that  food  production  would  be 
sharply  reduced.  Malnutrition  and  death 
for  many  millions  would  result,  because 
we  no  longer  have  any  food  reserves.  After 
1  or  2  bad  years,  even  the  lucky  one-third 
of  the  world  that  is  well  fed  may  find  it.self 
flirting  with  famine. 

In  a  good  year,  the  world  food  supply 
just  about  keeps  pace  with  increasing  de- 
mands. Food  production  must  rise  2%  a 
year  just  to  provide  the  present  inadequate 
diet;  it  would  have  to  be  increased  much 
more,  if  we  were  improve  global  nutrition. 
Were  we.  for  example,  to  set  as  a  standard 
the  diet  accepted  as  norr.ial  in  Western 


Europe  and  North  America  and  to  divide 
the  food  production  of  the  world  accord- 
ingly, there  would  be  enough  to  feed  only 
one-third  of  the  world's  population.  The 
absolute  number  of  desperately  poor 
people  who  do  not  have  enough  to  eat  is  far 
greater  today  than  ever  before  in  history; 
two-thirds  of  the  children  of  the  world  are 
underfed. 

It  is  becoming  clear  that  the  food  prob- 
lem is  developing  into  a  crisis,  due  mostly 
to  the  population  explosion.  Increasing 
demands  for  food  arise  from  increasing 
affluence,  as  in  Europe,  or  from  increasing 
population,  as  in  most  developing  coun- 
tries. Since  1968.  the  success  of  the  green 
revolution,  which  increased  grain  produc- 
tion by  \57c.  has  given  us  no  more  than  a 
T7c  overall  gain  in  available  food,  because 
of  the  increased  population.  It  has  some 
admitted  risks:  intensive  use  of  land,  some 
of  which  should  remain  fallow,  leads  to 
erosion;  irrigation  leads  to  waterbom  dis- 
eases and  reduced  fish  catches:  chemical 
fertilizer  pollutes  water  supply.  We  are 
reaching  some  of  the  outer  limits  of  global 
■"carrying  mass"  in  terms  of  food  produc- 
tion. 

We  are  often  told  that  there  is  no  possi- 
bility of  reducing  fertility  in  certain  areas, 
unless  we  reduce  child  mortality.  In  de- 
veloped countries,  less  than  1  child  in 
every  40  dies  before  the  age  of  one;  in 
Latin  America,  1  in  15;  in  Asia,  1  in  10; 
and  in  Africa,  I  in  7,  A  recent  study  in  15 
areas  of  the  western  hemisphere  concluded 
that  a  shocking  57%  of  the  infant  deaths 


were  linked  with  malnutrition  and  low 
birth  weight.  Poorly  nourished  mothers 
give  birth  to  low-weight  babies  who  con- 
tinue to  be  malnourished  and  highly  sus- 
ceptible to  infectious  diseases.  The  vicious 
circle  is  complete:  high  child  mortality  is 
caused  by  malnutrition;  malnutrition  is  as- 
sociated with  low  food  availability,  which 
is  associated  with  high  fertility. 

Our  supply  of  food  is  influenced  also  by 
the  availability  of  space.  Some  persons 
would  like  to  believe  that  there  are  vast 
areas  of  land  to  be  cultivated  and  oc- 
cupied, and  that  we  live  some  centuries 
back,  when  the  Americas  were  still  to  be 
discovered.  But  the  whole  world  is  inha- 
bited, in  some  parts,  very  densely.  Even 
the  massive  reserve  of  crop  land  in  the 
United  States  may  well  all  be  under  the 
plow  by  the  end  of  next  year.  Countries 
like  Brazil  claim  that  their  land  is  under- 
populated, that  they  have  the  large 
Amazonia  to  fill.  Experts  disagree  with 
this.  There  is  evidence  that  the  two  largest 
remaining  wilderness  areas  in  the  world, 
the  Amazon  and  Congo  River  basins, 
could  never  support  a  large  population. 

A  botanist  and  an  anthropologist  from 
the  Smithsonian  Institution  maintain  that 
the  luxuriant  vegetation  of  the  Amazon 
and  Congo  jungles  covers  soil  that  is  defi- 
cient in  nutrients  —  soil  that,  without  its 
beauteous  cover  of  vegetation,  would  be 
lashed  by  heavy  rains  and  washed  away, 
so  that  it  would  have  to  be  abandoned  after 
a  few  harvests.  In  Canada's  fragile  ecol- 
ogy, the  forest,  once  cut.  takes  much 
longer  to  grow  back  than  it  would  in  a 
more  temperate  climate. 

Ideology  of  growth 

The  current  problem  of  overpopulation 
has  one  cause  only:  decline  in  the  death 
rate,  due  to  the  achievement  of  medicine 
and  hygiene,  has  not  been  accompanied 
by  a  corresponding  decline  in  the  birth 
rate.  Pronatalist  policies  have  been  held  by 
religion,  commerce,  and  the  military  for 
obvious  and  different  reasons.  Until  re- 
cently, almost  no  government  has  been 
willing  to  encourage  a  decrease  in  the  birth 
rate  and,  in  fact,  many  are  still  committed 
to  the  ideology  of  growth. 

Two  or  three  centuries  ago,  wealth  was 
thought  to  derive  from  the  land.  Then  there 


were  new  theories;  wealth  did  not  come 
from  natural  resources  but  from  human 
labor,  so  the  larger  the  human  population, 
the  more  wealth  it  could  produce. 

The  energy  crisis  may  have  awakened 
us  to  the  fact  that  resources  of  the  earth  are 
finite.  We  may  soon  see  elections  fought  at 
the  national  level  by  progrowth  and  anti- 
growth  groups ,  as  they  are  at  the  municipal 
level.  It  is  interesting  to  realize  that,  while 
many  alternatives  are  considered  on  how 
the  major  urban  centers"  growth  can  best 
be  accommodated,  little  or  no  attention  is 
given  to  nongrowth  strategy.  This  is  part 
of  the  ideology  of  growth. 

To  stop  growing  is  not  synonymous 
with  regression.  Indeed,  it  could  be  just 
the  opposite.  Certainly,  no  growth  could 
create  difficulties,  but  they  would  be  tem- 
porary compared  to  the  exponential  prob- 
lems of  unlimited  growth. 

For  example,  if  we  decide  to  reduce 
population  growth,  there  will  be.  at  first,  a 
large  number  of  young  people,  which  will 
greatly  increase  the  labor  force  for  some 
decades.  After  that,  there  will  be  a  dispro- 
portionately large  number  of  dependent 
old  people.  Should  anybody  worry  about 
the  diminution  of  the  labor  force,  it  is 
reassuring  to  think  that  women  have  the 
immediate  potential  of  doubling  it  without 
increasing  the  population,  and  that  it  could 
be  a  good  occasion  to  raise  women's  edu- 
cational level,  while  lowering  their  fertil- 
ity. The  population  will  come  into  a 
reasonable  balance  only  over  a  period  of  3 
or  4  generations. 

Once  it  was  hoped  that  voluntary  family 
planning  would  suffice  to  control  popula- 
tion growth.  It  has.  in  developed  coun- 
tries, but  it  has  taken  a  long  time  to  show 
results;  it  is  probably  not  enough  in  the 
urgent  situation  of  today.  Furthermore, 
family  planning  programs,  by  themselves, 
are  unlikely  to  reduce  population  growth 
in  developing  countries,  because  most 
couples  are  motivated  to  have  larger 
families  than  are  needed  for  replacement. 

In  the  1940s  and  early  1950s,  social  and 
psychological  obstacles  to  birth  control 
were  considered  formidable.  Socialist 
ideology  and  church  morals  were  both  op- 
posing it.  Then,  the  church  and  the  com- 
munist countries  became  less  sUingent,  and 
it  was  shown  everywhere  that  women  de- 


sired only  a  moderate  number  of  childrj 
and  had  no  strong  resistance  to  famil 
planning. 

Later  on.  national  governments  and  ii 
ternational  organizations  declared  then 
selves  in  favor  of  family  planning  ar 
made  major  resources  available  for  it.  Th 
was  the  beginning  of  high  optimism.  In  tl 
1960s,  with  the  advent  of  the  pill  and  tl 
lUD.  zero  growth  was  thought  within  reac 
for  the  year  2000.  But.  today,  we  are  fac« 
with  the  fact  that  the  birth  rate,  in  mo 
developing  nations,  remains  high. 

Anxiety  over  population  has  intei 
sified,  because  of  the  influence  ( 
ecologists  who  think  of  human  populatic 
as  a  disease.  Man,  in  multiplying,  is  coi 
verting  large  amounts  of  organic  materi; 
into  human  beings,  just  like  bacteria  in 
culture  or  in  an  epidemic.  But  the  resultin 
damage  is  greater  because  of  men's  higl 
energy  technology.  Many  persons  now  bi 
lieve  that  what  is  important  is  not  to  enabi 
people  to  achieve  their  desired  number  ( 
children,  but  to  motivate  them  to  have  th 
number  of  children  that  is  deemed  best  f( 
society. 

Governmenf  role 

How  could  a  government  affect  populj 
tion?  Here  are  five  possible  ways; 
D  A  government  can  educate  people,  I 
influence  their  demographic  behavior  i 
the  desired  manner.  Education  assumt 
that  behavior  can  be  altered  by  reason  ar 
persuasion. 

n  A  government  can  provide  services  I 
affect  the  desired  behavior.  Governmen 
can  affect  the  demographic  rate  by  the 
decision  as  to  what  means  of  fertility  coi 
trol  shall  be  available  within  the  countr; 
Taxes  on  contraceptive  supplies  are  prol 
ably  a  factor;  so  is  the  legal  insistence  o 
oral  contraceptives  by  prescription  onl; 
and  the  banning  of  contraceptive  adverti; 
ing. 

Availability  of  sterilization  or  induce 
abortion  can  be  a  major  factor.  Althoug 
contraception  is  a  far  better  method  of  r« 
ducing  the  birth  rate  than  abortion,  it  take 
much  longer  to  make  its  effect  felt.  Socii 
science  has  not  provided  the  knowledge  1 
enable  the  motivation  of  masses  of  ind 
viduals  to  control  their  fertility. 
D  A  government  can  manipulate  the  b< 


tance  of  direct  incentives  and  disincentives 
to  achieve  the  desired  regulation  of  fertil- 
ity. Incentive  systems  do  not  seek  to  per- 
suade or  to  change  an  individual's  mind, 
but  to  make  an  offer  that  cannot  be  re- 
fused. Men  and  women  can  be  induced  to 
limit  their  family  size  because  of  rewards, 
but  their  basic  preference  for  large  families 
may  remain  unchanged.  Incentives  have 
often  been  used  to  encourage  higher  fertil- 
ity. The  incentives  for  lower  fertility  have 
been  tried  only  recently  and  they  have  not 
shown  decisive  results. 

No  pronatalist  effect  of  family  allow- 
ances has  been  observed.  Europe,  where 
child  allowances  have  been  most  fully  de- 
veloped, is  also  the  continent  with  the 
lowest  birth  rate.  In  the  developing  world, 
money  and  food  have  been  used  as  incen- 
tives for  vasectomy. 

D  The  fourth  possibility  is  to  shift  the 
weight  of  social  institutions  so  that  the 
desired  motivation  will  be  achieved;  this  is 
an  indirect  incentive.  Proponents  of  indi- 
rect incentives  believe  that  neither  educa- 
tion nor  direct  incentives  are  sufficiently 
powerful  or  feasible  to  affect  important 
changes  in  reproductive  behavior. 

Major  institutions  must  be  manipulated 
by  increasing  the  level  of  urbanization,  the 
level  of  education,  and  the  income  of  the 
nation;  reducing  the  availability  of  hous- 
ing;  and    increasing   the    proportion   of 
women  who  are  gainfully  employed.  Ob- 
viously, it  is  much  easier  to  mount  a 
family-planning,  mass  media  campaign, 
and  to  provide  services  or  incentives,  than 
it  is  to  industrialize  a  nation. 
D  Finally,  a  government  could  coerce  the 
desired  behavior  by  the  power  of  the  state. 
Robert  Audry  said:  ""If  our  most  treasured 
democratic    institutions   are    to   be   pre- 
served, and,  with  all  their  faults,  we  know 
of  none  better,  then  birth  control  must  be 
compulsory.  As  one  man,  poor  or  rich, 
cannot  be  granted  the  privilege  of  more 
than  one  vote,  as  one  man  whatever  his 
status  cannot  be  granted  the  privilege  of 
i  driving  through  a  red  light  at  70  miles  per 
I  hour,  as  one  man  cannot  be  sent  to  prison 
I  for  a  crime  for  which  another  is  free,  so 
i  one  human  being  cannot  be  granted  the 
I  privilege  of  burdening  society  with  more 
I  than  a  fair  share  of  youth . ' ' 

To  delineate  between  individual  free- 

THE  CANADIAN  NURSE  —  May  1975 


dom  —  which,  through  Anglo-Saxon 
democracy,  we  have  come  to  revere  above 
everything  else  —  and  the  welfare  of  soci- 
ety is  a  tricky  problem.  And  coercion  is  a 
dirty  word.  To  affect  population  growth, 
mortality  and  migration,  but  not  fertility, 
have  been  manipulated.  The  state  is  given 
the  right  to  impose  vaccination,  sanitation 
practices,  or  the  use  of  insecticides  to  con- 
trol disease  —  all  for  the  common  good. 

Similarly,  we  acknowledge  that  the 
state  has  the  power  to  decide  how  many 
foreigners  may  enter  the  country  and  under 
what  conditions. 

But  we  do  not  give  the  state  the  right  to 
determine  what  number  of  children  we 
should  have,  even  though  it  may  not  be 
much  different  in  logic  or  in  philosophy 
from  the  accepted  analogue  that  we  must 
have  only  one  spou.se  at  a  time.  State  con- 
trol of  fertility  level  is  objectionable,  al- 
though it  is  proposed,  predicted,  and  en- 
forced in  some  countries.  In  view  of  the 
population  situation,  some  consider  that 
childbearing  is  not  a  right,  but  a  privilege 
to  be  conferred  or  not  by  the  state,  to  be 
managed  —  like  death  control  —  for  the 
good  of  al  1 . 

Some  persons  speak  with  horror  about 
coercion  for  sterilization,  but  we  have  al- 
ways accepted  coercion  for  childbearing 
through  the  unavailability  of  medically  ac- 
cepted means  of  contraception  or  abortion. 
It  is  ironical,  also,  that  the  same  people 
who  are  against  sexual  freedom  are 
thoroughly  in  favor  of  it  when  it  concerns 
the  begetting  of  unlimited  children. 

Government  goals 

Whatever  its  option,  a  government,  in 
formulating  a  population  policy,  should 
set  some  goals  to  be  reached  as  soon  as 
possible.  The  first  goal  should  be  the  es- 
tablishment of  a  ministry  of  population. 
The  second,  if  there  is  time  to  do  it,  should 
be  the  appraisal  of  the  sustained  carrying 
capacity  of  a  country  in  terms  of  popula- 
tion. Finally,  there  should  be  surveillance 
of  the  trends  toward  or  away  from  such  a 
target. 

The  carrying  capacity,  that  is,  the  rela- 
tion of  population  to  availability  of  food 
and  shelter,  must  take  into  consideration 
the  existence  of  resources,  such  as  possi- 
ble fuels  and  minerals  that  can  be  ex- 


changed for  other  necessities;  the  ability  to 
save  and  invest;  ease  of  communications; 
and,  finally,  human  factors  such  as 
communal  organization,  literacy,  and  fit- 
ness of  mind  and  body. 

After  the  carrying  capacity  has  been 
evaluated  (it  is  lower  for  industrialized 
countries  with  a  cold  climate),  the  factors 
affecting  population  size  and  composition 
must  be  understood  before  targets  of  fertil- 
ity, morbidity,  and  mortality  are  set.  This 
calculation  which  has  not  been  attempted, 
should  come  from  governmental  agencies. 
Nongovernmental  groups  should  militate 
where  official  policies  have  not  been 
adopted  or  where  traditional  opposition  is 
strong  enough  to  influence  politicians 
negatively. 

Canada's  situation 

There  is  a  popular  belief  that  Canada, 
especially  the  prairies,  has  vast  areas  of 
fertile  land  yet  to  be  cultivated.  This  is  not 
so.  Of  all  potentially  arable  land  in 
Canada,  two-thirds  is  now  cultivated.  Al- 
most all  land  not  now  under  cultivation  is 
of  such  marginal  quality  that  its  develop- 
ment will  be  slow,  costly,  and  probably 
unwise.  In  fact,  during  the  30  years  from 
1 94 1  to  1 97 1 ,  the  cultivated  area  in  eastern 
Canada  decreased  by  about  2,400,000 
ha.* 

The  decrease  occurred  primarily  because 
Canadians  are  no  longer  willing  to  toil 
arduously  on  poor  land  for  an  uncertain 
level  of  living.  Furthermore,  Canada  fails 
to  protect  the  best  agricultural  land  from 
now  essential,  nonagricultural  encroach- 
ment, as  when  an  airport  is  located  on 
agricultural  land  on  the  basis  of  the  lowest 
immediate  cost  for  acquisition  and  de- 
velopment. 

It  seems  uncertain  that  we  will  be  able  to 
retain  the  present  high  quality  of  diet  in 
Canada  as  the  population  increases.  The 
percentage  of  Canadian  families'  income 
spent  for  food  is  likely  to  increase  sharply 
from  the  present  25%,  which  is  almost  a 
worid  low.  Canada  will  have  decreasing 


*  In  metric  measure,  a  hectare,  abbreviated  ha. 
is  the  unit  of  land  area.  An  acre  is  0.4  hectares. 
So  2.4  million  hectares  is  equal  to  6  million 
acres. 


amounts  of  food  to  expyort,  in  the  years 
ahead,  if  the  contemporary  diet  is  to  be 
maintained. 

If  all  cultivable  land  in  Canada  were  to 
be  planted  with  a  wheat  yielding  10% 
more  than  the  average  current  yield  (a 
most  unlikely  possibility),  and  if  all  the 
wheat  were  used  as  human  food,  in  1980 
when  the  world  population  will  have  in- 
creased by  500  millions,  the  wheat  would 
provide  to  the  increased  population  only 
the  actual  inadequate  diet  that  is  current  in 
India. 

Where  does  Canada  stand?  Although, 
with  present  mortality  conditions,  fertility 
has  virtually  reached  replacement  level 
(about  2. 1  births  per  woman),  it  will  take 
approximately  70  more  years  before  zero 
population  growth  is  achieved,  assuming 
that  the  current  level  of  mortality  is  main- 
tained and  that  there  will  be  zero  net  migra- 
tion. At  the  present  rate  of  growth,  there 
will  be  30.2  million  Canadians  by  the  year 
2000. 

It  was  hoped  that  immigration  in 
Canada,  which  accounted  for  20%  of 
population  augmentation  in  1971,  would 
populate  those  parts  that  are  vast,  empty 
spaces.  It  has  not  done  so;  50%  of  the 
immigrants  to  Canada  go  to  Toronto  anc 
there,  they  help  build  a  tentacular  city  that 
is  slowly  eating  up  the  best  arable  land  of 
the  country.  If  Canadian  people  migrate 
to  big  cities,  it  is  unreasonable  to  expect 
immigrants  not  to  do  so. 

Another  rather  disturbing  truth  about 
immigration  in  Canada  is  that  we  are  still 
accepting  skilled  immigrants,  while  many 
Canadian  graduates  are  finding  difficulties 
in  obtaining  the  employment  for  which 
they  were  trained;  such  selective  immigra- 
tion is  a  brain  drain  for  developing  coun- 
tries. Also,  immigrants  are  usually  young 
people  coming  from  cultures  that  favoi 
large  families.  Although  we  are  sympathe- 
tic to  the  overpopulation  of  other  coun- 
tries, Canada  can  do  little  to  help  by  in- 
creasing immigration.  We  should  limit 
immigration  to  refugee  groups,  admitted 
for  humanitarian  reasons. 

Statements  that  compare  the  human  den- 
sity per  square  kilometer  in  Canada  and 
India  are  meaningless.  We  have,  partly 
because  of  our  climate,  a  high  energy- 
consuming  economy.  Lands  also  diffei 


greatly  in  their  hospitality  toward  humans. 
The  possibility  for  human  beings  to  live  in 
an  environment  depends  on  how  much  the 
daily  necessities  are  supplied  by  the  envi- 
ronment, the  capacity  of  the  environment 
to  accept  the  waste  produced  and  process  it 
into  desirable  necessities ,  and  how  quickly 
it  recovers  w  hen  its  capacity  to  provide  has 
been  impaired.  Some  aspects  of  the  world 
are  inhospitable  with  respect  to  only  one  of 
these  three  factors,  but  Canada's  vast 
northern  regions  are  inhospitable  in  all 
three.  In  Canada,  the  harsh  climate,  the 
winter  darkness,  mosquitos,  and  black 
flies  increase  stress. 

At  its  presently  known,  sustainable  car- 
rying capacity,  Canada  is  already  over- 
populated  in  the  habitable  strip  (320  km 
wide  by  5,152  km  long,  a  total  of 
1.648,640  km^)from  which  must  be  sub- 
tracted water,  mountains,  and  arid  areas, 
leaving  only  one-fifth  of  the  total  land 
habitable. 

Population  policy 

Does  Canada  need  a  population  policy, 
or  w  ill  it  only  advocate  one  for  others?  Do 
we  need  measures  to  alter  characteristics, 
such  as  growth,  distribution  structure,  and 
composition?  A  federal  government  paper 
on  the  family  planning  program  says; 
"The  federal  program  has  no  demographic 
intent  ;  its  purpose  is  not  to  influence  the 
size  of  family  nor  the  rate  of  growth 
of  population. ■■  Indeed,  the  Canadian 
government's  attitude  has  been  one  of 
tacitly  supporting  unlimited  population 
growth  by  increasing  children's  allow- 
ances and  tax  benefits  for  larger  families, 
and  by  easy  immigration  laws. 

Compared  to  the  attitude  of  China,  there 
is  a  complete  lack  of  political  commitment 
to  restrained  population  growth.  One  aim 
of  any  population  policy  would  be  to  neut- 
ralize legal,  social,  and  institutional  pres- 
sures that  are  pronatalist.  In  this  light,  the 
one-child  family  should  be  considered  a 
wise  choice,  as  would  be  nonparenthood 
or  adoptive  parenthood. 

"Being  an  only  child  is  a  disease  in 
itself  said  a  renowned  psychologist, 
around  1900.  We  have  adopted  this  er- 
roneous belief.  Any  attempt  to  stabilize 
population  at  the  present  level  depends  on 
the  acceptability  of  the  one-child  family  as 

THE  CANADIAN  NURSE  —  May  1975 


a  social  norm.  There  should  be  no  dis- 
crimination through  taxation  policy 
against  the  one-child  family. 

The  government's  only  reaction  to  the 
population  problem  has  been  the  admis- 
sion that  concentration  of  population  is 
causing  certain  difficulties.  The  worry 
should  be  enough  to  initiate  immediate 
measures  to  discourage  further  growth  of 
urban  areas,  and.  at  the  same  time,  to 
encourage  optimal  land  use.  To  achieve 
this,  the  quality  of  rural  life  must  be  im- 
proved and  we  should  look  after  the 
health  and  social  conditions  of  our  Indian 
and  Eskimo  population,  who  suffer  from  a 
high  rate  of  growth  and  all  its  undesirable 
consequences. 

It  would  mean  using  tax  credit  and  in- 
centives to  influence  the  location  of  indus- 
try and  to  promote  regional  development. 
All  this,  because  of  its  demographic  im- 
pact, would  be  part  of  a  demographic  pol- 
icy. 

We  could  adopt  a  laissez-faire  attitude. 
Some  people  believe  that  we  will  not  have 
a  population  problem,  because  we  will 
have  new  technologies.  But  new  tech- 
nologies bring  problems,  and  it  is  pure 
madness  to  get  into  trouble  on  the  grounds 
that  someone,  as  yet  unknown,  will  dis- 
cover something,  as  yet  undiscovered,  that 
will  get  us  out  of  trouble  just  in  time.  No 
business  organization  would  manage  its 
affairs  on  the  assumption  that  a  technology 
that  may  never  exist  will  come  to  help. 

Most  people  understand  that  animals 
must  have  an  equilibrium  with  their  envi- 
ronment. It  was  announced  recently  that 
there  were  75.000  deer  on  Anticosti  Is- 
land, and  that  15.000  of  them  would  have 
to  be  killed  to  keep  them  from  overgrazing 
and  dying  of  hunger.  The  only  difference 
between  this  and  the  world  population  is 
that  we  do  not  shoot  people,  except  in 
wars;  we  believe  that  we  are  so  thoroughly 
masters  of  this  world  that  overpopulation 
and  famine  can  never  happen  to  us.  It  is 
happening  now  in  the  Sahel  and  in  Beng- 
ladesh. 

There  has  to  be  a  population  policy,  if 
the  quality  of  life  is  to  be  maintained.  This 
idea  has  been  expressed  by  many  associa- 
tions, including  the  Canadian  Medical  As- 
sociation, but  it  has  met  only  with  gov- 
ernmental indifference.  Such  a  policy  is 


not  considered  politically  profitable,  al- 
though it  may  be  essential  for  survival.  On 
the  international  front,  Canadian  money 
should  be  used  mainly  for  solving  the 
overpopulation  problem.  In  face  of  a 
danger  greater  than  the  atomic  bomb,  we 
should  abolish  all  military  spending,  pro- 
mote education  on  population  and 
evaluate  the  private  and  public  cost  of 
additional  children. 

Whenever  one  approaches  the  subject  of 
population,  some  persons  hasten  to  claim 
that  the  problem  lies  elsewhere,  in  de- 
velopment and  overconsumption.  Al- 
though it  is  evident  that  development  is 
essential,  I  cannot  but  disagree  that  one 
must  first  have  development  and  then 
population  will  diminish,  as  it  has  done  in 
Occidental  countries. 

Actually,  the  situation  is  different: 
when  Occidental  nations  started  to  have 
rapid  development,  because  of  the  still 
high  death  rate  and  immigration ,  the  popu- 
lation growth  was  light  compared  to  today. 
so  development  kept  ahead.  But  today, 
development  cannot  keep  up.  For  in- 
stance, by  the  time  the  Aswan  dam  was 
finished,  its  foreseen  profits  had  been  dis- 
sipated by  the  high  rate  of  population 
growth  in  Egypt. 

Short  of  miracles,  development  will 
never  catch  up  with  population  growth. 
Although  it  may  be  true  that  the  population 
explosion  is  not  the  source  of  all  evil,  one 
should  not  try  to  soft-pedal  it.  A  high  level 
of  fertility  is  not  consistent  with  economic 
and  social  development.  One  must  recog- 
nize that  many  problems  are  interdepen- 
dent, and  must  accept  the  need  of  a  papula- 
tion component  in  a  development  equa- 
tion. 

In  the  long  run.  the  problem  of  one 
country  is  the  problem  of  all.  Canada 
needs  a  population  policy  of  restrained 
growth,  for  our  own  good  and.  ultimately, 
for  the  global  good. 


Lise  Fortier  (F.R.C.S.  (C);  M.D..  University 
of  Montreal)  is  president  of  the  Canadian  Fam- 
ily Planning  Federation.  She  is  a  member  of  the 
medical  staff  in  obstetrics  and  gsnecologv  at 
Nolre-Danie  Hospital.  .Montreal,  and  professor 
of  iivnecologv.  Universit\  of  Montreal.       "U 


How  the  leukemic  child 
chooses  his  confidant 


The  child  with  a  life-threatening  illness  confides  in  persons  who  are  sensitive 
enough  to  pick  up  the  indirect  cues  he  throws  out  to  test  their  reaction  and  his 
own. 


June  Kikuchi 


Why  do  some  children  with  life- 
threatening  illnesses,  such  as  leukemia, 
communicate  their  concern  about  dying 
more  readily  and  directly  to  one  person 
than  to  another."  Does  a  child  decide  to 
confide  in  those  caring  for  him  whom  he 
likes  or  knows  best?  Does  he  choose  to 
communicate  deeply  with  those  who 
spend  the  most  time  with  him?  Or  does  he 
seek  out  those  persons  he  finds  it  easy  to 
talk  to? 

Probably  all  these  factors  influence  his 
choice;  however,  sometimes  none  seem  to 
apply.  How,  then,  does  he  choose? 

I  believe  a  child  talks  directly  to  those 
who  recognize  his  indirect  questions  about 
dying  for  what  they  are  and  who  reply 
honestly,  clearly,  and  supportively.  thus 
enabling  him  to  move  toward  direct  com- 
munication when  he  is  ready. 

Whether  or  not  the  dying  child  is  told 
directly  that  his  disease  is  life-threatening, 
he  senses  it  by  the  necessity  for  frequent 
visits  to  the  doctor,  daily  medications,  var- 
ious procedures,  blood  transfusions,  and 
repeated  hospitalization.^  At  the  hospital 


June  Kikuchi  (B.Sc.N..  University  of  Toronto. 
Toronto.  Ontario;  M.N..  University  of 
Pittsburgh.  Pittsburgh.  Pa.)  is  Clinical  Nurse 
Specialist.  The  Hospital  for  Sick  Children. 
Toronto  Ontario. 


he  sees  and  hears  many  things.  He  sees 
children,  sick  like  himself,  grow  increas- 
ingly ill  and  perhaps  die;  however,  be- 
cause he  has  learned  to  observe  our 
culture's  restriction  on  speaking  about 
death,  especially  one's  own  death,  only 
rarely  does  he  try  to  break  the  taboo 
directly.^  Thus,  he  is  caught  in  a  world  of 
silence  unless  he  discovers  some  way  of 
breaking  through  to  someone  he  can  talk 
openly  to  about  his  worries  and  fears. 

Some  of  the  leukemic  children  I  have 
worked  with  break  the  taboo  indirectly, 
either  by  talking  about  the  death  of  another 
child  or  perhaps  by  relating  a  dream.  They 
break  the  taboo  slowly  to  see  not  only  if  the 
adult  can  talk  about  death,  but  also  if  they, 
themselves,  can  talk  about  it. 

If  the  adult  does  not  want  to  talk  about 
death,  then  perhaps  he,  the  child,  should 
be  afraid  to  discuss  it.  However,  if  the 
response  to  his  first  tentative  opening  of 
the  subject  is  an  honest  answer,  and  the 
child  finds  he  can  bear  the  thought  when  he 
talks  in  the  third  person,  he  can  then  move 
on  to  talk  directly  in  the  first  person  about 
himself. 

Ann,  Karen,  and  Ruby 

Ann,  an  anxious,  intelligent, 
10-year-oId  who  had  been  hospitalized 
several  times,  was  approaching  the  termi- 
nal stage  of  her  leukemia.  She  knew  she 


had  leukemia  that  threatened  her  life.  In 
the  past,  she  had  asked  me  several  indirect 
questions,  such  as  "What  does  "In  Mem- 
ory of  Heidi  Ross"  on  that  plaque  mean?" 
She  rarely  talked  about  dying  directly. 

One  day  she  asked  to  be  taken  up  and 
down  the  hall  in  her  wheelchair.  She 
glanced  into  every  room,  but  paid  close 
attention  to  two  private  rooms  in  which  she 
could  see  two  obviously  ill  children,  Diana 
with  leukemia,  and  George  with 
hemophilia.  Ann  knew  both  children. 
After  passing  their  rooms  several  times, 
she  asked,  'is  Diana  going  to  die?  Why  is 
her  mother  sleeping  with  her?"  I  answered 
that  Diana  might  die  as  she  was  very  ill  and 
wanted  her  mother  with  her. 

After  several  more  walks  up  and  down 
the  hall,  Ann  asked.  "Could  George  die?" 
I  explained  that  he.  too.  was  very  ill  and 
might  die,  but  that  we  hoped  not  and  were 
trying  hard  to  help  him.  I  pointed  out  the 
transfusions  he  was  receiving  and  the 
nurse  and  doctor  who  stayed  with  him  all 
the  time. 

After  a  few  minutes,  Ann  said  she  had 
watched  a  television  show  called  "Doc 
Elliott"  about  a  man  with  leukemia.  After 
talking  about  the  program  and  telling  me 
what  happened  to  the  man,  Ann  cried,  "I 
have  the  same  thing  and  I'm  scared!" 
When  I  asked,  "What  are  you  scared 
of?"    she    replied,    "Dying."    When    I 


asked.  "What  scares  you  about  it?"  she 
explained.  "The  pain  and  the  bleeding. "' 
So.  we  talked  about  how  pain  and  bleeding 
could  be  controlled. 

Karen,  a  16- year-old.  was  sure  she  was 
cured  of  her  leukemia.  She  talked  little 
about  her  illness  until  her  first  relapse. 
Then,  one  morning,  she  said.  "You  know. 
Angle  died  last  night.  She  had  leukemia 
too."  Almost  nonstop,  she  asked  a  series 
of  questions:  "How  did  the  nurses  know 
she  had  died?  Were  her  parents  with  her? 
Did  she  suffer?  What  happened  that 
caused  her  to  die?  Did  she  run  out  of 
medicines?  Did  her  parents  know  she  was 
going  to  die?  Where  did  the  nurses  take  her 
when  they  took  her  out  of  her  room?  How 
are  they  going  to  bury  her,  as  the  ground  is 
hard  with  ice?" 

We  talked  about  all  these  things.  The 
following  day.  Karen  told  me  about  a  lady 
she  knew  who  had  a  brain  tumor.  She 
wondered  how  this  lady  would  die.  She 
talked  again  about  Angie  and  then  asked, 

fHE  CANADIAN  NURSE  —  May  1975 


" W  hat  about  me?  What's  going  to  happen 
to  me?  1  heard  they  only  have  seven  drugs. 
When  they  run  out  of  drugs,  am  I  going  to 
be  just  lying  here  or  will  1  be  at  home?"" 

Ruby,  a  bright,  quiet.  14-year-old, 
rarely  talked  about  leukemia  or  dying  until 
quite  late  in  her  disease.  Two  weeks  before 
she  died,  she  told  me  about  a  dream  she 
had  had.  "1  dreamt  that  my  mother  and 
father  were  standing  by  a  coffin  all  deco- 
rated with  flowers.  When  I  came  into  the 
room  and  asked  who  it  was  for,  my  father 
said.    For  you." 

We  talked  about  how  scared  she  felt 
when  she  woke  up  from  her  dream.  Ruby 
then  continued.  "Sometimes  I  think  Tm 
going  to  die  and  sometimes  I  don"t.  I  think 
I  don't  more  than  I  do." 

Picking  up  the  cues 

The  more  we  learn  about  how  a  child 
copes  with  knowing  that  death  is  near,  the 
better  we  can  help  him  face  it.  Just  know- 
ing that  a  child  will  not  directly  break  the 


taboo  against  speaking  of  death  because  it 
might  hurt  him  and  others,  is  not  enough. 
Knowing  that  he  will  try  to  talk  about  it. 
and  how,  can  be  much  more  helpful.  We 
can  then  be  sensitive  to  the  overture  and 
respond  to  the  need. 

The  child  chooses  to  talk  with  those  who 
are  sensitive  enough  to  pick  up  the  indirect 
cues  he  throws  out  to  test  their  reaction  and 
his  own.  If  we  pick  up  the  indirect,  third- 
person  cues  and  respond  honestly,  clearly, 
and  supportively,  the  child  will  trust  us 
and  will  then  be  able  to  move  on  when  he  is 
ready  to  talk  openly  in  the  first  person 
about  impending  death. 

Thus,  we  must  be  available  at  critical 
times  in  case  he  wants  to  talk.*  However, 
if  we  neglect  to  pick  up  the  indirect  cues 
because  they  seem  unimportant  or  make  us 
uncomfortable,  the  child  will  not  move  on 
to  communicate  directly.  Or,  if  we  do  pick 
up  the  indirect  cues  but  respond  dishon- 
estly, vaguely,  or  nonsupportively,  the 
child  will  again  be  caught  in  a  world  of 
silence.  Direct,  first-person  communica- 
tion is  given  to  the  person  who  recognizes 
the  third-person  overture. 

References 

1 .  Bluebond-Langner.  M.  I  know,  do  you?  A 
study  of  awareness,  communication,  and 
coping  in  terminally  ill  children.  In 
Schoenberg.  Bernard,  et  ai,  eds. 
Anticipatory  Grief.  New  York,  Columbia 
U.  Press.  1974.  p.  171-81. 

2.  Green.  M.  Care  of  the  dying  child. 
Pediatrics  40:Suppl:492-7.  Sep.  1967. 

3.  Bluebond-Langner.  loc.  cit. 

4.  Benoiiel.  Jeanne  Quint.  Talking  to  patients 
about  death.  Nurs.  Forum  9:3:  254-68, 
1970.  '^' 


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Most  home  care  programs  devote  the  greater  part  of  their  time  and  resources  to 
the  medical  aspect  of  their  clients'  care.  The  Edmonton  home  care  program  has  a 
different  philosophy:  it  emphasizes  the  social  needs  of  the  individual. 


Cecile  Rioux 


Most  home  care  programs  in  Canada  offer 
homemaker  or  home  help  service  only  to 
f)ersons  who  are  receiving  professional 
physical  care  from  a  nurse  or  a 
physiotherapist.  The  Edmonton  home  care 
program  gives  equal  emphasis  to  the  social 
and  the  medical  needs  of  their  clients.  If  a 
cleaning  person,  who  helps  with  the 
heavier  domestic  tasks,  can  give  the  ser- 
vice required  to  avoid  a  person's  in- 
stitutionalization, the  Edmonton  program 
may  be  able  to  provide  that  single  service. 
Ms.  Y.  was  referred  to  the  home  care 
program  by  the  liaison  nurse  at  hospital  B. 
This  43-year-old,  partly  blind  woman  had 
broken  both  wrists  when  she  fell  on  an  icy 
sidewalk.  Her  right  arm  had  required 
surgery;  she  was  now  ready  to  be  dis- 
charged home.  Both  Ms.  Y"s  wrists  were 


Cecile  Rioux  (R.N..  Noire-Dame  Hcispilal 
school  of  nursing.  Montreal;  B.Sc.N..  Univer- 
sity of  Montreal )  was  nurse-coordinator  of  the 
Edmonton  home  care  program.  Edmonton,  Al- 
berta, from  its  inception  until  November  1974. 
She  now  lives  in  Casper.  Wyoming.  U.S.A. 

24 


in  casts  for  6  to  8  weeks.  She  was  still 
experiencing  pain  in  her  right  hand  and 
was  apprehensive  about  going  home,  be- 
cause she  lived  alone  and  knew  no  one 
whom  she  could  ask  for  help. 

The  liaison  nurse  reassured  Ms.  Y. and 
arrangements  were  made  by  the  home  care 
staff  to  send  a  homemaker  on  the  day  she 
returned  home.  The  main  responsibility  of 
the  homemaker,  besides  housekeeping 
and  cooking,  was  to  get  things  organized 
so  Ms.  Y.  could  have  maximum  indepen- 
dence. Ms.  Y.  was  cooperative  and  ad- 
justed well  to  her  situation,  so  the 
homemaker  service  could  be  discontinued 
on  the  third  day.  Meals-on-wheels  were 
sent  daily,  and  home  help  was  provided  for 
one-half  day  each  week,  for  the  domestic 
tasks  she  could  not  perform. 

After  6  weeks,  the  cast  on  Ms.  Y.'s  left 
arm  was  removed,  and  meals-on-wheels 
were  discontinued  at  her  request;  she  felt 
she  could  manage  the  meal  preparation. 
With  better  weather  and  clean  sidewalks 
she  could  walk  safely  to  the  hospital  a  few 
blocks  from  her  residence  to  receive 
physiotherapy.  Two  weeks  later,  when  the 


cast  on  her  right  arm  was  removed,  she  hac 
gained  enough  strength  in  her  left  arm  tc 
be  totally  independent,  and  home  care  ser 
vices  were  discontinued. 

During  the  2-month  period  Ms.  Y.  wa; 
under  home  care,  the  communication  line; 
were  kept  open  between  her  physician.  th< 
hospital  liaison  nurse,  the  physio  depart 
ment,  and  the  home  care  staff.  Informatior 
was  exchanged  frequently  to  facilitate  con 
tinuity  of  care  and  to  make  sure  that  ever) 
member  of  the  team  was  working  in  th( 
same  direction. 

A  nurse-coordinator  determines  who  ii 
eligible  for  services  under  the  home  can 
program  in  Edmonton,  and  coordinates  al 
the  services.  In  doing  so,  she  fills  a  "sig- 
nificant role  in  providing  the  essentia 
element  of  continuity  to  the  client's  care,' 
as  Minister  of  Health  and  Welfare  Marc 
Lalonde  described  it  in  a  guest  editorial  foi 
The  Canadian  Nurse. ' 

Community  origins  and  objectives 

The  Edmonton  home  care  prograiT 
originated  in  the  community;  representa- 
tives of  various  agencies  formed  a  core 


committee  to  study  the  need  for  coordi- 
nated home  care.  The  recommendations 
that  they  submitted  to  the  Edmonton  city 
council  and  to  the  provincial  department  of 
health  and  social  development  were 
adopted,  with  slight  modifications,  and 
the  home  care  program  began  in 
November  1973. 

The  origins  of  the  Edmonton  program 
are  reflected  in  its  special  goals.  Home 
care  programs  have  several  basic  objec- 
tives: prevention  of  disease,  recovery  or 
maintenance  of  health,  and  improvement 
of  the  quality  of  life  by  making  health  and 
social  services  easily  accessible  to  selected 
persons  in  their  homes. 

The  specific  objectives  are  different  for 
each  home  care  program;  they  vary  with 
the  community  resources  and  the  needs  of 
the  clientele.  In  the  Edmonton  home  care 
program,  one  of  the  specific  objectives  is 
to  make  accessible,  through  one  contact 
only,  the  whole  variety  of  health  and  social 
services  provided  in  the  home. 

Other  goals  are  to  create  or  stimulate 
creation  of  needed  services  that  are  not  yet 
available;  to  decrease  the  financial  burden 
for  the  family  or  the  individual,  by  provid- 
ing services  at  a  cost  based  on  their  ability 
to  pay;  and  to  prevent  or  delay  in- 
stitutionalization for  the  elderly,  the  hand- 
icapped, or  the  chronically  ill  person.  It  is 
hoped  that  this  will  decrease  the  construc- 
tion of  costly  institutions  by  increasing  the 
percentage  of  persons  being  treated  out  of 
hospitals. 

The  home  care  program  is  essentially  an 
administrative  body  responsible  for  coor- 
dination of  all  home  care  services.  Its  staff 
members  do  not  give  direct  patient  care, 
but  arrange  for  services  through  existing 
community  agencies.  For  example,  the 
Victorian  Order  of  Nurses"  staff  provide 
nursing  visits;  homemaker  services  are 
supplied  by  the  Family  Service  Associa- 
tion of  Edmonton  and  by  commercial 
agencies;  most  equipment  is  obtained  from 
benevolent  organizations,  and  the  provin- 
cial government. 

One  disadvantage  to  this  is  the  lack  of 
direct  control  over  the  quality  of  service 
given  by  an  agency's  employees.  As  it  is 
not  possible  for  staff  of  the  home  care 
program  to  discipline  employees  of  other 

THE  CANADIAN  NURSE  —  May  1975 


agencies,  it  becomes  important  to  estab- 
lish good  relations  with  the  persons  in- 
volved. A  flexible  but  firm  attitude  and  a 
mind  open  to  criticism  and  suggestions  are 
needed. 

However,  numerous  advantages  com- 
pensate for  inconveniences.  This  mode  of 
operation  makes  it  possible  for  the  home 
care  program  to  offer  a  greater  variety  of 
services  than  if  it  were  restricted  to  its  own 
resources.  It  avoids  duplication  of  services 
involving  parallel  agencies,  which  is 
costly  and  confusing  to  the  public. 

Open  communication  lines  between  the 
home  care  program  and  the  other  agencies 
help  everybody  to  keep  better  informed  of 
the  services  available ,  for  the  benefit  of  the 
persons  who  need  assistance.  Conse- 
quently, more  referrals  from  agencies  to 
the  home  care  program,  and  from  the 
home  care  program  to  these  agencies,  can 
be  initiated.  Naturally,  many  calls  are  re- 
ceived from  noneligible  candidates.  Home 
care  can  help  by  directing  them  to  an  ap- 
propriate organization.  An  example  of  re- 
ferrals is  the  X.  family. 

Mr.  and  Ms.  X.  are  both  in  their  80s. 
They  have  been  living  in  the  same  home 
for  over  40  years.  Should  they  have  to 
move,  they  would  probably  lose  most  of 
their  friends  and  be  very  lonely,  as  they  do 
not  have  any  relatives. 

The  X.s  were  referred  to  the  home  care 
program  by  a  Local  Initiatives  Program 
worker,  who  felt  that  the  help  the  couple 
received  was  not  adequate.  The  home  care 
iiurse-coordinator  visited  them  to  assess 
their  needs. 

Ms.  X.  told  the  nurse  that  she  had  had  a 
colostomy  operation  18  months  earlier  and 
was  still  being  treated  for  cancer.  Al- 
though Ms.  X  could  still  manage  her  colos- 
tomy care,  she  had  lately  been  weak,  with 
frequent  nausea  and  dizziness.  She  had 
been  confined  to  her  wheelchair  most  of 
the  time,  and  her  husband  was  also  re- 
stricted in  his  activities,  because  of  cardiac 
insufficiency.  They  both  were  much  con- 
cerned about  the  coming  winter. 

Services  offered  to  the  couple  included 
a  nurse's  visit  once  a  week  to  supervise 
their  general  health  and  to  provide  assis- 
tance to  Ms.  X.  for  personal  hygiene  and 
colostomy  care;  daily  meals-on-wheels; 


and  home  help  once  a  week  for  the  laun- 
dry, house  cleaning,  and  grocery  shop- 
ping. 

The  X.s'  family  physician  was  con- 
tacted. He  agreed  with  the  plan  outlined 
and  suggested  physiotherapy  for  Ms.  X.  to 
alleviate  arthritic  pain  and  increase  mobil- 
ity. 

The  couple  was  referred  to  the  "Out- 
reach for  Senior  Citizens"  in  their  area, 
and  arrangements  were  made  to  have  a 
high  school  student  shovel  their  snow  reg- 
ularly. 

A  monthly  reassessment  was  conducted 
by  the  home  care  program  staff,  and  prog- 
ress reports  were  sent  to  the  X.s'  physician 
and  to  the  other  professional  people  in- 
volved. Mr.  X.'s  condition  remained  sta- 
ble. His  wife  gained  strength  and  could  be 
more  ambulatory  and  more  independent 
for  self-care. 

However,  her  illness  was  progressing 
and,  after  8  or  9  months,  her  condition 
started  to  deteriorate  slowly.  The  fre- 
quency of  home  care  services  was  de- 
creased and  increased  according  to  the 
X.s'  needs.  This  will  continue  as  long  as 
the  couple  can  be  maintained  comfortably 
in  their  own  home. 

Services  offered 

Home  care  programs  offer  two  kinds  of 
services:  basic  services  that  a  person  must 
require  to  be  eligible  for  home  care,  and 
ancillary  services,  which  can  be  offered  to 
persons  already  admitted  to  the  program. 

The  basic  services  of  the  Edmonton 
program  are  nursing  visits  and  orderly  ser- 
vice, physiotherapy,  homemaker  (which 
provides  a  person  to  be  responsible  for  the 
household  operation,  child  care,  and  non- 
professional basic  care  to  the  sick  or  hand- 
icapped), and  home  help  (that  is,  a  clean- 
ing person  to  perform  the  heavier  domestic 
tasks). 

Few  home  care  programs  offer  this  kind 
of  help.  Generally,  home  help  or 
homemaker  service  is  offered  only  to  per- 
sons already  receiving  health  services 
from  a  nurse  or  a  therapist.  Home  care 
programs  usually  devote  most  of  their  time 
and  resources  to  the  medical  aspect  of  pa- 
tient care.  The  Edmonton  home  care  pro- 
gram has  adopted  a  somewhat  different 

25 


philosophy  in  emphasizing  the  social 
needs  of  the  individual. 

Ancillary  services  of  the  Edmonton 
program  include:  meals-on-wheels  —  hot 
noon  meals  prepared  according  to  the 
individual's  diet  and  delivered  to  the  home 
daily  on  week  days;  occupational  therapy; 
nutrition  consultation  —  teaching  and 
supervising  diet,  meal  preparation,  and  the 
purchase  of  nutritious  food  within  budget 
limitations;  laboratory  service;  equipment 
and  supplies,  such  as  wheelchairs,  com- 
mode chairs,  and  walkers;  and  drugs  and 
dressings  on  discharge  from  hospital. 

Another  ancillary  service  is  transporta- 
tion by  cab  or  minibus  for  those  unable  to 
use  the  public  transit  system.  This  is  pro- 
vided only  for  appointments  to  a  doctor's 
office,  a  clinic,  or  hospital.  The  home  care 
program  also  offers  the  services  of  volun- 
teers who  do  friendly  visiting  to  the  lonely 
and  deliver  books,  records,  and  tapes, 
loaned  by  the  city  public  library. 

Admission  criteria 

For  admission  to  the  Edmonton  home 
care  program,  a  client  must  require  2  of  the 
4  basic  services  or  one  service,  if  provision 
of  this  will  avoid  institutionalization.  This 
exception  was  made  because  some  of  the 
supportive  services  are  not  available,  ex- 
cept at  a  prohibitive  cost.  It  also  avoids 
penalizing  persons  who  can  manage  with 
less  assistance  than  others  in  similar  cir- 
cumstances —  the  hardy,  independent 
types  should  not  suffer  because  of  their 
pioneer  spirit. 

To  avoid  institutionalization  means  to 
shorten  hospitalization,  as  well  as  to  pre- 
vent or  delay  admission  to  an  institution.  A 
handicapped  individual  who  is  confined  to 
a  wheelchair  can  sometiines  be  maintained 
in  his  own  home  if  he  has  some  help  for  the 
heavier  tasks  he  cannot  accomplish.  When 
a  person  keeps  in  the  home  a  relative  re- 
quiring constant  care  or  supervision,  some 
occasional  help  can  be  provided,  mainly  as 
a  relief  for  the  well  family  member. 

To  be  eligible,  a  person's  condition 
must  be  such  that  he  can  be  treated  ade- 
quately at  home  with  the  services  avail- 
able. Home  care  is  not  intended  to  replace 
hospitalization  when  it  is  required.  For 
example,  a  person  who  needs  constant 
care  or  supervision  should  be  treated  in  an 
institution  with  qualified  personnel  on 
duty  at  all  times. 

The  client  and  his  family  must  accept 
the  services  offered  according  to  the  pro- 
posed plan  of  care,  and  must  be  willing  to 

26 


cooperate.  In  home  care,  the  stress  is  on 
rehabilitation  and  personal  independence. 
The  client  and  the  family  are  an  important 
part  of  the  team,  and  their  participation  in 
the  treatment  is  necessary.  On  the  other 
hand,  nobody  can  impose  on  individuals  a 
service  they  are  not  ready  to  accept. 

The  home  situation  must  also  be  ade- 
quate, that  is,  satisfactory  hygienic  condi- 
tions, and  an  environment  adapted  to  the 
person's  needs.  For  example,  an  outside 
ramp  is  needed  for  the  wheelchair  user,  a 
grab  bar  in  the  bathroom  for  the  elderly  or 
the  handicapped. 

Because  of  the  limited  number  of 
homemakers  available  and  the  high  cost  of 
this  service,  it  has  been  restricted  to  a 
period  of  2  weeks  and  is  provided  only 
when  the  program  staff  believes  that  the 
client's  independence  may  result.  For 
humanitarian  reasons,  this  service  is  also 
provided  to  persons  who  are  in  the  termi- 
nal phase  of  a  fatal  illness.  In  some  cir- 
cumstances, this  2-week  period  can  be  ex- 
tended to  a  maximum  of  4  weeks. 

To  avoid  abuse  of  service  and  to  serve 
more  people,  the  home  help  is  restricted  to 
a  maximum  of  8  hours  per  week  on  a 
long-term  basis.  Experience  has  proven 
that,  in  most  cases,  4  hours  of  home  help 
every  2  or  3  weeks  is  sufficient. 

Home  care  personnel 

The  home  care  director  is  responsible 
for  the  effective  operation  of  the  program. 
He  hires  and  supervises  the  staff,  decides 
on  norms  and  procedures,  administers  the 
budget,  supervises  public  relations  and 
publicity,  prepares  statistics,  and  submits 
his  recommendations  to  the  municipal  and 
provincial  authorities. 

The   role   of  the   nurse-coordinator  is 
based  on  problem  solving.^  It  consists  of: 
»  Identifying  the  client's  needs  or  prob- 
lems —  physical,  psychological,  and  so- 
cial; 

•  Setting  up  realistic  objectives; 

•  Planning  for  needed  services; 

•  Providing  ongoing  supervision  and  as- 
sessment; 

•  Making  appropriate  changes  to  the  plan 
of  care;  and 

•  When  necessary,  setting  up  different  ob- 
jectives. 

The  nurse-coordinator  determines  who 
is  eligible  for  the  program.  She  coordi- 
nates all  the  services,  making  sure  the  dif- 
ferent members  of  the  team  are  working  in 
the  same  direction.  She  keeps  on  file  all 
pertinent  information  and  communicates 


to  the  persons  involved  when  there  is  an> 
significant  change  in  the  patient's  condi- 
tion or  any  modification  of  the  plan  ol 
services. 

Because  of  its  social  orientation,  the 
Edmonton  home  care  program  recently 
hired  a  social  worker,  who  works  in  close 
collaboration  with  the  nurse-coordinator. 

The  home  care  liai.son  person  in  the 
hospital  refers  appropriate  candidates  tc 
the  home  care  program.  The  position  car 
be  held  by  a  nurse  or  a  social  worker,  anc 
this  person  can  be  employed  by  either  the 
hospital  or  the  home  care  program.  The 
liaison  person  consults  the  medical  anc 
paramedical  professionals  treating  the  pa- 
tient; she  meets  the  family,  interviews  the 
patient,  and  forwards  information  to  the 
home  care  program.  With  the  nurse 
coordinator,  she  prepares  a  plan  of  ser- 
vices and  explains  this  plan  to  the  patien 
and  the  family.  She  provides  the  hospita 
staff  with  information  on  the  home  care 
program . 

A  medical  consultant,  hired  on  a  part- 
time  basis,  is  responsible  for  communica- 
tions with  the  medical  profession.  He 
takes  part  in  the  home  care  staff  meetings 
where  all  new  admissions,  recent  dis- 
charges, and  reassessments  are  re  vie  wee 
and  discussed. 

Persons  admitted  to  the  Edmontor 
home  care  program  are  not  only  referrec 
by  heispitals.  In  fact,  about  half  of  them  are 
already  at  home;  these  are  directed  te 
home  care  by  community  agencies,  the 
family  physician,  the  city  public  healtl 
nurse,  the  municipal  or  provincial  socia 
worker,  or  a  family  member,  or  they  cal 
the  program  on  their  own  initiative. 

Conclusion 

After  a  little  more  than  a  year  of  opera 
tion.  the  Edmonton  home  care  program  i; 
still  in  a  developmental  stage.  It  is  toe 
early  yet  to  make  a  value  judgment,  but  the 
rapid  and  regular  growth  that  has  beer 
experienced  seems  to  indicate  a  response 
to  a  definite  need.  In  the  program,  healtl 
and  seicial  services  work  together,  undei 
the  same  roof,  to  insure  the  physical 
psychological,  and  social  well-being  ol 
the  client. 

References 

1.  Lalonde.  Marc.  Guest  Editorial.  Cunad. 
Nurse.  70: 1: 19-20.  January  1974. 

2.  Moore.  M.A.  Philosophy,  purpose  and  ol> 
Jectivcs:  Why  do  we  have  them .'  J.  Nurs 
Admin.   1:3:9- 14.  Mav-Jun.  1971. 


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Hyperkinetic 
Child 


J        yf    '^  ^  hyperkinetic  child  is  described,  and  some  suggestions  are  offered  to  school 
~4.XS-ji_     '  health  nurese  to  help  parents  and  teachers  cope  with  his  problems. 

1,  D.  Carol  Anonsen  -^^^^ijk     . 


\ 


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r/V^iA.  tt0%  il-S-t 

THE  CANADIAN  NURSE  —  May  1975 


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27 


Children  in  the  primary  school  system  who 
exhibit  undesirable  and  unacceptable  be- 
havior in  the  classroom  are  quickly  labeled 
by  teachers  and  school  administrators  as 
"behavior  problems.'"  These  chronic  of- 
fenders cause  considerable  concern  to  the 
educator  because  of  their  unacceptable  be- 
havior. There  is  even  evidence  that  chil- 
dren with  behavior  problems  create  situa- 
tions unpleasant  enough  to  cause  teachers 
to  leave  the  profession. 

A  major  obstacle  to  maintaining  an  ef- 
fective classroom  learning  environment  is 
the  problem  child  who  is  described  as  hy- 
perkinetic, or  overactive.  He  cannot  sit 
still,  cannot  adjust  socially,  and,  as  his 
own  academic  progress  suffers,  disrupts 
the  learning  efforts  of  his  classmates  as 
well.  These  symptoms  of  developmental 
difficulties  may  be  temporary  or  perma- 
nent, and  may  not  necessarily  be  based  on 
actual  physical  findings. 

The  problem 

Hyperkinesis,  or  hyperactivity,  may  be 
defined  as  a  total  daily  motor  activity  that 
is  significantly  greater  than  the  normal. 
This  definition  presupposes  a  behavioral 
dimension,  called  ""activity  level,"" 
which,  when  measured  over  an  adequate 
period  of  time ,  tends  to  be  characteristic  of 
an  individual  child. 

The  hyperkinetic  child  is  described 
not  only  as  being  more  active  than  the 
average  child,  but  also  as  constantly 
getting  into  trouble,  aggressive,  rowdy, 
unable  to  sit  still,  often  disruptive,  and 
antisocial.  He  is  excitable,  easily  dis- 
turbed, and  has  a  short  attention  span.  A 
nonconforming  attitude  and  poor  social 
relations  with  peers  often  bring  this 
child  to  the  principaFs  office  for  disci- 
plining. 

The  physical  examination,  including 
neurological  tests,  is  essentially  negative. 
Intelligence  usually  falls  within  normal 
limits,  though  the  child  may  be  found  in 
remedial  arithmetic  or  reading  classes.  Al- 
though the  cause  of  this  syndrome  is  not 
definitely  known,  it  is  thought  to  be  a 


Until  recently.  D.  Carol  Anonsen  (R.N., 
B.Sc,  St.  Xavier  College.  Chicago  M.Sc.N.. 
The  University  of  Western  Ontario,  London 
was  nurse  coordinator  of  the  Clinical  Training 
course  for  Medical  Services  nurses,  the 
University  of  Western  Ontario.  She  is  now 
lecturer.  Medical-Surgical  nursing,  at  Case 
Western  Reserve  University,  Cleveland.  Ohio. 

28 


delay  in  the  maturation  of  those  areas  of 
the  brain  that  govern  motor  coordination 
and  language. 

Anoxia  in  the  prenatal  or  early  postnatal 
period,  without  sufficient  organic  involve- 
ment to  depress  the  intelligence,  is  a 
suspected  cause.  However,  because  of  a 
lack  of  physical  findings,  this  theory  is  not 
generally  accepted. 

About  4  percent  of  children  in  primary 
schools  are  hyperkinetic.  More  boys  than 
girls  are  affected.  Overactivity  tends  to 
decrease  at  puberty,  and  eventually  disap- 
pears completely. 

Peter 

Peter,  an  8-year-old  of  average  intelli- 
gence, is  in  grade  three.  He  is  in  constant 
trouble  from  misbehaving.  He  has  home- 
work every  night,  mostly  uncompleted 
work  assigned  during  the  day,  or  lines  to 
write,  such  as  "I  must  not  disturb  the 
teacher,"  —  200  times! 

He  is  sent  to  the  principal "s  office  at 
least  twice  a  week  and  spends  long  periods 
sitting  on  a  chair  in  this  office  or  outside 
the  door.  The  usual  reason  is  for  disrupting 
the  class.  His  own  comment  about  what 
the  teacher  thinks  is:  '"My  teacher  says, 
"Where  there  is  trouble  there  is  Peter!" 

Peter  is  the  youngest  of  4  children.  His 
brother,  a  year  older,  excels  in  school  and 
in  sports.  This  adds  to  Peter's  frustration. 
The  two  brothers  play  together  and  are  pals 
most  of  the  time,  but  with  the  usual  dis- 
agreements. The  two  older  children  are 
giris  of  18  and  19  and  have  always  helped 
care  for  the  two  smaller  boys. 

Perhaps  Peter  was  encouraged  to  be  the 
"baby""  instead  of  being  independent  and 
accepting  his  responsibilities.  He  has  as- 
signed chores  but  must  constantly  be  remind- 
ed to  complete  tasks,  otherwise  he  wan- 
ders off  and  starts  something  else.  He  is 
affectionate  and  loved  by  the  whole  fam- 
ily, even  though  he  frequently  irritates 
them.  "'Peter  likes  to  bug  everyone,""  ac- 
cording to  his  brother. 

The  physical  findings  are  negative  in 
Peter's  case.  There  are  no  abnormal  neuro- 
logical signs,  and  he  is  of  normal  intelli- 
gence. Although  Peter  is  not  achieving  as 
well  as  he  should  academically,  he  grasps 
concepts  quickly  enough  to  keep  up  with 
his  class.  All  his  grades  are  at  the  C  or  D 
level. 

Diagnosis 

The  diagnosis  of  hyperkinesis  is  based 
on  behavioral  studies,  the  lack  of  physical 
findings,  results  of  psychological  tests. 


and  the  history  obtained  from  the  parents 
and  the  school.  Child  behavior  rating 
scales  are  available  to  assist  teachers, 
nurses,  and  parents  to  assess  child  ac- 
tivity and  provide  concrete  data  for  the 
history.  As  mentioned,  intelligence  is 
normal. 

The  total  assessment  and  diagnosis  are 
not  only  to  pin  a  label  on  the  child's  prob- 
lem, but  also  to  obtain  a  complete  evalua- 
tion, and  to  plan  with  the  parents  and  the 
teachers  a  management  program  to  help 
them  cope  with  the  child.  It  is  important  to 
accept  him  as  he  is,  to  help  him  live  with 
his  frustrations,  and  to  keep  him  in  school 
at  his  normal  grade  level.  Without  support 
and  understanding,  these  children  are 
considered  potential  dropouts. 

General  management 

If  the  child  is  keeping  pace  with  his  age 
group  in  academic  subjects,  treatment  may 
be  confined  to  explaining  to  teachers  and 
parents  the  nature  of  his  condition  and 
some  methods  of  coping  with  it.  The 
school  gives  assurance  that  the  prognosis 
is  favorable,  ^fid  the  hyperactivity  usually 
disappears  by  the  time  the  child  reaches 
puberty. 

The  child  should  be  kept  in  the  regular 
school  system,  with  occasional  segrega- 
tion to  a  "quiet  area"  when  the  teacher 
perceives  that  he  is  losing  control.  One 
teacher  had  set  aside  a  quiet  area  in  her 
room,  away  from  the  windows,  and  had 
supplied  it  with  books  she  knew  her  pupil 
liked.  This  was  not  for  punishment  but  a 
place  the  child  enjoyed  and  where  he  had 
time  to  unwind. 

Firm,  consistent  control,  a  specific  set 
of  rules,  and  praise  for  good  behavior  are 
all  important  aspects  of  management. 

Medication 

If  the  hyperkinetic  child  shows  signs  of 
losing  ground  academically,  medical 
treatment  may  help.  Medication  should  be 
initiated  before  the  child  actually  does  fall 
behind  in  school  and  experiences  the  frus- 
tration that  eventually  leads  him  to  drop 
out. 

The  drugs  of  choice  are  Ritalin  (methyl- 
phenidate  hydrochloride)  and  Dexedrine 
(dextroamphetamine).  They  suppress  over- 
activity in  the  child  and  increase  attentior 
span.  The  physiological  reason  for  this 
action  is  not  entirely  understood. 

The  usual  method  is  to  start  with  a  min- 
imal dose  of  Dexedrine  5  mg  at  breakfast 
time.  Dosage  is  then  increased  every  3  to  f 
days  up  to  a  maximum  dosage  of  40  mg  pet 


day,  until  improvement  in  behavior  is  at- 
tained. 

Improved  behavior  continues  as  long  as 
medication  is  given  regularly,  but  returns 
to  base  line  if  a  dose  is  omitted. 

Most  common  side  effects  are  insomnia 
and  anorexia,  which  usually  disappear 
after  a  week  or  two  of  regular  dosage.  The 
drug  is  given  early  in  the  morning  and  at 
noon,  never  later,  to  avoid  insomnia.  To 


them  that  his  difficulties  will  disappear 
with  adolescence  and  that  good  adult-child 
relationships  will  avoid  the  emotional 
reactions  that  often  make  a  situation  more 
difficult.  Such  a  child  often  needs  extra 
attention,  reassurance,  and  support. 

It  is  advisable  to  have  a  screened  off 
area  in  the  school  where  the  hyperkinetic 
child  can  be  alone  and  away  from  external 
sensory  stimuli,  and  where  he  can  work  by 


The  hyperkinetic  child  is  described  not  only  as  being 
more  active  than  the  average  child,  but  also  as  con- 
stantly getting  into  trouble,  aggressive,  rowdy ,  unable 
to  sit  still,  often  disruptive,  and  antisocial.  He  is  excit- 
able, easily  disturbed,  and  has  a  short  attention  span. 


check  for  weight  loss,  weight  charts 
should  be  faithfully  maintained.  If  side 
effects  continue  beyond  two  weeks,  the 
dosage  must  be  adjusted. 

It  seems  strange  that  there  has  been  no 
documented  evidence  of  pharmacologic 
habituation  or  of  withdrawal  symptoms 
when  the  drug  is  discontinued.  Children 
are  usually  off  drug  therapy  during  their 
summer  vacation. 

Treatment  may  be  required  for  only  6 
months,  or  up  to  5  years.  These  drugs  do 
not  help  learning,  but  only  make  it  possi- 
ble to  pay  attention. 

Phenobarbital  and  similar  depressants 
are  contraindicated  because  they  induce 
further  excitement  in  these  children.  Why 
this  occurs  is  also  not  understood.  Further 
pharmacologic  research  is  required,  but 
this  is  difficult  as  it  is  not  ethical  to  give 
either  phenobarbital  or  Dexedrine  to  nor- 
mal children. 

Management  in  school 

It  is  generally  agreed  that,  where  possi- 
ble, the  hyperactive  child  should  be  in  the 
regular  school  system,  and  not  segregated. 
However,  he  can  better  cope  with  school 
and  the  learning  situation  if  he  is  a  member 
of  a  small  group  of  8  to  10  pupils,  as  larger 
groups  tend  to  offer  too  much  distraction. 

The  school  nurse  can  help  parents  and 
teachers  understand  this  child  and  the  nat- 
ure of  his  problem.  She  should  impress  on 

THE  CANADIAN  NURSE  —  May  1975 


himself  when  he  needs  to  regain  his 
composure  after  a  particularly  overactive 
period. 

Recognition  of  effort  is  of  prime  impor- 
tance. To  reinforce  good  behavior  by  ap- 
proval and  encouragement  and  to  ignore 
any  disruptive  behavior  is  founded  on 
Skinner's  theories  of  operant  condition- 
ing, and  has  come  to  be  called  "praise 
and  ignore  therapy"  by  educators.  These 
children  have  a  low  tolerance  for  frustra- 
tion, but  are  usually  affectionate,  kind, 
and  obliging. 

The  teacher  in  any  primary  school  sys- 
tem can  expect  about  4  to  10  percent  of  her 
class  to  exhibit  problem  behavior.  To  as- 
sess these  children  and  recognize  their 
need  for  professional  help  could  be  the 
first  step  in  saving  many  of  them  from 
complete  ruin. 

Misbehavior  may  be  an  expression  of  an 
unmet  need,  a  cry  for  help  that  even  the 
parents  do  not  recognize.  Treating  the 
symptoms  will  not  solve  the  problem,  but 
the  combined  efforts  of  school  psycholo- 
gist, family,  family  doctor,  teacher,  and 
school  nurse  may  uncover  the  causative 
factor.  If  there  are  no  identifiable  causes, 
no  physical  or  neurological  signs  or  symp- 
toms, and  if  the  child  is  diagnosed  as  hy- 
perkinetic, then  the  teacher  must  accept 
the  child  as  he  is,  for  his  misbehaviors  are 
not  willful. 

Organization,  orderliness,  and  clear-cut 


rules  will  decrease  the  child's  confusion. 
Assignments  must  be  clearly  stated  and  of 
short  duration  to  match  his  short  attention 
span.  Small  group  projects  and  individual 
work  should  be  encouraged.  The  main  ob- 
jective in  the  plan  of  care  for  these  children 
should  be  to  have  them  achieve  as  well 
academically  as  their  own  age  group. 

The  school  health  nurse  can  help  the 
teacher  identify  and  meet  some  of  the 
needs  of  the  hyperkinetic  child  and  help 
.arry  out  the  professional  recommenda- 
;ions  made.  In  communicating  with  par- 
ents of  hyperkinetic  children,  the  nurse 
can  help  them  understand  their  child  and 
accept  him  as  he  is,  reassuring  them  that  it 
is  a  condition  that  does  not  persist  beyond 
adolescence.  She  should  be  aware  of  the 
underachievers  in  her  school  district  as 
soon  as  they  are  identified,  and  initiate 
assessment  and  care  before  they  become 
so  frustrated  with  their  academic  perfor- 
mance that  they  drop  out  of  the  school 
system.  The  hyperkinetic  child,  espe- 
cially, can  be  helped  if  recognized  early. 

Conclusion 

Hyperkinetic  children  need  help  to  cope 
with  their  frustrations  their  constant  mo- 
tion, their  difficulties  with  peers  and  prob- 
lems with  school  and  teachers.  Parents 
and  the  school  nurse  can  give  the  help  and 
understanding  these  children  need  to  grow 
into  useful,  productive,  happy  adults. 

Bibliography 

Eisenberg.  Leon.  Symposium:  behavior  mod- 
ification by  drugs.  3.  The  clinical  use  of 
stimulant  drugs  in  children.  Pediatrics 
49:5:709-15.  May  1972. 

Salterfield.  James  H.  et  al.  Pathophysiology  of 
the  hyperactive  child  syndrome. /4r(7i.  Gen. 
Psychiat.  31:6:839-44.  Dec.  1974. 

Childrens"  Psychiatric  Research  Institute.  The 
hyperkinetic  child  symposium.  London, 
Ontario,  1974.  (Videotaped).  '^ 


29 


Two  wheels 
unsafe  for  two 


Bicycling  is  regaining  popularity  as  a  family  sport,  and  the  bicycle  child-carrier 
seat  is  often  used  to  allow  young  children  to  come  along  for  the  ride.  The  authors 
contend  that  a  bicycle  fitted  with  such  a  carrier  seat  becomes  an  unsafe  vehicle  for 
two  persons. 


Goldalyn  Cooperman  and  Earl  M.  Cooperman 


The  bicycle  is  now  being  looked  on  as  an 
energy-saving,  anti-pollution  device,  and 
a  symbol  of  good  health  through  exercise. 
In  many  countries  the  bicycle  has  always 
been  popular  as  a  vehicle  for  sport  and 
transportation.  In  North  America,  bicy- 
cling has  recently  regained  widespread 
popularity  as  a  sport  and  pastime  for  peo- 
ple of  all  age  groups. 

As  the  number  of  persons  who  cycle 
increases,  there  is  a  parallel  increase  in  the 
number  of  accidents;  but  the  dangers  as- 
sociated with  bicycling  are  not  well  publi- 
cized. 

Accurate  statistical  data  on  bicycle- 
related  accidents  are  not  yet  available  in 
Canada,  but  some  statistics  can  be  ob- 
tained by  reviewing  hospital  emergency 
room  charts.  These  records  have  limited 
value  because  most  bicycle-related  in- 
juries are  treated  at  home  or  in  the  doctor's 
office  and  are  not  officially  reported  and 
tabulated.  In  other  bicycle-related  acci- 


The  authors,  Goldalyn  Cooperman  (R.N., 
Jewish  General  Hospital  School  of  Nursing, 
Montreal:  B.N.,  McGill  University)  and  her 
pediatrician  husband.  Earl  M.  Cooperman, 
(M.D.,  Queen's  University,  Kingston, 
F.R.C.P.  (O)  have  two  young  daughters.  They 
acknowledge  the  advice  of  Dr.  H.C.  Leitch  of 
the  Product  Safety  Branch,  Consumer  and  Cor- 
porate Affairs,  Ottawa,  in  preparing  the  article. 


dents,  although  the  injury  is  described,  the 
mode  of  injury  is  not  reported. 

In  the  United  States,  a  National  Injury 
Information  Clearing  House  regularly 
publishes  a  National  Electronic  Injury 
Surveillance  System  news  bulletin.  In 
1973,  information  gathered  on  bicycle- 
related  injury  gave  an  estimated  popula- 
tion injury  rate  of  28.7  per  100,000.  The 
increasing  use  of  bicycles  would  mean  that 
the  actual  current  frequency  of  injuries  is 
much  higher. 

Bicycle  child-carrier  seat 

Our  interest  is  with  one  aspect  of  bicycle 
safety:  the  Bicycle  Child-Carrier  Seat 
(BCCS).  Although  manufactured  by  many 
companies,  the  concept  is  standard.  The 
BCCS  may  be  attached  to  the  front  or  back 
wheel  of  a  bicycle.  It  is  usually  made  of 
metal  or  plastic,  with  supporting  arms  ex- 
tending on  both  sides  from  the  seat  to  the 
center  of  the  wheel,  where  it  is  secured  to 
the  axle. 

Given  the  present  structure  of  the  bicy- 
cle, none  of  these  carriers  can  be  consi- 
dered safe.  To  illustrate  the  danger  of  this 
appliance,  we  cite  three  cases  with  which 
we  have  had  personal  experience. 

Case  1. 

A  young  mother  was  riding  on  a  quiet 
residential  street  with  her  37-pound 
3-year-old  strapped  into  a  rear-mounted 


30 


BCCS.  The  mother  stood  on  the  pedals  of 
the  bicycle  to  gain  strength  for  uphill 
pedalling. 

She  lost  her  balance,  and  the  bicycle  fell 
to  the  ground.  In  trying  to  shield  her  child 
from  the  fall,  the  mother  fractured  her  own 
clavicle.  The  whole  family  had  to  carry  on 
for  several  weeks  with  an  incapacitated 
mother. 

Case  2. 

A  3-year-old  girl  was  strapped  carefully 
into  a  rear-mounted  BCCS.  Her  mother 
began  to  pedal,  but  stopped  quickly  when 
the  child  cried  out  loudly.  The  child's  toes 
were  bruised  in  the  spokes  of  the  bicycle's 


rear  wheel.  The  mother,  a  physician,  was 
relieved  that  nothing  more  serious  had  oc- 
curred. 

Case  3. 

A  32-year-old  man  suffered  a  severe 
myocardial  infarction  in  late  1973.  Hoping 
to  improve  his  general  circulation,  he 
bought  a  new  5-speed.  name-brand  bicy- 
cle and  pedalled  daily  for  8  to  10  miles 
along  the  Ottawa  bicycle  paths. 

Being  safety  conscious,  he  purchased 
the  most  expensive  BCCS  available  and  in- 
stalled it  at  the  rear  of  his  bicycle.  One 
morning  in  June  1974.  with  his  5-year-old 
daughter  strapped  into  the  carrier  seat,  he 
swerved  to  avoid  a  pedestrian  and  lost  con- 
trol of  the  vehicle.  His  daughter,  still  tied 
in  the  BCCS.  was  thrown  to  the  pavement. 
The  child,  when  taken  to  hospital,  was 
found  to  have  a  frontal  skull  fracture. 

Initially,  her  hospital  course  was  une- 
ventful. However,  four  days  after  admis- 

THE  CANADIAN  NURSE  —  May  1975 


sion  she  developed  fever  and  irritability. 
Pneumococcal  meningitis  and  septicemia 
were  diagnosed.  Fortunately,  this  girl 
eventually  made  a  total  and  complete  re- 
covery. 

Oiscussion 

Several  lessons  about  the  BCCS  can  be 
learned  from  these  three  cases: 
D  Bicycle    accidents    can    occur    on 
■proper""    bicycle    paths    and    quiet, 
"traffic- free""  streets. 
D  Accidents  can  occur  even  if  the  bicycle 
driver  is  experienced  and  competent. 
n  Accidents  can  occur  even  if  the  vehicle 
itself  is  in  the  best  of  running  order  and 


/        V 


\ 


the  BCCS  is  of  the  best  quality  and  in  good 
repair. 

n  Children's  fingers  and  toes  can  be  in- 
jured in  bicycle  wheel  spokes  unless  the 
BCCS  is  specifically  designed  to  protect 
against  this. 

n  In  the  event  of  an  accident,  even  experi- 
enced, careful  bicycle  drivers  often  cannot 
prevent  serious  injury  to  themselves 
and/or  the  occupant  of  a  BCCS. 

The  use  of  children's  hard  helmets  (such 
as  those  now  used  to  prevent  serious  head 
injury  in  hockey)  by  occupants  of  a  BCCS 
would  help  prevent  serious  head  injury. 
They  would  not  give  total  protection. 
Small  children  are  likely  to  refuse  to  wear 
a  hat  of  any  type,  and  harried,  hurried 
parents  would  just  not  have  time  to  insist 
that  they  do. 

The  traffic  act  says:  "'No  person  riding 
on  a  bicycle  designed  for  carrying  one 
person  shall  carry  any  other  persons 
thereon."    For  safety  reasons,  the  law 


should  be  enforced.  Technically,  as  the 
law  now  stands  in  Ontario,  persons  who 
carry  any  passenger  (including  a  child)  on 
a  2- wheel  bicycle  are  breaking  the  law. 

The  bicycle  is  not  designed  to  carry  pas- 
sengers; it  is  designed  for  only  one  person. 
It  is  our  thesis  that  it  is  not  possible  to  make 
any  existing  2- wheel  bicycle  safe  for  more 
than  one  person. 

Many  devices  have  been  created  by  en- 
terprising parents  who  want  to  take  their 
youngsters  along  for  a  safe  bicycle  ride. 
These  often  become  a  second  vehicle,  and 
are  too  cumbersome  to  manage  easily. 
Securing  the  child  in  such  a  second  vehicle 
would  be  a  problem ,  and  pedalling  the  lead 
bicycle  would  be  real  work.  In  the  event  of 
an  accident,  there  is  no  assurance  that  the 
driver  or  the  occupant  of  the  child  carrier 
would  be  safe. 

Perhaps  a  redesigned  family  bicycle 
with  three  wheels  and  a  broader  base 
would  give  greater  stability  and  allow  for 
the  safe  attachment  and  use  of  a  BCCS 
appliance. 

Conclusions 

In  speaking  out  against  the  BCCS  we 
seem  to  be  casting  a  vote  against  mother- 
hood and  family.  Unfortunately,  antici- 
pated pleasure  in  most  families  overrides 
rational  thought.  Emotional  factors  cloud 
a  person's  reasoning  about  the  safe  and 
proper  use  of  all  sport  and  transportation 
vehicles,  including  the  bicycle.  We  would 
like  to  encourage  people  to  realize  this  and 
think  logically  about  potential  dangers  be- 
fore using  a  BCCS. 

All  of  us  in  the  medical  and  paramedical 
fields  know  that  any  vehicle  and  any  vehi- 
cle appliance  can  be  dangerous;  we  also 
know  that  accidents  and  traumatic  morbid- 
ity can  be  minimized  or  prevented. 

Prior  to  using  any  vehicle  or  any  vehicle 
appliance,  the  safety  factors  should  be 
considered.  In  certain  cases  (under 
specified  circumstances),  a  vehicle  or  a 
vehicle  appliance  is  safe;  in  other  cases  the 
vehicle  is  unsafe  or  the  appliance  is  un- 
safe, or  the  two  together  make  for  an  in- 
herently unsafe  combination. 

We  consider  the  bicycle,  fitted  with  a 
BCCS.  an  unsafe  vehicle  for  transporting 
two  persons.  The  BCCS  as  presently  de- 
signed should  not  be  sold,  and  owners 
should  be  discouraged  from  using  it.    fy 


31 


Promoting  collaboration 

between 


The  author  describes  one  approach  to  overcome  the  barrier  between  nursing 
education  and  nursing  services. 

lannetta  MacPhail 


There  is  strength  in  unity,  and  nursing's 
major  problem  is  lack  of  unity.  A  harrier 
exists  between  nursing  education  and 
nursing  service.  The  new  graduate  is  not 
prepared  for  the  "real"  world.  Nursing 
service  does  not  provide  opportunities  for 
new  graduates  to  function  as  they  have 
been  taught.  Nurses'  talents  and  time  are 
poorly  used.  There  is  a  paucity  of  leader- 
ship in  nursing.  Anti-intellectualism  e.xists 
in  nursing. 

Are  these  statements  familiar?  How 
long  have  we  been  hearing  such  allega- 
tions? Are  they,  in  fact,  truths?  Are  they 
inadequacies  that  impede  our  progress  and 
make  nursing  particularly  vulnerable? 
What  have  we  done  to  overcome  them? 
What  can  we  do  to  unite  nurses  in  address- 
ing such  crucial  issues  and  in  resolving 
some  of  our  internal  problems  so  that  the 
consumers  of  our  services  will  be  well 
served?  Conflicts   within  a  professional 


Jannetta  MacPhail  (RN.  Victoria  Hospilal 
School  of  Nursing.  London.  Ontario;  Ph.D.. 
University  of  Michigan.  Ann  Arbor,  Michigan. 
U.S.A.)  is  Professor  and  Dean.  Frances  Payne 
Bolton  School  of  Nursing.  Case  Western  Re- 
serve University.  Cleveland.  Ohio,  and  Nurs- 
ing Administrator.  University  Hospitals  Cleve- 
land. This  article  is  adapted  from  a  paper  Dr. 
MacPhail  presented  at  an  rnao  workshop  in 
Ottawa  24  February  1975. 


group  can  divert  time  and  energy  from  the 
profession's  mission,  whether  that  be  the 
provision  of  quality  nursing  care  to 
clients/patients  or  the  provision  of  exem- 
plary learning  opportunities  for  nursing  stu- 
dents. 

One  can  identify  a  number  of  conflicts 
within  nursing.  I  shall  focus  on  the  conflict 
between  nurse  educators  and  the  prac- 
titioners of  care,  which  gives  rise  to  un- 
necessary divisiveness  and  impedes  our 
impact  on  the  provision  of  health  care.  I 
shall  share  with  you  what  colleagues  in 
one  setting  have  done,  and  are  continuing 
to  do,  to  resolve  conflicts  and  join  forces  in 
a  cominon  endeavor. 

Although  this  effort  is  in  a  university 
health  center  and  involves  a  university 
school  of  nursing,  the  concepts  have  rele- 
vance for.  and  can  be  applied  to.  any  nurs- 
ing school  and  any  nursing  service  setting 
used  for  student  practice.  Indeed,  they  can 
be  applied  to  any  area  of  nursing  service, 
because  they  are  concerned  with  promot- 
ing quality,  continued  learning,  a  spirit  of 
inquiry,  wise  use  of  human  and  material 
resources,  and  collaboration  among  health 
professionals. 

Statement  of  problem 

Quality  nursing  practice  must  exist  in  a 
clinical  setting,  whether  that  be  hospital, 
nursing  home,  public  health  agency, 
doctor's  office,  or  other  setting,  to  provide 
an  exemplary  learning  climate  for  students 


and  staff.  Although  one  can  learn  from 
poor  role  models  what  not  to  do,  negative 
learning  is  expensive  of  time  and  is  dif- 
ficult. 

A  spirit  of  inquiry  and  a  positive,  sup- 
portive attitude  toward  learners  must  exist 
to  permit  learners  to  question  and  test  out 
new  ideas,  and  to  help  promote  learning. 
These  seem  to  be  logical  expectations  or 
requirements,  but  it  is  known  that  they  do 
not  exist  in  many  clinical  settings  used  by 
nursing  schools.  Only  last  week,  a  nurse 
educator  was  complaining  to  me  about 
poor  practices  and  inadequate  leadership 
in  the  setting  in  which  she  guides  students. 
When  asked  what  she  had  done,  or 
planned  to  do,  about  it,  her  negative 
response  was  disappointing,  although 
perhaps  not  unexpected. 

Nurse  educators,  in  general,  have  not 
assumed  responsibility  for  ensuring  high 
standards  of  care  in  the  health  care  agen- 
cies used  for  student  practice.  Usually  in- 
structors are  "guests"  with  no  legitimate  or 
effective  mechanism  for  influencing  stan- 
dards of  practice.  Frequently,  the  attitudes 
of  nursing  staff  are  not  helpful  and  suppor- 
tive of  students  because  they  do  not  under- 
stand the  goals  and  rationale  underlying 
changes  in  nursing  education. 

In  the  past,  the  modus  operandi  in  nurs- 
ing service  settings  tended  to  engender 
rigidity,  conformity,  dependence  on  rules 
and  regulations  and  superiors,  and  adher- 
ence to  long-standing  patterns  that  lacked 


established  scientific  bases.  These  condi- 
tions prevail  in  some,  if  not  many,  nursing 
service  settings  today. 

Such  an  environment  is  antithetical  to 
the  mission  of  educational  programs  that 
are,  or  should  be.  promoting  the  develop- 
ment of  habits  of  mind  that  will  be  useful 
in  dealing  with  new  situations.  These 
habits  of  mind  include  curiosity,  open- 
mindedness.  objectivity,  respect  for  evi- 
dence, ability  to  think  critically,  flexibil- 
ity, tolerance  of  ambiguity,  independence 
of  thought  and  action,  and  responsibility 
for  continued  learning. 

Nurse  educators  and  nursing  service 
administrators  were,  and  many  still  are. 
hypercritical  of  each  others'  policies  and 
practices,  to  the  detriment  of  both  patients 
or  clients  and  students.  A  logical  means  of 
resolving  this  dilemma  seemed  to  my  col- 
leagues and  me  to  be  to  develop  an  inter- 
institutional  relationship,  whereby  compe- 
tent nurse  educators  could  have  influence 
on  the  quality  of  nursing  care  in  the  set- 
tings used  for  students'  practice,  and 
hence  on  the  learning  climate  provided 
students.  At  the  same  time,  capable 
educators  and  administrators  in  nursing 
service  could  work  together  toward  their 
common  goals,  even  though  their  primary 
goal  differs. 

Goals  of  the  joint  endeavor 

The  goals  of  the  joint  endeavor  were  to 
develop  and  test  new  patterns  of  inter- 
institutional  relationships  and  to  effect 
changes  in  the  patterns  of  organization  and 
functioning  within  each  of  the  two  institu- 
tions. These  patterns  were  designed  to: 
n  enhance  the  quality  of  nursing  care: 
D  provide  an  exemplary  learning  climate 

for  nursing  students  and  staff; 
D  increase  the  spirit  of  inquiry  and  re- 
search in  nursing  practice: 
D  improve  the  use  of  human  and  material 

resources:  and 
D  promote   collaboration   among  health 
professionals. 

Implementing  change 

Mechanisms  were  devised  to  implement 
theories  of  change  and  to  assess  the  conse- 
quences of  planned  change.  Planned 
change  is  defined  by  Warren  Bennis  as  a 
deliberate  and  collaborative  process  that. 
1.  involves  mutual  goal  setting  between  a 
change  agent  and  a  client  system,  and  2.  is 
undertaken  to  resolve  a  problem  or  attain 
an  improved  state  of  functioning.* 

*  Warren  G.  Bennis.  ed..  The  Planning  of 
Change.  2ed.  New  York.  Holt.  Rinehan  and 
Winston.  1969.  pp.  62-78. 

THE  CANADIAN  NURSfc  —  May  1975 


Many  of  the  changes  needed  were  in 
nursing  service,  which  had  a  centralized 
system  or  organization:  involved  tradi- 
tional nursing  roles,  which  were  function- 
ally oriented  and  diverted  nurses  from  di- 
rect care:  and  which  provided  inadequate 
support  services.  In  contrast,  the  educa- 
tional setting  was  decentralized,  with  au- 
thority and  responsibility  delegated  to 
competent  clinical  leaders,  with  emphasis 
on  clinical  expertise,  and  with  support  ser- 
vices that  permitted  faculty  to  concentrate 
their  time  and  efforts  on  the  education  of 
students.  However,  the  educators  needed 
more  emphasis  on  maintaining  clinical 
competence  and  in  assuming  responsibil- 
ity for  the  quality  of  care  provided  to  pa- 
tients. 

Recruitment  of  leaders 

Recruitment  of  leaders,  who  were  to  be 
key  persons  in  implementing  the  concept, 
was  a  major  task.  There  was  need  for 
"risk-takers""  who  would  try  a  new  ap- 
proach and  assume  joint  responsibility  for 
nursing  service,  nursing  education,  and 
research.  Hence,  they  had  to  be  clinically 
able  and  experienced  in  both  education 
and  service. 

Those  attracted  were  leaders  in  their 
clinical  field  w  ho  were  dissatisfied  enough 
with  the  status  quo  to  embark  on  a  new 
endeavor.  They  also  had  to  be  nurses  who 
believed  in  the  concept  of  administration 
as  support,  rather  than  control:  in  develop- 
ing leadership  potential  at  the  operational 
level;  and  in  developing  some  new  roles 
and  facilitating  change  in  old  roles. 

Interinstitutional  relations 

A  key  to  enhancing  relationships  be- 
tween nursing  education  and  nursing  ser- 
vice was  to  promote  increased  interaction 
through  a  variety  of  joint  appointments. 
Representatives  of  two  organizations  can- 
not learn  to  respect  and  trust  each  other  and 
commit  themselves  to  common  goals  if 
they  do  not  have  opportunities  to  interact 
and  to  get  to  know  each  other.  This  seems 
only  logical,  yet  our  systems  in  nursing 
have  promoted  separation  and  have  tended 
to  emphasize  differences. 

Three  major  types  of  joint  appointments 
were  developed: 

D  Shared  Appointment  involves  shared 
cost  as  well  as  shared  responsibility  for 
education  and  service.  The  joint  appoint- 
ment may  be  known  as  chair- 
person/director, faculty-nurse  clinician, 
and  so  on.  The  extent  of  sharing  is 
determined  by  the  needs  of  the  two  organi- 
zations. The  shared  appointment  must  be 
viewed  as  one  job,  and  reasonable  expec- 
tations should  be  set  bv  the  role  encumbent 


and  held  by  others  to  prevent  role  over- 
load, role  conflict,  and  role  ambiguity. 

The  secret  for  the  chairperson/director 
is  to  have  a  cadre  of  competent  associates 
in  each  organization  to  whom  she  can  de- 
legate responsibility  for  day-to-day  opera- 
tions. For  the  encumbent  of  the  faculty- 
clinician  role,  it  is  important  to  have  had 
some  experience  in  both  and  be  helped  to 
set  reasonable  expectations  by  the 
chairperson/director. 

n  Clinical  Appointment  —  or  a  "■lead- 
ership-clinical"" appointment  —  is  that 
held  by  other  leaders  in  nursing  service 
who  are  paid  fully  by  the  service  agency 
and  have  their  primary  responsibility 
there.  Their  major  contribution  to  the  edu- 
cation of  students  is  to  ensure  that  the  qual- 
ity of  care  provided  to  patients  is  that  de- 
sired for  students  to  observe  and  emulate, 
and  to  ensure  that  attitudes  toward  students 
are  supportive  and  helpful. 

Other  involvement  in  learning  oppor- 
tunities provided  students  varies  with  the 
individual  and  the  situation.  The 
privileges  of  the  clinical  appointment  in- 
clude participation  in  general  and  clinical 
faculty  meetings,  gaining  knowledge  of 
and  contributing  to  curriculum  develop- 
ment, serving  on  committees,  and  par- 
ticipating in  educational  and  social  ac- 
tivities for  the  faculty. 

n  Associate  Appointment  is  given  to  all 
faculty  who  guide  students  in  practice  or 
research  in  the  clinical  setting.  It  has  been 
formalized  only  in  the  hospital,  but  some 
of  the  privileges  and  responsibilities  apply 
in  other  agencies  used  for  student  practice. 
The  major  responsibility  is  to  influence  the 
quality  of  care  and  attitudes  of  staff  in  the 
agency  to  promote  an  exemplary  learning 
climate.  The  privileges  afforded  are  for 
practice  and  research,  and  include  partici- 
pation on  committees  and  in  work  groups 
that  are  designed  to  enhance  care. 

Intraorganizational  change 

Major  changes  were  needed  within  the 
service  organization  to  promote  wise  use 
of  human  and  material  resources.  Data  col- 
lected previously  revealed  that  the  services 
of  nurses  were,  in  fact,  poorly  used  and 
that  support  services  had  to  be  greatly  en- 
hanced to  improve  their  use.  In  addition,  it 
was  known  that  nurses  would  need  help  in 
changing  their  roles  to  make  use  of  the 
support  services  and  to  use  their  time  and 
talents  to  better  advantage. 

The  approach  was  two-pronged:  1 .  to 
improve  support  services  by  implementing 
a  unit  manager  program,  and  2.  to  apply 
role  theorv'  in  helping  nurses  to  change 
their  roles. 

33 


Role  theorists  have  pointed  up  5  factors 
known  to  be  important  in  developing 
roles,  namely,  education  and  training,  ex- 
perience, reference  group  identification 
(role  modeling),  status  system,  and  the 
reward  system  of  an  organization.  These 
same  factors  were  considered  to  be  impor- 
tant in  effecting  change  in  roles.  Hence, 
opportunities  were  provided  for  reeduca- 
tion through  workshops  and  conferences. 
The  experience  needed  to  reinforce  the 
reeducation  was  much  more  difficult  to 
provide,  because  the  system  had  to  change 
enough  to  permit  the  nurse  to  perfomi  a 
different  role.  That  requires  time! 

New  role  models  were  introduced.  In 
our  setting  these  were  clinical  experts  and 
beginning  specialists,  or  clinicians,  who 
were  committed  to  providing  quality  care 
and  to  devoting  their  time  to  it.  The  status 
and  incentive  systems  had  to  be  changed  to 
reward  what  was  desired,  namely,  role 
change,  clinical  expertise,  and  giving  up 
nonnursing  managerial  tasks.  The  latter 
tasks  are  important  to  the  provision  of  pa- 
tient care,  but  can  be  done  as  well,  and 
probably  better,  by  someone  other  than  a 
nurse  who  can  focus  full  attention  on  such 
activities  and  on  improving  the  services. 


Factors  Known  to  be  Important  in  Effecting  Planned  Change 

D  Involvement  of  persons  affected  by  the  change  in  planning  and  goal  setting 

n  Administrative  support  —  from  the  top  level 

D  Readiness  —  dissatisfaction  with  existing  practices  and  the  system 

D  Risk-takers  w/ho  are  ready  to  take  a  chance  on  a  new  mode  of  operation 

D  Tolerance  of  ambiguity  and  flexibility 

D  Change  in  accord  with  the  values  and  ideals  of  organizational  members 

(some  change  in  values  may  be  needed  as  a  first  step) 
D  Opportunity  offered  for  a  new  experience  that  is  of  interest  to  the  participants 
D  Participants  can  see  the  benefits  for  themselves  in  the  change 
D  Participants'  authority  and  security  is  not  too  threatened  —  difficult  in  many 

cases,  as  all  ruts  are  more  comfortable 
D  Participants  experience  support,  trust,  and  confidence  in  their  relationships 
n  Plan  is  adopted  by  consensus 
n  Plan  is  kept  open  to  revision  —  not  "set  in  stone,"  but  tested,  evaluated,  and 

revised  accordingly 
D  Timing  of  change  is  as  important  as  the  change  itself. 


Wise  use  of  human  resources 

The  concept  of  wise  use  of  human  re- 
sources was  extended  to  all  categories, 
recognizing  that  poor  use  can  be  either 
underutilization  or  overutilization.  Roles 
were  differentiated  for  the  three  categories 
of  registered  nurses  to  try  to  resolve  the 
common  problem  of  underutilization  of 
baccalaureate  degree  graduates  and  over- 
utilization  of  associate-degree  graduates, 
in  most  service  agencies  there  is  a  staff 
nurse  role  and,  hence .  the  same  role  expec- 
tations are  held  for  graduates  from  the  three 
types  of  undergraduate  programs.  Is  this 
not  illogical  when  the  objectives,  product, 
process,  and  content  of  each  type  of  pro- 
gram differ  so  much? 

Unfortunately,  nurses  conceptualize  the 
different  types,  or  categories,  of  registered 
nurses  and  nursing  assistants  as  ""levels."" 
This  tends  to  create  a  sense  of  one  level 
being  better  than  another,  when  each 
category  of  health-care  giver  makes  an 
important  contribution  in  his  or  her  own 
right.  It  is  important  to  engender  in 
everyone  a  sense  of  pride  in  her  contribu- 
tion so  that  she  experiences  satisfaction 
from  meeting  reasonable  expectations  for 
her  particular  category. 

Not  everyone  should  aspire  to  move  up 
the  so-called  '"career  ladder.""  The  ladder 
concept  engenders  the  same  idea  of  levels 
and  of  being  less  than  someone  else.  Does 
every   nurse  aspire   to  be  a  physician? 

34 


Should  every  nursing  assistant  aspire  to  be 
a  nurse?  Should  every  associate-degree 
graduate  or  hospital-school  graduate  as- 
pire to  earn  a  baccalaureate  degree?  Or 
should  we  try  initially  to  channel  them  into 
the  proper  program  to  use  their  talents  and 
get  them  to  their  goal  more  expeditiously 
so  they  can  take  pride  in  perfomiing  their 
proper  role  to  the  best  of  their  ability? 
There  would  still  be  opportunity  for  those 
whose  career  goals  change  and  who  wish 
to  continue  their  formal  education. 

Collaboration 

Continued  learning  to  maintain  compe- 
tence, and  an  opportunity  to  interact  with 
other  health  professionals  are  two  ingre- 
dients needed  to  promote  collaboration  in 
planning,  implementing,  and  evaluating 
patient  care.  Since  a  common  language  is 
needed  for  effective  communication,  clin- 
ical expertise  as  possessed  by  specialist  or 
clinicians  facilitates  collaboration  in  a  set- 
ting in  which  most  physicians  are 
specialists. 

The  nurse  clinician  was  a  new  role  in 
our  setting,  as  in  others  a  decade  ago. 
Resistance  was  probably  even  greater  to 
this  new  role  than  to  a  change  in  existing 
roles.  Various  approaches  were  used  and 
evaluated,  with  the  belief  that  revision  was 
possible  and  flexibility  essential. 

The  traditional  concepts  of  ""line"  and 
"staff""  were  found  not  to  be  suitable  in 


differentiating  the  roles  and  role  relations 
between  specialists,  that  is.  assistant  direc- 
tors as  ""line"'  and  nurse  clinicians  as 
""staff."  Rather,  a  concept  of  shared  re- 
sponsibility has  evolved,  with  the  two 
types  of  specialist  sharing  responsibility 
for  the  nursing  care  rendered  patients  and 
for  the  development  of  staff,  on  the  basis 
of  their  clinical  expertise.  Both  can  be 
viewed  as  serving  as  role  models  in  prac- 
tice, as  consultants,  and  as  change  agents; 
providing  opportunities  for  continued 
learning  of  staff;  and  promoting  a  spirit  of 
inquiry  and  collaboration.  The  major  dif- 
ferences are  involvement  in  personnel  ad- 
ministration activities,  and  the  emphasis 
placed  on  the  varied  aspects  of  their  roles 
in  effecting  change  in  the  provision  of  care 
and  the  learning  climate. 

Effecting  planned  change 

Effecting  change  in  the  provision  of 
health  care,  or  in  nursing  alone,  has  been 
likened  to  moving  a  graveyard.  It  is  really 
not  that  difficult,  but  it  requires  know  ledge 
of  change,  sensitivity,  maturity,  flexibil- 
ity.  relational  skills,  and  the  ability  to  prac- 
tice what  you  preach! 

Change  must  be  planned.  It  is  a  deliber- 
ate and  collaborative  process  that  involves 
mutual  goal-setting  by  the  change  agent 
and  client  system.  This  implies  that  those 
to  be  affected  by  the  change  are  involved 
in  the  planning  and  the  goal-setting.      >~ 


riTTTSiTriiuiuFrgTsii 


today's  students 


INTRODUCTORY 


FUNDAMENTALS  OF  NURSING 
The  Humanities  and  the  Sciences  in  Nursing 
Elinor  V.  Fuerst,  R.N.,  M.A.;  LuVerne  Wolff,  R.N. 
M.A.;  Marlene  H.  Weitzel,  R.N.,  M.S.N. 


/^I 


ILIPPINCOTT 
I  PRICE  $10.50 


A  major  revision  of  an  out- 
standing text,  with  much  new 
material  reflecting  current 
nursing  concepts  and  practice. 
A  holistic  approach  to  nursing 
practice  and  preventive  care  is 
emphasized.  The  application  of 
systems  theory  to  nursing  care 
is  a  feature  of  this  edition.  New 
chapters  focus  on  community 
environment  and  the  nurse's 
role  in  promoting  optimum 
sensory  stimulation. 

450  Pages 
Illustrated,  1974 


PERSPECTIVES  IN  HUMAN  DEVELOPMENT 
Nursing  Throughout  the  Life  Cycle 
Doris  Cook  Sutterley,  R.N.,  M.S.N,  and  Gloria 
Ferraro  Donnelly,  R.N.,  M.S.N. 

An  entirely  new  approach  to  the  study  of  human 
development,  designed  to  prepare  nurses  to  meet 
the  challenges  of  the  present  and  future,  and  to 
apply  recent  findings  in  the  physical  and  social 
sciences  to  the  care  of  patients.  It  is  a  superb  foun- 
dation for  curricula  built  around  the  human  organ- 
ism as  an  open  system  within  an  ecological  and 
social  framework. 

LIPPINCOTT  331  Pages 

PRICE  $8.75  Diagrams  and  Charts,  1973 


NEW 

SCIENTIFIC  FOUNDATIONS  OF  NURSING 

Madelyn  T.  Nordmark,  R.N., 
M.S.  (N.E.)  and  Anne  W. 
Rohweder,  R.N.,  M.N. 

This  thoroughly  revised  edition 
applies  the  principles  and  facts 
from  the  biophysical,  social 
and  behavioral  sciences  to 
clinical  nursing.  It  is  expressly 
designed  to  aid  the  student  in 
developing  a  greater  under- 
standing of  the  relevance  of 
science  content  to  effective 
nursing  care. 

About  480  Pages 
3rd  Edition,  1975 


LIPPINCOTT 
PRICE  About  $9.50 


NEW 

MASSACHUSETTS  GENERAL  HOSPITAL: 

Manual  of  Nursing  Procedures 
By  Department  of  Nursing,  M.G.H. 

This  book  makes  available  to 
all  nurses  a  practical,  compre- 
hensive manual  from  one  of  the 
leading  hospitals  in  the  United 
States.  The  convenient  and 
thorough  presentation  features 
unusually  broad  coverage  of 
standard  procedures  applic- 
able to  all  hospitals.  The  rigor- 
ously tested  procedures  are 
presented  in  a  clear,  step-by- 
step  format. 


LITTLE,  BROWN 
PRICE  $8.95 


389  Pages 
Illustrated,  1975 


NURSING  CARE  PLANNING 

Dolores  E.  Little,  R.N.,  M.N..  and  Doris  L.  Camevali, 

R.N. ,  M.N. 

This  book  presents  the  rationale  for  patient  care 
planning  as  a  key  process  inherent  in  the  profes- 
sional nursing  role.  Content  reflects  the  authors' 
philosophy  that  nursing  of  truly  professional  caliber 
must  embody  systematically  planned  assessment 
and  intervention,  based  upon  priorities  of  patients' 
needs  and  most  effective  use  of  available  personnel. 
LIPPINCOTT  245  Pages 

PRICE  $4.75  1969 

COMMUNICATION  IN  NURSING  PRACTICE 
Eleanor  C.  Hein,  R.N.,  M.S. 

The  author  covers  a  wide  range  of  skills  that  nurses 
must  use  to  communicate  effectively  with  an  infinite 
variety  of  patients,  and  she  analyses  a  communica- 
tion model  that  takes  the  reader  along  a  sequential 
route  comprising  the  component  parts  of  the  com- 
munication process. 

LITTLE,  BROWN  242  Pages 

PRICE  $6.95  1973 


Preparation  for 


BIOLOGIC  SCIENCES 


BASIC  PHYSIOLOGY  AND  ANATOMY 

Ellen  E.  Chaffee,  R.N., 
M.N.,  M.Litt.;and  Esther  M. 
Greisheimer,  Ph.D.,  M.D. 

Redesigned  with  a  handsome  new 
format,  this  major  revision  of  a 
well  established  text  retains  the 
successful  organization  of  earlier 
editions.  Coverage  of  human  physi- 
ology is  expanded;  a  new  chapter 
is  devoted  to  body  fluids  and 
electrolytes;  some  200  drawings 
are  new. 


LIPPINCOTT 
PRICE  $11.50 


530  Pages 
Illustrated,  3rd  Edition,  1974 


Also  available  . . . 

LABORATORY  MANUAL  IN  PHYSIOLOGY  AND 

ANATOMY 

LIPPINCOTT  264  Pages 

PRICE  $5.75      Illustrated,  3rd  Edition  Revised,  1974 

BASIC  MICROBIOLOGY 

Wesley  A.  Volk,  Ph.D.,  and  Margaret  F.  Wheeler,  M.A. 

Extensively  revised,  reorganized  for  greater  sequential 
logic,  and  updated  to  include  recent  research  findings, 
the  Third  Edition  meets  all  of  the  criteria  for  a  one- 
semester  course. 

LIPPINCOTT  592  Pages 

PRICE  $12.75  Illustrated,  3rd  Edition,  1973 

LABORATORY  EXERCISES  IN  MICROBIOLOGY 
Raymond  B.  Otero,  Ph.D. 

Designed  for  use  with  Basic  Microbiology,  this  manual  is 
adaptable  for  use  with  similar  one-semester  textbooks. 
LIPPINCOTT  165  Pages 

PRICE  $4.95  1973 

NEW 

BASIC  PHYSIOLOGY  FOR  THE  HEALTH  SCIENCES 

Ewald  E.  Selkurt,  Ph.D. 

Here  is  a  complete  basic  textbook  covering  all  physiology 

from  the  standpoint  of  the  allied  health  professions.  Each 

of  the  nine  contributing  authors  is  an  expert  in  a  given 

physiological  specialty  and  presents  the  most  up-to-date 

and  significant  information   in  the  context  of  the  latest 

physiological  theory.  Excellent  diagrams  lavishly  illustrate 

this  text. 

LITTLE,  BROWN 

PRICE  Paper  About  $11.50  612  Pages 

Cloth  About  $16.50  Illustrated,  May  1975 


CLINICAL 


ADVANCED  CONCEPTS  IN  CLINICAL  NURSING 

KayKlntzel,  R.N. ,  M.S.N. 

In-depth  knowledge  of  16  complex  areas  of  patient  care. 
Includes  intensive-care  nursing,  dialysis,  burns,  central 
nervous  system  dysfunction. 

LIPPINCOTT  427  Pages 

PRICE  $13.95  86  Illustrations,  1971 


NEW 

TEXTBOOK  OF  MEDICAL  —  SURGICAL  NURSING 

Lillian  S.  Brunner,  R.N.,  M.S.;  Doris  S.  Suddarth, 

R.N.,B.S.N.E.,  M.S.N. 

Outstanding  in  its  depth  of  scien- 
tific content  and  in  the  practicality 
of  its  application,  this  leading  text 
has  been  heavily  revised  and  up- 
dated, with  much  new  material.  In 
the  unit,  Assessment  of  the  Patient, 
three  new  chapters  have  been 
added:  Clinical  Interviewing  of 
Patients;  Physical  Examination  by 
the  Nurse;  and  Guidelines  for 
Writing  Problem-Oriented  Records 
to  promote  continuity  of  patient 
care.  Other  new  chapters  include 
Care  of  the  Cardiovascular  Surgi- 
cal Patient,  and  The  Person  Ex- 
periencing Pain.  Nursing  management  in  various  clinical 
situations  is  frequently  outlined  in  tabular  form. 
LIPPINCOTT 
PRICE  About  $21.00 
Illustrated,  3rd  Edition,  Ready  May  1975 

NEW 

CARE  OF  THE  ADULT  PATIENT 

Medical-Surgical  Nursing 

Dorothy  W.  Smith,  R.N.,  Ed.D.;  Carol  P.  Hanley 

Germain,  R.N.,  M.S. 

A  superbly  useful  tool  for  nursing 
education  and  practice,  this  well 
established  text  has  been  mas- 
sively revised,  updated  and  ex- 
panded, and  provides  an  authori- 
tative basis  for  understanding  the 
patient's  therapeutic  regimen,  in- 
cluding surgery,  drugs,  nursing 
intervention  and  rehabilitation.  The 
nursing  process  is  stressed  and 
pathophysiologic  content  has  been 
expanded.  Each  chapter  empha- 
sizes assessment  of  the  physical, 
emotional  and  social  needs  of  the 
patient  and  his  family.  New  chap- 
ters include  The  Nursing  Process,  Nursing  Assessment, 
and  The  Development  Process. 
LIPPINCOTT 
PRICE  About  $19.00 

Illustrated,  4th  Edition,  Ready  June  1975 


THE  LIPPINCOTT  MANUAL  OF  NURSING 

PRACTICE 

Lillian  S.  Brunner,  R.N.,  M.S.;  and  Doris  S.  Suddarth, 

R.N.,  M.S.N. ;  with  four  coauthors,  three  contributors. 
This  now-famous  ready  reference  puts  virtually  all  of 
nursing  right  at  your  fingertips!  In  three  major  units  .  .  . 
medical/surgical,  maternity,  pediatric  . .  .  this  unique  book 
presents  clinical  problems,  their  causes,  manifestations, 
potential  complications,  plus  overall  nursing  management 
in  concise,  outline  form  .  .  .  instant  information  you  can 
put  to  immediate  use.  With  Capsule  Guidelines  to  Nursing 
Action,  Nursing  Alerts,  Sections  on  Pharmacology  and 
Medication,  and  much,  much  more! 

LIPPINCOTT  1473  Pages 

PRICE  $21.50  Profusely  Illustrated,  1974 


total  patient  care 


CRITICAL  CARE  NURSING 

Carolyn  M.  Hudak,  R.N.,  M.S..  Barbara  M.  Gallo, 

R.N.,  M.S.;  and  Thelma  Lohr,  R.N.,  M.S. 

With  21  Contributors. 
'excelled  in  scope  and  content,  and  holistic  in  ap- 
ach,  this  text  deals  with  the  physiological/emotional 
olems  of  the  ICU  patient;  examines  the  structure, 
:tion  and  pathophysiology  of  major  body  systems; 
esses  professional  practice  in  the  ICU,  Including  the 

nurse's  role  and  responsibilities. 

LIPPINCOTT       351  Pages/drawings,  charts,  tables 
PRICE  $9.50  1973 

Also  available  . . , 

WORK  MANUAL  FOR  CRITICAL  CARE  NURSING 

-IPPINCOTT         99  Pages/perforated  and  punched 
='RICE  $3.50 1973 

^JURSES'  HANDBOOK  OF  FLUID  BALANCE 

Morma  M.  Metheny,  R.N.,  M.S.:  and  William  D. 
Snively,  Jr.,  M.D.,  F.A.C.P. 

The  nurse's  expanded  role  In  diagnosis,  treatment  and 
Bvaluation  of  lab  findings  is  reflected  in  this  edition.  A 
;hapter  on  Fluid  Balance  in  Pregnancy  is  entirely  new; 
)ther  new  chapters  deal  with  routes  of  transport,  organs 
)f  homeostasis,  disturbances  of  water  and  electrolytes 
JPPINCOTT  325  Pages 

■^RICE  $8.75 Illustrated,  2nd  Edition,  1974 

\  GUIDE  TO  PHYSICAL  EXAMINATION 

Jarbara  Bates,  M.D. 

^n  expertly  illustrated,  "how-to"  text  that  bridges  the  gap 

letween  anatomy  and  physiology  and  their  application  to 

he  physical  examination.  Within  each  region  or  system 

hree  topics  are  presented:  1)  anatomy  and  physiology 

iasic  to  the  examination,  2)  examination  techniques,  3) 

'xamples  of  selected  abnormalities. 

-IPPINCOTT  375  pages 

^RICE  $18.75 Illustrated,  1974 

'HYSICAL  AND  APPRAISAL  METHODS  IN 

JURSING  PRACTICE 

osephine  M.  Sana,  R.N.,  and  Richard  D.  Judge,  M.D. 

:igh*een  contributing  authors,  all  experts  in  their  fields, 
ave  written  a  comprehensive  survey  on  all  aspects  of 
hysical  examination  and  appraisal.  Each  of  the  body  sys- 
sms  is  extensively  covered  with  step-by-step  instructions 
n  procedures  for  conducting  examinations.  There  is  also 
unique  section  on  age-group  considerations  in  physical 
ppraisal. 

.ITTLE,  BROWN 

^RICE  Paper  About  $9.50  402  Pages 

^loth  About  $14.50  Illustrated,  1975 


MATERNAL  CHILD  HEALTH 


lATERNITY  NURSING 

lise  Fitzpatrick,  R.N..  M.A.;  Sharon  R.  Reeder,  R.N., 

f'A  ^"*^   '■"'3'   Mastroianni,   Jr.,   M.D.,   F.A.C.S., 
.A.C.O.G. 

urrent  thinking  is  reflected  in  material  on  ante-partal  care, 

atient  education,  conduct  of  normal  labor,  care  of  full- 

»rm,  premature  and  low-birth  weight  infants,  and  nursing 

emergency  situations.   Psychosocial  factors  are  inte- 

ated  throughout. 

PPINCOTT  638  Pages 

RICE  $10.75       322  Illustrations,  12th  Edition,  1971 


MATERNAL  CHILD  NURSING 

Violet  Broadribb,  R.N.,  M.S.;  and  Charlotte  Corliss, 
R.N.,  M.Ed. 

A  family-centered  text,  designed  for  combined  maternal- 
nursing  courses,  covering  the  entire  maternity  ex- 


child 


perience,  and  the  child  from  birth  to  adolescence  Ques 
tions  and  situation-type  problems  follow  each  unit 

FOUNDATIONS  OF  PEDIATRIC  NURSING 
Violet  Broadribb,  R.N.,  M.S. 

The  text  has  been  broadened  and  enriched  to  reflect 
nursing  concepts  stemming  from  recent  findings  in  child 
psychology,  and  advances  in  pediatric  medicine  and 
surgery.  New  or  expanded  material  includes  psychosocial 
development;  genetic  factors;  the  child  in  the  family  the 
newborn  in  the  intensive  care  unit;  pediatric  pharma- 
cology. '^ 

LIPPINCOTT 

PRICE  Paper  $7.75  500  Pages 

Cloth  $9.75  Illustrated,  2nd  Edition,  1973 

NURSING  CARE  OF  CHILDREN 

Florence  G.  Blake,  R.N.,  M.A.;  F.  Howell  Wright, 

M.D.;  and  H.Waechter,  R.N. ,  Ph.D. 
Without  peer  as  an  in-depth  study  of  pediatric  nursing 
this  text  deals  with  both  the  cognitive  and  emotional 
spheres  of  development.  Concise  overviews  for  each  unit 
??i^rf;K?^'®''"®"'^  situations  add  to  the  teaching  potential. 
LIPPINCOTT  588  Pages 

PRICE  $10.50         245  Illustrations,  8th  Edition,  1970 

EMOTIONAL  CARE  OF  HOSPITALIZED  CHILDREN 

An  Environmental  Approach 

Madeline  Petrillo,  R.N.,  M.Ed., 
and  Sirgay  Sanger,  M.D. 
Techniques  of  communicating  with 
children  and  their  parents  are  pre- 
sented in  realistic  and  practical 
terms.  Preventive  approaches  to 
minimizing  potentially  unhappy  ex- 
periences are  supported  by  an- 
alyses of  actual  clinical  situations. 


LIPPINCOTT 

PRICE  Paper  $5.50  Cloth  $7.50 


MENTAL  HEALTH 


259  Pages 
Illustrated,  1972 


BASIC  PSYCHIATRIC  CONCEPTS  IN  NURSING 
Joan  J.  Kyes,  R.N.,  M.S.N. ;  and  Charles  K.  Hofling, 

M.D. 

This  revised  edition  focuses  on  the  dynamics  of  the 
nurse  s  role  and  function,  and  facilitates  student  progress 
from  the  theoretical  to  the  operational  level.  Many  case 
studies  reinforce  basic  psychiatric  concepts  and  explain 
the  rationale  for  nursing  intervention.  Heavily  revised  con- 
tent includes  drug  abuse,  sexual  deviation,  patient  man- 
agement, self-understanding,  and  recognition  of  patient 
problems. 

tmc? $f  tV  600  Pages 

PRICE  $9.75 3rd  Edition,  1974 


Instructors  are  invited  to  write  to  our  educational  consultant 
NANCY  C.  CASHIN,  R.N.,  M.Sc,  concerning  their  requirements. 


THE  PRACTICE  OF  MENTAL  HEALTH  NURSING 
A  Community  Approach 
Arthur  James  Morgan,  M.D. 

Written  by  a  nurse  and  a  psychiatrist  actively  engaged  in 
the  practice  of  community  mental  health,  content  focuses 
on  reality-oriented  practice  and  the  presentation  of  con- 
cepts basic  to  the  delivery  of  patient  care.  The  absence  of 
traditional  and  often  mysterious  psychiatric  jargon  will 
appeal  to  students  as  well  as  experienced  nurse  prac- 
titioners. 

LIPPINCOTT  211  Pages 
PRICE  Paper  $5.95  Cloth  $8.25 1973 

NURSING  OF  FAMILIES  IN  CRISIS 

Joanne  E.  Hall,  R.N.,  M.S.,  and  Barbara  R.  Weaver, 

R.N. ,  M.S. 

This  unique  book  provides  an  introduction  to  crisis  theory 
as  a  conceptual  approach  to  nursing  of  families.  The 
authors  include  numerous  case  studies  of  families  who 
have  experienced  maturational  or  situational  crises. 
LIPPINCOTT  250  Pages 
PRICE  $6.50 1974 

THE  NURSE  AND  HER  PROBLEM  PATIENTS 

Gertrud  Bertrand  Ujhely,  R.N.,  Ph.D. 

Whether  a  nurse-patient  difficulty  stems  from  the  patient, 

the  nurse,  or  both,  there  is  help  for  the  situation  in  this 

widely-used  book.  In  three  parts,  it  discusses  I)  why  nurses 

have  difficult  patients;  II)  types  of  problem  patients;  and 

III)  solutions  to  specific  problems. 

SPRINGER  192  Pages 

PRICE  $5.25  Sixth  Printing,  1972 


PHARMACOLOGY 


CLINICAL  PHARMACOLOGY  IN  NURSING 

Morton  J.  Rodman,  B.S.,  Ph.D.  and  Dorothy  W.  Smith, 


R.N.,M.A.,  Ed.D 


LIPPINCOTT 
PRICE  $11.75 


This  entirely  new  text  by  the 
authors  of  Pharmacology  and  Drug 
Therapy  in  Nursing  offers  quick, 
easy  access  to  information  needed 
for  expert  patient  care.  Essential 
scientific  material  is  clearly,  con- 
cisely presented.  Drug  Digests  at 
the  end  of  each  chapter  include 
data  on  dosage,  administration,  ad- 
verse effects,  indications  and  con- 
traindications for  specific  drugs. 
Factual  data  and  fundamental 
principles  are  presented  in  tables 
and  summaries. 

701  Pages 
1974 


ARITHMETIC  FOR  NURSES 

Marilyn  Ferster  (Gilbert),  M.A. 

A  manual  designed  to  teach  the  mathematical  operations 

the   student   of   nursing    needs   to    learn,    including    the 

mathematics  for  computing  dosages  and  solutions. 

SPRINGER  128  Pages 

PRICE  $5.50  2nd  Edition,  1973 


PHARMACOLOGY  AND  DRUG  THERAPY  i 

IN  NURSING 

Morton  J.  Rodman,  B.S.,  Ph.D.  and  Dorothy  W.  Smith 

R.N.,  M.A.,  Ed.D. 

Help  for  the  nurse  to  better  understand  the  nature  of  drui 
action  and  her  role  in  drug  therapy.  Covers  sourcesj 
dosage,  physiologic  action,  adverse  effects  and  implicaj 
tions  for  nursing  action.  | 

LIPPINCOTT  738  Page." 

PRICE  $10.75  Illustrated,  1961! 

PROGRAMMED  MATHEMATICS  OF  DRUGS  AND 

SOLUTIONS 

Mabel  E.  Weaver,  R.N.,  M.S. 

To  serve  as  a  refresher  for  the  nurse  practitioner  and  a 
an  introduction  for  the  student,  this  programmed  te> 
presents  the  principles  of  mathematics  in  an  applied  an 
practical  way. 

LIPPINCOTT  109  Page} 

PRICE  $2.75  Paperbounc! 

1966  Printing  with  Revision 

PHARMACOLOGY  AND  PATIENT  CARE 

Solomon  Garb,  M.D.;  Betty  Jean  Crim,  R.N.,  M.Ed 

and  Garf  Thomas,  R.Ph.,  M.S. 

The  main  section  of  the  book  contains  54  chapters  O; 

drug  groups,  with  each  chapter  generally  consisting  c| 

1)  brief  text,  devoted  to  purposes,  principles  and  broa^ 

issues,  and  2)  tables  that  show  related  drugs,  enabling  th 

nurse  to  compare  their  uses  at  a  glance. 

SPRINGER  608  Page, 

PRICE  Paper  $8.95  Cloth  $11.95      3rd  Edition,  197| 


DIET  THERAPY 


COOPER'S  NUTRITION  IN  HEALTH  AND  DISEASE'; 

Helen  S.  Mitchell,  Ph.D.,  Sc.D.;  Henderika  J. 

Rynbergen,  M.S.;  Linnea  Anderson,  M.P.H.;  and 

Marjorie  V.  Dibble,  R.D.,  M.S. 

The  15th  edition  presents  a  comprehensive  survey  of  th 

science  of  nutrition,  with  emphasis  on  the  biochemic 

and  physiological  effects  of  the  various  nutrients  in  maii 

taining  or  restoring  health. 

LIPPINCOTT  685  Page 

PRICE  $10.50       121  Illustrations,  15th  Edition,  19e 

NUTRITION  IN  NURSING 

Linnea  Anderson,  M.P.H.;  Marjorie  V.  Dibble,  R.D., 
M.S.;  Helen  S.  Mitchell,  Ph.D.,  Sc.D.;  and  Henderikf' 
J.  Rynbergen,  M.S. 

A  compact  text  that  provides  the  essentials  of  norm 
nutrition  and  patient-centered  clinical  nutrition,  witho 
extensive  coverage  of  biochemistry  research  data,  or  foe- 
preparation.  The  authors  survey  our  present  nutritior 
knowledge  and  what  this  means  to  the  nurse  in  fulfillii 
her  therapeutic  role  in  the  hospital  and  community. 
LIPPINCOTT  406  Pagij 

PRICE  $9.75  Tables  and  Charts,  19 


Lippincott 


J.  B.  LIPPINCOTT  COMPANY  OF  CANADA  LIMITED 

SERVING  THE  HEALTH  PROFESSIONS  IN  CANADA  SINCE  1897 

75  HORNER  AVE.,  TORONTO,  ONTARIO  M8Z  4X7       (416)  252-5277    , 


.1 


idea 
exchange 


CVA  victims'  program 

Corinne  Tench 


When  a  rare  vascular  disease  struck  two 
years  ago,  I  was  thought  to  have  suffered  a 
paralytic  stroke  —  I  had  overnight  become 
hemiplegic  and  aphasic.  Fortunately,  I 
have  now  regained  control  of  speech  and 
of  the  muscles  on  the  left  side.  But,  being 
right-handed,  there  are  still  many  things  I 
cannot  do.  and  there  can  be  no  thought  of 
resuming  an  active  nursing  career.  How- 
ever, there  are  other  ways  of  being  useful. 
Last  October  we  formed  a  group  for 
hemiplegics.  with  meetings  held  monthly 

it  the  "Y"  in  downtown  Victoria.  Here, 
the  handicapped  and  their  families,  about 
50  altogether,  exchange  and  share  ideas  on 
methods  of  self-help,  followed  by  a  social 

lOur  over  tea.  coffee,  or  a  cold  drink.  For 

Corinne  Tench  (R.N..  St.  Pauls  Hospital. 
Vancouver)  was  head  nurse  of  the  coronary 
are  unit.  Victoria  General  Hospital,  prior  to 
ler  illness.  She  is  once  again  able  to  care  for  her 
lusband  and  familv. 


our  dysphasic  members,  this  has  become 
one  of  the  few  gatherings  where  they  do 
not  feel  self-conscious. 

The  stroke  victim's  road  to  recovery  or 
acceptance  of  his  condition  is  a  long,  ar- 
duous one,  and  sharing  common  problems 
eases  the  lonely  burden.  For  instance, 
members  of  the  group  learn  that  depres- 
sion, crying  jags,  or  withdrawal  from 
friends  are  common  manifestations  of  the 
frustrations  caused  by  their  handicap. 
Some  may  find  out  through  the  group  that 
they  are  eligible  for  a  pension,  or  see  a 
handy  ""picker- upper"  used  for  articles 
that  have  a  way  of  dropping  irretrievably 
to  the  floor.  Then,  for  bridge  buffs,  there  is 
the  homemade  card  holder  —  what  may 
seem  a  trivial  gadget  to  one  person  may 
help  to  lift  another  out  of  debilitating  bore- 
dom. Family  members  come  to  seek  guid- 
ance in  caring  for  stroke  victims. 

We  collaborated  with  St.  John  Ambul- 
ance in  making  a  film  depicting  good  body 
mechanics  for  both  the  operator  and  the 


handicapped  person.  This  has  proved  to  be 
beneficial  to  all  concerned. 

Group  activities,  as  such,  are  slower  to 
develop.  Threaded  through  the  emerging 
program  is  a  constant  attempt  to  educate 
members  and  the  public-at-large  as  to  the 
dangers  of  atherosclerosis,  and  to  help  po- 
tential victims  recognize  its  symptoms  be- 
fore the  need  for  care  becomes  imminent. 
We  hope  to  affiliate  with  the  Canadian 
Heart  Foundation,  and  we  use  its  literature 
in  our  educational  kits. 

Other  groups,  such  as  the  Handicapped 
Action  Committee,  deal  with  the  more 
general  areas  of  housing,  transportation, 
and  entertainment.  We  are  therefore  con- 
centrating on  matters  that  are  more 
specific  to  hemiplegia.  t^ 


Slide-tape  on  pacemakers 

ivelyn  Bentley 


»!any  times  I  found  myself  staring  into  the 
mzzled  faces  of  persons  who  answered, 
es,  they  understood  about  their  pacemak- 
rs.  There  had  to  be  a  better  way  to  inform 
lem.  There  was  a  booklet  available,  but  it 
id  not  seem  adequate. 

I  took  many  avenues,  trying  to  find  the 
est  means  our  hospital  could  use  to  edu- 
ate  our  pacemaker  patients.  Finally,  it 
:emed  that  the  slide-tape  method  was  the 
lost  feasible  and  least  expensive.  With 
lis  method,  the  tape  is  inserted  and  the 
lides  change  automatically.  The  equip- 


ivelyn  Bentley  (R.N.,  Si.  Joseph's  Hospital 
chool  of  Nursing,  Thunder  Bay.  Ont.)is  even- 
ig  supervisor  ai  Edmonton  General  Hospital. 
he  was  formerly  clinical  teacher  in  the  Inten- 
ive  Care  Unit. 

■iE  CANADIAN  NURSE  —  May  1975 


ment  is  portable  and  the  slides  can  be  pro- 
jected on  a  wall  in  the  patient's  room. 

A  few  slide-tapes  were  already  used  in 
other  areas  of  the  hospital,  so  I  was  fortu- 
nate to  have  experienced  help.  The  first 
step  was  writing  the  script.  Patients  had  to 
be  informed  of  the  facts  in  a  way  easily 


understood.  When  the  script  was  finished, 
it  was  broken  down  into  parts:  each  new 
idea  introduced  was  depicted  by  a  picture 
and  later  transformed  into  a  slide. 

Acquiring  the  right  picture  to  get  across 
the  message  was  the  most  time-consuming 
part  of  the  project.  The  photograph)  de- 
partment was  a  great  help  in  this  aspect. 
Once  all  these  were  collected,  the  com- 
plete script  and  slides  were  reviewed  with 
a  physician  who  had  experience  doing 
slide-tapes. 

Finally,  the  finished  product  was  ready 
for  use.  Where  applicable,  it  is  shown  to 
the  patient  and  his  family  preoperatively; 
this  gives  oppcmunities  for  questions  and 
reassurance.  Postoperatively,  the  slide- 
tape  is  shown  as  many  times  as  necessary. 
Following  this,  questioning  the  patient  on 
aspects  of  pacemaker  care  reassures  us  of 
his  knowledge.  w 


in  a  capsule 


Needed:  brickbats  and  laurels 

Do  you  ever  hear  or  read  something 
that  either  annoys  you,  tickles  your 
fancy,  or  pleases  you?  We  do,  and  we 
decided  that  it  would  bt  a  good  idea  to 
bring  such  items  to  your  attention  in 
this  column,  and  either  applaud  or 
condemn  them.  What  we  applaud,  we'll 
call  a  "laurel,"  and  what  we  con- 
demn, we'll  call  a  "brickbat."  If  you 
come  across  anything  that  warrants 
one  of  these  labels,  send  it  to  us  and 
we'll  be  delighted  to  share  it  with  our 
readers!  —  Eds. 

Brickbats  and  laurels 

Our  first  brickbat  goes  to  Roche,  the 
pharmaceutical  company,  for  their  ad- 
vertisement about  llibrax,  which  aj> 
peared  in  the  January  1975  issue  of 
Prism,  a  journal  published  by  the 
American  Medical  Association.  The  ad 
advises  physicians  to  consider  Librax 
as  adjunctive  therapy  to  help  "relieve 
anxiety-linked  symptoms  in  irritable 
bowel  syndrome."  The  caption  ac- 
companying the  illustration  states: 
"Her  [  italics  ours  ]  abdominal  discom- 
fort and  diarrhea  may  be  irritable  bowel 
syndrome."" 

Advertisements  such  as  this  per- 
petuate the  myth  that  women  —  and 
women  only  —  suffer  from  functional 
disorders  and  "anxiety-linked  symp- 
toms."' As  nurses,  we  know  otherwise. 

Laurels  to  the  Law  Reform  Commis- 
sion of  Canada,  which  has  recom- 
mended equal  sharing  of  property  when 
a  marriage  ends.  The  commissioners 
condemn  the  system  of  separate  prop- 
erty that  is  in  force  in  most  of  Canada  as 
"contradictory,  irrational,  and  dis- 
criminatory," mainly  against  women. 

Only  in  British  Columbia,  the 
Northwest  Territories,  and  Quebec  do 
women  have  some  semblance  of  equal- 
ity in  marriage  property  rights  before 
the  law. 


A  brickbat  to  Ottawa's  Laurentian 
Club,  a  men's  club  that  refused  admis- 
sion to  a  female  city  executive  who  was 
invited  there  for  lunch. 


Susan  Riley,  Ottawa"s  housing 
supervisor,  was  invited  to  the  Lauren- 
tian Club  by  a  member,  who  apparently 
hadn"t  considered  the  possibility  that  a 
city  supervisor  could  be  a  woman. 

Acting  Ottawa  mayor  Marion  Dewar 
wrote  a  letter  to  the  club"s  directors, 
calling  the  refusal  reprehensible,  and 
asking  the  directors  to  change  the 
club's  all-male  policy.  She  received  no 
answer  from  club  president  Allan 
Castledine. 

Laurels  to  Albert  Roy,  Liberal 
member  of  the  Ontario  Legislature, 
who  attempted  to  get  liquor  licenses 
removed  from  establishments  such  as 
the  Laurentian  Club,  which  discrimi- 
nate against  women.  And  n  brickbat  to 
Sydney  Handleman,  minister  responsi- 
ble for  the  Ontario  Liquor  Licence 
Board,  who  apparently  ignored  Mr. 
Roy's  request. 

A  laurel  to  the  Canadian  Medical 
Association  Journal  for  giving  us 
permission  to  use  their  attractive  cover 
artwork,  which  illustrates  the  hyperac- 
tive child,  onoM/- cover  this  month.  The 
artist  is  John  Ball,  Ottawa. 


Have  trouble  sleeping? 

People  love  to  talk  about  sleep,  says 
James  Paupst,  md.  who  was  inter- 
viewed recently  by  Derek  Cassels  (The 
Medical  Post,  4  February  1975). 

Dr.  Paupst,  a  general  practitioner  in 
Toronto,  sent  a  questionnaire  to  2,500 
persons,  while  collecting  material  for  a 
book  on  sleep.  He  found  that  most  per- 
sons have  a  sleep  ritual  which,  if  dis- 
turbed, can  affect  sleep.  The  room  must 
be  at  a  certain  temperature,  the  person 
either  sleeps  naked  or  wears  night- 
clothes,  he  must  read  before  sleep,  etc. 

About  a  quarter  of  those  answering 
Dr.  Paupst"s  questionnaire  said  they 
performed,  perceived,  and  executed 
tasks  better  as  the  day  went  along.  This 
raises  an  interesting  social  question, 
says  Dr.  Paupst.  "Should  this  group  be 
asked  to  come  to  work  at  the  same  time 
as  their  colleagues  who  are  feeling  as 
great  as  the  first  group  are  feeling 
lousy?" 


Handlebar  palsy 

Are  you  an  ardent  cyclist?  Planning  a 
bicycle  trip  from  British  Columbia  to 
New  Brunswick,  perhaps?  Before  you 
complete  your  plans,  better  read  the 
following  letter,  which  David  F.  Small, 
MD,  wrote  to  The  New  England  Jour- 
nal of  Medicine  recently: 

"This  past  autumn  I  rode  my 
lO-spefed  bicycle  from  Seattle  to  Min- 
neapolis, a  distance  of  2900  km,  spend- 
ing up  to  10  hours  a  day  on  the  road. 
The  riding  position  that  permits 
strongest  pedaling  and  mercifully 
transfers  the  weight  away  from  the 
rider's  aching  ischia  requires  about 
one-third  of  the  rider's  weight  to  be 
borne  by  the  palms  of  the  hands.  By  the 
end  of  the  first  week,  I  had  noticed  the 
onset  of  continuous  numbness  and 
parasthesia  of  both  hands  in  ulnar  dis- 
tribution. 

"During  the  second  week,  I  began  to 
experience  weakness  of  lumbricals,  in- 
terossei,  opponens  poUicis,  and  adduc- 
tor pollicis.  Through  the  third  and 
fourth  weeks  I  suffered  progressive 
weakness  of  virtually  all  intrinsic  hand 
muscles.  Zipping  up  my  pants  became 
an  exceedingly  exasperating  task,  and  1 
had  to  decide  whether  to  ask  salespeo- 
ple to  put  coins  in  my  pocket  for  me  or 
to  say  'Keep  the  change.'  Wrapping 
my  handlebars  with  4-cm  thicknesses 
of  kitchen  sprange  at  the  end  of  the  first 
week  may  have  slowed  this  progres- 
sion, but  certainly  did  not  prevent  it.  I 
had  no  median-nerve  parasthesia. 
Now,  after  two  months  of  essentially 
no  bicycle  riding,  I  have  completely 
recovered  except  for  parasthesia  at  the 
tip  of  each  fifth  finger. 

"Although  bicycle  literature  is  re- 
plete with  warnings  about  sunburn  and 
sore  bottoms,  compression  neuropathy 
of  median  and  ulnar  nerves  at  the  palms 
is  not  mentioned;  nor  is  handlebar  palsy 
to  be  found  in  the  medical  literature. 
Have  I  received  an  injury  to  which  no 
one  else  is  susceptible?  With  the  cur- 
rent booming  interest  in  long-distance 
bicycle  touring,  some  readers  of  the 
Journal  may  see,  or  experience,  cases 
similar  to  mine.  And  for  the  sake  of  my 
bruised  ego,  I  rather  hope  so."         ._^i 


names 


Five  nurses  were  among  the  ten  recipients 
of  Pan  American  Health  Organization 
travelling  fellowships  for  1975: 

Roberta  Clegg  (R.N.,  Royal  Victoria 
Hospital  school  of  nursing,  Montreal; 
B .N . ,  McGill  University ,  Montreal)  assis- 
tant administrator  of  nursing  service.  In- 
ternational Grenfell  Association,  St.  An- 
thony, Newfoundland,  hopes  to  visit 
health  service  units  in  remote  northern 
areas  of  eastern  Siberia,  USSR,  and  Alaska. 


R.  Clegg 


Sr.  Cote 


Sister    Gemma    Cote    (R.N.,    Hopital 

. Maisonneuve,  Montreal;  B.Sc.N.,  Uni- 

i  versity  of  Montreal),  director  of  nursing 

;  Foyer  de  Nicolet,  Nicolet,  Quebec,  is  to 

visit  various  gerontological  and  geriatric 

centers  in  England,  France,  Belgium,  and 

Scandinavia. 


R.  Dussault 


L.  Morin 


Rita  Dussault  (B.Sc.N..  LInstitut 
Marguerite  d'Youville,  Montreal; 
M.Sc.N.,  Catholic  University  of  America, 
Washington,  D.C. ),  director  of  the  school  of 
nursing  sciences,  Laval  University,  Quebec 
and  Laurette  Morin  (R.N..  Hopital  St- Jean, 
St-Jean,  Quebec;  B.Sc.N.,  University  of 
Montreal;  M.  Sc.N.,  Catholic  University  of 
America,  Washington)  director  of  nursing. 
Centre  Hospitalier,  Laval  University, 
Quebec,  intend  to  visit  geriatric  and 
rehabilitative     facilities     in     France. 


Switzerland,  and  the  United  Kingdom. 

Ada  McEwan  (K.N.. 
Montreal  General 
Hospital;  M.P.H., 
University  of  North 
Carolina.  Chapel 
Hill),  national  direc- 
tor of  the  Victorian 
Order  of  Nurses,  is  to 
visit  geriatric  centers 
in    Great    Britain. 

Denmark.  Sweden,  and  the  Netherlands. 

O  Marion  E.  Kerr 
(Reg.  N..  Peterbo- 
rough Civic  Hospital 
school  of  nursing; 
B.N.Sc.  Queen's 
University.  Kings- 
,  </>^^»"'  ton;  M.Sc.  (Appl.), 
^5^  McGill    University) 

-,^^S^^^^  recently  joined  the 
^A  sEbIm  staff  of  the  Canadian 
Nurses'  Association  in  Ottawa  as  research 
officer.  Her  most  recent  appointment  was 
that  of  associate  professor,  .school  of  nurs- 
ing. Queen's  University,  prior  to  which 
she  had  been  assistant  director  of  nursing 
at  the  Cobourg  District  General  Hospital, 
Cobourg,  Ontario. 

During  her  years  in  Montreal,  Kerr  had 
taught  at  McGill  University  school  of 
nursing  and  had  been  clinical  instructor  at 
The  Montreal  General  Hospital  and  at  the 
Royal  Victoria  Hospital. 


The  Canadian  Red  Cross  Society  has  re- 
cently honored  three  nurses  for  their  con- 
tribution to  the  advancement  of  the  nursing 
profession  in  Canada.  Recipients  of  these 
special  citations  from  the  Society  are: 
Verna  Huffman  Splane  of  Vancouver,  third 
vice-president;  International  Council  of 
Nurses;  Jean  Leasl<  of  Toronto,  former  na- 
tional director  of  the  Victorian  Order  of 
Nurses;  and  Helen  K.  Mussallem,  of  Ottawa 
executive  director  of  the  Canadian  Nurses' 
Association. 


Jacqueline  Michelle  Marier,  (Reg.N.,  St. 
Joseph's  Hospital  school  of  nursing.  North 
Bay,  Ontario)  has  joined  a  medical  team  in 
Kontum,  South  Vietnam,  under  a  new 
CARE-MEDICO  program  involving  the  train- 


ing of  Montagnard  personnel  as  village 
health  workers  and  rural  midwives. 

Marier  has  worked  at 
hospitals  in  North 
Bay.  Sturgeon  Falls, 
and  Timmins.  She 
spent  five  years  in 
public  health  nursing 
with  the  North  Bay 
and  district  health 
unit  in  the  Sturgeon 
Falls  area  and  has 
also  worked  with  Ontario  Hydro  in 
Fraserdale  and  with  nursing  registries  in 
Toronto  and  Ottawa. 


Mary  Newington  has  been  chosen  "Citizen 
of  the  Year  "  by  the  Kinsmen  Club  of  Dun- 
can. British  Columbia.  She  is  head  nurse 
of  the  maternity  ward  and  of  the  women's 
surgical  ward  of  the  Cowichan  District 
Hospital. 

In  recognition  of  International  Women's 
Year,  the  Manitoba  Association  of  Regis- 
tered Nurses  is  acknowledging  a  "Woman 
of  the  Month"  throughout  1975.  The  first 
to  receive  this  honor  is  Sister  Delia 
Clermont,  who  was  made  a  life  member 
of  MARN  in  1958  for  her  contribution  to 
nursing  education. 

Long  associated  with  the  St.  Boniface 
General  Hospital,  both  as  educator  and 
administrator.  Sr.  Clermont  has  also  en- 
gaged in  association  activities  on  both  the 
provincial  and  national  levels.  In  more  re- 
cent years  she  has  been  director  of  the 
school  for  nursing  assistants  at  La  Veren- 
drye  Hospital,  Fort  Frances.  Ontario. 

Margaret  Price  (B.Sc.N..  University  of 
Windsor  school  of  nursing;  M.Sc,  Univer- 
sity of  Western  Ontario,  London)  became 
dean  of  the  faculty  of  nursing  education. 
Fanshawe  College.  London.  Ontario,  ef- 
fective 15  January  1975. 

Prior  to  coming  to  Canada,  Price  had 
shared  responsibility  for  the  management 
and  administration  of  a  psychiatric  facil- 
ity ,  and  had  been  a  staff  midwife  at  Mater- 
nity Hospital  in  Huntingdon.  England.  In 
Canada,  she  has  been  on  the  teaching  staff 
of  St.  Joseph's  Hospital  school  of  nursing 
in  Toronto  and  of  the  Oshawa  General 
Hospital  school  of  nursing.  Her  most  re- 
cent appointment  has  been  that  of  director 
of  nursing  at  the  London  Psychiatric  Hosp. 


THE  CANADIAN  NURSE  —  May  1975 


new  products 


Device  for  foot  drop 

AliMed  has  introduced  a  prefabricated, 
short  leg  brace  that  can  be  fitted  at  once 
to  eliminate  delay  and  complications  in 
rehabilitation.  This  device  has  im- 
mediate applications  in  post-stroke 
stabilization  and  flaccid  foot  drop. 
With  improved  medial-lateral  stability, 
the  brace  can  be  used  in  cases  of  mild 
plantar  flexion  contracture. 


The  unique,  flexible,  light-weight 
design  means  that  the  standard  sizes, 
(small,  medium,  and  large,)  will  fit 
nearly  75%  of  the  adult  population. 
Thus,  lengthy  custom  fabrication  is 
eliminated  in  a  large  number  of  cases. 
Since  custom  fitting  is  eliminated,  the 
brace  is  extremely  economical  com- 
pared to  conventional  methods.  Neutral 
in  color,  it  boasts  high  cosmetic  appeal . 

This  low-price  brace  is  available  in 
three  sizes  in  right  and  left,  and  is  dis- 
tributed by  AliMed,  172  West  Newton 
Street,  Boston,  Mass.  02118,  U.S.A. 


Heat  sealer  for  polyethylene 

The  Tower  continuous-band  Heat  Seal- 
er can  seal  packages  of  any  width 
needed  in  central  service  or  operating 
rooms.  Continuously  moving,  stainless 


stick-free  steel  bands  support  the  pack- 
age throughout  the  sealing  cycle  — 
heating  and  cooling. 

The  apparatus  seals  both 
polyethylene  and  paper/plastic 
pouches,  eliminating  the  need  for  two 
neat  sealers.  The  temperature  is  con- 
trolled by  a  thermostat,  and  a  pilot  light 
shows  when  the  required  temperature  is 
reached.  Flexible  bars  assure  adequate 
pressure  for  sealing  various  thicknesses 
of  material. 

For  information  write:  Tower  Pro- 
ducts, Inc.,  1919  S.  Butterfield  Road, 
Mundelein,  U.  60060,  U.S.A. 


Surgical  television  system 

The  Castle  9300  Daystar  Surgical 
Television  System  will  enable  surgeons 
to  televise  and  record  procedures  for 
teaching  and  documentation  purposes. 
It  provides  lifelike  color  definition  and 
resolution.  An  upright  image  is  always 
projected  on  the  monitor  regardless  of 
the  positioning  of  the  surgical  light. 

The  O.R.  staff  can  operate  the  televi- 
sion system.  Its  master  power  switch 
and  the  zoom,  iris,  and  focus  of  the 
camera  are  located  on  the  wall- mounted 
control  panel. 

The  color  videocassette  recorder  al- 
lows up  to  one  hour  of  recording.  A 
microphone  is  built  into  the  camera  for 
general  audio  pickup,  with  an  optional 
portable  microphone  available  for  dub- 
bing after  completion  of  the  procedure . 

The  Castle  9300  Daystar  surgical 
television  system  is  self-contained 
within  the  O.R  and  is  compatible  with 
any  hospital  video  system  outside  the 
OR. 

For  information  write  to  Castle 
Company,  1777  E.  Henrietta  Rd., 
Rochester,  N.  Y.  14623. 


Posey  Pants 

Posey  Pants  are  an  attractive  and  func- 
tional undergarment  for  ileostomy  or 
colostomy  patients.  Designed  to  cover 
the  stoma  and  bag,  they  have  an  inner 
pocket  across  the  front  to  hold  the  bag, 
prevent   bag   movement,    and   lessen 


noise.  Posey  Pants  take  the  bag's 
weight  off  the  adhesive,  reducing  the 
chance  of  breaking  the  seal. 

Made  of  quick-drying  spandex, 
Posey  Pants  are  available  for  men  and 
women  in  small,  medium,  large,  and 
extra  large  sizes.  Children's  pants  are 
available  according  to  hip  size.  They 
are  black,  white,  or  flesh  colored. 

For  further  information,  contact 
Enns  and  Gilmore  Limited,  1033 
Rangeview  Road,  Port  Credit,  Ont. 


Chick  cast  boot 

Chick  Orthopedic  has  developed  a  new 
cast  boot.  It  has  a  slightly  curved  sole 
and  patterned  surface  to  allow  almost 
normal  walking  habits,  provide  good 
traction,  and  reduce  rotational  friction. 


The  Chick  cast  boot  is  available  in 
three  sizes  (small,  medium,  and  large) 
and  in  three  styles  (canvas  lace-up, 
vinyl  with  Velcro  closures,  and  a 
weatherproof  model  of  washable  vinyl 
with  Velcro  closures  and  closed  toe). 

For  information  write:  Cast  Boot, 
Chick  Orthopedic,  c/o  J.  Stevens  and 
Son  Co.  Ltd.,  2050  Kipling,  Toronto, 
Ontario. 


Whirlpool  unit 

Bath- Aid,  a  sit-down  tub  with  a  door 
near  the  floor,  is  now  available  with  an 
optional  whirlpool  unit  for  hospital  or 
nursing  home  use.  The  whirlpool  ac- 
cessory offers  patients  a  soothing  form 
of  therapy  at  the  twist  of  a  timer  switch 
(Continued  on  page  44) 


42 


What  the  well-bandaged 
patient  should  wear: 


*fci- 


Bandafix  is  a  seamless  round- 
woven  elastic  "net"  bandage, 
composed  of  spun  latex 
threads  and  twined  cotton. 

Bandafix  has  a  maximum  of 
elasticity  (up  to  10-fold)  and 
therefore  makes  a  perfect 
fixation  bandage  that  never 
obstructs  or  causes  local 
pressure  on  the  blood  vessels. 

Bandafix  is  not  air-tight, 
because  it  has  large  meshes;  it 
causes  no  skin  irritation  even 
when  used  for  the  fixation  of 
greasy  dressings.  The  mate- 
rial is  completely  non-reactive. 


Bandafix  stays  securely  in 
place ;  there  are  eight  sizes, 
which  if  used  correctly  will 
provide  an  excellent 
fixation  bandage  for 
every  part  of  the 
body. 


Bandafix  does  not  change  in 
the  presence  of  blood,  pus, 
serum,  urine,  water  or  any 
liquid  met  in  nursing. 

Bandafix  saves  time  when 
applying,  changing  and 
removing  bandages;  the  same 
bandage  may  be  used  several 
times ;  it  is  washable  and 
may  be  sterilized  in  an 
autoclave. 

Bandafix  is  an  up-to-date 
easy-to-use  bandage  in  line 
with  modern  efficiency. 

Bandafix  replaces  hydrophilic 
gauze  and  adhesive  plaster, 
is  very  quick  to  use  and 
has  many  possibilities  of 
application.  It  is  very  suit- 
able for  places  that  otherwise 
are  difficult  to  bandage. 


Bandafix  is  economical  in  use, 
not  only  because  of  its  rela- 
tively low  price  but  because 
the  same  bandage  may  be 
used  repeatedly. 


Bandafix  does  not  fray, 
because  every  connection 
between  the  latex  and  cotton 
threads  is  knotted ;  openings 
of  any  size  may  be  made  with 
scissors  or  the  fingers. 


Bandafix"" 


Distributed  by 

1956  Bourdon  Street.  Montreal,  P.Q.  H4M  1V1 


Now  available 

■Ready to  Use' 
Bandafix 

•  Pre-measured 

•  Pre-cut 

•  14  different  applications 

•  Individually  illustrated 

peel-open  packages 


^Registered  trademark  of  Continental  Pharma. 


-May  1975 


new  products 


(Continued  from  page  42) 

that  brings  up  to  60  minutes  of  whirling 
jet  streams. 

Lightweight,  portable,  and  easy-to- 
use,  the  whirlpool  is  equipped  with  a 
pump  that  permits  flow  toward  any  part 
of  the  body.  Operations  such  as  adjust- 
ing flow  direction,  air  intake,  and  in- 
tensity can  be  preadjusted  or  set  by  the 
patient. 

Motor  and  electrical  parts  are 
double-insulated  and  are  outside  the 
tub.  The  motor  is  completely  enclosed 
in  an  attractive,  waterproof  case  that 
resists  oil  and  chemicals.  All  parts' ex- 
posed to  water  are  made  to  withstand 
the  adverse  effects  of  oil,  epsom  salts, 
and  other  corrosives.  This  material 
eliminates  the  major  source  of  conven- 
tional whirlpool  maintenance  prob- 
lems. 

The  whirlpool  carries  a  one-year 
warranty  from  the  manufacturer,  rather 
than  the  usual  90  days  for  similar  items. 

Write  to  the  American  Sterilizer 
Company,  Marketing  Division,  2424 
West  23rd  Street,  Erie,  Pennsylvania 
16512,  U.S.A.,  for  further  informa- 
tion. 


Wheeled  high-back  chair-table 

The  Lumex  5641  deluxe  upholstered 
chair-table  has  an  adjustable  winged 
head-rest,  retractable  foot-rest,  and  re- 
tractable leg-rest  that  adjust  automati- 
cally to  suit  a  patient's  needs. 


The  chair's  self-storing,  swing-away 
table  features  pull  button  adjustment  to 
any  of  four  positions.  It  has  a  plastic 
laminate  top  with  a  mica-backed  under- 
side. 

Address  enquiries  to  Bercotec,  Inc., 
11422  Albert  Hudon  Blvd.,  Montreal 
Nord  462,  Quebec. 


Stackable  Carousels  for  cassettes 

Tab  Products  Co.  offers  a  patented  cas- 
sette storage  carousel  to  provide  easy 
access  and  dust  protected  storage  for 
computer  and  word-processing  tapes. 
Each  carousel  stores  25  standard  cas- 
settes without  the  plastic  boxes.  Slid- 
ing, clear  plastic  sides  open  quickly  for 
tape  access.  Tab  provides  labels  for 
each  cassette  and  for  the  clear  plastic 
side  ■■  window"  to  identify  tapes. 


The  carousel  is  of  high-impact  plas- 
tic, measures  10"  in  diameter  and 
5'/2"  in  height,  and  can  be  stacked. 
For  complete  information,  contact  Tab 
Products  Co.,  2690  Hanover  Street. 
Palo  Alto.  California  94304,  U.S.A. 


Visual  scheduling  system 

Optimum  use  of  staff  and  equipment 
for  both  inpatient  and  outpatient 
therapy  treatment  is  ensured  with  a  neu 
visual  scheduling  system  called  the 
Beanstalk. 

The  Beanstalk  system  can  be  adapted 
to  a  wide  range  of  scheduling  func- 
tions. Its  wall-mounted  modular  grid 
boards  can  be  added  to  for  any  required 
capacity,  and  its  inch-square  signals 
can  be  written  on  and  dropped  into 
place  anywhere  in  the  grid  pattern. 

For  example,  the  Hamilton  General 
Hospital  uses  the  system  in  the 
physiotherapy  department  to  coordi- 
nate treatment  sessions,  patients, 
therapists,  type  of  treatment,  and  avail- 
able eauipment  in  one  master  weekly 
schedule  that  is  comprehensive,  yet 
understood  at  a  glance. 

For  ideas  on  visual  scheduling,  a 
4-page  folder,  "Scheduling  Made 
Easy,"  is  offered  by  the  Canadian  dis- 
tributor of  the  Beanstalk  system,  Ken- 
tron  Services,  50  Firwood  Crescent, 
Islington.  Ontario.  M9B  2W2. 


Anesthesia  machine 

A  lightweight,  compact  anesthesia 
machine,  called  Compact  "75",  has 
been  designed  for  confined  areas.  It  is  a 
two-gas  unit  with  pipeline  inlet  connec- 
tions, a  cylinder  yoke  for  oxygen,  and 
one  for  nitrous  oxide. 

The  Compact  "75"  offers  a  choice 
of  4Foreggerdirect  reading  vaporizers: 
Fluomatic,  Pentomatic,  Ethermatic, 
and  Enfluormatic.  It  is  also  equipped 
with  rib-guide  ball  flowmeters,  a  low 
pressure  guardian  system,  a  telescop- 
ing pole,  hospital  service  connections, 
and  a  mobile  stand  with  conductive 
casters. 

For  information,  write:  Air  Products 
and  Chemicals.  Inc.,  Allentown, 
Pennsylvania,  18105,  U.S.A. 


Hospital  and  home-use  mist  tent 

A  new  mobile  canopy  stand  (Model 
2-515),  designed  to  disassemble 
quickly  into  a  compact,  integral  pack- 
age that  is  easy  to  handle  and  easy  to 
store,  has  been  develojjed  by  the 
DeVilbiss  Company. 


The  canopy  stand  is  ideal  for  home  or 
hospital  use,  and  without  the  canopy  it 
serves  as  an  all-purpose  aerosol  therapy 
stand.  It  is  made  of  durable  lightweight 
aluminum,  features  swivel  casters,  and 
comes  complete  with  adjustable  brack- 
ets, canopy,  elbow,  and  60"  autoclav- 
able  hose. 

The  further  information  write:  The 
DeVilbiss  Company,  Medical  Products 
Division,  Somerset,  Pennsylvania, 
15501,  U.S.A.  ^5- 


dates 


May  26-28,  1975 

Seminar:  Accreditation  of  psychiatric 
facilities,  University  of  Ottawa.  For 
information,  contact:  Carolyn  Belzlle, 
Coordinator,  Continuing  Education 
Program,  School  of  Health  Administration, 
University  of  Ottawa,  Ottawa,  Ontario. 


May  27-30,  1975 

Spectrum  75  —  National  convention  of  the 
Canadian  Vocational  Association  to  be 
held  at  University  of  Saskatchewan. 
Saskatoon.  Saskatchewan.  For 
information,  contact:  E.L.  Conrad.  Box 
9209,  Saskatoon,  Sask,,  S7K  3X5. 


June  16-17,  1975 

Health  Administration  Research  Forum, 
University  of  Ottawa,  to  allow  health 
administrators  and  planners  to  share  their 
experiences  with  colleagues  outside  their 
own  group.  For  information  write:  Carolyn 
Belzile.  Coordinator.  Continuing  Education 
Program,  School  of  Health  Administration. 
University  of  Ottawa,  Ottawa.  Ontario. 


June  16-17,  1975 

Annual  meeting,  Canadian  Council  on  So- 
cial Development.  Holiday  Inn,  Ottawa.  For 
information,  write:  CCSD,  55  Parkdale  Av- 
enue, Box  3505,  Station  C,  Ottawa,  Ont. 


(N4340),  school  of  nursing,  Memorial 
University  of  Newfoundland.  For  in- 
formation, write:  School  of  Nursing, 
Memorial  University  of  Newfoundland, 
St.  John's,  Newfoundland,  AlC  5S7. 

July  29  -  August  26,  1975 

Workshop:  Counseling  the  emotionally/ 
mentally  disturbed  patient.  Pari  1,  (5 
consecutive  Tuesdays  —  full  days)  at  The 
Clarke  Institute  of  Psychiatry,  250  College 
Street,  Toronto,  Ontario.  For  information, 
write:  Dorothy  Brooks,  Chairman,  Conti- 
nuing Education  Program  for  Nurses,  50 
St.  George  St.,  Toronto,  Ont.,  M5S  1A1. 


May  28,  1975 

Annual  meeting,  Association  of  Nurses  of 
Prince  Edward  Island,  to  be  held  at  Sum- 
merside,  P.E.I. 

June  3-6,  1975 

Canadian  Hospital  Association  national 
convention  and  32nd  annual  meeting  will 
be  held  in  Saskatoon.  Sask. 


June  9  -  10,  1975 

Seminar:  Conflicts  and  relationships 
between  the  various  disciplines  and 
organizations  involved  in  the  care  of  the 
physically  disabled,  University  of  Ottawa. 
For  information,  write:  Carolyn  Belzile, 
Coordinator,  Continuing  Education 
Program,  School  of  Health  Administration, 
University  of  Ottawa,  Ottawa,  Ontario. 


June  10-  12,  1975 

Annual  meeting  New  Brunswick 
Association  of  Registered  Nurses  to  be 
held  at  Algonquin  Hotel,  St.  Andrews,  N.B. 


June  11-14,  1975 

The  annual  meeting  of  the  Registered 
Nurses  Association  of  Ontario  will  coincide 
with  RNAOs  50th  birthday.  The  meeting 
and  anniversary  celebrations  are  to  be  at 
the  Royal  York  Hotel,  Toronto,  Ontario. 


June  25  — July  15,  1975 

Maternal  High  Risk  —  credit  summer 
course  (N2240),  school  of  nursing. 
Memorial  University  of  Newfoundland.  For 
information,  write:  School  of  Nursing, 
Memorial  University  of  Newfoundland,  St. 
Johns.  Newfoundland,  A1C  5S7. 


July  2  -August  8,  1975 
Lakehead  University.  Thunder  Bay,  On- 
tario: family  life  program,  with  focus  on  in- 
terpersonal relatedness  and  human  sexual- 
ity. Discussion  topics  include:  maleness 
and  femaleness;  sexual  problems  and 
methods  of  treatment:  clarification  of  per- 
sonal values:  self,  family,  and  alienation; 
death  and  the  family.  For  information,  write: 
Dr.  K.  Wood.  Director,  Continuing  Educa- 
tion, Lakehead  U.,  Thunder  Bay  N.,  Ont. 


July  10-12,  1975 

Final  reunion  of  graduates  of  the  Hotel- 
Dieu  St.  Joseph  School  of  Nursing, 
Bathurst.  N.B..  to  coincide  with  Bathurst 
Festival  Week.  For  information  write: 
C.  Morrison,  Chairman,  Reunion  75  Commit- 
tee, School  of  Nursing,  Chaleur  General 
Hospital,  Bathurst,  N.B. 


July  15  —August  5,  1975 

Infant  High  Risk  —  credit  summer  course 


August  4-8,  1975 

National  Paraplegia  Foundation  annual 
convention.  Fort  Worth.  Texas.  Theme: 
Care  and  Cure  —  a  call  to  action.  For 
information,  write:  National  Paraplegia 
Foundation,  333  N.  Michigan  Avenue, 
Chicago,  Illinois,  60601,  U.S.A. 


August  14-17,  1975 

The  Moncton  Hospital  school  of  nursing 
homecoming  reunion  and  the  last  gradua- 
tion of  the  school  of  nursing.  For  more 
information  write  Harriett  Hayes,  Chair- 
man, Reunion  Committee,  43  Walsh 
Street,  Moncton,  N.B.,  E1C  6W6. 


August  29-31,  1975 

Hotel-Dieu  St.  Joseph  school  of  nursing, 
Campbellton.  N.B.,  final  graduation  and 
grand  reunion  of  graduates.  Write:  Claire 
C.  Doucet.  Director,  School  of  Nursing, 
Hotel-Dieu  St.  Joseph,  Campbellton,  N.B. 


September  20-23,  1975 

Workshop  of  the  Professional  Health 
Workers  Section,  Canadian  Diabetic  As- 
sociation, at  Banff  Centre.  Banff,  Alberta. 
Theme:  Diabetes  —  1975  —  the  team 
approach.  For  information,  write:  Olive 
Gerrard,  330-9939,  Jasper  Avenue 
Edmonton,  Alberta,  T4J  2X4.  & 


It  CANADIAN  NURSE  —  May  1975 


books 


Donny  and  Diabetes;  An  Educational  Guide 
for  Children  with  Diabetes,  by  H.  Lee 
Bretz.  55  pages.  Vancouver.  Tad  Pub- 
lishing (1973)  Ltd..  1974. 

Having  experienced  difficulties  in  explain- 
ing to  young  diabetic  children  the  need  for 
a  balance  between  food  intake,  exercise, 
and  insulin  dosage,  a  Calgary  pediatric 
nurse  resorted  to  preparing  a  visual  presen- 
tation to  help  her.  The  cartoons  and  narra- 
tive that  resulted  in  this  book  are  directed 
to  children  between  4  and  14  years  of  age. 

The  author  has  used  a  key  to  illustrate 
how  insulin  works.  For  example,  the  key 
(insulin)  unlocks  the  door  of  a  cell  and  this 
allows  the  cell  to  take  in  the  carbohydrate 
it  needs  to  make  energy.  Throughout  the 
book,  she  has  shown  Donny  as  a  happy, 
healthy  boy  who  "eats  well,  has  lots  of 
exercise,  takes  his  insulin,  and  tests  his 
urine"  ■  and  who  knows  what  to  do  if  he  has 
too  much  insulin  or  exercise,  or  not 
enough  food. 

The  author's  colored  drawings,  simple 
language,  and  positive  approach  have 
combined  to  make  her  book  a  useful  and 
interesting  teaching  tool  for  nurses, 
teachers,  parents,  and  others  working  with 
diabetic  children. 

The  book  has  been  approved  and  rec- 
ommended by  the  Canadian  Diabetic  As- 
sociation and  the  International  Diabetes 
Federation.  Future  editions  will  also  be 
printed  in  French,  German,  and  Italian. 
Information  about  the  book's  distribution 
may  be  obtained  from  the  Canadian  Dia- 
betic Association,  1491  Yonge  Street. 
Toronto.  Ontario.  M4T  1Z5. 

Surgical  Technology:  Basis  for  Clinical 
Practice,  3ed.  by  Mary  Louise  Hoeller. 
386  pages.  St.  Louis,  C.V.  Mosby, 
1974.  Canadian  Agent:  C.V.  Mosby, 
Toronto. 

Reviewed hy  Ethel  Warhinek,  Assistant 
Professor.  University  of  British 
Columbia  School  of  Nursing. 
Vancouver.  B.C. 

This  book  is  written  for  "those  interested 
in  becoming  actively  involved  in  the  field 
of  surgical  practice."  It  deals  with  an 
overview  of  all  aspects  of  the  care  of  the 
patient  who  is  to  undergo  surgical 
intervention:  for  example,  preoperative 
care:  types  of  surgical  supplies  such  as 


instruments,  drains,  sutures;  and  some  of 
the  more  common  positions  for  general 
and  specialty  surgery.  The  book  contains 
many  illustrations,  295  to  be  exact,  and 
those  found  in  the  section  on  nursing  re- 
sponsibilities in  surgical  intervention  are 
well  presented. 

The  chapter  on  surgical  approaches  to 
the  body,  anatomy,  and  positioning  is 
perhaps  too  simplistic  and  fails  to  achieve 
the  purpose,  which  was  to  "present  a  sim- 
ple review  of  anatomy  to  provide  a  ready 
reference  for  the  discussion  of  operative 
procedures." 

Anesthesiology  is  briefly  described  and 
perhaps  contains  enough  information  for 
the  beginning  student  by  providing  mater- 
ial on  the  various  types  of  anesthetic 
agents,  both  local  and  general. 

The  chapter  on  clinical  nursing  special- 
ties presents  some  of  the  current  views  on 


STETHOSCOPE  NEVER  HANDY? 
GET  YOUR  OWN 

PERSONAL 
STETHOSCOPE! 

SAVE  TIME,  TROUBLE,  FUSS. 


If  you  have  to  go  searching  for  a  stethoscope 
every  time  you  need  one  —  here's  the  perlect 
solution,  A  top  quality  "Professional"  stethos- 
cope, exactly  as  used  by  doctors.  Has  rugged 
metal  tubes  and  heavy  duty  Bowles  chestpiece 
with  large  diaphragm  for  maximum  sensitivity. 
Next  time  you  need  a  stethoscope,  you  wont 
need  to  look  any  further  than  your  own  neck  — 
or  pocket.  Always  ready  for  instant  use  — 
sanitary  clean,  and  adjusted  for  your  own  person- 
al comfort.  10  day  money-back  guarantee  and 
1  year  warranty  against  defects.  Only  $9  plus  $1 
postage  from:  EQUITY  MEDICAL  SUPPLY  CO. 
P.O.  BOX  726-N,  BROCKVILLE,  ONT.  K6V5V8. 


the  role  of  the  professional  operating  rooni 
nurse  whose  objective  for  clinical  practict 
is  to  "provide  a  standard  of  excellence  ii 
the  care  of  the  patient  before,  during,  an( 
aftersurgical  intervention."  Theemphasi: 
is  on  the  patient's  welfare  and  safety,  an( 
on  direct  patient  interactions  rather  than  oi 
the  technical  assisting  functions  of  thi 
past. 

This  book  would  be  useful  for  the  be  i 
ginning  student  in  a  technical  or  profes 
sional  school,  if  operating  room  experii 
ence  is  part  of  the  curriculum.  It  wouk] 
need  to  be  supplemented  by  additional 
readings  to  ensure  more  depth  of  under! 
standing,  particularly  in  the  areas  of  surgi  i 
cal  anatomy  and  more  sophisticated  surgi ' 
cal  procedures,  for  example,  coronary  ar 
tery  surgery.  It  would  also  provide  a  usefu 
guide  for  a  teacher  in  the  selection  of  con 
tent  when  planning  a  course  in  operatin; 
room  nursing. 

A    Guide    to    Physical    Examination    b)} 

Barbara  Bates.  375  pages.  Philadelphia! 
Lippincott,  1974.  Canadian  Agent 
Lippincott,  Toronto. 
Reviewed  by  Janet  Gormick,  Assistan.\ 
Professor,  School  of  Nursing] 
University  of  British  Columbia] 
Vancouver,  B.C.  ' 

The  author  has  designed  this  book  for  be 
ginning   practitioners   of  physical   diag- 
nosis. The  book  is  based  on  the  assump- 
tion that  the  reader  already  has  a  basit 
knowledge  of  anatomy  and  physiology ; 
Although    the    author    includes    some 
anatomy  and  physiology  basic  to  under' 
standing  the  examination,  her  emphasis  i; 
on  the  technique  of  physical  examination 
Abnormal  findings  have  been  included  ac 
cording  to  the  frequency  and  importance 
of  their  occurrence,  and  are  provided  b 
alert  the  examiner  to  their  presence. 

Among  the  excellent  features  of  iht 
book  are  a  distinctive  format  and  the  lib 
eral  illustrations  that  are  provided.  Eact 
page  is  divided,  with  the  main  column 
outlining  the  purpose  and  technique  of  ex 
amination,  in  black  print.  The  parallel  col 
umn  indicates  possible  abnormal  findings 
in  a  contrasting  red  print.  A  further  de 
scription  of  abnormalities  is  included  ir 
table  format  at  the  end  of  each  chapter 
these  pages  are  indicated  by  a  red  corner 

Each  area  of  the  body  is  clearly  illus 


trated,  showing  external  body  landmarks 
and  the  underlying  organs  to  be  considered 
during  examination.  The  positioning  of 
the  patient  and  examiner  is  clearly  pic- 
tured. Physical  examination  of  the  adult  is 
covered  in  a  comprehensive  and  system- 
atic fashion.  The  material  is  presented  in  an 
interesting  style  that  is  both  clear  and  easy 
to  read. 

A  chapter  is  also  included  on  the  pediat- 
ric patient.  Emphasis  is  on  the  distinctive 
findings  nonnally  expected  in  the  child 
and  necessary  adaptations  in  the  examin- 
ing procedure  pertinent  to  infants  and 
young  children. 

A  useful  addition  would  be  the  inclusion 
of  samples  of  descriptive  terminology  at 
the  end  of  each  chapter,  to  illustrate  the 
recording  of  normal  findings.  Illustrations 
of  abnormalities  would  be  enhanced  by  the 
use  of  color  plates  in  some  instances. 

This  text  is  an  invaluable  reference  for 
nursing  students  and  nurse  practitioners 
involved  in  primary  care  activities. 


Agenda  for  Continuing  Education;  a  Chal- 
lenge to  Health  Care  Institutions,   by 


Daniel    S.    Schechter.     112 


pages. 


Chicago,  Hospital  Research  and  Edu- 
cational Trust,  1974. 
Reviewed  by  Cornelia  A.  Gibson, 
Assistant  Professor,  School  of  Nursing, 
University  of  British  Columbia, 
Vancouver,  B.C. 

A  text  that  includes  in  its  title  "A 
Challenge  to  Health  Care  Institutions," 
leads  one  to  believe  that  the  contents  will 
contain  new,  exciting, and  possibly  con- 
troversial subjects. 

Describing  the  position  of  a  hospital 
trainer  and  how  this  position  can  enhance 
the  efficiency  of  the  institution  for  which 
he  works,  hardly  seems  new,  provocative. 
or  challenging. 

The  author  describes  certain  needs  that 
were  identified  through  a  hospital  continu- 
ing education  project  and  a  survey  of 
members  of  the  American  Society  for 
Health  Manpower,  Education,  and  Train- 
ing. He  discusses  these  needs  and  suggests 
some  specific  proposals  for  meeting  them. 

The  book  could  have  been  a  good  deal 
more  interesting  had  not  one  entire  chapter 
been  devoted  to  the  details  on  the  survey. 

The  primary  discussion  centers  around 


the  constructive  role  of  a  full-time  educa- 
tion director;  the  desirability  of  coopera- 
tive training  programs  among  neighboring 
hospitals;  the  challenge  to  hospital  associ- 
ations to  take  the  lead  in  planning  for 
cooperative  programming  and  assisting 
medical  and  educational  centers  to  take 
professional  leadership  in  continuing  edu- 
cation programs;  the  suggestion  that  more 
use  be  made  of  new  educational  technol- 
ogy; and  the  suggestion  that  the  results  of 
continuing  education  programs  be 
evaluated. 

The  book  is  well  organized  and  clearly 
written.  Many  often  confusing  concepts 
pertaining  to  continuing  education  are  pre- 
sented in  a  clear,  concise,  and  meaningful 
manner. 

Because  the  author's  ideas  and  sugges- 
tions are  sound  and  can  hardly  be  disputed, 
the  book  may  interest  proponents  of  con- 
tinuing education  programs  as  a  supple- 
mental resource  for  clarifying  concepts. 


Staffing:  A  Journal  of  Nursing 
Administration  Reader  edited  by  Mary 
Ellen  Warstler.  57  pages.  Wakefield, 
Mass.,  Contemporary  Publishing  Inc., 
1974. 

Reviewed  by:  Dr.  June  Scollie.  School 
of  Nursing,  University  of  Manitoba, 
Fort  Garry,  Winnipeg,  Man. 

The  first  article  in  this  group  suggests  an 
answer  to  a  poorly  functioning  team  nurs- 
ing process  may  be  the  assignment  to  the 
staff  nurse  on  each  shift  of  a  "  'district' "  of 
patients.  This  method  must  be  supported 
by  the  concept  of  comprehensive  care  for 
the  patient  by  this  nurse,  and  the  whole  is 
viewed  as  "primary  nursing." 

The  second  article  discusses  a  process 
for  determining  staffing  need,  and  in- 
cludes valuable  suggestions  as  to  evaluat- 
ing predictions  for  staffing. 

The  third  article  presents  a  fomi  of  pa- 
tient categorization,  which  provides  a  day 
by  day  accumulation  of  data  that  can  form 
a  basis  for  determining  personnel  need. 
This  article  would  seem  to  hold  value  for 
nursing  administrators  in  small  units  or 
hospitals  as  a  way  to  present  concrete  data 
on  required  staffing. 

Articles  4  to  6  discuss  various  work 

schedules  used  to  meet  staffing  need.  In- 

(Continued  on  page  50) 


Next  Month 
in 


The 

Canadian 

Nurse 


Frankly  Speaking: 
Sex  Talk  and  Nursing 


•   Cystic  Fibrosis 


•  CNA  Annual  Meeting  Report 


Nurses  Can  Help  the  Bereaved 


^^P 


Photo  Credits 
for  May  1975 

Cover  I,  Artwork 
courtesy  of  the 
Canadian  Medical 
Association  Journal 

Health  and  Welfare  Canada, 
Ottawa,  Ont.  p.   19 

Miller  Photo  Services, 
Toronto,  Ont.  p.  19 

Misericordia  Hospital, 
Edmonton,  Alta.  p.  40 

Studio  C.  Marcil, 
Ottawa,  Ont.  p.  1 1 


THE  CANADIAN  NURSE  —  May  1975 


Leaders  are  people  others  depend  on... depend  on  Mosby  texts 


New  9th  Edition! 


Anthony-Kolthoff 


TEXTBOOK  OF  ANATOMY 
AND  PHYSIOLOGY 

This  new  9th  edition  of  a  popular  text  upholds  a 
tradition  of  excellence  and  adds  fresh  features  and  a 
wealth  of  new  information  on  recent  findings.  As  in 
previous  editions,  outline  surveys  introduce  each  chapter; 
outline  summaries  and  review  questions  conclude  each 
chapter.  Diagrams  and  tables  appear  in  nearly  all  chapters 
with  suggested  readings,  abbreviations  and  prefixes,  and 
glossary.  New  material  includes:  brain  waves,  altered 
states  of  consciousness,  and  the  "emotional  brain"; 
biofeedback  training;  physiological  changes  that  occur 
during  meditation  (yoga);  and  more. 

By  CATHERINE  PARKER  ANTHONY.  R.N.,  B.A.,  M.S.;  with 
the  collaboration  of  NORMA  JANE  KOLTHOFF,  R.N.,  B.S., 
Ph.D.  April.  1975.  Approx.  624  pages,  8"  x  10",  335  figures 
(144  in  color),  including  239  by  ERNEST  W.  BECK,  and  an 
insert  on  human  anatomy  containing  15  full-color,  full-page 
plates,  with  six  in  transparent  Trans-Vision  *  (by  ERNEST  W. 
BECK).  About  $13.10. 


New  9th  Edition! 


Anthony 


ANATOMY  AND  PHYSIOLOGY 
LABORATORY  MANUAL 

This  widely-accepted  supplement  to  TEXTBOOK  OF 
ANATOMY  AND  PHYSIOLOGY,rewritten  to  reflect  up- 
to-the-minute  information  in  the  text,  retains  the  flexi- 
bility and  time-saving  effectiveness  teachers  have 
appreciated  through  eight  previous  editions. 

By  CATHERINE  PARKER  ANTHONY,  R.N.,  B.A.,  M.S.  April, 
1975.  Approx.  224  pages,  8"  x  10",  115  drawings,  69  to  be 
labeled.  About  S6.55. 


Newly  revised! 

The  35mm  Teaching  Slides 

These  color  slides  (reproductions  of  key  illustrations  in 

the  book)  fully  complement  and  clarify  the  text.  Ten 

new  slides  have  been  added  to  the  set,  four  of  them 

devoted  to  new  material  on  stress. 

Forty  2x2  teaching  slides  in  color,  suitable  for  use  with  any 
35mm  projector.  About  $42.00. 


New  6th  Edition! 


Shafer  et  al 


MEDICAL-SURGICAL  NURSING 

The  new  edition  of  this  classic  text  effectively  combines 
both  medical  and  surgical  nursing  as  it  explores  such 
vital  areas  as  nutrition,  personality  disorders,  treatment 
of  cancer  and  heart  disease,  ecology  and  health,  against  a 
background  of  individualized  care  of  the  total  patient. 
Comprehensive  changes  have  been  made  to  include 
greater  depth  in  physiology  and  pathophysiology. 

By  KATHLEEN  NEWTON  SHAFER,  R.N.,  M.A.,  JANET  R. 
SAWYER,  R.N.,  Ph.D.;  AUDREY  M.  McCLUSKEY,  R.N.,  MS.. 
Sc.M.Hyg.;  EDNA  LIFGREN  BECK,  R.N.,  M.A.,  and  WILMA  J. 
PHIPPS,  R.N.,  A.M.  April,  1975.  Approx.  1,056  pages,  8/2"  x 
11",  608  illustrations.  About  $17.30. 

Labunski  et  al 

WORKBOOK  AND  STUDY  GUIDE  FOR 
MEDICAL-SURGICAL  NURSING: 

A  Patient-Centered  Approach 

This  workbook  encourages  the  use  of  problem-solving 
techniques  to  make  nursing  diagnoses  and  plans  for  care. 

By  ALMA  JOEL  LABUNSKI,  R.N.,  B.S.N.;  MARJORIE 
BEYERS,  R.N.,  B.S.,  M.S.;  LOIS  S.  CARTER,  R.N.,  B.S.N.; 
BARBARA  PURAS  STELMAN,  R.N.,  B.S.N.;  MARY  ANN 
PUGH  RANDOLPH,  R.N.,  B.S.N.;  and  DOROTHY  SAVICH, 
R.N.,  BS.  1973,  331  pages  plus  FM  l-VIII,  714  '  x  1054".  Price, 
$6.70. 


48 


New  3rd  Edition!  PROGRAMMED  INSTRUCTION  IN 
ARITHMETIC,  DOSAGES,  AND  SOLUTIONS.  This 
u|xlated  review  of  basic  arithmetic  includes  "old"  and 
"new"  math,  as  well  as  newer  logarithms  for  division  and 
subtraction.  The  text  describes  centigrade  and  Fahren- 
heit temperature  scales;  apothecaries,  metric  and  house- 
hold systems  of  measurement,  and  the  problems  en- 
countered in  conversion  from  one  system  to  another.  By 
DOLORES  F.  SAXTON,  R.N.,  B.S.,  M.A..  Ed.D.  and 
JOHN  F.  WALTER,  Sc.B.,  M.A..  Ph.D.  June.  1974.  76 
pp.  $5.00. 


New  2nd  Edition!  CARE  OF  PATIENTS  WITH  EMO- 
TIONAL PROBLEMS:  A  Textbook  for  Practical  Nurses. 

Designed  to  assist  practical  nursing  students  in  identify- 
ing and  meeting  emotional  needs  of  patients,  this  new 
edition  provides  essential  background  knowledge  of 
personality  development,  dynamics  of  behavior,  mani- 
festations of  anxiety  and  defense  mechanisms.  By 
DOLORES  F.  SAXTON,  R.N.,  B.S.,  M.A.,  Ed.D.  and 
PHYLLIS  W.  HARING,  R.N.,  B.S.,  l\4.S.,  M.Ed.  June, 
1975.  Approx.  128  pp.,8  illus.  About  $5.00. 


A  New  Book!  PROBLEM-ORIENTEDMEDICAL  REC- 
ORD IMPLEMENTATION  (Allied  Health  Peer  Re- 
view). This  book  provides  a  set  of  guidelines  for  the 
nurse  and  allied  health  professional  in  the  use  of 
P.O.M.R.  in  order  to  reduce  confusion,  duplication  of 
effort,  omission  and  commission  of  needless  work  in 
patient  record  keeping.  By  ROSEMARIAN  BERN!, 
R.N.,  M.N.  and  HELEN  READEY,  R.N.,  M.S.  October, 
1974.  197pp.,  14  illus.  $6.25. 


New  9th  Edition!  SOCIOLOGY:  Nurses  and  Their 
Patients  in  a  Modern  Society.  Covering  health  and 
society  from  a  systems  theory  perspective,  this  new  text 
provides  sociological  perspectives  for  students  pursuing 
careers  in  health  care.  It  demonstrates  sociological 
principles  in  terms  of  their  effects  on  nurses  and 
patients,  and  presents  information  essential  for  the  nurse 
to  see  her  profession  in  its  societal  setting.  By  LIDA  F. 
THOMPSON,  R.N.,  B.S.,  M.S.;  MICHAEL  H.  MILLER, 
Ph.D.;  and  HELEN  BIGLER,  D.N.Sc.  August,  1975. 
Approx.  336  pp.,  60  illus.  About  $9.65. 


A  New  Book!  OPEN  LEARNING  AND  CAREER 
MOBILITY  IN  NURSING.  Looking  into  the  future,  this 
new  text  explores  the  issues  and  problems  generated  by 
various  open  learning  and  career  mobility  approaches.  In 
a  single  volume,  well-known  leaders  in  nursing  education 
have  contributed  information  about  21  successful  pro- 
grams, their  development,  implementation,  problems, 
evaluation,  and  resources.  By  CARRIE  B.  LENBURG, 
Ed.D.,  R.N.  May,  1975.  Approx.  400pp.,  27  illus.  About 
$11.00. 


A  New  Book!  PSYCHOLOGICAL  ASPECTS  OF  MYO- 
CARDIAL INFARCTION  AND  CORONARY  CARE. 
This  cogently  written  new  text  presents  the  coronary 
care  nurse  with  specific  material  related  to  psychological 
factors  which  influence  myocardial  infarction.  The  book 
contains  chapters  on  the  coronary  prone  personality; 
occupational  stress  as  a  precursor  to  myocardial  in- 
farction; pre-admission  behavior;  coping  in  acute  myocar- 
dial infarction;and  more\Edited  by  W.  DOYLE  GENTRY, 
Ph.D.  and  REDFORD  B.  WILLIAMS, M.D;with  8  contri- 
butors. August,1975.  Approx.  150  pp.,8  illus.  About  $6.80. 


HE  CANADIAN  NURSE  —  May  1975 


MOSBV 

TIMES  MIRROR 

THE    C.  V.  MOSBY  COMPANY,  LTD 

86   NORTHLINE    ROAD 

TORONTO,  ONTARIO 

M4B   3E5 


books 


(Continued  from  page  47) 

eluded  are  a  10-week,  permanent  cyclic 
schedule,  a  2-week  cycle  with  a  short 
evening  shift,  and  a  4-day  week, 
10-hour-day  cycle.  The  seventh  article  is 
related  to  nursing  utilization  in  community 
nursing.  It  is  a  report  of  a  beginning  study 
in  task  analysis  in  community  nursing  to. 
redefine  tasks  and  resp)onsibilities  of  the 
nurse. 


Float  nurse  job  satisfaction  is  the  topic 
of  the  eighth  article.  Quite  significant  are 
study  findings  that  many  such  nurses  "ap- 
parently do  not  see  any  relationship  be- 
tween knowing  patients  and  continuity  of 
care."  When  this  is  linked  with  float  nurse 
reporting  of  unsatisfactory  job  factors  that 
include  no  sense  of  belonging,  poor  orien- 
tation, staff  attitudes,  etcetera,  the  impli- 


Get  what  youVe 

always  wanted 

from  nursing 


Like  a  wealth  of  professional  experience 
to  enrich  your  career. 


Nursing  has  a  lot  to  offer  Remember' 
But  sometimes  you  can  get  so  stuck  in 
a  rut  you  almost  forget  those  exciting 
challenges  that  made  you  choose  a 
nursing  career  in  the  first  place 

With  Medox,  you  can  revive  those 
challenges. 

Since  Medox  serves  almost  the 
entire  spectrum  of  nursing  services, 
you  can  get  more  variety  of 


assignments  in  a  month  than  you 
could  in  a  year  back  in  that 
comfortable  rut.  Operating  room. 
Intensive  Care.  Cardiac  Unit.  Pediatric 
care. 

There's  more  to  nursing  than 
punching  a  time  clock. 

With  Medox,  there  can  be  a  lot 
more. 


a  DRAKE  INTERNATIONAL  company 

CANIACA  •  USA .  UK .  AUSTRALIA 


cations  for  care  of  patients  are  many.  The 
final  article  discusses  factors  of  personal- 
ity, attitude,  and  so  on  that  require  consiJ 
eration  in  relation  to  motivating  the  older 
nurse. 

The  compilation  of  these  articles  pre- 
sents ideas,  possible  methods  of  coping 
with  staffing  problems,  and  worthwhile 
information  for  the  nursing  administratm 
faced  with  such  problems.  A  variety  ol 
possible  solutions  contained  in  one  puhli 
cation  has  a  positive  value  for  nursing  ad 
fTiinistrators  in  agencies  where  a  large  var 
iety  of  publications  are  not  available. 


Fundamental  Skills  in  the  Nurse-Patient  Re- 
lationship: a  programmed  text,  2ed. ,  by 
Lianne  S.  Mercer  and  Patricia 
O'Connor.  216  pages.  Philadelphia 
W.B.  Saunders,  1974.  Canadian 
Agent:  Saunders,  Toronto. 
Reviewed  by  Sandy  Leadbeater, 
Teacher,  Department  of  Nursing, 
Humber  College  of  Applied  Arts  ana 
Technology,  Rexdale,  Ontario. 

The  text,  in  three  parts,  "is  designed  tc 
teach  a  basic  repertoire  of  skills  withj 
which  a  student  may  begin  her  nursin|j 
practice."  The  skills  referred  to  are  thosej 
that  effectively  improve  the  interpersona 
asjjects  of  nursing  care.  Emphasis  i; 
placed  on  the  use  of  the  text  as  a  founda-j 
tion  to  later  learning,  and  the  authors  sug- 
gest that  it  could  be  covered  in  8  to  1( 
hours. 

The  format  of  this  programmed  learnins 
book  is  easily  grasped.  Different  types  o 
print  are  used  and  a  "slider"  is  provided  t( 
mask  the  answers  until  needed.  Behaviora 
objectives  are  clearly  outlined  in  italicizec 
print  at  the  commencement  of  each  sub 
section.  Interaction  studies  and  dialogu; 
are  presented  in  a  realistic,  thorough  man* 
ner  and  followed  by  detailed,  relevan 
questions,  that  incorporate  appropriatt 
nursing  actions  and  charting,  as  well  a: 
verbalization. 

Part  I,  "Utilizing  Resources  in  Patien 
Care,"  introduces  the  student  to  effective 
use  of  available  resource  materials  am 
identifies  methods  of  approach  for  askin; 
the  patient  questions  and  making  relevan 
observations. 

Part  II,  "Structuring  the  Professiona 
Relationship,  is  subdivided  into  area 
covering  personal  and  confidential  infor 
mation  and  orientation,  both  basic,  am- 
modifications  for  use  in  precipitate  situal 
tions.  Approaches  are  also  provided  to 
ward  termination  of  care  and  orientation  o 
the  patient  to  treatments  and  activities 
The  inclusion  of  the  patient  in  care  plan 

(Continued  on  page  52 


so 


i^^^ry   • 


5  reasons  why 

nurses  prefer  these  colorful 

blanket/bedspreads  from  Hardie. 

Nurses  like  them  —  patients  like  them! 

(1)  Zorbit  dual  purpose  cotton  terry  blanket  bedspreads  are  made  from  a  special 
tufted  construction  that  provides  warmth  without  weight. 

(2)  Time  and  effort  is  saved  making  beds  since  the  blankets  are  so  light  in  weight 
and  also  serve  as  bedspreads. 

(3)  They  are  draft-proof. 

(4)  Non-allergenic. 

(5)  Available  in  eleven  bright,  cheerful  colors  to  help  lift  patient  morale. 
Hospital  administrators  also  like  Zorbit  blankets  since  they  improve  patient 
comfort  and  at  the  same  time  reduce  overall  costs. 

Zorbit  blankets  resist  hard  wear  and  rough  usage.  They  are  static  free,  easy  to 
wash  —  quick  to  dry  —  do  not  shrink  or  felt  —  and  they  maintain  quality,  warmth 
and  size  through  repeated  launderings. 


Ney.  Cheeftui  Colors 


Zend  a  boofcJef  wifh  samples  ot  ZORBIT  blanket- bedspread  material  in  eleven  cheerful 
colors  and  white.  I  am  invoived  in  recommending  patient  comfort  products  tor  use  in  our 
hospital. 

Name 

Title 

Hospital 


Address 


Over  50  years  of  Service . 


Hardie 


G.  A.  Hardie  &  Co.  Limited,  3  Dorchester  Avenue,  Toronto  M8Z  4W2,  Tel:  (416)  259-8461       Offices  across  Canada 


books 

(Continued  from  page  50) 


ning  is  also  a  component  of  this  section. 

Part  III  focuses  on  communication 
skills,  clarification  of  the  meaning  of  the 
patient's  methods  of  expression,  and  ef- 
fective responses.  This  section  effectively 
incorporates  interaction  analysis  and 
therapeutic  communication  techniques. 

Resource  materials,  a  glossary,  and 
sample  chart  sheets  are  provided  in  Ap- 
pendix A.  Appendixes  B  and  C  provide  a 
criteria  test  and  related  resource  materials. 

An  instructor's  manual  is  available, 
which  provides  the  rationale  for  the  pro- 
gram, student  performance  data,  a  key  to 
the  examination,  and  suggested  weighting 
for  items. 

This  book,  easy  to  follow  and  highly 
instructive,  will  be  a  valuable  adjunct  in 
helping  the  student  develop  competence 
and  confidence  in  interpersonal  skills  and 
the  nurse-patient  relationship. 


Emergency  Care;  Assessment  and  Interven- 
tion. Edited  by  Carmen  Warner  Sproule 
and  Patrick  J.  Mullanney.  374  pages. 
St.  Louis,  C.V.  Mosby  Company, 
1974.  Canadian  Agent;  Mosby, 
Toronto. 

Reviewed  by  Jane  Dijfm  Watt.  Lec- 
turer. Laurentian  University  School  of 
Nursing,  Sudbury.  Ontario. 

This  text  is  designed  to  be  a  comprehen- 
sive handbook  on  emergency  management 
for  all  personnel  who  provide  emergency 
care,  both  outside  the  hospital  setting  and 
within  the  emergency  department.  As 
such,  it  stresses  an  interdisciplinary  ap- 
proach. The  contributing  authors  include 
27  medical  doctors,  a  medical  student,  3 
nurses,  and  5  attorney s-at-law. 

The  book  is  comprised  of  26  chapters, 
the  first  3  being  of  a  general  and/or  sup- 
plementary nature.  The  remaining  chap- 
ters each  cover  a  specific  topic  or  body 
system.  Each  author  has  included  a  clas- 
sification of  emergency  situations  or  con- 
ditions for  her/his  particular  area  of  refer- 
ence. The  presenting  signs  and  symptoms 
and  methods  of  diagnosis  are  discussed 
and  also  the  theories  of  immediate  man- 
agement. There  is  a  point  summary  at  the 
end  of  each  chapter. 

Because  of  the  general  overview  style  of 
this  text  and  its  purpose  as  a  quick  refer- 
ence handbook,  there  are  obvious  limita- 
tions in  the  amount  of  data  and  the  depth  of 
discussion  on  any  one  subject.  The  reader 
is  advised  frequently  by  the  various  au- 
thors to  make  use  of  the  good  reference 
lists  at  the  end  of  each  chapter  to  pursue  the 
subject  in  more  depth.  To  avoid  repetition, 
the  reader  is  referred  to  other  chapters  that 


contain  information  that  is  relevant  to 
more  than  one  topic. 

This  reviewer  was  particularly  in- 
terested in  the  chapter  on  "Aquatic  Medi- 
cal Emergencies,"  which  presents  concise 
physiological  information  on  drowning, 
changing  pressures,  and  changing  temper- 
atures, and  on  the  effects  of  aquatic  or- 
ganisms. 

Also  of  note  is  a  specific  chapter  on 
"Life  Support  in  Emergency  Depart- 
ments," which  includes  technical  proce- 
dures, discussions  of  post-resuscitation 
care,  and  appropriate  termination  of 
emergency  measures. 

The  legal  information  in  this  book  is 
applicable  only  in  the  United  States;  how- 
ever, the  general  principles  of  legal  rights 
and  responsibilities  can  be  generalized  to 
the  Canadian  situation.  There  is  a  con- 
spicuous absence  of  discussion  of  the 
management  of  the  donor-patient,  and 
only  a  brief  reference  to  implications  of 
religious  restrictions  on  specific  types  of 
therapy. 

This  book  is  a  valuable  source  of  basic, 
concise  information  on  assessment  and 
management  of  most  emergency  situa- 
tions, suitable  for  reading  by  various  allied 
health  workers.  Nurses  using  this  text 
would  be  well  advised  to  supplement  the 
information  by  pursuing  the  given  refer- 
ences, and  to  consider  implications  and 
responsibilities  specific  to  their  own  pro- 
fession. 


av  aids 


FILMS 

A  series  of  8  short  films  (16  mm,  color, 
sound)  by  filmmaker  Kathleen  Shannon  is 
now  available,  distributed  through  the  Na- 
tional Film  Board.  The  film  series  is  de- 
signed to  promote  discussion  about  the 
issues  women  face  concerning  their  work 
and  their  children. 

nit's  Not  Enough,  the  overview,  intro- 
ductory film  (15  min,  57  sec),  presents  a 
broad  spectrum  of  women  discussing  the 
conflicts  of  women  who  don't  work  but 
would  like  to,  those  who  work  because 
they  must,  and  those  who  can  and  do 
choose  to  work.  It  included  statistics  illus- 
trating societal  disparities,  particularly  in 
salaries. 

D  Would  I  Ever  Like  to  Work  (8  min,  53 
sec).  A  deserted  mother  of  7  children,  on 
welfare,  longs  to  work  but  is  prevented 
from  doing  so  by  lack  of  day  care  facilities 
in  her  district. 

a  Luckily  I  Need  Little  Sleep  (7  min,  38 
sec)  shows  Kathy  who,  without  household 
help,  is  a  professional  nurse,  works  on  the 


farm,  and  sews  for  her  children. 
UMothers  Are  People  (7  min,  18  sec) 
Joy,  a  research  biologist  and  mother  of  3 
feels  society  has  a  long  way  to  go  in  it 
attitudes  toward  women  and  children. 
n  Tiger  on  a  Tight  Leash  (7  min,  35  seci 
Cathy  is  a  university  department  head  an, 
mother  of  3.  She  speaks  of  the  insecuritie, 
she  experiences  because  of  unpredictablj 
day  care  arrangements  and  of  her  marriei 
students  who  reflect  the  same  difficultiei! 
"they  don't  work  as  creatively  as  thei 
could." 

OThey  Appreciate  You  More  ( 14  min,  4 
sec)  concerns  a  married  working  coupli 
with  3  children  who  share  household  re 
sponsibilities. 

nLike  the  Trees  (14  min,  30  sec)  show 
Rose,  a  Metis  woman  who  has  lifted  hei 
self  out  of  an  anguished  existence  by  rt 
discovering  her  roots  among  the  woodlani 
Cree. 

n  Extensions  of  the  Family  (14  min,  2  sei 
focuses  on  a  group  of  13  adults  and  chi 
dren  in  a  cooperative  household,  who  ha\ 
joined  together  to  share  financial  an 
domestic  responsibilities. 

For  information  about  this  film  serie 
contact  the  nearest  National  Film  Boai; 
office  or  write  to;  Challenge  for  Changi! 
National  Film  Board,  Film  Library,   if 
Kent  Street,  Ottawa,  KIA  0M9. 


accession  list 


Publications  recently  received  in  tl 
Canadian  Nurses'  Association  library  a- 
available  on  loan  —  with  the  exception  i 
items  marked  R  —  to  cna  member 
schools  of  nursing,  and  other  institution 
Items  marked  R  include  reference  and  a 
chive  material  that  does  not  go  out  on  loai 
Theses,  also  R,  are  on  Reserve  and  go  o 
on  Interlibrary  Loan  only. 

Requests  for  loans,  maximum  3  at 
time,  should  be  made  on  a  standard  Inte 
library  Loan  form  or  on  the  "Reque 
Form  for  Accession  List"  printed  in  ih 
issue. 

If  you  wish  to  purchase  a  book,  coma 
your  local  bookstore  or  the  publisher. 

BOOKS  AND  DOCUMENTS 

1 .  About  bedsores:  what  you  need  to  know  to  he 
prevent  and  treat  them,  by  Marian  E.  Miller  a: 
Marvin  L.  Sacks.  Philadelphia,  Lippincott,  14" 
45p. 

2.  Antenatal  education:  guidelines  for  teacher^ 
Margaret    Williams    and    Dorothy    Booth    («:' 
foreword  by  Professor  Philip  Rhodes.  Edinburg 
Churchill  Livingstone,  1974.  178p. 


libu  open  the  door  to  new  ideas... 


LeMaitre  &  Finnegan: 

THE  PATIENT  IN  SURGERY— 

A  Guide  for  Nurses,  New  3rd  Edition 

In  this  comprehensive  review  of  modern  surgical  nursing  the  authors 
examine  sequentially  all  the  factors  involved  in  patient  care.  Part 
I — General  Considerations  in  the  Care  of  the  Surgical  Patient — 
introduces  the  components  of  surgery,  the  surgical  experience  for 
the  patient,  and  the  elements  of  superior  patient  care.  Parr  // — 
Specific  Operative  Procedures — employs  a 
convenient  outline  format  to  summarize 
individual  surgical  procedures  and  the  spe- 
cific postoperative  care  for  each  operation. 
Eighteen  chapters  are  new  to  this  edition, 
including  those  on  laparoscopy,  cholecysto- 
jejunostomy,  radical  pancreaticoduodenec- 
tomy, lysis  of  adhesions,  excision  of  tes- 
ticular tumor,  lumbar  sympathectomy, 
aorto-iliac  bypass  graft,  ureterostomy, 
breast  biopsy,  bilateral  adrenalectomy,  and 
coronary  artery  bypass  graft. 

By  George  D.  LeMaitre,  MD,  FACS.  Diplo- 
mate  Am.  Bd.  of  Surgery;  and  Janet  A.  Fin- 
negan, RN,  MS.  About  545  pp.  110  ill.  Soft 
Cover.  About  $9.05.  Just  Ready. 

Order  #5717-6. 


THE  NURSING  CLINICS 
OF  NORTH  AMERICA 

Alert  yourself  to  the  newest  nursing  tech- 
niques which  make  your  work  easier,  while 
insuring  the  patient  of  greater  comfort  and 
security.  A  year's  subscription  will  bring  you 
symposia  examining  these  rapidly  changing 
aspects  of  nursing  care:  March — Intensive 
Care  of  the  Surgical  Patient,  edited  by  Joan 
DeLong  Harrington,  RN;  June —  The  Child 
with  Developmental  Disabilities,  edited  by 
Elizat>eth  J.  Worthy,  RN;  and  Restructuring 
Maternity  Care,  edited  by  Elizabeth  S.  Sharp, 
RN;  September — Human  Sexuality,  edited 
by  Fern  Mims,  RN;  and  Kidney  and  Urologic 
Nursing,  edited  by  Mary  O  Neill,  RN; 
December — Perspectives  in  Operating 
Room  Nursing,  edited  by  Mary  Gill  Nolan, 
RN;  and  Community  Health  Nursing,  edited 
by  Verna  Huffman  Splane,  RN. 

Yearly  subscription — $15.15.  Published 
quarterly:  March,  June,  Sept.,  Dec.  Each 
issue  is  approximately  180  pages,  hard- 
bound, illustrated,  and  contains  no 
advertising.  Order  #0003. 


*^  pages 
Yaunde 


Wood: 

NURSING  SKILLS  FOR 

ALLIED  HEALTH  SERVICES,  Volume  III 

In  the  new  third  volume  of  this  practical  series,  the  author  discusses 
"level  two  "  skills — those  appropriate  for  the  LPN/LVN  and  RN:  asep- 
tic techniques,  preparation  and  administration  of  medications,  uri- 
nary catheterization,  hot  and  cold  compresses,  pharyngeal  suction, 
tracheostomy  care,  tourniquets,  smears  and  cultures,  skin  tests, 
immunizations,  and  more.  A  typical  unit  con- 
tains directions  to  the  student,  general  and 
specific  performance  objectives,  vocab- 
ulary, step-wise  instructions  with  clear  illus- 
trations, a  post-test  with  annotated  answer 
sheet,  preparation  for  a  performance  test, 
and  a  performance  check-list.  The  first  two 
volumes  cover  "level  one  "  skills  for  the  be- 
ginning practitioner.  (Individual  Teacher's 
Guides  are  available.) 

By  Lucille  A,  Wood,  RN.  MA.  Vol.  3:  449  pp. 
447  ill.  Soft  cover.  $7.75.  Jan.  1975. 

Order  #9602-3. 
Vol.  1:394  pp.  281  ill.  Soft  cover  $5.15  May 
1972.  Order  #9600-7. 

Vol.  2:  374  pp.  279  ill.  Soft  cover.  $5  15  May 
1972.  Order  #9601-5. 


I 


McQuillan: 
FUNDAMENTALS  OF 
NURSING  HOME 
ADMINISTRATION,  2nd  Edition 

Both  a  guide  for  licensure  preparation  and  a 
day-to-day  reference,  this  text  has  found  a  place 
with  administrators,  supervisors  and  nurses 
alike.  It  reviews  every  aspect  of  building  and 
planning,  internal  management,  nursing  care 
and  patient  service.  The  second  edition  also 
includes  new  data  on  licensing,  a  penetrating 
look  at  Medicare,  and  a  projection  of  the  nursing 
home's  future  based  on  current  trends. 

RN 


By  Florence  L  McQuillan 

lustd.  $12.90.  July  1974. 


MS.  403  pp.  II- 
Order  #5971-3. 


Crelghton: 

LAW  EVERY  NURSE 

SHOULD  KNOW 

New  3rd  Edition 

It  takes  an  expert  to  understand  all  the  legal 
complications  that  today's  nursing  practice 
may  entail — an  expert  like  Dr.  Helen  Creigh- 
ton,  who  is  a  nurse  and  nursing  educator  as 
well  as  an  experienced  lawyer.  Dr. 
Creighton's  text  has  been  totally  revised  and 
substantially  expanded  to  include  data  on: 
ANA.  certification;  minors  and  birth  control, 
abortion,  and  drug  abuse;  care  of  psychiatric 
patients;  pronouncing  the  patient  dead;  con- 
fidential communications;  narcotics  viola- 
tions; legitimacy;  acupuncture;  rights  prior 
to  birth;  and  many  more  topics.  An  entire 
chapter  examines  Canadian  Law  and  Legal 
Practice. 

By  Helen  Creighton,  RN,  JD.  About  350  pp. 
Ready  July  1975.  Order  #2752-8. 


lW.B.  SAUNDERS  COMPANY  CANADA  LTD. 


833  Oxford  Street, 

Toronto  18,  Ontario  M8Z  5T9 


To  receive  titles  on  30-day  approval, 
please  fill  in  order  numbers  below: 


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■  CANADIAN  NURSE  —  May  1975 


S3 


accession  list 


(Continued  from  page  52) 


3.  The  application  of  DACUM  in  retraining  and 
post-secondary  curriculum  development,  by  William 
E.  Sinnett.  2ed.  Toronto.  Humber  College.  1974. 
49p. 

4.  Associate  degree  education  for  nursing  current 
issues,  1974.  Papers  presented  at  the  seventh 
conference  of  the  Council  of  Associate  Degree 
Programs,  Washington.  D.C..  Feb.  27-Mar.  I. 
1974,  by  the  National  League  for  Nursing,  Dept,  of 
Associate  Degree  Programs.  New  York.  1974.  49p. 

5.  Basic  psychiatric  concepts  in  nursing,  by  Joan  J. 
Kyes  and  Charles  K.  Hofling.  Toronto.  Lippincott. 
cl974.  527p, 

6.  Care  and  rehabilitation  of  the  stroke  patient,  by 
Benjamin  Gould  Cox  Springfield.  III..  Charles  C. 
Thomas.  cl973.  91p. 

7.  Caring  for  ami  caring  about  elderly  people:  a 
guide  to  the  rehabilitative  approach .  Editor.  J  anet  M . 
Long.  led.  Rochester,  N.Y.  Rochester  Regional 
Medical  Program  and  the  University  of  Rochester 
School  of  Nursing.  1972.  I27p. 

8.  Centre  hospitaller  universitaire  1969-1974. 
Sherbrooke.  P.Q.,  Centre  hospitalier  universitaire, 
1974.  54p. 

9.  Clinical  pharmocology  in  nursing,  by  Norton  J. 
Rodman  and  Dorothy  W.  Smith.  Philadelphia, 
Lippincott,  cl974.  701p. 

10.  Colombo's  Canadian  quotations,  edited  by  John 
Robert  Colombo.  Edmonton.  Hurtig,  cl974.  735p. 
R 

1 1 .  Developing  nursing  programs  in  institutions  of 
higher  education  1974.  Papers  presented  at  the  con- 
ference jointly  sponsored  by  the  Dept.  of  Associate 
Degree  and  the  Dept.  of  Baccalaureate  and  Higher 
Degree  Programs.  New  York.  National  League  for 
Nursing.  1974.  94p.  (NLN  Pub.  no.  14-1533) 

12.  Faculty  curriculum  development.  New  York. 
National  League  for  Nursing,  Dept.  of  Baccalaureate 
and  Higher  Degree  Programs.  cl974.  2pls.  (NLN 
Pub.  no.  20-1521  and  1530) 

13.  The  final  plateau:  the  betrayal  of  our  older 
citizens,  by  Daniel  Jay  Baum.  Toronto.  Bums  and 
MacEachem.  1974.  312p. 

14.  Financial  management  for  schools  of  nursing. 
Papers  presented  at  the  1973-74  regional 
workshops.  New  York.  National  League  for  Nursing. 
Department  of  Diploma  Programs.  1974.  I13p. 
(NLN  Pub.  no.  16-1549) 

15.  Health  education  guide:  a  design  for  teaching:  a 
program  continuum  for  health  instruction .  by  Morris 
Barrett.  2ed  Philadelphia.  Lea  &  Febiger.  1974. 
337p. 

16.  Health  status  indexes:  proceedings  of  a 
conference  on  a  Health  Status  Index.  Tucson,  Ariz.. 
1972,  conducted  by  Health  services  research. 
Tucson.  Arizona,  October  1-4.  1972.  Chicago. 
Hospital  Researc  and  Educational  Trust.  1973.  262p. 

17.  Intensive  and  rehabilitative  respiratory  care:  a 
practical  approach  to  the  management  of  acute  and 
chronic  respiratory  failure,  by  Thomas  L.  Petty. 
2ed.  Philadelphia.  Lea  &  Febiger.  1974.  404p. 

1 8 .  Intermediate-level  health  practitioners:  report  of 
Macy  Conference  on  Intermediate-Level  Health 
Personnel  in  the  Delivery  of  Direct  Health  Services, 
Williamberg,    Va.,    1972.    Edited   by    Vernon   W. 


Lippard  and  Elizabeth  F.  Purcell.  New  York.  Josiah 
Macy  Jr.  Foundation,  c  1973.  232p.  (Conference  held 
on  Nov.   12-14,  1972) 

19.  Just  an  ordinary  patient:  a  preliminary  survey  of 
opinions  on  psychiatric  units  in  general  hospitals,  by 
Winifred  Raphael.  London,  King  Edward's  Hospital 
Fund  for  London,  cl974.  48p. 

20.  Maternity  nursing,  by  Constance  Lerch.  2ed. 
Saint  Louis,  Mosby.  1974.  432p. 

21.  Neurology  and  neurosurgical  nursing  continuing 
education  review:  408  essay  questions  and 
referenced  answers,  by  Barbara  Ann  Russo. 
Flushing.  NY..  Medical  Examination  Publishing 
Co.,  cl974.  241p. 

22.  New  roles  for  social  science  and  medicine  in 
Canada:  promoting  and  sustaining  innovation  in 
health  care  .nstems.  Papers  and  themes  of  third 
Conference  on  Social  Science  and  Medicine  in 
Canada.  Montreal.  June  4  —  5.  1971  Edited  by 
Joseph  W.  Leila.  Montreal.  McGill  University. 
1974.   141p. 

23  Nursing  care  in  eye,  ear,  nose  and  throat 
disorders,  by  William  H.  Havener  et  al  3ed.  Saint 
Louis.  Mosby.  1974.  459p. 

24.  Nursing  home  administration,  edited  by  Stephen 
M.  Schneeweiss  and  Stanley  W.  Davis.  Baltimore. 
Md..  University  Park  Press.  cl974.  278p. 

25.  Nutrition  misinformation  and  food  faddism. 
Boston,  Mass.,  Nutrition  Foundation.  1974.  73p. 
(Nutrition  reviews  vol.  32;  July  1974,  Supplement 
no.  I) 

26.  Patient  care  systems,  by  Janet  Kraegel  et  al. 
Toronto.  Lippincott.  cl974.  219p. 

27.  The  problem-oriented  system:  a 
multidisciplinary  approach.  New  York.  National 
League  for  Nursing.  Dept.  of  Hospital  and  Related 
Institutional  Services,  cl974.  91p.  (NLN  Pub.  no. 
20-1546) 

28 .  Proceedings  of  Open  Curriculum  Conference ,  I , 
St.  Louis.  Mo.,  Nov.  27-28.  1973.  Edited  by  Lucille 
Notter.  A  project  of  the  NLN  Study  of  the  Open 
Curriculum  in  Nursing  Education.  New  York, 
National  League  for  Nursing.  cl974  I54p.  (NLN 
Pub.  no.   19-1534) 

29.  Psychiatric  nursing,  by  Ruth  Virginia 
Matheney.  1911-1974.  Mary  Topalis  and  guest 
contributor  Jeanette  A.  Weiss.  6ed.  St.  Louis. 
Mosby,  1974.  439p. 

30.  Psychotropic  drugs:  a  manual  for  emergency 
management  of  overdosage,  by  Nathan  S.  Kline, 
Stewart  F.  Alexander  and  Amparo  Chamberlain. 
Oradell,  N.J.,  Medical  Economics  Co.,  1974.  I36p. 
J].  Public  education  about  cancer.  Geneva. 
International  Union  Against  Cancer.  1974.  73p. 
(UICC  Technical  Report  Series,  vol.1 1) 

32.  Reality  shock:  why  nurses  leave  nursing,  by 
Marlene  Kramer.  St.  Louis.  C.V.  Mosby.  1974. 
249p. 

33.  Social  indicators:  a  rationale  and  research 
framework,     by     D.W.     Henderson.     Ottawa, 

Information  Canada  for  Economic  Council  of 
Canada.  cl974    90p. 

34.  Special  needs  of  long-term  patients,  by  Carolyn 
B   Stevens.  Philadelphia.  Lippincott.  cl974.  288p. 

35.  Staffing:  a  journal  of  nursing  administration 


reader,  compiled  by  Mary  Ellen  Wars  i 
Wakefield.  Mass..  Contemporary  Pub.  Co  ,  cl4"- 
57p. 

36.  Stress.  Chicago.  Blue  Cross  Association. 
96p.  (Blueprint  for  health  v. 25,  no.l) 

37.  Theoretical  foundations  for  nursing,  compile 
by  Margaret  E.  Hardy.  New  York,  MSS  Infonnuti. 
Corp.,  cl973.  490p. 

PAMPHLETS 

38.  The  balloon  lady:  you  and  Mrs.  MurJuct 
Transcript  of  the  Brunkild,  Manitoba  tape.  Nov   2. 

1973.  Compiled  by  June  Menzies.  Muriel  Arpin  an 
Jean  Carson,  members  of  the  Manitoba  AlIk 
Committee  on  the  Status  of  Women.  Made  availab 
by  Advisory  Council  on  the  Status  of  Woiiiei 
Ottawa,  1974   35p 

39.  Child  abuse  bibliography ,  by  Paul  Gregur 
Montreal,  Abused  children  —  Violence  in  the  famii 
research  unit,  1974.  42p. 

40.  The  concept  of  family  practice:  the  fuuin 
continuing  family  care,  by  PL.  Delva.  Ottavi, 
Canadian  Public  Health  Association.  1974  i8] 
(Canada.  Community  Health  Centre  Priie 
Committee,  Commissioned  paper.) 

i\.The  future  is  now.  Presentations  at  tt 
Conference  of  the  Northeast  Regional  AssembI; 
New  York.  National  League  for  Nursing,  Division. 
Community  Planning,  1974.  39p.  (NLN  Pub  m 
55-1553) 

42.  ,4  guide  for  nursing  staff  education.  Toronto 
Registered  Nurses'  Association  of  Ontario.  1^" 
12p. 

43.  The  health  profession  education  organizutu 
and  the  governmental  process,  by  Margarei  I 
Walsh.  New  York.  National  League  for  Nursin 
cl974.  18p.  (NLN  Pub.  No.  14-1541) 

44.  Management  engineering  for  hospital 
Chicago,  111..  American  Hospital  Association.  147' 
26p. 

45.  Statement  on  nursing.  Toronto.  Registerc 
Nurses'  Association  of  Ontario.  1974.  20p. 

GOVERNMENT  DOCUMENTS 

Canada 

46.  Dept.  of  National  Health  and  Welfare.  Gei/ii 
keep  fit:  a  physical  fitness  and  training  guide  for  m. 
and  women.  Prepared  by  the  Special  Committee 
the  Canadian  Medical  Association  and  the  Canadi 
Association  for  Health  Physical  Education  a 
Recreation.  Ottawa,  Queen's  Pnnter.  1968.   Ihp 

47.  Economic  Council  of  Canada.  Annual  n 
Ottawa,  Queen's  Printer.  1974.  264p 

48.  Health  and  Welfare  Canada.  Fitness  a 
Amateur  Sport  Branch.  Health  and  fitness.  Ollau 

1974.  48p. 

49.  Health  and  Welfare  Canada.  Fitness  a 
Amateur  Sport  Branch.  Terms  and  conditiom  J 
contributions.  Ottawa.  1974.   12p. 

50.  Health  and  Welfare  Canada.  Health  Econonn 
and  Statistics  Division.   Health  Programs  Br 
Salaries    and    wages    in    Canadian    hos[> 
1969-1973.  Ottawa,  1974.  89p. 

51.  Health    Sciences    Resource    Centre.    H.- 
science  serials  on  order  in  Canadian  libraries,  i 


accession  list 


6.  no.  I.  January  1975.  Ottawa.  Health  Sciences 
Resource  Centre.  Canada  Institute  for  Scientific  and 
Technical  Information,  1975.  I9p.  R 

52.  IJnformation  Canada.  Rfporr.  1973174.  Ottawa. 
Information  Canada.  1974.  18p. 

53.  Law  Reform  Commission.  Report,  1973/74. 
Ottawa.  Information  Canada.  1974.  18p. 

54  Metric  Commission .  Canada  prepares/or  metric 
conversion.  Ottawa,  1974.  4pts.  in  1. 

55  National  Conference  on  Fitness  and  Health, 
Ottawa,  Dec.  4,  5  and6,  1972.  Proceedings.  Ottawa, 
Information  Canada,  for  Health  and  Welfare  Canada, 
cl974.  160p. 

56  National  Library  of  Canada.  Canadian  theses, 
il970f7J.  Ottawa,  Information  Canada.  1974.  33 Ip. 

R 

57.  National  Library  of  Canada.  Union  list  of  serials 
indexed  by  social  sciences  citation  index  held  by 
Canadian  libraries.  Ottawa,  Union  Catalogue  of 
Serials  Division,  1974.  192p.  R 

58.  National  Science  Library.  Directory  of  federally 
supported  research  in  universities.  Ottawa,  National 
Science  Library.  Nationat  Research  Council  of 
Canada,  1973/74.  2v.  (NRC  no.  13895)  R 

59.  Nutrition  Canada.  Report.  Ottawa,  Bureau  of 
Nutritional  Sciences,  Dept.  of  National  Health  and 
Welfare.  1975.  I2v. 

.  Unemployment   Insurance   Commission.  33rd 


annual  report.  Ottawa,  1974.   18p. 

Northwest  Territories 

61.  Laws  and  Statutes.  Ordinances,  1974  —  third 
session.  Ottawa,  Information  Canada,  1974.  I52p. 

Quebec 

62.  Conseil  des  affaires  sociales  et  de  la  famille. 
Rapport  annuel  1973/74.  Quebec.  Iv. 

United  States 

63.  Dept.  of  Health,  Education  and  Welfare. 
Developments  in  health  manpower  licensure:  a 
follow-up  to  the  1971  report  on  licensure  and  related 
health  personnel  credentialing,  by  Harris  S.  Cohen 
and  Lawrence  H.  Miike.  Washington.  DC.  U.S. 
Dept.  of  Health.  Education  and  Welfare,  1973.  69p. 
(U.S.  DHEW  Pub.  no  HRA  74-3101) 

64.  Public  Health  Service.  Division  of  Nursing.  A 
methodology  for  monitoring  quality  of  nursing  care. 
Principal  investigator  was  Richard  E.  Jelinek  el  al. 
Bethesda,  Md.,  1974.  88p.  (DHEW  pub.  no.  HRA 
74-25) 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLECTION 

65 .  Changes  in  the  amount  and  nature  of  contacts  of 
cardiac  surgical  patients  following  transfer  from  an 
intensive  care  unit,   by  Patricia  Keams.  Toronto, 


CI974.  114p.  R 

66.  Evaluation  des  effets  dun  programme  de 
preparation  preoperatoire  sur  le  relablissement  des 
clients  de  chirurgie  elective.  Par  Doris  Cusleau  et 
Yolande  Lepage-Cyr.  Montreal,  1974.  I26p.  R 

67.  Personal  history  of  persons  complaining  of  back 
pain,  by  Claire  Paquette.  Seattle,  1972.  I62p.  R 

68.  Senior  ward  clerk  activity  reassessment  by  Jane 
E.  Henderson  and  R.  Cross.  Montreal.  1971.  lOp.  R 

69.  Survey  of  nutrition  education  provided  to  nursing 
students  in  Canada.  Toronto.  Canadian  Dietetic 
Association.  Nutrition  Committee,  1973  p. 9- 1 1 .  (/n 
Canadian  Dietetic  Association.  Folio  of  reports, 
1974) R 

70.  Unit  administration  project.  Royal  Victoria 
Hospital.  Final  report,  by  Jane  E.  Henderson. 
Montreal.  1970.  32p.  R 

AUDIO- VISUAL  AIDS 

11.  Medlars:  capabilities  and  limitations. 
Washington.  DC.  National  Audiovisual  Centre. 
1974.  31  slides.  1  audio  cassette. 

72.  Medlars  on  line;  medline;  what  it  is.  and  how  to 
use  it.  (Video  record  Atlanta.  Ga. .  National  Medical 
Audiovisual  Center,  1974.  X  tape  cassette. 

73.  Medline -in-context.  Washington,  D.C..  Na- 
tional Audiovisual  Center,  1974.  30  slides.  I  audio 
cassette. 


Request  Form  for  "Accession  List" 
CANADIAN  NURSES'  ASSOCIATION  LIBRARY 

Send  this  coupon  or  facsimile  to: 

LIBRARIAN,  Canadian  Nurses'  Association,  50  The  Driveway,  Ottawa,  Ontario.  K2P  1E2. 

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) 


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 


HE  CANADIAN  NURSE  —  May  1975 


SKIN-CONFORMING  KARAYA  BLANKET 

PROTECTS  SKIN  AROUND  WOUND  SITE  . . .  DIRECTS 

DISCHARGE  INTO  AHACHED  COLLECTOR. 


THE  HOLLISTER  DRAINING-WOUND 
MANAGEMENT  SYSTEM 

KEEPS  FLUIDS  AWAY  FROM 

PATIENT'S  SKIN  AND  GUARDS  AGAINST 

IRRITATION  AND  CONTAMINATION, 

Odor-barrier,  translucent  Drainage  Collector  tx)lds  exu- 
date for  visual  assessment  and  accurate  measurement. 
There  are  no  messy,  wet  dressings  to  tiandie. 

View  wound  through  Access  Cap.  Remove  cap  for 
wound  examination  and  drain  tube  adjustment.  There  is 
no  need  for  painful  dressing  removal. 

Supplied  sterile,  for  application  in  O.R.  or  patienf  s  room. 


i 


The  better  alternative 
to  absorbent  dressings. 

Write  for  more  information 

HOLLISTER 

Hollister   Ltd.,  332  Consumers  Rd.,  Willowdale,  Ont.  M2J  1P8 


DIRECTOR 
OF  NURSING  SERVICES 


St.  Boniface  General  Hospital,  a  900  bed  fully  accredited  teaching 
and  referral  organization,  has  an  excellent  opportunity  for  a  Director 
of  Nursing.  Tine  successful  candidate  for  this  position  will  assist  in 
setting  objectives  and  policies  of  the  nursing  division,  and  will  work 
closely  with  the  medical  division  and  with  the  directors  of  the  schools 
of  nursing.  Extensive  committee  work  will  be  required,  and  other 
responsibilities  will  include:  program  planning  and  development, 
budget  preparation  and  control,  Implementation  of  administrative 
and  personnel  policies,  staffing  and  recruitment,  and  resource  and 
equipment  allocation.  Administrative  assistance  will  be  provided  by 
three  full  time  staff  assistants. 

A  new  management  structure  coupled  with  a  recent  200  bed  expan- 
sion will  require  an  individual  with  excellent  clinical  and  managerial 
credentials,  and  one  who  Is  capable  of  maintaining  the  climate  of 
trust,  confidence  and  harmonious  relationships  among  the  various 
departments.  In  directing  a  competent  group  of  head  nurses,  prefer- 
red applicants  will  have  demonstrated  leadership  ability,  judgment, 
and  initiative.  Reporting  to  the  Vce-President,  Health  Services, 
he/she  will  preferably  have  obtained  a  Master's  Degree  in  Health 
Administration  and  will  have  a  minimum  of  five  years  successful 
teaching  and  administrative  fexperience.  Compensation  will  be  at- 
tractive and  fully  appropriate  to  qualifications. 

Referring  to  45-32-525,  reply  to 

R.W.  Miller,  213  Notre  Dame  Avenue, 

Winnipeg,  Manitoba.  R3B  1N3 

P.  S.  ROSS  Si  PARTNERS 

MANAGEMENT  CONSULTANTS 

MEMBER:  CANADIAN  ASSOCIATION  OF  MANAGEMENT  CONSULTANTS. 


Tropical 
Diseases 
and 
Parasitology 


Seneca  College  is  offering  short  courses  at  post- 
diploma  level  in  Tropical  and  Parasitic  Diseases. 

International  Health  Course  one  semester 
Preparation  to  function  intelligently  in  an  environment 
where  such  diseases  [JOse  a  health  problem. 

International  Health  — Short  Course  40  hours 
(incorporated  in  the  one  semester  course) 
Emphasis  on;  Incidence  of  Tropical  and  Parasitic 
Disease  in  Canada,  Detection  and  referral,  Prevention 
and  control. 

For  information  write  to: 

»f  SENECA  COLLEGE 

OF  APPLIED  ARTS  AND  TECHNOLOGY 

l.>5iSHEPPARD  AVENUE  EAST  WIllOWDAlE  OMARIO  M.'K  1EJ 


classified  advertisements 


ALBERTA 


REGISTERED  NURSES  required  lor  70  bed  accrediled  active 
I'Tient  Hospital  Full  time  and  summer  relief.  All  AARN  per- 
-el  policies  Apply  in  wnting  to  the.  Director  of  Nursing 
,n heller  General  Hospital,  Drumheller  Alberta 


-cJc^,  ^M-?«"!?';r®"'  'hospital  requires  NURSES   FOR 
GENERAL  DUTY.  O.R.,   and  INTENSIVE   CARE   NURSING 

1-  member  medical  stall   Personnel  policies  per  A  A  R  n' 

.ement  -  starting  at  $900    per  month.  This  hospital  is 

^■ed  in  the  southern  pan  of  the  province  (30  miles  east  of 

Dfidge)  which  enpys  a  fairly  moderate  winter  climate  Easy 

ss  to  winter  and  summer  recreational  activities.  Apply 

2G0°        '*'"^'  ^^'*'  <5«"eral  Hospital.  Taber.  Alberta 


,  jRAOUATE  NURSES  —  Vacancies  exist  for  Graduate  Nurses 

T  25-Ded  active  treatment  hospital.  1 10  miles  east  of  Lacombe 
.alary  and  conditions  in  accordance  with  AARN    Residence 
ible.  Apply  to:  Director  of  Nursing  Coronation  Municipal 
.  lal.  Coronation.  Alberta.  TOG  ICO. 


BRITISH  COLUMBIA 


new'^^^^n  ^Z'r'^  K^^'^'y  interesting  and  challenging 
fho  £^  T..^^  '^"""^  ^  ^-C-  REGISTERED  NURSE  to  a&ist 
Prpfpr/n.^  Admmistraior  to  be  classified  as  a  Head  NuTse 
N  frLln^  ""^  *'"  '^  9'™"  °"«  *""  P"°'  Emergency  or  Ob^telnc 
Nu  s  n§  Un^inm"  T",  "^""9  ='^=<:««'-"y  com°pletS  tl^^ 
^^rS  '^aministratioh  course    The  hospital  is  a  newly 

rKam,o°o"^s'  B  c'^Th"  ""  ^«"°"^«^^  Highwa?  80  mills  ^l 
01  Kamioops,  B  C   The  area  is  a  vacationers  paradise  both  in 

D?  Hrtmri,rj  u^  '^"'y  '°   '^'^  "^   f''"'  ^"^e  Administrator 
Dr  Helmcken  Memonal  Hospital.  Clean*ater.  Bntish  Columbia 


REGISTERED  NURSES  AND  NURSING  SUPERVISORS  re- 
quired by  a  100-bed  acute  care  and  40-bed  extended  care 
accredited  hospital.  Musi  be  eligible  lor  BC  registration 
Supervisory  applicants  must  have  experience  in  admrnistralive 
or  supervisory  nursing  R.N  s  salary  $985.  to  $1  163  and 
Supen/isors  salary  $i,i81.  to  $1,391  (RNABC  Agreement  - 
1975)  Apply  in  writing  to  the:  Director  of  Nursing,  G  R  Baker 
vSTkV         ""^'^  ^^  '"'""'  ^"**''  0"«^"«'>  Bhtish  Columbia 


NOVA  SCOTIA 


treatnient  hospital  Permanent  night  duty  medical  unit  Salary  in 
f«fe?;n^.»f  *."'.."''*'^  I  *PP'V-  9'""g  <^«  pamcurars  and 
»  %™  ,S,\'?i  "'^'^"f  '°  °"^°'  °'  N"'sing.  All  Saints  Hospi- 
tal, Spnnghill,  Nova  Scotia. 


ONTARIO 


t^d  7^ trj'S  ROOM  STAFF  NURSE  required  tor  fully  accredi- 
ted 75-bed  Hospital.  Basic  wage  3689  00  with  considwation  for 
waoe  sSII  m  r'.n  f^^^^NG  ROOM  TECHNICIAN,  bas^ 
^h.£f  IS  r?°  '^^"  """^  '3'"=  available  on  reguesi  Wnte  or 
Cen,  Oh?ana'°'     ''"""^'  °"^'"  °'='""  '^^"«'^'  »°^"^- 


BRITISH  COLUMBIA 


H 


)PERATING    ROOM    NURSE    wanted    for    active    mo- 
acute    hospital.     Four    Certified    Surgeons    on 
■ding    staff.    Experience    of    training    desirable 
be    eligible    for    BC      Registration      Nurses 
:ence    available.    Salary    according    to    RNABC 
•act     Apply    to:    Director    of    Nursing.    Mills    Mem- 
.       J^°spilal.     2711     Tetrault     St..     Terrace.     British 


ADVERTISING 
RATES 

FOR   ALL 
CLASSIFIED   ADVERTISING 


$15.00   for   6   lines   or   less 
$2.50  for  each   additional   line 

Roles   for   display 
odverfisemenfs   on    request 

osing  dote  for  copy  ond  concellation  is 
c  weeks  prior  to  1st  day  of  publication 
T^onth. 

e    Canadion     Nurses'    Association    does 

•     review     the     personnel      policies     of 

hospltols     ond     agencies     advertising 

'he   Journal.    For   authentic   information, 

^   ospective     oppliconts     should     opply     to 

'he   Registered    Nurses'   Associotion   of   the 

Province     in     which     they     ore     interested 

in    working. 


Address  correspondence  to: 

The 

Canadian  ^ 
Nurse        ^ 


^^ 


50  THE  DRIV^EWAY 
OTTAWA,  ONTARIO 
K2P  1E2 


REGISTERED  NURSES  wanted  for  the  opening  of  the 
expansion  to  the  Campbell  River  Hospital  pjly  i:credi  ed 
^Zn  '',T''  ""i'^^'"""'  Vancouver  Island.  Far^ou^forlp^ 
salmon  f  shing  and  all  water  sports  activities.  Please  diiS 
SSSren'i'rli  2"«^'?',°' N"rs,hg  Services,  Campbell  fliver* 


"a^e '^hlfp^af  "sTal"  'T'"" '°' '  "^-"^  *="«*'«'  «="<« 
RNARr  An?,K,  f  V  ^'^  Peraonnel  policies  according  to 
HNABC  Apply  to:  Mrs,  M,  Standidge,  R,N  DON  CrMton 
Valley  Hospital,  Creston,  Bntish  CoHjmbia 


rfS^l^f  "nd  GRADUATE  NURSES  required  for  new 
41-bed  acute  care  hospital,  200  miles  north  of  Vancouver  60 
miles  from  Kamloops.  Limited  furnished  accommodation  availa- 
?J  t'^  Director  of  Nursing,  Ashcroft  &  District  General  Hospi- 
tal, Ashcroft.  British  Columbia, 


pSaI^'ica? I'JlSI?!"*'-  '^T''  """SES  AND  LICENSED 
PRACTICAL  NURSES  required  for  small  upcoast  hospital  Sal- 
ary and  personnel  policies  as  per  RNABC  and  HE  U  contracts 
Residence  accommodation  $25  00  per  month.  Transportation 
paid  from  Vancouver  Apply  to  Director  of  Nursing.  St,  Georqes 
Hospital,  Alert  Bay,  British  Columbia,  VON  1A0,  ^""'Ses 


.  5o  E^*^^"  NURSES  (eligible  for  B  C,  registration)  required 
S'„  5^'^  ^'^"'^  ^^"^  teaching  hospital  tacated  in  Fraser 
valley,  20  minutes  by  freeway  from  Vancouver,  and  within 
easy  access  of  varied  recreational  facilities  Excellent  Onenta- 
non  and  Continuing  Education  programmes  Salary  $1  026  00  to 
$1  212,00,  Clinical  areas  include  Medicine,  General  and  Spe- 
cialized Surgery,  Obstetrics,  Pedialncs,  Coronary  Care  Herrio^ 
dialysis,  RehabiMation  Operating  Room,  Intensive  Care  Emer- 
gency, PRACTICAL  NURSES  feligible  for  B  C,  Liclnse)  Tteo 
required  Apply  to  Administrative  Assistant,  Nursing  Personnel 
wS/^i,.  '"'"'"^"  Hospital,  New  Westminster.  British  Columbia' 
V3L  3W7, 


GRADUATE  NURSES  —  Looking  for  variety  in  your  work' 
Consider  a  modern  i0-bed  hospital  located  on  a  beautiful  fiord- 
Qrpe  inlet  of  Vancouver  Island  s  west  coast.  Apply:  Administrator 
Box  399,  Tahsis,  Bntish  Columbia,  VOP  1X0 


GENERAL  DUTY  NURSES  for  modem  41-bed  hospital  located 
on  the  Alaska  Highway,  Salary  and  personnel  policies  in 
accordance  with  RNABC,  Accommodation  available  in  resi- 
dence. Apply:  Director  of  Nursing.  Fort  Nelson  General  Hospital 
Fort  Nelson.  Bntish  Columbia, 


iNADIAN  NURSE  —  May  1975 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  care 
hospital  in  Northern  BC  residence  accommodations  available 
RNABC  policies  in  effect.  Apply  to:  Director  ol  Nursing  Mills 
Memonal  Hospital,  Terrace.  Bntish  Columbia.  V8G  2W7 


?^°'®Jf,^^.5  NURSES  for  34-bed  General  Hospital 
Salary  $915,00  per  month  to  $1,1 15  00  plus  experience  altow- 
ance.  Excellent  personnel  policies  Apply  to:  Director  of  Nursing 
Englehart  &  District  Hospital  Inc  ,  Englehart,  Ontano  POJ  1H0 


REGISTERED  NURSES  lor  107-bed  General  Hospital  Salary 
range  $915  00  —  $i  ,1 15,00  plus  experience  atowance  Yearly 
increments.  Excellent  personnel  policies.  Rooming  accommoda- 
tions available  in  town  Apply  to:  Director  of  Nursing  La  Veren- 
drye  Hospital,  Fort  Frances,  Ontario.  P9A  2B7or  call  collect  (8071 
274-3261 , 


REGISTERED  NURSES  required  lor  our  ultramodern  79-bed 
General  Hospital  in  bilingual  community  of  Northern  Ontario 
French  language  an  asset,  but  not  compulsory.  Salary  is  $945  to 
$1 145  monthly  (subject  to  increase  July  tsi)  with  allowance  lor 
past  experience  and  4  weeks  vacation  after  i  year  Hospital  pays 
IM/.  of  OH  IP,,  Life  Insurance  (10,0001,  Salary  Insurance 
(75%  of  wages  to  the  age  of  65  with  u  I  C  carve-out)  a35<t  druq 
plan  and  a  denial  care  plan  Master  rotation  m  effect  Rooming 
accommodations  available  in  town  Excellent  personnel  policies 
Apply  to:  Personnel  Director,  Notre-Dame  Hospital  P  O  Box 
860.  Hearst.  Ontarxj 


REGISTERED  NURSES  AND  REGISTERED  NURSING 
ASSISTANTS  lor  45-bed  Hospital  Salary  ranges 
include  generous  experience  allowances  R  N  s 
salary  $945  to  $1,115,  and  HNA  s  salary  $650  to  $725 
Nurses  residence  —  private  rooms  with  bath  —  $60  per  month 
Apply  to  The  Director  of  fMursing  Geraldton  District  Hospital 
Geraldton.  Ontarb,  POT  1  MO 


REGISTERED  NURSES  FOR  GENERAL  DUTY  ICU 
C.C.U.  UNIT  and  OPERATING  ROOM  required  lor 
r^J.L,^""^''"^''  ^°5P"al  Starting  salary  $850,00  with 
regular  increments  and  with  allowance  tor  experi 
ence  Excellent  personnel  policies  and  temporary 
residence  accommodation  available.  Apply  to  The 
Director  ol  Nursing.  Kirkland  &  District  Hospital 
KirKland  Lake.  Cnlano,  f2N  1 R2, 


muPt'-^  "^*'-TH  nurse  -  GREY-OWEN  SOUND  HEALTH 
UNIT  has  an  opening  lor  a  qualifieO  PUBLIC  HEALTH  NURSE 

It  you  are  interested  m  obtaining  more  inlonnation  about  this 
position  please  contact  Miss  E   Davidson,  B  Sc  N  ,  Director  of 

^"[,nd'bma7K.%'K Iex'  "'""  ""•'  '^"""'^ ^"'"^'"9'  O"*^ 


QUALIFIED  PUBLIC  HEALTH  NURSES  required  lor 
generalized  public  health  nursing  program  Health  Unit  located  in 
a  rapidly  devetopmg  area  ol  the  province  Generous  Innge  be- 
nefits and  car  altowance  For  application  form  and  further  infor- 
mation write  to:  Dr  H,H  Washburn,  Medical  Officer  of  Health 
Haldirnand-Nortolk  Regional  Health  Unit.  Box  247.  Simcoe  On- 
tano. N3y  4L1. 


57 


ONTARIO 


Chiidrens  summer  i^amps  in  Scenic  Areas  of  Northern  Ontario 
Require  Camp  Nurses  for  July  and  August.  Each  has  resident 
M.D,  Contact:  Harold  B  Nashman,  Camp  Services  Co-op,  821 
Eglinton  Avenue  West.  Toronto,  Ontario.  MSN  1E6- 


QUEBEC 


■WHY  GO  OVERSEAS  FOR  CHALLENGE?"  Canada  #iative 
people  need  you.  Come  to  Caughnawaga  Indian  Reserve.  15 
minutes  from  exciting  Montreal.  REGISTERED  NURSES 
needed  lor  small  English  speaking  community  hospital.  No 
special  language  requirement  tor  Canadian  citizens,  but  the 
opportunity  to  learn  French  is  available.  Apply  to:  Miss  J.  Delisle. 
Kateri  Memorial  Hospital  Centre.  PC.  Box  10,  Caughnawaga, 
Quebec,  JOL  180,  Telephone:  (514)  632-7620, 


REGISTERED  NURSE  required  for  co  ed  children  s  summer 
camp  in  the  Laurenttans  (seventy  miles  north  of  Montreal)  from 
JUNE  20,  1975  lo  AUGUST  20,  1975.  Call  (514)  688  1753  or 
write:  CAMP  MAROMAC,  5901  Fleet  Road,  Montreal,  Quebec, 
H3X  1G9   Telephone:  487-5177, 


English  girls'  camp  in  Laurentians  requires  TWO  NURSES  for  4 
or  8  week  period  —  July  &  August,  Write  to:  Mrs.  J. R,  Allen,  Camp 
Ouareau,  26  Lome  Avenue.  Lennoxville,  Quebec;  or  call  (819) 
562-9641, 


REGISTERED  NURSES  and  NURSES  AIDES  wanted  for 
summer  camps  end  of  June  to  end  of  August,  Must  be  qualified  to 
work  in  Quebec,  Apply:  JEWISH  COMMUNITY  CAMPS,  5151 
Cole  Ste  Catherine  Road.  Montreal.  Quebec,  H3W  1M6, 
Telephone:  (514)  735-3669 


SASKATCHEWAN 


2  REGISTERED  NURSES  and  1  COMBINED  LABORATORY  & 

X-RAY  TECHNICIAN  required  in  21 -bed  General  Hospital. 
CU.PE.  and  S-U,N,  Union  Rates.  A  friendly  community  with 
fresh  air  and  clear  water  in  beautiful  surroundings  Apply  to: 
Margarete  Lathan,  Director  of  Nursing,  Union  Hospital,  Paradise 
Hill.  Saskatchewan. 


R.N.  required  Immediately  —  Porcupine  Carragana  Union 
Hospital  requires  General  Duty  Registered  Nurse  immediately 
Salary  scale  and  fringe  benefits  as  negotiated  by  SUN.  Modern 
20-bed  hospital.  Near  Provincial  Park  Progressive  community 
Apply,  in  writing,  to;  Administrator.  Porcupine  Carragana  Union 
Hospital,  Box  70,  Porcupine  Plain.  Saskatchewan,  SOE  1H0 


UNITED  STATES 


UNITED  STATES 


TEXAS  wants  you!  If  you  are  an  RN.  experienced  or 
a  recent  graduate,  come  to  Corpus  Christi,  Sparkling 
City  by  the  Sea'.  .  a  city  building  for  a  better 
future,  where  your  opportunities  for  recreation  and 
studies  are  limitless.  Memorial  Medical  Center,  500- 
bed,  general,  teaching  hospital  encourages  career 
advancement  and  provides  in-service  orientation. 
Salary  from  $682.00  to  $940.00  per  month,  com- 
mensurate with  education  and  experience  Differential 
for  evening  shifts,  available.  Benefits  include  holi- 
days, sick  leave,  vacations,  paid  hospitalization, 
health,  life  insurance,  pension  program.  Become  a 
vital  part  of  a  modern,  up-to-date  hospital,  write  or 
call  collect:  John  W-  Gover.  Jr..  Director  of  Per- 
sonnel, Memorial  Medical  Center.  P.O.  Box  5280. 
Corpus  Christi,  Texas,  78405. 


o 

A 


6 


AB 


WE  NEED  ALL  TYPES 


BE  A  REGULAR  BLOOD  DOHOR 


GRANDE  PRAIRIE  HEALTH  UNIT 

requires  a 

NURSE 


For  general  public  health  nursing  to  work  out  of 
Spirit  River  Sub-Office.  Minimum  qualifications 
R.N.  (P.H.N,  or  B.SC.  preferred).  Annual  salary 
range  $10,800  —  $15,480.  Starting  salary  de- 
pendent on  qualifications  and  experience 
Generous  fringe  benefits. 


Application  tormt  and  turthar  datalls  from: 

GRANDE  PRAIRIE  HEALTH  UNIT 
9640  -  105  Avenue 
GRANDE  PRAIRIE,  Alberta 
T8V  3B5 
Telephone:  532-4441 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from 

REGISTERED  NURSES 

54-bed  accredited  general  hospi- 
tal. Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to: 

Miss  E.LOCKE 

Director  of  Nursing 

Tfie  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  1  CO 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

Staff  nurses  for  St.  Anthony.  New  hospital  of 
150  beds,  accredited.  Active  treatment  in  Surgery. 
Medicine,  Paediatrics,  Obstetrics,  Psychiatry. 
Large  OPD  and  ICU.  Orientation  and  In-Service 
programs,  40-hour  week,  rotating  shifts.  PUBLIC 
HEALTH  has  challenge  of  large  remote  areas. 
Furnished  living  accommodations  supplied  at  low 
cost.  Personnel  benefits  include  liberal  vacation, 
and  sick  leave,  travel  arrangements.  Staff  RN 
$637  —  $809,  prepared  PHN  $71 2  —  $903,  steps 
for  experience. 


Apply  to: 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Anthony,  Newfoundland 

AOK  4S0 


R.N.'s  —  (Jpenings  now  available  in  a  variety  of  areas  of  a  458 
bed  leaching  and  researcti  hospital  affiliated  with  the  school  of 
medicine  of  Case  Western  Reserve  University.  New  facility 
opening  in  the  spring  Personalized  orientation,  excellent  salary, 
full  paid  benefits  and  housing  available  in  hospital  residence. 
Will  assist  you  with  H  1  visa  for  immigration.  A  license  in  Ohio  to 
practice  nursing  is  necessary  for  employment.  For  further 
information  write  or  phone:  Mrs  fvlary  Herrick,  Personnel 
Department,  Saint  Luke  s  Hospital,  11 31 1  Shaker  Blvd..  Cleve- 
land. Ohio.  44104.  Phone:  Monday  -  Friday,  9  A.fyl.  -  4  P.IVI., 
1-2 16-368-7440. 


Summer  1975  Curriculum  Institutes  offered  by  the  Institute  of 
Nursing  Consultants:  Institute  I,  Becoming  an  INSERVICE 
EDUCATOR.  Two  sessions:  I  East.  Key  West  Florida.  June 
16-20.  I  West,  Morro  Bay.  California,  August  18-22,  Institute  II, 
CONCEPTUAL  FRAMEWORK  for  Curriculum  Development, 
Calgary.  Alberta.  Canada,  July  14-18.  Institute  III.  Developing 
LEARNING  MODULES  for  Nursing  Instruction.  San  Francisco. 
California.  August  4-8.  Tuition  for  each  institute  is  $200.00.  The 
all  day  sessions  will  include  a  variety  of  learning  activities:  lec- 
tures, discussions,  small  group  work  and  modules  Institute  fa- 
culty: Em  Olivia  Bevis.  Fay  L.  Bower,  Verle  Waters,  Holly  S, 
Wilson,  For  information  and  registration  write:  F.  Bower,  874 
Miranda  Green,  Palo  Alto,  California,  94306, 


■IT'S  SO  PEACEFUL  IN  THE  COUNTRY"  —  Modern  54-bed 
accredited  general  hospital  (JCAH)  in  lakeside  Florida  town 
(good  fishing,  two  stoplights).  Seeks  R.N.  SUPERVISORS,  R.N, 
STAFF  NURSES,  and  L.P.N, 's.  Send  resume  and  salary 
requirements  to:  Mrs  Gladys  Meyett.  Director  of  Nurses, 
Everglades  Memorial  Hospital,  P.O  Box  659,  Pahokee,  Florida, 
33476.  Telephone  number:  (305)  924-5201. 


LIVERPOOL  HOSPITAL 

NEW  SOUTH  WALES 

AUSTRALIA 

A  230  tjed  hospital  —  expanding  to  334 
beds  In  1975.  Acute  Medical,  Surgical,  Ac- 
cident Trauma,  Maternity,  Paediatrics. 

GENERAL  TRAINED  NURSES 

Liverpool  is  situated  20  miles  from  the  heart 
of  Sydney  in  a  semi  rural  area. 

For  further  Information  write  to: 

(Miss)  J.M.  Grauss  —  MATRON 
Liverpool  District  Hospital, 
P.O.  Box  103, 
LIVERPOOL,  N.S.W. 
AUSTRALIA 


CLINICAL  NURSE  SPECIALIST 


For 


MED-SURG  NURSING 

Required  In  254-Bed 

Active  Care 

General  Hospital 


Qualified  Parties  Apply  to: 

Director  of  Nursing 

Moose  Jaw  Union  Hospital 

Moose  Jaw,  Sasl(. 

(306)692-1841  (Call  Reverse) 


58 


CONSIDERING  MIGRATION? 


WE  WELCOME 

CANADIAN 

REGISTERED 

NURSES! 


Consider  these  points. . . 

•  The  Auckland  climate  is  great 

•  Year-round  outside  activities 

•  Desirably  moderate  pace  of  living 

•  Job  security  with  New  Zealand's  largest  Hospital  Board 

•  Opportunities  for  advancement 

•  Wide  variety  of  specialties 


AND  REMEMBER,  N.Z.  IS  A  WORLD  LEADER  IN  SOCIAL  WELFARE  CONDITIONS 

WRITE  NOW  TO:  Miss  E.M.  MILLAR 
MATRON-IN-CHIEF 
AUCKLAND  HOSPITAL  BOARD 
P.O.  Box  5546 
AUCKLAND 
NEW  ZEALAND 


CANADIAN  NURSE  —  May  1975 


59 


ROYAL  JUBILEE  HOSPITAL 
SCHOOL  OF  NURSING 

requires 

NURSING  INSTRUCTORS 

for 

Medical  Surgical  Nursing 
Pediatric  Nursing 
Psychiatric  Nursing 

Qualifications: 

Baccalaureate  Degree  &  experience,  eligibility  (or 
B.C.  registration. 

Appty  to: 

Director  of  Education  Resources 
Royal  Jubilee  Hospital 
Victoria,  B.C. 
V8R  1J8 


^,oO«  Cq,^^ 


.CSC 


Canadore  College 


Cfe  i    Applied  Arts  and 
Technology 


TEACHER 
DIPLOMA  NURSING 

Responsibilities  will  include  classroom 
and  clinical  teaching  in  the  Diploma 
Nursing  Program. 

Applicants  must  possess  Ontario 
registration,    a  mininnum  of  a  baccalaureate 
degree  in  Nursing  and  a  minimum  of  two 
years  of  nursing  practice. 

Salary  commensurate  with  preparation  and 
experience  within  the  C.   S.  A.    O. 
agreement. 

Duties  to  commence  in  August,    1975. 

Applications,    stating  qualifications, 
experience,    references  and  other  pertinent 
information  should  be  addressed  to: 
Personnel  Officer,    Canadore  College  of 
Applied  Arts  and  Technology.  P.  O.    Box 
5001,    North  Bay,    Ontario.     PI  B  8K9 


DIRECTOR 

of 
NURSING 


Applications  are  invited  for  the  position  ot  Director  of  Nurs- 
ing in  a  fully  acaedited  50-bed  Acute  Care  Hospital  lo- 
cated in  the  beautiful  East  Kootenay  Industrial  and  Recre- 
ational area  of  Bntish  Columtxa. 
Successful  applicant  will  be  responsible  for  all  nursing 
services  including  In-Service  Education. 
Minimum  qualifications  include  registration  or  eligibility  for 
registration  in  the  Province  of  Bntish  Columbia.  Previous 
training  and  expenence  in  a  senior  nursing  position  is 
required. 
Position  available  September  1 ,  1 975 

PiBaaa  apply  In  writing  to: 

ADMINISTRATOR 
KImberley  &  District  Hospital 
260  -  4th  Avenue  J 

KImberley,  British  Columbia        ' 
V1A2R6 


OSHAWA  GENERAL  HOSPITAL 

Applications  are  being  accepted  for  the  position 
of: 


NURSING  CO-OROINATOR 
OBSTETRICS/PAEDIATRICS 

Responsibilities  will  include  the  co-ordinating  of  Nursing 
Activities  as  well  as  the  development  and  implementalJon 
o(  innovative,  creative  concepts 
The  successful  applicant  will  possess: 

—  current  Ontario  Registration 

—  post-basic  ctinicai  preparation/experience 

—  administrative  preparation/experience 

Inqukfes  may  be  directed  to: 

Mrs.  J.  Stewart 
Director  of  Nursing 
Oshawa  General  Hospital 
24  Alma  Street 
Oshawa,  Ontario 
L1Q  2B9 


PUBLIC  HEALTH 

NURSING 

SUPERVISOR 


REQUIRED  for  the  Waterloo  Regional 
Health  Unit  by  July  1 ,  1 975.  Preference  will 
be  given  to  holder  of  a  Baccalaureate  de- 
gree and  applicants  should  have  had  sev- 
eral years  experience  in  public  health  nurs- 
ing. APPLICATIONS  with  curriculum  vitae 
should  be  submitted  to: 


DR.  G.P.A.  EVANS 

MEDICAL  OFFICER  OF  HEALTH 

850  KING  ST.  W.,  KITCHENER,  ONT. 


REGISTERED 

NURSES 

Registered   Nurses  required  for  a 
142-bed  General  Hospital  in  Northern 
Manitoba.  St.  Anthony's  General  Hos- 
pital is  a  fully  accredited,  active  treat- 
nnent  Hospital  with  modern  equipment 
and  facilities. 

For  partkulan  apply  to:                                 1 

Personnel  Director 
St.  Anthony's  General  Hospital 

Box  240                          ■ 

The  Pas,  Manitoba               1 
R9A1K4                        1 

GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit. 
Clinical  areas  include:  medicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R.N.A.B.C.  contract: 

SALARY:  $850  —  $1 020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


THE  MAGDALEN  ISLANDS'  LCSC 
(Local  cominunity  sen/ice  Center) 

requires 

OUTPOST  NURSE 

Location:  Health  dispensary  of  lie  d'Entr6e 
(an  Englisti  speaiiiing  community) 

Means  of  transportation: 

Summer  —  boat  (60  min.  from  LCSC 
and  the  Hospital  center) 
Winter  —  plane  or  ski-doo 

Starting  date:  June  1975 

Outpost  allowance:  $780 

Availability  premium:  $2,000 

Appty  to: 

Dorlna  CMraspe 

Director  of  Health  Services 

The  Islands'  LCSC 

(Magdalen  Islands 

Que.  GOB-1B0 

Telephone  no.:  (418)  986-2121 

Local  272 


REGISTERED  NURSES 


Registered  Nurses  required  for  large 
metropolitan  general  hospital. 
Positions  available  in  all  clinical  areas. 
Salary  Range  in  effect  until  December 
31,1975. 

$900.  —  $1,075.  Starting  rate  de- 
pendent on  qualifications  and  experi- 
ence. 


Apply  to: 


Staffing  Officer-Nursing 
Personnel  Department 
Edmonton  General  Hospital 
Edmonton,  Alberta 
T5K  0L4 


«M/         NURSE  CO-ORDINATORS 


Vancouver  Health  Services  are  progressive  — 
so  is  Its  Nursing  Programme 


Nura«  Co-ordinator*  provide  nursing  leadership  in  the  five 
health  unit  areas  of  the  City.  To  meet  the  particular  needs  of  the 
people  in  the  local  community,  they  collalxirate  with  a  large 
professional  and  paraprofessional  staff  to  develop  comprehen- 
sive and  innovative  health  programmes.  As  well,  nurse  co- 
ordinators participate  with  memtjers  of  the  community  and 
workers  from  a  variety  of  health,  social,  educational  and  recrea- 
tional agencies  to  promote  health  care  programmes. 

Nurse  Co-ordlnators  must  have  a  high  level  of  energy,  imagi- 
nation and  flexibility  and  use  skillfully  the  techniques  of  plan- 
ning, consultation,  collaboration  and  team  wori<.  They  must 
welcome  the  challenge  of  responding  to  health  care  needs  and 
the  practice  of  community  health  care  nursing.  They  have  ot)- 
tained  advanced  training  in  community  health  care  already, 
preferably  at  the  master  level  including  courses  in  supervision 
and  administration.  They  have  had  considerable  experience  as 
community  health  nurses  and  some  experience  in  a  supervisory 
or  nurse  clinician  capacity  Nurse  Co-ordinators  must  be  regis- 
tered or  eligible  for  registration  as  memt)ers  of  the  Registered 
Nurses  Association  of  British  Columbia. 


O 
O 

c 

(0 


Salary:  $1243 - 
(1974  rates). 


-  $1492  per  nnonth  plus  literal  fringe  benefits 


o 


All  applications  should  tie  made  on  "Application  for  Employ- 
ment Form  Pers.  35  and  returned,  together  with  a  detailed 
resume,  to  the  Director  of  Personnel  Services,  Second  Floor, 
City  Hall.  453  West  12th  Avenue.  Vancouver,  B.C,  V5Y  1V4. 


MOUNT  ROYAL  COLLEGE 

a  Comnnunlty  College  located  in  Calgary,  Alta, 
invites  applications  for  the  following: 

NURSING 
INSTRUCTOR 

Mount  Royal  College  offers  a  two  year  basic  Nursing  program 
leading  to  an  Associate  Diploma  in  Nursing.  The  college  is  dedica- 
ted to  the  Community  College  philosophy  and  has  an  "open  door" 
policy. 

Quailfications:  Masters  degree  in  Nursing  preferred,  clinical  and 
teaching  experience  with  preparation  in  curriculum  development: 
Baccalaureate  with  considerable  teaching  experience  considered. 
Specialities:  Fundamentals,  pediatrics  or  medical-surgical 
Saiary:  Depending  on  education  and  experience 

from  $12,631  to  $15,955  for  Bachelors 
$15,343  to  $19,063  for  Masters 

for  salary  schedule  up  to  15  August  deduct  $2000 

Appointment  Effective:  August  15,  1975  or  earlier 
Send  Curriculum  Vltae  to: 


F.R.  Fowlow 

Director,  Faculty  of  Sciences 

Mount  Royal  College 

4825  Richard  Road  S.W. 

Calgary,  Alta. 

T3E  6K6 

For  more  particulars, 
telephone  (403)  246-6312 


i 


g 


ul 


THE  JEWISH  GENERAL  HOSPITAL 

Montreal,  Quebec 

invites  applicants  for  the  position  of 


DIRECTOR 
OF  NURSING 


THE  HOSPITAL 

The  Jewish  General  Hospital,  affiliated  with  McGill 
University,  is  a  700  bed  acute  general  Hospital  with  a 
large  out-patient  and  emergency  service. 


THE  POSITION 

The  Director's  responsibilities  will  include:- 

-  Coordination  of  all  nursing  activities  relative 
to  the  delivery  of  health  care. 

-  Direction  of  prograins  of  recruitment  and  in- 
service  education. 

-  Participation  in  the  Hospital's  organizational 
and  operating  structures  as  a  member  of  a 
progressive  administrative  team. 


THE  APPLICANT 

Preference  will  be  given  to  bilingual  applicants  holding 
a  Master's  Degree  in  Nursing,  with  a  proven  record  of 
administrative  leadership.  Qualifications  must  include 
licensure,  or  eligibility  for  licensure  in  the  Province  of 
Quebec. 

The  Director  is  responsible  to  the  Executive  Director 
for  the  total  administration  of  the  Nursing  Department. 

Salary  commensurate  with  training  and  experience. 


Applications  in  writing  stating  qualifications  and  experi- 
ence should  be  forwarded  to:- 

EXECUTIVE  DIRECTOR 

JEWISH  GENERAL  HOSPITAL 

3755  COTE  STE.  CATHERINE  ROAD 

MONTREAL,  QUEBEC  H3T  1E2 


CANADIAN  NURSE  —  May  1975 


61 


CHALLENGING  POSITIONS 

at 

"THE  NEURO" 

CO-ORDINATOR  STAFF  EDUCATION 
HEAD  NURSE 
INTENSIVE  CARE  and 
OPERATING  ROOM  NURSES 


Appfy  to: 


The  Director  of  Nursing 

Montreal  Neurological  Hospital 

3801  University  Street 

Montreal  H3A  2B4 

Quebec,  Canada 


REGISTERED  NURSES 

AND 

NURSING  ASSISTANTS 

required  for 

110-beds  chest  hospital  situated  in  the  beautiful 
Laurentians,  only  a  50  minute  drive  trom 
Montreal.  We  have  excellent  personnel  policies. 
Residence  accommodation  is  available. 
(Quebec  language  requirements  do  not  apply  for 
Canadian  applicants). 

Apply  to: 

Director  of  Nursing 

Mount  Sinai  Hospitai 

P.O.  Box  1000 

Ste.  Agathe  des  Monts,  Quebec 

J8C  3A4 

Telephone  number:  (819)  326-2303 


The  Brome-Missisquol-Perklns 
Hospital 

requires 


REGISTERED 
NURSES 


Please  write  to: 

Director  of  Nursing 
Brome-Mlsslsquoi-Perkins  Hospital 
950  Main  Street 
Cowansvllle,  Quebec 
J2K1K3 


ST.  THOMAS -ELGIN 
GENERAL  HOSPITAL 

Invites  Applications  from 

REGISTERED  NURSES 


To  work  in  our  modern  fully  accredited  400  bed  General 

Hospital  located  in  Soutfiwestern  Ontario. 

We  offer  opportunities  in  medical,  surgical,  paediatric, 

obstetrical  and  geriatric  nursing. 

Our  specialties  include  Coronary  Care,  Intensive  Care 

and  an  active  Emergency  Department. 

Orientation  Program. 

Progressive  Personnel  Policies. 

APPLY  TO: 

Personnel  Office 

St.  Thomas-Elgin  General  Hospital 

St.  Thomas,  Ontario 

N5P  3W2 


Required  for  September  1975 

RESIDENT  R.  N. 
FOR 
BOYS'  BOARDING  SCHOOL 
IN  QUEBEC 


Contact: 


The  Headmaster 
Stanstead  College 
Stanstead,  Quebec 
JOB  3E0 
Telephone:  (819)  876-5612 


UNIVERSITY  OF  OTTAWA 

SCHOOL  OF  NURSING 

FACULTY  OPENINGS 


Positions  available  for  basic  undergraduate  prog- 
ramme in  nursing.  Masters  degree  in  clinical 
nursing  and  successful  experience  required.  Pre- 
ference given  to  candidate  with  medical-surgical 
nursing  (critical  care)  and  community  nursing. 
Salary  commensurate  witfi  preparation. 


Apply  to: 


Dean 

School  of  Nursing 

University  of  Ottawa 

770  King  Edward  Avenue 

Ottawa,  Ontario 

K1N6N5 


R.N.'s  \ 

ENJOY  CHALLENGE! 


Come  work  at  our  30-bed  fully  accredited 
very  active  treatment  hospital.  $900.00 
starting  plus  $20.00  responsibility  allow- 
ance. 


Appllcantt  may  apply  to: 

Director  of  Nursing 

Daysland  General  Hospital 

Daysland,  Alberta 

TOB  1A0 

or  PHONE  COLLECT 

(403)  374-3746 


I 


GENERAL  DUTY 
NURSES 


—  360-bed  acute  general  hospital 

—  personnel  policies  in  accordance  with 
RNABC  Contract 


Direct  Inquiries  to: 

Director  of  Nursing 

Nanaimo  Regional  General  Hospitai 

Nanaimo,  British  Columbia 

V9S  2B7 


i 


DIRECTOR  OF  NURSING 


Director  of  Nursing  required 
for  an  accredited  General  Hospital 
I  07    bed    capac  i  ty . 

Responsibility  includes  organizinu 
and  coordinating  all  activities 
of  the  Department  of  Nursing. 
The  Director  will  be  part  of  the 
senior  management  team.  Previous 
supervisory  and  nursing  adminis- 
tration experience  necessary, 
BScN   desi  r ab I e. 

Excellent  salary:  appropriate 
to    qua  I  i f i ca t i ons  and    experience. 

For    fu  r  ther    de tai  I s    app I y    to: 

Admi  n  i  St  rato  r 

LA  VERENDRYE  HOSPITAL 

FORT  FRANCES,  ONTARIO 

P9A  2B7 


FALOONBRIDGE 


^   NURSE 


A  nurse  is  required  by  Wesfrob  Mines  Limited,  located 
at  Tasu,  Queen  Charlotte  Islands,  British  Columbia. 
Applicants  must  have  at  least  two  years  of  experience, 
preferably  in  the  Emergency  Department  of  a  large 
hospital  or  General  Duty  in  a  small  hospital. 
Salary  $1,100.  per  month  —  Room  and  Board  $2.75 
per  day  or  one  bedroom  apartment  $67.00  per  month. 
Many  other  liberal  fringe  benefits. 
This  is  a  challenging  opportunity.  Qualified  applicants 
are  invited  to  submit  resumes  to: 

C.  L.  Stafford 

Production  Superintendent 
Wesfrob  Mines  Limited 
Tasu,  B.C.  VOT  1X0 


Falconbridge  . .  .a  mining  and  industrial  group  producing  over  20 
products  in  countries  around  the  world. 


NURSES 


Everyone  Is  A  Westerner  At  Heart 

Make  Your  Dream  Come  True 

And  Join  Us 


AT  OUR 

NEW  MEDICAL  SURGICAL  TEACHING  HOSPITAL 

302  BEDS  (SINGLE  ROOMS) 


I  C  U    ecu    R  R 
UNIVERSITY  &  APPLIED  ARTS  CITY 


FAMILY  MEDICINE 
CAPITAL  CITY 


BIG  ENOUGH  FOR  PRIVACY 

SMALL  ENOUGH  FOR  FRIENDS 

WED  LIKE  TO  MEET  YOU 


Myrna  Sinclair 

Personnel  Selection  Officer  (Nursing) 

Plains  Health  Centre 

4500  Wascana  Parkway 

Regina,  Saskatchewan 

Canada  S4S  SW9 

Would  you  please  send  me  Information  regarding  nursing  at  the  Plains  Health  Centre. 

Name     

Address     


Nurses  -  Sunshine  unlimited! 

Medox  International  offers  a  golden  opportunity  to  work  in  Los 
Angeles.  You  should  be  available  after  May  1st  and  willing  to  stay  in 
California  for  6  months  to  one  year.  All  specialties  required,  especially 
ICU,  ecu,  medical/surgical,  dialysis,  newborn  ICU  and  rehabilitation. 

We  will  assist  with  visa,  licensing,  travel  arrangements  and  accom- 
modation. 

If  you'd  like  to  take  advantage  of  this  great  opportunity,  complete  the 
coupon  below  and  return  to  us  immediately  —  we'll  be  in  touch  with 
more  information. 


^ 


Specialty  desired 


Years  experience  in  that  specialty   j 


Citizenship 

Licensed  in  which  province   

Classification  (R.N.,  B.N.,  BScN..  M.S.,  etc.) 

Address   

Telephone  number  (home  and  work)   


a  DRAKE  INTERNATIONAL  company 

CANADA  •  USA  •  UK  •  AUSTRALIA 

i 


Return  this  coupon  to: 

Travelling  Nurse  Co-ordinator,  Medox  Limited,  3  Place  VUle  Marie,  Montreal.  Que. 


THE  CANADIAN  NURSE  —  May  1975 


63 


PROVINCE  OF  NEWFOUNDLAND 

Health  Consultant 

(NURSING) 


Applications  are  invited  for  the  position  of  Health 
Consultant  (Nursing)  with  the  Department  of 
Healtfi,  St.  Jotin's,  Newfoundland.  This  is  a  chal- 
lenging position  which  involves  evaluation  and 
review  of  nursing  services  within  hospitals  and 
other  health  agencies  in  the  Province.  The  suc- 
cessful applicant  will  be  expected  to  advise  and 
assist  senior  officials  of  the  Department  of  Health 
in  developing  policies  relating  to  nursing  and  al- 
lied occupations.  In  addition,  the  successful  ap- 
plicant must  maintain  a  close  liaison  with  nursing 
personnel,  hospital  administrators,  education  di- 
rectors, professional  associations  and  other  pro- 
fessional people  within  the  health  field  in  the  Pro- 
vince. 

Educational  and  axparlence  i^ulrements 

Master's  or  Bachelor's  Degree  in  Nursing  with 
management  experience. 


Salary 

Approved  salary  range  $13,420  ■ 
(presently  under  review) 


$17,070. 


Appllcatlont  thould  be  addn—td  to: 

Director 

Hospital  Services  Division 

Department  of  Health 

Confederation  Building 

St.  John's,  Nfid 

A1C5T7 


DIRECTOR 
OF  NURSING 


Applications  are  invited  for  the  position  of  Nurs- 
ing Director,  at  Leamington  District  Memorial 
Hospital. 

Candidates  should  have  a  baccalaureate  degree 
in  nursing,  a  minimum  of  three  years  supervisory 
experience  and  be  cognizant  of  current  manage- 
ment techniques. 

Responsibilities  will  Include: 

—  Insuring  that  the  hospital  objective  of  in- 
dividualized patient  care  Is  met 

—  developing  all  Nursing  personnel 

—  dlrectlr>g  all  aspects  of  the  nursing  de- 
partment 

—  co-ordinating  the  educatiorwi  programs 
for  diploma  students  and  nursing  assis- 
tant students  affiliated  with  St.  Clair  Col- 
lege of  Applied  Arts  and  Science. 

Leamington  District  Memorial  Hospital  is  an 
Accredited  1 72  bed  active  treatment  hospital  with 
a  30  tied  chronic  care  unit.  Leamington  is  a  pleas- 
ant progressive  residential  community  of  10,000, 
with  complete  recreational  facilities,  located  35 
miles  South  East  of  Windsor. 

Salary  commensurate  with  qualifications  and  ex- 
perience. 

Intansted  applicants  should  send  resume  to: 

Mr.  H.J.  Seckington 
ADMINISTRATOR  ^ 

Leamington  District  Memorial  Hospital 
Leamington  Ontario 
N8H  1N9 


"MEETING  TODAY'S  CHALLENGE  IN  NURSING" 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGIII  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 
Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


I 


INSERVICE 
CO-ORDINATOR 


Required  for  a  1 10  bed  accredited 
hospital. 

Applicants  will  be  responsible  for 
planning,  organizing  and  imple- 
menting an  Inservice  Education 
Program. 

Experience  in  teaching/super- 
vision essential.  B.  Sc.  in  Nursing 
preferred. 


Applications  to: 

Personnel  Department 
Highland  View  Regional  Hospital 
Amherst,  Nova  Scotia 
B4H  1N6 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
ttie  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  In  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound   in   our  clinics  and 

their  numbers  increase  daily  in  our 

Emergency. 

If  you   do   not   like  worl<ing  with 

children   and   with   their   families, 

you  would  not  lil<e  it  here. 

If  you  do  lil<e  children  and  their 
families,  we  would  lil<e  you  on  our 
staff. 

Interested  qualified  applicants 
should  apply  to  the: 

DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108,  Quebec 


\ 


w 


657  bed, accredited. modern, 
well  equipped  General  Hospital, 

rapidly  expanding... 


Saint  John 
General 
^ospitaL  .  ^^  ^^ 

^^  Saint%hn,N.B.. 

General  Staff  I^rses  <^ 
Registered  Nursing  Assistants 


In  all  general  areas:  Medical,  Surgical, 
Pediatrics, Obstetrics,  Chronic  and 
Convalescent,  several  Intensive  Care 
areas  and  Psychiatry. 


^  Active,  progressive  in-service  education  program. 
Special  Attention  to  Orientation. 
Allowance  for  Experience  and  Post  Basic  Preparation 


FOR  FURTHUR  INFORMATION  APPLY  TO 

"PERSONNEL  DIRECTOR 

^aintjohn  General  Hospital 

po  BOX  2000  Saint  John.  New  Brunswick  E2L4L2 


McGILL  UNIVERSITY 


NURSE  RESEARCHER 


PH.D.  PREFERRED 


To  undertake  investigation  in  the  health  care  field  of  prob- 
lems relevant  to  nursing,  health  care,  and  health  care  deliv- 
ery, in  a  new  multi-disciplinary  research  unit.  Preliminary 
study  is  under  way  into  the  development  of  the  expanded 
function  of  nursing  in  new  types  of  health  services,  into  the 
nature  of  family  health  and  health  status,  and  into  the  learn- 
ing of  health  behavior  in  children  —  newborn  to  adolescent. 
Application  will  be  made  for  funding.  Send  letter  of  applica- 
tion and  r6sum6  to: 


RESEARCH  UNIT 
SCHOOL  OF  NURSING 
McGILL  UNIVERSITY 
3506  UNIVERSITY  ST. 
MONTREAL,  QUEBEC 
H3A  2A7 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  287 


O^^ 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


:anadian  nurse  —  May  1975 


DIRECTOR 
OF  NURSING 


Required  September  1 , 1 975,  for  a  modern,  fully-accredited 
147-bed  general  hospital  with  a  medical  staff  of  18  physi- 
cians and  1 6  visiting  specialists.  This  position  reports  directly 
to  the  administrator,  and  is  responsible  for  the  administration 
and  organization  of  all  aspects  of  nursing  service  concerned 
with  patient  care. 

Applicants  must  have  graduated  from  an  accredited  school 
of  nursing,  qualify  for  registration  in  British  Columbia,  and 
have  a  minimum  of  five  years'  nursing  experience  as  an 
instructor  or  supervisor  with  some  experience  or  qualifica- 
tions in  administration.  A  baccalaureate  degree  in  nursing  is 
desirable.  Salary  negotiable. 


Apply  to: 


Administrator 

Prince  Rupert  Regional  Hospital 

1305  Summit  Avenue 

Prince  Rupert,  British  Columbia 

V8J  2A6 


THE  SCARBOROUGH 
GENERAL  HOSPITAL 

invites  applications  from: 
Registered  Nurses  and  Registered  Nursing  Assis- 
tants to  work  in  our  650-bed  active  treatment 
ttospital  and  new  Chronic  Care  Unit. 

We  offer  opportunities  in  Medical,  Surgical.  Paediatric,  and  Obstetrical  nursing. 
Our  specialties  include  a  Burns  and  Plastic  Unit,  Coronary  Care,  Intensive  Care  and 
Neurosurgery  Units  and  an  active  Emergency  Department. 

•  Obstatrlcai  Department  —  participation  In  "Family  centarad"  teaching 
program. 

•  Paediatric  Department  —  participation  In  Play  Therapy  Program. 

•  Orientation  and  on-going  staff  education. 

•  Progreulve  personnel  policies. 

The  hospital  is  located  in  Eastern  Metropolitan  Toronto. 

For  further  information,  write  to: 

The  Director  of  Nursing, 

SCARBOROUGH  GENERAL  HOSPITAL 

3050  Lawrence  Avenue,  East,  Scarborough,  Ontario 


ASSISTANT 

NURSING  DIRECTOR 

OF  SPECIAL  SERVICES 


REQUIREMENTS 

Registered  Nurse  with: 

—  Advanced  preparation 

—  Proven  administrative  ability 

—  A  minimum  of  3  years  experience  in  O.R.  Tecfinique  and  Manage- 
ment 


RESPONSIBILrriES 

—  Planning,  directing  and  controlling  of  activities  for  the  O.B.,  P.A.R.R., 
Cystoscopy  and  Emergency  Departments,  including  educational 
programs. 


Apply 


Recruitment  Officer  —  Nursing 
Employment  Office 
University  of  Alberta  Hospital 
Edmonton,  Alberta  T6G  2B7 


A  NURSING  ALTERNATIVE 

Were  Big  Enough  to  Try  Things  and  Small  Enough  to  Get  Them  Done! 


THE  HOSPfTAL: 

A 1 00  bed  extended  care  and  rehabilitation  centre,  adjacent  to  a  general  hospital,  featuring 
professionally  staffed  and  well  equipped  departments  of  Physiotherapy.  Occupational 
Therapy,  Recreational  Therapy.  Social  Service,  Counselling  and  Pastoral  Care. 

THE  PROFESSIONAL  OPPORTUNITY: 

—  Something  to  Say  About  Decisions  that  Affact  You:  Management  by  Obiectives 
allows  you  to  contribute  your  ideas  about  new  programs,  budget  priorities  and  day  to 
day  problems  at  monthly  nursing  department  meetings. 

—  An  Interdisciplinary  Approach  to  Patient  Care:  Weekly  patient-centered  confer- 
ences and  the  opportunity  to  practice  primary  nursing. 

—  Orientation  and  OrnGoIng  In-Service  Education:  Up  to  three  weeks  pakj  orienta- 
tion time  designed  around  your  indivkjual  needs:  time  off  wrth  pay/or  financial  assis- 
tance to  attend  workshops  and  professional  meetings. 

—  Salary  and  Working  Conditions;  Cun^ent  A. A. R.N.  contract. 

THE  NURSE: 

—  Should  possess  or  be  willing  to  develop  current  knowledge  in  the  areas  of  geriatrics 
and  rehabilitation,  mental  health  and  medical  surgical  nursing;  eligible  for  Alberta 
registration 

—  Should  have  well  devetoped  interpersonal  and  problem- solving  skills:  the  ability  to 
work  with  an  interdisciplinary  team  and  to  provide  leadership  to  non- professional 
workers 

—  Should  see  him  or  herself  as  the  patients  advocate,  and  be  willing  to  assume 
responsibility  for  practicing  in  an  expanded  and  changing  nursing  role. 

THE  CITY: 

—  Lethbridge  is  a  city  of  45,000  with  a  University  and  Community  College,  near  ski  and 
recreation  areas  in  the  Rocky  Mountains. 


SEND  RiSUMi  TO: 


Donna  Lynn  Smith, 
Director  of  Nursing, 
Lethbridge  Auxiliary  Hospital, 
Lethbridge,  Alberta. 


DIRECTOR 
OF  NURSING 


Applications  are  invited  for  the  position  of  DIRECTOR  OF 
NURSING  for  this  progressive  general  hospital.  Bed  com- 
plement of  31 3-beds  is  made  up  of  21 3  active  treatment  and 
1 00  chronic  beds  with  an  active  rehabilitation  program. 


The  Hospital  is  affiliated  as  base  hospital  for  a  community 
college  School  of  Nursing  and  provides  other  services  on  a 
district  level.  Outpatient  Psychiatric  Day  Care  Program  is 
offered. 


Stratford  is  a  pleasant  city  of  25,000  located  ninety  miles 
from  Toronto,  forty  miles  from  London  and  twenty  six  miles 
from  Kitchener. 


This  position  will  be  available  1  September,  1975. 


Please  direct  correspondence,  In  confidence  to: 

The  Executive  Director 
Stratford  General  Hospital 
Stratford,  Ontario 
N5A  2Y6 


BRANDON  GENERAL  HOSPITAL 
SCHOOL  OF  NURSING 

For 

TWO-YEAR  DIPLOMA  PROGRAM 

POSITIONS  AVAILABLE  AUGUST  1975 

IN 

NURSING  CONTENT  AREAS 

Of 

"FUNDAMENTALS"  —  "MATERNAL  —  CHILD" 
"MEDICAL-SURGICAL"  —  "PSYCHIATRIC  NURSING" 


QUAUFCATIONS: 

Baccalaureate  Degree  in  Nursing  is  required. 

Preference  given  to  applicants  with  experience  in  Nursing  and 

Teaching. 

Apply  In  writing  staling  qualHIcatlons,  sxpwfence,  r»ferenc«s  to: 

Director  of  Personnel 

BRANDON  GENERAL  HOSPITAL 

150  McTavish  Avenue  East 

Brandon,  Manitoba 

R7A  2B3 


if  Paris  appeals  to  you  . . . 


. .  .so  will  Montreal 


•  modern  700  bed  non-sectarian  hospital 

•  excellent  personnel  policies 

•  Registered  Nurses  and  Nursing  Assistants 
are  asl<ed  to  apply 


•  active  In-Service  Education  program 

•  bursaries  available 

•  Quebec  language  requirements  do  not 
apply  to  Canadian  applicants 


Director,  Nursing  Service 
Jewish  General  Hospital 
3755  cote  ste.  Catherine  Road 
Montreal,  Quebec  H3T  1E2 


S  CANADIAN  NURSE  —  Mav  '975 


67 


THE  REGIONAL  MUNICIPALITY  OF  PEEL 

DIRECTOR  OF  NURSES 

THE  REGIONAL  MUNICIPALITY  OF  PEEL  is  seeking  a  fulty  experienced  profes- 
sional to  head  up  their  Public  Health  Nursing  functions. 

ReponingtotheMedicalOfficerof  Health,  the  Director  of  Nurses  will  be  responsible 
for  directing  a  broad  range  of  policies  and  programs  for  a  growing  work  force. 

Priorcties  identified  by  Regional  Management  include: 

•  Adding  specialists  with  responsibility  for  their  training,  development  and 
performance. 

•  Providing  the  leadership  and  organizational  skill  required  to  provide  a  diver- 
sity of  staff  functions  and  related  programs. 

•  Capacity  for  understanding  community  Public  Health. 

•  Applying  the  administrative  skills  required  for  the  satisfactory  performance 
of  the  PuWic  Health  Nursing  operation. 

Considerable  past  proven  Public  Health  administrative  experience  is  required,  prefer- 
ence will  be  given  to  candidates  with  a  degree  in  Masters  of  Science  ol  Nursing. 

This  very  challenging  position  is  based  in  Mississauga  (adjacent  to  Metropolitan 
Toronto)  with  a  Regional  populatksn  of  325,000  persons. 

Interested  appficants  are  invited  to  repfy  m  confidence  giving  detals  of  their  experi- 
ence, accomplishments,  qualifications  and  current  salary,  to: 

Director  of  Personnel, 

THE    REGIONAL    MUNICIPALITY 
OF  PEEL, 

150  Central  Park  Drive, 

BRAMALEA, 

Ontario. 

L6T2V1. 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 
Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 
Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


THE  REGIONAL  MUNICIPALITY  OF  PEEL 

SUPERVISOR 

PUBLIC  i 

HEALTH  NURSING 


This  position  with  the  REG  lONAL  PUBLIC  HEALTH  UNfT  will  be  of  interest  toqualified 
indivkjuals  with  proven  supervisory  and  administrative  skills. 
Reporting  to  the  Director  of  Nurses,  the  successful  candidate  will  assume  respon- 
sibilities for  the  superviskin  and  direction  of  the  Public  Health  Nursing  teams  and  to 
carry  out  Public  Health  Nursing  programs.  Additional  administrative  and  supervisory 
duties  will  include  determining  and  executing  priorities  in  accordance  with  prescribed 
Public  Health  practices. 

Qualifications  for  this  position  will  include  a  certificate  in  Public  Health  Nursing  or  a 
Bachelor  of  Science  Degree  in  Nursing  with  3-5  years  Public  Health  Nursing  and 
supervisory  and  administrative  experience- 
Remuneration  is  commensurate  with  qualifications  and  experience. 
Interested  applicants  are  invited  to  apply  in  writing  providing  personal  data,  experience 
and  salary  requirements  to: 


PERSONNEL  OFFICER. 

THE    REGIONAL    MUNICIPALITY 
OF  PEEL, 

150  CENTRAL  PARK  DRIVE, 

BRAMALEA, 

ONTARIO. 

L6T2V1. 


RN'S 


The  Royal  Alexandra  Hospital  offers  a  challenging  position 
to  interested  nurses  in  a  new  45  bed  neonatal  intensive  care 
unit  in  a  large  1000  bed  hospital. 

WE  OFFER: 

(1)  A  teaching  full  time  neonatologist. 

(2)  Formal  orientation  and  in-service  programs. 

(3)  Excellent  salaries  ($900.  —  $1075.)  plus  shift  diffe- 
rential. 

(4)  Three  weeks  holidays  after  one  year  employment 
and  many  other  fringe  t>enefits. 

Salary  commensurate  with  experience. 


Send  complete  resume  to: 

Mrs.  R.  Tercler 

Director  of  Nursing  Personnel  Administration 

Nursing  Office 

Royal  Alexandra  Hospital 

10240  Kingsway  Ave.  Edmonton,  Ait)erta 

T5H  3V9 


CLINICAL  NURSING  COORDINATORS 

STANFORD  UNIVERSITY  HOSPITAL 
PALO  ALTO,  CALIFORNIA 

RESPONSIBLE  for  the  delivery  of  nursing 
care  to  patients  within  a  specified 
patient  care  unit  on  a  2't-HOUR  BASIS; 
PERSONNEL  MANAGEMENT,  STAFF  DEVELOPMENT, 
PARTICIPATION  IN  PATIENT  CARE  ACTIVITIES. 

R.N.  with  Master's  Degree  in  Nursing  and 
minimum  of  TWO  YEARS'  NURSING  EXPERIENCE. 
Demonstrated  COMPETENCE  IN  ADMINISTRATION, 
TEACHING  and  CLINICAL  SPECIALTY. 

Current  openings  in  MEDICAL/SURGICAL 
UNITS,  PEDIATRICS,  UROLOGY,  PERINATAL, 
GENERAL  CLINICAL  RESEARCH  CENTER  and 
INTENSIVE  CARE  UNITS. 

OUR  R.N.  RECRUITER  WILL 
BE  VISITING  MAJOR  CITIES 
IN  CANADA  IN  MAY  h   JUNE. 

For  further  information  regarding  TIME  £ 
PLACE  please  CONTACT  the  Personnel  Dept., 
Stanford  University  Hospital,  Stanford, 
CA  S'^BOS.  {h\5)    497-6361.   An  Affirmative 
Action/Equal  Opportunity  Employer. 


FOOTHILLS  HOSPITAL 
Calgary,  Alberta 

Advanced  Neurological- 
Neurosurgical  Nursing 

for 
Graduate  Nurses 

a  five  month  clinical  and 

academic  program 

offered  by 

The  Department  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

(Department  of  Surgery) 

Beginning:  September,  1975 
March,  1976 

Limited  to  8  participants 
Applications  now  being  accepted 

For  further  information,  please  write  to: 

Co-ordinator  of  In-service  Education 

Foothills  Hospital 
1403  29  St.  N.W.    Calgary,  Alberta 
T2N  2T9 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 
teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

1975  Salary  Scale  $1,026.00  —  $1,212.00  per  month  (subject  to  change) 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 
VANCOUVER  GENERAL  HOSPITAL 
855  WEST  12TH  AVE. 
VANCOUVER,  B.C. 


ANADIAN  NURSE  —  May  1975 


89 


NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  for  all  Nursing  Units 
Intensive-Coronary  Care,  Psychiatry,  Med. -Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservice  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries    Reg.  N.  Jan.  1st,  1975  —  915.  —  1,115. 
April  1st,  1975  —  945.  —  1,145. 

R.N.A.  Jan.  1st,  1975  —  686.  —  728. 
July  1st,  1975  —  738.  —  780. 

Contact 
Director  of  Nursing 


R.N.'S 


The  Royal  Alexandra  is  a  friendly  place  to  work;  a  modern 
progressive  1000  bed  teaching  hospital  in  the  "just-right- 
size"  city  of  Edmonton,  Alberta. 

Fully  accredited,  the  Royal  Alexandra  offers  challenging  ex- 
perience, on-going  in-service  programs,  generous  fringe 
benefits  and  competitive  salaries.  All  previous  experience  is 
recognized.  You  may  skate,  ski  and  curl  Inexpensively.  Ed- 
monton is  within  easy  driving  distance  of  many  lakes  where 
you  may  enjoy  the  sunny  Alberta  summer. 


Vacancies  exist  in  most  areas  including  ICU,  O.R.  &  Psy- 
chiatry. 


Salary  Range  for  General  Duty:  $900.  -  $1075. 


For  Information  pf*«««  writu  to: 

Mrs.  R.  Tercier 

Director  of  Nursing  Personnel  Administration 

Nursing  Office 

Royal  Alexandra  Hospital 

10240  Kingsway  Ave. 

EDMONTON,  ALBERTA 

T5H  3V9 


Post-Basic  Course 


In 


PSYCHIATRIC  NURSING 


for 


Registered  Nurses 


currently  licensed  in  Manitoba  or  eligible  to  be  so  licensed 


The  course  is  of  nine  months  duration  and  includes  theory 
and  clinical  experience  in  hospital  and  community  agen- 
cies, as  well  as  four  weeks  nursing  of  the  mentally  retarded. 
Successful  completion  of  the  program  leads  to  eligibility  for 
licensure  with  the  R.P.N. A.M. 


For  further  Information  please  write  no  later  than  June  15/75 
to: 


Director  of  Nursing  Education 

School  of  Nursing 

Box  9600 

Selkirk,  Manitoba,  R1 A  2B5 


REGISTERED   NURSES 

STANFORD   UNIVERSITY   HOSPITAL 
PALO   ALTO,    CALIFORNIA 


624   bed   TEACHING   and 
in    tine  midst   of   an  ou 
CENTER   has    positions 
EXPERIENCED   R.N.    who 
CAREER  ADVANCEMENT    th 
ORIENTATION   and   cent 
EDUCATION.      The   conce 
NURSING    CARE    is    being 
ICU   will    expand    from 
the    near    future.      SPE 
in    this    CRITICAL    CARE 
SPECIALTY   UNITS    Is   gi 


RESEARCH    Faci 1 i ty 
tstanding   MEDICAL 
avai  table    for    the 
is    interested    in 
rough   extensive 
nuous    INSERVICE 
pt   of   PRIMARY 

implemented. 
34    to  59    beds    in 
CIALTY   TRAINING 

area   and  other 
ven. 


OUR   R.N.    RECRUITER   WILL 
BE   VISITING   MAJOR   CITIES 
IN    CANADA    IN    .MAY    &.   JUNE. 

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May  1975 


Abbott  Laboratories  Cover  4 

Canadian  Nurses'  Association 1 

Collier-Macmillan  Canada,  Ltd 9 

Equity  Medical  Supply  Co 46 

G.A.  Hardie  &  Co.,  Ltd 51 

Heelbo  Corporation 16 

Hollister  Limited 56 

ICN  Canada,  Limited 2,  5,  43 

J.B.  Lippincott  Co.  of  Canada,  Ltd.   .  .  .35,  36,  37,  38 

MedoX 50,  63 

The  C.V.  Mosby  Company,  Ltd 48,  49 

Nordic  Pharmaceuticals  Ltd. 15 

Posey  Company 8 

Reeves  Company 10 

P.S.  Ross  &  Partners 56 

W.B.  Saunders  Company  Canada,  Ltd 53 

Seneca  College  of  Applied  Arts  and  Technology   . .  .56 

Smith  &  Nephew,  Ltd 6 

Wesfrob  Mines  Limited 63 

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Advertising  Manager 
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Advertising  Representatives 
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Ardmore,  Penna.  19003 
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this  comprehensive  review  of  modern  surgical  nursing  the  authors 
amine  sequentially  all  the  factors  involved  in  patient  care.  Part 
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George  D.  LeMaitre,  MD.  FACS,  Diplo- 
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Creighton: 

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Phillips  &  Feeney: 

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Reflects  the  modern  concepts  and  methods 
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The 

Canadian 
Nurse 


^^p 


A  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  bv  the  Canadian  Nurses'  Association 


Volume  71,  Number  6 


)une  1975 


4      Letters 

7      News 

40      Names 


43  Dates 

44  Books 

46      Accession  List 


Executive  Director:  Helen  K.  Mussallem  • 
Editor:  Virginia  A.  Lindabury  •  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Dorothy  S. 
Starr  •  Production  Assistant:  Mary  Lou 
Downes  •  Circulation  Manager:  Beryl  Dar- 
ling •  Advertising    Manager:    Ceorgina    Clarke 

•  Subscription  Rates:  Canada:  one  year 
J6.00;  two  years.  $11.00.  Foreign:  one  year. 
$6.50:  two  years.  $12.00.  Single  copies: 
$1.00  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  registration  number  in  a  pro- 
vincial nurses'  association,  where  applicable. 
Not  responsible  for  journals  lost  in  mail  due 
loerrors  in  address. 


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  rale 
MONTREAL.  P.Q.  Permit  No.  10,001. 
50    The    Driveway.    Ottawa.    Ontario.    K2P1E2 

®    Canadian  Nurses'  Association  1975. 


15  Frankly  Speaking  —  Sex  Talk  and  Nursing L.  Besel 

16  Nurses  Can  Help  the  Bereaved  J.  Rogers,  M.L.S.  Vachon 

20      Of  Half  Cods  and  Mortals: 

Aesculapian  Authority B.J.  Kalisch 

27      Preop  Visits  Expand 

the  OR  Nurse's  Role W.S.  Dirksen,  M.G.  Shewchuk 

31       CNA  Annual  Meeting N.  Blais 

36      CNA  Directors  Hold  April  Meetings   N.  Blais 


The  views  expressecJ  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


editorial 

"I  am  sick  to  death  of  being  put  down 
because  I  am  a  product  of  a  two-year 
program."  This  statement,  made  by 
Janet  L.  Westbury  (letters,  p.  5),  sums 
up  the  frustration  felt  by  many  rns  who 
are  either  teaching  in  two-year  nursing 
programs  or  who  Fiave  graduated  from 
such  programs. 

I  understand  their  frustration  and 
sympathize  with  their  predicament. 
They  are  pioneers  of  a  new  system  of 
nursing  education,  and  they  are  not  re- 
ceiving the  support  they  deserve  from 
all  their  colleagues. 

I  believe  that  those  rns  who  are  so 
bitterly  opposed  to  the  two-year  prog- 
ram are  deceiving  themselves.  What 
really  upsets  them  is  that  nursing  edu- 
cation has  moved  out  of  the  hospital 
setting  —  where  most  of  us  were 
trained  —  into  the  general  stream  of 
education.  My  reason  for  this  belief? 
Students  and  graduates  of  three-year 
community  college  programs  are  re- 
ceiving their  share  of  the  same  type  of 
criticism. 

Let's  face  it:  it's  difficult  to  give  up  old 
ways  and  replace  them  with  the  new. 
As  Dr.  Helen  K.  Mussallem  wrote  in  an 
April  1967  editorial  about  changes  in 
education:  "These  changes,  although 
rapid  and  profound,  will  not  come  eas- 
ily. Emotions  will  get  in  the  way.  Can 
we  survive  the  torture  of  watching  the 
new  nurse  emerge  better  equipped  for 
today  and  tomorrow's  health  needs? 
To  hurdle  the  emotional  obstacles, 
submit  to  sincere  self-examination, 
sort  out  the  false  from  the  true  tradi- 
tions in  nursing,  and  then  add  up  the 
pros  and  cons  of  the  newly  emerging 
systems  of  education,  is  to  conclude 
that  it  is  our  responsibility  to  stand 
squarely  behind  the  policies  to  which 
we  have  subscribed. " 

The  objective  of  the  community  col- 
lege program  is  to  prepare  a  nurse  who 
can  handle  a  beginning  staff  nurse 
position  and  who  has,  as  one  nurse 
educator  put  it,  the  basis  in  knowledge 
and  skill  to  acquire  more  refined  skills 
in  the  so-called  'specialty'  areas.  "No 
basic  diploma  program  can,  or  should, 
be  asked  to  claim  more,"  this  same 
educator  said.  And  she  is  correct. 

The  time  has  come  to  stop  our  bick- 
ering. As  Bernice  Donaldson  wrote  in  a 
letter  to  the  editor  in  January  of  this 
year:  "We  must  all  accept  our  respon- 
sibilities as  mentors  to  the  newer 
members  of  our  profession,  and  stop 
expecting  new  graduates  to  function  as 
though  they  have  been  in  active  nurs- 
ing for  5  or  more  years.  It  is  necessary 
to  find  out  what  things  the  students 
have  not  had  a  chance  to  do  and  to  give 
them  the  opportunity  to  do  these  things 
with  interested  guidance,  not  critical 
supervision."  —  V.A.L 


E  CANADIAN  NURSE  —  June  1975 


letters 


Urges  further  education 

1  would  like  to  comment  on  Dorothy 
McFarlane's  letter  concerning  the 
CNJ's  '  all-knowing" ■  image  (Letters, 
March  1975,  p.  7). 

McFarlane  admits  she  "has  chosen 
to  marry ■■  and  that  she  '"wants  to  ex- 
perience the  career  of  a  wife  and 
mother.""  but  then  she  says,  ".  .  .yet 
you.  .  .  make  me  feel  guilty."'  If  she 
feels  guilty,  perhaps  it  is  because  she  is 
negating  her  desires  for  a  nursing 
career.  Her  feelings  that  "nursing  and 
education  are  sliding  past""  would  sup- 
port this. 

It  is  unfortunate  that  McFarlane  sees 
no  way  to  continue  her  nursing  career 
on  apart-time  basis.  1  would  urge  her  to 
explore  all  possible  avenues  for  con- 
tinuing to  develop  her  abilities  in  nurs- 
ing and  in  other  areas.  Perhaps  she 
could  take  one  course  a  year  toward  her 
degree.  The  expense  and  inconveni- 
ence of  baby-sitters  would  be  well 
worth  while  m  terms  of  her  own  per- 
sonal growth  and  satisfaction. 

As  forMcFarlane's  idea  of  including 
articles  on  politics  or  the  arts  in  the 
CNJ.  I  believe  it  is  quite  unnecessary 
and  undesirable.  The  Vancouver  Sym- 
phony Society  keeps  me  up-to-date 
with  happenings  in  the  classical  music 
world.  1  would  no  more  expect  to  dis- 
cuss cardiac  arrest  procedures  at  a 
meeting  there,  than  I  would  expect  to 
read  about  the  role  of  the  music  critic  in 
the  CNJ. 

1  believe  it"s  time  we  stopped  look- 
ing to  any  one  field,  organization,  or 
person,  for  that  matter,  to  fulfill  all  our 
needs.  — Gisele  Fontaine,  LPN,  RN, 
Vancouver,  B.C. 


"I  was  hungry  . .  ." 

After  reading  the  ""letters"  section  of 
the  April  1975  issue  of  The  Canadian 
Nurse,  1  felt  ashamed  that  so  many  of 
my  fellow  nurses  could  unemotionally 
write  off  the  starving  people  of  the 
world.  Blanket  statements,  such  as 
■"Perhaps  these  millions  have  to  starve 
to  make  them  realize  the  need  for  birth 
control.'"  hardly  smack  of  the  Golden 
Rule,  but  sound  more  like  vindication. 
Do  these  people  in  other  countries 
have  to  accept  our  so-called  "ideals"" 
and  values  before  we  extend  the  help- 


ing hand?  Can  we  not  see  that  maybe 
these  people  cherish  their  children  and 
families,  even  though  they  cannot  pro- 
vide for  them  materially?  Do  there  have 
to  be  conditions  attached  to  our  giving 
—  ""Be  like  me,  or  else  I  won"t  help 
you?"' 

The  solution  to  the  world  food  shor- 
tage will  not  come  easily,  and  the  prob- 
lem of  having  food  actually  reach  the 
needy  does  exist.  But  are  we  going  to 
solve  anything  by  throwing  up  our 
hands  in  despair?  How  do  you  think  we 
will  look  in  the  eyes  of  the  world,  let 
alone  in  the  eyes  of  our  Creator? 

At  least  the  "editor"s  note""  and  the 
letter  following  it  left  some  hope.  — 
Janice  Zonneveld.  RN,  Portage  la 
Prairie,  Manitoba. 


Acknowledgments  added 

In  the  last  draft  of  our  article,  '"The 
Case  of  the  Warm  Moist  Compress."" 
which  appeared  in  the  March  1975 
issue,  we  were  remiss  in  omitting  sev- 
eral acknowledgments.  We  would  like 
to  express  our  appreciation  to  Judith 
Hibberd,  who  advised  us  regarding  the 
design  of  the  study,  and  to  Doris  Fran- 
cis, who  performed  the  clinical  proce- 
dures. Without  their  assistance,  the 
study  could  not  have  been 
undertaken.  — Jannice  Moore  and 
Maureen  Weinberg,  Alta. 

Error  corrected 

1  would  like  to  point  out  that  the  re- 
search abstract  printed  on  page  51  of 
the  April  edition  of  The  Canadian 
Nurse  is  not  that  of  Louise  Alcock  but. 
rather,  belongs  to  Denise 
Alcock.  — Denise  Alcock.  Ottawa. 

Our  apologies  —  the  Gremlins  were  at 
work  again!  —  Eds . 


Supports  the  two-year  program 

I  have  yet  to  read  a  convincing  article 
proving  thepoorquality  of  the  two-year 
nursing  programs.  Cathy  Rath  well"  s 
comments  on  the  subject  (Letters,  April 
1975.  p.  8)  show  a  singular  lack  of 
understanding  of  the  needs  of  the  nurse 
upon  graduation. 

First,    nobody    could    argue    that 
■"there  is  no  replacement  for  practical 


experience."'  but  the  type  and  quality 
of  the  experience  is  at  least  as  impor- 
tant, if  not  more  so,  than  the  quantity. 

One  wonders  what  the  "ideal  condi- 
tions" are  to  which  Rathwell  refers, 
when  speaking  of  two  days  per  week  of 
clinical  experience.  There  are  only  two 
"ideal  conditions"  that  are  apparent:  1. 
there  is  a  teacher  present  most  of  the 
time  (I  had  this  too.  though  in  a  some- 
what different  organization);  and  2.  the 
patient  load  is  more  controlled.  1  won- 
der if  Rathwell  believes  that  students 
should  have  less  than  the  best  environ- 
ment in  which  to  learn  —  for  example, 
more  pressure,  more  anxiety.  We  have 
moved,  fortunately,  from  the  era  of 
hands  and  feet  only,  to  that  of  the  total 
nurse,  nursing  a  total  person. 

I  can  defend  easily  a  two-year  pro- 
gram that  does  not  provide  skills  in 
catheterization,  when  trends  show  that 
the  incidence  of  this  particular  proce- 
dure indicates  a  need  to  decrease  em- 
phasis on  it.  It  is  most  certainly  a  com- 
plex skill,  but  there  are  many  other 
skills  in  which  certain  aspects  of  it  are 
learned  —  for  example,  aseptic  techni- 
que, emotional  support,  health  teach- 
ing, and  observation,  to  mention  just  a 
few.  It  is  interesting,  and  perhaps  of 
concern,  that  the  skill  of  catheterization 
is  considered  to  be  a  criterion  of  a 
"good"  nursing  program. 

Rathwell  does  not  comment  on  the 
amount  of  learning  required  by  todays 
basic  diploma  nursing  student.  Two 
years  of  1 0  or  II  months  each  is  a  short 
time  in  which  to  learn  what  is  required 
of  her.  Yet,  following  graduation, 
these  graduates  show  themselves  quite 
able  to  function  at  a  beginning  level. 

Rathwell  does  not  comment  on  the 
need  for  a  change  in  the  expectations  of 
employers  for  these  new  graduates. 
Many  employers  have  "seen  the 
light,"  and  are  realizing  that  the  effi- 
cient, fast-moving  nurses  of  my  genera- 
tion are  not  the  models  for  today's  new 
nurses.  The  nurse  who  buries  herself  in 
procedure,  policy,  and  bureaucratic  or- 
gies is  abdicating  her  responsibility  to 
be  a  decision-making  member  of  the 
health  team. 

Many  years  ago,  one  writer  talked 
about  "high  visibility  and  low  visibility 
nursing."  It  is  rather  frightening  to 
realize  that  many  of  our  nursing  leaders 


still  believe  that  a  nui^e  must  be  seen  to 
be  busy,  and  that  leadership  in  nursing 
care  should  come  from  ourmedical  col- 
leagues. 

When  we  acknowledge  our  place  as 
educated  members  of  the  health  profes- 
sions, perhaps  we  can  improve  our 
self-image  and  gain  the  respect  of  the 
public.  —  Patricia  McMeekan, 
B.Sc.N..  M.  Ed.,  Sheridan  College 
School  of  Nursing,  Mississauga.  Ont. 

I  would  like  to  respond  to  Cathy 
Rathwell's  letter,  and  I  would  hope  that 
many  of  my  former  classmates  and 
other  R.Ns  of  2-year  programs  would 
also.  No  one  is  going  to  defend  us  if  we 
don't  defend  ourselves. 

I  am  sick  to  death  of  being  put  down 
because  I  am  a  product  of  a  2-year  pro- 
gram. Some  hospitals  do  not  want  2-year 
nurses  because  bt  a  previous  expen- 
ence  with  a  graduate  of  such  a  program, 
but  do  they  ever  count  up  the  number  of 
situations  with  3-year  nurses'? 

I  agree  there  are  both  good  and  had 
products  of  both  programs,  as  well  as 
good  and  bad  teaching  methods.  Most 
of  us  are  as  well  qualified  and  know- 
ledgeable about  nursing  care  as  any 
other  RN.  We  just  need  the  opportunity 
and  experience  to  prove  ourselves. 
After  all,  2-year  programs  are  rela- 
tively young. 

I  have  worked  with  new  graduates  of 
both  types  of  programs  and  found  little 
difference  in  performance  at  the  same 
level.  Experience  goes  along  with  good 
perfomiance.  so  please  remember  we 
all  started  at  the  same  place. 

The  2-year  program  puts  a  lot  of  re- 
sponsibility on  the  student.  The  instruc- 
tors feel  if  a  person  is  not  responsible  as 
a  student,  she  certainly  will  not  be  any 
more  responsible  on  graduation.  There- 
fore, if  you  wanted  to  be  a  good  nurse, 
you  had  to  work  at  it  while  you  were  a 
student.  We  were  taught  all  the  princi- 
ples of  nursing,  and  from  those  we 
should  be  able  to  carry  out  good  nursing 
care  and  be  responsible  for  our  uork. 

1  believe  that  1  received  adequate 
practical  experience  during  my  educa- 
tion. We  worked  in  all  clinical  areas, 
and  our  training  was  not  limited  to  one 
hospital.  We  also  had  practical  experi- 
ence in  nursing  homes  and  sanitoriums. 


It  was  our  own  responsibility  to  see  that 
we  had  done  as  many  procedures,  such 
as  catheterizations,  suctioning,  etc.,  as 
the  situation  provided. 

As  for  confidence  upon  graduation,  I 
believe  that  any  RN  (2-  or  3-year  prog- 
ram) is  nervous,  frightened,  and  lack- 
ing in  confidence  the  first  day  of  work 
in  a  new  situation.  Once  you  become 
familiar  with  the  new  setting,  you  cer- 
tainly relax  and  gain  confidence.  If awy 
RN.  whether  a  graduate  of  a  2-  or  3-year 
program,  can  state  that  she  had  com- 
plete confidence  on  graduation,  then  1 
say  —  congratulations!  You"ve  done 
belter  than  most  of  us. 

As  for  patients"  complaints:  I  have 
had  few  patients  complain  about  me  or 
my  nursing  care  merely  because  1  am  a 
product  of  a  2-year  program.  In  five 
years  as  an  RN,  1  have  had  only  one 
person  refuse  to  have  me  as  her  nurse. 
She  had  already  formed  a  stereotyped 
idea  of  2-year  nurses  from  gossip  she 
had  heard  from  RNs  in  the  unit. 

I  feel  as  able  and  as  qualified  as  any 
other  RN,  both  because  of  my  training 
and  of  my  experience  in  many  areas  of 
nursing.  I  have  never  had  any  serious 
complaints  about  my  ability  as  a  nurse 
from  my  superiors.  With  my  experi- 
ence, 1  hope  I  have  worked  to  improve 
myself  both  as  a  nurse  and  a  person.  I 
hope  all  other  RNs  will  do  the  same. — 
Janet  L.  Westbur\,  R.N.,  Trail,  B.C. 


As  a  nurse  educator,  I  feel  obliged  to 
respond  to  the  letter  written  by  Cathy 
Rathwell. 

Certainly  the  2-year  program  is  not 
without  its'shortcomings.  Many  of  the 
programs  have  experienced  growing 
pains,  especially  since  nursing  educa- 
tion has  moved  into  the  stream  of  gen- 
eral education.  However,  after  reading 
the  last  paragraph.  I  became  quite  agi- 
tated. Rathwell  asks:  ""How  can  these 
educators  defend  their  2-year  programs 
when.  .  .  some  of  these  RNs  have  never 
catheterized  a  patient,  have  given  only 
a  few  needles,  have  never  suctioned  a 
tracheotomy,  and  so  on.  .  .?" 

I  would  like  to  comment  on  this  by 
making  a  few  statements  and  raising  a 
few  questions. 
D  Since  when  is  nursing  just  skills? 


n  How  many  times  do  you  have  to  per- 
form a  skill  to  gain  proficiency  or  con- 
fidence? Indeed,  what  is  proficiency, 
and  how  long  does  it  take  to  achieve 
confidence?  (Is  feeling  confident  some- 
thing we  should  standardize?)  A 
graduate  from  a  3-year  program  may 
have  suctioned  a  patient  with  a 
tracheotomy  20  times  as  a  student. 
However,  if  she  is  not  put  in  that  posi- 
tion for  several  years.  1  challenge  her  to 
do  it  with  the  same  degree  of  profi- 
ciency and  confidence.  The  fact  is. 
does  she  remember  her  anatomy  and 
physiology  and  her  principles  of  asep- 
tis? 

n  A  3- ,  4- ,  6- ,  or  1 0-year  nursing  pro- 
gram will  not  guarantee  that  a  graduate 
will  be  able  to  perform  all  skills  confi- 
dently. In  fact,  a  student  may  have  to 
wait  10  years  for  some  of  these  experi- 
ences. (I'm  still  waiting  to  operate  a 
respirator.) 

n  With  the  increase  in  new  technol- 
ogy, there  are  many  techniques  that  a 
nurse  will  have  to  learn  through  the 
hospital's  inservice  program. 
n  Each  student  is  a  unique  individual. 
What  takes  one  student  two  perfor- 
mances at  a  certain  skill  may  take 
another  student  six.  Do  we  assume  that 
all  students  fall  into  the  latter  category 
and.  therefore,  extend  the  educational 
program? 

n  Regarding  the  matter  of  never  hav- 
ing done  a  catheterization:  I  don't  see 
w  hy  never  having  done  one  should  mar 
a  student's  record  of  nursing  care. 

Does  a  student  have  to  be  used  for 
service?  Does  she  have  to  be  shifted 
around  the  hospital  to  do  those  services 
that  no  one  else  wants?  Does  she  have 
to  staff  the  midnight  shift  for  months  to 
gain  proficiency  in  giving  backrubs?  If 
this  is  what  is  needed  to  produce  confi- 
dence and  proficiency,  then  Rathwell  is 
right,  and  our  present  programs  — 
where  the  students'  education  gets  pri- 
ority and  where  each  student  is  taught 
the  ability  to  problem-solve  and  to  care 
for  the  total  patient  —  are  all  wrong. 

If  schools  were  concerned  with  turn- 
ing out  nurses  who  just  ""did  things," 
then  maybe  our  whole  concept  of  health 
care  should  be  changed.  Maybe  we 
could  just  graduate  well-disciplined 
morons  who  could  ""do  things"  in  the 
(Continued  on  page  6) 


THE  CANADIAN  NURSE  —  June  1975 


't  ■ 


letters 

(Continued  from  page  5) 


hospital.  It  could  be  done,  but  is  this 
what  we  want?  — Catherine  Primeau, 
Toronto,  Ont. 

I  feel  1  must  answer  Cathy  Rathwell's 
letter  (April  1975,  p. 8).  She  says  she 
has  yet  to  read  a  convincing  article  on 
the  merits  of  a  2-year  program  of  nurs- 
ing education.  Why  doesn't  she  look 
for  a  nurse  who  graduated  from  one?  It 
will  probably  take  a  graduate  from  such 
a  program  to  help  her  change  her  mind. 
No  amount  of  reading  will  help.  Give 
the  graduate  a  chance! 

Of  course  Rathwell  thinks  the  hospi- 
tal-based program  is  better — she 
graduated  from  one.  Many  of  the  new 
nursing  programs  teach  nurses  to  ask 
'"why"  and  not  just  "do";  they  prepare 
them  to  learn,  and  they  stimulate  and 
encourage  the  student  to  continue  learn- 
ing after  graduation. 

Making  600  beds  will  not  make  one  a 
better  nurse.  You  move  so  fast  you 
don't  have  time  to  listen  to  a  patient  — 
but  boy  are  your  beds  neat!  Also,  one 
doesn't  need  to  be  a  workhorse  in  a 
hospital  for  3  years  to  learn  how  to 
catheterize  a  patient. 

The  graduates  from  the  new  pro- 
grams have  a  better  education  and  more 
basic  knowledge.  With  that,  plus  a  little 
time,  understanding,  and  help  from  ex- 
perienced staff —  and,  most  important, 
the  will  and  want  to  nurse  —  these 
graduates  will  pull  through. 

No,  I  didn't  graduate  from  a  2-year 
program.  1  graduated  from  a  3-year 
CEGEP  program.  It  is  not  the  same,  but 
the  arguments  Rathwell  gives  are  the 
ones  I'm  sick  of  hearing. 

We  didn't  choose  to  enter  the  new 
nursing  programs,  and  arrogant  al- 
titudes like  Rathwell's  do  not  help  our 
learning  experience  at  the  hospital.  Ul- 
timately, the  patient  suffers  — Donna 
Burgess,  R\.  Montreal,  Quebec. 

Warm  compress  becomes  hot  issue 

The  article  on  "The  Case  of  the  Warm 
Moist  Compress'  (March  1975)  has  a 
valid  message. 

Fortunately,  I  am  employed  in  a  hos- 
pital that  has  a  "products  committee," 
whose  members  sleuth  not  only  pro- 
ducts, but  also  their  value  to  the  patient . 

It  is  beyond  me  that  two  "lettered" 
ladies  would  perform  such  a  detailed 
investigation  of  two  compresses,  with 
two  thermometers  and  a  stop  watch, 
and  ignore  their  physiological  worth  to 
the  consumer  of  the  product.  It  further 
escapes  me  how  this  article  was  ac- 
cepted for  publication,  let  alone  merit 
feature  article,  cover  story,  and  editor- 


ial recognition  in  the  magazine. 

File  it  under  Useless  Information. 
F.  Thibeau,  RN,  Victoria,  B.C. 


The  authors  reply: 

F.  Thibeau  is  to  be  commended  for  her 
concern  over  the  "physiological  worth 
to  the  consumer"  of  products  used  by 
nurses.  Unfortunately,  she  appears  to 
have  missed  the  main  point  of  the  arti- 
cle. While  it  is  true  that  we  omitted  the 
measurement  of  physiological  impact 
on  the  patient  and  stated  that  this  was  a 
limitation  of  our  study,  such  measure- 
ment was  not  our  purpose  and  would 
have  required  more  resources  and  ex- 
pertise than  were  available  to  us. 

However,  we  did  review  previous 
research  that  indicated  the  temperature 
and  duration  of  compres.ses  which  are 
considered  to  have  the  most  beneficial 
effect  on  the  patient.  The  focus  of  our 
study  was  to  determine  which  compress 
best  met  these  criteria  of  effectiveness. 

If  Thibeau  will  carefully  considerthe 
section  titled  "discussion,"  she  should 
realize  that  her  concern  regarding  the 
value  of  the  procedure  to  the  patient 
was  indeed  our  major  concern  as 
well.  —  Jannice  Moore,  and  Maureen 
Weinberg. 


Reader  is  against  abortion 

I  wish  to  offer  a  suggestion  that  may 
help  the  campaign  of  those  who  are 
against  abortion. 

Hundred  of  sterile  couples  in  Quebec 
cannot  adopt  children  because  the  or- 
phanages are  empty.  Other  couples 
wait  up  to  5  years  to  adopt  a  baby. 

I'd  like  to  tell  those  women  who 
want  an  abortion  that  we  do  not  really 
believe  them  when  they  say  it  is  in  the 
baby's  interest,  because  the  waiting  list 
at  adoption  centers  proves  that  there  are 
many  couples  who  can  offer  these  in- 
fants the  security  of  a  good  home  as 
well  as  their  love.  These  unwanted 
babies  are  a  last  hope  for  couples  for 
whom  science  has  nothing  to  offer. 

Perhaps  women  who  want  an  abor- 
tion should  be  reminded  that  childless 
couples  have  neither  requested  nor  de- 


Registered  Nurses 

Your  community  needs  the  benefit 
of  your  skills  and  experience.  Volun 
teer  now  to  teach  Patient  Care  in 
The  Home  and  Child  Care  in  The 
Horne  Courses. 

contact    .  ' 


served  sterility  any  more  than  the  new- 
born child  has  asked  for  life.  If  brought 
together,  they  could  be  happy. 

If  their  bodies  "belong  to  them- 
selves," as  these  women  claim,  then, 
according  to  their  theory,  the  body  of 
the  child  belongs  to  the  child.  Hence, 
they  do  not  have  the  right  to  destroy  the  I 
child,  knowing  that  it  has  a  good 
chance  to  be  happy  if  given  to  a  child- 
less couple. 

These  women  ought  to  understand 
that,  if  they  are  granted  abortion  on 
demand,  thousands  of  others  are  being 
denied  the  privilege  of  loving  and 
educating  children  that  they  can  have 
only  through  others. 

Please  let  us  liberate  sterile  women 
also,  by  giving  them  the  unwanted 
children  of  others,  instead  of  having 
them  [  the  children  ]  killed.  — 
Madeleine  Cote,  Quebec. 


Hemoglobinometer  gets  new  role 

I  recently  read  your  most  interesting 
article  on  nursing  in  the  Canadian 
north.  On  page  23  there  is  a  picture  of  a 
nurse  "examining  the  eyes  of  an  old 
Indian  woman."  If  I  am  not  mistaken, 
the  machine  she  is  using  is  a  Spencer 
hemoglobinometer. 

The  nurse  had  probably  done  a 
hemoglobin  on  this  woman  and  was 
showing  her  how  she  had  matched  the 
colors  on  the  machine. 

I  enjoy  reading  your  magazine  very 
much  and  find  it  interesting.  —  7. 
Kushner,  Student,  1st  year  diploma 
nursing  program.  Red  River  Commun- 
ity College,  Winnipeg,  Manitoba. 

We  read  with  interest  the  article  "The 
Nurses  of  Brochet"  (April  1975).  The 
picture  of  Christine  Johnson  examining 
the  eyes  of  an  elderly  woman  also  in- 
terests us.  We  are  wondering  how  she 
managed  to  do  it  with  a  hemo- 
globinometer, an  instrument  we  use 
every  day  to  measure  the  hemoglobin 
of  our  patients.  —  Betty  Yake,  RN. 
Cheryl  Fatteicher,  RN.  Staff  nurses, 
Dept.  of  General  Practice,  University 
ofSask..  Saskatoon,  Sask. 

We  wonder,  too.  Obviously  it  is  our 
exes  that  need  to  be  examined.  —  Eds. 


I  can't  quit  now 

Since  reading  and  rereading  Carolyn 
Klute's  moving  ordeal,  "I  Can't  Quit 
Now"  (March  1975),  my  faith  [in  The 
Canadian  Nurse  ]  and  my  subscription 
have  been  renewed! — Donna  Grey 
RN,  BN,  Montreal,  Quebec. 


news 


British  Nurses  Withdraw  From  ICN 
On  "Yes"  Vote  By  .01%  Of  Members 

London,  England  —  At  a  special  general  assembly  on  16  April  1975,  .01%  of  the 
members  of  the  Royal  College  of  Nursing  (Ren)  and  National  Council  of  Nurses 
carried  the  vote  in  favor  of  withdrawal  from  the  International  Council  of  Nurses 
(ICN),  effective  31  December  1975.  The  ICN  has  been  officially  notified  of  the 
British  nursing  organization's  decision  to  sever  ties  with  the  international  nursing 
bod  v. 


The  decision  in  favor  of  withdrawal 
was  carried  by  a  narrow  margin  of  194 
votes.  Only  796  of  some  42,000  mem- 
bers of  the  Ren  exercised  their  right  to 
vote:  of  this  number.  495  voted  in  favor 
of  withdrawal,  and  301  against  it.  All 
Ren  members  were  eligible  to  vote  in 
person  or  by  proxy  at  the  meeting. 

The  special  meeting  was  called  by 
the  Royal  College  of  Nursing's  board 
of  directors  to  request  withdrawal  from 
the  international  organization  of 
nurses.  The  Ren  contends  that  ICN  ob- 
jectives are  not  realistic  and  are  not  in 
Iceeping  with  present-day  needs. 
(News.  April  1975,  page  II.) 

According  to  ICN  President  Dorothy 
Cornelius,  U.S.A..  the  Ren  decision  is 
regrettable  because  the  support  of  the 
United  Kingdom  nurses  for  the  ICN  and 
for  other  countries  has  always  been  an 
important  consideration. 

"The  ICN  was  founded  by  an  English 
nurse,  and  the  United  Kingdom  has 
provided  leaders  in  the  organization, "" 
Cornelius  said  in  a  telephone  interview 
with  the  CNA  journals.  She  does  not 
believe  that  the  Ren  decision  spells  the 
end  of  the  ICN,  however.  "The  interna- 
tional body's  role  becomes  increas- 
ingly important  from  yearto  year."  she 
said. 

The  ICN  president  said  that  she  could 
not  predict  whether  the  question  of  the 
Ren  withdrawal  would  be  on  the  agenda 
when  the  iCN's  Council  of  National 
Representatives  meets  in  Singapore  in 
August. 

Helen  K.  Mussallem.  executive  di- 
rector of  the  Canadian  Nurses'  Associa- 
tion, also  expressed  deep  regret  at  the 
decision  of  Ren  to  withdraw  from  the 
International  Council  of  Nurses. 
"Since  the  founding  of  ICN.  the  United 
Kingdom  has  provided  a  high  caliber  of 
leadership  and  has  played  a  unique  role 


as  a  stabilizing  force  during  times  of 
stress."  Mussallem  said. 

At  its  meeting  in  April  1975.  the  CNA 
board  of  directors  affirmed  its  intention 
of  maintaining  Canadian  membership 
in  the  International  Council  of  Nurses. 
Mussallem  stated  that  CNA  has  no  inten- 
tion of  withdrawing  its  support  from 
ICN  because  it  is  heavily  committed  to 
aiding  the  work  of  international  organi- 
zations. 

"This  phase  of  the  Association's 
work  is  extremely  important  in  view  of 
contemporary  international  concerns." 
Mussallem  told  the  CNA  journals. 

CNA  directors  asked  CNA  President 
Labeile  to  vote  for  an  increase  in  ICN 
fees,  up  to  100'7f  if  necessary,  when 
finances  are  discussed  at  the  meeting  of 
the  ICN  Council  of  National  Representa- 
tives in  August.  (See  report  of  CNA 
Board  meeting  page  36.) 


CNF  Fees  Raised, 

Board  Reduced 

Ottawa  —  Members  of  the  Canadian 
Nurses'  Foundation  (cnf)  approved 
bylaw  changes  that  raised  the  member- 
ship fee  from  S5  to  SIO.  effective  in 
1 9'76.  and  reduced  the  number  of  mem- 
bers on  the  board  of  directors  and  on  the 
selections  committee.  The  annual 
meeting  was  held  2  April  1975  in  cna 
House. 

The  bylaw  changes,  which  were  re- 
commended by  the  Foundation's  board 
of  directors,  changed  the  board  of  di- 
rectors to  5  members  from  9.  and  re- 
moved the  requirement  for  CNA  rep- 
resentation on  the  CNF  board.  The 
selections  committee  will  have  5  mem- 
bers, instead  of  7;  the  original  recom- 
mendation called  for  3  members,  who 
might  be  chosen  from  the  board  of  di- 


rectors, but  CNF  members  approved  an 
amended  resolution. 

To  save  administrative  expenses,  a 
simplified  procedure  for  processing 
scholarship  applications  was  im- 
plemented in  November  1974.  Helen 
K.  Mussalem,  secretary-treasurer  of 
CNF,  told  members  that  the  resultant 
savings  will  be  apparent  in  1975. 

It  was  reported  to  the  annual  meeting 
that,  at  the  beginning  of  1975.  CNF  and 
some  provincial  associations  carried 
out  a  recruiting  campaign  for  former 
members;  it  produced  424  membership 
renewals.  A  second  campaign,  aimed 
at  former  CNF  scholars,  produced  47 
memberships  from  105  scholars  who 
were  contacted.  Some  members  of  CNF 
expressed  disappointment  at  the 
number  of  scholars  who  did  not  support 
the  Foundation. 

In  1974.  membership  reached  850. 
an  increase  of  6  percent  over  1973.  Dr. 
Mussallem  reported  that  total  revenue 
was  approximately  S6 1,000.  of  which 
54.4%  came  from  6  provincial  associa- 
tions: Alberta,  Saskatchewan.  Man- 
itoba. New  Brunswick.  Nova  Scotia, 
and  Prince  Edward  Island. 

The  annual  meeting  heard  that  4 
nurses  were  awarded  a  total  of  SI  3.500 
in  scholarships  in  1974-75.  Names  of 
1975-76  scholars  will  be  published  in 
the  near  future. 


U.  of  A.  Hospital  Offers 
Nursing  Scholarship 

Edmonton.  Aha.  —  The  University  of 
Alberta  Hospital  board  will  award  a 
SI. 000  nursing  scholarship  annually, 
in  recognition  of  the  50th  anniversary 
of  the  University  of  Alberta  schools  of 
nursing. 

The  scholarship  will  be  awarded  to  a 
graduate  of  the  University  of  Alberta 
Hospital  who  has  been  accepted  by  a 
recognized  university  for  advanced 
study  relevant  to  nursing:  it  may  be 
used  for  full-time  study  at  the  bac- 
calaureate, master's  or  doctoral  level. 

Applications  must  be  submitted  to: 
Assistant  Executive  Director  —  Nurs- 
ing. University  of  Alberta  Hospital, 
Edmonton,  Alta.,  T6G  2B7,  on  or  be- 
fore 1  July  each  year. 

(Continued  on  page  8) 


news 


(Continued  from  page  7) 


Pay  Parity  Will  Be  Short-lived: 
Federal  Nurses  Are  Dismayed 

Ottawa  —  A  conciliation  board  report  supported  the  concept  of  wage  parity  for 
federal  nurses  with  their  provincial  counterparts,  but  "any  gains  in  this  direction 
will  disappear  almost  immediately,"  according  to  federally  employed  nurses. 

"We're  behind  practically  before  we  get  started," "  Ruth  Sear,  past-president  of 
the  nursing  group  told  The  Canadian  Nurse.  The  federal  nurses'  contract  covers  a 
2-year  period  ending  December  1 976;  negotiations  for  nurses'  contracts  in  several 
provinces  are  in  process  or  will  soon  begin,  while  the  federal  nurses  are  "locked  in 
for  2  years,"  Sear  said. 


The  Professional  Institute  of  the  Pub- 
lic Service  of  Canada,  bargaining  agent 
for  nurses  employed  by  the  federal 
government,  received  "with  dismay" 
the  conciliation  board  report  on  25 
April  1975.  Federally  employed  nurses 
not  designated  as  essential  were  in  a 
legal  position  to  strike  7  days  later  — 
Saturday,  3  May  1975. 

Wage  parity  between  nurses  in  the 
federal  public  service  and  hospital 
nurses  in  the  private  or  provincial  sec- 
tor seems  "reasonable  and  fair,"  and 
the  final  offers  made  by  the  Treasury 
Board  "  seem  fair  to  the  members  of  the 
Conciliation  Board,"  the  report  said. 
Members  of  the  3-person  conciliation 
board  were:  Roland  Tremblay,  Q.C., 
chairperson:  Paul  Jolin,  Treasury 
Board  appointee;  and  Helene  Wavroch, 
representing  the  nurses. 

Wavroch  is  president  of  United 
Nurses,  Inc.,  Montreal,  a  professional 
union  of  over  6,000  female  nurses.  She 
agreed  with  the  other  2  members  of  the 
conciliation  board  that  the  Treasury 
Board  offer  was  fair;  however,  some  of 
the  federal  nurses  were  not  happy  with 
the  board's  decisions. 

In  a  report  to  federal  nurses,  dated  28 
April  1975,  Jan  Traynor,  chairperson 
of  the  nursing  group,  said  that  the  con- 
ciliation board's  report  is  inconsistent. 
Although  it  said  that  parity  with  pro- 
vincial salary  rates  is  reasonable  and 
fair,  it  did  not  provide  "an  open  clause 
that  would  permit  the  parties  to  review 
salary  scales  as  new  provincial  rates 
become  established."  Such  an  open 
clause  is  necessary  to  maintain  the  par- 
ity that  "might  be  achieved  in  the  first 
year  of  a  contract  under  the  terms  of  this 
[conciliation  board]  report,"  Traynor 
said. 

In  her  report  to  the  federal  nurses, 
she  said  that  the  conciliation  board's 
report  is  inconsistent  with  support  of 
parity  because  it  also  refuses  to  "take 


into  account  the  deficit  position  of  the 
federal  nurses  prior  to  1975  by  recom- 
mending the  payment  of  a  lump  sum  to 
offset  the  effect"  [of  the  deficit 
position]. 

"It  has  been  calculated  that  during 
1974  federal  nurses  lagged  behind  their 
provincial  counterparts  by  a  total  in  ex- 
cess of  $1  1/4  million.  Despite  its  un- 
dertaking to  negotiate  a  lump  sum  to 
help  offset  this  —  an  undertaking  that 
prompted  the  [Professional]  Institute  to 
enter  into  negotiations  long  before  the 
expiry  of  the  contract  —  Treasury 
Board  has  dismissed  out  of  hand  all 
proposals  to  make  such  payment," 
Traynor  said. 

"The  concept  of  parity  has  been 
completely  disregarded,  because  any 
gains  in  this  direction  will  disappear 
almost  immediately.  The  province  of 
Nova  Scotia  is  currently  bargaining  for 
a  new  collective  agreement  with  its 
nurses  to  be  retroactive  to  1  January 
1975;  Ontario  will  open  negotiations 
shortly  for  a  new  contract  to  become 
effective  1  July  1975. 

"It  is  more  than  likely  that  Saskatch- 
ewan will  bring  its  rates  into  line  with 
Alberta  and  Manitoba  in  the  course  of 
this  year;  Quebec  is  starting  negotia- 
tions for  a  new  contract  at  this  time; 
British  Columbia  has  an  escalator 
clause  by  which  the  cost  of  living  is 
reviewed  each  quarter,  and  salaries  are 
adjusted  accordingly. 

"It  is  obvious  that  in  a  matter  of 
months  the  salaries  of  federal  nurses 
will  be  lagging  behind  once  more," 
Traynor  concluded. 

Negotiations  in  the  current  round  of 
bargaining  between  the  federal  nurses 
and  the  Treasury  Board  began  in  Au- 
gust 1974.  The  Professional  Institute 
indicated  that  it  was  prepared  to  accept 
the  Treasury  Board's  proposal  for 
salaries  under  one  of  two  conditions: 
that  the  contract  should  be  of  1-year' s 


duration,  or  that,  if  a  longer  contract 
were  agreed  on,  it  should  contain  an 
open  clause  that  would  permit  the  par- 
ties to  review  salary  scales  as  new  pro- 
vincial rates  become  established  and  to 
negotiate  with  a  view  to  maintaining 
parity. 

Treasury  Board  rejected  both  alter- 
natives, and  negotiations  for  the 
1975-76  contract  became  deadlocked 
in  December  1974.  In  January  1975, 
some  83%  of  federal  nurses  rejected  the 
contract  proposed  by  Treasury  Board, 
and  the  conciliation  board  hearing  was 
requested.  (News,  March  1975,  page 
10.), 

Some  81%  of  nursing  group  mem- 
bers indicated  their  preference  for  the 
option  of  conciliation/strike  following 
the  use  of  arbitration  in  negotiations  for 
the  1973-74  contract;  the  arbitral  award 
was  made  late  in  1973. 

There  are  approximately  1.900  em- 
ployees in  the  nursing  group  across 
Canada;  most  of  them  are  employed  by 
the  Department  of  Veterans  Affairs, 
Health  and  Welfare  Canada,  and  Na- 
tional Defence.  About  63%  of  these 
nurses  were  designated  "essential" 
(ineligible  to  strike);  100%  of  the 
Canadian  Penitentiary  Service  nurses 
were  designated  in  this  way.  The  nurs- 
ing group  agreed  to  the  designations  as 
a  prerequisite  to  the  appointment  of  a 
conciliation  board  after  1975-76  con- 
tract negotiations  broke  down. 


Nurses'  Threatened  Strike 
Forces  Collective  Agreement 

Winnipeg.  Man.  —  "For  the  third  time 
in  a  little  over  a  year,  a  strike  vote  taken 
by  nurses  has  served  the  intended  pur- 
pose of  forcing  a  collective  agree- 
ment." said  the  Provincial  Staff 
Nurses'  Council,  as  reported  in  Nurs- 
cene.  the  bulletin  of  the  Manitoba  Re- 
gistered Nurses'  Association.  March 
—  April  1975  issue. 

Nurses  at  6  hospitals.  5  in  Winnipeg 
and  one  in  Brandon .  reached  agreement 
with  the  employing  hospitals  only  1 1 
hours  before  a  strike  was  to  begin  on  17 
March  1975. 

The  agreement,  which  extends  over 
a  22-month  period,  gives  salaries  that 
approximate  parity  with  Alberta.  It  in- 
cludes a  clause  to  reopen  wages  on  I 
January  1976,  with  provision  to  reach  a 
settlement  of  that  salary  through  bind- 
ing arbitration  if  necessary. 

(Continued  on  page  10) 


Pampas 


you  both 

abieak 


KeepvS 
lim  drier 

Instead  of  holding 
moisture,  Pampers 
hydrophobic  top  sheet 
allows  it  to  pass 
through  and  get 
"trapped"  in  the 
absorbent  wadding 
underneath.  The  inner 
sheet  stays  drier,  and 
babv's  bottom  stays 
drier  than  it  would  in 
cloth  diapers. 


Saves 
you  time 

Pampers  construction 
helps  prevent  moisture 
from  soaking  through 
and  soiling  linens.  As  a 
result  of  this  superior 
containment,  shirts, 
sheets,  blankets  and 
bed  pads  don't  have  to 
be  changed  as  often 
as  they  would  with 
conventional  cloth 
diapers.  And  when  less 
time  is  spent  changing 
linens,  those  who  take 
care  of  babies  have 
more  time  to  spend  on 
other  tasks. 


PROCTER   «  GAMBLE 


Next  Month 
in 


The 

Canadian 
Nurse 


•  Continuing  Education  For  Nurses 
Should  Be  Voluntary 

•  What  Price  Education? 

•  Cystic  Fibrosis 

•  Histoplasmosis  —  A  Review 

•  Frankly  Speaking: 

About  Nursing  Administration 

•  Multiple  Sclerosis: 
Experiences  of  Alienation 

•  Going  Home  With  C.O.L.D. 
Is  Your  Patient  Ready? 


^ 

^^P 


Photo  Credits 
for  June  1975 


John  Lockyer, 

Dept.  of  Information,  N.W.T. 
p.  12 

Miller  Services, 
Toronto,  Ontario, 
p.  17 

University  of  Alberta  Hospital, 
Edmonton,  Alberta, 
pp.  27,  28,  29 


news 

(Continued  from  page  8) 


Nurses  employed  at  the  hospitals  on 
the  date  of  ratification  of  the  agreement 
will  receive  a  prorated  signing  adjust- 
ment of  $500  for  registered  nurses  and 
$420  for  practical  nurses. 

The  monthly  salaries  negotiated  for 
1975  are:  general  duty  registered  nurse, 
$900  —  $1 ,075;  assistant  head  nurse, 
$970  —  $  1 ,145;  head  nurse  and  teacher 
(nurse  IV),  $1,005  —  $1,225;  head 
nurse  and  teacher  (nurse  V), 
$1,085  — $1,325.  Licensed  practical 
nurses"  salaries  for  1975  are 
$700  —  $840  per  month. 

The  agreement  also  provides  for  a 
5-week  vacation  after  20  years'  em- 
ployment, 10  recognized  holidays  at 
time  and  one-half,  shift  premiums  and 
responsibility  pay  of  20  cents  per  hour 
in  1975  and  25  cents  per  hour  in  1976, 
and  standby  pay  of  $5  per  shift  in  1 975 
and  $6  per  shift  in  1976. 

Two  Male  Nurses  Win 
3M  Nursing  Fellowships 

Geneva,  Switzerland  —  Ibrahima  Lo, 
Senegal,  and  Audun  Tommeras,  Nor- 
way, are  the  two  nurses  to  be  awarded 
the  3M  Nursing  Fellowships  for  1975. 
Selections  committee  for  the  two 
awards  is  composed  of  the  board  of 
directors  of  the  International  Council  of 
Nurses  (ICN). 

The  two  men  will  receive  us  $6,000 
each  to  further  their  studies  in  nursing. 
This  is  the  first  year  that  the  3M  nursing 
fellowship  program  includes  two 
awards  of  $6,000.  The  fellowships, 
administered  by  ICN,  are  sponsored  by 
the  Minnesota  Mining  and  Manufactur- 
ing (3M)  Company. 

Ibrahima  Lo,  who  is  president  of  the 
National  Nurses  Association  of 
Senegal,  plans  to  use  his  award  for 
study  toward  a  master's  degree  in  nurs- 
ing from  the  University  of  Montreal. 
Audun  Tommeras,  who  holds  the  posi- 
tion of  managing  director,  department 
of  nursing  service,  with  the  Norwegian 
Nurses  Association,  will  undertake 
study  in  social  pedagogy  in  his  own 
country. 

A  total  of  45  national  nurses'  associ- 
ations submitted  the  name  of  a  candi- 
date for  the  1975  awards.  Each 
nominee  will  receive  a  $200  national 
prize,  also  awarded  by  the  3M  Com- 
pany. 

The  3M  Fellowship  program  was  in- 
stituted in  1970.  In  1973,  Alice 
Baumgart,  cna's  nominee,  was 
awarded  the  fellowship.  Other  fellow- 
ship  winners    were:    Berenice    King, 


New  Zealand,  1970;  Junko  Kondo, 
Japan,  1971;  Margaret  Dean,  India, 
1972;  and  Irma  Sandoval,  Costa  Rica, 
1974. 

Diploma  Nursing  Teachers 
Hold  Conference  In  N.S. 

Halifax.  N.S.  —  Some  106  nurses 
from  the  faculties  of  all  diploma 
schools  of  nursing  in  Nova  Scotia  at- 
tended a  two  and  one-half  day  confer- 
ence at  the  Nova  Scotia  Hospital  in 
April.  This  was  the  first  gathering  that 
brought  together  nurse  educators  from 
all  over  the  province  to  confer,  to  ex- 
change ideas,  to  learn  from  each  other, 
and,  in  general,  to  get  to  know  one 
another.  Participants  requested  that  it 
become  an  annual  event. 

The  diploma  programs  have  similar 
philosophies,  but  there  is  allowance  for 
flexibility  and  uniqueness  in  operation. 
One  of  the  highlights  of  the  conference 
was  the  exhibit  in  which  each  school 
presented  a  pictorial  display  of  its  pro- 
gram. 

During  2  days  of  formal  agenda,  the 
Victoria  General  Hospital  faculty  pre- 
sented a  paper  on  "integration";  other 
papers  included  "Rationale  of  Clinical 
Experience  Rotations  and  Expectations 
of  Students  at  Each  Level  of  Develop- 
ment," discussed  by  St.  Martha's  Hos- 
pital faculty,  "Approaches  to  Teaching 
and  Learning"  by  Dr.  Burt,  the  Nova 
Scotia  Teachers  College,  and  "Au- 
diovisual Aids  in  Teaching,"  by 
Margaret  Arklie  of  the  Dalhousie 
University  School  of  Nursing. 


Students  Involved  In  1977 
ICN  Congress  In  Tokyo 

Geneva,  Switzerland —  Student  nurses 
attending  the  congress  of  the  Interna- 
tional Council  of  Nurses  (ICN),  to  be 
held  in  Tokyo  in  1977,  will  have  the 
opportunity  to  participate  in  a  special 
student  assembly. 

This  decision  was  made  at  the  ICN 
board  of  directors'  meeting  in  Geneva 
19-21  March  1975.  Two  Canadian 
nurses  are  members  of  the  ICN  board: 
Verna  Huffman  Splane,  icn's  third 
vice-president,  and  Nicole  Du 
Mouchel,  a  director. 

The  student  assembly  will  be  or- 
ganized in  Tokyo  by  the  student  nurses 
present;  an  ICN  representative  will  be 
available  to  the  students  on  request. 
The  elected  chairman  of  the  student  as- 
(Continued  on  page  12) 


Can  3M  produce 
a  personal 
stethoscope 
for  nurses?     Yes  we  can. 


Three  of  them,  in  fact,  each  as  personal 
as  a  pair  of  glasses. 

There's  the  2-ounce  "Littmann" 
Nursescope  stethoscope,  fitting  neatly  in  a 
uniform  pocket,  and  combining  the  finest 
quality'and  performance  features  with 
graceful  design,  in  5  pretty  colours. 

And  3M  now  offers  two  new 
stethoscopes  for  nurses ...  the  "Littmann" 
Medallion  Mursecope  and  the  Nurses' 
Medallion  Combination  Stethoscope.  The 
Medallion  is  available  in  Goldtone,  Silvertone, 
Blue,  Green  or  Pink,  with  colour  co-ordinated 
tubing,  making  it  ideal  for  colour  coding  by 
department  or  for  individual  identification. 

The  "Littmann"  Medallion  Combination 
Stethoscope  comes  in  the  same  colours  and 
is  recommended  for  nurses  who  practice  in 
critical  area  areas. 


The  reproduction  in  this  book  after  an  original  by  Leonardo  da  Vinci,  in  Turin 

A  rephnt  of  Blblioteca  Reale  suitable  for  framing  is  personally  yours  by  calling  or  writing 

3M  Canada  Limited. 


To  order  your  personal  stethoscope  just 
call  1-800-265-4439  toll  free  or  write: 
3M  CANADA  LIMITED  P.O.  BOX  5757 
LONDON,  ONTARIO  N6A  4T1 
ATTENTION:  MEDICAL  PRODUCTS 


3m 

Yes  we  can. 


THE  CANADIAN  NURSE  —  June  1975 


news 


(Continued  from  page  10) 


sembly  will  be  asked  to  bring  a  report  of 
the  assembly  to  the  Council  of  National 
Representatives. 

At  the  same  board  meeting,  ICN  di- 
rectors made  plans  to  institute  a  pro- 
gram of  awards  to  member  associations 
to  recognize  membership  growth.  The 
awards,  in  the  form  of  certificates,  will 
be  presented  to  associations  having  the 
highest  percentage  increa.se  in  mem- 
bership based  on  the  potential  member- 
ship in  that  country,  and  to  associa- 
tions, which  already  have  a  high  mem- 
bership, for  maintaining  S59c  or  more 
of  the  potential  during  each  quadren- 
nium. 

The  first  certificates  will  be  awarded 
at  the  Tokyo  congress  in  1977. 


NWT  Refresher  Course 
Prepares  7  For  Registration 

Yellowknife.  NWT  —  The  first  re- 
fresher course  for  inactive  nurses  ever 
to  be  offered  in  the  Northwest  Ter- 
ritories was  held  3  February  to  28 
March  1975  in  Yellowknife.  Seven 
nurses  are  now  re-eligible  for  registra- 
tion. 

The  course  was  a  joint  project  of  the 
Northwest  Territories  Registered 
Nurses"  Association  (nwtr.na)  and  the 
department  of  education,  government 
of  the  NWT:  it  was  sponsored  by  Canada 
Manpower. 

Although  the  course  outline  fol- 
lowed existing  provincial  refresher 
programs,  it  offered  special  learning 
experiences  in  the  care  of  Native  pa- 
tients, and  in  social  problems,  such  as 
alcoholism,  drug  abuse,  and  venereal 
disease.  The  8-week  course  correlated 
4  weeks  of  theory  with  4  weeks  of  clini- 
cal practice  at  Stanton  Yellowknife 
Hospital.  The  course,  which  was  coor- 
dinated and  instructed  by  Mary  Lou 
Pilling  of  Yellowknife,  used  guest  lec- 
turers and  resource  personnel  from  Yel- 
lowknife and  Edmonton. 

Prepared  for  reregistration  were 
Barbara  Bromley,  Linda  France,  Irma 
Johns,  Carol  Morison,  Wilhemene 
Murphy,  and  Gwen  Morton,  Yellow- 
knife, and  Stella  Malkauskas  of  Clyde 
River. 

+  R0II  up 
your  sleeve 
to  save  a  life... 


0^P>  ^^^;,.^ 


Graduates  of  the  first  refresher  course  for  former  registered  nurses  in  the  North- 
west Territories  are.  left  to  right.  Carol  Morison:  Mary  Lou  Pilling,  instructor: 
Barbara  Bromley:  Stella  Malkauskas:  Norm  MacPherson,  education  director: 
Wilhemene  Murphy:  Irma  Johns:  Gwen  Morton:  and  Linda  France. 

One  Northern  Nurse's  Refreshing  Course 

Stella  Malkauslias  of  Clyde  River,  NWT,  describes  her  experience  with  the  first 
refresher  course  for  nurses  to  be  held  in  the  Northwest  Territories: 

"Sheer  delight  filled  me  when  1  saw  the  RN  refresher  course  advertised  in  the 
News  of  the  North,  then  panic  as  the  deadline  for  application  was  only  days  ahead. 
The  isolation  and  poor  air  service  to  and  from  Clyde  River,  Baffin  Island,  posed 
several  problems.  Also,  what  would  I  do  with  my  3  1/2-year-old  son?  There  are  no 
telephones  in  Clyde  River,  which  makes  communication  all  the  more  difficult. 
Since  this  was  of  urgent  medical  concern.  Ministry  of  Transport  allowed  me  to 
send  several  telexes  to  Leone  Trotter  [  president  of  NWTRNA  ]  in  Yellowknife, 
making  arrangements  to  attend  the  course. 

"Manpower  assisted  with  my  travel  arrangements,  but  bad  weather  intervened 
and  there  was  a  10-day  wait  in  Clyde  River  to  get  out  to  Frobisher,  where  1  could 
make  a  connecting  flight  to  Yellowknife.  There  was  an  additional  4-day  wait  in 
Frobisher,  because  no  aircraft  was  available.  Finally,  a  DC-3  was  available,  and  a 
chilly  I  l-hourtrip,  complete  with  frozen  sandwiches,  brought  us  to  Yellowknife. 

"First  impression:  trees!  And  Barbara  Bromley,  smiling  as  always,  was  thereto 
meet  me  with  a  key  to  an  apartment,  arranged  by  Trotter,  through  the  department 
of  education  of  the  Northwest  Territories. 

"Over  the  next  7  weeks  several  problems  were  encountered  —  baby-sittting, 
having  to  catch  up  on  a  week's  lectures,  finding  uniforms  and  shoes  to  fit,  and,  in 
general,  trying  to  cope  with  the  fears  of  'going  back'.  These  difficulties  were 
overcome,  however:  there  was  always  someone  willing  to  help,  and  the  hospital 
atmosphere  was  friendly  and  interested.  The  camaraderie  and  support  of  the  group 
and  of  our  instructor,  Mary  Lou  Pilling,  was  refreshing  in  itself. 

"Certainly  nursing  must  be  one  of  the  most  challenging  professions  to  step  back 
into  after  several  inactive  years.  We  wanted  to  know  everything,  and  grumbled 
when  we  stumbled!  And  writing  exams  —  what  a  crisis! 

"The  8  weeks  ended  too  soon.  Regretfully,  1  left  Yellowknife,  but  1  had  a  host 
of  good  memories,  a  new  approach  to  nursing,  and  additional  knowledge.  I  am  no 
longer  afraid  to  return  to  nursing.  1  realize  that  one  must  continue  to  read  and  keep 
up  with  current  trends.  Personal  enrichment  from  this  course  can  be  measured  only 
by  personal  objectives. 

"Many  thanks  to  Manpower  and  to  the  department  of  education  for  making  this 
course  possible,  to  the  Stanton  Yellowknife  Hospital  and  staff  for  accommodating 
it.  and  to  the  NWT  Registered  Nurses"  Association  for  fostering  the  idea."" 


You  should  know  about  a  new  concept  in  contraception 

Cu-7®(CopperSeven) 
intrauterine  copper  contraceptive 


How  does  Cu-7  work?  Copper  provides  the  major  con- 
traceptive effect,  not  the  inert  plastic  7- shaped  carrier. 
The  effect  is  local  and  non-systemic.  The  minute  quantity 
of  copper  released  daily  by  Cu-7  is  only  2-3%  of  the 
usual  daily  dietary  intake  of  copper 

How  effective  is  Cu-7?  Simply,  Cu-7  is  virtually  as  effec- 
tive as  "The  Pill ". 

Who  can  use  Cu-7?  Cu-7  can  be  inserted  into  most 
normal  women  whether  nulliparous  or  multiparous.  The 
small  diameter  of  the  inserter  usually  permits  insertion 
without  cervical  dilation  and  usually  with  little  or  no 
patient  discomfort.  The  flexible  7  shape  is  highly  com- 


patible with  the  uterine  environment,  ensuring  a  high 
retention  rate. 

What  are  the  future  effects  of  Cu-7?  Following  proper 
insertion,  Cu-7  is  immediately  active,  rarely  expelled  and 
usually  easily  removed.  Cu-7  is  unlikely  to  affect  future 
fertility.  Studies  have  shown  that  most  women  wishing  to 
become  pregnant  did  so  within  four  months  after  removal 
of  Cu-7. 

Do  you  desire  further  information?  Further  information 
is  available  to  all  registered  nurses  by  writing  Searle 
Pharmaceuticals,  Oakville,  Ontario. 


SEARLE 


Searle  Pharmaceuticals 

Oakville,  Ontario 


Note:  This  space  is  paid  for  by  Searle  Pharmaceuticals  as  an 
educational  service  to  the  nursing  profession  and  does  not 
constitute  a  solicitation  or  reconnmendation  for  use  of  Cu-7. 


THE  CANADIAN  NURSE  —  June  1975 


13 


Leadership  is  inJierited  through  learning... 

learn 
to  lead 
with 
Mosby 
books 


New  2nd  Edition! 
LaguaClaudio-  Thiele 

NUTRITION  AND  DIET  THERAPY 
REFERENCE  DICTIONARY 

More  than  3,500  word  entries  relating  to  technical  and  specific 
aspects  of  nutrition  and  diet  therapy  in  disease  are  contained  In 
this  compact  reference.  Encyclopedic  treatment  of  terms  and  a 
dictionary  format  simplify  your  search  for  information.  Word 
cross-referencing  and  appendix  materials  provide  further 
knowledge  and  add  fullness  to  the  definitions. 

By  ROSALINDA  T.  LAGUA,  M.N.S.;  VIRGINIAS.  CLAUDIO.  Ph.D.; 
and  VICTORIA  F.  THIELE,  Ph.D.  July,  1974.  330  pages  plus  FM 
l-XII,  7"  X  10".  7  illustrations.  Price,  $10.45. 


A  New  Book!  Milliard 

ORIENTATION  AND  EVALUATION 
OF  THE  PROFESSIONAL  NURSE 

Based  on  the  philosophy  of  "self -directed  learning,"  this  new 

volume  provides  the  foundation  for  change  in  attitudes,  ideas, 

and  patterns  of  behavior  of  the  soon-to-be  professional  nurse. 

The   unique  approach  to  orientation  presented  here  clearly 

outlines    the    transitional    process    from    student    nurse    to 

professional    nurse.    It    provides    easy    reference   to   hospital 

procedures  and  offers  statistically  valid  measurement  tools  for 

evaluating  competency  in  nursing. 

By  MILDRED  MILLIARD.  R.N.,  B.S..  M.S.  August,   1974.    168  pages 
plus  FM  l-X.  7'/4"x  10'/,".  31  figures.  Price.  $6.60. 


A  New  Book! 
Davis-Kramer-Strauss 

NURSES  IN  PRACTICE: 

A  Perspective 

on  Work  Environments 


This  new  book  is  a  collection  of  articles 

.'  <  which  considers  the  work  of  nurses  in  a 

variety  of  settings  and  presents  relevant 

insights  in  the  nurse's  lack  of  autonomy; 

the  attitudes  concerning  the  role  of  wometi 

today;  and  the  care  components  of  health  professionals. 

By  MARCELLA  Z.  DAVIS.  R.N..  D.N.Sc.;  MARLENE 
KRAMER.  R.N..  Ph.D.;  and  ANSELM  L.  STRAUSS.  Ph.D.; 
with  11  contributors.  January.  1975.  274  pages  plus  FM 
l-X IV.  6%" x9'A".  Price,  $7.30. 


New  3rd  Edition! 

BASIC  MATERNITY  NURSING 


Hamilton 


This  new  edition  fully  incorporates  recent  maternity 
nursing  trends  which  affect  today's  practical  nurse.  A 
brief  introductory  chapter  offers  historical  back- 
ground; then  anatomy  and  physiology  are  discussed, 
followed  by  normal  aspects  of  pregnancy  and  infant 
care. 

By  PERSIS  MARY  HAMILTON,  R.N..  P.H.N. .  B.S.,  M.S. 
July.  1975.  Approx.  256 pages.  7"  x  10".  104  illustrations. 
About  $7.30. 

MOSBY 

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THE   C   V    MOSBY  COMPANY.  LTD 

86  NORTHLINE   ROAD 

TORONTO.  ONTARIO 

M4B  3E5 


FRANKLY  SPEaKlNG 

about  nursing  practice 


Sex  Talk  and  Nursing 


Two  women  patients  are  overheard  as  fol- 
ows: 

Urs.  A.  (bitterly):  "I  came  in  here  with  a 

pain  in  my  stomach  and  headaches. 

Now  they  say  I'm  depressed.  Depres- 

,sedl  It's  my  husband  is  the  probiemi 

He"s  just  no  good  in  bed." 
Urs.  B:  "Have  you  told  your  doctor?" 
Mrs.  A:  "I  just  can't  talk  to  a  man  about 

something  like  that.  He'd  say  it  was  my 

fault  anyway." 
Mrs.  B:  "How  about  the  nurses?" 
Mrs.  A:  "Are  you  kidding?  What  does  a 

22-year-old  doll  know  about  a  man  who 

can't  get  it  up  in  bed!" 

When  I  heard  this  conversation.  I  was 
not  in  uniform,  was  unknown  to  the  pa- 
tients, and  was  not  identifiable  as  a  nurse 
or  other  staff  member.  I  was  much  struck 
by  the  subject  matter  of  the  patient's  prob- 
lem, by  the  vehemence  and  bitterness  of 
tier  tone  in  discussing  her  husband,  the 
doctor,  and  the  nurses,  and  by  my  own 
empathetic  sense  of  helplessness  and  hope- 
lessness. Where  could  she  tum  now  for 
he  help  that  she  needed? 

Surely  it  was  our  professional  responsi- 
bility to  determine  the  real  nature  of  Mrs. 
A's  life  problem  by  means  other  than  those 
of  chance  eavesdropping.  But  were  we  in 
fact  prepared,  personally  or  profession- 
lly.  to  assess  her  true  situation?  Were  we 
able  to  deal  w  ith  it  in  a  helping  way  if  she 
had  told  us  the  truth? 

This  small  fragment  of  conversation 
caused  me  to  examine  some  of  my  reac- 
tions and  ask  several  questions  of  myself 
as  a  nurse.  My  first  reaction  was  a  sense  of 
shock  at  theexplicitnessof  Mrs.  A's  state- 
ment of  her  problem  —  the  same  sense  of 


Lorine  Besel 


Beginning  this  month.  The  Canadian 
Nurse  will  feature  a  monthly  column 
presented  by  the  four  CNA  mem- 
bers-at-large.  This  month's  column 
is  written  by  the  member-at-large 
for  nursing  practice,  Lorine  Besel. 
She  welcomes  your  comments. 


shock  and  embarrassment  I  noted  in  a  staff 
nurse  when  Mr.  Y.  a  76-year-old  man  with 
genitourinary  problems  said,  crudely  but 
flirtatiously.  "I  can't  do  my  duty  for  all 
you  pretty  nurses  with  my  cock  wired  to 
the  bed."  That  staff  nurse  stiffened, 
blushed,  shoved  the  medication  at  the  pa- 
tient coldly  and.  without  a  word,  practi- 
cally ran  from  the  room.  All  without  any 
appreciation  that  what  she  had  heard  was 
only  a  feeble  effon  on  the  part  of  this  man 
to  maintain  some  sense  of  self  and  man- 
hood as  he  saw  it. 

This  is  nursing?  Can  we  really  nurse  if 
our  personal  reactions  to  the  patients' 
mode  of  expression  or  the  subject  matter 
precludes  our  even  listening  to  them? 

Some  of  you  will  have  experienced  a 
shcKk  reaction  to  the  examples  I  have  giv- 
en here.  After  all.  you  will  ask.  is  this  fit 
material  for  our  professional  journal  —  for 
our  delicate,  ladylike,  professionally  sen- 
sitive ears?  Perhaps  you.  too.  need  to  ask 
yourself  these  same  questions. 

The  choice  of  language,  the  differences 
between  the  patients"  mode  of  expression 
and  our  own  seem  important  to  consider. 
There  is  evidence  that  some  patients  feel 
freer  to  discuss  their  difficulties  with  nurs- 
ing   assistants,    cleaners,    and    other   pa- 


tients than  with  professional  staff. 

Much  of  our  professional  education 
converts  us  to  a  use  of  technical  jargon.  In 
assessing  patients,  we  are  given  to  organi- 
zed data  collection  in  the  form  of  nursing 
histories  and  interview  protocols.  The  lan- 
guage used  in  such  nurse-patient  inter- 
changes is  inherently  our  mode  of  expres- 
sion —  not  that  of  the  patients.  We  check 
on  bowel  movements,  urination,  dischar- 
ges from  various  sources,  and  sexual 
compatibility.  And.  in  the  course  of  such 
interchanges,  we  teach  the  patient  the  lan- 
guage that  will  be  acceptable  to  us. 

By  the  time  Mrs.  A.  comes  to  us  with 
her  problem,  we  expect  her  to  state  her 
difficulty  as  "sexual  incompatibility"  or 
"impotency."  What  subtle  tyranny!  The 
patient  is  required  to  respond  toyour  need, 
rather  than  you  to  hers.  Further,  the 
translation  of  "he's  no  good  in  bed"  into 
"my  husband  is  impotent"  does  not  seem 
to  me  to  express  as  clearly  the  rage  and 
resentment  Mrs.  A.  feels  about  the  situa- 
tion —  surely  an  important  piece  of  infor- 
mation if  we  are  to  help  both  of  them  work 
with  this  problem.  Does  our  professional 
education  prepare  us  to  deal  with  the  lan- 
guage and  problems  of  sex? 

Would  you  rather  discuss  Mrs.  A.'s 
headaches?  Are  you  the  sort  of  nurse  with 
whom  Mrs.  A.  would  not  dare  to  discuss 
sexual  difficulties?  Do  you  consider  this 
an  "ask  your  doctor"  type  of  problem? 
How  would  you  react  to  Mr.  Y?  Can  we 
call  ourselves  nurses  if  we  are  not  ready  to 
deal  with  one  of  the  most  vital  aspects  of  a 
patient's  life? 

We  all  subscribe  to  total  health  care  as 
an  idea.  Do  either  Mrs.  A.  or  Mr.  Y.  have 


true  access  to  total  health  care? 


^ 


THE  CANADIAN  NURSE  —  June  1 975 


Nurses  can  help  the  bereaved 


The  authors  believe  that  nurses  are  uniquely  suited  to  provide  preventive  and 
therapeutic  intervention  to  reduce  stress  experienced  by  those  who  are  recently 
widowed.  They  focus  on  ways  in  which  nurses  can  better  use  their  roles  and  skills 
to  promote  healthier  adjustment  to  bereavement. 


Joy  Rogers  and  Mary  L.S.  Vachon 


There  is  a  great  deal  of  evidence  that  the 
death  of  a  spwuse  is  the  life  event  most 
liiceiy  to  produce  the  highest  level  of  stress 
in  individuals.'  Thus,  it  is  impoHant  that 
those  interested  in  preventive  medicine 
turn  their  attention  to  this  high-risk  popula- 
tion. What  sort  of  intervention  is  most 
likely  to  mitigate  the  risk  of  a  high  level  of 
stress?  How  is  access  to  help  best  provided 
in  the  months  immediately  following  be- 
reavement? 

We  believe  that  nurses,  by  virtue  of 
their  personal  caring  roles  and  their  posi- 
tions within  institutions  and  in  the  com- 
munity at  large,  are  uniquely  suited  to 
carry  more  responsibility  in  providing  ser- 
vice to  the  bereaved.  We  want  to  focus 
attention  on  the  ways  in  which  nurses  can 
better  use  their  roles  and  skills  to  reduce 
the  incidence  of  pathology  and  promote 
healthier  adjustment. 

Stress  of  bereavement 

The  physical,  emotional,  and  social  se- 
quelae of  the  stress  of  bereavement  on 


Jov  Rogers  (R.N..  Toronio  Ea.sl  General 
School  of  Nursing.  Toronio,  Ont.)  and  Mary 
L.S.  Vachon  (R.N..  Massachusetts  General 
Hospital  School  of  Nursing,  Boston.  Mass; 
B.S.,  Boston  University,  Boston,  Mass.; 
M.A.,  University  of  Toronto,  Toronto.  Ont.) 
are  Mental  Health  Con.sultants  in  the  Commun- 
ity Resources  Section  of  the  Clarke  Institute  of 
Psvchiatr>.  Toronto.  Vachon  is  principal  in\es- 
tigator  and  Rogers  is  eo-invesligalor  of  a  re- 
search project.  ""A  Preventive  Intervention  for 
the  Newly  Bereaved." "  funded  by  the  Ontario 
Minislrv  of  Health  under  a  Demonstration 
Model  Grant. 

16  jir"   " 


widows  and  widowers  have  been  well 
documented.  Studies  have  viewed  be- 
reavement as  illness,^  as  crisis,'.'*  and  as 
psychosocial  transition.'  Other  studies 
have  focused  on  such  indicators  as  physi- 
cal and  mental  illness,  and  death,  includ- 
ing suicide,  among  the  bereaved. 

We  now  know  that  mortality  rates  and 
the  incidence  of  somatic  and  emotional 
problems  are  much  higher  among  be- 
reaved persons  than  in  the  normal 
population.*"'"  However,  despite  the  evi- 
dence of  the  extent  of  their  needs,  the 
widowed  are  rarely  offered  adequate,  on- 
going help  specifically  focused  on  the 
stress  of  bereavement. 

Community  care 

For  some  years,  nurses  have  been  en- 
couraged to  take  into  account  the  envi- 
ronment, the  family,  and  various  social 
and  emotional  needs  when  they  make  a 
care  plan  for  a  patient.  Increasingly,  death 
takes  place  in  institutions  rather  than  at 
home,  and  institutions  rarely  have 
mechanisms  whereby  staff  can  continue  to 
reach  out  to  families  after  death  occurs. 
When  the  patient  dies,  the  family  disap- 
pears into  the  community,  and  the  nurses, 
like  other  hospital-based  professionals, 
are  trained  to  transfer  their  attention  to  new 
patients.  Also,  the  family  can  be  forgotten 
even  before  death  occurs,  especially  when 
there  is  a  lingering  illness  or  the  patient  is 
comatose,  and  the  family's  visits  taper 
off." 

St.  Christopher's  Hospice  in  England 
has  developed  mechanisms  to  enable  staff 
to  reach  out  to  families  of  terminally  ill 
patients .  and  to  arrange  for  help  after  death 
occurs,  if  help  is  indicated.  An  assessment 


procedure  has  been  developed,  whic 
helps  staff  to  predict  those  family  men 
bers  who  are  more  likely  to  undergo 
pathological  bereavement  reaction.  Ir 
terestingly  enough,  in  this  institutio 
nurses  have  been  found  to  be  best  suited  t 
carry  out  both  the  as,sessment  and  th 
intervention.'^ 

In  New  Haven.  Connecticut,  a  group  c 
professionals  are  in  the  process  of  settin 
up  a  hospice,  that  is.  a  facility  providin 
comprehensive  care  for  the  terminally  ill; 
nurse  spearheaded  this  project. '^  1 
Canada,  the  Royal  Victoria  Hospital  i 
Montreal  has  received  funding  to  set  up 
special  palliative  care  unit  for  dying  p< 
tients.  This  project  includes  home  care  an 
ongoing  service  to  families,  which  will  t 
undertaken  by  nurses  and  soci. 
workers. '"• 

At  the  Clarke  Institute  of  Psychiatn 
Toronto,  we  are  involved  in  researchir 
the  stresses  of  bereavement  and  the  eff 
cacy  of  a  program  of  intervention  for  th 
newly  bereaved.  Our  clinical  respoi 
sibilities  include  responding  to  reques 
from  other  hospitals  for  individual  an 
family  bereavement  counseling,  and  it 
tervention  with  dying  patients  and  the 
families,      i         r.  j.     i 

There  are' obvious  reasons  why  it  is  nt 
easy  for  hospitals  to  institute  outreac 
programs.  Funding  and  staffing  are  geare 
to  bed  occupancy  rather  than  communil 
service,    institutional    hierarchies    with! 

The  authors  gratefully  acknowledge  the  su| 
port  of  colleagues  in  the  Community  Resourct 
Section  of  the  Clarke  Institute  of  Psychiatr 
Toronto,  particularly  Dr.  W.A.L.  Lyall  ar 
Dr.  S.J.J.  Freeman. 


V 


professional  departments  do  not  encour- 
age flexibility  and  interdisciplinary  en- 
deavors, and  nurses  are  often  hesitant  to 
initiate,  on  their  own,  any  change  within 
their  institutions.  However,  the  foregoing 
examples  illustrate  that  it  is  possible  to  do 
more  than  is  presently  being  accomplished 
within  most  hospital  settings. 

There  may  be  even  more  opportunities 
for  innovative  programs  in  community  set- 
tings, most  of  which  are  less  rigidly  struc- 
tured than  hospitals.  In  such  settings  as 
schools,  public  health  agencies,  family 
practice  clinics,  and  industries,  it  is  often 
the  nurse  who  is  most  likely  to  have  an 
opportunity  to  relate  to  and  provide  ongo- 
ing support  for  recently  bereaved  indi- 
viduals. Important  contributions  to  pre- 
ventive medicine  could  be  made  by  public 
health  nurses,  nurse  practitioners, 
psychiatric  nurses,  industrial  nurses,  and 
so  on,  if  they  were  encouraged  to  expand 
their  roles. 

However,  before  nurses  can  feel  more 
competent  in  their  ability  to  do  grief  coun- 
seling, they  must  be  given  a  broader  base 
of  theoretical  and  practical  knowledge  re- 
lated to  the  study  of  death  and  dying.  Nurs- 
ing education  should  include  theoretical 
knowledge  of  the  psychology  of  grief,  the 
phases  and  adjustments  of  bereavement, 
and  the  various  potential  problem  areas 
that  have  been  established  as  contributing 
to  decreased  emotional,  physical,  and  so- 
cial well-being  in  the  absence  of  therapeu- 
tic intervention. 

As  well,  nurses  must  see  this  knov\  ledge 
as  being  professionally  relevant  to  them: 
they  need  examples  of  model  programs 
and  clinical  material  so  they  can  see  them- 
selves as  care-givers  in  this  area. 

The  following  case  histories  illustrate 
how  nursing  skills  can  be  used  in  counsel- 
ing bereaved  persons. 

Patient  histories 

Ms.  B.  is  a  53-year-old  woman  whose 
husband  died  suddenly  of  a  massive  coro- 
nary occlusion  a  year  and  a  half  before  we 
saw  her  for  counseling.  Dr.  B.  was  a  suc- 
cessful dentist  who  was  a  warm,  capable 


;  CANADIAN  NURSE  —  June  1975 


person,  well  liked  by  everyone.  Ms.  B. 
was  dependent  on  him  and  always  had 
difficulty  making  decisions. 

For  years  she  suffered  from  mild 
phobias,  and  had  several  episodes  of  phys- 
ical symptoms  that  were  likely 
psychogenic  in  origin.  She  was  seen  by 
friends  and  family  as  a  rather  self- 
concerned,  nagging,  and  complaining  per- 
son. 

Her  husband  drank  moderately  to  help 
him  cope  with  his  marital  difficulties,  and 
her  general  practitioner,  a  close  friend  of 
Dr.  B.,  accepted  her  frequent  visits  and 
gave  her  minimal  amounts  of  medication 
when  she  was  upset.  During  the  last  5 
years  of  her  husband's  life,  the  B.s'  three 
children  left  home  to  marry,  and  Ms.  B"s 
aged  mother,  who  lived  with  the  family, 
died. 

In  the  months  following  her  husband" s 
death.  Ms.  B.'s  emotional  state  deterior- 
ated steadily.  It  became  increasingly  clear 
that  her  children  and  her  social  network 
had  really  related  to  her  husband  rather 
than  to  her.  Her  entire  support  structure 
had  disappeared,  and  her  overwhelming 
dependency  needs  were  unmet.  Those 
who  reached  out  to  Ms.  B.  found  that  she 
latched  onto  them  completely,  and  so  they 
either  fell  away  or  attempted  to  distance 
the  relationship  by  assuming  the  role  of 
advice-giver.  She  received  large  amounts 
of  conflicting  advice. 

Her  children  were  unwilling  to  consider 
having  her  move  in  with  them,  which  she 
was  requesting.  They  were  extremely  frus- 
trated by  their  mother's  behavior  and 
could  not  see  the  dynamics  involved.  As 
they  became  less  tolerant,  she  became  in- 
creasingly agitated  and  depressed,  and 
began  losing  weight.  Finally,  on  a 
weekend,  she  decided  impulsively  to  go  to 
a  hospital  and  request  immediate  admis- 
sion. On  the  way  there,  she  slipped  on  the 
ice,  sustaining  several  severe  contusions 
and  lacerations. 

The  team  preferred,  if  at  all  possible,  to 
avoid  starting  her  on  a  "patient  career." 
She  was  referred  to  Ms.  Rogers,  one  of  the 
authors,  as  a  person  who  had  a  problem  of 
adjustment  to  widowhood.  For  4  months, 
Ms.  B.  was  seen  regularly,  at  bi-weekly 
intervals,  on  an  outpatient  basis;  Ms.  B. 
has  made  steady  improvement. 

The   treatment   approach   was   to   use 

18 


knowledge  of  the  dynamics  of  bereave- 
ment and  of  the  dynamics  of  Ms.  B's  basic 
personality  to  explore  her  feelings  in  a 
positive,  supportive  manner.  She  was 
gradually  able  to  express  her  previously 
repressed  anger,  which  was  directed  to- 
ward her  husband  for  dying  and  leaving 
her  in  what  was,  to  her,  a  totally  unaccept- 
able situation. 

When  Ms.  B.  was  allowed  to  ventilate 
and  to  review  her  life  before  and  after  her 
husband's  death,  she  began  to  grieve  ap- 
propriately. She  realized  that  all  herefforts 
had  been  directed  toward  avoiding  ad- 
justment to  an  independent  life.  She  also 
began  to  understand  why  her  children  were 
hostile,  and  she  realized  that  she  could  not, 
and  did  not  want  to,  transferal!  her  depen- 
dency needs  to  them. 

The  nurse  therapist  involved  Ms.  B's 
family  and  her  doctor  from  the  outset. 
Their  new  understanding  of  the  situation, 
and  their  relief  that  professional  support 
was  available,  enabled  them  to  adjust  their 
expectations  and  to  offer  Ms.  B.  more 
appropriate  help.  She  is  now  able  to  make 
some  decisions  about  her  future,  is  selling 
her  large  house,  and  is  doing  some  volun- 
teer work  in  the  community. 

Ms.  R.  is  a  30-year-old  mother  of  3 
children  who  was  referred  to  Ms.  Vachon, 
one  of  the  authors,  because  of  difficulty  in 
adjusting  to  the  impending  death  of  her 
husband.  Nursing  staff  on  the  unit  where 
he  was  hospitalized  complained  that  Ms. 
R.  was  extremely  angry  because  she  felt 
her  husband's  fatal  illness  should  have 
been  diagnosed  sooner  than  it  was.  She 
seemed  incapacitated  by  her  anger,  and 
her  overt  hostility  was  bringing  about  re- 
jection by  hospital  personnel,  family,  and 
friends.  This,  of  course,  added  more  fuel 
to  her  anger. 

In  the  first  3  therapy  sessions.  Ms.  R. 
angrily  reviewed  her  husband's  symptoms 
and  questioned  why  he  wasn't  diagnosed 
earlier.  Her  pain  and  outrage  were  pro- 
jected onto  the  doctors,  who  were  accused 
of  missing  the  diagnosis,  of  operating  too 
late,  and  of  making  him  a  "vegetable." 
She  said  they  were  sending  her  husband  to 
a  chronic  care  hospital  so  they  wouldn't 
have  to  see  "their  mistake." 

She  was  accompanied  to  the  first  3  ses- 
sions   by    family    members;    the    nurse 


therapist  assumed  that  this  was  because 
some  resistance  and  that  Ms.  R.  needed 
feel  family  support.  On  the  fourth  sessic 
she  came  alone,  and  her  anger  dissolv 
into  tears  as  she  began  to  grieve  for  I 
husband  she  had  known. 

In  the  following  weeks,  as  she  watch 
a  formerly  meticulous  man  regress  a 
become  incontinent,  she  began  to  face  I 
fact  that  he  was  dying.  Ms.  R.  stated  tl 
the  therapist  was  important  to  her  becai 
she  was  the  only  person  to  whom  she  coi 
talk  about  the  fact  that  Mr.  R.  was  rea 
dying.  Doctors  evaded  her,  and  fam 
members  tried  to  reassure  her  that  her  hi 
band  would  soon  be  well.  When  she  i 
derstood  that  she  was  essentially  alone 
her  attempt  to  accept  the  reality  of  1 
death,  she  realized  how  much  easier  it  h 
l)een  to  maintain  her  hostility  than  to  fa 
her  impending  loss. 

As  she  began  to  grieve,  Ms.  R's  an< 
decreased  considerably,  but  she  still  f 
her  husband  had  been  misdiagnosed  a 
she  wanted  to  do  something  about  it.  S 
was  encouraged  in  this  (with  an  empha 
on  the  need  to  make  any  act  as  constructi 
as  possible)  because  we  felt  that  this  coi 
decrease  the  impotence  she  felt  and  h( 
her  to  mobilize  her  resources. 

Ms.  R.  decided  to  write  to  the  medii 
director  of  the  hospital,  and  Ms.  Vach 
accompanied  her  to  the  ensuing  intervie 
This  woman  had  the  satisfaction  of  feeli 
that,  although  her  husband  would  die,  1 
death  and  the  suffering  it  caused  would  i 
go  unnoticed. 

After  two  months  in  therapy,  Ms. 
was  able  to  face  her  husband's  immim 
death  and  to  talk  openly  about  it  with  h 
children .  Her  anger  had  decreased ,  but  s 
remained  sufficiently  aggressive  to  ensi 
that  her  husband  received  good  care  in  t 
chronic  care  facility. 

When  Mr.  R.  died  suddenly,  Ms. 
was  able  to  insist  that  she  be  allowed  to  s 
her  husband's  body  despite  protestatio 
from  the  physician.  She  was  able  to  e 
plain  her  husband's  death  to  her  chiidr 
and  accept  their  individual  reactions  to 
In  addition,  she  was  able  to  carry  throu 
with  the  funeral  plans  she  wanted,  desp 
her  family's  disapproval.  Through  herd 
cussions  with  the  nurse,  Ms.  R.  had  gain 
the  insight  and  strength  necessary  to  cai 
her  through  these  difficult  davs. 


Four  months  after  her  husband's  death, 
he  has  a  successful  job,  and  she  and  her 
:hildren  are  coping  well. 

These  two  anecdotes  reveal  some  of  the 
Afays  in  which  nurses  can  help  with  the 
xoblems  faced  by  the  bereaved  and  those 
nticipating  bereavement. 

Grief  counseling 

The  therapeutic  tasks  illustrated  by  the 
rase  histories  can  be  summarized  as  fol- 
ows: 

Give  ongoing  social  and  emotional  sup- 
X)rt  as  needed  by  the  bereaved  person. 
Fhis  includes  regular  interviews  with  the 
creaved  and  acceptance  of  the  feelings 
xpressed. 

I]  Allow  grief  to  proceed  and  be  expressed 
without  censure. 

D  Realize  that  there  is  often  repressed 
mger  toward  the  deceased  for  dying  and 
eaving  others  behind.  Allow  the  person  to 
jxpress  hostility  toward  the  deceased  or 
ibout  the  impending  death. 
D  Mobilize  family,  friends,  and  profes- 
iionals  by  making  interpretations  to  them 
regarding  the  grief  process  and  giving 
suggestions  for  maintaining  and/or  im- 
ifoving  support  systems. 
3  Encourage  reassessment  of  the  current 
eality  situation  and  make  suggestions 
iboui  coping  with  use  of  time:  finances. 
)ensions,  wills,  dwelling  place,  and  other 
jractical  matters;  relationships  with  fam- 
ly  and  friends;  and  relationships  w  ith  pro- 
fessional helpers. 

DUse  the  termination  of  therapy  as 
mother  "loss"  and  help  the  individual  to 
work  through  the  grief  associated  with  this 
lew  loss.  Help  the  person  to  realize  that  he 
)rshe  now  has  an  enhanced  ability  to  cope 
ivith  loss  and  grieving,  by  virtue  of  having 
orked  through  this  and  other  losses. 
Many  professionals  feel  inadequate  in 
jrief  counseling  and,  accordingly,  tend  to 
void  it.  It  is  difficult  to  shoulder  the  re- 
iponsibility  of  dealing  with  the  emotional 
leeds  i)f  the  dying,  who  are  clearly  defined 
a  requiring  professional  attention.  The 
)ereaved,  however,  are  out  in  the  corn- 
unity,  and  it  is  still  a  widely  held  as- 
sumption (or rationalization)  that  they  will 
require  only  the  technical  services  of  doc- 
ors  and  nurses,  and  that  they  will  request 
hese  services  as  they  need  them." 
Health  professionals  are  busy  people 

THE  CANADIAN  NURSE  —  June  1975 


who  can  mask  their  feelings  of  inadequacy 
by  claiming  that  time  pressures  underly 
their  preference  for  giving  concrete  treat- 
ment or  advice,  rather  than  emotional  sup- 
port over  an  unknown  period.  Thus,  doc- 
tors may  medicate,  clergymen  may  urge 
prayer  and  faith,  and  social  agency  work- 
ers may  attempt  to  identify  legal,  finan- 
cial, and  vocational  problems.  Nurses  re- 
strict themselves  to  referring  people  to  one 
or  more  of  these  professionals,  and  ad- 
vocating that  the  family  be  supportive. 

When  death  occurs .  families  and  friends 
gather  around  for  a  w  hile  and  offer  consid- 
erable support  and  advice;  following  this, 
they  tend  to  take  up  their  own  lives  again. 
Their  withdrawal  from  the  bereaved  per- 
son is  reinforced  by  their  own  uncomfort- 
able feelings  in  the  face  of  the  grieving 
process  and.  frequently,  by  their  general 
frustration  that  the  bereaved  person  is  not 
responding  as  quickly  as  expected.  Thus 
the  buck  continues  to  be  passed,  and  no- 
body takes  ongoing  responsibility  for  the 
service  that  is  required. 

Summary 

We  contend  that  there  is  an  important 
role  for  nurses  in  preventive  and  therapeu- 
tic intervention  with  the  bereaved.  The 
clinical  and  interpersonal  skills  nurses  al- 
ready possess,  and  their  key  positions  in 
various  settings,  contribute  to  their  unique 
suitability. 

However,  nurses  should  be  provided 
with  more  theoretical  knowledge  and 
supervised  clinical  experience  to  help 
them  feel  more  competent.  As  they  do  so. 
they  can  enlarge  their  traditionally  defined 
roles  and  move  into  this  field  in  an  innova- 
tive manner. 

The  rewards  of  making  a  contribution  in 
this  aspect  of  preventive  medicine  are 
many,  not  only  in  terms  of  the  personal 
and  professional  satisfaction  to  be  derived 
from  performing  a  valuable  clinical  ser- 
vice, but  also  in  the  ripple  effect  that  en- 
sues, as  awareness  of  the  needs  of  this  high 
risk  group  —  the  bereaved  —  rises.  ' 

References 

1.  Homes.  T.H.  and  Rahc.  R.H  The  social 
readjuslmenl  rating  scale.  J.  PsycliDsom. 
Res.   I  I  ;2 1 3-8.  Aug.  1967. 

2.  Perelz.  David.  Reaction  to  loss.  In  Loss 
and  grief:  psychological  management  in 


medical  practice.  Edited  by  Schoenberg. 
Bemard  et  al.  New  York,  Columbia  Uni- 
versity Press.  1973.  p.  20-35. 

3.  Raphael.  B.  Crisis  intervention:  theoreti- 
cal and  methodological  considerations. 
Aiisl.  N.ZJ.  Psychiairy  5: 183,  Sep.  197 1 . 

4.  Maddison,  D.  and  Viola.  A.  The  health  of 
widows  in  the  year  following  bereave- 
ment. 7.  Psychosom.  Res.  12:4:297.  Dec. 
1968. 

5.  Parkes.  CM.  Psycho-social  transitions:  a 
field  for  study.  5or.  Sci.  Med.  5:101.  Apr. 
1971. 

6.  — .  Effects  of  bereavement  on  physical 
and  mental  health.  A  study  of  the  medical 
records  of  widows.  Bril.  Med.  J.  2:274, 
Aug.  1964. 

7.  — .  Bereavement  and  mental  illness.  I.  A 
clinical  study  of  the  grief  of  bereaved 
psychiatric  patients.  Brit.  J.  Med. 
Psychol.  38:1.  Mar.  1965. 

8.  Maddison,  D.  The  sting  of  death.  Paper 
presented  al  St.  Michael's  Hospital,  To- 
ronto. Ontario.  Dec.  1971. 

9.  Bunch.  J.  Recent  bereavement  in  relation 
to  suicide.  J.  Psychosom.  Res.  16:361, 
Aug.  1972. 

10.  Kraus.  AS.  and  Lilienfeld.  .\.M.  Some 
epidemiological  aspects  of  the  high  mortal- 
ity rate  in  the  young  widowed  group.  J. 
Chron.  Dis.   10:3:207.  Sep.  1959. 

1  1.  Glaser.  Bamey  G.  and  Strauss.  Anselm  L. 
The  social  loss  of  dying  patients.  In  The 
dying  patient:  a  nursing  perspective.  Com- 
piled by  Browning.  Mary  H.  and  Lewis. 
Edith  P.  New  York.  American  Journal  of 
Nursing.  cl972.  p.  141-7. 

12.  Twycross.  R.  Keynote  address  to  Confer- 
ence on  Acute  Grief  and  the  Funeral.  New 
York,  Columbia  University.  29-30  March. 
1974.  (Unpublished.) 

13.  Wald.  F.  Symposium  on  "Living.  Dying 
and  Those  Who  Care."  New  York,  Col- 
umbia University,  1-2  November,  1974. 
Personal  communication. 

14.  Mount.  B.M.  Personal  communication. 

15.  Dobrof.  R.  Community  resources  and  care 
of  the  temiinally  ill  and  their  families.  In 
Psychosocial  aspects  of  terminal  care. 
Edited  by  Schoenberg.  Bernard  el  al.  New 
York.  Columbia  Uni\ersity  Press.  1972, 
p.  290-308.  Q 


Of  Half  Gods  and  Mortals: 
Aesculapian  Authority 


This  awesome  authority,  which  rules  out  any  patient  participation  in  the 
decision-making  process,  stems  from  a  three-pronged  power- base:  the 
physician's  expertise,  the  patient's  faith  in  him,  and  the  belief  that  he  has  almost 
mystical  powers. 


Beatrice  j.  Kalisch 


O  you  that  are  half  gods,  lengthen  that  life  .  .  . 
turn  o'er  all  the  volumes  of  your  mysterious 
Aesculapian  science. ' 

A  recent  and  personal  encounter  with 
illness  and  hospitalization  reminded  me  of 
the  above  line  in  Philip  Massinger's  play 
of  1622,  The  Virgin-Martyer.  I  can  testify 
that  Aesculapius,  the  god  of  medicine  in 
ancient  Roman  mythology,  is  alive  and 
well  today  and  working  in  medical  care 
delivery  settings. 

As  I  entered  the  hospital.  I  glanced  with 
a  practiced  eye  at  the  surroundings  and 
judged  that  everything  looked  the  same  as 
it  always  did.  But  soon  I  found  that  the 
experience  of  being  a  patient  was  like  sud- 
denly being  lowered  to  the  bottom  of  a 
well  or  raised  to  the  top  of  a  tower;  the 
view  of  the  same  places  and  the  same  peo- 
ple drastically  changed.  For  me,  the  most 
revealing  and  surprising  insights  occurred 
as  a  direct  result  of  the  relationship  be- 
tween myself  and  the  physician.  These 
revelations  derived  from  one  important 
concern  throughout  my  hospitalization: 
my  loss  of  control  and  lack  of  power  to 
determine  the  events  that  affected  me. 


Active- Passive  continuum 

As  any  two  people  interact,  each  person 
assumes  a  degree  of  activity  and  passivity. 
To  the  extent  that  one  person  is  overly 
active,  the  other  individual  must  become 
passive,  or  a  clash  occurs.  The  activity- 
passivity  dimension  determines  who  will 
be  in  control,  the  passive  partner  giving 
way  to  the  more  active  one.  Control  also 
determines  the  nature  of  the  decision- 
making process  between  two  people. 
Thus,  in  a  patient-physician  relationship, 
if  the  patient  is  totally  passive  and  im- 
mobilized (as,  for  example,  during 
surgery),  the  surgeon  assumes  all  of  the 
activity,  and  there  is  virtually  no  interac- 
tion.   The   patient   is   a   passive   object. 


Formerly  associate  professor  at  the  University 
of  Southern  Mississippi.  Haitiesburg.  Dr. 
Kalisch.  a  graduate  of  the  University  of  Neb- 
raska School  of  Nursing.  Omaha,  with  her  doc- 
torate in  human  developinent  from  the  Univer- 
sity of  Maryland.  College  Park,  is  now  profes- 
sorand  chairperson,  department  of  parent-child 
nursing.  University  of  Michigan  School  of 
Nursina.  Ann  Arbor. 


wholly  submissive  to  the  activity  of  th 
physician  —  a  state  of  affairs  which  i 
obviously  essential .  Even  when  the  palier 
is  conscious  and  capable  of  reasoning  an 
feeling,  the  physician  may  still  exercis 
full  control;  he  issues  orders,  and  the  pa 
tient  is  expected  to  follow  along  subinis 
sively. 

On  the  other  end  of  the  continuum, 
patient  inay  assuine  a  highly  active  role  i' 
the  interaction,  and  the  physician  a  totall 
passive  stance.  It  may  be  difficult  to  iin 
agine  such  a  circumstance,  and  man 
would  consider  it  altogether  unprofes 
sional.  Yet  it  does  happen,  as  Duff  am 
Hollingshead  have  docuinented  in  thei 
exhaustive  study  of  hospitals,  physicians 
and  nurses: 

The  practitioners  acted  to  protCLt  their  posiliol 
as  physician  to  the  patient,  but  they  were  nc 
always  free  to  use  their  best  medical  judgment 
Many  physicians  responded  to  the  demands  o 
the  sick  persons  or  their  fainilies  even  whei 

Copyright  January  1975.  The  American  Joui 
nal  of  Nursing  Company.  Reprinted  (mmNurs 
ing  Outlook,  January  1975. 


iuch  demands  had  little  to  do  with  solving  the 
patient's  problems;  such  demands  commonly 
involved  hospitalization,  a  "dictated"'  diag- 
losis.  and  inappropriate  therapy.  The  physi- 
;ian  feared  loss  of  status  and  income  as  well  as 
involvement  in  the  problems  of  the  patients.^ 

In  this  last  instance,  the  patient  is  con- 
trolling the  physician.  Thus,  we  see  there 
are  two  possible  models  of  physician- 
patient  relationships:  one  based  on  what  is 
known  as  "aesculapian  authority."  and 
the  other  based  on  joint  participation. 

Aesculapian  model 

Where  along  this  continuum  of 
activity-passivity  do  most  patient- 
physician  relationships  fail'?  In  the  vast 
majority  of  instances,  the  physician  holds 
iractically  all  of  the  control.  In  fact,  the 
power  he  wields  is  so  remarkably  potent 
that  it  has  been  specifically  labeled  as 
"aesculapian  authority"  by  Paterson.^  ■*  It 
is  utilized  to  convince  patients  that  they  are 
indeed  "sick"  and.  furthermore,  that  they 
must  submit  to  various  treatments,  hos- 
pitalization, and  curtailment  of  normal  ac- 
tivities. 

For  the  person  who  is  ill,  this  authority 
is  greater  than  any  other  existing  pow  er  — 
at  least,  within  that  particular  context  and 
for  that  particular  moment.  And  he  re- 
sponds by  ineekly  following  along  with 
what  is  ordered,  no  matter  how  embarras- 
sing, dangerous,  or  painful  it  may  be. 
People  who  are  ordinarily  aggressive  turn 
passive,  the  dominant  become  submis- 
sive, and  the  boisterous  yield  to  silence. 
Outrages  are  tolerated  from  physicians 
that  would  not  be  acceptable  for  a  second 
from  anyone  else.  The  most  surprising  and 
perplexing  characteristic  of  this  power  is 
that  it  is  invisible;  most  people  are  totally 
unaware  that  it  exists. 

According  to  Paterson,  aesculapian  au- 
thority combines  three  different  kinds  of 
authority,  which  accounts  for  its  extreme 
potency.  First,  the  physician  carries  the 
authority  of  an  expert,  as  is  true  of  all 
people  who  have  the  knowledge  and  skills 
essential  for  rendering  a  needed  service 
valued  by  society.  An  auto  mechanic,  for 
example,  possesses  an  expertise  thought  to 
be  essential  by  most  people:  he  is  looked 
upon  as  an  important  authority  figure  —  at 
least,  within  the  specific  context  of  having 
one's  car  repaired.  As  contrasted  with  the 

THE  CANADIAN  NURSE  —  June  1975 


advice  of  the  physician,  however,  we  find 
it  relatively  easy  to  reject  the  auto 
mechanic's  suggestions.  Granted,  the 
seriousness  of  the  medical  enterprise  ac- 
counts for  a  portion  of  this  difference,  but 
not  all  of  it  by  any  means.  The  physician 
wields  something  more  than  authority  by 
expertise. 


Part  of  this  superpower  is  moi^ally 
based,  derived  from  the  Hippocratic  oath. 
It  gives  the  physician  the  right  to  control 
the  patient  because  he  is  believed  to  be 
morally  committed  to  act  for  the  good  of 
his  patients.  He  is  a  professional,  guided 
by  certain  ethical  principles  and  thus  be- 
lieved to  act  in  the  client's  interest  rather 
than  his  own.  The  thought  that  he  might 
not  do  his  very  best  never  occurs  to  most 
people. 

Beyond  this,  there  is  a  third  type  of 
power,  perhaps  of  major  significance 
here.  The  result  of  tradition  that  dates  back 
to  centuries  ago  when  medicine  was  a  pro- 
duct of  "natural  philosophy,"  this  power 
stems  from  the  concept  that  the  physician 
has  license  to  control  by  reason  of  God- 
given  grace.  People  believe  —  in  a  vague 
and  almost  unconscious  way  —  that  he  has 
special  connections  with  the  world  of  the 
unknown,  philosophically  and  spiritually. 

For  the  layman,  in  contrast,  medicine  is 
still  mysterious  and  unpredictable,  set 
apart  from  normal  human  affairs.  The  key 


element  that  sustains  this  attitude  is  the 
arbitrary  nature  of  life  and  death.  In  other 
words,  it  is  the  patient's  fear  of  death  and 
his  desire  to  live,  along  with  the  conviction 
that  the  physician  has  special  powers 
withheld  from  ordinary  mortals,  that 
causes  the  average  person  to  believe  that 
the  physician  has  more  going  for  him  than 
expertise  alone.  It  is  somewhat  suggestive 
of  the  tribal  medicine  man.  and  actually 
the  physician  does  assume  a  half-godlike 
role. 

I  am  reminded  of  a  meeting  where  one 
of  the  speakers  asked  the  audience:  "What 
do  you  think  the  initials  M  D  really  stand 
for'?"  After  a  few  moments  of  suspenseful 
silence,  he  answered  his  own  question: 
"Minor  Deity,  of  course."  No  one  failed 
to  get  the  point,  since  the  privileged  status 
attributed  to  physicians  (how  often  do  they 
get  a  parking  ticket?)  and  the  high  order  of 
egotism  which  typifies  their  behavior  im- 
mediately came  to  everyone's  mind.  But 
beyond  this,  it  is  apparent  that  this  priestly 
role  is  utilized  as  part  of  the  "bedside 
manner' '  for  the  purpose  of  persuading  the 
patient  to  do  what  is  "best"  as  diagnosed 
by  the  physician. 

Only  one  choice 

As  a  result,  the  health  care  system  is  set 
up  so  that  the  patient  has  only  one  major 
choice  —  that  of  the  primary  care  or  first- 
line  physician.  And  this  choice,  it  might  be 
said,  is  usually  based  on  such  unreliable 
information  as  a  friend's  recommendation: 
"He's  a  good  doctor."  Few  individuals 
know  such  basic  facts  as  where  their 
physician  earned  his  medical  degree,  his 
years  of  experience  and  in  what  settings, 
and  whether  or  not  he  is  board  certified. 

After  this  initial  choice,  most  decisions 
are  made  for  the  patient  by  that  physician. 
This  includes  the  choice  of  treatment,  as 
w  ell  as  the  choice  of  specialists  for  referral 
or  no  referrals  at  all.  Even  the  choice  of 
hospitals  is  often  determined  for  the  pa- 
tient. 

This  is  quite  a  departure  from  other  in- 
stances of  consumer  behavior.  When  an 
individual  wishes  to  buy  a  new  car.  for 
instance,  he  not  only  determines  which 
dealership  he  wants  to  patronize  but  also 
what  he  really  would  like  in  the  way  of  a 
car  and  how  much  he  is  willing  to  pay  for 
it.  These  basic  decisions  are  not  made  for 


him,  even  though  salesmen  may  inspire 
some  upward  modifications  in  style  and 
price. 

In  summary,  then,  the  medical  market- 
place can  be  described  as  follows: 

The  physician,  not  the  patient,  combines  the 
components  of  care  into  a  treatment.  In  other 
markets,  the  consumer,  with  varying  degrees  of 
knowledge,  selects  the  goods  and  services  he 
desires  from  the  available  alternatives.  In  med- 
ical care,  however,  the  patient  does  not  usually 
make  his  choice  directly  ...  He  selects  a 
physician  who  then  makes  .  .  .  choices  for 
him.' 

As  mentioned  earlier,  there  does  exist 
some  variation  in  this  pattern.  For  one 
thing,  the  degree  of  activity  or  control  the 
patient  is  allowed  to  assume  is  related  to 
whether  he  is  consulting  a  medical  prac- 
titioner with  a  ■ 'client-dependent' ■  or  a 
"colleague-def)endent"  practice.  In  the 
former  instance,  the  success  of  the  physi- 
cian (usually  a  general  practitioner, 
jjediatrician,  or  internist)  may  depend  on 
the  kind  of  relationship  he  develops  with 
his  patients.  As  he  continues  to  see  and 
know  a  patient  over  a  period  of  time,  he 
may  be  more  inclined  to  share  infomiation 
with  him,  give  him  more  control  over  his 
treatment  —  sometimes,  to  the  point  of 
yielding  to  patient  demands  for  medica- 
tions, hospitalization,  and  the  like. 

These  client-dependent  physicians  par- 
ticipate in  the  professional  referral  system. 
The  ca.ses  they  cannot  handle  are  funneled 
deeper  into  the  medical  care  system  to  the 
specialists  —  surgeons,  neurologists, 
urologists,  radiologists,  and  the  like  — 
whose  practices  are  colleague-dependent. 
These  practitioners,  who  have  no  continu- 
ing relationship  with  the  patient  and  see 
him  only  on  referral,  are  generally  guided 
almost  completely  by  their  medical  exper- 
tise and  not  by  the  patient's  demands.  This 
is  considered  quite  desirable  by  the  profes- 
sion. 

The  patient,  however,  usually  loses 
whatever  degree  of  control  he  may  have 
enjoyed  with  his  primary  care  practitioner. 
He  is  usually  sicker,  more  frightened  and 
overwhelmed,  and  thus  more  dependent. 
The  specialist,  by  virtue  of  the  system, 
offers  the  patient  very  little  independence 
and,  generally  speaking,  interaction  is  de- 
creased and  less  open. 

The  decline  in  client-dependent  prac- 


tices has  resulted  in  an  overall  decrease  in, 
the  input  patients  have  in  decisions  about 
their  health  care.  And,  even  in  such  prac- 
tices, the  aesculapian  concept  does  not 
dispose  toward  sharing  information  about 
diagnostic  studies,  treatment  approaches, 
prognoses,  and  other  data  with  the  patient. 
His  questions  go  unanswered  or  are 
evaded.  Obviously,  without  the  necessary 
data,  decision-making  and  controlling  be- 
havior on  the  part  of  the  patient  are  ruled 
out.  If  he  doesn't  know  that  there  are  other 
ways  in  which  his  problem  inight  be 
treated,  he  cannot  ask  for  a  different  ap- 
proach, even  when  the  one  currently  being 
used  turns  out  to  be  unsuccessful. 

Joint  participation  model 

Moving  toward  the  opposite  end  of  the 
continuum,  a  model  for  joint  participation 
emerges.  Here,  the  interaction  between 
physician  and  patient  comes  much  closer 
to  being  one  of  equals,  and  decisions  are 
arrived  at  through  a  mutual  process  involv- 
ing considerable  two-way  cominunica- 
tion.  The  influence  of  the  physician  will 
depend  not  on  his  power  and  authority  but 
rather  on  his  persuasive  and  instructional 
capacities  —  on  his  expertise  rather  than 
his  authority. 

Under  these  circumstances  the  patient 
retains  a  high  degree  of  control  over  events 
that  will  affect  him.  Where  a  surgical  pro- 
cedure seems  indicated,  for  example,  the 
physician  makes  his  informed  decision 
after  weighing  the  feasible  alternatives  and 
the  risks  versus  the  benefits.  Then  he  pro- 
vides the  patient  with  the  right  to  under- 
take a  secondary  estimation  and,  in  order 
to  help  him  with  this  decision,  he  provides 
the  needed  data  on  other  treatinent  ap- 
proaches and  the  likelihood  of  success. 

To  arrive  at  his  own  decision,  the  pa- 
tient must  know  the  physician's  prefer- 
ences, as  well  as  details  on  how  he  selects 
data  from  his  universe  of  experience.  The 
physician,  having  made  his  own  decision, 
attemps  to  persuade  and  instruct  the  pa- 
tient; but  he  does  not  flatly  disagree  with 
him,  mislead  him,  bully  him,  or  reject  him 
for  a  questioning  attitude  or  a  final  deci- 
sion that  differs  from  his  own.  To  do  so 
would  destroy  the  collaborative  status  in- 
herent in  the  joint  participation  model. 

In  situations  where  the  best  mode  of 
management  is  not  readily  apparent  or 
known  by  the  physician,  then  patient  and 


physician  jointly  decide  what  is  best  foi 
the  patient.  An  example  would  be  a  newly 
diagnosed  diabetic,  whose  life  style,  eat- 
ing patterns,  occupation,  and  other  vari- 
ables should  all  be  considered  as  the  deci- 
sions for  treatment  are  made.  The  search 
for  the  answers  is  part  of  the  therapeutic 
process. 

Pro's  and  con's 

Proponents  of  the  concept  of  aescula- 
pian authority  vehemently  argue  that  this 
power  is  quite  essential  because  without  i 
most  patients  would  not  undergo  th< 
treatrnent  they  need.  They  would  be  toe 
afraid.  Unlike  the  storekeeper  whose  suc- 
cess comes  from  giving  his  customers 
what  they  want,  physicians  must  give  Iheii 
clients  what  they  really  need  —  which 
sometimes  means  giving  them  what  they 
don't  want  at  all!  To  accomplish  this,  the 
argument  goes,  control  and  manipulatior 
of  the  patient  are  mandated  Furthermore 
supporters  of  aesculapian  authority  sec  the 
successful  wielding  of  this  p<iwer  as  ar 
achievement  whereby  the  patient's  normal 
decision-making  abilities  are  momentaril) 
suspended,  much  to  his  own  advantage. "  ' 

Another  rationale  for  the  use  of  aescula- 
pian authority  is  that  the  body  of  medica 
knowledge  is  so  esoteric  and  complex  tha 
the  layman  would  find  it  difficult  to  grasp 
much  less  evaluate,  the  tneaning  of  hii 
diagnosis  and  treatment.  Because  of  ihii 
presumed  ignorance,  it  is  argued,  the  pa 
tient  could  harm  himself  if  allowed  t( 
share  in  the  medical  decisions. 

Although  many  patients  have  undoubt- 
edly been  pressured  by  this  awesome  au- 
thority into  accepting  the  orders  of  theii 
physicians,  the  exercise  of  this  acscula 
pian  power  has  also  led  to  noncompliance 
While  physicians  have  been  found  to  un- 
derestimate the  extent  of  noncomplianct 
among  their  patients,  studies  reveal  a  ratt 
of  33  to  50  percent.*  Davis,  who  carriec 
out  a  thorough  and  analytical  study  of  th< 
influence  of  physician-patient  interactioi 
on  compliance,  notes  that  noncomplianci 
relates  directly  to  attempts  by  the  physi- 
cian to  control  the  patient.''  '" 

Other  situations  found  to  foster  non 
compliance  include  occasions  when  th« 
physician  expresses  outright  disagreemen 
with  the  patient,  when  he  is  formal  am 
rejecting,  and  when  he  fails  to  provid< 
feedback  after  extracting  information    1 


ippears,  then,  that  when  patients  are  in- 
/olved  in  the  decision-making  process, 
hey  are  more  likely  to  accept  the  respon- 
sibilities imposed  by  their  condition  and 
»o  along  with  the  necessary  treatment. 

4ow  much  participation? 

The  question,  then,  is  the  relative  de- 
cree of  control  to  be  assumed  by  both 
partners  in  the  transaction.  Some  physi- 
:ians  involve  their  clients  to  the  fullest 
jxtent  possible   in   the  decision-making 


ment  modes  which  the  physician  offers  is 
often  underestimated.  After  all.  the 
public's  knowledge  of  medicine  has 
grown  considerably  in  the  last  50  years,  as 
has  the  level  of  fonnal  education  of  the 
populace.  Popularized,  self-help  medical 
literature  —  books,  newspaper  and 
magazine  articles  —  are  read  avidly  these 
days  C"!  read  about  it  in  the  Reader's  Di- 
gest," the  patient  tells  his  physician),  and 
television  documentaries  and  medically- 
oriented  soap  operas  all  tend  to  alert  the 


"It  appears  that  when  patients  are  involved  in  the 
decision-making  process,  they  are  more  likely  to  accept 
the  responsibilities  imposed  by  their  condition  and  go 
along  with  the  necessary  treatment." 


(recess,  but  others  find  it  difficult  to  relin- 
|uish  control  even  when  it  is  warranted. 
!ome  patients,  too.  prefer  the  passive  or 
'sick"  role,  finding  dependency  more  ac- 
:eptable  than  the  need  to  make  decisions. 

Each  patient's  capabilities  and  emo- 
ional  responses  will  influence  the  degree 
)f  participation  that  is  appropriate  for  him. 
"he  complexity  of  the  interaction  necessi- 
ated  by  joint  participation,  for  example, 
vould  make  this  model  quite  inappropriate 
or  those  of  low  intelligence  levels  or  emo- 
ionally  incapable  of  using  their  thinking 
:apacities.  If  the  problem  has  been  so  dis- 
urbing  to  the  patient  that  he  cannot  be 
ational  about  it,  he  is  not  in  a  position  to 
;hoose  what  should  be  done  for  himself. 

imilarly,  life-threatening  events  must  be 
landled  with  very  little  or  no  patient  in- 
volvement. On  the  other  hand,  if  the 
»hysician  and  patient  have  similar  educa- 
ional,  intellectual,  and  experiential  back- 
jrounds  and  the  patient  is  psychologically 
ible  to  deal  with  the  situation  at  hand,  he 
hould  be  allowed  to  participate  to  a  much 
pieater  extent  than  is  usually  the  case. 

The  patient's  ability  to  participate  re- 
iponsibly  in  the  evaluation  of  the  treat- 

HE  CANADIAN  NURSE  —  June  1975 


layman  to  issues  of  medical  care.  There- 
fore, even  when  a  patient  seems  to  accept 
the  passive,  unquestioning  role,  he  may  be 
harboring  serious  doubts  and  misconcep- 
tions about  the  way  his  condition  is  being 
managed.  He  hesitates  to  say  so ,  however. 

Beyond  this  consideration  is  the  detri- 
mental effect  that  the  authoritarian  stance 
has  on  the  patient's  self-concept;  it  takes 
away  his  usual  status  as  a  self-determining 
adult  with  reasoning  capacity  and,  above 
all.  human  dignity.  The  sacrifice  of  an 
individual's  dignity  seems  to  be  an  un- 
necessarily high  price  to  pay  for  medical 
treatment. 

It  might  be  said  that  the  patient  should 
be  able  to  resist  the  authority  of  a  physician 
if  he  were  motivated  to  do  so .  but  a  number 
of  factors  work  against  the  client's  de- 
veloping such  an  assertive  posture.  First  of 
all.  we  are  just  beginning  to  learn  about 
human  response  to  authority  in  general, 
and  some  of  the  recent  findings  have  been 
both  shocking  and  disillusioning. 

In  Milgram's  landmark  studies  on 
man's  obedience  to  authority,  individuals 
were  commanded  by  an  experimenter  to 
administer  electric  shocks  of  increasing 


severity  to  protesting,  possibly  en- 
dangered, victims.  Most  of  the  subjects 
obeyed  the  authority  figure  in  spite  of  the 
fact  that  the  directed  action  conflicted  with 
their  fundamental  standards  of  morality. 
The  author  explains.  "The  key  to  the  be- 
havior of  the  subject  lies  not  in  pent-up 
anger  or  aggression  but  in  the  nature  of 
their  relationship  to  authority.  They  have 
given  themselves  to  authority."" 

In  short,  few  people  were  found  to  have 
the  resources  needed  to  resist  authority. 
Then,  when  we  remember  the  potency  of 
physician  authority,  we  can  readily  see  the 
difficulty  a  patient  would  have  in  resisting 
such  power.  In  addition,  the  patient  has  a 
strong  desire  to  be  accepted,  liked,  and 
cared  for  by  the  physician  and  a  deep  fear 
of  being  rejected,  which  stems  from  his 
enforced  and  very  real  dependency  on  the 
physician.  He  hesitates  to  disagree,  to  as- 
sert himself. 

Patients'  rights 

In  a  free  society  such  as  ours  there  is  the 
philosophical  question  of  individual 
rights.  Basically,  I  believe  that  the  issue  of 
what  is  good  for  the  individual  is  an  issue 
that  only  he  can  determine.  Immediate 
threats  to  life  are  the  obvious  exception. 
Furthermore,  the  fact  that  a  client  has 
made  a  choice  of  professional  services 
does  not  mean  that  he  has  forever  relin- 
quished his  right  to  participate  in  the 
decision-making  process  and  to  be  in- 
formed of  significant  alternatives  in  diag- 
nosis and  treatment.  He  also  retains  the 
right  to  withdraw  from  the  service  if  he  so 
desires. 

The  whole  concept  of  patients'  rights  is 
fairly  new.  Yet,  gradually,  there  has  been 
a  rise  in  client  demands,  evidenced  primar- 
ily in  the  escalation  of  lawsuits  against 
physicians,  nurses,  and  health  care  agen- 
cies. "Informed  consent"  for  procedures 
has  become  a  legal  issue  of  growing  mag- 
nitude. Prior  to  the  eady  1960's  the  deci- 
sion to  perform  a  medical  procedure  be- 
longed to  the  physician  alone.  Since  that 
time  a  number  of  court  decisions  have 
clearly  and  firmly  established  the  patient's 
right  of  "self-determination."  In  a  recent 
article  \nthc  Journal  of  the  American  Med- 
ical Association  on  this  subject,  Don  H. 
Mills  remarks: 

He  [the  patient]  cannot,  of  course,  decide 

23 


whether  the  procedure  is  adequately  indicated, 
forthat  requires  more  medical  expertise  than  he 
possesses.  But  once  he  is  told  that  the  proce- 
dure is  recommended,  he  then  must  have 
enough  information  to  decide  whether  the 
hoped-for  benefits  are.  in  his  eyes,  sufficient  to 
risk  the  possible  hazards.'^ 

Mills  goes  on  to  explore  just  how  far  the 
physician  must  go  in  listing  hazards.  He 
suggests  a  middle-of-the-road  approach 
that  would  be  '"both  consistent  with  good 
medical  care  and  that  affords  reasonable 
legal  safety."  He  never  explains  why  full 
information  disclosed  to  the  patient  would 
be  antithetic  to  "good  medical  care,"  but 
this  surely  stems  from  the  belief  that  the 
patient  would  be  too  afraid  to  undergo  the 
procedure  if  he  were  acquainted  with  the 
potential  danger. 

But,  counterbalancing  the  presumed 
fear,  what  degree  of  rage  may  result  when 
a  patient  does  suffer  a  complication  and 
has  had  no  forewarning  of  the  possibility 
and  no  part  in  the  decision  to  take  that  risk? 
Consider,  for  example,  the  physician  who 
recommends  a  simple  mastectomy  to  a 
woman  with  breast  cancer  but  fails  to  tell 
her  that  a  modified  radical  or  a  radical 
mastectomy  is  another  approach.  I  believe 
he  has  done  his  patient  a  great  disservice. 
She  has  the  right  to  decide  whether  the 
increased  hazards  or  the  degree  of  bodily 
disfigurement  are  worth  even  a  small  hope 
of  greater  success.  Moreover,  according  to 
a  study  by  Hershey  and  Bushkoff,  disclos- 
ures to  the  patient  did  not  cause  clients  to 
withhold  their  consent  for  procedures." 

A  personal  experience 

It  was  when  my  own  need  for  medical 
care  arose  that  I  learned  so  much  about  the 
character  and  effects  of  physician-patient 
relationships.  My  physician  first  in- 
teracted with  me  in  a  highly  authoritarian 
way  but,  fortunately,  our  relationship  soon 
developed  into  one  that  was  highly  facilita- 
tive  and  essentially  based  on  joint  partici- 
pation. The  difference  that  the  two  ap- 
proaches made  in  my  feelings  of  self- 
esteem  and  control,  and  thus  my  ability  to 
cope  with  the  crisis  at  hand,  was  marked. 

As  my  illness  and  hospitalization 
began,  I  followed  along  in  the  usual  way 
with  what  my  physician  ordered.  I  had  no 
reason  not  to  be  compliant.  Relief  from 
pain  was  my  foremost  need.  It  was  after 

24 


the  x-rays  and  other  diagnostic  tests  were 
completed  and  the  physician  recom- 
mended surgery  that  I  began  to  resist  his 
controlling  behavior.  Over  the  telephone, 
our  conversation  went  as  follows: 

DOCTOR:  Your  gall  bladder  didn't  vi- 
sualize again  today. 

PATIENT:  I  knOw! 

DOCTOR:  You  do?  I  think  we  should  take 
you  to  surgery  tomorrow 
(warmly). 

PATIENT:  I'm  not  ready  {ox  that. 

DOCTOR:  Well,  we  work  for  you!  (asser- 
tively) 

PATIENT:  But  I  haven't  had  any  symptoms 
before  (voice  shrinking). 

DOCTOR:  You  can  have  a  perforated  ulcer 
without  any  symptoms,  too! 

PATIENT:  (sighing  heavily)  Does  it  have  to 
be  done  now?  This  is  not  a  good 
time  for  me. 

DOCTOR:  If  you  came  back  to  me  in  two 
weeks,  I  would  tell  you  the  same 
thing.  Youre  sitting  on  a  loaded 
pistol !  (aggressively) 

This  interchange  continued  for  a  while 
longer,  with  him  dictating  to  me  from  his 
position  of  authority.  He  was  the  parent 
and  I  the  dependent,  deferent,  acquiescing 
child. 

This  physician  obviously  uses  au- 
thoritarianism with  considerable  success, 
and  his  actions  undoubtedly  stem  from  a 
well-intentioned  belief  that  his  patients" 
welfares  are  at  stake.  Surgeons  may  rely 
more  heavily  on  this  interaction  model 
than  other  rnedical  practitioners,  because 
surgery  tends  to  create  more  stress  and 
anxiety  in  the  patient  than  other  methods 
of  treatment.  For  me,  though,  the  ap- 
proach was  devastating  because  I  felt  as  if 
my  usual  identity  as  a  self-determining 
adult  was  being  replaced  with  that  of  a 
dependent,  passive,  and  helpless  non- 
being.  This  altered  self-image  was  quite 
unacceptable;  the  result  was  feelings  of 
anxiety,  frustration,  and  anger. 

The  physician  expected  a  childlike, 
unquestioning  faith  and  trust,  and  I  found 
myself  unable  to  meet  his  expectations. 
True.  I  respected  his  abilities  as  a  highly 
competent  clinician  and  surgeon  and  felt 
physically  safe  in  his  care;  this  made  it  all 
the  more  difficult  to  resist  his  authority. 
But  that  wasn't  enough.  I  wanted  full  ac- 


cess to  the  data  and  reasoning  upon  whi> 
he  made  his  decision.  Furthermore,  1  b 
lieved  that  1  was  in  the  best  position 
decide  whether  or  not  to  undergo  surge 
at  that  time.  I  needed  his  help  to  make  th 
decision,  however.  And  I  also  needed 
know  that  he  saw  me  as  an  individu 
rather  than  just  "another  cholecyste 
tomy." 

While  I  was  able  to  put  up  some  passi'' 
resistance  to  his  demands,  it  surprise;^  ii 
that  I  was  not  more  openly  aggressive  i 
my  interaction  with  him.  In  fact,  as  \\ 
became  more  dominant.  I  became  less  i 
sertive  and  more  passive.  In  normal  siiu: 
tions,  my  respwnse  is  just  the  opposite.  .\' 
reaction  was  certainly  not  due  to  the  fa 
that  he  was  a  physician  per  se,  becau' 
over  the  year  I  had  established  loo  mar 
professional  co-equal  relationships  wiii 
physicians  to  be  impressed  by  the  fac| 
Instead,   I  attribute  my  response  to  th 
awesome  power  physicians  exercise  o\\ 
their  patients:  I  was  no  exception. 

Two  or  three  hours  after  our  telephoii 
conversation,  the  physician  appeared  i 
person.  He  had  made  the  trip  to  help  m 
with  my  decision,  and  his  approach  w; 
entirely  different  this  time.  He  provide 
me  with  much  of  the  basis  for  his  decisic 
and  when  I  decided  against  surgery  for  th 
time  being,  he  said.  "All  right,  that 
fine."  obviously  genuine  in  his  accef 
tance  of  me. 

I  remember  being  quite  surprised  an  1 
puzzled  by  the  decided  contrast  in  his  be 
havior.  In  the  next  few  days  our  relatim: 
ship  continued  to  develop  according  to  th 
latter  interaction  pattern,  and  my  confi 
dence  in  him  grew  immeasurably.  Eventu 
ally  I  decided  to  have  surgery.  Although 
was  moved  to  this  decision  both  by  th 
continuation  of  pain  and  by  the  passage  o 
enough  time  to  work  through  the  shoe 
and  denial  phases  of  my  illness,  I  am  abso 
lutely  certain  that  I  would  have  continuci 
to  reject  surgery  if  I  had  not  had  the  benefi 
of  the  ensuing  therapeutic  relationshij 
with  my  physician. 

Before  I  felt  safe  enough  to  relinquisl 
all  control  of  myself  and  my  destiny  to  ihi 
physician,  I  had  to  believe  that  he  caiei 
what  happened  to  me  and  valued  my  e\iv 
tence  as  an  individual.  The  extensive  hel[ 
he  provided  me  in  making  the  decision  to 
surgery  went  a  long  way  toward  con  vine 
ing  me  that  he  did,  indeed,  value  me  as  ai 


individual.  In  addition,  his  interaction 
with  me  immediately  before  the  surgery, 
even  when  I  was  already  in  the  operating 
room,  was  extremely  reassuring  —  more 
so  than  I  would  have  predicted.  His  evi- 
dent concern  apparently  represented  the 
much  needed  validation  that  I  was  still  a 
person  (even  in  that  setting)  and  not  just  a 
"gall  bladder." 


from  the  usual  sources  of  information  and 
social  support  needed  to  assume  an  active 
role  in  making  decisions.  It  is  not  uncom- 
mon for  the  staff  to  intimidate  the  patient 
in  subtle  ways  or  to  exercise  covert  threats 
of  rejection  to  get  him  to  go  along  with 
what  the  physician  and  nurse  dictate.  The 
nurse's  actions  sometimes  stem  from  her 
feeling  of  subordination  to  the  physician. 


, 


"  .  .  .  The  aesculapian  concept  does  not  dispose  toward 
sharing  information  about  diagnostic  studies,  treatment 
approaches,  prognoses,  and  other  data  with  the  patient. 
His  questions  go  unanswered  or  are  evaded." 


Implications  for  the  nurse 

This  discussion  has  centered  on  the 
dynamics  of  the  patient-physician  rela- 
tionship and  has  explored  a  phenomenon, 
labeled  aesculapian  authority,  that  usually 
goes  unnoticed,  but  nonetheless  plays  a 
highly  significant  role  in  the  health  care 
delivery  system.  An  understanding  of  the 
phenomenon  should  help  the  nurse  to  im- 
prove both  the  system  and  her  nursing 
care. 

First  of  all ,  the  nurse  is  in  a  key  position 
to  help  both  the  patient  and  his  family  deal 
effectively  with  problems  they  may  be  ex- 
periencing, either  in  their  relationship  with 
the  physician  or  with  the  advice  he  has 
given  them.  As  with  other  problems,  the 
patient  needs  the  benefits  of  facilitative 
communication.  Yet  many  nurses  become 
extremely  anxious  when  a  patient  alludes 
in  any  way  to  negative  feelings  about  a 
physician  —  or  another  nurse,  for  that 
matter.  Many  times  the  nurse  rushes  to 
protect  the  physician:  "You  have  an  excel- 
lent doctor."  This  effectively  blocks 
further  communications  on  the  subject  and 
makes  it  even  more  difficult  for  the  patient 
to  exercise  his  decision-making  powers. 

The  hospitalized  patient  is  literally  an 
inmate  of  a  total  institution,  wholly  de- 
pendent on  the  nurses  for  care  and  cut  off 

THE  CANADIAN  NURSE  —  June  1975 


She  may  actually  fear  rejection  by  him  or 
retributive  measures.  Instead  of  seeing 
herself  as  a  patient  advocate,  she  sees  her- 
self as  a  physician  helper.  It  is  more  re- 
warding or  less  threatening  for  her  to 
please  the  physician  than  it  is  to  meet  the 
needs  of  the  patient. 

This  does  not  imply  in  any  way  that  the 
nurse  should  feel  that  she  must  protect  the 
patient /row  the  physician.  I  say  this  be- 
cause 1  have  known  a  number  of  nurses 
who  have  adopted  this  stance  as  a  defen- 
sive response  to  physician  dominance. 
Even  though  the  patient  may  have  diffi- 
culty confronting  or  communicating  with 
the  physician,  he  usually  doesn't  need  or 
want  protection  from  him.  What  he  does 
need  is  the  opportunity  to  talk  about  his 
concerns  with  a  genuine,  warm,  and  em- 
pathic  helper  who  will  help  him  to  work 
out  his  own  solutions. 

It  should  be  pointed  out  that  the  patient 
is  not  too  1  ikely  to  think  of  the  nurse  in  this 
way.  He  probably  feels  that  his  physician 
is  the  only  person  that  he  can  count  on  to 
take  care  of  him  on  a  continuing  basis  and 
be  concerned  with  his  needs  over  time. 
With  the  prevailing  nursing  care  system, 
the  patient  receives  care  from  innumerable 
nurses  during  hospitalization,  and  rarely 
do  opportunities  exist  for  in-depth,  con- 


tinuing relationships.  Primary  nursing  is 
an  exciting  departure  from  the  traditional 
system  and  promises  to  go  a  long  way 
toward  improving  this  situation.'* 

Offering  advice  and  opinions  is  not  ap- 
propriate, as  is  true  in  all  instances  of 
therapeutic  communication.  Moreover, 
the  nurse  is  obviously  not  in  a  position  to 
advise  about  medical  decisions.  It  is  the 
physician's  responsibility  to  present  the 
patient  with  his  medical  opinion  and  the 
data  he  bases  it  on,  although  the  nurse 
should  assume  responsibility  for  clarifying 
any  misconceptions  on  the  patient's  part  of 
a  physician's  explanations.  Primarily, 
however,  she  helps  the  patient  to  work 
through  his  feelings  by  means  of  a  helping 
relationship  based  on  a  high  level  of  em- 
pathy. Knowledge  of  the  phenomenon  de- 
scribed here  should  offer  valuable  data  for 
this  empathic  interaction." 

As  a  patient,  I  was  fortunate  to  have  this 
kind  of  help.  On  only  one  occasion  did  a 
nurse  argue  with  a  decision  I  had  made. 
Several  nurses,  however,  erred  in  the  other 
direction,  for  it  is  equally  unwise  to  agree, 
unreservedly  and  on  all  occasions,  with  a 
patient's  point  of  view.  As  Rogers  ex- 
plains: 

In  almost  every  phase  of  our  lives  ...  we  find 
ourselves  under  the  rewards  and  punishments 
of  external  judgments  .  .  .  But  in  my  experi- 
ence they  do  not  make  for  personal  growth,  and 
hence  I  do  not  believe  that  they  are  a  part  of  a 
helping  relationship.  Curiously  enough,  a  posi- 
tive evaluation  is  as  threatening  in  the  long  run 
as  a  negative  one.  since  to  inform  someone  that 
he  is  good  implies  that  you  also  have  the  right  to 
tell  him  he  is  bad.  So  I  have  come  to  feel  that  the 
more  I  can  keep  a  relationship  free  of  judgment 
and  evaluation,  the  more  this  will  permit  the 
other  person  to  reach  the  point  where  he  recog- 
nizes that  the  locus  of  evaluation,  the  center  of 
responsibility,  lies  within  himself.  The  mean- 
ing and  value  of  his  experience  is  in  the  last 
analysis  something  which  is  up  to  him.  and  no 
amount  of  external  judgment  can  alter  this." 

Decisions,  then,  to  be  good  ones  for  the 
individual  making  the  choice,  should 
emanate  solely  from  within  that  person. 

As  has  been  pointed  out,  one  of  the  key 
ways  to  keep  patients  from  exercising  con- 
trol is  to  restrict  the  information  they  re- 
ceive. Throughout  my  years  of  practice,  I 
have  made  it  a  habit  to  do  just  the  opposite; 
while  this  generally  goes  against  estab- 


lished  policies,  I  believe  that  it  is  quite 
essential  for  the  nurse  to  break  down  the 
barriers.  As  a  patient,  I  wanted  to  know 
my  vital  signs,  the  drugs  I  was  being 
given,  the  results  of  diagnostic  tests,  and 
all  other  data  on  my  "case."  To  get  this 
information,  I  usually  had  to  ask  for  it. 
sometime  with  quite  a  bit  of  determination 
and  forcefulness  in  my  voice. 

In  other  words,  nurses  and  other  health 
team  members  weren't  in  the  habit  of  vol- 
unteering this  information  and  sometimes 
felt  quite  uncomfortable  in  doing  so.  I  got 
my  share  of  stylized  responses  such  as 
"Your  temperature  is  fine."  I  didn't  want 
reassurance;  I  wanted  exact  information. 
In  one  instance,  a  staff  nurse  brought  in  a 
new  medication  and  when  I  asked  what  it 
was,  she  responded,  "I  can't  tell  you!  You 
of  all  people  should  know  that!"  That 
made  me  angry,  even  though  I  knew  I 
could  ask  another  nurse  who  would  tell 
me.  It  seemed  illogical,  indeed,  that  this 
nurse  had  the  right  to  know  more  about  my 
treatment  than  I  did  myself. 

After  surgery  a  nurse  colleague  who 
was  taking  care  of  me  let  me  look  at  the 
pathology  report.  This  was  very  reassur- 
ing, not  because  I  would  have  doubted  her 
truthfulness  if  she  had  simply  told  me  the 
results,  but  because  she  was  allowing  me 
to  exercise  my  usual  way  of  assessing  a 
patient  —  this  time,  myself.  All  the  con- 
crete knowledge  I  had  about  myself  in- 
creased my  feelings  of  power  and  control 
as  well  as  my  self-esteem. 

There  are  a  few  patients  who  definitely 
do  not  want  this  kind  of  information;  they 
are  less  anxious  if  they  assume  a  position 
of  blind  dependence.  Then,  again,  many 
people  may  not  seem  to  want  to  know; 
when  questioned,  however,  they  express  a 
deep-felt  desire  to  be  informed,  but  say 
they  "didn't  feel"  that  it  was  their  right. 
Therefore,  it  is  absolutely  essential  for  the 
nurse  to  make  keen  assessments  as  to  each 
patient's  needs  and  capabilities. 

More  than  one  villain 

Physicians  are  not  the  only  ones  to  exer- 
cise aesculapian  authority.  Nurses  are 
often  authoritarian,  too,  so,  while 
medicine  has  been  singled  out  here,  it  is 
little  more  of  a  villain  than  nursing.  The 
pervasiveness  of  the  medical  model  ac- 
counts for  some  of  this  behavior;  however, 
it  seems  to  me  that  the  nurse  sometimes 
uses  her  authority  to  build  up  her  profes- 

26 


sional  status  as  well.  How  often  for  in- 
stance, is  the  patient  allowed  to  participate 
in  decisions  about  his  nursing  care?  Here  is 
where  the  nurse  can  considerably  enhance 
the  patient's  sense  of  control,  by  encourag- 
ing him  to  participate  in  innumerable  deci- 
sions, ranging  from  whether  or  not  he  will 
have  a  public  health  nurse  referral  to  the 
determination  of  the  time  of  his  treatments 
and  medications. 

As  is  true  in  medical  management,  the 
nurse  who  allows  the  patient  to  participate 
in  these  decisions  runs  the  risk  that  he  will 
choose  an  alternative  that  she  does  not 
believe  to  be  in  his  best  interest.  If  at- 
tempts to  instruct  and  persuade  the  patient 
fail,  then  the  nurse  must  have  enough 
humility  to  allow  him  the  greater  value  of 
the  dignity  of  his  own  choice.  If  she  im- 
poses her  own  notion  of  what  is  good  onto 
the  patient,  she  will  at  the  same  time  re- 
duce his  dignity. 

In  retrospect 

An  unexpected  encounter  with  hos- 
pitalization and  surgery  has  prompted  this 
attempt  to  provide  some  insight  into  the 
almost  mystical  relationship  between 
physicians  and  patients.  Half-gods,  physi- 
cians resemble.  Yet  for  patients  to  ac- 
quiesce completely  with  this  concept, 
without  demanding  some  reasonable  de- 
gree of  participation  in  the  decision- 
making, seems  unreasonable.  Certainly 
this  whole  process,  especially  as  it  relates 
to  the  third  party  in  the  person  of  the  nurse, 
deserves  much  more  attention  than  it  has 
received. 

In  the  same  play  from  which  I  quoted  at 
the  beginning  of  this  article  is  the  follow- 
ing exchange: 

DOCTOR.  Take  again  your  bed.  sir: 
Sleep  is  a  sovereign  physic. 

ANTONINUS.  Take  an  asss  head,  sir: 
Confusion  on  your  fooleries,  your  charmsl 
Thy  pills  and  base  apothecary  drugs 
Threalcn'd  to  bring  unto  me?  Out.  you  im- 
postor! 

Quacksalving.    cheating    mountebank!    Your 
skill 
Is  to  make  sound  men  sick,  and  sick  men  kill." 

Strong  language,  perhaps,  and 
medicine  has  come  a  long  way  in  the  over 
350  years  that  have  passed  since  those 


words  were  spoken.  Nevertheless,  toda\ 
society  is  more  and  more  an  outspoken  am 
critical  one  —  one  that  demands  to  know 
rather  than  just  be  told.  An  unresponsive 
dictatorial  attitude  on  the  part  of  eithe 
physician  or  nurse  is  increasingly  likel\  h 
evoke  a  reaction  that  could  strongly  rei 
semble  that  of  Antoninus  —  three  ceni 
turies  later. 

References 

l.Gifford.  W..  ed.  The  Plays  of  PhiliA 
Massenger.  London,  W.  Bulmer  and  Co  ' 
1813.  p.  76. 

2. Duff.  R.S.  and  Hollingshead.  A.B.  SV 
ness  and  Society.  New  York.  Harpc; 
Row,  1968.  p.  382. 

3.Paterson.  T.T.  Management  Theory.  Lon- 
don, Business  Publications.  1966. 

4.Siegler.  !VIiriam.  and  Osmond.  Humphav 
Aesculapian  authority.  Hastings  Ceiiwi 
Studies  l(2):41-52,  1973. 

S.Feldstein,  P.J.  Research  on  the  demand  foi 
health  services.  Milhank  Mem.  Fund  Q. 
44(Suppl):  138.  July  1966. 

6.Paterson.  op  cil. 

7.Siegler  and  Osmond,  op.  cit. 

S.Davis,  M.S.  Variations  in  patients'  com- 
pliance with  doctors'  advice.  Am.  J.  Public 
Health  58:274-288.  Feb.  1968. 

9. 1  bid. 

10. Davis.  M.S..  and  Von  der  Lippe.  R.P.  Dis- 
charge from  hospital  against  medical  ad- 
vice: a  study  of  reciprocity  in  the  doctor- 
patient  relationship.  Soc.  Sci.  Med. 
1:336- .^42.  1968. 
1  1  .Milgram,  Stanley.  Obedience  to  Authority.' 
An  Experimental  View.  New  York.  Harpet 
&  Row,  1973.  p.  168. 
12. Mills.  D.H.  Whither  informed  consent? 
JAMA  229:307.  July  15.  1974. 

l3.Hershey,  Nathan,  and  Bushkoff.  S.H.  In- 
formed Consent  Study.  Pittsburgh,  Aspen 
Systems  Corp..  1969. 

1 4. Marram.  G.D..  and  others.  Primary  Nurs- 
ing: A  Model  for  Individualized  Care.  Si. 
Louis.  C.  V.  Mosby  Co..  1974. 

15.Kalisch,  B.J.  What  is  empathy?  Am.  J. 
Nurs.  73:1548-1552.  Sept.  1973. 

16. Rogers.  C.R.  The  characteristics  of  a  help 
ing  relationship.  Personnel  Guid  ' 
27:6-15.  Sept.  1958. 

17.Gifford.r)p.  cit..  p.  78. 


Preop  visits  expand 
the  OR  nurse's  role 


The  operating  room  nurse  can  improve  the  standards  and  practice  of  nursing  care 
given  to  surgical  patients  by  pre-  and  postoperative  visits  to  them.  This  article 
describes  a  program  of  pre-  and  postoperative  visiting  carried  out  by  the  operating 
room  nurses  at  the  University  of  Alberta  Hospital  in  Edmonton. 


Wendy  S.  Dirksen  and  Muriel  G.  Shewchuk 


How  can  operating  room  nurses  improve 
the  nursing  care  given  to  patients?  By  pre- 
and  postoperative  visits  to  surgical  pa- 
tients. The  case  of  Ms.  Z.  shows  how  such 
visits  can  improve  professional  nursing 
care  in  the  OR. 

Ms.  Z. ,  an  84-year-old,  was  booked  for 
an  amputation  of  her  left  leg  above  the 
knee.  When  an  OR  nurse  went  to  the  ward 
for  a  preoperative  visit  with  Ms.  Z.,  the 
ward  nurse  told  her  that  the  patient  was 
confused  and  did  not  understand  English. 
From  the  chart,  the  OR  nurse  learned  that 
Ms.Z.  had  diarrhea,  bilateral  cataracts, 
renal  insufficiency,  congestive  heart  fail- 
ure, and  diabetes. 

The  OR  nurse  went  to  visit  her,  fully 
expecting  limited  communication.  The 
patient's  roommate  suggested  an  approach 
to  the  communication  problem  when  she 
described  Ms.  Z.  as  nearly  blind,  but  not 
as  confused  as  she  appeared,  if  she  were 
spoken  to  in  her  native  tongue. 

The  OR  nurse  arranged  for  an  interpreter 
to  be  present  in  the  operating  room  the 
following  morning  to  convey  necessary 
information  to  the  patient.  Because  of  the 
old  woman's  poor  medical  condition,  she 
was  given  a  spinal  anesthetic.  The  in- 
terpreter was  able  to  explain  this  to  her  and 
to  allay  some  of  her  fears. 

We  draped  Ms.  Z.  with  special  water- 
proof, orthopedic  drapes  in  an  attempt  to 
protect  the  surgical  field  from  possible 
fecal  contamination.  During  the  proce- 
dure, she  had  a  large  watery  bowel  move- 
ment, but  the  surgical  field  remained 
sterile.  When  the  nurse  revisited  the  pa- 
tient postoperatively,  she  was  fine,  and  the 
incision  was  healing  nicely.  Ms.  Z.  had  no 
postoperative  infection. 


This  example  clearly  illustrates  that  a 
nursing  assessment,  made  during  a 
preof)erative  visit,  can  assist  the  nurse  to 
prepare  an  individualized  plan  for  safe 
nursing  care. 

Safe  nursing  care  "describes  nursing 
care  that  leaves  the  patient  free  from  any 
preventable  damage,  danger,  or  injury. "' ' 

Visiting  program 

The  operating  room  staff  nurses'  group 
at  the  University  of  Alberta  Hospital  pro- 
posed the  idea  of  preoperative  and  post- 
operative visits.  After  they  obtained  aj)- 
proval  from  nursing  administration  for  the 
visit  program,  they  sent  letters  to  the 
surgeons  and  anesthetists,  outlining  the 
objectives  and  approach  for  the  visits. 

They  defined  preoperative  visits  as  a 
professional  nursing  action  to  assess  the 
surgical  patient,  with  the  goal  of  improv- 
ing patient  care  in  the  operative  phase.  The 
program  objectives  were  that  the  operative 
visits  will; 

n  Enable  the  or  nurse  to  be  prepared 
thoroughly  for  her  patients  in  the  operating 
room,  so  that  patient  care  will  be  effective, 
that  is,  will  produce  the  desired  results.^ 
n  Decrease  the  depersonalization  experi- 
enced by  the  patient  and  the  operating 
room  nurse,  by  increasing  patient  contact. 
D  Expand  the  role  of  the  OR  nurse  and 
increase  her  job  satisfaction. 
n  Enable  the  OR  nurse's  role  to  comple- 
ment the  roles  of  the  surgeon,  anesthetist, 
and  ward  nursing  staff. 
D  Improve  communication  between  the 
OR  nurse  and  the  ward  nurse. 

Prior  to  the  initiation  of  the  program,  the 
nurses  held  an  8-week  trial  to  determine 


THE  CANADIAN  NURSE  —  June  1975 


method 


1 

^  Prior  to  leaving  the  OR  to  visit  the  patient,  the 
nurse  takes  information  from  the  Ofi  booking  schedule, 
which  includes  the  patient's  name,  ward,  religion,  sur- 
geon, scheduled  time  of  surgery,  and  operative  pro- 
cedure. She  records  these  on  the  nursing  care  plan. 
The  surgeon's  preference  card  is  reviewed  for  special 
techniques  of  which  the  patient  should  be  aware  in 
the  postoperative  period. 


< 


On  the  ward,  the  nurse  introduces  herself  to  the 
charge  nurse  or  team  coordinator  and  asks  her  for 
information  that  will  make  the  preoperative  visit  more 
valuable.  If  the  patient  has  not  been  informed  of  the 
surgery,  the  visit  is  delayed.  The  OR  nurse  reviews 
the  patient's  chart,  checking  for  the  completeness  and 
accuracy  of  the  consent;  special  consultation  or  special 
consent  forms;  height;  weight;  age;  allergies;  physical, 
visual,  or  auditory  disai^.'ities;  previoussurgery;special 
doctor's  orders  or  medications;  and  language  barriers. 


,reop  visit 


The  immediate  effectiveness  of  nursing  care  in  the 
OR  is  evaluated  and  recorded  on  the  nursing  care 
plan.  Questions  asked  to  determine  this  success  in- 
clude: was  the  patient  safely  nursed?  were  all  supplies 
present  in  the  theatre?  and  were  the  patient's  indi- 
vidual needs  met?  ^ 


A  relaxed,  receptive  atmosphere  is  necessary  for  a 
successful  interview.  The  key  point  is  to  make  the 
nursing  assessment.  After  introducing  herself  to  the 
patient,  the  OR  nurse  explains  the  purpose  of  her 
visit.  This  gives  the  patient  time  to  collect  her 
thoughts  before  being  given  information.  Informa- 
tion is  modified  to  accommodate  the  needs  of  each 

patient 

The  nurse  usually  tells  the  patient  about  the  effects 
of  premedication,  if  it  is  ordered;  the  time  of  her  sur- 
gery, and  the  possibility  of  a  change  because  of  sur- 
gery already  in  progress  or  an  emergency.  She  advises 
the  patient  that  there  will  be  routine,  repeated  checks 
of  her  identification  and  of  her  chart,  and  tells  her 
the  average  time  away  from  the  ward,  so  that  she  can 
inform  her  relatives. 

The  nurse  describes  the  transportation  to  the  OR 
holding  area,  reassuring  the  patient  that  a  nurse  is  al- 
ways available;  the  transfer  to  the  operating  room, 
including  details  on  the  coolness  of  the  room,  the 
overhead  surgical  lights,  and  the  appearance  of  the 
staff;  moving  to  the  operative  bed;  and  the  possibility 
of  an  intravenous  being  started. 

Telling  the  patient  about  the  postanesthetic  recov- 
ery room,  the  nurse  includes  the  information  that 
there  will  be  a  mixture  of  patients  -  male,  female,  and 
children;  several  nurses  caring  for  her;  safety  restraint 
straps  across  her  legs  and  chest;  and  that  she  will  be 
repeatedly  asked  her  name.  Briefly  she  tells  the 
patient  about  the  transfer  back  to  her  room,  and  con- 
cludes with  some  things  the  patient  will  notice  in  the 
postoperative  period.  Only  common  things,  such  as 
the  possibility  of  drains,  skin  discoloration  from 
prepping  solutions,  and  the  type  of  dressing  are  dis- 
cussed. The  patient's  questions  directly  relating  to 
the  surgical  procedure  or  anesthesia  are  referred  to 
the  appropriate  members  of  the  medical  staff. 

The  preoperative  nursing  care  plan  is  completed 
after  the  visit  (note  taking  in  front  of  the  patient  is 
discouraged)  and  is  taken  to  the  theatre  where  the 
patient  is  booked.  It  is  reviewed  by  the  OR  nursing 
staff  the  day  preceding  surgery,  or  the  following 
morning  at  team  conference. 


The  patient  is  revisited  one  to  two  days  postopera- 
tively to  determine  if  she  benefited  from  the  preoper- 
ative  visit.    The  nurse  evaluates  this  by  asking  the 
patient:  did  you  appreciate  a  visit,  and  if  so,  why? 
what  specific  information   was  helpful?    and  what 
additional  information  would  have  been  helpful? 


V 


THE  CANADIAN  NURSE  —  June  1975 


if  the  objectives  could  be  achieved.  They 
proposed  to  visit  13  patients  per  day  (one 
patient  per  operating  room). 

Nurses  who  were  interested  in  the  visits 
formed  a  committee  to  initiate  and  plan 
this  trial  period.  The  committee  arranged 
meetings  with  ward  nurses  to  develop  a 
spirit  of  cooperation  and  an  understanding 
of  the  information  that  would  be  given  to 
the  patient  by  the  or  nurse. 

The  committee  devised  two  forms  to  be 
used  in  the  program:  a  preoperative  visit 
guide  and  a  nursing  care  plan.*  The  guide 
contained  the  nursing  objectives,  specific 
instructions  for  the  nurse  making  the  visit, 
and  information  to  be  given  to  the  patient. 
The  nursing  care  plan  was  designed  to  help 
the  nurse  record  specific  needs  of  the  pa- 
tient and  specific  nursing  actions  to  be 
taken  in  the  or  to  meet  these  needs. 

The  committee  also  planned  inservice 
sessions.  Operating  room  technicians 
were  not  included,  because  the  committee 
agreed  that  "technicians  do  not  have  the 
professional  education  or  experience  to 
pjovide  the  necessary  counselling  for  the 
surgical  patient."' 

Inservice  sessions  included:  a  lecture  on 
the  concept  and  purposes  of  preoperative 
visiting,  for  which  a  list  of  related  articles 
was  posted;*  *  a  lecture  and  audiovisual 
presentation  of  the  preoperative  visit  guide 
and  nursing  care  plan,  with  several  exam- 
ples of  the  use  of  both  forms;  and  role- 
playing  to  demonstrate  effective  patient 
interviewing,  and  difficult,  or  improperly 
conducted,  interviews.  During  the  inser- 
vice sessions,  the  OR  nurses  also  viewed 
the   film.   Preoperative  Interviewing:    t 

*  Copies  of  the  preoperative  visit  guide  and 
preoperative  nursing  plan  may  be  obtained 
from  Wendy  Dirksen,  Assistant  Director  of 
Special  Services,  University  of  Alberta  Hospi- 
tal, 112  St.  and  83  Ave.,  Edmonton.  Alta.. 
T6G  2B7. 

*  *  The  list  of  reference  articles  may  be  ob- 
tained from  the  authors,  at  the  address  given  in 
the  first  footnote  (*). 

■i  Pre-Op  Interview  (CSl  I7B)  is  available  from 
Davis  and  Geek  Film  Library.  Cyanamid  of 
Canada.  5550  Royal  Mount  Ave..  Town  of 
Mount  Royal.  Montreal.  Quebec. 

30 


group  discussions  explored  the  nurses' 
feelings  and  reactions  to  the  hostile,  cry- 
ing, angry,  demanding,  or  dying  patient. 

Method  of  the  visit 

The  OR  supervisor,  charge  nurse,  or  a 
member  of  the  committee  accompanied 
each  nurse  on  her  first  visit  and  continued 
until  the  nurse  felt  comfortable  and  confi- 
dent. This  allowed  the  nursing  staff  to  de- 
velop a  consistent  pattern  of  information 
giving  and  to  standardize  the  use  of  the 
guide  and  nursing  care  plan.  (See  pages  28 
and  29  for  photo  story  of  the  preop  visit.) 

Results  of  the  trial 

The  trial  resulted  in  preoperative  visits 
to  171  patients.  Of  these,  130  required 
definite  nursing  actions;  40  required  pa- 
tient comfort  needs,  such  as  special  posi- 
tioning, attention  to  allergies,  or  the  pres- 
ence of  an  interpreter;  90  required  nursing 
action,  such  as  weighing  sponges  for 
blood  loss;  adding  deeper  retractors;  add- 
ing additional  instruments,  sutures,  and 
supplies  for  procedures  on  the  consent 
form  that  were  not  on  the  OR  booking 
schedule;  or  correction  of  incomplete  or 
incorrect  consents. 

Some  110  postoperative  visits  were 
made.  We  found  that  70  of  these  patients 
indicated  that  they  appreciated  the 
preoperative  visit —  "it  was  good  to  know 
someone"  —  or  expressed  appreciation  in 
a  comfort  result  —  "my  back  is  not  as  sore 
this  time,"  or  "that  new  tape  (nonallergic) 
sure  is  nice." 

The  number  of  patients  visited  was  con- 
siderably less  than  the  committee  had  ex- 
pected. Nurses  did  not  complete  the  ex- 
pected number  of  visits  because  time  was 
not  always  available,  either  at  the  end  of 
the  day  or  during  the  day;  staffing  was 
frequently  not  sufficient  to  allow  one  or 
more  staff  to  leave  the  theatre  (Monday's 
patients  were  not  visited  because  the  min- 
imal weekend  staff  was  required  in  the  OR 
for  emergencies);  nurses  lacked  confi- 
dence in  interviewing  skills  and  interper- 
sonal relations;  they  avoided  the  "pain  of 
involvement,"  especially  if  the  patient's 
prognosis  were  poor;  they  said  the  patient 
gets  "too  many  visitors"  in  a  teaching 
hospital:  and  the  patient  was  not  available. 

Because  of  these  difficulties  and  be- 


cause of  an  apparent  decrease  in  en- 
thusiasm for  preoperative  visits,  we  re- 
viewed the  concept  of  preoperative  visit- 
ing, and  the  nurses  voted  on  whether  or  noi 
they  should  continue.  The  result  was  over- 
whelmingly in  favor  of  visiting.  However, 
preoperative  and  postoperative  visits  werej 
still  not  being  completed  at  the  rale  estab-' 
lished  as  acceptable  (60^^  of  all  patients ) 

Remedies  suggested 

To  make  preoperative  visiting  a  con- 
tinuing success,  we  suggest  that  regular 
inservice  programs  be  held  for  nurses  tc 
share  experiences  and  discuss  problems:| 
the  senior  nurse  should  review  each  nurs-i 
ing  care  plan  for  completeness;  and  a  re- 
source committee  of  enthusiastic  nursesi 
should  be  maintained  to  assist  with  prob-j 
lems  and  teaching. 

The  OR  supervisor  can  contribute  to  thi 
program  by  making  frequent  checks  to  de 
termine  the  number  of  visits  completecj 
and,  if  it  is  declining,  she  can  provide 
incentives  for  the  staff  to  continue  the  vis- 
its. Also,  she  can  recognize  the  staff' 
efforts  and  accomplishments  and.  ai 
evaluation  time,  discuss  preoperative  vis- 
its as  an  integral  part  of  the  job  perfor- 
mance. 

At  present,  most  patients  are  being  vis- 
ited preoperatively  and  a  selected  group 
postoperatively.  The  concept  has  been  in- 
corporated into  the  orientation  of  new! 
graduate  nurses,  and  the  suggested  plans;| 
and  sessions  are  underway  to  maintairj 
confidence  and  motivation.  We  hope  thai' 
our  goals  will  become  an  ongoing  realit\ . 

References 

1 .  Lindenian.  Carol  A.  and  Stetzer.  Steven  L.' 
Effect  of  preoperative  visits  by  operating 
room  nurses.  Nurs.  Res.  22:1:4-16.  Feb. 
1973. 

2.  Ibid. 

3.  Schrader.  Elinor  S.  Is  the  preop  visit  a  nurs- 
ing function?  AORN  J.  19:2:375-6.  Feb. 
1974. 


Voting  delegates  accepted  a  new  fee  structure  that  equalizes  the  payment  of  provincial 
associations.  A  panel  discussion  with  the  four  CNA  members-at-large  gave  nurses  an 
opportunity  to  share  concerns  about  the  reality  of  nursing  today. 

Nicole  Blais 


The  worst  storm  of  the  winter  did  not  prevent  more  than  150 
nurses  from  attending  the  Canadian  Nurses"  Association's  an- 
nual meeting  at  the  Chateau  Laurier  Hotel  in  Ottawa  3  April 
1975.  Once  there,  they  heard  a  variety  of  annual  reports,  studied 
resolutions  from  membership,  participated  in  a  lively  forum  on 
nursing  concerns,  and  heard  the  director  of  the  Women's 
Bureau  of  the  federal  Department  of  Labor  challenge  them  to 
face  today's  labor  issues  head-on. 

For  voting  delegates,  one  of  the  highlights  of  the  day  was  the 
consideration  of  resolutions  from  membership.  Of  the  three 
resolutions  submitted,  only  the  one  concerning  fee  structure  was 
adopted. 

The  first  resolution  called  for  CNA  to  investigate  the  possibil- 
ity of  national  registration  for  Canadian  nurses.  This  resolution 
was  declared  out-of-order  when  voting  delegates  challenged 
CNa's  authority  in  this  field,  as  the  provinces  have  jurisdiction 
over  registration  and  licensing.  A  second  resolution  asked  that 
CNA  investigate  the  need  to  develop  Canadian  achievement 
tests  to  replace  those  prepared  by  the  National  League  for 
Nursing  and  used  in  some  Canadian  schools.  Delegates  did  not 
consider  this  a  priority  for  CNA  at  present,  and  the  resolution 
was,  therefore,  defeated. 

New  Fee  Structure 

Delegates  adopted  w  ithout  discussion  the  fee  structure  proposed 

by  the  CNA  board  of  directors.  The  formula  is  based  on  a  unit  fee 

distributed  as  follows: 

V2  unit  —  first  250  members 

V4  unit  —  251  to  1.000  members 

1  unit—  1.00!  to  15. OCX)  members 

V4  unit  —  15.001  to  25.000  members 

V2  unit  —  25.001  and  up 

A  unit  fee  of  $10  was  also  accepted  without  discussion,  but 
with  the  provision  that  the  ceiling  for  payment  of  fees  for  one 

THE  CANADIAN  NURSE  —  June  1975 


association  member  shall  not  exceed  '/3  of  the  CNA  membership 
fee  income  for  the  preceding  year.  The  new  formula,  which  will 
come  into  effect  January  1976.  does  not  substantially  increase 
revenue  for  CNA.  but  is  a  method  of  equalizing  the  payments  by 
provincial  associations.  Under  the  present  system,  provincial 
associations  with  more  than  20.000  members  pay  $6  per  capita, 
and  those  with  less  than  20,000  members  pay  $10. 

Action  on  Resolutions  from  Ihe  1974  Annual  Meeting 

Since  June  1974.  cna  has  made  substantial  progress  m  its 
efforts  to  meet  association  objectives  as  well  as  requests  from 
membership.  In  December  1974.  a  report  on  the  action  taken 
between  June  and  October  1974  was  published  in  the  CNA 
journals.  This  report  deals  with  the  action  taken  since  that  date. 

Resolution  B 

"...  that  the  cna  board  of  directors  request  the  minister  of 
Consumer  and  Corporate  Affairs  to  amend  the  Letters  Patent  of 
the  cna  so  that  the  French  will  read  I'Association  des  infir- 
mieres  et  infirmiers  du  Canada." 

Action:  Since  the  Letters  Patent  are  now  in  the  process  of  being 
modified  to  include  the  name  of  The  Order  of  Nurses  of  Quebec, 
the  board  of  directors  decided  to  postpone  changing  the  title  of 
the  Association.  However,  at  the  request  of  the  Quebec  delega- 
tion, the  board  of  directors  has  agreed  to  place  this  question  on 
the  agenda  for  their  next  meeting  in  October. 

Resolution  1 

"...  that  cna  explore  ways  and  means  of  developing  a  plan  of 

action  to  sensitize  or  raise  the  level  of  awareness  of  nurses  to 

life-styles  conducive  to  optimum  health." 

(Continued  on  p.  34) 

Nicole  Blais  is  with  the  CNA  Information  Services,  Ottawa. 


Trom  Lippincott . . . 


New  (3rd)  Edition 

TEXTBOOK  OF 
MEDICAL-SURGICAL  NURSING 


is  to  stimulate 
ing  standpoint 


Outstanding  in  its  depth  of  scientib 
content  and  in  the  practicality  of  $ 
application,  this  leading  text  hk 
been  heavily  revised  and  update!, 
with  much  new  material.  In  the  ur, 
Assessment  of  the  Patient,  three  ne; 
chapters  have  been  added:  Clinic! 
Interviewing  of  patients;  Physical  £h 
amination  by  the  Nurse;  and  GuiQ\- 
lines  for  Writing  Problem-Orientd 
Records  to  promote  continuity  f 
patient  care.  New  material  In  tl^ 
cardiovascular  unit  Includes  esser 
tials  of  interpreting  EGG  patterns  ar|l 
arrhythmias;  a  new  chapter  on  Ca^ 
of  the  Cardiovascular  Surgic^ 
Patient;  and  total  rewriting  of  tl^ 
chapter  on  The  Patient  in  the  Cardii} 
Care  Unit.  Another  new  chapter  deai 
with  The  Person  Experiencing  Paii 
Nursing  management  In  various  dirt- 
cal  situations  is  frequently  outline! 
intabularform. 

Authoritative,  up-to-date,  and  prac-- 

cal  bibliographical  citations  are  I 

eluded  to  help  the  student  assurr 

the  role  of  an  active  learner.  The  goj 

the  nurse  practitioner  to  think  clinically,  and  to  ask  questions  from  a  nur' 


1156  pages,  Third  Edition,  May  1975  $19.75 
Lillian  S.  Brunner,  R.N.,  M.S. 
Doris  S.  Suddarth,  R.N.,  IVI.S.N. 


Leadership  in  learning. 


4ew  (4th)  Edition 

CARE  OF  THE  ADULT  PATIENT 

Medical-Surgical  Nursing 

A  superbly  useful  tool  for  nursing  education  and  prac- 

ice,  this  popular  text  has  been   massively  revised, 

pdated  and  expanded,  and  provides  an  authoritative 

idsis    for    understanding    the    patient's    therapeutic 

I'legimen,  including  surgery,  drugs,  nursing  intervention 

ind  rehabilitation.  The  nursing  process  is  stressed,  and 

liathophysiologic  content  has  been  expanded.  Each 

^  i:hapter    emphasizes    assessment    of    the    physical, 

'  j-motiona!  and  social   needs  of  the  patient  and   his 

family.  New  chapters  include  The  Nursing  Process, 

\lursing  Assessment,  and  The  Developmental  Process. 

If  |llustrated/4th  edition,  June  1975/about  $19.00 

i)orothy  W.  Smith,  R.N.,  Ed.D.;  Carol  P.  Hanley  Germain, 

■'  N.,  M.S. 


A  GUIDE  TO  PHYSICAL 
EXAMINATION 

An  expertly-illustrated,  "how-to"  text  that  bridges  the 
gap  between  anatomy  and  physiology  and  their  appli- 
cation to  the  physical  examination.  Within  each  body 
region  or  system,  three  topics  are  covered:  1)  anatomy 
and  physiology  basic  to  the  examination,  2)  exami- 
nation techniques,  3)  selected  abnormalities.  A  superb 
teaching  tool  for  any  program  in  primary  health  care. 
375  pages/profusely  illustrated/ 1974/$18.75 
Barbara  Bates,  M.D. 

Also  available  .  . . 

PHYSICAL  EXAMINATION  FILMS 

A  series  of  twelve  sound  motion  pictures,  correlated 
with  the  content  of  A  Guide  to  Physical  Examination. 
(Write  to  the  Marketing  Coordinator,  A/V  Media  for 
information.) 


lew  (3rd)  Edition 

SCIENTIFIC  FOUNDATIONS  OF 
|4URSING 

ieavily  revised  and  updated  in  the  third  edition,  this 
nique  source  book  applies  principles  from  the  bio- 
iihysical,  social  and  behavioral  sciences  to  clinical 
jursing.  In  this  edition  nursing  care  selections  are  ex- 
•anded  throughout;  anatomy  and  physiology  sections 
re  rewritten;  the  pathology  section  is  more  detailed 
nd  pathophysiology  is  expanded.  Patient  care  includes 
■ore  emphasis  on  children  and  the  elderly.  Psycho- 
ocial  Principles  and  Nursing  Applications  are  ex- 
landed,  and  crisis  intervention,  aging,  death  and  dying 
re  stressed. 

80  pages,  3rd  edition,  June  1975/paperbound/about  $9.50 
ladelyn  T.  Nordmark,  R.N.,  M.S.  (N.E.);  and  Anne  W. 
"ohweder,  R.N.,  M.N. 


CLINICAL  PHARMACOLOGY  IN 
4URSING 

luick,  easy  access  to  information  required  for  expert 
atient  care  is  provided  in  this  up-to-date  text. 
ssential  scientific  material  is  clearly,  concisely  pre- 
ented.  Drug  Digests  at  the  end  of  each  chapter  in- 
ude  data  on  dosage,  administration,  adverse  effects, 
idications  and  contraindications  for  specific  drugs. 
actual  data  and  fundamental  principles  are  presented 
1  tables  and  summaries. 
31  pages/1974/$11.75 

lorton  J.  Rodman,  B.S.,  Ph.D.;  Dorothy  W.  Smith,  R.N.,  M.A., 
d.D. 

icluded 

lURSES'  GUIDE  TO  CANADIAN  DRUG  LEGISLATION 

avid  R.  Kennedy,  Ph.D.  1973 


NURSES'  HANDBOOK  OF 
FLUID  BALANCE 

2nd  Edition 

This  edition  reflects  the  nurse's  expanded  role  in  diag- 
nosis, treatment  and  evaluation  of  laboratory  findings. 
All  chapters  include  the  latest  findings  in  types  of  im- 
balances, treatments,  and  medication;  eacii  element, 
deficit  and  excess  is  discussed  in  greater  depth  and 
clarity.  A  new  chapter  on  Fluid  Balance  in  Pregnancy 
incorporates  recent  knowledge  of  body  fluid  distur- 
bances. Other  new  chapters  deal  with  routes  of  trans- 
port, organs  of  homeostasis,  and  disturbances  of  water 
and  electrolytes.  Many  new  illustrations. 
313  pages/illustrated/2nd  edition,  1974/paperbound,  $8.75 
Norma  M.  Metheny,  R.N.,  M.S.;  and  W.  D.  Snively,  Jr.,  M.D., 
F.A.C.P. 

PERSPECTIVES  IN  HUMAN 
DEVELOPMENT 

Nursing  Throughout  the  Life  Cycle 

An  exciting  approach  to  the  study  of  human  develop- 
ment that  applies  findings  of  the  physical,  behavioral 
and  social  sciences  to  patient  care.  Emphasis  is  on 
health  care  and  wellness,  rather  than  illness,  as  basic 
to  nursing  philosophy  and  practice.  The  human  organ- 
ism and  human  development  are  viewed  holistically. 
Many  case  studies  demonstrate  principles  of  health 
maintenance,  and  intervention  in  times  of  physical, 
emotional  and  social  stress. 
331  pages/diagrams  and  charts/1973/$8.25 
Doris  Cook  Sutterley,  R.N.,  M.S.N. ;  Gloria  Ferraro  Donnelly, 
R.N.,  M.S.N. 


Lippincott 

J.  B.  LIPPINCOTT  COMPANY  OF  CANADA  LIMITED 

SERVING  THE  HEALTH  PROFESSIONS  IN  CANADA  SINCE  1897 
75  HORNER  AVE.,  TORONTO,  ONTARIO  M8Z  4X7      (416)  252-5277 


(Continued  from  p.  31) 

Action:  the  intent  of  this  resolution  has  been  incorporated  in  the 

program  of  CNA  activities  for  1974-76. 

Resolution  2 

"...  that  CNA  take  leadership  in  establishing  guidelines  for 
preparation,  continuing  competence  to  practice,  respon- 
sibilities, legal  protection  and  remuneration  for  the  nurse  in  an 
expanded  role:  and  .  .  .  that  cna  take  whatever  action  it  deems 
necessary  to  protect  the  public  and  the  nurse,  and  di.scuss  these 
concerns  with  other  appropriate  organizations,  such  as  the 
Canadian  Medical  Association."  ^c/»o«.-  To  meet  this  request, 
CNA  must  gather  additional  data.  The  board  of  directors  has 
approved  a  project  "National  Survey  of  Nurses,'"  which  should 
provide  the  background  information  needed.  (See  The  Cana- 
dian Nurse,  April  1975,  p.  35.) 

Resolution  4 

"...  that  the  CNA  board  of  directors  be  urged  to  encourage  the 
development  of  programs  for  registered  nurses  in  geriatric  and 
long-term  care  in  some  Canadian  colleges  and  universities." 
Action:  Letters  expressing  the  intent  of  this  resolution  have  been 
sent  to  the  Association  of  Canadian  Community  Colleges,  the 
Canadian  As.sociation  of  University  Schools  of  Nursing,  and  to 
provincial  nurses"  associations  and  other  interested  groups, 
including  the  Canadian  Association  on  Gerontology.  The  presi- 
dent of  the  latter  association  expres.sed  the  complete  support  of 
his  association  and  stated  that,  in  his  view,  undergraduate  edu- 
cation of  nurses  in  gerontology  and  geriatrics  is  far  ahead  of 
other  professions. 

CNA  Priorities  for  1 974-76 

CNA  President  Huguette  Labelle  welcomed  delegates  and  rep- 
resentatives of  other  associations.  She  reminded  them  that  the 
ultimate  goal  of  the  Association  is  to  contribute  to  the  main- 
tenance and  improvement  of  the  health  of  Canadians  by  help- 
ing nurses  to  provide  the  highest  possible  level  of  care.  To 
achieve  this,  cna  must  advance  on  four  fronts: 
n  evaluation  of  nursing  care; 
n  evaluation  of  educational  programs  for  nurses  and  of  the 

competence  of  nurses: 
D  advancement  of  nursing  research: 
D  maintenance  and  promotion  of  the  health  and  of  the  rights  of 

the  individual. 

The  CNA  president  expressed  confidence  that  the  projects 
being  undertaken  by  the  Association  will  yield  tangible  results 
before  the  end  of  the  year. 

Report  of  the  Executive  Director 

In  her  report,  CNA  executive  director  Helen  K.  Mussallem 
reviewed  the  activities  of  the  staff  of  CNA  House  since  June  1 974 
and  answered  questions  from  the  audience. 

A  delegate  from  British  Columbia  expressed  his  concern  over 
the  content  and  format  of  The  Canadian  Nurse,  and  requested 
infomiation  on  editorial  policy.  The  president  replied  that  the 
CNA  ad  hoc  committee  on  the  journals  had  just  presented  its 
report  of  both  magazines  to  the  board  of  directors,  and  that  this 
report  would  be  studied  soon. 

The  director  of  information  services  explained  that  the  jour- 
nals had  been  incorporated  in  the  information  services  depart- 
ment and  that  changes  are  being  planned  to  reflect  unity  of 
content  and  fomiat  in  both  journals.  It  was  noted  that  one  issue 
of  the  CNA  journal  costs  approximately  25i  per  member,  and 


this  fact  imposes  severe  limitations  on  the  quality  of  thi 
magazines. 

Another  delegate  asked  for  more  information  on  thi 
CHA/CMA/CNA  joint  committee.  According  to  the  president,  thi 
main  purpose  of  this  joint  committee  is  to  provide  a  forum  fo 
discussion  on  matters  of  mutual  interest.  To  date,  this  commit 
tee  has  not  made  any  official  statement. 

The  executive  director  was  asked  why  CNA  had  become  ai 
affiliate  member  of  the  Association  of  Community  Colleges  o 
Canada.  In  reply,  she  pointed  out  that  many  nurses  are  nov 
teaching  in  institutions  that  are  members  of  ACCC.  "CNA  must  bi 
present  when  decisions  are  taken  that  will  influence  the  future  o 
nursing  education  programs,""  said  the  executive  director. 

In  answer  to  a  question  on  International  Women" s  Year,  thr 
CNA  president  stated  that  this  subject  was  being  studied.  Shi 
pointed  out  that  the  cna  journals  are  asking  nurses  to  sugges 
areas  that  require  investigation. 

Financial  Report 

CNA  treasurer.  Helen  K.  Mussallem,  presented  the  CNA  finan 
cial  statement  for  1974,  and  the  1975  budget.  Although  CNA  wa; 
successful  in  maintaining  a  balanced  budget  during  1974,  it  ha; 
accepted  a  projected  deficit  of  $  120.633  for  the  current  year.  Ir 
addition,  the  Association  will  spend  approximately  $  100,000  to 
upgrade  its  existing  pension  plan.  The  CNA  Testing  Service  i; 
also  predicting  a  budget  deficit  in  1975. 

The  expected  increase  in  expenditures  is  due  to  several  fac- 
tors, including:  higher  salaries  and  fringe  benefits  ($129,000) 
anticipated  cost  increases  for  paper  and  printing  of  tht 
magazines  ($15,000):  increasing  costs  of  transportation  am 
accommodation  for  members  of  committees:  an  increase  in  th( 
ICN  fee  due  to  increased  membership  and  higher  rate  of  exi 
change:  provision  of  a  contingency  fund  of  $34,000  to  be  usee 
for  special  projects. 

Two  sources  of  revenue  will  produce  higher  yields  durinj 
1975:  fee  revenue  is  expected  to  increase  by  $41,000,  an< 
advertising  revenue  in  the  journals  will  bring  in  an  additiona. 
$30,000  over  1975. 


Special  Committee  Reports 


The  chairman  of  the  Special  Committee  on  Nursing  Research. 
Josephine  Raherty,  presented  her  report,  which  described  the 
committee"s  terms  of  reference,  meetings  held,  and  time  allot- 
ted for  each  activity.  (The  work  of  the  committee  has  been 
reported  in  The  Canadian  Nurse  during  the  year.)  Helen  Grice, 
chairman  of  the  Special  Committee  on  the  Testing  Service, 
reported  on  the  SCOTS  administration,  test  development 
budget,  and  nominations.  (For  more  details,  see  p.  37) 

On  Guard! 

Nurses  are  one  of  the  few  groups  of  women  within  the  laboi 
force  who  have  learned  the  value  of  collective  bargaining.! 
according  to  the  director  of  the  Women"s  Bureau  of  Canada"s 
Department  of  Labor.  In  a  luncheon  address  during  the  C\  ^ 
meeting.  Sylva  Gelber  called  on  members  of  the  organi/ct: 
nursing  profession  to  use  their  special  strengths  and  skills  u 
bring  a  new  approach  to  problems  in  the  labor  field. 

"CNA  has  shown  the  way  to  other  professions  in  the  past." 
Gelber  stated.  "Now  nurses  have  a  moral  obligation  to  help 
solve  the  problems  arising  out  of  the  use  of  collective  bargaining 
in  the  area  of  essential  services."" 


^ 


#  w> 


K  members  that 
recognize  that 
Canadian  labor 
1  one-quarter  of 
.  she  continued, 
le  continuing  to 

said  that  women 
my  generations, 
male  occupation 
der  their  leader- 
s  already  been 
ecoming  evident 

held  the  position 
/hile  only  3*^  of 
d.  "Twenty-one 
irses,  while  only 


eting  was  a  panel 
at-large  answered 

questions  reiaicu  lo  n.^,,  ,^.., .  jf  expertise.  The 

members-at-large  are:  Lorine  Besel.  nursing  practice:  Femande 
Harrison,  nursing  service;  Glenna  Rowsell.  socioeconomic 
welfare;  and  Shirley  Stinson.  nursing  education. 

Although  the  symposium  provided  few  concrete  answers,  it 
gave  nurses  an  opportunity  to  share  common  concerns.  An 
example  of  the  issues  raised  was  the  nurse-patient  relationship, 
which  at  present  satisfies  neither  the  patient  nor  the  nurse. 
According  to  Lorine  Besel.  "'we  should  redefine  this  relation- 
ship in  the  light  of  changes  in  the  health  system." 
Some  comments: 

•  "'The  final  products  of  nursing  education  programs  do  not 
correspond  to  the  situation  in  the  clinical  areas." 

•  ■  ■  We  talk  about  mental  health .  but  we  act  in  terms  of  mental 
illness.  " 

•  "How  can  we  explain  that  several  administrative  positions 
remain  unfilled,  while  we  create  new  programs  for  nurses? 
Are  we  educating  nurses  for  positions  that  do  not  exist?" 

THE  CANADIAN  NURSE  —  June  1975 


L.  Besel 


F.  Harrison 


G.  Rowsell 


S.  Stinson 


•  "How  can  I  use  my  experience  to  become  a  leader?" 

•  "The  nurse  tends  to  turn  to  a  superior  to  resolve  problems. 
She  does  not  know  what  attitude  to  take  when  placed  in  a 
difficult  situation." 

•  "Why  do  some  nurses  use  alcohol  and  drugs?"' 

•  "What  is  the  role  of  cna  with  relation  to  collective  bargain- 
ing?" 

•  'Much  work  is  being  accomplished  in  many  areas  on  many 
topics,  but  that  work  is  being  done  in  isolation.  Why  do  we 
not  have  enough  confidence  to  set  forth  our  ideas  and  plans 
even  before  they  are  letter  perfect?" 

•  "We  all  worry  about  the  system,  but  we  are  the  system.  It  is 
what  it  is  because  we  allow  it.  Administrators  might  be 
willing  to  gather  the  troops,  but  one  may  ask  whether  the 
troops  want  to  be  bothered!" 

At  the  end  of  the  session,  CNA  members-at-large  were  unani- 
mous in  their  desire  to  promote  further  dialogue  w  ith  member- 
ship. "Write  to  us."'  they  said  ""at  the  places  where  we  work  or 
at  CNA  House.  We  will  make  sure  that  the  other  CNA  directors 
are  made  aware  of  your  concerns."  W 

35 


(Continued  from  p.  31) 

Action:  the  intent  of  this  resolution  has  been  incorporated  in  the 
program  of  CNA  activities  for  1974-76. 

Resolution  2 

■■.  .  .  that  CNA  take  leadership  in  establishing  guidelines  for 
preparation,  continuing  competence  to  practice,  respon- 
sibilities, legal  protection  and  remuneration  for  the  nurse  in  an 
expanded  role:  and  .  .  .  that  CNA  take  whatever  action  it  deems 
necessary  to  protect  the  public  and  the  nurse,  and  discuss  these 
concerns  with  other  appropriate  organizations,  such  as  the 
Canadian  Medical  Association." /Icr/ow;  To  meet  this  request, 
CNA  must  gather  additional  data.  The  board  of  directors  has 
approved  a  project  ■"National  Survey  of  Nurses,"  which  should 
provide  the  background  information  needed.  (See  The  Cana- 
dian Nurse,  April  1975,  p.  35.) 

Resolution  4 

"...  that  the  CNA  board  of  directors  be  urged  to  encourage  the 
development  of  programs  for  registered  nurses  in  geriatric  and 
long-term  care  in  some  Canadian  colleges  and  universities." 
Action:  Letters  expressing  the  intent  of  this  resolution  have  been 
sent  to  the  Association  of  Canadian  Community  Colleges,  the 
Canadian  Association  of  University  Schools  of  Nursing,  and  to 
provincial  nurses"  associations  and  other  interested  groups, 
including  the  Canadian  Association  on  Gerontology.  The  presi- 
dent of  the  latter  association  expressed  the  complete  support  of 
his  association  and  stated  that,  in  his  view,  undergraduate  edu- 
cation of  nurses  in  gerontology  and  geriatrics  is  far  ahead  of 
other  professions. 

CNA  Priorities  for  1974-76 

CNA  President  Huguette  Labelle  welcomed  delegates  and  rep- 
resentatives of  other  associations.  She  reminded  them  that  the 
ultimate  goal  of  the  Association  is  to  contribute  to  the  main- 
tenance and  improvement  of  the  health  of  Canadians  by  help- 
ing nurses  to  provide  the  highest  possible  level  of  care.  To 
achieve  this,  CNA  must  advance  on  four  fronts: 
n  evaluation  of  nursing  care; 
n  evaluation  of  educational  programs  for  nurses  and  of  the 

competence  of  nurses: 
n  advancement  of  nursing  research: 
n  maintenance  and  promotion  of  the  health  and  of  the  rights  of 

the  individual. 

The  CNA  president  expressed  confidence  that  the  projects 
being  undertaken  by  the  Association  will  yield  tangible  results 
before  the  end  of  the  year. 

Report  of  the  Executive  Director 

In  her  report,  CNA  executive  director  Helen  K.  Mussallem 
reviewed  the  activities  of  the  staff  of  CNA  House  since  June  1974 
and  answered  questions  from  the  audience. 

A  delegate  from  British  Columbia  expressed  his  concern  over 
the  content  and  format  of  The  Canadian  Nurse,  and  requested 
infomiation  on  editorial  policy.  The  president  replied  that  the 
CNA  ad  hoc  committee  on  the  journals  had  just  presented  its 
report  of  both  magazines  to  the  board  of  directors,  and  that  this 
report  would  be  studied  soon. 

The  director  of  information  services  explained  that  the  jour- 
nals had  been  incorporated  in  the  information  services  depart- 
ment and  that  changes  are  being  planned  to  reflect  unity  of 
content  and  fonnat  in  both  journals.  It  was  noted  that  one  issue 
of  the  CNA  journal  costs  approximately  25«!  per  member,  and 


this  fact  imposes  severe  limitations  on  the  quality  of  the 
magazines. 

Another  delegate  asked  for  more  information  on  the 
CHA/CMA/CNA  joint  committee.  According  to  the  president,  the 
main  purpose  of  this  joint  committee  is  to  provide  a  forum  foi 
discussion  on  matters  of  mutual  interest.  To  date,  this  commit 
tee  has  not  made  any  official  statement. 

The  executive  director  was  asked  why  CNA  had  become  an 
affiliate  member  of  the  Association  of  Community  Colleges  of 
Canada.  In  reply,  she  pointed  out  that  many  nurses  are  now' 
teaching  in  institutions  that  are  members  of  ACCC.  "CNA  must  be 
present  when  decisions  are  taken  that  will  influence  the  future  ol 
nursing  education  programs,"  said  the  executive  director. 

In  answer  to  a  question  on  International  Women's  Year,  ihi 
CNA  president 
pointed  out  th, 
areas  that  reqi 


CNA  treasurer, 
cial  statement  f 
successful  in  m 
accepted  a  proj( 
addition,  the  A; 
upgrade  its  exi; 
also  predicting 

The  expectec 
tors,  including: 
anticipated   cos 
magazines  ($15 
accommodation 
ICN  fee  due  to 
change:  provisic 
for  special  proje 

Two  sources 
1975:  fee  reven 
advertising  reve] 
$30.0(X)  over  19 


The  chairman  of 

Josephine  Flaherl 

committee's  term 

ted  for  each  acti 

reported  in  The  Cu.iuutun  ivurse  uunng  the  year.)  Helen  Grice. 

chairman  of  the  Special  Committee  on  the  Testing  Service,!. 

reported    on    the    SCOTS    administration,    test    development,. 

budget,  and  nominations.  (For  more  details,  see  p.  37) 

On  Guard! 

Nurses  are  one  of  the  few  groups  of  women  within  the  lahn 
force  who  have  learned  the  value  of  collective  bargaining.i 
according  to  the  director  of  the  Women's  Bureau  of  Canada'^! 
Department  of  Labor.  In  a  luncheon  address  during  the  C\  ^ 
meeting.  Sylva  Gelber  called  on  members  of  the  organize^ 
nursing  profession  to  use  their  special  strengths  and  skills  u 
bring  a  new  approach  to  problems  in  the  labor  field. 

"CNA  has  shown  the  way  to  other  professions  in  the  past. 
Gelber  stated.  "Now  nurses  have  a  moral  obligation  to  helf 
solve  the  problems  arising  out  of  the  u.se  of  collective  bargain:  ni 
in  the  area  of  essential  services." 


t 


(4    ♦■?"  ♦ 


» 


5.  Gelber 


The  Women's  Bureau  director  reminded  cna  members  that 
professionals,  too.  are  workers,  and  they  must  recognize  that 
fact  and  organize  themselves  accordingly.  The  Canadian  labor 
force  includes  2'/2  million  women,  fewer  than  one-quarter  of 
whom  belong  to  a  union.  Gelber  said.  In  1975.  she  continued, 
labor  faces  a  dilemma:  how  to  obtain  justice  while  continuing  to 
provide  an  essential  service  to  society. 

Gelber  had  a  word  of  caution  for  nurses.  She  said  that  women 
'  have  accepted  men  as  authority  figures  for  many  generations, 
and  when  men  begin  to  enter  a  traditionally  female  occupation 
in  significant  numbers,  women  tend  to  surrender  their  leader- 
ship positions.  Gelber  said  this  trend  has  already  been 
documented  in  the  field  of  social  work  and  is  becoming  evident 
now  in  nursing. 

"For  example,  in  1973.  57r  of  male  nurses  held  the  position 
of  director  or  assistant  director  of  nursing,  while  only  3%  of 
female  nurses  held  those  positions"  she  said.  "Twenty-one 
percent  of  male  nurses  in  1973  were  head  nurses,  while  only 
1 17c  of  female  nurses  were  at  that  level." 

i  A  Dialogue  with  Membership 

The  last  item  on  the  agenda  of  the  annual  meeting  was  a  panel 
discussion  in  which  the  four  CNA  members-at-large  answered 
questions  related  to  their  respective  areas  of  expertise.  The 
members-at-large  are:  Lorine  Besel.  nursing  practice;  Femande 
Harrison,  nursing  service;  Glenna  Rowsell,  socioeconomic 
welfare;  and  Shirley  Stinson.  nursing  education. 

Although  the  symposium  provided  few  concrete  answers,  it 
gave  nurses  an  opportunity  to  share  common  concerns.  An 
example  of  the  issues  raised  was  the  nurse-patient  relationship, 
which  at  present  satisfies  neither  the  patient  nor  the  nurse. 
According  to  Lorine  Besel.  "we  should  redefine  this  relation- 
ship in  the  light  of  changes  in  the  health  system." 
Some  comments: 

•  "The  final  products  of  nursing  education  programs  do  not 
correspond  to  the  situation  in  the  clinical  areas." 

•  "We  talk  about  mental  health,  but  we  act  in  terms  of  mental 
illness." 

•  "How  can  we  explain  that  several  administrative  positions 
remain  unfilled,  while  we  create  new  programs  for  nurses? 
Are  we  educating  nurses  for  positions  that  do  not  exist?" 

THE  CANADIAN  NURSE  —  June  1975 


L.  Besel 


F.  Harrison 


G.  Rowsell 


S  Stinson 


•  "How  can  I  use  my  experience  to  become  a  leader?" 

•  "The  nurse  tends  to  turn  to  a  superior  to  resolve  problems. 
She  does  not  know  what  attitude  to  take  when  placed  in  a 
difficult  situation. ■■ 

•  "Why  do  some  nurses  use  alcohol  and  drugs?"' 

•  "What  is  the  role  of  cna  with  relation  to  collective  bargain- 
ing? " 

•  "Much  work  is  being  accomplished  in  many  areas  on  many 
topics,  but  that  work  is  being  done  in  isolation.  Why  do  we 
not  have  enough  confidence  to  set  forth  our  ideas  and  plans 
even  Ijefore  they  are  letter  perfect?" 

•  "We  all  worry  about  the  system,  but  we  are  the  system.  It  is 
what  it  is  because  we  allow  it.  Administrators  might  be 
willing  lo  gather  the  troops,  but  one  may  ask  whether  the 
troops  want  to  be  bothered!"' 

At  the  end  of  the  session,  cna  members-at-large  were  unani- 
mous in  their  desire  to  promote  further  dialogue  with  member- 
ship. "Write  to  us."  they  said  ""at  the  places  where  we  work  or 
at  cna  House.  We  will  make  sure  that  the  other  cna  directors 
are  made  aware  of  your  concerns."  W 

35 


CNA  Directors  Hold 
April  Meetings 


Highlights  from  the  CNA  directors'  meeting, 
held  in  Ottawa,  April  1,  2,  and  4,  1975. 


Nicole  Blais 


Two  reports  from  special  committees  occupied  the  attention  of 
CNA's  directors  at  meetings  held  before  and  after  the 
association's  annual  meeting  3  April  1975.  These  reports  were 
from  the  ad  hoc  committee  on  the  testing  service  and  the  ad  hoc 
committee  on  CNA  journals.  In  addition  to  last-minute  prepara- 
tions for  the  annual  meeting,  directors  also  discussed  the  follow- 
ing items  of  business:  plans  for  the  1976  annual  meeting;  na- 
tional liability  insurance  plan;  ICN  fee;  CNA  employees'  pension 
plan,  and  so  on. 


1976  Annual  Meeting 

"Quality  of  Life"  will  be  the  theme  of  next  year's  biennial 
meeting  and  convention  of  the  Canadian  Nurses'  Association  in 
Halifax.  Convention  delegates  will  examine  the  concept  of 
quality  of  life  as  it  affects  the  nurse,  the  recipient  of  health  care 
services,  and  relationships  between  health  professionals.  Fol- 
lowing the  opening  ceremonies  on  Sunday  20  June,  the  next  3 
days  will  be  devoted  chiefly  to  development  of  the  program 
theme,  with  business  sessions  on  the  second  day.  The  conclud- 
ing day  will  permit  a  variety  of  activities,  including  social 
events  and  sightseeing. 


Liability  Insurance  Plan  Postponed 

CNA  directors  agreed  that  development  of  a  national  liability 
insurance  plan  would  not  be  practical  at  this  time.  Only  three 
provincial  associations  lack  plans  of  this  type,  and  several  are 
already  committed  for  several  years  to  arrangements  with  insur- 
ance brokers  in  their  province. 

To  make  a  national  insurance  scheme  beneficial,  it  would  be 
necessary  for  several  provincial  associations  to  participate.  At 
present,  this  is  not  possible. 


applies  to  members  of  the  various  cna  committees  should  appl; 

to  directors  of  the  organization.  The  policy  will  be: 
"If  a  member  of  the  board  of  directors  suffers  loss  of  salar\ 
by  virtue  of  attendance  at  a  CNA  board  meeting  and  has  a 
letter  concerning  loss  of  salary  from  the  employer,  CNA  will 
cover  that  loss." 


ICN  Fee  to  Double? 

CNA  directors,  informed  of  the  possibility  that  delegates  to  iht 
next  ICN  council  meeting  in  Singapore  in  August  may  be  askec 
to  authorize  a  fee  increase,  decided  to  leave  it  to  the  c\ 
president  to  vote  in  favor  of  a  fee  increase  up  to  100  percent,  i 
necessary.  She  will  base  her  decision  on  a  number  of  factors 
including  discussions  held  during  the  meeting,  the  reaction  o 
representatives  of  other  countries,  and  the  proposed  program  o 
activities. 

Board  members  reaffirmed  their  support  for  the  ICN.  Curren 
fees  are  40^  (1,50  Swiss  francs)  annually  for  each  individua 
member. 


Two-year  Mandate  for  CNA  Committees 
In  future,  all  appointments  to  internal  and  external  committees 
of  the  association,  working  parties,  task  forces,  and  special  anci 
ad  hoc  committees  will  be  for  a  two-year  period  and  can  bt' 
renewed  only  once.  The  exception  to  this  is  theCNAexecuti\c 


National  Nursing  Consultant 

The  association,  on  behalf  of  the  board  of  directors,  will  requcs. 
the  acting  deputy  minister  (health).  Health  and  Welfare 
Canada,  to  consider  appointing  a  nursing  consultant  in  occupa-j 
tional  health. 


Loss  of  Salary  Adjustment 

After  a  discussion  of  the  pros  and  cons  of  compensating  direc- 
tors of  the  association  for  salary  lost  through  attendance  at  CNA 
meetings,  members  of  the  board  agreed  that  the  same  policy  that 


Nicole  Blais  is  with  the  Canadian  Nurses'  Association's  Informal 
Services  Department,  Ottawa,  Ontario,  Canada. 


A  Definition  of  Standards  of  Nursing  Practice 

!  Members  of  the  CNA  board  approved  a  motion  authorizing  the 
'  appointment  of  an  ad  hoc  committee  to  assist  in  the  preparation 
I  of  implementation  models  for  the  development  of  a  definition 

and  standards  of  nursing  practice.  This  committee  will  report  to 

the  next  meeting  of  the  board  of  directors. 


II  Green  Paper  on  Immigration 

To  achieve  some  input  into  the  federal  government's  Green 
Paper  on  Immigration,  the  association  will  submit  a  brief  to  the 
joint  committees  of  the  House  of  Commons,  setting  out  cna's 
official  position  on  the  subject  of  immigration.  The 
association's  involvement  is  due  to  the  number  of  nurses  who 
immigrate  to  Canada  and  practice  their  profession  here.  (More 
details  will  appear  in  a  later  issue  of  The  Canadian  Nurse.) 


Fee  Increase  for  NUA 

The  CNA/CHA  joint  committee  on  the  extension  course  in  Nurs- 
ing Unit  Administration  will  increase  fees  for  the  course  to  $200 
in  1975-76.  Last  year,  a  total  of  545  English-speaking  students 
enrolled  under  22  instructors;  76  French-speaking  students  were 
enrolled  with  7  instructors.  The  committee  is  continuing  to 
investigate  the  possibility  of  making  the  courses  available  to 
nurses  other  than  head  nurses. 


Narcotic  Control  Act  Should  be  Amended 

In  a  special  submission  to  CNA  directors,  the  Alberta  Associa- 
tion of  Registered  Nurses  termed  the  Narcotic  Control  and  Food 
and  Drug  Acts  "inadequate  and  unrealistic  pieces  of  legisla- 
tion,""  and  asked  the  national  association  to  initiate  action  at  the 
federal  level  to  have  the  legislation  amended. 

According  to  the  aarn,  nurses  practicing  in  places  other  than 
hospitals  presently  have  no  legal  authority  to  administer  or 
furnish  narcotics  or  controlled  drugs.  Under  the  terms  of  the  Acts, 
the  nurse  becomes  an  agent  acting  on  behalf  of  a  practitioner 
(i.e.,  veterinarian,  physician,  dentist).  If  she  is  working  in 
community  health,  a  physician's  office,  clinic,  school  or  occu- 
pational health,  she  is  permitted  to  have  these  drugs  in  her 
possession,  but  not  to  furnish  or  administer  them. 

CNA  directors  agreed  that  the  association  would  undertake  to 
find  ways  of  influencing  amendments  to  these  laws.  Progress 
will  be  reported  in  The  Canadian  Nurse. 


Testing  Service 

Since  presenting  a  balanced  budget  in  October  1 974,  the  Testing 
Service  has  had  to  change  its  forecast  substantially,  because  of 
the  cost  of  developing  a  comprehensive  examination.  The  in- 

THE  CANADIAN  NURSE  —  June  1 975 


crease  is  due  largely  to  the  fact  that  the  examination  will  have  to 
be  developed  simultaneously  in  French  and  English,  while  the 
staff  will  have  to  continue  to  produce  exams  under  the  existing 
system  until  the  new  examination  is  actually  in  use. 

To  have  the  comprehensive  exam  ready  by  1978,  the  Testing 
Service  will  have  to  hire  additional  staff  and  provide  extra  office 
space.  At  their  February  1975  meeting,  CNA  directors  approved 
a  revised  budget  for  the  Testing  Service  to  permit  this  expan- 
sion. The  new  budget  contains  a  deficit  of  $104,600  for  1975. 
At  the  same  time,  directors  requested  staff  to  investigate  possi- 
ble external  sources  of  financing. 

The  board  of  directors  decided  that,  effective  January  1976. 
user  jurisdictions  will  be  charged  S 12  for  each  examination  for 
registered  nurses.  The  charge  for  the  one-part  examination  for 
nursing  assistants  will  be  $14;  this  charge  will  be  increased  to 
$20,  if  this  becomes  a  two-part  exam. 

Ad  hoc  committee  on  testing  service. 

In  February  1974.  cna  directors  established  an  ad  hoc  commit- 
tee to  examine  the  structure  and  functions  of  the  Testing  Service 
and  to  make  recommendations  on  necessary  changes.  This 
committee  presented  its  recommendations  to  the  board  of  direc- 
tors 2  April  1975.  Changes  accepted  by  the  directors  are  as 
follows: 

Old  Structure 

According  to  the  former  set-up,  the  Testing  Service,  although  a 
property  of  CNA.  was  not  administered  in  the  same  manner  as  the 
other  departments  within  the  association;  two  directors  were  in 
charge,  and  they  answered  to  the  CNA  board  of  directors.  The 
Special  Committee  on  Testing  Service  was  composed  of  17 
members;  7  members,  plus  one  representative  for  each  user 
jurisdiction.  However,  each  jurisdiction  was  allowed  one  addi- 
tional member  for  each  1 ,0(X)  candidates  who  wrote  the  examin- 
ation the  previous  year. 

New  Structure 

CNA  retains  ownership  of  the  Testing  Service.  It  becomes  an 
organizational  unit  within  the  association,  but  will  continue  to 
be  self-supporting.  There  will  be  a  single  director  of  the  Testing 
Service,  who  will  report  to  the  CNA  executive  director. 

Decisions  pertaining  to  the  content  of  tests,  test  construction, 
security,  delivery  to  jurisdictions,  and  processing  and  evaluat- 
ing results  will  rest  with  the  organizational  unit  called  the 
Testing  Service. 

The  present  Special  Committee  on  Testing  Service  has  been 
dissolved  and  will  be  replaced  by  a  committee  consisting  of  one 
representative  from  each  user  jurisdiction,  appointed  by  that 
jurisdiction.  The  terms  of  reference  of  this  committee  are; 
n  to  advise  the  board  of  directors  on  proposed  test  development 
policy,  including  attendant  budgetary  implications; 
D  to  advise  the  board  of  directors  of  budgetary  implications  of 


fulfillment  of  current  testing  service  policy; 
D  to  advise  staff  regarding  quality  control  for  examination 
development  and  processing;  and 

n  to  determine  examination  development  and  examination  ad- 
ministration procedures,  including  the  appointment  of  sub- 
committee members,  to  achieve  the  purpose  of  the  testing  ser- 
vice. 


CNA  Journals  to  Reflect  Unity 

In  February  1974,  an  ad  hoc  committee  was  created  to  examine 
the  CNA  journals  (The  Canadian  Nurse  and  L'infirmiere 
canadienne).  This  committee  was  required  to  review  all  deci- 
sions taken  by  the  board  of  directors  concerning  the  journals,  to 
make  recommendations,  and  to  report  their  findings  to  the 
board . 

Some  concerns  that  prompted  the  board  to  set  up  the  commit- 
tee were: 

n  the  need  to  keep  nurses  and  other  readers  informed  of  the 
concepts  governing  nursing  practice  in  Canada; 
D  the  need  to  communicate  CNa's  goals  and  priorities  to  mem- 
bers; and 

D  the  need  to  share  the  same  message  in  both  languages  with 
Canadian  nurses. 

Before  making  its  report,  the  committee  had  requested  sug- 
gestions from  members.  Contributions  were  received  from  a 
member  from  Ontario,  the  Registered  Nurses'  Association  of 
Prince  Edward  Island,  2  nurses"  regional  associations  from  New 
Brunswick,  and  a  group  of  5  nurses  from  Alberta.  The  commit- 
tee also  learned  the  results  of  an  informal  investigation  carried 
out  among  300  French-speaking  nurses  in  Quebec. 

Conclusions  and  recommendations 

According  to  the  committee,  the  written  message  seems  to  be 
the  only  practical  means  of  communicating  with  membership 
and  of  strengthening  the  federation,  which  is  made  up  of  10 
provincial  associations. 

On  the  recommendation  of  the  ad  hoc  committee,  the  board  of 
directors  decided  that  CNA  should  continue  to  publish  a  journal- 
type  publication,  produced  in  12  issues  annually,  and  that  this 
magazine  should  reach  each  member  in  the  language  of  her 
choice.  The  publication  will  have  to  be  identifiable  as  CNA's 
official  organ,  and  should  interpret  the  association's  objectives. 
The  contents  and  method  of  presentation  in  both  editions  will 
also  have  to  reflect  unity. 

In  the  opinion  of  the  committee,  the  publication  should  strive 
to  give  nurses  the  impression  that  they  are  all  members  of  one 
group,  whatever  their  age,  background,  area  of  residence, 
working  environment,  or  nursing  activity. 

Financial  responsibility 

On  the  subject  of  finances,  the  committee  believes  that  mem- 
bers should  be  made  aware  of  how  little  they  pay  to  receive  the 
journal.  In  1%9,  the  average  annual  cost  was  $3.03  for  each 
member;  in  1974,  it  was  $3.09.  The  total  number  of  pages  has 
been  curtailed  at  the  same  time  that  the  number  of  pages  of 

38 


advertising  has  been  increased  in  the  magazine. 

Members  of  the  board  requested  that  current  restrictions  on 
costs  be  maintained,  although  regarded  as  minimum  acceptable 
standards.  The  proportion  of  advertising  in  relation  to  editorial 
content  must  never  be  higher  than  it  now  is  in  The  Canadian 
Nurse  (50%  advertisements,  50%  editorial  content). 

Administrative  reorganization 

During  the  course  of  an  administrative  reorganization  within  the 
CNA  national  office  in  September  1974,  the  journals  were 
incorporated  into  the  Information  Services  Department.  The 
committee  was  unable  to  evaluate  the  results  of  this  change. 

The  board  of  directors  requested  that  staff  develop  a  plan  of 
action  for  the  journals  and  present  it  to  the  directors  at  their  next 
meeting.  They  directed  that  this  plan  show  imagination  and 
creativity,  that  it  take  into  account  the  objectives  of  the  journals 
and  the  Information  Services,  and  that  costs  be  evaluated  but  not 
necessarily  limited,  by  the  1975  budget.  In  addition,  the  board 
recommended  that  some  mechanism  be  set  up  to  ensure  a 
systematic  and  periodic  evaluation  of  the  journals'  objectives, 
which  should  be  the  same  for  both  French  and  English  editions 


Revision  to  CNA  Employees'  Retirement  Plan 

The  CNA  directors  voted  to  increase  CNA  employee  retirement 
pension  benefits  to  parallel  the  basic  federal  service  superannua- 
tion of  a  2%  pension  at  retirement  (based  on  salary  averaged 
over  the  best  6  years)  for  each  year  of  participation  in  the  CNARP. 

This  decision  necessitates  a  very  significant  outlay  of 
$445,000  in  past-service  benefits  for  employees.  Amortized 
over  15  years,  this  will  involve  an  annual  expenditure  for  past 
service  of  $38,500.  In  addition,  it  represents  an  increase  of 
nearly  $95,999  in  current  employer  contributions,  bringing  thej 
total  expenditure  to  approximately  $133,000  in  1975. 

In  the  past,  employees  and  employer  each  contributed  5%  of 
salary,  but  for  the  last  7  years,  CNA's  contribution  included  the 
employer's  contribution  to  the  Canada  Pension  Plan. 

Portability  with  federal  public  service 

The  Canadian  Nurses'  Association  Retirement  Plan  has  been  ' 
reviewed  by  Treasury  Board  and  accepted  for  portability  with  ( 
the  federal  public  service. 

Portability  will  permit  participants  of  the  CNA  Retiremeni 
Plan  who  leave  present  employment  to  work  for  the  federal 
public  service,  to  transfer  their  CNA  retirement  benefits  to  the 
public  service  superannuation  plan.  Similarly,  a  public  servant 
who  wishes  to  join  CNA  or  accept  employment  with  an  em- 
ployer participating  in  the  CNA  Retirement  Plan  will  be  able  to 
transfer  superannuation  credits  to  the  CNA  Retirement  Plan.  The 
application  for  transfer  in  each  case  must  be  made  within  three 
months  from  the  lime  the  employee  changes  employment. 

Other  employer-employee  groups  that  participate  in  the 
CNARP  and  that  may  wish  to  take  similar  action  on  behalf  of  their 
employees  are  invited  to  contact  the  Canadian  Nurses'  Associa- 
tion for  further  information. 


Help  us  with  our  International  Women's  Year  Project! 


The  Canadian  Nurse  and  L'infirmiere  canadienne  want  to  docu- 
ment instances  of  sex  discrimination  in  health  care  so  that  action 
can  be  taken  to  correct  it. 

Are  women  discriminated  against  in  health  care?   As  patients? 
As  nurses? 

We  invite  nurses  to  send  us  examples  of  discrimination.  Use  the 
form  below,  and,  please,  sign  it.  Your  identity  will  not  be  revealed. 

Return  the  form  not  later  than  31  July  1975,  to: 
Canadian  Nurses'  Association 
Director  of  Information  Services 
50  The  Driveway 
Ottawa,  Ontario  K2P  1  E2 


Incident: 


In  your  opinion, how  does  this  incident  show  discrimination  against  women? 


Areyou:na  nurse, □  a  patient,  □  other  (specify). 


THF  CANAniAN  NIIRRF  - 


names 


Patricia  Wallace  (R.N. .  Montreal  Gen- 
eral Hospital;  B.ScN.,  Dalhousie 
University.  Halifax)  has  been  ap- 
pointed administrative  assistant  to  the 
assistant  executive  director  (nursing)  at 
the  Royal  Alexandra  Hospital.  Edmon- 
ton, Alberta.  She  is  currently  complet- 
ing requirements  for  her  masters  degree 
in  health  services  administration.  Uni- 
versity of  Alberta.  Wallace  has  taught 
administration  in  the  basic  degree  prog- 
ram at  the  University  of  Alberta  and  has 
experience  in  cardiovascular  intensive 
care  nursing  and  emergency  nursing. 


i- 


A^^^Mi 


M.  Johiisuii 


P.  Wallace 


Margaret  lohnson  (R.N. .  U.  of  Alberta 
Hospital.  Edmonton;  B.Sc.  U.  of  Al- 
berta) has  been  appointed  director  of 
nursing  service  at  the  Royal  Alexandra 
Hospital.  Edniunton.  Alberta.  She  has 
had  experience  as  an  obstetrical  nursing 
supervisor,  obstetrical  instructor,  and  in- 
service  education  supervisor. 

Nancy  Conrod  (J.D..  Northwestern 
University.  Evanston.  111.;  A.B..  Rad- 
cliffe  College.  Cambridge.  Mass.)  has 
been  appointed  to  the  newly  created 
position  of  research  officer  in  the  labor 
relations  department  of  the  Registered 
Nurses'  Association  of  British  Colum- 
bia. She  was  formerly  with  the  Ombuds 
Service  of  the  Vancouver  Status  of 
Women,  priorto  which  she  had  been  an 
attorney  adviser  in  the  Chicago  Reg- 
ional office  of  the  U.S.  Department  of 
Housing  and  Urban  Development. 


Kathleen  EllioH  has  retired  as  director  of 
the  Clinton  Public  Hospital,  Clinton, 
after  39 years  of  service  to  that  hospital. 
She  was  honored  by  several  beautiful 
gifts  at  a  special  banquet. 


The  new  executive  of  the  Ontario  Tu- 
berculosis and  Respiratory  Disease  As- 
sociation Nurses"  Section  are:  Presi- 
dent .  Susan  Arnold,  supervisor  of  health 
service  of  Port  Weller  Dry  Dock.  St. 
Catharines;  first  vice-president.  Gloria 
Murdoch,  Chest  Wing,  University 
Hospital.  London;  second  vice- 
president.  Norah  O'Leary,  assistant  pro- 
fessor. Lakehead  University,  Thunder 
Bay. 

Members-at-large  are:  Jean  Buller, 
senior  nurse-epidemiologist.  East  York 
Health  Unit.  Leona  Cairnie,  supervisor. 
Allergy  Clinic.  National  Defence  Me- 
dical Centre.  Ottawa:  Edna  McDonnell, 
public  health  nurse.  Ha.stings  and 
Prince  Edward  County  health  unit;  and 
Ellen  Black,  supervisor.  Chest  Clinic. 
Metro  Windsor-Essex  County  health 
unit. 


Brunhilda(Hildy)Haipllk(Reg.N..The 

Hospital  for  Sick  Children  school  of 
nursing;  Cert.  Nursing  Educ.  Univer- 
sity of  Toronto;  B.N..  McGill  Univer- 
sity) has  been  appointed  assistant  direc- 
tor of  nursing,  ambulatory  services. 
The  Hospital  for  Sick  Children. 
Toronto. 

Except  for  a  year  on  the  nursing  staff 
of  Karolinska  Hospital  in  Stockholm. 
Sweden.  Haiplik  has  been  based  at  The 
Hospital  for  Sick  Children.  She  has 
been  staff  nurse,  in.structor,  assistant 
coordinator  in  medicine,  project  super- 
visor, and  supervisor  of  the  outpatient 
department. 


Elaine  P.  Hykawy  (B.Sc.N..  University 
of  Saskatchewan;  B.Sc.N.  (Ed.),  Uni- 
versity of  Western  Ontario,  London) 
has  been  appointed  adviser,  nursing 
and  allied  health  manpower,  research 
and  analysis  division.  Ontario  Ministry 
of  Health.  Toronto. 

Having  been  staff  nurse  and  inser- 
vice  nurse  at  The  Montreal  Children's 
Hospital,  she  taught  at  the  St.  Boniface 
General  Hospital  school  of  nursing,  in 
Winnipeg,  and  at  the  University  of 
Western  Ontario.  London.  Her  most 
recent  appointment  was  that  of  nursing 
care  analyst.  Scarborough  General 
Hospital.  Toronto. 


Betty  Eggen  (R.N. .  U.  of  Alberta  Hospi- 
tal. Edmonton;  Dipl.  in  P.H.N,  and 
B.N..  McGill  University,  Montreal) 
was  recently  appointed  assistant  direc- 
tor of  nursing,  local  Board  of  Health. 
Calgary  Health  District.  Calgary.  Al- 
berta. 

Eggen  has  held 
various  nursing 
positions  across 
Canada:  staff 
nurse  of  U.  of 
Alberta.  Hospital; 
nursing  sister  in 
the  Canadian 
Army;  assistant 
director  of  serv- 
ice. Montreal  Branch  of  the  vON;  the 
director  of  service,  Calgary  branch  of 
the  VON;  and.  for  the  past  3  years,  field 
nursing  officer  with  medical  services. 
Health  and  Welfare  Canada. 


F.  Lillian  Campion  (Reg.  N..  Wellesley 
Hospital  school  of  nursing.  Toronto, 
B.Sc,  M.A.,  Teachers  College, 
Columbia  University,  New  York)  for- 
merly nursing  service  secretary  and  di- 
rector of  the  project  for  evaluation  of 
nursing  services,  the  Canadian  Nurses' 
Association,  Ottawa,  died  18  April 
1975.  Prior  to  joining  the  staff  of  CNA 
Campion  had  been  night  supervisor  and 
nursing  instructor  at  the  Wellesley 
Hospital,  then  associate  director  of 
nursing  service,  at  the  Kitchener  — 
Waterloo  Hospital. 

She  was  awarded  the  centennial 
medal  in  1967  for  her  work  in  nursing 
in  Canada. 


Caroline  E.  Robertson  (R.N.,  Royal 
Victoria  Hospital.  Montreal;  B.N.. 
M.Sc.  (Applied).  McGill  University) 
has  been  appointed  director  of  nursing. 
Montreal  Neurological  Hospital. 
Montreal.  Since  1972.  she  has  been 
director  of  nursing  at  the  Sherbrooke 
Hospital.  Sherbrooke. 

Earlier  in  her  career,  she  had  been 
associated  with  the  Montreal  Neurolog- 
ical Hospital  as  staff  nurse,  head  nurse, 
nursing  instructor,  assistant  director  of 
nursing  education,  and  as  clinical  coor- 
dinator. 


40 


23  or  Mort  Sime  Itimt,  20% 


Christina  Macleod  {R.N..  Brandon  Ge- 
neral Hospital  school  of  nursing)  has 
been  honored  as  the  February  1975 
"Woman  of  the  Month"  by  the  Mani- 
toba Association  of  Registered  Nurses. 
Since  her  graduation  in  1908  and  until 
her  retirement  as  superintendant  of 
Brandon  General  Hospital  in  the  for- 
ties, her  career  has  been  devoted  to 
nursing  and  the  improvement  in  stan- 
dards of  nursing  and  hospital  care. 
Since  her  retirement,  she  has  been  es- 
pecially interested  in  hospital  auxilia- 
ries. 

She  has  received  a  number  of  ho- 
nors, including  an  honorary  lifetime 
membership  in  marn:  the  Centennial 
Medal  for  Hospital  Auxiliaries;  and 
Brandon's  special  recognition  of  her 
contribution  to  that  city,  a  street  named 
Macleod  Drive. 


Donna  Barber  (R.N.,  Regina  General 
Hospital:  B.N..  Dipl.  contin.  educ. 
University  of  Saskatchewan)  has  been 
appointed  coordinator  for  continuing 
medical  and  continuing  nursing  educa- 
tion, based  at  Plains  Health  Centre, 
Regina.  This  program  is  offered 
through  the  College  of  Nursing,  Uni- 
versity of  Saskatchewan. 

She  has  also  been  appointed  clinical 
lecturer  on  the  faculty  of  the  College  of 
Nursing.  She  was  for  several  years 
coordinator  and  assistant  director  of 
nursing  education  at  the  Regina  Gen- 
eral Hospital  school  of  nursing,  and  has 
more  recently  been  connected  with  the 
correspondence  refresher  courses  for 
nurses.  University  of  Regina. 

Anna  Archibald  Christie  has  resigned 
from  her  position  as  educational 
consultant  with  the  New  Brunswick 
Association  of  Registered  Nurses. 
Prior  to  returning  to  the  maritimes  in 
1962  to  assume  this  position,  she  had 
been  associate  director  of  nursing  edu- 
cation at  The  Montreal  General  Hospi- 
tal. 

Christie's  contribution  to  nursing 
education  in  New  Brunswick  has  been 
particularly  appreciated,  especially  du- 
ring the  period  of  transition  from  hospi- 
tal to  two-year  programs  for  student 
nurses. 


Myrna  Sherrard  ( R .  N . ,  Moncton  Hospi- 
tal schtx)l  of  nursing,  Moncton,  N.B.; 
B.N.,  McGill  University)  has  been  ap- 
pointed director  of  nursing  operations. 
The  Moncton  Hospital.  She  has  been 
associated  with  this  hospital  for  several 
years,  having  served  on  the  faculty  of 
the  school  of  nursing,  held  the  position 
of  nurse  clinician  and.  since  1970.  that 
of  associate  director  of  nursing  servi- 
ces. 


Beatrice  Knock  has  been  elected  for  a 
three-year  term  as  chairman  of  the 
Nova  Scotia  section  of  the  Nurses"  As- 
sociation of  the  American  College  of 
Obstetricians  and  Gynecologists.  She 
is  the  inservice  education  coordinatorat 
the  Grace  Maternity  Hospital.  Halifax, 
Nova  Scotia. 


Suzanne    Kirouac 

(M.N.,  University 
of  Montreal)  is 
the  recipient  of 
the  1974  Warner- 
Lambert  Canada 
Limited  nursing 
fellowship  award, 
made  available 
..':'  V'M .       annually     to     a 

promising  nursing  graduate  to  assist  in 
furthering  her  knowledge  and 
experience  in  the  field  of  nursing. 

Kirouac  is  an  assistant  professor  in 
the  faculty  of  nursing.  University  of 
Montreal. 

Thurley  Duck  (B  N.,  McGill  Univer- 
sity, Montreal)  has  been  elected  presi- 
dent of  the  Registered  Nurses"  Associa- 
tion of  British  Columbia.  She  is  super- 
visor of  the  Heather  Pavilion.  Van- 
couver General  Hospital,  and  is  work- 
ing toward  a  master  of  science  degree  in 
nursing  at  the  University  of  British 
Columbia. 

First  vice-president  of  rn.abc  is 
Norman  Roberts,  assistant  director  of 
nursing  at  Woodlands  School,  New 
Westminster:  and  second  vice- 
president  is  Dorothy  Bonnett,  director 
of  nursing.  South  Okanagan  General 
Hospital.  Oliver,  B.C. 

(Continued  on  page  42) 


Mrs.  R.  F.  JOHNSON 
SUPERVISOR 


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THE  CANADIAN  NURSE  —  June  1975 


PEOPLE 
ARE  SOFTER 

THAN  BEDS. 

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is  indicated  in  the  treatment  of  dry,  irritated  skin  due  to 

external  disorders.  The  lotion  is  effective  as  a  hospital 

body  rub  and  is  specially  formulated  for  this 

purpose.  Hospital      Lotion  contains  no 

aromatic  sensitisers. 


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names 


(Continued  from  page  41) 


Viviane      Marcil 

(Reg.  N.,  Ottawa 
General  Hospital 
school  of  nursing) 
has  been  appoint- 
ed assistant  editor 
of  L'  infirmiere 
canadienne.  She 
.^^^  has     previously 

^'' JWKl  worked  in  the  or- 

thopedic and  emergency  departments 
of  the  Ottawa  General  Hospital.  Her 
personal  interests  include  music  and  the 
arts. 


Mary  Lou  Pilling  (B.Sc.N.,  University 
of  Saskatchewan)  has  become  the  first 
registrar  of  the  Northwest  Territories 
Registeied  Nurses'  Association.  She 
had  been  a  classroom  and  clinical  in- 
structor with  the  Brandon  General 
Hospital  school  of  nursing  prior  to 
moving  to  Yellowknife,  where  she  has 
recently  been  engaged  in  designing  and 
instructing  a  refresher  program  for 
nurses. 


Daisy  C.  Motriuk  (R.N. ,  The  Children's 
Hospital  of  Winnipeg  school  of  nurs- 
ing; B.S.N. ,  M.S.N.,  University  of 
Minnesota,  Minneapolis;  is  in 
Indonesia  on  a  two-year  tour  of  duty  as 
nurse  educator  with  MEDICO,  a  service 
of  CARE. 

Previously  serv- 
ing with  the 
World  Health  Or- 
ganization, she 
began  a  diploma 
school  of  nurs- 
ing in  Hargeisa, 
Somalia;  assisted 
in  developing  a 
university  nursing 
program  in  Cairo,  Egypt;  and,  for  the 
six  years  prior  to  her  current  appoint- 
ment, was  a  nurse  administrator/ 
educator  in  Kabul,  Afghanistan. 


Joan  M.  Ross  (R.N. ,  St.  Paul's  Hospital 
school  of  nursing;  B.Sc.N.,  University 
of  Saskatchewan)  has  been  appointed 
associate  director  of  nursing  service, 
Calgary  General  Hospital. 

Her  nursing  career  has  included  posi- 
tions as  staff  nurse,  clinical  instructor, 
residence  director,  inservice  director, 
and  supervisor.  She  has  been  with  the 
department  of  nursing  service  of  the 
Calgary  General  Hospital  since  1971. 


dates 


June  27-29,  1975 

Continuing  education:  Case  Manage- 
ment (R.N.s  giving  direct  care)  to  be 
held  in  Vancouver  under  sponsorship  of 
Registered  Nurses'  Association  of 
British  Columbia.  Contact:  S.  Rothwell, 
c/o  University  of  British  Columbia 
school  of  nursing,  Vancouver. 

luly  10-12,  1975 

Final  reunion  of  graduates  of  the 
Hotel- Dieu  St.  Joseph  School  of  Nurs- 
ing. Bathurst.  N.B..  to  coincide  with 
Bathurst  Festival  Week.  For  information 
write:  C.  fvlorrison,  Chairman,  Reunion 
75  Committee,  School  of  Nursing, 
Chaleur   General    Hospital,    Bathurst, 

August  17-19,  1975 

Annual  meeting/educational  workshop 
of  the  American  Association  of  Diabetes 
Educators  to  be  held  at  Philadelphia 
Marriott  Motor  Hotel,  Philadelphia.  For 
information,  write:  AADE  Headquarters. 
3553  W.  Peterson  Ave.,  Chicago,  III. 
60659,  U.S.A. 

August  25-27,  1975 
Seminar  on  conflicts  in  the  physical  re- 
habilitation team,  to  be  held  at  University 
of  Ottawa,  Ottawa.  For  information, 
write:  Carolyn  Belzile,  Coordinator,  Con- 
tinuing Education  Program,  School  of 
Health  Administration,  University  of  Ot- 
tawa, Ottawa,  Ontario. 


August  29-31,  1975 

Three-day  seminar  on  orthopedics  and 
rehabilitation  for  nurses,  presented  by 
the  University  of  Miami  School  of 
Medicine,  will  be  held  at  the  Americana 
Hotel,  Miami  Beach,  Florida.  For  further 
information  contact  the  Dept.  of  Or- 
thopedics and  Rehabilitation.  P.O.  Box 
520875,  Biscayne  Annex,  Miami,  Fla., 
33152.  U.S.A. 

September  1-3,  1975 

International  workshop-conference  on 
Atherosclerosis  at  University  of  Western 
Ontario,  London,  Ontario.  For  informa- 


tion, write:  Evelyn  McGloin,  Director  of 
Professional  Education,  Ontario  Health 
Foundation,  310  Davenport  Road, 
Toronto,  Ontario,  M5R  3K2. 

September  3-5 

Canadian  Society  of  Respiratory  Tech- 
nologists' annual  educational  forum  to 
be  held  in  Halifax.  For  information,  write: 
T.  Cashen,  R.R.T.,  Department  of  Re- 
spiratory Technology,  Victoria  General 
Hospital.  Halifax,  N.S.  B3H  2Y9. 


September  14-18,  1975 

Canadian  Foundation  on  Alcohol  and 
Drug  Dependencies  10th  annual  con- 
ference to  be  held  at  Auberge  des 
Gouverneurs  (Downtown),  Ouebec 
City.  Theme:  Anticipation.  For  informa- 
tion, write:  Mary  S.  Lamontagne.  Con- 
ference Programme  Committee,  Optat, 
969.  route  de  I'Eglise,  Sainte-Foy. 
Quebec,  lOe,  G1V  3V4. 

September  22-24,  1975 

Seminar  —  "Care  in  the  Home:  1975  a 
year  of  decision  to  be  held  at  University 
of  Ottawa.  For  information,  write: 
Carolyn  Belzile,  Coordinator  Continuing 
Education  Program,  School  of  Health 
Administration,  University  of  Ottawa, 
Ottawa,  Ontario. 

September  23-24,  1975 

Canadian  Hospital  Association  national 
conference  on  Health  and  the  Law,  to  be 
held  in  Ottawa.  Subjects  under  discus- 
sion include:  euthanasia,  consent,  med- 
ical staff  pnvileges,  and  legal  aspects 
of  computerization.  For  information, 
write:  Canadian  Hospital  Association, 
25  Imperial  Street.  Toronto,  Ontario, 
MSP  1C1. 

September  23-26,  1975 
25th  annual  meeting  of  the  Canadian 
Psychiatric  Association.  Banff  Springs 
Hotel,  Banff.  Alta.  For  information  write: 
Dr.  K.  Roy  MacKenzie.  Faculty  of 
Medicine,  The  University  of  Calgary, 
Calgary,  Alta..  T2N  1N4. 


October  5-7,  1975 

Annual  meeting  of  Health  Sciences 
Educational  Associations,  to  be  held  at 
Skyline  Hotel,  Ottawa.  This  is  a  conjoint 
meeting  of  the  Association  of  Canadian 
Medical  Colleges,  Association  of  Cana- 
dian Faculties  of  Dentistry,  Association 
of  Deans  of  Pharmacy  of  Canada,  As- 
sociation of  Canadian  Teaching  Hospi- 
tals, Canadian  Associations  of  Univer- 
sity Schools  of  Nursing,  and  Canadian 
Association  of  University  Schools  of 
Rehabilitation.  For  information,  write: 
C.A.  Casterton,  Executive  Secretary, 
Association  of  Canadian  Medical  Col- 
leges, 151  Slater  Street,  Ottawa,  Ont. 

October  20-22,  1975 

Canadian  Conference  on  Medical  De- 
vices in  Health  Protection  to  be  held  in 
the  Government  Conference  Centre, 
Rideau  Street,  Ottawa,  Ontario.  For 
information,  write:  Jean  Anderson. 
Technical  Secretariat,  Health  Protection 
Branch,  Health  and  Welfare  Canada, 
Ottawa,  Ontario,  K1A  0L2. 

October  20-24,  1975 

Ontario  Occupational  Health  Nurses' 
Association  Conference,  Prince  Hotel, 
Toronto,  Ontario.  For  information,  write: 
Joan  Subasic,  Conference  Chairman, 
Medical  Department,  Bell  Canada,  393 
University  Ave.,  Toronto,  Ontario. 

October  27-28,  1975 

Public  Health  Association  of  Nova 
Scotia  annual  meeting  to  be  held  at 
Chateau  Halifax,  Halifax.  Registration 
opens  October  26.  For  information  write: 
Ralph  E.J.  Ricketts,  phans,  17  Alma 
Crescent.  Halifax.  N.S.  B3N  2C4. 

November  10-12,  1975 

Annual  meeting  of  the  Order  of  Nurses 
of  Quebec  to  be  held  at  the  Queen 
Elizabeth  Hotel,  Montreal,  Quebec. 

November  16-20,  1975 

American  Public  Health  Association  an- 
nual meeting.  Chicago.  III.  Theme: 
Health  and  Work  in  America.  -Q: 


irIE  CANADIAN  NURSE  —  June  1975 


books 


Medical  Care  and  Rehabilitation  of  the 
Aged  and  Qironically  III,  3ed..  by 
Charles  D.  Bonner.  31 1  pages.  Bos- 
ton, Little.  Brown,  and  Co.  1974. 
Canadian  Agent:  J.B.  Lippincott. 
Toronto. 

Reviewed  by  Mary  V.  Peever,  Prog- 
ram Coordinator.  Advanced  Clini- 
cal Studies  for  Community  Health 
Nurses.  School  of  Nursing,  Univer- 
sity of  Manitoba,  Winnipeg.  Man- 
itoba. 

The  author  of  this  book  addresses  what 
he  feels  are  weak  points  in  medical  care 
and  rehabilitation  of  the  aged  and 
chronically  ill.  The  intent  is  to  exclude 
diseases  that  are  well  covered  in 
specialized  textbooks  and  to  highlight 
areas  where  physicians  and  allied 
health  personnel  have  failed  to  accept 
their  responsibilities. 

Disease  conditions  commonly  en- 
countered among  the  aged  and  chroni- 
cally ill  are  described  in  Section  1. 
Simple  procedures  and  techniques  used 
in  the  rehabilitation  process  are  well 
illustrated  with  photographs  through- 
out the  book.  These  should  prove  help- 
ful for  both  professional  and  lay  per- 
sons working  in  this  field. 

In  Section  II.  a  rather  inconsistent 
and  distorted  picture  of  the  health  team 
emerges  as  roles  and  responsibilities  of 
team  members  are  outlined.  The  physi- 
cian and  nurse  are  described  in  terms  of 
what  they  should  know  about  the  care 
of  the  elderly  and  incapacitated. 

The  physiotherapist,  occupational 
therapist,  speech  therapist,  and  social 
worker  are  depicted  in  terms  of  the 
knowledge  and  skills  they  can  contri- 
bute to  this  field  of  endeavor.  The  role 
of  the  dietitian  is  given  in  terms  of  nutri- 
tional needs  of  the  chronically  ill.  and 
the  psychiatrist  is  shown  by  case  his- 
tories of  individuals  suffering  depres- 
sive reactions  to  painful  readjustments. 
Finally,  the  family's  role  appears  in 
terms  of  problems  that  may  be  faced 
when  a  family  member  suffers  from  a 
chronic  disability. 

The  author  highlights  many  areas 
that  have  been  long  neglected  in  the 
care  of  the  elderly  and  chronically  ill. 
In  describing  the  physician  as  the  direc- 
tor of  the  medical  plan,  he  points  to 


serious  gaps  in  medical  supervision, 
especially  in  long-term  care  facilities, 
mental  hospitals,  and  nursing  homes. 

A  similar  approach  might  have  been 
realistic  in  dealing  with  the  role  of  the 
nurse.  Instead,  the  author  describes  the 
nurse  as  '"the  provider  of  much  of  the 
care."  while  omitting  almost  com- 
pletely the  specific  knowledge  and 
skills  with  which  nurses  are.  or  should 
be.  prepared.  He  also  omits  the  public 
health  nurse  in  the  chapter  on  home 
evaluation. 

Some  mention  of  skilled  nursing  care 
appears  in  the  chapter  on  the  nursing 
home:  criteria  for  classification  of  pa- 
tients according  to  levels  of  care  are 
discussed.  Nevertheless,  failure  to  de- 
tail the  specific  contribution  of  the 
nurse  as  a  member  of  the  rehabilitation 
team  is  a  serious  discrepancy,  limiting 
the  use  of  this  book  as  a  nursing  refer- 
ence, except  on  a  selective  basis. 

Psychiatric  Nursing  6ed.  by  Ruth  V. 
Matheney  and  Mary  Topalis.  439 
pages.  St.  Louis.  Mosby.  1974. 
Canadian  agent:  Mosby.  Toronto. 
Reviewed  by  Irene  L.  Myles, 
Psychiatric  Nursing  Teacher, 
Loyalist  College,  Belleville,  On- 
tario. 

This  book  emphasizes  the  benefits  to  be 
gained  when  all  registered  nurses  use 
good  interpersonal  skills  to  give  under- 
standing care  to  clients.  Directing  the 
contents  to  this  group,  the  writers  give  a 
good  summary  of  past  trends  that  pre- 
vented such  activity  and  show  how  pre- 
sent trends  open  exciting  possibilities. 

The  extent  of  mental  illness  is  out- 
lined, and  the  scope  for  real  accomp- 
lishment by  registered  nurses  is  re- 
vealed. What  we  are  as  young  human 
beings  and  what  we  become  through 
socialization  and  individually  em- 
ployed defensive  maneuvers  is  re- 
viewed. 

As  in  past  editions  by  the  authors, 
emotional  disorders  are  dealt  with 
under  recognizable  and  frequently  ob- 
served behavioral  patterns.  It  is  this  ap- 
proach that  makes  the  information  of 
value  to  nurses  in  any  area.  This  may 
lessen  the  functional  use  of  the  book  as 
a    text    for    beginning    students    in 


psychiatry,  but  it  does  not  detract  from 
its  value  as  a  reference  source. 

While  it  is  true  that  nurses  are  re- 
quired to  deal  with  behavior  as  it  pres- 
ents, they  can  be  more  effective  if  they 
gain  a  comprehensive  view  of  the  prob- 
lem. Students  need  an  understanding  of 
behavioral  patterns  in  relation  to  a  de- 
velopmental pattern  and  a  particular 
disorder,  and  some  knowledge  of  prob- 
able behavioral  change  to  be  achieved 
through  therapy. 

Such  understanding  and  knowledge 
could  be  acquired  through  a  book  that 
brings  these  aspects  together  or  through 
extended  experience  in  a  psychiatric 
facility,  which  is  not  possible  in  the 
present  diploma  nursing  program. 

Sex  and  the  Intelligent  Woman  by  Man- 
fred F.  de  Martino.  308  pages.  New 
York,  Springer,  1974.  Canadian 
Agent:  Toronto,  Longman  Canada 
Ltd. 

Reviewed  by  Alice  E.  Caplin,  Assis- 
tant Professor,  College  of  Nursing, 
University  of  Saskatchewan,  Saska- 
toon. Sask. 

Se.x  and  the  Intelligent  Woman  is  the 
second  book  by  Manfred  F.  de  Mar- 
tino. It  shows  a  strong  resemblance  to 
its  predecessor.  The  New  Female  Sexu- 
ality, in  which  de  Martino  studied  the 
sex  habits  of  female  nudists.  His  ver- 
batim quotes  from  his  subjects  have  a 
familiar  ring. 

The  author  tells  us  that  the  sample 
used  in  this  present  report  consisted  of 
327  women,  whose  participation  was 
solicited  from  the  membership  of 
Mensa.  an  international  organization  of 
individuals  with  high  IQs.  Two  self- 
administered  personality  inventories 
measuring  self-esteem  or  dominance 
and  security-insecurity  accompanied 
an  8-page  questionnaire  sent  to  these 
women,  "to  see  if  any  correlation  ex- 
isted between  sexual  practices  and  the 
levels  of  self-esteem  and  security  in 
women  of  high  intelligence."" 

From  a  book  titled  5f.v  and  the  Intel- 
ligent Woman,  one  might  expect  a 
comparison  of  sexual  behavior  between 
women  of  superior  intelligence  and 
those  of  less  intelligence,  and  a  com- 
parison of  correlations  between  those 


whose  behavior  differs.  One  might  also 
expect  to  learn  in  what  ways  intellig- 
ence affects  sexual  behavior.  In  this 
book,  intelligence,  except  as  it  accom- 
panies a  robust  constitution,  is  irrelev- 
ant. 

Dominance  and  security  feelings  are 
also  irrelevant.  In  the  chapter  on  Group 
Sex  and  Mate  Swapping,  over  lO^c  of 
the  correspondents  did  not.  apparently, 
find  the  idea  appealing.  However,  only 
those  who  professed  to  have  had  posi- 
tive feelings  or  experience  —  and  two 
pages  are  devoted  to  their  remarks  — 
had  their  dominance  and  security  feel- 
ings noted. 

The  intelligent  woman  can  only  con- 
clude that  the  shiny  dust  jacket  and  the 
hard  cover  of  Sex  and  the  Intelligent 
Woman  cover  a  core  of  pornography. 
Another  group  of  women  is  being  ex- 
ploited to  provide  vicarious  thrills  to 
the  prurient. 

If  you  have  a  free  weekend  and  a  new 
vibrator  (or  perhaps  an  electrode  in 
your  brain),  you  may  want  to  turn  your- 
self on  by  reading  this  book. 

Problem-Oriented  Medical  Record  Im- 
plementation by  Rosemarian  Berni 
and  Helen  Readey.  183  pages.  St. 
Louis.  C.V.  Mosby:  1974?  Cana- 
dian Agent;  Toronto.  C.V.  Mosby. 
Reviewed  by  Donna  Blight. 
Teacher.  St.  Boniface  General  Hos- 
pital School  of  Nursing.  Winnipeg, 
Manitoba. 

This  book  seeks  to  provide  health  care 
professionals  with  a  "how  to  do  it" 
manual  on  keeping  medical  records  by 
using  the  method  that  Dr.  Lawrence 
Weed  described  in  1970  as  the 
problem-oriented  medical  record 
(POMRl 

There  have  been  only  7  years  of  ac- 
cumulated experience  in  using  and  re- 
searching this  system  of  keeping  medi- 
cal records,  and  the  authors  do  not  pre- 
sume to  have  all  the  magic  answers  for 
its  implementation.  Instead,  they  have 
illustrated  how  the  method  can  work, 
not  only  in  hospitals,  emergency 
rooms,  intensive  care  units,  psychiatric 
settings,  physicians"  offices,  nursing 
homes,  and  extended  care  facilities,  but 
also  in  the  communitv. 


They  discuss  at  length  the  advan- 
tages, not  only  to  the  patient,  but  also  to 
health  care  personnel  and  the  tax  payer. 

POMR  serves  to  protect  the  patient 
from  errors  in  management,  because 
the  problem  list  provides  a  quick  refer- 
ence to  the  patient's  problems.  For  the 
protection  of  the  nurse  returning  from 
days  off,  this  list  helps  her  comprehend 
salient  facts  and  determine  quickly  the 
problems  of  unfamiliar  patients.  The 
retrieval  of  data  serves  as  a  protective 
mechanism. 

There  have  been  grey  areas  in  patient 
education  where  neither  the  doctor  nor 
the  nurse  knew  what  the  other  had  told 
the  patient.  The  pomr  prescribes  that 
patient  education  be  explicitly  expres- 
sed in  each  plan.  For  example,  clinical 
step-by-step  procedures  have  been  de- 
vised that  would  define  the  role  of  all 
health  personnel  in  patient  teaching  of  a 
particular  problem,  such  as  diabetic 
care,  colostomy  care,  respiratory  venti- 
lation, and  for  labor  and  coronary  care 
units.  The  pooling  of  expertise  in  de- 
veloping these  steps  serves  to  improve 
patient  care  and  give  direction  to  nurs- 
ing education. 

With  the  emphasis  today  on  the  nurse 
being  accountable  and  responsible  for 
the  quality  of  nursing  care  rendered,  a 
peniianent  record  is  of  the  utmost  im- 
portance. The  PO.MRallows  forthe  nurs- 
ing process  to  be  permanently  re- 
corded. 

The  authors  of  this  manual  support 
Dr.  Weed  in  the  view  that  the  patient 
has  the  right  to  see  his  own  record  and 
that  the  patient  is  a  good  auditor,  pro- 
viding on-the-spot  feedback.  If  the  pa- 
tient is  included  in  problem  solutions, 
he  may  provide  the  most  important  re- 
source—  his  ow  n  health  care  behavior. 

Finally,  the  book  tells  how  the  POMR 
can  be  mtxlified  or  refined  so  that  it  will 
be  suitable  for  computerization  without 
altering  the  objectives  that  reflect  the 
thinking  and  action  of  the  persons  in  the 
health  care  system. 

My  only  criticism  of  the  book  is  that 
it  uses  an  uncommon  term,  "al- 
gorithm.""  Although  it  is  clearly  de- 
fined by  the  authors,  the  use  of  the  word 
in  one  section  of  the  book  leads  to  some 
confusion.  The  term  does  not  appear  in 
some    commonly    used    dictionaries. 


Professional  jargon  should  be  avoided. 
This  book  would  benefit  all  members 
of  the  health  team,  but  especially  inser- 
vice  teachers,  who  have  the  responsi- 
bility of  implementing  the  POMR  The 
final  chapter  gives  a  dynamic  model  on 
how  to  implement  pomr.  In  other 
words,  how  to  get  it  off  the  ground  in  a 
facilitv  or  institution. 


The  Head  Nurse:  Her  Leadership  Role, 
3ed..  by  Jean  Barrett,  Barbara 
Gessner,  and  Charlene  Phelps.  450 
pages.  New  York,  Appleton- 
Century-Crofis,  1975. 
Reviewed  by  Pauline  Mclnnis.  Head 
Nurse.  Foothills  Hospital.  Calgary, 
Alberta. 

In  this  third  edition,  the  authors  en- 
deavor "to  show  the  leadership  f)os- 
sibilities  forthe  head  nurse,  and  to  chal- 
lenge present  and  potential  occupants 
of  the  role  to  take  advantage  of  the 
many  available  educational  oppor- 
tunities in  developing  the  art  of  leader- 
ship." The  purpose  of  the  book  is 
clearly  achieved  in  a  comprehensive, 
sound,  realistic  approach  to  the  com- 
plex role  of  the  head  nurse. 

The  main  theme  of  the  text  encom- 
passes tw  o  major  responsibilities  of  the 
head  nurse:  administering  the  nursing 
care  of  the  patient,  and  guiding  the 
growth  and  development  of  staff. 
These  responsibilities  are  presented  in 
Paris  1  and  2  of  the  text,  involving  the 
needs  and  rights  of  patients,  the  goals 
of  nursing  care,  and  the  nursing  pro- 
cess, and  in  Part  4,  which  deals  with  the 
methods  of  staff  development,  includ- 
ing self-development  of  the  head  nurse. 

To  meet  the  authors"  objectives,  role 
changes  for  the  head  nurse  are  consi- 
dered in  Part  3.  The  unit  manager  is 
introduced  to  assume  responsibility  for 
the  coordinating,  managerial,  and  cler- 
ical functions  of  the  unit,  and  to  relieve 
the  head  nurse  of  nonnursing  functions. 
The  clinical  specialist  is  presented  as  a 
consultant  to  the  head  nurse  or  as  one 
responsible  for  the  administration  of 
nursing  care. 

Questions  for  discussion,  exercises, 

and  problems  for  investigation  at  the 

end  of  every  chapter  provide  stimulat- 

(Continued  on  page  46) 


THE  CANADIAN  NURSE  —  June  1975 


books 


(Continued  from  page  45) 

ing  means  for  planning  to  realize  goals 
in  nursing  care  and  staff  development. 

This  text  is  informative.  The  authors 
demonstrate  an  understanding  of  the 
multidisciplinary  facets  of  the  role  of 
the  head  nurse.  It  provides  methods, 
plans,  and  solutions  for  meeting  objec- 
tives. 

This  text  should  prove  beneficial  to 
the  practicing  head  nurse,  to  the  poten- 
tial head  nurse,  and  to  nurses  involved 
in  leadership  roles. 


Childbirth:    Family-Centered    Nursing, 

3ed.  hv  Josephine  lorio.  468  pages. 
St.  Louis,  C.V.  Mosby,  1975. 
Canadian  Agent:  Mosby,  Toronto. 
Reviewed  by  Phyllis  Robinson.  As- 
sistant Professor.  School  of  Nurs- 
ing, University  of  Calgary,  Cal- 
gary, Alberta. 

The  author's  slated  purpose  is  to  pro- 
vide a  resource  for  nurses  responsible 
for  the  guidance  of  families  during  the 
childbirth  experience  and  for  nursing 
students  in  learning  basic  concepts  rela- 
tive to  it.  These  aims  have  been 
achieved,  resulting  in  an  informative 
and  easily  read  text. 

The  material  covers  the  normal  as- 
pects of  maternity  care  and  common 
difficulties  encountered  in  the  prenatal, 
intrapartal,  and  postpartal  periods. 
Characteristics  and  care  of  the  newborn 
are  well  documented.  The  material  re- 
lated to  the  mother-child  relationship 
would  be  particularly  helpful  to  nursing 
students  and  to  the  practitioner  who 
needs  review. 

Incorporation  of  material  on 
gynecological  problems  is  a  good  blend 
of  two  subject  areas.  It  provides  a  con- 
venient source  of  informatiwn  that  can 
be  used  in  the  nurse's  teaching  riile  and 
in  preventive  health  care. 

A  good  basic  introduction  to  infertil- 
ity, sterility,  the  menopause,  abortion, 
and  unwed  parents  is  included.  No  par- 
ticular bias  is  evident  in  dealing  with 
the  controversial  aspects  of  these 
topics. 

From  time  to  time,  reference  is  made 
to  the  fact  that  the  nurse  may  need  assis- 
tance in  coping  with  her  own  feelings 
before  she  can  help  others.  This  recog- 
nition that  nurses  are  human  is  refresh- 
ing. 

The  organization  of  the  material  is 
based  on  a  theme  of  normal  to  abnor- 
mal. Within  any  given  section,  factual 
data  is  presented  first,  followed  by  the 
appropriate  nursing  interventions. 
Study  questions  provide  a  helpful  learn- 
ing tool  for  basic  students. 


Diagrams,  charts,  and  pictures  gen- 
erally support  the  written  text.  In  one 
instance,  however,  an  error  in  labeling 
an  anatomical  site  is  noted  (p.  27.  Fig. 
4  -  1.  sacrococcygeal  joint). 

Although  this  book  is  comprehen- 
sive in  relation  to  the  variety  of  topics 
included,  it  has  not  included  material 
related  to  human  sexuality  as  re- 
searched by  Masters  and  Johnson.  This 
kind  of  information  would  be  helpful  to 
those  dealing  with  couples  in  the  child- 
bearing  period.  It  is  also  pertinent 
to  the  aims  of  this  book. 

In  summary,  this  book  is  a  valuable 
basic  text  for  nursing  students  and  a 
good  reference  for  binh  hospital  and 
public  health  nursing  practitioners. 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses"  Association  Library 
are  available  on  loan  —  with  the  ex- 
ception of  items  marked  R  —  to  CNA 
members,  schools  of  nursing,  and  other 
institutions.  Items  marked  R  include 
reference  and  archive  material  that  does 
not  go  out  on  loan.  Theses,  also  R,  are 
on  Reserve  and  go  out  on  Interlibrary 
Loan  only. 

Requests  for  loans,  maximum  3  at  a 
time,  should  be  made  on  a  standard 
Interlibrary  Loan  form  or  on  the  "Re- 
quest Form  for  Accession  List""  printed 
in  this  issue. 

If  you  wish  to  purchase  a  book,  con- 
tact your  local  bookstore  or  the  pub- 
lisher. 


BLOOD  TRANSFUSION  REACTIONS  antJ 
COMPLICATIONS  A  Programmed  Text 

by  Cecelia  F.  Capuzzi,  MSN 

Teaches  the  origins,  symptoms,  nursing  in- 
terventions and  prevention  of  the  more 
usual  transfusion  reactions  and  complica- 
tions. Useful  as  a  supplemental  text  in  clas- 
ses, learning  labs,  cont.  ed.  courses. 

64  pages,  219  frames,  1975,  $2,50 

Handbook  for  CAMP  NURSES 
and  Other  Camp  Health  Workers 

by  Mary  Lou  Hamessley,  RN 

A  really  helpful  book  for  txDth  novice  and 
experienced  camp  nurses.  Discusses  in- 
firmary routines,  health  programs,  sanita- 
tion, treating  the  illnesses  and  Injuries  that 
occur  at  camp,  and  a  great  deal  more 
159  pages,  lllus,,  index,  1973,  S3. 95 

Order  from:  THE  TIRESIAS  PRESS,  INC. 
116  Pinehurst  Ave.,  New  York  City  10033 

(Please  add  35c  for  post  &  hdlg  if  ordering  on  fy  l  book) 
WE  SHIP  SAME  DAY  ORDER  IS  RECEIVED 


BOOKS  AND  DOCUMENTS 

I  Baker.  Ethel  Jo.  Middle-level  workers: 
characleri.ilics.  training  and  ulilizaiian  of  mental 
health  associates.  New  York.  Behavioral  Publi 
cations.  cl975.  67p. 

2.   Bates.  Barbara.  A  guide  lo  physical  examina- 
tion. Philadelphia.  Lippincott.  1974,  375p 
.1.   Braga.  Joseph,  coinp.  Growing  with  children: 
the  early  childhood  years.    Englewoixl  Cliffs. 
N.J..  Prentice-Hall.  cl974.  2().<ip. 

4.  Brailhwaite.  iVlax.  Sic  it  kids:  the  story  of  the 
Hospital  for  Sick  Children  in  Toronto.  Toronto. 
McClelland  and  Stewart.  cl974.  294p. 

5.  Canadian  almanac  and  directory.  Toronto. 
Copp  Clark.  [975.  9l4p.  R 

6.  Canadian  Pharmaceutical  Association.  Com- 
pendium of  pharmaceutical  and  specialties 
(Canada)  lOed.  Toronto.   1975.   I()34p.  R 

7.  Caring  for  patients  with  chronic  renal  dis- 
ease: a  reference  guide  for  nurses,  led  Roches- 
ter Regional  Medical  Program  and  University  of 
Rochester  Medical  Center.  1972.  I32p. 

8.  De  Friese.  Gordon  H.  The  Saull  Ste.  Marie 
Community  health  sur\'ey  of  1973 :  community 
health  centres  and  private  solo  practice  under 
universal  health  insurance:  the  consumers'  view. 
Sault  Ste  Marie.  Ontario.  Saull  Ste.  Marie  and 
District  Group  Health  Association.  1974.  140p 

9.  Ethicon.  Inc  The  human  body:  its  major  sys- 
tems and  their  functions.  Somerville.  N.J.. 
cl972.  50p. 

10.  — .  Nursing  care  of  the  patient  in  the  O.R. 
Somerville,  N.J.,  cl973.   I07p. 

I  I .   — .  Suture  use  manual:  use  and  handling  of 
sutures  and  needles.  Somerville.  N.J..  cl972 
48p. 

12.  — .  Technics  in  surgery.  Somerville.  N.J.. 
c  197 1-2.  5  pis.  in  1. 

1.3.  First  aid.  3d  Canadian  ed.  Ottawa,  St.  John 
Ambulance,  The  Priory  of  Canada  of  the  Most 
Venerable  Order  of  the  Hospital  of  St.  John  of 
Jerusalem.  cl974.  248p. 

14.   Foster.  George  M .  Problems  in  iniercultural 
health  programs.  New  York.  Social  Science  Re 
search  Council.  I9.58.  49p.  (Social  Science  Re- 
search Council.  Pamphlet  12) 
\fi.   Franklin,  Barbara  Lane.  Patient  anxiety  on 
admission  to  hospital.  London.  Royal  College  of 
Nursing.  cl974.  70p.  (The  study  of  nursing  care 
project  reports  ser.  I.  no. 5) 
Id.   Haase.  Patricia  T.  Nursing  education  in  the 
south,   1973.   Atlanta.  Ga..  Southern  Regional 
Education  Board.  1973.  59p.  (Pathways  to  prac- 
tice, vol.  I.  SREB  Nursing  curriculum  project) 

17.  Health  Computer  Information  Bureau 
Health  computer  applications  in  Canada: 
catalogue  and  descriptions,  vol.  I.  Dec.  1974. 
Ottawa.  1974.  232p.  R 

18.  Hoeller.  Mary  Louise.  Surgical  technology: 
h<isis  for  clinical  practice.  3ed.  St,  Louis. 
.Mosby.  1974.  386p. 

19.  Joint  Practice  Committee  of  the  Colorado 
Medical  Society  and  the  Colorado  Nurses'  As- 
sociation.  Guidelines  for  nurse  practitioners 
Denver.  Col..  Colorado  Nurses'  Assoc  .   1974 
Iv. 


accession  list 


20  The  lei>al  rights  of  children:  every  child  has 
the  right  lo he  happy.  Montreal,  Canadian  Mental 
Health  Assoe..  Quebec  Div..  1974.  I44p. 

21  Lerch.  Constance.  Maternity  nursing.  2ed. 
St.  Louis.  Mosby.  1974.  432p. 

22.  Marram.  Gwen  D.  Primary  nursing:  a  model 
for  individualized  care.  St.  Louis,  .Mosby.  1974. 
.156p. 

23.  Mereness.  Dorothy  A.  Essentials  of 
psychiatric  nursing.    9ed.   St.   Louis.   .Mosby. 

1974.  .356p. 

24.  Minnesota  Hospital  Association.  Manage- 
ment Engineering  Division. /I  manual  for  nursing 
quality  audit.  Minneapolis.  Minnesota  Hospital 
.Assoc,  1973.  78p. 

25.  National  League  for  Nursing.  Dept.  ol'Home 
Health  .Agencies  and  Community  Health  Ser- 
vices. Problem-oriented  systems  of  patient  care. 
New  York,  1974.  227p. 

26.  The  nursing  clinics  of  North  Ainerica  vol  9. 
no.  4,  Dec.  \97'i.  Neurologic  and  neurosurgical 
nursing.  Toronto,  Saunders,  1974.   192p. 

27  Pack.  Mary,  .\ever  surrender.  Vancouver. 
B.C..  Mitchell  Press.  cl974    256p. 

28.  Reitt,  Barbara  B.  To  serve  the  future  hour: 
an  anthology  on  new  directions  for  nursing.  At- 
lanta. Ga..  Southern  Regional  Education  Board, 
1974.  I  I  Ip  (Pathways  to  practice,  vol.  2.  SREB 
Nursing  curriculum  project) 

29.  Ruppel.  Gregg.  Manual  of  pulmonary  func- 
tion testing    St.  Louis.  .Mosby.   1975.   Il5p. 

30.  St  John  Ambulance.  Safety  oriented  first 
aid.  Workbook  unit  1-4.  Ottav^a.  St.  John  Priory 
of  Canada  Properties.  1974.  4  v. 

31.  Schraml.  Walter  J.  Pour  un  hopital  plus 
humaine.  Guide  a  I'usage  des  infirmiires.  du 
personnel  medical  el  paramedical.  Paris. 
Salvator-Mulhouse.  1974.  239p. 

32.  Symposium  on  Publishing  in  the  Health  Re- 
lated Professions.  Gainesville.  Fla..  Mar  21-22. 
May  14-15,  1973.  Report  Gainesville.  Fla. 
Center  for  Allied  Health  Instructional  Personnel. 

1973.  I75p. 

33.  Symposium  on  Today's  Psychiatric  Unit  in 
the  General  Hospital.  Foothills  Hospital  Calgary. 
Alberta.  .Apr.  17-19.  1974  Papers.  Calgary. 
Alta.  Foothills  Hospital.  1974.   Iv. 

.14.  Victorian  Order  of  Nurses  for  Canada.  Re- 
port 1973.  Ottawa.  1974,  92p. 

35.  World  Health  Organization  Handbook  on 
human  nutritional  requirements  Geneva.  1974. 
c  Food  and  Agriculture  Organization  of  the  Un- 
ited Nations  and  WHO.   1974.  66p. 

36.  Worid  Health  Organization.  The  medical  as- 
sistant: an  intermediate  level  of  health  care  per- 
sonnel. Proceedings  of  an  international  confer- 
ence. Bethesda.  Md..  June  5-7.  197}.  Geneva. 

1974.  I7lp. 

37.  The  World  Medical  .Association.  Interna- 
tional medical  directorx .  New  York,  c  1972.  64p. 


PAMPHLETS 

38.  Addiction   Research   Foundation.   Library 
Ottawa,  1974    I9p. 

39.  Alberta  Association  of  Registered  Nurses. 


Provincial  Supervisory  Nurses  Committee. 
Guidelines  for  performance  appraisal.  Edmon- 
ton. 1974.  6p. 

40.  College  of  Nurses  of  Ontario.  Nursing  prac- 
tice project:  panel  of  practitioners  position  paper 
June  1974.  rev.  Nov.  1974.  Toronto.  1974.  33p. 

41 .  Colloquesurlhumanisationdessoins,  Man- 
iwaki.  Quebec.  Novembre  1974.  Proces-verbal 
de  la  pleniere.  Hull.  P.Q..  Conseil  de  la  Same  et 
des  services  sociaux  de  TOulaouais.  1974.  I4p. 

42.  Education  Design  Inc.  Pour  mieux  com- 
prendre  I'hostilile.  Rev.  Traduction  fran(;aise: 
Claire  Catellier.  Quebec  (ville)  Corporation  des 
Infirmieres  el  Infirmiers  de  la  Region  de  Quebec, 
rive-nord,  Comite  d' Education,  1974    3lp. 

43.  Katz.  Gregor.  La  vie  se.xuelle  des  arrieres 
mentawf.  Bruxelles.  Ligue  inlemalionaledes  As- 
sociations d'Aide  aux  Handicapes  Menlaux, 
1974.  32p. 

44.  National  League  for  Nursing.  Dept.  of  Prac- 
tical Nursing  Programs.  Practical  nursing 
career.  New  York.  1975.  39p. 

45.  — .  Division  of  Research.  Some  statistics  on 
baccalaureate  and  higher  degree  programs 
1973-74.  New  York.  1973.  26p. 

46.  New  York  Stale  Nurses"  Association.  The 
scope  of  nursing  practice:  selected  demonstra- 
tions. Albany.  NY..  1974.  38p. 

47.  Ontario  Hospital  Association.  .4  prototype 
orientation  program  for  nen  nurse  employees. 
Toronto.  1974.  I5p. 

48.  Russell.  Phyllis  J.,  ed.  Guide  to  Canadian 
Health  science  information  serxices  and  sources. 
Ottawa.  Canadian  Library  Assoc..  1974.  34p. 
49  Seminar  on  the  Serving  Professions.  Ste- 
Adele.  P.Q..  Mar.  4-6.  1974.  The  serving  profes- 
sions.' Ottawa.  Vanier  Institute  of  the  Family. 
1974.  20p. 

50.  Thomson. G.  AsMey  How  to  review  a  book. 
Saskatoon,  Sask.,  Instruction  and  Inforination 
Services.  University  of  Saskatchewan  Library, 
1974.  .5p. 

GOVERNMENT  DOCUMENTS 

Caiuuki 

51.  Conseil  des  sciences  du  Canada.  Savoir. 
Pouvoir  et  politique  generale.  par  Peter  Aucoin  et 
Richard  French.  Ottawa.  Information  Canada. 
1974.  93p.  (Its  Etude  de  documentation,  no.  3 1 ) 

52.  Dept.  of  External  Affairs.  Canadian  rep- 
resentatives abroad.  Ottawa.  Information 
Canada.  Nov    1974.   I  v.  R 

53.  Economic  Council  of  Canada.  Social  indi- 
cators: the  need  for  a  broader  socioeconomic 
framework.  Ottawa.  1974.  20p 

54.  Health  and  V\clfare  Canada.  Canada  health 
manpower  inventory.  Ottawa.  1974.   177p. 

55 .  — .  Extent  of  movement  of  Canadian  trained 
physicians  between  provinces,  by  Jawed  Aziz. 
Ottawa.  1974  I8p.  (Health  manp<iwerrepon  no. 
12/74) 

56.  — .  Social  security  in  Canada.  3ed.  Ottawa. 
Information  Canada.  1974.  (Social  security 
memorandum  no.  19) 

57  —  Federal-Provincial  Advisory  Committee 
on  Hospital  Insurance.  Working  Party  on  Special 


Care  Units  in  Hospitals.  Guidelines  for  minimum 
standards  in  the  planning,  organization  and  op- 
eration of  special  care  units  in  hospitals.  Phase 
2.  Ottawa.  1974.  Iv. 

58.  — .  Non-Medical  Use  of  Drugs  Directorate. 
Smoking  habits  of  Canadians.  1973.  Ottawa. 
1974.   Iv. 

59.  — .  Sport  Canada.  Soyez  en  forme:  guide 
d'  entrainement  et  de  sante  physique  pour  les 
jeunes  canadiens.  Ottawa.  cl972.  29p. 

60.  Statistics  Canada.  Canada  yearbook  1973. 
Ottawa.  Information  Canada.  1974.  104lp.  R 

61.  Treaties,  etc..  World  Health  Assembly.  July 
25.  1969.  Health.  International  health  regula- 
tions, adopted  at  the  22nd  World  Health  Assem- 
bly. Boston.  Jul)  25.  1969.  Entered  into  force 
Jan.  1.  1971.  Ottawa.  Information  Canada,  1974. 
78p.  (Canada.  Treaty  series  1971.  no.  12) 

STUDIES      DEPOSITED      IN      CNA      REPOSITORY 

62.  Crutnp.  C.  Kenneth.  The  twelve-hour  shift  in 
nursing  services.  London.  Onl..  Research  and 
Publications  Division.  School  of  Business  Ad- 
ministration. University  of  Western  Ontario. 
1974.  44p.  (University  of  Western  Ontario. 
Schot)l  of  Business  Administration.  Working 
paper  series  no.  1 12)  R 

63.  Engwer,  Layton  T.  Nursing  supplies  inven- 
tory and  control  study.  Ottawa.  Ottawa  General 
Hospital.  Industrial  Engineering.  1973    23p.  R 

64.  Imai.  Hisako  Rose.  .\'ursing  resources  in 
Canada.  Ottawa,  Health  and  Welfare  Canada. 
1974.  53p.  (Health  Manpower  report  no.  1 1/74) 
R 

65.  Lampart.  Rhona  Eudoxie.  Guidelines  to  as- 
sist in  decision-making  by  health  agency  person- 
nel regarding  utilization  of  the  cardiopulmonary 
resuscitation  team.  Buffalo.  1972  68p.  (Thesis 
(M.Sc)  —  New  York)  R 

66.  Nicholson.  Billie  Patricia.  A  study  lo  deter- 
mine the  type  and  frequency  of  interruptions  sus- 
tained b\  poslcardiotomy  patients  in  an  intensive 
care  unit.  Vancouver,  B.C.,  1974.  7lp.  (Thesis 
(M.S.N.)  —  British  Columbia)  R 

67.  Pfislerer,  Janet.  Learning  needs  of  the  car- 
diac patient  being  discharged  from  hospital  as 
seen  bv  the  patient,  his  doctor,  and  his  nurse. 
London.  Ont..  1973.  63p.  (Thesis  (M.Sc. N.)  — 
Western  Ontario)  R 

68.  Quirion.  Richard.  Rapport  sur  les  or- 
ganismes  de  placement  d' infirmieres.  Montreal. 
Conseil  de  la  Sante  et  des  Services  sociaux  de 
Montreal  metropolitain.  1974.  Iv.  R 

AUDIO- VISUAL  AIDS 

69.  American  Journal  of  Nursing  Co.  Educa- 
tional Services  Division.  Emergency  department 
nursing:  a  programmed  learning  series.  New 
York.  cl973.  8  audio  cassettes. 

70.  —  Instructor's  manual.  New  York.  cl973. 
I45p. 

71.  — .  Student  workbook.  New  York.  cl973. 
73p. 

72.  Cumulative  Index  to  Nursing  Literature.  Let 
us  show  you  where  to  find  it.  Glendale.  Calif.. 
1974.  58  slides.  I  audio  cassette. 


THE  CANADIAN  NURSE  —  June  1975 


Johns  Hopkins  is  Hiring 

New  Grads 

Now! 

Start  at  $10,750.  Advance 
to  $11,2'32  after  licensure. 

Our  extensive  expansion  progrdm  has  created  several 
openings  tor  new  grads  in  the  Medical  and  Surgical 
Units,  We  ofter; 

•  Intensive  orientation 

•  Full  tuition  reimbursement 

•  \lan\  benetits 

•  Visas  available  in  4-h  weeks 

•  Inexpensive  housing  on  hospital  property 

•  Licensure  reciprocity  granted 

SPECIALTY  OPENINGS  FOR  EXPERIENCED  RNs  in- 
clude HEAD  NURSES  for  Pediatrics  and  tor  Medical 
ICU,  and  CLINICAL  SPECIALISTS  toi;,ICU,  Medical  and 
Surgical. 

Ne\\  graduate  or  experienced,  there  is  immediate 
opportunity  waiting  tor  you  in  our  1  l(X)  bed  acute 
care,  teaching  and  research  center.  Call  collect  or 
write 

|u(l\   Pvk',  RN,  or  joe  Hess 
Otiire  ot  Professional  Recruitment 
THE  lOFHNS  HOPKINS  HCiSPITAL 
Bdllimore.  Maryldncl  JlJdi     Phone    iOl   4sS  '>sWJ 


THE  lOHNS  HOPKINS  HOSPITAL 


Request  Form 
for  "Accession  List" 

CANADIAN  NURSES' 
ASSOCIATION  LIBRARY 

Send  this  coupon  or  facsimile  to 
LIBRARIAN.  Canadian  Nurses'  Association. 
50  The  Driveway.  Ottawa  K2P  1 E2.  Ontario. 

Please  letid  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. 

Borrower 

Registration  No 

Position 

Address 

Date  of  request 


Tropical 
Diseases 
and 
Parasitology 


Seneca  College  is  offering  short  courses  at  post- 
diploma  level  in  Tropical  and  Parasitic  Diseases. 

International  Health  Course  one  semester 
Preparation  to  function  intelligently  in  an  environment 
where  such  diseases  pose  a  health  problem. 

International  Health  — Short  Course  40  hours 
{incorporated  in  the  one  semester  course) 
Emphasis  on:  Incidence  of  Tropical  and  Parasitic 
Disease  in  Canada,  Detection  and  referral.  Prevention 
and  control. 

For  information  write  lo; 

SENECA  COLLEGE 

OF  APPLIED  ARTS  AND  TECHNOLOGY 

li'.'>  SHePPARIJ  AVl\U!  [AST  WIllDWDAll  OSTARIO  Mik  Hi 


THE  NEW  CARDIAC  UNIT 

OF  THE 

OTTAWA  CIVIC  HOSPITAL 

Opening  the  spring  of  1976 


Requires: 

"Assistant  Director  cf  Nursing  Service " 

Applicants  should  have  a  degree  in  nursing  and  preferably 
some  expertise  in  this  speciality. 

Applications  &  enquiries  to: 

Miss  M.  Mills 

Assistant  Director  of  Nursing  Service 

Ottawa  Civic  Hospital 

1053  Carling  Avenue 

Ottawa,  Ontario 

K1Y  4E9 


48 


\)1iid0wto 
the  wound 

VIEW  WOUND  SITE  THROUGH  ACCESS 

CAP.  REMOVE  CAP  FOR  EXAMINATION  AND 

DRAIN  TUBE  ADJUSTMENT. 


THE  HOLLISTER  DRAINING-WOUND 
MANAGEMENT  SYSTEM 


KEEPS  FLUIDS  AWAY  FROM 

PATIENT'S  SKIN  AND  GUARDS  AGAINST 

IRRITATION  AND  CONTAMINATION, 

Skin-conforming  Koraya  Blonket  protects  skin  around 
wound  site.  It  directs  dischorge  into  odor-barrier,  translu- 
cent Drainage  Collector  wtiicti  tx)lds  exudate  for  visual 
assessment  and  accurate  measurement. 

There  are  ro  messy,  wet  dressings  to  tiandle  or  ctiange 
...  no  need  for  painful  dressing  removal. 

Supplied  sterile,  for  application  in  O.R.  or  patienf  s  room. 


The  better  alternative 
to  absorbent  dressings. 


B 


Write  for  more  information 


HCM_LISTER 

HolNster   Ltd.,  332  Consumers  Rd..  Willowdale,  Ont.  M2J  1P8 


of  providing  heoltli 
car«  for  the 
Indian  people, 
of  Canada 


1^ 


Heattti  Sante  et 

and  Welfare       Bien-etre  social 

Canada  Canada 


Medical  Services  Branch 

Department  of  National  Health  and  Welfare 

Ottawa,  Ontario  K1A0K9 


Please  send  me  more  information  on  career 
opportunities  In  Indian  Health  Services. 


Name: 

Address: 

City: 


Prov: 


■•*£  CANADIAN  NURSE  —  June  1975 


49 


classified  advertisements 


ALBERTA 


BRITISH  COLUMBIA 


REGISTERED  NURSES  AND  NURSING  SUPERVISORS  re 

quired  by  a  100-bed  acute  care  and  40-bed  extended  care 
accredited  hospital  Must  be  eligible  for  8C  registration 
Supervisory  applicants  rnust  liave  experience  in  administrative 
or  supervisory  nursing  RN  s  salary  S985  to  $1,163  and 
Supervisors  salary  $1,181  to  $1,391  (RNABC  Agreement  — 
1975)  Apply  in  writing  to  the  Director  of  Nursing  GR  Baker 
Memorial  Hospital  543  Front  Street,  Ouesnel,  British  Columbia 
V2J2K7 


REGISTERED  NURSES  wanted  tor  the  opening  of  the 
expansion  to  the  Campbell  River  Hospital  Fully  accredited 
general  hospital  on  beautiful  Vancouver  Island  Famous  for  sport 
salmon  fishing  and  all  water  sports  activities  Please  direct 
inquiries  to  the  Uiteclor  of  Nursing  Services.  Campbell  River  & 
District  General  Hospital.  375-2nd  Ave..  Campbell  River  British 
Columbia.  V9W  3V1 


ADVERTISING 
RATES 

FOR   ALL 

CLASSIFIED    ADVERTISING 

$15,00   for   6   lines   or   less 
$2.50  for  each   odditiorxj!   line 

Rates    for    display 
odvertisements    on    request 

Closing  dale  for  copy  and  concellation  is 
6  weeks  prior  to  1st  day  of  publication 
month 

The  Canodion  Nurses'  Association  does 
not  review  the  personnel  policies  of 
the  hospitals  and  agencies  advertising 
in  the  Journal.  For  outhentic  information, 
prospective  apphconts  should  apply  to 
the  Registered  Nurses'  Association  of  the 
Province  in  which  they  ore  interested 
in    working 


Address  correspondence  to: 

The 

Canadian  ^ 
urse        ^ 

50  THE  DRIVEWAY 
OTTAWA,  ONTARIO 
K2P  1E2 


BRITISH  COLUMBIA 


REGISTERED  NURSES  required  tor  70  bed  accredtled  aclive 
ireatment  Hospital  Full  time  and  summer  relief.  Atl  AARN  per- 
sonnel policies  Apply  in  writing  to  ttie:  Director  o(  Nursing, 
Drumtieller  General  Hospital,  Drumheller.  Alberta 


GRADUATE  NURSES  —  Vacancies  exist  tor  Graduate  Nurses 

in  25-bed  active  treatment  hospital.  1 10  miles  east  of  Lacombe 
Salary  and  conditions  in  accordance  with  AARN,  Residence 
available  Appty  to  Director  ot  Nursing  Coronation  Municipal 
Hospital.  Coronation,  Alberta.  TOG  ICO. 


Applications  are  invited  for  a  very  interesting  and  ctiatlengmg 
new  position  We  require  a  B.C.  REGISTERED  NURSE  to  assist 
the  Nurse  Administrator  to  be  classified  as  a  Head  Nurse  . 
Preference  will  be  given  one  with  pnor  Emergency  or  Obstetric 
Nursing  experience  and  having  successfully  completed  the 
Nursing  Unit  Administration  course.  The  hospital  is  a  newly 
opened  one  situated  on  the  Yeliowhead  Highway,  80  miles  north 
of  Kamloops  BC  The  area  is  a  vacationers  paradise  both  m 
Summer  and  Winter  RNABC  salary  scale  and  fnnge  benefits 
applicable  Please  reply  to:  Mrs  K  Rice.  Nurse  Administrator. 
Dr  Helmcken  Memonal  Hospital.  Cleanwater.  Bntish  Columbia 


REGISTERED  NURSES  required  for  a  44-bed  accredited  acute 
care  hospital  Salary  and  personnel  policies  according  to 
RNABC  Apply  to  Mrs.  M.  Standidge,  R.N..  DON.,  Creston 
Valley  Hospital.  Creston,  British  Columbia. 


REGISTERED  NURSES  required  for  250-bed  accredited 
hospital  on  Vancouver  Island  36  miles  north  of  Victoria  Eligibility 
for  B.C.  registration  required  Positions  open  for  Coronary  Care. 
Psychiatry  and  Med  -Surg  areas.  RNABC  contract  m  effect 
Apply  to.  Director  of  Nursing,  Cowichan  District  Hospital. 
Duncan.  British  Columbia 


Two  GRADUATE  NURSES  required  for  General  Duty  in  30-bed 
hospital  PNABC  salary  rates  prevailing  Accommodation  m 
Nurses  Residence.  Three  hours  from  Vancouver,  BC  on 
Trans-Canada  Highway,  and  on  mam  lines  of  both  C,P  and  CN 
Railways  Situated  in  beautiful  Mouniam-River  scenery 
recreations,  etc  Apply  to  Administrator.  Lytton  General  Hospital, 
Lytton,  British  Columbia.  OR  phone  collect:  455-2222  or  Res. 
455-2266,  Area  Code  (604) 


EXPERIENCED  NURSES  (eligible  for  BC  registration)  required 
for  409-bed  acute  care,  teaching  hospital  located  in  Fraser 
Valley,  20  minutes  by  freeway  from  Vancouver,  and  within 
easy  access  of  varied  recreational  facilities  Excellent  Orienta- 
tion and  Continuing  Education  programmes  Salary  S1 ,026  00  to 
Si  212  00  Clinical  areas  include:  Medicine,  General  and  Spe- 
cialized Surgery,  Obstetrrcs,  Pediatrics.  Coronary  Care,  Hemo- 
dialysis, Rehabilitation  Operating  Room,  Intensive  Care.  Emer- 
gency PRACTfCAL  NURSES  (eligible  for  BC  License)  also 
required  Apply  to  Administrative  Assistant,  Nursing  Personnel, 
Royal  Columbian  Hospital,  New  Westminster,  British  Columbia 
V3L  3W7 


GRADUATE  NURSES  —  Looking  for  variety  in  your  work'' 
Consider  a  modem  10-bed  hospital  located  on  a  beautiful  fiord- 
type  inlet  of  Vancouver  Island  s  west  coast.  Apply:  Administrator, 
Box  399,  Tahsis,  British  Columbia,  VOP  1X0. 


EXPERIENCED  GENERAL  DUTY  NURSES  AND  LICENSED 
PRACTICAL  NURSES  required  for  small  upcoast  hospital  Sal- 
ary and  personnel  policies  as  per  RNABC  and  HE  U  contracts 
Residence  accommodation  S25  00  per  month  Transportation 
paid  from  Vancouver  Apply  to:  Director  of  Nursing,  St  Georges 
Hospital,  Alert  Bay  British  Columbia.  VON  lAO 


GENERAL  DUTY  NURSES  for  modern  41-bed  hospital  located 
on  the  Alaska  Highway  Salary  arKi  personnel  policies  in 
accordance  with  RNABC,  Accommodation  available  m  resi- 
dence. Apply:  Director  of  Nursing.  Fort  Nelson  General  Hospital, 
Fort  Nelson,  Bntish  Columbia. 


GENERAL  DUTY  NURSES,  for  modern  35-bed  hospital  located 
in  southern  6  C  s  Boundary  Area  with  excellent  recreation  faci- 
lities Salary  and  personnel  policies  in  accordance  with  RNABC 
Comfortable  Nurses  s  home.  Apply  Director  of  Nursing,  Bound- 
ary Hospital,  Grand  Forks,  British  Columbia,  VOH  IHC 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  care 
hospital  tn  Northern  B  C  residence  accommodations  available. 
RNABC  policies  m  effect.  Apply  to  Director  of  Nursmq.  Mills 
Memorial  Hospital,  Terrace,  British  Columbia,  V8G  2W7 


BRITISH  COLUMBIA 


OPERATING  ROOM  NURSE  wanted  for  active  m 
dern  acute  hospital.  Four  Certified  Surgeons  c 
attending  staff  Experience  of  framing  desirabl- 
Must  be  eligible  for  BC  Registration.  Nurse 
residence  available  Salary  according  to  RNAB 
Contract.  Apply  to:  Director  of  Nursing,  Mills  Mer 
orial  Hospital.  2711  Tetrault  St.,  Terrace,  B 
Columbia. 


ONTARIO 


OPERATING  ROOM  STAFF  NURSE  required  for  fully  & 
ted  75-bed  Hospital  Basic  wage  $689  00  with  considera: 
experience:  also  an  OPERATING  ROOM  TECHNICIAN 
wage  S526.00  Call  time  rates  available  on  request  V. 
phone  the:  Director  of  Nursing,  Dryden  District  General  Hl 
Dryden,  Ontario. 


REGISTERED  NURSES  for  34bed  General  He 
Salary  S945  00  to  Si ,  1 45  00  per  month,  plus  experience 
ance.  Excellent  personnel  policies  Apply  to  Director  otN'. 
Englehart  &  Districl  Hospital  Inc.  Englehan,  Ontario,  PCj 


NURSES  required  for  general  duty  nursing  at  the  Hospit 
Amazonico.  Pucallpa,  Peru  For  details  write:  Amazoni* 
Hospital  Foundation,  Box  252,  Etobicoke,  Ontario. 


REGISTERED  NURSES  required  for  our  ultramodern  79-bi 

General  Hospital  in  bilingual  community  of  Northern  _Ontan 
French  language  an  asset,  but  not  compulsory  Salary  is  S945. 
$1 145.  monthly  (subject  to  increase  July  1st)  with  allowance  f 
past  experience  and  4  weeks  vacation  after  1  year  Hospital  pa*, 
100%  of  OH  I  P  .  Life  Insurance  (10,000)  Salary  Insuram 
{75°oof  wages  to  the  age  of  65  with  U  I  C  carve-out),  a^dn 
plan  and  a  dentaLcare  plan.  Master  rotation  in  effect  Roomit 
accommodations  available  in  town.  Excellent  personnel  policic 
Apply  to:  Personnel  Director,  Notre-Dame  Hospital,  P.O  B« 
850,  Hearst,  Ontario. 


REGISTERED  NURSES  AND  REGISTERED  NURSIN' 
ASSISTANTS  for  45-bed  Hospital  Salary  r  ; 
include  generous  experience  allowances.  ' 
salary  S945  to  Sl.115,  and  RN.A.s  salary  S650.  to 
Nurses  residence  —  private  rooms  with  bath  —  S60.  per  ■ 
Apply  to:  The  Director  of  Nursing,  Geraldton  District  Hr 
Geraldton,  Ontario,  POT  1M0. 


REGISTERED     NURSES     FOR    GENERAL    DUTY.     iCU 
ecu.    UNIT    and    OPERATING    ROOM     require 

fully    accredited    hospital.    Starting    salary    $850".0r 
regular    increments    and    with    allowance    for    e- 
ence.     Excellent    personnel     policies    and    tem^ 
residence    accommodation    available.     Apply    to 
Director    of    Nursing,     Kirkland    &    District    Hos: 
Kir1<land  Lake,  Cntanc.  P2N  1 R2 


St.  John  Ambulance 

needs  Registered  Nurses  to  volun- 
teer their  services  to  teach  Patient 
Care  in  The  Home.  Will  you  help? 


contact 


SASKATCHEWAN 


Zl 


TWO  REGISTERED  NURSES  urgentty  requirefl  tor  8-bed  rural 
hospital  Ample  learning  situations  Jor  new  grads  Wages 
'  S797-927  based  on  experience  Extra  monetary  benefits  to  those 
who  can  stay  one  year  at  least  Residence  available  Apply  The 
Matron,  Kyle  White  Bear  Union  Hospital.  Kyle  Saskatchewan 
SOL  1T0 


2  REGISTERED  NURSES  and  1  COMBINED  LABORATORY  & 

X-RAY  TECHNICIAN  required  in  21 -bed  General  Hospital 
.,  C  U  P  E  and  SUN  Union  Rates  A  Inendiy  community  with 
■'    (resh  air  and  clear  water  in  t)eautiful  surroundings.  Apply  to 

Margarele  Lathan  Director  of  Nursing.  Union  Hospital.  Paradise 

mi.  Saskatchewan 


UNITED  STATES 


,   "tTS  SO  PEACEFUL  IN  THE  COUNTRY"  —  r^odern  S4-bed 

il  accredited  general  hospital  (JCAH)  in  lakeside  Florida  town 

'  fgcod  fishmg.  two  stoplights)  Seeks  R.N.  SUPERVISORS.  R.N. 

4FF  NURSES,   and   L.P.N.'s.   Send  resume  and   salary 

'ements   to    Mrs    Gladys   Meyett.   Director   of   Nurses 

.jiades  Memonal  Hospital,  PO  Box  659  Pahokee  Florida. 

33.176   Telephone  number   (305)  924-5201 


GENERAL  DUTY  NURSES 


Required  Immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit. 
Clinical  areas  include:  medicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R,N,A.B.C.  contract; 

SALARY:  S850  —  SI  020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


REGISTERED  NURSES 


Registered  Nurses  required  for  large 
metropolitan  general  hospital. 
Positions  available  in  all  clinical  areas. 
Salary  Range  in  effect  until  December 
31,1975. 

$900.  —  SI, 075.  Startinq  rate  de- 
pendent on  qualifications  and  experi- 
ence. 


Apply  to: 


Staffing  Officer-Nursing 
Personnel  Department 
Edmonton  General  Hospital 
Edmonton,  Alberta 
T5K  0L4 


UNITED  STATES 


UNITED  STATES 


Summer  1975  Curriculum  Institutes  offered  by  the  Institute  ot 
Nursing  Consultants  Institute  1.  Becoming  an  INSERVICE 
EDUCATOR  Two  sessions  1  East.  Key  West  Florida,  June 
16-20  I  West,  Morro  Bay,  California,  August  18-22  Institute  II, 
CONCEPTUAL  FRAMEWORK  for  Curriculum  Development, 
Calgary,  Alberta,  Canada,  July  14-18  Institute  111  Developing 
LEARNING  MODULES  (OT  Nursing  Instruction  San  Francisco, 
California,  August  4-8  Tuition  for  each  institute  is  S200,00  The 
all  day  sessions  will  include  a  variety  of  learning  activities:  lec- 
tures, discussions,  small  group  work  and  modules  Institute  fa- 
culty Em  Olivia  Bevis,  Fay  L  Bower,  Verle  Waters  Holly  S, 
Wilson  Fot  information  and  registration  write  F  Bower  874 
Miranda  Green,  Palo  Aito,  California  94306 


TEXAS  wants  you!  If  you  are  an  RN  expenenced  or 
a  recent  graduate,  come  to  Corpus  Chnsli,  Sparkling 
City    by    the    Sea  a    city    building    (or    a    better 

future  where  your  opportunities  for  recreation  and 
studies  are  limitless  Memorial  Medical  Center  500- 
bed  general,  teaching  hospital  encourages  career 
advancement  and  provides  in-service  orientation 
Salary  (rom  S682  00  to  3940  00  per  month  com- 
mensurate with  education  and  experience  Differential 
for  evening  shifts  available  Benefits  include  holi- 
days, sick  leave,  vacations,  paid  hospitalization, 
health  li(e  insurance,  pension  program  Become  a 
vital  part  o(  a  modern,  up-to-date  hospital  write  or 
call  collect  John  W  Cover,  Jr  Director  o(  Per- 
sonnel Memorial  Medical  Center  P  O  Box  5280, 
Corpus  Chnsti   Texas   78405 


Get  what  you've 

always  wanted 

from  nursing 


Like,  for  a  change, 
working  the  way  you  want  to 


Medox  can't  make  you  a  better  nurse. 

Only  you  can  do  that. 

But  we  can  help  you  see  to  it  you're 
working  under  the  kind  of  conditions 
that  allow  \;ou  to  make  the  most  of 
your  talents  and  experience. 

With  Medox,  you  get  a  flexibility 
that  lets  you  direct  your  own  career. 

For  instance,  did  you  know  that 
Medox  can  help  you  find  a  permanent 
nursing  position?  That's  right. 

It's  part  of  the  service.  Or  you  can 


work  at  temporary  assignments  on  a 
permanent  basis.  Another  interesting 
possibility. 

Or  you  can  pick  and  choose  from  a 
wide  range  of  temporary  positions  in 
just  about  any  nursing  field  to 
broaden  your  professional  experience. 
Permanent.  Permanent/temporary. 
Temporary.  With  Medox,  it's  up  to  you. 

And,  since  it's  up  to  you,  better 
come  to  Medox. 


a  DRAKE  INTERNATIONAL  company 

CANADA .  USA  •  UK  •  AUSTRALIA 


-E  CANADIAN  NURSE  —  June  1975 


ORTHOPAEDIC    t£    AR-THRITIC 
HOSR|-rAL_ 


\:^  II  '  W 


43  WELLESLEY  STREET,  EAST 
TORONTO,  ONTARIO 
M4Y1H1 

Enlarging  Specialty  Hospital  offer's  a  unique 
opportunity  to  nurses  and  nursing  assistants 
interested  In  the  care  of  patients  with  bone  and 
joint  disorders. 

Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  all 
units 

Clinical  specialists  for  Operating  Room,  Intensive 
Care,  Patient  Care  and  Education. 


FOOTHILLS  HOSPITAL 
Calgary,  Alberta 

Advanced  Neurological- 
Neurosurgical  Nursing 

for 
Graduate  Nurses 

a  five  month  clinical  and 

academic  program 

offered  by 

The  Department  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

(Department  of  Surgery) 

Beginning:  September,  1975 
March,  1976 


Limited  to  8  participants 
Applications  now  being  accepted 


For  further  information,  please  write  to: 

Cc-ordinator  of  In-service  Education 

Foothills  Hospital 
1403  29  St.  N.W.    Calgary,  Alberta 
T2N  2T9 


DIRECTOR  OF 
NURSING  EDUCATION 


and 


NURSING  INSTRUCTORS 


Medicine  Hat  College  has  about  80  students  in  the  Diploma  Nursing 
Program.  The  College  enjoys  a  new  campus  in  a  rapidly  expanding 
industrial  city  of  about  30,000  people.  Close  to  skiing,  camping, 
boating  areas.  Liberal  fringe  benefits  —  Ivledical,  Hospitalization, 
Life  Insurance.  Disability,  Sabbatical  Leaves,  etc.  Director  should 
have  completed  Masters  degree.  Instructors  should  have  com- 
pleted Bachelor  degree. 

Starting  Salary  on  1974-75  scale  —  up  to  $16,836.00 
Salary  scale  for  1975-76  is  being  negotiated 
Extra  salary  for  Director  and  for  teaching  in  Spring  Session. 


Send  full  details  of  training  and  experience  with  references  to: 

Dr.  MELVIN  S.  TAGG 
Academic  Vice-President 
Medicine  Hat  College 
Medicine  Hat,  Alberta 
T1A3Y6 


DIRECTOR 
OF  NURSING 


Applications  are  invited  for  the  position  of  DIRECTOR  OF 
NURSING  for  this  progressive  general  hospital.  Bed  com- 
plement of  31 3-beds  is  made  up  of  21 3  active  treatment  and 
100  chronic  beds  with  an  active  rehabilitation  program. 


The  Hospital  is  affiliated  as  base  hospital  for  a  community 
college  School  of  Nursing  and  provides  other  services  on  a 
district  level.  Outpatient  Psychiatric  Day  Care  Program  is 
offered. 


Stratford  is  a  pleasant  city  of  25,000  located  ninety  miles 
from  Toronto,  forty  miles  from  London  and  twenty  six  miles 
from  Kitchener. 


This  position  will  be  available  1  September,  1975. 


Please  direct  correspondence,  in  confidence  to: 

The  Executive  Director 
Stratford  General  Hospital 
Stratford,  Ontario 
N5A  2Y6 


RN'S 


The  Royal  Alexandra  Hospital  offers  a  challenging  position 
to  interested  nurses  in  a  new  45  bed  neonatal  intensive  care 
unit  in  a  large  1000  bed  hospital. 

IVE  OFFER: 

(1)  A  teaching  full  time  neonatologist. 

(2)  Formal  orientation  and  in-service  programs. 

(3)  Excellent  salaries  ($900.  —  $1075.)  plus  shift  diffe- 
rential. 

(4)  Three  weeks  holidays  after  one  year  employment 
and  many  other  fringe  tienefits. 

Salary  commensurate  with  experience. 


Send  complete  resume  to: 

Mrs.  R.  Tercier 

Director  of  Nursing  Personnel  Administration 

Nursing  Office 

Royal  Alexandra  Hospital 

10240  Kingsway  Ave.  Edmonton,  Alberta 

T5H  3V9 


REGISTERED  NURSES 

Immediate  Openings  in  all  Services 


Come  work  and  play  m  Newfoundland  s  second  largest  city' 

Corner  Brook  has  a  populatton  of  approximately  35  000  with  a  temperate  climate  in 
comparison  with  most  of  Canada  Outdoor  life  is  among  the  finest  to  be  found  in  North 
America  The  airports  serving  Corner  Brook  are  at  Deer  Lake.  32  miles  away,  and 
Stephenvtlie.  50  miles  away.  Connections  with  these  airports  make  readily  available  air 
travel  anywhere  m  the  world 

—  Salary  Scale:  $7,652.  —  S9.715.  per  annum:  Contract  expires  March  31, 
1975. 

—  Sei^ice  Credits  —  One  step  for  four  years  experience:  two  steps  for  six 
years  experience  or  more. 

—  Educational  differential  for  B.N.  and  master  s  degree  in  Nursing. 

—  S2.00  per  shift  for  Charge  Nurse. 

—  $50.00  uniform  allowance  annually. 

—  20  worVIng  days  annual  vacation. 

—  8  statutory  holidays. 

—  Sick  Leave  —  I  1/2  days  per  month. 

—  Accommodation  available. 

—  Two  week  orientation  on  commencement. 

—  Continuing  Staff  Education  program. 

—  Transportation  available. 

At  the  present  time,  a  ma)or  expansion  project  is  in  progress  to  provide  regional  hospital 
facilities  for  the  West  Coast  of  the  Province  The  Hospital  wilt  have  a  350  bed  capacity  by 
June.  1975.  Services  include  Medicine,  Surgery.  Paediatrics.  Obstetrics.  Psychiatry.  CCU 
and  ICU. 


L9ttBra  of  application  ahould  be  aubmlttad  to: 

Director  of  Personnel 
WESTERN  MEMORIAL  HOSPITAL 
CORNER  BROOK,  NFLD. 
A2H6J7 


657  bed, accredited, modern, 
well  equipped  General  Hospital, 
rapidly  expanding... 


Saint  John 

General 

hospital 


'/ 


\ 


\> 


Saint%hn,N.B., 
CANADA 


'SQUIRES- 

General  Staff  l^rses  <^ 
Registered  Nursing  Assistants 


In  all  general  areas:  Medical,  Surgical, 
Pediatrics, Obstetrics,  Chronic  and 
Convalescent,  several  Intensive  Care 
areas  and  Psychiatry. 


0  Active,  progressive  in-service  education  program. 
Special  Attention  to  Orientation. 
Allowance  for  Experience  and  Post  Basic  Preparation 


FOR  FURTHUR  INFORMATION  APPLY  TO 

"■PERSONNEL  DIRECTOR 

^aintyohn  General  Hospital 

po.  BOX  2000  Saint  John.  New  Brunswick  E2L4L2 


DIRECTOR 

OF 

NURSING  SERVICE 


Applications  are  invited  for  the  position  of  DIRECTOR  OF 
NURSING  SERVICE  in  this  fully  accredited  500  bed  modern 
hospital. 

A  Bachelors  degree  in  Nursing  Science  Is  essential.  A 
Master's  degree  in  Nursing  or  Hospital  Administration  is 
preferred.  Several  years  experience  in  a  senior  administra- 
tive position  is  desirable. 


For  furttter  information  please  write  to: 

Director  of  Personnel 
Belleville  General  Hospital 
Belleville,  Ontario 
K8N  5A9 


THE  CANADIAN  NURSE  —  June  1975 


NORTH  YORK  GENERAL  HOSPITAL 

INVITES  APPLICATIONS  FROM: 

REGISTERED  NURSES  AND 
REGISTERED  NURSING  ASSISTANTS 

FULL  AND  PART-TIME  POSITIONS 

N.Y.G.H.  is  a  585-becl,  fully  accredited,  active  treatment  hospital 

located  in  North  Metropolitan  Toronto  offering  opportunities  in  all 

services. 

The  Hospital  embraces  the  full  concept  of  Progressive  Patient 

Care  featuring  a  Self  Care  Unit  and  a  Psychiatric  Day  Care 

Program. 

Our  Nursing  Philosophy  focuses  on  the  patient  as  an  individual  and 
recognizes  the  importance  of  continuing  education  for  the 
improvement  of  patient  care. 

An  active  Staff  Development  program  focusing  on  individual 
learning  needs  is  maintained. 

Apply  to: 

Personnel  Department 
North  York  General  Hospital 
4001  Leslie  Street 
Willowdale,  Ontario 
M2K1E1 


THE  SCARBOROUGH 
GENERAL  HOSPITAL 

invites  applications  from: 
Registered  Nurses  and  Registered  Nursing  Assis- 
tants  to    work    in    our   650-bed    active   treatment 
hospital  and  new  Chronic  Care  Unit. 

We  offer  opportunities  in  Medical.  Surgical,  PaetJiatnc,  and  Obstetrical  nursing 

Our  specialties  include  a  Burns  and  Plastic  Unit,  Coronary  Care,  Intensive  Care  and 
Neurosurgery  Units  and  an  active  Emergency  Department. 

•  Obstetrical  Department  —  participation  in  "Family  centered"  teaching 
program. 

•  Paedlatric  Department  —  participation  In  Play  Therapy  Program. 

•  Orientation  and  on-going  staft  education. 

•  Progressive  personnel  policies. 

The  hospital  is  located  in  Eastern  Met.'opolitan  Toronto. 

For  further  information,  write  to: 

The  Director  of  Nursing, 

SCARBOROUGH  GENERAL  HOSPITAL 

3050  Lawrence  Avenue,  East,  Scarborough,  Ontario 


DIRECTOR 

OF 
NURSING 


Applications  are  invited  for  this  position  in  a  modem  10-bed  general 
hospital  located  in  picturesque  Stewart,  B.C.  The  successful  applic- 
ant will  be  responsible  for  the  day  to  day  management  of  the  hospital 
and  preference  will  be  given  to  registered  nurses  who  have  had 
previous  head  nurse  experience  and  have  either  completed  or 
would  be  prepared  to  take  the  nursing  unit  administration  course.  An 
attractive  salary,  commensurate  with  qualifications,  will  be  offered 
and  accommodation  is  also  available.  The  position  is  currently  av- 
ailable and  written  applications  should  be  submitted  to: 


The  Administrator 

c/o  Prince  Rupert  Regional  Hospital 

1305  Summit  Avenue 

Prince  Rupert,  British  Columbia 

V8J  2A6 


CLINICAL   NURSING    COORDINATORS 

STANFORD   UNIVERSITY   HOSPITAL 
PALO  ALTO,    CALIFORNIA 


RESPONSIBLE    for    the   delivery  of  nursing 
care    to   patients   within   a   specified 
patient    care    unit   on   a   Zii-HOUR   BASIS; 
PERSONNEL    MAfJAGEMENT,    STAFF    DEVELOPMENT, 
PARTICIPATION    IN    PATIENT   CARE    ACTIVITIES. 

R.N.    with   Master's    Deqree    in   Nursing   and 
minimum  of  TWO   YEARS'    NURSING    EXPERIENCE. 
Demonstrated   COMPETENCE    IN   ADMINISTRATION, 
TEACHING   and   CLINICAL    SPECIALTY. 

Current   openings    in   MEDICAL/SURGICAL 
UNITS,    PEDIATRICS,    UROLOGY,    PERINATAL, 
GENERAL   CLINICAL    RESEARCH    CENTER   and 
INTENSIVE    CARE    UNITS. 

OUR    R.N.     RECRUITER   WILL 
BE    VISITING    MAJOR    CITIES 
IN    CANADA    IN    MAY    &    JUNE. 

For    further    information    regarding   TIME    & 
PLACE    please    CONTACT    the   Personnel    Dept. , 
Stanford   University   Hospital,    Stanford, 
CA   g'tSOS.     CilS)    497-6361.      An  Affirmative 
Action/Equal    Opportunity    Employer. 


DIRECTOR  OF  NURSING 


Required  for  the  Charlotte  Eleanor  Englehart  Hospital, 
Petrolia,  Ontario  to  assume  duties  as  soon  as  possible. 


This  is  a  63  bed  fully  accredited  acute  care  hospital  which 
prides  itself  on  its  ongoing  progressive  training  program- 
mes and  the  fact  that  it  provides  much  higher  than  average 
T.L.C.  to  its  patients.  The  successful  applicant  will  be 
expected  to  use  her  ingenuity  in  continuing  and  developing 
further  these  philosophies  despite  a  tightening  of  govern- 
mental monies  available.  This  position  should  be  of  interest 
to  nurses  with  several  years  experience  at  the  Head  Nurse 
or  Nursing  Supervisor  level.  Preference  will  be  shown  to 
applicants  with  further  formal  education  in  the  field  of 
nursing  administration. 

Applicants  must  be  eligible  for  registration  in  Ontario. 
Salary  commensurate  with  training  and  experience.  Appli- 
cations stating  experience,  education,  references  and 
salary  expected  should  be  directed  to: 


Robert  P.  Finlayson 

Administrator 

Charlotte  Eleanor  Englehart  Hospital 

Petrolia,  Ontario 


1 

^^F5 

WELCOME 
\ 

1 

I  "THE  NEURO" 

i 

^m 

)» •(         A  Teaching  Hospital 

•J 

^^t^S^^Ma  i                       university 

*^ 

I             Positions  available 

■j^ 

^^P  ^»TE^W   Tft 

for  nurses  in  all  areas 

i 

1       including  Operating  Room 

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'        Individualized  orientation 

^        On-going  staff  education 

5  '^ 

\ 

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S      (Quebec  language  requirements 

r 

1  do  not  apply  to  Canadian  applicants) 

r 

> 

Apply  to: 

hi 

£ 

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Jfi^~2iifi(^3'^'~V~^V^^ 

1        The  Director  of  Nursing, 

l^ 

f  IVIontreal  Neurological  Hospital, 

v\. 

^JlSI&^ii^f^j'           "^^^^  Universltv  Street, 

5r 

J|^v3ii'?r^T7'^^            Montreal  H3A  2B4. 

lair^  X^jf^'-jVafi^^^-^ 

%i: 

:.              Quebec,  Canada. 

ST.  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

We  offer  opportunities  in  Emergency,  Operating  Room,  P.A.R.,   Intensive  Care  Unit,  Orthopaedics,  Psychiatry, 

Paediatrics,  Obstetrics  and  Gynaecology.  General  Surgery  and  Medicine. 

We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Service  programs. 

We  offer  —  Toronto  —  with  some  of  Canada's  finest  Theatres,  Restaurants  and  Social  events. 

We  offer  progressive  personnel  policies. 

We  offer  a  starting  salary,  depending  on  experience,  of: 

effective  April  1, 1975     -  $945  to  $1,145  per  month. 
•  We  offer  monthly  educational  allowances  up  to  $1 20.  per  month  in  addition  to  the  above  starting  salary. 

Apply  to:  Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1B5 


THE  CANADIAN  NURSE  —  June  1975 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from 

REGISTERED  NURSES 

54-bed  accredited  general  hospi- 
tal. Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to: 

MISS  E.LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  ICO 


ST.  THOMAS  -  ELGIN 
GENERAL  HOSPITAL 

Invites  Applications  from 

REGISTERED  NURSES 

To  worl(  in  our  modern  fully  accredited  400  bed  General 
Hospital  located  in  Souttiwestern  Ontario 

We  otter  opportunities  in  medical,  surgical,  paediatric, 
obstetrical  and  geriatric  nursing. 

Our  specialties  include  Coronary  Care.  Intensive  Care 
and  an  active  Emergency  Department. 
Orientation  Program. 
Progressive  Personnel  Policies. 

APPLY  TO: 

Personnel  Office 

St.  Thomas-Elgin  General  Hospital 

St.  Thomas,  Ontario 

N5P  3W2 


/^^°\    Canadore  College 

\  ^^m  I    Applied  Arts  and 
%,-■  ,/     Technology 

TEACHER 
DIPLOMA  NURSING 

Responsibilities  will  include  classroom 
and  clinical  teaching  in  the  Diploma 
Nursing  Program- 
Applicants  must  possess  Ontario 
registration,    a  minimum  of  a  baccalaureat*- 
degree  in  Nursing  and  a  minimum  of  two 
years  of  nursing  practice. 

Salary  commensurate  with  preparation  and 
experience  within  the  C.    S.    A.    O. 
agreement. 

Duties  to  commence  in  August,     1  97S. 

Applications,    stating  qualifications, 
experience,    references  and  other  pertinent 
information  should  be  addressed  to; 
Personnel  Officer,    Canadore  College  of 
Applied  Arts  and  Technology,    P.   O.    Box 
5001.    North  Bay.    Ontario.      P1BHK'» 


EDUCATION 
COORDINATOR 

required  for 

MAPLE  RIDGE  HOSPITAL 
British  Columbia 

A  nurse  educator  is  required  to  organize  and  coordinate 
orientation,  in-service  and  continuing  education  programs 
in  a  general  tiospilal  of  1 15  acute  care  beds  and  75  ex- 
tended care  beds 

The  tiospital  is  planning  for  expansion  to  meet  the  needs 
of  Mapie  Ridge,  a  growing  community  in  the  Lower  Fraser 
Vaiiey  30  miles  from  downtown  Vancouver 

Personnel  policies  in  accordance  with  the  R-N-A,B.C.  con- 
tract 

Submit  application  with  resume  to: 

Miss  M.  Dolphin,  R.N. 
Director  of  Nursing 
Maple  Ridge  Hospital 
Maple  Ridge,  B.C. 


Experienced 

Registered  Nurses 


required  for 
a  dispensary  in 


LA  BASSE  COTE-NORD 


Knowledge  of  English  essential. 


Please  send  curriculum  vitae  to  the 

Director  of  Nursing  Service 
Hopital  Notre-Dame 
Lourdes  du  Blanc-Sablon 
Ct6  Duplessis,  P.O. 
GOG  two 


HEAD  NURSE 


HEAD  NURSE  required  for  18-bed 
Medical  Unit. 

Previous  experience  and/or  prepara- 
tion In  administrative  nursing  techni- 
ques including  ward  management  and 
principles  of  supervision  required. 

Position  becomes  available  early  July, 
1975. 


Apply  to: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

2000,  15th  Avenue 

Prince  George,  British  Columbia 

V2M  1S2 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

Staff  nurses  for  St.  Antfiony.  New  hospital  of 
150  beds,  accredited.  Active  treatment  in  Surgery. 
Medicine.  Paediatrics.  Obstetrics,  Psycfiiatry, 
Large  OPD  and  ICU,  Orientation  and  In-Service 
programs.  40-hour  week,  rotating  shifts.  PUBLIC 
HEALTH  has  challenge  of  large  remote  areas. 
Furnished  living  accommodations  supplied  at  low 
cost.  Personnel  benefits  include  liberal  vacation 
and  sick  leave,  travel  arrangements.  Staff  RN 
$637  —  5809,  prepared  PHN  $71 2  —  $903.  steps 
for  expenence. 


Apply  to: 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Anthony,  Newfoundland 

AOK  4S0 


OSHAWA  GENERAL  HOSPITAL 

Applications  are  being  accepted  for  the  position 
of: 


NURSING  CO-ORDINATOR 
OBSTETRICS/PAEDIATRICS 


Responsibilities  win  include  ttie  co-ordinating  ot  Nursing 
Activities  as  vkiell  as  the  development  and  implementation 
ot  innovative,  creative  concepts 
The  successtui  applicant  will  possess 

—  current  Ontario  Registration 

—  post-basic  clinical  preparation/experience 

—  administrative  preparation/experience 

Inquiries  may  be  directed  to: 

Mrs.  J.  Stewart 
Director  of  Nursing 
Ostiawa  General  Hospital 
24  Alma  Street 
Oshawa,  Ontario 
L1G  2B9 


The  Brome-Missisquoi-Perkins 
Hospital 

requires 

REGISTERED 
NURSES 


Ptease  write  to: 

Director  of  Nursing 
Brome-Missisquoi-Perkins  Hospital 
950  Main  Street 
Cowansville,  Quebec 
J2K1K3 


YOUR  FUTURE  IS  HERE. 

/dbena 

GOVERNMENT  OF  ALBERTA 

PUBLIC  HEALTH 
NURSES 

Opportunity  for  two  public  health  nurses  for  Wabasca  l\^unic- 
ipal  Nursing  Service. 

This  is  a  three-nurse  station  located  85  miles  north  of  Slave 
Lake.  In  addition  to  the  preventive  programs,  the  nurses 
provide  minor  and  emergency  care.  Physicians  visit  the  area 
weekly. 

Salary  presently  under  review  to  include  isolation  bonus. 
Modern  living  accommodation  is  supplied.  Nurses  with  pub- 
lic health  qualification  preferred  but  R.N.'s  would  be  consi- 
dered. 

Applications  and  enquiries  to;  MRS  J.  Bailey,  Director, 
Public  Health  Nursing,  Department  of  Health  and  Social 
Development,  1 0820  —  98th  Avenue,  Edmonton,  Alberta 
—  T5K  0C8. 

pcira 


■  tree 

llcc 


NURSES 

ALBERTA  —  MANITOBA  —  SASKATCHEWAN 

DO  YOU  FEEL  YOU  CAN  TAKE  ON  A  NEW  CHALLENGE? 

If  so,  Parabec  Ltd  offers  you  this  possibility. 

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tunity of  developing  a  paramedical  service  in  your  area. 

Through  its  team  of  specialists  both  in  the  medical  and  marketing  fields,  Parabec  Ltd 
can  bring  you  the  opportunity  you  have  always  looked  for,  that  is  combining  your 
nursing  and  management  experience. 

By  letting  us  know  your  interest  we  will  be  happy  in  discussing  ourfranchise  program 
allowing  you  to  set  up  a  franchise  business  in  your  province  and  benefiting  of  our 
experience. 

PARABEC  LTD  —  Marketing  Manager 

2120  East  Sherbrooke  —  Montreal  H2K  1C3 


THE  GENERAL  HOSPITAL 

ST.  JOHNS  NEWFOUNDLAND 

OPERATING  ROOM 

We  Will  De  moving  nexl  year  lo  a  new  320  Ded  riospftal  with  some 
Fnesen  Concepts 

BUT  NOW  —  we  need  an  0  R   Manager 
To  carry  ihe  adminisUalion  oi  the  O.R 
an  0  R   Head  Nurse  or  Co-ordinator 
To  manage  Ihe  internal  (Stenle)  area 
an  0  R   Inslruclor 
To  develop  and  teach  a  course  m  0  R   Technique  tor  nurses 
We  are  planning  systems  and  practices  now  and  trying  ihem  out 
in  our  present  hospital 

Opporlunity  to  develop  and  try  out  new  ideas  and  systems 
The  present  General  Hospital  is  the  major  teaching  hospital  tor 
the  Medical  School  and  will  continue  to  be  m  the  future 
Clinical  Services  —Orthopaedic,  Neurosurgery,  Cardiovascu- 
lar    Psychiatry,    Renal    Dialysis,    Urology,    Gynecology, 
Radiotherapy 

Orientation,  active  Inservice  Program    liberal  fringe  benefits, 
assistance  with  transportation,  depending  on  contract 


1                     THE  GENERAL  HOSPITAL 

1                      St  John  s,  Newfoundland 

Please  te"  me  about  nursing  ai  The  General. 

1    NAME                                 

1  ADDRESS 

[                                

1 

ASSISTANT 
DIRECTOR  OF  NURSING 

Applications  are  mviied  for  the  position  of  Assistant  D^ 
rector  of  Nursing  in  a  300  bed  fully  accredited  hospital  in 
St  Catharines,  Ontario. 
As  a  member  of  the  Nursing  Administrative  team,  this 

challenging  position  requires  a  nurse  with  innovative  qual- 
ities and  ability  to  organize-  delegate  and  direct  the  work  of 
others  as  well  as  ability  to  work  m  close  co-operation  with, 
communicate  with,  and  gam  the  confidence  of  others,  and 
enthusiasm  for  initiating  and  following  up  new  ideas,  pro- 
jects and  programs. 

Preference  will  be  given  to  candidates  with  a  Degree  in 
Nursing  and  with  previous  experience  in  Nursing  Service 
and- or  education 

Completed  applications,  slating  education,  experience 
and  references  should  be  directed  lo 

Administrator 
Hotel  Dieu  Hospital 
155  Ontario  Street 
St.  Catharines,  Ontario 
L2R  5K3 


THE  GENERAL  HOSPITAL 

ST.  JOHNS  NEWFOUNDLAND 


SCHOOL  OF  NURSING 


fleguires  Nursing  Instructors  lor  Medical-Surgical  Nursing. 
Maternal  and  Child  Care  Nursing 

Qualifications 

Baccalaureate  Degree  preferred 

Diploma  in  leactiing  witn  experience  will  be  considered 


THE  GENERAL  HOSPITAL 
St.  John  s.  Newfoundland 

Please  tell  me  atioul  teactimg  nursing  at  The  General 


Name 
Address 


57 


■E  CANADIAN  NURSE  —  June  1975 


DIRECTOR  OF 
NURSING  SERVICE 


Applications  are  invited  tor  this  position  m  a  lifty-eighl  bed 
fully  accredited  hospital  which  includes  a  sixteen  bed 
chrontc  unit  and  has  a  nursing  staff  of  53 

The  hospital  is  located  on  Mamtoulm  Island  which  is  noted 
for  fis  natural  beauty  and  recreational  facilities 

Applicants  will  be  requred  to  have  a  B  Sc  Nursing  and'Or 
previous  nursing  adrrnnistrative  experience- 
Fringe  benefits  include  four  weeks  vacation,  Ontario  Hos- 
pital Insurance  and  Pension  Plan  and  Group  Life  Insur- 
ance Salary  is  negotiable  and  will  be  commensurate  with 
qualifications  and  experience. 

Applications  and  inquiries  should  be  directed  to. 


Administrator 

St.  Joseph's  General  Hospital 

P.O.  Box  640 

Little  Current,  Ontario 


PAEDIATRIC 
SUPERVISOR 


Excellent  opportunity  in  a  fully  accredited  333- bed 
active  treatment  hospital  located  in  the  Toronto- 
Hamilton  area. 

Responsible  for  administration  and  nursing  care 
in  a  45-bed  mixed  medical-surgical  paediatric 
unit.  Good  clinical  background  in  Paediatric  Nur- 
sing is  essential. 

Excellent  salary  and  working  conditions.  Further 
information  will  be  forwarded  on  receipt  of 
complete  resume  of  education  and  experience. 


Reply  to: 

PERSONNEL  MANAGER 
Oakville-Trafalgar  Memorial  Hospital 
327  Reynolds  Street 
Oakvllle,  Ontario 
L6J  3L7 


NURSING 
OFFICE  SUPERVISOR 

NURSING  OFFICE  SUPERVJSOR  required 
for  340-bed  acute  care,  fully  accredi- 
ted Hospital. 

Personnel  Policies  in  accordance  with 
RNABC  Contract. 

Must  be  eligible  for  B.C.  Registration 
SALARY:  $1283  to  $1513  per  month 
(1975  rates) 

Preference  will  be  given  to  applicant 
with  University  preparation  in  Adminis- 
tration and  Clinical  Supervision 
Apply,  stating  qualifications  to: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 

V2M  1S2 


OKANAGAN  COLLEGE 
NURSING  FACULTY 

The  College  is  implementing  a  two- 
year,  Registered  Nursing  Program  in 
September,  1976.  Applications  are  in- 
vited for  the  following  positions: 

1.  Senior  instructor:  to  take  office  in 
September,  1975. 

2.  Other  instructors  to  be  appointed  in 
the  spring  of  1976. 

DUTIES: 

Classroom  teaching  and  clinical 
supervision  of  nursing  students;  cur- 
riculum development;  other  duties  as 
assigned  by  the  Coordinator  of  Nurs- 
ing Education.  Some  positions  may 
require  travelling  to,  or  residence  in, 
nearby  communities. 

QUALIFICATIONS: 

Master's  degree  preferred;  bachelors' 
minimum.  Teaching  experience  desir- 
able; clinical  experience  essential. 

Salary  and  working  conditions  in  ac- 
cordance with  the  academic  faculty 
agreement. 
APPLICATIONS: 

The  Principal, 

Okanagan  College, 

1000  K.LO.  Road, 

Kelowna,  B.C. 

V1Y  4X8 


Position  Available 
Immediately 


in 


Labour  Relations 


Required  —  A  registered  nurse  to  work  as  an  as- 
sociate to  the  Labour  Relations  Officer:  to  assist 
with  the  organization  of  bargaining  units,  negotia- 
tions, administration  of  contracts:  to  do  pertinent 
research:  to  assist  with  the  educational  program 
related  to  collective  bargaining.  The  nurse  must 
tie  available  for  extensive  travel  throughout  the 
province. 

Qualifications  preferred:  Practical  experience  in 
some  area  of  iatwur-management  or  personnel 
relations.  Experience  in  negotiations  an  asset: 
three  to  five  years'  experience  in  nursing  neces- 
sary. A  nurse  without  experience  in  labour  rela- 
tions will  be  considered. 
Salary  —  Related  to  experience  and  qualifica- 
tions, but  no  lower  than  the  top  of  the  general  duty 
scale  ($9230  in  1974,  1975  under  negotiation) 

Apply  stating  qualilicatlona,  experience,  avallabllltr 
and  salary  expected,  to 

Nurses'  Staff  Associations 

of  Nova  Scotia 

6035  Coburg  Road  Halifax 

B3H  1Y8 


OPERATING 

ROOM 
SUPERVISOR 


Operating    Room    Supervisor    re 

quired  for  226-bed  active  treatment 
hospital  in  the  southern  Okanagan  Val 
ley.  Apply  in  writing,  listing  qualifica- 
tions and  experience,  to; 


Director  of  Nursing 
Penticton  Regional  Hospital 
Penticton,  B.C. 
V2A  306 


PUBLIC 
HEALTH 
NURSES 

Required 

for  the  Sudbury 

&  District  Health  Unit 

Apply  to: 

Director  of  Nursing 
1300  Paris  Crescent 
Sudbury,  Ontario 
P3E  3  A3 


GENERAL  DUTY 
NURSES 

—  360-bed  acute  general  hospital 

—  personnel  policies  in  accordance  with 
RNABC  Contract 


Dlnct  Inquiries  to: 

Director  of  Nursing 

Nanaimo  Regional  General  Hospital 

Nanaimo,  British  Columbia 

V9S  2B7 


DIRECTOR, 
EDUCATION    SERVICES 

wanted  for 

REGISTERED  PSYCHIATRIC  NURSES  ASSOCIATION 
OF  BRITISH  COLUMBIA 


QUALIFICATIONS  DESIRED: 

—  Registration  as  a  Psychiatric  Nurse,  or  Registered  Nurse  with  extensive  psychiatric 
experience 

—  Recognized  Degree  in  Nursing 

—  Experience  m  Nursing  Education, 

DUTIES: 

~  With  a  selected  committee,  to  determine  the  terminal  behaviours  required  of 
graduates  from  programs  in  Psychiatric  Nursing 

—  With  a  selected  committee,  to  set  and  maintain  the  education  standards  to  be  met  by 
facilities  offering  programs  in  basic  Psychiatric  Nursing  education  and  in  post  basic 
Psychiatric  Nursing  education 

—  To  be  responsible  for  establishing  and  maintaining  the  Association  s  Regislralon 
examinations 

—  To  assume  responsibility  for  tf>e  Associations  continuing  education  programs.  This 
entails  arranging  refresher  and  post-graduate  courses  for  Association  members 
througfx)ut  tf>e  Province 

—  To  assume  other  related  duties  on  the  direction  of  the  Council  or  the  Executive  Director 

BENEFITS: 

—  Salary  open  to  negotiation 

—  Good  fringe  benefits 

GENERAL: 

—  This  IS  a  staff  position  directly  responsible  to  the  Executive  Director,  and  will  require 
some  overtime  and  travelling. 

This  position  IS  available  on  or  after  May  1st,  1975  Applicants  should  submit  a  letter  of 
application,  resume,  and  salary  expected  to  the  President  Registered  Psychiatric  Nurses 
Association  of  British  Columbia.  7790  Edmonds  Street,  Burnaby.  B  C.  V3N  1B8 


R.N.'S 


The  Royal  Alexandra  is  a  friendly  place  to  work;  a  modern 
progressive  1000  bed  teaching  hospital  in  the  "just-right- 
size"  city  of  Edmonton,  Alberta. 

Fully  accredited,  the  Royal  Alexandra  offers  challenging  ex- 
perience, on-going  in-service  programs,  generous  fringe 
benefits  and  competitive  salaries.  All  previous  experience  is 
recognized.  You  may  skate,  ski  and  curl  inexpensively.  Ed- 
monton is  within  easy  driving  distance  of  many  lakes  where 
you  may  enjoy  the  sunny  Alberta  summer. 


Vacancies  exist  in  most  areas  including  ICU,  O.R.  &  Psy- 
chiatry. 


Salary  Range  for  General  Duty;  $900.  -  $1075. 


For  Mormatlon  pl«aso  write  to: 

Mrs.  R.  Tercier 

Director  of  Nursing  Personnel  Administration 

Nursing  Office 

Royal  Alexandra  Hospital 

10240  Kingsway  Ave. 

EDMONTON,  ALBERTA 

T5H  3V9 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 
teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre, 

1975  Salary  Scale  $1,026.00  —  $1,212.00  per  month  (subject  to  change) 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 
VANCOUVER  GENERAL  HOSPITAL 
855  WEST  12TH  AVE. 
VANCOUVER,  B.C. 


THr  rAKlAHlAM  Ml  IDCC   _ 


r 


The  Department  of  Community  Health 
Hauterive  Hospital, 

requires  an 

OUTPOST  NURSE 

VILLAGE  OF  ASSIGNMENT 

Kegaska  (Lower  North  Shore  ot  the  Saint  Lawrence, 
Quebec):  an  English-speaking  fishing  settlement  of  200 

inhabitants. 

REQUIREMENTS 

Canadian  professional  registration 

A  wide  range  of  practical  experience  in  both  preventive 

and  therapeutic  medicine 

Good  judgment,  a  sense  of  responsibility  and  consider- 

abte  rnatunty 

PRINCIPAL  DUTIES 

Cover  the  needs  ot  the  villagers  in  the  fields  of 
1)         preventive  medicine 

a)  maternity  and  child  welfare: 

b)  reporting  infectious  diseases: 

c)  vaccinations, 

d}  food,  dental  and  medical  education; 

e)  examination  and  health  education  of  school  chil- 
dren, 

f)  all  other  related  tasks, 
therapeutic  medical  care; 

a)  everyday  medical  care. 

b)  preparation  of  patients  for  transfer  to  the  sub- 
regional  hospital: 

c)  cooperation  with  the  doctor  on  his  monthly 
round. 

d)  m  case  of  extreme  emergency,  delivery  of  babies 
and  minor  surgery. 

SALARY 

According  to  the  collective  agreement  ot  the  hospital.  Plus 
a  disponibility  bonus  and  a  responsibilMy  bonus 
Write  and  send  curriculum  vitae  to 

The  Director  of  Personnel 
Hbtel-Dieu  de  Hauterive 
635  boul.  Joliet 
Hauterive,  Qu6. 
G5C  1P1 


2) 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound    in   our  clinics   and 

their  numbers  increase  daily  in  our 

Emergency. 

if    you    do    not    like   working   with 

children    and   with   their   families. 

you  would  not  like  it  here. 

If  you  do  like  children  and  their 
families,  we  would  like  you  on  our 
staff. 

Interested  qualified  applicants 
should  apply  to  the: 

DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108.  Quebec 


•MEETING  TODAY'S  CHALLENGE  IN  NURSING  " 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGill  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 
Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE..  MONTREAL,  QUE.,  H4A  3L6. 


INSERVICE 
CO-ORDINATOR 


Required  for  a  1 1 0  bed  accredited 
hospital. 

Applicants  will  be  responsible  for 
planning,  organizing  and  imple- 
menting an  Inservice  Education 
Program. 

Experience  in  teaching/super- 
vision essential.  B.  So.  in  Nursing 
preferred. 


Applications  to: 

Personnel  Department 
Highland  View  Regional  Hospital 
Amherst,  Nova  Scotia 
B4H  1N6 


MOVING? 
BEING  MARRIED? 

Be  sure  to  notify  us  six  weeks  in  advance , 
otherwise  you  will  likely  miss  copies. 


> 


Attach  the  Label 
From  Your  Last  Issue 

OR 
Copy  Address  and  Code 
Numbers  From  It  Here 


NEW  (NAME) /ADDRESS: 


Street 


City 


Zone 


Prov. /State  Zip- 

Please  complete  appropriate  category: 

I     I     I  hold  active  membership  in  provincia 
nurses'  assoc. 


reg.  no. /perm,  cert./  lie,  no. 
I     I    I  am  a  Personal  Subscriber. 
MAILTO: 

The  Canadian  Nurse 

50  The  Driveway 

OTTAWA,  Canada  K2P  1E2 


WE  CARE 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

immediately  north  of  Toronto. 
APARTMENTS: 

Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 

Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


REGISTERED  NURSES 

STANFORD  UNIVERSITY  HOSPITAL 
PALO  ALTO,  CALIFORNIA 


62'(  bed  TEACHING 
in  the  midst  of 
CENTER  has  pos i  t 
EXPERIENCED  R.N. 
CAREER  ADVANCEME 
ORIENTATION  and 
EDUCATION.   The 
NURSING  CARE  is 
I CU  will  expand 
the  near  future, 
in  this  CRITICAL 
SPECIALTY  UNITS 


and  RESEARCH  Faci 1 i  ty 
an  outstanding  MEDICAL 
ions  available  for  the 

who  is  interested  in 
NT  through  extensive 
continuous  INSERVICE 
concept  of  PRIMARY 
being  implemented, 
from  3^    to  59  beds  in 
SPECIALTY  TRAINING 

CARE  area  and  other 
is  g  i  ven . 


OUR  R.N.  RECRUITER  WILL 
BE  VISITING  MAJOR  CITIES 

IN  CANADA  IN  .MAY  &  JUNE, 

For  further  information  regarding  TIME  S 
PLACE  please  CONTACT  the  Personnel  Dept. , 
Stanford  University  Hospital,  Stanford, 
CA  9'<305.  (A15)  '(97-6361. 

An  Affirmative  Action/ 

Equal  Opportunity  Employer 


if  Paris  appeals  to  you  . . . 


. .  .so  will  Montreal 


•  modern  700  bed  non-sectarian  hospital 

•  excellent  personnel  policies 

•  Registered  Nurses  and  Nursing  Assistants 
are  asked  to  apply 


•  active  In-Service  Education  program 

•  bursaries  available 

•  Quebec  language  requirements  do  not 
apply  to  Canadian  applicants 


Director,  Nursing  Service 
Jewish  General  Hospital 
3755  cote  ste.  Catherine  Road 
Montreal,  Quebec  H3T  1E2 


|THE  CANADIAN  NURSE  —  June  1975 


LIVERPOOL  HOSPITAL 

NEW  SOUTH  WALES 

AUSTRALIA 

A  230  bed  hospital  —  expanding  to  334 
beds  in  1975.  Acute  Medical,  Surgical,  Ac- 
cident Trauma,  Maternity,  Paediatrics. 

GENERAL  TRAINED  NURSES 


Liverpool  Is  situated  20  miles  from  the  heart 
of  Sydney  in  a  semi  rural  area. 

For  further  Information  write  to: 

(Miss)  J.M.  Grauss  —  MATRON 
Liverpool  District  Hospital, 
P.O.  Box  103, 
LIVERPOOL,  N.S.W. 
AUSTRALIA 


Required  for  September  1975 

RESIDENT  R.  N. 
FOR 
BOYS'  BOARDING  SCHOOL 
IN  QUEBEC 


Contact: 


The  Headmaster 
Stanstead  College 
Stanstead,  Quebec 
JOB  3E0 
Telephone:  (819)  876-5612 


UNIVERSITY  HOSPITAL 
SASKATOON,  SASKATCHEWAN 

Invites  applications 
for 

REGISTERED  NURSE 

positions 

Experienced  nurses  are  required  in 
Pediatrics,  Neurosurgery,  Neonatal, 
Psychiatry, 

also 
Positions  in  General  Areas. 
Policies  according  to  S.U.N. 

Apply  to: 

Employment  Officer,  Nursing 
University  Hospital 
SASKATOON,  Sasltalchewan 
S7N  0W8 


Qucrscas 


^jrc> 


Experienced  nurses  are  need- 
ed to  work  in  Africa,  Asia, 
Latin  America,  and  the  South 
Pacific. 

Become  involved  in  public 
health,    primary    care,    and 
training  programmes. 
Two  year  contracts. 
Contact:  CUSO  —  Health  -  5 
151  Slater  Street 
Ottawa,  Ontario 
K1P5H5 


Thi.s 
.  PuUication 
isArailaUein 

MHM>FORM 

...from 


Xerox 
University 
Microfilms 

300  North  Zeeb  Road 
Ann  Arbor,  Michigan  48106 

Xerox  University  (Microfilms 

35  Mobile  Drive 
Toronto,  Ontario, 
Canada  M4A  1H6 

University  Microfilms  Limited 

St.  John's  Road, 

Tyler's  Green,  Penn, 

Buckinghamshire,  England 

PLEASE  WRITE  FOR 
COMPLETE  INFORMATION 


CLINICAL  NURSE  SPECIALIST 


For 


MED-SURG  NURSING 

Required  in  254-Bed 

Active  Care 

General  Hospital 


Qualified  Parties  Apply  to: 

Director  of  Nursing 

Moose  Jaw  Union  Hospital 

Moose  Jaw,  Sask. 

(306)692-1841  (Call  Reverse) 


DIRECTOR 

Of 
NURSING 


Applications  are  invited  tor  the  position  of  Director  of  Nurs- 
ing in  a  fully  accredited  50-t)ed  Acute  Care  Hospital 
cated  in  the  beautiful  East  Kootenay  Industnal  and  Rec 
ational  area  of  Bntish  Columbia 

Successful  applicant  will  be  responsible  for  all  nursmg 
services  including  In-Service  Education, 
Minimum  qualifications  include  registration  or  eligitJtlity  for 
registration  in  the  Province  of  Bntish  Columbia-  Previous 
training  and  experience  in  a  senior  nursing  position 
required 
Position  available  September  1,  1975 

Pfoase  appty  in  writing  to: 

ADMINISTRATOR 
Kimberley  &  District  Hospital 
260  -  4th  Avenue 
Kimberley,  British  Columbia 
V1A2R6 


REGISTERED  NURSES 

AND 

NURSING  ASSISTANTS 

required  for 

110-beds  chest  hospital  situated  in  the  beautiful 
Laurentians,  only  a  50  minute  drive  trom 
Montreal.  We  have  excellent  personnel  policies 
Residence  accommodation  is  available. 
(Quebec  language  requirements  do  not  apply  for 
Canadian  applicants). 

Apply  to: 

Director  of  Nursing 

Mount  SInal  Hospital 

P.O.  Box  1000 

Ste.  Agathe  des  Monts,  OuelMC 

J8C  3A4 

Telephone  number:  (819)  326-2303 


1 1— 


NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  for  all  Nursing  Units 
Intensive-Coronary  Care,  Psychiatry,  Med. -Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservice  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries     Reg.  N.  Jan.  1st,  1975  —  915.  —  1,115. 
April  1st,  1975  —  945.  —  1,145. 

R.N. A.  Jan.  1st,  1975  —  686.  —  728. 
July  1st,  1975  —  738.  —  780. 

Contact 
Director  of  Nursing 


THE  UNIVERSITY  OF  BRITISH  COLUMBIA 

invites  applications  for  the  position  of 

DIRECTOR  OF  NURSING  SERVICES 
EXTENDED  CARE  HOSPITAL 


This  will  be  a  joint  appointment  between  the  School  of  Nurs- 
ing and  the  Extended  Care  Hospital. 

The  appointment  will  be  at  the  Associate  Professor  level, 
and  salary  will  be  negotiable  from  $30,000  upward. 

Master's  degree  essential,  Ph.D.  preferred.  Candidate  must 
be  a  specialist  in  long  term  care  of  all  age  groups.  Successful 
experience  in  nursing  administration  required. 

Apply  to: 


Muriel  Uprichard,  Ph.D. 
Professor  and  Director 
School  of  Nursing 
2075  Wesbrook  Place 
Vancouver,  British  Columbia 
V6T  1W5 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 


THE  CANADIAN  NURSE  —  June  1975 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


63 


Dr  Welby  is  a  . . . 
NURSE 


It  seems  clear  from 
watching  this  program 
that  poor  Dr  Welby  is 
spending  2/3  of  his 
time  NURSING. 

The  nursing  profession  at 

the  ROYAL  VICTORIA  HOSPITAL 

is  concerned  about  this. 
We  are  reviewing  nursing 
roles  in  depth  in  this 
teaching  hospital  center, 
and  we  feel  that  we  can 
relieve  Dr  Welby  of  his 
non-doctoring  functions. 

You  are  invited  to  join 

an  extensive  change 

program  in  the  nursing 

profession  at  the 

ROYAL  VICTORIA  HOSPITAL. 

Areas  where  you  can  be  a 
part  of  the  change  program 
are,  Medical  and  Su.gical 
Specialties,  Intensive  Care 
Areas,  Operating  Room, 
Psychiatry,  Obstetrics, 
Emergency  and  Ambulatory 
Services. 

No  special  language 
requirement  for  Canadian 
Citizens,  but  the  opportunity 
to  improve  your  French  is 
open  to  you. 

For  Information,  Write  To: 

Anne  Bruce,  R.N., 
Nursing  Recruitment  Officer 
Royal  Victoria  Hospital 
687  Pine  Avenue  West 
Montreal,  Quebec,  Canada 
H3A  1A1. 


Index 

to 

Advertisers 

« 

June  1975 

The  Clinic  Shoemakers 

2 

Colgate-Palmolive,  Limited 

.  .  .Cover  3 

HoUister  Limited 

49 

J.B.  Lippincott  Co.  of  Canada,  Limited    .  . 

.  .32  &  33 

MedoX 

51 

The  C.V.  Mosby  Company,  Limited 

14 

Procter  &  Gamble 

9 

Reeves  Company 

41 

Roots  Natural  Footwear 

.  .  .Cover  4 

W.B.  Saunders  Company  Canada,  Limited 

1 

Searle  Pharmaceuticals   

13 

Seneca  College  of  Applied  Arts  and  Technology   .  .  .48 

Smith  &  Nephew,  Limited 

42 

Three  (3)  M  Canada,  Limited 

11 

The  Tiresias  Press,  Inc  

46 

White  Sister  Uniform,  Inc 

. . .Cover  2 

Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  IE2  (Ontario) 

Advertising  Representatives 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore,  Penna.  19003 
Telephone:  (215)  649-1497 

Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills,  Ontario 
Telephone:(4l6)  444-4731 

.Member  of  Canadian 
Circulations  Audit  Board  Inc. 

Fm 

Nurse 


"JUI  i  5  '97S 


Do 
UT 


^^OT   T 


Of 


LID 


^K^ 


^AR 


KIN   6N5 


Look  what  we've  done!! 


^^^^mmr^-'       -          Wm                                      234l?-0!0 

m^f^B       HYGIENIC  CLEANSING  CLOTH 

In  a  time  of  rapidly  rising  costs,  we've  taken  a  proven  concept  in  postpartum  care,  MEDICATED 
PADS,  and  IMPROVED  THEM  SIX  WAYS  while  LOWERING  your  cost! 


Here's  how: 

—  Each  packet  individually  foil  wrapped  to  guarantee  shelf  life 

—  Larger  surface  area  per  pad 

—  Uniform  saturation  —  (no  dripping  or  dry  pads) 

—  No  cross  contamination  (with  jars,  patient  continually  puts  hands  back  in  the  same  jar) 

—  Rectangular  shape  —  adapts  better  for  use  with  sanitary  napkin 

—  Less  Waste  —  20  packets  per  box  (average  patient  stay  5  days  x  4  applications  per  day) .  Naturally 
if  more  pads  are  required,  a  second  box  of  20  can  easily  be  issued. 


All  of  the  above  is  yours  with  the  Tomac  Hygienic  Cleansing  Cloth  at  a  significant  savings  over  your 
present  jar  system!! 

For  free  samples  and  additional  information,  mail  us  this  coupon  — 


FOR  FREE  SAMPLE  AND  ADDITIONAL  INFORMATION 
MAIL  US  THIS  COUPON 

Name 

Hospital  

Title  

Address 

City Prov 


American  Hospital  Supply 
Division  of  McGaw  Supply. 
1076  Lakeshore  Rd.  E., 
Mississauga,  Ontario.  L5E  3B6 


A  Bedrock  o(  Knowledge 


LeMaitre  &  Finnegan: 

THE  PATIENT  IN  SURGERY— 

A  Guide  for  Nurses,  New  3rd  Edition 

In  this  comprehensive  review  of  modern  surgical  nursing  the  authors 
examine  sequentially  all  the  factors  involved  in  patient  care.  Pan  I 
—General  Considerations  in  the  Care  of  the  Surgical  Patient— 
introduces  the  components  of  surgery,  the  surgical  experience  for 
the  patient,  and  the  elements  of  superior  patient  care.  Part  II— 
Specific  Operative  Procedures-employs  a 
convenient  outline  format  to  summarize  in- 
dividual surgical  procedures  and  the 
specific  postoperative  care  for  each  opera- 
tion. Eighteen  chapters  are  new  to  this  edi- 
tion, including  those  on  laparoscopy 
cholecystojejunostomy,  radical  pan- 
creaticoduodenectomy, lysis  of  adhesions, 
excision  of  testicular  tumor,  lumbar  sym- 
pathectomy, aorto-iliac  bypass  graft, 
ureterostomy,  breast  biopsy,  bilateral  ad- 
renalectomy, and  coronary  artery  bypass 
graft. 

By  George  D.  LeMaitre,  MD,  FACS,  Diplo- 
mate  Am.  Bd.  of  Surgery;  and  Janet  A.  Fin- 
negan, RN.  MS.  About  545  pp.  110  ill.  Soft 
cover.  About  $8.75.  Just  Ready. 

Order  #5717-6. 


^^^0 

TEXTBOOK 

OK 
.PEDIATRIC- 

VAU6HAN 
fckKAY 

^il^^^^^ 

Creighton: 

LAW  EVERY  NURSE 

SHOULD  KNOW 

New  3rd  Edition 

It  takes  an  expert  to  understand  all  the  legal 
complications  that  todays  nursing  practice 
may  entail — an  expert  like  Helen  Creighton, 
who  is  a  nurse  and  nursing  educator  as 
well  as  an  experienced  lawyer.  This  new  edi- 
tion has  been  totally  revised  and  substan- 
tially expanded  to  include  data  on:  A.N.A. 
certification;  minors  and  birth  control,  abor- 
tion, and  drug  abuse;  care  of  psychiatric  pa- 
tients; pronouncing  the  patient  dead;  confi- 
dential communications;  narcotics  viola- 
tions; legitimacy;  acupuncture;  rights  prior 
to  birth;  and  many  more  topics.  An  entire 
chapter  examines  Canadian  Law  and  Legal 
Practice. 

By  Helen  Creighton,  RN,  JD.  About  385  pp. 
Just  Ready.  Order  #2752-8. 


THE  PAIiENT  IN  : 


Law  Every  Nurse  Should  Know  , 


Aeece  &  Chamberlain: 

MANUAL  OF  EMERGENCY 

PEDIATRICS 

This  eminently  practical  volume  covers  most 
pediatric  problems  seen  in  the  clinic,  office  or 
emergency  room.  Its  arranged  alphabetically 
by  symptoms  and  cross-indexed  for  quick  ref- 
erence. Coverage  includes  iiurris,  ear  problems, 
lacerations,  seizures,  much  more. 

MD;  and  the  late  John  W. 

483   pp.     $10.30.   Oct. 

Order  #7497-6. 


By  Robert  M.  Reece, 
Chamberlain,   MD. 

1974. 


Falconer  et  al.: 

THE  DRUG,  THE  NURSE,  THE  PATIENT 

5th  Edition 

It's  two  books  in  one— a  complete  textbook  for  use  in  the  classroom 
and  a  handy  reference  for  on-the-job  questions.  Initial  material  takes 
up  the  basics  of  pharmacology,  dosage  and  administration;  and 
investigates  changes  and  special  considerations  in  pediatric  and 
geriatric  drug  therapy.  Bound  into  the  text  is  the  complete  1974-76 
Current  Drug  Handt>ook  which  puts  at  your 
fingertips  concise  clinical  data  on  more  than 
1500  drugs  in  current  use.  Names,  sources, 
synonyms,  preparations,  dosages,  adminis- 
tration, uses,  action,  contraindications  and 
remarks  are  described  in  accessible  tables. 

By  Mary  W.  Falconer,  RN;  Annette  Schram 
Ezell,  RN;  H.  Robert  Patterson,  PharmD; 
and  Edward  A.  Gustafson,  PharmD.  621  pp. 
Illustd.  $13.90.  Sept.  1974.    Order  #3548-2. 


Robinson: 

PSYCHIATRIC  NURSING 
AS  A  HUMAN  EXPERIENCE 

Emphasizing  the  human  qualities  in  psy- 
chiatric nursing,  this  text  shows  you  how  to 
cope  with  and  creatively  respond  to  a  pa- 
tient's problems  and  anxieties.  It  depicts  pa- 
tients with  psychological  problems  under  a 
variety  of  settings — individual  psycho- 
therapy, community  work,  family,  group, 
and  institutional  therapy. 

By  Lisa  Robinson,  RN,  PhD.  352  pp.  $8.25. 
Sept.  1972.  Order  #7620-0. 

Vaughan  &  McKay: 
Nelson  TEXTBOOK  OF 
PEDIATRICS,  New  10th  Edition 

This  single  volume  provides  complete,  de- 
tailed information  on  all  aspects  of  virtually 
every  childhood  illness  or  injury.lfs  all  here: 
embryology,  pathology,  diagnosis,  prog- 
nosis, and  followup.  If  this  is  the  first  place 
you  look  for  answers,  it  will  most  likely  be  the 
only  place  you'll  need  to  look. 

Edited  by  Victor  C.  Vaughan,  III,  MD;  and  R. 
James  McKay,  MD;  with  102  contributors. 
1876  pp.  539  ill.  $33.75.  Feb.  1975. 

Order  #9018-1. 


~:,iR\ 


You  II  Pind  \o  Faults. 


% 


W.  B.  SAUNDERS  COMPANY  CANADA  LTD. 

833  Oxford  Street,  Toronto,  Ontario  M8Z  5T9 


Frl 


Prices  subject  to  change. 
CN775         I 


order  tHles  on  30-day  approval,  enter  order  number  and  author: 


Please  Print: 


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HOME  ADDRESS 


I     ^  check  enclosed— Saunder*  pays  postage        J  sendC.O.D.        ^  bill  me 

HE  CANADIAN  NURSE  —  July  1975 


PROVINCE 


ZONE 


.J 


for  relief  of  postpartum  discomforts 

only  Tucks  bobies 
tender  tissues  two  woys 

QS  Q  soothing  wipe...Qs  q  cooling  compfess...Qnd  os  often  qs  she  likes 


Tucks  medicated  pads  give  your  postpartum 
patient  more  relief,  more  often  than  ointments  or 
aerosols  because  pads  can  be  used  more  ways. 
Cooling  Tucks  medication  can  be  applied  by 
using  the  pad  as  a  compress.  Or  the  pad  can  be 
used  as  a  wipe  to  both  soothe  and  cleanse.  As  a 
wipe,  it  lets  her  avoid  the  mechanical  irritation  of 
harsh,  dry  toilet  paper.  A  Tucks  pad  under  her 
sanitary  pad  prevents  chafing  too. 

Tucks  medication  gives  prompt,  temporary 
relief  from  postpartum  discomforts — the  itching, 
burning  and  irritation  of  episiotomies  and  simple 
hemorrhoids.  Its  active  ingredients  are  witch  hazel 
and  glycerine — there  is  no  "caine"  type  anesthetic 


in  it.  Your  patient  can  have  her  own  supply  of 
Tucks  at  bedside  for  self-administered  relief  with 
minimum  risk  of  over-treatment  or  sensitization. 

In  addition.  Tucks  medication  is  buffered  to  an 
approximate  pH  of  4.6.  This  helps  tissues  maintain 
their  normal  acid  defenses.  Prescribe  Tucks  pads 
at  bedside  for  soothing,  cooling  comfort  from  the 
first  postpartum  day  on. 

Order  a  trial  supply  on  ybur  Rx.  Write  to: 


1956  Bourdon  Street.  Montreal.  P.O.  H4M  1V1 


1 


The 

Canadian 
Nurse 


editorial 


A  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  by  the  Canadian  Nurses'  Association 


Volume  71,  Number  7 


July  1975 


15  Frankly  Speaking  — 
Today's  Administrator  Wears  Many  Hats F.P.  Harrison 

16  Multiple  Sclerosis: 
Experiences  of  Personal  Alienation W.  Pulton 

19      Continuing  Education  Should  Be  Voluntary M.J.  Flaherty 

22      What  Price  Education? D.  Scott 

24      Going  Home  with  COLD: 

Is  Your  Patient  Ready? S.  Pasch,  T.  Jamieson 

26      Idea  Exchange A.  Blatz,  A.  De  Filippi,  N.  Watson 

J.  Funke,  H.  Niskala,  P.A.  Field 

30      Is  the  Postpartum  Period 

a  Time  of  Crisis  for  Some  Mothers? L.  Melchior 

32      Cystic  Fibrosis A.A.  Marcotte 

The  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

7  News 

12  Dates 

13  In  A  Capsule 


38  Names 

40  Books 

43  Accession  List 

56  Index  to  Advertisers 


Executive  Director:  Helen  K.  Mussallem  • 
Editor  Virginia  A.  Llndabury  «  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Lynda  S. 
Cranston  •  Produciion  Assistant:  Mary  Lou 
Downes  •  Circulation  Manager:  Beryl  Dar- 
ling *   Advertising     Manager:     Ceorgina     Clarke 

•  Subscription  Rates:  Canada;  one  year, 
$6.00:  two  years,  $11.00.  Foreign:  one  year, 
$6.50:  two  years,  $12.00.  Single  copies: 
$1.00  each.  Mal<e  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  registration  number  in  a  pro- 
vincial nurses'  association,  where  applicable. 
Not  responsible  for  journals  lost  in  mail  due 
lo  errors  in  address. 


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  lo  indicate  definite  dales  of  publication. 

Postage  paid  in  cash  at  third  class  rale 
MONTREAL.  P.Q.  Permit  No.  10,001. 
50    The    Driveway,    Ottawa,    Ontario,    K2P1E2 

©  Canadian  Nurses'  Association  1975 


=  CANADIAN  NURSE  —  July  1975 


letters 


Cigarettes  and  calories 

The  March  issue  of  The  Canadian 
Nurse  contained  an  article  entitled 
■"Control:  Cigarettes  and  Calories."  It 
was  very  well  written  and  certainly  con- 
tained good  advice  for  the  person  at- 
tempting to  stop  smoking.  However,  in 
■"Step  5:  Start  losing.""  there  is  one 
sentence  that  I  must  disagree  with.  It 
states.  ""Don't  overdo  the  exercise  or 
you  will  be  ravenously  hungry." 

According  to  research  by  Roy  J. 
Shephard  MD  (Shephard.  Roy  J.  En- 
durance Fitness.  Toronto.  University 
of  Toronto  Press.  1969.  p.  164).  ""vig- 
orous exercise  has  the  immediate  effect 
of  inhibiting  both  appetite  and  food  in- 
take. Thus,  if  a  person  who  is  losing 
weight  feels  hungry,  it  is  often  helpful 
to  go  for  a  brisk  run.  The  mechanism  of 
relief  is  probably  that  exercise  in- 
creases the  blood  sugar  level."  — 
Charlotte D.  Lefcoe.  RN.  London.  Ont. 


Last  of  the  four-letter  words 

I  read  with  interest  the  letter  of  Lydia 
Ziola  (""letters.""  April  1975.  p.  8)  re- 
garding the  CBC  Performance  Series 
play.  Last  Of  The  Four-Letter  Words. 
m  which  she  states  she  was  so  mad  at 
the  portrayal  of  nurses  and  other  hospi- 
tal staff  that  she  turned  her  TV  off  dur- 
ing the  first  act. 

I  did.  too.  For  the  same  reason.  I  was 
really  shaken  by  that  first  act,  protest- 
ing it!  But  I  wanted  to  see  how  this 
subject,  cancer,  was  going  to  be  hand- 
led. As  far  as  I  am  concerned,  cancer, 
not  death,  is  the  last  of  the  four-letter 
words!  So.  I  turned  the  TV  on  again, 
hung  on  through  the  whole  play  — 
emotionally  disturbing  and  shattering 
as  it  was  —  to  the  tremendously  mov- 
ing end.  which  was  an  extremely  effec- 
tive statement  on  the  kind  of  caring  that 
nursing  is  supposed  to  be  all  about.  I 
didn't  like  that  show,  but  I  felt  that  it 
was  the  most  honest  thing  I've  ever 
seen  or  read  on  the  subject. 

However.  I  still  felt  like  protesting  to 
the  CBC  about  the  hospital  image!  But  I 
was  fortunate  enough  to  catch  the  play 
the  second  time,  and  this  time  I  focused 
on  the  hospital  angle  as  much  as  possi- 
ble. At  the  end.  I  felt  that,  in  that  area 
loo,  the  play  was  honest,  though  not 
flattering.  For  flattery,  all  one  needs  to 


do  is  to  view  training  films  and  public 
relations  stuff,  where  the  hospital/ 
nurse  image  is  projected  as  we  like  to 
see  ourselves. 

But  this  hospital,  as  shown  on  TV, 
was  a  busy,  working  hospital,  its  staff 
coping  with  ""non-ideal"  patients  and 
working  conditions,  seen  through  the 
eyes  of  a  victim  thrown  into  it  against 
her  will.  There  have  been  letters  from 
RNs  to  this  magazine,  detailing  and 
criticizing  the  treatment  and  care  they 
received  from  their  colleagues,  which 
were  worse  than  anything  shown  in  this 
play!  (Oddly  enough,  I  have  never 
heard  or  seen  any  protest  from  nurses 
regarding  the  image  projected  by  the 
M*A*S*H  series!) 

Judging  from  the  reaction  to  the  Per- 
formance Series,  it  would  seem  that  we 
Canadians  are  more  concerned  with 
images  than  with  issues.  —  Margaret 
B.  Evans.  Nipawin.  Saskatchewan. 


Author  pleased 

Thank  you  so  much  for  the  honorarium 
I  received  for  the  article  ""The  Hy- 
perkinetic Child."  (May  1975,  p.  27.)  I 
was  so  pleased  with  the  way  it  was 
presented  in  the  magazine  —  and  the 
cover  was  quite  an  honor!  —  Carol 
Anonsen.  formerly  nurse  coordinator 
of  the  Clinical  Training  course  for  Me- 
dical Services  Nurses,  the  University 
of  Western  Ontario. 

Here  is  the  nurse  who  cares! 

I  feel  that  1  must  reply  to  the  comments 
expressed  by  Gladys  Creelman  in  her 
letter  of  April  19^75,  ""Where  is  the 
nurse  who  cares?"" 

At  the  hospital  where  I  work  in  On- 
tario, our  patients  are  indeed  treated  as 
people,  not  as  names  on  beds  or 
medicine  cards. 

I  admit  there  may  be  an  occasional 
RN  or  RNA  who  contaminates  a  sterile 
field  or  treats  a  patient  like  a  nuisance. 
But  surely  they  cannot  constitute  the 
majority.  What  about  all  the  good 
nurses,  the  nurses  who  treat  patients  as 
individuals  with  thoughts,  feelings, 
and  needs  all  their  own?  Why  don't  we 
hear  more  about  these  nurses? 

We  cannot  blame  nursing  education 
for  the  poor  quality  of  nursing  care 


given  by  a  few  nurses.  After  all.  each 
nurse  is  an  individual  and  performs  in 
her  own  unique  fashion. 

On  the  gynecological  fioor  where  I 
work,  our  nursing  care  standards  ;ii 
high  and  our  patients  appreciate  it 
sincerely  believe  that  most  of  ioda\ 
nurses  are  professionals  who  have 
grave  sense  of  responsibility. 

We  are  not  perfect  by  any  means,  bin 
neither  are  we  the  uncaring. 
procedure-oriented  individuals  as  pre- 
sented by  Creelman.  As  far  as  1  am 
concerned,  patients  are  people.  — 
Linda  D.  Silhurt.  B.Sc.N..  RN.  Toronto 
Ontario. 


Feed  the  world's  starving  people 

I  was  amazed  to  read  the  letter  to  ih, 
editor    written    by    Maureen    Murph 
(April  1975.  p.  4)  in  which  she  write 
against  the  January  1975  editorial  o; 
helping  the  world's  starving  people. 

I  do  not  have  my  B.Sc.  N.  or  M.Sc.  \ 
degree.  My  only  credentials  are  my  R\ 
plus  whatever  common  sense  I  have  i 
have  not  acquired  in  19  years  of  nui^ 
ing. 

When  I  was  a  student,  we  were  told 
simply,  but  emphatically,  that  ""the  pa- 
tient comes  first."  As  we  became  more 
""vocabulary  oriented."  that  creed  wa^ 
replaced  by  the  term  ""patient-cen 
tered  care."  which  of  course  meant  the 
same  thing.  Now  the  emphasis  ha^ 
shifted  somewhat  to  the  newly  popuhn 
slogan,  ""problem  solving." 

Picture,  if  you  will,  the  contempoi 
ary  nurse  as  team  leader,  closeted  in  the 
conference  room  with  her  team  mem 
bers,  formulating  a  nursing  care  plan 
for  a  new  patient.  "Mr.  Third  World  ' 
Much    intellectual    inpul    would    he 
forthcoming,    and    much    long-rant' 
problem  solving  would  be  discusscii 
Social  services  would  be  called  in  toai 
in  the  patient's  rehabilitation  into  soei 
ety  after  recovery. 

Meanwhile,   the   patient,   who   ha- 
been  lying  unattended  all  this  time  r 
the  emergency  room,  dies  of  star\.i 
tion. 

This  sounds  ridiculous.  But  it  is  ex- 
actly what  Murphy  suggests  we  do  — 
on  an  international  scale. 

Nurses  seem  to  be  getting  more  aih 
more  intellectual,  and  less  and  less  em 


pathetic.  What  is  happening  to  our 
profession?  —  Valerie  Morsette.  RS. 
Thunder  Ba\.  Ontario. 


It  was  with  utter  disbelief  that  I  read 
letter  after  letter  from  "Angels  of 
MercN  '■  all  over  the  country,  urging  us 
to  be  sophisticated  about  the  subject  of 
starvation.  (See  "letters, ""  April  1975, 
p.  4.)  As  long  as  we  can  rationalize,  in 
well-turned  phrases  and  platitudes,  our 
reasons  for  ignoring  the  subject,  then 
maybe  the  problem  will  stay  away  over 
there  and  leave  us  alone. 

But  is  this  logical  thinking.'  Do  we, 
for  one  moment,  believe  that  the  starv- 
ing multitudes  do  not  know  about  the 
good  life  we  enjoy  and  defend  so  gal- 
lantly.' It  seems  to  me  that  the  best 
defense  we  can  possibly  have  is  to  ex- 
tend a  hand  of  friendship  to  these  peo- 
ple in  their  own  lands  before  they,  by 
the  sheer  force  of  their  numbers  and 
frustration,  overflow  into  ours. 

Are  we  going  to  withhold  what  help 
we  can  give  because  no  one  can  come 
up  with  a  sweeping,  all-embracing  sol- 
ution? There  is  no  simple  solution!  The 
only  hope  we  have  for  a  solution  lies 
with  dedicated  and  concerned  persons 
who  work  for  our  agencies  in  desolate 
places. 

While  visiting  a  CARE-sponsored 
hospital  in  Kabul.  Afghanistan,  two 
years  ago.  I  was  overwhelmed  by  the 
immensity  of  the  problems  facing  a  de- 
dicated staff  of  Canadian  doctors  and 
nurses,  l'nicef  was  there  too.  and  the 
Peace  Corps  kids  were  out  in  the  vil- 
lages doing  what  they  could  with  their 
limited  resources.  Many  agencies  from 
many  countries  were  evident  every- 
where, and  only  because  the  need  was 
so  critical  would  these  proud  people 
accept  the  services  offered.  Kabul  is 
typical  of  many  Asian  cities,  where  the 
operating  agencies  typify  the  warmth 
and  concern  of  the  countries  sponsoring 
them;  therein  lies  our  hope  for  some 
sanity  and  peace  in  the  world. 

We  can  suggest,  in  all  sincerity,  any 
number  of  long-term  solutions,  but 
God  help  us  if  we  ignore  the  fact  that 
this  is  a  crisis,  aggravated  by  the  shift- 
ing of  the  monsoons  out  into  the  Indian 
Ocean,  leaving  behind  a  parched  and 
(Continued  on  page  6) 


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I  THE  CANADIAN  NURSE  —  July  1 975 


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contamination. 

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s 


HOLLISTER 

332  Consumers  fld     WiHowdale,  Ont    M2J  1P 


letters 

(Continued  from  page  5) 


unproductive  land.  We  are  not  going  to 
educate  a  person  who  is  barely  alive. 
Let  us  do  what  we  can,  each  in  her 
own  way,  and  let  us  pray  it  will  be 
enough  to  sustain  us  in  our  own  dark 
moments.  —  Helen  Strang,  Delta, 
British  Columbia. 


Regrets  change  in  nursing  education 

Having  worked  in  many  medical  in- 
stitutions across  Canada  during  the  past 
10  years  or  so,  I  have  witnes.sed  the 
great  change  of  nursing  training  and 
education.  I  must  admit  something  ex- 
tremely important  has  been  taken 
away. 

I  am  by  no  means  an  authority  on  the 
quality  of  education  received  by  nurses 
today,  nor  am  1  about  to  comment  on 
the  merits  and  demerits  of  the  3-year, 
compared  to  the  2-year  program. 

With  the  nursing  students  being 
taken  away  from  residence  living,  1  be- 
lieve a  vital  experience  has  been  elimi- 
nated from  the  overall  training.  One  no 
longer  feels  the  strong  bond  that  was 
once  so  evident  in  schools  of  nursing. 

I  recall  the  time  when,  after  every 
shift,  you  could  see  the  students  in 
groups  as  they  returned  to  residence, 
discussing  the  day's  trials  and  tribula- 
tions. Some  were  laughing,  some  were 
in  tears;  however,  they  were  colleagues 
who  had  had  similar  experiences  and 
who  felt  the  same  joys  and  sorrows. 
They  gave  each  other  a  little  moral  sup- 
port, and  were  always  ready  to  plan  the 
evening  festivities  together. 

When  speaking  with  student  nurses 
today,  I  find  that  there  doesn't  appear  to 
be  the  same  fraternal  closeness,  and 
nursing  is  discussed  indirectly  rather 
than  with  a  real  purpose.  Undoubtedly 
this  has  resulted  in  merely  a  job  at  the 
end  of  training,  and  not  the  profession  it 
once  was.  — T.  Ruhlman,  Edmonton, 
Alberta. 


Two-year  vs.  three-year  programs 

I  am  writing  to  elaborate  on  the  letters 
by  B .  Donaldson  ( Jan  uary  1 975 )  and  C . 
Rathwell  ( April  1 975)  that  deal  with  the 
3-year  versus  the  2-year  nursing  pro- 
gram. Donaldson  appears  to  be  en- 
thusiastic about  the  2-year  program, 
whereas  Rathwell  lakes  the  opposite 
stand  by  condemning  the  2-year  pro- 
gram ahogether.  This  is  too  arbitrary  a 
position  for  either  to  take.  There  are 
pros  and  cons  to  be  considered  in  rela- 
tionship to  both  programs. 

On  the  one  hand,  the  emphasis  in  the 


3-year  program  is  on  clinical  practiec 
As  Rathwell  states,  "there  is  no  i. 
placement  for  practical  experience 
True,  but  experience  without  under 
standing  results  in  a  technician  only  - 
a  good  technician,  no  doubt  —  bui 
nonetheless,  a  technician. 

On  the  other  hand,  the  emphasis  in 
the  2-year  program  shifts  to  the  theorei 
ical  (as  Donaldson  si'\u's.  "the  "whv 
of  action,  not  merely  the  "hows'  '  i 
Also  true,  but  in  this  case  the  result  is  ;i 
person  filled  with  textbook  theoriev 
but  little  experience  to  back  it  up. 

In  both  cases  1  have  overstated  .i 
generalization  to  stress  the  extremes  ol 
both.  I  agree  with  Donaldson  that  the 
role-of  the  instructor  is  vital  in  influenc- 
ing the  attitudes  of  future  graduates. 
But  Rathwell's  statement,  that  many 
2-year  graduates  do  not  feel  competent . 
is  no  less  valid.  Yet,  how  secure  docs 
anyone  feel  when  initially  embark  in  l: 
on  a  new  career? 

I  am  a  2-year  graduate.  Although  I 
wish  that  1  had  had  more  clinical  c\ 
perience,  I  did  do  some  of  those  thiny-- 
Ihat  Rathwell  stales  2-year  graduates  d.  i 
not  do.  such  as  catheterizations,  sue 
tioning  of  tracheotomies,  giving  injec 
lions,  and  so  on. 

I  am  well  aware  of  the  drawbacks  to 
the  2-year  program,  but  that  does  noi 
prevent  me  from  learning;  rather,  it  en 
courages  me  to  seek  out.  learn  about. 
and  do  those  things  that  1  know  1  need 
more  experience  in  doing.  I  was  fortu- 
nate that  my  instructors  (both  theoreti- 
cal and  clinical)  were  well  qualified 
academically,  were  enthusiastic,  and. 
in  my  opinion,  good  nurses.  — Ellen 
Corbett,  RN,  Don  Mills.  Ont. 

Information  needed 

We  are  attempting  to  locate  names  and 
current  addresses  of  the  1970  graduat- 
ing class  of  the  Saskatchewan  Institute 
of  Applied  Arts  and  Sciences,  as  wc 
wish  to  compile  a  newsletter,  and  arc 
considering  holding  a  5-year  reunion. 
We  ask  graduates  to  write  and  tell  us 
where  they  have  been  working  for  the 
past  5  years,  if  they  are  married,  have  a 
family,  and  so  on.  Also,  we'd  like  to 
know  the  graduates'  present  emplo\ 
ment. 

Please  reply  by  15  July  to:  Brenda 
Hartley,  Box  245,  Briercrest,  Sask.^^ 


news 


700  Quebec  Management  Nurses 
Plan  Further  Work  Stoppages 

Montreal.  Que.  —  In  May  and  June,  700  managemeni  nurses  of  30  hospitals  in 
Montreal,  Sherbrooice,  Victoriaville.  and  Quebec  City  held  short  work  stoppages. 
These  were  a  protest  against  the  Quebec  governments  refusal  to  disclose  salary 
scales  after  its  annoucement  of  a  new  rating  system  for  hospital  management.  If  the 
situation  is  not  clarified,  they  plan  further  walkouts  in  the  fall. 


Joan  Porcheron,  director  of  the  Uni- 
ted Management  Nurses,  Inc.,  Mon- 
treal, said  that  the  association  mem- 
bers, ranging  from  head  nurse  to  assis- 
tant nursing  director,  had  had  no  pre- 
cise respon.se  to  their  demands  for  dis- 
closure. They  want  to  see  the  dollar 
sign,  she  said.  There  have  been  four 
meetings  this  year  with  the  Ministry  of 
Social  Affairs,  which  has  been  stu- 
dying the  classification  system  for  the 
past  2  years.  Management  nurses  insist 
on  knowing  exact  salary  scales  before 
accepting  the  new  rating  scheme  be- 


cause, according  to  Porcheron,  the  sys- 
tem rpay  mean  declassification,  with  a 
decrease  in  salary  for  some  of  the  700 
nurses  concerned.  "We  have  agreed  to 
continue  our  fight  if  the  figures  given  us 
are  not  satisfactory,"  she  said. 

Now,  head  nurses  and  supervisors 
often  earn  less  than  unionized  nurses 
working  forthem,  she  said.  Inaddition, 
management  nurses  are  not  eligible  for 
study  leaves  or  grants  nor  for  overtime 
pay ,  and  do  not  get  paid  for  unused  sick 
leave,  as  is  the  case  for  other  nursing 
staff. 


CNA  President  Joins  "Kilometres  For  Millions" 


Huguette  Labelle,  president  of  the  Canadian  Nurses'  Association,  was  one  of  a 
few  celebrities  chosen  to  walk  between  various  checkpoints  in  Ottawa's  recent 
"miles  for  millions"  marathon.  She  is  shown  here  passing  the  "torch"  to  another 
celebrity,  skater  Lynn  Nightingale.  Labelle,  who  represented  the  nurses  of  Canada 
in  the  walk,  said  that  she  was  impres.sed  with  the  community  spirit  displayed  by  the 
marchers.  "It  gave  people  an  opportunity  to  participate  in  something  worth- 
while," she  said,  "and  there  was  a  real  feeling  of  community  cohesiveness." 


Federal  Nurses  Accept' 
Conciliation  Board  Report 

Ottawa  —  Federally  employed  nurses 
have  voted  by  a  narrow  margin  to  ac- 
cept the  report  of  the  conciliation 
board,  which  recommends  that  the  nur- 
ses have  wage  parity  with  their  provin- 
cial counterparts.  The  conciliation 
board  was  appointed  after  negotiations 
with  the  Treasury  Board  for  the  1975- 
76  contract  became  deadlocked  in  De- 
cember 1974.  (News,  March  1975, 
page  10.) 

Eighty-two  percent  of  the  1,750  fe- 
deral employees  in  the  nursing  group 
voted;  the  results  are,  therefore,  bin- 
ding. Study  of  the  results  indicates  that 
nurses  were  divided  in  their  opinions 
according  to  the  region  in  which  they 
work.  In  the  Atlantic  region  and  in 
Quebec,  Ontario  and  Manitoba,  the 
majority  favored  acceptance  of  the  re- 
port; nurses  in  Saskatchewan,  Alberta, 
and  the  Northwest  Territories  voted  to 
reject  the  proposal. 

The  margin  was  so  narrow  that  a 
spokesman  for  the  Professional  Insti- 
tute of  the  Public  Service  of  Canada, 
bargaining  agent  for  the  nurses,  stated: 
"All  the  nurses  were  more  or  less  in 
favor  of  the  report,  but  it  was  the  deci- 
sion of  the  majority  that  settled  the 
question." 

Several  questions  remain  to  be  set- 
tled before  the  contract  is  signed,  in- 
cluding the  fate  of  the  20  nurses  em- 
ployed at  the  National  Defence  Medical 
Centre  in  Ottawa,  who  were  not  reins- 
tated in  their  positions  at  the  conclusion 
of  a  one-day  legal  walkout  on  the 
seventh  of  May  1975. 


VON  To  Strengthen 
Services  To  Older  Persons 

Ottawa.  Out.  —  "From  the  national 
level,  spetnal  attention  [  will  |  be  di- 
rected to  assisting  branches  in 
strengthening  and  expanding  present 
programs  and  initiating  new  programs 
for  older  persons,"  Ada  McEwen,  na- 
tional director  of  the  Victorian  Order  of 
Nurses  for  Canada,  said  in  her  annual 
report. 

She  spoke  to  the  77th  annual  meeting 
(Continued  on  page  8) 


THE  CANADIAN  NURSE  —July  1975 


nevus 


(Continued  from  page  7) 


of  the  VON,  which  was  held  at  the 
Chateau  Laurier  Hotel,  Ottawa,  on  8 
and  9  May  1975.  "von  nurses  see  pa- 
tients in  all  age  groups,  but  older  pa- 
tients are  in  the  majority,"  McEwen 
said. 

In  a  panel  discussion  on  "Our  Pres- 
ent Challenge  —  New  Programs."  4 
VON  nurses  told  about  innovative  pro- 


grams in  which  they  are  involved. 

Mary  Ellen  Thompson,  district  di- 
rector of  the  Regina  voN,  said, 
"Problem-oriented  recording,  or- 
ganized around  health  problems,  offers 
a  framework  for  nursing  care  and  for 
continuity  of  care. 

"Nurses"  notes  should  be  not  merely 
observations  on  medical  therapy;  they 


Get  what  you've 

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from  nursing 


Like  a  wealth  of  professional  experience 
to  enrich  your  career. 


Nursing  has  a  lot  to  offer  Remember? 
But  sometimes  you  can  get  so  stuck  in 
a  rut  you  almost  forget  those  exciting 
challenges  that  made  you  choose  a 
nursing  career  in  the  first  place 

With  Medox.  you  can  revive  those 
challenges. 

Since  Medox  serves  almost  the 
entire  spectrum  of  nursing  services, 
you  can  get  more  variety  of 


assignments  in  a  month  than  you 
could  in  a  year  back  in  that 
comfortable  rut  Operating  room 
Intensive  Care.  Cardiac  Unit  Pediatric 
care. 

There's  more  to  nursing  than 
punching  a  time  clock. 

With  Medox,  there  can  be  a  lot 
more. 


r. 


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should  tell  problems  and  solutions.  Th 
VON  is  pioneering  in  adaptin 
problem-oriented  recording  to  con 
munity  health  nursing." 

Ruth    Milne,    a    member    of    th 
Hamilton-Dundas  branch  of  vON  is  a 
nurse  practitioner  working  with  a  group 
of  5  family  physicians,  4  family  nurv 
practitioners,    and    a    social    workci 
Milne  said,  "The  more  closely  1  work 
with  other  disciplines,  the  more  1  have 
to  define  the  nursing  role. 

"An  assessment  of  health  problem^ 
leads  to  nursing  interventions.  The 
most  accurate  way  to  assess  whethci 
the  patient's  needs  are  met  is  to  ask 
him,"  she  said. 

During  a  "bear  pit"  discussion  of 
"What  should  we  be  doing?."  the 
place  of  the  Victorian  Order  of  Nurses 
as  a  voluntary  agency  or  a  tax-funded 
organization  was  debated.  Joan 
Gilchrist,  director  of  the  McGill  Uni 
versity  school  of  nursing  and 
president-elect  of  cna,  said,  "von  can 
negotiate  a  service  role  for  itself.  The 
work  you  are  doing  will  not  disappear 
Who  is  better  able  to  do  it? 

"VON  must  become  an  integral  pari 
of  the  system,  with  an  independent  role 
of  working  with  families  over  a  period 
of  time  to  improve  and  maintain  health. 
Your  autonomy  and  innovations  are  cs 
sential;   voN    must    be   responsive   t 
needs  identified  by  the  family  and  h 
VON,"  she  said. 

Nicholas  Steinmetz,  director  of  faiii 

a  medicine  at  Children's  Hospital, 
ontreal,  and  president  of  the  board  ol 
the  Montreal  voN,  said,  "The  volun 
tary  agency  ought  not  to  fit  in.  von  has 
become  too  respectable,  too  estab- 
lished. For  a  voluntary  agency  to  re- 
main viable,  it  should  remain  radical." 

Thomas  Boudreau,  assistant  deput> 
minister  (long-range  planning).  Health 
and  Welfare  Canada,  said:  "In  creatinij 
a  huge  sickness  care  system,  we  ha\ 
created  a  huge  sickness  clientele  whi 
have  been  trained  to  leave  the  othei 
systems  in  which  they  operate  —  labiM 
family,  education,  and  so  on  —  and  i 
enter  the  sickness  system,  which  is  eas 
to  administer. 

"When  we  think  about  reaching  well 
people,  we  have  to  reach  them  inside 
these  other  systems.  We  who  have  a 
preoccupation  with  health  have  to  pei 
suade  huge,  stable,  inert  bureaucracie 
to  consider  the  health  variable,"  he 
said. 

"VON  has  a  foot  in  other  system- 
They  have  knowledge  of  life-style  an 
environmental  problems  and  know  hi>' 


to  approach  them.  voN  should  take  the 
opportunity  it  has  to  enter  the  real  world 
and  gather  information  about  the  rela- 
tion of  health  status  to  life-style  and 
environment.""  Boudreau  said. 

Margaret  Mackling,  district  director 
of  Winnipeg  vON.  said  the  von"s  ener- 
gies should  be  directed  toward  helping 
individuals  learn  about  health  and 
healthful  living  "We  should  give  more 
individual  authority  to  nurses:  they 
should  be  accountable  to  the  family, 
rather  than  to  an  organization."  she 
said. 

Dr.  Steinmetz  said  that  the  title 
"Victorian  Order  of  Nurses"'  tethers 
the  organization  to  an  anachronistic 
concept.  "The  name  ought  to  be 
changed.""  he  said.  "This  is  not  a 
frivolous  notion.  The  old  name  served  a 
social  purpose.  \'ON  needs  a  new  name 
to  free  up  new  avenues  of  service."" 

A  member  of  the  meeting  suggested 
from  the  floor  that  the  new  name  should 
be  "Victorian  Order  of  Nurturists."" 

Mackling  said:  "We  go  when  we  are 
called  in  illness.  Why  can"t  the  v  on 
nur.se  knock  on  the  door  and  introduce 
herself  as  providing  health  care?  We 
have  done  a  great  job  of  selling  illness. 
Why  not  sell  heahh?"" 

Dr.  Steinmetz  agreed  and  suggested 
that  from  V0N"s  present  expertise,  it 
could  develop  a  health  visitor  role, 
going  on  to  become  a  " "community 
health  issues  activator."" 

The  chairman  of  the  bear  pit  discus- 
sion said  that  voN  has  many  different 
roles,  which  may  be  one  of  its  weak- 
nesses, but  is  also  a  strength. 

Alice  Girard.  Montreal,  is  president 
of  the  Victorian  Order  of  Nurses  for 
Canada.  The  1976  annual  meeting  of 
the  VON  will  be  held  in  Halifax,  N.S.. 
on  3  and  4  June  1976. 


Nurse  Manpower  Comm. 
Proposes  4  Strategies 

Frederkton,  N.B.  —  The  provincial 
Committee  on  Nursing  Manpower,  es- 
tablished in  the  Fall  1974,  has  iden- 
tified 4  strategies  to  help  avert  seasonal 
staffing  problems  in  New  Brunswick 
hospitals.  The  committee  recently 
submitted  its  report  to  provincial 
Health  Minister  G.N. W.  Cockburn. 

The  committee  was  established  by 
the  Minister  of  Health  in  response  to 
summer  staffing  problems  experienced 
by  several  N  B  hospitals.  (News,  Feb- 
ruary 1975,  p.  10).  The  4  strategies 
proposed  by  the  committee  are:  in- 
crease the  supply  of  nurses,  provide 


All  That  Sun  And  No  Income  Tax! 


The  300-bed  King  Edward  Vll  Hospital  in  Bermuda  has  20  Canadian  nurses  on  its 
staff.  Nursing  administrators  expect  applications  to  pour  in,  because  Bermudian 
pay  has  returned  to  a  par  with  Canadian  pay  scales,  after  a  2-year  slump.  There  is 
no  income  tax  paid  on  salaries  in  Bermuda.  Canadian  nurses  pictured  in  the  King 
Edward  Hospital  resuscitation  room  are,  left  to  right,  Karen  McLean,  Edmonton; 
Pal  Lenihan,  Ottawa:  Kathleen  Klaehn.  Waterloo;  Martha  Murray,  Toronto. 


incentives  to  keep  nurses  working  dur- 
ing the  summer  months,  improve  pro- 
ductivity and  use  of  nurses,  and  reauce 
the  number  of  hospital  services. 

The  Nursing  Manpower  Committee 
recommended  that: 

•  the  Department  of  Health  establish  a 
system  for  collecting  data  on  vacan- 
cies, recruitment,  and  terminations; 

•  foreign  trained  nurses  not  be  re- 
cruited on  a  part-time  basis  to  fill  sum- 
mer vacancies; 

#the  Department  of  Health,  New 
Brunswick  Association  of  Registered 
Nurses  (NBarn),  and  Canada  Man- 
power determine  locations,  schedules, 
and  financing  of  reorientation  prog- 
rams for  nurses  interested  in  returning 
to  work; 

•  hospitals  make  an  immediate  start  on 
vacation  scheduling; 

•  hospitals  develop  flexible  staffing 
patterns  suited  to  the  needs  of  the  non- 
practicing  nurse; 

•  hospitals  work  with  the  Unemploy- 
ment Insurance  Commission  to  control 
the  abuse  of  unemployment  insurance 
benefits; 

•  hospitals  make  maximum  use  of 
summer  relief  in  all  health  manpower 
categories; 

•  hospitals  plan  well  in  advance  for  re- 


ductions in  services,  and  inform  the 
public  of  the  need  for  such  action:  and 
•  a  steering  committee  be  established 
to  coordinate  the  program  for  averting 
the  anticipated  seasonal  shortage. 

According  to  the  report,  a  concerted 
province-wide  effort  to  tackle  the 
short-term  nurse  shortage  problems 
must  be  undertaken  before  it  becomes 
critical.  "The  residents  of  the  pro- 
vince, by  being  better  informed,  should 
understand  that  any  inconveniences 
caused  by  staffing  problems  will  only 
be  short  term,  that  quality  of  care  will 
not  suffer,  and  that  their  own  judicious 
use  of  the  care  facilities  available  can, 
in  itself,  help  to  improve  the  situa- 
tion,"" the  report  says. 

The  report  indicates  that,  in  1971, 
there  was  1  nurse  for  every  187  resi- 
dents in  the  province,  which  corres- 
ponds exactly  with  the  situation  in 
Canada  as  a  whole.  Based  on  the  in- 
crease in  the  number  of  registered 
nurses  in  1972  and  1973,  this  relative 
position,  compared  to  all  of  Canda,  has 
been  maintained  or  possibly  improved. 

However,  over  the  same  period, 
there  has  been  a  sharp  increase  in  the 
use  of  emergency  facilities,  and  a  de- 
cline in  the  numbers  of  student  nurses 
(Continued  on  page  10) 


THE  CANADIAN  NURSE  —  July  1975 


news 


(Continued  from  page  9) 


in  service  in  hospitals.  The  combined 
effect  of  these  events  is  that  the  number 
of  nurses  providing  care  to  patients  in 
hospital  remained  constant  over  the  last 
2  or  3  years,  while  the  demand  for 
nurses  in  hospitals  has  increased  as  a 
result  of  a  provincial  trend  toward  more 
specialized  nursing  units  for  coronary 
care,  burns,  and  newborn  care. 

Members  of  the  Nursing  Manpower 
Committee  are:  Myrna  Sherrard,  RN, 
chairperson;  Claudette  Redstone,  RN; 
Eva  O'Connor,  RN;  Lorraine  Mills,  RN; 
Gail  Dennison.  RN;  Inez  Smith,  RNa; 
Dr.  T.L.  Creamer;  and  Dr.  Carl  Trask. 
Bryan  Ferguson,  director  of  Research 
and  Planning,  Department  of  Health,  is 
secretary  to  the  committee. 

The  second  phase  of  the  committee's 
task,  an  analysis  of  the  longer-term  re- 
quirement for  nurses  in  N.B.,  is  now 
under  way. 


Inservice  Coordinators 
From  N.S.  Hospitals  Meet 

Halifax.  N.S.  —  Inservice  coordinators 
from  hospitals  throughout  Nova  Scotia 
met  together  at  RNA  House  in  Halifax 
recently  at  a  conference  sponsored  by 
the  Registered  Nurses'  Association  of 
Nova  Scotia  (rnans)  and  the  Nova 
Scotia  Health  Services  and  Insurance 
Commission. 

"The  main  objective  of  the  confer- 
ence —  to  provide  an  opportunity  for 
coordinators  to  share  ideas  about  hospi- 
tal inservice  programs  with  a  view  to 
extending  and  improving  the  services 
that  are  now  available  —  appears  to 
have  been  reasonably  well  achieved 
through  the  various  discussions  in 
which  the  participants  involved  them- 
selves," said  Tom  Jones.  Jones,  who  is 
acting  director  of  adult  education,  N  S.. 
Department  of  Education,  acted  as  re- 
source person  at  the  conference. 

"More  specifically,  two  main  points 
in  relation  to  job  scope  seemed  to  be  the 
focus  of  discussion  and  conclusion," 
said  Jones.  "They  were:  the  coor- 
dinator should  function,  in  terms  of 
programming,  with  all  categories  of 
hospital  staff,  at  the  same  time  retain- 
ing a  separate  professional  identity;  and 
program  activities  should  include  both 
general  topics  of  concern  to  all  staff 
involved  in  patient  care  and  topics 
specific  to  the  inservice  needs  of  indi- 
vidual staff  groups." 

In  discussion  of  the  role  of  the  coor- 
dinator, 3  major  points  were  made:  that 
a  clear  distinction  should  be  made  be- 


tween the  coordination  of  inservice 
programs  and  personal  involvement  in 
the  provision  of  such  services,  as  far  as 
the  coordinator  is  concerned;  that  prog- 
rams designed  by  the  coordinator  must 
reflect  both  institutional  needs  and  in- 
dividual needs  of  staff  for  development 
opportunities;  and  that  the  role  of  the 
coordinator  must  be  seen  as  a  clearly 
defined  .set  of  functions  requiring  train- 
ing and  experience  in  program  design 
and  evaluation,  group  skills,  counsel- 
ing, management  skills,  and  health  ser- 
vices operations.  The  coordinator's 
role  should  not  be  diluted  by  combining 
it  with  other  functions  in  the  hospital. 
Three  further  points  came  out  of  a 
discussion  on  resources.  These  were: 

•  resources  external  to  the  hospital  are 
not  generally  exploited,  such  as  the 
services  of  government  agencies, 
community  organizations,  special  insti- 
tutes, foundations,  and  the  sharing  of 
programs; 

•  hospitals  generally  are  not  geared  for 
inservice  programs,  in  terms  of  space 
and  facilities,  and  provision  should  be 
made  for  sharing  resources  between 
hospitals,  and  for  ensuring  compatibil- 
ity of  equipment  in  the  interests  of 
economy  and  the  sharing  of  programs; 
and 

•  the  coordinator  should  have  an  input 
to  budget  preparation  to  supplement 
both  internal  and  external  resources. 


Male  Nurses  Demand  Quota 
Of  Men  In  Nursing  Schools 

Saginaw.  Mich.  —  At  their  first  na- 
tional conference,  male  nurses  from  the 
United  States  supported  a  resolution 
asking  that  nursing  schools  establish  a 
quota  of  men  students  to  be  admitted, 
as  has  been  done  for  women  students  in 
programs  of  predominantly  male  pro- 
fessions. The  conference  was  held  3 
May  1975  in  Bay  City,  Michigan. 

Male  nurses  from  Quebec  and  On- 
tario attended  the  conference,  Dennis 
Martin  told  The  Canadian  Nurse.  Mar- 
tin is  secretary  of  the  Michigan  Male 


St  John  Ambulance 

needs  Registered  Nurses  to  volun 
teer  their  services  to  teach  Patient 
Care  in  The  Home.  Will  you  help^ 


Nurses'  Association,  which  hosted  the 
conference.  Some  430  men  attended 
the  meeting,  according  to  Martin;  they 
came  from  Alabama  to  the  south, 
Maryland  to  the  east,  and  Wisconsin  to 
the  west. 

Conference  attenders  gave  unanim- 
ous approval  to  the  resolution  request- 
ing official  minority  status  for  men  in 
nursing.  The  resolution  pointed  out  that 
the  U.S.  has  a  national  Affirmative  Ac- 
tion Program  to  democratize  profes- 
sions consisting  of  a  majority  of  men, 
and  that  the  program  has  had  a  signific- 
ant effect. 

The  resolution  asks,  in  part:  "That 
each  school  or  college  of  nursing  in  this 
country  establish  an  Affirmative  Ac- 
tion Program  to  recruit  men  students  in 
numbers  adequate  to  reflect  the  na- 
tional proportion  of  men  in  the  popula- 
tion." It  also  asks  that  nursing  educa- 
tional institutions  recruit  and  retain 
male  faculty  members  in  numbers  re- 
flective of  the  national  proportion  of 
men. 

Finally,  the  resolution  asks  that  the 
U.S.  federal  government,  through  the 
Department  of  Health,  Education  and 
Welfare,  "establish  an  enforcement 
program  to  ensure  compliance  on  the 
part  of  the  nursing  profession  with  the 
word  and  spirit  of  the  laws  of  the  land." 

During  the  conference,  Dr.  Luther 
Christman  received  an  award  as  the 
"Number  One  Male  Nurse  in  the  Na- 
tion." Christman  is  professor  and  dean 
of  nursing  at  Rush  University's  College 
of  Nursing  and  Allied  Health  Sciences, 
and  vice-president  of  nursing  affairs  at 
Rush-Presbyterian-St.  Luke's  Medical 
Center  in  Chicago,  III. 

A  national  association  of  men  nurses 
will  be  formed  in  the  U.S.,  according  to 
the  conference,  after  state  chapters 
have  been  organized.  At  present,  the 
Michigan  association  is  the  only  state 
association  that  has  been  organized. 

According  to  Martin,  Canadian  male 
nurses  can  be  honorary  members  of  the 
Michigan  association  and,  thus,  are 
eligible  to  be  members  of  the  U.S. 
association  when  it  is  established. 


Flying  Nurses  Organize 
International  Association 

Kansas  City,  Missouri  —  The  Interna- 
tional Flying  Nurses  Association  held 
its  first  meeting  at  the  Holiday  Inn. 
Kansas  City,  26-28  April  1975.  Ni.-.e 
prospective  members  attended  the 
2-day  conference. 


Two  registered  nurses  who  were  in- 
terested in  flying  had  the  idea  in 
November  1973  of  organizing  nurses 
who  shared  the  same  interest.  They 
wanted  to  exchange  ideas,  problems, 
and  experiences  with  other  "flying 
nurses."' 

The  association's  purpose  is  to  en- 
courage and  promote  mutual  exchange 
of  ideas,  problems  and  experiences 
among  its  members;  to  promote  safe 
flying  through  education;  to  combine 
nursing  and  flying  to  be  of  service  to  the 
community;  and  to  engage  in  activities 
to  promote  the  objectives. 

Any  RN  or  LPN  holding  a  pilot's  li- 
cence or  taking  flying  lessons  and  wish- 
ing more  information  about  this  associ- 
ation should  contact:  Frances  Oliver, 
2531  Briarcliffe  Road,  N.E.,  Suite 
211,  Atlanta,  Georgia  30329,  U.S.A. 


Surgery  Plus  Chemotherapy 
Better  For  Breast  Cancer 

Chicago,  III.  —  Surgery  alone  is  inade- 
quate to  bring  about  a  "permanent, 
tumor- free  state"  in  most  breast  cancer 
patients,  according  to  a  clinical  study 
published  in  the  April  1975  issue  of 
Surgery,  Gynecology  &  Obstetrics,  the 
official  scientific  journal  of  the  Ameri- 
can College  of  Surgeons. 

The  study,  conducted  over  a  10-year 
period,  found  that  chemotherapy,  ad- 
ministered immediately  after  surgery, 
can  be  significant  in  enhancing  the 
disease- free  state  as  well  as  the  survival 
rate  of  some  patients. 

The  study  group  gathered  data  on 
826  women  who  received  either  a 
placebo  or  a  chemotherapeutic  agent, 
thiotepa  (triethylene  thiophos- 
phoramide),  immediately  following 
mastectomy.  They  found  that  there  was 
an  "inadequacy  of  standard  operative 
therapy  in  effecting  a  permanent 
tumor-free  state  in  a  majority  of  pa- 
tients." They  considered  it  "particu- 
larly distressing"  that  76  percent  of  all 
patients  with  positive  axillary  nodes 
had  a  recurrence  of  the  disease  by  10 
years,  and  that  only  24.9  percent  sur- 
vived. The  survival  rate  of  those  with 
one  to  three  positive  nodes  was  37.5 
percent,  and  only  13.4  percent,  if  four 
nodes  contained  cancer. 

"Also  disturbing  was  the  observa- 
tion that  one  of  four  patients  with  nega- 
tive axillary  nodes  displayed  treat- 
ment failure  by  10  years,"  the  authors 
report. 

Discussing       the        value       of 


chemotherapy  administered  after 
surgery,  the  authors  noted  that  in  pre- 
menopausal patients  who  had  the 
greatest  spread  of  cancer  —  four  posi- 
tive lymph  nodes  —  there  were  2 1  per- 
cent fewer  treatment  failures  and  a  21 
percent  longer  survival  in  those  who 
had  chemotherapy  than  in  those  pa- 
tients who  did  not  have  this  treatment. 
The  study  also  discredits  the  claim 
that  the  worth  of  an  alternate  treatment 
for  breast  cancer  can  be  ascertained 
only  by  a  period  of  observation  much 
longer  than  5  years.  The  authors  found 
that  80  percent  of  the  treatment  failures 
occurring  at  10  years  were  apparent  by 
5  years.  Eighty-six  percent  of  10-year 
treatment  failures  in  patients  with  posi- 
tive nodes  occurred  by  5-years;  in  pa- 
tients with  four  positive  nodes,  this  was 
true  in  92  percent  of  the  cases. 


Respiratory  Nursing  Awards 

Open  to  Canadian  Nurses 

New  York.  N.Y.  —  Nursing  fellow- 
ships for  graduate  study  in  respiratory 
disease  are  being  offered  by  the  Ameri- 
can Lung  Association.  The  awards  are 
limited  to  U.S.  and  Canadian  citizens 
or  holders  of  bona- fide  permanent  visas 
for  study  in  U.S.  institutions. 

Training  fellowships  directed  toward 
a  career  as  clinical  specialist,  teacher, 
or  researcher  in  the  care  of  patients  with 
respiratory  conditions  are  offered  to 
graduates  of  accredited  baccalaureate 
schools  of  nursing. 

The  fellowships  are  in  the  amount  of 
$6,000  per  year,  with  the  possibility  of 
one  renewal  for  a  maximum  of  2  years 
of  support. 

Completed  applications  must  be  re- 
ceived by  15  March  1976.  Address  in- 
quiries to:  Seigina  M.  Frik,  Director. 
ALA  Nursing  Department  at  National 
League  for  Nursing.  10  Columbus  Cir- 
cle, New  York.  NY  10019,  USA. 


Note 

The  authors  of  the  article  "Preop  Visits 
Expand  the  OR  Nurse's  Role"  (June 
1975,  pp.  27-30)  are  Wendy  S.  Dirksen 
and  Muriel  G.  Shewchuk.  Dirksen  is 
Assistant  Director  of  special  services. 
University  of  Alberta  Hospital.  Ed- 
monton, Alberta,  and  Shewchuk  is  In- 
service  Instructor  in  the  operating  room 
of  the  same  hospital. 


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THE  CANADIAN  NURSE  —  July  1975 


■      ■      ■ 


■     ■      ■ 


TO:  REEVES  CO.,  Box  TIM,  Attleboro,  Mass.  02703 


NAMEPINS:  Style  No. 


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dates 


August  17-18,  1975 

American  Academy  of  Medical  Adminis- 
trators 18th  annual  convocation  and 
meeting,  Continental  Plaza  Hotel, 
Chicago,  Illinois.  For  information  write: 
ACMA,  6  Beacon  Street,  Boston,  Mass., 
02108. 

August  18-20,  1975 

International  Association  for  enteros- 
tomal therapy  annual  meeting,  to  be 
held  at  the  Royal  York  Hotel,  Toronto. 
For  information,  write:  Dianne  E.  Garde 
E.T.,  chairperson,  1975  Conference 
lAET,  236  Tedwyn  Drive,  Mississauga, 
Ontario. 

August  21-23,  1975 

13th  annual  conference  of  United  Os- 
tomy Association,  Inc.,  to  be  held  at  the 
Royal  York  Hotel,  Toronto.  For  informa- 
tion, write:  Allan  M.  Porter,  conference 
chairperson.  Department  of  Labo- 
ratories, Hamilton  General  Hospital, 
Hamilton,  Ont.  L8L  2X2. 

September  1-3,  1975 

International  workshop-conference  on 
Atherosclerosis  at  University  of  Western 
Ontario,  London,  Ontario.  For  informa- 
tion, write:  Evelyn  McGloin,  Director  of 
Professional  Education,  Ontario  Health 
Foundation,  310  Davenport  Road, 
Toronto,  Ontario,  M5R  3K2. 

September  20-23,  1975 

Workshop  of  the  Professional  Health 
Workers  Section,  Canadian  Diabetic 
Association,  at  Banff  Centre,  Banff,  Al- 
berta. Theme:  Diabetes  —  1975  —  the 
team  approach.  For  information,  write: 
Olive  Gerrard,  330-9939  Jasper  Av- 
enue, Edmonton,  Alberta,  T4J  2X4. 

September  22-24,  1975 

Seminar  —  "Care  in  the  Home:  1975  a 
year  of  decision"  to  be  held  at  University 
of  Ottawa.  For  information,  write: 
Carolyn  Belzile,  Coordinator  Continuing 
Education  Program,  School  of  Health 
Administration,  University  of  Ottawa, 
Ottawa,  Ontario. 


September  24-26,  1975 

Institute  on  progressive  extended  care, 
Calgary  Inn,  Calgary.  For  information 
write:  Alberta  Hospital  Association, 
10025-1 08th  Street,  Edmonton,  Alta. 

September  29-October  3,  1975 

Third  annual  Childbirth  Education 
Workshop,  McMaster  University  Medi- 
cal Centre,  Hamilton,  Ontario.  For  in- 
formation, write:  School  of  Adult  Educa- 
tion, McMaster  University  Medical 
Centre,  1200  Main  St.  W.,  Room  4F2, 
Hamilton,  Ontario  L8S  4J9. 

October  1-3,  1975 

Interdisciplinary  Conference  on  Con- 
joint Emergency  Care  at  Four  Seasons 
Sheraton  Hotel,  Toronto,  Ontario. 
Sponsored  by  the  Emergency  Nurses' 
Association  of  Ontario.  For  information, 
write:  M.  Victoria  Eld,  Apt.  5,  65  Old  Mill 
Road,  Etobicoke,  Ontaho,  M8X  1G7. 

October  6-8,  1975 

Nurses'  Association  of  American  Col- 
lege of  Obstetrics  and  Gynecology  Dis- 
trict#1  Conference,  to  be  held  at  Queen 
Elizabeth  Hotel,  Montreal.  For  informa- 
tion, write:  Judith  Collins,  Secretary- 
Treasurer,  Quebec  Section,  NAACOG, 
4375  Royal  Avenue,  Montreal,  Que., 
H4A  2M7. 

October  6-8,  1975 

Annual  meeting  and  workshop  of  the 
Association  of  Remotivation  Therapists 
of  Canada  to  be  held  at  Cape  Breton 
Hospital,  Sydney,  N.S.  For  information, 
write:  Isobel  Williams,  Corresponding 
Secretary,  ARTC,  375  Church  Street, 
Beaconsfield,  Quebec,  H9W  3R3. 

October  7-9,  1975 

Maritime  Operating  Room  Nurses  Con- 
vention to  be  held  at  Hotel  Nova  Scotian, 
Halifax.  For  information,  write:  Mabel  de 
Varnes,  14  Melville  Avenue,  Armdale, 
Halifax,  N.S. 

October  9-10,  1975 

Seminar  on  emergency  care  of  surgical 


and  neurosurgical  trauma  in  Edmonton. 
Presented  by  the  Emergency  Depart- 
ment Nurses  Association  of  Alberta  and 
the  Canadian  Association  of  Neurologi- 
cal and  Neurosurgical  Nurses  (Alberta) 
For  information,  write:  Lasha  Zenko 
304-9730  —  156  Street,  or  Joan  Stuart, 
8437  —  1 18  Street,  Edmonton,  Alberta. 

October  15-17,  1975 

Ontario  Public  Health  Association  an- 
nual-meeting,  King  Edward  Sheraton 
Hotel,  Toronto.  For  information,  write: 
Kae  Sutherland,  OPHA,  Box  160 
Etobicoke,  Ontario,  M9C  2Y0. 

October  20-22,  1975 

Canadian  Conference  on  Medical  De- 
vices in  Health  Protection  to  be  held  in 
the  Government  Conference  Centre, 
Rideau  Street,  Ottawa,  Ontario.  For 
information,  write:  Jean  Anderson, 
Technical  Secretariat,  Health  Protection 
Branch,  Health  and  Welfare  Canada. 
Ottawa,  Ontario,  K1A  0L2. 

November  20-21,  1975 

Symposium  on  Nutritional  Disorders  of 
American  Women,  to  be  held  at  the 
Commodore  Hotel,  New  York  City 
Chairman:  Dr.  Myron  Winick,  director  of 
the  Institute  of  Human  Nutrition.  For  in- 
formation, write:  Director,  Institute  of 
Human  Nutrition,  Columbia  University. 
511  West  166th  Street,  New  York,  N.Y.. 
10032,  U.S.A. 

March23-27,  1976 

Association  for  the  Care  of  Children  in 
Hospitals  conference  to  be  held  at  Hilton 
Hotel,  Denver,  Colorado.  Theme:  Who 
works  for  children;  the  realities.  For  in- 
formation, write:  Cyndi  Lepley,  School  of 
Nursing,  University  of  Colorado  Medical 
Center,  4200  E.  9th  Avenue,  Denver, 
Colorado  80220,  U.S.A. 

June  21-23,  1976  | 

Canadian  Nurses'  Association  annual 
meeting  and  convention  to  be  held  at 
Hotel  Nova  Scotian,  Halifax,  Nova 
Scotia.  Theme:  The  Quality  of  Life.    -- 


in  a  capsule 


Wheelchair  hike  can  be  arranged 

Even  though  wheelchair-bound,  a  per- 
son can  have  a  hiking  holiday  in  the 
Swiss  Alps.  Sygeplejersken,  the  jour- 
nal of  the  Danish  Nurses'  Association, 
reports  that  Zurich  has  a  3-kilometer 
trail  esp)ecially  designed  for  wheel- 
chairs. 

Having  a  gradual  incline,  this  trail 
winds  through  a  secluded  and  beautiful 
forest  area  and  affords  many  breathtak- 
ing views  over  a  wide  expanse  of  alpine 
plateau.  At  eight  vantage  points  along 
the  way.  there  are  special  facilities  for 
the  handicapped. 

Wheelchairs  can  be  rented  on  site  at 
minimal  charge. 

Indiscriminate  use  of  IPPB 

Commenting  on  the  increased  use  of 
intermittent  positive  pressure  breathing 
(iPPB)  devices,  Drs.  Alvan  L.  Barach 
and  Maurice  S.  Segal  write  that  IPPB 
therapy  is  often  unnecessary  (JAMA  17 
March  1975). 

For  example,  the  two  doctors  report 
that  many  patients  scheduled  for 
surgery  are  given  IPPB  treatments  be- 
fore and  after,  with  the  theoretical  aim 
of  preventing  postoperative  pulmonary 
atelectasis.  However,  in  at  least  one 
study  cited  by  Drs.  Barach  and  Segal, 
the  incidence  of  postoperative 
pneumonia  or  atelectasis  was  not  al- 
tered by  IPPB  in  cases  of  routine  abdom- 
inal or  thoracic  operations.  It  is  likely, 
the  doctors  surmise,  that  deliberate 
voluntary  expansion  of  the  lungs  is  of  a 
value  similar  to  IPPB  in  preventing  post- 
operative problems. 

"The  prolonged  use  of  ippb  after  op- 
eration does  not  appear  to  be  justified  in 
view  of  the  fact  that  deep  breathing 
methods  can  be  used  by  convalescent 
patients," ■  the  MDs  state. 


Early  diagnosis  of  CVA 

A  new  method  of  diagnosis  that  allows 
an  impending  cerebrovascular  accident 
to  be  identified  at  an  early  stage,  thus 
permitting  prophylactic  measures  to  be 
taken  in  good  time,  has  been  developed 
by  Dr.  Gunnar  Hornsten  of 
Stockholm's  Sodersjukhuset  Hospital. 
The  method,  using  TV  equipment,  a 


monitor,  and  a  videotape  recorder,  al- 
lows a  developed  or  incipient  blood  clot 
to  be  identified  indirectly  with  the  aid 
of  infrared  light.  It  especially  lends  it- 
self to  early  diagnosis  of  the  Wallen- 
berg Syndrome,  a  variety  of  hemor- 
rhagic infarct  that  afflicts  the  cerebel- 
lum and  the  upper  extremity  of  the  spi- 
nal marrow. 

The  patient  is  placed  in  total  dark- 
ness and  his  eyes  are  exposed  to  in- 
frared light,  which  allows  eye  move- 
ments to  be  followed  by  the  camera. 
The  reactions  of  the  eye  mechanism  can 
later  be  studied  on  a  TV  screen.  Dr. 
Hornsten"  s  researches  have  shown  that 
afflicted  patients  display  ocular  distur- 
bances with  a  characteristic  pattern. 

Lord,  deliver  us  . . . 

A  recent  editorial  in  Ihe  Journal  of  the 
American  Medical  Association  by 
Hugh  H .  Hussey ,  MD.  took  a  poke  at  the 
fashionable  misuse  of  words  in  medical 
language.  Several  of  Dr.  Hussey's  col- 
leagues have  reacted  to  his  editorial, 
and  have  themselves  added  a  few  ex- 
amples of  misused  words. 

One  MD  from  California  objects  to 
the  use  of  the  expression  ""delivery  of 
medical  services,"  saying  it  implies 
that  medical  care  is  a  ""commodity,  to 
be  delivered  at  the  door."  (Editor's 
note:  Whatever  else  might  be  said 
about  medical  care,  we  can  safely  say 
that  it  is  rarely,  if  ever,  brought  to  one's 
door.)  Dr.  Hussey  agrees  with  the 
California  md  and  adds; 

"Writers  and  speakers  on  the  subject 
of  medical  (health)  care  should  learn 
that  physicians  provide:  they  do  not 
deliver.  Even  in  the  case  of  childbirth. 


Registered  Nurses 

Your  community  needs  the  benefit 
of  yourskiJisand  experience.  Volun 
tear  now  to  teach  Patient  Care  in 
The  Home  and  Child  Care  in  The 
Home  Courses.  ""^ 


contact 


in  Ambulance 


the  mother  delivers  the  baby  while  the 
physician  may  assist  in  the  act." 


Origin  of  functional  complaints 

In  ""Myths  and  Mirths:  Women  in 
Medicine"  —  an  article  in  the  13  Feb- 
ruary 1975  issue  of  The  New  England 
Journal  of  Medicine  —  author  Howard 
M.  Spiro.  MD.  makes  these  comments 
about  female  patients: 

"The  woman  as  patient  has  also 
come  in  for  her  share  of  trouble  at  the 
hands  of  a  male  [medical]  profession. 
As  evidence  for  complications  from  the 
birth-control  pill  piles  up,  it  seems  ever 
clearer  that  the  only  evidence  that  male 
physicians  will  pay  attention  to  is  wit- 
ness that  the  pill  is  associated  with  an 
increased  incidence  of  cancer  of  the 
penis.  Yet  women  physicians  should 
not  deny  the  persistent  observations 
that  women  in  Western  society  at  least 
have  more  than  their  share  of  ""func- 
tional"' indefinable  complaints. 

""Physicians  simply  need  to  recog- 
nize the  origin  of  these  complaints  in 
the  social  and  cultural  constraints  on 
women  rather  than  to  see  such  prob- 
lems as  inherently  "feminine."  Con- 
sider a  woman  of  40  with  constipation 
and  abdominal  pain.  Part  of  her 
stomach  and  her  gallstones  may  be 
gone;  a  laminectomy  and  a  hysterec- 
tomy may  have  left  her  still  complain- 
ing. What  her  pain  means  and  whence  it 
originates  the  physician  cannot  say,  but 
a  man  too  might  find  himself  no  less 
disordered  when  there  was  no  meaning 
to  his  work  or  when  custom  blocked  his 
way.  Yoked  to  an  alcoholic  woman,  or 
to  one  consumed  in  her  career,  or  to  a 
dull  wife  without  interests,  in  a  society 
that  gave  him  no  means  of  self- 
expression  and  kept  him  from  knowing 
that  he  had  a  self  to  express  other  than 
in  the  kitchen,  a  man  too  might  acquire 
"functional"  complaints. 

""With  so  few  outlets  until  recently, 
women  must  have  enormous  strength 
not.  .  .  to  have  taken  more  often  un- 
conscious refuge  in  the  care  and  con- 
cern and  interest  that  disease  or  pain 
confers.  It  may  be  no  accident  that  male 
physicians  have  been  willing  to  remove 
one  organ  after  another  in  a  fruitless 
search  for  the  cure  of  that  pain."     i^i 


THF  nAKJAniAM  KJI  IRQF  Lilv,  107^; 


13 


Help  us  with  our  International  Women's  Year  Project 


I 


The  Canadian  Nurse  and  L'infirmiere  canadienne  want  to  docu 
ment  instances  of  sex  discrimination  in  health  care  so  that  actioi 
can  be  taken  to  correct  it. 

Are  women  discriminated  against  in  health  care?  As  patients' 
As  nurses? 

We  invite  nurses  to  send  us  examples  of  discrimination.  Use  thi 
form  below,  and,  please,  sign  it.  Your  identity  will  not  be  revealed 

Return  the  form  not  later  than  31  August  1975,  to: 
Canadian  Nurses'  Association 
Director  of  Information  Services 
50  The  Driveway 
Ottawa,  Ontario  K2P  1E2 


Incident: 


In  your  opinion,how  does  this  incident  show  discrimination  against  women? 


Are  you:[I]a  nurse, □  a  patient,  □  other  (specify). 


:t!| 


FRANKLY  SPEAKING 

about  nursing  administration 


Today's  Administrator  Wears  Many  Hats 


Fernande  P.   Harrison 


This  open  letter  to  readers  of  The  Cana- 
dian Nurse  is  the  second  stage  in  an  at- 
tempt to  open  up  the  channels  of  com- 
munications between  meiribers  of  the 
Canadian  Nurses"  Association  and  the 
people  they  elected  to  represent  them  as 
members-at-large  on  the  Association's 
board  of  directors. 

The  first  step  in  bridging  the  communi- 
cations gap  was  the  forum  on  nursing  is- 
sues held  during  the  CNA  annual  meeting 
in  April.  For  me,  this  experience  provided 
concrete  proof  of  the  value  of  dialogue  in 
helping  nurses  to  bring  their  concerns  into 
the  open,  to  discuss  them  frankly,  and  to 
look  together  for  the  kind  of  solutions  that 
will  strengthen  the  entire  health  care  sys- 
tem. 

This  series  of  opinion  pieces  is  another 
step  in  the  same  direction.  It  involves  a 
different  media  —  print  —  but  it  will  also. 
1  hope,  help  to  meet  the  need  for  better 
communication  between  members  of  the 
nursing  profession  and  between  cna 
members  and  their  representatives. 

Today,  new  patterns  of  nursing  care  are 
emerging  in  response  to  long  overdue 
changes  in  the  heahh  care  system.  AH 
nurses  have  questions  to  ask  about  these 
changes.  Most  are  anxious  to  use  their 
education,  experience,  and  skill  to  influ- 
ence, direct,  and  participate  in  this  process 
of  change. 

Overnight .  the  job  of  the  nursing  service 
administrator  has  become  incredibly  com- 
plex. It  is  her  responsibility  to  provide 
leadership  for  a  generation  of  nurses  who 
have  come  to  understand  the  scientific  and 
philosophical  basis  for  nursing  action. 
These  nurses  have  been  taught  to  recog- 
nize their  worth  as  individuals  and  profes- 


Each  month  The  Canadian  Nurse  fea- 
tures a  column  presenting  the  views  of 
the  four  CNA  members-at-large.  This 
month's  column  is  written  by  the  mem- 
ber-at-large  for  nursing  administration, 
Fernande  P.  Harrison.  She  welcomes' 
your  comments. 


sionals.  and  they  want  to  use  this  know- 
ledge to  fill  the  gap  they  see  in  the  existing 
health  care  system. 

The  nursing  service  administrator, 
perhaps  more  than  anyone  else,  is  con- 
scious of  the  immediate  need  for  the  hospi- 
tal to  become  part  of  an  integrated,  ra- 
tional, regional  system  of  health  care.  She 
realizes  this  system  will  require  more  ef- 
fective use  of  all  hospital  staff,  especially 
nurses.  She  realizes  also  that  she  is  ac- 
countable to  the  patient,  who  must  receive 
adequate  care  in  spite  of  the  increasingly 
complex  bureaucratic  structure. 

Today's  nursing  administrator  wears 
many  hats.  She  is  committed,  first  of  all. 
to  advancement  of  the  practice  of  nursing, 
and  she  must  possess  the  same  manage- 
ment skills  as  other  administrators.  She  is 
a  teacher,  a  researcher,  a  scholar,  and  a 
leader.  At  the  same  time,  she  must  use  all 
the  resources,  skills,  and  political 
strategies  she  can  muster  to  negotiate  im- 
provements in  health  care. 

More  and  more,  health  care  is  moving 
out  from  behind  hospital  walls  into  the 
community.  Accessibility  has  become, 
along  with  accountability,  the  touchstone 
of  any  assessment  of  the  health  care  Cana- 
dians receive.  Growing  numbers  of  nurse 
administrators    are    organizing    com- 


munity-based services  in  health  cen- 
ters, community  clinics,  industrial  and 
educational  settings,  health  units,  physi- 
cians' offices,  and  ambulatory  care  set- 
tings. 

The  problems  associated  with  nursing 
service  administration  in  these  areas  are 
not  basically  different  from  those  in  the 
hospital  setting.  Invariably,  adminis- 
trators ask: 

n     How  can  we  ensure  quality  of  care 
within  the  power  structure  of  the  in- 
stitution and  the  framework  of  exist- 
ing legislation? 
D     Can  nursing  performance  and  patient 

care  be  evaluated? 
D     How  can  the  director  of  nursing  in  a 
rural  area  meet  the  challenge  of  re- 
cruitment, selection,  inservice  train- 
ing,   and   performance   appraisal   of 
staff  within  the  limits  of  that  setting? 
n     Would   a   recognized   definition   of 
nursing  practice  help  to  establish  pro- 
fessional boundaries  and  ensure  max- 
imum use  of  available  manpower? 
D     What  is  the  most  efficient  way  of  pro- 
viding long-term  care  for  older  citi- 
zens? 
n     What  is  the  role  of  the  professional 
association  in  support  of  nursing  ser- 
vice administrators? 
It  is  my  contention  that  CN.A  has  an 
important  role  to  play  in  helping  nurses  to 
find  the  answers  to  these  and  other  ques- 
tions. This  is  your  professional  associa- 
tion.   It    exists    to    represent    you.    As 
member-at-large.  I  urge  you  to  make  your 
concerns  known  at  both  the  provincial  and 
national  level  so  that  we  can  work  together 
to  strengthen  nursing  practice.  <^ 


I  THE  CANADIAN  NURSE  —  July  1975 


Multiple  sclerosis: 

experiences  of 


personal  aljenatioi 


T.W.  Pulton 


Five  years  ago,  I  was  traveling  in  Sasi<at- 
chewan  with  the  salesman  who  covered 
this  territory  for  the  company  we  both 
worked  for.  In  my  capacity  as  sales  mana- 
ger, I  made  a  number  of  these  routine  trips, 
meeting  new  retailers  and  assuring  our  old 
accounts  of  our  continued  interest  in  their 
affairs. 

One  Friday  evening,  as  planned, -Don 
and  1  had  finished  our  tour  and  were  look- 
ing forward  to  a  few  drinks  and  a  steak 
dinner.  I  was  sharing  a  motel  room  with 
Don  and,  after  showering,  remarked  to 
him  how  peculiar  my  right  leg  had  sud- 
denly begun  to  feel  —  a  kind  of  numb, 
heavy  sensation  that  was  hard  to  explain. 
Don  suggested  that  I  take  a  nap,  as  I  was  no 
doubt  tired  after  our  long  drive.  He  remin- 
ded me  thai  I  had  done  all  the  driving  that 
day ,  and  suggested  that  I  had  some  kind  of 
a  muscle  cramp. 

Next  morning,  on  my  flight  back  home, 


Bill  Pulton  {B.A..  University  of  Alberta, 
Edmonton;  M.A.,  University  of  Victoria, 
Victoria,  B.C.)  is  presently  a  doctoral  candi- 
date in  psychology  at  the  University  of  Vic- 
toria. During  recent  years,  his  fields  of  research 
have  included  the  assessment  of  altitudes  to- 
ward the  physically  disabled  and  the  develop- 
ment of  techniques  for  positively  altering  these 
attitudes. 


I  noticed  that  the  numbness  had  now  tra- 
veled up  my  leg  to  about  mid-thigh  and 
didn't  appear  to  be  decreasing  in  intensity. 
I  went  into  the  University  Hospital  the  next 
week  for  the  usual  barrage  of  tests,  and 
was  ultimately  told  that  an  examination  of 
my  spinal  fluid  revealed  multiple 
sclerosis. 

The  course  of  the  numbness  had  now 
stopped  at  the  small  of  my  back  and,  al- 
though it  was  also  in  my  hands,  1  felt  quite 
well  otherwise  and  returned  to  work,  in- 
tending to  modify  my  life-style  only  as  it 
became  necessary. 

It  has  taken  the  past  four  or  five  years  to 
understand  the  disease  completely  and  to 
comprehend  the  types  of  personal  aliena- 
tion that  my  condition  has  brought  into 
focus.  The  types  of  alienation  1  have  expe- 
rienced are  grouped  into  several  main  cat- 
egories, but  they  are  all  interrelated. 

My  family 

My  first  and  continuing  feeling  of  alien- 
ation came  from  the  change  in  sex  rela- 
tions with  my  wife,  which  had  always 
been  extremely  satisfactory.  The  insensi- 
tivity  that  pervaded  my  entire  lower  trunk 
had  drastically  reduced  the  tactile  sensa- 
tions in  my  sex  organs. 

I  now  found  it  difficult  to  feel  myself 
inside  my  wife,  or  to  feel  her  clasping  me 
as  we  made  love.  My  ability  to  bring  her  to 


orgasm  was  not  impaired;  rather,  it  w| 
enhanced  because  1  had  all  the  time  necej 
sary  to  accomplish  this  and  more.  To  reai 
an  orgasm  myself,  however,  requin 
considerable  concentration  on  my  part  ai 
the  cooperation  of  my  wife.  Sometimes 
would  fake  it  and  hope  that  1  had  co 
vinced  her  that  1  was  satisfied,  but  this  i.s 
game  I  play  poorly,  and  the  sham  in  ai 
case     is     usually     quickly     revealei 

We  go  to  bed  now  knowing  that  perha|| 
it  will  work,  but  probably  it  will  not.  , 
feeling  of  alienation  has  entered  n| 
consciousness  toward  this  act,  which  Cc! 
be  such  an  incredibly  beautiful  exp' 
rience.  1  know  of  ways  whereby  my  sexu 
feelings  might  be  further  heightened,  buij 
rarely  discuss  these  techniques  with  nr 
wife.  She  always  takes  my  failure  as  h<| 
failure,  and  she  becomes  terribly  frustra 
ed  when  I  start  to  suggest  ways  we  cou! 
try  to  deal  with  the  problem.  Still,  tl 
experience  is  truly  alienating;  1  am  ine, 
capably  estranged  from  the  act  of  io| 
because  of  the  dissatisfaction  I  find  in  i 

My  wife's  anxiety  concerning  my  situ;, 
tion  makes  my  awareness  of  the  frustratic) 
all  the  more  acute,  and  so  we  are  losing  oi 
spontaneity  and  exuberance  and  replacir 
this  with  a  sort  of  clinical  exercise  that  \» 
perform,  knowing  in  our  hearts  that  it  ma 
be  fruitless.  I  believe  she  is  thinkin 
"Will  he  make  it  this  time?"  And  1  a 


thinking.  "God,  why  does  this  thing  elude 
me?"  And  the  more  I  think  about  the  un- 
reasonableness and  the  futility  of  it.  the 
more  my  chances  are  reduced  and  my  alien- 
-i:on  increased. 
I  feel  alienated,  too,  from  my  children 
^ause  they  do  not  yet  understand  the  dis- 
ease, and  I  sense  their  disappointment  in 
my  inability  to  participate  actively  in  their 
-ames.  1  believe  I  am  failing,  to  a  degree. 
in  my  role  as  father;  this  is  confirmed 
when  I  see  the  delight  my  daughters  take  in 
playing  with  my  friends  —  something  they 
cannot  enjoy  with  their  own  father.  Joan 
!six)  has  been  announcing  for  years  that 
my  Daddy  s  ankle  is  broken,  but  it  will 
be  fixed  soon  and  then  he  will  be  able  to 
play  with  us!"' 

Work 

1   experienced   enormous    feelings   of 
'ienation  due  to  an  abortive  partnership  I 

=  CANADIAN  NURSE  —  July  1975 


entered  into  just  prior  to  my  returning  to 
university.  The  man  I  went  into  business 
with,  and  his  father  were  long-lime  person- 
al friends.  The  son  is  a  young  fellow  who 
i£  totally  dedicated  to  building  up  his  busi- 
ness into  a  profitable  venture.  I  gave  Bob 
his  first  good  job,  and  my  wife  and  I  saw 
much  of  him  and  his  wife  socially,  taking 
trips  together  and  constantly  visiting  each 
other's  homes. 

The  son  and  his  father  enthusiastically 
encouraged  me  to  come  into  business  with 
them.  I  was  delighted,  because  I  reasoned 
that  it  would  be  perfect  to  work  with  peo- 
ple whom  I  knew  and,  more  than  that,  with 
people  who  knew  and  understood  my  dis- 
ability. 

Earlier,  I  had  suddenly  realized  that  out- 
side of  the  protective  shelter  of  a  family 
business,  my  management  talents  were  not 
considered  as  desirable  as  they  once  had 
been.  When  my  father  decided  to  sell  the 


business,  I  began  to  contact  those  people 
in  the  industry  who  used  to  ask  me  if  I 
would  consider  working  for  them. 

I  found  that  they  now  considered  me 
more  of  a  liability  than  an  important  addi- 
tion to  their  firms.  Their  letters  were  flatter- 
ing, but  crystal  clear;  it  was  true  that  I 
probably  knew  as  much  about  the  industry 
as  anyone  in  Canada,  but  the  nature  of  my 
illness  made  it  impossible  for  them  to 
collider  me.  There  was,  they  reminded 
me,  the  ever-present  possibility  of  a  wors- 
ening of  my  mobility,  which  might  leave 
me  unable  to  travel,  a  vital  part  of  any  sales 
manager's  job. 

At  first  I  was  unwilling  to  believe  that 
these  persons  would  not  have  me;  some  of 
them  owed  their  very  success  in  part  to  my 
strenuous  efforts.  But  now  I  had  no  need  to 
feel  alienated;  two  friends  wanted  me  as  I 
was.  Their  warm  and  insistent  approaches 
soon  won  me  over  and,  after  a  few  months 


of  familiarization,  we  signed  the  papers 
and  I  bought  a  third  of  the  business. 

Less  than  six  months  later,  the  son  and 
his  father  were  to  call  me  into  our  small 
office  and  tell  me  that  all  was  not  right. 
They  pointed  out  that  Bob  was  doing  more 
traveling  and  that  1  was  staying  inside 
more.  I  agreed,  but  reminded  them  that  the 
walking  was  tricky  in  winter,  and  that  1 
would  no  doubt  be  getting  out  more  when 
the  weather  cleared.  They  reminded  me 
that  everyone  had  to  pull  his  weight,  and  I 
offered  to  make  all  the  calls  where  parking 
was  readily  accessible. 


guitar  with  varying  degrees  of  proficiency . 
Now  my  wooden  fingers  wouldn't  prop- 
erly depress  the  keys,  close  the  stops,  or 
hold  the  strings  to  the  frets.  I  felt  removed, 
alienated  from  one  of  my  greatest  plea- 
sures. I  continued  to  try  to  play,  but  the 
frustration  from  these  attempts  soon 
caused  me  to  abandon  the  instruments  en- 
tirely. Now  1  build  sound  systems,  and  I 
try  to  content  myself  with  listening  to,  and 
not  making,  music;  slowly  the  alienation 
dissipates. 

No  longer  can  1  backpack  to  the  high 
mountain  lakes  and  revel  in  their  tranquil- 


I  discovered  the  alienation 
understanding  that  even  the 
fragile  foundations. 


that  comes  from 
closest  of  friendships  have 


A  few  weeks  later,  my  friends  advised 
me  that  the  partnership  would  have  to  be 
dissolved.  The  agony  they  suffered  was  no 
doubt  severe,  but  they  were  fortunate  in 
being  able  to  rationalize  that  their  decision 
was  only  for  the  good  of  the  company  and 
that  I  really  hadn't  told  them  the  extent  of 
my  disability. 

The  parting  was  not  amicable.  Bob  and  I 
have  not  spoken  to  each  other  for  months, 
and  our  mutual  friends  arrange  their  par- 
ties so  that  we  will  never  be  together.  I 
have  not  requested  this,  but  apparently 
Bob  wishes  it  to  be  this  way. 

From  this  experience,  1  discovered  two 
kinds  of  alienation:  the  alienation  that 
comes  from  understanding  that  even  the 
closest  of  friendships  have  fragile  founda- 
tions, and  the  even  more  devastating  alien- 
ation that  comes  from  discovering  that 
one's  personal  worth  is  minimal! 

This  feeling  of  overwhelming  pow- 
erlessness  and  emptiness  stayed  with  me 
for  many  weeks.  I  felt  that  1  had  no  pur- 
fKjse,  that  I  was  beaten  and  could  sec  no 
way  out.  From  this  emotionally  exhaust- 
ing interlude  came  the  decision  to  return 
.to  university  after  a  10-year's  absence,  as 
it  seemed  to  me  that  my  only  hope  might 
come  from  more  education. 

Leisure 

At  work  and  at  play,  the  disease  has 
opened  up  new  channels  of  alienation.  I 
had  always  enjoyed  making  music,  and  I 
could  play  the  piano,  the  clarinet,  and  the 


ily.  1  feel  alienated  from  something  I  love, 
but  which  I  cannot  see  or  touch .  Nature  has 
always  delighted  and  soothed  me,  and  the 
alienation  I  experience  is  from  the  depriva- 
tion of  this  most  meaningful  stimulus. 

Last  fall,  an  old  friend  suggested  we  go 
to  a  place  he  knew  on  the  riverbank  and 


to  stretch  out  on  the  warm  bank  that  parti 
ular  October  afternoon.  We  talked  abo 
the  old  times  and  about  our  troubles,  at 
we  laughed  and  cried  and,  later,  after  v 
had  slept ,  we  somehow  made  it  back  to  tl 
car.  John  knew  the  alienation  I  felt  and  1 
was  determined  that  day  to  offer  me 
powerful  reprieve. 

Self 

Finally,  what  the  disease  brings  with 
is  a  change  in  one's  perspective,  a  sort  ■ 
alienation  of  the  self.  My  peculiar  disord 
is  presently  incurable  and  usually  progre 
sively  debilitating.  Stabilized  at  a  partici 
lar  level,  as  I  am  now,  I  can  never  1 
certain  that  I  will  not  experience  an  exa( 
erbation  and  slip  quickly  to  a  lower  stai 
of  functioning.  Living  with  th 
knowledge  has  made  me  more  aware  oft! 
people  and  things  around  me  that  1  consii 
er  important,  and  less  prepared  to  acce 
those  things  I  believe  to  be  meaningless  ( 
unauthentic. 

The  alienation  of  self  comes  to  me  whe 
1  knowingly  conform  to  these  unaccep 
able  standards  I  have  set.  More  than  evi 
before,  I  find  myself  intensely  uncomfor 
able  when  I  am  agreeing  with  popuh 
misconceptions,  stereotypes,  andunreali, 
tic  evaluations.  I  am  now  directed,  muc 
more  frequently,  to  the  relative  signif 


My  first  and  continuing  feeling  of  alienation  came 
from  the  change  in  sex  relations  with  my  wife,  which 
had  always  been  extremely  satisfactory.  The 
insensitivity  that  pervaded  my  lower  trunk  had  drasti- 
cally reduced  the  tactile  sensations  in  my  sex  organs. 


spend  the  afternoon  talking,  drinking  beer, 
and  looking  at  the  river  and  the  glorious 
fall  leaves.  The  walk  to  the  river  was  long- 
er than  he  had  remembered,  over  heavy 
deadfall  and  thick  underbrush;  finally,  I 
collapsed  and  announced  that  I  wasn't 
going  to  make  it.  John  refused  to  accept 
this,  and  without  hesitation  he  picked  me 
up  and  carried  me  the  rest  of  the  way, 
.  muttering  that  he  "would  be  goddamned  if 
I  was  going  to  miss  this  view!" 

I  still  cannot  understand  how  he  was 
able  to  carry  me,  but  I  believe  it  was  his 
determination  to  get  me  there,  coupled 
with  his  realization  of  how  much  1  needed 


cance  of  the  small  crises  that  daily  cha 
lenge  us.  Agitated  by  my  failure  to  react  t 
unauthentic  values  and  inflated  issues,  m 
alienation  of  self  continues  unabated. 

Perhaps  my  intolerance  arises  from  lb 
continuous  dialogue  I  conduct  with  ih 
puzzling  disease;  but  here,  on  paper,  th 
issues  appear  extraordinarily  straigh 
forward,  and  the  solution  obvious:  accej 
the  reality  of  my  physical  condition,  an 
then,  while  occasionally  pondering  th 
capriciousness  of  fate,  resolve  to  live  cat 
day  honestly,  completely,  and  wit 
enthusiasm. 


OPINION 


Continuing  education 
should  be  voluntary 


"^ 


To  maintain  herself  in  a  state  of  reasonable  competence,  a  professional  must  learn 
continually  and,  hence,  must  have  access  to  opportunities  for  continuing 
education.  The  author  suggests  alternatives  to  mandatory  continuing  education 
and  concludes  that  the  real  question  is  not  whether  continuing  education  for 
nurses  should  be  voluntary  or  mandatory,  but  whether  nurses  are  prepared  to 
demonstrate  professional  behavior. 


WHEREVER  NURSES  MEET.  THEY 
express  concern  about  the  quality 
and  quantity  of  nursing  that  is  available 
loday.  It  is  recognized  widely  that  ad- 
\ances  in  knowledge  and  methodological 
innovations  are  making  obsolescence  of 
professional  practice  in  nursing  almost  as 
troublesome  a  problem  as  is  the  obsoles- 
cence of  machines.  The  organized  nursing 
profession  has  accepted  continuing  educa- 
tion as  a  professional  imperative.  What  is 
not  known,  however,  is  the  extent  to 
which  individual  nurses  are  committed  to 

I  continuing  education  as  a  way  of  life. 
I     Nurses  in  the  seventies  have  expressed 

'the  belief  that  they  are  professionals  and 
that  they  expect  to  retain  the  privileges  of 
professional  status.  These  privileges  ac- 
cord to  nurses  the  rights  to  control  their 
own  profession,  to  be  autonomous  in  pro- 
fessional practice,  and  to  be  accountable 
for  their  own  professional  behavior.  With 
these  privileges  goes  responsibility  on  the 

'  part  of  each  practitioner  for  the  mainte- 

'  nance  of  professional  competence  —  a 
goal  that  involves  sustained  effort  by  the 
individual  to  continue  his  own  education. 
Maintenance  of  competence  has  become 
one  of  the  most  critical  problems  within 
the  entire  health  care  system  ....  The 
challenge  to  the  health  professionals  is  to 


M  Josephine  Raherty  (B.Sc.N.,  B.A.,  M.A.. 
Fti  D.,  U.  ofToronto)  is  dean  of  the  faculty  of 
nursing.  University  of  Western  Ontario,  Lon- 
'   n.  Ontario. 


M.  Josephine  Flaherty 

develop  an  effective  means  of  maintaining 
professional  competency  throughout  an 
entire  career.""* 

Today,  many  nurses  regard  continuing 
education  as  mandatory  at  the  personal 
level,  in  the  sense  that  it  is  obligatory  if  the 
practitioner  is  to  maintain  competence. 
They  see  it  as  a  personal  activity,  accepted 
by  the  nurse  as  a  professional  commit- 
ment, with  the  responsibility  for  action 
resting  on  the  individual.  Other  nurses  be- 
lieve that  continuing  education  should  be 
mandatory  at  the  statutory  level  and  that 
participation  in  continuing  education 
should  be  required  for  the  nurse  to  retain 
registration  to  practice  nursing. 

Had  all  professional  nurses  accepted  a 
commitment  to  lifelong  learning  in  nurs- 
ing and  implemented  individual  plans  to 
achieve  the  goal  of  continuing  profes- 
sional education  as  a  way  of  life,  there 
would  be  no  debate  about  statutory  versus 
voluntary  requirements  for  continuing 
education  for  nurses.  The  fact  is  that  nurs- 
ing has  a  tradition  of  nonleaming  among 
its  practitioners  —  a  tradition  that  grew  out 
ofanti-intellectual  attitudes  ofnurses  and  a 
diminishing,    but    still    present,    belief 


*  Erline  P.  McGriff  and  Signe  S.  Cooper. 
Accounlabilily  to  the  consumer  through  con- 
tinuing education  in  nursing,  paper  presented 
at  .  .  .  1973  Biennial  Convention.  National 
League  for  Nursing  (New  York:  Division  of 
Nursing.  National  League  for  Nursing,cl974), 
page  10. 


among  some  nurses  that  basic  education  in 
nursing  prepares  the  graduate  for  a  lifetime 
of  professional  practice. 

I  BELIEVE  THAT  CONTINUING  EDU- 
cation  in  nursing  should  be  vol- 
untary, and  that  statutory  regulation  of 
continuing  education  for  nurses  in  Canada 
is  neither  practical  nor  philosophically 
palatable  at  this  time. 

At  the  outset,  it  seems  essential  to 
clarify  definitions  of  terms.  Basic  educa- 
tion in  nursing  refers  to  diploma  or 
bachelor's  degree  programs  that  prepare 
candidates  to  apply  for  initial  registration 
or  licensure  as  professional  nurses.  Con- 
tinuing education,  in  its  broadest  sense, 
embraces  all  those  learning  activities  that 
occur  after  completion  of  basic  education . 
Further  or  higher  education  in  nursing 
refers  usually  to  formal  education  leading 
to  a  certificate  or  a  degree,  which  follows 
initial  qualification  for  registration  or 
licensure  in  nursing.  Graduate  education 
is  regarded  generally  as  embracing  formal 
education  leading  to  a  master's  or  doctoral 
degree,  or  to  a  certificate  of  attendance  or 
achievement  as  a  postmaster's  or  doctoral 
student. 

Although,  strictly  speaking,  continuing 
education  includes  both  further  and 
graduate  education,  it  is  described  most 
often  as  formal  and  informal  activities  that 
do  not  lead  to  recognized  educational  cred- 
its, such  as  degrees  and  diplomas.  Con- 
tinuing education  also  includes,  but  goes 
far  beyond,  insenice  education,  which  is 


£  CANADIAN  NURSE  —  July  1 975 


defined  usually  as  "those  educational  ac- 
tivities provided  to  employees  by  the  em- 
ploying agency  and  designed  to  improve 
on-the-job  practices. '"**  Mandatory  con- 
tinuing education  in  nursing  is  continuing 
education  that  is  a  condition  for  reregistra- 
tion  or  relicensure;  voluntary  continuing 
education  in  nursing  involves  participa- 
tion in  educational  activities  by  nurses  on 
their  own  volition,  without  the  pressure  of 
statutory  regulations. 

The  need  for  continuing  education  for 
nurses  has  been  established  on  the  grounds 
that  nursing  requires  practitioners  who  are 
able  to  make  appropriate  adjustments  to 
the  continuous  social  and  professional 
changes  that  are  the  mark  of  a  dynamic 
profession.  To  maintain  himself  in  a  state 
of  reasonable  competence,  a  professional 
must  learn  continually  and,  hence,  must 
have  access  to  opportunities  for  continuing 
education. 


THE  NATURE  AND  SCOPE  OF  THE 
learning  needs  of  nurses  are  com- 
plex, and  continuing  education  must  in- 
volve a  number  of  dimensions.  Among 
these  are  the  following: 

D  Learnings  that  enhance  the  develop- 
ment of  the  individual  as  a  human  being 
and  as  an  involved  and  committed  profes- 
sional. Such  activities  will  assist  the  nurse 
to  develop  more  broadly  the  skills  of  as- 
sessment, judgment,  and  decision  making 
in  nursing.  These  skills  go  beyond  simple 
acquisition  of  information  from  well- 
defined  sources  and  involve  heightened 
sensitivity  to  the  significance  of  many 
kinds  of  data  and  the  ability  to  synthesize 
information  with  a  view  to  the  identifica- 
tion and  solution  of  human  problems. 
n  Learnings  that  relate  to  the  specific  job 
or  position  of  the  nurse.  These  activities 
will  assist  the  nurse  to  be  more  effective  in 
the  performance  of  day-to-day  nursing  ac- 
tivities that  require  cognitive,  affective, 
and  psychomotor  skills. 


**  Signe  S.  Cooper.  This  I  believe  .  .  .  about 
continuing  education  in  nursing, Nuri.  Outlook 
20:9:579-83.  Sep:   1972. 

20 


D  Learnings  that  relate  to  the  profession  i 
nursing  in  general,  to  the  health  care  sv 
tern,  and  to  the  place  of  nursing  in  th; 
system. 

It  is  obvious  that  there  is  no  one  systei 
or  constellation  of  educational  offering 
that  is  appropriate  for  all  nurses.  Statutor 
requirements  would  make  necessary  a  sy; 
tem  of  accreditation  of  educational  offei 
ings  so  that  judgments  could  be  made  en 
consistent  basis  about  what  educational  ai 
tivities  would  be  acceptable  and  recog 
nized.  Accreditation  systems  have  the  pc 
tential  to  foster  rigidity,  a  condition  that  i 
particularly  dangerous  in  a  population  th£ 
is  as  heterogeneous  as  the  nursing  popula 
tion  in  Canada. 

The  needs  of  nurses  for  various  types  c 
continuing  education  will  vary  from  tim 
to  time,  and  fronj  person  to  person,  y 
system  of  voluntary  continuing  educatio 
allows  and  encourages  nurses  to  asses 
their  own  learning  needs,  to  explore  avail 
able  resources  for  meeting  these  needs  c 
to  press  for  creation  of  such  resources,  an 
to  make  use  of  opportunities  for  learning 
This  accords  to  each  nurse  the  responsibil 
ity  for  her  own  continued  learning.  Sue 
responsibility  is  the  right  of  every  prote^ 
sional  and  forms  the  basis  for  what  ma\  h 
the  strongest  philosophical  argument  t( 
voluntary  continuing  education  systems 

At  a  time  when  attempts  are  being  mad 
to  foster  autonomous  behavior  in  puis 
professionals,  who  are  urged  to  be  a;. 
countable  for  their  practice  rather  than  ai 
countable  to  a  hierarchy  or  a  set  of  rules , 
seems  particularly  inappropriate  to  ai 
tempt  to  legislate  learning  behavior.  On 
of  the  hallmarks  of  the  professional  wit  i 
integrity  is  his  capacity  and  willingness  i 
do  what  he  believes  to  be  right,  no  muiiL- 
what  the  cost ,  rather  than  what  he  is  told  i 
do.  Should  nurses  be  denied  sell 
determination  in  learning? 

LEGAL  REQLMREMENTS  MAY  AL5> 
foster  dependence  on  an  edi 
cational  system  or  a  statutoiy  body,  rathi 
than  independence  and  responsibility  f 
the  part  of  the  individual  professional  \ 
though  nurses  could  be  forced  by  law  i 


)resent  at  educational  sessions,  their  learn- 
ing could  not  be  legislated.  Compulsory 
'jllendance  at  irrelevant  or  inappropriate 
Ifducational    programs    may    discourage, 
l-ather  than  encourage,  behavior  change  by 
.  nurses.  Evidence  continues  to  accumulate 
.hat  learning  is  more  likely  to  take  place 
;  ;ind  is  more  effective  when  the  learner 
l.-hooses  to  take  part  in  the  learning  pro- 
-- .  rather  than  when  he  is  coerced  to  do 
Coercion  may  foster  negative  attitudes 
ov^ard  learning  and  do  more  harm  than 
:ood  in  the  long  run. 

Frequently,  legal  requirements  are 
ninimum  requirements,  which  are  tied  to 
I  specific  time  and  are  associated  with 
eregistration  or  relicensure  activities. 
\fler  meeting  these  requirements,  regis- 
rants  may  tend  to  discontinue  leaming 
,^ii  vity  until  the  expiry  date  for  the  current 
licence,  rather  than  regard  leaming  as  a 
:ontinuing  process. 

It  has  been  shown  that  mandatory  con- 
inuing  education  may  be  philosophically 
indesirable.  it  may  also  be  impractical  in 
jnany  situations  and  locations  in  Canada. 
.  Dne  problem,  which  is  of  particular  con- 
cm  to  educators,  is  the  extent  to  which 
ducational  resources  would  be  available 
•  1  support  a  system  of  mandatory  continu- 
ng    education.     Even    now,     learning 
acilities     are    distributed    unevenly 
hroughout  the  country,  and  most  educa- 
lonal  facilities  are  stretched  to  the  limit. 
If  continuing  education  were  manda- 
> .  would  educational  offerings  be  made 
mailable  equally  in  rural  and  urban  set- 
ings?  How  would  these  be  staffed  and 
inanced?  If  exceptions  in  continuing  edu- 
.  ation  requirements  were  made  for  nurses 
.  n  isolated  areas,  how  would  these  be  jus- 
ified  in  terms  of  equality  of  access  to 
-  xcellent  care  for  the  consumers  of  heahh 
are  services?  If  the  onus  for  provision  of 
jontinuing  education  were  put  on  em- 
iloyers,  how  would  they  provide  for  ap- 
propriate programs  and  still  retain  the  pro- 
ision  of  health  care  service  as  their  prior- 

Does  anyone  know  whether  or  not  con- 
inuing  education  would  result  in  substan- 
;ial  behavior  change  and  whether  nursing 
-actice  would  improve  sufficiently  to  jus- 

::  CANADIAN  NURSE  —  July  1975 


tify  a  complex  and  expensive  system  of 
continuing  education  in  nursing?  How 
would  such  behavior  change  be  measured? 
Would  nurses  be  required  to  demonstrate 
change  of  behavior,  or  would  proof  of 
attendance  at  educational  activities  be  suf- 
ficient to  qualify  nurses  for  reregistration 
or  relicensure? 

Answers  to  these  questions,  although 
not  readily  available,  are  important  and 
should  be  sought  before  decisions  are 
made  on  mandatory  educational  require- 
ments for  health  professionals. 

ALTHOUGH  MANDATORY  CONTINU- 
ing  education  for  nurses  may 
not  be  an  appropriate  solution  to  the  ques- 
tion of  quality  in  nursing  practice,  the 
threat  of  obsolescence  of  nursing  prac- 
titioners cannot  be  ignored.  Among  other 
approaches  that  should  be  pursued  with 
vigor  are  the  following: 

n  The  development  of  commitment  by  all 
professional  nurses  to  continuing  educa- 
tion as  one  way  of  achieving  and  maintain- 
ing excellence  in  nursing  practice.  Such 
commitment  must  be  fostered  in  basic  and 
further  education  programs  through  provi- 
sion of  opportunities  for  students  to  ac- 
quire self-leaming  skills  and  positive  at- 
titudes toward  continuing  education.  It  is 
the  responsibility  of  all  nurse  educators  to 
develop  and  demonstrate  such  skills  and 
attitudes. 

C  The  development  and  implementation 
b\  employers  and  statutory  bodies  of 
measures  of  competence  in  nursing  prac- 
tice. It  may  be  difficult  to  measure  compe- 
tence, but  it  is  not  impossible.  If  nursing  is 
serious  about  being  a  profession,  it  must 
distinguish  between  competence  and  in- 
competence, and  must  be  prepared  to 
stand  behind  its  judgments  in  this  regard. 
Most  professionals  want  to  be  judged  by 
their  peers;  traditionally,  nurses  have  al- 
lowed themselves  to  be  evaluated  by 
superiors  and  nonnurses .  As  long  as  nurses 
remain  unprepared  to  use  their  own  pro- 
fessional expertise  in  the  evaluation  of 
nursing  practice  through  peer  review,  they 
will  not  be  masters  of  their  own  destinies, 
and  nursing  will  not  be  a  profession. 


n  The  development  of  systems  for  recog- 
nizing and  rewarding  excellence  in  nurs- 
ing practice.  These  might  be  achieved 
through  professional  certification,  through 
the  requirement  of  demonstrated  excel- 
lence in  practice  for  membership  in  pro- 
fessional associations,  and  through  man- 
ifestation of  respect  by  nurses  for  col- 
leagues whose  practice  is  of  high  quality. 
a  Employer  and  consumer  expectations. 
Most  employees  perform  at  the  level  that  is 
expected  of  them.  In  a  country  like 
Canada,  where  health  care  resources  are 
among  the  best  in  the  world,  employers 
and  consumers  have  the  right  to  demand  a 
high  standard  of  performance  from  health 
care  professionals.  Given  reasonable  op- 
portunities to  develop,  maintain,  and  en- 
hance their  skills,  nurses  will  rise  to  the 
challenge. 

The  real  question,  then,  is  not  whether 
continuing  education  for  nurses  should  be 
voluntary  or  mandatory,  but  whether 
nurses  believe  they  are  professionals  and 
are  prepared  to  demonstrate  professional 
behavior.  <1 


What  price  education 


How  two  Alberta  nurses  struggled  with  everything  but  poisonous  poppies  and  th 
Wicked  Witch  of  the  West  to  reach  their  goal  —  education. 

Doreen  Scott 


Five  years  ago,  I  began  the  long  "yellow 
brick  road"  to  Education.  Like  Dorothy, 
in  the  Wizard  of  Oz,  I  too,  had  a  friend  — 
Barbara  Greshner  —  who  came  with  me. 
right  to  the  end. 

We  began  slowly,  in  evening  credit  ses- 
sions at  Red  Deer  College,  30  miles  away. 
We  took  winter  sessions,  and  completed 
courses  that  qualified  us  for  entrance  into 
the  postbasic  baccalaureate  degree  pro- 
gram in  nursing  at  the  University  of  Al- 
berta. (U.  of  A.)  I  continued  working  in 
psychiatry,  and  Barbara,  in  public  health. 

It  wasn't  easy.  Both  of  us.  mothers  of 
7  children  between  us.  left  our  quiet  little 
town  for  a  3-week  spring  session  at  the  U. 
of  A.,  70  miles  away.  Each  morning  at 
6:30  A.M.,  you  would  find  us.  picking  out 
sleep-dust,  burning  up  the  road  to  the  fair 
city  of  Edmonton. 

We  were  totally  lost  on  a  huge  campus 
like  the  U .  of  A . ,  and  struck  by  the  hustle 
and  bustle  at  the  book  store,  the  library, 
and  the  cafeteria.  Also,  we  began  our  first 
day  with  a  bang-up  attitude,  but  finished 
the  day  by  losing  our  car  keys!  Ever  tried 
to  explain  to  a  key-shop  where  your  car  is 
when  you  don't  know  for  sure  yourself? 

Bravely,  we  kept  on,  with  duplicate 
keys  in  our  purses  and  a  key  hidden  on  the 


Doreen  Scoll  (RN,  Calgary  General  Hospital) 
is  completing  her  degree  in  nursing  at  the  Uni- 
versity of  Alberta,  Edmonton.  She  is  FVogram 
Coordinator  at  Alberta  Hospital.  Ponoka,  a 
500-bed  psychiatric  hospital.  Scott  and  her 
husband  live  in  Ponoka  with  their  3  children.  6 
horses,  I  cow,  and  2  dogs. 


car,  ready  for  the  '"next  lime."  We  had 
gasket  blow  off  and  lost  our  way  in  traff 
circles;  one  day  the  transmission  sudden 
became  very  loud,  and,  another  time 
ran  out  of  gas.  Often,  as  we  moved  into  t; 
and  winter  sessions,  the  wind  blew  and  tl 
snow  fell  thick  and  fast.  But  we  kept  o 
We  even  slithered  into  a  ditch  one  i( 
morning  on  our  way  to  write  two  exam 
Made  it.  with  10  minutes  to  spare! 

The  tremendous  cost,  you  ask?  It  is  ir 
possible  to  evaluate,  but  a  few  compai 
sons  might  be  enlightening: 

llem  1 :  hours  of  sleep  lost  for  exams,  ter 

papers,  and  for  required  and  recoi 

mended  readings  =  approx.  I  year. 
Item!:  amount  of  coffee  consumed  to  st 

awake:  I  lb.  of  coffee  at  50  cups  x  ^i 

=  10  lbs.,  or  enough  to  last  my  family 

months. 
Item  3:  amount  of  weight  gained  throuj' 

anxiety  and  midnight  snacks  =  20  lbs\ 

give  or  take  an  ounce. 
Item  4:  one  pair  of  glasses  dropped  in  snc|j 

=  $43.00. 
Item  5:  amount  of  money  used  for  fee 

typing  materials,  texts  =  price  of  oi 

mink  coat. 
Item   6:    Number    of   miles  traveled 

15,000  miles,  or  1 12 -way  round  r 

world. 
Item  7:  amount  of  grey  hairs  =  onl . 

hairdresser  can  tell. 

The  price  has  been  high,  admittedly .  b 
it  has  been  worth  it.  We  found  that  a  ba 
calaureate  degree  in  nursing  is  not  gaim 
without  commitment,  lots  of  hard  \<.o 
and  eyestrain,  and  immense  quantities 


22 


cooperation  from  a  long-suffering  family. 
It  was  not  easy  to  write  a  soon-due  (like 
tomorrow!)  term-paper,  with  a  two-year- 
old  clinging  to  one  part  of  my  jeans,  a 
four-year-old  on  t'other,  and  dear,  patient 
husband  yelling  for  his  newspaper! 

We  are  starting  to  get  quite  excited 
about  Convocation  in  the  fall.  I  am  40  plus 
—  Barb  is  much  younger  —  and  we  cannot 
fathom  why  many  of  the  younger 
graduates  are  not  planning  to  attend,  are 
not  getting  their  class  pictures  taken,  or 
buying  classpins  —  the  whole  bit.  Why 
not?  We  are  indeed  puzzled,  for  already 
we  plan  to  invite  our  parents,  our  inlaws, 
our  friends,  spouses,  and  kids  to  share 
with  us  our  joy  on  that  eventful  day.  I  can't 
help  but  feel  a  bit  sorry  (after  being  envi- 
ous) for  those  jaded  young  maidens.  Just 
looking  for  the  grey-haired  lady  in  the 
class  picture  gives  me  a  thrill,  cause  that's 
me! 

What  do  1  expect  from  my  baccalaureate 
degree?  1  can  only  reiterate  the  thoughtful 
comments  of  others  before  me:  The  pro- 
gram of  independent  study  helps  one  to 
read  with  a  more  critical  eye  and  to  know 
where  to  look  for  new,  different  resources 
and  ideas;  it  also  gives  one  a  heightened 
capacity  to  solve  problems  and  to  look  at 
other  alternatives  or  solutions.  1  need  this 
in  my  work  situation.  So  do  a  lot  more  of 
us,  if  we  would  admit  it. 

Finally,  1  would  add  a  note  of  caution. 
Many,  many  times,  we  have  been  discour- 
aged, worried,  and  ready  to  leave  the  'yel- 
low brick  road"  for  a  variety  of  reasons. 
One  needs,  at  these  moments,  the  ready 
ear  of  a  listener  who  doesn't  lake  sides, 
and  a  strong  constitution  to  look  at  another 
day  with  determination. 

Like  Dorothy,  once  she  got  to  Oz  and 
went  home,  she  wanted  to  go  back.  Like 
Dorothy,  we  are  looking  at  courses  for 
next  year. 

Education  has  no  price:  it  just  'keeps 
on  trucking"  one's  brain  cells! 

And,  in  1975,  Why  Not!  ^ 


I  THE  CANADIAN  NURSE  —  July  1 975 


Going  home  with  COLD: 
is  your  patient  readyi 


The  condition  of  the  patient  with  chronic  obstructive  lung  disease  will  eventually 
worsen.     With  proper  teaching  by  members  of  the  health  team,  however,  he  can 
learn  to  cope  with  his  illness  and  often  nip  in  the  bud  any  acute  upper  respiratory 
infection. 


Susan  Pasch  and  Tori  Jamieson 

When  I  arrived  to  give  Ms.  Y.  her  morning 
care,  she  had  already  completed  her  bath 
and  was  waiting  for  breakfast.  This  first 
encounter  led  me  to  believe  that  she  would 
need  minimal  nursing  care,  as  had  been 
indicated  by  other  members  of  the  health 
team.  Onestaff  nurse  had  said  to  me:  "Oh, 
you  have  Ms.  Y.  There's  not  a  lot  to  do  for 
her."  I  soon  disagreed  with  this  nurse's 
opinion. 

The  patient  was  diagnosed  as  having 
COLD  (chronic  obstructive  lung  disease), 
suffering  particularly  from  chronic  bron- 
chitis and  emphysema.  As  students,  we 
were  required  to  complete  a  respiratory 
assessment  on  her. 

Patient  history 

Ms.  Y  was  only  55  years  old,  but  her 
physical  appearance  resembled  a  woman 
of  at  least  70.  She  was  emaciated,  and  her 
face  was  gaunt,  with  severe  lines  around 
her  eyes.  The  accessory  muscles  of  respir- 
ation in  her  neck  region  were  harshly  ex- 
aggerated. 

She  slumped  forward  when  in  a  sitting 
position  and  required  the  support  of  her 
arms  when  doing  deep-breathing  and 
coughing  exercises.  This  accentuated  the 
barrel-shape  of  her  chest.  When  sitting  or 
walking,  Ms.  Y.  kept  her  head  down  and 
leaned  forward. 

The  authors  are  third-year  nursing  students  at 
the  University  of  Ottawa.  Ottawa,  Ontario. 


Ms.  Y.  experienced  dyspnea,  and  th 
led  to  a  wheezing  sound  on  expiratioi 
When  she  carried  on  a  conversation,  hi 
respirations  and  the  use  of  her  accessot 
muscles  increased,  as  she  was  subject  i 
air-hunger.  But  she  did  not  experience  an 
pain  with  chest  expansion.  She  had  a  pn 
ductive  cough  that  enabled  her  to  expecK 
rate  a  fair  amount  of  sputum. 

Ms.  Y.  had  never  smoked  and  had  live 
on  a  farm  all  her  life,  thus  avoiding  th 
pollutants  usually  considered  as  irritants  I 
the  cilia.  Yet  she  was  allergic  to  ha> 
which  could  be  considered  an  irritant. 

Generally,  in  cold,  the  cilia  along  th 
trachea  are  damaged,  and  the  secretiur 
cannot  be  propelled  from  the  lungs  to  b 
expectorated.  Consequently,  the  tracht 
constricts  because  of  the  increased  reter 
tion  of  secretions.  The  retained  secretior 
become  a  media  for  the  growth  of  bacteri. 
leading  to  an  infection  that  can  cau.'- 
further  exacerbations.  Pseudomona 
Aeruginosa  had  been  discovered  in  M: 
Y's  sputum,  and  the  infection  was  difficu 
to  cure,  even  with  antibiotic  therap\ . 

Retention  of  carbon  dioxide  usual!", 
curs  in  these  patients  because  of  the 
proper  exchange  of  gases.  This  leads  i 
respiratory  acidosis,  another  contributir 
factor  to  Ms.  Y's  illness.  The  lungs  (r 
compensate  by  making  the  body  bn 
deeper  and  faster. 

Ms.  Y.  could  not  eat  large  meals,  as  ih 
tired  her.  There  also  was  insufficient  >> 


24 


ygen  for  her  body  processes,  resulting  in 
the  use  of  fat  and  protein  stores  in  the 
body. 

Our  patient  had  had  respirator^'  prob- 
lems since  the  age  of  one,  when  she  had 
pneumonia  and  whooping  cough.  In  1970, 
she  had  a  right  spontaneous  pneumo- 
thorax, due  to  bullous  emphysema.  At  that 
time  she  also  had  a  rib  removed  on  the 
right  side  to  aid  lung  expansion.  During 
her  present  hospital  stay,  she  had  bron- 
choscopies and  bronchial  lavages. 

After  our  assessment,  many  problems, 
which  required  teaching,  surfaced.  Some- 
how, Ms.  Y.  had  to  be  taught  to  live  with 
her  illness. 

Patient  care 

One  of  our  goals  was  to  help  the  patient 
to  clear  her  airway  passages  of  secretions. 
Clapping  exercises,  with  the  simultaneous 
use  of  vibrations,  were  performed  over  the 
lobes  of  the  lungs  while  the  patient  was 
lying  in  left  and  right  Sims"s  position. 

During  this  procedure,  which  lasted 
about  10  minutes  on  each  side  and  was 
given  before  meals  and  bedtime,  the  nurse 
cupped  her  hands  and  clapped  the  patient's 
back  to  try  to  loosen  the  secretions.  As  the 
patient  exhaled,  the  rib  cage  was  vibrated 
to  help  her  expectorate. 

To  help  moisturize  the  secretions,  a 
humidifier  was  used  in  her  hospital  room. 
She  also  received  oxygen  by  mask  when 
she  was  excessively  short  of  breath.  Ms. 
Y.  would  have  a  humidifier  and  oxygen 
tank  at  her  home. 

We  taught  Ms.  Y.  breathing  exercises. 

■v  hich  she  performed  at  the  same  time  as 

the  clapping  and  vibration  therapy.  We 

taught  her  to  breathe  in  through  her  nose. 

vMth  her  mouth  closed,  as  this  moistens, 

warms,  and  filters  the  air.  Then  she  was  to 

I  breathe  out  through  her  mouth  in  a  blow- 

!  ing,  pursed-lip  fashion,  twice  the  length  of 

lime  inhaled.  When  she  folded  her  arms 

!cross  her  abdomen  and  pushed  in  on  expi- 

jiion,  air  expulsion  was  further  aided. 

We  encouraged  Ms.  Y.  to  carry  out 
these  exercises  when  she  returned  home. 

Our  patient  was  given  5  mg  Prednisone 

i  glucocorticoid)  b.i.d.  to  reduce  bron- 

hospasms  and  bronchial  inflammation. 

We  wrote  out  a  list  of  possible  adverse 

J    THE  CANADIAN  NURSE  —  July  1975 


drug  effects,  and  gave  her  written  instruc- 
tions about  the  medication;  take  after 
meals;  check  weight  every  day;  report  any 
skin  rash;  call  the  doctor  if  temperature  is 
elevated,  if  tongue  becomes  furry,  or  if 
you  feel  ill. 

Ms.  Y.  was  also  on  Dynaphylline  (a 
bronchodilator)  and  Gantanol  (an  antibac- 
terial sulfonamide)  while  in  hospital.  She 
was  to  continue  these  medications  at 
home,  so  we  gave  her  written  notes  on 
both  drugs  concerning  their  actions  and 
side  effects. 

We  taught  Ms.  Y.  as  much  as  we  could 
about  her  infection.  She  always  covered 
her  mouth  when  coughing,  and  disposed 
of  soiled  tissues  safely.  We  showed  her 
how  to  read  a  thermometer  so  that  she 
could  keep  a  daily  record  of  her  tempera- 
ture when  she  went  home  and  report  any 
elevation.  We  encouraged  her  to  avoid 
crowds  and  persons  with  colds. 

We  w  rote  out  the  signs  and  symptoms  of 
an  upper  respiratory  tract  infection  for  her. 
These  include:  an  increase  in  the  amount 
of  phlegm  and  changes  in  its  color  from 
clear  to  grey-brown  or  yellow;  an  increase 
in  shortness  of  breath;  coughing  or  wheez- 
ing or  a  change  in  the  character  of  the 
cough;  chest  pain;  excessive  drowsiness; 
and  fever.  These  are  important,  as  early 
recognition  allows  the  patient  to  get  help 
before  a  crisis  occurs. 

In  performing  her  daily  activities.  Ms. 
Y.  usually  overexerted  herself  and  became 
more  dyspneic  and  tired.  As  she  lived  in  a 
house  with  many  stairs,  we  devised  a  pro- 
gram to  help  her  climb  them  with  more 
ease.  We  told  her  to  breathe  in  when  stand- 
ing still  on  each  step  and  to  breathe  out  as 
she  moved  from  one  step  to  the  next.  We 
also  stressed  that  in  any  activity  she  should 
inhale  when  still  and  exhale  when  moving. 
She  could  save  energy  this  way.  as  greater 
effort  is  needed  on  expiration  as  well  as 
during  movement. 

Diet,  in  the  form  of  caloric  and  protein 
intake,  was  another  problem.  We  ex- 
plained to  her  the  importance  of  eating 
meats,  milk,  cheese,  and  eggs  to  maintain 
adequate  protein  stores,  and  we  introduced 
her  to  the  idea  of  eating  frequent,  small 
meals. 

A  1  adequate  fluid  intake  was  important. 


since  Ms.  Y.  occasionally  breathed 
through  her  mouth;  excessive  moisture  is 
lost  this  way.  She  also  lost  fluid  through 
constant  expectoration  of  secretions.  We 
encouraged  her  to  drink  at  least  16  juice 
glasses  of  fluids  daily  and  suggested  that 
she  mark  down  the  amount  she  consumed. 

Home  visit 

Just  where  does  one  place  an  individual 
with  this  disease  on  the  health-illness  con- 
tinuum? Ms.  Y.  will  never  be  able  to  per- 
form activities  without  some  degree  of 
dyspnea,  as  she  has  permanent  damage  to 
the  air  sacs  w  ithin  her  lungs.  However,  the 
health  team  can  help  the  patient  to  lessen 
the  stress-causing  factors. 

We  visited  Ms.  Y.  in  her  home  one 
month  after  discharge.  In  many  respects, 
the  teaching  program  was  a  success.  We 
found  that  she  was  taking  her  tempterature 
daily  at  home;  maintaining  and  recording 
an  adequate  fluid  intake;  and  attempting 
■■  nose-to-mouth""  breathing.  She  was 
aware  of  the  signs  and  symptoms  of  infec- 
tion and  had  a  general  knowledge  of  the 
need  for  humidification  and  oxygen 
therapy  in  her  home. 

A  COLD  patient's  state  of  health  will 
eventually  worsen.  But,  with  proper  teach- 
ing, remissions  may  be  prolonged.  This 
involves  beginning  a  teaching  program  — 
suited  to  the  needs  of  each  patient  —  as 
soon  as  the  initial  diagnosis  is  made.  The 
health  team  members  should  educate  the 
patient  when  he  is  in  hospital  so  he  can 
handle  more  effectively  his  disability  at 
home. 

When  you  send  yoMr  patient  home  with 
COLD,  is  he  realty  ready?  ^ 


idea  exchange 


Unit  dose  medication  carts 

Anne  Blatz 


In  1972,  the  Misericordia  Hospital's 
pharmacy,  nursing,  and  research  depart- 
ments undertook  a  project  to  evaluate  the 
unit  dose  drug  administration  system  on  a 
40-bed.  active  medical  unit.  Under  the 
previous  drug  administration  system, 
nurses  used  trays  to  distribute  drugs  to  the 
patients. 

With  the  introduction  of  unit  dose, 
medication  carts  were  required.  The  carts 
had  to  have  adequate  space  to  accommo- 
date drugs,  needles,  syringes,  garbage  re- 
ceptacles, and  any  other  equipment  re- 
quired by  the  nurse  distributing  medica- 
tions. 

Several  alternatives  were  considered. 
Lakeside  Carts  were  easy  to  transport,  but 

Anne  Blatz  (R.N..  Misericordia  Hospital 
school  of  nursing.  Edmonton;  B.S.N. .  Univer- 
sity of  Saskatchewan.  Saskatoon)  is  director  of 
medical  and  psychiatric  nursing  units. 
Misericordia  Hospital,  Edmonton,  Alberta. 


they  did  not  provide  the  drawer  spact 
needed  for  efficient  organization  of  sup 
plies.  It  was  too  expensive  to  buy  com 
mercial  unit  dose  carts  for  a  trial  run.  Ef 
forts  were  directed  toward  using  somi 
equipment  already  available  in  the  hospi 
tal. 

We  hit  on  the  idea  that  surplus,  outdatei 
bassinets  could  be  made  into  unit  doscj 
medication  carts.  With  minor  renovations! 
the  bassinets  proved  to  be  ideal;  they  me 
all  our  needs.  They  were  easily  transport 
able,  and  had  sufficient  drawer  and  cup 
board  space  to  accommodate  necessari 
supplies. 

The  use  of  bassinets  as  medication  cart 
demonstrated  to  us  that,  with  a  littl 
thought  and  ingenuity,  a  piece  of  equip 
ment  can  be  used  for  something  totall 
different  than  its  original  purpose! 


Parent  services 

Andree  De  Filippi  and  Nancy  Watson 


In  September  1973,  the  Alberta  Children's 
Hospital  opened  a  diagnostic,  assessment, 
and  treatment  center  for  children  with 
complex  health  problems. 

We  soon  saw  that  most  parents  who 
brought  a  child  for  assessment  needed 
someone  to  talk  to,  to  help  with  the  care  of 
their  other  children,  or  to  listen  to  any 
problems  they  encountered  during  their 
visit  to  the  center.  Parent  Services  was 
subsequently  developed. 

Our  parent  services  staff  member  greets 
the  parents,  takes  them  to  coffee,  and  gen- 
erally oversees  the  well-being  of  the  fam- 
ily while  they  go  through  the  assessment. 
In  addition,  she  has  literature  available  for 
parents,  and  can  inform  them  about  vari- 
ous parent  groups  in  which  they  may  be 
interested. 

Because  the  role  of  parent  services  is 


Andree  De  Filippi  (R.N..  Edmonton  General 
Hospital  School  of  Nursing.  Edmonton,  Al- 
berta) is  outpatient  coordinator,  and  Nancy 
Watson  (B. A.,  University  of  Alberta.  Edmon- 
ton, Alberta)  is  parent  services  worker  at  the 
Alberta  Children's  Hospital,  Calgary,  Alberta. 


nonthreatening,  parents  are  more  relaxed 
during  the  trying  experience  of  the  child's 
assessment.  They  are  able  to  verbalize 
their  concerns  and  their  hostility,  as  well 
as  their  satisfaction,  regarding  their  con- 
tact with  the  center. 

Approximately  2  weeks  after  the 
family's  visit  for  assessment,  the  parent 
services  staff  member  contacts  the  family 
to  receive  feedback  on  how  successful 
they  thought  the  assessment  was.  Was  the 
interpretation  understandable?  Was  the 
staff  courteous  and  helpful? 

Our  first  parent  services  worker  is  a 
mature  woman  who  is  the  parent  of  a  hand- 
icapped child .  She  has  a  ba  in  psychology , 
library  extJerience,  and  previously  worked 
for  many  years  at  a  day-care  training 
center  for  children  who  are  severely  hand- 
icapped by  cerebral  palsy.  She  brings  a 
special  empathy  and  understanding  to  each 
family  —  the  prime  qualities  required,  re- 
gardless of  professional  background. 

The  strength  of  parent  services  lies,  to  a 
large  degree,  in  its  reserves  —  the  extra 
effort  that  can  be  exjjended  on  behalf  of 
parents  who  are  placed  in  a  particularly 
stressful  situation.  Three  examples  come 
to  mind. 


The  language  and  behavior  program  . 
the  Alberta  Children's  Hospital  is  di 
signed  for  a  small  group  of  young  childrei 
who  have  a  diagnosed  need  for  intensi^' 
treatment  in  both  these  areas.  Their  pal 
ents  must  commit  themselves  to  involv 
ment  in  the  treatment  process.  For  sever 
months,  one  mother  drove  her  child 
from  a  town  75  miles  away,  in  spite  r, 
severe  weather  and  adverse  road  cond-i 
tions,  to  participate  in  the  program.  Suj 
tained  efforts  of  this  caliber  deserve  —  arj 
require  —  extra  support. 

The  parent  services  worker  frequent , 
joined  this  mother  for  coffee  or  lunc! 
often  including  other  staff  members  ' 
provide  the  woman  with  adult  convers 
tion.  This  made  the  mother  feel  like  "01, 
of  the  family,"  and  notjust  another  pare  j 
with  a  difficult  child.  The  incidental  prdi 
lems  of  locating  a  high  chair  for  the  chili 
finding  someone  to  open  the  mother's  c 
when  her  keys  got  locked  inside,  and  pic; 
ing  up  and  channeling  particular  concen 
have  been  dealt  with  at  the  same  time. 

On  another  routine  developmental  a 
sessment  of  a  child  who  had  problems  wi 
school,  the  diagnosis  of  muscular  dy 
trophy  was  made.  To  offer  additional  su 


port  for  the  parents  in  this  traumatic  situa- 
tion, the  parent  advocate  met  them  when 
they  brought  the  youngster  in  for  further 
physiotherapy  assessment  and,  over  cof- 
fee, helped  them  to  work  through  some  of 
the  problems:  explaining  to  friends;  and 
dividing  their  time  and  attention  between 
their  other  children,  work,  community  ac- 
tivities, and  this  new  problem. 

In  the  course  of  these  conversations,  it 
became  apparent  that,  in  a  state  of  shock 
following  the  diagnosis  of  their  child,  this 
couple  had  blanked  out  90  percent  of  the 
information  given  to  them  by  the  pediatri- 
cian. In  an  attempt  to  recover  reality,  they 
had  replaced  the  child's  actual  disorder 


with  multiple  sclerosis.  The  problem  was 
referred  to  the  pediatrician  who  arranged 
an  appointment  with  the  parents,  in  con- 
junction with  a  physio  appointment,  and 
skillfully  corrected  the  misunderstanding. 

The  third  instance  involved  a  child  with 
a  brain  tumor  that  altered  her  personality, 
resulting  in  the  alienation  of  her  peer  group 
prior  to  diagnosis.  It  subsequently  hos- 
pitalized her  for  several  months,  and  left 
her  with  a  physical  impairment  and  the 
need  for  rehabilitation  through  the  hospital 
school  before  she  could  resume  a  place  in 
her  former  class. 

The  mother  worked  tirelessly  to  assist 
her  child  in  reorienting  to  her  environ- 


ment, but  she  reached  the  point  where  the 
child  had  to  regain  her  independence  and 
rebuild  her  self-esteem  with  her  own  peer 
group.  Here,  the  mother  asked  for  help 
from  parent  services.  After  a  considerable 
search,  a  suitable  group  was  found  —  ap- 
propriate in  age.  small  in  numbers,  with  a 
high  leader  ratio  —  meeting  weekly  within 
the  child's  own  community. 

These  are  only  a  few  instances  in  which 
the  assistance  provided  by  the  parent  ad- 
vocate has  been  invaluable.  Parental  re- 
sponse has  shown  us  that  we  are  providing 
a  necessary  service  that  has  made  the 
whole  assessment  process  more  pleasant 
for  the  families. 


Slide-tape  Helps  Recruitment 

'jeannette  Funke,  Helen  ISTiskala,  and  Peggy-Anne  Field 


A  slide-tape  presentation  can  be  sent  on 
the  recruitment  circuit  to  high  schools,  in- 
stead of  nursing  faculty  and  students  mak- 
ing the  visits. 

During  1974,  the  University  of  Alberta 
school  of  nursing  developed  a  slide-tape 
explaining  Alberta  programs  leading  to  a 
|B..Sc.  in  nursing,  and  career  opportunities 
for  baccalaureate  nursing  graduates.  The 
idea  of  an  audio- visual  presentation 
leinerged  in  response  to  a  request  from  the 
ihigh  school  liaison  officer  of  the  Univer- 
isity  of  Alberta.  Its  development  was  a 
cooperative  venture.  A  committee  com- 
posed of  faculty  members  and  a  graduate 
of  the  program,  who  had  previously  par- 
ticipated in  high  school  recruitment  pro- 
grams, planned  the  content. 

We  chose  a  slide-tape  format  because: 
D  It  is  more  easily  updated  than  a  film; 

Both  initial  and  maintenance  costs  are 

|D  Reproduction  of  additional  kits  is  easy 

jand  relatively  inexpensive; 
D  Playback  equipment  for  slides  and  cas- 
sette tapes  is  readily  available  in  the  com- 
lunity; 

Ml  three  authors  are  faculty  members  of  the 

kchool  of  nursing.  University  of  Alberta.  Jean- 

neltel.  Funke  (R.N..  ReginaGrey  Nuns  Hos- 

niial;   B.N.,  McGill;  M.Sc.   (Maternal-Child 

sing),  U.  of  Colorado)  is  assistant  profes- 

Helen  Niskala  (R.N..  Toronto  Western 

^pilal;  B.N.,  McGill;  M.Sc.  in  Nursing,  U. 

i  Calif. .  San  Francisco)  is  associate  professor; 

the  lime  the  article  was  written,  she  was 

rdinalor  of  undergraduate  programs  in  the 

^mg  school.  Peggy-Anne  Field  (R.N.  and 

M.,  England;  B.N.,  McGill;  M.N.,  Uni- 

Miy  of  Washington)  is  associate  professor 

id  Cdordinalor  of  special  programs. 

"HE  CANADIAN  NURSE  -  Juty  1975 


n  With  use  of  a  slide  carousel  and  audio 

cassette,  risk  of  damage  or  loss  is  minimal; 

and 

D  Transportation  to  outlying  areas  is  easy, 

and  mailing  costs  are  low. 

We  reduced  wastage  of  photographers" 
time  and  film  by  using  a  script,  which 
identified  the  number  and  type  of  slides 
required.  These  included  action  pictures, 
graphics,  and  cartoons.  The  committee 
identified  major  knowledge  areas,  skills, 
and  attitudes  for  each  year  of  the  B.Sc.N. 
program,  and  selected  appropriate  situa- 
tions for  photography.  We  used  graphics 
to  identify  course  content,  admission  re- 
quirements, alternative  routes  to  R.N.  and 
B.Sc.N.,  and  job  opportunities.  We  kept 
printed  information  brief  to  facilitate  the 
student's  ability  to  focus  on  the  pictorial 
and  narrative  content  of  the  slide-tape. 

The  slide-tape  is  16  minutes  in  length, 
with  60  slides  in  a  carousel  and  audio  on  a 
taped  cassette.  Production  costs  were 
about  $1.20  per  slide.  The  initial  cost  is 
high,  because  at  least  4  pictures  must  be 
shot  to  obtain  one  that  is  of  acceptable 
quality.  Reproduction  of  a  second  kit  runs 
to  $0.30  per  slide.  The  carousel  for  as- 
sembling the  slides  costs  $4.60. 

The  narrative  was  recorded  on  a  master 
reel-to-reel  tape  ($4.50)  and  transferred  to 
a  20-minute  cassette  ($2.00).  A 
technician's  help  in  recording  is  essential; 
high-quality  sound  is  necessary  if  the  tape 
is  to  be  used  in  a  large  auditorium.  This 
assistance  can  be  kept  to  a  minimum, 
however,  if  music  is  preselected  and  narra- 
tive is  well  scripted  and  rehearsed. 

The  audio  section  takes  the  form  of  an 
interview  in  which  a  faculty  member  talks 
with  a  prospective  student  and  a  graduate 
of  the  program.  They  exchange  informa- 
tion in  an  informal  manner,  with  musical 
interludes  to  provide  a  variety  of  pace.  We 


chose  music  with  the  audience  in  mind;  it 
reinforces  the  attitudes  being  presented. 

Although  the  initial  production  required 
heavy  time  input,  this  has  been  recovered; 
the  package  has  reduced  the  need  for  fa- 
culty involvement  in  high  school  recruit- 
ment programs. 

The  university  liaison  officer  takes  the 
slide-tape  series  on  his  visits  to  high 
schools.  He  does  not  have  a  nursing  back- 
ground but,  with  the  school  of  nursing 
calendar  and  a  general  information  sheet, 
the  slide-tape  appears  to  provide  sufficient 
information  for  students.  He  informs 
prospective  students  that  we  require  an 
interview,  and  gives  them  the  phone 
number  to  call  if  they  wish  to  follow  up  to 
get  more  information  and/or  make  applica- 
tion. So  far,  the  high  school  liaison  officer 
has  not  reported  any  difficulties  in  provid- 
ing specific  information  about  nursing. 

In  addition  to  its  use  in  high  schools,  the 
school  of  nursing  faculty  has  used  the 
slide-tape  kit  for  freshman  and  facuhy 
orientation,  in  alumae  activities,  such  as 
the  50th  anniversary  program,  and  in  in- 
forming diploma  nursing  students  and 
other  interested  citizens  about  bac- 
calaureate nursing  programs. 

Potential  uses  of  the  slide-tape  are  to 
inform  prospective  faculty  about  the  bac- 
calaureate programs,  and  to  communicate 
curriculum  changes  to  alumnae. 

Problems  encountered  in  its  use  have 
been  minimal:  a  broken  carousel  tray  and 
three  bent  slides.  Independent  use  of  the 
slide-tape  in  outlying  regions  of  the  pro- 
vince by  individuals  and  groups  will  de- 
pend on  the  availability  of  synchronizer 
equipment  and  personnel  familiar  with  the 
operation  of  the  synchronizer.  <^ 


27 


'Trom  Uppincott 


TEXTBOOK  OF  MEDICAL-SURGICAL  NURSING 

By  Lillian  S.  Brunner,  R.N.,  M.S.;  Doris  S.  Suddarth,  R.N.,  B.S.N.E.,  M.S.N. 

Outstanding  in  its  depth  of  scientific  content  and  in  the  practicality  of  its  ap 
cation,  this  leading  text  has  been  heavily  revised  and  updated,  with  much  r 
material.  In  the  unit.  Assessment  of  the  Patient,  three  new  chapters  have 
added:  Clinical  Interviewing  of  Patients;  Physical  Examination  by  the  Nurse,  .  _ 
Guidelines  for  Writing  Problem-Oriented  Records  to  promote  continuity  of  patijit 
care.  Other  new  chapters  include  Care  of  the  Cardiovascular  Surgical  Pati(jt, 
and  The  Person  Experiencing  Pain.  Nursing  management  in  various  cliniM 
situations  is  frequently  outlined  in  tabular  form.  [ 


i-'S^S 


rfli 


519.75 


Illustrated 


1975 


3rd  Edil'n 


A  GUIDE  TO  PHYSICAL  EXAMINATION  ' 

By  Barbara  Bates,  M.D. 

An  expertly  illustrated,  "how-to"  text  that  bridges  the  gap  between  anatomy  ijd 
physiology  and  their  application  to  the  physical  examination.  Within  each  regjn 
or  system  three  topics  are  presented:  1)  anatomy  and  physiology  basic  to  le 
examination,  2)  examination  techniques,  3)  examples  of  selected  abnormalitL 


$18.75 


Illustrated 


1974 


375  Pai  8 


MASSACHUSETTS  GENERAL  HOSPITAL  MANUAL  Ol^l 
NURSING  PROCEDURES 

By  Department  of  Nursing,  M.G.H.  { 

General  procedures  for  efficient  and  effective  patient  care  are  covered,  as  wel  s 
more  specialized  material  on  cardiac  (including  cardiopulmonary  resuscitati<l), 
respiratory,  urological,  ostomy,  neurological,  orthopedic,  eye,  ear,  and  nose,  bip, 
and  psychiatric  nursing  care.  All  procedures  are  presented  in  a  clear,  step-^ 
step  format.  When  necessary,  notes  stressing  the  rationale  behind  a  participr 
step,  critical  techniques,  and  specific  notes  on  good  care  are  also  offered.  '  e 
content  of  this  book  has  been  rigorously  tested,  reviewed  by  specialists,  :  d 
approved  by  a  board  of  reviewers  from  the  medical  and  nursing  staffs  at  le 
Massachusetts  General  Hospital.  i 


$8.95 


Illustrated 


1975 


389  Pass 


SCIENTIFIC  FOUNDATIONS  OF  NURSING 

By  Madelyn  T.  Nordmark,  R.N.,  M.S.  (N.E.)  and  Anne  W.  Rohweder,  R.N.,  M.N. 

This  thoroughly  revised  edition  applies  the  principles  and  facts  from  the  l> 
physical,  social  and  behavioral  sciences  to  clinical  nursing.  It  is  expressly  p- 
signed  to  aid  the  student  in  developing  a  greater  understanding  of  the  releva-f 
of  science  content  to  effective  nursing  care. 


About  $6.95 


3rd  Edition,  1975 


About  480  Pais 


Leadership  in  learning. 


:are  of  the  adult  patient 

/iedical-Surgical  Nursing 

Jy  Dorothy  W.  Smith,  R.N.,  Ed.D. ;  Carol  P.  Hanley 
Jermain,  R.N.,  M.S. 

K  superbly  useful  tool  for  nursing  education  and  prac- 
;ice,  this  well  established  text  has  been  massively 
levised,  updated  and  expanded,  and  provides  an  au- 
ihoritative  basis  for  understanding  the  patient's  thera- 
jieutic  regimen,  including  surgery,  drugs,  nursing 
jntervention  and  rehabilitation.  The  nursing  process  is 
stressed  and  pathophysiologic  content  has  been 
expanded.  Each  chapter  emphasizes  assessment  of 
he  physical,  emotional  and  social  needs  of  the  patient 
ind  his  family.  New  chapters  include  The  Nursing 
'rocess,  Nursing  Assessment,  and  The  Development 
'rocess. 

ivbout  $19.00        Illustrated       1975  4th  Edition 

SASIC  PEDIATRICS  FOR  THE 
>RIMARY  HEALTH  CARE  PROVIDER 

iy  Catherine  DeAngelis,  M.D.,  R.N.,  M.P.H., 
Ihe  goal  of  this  innovative  new  paperback  textbook  is 
10  impart  specific,  pertinent  knowledge  from  the  broad 
'ield  of  pediatrics  that  will  be  useful  to  nonphysicians 
ii/ho  function  as  primary  health  providers.  The  material 
5  organized  into  four  general  areas.  Part  I,  Date  Base, 
(liscusses  history-taking,  physical  examination,  screen- 
ng  tests,  and  the  problem-oriented  record.  Part  II, 
herapy,  covers  immunizations  and  nutrition.  Part  III 
letails  Common  Signs,  Symptoms  and  Diseases  and  is 
iirganized  by  organ  systems.  Three  special  chapters 
-on  allergies;  on  acute,  benign,  and  communicable 
ABC)  diseases;  on  streptococcal  illnesses  and  com- 
ilications  —  will  be  of  particular  interest.  Part  IV, 
'robiems  of  Behavior,  considers  both  ctiildhood  and 
idolescence. 


9.95 


lustrated 


1975 


397  Pages 


MANUAL  OF  MEDICAL 
THERAPEUTICS 

:1st  Edition 

!)y  Washington  University  Department  of  Medicine 

')ne  of  the  most  widely  read,  used,  and  respected 
'eferences  in  medical  literature.  It  contains  information 
')n  the  most  important  group  of  drugs  —  their  prepar- 
ition,  dosages,  side  effects,  and  clinical  applications. 
i>7.95  455  Pages 

MANUAL  OF  PEDIATRIC 
THERAPEUTICS 

iy  Children's  Hospital  Medical  Center,  Boston 

\  new  and  essential  counterpart  to  the  Washington 

Jniversity   MANUAL   OF   MEDICAL   THERAPEUTICS. 

A/ritten  by  house  officers  and  staff,  it  provides  specific, 

ip-to-date  information  on  all  pediatric  therapy,  includ- 

fig  new  and  old  drugs,  when  to  administer  them,  and 

n  what  dosages. 

98.95  525  Pages 

Lippincott 


THE  LIPPINCOTT  MANUAL  OF 
NURSING  PRACTICE 

By  Lillian  S.  Brunner,  R.N.,  M.S.;  and  Doris  S.  Suddarth, 
R.N.,  M.S.N. ;  with  four  co-authors,  three  contributors. 

This  now-famous  ready  reference  puts  virtually  all  of 
nursing  right  at  your  fingertips!  In  three  major  units 
.  .  .  medical/surgical,  maternity,  pediatric  .  .  .  this 
unique  book  presents  clinical  problems,  their  causes, 
manifestations,  potential  complications,  plus  overall 
nursing  management  in  concise,  outline  form  ...  in- 
stant information  you  can  put  to  immediate  use.  With 
Capsule  Guidelines  to  Nursing  Action,  Nursing  Alerts, 
Sections  on  Pharmacology  and  Medication,  and  much, 
much  more! 
$21.50  Profusely  Illustrated  .1974  1473  Pages 

PHYSICAL  APPRAISAL  METHODS 
IN  NURSING  PRACTICE 

By  Josephine  M.  Sana,  R.N.,  and  Richard  D.  Judge, 

M.D. 

Eighteen  contributing  authors,  all  experts  in  their  fields, 
have  written  a  comprehensive  survey  on  all  aspects  of 
physical  examination  and  appraisal.  Each  of  the  body 
systems  is  extensively  covered  with  step-by-step  in- 
structions on  procedures  for  conducting  examinations. 
There  is  also  a  unique  section  on  age-group  consider- 
ations in  physical  appraisal. 
$9.50  (paper)  $14.50  (cloth)  Illustrated,  1975  402  Pages 

CONTEMPORARY  COMMUNITY 
NURSING 

By  Barbara  Walton  Spradley,  R.N.,  M.N. 
This  multi-author  volume  brings  together  the  innovative 
thinking  and  practical  guidance  of  practitioners  and 
educators  in  many  specialties,  while  at  the  same  time 
demonstrating  the  interrelationships  among  the  com- 
munity-based nurse's  wide-ranging  new  activities. 
$9.95  1975  467  Pages 

CLINICAL  PHARMACOLOGY  IN 
NURSING 

By  Morton  J.  Rodman,  B.S.,  Ph.D.  and  Dorothy  W. 

Smith,  R.N.,M.A.,  Ed.D. 

This  entirely  new  text  by  the  authors  of  Pharmacology 
and  Drug  Therapy  in  Nursing  offers  quick  access  to  in- 
formation needed  for  expert  patient  care.  Essential 
scientific  material  is  clearly,  concisely  presented.  Drug 
Digests  at  the  end  of  each  chapter  include  data  on 
dosage,  administration,  adverse  effects,  indications 
and  contraindications  for  specific  drugs.  Factual  data 
and  fundamental  principles  are  presented  in  tables 
and  summaries. 
$11.75  1974  701  Pages 

included:  NURSES'  GUIDE  TO  CANADIAN  DRUG 

LEGISLATION 

By  David  R.  Kennedy,  Ph.D. 

This  pamphlet  outlines  the  history  and  application  of 

the  Food  and  Drugs  Act  and  Regulations  of  Canada 

and   the    Narcotic   Control   Act   and   Regulations   of 

Canada. 


J.  B.  LIPPINCOTT  COMPANY  OF  CANADA  LIMITED 

SERVING  THE  HEALTH  PROFESSIONS  IN  CANADA  SINCE  1897 
75  HORNER  AVE  .  TORONTO.  ONTARIO   M8Z  4X7       (416)  252-5277 


Is  the  postpartum  period  a  time  of  crisis 


for  some  mothers? 


A  study  of  six  mothers  showed  that  those  who  perceived  few  problems  during  hospitalization  had 
fewer  problems  when  they  returned  home.  On  the  other  hand,  the  mothers  who  perceived  many 
problems  while  in  hospital,  continued  in  this  fashion  after  discharge. 

Lorraine  Melchior 


Traditionally,  the  arrival  of  children  has 
been  highly  valued  in  society,  and  has 
been  seen  as  an  integrating  factor  that  in- 
creases the  bonds  between  marriage  part- 
ners. Nonetheless,  the  birth  of  a  child  gen- 
erates a  multitude  of  changes  in  a  mar- 
riage, and  many  biologic,  emotional,  and 
social  adjuslmenis  are  essential.  Due  to  the 
number  of  changes  in  the  puerperium,  one 
might  question  if  individuals  are  more  sus- 
ceptible to  crisis  at  this  lime  than  at  some 
other  periods  of  life. 

The  purpo.se  of  this  study  was  to  ex- 
amine the  problems  encountered  by 
mothers  in  the  puerperium  and  to  see  if 
they  viewed  this  period  as  a  time  of  crisis. 
If  this  were  the  case,  there  were  implica- 
tions for  nursing  intervention. 

The  sample 

A  convenience  sample  of  three 
primiparas  and  three  multiparas  was 
selected,  based  on  the  criteria  of  a  vaginal 
delivery  with  no  serious  medical  problems 
of  either  the  babies  or  their  mothers.  The 
mothers  were  contacted  and  interviewed 
once  in  the  hospital  and  three  times  in  their 
homes  during  the  six-week  period  —  in  the 
first,  second,  fourth,  and  sixth  week  post- 
partum. 

A  semi-structured  interview  guide  was 
used  to  explore  the  problems  associated 
with  the  functions  of  the  nuclear  family. 

Lorraine  Melchior  (RN,  Victoria  Hospital 
School  ol" Nursing.  London,  Ontario;  B.Sc.N.. 
University  of  Weslern  Ontario)  has  completed 
the  M.Sc.N.  program  at  the  University  of 
Western  Onlurio.  Before  beginning  her  studies, 
she  was  emplo\ed  b>  the  L'wo  facullv  of  nurs- 
ing as  a  leelurer  in  maternal-child  health  nurs- 
ing and  community  health  nursing. 

30 


The  mothers  were  asked  if  they  perceived 
the  puerperium  to  be  a  time  of  crisis.  Crisis 
was  defined  as  a  period  that  is  unsettled. 
At  this  time  the  mother  might  find  it  more 
difficult  to  solve  problems  and  might 
query  if  life  would  ever  be  .settled  again. 

Crisis  theory 

Crises  have  been  categorized  into  two 
typ)es:  developmental  or  maturational.  and 
situational  or  accidental.  The  developmen- 
tal crises,  examples  of  psychosocial 
growth,  are  stages  of  the  normal  life  cycle 
and  are  periods  of  physical,  psychologi- 
cal, and  social  changes  that  are  accom- 
panied by  disturbances  of  thought  and  feel- 
ing. The  adjustment  to  parenthood  could 
be  considered  a  major  example  of  a  de- 
velopmental crisis. 

Caplan  has  postulated  that  the  essential 
factor  influencing  the  occurrence  of  crisis 
is  an  imbalance  between  the  difficulty  and 
importance  of  a  problem  and  the  im- 
mediate resources  available  to  cope  with 
it.*  He  stales  thai  the  following  critical 
factors  might  influence  a  crisis  outcome: 
the  bodily  state  of  the  individual  at  the 
time,  the  "chance""  aspects  of  the  de- 
velopment of  external  stress,  the  availabil- 
ity of  external  social  resources,  and  the 
personality  of  the  individual.*  * 

In  light  of  the  above  factors,  it  seems 
appropriate  to  consider  crisis  theory  as  a 
viable  approach  to  the  study  of  the  family 
at  the  lime  of  childbirth.  The  bodily  state 
of  the  mother  is  in  an  upheaval.  Since 
many  families  in  contemporary  society  are 

*  Gerald  Caplan.  An  Approach  ro  Community 
Mental  Health.  New  York,  Grune  and  Slrallon, 
1961.  pp.  3941. 

*  *  Ibid. 


mobile,  the  extended  family  might  not  K 
available  at  this  lime  to  act  as  a  resource 
The  personality  of  the  mother  would  aisc 
be  an  important  factor.  The  mother's  rok 
in  the  family  is  pivotal;  therefore,  if  she 
experiencing  crisis,  the  whole  family  w  ,; 
be  influenced. 

Characteristics  of  crisis  state 

Crisis  is  self-limiting  in  a  tempora 
sense,  as  it  cannot  continue  indefinitely.  Ir 
general,  crisis  lends  to  last  from  one  to  si^ 
weeks. 

Caplan  has  delineated  four  stages  in  thi; 
process:  During  phase  one,  the  stimulus 
evokes  the  habitual  problem-solving  re- 
sponses of  homeostasis.  In  phase  two,  one 
witnesses  a  lack  of  success  in  the 
problem-solving  responses.  There  is  i 
continuation  of  the  stimulus,  which  is  as 
socialed  with  a  rise  in  tensions. 

During  phase  three,  the  individual  calls 
on  reserves  of  strength  and  emergencs 
problem-solving  mechanisms.  Novel 
methods  to  attack  the  problem  might  be 
u.sed,  or  the  individual  might  define  the 
problem  in  a  new  way  so  that  it  comes 
within  the  range  of  previous  experient 
Phase  four  occurs  if  the  problem  continue  - 
and  can  neither  be  .solved  with  need  satis- 
faction, nor  avoided  by  need  resignation. 
At  this  lime,  tension  mounts  further  and  a 
major  disorganization  might  occur. t 

During  a  lime  of  crisis,  old  problems 
might  surface  and  new  problems  might  be 
experienced.  There  is  the  possibility  at  tl 
lime  of  novel  solutions  that  might  go  ii 
healthy  or  unhealthy  direction.  Howe\. 
a  person  who  is  in  a  state  of  disequilibriun; 
is  more  susceptible  to  influence  than  .ii 

t  Caplan,  An  Approach  to  .  .  .  loc.  cil. 


THE  CANADIAN  NURSE  —  July  1975 


f. 


^ 


/ 


other  (imes.  Therefore,  individuals  and 
families  are  emolionally  accessible  to 
help;  this  makes  the  liming  of  intervention 
of  strategic  importance. 

Problems  related  to  puerperium 

Mothers  were  first  interviewed  on  the 
third,  fourth,  or  fifth  day  of  the  postpar- 
tum. Most  of  their  concerns  were 
physiological.  The  common  problems 
cited  were:  tender  episiotomy.  abdominal 
pain,  constipation,  hemorrhoids,  en- 
gorged breasts,  depression,  fatigue,  lone- 
liness due  to  absence  of  husband  and  chil- 
dren, apprehensions  related  to  baby  care, 
and  "nervousness."  The  number  of  prob- 
lems ranged  from  6  to  17. 

The  second  series  of  interviews  took 
place  during  the  mothers'  first  week  at 
home.  At  this  lime  the  problems  they  ex- 
perienced included:  backache;  constipa- 
tion; leaking  breasts;  lack  of  appetite; 
fatigue;  severe  depression;  problems  re- 
lated to  baby  care,  such  as  diaper  rash  and 
"fussy  periods";  feelings  of  being  "tied 
down";  excessive  visitors;  mother-in-law 
problems;  tensions  due  to  abstinence  of 
sexual  intercourse;  guilt  feelings  due  to 
lack  of  lime  for  other  children;  frustrations 
because  of  lack  of  energy  for  housework; 
concerns  related  to  birth  control  measures; 
financial  problems;  and  distress  caused  by 
health  care  workers.  The  range  in  the 
number  of  problems  was  from  6  to  19, 
with  many  concerns  still  focused  on  the 
physical  and  emotional  problems.  There 
was  the  added  dimension  of  the  social 
problems. 

During  this  visit,  3  mothers  perceived 
the  period  to  be  a  time  of  crisis  for  them- 
selves and  for  the  family.  Interestingly, 
the  three  mothers  who  did  not  perceive  a 
crisis  situation  had  encountered  the  fewest 
number  of  problems  in  hospital. 

The  third  series  of  interviews  transpired 
in  the  homes  during  the  fourth  week  post- 
partum. The  following  problems  were 
cited:  constipation;  backache;  inability  to 
lose  weight;  fatigue;  depression;  "nerv- 
ousness"; problems  related  to  the  baby, 


such  as  colic,  diaper  rash,  and  diet;  con- 
cerns about  babysitters;  tensions  due  to 
abstinence  of  sexual  intercourse;  and  con- 
cerns regarding  family  planning.  The 
number  of  problems  ranged  from  3  to  25, 
with  many  of  the  problems  related  to  baby 
problems  and  problem  areas  associated 
with  sexual  relations. 

During  this  visit,  the  same  3  mothers  as 
previous  continued  to  perceive  the  period 
as  one  of  crisis  magnitude.  The  other  3 
slated  that  it  was  not;  this  might  be  because 
they  had  planned  the  pregnancy.  All 
6mothers  stated  that  Ihey  had  the  assis- 
tance of  their  husbands. 

The  final  interviews  occurred  during  the 
sixth  week  postpartum.  The  problems 
cited  were:  discomfort  during  voiding;  de- 
pression; fatigue;  baby  problems,  includ- 
ing diaper  rash  and  "irritable"  baby;  feel- 
ings of  being  "tied  down";  unable  to  be 
"self;  unable  to  go  to  work  due  to 
husband's  negative  feelings;  disorganiza- 
tion in  the  home;  concerns  about  future 
pregnancy;  method  of  family  planning  un- 
resolved; dyspareunia;  and  distress  caused 
by  health  care  workers  due  to  poor  com- 
munications. The  number  of  problems 
ranged  from  2  to  17.  In  this  series  of  inter- 
views, there  was  again  a  focus  on  the  prob- 
lems associated  with  sexual  relations  as  a 
function  of  the  nuclear  family. 

During  the  final  interview,  5  of  the  6 
mothers  staled  thai  it  was  nol  a  crisis  situa- 
tion at  this  time.  One  mother,  a  primipara 
who  had  not  perceived  a  crisis  situation 
previously,  stated  that  she  now  experi- 
enced a  crisis.  She  fell  "tied  down"  and 
could  not  be  herself.  She  stated  that  she 
wanted  to  run  away  at  this  time.  It  should 
be  noted  that  2  mothers,  1  multipara  and  1 
primipara,  never  p>erceived  the  puer- 
perium to  be  a  lime  of  crisis. 

Major  findings 

This  small  study  of  6  mothers  revealed 
that  the  2  mothers  —  1  primipara  and  1 
multipara  —  who  perceived  the  fewest 
number  of  problems  during  hospitaliza- 
tion, continued  in  this  fashion  at  home.  At 


no  time  during  the  puerperium  did  these 
mothers  perceive  a  crisis  situation.  Als 
all  6  participants  believed  that  they  h; 
assistance  and  support  from  their  hu 
bands,  throughout  the  entire  period. 

Conclusions  and  implications 

Nurses  who  care  for  mothers  in  ti 
postpartum  period  should  be  sensitive 
the  problems  that  their  patients  experien 
in  hospital.  It  seems  reasonable  that  a  r 
ferral  to  the  community  health  nurse  cou 
be  made  for  those  mothers  who  perceive 
large  number  of  problems  while  in  hosf 
lal.  The  community  health  nurses  cou 
assess  the  need  for  further  visits  after  tl 
first  home  contact. 

It  is  recommended  that  these  nurses  i 
terview  all  mothers  to  assess  the  numb 
and  types  of  problems  encountered  durir 
hospitalization.  Since  some  mothers  pe 
ceive  childbirth  to  be  a  time  of  crisis  for  til 
family,  nurses  who  are  working  with  pr 
and  postnatal  patients  might  find  a  study 
crisis  intervention  theory  beneficial  to  u 
derstand  the  family  and  the  assistance  tht' 
require. 

Summary  | 

This  was  a  small  descriptive  study  d! 
signed  to  discover  the  problems  encini 
tered  by  3  primiparas  and  3  multipara 
during  the  6  weeks  following  the  birth  > 
their  babies.  The  size  and  type  of  samp 
allows  no  generalizations  to  larger  group' 
Since  many  problems  surfaced  for  the 
few  families,  nurses  should  continue 
explore  this   maturational  period   in  tl 
family's  growth  cycle  to  develop  a  great' 
understanding  of  their  potential  nursir 
intervention  role. 


Cystic  fibrosis 


Cystic  fibrosis,  whether  it  is  called  fibrocystic  disease  of  the  pancreas, 
mucoviscidosis ,  or  simply  C.F..  is  a  condition  that  currently  afflicts  one  in  every 
2,500  children.  A  glimpse  of  this  disease  is  gained  through  the  experience  of 
Amelia,  one  of  its  victims. 


Ange-Aimee  Marcotte 


Six-year-old  Amelia,  the  younger  of  two 
children,  was  admitted  to  hospital  because 
her  general  condition  was  deteriorating. 
Diagnosed  at  birth  as  a  victim  of  cystic 
fibrosis,  she  had  already  been  hospitalized 
elsewhere. 

She  seemed  tired,  was  pale,  with 
slighdy  cyanosed  lips,  and  had  difficulty  in 
breathing,  judging  from  the  flaring  of  her 
nostrils  and  the  intercostal  indrawing. 
Her  mother  stated  that,  for  the  two  weeks 
prior  to  admission,  Amelia  had  coughed 
constantly,  expectorating  thick,  greenish 
mucus  that  was  sometimes  accompanied 
by  vomiting. 

The  nurse  made  a  few  observations  of 
her  own,  based  on  her  knowledge  of  the 
disease,  before  making  a  plan  of  care  for 
the  child. 


The  disease 

The  name,  cystic  fibrosis.  (CF)  was  in- 
troduced in  1936  by  Guido  Fanconi.  a 
Swiss  doctor,  following  discoveries  that  a 
certain  jjercentage  of  children  who  died  at 


Ange-Aimee  Marcolle  (BSc.inf.,  Laval  U.. 
Quebec)  is  head  nurse,  pediairic  adolesceni  ser- 
vices. Hospital  Centre  of  Laval  University. 
Marie-France  Ebacher  (B.Sc.inf..  Laval  U.) 
and  Harriet  Gravel  (Reg. N..  Cornwall  General 
Hospital  school  of  nursing.  Cornwall.  Oni.) 
who  are  on  staff  at  the  Centre,  contributed 
background  material.  This  article  has  been 
translated  and  adapted  from  the  original 
French  version. 


THE  CANADIAN  NURSE  —  July  1975 


an  early  age  had  common  symptoms: 
diarrhea,  growth  problems,  and  repeated 
pulmonary  infections.'  The  name, 
mucoviscidosis,  was  suggested  when  re- 
searchers observed  the  abnormal  character 
of  the  mucous  secretions  in  such  patients. 

Cystic  fibrosis  is  actually  a  generalized 
disorder  that  affects  the  exocrine  glands  of 
the  body,  causing  them  to  secrete  abnor- 
mally thick,  viscous  mucus. ^  The  pan- 
creas, the  liver,  the  sudoriparous,  and  the 
salivary  glands  are  most  severely  affected. 
(see  illustration) 

Mucus,  which  lubricates  and  protects 
the  lining  of  mucous  membranes,  is  nor- 
mally excreted  and  carries  various  foreign 
bodies  with  it.  like  a  coiitinuous  belt.'  In 
mucoviscidosis,  secretions  of  mucus  in- 
crease and  thicken  in  consistency,  so  that 
organ  passages  tend  to  become  distended 
and  eventually  blocked.  Adjacent  tissues, 
deprived  of  their  lubricant .  atrophy  and  are 
replaced  by  fibrous  tissue. 

The  condition  is  hereditary  and  is 
transmitted  as  a  recessive  mendelian  trait, 
unrelated  to  sex.  Thus,  when  a  child  is 
afflicted,  both  parents  must  be  carriers  of 
the  pathological  gene  (CF7CP).'* 

At  present,  it  is  not  possible  to  isolate 
the  carriers.  Some  authors  estimate  the 
incidence  of  the  disease  at  1:2500  births; 
others  set  the  figure  at  1: 1000.  Hence,  the 
number  of  carriers  would  be  1:20  to  1:50. 
The  racial  distribution  is  striking,  the 
highest  incidence  being  among 
Caucasians.  It  is  comparatively  rare  in 
Negroes  and  virtually  absent  in  Orientals.* 

33 


Amelia's  older  sister  appeared  healthy. 
She  could  be  a  carrier  of  CF  because  with 
each  pregnancy  there  is  a  2 :4  probability 
that  the  mother  will  bear  a  child  capable  of 
transmitting  the  condition.  The  chances  of 
giving  birth  to  a  child  afflicted  with  the 
condition  (1:4)  present  a  serious  birth 
control  problem  to  carriers.  Amelia's  par- 
ents had  already  decided  not  to  have  any 
more  children,  so  it  did  not  seem  neces- 
sary to  discuss  family  planning  with  them. 

Areas  affected 

Lungs 

Thick,  slimy  mucus  coats  and  clings  to 
the  cilia,  thus  impairing  normal  respira- 
tory function  and  impeding  the  usual  clear- 
ance of  waste  products  through  the  nose 
and  mouth.  This  leads  to  obstruction  of  the 
bronchial  passages  and,  subsequently,  to 
infection.  Atalectasis  may  develop  if  ob- 
struction is  complete.  Air  no  longer 
reaches  a  portion  of  (he  lung,  although 
circulation  of  the  blood  continues  as  usual. 

If  there  is  partial  obstruction  and  air  is 
retained  in  the  alveoli,  emphysema  re- 
sults. The  normally  elastic  fibers  of  the 
pulmonary  tissue  diminish  or  disappear. 
The  excessive  and  permanent  distention  of 
the  alveoli  that  is  associated  with  em- 
physema can  result  in  rupture  of  the  alveo- 
lar walls,  gaseous  infiltration  of  cellular 
tissue,  and  reduction  of  the  vascular  bed. 
Another  complication  may  be  spontaneous 
pneumothorax. 

Amelia  showed  the  physical  and  clinical 
signs  of  pulmonary  involvement.  Her 
slightly  distended  thoracic  cage  indicated 
emphysema,  which  was  confirmed 
radiologically . 

Bacteriological  examination  of  the 
sputum  usually  reveals  the  the  presence  of 
Staphylococcus  aureus  and  Pseudomonas, 
the  organisms  most  commonly  found  in 
these  patients.  Stagnating  secretions 
within  the  alveoli  and  the  bronchi  provide 
a  favorable  milieu  for  bacterial  growth. 
Bronchial  obstruction  and  a  superimposed 
infection  combine  in  a  vicious  cycle  to 
promote  destruction  of  the  alveoli  and  the 
parenchyma.  The  gradual  change  from 
normal  to  fibrous  tissue  in  the  lung  inter- 
feres with  gas  exchange  which,  in  turn, 
increases  the  work  of  the  heart.  At  this 
point,  signs  of  cor  pulmonale  or  right  car- 
diac insufficiency  and  chronic  pulmonary 
insufficiency  may  app>ear. 


Steinschneider  has  proposed  certain 
criteria  to  be  used  in  assessing  the  condi- 
tion of  a  patient  with  mucoviscidosis:* 

Primary  stage:  polypnea;  dry,  non- 
productive cough:  distress  on  expiration  of 
air;  and  decreased  physical  activity. 

Intermediate  stage:  irritability;  de- 
creased appetite;  productive  or  non- 
productive cough;  bronchial  rales;  lack  of 
weight  gain  or  emaciation;  early  signs  of 
emphysema;  increased  anteroposterior 
diameter  of  chest;  muffled  cardiac  sounds; 
and  lowered  diaphragmatic  arch. 

Advanced  stage:  extreme  fatigue;  min- 
imal physical  activity:  loss  of  weight  and 
appetite:  productive  cough,  frequently  ac- 
companied by  vomiting;  muscular  weak- 
ness; digital  clubbing;  dyspnea;  or- 
thopnea; intercostal  indrawing;  cyanosis; 
increased  signs  of  emphysema;  signs  of 
cardiac  insufficiency;  edema;  hepatomeg- 
aly; and  venous  distention. 

According  to  these  criteria.  Amelia  was 
between  the  intermediate  and  advanced 
stages. 

Sinuses 

Mucus  secreted  by  the  glands  of  the 
sinus  can  cause  obstruction  which,  in  turn, 
leads  to  the  development  of  polyps.  This 
interferes  with  nasal  breathing. 

Amelia  did  not  exhibit  any  upper  re- 
spiratory tract  involvement. 

Pancreas 

Fibrocystic  disease  of  the  pancreas 
rarely  affects  one  gland  only  or  a  single 
type  of  gland.  Generally,  all  glands  of  the 
digestive  tract,  especially  the  pancreas  and 
liver,  are  affected,  whether  one  at  a  time  or 
concurrently. 

In  cystic  fibrosis,  the  pancreatic  juice, 
due  to  its  increased  thickness  and  vi.scos- 
ity,  no  longer  releases  the  digestive  en- 
zymes, trypsin,  lipase,  and  amylase  into 
the  duodenum.  Obstruction  of  the  canals 
tends  to  occur,  and  while  they  are  becom- 
ing distended,  affected  tissues  atrophy  and 
are  replaced  by  fibrous  tissue.  Sometimes 
cy sis  form,  hence  the  name  cystic  fibrosis. 

With  pancreatic  involvement,  the  symp- 
toms are  as  follows:  slow  weight  gain  in 
spite  of  a  voracious  appetite;  increase  in 
frequency  of  bowel  movements;  massive, 
foul-smelling  stools  with  fatty  deposits 
(steatorrhea);  abdominal  distention;  rectal 
prolapse,  abdominal  cramps,  and  foul- 
smelling  flatus  in  advanced  states  of  mal- 


nutrition; muscular  hypotonia;  and  inics 
nal     obstruction     with     or     withoi 
intussusception.^  i 

Amelia  had  two  or  three  large,  fn 
smelling  bowel  movements  with  fatty  a 
posits  every  day.  She  ate  large  amounts 
food  and  craved  sweets  but,  in  spite  ofh 
enormous  appetite,  she  gained  very  liii 
weight. 

Liver 

Hepatic  involvement  —  obstruction 
the  biliary  canals  due  to  increased  bi 
viscosity  —  leads  to:  deficiency  of  vit 
mins  A,  D,  E,  and  K  through  insufficiem 
of  biliary  salts  and  probable  lack  of  pa 
crealic  lipase:  malabsorption  of  fats  duo 
enzymatic  malfunction:  and  hepalomega 
as  a  result  of  distention  of  excretory  canj 
and  degeneration  of  liver  tissue;  with  su 
sequent  venous  stasis  and  portal  hyperie 
sion. 

Amelia  did  not  show  signs  of  liver  i 
volvement. 

Sudoriparous  glands 

The  physiopathology  of  the  conditi( 
where  the  sudoriparous  glands  are  i 
volved  is  poorly  understood.  The  ma 
Symplons  are  excessive  perspiration  a^ 
increased  concentration  of  certain  electr 
lytes  in  the  sweat.  Studies  show  increasi 
levels  of  Na+ ,  K+  ,  and  CI   . 

Parents  comment  on  the  sally  taste  if 
contact  with  their  child's  skin.  This  is  oii 
of  the  most  consistent  aspects  of  the  di 
ease  and  need  not  be  alarming  if  one  bea 
in  mind  that  profuse  perspiration  in  ai 
child  (from  heat  or  vigorous  exercise)  < 
dehydration  (from  diarrhea,  vomiting.  ■ 
fever)  can  bring  about  circulatory  collap 
or  electrolytic  imbalance. 

Amelia  drank  a  great  deal,  but  per 
pired  profusely  in  spite  of  wearing  lie 
clothing . 

Salivary  glands 

Secretions    from    the    salivary    glani 
show    increased    electrolytes.    Saliva 
thicker  and  more  abundant  than  normal 

Diagnostic  base 

The  main  tools  in  diagnosing  cystic  fi 
rosis  are:  patient's  history,  physical  e 
amination,  and  biochemical  analysis  > 
stools.  The  sweat  test  is  a  most  useful  on^ 
It  is  considered  to  be  positive  when  '' 
level  of  chloride  is  greater  than  60nil 


Drawings  by  Catherine  Hall, 
Graphic  Arts  Department,  CHUL. 


Frontal  sinus 


Right  bronchus, 
Terminal  bronchiole 
Alveolus 


Duodeum 


=EPIDERMUS 


^Sudoriparous  gland 


35 


THE  CANADIAN  NURSE  —  July  1975 


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36 


or  of  sodium  is  greater  than  70  mEq/1. 
There  may  be  slight  variations,  depending 
)on  the  technique  used. 
I  In  Amelia's  case,  diagnosis  was  made 
shortly  after  birth  during  an  emergency 
hospitalization  for  meconium  ileus,  which 
is  one  of  the  earliest  manifestations  of 
mucoviscidosis.  Her  signs  and  symptoms 
included  abdominal  distention  from  ac- 
cumulated meconium,  vomiting,  and  the 
^inability  to  evacuate  meconium. 

;  Prognosis 

I  Prognosis  depends  on  the  severity  of  the 
Icondition.  on  how  soon  diagnosis  is  made, 
land  on  the  early  initiation  of  a  lifetime 
jprogram  of  patient  therapy.  It  has  been 
jreported  that  50  percent  of  afflicted  chil- 
dren die  before  they  reach  10  years  of  age 
and  80  percent  before  the  age  of  20. 

Sometimes  the  disease  progresses  re- 
lentlessly, marked  by  augmenting  symp- 
toms, in  spite  of  intensive,  carefully  pre- 
scribed treatment.* 

Therapy 

Essentially,  treatment  is  designed  to  re- 
lieve symptoms  and  prevent  progress  of 
the  disease.  The  objectives  are  as  follows: 

1.  To  ensure  good  nutrition  through: 

Adequate  protein  intake. 

•  Additional  fluids  containing  electro- 
lytes, such  as  juices  and  carbonated  be- 
verages, particularly  if  there  is  profuse 

L  sweating. 
Pancreatic  enzyme  preparations,  such 
as  Cotazym,  to  replace  those  that  do  not 
reach  the  duodenum. 

•  Supplementary  bile  salts  (Accelerase  or 
Cotazym  B)  where  there  is  hepatic  in- 
volvement and  the  normal  bile  is  not 
reaching  the  duodenum. 

. !•  Supplementary  vitamins  (A,  D,  E,  K,) 
in  a  water-soluble  base  to  facilitate  ab- 
sorption where  there  is  a  shortage  of 
i  pancreatic  lipase  and  biliary  salts. 
2.  To  prevent  pulmonary  infection 
hrough: 
I  Postural  drainage,  aided  by  such  tech- 
niques as  tapotement  and  vibration,  to 
encourage  drainage  and  expectoration 

^of  secretions  and  thus  prevent  infection 
and  obstruction. 
Abundant  fluid  intake  to  ensure  li- 
quefaction and  fluidity  of  pulmonary 
secretions,  and  the  maintenance  of  con- 
stant optimum  humidity  (more  than  60 
percent)  in  the  patient's  environment, 
t  Aerosol  therapy  to  help  liquefy  secre- 
'      tions. 

THE  CANADIAN  NURSE  —  July  1975 


•  Antibiotics  used  prophy tactically .  or  to 
treat  respiratory  tract  infections  (ad- 
ministered by  aerosol,  by  mouth,  or 
parenterally). 

•  Anti-influenzal  vaccines  to  help  pre- 
vent respiratory  tract  infections. 

3.  To  maintain  vital  functions  through: 

•  Symptomatic  treatment,  which  is  es- 
sential in  advanced  stages.  This  may 
involve  the  use  of  cardiac  stimulants 
such  as  digitalis,  oxygen  therapy,  and 
so  on. 

4.  To  respond  to  the  socioemotional 
needs  of  the  patient  and  give  emotional 
support  to  the  parents  in  their  efforts  to 
contribute  to  their  child's  welfare  by: 

•  Being  honest  with  both  the  child  and 
the  parents. 

•  Encouraging  frank  discussion  on  how 
they  are  coping  with  the  situation. 

•  Making  the  most  of  periods  of  remis- 
sion by  encouraging  the  child  and  his 
parents  to  plan  activities,  such  as  travel 
or  a  vacation,  that  they  can  enjoy  to- 
gether. 

•  Ensuring  consistency  by  all  members 
of  the  therapeutic  team  in  their  ap- 
proach to  the  parents  as  well  as  to  the 
patient. 

Multidisciplinary  team's  challenge 

Refusal  to  accept  the  diagnosis,  am- 
bivalence, and  insecurity  are  problems 
common  to  parents  of  children  suffering 
from  any  chronic  illness.  The  absence  of 
symptoms  or  complaints  of  emotional  dis- 
tress related  to  the  child's  organic  disease 
by  no  means  excludes  the  existence  of  the 
problem.'  it  is  difficult  to  determine  what 
type  of  parental  behavior  would  be 
considered  normal  under  such 
circumstances.'" 

The  team  members  must  offer  support 
to  the  parents.  The  team's  attitudes, 
whether  positive  or  negative,  influence  the 
parents'  current  and  future  expectations 
for  their  child.  Outside  help  is  needed  and 
this  presents  a  major  challenge  to  all  mem- 
bers of  the  therapeutic  team. 

In  Amelia's  case,  we  decided  to  etain 
only  the  portion  of  the  nursing  care  plan 
that  related  to  the  fourth  objective  of  care 
above. 

Comments 

Amelia  had  been  hospitalized  several 
times  prior  to  her  admission  to  our  hospi- 
tal three  years  ago.  Now  9  years  old,  she 
behaves  as  normally  as  her  sister.  She 
attends  classes  regularly  and  goes  on  trips 


with  her  family.  A  sustained  effort  has 
been  necessary  to  meet  the  challenges 
posed  by  her  needs.  It  is  only  through 
constant  cooperation  of  the  team  that 
Amelia  is  out  of  hospital  for  longer  and 
longer  periods  at  a  time . 

Each  team  member  has  been  aware  that 
the  parents'  adjustment  to  the  chronic  na- 
ture of  their  child's  illness  would  have  to 
be  achieved  in  stages,  over  a  series  of 
hurdles,  from  the  moment  the  diagnosis 
was  made,  confirmed,  and  accepted." 
The  periods  of  denial,  guilt,  or  ambival- 
ence vary  from  one  set  of  parents  to 
another.  Patience,  understanding,  mutual 
respect ,  and  honesty  combine  to  help  them 
accept  their  child  during  a  period  of  crisis 
or  revolt.  We  have  come  to  know  that 
treatment  improves  the  condition  of  a  child 
with  cystic  fibrosis,  and  prolongs  life. '  ^ 

References 

1.  Gardner,  Lytt  I.  Endocrine  and  genetic 
diseases  of  childhood.  Philadelphia, 
Saunders.  1969.  p.  991 

2.  Beimonle.  Mimi  Madeleine.  Cystic  fib- 
rosis: most  serious  lung  problem  in  Cana- 
dian children.  Toronto,  Canadian  Cystic 
Fibrosis  Foundation,  n.d.  p.   1 

3.  Beimonle.  Mimi  Madeleine.  Fibrose  kys- 
lique:  un  manuel  a  I '  intention  des  parents . 
Ville  Mont-Royal.  Quebec,  Association 
de  la  Maladie  Fibro-Kystique  du  Pancreas 
du  Quebec.  1968.  p.  2 

4.  Ibid.,  p.  6 

5.  Sieinschneider,  R.  Soins  el  observations: 
mucoviscidose.Somi  18:7:30.  sep.  1973. 

6.  Ibid.,  p.  25. 

7.  Beimonle.  Fibrose  kysiique:  un  manuel  a 
I' intention  des  parents,  p.  17. 

8.  Gilly.  R.  La  mucoviscidose.  Donnees 
palhogeniques  acluelles.  Annates  Fed. 
20:1:11,  Janv.  1973. 

9.  Tropauer,  Alan  et  al.  Psychological  as- 
pects of  the  care  of  children  with  cystic 
fibrosis.  Amer.  J.  Dis.  Child.  119:431, 
May  1970. 

10.  Ibid.,  p.  430. 

1 1 .  McCollum.  Audrey  T.  et  al.  Family  adap- 
tation 10  the  child  with  cystic  fibrosis.  J. 
Pediat.  77:4:572.  Oct.   1970. 

12.  Belmonte,  Mimi  Madeleine.  Aspects 
psychologiques  et  emotifs  de  la  fibrose 
kystique  du  pancreas.  Union  Med.  Can. 
98:1944,  nov.  1969.  'te? 


37 


names 


-L 


Virginia  Ann 
Lindabury  (RN, 
Toronto  General 
Hospital  School 
of  Nursing; 
B.scN.,  Univer- 
sity of  Western 
Ontario,  London, 
Ontario)  has  re- 
signed as  editor 
of  The  Canadian  Nurse,  effective  31 
August  1975.  Lindabury  began  her 
career  with  the  journal  as  an  assistant 
editor  in  1962,  and  became  editor  when 
Margaret  E.  Kerr  retired  in  1965. 

During  the  10  years  of  Lindabury 's 
editorship,  the  journal  office  moved 
from  Montreal  to  CNA  House  in  Ottawa; 
a  major  readership  survey  was  carried 
out;  the  journal  format  was  redesigned; 
and,  more  recently,  the  two  cna  jour- 
nals became  part  of  the  Canadian 
Nurses'  Association's  information  ser- 
vices department. 

Editorials  in  The  Canadian  Nurse 
were  first  signed  in  June  1967  and, 
since  then,  v.a  L.  has  written  over  85 
editorials  expressing  concise,  well- 
reasoned  views  on  nursing  and  health 
issues.  Her  editorials  on  such  topics  as 
the  physician's  assistant  and  the  ineq- 
uities of  the  Canada  Pension  Plan 
were  quoted  extensively  in  newspapers 
from  coast  to  coast,  including 
Toronto's  Globe  and  Mail,  the  Van- 
couver Sun,  andTheSi.  John's  Evening 
Telegram.  Lindabury  has  also  written  a 
number  of  articles  and  has  reported  on 
national  and  international  nursing 
meetings  for  The  Canadian  Nurse. 

Prior  to  joining  the  journal  staff,  she 
was  assistant  director —  nursing  educa- 
tion, Brockville  General  Hospital, 
Brockville.  Ont.;  and  instructor  in 
schools  of  nursing  at  the  Wellesley 
Hospital,  Toronto,  and  the  Royal  Vic- 
toria Hospital,  Barrie,  Ont.  She  has 
also  worked  as  a  staff  nurse,  a  camp 
nurse,  and  a  private  duty  nurse. 

Lindabury  is  a  member  of  the  Media 
Club  of  Canada  and  of  the  National 
Press  Club  of  Canada. 


Heather  Buchan  has  been  appointed 
public  information  officer  for  the  Sas- 
katchewan Registered  Nurses'  Associ- 
ation. Following  graduation  from  the 


University  of  Saskatchewan  and  jour- 
nalism studies  at  the  Southern  Alberta 
Institute  of  Technology  at  Calgary,  she 
was  an  information  officer  with  Envi- 
ronment Saskatchewan. 


Dorofhy    S.    Starr 

(B.A.,  Simpson 
College,  Indianola. 
Iowa;  M.N.,  Yale 
U.  school  of  nurs- 
ing. New  Haven, 
Conn.)  has  re- 
signed as  assist- 
ant editor  of  The 
Canadian  Nurse 
to  become  executive  director  of  the 
Ottawa  Distress  Centre. 

Her  career  has  included  positions  as 
assistant  professor  at  University  of 
Ottawa  school  of  nursing  and  principal 
of  the  Ottawa  Civic  Hospital  school  of 
nursing.  She  has  been  a  member  of  the 
board  of  directors.  Registered  Nurses 
Association  of  Ontario,  and  the 
Council  of  the  College  of  Nurses  ol 
Ontario. 

Starr  has  also  been  president  of  the 
board  of  the  Ottawa  Distress  Centre  and 
one  of  the  volunteers  who  provide 
telephone  crisis  intervention.  Several 
of  her  articles  have  appeared  in  The 
Canadian  Nurse  and  local  newspapers. 


Alice  K.  Smith  (R.N.,  Winnipeg  Gen- 
neral  Hospital  school  of  nursing; 
B.S.N. Ed..  Columbia  U.,  New  York; 
M.P.H.,  Yale  U.,  New  Haven,  Conn,) 
has  recently  retired  as  senior  consul- 
tant, nursing  services,  medical  services 
branch  of  Health  and  Welfare  Canada. 
She  has  been  as- 
sociated with  the 
federal  govern- 
ment since  1950, 
when  she  became 
public  health 
nursing  super- 
visor for  the  Cen- 
tral Region  Indian 
Health  Services, 
with  headquarters  in  Winnipeg.  Later, 
she  was  for  several  years  chief  nursing 
consultant  with  the  Indian  and  Northern 
Services  directorate  in  Ottawa  before 
becoming    senior    nursing    consultant 


with  the  Medical  Services  Branch. 

A  year  ago.  Smith  received  an 
achievement  award  for  her  contribution 
to  nursing  service  from  the  nursing 
education  alumnae  association  of 
Teachers  College,  Columbia  Univer- 
sity, New  York.  This  June,  an  honorary 
doctorate  in  nursing  was  conferred  on 
her  by  the  University  of  Ottawa. 


Margaret  McPhedran  (Reg.  N.,  Char- 
lotte'E.  Englehad  Hospital,  Petrolia. 
Ont.;  B.A.,  University  of  Toronto; 
M.A.,  Columbia  University,  New  York) 
has  recently  retired  from  the  University 
of  New  Brunswick  after  16  years  of 
service  as  teacher,  administrator,  and 
dcin  .'1  the  faculty  of  nursing. 

Her  nursing 
career,  largely 
devoted  to  teach- 
ing, has  included 
positions  as  in- 
structor of  nurs- 
^^  ing  at  the  Metro- 
^  ^^^m  politan  (Demon- 
^^^  stration)  School 
of  Nursing  in 
Windsor  and  as  assistant  professor, 
school  of  nursing.  University  of 
Toronto. 

McPhedran  wrote  The  Maternity 
Cycle:  A  Physiological  Approach  to 
Nursing  Care,  published  in  1961,  and 
collaborated  with  Dr.  Norman  B. 
Taylor  of  the  University  of  Toronto  on 
the  lexthook.  Anatomy  and  Physiology, 
published  in  1965.  In  1970.  her  article 
on  the  development  of  The  University 
of  New  Brunswick  Faculty  of  Nursing 
was  published  in  the  International 
Journal  of  Nursing  Studies. 


Isabel  MacRae  (B  s.,  Columbia  Univer- 
sity; Ph.D.,  New  York  University)  has 
been  appointed  director  of  the  Univer- 
sity of  Victoria  school  of  nursing  for  a 
term  of  five  years.  The  school  is 
scheduled  to  open  in  1976. 

She  began  her  nursing  career  at  the 
Toronto  General  Hospital  as  a  staff 
nurse,  later  becoming  head  nurse  in  or- 
thopedic surgery.  She  has  been  on  the 
nursing  staff  of  the  Nuffield  Or- 
thopaedic Centre  in  Oxford,  England, 
and  of  the  Columbia  Presbyterian  Med- 


ical  Center  at  the  New  York  Orthopedic 
Hospital.  She  has  been  an  assistant  pro- 
fessor at  the  University  of  Iowa.  Prior 
to  her  current  appointment,  MacRae 
was  associate  professor  at  the  Univer- 
sity of  lUinois  and  associate  member  of 
its  Graduate  College  Medical  Center  at 
Chicago. 


Rita  Dozois  (R.N.,  Misericordia 
Hospital,  Winnipeg;  Cert.  Public 
Health,  McGill  University,  Montreal) 
is  the  third  "Woman  of  the  Month" 
selected  by  the  Manitoba  Association 
of  Registered  Nurses.  She  has,  for  the 
most  part,  worked  in  the  specialized 
field  of  medical  services  in  remote 
areas,  under  the  aegis  of  Medical 
Services  of  Health  and  Welfare 
Canada.  She  has  been  based  at  Big 
Trout  Lake,  Lac  Seul,  Sioux  Lookout, 
and  Brandon.  Later,  in  Winnipeg,  she 
was  assistant  nursing  officer,  then 
nursing  officer  for  Southern 
Manitoba.  Since  1974,  Dozois  has 
been  nursing  coordinator  for  the 
clinical  training  of  northern  nurses. 


Barbara  Archibald  (Reg.N.,  Toronto 
General  Hospital;  B.Sc.N.,  University 
of  Western  Ontario,  London)  is  leaving 
her  position  at  CNA  House  as  assistant 
to  the  secretary-treasurer  of  the  Cana- 
dian Nurses  Foundation  to  become 
liaison  officer  with  the  health  division 
of  the  institutions  and  public  finance 
branch  of  Statistics  Canada. 

Her  nursing  experience  has  included 
public  health  nursing  in  London.  On- 
tario, and  teaching  at  the  John  Abbott 
CEGEP  in  Montreal  and  the  University 
of  Ottawa  school  of  nursing.  She  is 
currently  studying  toward  a  master's 
degree  in  public  administration  at 
Carleton  Universitv,  Ottawa. 


A  Solemn  Moment 

Nancy  Kennedy-Reid  of  Simcoe,  Ontario,  pays  her  respects  at  the  grave  of  a 
wartime  friend.  Nursing  Sister  Nora  Hendry  Peters  in  a  Canadian  War  Cemetery  in 
central  Italy.  Kennedy-Reid  wears  the  Royal  Red  Cross  and  the  Queen  Elizabeth 
Coronation  Medal .  She  was  chosen  by  the  Royal  Canadian  Army  Medical  Corps  to 
represent  Canadian  Nursing  Sisters  on  the  Veterans  Affairs  pilgrimage  in  April 
1975.  marking  the30lh  Anniversary  of  haly's  liberation  in  World  War  II.  During 
1943-5.  some  91,000  Canadians  served  in  Sicily  and  halv-  More  than  5.900 
Canadians  are  buried  in  39  cemeteries  scattered  from  Sicily  to  the  Po  Valley. 


eral  Hospital  School  of  Nursing;  B.N., 
McGill  University;  M.Ed.,  Columbia 
University,  New  York),  who  is  director 
of  the  Saint  John  School  of  Nursing, 
has  been  elected  vice-president. 

Margaret  Stephenson  (RN.  Montreal 
General  Hospital  School  of  Nursing; 
B.N.  McGill  University,  Montreal), 
who  is  the  employee  health  nurse.  St. 
John  General  Hospital,  has  been 
elected  secretary  of  the  NBARN. 


Before  leaving  England  in  1956, 
Bowly  had  nursed  in  the  areas  of  surgi- 
cal, operating  room,  and  maternity 
nursing  and  had  done  midwifery  and 
health  visiting.  Since  coming  to 
Canada,  her  career  has  been  devoted 
largely  to  nursing  and  supervisory  posi- 
tions in  northern  British  Columbia  and 
the  Northwest  Territories.  The  Keewa- 
tin  Zone  has  its  headquarters  in  Chur- 
chill, Manitoba. 


Simonne  Cormier  (graduate  of  I'Ecole 
dlnfimiieres  St.  Joseph  and  ITnstitut 
Deux  Alices,  Brussels.  Belgium)  direc- 
tor of  nursing.  Hotel  Dieu  Hospital. 
Campbellton.  has  been  elected  presi- 
dent of  the  New  Brunswick  Association 
of  Registered  Nurses. 

Anne  D.Thorne(R  N  .  St.  John  Gen- 


Valerie  Bowly  (S.R.N. ,  London  Hospi- 
tal. Whitechapel;  Health  Visitors" 
Cert..  London  University;  Cert.  Super- 
vision and  Admin..  Dalhousie  Univer- 
sity. Halifax)  has  been  appointed  zone 
director  of  the  Keewatin  Zone.  Medical 
Services.  Health  and  Welfare  Canada. 
She  is  the  first  nurse  to  become  a  zone 
director. 


Barbara  Francoeur  (R.N..  Prince 
County  Hospital  school  of  nursing. 
Summerside;  Dipl.  Teaching  and  Su- 
pervision. McGill  University.  Mon- 
treal) has  been  appointed  director  of 
nursing.  Prince  County  Hospital. 
Summerside.  P.E.I.  Until  recently,  she 
was  associate  director  of  nursing  educa- 
tion at  that  hospital. 


THE  CANADIAN  NURSE  —  July  1975 


books 


Classification    of    Nursing    Diagnoses 

edited  by  Kristine  M.  Gebbie  and 
Mary  Ann  Lavin.  171  pages.  St. 
Louis.  C.V.  Mosby,  1975  Cana- 
dian Agent:  Mosby,  Toronto. 
Reviewed  by  Audrey  M.  DeBlock, 
Assistant  Professor,  College  of 
Nursing,  Univ.  of  Saskatchewan, 
Saskatoon,  Sask. 

Hurrah  and  congratulations  to  the  First 
National  Conference  on  Classification 
of  Nursing  Diagnoses!  This  conference 
has  accepted  as  a  challenge  what  has 
often  been  considered  the  impossible:  It 
no  longer  works  to  say,  "We  know 
what  we  do.  but  we  cannot  put  it  into 
words  ..." 

In  one  week.  100  nurses  have  in- 
itiated the  process  of  preparing  an  or- 
ganized, logical,  comprehensive  sys- 
tem for  classifying  those  health  prob- 
lems or  health  states  diagnosed  by 
nurses  and  treated  by  nursing  interven- 
tions. The  conference  incorporated  the 
thinking  of  persons  outside  nursing  on 
issues  related  to  classifying  informa- 
tion. The  conference  participants  iden- 
tified several  methods  of  approach  to 
nursing  diagnoses  and  suggested 
frameworks  for  categorizations. 

What  does  all  this  have  to  do  with 
you  and  me  in  nursing?  First  of  all,  the 
glossary  developed  is  a  step  toward 
helping  nurses  talk  the  same  language. 
That  is,  nurses  need  definitions  that 
nurses  can  accept  and  understand. 

Second,  the  editors  state  that  a  tax- 
onomic  system  could  be  of  value  to 
nursing  service,  education,  and  re- 
search. If  this  is  so,  might  it  bridge  the 
gap  between  theoretical  abstractions 
and  the  realities  of  nursing  by  classify- 
ing those  problems  and  interventions 
identified  by  nurses?  Perhaps  for  this 
reason,  the  editors  hope  that  after  read- 
ing the  book  and  after  raising  many 
questions,  you  will  share  these  with  the 
editors  and  future  conferences. 

Third,  conferences  such  as  this  can 
help  nursing  to  move  from  where  it  is  to 
where  it  wants  to  go.  or,  as  the  text 
brings  out,  "to  produce  a  workable  sys- 
tem of  classification,"  that  is,  work- 
able in  terms  of  "users"  both  within 
and  without  the  nursing  system  (p. 
9-10).   As  Bernzweia  states,   "Good 


nursing  diagnosis  is  one  of  the  keys  to 
the  successful  practice  of  nursing  and 
is,  therefore,  a  skill  all  nurses  should 
learn." 

Chapter  three  deals  with  the  actual 
use  and  potential  application  of  a  nurs- 
ing diagnosis.  This  is  done  from  the 
perspectives  of  a  nursing  and  a  non- 
nursing  panel  and  relates  to  practice, 
education,  research,  legislation,  record 
keeping,  and  accreditation. 

The  fruits  of  this  First  Conference 
will  undoubtedly  prove  to  be  one  of  the 
most  worthwhile  embarkments  of  the 
era.  Therefore,  this  book  is  a  must  for 
every  professional  nurse.  The  editors 
make  it  implicit  that  this  is  an  ongoing 
process,  and,  as  such,  it  is  hoped  that 
professional  nurses  will  become  con- 
tributory participants  to  subsequent 
conferences.  Then,  perhaps,  as  nurses, 
we  can  proceed  to  predict  and  prescribe 
the  outcomes  we  hope  to  achieve. 

With  anticipation,  we  await  the  pro- 
ceedings of  the  Second  National  Con- 
ference on  Classification  of  Nursing 
Diagnoses! 


Perspectives  on  Human  Sexuality: 
Psychological,  Social  and  Cultural 
Research  Findings,  edited  by 
Nathaniel  N.  Wagner.  517  pages. 
New  York,  Behavioral  Publica- 
tions, Inc.,  1974. 
Reviewed  by  Mona  June  Horrocks, 
Associate  Professor,  School  of 
Nursing,  Dalhousie  University, 
Halifax,  Nova  Scotia. 

Although  this  book  is  designed  to  be 
used  as  a  source  book  in  courses  on 


GET  INVOLVED! 


BECOME  A 
RED  CROSr 
VOLUNTEER 


human  sexuality,  it  clearly  has  a  much 
wider  potential  for  use.  It  consists  of 
original  research  projects  divided  into 
four  areas:  sex  difference  and  the  de- 
velopment of  sexuality,  psychological 
factors  in  sexual  behavior,  sexual  be- 
havior in  cross-cultural  perspective, 
and  studies  of  special  populations. 
Each  section  is  prefaced  by  a  short  in- 
troduction by  the  editor. 

The  first  essay  in  the  collection  is 
Freud's  "Some  Psychological  Conse- 
quences of  the  Anatomical  Distinction 
Between  the  Sexes,"  first  published  in 
1925  and  often  mentioned  but  rarely 
read.  Perhaps  the  most  valuable  phrase 
in  the  article  is:  "I  feel  justified  in  pub- 
lishing something  which  stands  in 
urgent  need  of  confirmation  before  its 
value  or  lack  of  value  can  be  decided." 
As  we  know,  subsequent  psychiatrists 
took  the  Freudian  theory  of  penis  envy 
in  women  as  dogma  and  did  not  ques- 
tion "its  lack  of  value,"  but  accepted  it 
as  a  fact. 

The  now  famous  Broverman  study 
on  "Sex-Role  Stereotypes  and  Clinical 
Judgments  of  Mental  Health"  is  in- 
cluded and  reminds  thoughtful  readers 
that  much  of  the  mental  health  com- 
munity does  not  consider  women  men- 
tally healthy  if  they  possess  the  charac- 
teristics of  a  mentally  healthy  adult. 
This  study  should  be  discussed  in  rela- 
tion to  the  short  piece  "Women  in 
Medicine"  in  Sisterhood  is  Powerful, 
edited  by  Robin  Morgan,  in  which 
Miriam  Gilbert,  RN  says:  "A  request 
voiced  too  aggressively  by  a  nurse  may 
not  be  answered  for  hours;  the  same 
request  made  passively  usually  gets  an 
immediate  response."  That  women  are 
expected  to  be  passive  by  our  society  is 
one  of  the  major  stereotypes  that  must 
be  overcome  if  nurses  are  to  gain  their 
proper  place  as  equals  in  the  health  care 
system. 

The  answer,  however,  does  not  lie  in 
having  more  women  doctors,  as 
Goldberg's  "Are  Women  Prejudiced 
Against  Women?"  shows  clearly. 
Goldberg's  research  design  was  so 
simple  that  anyone  can  replicate  it.  He 
gave  2  matched  groups  of  women  col- 
lege students  6  articles  to  evaluate .  One 
group  received  articles  bearing  a  man's 
name  as  author;  the  second  group  re- 


ceived  articles  bearing  a  woman's 
name.  The  articles  were  identical,  yet 
women  downgraded  those  written  by 
women,  and  Goldberg  concluded; 
"Since  the  articles  supposedly  written 
by  men  were  exactly  tne  same  as  those 
supposedly  written  by  women,  the  per- 
ception that  the  men"s  articles  were 
superior  was  obviously  a  distortion. 
For  reasons  of  their  own,  the  female 
subjects  were  sensitive  to  the  sex  of  the 
author,  and  this  apparently  irrelevant 
information  biased  their  judgments.'" 
It  would  be  interesting  to  discover 
whether  women  doctors  are  consis- 
tently more  rejecting  of  women  nurses' 
opinions  and,  conversely,  whether 
nurses  hold  women  doctors  to  a  differ- 
ent standard  of  behavior  than  they  hold 
males.  Moreover,  it  would  be  valuable 
to  know  to  what  degree  nurses  value 


other   nurses'    opinions,   orders,   and 
general  competencies. 

A  number  of  articles  have  direct  im- 
portance to  persons  teaching  growth 
and  development  courses.  For  in- 
stance, the  Jones  and  Mussen  study 
sought  to  discover  whether  early  matur- 
ing girls  had  a  more  negative  self- 
image  than  late  maturing  girls.  To  their 
surprise,  the  authors  discovered  that, 
while  early  maturing  girls  are  at  a  dis- 
advantage in  early  adolescence,  they 
■"had  significantly  lower  scores  on  the 
category  negative  characteristics,  in- 
dicating more  favorable  self- 
concepts,  '  by  the  time  they  reached 
late  adolescence. 

Individuals  involved  in  any  kind  of 
sexual  counseling  are  often  called  on  to 
discuss  with  young  people  the  question 
of  how  open  they  should  be  with  their 


parents  about  their  sexual  behavior. 
The  study,  "Mothers  and  Daughters: 
Perceived  and  Real  Differences  in  Sex- 
ual Values"  by  Joseph  Lo Piccolo  con- 
cludes that  generational  conflict  will  be 
reduced  if  young  women  do  not  talk 
frankly  with  their  mothers,  because  the 
mothers  perceive  the  daughters  as  hold- 
ing values  close  to  their  own. 

Finally,  of  major  importance  is  "At- 
tribution of  Fault  to  a  Rape  Victim  as  a 
Function  of  Respectability"  in  which 
Jones  and  Aronson  discovered  that  the 
more  respectable  the  victim,  the  more 
(people  have  a  need  to  assign  blame  lo 
her.  This  is  a  complex  subject,  the  basis 
of  which  rests  on  our  assumption  that 
we  live  in  a  "just  society"  in  which 
people  get  what  they  deserve.  Thus,  a 
prostitute  who  is  raped  got  what  she 
(Continued  on  page  42) 


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THE  lOHNS  HOPKINS  HOSPITAL 


EDITOR 


The  Canadian  Nurses'  Association  invites  applications  for 
the  position  of  editor  of  the  Association's  monthly  English 
journal,  The  Canadian  Nurse. 

Requirements: 

—  Demonstrated  ability  in  journalism  and  communica- 
tions, with  specialization  in  the  health  field  or  social 
sciences. 

—  Academic  degree  in  journalism  or  equivalent  experi- 
ence. 

—  Willingness  to  travel. 

—  Bilingualism  would  be  an  asset. 

Headquarters: 

—  Ottawa 

Applicants  should  submit  risum^s  to: 


Director  of  Information  Se 
Canadian  Nurses'  Associa 
50  The  Driveway 
Ottawa,  Ontario 
K2P  1E2 


?s 


^ANADIAN  NURSE  —  Julv  1975 


books 

(Continued  from  page  41) 


asked  for;  a  middle-class  housewife 
does  not  ■"deserve"  to  be  raped  and 
therefore  must  have  somehow  contri- 
buted to  her  fate.  Walter  Kaufmann's 
Without  Guilt  and  Justice  should  be 
read  by  persons  who  wish  to  pursue  in 
depth  the  question  of  distributive  jus- 
tice and  the  pitfalls  it  leads  us  into. 

Every  article  in  Perspectives  on 
Human  Se.xualir\'  has  significance  for 
some  portion  of  the  health  sciences  pro- 
fession, and  the  book  is  highly  recom- 
mended. 


First  Aid,  3ed,  by  St.  John  Ambulance, 
the  Priory  of  Canada.  248  pages. 
Ottawa.  Runge  Press,  1975. 
Reviewed  by  Helen  K.  O'Connell, 
Assistant  Director  of  Public  Health 
Nursing.  Ottawa-Carleton  Regional 
Area  Health  Unit,  Ottawa,  Ont. 

The  purpose  of  this  manual  is  to  gener- 
ate widespread  interest  in  first  aid  and 
to  perfect,  upgrade,  and  standardize  the 
teaching  of  this  vital  subject  to  all 
Canadians. 

The  material  is  well  organized,  and 
the  explanations  are  clear  and  concise. 
The  language  is  simple  without  appear- 
ing to  "talk  down"  to  the  reader.  Pages 
are  numbered  midway  in  the  margin, 
facilitating  quick  reference. 

The  structures  and  functions  of  the 
body  are  fully  but  briefly  explained. 
Each  injury  or  condition  is  well  de- 
scribed. Directions  for  treatment  are 
easy  to  follow.  The  first-aider  is 
cautioned  to  use  common  sense,  not  to 
attempt  to  give  more  than  emergency 
treatment,  and  to  refer  to  a  physician, 
nurse,  or  medical  facility  when  the 
emergency  has  been  dealt  with. 

Diagrams  are  clear  and  well  labeled. 
Wider  color  contrast  for  indicating  in- 
ternal organs  and  closed  and  open  air- 
ways would  enable  the  lay  person  to 
identify  these  organs  more  easily.  In 
one  or  two  instances,  parts  of  the  text 
are  separated  by  the  diagram  to  which 
the  text  refers,  thus  interrupting  the 
train  of  thought.  In  at  least  one  in- 
stance, the  text  is  on  one  page,  the 
diagram  is  on  the  overleaf. 

The  appendix  on  emergency  child- 
birth leaves  something  to  be  desired. 
The  text,  unlike  that  of  previous  sec- 
tions, talks  down  to  the  reader  and  yet 
leaves  the  reader  ignorant  of  the  birth 
process.  The  work  of  the  first  stage  is 
described  as  "when  the  mouth  of  the 
uterus  is  being  stretched  to  let  the  baby 
pass  through."  Pass  through  what? 

The  second  stage  is  described  as 


"when  the  baby  is  being  pushed 
through  to  the  outside."  Pushed 
through  what,  and  how?  No  mention  is 
made  of  the  normal  time  lapse  between 
the  delivery  of  the  head  and  the  rest  of 
the  body.  Although  the  text  states  that 
the  baby  "may  be  placed  on  the 
mother's  abdomen"  following  deliv- 
ery, it  neglects  to  add  that  the  baby's 
head  should  be  kept  low  to  promote 
postural  drainage. 

The  inclusion  of  well-labeled  diag- 
rams or  reprints  of  the  Dickinson- 
Belskie  models,  a  more  thorough  dis- 
cussion of  the  birth  process,  a  mention 
of  the  need  for  relaxation,  and  the  im- 
portance of  panting  as  the  head  deliv- 
ers, would  prepare  the  first-aider  to 
support  and  reassure  the  mother  more 
intelligently.  The  appendix  should  be 
reviewed  and  rewritten  for  any  future 
edition. 

Despite  my  criticism  of  the  section 
on  emergency  childbirth,  I  heartily  en- 
dorse this  manual  on  first  aid.  This 
book  will  be  valuable  not  only  to  first- 
aiders  and  professionals,  but  also  to  the 
general  public.  There  should  be  a  copy 
in  every  home,  and  the  operator  of 
every  car,  boat,  and  snowmobile 
would  be  well  advised  to  purchase  one. 


Caring  for  and  Caring  About  Elderly 
People:  a  Guide  to  the  Rehabilitative 
Approach.  Edited  by  Janet  M.  Long. 
127  pages.  Rochester,  N.Y. 
Rochester  Regional  Medical  Prog- 
ram and  University  of  Rochester 
School  of  Nursing,  1974.  Canadian 
Agent:  J.B.  Lippincott,  Toronto. 
Reviewed  by  Patricia  Hanson,  Vic- 
torian Order  of  Nurses,  Calgary, 
Alberta. 

The  emphasis  in  this  collection  of  pap- 
ers was  the  improvement  of  health  care 
of  elderly  people  through  a  rehabilita- 
tive approach.  Much  of  the  material 
presented  originated  in  a  three-week  in- 
tensive course,  "Principles  and  Prac- 
tices of  Rehabilitation,"  conducted  by 
the  Rochester  Regional  Medical  Pro- 
gram. 

The  material  is  well  organized.  A 
general  discussion  of  health  and  the 
specific  problems  and  needs  of  the  el- 
deriy  is  followed  by  a  discussion  of  the 
rehabilitative  philosophy  held  by  the 
authors.  Application  of  this 
philosophy  maintains  the  elderiy  per- 
son at  his  highest  level  of  indepen- 
dence. The  physiological  effects  and 
the  socio-cultural  aspects  of  aging  are 
discussed,   with  implications  for  the 


teaching  and  learning  process. 

Rehabilitation  is  viewed  as  a  process 
involving  the  concepts  of  prevention, 
maintenance,  restoration,  learning,  and 
resettlement.  Because  aging  is  an  ongo- 
ing stage  in  our  growth  and  develop- 
ment, rehabilitation  must  be  a  continu- 
ing process  —  "a  constant  adjustment 
to  disabilities."  The  discussion  of  re- 
habilitation in  the  home,  in  a  nursing 
home,  and  in  an  acute  hospital  aptly 
illustrates  its  effectiveness,  regardless 
of  the  setting  and  the  state  of  health. 

Eight  chapters  deal  generally  with 
some  common  systems  disorders  and 
specifically  with  their  effect  on  the 
older  person.  There  are  several  good 
illustrations  and  some  practical 
therapies  found  helpful  by  the  authors. 

Much  of  the  material  presented 
within  the  context  of  the  rehabilitative 
approach  is  basic  information  and 
would  be  useful  to  a  nurse  new  to 
geriatrics.  It  should  be  supplemented 
with  more  recent  published  material  — 
specifically  on  the  treatments  for  the 
mentioned  disorders  and  on  informa- 
tion about  current  geriatric  health  care 
in  Canada. 


The  Saccharine  Disease  by  T.  L .  Cleave . 
200  pages.  Bristol.  John  Wright  and 
Sons  Ltd..  1974.  Canadian  Agent: 
Toronto.  W.B.  Saunders. 
Reviewed  by  Olive  W.  Simpson, 
School  of  Nursing,  University  of 
British  Columbia,  Vancouver,  B.C. 

The  author  believes  that  many  major 
diseases  particular  to  our  Western 
civilization  are  due  to  the  consumption 
of  refined  carbohydrate  foodstuffs. 
Through  evidence  accumulated  by  his 
epidemiological  studies  and  the  simple 
deductions  made,  he  attempts  to  iden- 
tify cause-and-effect  relationships  be- 
tween diseases  and  environmental  fac- 
tors. 

The  word  "saccharine"  (pro- 
nounced like  the  river  Rhine)  is  not 
synonymous  with  the  chemical 
sweetener,  saccharine.  It  is.  however, 
related  to  white  or  brown  sugar  and 
white  flour,  since  the  starch  in  the  flour 
is  digested  in  the  body  into  sugar.  The 
term  "saccharine  disease"  refers  to 
any  condition  that,  the  author  main- 
tains, is  due  to  the  consumption  of  re- 
fined carbohydrates.  This  may  include 
diabetes,  coronary  disease,  peptic 
ulcer,  varicose  veins ,  escherichia  coli . , 
periodontal  disease,  and  gout. 

I  question  the  validity  of  the  state- 
ment, "The  cause  of  diabetes  lies  es- 


sentially  in  the  consumption  of  refined 
carbohydrates,  which  imposes  un- 
natural strains  upon  the  pancreas.  .  ."" 
(page  85).  The  fact  that  an  undesired 
effect  would  be  elicited  on  an  already 
poorly  functioning  pancreas  or  on  the 
person  predisposed  to  diabetes  cannot 
be  refuted,  but  to  accept  the  atxive- 
quoted  statement  requires  more  statisti- 
cal evidence  than  observation. 

The  author's  theory  on  obesity  I  can 
accept  in  part.  He  discusses  the  ordi- 
nary idiopathic  type  of  obesity,  which 
is  by  far  the  most  common,  with  the 
argument  that  the  body  is  used 
wrongly;  he  bases  this  on  the  theory 
that  w  ild  creatures  in  their  natural  envi- 
ronment never  eat  too  much,  no  matter 
how  plentiful  the  food  supply.  He  con- 
tends that  the  sole  cause  lies  in  the  con- 
sumption of  refined  carbohydrates  — 
the  danger  in  carbohydrate  foods  is  not 
their  calorific  value,  but  whether  they 
are  natural  or  refined.  A  person  may 
easily  overconsume  sugar,  but  not  ap- 
ples. This  is  a  fair  argument:  however, 
where  does  the  difference  in  metabolic 
rate  for  individuals  enter  into  this 
theory? 

The  concept  of  this  "■  master  dis- 
ease" is  founded  on  human  evolution 
and  the  adaptation  of  all  species  to  their 
natural  environment.  The  author  draws 
on  evidence  from  many  parts  of  the 
world  and  on  his  own  research  to  elabo- 
rate and  strengthen  this  concept. 

He  includes  a  broad  spectrum  of  dis- 
eases as  the  result  of  consumption  of 
refined  carbohydrates  and  states  that,  if 
we  refrain  from  using  anything  that  will 
eventually  result  in  refined  carbohyd- 
rates, the  onset  of  these  diseases  will 
decrease.  1  need  more  evidence  before 
being  convinced. 

The  importance  of  observation  ver- 
sus results  of  laboratory  experiments 
seems  to  prevail,  but  I  question  making 
inference  from  observation  alone.  The 
book  presents  an  adventurous  and  in- 
teresting theoretical  concept,  but  it 
needs  extensive  validation  before  it  is 
accepted.  >^ 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses'  Association  Library 
are  available  on  loan  —  with  the  excep- 
tion of  items  marked  R  —  to  CNA  mem- 
bers, schools  of  nursing,  and  other  in- 


stitutions. Items  marked  R  include  re- 
ference and  archive  material  that  does 
not  go  out  on  loan.  Theses,  also  R,  are 
on  Reserve  and  go  out  on  Interlibrary 
Loan  only. 

Requests  for  loans,  maximum  3  at  a 
time,  should  be  made  on  a  standard 
Interlibrary  Loan  form  or  on  the  "Re- 
quest Form  for  Accession  List"  printed 
in  this  issue. 

If  you  wish  to  purchase  a  book,  con- 
tact your  local  bookstore  or  the  pub- 
lisher. 

BOOKS  AND  DOCUMENTS 

1.  Bonner,  Charles  D.  and  Homburger.  Freddy. 
Medical  care  and  rehabililalion  of  the  aged  and 
chronically  ill.  3ed.  Boslon.  Little  Brown.  1974. 
311  p. 

2.  Brigden.  Raymond  J.  Operating  theatre  tech- 
nique: a  textbook  for  nurses  .  .  .  and  others  as- 
sociated with  the  operating  theatre.  3ed.  Edin- 
burgh. Churchill  Livingstone.  1974.  698p. 

3.  Caimey,  John  and  Cairney,  J.  Surgery  for 
students  of  nursing  6ed.  Edited  and  revised  by 
Eric  M.  Nanson  and  Richard  Orgias.  Christ- 
church.  New  Zealand.  Peryer.  1974.  494p. 

4.  Canadian  Education  Association.  Canadian 
education  Inde.x.  1973.  Toronto.  Canadian  Edu- 
cation Association.  1974.  379p.    R 

5.  Crepeault,  Claude  et  Gemme.  Robert.  La 
sexualite  premaritale:  etude  sur  la 
differenciation  sexuelle  des  jeunes  adultes 
quebecois.  Montreal.  Les  presses  de  I'Universite 
du  Quebec.  1975.  204p. 

6.  Directory  of  social  services  Ottawa  — Carle- 
ton.  Ottawa.  Community  Information  Service, 
1974.  109p.  R 

7.  Hulton,  Shirley  W.  Basic  nursing  care:  a 
guide  for  nursing  auxiliaries.  London.  Bailliere 
Tindall,  1974.  72p. 

8.  International  nursing  index,  1974.  New  York. 
American  Journal  of  Nursing  Compan>  m  coop- 
eration with  the  National  Library  of  .Medicine. 
1974.  382p.  R 

9.  Jessee.  Ruth  W.  and  McHenry.  Ruth  W.  Self 
teaching  tests  in  arithmetic  for  nurses.  9ed.  St. 
Louis.  Mosby.  1975.  215p. 

10.  Massachusetts  General  Hospital.  Boston. 
Dept .  of  Nursing .  Manual  of  nursing  procedures. 
Boston.  Little  Brown.  cl975.  389p. 

1 1 .  Mowry.  LiWian.  Mowry' s  basic  nutrition  and 
diet  therapy,  edited  by  Sue  Rodwell  Williams. 
5ed.  St.  Louis,  Mosby,  1975.  215p. 

12.  Mustard,  Robert  A.  Fundamentals  of  first 
aid.  led.  rev.  Ottawa.  St.  John  Ambulance, 
1972.  119p. 

13.  National  League  for  Nursing.  Council  of 
Hospital  and  Belated  Institutional  Nursmg  Ser- 
vices. Who  is  taking  care  of  the  patient.'  Papers 
presented  at  the  eighth  annual  meeting.  Oct.  i-4. 
1974.  Philadelphia.  Pa.  New  York.  National 
League  for  Nursing.  1975.  51p. 

14.  Nave,  Carl  R.  and  Nave,  Brenda  C.  Physics 

(Continued  on  page  44) 


Next  Month 
in 


The 

Canadian 
Nurse 


•  Frankly  Speaking: 
About  Nursing  Education 

•  Nurses  as  Investigators: 
Some  Ethical  and  Legal  Issues 

•  Treatment  of  Patients 
with  Spinal  Cord  Injuries 

•  Histoplasmosis  —  A  Review 

•  Bunion  Surgery 

•  Fitness  for  39c 


^^P 


Photo  Credits 
for  July  1975 


Miller  Photo  Services, 
Toronto,  Onl.  p.  31 

Misericordia  Hospital, 
Edmonton,  Alia.  p.  26 

Murray  Mosher  Photo  Features, 
Ottawa,  Ont.  p.  7 

Veterans  Affairs  Dept., 
Ottawa,  p.  39 


THF  rAMAniANi  KJ)  IRC^F  - 


43 


accession  list 


for  the  health  sciences .  Toronto,  Saunders,  1975. 
300p. 

15.  Nursing  and  the  aging  patient,  compiled  by 
Mary  H.  Browning.  New  York,  American  Jour- 
nal of  Nursing  Co.,  1974.  27lp. 

16.  The  nursing  pro<  ess  in  practice,  compiled  by 
Mary  H.  Browning,  with  consultant  Paula  L. 
Minehan.  New  York,  American  Journal  of  Nurs- 
ing Co.,  1974.  327p. 

17.  Radiguet  de  la  Bastaie,  P.  Nations 
elementaires  d'anesthesie.  2ed.  revue  et 
completee.  Paris,  Arnetle,  1974.  269p. 

18.  Schlesinger,  Benjamin,  comp.  Family  plan- 
ning in  Canada:  a  source  book.  Toronto  Pr., 
CI974.  291p. 

19.  St  John  Ambulance.  Safety  oriented  first 
aid:  Workbook  unit  1-4.  Ottawa,  St.  John  Priory 
of  Canada  Propenies,  1974. 

20.  Schools  of  nursing  directory  1974.  2ed. 
Compiled  by  Paulina  Pepys.  Sponsored  by  Nurs- 
ing and  Hospitals  Careers  Information  Centre  and 
King  Edward's  Hospital  Fund  for  London.  Lon- 
don, King  Edward's  Hospital  Fund,  1974.  540p. 
R 

21.  Scheinfeld,  Amram.  Twins  and  supertwins. 
Philadelphia,  Lippincott,  cl967.  292p 

22.  Siddiqui,  Farid.  Some  concepts  and 
methodologies  in  manpower  forecasting.  To- 
ronto, Ontario  Ministry  of  Labour,  Research 
Branch,  1974.  47p. 

23.  Simmons,  Janet  A.  Nursing  psychiatrique : 
guide  de  relation  infirmi'ere-client.  Montreal,  Les 
Editions  HRW,  1975.  212p. 

24.  Stevens.  Marion  Kei\\\. Geriatric  nursing  for 
practical  nurses.  2ed.  Toronto,  Saunders,  1975. 
244p. 

25.  Stonehouse,  Bernard  et  al.  The  way  your 
body  works.  New  York,  Mitchell  Beazley,  1974. 
96p. 

26.  Tollefson,  Arthur  L.  New  approaches  to  col- 
lege student  development .  New  York .  Behavioral 
Publications,  cl975.   150p. 

27.  Ulrich's  international  periodicals  directory 
I5ed.  1973-74.  2706p.  R 

28.  Visiting  Nurse  Association  Inc.,  Burlington, 
Vermont .  The  problem-oriented  system  in  a  home 
health  agency:  a  training  manual.  New  York, 
National  League  for  Nursing,  cl974.  127p. 

29.  World  Health  Organizations;  Expert  Com- 
mittee on  Planning  and  Organization  of  Geriatric 
Services,  Geneva,  6-12  Nov.,  1973.  Planning 
and  organization  of  geriatric  services.  Geneva, 
World  Health  Organization,  cl974.  46p. 

30.  World  Health  Organization.  Publications  of 
the  World  Health  OrganiziOtion:  1968-72:  a  bib- 
liography. Geneva,  1974.  I58p. 

PAMPHLETS 

31.  Canadian  International  Development 
Agency.  Non-Governmental  Organizations  Divi- 
sion. CIDA  and  NGOs.  Ottawa,  1974.   17p. 

32.  — .  Guide  for  project  submissions.  9p. 

33.  Canadian  Mental  Health  Association.  Re- 
port. Toronto.  1973.  3p. 

34.  Ethicon.  inc.  The  inguinal-femoral  region 


and  hip.  Somerville,  N.J.,  cl972.  22p. 

35.  National  League  for  Nursing  Dept.  of  Dip- 
loma Programs .  The  changing  role  of  the  hospital 
and  implications  for  nursing  education.  Papers 
presented  at  the  annual  meeting  of  the  Council  of 
Diploma  Programs  held  at  Kansas  Ciry.  Mis- 
souri. May  /-.?.  1974.  New  York.  1974.  41p. 

36.  — .  Division  of  Community  Planning.  De- 
veloping strategies  to  effect  change.  Presenta- 
tions at  the  1973  forum  for  nursing  service  ad- 
minislralors  in  the  west.  New  York.  1974.  35p. 

37.  Public  Affairs  Committee.  New  York.  1974. 
Pamphlets. 

no.  512  Talking  it  over  before  marriage:  exer- 
cises in  premarital  communication,  by  Wi  I  lard  J. 
Bienvenu.  28p. 

no.  513  Family  planning:  to-day's  choices,  by 
Dorothy  Millstone.  28p. 

no .  514  Understand  your  heart,  by  Theodore 
Irvin.  28p. 

no.  516  The  fight  for  racial  justice,  by  Charles 
U.  Hamilton.  28p. 

no.  517  V.D.  epidemic  among  teenagers,  by 
Jules  Saltman.  28p. 

no.  518  The  challenge  of  inflation  and  recession, 
by  Maxwell  S.  Stewart.  20p. 

38.  Universidad  de  la  Havana.  Facultad  de  Cien- 
cias  Medicas.  Comision  para  el  Projects  de  la 
Carrera  de  Licenciatura  en  Enfermeria.  Informe 
de  los  estudios  relalyados.  Havana.  1974.  25p. 

39.  Zikria.  Bashir  A.  Manual  of  surgical  knots. 
Somerville.  N.J..  cl972.  42p. 

GOVERNMENT  DOCUMENTS 
Canada 

40.  Advisory  Committee  on  Northern  Develop- 
ment. Government  activities  in  the  North.  Ot- 
tawa. Information  Canada,  1974.  I80p. 

41.  Dept.  of  External  Affairs.  Annual  review. 
1973.  Ottawa,  Information  Canada,  1974.  89p. 

42.  Law  Reform  Commission.  Family  property. 
Ottawa,  Information  Canada,  1975.  45p.  (It's 
working  paper  No.  8) 

43.  — .  Omvia.  Diversion.  Information  Canada, 
1975.  25p.  (It's  working  paper  No.  7) 

44.  — .  Restitution  and  compensation.  Fines. 
Ottawa,  Information  Canada,  1974.  48p.  (It's 
working  paper  Nos.  5  and  6) 

45.  Statistics  Canada  Health  manpower  regis- 
tered nurses.  1973.  Ottawa,  Information  Canada, 
1975.  57p. 

46.  — .  Hospital  indicators,  Jan. -Sep.  1974.  Ot- 
tawa, Information  Canada,  1975.  I56p. 

47.  Transport  Canada.  The  seat  belt  argument. 
Ottawa,  Information  Canada,  cl974.  27p. 

Great  Britain 

48.  Central  Office  of  Information.  Reference  Di- 
vision. Care  of  the  elderly  in  Britain.  Rev.  ed. 
London,  H.M.  Stationery  Off.,  1974.  35p. 

Ontario 

49.  Ministry  of  Health.  OHIP  practitioner  care 
statistics  fiscal  (pre-audit)  1973-74.  Toronto, 
1975.  38p. 


50.  Council  of  Health.  Acupuncture.  Toronto, 
1974.  32p. 

51.  — .  Biomedical  engineering  and  biophysics. 
Toronto,  1974.  42p. 

52.  — .  Health  ser\-ices  for  new  towns  and  major 
developments  or  redevelopmenis  in  e.xisting 
communities  and  in  underser\iced  areas.  To- 
ronto, 1974.  54p. 

53.  — .  Physician  manpower.  Toronto,  1974. 
62p. 

United  Stales 

54.  National  Center  for  Health  Statistics.  Acute 
conditions,  incidence  and  associated  disability. 
Washington,  Public  Health  Service,  1975.  68p. 
(Vital  and  health  statistics,  ser.  10,  no.  98) 

55.  — .  Hearing  levels  of  youths  12-17  years. 
Washington,  Public  Health  Service,  1975.  84p. 
(Vital  and  health  statistics,  ser.  11.  no.  145) 

56.  National  Center  for  Health  Statistics.  Inter- 
national classification  of  diseases,  adapted  for 
use  in  the  United  Stales.  8th  revision,  vol.  2. 
Alphabetical  index.  Washington,  For  sale  by  the 
Supl.  of  Doc,  U.S.  Govt.  Print.  Office,  1968. 
685p. 

57.  National  Medical  Audiovisual  Center.  1974 
catalog:  audiovisuals  for  the  health  scientist.  At- 
lanta, Ga.,  1974.  178p.(DHEW  Publication  No. 
(NIH)  75-506) 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLEC- 
TION 

58.  Chamberlain,  Eleonore.  Une  etude  de  la 
deperdition  scolaire  dans  les  ecoles  d'  infirmieres 
du  cours  diplome  de  trois  ans  au  Nouveau- 
Brunswick,  durant  les  annees  1960-72.  Monc- 
ton,  1974.  73p.  (These  (M.Educ. Admin.)  — 
1974)  R 

59.  McGill  University.  School  for  Graduate 
Nm^es,.  Nursing  papers.  Montreal,  McGill  Uni- 
versity, Fall  1974.  35p.  R 

60.  Morgan,  Anne  M.  A  cost-effectiveness 
analysis  of  patients  treated  by  hospital  based  — 
home  dialysis  programs  in  two  Montreal  hospi- 
tals. Montreal,  1972.  129p.  (Thesis(M.H.A.)  — 
Ottawa)  R 

61.  National  Conference  on  Research  in  Nurs- 
ing, Third,  Toronto,  May  21  —  1974.  "Decision 
making  in  nursing  research  " .  Papers  presented. 
Toronto,  School  of  Nursing.  University  of  To- 
ronto, 1974.  Iv  (various  pagings)  R 

62.  Rousseau,  Chantal.  Les  hemodialyses  et 
leurs  besoins  d' aide  en  sains  infirmiers. 
Montreal,  1974.  I12p.  (These  (M.N.)  — 
Montreal)  R 

AUDIO- VISUAL  AIDS 

63.  National  Library  of  Medicine.  Principles  of 
indexing.  Part  1  of  Medline  and  the  health  science 
librarian.  Bethesda,  Md.  18p.  Syllabus  for  vid- 
eotape no.  v3130-x. 

6^4.  — .  Video  record.  Atlanta  Ga.,  National 
Medical  Audiovisual  Center.  1974.  2  tape  cas- 

fsettes,  Sony  Video  cassettes  KC-60  and  KC30 
U-matic.  S^' 


classified  advertisements 


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BRITISH  COLUMBIA 


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n  accredited  School  of  Nursing,  qualify  for  registration  in  Al- 
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V2J  2K7 


EXPERIENCED  NURSES  (eligible  for  B  C  registratton)  required 
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tion and  Continuing  Education  programmes  Salary  $1 ,026  00  to 
$1,212,00  Clinical  areas  include:  Medicine,  General  and  Spe- 
cialized Surqery,  Obstetrics,  Pediatrics,  Coronary  Care,  Hemo- 
dialysis Rehab'liiation  Operating  Room.  Intensive  Care.  Emer- 
gency. PRACTICAL  NURSES  (eligible  for  B  C  License)  also 
required  Apply  to  Administrative  Assistant,  Nursing  Personnel, 
Royal  Columbian  Hosprtal,  New  Westminster,  British  Columbia. 
V3L  3W7. 


Two  GRADUATE  NURSES  required  for  General  Duty  in  30-bed 
hosprtal  PNABC  salary  rates  prevailing.  Accommodation  in 
Nurses  Residence  Three  hours  from  Vancouver,  B  C  on 
Trans-Canada  Highway,  and  on  main  lines  of  both  C  P  and  C.N. 
Railways.  Situated  in  beautiful  Mountain- River  scenery: 
recreations,  etc.  Apply  to:  Administrator,  Lytton  General  Hospital, 
Lytton.  Brrtish  Columbia.  OR  phone  collect:  455-2222  or  Res 
455-2266.  Area  Code  (604) 


GRADUATE  NURSES  —  Looking  tor  variety  in  your  work? 
Consider  a  modern  lO-bed  hospital  located  on  a  beautiful  fiord- 
type  inlet  of  Vancouver  Island  s  west  coast  Apply:  Administrator, 
Box  399  Tahsis,  Bntish  Columbia.  VOP  1X0 


GRADUATE  NURSES  for  21-bed  hospital  preferably 
with  obstetrical  experience.  Salary  in  accordance 
with  RNABC  Nurses  residence  Apply  to:  Matron, 
Tofino  General  Hospital,  Tofino,  Vancouver  Island. 
British  Columbia. 


EXPERIENCED  GENERAL  DUTY  NURSES  AND  LICENSED 
PRACTICAL  NURSES  required  for  small  upcoast  hospital  Sal 
ary  and  personnel  policies  as  per  RNABC  and  H  E  U.  contracts 
Residence  accommodation  $25. 00  per  month.  Transportation 
paid  from  VarKOuver  Apply  to:  Director  of  Nursing.  St,  George's 
Hospital.  Alert  Bay.  British  Columbia.  VON  1A0. 


GENERAL  DUTY  NURSES  for  modern  41-bed  hospital  located 
on  the  Alaska  Highway  Salary  and  personnel  policies  in 
accordance  with  RNABC.  Accommodation  available  in  resi- 
dence. Apply:  Director  of  Nursing.  Fort  Nelson  General  Hospital. 
''■orX  Nelson,  Bntish  Columbia. 


GENERAL  DUTY  NURSES,  for  modern  35-bed  hospital  located, 
in  southern  B  C  s  Boundary  Area  with  excellent  recreation  faci- 
lities Salary  and  personnel  policies  m  accordance  wtth  RNABC 
Comfortable  Nurses  s  home,  Apply  Director  of  Nursing.  Bourxl- 
ary  Hosprtal,  Grand  Forks.  British  Cohjmbia.  VOH  IHC 


WANTED:  GENERAL  DUTY  NURSES  for  modern  70- 
bed  hospital  \A&  acute  beds — 22  Extended  Care) 
located^on  the  Sunshine  Coast.  2  hrs  from  Vancou- 
ver Salanes  and  Personnel  Policies  in  accordance 
with  RNABC  Agreement  Accommodation  available 
(female  nurses)  m  residence  Apply  The  Director 
of  Nursing.  St.  Marys  Hospital,  PO  Box  678.  Se- 
cheit.  British  Columbia. 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  care 
hospital  in  Nonfiern  B  C  residence  accommodations  availat)le 
RNABC  policies  m  effect  Apply  to  Director  ot  Nursing,  Mills. 
Merrrarial  Hospital,  Terrace,  Bntish  Columbia.  V8G  2W7 


GENERAL  DUTY  NURSES  for  modern  46-bed  hospital,  located 
in  north  central  British  Columbia  Salary  and  personnel  policies  in 
accordance  with  the  RNABC  contract  Accommodaiions  availa- 
ble in  residence  adjacent  to  hospital  Apply  Director  of  Nursing. 
Si,  John  Hospital  R  R  2.  Vanderhoof,  British  Columbia.  VOJ 
SAO 


MANITOBA 


REGISTERED   and   LICENSED   PRACTICAL   NURSES   are 

needed  tor  a  modem  25-bed  acute-care  hospital  and  a  new 
50-bed  personal  care  home  Salary  and  policies  as  per  Manitoba 
Association  of  Registered  Nurses  Nurse  s  residence  Apply  Di- 
recior  of  Nurses,  Seven  Regions  Health  Centre,  Box  535,  Glads- 
tone Manrtoba.  ROJ  OTO 


REGISTERED    NURSES    AND    LICENSED    PRACTICAL 

NURSES  required  for  68-bed  Personal  Care  Home  m  Notre 
Dame  de  Lourdes,  80  miles  southwest  of  Winnipeg  Areas  of 
nursing  include  hostel,  personal  and  extended  care  Apply  lo 
Director  of  Nursing.  Foyer  Notre  Dame  Inc.  Noire  Dame  de 
Lourdes.  Manrtoba.  ROG  1M0. 


ONTARIO 


CHALLENGING  POSmON  FOR  A  CREATIVE  PERSON  — 

Assistant  Director  of  Nursing  to  be  primarily  responsible  tor  mser- 
vice  education  and  program  development  This  is  a  new  senror 
position  within  \he  nursing  division  of  an  agency  covering  a  rural 
and  urban  population  of  nearly  3O0.00C  Applicants  should  have 
a  minimum  of  five  years  nursing  expenence  —  Bachelor  s  degree 
considered,  Master  s  degree  preferred  Salary  competitive. 
Apply  to  (Mrs  )  Dorothy  M  Mumpy.  B  Sc  N  ,  M  A  ,  Director  of 
Public  Health  Nursing,  Middlesex- London  District  Health  Unit. 
346  South  Street,  London,  Ontario,  N6B  189 


OPERATING  ROOM  STAFF  NURSE  required  for  fully  accredi- 
ted 75-bed  Hospital  Basic  wage  S689  00  with  consideration  for 
experience;  also  an  OPERATING  ROOM  TECHNICIAN,  basic 
wage  $526  00,  Call  time  rates  available  on  request  Write  or 
phone  the:  Director  of  Nursing.  Dryden  Distnct  General  Hospital, 
Dryden.  Ontario 


i+ 


:  CANADIAN  NURSE  —  July  1975 


45 


ONTARIO 


UNITED  STATES 


REGISTERED  NURSES  for  34'bed  General  Hospital 
Salary  S945  00  10  $1,145  00  per  monlh,  plus  experience  allow- 
ance Excellent  personnel  policies  Apply  to  Director  ol  Nursing. 
Englehari  &  Dislrici  Hospital  Inc.  Englehan,  Ontario.  POJ  1H0 


REGISTERED  NURSES  required  for  our  ultramodern  accredited 
79-bed  General  Hospital  in  bilingual  community  of  Nontiern  On- 
tario French  language  an  asset,  but  not  compulsory  Salary  is 
$945  toSi145  monthly  (subject  to  increase  July  tst)  with  allow- 
ance lor  past  experience  and  4  weeks  vacation  after  1  year. 
Hospital  pays  100°o  ol  O  H  IP  .  Life  Insurance  (10.000).  Salary 
tnsurance(75°oOf wagestoiheageof 65 withu  IC  carve-out), a 
35^  drug  plan  and  a  dental  care  plan  Master  rotation  m  effect 
Rooming  accommodations  available  m  town  Excellent  person- 
nel policies  Apply  to  Personnel  Director,  Notre-Dame  Hospital. 
P  0   Box  8000.  Hearst.  Ontano  POL  1N0 


REGISTERED  NURSES  AND  REGISTERED  NURSING 
ASSISTANTS  lor  45bed  Hospital  Salary  ranges 
include  generous  experience  allowances  R  N  s 
salary  S945  to  $11 15,  and  RNA  s  salary  $650  to  $725 
Nurses  residence  —  private  rooms  with  bath  —  $60  per  month 
Apply  to:  The  Director  of  ^.'L'rsing,  Geraldton  District  Hospital, 
Geraldlon,  Ontarb,  POT  i  MO. 


REGISTERED  NURSES  FOR  GENERAL  DUTY,  I.C.U., 
ecu.  UNIT  and  OPERATING  ROOM  required  lor 
fully  accredited  hospital  Starting  salary  $85000  with 
regular  increments  and  with  allowance  for  experi- 
ence. Excellent  personnel  policies  and  temporary 
residence  accommodation  available.  Apply  to:  The 
Director  of  Nursing.  Kirkland  &  District  Hospital, 
Kir1<land  Lake.  Cnlario.  P2N  1R2. 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound   in   our  clinics  and 

their  numbers  increase  daily  in  our 

Emergency. 

It   you   do   not   like  working  with 

children    and   with   their   families, 

you  would  not  like  it  here. 

If  you  do  like  children  and  their 
families,  we  would  like  you  on  oui 
staff. 


Interested     qualified 
should  apply  to  the: 


applicants 


DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108,  Quebec 


■ITS  SO  PEACEFUL  IN  THE  COUNTRY"  —  Modern  54-bed 
accredited  general  hospital  (JCAH)  in  lakeside  Florida  town 
(good  fishing,  two  stoplights)  Seeks  R.N.  SUPERVISORS.  R.N. 
STAFF  NURSES,  and  L.P.N.'s.  Send  resume  and  salary 
requirements  to:  Mrs  Gladys  Meyett.  Director  of  Nurses 
Everglades  Memorial  Hospital.  P.O  Box  659.  Pahokee  Florida 
33476   Telephone  number  (305)  924-5201 


OCEAN  FRONT  COMMUNITY  —  A  small  nursing  home  needs 
TWO  REGISTERED  NURSES  who  are  dedicated  lo  giving  good 
care  to  the  elderly,  Portland  is  a  community  with  many  cultural 
and  continuing  education  opportunities  For  further  information 
apply  to  Director  of  Nursing.  Whitehaven  Nursing  Home.  109 
Emery  Street.  Portland.  Maine.  04102. 


Summer  1975  Curriculum  Institutes  offered  by  the  Institute  of 
Nursing  Consultants  Institute  I,  Becoming  an  INSERVICE 
EDUCATOR  Two  sessions:  I  East,  Key  West  Florida,  June 
16-20,  I  West.  Morro  Bay.  California.  August  18-22  Institute  II. 
CONCEPTUAL  FRAMEWORK  lor  Curriculum  Development. 
Calgary.  Alberta.  Canada.  July  14-18.  Institute  III.  Developing 
LEARNING  MODULES  for  Nursing  Instruction.  San  Francisco. 
California.  August  4-8  Tuition  lor  each  institute  is  $200.00.  The 
all  day  sessions  will  include  a  variety  ol  learning  activities:  lec- 
tures, discussions  small  group  work  and  modules  Institute  fa- 
culty: Em  Otivia  Bevis.  Fay  L  Bower.  Verle  Waters,  Holly  S, 
Wilson,  For  tnlormation  and  registration  write:  F  Bower,  874 
Miranda  Green.  Palo  AJto.  California.  94306. 


TEXAS  wants  you!  II  you  are  an  RN.  experienced  or 
a  recent  graduate,  come  to  Corpus  Christi.  Sparkling 
City    by    the    Sea  a    city    building    lor    a    better 

future,  where  your  opportunities  tor  recreation  and 
studies  are  limitless.  Memorial  Medical  Center.  500- 
bed,  general,  leaching  hospital  encourages  career 
advancement  and  provides  in-service  orientation 
Salary  from  $682  00  to  $940,00  per  monlh,  com- 
mensurate with  education  and  experience  Differential 
for  evening  shifts,  available.  Benefits  include  holi- 
days, sick  leave,  vacations,  paid  hospitalization 
health,  life  insurance,  pension  program  Become  a 
vital  part  of  a  modern,  up-to-date  hospital,  write  or 
call  collect:  John  W,  Gover,  Jr  ,  Director  of  Per- 
sonnel, Memorial  Medical  Center,  P.O,  Box  5280 
Corpus  Chnsti,  Texas,  78405, 


CLINICAL  NURSE  SPECIALIST 


For 


MED-SURG  NURSING 

Required  in  254-Bed 

Active  Care 

General  Hospital 


Qualified  Parties  Apply  to: 

Director  of  Nursing 

Moose  Jaw  Union  Hospital 

Moose  Jaw,  Sask. 

(306)692-1841  (Call  Reverse) 


Registered  Nurses 

Your  community  needs  the  benefit 
of  your  skills  and  experience.  Volun- 
teer now  to  teach  Patient  Care  in 
The  Home  and  Child  Care  in  The 
Home  Courses.  — 

contar 


"MEETING  TODAY'S  CHALLENGE  IN  NURSING" 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGill  University 

requires 

REGISTERED  NURSES 

AND 
REGISTERED  NURSING  ASSISTANTS 

Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


CANBERRA  HOSPITAL 

ACTON.  A.C.T.  AUSTRALIA 

NURSE  EDUCATOR 

THREE  POSITIONS:- 


1.  Principal  Educator  $10,799  per  annum 

2.  Senior  Educator  for  two-year 

general  nursing  course    S  9,661  per  annum 

3.  Midwifery  Educator  $  9,051  per  annum 
Additional  payment  for  diploma  and  certificates  up  to  $1 2  per 
week.  Total  tutorial  staff  —  23. 


Courses  under  control: 

GENERAL  NURSING 
GENERAL  NURSING 
MIDWIFFERY 
INTENSIVE  CARE 
NURSING  AIDE 


3  years 
2  years 
1  year 
1  year 
1  year 

Full  accommodation  (single)  available  —  $14  per  week, 
assistance  with  married  accommodation  may  be  offered. 
For  further  particulars  and  application  forms  plaasa  contact: 

MISS  J.  JAMES, 
Director  of  Nursing, 
Canberra  Hospital, 
ACTON,  A.C.T.  2601 
AUSTRALIA. 


SIMCOE  COUNTY  DISTRICT  HEALTH  UNIT 


DIRECTOR, 
PUBLIC  HEALTH  NURSING 


For  progressive  generalized  public  health  programme. 
Salary  commensurate  with  experience,  good  fringe 
benefits  and  car  allowance. 

QUALIFICATIONS:  Bachelors  Degree  with  several 
years  experience  as  Director  or  equivalent. 

APPLICATION:  with  names  of  references  to  be  sub- 
mitted to  the: 


Secretary-Treasurer 

Simcoe  County  District  Health  Unit 

County  Administration  Building 

Midhurst,  Ontario 

LOL  1X0 


657  bed, accredited, modern,           y. 
well  equipped  General  Hospital,     (j 
rapidly  expanding...                      ^ 

^Smntjohnf^^ 
Lreneral   M\i  ^ 
^ospitaL    ^ 

^^            Saint%hn,KB., 
<=REQUIRE»                       CANADA 

General  Staff  l^rses  ^ 
Registered  Nursing  Assistants 

» 

In  all  general  areas:  Medical,  Surgical, 
Pediatrics, Obstetrics,  Chronic  and 
Convalescent, several  Intensive  Care 
areas  and  Psychiatry. 

^  Active,  progressive  in  service  education  program. 
V                     Special  Attention  to  Orientation.                                          i 
^^.A/Zowance  for  Experience  and  Post  Basic  Preparation ^M 

FOR  FURTHUR  INFORMATION  APPLY  TO 

^PERSONNEL  DIRECTOR 

^ainfjohn  General  Hospital 

po  BOX  2000  Saint  John.  New  Brunswick  e2L4L2 

DIRECTOR 

OF 
NURSING 


Applications  are  invited  for  the  position  of  Director  of  Nur- 
sing in  a  modern,  fully-accredited,  147-bed  general  hospi- 
tal, located  in  northwestern  British  Columbia.  Responsibili- 
ties include  planning,  organizing  and  co-ordinating  all  as- 
pects of  nursing  services.  The  Director  of  Nursing  is  also  a 
member  of  the  senior  management  team  and  involved  in 
the  administration  and  planning  activities  of  the  hospital. 
Applicants  must  have  experience  or  qualifications  in  nur- 
sing administration.  A  baccalaureate  degree  in  nursing  is 
desirable.  Salary  negotiable. 

Apply,  In  confidence,  giving  details  as  to  experience, 
education  and  references,  to: 

Administrator 

Prince  Rupert  Regional  Hospital 

1305  Summit  Avenue 

Prince  Rupert,  British  Columbia 

V8J2A6 


iE  CANADIAN  NURSE  —  July  1975 


The  Brome-MissisquoJ-Perkins 
Hospital 

requires 

REGISTERED 
NURSES 


Please  write  to: 

Director  of  Nursing 
Brome-Missisquoi-Perkins  Hospitai 
950  Main  Street 
Cowansvllle,  Quebec 
J2K1K3 


GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit. 

Clinical  areas  include:  medicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R.N.A.B  C.  contract: 

SALARY:  $850  —  $1 020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regionai  Hospital 

Prince  George,  B.C. 


REGISTERED 
NURSES 

Two  live-in  nurses  required  for  infirmary  in 
boys'  t>oarding  school.  Apartment  adjacent 
to  sick  quarters  available  on  a  12  month 
basis  and  meals  provided  during  the 
academic  year.  Holidays  from  mid-June  to 
the  end  of  August  and  generous  holidays  at 
Chhstmas  and  Easter.  Positions  might  be 
best  suited  to  mature  persons  wishing  a 
settled  life. 

Apply  In  writing  to 

Dr.  T.A.  Hockin 

Headmaster 

St.  Andrew's  Coilege 

Aurora,  Ontario 

L4G  3H7 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from 

REGISTERED  NURSES 

54-bed  accredited  general  hospi- 
tal. Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to: 

MISS  E.LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  ICO 


MOVE  TO  THE  BEACHES  OF 

SUNNY  SO.  CALIFORNIA 

Positions  for  RN's  now  available  at 
Marina  Mercy  Hospital,  a  203-bed 
General  Acute  facility  located  right  in 
Marina  Del  Rey  near  Los  Angeles. 

We  offer  a  congenial  staff,  excellent 
benefits,  every  other  weekend  off! 

We  will  assist  you  in  obtaining  your 
California  License  &  H-1  Visa. 

Write  or  send  resume  to: 

Director  of  Personnel 
Marina  Mercy  Hospitai 
4650  Lincoln  Blvd. 
Marina  Del  Rey,  Ca.  90291 


ST.  MICHAEL'S  HOSPITAL 
Toronto,  Ontario 

Invites  applications  from 

REGISTERED  NURSES 

for 

RESPIRATORY 

INTENSIVE  CARE, 

CORONARY  CARE, 

and  ACUTE  CARE  UNITS 

Three  separate  but  adjoming  units,  of  14,  7,  and  24  beds  i 
respectively     Planned   orientation   and   in-servtce   pro- 
gramme will  enable  you  to  collaborate  in  the  most  advan- 
ced of  treatment  regimens  for  the  posl-operalive  cardio- 
vascular, cardiac  and  other  acutely  ill  patients.  One  year  of  i 
nursing  experience  a  requirement. 

For  details  apply  to: 

The  Director  of  Nursing 
St.  Michael's  Hospital 
Toronto,  Ontario 
MSB  1W8 


DIRECTOR 

of 
NURSING 


Applications  are  invited  tor  the  position  of  Director  of  Nurs- 
ing in  a  fully  accredited  50-bed  Acute  Care  Hospital  lo- 
cated in  the  beautiful  East  Kootenay  Industrial  and  Recre- 
ational area  of  British  Columbia. 

Successful  applicant  will  be  responsible  for  all  nursing 
services  ir>duding  In-Service  Education- 
Minimum  qualifications  include  registration  or  eligibility  for 
registration  in  the  ProvirKe  of  British  Columbia.  Previous 
training  and  expenence  in  a  senior  nursing  position  is 
required 
Position  available  September  1,  1975 

Pl00$e  appty  In  writing  to: 

ADMINISTRATOR 
Kimberley  &  District  Hospital 
260  -  4th  Avenue 
Kimberley,  British  Columbia 
V1A2R6 


NURSING 
OFFICE  SUPERVISOR 

NURSING  OFFICE  SUPERVISOR  required 
for  340-bed  acute  care,  fully  accredi- 
ted Hospital. 

Personnel  Policies  in  accordance  with 
RNABC  Contract. 

Must  be  eligible  for  B.C.  Registration 
SAUVRY:  $1283  to  $1513  per  month 
(1975  rates) 

Preference  will  be  given  to  applicant 
with  University  preparation  in  Adminis- 
tration and  Clinical  Supervision 
Apply,  stating  qualifications  to: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 

V2M  1S2 


HEAD  NURSE 

HEAD  NURSE  required  for  18-bed 
Medical  Unit. 

Previous  experience  and/or  prepara- 
tion in  administrative  nursing  techni- 
ques including  ward  management  and 
principles  of  supervision  required. 

Position  tjecomes  available  early  July, 
1975. 


Apply  to: 

Director  of  Nursing 

Prince  George  Regionai  Hospitai 

2000,  15th  Avenue 

Prince  George,  British  Coiumbia 

V2M  182 


48 


DIRECTOR  OF 
PATIENT  CARE  SERVICES 

A  Director  is  required  by  a  255  bed  (146  Active,  109  Conti- 
nuing Care),  fully  accredited  hospital,  to  assume  responsi- 
bility for  the  overall  direction  and  control  of  Patient  Care 
areas,  including  Nursing  Service  and  Physical  Rehabilita- 
tion Services.  The  Director,  who  reports  to  the  Executive 
Director,  will  participate  in  policy  making  as  a  member  of 
the  Hospital's  Senior  Management  Team. 

The  successful  applicant  should  have  a  B.ScN.  or  equiva- 
lent experience  and  education,  plus  practical  expehence  at 
the  senior  nursing  administration  level,  and  registration  or 
eligibility  for  registration  in  Ontario. 

Salary  will  be  commensurate  with  qualifications  and  expe- 
rience. 

Guelph  is  a  pleasant  university  city  of  over  60,000  popula- 
tion within  one  hours  drive  of  Toronto. 

Reply  In  confidence,  giving  details  of  education,  experience 
and  references  to: 

EXECUTIVE  DIRECTOR, 
ST.  JOSEPH'S  HOSPITAL, 
80  WESTMOUNT  ROAD, 
GUELPH,  ONTARIO.  N1H  5H8 


NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  for  all  Nursing  Units 
Intensive-Coronary  Care.  Psychiatry,  Med. -Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservice  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries     Reg.  N.  Jan.  1st.  1975  —  915.  —  1,115. 
April  1st,  1975  —  945.  —  1.145. 

R.N.A.  Jan.  1st,  1975  —  686.  —  728. 
July  1st,  1975  —  738.  —  780. 

Contact 
Director  of  Nursing 


if  Paris  appeals  to  you . . . 


...  so  wili  Montreal 


•  modern  700  bed  non-sectarian  hospital 

•  excellent  personnel  policies 

•  Registered  Nurses  and  Nursing  Assistants 
are  asked  to  apply 


•  active  In-Service  Education  program 

•  bursaries  available 

•  Quebec  language  requirements  do  not 
apply  to  Canadian  applicants 


Director,  Nursing  Service 
Jewish  General  Hospital 
3755  cote  ste.  Catherine  Road 
Montreal,  Quebec  H3T  1E2 


^E  CANADIAN  NURSE  —  July  1975 


ST.  THOMAS  -  ELGIN 
GENERAL  HOSPITAL 

Invites  Applications  from 

REGISTERED  NURSES 

To  work  in  our  modem  tully  accredited  400  bed  General 
Hospital  located  In  Southwestern  Ontario 

We  offer  opportunities  In  nnedlcal.  surgical,  paedlatric, 
obstetrical  and  geriatric  nursing 

Our  specialties  include  Coronary  Care,  Intensive  Care 
and  an  active  Emergency  Department. 
Orientation  Program. 
Progressive  Personnel  Policies. 

M>PL>(  TO: 

Personnel  Office 

St.  Thomas-Elgin  General  Hospital 

St.  Thomas,  Ontario 

N5P  3W2 


DIRECTOR 
OF  NURSING 

This  position  carries  responsibilities  for  the 
co-ordinating  of  ail  nursing  services  w/ithin 
the  Cancer  Control  Agency,  Including  a  56 
bed  hospital  unit,  an  outpatient  clinic  with 
20,000  visits  yearly,  and  an  active  planning 
program  for  extension  of  cancer  control 
services  throughout  the  province  of  B.C. 
Preference  will  be  given  to  applicants  with 
related  university  preparation  who  have 
proven  competence  in  supervision  and 
nursing  administration.  Send  letter  of  appli- 
cation, together  with  a  detailed  resume,  to: 

Personnel  Department,  Cancer  Control 
Agency  of  British  Columbia,  2656  Hea- 
ther Street,  Vancouver,  B.C.  V5Z  3J3. 


ST.  MICHAELS  HOSPITAL 

Toronto,  Canada, 

MSB  1W8 


This  university  hospital  in  metropolitan  area 
invites  applications  for  position  of 

Head  Nurse, 
Psychiatry 

for  a  19-bed  in-patient  unit  and  separate 
Day  Care  Centre.  Registered  Nurse  with 
baccalaureate  degree  and/or  depth  of  ex- 
perience in  psychiatric  nursing. 


For  details  contact:  Director  of  Nursing 


THE  EAAK  WALTON  KILLAM 

HOSPITAL  FOR  CHILDREN 

HALIFAX,  NOVA  SCOTIA 

Offers  a  13 -week 

POST  BASIC 
PAEDIATRIC    NURSING 
PROGRAM 
for 
REGISTERED  NURSES 

CLASSES  ADMITTED 
JANUARY,  MAY,  SEPTEMBER 

For  turthtr  Irtlormatlon  and  details  writa: 

Associate  Director  of  Nursing  Education 

THE  IZAAK  WALTON  KILLAM  HOSPITAL 

FOR  CHILDREN 

Halitax.  Nova  Scolia 

B3J3G6 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

Staff  nurses  for  St.  Anttiony.  New  hospital  o' 
150  beds,  accredited.  Active  treatment  in  Surgery 
Medicine.  Paediatrics,  Obstetrics,  Psychiatry 
Large  OPD  and  ICU.  Orientation  and  In-Service 
programs.  40-hour  wee(<.  rotating  shifts.  PUBLIC 
HEALTH  has  challenge  of  large  remote  areas 
Furnished  living  accommodations  supplied  at  low 
cost  Personnel  benefits  include  liberal  vacation 
and  sick  leave,  travel  arrangements.  Staff  RN 
$637  —  $809.  prepared  PHN  $71 2  —  $903,  steps 
for  experience. 


Apply  to: 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Antliony,  Newfoundland 

AOK  4S0 


COMMUNITY  MENTAL 
HEALTH  NURSE 

Required  for  a  30-bed  Psychiatric  Unit  with 
an  active  Day  Care  Programme. 

Successful  applicant  will  be  directly  re- 
sponsible to  Psychiatric  Clinical  Co- 
ordinator. 

Educational  Requirements: 

Baccalaureate  Degree  with  experience  in 
Psychiatry  or  Public  Health. 

Applicants  apply  to: 

Director  of  Personnel 
Cornwall  General  Hospital 
Cornwall,  Ontario 
K6H  1Z6 


Experienced 

Registered  Nurses 


required  for 
a  dispensary  in 


LA  BASSE  COTE-NORD 


Knowledge  of  English  essential. 


Please  send  curriculum  vltae  to  the 

Director  of  Nursing  Sen/ice 
Hopital  Notre-Oame 
Lourdes  du  Blanc-Sabion 
Cte  Duplessis,  P.O. 
GOG  1W0 


PUBLIC 
HEALTH 
NURSES 

Required 

for  the  Sudbury 

&  District  Health  Unit 

Apply  to: 

Director  of  Nursing 
1300  Paris  Crescent 
Sudbury,  Ontario 
P3E  3A3 


EXPERIENCED 

REGISTERED 

NURSE 

required  July  1  for  45-bed  hospital 
at  North  West  River,  Labrador.  Sub- 
sidized accommodation.  Salary  in  ac- 
cordance with  Newfoundland  Gov- 
ernment scale.  Fringe  benefits.  Travel 
paid  for  minimum  one  year  service. 

Please  contact: 

Mr.  Douglas  Heath 
International  Grenfell  Association 
Room  701,  88  Metcalfe  Street 
Ottawa,  Ontario     K1P5L7 


so 


HOSPITAL: 

Accreaited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 
Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 
Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


NURSING  ADMINISTRATIVE 
ASSISTANT 

Applications  are  invited  for  the  position  of  Nursing  Adminis- 
trative Assistant  in  a  41 7  bed  general  hospital  located  in  the 
Niagara  Peninsula. 

Responsibilities 

The  Successful  applicant  will  be  responsible  for  the  provi- 
sion and  improvement  of  nursing  care;  for  the  supervision, 
teaching  and  guidance  of  nursing  personnel  for  the  day, 
evening  or  night  tour  on  a  rotating  basis. 

Qualifications 

Preference  will  be  given  to  applicants  having  a  Bachelor 
Degree  in  Nursing. 

Progressive  leadership  qualities  and  nursing  experience 
are  required. 

Salary 

Negotiable. 

Irtterested  appllcartts  should  apply  In  writing  to: 

Director  of  Nursing, 

Welland  County  General  Hospital 

Third  Street 

Welland,  Ontario 

L3B  3W6 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 
teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

1975  Salary  Scale  $1,026.00  —  $1,212.00  per  month  (subject  to  change) 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 
VANCOUVER  GENERAL  HOSPITAL 
855  WEST  12TH  AVE. 

VANCOUVER,  B.C. 


: CANADIAN  NURSE  —July  1975 


THE  GENERAL  HOSPITAL 

ST.  JOHN  S  NEWFOUNDLAND 

OPERATING  ROOM 

We  will  be  moving  nexl  year  !o  a  new  320  bed  hospital  with  some 
Friesen  Concepts 

BUT  NOW  —  we  need  an  0  R   Manager 
To  carry  the  administration  of  the  0  R. 
an  0  R   Head  Nurse  or  Co-ordinalor 
To  manage  the  internal  (sterile)  area 
an  0  R   Instructor 
To  develop  and  teach  a  course  in  OR   Technique  lor  nurses 
We  are  planning  systems  and  practices  now  and  trying  them  out 
in  our  present  hospital . 

Opportunity  to  develop  and  try  out  new  ideas  and  systems. 
The  present  General  Hospital  is  the  major  teaching  hospital  for 
Ihe  Medical  School  and  will  conllnue  to  be  m  the  future 
Clinical  Services  —  Orthopaedic,  Neurosurgery.  Cardiovascu- 
lar,   Psychiatry.    Renal    Dialysis,    Urology,    Gynecology, 
Radiotherapy 

Onenlalion,  active  Inservice  Program,  liberal  fringe  benefits, 
assistance  with  transportation,  depending  on  contract 

I  THE  GENERAL  HOSPITAL 

I  St,  John  s.  Newfoundland 

Please  tell  me  about  nursing  al  The  General. 


NAME 

ADDRESS . 


SMOOTH  ROCK  FALLS  HOSPITAI 

REGISTERED  NURSES 

Required 

For  o  small  20-bed  community  hospital  in 
Northern  Ontario.  Located  within  35  miles 
of  two  larger  centers.  Full  active  treat- 
ment hospital  —  all  services  including 
surgery.  Full  fringe  benefits  including 
salary  consideration  for  experience.  Ex- 
cellent residence  accommodation  avail- 
able, a  winter  sports  centre  providing 
excellent  opportunity  for  nurses  who 
enjoy     small     community     living. 

Send  applications  to: 

Mrs.  A.E.  Lebarron,  R.N., 

Director  of  Nursing 

SMOOTH  ROCK  FAUS  HOSPITAL 

Smooth  Rock  Falls,  Ontario 


OSHAWA  GENERAL  HOSPITAL 

Applications  are  being  accepted  for  the  positio 
of: 


NURSING  CO-ORDINATOR 
OBSTETRICS/PAEDIATRICS 

Responsibtlittes  wtll  include  the  co-ordinating  of  Nursing 
Activities  as  well  as  the  development  and  implementation 
of  innovative,  creative  concepts. 
The  successful  applicani  will  possess 

—  current  Ontario  Registration 

—  post-basic  clinical  preparation /experience 

—  administrative  preparation/experience 

Inquiries  may  be  directed  to: 

Mrs.  J.  Stewart 
Director  of  Nursing 
Oshawa  General  Hospital 
24  Alma  Street 
Oshawa,  Ontario 
L1G  2B9 


REGISTERED  NURSES 

Southern  California 

This  rapidly  expanding  573-Ded  Medical  Center  has 
opportunities  for  RN  s  interested  in  professional  growth. 
Huntington  Memorial  is  recognized  for  its  excellence  of  patient 
care,  research  facilities  and  teaching  programs,  and  offers  a  full 
range  of  patient  care  services  including  Intensive  Care. 
Coronary  Care,  Emergency  Room,  Neurosurgery.  Open  Heart 
Surgery  and  Rehabilitation  Our  full  on-going  in-service 
orientation  and  training  program  includes  classes  in  Critical 
Care,  Neonatal  and  an  Arrhythmia  Recognition  Class  Other 
programs  are  given  for  Medical-Surgical,  Rehabilitation  and 
Pediatrics  Cardiology 

Located  in  the  Rose  Bowl  capitol,  Pasadena.  California. 
Huntington  Memorial  enioys  the  year  arouna  milo  climate. 
excellent  tor  Ocean,  Mountain,  and  Desert  sports  and  activities, 
all  within  a  one  hour  drive  Our  hospital  is  located  in  a 
residential  area,  which  offers  excellent  living  conditions. 
We  invite  your  inquiry  concerning  our  salaries,  benefits, 
education,  working  conditions  and  facilities.  We  will  also  assist 
qualified  RNs  to  acquire  visas  for  those  interested  in  a  position 
with  this  progressive  Medical  Center 

Write  Miss  Ann  Kaiser,  Dir.  of  Nursing 

HUNTINGTON  MEMORIAL  HOSPITAL 
747  S.  FAIRMONT  ST. 
PASADENA.  CALIF..  91105 

An  equal  opportunity  employer. 


SHIFT 
NURSING  SUPERVISOR 

warned  tor 

Fully  accreditaled  175-bed  hospital,  situated  on 
beautiful  Lake  of  the  Woods. 
Starling  salary  in  excess  of  $13,000.00  per  year, 
dependent  upon  experience  and  qualifications. 
Applicants  must  be  eligible  for  Registration  in  the 
Province  of  Ontario. 

Qualifications:  BScN.  and/or  Post  Graduate  Pre- 
paration in  Administration. 


Please  direct  complete  resumi  to: 

Mrs.  B.  Schottrotf 

Director  ol  Nursing 

Laks  of  the  Woods  District  Hospital 

Kenora,  Ontario 


N  U  K  O  t  O  eligible  for  full  registration 
with  the  Association  of  Registered  Nurses 
of  Newfoundland  and  who  also  have  post 
registration  psychiatric  nursing  experience 
are  invited  to  apply  for  the  post  of  psychiat- 
ric nurse  on  the  mental  health  team  recently 
started  in  Happy  Valley/Goose  Bay.  This 
new  position  will  include  all  aspects  of 
psychiatric  care  and  assessment  both  in 
the  hospital  and  on  a  community  basis. 

Salary  in  accordance  with  ARNN  and 
Newfoundland  Hospital  Association  collec- 
tive agreement.  Usual  fringe  benefits.  Rec- 
ognition given  to  previous  experience. 


PSE  apply  to: 


Director  of  Nursing 
Paddon  Memorial  Hospital 
International  Grenfell  Association 
Happy  Valley,  Labrador 
A0P1E0 


THE  GENERAL  HOSPITAL 

ST.  JOHN'S  NEWFOUNDLAND 


SCHOOL  OF  NURSING 


Requires  Nursing  Instructors  for  Medical-Surgical  Nursing. 
Maternal  and  Child  Care  Nursing. 

Qualifications 

Baccalaureate  Degree  preferred 

Diploma  in  teaching  with  experience  will  tw  considered 


THE  GENERAL  HOSPITAL 
St.  John's,  Newfoundland 


Please  tell  me  about  teaching  nursing  at  The  General 


Name  . . , 
Address 


UNIVERSITY  HOSPITAL 

SASKATOON, SASKATCHEWAN 

is  featuring: 

1.  New  neonatology  unit  (20  bed)  opening  in  Sep- 
tember. 

2.  Unit  and  Team  Systems  of  Nursing  on  Surgical  and 
Medical  wards. 

3.  Opportunity  in  general  and  specialized  nursing. 
550  bed  Hospital  located  on  University  Campus. 


Apply  to: 


Employment  Officer,  Nursing 
University  Hospital 
Saskatoon,  Saskatchewan 
S7N  0W8 


REGISTERED  NURSES 


Registered  Nurses  required  for  large 
metropolitan  general  hospital. 
Positions  available  in  all  clinical  areas. 
Salary  Range  in  effect  until  December 
31,1975. 

$900.  —  $1,075.  Starting  rate  de- 
pendent on  qualifications  and  experi- 
ence. 


Apply  to: 


Staffing  Officer-Nursing 
Personnel  Department 
Edmonton  General  Hospital 
Edmonton,  Aiberta 
T5K  0L4 


Health  Sciences  Centre 

requires  a 

DIRECTOR, 
SCHOOL  OF  NURSING 


Applications  are  invited  for  a  challenging,  leadership  position  as 
Director  of  the  School  of  Nursing,  Health  Sciences  Centre. 

The  Director  is  responsible  for  the  administration  of  the  School  of 
Nursing  and  collaborates  with  a  faculty  of  33  teachers  in  planning, 
implementing  and  evaluating  the  curriculum  for  more  than  300 
students.  The  School  program  is  approximately  22  months  in 
^ngth  and  prepares  nurses  at  a  diploma  level. 
ie  School  of  Nursing  Advisory  Committee  is  a  standing  commit- 
?e  of  the  Board  of  Directors  of  the  Health  Sciences  Centre  and 
lakes  provision  for  both  student  and  teacher  representation. 

The  Health  Sciences  Centre  is  a  1345  bed  complex  with  several 
ambulatory  care  clinics  affiliated  with  the  University  of  Manitoba, 
entrally  located  in  a  large,  culturally  alive  cosmopolitan  city. 
The  successful  candidate  must  have  preparation  at  a  Masters 
level:  be  eligible  for  the  registration  in  Manitoba  and  have  demons- 
trated skills  in  leadership  in  an  educational  setting. 
Salary  will  be  competitive. 

Send  applications  witti  resume  or  enquiries  to: 

Ms.  M.  McCi^dy 

Director  of  Educational  Services,  Nursing 

Health  Sciences  Centre 

700  William  Avenue 

Winnipeg,  Manitoba  R3E  0Z3 


ia  m  hlo it  college 

of  A|)|)li«tl    Vrt«  and  '!  trhnolojrv 


P.O    Box  969.  Sarnia.  Ontario 


DIRECTOR  —  SCHOOL  OF  NURSING 

This  senior  academic  administrator  will  report  directly  to  the 
Vice-President  (Academic),  and  is  responsible  for  the  de- 
velopment and  administration  of  the  School  of  Nursing,  its 
staff  and  educational  programs. 

The  successful  candidate  will  have  a  background  in  Nursing 
Service  with  instructional  and  administrative  experience  in 
nursing  education.  A  minimum  of  a  B.Sc.  Nursing  degree  is 
required. 

CO-ORDINATOR 

DIPLOMA  NURSING  PROGRAM 

Duties  include  co-ordination  of  clinical  resources,  teaching, 
assisting  the  Director  and  Faculty  in  developing  and  imple- 
menting a  new  curriculum.  Candidates  should  have  Ontario 
Nursing  Registration,  a  baccalaureate  degree  in  Nursing  or 
its  equivalent,  and  at  least  2  years  relevant  nursing  and 
curriculum  experience. 

Excellent  potential  exists  for  creative  educators  in  a  beautiful 
new  campus  setting. 

Please  reply  in  confidence  to: 

The  Personnel  Officer 
Lambton  College.  Box  969 
Samia,  Ontario,  NTT  7K4 


ST,  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

•  We  offer  opportunities  in  Emergency,  Operating  Room,  P.A.R.,   Intensive*  Care  Unit,  Orthopaedics,  Psychiatry, 
Paediatrics,  Obstetrics  and  Gynaecology,  General  Surgery  and  Medicine. 

•  We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Service  programs. 

•  We  offer  —  Toronto  —  with  some  of  Canada's  finest  Theatres,  Restaurants  and  Social  events. 

•  We  offer  progressive  personnel  policies. 

•  We  offer  a  starting  salary,  depending  on  experience,  of: 

effective  April  1, 1975     -  $945  to  $1,145  per  month. 

•  We  offer  monthly  educational  allowances  up  to  $1 20.  per  month  in  addition  to  the  above  starting  salary. 

Appiyto:  Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1B5 


ANADIAN  NURSE  —July  1975 


THE  NEW  CARDIAC  UNIT 

OF  THE 

OTTAWA  CIVIC  HOSPITAL 

Opening  the  spring  of  1976 


Requires: 

"Assistant  Director  of  Nursing  Service" 

Applicants  should  have  a  degree  in  nursing  and  preferably 
Sonne  expertise  in  this  speciality. 

Applications  &  enquiries  to: 

Miss  M.  Mills 

Assistant  Director  of  Nursing  Service 

Ottawa  Civic  Hospital 

1053  Carling  Avenue 

Ottawa,  Ontario 

K1Y  4E9 


NEWFOUNDLAND  PUBLIC  STAFF  NURSES 
SERVICE  COMMISSION       EXON  HOUSE 

Applications  are  invited  for  the  positions  of 

Staff  Nurses 

at 
Exon  House 

—  an  Institution  caring  for  mentally  and  physically  handicap- 
ped children. 

The  salary  In  these  positions  is  on  the  scale  $7,652.  — 
$9,71 5.  per  annum  plus  a  special  allowance  of  $2.00  a  shift 


Applications  In  writing  should  be  forwarded  to: 

Director 

Homes  for  Special  Care 

Dept.  of  Rehabilitation  &  Recreation 

Box  4750,  Confederation  Building 

St.  John's 

A1C  5T7 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


^ 


NUMBER 
COLLEGE 


Requires 

CO-ORDINATOR  —  OPERATING  ROOM  PROGRAM  — 

To  co-ordinate  and  supervise  development,  implementation 
and  evaluation  of  post  diploma  programs  for  Registered 
Nurses  and  Registered  Nursing  Assistant  in  the  Operating 
Room.  Teaching  O.R.  theory  and  supervision  of  students 
clinical  practice  will  be  required.  Successful  applicant  should 
have  B.Sc.N.  with  additional  preparation  and/or  experience 
in  the  Operating  Room. 

TEACHER,  OPERATING  ROOM  PROGRAM  —  To  teach 
nursing  theory,  operating  room  content  and  to  supervise 
students  in  the  clinical  areas  for  the  R.N. A.  —  Operating 
Room  Program.  Must  have  B.Sc.N.  with  experience  in 
Operating  Room.  Previous  teaching  experience  an  asset. 
TEACHERS  IN  THE  NURSING  ASSISTANT  AND  NURS- 
ING DIPLOMA  PROGRAMS  —To  teach  nursing  theory  and 
practice  as  well  as  supervision  of  student's  clinical  practice. 
Successful  applicant  should  have  B.Sc.N.  with  a  minimum  of 
two  years  experience  in  nursing  practice.  Must  be  a  Regis- 
tered Nurse  in  the  Province  of  Ontario. 
Apply  in  writing  with  resume  to: 

Personnel  Relations  Centre 

Number  College  of  Applied  Arts  and  Technology 

P.O.  Box  1900,  Rexdale,  Ontario. 

We  are  interested  In  Male  and/or  Female  applicants 


THE  SCARBOROUGH 
GENERAL  HOSPITAL 

Invites  applications  from: 
Registered  Nurses  and  Registered  Nursing  Assis- 
tants  to   work    in   our   650-bed   active   treatment 
hospital  and  new  Chronic  Care  Unit. 

We  offer  opponunlties  m  Medical,  Surgical,  Paedlatnc.  and  Obstetrical  nursing. 
Our  specialties  include  a  Burns  and  Plastic  Unit.  Coronary  Care.  Intensive  Care  and 
Neurosurgery  Units  and  an  active  Emergency  Department. 

•  Obstetrical  Deparlment  —  participation  in  "Family  centered"  leeching 
program. 

•  Paedlatric  Department  —  participation  in  Play  Therapy  Program. 

•  Orientation  and  on-going  staff  education. 

•  Progressive  personnel  policies. 

The  hospital  is  located  in  Eastern  Metropolitan  Toronto. 

For  further  Information,  write  to: 

The  Director  of  Nursing, 

SCARBOROUGH  GENERAL  HOSPITAL 

3050  Lawrence  Avenue,  East,  Scarborough,  Ontario 


CERTIFIED  NURSING  AIDES 
NURSING  HOME  ATTENDANTS 

The  Government  of  Yukon  Territory  seeks  applications  to  establish  an  eligible  list  of  persons  desiring 
periodic,  casual  employment  in  either  the  Whitehorse  or  Dawson  City  senior  citizens  facilities. 

CERTIFIED  NURSING  AIDES 

Under  the  direction  of  a  nurse  supervisor,  Certified  Nursing  Aides  are  required  to  provide  nursing  and 
personal  care  to  resident  senior  citizens.  Duties  include  administering  simple  medications  and  catheriza- 
tions;  recording  temperatures,  pulse,  respiration  and  blood  pressure;  performing  other  related  duties. 
Formal  training  and  registration  as  a  Certified  Nursing  Aide,  Registered  Nursing  Assistant  or  Licensed 
Practical  Nurse  is  required. 

NURSING  HOME  ATTENDANTS 

These  persons  are  required  to  assist  the  Certified  Nursing  Aides  in  extending  services  to  patients.  Duties 
include  bathing,  dressing  and  providing  personal  assistance  as  well  as  minor  housekeeping  duties.  While 
previous  related  experience  is  desirable,  a  sincere  desire  to  assist  and  care  for  the  elderly  is  required. 

SALARY:  Certified  Nursing  Aides  S3.64  per  hour  and  under  review 
Nursing  Home  Attendants  $3.32  per  hour  and  under  review 
(evening  and  night  shift  premiums  will  apply) 

Applicants  should  state  level  and  location  of  position  for  which  they  wish  t(^  '  3  considered. 

Applications  may  be  obtained  from: 

PERSONNEL  DEPARTMENT, 
GOVERNMENT  OF  YUKON  TERRITORY, 
P.O.  BOX  2703, 
WHITEHORSE,  Y.T. 


ANADIAN  NURSE  —July  1975 


Arctic^ 
warmth 


•  •  •  -Avhen 

somebody 

cares. 


if  you  care, 

send  this 

coupon  today. 


|,       w?--'^        Medical  Services  Branch 
f  ..-_-  itv;    ^      Department  of  National 


t'* 


Health  and  Welfare 
Ottawa,  Ontario   K1 A  0K9 


Please  send  me  more  information  on  nursing 
opportunities  in  Canada's  Northern  Health  Service. 


Name: 
Address: 


City; 


Prov: 


!♦ 


Index  to  Advertisers 
July  1975 

American  Hospital  Supply Cover  2 

Canadian  Nurses"  Association    41 

Hollister  Limited 6i 

ICN  Canada  Limited 2,  Cover  3 

J.B.  Lippincott  Co.  of  Canada  Limited 28,  29 

MedoX 8 

V.  Mueller Cover  4 

Posey  Company  5 

Reeves  Company   11 

W.B.  Saunders  Company  Canada  Limited 1 


Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  1E2  (Ontario) 


Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills,  Ontario 
Telephone:  (416)444-4731 


Advertising  Representatives 

Richard  P.  Wilson  Member  of  Canadian 

219  East  Lancaster  Avenue      Circulations  Audit  Board  Inc. 

Ardmore.  Penna.  19003 

Telephone:  (215)649-1497  l^4^in 


Hearth  and  Welfare       Sante  et  Bien-etre  social 
Canada  Canada 


DIRECTOR 

OF 
NURSING 


Applications  are  invited  for  a  DIRECTOR  OF  NURSING  for  a 

138  bed  fully  accredited  brand  new  hospital,  presently  in  the 
final  stages  of  construction,  and  which  we  will  occupy  in 
August  1975. 


Qualified  applicants  are  requested  to  reply  in  writing, 
giving  curriculum  vitae  to: 

The  Administrator 
Kirl<land  &  District  Hospital 
Kirkland  Lake,  Ontario 
P2N  1R2 


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The 

Canadian 
Nurse 


^^^ 


\  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  by  the  Canadian  Nurses'  Association 


Volume  71,  Number  8 


August  1975 


17  Frankly  Speaking  — 

Mandatory  Continuing  Education?  Shirley  M.  Stinson 

18  Intra-Aortic  Balloon  Punnp  E.  Joan  Breakey 

22      Dyspareunia:  A  Symptom  of 

Female  Sexual  Dysfunction L.  Spano,  J.A.  Lamont 

26      Treatment  of  Patients 

with  Spinal  Cord  Injuries   P.J.  Vincent,  J.  Smith,  E.  Danglasan 

31  Children's  Value  to  Their  Parents M.  Vaillancourt-Wagner 

38  Histoplasmosis J.W.  Davies,  G.  Jessamine 

41  Bunion  Surgery    S.  Robb 

45  Fitness  for  39c Helen  Krafchik 

1  he  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

9  News 

46  Names 

48  New  Products 


50  Dates 

51  Research  Abstracts 
53  Books 

55  Accession  List 


Executive  Director:  Helen  K.  Mussallem  • 
Edilor:  Virginia  A.  Lindabury  •  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Lynda  S. 
Cranston  «  Production  Assistant:  Mary  lou 
Downes  •  Circulation  Manager:  Beryl  Dar- 
ling •  Advertising    Manager:    Ceorgina    Clarke 

•  Subscription  Rates:  Canada:  one  year, 
$6.00;  two  years,  $11.00.  Foreign:  one  year, 
$6  50;  two  years,  $12.00.  Single  copies: 
$1.00  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  registration  number  in  a  pro- 
uncial  nurses'  association,  where  applicable. 
Not  responsible  for  journals  lost  in  mail  due 
!o  errors  in  address. 


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  printsi  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,    Ontario,    K2P1E2 

©  Canadian  Nurses'  Association  1975. 


editorial 

A  letter  published  a  few  months  ago 
in  this  magazine  criticized  nursing 
and  asked,  "Where  is  the  nurse  who 
cares?"  Replying  to  this  letter,  Linda 
Silburt  wrote  that  patients  in  the 
hospital  where  she  works  are 
treated  as  persons,  "not  as  names 
on  beds  or  on  medicine  cards"  (Let- 
ters, July  1975,  p.  4).  "What  about 
all  the  good  nurses,  the  nurses  who 
treat  patients  as  individuals  with 
thoughts,  feelings,  and  needs  all 
their  own?"  Silburt  asked.  "Why 
don't  we  hear  about  these  nurses?" 

I  thought  about  her  words  two 
weeks  ago,  as  I  waited  at  the 
McMaster  Cancer  Clinic  in  Hamil- 
ton, Ontario,  while  my  father  had  a 
Cobalt  treatment.  He  had  suddenly 
become  seriously  ill,  and  I  arrived 
from  Ottawa  in  time  to  be  with  him. 
We  were  both  in  a  state  of  shock,  as 
his  severe  dyspnea  and  pain 
seemed  to  have  appeared  almost 
overnight. 

The  gentleness  and  understand- 
ing of  the  head  nurse,  her  staff,  and 
other  health  care  workers  in  this 
Clinic  helped  both  of  us  get  through 
the  ordeal.  On  our  return  for  another 
treatment,  I  noticed  that  this  same 
solicitous  care  was  given  to  all  pa- 
tients and  their  families. 

These  are  the  nurses  who  care. 
And  they  can  be  found  in  hospitals, 
clinics,  and  communities  from  coast 
to  coast  in  Canada.  Along  with  their 
clinical  expertise,  these  nurses  still 
have  time  to  show  love,  compas- 
sion, and  empathy  to  patients  and  to 
relatives.  They  make  me  proud  to  be 
a  nurse. 

This  is  my  last  editorial.  On  1  May 
1975  —  two  months  before  my 
father  became  ill  —  I  decided  the 
time  had  come  for  me  to  leave  the 
position  as  editor  of  The  Canadian 
Nurse.  My  10  years  as  editor  have 
been  —  to  use  a  clich6  —  a  real 
challenge,  and  one  that  I  have  en- 
joyed. 

I  thought  of  many  topics  for  my 
final  editorial  —  including  the  impor- 
tance of  editorial  freedom  for  a 
magazine  —  but  my  experiences  of 
the  past  two  weeks  led  me  inevitably 
to  the  topic  of  nurses  and  nursing 
care. 

I  leave  with  these  words,  which 
express  my  deepest  belief:  In  our 
society,  which  often  seems  so  im- 
personal, so  competitive,  and,  in- 
deed, even  cruel,  love  and  compas- 
sion for  one's  fellow  human  beings 
are,  in  the  last  analysis,  all  that  really 
matter.  And  I  am  confident  that  most 
nurses  in  this  country  share  this 
belief.         —  Virginia  A.  Lindabury 


15  CANADIAN  NURSE  —  August  1975 


letters 


Nurses  of  Brochel 

The  article  "The  nurses  of  Brochet"  by 
Hilary  Brigslocke (April  1 975,  p.  2 1)  is 
one  of  the  best  I  have  ever  read  on  the 
problems  faced  by  nurses  in  the  north. 
For  three  years  I  worked  at  Sandy  Bay, 
Saskatchewan,  a  few  miles  from  the 
Manitoba  border,  which  was  in  some 
ways  even  more  isolated  than  Brochet. 
Because  there  was  a  road  of  sorts,  we 
had  no  scheduled  flights,  and  the 
nearest  hospital  and  medical  center  was 
122  miles  away  at  FlinFlon,  Manitoba. 

Boredom  was  something  I  never  ex- 
perienced. Perhaps  the  lack  of  time  off 
on  a  regular  basis  kept  me  from  getting 
bored.  I  was  the  only  nurse,  with  some- 
thing over  600  native  people  of  Cree 
ancestry.  After  1  left,  the  provincial  of- 
fice was  going  to  try  to  get  two  nur.ses. 

I  wholeheartedly  endorse  the  state- 
ments of  the  author,  who  writes,  "  .  .  . 
one  sometimes  feels  this  sense  of  isola- 
tion in  the  northern  parts  of  the  pro- 
vinces more  than  in  the  Arctic  regions 
where  communications,  by  and  large, 
are  surprisingly  good."  I  didn't  even 
have  a  radio-telephone  at  the  hospital, 
but  had  to  dress  up  and  walk  to  a  store 
over  a  quarter  of  a  mile  away! 

There  is  much  criticism  of  The 
Canadian  Nurse.  I  look  through  my 
copy  as  soon  as  I  receive  it ,  and  there  is 
always  at  least  one  article  that  I  read 
right  away.  I  enjoy  the  magazine.  — 
Sister  Patricia  Trainor,  B.Sc.N.,  Sask- 
atoon, Sask. 

In  reference  to  the  article  "The  Nurses 
of  Brochet"  by  Hilary  Brigstocke, 
which  appeared  in  the  April  1975  issue 
of  The  Canadian  Nurse,  we  feel  that  a 
more  realistic  article  is  in  order  for  a 
nursing  magazine. 

It  is  true  that  radio  and  telephone 
communications  are  not  always  ade- 
quate. It  is  also  true  that  a  more 
thorough  orientation,  including  work 
situations,  should  be  provided.  How- 
ever, the  gross  generalizations  made  by 
H.  Brigstocke,  after  a  2-day  visit  to  one 
particular  nursing  station,  show  inac- 
curacies of  the  observer  and  in  no  way 
reflect  the  scope  of  health  care  given  in 
all  nursing  stations  —  or,  for  that  mat- 
ter, reflect  the  care  given  in  this  particu- 
lar nursing  station  every  day. 


This  melodramatic  article  showed 
heroism  as  a  basis  of  nursing  stations. 
In  fact,  there  are  emergencies  and 
treatment  clinics,  but  these  do  not  oc- 
cupy the  majority  of  nursing  time.  The 
main  focus  of  care  in  a  nursing  station  is 
on  public  health.  This  requires  team 
effort  on  the  part  of  the  nurses.  They 
must  work  closely  with  each  other  to 
establish  objectives  and  to  build  on 
them.  They  function  in  many  areas  of 
the  community.  For  example,  the 
nurses  organize  and  direct  such  things 
as  well  baby  clinics,  prenatal  classes, 
health  teaching  in  homes  and  schools, 
and  preventive  and  prophylactic  pro- 
grams. They  meet  with  other  members 
of  the  health  team,  e.g.,  community 
workers  and  other  auxiliary  services,  to 
plan  and  carry  out  special  functions. 

We  would  like  to  emphasize  the  team 
effort  involved  and  dissolve  the  impres- 
sions of  "man  and  dog"  effort,  which 
H.  Brigstocke  planted  in  his  article.  He 
mentioned  one  of  the  nurses  very 
briefly,  as  though  she  were  a  casual 
observer.  Every  member  of  the  health 
team  is  of  vital  importance.  A  nurse's 
knowledge  and  capability  does  not  de- 
pend on  her  school  of  nursing,  whether 
it  be  in  Canada  or  overseas.  Capable 
Canadian,  as  well  as  British  and  Au- 
stralian, nurses  work  in  outpost  hospi- 
tals throughout  the  provinces,  ter- 
ritories, and  the  Yukon. 

On  page  23  of  the  article,  "Johnson 
examines  the  eyes  of  an  old  woman, 
during  her  daily  house  visits  to  the  In- 
dian Community."  Could  you  please 
clarify  exactly  what  "Johnson"  was 
examining  in  the  patient's  eye?  Placing 
an  upside-down  hemoglobinomeier  to  a 
person's  eye  for  eye  examination  pur- 
poses seems  more  than  a  little  strange  to 
us.  [Editor's  Note:  We  answered  this  in 
the  June  1975  issue,  p.  6] 

Nurses  are  referred  to  by  their  last 
names  in  this  article .  For  a  more  human 
feeling,  we  prefer  Christian  names  to 
the  militaristic  surname.  Also,  we  as 
individuals  do  not  like  being  referred  to 
coldly  by  our  last  names  only. 

In  conclusion,  we  would  like  to  sug- 
gest that  Brigstocke's  impressions  may 
have  caused  some  sensationalism  in  a 
weekend  magazine,  but  we  certainly 
can  see  no  place  for  them  in  a  profes- 


sional magazine.  — Nurse  Practitioner 
Program,  The  University  of  Alberta: 
Sue  Bayley,  Tuktoyaktuk,  N.W.T.: 
Margaret  Murray,  Port  Simpson. 
B.C.;  Shona  Johansen,  Alexis  Creek. 
B.C.:  Sue  Neilson,  Rankin  Inlet. 
N.W.T.:  Phyllis  Kaufhold,  Cambridge 
Bay,  N.W.T.;  Faye  Skakun,  Pelican 
Narrows,  Sask.:  Maureen  McEwan. 
Cambridge  Bay,  N.  W.T.;  and  Ling  Ing 
Tan,  Fox  Lake,  Alta. 


Editor's  Note: 

The  Canadian  Nurse  uses  a  person's 
complete  name  (given  name  and  sur- 
name) when  first  identifying  the  indi- 
vidual. Then,  the  surname  only  is  used, 
because  repetition  of  both  names 
throughout  the  text  would  be  both  re- 
dundant and  awkward.  This  style  was 
adopted  by  The  Canadian  Nurse  fol- 
lowmg  a  resolution  passed  at  the  Cana- 
dian Nurses'  Association's  1974  an- 
nual meeting  and  convention.  This  re- 
solution states: 

Whereas  today's  trends  do  not  sup- 
port the  practice  of  categorizing  indi- 
viduals according  to  sex  and/or  marital 
status; 

Be  it  resolved  that  the  Canadian 
Nurses'  Association  adopt  the  practice, 
to  the  extent  possible,  of  using  the 
given  name  and  surname  only  for  all 
identification  purposes. 


I  read  with  great  pleasure  the  article  by 
Hilary  Brigstocke,  entitled  "The 
Nurses  of  Brochet."  (April  1975,  p. 
21.) 

For  those  of  us  who  have  not  had  the 
opportunity  of  either  working  or  visit- 
ing an  outpost  nursing  station,  it  gives 
us  a  glimpse  of  the  nursing  demands 
placed  on  these  nurses. 

The  honesty  of  the  author  appealed 
to  me.  His  comment,  "Life  in  these 
isolated  stations  is  one  of  peaks  of  ac- 
tivity and  stretches  of  boredom,"  does 
not  lead  one  to  believe  that  all  things  are 
"beautiful."  He  reports  freely  that  the 
turnover  rate  is  high. 

One  cannot  help  but  admire  these 
nurses,  who  so  selflessly  give  of  them- 
selves. I  am  sure  it  is  not  easy  at  times. 
(Continued  on  page  6) 


In  law,  as  in  medicine, 
tiie  safest  approach  to  a  proiilein 

is  its  prevention. 


In  the  new  third  edition  of  Helen  Creighton's  Law  Every  Nurse  Should 

Know  you'll  find  practical,  clearly  written  information  on  every  possible  legal 
repercussion  you  might  encounter  as  a  nurse — and  more  importantly,  you'// 
learn  how  to  avoid  them. 

Helen  Creighton,  who  is  a  nurse  and  nursing  educator  as  well  as  a  lawyer, 
clarifies  both  sides  of  the  complications  that  can  arise  between  the  nursing 
profession  and  the  law.  Her  pertinent  advice  on  problems  of  licensure; 
contractual  rights;  duties  and  remedies;  student  rights;  cases  involving 
negligence  and  malpractice;  and  confidential  communications  makes  this  a 
reference  you'll  turn  to  time-and-time  again  with  your  legal  questions. 

Completely  updated  to  reflect  modern  trends  in  patient  care  and  to  show 
how  recent  legal  decisions  affect  the  nursing  profession,  this  text  brings  you 
greater  awareness  of  your  rights  and  responsibilities  under  the  law.  There 
are  new  discussions  of  minors  and  birth  control,  abortion,  and  drug  abuse; 
pronouncing  the  patient  dead;  acupuncture;  rights  prior  to  birth;  narcotics 
violations;  and  continuing  education  for  renewal  of  licensure.  A  helpful  new 
appendix  contains  excerpts  from  Dr.  Creighton's  recent  journal  articles 
concerning  current  problems  affecting  your  profession.  A  full  chapter  looks 
at  the  special  considerations  peculiar  to  Canadian  Law  and  Legal  Practice. 

You  be  the  judge.  Examine  this  book  on  30-day  approval  and  discover  how 
its  legal  counsel  can  be  of  immediate  practical  value  to  you. 


Creighton: 

LAW  EVERY  NURSE  SHOULD  KNOW 

New  Third  Edition 

Table  of  Contents 

Law  and  Society 1 

The  Practice  of  Nursing  8 

Contracts  for  Nursing  29 

Breach  and  Termination  of  Contract 46 

The  Legal  Status  of  the  Nurse 58 

The  Relation  of  a  Nurse's  Rights  and  Liabilities 

to  Her  Position  and  Status 79 

Negligence  and  Malpractice  119 

Torts  as  a  Source  of  Other  Civil  Actions  145 

Crimes:  Misdemeanors  and  Felonies  177 

Witnesses,  Dying  Declarations,  Wills  and  Gifts 196 

Canadian  Law  and  Legal  Practice 207 

Appendix  247 

Index  315 


2. 
3. 

4. 
5. 
6. 

7. 

8. 

9. 
10. 
11. 


By  Helen  Creighton,  RN,  BSN,  AB,  AM,  MSN,  JD,  Professor  of  Nursing, 
University  of  Wisconsin,  Milwaukee.  About  330  pages.  About  $10.55. 
Just  Ready.  Order  #2752-8. 


Also  of  Interest 

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CRITICAL  INCIDENTS  IN  NURSING 

From  euthanasia  to  a  professional  disagreement  with  a  doctor,  each  of 
38  frequently  encountered  human  relations  problems  is  discussed  by 
a  panel  of  specialists  in  an  attempt  to  determine  the  most  ethical  and 
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quent evaluation  of  these  situations,  and  the  comparison  of  views  by 
the  highly  qualified  consultants,  provides  exciting  and  informative 
reading  for  any  nurse. 

Edited  by  LoreRa  Sue  Bermosic,  RN:  and  Raymond  J.  Corslnl,  PhO;  with  66 
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letters 

(Continued  from  page  4) 


I  hope  there  will  be  more  articles  like 
■'The    Nurses    of    Brochet"    in    our 
magazine.  —  Heather  Kents.  Brant- 
ford,  Ontario. 


As  a  writer  myself,  I  take  this  oppor- 
tunity to  congratulate  you  on  the  excel- 
lent article  you  carried  in  the  April  issue 
of  The  Canadian  Nurse,  concerning 
nurses  in  the  Canadian  north. 

I  thought  the  author,  Hilary  Brigs- 
tocke,  did  a  fine  job  of  underlining  the 
responsibilities  of  the  nurses  in  that  reg- 
ion and  the  versatility  they  need.  He 
established  well  the  fact  that  team  work 
is  needed  and  that  the  nurses  work 
closely  with  community  workers  and 
those  in  auxiliary  services. 

It  was  interesting  to  see  that  nurses 
are  strongly  into  preventive  medicine, 
that  they  carry  their  message  into  the 
homes  and  the  schools,  and  are  deeply 
concerned  with  children,  almost  from 
the  moment  of  conception  and  through 
their  early  lives.  Surely,  this  must  have 
resulted  in  vastly  more  children  in  the 
North  living  through  the  critical  first 
few  years. 

As  an  aside,  the  eating  habits  taught 
by  these  nurses  should  also  result  in  a 
sturdier  group,  much  less  prone  to  ill- 
nesses of  our  so-called  civilization. 

Thanks  to  Brigstocke  for  bringing 
out  these  salient  points,  and  my  respect 
to  those  nurses  in  the  Northland  and 
other  isolated  areas  who  do  their  work 
so  well.  —  William  G.  Lovatt,  Health 
and  Welfare  Canada,  Ottawa. 

Enjoyed  April  issue 

This  note  is  to  say  how  much  I  enjoyed 
the  April  issue  o^The  Canadian  Nurse. 
It  was  refreshing  and  educational.  The 
article  on  rape  victims  was  particularly 
sensitive.  —  Rebecca  Bergman,  Fa- 
culty of  Continuing  Medical  Educa- 
tion, Nursing  Department,  Tel-Aviv 
University,  Israel. 

The  hyperkinetic  child 

Thank  you  so  much  for  the  article  by 
Carol  Anonsen  on  the  hyperkinetic 
child.  (May  1975,  p.  27.)  It  was  a 
well-written  article  that  could  be  under- 
stood by  nurse  or  layman. 

I  have  a  hyperkinetic  son,  now  10 
years  old,  who  was  diagnosed  before  he 
went  to  school,  and  this  article  fits  him 
to  such  a  degree  that  I  sent  it  to  school 
for  his  teacher  to  read.  She  has  put  it 
with  his  file,  so  that  now,  and  in  the 
future,  it  is  available  for  people  to  read 


to  get  a  little  more  insight  into  my  son 
and  perhaps  some  other  child  who  has 
escaped  diagnosis  and  is  only  labeled  as 
a  troublemaker. 

My  son  has  been  on  drugs  for  his 
condition  for  some  time;  he  is  in  grade 
3,  and  doing  very  well.  We  still  have 
bad  days,  but  he  is  steadily  improving 
and  slowly  outgrowing  it.  To  mothers 
who  are  leery  of  trying  the  drugs  on 
their  child,  I  say:  "Try  them,  as  there  is 
no  comparison  once  the  child  gets  regu- 
lated, and  it  makes  life  livabfe  for  him 
and  you."  — Joan  Holland,  Calgary, 
Alberta. 

The  population  issue 

I  particularly  enjoyed  the  "Opinion" 
feature  in  the  May  1975  issue  of  our 
journal.  Dr.  Lise  Fortier  has  presented 
some  most  fascinating  data  and  view- 
points expressed  in  a  very  readable 
manner.  Such  information  should  re- 
ceive wide  circulation  to  make  people 
realize  that  Canada  does  not  contain 
limitless  resources. 

I  would  be  interested  in  other  opin- 
ions of  Fortier.  — Doris  Stevenson,  RN, 
Director.  Holy  Cross  School  of  Nurs- 
ing. Calgary,  Alberta. 


Thanks  to  immigrants  who  had  hope 
and  faith  in  the  future,  we  in  Canada  in 
1975  have  reached  a  standard  of  living 
second  only  to  the  United  States.  Now, 
Dr.  Lise  Fortier  would  have  us  believe 
that  because  we  have  22  million  people 
in  Canada,  we  should  cease  to  grow. 
("Does  Canada  Need  a  Population  Pol- 
icy?," May  1975,  p.  17) 

Can  a  stagnant  population  growth 
maintain  a  set  standard  of  living  in  a 
consumer-oriented  society?  Fortier 
points  a  finger  at  the  underdeveloped 
world  and  blames  it  for  being  so  be- 
cause of  overpopulation.  She  manages 
to  convey  the  idea  that  if  Canada  stops 
population  growth,  somehow  every- 
thing will  be  "peachy-dandv."  No  one 
who  has  an  eye  and  ear  to  the  "global- 
village"  world  of  today  could  possibly 
agree  with  this  notion. 

Reputable  writers,  and  published  ar- 
ticles that  have  come  out  of  the  United 
Nations-sponsored  World  Population 
Conference  in  Bucharest  last  fall,  reject 
the  argument  that  lowering  population 
raises  standards  of  living.  In  fact,  there 
is  general  agreement  among  those  who 
take  an  objective  judgment,  that  popu- 
lation growth  is  the  outcome,  rather 
than  the  cause,  of  low  standards  of  liv- 
ing. This  is  because  population  growth 


is  an  integral  part  of  the  social  structure 
and  developmental  process,  as  well  as 
the  result  of  several  variables ,  of  which 
we  possess  only  a  groping  and  imper- 
fect understanding. 

Responsible  action  re  Canada's 
population  policy  today  would  be  to 
create  an  open-hearted  approach  that 
invites  people  to  share  some  of  the 
wealth  we  possess,  not  to  advocate  zero 
population  growth  nor  to  keep  people 
out.  It  is  well  known  that  the  high  levels 
of  consumption  of  industrial  nations, 
such  as  Canada,  represent  a  much  great- 
er drain  on  world  resources  and  stabil- 
ity than  the  rapid  population  growth  of 
the  poor  countries. 

The  truth  of  the  matter  is  that  we  will 
have'  to  change,  rather  than  telling 
others  to  accommodate  to  us.  It  will 
take  money  and  effort  to  raise  the  living 
standards  of  the  poor. 

I  believe  Canadians  want  to  help 
their  brothers  and  sisters  who  have  not 
been  fortunate  enough  to  have  had  the 
chances  we  in  Canada  have  had.  I  be- 
lieve, too,  that  we  will  have  to  influ- 
ence the  foreign  policy  of  our  govern- 
ment so  that  a  fair  share  of  the  worid's 
goods  is  available  to  all  mankind. 

We  will  certainly  have  to  ask  ques- 
tions of  the  large  multinational  com- 
panies. It  is  estimated  that  within  the 
next  25  years,  a  few  hundred  of  these 
companies  will  control  approximately 
54%  of  the  world's  production  of  goods 
and  services.  They  will  have,  and,  to  a 
degree  already  have,  the  power  to  con- 
trol the  lives  of  millions,  and  are  guided 
only  by  the  profit  motive!  Should  they 
be  allowed  to  hoard  all  their  wealth  for 
the  few?  Was  not  this  world  made  for 
all  men  and  women? 

I  reject  Fortier's  opinion  as  being 
narrow  and  selfish,  an  opinion  that 
would  have  been  rejected  also  by  our 
late  Prime  Minister  Lester  Pearson, 
who  said,  "A  planet  cannot,  any  more 
than  a  country,  survive  half  slave,  half 
free,  half  engulfed  in  misery,  half 
careening  along  toward  the  supposed 
joys  of  almost  unlimited  consump- 
tion . "  —  Elizabeth  Donohoe,  Toronto. 


The  author  replies 

I  could  not  agree  more  with  Elizabeth 
Donohoe  about  the  fact  that  our  level  of 
consumption  is  depleting  the  wealth  of 
the  world  and  that  large  multinational 
companies  will  have  to  account  for 
their  attitudes. 

She  accuses  me  of  blaming  the  un- 
(Continued  on  page  8) 


I  Items  shown,  for  group  purchases,  graduation  gifts,  favors,  etc. 

6-1 1  Same  Items,  Deduct  10%;    12-24  Same  Items,  Deduct  15% 
25  or  More  Same  Items,  Deduct  20%  p 


/wamt  HfU  'K  /lu§^...^m  rCeem 


IT'S  EASY  TO  ORDER  REEVES  NAME  PINS  FOR  YOURSELF  OR  FRIENDS ! 


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Mrs.  R.  F.  JOHNSON 
SUPERVISOR 


LETTERING; 2nd  LINE:- 


KSCUmON 


ALL  METAL        S-nootn    '0>.".:r=:; 
■romers  Cfioose  Polished  Sa'iri.  o 
ne*  Duotone  combining  satin 
background  with  polisfi«d  edges 


PLASTIC  LAMINATE  slirr^rrier. 
Ofoaoer.  engraved  thru  surface  to 
:o"!rasting  core  color  Beveled 

Do'def  matches  lettering. 


METAL  FRAMED       Classic 
^  design,  snow-whrte  plastic  with 
tiQotfi.  pohsfied  beveled  frame 


MOLDED  PLASTIC        %>mple.iman. 

i  economical.  Will  never  discolor. 
Sf^ooth  rounded  comers  and  edges. 


wan 


a  Gold 
n  Sliver 


QGoid 

n  Sliver 


mtn 


,  _'^atone 

G  Polished 
D  Sat.n 


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frame 
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apply 


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D  Wfti'ie  ■ 
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Di 

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White 
only 


CISSORS  and  FORCEPS 


Finest  Forged  Steel. 
I  Guaranteed  2  years. 


LfTTOMC 
COIN 


D0»  Blue 
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Black 
M.  Blue 

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Letters  only 


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DBack 

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2  Pins  3.M 
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D  1  Pin    1J5 
D  J  Pins  1.95 


D  1  Pin    2A9 
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D  1  P.n    lis 
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n  1  Pin    1« 


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CHARLENE  HAYNES 


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LISTER  BANDAGE  SCISSORS 
3"i"  Minv-scissor.  Tiny,  handy,  slip  into 
;.niform  pocket  or  purse  Choose  jewelers 
^old   or   gleaming   chrome   plate    finish 

No.  3500  V/i"  Mini 2.75 

No.  4500  4V2''  size.  Chrome  only  .  . .  2.95 

No.  5500  5^/3"  size,  Chrome  only  .  . .  3.25 

No.    702  T/4"  size.  Chrome  only  . . .  3.75 

For  engraved  initials  add  50«  per  instrument 


5W"  OPERATING   SCISSORS 

oolistied  Stainless  Steel,  straight  blades 
No.  705  Sharp 'Blunt  points  . . .  2.95 
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Ho.  710  4' 2"  IRIS  Scis..  Straight .  . .  3.75 
or  engraved  initials  add  50*  per  instrument 


KELLY   FORCEPS 

So  hand)  for  every  nurse'  Ideal  for  clamping 
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No.  25-72  Straight.  Box  Lock 4.49 

No.  725  Curved.  Box  Lock 4.49 

No.  741  Thumb  Dressing  Forcep, 

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No.  289  Card  Set  .  .  .  1.50  ea. 
Initials  gold-stamped  on  back  of 
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Nurses'  POCKET  PAL  KIT     <2e^-^^ 

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ENAMELED  PINS  Beautifully  sculptured  status 
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(Continued  from  page  6) 


derdeveloped  world  for  being  so  be- 
cause of  overpopulation;  it  is  not  the 
sole  factor,  but  its  rapid  growth  com- 
pounds the  problems  and  makes  it  al- 
most impossible  to  catch  up.  Further- 
more, underdeveloped  countries  can 
not  count  anymore  on  large,  uninhab- 
ited continents  to  swallow  great  num- 
bers of  immigrants.  This  factor,  which 
helped  European  countries  solve  all 
their  population  problems  (plus  war, 
alas),  does  not  exist  anymore.  The  only 
solution  left  is  to  attain  an  equilibrium 
between  resources  and  population. 

While  immigrants  furnished  the 
manpower  to  develop  the  country,  an 
industrialized  country  like  ours  owes  its 
wealth  not  so  much  to  immigration,  as 
to  its  resources.  And  if  our  population 
keeps  growing,  we  will  use  more  and 
more  of  those  resources  and  have  less 
and  less  to  share  with  other,  poorer 
countries.  Furthermore,  I  am  not  telling 
others  to  accommodate  to  us,  but  ex- 
actly the  opposite.  I  am  telling  Canada 
to  stop  growing  so  that  it  can  be  an 
example  and  a  guarantee  of  survival  for 
others. 

I  challenge  the  affirmation  that  popu- 
lation growth  is  the  outcome,  rather 
than  the  cause,  of  low  standards  of  liv- 
ing. Population  growth  in  America 
which,  until  recently,  was  rapid,  did  not 
keep  this  continent  from  being  affluent, 
because  there  were  large  resources  to 
be  exploited  and,  being  underde- 
veloped, the  country  could  expand. 

We  are  told  we  should  share,  and 
dispense  with  our  high  standard  of  liv- 
ing. Having  a  certain  knowledge  of 
human  nature,  I  cannot  dream  that  peo- 
ple would  do  this  of  their  own  freewill. 
Which  one  of  us  would  be  ready  to 
dispense  with  the  amenities  of  life  in 
North  America:  hot  water,  central  heat- 
ing, refrigerators,  cars,  good  food, 
T.V.,  and  so  on? 

Sharing  willingly  is  a  Christian 
dream,  and  sharing  forcefully,  a  com- 
munist one;  and  both  dreams  are 
strongly  opposed.  It  is  most  surprising 
thus  that  certain  Christian  churches  and 
communist  countries  were  bedfellows 
at  the  Bucharest  conference  on  popula- 
tion. 

These  are  but  a  few  of  the  remarks  I 
could  make,  and  I  hope  they  will  be 
well  taken.  —  Use  Fortier,  M.D., 
F.R.C.S.  (C),  Quebec. 

Women  should  be  paid  for  service 

I  wish  to  answer  Madeleine  Cote's 
anti-abortion  letter  (June  1975,  p.  6). 


If  a  woman  is  told  she  cannot  have  an 
abortion  because  other  people  want  her 
baby,  she  should  be  paid  for  the  service 
and  product  that  she  is  providing.  As 
this  service  goes  on  for  24  hours  a  day 
for  9  months,  she  should  be  paid  for 
that  time.  As  the  service  ends  in  dif- 
ficult physical  labor,  the  woman  should 
be  paid  more  for  this  period  of  hard 
labor.  And,  as  this  service  results  in 
continued  physical  stress  following 
completion  of  the  product,  she  should 
also  be  paid  for  this. 

Childless  couples  are  selfish  if  they 
expect  this  service  and  product  to  come 
to  them  through  charity. 

I  do  not  believe  that  abortion  should 
be  encouraged  as  birth  control .  I  also  do 
not  believe  a  woman  should  be  forced 
to  provide  a  service  and  product  at  such 
a  loss  to  her  time,  work,  and  physical 
well-being,  without  adequate  and 
reasonable  payment.  —  K.M.  Witt, 
RN,  Nelson,  British  Columbia. 


No  need  for  competition 

A  noble,  but  uninformed,  view  is  usu- 
ally expressed  when  nurses  attempt  to 
compare  the  virtues  and  faults  of  a 
3-year  hospital  program  and  the  2-year 
college  program  in  nursing.  Cathy 
Rathwell's  comment  in  her  letter  in  the 
April  1975  issue  is  an  example. 

Hospital-based  nursing  programs 
have  been  a  historical  fact  in  nursing 
education.  No  one  questioned  the  valid- 
ity of  this  education,  primarily  because 
it  was  an  economic  necessity  for  hospi- 
tals to  have  cheap  labor.  Certainly  a 
great  deal  of  experiential  learning  oc- 
curred. It  is  questionable  whether  it  was 
due  to  controlled  learning  situations  or 
to  the  fact  that  the  job  had  to  be  done. 

The  emergence  of  the  2-year  college 
nursing  programs  seems  to  be  due  to  the 
evolving  of  nursing  into  an  applied 
health  science.  This  naturally  means 
controlled  education,  integrated  with 
other  social  behavioral,  medical,  and 
physical  sciences.  These  sciences  thus 
take  priority  over  programs  stressing  a 
great  deal  of  experiential  learning. 

No  one  denies  that  graduates  from 


Roll  up  your 
sleeve  to 
save  a  life... 


\BE A  BLOOD  DONOR 


2-year  programs  are  not  as  experienced  as 
3-year  graduates.  The  idea  is  to  estab- 
lish a  firm  theoretical  framework  from 
which  to  apply  'their  nursing  skills. 
Nurses  from  2-year  college  programs 
have  selective  clinical  experiences  in 
several  hospitals  and  community  health 
agencies  throughout  their  training. 
Flexibility  and  critical  analysis  of  ward 
routine  is  an  outcome  of  such  a  diverse 
background. 

The  feeling  of  not  being  prepared 
and  confident,  expressed  by  Rath  well, 
is  more  a  state  of  mind  commonly  ex- 
pressed by  students  entering  a  profes- 
sional role  and  leaving  the  projective 
environment  of  the  student.  To  this  ex- 
tent, the  3-year  hospital  graduate  shares 
this  Same  real  and  growing  experience, 
along  with  college  graduates. 

The  statement,  "there  is  no  replace- 
ment to  experience"  needs  to  be  qual- 
ified as  to  what  kinds  of  experiences  the 
author  is  referring.  Clinical  experience 
does  improve  nursing  skills,  but  re- 
petitious exercises  are  a  waste  of  lime. 

Two-year  college  nursing  programs 
do  not  profess  to  put  out  super-nurses. 
They  do  claim  to  educate  nurses  who 
are  flexible,  safe,  and  analytical  in 
nursing  care  and  ward  administration. 
Registered  nurses  may  then  study  clini- 
cal specialties  or  go  on  to  obtain  de- 
grees in  nursing.  The  latter  opens  many 
avenues  where  the  nurse  may  pursue 
clinical,  teaching,  administrational.  or 
community  health  specialties. 

Finally.  I  do  strongly  believe  that 
there  is  no  need  for  competition  be- 
tween 3-year  and  2-year  registered 
nurses.  Leaving  pride  aside,  we  can 
learn  from  each  other.  All  too  often 
nurses  are  in  conflict  with  each  other, 
rather  than  uniting  and  confronting 
more  critical  issues  in  a  professional 
manner. 

I  received  my  basic  nursing  educa- 
tion through  a  2-year  community  col- 
lege program.  —  Christopher 
Lemphers.  RN,  Old  Masset,  B.C. 

Not  a  rape  crisis  center 

We  are  not  a  "Rape  Crisis  Center."  as 
listed  in  the  May  1975  issue  of  The 
Canadian  Nurse  (p.  13). 

We  are  not  organized  to  provide  the 
24-hour  service  necessary  for  rape  vic- 
tims. We  do  distribute  anti-rape  litera- 
ture to  our  members,  have  held  group 
discussions  on  rape,  and  have  given  a 
course  in  self-defence.  —  Diane 
Siegel,  Women's  Centre,  St.  John's, 
Newfoundland.  w 


news 


Nova  Scotia  Nurses  Strike, 

But  Maintain  Emergency  Services 

Halifax,  Nova  Scotia  —  One  thousand  Nova  Scotia  nurses  took  strike  action 
against  12  hospitals  in  that  province  in  mid-June.  The  nurses  informed  hospital 
administrators  of  their  intention  to  strike  24  hours  before  they  walked  out.  They 
also  took  steps  to  ensure  that  emergency  services  were  maintained  in  all  hospitals 
for  the  duration  of  the  strike.  The  full  effects  of  the  strike  were  felt  for  8  days  before 
one  group  of  nurses  accepted  a  government  wage  offer.  The  remaining  nurses 
returned  to  work  5  days  later,  "under  protest,"  without  accepting  the 
government's  offer. 


The  nurses,  who  had  been  without  a 
contract  for  5  months,  initiated  the 
strike  action  to  back  contract  demands 
of  the  Nurses'  Staff  Associations  of 
Nova  Scotia,  which  were  seeking  re- 
lativity with  nurses'  salaries  in  other 
Canadian  provinces.  The  starting  sal- 
ary of  registered  nurses  in  Nova  Scotia, 
under  the  terms  of  a  contract  signed  1 
January  1974  was  $651  per  month,  or 
$7,817  annually. 

The  new  offer,  according  to  the 
Nova  Scotia  government,  will  increase 
salaries  by  37.5  percent  over  2  years; 
22.8  percent  the  first  year,  plus  ex- 
panded increments,  and  12  percent  for 
the  second  year. 

Negotiations  between  the  Nurses' 
Staff  Associations  of  Nova  Scotia  and 
representatives  of  the  Association  of 
Health  Organizations  (hospitals)  had 
been  going  on  from  January  to  May 
before  the  strike.  On  23  May,  a  general 
meeting  of  the  NSANS  was  held  in 
Halifax.  Representatives  of  the  24  staff 
associations  learned  that  the  minister  of 
labor,  Walter  Fitzgerald,  had  requested 
nurses  not  to  take  strike  action  if  he 
appointed  an  Industrial  Inquiry  Com- 
mission. The  nurses  agreed  to  delay 
action  for  14  days,  and  a  one-man 
commission.  Judge  Nathan  Green,  was 
appointed. 

Meetings  of  the  commission  began 
the  following  day  and  concluded  9 
June,  with  no  decision  having  been 
taken  on  salary.  Two  days  later,  the 
NSANS  gave  notice  of  strike  action  at  all 
12  hospitals,  and  on  12  June,  the  strike 
was  on. 

Within  hours,  and  before  the  Inquiry 
Commission  had  filed  its  report.  Bill 


131,  to  legislate  the  nurses  back  to 
work,  was  introduced  to  the  N.S. 
Legislature  by  the  minister  of  labor. 
The  government  attempted  to  limit  de- 
bate, but  the  opposition  refused  to 
comply,  and  debate  proceeded.  On  14 
June,  the  negotiating  committee  met 
with  the  hospital  representatives  and 
the  N.S.  premier,  minister  of  health, 
minister  of  labor,  minister  of  finance 
and  attorney  general.  No  agreement 
was  reached,  and  no  counter-proposal 
issued  from  either  side.  The  NSANS 
would  not  agree  to  voluntary  arbitra- 
tion. 

As  a  result  of  representations  from 
the  nurses  and  the  Nova  Scotia  federa- 
tion of  labor,  several  minor  changes 
were  made  in  Bill  131:  to  permit  con- 
sideration of  previous  contract  negotia- 
tions of  offers  made  before  strike  ac- 
tion; to  permit  the  final  contract 
reached  through  arbitration  to  be  ret- 
roactive to  1  January  of  this  year;  and 
to  exclude  the  possibility  of  a  person 
being  fined  more  than  once  for  the  same 
offence  (that  is,  for  those  who  defied 
the  back-to-work  order).  The  request 
for  the  appointment  of  an  out-of- 
province  arbitrator  was  turned  down. 

On  17  June,  NSANS  negotiators  pre- 
sented their  final  position  and  were  in- 
formed that  their  wage  demands  would 
not  be  met.  In  the  meantime,  the  minis- 
ter of  health  presented  the 
government's  final  offer  in  the  Legisla- 
ture. Nurses  in  Halifax  accepted  the 
government  offer  and  returned  to  work 
the  following  day.  Five  days  later, 
nurses  in  Cape  Breton,  who  had  re- 
mained out,  voted  to  return  to  work,  but 
not  to  accept  the  wage  offer. 


Commenting  on  the  strike,  the  presi- 
dent of  the  Registered  Nurses'  Associa- 
tion of  Nova  Scotia,  Sister  Marie 
Barbara,  said  that  the  nurses  had  acted 
responsibly  in  forming  contingency 
plans  that  provided  for  emergency  ser- 
vices in  all  hospitals  affected  by  the 
strike.  She  regretted  that  the  govern- 
ment had  seen  fit  to  introduce  back- 
to- work  legislation.  "The  government 
recently  gave  the  nurses  the  right  to 
strike,  and  now  that  they  are  using  it, 
the  government  is  trying  to  take  it 
away,"  Sister  said. 

RNAO  Members  And  Guests 

Anticipate  Exciting  Future 

Toronto,  Ont.  —  Members  of 
Ontario's  professional  association  for 
registered  nurses  have  accepted  the 
challenge  of  their  50th  birthday,  and 
have  begun  to  prepare  for  the  exciting 
future  they  anticipate. 

The  1,200  guests  who  attended  the 
anniversary  celebrations  of  the  Regis- 
tered Nurses'  Association  of  Ontario  in 
Toronto.  10- 14  June  1975,  ranged  from 
founding  members  and  past  presidents 
to  students  and  recent  graduates.  Rep- 
resentatives of  allied  organizations  that 
the  RNAO  has  been  instrumental  in  es- 
tablishing also  attended,  including  the 
College  of  Nurses  of  Ontario,  the  As- 
sociation of  Registered  Nursing  Assis- 
tants of  Ontario,  and  the  Ontario 
Nurses"  Association.  As  a  group,  they 
gave  their  collective  endorsement  to  a 
stronger  professional  association, 
committed  to  improvement  of  the  qual- 
ity of  life  and  a  program  of  total  health 
care  for  all  Ontario  residents. 

Taking  their  cue  from  keynote 
speaker.  Dr.  Virginia  Henderson,  in- 
ternationally known  author  and  re- 
search associate  emeritus,  school  of 
nursing,  Yale  University,  who  told  her 
enthusiastic  audience  that  "in  nursing, 
the  sky's  the  limit."  they  approved  a 
plan  of  action  that  would  see  the  tradi- 
tional emphasis  on  illness  replaced  by  a 
broader  focus  on  health  promotion  and 
maintenance.  This  program  includes: 
D  support  for  extension  of  prepaid  in- 
surance benefits  to  cover  therapeutic 
and  health  maintenance  services,  over 
and  above  existing  institutional  care. 
(Continued  on  page  10) 


news 

(Continued  from  page  9) 


O  support  for  government  action  in- 
tended to  encourage  moderation  in  the 
consumption  of  alcohol;  and 
D  an  increase  in  the  annual  member- 
ship fee  to  $75.00,  to  enable  the  associ- 
ation to  meet  its  new  commitments. 

Retiring  RNAO  president,  Wendy 
Gerhard,  challenged  nurses  to  confront 
change,  rather  than  merely  experience 
it.  She  reminded  them  that  80  percent 
of  nursing  manpower  is  still  concen- 
trated in  a  setting  that  essentially  ad- 
dresses only  15  percent  of  actual  health 
care  problems.  "Nurses  must  take  a 
stand  about  expenditures  for  other  as- 
pects of  health  care  in  an  attempt  to 
reduce  expenditures  for  illness,""  she 
said.  "When  the  incidence  of  illness  is 
reduced  and  the  quality  of  life  is  im- 
proved, we  will  indeed  confront  an  ex- 
citing future."' 

Gerhard  called  on  nurses  to  assume 
some  responsibility  for  ""the  quality  of 
life  after  hospitalization,"  to  ensure 
that  patients  understand  their  treatment 
programs  and  the  importance  of  con- 
tinuing their  prescribed  maintenance 
regimes.  "Under  the  present  system, 
no  one  is  given  explicit  authority  and 
responsibility  for  dimensions  of  health 
care  outside  illness.  Although,  nurses 
traditionally  have  performed  many  of 
the  tasks  related  to  health  maintenance, 
counseling,  and  teaching.'"  She  chal- 
lenged RNAO  members  to  declare  that 
nursing  has  independent  functions  and 
to  accept  responsibility  for  other  di- 
mensions of  health  care. 

The  resolution  requesting  extended 
insurance  coverage  for  home  care,  as 
approved  by  voting  delegates,  directed: 
"That  RNAO  agressively  pursue  a 
change  in  government  policy  whereby 
the  Ontario  Health  Insurance  Plan 
would  be  extended  so  that  required 
therapeutic  and  health  maintenance 
services  would  be  made  available  in  the 
place  of  residence  of  the  recipient  as  an 
alternative  to  institutional  care."' 

Originally,  the  resolution  had  sug- 
gested extension  of  benefits  to  persons 
over  the  age  of  65  and  had  specified  that 
care  be  received  in  the  home  of  the 
recipient.  Delegates  amended  the  re- 
solution to  cover  all  those  needing  care. 
Supporters  of  the  resolution  pointed  out 
that  the  existing  system  is  limited  by 
emphasis  on  the  rehabilitative  aspect  of 
nursing  care,  and  fails  to  provide  ade- 
quately for  chronic  or  long-term  cases. 

Delegates  also  approved  RNAO 
promotional  and  educational  activity  in 
another  field  of  health  care  —  the  pre- 
vention of  alcoholism.  Evidence  was 


^'1  f  -  ■     W 


Like  individuals,  professional  associations  celebrate  their  anniversaries  by  re- 
memberering  the  milestones,  anticipating  the  future,  and  enjoying  the  present. 
The  Registered  Nurses"  Association  of  Ontario  is  no  exception.  On  its  50th 
birthday,  more  than  1 ,200  members  gathered  in  Toronto  for  4  days  of  work  and 
festivities.  All  the  essentials  for  a  memorable  birthday  party  were  there  — 
including  a  cake  (on  wheels),  a  birthday  party  luncheon,  costumes,  music,  and 
distinguished  guests.  Here,  three  of  the  associations's  presidents  —  past  and 
present  —  are  shown  slicing  the  cake  featured  at  the  birthday  party  luncheon. 
From  left  to  right:  Dr.  Florence  H.  M.  Emory,  first  president  of  RNAO;  Norma 
Marossi,  current  president,  and  Wendy  Gerhard,  past  president. 


presented  to  the  audience  indicating 
that  lowering  the  drinking  age  to  18  in 
Ontario  in  1971  has  resulted  in  in- 
creased alcohol  consumption  among 
young  people.  It  has  also  resulted  in 
other  alcohol-related  problems,  includ- 
ing more  impaired  driving  charges  and 
personal  injury  accidents.  RNAO  mem- 
bers expressed  concern  over  both  the 
social  and  medical  costs  of  alcoholism. 

The  resolution  approved  by  the  dele- 
gates commends  the  government  of  On- 
tario for  its  current  program,  intended 
to  encourage  moderation  in  alcohol 
consumption,  and  urges  the  govern- 
ment to  continue  to  search  for  ways  to 
decrease  the  accessibility  of  alcohol  to 
those  under  18  years  of  age  and  to 
change  prevailing  drinking  practices. 

Delegates  also  approved  a  resolution 
that  the  RNAO  investigate  the  possibility 
of  requesting  the  federal  government  to 
allow  registered  nurses  to  act  as  guaran- 
tors on  passport  applications. 

A  resolution  recognizing  the  respon- 
sibility of  members  "to  contribute  arti- 
cles to  The  Canadian  Nurse  journal  for 
publication'"  and  to  influence  the  qual- 
ity of  the  journal  was  also  approved.  As 


a  result,  the  RNAO  board  of  directors 
will  encourage  members  to  take  a  lead- 
ership role  in  contributing  material  to 
The  Canadian  Nurse. 

The  RNAO  will  embark  on  its  pro- 
gram for  the  next  half  century  with  in- 
creased financial  support  from  mem- 
bers, and  evidence  of  renewed  interest 
in  association  membership.  Approval 
of  a  bylaw  amendment  increases  the 
annual  regular  membership  fee  from 
$50  to  $75.  Membership  in  the  associa- 
tion in  1975  is  already  up  by  more  than 
1,500  over  1974  and  further  increases 
are  expected. 

In  her  report  to  members,  RNAO  ex- 
ecutive director,  Laura  Barr,  termed 
the  increase  "most  encouraging""  and 
pointed  out  that  the  association  is  also 
gaining  strength  through  its  affiliation 
with  other  nursing  groups,  rnao 
policies  now  provide  for  formal  liaison 
with  allied  health  professions.  Applica- 
tions for  affiliation  with  the  Commun- 
ity Mental  Health  Nurses"  Association 
and  the  Ontario  Nurse  Mid- Wives  As- 
sociation were  recently  approved  by  the 
RNAO  and  others  are  being  considered. 
(Continued  on  page  12) 


.  When 
it  comes  to 

better  instruments 


We  wrote  the  bcx)k 


We  know  V.  Mueller  makes  fine  instruments  for  today's  surgery. . .  and  backs 
them  with  a  no-nonsense  guarantee. 

And  we  know  our  inventory  of  over  8,000  patterns  is  something  you  can 
rely  on  .  .  .  all  instruments  to  give  you  dependable,  lasting,  economical 
service. 

We  know.  But  consult  your  V.  Mueller  man.  Then  you'll  know.  For  sure. 

\i,   IV/J  LJ  L^  1 1 L^  I  Division  of  Mc  Gaw  Supply  Ltd. 

536  Gordon  Baker  Rd.,  Willowdale.  Ont..  M2H  3B4  Phone  4 1 6/497-2229 


THE  CANADIAN  NURSE  —  August  1975 


news 


(Continued  from  page  10) 

RNABC  Members  Examine 
The  Nurse's  Role 

In  Health-Care  Planning 

Penticton,  B.C.  —  Close  to  500  mem- 
bers of  the  Registered  Nurses'  Associa- 
tion of  British  Columbia  took  advan- 
tage of  the  63rd  anniversary  of  their 
association  to  canvass  the  possibilities 
involved  in  the  potential  role  of  the 
nurse  in  health-care  planning.  The 
3-day  RNABC  conference  took  place  in 
May,  and  included  addresses  from  sev- 
eral outstanding  speakers,  problem- 
oriented  group  discussion,  and  advice 
from  a  panel  of  4  nurses  already  active 
in  the  planning  process.  Some  of  the 
conclusions  were: 

D  Nurses  owe  it  to  themselves  and  to 
their  patients  to  adopt  a  more  active  role 
in  planning  the  care  they  administer. 
D  When  they  begin  to  participate 
meaningfully  in  health-care  planning, 
the  system  will  benefit  from  the  funda- 
mental concern  of  the  nursing  profes- 
sion for  the  well-being  of  people,  not 
simply  the  reduction  of  sickness  and 
suffering. 

n  Nurses  not  only  have  a  lot  to  offer  in 
the  area  of  health  care  planning,  but 
they  are  in  a  position  to  make  a  unique 
contribution  to  the  totality  of  heahh 
care. 

"Because  of  nurse  preparation  — 
the  daily  contacts,  the  continuity  of 
care  —  nurses  can  become  very  strong 
client  advocates,"  according  to 
Huguette  Labelle,  president  of  the 
Canadian  Nurses'  Association.  She 
pointed  out  that  nurses  could  help  the 
population  to  assume  a  greater  degree 
of  self-reliance  and  also  help  to  prevent 
consumer  input  from  becoming  merely 
tokenism. 

Guest  speaker  Dorothy  Hall,  re- 
gional nursing  officer  with  the  World 
Health  Organization,  conceded  that,  to 
date,  nurses  have  not  been  either  active 
or  forceful  enough  in  the  planning  pro- 
cess. "Nurses  must  shed  outmoded 
traditions  and  stop  relying  on  others  to 
plan  health  care  systems,"  she  said. 
She  blamed  problems  of  nursing  educa- 
tion, coupled  with  outmoded  nursing 
service  systems  and  the  fact  that  most 
nurses  are  women,  for  the  minimal  role 
of  nurses  in  health-care  planning. 

B.C.  Minister  of  Health,  Dennis 
Cocke  said  that  nurses  are  sometimes 
"just  a  bit  hung  up  on  traditional  roles. 
You  have  served  two  sides:  the  institu- 
tion and  the  patient.  I  say  that  it's  great 
to  serve  but  not  so  great  to  be  subser- 
vient." 


More  than  100  municipalities  in  the  province  of  Ontario  marked  the  celebration  of 
the  Registered  Nurses'  Association  of  Ontario's  50th  anniversary  by  proclaiming 
"Nurses'  Week"  during  the  month  of  June.  Local  chapters  cooperated  by  arrang- 
ing a  series  of  public  information  campaigns  and  displays  on  nursing,  including 
exhibits  in  major  shopping  centers.  The  display  above  was  one  of  two  arranged  by 
Ottawa  chapters  of  the  RNAO,  with  the  cooperation  of  the  Canadian  Nurses' 
Association.  Nancy  Poichuck,  research  officer  with  CNA,  was  on  hand  to  answer 
questions  from  the  public  and  to  welcome  cna  president  Huguette  Labelle. 


He  predicted  that  health  care  in  B.C. 
would  evolve  in  the  direction  of  the 
team  management  principle  and  that  a 
basic  element  of  the  team  concept  will 
be  a  focus  on  prevention. 

Delegates  who  took  part  in  the 
problem-oriented  group  discussions 
found  3  major  obstacles  standing  in  the 
way  of  nursing  involvement  in  health 
care  planning.  They  identified  them  as: 
"apathy  among  nurses,"  "lack  of  con- 
fidence," and  "lack  of  knowledge  and 
training." 

Other  deterrents  included: 
"traditionalism  of  the  health  system." 
"lack  of  time  and  other  commit- 
ments," "poor  communication 
skills,"  and  "lack  of  public  recogni- 
tion of  nurses'  potential  contribution." 

The  discussion  groups  were  also 
asked  to  suggest  ways  of  overcoming 
the  deterrents.  Their  proposed  solu- 
tions were  divided  into  3  categories: 
1.  Personal  solutions  included  pro- 
moting more  egalitarian  sex  roles, 
keeping  up-to-date  with  journals  and 
association  news,  becoming  involved 
in  association  activities,  and  establish- 
ing priorities  by  critically  examining 
personal  allocations  of  time. 


2.  Professional  solutions  included  ac- 
cepting and  supporting  colleagues,  in- 
creasing public  awareness  of  nursing 
roles,  involving  younger  nurses,  and 
using  all  communication  media  to  in- 
fluence health  planning. 

3.  Educational  solutions  included  im- 
proving basic  skills  in  planning  and  par- 
ticipation, identifying  and  learning  the 
"politics  of  health  care,"  and  making 
nurses  better  informed  through  a  vari- 
ety of  approaches. 


Nurses  Invited 

To  Submit  Abstracts 

New  York,  N.Y.  —  Officials  of  the  Na- 
tional League  for  Nursing  invite  Cana- 
dian nurses  with  a  special  interest  in  the 
nursing  care  of  patients  with  respiratory 
dysfunction  to  submit  abstracts  of  orig- 
inal research  papers  for  presentation  at 
the  American  Lung  Association  — 
American  Thoracic  Society  Annual 
Meeting  in  New  Orleans,  May  1976. 
The  deadline  for  submission  is  1  De- 
cember 1975.  Requests  for  information 
or  research  abstracts  should  be  mailed 
(Continued  on  page  14) 


12 


Pampos 


ives 


you  both 

atweak 


(eeps 
lini  drier 

Instead  of  holding 
moisture,  Pampers 
hydrophobic  top  sheet 
allows  it  to  pass 
through  and  get 
"trapped"  in  the 
absorbent  wadding 
underneath.  The  inner 
sheet  stavs  drier,  and 
baby's  bottom  stays 
drier  than  it  would  in 
cloth  diapers. 


SavCvS 
you  time 

Pampers  construction 
helps  prevent  moisture 
from  soaking  through 
and  soiling  linens.  As  a 
result  of  this  superior 
containment,  shirts, 
sheets,  blankets  and 
bed  pads  don't  have  to 
be  changed  as  often 
as  they  would  with 
conventional  cloth 
diapers.  And  when  less 
time  is  spent  changing 
linens,  those  who  take 
care  of  babies  have 
more  time  to  spend  on 
other  tasks. 

PROCTER   *  GAMBLE  C*ll-3*1 


news 

(Continued  from  page  12) 


to:  Chairperson,  Annual  Meeting  Nurs- 
ing Program  Subcommittee,  American 
Lung  Association  Nursing  Depart- 
ment, National  League  for  Nursing,  10 
Columbus  Circle,  New  York,  N.Y. 
10019,  U.S.A. 


Listen  to  Children,  Build  On 

Their  Strengths,  ACCH  Urges 

Boston,  Mass.  —  "Listen  to  children 
and  their  families,"  was  the  message  of 
the  10th  annual  conference  of  the  1,200 
member  Association  for  the  Care  of 
Children  in  Hospitals  in  May  1975. 
Close  to  1,700  attended  the  four-day 
meeting  of  this  interdisciplinary  as- 
sociation. 

"Observing  is  included  in  listen- 
ing," said  Dr.  T.B.  Brazelton,  as- 
sociate professor  of  pediatrics  at  the 
Harvard  Medical  School,  who  was  one 
of  the  keynote  speakers.  According  to 
him,  you  listen  to  a  toddler's  parents 
and  observe  the  toddler  to  pave  the  way 
to  personal  communication  with  him. 
"We  should  study  how  toddlers  cope, 
as  they  may  have  resources  we  can 
work  with,"  he  added. 

Dr.  Dorothy  Huntington,  a  child  de- 
velopment specialist,  stressed  the  need 
to  be  "pro-active,"  (to  act  before  a 
breakdown  occurs)  and  to  promote  a 
person's  strength  to  alleviate  the  need 
of  treating  symptoms.  She  is  coor- 
dinator of  preschool  programs.  Penin- 
sula Hospital  and  Medical  Center,  Bur- 
lingame,  Calif.  "In  hospitals,  we  put 
the  parent  and  child  in  a  passive  role. 
This  makes  them  lose  their  compe- 
tence. We  must,  rather,  respect  their 
strengths  and  capabilities,"  she  said, 
"for  when  we  expect  them  to  be  capa- 
ble, they  become  just  that.  We  should 
move  away  from  the  disease  and  to- 
ward the  health  model  wherein  one 
learns  to  cope  with  stress,"  she  said, 
and  cited  as  an  example  the  amputee 
who  can  live  a  heahhy  life  without  a 
leg. 

"The  latent,  or  school-aged  child 
needs  help  to  master  a  hospital  experi- 
ence," said  Dr.  Albert  Solnit,  presi- 
dent of  the  International  Association  of 
Child  Psychiatry  and  Allied  Profes- 
sions. "These  children  have  the  capac- 
ity to  record,  but  are  not  yet  ready  to 
digest,  the  significance  of  events  and 
must  be  helped  to  define  the  problems 
they  want  to  solve,"  he  said.  "We  tend 
to  expect  children  to  grow  up  suddenly 
when  in  hospital,  even  the  architecture 
of  our  hospitals  reflects  an  adult- 


oriented  society.  The  proliferation  of 
professions  and  the  acceleration  of 
technical  developments  have  de- 
humanized the  care  of  the  child.  But," 
he  continued,  "we  have  lagged  on 
such  ethical  issues  as  the  dying  child, 
and  tissue  transplants.  The  child  asks 
questions  that  touch  on  our  lack  of 
knowledge  in  these  areas.  It's  time  for 
us  to  catch  up  with  latency  children," 
he  concluded. 

Many  Canadians  attended  this  meet- 
ing. One  Regina  hospital  sent  3  nurses, 
a  social  worker,  and  a  dietitian.  All 
agreed  they  learned  a  great  deal  from 
the  sessions  and  would  have  much  to 
share  with  their  colleagues  at  home. 

The  next  meeting  of  the  ACCH  will  be 
in  Denver,  Colorado,  in  March  1976. 


We're  A  Pill-Popping  Society, 
Panelists  Tell  Colleagues 

Toronto,  Ont.  —  "When  I  told  some 
friends  that  I  was  nervous  about  being 
on  this  panel,  one  person  asked,  'Why 
not  take  a  tranquilizer?'  "  This  com- 
ment, by  Marjorie  Musselman,  a  public 
health  nurse  at  Scarborough  Borough 
Health  Unit.  Scarborough,  Ontario, 
brought  laughter  from  nurses  attending 
the  session  "What  Pill  Did  You  Take 
Today?",  but  helped  to  emphasize  the 
point  made  by  all  panelists,  that  we 
have  become  a  ' ' pill-popping  society . ' ' 

The  session  was  one  of  several  held 
during  the  Registered  Nurses'  Associa- 
tion of  Ontario's  50th  annual  conven- 
tion at  the  Royal  York  Hotel.  11-14 
June  1975. 

In  her  introduction,  panel  moderator 
Rosella  Cunningham,  associate  profes- 
sor, faculty  of  nursing  at  the  University 
of  Toronto,  said  that  patients  expect  to 
get  a  prescription  for  medication  when 
they  visit  a  physician's  office.  And  no 
wonder,  she  added,  as  we  are  all  bom- 
barded by  advertisements  for  every 
possible  drug  as  a  relief  for  every  pos- 
sible ailment.  "I'd  guess  that  about  80 
percent  of  those  attending  this  session 
will  take  at  least  one  type  of  medication 
at  some  time  today."  she  said. 

Panelist  Bonnie  O'Neill,  nurse-in- 
charge  of  the  Peel  Branch,  Victorian 
Order  of  Nurses,  spoke  of  the  voN 
nurse's  responsibility  for  drugs  —  pre- 
scription and  nonprescription  —  when 
the  patient  is  at  home.  "The  nurse  must 
ask  herself:  'Is  my  patient  aware  of  the 
side-effects  of  the  drugs  he  is  taking? 
Will  he  take  the  right  pill  at  the  right 
time,  in  the  right  dosage?'  "  This  is  a 


real  concern.  O'Neill  said,  and  the  vis- 
iting nurse  must  continually  educate 
herself  and  her  patients  about  every  as- 
pect of  a  medication. 

"Nurses  have  a  responsibility  to 
make  the  patient  aware  of  the  expiry 
date  of  the  drug  he  is  taking,"  O'Neill 
said.  "Certain  drugs,  such  as  nitro- 
glycerine, have  a  short  lifespan  and 
must  be  kept  in  an  air-tight  container  at 
room  temperature."  Many  patients 
with  cardiac  problems  are  unaware  of 
this,  O'Neill  added,  and  they  carry 
around  nitroglycerine  tablets  for  years, 
believing  the  tablets  are  still  potent. 

Describing  the  "self-medication  sys- 
tem" used  on  the  physical  medicine 
and  rehabilitation  unit  at  the  University 
Hospital.  London.  Ontario,  Judy 
Fisher,  a  team  leader  on  the  unit,  said 
the  system  gives  the  patient  a  sense  of 
independence,  and  allows  him  to  be 
more  self-reliant.  "It  also  encourages 
him  to  become  aware  of  the  adverse 
effects  of  the  medication  he  is  taking," 
she  said. 

This  does  not  relieve  the  nurse  of  her 
responsibility  to  keep  informed  about 
the  various  drugs.  Fisher  added.  "She 
must  know  what  drugs  each  patient  is 
taking,  and  watch  for  any  side-effects. 

"We  find  that  patients  on  the  'self- 
medication  system'  take  fewer  sleeping 
pills  than  when  the  pills  are  given  by  the 
nurse."  Fisher  commented. 

Later,  during  a  question-and-answer 
period.  Fisher  said  that  hospital  phar- 
macists should  have  more  responsibil- 
ity for  giving  medication  to  patients. 
Sister  Francis,  a  pharmacist  at  St. 
Joseph's  Hospital.  Toronto,  the  panel's 
resource  person,  replied,  saying  that 
the  primary  responsibility  of  dispens- 
ing medications  to  patients  should  be- 
long to  the  hospital  pharmacist. 

Sister  Francis  added  that  the  problem 
is  that  personnel  don't  look  beyond  the 
status  quo.  "Pharmacists  would  like  to 
be  accepted  as  members  of  the  heahh 
team."  she  said,  "and  many  pharma- 
cists are  frustrated  at  being  in  a  dispen- 
sary.  with  little,  if  any,  patient  contact. 
When  pharmacists  try  to  become  more 
involved,  the  physician's  think  we  are 
sticking  our  noses  into  other  people's 
business,  and  the  nurses  feel  we  are 
trying  to  take  some  responsibility  away 
from  them.  We  must  start  out  without 
any  idea  of  a  "trade-off  as  far  as  phar- 
macy and  nursing  staff  are  concerned," 
Sister  added. 

Approximately  150  persons  attended 
the  session ,  which  was  held  on  the  third 
day  of  the  RNAO  annual  convention .<i' 


14 


Elastic  hosiery 


her  secret. 


Now  nobody  need  know  she's  wearing 
support  hosiery.  Bauer  and  Black  make  a 
complete  line  of  attractive  and  fashionable 
Elastic  Panty  Hose  and  Cosmetic  Sheer  Stock- 
ings. All  provide  firm,  medically  correct  "grad- 
uated compression",  the  kind  of  support  she 
needs  for  improved  circulation. 

Very  simply,  "graduated  compression"  is  con- 
trolled compression  at  the  ankles,  with  diminish- 
ing pressure  up  the  leg.  Because  Bauer  and  Black 
Elastic  Hosiery  is  made  with  stronger,  tougher 
yarns,  your  patient  will  get  up  to  twice  the  com- 
pression that  ordinary  support  hosiery  would 
provide  her.  And  that's  important. 

So  now  that 
you've  helped  get 
her  back  on  her 
feet,  you  can  hon- 
estly tell  her  that 
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FRflNKLY  SPEaKlNG 

about  nursing  education 


Mandatory  Continuing  Education? 


Shirley  M.  Stinson 


Controversial  issues  in  nursing  education 
today  are  many  and  wide-ranging.  Exam- 
ples include:  To  what  extent  are  the  know- 
ledge, attitudes,  and  skills  of  today's  nurs- 
ing education  products  relevant  to  the 
"real"  health  services  needs  of  society? 
We  talk  about  the  importance  of  expand- 
ing nursing  curricula  in  terms  of  such  areas 
as  evaluation  of  nursing  interventions, 
lobbying  skills  for  nurses,  health  care 
economics,  physical  assessment  and  his- 
tory taking,  and  community  mental  health. 
But  it  would  seem  that,  in  most  schools, 
faculty  expertise  in  these  areas  is  shaky,  if 
not  absent,  and  priority  is  given  to  tradi- 
tional content.  A  second  issue  is,  should 
Canadian  university  schools  of  nursing 
offer  RNs  advanced  standing  by  way  of 
challenge  exams?  Where  should  such 
leadership  come  from?  Another  question 
is,  should  continuing  education  be  man- 
datory? It  is  toward  this  last  controversy 
that  this  "Frankly  Speaking"  article  is  di- 
rected. 

Within  the  profession  there  seems  to  be 
widespread  agreement  that,  given  the 
rapid  expansion  and  change  in  the  knowl- 
;dge-skill  base  of  nursing,  all  nurses 
must  keep  learning  beyond  their  basic  prep- 
aration. Those  who  argue  for  mandatory 
continuing  education  (MCE)  maintain  that 
unless  there  are  explicit  ongoing  educa- 


Each  month.  The  Canadian  Nurse 
features  a  column  presented  by  the 
four  CNA  members-at-large.  This 
month's  column  is  written  by  the 
member -at- large  for  nursing  educa- 
tion, Shirley  M.  Stinson.  She  wel- 
comes your  comments. 


tional  requirements  for  continuing  licen- 
sure, competency  cannot  be  assured,  be- 
cause without  MCE  a  nurse  could  virtually 
work  a  lifetime  without  having  to  present 
evidence  of  continued  learning  through 
recognized  workshops,  seminars,  and 
formal  courses. 

Another  argument  for  MCE  is  that  often 
"we  don't  know  what  we  don't  know."  In 
other  words,  through  MCE,  nurses  might 
well  get  involved  in  areas  of  learning  that 
they  would  otherwise  be  unlikely  to  pur- 
sue, because  they  don't  even  know  about 
them,  much  less  see  their  relevance  for 
practice. 

Opponents  maintain  that  MCE  is  an  in- 
valid scheme,  for  several  reasons.  A  major 
argument  is  that  professional  competency 


depends  upon  such  a  vast  amount  and  wide 
range  of  ongoing  educational  inputs  (for 
example,  discussions  in  the  work  situa- 
tion, reading  journals,  testing  one's  own 
ideas,  and  so  on)  that  it  is  absurd  to  imply 
that  MCE  "ensures"  competency.  Sec- 
ondly, they  argue  that  even  if  MCE  can  help 
the  nurse  to  know,  in  no  way  does  it  ensure 
that  her  actual  performance  is  sound. 
Thirdly,  opponents  maintain  that  if  all 
provinces  in  Canada  endorsed  MCE  policy 
to  the  level  of  ensuring  competency  to 
practice,  the  current  inadequacies  in  the 
types,  amounts,  quality  levels,  and  dis- 
tribution of  continuing  education  re- 
sources across  the  country  make  the  im- 
plementation of  such  a  policy  totally  un- 
realistic. 

I  believe  it  makes  sense  for  the  profes- 
sion to  make  definite,  active  provision  for 
continuing  education  as  an  important 
means  of  increasing  one's  knowing  and 
doing  potential.  But  there  should  be  no 
illusions  that  continuing  education 
"guarantees"  a  safe  basis  for  determining 
continuation  of  licensure.  Licensure  deci- 
sions, whether  initial  or  continuing,  must 
rest  not  on  what  nurses  "know,"  but  on 
evaluation  of  inputs,  processes,  and  out- 
comes of  actual  nursing  performance.  ^ 


THE  CANADIAN  NURSE  —  August  1975 


Intra-aortic  balloon  pump 


A  new  device  fo  assist  circulation  mechanically,  which  can  support  a  patient's 
heart  before,  during,  and  after  cardiac  surgery,  requires  expert  nursing  care  and 
knowledge.  A  clinical  coordinator  of  cardiovascular  surgery  describes  the 
intra-aortic  balloon  pump  and  its  nursing  care  implications. 


E. Joan  Breakey 


The  intra-aortic  counterpulsation  balloon 
pump  is  a  specific  and  relatively  new  form 
of  care  for  the  individual  who  has:  a 
myocardial  infarct,  an  impending 
myocardial  infarct,  or  unstable  angina. 
The  balloon  pump  provides  mechanical 
assistance  to  the  patient's  circulation  be- 
fore, during,  and  after  surgery  to  perform 
an  aorto-coronary  artery  bypass  graft. 

Most  of  the  pioneering  work  on  the 
intra-aortic  balloon  pump  was  done  by 
Drs.  Mortimer  Buckley  and  Eldred 
Mundth,  who  began  work  on  it  some  10 
years  ago  at  the  Massachusetts  General 
Hospital  in  Boston.  The  balloon  pump  was 
first  used  at  the  Toronto  General  Hospital 
and  other  Canadian  hospitals  in  1973. 

The  physiology  of  the  disease  process 
called  a  myocardial  infarction  can  be  diag- 
ramed as  in  Figure  1 . 

A  damaged  myocardium  is  unable  to 
maintain  an  adequate  cardiac  output  for 
perfusion  of  vital  organs,  and  the  signs  of 
cardiogenic  shock  appear.  They  include: 
blood  pressure  of  less  than  80  mm  Hg; 
heart  rate  over  100;  oliguria;  impaired  sen- 
sorium;  pallor  or  cyanosis;  cold,  clammy 
skin;  and  acidosis. 


E.  Joan  Breakey  (rn,  Toronto  General  Hospital 
School  of  Nursing,  Toronto.  Oni.;  b.Sc.N., 
University  of  Toronto)  is  clinical  coordinator  of 
cardiovascular  surgery  at  Toronto  General 
Hospital.  She  is  serving  a  second  term  as  chair- 
person of  the  Canadian  Council  of  Cardiovas- 
cular Nurses.  This  article  is  adapted  from  a 
paper  thai  the  author  presented  at  the  Canadian 
Council  of  Cardiovascular  Nurses  in 
Winnipeg,  18  October  1974. 


To  compensate  for  hypotension  and  low 
perfusion,  the  heart  beats  faster,  and 
peripheral  arteries  constrict.  This  in- 
creases the  load  of  the  injured  myocardium 
and  increases  the  oxygen  requirement  of 
the  already  hypoxic  heart,  leading  to 
further  deterioration. 

Medical  management  of  the  patient  in 
cardiogenic  shock  should  do  3  things: 
n  increase  oxygen  to  the  myocardium; 
n  decrease  the  work  load  of  the  left  ven- 
tricle; and 

n  increase  cardiac  output  and  the  perfu- 
sion of  vital  organs. 

Conservative  management 

Conservative  medical  management  will 
work  successfully  for  most  patients  who 
have  an  infarcted  area  of  less  than  40%  of 
the  left  ventricle.  Many  of  these  patients 


convalesce  until  their  cardiac  condition  i.s 
stable  and  return  home.  Should  the  angina 
or  myocardial  dysfunction  persist,  the  pa- 
tient returns  to  the  hospital  for  selective 
coronary  angiography. 

If  angiography  demonstrates  occlusion 
of  1 , 2,  or  3  coronary  arteries,  the  patient  is 
electively  booked  for  an  open  heart  opera- 
tion called  an  aorto-coronary  artery  bypass 
graft.  The  patient  is  admitted  to  a  surgical 
unit  about  3  days  prior  to  surgery  for  preop 
assessment  and  preparation. 

During  the  surgery  for  an  aorto- 
coronary  artery  bypass  graft,  a  section  ot 
saphenous  vein  is  removed,  the  patient  i.s 
placed  on  the  heart-lung  pump,  and  sec- 
tions of  the  removed  saphenous  vein  are 
used  to  bypass  the  occlusion  in  the  ob- 
structed coronary  artery  by  inserting  onej 
end  of  the  vein  in  the  aorta  above  the 


Figure  1:  The  physiology  of  the  disease  process  of  myocardial  infarction. 


Myocardial  Infarction 
Myocardial  Dysfunction 
Hypotension 


Systemic  Acidosis 


rrhythmias 


Myocardial 
Hypoxia 


/ 


Decreased  Coronary 
Perfusion  Pressure  and 
Decreased  Perfusion  of 

Vital  Organs 


Figure  2:  Inflated,  3-chambered  intra-aortic  balloon 


ided  area  and  the  other  below  it.  This 
..^cdure  may  be  done  for  single,  double, 
r  triple  vessel  disease,  that  is.  occlusion 
t  tiie  left  anterior  ascending  coronary  ar- 
j; . .  the  left  circumflex  artery ,  or  the  right 

nary  artery. 
\tter  surgery,  the  patient  goes  to  the 
ii.nsive  care  unit  for  approximately  48 

^ .  until  his  condition  is  stable  and  he  is 
wnl>  to  return  to  a  convalescent  area.  He 
s  usually  discharged  home  in  about   10 
to  2  weeks. 

'drdiogenic  shock 

\S  hat  about  the  patient  with  a  myocar- 
liai  infarct  for  whom  the  conservative 
neJical  management  does  not  reverse  the 
icious  cycle  of  cardiogenic  shock? 


The  management  of  cardiogenic  shock 
has  5  components: 

D  supportive  therapy  —  oxygen,  seda- 
tion, blood  volume  adjustment,  and  cor- 
rection of  acidosis; 

D  electrical  pacing  —  atrial.  A. v.  sequen- 
tial, and  ventricular; 

n  pharmacologic  therapy  —  antiarrhyth- 
mic drugs,  catecholamines,  and  digitalis; 
D  circulatory  assistance  — e.g..  intra- 
aortic  balloon  pump  assist;  and/or 
D  emergency  surgery  —  revasculariza- 
tion, infarctectomy,  ventricular  septal  de- 
fect closure. 

The  new  form  of  mechanical  circulatory 
assistance  —  the  intra-aortic  counterpulsa- 
tion balloon  pump  —  is  a  machine  that  is 
triggered  by  the  patient's  ECG  and  timed 


from  the  patient's  peripheral  arterial  pres- 
sure to  fill  a  triple-segmented  balloon  with 
helium  and  to  deflate  the  balloon. 

Figure  2  shows  the  intra-aortic  balloon. 
Inside  the  3-chambered  balloon  is  a  cathe- 
ter with  many  tiny  holes;  the  catheter  con- 
tains 4  lines:  1  to  provide  helium  to  inflate 
each  of  the  3  sections  of  the  balloon,  anda- 
suction  line  to  withdraw  helium  from  all 
chambers.  The  outer  surface  of  the  balloon' 
is  Avcothane,  which  discourages  adher- 
ance  of  platelets  and  avoids  the  need  to 
heparinize  the  patient.  The  balloon  used 
may  be20cc.  30  cc.  or40cc  size,  accord- 
ing to  the  patient's  aorta  size. 

The  deflated  balloon  is  inserted  through 
a  femoral  cut-down,  which  is  performed 
under  local  or  general  anesthesia.  It  is 
guided  up  the  aorta  until  the  tip  of  the 
balloon  rests  just  below  the  left  subclavian 
anery.  The  balloon  is  filled  with  helium 
from  the  pump  console,  and  it  is  ready 
to  assist  the  patient's  circulation. 

There  are  2  stages  to  the  balloon  pump's 
action:  inflation  and  deflation.  (Figure 3.) 
The  first  phase  —  inflation  —  occurs  at 
the  beginning  of  diastole;  just  as  the  aortic 
valve  closes,  the  balloon  inflates  with 


Figure  3:      The  deflated  balloon  is  shown  in  sketch  number  1;  the  middle  segment  of  the  balloon  is  inflated  in  sketch 
number  2;  and  the  entire  balloon  is  inflated  in  sketch  number  3. 


V    ^  \ 


X.>  \ 


i^^\ 


/ 


) 


I 


1 

u 


:ANA0IAN  nurse  —  Augusl  1975 


19 


helium  to  provide  diastolic  augmentation. 
The  balloon  fills  in  stages:  the  middle  seg- 
ment first  and,  then,  the  2  end  sections. 
The  coronary  arteries  are  most  easily  per- 
fused at  this  time  in  the  cardiac  cycle  be- 
cause they  are  dilated  and  easily  filled. 

The  inflated  balloon  creates  a  partial 
obstruction  of  the  aorta  and  forces  blood 
distally  into  the  extremities  and  proxi- 
mally  into  the  coronary  arteries  and  the 
main  branches  of  the  aortic  arch.  This 
satisfies  2  of  the  3  criteria  for  treatment  of 
infarction:  it  increases  the  perfusion  of 
vital  organs,  and  it  increases  the  oxygena- 
tion of  the  myocardium  by  increasing 
coronary  blood  flow.  (Figure  4.) 

Deflation  of  the  balloon  occurs  in  late 
diastole,  just  prior  to  systole  and  just  as  the 
aortic  valve  opens.  The  helium  is  removed 
from  the  balloon  by  a  vacuum  action  that 
creates  a  reduced  resistance  in  the  aorta 
and,  therefore,  decreases  the  work  load  of 
the  left  ventricle  when  it  contracts. 

The  decrease  in  preload  and  afterload 
reduces  the  left  ventricular  end  diastolic 
volume,  which  in  turn  decreases  in- 
tramyocardial  tension  and  myocardial  ox- 
ygen consumption.  This  stage  satisfies  the 
third  criterion  for  infarction  management: 
it  decreases  left  ventricular  oxygen  de- 
mand. The  alternating  action  of  inflation 
and  deflation  of  the  balloon  is  termed 
counterpulsation.* 

To  summarize  the  physiologic  functions 
of  the  intra-aortic  balloon  counterpulsa- 
tion, it  decreases: 
m  left  ventricular  afterload; 

•  left  ventricular  preload; 

•  peak  systolic  pressure; 

•  intramyocardial  wall  tension; 

•  left  ventricular  work;  and 

•  myocardial  O2  consumption. 
And  it  increases: 

•  diastolic  coronary  perfusion; 

•  systemic  blood  flow; 

•  subendocardial  blood  flow;  and 

•  total  coronary  blood  flow. 

Thus,  balloon  pumping  restores  a  better 
supply  demand  ratio  for  myocardial  ox- 
ygenation. 

Patients  for  pump 

Basically,  there  are  3  groups  of  patients 
who  benefit  from  the  intra-aortic  counter- 
pulsation balloon  pump:  those  with  a 


*  Not  all  inira-aortic  balloon  pumps  have  coun- 
terpulsation. The  pumps  used  al  the  Toronto 
General  Hospital,  which  have  this  feature,  are 
Avco.  machines. 
20 


EFFECTS  OF  BALLOON  PUMPING 


Aortic  pressure 


Coronary  flow    | 


Figure  4 


documented  myorcardial  infarction,  those 
with  intermediate  coronary  artery  syn- 
drome, and  —  most  recently  discovered 
—  those  who  are  on  the  heart-lung 
machine  for  a  prolonged  period. 

Eligible  for  balloon  pump  assistance  are 
patients  with  a  documented  myocardial  in- 
farction, or  with  angina  (preinfarction), 
who  show  no  improvement  with  medical 
therapy,  that  is,  no  pain  relief  with  Inderol 
and  nitroglycerine,  continued  ECG 
changes,  and  continued  rise  in  SGOT.  The 
patient  must  have  an  ECG  trace  to  trigger 
the  pump,  arterial  pressure  to  time  it ,  and  a 
good  aortic  valve. 

Patients  in  this  group  who  respond 
favorably  to  the  assistance  of  the  intra- 
aortic  balloon  pump  begin  to  show  signs  of 
improvement  within  one  hour  after  the  bal- 
loon is  inserted.  The  maximum  effect  is 
usually  attained  within  36  hours.  Once  the 
patient's  condition  is  stable  enough  so  that 
he  can  be  moved,  he  can  have  coronary 
angiography  and  proceed  to  the  OR  for  an 
aorto-coronary  artery  bypass  graft. 

Balloon  support  continues  postopera- 
tively for  about  48  hours  or  until  the  pa- 
tient is  ready  to  be  weaned  from  mechani- 
cal assistance.  Before  weaning,  the  bal- 
loon pump  supports  every  cardiac  cycle;  in 
weaning,  the  support  is  1:2  cycles,  then 
1:4  cycles,  and  finally  1:8  cycles.  Then, 
the  balloon  is  removed  in  the  OR,  and  a 
normal  postoperative  course  follows,  it  is 
hoped. 

The  second  group  of  patients  suitable 
for  the  balloon  pump  are  those  with  inter- 
mediate coronary  artery  syndrome,  such 


as  crescendo  angina,  progressive  angint 
Prinzmetal's  angina,  and  those  with  tru 
preinfarction  angina  in  which  the  pain  i 
not  controlled  by  drugs.  These  patients  ari 
at  risk  of  an  acute  myocardial  infarctio  ■ 
and  require  circulatory  assistance  durin 
diagnostic  angiography,  with  a  view  i 
immediate  surgery  for  myocardial  reva^ 
cularization.  The  balloon  pump  is  als 
used  for  support  during  anesthesia  indue 
tion  and  for  about  48-72  hours  postopera 
tively. 

The  most  recent  use  of  the  balloon  pum 
is  to  provide  patients  with  a  pulsatile  bloc 
flow  during  open  heart  surgery;  this  help 
to  prevent  the  occurrence  of  "stone  heart' 
—  an  inertia  of  the  heart  muscle  that  occa 
sionally  follows  a  prolonged  period  on  th.< 
heart-lung  machine,  which  provides 
steady  flow  of  blood  rather  than  a  pulsa 
ting  flow.  When  the  balloon  pump  is  use( 
for  a  patient  on  the  heart-lung  machine, 
simulated  ECG  trace  is  used  to  trigger  th( 
pump. 

Results 

Results  of  using  the  intra-aortic  ballooi 
pump  on  patients  at  Toronto  General  Hos 
pital  from  October  1973  to  May  1975  an 
shown  on  page  21. 

Contraindications  to  balloon  use 

Contraindications  to  using  mechanica 
circulatory  assistance  include:  irreversible 
brain  damage;  severe  associated  disease  | 
chronic  end-stage  heart  disease;  bleeding 
sources  or  diathesis;  septicemia;  dissect 
ing  aortic  aneurysm;  aortic  valvular  insuf 


'ficiency:  and   advanced  obliterative 
atherosclerotic  peripheral  vascular  dis- 
ease. The  latter  two  contraindicate  use  of 
I  he  intra-aortic  balloon  pump  in  particular. 
Criteria  for  discontinuing  mechanical 
.  irculatory  assistance  (MCA)  are:  im- 
proved patient  status;  lack  of  benefit  — 
lack  of  evidence  of  hemodynamic  im- 
vement  after  MCA  for  96-120  hours; 
complications,  such  as  bleeding,  clot- 
!:ng,  failure  of  oxygenation,  or  poor  distal 
iinib  circulation. 

Nurses  for  pump  patients 

Nurses  who  use  intricate  equipment, 
such  as  the  intra-aortic  balloon  pump,  in 
caring  for  patients  must  have  a  clear  un- 
derstanding of  the  continuum  of  patient 
:are.  In  our  cardiovascular  surgical  ICU,  a 
lurse  begins  by  working  in  the  preop  and 
lo.stop  area  to  gain  an  awareness  of  the 
3atients'  condition  before  and  after  inten- 
sive care.  In  the  ICU,  she  moves  through 
-tages:  sheer  terror  of  equipment,  being 
ible  to  use  all  the  equipment  as  an  aid  to 
nursing  care  and,  finally,  focusing  all  her 
iitention  on  the  patient  and  coordinating 
he  team  around  her  patient. 

After  a  nurse  has  become  familiar  with 
he  use  of  arterial  lines,  monitors,  ven- 
ilators,  arterial  pressure  transducers,  pa- 
lent  conditions,  and  psychological  sup- 
port ,  she  learns  to  care  for  patients  on  the 
intra-aortic  balloon  pump. 
We  run  a  4-day  training  program  on  the 


balloon  pump.  It  starts  with  an  introduc- 
tion to  the  hospital's  philosophy  about 
which  patients  will  be  ballooned,  and  a 
general  overview  of  the  4-day  inservice 
education  program. 

Specific  aspects  of  the  program  include; 
review  of  anatomy  and  physiology  of  car- 
diac conditions  requiring  the  balloon 
pump;  review  of  ECG.  stressing  acceptable 
ECG  tracings  for  the  pump  and  aspects  of 
ECG  that  are  essential  to  the  concept  of  the 
pump;  general  concepts  of  the  pump,  in- 
cluding balloon  action,  patient  evaluation, 
and  balloon  insertion;  specific  procedures, 
such  as  transporting  the  balloon  patient, 
weaning,  and  balloon  removal;  and  essen- 
tial concepts,  including  ECG  lead  place- 
ment, pacer  artifact,  balloon  timing,  and 
interpretation  of  the  balloon  pressure 
curve. 

Nursing  responsibilities  and  specifics  of 
nursing  care  are  then  taught.  Often,  by  this 
time,  the  nurses  are  a  bit  apprehensive 
about  the  technicality  of  it  all,  and  so  the 
training  program  goes  back  to  nursing  the 
patient  while  he  is  on  the  balloon  pump. 
Charting  for  the  patient  with  a  balloon 
pump  must  include  balloon  pressures, 
augmented  diastolic  pressure,  systolic 
pressure,  and  balloon  weaning.  We 
use  the  usual  icu  flow  sheet  with  special 
charting  in  color. 

The  balloon  is  inserted  and  removed 
under  sterile  technique.  The  dressing  on 
the  insertion  site  is  changed  daily,  and  the 


Balloon  Pump  Results  at  T.G.H. 


1  Complicated  Myocardial  Infarction 

cardiogenic  shock 
acute  mitral  valve  replacement 
acute  ventricular  septal  defect 
recurrent  ventricular  tachycardia, 

ventricular  fibrillation 
extending  myocardial  infarction 

2  Elective  Prophylactic  Support 

continued  coronary  artery  disease 

with  valve  replacement 
valve  replacement  with  left 

ventricular  dysfunction 

3.  Unstable  Angina 

crescendo 
pre-infarction 

4.  Post-Cardjotomy  Intra-Aortic 

Balloon  Pump 

iE  CANADIAN  NURSE  —  AugusI  1975 


Total  3 

Alive 

2 

Total  4 

Alive 

3 

Total  1 

Alive 

0 

Total  7 

Alive 

4 

Total  2 

Alive 

2 

Total  2 

Alive    2 

Total  6 

Alive    4 

Total  19 

Alive  19 

Total  44 

Alive  43 

Total  23      Alive  13 


site  is  cleansed  with  Betadine  (povidone- 
iodine)  and  gentamicin  cream.  The  dres- 
sing is  taped  well  to  prevent  contaminants 
from  entering  the  wound.  In  the  initial 
hours  of  balloon  pump  use,  the  patient's 
leg  must  be  watched  for  signs  of  hema- 
toma and  for  adequacy  of  distal  pulses. 

The  line  from  the  insertion  site  to  the 
balloon  pump  must  be  kept  free  from 
kinks,  and  not  taped  too  far  down  the  leg, 
to  allow  flexibility. 

The  balloon  pump  must  be  kept  on  au- 
tomatic so  that  the  alarms  will  work,  and 
should  be  chained  to  the  end  of  the  bed  to 
prevent  accidental  separation  from  the  pa- 
tient. 

A  patient  on  the  balloon  pump  is  only 
transported  on  a  doctor's  order.  When  he 
is  moved,  a  portable  defibrillator  should 
accompany  him.  It  is  important  to  re- 
member that  the  battery  of  the  balloon 
pump  is  good  for  one  hour  only,  so  there 
must  be  electricity  available  at  the 
patient's  destination.  When  the  pump  is 
battery  operated,  there  is  no  negative  pres- 
sure, so  the  suction  effect  to  reduce  the  left 
ventricular  afterload  is  absent. 

If  a  patient  is  booked  on  the  elective  list 
for  aorto-coronary  artery  bypass  graft 
surgery  with  balloon  support,  the  nurse 
visits  him  preoperatively  and  includes  in 
her  preop  teaching  the  information  that  a 
balloon  will  be  used,  that  there  will  be  a 
machine  at  the  end  of  his  bed,  and  that  a 
line  in  his  leg  will  be  connected  to  the 
machine.  She  tells  the  patient  that  he  will 
be  able  to  roll  from  side  to  side  and  to  have 
the  bed  elevated  to  30°.  (More  than  30° 
elevation  predisposes  to  kinking  the  cathe- 
ter in  the  femoral  artery.) 

The  nurse  can  tell  the  patient  that  he 
really  won't  feel  the  balloon  working  in- 
side his  chest ,  except  that  it  may  give  him  a 
slightly  increased  sense  of  "heart  con- 
sciousness." Ideally,  at  the  time  of  her 
preop  visit  to  the  patient,  the  nurse  will  see 
his  family,  too. 

Summary 

The  intra-aortic  counterpulsation  bal- 
loon pump  is  a  sophisticated  piece  of 
equipment  that  provides  mechanical  cir- 
culatory assistance  to  patients  with 
myocardial  infarction,  unstable  angina, 
and  those  who  spend  prolonged  periods  on 
the  heart-lung  machine.  "§> 


Dyspareunia:  a  symptom  of 
female  sexual  dysfunction 


Dyspareunia  is  one  of  the  most  common  sexual  symptoms  affecting  women.  There 
are  many  causes  of  painful  sexual  intercourse,  and  the  first  step  in  helping  the 
person  is  to  define  the  problem. 


Linda  Spano  and  John  A.  Lamont 


The  human  need  for  connection  is  compel- 
ling. Sexual  expression  is  closely  bound  to 
this  need,  and  therefore  tends  to  reflect 
many  facets  of  development.  Since  learn- 
ing is  related  to  experience,  and  sexual 
learning  is  frequently  denied  confirmation 
in  society,  it  is  not  surprising  that  the  es- 
tablishment of  an  effective  sexual  relation- 
ship is  rarely  accomplished  easily,  and  is 
frequently  accompanied  by  problems  that 
interfere  with  satisfaction  of  needs. 

Perhaps  no  other  aspect  of  our  de- 
velopment has  undergone  greater  change 
in  social  perspective  than  has  sexuality  in 
the  period  from  Freud  to  Masters  and 
Johnston.  Despite  this  shift,  families, 
schools,  and  helping  professions  are  only 
beginning  to  come  to  grips  with  sexual 
needs  in  their  attempts  to  foster  health  and 
growth.  Our  capacity  to  respond  to  prob- 
lems of  sexual  functioning  is  influenced  by 


Linda  Spano  is  presently  enrolled  in  the  Master 
of  Health  Science  Program  of  McMaster  Uni- 
versity. Hamilton.  Ontario.  Her  previous 
experience  has  been  as  a  family  practice  nurse 
at  the  Victoria  Family  Medical  Center, 
London,  Ontario.  Dr.  John  A.  Lamont  is 
currently  an  Assistant  Professor  in  Obstetrics 
and  Gynecology  at  McMaster  University,  and 
also  Director  of  the  Human  Sexuality  Program 
at  McMaster.  splitting  his  practice  time 
between  gynecology  and  sex  therapy. 

22 


our  attitudes,  information,  skill,  and  ex- 
perience. Reluctance  to  provide  guidance 
arises  when  nether  training  nor  experi- 
ence has  prepared  us  for  this  role. 

Nurses  have  a  particular  need  to  acqu  ire 
knowledge  and  awareness  so  they  can  deal 
with  patients"  sexual  concerns  as  readily  as 
any  other  problem  that  affects  the  patient's 
well-being.  Along  with  other  profession- 
als, nurses  have  ignored  the  sexuality  of 
their  patients.  They  have  a  clear  opportun- 
ity to  use  to  advantage  their  orientation  to 
health. 

Our  purpose  here  is  to  examine  dys- 
pareunia as  a  symptom  of  female  sexual 
dysfunction,  and  to  encourage  a  sensitive 
approach  to  problems  of  human  sexuality. 

Dyspareunia  is  among  the  most  com- 
mon of  sexual  symptoms  affecting 
women.  The  term  simply  means  painful 
intercourse.  (The  symptom  can  occur  in 
males,  but  that  will  not  be  dealt  with  in  this 
article.) 

The  causes  of  discomfort  are  many.  The 
first  step  in  helping  is  to  define  the  prob- 
lem. When  inquiring  about  painful  inter- 
course, it  is  important  to  outline  clearly  the 
nature  of  "'pain""  and  the  circumstances 
around  the  onset  of  the  complaint. 
D  What  does  the  patient  mean  by  pain? 
n  Is  the  complaint  primary  or  secondary 

dyspareunia? 
n  Is  the  pain  chronic  or  episodic? 
D  Does   the  pain  occur  both  with  and 


without  sexual  response? 

n  Did  the  pain  start  after  a  delivery,  sur 
gical  procedure,  marital  crisis,  or  firs 
intercourse? 

D  Does  the  pain  occur  during  or  after  in: 
tercourse?  If  it  occurs  every  time,  caii 
the  patient  point  to  the  spot? 

D  Is  the  pain  sharp  with  deep  penetration 
suggesting  retroversion  or  prolapsci 
uterus?  Is  the  pain  dull  during  sexua 
arousal  and  after  intercourse,  suggest 
ing  chronic  pelvic  congestion,  or  is  i 
burning  during  and  after  intercourse 
suggesting  lack  of  lubrication  or  monil 
ial  vaginitis? 

D  Is  the  pain  related  to  ovulation  linn 
(suggesting  ovarian  problems),  or  re 
lated  to  the  premenstrual  or  menstrua 
period  (suggesting  endometriosis)?' 

Most  patients  can  clearly  describe  pair 
of  organic  origin  concerning  circunis 
tances  of  onset,  the  exact  nature  and  loe.i 
tion  of  the  pain,  as  well  as  the  fact  thai  i 
usually  occurs  with  each  coiia 
experience.' 

Through  an  open  and  sensitive  inquire 
a  professional  communicates  acceptaiKi 
of  the    person    and    her    problem.    1 
patient's  discomfort  and  vulnerabilit)  \. 
quire  affirmation  that  her  trust  in  the  nursi. 
is  justified. 

Frequently,  out  of  a  lack  of  knowleu 
about  sexual  dysfunction,  we  confci 
message  of  rejection.  An  early  experieiK  l 


I  of  a  nurse  in  family  practice  serves  to  illus- 
trate this. 

As  part  of  a  prenatal  visit,  an  18- year-old 
patient  who  had  been  married  only  4  months 
confided  that  intercourse  had  been  painful  even 
before  her  marriage.  She  had  had  comfortable 
intercourse  with  another  partner,  previous  to 
her  husband.  Her  marriage  was  precipitated  by 
the  pregnancy.  She  was  the  oldest  child  in  the 
family  and  had  run  away  with  her  husband, 
unable  to  confront  her  parents.  Her  history  also 
\  revealed  that  she  had  a  neurectomy  as  treatment 
I  for  persistent  dysmenorrhea  a  year  earlier. 

Inexperienced  at  that  time,  the  nurse  im- 

'  mediately  decided  that  the  patient  must  discuss 

;  this  with  the  physician  at  the  next  visit.  Lacking 

confidence,  the  patient  failed  to  raise  the  issue, 

1  and  nothing  was  done  until  the  postpartum 

period.  By  this  time  the  nurse  was  comfortable 

enough  to  ask  about  the  problem  again  and 

pursue  it  to  a  satisfactory  resolution. 

A  second  opportunity  may  not  be  avail- 
able for  the  nurse  to  reexplore  a  sexual 
complaint.  The  patient's  trust  lies  with  the 
person  to  whom  she  communicates  the 
•problem.  Simply  referring  responsibility 
without  negotiation  carries  the  risk  of  the 
patient  inferring  rejection. 

Causes  of  Dyspareunia 

The  causes  of  dyspareunia  have  tradi- 
tionally been  divided  into  two  classes,  or- 
ganic and  psychogenic.  They  are,  of 
course,  inseparable  in  reality.  Psychologi- 
cal and  physiological  features  are  compon- 
ents of  any  sexual  problem,  regardless  of 
the  identified  symptom.  The  origin  of  the 
problem  must  be  determined  before  de- 
veloping a  helping  strategy. 

In  genera],  dyspareunia  may  be  prim- 
ary, the  situation  in  which  penetration  has 
always  been  painful:  or  secondary,  which 
refers  to  the  onset  of  painful  intercourse 
following  previously  comfortable  intro- 
mission. A  possible  finding  on  examina- 
tion includes  spasm  of  the  muscles  of  the 
outer  vagina  and  perineum,  called  vag- 
inismus. This  effectively  places  a  strong 
muscular  barrier  to  penetration  of  the  vag- 
ina by  the  penis  or  a  finger.  This  is  usually 
involuntary,  and  may  or  may  not  be  as- 
sociated with  a  conscious  fear  of  penetra- 
tion. Certainly,  following  a  painful  ex- 
perience, fear  of  recurrence  reinforces  the 
'  perpetuation  of  the  symptom. 

The  confusion  in  origin  of  the  symptom 
IS  evident  in  an  example  of  postpartum 
onset  of  dyspareunia.  A  painful 
episiotomy  may  interfere  with  comfort- 
able intercourse  following  delivery.  The 
pain  may  be  related  to  incomplete  healing 

J/or  levator  muscle  spasm,  associated 

CANADIAN  NURSE  —  August  1975 


with  guarding  against  the  discomfort. 
Knowledge  of  all  the  mechanisms  of  pain 
can  be  used  to  reassure  both  partners,  who 
are  by  now  suspecting  either  a  dreaded 
physical  disorder,  or  serious  inadequacy. 

The  close  association  of  vaginismus  and 
dyspareunia  is  illustrated  in  Figure  L'*  The 
cycle  of  vaginismus  and  dyspareunia  can 
start  at  number  one,  with  the  initial  factor 
being  vaginismus  that  produces  painful 
coitus  which,  in  turn,  produces  fear  of  pain 
with  each  coital  experience.  This  results  in 
anxiety  and  lack  of  sexual  response,  which 
supports  the  original  condition  of  vag- 
inismus. 

The  cycle  can  also  start  at  any  other 
point.  Dyspareunia  from  any  cause,  in- 
cluding organic  cause,  can  result  in  fear  of 
pain  with  each  coital  experience,  produc- 
ing anxiety  with  or  without  sexual  re- 
sponse. This  can  result  in  vaginismus 
because  of  the  anticipated  pain. 

The  following  case  summary  illustrates 
this  cyclic  overlap: 

A  24- year-old  woman  had  a  5-year  history  of 
dyspareunia  related  to  breakdown  of  her 
episiotomy  repair  following  her  last  delivery. 
On  examination,  the  vulva  was  healthy,  but 
terribly  scarred  in  the  area  of  the  episiotomy. 
There  was  a  defect  in  the  area  of  the  left  medio- 
lateral  episiotomy,  consisting  of  a  bridge  of 
skin  across  the  introilus.  covering  a  tunnel, 
which  was  completely  epilhelialized  and  pain- 


ful. On  digital  examination,  it  was  also  noted 
that  the  patient  had  a  marked  degree  of  vag- 
inismus. 

The  patient  requested  revision  of  her 
episiotomy.  The  surgery  was  booked,  and  she 
was  taught  to  relax  the  perineal  muscles.  She 
was  started  on  a  course  of  exercises,  using 
muscle  relaxation  and  graduated  dilators.  On  a 
follow-up  visit  prior  to  the  date  of  surgery  ,  the 
patient  returned  free  from  vaginismus  and  able 
to  have  coitus  without  pain.  She  cancelled  the 
surgery. 

Vaginismus  had  occurred  because  of  painful 
coitus  while  the  episiotomy  was  healing;  once 
the  healing  was  complete,  the  vaginismus  per- 
sisted. The  patient  interpreted  the  persistent 
pain  as  a  result  of  an  organic  problem,  and 
sought  surgery  as  a  solution.' 

In  women  for  whom  vaginismus  is  a 
problem,  our  experience  confirms  that  a 
relatively  short-term,  guided,  relearning 
process  will  result  in  the  reestablishment 
of  comfortable  coitus.  Therapy  in  this  in- 
stance includes  learning  to  be  aware  of  the 
perineal  muscles  and  learning  to  relax 
them.  Some  therapy  then  uses  a  progres- 
sion of  fantasy  and  relaxation. 

A  hierarchy  is  constructed  with  the 
couple,  first  in  fantasy,  then  in  reality,  to 
progress  toward  their  goals.  It  is  stressed 
that  these  goals  vary  widely  and,  from  the 
therapist's  viewpoint,  are  focused  on  ex- 
panding the  options  for  interpersonal  and 


,11  Dyspareunia- 


I  Vaginismus 


Fear  of  pain 
with  intercourse 


Anxiety 

with  or  without' 

sexual  response 


Figure  1 :  An  illustration  of  the  close  association 
of  vaginismus  and  dyspareunia. 


intrapersonal  sexual  expression. 

The  implication  that  painless  inter- 
course, culminating  in  mutual  simulta- 
neous orgasm,  is  the  acme  of  sexual  ex- 
pression can  not  be  accepted.  The  couple 
are  encouraged  not  to  set  goals  that  heigh- 
ten performance  expectations. 

Causes  of  painful  intercourse  that  may 
or  may  not  be  associated  with  vaginismus 
are  listed  below.  In  the  general  population, 
as  opposed  to  gynecological  practice,  or- 
ganic causes  are  rare:  / .  lack  of  arousal,  2 . 
inflammation  or  infection,  3.  situational 
conditions,  or  4.  other  problems. 

Lack  of  arousal  or  response 

When  sexually  aroused,  the  normal 
woman  experiences  a  number  of 
physiological  changes  that  prepare  her  for 
intercourse.  Sexual  response  is  charac- 
terized by  vasocongestion  and  neuromus- 
cular excitation.  This  produces  lubrication 
of  the  vagina  and  erection  of  the  clitoris. 
The  mucosa  of  the  vagina  is  lubricated  by  a 


Less  common,  but  more  serious,  is  pelvic 
inflammatory  disease,  which  can  be 
caused  by  gonorrhea.  Atrophic  changes 
will  often  be  associated  with  pain  in  post- 
menopausal women  during  penetration 
and  with  thrusting. 

Most  causes  of  inflammation  or  infec- 
tion are  readily  remedied,  once  identified. 
Many  complaints  are  caused  by  sensitivity 
to  self-administered  irritants,  such  as 
douche  solutions  and  feminine  hygiene 
deodorants,  or  by  restrictive  clothing. 
Without  exception,  feminine  hygiene 
deodorants  are  unnecessary,  and  may  be 
damaging.  Women  who  insist  on  using 
these,  in  the  absence  of  a  specific  problem , 
must  ask  the  question  of  why  they  need  to 
disguise  their  normal  odor.  The  suggestion 
is  one  of  denial  of  their  natural  sexuality. 

Situational  conditions 

Virginity:  An  inelastic  hymen  may  not 
stretch  at  first  coitus.  Initial  tearing  of  the 
hymenal  tissue  usually  produces  tempor- 


Frequently,  no  clear  cause  of  dyspareunia  can  be 
identified,  and  intensive  exploration  of  the  problem 
with  both  partners  is  necessary.  In  the  absence  of 
abnormal  findings,  dyspareunia  can  be  regarded  as  a 
symptom  of  underlying  psychosexual  dysfunction. 


clear,  viscous  fluid  that  has  a  distinctive 
odor  not  unattractive  to  healthy  people. 
The  vaginal  vault  expands,  resulting  in 
elevation  of  the  uterus. 

Each  of  these  steps  is  necessary  if  pene- 
tration is  to  be  accomplished  easily  and 
painlessly.  Failure  of  arousal  is,  therefore, 
a  potential  cause  of  dyspareunia.  Reasons 
for  this  are  complex  and  varied,  and  the 
reader  is  referred  to  Helen  Kaplan's  A^^u' 
Sex  Therapy  for  discussion  beyond  the 
depth  of  this  article.^ 

Inflammation  or  infection 

The  vaginal  and  perineal  areas  are 
warm,  moist,  and  enclosed,  thus  offering 
an  excellent  environment  for  the  growth 
of  organisms.  Many  of  these  do  not  inter- 
fere with  natural  homeostasis  and  are,  in 
fact,  protective.  At  some  time  in  a 
woman's  life,  candidiasis,  trichomoniasis, 
or  a  nonspecific  infection  may  produce 
inflammation  that  causes  burning  discom- 
fort   during    and    following    intercourse. 

24 


ary  discomfort.  Females  who  can  accept 
masturbation  as  a  pleasurable  viable  op- 
tion of  sexual  expression  may  dilate  the 
vaginal  ring,  so  that  first  intercourse  is 
painless. 

Postsurgical  or  Postpartum:  Surgery  in 
the  perineal  region  may  result  in  a  rela- 
tively temporary  problem  until  inflamma- 
tion subsides  and  healing  occurs.  Adhe- 
sions or  scars  rarely  interfere  indefinitely 
and,  for  this  reason,  expert  assessment  is 
necessary  for  persistent  postsurgical  dys- 
pareunia. 

Other  problems 

Other  possible  causes  of  dyspareunia 
include  trauma,  irradiation,  tumors,  cys- 
titis, constipation,  proctitis,  and  ectopic 
pregnancy.^  Uncommon  causes  are  usu- 
ally suggested  by  the  specificity  of  the 
complaint,  and  again  are  not  generally 
seen  outside  of  specialty  practice. 

Frequently,  no  clear  cause  of  dys- 
pareunia can  be  identified,  and  more  in- 


tensive exploration  of  the  problem  witll 
both  partners  is  necessary.  In  the  absenc! 
of  abnormal  findings,  which  is  genera! 
the  case,  dyspareunia  can  be  regarded  a 
symptom  of  underlying  psychosexual  d; 
function. 

First,  there  is  always,  inourexperienc. 
a  cause  of  dyspareunia.  This  fact  must  bij 
made  clear  to  the  patient  or  she  may  inte- 
pret  that  you  are  saying  her  problem 
imagined.''  Faced  with  the  reality  of  hel 
experience  of  pain,  there  is  a  basic  confiic' 
in  this  message  that  threatens  the  patii 
and  her  relationship  to  the  helping  protesi 
sional.  The  pattern  of  presentation  of  th-l 
symptom  may  be  complex,  and  the  prec 
origin  of  the  problem  unknown,  but  it  i . 
nonetheless,  real. 

Relationship  Issues 

Conscious  or  unconscious  expression 
relationship  conflict  is  a  common  cause 
dyspareunia.    Issues    of    control    figi 
largely  in  such  situations.  A  woman  ma; 
feel  that  the  sexual  relationship  is  the  onl 
domain  within  the  partnership  that  she  ca! 
control . 

She  is  either  unable  or  unwilling  i. 
admit  her  partner's  penis,  because  of  sonn 
"interference."  For  example,  she  ma> 
fantasize  that  she  will  be  "ripped  apan 
In  reality,  she  may  feel  angry  toward  him 
feel  used  by  him,  or  feel  that  he  is  m 
longer  attractive  or  stimulating.  Her  rei, 
tion  of  him  may  be  a  projection  of  hero,  , 
poor  self-image. 

Suspicion  that  these  issues  are  sigmii 
cant,  frequently  causes  couples  to  axcii 
seeking  help.  They  feel  unable  to  confrim 
the  conflicts  in  their  relationship,  perha" 
fearful  that  they  are  not  resolvable.  Scm 
dysfunction  is  but  a  symptom  of  this  prob 
lem.  Our  whole  person  is  not  so  easil\ 
divisible  as  it  sometimes  seems. 

As  opposed  to  relationship  proble^l^ 
old  conflicts  referrable  to  developmenta 
experiences  may  lie  behind  the  problem  o! 
dyspareunia;  these  conflicts  include  fear .  n 
penetration,  guilt  about  sexual  arouv 
guilt  about  sexual  pleasure,  or  fear  of  K 
of  control  with  orgasm.  These  conflu 
may  be  obvious,  as  in  the  case  of  a  woniai 
raised  in  a  guilt-producing  family,  or  thc> 
may  be  more  obscure,  as  in  the  case  ot  . 
rejecting  father  whose  image  is  transferi 
to  the  male  partner.  The  woman  whi 
motivated  to  assume  responsiblity  for  I 
own  sexual  pleasure  will  readily  respc 
to  professional  help. 

A  full  exploration  and  resolution  of  ■ 
problem  underlying  dyspareunia  requ 
the  participation  of  both  partners.  So: 
areas  worthy  of  assessment  include: 


I  What  is  the  problem?  How  do  Ihey  feel  about 
(it?  How  does  it  affect  them  as  individuals? 
iwithin  the  relationship? 

What  other  souces  of  conflict  or  frustration 
■evisi  in  their  lives?  What  sources  of  strength 
und  pleasure  are  there?  What  are  their  needs 
ind  goals' 

I  What  significant  experience  does  each  part- 
,ner  bring  to  the  relationship?  What  experiences 
hu\  e  they  had  together  that  relate  to  their  sexual 
|iunciioning  (positive  and  negative)? 
I  How  do  they  view  sexuality  in  general? 
jv\hai  values,  feelings,  fantasies,  and  conflicts 
ijo  ihey  have?  What  role  does  sexual  interaction 
iiold  in  the  relationship' 

How  do  they  view  themselves,  in  terms  of 
•cil-image  and  body-image?  What  questions. 
-.  and  concerns  do  they  have?  What  is  their 
I  of  information  that  supports  understand- 
>f  sexual  functioning? 
\  ill  both  accept  responsibility  for  their  own 
^ure?  Do  they  welcome  honest,  open 
munication  on  an  adult  le\el? 

Educational  Aspects 

Of  considerable  importance  to  any  heip- 

!l:  approach  are  the  educational  aspects. 
f  he^e  may  be  effectively  addressed  during 
1  conjoint  physical  examination  conducted 
\\  a  physician.  Attentive  examination  (in- 

luding  instruction  in  self-examination), 
luring  which  there  is  explanation  of  the 
lormal  appearance  and  function  of  the 
;enitalia,  offers  reassurance  and  shared 
earning. 

It  is  still  not  uncommon  to  find  couples 
>.ho  are  unaware  of  the  location  of  the 

liuiris  or  its  function  as  the  locus  of 
:reatest  sensitivity  for  most  women. 
^hths  persist   about   the   superiority   of 

vaginal"  orgasm,  which  is  undisting- 
il^hed  from  clitoral  or  any  other  kind  of 
'rgasm.   according   to   present   research 
indings.'' 
The  expansibility  and  irregularity  of  the 
nal  mucosa  and  the  nodular  feel  and 
ippcarance    of    the    cervix    as    normal 
ifienomena  are  a  revelation  to  many  cou- 
ples,  who  have  never  examined  them- 
ehes  or  each  other.  They  may  be  unfamil- 
ar  with  changes  that  occur  with  sexual 
iiaiurity,  such  as  thickening  of  the  labia. 
rtirough  this  examination,  the  therapist 
p.s  a  great  deal  about  the  couple's  com- 
ri  with,  and  acceptance  of.  their  genital- 

^^'e  believe  that  professional  learning 
mist  proceed  in  much  the  same  way  as  for 
hose  seeking  help.  Components  essential 
o  a  therapeutic  approach  include: 

developing  attitudes   consistent   with 
-  ptance  of  sexual  expression  in  various 

-ANADIAN  NURSE  —  AugusI  1975 


forms,  as  these  methods  of  expression 
meet  the  needs  of  the  patient.  Open,  exp- 
loring, pleasure-affirming,  intimacy- 
seeking  approaches  characterize  the  per- 
son who  is  able  to  enjoy  and  foster  growth 
in  human  sexuality. 

D  Acquiring  knowledge,  which  is  com- 
prised of  two  components,  information 
and  experience.  The  helping  professional 
must  be  aware  of  the  normal  sexual  re- 
sponse, of  normal  variations,  of  why  prob- 
lems arise,  and  of  how  new  patterns  of 
behavior  may  be  learned.  He  or  she  re- 
quires an  understanding  of  psycho- 
dynamics,  including  those  that  operate  in 
families  and  relationships. 

Principles  of  fertility  and  family  plan- 
ning, which  surround  the  issue  of  freedom 
for  sexual  expression,  must  be  clear. 
D  Enhancing  skills  that  confer  the  ability 
to  use  knowledge  and  attitides  to  facilitate 


can  be  useful  in  helping  a  person  with 
sexual  problems.  Organic  causes  underly- 
ing dyspareunia  are  usually  temporary  and 
easily  correctable.  They  are  rare  as  a  cause 
of  a  continuing  problem,  compared  to  is- 
sues of  intrapersonal  and  interpersonal 
conflict. 

One  of  the  keys  to  achieving  a  satisfying 
relationship  on  an  adult-to-adult  basis  re- 
quires that  each  partner  assume  responsi- 
bility for  his/her  own  sexual  pleasure.  The 
woman  who  withdraws  into  the  assump- 
tion that  she  has  an  organic  problem  in  the 
absence  of  abnormal  findings,  or  that  her 
partner  or  therapist  must  find  a  solution, 
abdicates  responsibility  for  her  own  sexual 
pleasure.^ 

Although  few  of  us  will  be  therapists  in 
the  sense  that  the  role  is  generally  under- 
stood, indentifying  and  responding  to  sex- 
ual concerns  of  patients  is  part  of  the 


Conscious  or  unconscious  expression  of  relationship 
conflict  is  a  common  cause  of  dyspareunia.  Issues  of 
control  figure  largely  in  such  situations.  A  woman 
may  feel  that  the  sexual  relationship  is  the  only  domain 
within  the  partnership  that  she  can  control. 


the  learning  of  sexuality  in  a  way  that  is 
satisfying  and  acceptable  to  the  clients. 
The  skill  most  essential  to  a  therapeutic 
approach  is  the  ability  to  communicate  ef- 
fectively. Facilitative,  supportive, 
reality-oriented  techniques  of  communica- 
tion must  be  highly  developed.  Arousal  of 
feelings  in  the  therapist  as  well  as  the  pa- 
tient may  occur. 

In  a  therapeutic  situation,  the  helping 
professional  must  be  able  to  accept  these 
feelings,  to  recognize  the  process  they  re- 
veal, and  to  use  the  feelings  therapeuti- 
cally, where  indicated. 

Parallels  are  readily  indentified  between 
the  learning  of  professionals  and  of  pa- 
tients. The  patients  are  helped  by  develop- 
ing attitudes  and  acquiring  knowledge  and 
communication  skills  that  allow  them  to 
meet  their  own  needs  for  sexual  pleasure. 

Summary 

Dyspareunia  is  one  of  the  most  common 
sexual  symptoms  that  carries  wide-rang- 
ing potential  for  emotional  and  physical 
pain.    Informed  therapeutic  intervention 


professional's  commitment.  Ultimately, 
our  goal  is  the  same  for  any  problem  of 
human  development  —  to  facilitate  the 
realization  of  the  potentialities  of  the  per- 
son. 

References 

1.  Lamoni.  John  A.  Female  dyspareunia. 
CanciJ.  Fam.  Phys.  20:8:53-6,  Aug.  1974. 

2.  Kaplan.  Helen  S.  The  New  Sex  Therapy: 
Active  Treatment  of  Sexual  Dysfunctions . 
New  York.  Brunner/Mazel.  1974. 

3.  Balint,  .Michael.  The  Doctor.  His  Patient 
and  the  Illness.  New  York,  International 
Universities  Press.  1957. 

4.  Masters.  William  Howell,  and  Johnson, 
Virginia  E.  Human  Sexual  Response.  Bos- 
ton. Liule.  Brown.  cl966. 

5.  Gosling.  R.  el  al.  The  Use  of  Small  Groups 
in  Training.  New  York,  Grune  and  Stratton. 
1%7.  p.  19.  <^ 


25 


Treatment  of  patients  with 

spinal  cord  injuries 


The  amount  of  function  that  a  patient  with  acute  spinal  cord  injuries  will  recovt 
depends  not  only  on  the  degree  to  which  the  cord  is  damaged,  but  also  on  the 
concerted  efforts  of  the  patient  and  the  therapeutic  team.  The  authors  describ 
the  care  given  to  their  patients  in  a  special  unit  at  Sunnybrook  Medical  Centre 
Toronto.  This  unit  is  the  first  of  its  kind  in  Canada. 


Patricia  |.  Vincent 

in  collaboration  with 

Janet  Smith  and  Elma  Danglasan 


A  tree  topples  on  a  logger;  a  hydro  re- 
pairman suddenly  loses  his  fooling  and 
falls;  a  young  driver  steps  on  the  brake  too 
late.  Several  more  healthy  young  persons 
have  been  catapulted  into  the  nightmare  of 
paraplegia  or  quadriplegia. 

There  have  been  no  new  dramatic  break- 
throughs in  the  treatment  of  acute  spinal 
cord  injuries.  However,  research  shows 
that  treatment  must  be  started  im- 
mediately, in  a  centre  where  there  are  spe- 
cially equipped  units  staffed  by  skilled 
personnel.  Prompt  diagnosis  and  treat- 
ment increase  significantly  the  percentage 
of  patients  who  will  regain  some  function. 

Last  year,  a  special  unit  was  set  up  at 
Sunnybrook  Medical  Centre  to  care  for 
persons  with  acute  spinal  cord  injuries.*  In 
this  unit  the  team  concept  is  a  vital  part 
of  the  underlying  philosophy  of  care. 

Nurses  working  in  the  unit  knew  they 
were  encountering  an  enormous  chal- 
lenge. They  were  faced  not  only  with 
learning  new  approaches  and  skills,  but 
also  with  much  relearning.  These  efforts 
have  been  worthwhile,  as  staff  see  patients 


*  Dr.  Charles  Tator,  head  of  the  division  of 
neurosurgery  at  Sunnybrook  Medical  Centre, 
received  a  gram  from  ihe  Ontario  Ministry  of 
Health  and  established  Ihe  unit  last  fall. 

26 


reach  full  or  partial  independence  in  a 
shorter  time  and  to  a  greater  degree  than 
previously. 

An  alarming  number  of  cord  injuries 
occur,  not  at  the  time  of  injury ,  but  during 
transportation.  Persons  helping  the  victim 
must  assume  that  anyone  with  face,  head, 
or  shoulder  injuries  has  a  spinal  injury 
until  proven  otherwise.  At  least  4  persons 
are  needed  to  move  the  injured  person  so 
that  the  spinal  column  is  kept  rigid. 

These  problems  are  solved  partially  at 
Sunnybrook  Medical  Centre  by  placing 
the  patient  on  a  Mobilizer  when  he  arrives 
in    the   emergency    department.    The 


Patricia  J.  Vincent  (rn.  St.  John's  General 
Hospital  School  of  Nursing,  St.  John's  New- 
foundland) is  nurse  clinician  in  Neurosciences 
at  the  Sunnybrook  Medical  Centre.  Toronto. 
Ontario;  Janet  Smith  (RN.  Victoria  General 
Hospital,  Halifax,  Nova  Scotia)  is  head  nurse 
of  the  Neurosurgical  Unit  at  Sunnybrook  Medi- 
cal Centre;  and  Elma  Danglasan  (RN.  San  Juan 
de  Dios  Hospital,  Manila)  is  head  nurse  of  the 
Acute  Spinal  Cord  Injury  Unit  at  the  same 
Centre.  The  authors  acknowledge  the  assis- 
tance of  Dr.  C.H.  Talor.  neurosurgeon,  Sun- 
nybrook Medical  Centre:  and  Virginia  Ed- 
monds. RN.  Special  Studies  and  Coordinator  of 
the  Acute  Spinal  Cord  Injury  Unit. 


Mobilizer  is  a  stretcher-like  machine  thi 
gently  transfers  the  patient  by  a  method  c 
surface  replacement  to  any  flat  surface 
while  keeping  the  spine  in  perfect  align 
menl.  See  photograph  on  page  27.)  Th 
Mobilizer  also  enables  the  nurse  to  chang 
the  bed  sheet  without  moving  th 
patient.** 


The  Team 

The  ""acute  spinal  cord  injury  unii' 
( ASCIU)  team  offers  a  comprehensive  rang 
of  services.  The  philosophy  and  objec 
tives,  policies,  and  procedures  for  the  uni 
are  drawn  up  by  the  asciu  committee 
Members  represent  many  disciplines  an' 
are  under  the  chairmanship  of  ; 
neurosurgeon.  Specialists  in  neurosur: 
gery,  orthopedics,  urology,  physical 
medicine,  neurology,  and  neuroradi. 
logy  are  all  included. 

The  nursing  service  department  is  rep 
resented  by  the  clinical  nurse  specialist  ir 
rehabilitation,  the  nurse  clinician  ir 
neurosciences,  the  head  nurses  of  the 
ASCIU  and  neurosurgical  nursing  unit,  and 


••More  information  on  the  Mobilizer  can  b« 
obtained  from  Diamondhead  Corporation 
Medical  Products  Division.  200  ShetTielc 
Street.  Mountainside,  New  Jersey,  us. a 


he  nursing  administrator.  An  occupa- 
ional  therapist,  physiotherapist,  neuro- 
)sychologist,  social  worker,  dietitian, 
ind  the  special  studies  nurse-coordinator 
or  the  project  complete  the  committee. 

When  a  patient  is  admitted,  consultation 
Requests  are  sent  to  each  department .  Fol- 
I owing  this,  a  conference  of  committee 
Inembers  and  personnel  who  are  working 
directly  with  the  patient  is  held  to  assess 
Satient  care  needs  and  to  plan  treatment. 
These  conferences  continue  monthly  to 
evaluate  the  patient's  changing  status  and 
leeds.  Experts  from  other  centres  are  fre- 
quently invited  to  share  their  knowledge  in 
jipecific  areas. 

I  Our  acute  spinal  cord  injury  unit  is  in- 
corporated within  the  neuro-intensive  care 
unit,  which  has  a  capacity  of  8  beds.  The 
)atient  is  admitted  here  for  2  to  4  weeks. 
After  this,  he  is  transferred  to  the  adjacent 
general  neurosurgical  area.  This  provides 
rontinuity  of  care,  as  the  same  staff  work 
n  both  areas. 

Surgical  Treatment 

Surgical  procedures  are  adapted  to  meet 
he  needs  of  the  patient  and  vary  from 
nsertion  of  skull  tongs  to  laminectomy, 
lecompression,  and  fusion. 

A  relatively  new  method  of  treatment  is 
Spinal  cord  perfusion.  (See  box  on  page 
?S.)  This  is  done  during  surgery  by  cir- 
i.-ulating  a  synthetic  cerebrospinal  fluid 
solution,  either  at  5°C  or  36°C,  over  the 
exposed  injured  segment  of  the  cord. 

The  neurosurgeon  must  consider  3  im- 
portant factors  before  deciding  whether  or 


not  to  use  perfusion  as  a  form  of  treatment. 
Of  primary  importance  is  the  medical  state 
of  the  patient,  that  is,  whether  or  not  there 
are  other  life-threatening  injuries  that  take 
precedence  over  the  spinal  cord  injury. 
Second,  the  patient  must  have  complete 
motor  and  sensory  loss  below  the  level  of 
injury.  The  third  factor  is  the  length  of 
time  from  injury  to  the  beginning  of  the 
perfusion  treatment.  Ideally,  perfusion 
should  begin  within  3  hours  of  injury. 

It  is  not  clearly  understood  how 
hypothermic  perfusion  works,  but  it  is 
possible  that  the  lowering  of  metabolic 
rate,  correction  of  acidosis,  or  dialysis  of 
toxic  substances  from  the  cord  are  in- 
volved. Although  experience  with  perfu- 
sion is  limited  at  present,  results  are  en- 
couraging. 

Nursing  Care 

An  acute  spinal  cord  injury  affects  vir- 
tually every  body  system.  Nursing  must 
be  based  on  knowledge,  and  patience  and 
understanding  are  as  important  as  techni- 
cal skill.  Patients  frequently  have  multiple 
other  injuries  as  well  as  a  damaged  cord. 
Since  common  ones  are  head  injuries  and 
fractures  of  the  extremities,  neurological 
testing  and  pertinent  observation  of  the 
patient  are  essential. 

Respiratory  function 

An  early  serious  complication  of  spinal 
cord  injury  is  respiratory  dysfunction. 
This  may  occur  immediately  or  may  be 
delayed.  For  example,  48  hours  may 
elapse  before  any  abnormality  is  noted. 


Marni  Besser,  staff  nurse  in  the  acute  spinal  cord  injury  unit  at  Sunnybrook 
Medical  Centre,  moving  a  "patient"  into  bed,  using  the  Mobilizer. 

-  CANADIAN  NURSE  —  Augusl  1975 


because  cord  edema  may  not  develop  im- 
mediately. If  edema  spreads  up  the  cord 
and  involves  the  segment  that  supplies  the 
respiratory  muscles,  the  patient  may  need 
a  tracheostomy  or  assisted  ventilation  on  a 
respirator. 

Careful  respiratory  monitoring  is  done, 
and  changes  are  reported  immediately.  If  a 
tracheostomy  is  required,  a  clear  explana- 
tion and  frequent  reassurance  to  both  the 
patient  and  his  family  are  given.  When  the 
patient  realizes  that  breathing  is  easier  and 
the  situation  is  temporary,  his  acceptance 
and  cooperation  during  suctioning  are 
more  readily  obtained. 

To  alleviate  feelings  of  fear  and  isola- 
tion, a  method  of  communication  is  pro- 
vided. Even  quadriplegic  patients  can  at- 
tract attention  by  touching  a  hand  bell  or 
other  device  with  their  arms  or  head.  We 
explain  to  the  patient  why  he  is  on  a  res- 
pirator, to  allay  his  fear  and  to  prevent 
overdependency  on  the  ventilator.  If  he  is 
told  that  he  needs  assistance  to  breathe  for 
a  short  time  to  prevent  pulmonary  compli- 
cations, he  is  less  likely  to  panic  when 
being  weaned  off  the  machine  after  the 
critical  period  has  passed. 

Cardiovascular  function 

Pooling  of  the  blood  in  the  abdomen  and 
lower  extremities  encourages  thrombus 
formation  and  hypotension.  Dorsi  and 
plantar  flexion  of  the  ankles,  ankle  circl- 
ing, and  flexion  and  extension  of  both 
knees  alternately  are  done  for  the  patient 
to  help  blood  flow  return.  Some  doctors 
order  anti-embolitic  hose  for  the  patient  as 
a  preventive  measure. 

Orthostatic  hypotension,  manifested  by 
pallor,  sweating,  and  syncope  can  be  a 
problem  when  the  patient  becomes 
mobile.  To  avoid  or  minimize  this,  we  use 
a  tilt  table,  increasing  the  degree  of  tilt 
daily.  We  take  the  patient's  blood  pressure 
before  he  is  placed  on  the  table,  and  at 
10-minute  intervals  thereafter.  As  soon  as 
his  pressure  shows  a  decrease,  he  is  re- 
turned to  a  horizontal  position.  When  he 
can  tolerate  an  angle  of  75°  to  80°  for 
approximately  half  an  hour,  he  progresses 
to  a  wheelchair.  During  this  time,  he  wears 
a  firm  abdominal  binder  and  anti- 
embolitic  stockings. 

Skin  care 

A  major  responsibility  in  caring  for  a 
cord-injured  patient  is  to  maintain  skin  in- 
tegrity and  prevent  decubiti.  Rehabilita- 
tion is  delayed  and  the  cost  is  astronomi- 
cal if  decubiti  develop.  Prevention  begins 
at  the  moment  of  the  patient's  admission  to 


the  emergency  department.  Turning  him 
every  2  hours  is  essential,  and  there  can  be 
no  deviation  from  this  practice. 

Many  patients  are  nursed  on  Stryker 
frames  for  the  first  8  to  10  weeks.  If  a 
frame  is  not  used,  the  same  policy  is  en- 
forced, and  we  turn  him  by  the  log-rolling 
method ,  using  at  least  3  persons  to  keep  his 
spine  in  alignment.  Adjuncts  are  used  as 
well,  including  sheepskin  boots,  ahemat- 
ing  pressure  mattresses,  and  foam  pads, 
but  they  do  not  replace  nursing  care. 

We  teach  the  patient  and  his  family  how 
to  care  for  the  skin  to  prevent  breakdown. 
The  patient  is  given  a  hand  mirror  so  that 
he  can  examine  his  skin  at  least  twice 
daily,  and  he  is  taught  to  massage  and 
report  any  reddened  areas.  If  the  family 
members  understand  the  importance  to  the 
patient  of  maintaining  heahhy  skin,  the 
likelihood  of  decubiti  formation  is  greatly 
decreased. 

Skeleto-muscular  function 

Although  Stryker  frames  keep  the  spine 
in  good  alignment,  keep  the  skull  traction 
centered,  and  facilitate  turning,  they  can 
be  frightening  to  the  patient.  In  the  early 
stages,  he  is  uncomfortable,  physically 
and  psychologically.  His  physical  space  is 
now  limited  to  floor,  ceiling,  and  a  few 
feet  at  the  sides.  This  fosters  the  develop- 
ment of  sensory  deprivation. 

Physical  comfort  can  be  attained  by 
using  thin,  foam-rubber  pads  under  bony 
prominences  and  concave  body  areas.  The 
visual  field  can  be  extended  laterally  by 
the  use  of  prism  eye  glasses.  Whether  on 
the  Stryker  frame  or  in  a  bed,  positioning 
to  prevent  deformity  is  essential.  We  use  a 
foot  board,  properly  placed,  to  prevent 
foot  drop.  Soft  rolls,  not  sandbags,  are 
used  to  prevent  external  rotation  of  the  hip 
and  ankle  joints. 

When  the  patient  is  nursed  in  a  bed,  the 
positioning  of  his  limbs  as  he  lies  in  the 
lateral  positions  is  extremely  important. 
His  legs  must  be  in  alignment  with  the 
hips,  and  he  must  not  lie  with  his  shoulders 
abducted.  We  place  pillows  between  his 
skin  surfaces  to  prevent  friction.  Passive 
range  of  motion  exercises  on  all  joints  of 
both  extremities  are  vitally  important  to 
prevent  contractures. 

Recovery  from  spinal  shock  is  almost 
always  accompanied  by  muscular  spasms 
of  the  extremities.  These  can  be  triggered 
by  a  variety  of  stimuli  —  cold  draughts, 
loud  noises,  and  changes  in  position.  Pa- 
tient and  nurse  should  attempt  to  identify 
stimuli  so  they  can  be  avoided. 

Autonomic  hyperreflexia 

One  of  the  most  frightening  complica- 
tions for  patients  with  a  cord  injury  is  au- 

28 


Laboratory  set-up  for  hypothermic  perfusion,  showing  peristaltic  roller  pump, 
being  adjusted  by  nurse,  and  the  frigister  (shown  at  the  end  of  the  O.R.  table). 
The  temperature  gauge,  shown  on  the  top  of  the  frigister,  is  connected  to  a 
flexible  thermistor  probe,  which  is  immersed  in  the  perfusate  in  the  laminect- 
omy site,  just  above  the  injured  spinal  cord. 


Spinal  Cord  Perfusion 


studies  have  shown  that  in  most  major 
cord  injuries,  the  spinal  cord  is  trans- 
ected functionally,  but  not  anatomically, 
at  the  time  of  injury.  When  the  cord  is 
examined  several  weeks  later,  massive 
destruction  and  cavitation  at  the  injured 
site  have  occurred.  This  extends  distally 
and  proximally  for  a  considerable 
length. 

Laboratory  data  Indicate  that  the  injury 
causes  a  physical  disruption  of  the  blood 
vessels  that  supply  the  Injured  segment, 
starting  an  ischemic  response  that  prog- 
resses to  necrosis  and  permanent  loss 
of  function,  below  the  level  of  Injury. 
When  perfusion  is  initiated  as  soon  after 
injury  as  possible,  blood  flow  may  be 
improved,  with  subsequent  retention  of 
some  function. 

The  two  types  of  spinal  cord  perfusion 
are  hypothermic  and  normothermic.  Our 
laboratory  studies  show  that  moderately 
severe  cord  Injuries  respond  to 
hypothermic  perfusion,  but  normother- 
mic perfusion  is  more  effective  for  se- 
vere injuries.  Experimentally,  the  length 
of  time  the  cord  is  compressed  is  an 
extremely  Important  factor  and  is  related 
directly  to  the  amount  of  recovered  func- 
tion. Unfortunately,  If  compression  of  the 
cord  persists  for  3  hours,  even  nor- 
mothermic perfusion  does  not  Improve 
recovery. 

The  equipment  used  In  spinal  cord  per- 
fusion consists  of:  a  hemocoll;  a  water 
bath  (normothermic);  a  peristaltic  roller 
pump;  a  thermistor  probe;  a  tempera- 
ture gauge;  and  a  spinal  cord  cryo- 


perfusor  (hypothermic).  The  method  is 
as  follows:  A  laminectomy  is  performed 
at  the  level  of  injury.  The  dura  Is  opened, 
and  the  dorsal  cord  is  perfused  through 
the  incision.  A  synthetic  cerebrospinal 
fluid  solution,  Elliott's  "B"  solution,  is  cir- 
culated over  the  cord  by  means  of  a  \ 
peristaltic  roller  pump.  This  Is  continued 
for  3  hours. 

Normothermic  Perfusion 
The  temperature  of  the  perfusate  Is  kept 
at  36-37°C  by  circulating  the  fluid 
through  a  hemocoll,  submerged  in  an 
electric  water  bath.  A  glass  thermometer 
registers  the  temperature  In  the  bath.  A 
reservoir  of  Elliott's  "B "  solution  is  main- 
tained in  the  incision  and  is  recirculated 
through  the  pump  and  water  bath.  A 
thermistor  probe  in  the  incision  registers 
the  temperature  of  the  perfusate  in  the 
reservoir. 

Hypothermic  Perfusion 
The  temperature  of  the  perfusate  is 
maintained  at  5°C.  A  frigister  spinal  cord 
cryo-perfusor  controls  the  temperature. 
A  temperature  gauge  is  connected  to  a 
flexible  thermistor  probe,  which  is  im- 
mersed in  the  perfusate  in  the  laminec- 
tomy incision,  just  above  the  injured  spi- 
nal cord. 

In  Dr.  Charles  Tator's  pilot  study  of  6 
patients,  3  have  regained  some  sensory 
function  below  the  level  of  the  lesion. 
Perfusion  was  unsuccessful  in  the  other 
3.  There  appears  to  be  a  direct  relation- 
ship between  the  time  of  injury  and  the 
time  of  perfusion,  as  laboratory  studies 
indicate. 


lonomic  hyperreflexia  (exaggeration  of  re- 
flexes). This  condition  is  specific  to 
paralyzed  patients  and  occurs  when  the 
lesion  is  above  the  level  of  T4.  The  cause 
is  thought  to  be  the  release  of  norepinep- 
hrine at  the  sympathetic  nerve  ganglia,  and 
is  an  exaggerated  response  to  a  stimulus, 
itien  from  an  overdistended  bladder  or 
howel.  or  from  a  decubitus  ulcer. 

Subjectively,  the  patient  may  develop 
headache,  goose  pimples,  sweating,  stuffy 
nose,  and  a  feeling  of  flushing  of  the  face. 
Objectively,  there  may  be  hypertension, 
tachycardia,  restlessness,  and  flushed 
face,  which  will  progress  to  coma  if  the 
cause  is  not  ascertained  and  treatment 
begun  immediatley .  The  patient  is  assisted 
to  a  sitting  position  at  a  90°  angle  to  de- 
L tease  hypertension. 

The  patient's  abdomen  is  checked  for 
distention.  If  urinary  drainage  is  in  situ, 
(tubes  are  observed  for  patency.  Medical 
help  is  obtained  when  there  is  any  prob- 
lem. If  symptoms  do  not  subside  following 
ihe  alleviation  of  urinary  or  fecal  obstruc- 
!ion.  spinal  anesthesia  may  be  necessary. 

Bladder  function 

The  spinal  cord  is  responsible  for  the 
iretlex  emptying  of  the  bladder,  the  con- 
traction of  the  detrusor  muscle,  and  the 
relaxation  of  the  internal  and  the  external 
i.^phincters.  In  normal  adults  the  bladder 
'capacity  is  about  500  cc. 

In  early  spinal  cord  injury ,  the  bladder  is 
atonic,  characterized  by  the  absence  of 
muscle  tone  and  contraction  and  a  greatly 
enlarged  capacity.  The  reflex  to  empty  the 
bladder  is  lost.  In  the  later  stages,  the 
bladder  becomes  hypertonic,  has  in- 
creased muscle  tone,  diminished  capacity, 
and  high  intravesical  pressure.  It  empties 
reflexly,  and  this  occurs  spontaneously, 
with  little  voluntary  control.  Bladder  func- 
tion is  evaluated  by  the  cystometrogram. 

After  injury  to  the  spinal  cord,  the  pa- 
iient  will  probably  be  unable  to  void  spon- 
taneously. During  this  time,  he  will  usu- 
ally receive  intravenous  therapy.  A  Foley 
<u  Gibbon  catheter  is  inserted  and  con- 
ted  to  a  closed  drainage  system.  How- 

cr,  once  the  patient  is  able  to  eat  a  regu- 
lar diet,  intermittent  catheterization  is 
begun,  usually  after  2  or  3  days. 

The  timing  of  catheterization  depends 
on  the  individual  patient,  but  is  usually 
about  every  4  hours  during  Ihe  day  and 
every  6  hours  during  the  night,  to  keep  the 
amount  of  urine  drained  at  500  cc  or  less. 
Specimens  of  urine  are  sent  for  culture  and 
sensitivity  weekly ,  and  antibiotics  specific 
tor  urinary  infections  are  ordered  as  indi- 
cated. 

The  urologist  follows  the  course  of  each 
''  "lent  carefully  and  conducts  urological 

-  ANADIAN  NURSE  —  Augusi  1975 


diagnostic  tests  and  procedures  to  make 
certain  any  potential  problems  are  detected 
while  still  manageable. 

Bowel  function 

Control  of  the  anal  sphincter  may  be 
impaired  or  lost,  leading  to  bowel  inconti- 
nence or  fecal  impaction.  These  complica- 
tions should  be  prevented  to  maintain  the 
patient's  comfort  and  morale.  During  the 
acute  stage,  enemas  may  have  to  be  given, 
but  they  are  discontinued  as  soon  as  the 
patient's  condition  has  stabilized.  Regular 
bowel  emptying,  by  reflex  activity,  should 
be  developed. 

If  possible,  the  patient's  normal  pattern 
of  bowel  elimination  is  followed,  and  it  is 
important  to  adhere  rigidly  to  a  scheduled 
time  for  elimination.  Equally  important 
are  the  diet,  the  fluid  intake,  the  avoidance 
of  constipating  drugs,  and  the  positive  at- 
titudes of  staff  and  patient.  As  soon  as 
possible,  the  bathroom  is  used  when  the 
patient  tries  to  have  a  bowel  movement. 

The  regimen  we  follow  for  laxatives  is: 
cascara  sagrada  15  cc,  h.s.;  dioctyl  cal- 
cium sulfosuccinate  (Surfak)  240  mg, 
b.i.d.  ort.i.d.;  and  a  bisacodyl  (Dulcolax) 
suppository,  daily. 

The  bisacodyl  suppository  is  inserted 
high  into  the  patient's  rectum,  followed  by 
rectal  stimulation  for  5  to  10  minutes.  If  no 
bowel  movement  results  in  about  half  an 
hour,  a  second  suppository  is  inserted.  We 
carry  out  this  routine  daily,  but  may  have 
to  give  Ihe  patient  an  enema  if  there  is  no 
result  after  2  days. 

The  bisacodyl  may  be  substituted  with  a 
glycerine  suppository,  and  the  cascara 
sagrada  or  suppository  discontinued,  as 
the  patient  progresses.  The  patient  must 
achieve  control  over  this  basic  function  so 
that  he  can  comfortably  and  confidently 
return  to  society. 

Psychological  aspects 

Acute  spinal  cord  injury  that  results  in 
paraplegia  or  quadriplegia  is  devastating. 
With  the  loss  of  sensation,  movement,  and 
control  over  body  function ,  there  is  sudden 
dependence  upon  others.  The  initial  re- 
sponse is  usually  one  of  denial,  followed 
by  a  period  of  depression,  as  harsh  realiza- 
tion of  the  situation  takes  place.  As  the 
patient  realizes  that  his  bowel,  bladder, 
and  sexual  functions  have  been  affected, 
he  may  begin  to  feel  he  would  be  better  off 
dead.  Many  patients  become  very  angry 
and  lash  out  at  everyone  who  comes  near 
them. 

The  nurse  can  do  much  to  help  him 
adjust  to  his  disability  and  give  him  hope 
by  using  a  positive  approach  and  by  shar- 
ing her  knowledge  and  the  past  experi- 
ences she  has  had  with  other  patients. 


Every  effort  is  made  to  keep  him  pleas- 
antly and  constructively  occupied.  In  our 
unit,  occupational  therapy  is  begun 
when  feasible. 

The  patient  is  encouraged  to  be  active, 
within  the  restrictions  imposed  on  him  for 
safety.  His  independence  is  increased  as 
soon  as  possible. 

Patient  History 

Susan,  20  years  old,  was  jostled  acci- 
dentally and  fell  down  2  flights  of  stairs  in 
her  apartment  building.  She  was  dazed, 
and  complained  only  of  some  weakness  in 
her  legs.  Two  friends  picked  her  up  under 
her  axillae  and  knees  and  carried  her  to  a 
couch.  Three  hours  later,  she  was  unable 
to  move  her  legs  and  was  brought  by  am- 
bulance to  Sunnybrook  Medical  Centre. 

On  arrival  in  the  emergency  depart- 
ment, Susan  was  alert,  oriented,  fright- 
ened, and  upset.  Immediate  neurological 
assessment  indicated  a  spinal  injury  at 
C6-7.  Following  radiological  and  laborat- 
ory investigation,  during  which  time  sup- 
portive medical  treatment  was  begun,  she 
was  transferred  to  the  operating  room. 

Skull  tongs  were  inserted  and  attached 
to  10  pounds  of  traction,  immediately 
prior  to  posterior  cervical  laminectomy 
and  normothermic  spinal  cord  perfusion. 
Her  spinal  cord  was  swollen,  contused,  and 
hemorraghic.  Severance  was  incomplete. 
She  was  moved  from  the  operating  table  to 
a  Stryker  frame,  and  transferred  to  the 
respiratory  failure  unit  (RFU),  since  she 
needed  mechanical  ventilatory  assistance. 

Within  24  hours,  Susan  was  breathing 
independently,  so  was  transferred  to  the 
ASCiU.  On  her  arrival,  a  nursing  assess- 
ment was  done,  and  the  care  plan  from  the 
RFU,  revised.  Her  physical  needs  and  prob- 
lems were  acute  and  vitally  important.  Of 
equal  importance  were  her  psychosocial 
needs.  A  previously  active,  independent, 
young  mother  now  had  major  motor  and 
sensory  loss  of  both  lower  extremities,  and 
only  gross  movement  and  limited  sensa- 
tion in  her  upper  limbs. 

For  a  few  days  she  was  unable  to  cough 
and  expectorate.  Chest  physiotherapy,  fol- 
lowed by  nasopharyngeal  suctioning,  was 
necessary  q.h..  and  humidification  was 
provided  via  a  Puritan  nebulizer.  Spinal 
cord  testing  was  done  every  2  hours  to 
ascertain  improvement  or  deterioration. 
Testing  included  blood  pressure  readings; 
pulse  (rate  and  rhythm);  respirations 
(depth,  rate,  rhythm);  temperature:  and 
motor  power  and  sensation  below  the  level 
of  injury.  Turning  and  positioning  were 
carried  out  q.2  h..  along  with  passive  ex- 
ercises of  both  extremities  and  measures  to 
maintain  skin  integrity. 

During  the  first  week,  Susan  had  diffi- 


culty  in  adjusting  to  a  prone  position  on  the 
Stryker  frame.  This  problem  was  al- 
leviated by  placing  half-inch  foam  pads 
under  her  chest,  chin,  and  forehead. 

Following  urological  assessment  on  the 
second  postoperative  day,  the  indwelling 
catheter,  which  had  been  inserted  on  ad- 
mission, was  removed.  Intermittent 
catheterization  was  scheduled  q  .4  h . ,  until 
intravenous  fluids  were  unnecessary. 
When  a  regular  diet  was  started,  Susan's 
fluids  were  restricted  to  2300  cc  daily,  and 
catheterization  frequency  was  adjusted  to 
her  output,  as  part  of  her  bladder  training 
program.  Close  cooperation  between  the 
urology  staff  and  the  ASCiu  staff  is  essen- 
tial to  achieve  effective  bladder  manage- 
ment. 

We  started  Susan's  bowel  training  6 
days  postoperatively.  Bisacodyl  supposit- 
ory insertion  was  followed  by  rectal  stimu- 
lation 20  minutes  later,  at  approximately 
the  same  time  on  alternate  days. 

Following  3  weeks  in  the  ASCiu,  Susan 
was  transferred  to  the  neurosurgical  nurs- 
ing unit,  where  her  rehabilitation  program 
was  continued  and  adjusted  to  meet  her 
changing  needs.  The  occupational 
therapist  worked  closely  with  her  during 
this  time.  With  the  use  of  assisting  de- 
vices, Susan  was  able  to  feed  herself, 
bathe,  and  carry  out  a  great  many  activities 
of  daily  living. 

About  a  month  after  transfer  from  the 
ASCIU,  the  skull  tongs  were  removed  and 
Susan  was  taken  off  the  Stryker  frame  and 
placed  into  a  bed.  She  was  quite  depressed 
over  this,  as  it  limited  her  functional  level 
somewhat;  for  example,  she  found  it  more 
difficult  to  feed  herself  in  bed.  But  she 
soon  adjusted  to  this  change. 

Susan  was  measured  and  fitted  with  a 
neck  brace  and  was  then  mobilized.  Be- 
cause of  the  danger  of  orthostatic  hypoten- 
sion, she  was  first  placed  on  a  tilt  table, 
wearing  a  neck  brace,  abdominal  binder, 
and  anti-embolitic  stockings.  As  her  toler- 
ance increased  from  10  minutes  at  50°  to 
30  minutes  at  80°,  she  advanced  to  a 
wheelchair. 

She  was  not  able  to  push  herself  at  first. 
Her  balance  was  poor,  but  improved 

30 


gradually.  Through  her  own  determina- 
tion, and  with  the  help  of  the 
physiotherapist  and  other  team  members, 
she  regained  her  balance  and  mobility. 

Psycho-social  aspects 

Susan  had  held  numerous  jobs.  At  the 
time  of  the  accident  she  worked  as  an  en- 
tertainer in  a  small  night  club.  She  was  the 
single  parent  of  a  two-year-old  daughter. 
Approximately  2  days  after  her  admission 
to  the  ASCIU,  she  began  verbalizing  many 
fears  and  concerns  regarding  her  ability  to 
work  and  care  for  the  child. 

The  team  members  decided  that  this  was 
an  appropriate  time  to  explain  to  her  the 
implications  of  her  injury.  This  was  done 
by  the  neurosurgeon,  who  discussed  the 
expected  outcomes,  stressing  the  func- 
tions that  remained,  and  explaining  that 
life  could  be  satisfying  and  meaningful, 
even  though  it  would  have  to  be  lived  from 
a  wheelchair.  His  explanation  initiated  a 
natural  reaction  of  acute  depression  and 
anger.  We  encouraged  her  to  express  her 
feelings.  Being  able  to  say  that  she  did  not 
want  to  live,  helped  her  to  begin  to  think 
more  realistically  about  her  future. 

During  this  time,  also,  she  showed 
marked  evidence  of  denial,  as  she  talked 
continuously  about  walking  again.  Much 
patience  was  needed  to  give  her  realistic 
support.  We  did  not  wish  to  reinforce  her 
ideas  about  walking,  but  realized  that  she 
needed  time  to  come  to  terms  with  and 
accept  her  limitations. 

Contributing  to  her  depression  were 
feelings  pertaining  to  her  sexuality .  Would 
men  find  her  attractive?  Were  intercourse 
and  pregnancy  possible?  Male  friends 
were  very  supportive  during  this  time;  they 
continued  to  visit,  and  their  attitudes  to- 
ward her  did  not  change.  This  helped  her 
to  gain  self-acceptance.  We  explained  that 
a  normal  pregnancy  was,  indeed,  possible, 
and  this  information  also  helped  her  to 
work  hard  in  her  rehabilitation  program. 

Four  months  after  the  accident,  Susan 
was  discharged  from  the  ASCIU.  She  was 
able  to  function  fairly  independently  from 
a  wheelchair,  had  satisfactory  bowel  and 
bladder  control,  and  was  adjusting  to  her 


altered  body  image  and  life-style.  The  di 
parlment  of  social  work  obtained  financi; 
assistance  for  her,  and  placed  her  daughtf 
in  a  foster  home.  Long-term  plannin 
should  find  Susan  in  her  own  apartmen 
able  to  care  for  her  daughter. 

Conclusion 

At  present,  spinal  cord  regeneration  i 
not  possible.  The  amount  of  function  thi 
the  patient  will  recover  depends  not  onl 
on  the  degree  to  which  the  cord  is  darr 
aged,  but  also  on  the  concerted  efforts  c 
the  patient  and  the  therapeutic  team.  B 
being  an  integral  member  of  the  team,  th 
patient  can  reach  his  full  potential  for  re 
covery.  Although  the  ASCIU  has  bee 
operative  for  less  than  a  year,  the  result 
are  encouraging. 

The  multidisciplinary  team  approac 
improves  the  prognosis  for  patients  wit 
spinal  cord  injuries,  through  the  sharing  c 
knowledge  and  communication  that  is  fos 
tered.  The  fact  that  patients  are  individual 
with  different  needs  and  problems  is  rec 
ognized  by  this  team  approach.  '- 


Children's  value  to  their  parents 


In  searching  for  the  value  parents  set  on  their  children,  a  1972  research 
program  in  5  Asian  countries  and  Hawaii  confirmed  the  results  of  an  earlier 
study  by  Henripin  and  Adamcyk.  Their  1971  survey  on  the  decline  of  fer- 
tility in  Quebec  led  them  to  conclude:  "Children  are  perceived  as  necessary 
for  a  couple's  happiness." 


Madeleine  Vaillancourt-Wagner 


Why  do  couples  have  so  many  chil- 
dren? Or,  conversely,  why  don't  they 
have  more?  In  a  given  society  or  social 
context,  what  determines  the  number  of 
children  parents  wish  to  bring  into  the 
world?  What  is  the  reasoning  behind 
their  choice,  and  how  is  it  influenced  by 
their  environment,  their  aspirations, 
and  their  needs? 

Whether  we  are  considering  the 
dramatic  rise  in  the  birth  rate,  as  in 
certain  countries  of  Asia,  or  its  alarm- 
ing decline,  as  in  Quebec  or  Nigeria, 
these  are  questions  that  must  be  an- 
swered if  we  want  to  understand  the 
evolution  of  a  population  and,  if  possi- 
ble, influence  it. 

The  how's  and  why's 

To  begin  with,  we  know  that  the 
number  of  children  in  an  average  fam- 
ily varies  from  one  region  to  another, 
and  that  in  each  case  it  is  the  expression 
of  a  balance  struck  between  the  value 
that  parents  put  on  having  children  and 
the  obstacles  that  limit  their  fertility. 

The  conditions  that  lead  to  the 
maintenance  of  this  balance  became  the 
subject  of  a  large  comparative  study 
undertaken  by  experts  from  5  Asian 
countries  and  the  American  state  of 
Hawaii.  Sociologists  and  demog- 
raphers from  Japan,  Korea,  the  Philip- 
pines, Thailand,   and  Taiwan  joined 


their  Hawaiin  colleagues  in  1972  to 
plan  a  series  of  surveys  to  be  conducted 
in  their  respective  countries ,  on  the  sub- 
ject of  "children's  value  to  their  par- 
ents." This  meeting  and  those  that  fol- 
lowed took  place  at  the  East-West 
Center  of  the  University  of  Hawaii, 
which  acted  as  coordinator.  It  was  the 
first  phase  of  a  research  program  on  the 
factors  influencing  population  growth 
in  each  of  the  countries  concerned. 

A  year  earlier,  in  1971,  Professors 
Jacques  Henripin  and  Evelyne 
Lapierre- Adamcyk  of  the  University  of 
Montreal  had  conducted  a  survey  on  the 
decline  of  fertility  in  Quebec.  Their 
goal  was  to  discover  the  causes  of  this 
phenomenon  and  to  find  a  means  to 
improve  the  situation,  if  not  to  actually 
reverse  it.  They  published  the  results  of 
their  survey  in  a  work  entitled  "The 
end  of  the  revenge  of  the  cradle:  what 
the  women  of  Quebec  think." 

There  is  no  formal  connection  be- 
tween the  Quebec  project  and  the  Asian 
one  but,  as  they  both  deal  with  the  fam- 
ily, we  have  compared  them  for  the 
purposes  of  this  article. 

Canada  becomes  involved 

The  Asian  project  was  financed  in 
part  by  Canadian  funds.  Canada's 
agency  for  scientific  cooperation,  the 
International  Development  Research 
Centre,  granted  $69,786  toward  the  re- 
search program  on  "children's  value  to 
their  parents,"  and  made  its  experts 
available  to  the  researchers. 

The  latter  closely  examined  the  value 
of  children  in  every  sense  except  one; 
they  did  not  question  the  human  worth 


of  children.  Rather,  they  set  out  to  as- 
sess the  value  of  children  in  measurable 
terms  and  to  determine  the  aspects  of 
their  existence  that  may  be  advanta- 
geous or  burdensome  for  the  parents. 
Ahhough  a  child's  value  cannot  be 
measured  in  dollars,  yen,  or  pesos,  the 
financial  burden  he  represents  to  his 
parents,  or  the  benefit  they  can  derive 
from  him  in  their  old  age  cannot  be 
ignored.  A  source  of  expense  and 
sometimes  of  income ,  the  child  is  also  a 
source  of  other  benefits  much  less  tan- 
gible, but  just  as  real.  He  satisfies  his 
parents'  emotional,  social,  psychologi- 
cal, and  even  metaphysical  needs.  Is  he 
not  a  means  by  which  the  parents  can 
perpetuate  their  own  existence  and  thus 
conquer  death? 

Parents  examined 

To  explore  such  a  vast  and  many- 
faceted  subject  in  6  countries  with  di- 
verse traditions,  some  type  of  precise 
instrument,  sensitive  to  all  the  varia- 
tions in  mentahty,  was  needed  — 
namely,  a  high-caliber  questionnaire. 
The  experts  meeting  at  the  University 
of  Hawaii  proceeded  with  caution,  and 
prepared  a  number  of  prequestionnaires 
and  pilot  polls  in  the  course  of  develop- 
ing the  questionnaire.  It  took  months, 
many  meetings,  and  an  impressive  ex- 
change of  correspondence  to  give  it  its 
final  form. 

Next,  the  researchers  had  to  deter- 
mine whom  should  be  asked  the  ques- 
tions. In  each  country,  some  300  hus- 
bands and  wives  were  selected,  and  in- 
terviewed separately.  Selection  en- 
sured that  at  least  60  middle-class  urban 


couples,  60  poor  urban  couples,  and  60 
farm  couples  were  among  those  to  be 
interviewed.  Each  interview  lasted  an 
hour  and  a  half. 

This  sampling,  which  was  intended 
to  provide  an  overview  of  the  opinions 
of  3  social  classes,  proved  to  be  particu- 
larly difficult  to  establish.  As  the  study 
was  a  comparative  one,  the  groups 
selected  had  to  be  truly  representative 
of  their  social  background  and  their 
country.  Regional  differences  being 
what  they  are  throughout  the  world, 
this  was  not  really  possible. 

Despite  their  scientific  training  and 
experience,  the  experts  were  not  able  to 
make  the  way  of  life  of  a  rural  or  urban 
family  in  Korea  correspond  exactly  to 
that  of  a  rural  or  urban  family  in  the 
Philippines  or  Japan .  The  sampling  was 
therefore  somewhat  arbitrary.  Thus,  a 
middle-class  family  in  the  Philippines 
was  defined  as  having  a  yearly  income 
of  more  than  $400,  which  roughly  cor- 
responds to  an  average  annual  income 
of  $700  for  a  Thai  family  in  the  same 
category,  but  is  not  at  all  comparable  to 
the  much  higher  standard  of  living  in  an 
industrialized  country,  such  as  Japan. 

Influence  of  social  environment 

In  the  long  run,  this  fiaw  in  the  sam- 
pling proved  to  be  instructive.  The  re- 
searchers naturally  expected  to  find 
some  agreement  in  the  results  of  a  sur- 
vey dealing  with  a  subject  as  universal 
as  the  family.  Nevertheless,  they  were 
astonished  to  discover  in  these  coun- 
tries that  cultural  values  seemed  to 
exert  less  influence  on  parents'  at- 
titudes toward  their  children  than  did 
the  social  class  to  which  they  belonged 
and  the  income  they  earned. 

The  distinctions  between  rich  and 
poor,  urban  and  rural,  were  similar 
from  one  region  to  another  despite  the 
variety  of  beliefs,  traditions,  local 
characteristics,  and  political  systems. 
Poverty  and  relative  affluence  were 
looked  on  in  the  same  way  everywhere, 
and  they  produced  comparable  at- 
titudes toward  offspring. 

Let  us  return  to  Quebec,  where  the 
situation  is  somewhat  puzzling.  The 
Henripin-Adamcyk  team  found,  after 


questioning  1,745  married  women  be- 
tween 15  and  65  years  of  age,  that 
Quebec  families  within  the  various  so- 
cial strata  are  tending  to  become  in- 
creasingly similar  in  ultimate  size.  In 
other  words,  the  women  of  Quebec, 
whether  they  be  urban  or  rural,  no 
longer  want  more  than  2  children,  and 
for  very  nearly  the  same  reasons. 

Emphasizing  quality  rather  than 
quantity,  the  vast  majority  —  80  per- 
cent for  their  sons  and  70  percent  for 
their  daughters  —  dream  of  educating 
their  children  and  sending  them  on  to 
university. 

In  Quebec,  where  nothing  was  sup- 
posed to  change,  the  Maria  Chap- 
delaines  of  today,  almost  without  dis- 
tinction as  to  social  class  or  income, 
and  without  consulting  one  another, 
have  thus  developed  radically  new  at- 
titudes regarding  the  importance  and 
value  of  children. 

Children  a  source  of  happiness 

It  is  impossible  to  compare  the  re- 
sults of  this  Canadian  survey  with  the 
Asian  one,  because  they  were  con- 
ducted for  different  purposes  and  used 
different  methods.  Nevertheless,  the 
conclusions  of  the  experts  overlap  on  at 
least  one  point,  which  Professor  Henri- 
pin  summarized  in  a  few  concise  words 
that  apply  just  as  well  to  the  Japanese  as 
the  Thais,  the  Filipinos,  the  Hawaiians, 
the  Koreans,  the  Formosans  of  Taiwan, 
and  the  Quebecers:  "Children  are  seen 
as  necessary  to  the  couple's  happi- 
ness." 

Naturally,  we  suspected  this,  but 
here  the  fact  has  been  established,  con- 
firmed, analyzed,  and  backed  up  by 
statistics.  We  are  now  reassured.  In 
Quebec,  we  were  beginning  to  wonder. 
"To  our  surprise,"  the  Henripin- 
Adamcyk  team  declares,  "the  results 
of  this  survey  show  that  attitudes  with 
regard  to  the  presence  of  children  in  a 
family  remain  mostly  favorable.  "But 
this  does  not  mean  that  parents  want  a 
large  number  of  children,"  it  adds 
further  on,  which  brings  us  to  the  ques- 
tion of  children's  value  to  their  parents. 

In  our  society,  children's  recognized 
role  as  a  source  of  happiness  definitely 


does  not  serve  to  stimulate  fertility. 
And,  in  other  societies'? 

The  wife  of  a  Korean  farmer  gave  the 
researcher  an  answer  that  sums  it  ail  up: 
"Our  children  are  our  wealth."  The 
results  of  the  questionnaire  are  any- 
thing but  ambiguous  about  this  point: 
for  parents  in  the  6  countries  in  the 
Asian  survey,  children  are  undeniably  a 
source  of  pleasure.  In  various  wa>s. 
parents  explained  that  their  children  en- 
liven family  life,  provide  entertain- 
ment, and  satisfy  the  need  for  affection. 
In  short,  they  are  the  best  antidote  for 
loneliness  and  boredom. 

From  Montreal  to  Honolulu,  from 
Seoul  to  Bangkok,  the  child  remains  a 
real  asset.  This  in  itself  is  most  hearten- 
ing. As  long  as  humanity  continues  to 
like  itself  well  enough  to  want  to  per- 
petuate itself,  there  is  hope. 

Not  all  the  resuhs  of  the  survey  are  as 
reassuring.  For  instance,  the  experts 
found  that,  among  some  2,500  fathers 
and  mothers  they  questioned,  there  was 
a  decided  preference  for  male  children 
This  had  long  been  suspected,  but  had 
not  been  proven.  This  tendency  is  most 
marked  in  Korea  and  Taiwan. 

The  reasons  for  preferring  male 
offspring  vary  considerably  from  one 
place  to  another.  However,  2  factors 
emerge  as  significant  in  all  the  regions 
surveyed  and  at  all  3  levels  of  socielv: 
sons  ensure  the  continuity  of  the  famil\ 
and  inherit  the  family  property.  In  thi-^ 
sense,  they  serve  to  prolong  the  pai 
ents"  existence.  Also,  they  are  counted 
on  to  provide  for  their  fathers  and 
mothers  in  old  age. 

A  premium  on  males 

What  the  male  child  offers  in  terms 
of  survival  and  security  enhances  his 
value.  Parents  hope  for  the  birth  ot 
daughters  for  more  immediate  and  pro- 
saic reasons  which,  unlike  those  for 
boys,  are  curiously  identical  from  one 
country  or  family  to  another.  Daughters 
participate  in  housekeeping  chores  and 
are  a  great  help  around  the  house.  The\ 
keep  their  mothers  company  and  ha\  c 
qualities  that  make  their  presence  wel 
come  within  the  family. 

The  polls  did  not  reveal  the  nature  of 


32 


these  qualities,  but  they  did  bring  out 
the  somewhat  transitory  value  of 
female  children  to  their  parents.  They 
are  loved  during  their  childhood,  but 
from  the  moment  they  leave  the  family 
home  to  marry,  they  seem  to  lose  their 
importance  in  the  eyes  of  their  parents. 
In  the  family,  little  boys  are,  from 
birth,  more  equal  than  their  sisters. 

Is  this  the  case  in  Quebec?  As  the 
Henripin-Adamcyk  team  did  not  ex- 
plore this  aspect  of  the  subject,  the 
reader  will  have  to  compare  his  per- 
sonal experience  with  the  opinions 
gathered  in  Asia. 

HE  CANADIAN  NURSE  —  August  1975 


The  researchers  of  the  Asian  team 
interviewed  the  father  and  mother  of  a 
family  separately.  If  their  opinions  are 
not  given  separately,  it  is  because,  ac- 
cording to  the  experts,  they  coincide 
closely  in  all  the  groups  and  subgroups 
studied.  The  battle  of  the  sexes  —  if 
such  a  phenomenon  exists  in  the  6 
countries  in  the  survey  —  apparently 
has  no  bearing  on  the  value  attributed  to 
children,  or  the  disadvantages  of  hav- 
ing them. 

The  same  couples  who  agree  on  the 
role  of  their  children  as  a  source  of 
happiness  and  the  comparative  advan- 


tages of  having  sons  or  daughters  are 
also  on  the  same  wavelength  when  it 
comes  to  evaluating  the  psychological 
and  financial  burden  that  children  rep- 
resent. Attitudes  varied  in  this  respect, 
but  they  were  influenced  by  the  par- 
ents' social  environment,  rather  than 
their  sex. 

The  financial  burden 

When  the  researchers  explored  the 
questions  concerning  the  cost  of 
educating  children,  they  did  not  try  to 
find  out  how  much  a  child  actually 
costs  his  parents,  but  rather  how  this 
cost  is  viewed  by  couples  and,  conse- 
quently, to  what  degree  it  influences 
the  family's  ultimate  size. 

Of  the  obstacles  to  the  growth  of  the 
family,  the  expenses  incurred  by  hav- 
ing children  come  at  the  top  of  the  list. 
Although  this  is  less  true  for  the  urban 
middle  class  than  for  the  other  2 
groups,  the  cost  entailed  by  having 
children  is  nevertheless  a  considera- 
tion, even  in  financially  secure 
families.  But  in  the  case  of  urban 
middle-class  couples,  this  cost  is  offset 
by  the  psychological  satisfaction  the 
father  and  mother  derive  from  educat- 
ing their  children. 

The  answers  to  the  questionnaire 
bear  witness  to  the  interest  they  take  in 
the  growth  and  development  of  their 
children,  the  pride  and  sense  of  accom- 
plishment they  derive  from  them,  and 
the  joy  that  the  parent-child  relation- 
ship brings  to  them.  The  child  is  loved 
for  himself,  and  this  attitude  is  more 
prevalent  in  the  city,  among  parents 
who  probably  have  fewer  pressing 
daily  worries  than  their  counterparts  in 
the  other  two  groups:  it  is  almost  nonex- 
istent in  the  rural  environment. 

In  low-income  families  —  those  who 
live  in  the  slums  and  are  exposed  to  all 
the  uncertainty  of  unemployment  and 
illness  —  children  are  not  so  much  a 
financial  burden  as  a  form  of  social 
security. 

People  who  live  from  one  day  to  the 
next  in  the  shadow  of  poverty  find  that 
savings  are  impossible  and  the  future  is 
uncertain.  Thus,  they  expand  their 
families  as  a  hedge  against  the  future  so 


33 


that  they  may  have  someone  to  count  on 
in  their  old  age.  Children  learn  quickly 
to  earn  their  way  and  contribute  to  the 
well-being  of  the  group. 

It  should  be  added  that  in  an  under- 
privileged environment  where  there  are 
few  amusements,  the  presence  of  chil- 
dren helps  the  parents  to  relax  and 
forget  their  cares.  From  a  psychologi- 
cal point  of  view,  it  is  this  aspect  of 
having  children  that  appears  to  count 
most  for  them. 

In  a  rural  environment,  the  survey 
clearly  showed  that,  in  the  profit-and- 
loss  column,  children  represent  a  most 
positive  credit.  If  there  are  many 
mouths  to  feed,  there  are  just  as  many 
pairs  of  hands  to  work  the  land  and  do 
the  many  tasks  required  on  a  farm.  As 
mentioned  above,  children  are  also  the 
best  investment  for  the  future.  Like  his 
cousin  the  poor  city  dweller,  the  little 
country  boy  is  called  upon  to  look  after 
his  father  and  mother  when  the  time 
comes. 

We  have  given  only  the  most  general 
results  of  the  polls  taken  in  Japan, 
Korea,  Tailand,  the  Philippines, 
Taiwan,  and  Hawaii.  Although  an  at- 
titude may  be  the  same  everywhere,  it 
differs  in  degree  from  one  place  to 
another  and  is  not  necessarily  caused  by 
the  same  factors. 

Similarly,  with  respect  to  the  Cana- 
dian study,  we  have  drawn  from  the 
Henripin-Adamcyk  sampling  only  the 
aspects  relevant  to  this  article ,  and  have 
not.tried  to  make  an  overall  assessment 
of  it.  The  results  are  particularly  in- 
teresting with  regard  to  the  cost  price  of 
children. 

Surprise  in  Quebec. 

"Calculations  made  in  France  show 
that  a  couple's  standard  of  living  drops 
as  the  number  of  children  increases," 
states  the  Henripin-Adamcyk  team. 
"We  wanted  to  know  whether  the 
women  of  Quebec  fully  understand  the 
reduction  of  the  standard  of  living  that 
accompanies  the  arrival  of  children." 

Their  report  further  states:  "The  re- 
sults indicate  that,  among  married 
women  aged  15  to  35,  only  13  percent 
notice  a  drop  in  the  standard  of  living 


after  the  birth  of  the  first  child  .  .  .and 
40  percent  assert  that  the  arrival  of  chil- 
dren has  no  effect  on  their  standard  of 
living;  moreover,  nearly  half  of  those 
who  say  there  is  a  drop  do  not  notice  it 
until  after  the  arrival  of  the  third  child 
and  the  ones  that  follov--." 

Thus,  most  families  carry  on  as  if  the 
first  3  children  had  been  provided  free 
of  charge.  If  they  tighten  their  belts, 
they  apparently  do  so  naturally,  with- 
out realizing  it. 

These  statistics  took  the  experts  from 
the  University  of  Montreal  by  surprise, 
and  they  do  not  hide  their  astonishment; 
"Such  a  perception  contradicts  all  fi- 


nancial calculations  and  defies  the  fam- 
ily budget  specialist." 

What  is  the  explanation  for  this  irra- 
tional attitude  on  the  part  of  the  women 
surveyed?  Henripin  and  Adamcyk 
propose  the  following  hypothesis; 
"...  Nonmonetary  satisfactions  de- 
rived from  having  children  replace 
other  satisfactions  that  require  expendi- 
ture." 

In  the  eyes  of  a  mother,  the  evenings 
out,  the  travel,  the  expensive  enter- 
tainment, and  the  new  clothes  that  she 
must  forego  have  less  value  than  the 
presence  of  children.  "Whatever  cer- 
tain experts  may  think,"  conclude  Pro- 


fessors  Henripin  and  Adamcyk,  "it  is 
not  irrational  to  love  children  and  to 
take  pleasure  in  educating  them. 

Other  side  of  the  coin 

Whether  or  not  it  is  perceived  as 
such,  the  financial  burden  that  children 
represent  has  a  profound  influence  on 
the  size  of  the  family  in  the  7  countries 
represented  in  the  2  polls.  Other  dif- 
ficulties inherent  in  the  presence  of 
children  also  bear  on  the  parents'  deci- 
sion. Of  course,  they  vary  from  one 
subgroup  or  region  to  another.  This  is 
the  other  side  of  the  coin. 

Against  the  value  attached  to  chil- 
dren —  seen  in  terms  of  their  charm, 
the  joy  they  inspire,  and  the  security 
they  offer  for  the  future  —  parents  must 
weigh  the  time  and  attention  they  re- 
quire, the  restrictions  they  impose  on  a 
couple's  freedom,  and  the  noise  and 
disorder  invariably  brought  on  by  their 
presence.  In  the  countries  of  the  Asian 
survey,  for  middle-class  urban  families 
as  well  as  for  lower-income  families, 
such  are  the  disadvantages  that  oblige 
parents  to  limit  the  size  of  their 
families. 

For  poor  city  dwellers,  the  lack  of 
adequate  housing  space  aggravates 
these  problems  even  more,  and  they 
find  it  a  particularly  difficult  task  to 
instill  good  principles  and  discipline  in 
their  children.  This  environment  does 
not  encourage  children  —  or  adults  for 
that  matter  —  to  develop  their  full  po- 
tential. 

On  the  other  hand,  the  experts  ob- 
served that  in  a  rural  setting,  it  is  health 
problems  that  preoccupy  parents  most, 
because  medical  attention  is  less  acces- 
sible than  in  the  cities.  In  addition, 
work  in  the  fields,  in  which  the  entire 
family  participates,  will  not  wait,  and 
any  illness  diminishes  the  productivity 
of  the  family  unit. 

In  this  respect,  farm  wives  must 
overcome  the  same  difficulties  as  work- 
ing women  in  industrialized  countries. 
They  have  a  double  task:  keeping  house 
and  tilling  the  land.  For  them,  pre- 
gnancy and  infant  care  often  mean 
overtiredness  and  backaches.  The  high 
rate  of  infant  mortality  and  the  illnesses 

•HE  CANADIAN  NURSE  —  August  1975 


of  their  offspring  tend  to  diminish  the 
satisfactions  of  motherhood  for  them. 

The  general  character  of  these  first 
results  masks  the  complexity  of  the 
facts  gathered  in  the  parallel  surveys. 
The  experts  who  carried  out  these 
studies  found  more  questions  to  answer 
than  recommendations  to  make. 

Phase  II  of  the  comparative  study  of 
children's  value  to  their  parents  got 
under  way  in  1974.  Its  purpose  is  to 
answer  questions  raised  by  the  prelimi- 
nary studies  and  to  set  up  a  third  phase 
of  the  project,  to  deal  with  a  larger, 
more  representative,  sampling  in  each 
region. 

Turkey  has  now  joined  the  countries 
already  under  study.  Specially  created 
for  the  purpose,  a  new  organization  cal- 
led the  Committee  for  Comparative 
Studies  on  Population  Ethology  will 
coordinate  the  various  aspects  of  the 
work. 

As  they  did  for  Phase  I,  the  research- 
ers have  received  a  grant  from  the 
International  Development  Research 
Centre,  as  well  as  support  from  the 
Ford  Foundation,  the  American  gov- 
ernment, and  the  governments  of  the 
countries  concerned. 

Social  policies 

This  multi-staged  study,  with  its  ex- 
haustive and  methodical  exploration  of 
the  factors  that  cause  the  birthrate  to 
fluctuate,  is  intended  to  find  ways  to 
stabilize  population  growth.  The  facts, 
so  carefully  assembled  and  scrutinized, 
will  also  be  of  more  immediate  use  in 
organizing  large-scale  campaigns  to  in- 
form and  awaken  the  public  in  regions 
suffering  the  consequences  of  un- 
checked population  growth. 

As  no  one  has  ever  decided  to  have  or 
not  to  have  children  for  such  abstract 
reasons  as  avoiding  overpopulation  or 
reducing  the  food  deficit  of  a  country, 
the  surveys  are  essentially  intended  to 
provide  governments  with  the  basis  for 
a  social  policy  that  can  influence  the 
birth  rate. 

Such  a  policy  would  not  be  designed 
to  lessen  the  satisfaction  associated 
with  parenthood  but,  in  places  where 
the  rising  number  of  births  is  leading  to 


disaster,  to  change  conditions  so  that  it 
would  no  longer  be  in  the  parents'  in- 
terest to  increase  unduly  the  size  of 
their  families. 

Finally,  the  results  of  the  study  will 
allow  predictions  to  be  backed  up  with 
reliable  statistics.  The  number  of  chil- 
dren parents  want  today  will  in  future 
be  translated  into  mouths  to  feed;  indi- 
viduals to  educate,  care  for.  and  house; 
and  jobs  to  create. 

In  Quebec,  where  couples  have  re- 
duced the  size  of  their  families  at  an 
unprecedented  rate  during  recent  de- 
cades, the  Henripin-Adamcyk  team 
polled  the  opinions  of  married  women 
concerning  various  measures  that  could 
be  taken  by  the  government  to  lessen 
the  difficulties  involved  in  educating 
children .  Of  the  6  measures  proposed  to 
them,  an  increase  in  family  allowances 
was  by  far  the  most  popular,  and  scho- 
larships came  second. 

In  Quebec,  as  elsewhere,  economic 
considerations  weigh  heavily  on  the 
decision  by  parents  on  the  number  of 
children  they  will  bring  into  the  world. 
Children's  value  to  their  parents  cannot 
be  measured  without  reference  to 
economic  and  social  realities. 

Bibliography 

Caris.se,  Colette.  Planificaiion  des  nais- 
sances  en  milieu  canadien-franfais. 
(family  planning  in  the  French-Canadian 
milieu).  Montreal.  University  of 
Montreal  Press.  1964. 

Henripin,  Jacques.  Elements  de  demo- 
graphie.  (elements  of  demography). 
Montreal.  University  of  Montreal 
Press,  1968. 

— .  Trends  and  faclors  of  ferlilily  in 
Canada.  Ottawa.  Statistics  Canada. 
1972. 

Henripin,  Jacques  and  Lapierre-Adamcyk. 
Eveiyne.  La  fin  de  la  revanche  des  ber- 
ceaux:  qu'en  pensent  les  Quebecoises? 
(the  end  of  the  revenge  of  the  cradle: 
what  do  the  women  of  Quebec  think 
about  il?).  Montreal.  University  of 
Montreal  Press,  1974. 

International  Development  Research 
Centre.  Internal  documents.  (Unpub- 
lished), si 


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1473  Pages/Profusely  Illustrated    $21.!l 

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'     TEXTBOOK  OF  MEDICAL  —  SURGICAL  NURSING 

\illian  S.  Brunner,  R.N.,  M.S.;  Doris  S.  Suddarth, 
;.N.,B.S.N.E.,  M.S.N. 

')utstanding  in  its  depth  of  scientific  content  and  in  the  practi- 
ality  of  its  application,  this  leading  text  has  been  heavily 
i3vised  and  updated,  with  much  new  material.  In  the  unit, 
assessment  of  the  Patient,  three  new  chapters  have  been 
dded:  Clinical  Interviewing  of  Patients;  Physical  Examination 
y  the  Nurse;  and  Guidelines  for  Writing  Problem-Oriented 
ecords  to  promote  continuity  of  patient  care.  Other  new 
hapters  include  Care  of  the  Cardiovascular  Surgical  Patient, 
nd  The  Person  Experiencing  Pain.  Nursing  management  in 
.arious  clinical  situations  is  frequently  outlined  in  tabular 
>rm. 


lustrated,  3rd  Edition,  1975 


$19.7f 


JEW 

CARE  OF  THE  ADULT  PATIENT 
Medical-Surgical  Nursing 

orothy  W.  Smith,  R.N.,  Ed.D.;  Carol  P.  Hanley 
ermain,  R.N.,  M.S. 

I  superbly  useful  tool  for  nursing  education  and  practice,  this 
ell  established  text  has  been  massively  revised,  updated 
id  expanded,  and  provides  an  authoritative  basis  for  under- 
anding  the  patient's  therapeutic  regimen,  including  surgerj.', 
jugs,  nursing  intervention  and  rehabilitation.  The  nursing 
ocess  is  stressed  and  pathophysiologic  content  has  been 
i<panded.  Each  chapter  emphasizes  assessment  of  the  physi- 
j|,  emotional  and  social  needs  of  the  patient  and  his  famiiy. 
3w  chapters  include  The  Nursing  Process,  Nursing  Assess- 
ent,  and  The  Development  Process, 
ustrated,  4th  Edition,  June  1975     Paper  $15.50,  Cloth  $19.75 


4    A  GUIDE  TO  PHYSICAL  EXAMINATION 

arbara  Bates,  M.D. 

n  expertly  illustrated,  "how-to"  text  that  bridges  the  gap 

•itween  anatomy  and  physiology  and  their  application  to  the 

lysical  examination.  Within  each  region  or  system  thrfte 

ipics  are  presented:  1)  anatomy  and  physic'ogy  basic  to  the 

<;amination,  2)  examination  techniques,  3)  examples  of  seiec- 

1d  abnormalities. 

■'5  Pages  Illustrated,  1974  $18.T5 


NEW 

5   INTRODUCTORY  CLINICAL  PHARMACOLOGY 

Jeanne  C.  Scherer,  R.N.,  M.S. 

Drug  therapy  is  one  of  the  most  important  treatment  modali 
ties  in  modern  health  care.  Because  of  its  importance  an( 
complexity,  and  the  ever-increasing  new  knowledge  in  th( 
field,  it  is  imperative  that  all  health  professionals  develop  i 
system  of  study  to  help  them  cope  with  drug  information 
This  book  is  designed  to  aid  the  student  and  practitioner  ii 
that  study. 

367  Pages,  1975  $8.7! 


NEW 

>      CONTEMPORARY  COMMUNITY  HEALTH  NURSING 

crirbara  Walton  Spradley,  R.N.,  M.N. 

I  his  is  an  exhaustive  and  comprehensive  collection  of  mor( 
than  fifty  readings  chosen  for  their  impact  on  today's  com 
munity  health  nursing  and  as  a  means  of  illustrating  (anc 
teoching)  its  rapid  expansion  into  related  fields.  Here  is  th< 
pfjrfect  means  of  preparing  students  for  the  practical  realitie; 
of  tfiis  increasingly  complex  and  vital  area  of  modern  nursing 
Little.  Brown  467  Pages,  1975  Paper  $9.9! 


NEW 

7      ML'Rf.iNG  RESEARCH 

Voiurne  1 
Phyllis  J.  Verhonick,  R.N.,  Ed.D. 

Thi.s  is  the  first  volume  in  a  unique  series  covering  all  aspect; 
of  nursing  research  —  from  the  purely  theoretical  to  the  ver^ 
pr=i::tical  This  volume  consists  of  two  separate  parts:  the 
development  and  use  of  conceptual  frameworks  and  the  prac 
lical  applications  of  behavioral  science  to  specific  nursinc 
questions. 
Little,  Brown  250  pages,  1975  $12.5( 


EW 

I    PHYSICAL  AND  APPRAISAL  METHODS  IN 
NURSING  PRACTICE 

isephine  M.  Sana,  R.N.,  and  Richard  D.  Judge,  M.D. 
Ighteen  contributing  authors,  all  experts  in  their  fields,  have 
vltten  a  comprehensive  survey  on  all  aspects  ot  physical 
tamination  and  appraisal.  Each  of  the  body  systems  i.s  ex- 
thsively  covered  with  step-by-step  instructions  on  procedures 
f'  conducting  examinations.  There  is  also  a  unique  section 
c  age-group  considerations  in  physical  appraisal, 
^tle.  Brown  402  Pages  Paper  $9.50  Cloth  $14.50 

listrated,  1975 


NEW 

Q     MANUAL  OF  NURSING  PROCEDURES 

Nursing  Dept. 
Massachuse'.is  General  Hospital 

Adapted  and  modified  from  the  manual  used  by  the  Nursinc 
Service  at  N/assachusetts  General  Hospital,  this  invaluable 
guide  presencs  those  practices  that  have  proved  most  effec 
tive  and  eff'oient  in  the  day-to-day  world  of  nursing,  and 
serves  as  both  an  excellent  teaching  tool  and  an  indispens- 
ab'a  reference. 
Little,  Brown 
339  pages.  Illustrated,  1975  spiral  bound  $8.9£ 


^ 


Where  there  are  colonies  of  roosting 
winged  creatures  —  whether  domestic 
hens  or  pigeons,  bats  or  starhngs  —  there 
is  also  the  hazard  to  humans  of  contracting 
histoplasmosis,  a  potentially  dangerous 
disease.  An  outbreak  of  histoplasmosis 
in  Montreal  in  1963  prompted  an 
epidemiological  survey,  which  pointed  up 
certain  districts  within  the  city  as  possible 
sources  of  the  disease.'  Such  outbreaks 
may  occur  again. 

Histoplasmosis  is  caused  by  the  dimor- 
phic fungus,  Histoplasma  capsulatum, 
which  grows  within  cells  of  the  re- 
ticuloendothehal  system  in  the  form  of 
budding,  oval  yeast  cells  2  to  4  microns  in 
size.  Usually  respiratory  in  origin,  it  may 
disseminate  throughout  the  body  to  in- 


Dr.  Davies,  M.B.,  B.S.,  D.P.H.,  M.Sc,  is 
the  director  and  Dr.  Jeassamine,  M.B., 
Ch.B.,  is  medical  officer  of  ihe  Bureau  of 
Epidemiology,  Laboratory  Centre  for  Dis- 
ease Control,  Health  Protection  Branch, 
Health  and  Welfare  Canada,  Ottawa. 

38 


Histoplasmosis 


Histoplasmosis,  a  fungal  disease,  is  not  contagious  among  humans  but  is  recogj 
nized  as  a  hazard  to  man  wherever  there  has  been  fecal  contamination  of  soil  b 
roosting  birds  or  bats. 

J.W.  Davies  and  G.  Jessamine 


volve  reticuloendothehal  cells  in  the  lung, 
spleen,  liver,  adrenals,  kidney,  skin,  et 
cetera.  Histoplasma  duboisii,  isolated  in 
tropical  Africa,  causes  a  clinically  differ- 
ent mycosis,  but  is  morphologically  indis- 
tinguishable on  culture  medium  from 
H.  capsulatum. 

Epidemiology 

Infection  with  this  organism  is  common 
in  focal  geographic  areas  of  the  Americas, 
Europe,  Africa,  and  the  Far  East,  but  the 
clinical  disease  is  far  less  frequent  and 
severe  progressive  disease  quite  rare.  In 
some  parts  of  the  central  and  eastern  Un- 
ited States,  histoplasmin  hypersensitivity 
may  occur  in  up  to  80  percent  of  the  popu- 
lation, but  prevalence  can  vary  widely 
within  geographic  areas  a  few  miles  apart . 

To  some  extent  histoplasmosis  is  a  dis- 
ease of  rural  occupations  related  to  expos- 
ure to  Histoplasma,  which  grows  in  soil 
enriched  by  fecal  material  of  chickens, 
birds,  and  bats.  Important  urban  sources  of 
exposure  have  also  been  revealed,  espe- 
cially soil  under  trees  used  by  starlings  as 
roosting  shelters. 


Susceptibility  of  the  population  is  gen 
eral,  and  inapparent  infections  are  ex 
tremely  common  in  endemic  areas.  The 
frequency  of  positive  skin  reactors  is  equali 
in  the  two  sexes  and  increases  with  agci 
from  childhood  to  adulthood.  \ 

In  Canada,  the  disease  occurs  as  an  ex- 
tension of  the  endemic  focus  in  the  central 
and  eastern  United  States  and  has  been 
recognized  in  eastern  Ontario  and  along 
the  lower  St.  Lawrence  in  Quebec 
Province.^  Outbreaks  may  occur  in 
families  or  groups  of  workmen  with  com- 
mon exposure  to  bat  or  bird  droppings,  as 
when  tearing  down  old  chicken  coops. 
Epidemic  histoplasmosis  has  been  recog- 
nized in  the  city  of  Montreal ,  the  resuh  of  a 
focal  area  of  contaminated  soil.  ^  In  en- 
demic areas,  histoplasmosis  occurs  fre- 
quently in  dogs,  cats,  foxes,  skunks,  and 
other  animals. 

Infectious  agent 

Histoplasma  capsulatum  grows  as  a 
mold  in  soil  and  as  a  yeast  form  in  animal 
and  human  hosts.  The  yeast  form  is  non in- 
fective, so  that  transmission  cannot  occur 


I  directly  from  man  to  man.  Infection  usu- 
ially   occurs   by    inhalation    of  airborne 
spores  in  dust.  Common  reservoirs  are  the 
soil  around  old  chicken  coops,  starling 
roosts  and  bat  caves,   or  areas  around 
houses  or  bams  sheltering  the  common 
,  brown  bat.  The  incubation  period  of  histo- 
■  plasmosis  in  reported  epidemics  is  com- 
monly less  than  2  weeks,  usually  about  10 
days. 

Clinical  forms 

The  following  clinical  types  are  recog- 
nized: 

Asymptomatic:  This  form  is  usually  de- 
tected by  histoplasmin  skin  testing.  Cal- 
cification of  the  primary  lung  lesion  may 
be  seen  on  x-ray. 

Acute  benign:  Cases  may  occur  quite 
commonly  in  endemic  areas  but  are  easily 
overlooked.  Illness  may  vary  from  mild 
respiratory  illness  to  a  more  severe  infec- 
tion with  fever,  chest  pains,  and  a  dry, 
productive  cough.  Erythema  multiforme 
may  occur.  Recovery  is  usually  spontane- 
ous ,  and  multiple  small  scattered  calcifica- 
tions may  be  noted  later  in  the  lung  and 
hilar  lymph  nodes. 

Acute  disseminated:  This  type  is  most 
frequently  seen  in  infants  and  young  chil- 
dren and  often  resembles  miliary  tuber- 
culosis. The  organism  becomes  widely 
disseminated  in  the  reticuloendothehal 
\\stem,  and  there  are  varying  degrees  of 
,  hepatosplenomegaly  with  a  septic-type 
'fever  and  a  rapidly  progressing  course. 
Without  therapy,  it  is  usually  fatal. 

Chronic  disseminated:  The  disease  usu- 
ally follows  a  subacute  course  and  is  found 
more  commonly  in  the  adult  male.  Symp- 
toms vary,  depending  on  the  organs  in- 
fected. There  may  be  an  unexplained 
fever,  anemia,  leukopenia,  endocarditis, 
weight  loss,  or  meningitis.  Hepato- 
splenomegaly and  generalized  lymph- 
adenopathy  characterize  the  illness.  In- 

Ti-E  CANADIAN  NURSE  —  August  1975 


testinal  lesions  may  predominate  in  some 
cases,  suggesting  that  the  primary  lesion 
may  have  been  in  the  intestinal  lymphatics 
and  that  infection  followed  ingestion, 
rather  than  inhalation,  of  histoplasma 
spores. 

Chronic  pulmonary:  Clinically  and 
radiologically,  this  form  resembles 
chronic  pulmonary  tuberculosis.  The  dis- 
ease is  most  commonly  found  in  adult 
males  and  may  progress  over  months,  or 
years,  with  periods  of  quiescence  and 
sometimes  spontaneous  cure. 

Differential  diagnosis 

The  disease  may  bear  a  remarkable 
similarity  to  tuberculosis.  The  primary 
acute  disease  may  closely  resemble  other 
systemic  mycoses,  viral  pneumonia,  sar- 
coidosis, and  so  on.  The  hepato- 
splenomegaly. anemia,  leukopenia,  and 
lymphadenopathy  may  strikingly  mimic 
leukemia  or  Hodgkin's  disease. 

Final  diagnosis  rests  upon  demonstra- 
tion of  the  fungus  in  cultures  of  sputum, 
body  fluids,  or  tissue  biopsies  on  modified 
Sabouraud's  agar  or  enriched  media.  If 
cultures  cannot  be  obtained,  diagnosis 
must  rest  on  the  presence  of  fungi  of 
characteristic  size  and  appearance  in  prop- 
erly prepared  and  stained  smears  or  sec- 
tions of  tissue. 

Several  serologic  tests  for  the  detection 
of  histoplasma  antibody  are  available,  e.g., 
complement  fixation  tests.  However,  both 
false  positive  and  false  negative  serologic 
reactions  may  occur.  Demonstration  of  ris- 
ing antibody  titers  is  strong  evidence  of 
active  disease.  The  intradermal  histoplas- 
min test  for  hypersensitivity  when  positive 
denotes  either  remote  or  recent  exposure  to 
histoplasma,  but  may  be  negative  in  late 
disseminated  disease. 

The  following  case  histories  illustrate 
some  of  the  clinical  types  and  diagnostic 
problems  that  are  not  uncommon. 


Case  I 

In  the  summer  of  1 973,  a  team  of  students 
and  instructors  from  Canadian  universities 
carried  out  an  "ecological"  survey  of 
caves  in  Puerto  Rico  that  were  inhabited 
by  large  colonies  of  bats.  Shortly  after 
their  return,  one  of  the  members,  a 
30-year-old  female  biologist  (S.R.),  de- 
veloped fever  to  39°  C,  headaches,  chest 
pains,  and  general  lassitude. 

A  chest  x-ray  one  month  after  onset  of 
symptoms  revealed  soft  nodular  densities 
in  the  periphery  of  the  left  mid-zone,  the 
left  base,  and  the  right  costophrenic  angle. 
The  histoplasmin  skin  test  reaction  was 
6  mm  in  diameter,  the  complement  fixation 
test  positive  in  a  1:32  dilution,  and  culture 
of  sputum  yielded  a  growth  of  H.  cap- 
sulatum.  No  complications  develop)ed, 
and  recovery  occurred  without  specific 
treatment. 

Case  2 

A  34-year-old  male  (D.J.)  was  admitted  to 
hospital  9  October  1974  for  investigation 
of  an  abnormal  chest  x-ray.  A  month  pre- 
viously, he  had  developed  an  infiuenza- 
like  illness  with  fever  to  40°  C,  chills, 
sweats,  headache,  and  productive  cough 
with  bloodstained  white  sputum.  The 
headache  became  worse  and  was  as- 
sociated with  photophobia,  forgetfulness, 
and  some  loss  of  balance.  Chest  x-ray 
showed  diffuse  infiltration  in  both  lung 
fields  with  hilar  lymphadenopathy. 

Four  weeks  after  the  onset  of  illness, 
D.J.  continued  to  have  mild  dyspnea  on 
moderate  exertion,  perspired  easily,  and 
had  lost  10  kilograms  in  weight.  His  chest 
x-ray  remained  unchanged. 

The  patient  owned  a  small  construction 
firm,  doing  work  mainly  on  farms.  About 
10  weeks  before  illness  began,  he  pulled 
down  a  hen  house  and  excavated  the  site. 
He  had  also  helped  his  father  pile  hay  in  a 
bam  2  weeks  before  admission  to  hospital. 


Special  investigations  revealed  normal 
S.M.A.  18:  normal  Hb.,  w.b.c  and  differ- 
ential; but  E.S.R.  had  increased  to  34. 
Sputum  specimens  were  negative  for 
tubercle  bacilli  and  malignant  cells.  Skin 
tests  were  negative  to  5  TU  Mantoux,  but 
histoplasmin  testing  was  positive.  The  his- 
toplasmosis complement  fixation  test  (be- 
fore skin  testing)  on  2  subsequent  occa- 
sions was  positive  at  a  titer  of  1:128. 

Open  lung  biopsy  was  performed,  and 
the  gross  lung  specimen  revealed  small 
nodules  that,  on  microscopy,  showed 
caseating  granulomas  with  typical  Histo- 
plasma  cells  on  methenamine  silver  prep- 
aration. Later,  a  sputum  culture  grew 
H.  capsiilutum.  Atelectasis  of  the  left  lower 
lobe  developed  following  biopsy  but 
cleared  up  gradually.  In  view  of  the  mini- 
mal symptoms,  no  specific  treatment  for 
histoplasmosis  was  given. 

Case  3 

A. P.  was  a  20-year-old  asymptomatic 
female  first  seen  in  July  1971  for  a  routine 
employment  chest  film.  Enlargement  of 
the  left  hilum  was  suspected,  but  the 
tuberculin  skin  test  was  negative. 

In  August,  a  Histoplasmin  skin  test  was 
positive  with  a  25mm  reaction.  A  com- 
plement fixation  test  revealed  a  rising  titer 
(27  August,  1:16  dils.  —  December,  1:64 
dils.).  Between  July  1971  and  June  1973. 
a  slow,  gradual  shrinkage  of  the  left  hilar 
and  perihilar  densities  occurred  without 
evidence  of  calcification  on  x-ray.  At  no 
time  could  fungus  be  cultured  from 
sputum. 

Case  4 

L.D.  was  a  40-year-old  male  who  com- 
plained of  a  "cold""  of4  months"  duration, 
which  had  been  treated  with  broad  spec- 
trum antibiotics.  A  chest  x-ray  revealed 
findings  consistent  with  bilateral  upper- 
zone  cavitary  tuberculosis.  The  tuberculin 
test  was  positive,  but  repeated  samples  of 
sputum  were  negative  for  acid-fast  bacilli. 
However,  H.  capsulatum  was  recovered 
from  sputum  by  culture.  Histoplasmin 
skin  test  was  positive  (10  mm),  yet  the 
complement  fixation  test  was  negative 
(1:8  dils.). 

No  treatment  was  given,  apart  from 
supportive  therapy  and  isonicotinic  acid 

40 


hydrazide  (INH)  300  mg  daily,  in  view  of 
the  positive  tuberculin  test  and  a  history  of 
contact  with  tuberculosis  (his  wife  having 
been  a  sanatorium  patient).  The  radiologi- 
cal appearances  gradually  improved,  and 
by  April  1973,  no  evidence  of  cavitation 
remained,  merely  bilateral  upper-zone 
linear  fibrotic  elements. 

Prognosis  and  therapy 

Prognosis  is  good  for  primary  pulmo- 
nary histoplasmosis  and  poor  in  untreated 
generalized  infection.  Bed  rest  and  sup- 
portive care  are  indicated  for  the  primary 
form,  and  normal  activities  should  not  be 
resumed  until  fever  has  subsided. 

Amphotericin  B  is  the  drug  of  choice 
and  has  proved  useful  for  some  patients 
with  progressive  and  disseminated  histo- 
plasmosis, but  side  effects  require  that  it 
be  used  with  caution.  In  chronic  progres- 
sive histoplasmosis,  its  use  may  be  as- 
sociated with  resolution  of  lesions  and 
clinical  improvement,  but  organisms  may 
persist  in  areas  of  cavitation  or  caseation. 

Confrol 

In  endemic  areas,  resistance  to  the  dis- 
ease is  acquired  by  most  persons  due  to 
repeated  small  exposures.  Prevention  of 
exposure  under  such  circumstances  may 
be  difficult,  if  not  impossible. 

Farmers  or  others  who  may  wish  to  tear 
down  old  chicken  coops  will  minimize  ex- 
posure by  spraying  the  chicken  coop  and 
surrounding  soil  with  water  or  a  disinfec- 
tant (3*^  formalin)  to  reduce  dusts.  Masks 
should  be  worn.  In  urban  areas,  fecally 
contaminated  soil  due  to  starling  roosts 
may  be  disinfected  with  a  formalin  solu- 
tion. 

The  occurrence  of  grouped  cases  of 
acute  pulmonary  disease,  particularly  with 
a  history  of  exposure  to  dust  within  a 
closed  space,  should  arouse  suspicion  of 
histoplasmosis. 

Suspected  sites,  such  as  chicken  coops, 
barns,  silos,  caves,  or  starling  roosts, 
should  be  carefully  investigated  and  de- 
contaminated if  necessary  so  as  to  avoid 
future  exposure.  The  occupational  hazard 
in  the  case  of  biologists,  or  others  exposed 
to  infection  in  ba'.-infected  caves,  has  been 
well  documented  and  should  be  borne  in 
mind."* 


References 

1 .  Lesnoff,  Arthur  el  al.  The  focal  disiributio 
of  hisloplasmosis  in  Montreal.  Canad.  J 
Piih.  Health  60:8:321-5,  Aug.  1969. 

2.  Jessamine.  A.G.  et  al.  Hisloplasmosis  i 
Eastern  Ontario.  Canad.  J.  Pub.  Healt, 
57:1:18.  Jan.  1966. 

3.  MacEachem,  Elizabeth  J.  and  McDonald.  J.C 
Histoplasmin  sensitivity  in  McGill  Uni 
versily  sludenls.  Canad.  J.  Pub.  Healti 
62:5:415,  Sep. /Oct.  1971. 

4.  Handzel.  S.  and  Jessamine,  A.G.  "Im 
ported""  hisloplasmosis  from  Puerto  Rico 
Canad.  J.  Pub.  Health.,  in  Press. 


BUNION 
SURGERY 


Appropriate  client  teaching 
can  shorten  the  convalescent 
and  rehabilitation  period 
which  follows  surgical 
correction  of  hallux  valgus. 


SUSANNE  ROBB 


"What  are  bunions?"  "Oh!  I  have 
those."  "Wasn't  surgery  painful?"  "You 
walk  very  well,  but  where  are  your  nursi:"^ 
shoes  and  stockings?"  These  responses 
from  friends  and  acquaintances  whenever 
i  mentioned  my  recent  bunionectomies 
prompted  me  to  gather  information  about 
bunions  and  corrective  surgery  that  might 
help  nurses  in  counseling  clients. 

Bunions  are  more  a  woman's  problem 
than  a  man's.  In  fact,  the  ratio  of  female  to 
male  incidence  of  hallux  valgus  is  40  to  1.' 
The  tips  of  most  women's  shoes  press  on 
the  top  of  the  second  toe  and  leave  little 
room  for  the  great  and  small  toes.  Nylon 
elastic  stockings  may  increase  the  con- 
striction. 

Congenital  and  hereditary  etiological 
factors  have  been  cited  in  the  development 

Susanne  Robb(B.S.N..  Case  Western  Reserve 
1-  niversity.  Cleveland,  Oh.;  M.  Ed.,  Duquesne 
I  niversity,  Pittsburgh,  Pa.)  is  an  assistant  pro- 
lessor  of  nursing  at  the  University  of  South 
Alabama,  Mobile.  Her  own  experiences  after 
liiiateral  Keller's  arthroplasties  stimulated  her 
r.ieresi  in  the  care  of  people  with  bunions. 

CANADIAN  NURSE  —  August  1975 


of  hallux  valgus  and  bunions.  Congenital 
hallux  valgus  conditions  tend  to  correct 
spontaneously  within  24  hours  after  birth. 
Hereditary  factors,  however,  may  be  more 
significant.  Detailed  histories  reveal 
familial  similarities  in  the  type  of  defor- 
mity and  unilateral  or  bilateral  occurrence. 

When  the  above  anomalies  occur  and  the 
forefoot  is  squeezed  into  a  narrow  shoe, 
the  result  is  a  lateral  deviation  of  the  great 
toe  (hallux  valgus)  and  a  prominence  of 
the  adjoining  metatarsal  head.  Continued 
pressure  at  the  metatarsophalangeal  joint 
causes  inflammation,  which  in  turn  trig- 
gers the  formation  of  exostosis  (bunion) 
beneath  the  bursa  and  joint  capsule. 

Bunions  are  ugly ,  but  the  persistent  pain 
of  the  recurrent  bursitis  is  the  major  cause 
of  complaints.  About  one-third  of  per- 
sons affected  complain  of  metatarsalgia. 
Often  he  or  she  can  no  longer  wear  regular 
shoes.  Activity  is  restricted  and  function 
of  the  great  toe  is  impaired.  Osteoarthritis 
of  the  metatarsophalangeal  joint  is  com- 
mon. This  may  become  severe  and  lead  to 
greatly  restricted  motion,  or  hallux 
rigidus. 

Great  toe  cosmesis  alone  is  an  unac- 


ceptable rationale  for  surgery.  However, 
joint  pain,  increasing  deformity,  and  di- 
minished push-off  action  of  the  great  toe 
do  justify  surgical  intervention  to  correct 
the  valgus  position  of  the  great  toe,  de- 
crease the  prominence  of  the  metatarsal 
head,  and  correct  the  deforming  pull  of  the 
muscles.  Several  procedures  can  be  used 
to  accomplish  these  goals.  Selection  of  a 
specific  technique  is  influenced  by  degree 
of  deformity,  presence  of  osteoarthritis, 
circulatory  efficiency,  and  the  client's 
needs. 

A  person  in  his  teens  or  early  twenties 
usually  requires  a  metatarsal  osteotomy  to 
correct  metatarsus  primus  varus.  People 
aged  20  to  40,  whose  metatarsophalangeal 
joints  are  still  in  good  condition,  may  have 
a  McBride  procedure.  This  corrects  hallux 
valgus  without  altering  the  joint  to  any 
great  extent.' 

Keller's  arthroplasty  is  often  done  for 
middle-aged  women  with  painful  bunions, 
pronounced  deformity,  and  osteoarthritis. 
The  joint  must  be  remodeled  to  prevent 
pain  and  stiffness.  This  technique  involves 
removal  of  the  exostosis  from  the  metatar- 
sal head  and  resection  of  the  proximal  third 


McBride's  operation:  Exostosis  (A)  and 
lateral  sesamoid  bone  (B)  are  excised. 


Then  the  adductor  tendon  is  fixed 
to  the  metatarsal  neck  (C). 


Mitchell's  operation  (metatarsal 
osteotomy):  Exostosis  is  removed: 
two  holes  are  drilled  in  metatarsal. 


A  complete  osteotomy  is  done  prox- 
Imally  (A);  a  partial  one  distally  (B). 
Suture  is  threaded  through  holes. 


The  metatarsal  head  is  moved 
laterally  and  then  sutured  to  the 
shaft  with  heavy  suture. 


of  the  phalanx  of  the  great  toe.  The  posi- 
tion of  the  toe  is  immediately  corrected.  A 
pseudoarthrodesis  subsequently  forms. 
The  great  toe  shortens  as  healing 
progresses.^ 

Recently,  silicone  rubber  implants  have 
been  used  to  improve  the  results  of 
Keller's  procedure.  The  implant  reduces 
the  hazards  of  narrowed  joint  space,  ex- 
cessive shortening  of  the  great  toe.  and 
increased  pressure  on  the  second  toe. 
Without  the  implant  replacement,  exces- 
sive bone  removal  would  cause  instability 
of  the  great  toe  and  loss  of  power  in  the 
take-off  phase  of  gait.  Implants  are  most 
beneficial  to  younger  persons  with  ad- 
vanced degenerative  changes  in  the 
metatarsophalangeal  joint.' 

Regardless  of  the  surgery  planned, 
preoperative  preparation  is  similar.  To  re- 
duce surface  bacteria,  many  surgeons  ask 
the  person  to  scrub  his  foot  with  a  hexach- 
lorophene  preparation.  This  scrub  may  be 
done  once  or  twice  daily  for  as  many  as 
seven  days  before  surgery.  Some  clients 
are  asked  to  scrub  only  the  night  before 
and  day  of  surgery.  The  foot  should  be 
shaved  to  the  ankle  and  may  be  wrapped  in 


a  sterile  boot  or  towel  after  the  final  scrub. 
Clients  should  be  told  preoperatively 
what  will  be  expected  of  them  postopera- 
tively, particularly  in  terms  of  early  ambu- 
lation and  flexion-extension  exercises.  If 
crutches  will  be  used,  a  practice  session 
with  emphasis  on  proper  technique  may 
spare  the  client  the  frustration  of  learning 
something  new  when  coping  with  postsur- 
gical discomfort  and  limited  mobility. 

Postoperative  Considerations 

The  composition  of  the  surgical  dres- 
sing varies  widely.  When  an  implant  is 
inserted,  a  small  drain  may  be  used  post- 
operatively. This  is  usually  removed  dur- 
ing the  first  dressing  change.  A  tongue 
blade  may  be  placed  in  the  medial  aspect 
of  the  pressure  dressing  to  splint  the  great 
toe  in  correct  position.  Three  to  five  days 
after  surgery,  the  initial  dressing  is 
changed  and  a  dynamic  splint  is  applied  to 
permit  exercise.  The  splint  is  kept  on  for 
three  weeks  and  then  worn  as  a  night  splint 
for  one  month.  A  "bunion  pad'"  (a  four- 
by-four  gauze  pad,  folded  longitudinally 
and  laid  along  the  incision)  and  a  "toe 
pad"  (a  four-by-four  pad  folded  in  half. 


then  lengthwise  into  fourths,  and  taped  iij 
the  "V"  between  the  great  and  first  toes; 
provide  an  alternative  to  the  dynaniii 
splint.  Paper  tape  is  preferable  to  adhesivt 
for  holding  the  toe  pad  in  place  because  i 
adheres  to  skin,  is  less  traumatic  wher 
removed,  and  doesn't  leave  a  sticky  res 
idue.  These  pads  are  enclosed  in  an  elas 
tic  gauze  pressure  dressing.  .After  the  tlrs 
change,  the  dressing  is  changed  evers 
other  day  or  more  frequently  if  it  becomes 
wet  or  soiled. 

Once  the  incision  closes,  all  dressings 
except  for  the  toe  pad  may  be  discon 
tinued.  Once  the  incision  has  closed. the 
client  should  not  worry  about  getting  i 
area  wet.  Moisture  will  help  dissolve  il-. 
remaining  sutures.  The  toe  pad  is  wurr 
until  edema  has  subsided.  This  may  take 
six  weeks  to  eight  months. 

If  cost  is  a  factor,  folded  tissues  may  he 
substituted  for  gauze  toe  pads,  although 
tissue  pads  are  less  durable  in  the  presence 
of  perspiration  and  joint  motion. 

Some  techniques,  such  as  a  metatarsal 
osteotomy  or  McBride  procedure,  require 
the  use  of  a  plaster  boot  or  forefoot  slipper 
to  immobilize  the  foot  and  maintain  the 


great  toe  in  plantar  flexion.  With  a  cast. 

I  ambulation  can  be  initiated  any  time  be- 

I  tween48  hours  to  two  weeks  after  surgery. 

.Ambulation  may  be  restricted  to  heel 

walking. 

Patients  without  casts  begin  walking  as 
^soon  as  comfort  permits.  Crutches  are  op- 
tional,  but    may   ease   discomfort   from 
weightbearing. 

Persons  having  bunion  surgery  come 
from  all  kinds  of  life  situations  and  have 
many  reasons  for  undergoing  surgery,  as 
well  as  varied  expectations  for  results .  The 
discussion  of  postoperative  care  presented 
here  assumes  that  the  client  is  highly  moti- 
vated to  achieve  full  return  of  joint  func- 
iion  and  is  free  of  biases  related  to  the 
overwhelming  nature  of  postoperative 
discomfort,  the  adverse  effects  of  aging, 
the  burdens  of  other  illnesses,  and  so  on. 
Client  counseling  is  based  on  indi- 
vidualized assessment  coupled  with  vali- 
dation between  client  and  counselor  as  to 
expected  outcomes  of  surgery .  The  pace  of 
recovery  will  vary  greatly  from  one  client 
to  another. 

Most  clients  experience  intense  throb- 
bing pain  in  the  operative  site  and  may 


require  potent  analgesics  during  the  first 
48  to  72  hours  postoperatively.  Morphine 
provides  more  effective  analgesia  than 
Demerol  for  this  joint  pain.  Prompt  ad- 
ministration of  analgesics  after  bunion 
surgery  is  a  most  effective  nursing  inter- 
vention. Elevating  the  feet  above  heart 
level  when  in  bed  or  as  high  as  possible 
when  seated  decreases  some  edema- 
related  discomfort.  Clients  should  be 
warned  that  the  rush  of  blood  to  the  feet 
before  walking  temporarily  increases  dis- 
comfort. Analgesics  may  be  administered 
15  to  20  minutes  before  walking  if  meas- 
ures are  taken  to  ensure  client  safety. 
However,  not  all  people  have  persistent 
discomfort,  and  care  should  be  taken  to 
assess  the  client's  condition  without  com- 
municating an  expectation  of  severe  pain. 
Impaired  circulation  of  the  great  toe  is  a 
possible  complication  during  the  first  48 
hours  after  surgery.  If  a  dressing  is  used, 
the  tip  of  the  toe  ordinarily  is  left  exposed. 
Warmth,  color,  absence  of  numbness  and 
tingling,  and  the  ability  to  move  the  toe 
indicate  adequate  circulation.  When  a  cast 
has  been  applied,  checking  the  circulation 
is  more  difficult  because  direct  visualiza- 


tion isn't  possible.  The  client  should  be 
asked  about  perceptions  of  numbness  or 
tingling  and  warmth.  He  should  be  en- 
couraged to  move  his  toe  within  the  cast  at 
least  every  hour  for  the  first  24  hours. 
Complaints  of  increasing  discomfort  may 
be  a  clue  to  circulatory  impairment. 

Exercises 

The  attainment  of  sufficient  plantar 
flexion  of  all  toes  is  necessary  to  reshape 
the  anterior  arch  of  the  foot  and  create  the 
smooth  arthroplasty  that  is  essential  for 
joint  mobility.  Failure  to  exercise  in- 
creases the  likelihood  of  persistent 
metatarsalgia  and  fixation  of  the  great  toe 
in  dorsiflexion.  Active  and  passive 
flexion-extension  exercises  of  the  great  toe 
are  started  immediately  if  soft  dressings 
are  used,  and  within  3  to  14  days  if  a  cast  is 
applied.  The  client  is  instructed  to  place 
his  ankle  in  a  neutral  position  (the  same 
position  as  standing)  and  flex  the  great  toe. 
The  toe  is  then  extended  dorsally  to  the 
limit  of  tolerance.  Of  the  two  motions, 
flexion  is  more  important,  as  it  is  essential 
for  adequate  power  in  the  take-off  stage  of 
gait.  These  exercises  should  be  repeated 


shortened 
tendon 


Keller's  arthroplasty:  Exostosis  (A) 
IS  removed  and  proximal  third 
of  phalanx  (B)  is  resected. 


Great  toe  is  straightened:  a 
pseudoarthrodesis  forms.  Toe  is 
shortened  as  it  heals 


A  silicone  implant  (C)  may  be  placed 
in  the  intramedullary  canal  to  reduce 
hazards  of  narrowed  joint  space. 


THE  CANADIAN  NURSE  —  August  1975 


every  time  stiffness  and  edema  threaten  to 
decrease  the  range  of  motion  attained  dur- 
ing the  exercise  session  —  as  frequently  as 
5  to  10  times  an  hour  when  awake. 

As  soon  as  the  person  is  walking,  the 
exercises  should  be  done  in  a  standing 
position.  The  great  toe  is  tightened  against 
the  floor.  Soon  the  unaffected  toes  will 
tighten  to  the  point  of  discomfort  while  the 
great  toe  remains  insufficiently  flexed.  At 
this  point ,  the  person  is  instructed  to  do  the 
exercises  with  the  metatarsophalangeal 
joint  supported  on  the  edge  of  a  step  or 
doorsiil.  The  great  toe  should  be  actively 
flexed  downward  through  space.  This  po- 
sition allows  ample  room  for  all  toes  to  flex 
fully  while  eliminating  pressure  on  the 
four  unoperated  toes.  Exercises  are  more 
effective  if  they  are  done  when  edema  is 
minimal  —  on  arising  in  the  morning  or 
after  resting  with  feet  elevated.  The  client 
may  need  to  put  the  joint  through  range  of 
motion  passively  until  the  muscles  become 
strong  enough  for  active  exercise. 

Edema  is  a  major  problem  in  post- 
operative management.  Exercise  and  re- 
sumption of  normal  activities  are  desir- 
able, yet  edema  increa.ses  with  the  effect  of 
gravity.  The  client  needs  to  balance  "up"" 
and  "down""  time  by  staying  up  until  joint 
redness  and  throbbing  become  constant, 
and  then  elevating  his  feet  above  heart 
level  until  these  symptoms  subside. 

An  important  teaching  point,  especially 
for  older  clients  who  may  favor  warm 
water  or  Epsom  salt  soaks,  is  that  foot 
soaking  will  not  alleviate  joint  pain.  Grav- 
ity is  the  major  cause  of  edema  and  eleva- 
tion works  best  to  relieve  discomfort. 

Edema  and  the  cast  or  dressing  make  the 
wearing  of  normal  shoes  impossible.  Cast 
boots  provide  suitable  protection  for  am- 
bulatory clients.  Ordinary  shoes  may  be 
worn  whenever  they  are  comfortable  and 
do  not  recreate  the  pressures  which  contri- 
buted to  the  development  of  the  deformity. 
Open-toed  sandals  or  tennis  shoes  with 
wide  forefeet  are  good  transition  shoes. 
Eventually,  the  foot  will  be  narrower  with 
the  bunion  gone,  and  shorter,  if  a  Keller 
procedure  was  performed.  If  the  varus  de- 
formity starts  to  recur,  the  client  should 
again  wear  the  toe  pad  to  move  the  toe 
back  into  normal  alignment. 

During  the  three  to  four  weeks  interval 


between  discharge  from  the  hospital, 
which  may  be  as  soon  as  Ave  days  after 
surgery,  and  the  first  visit  to  the  surgeon, 
several  events  are  apt  to  occur  that  may 
alarm  the  client  unless  he  is  forewarned  of 
them. 

Numbness  of  the  joint  may  result  from 
edema  and  surgical  disruption  of  small 
sensory  nerves.  This  is  transient  and  will 
diminish.  With  Keller's  procedure,  some 
■■floppiness""  of  the  great  toe  continues 
indeflnitely,  but  should  not  impair  mobil- 
ity. The  toe  will  return  to  the  preoperative 
varus  position  if  stockings  are  worn  before 
the  joint  stabilizes. 

Edema  and  decreased  blood  supply  dur- 
ing surgery  threaten  skin  integrity  and  con- 
tribute to  sloughing  of  the  superficial  layer 
two  to  three  weeks  after  surgery,  but  the 
incision  usually  heals  well,  leaving  a  small 
scar. 

The  wound  closes  fully  and  scar  forma- 
tion is  apparent  approximately  two  to  three 
weeks  after  surgery.  Then,  increased  ex- 
ercise may  reduce  edema  formation  by 
improving  venous  return.  Tennis,  golf, 
cycling,  and  other  sports  that  involve  mo- 
bility of  the  feet  should  be  suggested,  as 
most  people  don"t  consider  resuming 
sports  activities. 

The  person  should  not  drive  until  he  can 
tolerate  a  bump  or  blow  to  the  great  toe 
without  discomfort  because  this  might 
cause  him  to  lose  control  of  the  vehicle. 
Sufficient  .strength  for  quick  braking  is 
mandatory.  Again,  the  time  period  varies 
—  from  two  weeks  to  two  months  after 
surgery. 

Return  to  work  is  determined  by  the 
client's  ability  to  be  up  without  undue  joint 
redness,  throbbing,  and  edema.  Two  to  12 
weeks  may  elapse  between  surgery  and 
resumption  of  work  activities.  Return  to 
■"housewifely"  duties  may  be  more  taxing 
in  terms  of  long  periods  of  time  on  foot 
than  return  to  "work.""  Returning  to  eight 
hours  of  supervising  nursing  students,  for 
example,  involves  a  better  balance  of 
standing  and  stitting  than  preparing  dinner 
for  eight. 

Clients  may  have  questions  about  the 
outcome  of  the  surgery.  The  most  com- 
mon technical  error  with  Keller"s  arthro- 
plasty is  excision  of  more  than  one  third  of 
the  proximal  phalanx.  This  results  in  a 


short  floppy  toe  and  predisposes  i 
metatarsalgia  and  pressure  on  the  longt 
second  toe  that  may  result  in  hammer  to 
deformity.  Failure  to  exercise  may  lead  t 
contracture  in  hyperextension,  recurrer 
deformity,  or  improper  weight  bearing  o 
the  metatarsal  arch. 

Improper  footwear  may  cause  a  recui 
rence  of  hallux  valgus  and  bunion  formi 
tion.  Premature  return  to  shoes  with  hig 
heels  for  long  periods  each  day,  no  matte 
how  comfortable  in  terms  of  lateral  pres 
sure,' forces  the  great  toe  into  dorsiflex ion 
The  client  must  be  vigilant  in  exercisin 
the  toe  back  into  a  neutral  position,  lei 
contracture  develop.  This  effort  may  mak 
wearing  high  heels  too  much  trouble. 

Most  clients  are  satisfied  with  the  re 
suits  of  surgery.  Joint  pain  and  deformil 
are  eliminated.  Range  of  motion  for  plan 
tar  flexion  and  dorsiflexion  varies  from 
to  25  degrees.  Full  ability  to  walk  i 
household  and  professional  activity  i 
achieved.  Clients  under  40  years  of  ag' 
seem  more  likely  to  achieve  excellent  re 
suits  than  those  over  40. 

People  who  have  had  this  operalioi 
need  no  prompting  to  advise  younger  peo 
pie  to  avoid  wearing  the  kinds  of  shoe 
which  promote  bunion  formation  or,  onci 
bunions  have  formed,  to  undergo  surgica 
correction  as  soon  as  possible. 

References 

1.  Soren.  Arnold.  Surgical  correction  of  hiii 
lux.  valgus.  Surgery  71:44-50.  Jan.  1972 

2.  Wrighlon.  J.D.  A  ten-year  review  o 
Keller"s  operation.  Review  of  Keller's  hit 
eration  at  the  Princess  Elizabeth  Or 
Ihopaedic  Hospital.  Exeler.  Clin.  Onhor 
89:207-214.  1972.  , 

3.  Swanson.  A.B.  Implant  arthroplasty  for  the! 
great  toe.  Clin.  Onhop.  85:75-81.  1972 


Copyright  December  1974.  The  Ameri. 
Journal  of  Nursing  Company.  Reprinted  I: 
\\\e  American  Journal  of  Nursing.  Dec.  19" 


Fitness  for  39(z! 


The  author,  an  occupational  health  nurse,  tried  a  skipping  rope  to  improve  her 
physical  fitness  .  .  .  and  found  she  attracted  as  many  children  as  the  Pied  Piper  or 
I  the  Good  Humor  person. 


j  Helen  Krafchik 

I 

Summer  is  here,  and  we  have  managed  to 
gel  Ihrough  another  winter.  For  some  of 
us.  winter  was  a  fun  time:  forothers,  it  was 
a  drag.  In  all  probability,  the  persons  who 
are  happy  in  winter  are  physically  fit,  as 
ihev  spend  the  cold  months  skiing  down 
,ihe  slopes,  cross-country  skiing,  snow- 
'mobiiing.  skating,  taking  brisk  walks,  or 
running  through  their  subdivisions! 

The  ones  who  are  unhappy  are  those 
uho  are  unfit  physically.  We  sat  on  the 
gluteus  maximus  most  of  the  winter,  in 
trtint  of  the  TV.  We  did  see  a  great  deal  of 
advertising  by  Participaction,  telling  why 
and  how  we  should  be  exercising.  And  we 
agreed  that  it  was  probably  what  we  should 
dii  when  the  sunshine  and  good  weather 
arrived  tomorrow  or  next  week  —  we  are 
great  at  procrastinating. 

.Motivating  individuals  to  become  phys- 
ically fit  has  been  tried  in  every  manner 
possible  —  films,  TV,  at  their  work,  by 
(heir  doctor.  But  it  comes  right  down  to  a 
'personal  issue,  like  one's  bank  account  — 
ii  IS  only  my  business.  Children  can  have  a 
Jefmite  effect.  In  my  case,  our  children 
have  a  physically  fit  father  who  is  always 
icti  ve  and  involved  in  sports,  and  a  mother 
v\ho  is  borderline.  So  I  decided  to  try  to  be 
like  the  rest  of  the  family  —  physically  fit. 

Ii  all  started  with  a  39c  skipping  rope.  I 
Jo  not  relate  to  running  on  the  spot  —  I  go 
io\>.  here  in  a  hurry  and  get  bored  —  but  I 
an  relate  to  skipping  on  the  spot.  So, 
down  to  the  basement  where  no  one  could 
^ee  me,  1  went  with  my  skipping  rope.  I 
blurted  out  doing  10  skips,  which  was  tor- 
ure.  and  added  one  skip  each  night. 

Well,  the  basement  wasn't  really  the 
x'si  place  because  of  beams  and  so  on,  so  1 
decided  to  use  the  garage.  I  closed  the  back 


Helen  Krafchik  (R.N. .St.  Michael's  School  of 

Cursing.  Toronto.  Onl.)  is  occupational  health 

(urse  in  the  Warner-Lambert  Canada  Limited 

■1  ni  in  Scarborough.  Ontario.  She  says  that 

ig  10  keep  physically  fit  is  "like  being  an 

holic.  I  fell  off  the  wagon  and  I  am  strug- 

L-  now  to  gel  back  on  and  start  the  program 

n.  The  skipping  I  find  the  most  fun  —  it  has 

c  fun  for  the  whole  family  to  enjoy  it." 

:ANADIAN  nurse  —  Augusi  1975 


and  front  doors,  because  1  didn't  v\ant  an 
audience.  But  the  muttering  and  giggling 
of  little  voices  meant  that  my  audience  was 
already  on  the  scene.  I  invited  the  little 
girls  to  turn  the  ends  of  the  skipping  rope, 
and  mother  skipped.  We  then,  as  a  group, 
graduated  outdoors  to  the  driveway ,  where 
the  fun  began. 

We  live  on  a  cul-de-sac,  which  is  rather 
private  and  quiet,  and  the  group  of  chil- 
dren —  boys  and  girls  —  decided  to  join  in 
the  game  of  skipping.  It  was  fun!  The  boys 
tried  to  coordinate  their  2  left  feet  in  the  art 
of  skipping.  Everyone  ran  for  his  own 
skipping  rope.  Then  we  decided  to  skip 
around  the  crescent.  In  doing  so.  a  couple 
of  the  other  mothers  decided  to  join  the 
flock  and  get  in  on  the  fun. 

By  this  time,  the  fathers,  who  were  ar- 
riving home  from  work  and  entering  the 
driveways,  were  applauding  and  having  a 
great  laugh.  But  then  the  children  began. 
"Come  on.  dad.  we  bet  you  can't  skip  like 
mom"  and.  because  he  isnumberone  man 
at  home,  dad  had  to  prove  he  could  do  such 
a  simple  thing  as  skip. 


There  were  a  lot  of  laughs  as  these  great 
men  of  our  neighborhood  lumbered  along 
with  the  colorful  pink  and  green  skipping 
ropes;  all  of  us  collapsed  on  the  front  lawn 
gasping  for  breath,  feeling  good,  and 
laughing.  Then  one  of  the  younger  set, 
looking  at  her  parents,  said.  "Gee.  mom 
and  dad,  this  is  great  fun,  and  we  can  all  do 
it  together." 

In  our  society  of  working  parents,  we 
hear  much  about  the  family  unit  going  in 
different  directions  —  son  to  hockey, 
daughter  to  dancing  lessons,  mom  to 
ceramic  classes,  and  dad  to  night  classes. 
Here  is  a  little  physical  exercise  that  takes 
approximately  15  minutes  per  day.  cer- 
tainly does  a  great  job  for  cardiovascular 
and  respiratory  fitness,  makes  you  feel 
good,  and  look  good.  In  this  time  of  infla- 
tion and  recession,  there's  little  laughter 
shared  among  us.  so  if  a  little  skip  around  a 
crescent  or  down  a  street  with  our  family 
or  friends  will  encourage  a  smile  and  keep 
us  physically  fit.  let's  try  it.  We  may  all 
like  it!  p 


45 


names 


Barbara  A.  Chandler,  Rosemary  Detzler, 
Christine  A.  Smith,  Carol  Stockall,  and 
Cynthia  Ross  are  recipients  of  this 
year's  award  from  the  Mildred  I. 
Walker  Bursary  Fund.  This  fund  was 
established  at  the  University  of  West- 
em  Ontario  faculty  of  nursing,  London, 
Ontario,  by  the  many  students  and 
friends  of  Mildred  Walker. 


An  honorary  doctorate  was  conferred 
by  the  University  of  Montreal  on 
Alice  Girard  who 
was  the  first  wo- 
man dean  at  that 
university.  Al- 
though officially 
retired  as  an 
educator,  she  is 
currently  president 
of  the  Victorian 
Order  of  Nurses 
of  Canada,  chairman  of  a  committee  on 
uniform  nursing  examinations  for 
Canada,  and  nursing  consultant  to  vari- 
ous organizations. 


The  alumnae  association  of  the  Royal 
Victoria  Hospital,  Montreal,  has 
awarded  3  bursaries  of  $1,500  each. 
The  recipients  are:  Carolyn  Rushton, 
who  will  study  toward  a  B.N.  at 
Dalhousie  University,  Halifax;  Leslie 
Chisholm  Hardy,  who  will  study  toward 
a  B.N.  (teaching)  at  McGill  University, 
Montreal;  and  Linda  Mutch,  who  will 
study  toward  a  B.A.  in  community 
health  nursing  at  Loyola  University, 
Montreal,  Quebec. 

The  1975  Judy  Hill  Memorial  Scholar- 
ship has  been  awarded  to  Beverley  A. 
Robson.  She  will  study  midwifery  in 
Edinburgh,  Scotland. 

A  graduate  of  the  University  of  Sas- 
katchewan ,  Robson  completed  the  Arc- 
tic Nurse  Practitioner's  course  at 
McGill  University.  She  has  served  as 
an  assistant  to  missionnaries  in  North 
Thailand,  and  was  for  three  years  based 
in  various  arctic  outposts,  including 
Cape  Dorset,  Hall  Beach,  Pond  Inlet, 
and  Frobisher  Bay. 

Upon  completion  of  her  year's  train- 


mg  m  Edinburgh,  she  will  rejoin  the 
Medical  Services  Branch  of  Health  and 
Welfare  Canada  for  appointment  to  a 
northern  nursing  post. 

The  Ontario  Confederation  of  Univer- 
sity Faculty  Associations  has  conferred 
1975  teaching  awards  on  two  outstand- 
ing nurse  educators,  the  first  time  these 
awards  have  been  granted  to  nursing 
faculty  members.  The  recipients  are: 
Jessie  Helen  Mantle  (R.N.,  Royal 
Jubilee  Hospital  school  of  nursing ,  Vic- 
toria; B.N.,  McGill  University; 
M.S.N. ,  University  of  California  at 
San  Francisco),  who  is  professor  at  the 
faculty  of  nursing.  University  of  West- 
em  Ontario,  London;  and 


J.H.  Mantle 


H.J.  Alderson 


Henrietta  ).  Alderson  (R.N.,  Hamilton 
General  Hospital  school  of  nursing; 
B.Sc.  and  M.Sc,  Teachers  College, 
Columbia  University,  New  York)  who 
has  been,  until  her  retirement  in  June, 
associate  professor  of  nursing,  McMas- 
ter  University  school  of  nursing, 
Hamilton,  Ontario. 


Jean  Dalziel  (R.N.,  Atkinson  School  of 
Nursing,  Toronto  Western  Hospital; 
B.A.,  University  of  Toronto;  M.A., 
Columbia  University,  New  York)  has 
been  appointed  assistant  director,  pro- 
fessional standards.  College  of  Nurses 
of  Ontario.  She  joined  the  staff  of  the 
College  in  1972,  as  nursing  practice 
coordinator.  Previously,  she  had  been 
on  the  faculty  at  the  University  of  To- 
ronto school  of  nursing;  assistaiil  direc- 
tor of  the  Atkinson  School  ot  Nursing; 
and  assistant  to  the  consultant,  nursing 
education  and  practice.  Registered 
Nurses  Association  of  Ontario. 


Mary  E.  Murphy  (R  N.,  St.  Joseph's 
Hospital,  London,  Ontario;  B.Sc.N., 
University  of  Windsor,  and  m.h.a.. 
University  of  Ottawa)  has  been  ap- 
pointed assistant  executive  director  — 
nursing  at  the  University  of  Alberta 
Hospital. 

Murphy  has  been 
director  of  nurs- 
ing at  the  North 
York  hospital  for 
the  past  four 
years.  She  has 
also  held  super- 
visory and  ad- 
ministrative posi- 
tions in  London 
and  Hamilton. 

Lynda  Cranston  (R.N.,  B.Sc.N.,  Uni- 
versity of  Ottawa)  has  joined  the  staff 
of  the  Canadian  Nurses'  Association, 
as  an  assistant  editor  of  The  Canadian 
Nurse.  She  is  currently  completing  re- 
quirements for  her  master's  degree  in 
nursing  science  at  the  University  of 
Western  Ontario. 

Cranston  has  held  various  positions 
in  nursing:  staff  nurse  at  The  Hospital 
for  Sick  Children,  Toronto;  teacher  at 
the  Kingston  General  Hospital  School 
of  Nursing,  Kingston;  part-time  staff 
nurse  at  the  University  of  Western 
Ontario's  health  services  clinic,  Lon- 
don; and  staff  nurse  in  the  emergency 
department  at  the  Ottawa  Civic  Hospi- 
tal, Ottawa.  She  has  also  had  experi- 
ence in  medical-surgical  and  psychiat- 
ric nursing. 


Molly  Mitchell,  (R.N.,  Medicine  Hat 
General  Hospital,  Alberta),  recently  re- 
tired as  unit  coordinator  at  the  Brandon 
General  Hospital,  has  been  honored  as 
"Woman  of  the  Month"  by  the  Man- 
itoba Association  of  Registered 
Nurses.  She  has  been  associated  with 
the  Brandon  General  hospital  since 
1963,  and  has  worked  on  various  com- 
mittees for  MARN.  From  her  involve- 
ment in  a  committee  on  educational 
programs  to  upgrade  patient  care  came 
the  planning  of  workshops  in  the  rural 
areas  of  Manitoba.  She  plans  to  live  in 
Duncan,  B.C. 


Alma  Elizabeth  Reid,  former  director  of 
the  McMaster  University  School  of 
Nursing,  has  been  awarded  an  honorary 
Doctor'of  Laws  degree  by  McMaster 
University,  Hamihon.  at  its  spring 
convocation.  A  noted  educator,  she  de- 
voted special  attentit)n  to  fostering  a 
sense  of  humane  concern  within  the 
generations  of  nurses  who  graduated 
from  the  McMaster  school  of  nursing. 
Dr.  Reid  was  also  presented  with  an 
honorary  life  membership  in  the  Regis- 
tered Nurses  Association  of  Ontario,  at 
the  RN.AO's  50th  annual  convention  in 
June. 


Judith       Proctor 

(R.N..  Vancouver 
General  Hospital 
school  of  nursine; 
B.N..  McGill 
University),  who 
succumbed  to  a 
short,  but  fatal 
illness  this  spring 
was  awarded, 
posthumously,  a  bachelor  of  nursine 
degree  (with  distinction)  by  McGif! 
University.  Before  entering  the  bac- 
calaureate program  in  nursing  ad- 
ministration in  1973.  Proctor  had 
specialized  in  cardiac  care  at  The 
Montreal  General  Hospital.  Her  gra- 
duating class  said  of  her;  ""Her  method 
of  thinking  and  evaluating  through  dis- 
cussion .  debate,  and  examination  was  a 
source  of  inspiration  of  those  around 
her."' 


Dorothy  M.  Morgan  (R.N..  Victoria 
Hospital  School  of  Nursing,  London. 
Ontario:  B.A..  University  of  Western 
Ontario;  B.S.,  McGill  University: 
M.B.A.,  University  of  Chicago)  has 
been  made  a  life  fellow  of  the  American 
College  of  Hospital  Administrators. 
She  is  nursing  consultant  for  Dimen- 
sions in  Health  Service  and  was  for- 
meriy  director  of  nursing  at  the  Victoria 
Hospital,  London. 


Marlene  Ann   Schulhauser   of  Cupar, 
Saskatchewan,  has  been  awarded  the 


All  smiles  as  they  display  their  certificates  of  honorary  membership  in  the  Regis- 
tered Nurses  Association  of  Ontario  are,  left:  Alma  E.  Reid,  former  director  of 
McMa.ster  University  school  of  nursing.  Hamilton,  now  retired,  and  a  past  presi- 
dent of  RNAO;  and  rij^ht:  Jeannelte  E.  Watson,  former  professor.  Universit>  of 
Toronto  faculty  of  nursing,  now  retired.  Not  photographed  is  Dr.  Virginia  Hender- 
son, research  associate  emeritus,  school  of  nursing,  Yale  University ,  New  Haven, 
Connecticut,  who  is  internationally  known  for  her  contribution  to  nursing  litera- 
ture, education,  and  practice.  The  honorary  memberships  were  conferred  at  the 
50th  annual  meeting  of  the  RNAO  in  Toronto,  June  1975. 


Kathleen  Ellis  prize  for  the  most  distin- 
guished 1 975  graduate  in  the  College  of 
Nursing,  University  of  Saskatchewan. 
Saskatoon. 

Millicent  Taylor  ( R  N  ,  General  Hospital 
Scho<:)l  of  Nursing,  St.  John's;  B.Sc.N.. 
University  of  Toronto)  has  been  ap- 
pointed administrator  of  the  St.  John's 
Home  Care  Program. 

She  has  had  wide  experience  in  hos- 
pital and  community  nursing  and  has 
held  positions  in  nursing  education  and 
as  a  public  health  nursing  supervisor. 

Dr.  Douglas  Waugh  has  accepted  the 
position  of  executive  director  of  the  As- 
sociation of  Canadian  Medical  Col- 
leges. He  has  been  dean  of  medicine  at 
Queen's   University,   Kingston,   since 


1970  and  was  formedy  chairman  of  the 
department  of  pathology  at  the 
Dalhousie  Medical  School  in  Halifax. 


Myrtle  R.  Tregunna  (Reg.  N.,  Kingston 
General  Hospital  school  of  nursing; 
B  N  Sc.  Queen's  University.  Kingston) 
has  been  appointed  assistant  director  of 
nursing  services.  Registered  Nurses' 
Association  of  British  Columbia. 

She  has  for  several  years  been  as- 
sociated with  St.  Paul's  Hospital,  Van- 
couver, as  instructor  in  medical  nurs- 
ing, head  nurse  of  the  medical  teaching 
unit,  and  head  nurse  of  the  renal 
dialysis  unit.  Earlier  in  her  career  she 
was  a  nursing  instructor  at  Hannemann 
Medical  College  and  Hospital. 
Philadelphia,  and  at  the  Kingston  Gen- 
eral Hospital,  Kingston.  Ontario,      u. 


THE  CANADIAN  NURSE  —  AugusI  1975 


nevu  products 


One-Size  Foster  Bed 

Chick  Orthopedic  Co.  recently  an- 
nounced the  availability  of  a  new, 
universal-size  Foster  reversible  or- 
thopedic bed  (ROB).  The  new  model 
replaces  three  "fixed  size"  Foster 
ROBS. 

The  new  bed  is  so  constructed  that 
both  the  Bradford  frames  and  side  rails 
can  be  positioned  to  any  desired  length, 
even  extra  long,  and  secured  through 
pre-drilled  holes.  The  adjustment  can 
be  made  by  one  person  in  a  matter  of 
minutes. 

The  Foster  ROB  is  delivered  pre-set  at 
the  ordered  length,  with  the  exact 
length  of  canvas  covers.  If  the  frame  is 
shortened,  the  foot  canvas  covers  can 
be  turned  under.  If  the  frame  is 
lengthened,  additional  canvas  sections 
are  used. 

For  information,  write  Foster  ROB, 
Chick  Orthopedic,  821 -75th  Ave., 
Oakland,  Calif.  94621,  U.S.A. 


Chloraseptic  oral  anesthetic 

Eaton  Laboratories  has  introduced 
Chloraseptic,  an  anesthetic-antiseptic 
spray,  mouthwash,  and  lozenge  for 
rapid  relief  of  minor  throat,  mouth,  and 
gum  soreness. 

Available  without  a  prescription,  it  is 
sold  only  in  pharmacies  and  marketed 
as  a  professional  product.  Eaton 
Laboratories  (P.O.  Box  2002,  Paris, 
Ontario)  is  a  division  of  Norwich 
Pharmacal  Company,  Limited. 

Filter  isolator 

A  new  booklet  from  Acculab,  a  Divi- 
sion of  Precision  technology,  Inc., 
describes  the  newest,  fastest,  and  most 
reliable  method  of  separating  and  filter- 
ing blood  serum  to  remove  filorin  be- 
fore analysis.  ACCU-SEP,  a  disposable 
filter/isolator,  introduces  no  impurities 
into  the  blood  sample,  and  eliminates 
the  need  to  use  additional  vessels  for 
storage  or  shipment  of  the  filtered 
serum.  Made  entirely  of  solid,  inert 
materials,  it  features  a  one-way  valve  to 
eliminate  leakage  and/or  interaction  of 
serum  and  clot  after  the  sample  has 
entered  the  isolation  area. 

Color    illustrations    give    complete 


step-by-step  information  that  can  be 
followed  by  any  laboratory  technician 
or  employee  in  a  doctor's  office.  The 
literature  can  be  obtained  by  writing  to 
Acculab,  50  Maple  Street,  Norwood, 
N'  07648  U.S.A. 

Disposable  obstetric  pack 

Convenors  Division  of  American  Hos- 
pital Supply  Corporation  have  added 
the  750  OB  pack  to  their  line  of  sterile, 
disposable  OB  packs.  It  contains  every- 
thing needed  for  the  delivery  room,  in- 
cluding a  new  preformed  plastic 
placenta  basin ,  a  plastic  under-buttocks 
drape,  a  T-binder  with  safety  pins,  a 
Hollister  umbilical  cord  clamp,  and  an 
ear  syringe.  Components  are  packed  in 
their  order  of  use. 

All  Convenors  OB  packs  are  sterile- 
packed  in  a  double-walled  laminate 
bag,  which  is  2  layers  of  plastic  perma- 


Descriptions  of  "new  products"  are 
based  on  information  supplied  by 
the  manufacturer.  No  endorsement 
is  intended. 


nently  bonded  together  to  create  a 
strong,  impermeable  package  to  assure 
sterility. 

The  draf)es  and  gowns  are  made  of 
virtually  lint-free,  nonwoven  fabric, 
chemically  treated  to  provide  resistance 
to  all  fluids,  including  those  with  an 
alcohol  base. 

In  addition  to  the  convenience  and 
patient  safety  offered  by  sterile, 
single-use  delivery  room  items.  Con- 
venors 750  OB  pack  eliminates  ex- 
penses of  handling,  laundering, 
sterilizing,  and  packaging.  For  infor- 
mation, contact:  Convenors  Division 
of  American  Hospital  Supply  Corpora- 
tion, 1633  Central  Street,  Evanston,  IL 
60201,  USA. 

Intrusion  detection  system 

The  "Spaceguard"  ultrasonic  motion 
detector,  an  intrusion  detection  system, 
has  been  develof)ed  in  response  to  the 
increasing  number  of  burglaries. 

It  consists  of  a  master  control  unit 
with  up  to  20  pairs  of  transmitting  and 
receiving  transducers.  The  system  can 
accommodate  additional  detection  de- 
vices and  a  variety  of  reporting  devices. 
It  is  highly  immune  to  "false  alarms" 


48 


from  background  noises  and  random 
disturbances. 

For  information,  write:  massa  Cor- 
poration, 280  Lincoln  Street.  Hina- 
ham.  Mass.  02043,  U.S.A. 


Shield  for  IV  protection 

(The  Posey  IV  shield  is  made  of  translu- 
I  cent  plastic  that  permits  early  detection 
of  trauma,   abrasion,    infiltration,   or 
I  needle  dislodgement. 


The  shield  has  a  medically  approved, 
nontoxic,  nonallergenic  tape  that 
adheres  to  the  patient's  skin.  Complete 
flexibility  enables  the  shield  to  conform 
to  any  part  of  a  patient's  body. 

For  futher  information,  write:  Enns 
and  Gilmore  Limited,  1033  Rangeview 
Rd.,  Port  Credit,  Ont. 


Teflon  cysloscopic  electrode 

jreenwald  Surgical  Companv'b  new 

ssioscopic  electrode  line  consists  of  5 

haft  diameters  and   15  different  tips 

ind  is  completely  compatible  with  all 

Lilarcystoscopes.  All  shafts  are  color 

ed  for  easy,  foolproof  size  identifi- 

-m.  They  feature  flexibility,  high 

stance  to  temperature  and  chemi- 

:als.  and  good  electrical  insulation. 

Shaft  colors  are  red,  gray,  green, 
orange,  and  blue  for  respective  sizes 
4FR,  5FR,  6FR,  7FR,  and  8FR.  Tip 
^t\les  include  pointed,  conical,  ta- 
pered, domed,  bayonet,  beavertail,  an- 
i;ular,  straight,  flat,  semi-flat,  ball, 
loop,  bugbee,  and  bunge  meatome. 

Descriptive  literature  and  prices  are 
ivailable    from    Greenwald    Surgical 
mpany.  Inc.,  2688  DeKalb  Street, 
I  Gary.  Indiana  46405  U.S.A. 


Lotion  for  dry  skin 

Com-pat  is  a  new  hypo-allergenic  gen- 
eral body  lotion  for  dry  skin. 

Especially  designed  for  wearers  of 
Jobst  Ela.stic  Garments,  it  will  not  harm 
elastic  in  girdles,  bras,  swimsuits,  sup- 
port hose,  or  surgical  elastic  garments. 

Com-pat  is  a  careful  formulation  of 
moisturizers  that  soften  dry  skin.  It  is 
neither  sticky,  oily,  nor  greasy,  and 
may  be  used  frequently  to  maintain  a 
soft,  smooth  skin. 

Com-pat  is  available  from  Jobst  Ser- 
vice Centers  at  1538  Sherbrooke  Street 
West.  Montreal.  Quebec,  or  123  Ed- 
ward Street,  Toronto,  Ontario. 


Disposable  laparotomy  sponge 

A  disposable  laparotomy  sponge  intro- 
duced by  Convenors  features  a  triple 
layer  for  sujjerior  absorbency  as  well  as 
a  down-soft  exterior.  Softer  and  more 
flexible  than  gauze,  the  non-woven 
sponge  allows  fluids  to  pass  through  to 
the  highly  absorbent  inner  core,  where 
they  are  held. 


7W,v  j"  -  fj-'< 


The  Convenors  sponge  has  virtually 
no  lint  and  "pilling",  and  eliminates 
the  danger  of  irritating  traces  of  de- 
tergent inherent  from  the  laundering  of 
gauze  sponges. 

Sterile-packed  in  a  unique  double- 
wall  laminate  bag,  the  12"  x  12" 
sponges  are  free  of  contamination.  The 
bag  consists  of  a  tough,  durable,  white 
outer  layer  with  an  inner  "blue  alert" 
layer,  which  assures  that  any  damage  to 
the  bag  before  opening  will  im- 
mediately expose  the  blue  liner  to  alert 
the  circulating  nurse. 

For  information,  write  Converters, 
1633  Central  Street,  Evanston.  Illinois 
60201.  USA. 


:ANADIAN  nurse  —  Augusl  1975 


Next  Month 
in 


The 

Canadian 
Nurse 


•  Nurses  as  Investigators: 
Some  Ethical  and  Legal  Issues 

•  Myths  About  Unemployment 

•  Nurse  Therapist  in 

A  Psychiatric  Setting 

•  Grand  Rounds 
on  Brain  Tumors 

•  One  Woman  Kicks 
The  Smoking  Habit 


^^P 


Photo  Credits 
for  August  1975 


J.R.G.  Benoit, 

Ottawa,  Ont.  p.  12 

International  Development 

Research  Centre,  Ottawa,  pp.  33,  34 

Julien  Lebourdais, 

Toronto,  Ont.  pp.  10,  47 

Sunnybrook  Medical  Centre, 
Toronto,  Ont.  pp.  27.  28 


49 


dates 


September  3-5,  1975 

Memorial  Sloan-Kettering  Cancer 
Center  international  nursing  symposium 
on  nursing  care  of  the  patient  with 
cancer,  to  be  held  at  the  Americana 
Hotel,  New  York  City.  Registration  fee: 
$100  US.  payable  to  MSKCC,  Nursing 
Symposium,  850  Third  Avenue,  21st 
Floor,  New  York,  NY.  10022,  U.S.A. 

September  3-6,  1975 

"An  Interdisciplinary  Approach  to 
Chronic  Respiratory  Disease,"  spon- 
sored by  the  Sanatorium  Board  of  Man- 
itoba Department  of  Continuing  Medical 
Education,  University  of  Manitoba,  to  be 
presented  in  Theatre  A,  Basic  Sciences 
Building,  730  William  Avenue,  Win- 
nipeg. For  information,  write;  The  Execu- 
tive Director,  Sanatorium  Board  of  Man- 
itoba, 825  Sherbrook  Street,  Winnipeg, 
Manitoba,  R3A  1M5. 

September  8  -  December  1,  1975 

Counselling  the  emotionally/mentally 
disturbed  patient,  Part  II.  Monday  even- 
ings at  the  Clarke  Institute  of  Psychiatry, 
Toronto.  For  information,  write:  Dorothy 
Brooks,  Chairman,  Continuing  Educa- 
tion Programme,  Faculty  of  Nursing,  U. 
of  T.,  50  St.  George  Street,  Toronto,  On- 
tario, M5S  1A1. 

September  9-December  2,  1975 

Counseling  the  emotionally/mentally 
disturbed  patient.  Pari  I.  Tuesday  even- 
ings at  the  Clarke  Institute  of  Psychiatry, 
Toronto.  For  information,  write:  Dorothy 
Brooks,  Chairman,  Continuing  Educa- 
tion Programme,  Faculty  of  Nursing,  U. 
ofT.,  50  St.  George  Street,  Toronto,  On- 
tario, M5S  1A1. 

September  10-11,  1975 

Psychogeriatric  Association  2nd  annual 
convention  to  be  held  in  Stratford,  On- 
tario. Theme:  Care  of  the  Difficult  Pa- 
tient. For  information,  write:  P.  Stanley, 
Director  of  Nursing,  Stratford  General 
Hospital,  Stratford,  Ontario 

September  1 1  -November  20,  1975 

Family  Dynamics.  Thursday  evenings  at 


the  Clarke  Institute  of  Psychiatry,  To- 
ronto. For  information,  write:  Dorothy 
Brooks,  Chairman,  Continuing  Educa- 
tion Programme,  Faculty  of  Nursing,  U. 
of  T.,  50  St.  George  Street,  Toronto,  On- 
tario, M5S  1A1. 

September  24  -  November  12,  1975 

Gynecology  for  nurses.  Wednesday 
evenings  at  the  Faculty  of  Nursing,  Uni- 
versity of  Toronto.  For  information, 
write:  Dorothy  Brooks,  Chairman,  Con- 
tinuing Education  Programme,  Faculty 
of  Nursing,  U.  of  T.  50  St.  George  Street, 
Toronto,  Ontario,  M5S  1A1. 

September  30,  1975 

Health  League  of  Canada  conference 
on  the  life  style  and  health  of  Canadians 
to  be  held  in  the  Concert  Hall,  Royal 
York  Hotel,  Toronto,  Ontario.  For  infor- 
mation, write:  Dr.  Gordon  Bates,  Gen- 
eral Director,  Health  League  of  Canada, 
76  Avenue  Road,  Toronto,  Ontario 
M5R2H1. 

October  2-3,  1975 

Seminar  on  disease  costing  to  be  held  at 
School  of  Health  Administration,  Uni- 
versity of  Ottawa.  For  information,  write: 
Carolyn  Belzile,  Coordinator  Continuing 
Education  Program,  School  of  Health 
Administration,  University  of  Ottawa,  Ot- 
tawa, Ontario. 

October  3-5,  1975 

Vanier  institute  of  the  Family  annual 
meeting  to  be  held  at  the  Chateau 
Laurier  Hotel,  Ottawa,  Ontario.  Theme: 
Pathways  Toward  the  Familial  Society. 
For  information,  write:  Vanier  Institute  of 
the  Family,  151  Slater  Street,  Suite  207, 
Ottawa,  Ontario,  KIP  5H3. 

October  4,  1975 

Headache  symposium  to  be  held  at 
Sunnybrook  Medical  Centre,  Toronto. 
For  information,  contact:  Rosemary 
Dudley,  The  Migraine  Foundation,  390 
Brunswick  Avenue,  Toronto,  Ontario, 
M5R  2Z4.  Tel:  (416)920-4916. 


October  5-8,  1975 

The  Association  of  Registered  Nurses  of 
Newfoundland  annual  meeting  is  to  be 
held  in  St.  John's,  Nfld.  For  information, 
write:  Phyllis  Barrett,  ARNN,  67  LeMar- 
chant  Road,  St.  Johns,  Nfld. 

October  19-24,  1975 

Institute  on  health  care  administration, 
Banff  Springs.  For  information  write:  Al- 
berta Hospital  Association, 
10025- 108th  Street,  Edmonton,  Alta. 

October  20- November  12,  1975 

Leadership  roles  in  nursing,  Monday 
and  Wednesday  evenings  at  the  Faculty 
of  Nursing,  University  of  Toronto,  To- 
ronto. For  information,  write:  Dorothy 
Brooks,  Chairman,  Continuing  Educa- 
tion Programme,  Faculty  of  Nursing,  U 
of  T.,  50  St.  George  Street,  Toronto,  On- 
tario, M5S  1A1. 

October  20  -  November  28,  1975 

Refresher  course  for  nonpracticing  reg- 
istered nurses.  Daily  at  Mount  Sinai 
Hospital  and  Faculty  of  Nursing,  Univer- 
sity of  Toronto,  Toronto.  For  information, 
write:  Dorothy  Brooks,  Chairman,  Con- 
tinuing Education  Programme,  Faculty 
of  Nursing,  U.  of  T.,  50  St.  George 
Street,  Toronto,  Ont. 

November  14-15,  1975 

Course  in  clinical  application  of  intra- 
aortic  balloon  pump,  to  be  held  at 
Americana  Hotel,  9701  Collins  Avenue, 
Bal  Harbour,  Florida.  Sponsored  by  Di- 
vision of  Thoracic  and  Cardiovascular 
Surgery,  University  of  Miami  School  of 
Medicine.  For  information,  write:  Divi- 
sion of  Continuing  Medical  Education, 
University  of  Miami  School  of  Medicine. 
P.O.  Box  520875,  Biscayne  Annex, 
Miami,  Florida  33152,  U.S.A. 

December  3-5,  1975 

Alberta    Hospital    Association    annual 
meeting  and  convention,  Edmonton.  For 
information  write:  Alberta  Hospital  As- 
sociation, 10025-1 08th  St.  Edmonton 
Alta. 


research  abstracts 


Shack,  Joyce  O.  Role  expectations  and 
perceptions  of  the  director  of  nurs- 
ing role.  Boston,  Mass.,  1974. 
Thesis  (M.S.)  Boston  U. 

The  study  examined  the  question  of 
whether  there  was  consensus  of  role 
expectations  and  role  perceptions  be- 
tween the  staff  nurse  and  the  director  of 
nursing. 

The  data  revealed  that  there  was  a 
difference  in  consensus  between 
groups.  Greater  consensus  of  expecta- 
tions was  found  than  in  perceptions. 
The  director  of  nursing  group  had  a 
greater  consensus  of  perceptions  than 
did  the  staff  nurse  group. 

The  study  could  not  determine  sig- 
nificant relationships  between  percep- 
tions and  age.  experience,  type  of  prep- 
aration, and  other  findings. 

Sommerfeld,  Denise  Mary  Power.  The 

effectiveness  of  planned  teaching  of 
mothers  with  children  treated  in 
emergencx  departments.  Van- 
couver, B.C.,  1972.  Thesis 
(M.S.N.)  U.  of  British  Columbia. 

This  smdy  concerned  itself  with  plan- 
ned teaching  in  the  hospital  emergency 
department,  an  area  of  the  hospital 
health  care  system  that  is  becoming  in- 
creasingly popular  for  short-term  am- 
bulatory care.  However,  the  nursing 
care  provided  by  this  department  has 
been  largely  unexplored  by  research. 

The  purpose  of  this  experimental 
study  was  to  determine  whether  the 
mother  who  received  planned  teaching 
would  cope  more  adequately  with  the 
home  care  of  her  child  than  the  mother 
not  receiving  this  planned  teaching. 
The  teaching  involved  verbal  and  writ- 
ten instructions  given  to  a  mother  prior 
to  the  discharge  of  her  child  from  the 
emergency  department  following 
treatment  for  a  traumatic  limb  fracture 
requiring  cast  application. 

The  null  hypothesis  was  tested:  there 
is  no  significant  difference  in  the  cop- 
ing abilities  of  the  mothers  of  the  ex- 
perimental group  as  compared  with  the 
mothers  of  the  control  group. 

Using  5  general  hospital  emergency 
departments.  20  mothers  were  assigned 
to  alternate  experimental  and  control 


groups,  with  the  experimental  subjects 
receiving  the  planned  leaching  before 
discharge.  Through  home  visit  inter- 
views with  all  subjects,  the  mothers" 
coping  abilities  were  asses,sed  by  the 
number  of  specified  care  objectives 
they  had  achieved. 

The  individual  totals  were  ranked 
and  analyzed,  using  the  Mann-Whiiney 
U  test,  the  results  of  which  led  to  the 
rejection  of  the  null  hypothesis  with  p 
=  .001.  thus  indicating  a  greater  ability 
to  cope  by  the  mothers  receiving  the 
planned  teaching.  The  total  achieve- 
ment scores  of  each  objective  were 
analyzed  using  the  Fisher  Exact  Proba- 
bility Test,  resulting  in  5  of  the  20  ob- 
jectives achieving  significance  at  the 
.05  level. 

As  4  of  the  control  subjects  received 
routine  written  instructions  before  dis- 
charge from  one  hospital,  the  evalua- 
tion scores  of  these  were  compared 
with  the  remaining  control  subjects 
using  the  Mann-Whitney  U  test.  No 
significant  difference  was  found,  sug- 
gesting the  ineffectiveness  of  written 
instmctions  without  explanatory  verbal 
instmctions  as  well.  Selected  personal 
characteristics  of  the  subjects  and  their 
children  provided  a  description  of  the 
study  population. 

The  study's  findings  suggested  that 
there  is  a  lack  of  planned  patient  teach- 
ing in  emergency  departments,  al- 
though literature  sources  indicate  that 
such  teaching  is  necessary  if  patients 
and  their  families  are  to  assume  full 
responsibility  for  their  own  care. 

The  study  recommends  that  nurse 
practitioners  be  made  aware  of  their 
teaching  function  and  be  encouraged  to 
achieve  competence  and  confidence  in 
this  function  through  inservice  pro- 
grams. 


Mcintosh,  Kathleen./!  study  of  the  effect 
of  immediate  videotape  feedback  on 
nurses'  interpersonal  skill.  Van- 
couver. B.C..  1972.  Thesis  (M.A. 
(Ed))  Simon  Eraser  University. 

This  study  examines  the  effect  of  im- 
mediate video  feedback  on  the  interper- 
sonal skills  of  nurses.  Interpersonal 
skill  was  measured  by  two  criteria:  a  set 


of  specific  behavioral  responses,  de- 
veloped by  Parsons,  and  the  set  of  core 
dimensional  behaviors  of  Carkhuff  and 
Berensen  (4  qualities  exemplifying 
therapeutic  interactions:  empathy,  re- 
spect, genuineness,  and  concreteness). 

Recent  literature  suggests  videotape 
feedback  is  a  potentially  powerful 
agent  for  changing  behavior,  but  that 
the  use  of  videotape  feedback  is  rela- 
tively untested. 

Four  hypotheses  were  tested. 

Hypothesis  I  —  All  students  will 
improve  in  interpersonal  skill  in  a 
situation  that  is  supervised,  indepen- 
dent of  the  effect  of  videotaped  feed- 
back. 

Hypothesis  2  —  Students  who  have 
immediate  videotaped  feedback  of  their 
interviews  with  patients  will  show 
more  improvement  than  the  students  in 
the  control  group. 

Hypothesis  3  —  Improvement  in  the 
set  of  specific  responses  will  be  accom- 
panied b\  improvement  in  the  core  di- 
mensions. 

Hypothesis  4  —  The  experience  of 
receiving  videotaped  feedback  in  the 
clinical  practice  period  will  have  a 
negative  effect  on  the  nurse  initially 
and  a  p^isitive  effect  later. 

Although  data  presented  failed  to 
support  hypotheses  2  and  3.  the  treat- 
ment as  a  whole  effected  change  in 
nurses"  interpersonal  skills  as  reflected 
in  response  ratings.  Furthermore, 
nurses  perceived  immediate  videotape 
feedback  as  productive  and  attributed 
attitude  and  behavior  change  to  it. 

Further  investigations  must  deal  with 
two  possible  limitations  of  this  study: 
the  short  treatment  time  and  the  need 
for  continual  refinement  of  instru- 
ments. 


Schilder,  Erna  J.  Time  perception  pre- 
and  post-body  temperature  eleva- 
tion. Seattle.  Wash..  1974.  Thesis 
(M.A.)  U.  of  Washington. 

This  was  an  exploratory  study  of  ex- 
perimental design  to  investigate  the  ef- 
fect of  body  temperature  elevation  on 
the  perception  of  time.  Time  estimation 
by  the  method  of  production  was  done 
(Continued  on  page  52) 


THE  CANADIAN  NURSE  —  Auausl  1975 


research  abstracts 


(Continued  from  page  51) 


before,  during,  and  after  body  tempera- 
ture elevation. 

Ten  healthy  female  volunteers  were 
asked  to  estimate  one  minute  of  clock 
time.  An  elevation  of  body  temperature 
was  achieved  by  dressing  the  subjects 
in  a  special  garment  that  allowed  for 
perfusion  of  the  suit  by  water  from  a 
Temperature  Circulator. 

After  an  initial  lO-minute  rest 
period,  during  which  the  circulating 
water  temperature  was  held  constant, 
the  body  garment  was  perfused  with 
water  gradually  heated  toward  50°C. 
This  heating  period  took  35  minutes, 
after  which  time  water  temperature  was 
maintained  at  47°  C  for  a  further  15 
minutes. 

When  the  50  minutes  of  heating  the 
subject  had  elapsed,  a  rapid  return  to- 
ward initial  levels  of  skin  temperature 
was  attempted  by  circualting  cold  tap 
water  through  the  suit. 

The  oral  and  skin  temperatures  were 
registered,  using  a  telethermometer. 
Data  collection  of  skin  and  oral  temper- 
atures, pulse  rate,  and  circulating  water 
temperature  was  done  at  random  inter- 
vals ranging  from  2  to  9  minutes. 

Time  estimation  was  measured  by 
the  subject  starting  and  stopping  a 
stopwatch,  producing  what  she  felt  to 
be  one  minute  of  clock  time.  Time  es- 
timations were  done  at  the  outset,  and 
after  10,  66.  and  75  minutes  of  the 
study.  The  pulse  rate  was  measured  to 
monitor  the  heat  stress,  and  for  the 
subject's  safety. 

The  Pearson  Product- Moment  Cor- 
relation Coefficient  and  paired  /-test 
were  used  to  analyze  selected  data.  A 
weak  negative  correlation  was  evident 
between  oral  temperature  and  time  es- 
timation. The  paired  /-test,  used  to  de- 
termine the  statistical  significance  level 
for  time  estimations  prior  to  and  during 
body  temperature  elevation,  was  sig- 
nificant at  the  .005  level  (two-tailed  test 
with  9  degrees  of  freedom). 

The  findings  of  this  study  were  that, 
after  an  increa.se  in  body  temperature, 
subjective  time  shortened  when  com- 
pared to  clock  time.  Five  of  the  10 
subjects  demonstrated  a  further  reduc- 
tion in  this  subjective  minute  after  the 
oral  temperature  had  decreased  toward 
its  initial  level  by  the  termination  of  the 
study  (75  minutes). 

Although  generalizations  cannot  be 
made  from  the  results  of  this  study,  and 
the  limited  parameters  that  were  mea- 
sured allow  only  a  precursory  view,  the 
findings  support  reported  data  by  other 
investigators  and  point  to  the  potential 


usefulness  of  time  perception  in  both 
the  assessment  of  patients  and  in  the 
planning  of  nursing  interventions. 

Balchelor,  Grace  lohnston.  Accuracy  of 
emergency  department  staff  in  clas- 
sifying the  urgency  of  patients. 
Edmonton,  Alta.,  1974.  Thesis 
(M.H.S.A.)U.  of  Alberta. 

Numerous  authors  have  proposed  in- 
stituting a  patient  sorting,  or  triage,  sys- 
tem. At  the  same  time,  there  is  a  pauc- 
ity of  infomiation  on  the  effect  of  train- 
ing and  experience  on  the  ability  of 
persons  to  sort  emergency  department 
patients.  Consequently,  this  study  was 
designed  to  investigate  the  accuracy  of 
emergency  department  clerks,  nurses, 
and  physicians  in  classifying  patients" 
conditions  as  emergent,  urgent,  or 
nonurgent.  These  classification 
categories  have  been  widely  used  in  the 
literature,  and  their  criteria  were  more 
comprehensive  than  other  emergency 
department  patient  classifications. 

A  second  component  of  the  study 
was  the  examination  of  an  indirect 
measure  of  the  patient's  perception  of 
the  urgency  of  his  own  condition. 

The  study  was  carried  out  in  2 
Edmonton  emergency  departments  in 
June  1973.  The  nonrandom  patient 
sample  was  restricted  to  patients  seen 
by  emergency  physicians  in  no  more 
than  7  consecutive  24-hour  days.  The 
study  was  not  carried  out  at  the  same 
time  in  both  hospitals.  The  clerk's  as- 
sessment and  the  indirect  measure  of 
the  patient's  perception  of  urgency  was 
only  obtained  for  one  of  the  two  hospi- 
tals. 

The  estimate  of  "true  urgency," 
which  was  used  to  calculate  the  accu- 
racy of  the  staff  and  patient  assess- 
ments, was  the  rating  assigned  inde- 
pendently by  at  least  two  of  three 
physicians  who  reviewed  the  patient 
records.  These  "panel"  physicians  did 
not  agree  unanimously  on  their  urgency 


Registered  Nurses 

Your  community  needs  the  benefit 
of  your  skills  and  experience.  Volun 
teer  now  to  teach  Patient  Care  in 
The  Home  and  Child  Care  in  The 
Home  Courses.  ^^ 

contact 


ratings  for  almost  half  of  the  patient 
records.  Most  of  the  patients  were  clas- 
sified urgent  or  nonurgent. 

Kendall's  correlation  coefficients, 
percentages  of  agreement,  and  chis- 
quare  goodness  of  fit  tests  were  used  to 
measure  the  agreement  of  the  staff  and 
patient  ratings  with  the  "true  urgency" 
estimates.  No  significant  differences 
were  apparent  between  the  accuracy  ot 
the  emergency  physician,  nurse,  and 
the  indirect  patient  urgency  ratings. 
The  ability  of  the  clerk  closely  ap- 
proached that  of  the  other  staff,  a! 
though  she  tended  to  be  more  conserva- 
tive in  her  assessments.  Experience  did 
not  appear  to  influence  the  accuracy  of 
the  staff. 

The  sampling  design  of  this  stud\ 
was  inadequate  for  the  generalization 
of  the  findings.  Although  the  ability  ot 
the  staff  to  classify  patients  was  meas- 
ured, an  actual  triage  situation  was  not 
simulated. 

The  findings  of  this  study  demon- 
strate the  need  for  refinement  of  "true 
urgency"  criteria,  more  extensive  ex- 
amination of  factors  infiuencing  the 
ability  of  staff  to  classify  patients,  and 
further  investigation  into  the  accuracy 
of  the  patients  to  categorize  them- 
selves. 


Connors,  John  |.  G.  Alberta's 
emergency  air  ambulance  service. 
Edmonton,  Alta.  1975.  Paper 
(M.H.S.A.)  U.  of  Alberta. 

This  study  is  a  critical  analysis  of 
Alberta's  Emergency  Air  Ambulance 
Service  from  its  inception  to  the  pres- 
ent. Alberta's  service  is  placed  in  na- 
tional perspective,  involving  a  review 
of  all  the  principal  air  ambulance  ser- 
vices in  Canada.  Alberta's  current 
Emergency  Air  Ambulance  Service  al- 
ternatives are  compared,  and  the  alter- 
native of  choice  is  outlined  and  substan- 
tiated. 

The  author  concludes  that  the  de- 
velopment of  Alberta  and  Canadian  air 
ambulance  services  has  been  slow, 
fragmented,  and  has  evolved  largely  in 
isolation  from  other  developments  in 
the  related  areas  of  patient  transporta- 
tion and  emergency  medical  care.  He 
recommends  that  Alberta  should  de- 
velop a  comprehensive  patient  trans- 
portation and  emergency  care  policy, 
one  which  would  include  a  revitalized 
emergency  air  ambulance  service,  pro- 
vided primarily  through  "ad  hoc"  and 
contract  use  of  charter  carriers.        •-/•■ 


books 


Nursing  Concepts  for  Health  Promotion 

by  Ruth  Murray  and  Judith  Zentner. 
383  pages.  Englewood  Cliffs,  N.J., 
Prentice-Hall.  1975. 
Reviewed  by  Norma  E.  Thurston. 
Instructor,  Faculty  of  Nursing.  Uni- 
versity of  Calgary,  Calgary.  Al- 
berta. 

"We  believe  the  nurse  must  consider 
the  total  health  of  the  person  and  fam- 
ily.... Increasingly  your  emphasis  must 
be  on  comprehensive  health  promotion 
rather  than  on  patchwork  remedies." 
These  statements  introduce  the  reader 
to  the  basic  premise  that  health  care 
should  be  provided  from  a  broad  pers- 
pective of  wellness  and  that  the  nurse's 
role  should  be  one  of  advocacy. 

The  authors  present  a  unique  and 
practical  approach  to  the  application  of 
nursing  knowledge  for  the  patient,  the 
family,  and  the  community  in  a 
pluralistic  society.  They  have  recog- 
nized the  need  for  guidelines  focusing 
on  health  promotion,  in  keeping  with 
current  altitudes  and  trends  toward  pre- 
vention rather  than  cure. 

The  book  is  exciting  because  of  its 
empirical  approach  and  the  relevancy 
of  material  presented.  It  is  divided  into 
two  units,  the  first  of  which  provides  a 
framework  for  health  promotion.  Top- 
ics include  the  nursing  process, 
therapeutic  communication,  health 
teaching,  and  health  care  systems.  Def- 
initions receive  particular  attention.  A 
wide  variety  of  reference  sources  is 
evident,  providing  depth  and  scope  to 
the  topics  discussed.  The  emphasis  on 
chapters  relating  to  epidemiology, 
adaptation  (including  biological 
rhythms),  and  crisis  theories  is  excel- 
lent. 

The  second  unit  discusses  major  in- 
fluences on  the  person  in  today's  com- 
plex society,  including  environmental, 
cultural,  religious,  and  social  factors. 
Material  concerning  environmental 
pollution  with  nursing  implications  is 
meaningful  and  timely.  In  discussions 
on  communication,  families,  and  life- 
styles, the  authors  have  interwoven 
concepts  from  outside  disciplines. 

The  book  is  interesting,  logical,  and 
easily  read;  examples  and  case  studies 
are  used  effectively.  Particularly  nota- 
ble are  behavioral  objectives  for  the 


reader,  listed  at  the  beginning  of  each 
chapter.  Canadian  readers  will  need  to 
make  the  necessary  adaptations  to  mesh 
our  health  care  practices  with  American 
ones  discussed. 

This  book  is  not  intended  to  replace  a 
nursing  fundamentals  text:  topics  such 
as  charting,  skill  performance,  and  ill- 
ness care  are  omitted.  It  would  be  an 
excellent  basic  textbook  for  a  bac- 
calaureate curriculum  focusing  on 
health  promotion  or  for  reference  read- 
ing in  agencies  where  this  emphasis  is 
seen  as  a  major  nursing  responsibility. 
The  authors'  unique  and  comprehen- 
sive philosophy  of  heahh  care  should 
stimulate  practitioners  to  consider  these 
suggestions  in  their  performance  of 
nursing  care. 


Bed  Wetting:  Origins  and  Treatment  by 

Warren  R.  Bailer.  124  pages.  To- 
ronto. Pergamon  Press.  Inc..  1975. 
Reviewed  by  Frances  M. 
Chinchilla.  Lecturer.  School  of 
Nursing.  University  of  Manitoba. 
Winnipeg,  Man. 

The  main  purpose  of  this  book  is  to 
stress  the  detrimental  effects  to  person- 
ality that  may  result  from  nocturnal 
enuresis  (bed-wetiing)  and  to  provide 
evidence  that  the  habit  can  be  corrected 
in  a  high  percentage  of  cases. 

The  book  is  divided  into  three  parts. 
The  first  part  deals  with  the  nature  and 
origins  of  bed- wetting  and  the  experi- 
ence of  being  a  bed  welter.  The  second 
pari  discusses  the  methods  of  treatment 
and  the  behavior  developments  that 
emerge  as  enuresis  is  corrected.  The 
last  section  provides  information  on  the 
psychological  dynamics  that  relate  to 
the  effectiveness  of  methods  of  treat- 
ment and  how  professional  persons  can 
cooperate  in  reducing  the  incidence  of 
bed-wetting. 

The  topics  presented  first  are  of  im- 
mediate concern  to  the  bed  welters  and 
their  families.  Topics  of  less  immediate 
concern  are  included  in  later  chapters. 
Each  chapter  is  interesting  and  informa- 
tive. Actual  cases  are  presented  from 
the  author's  experience. 

Since  the  achievement  of  self-esteem 
is  measured  by  the  individual's  accom- 
plishments, for  many  the  shame  and 


embarrassment  accompanying  enuresis 
is  indeed  difficult.  Evidence  provided 
supports  the  causes  of  bed- welling  to  be 
largely  psychological.  There  is  a  lack 
of  evidence  to  support  the  idea  that  the 
child  uses  bed-wetting  to  alliact  atten- 
tion or  to  be  spiteful. 

The  family  of  the  bed  welter  plays  a 
critical  role.  Without  family  participa- 
tion under  the  guidance  of  a  profes- 
sional counselor,  treatment  is  not  likely 
to  be  successful. 

In  reading  the  book,  one  gets  the 
feeling  of  involvement  with  the  sub- 
ject. The  distressing  amount  of  ignor- 
ance about  the  causes  of  bedwetting 
and  the  cruel  treatment  to  which  bed 
welters  have  been  subjected  encourage 
the  reader  to  increase  her  knowledge 
about  the  problem. 

The  book  is  easy  to  read,  and  the 
ideas  are  clearly  discussed.  It  is  suitable 
for  the  general  reader  and  for  the  pro- 
fessional person  who  is  involved  with 
the  problem  of  enuresis  or  working  in 
areas  of  child  and  adolescent  develop- 
ment. It  would  be  of  particular  interest 
for  individuals  in  the  health-related 
professions  and  as  a  reference  for  stu- 
dents in  the  health  field,  as  well  as  in 
areas  of  professional  education. 


Infection  Control  in  the  Hospital  3ed .  by 

American  Hospital  Association.  198 
pages.  Chicago.  American  Hospital 
Association.  1974. 
Reviewed  by  William  Munro,  Direc- 
tor of  Nursing.  County  of  Bruce 
General  Hospital,  Walkerton,  Ont. 

I  am  sure  that  most  nurses  have  had 
questions  about  infection  control  in 
their  work  —  questions  that  were  never 
answered  or  that  were  not  answered 
adequately.  This,  of  course,  is  inevit- 
able. However,  this  updated  handbook 
will  answer  many  questions,  and  may 
change  altitudes  toward  infection  con- 
trol. 

Like  its  predecessors,  this  book  con- 
tains solutions  for  the  management  of 
infection  problems.  This  edition  is  up- 
to-date;  it  deals  with  problems  that  have 
existed  for  years,  and  with  those  that 
have  been  discovered  or  created  more 
(Continued  on  page  54) 


THE  CANADIAN  NURSE  —  AugusI  1975 


53 


books 

(Continued  from  page  53) 

recently.  "The  sections  on  hemo- 
dialysis units,  carpeting,  fogging,  and 
laminar  How  are  completely  new.'" 

Generally,  the  book  presents  excel- 
lent solutions  for  infection  control 
problems,  in  a  concise  and  explicit 
manner.  You.  too.  can  be  maximally 
effective  in  the  control  of  nosocomial 
infections. 


Nurses  in  practice,  edited  by  Marcel  la 
Z.  Davis.  Marlene  Kramer,  and 
Anselm  L.  Strauss.  273  pages.  St. 
Louis.  Mosby.  1975. 
Reviewed  t>y  Jean  E.  Fry.  Lecturer 
in  Nursing.  McMaster  University, 
Hamilton.  Ontario. 

Davis.  Kramer,  and  Strauss  state  that 
their  reason  for  presenting  this 
overview  of  nursing  is  to  provide  a 
perspective  (the  work  situation)  for 
critically  examining  nursing,  its 
practitioners,  and  the  care  that  they 
give.  Their  goal  in  doing  so  is  to  extract 
guidelines  for  nurse  education  that 
would  influence  and.  ultimately, 
iinprove  health  care. 

According  to  the  authors,  the  nurse's 
role  and  how  the  nurse  functions  are 
largely  influenced  by  the  physical 
context  in  which  she  finds  herself  and 
by  informal  arrangements  made  with 
those  with  whom  she  works;  she  may, 
therefore,  function  very  differently  and 
exercise  varying  levels  of  autonomy  as 
her  work  context  shifts.  The  work 
situations  considered  fall  within  two 
general  categories:  intra-  and 
extra-hospital. 

Within  the  hospital,  the  focus  is  on 
various  categories  of  worker  and  the 
complexity  of  interrelationships  within 
the  hierarchical  structure.  Possible 
conflicts  of  interest  and  philosophy, 
which  inay  be  encountered  and  which 
demand  priority  setting  by  the  nurse, 
are  discussed. 

Also  considered  are  the  nurses'  roles 
in  various  community  settings,  the 
types  of  illness,  and  the  attendant 
problems  encountered.  The  final 
section  deals  with  problems  of  social 
isolation  among  patients. 

The  authors  have  presented  a  broad 
view  of  nursing  as  practiced  in  many 
settings  and  as  influenced  by  internal 
and  external  variables.  While  the 
content  of  the  section  dealing  with 
social  isolation  was  valuable  and  had 
implications  for  nursing,  it  failed  to 
meet  the  slated  purpose  of  dealing  with 
the     "work    of  nurses    in    variety    of 


settings"  and  "providing  a  perspective 
for  looking  at  and  talking  about  the 
practice  of  nursing  in  the  context  of 
work  environments." 

Nurses  in  Practice  would  be  useful 
to  students  and  teachers  of  nursing.  For 
students  and  young  graduates,  it 
provides  in  one  book  a  general 
overview  of  nursing  as  it  is  practiced  in 
a  variety  of  real  life  situations.  It  could 
provide  the  beginning  practitioner  with 
the  mental  preparation  required  to 
make  a  choice  of  nursing  area  and  with 
a  critical  focus  to  bring  to  the  work 
situation. 

It  would  be  especially  valuable  to 
bedside  nurses  who  recognize  the  need 
for  and  who  are  interested  in  improving 
nursing  care,  but  who  think  they  lack 
the  skills  needed  to  contribute  to 
research.  By  providing  them  with  a 
description  of  how  fieldwork  is  carried 
out  in  the  clinical  setting,  these  nurses 
might  be  encouraged  to  make  greater 
contributions  to  clinical  research. 


Every  OR  Supervisor  Should  Know  by 

Rose  Marie  McWilliams,  Helen 
Wells,  and  June  Pellet.  498  pages. 
Denver,  aorn.  Inc.,  1974. 
Reviewed  by  Mary  Rickwood,  Clini- 
cal Co-ordinator,  Operating  Room, 
Toronto  General  Hospital.  Toronto, 
Ontario. 

The  purpose  of  the  manual  is  to  make 
the  operating  room  supervisor  and  the 
potential  operating  room  supervisor 
aware  of  various  management  skills. 


Seeking  Employment? 

Do  you  know  how  to  apply  anonymously  to 
protect  your  existing  position;  apply  to  organiza- 
tions that  appeal  to  you  but  are  not  adverlising:  or 
employ  follow  up  letters  to  enhance  your  ctiances 
of  success? 

The  answers  to  these  and  many  more  questions 
can  be  found  in  our  informative  publication  Suc- 
cessful Job  Search  Techniques. 

It  also  describes  and  gives  examples  of  how  to 
compose  application  letters,  formulate  a  portfolio 
of  proof,  answer  correspondence  correctly,  pre- 
pare r6sum6s.  write  covering  letters,  and  even 
compose  your  letter  of  resignation. 

Take  a  professional  approach 

to  furthering  your  career! 

Send  $4  00  by  cheqije/money  order  to: 

Career  Development  Service.  Den!.  931, 

INTERNATIONAL  BUSINESS  SERVICES 

Post  Office  Box  1292,  Postal  Station  "A", 

Toronto,  Ontario,  CANADA  M5W  1G7 


and  to  assist  in  the  development  of 
those  skills  applicable  to  her  own  work 
situation. 

The  manual  is  divided  into  four  sec- 
tions: What  is  Management?,  Man- 
agement in  the  Operating  Room,  Man- 
agement of  People,  and  Management 
of  Things.  Each  section  begins  with  a 
brief  outline  of  the  subject  by  the  au- 
thors. The  remaining  material  is  a  col- 
lection of  articles  reprinted  from 
American  management,  hospital,  nurs- 
ing, and  medical  journals. 

In  discussing  management,  the  arti- 
cles highlight  principles  and  their  prac- 
tical applications.  One  author  states 
that  it  is  important  that  a  manager  rec- 
ognise the  need  to  define  clearly  her 
role  in  a  particular  situation  at  a  particu- 
lar time,  rather  than  concentrate  on  de- 
veloping one  specific  leadership  style 
for  all  occasions.  [ 

The  manual  includes  material  on  all 
aspects  of  operating  room  manage- 
ment, from  philosophy  and  objectives 
to  product  evaluation.  The  headings  in 
the  manual  could  be  used  as  a  basis  for 
compiling  an  operating  room  manual, 
and  the  procedures  and  forms  could  be 
adapted  to  any  operating  room. 

By  presenting  so  much  material  in 
one  volume  of  498  pages,  the  authors 
tend  to  overwhelm  the  reader.  The  sub- 
ject matter  in  the  articles  is  pertinent 
and  current,  but  tends  to  stand  alone, 
preventing  any  progressive  develop- 
ment of  a  topic. 

The  manual  succeeds  in  covering  all 
the  management  skills  required  by  an 
operating  room  supervisor.  A  new 
operating  room  supervisor  could  use 
the  principles  presented  to  assist  her  in 
compiling  the  written  policies  and  pro- 
cedures that  must  be  available  in  every 
operating  room.  For  the  experienced 
operating  room  supervisor,  the  volume 
provides  a  complete  reference  manual 
to  use  in  evaluating  or  revising  her  ex- 
isting departmental  guidelines. 


Pediatric  orthopedic  nursing  by  Nancs 
E.  Hilt  and  E.  William  Schmitt,  Jr 
248  pages.  St.  Louis,  Mosby,  1975. 
Canadian  Agent:  Mosby,  Toronto. 
Reviewed  by  Mary  Willsher.  In- 
structor in  Pediatric  Nursing.  Al- 
gonquin College  School  of  Nursing. 
Ottawa.  Ontario. 

This  book  describes  how  to  plan  for  the 
needs  of  children  who  have  common 
orthopedic    diseases    and    disorders 


Nursing  care  plans  are  described  for 
children  of  different  age  groups  with 
the  various  casts  and  traction  that  are 
used  to  correct  these  conditions.  The 
philosophy  of  family-centered  nursing 
care  is  evident  in  all  the  nursing  care 
plans  for  the  child:  the  admission  to 
hospital,  diagnostic  tests  and  treat- 
ments, and  the  plan  for  home  care. 

There  is  a  brief  review  of  the 
anatomy  and  physiology  of  the  mus- 
culoskeletal system.  The  authors  have 
outlined  the  kinds  of  information  that 
nurses  should  know ,  such  as  the  normal 
range  of  motion  of  normal  joints. 
Common  orthopedic  diseases  are  de- 
scribed briefly.  There  is  an  extensive 
bibliography  that  provides  a  wide 
choice  from  which  the  nurse  can 
broaden  her  knowledge. 

Throughout  the  text,  Nancy  Hilt  de- 
scribes techniques  that  have  been  suc- 
cessful in  her  experience.  For  instance, 
she  describes  a  program  for  physical 
education  instructors  in  grade  school 
and  high  school,  which  was  successful 
in  the  early  recognition  of  scoliosis. 

TheCircOlectricbed,  Strykerframe, 
and  Bradford  frame  are  examples  of 
special  equipment  described  with  il- 
lustrations. There  are  instructions  on 
how  to  construct  a  Bradford  frame,  a 
spica  bug,  and  a  wagon;  these  would  be 
useful  to  hospital  maintenance  depart- 
ments and  to  home  handymen. 

There  are  illustrations  of  the  casts, 
splints,  and  traction  used  in  the  care  and 
treatment  of  children.  The  nursing  care 
includes  plans  for  all  the  standard  types 
of  casts,  which  nurses  in  general 
pediatric  units  and  specialized  or- 
thopedic pediatric  units  could  alter  to 
their  own  specific  needs. 

The  book  includes  instructions  for 
parents  on  the  home  care  of  the  child  in 
a  spica  cast.  Public  health  nurses 
should  find  these  objectives  useful  in 
providing  continuity  of  care. 

Student  nurses  will  find  the  many 
illustrations  of  nursing  techniques  use- 
ful, such  as  evaluating  neurovascular 
status  and  petalling  a  cast  edge  with 
adhesive  tape.  There  are  many  exam- 
ples of  how  to  use  the  principles  of 
growth  and  development  in  meeting  the 
needs  of  different  age  groups.  In  this 
respect,  the  authors  support  the  need  to 
treat  as  a  specialty  the  care  of  children 
with  orthopedic  conditions. 

There  is  no  question  that  there  is  a 
need  for  a  reference  text  on  pediatric 
orthopedic  nursing.  The  need  has  been 
well  met  by  Nancy  Hilt  and  E.  William 
Schmitt.  The  content  of  their  book  fol- 


lows a  logical  sequence  and  is  easily 
understood. 

As  a  teacher,  1  recommend  this  text 
for  students  and  nurses  in  hospital  and 
community;  it  can  be  u.sed  as  a  tool  to 
evaluate  nursing  care. 


Physics  for  the  Health  Sciences  by  Carl 
R.  Nave  and  Brenda  C.  Nave.  300 
pages.  Toronto,  Saunders  Canada 
Ltd.,  1975. 

Reviewed  by  Helene  Wieler. 
Teacher,  Grace  General  Hospital 
School  of  Nursing,  Winnipeg.  Man. 

The  preface  indicates  that  this  book  is 
intended  for  use  in  a  one-semester 
course  early  in  the  studies  of  students 
who  do  not  intend  to  major  in  physics, 
yet  require  basic  knowledge  of  the  sub- 
ject. The  authors  propose  to  accom- 
plish the  teaching  by  presenting 
principles,  indicating  where  these 
principles  are  applicable,  and 
providing  problems  for  practice. 

Technical  terms  are  explained  as 
they  are  used.  Principles  are  interwo- 
ven with  the  rest  of  the  text  and.  hence, 
are  difficult  to  find.  It  would  be  helpful 
if  the  principles  were  highlighted  or 
listed  at  the  beginning  of  the  chapter. 
Applications  are  cleariy  lalieled; 
they  seem  appropriate  to  problems 
commonly  encountered  by  health  per- 
sonnel. Sample  problems  are  worked 
out.  both  in  the  body  of  the  text  and  at 
the  end  of  each  chapter.  Additional 
problems  are  presented  for  practice; 
answers  are  at  the  back  of  the  text.  This 
arrangement  should  provide  enough 
practice  to  ensuie  minimal  compe- 
tence. 

The  standard  order  of  contents,  used 
for  physics  textbooks,  is  used.  A  list  of 
educational  objectives,  expressed  in 
behavioral  terms,  is  found  at  the  begin- 
ning of  each  chapter.  Data  is  presented 
in  short  sections,  labeled  with  a  bold 
headline.  Liberal  use  is  made  of  tables, 
diagrams,  and  line  drawings  to  clarify 
the  "text.  These  drawings  feature  rele- 
vant data  only.  Applications,  which  fol- 
low discussion  of  the  principles,  per- 
tain to  real  problems,  such  as  ascertain- 
ing the  weight  of  a  patient  who  cannot 
bemoved  from  his  bed  or  the  effects  of 
inadequate  grounding  when  monitoring 
patients,  or  why  it  is  more  effective  to 
pump  brakes  than  to  slam  them  on. 

Salient  facts  are  summarized  at  the 
end  of  each  chapter.  A  variety  of  re- 
view questions  follows  the  summary. 


These  review  questions  repeat  the  stu- 
dents" previous  experience.  For  in- 
stance, the  questions  in  the  chapter  on 
heat  energy  concern  cool,  damp  base- 
ments; bottles  with  stuck  stoppers;  the 
use  of  silver  on  vacuum  flasks;  and  the 
effects  of  insulation  on  houses.  Each 
chapter  also  presents  problems  involv- 
ing the  use  of  formulae  and  mathema- 
tics. The  chapter  concludes  with  refer- 
ences ranging  from  1 944  to  1 974;  med- 
ical references  tend  to  be  the  oldest. 

The  arrangement  of  the  book  lends 
itself  to  a  variety  of  purposes.  By  in- 
cluding the  suggested  laboratory  exer- 
cises and  requiring  solutions  to  the 
problems  posed  in  each  chapter,  a  fairly 
rigorous  course  could  be  set  up.  A  less 
demanding  program  could  delete  the 
formulae  and  mathematics,  dwelling 
instead  on  general  principles. 

The  chapter  summaries  and  bold 
headlines  within  the  chapter  make  it 
easy  for  someone  who  wishes  to  use 
selected  sections  only .  It  is  for  the  latter 
purpose  that  1  would  see  this  book  most 
widely  used  in  a  diploma  school  of 
nursing. 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses'  Association  Library 
are  available o/i  loan  —  with  the  excep- 
tion of  items  marked  R  —  to  CN.\  mem- 
bers, schools  of  nursing,  and  other  in- 
stitutions. Items  marked  R  include  re- 
ference and  archive  material  that  does 
not  go  out  on  loan.  Theses,  also  R,  are 
on  Reserve  and  go  out  on  Interlibrary 
Loan  only. 

BOOKS  AND  DOCUMENTS 

I  Akhlar.  Shahid.  Health  care  in  the  People's 
Republic  of  China:  a  bibliography  with  abstracts. 
Introduction  by  J.  Wendell  MacLeod.  Ottawa. 
International  Development  Research  Centre. 
CI97.S.  IK2p. 

2.  Bergman.  Rebecca  et  al.  Work-life  of  the  Is- 
raeli registered  nurse.  Tel-Aviv.  Dept.  of  Nurs- 
ing. Tel-Aviv  University.  1974.  64p. 
i.  Blackburn.  Marc  et  al.  Comment  rediger  un 
rapport  de  recherche.  5ed..  Montreal.  Lemac. 
cl974.  72p. 

4.  Boileau.  Jacqueline.  Puericulture.  Montreal. 
Renouveau  Pedagogique.  cl97l.  I7.^p. 

5.  Canadian  Library  Association.  .Annual  con- 
ference, proceedings  1974   Ottawa.  1974.  l7.Sp. 

6.  Cholelte-Perusse.  Fran?oise.  La  se.xualite 
expliquee  au.x  enfants:  quoi  dire,  comment  le 

(Continued  on  page  56) 


IHE  CANADIAN  NURSE  —  Aiioust  197S 


accession  list 


(Continued  from  page  55) 


dire.  Montreal.  Edilions  du  Jour.  cl965.  159p. 

7.  Un  Colloque  sur  la  Garderie  de Jour au  Service 
de  la  Famille  Moderne,  Ottawa  29-30  seplembre 
1969.  Procei-verhal.  Publication  autorisee  par  le 
ministre  de  la  Sanle  nationale  et  du  Bien-etre 
social  Ottawa.  Information  Canada.  1974.  71p. 

8.  Conference  on  Health  Care  and  Changing 
Values.  Institute  of  Medicine,  1973.  Eihics  of 
health  care.  Washington.  D.C.  National 
Academy  of  Sciences.  1974.  3l3p. 

9.  Convention  liaison  manual:  a  working  guide 
for  successful  conventions.  Edited  by  Virginia  M. 
Lofft.  Philadelphia.  SM/Sales  Meetings  Machine 
for  Convention  Liaison  Committee.  cl972.  96p. 

10.  Dietrich.  Claude.  L' intelligence  s'apprend. 
Ce  que  vous  pouvez  faire  pour  favoriser  le 
developpement  intellectuel  de  vos  enfants. 
Adapte  par  Catherine  Chaine.  Paris.  Librairie 
Armand-Colin.  cl974.  112p.  (Special  parents 
no.  3) 

1 1.  Dreyer,  Sharon.  Bailey.  David  and  Doucet. 
Wills.  A  guide  to  nursing  management  of 
psychiatric  patients.  St.  Louis.  Mosby.  1975. 
246p. 

12.  Dupuy.  Jean-Pierre  et  Karsenty.  Serge. 
L'invasion  pharmaceutique.  Paris.  Editions  du 
Seuil.  1974.  269p.  (Collection  sociologie) 

13.  Farley.  Venner.  M.  First  level  nursing  work- 
hook.  Seal  Beach.  California,  Walleur,   1975. 

.  14..  Fish,  Elizabeth,  J.  Surgical  nursing.  Rev 
8ed.  London,  Bailliere,  Tindall,  1974.  384p. 
(Nurses'  aids  series) 

15.  Filzpatrick,  M.  Louise.  The  national  organi- 
zation for  public  health  nursing.  1912-1952:  de- 
velopment of  a  practice  field.  New  York.  Na- 
tional League  for  Nursing,  c  1 975.  226p.  (Thesis  - 
Columbia) 

16.  General  Nursing  Council  for  England  and 
Wales.  Report.  London.  General  Nursing  Coun- 
cil for  England  and  Wales.  1974.  60p. 

17.  Gougeon.  Rejeanne  et  Sekely.  Trude. 
Alimentation  pour  futures  mamans.  Montreal. 
Editions  de  I'Homme,  cl973,  I52p. 

18.  Heroux-Menard.  Claire.  O.R.L.O.  Oto- 
rhino-laryngo-ophlalmologie.  Montreal.  Re- 
nouveau  de  I'Homme.  cl973.  152p. 

18.  Heroux-Menard.  Claire.  O.R.L.O.  Oto- 
rhino-laryngo-ophtalmologie.  Montreal.  Re- 
nouveau  Pedagogique.  cl970.  63p. 

19.  Hopital  general  de  Quebec.  Gerontologie. 
Montreal.  Renouveau  Pedagogique.  cl970.  79p. 

20.  Intensive  care  of  the  surgical  patient.  To- 
ronto. Saunders.  1975.  214p.  (The  nursing 
clinics  of  North  America,  v.  10.  no.  I.  Mar. 
1975) 

21.  International  Commission  on  the  Develop- 
ment of  Education.  Education  on  the  move.  Ex- 
tracts from  background  papers  prepared  for  the 
report  of  the.  .  .  Paris.  Unesco.  1975.  307p. 

22.  International  Senimar  on  the  Role  of  Tradi- 
tional Birth  Attendants  in  Family  Planning. 
Bangkok  and  Kuala  Lumpur.  19-26  July  1974. 
Proceedings.    Ottawa.    International    Develop- 


ment Research  Centre.  1974.  107p. 

23.  Kowalski.  Claude.  Laissez-les  peindre! 
Aidez  vos  enfants  de  moins  de  7  ans  a  s'e.xprimer 
par  la  peinture.  le  dessin,  le  hricolage.  Adapte 
par  Catherine  Chaine.  Paris.  Librairie  Armand- 
Colin.  cl974.   154p.  (Special  parents  no.  1) 

24.  Lambert-Lagace.  Louise.  Comment  nourir 
son  enfant.  Montreal.  Les  Editions  de  I'Homme. 
cl974.  245p. 

25.  Lautwein.  Theo  et  Sack,  Maria.  A  vous  de 
jouer  Ce  que  vous  pouvez  faire  pour  stimuler  le 
developpement  physique  de  vos  enfants  de  moins 
de  (5  ans.  Adapte  par  Anne  de  Vogue.  Paris, 
Librairie  Armand-Colin,  cl974  I09p.  (Special 
parents  no.  2) 

26.  Legrix,  Denise.  Vivre comme  les  autres.  Nee 
comme  (u  tome.  3.  Paris,  Kent  Segep,  cl974. 
228p. 

27.  Midenet,  M.  et  Favre.  J.P.  Psychiatrie infan- 
tile a  r usage  de  I'equipe  medico-sociale.  Paris, 
Masson,  1975.  204p. 

28.  Miller,  George  E.  ed.  and  Fulop  Tamas. 
Educational  strategies  for  the  health  professions. 
Geneva,  World  Health  Organization,  1974. 
106p.  (World  Health  Organization.  Public  health 
papers  no.  61) 

29.  National  League  for  Nursing.  Division  of 
Community  Planning.  Organizational  behavior, 
conflict  and  its  resolution.  Presentation  at  1972 
Seminar  for  Directors  of  ntirsing  senice  in  the 
west.  New  York.  cl974.  56p. 

30.  Never  done:  three  centuries  of  women's  work 
in  Canada,  by  Patricia  Davitt  et  al.  Toronto. 
Canadian  Women's  Educational  Press.  1974. 
150p. 

3 1 .  Order  of  Nurses  of  Quebec.  Brief  presented 
to  the  Superior  Council  of  Education  on  the  nurs- 
ing option  in  the  present  college  system. 
Montreal.  1974.  59p. 

32.  Organization  mondiale  de  la  Sante.  Manuel 
sur  les  besoins  nuiritionnels  de  I'homme. 
Geneve,  1974.  64p.  (Sa  Serie  de  Monographies 
no.  61) 

33.  Piternick.  Anne.  Comment  vous  procurer  les 
documents  qui  vous  manquem:  guide  d'obtention 
de  prets.  de  photocopies  ou  de  murocopies  des 
publications  scientifiques  et  techniques.  Ottawa. 
Conseil  national  de  recherches  Canada.  1973. 
52p. 

34.  How  to  get  what  you  don't  have:  a  guide  to 
obtaining  loans,  photocopies  or  microcopies  of 
sci-tech publications.  Ottawa.  National  Research 
Council  of  Canada.  1973.  53p. 

35.  Roodman.  Zelda  and  Roodman.  Herman  S. 
Effective  business  communication.  Toronto. 
Gregg  Division.  McGraw-Hill.  cl964    220p. 

36.  Salk.  Lee.  Preparing  for  parenthood:  under- 
standing your  feelings  about  pregnancy,  child- 
birth, and  your  baby.  New  York.  David  McKay. 
C1974.  206p. 

37.  Schwartz.  Anhur  N.  ed.  and  Mensh.  Ivan  N. 
Professional  obligations  and  approaches  to  the 
aged.  Springfield.  Charles  C.  Thomas.  cl974. 


38.  Seminar  on  Day  Care  —  a  Resource  for  ih 
Contemporary    Family.    Ottawa.    Septemhi 
29-30.  \969.  Papers  and  proceedings.  Published 
by  authority  of  the  Minister  of  National  Health 
and  Welfare.  Ottawa.  Information  Canada.  1974. 

39.  Simmons,  Janet  A.  Nursing  psychiatrique: 
guide  de  relation  infirmiere-client.  Montreal.  1 
editions  HRW.  1975.  212p. 

40.  Soeurs  de  la  Charite.  Services  de  same 
cTurgence.  Montreal.  Renouveau  Pedagogique, 
cl%7.  74p. 

41.  Symposium  on  Health  Care  Research.  M.i 
29-31.    1973   Calgary.    Alta.   Health  care   ;. 

search.  Proceedings.  Edited  by  Donald  E. 
Larsen  and  Edgar  L.  Love.  Calgary.  Alta.  Uni- 
versity of  Calgary  Bookstore.  cl974.  247p. 

42.  Touitou.  \van.  Pharmacie.  4ed.  Paris.  Mas- 
son. 1974.  273p. 

43.  Viel.     E.    Enseignement    des    disciplin, 
paramedicales.    Formation    des    cadres    hi 
pitaliers.  Paris.  Mas.son.   1974.   I66p.  (Monog- 
raphies de  I'ecole  de  cadres  de  kinesitherapie  de 
Bois-Larris  no.  4) 

44.  Warner.  Morton  M.  An  annotated  biblif 
raphy  of  health  care  teamwork  and  health  ceni 
development.  Vancouver.  Dept.  of  Health  Cai. 
and  Epidemiology.  University  of  British  Coluni 
bia.  1975.  274p.  (Project  T.E.A.M.) 

45.  Wilchenne.   Lucienne  et   Hudon  Louis-N. 
Comportement    professionnel:     deontolo^f 
Chicoutimi.   P.Q..   Editions  science  modern 
cl968.  I71p. 

46.  Wood.  Lucile.  A.  Nursing  skills  for  alln:. 
health  services,  volume  3.  Toronto.  Saunders. 
1975.  449p. 

PAMPHLETS  ' 

47.  American  Association  of  Operating  Room 
Nurses.  Inc.  Nursing  audit:  challenge  to  tin 
operating  room  nurse.  Denver.  Co..  c  1 974.  I8p 

48.  Association  of  Canadian  Community  Col-  | 
leges.   Annual    report.    1973/74.    Willowdale. 
Ont..  Association  of  Canadian  Community  d 
leges.  1974.  n.p. 

49.  Basic  Systems,  lt\c.  An.xiety.  identification  el 
intervention.    Traduction    fran^aise.    Moniq: 
Couture.  Quebec,  (ville)  Corporation  des  Inl 
mieres  et  Infirmiers  de  la  Region  de  Quebec, 
rive-nord,  Comite  d'Education.  1973.  c.  Amer    , 
J.  Nurs.  Co.  4lp.  (C.I.I.R.Q.  rive-nord.  En-  | 
seignemeni  programme) 

50. — .  Identification  precose  des  signes  d'uiu 
hemoragie  interne.  Traduction:  Lillian  Langkii^ 
el  Therese  Taylor.  Quebec  (ville).  Corporation 
des  Infirmieres  et  Infirmiers  de  la  Region  de 
Quebec,  rive-nord,  Comite  d'Education,  1973  ' 
c.  Amer.  J.  Nurs.  Co  1965.  24p  (C.l.l.R  i j 
rive-nord.  Enseignement  programme) 

5 1 .  College  of  Nurses  of  Ontario.  Report  of  /' 
directors.  1974.  Toronto,  College  of  Nurses 
Ontario,  1974.  n.p. 

52.  Educational    Design    Inc.    L'equilibre    . 
potassium   dans   I'organisme.    Quebec   (villi 


accession  list 


Corporation  des  Inflrmieres  el  Infimiiers  de  la 
Region  de  Quebec,  rive-nord,  Comile  de 
I'Educalion.  1973.  c.  Amer.  J.  Nurs.  Co.  1%7. 
35p.  (C.I.l.R.Q.  Enseignemeni  programme) 
53. — .  Pour  mieux  comprendre  Ihoslilile.  Rev. 
Traduction  fran^aise:  Claire  Calellier.  Quebec 
(ville).  Corporation  des  Infirmieres  et  Infirmiers 
de  la  Region  de  Quebec,  rive-nord,  Comite 
d'Educalion.  1974.  31p. 

54.  Federation  des  SPIIQ.  Dossiers  griefs. 
Quebec,  1975.  !5p. 

55.  Les  Infirmieres  et  Infirmiers  Unis.  Inc.  (Les 
resullats  de  /'  enquete  des  infirmieres  el  infirmiers 
unis).  La  motivation,  i organisation,  la  compila- 
tion, les  fails  saillants.  Montreal,  n.d.  I6p. 

56.  National  League  for  Nursing.  Report  1973. 
New  York.  National  League  for  Nursing.  1975. 
23p. 

57. — .  Report  of  the  Task  Force  to  study  the 
implications  of  the  recommendations  presented 
in  An  abstract  for  action.  New  York,  1972.  8p. 

58.  National  League  for  Nursing.  Dept.  of  Dip- 
loma Programs.  The  changing  role  of  the  hospital 
and  implications  for  nursing  education.  Papers 
presented  at  the  Annual  Meeting  of  the  Council  of 
Diploma  Programs  held  at  Kansas  City,  Missouri 
May  1-3.  1974.  New  York.  1974.  4lp. 

59.  National  League  for  Nursing.  Division  of 
Community  Planning.  Developing  strategies  to 
effect  change.  Presentations  at  the  1973  forum 
for  nursing  science  administrators  in  the  west. 
New  York.  National  League  for  Nursing.  1974. 
35p. 

60.  Paine.  Leslie.  Coordination  of  services  for 
the  mentally  handicapped.  London,  King 
Edward's  Hospital  Fund  for  London.  1974.  44p. 

61.  Peterson,  .Margaret  H.  Comprehension  des 
mecanismes  de  defenses.  Traduction  fran^aise: 
Claire  Calellier  et  al .  Quebec  (ville).  Corporation 
des  Intlrmieres  el  Infirmiers  de  la  Region  de 
Quebec,  rive-nord.  Comite  d'Education.  1973. 
c.  .Amer.  J.  Nurs.  Co.  1972.  Iv.  (unpaged) 
(C.I.l.R.Q..  rive-nord.  Enseignemeni 
programme) 

62.  Registered  Nurses'  Association  of  Ontario. 
Proposal  for  an  educational  program  for 
teachers  of  nursing  to  teach  registered  nurses 
long-term  care.  Toronto.  1974.  6p. 

63.  Riley.  Marilyn  and  MacLean.  Jean.  A  report 
to  the  Nova  Scotia  Health  Senices  and  Insurance 
Commission  as  the  Registered  Nurses'  .Associa- 
tion of  Nova  Scotia  concerning  the  need  for  staff 
development  programs  by  nursing  personnel  in 
our  hospitals,  Halifax.  1974.   18p. 

64.  Sallman.  Jules.  VD-epidemic  among  teen- 
agers. New  York.  Public  Affairs  Committee. 
cl974.  28p.  (Public  Affairs  Pamphlet  no,  517) 

65.  University  of  Manitoba.  School  of  nursing. 
The  nursing  process  with  a  guide  to  the  systema- 
tic assessment  of  the  health  status  of  an  indi- 
vidual. Winnipeg.  1974.  I2p. 

GOVERNMENT  DOCUMENTS 

Canada 


66.  Radio-Television  Commission.  List  of 
broadcasting  stations  in  Canada.  Ottawa,  Infor- 
mation Canada.  1975.  I83p. 

67.  Conference  of  Federal-Provincial  Ministers 
of  Health  Jan.  14-15.  1975.  Ottawa.  Final 
communique.  Ottawa,  Health  and  Welfare 
Canada,  1975.  14  items. 

68.  Conseil  des  sciences  du  Canada.  Les  options 
energetiques  du  Canada.  Ottawa,  Information 
Canada,  1975.  I5lp. (Son  Rappon  no.  23) 

69.  Conseil  economique  du  Canada.  Les  indi- 
cateurs  sociaux:  expose  analytique  et  cadre  de 
recherche,  par  D.W.  Henderson.  Ottawa,  Infor- 
mation Canada,  cl974.  90p. 

70.  Dept.  of  Indian  and  Northern  Affairs.  Re- 
port,   1973 f74.    Ottawa.   Information   Canada. 

1974.  86p. 

71.  Dept.  of  Labour.  Labour  organizations  in 
Canada.  Ottawa.  Information  Canada.  1974. 
160p. 

72.  —  Working  conditions  in  Canadian  indus- 
try. Ottawa.  Information  Canada.  1974.  109p. 

73.  — .  Womfn'ifcurfaH /974.  Ottawa.  Informa- 
tion Canada.  1975.  106p. 

74.  Dept.  of  Manpower  and  Immigration.  Re- 
port.   I973r74.    Ottawa.   Information   Canada. 

1975.  46p. 

75  Dept.  of  National  Health  and  Welfare. 
Health  Protection  Branch.  Committee  to  Con- 
sider Potential  Hazards  to  Operating  Room  Per- 
sonnel Consequent  to  Repeated  Exposure  to 
Anaesthetic  Gases.  Report  of  meeting  of  July  31 , 
1974.  Ottawa.  1974.  6p. 

76.  Government  Specifications  Board.  Glossary 
of  editorial  terms  in  general  use  in  the  graphic 
arts.  Ottawa.  1973.  20p. 

77.  Medical  Research  Council.  Report  of  the 
President.  Ottawa.  Information  Canada.  1974. 
20lp. 

78.  Metric  Commission.  Introduction  to  the  met- 
ric system.  Ottawa.  1974.  62p. 

79.  Statistics  Canada.  .Cental  health  statistics: 
patient  movement  Preliminary.  Ottawa.  Statis- 
tics Canada.  1975.  pam. 

80. — .  New  primary  sites  of  malignant  neo- 
plams  in  Canada  (as  reported  by  Provincial 
Tumour  Registries).  Ottawa.  Information 
Canada.  1972.  Iv. 

81.  —  A  short  guide  to  Canadian  universities 
and  colleges.  Ottawa.  Information  Canada. 
1974.  I34p. 

82.  — .  yital  statistics.  1973:  v.  I  Binhs.  v. 3 
Deaths.  Ottawa.  Information  Canada.  2v. 

83.  — .  La  statistique  de  I'etat  civil:  v.  I  nais- 
sances.  v. 3  deces.  Ottawa.  Information  Canada. 
2v. 

84.  Treasury  Board.  Operational  performance 
measurement.  Ottawa.  Information  Canada. 
1974.  2v. 

On  tario 

85.  Cancer  Treatment  and  Research  Foundation. 
Cancer  in  Ontario.  1973-1974.  Toronto,  Ontario 
Cancer  Treatment  and  Research  Foundation. 
1974.  250p. 


Saskatchewan 

86.  Department  of  Health. /J^-porf.  1973-74.  Re- 
gina.  Province  of  Saskatchewan.  Dept.  of 
Heahh.  1975.  93p. 

Toronto 

87.  Home  Care  Program  for  Metropolitan  To- 
ronto. Tenth  annual  report.  Toronto.  1974.  23p. 
United  States 

88.  Public  Health  Service.  The  health  consequ- 
ences of  smoking.  Bethesda,  Md.,  1974.  I24p. 
(DHEW  Publication  no.  (CDC)  74-8704) 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLEC- 
TION 

89.  Feeney,  Joanne.  A  study  of  information- 
processing  among  ambulatory  patients. 
Montreal,  McGill  University,  1972.  56p.  (Thesis 
(M.Sc(App))  -  1972)  R 

90.  Imai ,  Hisako  Rose.  Analysis  of  data  on  nurs- 
ing personnel  (CCDO  313  >  from  the  job  vacancy 
survey,  1st  quarter  1971  —  4th  quarter  1973. 
Ottawa,  Health  and  Welfare  Canada.  1974.  27p. 
(Health  manpower  report  no.  9-74)  R 

91.  Johnston.  Grace  (Baichelor)  Accuracy  of 
emergency  department  staff  in  classifying  the 
urgency  of  patients.  Edmonton.  1974.  lOOp. 
(Thesis  (MHSA)  -  Albena)  R 

92.  Lampart.  Rhona  Eudoxie.  Guidelines  to  as- 
sist in  decision-making  by  health  agency  person- 
nel regarding  utilization  of  the  cardio-pulmonary 
resuscitation  team.  Buffalo.  1972.  68p.  (Thesis 
(M.Sc.)  -  New  York)  R 

93.  Mcintosh.  Kathleen  Kerr.  A  study  of  the  ef- 
fect of  immediate  videotape  feedback  on  nurses' 
interpersonal  skill.  Vancouver.  B.C..  cI972. 
56p.  (Thesis  (MA  (EduO)  -  Simon  Eraser)  R 

94.  Power.  Denise  Mary  (Sommerfeld).  The  ef- 
fectiveness of  planned  teaching  of  mothers  with 
children  treated  in  emergency  departments.  Van- 
couver. 1972.  88p.  (Thesis  (M.Sc.N.)  -  British 
Columbia)  R 

95.  Robinson.  Harold  C.  Constant  care  and  the 
smaller  Ontario  community  Hospital.  Ottawa. 
1975.  69p.  (Thesis  (MHA)  -  Ottawa)  R 

96.  Schilder.  Erna  J.  Time  perception  pre-  and 
post-body  temperature  elevation.  Seattle.  Wash.. 

1974.  74p.  (Thesis  (M.A.)  -  Washington)  R 

97.  Shack,  Joyce  O.  Role  expectations  arut  per- 
ceptions of  the  director  of  nursing  role.  Boston, 
1974.  lOlp.  (Thesis  (M.S.)  -  Boston)  R 

AUDIO-VISUAL  AIDS 

98.  Association  des  Medecins  de  Langue 
fran^aise  du  Canada.  Sonomed.  serie  2.  no.  4. 
Montreal,  1974.  I  cassette.  Cote  A. 
.Medicaments  et  malformations.  Cole  B. 
Medicaments  el  malformations  (suite). 

99.  — .  Sonomed,  serie  2,  no.  5.  Montreal. 
1974.  I  cassette.  Cote  .\.  Pontages  coronariens 
(table  ronde).  Cole  B.  Infection    a  virus. 

100.  National  Library  of  Medicine. /"nmi/j/f. to/' 
indexing.  (Video  record)  Atlanta.  Ga..  National 
Medical  Audiovisual  Center.  1974.  2  tape  cass- 
eiles.  Syllabus  by  National  Library  of  Medicine. 


CANADIAN  NURSE  —  AuguSl  1975 


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residence  available  Salary  according  to  RNABC 
Contract  Apply  to  Director  of  Nursing.  Mills  Mem- 
orial Hospital,  2711  Tetrault  St  Terrace  Bntish 
Columbia 


EXPERIENCED  NURSES  (eligible  for  B  C  registration)  required 
for  409-bed  acute  care,  teaching  hospital  located  in  Fraser 
Valley,  20  minutes  by  freeway  from  Vancouver  and  within 
easy  access  of  varied  recreational  facilities  Excellent  Orienta- 
tion and  Continuing  Education  programmes  Salary  Si  026  00  to 
Si  21200  Clinical  areas  include  Medicine,  General  and  Spe- 
cialized Surqerv  Obstetrics  Pediatrics  Coronary  Care  Hemo- 
dialysis Rehabilitation  Operating  Room  Intensive  Care,  Emer- 
gency PRACTICAL  NURSES  (eligible  for  BC  License)  also 
required  Apply  to  Administrative  Assistant  Nursing  Personnel. 
Royal  Columbian  Hospital,  New  Westminster  Bnlish  Columbia. 
V3L  3W7 


TWO  GRADUATE  NURSES  required  immediately  for  a  modern 
10-bed  General  Hospital  located  m  picturesque  Stewart.  B  C 
Accommodation  is  available  m  a  closely  situated  residence 
Apply  lo  Assistant  Administrator,  Prmce  Rupert  Regional 
Hospital,  Prince  Rupert  Bnttsh  Columbia  V8J  2A6 


GRADUATE  NURSES  —  Looking  for  variety  in  your  work? 
Consider  a  modern  10-bed  hospital  located  on  a  beautiful  fiord- 
type  inlet  of  Vancouver  Islands  west  coast  Apply:  Administrator 
Box  399  Tahsis,  Bntish  Columbia   VOP  1X0 


EXPERIENCED  GENERAL  DUTY  NURSES  AND  LICENSED 
PRACTICAL  NURSES  required  for  small  upcoast  hospital  Sal- 
ary and  personnel  policies  as  per  RNABC  and  H  E.U.  contracts 
Residence  accommodation  S25  00  per  month  Transportation 
paid  from  Vancouver  Apply  to  Director  of  Nursing.  St  Georges 
Hospital   Alert  Bay.  British  Columbia.  VON  lAO 


GENERAL  DUTY  NURSES  for  modern  41-bed  hospital  located 
on  the  Alaska  Highway  Salary  and  personnel  policies  m 
accordance  with  RNABC  Accommodation  available  in  resi- 
dence Apply:  Director  of  Nursing  Fort  Nelson  General  Hospital. 
Fort  Nelson,  British  Columbia 


GENERAL  DUTY  NURSES,  for  modern  35-bed  hospital  located. 
in  southern  B  C  s  Boundary  Area  with  excellent  recreation  faci- 
lities Salary  and  personnel  polices  in  accordance  with  RNABC 
Comfortable  Nurses  s  home  Apply  Director  of  Nursing,  Bound- 
ary Hospital  Grand  Forks.  British  Columbia.  VOH  IHC 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  care 
hospital  m  Northern  B  C  residence  accommodations  available 
RNABC  policies  m  effect  Apply  to  Director  ot  Nursmq  Mills 
Memorial  Hospital,  Terrace,  British  Columbia,  V8G  2W7 


GENERAL  DUTY  NURSES  for  modern  46-bed  hospital,  located 
in  north  central  British  Columbia  Salary  and  personnel  policies  in 
accordance  with  the  RNABC  contract  Accommodations  availa- 
ble in  residence  adjacent  to  hospital  Apply  Director  of  Nursing, 
SI,  John  Hospital.  R  R.  2.  Vanderhoof.  British  Columbia.  VOJ 
3A0 


MANITOBA 


REGISTERED    and    LICENSED    PRACTICAL    NURSES    are 

needed  for  a  modern  25-bed  acute-care  hospital  and  a  new 
50-bed  persona!  care  home  Salary  and  policies  as  per  Manitoba 
Association  of  Registered  Nurses  Nurses  residence  Apply  Di- 
rector of  Nurses,  Seven  Regons  Health  Centre.  Box  535,  Glads- 
tone, Manitoba.  ROJ  OTO. 


ONTARIO 


Queen  s  University  is  seeking  candidates  for  the  position  » 
DEAN/DIRECTOR  of  the  School  of  Nursing  Persons  are  sougi 
with  earned  doctoral  degrees,  demonstrated  scholarstrif 
professional  achievement  and  competence  m  admmtslratic 
appropriate  for  effective  leadership  m  an  established  Universl 
with  other  professional  faculties  and  schools  Reports  to  !^ 
Vice-Pnncipal  (Health  Sciences)  Salary  commensurate  wfc 
educational  preparation  and  experience  Excellent  frinc 
benefits  Applications  and  nominations  should  be  sent  to:  0 
HG  Kelly,  Vice-Principal (Health  Sciences). Queen  s  Univef! 
Kingston.  Ontario,  K7L  3N6 


OPERATING  ROOM  STAFF  NURSE  required  for  fully  accred 
ted  75-bed  Hospital  Basic  wage  S689  00  with  consideration  fc 
experience  also  an  OPERATING  ROOM  TECHNICIAN,  basi 

wage  S526  (Xi  Call  time  rates  available  on  request  Write  < 
phone  the  Director  of  Nursmg  Dryden  District  General  Hosprta 
Dryden,  Ontario 


REGISTERED  NURSES  for  34-bed  General  Hospita 
Salary  S945  00  to  SI. 145  00  per  month,  plus  experience  aUm 
ance  Excellent  personnel  policies  Apply  to  Director  of  Nursira 
Englehart  &  District  Hospital  Inc.  Englehan.  Ontario.  POJ  IHC 


REGISTERED  NURSES  required  for  our  ultramodern  accreditee 
79-bed  General  Hospital  tn  bilingual  community  of  Northern  On 
tario  French  language  an  asset,  but  not  compulsory  Salary  b  i 
S945  toSll45  monthly  (subject  to  increase  July  1st)  with  allow 
ance  for  past  experience  arid  4  weeks  vacation  after  i  year 
Hospital  pays  lOO^'o  of  O  H  I  P  .  Life  Insurance  (lO.OOOi  Salan 
lnsurance(75°oof  wages  to  the  ageof  65  with  U  l.C  carve-out), i 
35(  drug  plan  and  a  dental  care  plan  Master  rotation  in  effect 
Rooming  accommodations  available  m  town  Excellent  person 
nel  policies  Appty  to  Personnel  Director  Notre-Dame  Hospte' 
PO  Box  8000   Hearst.  Ontario  POL  1N0, 


il 


REGISTERED  NURSES  AND  REGISTERED  NURSINO 
ASSISTANTS  for  45-bed  Hospital  Salary  ranges] 
include  generous  experience  allowances  R,N.'i|l 
salary  S945  to  S1,115,  and  RNA  s  salary  S650  to  $725fl 
Nurses  residence  —  private  rooms  with  bath  —  $60  per  month  |j 
Apply  to  The  Director  of  Nursing,  Geraldton  District  Hospitali' 
Geraldlon  Ontario,  POT  iMO 


REGISTERED  NURSES  and  REGISTERED  NURSING, 
ASSISTANTS  for  83-bed  Home  for  Mentally  Retarded  anc" 
Physically  Handicapped  Children  40  Hour  Week.  RN  s  salary; 
S840  —  S 1 .020  and  RNA  s  S3  65  per  hour  plus  allowance  foi 
experience  Apply  to  Lahewood  Nursing  Home,  Box  1830 
Hunlsville.  Ontario   POA  IKO  ^ 


REGISTERED  NURSES  FOR  GENERAL  DUTY.  I.C.U., 
ecu.  UNIT  and  OPERATING  ROOM  required  for 
fully  accredited  hospital  Starting  salary  $850,00  wit) 
regular  increments  and  with  allowance  for  expen 
ence  Excellent  personnel  policies  and  temporary 
residence  accommodation  available  Apply  to  The 
Director  of  Nursing.  Kirkland  &  District  Hosp  ' 
Kir1tlandLake.Cntano.P2N  1R2, 


QUEBEC 


REGISTERED  NURSE  required  beginning  of  September  in 
Co-ed  Boarding  School  m  country.  Applicant  must  live  in  and 
share  duties  with  another  resident  nurse.  Apartment  with  maid 
service  provided  Excellent  working  conditions  Liberal  holidays 
Applications  slating  qualifications  and  experience  '" 
Comptroller.  Bishop  s  College  School.  Lennoxville.  Quebec 
1Z0 


SASKATCHEWAN 


UNITED  STATES 


UNITED  STATES 


i.  required  fmmadiatety  —  Porcuptne  Carragana  Union 
fSpital  requ'res  General  Duty  Registered  Nurse  immedialety 
lary  scale  and  fringe  benefits  as  negotiated  t>y  S  U  N.  Modern 
bed  hospital  Near  Provincial  Park  Progressive  community 
■)ty.  in  writing,  to.  Administrator,  Porcupine  Carragana  Union 
l^pital.  Box  70,  Porcupine  Plain.  Saskatchewan.  SOE  IHO. 


jISTERED  nurse  required  tor  active  10-bed  Hospital  m 
Ihem  Saskatchewan,  Salary  Range  S798,  to  S927  as  per  the 
ective  Agreement  between  Sask  Unon  of  Nurses  arxJ  Sask 
pital  Association  Residence  accommodation  available.  For 
yet  particulars  appty  to  Mrs.  Dorothy  L.  Knops,  Sec  Treas., 
kglen  Union  Hospital,  Rockglen,  Saskatchewan,  SOH  3R0. 
t^ne.  476-2105  or  476-2012. 


Summer  1975  Curricuium  institutes  ottered  by  thj  Institute  of 
Nursing  Consultants  Institute  I.  Becoming  ar\  INSERVICE 
EDUCATOR  Two  sesstons  I  East,  Key  West  Flonda,  June 
16-20  I  West,  Morro  Bay,  Calitomta,  August  18-22  Institute  II, 
CONCEPTUAL  FRAMEWORK  for  Curriculum  Development, 
Calgary.  Alberta  Canada,  July  14-18  Institute  III  Developing 
LEARNING  MODULES  tor  Nursing  Instruction.  San  Francisco. 
California.  August  4-8  Tuition  for  each  institute  is  S200  00  The 
all  day  sessions  wiH  include  a  variety  of  learning  activities  lec- 
tures, discussions,  small  group  work  and  modules.  Institute  fa- 
culty. Em  Olivia  Bevis,  Fay  L.  Bower.  Verle  Waters,  Holly  S 
Wilson  For  information  and  registration  write:  F  Bower,  874 
Miranda  Green.  Pak)  Alto.  California.  94306. 


TEXAS  wants  you!  If  you  are  an  RN.  expenenced  or 
a  recent  graduate  come  to  Corpus  Chnsli.  Sparkling 
City     by    the     Sea  a     city    buildmg     tor     a    better 

future,  where  your  opportunities  lor  recreation  and 
studies  are  limitless  Memorial  Medical  Center  500- 
bed.  general  teaching  hospital  encourages  career 
advancement  and  provides  in-service  orientation. 
Salary  from  S785.20  lo  $1,052  13  per  month,  com- 
mensurate with  education  and  experience  Differential 
for  evening  shifts,  available  Benefits  include  holi- 
days, sick  leave,  vacations,  paid  hospitalizalion. 
health,  life  insurance,  pension  program  Become  a 
vital  part  of  a  modern,  up-to-date  hospital,  wnte  or 
call:  John  W  Gover.  Jr  .  Director  of  Personnel, 
Memorial  Medical  Center,  P  O  Box  5280  Corpus 
Christi.  Texas,  7B405 


NERAL  DUTY  NURSE,  eligible  for  Saskatchewan 
siration.  required  tor  26-bed  active  treatment  hospital.  Salary 
S.U.N,  agreement,  currently  under  review  Three  doctors  on 
t.  Apply  10  Director  ot  Nursing.  Riverside  Memorial  Union 
pital.  Turtleford.  Saskatchewan.  SOM  2Y0. 


ST.  MICHAEL'S  HOSPITAL 
Toronto,  Ontario 

invites  applications  from 

REGISTERED  NURSES 

for 

RESPIRATORY 

INTENSIVE  CARE, 

CORONARY  CARE, 

and  ACUTE  CARE  UNITS 

Ti-.ree  separate  but  adjoining  units,  of  14,  7.  and  24  beds 
'espectively  Planned  orientation  and  in-service  pro- 
gramme will  enable  you  to  collaborate  in  the  mosi  advan- 
::ed  of  treatment  regimens  tor  the  post -operative  cardio- 
.ascjlar,  cardiac  and  other  acutely  ill  patients.  One  year  of 
Tursng  experience  a  requirement- 

For  details  apply  to: 

The  Director  of  Nursing 
St.  MlchaeCs  Hospital 
Toronto,  Ontario 
MSB  1W8 


DIRECTOR 

OF 
NURSING 


-equired  for  1 50- bed  accredited  hospi- 
tal in  northern  Newfoundland. 


Please  apply  to: 

Mr.  Douglas  Heath 
International  Grenfell  Association 
Room  701,  88  Metcalfe  Street 
Ottawa,  Ontario  K1P  5L7 


'  ANADIAN  NURSE  —  August  1975 


Get  what  you've 

always  wanted 

from  nursing 


Like,  for  a  change, 
working  the  way  you  want  to 


Mcdox  can't  make  you  a  better  nurse. 

Only  you  can  do  that. 
•   But  we  can  help  you  see  to  it  you're 
working  under  the  kind  of  conditions 
that  allow  iiou  to  make  the  most  of 
your  talents  and  experience. 

With  f^edox,  you  get  a  flexibility 
that  lets  you  direct  your  own  career. 

For  instance,  did  you  know  that 
Medox  can  help  you  find  a  permanent 
nursing  position?  That's  right. 

It's  part  of  the  service.  Or  you  can 


work  at  temporary  assignments  on  a 
permanent  basis.  Another  interesting 
possibility. 

Or  you  can  pick  and  choose  from  a 
wide  range  of  temporary  positions  in 
just  about  any  nursing  field  to 
broaden  your  professional  experience. 
Permanent.  Permanent'temporary. 
Temporary.  With  Medox.  it's  up  to  you. 

And,  since  it's  up  to  you,  better 
come  to  Medox. 


MedoX 


a  DRAKE  INTERNATIONAL  company 

CANADA  •  USA .  UK .  AUSTRALIA 


59 


SUPERVISOR 
OPERATING  SUITE 


For  a  300  bed  fully  accredited  general  hospital. 
Applicants  are  required  to  have  management  ex- 
perience and  advanced  preparation  in  operating 
room  technique  and  administration. 

Excellent  benefits  and  a  salary  commensurate 
with  experience  will  be  offered  plus  extra  lor  ad- 
vanced preparation. 


Apply  to: 


Director  of  Nursing 
St.  Joseph's  Hospital 
290  N.  Russell  Street 
Sarnia,  Ontario 
NTT  683 


REGISTERED  NURSES 


Registered  Nurses  required  for  large 
metropolitan  general  hospital. 
Positions  available  in  all  clinical  areas. 
Salary  Range  in  effect  until  December 
31,1975. 

S900.  —  SI  .075.  Starting  rate  de- 
pendent on  qualifications  and  experi- 
ence. 


Apply  to: 


Staffing  Officer-Nursing 
Personnel  Department 
Edmonton  General  Hospital 
Edmonton,  Alberta 
T5K  0L4 


GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  gen 
eral  hospital  expanding  to  343  beds  plu 
proposed  75  bed  extended  care  unit. 
Clinical  areas  include:  medicine,  surger, 
obstetrics,  paediatrics,  psychiatry,  activ;- 
tion  &  rehabilitation,  operating  roc- 
emergency  and  intensive  and  corona- 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R.N.A.B.C.  contract: 

SALARY:  S850  —  SI  020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


MOVE  TO  THE  BEACHES  OF 

SUNNY  SO.  CALIFORNIA 

Positions  for  RN's  now  available  at 
Marina  Mercy  Hospital,  a  203-bed 
General  Acute  facility  located  right  in 
Marina  Del  Rey  near  Los  Angeles. 

We  offer  a  congenial  staff,  excellent 
benefits,  every  other  weekend  off! 

We  will  assist  you  in  obtaining  your 
California  License  &  H-1  Visa. 

Write  or  send  resume  to: 

Director  of  Personnel 
Marina  Mercy  Hospital 
4650  Lincoln  Blvd. 
Marina  Del  Rey,  Ca.  90291 


REGISTERED 
NURSES 

eligible  for  registration  with  the  Association 
of  Registered  Nurses  of  Newfoundland 
required  for  20-bed  hospital  in  Labrador. 

Apply  to: 

Director  of  Nursing 

Paddon  Memorial  Hospital 

International  Grenfell 

Association 

Happy  Valley,  Labrador 

ACPI  EG 


REGISTERED 
NURSE 


RN  required  for  small,  modern  Home 
for  the  Aged  in  Little  Current,  Ontario. 
Salary  511,700. 
Low  Cost  of  living 
Beautiful  scenery 
Friendly  surroundings 


Apply: 


The  Administrator 
Manitoulin  Centennial  Manor 
Little  Current,  Ontario 


EDUCATIONAL 
CO-ORDINATOR 


required  to  co-ordinate  the  in-service  training 
programme  for  the  Nursing  Dept  of  a  500  bed 
general  hospital. 

Qualifications  —  Registered  Nurse  with  additional 
educational  preparation:  experience,  at 
minimum,  at  Head  Nurse  level  with  some  teach- 
ing background 


Apply  in  writing  to: 

Personnel  Director 

Joseph  Brant  Memorial  Hospital 

1230  North  Shore  Blvd.  E. 

Burlington,  Ont. 

L7S  1W7 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

staff  nurses  for  SI.  Anthony.  New  hospital 
150  tjeds.  accredited.  Active  treatment  in  Surger. 
Medicine,    Paediatncs.    Obstetncs,    Psychiaf. 
Large  OPD  and  ICU  Onentation  and  In-Servi 
programs,  40-hour  week,  rotating  shifts.  PUBLK 
HEALTH  has  challenge  of  large  remote  area 
Furnished  living  accommodations  supplied  at  Ir 
cost.  Personnel  benefits  include  liberal  vacali 
and  sick  leave,  travel  arrangements.  Staff  R' 
$637  —  $809,  prepared  PHN  $71 2  —  S903.  ste; 
for  experience. 


Apply  to: 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Anthony,  Newfoundland 

AOK  4S0 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from  L 

REGISTERED  NURSES 

54-bed  accredited  general  hospi- 
tal. Northeastern  Ontario,  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to: 


MISS  E.LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane.  Ontario 

POL  ICO 


WELCOME 


to 


i^-'r-    (( 


THE  NEURO" 


A  Teaching  Hospital 
of  McGill  University 

Positions  available 

for  nurses  in  all  areas 

including  Operating  Room 

Individualized  orientation 

On-going  staff  education 


(Quebec  language  requirements 
do  not  apply  to  Canadian  applicants) 


Apply  to: 

Ttie  Director  of  Nursing. 

IVIontreal  Neurological  Hospital. 

3801  University  Street. 

IVIontreal  H3A  2B4. 

Quebec.  Canada. 


CANBERRA  HOSPITAL 

ACTON.  A.C.T.  AUSTRALIA 

NURSE  EDUCATOR 

THREE  POSITIONS:- 


1.  Principal  Educator  Si 0,799  per  annum 

2  Senior  Educator  for  two-year 

general  nursing  course    S  9.661  per  annum 
3.  Midwifery  Educator  S  9.051  per  annum 

Additional  payment  for  diploma  and  certificates  up  to  $1 2  per 
week.  Total  tutorial  staff  —  23. 

Courses  under  control: 

GENERAL  NURSING  3  years 

GENERAL  NURSING  2  years 

MIDWIFFERY  1  year 

INTENSIVE  CARE  1  year 

NURSING  AIDE  1  year 

Full  accommodation  (single)  available  —  SI  4  per  week, 
assistance  with  married  accommodation  may  be  offered. 
For  further  particulars  and  application  forms  please  contact: 

MISS  J.  JAMES, 
Director  of  Nursing, 
Canberra  Hospital, 
ACTON,  A.C.T.  2601 
AUSTRALIA. 


PATIENTS  MATTER 
AT  THE 

PLAINS  HEALTH  CENTRE 

AND  SO  DO  YOU 


Myrna  Sinclair 
Personnel  Selection 
Officer  (Nursing) 
Plains  Health  Centre 
4500  Wascana  Parkway 
Regina,  Saskatchewan 
S4S  5W9 

Would  you  please  send  me  informa- 
tion regarding  employment  at  the 
Plains  Health  Centre. 


Name- 


Address- 


'.  CANADIAN  NUHSE  —  Augusl  1975 


Experienced 

Registered  Nurses 

required  for 
a  dispensary  In 

LA  BASSE  COTE-NORD 

Knowledge  of  English  essential. 

Please  send  curriculum  vitae  to  the 

Director  of  Nursing  Service 
Hopltal  Notre-Dame 
Lourdes  du  Blanc-Sablon 
Cte  Duplessis,  P.O. 
GOG  1W0 


McKELLAR  GENERAL  HOSPITAL, 
Ttiunder  Bay,  Ontario 


OPERATING  ROOM 
SUPERVISOR 


Required  for  389  bed.  fuily  accredited,  active  treatment 
hospital  Duties  lo  commence  December  1,  1975. 
Preference  will  begrven  loan  individual  with  aB  Sc  N.or 
a  nurse  with  related  nursing  and  administrative  expe- 
rience 

Excellent  salary  and  working  conditions 
Further  information  will  be  forwarded  on  receipt  of  a  com- 
plete resume  of  education  and  experterlce. 

Reply  to:  Director  of  Nursing  Service. 

McKELLAR  GENERAL  HOSPITAL, 
Thunder  Bay,  Ontario 


FUN  FLON  GENERAL  HOSPITAL  INC. 
FUN  FLON,  MANITOBA 

Opporlunilies  are  available  in  mis  modern  125-bed  hos; 
lal  in  ihe  summer  and  winter  vacation  land  of  Noriri> 
Manitoba  for  tne  following  positions  — 

EVENING  SUPERVISOR 

Qualifications  — 

Current  provincial  registration  or  eligibility  for  registration 
Previous  training  and  experience  in  a  senior  nursing  posi- 
tion. 

CLINICAL  INSTRUCTOR 

for 
PRACTICAL  NURSING  STUDENTS 

Qualifications  — 

Current  provincial  registration  or  eligibility  tor  registration 

Previous  nursing  experrence  required 

Experience  as  Head  Nurse,  Supervisor  or  Instructor  Oe 

sirable 

GENERAL  DUTY  REGISTERED  NURSES  alio  required 

For  further  details  apply: 

PERSONNEL  DIRECTOR 
Flin  Flon  General  Hospital 
Box  340 

Flin  Flon,  IManitoba 
R8A  1N2 


MCIMASTER  UNIVERSITY 

MASTER  OF  HEALTH  SCIENCES 

(HEALTH  CARE  PRACTICE) 

PROGRAMME 

DEGREE  PROGRAMME 

INTERPROFESSIONAL  PROGRAMI^E  IN  HEALTH  CARE  PRACTICE 
OPEN  TO  NURSES  —  OCCUPATIONAL  THERAPISTS  —  PHYSI- 
CIANS -  PHYSIOTHERAPISTS  —  AND  OTHER  HEALTH  CARE 
PRACTITIONERS  THE  PROGRAMME  EXTENDS  OVER  THREE 
TERMS  AND  OPPORTUNITY  IS  PROVIDED  TO  INCREASE  AND 
BROADEN  KNOWLEDGE  AND  SKILLS  AS  INDIVIDUAL  PROFES- 
SIONALS AND  AS  MEMBERS  OF  THE  HEALTH  CARE  TEAM 

ADMISSION  REOUIREMENTS: 

APPLICANTS  ARE  ASSESSED  INDIVIOUAUY  ON  THE  BASIS  OF 
THEIR  EDUCATION,  EXPERIENCE,  PERSONAL  DUALITIES  AND  EX- 
PECTED ABILITY  TO  COMPLETE  A  GRADUATE  PROGRAMME  A 
PERSONAL  INTERVIEW  OR  THE  EQUIVALENT  IS  PART  OF  THE 
USUAL  ADMISSION  PROCESS  ADMISSION  DOES  NOT  NECESSAR- 
ILY REQUIRE  THE  POSSESSION  OF  A  BACCALAUREATE  DEGREE 
LICENCE  OR  REGISTRATION  TO  PRACTISE  AS  A  HEALTH  PROFES- 
SIONAL IN  ONTARIO  lOR  ITS  EQUIVALENT)  IS  REQUIRED  FOR  THE 
YEAR  1976/77  ALLAPPLICATION  MATERIALS  MUST  BE  AVAILABLE 
FOR  REVIEW  BY  DECEMBER  1ST  1975  APPLICATIONS  AND  EN- 
QUIRIES SHOULD  BE  DIRECTED  TO  THE  DIRECTOR.  MASTER  OF 
HEALTH  SCIENCES  (HEALTH  CARE  PRACTICE)  PROGRAMME, 
ROOM  3C  17,  HEALTH  SQENCES  CENTRE,  MCMASTER  UNIVER- 
SITV,  HAMILTON,  ONTARIO,  L8S  4J9, 


ST.  MICHAEL'S  HOSPITAL 

Toronto,  Canada, 

MSB  1W8 


This  university  hospital  in  metropolitan  area 
Invites  applications  for  position  of 

Head  Nurse, 
Psychiatry 

for  a  19-bed  in-patieni  unit  and  separate 
Day  Care  Centre.  Registered  Nurse  with 
baccalaureate  degree  and/or  depth  of  ex- 
perience in  psychiatric  nursing. 


For  details  contact:  Director  of  Nursing 


REGISTERED 
NURSES 

required 

for  a  21 -bed  active  treatment  hospital 
in  the  Peace  River  District.  Salaries  in 
accordance  w\h  the  A.A.R.N.  Agt.  — 
$900.00  — $1,075.00. 

Accommodation  for  single  girls  availa- 
ble at  very  reasonable  rates. 

Apply  to: 

The  Director  of  Nursing 
Berwyn  Municipal  Hospital 
Box  154 
Berwyn,  Alberta 
TOH  GEO 


The  Brome-Missisquoi-Perkins 
Hospital 

requires 

REGISTERED 
NURSES 


Please  write  lo: 

Director  of  Nursing 
Brome-Missisquoi-Perkins  hospital 
950  Main  Street 
Cowansville,  Quebec 
J2K1K3 


DIRECTOR 
OF  NURSING 


Applications  are  invited  for  this  position  in  a 
newly  renovated  and  expanded  35-bed 
Level  2  and  3  care  senior  citizens  Home  at 
Balcarres. 

Must  be  R.N.  or  R.PN.  Accommodation 
available.  Direct  applications,  stating  ex- 
perience and  qualifications  to: 

Parkland  Lodge  Corporation 

Box  488 

Balcarres,  Saskatchewan 

SOG  OCO 

Telephone:  334-2677 


DIRECTOR  OF 
NURSING  SERVICE 

Applications  are  invited  for  the  position  of  Direc- 
tor of  Nursing  Service  in  a  modem  44-bed  Gen- 
eral Hospital 

Previous  experience  in  a  senior  nursing  position 
is  required,  I 

Position  will  be  available  1  August  1975,  Hospital  | 
is  located  in  the  centre  of  the  Red  Lake  Gold  i 
Mining  District  —  offering  a  variety  of  recreational  j 
activities  Air  service  daily  lo  Winnipeg  and  Thun-  I 
der  Bay, 

Salary  comnwnsurate  with  qualifications  and  ex 
perience. 

Interested  applicants  send  resume  to: 

Administrator 

Red  Lake  Margaret  Cochenour 

Memorial  Hospital 

Box  314 

Red  Lake,  Ontario 

POV  2M0 


REGISTERED  NURSES 

Southern  California 

THIS    'apidiy    expanding    573-I)ed    Medical    Center    has 

opportunilies  for  RN  s  inletesled  m  professional  growlti 

Huntington  Memorial  is  recognized  tor  its  excellence  of  patient 

cs'p  'esea'cn  facilities  and  teaching  programs,  and  offers  a  full 

at   patient  care   services   including    Intensive   Care 

:7  Care   Emergency  Roorn,  Neurosurgery   Open  Heart 

,    and    RehaDiliIation     Our   full   on-going    in-service 

:ion  and  training  program  includes  classes  in  Critical 

■Jeonatal  and  an  Arrhythmia  Recognition  Class   Other 

P'og^ams  are  given  for  Medical- Surgical,  Rehabilitation  and 

Pediatrics  Cardiology 

-    '"I   m   the   Rose  Bowl   capitol     Pasadena    California 

jton  Memorial  eo|oys  the  year  around  mila  climate, 

-  I  for  Ocean,  Mountain,  and  Desert  sports  and  activities 

a,  /iittim  a  one  hour  drive    Our  hospital  is  located  in  a 

residential  area  which  offers  excellent  living  conditions 

We   invite  your  inquiry   concerning   our   salaries    benefits 

education,  working  conditions  and  facilities  We  will  also  assist 

Qualified  RN  s  to  acquire  visas  for  those  interested  in  a  position 

with  this  progressive  Medical  Center 

Write  Miss  Ann  Kaiser,  Dir.  of  Nursing 

HUNTINGTON  MEMORIAL  HOSPITAL 
747  S    FAIRMONT  ST 
PASAOENA,  CALIF,,  91105 

An  equal  opportunity  employer. 


NURSING 
OFFICE  SUPERVISOR 

NURSING  OFFICE  SUPERVISOR  required 
for  340-bed  acute  care,  fully  accredi- 
ted Hospital. 

Personnel  Policies  in  accordance  with 
RNABC  Contract. 

Must  be  eligible  for  B.C.  Registration 
SALARY;  SI 283  to  $1513  per  month 
(1975  rates) 

Preference  will  be  given  to  applicant 
with  University  preparation  in  Adminis- 
tration and  Clinical  Supervision 
Apply,  stating  qualifications  to: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 

V2IM  1S2 


REGISTERED 
NURSE 

Registered  Nurse  required  for  a  3-becl 
I.C.U.-C.C.U  opening  in  the  Fall  of  75  In  an 
86-bed  Accredited  General  Hospital.  Ex- 
perience and/or  past  basic  training  is 
necessary. 

Prevailing  Ontario  salary  rates  as  well  as 
other  generous  fringe  benefits. 


J^pply  to: 


Director  of  Nursing 
Sensenbrenner  Hospital 
10  Drury  Street 
Kapuskasing,  Ontario 
P5N  1K9 


The  Nova  Scotia  Department  of  Public  Health.  Occupational  Health  Division,  Health  Engineering  Ser- 
vices, invites  applications  for  the  above  position  from  Nurses  registered  or  eligible  for  registration  with  the 
Registered  Nurses  Association  of  Nova  Scotia. 
QUALIFICATIONS: 

The  successful  candidate  should  have  an  Occupational  Health  Nursing  Certificate  or  its  equivalent  by 
examination  and  not  less  than  ten  years  varied  experience  in  occupational  health  nursing  in  industry  of 
which  five  years  should  be  at  the  supervisory  level  Fairly  extensive  travel  throughout  all  areas  of  the 
Province  will  be  necessary  and  applicants  must  have  a  current  drivers  license  Training  in  audiometry, 
advanced  preparation  in  Occupational  Health  Nursing,  and  some  knowledge  of  basic  industrial  hygiene 
would  be  an  advantage. 
DUTIES: 

A  comprehensive  occupational  health  program  is  now  being  developed  and  an  O  H  Nurse  Consultant  will 
be  a  key  member  of  the  consultant  team,  responsible  to  the  Director  of  the  Occupational  Health  Division  for  a 
major  segment  of  the  total  program. 
SALARY: 

Commensurate  with  qualifications  and  experience. 
BENEFITS: 

Full  Nova  Scotia  Civil  Service  Benefits. 

Competition  is  open  to  Ixjth  women  and  men. 

Please  quote  competition  number  75-548. 

Closing  date  —  September  1.  1975 

Application  forms  may  be  obtained  from  the  Civil  Sen/ice  Commission,  P.O.  Box  943,  Johnston  BuiWing, 

Halifax,  Nova  Scotia,  B3J  2V9.  and  the  Provincial  BuiWing,  Sydney.  Nova  Scotia 


SUR5ES 


f^w 


.  /'' 


■I'll' 


E'^ery  Prairie  Scene  . , 

Can  be  -% 

;  ,  A  Lovely  New  'V 

||..'-,^|'";';"-,...    Discovery 

I'i  .■'i'l!,'"  ■      •■■:'./ 

For  further  information  and  an  application  form,  clip,  complete  and  convey  your 
interest  in  employment  at  the  Plains  Health  Centre,  a  newly  opened  300  bed, 
teaching,  research  hospital,  by  returning  this  to; 


.'li-,-;.*^ 

m  ■ 


Myrna  Sinclair 

Personnel  Selection  Officer  (Nursing) 

Plains  Healtti  Centre 

4500  Wascana  Parl(way 

Regina,  Saskatcfiewan 

Canada  S4S  5W9 


Would  you  please  send  me  information  re- 
garding employment  at  the  Plains  Health 
Centre: 


PS.    with  an  approximate  2.9%  unemployment  rate  in  Saskatchewan  your  spouse  may  find  work 
readily  available. 


I  CANADIAN  NURSE  —  August  1975 


HEAD  NURSE 


HEAD  NURSE  required  for  18-bed 
Medical  Unit. 

Previous  experience  and/or  prepara- 
tion in  administrative  nursing  techni- 
ques including  ward  management  and 
principles  of  supervision  required. 

Position  becomes  available  early  July, 
1975. 

Apply  to: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

2000,  15th  Avenue 

Prince  George,  British  Columbia 

V2M  1S2 


CLINICAL 
SPECIALIST 

We  require  the  services  of  an  aniculate,  dynamic 
nurse  with  a  Masters  Degree  and  a  Major  in  Medi- 
cal, Surgical  nursing  in  a  300-bed  Hospital  Com- 
plex. 

The  nurse  in  this  position  will  work  closely  with  our 
staff  nurses .  as  well  as  Medical  Staff,  to  further 
develop  patient  centered  projects  The  salary  for 
this  position  is  based  on  qualifications  and  ex- 
perience 

For  further  information  about  ttiis  opportunity, 
please  forward  a  complete  resume  to: 

Director  of  Personnel 
Red  Deer  General  Hospital 
Red  Deer,  Alberta 
T4N  4E7 


ST.  THOMAS -ELGIN 
GENERAL  HOSPITAL 

Invites  Applications  from 

REGISTERED  NURSES 

To  work  in  our  modern  fully  accredited  400  bed  General 
Hospital  located  in  Southwestern  Ontario 

We  offer  opportunities  in  medical,  surgical,  paediatric, 
obstetrical  and  geriatric  nursing. 

Our  specialties  include  Coronary  Care.  Intensive  Care 
and  an  active  Emergency  Department, 
Orientation  Program, 
Progressive  Personnel  Policies. 

APPLY  TO: 

Personnel  Office 

St.  Thomas-Elgin  General  Hospital 

St.  Thomas,  Ontario 

N5P  3W2 


+ 


Once  a  Nurse  . . . 
Always  a  Nurse 

Whether  you  re  a  practicing  R.N. 
or  just  taking  time  out  to  raise  a 
family,  you  can  serve  your  commu- 
nity by  teaching  lay  persons  the 
simple  nursing  skills  needed  to 
care  for  a  sick  member  of  the 
family  at  home. 

Red  Cross  Branches  need 

VOLUNTEER  INSTRUCTORS 

to  teach  Red  Cross  Care 

m  the  Home  courses. 

VOLUNTEER  NOW  AS  A  RED 

CROSS  INSTRUCTOR  IN  YOUR 

COMMUNITY 

For  further  iniormation.  contact: 
Director 

National   Department  of  Family 
Health 

THE  CANADIAN 
RED  CROSS  SOCIETY 

95  Wellesley  Street  East 
Toronto,  Ontario.  M4Y  1H6. 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them 
Intensive  Care,  in  one  of  the  Mec 
ical  or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound    in    our   clinics   and 

their  numbers  increase  daily  in  our 

Emergency. 

If   you   do   not   like  working  wiv 

children    and   with   their  familie: 

you  would  not  like  it  here. 

If' you  do  like  children  and  their 
families,  we  would  like  you  on  oui 
staff. 


Interested     qualified 
should  apply  to  the: 


applicants 


DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108,  Quebec 


"MEETING  TODAY'S  CHALLENGE  IN  NURSING  " 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGill  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 
Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


MINISTRY  OF  HEALTH 

MENTAL  HEALTH  CENTRE 

PENETANGUISHENE 

has  an  immediate  vacancy 
for  an 

ASSISTANT  DIRECTOR  OF  NURSING, 
OAK  RIDGE 

CLASSIFICATION:  Nurse-5-General 

SALARY  RANGE:  $269.27  —  $331.65  PER  WEEK 

DUTIES: 

To  direct  and  supervise  all  nursing  administration  and  nursing  ser- 
:e  activities  in  the  300-bed  Oak  Ridge  Maximum  Security  Unit. 

QUALIFICATIONS: 

Registration  as  a  nurse  in  Ontario:  good  knowledge  of  the  principles 
and  practice  of  institutional  nursing  relating  to  mental  patients.  B. 
Sen.  degree  or  its  academic  equivalent,  and  three  years  of  progres- 
sively responsible  nursing  experience  or  post-graduate  certificate  in 
nursing  education  or  administration  and  six  years  of  progressively 
responsible  nursing  experience,  including  several  years  in  a  super- 
visory capacity. 

Qualified  male /female  applicants  should  apply  to: 
PERSONNEL  OFFICER 
MENTAL  HEALTH  CENTRE 
PENETANGUISHENE 
ONTARIO 
LOK  1P0 


REGISTERED  NURSES 

Immediate  Openings  in  all  Services 


Come  work  and  play  In  Newfoundland's  second  largest  city! 

Corner  Brook  has  a  population  of  approximately  35.000  with  a  temperate  climate  in 
comparison  with  mosi  of  Canada  Outdoor  life  is  among  the  fines!  to  be  found  in  North 
America  The  airports  serving  Corner  Brook  are  at  Deer  Lake  32  miles  away,  and  Ste- 
phenville.  50  miles  away  Connections  with  these  airports  make  readily  available  air  travel 
anywhere  in  the  world 

—  Salary  Scale:  $7,652.  —  $9,715.  per  annum;  Contract  expires  March  31, 
1975. 

—  Service  Credits  —  One  step  for  four  years  experience:  two  steps  for  six 
years  experience  or  more. 

—  Educational  differential  for  B.N.  and  master's  degree  in  Nursir>g. 

—  $2.00  per  shift  for  Charge  Nurse. 

—  $50.00  uniform  allowance  annually. 

—  20  working  days  annual  vacation. 

—  8  statutory  fioltdays. 

—  Sick  Leave  —  I  1/2  days  per  month. 

—  Accommodation  available. 

—  Two  week  orientation  on  commencen>enL 

—  Continuing  Staff  Education  program. 

—  Transportation  available. 

Ai  the  present  time,  a  major  expanston  project  is  in  progress  to  provide  regional  hospital 
facilities  tor  the  West  Coast  of  the  Province  The  Hospital  will  have  a  350  bed  capacity  by 
June,  1975-  Services  include  Medicine.  Surgery.  Paediatrics.  Obstetrics,  Psychiatry.  CCU 
and  ICU 


iMttfs  of  application  should  ty  9ubmltt9d  to: 

Director  of  Personnel 
WESTERN  MEMORIAL  HOSPITAL 
CORNER  BROOK,  NFLD. 
A2H6J7 


657  bed, accredited, modern, 
well  equipped  General  flospltal, 
rapidly  expanding... 


Saint  John 

General 

hospital 


H. 


'SQUIRES- 


Saint%hn.N.B., 
CANADA 


General  Staff  I^rses  (^ 
Registered  Nursing  Assistants 


In  all  general  areas:  Medical,  Surgical, 
Pediatrics, Obstetrics,  Chronic  and 
Convalescent,  several  Intensive  Care 
areas  and  Psychiatry. 


0  Active,  progressive  in-service  education  prograrr}. 
Special  Attention  to  Orientation. 
Allowance  for  Experience  and  Post  Basic  Preparation 


FOR  FURTHUR  INFORMATION  APPLY  TO 

'PERSONNEL  DIRECTOR 

^aint^ohn  General  Hospital 

po  BOX  2000  Saint  John,  New  Brunswick  E2L4L2 


DIRECTOR 

OF 
NURSING 


Applications  are  invited  for  a  DIRECTOR  OF  NURSING  for  a 

138  bed  fully  accredited  brand  new  hospital,  presently  in  the 
final  stages  of  construction,  and  which  we  will  occupy  in 
August  1975. 


Qualified  applicants  are  requested  to  reply  in  writing, 
giving  curriculum  vitae  to: 

The  Administrator 
Kirkland  &  District  Hospital 
Kirkland  Lake,  Ontario 
P2N  1R2 


r  CANADIAN  NURSE  —August  1975 


65 


THE  SCARBOROUGH 
GENERAL  HOSPITAL 

invites  applications  from: 
Registered  Nurses  and  Registered  Nursing  Assis- 
tants  to   worl<    in    our    650-bed    active   treatment 
hospital  and  new  Chronic  Care  Unit. 

We  offer  opportunities  in  Medical,  Surgical.  Paedlatric,  and  Obstetrical  nursing. 

Our  specialties  Include  a  Burns  and  Plastic  Unit.  Coronary  Care.  Intensive  Care  and 
Neurosurgery  Units  and  an  active  Emergency  Department. 

•  Obstetrical  Department  —  participation  In  "Family  centered"  teaching 
program. 

•  Paedlatric  Department  —  participation  In  Play  Therapy  Program. 

•  Orientation  and  on-going  staff  education. 

•  Progressive  personnel  policies. 

The  hospital  is  located  in  Eastern  Metropolitan  Toronto. 
For  further  information,  write  to: 

The  Director  of  Nursing, 

SCARBOROUGH  GENERAL  HOSPITAL 

3050  Lawrence  Avenue,  East,  Scarborough,  Ontario 


WE  CARE 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

immediately  north  of  Toronto. 
APARTIVIENTS: 

Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 

Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


DIRECTOR 

OF 
NURSING 


Required  for  an  accredited  tiospltal  witti  a  bed  compliment  of  147 
beds,  including  22  long  term  and  a  6  bed  Coronary/Intensive  Care 
Unit  Affiliated  with  Fansfiawe  College  School  of  Nursing  for  the 
provision  of  some  clinical  facilities. 

Applicants  will  have  creative  and  innovative  leadership  qualities  with 
the  ability  to  anticipate  and  plan  for  the  indicated  changes  develop- 
ing In  the  fields  of  Health  and  Hospital  care. 

Preferrable  qualifications  will  include  a  Bachelor's  Degree  in  Nurs- 
ing, and,  some  formal  administrative  training  and/or  experience 

Position  available  September  1st,  1975. 


Please  direct  all  correspondence  In  confidence  to: 

The  Administrator 

Tillsonburg  District  Memorial  Hospital 

P.O.  Box  3100 

Tillsonburg,  Ontario 


SHERBROOKE  HOSPITAL 

SHERBROOKE.  QUEBEC, 
invites  applications  from 

REGISTERED  NURSES 
GENERAL  DUTY 


138-bed  active  General  Hospital;  fully  accredited  with 
Coronary,  Medical  and  Surgical  Intensive  Care. 
Situated  in  the  picturesque  eastern  Townships, 
approximately  80  miles  from  Montreal  via  autoroute. 
Friendly  community,  close  to  U.S.  border.  Good 
recreational  facilities.  Excellent  personnel  policies, 
salary  comparable  with  Montreal  hospitals. 


Apply  to: 
Director  of  Nursing 

SHERBROOKE  HOSPITAL 

Sherbrooke,  Quebec. 


NURSING 
INSTRUCTOR 


The  Nova  Scotia  Hospital,  a  progressive  595  bed  Psychiatric  Hospital, 
Dartmouth.  Nova  Scotia,  requires  the  services  of  a  Nursing  Instructor  Present 
programs  in  Psychiatric  Nursing  include:  student  nurse  affiliation,  post 
graduate  C  N.A,  and  R.N, 

QUAUFICATIONS: 

The  applicant  should  have  a  Bachelor's  degree  in  Nursing,  or  its  equivalent, 
ana  experience  in  psychiatric  nursing.  Consideration  will  be  given  those  with  a 
dipioma  in  Nursing  Education. 

DUTIES 

Under  the  Director  of  Nursing  Education,  the  incumbent  w/ill  be  responsible 
for  nstruction  in  any  of  the  three  courses  in  Psychiatric  Nursing 

SALARY: 

Commensurate  with  qualifications  and  experience. 

BENEFITS: 

Full  Civil  Service  Benefits. 

Competition  is  open  to  both  men  and  women. 

Please  quote  competition  number  75-559 

Application  forms  may  be  obtained  from  the  Civil  Service  Com- 
mission, P.O.  Box  943,  Johnston  Building,  Halifax,  Nova  Scotia, 
B3J  2V9,  and  the  Provincial  Building,  Sydney,  Nova  Scotia. 


Public  Service 
Canada 


Fonction  publique 
Canada 


THESE  COMPETITIONS  ARE  OPEN  TO  BOTH  MEN  AND  WOMEN 

NURSES 

Department  of  National  Health  and  Welfare 

Salary:  Commensurate  with  training  and  experience 

Charles  Camsell  Hospital 
Edmonton,  Alberta 

Gerieral  duty  nurses  are  needed  to  fill  immediate  and  future  vacancies  at  tfie  Charles 
Camsell  Hospital  which  is  a  402-bed.  active  treatment  hospital,  serving  the  native 
people  of  Aitiena.  residents  of  the  Yukon  and  Northwest  Territones.  as  well  as 
residents  of  Edmonton  Good  opportunities  exist  for  promotion  and  transfer  to  various 
locations  in  Canada  within  the  Federal  Public  Service  Please  quote  competition 
number:  75-E-1740(CNI 

Medical  Services 
Northwest  Territories 

An  opportunity  to  see  parts  of  Canada  few  Canadians  ever  see  and  to  utilize  all  your 
nursing  skills  Nurses  are  required  to  provide  health  care  to  the  inhabitants  located  in 
some  settlements  well  north  of  the  Arctic  Circle  Radio  telephone  communication  is 
available  Transportation  to  and  from  employment  area  is  provided;  meals  and  ac- 
commodation at  a  nominal  rate  Please  quote  competition  number.  75-E-1741(CN) 

QUALIFICATIONS  FOR  BOTH  POSITIONS: 

Eligibility  for  registration  as  a  nurse  in  a  province  of  Canada  For  some  positions, 
mid-wifery.  obstetrics,  pediatrics  or  Public  Health  training  and  experience  is  essential 
Proficiency  in  English  is  essential 
HOW  TO  APPLY: 

Forward  'Application  for  Employment '  (form  PSC  367-4110)  available  at  Post  Of- 
fices. Canada  Manpower  Centres  and  offices  of  the  Public  Service  Commission  of 
Canada  to: 

PUBLIC  SERVICE  COMMISSION  OF  CANADA 

300  CONFEDERATION  BUILDING 

10355  JASPER  AVENUE 

EDMONTON,  ALBERTA  T5J  1Y6 


if  Paris  appeals  to  you . . 


. .  .so  mil  Montreal 


•  modern  700  bed  non-sectarian  hospital 

•  excellent  personnel  policies 

•  Registered  Nurses  and  Nursing  Assistants 
are  asked  to  apply 


•  active  In-Service  Education  program 

•  bursaries  available 

•  Quebec  language  requirements  do  not 
apply  to  Canadian  applicants 


Director,  Nursing  Service 
Jewish  General  Hospital 
3755  cote  ste.  Catherine  Road 
Montreal,  Quebec  H3T  1E2 


.ADIAN  NURSE  — August  1975 


67 


ASSISTANT  EXECUTIVE 
DIRECTOR 

—  PATIENT  CARE  SERVICES 


The  setting  is  a  modern  550  bed  active  treatment  teaching  hospi- 
tal with  100  bassinets 

Reporting  to  the  Executive  Director,  this  position  has  responsibil- 
ity for  overall  administration  and  co-ordination  of  the  total  nursing 
service  function  and  related  policy  and  program  development. 

Candidates  will  have  post-graduate  training  in  health  or  business 
administration,  senior  level  nursing  experience,  and  proven  ad- 
ministrative skills. 


IntarBsted  applicants  pleasa  reply  with  a  comprehantlva  resume  to  the: 

PERSONNEL  DEPARTMENT 
MISERICORDIA  HOSPITAL 
16940  —  87  Avenue 
EDMONTON,  Alberta,  T5R  4H5 


CO-ORDINATOR 

STAFF  DEVELOPMENT 

NURSING 


For  community  orientated  General  Hospital  with  640  Active  Beds  and 
168-Bed  Continuing  Care  Unit. 

Duties  will  include  planning,  directing,  implementing  and  evaluating  educa- 
tional programs  for  all  levels  of  nursing  personnel  focusing  on  the  patient  as  a 
person,  a  member  of  the  family  and  the  community. 

QUALIFICATIONS: 

—  Ability  to  co-ordinate  and  direct  Programs  for  the  Clinical  Teachers. 

—  Clinical  expertise  and  teaching  skills. 

—  Skill  in  identifying  educational  needs  of  staff  members. 

—  Skill  in  designing  and  implementing  educational  programs. 

—  Experience  in  Continuing  Education  in  a  Staff  Development  Department 
—  Nursing. 

—  Preparation  at  University  level. 

—  Ontario  registration  required 

Apply  In  writing  to: 

DIRECTOR  OF  NURSING 
Scarborough  General  Hospital 
3050  Lawrence  Avenue  East 
Scarborough,  Ontario 
M1P2V5 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 
teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 
1975  Salary  Scale  $1,026.00  — S1, 21 2.00  per  month  (subject  to  change) 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 

VANCOUVER  GENERAL  HOSPITAL 

855  WEST  12TH  AVE. 

VANCOUVER,  B.C. 


NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  for  all  Nursing  Units 
Intensive-Coronary  Care,  Psyctiiatry,  Med. -Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservlce  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries     Reg.  N.  Jan.  1st,  1975  —  915.  —  1,1 15. 
April  1st,  1975  —  945.  —  1,145. 

R.N. A.  Jan.  1st,  1975  —  686.  —  728. 
July  1st.  1975  —  738   —  780. 

Contact 
Director  of  Nursing 


DIRECTOR  OF  NURSING 

Applications  are  invited  for  the  position  of  Director  of  Nursing 
for  the 

FORT  MC  MURRAY  GENERAL  HOSPITAL 

The  Hospital 

The  Fort  f^/lcMurray  General  Hospital  is  in  the  process  of  expanding  to  a 
Community  Health  Care  Centre  of  350  beds. 

The  Community 

The  town  has  a  population  of  1 5,000  but  is  expected  to  reach  60.000  by 
1990.  It  is  located  In  the  centre  of  the  Tar  Sands  Oil  Devetopment. 

The  Position 

The  Director  s  responsibilities  will  include; 

Coordination  of  all  nursing  activities  relative  to  the  delivery  of  health 
care 

Direction  of  programs  of  reauitment  and  In-service  education. 

Participation  in  the  hospitals  planning  for  various  health  care  ser- 
vices. 

To  be  one  of  the  hospitals  Administralrve  team  In  structuring  and 
organizing  the  delivery  of  these  services. 

The  Applicant 

Preference  will  be  given  to  applicants  with  a  Baccalaureate  degree  In 
nursing  and  with  several  years  of  supervisory  and  administrative  experi- 
ence. 
Salary  is  negotiable. 

Address  applications  to: 

Mr.  R.D.  Millar,  Administrator, 

Fort  McMurray  General  Hospital, 

7  Hospital  St., 

Fort  McMurray,  Alta.  T9H  1P2  Phone  no.  743-3381 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


,ADIAN  NURSE  —  Augusi  1975 


CRITICAL  CARE  CONSULTANT 
CO-ORDINATOR 

THE  POSITION 

—  To  be  a  consultant  to  the  Head  Nurses  and  staff  in  the  critical 
care  units  of  the  hospital  as  well  as  co-ordinating  effective  and 
efficient  health  care  in  both  critical  care  and  other  units. 

—  We  envision  this  person  developing  an  Orientation  Pro- 
gramme directed  towards  the  critical  care  nurse. 

—  In  conjunction  with  the  other  co-ordinators.  assumes  some 
weekend  coverage. 

—  Directly  responsible  to  the  Associate  Director  of  Nursing  — 
Patient  Care. 

THE  REQUIREMENTS 

—  At  least  two  years  experience  in  a  critical  care  setting  —  prefer- 
ably respiratory  and  cardiology  experience. 

—  Preferably  a  post-graduate  degree  in  nursing  and/or  previous 
experience  in  a  supervisory  role, 

—  Should  have  well-developed  interpersonal  and  problem- 
solving  skills. 

THE  BENEFITS 

An  opportunity  —  to  become  involved  with  a  hospital  that  believes  in 
participative  management:  to  utilize  your  innovativeness  and  know- 
ledge in  the  promotion  of  better  nursing  care. 

—  A  starting  salary  from  $1 ,283.00  to  $1 ,583.00,  depending  upon 
education  and  previous  experience. 

—  4  weeks  annual  vacation  after  one  year  of  employment. 

—  progressive  personnel  policies. 
THE  LOCATION 

VICTORIA,  B.  C.  —  a  beautiful,  'just  the  right  size"  city  located  at  the 
southern  tip  of  Vancouver  Island.  Government  ferry  transportation 
every  hour  to  the  Mainland  (Vancouver).  Victoria  is  truly  one  of  the 
most  picturesque  cities,  with  the  most  moderate  climate  in  all  of 
Canada.  Scenery  and  weather  are  truly  incomparable  —  you  have 
to  see  it  to  believe  it! 

INTERESTED  APPLICANTS  please  reply  in  confidence:- 

Director  of  Employee  Relations 

VICTORIA  GENERAL  HOSPITAL 

841  Colllnson  Street 

VICTORIA,  B.  C. 

V8V  3B6 


DIRECTOR  OF 
NURSING  SERVICES 

REQUIRED 
THE  HOSPITAL 

A  Director  of  Nursing  Services  is  required  in  this  modern,  well 
equipped  227  bed  accredited  hospital  providing  general  acute,  out- 
patient, and  extended  care  services  in  a  community  of  30,000  popi 
lation  situated  on  the  sea  shore  30  miles  by  freeway  south  c 
Vancouver,  B.C. 

DUTIES 

Responsibilities  include  planning,  organizing,  staffing,  coordinating 
and  fully  directing  all  aspects  of  the  nursing  services.  The  Director 
will  be  a  member  of  the  senior  management  team  concerned  will- 
the  total  operation  of  the  hospital. 

QUALIFICATIONS 

Qualifications  required  are  several  years  experience  at  a  senior 
supervisory  level,  or  as  an  assistant  director  or  director  of  nursing,  in 
a  hospital  setting,  preferably  a  baccalaureate  or  master's  degree  in 
nursing,  and  eligibility  to  register  with  the  provincial  professional 
nursing  organization.        < 

SALARY 

This  position  offers  excellent  working  conditions  and  benefits.  The 
salary  is  open  to  negotiation.  The  position  requires  filling  by  January 
1,  1976.  Interestea  applicants  should  send  their  application  and 
resume  to: 

Derrald  L.  Thompson 

Administrator 

Peace  Arch  District  Hospital 

15521  Russell  Ave. 

White  Rock,  B.C.,  V4B  2R4 


■;/     ■^• 


ST.  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

•  We  offer  opportunities  in  Emergency,  Operating  Room,  P.A.R.,   Intensive-  Care  Unit,  Orthopaedics,  Psychiatry, 
Paediatrics,  Obstetrics  and  Gynaecology,  General  Surgery  and  Medicine. 

•  We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Service  programs. 

•  We  offer  —  Toronto  —  with  some  of  Canada's  finest  Theatres,  Restaurants  and  Social  events. 

•  We  offer  progressive  personnel  policies. 

•  We  offer  a  starting  salary,  depending  on  experience,  of: 

effective  April  1, 1975     -  $345  to  $1,145  per  month. 

•  We  offer  monthly  educational  allowances  up  to  $1 20.  per  month  in  addition  to  the  above  starting  salary. 

Appiyto:  Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1B5 


worth 
looking 
into... 


occopotionol 

licoltli 

norsing 

with  Canada's 

federal  public 

servants. 


I* 


Heaiir*  and  We'idre       S.ini.>  ei  B<en-ei'e  sociji 


Medical  Services  Branch 

department  of  National  Health  and  Welfare 

Ottawa,  Ontario  K1A  0K9 


please  send  nrte  information  on  career 
sportunities  in  this  service. 


ame: 
Jdress: 
lity: 


Prov: 


Dr  Welby  is  a  . . . 
NURSE 


It  seems  clear  from 
watching  this  program 
that  poor  Dr  Welby  is 
spending  2/3  of  his 
time  NURSING. 

The  nursing  profession  at 

the  ROYAL  VICTORIA  HOSPITAL 

is  concerned  about  this. 
We  are  reviewing  nursing 
roles  in  depth  in  this 
teaching  hospital  center, 
and  we  feel  that  we  can 
relieve  Dr  Welby  of  his 
non-doctoring  functions. 

You  are  invited  to  join 

an  extensive  change 

program  in  the  nursing 

profession  at  the 

ROYAL  VICTORIA  HOSPITAL. 

Areas  where  you  can  be  a 
part  of  the  change  program 
are,  Medical  and  Surgical 
Specialties,  Intensive  Care 
Areas,  Operating  Room, 
Psychiatry,  Obstetrics, 
Emergency  and  Ambulatory 
Services. 

No  special  language 
requirement  for  Canadian 
Citizens,  but  the  opportunity 
to  improve  your  French  is 
open  to  you. 

For  Information,  Write  To: 

Anne  Bruce,  R.N., 

Nursing  Recruitment  Officer 
Royal  Victoria  Hospital 
687  Pine  Avenue  West 
Montreal,  Quebec,  Canada 
H3A  1A1. 


'sofra-tulle 


The  bactericidal 
dressing 

Composition 

A  lightweight  lano-paraffin  gauze  dressing  impregnated  with 
1%  Soframycin  (framycetin  sulphate  BP) 

Proportlos 

The  addition  o(  the  antibiotic  Sotramycin  to  the  paraffin  gauze 
ensures  the  prevention  or  eradication  of  superficial  bacterial 
infection  from  wounds  in  a  few  hours,  thereby  reducing  the 
need  for  systemic  antibiotics 

Sotramycin  is  a  bactericidal  broad  spectrum  antibiotic,  effec- 
tive against  many  organisms  which  have  become  resistant  to 
other  antibiotics,  including: 
Staphylococcus  aureus 
Pseudomonas  pyocyanea 
Escherichia  coli 
Proteus  spp 

Sotramycin  is  highly  soluble  in  water,  mixes  readily  with  exu- 
dates, and  IS  not  inactivated  by  Wood,  pus  or  serum,  Althou^ 
it  is  uncommon,  sensitization  to  Sotramycin  may  occur  and 
cross-sensitization  between  Sotramycin  and  chemically 
related  antibiotics,  eg.  Neomycin.  Kanamycin  and  Paromomy- 
cin IS  common  Cross  resistance  between  Soframycin  and  this 
group  of  antibiotics  is  not  absolute 

Advantag*« 

Rapid  eradication  of  bacteria  from  the  wound 

Excellent  physical  protection 

Low  incidence  of  maceration  even  after  three  weeks  in  situ. 

Non-adherent  can  be  removed  painlessly. 

Saves  dressing  time 

Reduces  wastage 

Each  dressing  is  parchment-sheathed  lor  no-touch  handling. 

Sensitization  is  uncommon. 

Indication* 

Traumatic:  Lacerations,  abrasions,  grazes  (gravel  rash),  bites 
(animals  and  insects),  cuts  puncture  wounds,  crush  injuries, 
surgical  wounds  and  incisions,  traumatic  ulcers 
Ulctratlve:  Varicose  ulcers,  diabetic  ulcers,  bedsores,  tropica! 
ulcers 

Thermal:  Burns,  scalds 

Elective:  Skin  grafts  (donor  and  recippent  sites),  avulsion  of 
finger  or  toenails  circumcision 

MIscellaneout:  Secondarily  infected  skin  conditions  —  eg 
eczema,  dermatitis,  herpes  zoster,  colostomy,  acute  parony- 
chia, incised  abscesses  (packing),  ingrowing  toenails 

Contra  Indications 

Sensitization  to  lanolin  or  to  Soframycin 

Application 

If  required,  the  wound  may  first  be  cleaned  A  single  layer  of 
SOFRA-TULLE  Should  be  applied  directly  to  the  wound  and 
covered  with  an  appropriate  dressing  such  as  gauze,  linen  or 
crepe  bandages  in  the  case  of  leg  ulcers,  it  is  advisable  to  cut 
the  dressing  exactly  to  the  size  of  the  ulcer  m  order  to  minimize 
the  risk  of  sensitization  and  not  to  overlap  on  the  surrounding 
epidermis  When  the  infective  phase  has  cleared  the  dressing 
may  be  changed  to  a  non-impregnated  one  The  amount  of 
exudate  should  determine  the  frequency  of  dressing  changes. 

Precautions 

In  most  cases  absorption  of  the  antibiotic  is  so  slight  that  it  can 
be  discounted.  Where  very  large  body  areas  are  involved  (eg 
30%  or  more  body  burn)  the  possibility  of  ototoxicity  and 'or 
nephrotoxicity  being  produced,  should  be  remembered 

Packing 

10cm  X  10  cm  (4"  x  4"), 

cartons  of  10  and  50  sterile  single  units 
30cmx  10cm(l2"x4"). 

cartons  of  10  sterile  single  units. 


ROUSSEL 


Roussel  (Canada)  Ltd. 

153  Graveline 

Montreal,  Quebec  H4T  1R4 

72 


Index  to  Advertisers 
August  1975 


Canadian  Pharmaceutical  Association  Insert 

The  Clinic  Shoemakers  2 

Colgate-Palmolive  Limited   is 

Hampton  Manut'acturing  Limited   16 

International  Business  Services 54 

J.  B.  Lippincott  Co.  of  Canada  Limited 36,  3~ 

MedoX  5> 

V.  Mueller 11 

Procter  &  Gamble   13 

Reeves  Company 7 

Roussel  (Canada)  Limited 72,  Cover  4 

W.  B.  Saunders  Company  Canada  Limited 5 

White  Sister  Uniform,  Inc 1 ,  Covers  2,  3 


Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  1E2  (Ontario) 

Advertising  Representatives 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore.  Penna.  19003 
Telephone:  (215)649-1497 


Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills,  Ontario 
Telephone:  (416)444-4731 


Member  of  Canadian 
Circulations  Audit  Board  Inc. 


nmn 


RESCUE   BREATHING   (MOUTH-TO-MOUTH) 

THE    CANADIAN    RED    CROSS    SOCIETY 
Start  immediately:  The  sooner  you  start,  the  greater  the  chance  of  success. 


Op«n  airway  by  lifting 
n«ck  with  one  hand 
and  tilting  the  head 
back  with  the  other 
hand. 


Pinch  nostrils  to 
prevent  air  leakage. 
Maintain  open  airway 
by  keeping  the  neck 
elevated. 


Seal  your  mouth 
tightly  around  the 
victim's  mouth  and 
blow  in.  The  victim's 
chait  should  rite. 


Remove  mouth. 
Release  nostrils. 
Listen  for  air  escaping 
from  lungs.  Watch 
for  chest  to  fall. 


REPEAT  LAST  THREE  STEPS  TWELVE  TO  FIFTEEN  TIMES  PER  MINUTE, 

IF  AIR  PASSAGES  ARE  NOT  OPEN:  Check  neck  and  head  positions.  CLEAR  mouth  and 

throat  of  foreign  substances. 

For  infants  and  children,  cover  entire  mouth  and  nose  with  your  mouth.  Use  small  puffs 

of  air  about  20  times  per  minute. 

USE  RESCUE  BREATHING  when  persons  have  stopped  breathing  as  a  result  of:  DROWNING, 

CHOKING,  ELECTRIC  SHOCK,  HEART  ATTACK,  SUFFOCATION  and  GAS  POISONING. 

Don't  give  up.  Send  someone  for  a  doctor.  Continue  until  medicat  help 
arrives  or  breathing  is  restored. 


Nurse 


(FOR  FALL  by  WHITE  SISTEI^ 


A)  Stye  No.  45860 

Sizes  3-1 5 
Royale  Seersucker, 
100%  woven  Polyester 
White,  Mint . . .  about  $33.0' 

B)  Style  No.  5458 

Sizes  8-1 6 

Royale  Corded  Tricot 

White,  Mint.. .  about  S21.0 


C)  Style  No.  45470 

Sizes  5-15 

Royale  Corded  Tricot  |  v 

White,  Mint . . .  about  $26.0'  ^ 


IftfHITE 
SISTER 


CAREER  APPAREL 


Sharpen  your  nursing  skills 


. . .  with  this  detailed  text  on  medical-surgical  nursing. 
. . .  with  pertinent  data  on  pharmacology. 
. . .  with  this  practical  self-testing  guide. 


. . .  with  this  complete 
reference  source. 


our  library  just  isn't  complete 
v-ithout  Miller  &  Keane's  Ency- 
clopedia and  Dictionary  of 
Pledicine     and     Nursing.     Its 

•0,000-plus  entries  provide 
itraightforward  information  on 
liseases,  drugs,  treatment  and 
quipment — and  special  sections 
etail  nursing  care  for  most  com- 
lon  diseases,  conditions,  opera- 
ions  and  accidents.  Quick- 
'eference  tables,  anatomical  plates 
nd  extensive  appendices  round 
lut  its  comprehensive  coverage. 
iv  the  late  Benjamin  F.  Miller, 
!  D  ,  and  Claire  B.  Keane, 
:  -\.,  B.S.,  M.Ed.  1089  pp.  122 
11.  16  full-color  plates.  $11.95. 
•larch  1972.         Order  #6355-9. 


Studying  for  exams?  Changing 
specialties?  Returning  to  prac- 
tice? Even  if  you're  just  looking 
for  a  way  to  refresh  your  skills, 
turn  to  Gillies  &  Alyn.  Saunders 
Tests  for  Self-Evaluation  of 
Nursing  Competence  features 
15  new  units  in  its  second  edi- 
tion. A  total  of  62  frequently  en- 
countered nursing  problems  are 
presented  as  they  occur  in  ac- 
tual practice,  encompassing 
maternity/gynecologic,  pediat- 
ric, medical/surgical  and  psy- 
chiatric nursing.  Case  histories, 
multiple-choice  questions  and 
tear-out  answer  sheets  make  it 
easy  to  discover  for  yourself  just 
how  sharp  your  nursing  skills 
are. 

By  Dee  Ann  Gillies,  R.N  , 
Ed.D.,  and  Irene  Barrett  Alyn, 
R.N.,  Ph.D.  392  pp.  with  151 
answer  sheets.  $7.75.  Jan. 
1973  Order  #4131-8. 


Whatever  your  question  on  drugs 
in  nursing  care,  you'll  find  the 
most  recent  clinical  information 
in  Current  Drug  Handbook 
1974-76.  ...  and  you'll  find  it 
quickly,  too. 

Over  1500  drugs  are  included  in 
this  softcover  reference — grouped 
by  usage  and  fully  indexed  by 
both  proprietary  and  generic 
names.  The  tabular  format  lets 
you  grasp  pertinent  facts  at  a 
glance: 

•  name,  source,  synonyms  and 
preparations 

•  dosage  and  administration 

•  uses 

•  action  and  fate 

•  side  effects  and 
contraindications 

•  pertinent  remarks. 

By  Mary  W.  Falconer,  R.N.,  M.A.; 
H.  Robert  Patterson,  M.S., 
Pharm.D.;  and  Edward  A. 
Gustafson,  B.S.,  Pharm.D.  257 
pp.  $5.95.  Sept.  1974. 

Order  #3566-0. 


Just  how  good  is  Luckmann  and 
Sorensen's  Medical-Surgical 
Nursing?  Here  are  only  a  few 
examples  of  what  nurses  are  al- 
ready saying: 

"A  truly  great  book!" . . .  "the 
most  complete  book  of  its  kind" 
.  .  .  "excellently  organized,  log- 
ically presented,  and  perti- 
nently illustrated"...  "covers 
pathophysiology  to  a  greater  ex- 
tent than  other  nursing 
texts — plus  the  nursing  care  is 
more  detailed  than  usual"  .  .  . 
"principles  underlying  nursing 
care  are  clearly  defined" .  .  .  "ifs 
about  time  that  a  greater 
psychophysiologic  approach  is 
used  in  nursing  texts"  .  .  .  "it  is 
very  unusual  for  a  med/surg 
text  to  offer  quantity  of  content 
and  quality  at  the  same  time"  .  .  . 
"probably  the  BEST  medlsurg  text 
ever  written".  .  .  . 
By  Joan  Luckmann,  R.N., 
M.A.,  and  Karen  Creason 
Sorensen,  R.N.,  M.N.  1634  pp. 
422  illus.  $20.35.  Sept.  1974. 
Order  #5805-9. 


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The 

'Canadian 
Nurse 


^^p 


monthly  journal  for  the  nurses  of  Canada  published 

English  and  French  editions  bv  the  Canadian  Nurses'  Association 


olume  71,  Number  9  September  1975 

21      Nurses  and  the  Myth  of  Full  Employment C.  Monaghan 

-i      "No  Thanks,  I've  Quit  Smoking" M.  RazzeH 

26      Nurses  As  Investigators: 

Some  Ethical  and  Legal  Issues R.C.  McKay,  J.A.  Soule 

,iO      Primary  Therapist  Project 

on  an  Inpatient  Psychiatric  Unit A.M.  Marcus,  J.  Anderson, 

H.  Gemeroy,  F.  Perry,  and  A.  Camfferman 

!4      The  Expanded  Role  of  the  Nurse:  '"^^ 

Independent  Practitioner  or  Physician's  Assistant? J.  Anderson, 

A.M.  Marcus,  H.  Gemeroy,  F.  Perry  and  A.  Camfferman 

i8      Nursing  at  Canoe  Narrows D.  Brown 

40      A  Conceptual  Model  for  Nursing E.T.  Adam 

42      Grand  Rounds  on  Brain  Tumors. .  .H.  Kryk,  F.  Blenkhorn,  A.  Carney, 
W.  Hawkins,  C.  Robertson,  E.  Roll,  and  U.  Steiner 


>  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
icles  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

1 1  News 

47  Names 

48  Dates 


50  New  Products 

52  Research  Abstracts 

54  Books 

60  Accession  List 


•  culive     Director:     Helen    K.    Mussallem  « 
or;     Virginia     A.     Lindabury   •   Assistant 
ors:      Liv-Elien      Lockeberg,      Lynda      S. 
jnston   •   Production     AssislanI;     Mary     Lou 
)wnes   •   Circulation     Manager:     Beryl     Dar- 
ling •  Advertising    Manager:     Ceorgina    Clarke 

•  Subscription  Rates:  Canada:  one  year, 
ib  00;  two  years,  $11.00.  Foreign:  one  year. 
5b  50;  two  years,  $12.00.  Single  copies: 
i  1  00  each.  Make  cheques  or  money  orders 
l.iavable    to    the    Canadian    Nurses'    Association. 

•  Change  of  Address:  Six  weeks'  notice;  the 
:  address  as  well  as  the  new  are  necessary, 
;ether  with  registration  number  in  a  pro- 
vincial nurses'  association,  where  applicable. 
Not  responsible  for  journals  lost  in  mail  due 
'"  errors  in  address. 


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  rale 
MONTREAL.  P.Q.  Permit  No.  10,001. 
50    The    Driveway,    Ottawa,    Ontario,    K2P1E2 

©  Canadian  Nurses'  Association  1975. 


editorial 


At  CNA  House  once  a  month,  twelve 
months  of  every  year,  journal  staff 
members  heave  a  collective  sigh  of  re- 
lief as  the  copy  for  the  succeeding 
month's  issue  is  delivered  to  the  prin- 
ter. Another  issue  has  tseen  "put  to 
bed."  Two  weeks  later  advance  copies 
of  the  journals  reach  CNA  House. 

For  editor  Virginia  A.  Lindabury,  this 
September  issue  will  be  a  departure 
from  a  10-year  tradition.  In  mid-August 
she  supervised  the  final  production 
stages  of  Vol.  71 ,  No.  9.  When  her  staff 
receive  the  September  issue,  how- 
ever, her  resignation  will  have  become 
effective  and  she  will  no  longer  be  the 
editor  of  the  journal  which  was  origi- 
nally established  to  "aid  in  uniting  and 
uplifting  the  nursing  profession  and 
Keep  alive  the  esprit  de  corps'  which 
should  always  remain  to  us  a  daily 
ideal." 

In  the  70-year  history  of  the  CNJ 
there  have  only  been  7  editors.  V.A.L. 
is  the  third  of  these  to  assume  full-time 
responsibility  for  the  journal.  Since  she 
joined  the  staff  as  English  assistant 
editor  in  1962,  many  changes  have 
taken  place.  In  January  1965,  on  the 
occasion  of  its  Diamond  Jubilee,  the 
CNJ  changed  its  size.  Eighteen 
months  later  the  first  full-page  illus- 
trated cover  appeared.  In  1965  the 
journal  headquarters  was  shifted  from 
Montreal  to  CNA  House  in  Ottawa. 
That  was  also  the  year  that  V.A.L.  suc- 
ceeded Margaret  E.  Kerr  as  editor. 

In  the  decade  since  then,  V.A.L.  has 
supervised  the  publication  of  close  to 
120  issues  of  the  CNJ.  She  has  made 
those  some  of  the  best  issues  in  the 
history  of  this  journal.  These  were  jour- 
nals that  both  Ethel  Johns  and 
Margaret  Kerr  would  have  been  proud 
of. 

The  contribution  of  V.A.L.  will  be  re- 
membered with  respect  and  affection 
by  nurses  in  this  country  for  many 
vears  to  come.  Like  the  others  ahead  of 
her  she  was  motivated  by  an 
overwhelming  concern  with  the  need 
for  nurses  to  develop  an  awareness 
and  understanding  of  events  in  the 
health  field  that  directly  affect  nursing 

The  effects  of  the  communications 
revolution  are  being  felt  by  the  two 
CNA  journals  as  they  are  by  all  profes- 
sional publications.  Next  month  a  new 
editor  takes  over  where  V.A.L.  left  off 
but  the  dialogue  between  the  nurses  of 
this  country  must  continue  if  the  profes- 
sion is  to  advance  and  grow. 

Michele  Kilburn 
Director 
Information  Services 


•-ADIAN  NURSE  —  September  1975 


letters 


Frankly  speaking. .  . 

The  article  '"Sex  Talk  and  Nursing"  by 
L.  Besel  (Frankly  Speaking:  About 
Nursing  Practice,  June  1975)  is  an  arti- 
cle long  overdue.  Thank  you!  It  is  great 
that  our  journal  is  publishing  articles 
that  "tell  it  like  it  is."  —  Mary 
Groome.  RN,  Laval.  Quebec. 


It  is  not  often  that  I  have  any  reason  to 
complain  about  the  articles  in  The 
Canadian  Nurse.  If  anything,  I  enjoy 
reading  our  magazine ,  and  find  the  arti- 
cles helpful  and  beneficial,  profession- 
ally. 

Lorine  Besel 's  "Sex  Talk  and  Nurs- 
ing" is  not  a  nursing  problem.  It  is 
vulgar,  obscene,  and  degrading  to 
nurses. 

I  hate  to  bring  this  whole  thing  up 
and  really  wouldn't  have,  except  that  it 
was  troubling  me  very  much.  Besel 
states  that  she  was  not  in  uniform,  was 
unknown  to  the  patients,  and  was  not 
identifiable  as  a  nurse.  Why ,  then,  does 
this  article  appear  in  The  Canadian 
Nurse?  —  Vera  Tedford.  R.N.,  St. 
Lambert,  Quebec. 


When  I  first  started  to  reply  to  the  arti- 
cle "Sex  Talk  and  Nursing"  (June 
1975,  p.  15),  I  focused  on  the  patients. 
Then  I  realized  that  a  general  answer  to 
the  essential  ideas  expressed  by  Lorine 
Besel  might  be  in  order.  For  the  most 
part,  her  questions  are  rhetorical  in  na- 
ture. 

Our  so-called  professional  education 
has  not  prepared  us  to  deal  with  the 
language  and  problems  of  sex.  Even  in 
the  late  sixties,  when  the  "sexual  re- 
volution" was  in  full  swing  in  our  soci- 
€ty,  the  nursing  schools  trailed  behind, 
and  sex  was  still  a  dirty  word,  still  a 
skeleton  in  the  closet. 

It  always  seemed  odd  to  me  that  even 
on  an  educational  level  our  teachers  and 
many  of  our  doctors  could  not  comfort- 
ably come  to  grips  with  sex  and  sexu- 
ally related  problems  that  affect  di- 
rectly and  indirectly  the  physical  and 
mental  health  of  patients  and  staff.  Our 
society  is  geared  so  that  these  problems 
permeate  our  very  existence. 

Let  us  focus  on  the  specific  examples 


of  the  patients  Besel  mentions  —  Mrs. 
A.  and  Mr.  Y.  Each  represents  a  differ- 
ent problem. 

Mr.  Y  is  presented  as  a  76-year-old 
man  with  genitourinary  problems,  who 
makes  a  "crude"  joke;  then  we  have 
the  reaction  of  the  staff  nurse,  who 
"stiffened  and  blushed."  What  Mr.  Y 
needs  is  an  empathetic  nurse  with  a 
sense  of  humor  and  tact.  How  can  any- 
one function  in  caring  for  sick  or  well 
persons  without  a  sense  of  humor?  For 
a  patient,  a  smile  or  a  good  laugh 
warms  the  heart  and  the  spirit.  It  may  be 
his  only  sunshine  for  the  day. 

What  if  the  same  remark  came  from  a 
35-year-old  man?  How  would  you 
react?  It  isn't  always  cut-and-dried,  nor 
should  anyone  ever  imply  that  it  is  easy 
to  deal  with  such  situations. 

Occasionally,  the  same  nurse  who  is 
put  off  by  a  patient's  allusion  to  sex  or  a 
sexual  problem  will  have  no  difficulty 
participating  in  a  crude  joke  at  the 
nurses"  station  with  another  "profes- 
sional.' '  The  intricacies  of  this  problem 
are  such,  that  to  delve  deeply  is  to  enter 
into  a  labrinyth;  but  recognition  is  the 
first  step. 

Mrs.  A.  must  be  viewed  from 
another  aspect.  She  is  not  alone.  Many 
women  have  similar  complaints,  but  at 
least  Mrs.  A.  is  aware  of  her  problem 
and  able  to  verbalize  it.  In  this  situation 
the  patient  will  be  capable  of  discussing 
the  problem  if  only  she  can  find  an 
empathetic  nurse  to  listen.  What  about 
the  many  persons  with  psychosomatic 
complaints  and  other  problems,  which 
may  originate  from  sexual  difficulties, 
who  have  not  yet  realized  the  source  of 
their  physical  ailment  or  of  their 
fatigue? 

The  professional  nurse  must  be  pre- 
pared to  deal  with  all  aspects  of  health 
care.  She  has  a  responsibility  to  herself 
and  to  her  patient  to  be  educated  and 
comprehensive  in  her  care  of  the 
"total"  patient.  In  the  realm  of  sexual 
difficulties,  the  nurse  should  not  im- 
pose her  own  values  and  mores  on  the 
patient.  She  must  continually  make  an 
effort  to  analyze  and  to  understand  her 
own  feelings,  her  tendency  to  make  a 
value  judgment,  and  her  gut  reactions 
to  the  language  of  sex  and  varying  sex- 
ual problems.  She  should  remain  recep- 


tive and  open  to  the  patient. 

Perhaps  a  great  part  of  the  problem 
for  the  nurse  stems  from  her  own  per- 
sonal insecurity ,  lack  of  education ,  and 
understanding  regarding  the  vital  sex- 
ual aspect  of  life.  — Mary  S.A .  Fisher, 
R.N.,  B.N.,  Montreal.  Quebec. 


I  was  most  interested  in  the  comments 
about  ""Sex  Talk  and  Nursing"  in 
"Frankly  Speaking,"  June  1975. 
Whether  we  wish  to  admit  it  or  not,  we 
are  sexual  beings,  our  patients  are  sex- 
ual beings,  and  we  must  stop  avoiding 
the  difficulties  that  often  arise  from 
being  what  we  are. 

It  isn't  easy  for  most  nurses  to  ap- 
proach the  Mrs.  A's  or  Mr.  Y's  in  a 
comfortable,  perceptive,  and  problem- 
solving  manner.  First,  we  have  to  be 
comfortable  with  ourselves  as  sexual 
beings.  We  have  to  understand  our  at- 
titudes and  feelings  in  relation  to  our 
own  sexuality,  and  then,  as  objectively 
as  possible,  gain  an  understanding  of 
sexuality  as  others  see  it. 

There  is  much  to  learn  about  sexual- 
ity in  relation  to  the  "ages  and  stages" 
of  man,  to  the  mentally  and  physically 
handicapped,  to  the  deviant  person, 
and  to  those  who  portray  a  sexual  role 
that  society  does  not  traditionally  ac- 
cept as  the  norm  —  the  homosexual  and 
the  lesbian. 

The  language  of  sexuality,  which  is 
not  limited  to  just  the  reproductive  or- 
gans and  copulation,  is  extremely  var- 
ied. We  may  not  be  comfortable  using 
the  terminology  that  Mrs.  A.  or  Mr.  Y 
used  (and  it  is  mild!),  but  we  have  to  at 
least  understand  it.  If  our  terminology 
becomes  a  barrier  to  good  communica- 
tion, then  perhaps  we  will  have  to  use 
that  which  is  familiar  to  the  patient. 
However,  if  we  can  recognize  and  deal 
with  the  underlying  implications  of 
what  the  patient  is  saying,  the  language 
no  longer  causes  a  "sense  of  shock  and 
embarrassment"  that  freezes  our  abil- 
ity to  relate  appropriately. 

Nurses,  doctors,  teachers,  and  social 
workers  have  been  woefully  lacking  in 
any  adequate  education  regarding  sex- 
uality. Until  we  have  that  education, 
preferably  integrated  with  our  basic 
(Continued  on  page  6) 


'2it  careers  stari  wiin  rasniun 


at  Eaton  Stores 


iniHITE 
SISTER 


CAREER  APPAREL 


^^  A  Ik  I  A  r\  A 


letters 

(Continued  from  page  4) 


education,  we  will  not  be  meeting  the 
total  needs  of  those  we  serve  —  pa- 
tients, students,  and  clients. 

I  am  familiar  with  only  one  course  — 
Human  Sexuality  and  Fertility,  a  mul- 
tidisciplinary  extension  program  held 
at  McMaster  University  2 1  February — 
11  June  1975.  I  found  this  program 
extremely  valuable.  Such  multidiscip- 
linary  courses  on  sexuality  should  be 
encouraged  by  our  profession. 

Thank  you  for  speaking  frankly 
about  an  important  topic.  —  Barbara 
Gray,  B.N.,  Reg.  N.,  Teaching  Staff, 
The  Mack  Centre  of  Nursing  Educa- 
tion, Niagara  College  of  Applied  Arts 
&  Technology,  St.  Catharines,  Ont. 


The  author  replies 

The  above  letters  reflect  both  positive 
and  negative  reactions  to  the  questions 
raised  in  my  article,  and  I  am  pleased  to 
hear  both. 

In  response  to  Vera  Tedford:  I  am  so 
conditioned  to  hear,  think,  and  feel  as  a 
nurse,  even  when  out  of  uniform,  that  I 
heard  and  saw  situations  in  which  I  felt 
nurses  could  have  been  more  helpful. 
However,  I  appreciate  Tedford's 
straightforward  and  honest  expression 
of  opinion.  "Frankly  speaking,"  I 
would  like  to  meet  Tedford  and  others 
who  may  share  her  views.  Perhaps  I 
will  have  that  opportunity  at  the  Cana- 
dian Nurses"  Association's  annual 
meeting  and  convention  in  Halifax  in 
1976. 

Both  Mary  Fisher  and  Barbara  Gray 
bring  up  important  aspects  of  the  prob- 
lem that  I  did  not  discuss.  I  certainly 
agree  that  a  sense  of  humor  is  impor- 
tant. Humor  is  a  much  ignored  side  of 
the  nurse-patient  relationship  in  much 
of  nursing,  not  only  in  relation  to  sex. 

Both  Fisher  and  Gray  discuss  the  as- 
pect of  the  nurse's  own  sexual  identity 
as  a  factor  in  our  ability  to  meet  the 
patient  on  any  sort  of  common  ground. 
I  agree.  As  long  as  our  own  sexual 
identities  are  unexplored  and  unknown 
to  us,  we  remain  vulnerable  and  par- 
ticularly susceptible  to  control 
mechanisms  of  our  virgin-white  un- 
iforms, task-oriented  nursing,  and  pol- 
icy distancing  in  the  nurse-patient  rela- 
tionship —  which  should,  after  all,  be  a 
collaborative  one. 

Does  the  CNa,  or  do  the  provincial 
associations  have  a  role  to  play  in  fos- 
tering the  development  of  more 
courses,  such  as  the  one  mentioned  by 
Gray? 


What  about  sex  in  basic  education? 
Here  we  are  dealing  with  adolescents, 
whose  own  sexual  identity  and  atten- 
dant curiosity  are  an  abiding  concern. 
Surely  this  could  be  turned  to  good 
growth  and  learning  account. 

However,  wherever,  and  whenever 
we  learn  about  sex  and  its  implications 
for  ourselves  and  our  patients,  there  is 
still  that  giant  step  of  turning  that  know- 
ledge and  understanding  to  therapeutic 
account.  — Lorine  Besel. 


Books  needed 

This  is  a  special  appeal  to  readers  of 
The  Canadian  Nurse  on  behalf  of  the 
Overseas  Book  Centre,  a  voluntary, 
non-profit  organization  that  provides 
educational  assistance  to  developing 
countries.  The  Centre  supplies  books 
and  other  educational  aides  free-of- 
charge  to  institutions,  including 
schools  of  nursing,  training  colleges, 
universities,  schools,  and  libraries. 

We  welcome  books  of  all  kinds,  both 
textbooks  and  general  reading,  but 
have  a  constant  demand  for  books  on 
nursing  and  on  the  teaching  and  care  of 
the  handicapped.  As  we  have  no  steady 
source  of  supply  of  such  specialized 
books ,  we  have  to  depend  on  donations 
from  private  individuals. 

If  there  are  nurses  who  would  like  to 
assist  this  program,  please  contact  — 
Carlotta  Bolton,  Regional  Director, 
Overseas  Book  Centre,  896  Queen 
Street  West,  Toronto,  Ontario. 


Magazines  available 

We  have  in  our  library  copies  of  several 
nursing  periodicals  for  disposal.  These 
periodicals  include:  the  American 
Journal  of  Nursing,  1952—1974; 
Nursing  Outlook,  1965—1969;  The 
Canadian  Nurse,  1954—1969.  Not  all 
volumes  are  complete. 

These  magazines  are  available  for 
the  cost  of  mailing.  We  would  like  to 
see  them  used,  rather  than  destroyed. 
—  Sister  Jean  Morrison,  Librarian,  St. 
Martha's  Hospital  School  of  Nursing, 
Antigonish,  Nova  Scotia. 

A  continuing  battle 

How  long  will  the  battle  of  the  2-year 
versus  the  3-year  graduate  go  on? 

I  must  sav  that  I  was  very  prejudiced 
against  the  2-year  program.  Why?  Was 
it  pride  in  the  3-year  program?  No! 
Perhaps  one  will  understand  better  if 


the  whole  picture  is  looked  at. 

The  government  has  a  "thing"  about 
hospital  budgets,  and  the  pressure  is 
constantly  on  the  administration  to  cut 
costs.  In  this  atmosphere,  it  is  not  sur- 
prising that  there  is  no  extra  staff  to 
orient  new  graduates.  Consequently,  it 
must  be  done  on  the  job  by  existing 
staff. 

I  have  talked  to  nurses  from  Ontario 
to  British  Columbia,  and  this  is  the 
basic  resentment  —  they  have  to  carry 
the  burden  and  responsibility  for  the 
new  nurses  until  they  get  on  their  feet. 
This  may  be  anywhere  from  6  months 
to  a  year,  or  longer. 

I  believe  that  the  2-year  graduates  are 
capable  of  working  in  the  ward  situa- 
tion, but  can  they  be  expected  to  take 
full  responsibility  and  charge  after  one 
week  of  orientation  in  each  clinical 
area?  And  then,  too,  they  are  expected 
to  perform  efficiently  in  an  emergency 
situation  of  any  type.  Somehow,  the 
gap  must  be  filled  between  graduation 
and  responsible  positions. 

How  much  pressure  would  it  lake  to 
make  the  government  realize  that  orien- 
tation is  essential  for  the  welfare  of  the 
patient  and  therefore  must  be  ade- 
quately allowed  for  in  the  hospital 
budget? 

I  think  it  is  time  we  stopped  arguing 
about  the  pros  and  cons  of  the  2-  and 
3-year  programs  and  started  to  do 
something  about  the  problems  that 
exist.  As  the  editorial  (June  1975) 
states,  ".  .  .it  is  necessary  to  find  out 
what  things  the  students  have  not  had  a 
chance  to  do  and  to  give  them  the  op- 
portunity to  do  these  things  with  in- 
terested guidelines,  not  critical  super- 
vision." 

Let's  fight  to  make  this  possible  for 
all,  not  just  a  select  few.  —  Catherine 
Peckham  RN,  Killarney,  Manitoba. 

Two-year  programs  are  inferior 

Due  to  such  negative  responses  to  my 
letter  (April  1975),  1  feel  that  I  must 
respond  and  clear  up  a  few  points. 

I  cited  catheterization,  which  was 
mentioned  in  almost  every  letter,  as 
only  one  of  the  many  skills  in  which  we 
were  taught  the  principles  and  tech- 
niques of  asepsis,  emotional  support, 
and  health  teaching.  During  the  3 
years,  we  were  given  ample  opportun- 
ity to  practice  our  skills  —  an  opportun- 
ity not  afforded  in  a  2-year  program. 

Instead  of  crowding  the  knowledge 

into  2  years .  we  were  fortunate  to  have 

(Continued  on  page  8) 


IT'S  EASY  TO  ORDER  REEVES  NAME  PINS  FOR  YOURSELF  OR  FRIENDS ! 


I 


ilems  snown.  Tor  group  purcnases,  graauaiion  grns.  Tavors,  etc. 
6-1 1  Same  Items,  Deduct  10%;    12-24  Same  Items,  Deduct  15% 
25  or  More  Same  Items,  Deduct  20%  £ 

MPH^M%Mi^ P9nn 


/mme^ Hh^ 'h^  fMHa4...^^i^/^^i^ 


Choose  style  you  want,  shown  fight.  Pnnt  aame  (and  2nd 
line  if  desired)  on  dotted  lines  below,  Chech  olfier  info  m 
boies  on  chart,  clip  this  section  and  attach  to  coupon 


Oottom  right  Altacfi  tiXa  sheet  (or  additional  pms 
NOTE  SAVINGS  ON  2  IDENTICAL  PINS  .  .  .  more  convenient. 
s^re  in  case  of  loss. 


ETTERING: 2nd   LINE:. 


OESCIIIPTIOM 


ALL  METAL 

L  corners  Choose  f-on^nt^-t;   idiin.  o 
"  new  Duotone  combining  sann 
background  witn  polished  edges. 


PLASTIC  LAMINATE  sl<mmer. 
I  broader ;  engraved  thru  surface  to 
r  conlrasung  core  color.  Beveled 

border  matches  lettering. 


,  MOLDED  RUSTIC      ,  S-mple.  smart. 

econoir.ical  Will  never  discolor. 
'  SmootM  rounded  corners  and  edges 


MHAL 
COLOR 


D  Silver 


nGoitj 

n  Silver 


MCTU 
FIWM 


□  Polished 
DSaiin 


Polished 
frame 
only 


BUKGIIOUND 
COLO) 
Mitit) 


apply 


DWfiite 
n  Green 
DBIi 
D  Cocoal 


ein  *B 

oaj         "l 


White 
only 


White 
only 


unnnK 
ntM 


D  Dk  Blue 
D  White 


Blach 
DK.  Blue 

/^hite 

Letters  only 


D  Black 
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D  Black 
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races 

EipnMUiM  Ca|nn42Lii« 


D  :■  P  hs  3.99 

lsamenam«l 


D  1  Pin    1.25 


D  2  Pins  1.95 

(MRi«naiTi«l 


D  1  Pin    2.49 
D  ?  Pins  3.99 


D  1  Pin    1.25 
n  2  Pins  1.95 


C  'i  P'l^    3.25 
n  2  Pins  4.95 


n  1  Pin    l.«5 
D  2  Pins  2.90 


n  !  Pin    3.25 
D  2  Pms  4.95 


D  I  Pin    l.»5 
D  2  Pins  2.90 


Mrs.  R.  F.  JOHNSON 

SUPERVISOR 


CHARLENE  HAYNES 


l^HS, 


1— ------------- — -------------------- 


^ISSORS  and  FORCEPS 


Finest  Forged  Steel. 
Guaranteed  2  years. 


K^s^-^ 


O 


£  No.  i 


LISTER  BANDAGE  SCISSORS 

3^2"  Mini-scissor.  Tmy,  handy,  slip  into 
..nform  pocket  or  purse  Choose  jewelers 
rid   or   gleaming   chrome    plate   finish. 

No.  3500  S'/a"  Mini 2.75 

4500  4V2"  size.  Chrome  only  . . .  2.95 
No.  5500  5''^2"  size.  Chrome  only  .  . .  3.25 
No.    702  7V4"  size.  Chrome  only  .  . .  3.75 
For  engraved  initials  add  50*  per  instrument 


'2    OPERATING   SCISSORS 

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J   :'05  Sharp  Blunt  points  .  .  .  2.95 
:,  ^06  Sharp/  Sharp  points  . . .  2.95 
1   710  4V2"  IRIS  Scis.,  Straight...  3.75 
>-  engraved  initials  add  50<  per  instrument 


KELLY   FORCEPS 

So  handy  for  every  nurse'  Ideal  for  claniping 
off  tubing,  etc.  Stainless  steel.  5^7" 

No.  25-72  Straight.  Box  Lock 4.49 

No.  725  Curved.  Box  Lock 4.49 

No.  741  Thumb  Dressing  Forcep, 

Serrated.  Straight,  5Vi"  .  .  3.75 

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289  Card  Set  .  .  .  1.50  ea. 
iiitials  gold-stamped  on  back  of 
)lder,  add  50c. 


i 


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card  holder.  Carrying  straps  6"  x  8" 
X    12".   Your   initials   gold   embossed 
FREE  on  top.  An  outstanding 
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1^ 


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'  -.   detailed  1,20  12K  Gold  Filled  caduceus  with  14K 
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No.  J3/035.  .  .5.95  per  pair 

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a  fine  precision  instrument, 
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tubes  and  chest  piece  beau- 
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FREE  INITIALS  AND  SACKI 

Your  intials  engraved  FREE  on 
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No.  2160  Nursescope 
including  Free 
Initials  and  Sack 

Duty  Free  16.95  ea. 


•IMPORTANT:  Ne«  Medallion"  styling  inclutfes  tubing  in  colors  to  match 
metal  oarts  If  desired,  add  $1.  ea.  lo  price  above:  add  "M"  to  Order 
No.  2160M)  on  coupon. 

LITTMANN  COMBINATION  STETHOSCOPE 

Maximum  sensitivity  from  this  fine  professional  instrument.  Con- 
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CLAYTON   DUAL  STETHOSCOPE 

Lightweight  dual  scope  imported  from  Japan:  highest 
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grey  anti-collapse  tubing,  4  oz..  29"  long.  Extra 
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Our  lowest  cost  precision  stethoscope!  Single  diaphragm  iV t"  dia ! 
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No.   4140   Clay.    Steth    .  .  .  11.95    ea.    Duty  Free 


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'  While   barrel   with   caduceus   imprint,   alu- 

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SERRATED  NURSES  SHEAR 

Can  cut  a  penny'  For  bandages,  gauze, 
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No.  5-1000  Shear . . .  6.95.  Initials  engr.  add  50< 


cfer> 


loimLPN. 


M  pintada  with  Mf ity  catch 


NURSES  PERSONALIZED  SPHYG. 
Now  in  Fashion  Colors! 

A  Superb  aneroid  sphyg.  especially  designed 
io'  nurses  by  Reister,  precision  craftsmen 
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guaranteed  to  *3mm.  Serviced  by 
Reeves  if  ever  required.  Your  initials 
engraved  on  manometer  and  gold 
stamped  on  case  FREE.  Choose  BLACK 
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BLUE.  GREEN  or  BEIGE  with  plastic 
mano.  housing,  tubing,  cuff  and  case 
all  color-coordinated  (specify  on  coupon) 
No.  106  Sphyg....  39.95  ea. 

Duty  Free  ^^^^^    PRESSURE    SET 

An  outstanding  aneroid  sphyg.  made 
in  Japan  especially  for  Reeves.  Meets 
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guaranteed  10  years.  Black  and 
chrome  manometer,  cal,  to  300mm. 
Velcro"  grey  cuff,  black  tubing,  soft 
leatherette  zipper  case  measuring 
2W  X  4"  K  7",  Serviced  tn  USA  if 
ever  needed,  Clayton  No,  4140 
Stethescope  (silver)  and  Scope  Sack 
included  (see  photo  left).  FREE  gold 
initials  on  case.  Here  is  a  sensible, 
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for  every  nurse! 

No.  41-100  B.P.  Set... 
Duty  Free    33.95  set  complete 
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CAP  TOTE  keeps  your  caps  crisp  and  clean 

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No.  333  Tote...  2.95  ea. 
Gold  init.  add  50c. 


WHITE   CAP   CLIPS      Holds  caps 
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mXfl^l  V      No.CT-KSpecify  Init.) No.  CT-3  (RN 

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■       ■       ■ 


■  ■  ■  mzx. 


TO:  REEVES  CO.,  Box  71 9-  C,  Attleboro,  Mass.  02703 


ORDER  NO. 


Use  extra  stieet  for  additional  ilems  or  orders. 
INITIALS  as  desired:    


TO  ORDER  NAME  PINS,  fill  out  all  information  in  box.  top 
left,  clip  out  and  attacfi  to  this  coupon 


I  enclose  $_ 


\  Please  add  50c  handling/postage 
_r  on  orders  totalling  under  (5.00 


No  COD'S  or  billing  to  individuals.  Mass.  residents  add  3%  S.  T 


Send  to  . 
Street  .. 
City      . . 


.Stste 


.Zip 


letters 


(Continued  from  page  6) 


our  teach ing  exiended  over  3  years .  We 
were  offered  a  well-rounded  nursing 
education,  with  much  experience  in  ail 
areas  of  nursing.  This  type  of  training 
cannot  and  should  not  be  replaced  by  2 
years,  with  limited  clinical  experience. 

Contrary  to  what  some  writers  be- 
lieve, we  were  not  "morons""  who 
asked  no  questions,  nor  "workhorses"" 
who  did  nothing  for  3  years  but  work 
nights,  give  back  rubs,  and  make  beds. 
We  had  an  extensive  training  and  we 
were  not  used  for  service  by  the  hospi- 
tal. 

One  writer  suggested  that,  to  change 
my  mind  about  the  2-year  program,  I 
need  only  ask  a  2-year  graduate.  Well,  I 
asked  several  2-year  graduates,  and  all 
were  disappointed  with  their  training. 
They  felt  ill-prepared,  and  conse- 
quently were  quite  disillusioned  with 
the  nurse  training  program  being  of- 
fered today. 

Writers  have  stated  that  some  hospi- 
tals are  reluctant  to  hire  2-year 
graduates  and  that  a  patient  actually 
refused  to  have  a  2-year  graduate  as  her 
nurse.  Is  this  not  proof  enough  that  the 
2-year  program  is  inferior? 

Never  in  my  nursing  career  have  I 
ever  been  refused  employment  by  a 
hospital  or  by  a  patient.  I  am  glad  I 
graduated  when  I  did  and  am  proud  of 
the  training  I  received. 

A  writer  stated  that  I  had  an  arrogant 
attitude  about  this  issue.  Well,  indeed  I 
do,  because  I  am  adamant  in  my  belief 
that  this  2-year  vocational  nurse  train- 
ing program  is  inferior. 

I  believe  that  nurse  training  should 
be  returned  to  the  hospitals,  where  it 
belongs  —  Cathy  Rathwell,  RN,  Mas- 
set.  British  Columbia. 


Family-centered  mafernity  care? 

Over  the  past  year  I  have  read  numer- 
ous articles  in  "women"s  magazines"" 
about  childbirth.  I  have  hSd  an  increas- 
ing urge  to  respond  to  them.  Rather 
than  defend  my  fellow  nurses  to  the 
magazine  readers,  I  am  writing  to  alert 
nurses. 

The  articles  I  speak  of  seethe  with 
negative  feelings  toward  hospital 
maternity  nurses.  Women  apparently 
believe  that  nurses  and  doctors  are  un- 
feeling and  are  present  at  labor  and  de- 
livery to  act  only  as  a  control.  These 
women  and  their  husbands  seemingly 
believe  that  "family-centered  mater- 


nity care'"  is  possible  only  at  home. 

Have  we  really  come  the  full  circle? 
True,  home  deliveries  are  more  preva- 
lent and,  fora  healthy  family,  probably 
beneficial.  I  do  not  believe  that  the 
maternity  nurses  with  whom  I  work  are 
either  uncaring  or  authoritarian  toward 
their  patients. 

Let  us  be  more  aware  that  a  mother  in 
labor  is  vulnerable  but,  with  support, 
her  innate  strength  will  make  this  time  a 
remembered  joy. 

It  has  always  amazed  me  to  hear 
women  from  large  centers  say  they 
have  been  refused  natural  childbirth.  In 
most  centers,  prenatal  classes  have 
been  freely  available  for  years.  At  the 
Halifax  Infirmary  Hospital,  natural 
childbirth  is  still  encouraged.  Hus- 
bands are  welcome  in  the  labor  and 
delivery  rooms,  and  family  visiting  is 
very  much  in  evidence.  Parental  educa- 
tional classes  and  varied  forms  of 
rooming-in  are  also  available  to  post- 
partum patients. 

If  the  articles  we  read  in  these 
"women"s  magazines'"  are  based  on 
rare  and  isolated  situations,  nurses 
should  speak  up!  If  they  are,  for  the 
most  part,  true,  then  let  us  all  walk 
more  carefully.  These  families  should 
be  experiencing  one  of  the  most  beauti- 
ful and  meaningful  times  in  their  lives. 
—  Arline  Kirkpatrick,  RN.  B.Sc.N.. 
Halifax.  Nova  Scotia. 


Wants  crossword  puzzles 

As  a  faithful  reader  of  The  Canadian 
Nurse,  I  find  each  issue  timely,  infor- 
mative, and  interesting.  A  more  well- 
rounded  professional  magazine  cannot 
be  found  anywhere  for  nurses. 

I  would  like  to  put  forth  a  suggestion 
that  may  or  may  not  meet  with  readers' 
approval. 

Many  of  my  colleagues,  as  well  as 
myself,  are  avid  crossword-puzzle 
fans.  I  wonder  about  the  feasibility  of  a 
medical  crossword,  published  each 
month  in  the  CNJ,  with  the  solution  on 
a  different  page  or  in  the  next  month's 
issue. 

The  possibilities  are  endless.  We 
could  use  diseases,  symptoms,  and 
anatomical  names,  with  suitable  clues. 
This  might  be  a  good  teaching  experi- 
ence, as  well  as  a  quiet  night-shift  pas- 
time. 

I'd  be  interested  in  the  reactions  of 
other  nurses  to  this  suggestion.  — ^ 
Lynda  Paine.  R.N.,  Kerwood.  Ont.  V 


The  bactericidal 
dressing 

CompoaHlon 

A  lightweight  lano-paratfin  gauze  dressing  impregnated  with 
1%  Soframycin  (framycetin  sulphate  BP) 

Prop«r11«t 

The  addition  of  the  antibiotic  Soframycin  to  the  paraffin  gauze 
ensures  the  prevention  or  eradication  of  superficial  bacterial 
infection  from  wounds  in  a  few  hours,  thereby  reducing  the 
need  for  systemic  antibiotics 

Soframycin  is  a  bactericidal  broad  spectrum  antibiotic,  effec 
live  against  many  organisms  which  have  become  resistant  to 
other  antibiotics,  including: 
Staphylococcus  aureus 
Pseudomonas  pyocyanea 
Escherichia  coli 
Proteus  spp. 

Soframycin  is  highly  soluWe  in  water,  mixes  readily  with  exu- 
dates, and  is  not  inactivated  by  blood,  pus  or  serum,  Although 
it  is  ufKommon.  sensitization  to  Soframycin  may  occur  anc 
cross-sensitization  between  Soframycin  and  chemically 
related  antibiotics,  eg.  Neomycin,  Kanamycin  and  Paromomy- 
cin IS  common.  Cross  resistance  between  Soframycin  and  this 
group  of  antibiotics  is  not  absolute 

Advantagas 

Rapid  eradication  of  bacteria  from  the  wound. 

Excellent  physical  protection 

Low  incidence  of  maceration  even  after  three  weeks  in  situ 

Non-adherent  can  be  removed  painlessly 

Saves  dressing  time 

Reduces  wastage 

Each  dressing  is  parchment-sheathed  for  no-(ouch  handling 

Sensitization  is  uncommon. 

Indications 

Traumattc:  Lacerations,  abrasions,  grazes  (gravel  rash),  bites 
(animals  and  insects),  cuts  puncture  wounds,  crush  injuries, 
Surgical  wounds  and  incisions,  traumatic  ulcers 
Uicaratlva:  Varicose  ulcers,  diabetic  ulcers,  t>edsores.  tropical 
ulcers 

Tharmal:  Burns,  scalds 

Elactlva:  Skin  grafts  (donor  and  recippent  sites),  avulsion  of 
finger  or  toenails  circumcision 

MItcellanaous:  Secondarily  infected  skin  conditions  —  eg 
eczema,  dermatitis,  herpes  zoster;  colostomy,  acute  parony- 
chia, incised  abscesses  (packing),  ingrowing  toenails 

Contra  Indlcattons 

Sensitization  to  lanoim  or  to  Soframycin 

Application 

If  required,  the  wound  may  first  be  cleaned  A  single  layer  of 
SOFRA-TULLE  Should  be  applied  directly  to  the  wound  and 
covered  with  an  appropriate  dressing  such  as  gauze,  imen  or 
crepe  bandages  In  the  case  of  leg  ulcers,  it  is  advisable  to  cut 
the  dressing  exactly  to  the  size  of  the  ulcer  in  order  to  minimize 
the  risk  of  sensitization  and  not  to  overlap  on  the  surrounding 
eptdermis  When  the  infective  phase  has  cleared  the  dressing 
may  be  changed  to  a  non-impregnated  one.  The  amount  ol 
exudate  should  determine  the  frequency  of  dressing  changes 

Pracautlons 

In  most  cases  absorption  of  the  antibiotic  is  so  slight  that  it  can 
be  discounted  Where  very  large  body  areas  are  involved  (eg 
30%  Of  more  body  burn)  the  possibility  of  ototoxicity  and/or 
nephrotoxicity  being  produced,  should  be  remembered. 

Packing 

lOcm  X  lOcm  (4"x4"), 

cartons  of  10  and  50  sterile  single  units 
30  cm  X  10  cm  (12"x4"). 

cartons  of  10  sterile  single  units 


ROUSSEL 


Roussel  (Canada)  Ltd. 

153  Graveline 

Montreal,  Quebec  H4T  1R4 


\bucan1tsee 
the  antibiotic  in 


m 


sofra-tulle 


The  invisible  ingredient  in  Sofra-tulle 
is  Soframycin-an  antibiotic.  Reserved 
exclusively  for  topical  use,  Soframycin  has 
a  comprehensive  spectrum  of  activity 
against  organisms  normally  encountered 
in  burns,  ulcers  and  wounds  Soframycin 
is  present  in  Sofra-tulle  in  a  bactericidal 
concentration,  and  maintains  its 


effectiveness  even  in  the  presence  of 
blood,  pus  and  serum.  The  method  of 
manufacture  ensures  a  uniform 
distribution  of  Soframycin  on  the  wound 
and  sensitization  is  uncommon. 

True,  you  can  t  see  the  antibiotic  m 
Sofra-tulle... 


but  yoti  will  see 
the  results. 


Roussel  (Canada)  Ltd. 

153  Graveline 

Montreal,  Quebec  H4T  1R4 


Trcivenol 

SuroeoA'/ 

ylove/ 

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with  new  and  better 
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problems 

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With  all  your  other  concerns  in  the  O.R.  you  don't 
need  to  hear  glove  connplaints,  too.  But  a  glove 
that  causes  excessive  hand  fatigue,  tears  too  easily  o 
does  not  provide  adequate  sensitivity  can  make 
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Help  him  solve  his  problems. ..and  yours. ..have  him  tr 
TRAVENOLSurgeon'sGloves-the  "problem  solver." 

TRAVENOL  Surgeon's  Gloves  are  made  of  a  strong  bi 
thin  latex  which  provides  dependable  durability 
and  strength,  without  sacrificing  sensitivity.  And  a 
unique  patented  TRAVENOL  mold  forms  gloves  that 
provide  improved  fit  and  comfort  with  reduced  stress 
across  the  palm  and  less  strain  on  the  thumb  joint. 

CAUTION:  After  donning,  remove  powder  by  wiping 
gloves  thoroughly  with  a  sterile  wet  sponge,  sterile 
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news 


CNA  Warns  Public 
Of  "Baby  Lounger" 

Ottawa.  Ontario  —  The  Canadian 
Nurses"  Association  has  issued  a  warn- 
ing to  the  pubHc  of  possible  hazards 
arising  from  the  use  of  a  type  of  plastic 
baby  seat  nov.  on  the  Canadian  market. 
The  warning,  in  the  form  of  a  letter  to 
the  president  of  the  Canadian  Associa- 
tion of  Consumers,  was  issued  as  the 
result  of  a  motion  passed  by  CNA  Direc- 
tors at  a  meeting  in  April. 

Directors  were  informed  of  the  po- 
tential hazard  by  the  Manitoba  Associa- 
tion of  Registered  Nurses,  which  had 
already  taken  steps  to  have  distribution 
of  the  product  halted  in  Western  pro- 
vinces. 

In  the  letter  to  CAC  president  M.J. 
O'Grady,  cna  describes  the  product  as 
a  "moulded  plastic  baby  lounger  with 
attached  bottle  holder."  The 
"lounger"  is  manufactured  by  Puritan 
Products  of  Montreal,  and  is  advertized 
in  the  spring  and  summer  editions  of 
Eaton's  Catalogue. 

CNA  letter  states:  "In  the  opinion  of 
CNA  directors,  the  use  of  the  holder  to 
prop  a  bottle  during  feeding  e.xposes  the 
baby  to  unnecessary  risk.  A  baby  who 
burps  or  coughs  during  feeding  could 
aspirate  milk  into  his  lungs. 

"As  nurses.  CNA  directors  regard  the 
practice  of  'prop  feeding'  as  a  proce- 
dure generally  detrimental  to  the  well- 
being  of  the  baby.  Babies  who  are  "prop 
fed'  miss  out  on  the  cuddling  and  atten- 
tion to  which  they  are  entitled.  CNA 
directors  hope  that  you  will  share  their 
concern  and  take  steps  to  inform  the 
public  of  this  danger." 

Copies  of  the  letter  were  also  sent  to 
the  manufacturer,  Puritan  Products. 
Montreal.  The  Consumer.  Box  99.  Ot- 
tawa, and  Eaton's  Catalogue  Distribu- 
tion Centre.  Toronto. 

MARN  Members  To  Pay 
Higher  Fee  In  1976 

Dauphin.  Manitoba  —  Active  practic- 
ing members  of  the  Manitoba  Associa- 
tion of  Registered  Nurses  will  pay  an 
additional  $20  in  professional  fees  in 
1976.  The  increase,  approved  by  dele- 
gates at  the  MARN  annual  meeting  in 
Mav.  brines  the  total  fee  to  $70. 


MARN  delegates  elected  the  follow- 
ing new  members  to  the  board  of  direc- 
tors: Margaret  McCrady.  second  vice- 
president;  Sr.  Yvette  Aubert.  nursing 
sisterhood;  and  Claudette  Savard,  Ger- 
trude Bernard.  Diane  Letwin. 
members-at-large. 

Board  members  reelected  were:  R. 
Greer  Black,  president;  Marvelle 
McPherson.  1st  vice-president;  Fay 
McNaught,  past  president;  Mollie  Wif- 
lard.  president,  district  1;  H.  (Bud) 
Smith,  president,  district  2;  June 
Barber,  president,  district  3;  and  Gwen 
Grieg.  Agnes  Dyck.  Lorraine  McLeod. 
Myrtle  Nichols,  Marie  Rondeau.  Arley 
Wiley,  members-at-large. 


NBARN's  Resolution 
Generates  Debate 

St.  Andrews.  N.B.  — A  resolution  call- 
ing for  a  study  into  the  possibility  of 
combining  the  roles  of  the  professional 
association  and  the  bargaining  council 
was  defeated  at  the  New  Brunswick 
Association  of  Registered  Nurses'  an- 
nual meeting,  10-12  June  1975.  Betty 
Poley  of  Saint  John,  one  of  the  nurses 
who  presented  the  resolution,  said  that 
it  was  not  proposed  as  a  threat  to  nbarn 
or  the  Provincial  Collective  Bargaining 
Council,  or  to  any  individual  within 
either  organization. 

Poley  said  she  felt  that,  under  the 
existing  circumstances,  a  division 
among  the  nurses  of  the  province  had 
occurred.   "Most  nurses"  she  said. 

wear  two  hats  and  feel  that  they  are 
members  of  two  entirely  different 
and  unrelated  organizations,  nbarn 
seems  aloof  at  times  and  solely  for 
supervisory  and  management  nurses. 
The  bargaining  council,  on  the  other 
hand,  seems  to  deal  with  daily  issues, 
and  there  has  been  heavy  criticism  from 
all  areas  of  the  province  as  to  how  effec- 
tively we  are  carrying  out  this  responsi- 
bility." 

According  to  Poley,  who  stated  she 
was  active  in  both  PCBC  and  nbarn. 
there  seems  to  be  communication  dif- 
ficulties between  the  two  groups.  Meet- 
ings between  the  two  groups  have  not 
prevented  such  problems  from  aris- 
ing." she  said. 

Poley  acknowledged  the  many  excel- 


lent resource  persons  within  both 
groups  and  stressed  the  need  for  unity 
in  tackling  the  concerns  of  nursing  in 
New  Brunswick  today. 

Also  speaking  to  the  resolution  was 
Glenna  Rowsell.  employment  relations 
officer  for  the  bargaining  councils. ' "At 
the  present  time,  the  Public  Service 
Labor  Relations  Act  does  not  allow  any 
organization  with  management  in- 
volvement to  participate  in  collective 
bargaining."  Rowsell  said,  "and  the 
Act  would  have  to  be  changed  before 
the  roles  could  be  combined." 

Approximately  300  nurses  and  stu- 
dents gathered  at  the  nbarn's  annual 
meeting. 

New  Perspective  On  Health 

Is  Theme  Of  RNANS  Meeting 
Halifax.  N.S.  —  "It  is  widely  recog- 
nized that  nurses  have  been  in  the  fore- 
front when  it  comes  to  health  promo- 
tion and  disease  prevention."  Huguette 
Labelle,  president  of  the  Canadian 
Nurses'  Association  and  principal  nurs- 
ing officer.  Health  and  Welfare 
Canada,  told  more  than  300  nurses  at- 
tending the  66th  annual  meeting  of  the 
Registered  Nurses'  Association  of 
Nova  Scotia.  The  meeting  was  held  at 
St.  Francis  Xavier  University  in  An- 
tigonish  last  June. 

Presenting  the  keynote  speech  on  the 
theme  of  the  meeting.  "The  Nurse's 
Role  in  the  New  Perspective  On 
Health."  Labelle  said  that  in  this  period 
of  intense  change  we.  as  nurses,  can 
not  only  assist,  but  also  take  the  leader- 
ship in  guiding  that  change  to  creatively 
and  sensitively  reorganize  health  care 
systems  in  which  health  is  the  focal 
point.  She  said  that  if  nurses  are  to 
influence  health  care,  they  must  learn 
to  work  with  community  leaders,  get 
involved  in  current  and  long-range 
planning  of  health  services,  and  not 
wait  to  be  invited,  but  to  create  and 
seize  opportunities. 

Many  of  the  resolutions  reflected  the 
theme  of  health  promotion.  Members 
resolved  that  the  RNANS  ban  smoking  at 
all  their  meetings;  that,  because  of  the 
increase  in  alcoholism,  the  advertising 
of  alcoholic  beverages  in  the  media  be 
(Continued  on  page  12) 


news 

(Continued  from  page  1 1) 


reduced;  that,  because  violence  and 
crime  are  factors  in  poor  mental  health, 
and  children  are  being  increasingly  ex- 
posed to  violence  and  crime  on  TV.  the 
RNANS  should  develop  a  position 
statement  for  forwarding  to  appropriate 
authorities.  Other  resolutions  reflected 
awareness  of  the  need  for  better  care  of 
the  aged,  continuing  education,  and 
highway  safety. 

Sister  Marie  Barbara,  president  of 
RNANS,  commented  on  the  foresight 
and  initiative  of  nurses  who  had  formed 
the  association  65  years  ago  "in  an  age 
where  there  was  no  woman's  suffrage 
and  no  women's  lib."  She  said  that 
these  original  members,  as  pro- 
claimed in  their  first  constitution,  had  a 
strong  belief  in  a  professional  associa- 
tion, which  should  give  us,  their 
legatees,  pause  to  consider  carefully 
what  we  believe  about  our  profession 
and  our  professional  association. 

An  RNANS  Life  Membership  was 
presented  to  Adelaide  Munroe,  former 
director  of  nursing  at  the  Nova  Scotia 
Sanatorium  in  Kentville. 

The  AGiR  Branch  (Antigonish- 
Guysborough-Inverness-Richmond), 
which  hosted  the  meeting,  received  the 
"Branch-Of- The- Year"  award. 

Two  new  officers  elected  to  the 
RNANS  executive  committee  were: 
Marion  Riley,  second  vice-president, 
and  Pat  Fraser,  third  vice-president. 

Health  Disciplines  Act 
Proclaimed  In  Ontario 

Toronto,  Out.  —  The  Health  Disci- 
plines Act  was  proclaimed  with  its  regu- 
lations in  Toronto.  14  July  1975.  This 
new  legislation  is  intended  to  provide  a 
more  unified  and  coordinated  approach 
to  health  services  in  Ontario. 

"The  Health  Disciplines  Act  has  ob- 
ligated the  College  of  Nurses  of  Ontario 
to  establish  standards  for  initial  regis- 
tration and  continuing  membership  in 
the  college,"  said  Joan  Macdonald  ex- 
ecutive director  of  the  CNO,  in  a  tele- 
phone interview. 

"Professional  misconduct  is  now 
clearly  defined  in  the  Act,  and  therefore 
employers  will  be  required  to  report  to 
the  CNO  anyone  they  dismiss  for  such 
actions.  Many  points  in  the  Act  consti- 
tute a  major  breakthrough  for  the 
CNO,"  Macdonald  said. 

The  Act  provides  for:  representation 
of  laymen  on  the  councils  of  the  5  col- 
leges, the  establishment  of  30  district 
health  councils,  and  the  formation  of  a 


health  disciplines  regulatory  board. 
Edward  Pickering  has  been  named  by 
the  Ontario  government  to  head  this 
7-member  lay  regulatory  board. 

The  5  professional  colleges  (nurses, 
dentists,  doctors,  optometrists  and 
pharmacists)  will  continue  to  be  essen- 
tially self-regulating,  but  responsive  to 
the  requirements  of  the  health  board. 
This  board  will  act  as  an  appeal  court  in 
reviewing  the  decisions  otthe  5  profes- 
sional complaint  committees.  As  an 
appeal  mechanism  for  the  decisions  of 
the  Health  Board,  the  colleges  have  the 
right  of  appeal  to  the  Supreme  Court. 

The  Health  Disciplines  Act  was 
proposed  in  Toronto,  March  1971,  to 
update  and  revise  procedures  of  regula- 
tion and  education  in  the  health  discip- 
lines. The  proposal  resulted  from  rec- 
ommendations in  the  Report  of  the 
Committee  on  the  Healing  Arts. 


Fellowship  Established 

By  Heart  Foundation 

Ottawa.  Ont.  —  The  Canadian  Heart 
Foundation  has  announced  the  estab- 
lishment of  a  Nursing  Research  Fel- 
lowship for  the  support  of  qualified 
nurses,  during  a  period  in  which  they 
would  undertake  study  in  some  areas  of 
cardiovascular  or  stroke  research  lead- 
ing to  the  attainment  of  a  master's  or 
doctoral  degree.  The  objective  is  to  at- 
tract nurses  to  study  and  research  in  the 
cardiovascular  specialties. 

For  further  information  and  applica- 
tion forms,  contact:  Robert  Guy,  Cana- 
dian Heart  Foundation,  Suite  1200,  1 
Nicholas  Street,  Ottawa,  Ontario. 


Canada  Admitted  To 
Confederation  Of  Midwives 

Lausanne,  Switzerland  —  Sponsored 
by  the  Federal  Republic  of  Germany 
and  the  Netherlands,  Canada  was  ad- 
mitted to  full  membership  in  the  Inter- 
national Confederation  of  Midwives, 
during  the  17th  International  Congress 
held  21-27  June  1975. 

The  Canadian  National  Committee 
of  Nurse-Midwives,  which  was  formed 
during  the  Canadian  Nurses' 
Association's  1974  annual  meeting  and 
convention  in  Winnipeg,  was  rep- 
resented by  Pat  Hayes,  president  of  the 
Western  Nurse-Midwives  Association 
and  spokesman  for  the  national  com- 
mittee. 

Representatives  from  93  countries 


were  among  the  more  than  2,000  mid- 
wives  attending  the  triennial  congress, 
whose  theme  was  "The  Midwife  and 
the  Family  in  the  World  Today." 
Members  of  such  international  organi- 
zations as  WHO,  UNiCEF.  ICN,  Interna- 
tional Federation  of  Obstetrics  and 
Gynecologists,  and  the  International 
Planned  Parenthood  Association  were 
also  present. 

Although  from  widely  disparate 
backgrounds,  all  midwives  at  the  con- 
gress focused  on  methods  to  improve 
the  quality  of  maternity  care. 


Rape  Victims  Aided 
By  Federal  Bill 

Ottawa,  Ont.  —  Rape  victims  will  be 
aided  by  the  amendments  to  the  crim- 
inal code.  The  bill  was  introduced  into 
the  House  of  Commons  by  Justice 
Minister  Otto  Lang  on  17  July  1975. 

Lang  stated  that  there  must  be  a 
"continuing  review  of  the  criminal 
code' '  and  that  "this  continuing  review 
is  necessary  if  the  criminal  law  is  to 
continue  to  be  effective  as  a  means  of 
control  in  view  of  the  changing  nature 
of  society." 

These  proposed  amendments  will: 
remove  the  need  for  corroboration  of  a 
rape  victim's  testimony;  permit,  only  if 
reasonable  notice  is  given  in  writing, 
evidence  to  be  introduced  of  the 
victim's  sexual  conduct  with  a  person 
other  than  the  accused;  and,  at  the  dis- 
cretion of  the  judge,  exclude  the  public 
from  all  or  part  of  the  trial,  prohibit  the 
publication  of  the  victim's  identity,  and 
change  the  place  of  the  trial. 

In  an  editorial  (April  1975)  The 
Canadian  Nurse  asked  for  just  such  a 
bill,  to  right  the  "legal  injustices  for 
rape  victims." 

Eighteen  Percent  Raise 
Won  By  Ontario  Nurses 

Toronto.  Ontario  —  More  than  19,000 
nurses  in  104  hospitals  in  Ontario  have 
won  an  18%  increase  in  salary  over  a 
15-month  period.  The  Ontario  Nurses' 
Association  and  the  hospital  represen- 
tatives reached  an  agreement  in  To- 
ronto, 18  July  1975. 

The  agreement  was  officially  ratified 
as  of  3 1  July  1975,  when  two-thirds  of 
the  104  hospitals  voted  in  favor  of  the 
proposals. 

The  starting  monthly  salary  for  a  be- 
ginning registered  nurse  increases  from 
(Continued  on  page  14} 


for  relief  of  postpartum  discpmforts 

only  Tucks  babies 
tender  tissues  two  ways 

QS  Q  soothing  wipe...Qs  o  cooling  compfess...Qnd  os  often  os  she  likes 


Tucks  medicated  pads  give  your  postpartum 
patient  more  relief,  more  often  than  ointments  or 
aerosols  because  pads  can  be  used  more  ways. 
Cooling  Tucks  medication  can  be  applied  by 
using  the  pad  as  a  compress.  Or  the  pad  can  be 
used  as  a  wipe  to  both  soothe  and  cleanse.  As  a 
wipe,  it  lets  her  avoid  the  mechanical  irritation  of 
harsh,  dry  toilet  paper.  A  Tucks  pad  under  her 
sanitary  pad  prevents  chafing  too. 

Tucks  medication  gives  prompt,  temporary 
relief  from  postpartum  discomforts — the  itching, 
burning  and  Irritation  of  episiotomies  and  simple 
hemorrhoids.  Its  active  Ingredients  are  witch  hazel 
and  glycerine — there  is  no  "caine"  type  anesthetic 


in  It.  Your  patient  can  have  her  own  supply  of 
Tucks  at  bedside  for  self-administered  relief  with 
minimum   risk  of  over-treatment  or  sensitization. 

In  addition.  Tucks  medication  is  buffered  to  an 
approximate  pH  of  4.6.  This  helps  tissues  maintain 
their  normal  acid  defenses.  Prescribe  Tucks  pads 
at  bedside  for  soothing,  cooling  comfort  from  the 
first  postpartum  day  on. 

Order  a  trial  supply  on  your  Rx.  Write  to: 


1956  Bourdon  Street.  Montreal.  P.Q  H4I\/1 1V1 


nevus 


(Continued  from  page  12) 


$945.  to  $1.045.,  retroactive  to  1  July 
1975,  and  will  increase  again  as  of  1 
January  1976  to  $1,1 15.  The  maximum 
salary  will  be  boosted  by  $  1 70.  over  the 
same  period. 

The  agreement  calls  for  the  employer 
to  pay  80%  of  the  employees'  life  in- 
surance premium,  50%  of  the  premium 
for  extended  health  care,  and  the  full 
premium  for  OHlP. 

An  increase  in  the  differentials  be- 
tween position  levels  is  also  covered  by 
the  collective  agreement.  However,  no 
increase  was  obtained  in  the  pay  differ- 
ential for  those  nurses  educated 
beyond  the  diploma  level. 

In  a  telephone  interview  with  Anne 
Gribben,  executive  director  of  the  On- 
tario Nurses'  Association,  she  said, 
"the  hospitals  would  not  agree  to  a 
master  collective  agreement,  therefore 
the  ONA  bargained  for  as  many  standard- 
ized items  as  possible.  We  had  to  be 
careful  when  we  standardized,"  she 
continued,  "for  we  had  to  ensure  that 
those  hospitals  with  better  conditions 
than  the  norm  would  continue  to  main- 
tain their  status  quo."  Shift  differen- 
tial, stand-by  allowances,  vacation 
time,  and  maternity  leave  were  some  of 
the  items  that  were  standardized  by  the 
agreement. 

Hospitals  that  do  not  presently  have 
nursing  committees  will  be  required, 
by  the  new  agreement,  to  establish 
them.  The  committees,  with  represen- 
tatives from  both  sides,  will  be  required 
to  follow  formal  committee  proce- 
dures. 

Failure,  on  either  party's  side  to 
abide  by  the  new  procedures,  will  result 
in  formal  complaints  to  senior  hospital 
management.  "This  agreement  falls  far 
short  of  the  ona's  proposal,"  Gribben 
said. 

The  Ontario  Nurses'  Association  is 
the  bargaining  agent  for  more  than 
19,000  registered  and  graduate  nurses 
in  104  hospitals  in  Ontario.  The  ONA 
was  formed  on  13  October  1973  and 
was  officially  approved  as  such  by  the 
Ontario  Labor  Relations  Board  on  14 
January  1974. 

RNANS  Workshop  On  Aged 
Attracts  Nearly  70  Nurses 

Halifax,  N.S.  —  "Someone  Like  You: 
A  New  Look  At  Meeting  the  Needs  of 
the  Aged"  was  the  theme  of  a  2-day 
workshop  for  registered  nurses,  held  at 
the  Citadel  Inn,  Halifax,  in  May.  It  was 
sponsored  by  the  Registered  Nurses' 


Association  of  Nova  Scotia  (RNANS)  as 
one  of  the  projects  in  the  association's 
continuing  efforts  to  help  meet  the 
needs  of  aged  citizens  of  Nova  Scotia. 
Nurses  came  from  all  over  the  pro- 
vince, nearly  70  in  all,  and  there  was 
large  representation  from  nursing 
homes. 

"One  can  be  very  lonely  in  one's  old 
age,  even  with  many  people  around." 
This  point  was  made  by  the  star  of  the 
first  day's  session,  Marie  Sadler,  a 
91 -year-old  former  nurse.  She  was  a 
member  of  the  panel  on  "How  I  feel 
about  aging  —  by  persons  who  know. ' ' 
During  the  panel,  three  senior  citizens 
were  interviewed  by  Joyce  MacLellan 
of  the  VON. 

The  workshop  program  was  divided 
into  4  topics,  and  the  participants 
worked  in  small  discussion  groups.  In 


the  first  morning's  session  on  "Aging 
and  the  Aged  —  What  Do  We  Mean?' ' , 
there  was  a  discussion  on  facts  and  fan- 
cies about  aging;  a  talk  on  the 
physiolocal  aspects  of  aging,  by  Dr. 
Ronald  Stuart,  a  general  practitioner; 
and  the  panel. 

The  afternoon  theme  was  "Are  We  l| 
Doing  Enough?";  it  included  a  film  on  [1 
attitudes  and  feelings  about  aging,  dis- 
cussions on  nursing's  responsibility  to 
the  aged,  and  meeting  the  learning 
needs  of  the  aged. 

"Confusion  —  Are  We  Doing 
Enough  to  Prevent  it?  To  Decrease  It?' ' 
was  the  topic  for  the  second  morning. 
Highlight  of  this  session  was  an  intro- 
ductiQn  to  reality  orientation,  pre- 
sented by  Norman  Blackie  of  the 
Geriatric  Clinical  Teaching  Unit,  fac- 
(Continued  on  page  16) 


CNA  Submits  Brief  On  Immigration  Policy 


Ottawa,  Ont.  —  The  Canadian 
Nurses'  Association  has  reacted  to  the 
publication  of  the  Green  Paper  on 
Immigration  by  presenting  a  formal 
brief  to  the  Special  Joint  Committee 
on  Immigration  Policy,  currently 
holding  cross-Canada  hearings.  The 
CNA  submission  is  based  on  a  posi- 
tion statement  adopted  by  the  associa- 
tion in  March  1968. 

The  latest  CNA  statement  repre- 
sents an  attempt  by  the  association  to 
point  out  some  of  the  problems  arising 
out  of  current  immigration  policy  as  it 
affects  the  nursing  profession  in 
Canada  and  in  developing  countries. 

CNA  points  out  the  need  for  further 
refinement  of  selection  and  counsel- 
ing techniques  for  prospective  immi- 
grants. "Nursing  is  a  key  component  of 
health  care  in  Canada,  and  desirable 
standards  of  nursing  practice  can  be 
maintained  only  if  the  qualifications 
of  nurses  from  other  countries  em- 
ployed in  Canada  are  substantially 
equivalent  to  the  standards  of  prepara- 
tion required  of  Canadian  nurses.  For 
this  reason,  the  CNA  advocates  the 
close  collaboration  of  immigration  au- 
thorities and  employers  with  the  reg- 
istration and/or  licensing  authorities 
in  each  province,  so  that  immigrant 
nurses  will  be  assimilated  into  the 
nursing  profession  of  this  country  to 
the  mutual  satisfaction  of  the  nurse, 
the  employer  and  the  profession .  Only 


in  this  manner  will  the  client  continue 
to  receive  quality  care." 

According  to  the  cna  brief,  selec- 
tion officers  should  be  extremely  ac- 
curate in  relating  local  documents  to 
standards  and  requirements  in  the  var- 
ious Canadian  provinces.  Before 
awarding  units  of  assessment  for  ar- 
ranged employment,  selection  offic- 
ers must  satisfy  themselves  that  the 
applicant  meets  provincial  licensing 
requirements  for  nurses. 

The  association  points  out  that  im- 
migration officials  should  provide 
names  and  addresses  of  provincial  as- 
sociations to  nurses  intending  to  im- 
migrate to  Canada.  The  prospective 
immigrant  should  be  advised  to  con- 
tact these  provincial  officers  directly. 

"The  official  position  of  the  CNA 
supports  the  observation  in  the  Green 
Paper  that  'international  relations  and 
other  reasons  argue  against  attempt- 
ing to  stimulate  the  immigration  of 
people  from  countries  whose  de- 
velopment may  depend  on  their 
skills.'  As  a  member  of  the  Interna- 
tional Council  of  Nurses  and  a  propo- 
nent of  national  assistance  for  de- 
veloping countries,  the  association 
regrets  and  opposes  recruitment  ac- 
tivities of  Canadian  hospitals,  trans- 
portation and  placement  agencies, 
which  effectively  aggravate  nursing 
shortages  in  these  developing  coun- 
tries." 


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news 


nlty  of  medicine.  University  of  Man- 
itoba, and  Ueer  Lodge  Hospital,  Win- 
nipeg, and  Janet  Banks,  head  nurse. 
Deer  Lodge  HospitaL 

Topic  of  the  final  session  was: 
■'Teamwork  as  an  Approach  to  Meet- 
ing the  Health  Needs  of  the  Aged.  What 
Do  We  Mean?  Can  We  Do  a  Better 
Job?"'  Featured  was  a  panel  with  audi- 
ence participation,  chaired  by  Lloyd 
Brown,  chairperson  of  the  interprofes- 
sional gerontology  study  group,  social 
service  department,  Halifax  Infirmary. 
Panel  members  included: 

Margaret  Holder,  assistant  profes- 
sor, department  of  nursing,  St.  Francis 
Xavier  University;  Dr.  Roy  Fox,  fac- 
ulty of  medicine,  Dalhousie  Univer- 
sity: Sharon  Jeans,  director  of  nursing, 
Pinehaven  Estates,  Halifax:  Hilda 
Gilkie,  member  of  a  family;  and  Ruth 
Beere,  head  nurse,  Victoria  General 
Hospital,  Halifax. 

Recommendations  for  the  following 
came  from  the  workshop:  a  poslbasic 
course  in  gerontologic  nursing;  similar 
workshops  with  people  from  other  pro- 
vinces; Nursing  Home  Association  be 
alerted  to  the  philosophy  and  value  of 
reality  orientation;  resident  profiles  be 
instituted  in  nursing  home  settings:  and 
improved  communication  between 
homes  for  special  care  and  active 
treatment  hospitals. 

Bilingual  Nursing  School 
To  Open  In  Bathurst 

St.  Andrews,  N.B.  —  A  bilingual  dip- 
loma school  of  nursing  will  be  estab- 
lished in  Bathurst  as  a  " "modified  pilot 
project,'"  according  to  a  joint  an- 
nouncement made  by  Health  Minister 
G.W.N.  Cockbum  and  the  board  and 
nursing  education  committee  of  the 
Chaleur  General  Hospital.  The  2-year 
program  is  expected  to  begin  in  January 
1976,  and  the  school  will  be  operated 
by  an  independent  board  of  trustees. 
The  Chaleur  General  Hospital  will 
cooperate  by  providing  clinical  experi- 
ence for  the  students. 

The  report  of  the  Study  Committee 
on  Nursing  Education  had  recom- 
mended an  integrated  bilingual  pro- 
gram for  Bathurst.  However,  plans 
now  call  for  a  nonintegrated  school, 
with  separate  English  and  French 
streams  under  a  single  administration. 

The  executive  committee  of  the  Re- 
gistered Nurses'  Association  of  New 
Brunswick,  at  its  meeting  last  April 
17-18,  expressed  concern  over  the 


change  in  concept,  and  the  growing 
preoccupation  with  the  language  ele- 
ment of  the  school.  They  believe  that  a 
nursing  school's  major  responsibility  is 
to  educate  nurses. 

The  Bathurst  School  will  be  the  fifth 
2-year  school  to  be  established  in  New 
Brunswick.  Others  are  operating  in 
Saint  John  (English);  Moncton,  (En- 
glish); and  Edmundston  (French).  A 
French-language  school  opened  its 
doors  in  Moncton  this  September. 

The  opening  of  a  school  in  Bathurst 
will  complete  the  phasing  in  of  2-year 
diploma  programs  as  recommended  in 
the  report  of  the  Study  Committee  on 
Nursing  Education. 


N BARN'S  Research  Uncovers 
Optimum  Staffing  Ratio 

St.  Andrews.  N.B.  —  One  baccalau- 
reate nurse  to  four  diploma  nurses 
is  the  optimum  ratio  for  staffing  a  nurs- 
ing unit,  according  to  Helen  Beath, 
nurse  investigator,  for  the  New  Bruns- 
wick Association  of  Registered  Nurses' 
nursing  research  project.  Beath  spoke 
at  the  opening  session  of  the 
association's  59th  annual  meeting.  She 
was  reporting  on  the  findings  of  a  proj- 
ect, that  compared  2  methods  of  staf- 
fing a  hospital  unit. 

Comparison  of  the  2  identical  32-bed 
surgical  units,  was  based  on  nursing 
care  provided,  use  of  nursing  skills, 
cost  of  personnel,  and  the  cost  of  sup- 
plies and  services. 

Other  findings  of  the  report  included: 
the  staff  of  the  unit  that  used  the  bac- 
calaureate and  diploma  nurses  spent 
more  time  engaged  in  clinical  ac- 
tivities: the  cost  of  staffing  the  units  did 
not  differ;  the  altered  staff  pattern  had 
only  a  slight  effect  on  the  patient's  wel- 
fare and  the  frequency  of^entries  to  the 
patient's  room:  and  no  effect  was  found 
on  the  number  of  patient  calls. 

Based  on  results  found  in  this  study, 
it  was  recommended  that  further  re- 
search be  undertaken. 


Ex-cigarette  Smokers 
Warned  Against  Cigars 

Montreal.  Que.  —  Ex-cigarette  smok- 
ers who  switch  to  cigars  may  be  ex- 
changing a  bad  health  risk  for  a  worse 
one,  a  Florida  researcher  told  the  Inter- 
national conference  on  Lung  Diseases 
in  Montreal. 

Allan  L.  Goldman,  M.D.,  Tampa, 


said  that  inhaled  cigar  smoke  robs  the 
blood  of  more  oxygen  than  does  in- 
haled cigarette  smoke.  He  pointed  out 
that  ex-cigarette  users  intentionalh 
continue  inhaling. 

Sixteen  nonsmokers,  24  inhaling 
cigarette  smokers,  and  10  inhaling 
cigar  smokers,  who  were  all  ex- 
cigarette  smokers,  participated  in  the 
investigation.  Carboxyhemoglobin 
levels  of  the  10  cigar  inhalers  were  as 
much  as  4  times  as  high  as  those  of  the 
24  cigarette  smokers,  and  8  times  as 
high  as  those  of  nonsmokers.  Dr. 
Goldman  said.  Blood  oxygen  satura- 
tion was  significantly  less  in  cigar  than 
in  cigarette  inhalers,  and  also  was  less 
in  cigarette  smokers  than  in  nonsmok- 
ers. 

Dr.  Goldman  concluded  thai 
cigarette  smokers  should  quit  smoking 
entirely.  If  they  do  switch  to  cigars, 
they  should  be  warned  about  the  dan- 
gers of  the  extremely  high  carbox- 
yhemoglobin levels  that  result  from  in- 
haling cigar  smoke. 

More  than  2,500  physicians,  nurses, 
and  other  professional  and  volunteer 
health  workers  attended  the  joint  an- 
nual meeting  of  the  American  Lung  As- 
sociation and  its  medical  section,  the 
American  Thoracic  Society,  the  Cana- 
dian TB  and  Respiratory  Disease  As- 
sociation, and  the  Canadian  Thoracic 
Society.  This  International  Conference 
on  Lung  Diseases  was  held  in  Montreal 
18-21  May  1975. 


Reality  Shock 
Suffered  By  Nurses 

Lake  Coitchiching.  Ont.  —  Reality 
shock  causes  many  nurses  to  leave  the 
profession,  was  the  main  view  ex- 
pressed, at  the  3rd  annual  Registered  » 
Nurses'  Association  of  Ontario's  con- 
ference for  directors  of  nursing  and 
nursing  education  at  Geneva  Park, 
Lake  Couchiching,  last  May. 

Marlene  Kramer,  author  of  Realit)' 
Shock,  was  the  featured  resource  per- 
son and  provided  information  on  how 
educators  and  nursing  service  directors 
could  help  the  new  graduate  overcome 
reality  shock.  Kramer  described  how  a 
nurse  suffers  reality  shock  when  she 
discovers  that  her  school-bred  values 
conflict  with  the  work- world  values. 

The  next  conference  for  directors 
will  be  held  3-6  October  1976  and  will 
explore  in  further  detail  how  directors 
can  be  more  supportive.  ti? 


Your  patients 
will  amaze 
you  . . . 


T    q 


SO  will  retelast 

Your  patients  will  be  back  to  normal  in  no 
time  and  ready  to  start  their  activities  as  if 
nothing  happened. 

NOT  SURPRISING  .  .  . 

RETELAST  is  so  comfortable  and  gives 
such  fast  relief.  Moreover,  RETELAST 
costs  up  to  40%  less  than  any  other 
dressing  or  traditional  bandage. 


^/ 


jjyMb^ 


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PHARMACEUTIQUES  LTEE 

ACEUTICALS  LTD 

Canada. 


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New  3rd  Edition!  COMPREHENSIVE  CARDIAC 
CARE:  A  Text  for  Nurses  and  Other  Health 
Professionals.  By  Kathleen  G.  Andreoli,  R.N., 
B.S.N. .  M.S.N.:  Virginia  K.  Hunn,  R.N.,  B.S.N.: 
Douglas  P.  Zipes,  M.D.;  and  Andrew  G.  Wallace, 
M.D.  This  new  edition  continues  to  stress  preven- 
tion of  cardiac  arrhythmias  and  early  rehabilitation. 
Emphasizing  fundamental  principles,  this  leading 
text  discusses  coronary  artery  disease  and  complica- 
tions; covers  physical  examinations  in  detail;  in- 
cludes examination  of  significance  and  therapy  of 
arrhythmias;  details  management  of  patients  with 
pace-makers;  and  more!  Additional  illustrations, 
new  electrocardiogram  tracings,  and  an  updated 
appendix  complement  this  timely  revision.  October, 
1975.  Approx.  288  pp.,  959  iUus.  About  $7.65. 


New  2nd  Edition!  FAMILY  NURSING:  A  Study 
Guide.  By  Evelyn  G.  Sohol.  R.N..  A.M.  and  Paulette 
Robischon,  R.N..  Ph.D.  By  presenting  various 
family  situations,  this  new  edition  challenges  stu- 
dents in  clinical  application  of  family  nursing 
techniques.  Individual  sections  deal  in  depth  with 
beginning  families,  families  with  school  age  children, 
"middle  years"  families,  and  aging  families.  Each 
section  contains  actual  case  studies  of  families  from 
various  socio-economic  and  ethnic  backgrounds. 
Discussions  include  venereal  disease,  unwed  parent- 
hood, sex  education,  child  abuse,  alcoholism,  and 
more.  Several  new  case  studies  cover  sickle  cell 
anemia,  family  nutrition,  and  drug  abuse.  June, 
1975.  198  pp.,  1 1  illus.  Price,  $7.65. 


A  New  Book!  PATIENT  CARE  STANDARDS.  Sv 

Susan  Tucker,  R.N.,  B.S.N.,  P.H.N.,  coordinating 
author.  This  first-of-its-kind  book  includes  Patient 
Care  Standards  intended  to  guide  the  nurse  in  plan- 
ning, implementing  and  evaluating  nursing  care. 
More  than  400  Patient  Care  Standards  are  divided 
into  three  major  sections:  medical/surgical;  obstet- 
rics; and  pediatrics.  Each  Standard  contains  four 
parts:  observation;  acute  care;  convalescent  care; 
and  patient  teaching/discharge  planning.  More  than 
70  illustrations  augment  the  text.  September,  1975. 
Approx.  360  pp.,  71  illus.  About  $12.10. 


A    New  Book'  CLASSIFICATION   OF   NURSING 

DIAGNOSES.  Edited  by  Kristine  M.  Gebbie,  R.N., 
M.N.  and  Mary  Ann  Lavin.  R.N.,  M.S.N.,  M.S.  This 
new  text  presents  the  proceedings  of  the  First 
National  Conference  on  the  Classification  of  Nurs- 
ing Diagnoses.  It  represents  the  first  effort  at 
collectively  articulating  and  recognizing  the  prob- 
lems which  nurses  must  face  and  deal  with  in  their 
careers.  It  lists  more  than  30  diagnoses  agreed  upon 
by  members  of  the  conference.  Contents  include 
principles  of  classification;  utilization  of  a  classifica- 
tion of  nursing  diagnoses;  suggested  frameworks  for 
the  categorization  of  nursing  diagnoses;  and  more. 
January,  1975.  180  pp.  Price,  $7.10. 


A  New  Book!  THE  NURSING  PROCESS:  A  Scien- 
tific Approach  to  Nursing  Care.  By  Ann  Marriner, 
R.N.,  M.S.,  P/i.Z).  This  comprehensive  text  presents 
a  compilation  of  varous  theoretical  concepts  of  the 
four  phases  of  the  nursing  process:  assessment 
planning,  implementation  and  evaluation.  This  is  the 
first  book  of  its  kind  to  provide  such  detailed 
information  for  effective  and  efficient  nursing  inter- 
vention. An  introduction  by  the  author  precedes 
each  group  of  readings.  These  introductions  analyze 
each  phase  and  the  concepts  present  therein.  Se- 
lected readings  for  further  explanation  are  presented 
at  the  end  of  each  chapter.  June,  1975.  256  pp.,  illus. 
Price,  $7.10. 


A  New  Book!  NURSING  ADMINISTRATION: 
Theory  for  Practice  with  a  Systems  Approach.  By 

Clara  Arndt,  R.N.,  M.S.  and  Loucine  M.  Daderian 
Huckabay,  R.N,  Ph.D.  Offering  a  theoretical 
approach  to  nursing  administration,  this  new  text 
utilizes  a  general  systems  theory  frame  of  reference. 
Applying  principles  and  theories  of  business  man- 
agement to  nursing  service  administration,  the 
authors  cover  such  topics  as:  goals  and  objectives, 
administrative  composite  process,  conceptual  and 
physical  acts,  and  more.  September,  1975.  Approx. 
336  pp.,  26  illus.  About  $12.55. 


(he  clireelion  you  Icike  (o<lcii|... 
LCnD  THE  UlflY  UIITII  fflOlBY  TEKTI 


New  2nd  Edition'  REVIEW  OF  HEMODIALYSIS 
FOR  NURSES  AND  DIALYSIS  PERSONNEL.  By 

C.  F.  Gutch.  M.D.  and  Martha  H.  Stoner.  R.N..  M.S. 
Reflecting  recent  advances,  new  equipment  and 
techniques,  this  new  edition  offers  general  back- 
ground information,  basic  principles,  and  a  broad 
overview  of  dialysis,  its  application  and  problems. 
The  question  and  answer  format  facilitates  greater 
understanding.  Such  common  and  perplexing  prob- 
lems as  sexual  dysfunction,  rehabilitation,  and 
discontinuance  of  treatment  are  thoroughly  investi- 
gated. .An  enlarged  glossary,  along  with  such  topics 
as  mass  transfer,  water  treatment,  and  maintenance 
hemodialysis  complete  this  outstanding  work.  June, 
1975.  276  pp.  29  illus.  Price,  S8.95. 


A  New  Book'  PRACTICAL  MANUAL  OF  PEDIAT 
RICS:  A  Pocket  Reference  for  Those  Who  Treat 
Children.  By  William  W.  Waring.  M.D.  and  Louis  O. 
Jeansonne  III,  M.S..  M.D.  This  unique  new  manual 
is  a  ready  source  for  specific  and  detailed  information. 
It  presents  the  myriad  unrememberable  facts  and 
figures  necessary  for  effective,  "on-the-spot"  treat- 
ment of  children.  The  manual  first  covers  informa- 
tion gathering:  history,  examination,  and  recording 
of  various  systems;  numerous  laboratory  tests, 
results  in  normal  and  abnormal  children;  special 
diagnostic  tests  and  procedures;  and  more  -  includ- 
ing treatment  procedures.  The  bulk  of  the  book 
presents  the  "unrememberables,"  such  as:  fluid  and 
electrolytes;  drug  dosages;  nutritional  values;  stan- 
dards measurements;  conversion  tables;  and  a  very 
thorough  index.  April.  1975.  368  pp..  214  illus. 
Price,  S6. 25. 


New  3rd  Edition'  BASIC  MATERNITY  NURSING. 
By  Persis  Mary  Hamilton.  R.N.,  P.H.N. .  B.S..  M.S. 
Utilizing  a  family-centered  approach,  this  new  book 
emphasizes  principles  of  patient  care  rather  than 
procedures.  It  specifically  outlines  each  health  team 
member's  role  m  all  situations.  This  approach  gives 
you  a  clear  picture  of  the  practical  nurse's  role  in 
maternal  care.  Illustrations  depict  the  anatomy  and 
physiology  of  both  sexes  and  the  embryonic  de- 
velopment of  the  child.  Revisions  are  numerous 
for  example:  the  chapter  entitled  "The  Effects  of 
Pregnancy"  now  encompasses  responses  in  both  the 
male  and  female.  Abortion  discussions  have  been 
revamped  and  updated,  and  the  section  concerning 
infants  bom  of  drug  addicts  has  been  considerably 
revised.  May,  1975.  258  pp.,  159  iUus.  Price.  $7.30. 


ASSISTING  THE  HEALTH  TEAM:  An  Introduc 
tion  for  the  Nurse  Assistant.  By  Marcia  S.  Bregman. 
B.S..  R.N.  This  new  text  clarifies  the  role  of  the 
nursing  assistant  and  provides  basic  instruction  in 
anatomy,  physiology,  vital  signs  and  patient  needs. 
The  book  begins  with  a  discussion  of  the  normal, 
healthy  person,  then  considers  the  effects  of  illness 
on  the  patient,  how  illness  can  be  observed,  and 
how  care  can  be  provided.  Numerous  references  are 
made  to  the  importance  of  the  emotional  aspects  of 
patient  care.  Special  attention  is  given  to  the  aged 
and  bedridden  patient  and  also  to  diets  and  special 
treatments.  Many  illustrations  exemplify  various  pro- 
cedures. 1974,  214  pp..  190illus.  Price.  $6.85. 


3rd  Edition.  SURGICAL  TECHNOLOGY:  Basis  for 
Clinical  Practice.  Sv  A/drv  Louise  Hoeller,  D.C..  R.N.. 
B.S.N. Ed.;  with  5  contributors.  This  new  edition 
covers  the  basics  of  operating  room  technology, 
from  broad  conceptual  aspects  to  application  of  the 
latest  technical  advances.  Emphasizing  skills  and 
attitudes,  it  defines  the  technician's  role  on  the 
surgical  team  and  clearly  describes  duties  involved. 
Appendices  provide:  a  sample  course  plan  for  a 
two-year  program  in  operating  room  technology; 
curriculum  plan  for  the  community  college;  ethical 
and  religious  directives  for  patient  care;  fundamen- 
tals course  sample  rotation  first  level  experiences; 
advance  level  student  experiences;  bibliography  and 
film  resources;  and  more.  1974.  398  pp..  295  illus. 
Price,  $11.50. 


TIMES  MIRROR 

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86   NORTHLINE    ROAO 

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E  CANADIAN  NURSE  —  September  1975 


19 


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Nurses  and  the  myth 
of  full  empbyment 


The  author  says  it  is  a  myth  that 
nurses  are  never  involuntarily  un- 
;mployed.  She  discusses  some  of 
the  options  and  choices  open  to 
lurses  whose  positions  disappear 
A'ith  technological  change. 

jabrielle  Monaghan 


I 


Conventional  wisdom  has  long  held  that 
nurses  are  never  involuntarily  unem- 
ployed. From  an  occupational  vantage, 
those  inundated  with  work  regard  those 
seeking  work  and  having  difficulty  finding 
it  as  insufficiently  diligent  in  their  efforts 
to  obtain  employment.  The  federal  gov- 
ernment knows  otherwise,  as  is  evident  in 
the  revised  Unemployment  Insurance  Act 
of  1972. 

This  myth  of  easily  found  and  constant 
employment  for  nurses  in  Canada  is 
damaging  to  all  of  us ,  however  comforting 
it  may  be  to  those  who  believe  it. 

Wasted  human  resources 

The  myth  is  harmful  in  several  respects. 
It  leaves  the  nurse  who  finds  herself  out  of 
work  singularly  unprepared  for  her  situa- 
tion. It  disguises  the  real  need  for  short, 
intensive,  retraining  programs  for  nurses 
trying  to  refit  themselves  into  our  highly 
complex  field. 

The  general  duty  nurse  watching  her 
institution  change  and  expand  may  be- 
come concerned  for  her  future  role  in  it. 
She  may,  consequently,  develop  that  de- 


Gabrielle  Monaghan  ( RN.  Richmond  School  of 
Nursing,  Dublin,  Ireland:  B.A.,  Laureniian 
University,  Sudbury,  Onl.)  is  enrolled  in  the 
Health  Administration  course  ai  U.  of  Toronto, 
for  the  academic  years  1975-77.  She  is  spon- 
sored by  the  Newfoundland  Department  of 
Health. 


fensiveness  and  rigidity  so  foreign  to  the 
concept  of  continuous  self-development, 
openness,  and  personal  transformation 
that  are  embodied  in  the  best  ideals  of  the 
women's  movement. 

In  broader  terms,  unawareness  of  the 
real  employment  picture  for  nurses  pre- 
vents constructive  action  on  the  problem. 
Nurses  remain  out  of  work,  while  some 
nursing  departments  cannot  find  qualified 
staff,  and  there  is  a  consequent  waste  in 
human  resources. 

Technological  obsolescence 

The  health  service  is  dynamic  and  ra- 
pidly changing  in  the  content  of  jobs  and  in 
the  working  methods  that  it  demands,  both 
in  the  technical  and  management  areas. 
This  raises  for  nursing  personnel  the  spec- 
ter of  technological  obsolescence,  for- 
merly a  concern  of  industrial  workers 
only. 

Nursing  leaders  have  been  mute  on  this 
point.  Is  it  possible  that  they  have  been  too 
involved  to  see  it?  It  is,  perhaps,  necessary 
to  take  McLuhan's  advice  and  "drop  out 
to  get  in  touch."  Otherwise,  we  may  be 
somewhat  dashed  to  find  that  our  jobs  have 
outgrown  us. 

The  phenomenon  is  well  known:  dis- 
coveries in  technology  and  knowledge 
force  change  in  any  aspect  of  culture  or 
environment  that  is  incompatible  with 
their  use.  Just  consider  the  change 
wrought  by  the  automobile  and  the  pill. 
Then,  reflect  on  the  discoveries  in  health 


HE  CANADIAN  NURSE  —  September  1975 


science.  In  the  lag  between  these  dis- 
coveries and  their  implementation,  we 
must  search  for  our  future  jobs. 

Changes  in  health  care 

Two  obvious  points  capture  our  atten- 
tion. First,  the  nature  of  occupations  is 
changing  and,  second,  fundamental  altera- 
tions are  underway  in  the  structure  of 
health  care  systems. 

The  first  point  is  illustrated  by  the 
growth  in  the  numbers  of  health  care 
workers,  which  is  not  so  much  growth  in 
nursing  job  opportunities  as  it  is 
emergence  of  new  health  occupations. 
These  occupations  result  from  rapid 
change  in  the  technology  and  content  of 
care,  and  they  reflect  the  increasing  extent 
to  which  health  care  is  based  on  research 
into  the  fundamental  and  applied  sciences 
and  into  the  efficient  performance  of  par- 
ticular functions. 

The  second  point  relating  to  changes  in 
agency  and  hospital  structure  is  a  result  of 
the  adaptation  of  management  techniques 
that  are  found  to  be  successful  in  industry. 
Greater  programming  and  specialization 
will  make  it  possible  for  hospitals  to  dis- 
pense with  nurses  at  the  supervisory  level. 
Clustering  of  several  units  into  one  clinical 
area  will  eliminate  many  head  nurse  posi- 
tions. Given  the  budgetary  problems  of 
administrators,  it  would  be  unrealistic  to 
expect  them  to  ignore  the  cost  savings  of 
eliminating  head  nurses  and  supervisors. 

The  removal  of  the  main  focus  of  stu- 
dent training  to  community  colleges  and 
universities,  and  the  healthy  drive  for 
greater  responsibility  by  the  general  staff 


nurse  may  leave  the  nurse  supervisor  with 
no  one  to  supervise.  These  changes  are  not 
to  be  deplored. 

Many  nurse  supervisors  are  helping  to 
implement  change.  But  what  is  expedient 
for  the  health  service  may  be  disastrous  for 
the  individual,  if  she  is  unprepared  to  ad- 
just to  the  change.  Nursing  associations 
have  been  slow  to  admit  this  situation,  or 
to  initiate  programs  for  personnel  re- 
leased, however  gracefully,  by  hospital  or 
agency  reorganizations. 

Added  to  these  changes  are  alterations 
of  relationships  within  the  family  and  of 
the  timing  of  the  child-rearing  phase. 
Early  completion  of  families  occurs  as 
those  who  married  at  graduation  find  their 
children  independent  when  they  them- 
selves are  barely  middle-aged. 

This  freedom  makes  obsolete  the  ques- 
tion of  whether  or  not  a  nurse  should  work; 
the  relevant  inquiry  is  at  what  she  is  to 
work!  Unemployment  due  to  structural 
and  technological  change  in  health  care 
systems  is  a  fact,  but  it  need  not  be  a  crisis 
or  a  dilemma,  if  met  intelligently. 

The  new  challenge 

Paralleling  the  drive  for  economy  and 
efficiency  in  the  health  service  is  a  move 
toward  comprehensive  care  and  an  attempt 
to  grow  beyond  the  narrow  concept  of 
acute  remedial  care,  which  has  been  the 
emphasis  for  the  past  15  years.  These  new 
services  present  challenges  appropriate  to 
nurses  with  insight  and  motivation,  gained 
in  acute  care  facilities.  Geriatrics,  preven- 
tive health  care,  psychiatric  day  care,  re- 
habilitation, crisis  intervention,  and  ex- 


tended care  are  growing  areas  in  whic 
maturity  is  a  real  asset. 

The  traditional  advancement  of  nurse 
by  way  of  the  management  hierarchy  is  n 
longer  quite  so  certain,  but  other  option 
are  open.  Nursing  can  be  a  good  found.i 
tion  for  further  training  for  work  in  mated | 
als  management,  medical  records,  stafi 
scheduling,  hospital  supplies  sales  an. 
testing,  or  nurse  practitioner  service.  Thi 
list  is  long,  and,  in  each  case,  further  edu 
cation  will  probably  be  necessary. 

The  need  for  leadership 

If  the  problem  is  to  be  tackled,  an  e,\ 
amination  of  the  situation  in  all  province' 
is  necessary.  A  basic  standard  for  registra 
tion  of  nurses  in  all  parts  of  Canada  mus 
be  established  to  facilitate  mobility.  Tht 
idea  that  nurses  won't  move  must  be  chal 
lenged.  A  counseling  service  for  graduate- 
and  a  center  to  match  applicants  and  \a 
cancies  should  be  set  up.  Funds  anc 
facilities  for  retraining  must  be  found,  an^ 
research  on  future  trends  must  be  under 
taken. 

Coupled  with  freedom  from  some  fani 
ily  responsibilities,  the  changes  facint: 
nurses  can  be  a  chance  to  define  new  rolc^ 
for  themselves  and  an  opening  of  new  op 
tions  and  choices.  Choices  are  never  eas\ 
but  they  are  a  privilege  and  an  enlargem. 
of  freedom.  We  must  take  seriously  inc 
challenge  we  are  inheriting. 


"No  thanks, 
I've  quit  smoking" 


Although  she  may  still  be  only  one  puff  away  from  becoming  a  smoker  again,  the 
author  does  not  leave  herself  open  to  that  temptation.  She  describes  how  she 
kicked  the  cigarette  habit. 


Mary  Razzell 


rhis  summer  I  ran  into  an  old  schoolmate 
)n  the  ferry  to  Langdale.  There  we  were, 
«ated  at  one  of  the  tables  b>  the  window 
watching  Gambler  Island  slide  by:  two 
niddle-aged  housewives  comparing  notes 
)n  our  teenagers.  We  had  our  coffee,  and 
ny  companion  reached  into  her  purse  for 
jer  cigarettes.  I  watched  her  light  up  and, 
for  a  moment,  had  a  shockingly  strong 
mpulse  to  join  her  in  that  once  familiar 
ritual.  The  last  time  I  had  seen  her,  we 
shared  a  cigarette  after  a  basketball  game 
at  Port  Mellon. 

It  seemed  to  me  that,  in  that  one  gesture 
ol  sharing  a  cigarette  with  a  friend,  I  could 
recapture  all  the  excitement  of  growing 
up. 

■And  therein  lies  one  of  the  responses  to 
cigarettes  that  kept  me  hooked  for  27 
\ears.  Back  in  the  "405  when  I  was  15,  a 
v.ar  was  going  on  —  cigarettes  were 
cheap,  plentiful,  and  popular.  Bette  Davis 
used  a  cigarette  in  her  movies  to  portray 
sophistication  and  sex  appeal.  Humphrey 
Bogart  was  tough,  and  he  smoked.  The 
connection  was  obvious. 

I  smoked  all  through  nurse's  training 
although,  by  this  time,  I  did  have  a  misgiv- 
ing or  two.  I  saw  that  patients  who  smoked 
ran  into  complications,  such  as  pneumonia 
, after  surgery.  Lung  cancer,  heart  disease, 
and  emphysema  were  more  prevalent 


Trie  author  is  a  graduate  of  St.  Paul's  Hospital 
"     xil  of  nursing,  Vancouver,  B.C. 

CANADIAN  NURSE  —  September  1975 


among  smokers.  But  I  was  young,  and  it 
wouldn't  happen  to  me.  I  knew  that. 

It  wasn't  easy  to  rationalize  my  way 
through  3  pregnancies  as  a  smoker,  but  I 
managed.  The  babies  weighed  less  than 
they  should  have.  With  both  my  husband 
and  me  smoking  at  home,  we  found  that 
our  children  were  having  colds  almost  all 
the  time.  Children  of  our  nonsmoking 
friends  were  faring  better,  but  by  this  time 
I  couldn't  stop. 

I  tried.  I  stopped  smoking  10  times. 
Three  times  I  stopped  for  10  months,  only 
to  start  each  time  the  children  were  home 
all  day  on  summer  vacation.  That  was  the 
second  clue  to  what  made  me  a  smoker.  I 
seemed  to  have  two  choices  —  either  to 
yell  at  the  kids,  or  light  up  yet  another 
cigarette. 

Once,  I  quit  smoking  for  more  than  a 
year.  I  thought  I  had  won  that  time.  One 
night  at  a  party  I  was  offered  a  cigarette, 
and  I  thought,  "Why  not?  Smoking  is  no 
longer  a  problem  for  me.  I've  shown  I 
have  tremendous  willpower.  I'll  have  this 
one  cigarette  just  to  be  sociable."  Clue 
number  three.  I  didn't  start  smoking  the 
next  day  but,  at  the  next  social  gathering 
about  a  week  later,  I  had  two  or  three 
cigarettes,  just  to  join  my  smoking  friends. 
I  decided  to  smoke  only  at  social  events. 
When  several  weeks  had  gone  by,  1  was  up 
to  half  a  package,  but  only  at  parties. 

Parties  an  excuse 

Now  a  curious  pattern  emerged.  I  sud- 
denly craved  parties  and  people,  espe- 


cially if  they  were  smokers.  If  no  party  was 
in  sight,  I  gave  one.  It  was  a  brief,  mad 
whirl .  In  a  couple  of  months ,  I  was  back  to 
a  package  a  day,  party  or  no  party. 

About  this  time  I  noticed  I  was  hiding 
how  much  I  smoked.  If  the  doctor  asked,  I 
would  say  off-handedly,  "Oh,  about  half  a 
package."  This  had  been  true  15  years 
before ,  and  I  was  reluctant  to  admit  even  to 
myself  that  my  consumption  had  gone  up. 
I  would  never  have  confided  to  anyone  that 
sometimes  I  smoked  a  package  and  a  half 
—  I  figured  everyone  was  entitled  to  the 
occasional  crisis  in  her  life. 

The  night  I  ran  out  of  cigarettes  at  mid- 
night and  drove  10  miles  through  a  heavy 
rainstorm  to  find  a  drugstore  that  was  open 
seems  unreal  to  me  now. 

I  know  that  my  day's  schedule  began  to 
be  dictated  by  my  need  to  smoke.  If  it 
seemed  I  would  be  in  the  dentist's  chair  for 
two  hours,  then,  maybe,  I  could  work  in  3 
cigarettes  in  the  waiting  room  —  after  all ,  I 
had  to  have  my  quota.  When  I  woke  up  in 
the  morning,  the  first  thing  I  thought  about 
was  a  cigarette  and,  from  then  on,  my  day 
was  planned  around  when  I  would  have  a 
smoke. 

By  this  time  I  realized  I  was  enjoying 
few  of  the  cigarettes  I  smoked.  I  smoked 
more,  trying  to  find  that  promised  feeling 
of  relaxation  and  sense  of  well-being,  but  I 
was  caught  in  a  vicious  circle. 

I  was  now  smoking  only  to  relieve  the 
discomfort  of  not  smoking. 

It  was  time  to  do  something  about  my 
nicotine  addiction.  But  what?  I  had  failed 


so  many  times  that  I  already  had  a  sense  of 
frustration  when  I  thought  about  quitting. 
Surgery  that  was  looming  up  soon  added  to 
my  growing  panic. 

Group  sessions 

Then  one  of  those  minor  miracles  hap- 
pened, which  convinced  me  that,  if  we 
keep  ourselves  open,  solutions  present 
themselves  for  our  use. 

A  smoking  expert,  who  ran  her  own 
smoking  clinic,  was  on  one  of  the  local 
radio  open-line  programs.  What  she  said 
made  sense  to  me,  and  before  the  day  was 
out  I  had  made  contact  with  her. 

She  set  me  on  a  course  that  dealt  with 
my  particular  pattern  as  a  smoker.  I  began 
to  learn  why  and  when  I  smoked,  and  to 
use  harmless  alternatives.  I  remember  say- 
ing that  I  found  I  was  smoking  when  I  felt 
mad  at  the  kids,  and  she  suggested  my 
leaving  them  for  five  minutes  to  take  a 
quick  walk  around  the  block.  It's  hard  to 
say  what  the  neighbors  thought  while  I  was 
getting  fresh  air  and  developing  a  well- 
defined  stride.  But  it  worked.  By  the  time  I 
went  to  hospital  for  surgery,  I  was  no 
longer  smoking  and  was  feeling  better  than 
I  had  for  a  long  time. 

That  was  in  May  1972,  and  I  haven't 
smoked  since. 

Later,  when  I  had  recovered  from 
surgery,  1  returned  to  the  group  meetings 
to  reinforce  my  new  status  as  a  non- 
smoker.  By  having  the  support  of  others 
who  were  beating  the  smoking  habit  and 
by  sharing  our  solutions,  we  helped  our- 
selves and  helped  one  another. 

My  husband  watched  my  progress  with 
guarded  interest  and,  when  he  was  con- 
vinced that  he  could  work  without  smok- 
ing, he  joined  us  at  the  clinic  and  became  a 
nonsmoker,  too. 

Eventually,  I  was  to  take  over  the  lead- 
ership of  this  group.  I  discovered  that  most 
smokers  would  like  to  quit.  They  resent 
the  loss  of  money,  of  time,  of  self-respect, 
and  of  health.  If  they  thought  they  could 
stop  smoking  and  continue  functioning  as 
reasonable,  decent  human  beings,  they 
would. 

Now  the  good  news  —  they  can. 

There  are  many  sources  of  help.  In  Van- 
couver there  is  a  wide  choice  —  from 
group  session  clinics  to  electric  shock 
aversion  therapy. 


tfWVT-*- 


Now  employed  by  the  British  Columbia 
Tuberculosis  and  Christmas  Seal  Society, 
my  smoking  expert  has  planned  a  free 
smoking  clinic,  and  is  currently  screening 
applicants,  for  its  fall  session.  There  will 
soon  also  be  free  clinics  especially  for  ex- 
pectant mothers.  Lunch-hour  clinics  in  in- 
dustry, where  smokers  can  have  the  sup- 
port of  their  fellow  workers  while  they 
beat  the  habit,  have  begun. 

Aversion  therapy 

Aversion  therapy  is  also  offered  through 
the  department  of  psychology,  at  the  Uni- 
versity of  British  Columbia.  The  cigarette 
is  the  tool  used  for  aversion.  Research  by 
psychologists  has  demonstrated  that 
"oversmoking"  as  an  aversion  technique 
is  an  effective  method  of  helping  smokers 
quit.  Follow-up  checks  after  6  months  to  a 
year  show  that  60%  of  them  still  abstain 


from  smoking.  In  contrast,  group  session 
clinics  claim  only  about  30%  success  after 
one  year. 

I  asked  the  director  about  his  program. 
First,  the  smoker  is  asked  to  keep  a  diary 
for  one  week  to  record  when  he  smokes, 
why  he  wanted  that  cigarette,  how  much 
he  wanted  it,  and  what  he  was  doing  at  the 
time.  Answering  these  questions  shows 
the  smoker  "why"  he  smokes,  so  that 
smoking  now  becomes  an  "act  of  con- 
sciousness." The  major  purpose  of  this 
program  is  to  find  alternatives.  If  a  person 
smokes  every  time  he  watches  TV.  he 
should  find  a  harmless  alternative,  such  as 
sipping  ice  water  through  a  straw. 

Now  comes  the  aversion  therapy.  Th; 
can  include  machines  blowing  smoke  ai 
the  patient,  as  well  as  "oversmoking."  He 
will  be  asked  to  chain-smoke,  perhaps  10 
cigarettes,  puffing  every  5  to  6  seconds. 


He  should  then  be  under  the  supervision  of 
his  physician,  as  the  harmful  effects  of 
cigarette  smoking  are,  of  course,  in- 
creased by  this  ""satiation"  approach.  For 
example,  the  pulse  rate  may  jump  40-50 
beats  per  minute.  Three  days  before  the 
scheduled  ""quitting"  day.  the  smoker  will 
be  asked  to  double  or  triple  his  smoking  — 
a  satiation.  On  the  day  he  quits,  he  will  be 
seen  at  the  clinic  to  plan  alternatives  to  his 
smoking  pattern  problem.  The  remainder 
of  the  program  will  take  about  a  month  of 
weekly  sessions  with  the  clinic  staff  to 
help  him  work  out  alternatives  and  de- 
velop self-management  skills. 

Electric  shock 

Electric  shock  aversion  therapy  is  used 
at  the  "Quit  Centre,"  a  commercial  ven- 
ture in  Vancouver.  Applied  to  the  smoking 
habit,  this  type  of  behavioral  modification 
aversion  therapy  has  shown  a  909c  success 
rate. 

For  one  hour  a  day,  for  5  days,  the 
smoker  sits  in  a  small  room,  full  of  the 
clutter  that  surrounds  a  heavy  smoker  — 
overflowing  ashtrays,  heaps  of  ashes,  torn 
wrappers,  and  empty  packages.  He  is  en- 
couraged by  the  therapist  to  smoke  the  4 
cigarettes  set  before  him.  Each  time  he 
reaches  for  the  cigarette  to  smoke,  he  re- 
ceives a  small,  harmless  but  unpleasant. 
electric  shock  through  a  small  wrist  band 
that  is  worn  like  a  watch.  This  wrist  band  is 
"attached  to  a  6-voit  dry-cell  battery,  and 
the  amount  of  charge  necessary  can  be 
regulated.  I  found  the  minimal  amount  ef- 
fective for  me  when  I  tried  it  out  recently, 
but  a  heavy  and  muscular  truck  driver  in 
another  group  session  would  probably 
ha\e  needed  a  much  greater  charge. 

The  theory  behind  this  aversion 
therapy,  according  to  the  director  of  the 
Quit  Centre .  is  that  smokers  have  created  a 
■pleasure  pathway"  when  they  smoke. 
B\  blocking  this  pathway  and  by  creating  a 
new  one  that  is  unpleasant,  the  smoker  can 
simply  no  longer  bring  himself  to  smoke. 
By  the  time  he  leaves  the  smoke-filled 
room  after  his  first  hour,  he  has  made 
significant  progress  toward  becoming  a 
nonsmoker. 

Follow-up  group  sessions  once  weekly 
tor  7  weeks  help  the  new  nonsmoker  to 
cope  with  the  changes  in  his  life.  He  may 
have  surprising  amounts  of  free  time  and 


an  urge  to  do  something  with  his  hands. 
One  typical  male  executive  had  turned  to 
hooking  rugs  in  his  lunch  hour.  "It  bog- 
gles the  imagination,"  he  said,  with  quiet 
satisfaction. 

Films  are  shown,  and  the  one  I  saw- 
when  I  visited  the  center  was  on  the 
pathologist's  view  of  the  effects  of  smok- 
ing on  the  body. 

While  doing  the  research  for  this  article, 
I  was  offered  a  job  as  head  therapist  in  the 
Quit  Centre.  I  had  noticed  that,  when  I 
was  in  the  aversion  room,  a  curious  thing 
happened.  It  took  about  five  minutes  for 
my  initial  abhorrence  to  become  a  light, 
giddy  feeling.  I  was  reluctant  to  leave  the 
room.  I  thought.  ""I  want  to  stay  here." 

Later,  at  the  group  session,  a  young 
accountant  said  he  hadn't  smoked  for  a 
month  but  was  getting  concerned  about  a 
meeting  he  was  going  to  attend.  As  is  usual 
at  such  business  meetings,  a  number  of 
men  in  the  room  would  be  smoking.  He 
thought  this  would  get  to  him.  The  group 
tossed  it  around  for  a  while.  The  accoun- 
tant said  something  that  describes  the  way 
it  is  for  me. 

He  said.  ""I  feel  like  an  alcoholic,  only 
with  cigarettes.  1  think  that  if  I  take  one 
cigarette  it  will  be  easier  to  take  the  next. 
So  I've  decided  not  to  take  the  first  one.  I 
don't  want  to  smoke  again  and  I  won't  take 
the  chance  —  not  for  a  million  dollars." 

That  decided  my  job  offer  for  me:  I 
wasn't  willing  to  take  the  chance  either. 
That  reluctance  to  leave  the  smoke-filled 
room  was  a  clear  indication  to  me  that  my 
enemy  lay  in  waiting  and  was  still  strong. 

A  subtle  habit 

The  smoking  habit  is  insidious  and  sub- 
tle. It  has  been  woven  into  my  personality 
from  early  teens.  It  was  part  of  the  image  I 
had  of  myself.  I  went  through  much  of  my 
growing  up  with  a  cigarette  substituting 
for  more  appropriate  behavior.  If  1  felt 
awkward  and  ill  at  ease  —  not  uncommon 
in  adolescence  —  I  took  a  cigarette.  No 
doubt,  to  anyone  other  than  another  teen- 
ager, the  act  of  lighting  up  and  smoking 
shouted  the  fact  that  I  looked  awkward  and 
ill  at  ease. 

After  coming  off  duty  during  nurse's 
training,  it  was  easy  to  grab  a  cigarette  and 
coffee  and  talk  over  the  unwarranted  and 
entirely  undeserved  admonitions  of  the 


head  nurse.  To  get  out  and  away  from  the 
nurses'  home  for  a  walk  or  a  swim  and 
relieve  the  pressure  in  some  other  way 
would  have  been  more  beneficial  to  me. 

When  the  children  were  small,  the 
cigarette  seemed  handy  for  the  boredom 
from  being  limited  to  a  three-year-old's 
vocabulary.  Instead  of  finding  a  solution 
to  that  boredom  —  which  surely  would 
have  been  to  get  out  into  the  company  of 
other  adults — I  withdrew  into  my  cloud  of 
smoke  and  remained  bored,  although 
soothed  momentarily  by  the  depressant  ef- 
fect of  the  nicotine. 

I  watched  nonsmokers  to  see  what  they 
did  instead  of  smoke.  If  I  felt  restless  and 
therefore  thought,  "I  must  have  a 
cigarette!"  —  what  would  nonsmokers 
do?  Perhaps  they  were  not  restless. 

I  once  watched  one  of  my  brothers  w  ho 
had  never  smoked.  We  were  sitting  around 
talking,  and  I  began  to  feel  uneasy  and  in 
need  of  a  cigarette.  He  got  out  of  his  chair, 
stretched,  went  to  the  window,  looked  out. 
strolled  into  the  kitchen  for  a  drink  of 
water,  came  back,  and  rearranged  himself 
in  a  different  position  in  a  different  chair. 
Because  he  had  never  used  a  cigarette  to 
mask  a  situation,  he  unconsciously,  but 
with  a  great  awareness  of  his  body's 
needs,  did  what  was  necessary  to  settle  his 
unease. 

I  am  glad  that  I  am  now  free  of  the 
smoking  habit.  It  is  easier  to  remain  a 
nonsmoker  now  because  the  public  cli- 
mate reinforces  this  status.  It  is  no  longer 
smart  to  smoke. 


Information  on  anii-smoking  literature  and 
clinics  may  be  obtained  from  local  branches  of 
the  Canadian  Tuberculosis  and  Respiratory 
Disease  Association.  W 


-  «;<inl*imh*sr  1CJ7S 


Nurses  as  investigators: 

some  ethical  and  legal  issues 


Nursing  research,  similar  to  nursing  practice,  presents  both  ethical  and  legal 
issues  that  must  be  considered.  When  investigators  think  critically,  during  the 
planning  phase,  of  all  possible  hazards,  much  trouble  can  be  averted. 


Ruth  C.  MacKay  and  John  A.  Soule 


In  nursing  research,  as  in  nursing  practice, 
situational  dilemmas  can  arise.  For  exam- 
ple, we  recently  encountered  a  problem 
when  interviewing,  in  their  homes,  the 
mothers  of  children  who  had  been  treated 
in  a  pediatrician's  office.  Our  objective 
was  to  measure  attitudes  about  service. 
The  interviewers  were  public  health  nurses 
who  had  been  hired  and  trained  for  the 
project . 

One  stormy  winter  day,  an  interviewer 
was  asked  by  a  mother  what  she  should  do 
about  her  child,  who  seemed  to  be  running 
a  fever.  The  mother  was  reluctant  to  take 
her  child  out  in  the  cold  to  see  the  doctor. 
Some  details  were  given,  and  it  was  obvi- 
ous that  the  child  needed  further  examina- 
tion. In  such  a  situation,  what  do  we,  as 
nurses,  do  as  investigators'? 

Nurses  as  investigators 

As  nurse  investigators,  do  we  check  out 
the  temperature,  discuss  the  child's  symp- 
toms with  the  mother,  urge  her  to  get  med- 


Ruih  C.  MacKay  (R.N..  Hamilton  General 
Hospital,  Hamilton,  Onl.;  B.A.  McMasler  Uni- 
versity. Hamilton;  M  N  and  ma.,  Emory  Uni- 
versily,  Atlanta,  Georgia:  Ph.  D  ,  University  of 
Kentucky,  Lexington,  Ky.)  is  Associate  Pro- 
fessor at  McMaster  University's  Faculty  of 
Health  Sciences.  Hamilton.  Ont.  John  A.  Soule 
(B  A  .  McMasler  University:  LL.B.,  Osgoode 
Hall  Law  School  of  York  University,  Toronto, 
Ont.)  is  a  member  of  the  Bar  of  Ontario,  and 
presently  practices  lavs  in  Hamilton. 

26 


ical  attention,  or  institute  needed  measures 
for  the  immediate  present?  In  other  words, 
in  a  stress  situation,  do  we  abandon  our 
investigative  role  to  become  a  prac- 
titioner? Or  do  we  repress  these  nurturant 
drives,  so  carefully  developed  through  our 
education  and  experiences  as  nurses?  "I 
am  so  sorry,  but  I  am  unable  to  help  you 
with  this  problem." 

The  interviewer,  giving  service  as  a 
nurse,  might  bias  the  mother's  responses 
to  the  interview  questions,  perhaps  alter 
her  attitude  to  the  service  she  has  received, 
and  contaminate  the  study.  Many  nurse 
investigators  do  not  handle  this  type  of 
pressure  well,  and  all  too  often  capitulate 
to  the  practitioner's  role. 

Yet,  could  a  nurse  be  legally  liable  for 
refusing  to  give  information  or  service 
when  she  is  professionally  prepared  to  do 
so?  Legally,  in  the  absence  of  some  statu- 
tory or  common  law  duty  to  act,  a  person 
cannot  be  held  liable  in  law  for  failure  to 
act.  However,  in  this  particular  factual 
situation,  if  the  investigator  takes  positive 
steps  to  alleviate  the  situation,  she  opens 
herself  to  civil  liability  if  she  negligently 
omits  to  do  something  required,  or,  in  pur- 
suing some  positive  course  of  action,  neg- 
ligently performs  some  act.  This  liability 
would,  of  course,  be  subject  to  the  proviso 
that  some  loss  is  occasioned  to  the  child. 

A  well-planned  study  anticipates  the 
occurrence  of  such  a  dilemma,  and  de- 
velops an  approach  to  be  used  consistently 
when  problems  of  this  sort  arise.  "I  am  so 
sorry,  but  I  am  unable  to  help  you  at  this 


time.  I  have  been  told  to  advise  mothers  k 
call  the  pediatrician's  office,  if  they  havi 
any  concerns  about  the  condition  of  thei 
child."  Depending  on  the  immediacy  o 
the  problem,  the  interviewer  could  elect  h 
complete  the  interview,  or  to  arrange  i 
return  visit.  Collaborative  pre-plannin( 
between  the  investigative  team  and  the 
health  care  personnel  to  develop  an  ac 
ceptable  course  of  action  can  usually  avoic 
dilemmas  of  this  type. 

Nurses  as  investigators  are  confrontec 
with  a  number  of  ethical  and  legal  issuer 
that  need  to  be  considered  before  a  studv 
can  get  underway.  The  Canadian  Nurses 
Association  has  developed  guidelines  foi 
the  profession  that  assist  both  investigators 
and  practitioners  in  examining  ethical  im- 
plications of  a  nursing  study .  *  Using  these 
guidelines  as  a  focus,  let  us  review  some  of 
these  issues.  Our  objective  will  be  to  de- 
termine how  we  can  protect  the  interests  of 
study  subjects,  the  supporting  agency  in 
which  the  study  is  conducted,  the  inves- 
tigators, and  answer  questions  that  are 
vital  to  the  improvement  of  nursing  care. 

Free  and  informed  consent  of  subjects 

How  do  we  obtain  the  subjects  for  our 
studies?  Subjects  must  express  willingness 
to  participate,  have  the  right  to  refuse 
without  reprisal,  and  the  right  to  withdraw 


*  Canadian  Nurses'  Association,  "Ethics 
Nursing  Research."  The  Canadian  Nurse.  \ 
68.  no.  9.  Sept.  1972,  pp.  23-25. 


at  any  time.  Furthermore,  the  consent  we 
obtain  needs  to  be  informed  consent.  A 
jconsent  obtained  from  a  person  without 
ifull  disclosure  of  the  attendant  and  conse- 
jquential  risks  is  invalid. 
j  One  day  we  videotaped  a  nursing  care 
episode  in  a  hospital,  focusing  on  the  care 
that  a  very  sick  patient  on  a  Stryker  frame 
was  receiving.  The  patient  appeared  to  be 

>  Ml  enough  to  understand  the  reason  for 

jamera,  and  willingly  signed  a  consent 

iorni  giving  permission  to  make  a  video 

'fd.  During  the  filming,  the  patient's 

came  to  visit.  He  was  upset  that  his 

,iio;her  was  involved  in  the  study,  stating 

h,  was  not  well  enough  to  make  this  deci- 

\lthough  the  nursing  staff  and  the  nurse 
,  stigator  did  not  believe  the  patient  was 
impaired  to  the  extent  that  her  consent 
u  ould  not  be  valid,  the  filming  was  termi- 
nated and  the  tape  erased.  The  investigator 
-oniplied  with  the  son's  demands,  since 
Jivcussion  with  him  at  the  time  did  not 
modify  his  approach. 
' '  nder  such  circumstances,  this  could  be 
jgally  questionable  situation.  Assum- 
.  however,  that  the  mother's  consent 
-  freely  given  —  she  being  fully  aware 
he  facts  and  risks  involved,  and  being 
.>und  mind  —  then  the  fact  that  the  son 
lected  to  the  procedures  involved 
vwiuid,  in  a  legal  sense,  be  of  no  conse- 
.juence.  From  a  public  relations  point  of 
viL'w,  it  seemed  wiser  to  concede  to  the 
suns  wishes.  This  is  an  example  of  a  situa- 
n  in  which  the  right  to  withdraw  from  a 
Jy  is  honored. 

There  are  several  kinds  of  patients  who 
ma\  present  difficulties  in  securing  con- 
sents. Children,  of  course,  are  not  legally 
able  to  give  consent,  nor  are  those  who  are 
mentally  ill.  But  what  are  the  implications 
lor  a  study  involving  the  active  participa- 
n  of  a  dying  person,  or  of  someone 
ivering  from  an  anesthetic? 
in  the  latter  case,  consent  can  be  ob- 
led  from  the  patient  prior  to  surgery  so 
■tiat  he  has  the  opportunity  to  make  an 
■  ormed  decision  regarding  his  participa- 
11  afterward,  provided  any  risk  factor  the 
in\estigator  is  aware  of  is  explained  to 
him.   In  the  former  situation,  a  Court 
\>.  ould  scrutinize  carefully  any  consent  ob- 
lained  from  a  terminally  ill  patient,  con- 
^'dering.  among  other  things,  the  stress  the 
iient  was  under  when  giving  consent. 
1  lie  safest,  and  perhaps  the  most  ethically 
and  morally  acceptable,  course  would  be 
obtain  consent  from  the  patient  and  the 
-At  of  kin. 
Do  we  have  the  right  to  invade  a  dying 
■son's  privacy?  The  nature  and  impor- 


tance of  the  study  question  and  the 
safeguards  built  in  to  protect  the  patient's 
rights  need  to  be  debated.  Usually  this  is 
one  of  the  questions  discussed  by  inves- 
tigators with  agency  health  care  staff,  and 
it  is  a  question  most  peer  review  commit- 
tees examine  with  considerable  care. 

Can  we  assure  patients  or  staff  who  re- 
fuse to  participate  that  they  will  not  be 
penalized?  Are  we  sure  that  patients'  con- 
tinuing care,  as  a  consequence,  will  not  be 
substandard?  If  staff  fail  to  comply  with  a 
request  to  take  part  in  a  study,  either  as 
subjects  or  participants  in  data  collection 
or  other  phases  of  the  study,  will  they  feel 
there  may  be  some  retaliation  as  far  as 
promotion,  salary  increments,  or  evalua- 
tion of  work  performance  are  concerned? 

As  investigators,  even  if  we  are  sure  that 
reprisals  will  not  occur  following  refusal, 
how  can  we  promote  good  public  rela- 
tions, so  that  if  some  staff  member  is  dis- 


appomted  through  failure  to  achieve  rec- 
ognition, he  will  not  attribute  this  to  his 
refusal  to  participate  in  the  study?  Good 
communication  between  the  service  staff 
and  the  investigators  helps  to  develop 
mutual  trust  and  minimizes  the  arousal  of 
threatening  suspicions. 

Although  our  objective  is  to  share  with 
subjects  the  nature  of  the  study  in  which 
they  are  being  asked  to  participate,  some- 
times studies  are  designed  in  such  a  way 
that  the  experimental  variable  is  masked, 
since  exposing  the  exact  nature  of  the  vari- 
able would  introduce  a  serious  bias. 
Studies  on  attitudes  fall  into  this  category. 

In  an  as  yet  unpublished  study  of 
humanitarianism  of  nursing  students  dur- 
ing their  basic  nursing  education,  we 
wanted  to  know  how  this  characteristic 
varied  over  the  period  of  their  develop- 
ment as  professionals.  To  disclose  we 
were  studying  humanitarianism  might  re- 
sult in  subjects  altering  their  responses  in 
some  way  to  appear,  in  their  view,  as 
favorable. 


A  questionnaire  instrument  was  formed 
in  which  the  humanitarianism  items  were 
mixed  with  other  questions  to  generalize 
the  exact  intent  of  the  questionnaire.  The 
instrument  was  labeled  a  "social  survey," 
and  the  reason  for  wanting  the  information 
was  that  the  investigators  wished  to  know 
how  students  felt  about  important  life  is- 
sues. They  were  told  on  entering  the  pro- 
gram that  they  would  be  requested  to  give 
the  information  then,  and  once  more  near 
graduation.  The  investigators  stated  they 
would  share  the  full  details  of  the  study  on 
the  completion  of  the  second  question- 
naire. 

When  subjects  are  informed  about  a 
study  before  their  consent  is  obtained,  and 
there  are  aspects  of  the  study  that  cannot  be 
disclosed  to  avoid  creating  a  bias,  they  are 
told  about  this  and  the  plan  that  will  be 
used  to  communicate  the  findings  to  sub- 
jects who  wish  them,  when  the  study  is 
completed.  However,  if  the  information 
withheld  would  in  any  way  affect  the 
subject's  decision  as  to  whether  or  not  to 
participate,  then  any  consent  obtained 
would,  in  a  legal  sense,  probably  be  in 
jeopardy.  Here  is  an  opportunity  for  inves- 
tigators to  maintain  good  rapport  with  the 
study  population  through  earning  the  con- 
fidence of  subjects,  and  leaving  the  way 
clear  for  the  initiation  of  future  studies. 

Signed  consent 

When  do  we  need  the  subject's  signed 
consent  to  participate  in  a  study?  Most 
investigators  want  a  signed  consent  when 
data  are  obtained  in  a  recorded  media, 
such  as  tapes  or  films.  This  may  not  be 
necessary  for  data  collected  through  ob- 
servation or  interview,  if  the  subject's 
identity  is  not  recorded  or  cannot  be  ascer- 
tained. If  a  questionnaire  is  signed,  it  is 
usual  to  consider  the  signature  a  recogni- 
tion that  the  information  is  freely  given, 
unless  there  are  special  conditions  on  the 
use  of  the  information  collected.  Gener- 
ally, the  questionnaire  directions  state  that 
the  information  will  be  treated  confiden- 
tially. A  consent  is  unusual  for  most 
anonymous  questionnaires. 

The  use  of  codes,  whereby  a  question- 
naire instrument  may  be  linked  with  the 
subject's  identity,  is  considered  unethical. 
Occasionally  the  subject  is  asked  to  use  a 
code  number  to  correlate  a  variety  of  in- 
struments used  in  a  study  with  the  same 
subject.  When  this  occurs,  it  is  discussed 
with  the  subject  prior  to  participation  and, 
since  his  identity  is  probably  revealed  in 
such  a  maneuver,  a  signed  consent  form 
protects  both  subject  and  investigator. 

What  does  a  consent  form  cover? 


'AN  NURSE  —  Seotember  1975 


Among  possible  other  things,  the  form 
identifies  the  study,  the  subject's  name, 
the  nature  of  the  information  to  be  col- 
lected, the  method  of  obtaining  data,  and 
the  length  of  time  over  which  data  are  to  be 
collected  on  each  subject;  the  form  also 
notes  that  all  this  information  has  been 
explained  to  the  subject.  It  specifies 
whether  data  are  to  be  used  solely  for  the 
investigation  and  if  some  other  use  may 
also  be  made  of  it,  such  as  for  student 
learning.  If  there  are  hazardous  and 
specific  uses  for  which  data  may  not  be 
used,  such  as  observations  of  nursing  ac- 
tion for  the  evaluation  of  staff  perfor- 
mance, then  this  is  sometimes  stated,  if 
this  is  not  a  legitimate  objective  of  the 
study. 

The  consent  form  specifies  confidential- 
ity,  possibly  anonymity  if  this  is  provided, 
and  the  ultimate  disposition  of  recorded 
data  —  for  example,  audiotapes  would  be 
erased.  Most  forms  also  include  a  state- 
ment saying  that  the  subject  has  a  right  to 
refuse  without  reprisal,  or  to  withdraw  at 
any  time  during  the  study.  When  the  sub- 
ject signs  that  he  is  willing  to  participate, 
his  signature  is  dated  and  witnessed.  Many 
agencies  routinely  retain  legal  counsel, 
and  this  is  a  helpful  resource  that  can  be 
used  in  checking  out  the  adequacies  of  a 
consent  form. 

Confidentiality 

During  the  planning  stages  of  a  study, 
the  investigators  and  the  agency  will  want 
to  discuss  who  should  have  access  to  in- 
formation obtained  for  the  study.  In  gen- 
eral, there  are  usually  identified  and  sup- 
portable reasons  why  data  are  considered 
confidential  to  study  staff  alone. 

For  example,  in  a  study  on  nurse-patient 
interaction ,  we  wanted  to  make  audiotapes 
of  nursing  students  as  they  took  nursing 
histories  of  clinic  patients,  to  measure  the 
students"  ability  to  relate  helpfully  to  pa- 
tients. Students  were  justifiably  concerned 
that  the  tapes  would  be  used  to  evaluate 
their  nursing  skills  in  relation  to  grades 
given  in  a  nursing  course  in  which  they 
were  currently  enrolled.  Plans  were  made 
to  avoid  using  the  investigators  in  any  way 
as  teachers  in  the  conduct  of  the  nursing 
course,  so  that  confidentiality  could  be 
assured.  When  this  was  clarified,  we  had 
no  difficulty  in  securing  student  participa- 
tion in  the  project. 

The  use  of  patient  records  presents  spe- 
cial problems.  Quite  rightly  so,  agencies 
are  accountable  to  patients  and  the  public 
for  protecting  the  rights  of  patients.  Most 
agencies  have  well-developed  guidelines 
or  regulations  concerning  who  may  use 


records,  under  what  conditions,  and  for 
what  purposes.  When  data  are  sought  from 
this  source,  nurse  investigators  need  to 
have  the  same  rights  as  other  health  pro- 
fessionals in  obtaining  permission  to  use 
records. 

If  an  agency,  such  as  a  hospital,  has  a 
board  or  committee  that  reviews  requests 
to  use  records,  nurses  need  to  have  rep- 
resentation on  that  board.  Nurses  ought  to 
contribute  to  nursing's  involvement  in  on- 
going research  in  that  agency.  A  com- 
munication channel  that  provides  access  to 
permission  to  use  records  through  another 
professional  group  is  unacceptable. 

At  times,  agencies,  as  well  as  patients, 
need  protection  from  having  their  iden- 
tities disclosed.  This  is  another  factor  most 
investigators  discuss  with  agency  staff  be- 
fore the  study  is  launched.  If  confidential- 
ity of  the  identity  of  the  agency  is  deemed 
necessary  or  desirable,  the  way  this  may 
be  attained  is  vital  to  consider.  In  Canada, 
where  many  cities  have  only  one  agency  of 
a  type,  it  is  easy  to  identify  an  institution. 

When  the  study  has  been  completed, 
agency  staff  are,  as  a  rule,  anxious  to  hear 
the  findings  and  to  discuss  any  implica- 
tions there  may  be  to  the  service.  A  semi- 
nar or  meeting  of  some  type  is  one  way  this 
may  be  accomplished,  and  if  staff  know 
this  has  been  agreed  on  in  the  initial  plan- 
ning, they  may  be  more  patient  in  awaiting 
the  results.  Without  a  plan,  an  investigator 
sometimes  is  put  under  pressure  to  give 
isolated,  and  perhaps  identifiable,  find- 
ings to  individuals  who  express  curiosity 
or  who  perhaps  even  need  to  know 
specified  study  outcomes.  Again,  how  can 
we  share  information  without  revealing 
the  identity  of  easily  recognized  persons  or 
areas? 

Whatever  method  we  choose,  we  do 
have  the  obligation  of  sharing  our  findings 
with  those  involved.  Who  knows,  but  with 
a  creative  approach  to  working  with  staff, 
a  nurse  investigator  may  be  rewarded  by 
requests  to  study  some  additional  ques- 
tions! Further,  who  else  needs  to  hear  the 
results?  A  study  report  is  not  enough. 
Have  we  exposed  our  work  through  publi- 
cation to  the  criticism  of  our  colleagues? 
Are  we  publishing  in  media  where  nurses 
and  others  who  may  test  our  findings  can 
gain  access  to  them? 

Paid  subjects 

An  important  factor  that  may  relate  to 
the  question  of  confidentiality  is  the  paid 
subject.  Assume  that,  at  the  outset  of  the 
research,  the  subject  had  been  guaranteed 
anonymity.  On  publication,  sufficient  de- 
tail is  disclosed  to  allow  identification  of 


the  subject  in  the  community.  Assum 
further,  that  the  subject  of  the  research 
of  a  private  nature,  such  as  venereal  di 
ease  or  drug  usage. 

Should  the  release  of  this  informatic 
cause  some  emotional  reaction  ( 
economic  loss  —  for  example,  lessenin 
of  employability  —  then  the  subject  mai 
have  a  cause  of  action  against  the  n 
searcher  for  negligence  in  allowing  h 
identity  to  be  divulged.  Had  the  subjei 
been  paid  for  his  services,  then,  aside  froi 
any  action  in  negligence,  a  contract  havin 
been  made,  and  a  breach  having  occurrec 
the  subject  would  also  have  an  action  f( 
damages  for  breach  of  contract. 

Study  advisory  commilfee 

Throughout  life  we  hear  the  words  "tv.  ^ 
heads  are  better  than  one."  This  has  neve 
been  more  true  than  in  the  field  of  re 
search.  We  can  rack  our  brains  to  develo] 
a  proposal,  determine  good  ways  to  gaii 
agency  cooperation,  to  protect  the  rights  o 
patients,  and  to  disseminate  our  findings 
But  the  involvement,  support,  and  protc 
tion  of  an  advisory  committee  can  enharn. 
the  project  in  many  ways.  Not  only  an. 
professional  colleagues  in  both  researct 
and  service  usually  pleased  to  be  includcL 
in  an  advisory  capacity  on  a  project,  bu 
the  dividends  to  all  concerned  are  man 
ifold. 

Input  from  a  group  with  diverse  back- 
grounds and  interests  can  generate  idea^, 
identify  and  suggest  solutions  to  prob- 
lems, and  find  resources.  Further,  the\ 
may  be  used  to  distribute  risk  when  deci- 
sions must  be  made. 

For  instance,  let  us  take  the  first  exam- 
ple discussed,  where  nurses  interviewed 
mothers  at  home,  and  the  nurse  inter- 
viewer, on  being  asked  for  help,  suggests 
to  the  mother  that  she  call  the 
pediatrician's  office.  Suppose  the  mother 
fails  to  call,  the  child  becomes  critically  ill 
and  is  hospitalized,  and  the  mother  com- 
plains that  she  asked  the  nurse  (inter- 
viewer) for  help,  but  the  nurse  did  not  do 
anything.  When  the  project's  advisor\ 
committee  has  discussed  the  possible  oc- 
currence of  such  incidents  and  developed 
a  course  of  action  to  avert  difficulties,  the 
project  staff  can  look  to  the  committee  for 
support  in  standing  behind  the  course  of 
action  taken. 

Further  protection  is  provided  through 
the  record  (interview  form  or  tape)  of  the 
interviewer's  answer  in  responding  to  the 
mother's  request  for  help.  Notes  should 
always  be  kept  of  unusual  incidents.  In  this 
particular  situation,  however,  had  the  in- 
vestigator given  any  undertaking,  gratu- 


itous  or  otherwise,  and  the  mother  relied 
on  it,  then  liability  for  failure  to  perform 
ithe  undertaking  may  ensue. 
i  Advisory  committees  or  boards  usually 
contribute  to  the  development  of  the  re- 
isearch  plan  and  review  the  protocol.  In 
conjunction  with  agency  staff,  they  can 
evaluate  the  agency's  ability  to  accommo- 
date the  study  during  the  designated  study 
period.  They  are  helpful  in  examining  par- 
iicular  ethical  and  legal  considerations. 
\\  hen  the  study  plan  is  implemented,  they 
<tand  ready  to  give  assistance  with  the 
[operation  of  the  project.  On  completion, 
here  is  a  group  that  can  help  interpret  the 
findings  to  the  public. 

One  of  the  most  important  functions  of 
an  advisory  committee  is  to  look  at  the 
ethical  features  of  the  study  proposal.  No 
matter  how  hard  investigators  may  try  to 
consider  all  the  possible  outcomes  of  the 
research  they  propose  to  do,  there  may  be 
aspects  that  have  not  occurred  to  them, 
which  a  viewpoint  other  than  their  own 
may  reveal.  In  particular,  the  advisory 
committee  can  help  the  investigators 
weigh  the  possible  risks  in  a  study  against 
the  expected  gains.  Adjustments  to  design 
and  the  development  of  safeguards  may 
eliminate  or  reduce  a  risk.  Certainly, 
w  here  there  could  be  some  element  of  risk, 
this  must  be  carefully  examined  in  relation 
to  the  benefits  that  may  be  derived. 

The  following  is  an  example  of  how  a 
,  change  in  study  design  avoids  the  needless 
invasion  of  patients'  privacy: 

A  new  materity  nurse  had  been  hearing 
staff  say,  "'Watch  out  for  "redheads'  — 
ihey  may  be  bleeders."  She  was  curious  to 
find  out  whether,  in  fact,  redheads  pre- 
sented a  greater  risk  of  hemorrhage  than 
other  women  during  delivery,  and  wanted 
to  examine  patients'  records  to  identify 
who  were  or  were  not  bleeders  and  to 
phone  the  bleeders  to  see  if  they  had  red 
hair.  To  use  this  approach,  she  would  have 
to  use  stored  records  from  the  hospital  and 
then  tell  patients  where  she  had  obtained 
their  names  and  why  she  needed  this  in- 
formation. 

This  plan  would  probably  be  viewed  by 
the  medical  records  committee  as  unethi- 
cal, although  not  illegal,  since  patients 
would  know  their  records  had  been  re- 
leased for  examination  for  purposes  other 
than  health  service.  Even  if  this  point 
could  be  worked  through  —  and  generally 
hospitals  do  have  the  support  of  research 
as  one  of  their  objectives  —  there  is  the 
possibility  that  the  question  alone  could 
raise  fear  in  the  minds  of  women  with  red 
hair.  ""Is  it  safe  to  have  another  child?" 


Another  study  design  was  established,  a 
prospective  study,  in  which  women  who 
are  delivering  are  observed  for  blood  loss 
and  color  of  hair,  and  an  association ,  if  it  is 
present,  can  be  noted.  There  is  a  disadvan- 
tage to  this  approach  in  that  it  will  take 
longer  to  answer  the  study  question ,  as  the 
investigator  has  to  wait  until  enough 
women  have  been  admitted  and  delivered 
to  analyze  the  data  to  draw  conclusions. 
But  the  plan  avoids  a  potential  ethical  and 
possibly  legal  problem. 

Scientific  merit 

Once  a  research  plan  has  been  de- 
veloped, the  investigator  has  a  number  of 
steps  to  take  before  the  study  can  be  im- 
plemented. Peer  review  is  valuable  for 


many  reasons:  to  identify  weaknesses  in 
design  or  methodology;  to  contribute 
thinking  directed  toward  the  central  theory 
or  clinical  question  being  examined;  to 
reveal  potential  ethical  questions,  even 
legal  problems;  and,  most  importantly,  to 
give  expert  judgment  on  whether  the  study 
is  scientifically  sound  and  able  to  answer 
the  questions  it  asks.  To  attempt  a  study 
when  the  plan  has  obvious  weaknesses  is  a 
disservice  to  the  community  and  to  the 
profession  and  is,  therefore,  unethical. 

Ofien,  peer  review  is  available  to  an 
investigator  through  a  hospital  review 
board,  which  approves  of  research  that  can' 
be  done  in  the  hospital  or  through  a  grant- 
ing agency's  review  process.  Frequently, 
both  channels  are  required  and  used.  Many 
investigators  request  colleagues  to  give 
suggestions  as  well,  often  because  the  re- 
view boards  may  not  necessarily  have  rep- 
resentation that  can  give  a  specialist's 
criticism  to  some  of  the  fine  points  in  a 
study. 

Review  committees  are  interested  in 
more  than  the  study  methodology,  the  ef- 
fect of  the  study  on  the  planned  project 
environment,  and  any  ethical  considera- 


tions to  be  weighed .  They  also  evaluate  the 
investigators  for  their  ability  and  expertisci 
to  carry  out  the  project  and  for  their  plans 
to  accept  responsibility  reliably  and  ethi- 
cally. An  investigator's  competence  and 
willingness  to  be  accountable  are  impor- 
tant charactenistics  to  be  assessed. 

One  further  point  can  be  raised.  Once 
the  study  report  is  published,  it  is  open  to 
the  criticisms  of  both  peers  and  the  public. 
Sometimes  the  analysis  is  questioned. 
Could  there  be  a  mistake?  A  subject  could 
state  that  he  had  not  given  this  permission 
to  be  included  in  the  study.  His  consent 
form  will  protect  all  concerned. 

But  how  long  do  we  keep  all  the  materi- 
als that  accrue  in  the  process  of  completing 
a  study?  Some  material  can  and  should  be 
destroyed  as  being  redundant  —  for  exam- 
ple, coding  sheets  used  in  preparing  data 
for  the  computer.  And  we  need  to  be  sure 
that  the  materials  are  reliably  destroyed, 
not  subject  to  the  caprice  of  the  wind  from 
the  top  of  some  trash  can.  What  about  the 
basic  recorded  data,  the  consent  forms, 
and  mathematical  computations  stemming 
from  the  analysis?  This  is  a  hard  question 
to  answer  and  it  varies  with  each  study  and 
from  area  to  area. 

Each  province  has  its  own  statutory 
limitation  periods.  In  Ontario,  for  exam- 
ple, the  limitation  period  to  commence  an 
action  for  negligence  or  breach  of  contract 
is  6  years  from  the  date  of  the  negligence 
or  breach  (generally  speaking).  However, 
limitation  periods  with  respect  to  hospitals 
and  doctors  are  governed  by  provincial 
statute  and  often  are  much  shorter  than  the 
above-mentioned  period.  These  points 
should  be  cleared  by  legal  counsel. 

Summary 

Nursing  research,  similar  to  nursing 
practice,  presents  both  ethical  and  legal 
issues  to  be  considered.  Patient  safety  in 
both  enterprises  is  a  major  goal.  Much 
trouble  can  be  averted  when  investigators 
think  critically,  during  the  planning  phase, 
of  all  possible  hazards.  Vigilance,  prompt 
attention,  and  resource  to  others  for  coun- 
sel assist  the  investigators  in  dealing  with 
problems  that  may  arise  in  the  ongoing 
project  in  spite  of  careful  planning. 

All  this  requires  much  effort  and  time. 
Regardless,  at  the  conclusion  of  a  study, 
investigators  can  invariably  be  heard  ask- 
ing, '"Which  question  shall  we  look  at 
next?"  The  problems  encountered  in  the 
investigative  process  can  challenge  the 
creativity  of  the  nurse,  rather  than  squelch 
her  enthusiasm.  This  is  perhaps  a  good 
outcome,  if  we  are  to  continue  to  try  to 
build  a  body  of  nursing  knowledge.      Q 


CANADIAN  NURSE  —  September  1975 


Primary  therapist  project 
on  an  inpatient  psychiatric  unit 


The  authors  describe  a  project  to  experiment  with  a  primary  therapy  role  for 
selected  nurses  on  an  inpatient  psychiatric  unit  of  the  University  of  British 
Columbia's  Health  Sciences  Centre  Hospital.  Functions  for  the  nurse  therapist  are 
described,  and  some  of  the  impacts  of  change  are  discussed.  The  project  resulted 
in  a  number  of  recommendations. 


A.M.  Marcus,  J.  Anderson,  H.  Gemeroy,  F.  Perry  and  A.  Camfferman 


A  number  of  factors  influenced  the  de- 
velopment of  a  project  to  try  nonmedical 
primary  therapists  on  one  inpatient 
psychiatric  unit  of  the  Health  Sciences 
Centre  Hospital  of  the  University  of 
British  Columbia.  These  factors  included: 
D  nurses'  dissatisfaction  with  their  tradi- 
tional role  as  management  implementers  at 
the  behest  of  the  medical  practitioner; 
D  an  increasingly  blurred  nursing  role 
because  there  were  situations  where  nurses 
were  carrying  out  treatment  and  related 
psychosocial  interventions  without  clear 
affirmation; 

n  a  lack  of  psychiatric  residents  to  carry 
out  and  maintain  the  service  commitments 
in  the  hospital;  and 


Anthony  M.  Marcus.  FRCP.  D. Psych.,  is  As- 
sociate Professor  of  Psychiatry,  University  of 
British  Columbia,  and  Clinical  Supervisor  of  the 
project  unit  at  the  Health  Sciences  Centre  Hos- 
pital, Vancouver.  Joan  Anderson,  rn,  msn,  is 
Clinical  Specialist — Head  Nurse,  Heahh  Sci- 
ences Centre  Hospital,  and  Clinical  Assistant 
Professor,  School  of  Nursing,  UBC.  Helen 
Gemeroy,  rn,  ma,  is  Director  of  Nursing, 
Psychiatric  Unit,  Health  Sciences  Centre  Hos- 
pital, and  Associate  Professor,  School  of  Nurs- 
ing. UBC.  Fay  Perry,  rn,  and  Anna 
Camfferman,  rn,  are  Primary  Therapists, 
Health  Sciences  Centre  Hospital,  Vancouver, 
British  Columbia. 


D  more  individuals  were  defined  as  in 
need  of  help  at  a  much  earlier  stage  in  their 
dysfunction  and  were  admitted  to  the 
psychiatric  unit  with  a  wider  range  of 
psychosocial  problems. 

The  setting 

The  unit  is  a  21-bed,  psychiatric  inpa- 
tient service  in  the  Health  Sciences  Centre 
Hospital,  UBC.  It  receives  referrals  from 
the  Greater  Vancouver  area  and  also  from 
the  more  distant  towns  and  cities  in  British 
Columbia.  The  staff  members  have  always 
been  willing  to  accept  patients  who  present 
complicated,  difficult  diagnostic  and 
therapeutic  challenges.  We  have  always 
kept  the  dignity  of  the  patient  at  the  fore- 
front, and  there  is  an  appreciation  of  the 
fact  that  the  patient's  distress,  the  agony  of 
his  dilemma,  is  welded  into  the  social 
matrix  in  which  he  lives. 

We  acknowledge  that  our  patients  are 
affected  by  the  trivial  as  well  as  the  pro- 
found, by  people  close  to  them  and  not  so 
close;  we  attempt  to  provide  an  environ- 
ment in  which  the  patient  has  the  freedom 
and  encouragement  to  engage  in  the  task  of 
looking  frankly  at  the  behaviors  and  men- 
tal mechanisms  that  cripple  his  personality 
and  prevent  his  effective  coping. 

We  are  concerned  with  flattening  the 
hierarchical  authority  pyramid  in  relation 
to  the  personnel  on  the  ward,  and  with 
encouraging  and  permitting  each  profes- 


sional to  contribute  from  his  own  discip- 
line, with  the  understood  acknowledge-] 
ment  of  his  unique  specialization  in  hisi 
professional  role. 

We  attempt  to  create  a  milieu  where 
patients,  as  well  as  staff,  are  concerned  for 
patients  and  where  the  patients  are  en 
gaged  in  a  task-oriented  program  to  under- 
stand themselves  by  virtue  of  the  network 
of  relationships  that  are  possible  on  the 
unit.   Specific  examples  of  the  created 
milieu  are  the  one-to-one  relationship  toj 
the  therapist,  and  the  relationships  in  the' 
small  groups  and  community  meetings 

The  concerns 

Before  the  project  started  on  1  Februars 
1974,    there    had    been    much   dialogue 
among  the  nurses,  and  between  nurses  and 
other  professionals  in  the  clinical  settin; 
regarding  such  fundamental  questions  a 
^ho  could  do  therapy,  and  who  should  c 
therapy?  There  was  an  emerging  grout: „ 
swell  of  opinion  as  to  who  should  and 
could  provide  care  in  an  inpatient  setting, 
in  addition  to  such  traditional  persons  as 
the   psychiatric   clinician,   resident,   and 
medical  student. 

Early  in  1972,  at  a  2-day  workshop  on 
one  inpatient  unit  in  the  hospital,  membei 
of  staff  met  specifically  to  discuss  clariti 
cation  of  the  varying  roles  undertaken  b\ 
the  staff.  One  of  the  roles  under  considera- 
tion was  that  of  nonmedical  therapists  (us 


icy  were  called),  of  which  the  nurses 
^cre  only  one  group.  At  that  time,  a  few 
urses  showed  significant  interest  in  the 
tea  that  nurses  at  the  Health  Sciences 
tntre  Hospital  (HSCH)  could  move  into 
le  role  of  therapist. 

However,  many  areas  had  to  be  clarified 
efore  nurses  could  assume  a  therapist 
Die,  particularly  the  provision  of  an  edu- 
alional  program,  clinical  supervision  and 
iipport,  and  approval  by  the  administra- 
,on  of  the  hospital.  Because  of  the  time 
ig  in  getting  approval  from  administra- 
on,  enthusiasm  for  moving  into  this  role 
raned. 

Later,  in  the  summer  of  1973,  three 
ursing  leaders  in  the  hospital  studied  the 
attem  of  nursing  organization  and  the 
urrent  roles  nurses  were  assuming  at  the 
SCH.*  From  this  study,  a  viewpoint 
merged  that  nurses  could  function  in  an 
ipatient  unit  on  three  levels:  an  associate 
urse  level  in  which  the  nurse  functions 
nder  the  direction  of  the  primary  nurse,  a 
rimary  nurse  level  in  which  the  nurse 
ikes  24-hour  responsibility  and  account- 
'bility  for  planning  the  nursing  care  of 
atients  to  whom  she  is  assigned,  and  a 
urse  primary  therapist  level  in  which  a 
urse  has  total  responsibility  for  all  com- 
ponents of  the  patient's  care. 

In  August  1973,  a  clinical  nurse 
pecialist  moved  to  the  project  unit.  She 
Jok  on  the  role  of  primary  therapist  to  two 
■atients,  which  established  a  positive  cli- 
nate  and  provided  a  role  model  as  an  ex- 
mple  to  others.  The  social  worker  on  the 
nit  also  functioned  as  a  primary  therapist 
^  tme  patient.  The  concept  of  profession- 
iher  than  doctors  functioning  as  pri- 
.n >  therapists  was,  therefore,  introduced 
>  the  unit  prior  to  the  commencement  of 
le  pilot  project;  this  gave  some  indication 
t  how  such  a  project  could  influence  the 
ursing  and  medical  system. 


L  niversity  of  British  Columbia,  Depl.  of 
s\i.hiatry.  Health  Sciences  Centre  Hospital. 
ing  Division,  A  descriptive  suney  of  the 
"ded  role  of  the  nurse  in  the  Health  Sci- 
<  Centre  Hospital,  by  the  Ad  Hoc  Commit- 
n  the  Expanded  Role,  Vancouver,  B.C. 
(Chairman:  Beverlee  Cox). 

ANADIAN  NURSE  —  September  1975 


Six  months  later,  the  clinical  nurse 
specialist  accepted  an  appointment  as  head 
nurse  on  the  unit.  This  increased  her  ad- 
ministrr.tive  responsibility  for  the  func- 
tioning of  the  total  system  and  enabled  her 
to  support  nursing  development  along  the 
lines  outlined  in  the  earlier  study  of  nurs- 
ing roles.  She  also  continued  to  function  as 
a  nurse  therapist.  Some  nurses'  en- 
thusiasm about  the  role  of  primary  nurse 
therapist  was  renewed.  At  this  point,  the 
unit's  clinical  supervisor  committed  him- 
self to  work  within  the  existing  hospital 
system  to  develop  a  pilot  project  for  the 
primary  nurse  therapist  role. 

The  role 

The  nursing  staff  were  concerned  with 
defining  the  boundaries  of  the  expanded 
role.  They  viewed  the  primary  nurse 
therapist  as  functioning  within  a  nursing 
framework,  and  they  decided  that  nurses 
who  took  on  the  role  should  agree  to  re- 
main on  staff  for  at  least  one  year  from  the 
date  the  program  commenced. 

Functions  for  the  nurse  primary 
therapist  role  were  finally  defined  by  the 
clinical  supervisor  on  the  unit  (a  psychia- 
trist), the  director  of  nursing,  the  head 
nurse,  the  nurses  who  were  selected  to 
assume  these  functions,  and  the  unit  staff. 
The  role  was  described  as  follows: 

D  The  nurse  therapist  is  directly  responsi- 
ble to  the  clinical  supervisor  of  the  unit  for 
the  total  care  plan  of  patients  assigned  to 
her  in  the  primary  therapist  role .  The  n  urse 
therapist  is  responsible  for  presenting  her 
patients  at  rounds  and  for  keeping  the  clin- 
ical supervisor  informed  of  the  patients' 
progress.  The  clinical  supervisor  and  the 
head  nurse  are  responsible  for  assigning 
patients  to  the  nurse  therapist. 
D  The  primary  therapist  is  responsible  for 
the  patient's  record,  including  the  clinical 
data  base,  the  problem  list,  ordering, 
necessary  laboratory  tests,  the  incorpora- 
tion of  test  resuhs  into  the  plan,  consuhing 
on  medications,  recording  of  goals  and 
plans,  the  progress  notes,  the  discharge 
planning,  and  the  discharge  summary.  She 
is  also  responsible  for  communication  of 
the  discharge  summary  to  the  community 
agency  or  person  who  will  assume  the 
follow-up  care  of  the  patient. 


D  The  primary  therapist  transfers  certain 
responsibilities,  such  as  the  ordering  of 
medications  and  the  completion  of  the 
physical  examination,  to  the  medical  per- 
sonnel designated  to  carry  them  out. 
D  The  primary  therapist  uses  both  medical 
and  nursing  consultation  on  a  day-to-day 
basis  as  required,  and  has  weekly  super- 
visory meetings  with  both  the  psychiatrist 
and  the  head  nurse.  These  are  for  the  nurse 
therapists's  learning  and  professional  de- 
velopment, and  to  monitor  her  therapy  to 
patients. 

n  Although  a  major  focus  of  her  work  is 
on  the  patients  assigned  to  her,  the  primary 
therapist  continues  her  interest  and  con- 
cern for  the  ward  population,  through  lead- 
ing groups  or  other  activities. 
D  The  primary  therapist  continues  to  be  a 
role  model  for  associate  and  primary 
nurses  on  the  unit,  and  takes  part  in  the 
educational  program  on  the  unit. 
D  The  primary  therapist  assists  in  the  de- 
velopment of  the  work  schedule  and  the 
nursing  staff  rotation,  to  permit  her  par- 
ticipation in  the  program  and  to  allow  her 
to  act  as  therapist  for  assigned  patients. 
She  participates  in  organizing  her  own 
hours  of  work  and  is  accountable  for  these 
to  the  head  nurse,  and,  in  turn,  is  account- 
able to  the  director  of  nursing  for  making 
her  time  schedule  known  in  advance  to  the 
head  nurse.  The  hours  worked  are  based 
on  7.5  hours  per  day  and  a  5-day  week. 

It  was  agreed  that  the  nurses  would  take 
on  the  role  of  primary  therapist  only  after 
the  project  and  the  functions  were  given 
written  approval,  signed  by  the  director 
and  head  of  the  department  of  psychiatry 
(for  the  hospital) ,  the  clinical  supervisor  of 
the  unit  where  the  primary  therapist  would 
be  working,  and  the  director  of  nursing. 
Another  aspect  of  the  agreement  was  that 
the  primary  therapists  would  participate 
actively  in  a  scheduled  program  of  learn- 
ing designed  for  a  3-month  period. 

The  nurse  therapists  knew  that  addi- 
tional financial  remuneration  was  not  pos- 
sible at  the  beginning,  but  it  was  agreed 
that  if  the  primary  nurse  therapist  program 
were  to  continue  after  evaluation  of  the 
pilot  project,  nurses  assuming  this  role 
would  submit  a  bid  for  financial  compen- 
sation for  this  role. 

31 


The  therapists 

The  selection  of  the  primary  therapists 
was  difficult;  no  one  knew  what  basic 
qualifications  were  necessary.  There  were 
many  differences  of  opinion  within  the 
nursing  and  medical  professions.  It  was 
agreed  that  the  nurse  moving  into  this  role 
should: 

Dhold  a  registered  nurse's  diploma,  a 
psychiatric  nursing  diploma,  or  a  bac- 
calaureate degree  in  nursing; 
D  demonstrate  ability  to  achieve  the  ob- 
jectives for  the  functions  of  a  primary 
nurse;  and 

D  have  clinical  experience  with  psychiat- 
ric patients. 

The  nurses  who  were  finally  selected  for 
the  role  were  RNs  with  diplomas  in 
psychiatric  nursing.  After  they  had  been 
chosen,  there  was  a  time  lag  in  obtaining 
all  the  required  signatures  from  the  ad- 
ministrative individuals. 

As  one  of  the  selected  nurse  primary 
therapists  stated,  "This.  .  .  was  a  blow  to 
my  enthusiasm.  I  doubted  whether  the 
administration  was  really  in  favor  of  such  a 
program,  and  was  left  with  uncertainty.  I 
felt  I  couldn't  proceed,  although  there  was 
pressure  to  do  so,  unless  I  had  the  official 
backing  from  the  hospital.  I  felt  strongly 
enough  to  resist  the  temptation  of  begin- 
ning, because  I  was  concerned  for  my  own 
safety  as  well  as  the  safety  of  my  pa- 
tients." Enthusiasm,  however,  was  re- 
newed when  those  involved  in  the  program 
received  copies  of  the  agreements. 

A  scheduled  program  of  learning  was 
designed  for  a  3-month  period.  The  pro- 
gram included:  growth,  developmental,  and 
behavioral  concepts;  initial  assessment 
and  interviewing;  group  process;  family 
therapy;  crisis  intervention;  basic  phar- 
macology; and  clinical  aspects  of  psychol- 
ogy. 

After  1  February  1974  —  the  official 
starting  date  of  the  program  —  the  primary 
nurse  therapists  carried  out  all  activities 
assigned  to  treatment  personnel:  diagnos- 
tic interviewing,  preparation  of  the  treat- 
ment plans,  keeping  the  patients'  records 
appropriately,  collation  of  the  physical 
and  psychosocial  histories  of  their  pa- 
tients, outlining  a  problem  list,  integrating 
the  clinical  data  into  a  formulation  of  the 
problems,  monitoring  medications,  and 

32 


actively  engaging  in  treating  those  patients 
assigned,  as  well  as  being  involved  in  the 
total  gamut  of  experiences  associated 
with  their  care.  A  clinical  tutor  was  avail- 
able on  a  daily  basis  (one  of  the  attending 
psychiatrists,  the  clinical  supervisor,  or 
the  teaching  fellow)  for  consultation  re- 
garding patient  management;  the  tutor  as- 
sisted in  prescribing  medications,  and  car- 
ried out  physical  examinations  of  the  pa- 
tients. 

Impact  of  change 

The  new  nursing  role  of  the  primary 
therapist  had  a  great  impact  on  the  nursing 
system.  The  project  was  funded  entirely 
by  the  nursing  department.  Therefore,  the 
2  nurses  participating  in  it  were  part  of  the 
nursing  complement  of  the  unit  and  were 
expected  to  spend  50%  of  their  time  in 
nursing  functions  outside  the  role  of  pri- 
mary therapist. 

Because  many  of  the  seminars  in  the 
special  training  program  were  scheduled 
during  the  day,  these  nurses  worked  per- 
manently on  days.  They  worked  fewer 
weekends  than  other  nurses,  for  the  same 
reason . 

For  nurse  therapists  to  enter  into  an  edu- 
cational program,  to  act  as  nurse  therapist 
to  individual  patients,  and  to  give  50%  of 
their  time  to  general  nursing  needs  of  the 
unit,  which  include:  giving  nursing  in- 
struction to  junior  staff,  covering  for 
weekend  supervision  on  the  unit,  leading 
patient  groups,  and,  at  times,  leading  nurs- 
ing rounds  on  the  unit,  is  asking  more  than 
is  reasonable. 

During  the  selection  of  the  nurses,  and 
with  the  acknowledgement  by  the  staff  that 
this  pilot  project  was  indeed  going  to  get 
off  the  ground,  some  of  the  characteristics 
of  change  introduced  into  a  system  showed 
up.  One  pertinent  consideraton  in  intro- 
ducing change  into  a  system  is  the  effect 
on  those  members  who  do  not  participate 
in  the  change. 

Some  of  the  nurses  voiced  the  opinion 
that  the  primary  therapists  chosen  should 
not  be  able  to  have  a  selected  type  of  duty 
roster,  which  would  give  them  advan- 
tages, such  as  weekends  off,  when  they 
themselves  were  having  to  rotate  through 
weekends.  This  opinion  ranged  from  mut- 
tered grumbling  to  opposition  voiced  out- 


right. The  selected  nurses,  who  were  st 
by  other  staff  as  having  a  privileged  w 
felt  they  could  not  adequately  car 
through  their  function  without  adjustmei 
in  the  nursing  rotation. 

One  of  the  nurses  chosen  for  the  n 
described  her  initial  experience:  ".  .  .  t 
place  was  confusing.  Associate  and  p 
mary  nurses,  nurse  therapists,  problei 
solving  charting,  nurses  being  responsitj 
and  notably  aggressive  about  it  —  woul(| 
fit  in?  A  gathering  of  'all  the  saints'  w, 
held.  I  was  invited.  A  program  was  pr 
posed.  Two  nurses  would  enter  a  trainii 
program  to  carry  their  own  patients. 

"It  seemed  exciting,  but  I  was  new  i 
the  ladder.  Those  before  me  seemed  cw 
petitive.  There  appeared  to  be  an  aura 
jealousy  as  to  who  would  be  chosen .  The 
was  a  conflict  on  what  hours  they  wou 
work,  and  what  pay  (hey  would  receiv' 
Bittnemess!  Little  did  I  know  I  wou 
enter  this  role.  ..." 

Within  the  nursing  system,  thei 
seemed  to  be  a  double  bind  support  sy;; 
tem.  On  one  hand,  accomplishments  wo' 
favored;  on  the  other  hand,  equipmen 
such  as  rooms,  facilities,  or  a  telephomj 
was  difficult  to  acquire  smoothly.  On  ori 
hand,  the  nurse  therapists  participated  i 
making  up  their  hours  of  work;  on  th 
other  hand,  it  was  constantly  bein 
checked.  The  latter  seemed  to  exist  in  th; 
early  stages  of  the  program  and,  perhaps 
things  Hke  this  have  to  be  endured  to  ai. 
complish  change. 

It  is  an  open  question  whether  the  pri 
mary  nurse  therapist  can  realistically  havi 
other  nursing  commitments  during  thi 
training  program.  Two  factors  contributei 
to  reduce  participation  in  the  nursing  sys 
tem  by  the  nurse  therapists.  First,  it  wa.| 
evident  that  the  role  change  producci 
some  degree  of  personal  stress  becausi 
concentration  on  the  new  role  decreasec 
commitment  to  other  areas  of  service 
And,  second,  the  nurse  therapists  spen 
much  time  in  the  educational  program 
which  left  little  time  for  involvement  in  tht 
unit.  This  produced  tension  in  the  toia 
system,  because  initially  it  increased  the 
work  load  for  other  nursing  staff  members 
ahhough  they  ultimately  benefited  froir 
the  assistance  given  by  those  who  had  ac 
quired  new  knowledge  and  skills. 


As  the  nurses  in  the  program  became 
lore  confident  and  comfortable  in  their 
jle  and  as  the  number  of  seminars  de- 
feased, they  were  able  to  make  a  greater 

intribution  to  nursing.  They  assisted  with 
ome  leadership  functions  in  staff  de- 
elopment.  One  nurse  therapist  assumed 
ome  administrative  functions. 

It  was  imperative  for  the  leaders  on  the 
nit,  both  in  nursing  and  medicine,  to  di- 
:ct  their  attention  to  the  learning  needs  of 
ther  staff  members.  It  was  also  important 
lat  the  nurse  therapists  were  not  isolated 
rom  other  nursing  personnel.  A  crucial 
oint  in  the  expansion  of  the  nursing  role  is 
laintaining  identity  with  the  nursing  pro- 
•ssion  and  perceiving  the  rote  with  a  nurs- 
ig  framework.  With  this  in  mind,  the 
urse  therapists  were  supervised  by  nurs- 
ig  personnel  in  a  proup  with  other  staff 
urses.  This  was  .lisi'  conducive  to  leam- 
ng;  more  experien.  ^  d  nurses  were  able  to 
hare  their  knowltiJ'ze  with  the  novices. 

doctors'  reactions 

Reactions  to  the  program  by  the  medical 
•aff  in  the  hospital  and  outside  in  the 
immunity  ranged  from  those  who  saw 
he  nonmedical  primary  therapist  as  totally 
njppropriate,  to  some  who  displayed 
'.  ert  support.  Certainly  some  of  the  medi- 
al staff  had  intellectual  arguments  for 
heir  lack  of  encouragement;  if  patients 
.vere  seen  in  evaluation  or  were  in  ongoing 
Teatment  v.  ith  a  psychiatrist  in  the  com- 
iiunity  and  were  referred  for  further  inten- 
ive  help  to  an  inpatient  setting,  the  doc- 
ors  were  concerned  that  such  patients 
hould  not  receive  that  additional  help 
rom  a  nurse,  particularly  when,  perhaps, 
he\  themselves  were  not  able  to  see  the 
luiient  through. 

Primary  therapists  who  are  nonmedical, 
>■  hether  they  are  nurses,  social  workers,  or 
Psychologists,  require  support  for  their 
iiedical  management  of  patient  care.  Sup- 
port, such  as  physical  examinations, 
Pharmacological  coverage,  and  laboratory 
vquests  and  interpretation,  which  is  re- 
quired by  the  nonmedical  therapists,  is  re- 
garded ambivalently  by  certain  groups. 
-*s\chiatnc  residents,  who  perceive  them- 
eUes  to  be  engaged  in  a  training  program 
rom  which  they  hope  to  emerge  as  fully 
led  psychiatrists,  show  a  great  deal  of 

ANAOIAN  NURSE  —  September  1975 


resistance  to  assisting  with  the  physical 
aspects  of  patients  carried  by  nonmedical 
therapists.  They  feel  that  they  are  acting  as 
auxiliary  technicians,  and  find  it  difficult 
to  share  easily  in  the  patients'  management 
without  feeling  a  loss  of  role,  a  loss  of 
status.  It  seems  that  this  sharing  is  more 
difficult  for  individuals  who  are  in  a  train- 
ing program  and  who  feel  somewhat  un- 
sure both  of  themselves  and  of  their  pro- 
fessional role. 

Participants'  comments 

At  the  end  of  the  project,  the  primary 
therapists  reexamined  the  position  with 
which  they  approached  the  program,  that 
is:  nurses  can  do  therapy,  and  nurses  can 
be  accountable  for  therapy.  Both  nurses 
said  that  they  had  been  allowed  to  test  this, 
that  they  had  found  themselves  stimulated, 
and  that  they  were  satisfied  that  they  could 
be  accountable  and  could  do  therapy  with 
patients.  The  primary  therapists  said  that 
the  program  had  rounded  out  their  profes- 
sional lives  as  nurses  and  their  personal 
lives  as  women. 

■  ■  It  has  expanded  our  outlook  enough  to 
put  into  practice  what  we  always  felt  we 
could  be  doing,  but  felt  inhibited  to  do.  We 
think  this  program  should  continue,  and 
we  realize  this  is  only  a  beginning  —  a 
beginning  in  which  we  are  proud  to  be 
involved.  We  thank  all  the  people  who 
gave  us  support,  especially  our  patients. "" 

The  psychiatrist  who  was  clinical 
supervisor  on  the  unit  noted  that  in  the  6 
months  between  1  February  and  3 1  July 
1974,  the  2  nurses  had  seen  a  number  of 
patients,  taken  their  individual  histories, 
and  presented  appropriate  treatment  plans; 
as  a  result,  they  gained  some  measurable 
dimension  in  their  capacity  to  identify 
problem  areas  more  incisively  and  to 
clarify  situations  of  conflict. 

Although  the  qualities  are  not  measur- 
able, the  nurses  increased  their  confidence, 
which  stemmed  from  an  increase  in  know- 
ledge; their  capacity  to  tolerate  chaos;  their 
ability  to  move  through  a  crisis  with  a 
patient  a  little  more  easily  than  before;  and 
their  capacity  to  tolerate  their  own  counter- 
transference  problems  in  relation  to  pa- 
tients. 

Although  these  qualities  are  not  quanti- 
fiable, the  two  nurses  concerned  show 


some  of  these  enrichments,  compared  to 
the  beginning  of  this  program. 

In  the  6-month  project  period,  the  com- 
bination of  the  nurse  therapists'  particular 
personalities,  their  educational  compo- 
nent, and  their  contact  with  patients  has 
shown  that  it  is  possible  to  enhance  the 
skills  of  a  nurse  so  that,  given  the  oppor- 
tunity, she  can  take  direct  responsibility 
for  patient  care .  The  enhancement  of  skills 
can  come  only  from  being  in  action  and 
having  a  good  role  model. 

Recommendations 

•  Support  for  the  primary  therapist  pro- 
gram should  be  fully  endorsed  by  the  nurs- 
ing staff  of  the  hospital,  through  the  nurse 
leaders  to  the  nursing  body  as  a  whole. 

•  Nurses  involved  in  the  training  phase  of 
the  program  should  be  relieved  of  their 
traditional  nursing  functions  in  proportion 
to  the  demands  of  the  program,  for  in- 
stance, in  a  6-month  program,  total  relief 
in  the  first  3  months,  and  50%  relief  in  the 
second  3  months. 

•  The  cost  of  nursing  replacement  for  the 
nurses  who  are  learning  the  primary 
therapist  role  must  be  built  into  the  agency 
budget,  or  additional  funding  must  be  se- 
cured. 

•  Learners'  time  must  be  allocated  ap- 
propriately to  the  program  and  should  not 
be  determined  by  the  general  nursing  ros- 
ter or  nursing  agreements. 

•  Support  should  be  given  to  the  profes- 
sional nursing  organization  in  seeking, 
within  health  services  funding,  appro- 
priate compensation  for  nurses  working 
in  an  expanded  nursing  role. 

•  More  time  and  consideration  should  be 
given  to  initial  screening  of  psychiatric 
patients  by  nurse  therapists,  including  a 
physical  and  neurological  examination,  so 
that  the  identification  of  physical  problem 
areas  is  enhanced. 

•  Nurses  at  the  Health  Sciences  Centre 
Hospital  should  continue  to  examine  the 
position  that  nurses  can  do  therapy,  and 
that  nurses  can  be  accountable  for  doing 
that  therapy.  '^ 


33 


The  expanded  role  of  the  nurse 

independent  practitioner  or  physician's  assistant? 


The  authors  discuss  the  question:  Does  a  nurse  who  takes  on  the  expand- 
ed role  of  the  primary  therapist  enhance  her  status  as  an  independent 
nurse  practitioner?  Or  does  she  take  on  the  role  of  physician's  assistant? 


J.  Anderson,  A.M.  Marcus,  H.  Gemeroy, 
F.  Perry,  and  A.  Camfferman 


As  a  result  of  the  project  that  is  dis- 
cussed in  the  article  entitled  "Nurses  as 
Primary  Therapists  on  an  Inpatient 
Psychiatric  Unit"  (page  30),  a  number  of 
issues  come  to  the  forefront  that  require 
comment  at  this  time,  when  the  role  of  the 
nurse  is  being  enhanced  and  expanded. 

Do  nurses  who  take  on  the  expanded 
role  of  primary  therapist  enhance  their 
status  as  independent  nurse  practitioners 
or  do  they,  in  fact,  take  on  the  role  of 
physicians'  assistants?  In  the  context  of 
this  discussion,  the  term  "physician's  as- 
sistant" refers  to  a  person  who  contributes 
to  the  role  of  the  physician.  Tasks  and 
functions  performed  by  the  physician's  as- 
sistant are  delegated  by  the  physician. 

The  term  "independent  nurse  prac- 
titioner" means  that  the  nurse  is  not  sub- 
ject to  another's  authority  or  decisions. 
Inherent  in  this  role  are  the  concepts  of 


The  five  authors  work  in  the  psychiatric  unit. 
Health  Sciences  Centre  Hospital,  University  of 
British  Columbia.  Their  positions  are  described 
in  the  note  on  page  30. 


foreseeability  and  accountability  to  the  pa- 
tient. Foreseeability  means  that  the  nurse 
practitioner  hjis  adequate  scientific  prep- 
aration to  predict  with  a  high  degree  of 
accuracy  the  outcome  and  consequences 
of  her  act.  The  concept  of  accountability  is 
that  the  nurse  must  recognize  and  fulfill 
competently  her  responsibilities  for  the 
care  of  individuals.* 

However,  the  question  has  arisen  about 
who  has  final  responsibility  for  the  pa- 
tients' care.  Because  of  the  medical 
framework  within  which  hospitals  oper- 
ate, there  is  emphasis  on  medical  respon- 
sibility and  medical  supervision.  This  im- 
plies that  the  nurse  is  accountable  to  the 
physician,  as  she  is  now  moving  into  an 
area  that  has  previously  been  defined  as 
medical  care.  She  carries  out  functions 
delegated  by  the  physician  and  must  be 
supervised  by  him.  This  maintains  the 
physician  as  the  authority  figure,  and  rein- 


*  Loretia  C.  Ford,  Nursing  —  evolution  or 
revolution?,  The  Canadian  Nurse,  67:1:35. 
January  1971. 


forces  dependence  on  him,  and  accoun 
ability  to  him.  This  concept  is  clearl 
documented  by  Smith  and  English  wh^ 
describe  a  system  in  which  nurs 
therapists  are  trained  and  supervised  b; 
physicians. 

Consultation  from  a  peer  differs  froni 
supervision  by  one  in  authority.  The  con 
sultative  relationship  implies  that  one  per 
son  seeks  expert  opinions  from  another 
but  is  free  to  accept  or  reject  suggestion; 
from  him.  Ahhough  present  relationships' 
on  the  unit  fit  a  consultative  model,  thi^ 
derives  from  the  way  in  which  particulai 
individuals    function,    rather   than    fron 
changes  within  the  operation  of  the  hospi 
tal  system.  j 

If  the  physician  is  ultimately  responsi- 
ble, he  has  the  final  say  and  does  not  func- 
tion solely  in  the  capacity  of  consultant. 


**  Stuart  L.  Smith  and  J.  EngWsh,  The  training  | 
and  usefulness  of  tjie  nurse  therapist,  Paper 
presented  at  Canadiart  Psychiatric  Association 
Meeting,  Vancouver.  British  Columbia,  June 
1973  (Unpublished). 


The  legal  position  of  the  nurse  therapist  is 
still  unclear.  The  paradox  in  this  new  role 
is  that,  although  the  nurse  is  taking  on 
greater  responsibilities  for  patient  care .  the 
blurring  of  her  role  with  medicine  puts  her 
under  the  authority  of  the  physician. 

One  may  question  if  an  acute  care  set- 
ting provides  the  climate  for  the  nurse  to 
function  in  an  expanded  role.  Yet,  in  re- 
viewing the  patient  population  of  the  unit 
on  which  this  project  took  place  during  the 
past  year,  it  was  clear  that  not  all  patients 
were  in  need  of  medical  care.  In  fact,  de- 
pending on  the  patients'  behavior,  the 
nurse  therapist  was  often  better  suited  to 
work  with  them  and,  therefore,  the  need 
for  medical  involvement  was  lessened. 
This  could  be  a  step  in  steering  away  from 
a  model  that  reinforces  physician  respon- 
sibility for  all  patients,  regardless  ot 
whether  they  need  medical  care. 

This  direction  in  nursing  does  change 
the  traditional  nurse/doctor  relationship. 
The  medical  model  reflects  the  subordina- 
tion of  nursing  to  medicine.  The  nursing 
profession  has  always  valued  the  qualities 
of  diplomacy,  tact,  gentleness,  patience, 
and  the  many  other  sex-linked  virtues, 
which  are  supposedly  "feminine." 

As  Kushner  points  out.  the  male/ 
female  role  caricature  has  been  called 
the  "doctor/nurse  game"  in  the  hospi- 
tal setting.  The  object  of  the  game  is  to 
make  the  doctor  feel  in  control  at  all  times. 
To  do  this,  the  nurse  must  make  significant 
recommendations  in  such  a  way  that  they 
appear  to  be  initiated  by  the  doctor.  She 
must  be  actively  helpful,  yet  appear  pas- 
sive. This  type  of  oblique  communication 
usually  earns  the  nurse  the  reputation  of 
being  good.  If  she  refuses  to  play  the  game 
and  becomes  too  assertive,  she  is 
punished.  + 

At  present,  traditional  values  and  rela- 
tionships are  being  questioned.  As  nursing 
education  leaves  the  hospital  training 
school  setting  and  nurses  take  their  educa- 
tion among  other  students  in  junior  col- 
leges or  universities,  they  have  acquired  a 
new  consciousness,  both  as  nurses  and  as 


women.  Indeed,  the  qualities  of  self- 
assertiveness  and  decisiveness  are  now 
valued  and  are  necessary  if  nurses  are  to 
progress  in  areas  such  as  the  academic 
community. 

Furthermore,  nurses  who  move  into  an 
expanded  nursing  role  must  be  self- 
assertive  and  decisive  if  they  are  to  be 
effectual.  This  new  image  of  a  know- 
ledgeable practitioner  who  communicates 
directly,  rather  than  obliquely,  erodes  the 
doctor/nurse  game.  Relationships  can  be 
somewhat  strained,  if  the  physician  does 
not  accept  self-assertive,  competent 
women.  However,  in  view  of  social 
changes,  such  as  the  feminist  movement 
and  the  electorate's  concern  about  the  es- 
calating cost  of  health  care,  there  is  a  great 
movement  to  educate  nurses  to  be  compe- 
tent practitioners  rather  than  obedient 
handmaidens. 

The  issue  raises  questions  such  as: 
Should  nurse  therapists  and  residents  work 
on  the  same  unit?  If  the  independent  nurse 


t  Trucia  Kushner.  The  Nursing  Profession  — 
Condiiion:  Critical .  MS  Mag.  1 1;2;99.  Aug. 
1973. 

The  CANADIAN  NURSE  —  September  1975 


practioner  is  to  be  a  reality  of  the  future, 
and  this  appears  to  be  the  case,  physicians 
will  have  to  learn  to  accept  the  competent 
nurse  and  communicate  with  her  as  a  re- 
sponsible colleague.  Both  parties  must 
learn  to  work  together  and  to  develop  an 
environment  conducive  to  patient  care. 

Other  factors  that  would  enhance  the 
nurse's  role  as  an  independent  nurse  prac- 
titioner rather  than  a  physician's  assistant 
are  the  provision  of  education  within  a 
nursing  framework,  and  competent  role 
models  in  clinical  nursing  practice.  In  re- 
viewing the  pilot  project,  it  is  evident  that 
there  was  nursing  input.  However,  the 
elements  of  the  nursing  process  and  be- 
havioral concepts  were  an  adjunct,  rather 
than  the  core,  of  the  program. 

There  is  a  need  to  examine  how  these 
components  can  provide  the  framework 
for  the  organization  of  knowledge  relevant 
to  functioning  in  an  expanded  nursing 
role.  It  is  important  to  have  teaching  from 
other  disciplines,  whose  expertise  and  ex- 
perience are  extremely  valuable,  but  the 
sole  direction  should  not  come  from  them . 

There  should  be  nursing  role  models, 
both  as  teachers  and  clinicians,  so  that  the 
emergent  therapist  can  identify  with  mem- 
bers of  her  profession,  thereby  decreasing 
the  role  confusion  that  develops  when  one 
moves  into  a  new  role.  As  long  as  there  is  a 
paucity  of  highly  skilled  clinicians  in  nurs- 
ing, the  profession  will  continue  to  rely  on 
other  disciplines  for  direction.  However, 
as  numbers  increase  —  and  indeed  they  are 
increasing  —  nurses  in  the  future  will  be 
able  to  identify  more  fully  with  nurses. 

If  nursing  is  to  pursue  its  goal  of  being 
an  independent  profession,  nursing  con- 
tent should  be  at  the  core  of  education  for 
nursing  practitioners,  and  there  should  be 
competent  role  models  in  the  clinical  area. 
The  primary  therapist  project  supports  this 
viewpoint,  although  deficiencies  have 
been  recognized.  There  is  a  need  for  re- 
finement of  the  initial  ideas,  and  definition 
of  how  our  goals  can  best  be  achieved. 
This  has  been  a  challenging  experience  on 
the  unit,  and  one  that  has  provided  a  new 
feeling  of  achievement  among  the  par- 
ticipants. It  has  been  a  step  toward  the 
assumption  of  greater  responsibility  by 
nurses  in  clinical  practice.  ■§ 


Trom  Uppincott.  | 


%         HUMAN 
fe    D€V€LORM€Nr 
i    ANDD€HAV10R 

pSKHa06rHr*KM5 


DSIAffi„ 


'     ^-Sil^ 


1  New 
HUMAN  DEVELOPMENT  AND  BEHAVIOR 
Psychology  in  Nursing 

This  book,  with  its  special  focus  on  nursing  practice,  will  be  a  welcom 
addition  to  both  students  and  practitioners  of  nursing.  In  it  are  delineate 
the  major  psychological  concepts  as  they  relate  to  the  life  cycle  of  ind 
viduals  in  periods  of  health  as  well  as  illness.  What  emerges  is  an  overviei 
of  behavior  that  enables  the  nurse  to  intervene  more  effectively  with  he 
patients  to  promote  better  psychological  adaptation. 
By  BERNARD  D.  STARR,  Ph.D.  and  HARRIS  S.  GOLDSTEIN,  M.D.,  D.  Med.  Sc. 

SPRINGER 

436  pages/July  1975/  $10.1 


!  AGuldetoE«f.ctiv.Stu-y 


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2  New 

A  GUIDE  TO  EFFECTIVE  STUDY 

This  book  is  the  result  of  more  than  five  years  of  research  on  the  subject  ( 

study  skills.  Mental  operations  required  for  understanding  and  rememberinj 

course  material  are  described.  Typical  student  motivational  problems  ar 

discussed  with  suggested  corrective  measures. 

By  EDWIN  A.  LOCKE,  Ph.D. 

SPRINGER 

200  pages/ July  1 975/  $4.5oi 


3  New 

INTRODtiCTORY  CLINICAL  PHARMACOLOGY 


Drug  therapy  is  one  of  the  most  important  treatment  modalities  in  moderr 
health  care.  Because  of  its  importance  and  complexity,  and  the  ever-in- 
creasing new  knowledge  in  the  field,  it  is  imperative  that  ail  health  pro- 
fessionals develop  a  system  of  study  to  help  them  cope  with  drug  informa- 
tion. This  book  is  designed  to  aid  the  student  and  practitioner  in  that  study 
By  JEANNE  C.  SCHERER,  R.N.,  M.S. 

LIPPINGOTT  Ij 

367  pages/ 1975/  $8.75 1( 

^ i. 


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In 

rXTBOOK  OF  MEDICAL-SURGICAL 

NIRSING 

3  standing  in  its  depth  of  scientific  content  and  in  the 
jcticality  of  its  application,  this  leading  text  has 
)tn  heavily  revised   and   updated,  with   much  new 

|;erial.  In  the  unit.  Assessment  of  the  Patient,  three 
/  chapters  have  been  added:  Clinical  Interviewing 
jl'atients:  Physical  Examination  by  the  Nurse;  and 
delines  for  Writing  Problem-Oriented  Records  to 
mote  continuity  of  patient  care.  Other  new  chapters 
ude  Care  of  the  Cardiovascular  Surgical  Patient, 
The  Person  Experiencing  Pain.  Nursing  manage- 
it  in  various  clinical  situations  is  frequently  outlined 
ibular  form. 
JLLIAN  S.  BRUNNER,  R.N.,  M.S.;  DORIS  S.  SUDDARTH, 

B.S.N. E.,  M.S.N. 
fINCOTT 
itrated.  3rd  Edition,  1975  $19.75 


7  New 
CARE  OF  THE  ADULT  PATIENT 
MEDICAL-SURGICAL  NURSING 

A  superbly  useful  tool  for  nursing  education  and  prac- 
tice, this  well  established  text  has  been  massively  re- 
vised, updated  and  expanded,  and  provides  an  authori- 
tative basis  for  understanding  the  patient's  therapeutic 
regimen,  including  surgery,  drugs,  nursing  intervention 
and  rehabilitation.  The  nursing  process  is  stressed  and 
pathophysiologic  content  has  been  expanded.  Each 
chapter  emphasizes  assessment  of  the  physical, 
emotional  and  social  needs  of  the  patient  and  his 
family.  New  chapters  include  The  Nursing  Process, 
Nursing  Assessment,  and  The  Development  Process. 
By  DOROTHY  W.  SMITH,  R.N.,  Ed.O.;  CAROL  P.  HANLEY  GER- 
MAIN, R.N.,  M.S. 
LIPPINCOTT 

Illustrated,  4th  Edition,  June  1975/Paper  $15.50 

Cloth  $19.75 


riE  LIPPINCOTT  MANUAL  OF 
NJRSING  PRACTICE 

ris  now-famous  ready  reference  puts  virtually  all  of 
irsing  right  at  your  fingertips!  In  three  major  units  .  .  . 
Tii  cal/surgical,  maternity,  pediatric:.  .  .  this  unique 
3(ik  presents  clinical  problems,  their  causes,  mani- 
Bations.  potential  complications,  plus  overall  nursing 
Ti^^oement  in  concise,  outline  form  .  .  .  instant  infor- 
you  can  put  to  immediate  use.  With  Capsule 
juclines  to  Nursing  Action,  Nursing  Alerts,  Sections 
)i Pharmacology  and  Medication,  and  much,  much 
n-e! 

JylLLIAN  S.  BRUNNER,  R.N..  M.S.;  and  DORIS  S. 
'""^RTH,  R.N..  M.S.N. ;  with  four  coauthors,  three 

itors. 
-i-i-jCOTT 
U3  pages/Profusely  illustrated,  1974  $21.50 


fr 


l>SIC  PEDIATRICS  FOR  THE 
PIMARY  HEALTH  CARE 
>OVIDER 

ih  goal  of  this  innovative  new  paperback  textbo-  is 
onpart  specific,  pertinent  knowledge  from  the  bi  yi 
iei  of  pediatrics  that  will  be  useful  to  nonphysick  is 
vli  function  as  primary  health  providers.  The  ma- 
Bial  is  organized  into  four  general  areas.  Part  1,  Data 
he.  discusses  history-taking,  physical  examination, 
iCiening  tests,  and  the  problem-oriented  record.  Part 
1,-ierapy,  covers  immunizations  and  nutrition. Part  III, 
leiijs  Common  Signs,  Symptoms  and  Diseases  and  is 
>ranized  by  organ  systems.  Three  special  chapters  — 
)rallergies,  on  acute,  benign,  and  communicable 
AC)  diseases;  on  streptococcal  illnesses  and  compli- 
;aons  —  will  be  of  particular  interest.  Part  IV,  Prob- 
eis  of  Behavior,  considers  both  childhood  and  ado- 
ei;ence. 

Jy;ATHERINE  DeANGELIS,  M.D.,  R.N.,  M.P.H. 
JTLE  BROWN 
"^  -iges,  illustrated  1975  $9.95 


8  A  GUIDE  TO  PHYSICAL 

EXAMINATION 

An  expertly-illustrated,  "how-to"  text  that  bridges  the 
gap  between  anatomy  and  physiology  and  their  appli- 
cation to  the  physical  examination.  Within  each  body 
region  or  system,  three  topics  are  covered:  1) 
anatomy  and  physiology  basic  to  the  examination,  2) 
examination  techniques,  3)  selected  abnormalities.  A 
superb  teaching  tool  for  any  program  in  primary  health 
care. 

By  BARBARA  BATES,  M.D. 
LIPPINCOTT 
375  pages/profusely  illustrated/1974  $18.75 

Also  available  . . . 

PHYSICAL  EXAMINATION  FILMS 

A  series  of  twelve  sound  motion  pictures,  correlated 
with  the  content  of  A  Guide  to  Physical  Examination. 
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9  New 
SCIENTIFIC  FOUNDATIONS  OF 
NURSING 

Heavily  revised  and  updated  in  the  third  edition,  this 
unique  source  book  applies  principles  from  the  bio- 
physical, social  and  behavioral  sciences  to  clinical 
nursing.  In  this  edition  nursing  care  selections  are  ex- 
panded throughout;  anatomy  and  physiology  sections 
are  rewritten;  the  pathology  section  is  more  detailed 
and  pathophysiology  is  expanded.  Patient  care  in- 
cludes more  emphasis  on  children  and  the  elderly. 
Psycho-social  Principles  and  Nursing  Applications  are 
expanded,  and  crisis  intervention,  aging,  death  and 
dying  are  .-^    essed. 

By  MADELN  ..;  T.  NORDMARK,  R.N.,  M.S.(N.E.);  and  ANNE  W. 
ROHWEDER,  R.N..  M.N. 
LIPPINCOTT 
480  pages,  3rd  edition,  June  1 975/paperbound         $6.95 


Nursing  at  Canoe  Narrows 


The  author  offers  a  glimpse  of  his  weekly  rounds  as  a  nurse  practitioner  in  a 
remote  area  of  northern  Saskatchewan. 


Donald  Brown 


It's  Monday  morning,  9:30.  A  cloud  of 
white  powder  swirls  behind  a  large  green 
station  wagon,  trying  to  "make  up  time" 
on  the  narrow,  winding,  northern  road. 
Three  inches  of  snow  makes  the  landscape 
soft  and  beautiful,  but  the  driving 
treacherous. 

The  natives  who  drive  this  road  are  ap- 
prehensive, foreseeing  disaster  for  the  big 
green  Chevy  and  its  lone  occupant.  "You 
drive  too  damn  fast  on  those  roads,"  they 
tell  me. 

A  snake  with  arthiritis  couldn't  follow 
that  road.  It  has  more  blind  corners  per 
mile  than  any  other  road  in  Saskatchewan. 
"It's  a  full  day's  work  just  getting  up 
there,"  an  older,  experienced  public 
health  nurse  once  told  me  —  and  she's 
right.  But,  getting  "up  there"  is  just  the 
beginning. 

The  nursing  cabin  waits  quietly,  its  blue 
storm  door  swinging  gently  in  the  breeze. 
From  inside,  the  view  varies  from  beauti- 
ful to  beastly,  depending  on  which  win- 
dow you  look  out  of.  The  Canoe  Narrows 


The  author  (R.N. .  B.Sc.N..  University  of  Sas- 
katchewan) is  a  nurse  practitioner,  based  al 
Meadow  Lake.  Saskatchewan.  His  district  cov- 
ers approximately  600  square  miles. 

38 


nursing  cabin  is  new  and  well  built,  but 
small,  not  having  been  designed  with 
doctor-type  clinics  in  mind.  Clinic  hours 
are  from  3:00  —  5:30  P.M  Before  opening 
time,  I  must  unload  and  set  up  supplies, 
have  lunch,  and  visit  Jans  Bay,  three  miles 
away.  I  hurry. 

Jans  Bay.  perched  on  a  stump-dotted 
sand  ridge  between  the  bay  and  a  swamp, 
is  a  village  of  90  souls.  In  a  government 
trailer,  many  women  of  the  community 
gather  to  work  in  a  handicraft  co-op.  The 
trailer  is  my  first  stop.  Struggling  in 
through  the  storm  door,  which  is  always 
abominably  stuck  and  has  been  nearly 
wrecked  by  other  irate  entrants,  I  quickly 
canvass  the  mothers  to  determine  who  in 
the  community  needs  my  help  today.  The 
results  of  this  laconic,  soft-spoken,  and 
often  one-sided  interview  may  send  me  to 
any  one  of  the  many  tiny  houses  on  the 
ridge. 

There,  among  the  burned-out,  rolled- 
over,  stripped-down  old  cars,  and  stumps 
and  garbage,  1  find  the  people  I've  come  so 
far  to  see.  I  find  children  of  9  with  chronic 
suppurative  otitis  media  and  permanent 
hearing  impairment.  1  find  large,  pus- 
crypted  tonsils  that  fill  three-quarters  of 
the  oral  pharynx.  I  find  scabies,  ring- 
worm, impetigo,  and  various  combina- 
tions of  all  three.  I  find  low  hemoglobins 


and  high  fevers.  I  find  pale,  tired,  old 
looking  women  of  36,  who  have  historic- 
of  12  pregnancies  and  10  babies.  I  find 
16-year-olds,  in  the  seventh  month  of  theii 
first  pregnancy,  who  have  never  been  seeir 
by  any  medical  personnel. 

Back  at  the  clinic  2  hours  later,  the  list 
grows:  acute  chest  infections,  kidney  in- 
fections, and  obstructive  lung  disease.  Be- 
tween these  "heavy"  illnesses,  I  see  the 
colds,  influenza,  and  diarrheas  that  are 
ever  present. 

As  I  examine  these  people,  treating  the 
ones  I  can  and  arranging  for  the  others  to 
see  whatever  professional  person  can  best! 
deal  with  their  problem,  I  know  that  I  seei 
only  surface  problems.  There  is  a  large) 
pool  of  pathology  in  these  outlying  com- 
munities that  never  comes  to  me .  The  peo- 
ple seem  to  have  become  accustomed  to 
existing  in  a  state  of  "poor  health." 

By  5:30  P.M.,  if  I'm  lucky,  the  last  abra- 
sion has  been  dressed,  the  last  baby's  ears 
peered  into,  and  the  last  chest  auscultated. 
I've  completed  all  the  records  and  forms  in 
triplicate.  I've  dispensed  multitudinous 
vials,  tubes,  and  bottles  of  medication 
from  my  stock  cupboard  and,  glory  be,  it's 
supper  time! 

Fate  smiled  on  this  nurse  practitioner 
and  arranged  for  a  newly  married  couple  to 
be  teaching  at  the  Canoe  Narrows  Indian 


school.  A  song  writer  once  wrote  that  "he 
didn't  want  to  sleep  alone"'  — a  sentiment 
I  heartily  understand.  You  will  agree,  lam 
sure,  that  eating  alone  is  almost  as  bad, 
and  I  am  fortunate  to  have  such  good  com- 
pany and  good  food. 

The  meal  smells  delicious,  as  usual,  but 
before  I  can  start  on  the  concentrated 
calories,  the  door  bell  rings  —  "Is  Mr. 
Brown  there?" 

I  trudge  across  the  reserve  with  my  "lit- 
tle black  bag"  and  find  a  week-old  baby, 
covered  with  small  pustules.  They  tell  me 
she  has  been  crying  almost  continuously 
for  24  hours.  Examination  shows  mild 
fever,  with  no  ear  or  chest  involvement. 
The  history  tells  of  mild  diarrhea  and  occa- 
sional small  amounts  of  emesis.  Probably 
a  mild  gastrointestinal  upset  due  to  bac- 
teria from  none-too-clean  feeding  utensils 
and  practices. 

I  give  a  few  simple  instructions  regard- 
ing the  diet  and  feeding  of  the  baby  for  the 
next  48  hours.  This  is  the  mother's  first 


child  and ,  under  less  than  ideal  conditions, 
there  are  bound  to  be  some  problems.  Tak- 
ing my  leave,  I  urge  them  to  see  a  physi- 
cian soon  about  the  rash. 

On  my  way  back,  a  youngster  intercepts 
me  and  says,  "Veronica  wants  you  to 
come  right  away . ' '  Earlier  in  the  day ,  I  had 
treated  Veronica  at  home.  She  was  in  the 
seventh  month  of  her  twelfth  pregnancy 
and  had  been  coughing  for  the  previous  24 
hours. 

There  she  is,  sitting  cross-legged  in  a 
kitchen  chair.  I  help  her  walk  into  her 
bedroom.  "Something's  happening  down 
there,"  she  states  calmly.  She's  right,  of 
course,  because  examination  reveals  a 
grapefruit-sized  bulge  in  the  membranes 
presenting  at  the  introitus.  "Good  grief," 
I  say,  "you've  been  in  labor  all  day  and 
didn't  tell  me.  The  baby  is  almost  here. 
Don't  move,  take  deep  breaths,  and  don't 
push —  I'll  be  right  back."  I  charge  out  of 
the  house  to  get  supplies  for  "delivery 
under  less  than  optimum  conditions." 


Panting  back  into  the  room,  clutching 
my  arm  load  of  "goodies,"  I  discover  that 
the  membranes  have  ruptured,  the  bed  is 
soaked,  but  the  baby's  head  is  not.  as  I 
feared,  right  behind  it .  Two  more  bulges  in 
the  membranes  came  and  went  before  I 
summoned  the  courage  to  do  a  sterile  vag- 
inal exam  and  found  a  long,  reasonably 
firm  cervix  —  no  labor,  no  baby  I  So.  100 
miles  to  Meadow  Lake  in  the  old  station 
wagon,  holding  Veronica's  hand  to  com- 
fort her. 

Once  there,  Veronica  was  delivered  by 
cesarean  section,  and  we  learned  she  had 
been  carrying  twins,  one  of  which  had  died 
in  utero.  The  surviving  infant  is  alive  and 
well  in  a  premie  clinic. 

That  was  one  of  my  more  hectic  even- 
ings —  please  do  not  think  I  go  flapping 
about  the  countryside  until  1 : 30  A.M.  every 
night! 

No  matter  when  the  previous  night 
ends,  however,  the  Beauval  clinic  opens  at 
11:00  A.M.  The  clinic  in  Beauval  is  new 
and  well  equipped.  I  see  patients  there 
until  3:00  or  3:30  P.M..  or  whenever  I  ex- 
amine the  last  patient.  The  kinds  and  num- 
bers of  patients  vary  little  from  those  at 
Canoe  Narrows. 

As  soon  as  the  last  problem  is  seen, 
solved,  or  referred,  I  load  up  my  portable 
equipment  and  head  the  nose  of  the  scar- 
red, green  Chevy  toward  home.  The  road 
home  from  Beauval  is  even  more  wretched 
than  the  one  to  Canoe  Narrows,  but  with 
luck,  and  occasional  help  from  my  friends, 
5:30  P.M.  finds  me  rolling  into  Meadow 
Lake.  I  arrive  back  to  civilization  with  a 
briefcase  full  of  "patient  visit  forms," 
prescriptions  to  be  filled,  and  problems  to 
be  discussed  with  my  consultant  physician 
or  one  of  his  colleagues. 

Without  question,  one  of  the  most  posi- 
tive factors  in  this  program  is  the  strong 
support  given  to  me  by  the  doctors  in  the 
Meadow  Lake  group  practice.  I  would  be 
sorry  indeed  for  the  nurse  practitioner  who 
did  not  feel  free  to  seek  out  his  or  her 
physicians  to  talk  over  the  myriad  diagnos- 
tic and  management  problems  that  con- 
tinually arise. 

Wednesday  is  my  day  in  town  to  get  my 
affairs  in  order  and,  if  possible,  to  spend 
the  afternoon  in  the  clinic  with  one  of  the 
doctors  —  .seeing  patients  and  learning. 

Thursday  morning,  refreshed  in  mind, 
body ,  and  supplies,  I  "head  north"  todo  it 
all  over  again.  ^' 


THE  CANADIAN  NURSE  —  Seolember  1975 


fl  oonoGptuol  model 
for  nursing 


The  author  touches  upon  the  pro's  and  con's  of  adopting  a  conceptual 
model  for  nursing. 


Evelyn  T.  Adam 


The  word  "model"'  has  been  part  of  the 
nursing  vocabulary  for  several  years;  for 
some  members  of  the  profession  it  has 
acquired  a  rather  negative  connotation, 
while  for  others  it  offers  at  least  a  partial 
solution  to  some  basic  problems. 

What,  exactly ,  /s  a  conceptual  model?  It 
is  a  mental  image,  an  invention  of  the 
mind,  a  conceptualization,  or  a  way  of 
looking  at  something.'-  A  philosophy  is 
also  a  way  of  looking  at  something,  but  is 
more  abstract  than  a  model.  A  theory,  too, 
is  a  conceptualization  or  an  invention  of 
the  mind,  but  is  also  at  a  higher  level  of 
abstraction.  A  model  is  usually  based  on, 
or  derives  from,  a  theory.  Neither  is  the 
reality  itself;  a  theory  represents  the  sub- 
stance and  a  model  the  structure  of  a  real- 
ity. A  model,  emerging  from  a  theory, 
may  become  the  basis  for  a  new  theory. 

A  nursing  model  is,  therefore,  a  way  of 
looking  at  nursing.  In  a  sense,  every  nurse 


Evelyn  T.  Adam  (R.N.,  Hotel  Dieu  Hospital. 
Kingston,  Ontario;  B.Sc.Inf. ,  University  of 
Montreal;  M.N.,  University  of  California,  Los 
Angeles)  is  associate  professor.  Faculty  of 
Nursing ,  University  of  Montreal .  These  are  her 
personal  views  and  not  necessarily  those  of  the 
Faculty  of  Nursing. 


uses  a  model,  because  every  nurse  has  a 
personal  conception  of  the  service  she/he 
offers  to  society. 3  But,  is  that  conception 
clear,  communicable,  explicit;  or  is  it 
vague,  ambiguous,  and  difficult  to  put  into 
words? 

If  our  mental  image  of  nursing  is  not 
clear,  should  it  be  clarified?  How  useful 
would  that  be?  Would  it  provide  answers 
to  some  troublesome  questions? 

As  a  body,  we  are  at  present  insisting  on 
full-fledged  membership  on  the  multidis- 
ciplinary  team:  this  implies  that  we  have  a 
contribution  to  make  to  that  team.  What, 
exactly,  is  our  contribution? 

We  are  claiming  collegial  status  with 
other  professionals.  This  indicates  that  our 
service  to  society  is  important.  What,  ex- 
actly, is  that  service? 

We  are  also  asserting  our  right  to  the 
salary  of  a  health  professional,  which  im- 
plies that  the  nurse  plays  a  significant  role 
in  the  health  field.  What  is  her  role?  What 
does  she  do? 

The  are  many  answers  to  these  questions, 
and  several  well-known  authors,  including 
Virginia  Henderson,  Dorothy  E.  Johnson, 
Imogene  King.  Dorothea  Orem,  Hil- 
degarde  Peplau,  Martha  Rogers,  and  Cal- 
lista  Roy,  have  had  the  courage  to  publish 
their  own  conception  of  the  nursing  pro- 


fession. Whether  or  not  their  writings  ade- 
quately fit  the  criteria  of  a  model,  they 
nonetheless  offer  us  precise  statements  on 
our  social  mission. 

Arguments  against  a  definition  of  nurs- 
ing also  exist.  ^^  For  some  nurses,  a  model 
would  be  too  confining  and  narrow;  for 
them,  a  model  could  actually  be  harmful, 
in  that  it  might  smother  their  freedom, 
creativity,  and  individuality. 

Other  nurses  simply  prefer  to  maintain 
the  status  quo  and,  for  them,  this  is  a  fairly 
comfortable  situation.  They  say:  "We  are 
not  the  only  ones  whose  roles  are  not 
clearly  defined."  or  "Let's  get  on  with 
nursing  and  not  worry  about  what  it  is." 
For  still  others,  the  status  quo  means  am- 
biguity, confusion,  ambivalence,  and  a 
collective  identity  crisis.^ 

If  a  model  represents  the  structure  of 
reality,  a  nursing  model  represents  the 
structure  of  nursing  itself.  There  are  6 
major  units  in  a  conceptual  model; 

•  desired  goal 

•  target  of  action  (the  person  toward 
whom  the  action  is  directed) 

•  change  agent  (his  place;  his  role  or  the 
nature  of  his  activities) 

•  source  of  difficulty  (the  major  cause  of 
difficulty) 


•  intervention  (the  focus;  the  mode,  or 
means  of  intervention) 

•  consequences  (the  intended  results:  the 
unintended  results,  if  predictable.) 

Thus,  a  model  indicates  the  goal  of  our 
profession  —  an  ideal,  and  limited  goal.  It 
must  be  limited  to  some  extent,  as  it  is 
humanly  impossible  to  be  all  things  to  all 
people.  Our  goal  must,  of  course,  be  com- 
patible with  the  common  goal  of  all  the 
health  professions,  yet  distinct  enough  to 
justify  our  presence  among  those  same 
health  professions.  Some  overlapping  of 
roles  is  inevitable,  but  it  does  not  excuse  us 
from  clarifying  our  raison  d'etre. 

A  model  also  shows  us  how  to  achieve 
our  ideal  and  limited  goal,  because  it  gives 
us  direction  for  nursing  practice,  nursing 
education,  and  nursing  research.  In  prac- 

THE  CANADIAN  NURSE  —  September  1975 


tice,  and  in  education,  we  have  for  years 
talked  about  the  nursing  process,  of  which 
the  first  step  is  nursing  assessment  or  nurs- 
ing history.  We  do  not  seek  the  same  in- 
formation as  the  other  members  of  the 
health  team:  we  are  looking  for  nursing 
data,  and  we  are  making  a  nursing  assess- 
ment. The  model  indicates  what  kinds  of 
data  comprise  nursing  data. 

Should  we  choose  to  use  the  problem- 
solving  method,  the  model  indicates  what 
sorts  of  problems  are  ours  to  solve:  we  are 
therefore  less  likely  to  use  our  energies 
trying  to  solve  problems  that  belong  to 
another  discipline.  Similarly,  the  kinds  of 
nursing  intervention  jhat  might  be  most 
useful  are  suggested  by  the  conceptual 

model. 

Our  nursing  curricula  are  also  planned 
in  accordance  with  the  model.  Research 


problems  that  issue  from  the  model  are 
nursing  problems.^  Hence,  our  research 
will  promote  our  own  discipline  rather 
than,  or  as  well  as,  contribute  to  the  ad- 
vancement of  another  health  specialty. 

Discussions  about  the  extended  role,  en- 
larged role,  nurse  vs.  physician's  assis- 
tant, various  educational  levels,  et  cetera 
would  be  strengthened  by  the  clarification 
furnished  by  a  model. 

The  guidelines  of  the  model  are  broad 
enough  to  be  useful  in  practice,  teaching, 
and  research  whether  the  activity  is  within 
or  outside  a  hospital,  at  college  or  univer- 
sity level,  and  independently  of  any  medi- 
cal specialty  (e.g.  obstetrics,  psychiatry) 
as  a  chosen  field  of  endeavor. 

Ideally,  choosing  a  model  is  accomp- 
lished through  a  group  decision  of  those 
immediately  concerned.  They  will  have 
made  a  detailed  study  of  the  model,  includ- 
ing the  theory  used  by  the  author  to  con- 
struct the  model,  the  assumptions  and  val- 
ues on  which  the  model  is  based,  and.  of 
course,  its  major  components.  A  model  is 
chosen  for  its  social  significance  and  use- 
fulness in  every  area  of  activity.  It  must  be 
compatible  with  the  personal  beliefs  of 
those  making  the  choice:  it  is  considered 
the  most  useful,  most  practical,  and  most 
accessible  of  the  various  models. 

References 

1.  Riehl,  Joan  P.  and  Roy.  Callisla.  Concep- 
tual models  for  nursing  practice.  Englewood 
Cliffs.  New  Jersey.  Prentice  Halt.  1974. 

2.  Bennis.  Warren  G.,  Benne.  Kenneth  D..  and 
Chin,  Robert,  eds.  The  planning  of  change.  2d 
ed.  New  York.  Holt.  Rinehart  and  Winston,  c. 
1969. 

3.  Norris.  Catherine  M.  Delusions  that  trap 
nurses.  .  .  Nurs.  Outlook  21:1:18-21.  Jan. 
1973. 

4.  Storiie.  Frances.  Nursing  need  never  be  de- 
fined. Ini.  Nurs.  Rev.   17:3:254-7,  1970. 

5.  Lichty.  Joseph  S.  A  ho.spital  administrator 
looks  at  nursing  service.  Nurs.  Outlook 
14:11:53-55,  Nov.  1966. 

6.  .MacQueen.  Joyce  Shroeder.  A 
phenomenology  of  nursing.  Nurs.  Papers 
6:3:9-19.  Fall  1974. 

7.  Johnson.  Dorothy  E.  Developmeni  of 
theory:  a  requisite  for  nursing  as  a  primary 
health  profession.  Nurs.  Res.  23:5:372-7. 
Sep. /Oct.  1974.  ^ 


Grand  Rounds 

on 
brain  tumors 


The  authors  take  the  reader  with  them  on  their  Grand  Rounds,  where  they  discuss 
specific  nursing  management  of  patients  who  have  different  types  of  brain  tumors. 


Helena  Kryk,  Faye  Blenkhorn,  Anne 
Carney,  Wanda  Hawkins, 
Caroline  Robertson,  Elizabeth  Roll,  and 
Ursula  Steiner 


On  15  March  1975,  newspapers  across  the 
country  reported  that  Susan  Hay  ward, 
well-known  actress  and  an  Academy 
Award  winner,  had  died.  She  had  been 
suffering  from  a  terminal  brain  tumor  and 
had  died  following  a  seizure. 

This  fate  is  shared  by  many  individuals 
of  all  races  and  ages  around  the  globe. 
Brain  tumors  are  not  rare.  Statistics  reveal 
that  cerebral  tumors  comprise  1-2%  of 
autopsies." 

In  general,  the  primary  intracranial 
tumors  differ  from  neoplasms  in  other 
parts  of  the  body  in  that  they  do  not  metas- 
tasize outside  the  central  nervous  system. 
Yet,  if  untreated,  they  prove  fatal  by  caus- 


The  authors  are  members  of  the  nursing  staff  of 
the  Montreal  Neurological  Hospital.  Helena 
Kryk,  R.N..  B.N.,  is  assistant  director  of  nurs- 
ing education,  and  director  of  the  postbasic 
program  in  neurological  and  neurosurgical 
nursing;  Faye  Blenkhorn,  R.N.,  is  a  staff  nurse 
on  the  Intensive  Care  Unit;  Anne  Carney, 
R.N.,  B.N..  is  a  supervisor,  and  the  illustrator 
for  this  article:  Wanda  Hawkins.  R.N.,  is  a 
staff  nurse;  Caroline  Robertson,  R.N..  B.N., 
M.Sc.A.,isdirectorof  nursing;  Elizabeth  Roll. 
R.N.,  B.N..  is  nursing  instructor;  and  Ursula 
Steiner,  R.N.,  is  a  head  nurse.  The  authors 
thank  Carl  Dila,  M.D.,  F.R.C.S.  (C), 
F.  A.C.S. ,  for  his  suggeslionsand  review  of  the 
medical  aspects  of  this  study. 


ing  pressure  or  ultimate  destruction  of  vital 
centers  of  the  brain.  Intracranial  tumors 
are  composed  of  a  great  variety  of  neoplas- 
tic tissue.  They  arise  from  the  ghal  cells, 
blood  vessels,  meninges,  hypophysis, 
pineal  gland,  cranial  nerves,  ventricular 
lining-ependyma,  and  embryonic  cells. 

Extracerebral  tumors,  originating  from 
structures  surrounding  the  brain,  produce 
pressure  signs,  but  do  not  infiltrate  the 
neural  tissue.  Meningioma  is  an  example 
of  such  a  tumor.  Intracerebral  tumors, 
such  as  glioblastoma  multiforme,  start 
within  the  brain  and  infiltrate  it. 

Pathology  and  Classification 

The  nervous  system  of  man  develops 
from  the  neural  tube.  During  the  em- 
bryonic development,  nerve  cells  and 
neuroglial  cells  differentiate  from  the 
epithelium  of  the  neural  tube.  In  the  early 
stages,  the  medulloblasts  give  rise  to 
neuroblasts  and  spongioblasts.  The 
neuroblasts  mature  into  neurons;  spon- 
gioblasts are  prototypes  of  astrocytes  and 
oligodendrocytes  (glial  tissue). 

The  cells  of  intracerebral  tumors  have 
certain  characteristics  of  embryonic  or 
parent  cells.  Subsequently,  the  different 
types  of  tumors  derive  their  names  from 
mature  glial  cells,  for  example,  as- 
trocytoma and  oligodendrocytoma,  or 
from  primitive  cells  in  the  embryonic 
brain,  for  example,  medulloblastoma  and 
spongioblastoma. 


A  tumor  may  not  be  homogenous  and. 
furthermore,  may  change  its  character 
over  time.  With  increasing  anaplasia,  the 
degree  of  malignancy  becomes  higher 
Based  on  the  histological  examinations, 
the  intracerebral  tumors  of  the  glial  group 
are  graded  from  benign  Grade  I  type,  with 
favorable  prognosis,  to  Grade  4  malig- 
nant type,  with  limited  survival  time. 

In  evaluating  the  degree  of  malignancs . 
a  distinction  has  to  be  made  between  "his- 
tological" and  "clinical"  malignancy. 
The  final  outcome  of  an  expanding  lesion 
depends  not  only  on  the  type  of  growth, 
but  also  on  its  site,  position,  rate  of 
growth,  and  environmental  characteris- 
tics. 

Due  to  the  anatomical  properties  of  the 
skull,  which,  with  its  rigid  walls  resembles 
a  "closed  box,"  any  additional  mass  is 
likely  to  influence  the  functioning  of  the 
brain.  A  slowly  growing,  benign  mening- 
ioma may  lead  to  increased  intracranial 
pressure  and  highly  dangerous  intercom- 
partmental  displacements  of  brain  tissue, 
called  herniations. 

The  principle  of  total  removals,  as  prac- 
ticed in  cancer  surgery,  is  not  always  ap- 
plicable in  patients  with  brain  tumoR.  Rad- 
ical resection  of  some  parts  of  the  brain 
would  produce  devastating  and  crippling 
results,  both  physical  and  intellectual.  For 
example,  a  grade  I  ependymoma  of  the  4th 
ventricle  may  not  be  completely  removed 
because  of  its  location  —  close  to  vital 


tardiac  and  respiratory  centers  and  the 
liuclei  of  important  cranial  nerves. 
I  Due  to  the  difficulty  of  placing  brain 
jumors  in  clear-cut  categories,  the  classifi- 
bation  and  the  frequency  vary  depending 
i^n  the  source  of  published  statistics.  For 
Practical  purposes  in  clinical  nursing,  the 
itollowing  classification,  as  given  by 
Ilennett.^  is  used,  along  with  the  inci- 
dence: 


jlioma 
'Vleningioma 
[Pituitary  tumors 
[Acoustic  neuroma 
jMelastalic  tumors 
'ongeniial  tumors 
Vasc»iaj  tumors 


40-45% 

15-20% 

10-15% 

10% 

5% 

5% 


Brain  tumors  can  occur  at  any  time  of 
the  life  span.  Their  frequency  is  similar, 
irrespective  of  age. How  ever,  there  are  cer- 
tain features  of  origin  and  site  of  growth 
:hat  are  characteristic  to  tumors  of  child- 
jiood,  in  contrast  to  adulthood. 

In  general,  most  brain  tumors  in  chil- 
dren (50-60'7f )  are  located  in  the  posterior 
fossa,  below  the  tentorium.  The  most 
:ommon  tumors  of  childhood  are': 


"erebellar  astrocytoma 
^ledulloblasloma 
Brain  stem  glioma 
Craniopharyngioma 
Ependymoma 


18% 

17% 

10% 

9% 

9% 


porosaa 


;itu>l     me'runqioma.. 


qlioblasto. — 
^  multilorine 


:>ma. 


CUStiC 

astrocutom  a. 


Cfi-rcbellam.. 


iiooolendroQiiomcL . 


meto&lauc 
tumour 
(^pnonchooeni^ . 


Adaoted  from  an  original  painting  by  Frank  H.  Netter,  M.D.  from  The  Ciba  Collection  Of  Medical 
ntsil^JnscoTyZ^t  by  CIBA  Pharmaceutical  Company,  Division  of  CIBA-GEIGY  Corporation. 
All  rights  reserved. 

cerebral     aAtrocAjvoma. 


In  adults,  intracranial  tumors  prevail  in 
the  supratentorial  compartment  of  the 
skull .  In  addition,  the  brain  can  be  invaded 
by  metastatic  carcinoma  from  lung. 
breast,  kidney,  and  other  organs. 

Clinical  Features 

The  volume  of  the  intracranial  content  is 
made  up  of  brain  tissue,  cerebral  blood 
flow,  and  cerebrospinal  tluid.  The  volume 
pressure  relationship  of  these  three  com- 
ponents is  normally  in  dynamic  equilib- 
rium. 

A  brain  tumor  usually  results  in  an  in- 
crease in  the  volume  of  the  "brain  compo- 
nent" which,  in  early  stages,  is  compen- 
sated for  by  a  reduction  in  the  volume  of 
CSF  or  blood  components.  As  these  com- 
pensating mechanisms  become  exhausted. 
(he  symptoms  of  the  cerebral  space- 
occupying  lesion  become  more  apparent. 

The  chnical  manifestations  of  intracra- 

THE  CANADIAN  NURSE  —  Seplember  '975 


SpntruntXOX- 
unno 


cVi-roryyo. 


Oratyio 


(  otixxiXaruJ 


.LOrrVX 


A^.„..H  from  an  orieinal  painting  by  Frank  H.  Netter,  M.D.  from  The  Ciba  Collection  Of  Medical 
muTarionscoTv^^^^y  CIBA  Pharmaceutical  Company.  Division  of  CIBA^iElGY  Corporation. 
All  rights  reserved. 


nial  tumors  fall  into  2  main  catagories, 
namely,  the  local  destructive  effects  and 
the  signs  of  increased  intracranial  pres- 
sure. The  presenting  symptoms  depend  on 
the  site  and  the  tumor's  rate  of  growth.  A 
small  tumor  in  the  ventricular  system 
causes  obstruction  of  the  CSF  pathway  and 
leads  to  hydrocephalus.  A  parasagittal 
meningioma  pressing  on  the  motor  cortex 
may  produce  seizures  and  leg  weakness  as 
localizing  symptoms. 

The  cranium  can  accommodate  a  fairly 
large  mass,  if  it  is  growing  in  a  relatively 
silent  area  of  the  brain  and  does  not  inter- 
fere with  circulation  and  absorption  of  CSF. 
In  this  case  the  tumor  can  grow  large 
enough  to  show  general  signs  of  increased 
intracranial  pressure,  without  showing  sig- 
nificant localizing  neurological  deficits. 
The  tumors  of  the  pituitary  can  produce 
endocrine  disturbance  and  bitemporal 
hemianopsia  as  initial  findings. 

The  onset  of  symptoms  of  a  brain  tumor 
can  be  slow  and  progressive,  or  sudden, 
with  dramatic  changes. 

Considering  the  difference  in  types  and 
in  natural  histories  of  intracranial  tumors, 
the  presenting  symptomatology  can  be 
summarized  as  follows:  headache,  vomit- 
ing, papilledema,  seizures,  mental 
changes,  ataxia,  motor  and  sensory  de- 
ficits, tinnitus,  hemianopsia,  speech  dis- 
orders, and  endocrine  disturbances. 

In  our  Grand  Rounds,  we  will  demon- 
strate how  patients'  symptoms  and  be- 
havior give  direction  for  planning  their 
nursing  care.  In  the  following  patient  his- 
tories, we  relate  the  variety  of  ways  in 
which  intracranial  tumors  are  manifested 
in  the  patient.  The  nursing  care  is  indi- 
vidualized and  dependent  on  the  assess- 
ment derived  from  a  careful  nursing  his- 
tory, as  well  as  a  medical  history.  For  each 
patient,  one  or  two  problems  of  nursing 
management  are  described. 

Mr.  X:  Diagnosis  — 
Astrocytoma  Frontal  Lobe 

Specific  Nursing  Management  of  Seizures, 
and  Control  of  Euphoric  Behavior 

"Neoplasms  of  the  frontal  lobe  are  the 
most  common  of  all  cerebral  tumors  in 
adults,  and  comprise  16  to  209c  of  all  sup- 
ratentorial  tumors.""  The  symptoms  can 
be  both  mental  disturbances,  due  to  the 


locality  in  the  frontal  lobe,  and  the  secon- 
dary ones,  dut  to  raised  intracranial  pres- 
sure. Because  of  the  frequent  disturbances 
in  psyche,  patients  with  frontal  tumors  can 
be  misdiagnosed  as  having  a  psychiatric 
disorder. 

Focal  seizures  occur  as  the  initial  symp- 
tom in  30  to  50%  of  patients.'  Although 
focal  initially,  they  frequently  spread  to 
adjacent  brain  tissue,  causing  generalized 
convulsions. 

Euphoria  has  been  described  as  the  lead- 
ing personality  change.  Other  changes 
occur  in  mood,  activity,  and  intellectual 
range,  often  accompanied  by  decreasing 
inhibitions  and  defects  in  sexual  and  social 
behavior.  Often,  the  individual  retains 
normal  scores  on  intelligence  testings.  The 
intellectual  changes  seen  are  attention  and 
memory  disturbances,  probably  due  to  his 
inability  to  concentrate,  and  increased  dis- 
tractability.  Migraine-like  headaches  are 
frequently  encountered. 

Mr.  X.  was  a  40-year-old  accountant, 
whose  history  before  surgery  spanned  a 
2-month  period,  with  sudden  onset.  His 
initial  symptom  was  a  generalized  convul- 
sion. In  spite  of  complete  neurological  in- 
vestigation, the  examinations  proved 
negative.  One  month  later,  his  second 
seizure  occurred  and.  on  admission,  a 
third. 

His  mood  was  slightly  euphoric,  with 
apparent  lack  of  concern  about  his  condi- 
tion. He  was  easily  distracted  and  seemed 
to  search  for  words  to  identify  familiar 
objects.  It  was  difficult  for  him  to  describe 
events.  His  wife  found  him  to  be  some- 
what confused  at  times  (not  knowing  ex- 
actly wherehe  wasorthetimeof  day).  She 
felt  he  had  changed  drastically,  from  a 
zealous  executive  interested  in  his  job,  to  a 
man  lacking  in  incentive,  wishing  to  do  no 
more  than  sit  at  home. 

Surgery  was  performed  and  a  low- 
grade,  infiltrative  astrocytoma  was  par- 
tially removed.  He  was  then  treated  with 
radiotherapy.  During  his  course  in  hospi- 
tal, we  carried  out  seizure  precautions.  We 
observed  him  constantly,  and  made  sure 
that  oxygen  and  suction  were  easily  acces- 
sible if  needed  during  a  seizure.  He  was 
accompanied  during  his  bath  and  when  he 
left  the  ward  for  any  reason.  The  bedsides 
were  raised  for  his  protection  when  he  was 
in  bed,  and  a  small  pillow  was  used  so  he 


would  not  smother  during  a  seizure. 

As  Mr.  X.  was  euphoric,  itwasdiffici 
for  his  wife,  friends,  and  other  patients 
understand  him.  He  would  appear  ina 
propriately  lazy  or  unconcerned,  ar 
others  would  become  offended  or  sho 
apprehension  when  near  him.  Occasioi 
ally,  he  showed  a  lack  of  inhibition  i 
social  behavior  by  making  suggestive  n 
marks  about  female  staff  members'  ch 
thing.  Gentle  explanations  about  his  in; 
bility  to  control  these  remarks  were  mac 
to  others  who  had  little  knowledge  of  h 
disorder.  His  wife  came  to  accept  that  th 
behavior  was  not  volitional  and  would  in 
prove  with  treatment.  She  played  a  larg 
role  in  his  recovery  with  her  continuin 
support  and  encouragement. 

Following  surgery,  this  inappropriat 
behavior  improved,  although  he  exper 
enced  some  depression  as  he  realized  th| 
seriousness  of  his  condition.  He  was  ablj 
to  be  discharged  9  days  following  surgery! 
as  arrangements  were  made  for  taxi  trips  1 1 
bring  him  daily  for  radiation  therapy. 

Two  years  following  surgery,  Mr.  X.  i 
working  as  an  accountant  with  his  origina 
firm  and  appears  a  contented  person.  Hi 
tumor  was  a  low-grade  neoplasm  and,  al 
though  not  totally  removed,  it  was  disco 
vered  eariy  so  that  he  has  had  a  rewardinj 
recovery  period. 

Mr.  Y:  Diagnosis  — 
Pontine  Glioma  ' 

Specific  Nursing  Management  for  Inabiii 
it}-  to  Speak.  Quadriplegia,  and  Fears  o, 
Death. 

Aphasia  is  defined  as  "loss  of  the  fa 
culty  of  language  usage  (motor)  and  com-| 
prehension  (sensory)  in  any  form:  speak- 
ing, reading,  writing  or  hearing./'  *  Some 
patients  with  aphasia  may  demonstrau 
speech  and  writing  inabilities,  while  un- 
derstanding the  spoken  and  written  word. 
Others  speak  inappropriately  or  in  jargon, 
without  understanding.  Still  others  have 
difficulty  identifying  words  in  spite  of  ap- 
propriate use.''  Although  unable  to 
speak,  our  patient.  Mr.  Y..  did  not  have 
his  impairment  from  a  lesion  of  cerebral 
integrative  centers  (frontal  or  tempero- 
parietal)  as  in  aphasia,  but  from  his  brain 
stem  cranial  nerve  involvement. 

A  young  man  in  his  twenties,  Mr.  Y's 


Ifirsi  symptom  was  headache,  followed  by 
Idouble  vision,  walking  difficulties,  and 
'  :ht  dysarthria  —  the  latter  the  result  of 
lesion  that  interfered  with  the  cranial 
inerves  that  supply  muscles  of  articulation. 
jHis  speech  problems  progressed  to  com- 
jpiete  speech  arrest  with  further  infiltration 
of  the  tumor,  but  he  understood  both  the 
spoken  and  written  word. 
1  Mr.  Y's  glioma  was  treated  by  steroids 
|ind  radiation.  This  treatment  improved  his 
ppeech  temporarily,  although  it  remained 
jilurred.  Suddenly  he  was  unable  to  speak. 
:ither  than    using  the   words   "yes"'   oi 

no."  Over  time,  he  lost  all  power  of 
.learing  and  of  movement  in  any  of  his 
'imbs.  He  could  move  his  eyes,  ap- 
preciated sensations,  and  still  understood 
he  spoken  word. 

A  sign  placed  over  Mr.  Y's  bed  read. 
Please  observe  eyes  when  communical- 
n.;  "No"  is  demonstrated  by  his  looking 
im^n  and  closing  his  eyes.  'Yes'  is  shown 
when  his  eyes  are  opened  and  looking  up- 
ward." He  expressed  his  desire  to  com- 
municate by  rapidly  flicking  his  eyes  up- 
ward. 

The  alphabet  board  was  helpful.  Rows 
vvere  notched,  allowing  the  nurse  to  run 
ler  finger  along  the  rows  of  letters,  wait- 
ni;  for  him  to  indicate  "stop."  Having 
identified  the  row,  the  first  letter  of  the 
desired  word  was  found,  and  so  on,  until 
he  word  was  spelled  out. 

The  counterside  of  the  board  indicated 
frequently  asked  questions.  Communica- 
with  the  help  of  this  board  and  some 
.,  reading  on  Mr.  Y's  part  was  a  slow 
irocess,  but  patiently  carried  out  by  his 
family  and  the  nursing  staff.  We  made  sure 
that  everyone  in  contact  with  him  estab- 
lished communication  in  the  same  way  to 
^pare  him  from  feeling  he  was  being  stared 
at.  Other  sensations,  such  as  touch  and 
^mell,  were  used  in  communication. 

Due  to  the  location  of  his  tumor  in  the 
pons  area,  he  also  had  other  cranial  nerve 
deficits,  for  example,  loss  of  swallowing 
and  gag  reflex. 

Mr.  Y.  was  aware  that  he  would  eventu- 
j11\  die.  The  nurses  caring  for  him  needed 
5uppon  from  other  members  of  the  team, 
for  he  required  constant  attention  and  did 
noi  want  to  be  left  alone  for  an  instant.  A 
primary  nurse  was  preferable,  to  ensure  a 
tinuity  of  approach  and  the  develop- 

:aNADIAN  nurse  —  September  1975 


ment  of  a  caring,  understanding  relation- 
ship to  help  him  cope  with  his  fear  of 
death. 

His  family  performed  many  of  the  nurs- 
ing measures.  This  satisfied  their  need  for 
involvement  in  his  care  and  supported 
their  family  relationships. 

Mr.  Z:  Diagnosis  —  Meningioma, 

Left  Temporal  Lobe 

(Sphenoid  Wing) 

Specific  Nursing  Management  of  Irritable. 
Irrational  Behavior. 

Mr.  Z.  had  a  3-year  history  of 
headaches,  personality  and  mood 
changes,  memory  and  visual  impairment, 
irritability,  irrational  behavior,  and  confu- 
sion. In  the  course  of  his  3  hospital  stays, 
he  had  2  operations  for  partial  removal  of 
the  meningioma  and  a  course  of  radiation 
therapy. 

His  behavior  was  the  primary  nursing 
problem.  He  became  angry  and  aggres- 
sive, especially  in  response  to  an  au- 
thoritarian manner.  "I  can't  understand 
why  people  don't  like  me  —  maybe  it's  not 
them,  maybe  it's  me."  In  other  words,  he 
realized  his  aggressive  reactions. 

When  a  staff  member  banged  trays  as 
she  was  piling  these  on  a  carrier,  he  went 
to  her  and  yelled  at  her  to  stop.  He  put  up 
his  fist  as  if  to  strike  her.  Looking  at  him, 
the  nurse  said,  with  a  little  smile,  "You 
know  it  might  turn  out  that  I  strike  back. 
You're  strong,  and  a  man,  we  all  know 
that.  Why  do  you  want  to  prove  it?"  This 
mild  form  of  humor  turned  his  attention 
away  from  completing  his  aggressive  ac- 
tion. 

Mr.  Z.  seemed  to  react  well  to  touch. 
When  he  was  aggressive,  the  holding  of 
his  hand  and  asking  him  quietly  and 
gently,  "What  is  the  matter?"  was  more 
effective  than  backing  away  from  him  or 
leaving  him  alone. 

Such  patients  sometimes  wander,  going 
places  where  they  are  not  accepted  or  run- 
ning off  the  ward.  If  Mr.  Z.  was  refused  a 
tripoff  the  ward,  he  would  usually  become 
extremely  aggressive;  but,  when  accom- 
panied, he  made  his  own  decision  to  re- 
turn. 

This  patient  had  a  tumor  that  is  fre- 
quently encapsulated  and  easy  to  remove. 
Due  to  its  location,  size,  and  long  history 


of  growth,  this  was  not  a  success  story, 
however.  He  did  have  a  short  period  at 
home  with  his  wife,  but  entered  hospital 
later  in  a  semi-comatose  state;  he  died 
while  still  in  hospital. 

Ms.   A:    Diagnosis  ^-    Fronto-Parasagittal 
Meningioma. 

Nursing  Management  of  Hemiplegia 

A  meningioma  growing  into  the 
parasagittal  area  of  the  two  cerebral 
hemispheres  produces  the  symptoms  very 
similar  to  those  of  spinal  cord  lesions.  The 
patient  develops  bilateral  or  contralateral 
thigh  and  leg  paralysis  and  sensory  distur- 
bances, depending  on  whether  the  sensory 
or  motor  areas  of  one  or  both  cerebral 
hemispheres  are  involved.*  The  mening- 
ioma is  frequently  accessible  to  surgery, 
and  its  slow  growth  offers  the  possibility 
of  complete  cure  or  long  years  of  success- 
ful living,  in  spite  of  incomplete 
removal.' 

Four  years  ago,  Ms.  A.,  a  right-handed 
woman,  was  awakened  at  night  by  right 
frontal  headaches,  which  persisted.  A  year 
later,  she  fell  in  the  bathtub,  after  which 
she  observed  left-sided  weakness  and  left 
hand  and  arm  numbness.  On  admission, 
her  sensation  was  intact,  but  she  had  a  left 
hemiplegic  gait. 

During  surgery,  a  large  encapsulated 
tumor  was  removed.  Her  nursing  care  in- 
cluded a  great  deal  of  encouragement  to 
use  her  left  side,  and  to  see  that  all  staff 
assisted  her  to  perform  by  herself,  instead 
of  doing  things  for  her.  At  the  time  of  her 
discharge  from  hospital,  Ms.  A.  had  only 
slight  left  leg  weakness. 

Ms.  L:  Diagnosis  —  Medulloblastoma 

Specific  Nursing  Management  of  Projec- 
tile Vomiting  and  Withdrawal 

This  teenager  was  supported  through 
many  months  of  investigation  and  radia- 
tion therapy,  during  which  time  she  had 
episodes  of  projectile  vomiting  that  fre- 
quently amounted  to  more  than  1,000  cc. 
Initially.  Ms.  L.  lost  40  pounds  and  had  to 
be  maintained  on  intravenous  therapy. 

The  medications  Tigan  100  mg  and 
Gravol  50  mg  helped  her  somewhat,  but 
pressure  of  the  tumor  on  the  medulla 
stimulated  this  vomiting,  without  warn- 


ing,  with  extreme  force  through  her  mouth 
and  nose.  Small,  frequent  feedings  of  clear 
fluids  were  also  given  when  they  could  be 
tolerated.  A  nurse  always  stayed  with  Ms. 
L.  to  support  her  head  and  to  attempt  some 
reassurance  in  a  vomiting  episode.  Later, 
hyperalimentation  was  begun,  and  Ms.  L. 
was  fed  a  2,600  caloric  fluid  diet  via  the 
subclavian  vein. 

This  patient  was  aware  that  she  had  a 
malignant  brain  tumor  and  frequently 
asked  for  facts  about  her  progress.  Her 
family  did  not  wish  her  to  know,  and 
wanted  to  make  decisions  for  her.  There 
was  a  period  of  withdrawal,  when  she  did 
not  consult  with  the  staff  or  her  mother. 
Staff  members  found  it  extremely  difficult 
not  to  make  this  conflict  worse  by  ignoring 
her  mother.  Later,  when  the  staff  made 
positive  attempts  to  consult  her  mother, 
Ms.  L.  was  able  to  express  her  feelings  of 
anxiety. 

Does  the  patient  know  the  seriousness 
of  his  condition?  At  what  time  .should  this 
be  discussed  with  him?  How  can  we  dis- 
cuss it  to  allow  hope  that  he  will  be  con- 
tinually supported?  We  are  only  beginning 
to  learn  in  this  area,  and  we  are  conscious 
that  the  patient  is  telling  us  about  his  fear 
of  dying  in  his  own  way. 

When  a  4-year-old,  with  this  same  dis- 
order, can  tell  us  of  the  catastrophic  event 
that  is  happening  to  her  through  a  descrip- 
tion of  her  painting,  we  realize  that  adults 
do  this  as  well  through  verbal  pictures  and 
requests  for  attention.  The  child  says, 
"That  is  a  monster  who  is  going  to  bite  off 
the  little  girl's  head,  and  then  I  cannot  get 
back  into  the  nice  house."  The  adult  says, 
"Do  this  for  me,  nurse,  do  that  for  me, 
nurse."  In  other  words,  "Don't  leave  me, 
I  need  you  to  stand  by." 

Danielle:  Diagnosis  —  Brain  Stem  Glioma 
(Astrocytoma) 

Specific  Nursing  Management  of  Stagger- 
ing Gait  and  Staff  Feelings  of  Inadequacy . 

This  three-and-a-half-year-old  girl  was 
with  us  on  2  admissions  with  the  same 
problems  of  vomiting,  headache, 
lethargy,  and  staggering  gait.  Herunstead- 
iness  made  it  necessary  for  a  nurse  to  be 


with  her  when  up ,  although  she  could  sit  in 
a  chair  when  a  safety  belt  was  in  place  to 
keep  her  from  falling. 

Following  surgery  (a  ventriculo-atrial 
shunt  to  allow  cerebrospinal  fluid  to  pass 
to  the  atrium  of  the  heart)  and  radiation 
therapy,  she  was  able  to  go  home  for  a 
time.  She  and  her  mother  visited  weekly 
when  she  was  eating  and  walking  well  and 
taking  interest  in  her  daily  activities. 

It  is  as  a  tribute  to  her  mother  that  we 
describe  this  child,  for  on  her  second  ad- 
mission Danielle  was  at  ease  with  the  staff 
and  not  frightened,  in  spite  of  her  previous 
hospital  experience.  She  had  only  8 
months  of  improvement  and,  for  the  next  6 
months,  the  parents  and  staff  watched  her 
slowly  die.  Her  mother  came  every  second 
day.  She  said  she  needed  to  spend  alternate 
days  with  Danielle's  sister,  so  that  this 
other  child  would  not  resent  being  left 
alone. 

Sitting  at  her  daughter's  bedside,  she 
read  story  after  story,  with  Danielle  com- 
municating only  by  her  eyes.  Her  mother 
never  cried  with  her  and  was  able  to  talk  to 
the  staff  about  the  death  to  come  and  a 
future  without  her.  This  mother  has  kept  in 
touch  with  us,  and  visited  2  years  later 
with  the  new  brother,  who  will  "never 
quite  take  Danielle's  place." 

Conclusion 

For  all  these  patients,  we  had  to  assess 
the  changes  in  intracranial  pressure  by  ob- 
serving vital  signs. 

Headache  is  a  symptom  we  have  not 
discussed  at  length.  For  our  group  of  pa- 
tients it  was  not  a  major  nursing  problem. 
Perhaps  this  is  because  the  brain  substance 
has  no  feeling.  We  realize  that  pressure  on 
the  meninges  or  blood  vessels  can  cause 
acute  pain.  The  patient  who  holds  his  head 
and  frowns  is  easily  recognized. 

In  our  Grand  Rounds,  we  have  attemp- 
ted to  bring  into  focus  the  multiple  prob- 
lems the  patient  can  present  on  assess- 
ment. We  must  observe  him  for  headache 
and  seizures;  know  how  to  assess  levels  of 
consciousness  and  motor  and  speech  dif- 
ficulties; ascertain  his  basic  personality 
and  if  changes  have  occurred;  and  recog- 
nize  his   important    family   relationship. 


These  are  all  basic  nursing  skills.  Recogn 
tion  of  variations  from  his  baseline  a: 
sessment  helps  to  alert  the  team  to  changt 
in  his  condition,  of  which  the  patient  ma 
or  may  not  be  aware. 

So  many  times  the  words  "brai 
tumor"  immediately  conjure  up  a  feelin 
of  impending  death  and  hopelessness.  Th 
Rounds  demonstrate  that  this  is  not  alway 
so,  particularly  if  the  tumor  symptoms  ai 
recognized  early  and  if  action  is  taker 
Often,  even  if  the  tumor  is  malignant, 
symptom-free  period  can  be  achieved. 

Frequently,  we  talk  of  the  need  to  teac 
patients.  Here  is  a  group  who  are  contini 
ally  helping  «s  to  learn.  The  infinite  var 
ety  of  symptoms,  based  on  the  differenti 
affected  brain  structures,  and  the  searc 
for  ways  to  help  the  patient  overcome  hi 
problems  provide  a  constant  challenge 
Nursing  these  patients  demands  involve 
ment,  but  can  be  rewarding  when  we  d 
become  involved. 

References 

1.  Zulch.  K.J.,  and  Mennel,  H.D.  Thebioh 
of  brain  tumors.  In  Vinken,  P.J.  Handhou 
of  clinical  neurology,  vol.  16:  Tumors  of  th 
brain  and  skull,  Pt.  I.  Edited  by  P.J.  \  ir 
ken  andG.W.  Bruyn.  New  York,  America 
Elsevier,  1974,  p.  59. 

2.  Jennell.  William  Bryan.  An  Introduction  i 
Neurosurgery.  London.  Williai 
Heinemann,  1964,  p.  81. 

3.  Matson.  Donald  D.  Neurosurgery  of  in 
fancy  and  childhood.  2ed.  Springfield,  III.! 
C.C.  Thomas.  1969,  p.  406. 

4.  Vinken.  op.  cit.,  p.  235. 

5.  Ibid.,  p.  247.  | 

6.  de  Guiierrez-Mahoney,  G.G.,  and  Carini 
Esla.  Neurological  and  neurosurgical  nurs  \ 
ing.  3  ed.  St.  Louis,  Mo.,  Mosby.  I960,  p 
398. 

7.  Walton.  John  N.  Essentials  of  Neurolov\ 
2ed.  Toronto.  Isaac  Pitman.  1966.  p.  ^ 

8.  Smith.  Bernard  H.  Principles  of  Clin 
Neurology.  Chicago.  Year  Book  Medic.il 

1965,  p.  103. 

9.  Jennelt,  op.  cit.,  p.  133. 


names 


Dr.  Conrad  Mackenzie  has  been  elected 
chairman,  and  Helen  Taylor,  vice- 
chairman,  of  the  board  of  the  Canadian 
Council  on  Hospital  Accreditation. 

Dr.  Mackenzie,  representing  the 
Canadian  Medical  Association,  is 
chairman  of  the  department  of  general 
practice,  St.  Vincent's  Hospital,  Van- 
couver. 

Helen  Taylor,  representing  the 
Canadian  Nurses'  Association,  is 
vice-president  of  CNA  and  president  ot 
the  Canadian  Nurses'  Foundation. 


E.  Margaret  Bentley  (R.N.,  Royal 
Victoria  Hospital,  Montreal;  Dipl. 
PH.  Dalhousie  University,  Halifax), 
employment  re- 
lations officer 
of  the  Regis- 
tered Nurses' 
Association  of 
Nova  Scotia, 
has  become  a 
,^^^_  member    of    the 

1^4-^^^^L         e.xecutive    com- 
■HLJI^Hlllb.    mittee  of  the  cit- 
izens advisory  committee  to  the 
Halifax  district  office  of  the  Unem- 
ployment Insurance  Commission. 


Barbara  Anne  Sharpe  (R.N.,  St. 
Joseph's  School  of  Nursing,  Glace 
Bay;  B.Sc.N.,  St.  Francis  Xavier  Uni- 
versity, Antigonish,  Nova  Scotia)  has 
been  appointed  assistant  director  of 
nursing  education.  Western  Memorial 
Hospital,  Comer  Brook,  Newfound- 
land. Her  previous  appointments  have 
included  those  of  psychiatric  nursing 
instructor  at  the  Nova  Scotia  Hospital 
in  Dartmouth  and,  later,  at  the  Western 
Memorial  Hospital. 


Maureen  Powers  (R.N.,  St.  Mary's 
Hospital,  Montreal;  B.N.,  McGill 
University,  Montreal)  formerly  pediat- 
ric nursing  supervisor,  Ottawa  General 
Hospital,  has  been  named  the  new  di- 
rector of  nursing  at  the  Children's  Hos- 
pital of  Eastern  Ontario.  She  is  com- 
pleting requirements  for  a  master  of 
education  degree  at  the  University  of 
Ottawa,  Ottawa,  Ontario. 


Shirley  Post  (Reg.N..  Toronto  Hospital 
school  of  nursing;  B.Sc.N. Ed., 
M.H.A.,  University  of  Ottawa)  has  re- 
signed her  position  as  director  of  nurs- 
ing at  the  Children's  Hospital  of  East- 
ern Ontario,  Ottawa. 


Dr.  Isobel  MacLeod  retired  in  January 
1975  as  director  of  nursing  of  the 
Montreal  General  Hospital.  To  recog- 
nize her  service  to  the  hospital  and  nurs- 
ing at  large,  the  Isobel  MacLeod  An- 
nual Lectureship  has  been  instituted. 
The  first  lecture,  a  seminar  on  pain,  is 
planned  for  November  1975. 


Newly-elected  officers  of  the  board  of 
directors  of  the  Manitoba  Association 
of  Registered  Nurses  are: 
2nd  vice-president:  Margaret  McCrady, 
director  of  educational  services,  nurs- 
ing. Health  Services  Centre,  Winnipeg; 
Nursing  sisterhood  representative:  Sis- 
ter Yvette  Aubert,  staff  development 
coordinator,  St.  Anthony's  Hospital, 
The  Pas; 

Members  at  large:  Claudette  Savard, 
permanent  part-time  float  nurse,  St. 
Boniface  General  Hospital,  St. 
Boniface;  Gertrude  Bernard,  instructor, 
diploma  nursing  program.  Red  River 
Community  College;  and  Diane  Letvvln, 
director  of  nursing,  Concordia  Hospi- 
tal, Winnipeg. 


Dr.  Lloyd  Crisdale,  has  been  elected 
president  of  the  Canadian  Medical  As- 
sociation. He  is  associate  dean  of 
medicine  at  the  University  of  Calgary. 


Lynda  M.  Kushnir  (R.N.,  Gray  Nuns 
(Pasqua)  Hospital  school  of  nursing, 
Regina)  has  been  appointed  co- 
ordinator of  coronary  care  and  cardiol- 
ogy. University  of  Saskatchewan's  new 
Regina  office  for  continuing  medical 
and  nursing  education. 

Last  year  she  completed  a  one-year 
diploma  course  in  intensive  and  coro- 
nary care  at  the  Health  Sciences  Centre 
in  Winnipeg.  Manitoba. 


H.D.  Taylor 


Helen  D.  Taylor  (R.N.,  Montreal  Gen- 
eral Hospital  school  of  nursing;  B.N.. 
M.Sc.  (A).  McGill  University)  has 
been  appointed  director  of  nursing.  The 
Montreal  General  Hospital.  She  was 
formerly  director  of  nurses,  Jewish 
General  Hospital,  Montreal. 

Throughout  her  career.  Taylor  has 
been  active  in  professional  organiza- 
tions, having  been  on  the  executive  of 
the  Association  of  Nurses  of  the  Pro- 
vince of  Quebec.  Order  of  Nurses  of 
Quebec.  Canadian  Nurses'  Associa- 
tion. Canadian  Nurses'  Foundation, 
and  the  Association  of  Hospital  Ad- 
ministrators, Province  of  Quebec.  She 
also  represents  the  CNA  on  the  board  of 
directors,  Canadian  Council  on  Hospi- 
tal Accreditation. 


Sister  Eleonore  Chamberlain  (R.N., 
Hotel  Dieu  Hospital  school  of  nursing, 
Bathursi;  B.Sc.N..  University  of  Ot- 
tawa; M.Ed..  University  of  Moncton) 
has  been  appointed  director  of 
Moncton's  "TEcole  d'enseigne- 
ment  infirmier  Providence,"  which 
opened  in  September  1975. 

She  has  done  general  duty  nursing  in 
Bathurst,  Sudbury,  Sault  Ste.  Marie  and 
Lethbridge,  and  was  a  clinical  instruc- 
tor and  assistant  director  at  the  Georges 
Dumont  School  of  Nursing  prior  to  be- 
coming its  director  in  1968.  ^ 


dates 


September  23-25,  1975 

Canadian  Hospital  Association  national 
conference  on  Health  and  the  Law,  to  be 
held  at  the  Chateau  Laurier,  Ottawa.  For 
information,  write:  Canadian  Hospital 
Association,  25  Imperial  Street,  To- 
ronto, Ontario,  MSP  1C1. 

September  24,  1975 

General  annual  meeting  of  the  Corpora- 
tion of  Nurses  of  the  Montreal  District,  to 
be  held  at  7.00  p.m.  at  Champlain  Hall, 
Sheraton  Mount  Royal  Hotel,  Montreal. 
For  information,  contact:  Louise  Tenn, 
Delegate  Secretary,  CNMD,  1600  Berri 
Street,  Montreal,  Quebec  H2L  4E5. 

October  2-3,  1975 

"Medicine  in  Religion"  to  be  presented 
by  the  Catholic  Hospital  Association  of 
Canada  at  the  Hyatt  Regency  Hotel,  To- 
ronto. For  information,  contact:  Catholic 
Hospital  Association  of  Canada,  312 
Daly  Avenue,  Ottawa,  Ontario, 
KIN  6G7. 

October  15-17,  1975 

Canadian  Society  of  Perfusionists  8th 
Annual  meeting  at  Holiday  Inn,  Down- 
town Toronto,  Ontario.  Examinations  for 
certification  (members  only)  to  be  held 
October  14.  For  information,  write: 
Canadian  Society  of  Perfusionists,  399 
Bathurst  Street,  Toronto,  Ontario, 
M5T  2S8. 

October  16-17,  1975 

Annual  Pediatric  Seminar,  sponsored 
by  the  pediatric  nursing  department  of 
the  Calgary  hospitals,  to  be  held  at  Ger- 
trude M.  Hall  Auditorium,  Calgary  Gen- 
eral Hospital.  For  information,  contact: 
Mary  Ann  McLees,  Faculty  of  Nursing, 
University  of  Calgary,  2920  24  Ave. 
N.W.,  Calgary,  Alberta,  T2N   1N4. 

October  17-18,  1975 

Ontario  Nurses'  Association  annual 
meeting  to  be  held  at  the  Constellation 
Hotel,  900  Dixon  Road  (Highways  427 
and  401),  Rexdale,  Ontario. 


October  17-18,  1975 

Scientific  writing  for  nurses  at  the  Fa- 
culty of  Nursing,  University  of  Toronto, 
Toronto.  For  information,  write:  Dorothy 
Brooks,  Chairman,  Continuing  Educa- 
tion Programme,  Faculty  of  Nursing,  U. 
of  T.,  50  St.  George  Street,  Toronto,  On- 
tario, M5S  1A1. 

October  19-22,  1975 

Canada  Safety  Council  annual  confer- 
ence to  be  held  at  Vancouver,  B.C.  For 
information,  write:  Conference  Depart- 
ment, Canada  Safety  Council,  1765  St. 
Laurent  Blvd.  Ottawa,  Ont.  K1G  3V4. 

October  19-24,  1975 

Institute  on  health  care  administration, 
Banff  Springs.  For  information  write:  Al- 
berta Hospital  Association, 
10025-1 08th  Street,  Edmonton,  Alta. 

October  20  -  November  28,  1975 

Refresher  course  for  nonpracticing  reg- 
istered nurses.  Daily  at  Mount  Sinai 
Hospital  and  Faculty  of  Nursing,  Univer- 
sity of  Toronto,  Toronto.  For  information, 
write:  Dorothy  Brooks,  Chairman,  Con- 
tinuing Education  Programme,  Faculty 
of  Nursing,  U.  of  T.,  50  St.  George 
Street,  Toronto,  Ont. 

October  21-25,  1975 

Annual  meeting  and  scientific  session  of 
the  Canadian  Council  of  Cardiovascular 
Nurses  of  the  Canadian  Heart  Founda- 
tion and  the  Canadian  Cardiovascular 
Society  to  be  held  at  the  Queen 
Elizabeth  Hotel,  Montreal.  For  informa- 
tion, write:  Canadian  Heart  Foundation, 
1  Nicholas  Street,  Ottawa,  Ontario, 
KIN  7B7. 

October  23-25,  1975 

National  conference  on  Partnership  Ac- 
tion for  Troubled  People  to  be  held  at 
Hotel  Vancouver,  Vancouver,  B.C.  Dis- 
cussion will  center  around  effective 
models  of  partnership  in  relation  to 
community  care,  citizens'  advocacy, 
and  realistic  partnership.  For  informa- 
tion,   write:    George    Rohn    Mental 


Health/Canada,  21 60  Yonge  Street,  To- 
ronto, Ontario  M4S  2Z3. 

October  26-30,  1975 

28th  annual  scientific  meeting  of  Geron- 
tological Society  with  the  American 
Geriatrics  Society.  Write:  No.  1 ,  Dupont 
Circle,  Washington,  D.C.  20036,  U.S.A. 

November  6-7,  1975 

Enterostomal  Therapy  Seminar:  New 
Dimensions  in  Ostomy  Rehabilitation,  to 
be  held  at  St.  Paul's  Hospital,  Van- 
couver. For  information,  write:  M.  Grant, 
Stoma  Rehabilitation  Clinic,  St.  Paul's 
Hospital,  1081  Burrard  Street,  Van- 
couver, B.C. 

November  20-21,  1975 

Workshop  "What  every  operating  room 
supervisor  should  know "  to  be  held  in 
Regina,  Saskatchewan.  For  informa- 
tion, write:  Norma  J.  Fulton,  Continuing 
Nursing  Education,  University  of  Sas- 
katchewan, Saskatoon,  Sask.,  S7N 
OWO. 

November  24-28,  1975 

International  Congress  of  School  and 
University  Health  and  Medicine  to  be 
held  in  the  Congress  Unit  of  the  National 
Medical  Center,  Mexican  Institute  of  So- 
cial Security,  Mexico  City.  For  informa- 
tion write:  Secretaria  General,  "VII  Con- 
greso  Internacional  de  Higiene  y 
Medicina  Escolar  y  Universitaria, "  Di- 
reccion  General  de  Servicios  M6dicos 
UNAM,  Ciudad  Universitaria,  Mexico 
20,  D.F.,  Mexico. 

December  3-5,  1975 

Alberta  Hospital  Association  annual 
meeting  and  convention,  Edmonton.  For 
information  write:  Alberta  Hospital  As- 
sociation, 10025-1 08th  St.  Edmonton, 
Alta. 

June  21-23,  1976 

Canadian  Nurses'  Association  annual 
meeting  and  convention  to  be  held  at 
Hotel  Nova  Scotian,  Halifax,  Nova 
Scotia.  Theme:  The  Quality  of  Life.   ^ 


li 


What  the  well-bandaged 
patient  should  wean 


Bandafix  is  a  seamless  round 
woven  elastic  "net"  bandage, 
composed  of  spun  latex 
threads  and  twined  cotton 

Bandafix  has  a  maximum  of 
elasticity  (up  to  10-fold)  and 
therefore  makes  a  perfect 
fixation  bandage  that  never 
obstructs  or  causes  local 
pressure  on  the  blood  vessels, 

Bandafix  is  not  air-tight, 
because  it  has  large  meshes ;  it 
causes  no  skin  irritation  even 
when  used  for  the  fixation  of 
greasy  dressings.  The  mate- 
rial is  completely  non-reactive. 


Bandafix  stays  securely  in 
place ;  there  are  eight  sizes 
which  if  used  correctly  will 
provide  an  excellent 
fixation  bandage  for 
every  part  of  the 
body. 


Bandafix  does  not  change  in 
the  presence  of  blood,  pus, 
serum,  urine,  water  or  any 
liquid  met  in  nursing. 

Bandafix  saves  time  when 
applying,  changing  and 
removing  bandages ;  the  same 
bandage  may  be  used  several 
times ;  it  is  washable  and 
may  be  sterilized  in  an 
autoclave. 

Bandafix  is  an  up-to-date 
easy-to-use  bandage  in  line 
with  modern  efficiency. 

Bandafix  replaces  hydrophilic 
gauze  and  adhesive  plaster, 
is  very  quick  to  use  and 
has  many  possibilities  of 
application.  It  is  very  suit- 
able for  places  that  otherwise 
are  difficult  to  bandage. 

Bayidafix  is  economical  in  use, 
not  only  because  of  its  rela- 
tively low  price  but  because 
the  same  bandage  may  be 
used  repeatedly. 


Bandafix  does  not  fray, 
because  every  connection 
between  the  latex  and  cotton 
threads  is  knotted;  openings 
of  any  size  may  be  made  with 
scissors  or  the  fingers. 


Bandafix' 


Distributed  by 


1956  Bourdon  Street.  Montreal.  P.O.  H4M  1V1 


Now  available 

"Ready  to  Use" 
Bandafix 

•  Pre-measured 

•  Pre-cut 

•  14  different  applications 

•  Individually  illustrated 

peel-open  packages 


'Registered  trademark  of  Continental  Pharma. 


THE  CANADIAN  NURSE  —  September  1975 


49 


new  products 


Minidop-fetal  monitor 

The  Medical  Products  Division  of  The 
DeVilbiss  Company  has  developed  the 
610  Minidop,  a  compact  ultrasonic  in- 
strument designed  for  the  early  detec- 
tion and  monitoring  of  fetal  life. 

The  instrument  enables  the  physician 
to:  detect  fetal  life  as  early  as  10  weeks 
post-conception,  monitor  fetal  cardiac 
functions  throughout  pregnancy, 
localize  the  placenta,  and  diagnose  a 
multiple  pregnancy. 

The  battery-powered  Minidop-6 10  is 
safe,  convenient  and  reliable,  and  is 
operated  with  one  hand.  No  ear  plugs, 
probes,  or  power  cords  are  necessary. 


Other  Minidop-6 10  features  include 
a  large,  circular  speaker  to  provide 
tones  with  improved  amplitude  and 
fidelity;  volume  control  that  may  be 
adjusted  when  unit  is  in  operation:  re- 
cessed on-off  button  for  maximum 
comfort  during  operation:  and  an  im- 
proved transducer  assembly  that  is 
acoustically  isolated  to  minimize  audio 
feedback . 

The  Minidop  is  available  in  two 
operating  frequencies:  5  MHz  for 
superior  detection  of  early  fetal  life, 
and  2  MHz  for  precise  monitoring  of 
fetal  heartbeat  during  later  stages  of 
pregnancy. 

For  information,  write:  The  DeVil- 
biss Company,  Medical  Products  Divi- 
sion. Somerset.  Pennsylvania   15501. 


Resusci  intubation  model 

The  new  Resusci  Intubation  model  of- 
fers an  easy  and  complete  training  of 
endotracheal  intubation.  It  details  in 
true-to-life  scale  the  oropharynx,  vocal 
cords,  and  trachea. 

All  touches  of  realism  have  been  in- 
corporated to  provide  an  effective 
teaching  situation  —  natural  flesh  tones, 
a  proportionate  head,  and  simulated 
working  organs. 

The  Resusci  Intubation  model  is 
ideal  for  medical  schools,  hospitals, 
and  colleges.  It  is  available  from  Safety 
Supply  Company,  214  King  Street 
East,  Toronto,  Ontario,  M5A  1J8. 


Diprosone 

Schering  Corporation  Limited  has  re- 
cently developed  Diprosone,  a  cor- 
ticosteroid dermatological  preparation 
in  cream  form.  It  is  available  in  a 
20-gram  tube.  Each  gram  contains: 
0.64  mg  of  betamethasone  dipropion- 
ate  equivalent  to  0.5  mg  of  be- 
tamethasone alcohol  (0.05%).  Topi- 
cally applied,  Diprosone  produces 
anti-inflammatory,  antipruritic,  anti- 
allergic and  vasoconstrictive  effects. 

Diprosone  Cream  is  indicated  in  the 
topical  management  of  corticosteroid- 
responsive  dermatoses,  such  as 
psoriasis,  contact  dermatitis,  atopic 
dermatitis,  neurodermatitis,  intertrigo, 
dyshidrosis,  seborrheic  dermatitis,  ex- 
foliative dermatitis,  solar  dermatitis, 
stasis  dermatitis,  and  anogenital  and 
senile  pruritus. 

For  information,  write:  Schering 
Corporation  Limited,  3535  Trans- 
Canada.  Pointe  Claire,  Que. 
H9R    1B4. 


Sinemet 

Sinemet,  a  new  medication  for 
Parkinson's  syndrome,  has  just  been 
made  available  by  Merck,  Sharp  & 
Dohme  Canada  Limited.  This  medica- 
tion permits  some  patients  to  gradually 
resume  their  physical  activities  within 
weeks  after  it  is  administered. 

The  effectiveness  of  Sinemet  is  attri- 
buted to  the  combination  into  a  single 
product  of  levodopa  and  carbidopa,  the 
carbidopa  component  serving  as  an 
■"escort""  to  guard  the  levodopa  until  it 


reaches  the  brain  where  it  is  needed. 

Further  information  is  available 
from:  Merck,  Sharp  &  Dohme  Canada 
Limited,  P.O.  Box  899,  Pointe  Claire, 
Quebec,  H9R  4P7. 


"lust  for  Kids"  Catalog 

Chick  Orthopedic  has  introduced  a  full 
line  of  "ortho-pediatric"  products  — 
restraints,  slings,  traction  accessories, 
Bradford  Frames  —  designed  exclu- 
sively for  infants  and  children.  Many 


products  feature  colorful  print,  plaid, 
and  solid-colored  materials  for  size- 
coding  purposes,  and  because  children 
like  brightly  colored  apparel.  For  a  free 
catalog.  ""Just  For  Kids,"  write  Chick 
Orthopedic,  821-75th  Ave.,  Oakland, 
Cahf.  94621,  U.S.A. 


Shower  guard 

Chick  Orthopedic's  Shower  Guard,  a 
polyethylene  bag  for  keeping  lower  ex- 
tremity casts  dry  while  showering,  re- 
sembles an  oversized  sandwich  bag. 
The  Shower  Guard  is  secured  above  the 
cast  with  elastic  string  to  form  a  water- 
tight, cast-protecting  seal. 

Packed  in  dozens,  the  reasonably- 
priced  Shower  Guard  is  available  from: 
Chick  Orthopedic,  c/o  J.  Stevens  and 
Son  Co.  Ltd..  2050  Kipling,  Toronto. 
Ontario.  M9W  5M4. 


50 


wheelchair  safety  bar 

A  kit.  designed  to  help  prevent  patients 
from  sliding  and  slumping  in  wheel- 
chairs, has  been  developed  by  the  J.T. 
Posey  Company. 


The  Posey  wheelchair  safety  bar  kit 
tits  all  standard  wheelchairs,  uses  a  soft 
padded  bar  to  stop  the  torso  from  slid- 
ing forward  and  a  shoulder  ""Y""  strap 
■  '  counteract  slumping.  The  safety  bar 

i^  a  catch  mechanism  (which  only  the 
MLirse  knows  how  to  release)  to  prevent 
ihe  patient  from  getting  out  of  the 
\'.heelchair. 

Three  different  models  of  safety  bar 

Jet  the  needs  of  cooperative,  un- 
Mperative.  and  difficult  patients. 

Posey  products  are  stocked  in 
Canada  by  Enns  and  Gilmore  Limited, 
il'33  Rangeview  Road.  Port  Credit, 
Dntario. 


Nonwoven  sterilization  wrap 

Oennison  Wraps  AquaPlus  nonwoven 
^terilizatio^  wraps  have  the  drape  qual- 
ity of  muslin,  which  is  especially  useful 
when  wrapping  odd-shaped  articles. 

The  uniform  porosity  of  these  wraps 
"  rmits  rapid  penetration  of  steam  or 

^.  while  their  low  permeability  af- 
K'rds  protection  against  contaminants. 

Packages  wrapped  in  AquaPlus 
^i.  raps  take  25  percent  less  space  in  the 


sterilizer  than  do  muslin  packs. 

AquaPlus  Dennison  Wraps  are  dis- 
posable and  biodegradable.  They  come 
in  sheets  sized  to  meet  inost  wrapping 
needs.  This  eliminates  time-consuming 
cutting  and  sewing. 

For  more  information,  write:  Dennison 
Manufacturing  Company,  Specialty 
Products  Group,  Industrial  Division, 
Framingham,  Mass.,  01701,  U.S.A. 


Deyerle  hip  prostheses  brochure 

Orthopedic  Equipment  Company  has 
prepared  a  new,  6-page,  2-color 
brochure  on  the  Deyerle  Total  Hip  Joint 
Replacement  with  replaceable  liner.  A 
major  feature  of  this  hip  replacement 
system  is  that  it  does  not  require 
polymethylmethacrylate  bone  cement. 

The  brochure  describes  the  Deyerle 
system's  design  concepts  and  major 
components,  including  femoral  com- 
ponents, hexagonal  lag  screws,  and 
acetabular  components.  It  also  lists  the 
instruments  available  from  the  com- 
pany for  use  with  the  Deyerle  hip  re- 
placement system. 

Brochure  may  be  obtained  from  the 
Orthopedic  Equipment  Company, 
1011  Haultain  Court,  Mississauga, 
Ontario  L4W   IWl. 


Arm  Sling 

The  new  ■"Slinger"  arm  sling  from  Or- 
thopedic Equipment  Company  pro- 
vides comfortable,  effective  immobili- 
zation without  sacrificing  fashionable 
appearance. 

Designed  to  appeal  to  patients  in  all 
age  groups,  '"Slingers"  are  available  in 
3  sizes  (S,M,L)  in  3  styles:  patchwork 
denim,  light  blue,  and  black.  The 
patchwork  denim  "Slinger"  is  of 
heavy-duty,  all-cotton  twill.  The  light 
blue  and  black  "Slingers"  are  made  of 
poly  ester/ cotton. 

The  shoulder  strap  and  thumb  reten- 
tion loop  on  all  3  styles  are  made  of 
1-1/2"  heavy  strap  webbing.  Each  of 
the  3  styles  comes  with  a  metal  slide 
adjustment  in  the  back  and  a  Velcro 
adjustment  closure  in  the  front. 

For  further  information,  contact:  Or- 
thopedic Equipment  Co.,  1011  Haul- 
tain  Court,  Mississauga.  Ontario,  w 


POSEY 

QUALITY 
PRODUCTS 


Posey  Turn  and  Hold  Decubi- 
tus Pad  —  combines  a  turning, 
holding  and  pulling  concept  with 
the  protection  of  a  decubitus  pad. 
Use  to  re-position  patient;  helps 
prevent  slipping  in  bed.  #6325  (24 
X  30)  @  J  70.80 


Posey  Incontinent  Sheath  Holder 

—  holds  condoms  in  place  with 
'A"  polyurethane  foam.  One  size 
fits  all.  Hand  or  machine  washable 
or  disposable.  #6550  @  $13.50 
dozen. 


Posey  Safety  Belt  —  gently  re- 
minds patient  not  to  get  out  of 
bed.  Helps  prevent  thrashing  while 
sleeping,  yet  patient  can  loosen  it 
himself.    #7332   (cotton)    @   58.25. 


Send  your  order  today! 

Enns  and  Gilmore 

U76  Dixie  Road 
Mississauga.  Ontario. 
Canada  L4Y  1ZS 
(416)  274-5171 


-E  CANADIAN  NURSE  —  September  1975 


research  abstracts 


Peever,  Mary  V.  Social  and  psychologi- 
cal factors  influencing  application 
for  admission  to  nursing  homes  in 
the  City  of  Calgary.  Calgary,  Al- 
berta." 1974.  thesis  (M.A. 
[Sociology] )  U.  of  Calgary. 

The  object  of  thi.s  study  was  to  collect 
information  regarding  the  circum- 
stances surrounding  application  for 
nursing  home  care.  The  aim  was  to 
discover  who,  among  the  aged  in  the 
city  of  Calgary,  seek  admission  to  nurs- 
ing homes  when  the  "going  gets 
rough,"  while  others  with  similar 
characteristics  continue  to  live  in  their 
own  homes,  the  homes  of  others,  or  in 
senior  citizens"  residences. 

The  study  focused  on  3  groups  of  50 
individuals  of  65  years  and  over:  those 
who  had  been  admitted  to  nursing 
homes,  those  who  had  applications  on 
file  but  had  not  been  admitted,  and 
those  who  had  never  applied  for  nurs- 
ing home  care.  Six  hypotheses  dealing 
with  propensity  to  apply  for  admission 
to  nursing  homes  were  proposed  and 
tested. 

Data  were  collected  through  per- 
sonal interviews,  using  an  interview 
guide.  Comparisons  between  the  3 
study  groups  were  made  in  terms  of  8 
variables:  incapacity,  income,  know- 
ledge and  use  of  community  resources, 
life  satisfaction,  age,  sex,  marital 
status,  and  number  of  living  children. 
Incapacity  was  then  used  as  a  control  in 
studying  the  other  variables  and  in  test- 
ing the  hypotheses.  A  number  of  other 
phenomena  that  came  to  light  during 
the  course  of  the  investigation  were 
also  discussed. 

The  findings  indicated  that  appli- 
cants for  nursing  home  care  in  the  City  of 
Calgary  in  1971  were  most  commonly 
80  years  of  age  and  over,  and  that  the 
majority  of  both  applicant  and  non- 
applicant  subjects  were  living  on  mar- 
ginal incomes.  The  study  also  showed 
that  knowledge  and  use  of  community 
resources  among  all  subjects  —  but  par- 
ticularly among  those  admitted  to  nurs- 
ing homes  —  was  very  low. 

The  indications  are  that  application 
for,  and  admission  to,  nursing  homes  in 
Calgary  may  be  made  on  the  basis  of 
age,  marital  status,  or  number  of  chil- 


dren, rather  than  functional  ability. 
Disproportionate  numbers  of  the  very 
old,  and  of  those  who  are  widowed  and 
divorced  or  who  have  only  one  child, 
apply  and  are  admitted  to  nursing 
homes  regardless  of  level  of  incapacity . 

Single  persons  who  apply  tend  to 
have  lower  incapacity  scores  than  those 
who  are  married,  widowed,  or  di- 
vorced, though  single  persons  are  not 
over-represented  among  those  who 
have  been  admitted. 

The  most  interesting  of  the  other  ten- 
tative findings  reported  in  the  study  is 
that  14%  of  applicants  who  had,  and 
869(  of  those  who  had  not ,  been  admit- 
ted to  nursing  homes  denied  having 
made  application.  Examples  are  given 
of  the  circumstances  faced  by  elderly 
subjects,  both  in  and  out  of  nursing 
homes,  prior  to  submission  of  an  appli- 
cation. 

The  author  points  to  the  many  dif- 
ficulties encountered  by  the  elderly  in 
their  attempts  to  maintain  their  inde- 
pendence in  the  face  of  illness  or  in- 
capacity. Lack  of  alternatives  to  nurs- 
ing home  care  is  suggested,  and  the 
need  for  increasing  numbers  of  nursing 
home  beds  is  questioned. 

Further  investigation  of  the  circum- 
stances surrounding  application  and 
admission  to  nursing  homes  is  indi- 
cated. 


Robinson,  Harold  C.  Constant  care  and 
the  smaller  Ontario  community  hos- 
pital. Ottawa,  Ont.,  1975.  thesis 
(M.H.A.)  U.  of  Ottawa. 

In  Ontario,  there  are  78  public  general 
hospitals  in  the  50  - 1 99  bed  range .  This 
represents  38  percent  of  the  community 
hospitals  in  the  province.  These  hospi- 
tals provide  the  basic  clinical  services 
of  medicine,  surgery,  obstetrics,  and 
pediatrics,  and  they  are  responsible  for 
the  primary  hospital  care  of  the  com- 
munities they  serve.  They  must  be  pre- 
pared to  provide  intensified  nursing  and 
medical  care,  that  is,  "constant  care."" 
as  the  need  arises. 

It  is  the  purpose  of  this  project  to 
review  all  pertinent  aspects  of  constant 
care  applicable  to  the  smaller  Ontario 
community  hospital.  This  covers  the 


historical  development  of  intensive  or 
constant  care  units,  the  planning  pro- 
cess involved  in  establishing  an  effec- 
tive constant  care  unit,  and  the  factors 
involved  in  operating  and  evaluating  a 
constant  care  unit. 

A  survey  of  5  representative  hospi- 
tals is  included.  This  survey  describes 
the  hospitals  and  how  they  care  tor  pa- 
tients who  require  constant  monitoring 
and  treatment  of  life-threatening  situa- 
tions.' 

The  majority  of  such  patients  are 
cardiac  patients,  but  the  hypothesis  is 
that,  while  there  are  countless  diseases, 
the  mechanism  of  death  is  limited  to  a 
fairly  small  number  of  physiological 
events  that  can  be  influenced. 

This  paper  reviews  the  processes  and 
costs  involved  in  establishing  and 
operating  a  constant  care  unit  in  a  small- 
er Ontario  hospital,  and  compares  the 
costs  and  benefits  associated  with  pro- 
viding intensive  nursing  and  medical 
care  with  and  without  such  a  unit. 

The  facts  outlined  provide  the  infor- 
mation needed  for  a  smaller  hospital  to 
decide  if  it  should  establish  a  constant 
care  unit,  and  if  it  is  feasible  for  it  to 
operate  an  effective  constant  care  unit. 


Wilson,  Beverly  R.  Nursing  needs  of 
families  during  three  stages  of  a 
family  member's  respiratory  illness. 
Toronto,  Ontario,  1975.  Thesis 
(M.Sc.N.)  U.  of  Toronto. 

The  immediate  purpose  of  the  study 
was  to  describe  the  health  problems  of 
families  that  reveal  nursing  needs  when 
a  family  member  is  acutely  ill  in  a  re- 
spiratory intensive  care  unit,  con- 
valescing in  the  hospital,  and  at  home. 
The  ultimate  purpose  was  to  assist  nurs- 
ing staff  in  the  provision  of  comprehen- 
sive nursing  care  and  continuity  of 
care. 

This  descriptive  study  was  con- 
ducted in  the  respiratory  intensive  care 
unit  of  a  large  metropolitan  teaching 
hospital,  on  various  general  care  units, 
and  in  the  home  following  the  patient"s 
discharge. 

The  investigator  collected  data  by 
means  of  participant  observation,  use 
of  the  patient's  hospital  records,  and 


structured  interviews  with  those  family 
members  who  expected  to  assume  the 
major  responsibility  for  the  care  of  the 
patient  at  home. 

Eleven  families  were  interviewed 
when  the  patient  was  in  the  respiratory 
intensive  care  unit  and  on  a  general  care 
unit.  Three  patients  died  on  general 
care  units.  Eight  families  were  inter- 
viewed approximately  2  weeks  follow- 
ing the  patient's  discharge  from  hospi- 
tal. 

The  Freeman  Family  Coping  Index 
was  adapted  for  use  in  this  study.  The 
family's  coping  abilities  during  the  3 
stages  of  the  patient's  illness  were  re- 
corded on  a  scale,  from  1  to  5,  for  each 
of  the  9  categories  of  the  Index.  The 
coping  abilities  of  the  total  sample  of 
families  were  determined  for  each  of 
the  3  stages. 

The  findings  were  examined  to  de- 
termine whether  the  provision  of  nurs- 
ing service  could  have  assisted  the 
families  when  their  coping  abilities 
were  poor. 

The  needs  of  the  family  members 
\aried  according  to  the  stage  of  illness 
of  the  patient.  In  all  3  stages,  over  half 
the  families  had  needs  related  to 
therapeutic  independence  and  the  use 
of  community  resources.  In  the 
patient's  convalescent  stage  in  hospi- 
tal, over  half  the  families  also  had 
needs  related  to  physical  independence 
and  the  physical  environment. 

In  both  the  convalescent  stage  in 
hospital  and  at  home,  over  half  the 
families  had  needs  related  to  know- 
ledge of  the  patient's  condition  and  the 
application  of  the  principles  of  personal 
hygiene.  Six  of  the  8  families  had  nega- 
tive attitudes  in  relation  to  health  care, 
following  the  patient's  discharge  from 
hospital. 

Implications  are  stated  for  nursing 
practice,  nursing  education,  and  further 
research.  Generalizations  are  limited 
by  the  size  and  nature  of  the  sample. 
The  study  indicates  that  family  coping 
abilities  are  influenced  by  many  fac- 
tors. 

There  is  need  to  identify  the  prob- 
lems that  families  experience  in  coping 
with  illness.  This  would  permit  iden- 
tification and  provision  of  appropriate 
nursing  interventions.  '■'!' 


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books 


Planning  and  Implementing  Nursing  In- 
terventions by  Dolores  F.  Saxlon 
and  Patricia  A.  Hyland.  190  pages. 
St.  Louis.  Mosby  1975. 
Reviewed  by  Helen  L.  Shore.  Assis- 
tant Professor,  School  of  Nursing, 
University  of  British  Columbia, 
Vancouver,  B.C. 

The  purpose  of  the  book  is  "to  assist 
the  student  in  the  planning  and  im- 
plementation of  nursing  interventions 
based  on  a  recognition  of  the  patient's 
physiological  and  psychological  adap- 
tations to  stress."  Part  1  of  the  book 
presents  the  theoretical  concepts  and 
develops  the  problem-solving  ap- 
proach, and  Part  11  shows  application  of 
these  concepts  to  patient  care  situa- 
tions. 

Man  is  seen  as  an  organism  with 
specific  inherited  traits  and  an  innate, 
though  limited,  capacity  to  adapt. 
Stress  is  defined  as  "any  factor  or  fac- 
tors that  require  some  response  or  re- 
sults in  some  change  within  an  indi- 
vidual." Adaptation  is  "the  anatomi- 
cal, physiological  or  psychological  re- 
spon.ses  or  changes  in  an  individual  that 
occur  as  a  reaction  to  stress."  Five 
levels  of  adaptation  have  been  iden- 
tified. The  levels  of  adaptation  are  used 
as  a  guide  for  assessment  and  the  de- 
velopment of  a  plan  for  nursing  inter- 
vention. 

Nursing  intervention  is  defined  as 
"those  actions  undertaken  by  the  nurse 
that  are  directed  toward  preventing, 
limiting,  or  reducing  stress  and  sup- 
porting, altering,  limiting,  interrupt- 
ing, or  supplementing  adaptation." 
Five  objectives  for  nursing  intervention 
are  related  to  the  individual's  level  of 
adaptation.  This  relationship  is  used  to 
develop  a  plan  of  care  that  includes 
both  independent  nursing  actions  and 
doctor's  orders. 

In  determining  whether  the  purpose 
of  the  book  has  been  achieved,  the 
reader  must  return  to  the  theoretical 
framework  outlined  and  apply  it  to  pa- 
tient care  situations.  Although  the  great- 
er promotion  of  the  book  provides  il- 
lustrations of  patient  situations,  this  re- 
viewer found  difficulty  in  applying  the" 
theoretical  framework.  The  difficulty 
arose  from  these  basic  areas:  The  gen- 
erality at  which  the  concepts  were  pre- 


sented; the  lack  of  elaboration  about  the 
nature  of  man;  the  inclusion  in  each 
level  of  adaptation  of  cellular,  tissue, 
and  organic  components,  and  also  sys- 
temic and  emotional  components, 
which  leads  to  the  failure  to  distinguish 
between  independent  nursing  actions 
and  shared  and  delegated  respon- 
sibilities for  patient  care. 

The  authors  slate  their  belief  that 
nursing  intervention  should  be  based  on 
the  patient's  nursing  needs  as  diag- 
nosed by  the  nurse,  rather  than  on  the 
medical  diagnosis.  Nurses  need  clear 
direction  about  the  baseline  data  that 
must  be  collected  to  identify  patient 
problems  requiring  independent  nurs- 
ing intervention  if  this  belief  is  to  be 
realized. 

The  authors  deserve  recognition  for 
their  commitment  to  the  development 
of  a  conceptual  framework  and  for  the 
emphasis  that  they  give  to  the 
problem-solving  approach.  Their  book 
will  be  useful  to  nursing  faculty  and 
students  using  an  adaptation 
framework  or  to  those  who  are  studying 
various  conceptual  frameworks  for 
nursing. 


Dynamic  Anatomy  and  Physiology  by 

Ben  Pansky.  684  pages.  New  York, 
Macmiilan,  1975. 

Reviewed  by  Jean  Trenchard,  Night- 
ingale Campus,  The  George  Brown 
College.  Toronto,  Ontario. 

The  aim  of  this  book,  as  indicated  by  its 
title,  is  to  present  a  description  of  body 
structure  and  function  with  emphasis 
on  its  dynamic  nature.  This  is  achieved 
by  presenting  facts  and  concepts  about 
cells,  tissues,  and  organs,  with  a  de- 
scription of  their  interaction  to  maintain 
life. 

The  organization  of  the  material  is 
excellent.  Information  is  given  under 
units  dealing  with  major  concepts  — 
the  body ,  the  body  framework ,  external 
and  internal  integration,  the  life  cycle 
—  and  is  completed  with  a  final  unit  on 
development  and  aging.  More  on  de- 
velopment and  aging  could  have  been 
included. 

A  lengthy  description  of  the  cell  is 
necessary  for  this  organization  of  con- 
tent. This  makes  the  book  difficult  for 


students  at  the  diploma  level,  who  tend 
to  want  to  get  to  the  more  specific  sys- 
tems before  they  appreciate  the  more 
general  topics. 

Many  of  the  illustrations  are  new  and 
are  excellent  in  simplifying  the  written 
text;  however,  they  tend  to  be  small  and 
are  somewhat  cluttered  by  placing  them 
too  close  together.  The  print  used  is 
smaller  than  some  other  textbooks  on 
this  subject.  The  overall  impression  of 
the  book's  set-up  is  good  in  spite  of  the 
above. 

Review  questions  that  ask  for  recall 
and  correlation  of  pertinent  information 
are  listed  at  the  end  of  each  chapter,  as 
well  as  a  bibliography. 

This  is  an  excellent  and  up-to-date 
book  that  should  be  in  the  library,  but 
diploma-level  nursing  students  would 
find  it  more  difficult  than  most  pres- 
ently used  texts. 

The  Complete  Book  of  Breast  Care  by 

Robert  E.  Rothenberg.  244  pages. 
New  York,  Crown  Publishers, 
1975.  Canadian  Agent:  Don  Mills, 
Ont.,  General  Publishing  Company. 
Reviewed  by  Lois  A.  McElheran. 
Teacher,  Number  College,  Quo 
Vadis  Campus,  Toronto,  Ontario. 

This  book  is  written  in  a  clear,  concise 
manner  that  should  be  easily  read  and 
understood  by  the  lay  person ,  for  whom 
it  was  written.  It  should  also  be  helpful 
to  the  student  nurse  or  registered  nurse . 
The  book  has  numerous  descriptive  il- 
lustrations to  clarify  the  information 
provided. 

The  3 1  .short  chapters  encompass  the 
anatomy  and  physiology  of  the  female 
breast;  normal  breast  development 
from  infancy  to  the  menopause;  pre- 
gnancy and  the  breast,  including  breast 
feeding;  the  relationship  of  hormones 
on  the  breast;  benign  and  malignant 
diseases  of  the  breast;  and  breast 
surgery,  including  the  removal  of 
growths  and/or  breast,  and  plastic 
surgery.  There  is  also  a  chapter  on  the 
male  breast.  As  the  end  of  each  chapter 
there  is  a  question  and  answer  section 
that  tends  to  review  and  expand  the 
chapter  content.  For  example,  in  the 
chapter  on  pregnancy  and  the  breast  it 

(Continued  on  page  56} 


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72960.  PSYCHOTROPIC  DRUGS:  A  Manual  lor 
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Kline.  M.D.  For  trigger-quick  recognition  of  symp- 
toms, immediate  remedial  measures  and  total  care. 
Charts  and  photos  lor  fast  drug  recognition,       S12.95 

55820.  INTENSIVE  AND  REHABILITATIVE  RES- 
PIRATORY CARE.  2nd  Edition.  Thomas  L  Petty. 
M  D .  et  al.  Wonderfully  explicit  workbinik  on  res- 
piratory care.  SI3.50 


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(Continued  from  page  54) 


stales  that  massaging  the  breasts  does 
not  benefit  inverted  nipples.  The  state- 
ment is  then  expanded  in  this  question 
and  answer  section,  clearly  defining 
what  may  and  may  not  be  beneficial  for 
inverted  nipples. 

The  section  on  the  care  of  the  healthy 
breasts  and  the  use  of  the  brassiere  is 
informative  and  gives  a  helpful  expla- 
nation of  how  to  measure  for  a  pruper 
fitting  bra.  There  is  also  a  comprehen- 
sive explanation  given  of  self- 
examination  of  the  breasts,  including 
illustrations. 

Dr.  Rothenberg  stresses  the  impor- 
tance of  regular  self-examination  of  the 
breasts  and  regular  physical  examina- 
tions at  the  physician's  office.  He  gives 
clear  descriptions  and  the  merits  of  the 
various  diagnostic  tests  used  at  the  pre- 
sent time  for  disease  of  the  breasts. 

There  is  definitive  information  from 
which  the  lay  person  would  benefit, 
regarding  pre  and  postoperative  care  in 
all  aspects  of  breast  surgery,  including 
a  detailed  description  of  anesthetics 
used  and  reasons  for  their  use. 

Where  the  book  seems  to  be  most 
helpful,  especially  for  the  student  nurse 
or  registered  nurse,  is  in  the  area  of 
postoperative  expectations  of  the  pa- 
tient in  the  rehabilitative  phase  of  re- 
covery in  relation  to  pain,  wound  heal- 
ing, and  activity.  The  psychological 
aspects  of  the  rehabilitating  patient  and 
the  reactions  of  the  family  are  also  dis- 
cussed. Some  of  these  aspects  are  not 
found  in  a  clinical  textbook,  but  defi- 
nitely play  a  major  part  in  the  recovery 
of  the  patient. 

Therefore,  this  book  would  be  ex- 
tremely useful  for  the  lay  person,  espe- 
cially the  person  who  has  just  disco- 
vered a  breast  lump  and  needs  to  un- 
dergo further  tests  and  possible 
surgery.  It  could  also  be  an  excellent 
resource  book  for  the  student  or  regis- 
tered nurse  who  wishes  to  do  additional 
reading  in  this  area  of  disease. 

Nursing  Assessment  and  Health  Promo- 
tion through  the  Life  Span  by  Ruth 
Murray  and  Judith  Zentner.  354 
pages.  Englewood  Cliffs,  N.J., 
Prentice-Hall,  1975. 
Reviewed  by  Maggie  Smith,  Assis- 
tant Professor.  School  of  Nursing, 
University  of  British  Columbia, 
Vancouver,  B.C. 

This  book  is  designed  for  use  by  the 
beginning  practitioner  for  an  under- 
standing of  the  many  psychological  and 


physiological  adaptations  that  an  indi- 
vidual undergoes  throughout  his  life 
span.  Nursing  interventions  to  assist 
the  individual  to  either  avoid  potential 
problems  or  to  cope  with  actual  prob- 
lems is  an  excellent  contribution  of  this 
book  to  nursing  practice. 

The  1st  half  of  this  book  identifies  the 
developmental  tasks,  the  characteristic 
behaviours,  the  potential  problems  of 
children,  and  the  range  of  healthy 
adaptations  to  the  developmental  tasks. 
The  latter  half  of  the  book  deals  with 
adults,  their  developmental  tasks,  and 
potential  problems.  The  theories  of 
Freud,  Erikson,  Havighurst,  and  many 
others  are  integrated  throughout  the 
book. 

The  author  clearly  indicates  that  ad- 
ditional reading  is  required  in  the  area 
of  the  physical  assessment  of  an  indi- 
vidual throughout  his  life  span. 

Among  the  outstanding  features  of 
this  book  are  the  objectives,  at  the  be- 
ginning of  each  chapter,  clearly  indicat- 
ing the  direction  of  the  content.  There 
are  also  excellent  tables  throughout  the 
book  that  succinctly  summarize  the  sa- 
lient points  of  a  particular  chapter.  For 
example,  the  table  on  pg.  43  sum- 
marizes the  normal  behaviour  of  the 
infant,  the  possible  danger  arising  from 
his  coping  behaviours,  and  the  neces- 
sary precautions  required  to  avoid  prob- 
lems. 

The  book  also  deals  with  the  child's 
concept  of  sexuality.  Examples  are 
given  of  methods  which  parents  and 
profes,\ionals   might   use  to  answer 


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children's  questions  regarding  sexual 
differences  that  would  positively  affect 
the  child's  self  concept. 

The  chapters  on  the  middle-aged  and 
older  adult  present  a  very  complete  and 
positive  picture  of  these  age  groups. 
Lastly,  the  presentation  of  both  the 
child  and  adult's  view  of  death  removes 
much  of  the  fear  from  this  subject  area. 
This  section  portrays  a  factual  picture 
of  the  individual's  concept  of  death, 
and  equally  important,  the  nursing  in- 
terventions that  would  assist  the  mdi- 
vidual  to  meet  this  last  developmental 
task. 

In  summary,  this  text  presents  a 
comprehensive  data  base  for  each  of  the 
major  age  groups.  Highlighted 
throughout  the  book  are  the  major 
forces  influencing  the  individual's 
adaptations.  Nursing  interventions  for 
the  promotion  of  health  of  the  differing 
age  groups  are  clearly  described. 
Therefore,  I  feel  this  would  be  a  useful 
text  for  nursing  students  and  nursing 
practitioners. 


Comprehensive    Pediatric    Nursing    by 

Gladys  M.  Scipien,  Martha  Under- 
wood Bernard,  Marilyn  A.  Chard, 
Jeanne  Howe,  and  Patricia  J.  Phil- 
lips. 975  pages.  New  York, 
McGraw-Hill,  1975.  Canadian 
Agent:  McGraw-Hill  Ryerson, 
Scarborough,  Ont. 
Reviewed  by  Noreen  O'Brien, 
School  of  Nursing,  University  of 
British  Columbia,  Vancouver,  B.C. 

The  exfjerience  and  skill  of  many  au- 
thors have  been  brought  together  in  this 
text  for  the  purpose  of  providing 
".  .  .students,  practitioners,  and 
educators,"  with  a  comprehensive  vol- 
ume of  pediatric  knowledge.  The  book 
is  an  attempt  to  "integrate,  discuss,  and 
apply"  the  concepts  of  growth  and  de- 
velopment, and  normal  and  pathologi- 
cal pediatric  problems.  The  nursing 
process  is  viewed  as  it  applies  to  the 
care  of  children. 

As  with  any  text  that  seeks  to  handle 
a  wide  variety  of  topics  with  a  com- 
prehensive approach,  depth  in  most 
areas  is  somewhat  limited.  What  is  ad- 
vantageous in  this  multi-authored  ap- 
proach is  the  abundance  of  pertinent 
and  current  information  that  is  contri- 
buted by  specialists  from  many  discip- 
lines. Unlike  other  works  of  this  nature 
with  numerous  contributors,  the  editors 
of  Comprehensive  Pediatric  Nursing 


have  achieved  a  blending  of  styles  and 
objectives  to  produce  a  smooth,  flow- 
ing manuscript. 

The  technical  aspects  of  the  book  are 
appreciated  for  the  excellent  and  cur- 
rent references  and  bibliographies  at 
the  end  of  each  chapter,  for  the  accurate 
and  cross-referenced  index,  and  for  the 
clearly  delineated  titles  and  subhead- 
ings within  each  chapter. 

Speaking  to  the  content  of  the  book, 
one  finds  an  interdisciplinary  approach 
to  pediatric  nursing,  coupled  with  a 
strong  emphasis  on  the  nursing  pro- 
cess. The  text  is  divided  into  5  sections, 
with  the  first  part  being  completely  de- 
voted to  the  nursing  process,  with  em- 
phasis on  assessment.  Intervention  is 
stressed  in  parts  3  and  4,  which  deal 
with  illness,  hospitalization,  and 
pathophysiology  as  it  affects  the  grow- 
ing child  and  his  family. 

The  chapters  handling  topics  such  as 
mental  retardation,  cultural  influences 
on  development,  the  high-risk  infant, 
and  the  dying  child  have  long  needed 
the  special  attention  and  greater  depth 
that  they  are  awarded  here.  The  ter- 
minology, concepts,  and  interventions 
discussed  are  current  and  at  times  con- 
troversial, but  designed  to  stimulate 
high-level  pediatric  nursing  practice. 

In  general,  I  would  have  to  say  that 
this  is  a  very  good  text,  with  limited 
depth  and  comprehensive  scope  that 
would  be  most  useful  to  nurses  with 
some  basic  pediatric  background. 


Basic  Pediatrics  for  the  Primary  Health 
Care  Provider,  by  Catherine 
DeAngelis.  397  pages.  Boston.  Lit- 
tle, Brown  and  Co.,  1975. 
Reviewed  by  Carolyn  Roberts,  Fa- 
culty of  Nursing,  The  University  of 
Western  Ontario,  London,  Ontario. 

The  key  word  in  the  title  of  this  book  is 
" Provider.  ■■  The  author  attempts  to 
address  a  range  of  primary  health  care 
workers  with  a  wide  variance  in  health 
education,  ranging  from  a  four  month 
physician's  assistant  training  program 
right  through  to  the  postgraduate 
level.  Within  the  context  of  clinics  and 
private  medical  practices,  the  provider 
is  seen  as  the  person  on  the  health  team 
who  does  the  initial  assessment,  health 
teaching,  treats  minor  ailments,  and 
facilitates  the  child's  and  family's  cop- 
ing. The  text  is  intended  "to  impart 
specific,  pertinent  knowledge  carefully 
selected  from  the  broad  field  of  pediat- 


rics." This  reviewer  perceives  the 
breadth  of  audience  coupled  with  the 
selectivity  of  the  content  as  distinct  dis- 
advantages of  the  book. 

The  depth  and  range  of  the  content  is 
very  uneven.  For  example,  the  method 
for  collection  and  analysis  of  a  mid- 


stream urine,  including  culture  and 
microscopic  examination,  is  discussed 
in  a  detailed  procedural  format,  as  is  the 
collection  of  blood  for  a  hematocrit, 
and  the  procedure  of  determining  this 
blood    value.    However,    the    author 

(Continued  on  page  58) 


Get  what  youVe 

always  wanted 

from  nursing 


Like  a  wealth  of  professional  experience 
to  enrich  your  career. 


Nursing  has  a  lot  to  offer  Remember? 
But  sometimes  you  can  get  so  stuck  in 
a  rut  you  almost  forget  those  exciting 
challenges  that  made  you  choose  a 
nursing  career  in  the  first  place 

With  Medox.  you  can  revive  those 
challenges. 

Since  Medox  serves  almost  the 
entire  spectrum  of  nursing  services, 
you  can  get  more  variety  of 


assignments  in  a  month  than  you 
could  in  a  year  back  in  that 
comfortable  rut.  Operating  room. 
Intensive  Care.  Cardiac  Unit.  Pediatric 
care. 

There's  more  to  nursing  than 
punching  a  time  clock. 

With  Medox.  there  can  be  a  lot 
more. 


a  DRAKE  INTERNATIONAL  company 
CANIACA  •  USA  •  UK  •  AUSTRALIA 


THE  CANADIAN  NURSE  —  Seplemoer  1975 


57 


Next  Month 
in 

The 

Canadian 
Nurse 


Artificial  Urinary  Sphincter 


•   Home  Delivery  —  Dutch  Style 


•   Reawakening  Senses 
in  the  Elderly 


•   A  Young  Pregnant  Girl 
Tells  Her  Story 


•   Psychiatric  Management 
of  the  Deaf  Child 


•  Frankly  Speaking: 
About  Nursing  Practice 


•   Non-Accidental  Trauma 
In  Children:  Some  Guidelines 


^^P 


books 


states:  "The  method  for  performing  a 
hemoglobin  test  is  much  more  complex 
(than  hematocrit),  but  is  performed 
routinely  in  most  clinic  laboratories. 
The  procedure  will  not  be  discussed 
here." 

Some  important  pediatric  problems 
such  as  dehydration  are  inadequately 
covered  for  the  purpose  of  assessment 
and  referral.  Skin  turgor  and  hemato- 
crit are  the  only  assessment  indices 
suggested  for  this  particular  problem. 
However,  part  of  a  table  relative  to  nut- 
rition carries  more  of  the  symptomatol- 
ogy. This  source  is  not  indexed,  nor  are 
degrees  of  dehydration  offered.  The 
section  on  common  pediatric  accidents 
speaks  to  prevention  but  is  wholly  in- 
adequate as  a  resource  for  assessment, 
counseling  or  treatment,  notably  in  an 
emergency.  By  contrast,  the  manage- 
ment of  anaphylaxis  is  detailed  and  in- 
clusive of  the  injection  of  a  specified 
dose  of  epinephrine  into  the  sublingual 
mucosa.  Anaphylaxis  is  discussed 
under  "Bites"  in  the  chapter  entitled 
"Skin,"  but  not  in  the  section  on 
"Therapy." 

Canadian  readers  may  find  two 
further  drawbacks  in  using  the  book. 
One  of  the  strongest  chapters  is  on  im- 
munization, but  the  author  identifies 
and  advocates  the  prevailing  American 
philosophy  in  this  field  which  is,  in 
part,  at  variance  with  the  prevailing 
Canadian  philosophy.  Secondly,  where 
relevant,  tables  and  charts  include 
measures  in  the  metric  system.  How- 
ever, the  text  slips  back  and  forth  bet- 
ween the  imperial  and  metric  systems, 
notably  in  the  chapter  on  nutrition. 

The  book  has  a  number  of  strengths. 
The  discussion  on  the  assessment  inter- 
view and  systematic  physical  assess- 
ment is  very  good.  The  author  includes 
a  succinct,  cogent  section  on  problem- 
oriented  medical  records.  Half  of  the 
book  deals  with  minor  ailments.  Their 
presentation  adheres  to  the  medical 
model  with  two  important  inclusions: 
when  to  treat  and  when  to  refer;  coun- 
seling and  teaching  tips.  The  content 
speaks  more  strongly  to  the  "how"  of 
practice  than  to  the  " '  why"  and  does  so 
in  simple,  concrete  language. 

By  far  the  greatest  strength  of  this 
book  lies  in  the  attitudinal  set  of  the 
author.  Through  humor,  analogies  and 
adages,  a  warm  disposition  toward 
children  and  parents  is  consistently 
conveyed.  The  author  adheres  to  the 
premise  that  parents  are  doing  the  best 
they  can,  given  what  they  have.  It  is 


marvellously  refreshing  to  experience 
this  kind  of  sensitivity  in  this  kind  of 
book.  On  this  basis  in  particular,  this 
book  is  recommended  as  an  adjunct  to 
standard  pediatric  and  reference  texts. 


Human  Sexuality:  a  Health  Practitioner's 
Text  edited  by  Richard  Green  M.D. 
251  pages.  Bahimore,  The  Williams 
and  Wilkins  Company,  1975.  Cana- 
dian Agent:  Don  Mills,  Ont. ,  Burns 
and  MacEachem  Ltd. 
Reviewed  by  Sharon  K.  Turnbull, 
Director,  Continuing  Nursing  Edu- 
cation, The  University  of  British 
Columbia,  Vancouver,  B.C. 

Do  not  be  misled  by  the  title.  Human 
Sexuality: a  Health  Practitioner's  Text 
is  not  a  text,  and  the  editor  in  the  pre- 
face further  specifies  that  the  health 
practitioner  for  which  the  book  is  in- 
tended is  a  "medical  student." 

This  book  of  assorted  readings  could 
in  no  way  be  assumed  to  approach  the 
criteria  of  comprehensiveness  or  depth. 
While  devoting  considerable  attention 
to  relatively  uncommon  aspects  of  sex- 
uality, the  most  commonly  presenting 
concerns  are  mentioned  in  passing,  and 
are,  therefore,  virtually  neglected. 
While  this  may  negate  the  usefulness  of 
the  book  as  a  text  for  the  health  prac- 
titioner, it  does  not  detract  from  its 
value  as  reference  material. 

In  general.  Human  Sexuality:  a 
Health  Practitioner's  Text,  fails  to  ac- 
complish its  purpose  —  to  help  the 
health  practitioner  fulfill  his  helping 
role  in  the  area  of  sexual  adjustment. 
To  achieve  this  purpose  it  is  necessary 
to  provide  the  reader  with  three  things; 
accurate  information  about  human  sex- 
ual behavior,  a  tolerant  attitude  toward 
human  sexuality,  and  technique  (s)  for 
modifying  maladaptive  sexual  be- 
havior. Human  Sexuality:  a  Health 
Practitioner's  Text  touches  on  each  of 
these,  but  fails  to  accomplish  any 
purpose. 

One  of  the  strongest  contributions  is 
a  personal  account,  written  by  a 
homosexual  physician,  which  moves 
the  reader  toward  greater  understand- 
ing and  tolerance  of  the  homosexual  in 
our  society. 

At  its  weakest.  Human  Sexuality:  a 
Health  Practitioner's  Text  provides  the 
reader  with  a  stilted  approach  to  a  sex- 
ual assessment  interview  that  could  be 
predicted  to  send  patients  running  for 
the  latest  paperbacks  for  sexual  advice. 


The  contribution  dealing  with  the  pel- 
vic examination  provides  a  sample  of  a 
sensitive  approach  to  humanizing  pa- 
tient care,  but  unfortunately  is  an  iso- 
lated attempt  to  address  the  larger  con- 
cern of  the  woman  as  a  patient. 

This  book  contains  a  wealth  of  valu- 
able information.  The  readings  con- 
cerned with  sex  and  the  mentally  re- 
tarded, the  spinal  cord  injured,  the  car- 
diac patient,  and  the  pregnant  or  post- 
partum woman  provide  a  useful  synth- 
esis of  the  literature  in  these  areas. 
Other  readings,  including  those  on  sex 
II  change  procedures  and  the  infant  with 
ambiguous  genitalia,  offer  the  non- 
medical practitioner  an  understanding 
of  why  certain  ""  medical""  decisions  are 
made. 

Unfortunately  Human  Se.xiialin:  a 
Health  Practitioner's  Text  does  not  ad- 
dress in  depth  the  most  pressing  con- 
cerns of  the  health  practitioner  or  his 
patients. 

The  need  for  a  text  to  address  such 
questions  is  paramount.  Most  of  us 
have  considerable  learning  in  the  area 
of  sexuality  —  integrated  at  levels  from 
the  confused  to  the  sophisticated.  Until 
recently  we  could  be  excused  for  not 
being  informed,  for  there  was  little 
knowledge  about  sexual  behavior,  its 
range,  its  appetites,  and  its  idiosyn- 
crasies. Those  of  us  who  keep  sifting 
through  the  vast  literature,  integrating 
it  as  we  can,  still  await  the  publication 
of  the  first  real  text  on  human  sexuality. 


Political  Dynamics;  Impact  on  Nurses 
and  Nursing  by  Grace  L.  De- 
loughery  and  Kristine  M.  Gebbie. 
236  pages.  St.  Louis,  The  C.V. 
Mosby  Co.,  1975. 
Reviewed  by  Audrey  DeBlock,  As- 
sistant Professor,  College  of  Nurs- 
ing. University  of  Saskatchewan. 
Saskatoon,  Sask. 

Political  Dynamics  presents  a 
framework,  if  applied,  could  enable  a 
nurse  to  be  more  effective  in  political 
decision  making.  This  framework, 
based  on  theory,  is  of  timely  concern, 
and  the  reader  can  readily  see  that  nurs- 
ing and  politics  do  mix. 

The  first  8  chapters  stress  that  health 
issues  and  nursing  should  not  be  view- 
ed in  isolation,  but  as  an  integral  part 
of  the  political  system  and  life  within 
the  system.  Although  the  emphasis  is 
on  United  States  history,  roles,  and  re- 
lationships, some  of  the  data  and  issues 


presented  have  universal  applicability. 

The  emphasis  placed  on  United 
States  history  may  be  a  deterring  factor 
to  some  readers  despite  the  basic  intrin- 
sic message  it  offers.  Possible  connota- 
tions for  the  words  "'profession,  pro- 
fessional, and  professionalize"'  are 
well  presented  in  chapter  9,  as  is  the 
socialization  process  in  nursing. 

The  remainder  of  the  book  is  the 
"meat  of  the  matter."'  It  proposes  that 
nurses  and  nursing  have  a  societal 
mandate  to  be  involved  in  political  ac- 
tivities, particularly  when  they  concern 
meeting  society's  need  for  health  and 
health  care.  Involvement  would  in- 
clude the  following:  change,  ap- 
proaches to  change,  how  to  state  prob- 
lems, how  to  select  a  course  of  action, 
respect  for  the  rights  and  opinions  of 
self  and  others,  and  risk  factors. 

This  book  would  be  of  value  to 
nurses  individually  and  collectively. 
Health  systems  are  constantly  changing 
and  now  the  authors  are  challenging 
nurses  of  today  to  move  beyond  the 
stages  of  "awareness  of"  and  "know- 
ledge of"  the  intricacies  of  the  political 
world. 

In  the  words  of  the  authors,  each 
nurse  should  be  prepared  to  say,  "This 
is  where  I  am"  (this  is  my  position)  in 
regard  to  every  health  issue.  Then,  the 
next  step  of  behavioral  change  and  use- 
ful political  action  would  be  seen  as 
very  real  and  very  important  to  nurses 
and  nursing.  Action  should  follow. 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses'  Association  Library 
are  available  on  loan  —  with  the  excep- 
tion of  items  marked  R  —  to  CNA  mem- 
bers, schools  of  nursing,  and  other  in- 
stitutions. Items  marked  R  include  re- 
ference and  archive  material  that  does 
not  go  out  on  loan.  Theses,  also  R,  are 
on  Reserve  and  go  out  on  Interlibrary 
Loan  only. 

Requests  for  loans,  maximum  3  at  a 
time,  should  be  made  on  a  standard 
Interlibrary  Loan  form  or  on  the  "Re- 
quest Form  for  Accession  List"  printed 
in  this  issue. 

If  you  wish  to  purchase  a  book,  con- 
tact your  local  bookstore  or  the  pub- 
lisher. 

(Continued  on  page  60) 


'^ 


When  you  are 
asked  about 
nursing  care... 

Health  Care  Services  Upjohn 
Limited  can  assist  you  and 
your  patients  by  providing 
qualified  Health  Care  Person- 
nel for; 

•  Private  Duty  Nursing 

•  Home  Health  Care 

•  Staff  Relief 

We  are  a  reliable  source  of 
nursing  care  with  whom  you 
can  trust  your  patients  Our 
employees  are  carefully 
screened  for  character  and 
skill,  then  insured  (including 
Workmen's  Compensation), 
bonded  and  made  subject  to 
our  high  operating  code  of 
ethics. 

Your  patients'  care  and  well- 
being  are  our  business. 

If  you  would  like  more  informa- 
tion about  our  services,  call  the 
Health  Care  Services  Upjohn 
Limited  office  nearest  you. 


Health  Care  Services 
Upjohn  Limited 

(Operating  in  Ontario  as 
HCS  Upjohn) 

Victoria  •  Vancouver  •  Edmonton 
Calgary  •  Winnipeg  •  Windsor  •  London 
St  Catharines  •  Hamilton  •  Toronto  West 

Toronto  East  •  Ottawa  •  Montreal 

Trois  Rivieres  •  Quebec  •  Halifax 


THE  CANADIAN  NURSE  —  Seplember  1975 


accession  list 


(Continued  from  page  59) 


BOOKS  AND  DOCUMENTS 

1.  Approaches  to  ihe  care  of  adolescents.  Edited 
by  Audrey  J.  Kalafatich.  NY..  Applclon- 
Cenlury-Crofls.  cl975.  241p. 

2 .  Barren .  Jean .  et  al .  The  head  nurse:  her  lead- 
ership role.  3d.  ed.  New  York,  Appleton- 
Cenlury-Crofls,  cl975.  450p. 

3.  Commission  on  Education  for  Health  Ad- 
ministration. Education  for  health  administra- 
tion. Publislied  for  Commission.  .  .with  support 
of  the  W.K.  Kellogg  Foundation.  Ann  Arbor. 
Mich..  Health  Administration  Pr..  cl975.  2v. 

4.  Clinical  immunology,  allergy,  in  paedialric 
medicine.  Scientific  proceedings  of  the  1st  Un- 
igate  Paediatric  Workshop  held  at.  .  .London. 
June  1973.  Edited  by  Jonathan  Brostoff.  Oxford. 
Blackwell  Scientific  Publications.  1973.  176p. 
(Blackwell  scientific  publications  no.  1) 

5.  DeFriese.  Gordon  H.  The  Sault  Ste.  Marie 
Community  health  sur\ey  of  1973:  Community 
health  centres  and  private  solo  practice  under 
universal  health  insurance:  the  consumer' s  view. 
A  final  project  report  to  the  Minister  of  National 
Health  and  Welfare.  Sault  Ste.  Marie.  Ont,  Sault 
Ste.  Marie  and  District  Group  Health  Assn.. 
1974.  140p. 

6.  Reischman,  Marjorie  R.  Dosage  calculation. 
Method  and  workbook.  N.Y..  National  League 
for  Nursing.  cl975.  106p.  (League  for  Nursing 
106:  NLN  Publication  no.  20-1560) 

7.  Forrest.  Jane.  Foundations  of  surgical  nurs- 
ing. London.  Edward  Arnold.  cl974.  92p. 

8.  Gifford- Jones.  W.  T  he  doctor  game .  Toronto. 
McClelland  and  Stewart.  1975.  18 Ip. 

9.  Gordon.  Sydney  et  Allan.  Ted.  Docieur 
Belhune,  traduit  de  I'anglais  par  Jean  Pare.  2ed. 
Montreal.  I'Etincelle.  cl973.  313p. 

10.  Griffen.  Joanne  K.  ed.  et  al.  Maternal  and 
child  health  nursing:  1500  multiple  choice  ques- 
tions and  referenced  answers.  3d.  ed.  Rushing. 
N.Y..  Medical  Examination  Publishing.  cl972. 
256p.  (Nursing  examination  review  book.  no.  3) 
W.  Ileostomy:  a  guide.   Los  Angeles.  United 

Ostomy  Assoc.  cl974.  48p. 

12.  Illich.  Ivan.  Medical  nemesis:  the  expropria- 
tion of  health.  Toronto.  McClelland  and  Stewart 
in  association  with  Calder  &  Boyars.  cl975. 
I83p. 

13.  Jessee.  Ruth  W.  and  McHenry.  Ruth  W. 
Self-leaching  tests  in  arithmetic  for  nurses.  9ed. 
St.  Louis.  Mosby.  1975.  21 5p. 

14.  Legrix.  Denise.Vfe  rommf  f a.  Paris.  Kent- 
Segep,  cl960-  1974.  3v 

15.  Le  Riche.  W.  Harding  et  al.  The  control  of 
infections  in  hospitals.  With  special  reference  to  a 
survey  in  Ontario.  Toronto.  Univ.  ofTorontoPr.. 
CI966.  340p. 

16.  Marchak.  Nicole.  The  family  health  services 
of  the  Canadian  Red  Cross  Society.  Report  of  a 
survey  with  recommendations.  Toronto.  Cana- 
dian Red  Cross  Society,  1974.  2v. 

17.  The  medicine  show:  Consumers  Union's 
practical  guide  to  some  everyday  health  problems 
and  health  products  by  the  editors  of  Consumer 


Reports.    Mount    Vernon.    N.V..    Consumers 

Union.  1974.  384p. 

18.   Meetings  and  Conventions. /n/frHodwna/d/- 

reciory.   1975.   New  York.  Gellert  Pub.  Co.. 

1975. ■432p.  R 

19    Nurse  Scientist  Conference.  Fifth. Denver. 

Col.  Apr.  14  and  15.  \912.  Science  and  direct 

patient  care  II.  Papers  presented.  Denver,  Col.. 

University  of  Colorado  Medical  Center.  School 

of  Nursing.  1974.  I89p. 

20.  Open  Curriculum  Conference.  1,  St.  Louis. 
Mo..  Nov.  27-28,  1973.  Proceedings.  Edited  by 
Lucille  Notter.  A  project  of  the  NLN  Study  of  the 
Open  Curriculum  in  Nursing  Education.  New 
York.  National  League  for  Nursing.  cl974. 
I54p.  (NLN  Publication  No.  19-1534) 

21.  Open  Curriculum  Conference,  2.  New  York. 
Nov.  7-8.  1974.  Proceedings.  Edited  by  Lucille 
Notter.  A  project  of  the  NLN  Study  of  the  Open 
Curriculum  in  Nursing  Education.  New  York. 
National  League  for  Nursing.  cl975.  113p. 
(NLN  Publication  no.  19-1559.) 

22.  Janet  Kraegel  et  al  Patient  care  systems. 
Toronto.  Lippincotl.  cl974.  219p. 

23.  Priver.  Julien  and  Peltzie.  Kenneth  G.  Con- 
tinued care  and  cost  attainment.  Battle  Creek. 
Mich..  W.K.  Kellogg  Foundation.  1974.  79p. 

24.  Robinson.  Corinne  Hogden.  Basic  nutrition 
and  diet  therapy .  New  York.  Macmillan,  cl975. 
.369p. 

25.  Schulberg.  Herbert  C.  and  Baker,  Frank. 
The  mental  hospital  and  human  services.  New 
York.  Behavioral  Publications,  cl975.  385p. 

26.  Protection  of  human  rights  in  the  light  of 
scientific  and  technological  progress  in  biology 
and  medicine:  proceedings  of  a  round  table  con- 
ference organized  by  CIOMS  with  the  assistance 
ofUnesco  and  WHO.  Geneva.  14-16  November 

1973.  Geneva.    World    Health    Organization. 

1974.  384p. 

27.  Rotximan.  Herman  and  Roodman.  Zelda. 
Management  by  communication.  Toronto. 
Methuen.  cl973   340p. 

28.  Successful  Meetings. /;i(e'rHa//ona/ conif/i- 
tion  facilities  directory.  New  York. 
SM/Successful  Meetings.  1975.  494p.  R 

29.  Les  lo.xicomanies  aulres  que  I' alcoolisme . 
Guide  de  diagnostic  ei  de  Iruitemenl.  Montreal. 
Corporation  professionnelle  des  medccins  du 
Quebec.  1975   73p. 

30.  Western  Interstate  Commission  for  Higher 
Education.  Western  Council  on  Higher  Educa- 


Registered  Nurses 

Your  community  needs  the  benefit 
of  your  skills  and  experience.  Volun 
teer  now  to  teach  Patient  Care  in 
The  Home  and  Child  Care  in  The 
Home  Courses. 


tion  for  Nursing.  Regional  Program  for  Nursing 
Research  Development.  Delphi  survey  of  clinical 
nursing  research  priorities.  Boulder.  Col  . 
Western  Interstate  Commission  for  Higher  Edu 
cation.  1974.  199p.  Principal  Investigator:  Carol 
A.  Lindeman. 

31.  Xerox  University  Microfilms.  Serials  in 
microform.  Ann  Arbor.  Mich..  Xerox  University 
Microfilms.  1975.  8.36p. 

32.  Young,  Clara  Gene  and  Barger,  James  D 
Learning  medical  terminology  step  by  step.  3ed 
St.  Louis,  Mosby,  1975.  325p. 

33.  West  Suburban  Hospital  Association.  Con 
sortium  Information  Resources.  Dynamics  ot 
hospital  library  consortia.  Edited  by  Wend\ 
Ratcliff  Fink  et  al.  Wallam,  Mass..  1975.  304p. 

PAMPHLETS 

34.  Alberta  Association  of  Registered  Nurses 
Report  of  the  Task  Committee  studying  the  role  a' 
the  nurse.  Edmonton,  1971.  5p. 

35.  Canadian  Association  of  Universiis 
Teachers.  Guidelines  concerning  sabbatical 
leave.  Ottawa,  1967.  p.  138-140. 

36.  Canadian  Education  Association.  Leave 
policies  and  practices:  sabbatical  leave.  To- 
ronto, 1969.  5p. 

37.  Canadian  Mental  Health  Association. 
Mental/Health  Ottawa  Report.  Toronto,  Cana- 
dian Mental  Health  Association,  1974.  pam. 

38.  Canadian  University  Nursing  Students  As- 
sociation. Regional  Meeting,  Jan.  11-12,  1975. 
Report.  8p. 

39.  Christenson,  William.  The  community  hos- 
pital: history  and  prognosis.  Burlington,  Mass., 
Massachusetts  Hospital  Research  and  Education 
Assoc,  cl975.  9p. 

40.  International  Nursing  Foundation  of  Japan. 
Tokyo.  Japan.  1974.  6p. 

41.  International  Nursing  Foundation  of  Japan. 
The  development  of  nursing  education  in  Japan. 
Tokyo,  1975.  14p. 

42.  Joint  Commission  on  Accreditation  of  Hos- 
pitals. Accreditation  Council  for  Long  Term  Care 
Facilities.   Standards  for  accreditation  of  ex- 
tended care  facilities  and  resident  care  facilities 
2ed.  Chicago.  JCAH,  1975.  30p, 

43.  Kellogg  Foundation.  Battle  Creek.  Mich 
Report  Mich. .  Battle  Creek  Kellogg  Foundation . 

1974.  40p. 

44.  The  modernized  metric  system  explained 
Neenah.  Wi.,  J.J.  Keller  &  Assoc,  Inc..cl974. 

1975.  35p. 

45.  National  League  for  Nursing.  Dept.  of  As- 
sociate Degree  Programs.  Associate  degree  edu 
ration  for  nursing.  New  York.  National  Leagut 
for  Nursing.  1975.  -38p. 

46.  New  York  State  Teachers  Association.  Sab- 
batical leaves  reported  to  NYSTA  as  of  Aug.  /.'• 
1969.  9p. 

47.  Registered  Nurses'  Association  of  Ontari( 
Proposals   for    an    educational    program  foi 
teachers  of  nursing  to  teach  registered  nurses 
long  term  care.  Toronto.  1974.  6p 


accession  list 


4*.  Saskalehewan  Registered  Nurses'  Association. 
Repori.  Regina.  Saskatchewan  Registered  Nurses' 
Assixiation.  1975.  25p. 

49.  iVorkin^  Group  on  European  Studies  in 
SursinglMiJ»ifery.  Copenhagen.  Regional  Of- 
fice for  Europe,  World  Health  Organization.  1974. 
45p. 

GOVERNMENT  DOCUMENTS 
Canada 

50.  Cotnile  consultatif  pour  le  developpemeni 
Jes  regions  seplentrionales.  L'aciivile  du 
gouvernement  dans  le Mord .  Ottawa.  Inft)rniation 
Canada.  1974.  198p. 

51.  Conference  des  minislres 
federal-provinciau.\  de  la  Sante,  Ottawa.  14-15 
janv.  \975.  Communique  final.  Ottawa.  Same  et 
3ien-etre  social  Canada.  1975.  I8p. 

52.  Dept.  of  Energy.  Mines  and  Resources 
Mines  Branch  Library.  The  library  and  you.  A 
handbook  for  library  users.  Ottawa,  1972.  18p. 

53.  Health  and  Welfare  Canada  Health  and  fit- 
ness, by  P.O.  Aslrand  Published  by  authority  of 
the  Minister  of  National  Health  and  Welfare. 
Amateur  Sport  Branch.  Ottawa.  Information 
Canada.  cl975.  48p 

54.  — .  Review  of  health  services  in  Canada.  Ot- 


tawa, 1974.  33p. 

55.  National  Economic  Conference.  Ottawa. 
Dec.  1-3.  \914.  Priorities  in  transition.  Proceed- 
ings. Ottawa.  Information  Canada,  c  1975.  I25p. 

56.  Treasury  Board.  Job  description  guide  for 
the  Public  Service  of  Canada  Ottawa,  Informa- 
tion Canada,  cl975.  33p 

Northwest  Territories 

57  Laws  and  Statutes.  Ordinances.  Ottawa,  In- 
formation Canada.  1974.  87p.  R 

Ontario 

58.  Ministry  of  Labour.  Task  Force  on  Emp- 
loyee Benefits  Under  Part  10  of  the  Employment 
Standards  Act.  Rfporf.  Toronto.  1975,  169p. 

Manitoba 

59.  Department  of  Health  and  Social  Develop- 
ment. Mental  health  and  retardation  services  in 
Manitoba,  prepared  by  J.C.  Clarkson  and 
M  D.T.  Associates.  Winnipeg.  1972.  109p. 

United  Stales 

60.  Dept  of  Health.  Education,  and  Welfare. 
Public  Health  Service.  Center  for  Disease  Con- 
ITol  Reported  tuberculosis  data.  1973.  Atlanta. 


Ga.,  1974.  39p.  (DHEW  Publication  No.  (CDC) 
75-8201) 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLEC- 
TION 

61.  Anderson,  Marjorie  Carolyn.  Cardiac  re- 
sponse to  showering  activity  in  convalescent  pa- 
tients. Seattle,  Wash.,  1972.  (Thesis  (M.N.)  — 
Washington)  R 

62.  Hayes,  Patricia.  Competency  criteria  for 
nurse-midwifery:  a  methodological  study.  Ed- 
monton, Alberta,  cl974.  74p.  (Thesis 
(M.H.S.A.)—  1973)  R 

63.  Gagne,  Lucie.  Connaissances  de  la  mere  sur 
la  maladie  de  i  enfant  et  les  soins  presents:  etude 
comparative  de  dettx  types  de  service  de  sante. 
Montreal.  1974.  290p.  (These  (M.N.)  — 
Montreal)  R 

64.  Mackenzie.  Barbara  J.  and  Williamson.  Eva 
M.  Family  health  nurse  project,  Vancouver,  Di- 
vision of  Public  Health  Nursing,  Health  Depart- 
ment. 1974.  19p.  R 

65.  Philips.  K.  Special  care  homes  study:  an 
investigation  of  care  provided  to  level  J  residents 
in  Saskatchewan  special  care  homes.  Saskatoon, 
Sask.,  Hospital  Systems  Study  Group.  1974. 
I52p.  R  ^ 


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P.O    Box  969.  Sarnia.  Ontario 


DIRECTOR  —  SCHOOL  OF  NURSING 

The  Director  is  accountable  for  the  development  and 
administration  of  nursing  education  programs.  A 
background  in  nursing  service  with  instructional,  cur- 
riculum, and  administrative  experience  in  nursing 
education  is  required.  Candidates  should  possess  a 
minimum  of  a  B.Sc.  Nursing  degree  and  Ontario  Nurs- 
ing Registration. 

CO-ORDINATOR 
DIPLOMA  NURSING  PROGRAM 

Duties  include  co-ordination  of  clinical  resources, 
teaching,  assisting  the  Director  and  Faculty  in  develop- 
ing and  implementing  a  new  curriculum.  Candidates 
should  have  Ontario  Nursing  Registration,  a  bac- 
calaureate degree  in  Nursing  or  its  equivalent,  and  at 
least  2  years  relevant  nursing  and  curriculum  experi- 
ence. 

Excellent  potential  exists  for  creative  educators  in  a 
beautiful  new  campus  setting. 

Please  reply  in  confidence  to: 

The  Personnel  Officer 
Lambton  College,  Box  969 
Sarnia,  Ontario  N7T  7K4 


ORTHORAEDIC    U    ARTHR|-riC 
HOSR|-rAl_ 


'^/i\=/ 


43  WELLESLEY  STREET,  EAST 

TORONTO,  ONTARIO 
M4Y1H1 

Enlarging   Specialty  Hospital   offers  a   unique 
opportunity  to  nurses  and  nursing  assistants 
interested  in  the  care  of  patients  with  bone  and 
joint  disorders. 
Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  all 
units 

Clinical  specialists  for  Operating  Room,  Intensive 
Care,  Patient  Care  and  Education. 


NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  for  all  Nursing  Units 
Intensive-Coronary  Care,  Psychiatry,  Med. -Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservice  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries     Reg.  N.  Jan.  1st.  1975  —  915.  —  1.115. 
April  1st,  1975  —945.  —  1.145. 

R.N.A.  Jan.  1st,  1975  —  686.  —  728. 
July  1st,  1975  —  738.  —  780. 

Contact 
Director  of  Nursing 


Request  Form 
for  "Accession  List" 

CANADIAN  NURSES' 
ASSOCIATION  LIBRARY 

Send  this  coupon  or  facsimile  tO: 
LIBRARIAN,  Canadian  Nurses'  Association, 
50  Ttie  Driveway,  Ottawa  K2P  1E2,  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  CN' 

library. 

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ALBERTA 


BRITISH  COLUMBIA 


NEW  BRUNSWICH 


lEGISTERED  NURSES  required  for  70  t>ed  accredited  active 
,ea:f^ent  Hospital   Full  time  and  sumrner  rehet  All  AARN  per- 
•---=    ctolicjes    Apply  m  writing  to  the    Director  of  Nursmg, 
-  ler  General  Hospital,  Drumheller   Alberta 


I 

'general  duty  nurses  required  fo'  SO-bed  hospital  m 
Albena,  rnid  way  between  Calgary  and  Edmonton  on 
gnway  Salaries  and  personnel  policies  as  set  by  AARN 

-enl  Residence  accommodation  available  Contact:  Mrs 
oe.  R  N  ,  Director  of  Nursing.  Lacombe  Gereral  Hospital 

;^0  Lacombe,  Alberta,  TOC  tSO 


A  71-bed  active  treatment  hospital  requires  NURSES  FOR 
iSENERAL  DUTY.  O.R..   and  INTENSIVE   CARE  NURSING. 

-   -•  -lember  medical  slatf   Personnel  policies  per  A  A  R  N 

.,ent  —  starling  at  S900    per  month.  This  hospital  is 

...  0  in  me  southern  part  ol  the  province  (30  miles  east  ol 

ndge)  which  enioys  a  lairly  moderate  winler  climate  Easy 

■    (o  winter  and  summer  recreational  activities.  Apply 

of  Nursing    Taber  General  Hospital,  Taber,  Alberta, 

'2G0 


BRITISH  COLUMBIA 


I  lEGISTERED  and  GRADUATE  NURSES  required  tor  new 
t  .i-bed  acute  care  hospital,  200  miles  north  of  Vancouver,  60 
■  ii«s  from  Kamloops  Limited  furnished  accommodation  avatla- 
t  (e.  Apply  Director  of  Nursing,  Asncroft  &  District  General  Hospi- 
1  al.  AshcToN,  British  Columbia 


ADVERTISING 
RATES 

FOR   ALL 
CLASSIFIED    ADVERTISING 

$15.00   fof   6   lines   or   less 
$2  50  <or  each   odditiorxjl   line 

Roles    for   display 
odvertisements   on   request 

Closing  dole  for  copy  ond  concellotion  is 
6  weeks  prior  to  1st  doy  of  publication 
month. 

The  Conodion  Nurses'  Associotion  does 
not  review  the  personnel  policies  of 
•he  hospitals  and  agencies  advertising 
in  the  Journol.  For  outhentic  informotion, 
prospective  oppliconfs  should  apply  to 
the  Registered  Nurses'  Association  of  the 
Province  in  which  they  ore  interested 
In    working. 


GRADUATE  NURSES  —  Looking  lor  variety  in  your  work^ 
Consider  a  modem  to-bed  hospital  located  on  a  beautiful  fiord- 
type  inlet  of  Vancouver  Island  s  west  coast  Apply.  Administrator 
30X  399  Tahsis.  Briiish  Columbia.  VOP  1X0 


OPERATING  ROOM  NURSE  wanted  for  active  mo- 
dern acute  hospital  Four  Certified  Surgeons  on 
attending  staff  Experience  of  training  desirable 
Must  be  eligible  for  B  C  Registration  Nurses 
residence  available  Salary  according  to  RNABC 
Contract.  Apply  to  Director  of  Nursing,  Mills  Mem- 
orial Hospital  2711  Tetrault  St..  Terrace.  British 
Columbia 


EXPERIENCED  NURSES  {eligible  lor  B  C  registration)  required 
for  409-bed  acute  care,  teaching  hospital  located  in  Eraser 
Valley.  20  minutes  by  freeway  from  Vancouver,  and  within 
easy  access  of  varied  recreational  facilities  Excellent  Orienta- 
tion and  Continuing  Education  programmes  Salary  Si  026  00  to 
SI. 212  00  Clinical  areas  include  Medicine.  General  and  Spe- 
cialized Surqerv  Obstetrics  Pediatrics  Coronary  Care.  Hemo- 
dialysis Rehabilitation  Operating  Room  Intensive  Care  Emer- 
gency PRACTICAL  NURSES  (eligible  for  B  C  License)  also 
required  Apply  to  Administrative  Assistant,  Nursing  Personnel, 
Royal  Columbian  Hospital.  New  Westminster.  British  Columbia. 
V3L  3W7 


HEAD  NURSE  —  General  Duty  and  Speciality  Nursing 
Positions  available  tor  Fall  Staffing  of  Renovated  Areas  Salary 
Range  General  DulySi026  —  S1212  Credit  lor  past  experience 
and  Post-Graduate  training  B  C  Registration  required  Policies 
in  accordance  with  RNABC  Contract  Limited  Residence 
Accommodation  available  Apply  now  to:  Director  of  Nursing. 
Powell  River  General  Hospital.  5871  Arbutus  Avenue.  Powell 
River.  British  Columbia,  V8A  4S3 


EXPERIENCED  GENERAL  DUTY  NURSES  AND  LICENSED 
PRACTICAL  NURSES  required  lor  small  upcoast  hospital  Sal 
ary  and  personnel  policies  as  per  RNABC  and  H  E  u  contracts 
Residence  accommodation  S2500  per  month  Transportation 
paid  from  Vancouver  Apply  to  Director  of  Nursing,  St  George  s 
Hospital   Alert  Bay  British  Columbia  VON  lAO 


GENERAL  DUTY  NURSES  lor  modern  41-bed  hospital  located 
on  the  Alaska  Highway  Salary  and  personnel  policies  in 
accordance  with  RNABC  Accommodation  available  m  resi- 
dence. Apply  Director  of  Nursing,  Fort  Nelson  General  Hospital 
Fon  Nelson,  British  Columbia 


Address  correspondence  to; 

The 

Canadian  Ay 
urse 


^17 


50  THE  DRIVEWAY 
OTTAWA,  ONTARIO 
K2P  1E2 


GENERAL  DUTY  NURSES,  for  modern  35-bed  hospital  located 
in  southern  B  C  s  Boundary  Area  with  excellent  recreation  faci- 
lities Salary  and  personnel  policies  m  accordance  with  RNABC 
Comfortable  Nurses  s  home.  Apply  Director  of  Nursing,  Bound- 
ary Hospital,  Grand  Forks  British  Columbia,  VOH  1H0 


REGISTERED  NURSES  required  for  a  fully  accredited  iC4-bed 
hospital  locaied  m  a  small  city  offering  a  varied  year  round 
recreational  program  Our  salaries  are  presently  S8  C88  — 
59,384  per  year,  increasing  to  S8  652  —  S 10  044  effective  from 
October  1si  until  March  3t  1976  when  the  present  contract 
expires  A  mosi  attractive  package  of  fringe  tienefits  is  offered 
For  further  information  telephone  collect  (506)  753-4451 ,  or  wriie 
to  The  Personnel  Supervisor  Soldiers  Memorial  Hospital. 
Campbelllon    New  Brunswick    E3N1L1 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  care 
hospital  in  Northern  B  C  residence  accommodations  available 
RNABC  policies  in  effect  Apply  to  Director  of  Nursing  Mills 
Memorial  Hospital  Terrace.  Bntish  Columbia.  V8G  2W7 


GENERAL  DUTY  NURSES  for  modern  46-bed  hospital,  locaied 
in  north  central  British  Columbia  Salary  and  personnel  policies  m 
accordance  wiih  the  RNABC  contract  Accommodations  availa- 
ble in  resklence  adjacent  to  hospiial  Apply  Director  ol  Nursmg. 
St  John  Hospital-  R  R  2  Vanderhoof,  British  Columbia  VOJ 
3A0 


ONTARIO 


Queens  University  is  seeking  candidates  tor  the  position  of 
DEAN/DIRECTOR  of  the  School  of  Nursmg  Persons  are  sought 
with  earned  doctoral  degrees  demonstrated  scholarship, 
professional  achievement  and  competence  in  administration 
appropriate  for  effective  leadership  m  an  established  University 
with  other  professional  faculties  and  schools  Reports  io  the 
Vice-Prmcipal  (Health  Sciences)  Salary  commensurate  with 
educational  preoaration  and  experience  Excellent  fringe 
benefits  Applications  and  nominations  should  be  sent  to  Dr 
H  G  Kelly.  Vice-Principal  I  Health  Sciences) .  Queen  s  University. 
Kingston.  Ontario.  K7L  3N6 


REGISTERED  NURSES  for  34-bed  General  Hospital 
Salary  S945  CO  to  St  145  CO  per  month,  plus  experience  allow- 
ance Excelleni  personnel  policies  Apply  to  Director  of  Nursiriq. 
Englenari  8,  Distnci  Hospital  Inc  .  Englehan  Ontario.  POJ  tHO 


REGISTERED  NURSES  AND  REGISTERED  NURSING 
ASSISTANTS  'or  45-bed  Hosp  ;ai  Salary  ranges 
nciude  generous  experience  allowances  R  N  s 
salary  SI  045  to  Si  245  and  R  N  A  s  salary  S735  to  S810. 
Nurses  residence  —  private  rooms  with  bath  —  S60  per  month- 
Apply  to  The  Director  of  Nursing.  Geraldlon  Dislncl  Hospital 
Geraldton.  Ontario.  POT  1M0 


REGISTERED  NURSES  required  for  our  ultramodern  accredited 
79-bed  General  Hospital  in  bilingual  community  of  Northern  On- 
tario French  language  an  asset  txjt  not  compulsory  Salary  is 
S945  to  SI  145  monthly  (sub)ect  10  increase  July  isti  with  allow- 
ance for  past  experience  and  4  weeks  vacation  after  i  year 
Hospital  pays  100°o  of  O  H  I  P  .  Life  Insurance  (10.0001  Salary 
Insurancei75°o0twagestolheageol65withu  i  C  carve-outi.a 
35^  drug  plan  and  a  dental  care  plan  Master  rotation  m  effect 
Rooming  accommodations  available  m  town  Excellent  person- 
nel pokoes  Ap(^  to  Personnel  Director  Noire-Dame  Hospital. 
P  O  Box  8000.  Hearst  Omano  POL  1N0 


REGISTERED  NURSES  FOR  GENERAL  DUTY.  I.C.U.. 
ecu.     UNIT    and     OPERATING     ROOM     rec^uired     tor 

fully  accredited  hospital  Starting  salary  S850  00  with 
regular  increments  and  with  allowance  for  experi- 
ence Excellent  personnel  policies  and  temporary 
residence  accommodation  available  Apply  to  The 
Director    of    Nursing.    Kirkland    &    District    Hospital. 

Ki-klandLake.  Cnla>ic.P2N  1R2 


SASKATCHEWAN 


DIRECTOR  OF  NURSING  required  for  Kmcaid  L)n«n  Hospital. 
Kincaid  Sask  Duties  to  commence  September  i,  1975  Salary 
according  to  D  O  N  schedule  and  experience  For  further  infor- 
mation contaci  Daisy  Frostad  DON  Kmcaid  Union  Hospital. 
Kincaid  Saskatchewan  Telephone  264-3233 


n.N.  required  immediately  —  Porcupine  Carragana  Union 
Hospital  requires  General  Duty  Registered  Nurse  immediateiv 
Salary  scale  and  fringe  benefits  as  negoiiatea  By  S  U  N  fvloder- 
20-bed  hospital  Near  Provincial  Park  Progressive  communis, 
Apply,  in  writing,  to  Administrator  Porcupine  Carragana  Unicr^ 
Hospital  Box  70.  Porcupine  Plain  Saskatchewan  SOE  IHO 

63 


SASKATCHEWAN 


REGISTERED  NURSE  required  for  acltve  lO-bed  Hospital  in 
Southern  Saskatchewan  Salary  Range  $798- to  $927.  as  per  the 
Collecttve  Agreement  between  Sask  Unior)  of  Nurses  and  Sask. 
Hospital  Association  Residence  accommodation  available.  For 
further  particulars  apply  to:  Mrs  Dorothy  L  Knops,  Sec.  Trees  , 
Rockglen  Union  Hospital.  Rockglen.  Saskatchewan,  SOH  3R0. 
Telephone:  476-2105  or  476-2012. 


SWITZERLAND 


EXPERIENCED  OR  NURSES  for  our  operating  room  in  our 
hospital  in  Muenslerlingen/Switzerland  required  This  modern 
hospital  built  in  1972,  an  hour  s  ride  from  Zurich,  is  situated  next 
to  the  beautiful  Lake  of  Constance  There  are  160  general  sur- 
gery beds  and  excellent  working  conditions  The  spoken  lan- 
guage IS  German,  but  fluency  is  not  required,  as  lessons  are 
available  ai  the  language  school  in  the  next  town  Livmg-in  ac- 
commodation IS  available  on  request  Apply  lo  Diredof  of  Nur- 
sing Service,  Kantonsspital  Muensterlingen,  CH-8596,  Muens- 
terlingen   Switzerland 


UNITED  STATES 


TEXAS  wants  you!  If  you  are  an  RN  expenenced  or 
a  recent  graduate,  come  to  Corpus  Chnsti,  Sparkling 
Cily     by    the     Sea  a     city     building     for     a     better 

future  where  your  opportunities  for  recreation  and 
studies  are  limitless  Memorial  Medical  Center,  500- 
bed.  general  teaching  hospital  encourages  career 
advancement  and  provides  in-service  orientation 
Salary  from  $785  20  to  $1,052  13  per  month,  com- 
mensurate with  education  and  experience  Differential 
for  evening  shifts,  available  Benefits  include  holi- 
days, sick  leave,  vacations,  paid  hospitalization, 
health  life  insurance,  pension  program  Become  a 
vital  part  of  a  modern,  up-to-date  hospital,  write  or 
call:  John  W.  Cover,  Jr  ,  Director  of  Personnel, 
Memorial  Medical  Center,  P  O  Box  5280  Corpus 
Chrisli.  Texas.  78405. 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound    in   our  clinics  and 

their  numbers  increase  daily  in  our 

Emergency. 

If  you   do   not   like  working  with 

children    and   with   their   families, 

you  would  not  like  it  here. 

If  you  do  like  children  and  their 
families,  we  would  like  you  on  our 
staff. 

Interested  qualified  applicants 
should  apply  to  the: 

DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108,  Quebec 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invite  applications  from 

REGISTERED  NURSES 

54-bed  accredited  general  hospi- 
tal. Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquires  and  applications 
to; 

Miss  E.LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  ICO 


CLINICAL  CO-ORDINATOR 
EMERGENCY 
DEPARTMENT 

(Nursing) 


Required  for  380-bed,  fully  accredited  ge- 
neral hospital  in  the  Kawartha  Lakes  Dis- 
trict. 

Please  apply  to: 

Director  of  Personnel 

The  Peterborough  Civic  Hospital 

Weller  Street 

Peterborough,  Ontario 

K9J  706 


FOOTHILLS  HOSPITAL 
Calgary,  Alberta 

Advanced  Neurological- 
Neurosurglcal  Nursing 

for 
Graduate  Nurses 

a  five  monih  clinical  and 

acadennic  program 

offered  by 

The  DeparlmenI  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

(DeparlmenI  of  Surgery) 

Beginning:  March.  September 

Limited  10  8  participants 
Applicalions  now  being  accepted 

For  further  informal/on.  please  write  to: 

Co-ordinator  of  (n-servlce  Education 

Foothills  Hospital 

1403  29  St.  N.W.  Calgary,  Alberta 

T2N  2T9 


DIRECTOR 
OF  NURSING  SERVICES 

Applications  are  invited  for  the  position  of  Direc- 
tor of  Nursing  Services  for  the  Bulkley  Valle, 
District  Hospital  at  Smithers.  B  C-  Tfie  positic 
offers  a  ctiallenging  opportunity  for  a  caree 
minded  nurse  in  ttiis  new  79  bed  hospital  offenr 
a  broad  range  of  community  hospital  services 

Smithers  is  a  thriving  town  of  5,000  in  a  beaulif 
setting  serving  a  district  of  approximately  15.0C 
people.  There  is  a  broad  range  of  social,  cullura 
and  recreational  activities. 

Applicants  must  have  previous  supervisory  e> 
pehence.  preferably  with  some  post-gradua- 
training.  Salary  can  be  negotiated. 

Further  information  may  be  requested  from,  ana 
applications  may  be  submitted  in  confidence  to 

The  Administrator 

Bulkley  Valley  District  Hospital 

Box  370 

Smithers,  British  Columbia 

VOJ  2N0 


The  Brome-Mlssisquoi-Perkins 
Hospital 

requires 

REGISTERED 
NURSES 


Please  write  to: 

Director  of  Nursing 
Brome-Mlssisquol-Perkins  Hospital 
950  Main  Street 
Cowansville,  Quebec 
J2K1K3 


SCHOOL  OF  NURSING 

(GALT  SCHOOL  OF  NURSING) 

FACULTY  POSITIONS 


—  positions  in  a  3  year  basic  program  with  enrolment 
approximately  90  students 

—  required  to  teach  Medical-Surgical  Nursing,  Applican' 
should  possess  baccalaureate  degree  m  nursing  w  ■ 
teaching  expenence  an  asset 

—  opportunities  for  curriculum  de-/elopmenI.  innoval^.- 
and  creative  teaching. 

—  salary  commensurate  with  preparation  and  experience 

in  accordance  with  A  A  R  N  agreement  I 

For  further  information  and  applications  contact 


Personnel  Director 

Lethbridge  General  and  Auxiliary  Hospital 

and  Nursing  Home  District  No.  65 
LETHBRIDGE,  Alberta 

Phone:  (403)  327-4531 


(OmE  TO 
EUROPE 

Why  don't  you  let  BNA  International  organise  a  trip 

to  Europe  for  you.  Broaden  your  nursing  experience 

and  ski  in  your  spare  time,  while  the  Mediterranean 

sun  is  within  easy  reach.  This  is  the  way  to  get  out 

of  the  rut  and  try  a  new  life. 

BNA  International  has  arranged  jobs  for  qualified 

nurses  from  Canada  in  the  splendidly  equipped 

university  hospital  of  Lausanne. 

1  year  contracts  at  1800  S.Fr.  per  month  minimum. 

Subsidised  accommodation  —  attractive  studio  flats. 

In  the  first  instance  write  to: 

Miss  Sue  Bentley,  SRN,  BNA  International, 
Faiman  House,  3rd  Floor,  470  Oxford  Street, 
London  WIN  OHQ. 


nternational 


Public  Service      Fonction  publique 
Canada  Canada 


THESE  COMPETITIONS  ARE  OPEN  TO  BOTH  MEN  AND  WOMEN 

NURSES 

Department  of  National  Health  and  Welfare 

Salary:  Commensurate  with  training  and  experience 

Charles  Camsell  Hospital 
Edmonton,  Alberta 

General  duly  nurses  are  needed  to  till  immediate  and  future  vacancies  at  the  Ctiarles 
Camsell  Hospital  wtiich  is  a  402-t)ed.  active  treatment  hospital,  serving  the  native 
people  of  Alberta,  residents  of  the  Yukon  and  Northwest  Territories,  as  well  as 
•esidents  of  Edmonton .  Good  opportunities  exist  for  promotion  and  transfer  to  various 
ocations  in  Canada  within  the  Federal  Public  Service.  Plea:e  quote  competition 
number:  75-E-1740(CNV 

Medical  Services 
Northwest  Territories 

An  opportunity  to  see  parts  of  Canada  tew  Canadians  ever  see  and  to  utilize  all  your 
nursing  skills  Nurses  are  required  to  provide  health  care  to  the  inhabitants  located  in 
some  settlements  well  north  of  the  Arctic  Circle.  Radio  telephone  communication  is 
available.  Transportation  to  and  from  employment  area  is  provided;  meals  and  ac- 
commodation at  a  nominal  rate  Please  quote  competition  number:  75-E-1741(CN). 
QUALinCATIONS  FOR  BOTH  POSITIONS: 
Eligibility  for  registration  as  a  nurse  in  a  province  of  Canada,  For  some  positions, 
mid-wifery.  obstetrics,  pediatrics  or  Public  Health  training  and  experience  is  essential. 
Proficiency  in  English  is  essential, 
HOW  TO  APPLY: 

Forward  ■Application  for  Employment"  (form  PSC  367^110)  available  at  Post  Of- 
fices. Canada  Manpower  Centres  and  offices  of  the  Public  Service  Commission  of 
Canada  to: 

PUBLIC  SERVICE  COMMISSION  OF  CANADA 

300  CONFEDERATION  BUILDING 

10355  JASPER  AVENUE 

EDMONTON,  ALBERTA  T5J  1Y6 


LECTURERS  IN  NURSING 

STURT  COLLEGE 
OF  ADVANCED  EDUCATION 


Sturl  College  of  Advanced  Education,  situated  in  Adelaide,  began  in 
1975  the  first  tertiary-level  Diploma  in  Nursing  Course  in  South 
Australia  in  co-operation  with  the  Flinders  Medical  Centre,  a  new 
major  teaching  hospital  and  medical  school  located  on  an  adjoining 
campus  and  with  other  health  agencies  in  the  area.  The  College 
enjoys  autonomy  under  the  governance  of  its  own  Council  and  is 
engaged  in  the  preparation  of  primary  and  secondary  teachers  as 
well  as  speech  pathologists.  It  is  planned  to  add  other  areas  of 
health  sciences  and  social  work  in  the  future. 
Applications  for  lecturers  in  the  nursing  programme  are  invited. 
Each  lecturer  appointed  will  have  an  area  of  responsibility  related  to 
his/her  particular  interest  and  expertise.  Beyond  this,  lecturers 
share  responsibility  for  general  teaching  activities  within  the  pro- 
gramme, the  College  and  Medical  Centre.  Possession  of  a  univer- 
sity degree  is  not  essential  unless  specified  but  would  be  considered 
to  be  an  advantage.  For  positions  1  to  5,  it  is  essential  to  te  eligible 
for  registration  as  a  nurse  in  South  Australia.  Relevant  teaching 
experience  would  be  an  advantage. 

Position  1  Nurse  to  teach  and  supervise  basic  nursing  and  gene- 
ral technical  nursing  principally  In  the  first  year  pro- 
gramme. 

Position  2  Nurse  to  be  principally  responsible  for  leaching  and 
supervising  the  operating  theatre  experience  and  as- 
sist in  the  first  year  programme. 

Position  3  Nurse  to  be  responsible  for  teaching  and  supervising 
the  critical  care  experience  in  the  programme. 

Position  4  Nurse  (preferably  with  a  relevant  degree)  to  teach  and 
supervise  the  mental  disorders  (psychiatric  and  intel- 
lectual retardation  nursing)  module. 

Position  5  Nurse  (preferably  with  a  relevant  degree)  to  teach  and 
supervise  in  the  Family  Care  module  (paediatrics, 
obstetrics  and  contraceptive  practice). 

Position  6  Lecturer  with  a  relevant  degree  in  biological  sciences 
to  teach  in  the  area  of  bio/physical  sciences  applied  to 
nursing.  This  position  would  be  a  joint  appointment 
with  the  Department  of  Human  Communication  Di- 
sorders to  teach  Human  Biology  also  to  their  students. 


Salary  Range  :- 

Lecturer 
Assistant  Lecturer 


A  $11,655  to  A  $15,644 
A$  9,510  to  A  $11,230 


Appointments  will  be  made  within  these  ranges  depending  on  quali- 
fications and  experience.  The  usual  C.A.E.  conditions  of  appoint- 
ment and  staff  benefits  will  apply.  Appointees  will  be  expected  to 
commence  as  early  as  possible  in  1976. 

The  closing  date  for  applications  is  September  30th,  1 975.  however, 
late  applications  may  be  accepted  from  persons  currently  overseas. 
Applicants  should  forward  a  curriculum  vilae,  including  personal 
details,  qualifications,  and  experience  and  should  request  that 
confidential  information  from  three  (3)  referees  be  sent  directly  to  the 
Academic  Secretary,  Sturt  College  of  Advanced  Education,  Sturl 
Road,  Bedford  Part<,  South  Australia  5042.  Applications  should 
specify  ttie  particular  position(s)  applied  for  and  be  marked  Confi- 
dential'. 


lE  CANADIAN  NUflSE  —  September  1975 


65 


REGISTERED 
NURSES 

required 

for  a  21 -bed  active  treatment  hospital 
in  the  Peace  River  District.  Salaries  in 
accordance  with  the  A. A. R.N.  Agt.  — 
$900.00  — $1,075.00. 

Accommodation  for  single  girls  availa- 
ble at  very  reasonable  rates. 

Apply  to: 

The  Director  of  Nursing 
Berwyn  Municipal  Hospital 
Box  154 
Berwyn,  Alberta 
TOH  OEO 


REGISTERED 
NURSE 


Registered  Nurse  required  for  a  3-bed 
I. C.U.-C. CD.  opening  In  the  Fall  of  75  in  an 
86-bed  Accredited  General  Hospital.  Ex- 
perience and/or  past  basic  training  is 
necessary. 

Prevailing  Ontario  salary  rates  as  well  as 
other  generous  fringe  benefits. 


Apply  to: 


Director  of  Nursing 
Sensenbrenner  Hospital 
10  Drury  Street 
Kapuskasing,  Ontario 
P5N  1 K9 


CLINICAL 
SPECIALIST 

We  require  the  services  of  an  articulate,  dynamic 
nurse  with  a  Masters  Degree  and  a  Major  in  Medi- 
cal, Surgical  nursing  in  a  300-bed  Hospital  Com- 
plex. 

The  nurse  in  this  position  will  work  closely  with  our 
staff  nurses  ,  as  well  as  Medical  Staff,  to  further 
develop  patient  centered  projects.  The  salary  for 
this  position  is  based  on  qualifications  and  ex- 
perience. 

For  further  inforrrtatlor}  about  this  opportunity, 
please  forward  a  complete  resume  to: 

Director  of  Personnel 
Red  Deer  General  l-tospltal 
Red  Deer,  Alberta 
T4N  4E7 


Be  part  of  the  Nurses'  Asso- 
ciation of  Medical  Care, 
where  the  advantages  are: 

A  higher  salary, 

salary  and 
life  insurance, 

an  average  of  3  work 
days  per  week, 

paid  holidays 
after  6  months. 


For  information  call: 

(514)  871-0179 

or 
(514)  866-8091 


REGISTERED 
NURSES 


Dedicated,  caring  and  interested  in 
accepting  the  challenge  of  resto-  ^ 
ring  long  term  patients  to  full  poten- 
tial. Join  our  team  on  new  progres- 
sive long  term  unit. 

See  our  other  advertisement  for' 
further  details. 


Please  address  all  enquiries: 


Assistant  Administrator  (Nursing) 
York  County  Hospital 
NEWMARKET,  Ontario 
L3Y  2R1 


"IVIEETING  TODAY'S  CHALLENGE  IN  NURSING" 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGill  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 
Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

immediately  north  of  Toronto. 
APARTMENTS: 

Furnished  -  shared. 

Swimming  Pool.  Tennis  Court,  Recreation  Room, 

Free  Parking, 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital. 
NEWMARKET,  Ontario, 
L3Y2R1. 


CANBERRA  HOSPITAL 

ACTON.  A.C.T.  AUSTRALIA 

NURSE  EDUCATOR 

THREE  POSITIONS:- 


1.  Principal  Educator  $10,799  per  annum 

2.  Senior  Educator  for  two-year 

general  nursing  course     $  9,661  per  annum 

3.  Midwifery  Educator  $  9,051  per  annum 
Additional  payment  for  diploma  and  certificates  up  to  SI  2  per 
week.  Total  tutorial  staff  —  23. 


Courses  under  control. 

GENERAL  NURSING 
GENERAL  NURSING 
MIDWIFFERY 
INTENSIVE  CARE 
NURSING  AIDE 


3  years 
2  years 
1  year 
1  year 
1  year 

Full  accommodation  (single)  available  —  S14  per  week, 
assistance  with  marned  accommodation  may  be  offered. 
For  further  particulars  and  application  forms  please  contact: 

MISS  J.  JAMES, 
Director  of  Nursing, 
Canberra  Hospital, 
ACTON,  A.C.T.  2601 
AUSTRALIA. 


VANCOUVER 
GENERAL  HOSPITAL 


Invites  applications  for 


REGULAR  and  RELIEF 
GENERAL  DUTY 


Nursing  positions  in  all  clinical  areas  of  an  active 

teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 

VANCOUVER  GENERAL  HOSPITAL 

855  WEST  12TH  AVE. 

VANCOUVER,  B.C. 


IE  CANADIAN  NURSE  —  September  1975 


67 


REGISTERED  NURSES 


REQUIRED 

For  a  138-bed  Active  Treatment  Regional  Hospi- 
tal in  Medicine,  Surgery,  Paediatrics,  Obstetrics, 
and  qualified  R  N.'s  for  a  5-Bed  I.C.U.-C.C.U. 

Salaries  according  to  Provincial  Salary  Guide 

Usual  Fringe  Benefits 

Residence  accommodation  available 

The  Hospital  is  located  in  the  beautiful  Annapolis 
Valley  which  is  a  one-hour  drive  to  the  Provincial 
Capital  of  Halifax 

Apply  to: 

Director  of  Nursing 
Blanchard-Fraser  Memorial  Hospital 
186  Park  Street 
Kentvllle,  Nova  Scotia 
B4N  1M7 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

Staff  nurses  for  St.  Anthony,  New  hospital  of 
150  beds,  accredited.  Active  treatment  in  Surgery, 
Medicine.  Paediatrics,  Obstetrics,  Psychiatry. 
Large  OPD  and  ICU.  Onentation  and  In-Service 
programs,  40-hour  week,  rotating  shifts.  PUBLIC 
HEALTH  has  challenge  of  large  remote  areas. 
Furnished  living  accommodations  supplied  at  low 
cost.  Personnel  benefits  include  liberal  vacation 
and  sick  leave,  travel  arrangements.  Staff  RN 
$637  —  $809,  prepared  PHN  $71 2  —  $903,  steps 
for  experience. 


Appty  to: 


INTERNATIONAL  GRENFELL  ASSOOATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Anthony,  Newfoundland 

AOK  4S0 


McKELLAR  GENERAL  HOSPITAL, 
Thunder  Bay,  Ontario 


OPERATING  ROOM' 
SUPERVISOR 


Required  for  389  bed,  fulty  accrediled,  active  Ireatn-.. 
hospital.  Duties  to  commence  December  1.  1975 
Prelerence  will  be  given  to  an  individual  with  a  B.Sc  N 
a  nurse  with  related  nursing  and  admintstralive  e^ 
rience. 

Excellent  salary  and  working  conditions-  j 

Further  information  will  be  forwarded  on  receipt  of  a  co( 
plete  resume  of  education  and  experience. 

Reply  to:  Director  of  Nursing  Service, 

McKELLAR  GENERAL  HOSPITAL, 
Thunder  Bay,  Ontario  I 


GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit. 
Clinical  areas  include:  medicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R.N.A.B.C.  contract: 

SALARY:  $850  —  $1 020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  Georcie  Regional  l-lospital 

Prince  George,  B.C. 


ST.  MICHAELS  HOSPITAL 
Toronto,  Ontario 

invites  applications  from 

REGISTERED  NURSES 

for 

RESPIRATORY 

INTENSIVE  CARE, 

CORONARY  CARE, 

and  ACUTE  CARE  UNITS 

Ttiree  separate  txjt  adjoining  units,  of  1 4,  7,  and  24  t>eds 
respectively.  Pianned  onentation  and  in-service  pro- 
gramme wiii  enable  you  to  collaborate  in  ttie  most  advan- 
ced of  treatment  regimens  for  the  post-operative  cardio- 
vascular, cardiac  and  other  acutely  ill  patients.  One  year  of 
nursing  expenence  a  requirement. 

For  detailt  apply  to- 

The  Director  of  Nursing 
St.  Michael's  Hospital 
Toronto,  Ontario 
MSB  1W8 


NURSES    holding  or  eligible  fc 
full  Newfoundland  registration  are 
vited  to  apply  for  immediate  vacanci 
in  the  general  ward  area  or  with  th 
psychiatric  team  at  Paddon  Memorij 
Hospital.  Salaries  in  accordance  wit 
Newfoundland    rates    and    curren"  ' 
under  review  in  contract  negotiatio 

Applications  should  be  addressed 


Director  of  Nursing 
Paddon  Memorial  Hospital 
International  Grenfeli  Association 
Happy  Vaiiey,  Labrador 
A0P1E0 


ST.  THOMAS  -  ELGIN 
GENERAL  HOSPITAL 

Invites  Applications  from 

REGISTERED  NURSES 

To  work  in  our  modern  fully  accredited  400  bed  General 
Hospital  located  in  Souttiwestern  Ontario. 

We  offer  opportunities  in  medical,  surgical,  paediatric, 
obstetrical  and  geriatric  nursing. 

Our  specialties  include  Coronary  Care,  Intensive  Care 
and  an  active  Emergency  Department. 
Orientation  Program. 
Progressive  Personnel  Policies. 

APPLY  TO: 

Personnel  Office 

St.  Thomas-Elgin  General  Hospital 

St.  Thomas,  Ontario 

N5P  3W2 


FUN  FLON  GENERAL  HOSPITAL  INC. 
FLIN  FLON,  MANITOBA 

Opportunities  are  available  in  this  modern  125-bed  hospi- 
tal in  the  summer  and  winter  vacation  land  of  Northern 
Manitoba  for  the  following  positions:  — 

EVENING  SUPERVISOR 

Qualifications  — 

Current  provincial  registration  or  eligibility  for  registration. 
Previous  training  and  experience  in  a  senior  nursing  posi- 
tron, 

CLINICAL  INSTRUCTOR 

for 
PRACTICAL  NURSING  STUDENTS 

Qualifications  — 

Current  provincial  registration  or  eligibility  for  registration. 
Previous  nursing  expenence  required. 
Expenence  as  Head  Nurse,  Supervisor  or  Instructor  de- 
sirable 
GENERAL  DUTY  REGISTERED  NURSES  sito  required. 

For  further  details  apply: 

PERSONNEL  DIRECTOR 
Flln  Flon  General  Hospital 
Box  340 

Flln  Flon,  Manitoba 
RBA  1N2 


OIIIIIIIIIIIIIIIIIIIIIIIIJ 


BE  A  PART 
OF 


IBEAPART     I 
JOFTHE  ACTION! 

niiiiiiiiiiiiiiiiiiiiiiid 


DIRECTOR 

OF 
NURSING 


Applications  are  invited  for  a  DIRECTOR  OF  NURSING  for  a 

138  bed  fully  accredited  brand  new  hospital,  presently  in  the 
final  stages  of  construction,  and  which  we  will  occupy  in 
August  1975. 


Qualified  applicants  are  requested  to  reply  in  writing, 
giving  curriculum  vitae  to: 

The  Administrator 
Kirkland  &  District  Hospital 
KIrkland  Lake,  Ontario 
P2N  1R2 


657  bed, accredited, modern, 
well  equipped  General  Hospital, 
rapidly  expanding... 


Saint  John 
General 
^ospitaL    ^ 

^^  Saint%hn,N.B., 

^1<EQUIRE»  ^^  ^"^  ^^ 

General  Staff  Parses  <& 
Registered  Nursing  Assistants 

In  all  general  areas:  Medical,  Surgical, 
Pediatrics,  Obstetrics,  Chronic  and 
Convalescent,  several  Intensive  Care 
areas  and  Psychiatry. 

0  Active,  progressive  in-service  education  program. 
Special  Attention  to  Orientation. 
Allowance  for  Experience  and  Post  Basic  Preparation 


FOR  FURTHUR  INFORMATION  APPLY  TO 

'PERSONNEL  DIRECTOR 

^aintjohn  General  Hospital 

PO  BOX  2000  Saint  John.  New  Brunswick  E2L4L2 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILiTATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 


O^^ 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


BRITISH   COLUMBIA 
INSTITUTE  OF  TECHNOLOGY 

Department  of  Patient  Care  Services 

invites  applications  for  the  following  position: 

CHIEF   INSTRUCTOR 

PSYCHIATRIC 

MENTAL  HEALTH  NURSING 

This  position  is  available  September  1 , 1 975  and  will  involve  coordinating  and 
administering  a  two-year  diploma  in  psychiatric  nursing.  Coordinating  the 
mental  health  nursing  component  of  the  general  nursing  program  and  partici- 
pating in  some  classroom  teaching. 

Qualifications:  A  masters  degree  is  preferred;  baccalaureate  degree  with 
experience  in  psychiatric  nursing,  nursing  education  and  curriculum  deve- 
lopment. Elegibility  for  professional  nursing  registration  in  B.C. 
Salary:  Dependent  on  qualifications  and  experience  within  a  range  of  $1 ,570 
to  $2,095  per  month. 

Applications  are  available  from: 

The  Personnei  Office 
B.C.  institute  of  Technology 
3700  Wiiiingdon  Avenue 
Burnaby,  B.C.  V5G  3H2 

Closing  Date  for  applications:  August  15,  1975 
Please  quote  competition  Number:  7SS33 


CARIBOO 
COLLEGE 

KAMLOOPS 

BRITISH 
COLUMBIA 


Requires  a 

Nursing  Instructor 

Qualifications: 

An  MA  degree  is  preferred.  Consideration  will  be  given  to  persons  with  a 
Baccalaureate  degree 

a)  Service  and  teaching  ex()erience  in  Medical  Surgical  Nursing 

b)  Eligibility  for  registration  in  British  Columbia 

Duties:  (to  commence  January  1,  1976) 

1)  Classroom  teaching 

2)  Clinical  teaching  and  supervision 

3)  Participation  in  curriculum  planning,  and  other  faculty  activities. 

Mall  applications  together  with  curriculum  vitae  and  letters  of 
reference  to:  The  Principal,  Cariboo  College,  Box  860, 
Kamioops,  British  Columbia,  V2C  5N3, 

Closing  date  for  applications  November  1,  197S. 


if  Paris  appeals  to  you  . . 


. .  .so  will  Montreal 


•  modern  700  bed  non-sectarian  hospital 

•  excellent  personnel  policies 

•  Registered  Nurses  and  Nursing  Assistants 
are  asked  to  apply 


•  active  In-Service  Education  program 

•  bursaries  available 

•  Quebec  language  requirements  do  not 
apply  to  Canadian  applicants 


Director,  Nursing  Service 
Jewish  General  Hospital 
3755  cote  ste.  Catherine  Road 
Montreal,  Quebec  H3T  1E2 


Ministry      Director 
of  Health     of  Nursing 


$18,016  -  $22,783. 

An  opportunity  exists  for  an  energetic,  experienced  nurse  adminis- 
trator in  a  fully  accredited  psychiatric  hospital  which  is  about  to 
become  a  university  teaching  hospital. 

Reporting  to  the  Administrator,  the  Director  of  Nursing  will  develop 
programs  to  provide  optimum  patient  care;  review  treatment 
methods:  keep  abreast  of  new  nursing  techniques  and  ensure  the 
updating  of  staff. 

Applicants  must  have  registration  as  a  nurse  in  Ontario:  satisfactory 
completion  of  a  recognized  post-graduate  course  in  nursing  administ- 
ration or  hospital  administration,  preferably  a  Masters  or  Bachelors 
degree  in  Nursing  Science:  comprehensive  knowledge  of  nursing  and 
hospital  policies  and  administration  and  significant  progressive  re- 
sponsible experience,  preferably  in  Psychiatric  nursing. 

Please  send  application  or  resume  to  the  Personnel  Officer,  Brockville 
Psychiatric  Hospital,  Box  1050,  Brockville,  Ontario.  Competition 
Number  —  HL  20-22/75. 

This  competition  is  open  to  both  men  and  women. 

Ontario 
ontaro  PubHc  Service 


RE-OPENING  OF  THE 
GRANDFATHER  CLAUSE 


FOR 

TECHNICIANS/TECHNOLOGISTS 
PRACTISING  IN  THE  FIELD  OF 
NUCLEAR  MEDICINE  IN  CANADA 

The  Board  of  Directors,  Canadian  Society  of  Radiologlcaf 
Technicians  has  passed  the  following  to  permit  anyone  practising  in 
the  field  of  Nuclear  Medicine  technology  to  qualify  themselves  with 
the  Society. 

"Persons  working  In  the  Nuclear  Medicine  field  since  January  1  st, 
1 965,  be  permitted  to  sit  the  C.S.R.T.  Certification  Examinations  In 
Nuclear  Medicine  in  May  1976.  Applicants  shall  have  those  aca- 
demic educational  qualifications  deemed  necessary  by  the  Pro- 
vincial Society.  These  persons  must  have  been  working  In  the  field 
of  Nuclear  Medicine  in  Canada  continuously  since  January,  1965 
in  both  "in  vivo"  and  "in  vitro"  sections.  The  procedure  for  applica- 
tion for  examination  is  as  outlined  in  Rules  &  Procedures,  p.  55 
2(b)  All  applications  must  be  received  by  the  Committee  no 
later  than  December  31,  1975. 

Candidates  accepted  to  sit  the  examinations  shall  be  entitled  to 
existing  rewrite  privileges." 

All  interested  applicants  should  subn)it  their  request  for  exami- 
nation to: 

Miss  R.  Hudec,  R.T. 

Certification  Secretary 

Canadian  Society  of  Radiological  Technicians 

Ste.  410,  280  Metcalfe  St. 

Ottawa,  Ontario 

K2P  1 R7 


ST.  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

•  We  offer  opportunities  in  Emergency,  Operating  Room,   P.A.R.,   Intensive  Care  Unit,  Orthopaedics,   Psychiatry, 
Paediatrics,  Obstetrics  and  Gynaecology,  General  Surgery  and  Medicine. 

•  We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Sen/ice  programs. 

•  We  offer  —  Toronto  —  with  some  of  Canada's  finest  Theatres,  Restaurants  and  Social  events. 

•  We  offer  progressive  personnel  policies. 

•  We  offer  a  starting  salary,  depending  on  experience,  of: 

effective  April  1, 1975     -  $945  to  $1,145  per  month. 

•  We  offer  monthly  educational  allowances  up  to  $120.  per  month  in  addition  to  the  above  starting  salary. 

Appiyto:  Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1B5 


■  rAWAniAM  Ml  IDCP 


Serve  Canada's 
native  people 


in 
a  well 

equipped 

hospital. 


14 


Health  and  Welfare       Sant6  et  8ien-6tre  social 
Canada  Canada 


Medical  Services  Branch 

Department  of  National  Health  and  Welfare 

Ottawa,  Ontario  K1A0K9 


Please  send  me  information  on  hospital 
nursing  with  this  service. 


Name: 

Address: 

City: 


Prov: 


Index 
to 

Advertisers 
September  1975 


1 


Astra  Pharmaceuticals    Cover  4 

Barco  of  California 15 

Baxter  Laboratories  of  Canada 10 

BNA  International 65 

The  Clinic  Shoemakers 2 

Hampton  Manufacturing  ( 1966)  Limited 20 

Health  Care  Services  Upjohn  Limited  59 

Hollister  Limited 53 

ICN  Canada  Limited 13,  49 

J.B.  Lippincott  Co.  of  Canada  Limited 36,  37 

Macmillan  Book  Clubs,  Inc 55 

MedoX 57 

The  C. V.  Mosby  Company  Limited  18.  19 

Nordic  Pharmaceuticals  Limited 17 

Posey  Company 51 

Reeves  Company 7 

Roussel  (Canada)  Limited   8,  9 

W.B.  Saunders  Company  Canada  Limited    1 

White  Sister  Uniform,  Inc 5,  Cover  2,  3 


Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  1E2  (Ontario) 

Advertising  Representatives 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore,  Penna.  19003 
Telephone:  (215)649-1497 

Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills,  Ontario 
Telephone:  (416)444-4731 


Member  of  Canadian 
Circulations  Audit  Board  Inc. 


N  u  rsa 


i-i(. 


liblic 


1^  2  2   jy75 

OCT  2  5,1975 


October  1975 


DO    NOT    TAKE 
OUT    OF    LIBRARY 


2 


f97t 


suddenlyeverything's  white 

cool  bright  white  from  designer's  chJ 


A) 

Style  No.  45287 

Sweater  set 
Sizes  3-15 
Royale  Sweater  Knit. 
100%  Polyester  Double  Knit. 
White Sugg,  retail  $24.00 


AT    vmiD 


A  \l  f\  ryfrt^         tk    r%  r^    m    r^  w^  m  .M,^,^__i 


LeMaitre  &  Finnegan: 

THE  PATIENT  IN  SURGERY— 

A  Guide  for  Nurses,  New  3rd  Edition 

•1  this  comprehensive  review  of  modern  surgical  nursing  the  authors 
\amine  sequentially  all  the  factors  involved  in  patient  care.  Part 

-General  Considerations  in  t/ie  Care  of  the  Surgical  Patient 

itroduces  the  components  of  surgery,  the  surgical  experience  for  the 
,iatient,  and  the  elements  of  superior  patient  care.  Part  II — Specific 
\Operative  Procedures— employs  a  convenient  outline  format  to  sum- 
marize individual  surgical  procedures  and  the  specific  postoperative 
care  for  each  operation.  Eighteen  chapters  are  new  to  this  edition, 
including  those  that  discuss  such  operations  as  laparoscopy  cholecys- 
tojejunostomy,  radical  pancreaticoduodenectomy,  lysis  of  adhesions, 
excision  of  testicular  tumor,  lumbar  sympathectomy,  aorto-iliac 
bypass  graft,  ureterostomy,  breast  biopsy,  bilateral  adrenalectomy, 
and  coronary  artery  bypass  graft.  ^ 

By  George  D.  LeMaitre,  MD,  FACS,  Diplomate  Am.  Bd.  of  Surgery;  and  Janet 
I  A.  Finnegan,  RN,  MS.  506  pp.  108  ill.  $9.55.  July  1975.      Order  #57T  7-6. 


Alsoof  interest . . . 

THE  NURSING  CLINICS  OF  NORTH  AMERICA 

Nursing  Clinics  bring  you  informative  symposia  that  examine 
the  rapidly  changing  aspects  of  nursing  care  and  alert  you  to  the 
newest  techniques  and  concepts  in  the  field.  The  December 
1975  issue  features  an  All-Canadian  symposium  on  Community 
Health  Nursing  in  Canada  which  details  recent  innovations  in 
the  nurse-practitioner  role  in  community  health.  A  second  sym- 
posium entitled  Perspectives  in  Operating  Room  Nursing  in- 
cludes an  in-depth  discussion  of  post-operative  infections. 

Yearly  subscription:  $15.60.  Published  quarterly:  March,  June,  Sept. 
and  Dec.  Each  issue  is  approximately  180  pp.  Hardbound.  Illustrated. 
Contains  no  advertising.  Order  #0003. 


Creighton: 

LAW  EVERY  NURSE 

SHOULD  KNOW 

New  3rd  Edition 

It  takes  an  expert  to  understand  all  the  legal  complications  that 
today's  nursing  practice  may  entail — an  expert  like  Helen 
Creighton,  who  is  a  nurse  and  nursing  educator  as  well  as  an 
experienced  lawyer.  This  new  edition  has  been  totally  revised 
and  substantially  expanded  to  include  data  on:  A.N. A.  certifica- 
tion; minors  and  birth  control,  abortion,  and  drug  abuse;  care  of 
psychiatric  patients;  pronouncing  the  patient  dead;  confidential 
communications;  narcotics  violations;  legitimacy; 
acupuncture;  rights  prior  to  birth;  and  many  more  topics.  An 
entire  chapter  examines  Canadian  Law  and  Legal  Practice. 

By  Helen  Creighton,  RN,  |D.  327  pp.  $11.20.  June  1975. 

Order  #2752-8. 


§aui|der5 

the  name  on  your 
most  dependable 
nursing  references 

Table  of  Contents 

General  Considerations  in  the  Care  of  the  Surgical  Patient 

The  Meaning  of  Surgery  •  The  Surgical  Environment  •  Sur- 
gical Sepsis  •  Sterilization,  Disinfection,  and  Antisepsis  • 
Preparation  of  the  Patient  for  Surgery  •  Wounds  and  Wound 
Healing  •  Surgical  Drains,  Tubes,  and  Catheters  •  Anesthesia 
and  the  Patient  •  The  Operating  Room  Experience  •  Immediate 
Care  of  the  Postoperative  Patient 

Specific  Operative  Procedures 

Abdominal  and  Pelvic  Surgery:  Introduction  •  (The  Patient 
with)  An  Umbilical  Hernia/An  Inguinal  Hernia/An  Incisional 
Hernia/  Hepatomegaly  and  Jaundice/Chronic  Gallbladder 
Disease/Acute  Cholecystitis/Obstructive  Jaundice/Inoperable 
Cancer  of  the  Pancreas/Operable  Cancer  of  the  Pancreas/A  Lac- 
erated Liver/A  Perforated  Duodenal  Ulcer/Pyloric  Obstruction/A 
Severe  Duodenal  Ulcer/A  Ruptured  Spleen/Regional  lleitis/A 
Small  Bowel  Perforation/Small  Bowel  Obstruction/ 
Appendicitis/Acute  Large  Bowel  Obstruction/Diverticu litis  of 
the  Colon/Cancer  of  the  Rectum 

Vascular  Surgery:  Introduction  •  (The  Patient  with) 
Raynaud's  Disease/lschemic  Ulcers  and  Rest  Pain/Peripheral 
Vascular  Disease/Leriche  Syndrome/An  Abdominal  Aortic 
Aneurysm/Popliteal  Artery  Emtwiism/Gangrene  of  the  Foot/ 
Carotid  Artery  Insufficiency/Pulmonary  Embolism/Varicose 
Veins/Bleeding  Esophageal  Varices 

Gynecological  Surgery:  Introduction  •  (The  Patient  with) 
Abnormal  Uterine  Bleeding/An  Ovarian  Cyst/A  Fibroid  Tumor  of 
the  Uterus/A  Cystocele 

Genitourinary  Surgery:  Introduction  •  (The  Patient  with) 
Cancer  of  the  Kidney/A  Ureteral  Stone/Benign  Prostatic 
Hypertrophy/A  Maligant  Tumor  of  the  Testicle/A  Cutaneous  Uri- 
nary Fistula 

i-lead  and  Neck  Surgery:  Introduction  •  (The  Patient  with) 
Infected  Tonsils  and  Adenoids/Chronic  Lung  Disease/A  Parotid 
Gland  Tumor/Cancer  of  the  Larynx/Metastatic  Carcinoma  to  the 
Neck/A  Thyroid  Tumor 

Breast  Surgery:  Introduction  •  (The  Patient  with)  A  Breast 
Lump/Breast  Cancer/ Advanced  Breast  Cancer 

Cardiothoracic  Surgery:  Introduction  •  (The  Patient  with) 
Carcinoma  of  the  Lung/A  Hiatus  Hernia/Congenital  Heart 
Disease/Mitral  Stenosis/Mitral  Insufficiency/Coronary  Artery 
Disease/Marginal  Ulcer 

Neurological  Surgery:  Introduction  •  (The  Patient  with)  A 
Ruptured  Invertebral  Disc/A  Subarachnoid  Hemorrhage/Head 
Trauma 

Miscellaneous  Procedures:  Introduction  •  (The  Patient 
with)  A  Fractured  Right  Hip/A  Pilonidal  Sinus/Hemorrhoids/A 
Ganglion  of  the  Wrist/Index 


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PROCTER   ft  SAHBLE 


The 

Canadian 
Nurse 


^^p 


A  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  bv  the  Canadian  Nurses'  Association 


Volume  71,  Number  10 


October  1975 


17  Frankly  Speaking  — 

If  Only  the  Tale  Had  Been  Tattled L.  Besel 

18  Pediatric  Diabetes:  A  New  Teaching  Approach 

M.D.  Leahey,  S.A.  Logan,  R.G.  McArthur 

21      Reawakening  Senses 

in  the  Elderly  D.  Scott,  J.  Crowhurst 

23      Psychiatric  Management 

of  the  Deaf  Child S.R.  Lesser,  B.R.  Easser 

26      Non-Accidental  Trauma  in  Children C.  Stainton 

30      A  Young  Pregnant  Girl  Tells  Her  Story   M.  Smith 

36      Home  Delivery  —  Dutch  Style I-  Edgar 

The  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

7  News 

40  Names 

42  A.V.  Aids 

44  Dates 


46  New  Products 

48  Research  Abstracts 

49  Books 

50  Accession  List 

64  Index  to  Advertisers 


Executive  Director;  Helen  K.  Mussallem  • 
Editor:  M.  Anne  Hanna  •  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Lynda  S. 
Cranston  •  Production  Assistant:  Mary  Lou 
Oownes  •  Circulation  Manager:  Beryl  Dar- 
ling •   Advertising     Manager:     Ceofgina    Clarke 

•  Subscription  Rales:  Canada  one  year. 
$6.00:  two  years.  $11.00.  Foreign:  one  year, 
$6.50;  two  years,  $12.00.  Single  copies: 
$100  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  registration  number  in  a  pro- 
vincial nurses'  association,  where  applicable. 
Not  responsible  for  journals  lost  in  mail  due 
to  errors  in  address. 


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  tor  review  tor  exclusive  publication 
The  editor  reserves  the  right  to  make  the  usual 
editorial  changes.  Photographs  (glossy  printsi  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,    Ontario,    K2P  1E2 

(g)  Canadian  Nurses'  Association  1975. 


BEHIND  THE  SCENES 

Since  this  column  bears  little,  If  any, 
resemblance  to  an  editorial,  you  won't 
find  the  familiar  title  at  the  top.  Instead, 
"Behind  the  Scenes"  is  intended  to 
provide  some  insight  into  the  operation 
of  your  journal  and  help  you  get  to 
know  the  new  editor. 

To  introduce  myself:  My  profes- 
sional career  begins  with  graduation 
from  the  School  of  Journalism  at  Carle- 
ton  University  in  Ottawa,  followed  by 
work  for  several  government  depart- 
ments, a  daily  newspaper,  two  national 
associations,  the  Centre  of  Criminol- 
ogy of  the  University  of  Ottawa  and  the 
Special  Senate  Committee  on  Poverty. 
I  have  written  about  what  it  means  to 
be  poor;  what  it's  like  to  be  a  woman 
coming  to  live  in  Canada;  what  hap- 
pens to  the  young  offender  after  sen- 
tencing by  the  courts;  and  how  a  hand- 
ful of  concerned  people  provided  the 
spark  that  led  to  the  celebration  of 
Canada's  100th  birthday. 

If  there  is  a  common  thread  that  runs 
through  these  books,  articles  and  re- 
ports, it  is  the  honest  attempt  to  explain 
"the  way  it  is  '  for  a  particular  group  of 
people  so  that  others  who  have  never 
experienced  that  unique  conjunction  of 
events  and  circumstances  can  under- 
stand something  of  their  attitudes. 
Studying  and  interpreting  the  point  of 
view  of  people  whose  experiences  are 
alien  to  many  readers,  has  brought 
home  to  me  the  very  real  need  for  ef- 
fective communication  in  the  world  we 
live  in.  It  has  also  made  me  very  much 
aware  of  how  difficult  this  is. 

Two  years  ago  I  joined  the  staff  of  the 
Information  Services  of  the  CNA.  Since 
then  I  have  tried,  with  varying  degrees 
of  success,  to  interpret  your  national 
association  to  you,  and  also  to  interpret 
CNA  to  the  public,  to  other  health  pro- 
fessionals and  to  government. 

As  a  professional  journalist,  there  is 
no  way  I  could  lightly  assume  the  job  of 
editor  of  your  journal,  knowing  that  it 
hinges  on  an  accurate  interpretation  of 
what  individual  nurses  want  to  com- 
municate to  the  rest  of  the  nursing  pro- 
fession. The  "go-between"  is  in  a 
peculiarly  vulnerable  position. 

As  an  intermediary  however,  I  hope 
to  make  it  as  easy  as  possible  for  any- 
one with  a  notion  or  experience  to 
share,  to  communicate  that  message 
to  those  who  have  something  to  gain 
from  it.  Getting  your  message  into  print 
is  never  simple.  Even  professional 
writers  experience  creative  pangs  try- 
ing to  transfer  their  ideas  onto  paper.  I 
want  to  make  that  procedure  as  pain- 
less as  possible.  Communication  is 
sharing  and  the  editor's  job.  as  I  see  it, 
is  io  make  that  process  work. 

—  M.A.H. 


letters 


A  bouquet  for  CNJ 

The  Canadian  Nurse  is  the  most  help- 
ful, thought-provoking,  and  interesting 
of  all  the  magazines  that  come  across 
my  desk.  Your  July  1975  edition  gave 
me  so  much,  that  I  wanted  to  express 
my  appreciation  to  you  and  to  the  con- 
tributors. 

D  Continuing  Education  Should  Be 
Voluntary,  by  M.J.  Flaherty,  stated: 
"...  nurses  have  allowed  themselves 
to  be  evaluated  by  superiors  and  non- 
nurses. ""  Dr.  Flaherty  implies  that 
nurses  should  be  prepared  to  use  their 
own  professional  expertise  in  the 
evaluation  of  nursing  practice  through 
peer  review.  Why  Not?  It  would  be  a 
breath  of  fresh  air! 

n  VON  To  Strengthen  Services  To 
Older  Persons.  In  this  news  item, 
whole  sentences  and  phrases  applied  to 
both  VON  and  public  health  nursing, 
that  is,  "new  programs  for  the  older 
persons,"  and  "an  assessment  of 
health  problems  leads  to  nursing  inter- 
vention." Reading  it  made  me  feel  that 
I  was  back  with  my  enthusiastic  class- 
mates from  both  public  health  and  voN 
who  attended,  last  spring,  the  pilot 
course  on  the  "expanding  role  of  the 
public  health  nurses,"  given  by  the  fa- 
culty of  nursing.  University  of  To- 
ronto (funded  by  the  Ontario  Ministry 
of  Health).  We  are  all  working  toward 
the  same  goal. 

n  Going  Home  With  COLD,  by  S.  Pasch 
and  T.  Jamieson,  was  very  much  like  a 
sample  case  in  the  "expanding  role" 
course,  although  the  setting  was 
primarily  in  the  hospital  and  we  are  in 
the  community.  From  the  assessment  to 
the  home  visit,  it  was  right  on. 
D  Is  The  Postpartum  Period  A  Time  Of 
Crisis  For  Some  Mothers?,  by  L. 
Melchior,  really  made  me  sit  up  and 
take  notice.  I  thought  that  I  could  make  a 
"good"  postpartum/newborn  visit  and 
also  teach  new  public  health  nurses  how 
to  do  one.  After  checking  the  problems 
listed  for  the  different  time  periods,  I 
came  to  the  conclusion  that  this  material 
would  spark  meaningful  discussion  at  in- 
service  programs  for  new  and  experi- 
enced public  health  nurses,  and  will  cer- 
tainly be  used  for  my  orientation  of  new 
staff  and  to  help  students.  One  wonders 
why  one  did  not  do  a  similar  study  one- 
self? 


O  Multiple  Sclerosis  and  Cystic  Fi- 
brosis. Articles  like  these  are  great, 
and  go  straight  into  my  resource  mater- 
ial file  to  keep  me  updated  and  to  assist 
new  staff  nurses. 

Keep  it  up!  We  all  need  encourage- 
ment and  inspiration.  Thanks  to 
everyone.  —  Elizabeth  Hochner,  a 
coordinator  in  public  health  nursing, 
Brantford,  Ont. 


A  voice  for  children  needed? 

Is  there  a  need  to  organize  a  voice  for 
children  in  Canada  to  make  visible,  ar- 
ticulate, and  secure  action  in  relation  to 
their  health  needs? 

I  have  undertaken  a  study  to  investi- 
gate the  concept  of  a  Canadian  Institute 
of  Child  Health.  I  will  be  consulting 
parents,  doctors,  nurses,  social  work- 


MOVING? 
BEING  MARRIED? 

Be  sure  to  notify  us  six  weeks  in  advance, 
otherwise  you  will  likely  miss  copies. 


Attach  the  Label 
.  From  Your  Last  Issue 

p>  OR 

Copy  Address  and  Code 
Numbers  From  It  Here 


NEW  (NAME) /ADDRESS: 


Street 


City 


Zone 


Prov, 'State  Zip- 

Please  complete  appropriate  category: 

I 1     I  hold  active  membership  in  provincial 

nurses'  assoc. 


reg.  no.  perm,  cert.'  lie.  no. 
I     I    I  am  a  Personal  Subscriber. 
MAIL  TO; 

The   Canadian   Nurse 

50  The  Driveway 

OTTAWA,  Canada  K2P  tE2 


ers,  and  other  allied  health  groups.  The 
opinions  of  politicians,  economists, 
administrators,  and  existing  organiza- 
tions will  also  be  solicited. 

Many  of  the  problems  in  child  health 
have  been  documented.  A  national  nu- 
tritional survey  indicated  grave  con- 
cerns regarding  the  status  of  nutrition 
among  Canadian  children  and  teen- 
agers. 

The  Celdic  report  indicated  a  crisis 
situation  in  learning  disabilities.  Re- 
cent reports  indicate  a  rise  in  teenage 
suicides.  Child  abuse  is  now  recog- 
nized as  a  national  problem.  Accidents 
are  the  major  cause  of  death  between  2 
and  5  years,  and  V.D.  is  reported  as 
having  reached  epidemic  proportions 
among  adolescents. 

Suggestions  have  proposed  that  an 
Institute  of  Child  Health  could:  identify 
problems  and  assign  priorities;  under- 
take studies  to  document  these  prob- 
lems and  propose  solutions;  secure 
"action"  through  public  awareness, 
the  political  process,  and  legislation; 
act  as  a  resource  and  information 
center;  provide  liaison  and  coordina- 
tion between  child  health  related  as- 
sociations and  institutions;  and  develop 
a  national  plan  for  the  future  health  care 
of  children. 

I  would  like  the  opinions  of  readers. 
Do  you  agree  or  disagree  with  this  con- 
cept? I  would  also  welcome  sugges- 
tions on  the  location  of  the  institute  and 
how  you  think  it  might  be  established 
and  organized.  Please  write  or  call  — 
Shirle\  Post,  RN,  48  Powell  Avenue, 
Ottawa,  Ontario,  KIS  2AI.  tel.  (613) 
232-0702. 


IPPB  techniques  overlooked 

The  use  of  ippb  treatments  (In  A  Cap- 
sule, July  1975)  is  subject  to  much  con- 
troversy. One  thing  is  invariably  over- 
looked when  considering  IPPB  treat- 
ments —  technique.  Improper  tech- 
nique will  destroy  the  value  of  any 
treatment. 

It  is  all  very  well  to  advocate  deep 
breathing  to  prevent  postop  atelectasis, 
but  how  many  readers  are  aware  that 
improper  abdominal  splinting  (to  ease 
stress  on  the  incision)  can  reduce  vital 
capacity  by  as  much  as  75<Jf?  Do  you 
(Continued  on  page  6) 


inMi  rncon  vvv^i^iucnrui-  tmll  luuin. 


THAT  ONLY  WHITE  SISTER  CAN  CREATE 


A) 

Style  No.  5862 

Sizes  12-20 

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White,  Blue about  $25.0 

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Sizes  3-13 

Royale  Seersucker, 

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White,  Yellow about  $33.0 

C) 

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Sizes  1 2  -  20 

Royale  Seersucker, 

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White,  Blue about  $33.0 


^feMU 


CAREER  APPAREL 

o^ ^..^  ^^...  r.^^  A«  MfhitAc  anri  uuator  rnlniir<s  fit  fine  stores  across  Canada 


Next  Month  in 

The 

Canadian 
Nurse 

•  The  Artificial  Urinary  Sphincter 

•  Fashions  for  the 

Physically  Handicapped  Woman 

•  Screening  for  Adolescent 
Idiopathic  Scoliosis 

•  New  Lenses  for  Old  Ones  — 
a  promising  method 

for  treating  cataracts 


^^P 


Photo  Credits 
for  October  1975 

Information  Canada, 
Cover  photo 

Buckley's  Studio  Ltd., 
Antigonish,  N.S. 
p.  15 

Jim  Chambers, 
Toronto,  Ontario, 
p.  21  (photo  of  noted 
Canadian  artist  A.Y.  Jackson) 

Miller  Services, 
Toronto,  Ontario, 
pp.  30,  31 

H.  Tremblay, 
Ottawa,  Ontario, 
p.  28 

University  of  Calgary, 
Calgary,  Alberta, 
pp.  18,  19,  20 

Wambolt  Waterfield, 
The  Mail  Star, 
HaUfax,  N.S., 
p.  10 


letters 


(Continued  from  page  4) 


know  how  to  recognize  this  condition 
and  correct  it?  How  many  readers  al- 
ways set  ventilators  at  the  same 
parameters  and  how  many  adjust  them 
during  the  course  of  a  treatment? 

I  am  not  advocating  100%  use  of 
IPPB.  This  apparatus  cannot  do  any- 
thing that  healthy  persons  cannot  do  for 
themselves.  However,  the  patient  who 
cannot  or  will  not  adequately  expand 
his  lungs  will  benefit  from  properly  ap- 
plied IPPB  —  G.T.  McNabb,  R.N.. 
R.R.T.,  Surrey,  British  Columbia. 


Love  thy  neighbor. . . 

In  the  recent  controversy  regarding  aid 
to  the  starving  people  of  the  world,  it 
would  seem  that  emotionalism  is  being 
allowed  to  cloud  the  issue.  It  is  true  that 
if  we  are  to  be  compassionate  and  fol- 
low the  ""Golden  Rule,"  we  must  to 
some  extent  become  our  brother's 
keeper.  However  there  is  a  point  at 
which  rationality  and  reasonable  expec- 
tations must  take  over. 

Most  people  who  hold  out  their 
empty  food  bowls  to  us  today  live  in 
countries  that  have  suffered  chronic 
malnutrition,  starvation,  overpopula- 
tion, and  natural  disasters  for  centuries. 
They  are  made  more  visible  to  us  not 
because  the  problem  is  necessarily 
worse,  but  because  our  comunication 
systems  have  improved  and  now  bring 
the  acuteness  of  the  problem  to  us,  dis- 
aster by  disaster,  as  they  occur. 

This  is  not  to  say  that  we  should 
ignore  the  problem.  Far  from  it.  I  do, 
however,  believe  we  have  to  consider 
carefully  the  form  in  which  we  provide 
our  help.  If  we  do  nothing,  millions  will 
starve.  If  we  constantly  provide  con- 
tinuing handouts,  only  thousands  will 
starve.  But  what  do  they  look  forward 
to  in  the  future?  Will  those  who  survive 
do  so  only  to  live  on  and  bring  more 
children  into  the  world  to  share  this 
misery  and  cry  out  for  more  handouts 
when  famine,  flood,  or  pestilence 
strikes? 

How  much  better  it  would  be  to  pro- 
vide aid  under  controlled  conditions  to 
try  and  improve  the  outlook  for  the  fu- 
ture. I  do  not  believe  this  is  a  forcing  of 
ideals  and  values  on  others,  as  J.  Zon- 
neveld  suggests  ("letters,"  June  1975, 
p.  4).  I  believe  it  is  our  responsibility  to 
make  the  knowledge  we  have  available 
and  understandable  to  others,  so  they 
can  lower  mortality  and  birth  rates  and 
improve  the  quality  of  life  for  those 
now  living,  if  they  so  desire. 

Our  aid  should  be  a  two-pronged  ef- 


fort. The  short-term  goal  should  be  ' 
save  those  we  can.  The  long-term  g(\ 
should  be  to  enable  those  who  surv  i 
to  improve  the  future  for  themsel\ 
and  their  children  by  preventing  or  co 
ing  with  future  disasters.  It  would  i 
heartening  to  see  this  in  the  form 
more  small,  scattered,  local  self-he 
projects,      rather     than     massi\ 
govemment-to-govemment  aid  that 
often  goes  astray  and  does  not  reac 
those  for  whom  it  was  intended. 

The  choice  to  accept  the  aid  with  i 
short-  and  long-term  goals  would  1 
that  of  the  leaders  and  people  to  who; 
it  is  offered.  I  do  believe  that  we  ha\ 
the  right  to  insist  that  both  sets  of  goa 
be  accepted,  if  aid  is  received.  This 
ohly  common  sense  and  sell 
preservation.  If  we  do  not,  eventuall 
the  source  of  handouts  will  run  out  an 
then  we  will  all  starve.  After  all,  th 
Golden  Rule  is  '"Love  thy  neighbor  . 
thyself."  —  Dawn  McDonald  R.\ 
B.N..  Nurse-Teacher,  Mississauga,  Oni 


Takes  the  trash  out  of  M*A*S*H  ' 

Margaret  B.  Evans  reacted  intelligenil 
to  the  program  "Last  of  the  four  lettej 
words"  (Letters.  July  1975).  But  on' 
of  her  last  paragraphs  prompts  me  t 
take  the  trash  out  of  M*A*S*H. 

I  was  a  nursing  sister  in  Korea,  ani 
was  invited  to  both  the  American,  am 
Norwegian  MASH  units,  where  I  sav 
them  in  action. 

Most  of  the  staff  belonged  to  tht 
permanent  forces,  but  countless  doc 
tors,  surgeons  especially,  had  taker 
leaves  of  absence  from  eminent  posts  ii 
serve  a  cause.  They  sought  neither  per 
sonal  glory,  nor  material  gain. 

With  minimum  clerical  work,  thi' 
was  an  astounding  feat.  Useless  limhv 
were  amputated  and  major  abdominal, 
surgery  was  undertaken  on  a  maze  of; 
operating  room  tables.  Nurses  with  in-' 
finite  know-how  orchestrated  the  per- 
formance. There,  I  saw  a  true  dedica- 
tion to  one's  vocation. 

I  felt  that  the  operators,  performing 
to  save  patient's  lives,  were  fulfilling 
their  ideals  as  medical  workers  —  ide- 
als that  are  often  forgotten  by  many  of 
us. 

The  only  pertinent  similarity  be- 
tween fictional  M*A*S*H  and  the  ac- 
tual units  was  the  dramatic  sound  of 
war  in  the  background. 

If  love  affairs  developed,  I  say 
"good  for  them".  In  those  tragic  hours 
there  was  little  time  left  for  that  — ^ 
Therese  Berris,  R.N.,  Nanaimo,  B.C.i; 


news 


Singapore  Meeting  Proves 
ICN  More  Vital  Than  Ever 


Singapore  —  According  to  CNA  president  Huguette  Labelle,  the  meeting  of  the 
Council  of  National  Representatives  of  the  International  Council  of  Nurses  in 
Singapore  August  4  to  8  clearly  indicates  the  importance  of  the  ICN  to  the  nursing 
profession  in  many  countries  of  the  world. 

■'The  stand  taken  on  several  professional  issues,  along  with  exchanges  and 
discussion,  will  serve  as  a  lever  to  upgrade  the  quality  of  care  and  educational 
programs,"  Labelle  reported  on  her  return.  She  noted  that,  even  though  the 
question  of  annual  dues  was  discussed,  all  countries  worked  in  harmony  to  find  a 
solution  without  forgetting  that  the  professional  matters  on  the  agenda  required  as 
much  attention. 


Forty-eight  of  the  84  ICN  member 
associations  were  represented  at  the 
meeting.  The  Canadian  Nurses"  As- 
sociation was  represented  by  executive 
director,  Helen  K.  Mussallem,  as  well 
as  CNA  president  Labelle. 

Major  decisions  were  taken  on  the 
definition  of  the  nurse,  membership  in 
ICN.  annual  fees,  continuing  education, 
the  role  of  the  nurse  in  the  environment, 
and  the  role  of  the  nurse  in  the  care  of 
detainees  and  prisoners.  CNA  library 
will  receive  official  texts  of  these  posi- 
tion statements.  More  information  can 
also  be  obtained  directly  from  ICN 
Headquarters,  P.O.  Box  42,  1211 
Geneva  20,  Switzerland. 

Definition  of  the  nurse 

The  new  definition  of  the  nurse  dif- 
fers from  the  previous  one  in  that  it 
outlines  the  general  contents  of  the 
educational  program  and  respon- 
sibilities of  the  first  and  second  level 
nurse.  The  earlier  definition  was 
adopted  at  the  International  Convention 
in  Mexico  in  1973.  It  was  amended  at 
the  suggestion  of  the  Professional  Ser- 
vices Committee. 

A  definition  of  the  nurse  is  crucial 
since  it  both  determines  membership  in 
ICN,  and  also  defines  the  scope  of  nurs- 
ing  practice.  Since  it  is  the  only 
worldwide  definition,  ICN  believes  it 
will  influence  not  only  curricula  of 
schools  of  nursing  throughout  the 
world  but  also  the  attitude  of  govern- 
ments and  professional  groups. 

Fees  raised  38  percent 

The  recommendation  of  the  board  of 


directors  that  ICN  dues  be  increased  by 
Sw.  frs.  1.50  to  bring  the  total  to  Sw. 
frs.  3. 10  per  capita  was  withdrawn  and 
replaced  by  a  recommendation  that  the 
dues  be  increased  to  a  total  of  2.20  per 
capita. 

Before  this  resolution  was  carried, 
the  possibility  of  increasing  dues  on  a 
sliding  scale  was  discussed.  After  agree- 
ing on  the  increase  of  Sw.  frs.  0.60, 
effective  January  1976.  the  CNR  voted 
to  authorize  the  board  of  directors  to 
study  the  principle  of  a  sliding  scale  and 
to  prepare  for  1977  a  paper  with  rec- 
ommendations for  circulation  to  all 
member  associations  six  months  in  ad- 
vance of  the  CNR  meeting  if  at  all  possi- 
ble. 

Dues  for  member  associations  are 
based  on  annual  active  membership. 
An  active  member  was  defined  at  this 
meeting  as  one  who  meets  the  criteria 
of  the  iCNs  definition  of  the  nurse,  pays 
dues  to  a  national  association,  and  en- 
joys full  membership  rights  and 
privileges  on  a  continuing  basis. 

Based  on  these  changes,  CNA's  an- 
nual per  capita  contribution  to  ICN  will 
increase  from  63^  to  75^  making  a  total 
of  approximately  $88,505.40  com- 
pared to  $65,707.40  before  the  fee  in- 
crease. 

Continuing  education 

A  position  statement  on  continuing 
education  issued  by  the  ICN  stresses  the 
importance  of  continuing  education  to 
ensure  safe  and  effective  nursing.  Ac- 
cording to  the  statement,  continuing 
education  should  be  developed  by,  and 
conducted  within,  the  nursing  and/ or 


general  education  system  in  coopera- 
tion with  nurses"  associations,  gov- 
ernment and  health  agencies. 

The  ICN  urges  member  associations 
to  take  the  lead  in  initiating,  promoting, 
and  further  developing  a  national  sys- 
tem of  continuing  nursing  education. 
Although  Canada  cannot  "adopt  a  na- 
tional system  because  of  provincial  re- 
sponsibility in  education.  CNA  can  en- 
courage provincial  associations  to 
promote  continuing  education. 

The  nurse  and  the  environment 

According  to  the  ICN,  part  of  the 
nurse"s  role  in  safeguarding  the  envi- 
ronment consists  of  keeping  informed 
and  communicating  this  knowledge  to 
individuals,  families,  and  community 
groups.  It  also  involves  assisting  com- 
munities in  their  action  on  environmen- 
tal health  problems  and  participating  in 
research  to  detect  the  harmful  effects  of 
the  environment  on  man  and  vice  versa. 
Mussallem  believes  Canadian  nurses 
should  put  these  principles  into  prac- 
tice. "The  role  of  the  nurse  in  this  re- 
spect should  be  emphasized  in  basic  as 
well  as  continuing  and  in-service  edu- 
cational programs,""  she  urged. 

Care  of  detainees  and  prisoners 

In  a  statement  on  the  care  of  de- 
tainees and  prisoners,  ICN  condemns 
the  use  of  procedures  harmful  to  mental 
and  physical  health  and  encourages 
nurses  who  have  knowledge  of  such 
procedures  to  take  action.  This  would 
include  reporting  to  national  and  inter- 
national bodies. 

The  ICN  also  believes  a  nurse  should 
participate  in  clinical  research  on  pris- 
oners only  if  the  patient  has  given  free 
consent  after  having  been  given  a  com- 
plete explanation  of  the  implications. 

Other  resohitions 

Other  topics  included  participation 
of  students  in  the  next  quadrennial  con- 
vention in  Tokyo  in  1 977.  the  theme  of 
which  will  be  ""New  Horizons  for  Nurs- 
ing;" discussing  with  authorities  the 
disappearance  of  the  chief  nurse  posi- 
tion at  WHO  headquarters:  encouraging 
regional  groupings  of  nurses"  associa- 
tions; and  fighting  employment  dis- 
crimination on  the  grounds  of  sex. 

(Continued  on  page  10) 


'HE  CANADIAN  NURSE  —  OcloOer  1975 


TEAM 


Today's  practice  of  surgery 
requires  a  team  effort. .  .a  team  ci 
surgical  specialists,  cooperating  i 
to  give  the  patient  the  benefits 
of  new  and  advanced  procedure.'^ 
Many  such  new  techniques  i 
require  new  and  special  ' 

instruments . . .  and  that's  where 
we  come  in... 

We  are  TEAM  MUELLER. .. 

A  team  of  instrument  makers, 
trained,  skilled,  seasoned  in  our 
craft . . .  with  the  one  aim  of  puttin< 
into  your  hands  dependable 
instruments  with  which  to  make 
the  most  of  your  own  talents 
and  techniques. 

Each  of  us  is  a  specialist  in  his 
own  right. . .a TEAM  MUELLER 
man  fashioning  proper 
instruments  for  the  modern 
surgeon. 


MUELLER 

Together  we  can  do  more  for  you. 


Whatever  your  own  particular 
field  of  practice,  TEAM  MUELLER 
iprovides  more  of  tiie  instruments 
you  need.  Botli  standard  and 
special  instruments  for  all  surgery 
...abdominal  and  pelvic... 
gynecologic . . .  urologic . . .  tlioracic 
|. . .  cardiovascular . . .  plastic, 
Ireconstructive . . .  orthopaedic 
. .  neurologic . . .  ophthalmic, 
otologic,  rhinologic,  oral,  laryngeal 
and  bronchoscopic. . .  including, 
of  course,  superb  delicate 
instruments  for  all  microsurgery. 

Together  we  can  do  more  for  you, 

because  we  do  more  than  just 
make  fine  instruments.  We  have 
informed  representatives  and 
creative  consultants  to  help  you. 
And  our  research  and 
development  staffs,  plus  skilled 
and  experienced  model  makers, 
can  help  bring  your  own  new  ideas 
toauspfiil  rfialitv 


You  get  more  than  fine 
instruments  from  TEAM 
MUELLER.  You  also  get  our 
complete,  no-nonsense  guarantee 
with  every  V.  Mueller  instrument 
. .  which  means,  simply,  that  if 
it  isn't  right  in  every  way  we 
want  it  back  for  correction  or 
replacement. 


And  you  get  the  finest  of 
surgical  equipment,  too.  Carefully 
selected  products  of  foremost 
manufacturers,  both  here 
and  abroad. 

You  can  rely  on  TEAM  MUELLER. 
Together,  we  can  do  more  for  you! 


And  when  you  need  it.  you  get 
professional  repair  service . . . 
both  efficient  and  fast . . .  because 
the  same  men  who  make  fine 
instruments  will  repair  yours 
(regardless  of  who  may  have 
manufactured  them). 


CVASANTII 
¥   Mafc.  kHkr  »  I  ■■■■  -mr  miffml  — ■■■   ■       *— ^ 


VMUEllEr 

Division  of  IVIc  Gaw  Supply  Ltd. 

536  GORDON  BAKER  RD 


news 

(Continued  from  page  7) 


CNF  Awards  6  Scholarships 

For  1975-76  Academic  Year 

Ottawa  —  The  Canadian  Nurses' 
Foundation  has  announced  the  names 
of  6  nurses  who  will  receive  Founda- 
tion awards  for  graduate  studies  in  nurs- 
ing during  the  current  academic  year. 
The  6  scholarship  winners  will  share  a 
total  of  $17,900.  Scholarship  recipients 
are: 

DBeverlee  Ann  Cox,  Vancouver, 
B.C.,  has  been  awarded  the  Katherine 
E.  MacLaggan  Fellowship,  valued  at 
$4,500.  for  the  second  consecutive 
year.  Cox  is  a  former  nursing  consul- 
tant, department  of  psychiatry,  and  lec- 
turer, at  the  University  of  British  Col- 
umbia school  of  nursing.  She  will  con- 
tinue her  doctoral  studies  in  interper- 
sonal communication  in  psychiatric  set- 
tings at  Simon  Fraser  University. 
DFaye  M.  Brooks,  Toronto,  Ont.,  a 


public  health  nurse  with  the  Borough  of 
York  department  of  health,  has  re- 
ceived the  White  Sister  Uniform  Incor- 
porated Scholarship  Award  of  53,000. 
She  will  study  for  the  degree  of  master 
of  science  in  nursing,  with  a  major  in 
community  nursing,  at  the  University 
of  Toronto  school  of  nursing. 
DC.  Joy  Hackwell,  Montreal, 
Quebec,  has  received  $3,000.,  includ- 
ing the  W.B.  Saunders  Company 
Canada  Limited  Nursing  Fellowship 
and  CNF  scholarship  funds.  She  will 
continue  her  studies  for  a  master  of 
science  (applied),  degree,  with  a  major 
in  nursing  administration  at  the  school 
of  nursing,  McGill  University.  Hack- 
well  was  director  of  nursing  at  the 
Montreal  Neurological  Hospital. 
OGeraldine  A.  Hart,  Montreal, 
Quebec,  has  been  awarded $3,000.,  in- 
cluding The  Helen  McArthur  Canadian 
Red   Cross    Fellowship   for  Graduate 


The  ad  hoc  committee  appointed  by  the  Canadian  Nurses'  Association  to  plan  the 
CNA  annual  general  meeting  and  convention  is  shown  during  one  of  several 
meetings.  The  members  are:  Glenna  Rowsell,  Fredericton,  N.B.,  chairman; 
Frances  Moss,  Halifax,  N.S.,  seated:  and.  left  to  nghl.  standing,  Lorine  Besel, 
Montreal;  Dorothy  Miller.  Halifax;  and  Jane  Henderson,  Ottawa.  The  national 
convention  will  be  hosted  by  the  Registered  Nurses'  Association  of  Nova  Scotia, 
and  more  than  1,000  nurses  from  across  Canada  are  expected  to  attend. 


Studies  and  CNF  scholarship  funds.  She 
will  study  for  the  degree  of  master  ol 
science  in  nursing  at  the  University  ol 
British  Columbia.  Hart  is  an  inservice 
education  coordinator  at  the  Montreal 
Neurological  Hospital. 
D  Patricia  Dianne  McKeever 
Montreal,  Quebec,  has  received 
$3,000.,  including  The  Helen  McArthur 
Fellowship  for  Graduate  Studies  and 
CNF  scholarship  funds.  She  will  con 
tinue  to  study  for  the  degree  of  master 
of  science  (applied),  with  a  nurse  clini- 
cian major,  specializing  in  chronic  dis- 
eases in  adults,  at  McGill  University 
school  of  nursing. 

[2  Mary  Louise  McSheffrey, 
Ordmocto,  N.B.,  has  been  awarded 
$1,400.,  including  The  Helen 
McArthur  Canadian  Red  Cross 
Fellowship  for  Graduate  Studies  and 
CNF  scholarship  funds.  A  lecturer  with 
the  faculty  of  nursing.  University  of 
New  Brunswick,  McSheffrey  will 
study  for  her  master's  degree,  with  a 
major  in  maternal  and  child  health  care 
at  McGill  University. 

The  Canadian  Nurses'  Foundation 
was  established  by  CNA  in  1962  to  help 
educate  nurses  for  leadership  positions 
in  the  Canadian  health  field.  This 
year's  awards  bring  the  total  number  of 
CNF  scholars  to  132. 


Saskatchewan  Nurses  Stage 
58th  Annual  Meeting 

Saskatoon,  Sask.  —  Three  hundred 
nurses  who  attended  the  annual  meet- 
ing of  the  Saskatchewan  Registered 
Nurses'  Association  have  paved  the 
way  for  development  of  a  stronger  and 
more  effective  professional  association 
in  that  province.  The  suggestions  came 
from  a  panel  of  3  speakers  during  edu- 
cation sessions  on  the  theme  of  "You 
and  Your  Association." 

Alice  Baumgart,  associate  profes- 
sor, school  of  nursing.  University  ol 
British  Columbia,  pointed  out  that 
many  of  the  responsibilities  tradition- 
ally assumed  by  professional  associa- 
tions, such  as  salary  negotiations  and 
educational  standards,  have  been  taken 
over  by  other  agencies. 

In  her  opinion,  professional  associa- 
tions should  now  be  concentrating  on 
two  areas:  stimulating  the  development 
and  application  of  nursing  knowledge 
to  improve  the  quality  of  patient  care, 
and  undertaking  an  enlarged  political 
role  in  defining  social  priorities  and 
evaluating  the  results  of  social  policy. 


Marie-Claire  Pommez,  professional 
officer  in  charge  of  collective  bargain- 
ing with  the  Canadian  Association  of 
University  Teachers,  warned  that  the 
problem  of  overlapping  responsibilities 
of  unions  and  professional  associations 
could  lead  to  a  competitive  situation 
that  would  undermine  the  strength  of 
both  of  them.  She  called  on  nurses  to 
play  a  more  active  role  both  within  their 
union  and  w  ithin  their  professional  as- 
sociation. 

Marion  Jackson,  the  third  panelist, 
warned  that  "if  nursing  is  to  survive,  it 
must  be  the  nurse  at  the  bedside  who 
demands  and  assists  in  setting  stan- 
dards for  patient  care."  The  deputy  ex- 
ecutive director  of  patient  care  services 
at  Saskatoon  City  Hospital  said  that 
loss  of  the  collective  bargaining  func- 
tion by  the  SRN.a  left  the  association 
free  to  get  down  to  the  primary  goals  of 
defining  nursing  practice  and  setting 
standards  for  care. 

SRNA  members  elected  two  new 
council  members  and  approved  a  bylaw 
change  that  will  increase  fees  by  SIO. 
from  $40  to  $50.  New  committee 
chairpersons  are  Carol  Kihn  of  Saska- 
toon and  Fay  Michayluk  of  Wakaw . 
Sister  Bernadette  Bezaire  was  returned 
for  a  second  term  as  first  vice- 
president. 

Two  nurses  were  awarded  honorary 
memberships  at  the  meeting.  They 
were  Ethel  Colvin  Hall,  Edmonton, 
and  Alice  Rose  Milne,  Meadow  Lake. 

A  total  of  14  resolutions  were  ap- 
proved by  delegates,  including  a  rec- 
ommendation to  be  made  to  the  Sas- 
katchewan Medical  Association,  that 
registered  nurses  be  hired  in 
physician's  offices  to  carry  out  nursing 
practices.  Other  recommendations 
dealt  with  a  proposal  to  establish  a  mas- 
ter of  science  in  nursing  degree  pro- 
gram at  the  College  of  Nursing,  Univer- 
sity of  Saskatchewan,  and  the  exten- 
sion of  UIC  benefits  to  include  women 
on  leave  because  of  the  adoption  of  a 
child. 


Registered  Nurses 

Your  community  needs  the  benefit 
of  your  skills  and  experience.  Volun 
teer  now  to  teach  Patient  Care  in 
The  Home  and  Child  Care  in  The 
Home  Courses.  — 


In  her  1975  presidential  address, 
Jean  McKay  urged  nurses  to  set  aside 
■"old  controversies'"  and  address  them- 
selves in  a  collective,  positive  way  to 
the  issues  at  hand.  She  identified  some 
of  these  issues  as  nursing  supply,  stan- 
dards, association  structure,  and  con- 
tinuing education  and  refresher 
courses. 

"If  the  nursing  shortage  is  to  be  re- 
duced," she  said,  "one  of  the  areas 
which  will  require  careful  examination 
is  working  conditions.  Nurses  are  still 
expected  to  provide  service  within  the 
old,  rigid  traditional  framework."  She 
suggested  that  many  of  the  solutions 
will  be  found  outside  the  nursing  pro- 
fession. 


Nova  Scotia  Nurses 
Accept  Contract 

Halifax.  Nova  Scotia  —  Nurses  em- 
ployed by  the  Civil  Service  Commis- 
sion of  Nova  Scotia  have  voted  to  ac- 
cept a  contract  with  benefits  similar  to 
those  negotiated  by  4  Halifax  hospitals 
eariier  this  summer.  The  Nova  Scotia 
Government  Employees"  Association 
has  been  the  negotiating  body  for  the 
new  contract. 

The  negotiated  benefits  include  a 
premium  for  evening  and  night  shifts,  a 
pay  clause  for  "acting"'  in  a  higher 
position,  sick  leave  benefits  at  2  Vz  days 
per  month  up  to  300  per  year,  and  4 
weeks"  vacation  after  4  years  of  ser- 
vice. The  salaries  for  general  duty  will 
range  from  59,600  to  $12,000  for  1975 
andfrom$10,740to$l3,140for  1976. 
This  is  an  increase  on  the  basic  rate  of 
22.8<7f  for  1975  and  II. 8%  for  1976. 

A  fifth  increment  in  the  pay  level  has 
been  established  for  1975  and  this  will 
entitle  a  nurse  with  5  years  or  more  of 
experience  to  an  increase  of  299c  for 
1975  and  9.5%  for  1976. 

Nursing  personnel  represented  by 
the  association  work  in  4  provincial 
hospitals  including  the  Victoria  Gen- 
eral Hospital.  Halifax;  Nova  Scotia 
Sanatorium.  Kentville;  and  the  Pt.  Ed- 
ward Hospital.  Sydney.  The  public 
health  nurses  under  the  Provincial  De- 
partment of  Health  are  also  included. 

The  same  personnel  were  involved  in 
a  dispute  with  the  government  in  1973. 
The  conflict  led  to  mass  resignations  at 
the  Victoria  General  Hospital  and 
sporadic  resignations  at  the  Nova 
Scotia  hospital. 


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-E  CANADIAN  NURSE  —  October  1975 


The  Future  Depends  on  Leadership 

prepare  your  students 
today  for  the  challenge  of  tomorrow 


pindamentals 


New  9th  Edition!  TEXTBOOK  OF  ANATOMY  AND 
PHYSIOLOGY.  By  Catherine  Parker  Anthony,  R.N.. 
B.A.,  M.S.  with  the  collaboration  of  Norma  Jane 
Kolthoff.  R.N.,B.S. ,  Ph.D.  Through  eight  editions  this 
text  has  proven  its  quality  and  validity  as  THE  most 
widely  adopted  anatomy  and  physiology  textbook.  This 
new  edition  includes:  updating  of  nearly  all  chapters; 
three  new  chapters  on  the  nervous  system;  and  much 
more!  April,  1975.  608  pp.,  336  figs.  (145  in  color), 
including  239  by  Ernest  W.  Beck,  and  an  insert  on 
human  anatomy  containing  1 5  full-color  plates,  with  six 
in  transparent  Trans-Vision®  (by  Ernest  W.  Beck). 
Price,  $13.^5. 

New  9th  Edition!  ANATOMY  AND  PHYSIOLOGY 
LABORATORY  MANUAL.  By  Catherine  Parker  An- 
thony, R.N. ,B.A.,  M.S.  April.  1975.244  pp.,  8"  X  10", 
115  drawings,  69  to  be  labeled.  Price,  $6.60. 

Newly  Revised  for  the  9th  Edition!  THE  3SMM 
TEACHING  SLIDES.  Forty  2x2  teaching  slides  in 
color,  suitable  for  use  with  any  35mm  projector. 
August,  1975.  About  $42.00. 

New  10th  Edition!  WORKBOOK  OF  SOLUTIONS 
AND  DOSAGE  OF  DRUGS:  Including  Arithmetic.  By 

Ellen  M.  Anderson,  R.N..  B.S.,  M.A.  and  Thora  M. 
Vervoren,  R.Ph.,  B.S.  With  this  new  edition  the 
authors  have  included  many  new  problems,  extended 
emphasis  on  the  Metric  System  and  related  problems, 
and  expanded  appendix  information.  Logical  organiza- 
tion of  previous  editions  has  been  retained:  arithmetic 
and  measurements;  solutions;  dosage;  and  appendix. 
January,  1976.  Approx.  200  pp.,  32  illus.  About  $6.55 

A  New  Book!  BASIC  SCIENCE  AND  THE  HUMAN 
BODY:  Anatomy  and  Physiology.  By  Stewart  Brooks; 
with  II  consulting  authorities .  This  new  text  provides  a 
readable  presentation  of  anatomy,  physiology,  and 
pathology  of  human  body  systems,  with  background 
material  on  relevant  basic  sciences.  Each  chapter  has 
been  critically  reviewed  by  a  professional  in  the 
appropriate  field,  then  revised  on  the  basis  of  these 
insights.  The  text  is  organized  by  body  systems, 
presenting  anatomy  and  physiology,  and  relevant  basic 
sciences  of  each.  February,  1975.  500  pp.,  386  illus. 
Price,  $13.15. 


New  9th  Edition!  SELF-TEACHING  TESTS  IN 
ARITHMETIC  FOR  NURSES.  By  Ruth  W.  Jessee, 
R.N.,  Ed.D.  and  Ruth  W.  McHenry.  R.N.,  M.A.  This 
new  edition  continues  to  help  students  develop  a  strong 
background  in  basic  applied  arithmetic,  in  class  or  by 
independent  study.  Effective  organization  of  previous 
editions  has  been  retained.  Part  I  reviews  basic 
arithmetic  skills;  Part  II  deals  with  weights  and 
measures;  and  Part  III  covers  solutions  and  calculation 
ofdosages  for  infants  and  children.  February,  1975.228 
pp.,  15  illus.  Price,  $6.25. 


New  3rd  Edition!  CLINICAL  NURSING  TECH- 
NIQUES. By  Norma  Dison,  R.N..  B.A.,  M.A.  A  new 
edition  continues  to  provide  explanatory  text  and 
meaningful  illustrations  of  techniques  used  in  nursing. 
While  the  general  format  is  similar  to  past  editions, 
some  content  has  been  rearranged  and  new  material  has 
been  added.  Topics  new  to  this  edition  include:  use  of 
sterile  disposable  gloves,  heel  and  elbow  protectors, 
commercial  restraints,  and  more!  April,  1975.  400  pp., 
691  illus.  by  Marita  Bitans.  Price,  $8.95. 


family 
nursing 


New  2nd  Edition!  FAMILY  NURSING:  A  Study  Guide. 

By  Evelyn  G.  Sobol,  R.N.,  A.M.  and  Paulette 
Robischon.  R.N.,  Ph.D.  By  presenting  various  family 
situations,  this  new  edition  challenges  students  in 
clinical  application  of  family  nursing  techniques. 
Individual  sections  deal  in  depth  with  beginning 
families,  families  with  school  age  children,  "middle 
years"  families,  and  aging  families.  June.  1975.  198  pp. 
Price,  $7.65. 


12 


with  new  Mosby 

texts 


maternal/ 

child 

nursing 


New  3rd  Edition!  CHILDBIRTH:  FAMILY- 
CENTERED  NURSING.  By  Josephine  lorio.  R.N., 
B.S..  M.A..  M.Ed.  In  this  new  edition,  childbirth  is 
examined  as  a  life  cycle  event  and  a  family  experience, 
emphasizing  quality  rather  than  quantity.  Concepts  of 
planning,  intervention,  and  evaluating  interaction  with 
expectant  couples  are  clearly  detailed.  Content  is 
divided  into  units  including  reproduction,  maternity 
cycle,  and  deviations  from  normal  maternity  cycle. 
January  ,  1975.  480  pp..  199  illus.  Price,  $10.00. 


A  New  Book!  REVIEW  OF  MATERNAL  AND  CHILD 
NURSING.  By  Janice  L.  Goerzen,  R.N..  B.Sc.N.  and 
Peggy  L.  Chinn,  R.N.,  Ph.D.  In  question  and  answer 
form,  this  new  text  displays  a  comprehensive  review  of 
the  basic  elements  of  maternal  and  child  health  nursing. 
The  authors  provide  lucid  discussions  on:  family  and 
culture;  human  sexuality  and  family  planning;  nursing 
management  in  risk  situations;  behavioral  problems; 
the  battered  child;  and  more.  April,  1975.  222  pp.  Price, 
$7.30. 


issues, 

trends  and 

ilministration 

A  New  Book!  NURSING  SERVICE  ADMINISTRA- 
TION: Managing  the  Enterprise.  By  Helen  M.  Dono- 
van, R.N. ,  M.A.  This  new  book  will  be  valuable  to  any 
nurse  responsible  for  the  work  of  others.  The  author 
encourages  efficiency,  completeness,  and  economy  in 
executing  the  purposes  and  goals  of  the  nursing  service. 
Topics  include:  planning,  organizing,  staffing,  direct- 
ing, controlling,  coordination,  reporting,  budgeting, 
public  relations,  research  and  creativity,  and  more. 
November,  1975.  Approx.  384  pp.,  27  illus.  About 
$6.25. 

HE  CANADIAN  NURSE  —  Oclober  1975 


A  New  BooA. 'NURSING  ADMINISTRATION:  Theory 
for  Practice  with  a  Systems  Approach.  By  Clara  Arndt, 
R.N.,  M.S.  and  Loucine  M.  Daderian  Huckabay, 
R.N..  Ph.D.  This  new  book  uses  a  general  systems 
theory  frame  of  reference.  Applying  principles  and 
theories  of  business  management  to  nursing  service 
administration,  the  authors  discuss  such  topics  as: 
goals  and  objectives,  administrative  composite  pro- 
cess, conceptual  and  physical  acts.  August,  1975.  308 
pp.,  26  illus.  Price,  $12.55, 


A  New  Book !  NURSES  IN  PRACTICE :  A  Perspective  on 
Work  Environments.  By  Marcella  Z.  Davis,  R.N., 
D.N.Sc;  Marlene  Kramer,  R.N.,  Ph.D.;  and  Anselm 
L.  Strauss.  Ph.D.  This  text  offers  insights  into  nursing 
practice  in  a  variety  of  health  care  settings.  Among 
these  environments  are  the  intensive  care  unit, 
pediatric  ward,  emergency  department,  and  the  indi- 
vidual patient's  home  and  neighborhood.  January, 
1975.  288  pp.  Price,  $7.30. 


A  New  Book!  DECISION  MAKING  IN  NURSING: 
Tools  for  Change.  By  June  T.  Bailey.  R.N.,  Ed.D.  and 
Karen  E.  Claus.  Ph.D.;  with  4  contributors.  This  new 
text  offers  unique  approaches  to  solving  patient-care 
and  management  problems.  A  systems  model  and  other 
tools  have  been  designed  to  help  nurses  make  rational, 
defensible  decisions.  To  bridge  the  gap  between  theory 
and  practice,  actual  case  studies  are  presented.  May, 
1975.  190  pp.,  63  illus.  (29  drawings  by  Bee  Walters). 
Price,  $6.85. 


A  New  Book!  POLITICAL  DYNAMICS:  Impact  on 
Nurses  and  Nursing.  By  Grace  L.  Deloughery.  R.N.. 
Ph.D.  and  Kristine  M.  Gebbie,  R.N..  M.N.  This  book 
informs  nurses  about  the  political  process  in  general,  as 
well  as  specific  health  care  legislation  that  is  being 
passed  or  proposed  without  their  participation.  The 
authors  encourage  nurses  to  become  a  force  that  can 
influence  legislation  that  may  be  enacted  in  health  care. 
April,  1975.  246  pp.  Price,  $11.05. 

A  New  Book!  MANAGEMENT  FOR  NURSES:  A 
Multidisciplinary  Approach.  By  Sandra  Stone,  M.S.; 
Marie  Streng  Berger,  M.S.;  Dorothy  Elhart,  M.S.; 
Sharon  Cannell  Firsich,  M.S.;  and  Shelley  Baney 
Jordan,  M.N.  The  selected  readings  in  this  new  text 
explore  modem  concepts  of  nursing  management.  The 
authors  consider  the  major  factors  which  influence 
efficient  organization:  structure,  personnel,  and 
economic  or  extrinsic  factors.  December,  1975.  Ap- 
prox. 256  pp.,  24  illus.  About  $8.65. 


M05BV 

TIMES  MIRROR 

THE    C    V    MOSBY  COMPANY.  LTD 

86   NORTHLINE    ROAD 

TORONTO.  ONTARIO 

M4B   3E5 


13 


practical 
nursing 


New  3rd  Edition!  MATERNAL  AND  CHILD  HEALTH 

NURSING.  By  A.  Joy  Ingalls,  R.N.,  M.S.  and  M. 
Constance  Salerno,  R.N.,  M.S.  A  completely  unified 
presentation  combines  obstetric  and  pediatric  nursing 
in  a  manner  geared  to  the  needs  of  today's  bedside 
practical  nurse.  The  transition  from  obstetrics  to 
pediatrics  is  well  executed  and  unified  by  use  of  the 
family  and  family  relationship.  Two  completely  new 
chapters  are  "Intensive  Care  of  the  Newborn"  and 
"The  Long-Term  Pediatric  Patient  —  emphasizing 
Rehabilitation."  Markedly  revised  throughout,  the  text 
mcludes  new  charts,  discussions  and  tables  to  provide 
students  with  an  overview  of  past  and  present 
developments  in  maternal-child  care;  three  methods  of 
pelvic  measurement;  new  information  on  birth  control 
abortion;  and  more!  August,  1975.  704  pp.,  627  illus 
Price,  $12.55. 

New  3rd  Edition !  MATERNAL  AND  CHILD  HEALTH 
NURSING  STUDY  GUIDE.  By  A.  Joy  Ingalls,  R.N., 
M.S.  and  M.  Constance  Salerno,  R.N.,  M.S.  August 
1975.  Approx.  264  pages,  7  1/4"  x  10  1/2",  37  illustra- 
tions in  23  figures.  Price,  $6.25. 


New  5th  Edition!  MOWRY'S  BASIC  NUTRITION 
AND  DIET  THERAPY.  By  Sue  Rodwell  Williams, 
M.R.Ed.,  M.P.H.  Maintaining  the  style,  general 
purpose  and  organization  of  previous  editions.  Sue 
Rodwell  Williams  has  brought  the  material  and 
references  in  the  new  5th  edition  completely  up-to- 
date.  New  material  includes:  revisions  of  the  Recom- 
mended Dietary  Allowance  made  in  1973  by  the  Food 
and  Nutrition  Board  of  the  National  Research  Council- 
enlargement  of  the  table  of  The  Basic  Four  Food 
Groups  in  terms  of  food  types  and  quantities  and  the 
major  nutrient  contributions  of  each  group;  a  new 
section  on  community  nutrition;  and  new  material  in 
the  diet  therapy  sections.  February,  1975.  228  pp  5 
illus.  Price,  $6.25. 


New   2nd   Edition!    CARE    OF    PATIENTS    WITH 
EMOTIONAL  PROBLEMS:  A  Textbook  for  Practical 

^urses.By  Dolores E.Saxton.R.N.,B.S.,M.A.,  Ed. D 
and  Phyllis  W.  Haring,  R.N.,  B.S.,  M.S.,' M.Ed. 
Designed  to  assist  practical  nursing  students  in 
identifying  and  meeting  emotional  needs  of  patients, 
this  new  edition  provides  essential  background  know- 
ledge on  personality  development,  dynamics  of  be- 
havior, manifestations  of  anxiety  and  defense 
mechanisms.  Study  questions  have  been  added  to  the 
end  of  each  chapter  for'student  review.  May,  1975.  1 18 
pp.,  8  illus.  Price,  $5.00. 


New  2nd  Edition!  THE  CARE  OF  THE  ELDERLY 
PERSON:  A  Guide  for  the  Licensed  Practical  Nurse.  By 

Maureen  J.  O'Brien,  R.N.,  M.S.  This  new  edition 
demonstrates  the  role  and  responsibility  of  the  licensed 
practical  nurse  in  caring  for  the  elderiy  person.  It 
presents  a  balanced  picture  of  the  aging  process, 
recognizing  its  difficulties  as  well  as  its  joys.  Other 
topics  discussed  include  the  role  of  economics  in  aging 
and  the  ability  of  the  elderiy  person  to  adapt  to  internal 
and  external  stimuli.  March,  1975.  174  pp.,  30  illus 
Price,  $6.25. 


5th  Edition.  PRACTICAL  NURSING:  A  Textbook  for 
Students  and  Graduates.  By  Dorothy  R.  Meeks,  R.N.. 
M.S.; Doris  M.  Edwards,  R.N. ,  M.S.; Sue R.  Williams. 
M.R.Ed..  M.P.H. ;  Geraldine  E.  Phelps,  A.A.,  R.N., 
M.S.;  and  Anne  M.  Mulligan,  R.N.;  with  2  con- 
tributors. This  basic  text  encompasses  the  full  range  of 
subjects  essential  for  work  as  an  LPN  or  LVN. 
Reorganized  and  updated,  it  presents:  chapters  on 
nutrition  and  microbiology;  psychiatry,  legal  aspects, 
pharmacology,  family  and  community  nursing,  and 
much  more!  1974,  728  pp.,  383  illus.  and  a  Trans- 
Vision®  insert  of  human  anatomy  in  full  color.  Price. 
$12.10. 


The  Future  Depends  on  Leadership 


MOSBY 

TIMES  MIRROR 


THE    C.  V.  MOSBY  COMPANY.  LTD.   .   86   NORTHLINE    ROAD,  TORONTO, 


14 


ONTARIO      M4B   3E5 


(Continued  from  page  1 1) 


Commonwealth  Federation 
Studies  Five- Year  Plan 

Singapore  —  The  board  of  directors  of 
the  Commonwealth  Nurses"  Federation 
during  an  extra-ordinary  meeting  in 
Singapore,  6  August,  decided  that  a 
long-term  plan  should  be  drawn  up  in 
preparation  for  the  next  5  years. 

Under  the  plan  the  CNF  would: 
D  help  embryo  nurses'  associations  in 
each    region    to    become    self- 
supporting: 
D  assist  these  associations  to  give  in- 
dividuals the  opportunity  to  acquire 
expertise    through   study   tours   or 
other  means: 
□  share  resources  between  nurses"  as- 
sociations at  the  same  stage  of  devel- 
opment and  having  the  same  lan- 
guage and  background: 
n  plan   leadership  courses  on   a  re- 
gional basis; 
D  give  guidance  and  advice  on  the  role 

of  a  national  nursing  association; 
D  encourage  studies  in  the  fields  of 

education  and  training: 
D  arrange  seminars  with  other  health 
workers. 

To  implement  this  program  and 
maintain  a  salaried  secretariat,  the 
Commonwealth  Nurses"  Federation 
would  request  from  the  Common- 
wealth Foundation  a  further  grant  for  at 
least  five  years.  The  initial  grant  given 
by  the  Foundation  in  1 973  expires  at  the 
end  of  this  year.  Since  1973,  the  num- 
ber of  member  associations  has  risen 
from  25  to  40. 


Quebec  Nursing  Shortage 

Not  Due  To  Immigration 

Montreal.  Quebec,  —  The  registrar  of 
the  Order  of  Nurses  of  Quebec, 
Gertrude  Jacob,  states  that  the  shortage 
of  nurse  manpower  in  Quebec  is  not  a 
result  of  a  deficiency  in  nurse  immigra- 
tion to  the  province. 

■"Each  year,'"  Jacob  said,  "ONO 
accepts  more  than  one-half  of  the  4,000 
to  5,000  requests  from  foreign  nurses 
who  apply  for  registration.  We  refuse 
requests  from  nurses  who  come  from 
countries  that  do  not  meet  our  standards 
of  nursing  practice  and  education , " "  she 
said.  "We  are  concerned  with  the  pro- 
tection of  the  public,""  Jacob  stressed. 

Jacob  claims  that  the  Official  Lan- 
guage Act  does  not  affect  nursing  man- 
power. Immigrants  are  given  one  year 
in  which  to  learn  the  language  of 
Quebec . 

The  higher  salaries  offered  by  other 


Canadian  Nurses  Association  president,  Huguette  Labelle,  chats  with  members  of 
the  Registered  Nurses  Association  of  Nova  Scotia  at  a  reception  at  their  60th 
annual  meeting  in  Antigonish.  From  left:  lona  Boyd,  faculty,  school  of  nursing, 
St.  Martha"s  Hospital.  Antigonish;  Norma  Wylie,  Dalhousie  University  school  of 
nursing;  Mme.  Labelle;  Electa  MacLennan,  a  past  president  of  CNA  and  former 
director.  Dalhousie  University  school  of  nursing;  and  Jean  Magee,  director  of  the 
Victoria  General  Hospital  school  of  nursing,  in  Halifax. 


Canadian  provinces  influences  many 
nurses  in  Quebec  to  seek  employment 
elsewhere. 

The  shortage,  according  to  Jacob  is 
much  more  acute  in  other  countries 
than  in  Quebec.  "" Canada  will  have  to 
train  more  nurses,""  she  said. 

Bill  22  will  apply  to  Canadian  nurses 
from  other  provinces  as  of  1  July  1976. 
Temporary  registration  will  be  granted 
for  one  year,  and  a  certificate  must  then 
be  obtained,  attesting  that  an  RN  has  a 
working  knowledge  of  French.  After 
the  temporary  permit  has  expired, 
nurses  will  not  be  allowed  to  practice  in 
Quebec,  without  a  certificate. 


New  Opportunities: 
Training  In  Primary  Care 

Bethesda.  Maryland  —  The  division  of 
nursing  of  the  Department  of  Health, 
Education,  and  Welfare  has  awarded 
15  additional  contracts  to  prepare  regis- 
tered nurses  for  primary  care.  The 
2-year  training  contracts  will  be  used  to 
institute  programs  combining  instruc- 
tion with  clinical  practicums. 

Nine  of  the  contracts  will  be  used  to 
update  the  primary  skills  of  an  esti- 
mated 300  teachers  in  baccalaureate 
and  higher  degree  schools  of  nursing. 
This  program  will  emphasize  the  teach- 
ing of  primary  care  skills  and  faculty 
member  trainees  are  expected  to  com- 


bine teaching  with  clinical  practice  on  a 
continuing  basis. 

The  remaining  6  contracts  will  be 
used  to  train  240  geriatric  nurse  prac- 
titioners, particularly  for  service  in 
medically  disadvantaged  areas.  This 
program  centers  on  the  primary  care  of 
elderly  people  and  also  of  less  elderly 
adults  who  have  chronic  health  prob- 
lems. 

More  information  may  be  obtained 
by  writing  the  Department  of  Health, 
Education,  and  Welfare,  Public  Health 
Service.  Health  Resources  Administra- 
tion, Bethesda,  Maryland,  20014. 

Nurses  Needed 
For  Overseas  Teams 

New  York.  N.Y.  —  Registered  nurses 
are  needed  to  serve  on  overseas  teams 
in  programs  conducted  by  MEDICO,  a 
service  of  CARE. 

These  are  2-year  contract  posts.  Ap- 
plicants must  have  received  at  least  part 
of  their  training  in  the  U.S.  or  Canada, 
and  must  be  certified  or  licensed  in  the 
United  States  or  Canada. 

For  details  on  salary,  fringe  benefits, 
and  other  information,  write  to: 
Leonard  Coppold,  Director  of  Contract 
Personnel,  medico,  a  service  of  CARE 
660  First  Ave.,  New  York,  N.Y., 
10016,  USA.  or  telephone  Coppold  at 
212-686-3110.  C- 


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style  HS  443 
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100%  Polyester    •    '    ' 
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.  Sizes  3-15 

Suggested  Retail     32.98 


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JOIN  OUR 
COLORFUL 

FROM  O  White  Cross 


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f RflNKLY  SPEAKING 

about  nursing  practice 


If  Only  The  Tale  Had  Been  Tattled. . . 


Lorine  Besel 


Tiis  article  is  in  response  to  some  ques- 
ions  asked  of  me  at  the  Canadian  Nurses' 
[ssociation  annual  meeting  in  April  1975. 

:ase#1 

Axs.  A. ,  a  senior  nurse,  is  late  each  mom- 
ng.  sometimes  not  appearing  until  noon. 
!he  is  often  in  the  ward  bathroom,  drink- 
ng.  She  is  considered  a  "good  nurse"  by 
:olleagues.  No  report  of  her  behavior 
caches  the  supervisor. 
One  day,  after  several  months  of  this 
havior,  Mrs.  A.  does  not  appear  on  the 
vard.  She  has  been  admitted  to  another 
lospital  after  a  serious  suicidal  attempt. 
Guilt  now  tloods  the  staff  group.  Dis- 
ussion  reveals  that,  not  only  have  the  staff 
)een  covering  for  her  at  work,  but  several 
)f  them  have  been  spending  their  off-duty 
ime  with  her  to  "help"  her. 

:ase#2 

i4rs.  T. ,  a  suicidal  patient,  had  been  on  the 
isychiatric  unit  for  4  weeks.  After  3  weeks 
he  began  to  make  seemingly  realistic 
lans  to  leave  an  intolerable  home  situa- 
ion  and  get  a  job.  Doctors  and  nurses  alike 
lonsidered  their  efforts  successful  and 
nirs.  T.  was  given  a  day  pass  to  look  for  a 
Ob. 

She  was  discovered  3  days  later,  having 
:ommitted  suicide  in  a  hotel  room,  appar- 
intly  on  the  day  she  was  presumed  to  be 
ob  hunting. 

Staff  members  were  shocked  and  felt 
uilty,  but  the  other  patients  carried  a  spe- 
ial  load  of  guilt.  Several  patients  were 
iware  that  she  was  not  as  well  as  she  pre- 
ented  herself  to  staff  and  some  had  private 
nformation  concerning  the  details  of  her 
uicidal  plan. 

Why  did  those  who  were  close  to  these 
uicidal  patients  not  communicate  their 

HE  CANADIAN  NURSE  —  Oclober  1975 


knowledge  of  the  behavior  and  intentions 
of  the  victims  so  that  help  could  be 
mobilized?  Why  did  they  keep  this  infor- 
mation secret  until  it  was  too  late? 

Staff  Reasons  in  Case  #1 

•  "We  understood  her  better  than  you  (the 
supervisor)  ever  could,  and  so  we  thought 
we  could  help  her." 

•  "I  thought  you  would  get  her  fired." 

•  "I  didn't  want  to  be  a  "tattle-tale."  " 

•  ""She  trusted  me,  and  I  didn't  want  to  be 
a  sneak."" 


Each  month  The  Canadian  Nurse  fea- 
tures a  column  by  one  of  the  four  CNA 
members-at-large.  This  Is  the  second 
column  by  the  member-at-large  for 
nursing  practice,  Lorine  Besel.  She 
welcomes  your  comments. 


Patient  Reasons  in  Case  #2 

•  "We  thought  you  (doctors  and  nurses) 
must  know  about  it  and,  if  you  still  let  her 
out,  well  ...."■ 

•  "It  wasn't  our  job  to  take  care  of  her  — 
you  shouldn't  have  let  her  go  out." 

•  "She  made  me  promise  not  to  tell  any- 
one, especially  the  doctors  and  nurses,  and 
I  would  have  felt  as  if  I  were  tattling." 

Such  explanations  for  keeping  secrets 
can  be  understood  in  the  light  of  Eric 
Berne's  transactional  analysis  theory.  His 
concept  of  PARENT,  ADULT,  CHILD  as  a  de- 
termining factor  of  behavior  is  well- 
presented  in  the  book  I'/n  OK  —  You're 
OK,  by  T.  Harris. 


The  explanatory  remarks  given  by  staff 
and  patients  reveal  a  typical  PARENT- 
CHILD  model  of  interaction.  Certain  state- 
ments in  both  cases  assume  authority 
figues  to  be  distant  and  punitive,  albeit 
all-knowing,  figures: 

•  'We  understood  her  better  than  you 
could  .  .  .  .  " 

•  "We  thought  you  must  know  about  it." 

•  "I  thought  you  would  get  her  fired." 

Other  statements  reveal  a  hang-up  that  I 
will  call  the  tattle-tale  phenomenon: 

•  'She  made  me  promise  not  to  tell 
anyone  .  .  .  .  I  would  have  felt  as  if  I  were 
tattling." 

•  "She  trusted  me,  and  1  didn  t  want  to  De 
a  sneak. ■■ 

As  children,  we  soon  learn  the  sanctions 
against  being  a  "'tattle-tale"  — a  damning 
label  indeed.  To  become  privy  to  a  secret 
about  wrongdoing  on  the  part  of  another 
child  truly  places  a  child  between  the  devil 
and  the  deep  blue  sea.  The  other  child  will 
almost  surely  suffer  by  virtue  of  his 
""snitching."  Any  thanks  he  gets  from  an 
adult  for  telling  will  in  no  way  compensate 
for  the  guilt  he  feels  as  the  other  child 
suffers  punishment,  or  the  rejection  he  ex- 
periences at  the  hands  of  other  children 
when  his  tattle-tale  role  becomes  known. 

Among  adults,  the  sanctions  against 
tattling  are  most  apparent  in  the  criminal 
world.  Sometimes  crime  does  pay,  but 
being  a  "'stool  pigeon"  never  does. 

Not  only  our  society,  but  our  profes- 
sional world  of  work  is  replete  with  poten- 
tially destructive  behavior  of  this  type. 
Nurses  may  inadvertently  harm  both  pa- 
tients and  colleagues  by  well-intentioned, 
protective,  but  secretive  behavior.  We 
forget  that  refusing  to  act  can  be  the  most 
destructive  action  of  all! 


Pediatric  diabetes: 

a  new  teaching  approach 


Description  of  a  diabetic  program  that  is  geared  to  the  child  and  his  needs. 


M.D.  Leahey,  S.A.  Logan, 
and  R.G.  McArthur 


■"Flay  IS  a  child's  business  and  is  the  nor- 
mal and  traditional  road  to  learning."' 
Yet.  in  many  general  hospitals,  children 
continue  to  be  taught  about  their  disease  in 
diabetic  classes  designed  for  adults. 
Teaching  methods  and  the  materials  used, 
such  as  group  lectures,  slides,  and  book- 
lets, are  geared  to  passive  instruction  for 
the  older  diabetic. 

Recognizing  the  need  for  age-specific, 
action-oriented  learning,  a  children's 
diabetic  class  program  was  developed  at 
the  ambulatory  care  center  at  the  Univer- 
sity of  Calgary.  Each  lesson  incorporates 
some  type  of  teaching  tool  with  which  the 
child  can  play,  allowing  him  to  become  an 
active  participant  in  the  learning  process. 


M.  D  Leahey  (B.Sc.N,  Cornell  University)  is 
a  pediatric  nurse-practitioner  and  family 
therapist  at  the  Ambulatory  Care  Centre,  Uni- 
versity of  Calgary;  S.A.  Logan  (B.N..  Univer- 
sity of  Calgary)  was  a  fourth  year  nursing  stu- 
dent at  the  time  this  program  was  developed: 
R.G.  McArlhur  (M  D..  F.R.C.P.(C.))  is  a 
pediatric  endocrinologist  at  the  University  of 
Calgary  Medical  School.  He  and  Leahey  coor- 
dinate the  Child  and  Adolescent  Diabetic  Pro- 
gram sponsored  by  the  Alberta  Children's 
Health  Centre  and  located  at  the  University  of 
Calgary.  The  authors  acknowledge  the  advice 
and  suggestions  received  from  members  of  the 
Child  and  Adolescent  Diabetic  Program  and 
Fcxjthills  Hospital  Pediatric  nursing  staff. 


Program  description 

The  program  focuses  on  the  6-  to 
12-year-old  group,  and  covers  the  basic 
concepts  and  skills  that  the  child  must  un- 
derstand to  cope  with  his  diabetes.  The 
program  consists  of  a  manual,  evaluation 
sheets,  and  teaching  toys  and  materials. 
The  manual  is  divided  into  5  lessons,  each 
lesson  composed  of  the  following: 


1.  A  definition  of  the  objectives. 

2.  A  list  of  the  teaching  materials  to  bt 
used. 

3.  Directions  for  the  teacher  to  sugges 
how  she  can  convey  the  concepts  aiii 
when  to  use  the  teaching  materials. 

4.  A    sample    explanation    that    tl 
teacher  may  present  to  the  child.  We  ao 
vise  teachers  to  follow  this  closely  so  tha 


Shirley  Logan  asks  Brian  to  identify  anatomical  structures,  while  she  explains  the 
pathophysiology  of  diabetes. 


Kim,  age  9,  attemps  to  balance  food  intake  with  adequate  insulin,  using  the  toy 
scale  and  cardboard  models. 


rses  who  do  follow-up  teaching  will 
;0w  exactly  how  the  material  has  been 
ivered  and  can  use  the  same  terminology 
their  reinforcement  of  the  lesson. 
5.  Lists  of  questions  and  activities  that 
J  child  should  be  able  to  answer  and 
iform  if  he  has  achieved  the  objectives. 
lis  enables  the  teacher  to  evaluate  the 
ild's  comprehension  and  identify  areas 
at  need  reinforcement. 

The  first  lesson  deals  with  the 
ithophysiology  of  diabetes.  The  teaching 
ol  used  is  a  large  flannel  board  on  which 
!  body's  pertinent  anatomical  structures 
J  shown  (stomach,  heart,  blood  vessels, 

E  CANADIAN  NURSE  —  October  1 975 


and  pancreas) .  The  nurse  also  encourages 
the  child  to  draw  his  perception  of  body 
organs.  An  excerpt  of  the  explanation 
given  to  the  child  follows: 

""When  you  eat  some  food,  it  travels  down  a 
long  tube  to  your  stomach.  In  your  stomach,  it 
is  changed  into  sugar,  called  glucose.  From 
your  stomach,  glucose  passes  into  your  blood. 
Glucose  is  very  important .  Just  as  your  parents' 
car  needs  gas  to  produce  energy  to  move  the 
car,  your  body  needs  glucose  to  give  you 
energy  to  work  and  play. 

"Insulin  is  needed  for  glucose  to  travel  from 
the  blood  into  the  body  cells.  Insulin  comes 
from  the  pancreas.  A  diabetic  does  not  have 


enough  insulin,  because  the  pancreas  is  not 
making  it  appropriately.  Because  there  is  no 
insulin,  your  body  cannot  use  the  glucose  that  is 
in  your  blood  for  energy.  When  the  level  of 
glucose  becomes  too  high  in  the  blood,  the 
glucose  spills  into  the  urine.  Too  much  glucose 
in  the  urine  causes  you  to  go  to  the  bathroom 
very  often  and  to  pass  a  lot  of  urine." 

The  second  lesson  deals  with  the  ad- 
ministration and  storage  of  insulin.  The 
teaching  focuses  on  injection,  and  encour- 
ages play  with  dolls,  syringes,  and  nee- 
dles. Petrillo  points  out  that 
".  .  .injections,  part  of  the  treatment  of 
almost  all  pediatric  patients,  are  univer- 
sally feared....  A  child  will  interpret  any 
object  stuck  into  his  body  as  a  brutal  attack 
by  a  more  powerful  person."^  In  diabetes, 
this  is  a  particularly  important  factor  to 
consider,  as  it  is  usually  parents  who  ini- 
tially give  the  child  his  injections. 

The  third  lesson  deals  with  urine  test- 
ing. The  felt  board  outlining  body 
anatomy  is  again  used.  This  time,  the  child 
places  the  kidney,  bladder,  and  blood  ves- 
sels into  position  on  the  body. 

Urine  testing  technique  is  taught  in  this 
lesson.  The  child  tests  his  own  urine 
(and/or  synthetic  urine  specimens)  and  re- 
cords the  results.  This  provides  an  oppor- 
tunity for  assessing  and  reinforcing  know- 
ledge. For  example,  when  the  child  tests  a 
urine  that  manifests  both  sugar  and 
acetone,  the  teacher  can  ask  him  questions 
such  as:  "Why  does  glucose  appear  in  the 
urine?  Does  a  high  glucose  reading  mean 
you  need  more  or  less  insulin?  Where  do 
ketones  come  from?  What  causes  them  to 
appear  in  your  urine?" 

The  fourth  lesson  concentrates  on  the 
relationship  of  food,  exercise,  and  insulin 
to  blood  glucose  levels,  using  a  toy  bal- 
ance scale  and  cardboard  figures  as  teach- 
ing tools.  Facsimiles  of  hockey  sticks, 
tennis  rackets,  baseball  bats,  and  insulin 
bottles  are  added  to  one  side  of  the  scale  to 
lower  blood  glucose.  Models  representing 
food  and  infection  are  added  to  the  other 
side.  The  child  must  try  to  balance  the 
scale  to  obtain  an  even  blood  glucose 
level. 

The  scale  can  be  used  to  assess  the 
child's  understanding.  For  example,  the 
teacher  can  add  excess  food  models  to  one 
side  of  the  scale  and  then  ask  the  child,  "Is 
the  glucose  level  too  high  or  too  low  now? 
What  do  you  think  the  urine  test  will 
show?  Show  me  what  you  would  do  to 
balance  the  blood  glucose  level."  The 
child  can  balance  the  scale  by  adding  more 

19 


exercise  models  or  another  insulin  bottle. 

Children  have  fun  using  this  toy  scale 
and  are  able  to  comprehend  the  interrela- 
tionship of  food,  exercise,  illness,  and  in- 
sulin on  their  blood  glucose  level. 

For  diabetic  exchange  diet  instruction, 
the  teaching  tools  used  are  cardboard  food 
pictures  and  rubber  food  models.  The 
child  uses  these  to  plan  menus.  Even  6- 
year-olds  enjoy  doing  this,  and  usually  can 
do  it  correctly .  However,  their  choices  are 
sometimes  rather  eccentric  —  such  as  a  hot 
dog  for  breakfast! 

The  final  lesson  centers  on  insulin  reac- 
tions and  ketoacidosis.  Again,  the  toy  bal- 
ance scale  is  used.  At  the  completion  of 
this  lesson,  the  child  is  expected  to  be  able 
to:  tell  the  instructor  whether  the  blood 
glucose  level  is  too  high  or  too  low  in  an 
insulin  reaction  and  in  ketoacidosis;  state 
at  least  5  common  symptoms  of  an  insulin 
reaction  and  ketoacidosis;  verbally  de- 
scribe appropriate  action  to  take  if  symp- 
toms of  an  insulin  reaction  or  ketoacidosis 
occur;  and  demonstrate  an  understanding 
of  3  common  causes  of  an  insulin  reaction 
and  ketoacidosis  by  using  the  toy  scale  and 
models  representing  insulin,  food,  exer- 
cise, and  infection. 

To  supplement  the  teaching  classes,  2 
books  designed  for  diabetic  children  are 
used:  Donny  and  Diabetes.^  by  H.  Lee 
Bretz,  RN,  is  appropriate  for  children  ages 
6  to  9;  for  older  children,  /!/?  Instructional 


Aid  on  Juvenile  Diabetes/  by  Dr.  Luther 
B.  Travis,  is  helpful. 

Program  Is  flexible 

One  major  advantage  of  this  children's 
diabetic  class  program  is  its  flexibility.  For 
example: 

D  It  may  be  used  to  teach  a  newly  diag- 
nosed child  or  to  provide  review  for  chil- 
dren who  have  had  the  disease  for  some 
time. 

D  Although  written  primarily  for  instruct- 
ing the  child  on  an  individual  basis,  the 
program  has  also  proved  useful  for  teach- 
ing small  groups  of  diabetic  children. 
D  The  program  is  portable  and  adaptable 
for  use  in  a  variety  of  health  agencies.  The 
manual  consists  of  22  typewritten  pages. 
All  of  the  teaching  materials  can  be  con- 
tained in  2'  X  2"  X  2'  cardboard  box. 
D  The  lessons  may  be  taught  one  at  a  time, 
or  they  may  be  combined,  depending  on 
the  child's  intellectual  capability,  atten- 
tion span,  and  the  time  available  to  the 
teacher.  For  example,  a  6-  or  7-  year-old 
child  may  be  able  to  concentrate  for  only 
10  minutes  and  cover  half  of  a  lesson, 
whereas  a  10-  or  12-year-old  may  easily 
absorb  two  lessons  in  one  session. 

Evaluation 

To  facilitate  communication  among  the 
various  personnel  who  teach  the  child,  the 
evaluation  criteria  are  summarized  on  3 


Brian,  age  7,  concentrates  on  drawing  up  insulin  during  needle  play  session.  His 
sister,  Lorraine,  age  5,  looks  on. 


sheets,  which  are  inserted  into  the  chile 
hospital  or  outpatient  chart.*  Each  she 
has  4  columns:  ( 1)  objectives,  (2)  date,  ( 
comments  by  teacher,  and,  (4)  commer 
by  nursing  staff. 

The  teacher  indicates  on  these  sheets  t! 
child's  mastery  of  the  objectives  and/ 
skills.  She  may  also  specify  areas  that  s> 
would  like  other  staff  members  to  revie 
with  the  child.  For  example,  she  m; 
write:  "He  has  difficulty  drawing  up  cc 
rect  amount  of  insulin,  but  his  sterile  tec 
nique  is  good.  Please  review  accura 
reading  of  syringe  scale."  Or,  pediatr 
staff  may  write,  "The  urine  testing  techr 
que  is  excellent ,  but  he  cannot  explain  wl 
glucose  appears  in  the  urine." 

The  form,  which  may  become  a  perm; 
nent  part  of  the  child's  chart,  can  be  n 
ferred  to  again,  if  the  child  is  rehospitalizet 
A  copy  may  also  be  given  to  the  publi 
health  nurse  or  pediatric  nurse-practitione 
who  is  to  do  the  follow-up  teaching.  Sue 
an  evaluation  form  indicates  at  a  glanc 
how  many  lessons  the  child  has  coverec 
and  identifies  which  skills  or  concepts  ar 
difficult  for  him. 


Summary 

This  pediatric  diabetic  program  pre 
motes  continuity  and  consistency  for  th 
child  who  is  taught  about  his  diseas 
through  a  group  approach.  The  program 
other  major  asset  is  that  it  is  geared  to  hi 
age-specific  needs.  Medical  jargon  is  ex 
pressed  in  vocabulary  he  can  understand! 
The  child  plays  actively  during  the  lessoj' 
and,  if  taught  in  a  group,  interacts  with  hi 
peers,  rather  than  adult  patients. 

References 

1 .  Cleverdon,  Dorothy,  et  al.  Play  in  a  Hosp^ 
lal:.  Why  and  How.  New  York ,  Play  School 
Assoc,  1971. 

2.  Petrillo.  Madeline,  and  Sanger,  SIrgayi 
Emotional  Care  of  Hospitalized  Children] 
An  Environmental  Approach.  Toronto 
Lippincotl.  1972. 

3.  Bretz,  H.  Lee.  Donny  and  Diabetes.  Van^ 
couver.  Tad  Publishing.  1973. 

4.  Travis,  Luther  B.  An  Instructional  Aid  or 
Juvenile  Diabetes  Mellitus .  3ed.  Galveston 
University  of  Texas  Medical  Branch,  De 
partment  of  Pediatrics,  1973. 


>     *More  information  is  available  on  request 
•*•     the  authors. 


20 


Reawakenin 


in  the  elderly 

A  song,  a  touch  of  the  hand,  or  even  a  wild  strawberry;  this  is  the  recipe  for 
sensory  retraining  in  a  geriatric  ward  in  a  psychiatric  setting. 


^  Netting  is  beautiful,  and  has  cost  the 

\  payer  vast  sums  of  money.  But  the  most 

ip'irtant  ingredient,  often  overlooked,  is 

'^ght  kind  of  care  needed  bv  those  in 


-n  Scott  (R.N..  Calgary  General  Hospital 

li  >'il  of  nursing:  B.Sc.N.,  University  of  Al- 

is  program  coordinator.  Alberta  Hospi- 

'  >noka;  Jean  Crowhurst  (R.N..  Alberta 

lal.  Ponoka)  supervisor,  nursing  service 

-. .  Alberta  Hospital.  Ponoka.  was  assistant 

iiyrum  coordinator,  geriatric  services,  when 

lis  article  was  written. 

IE  CANADIAN  NURSE  —  Oclober  1975 


Doreen  Scott  and  Jean  Crowhurst 

this  handsome  nursing  home,  auxiliary 
hospital,  or  geriatric  unit  in  a  psychiatric 
setting. 

And,  what  is  the  right  kind  of  care? 

We  believe  that  the  most  meaningful 
and  effective  care  must  be  personal  and 
individual,  especially  in  a  setting  such  as 
ours  —  a  geriatric  ward  in  a  psychiatric 
hospital. 

When  a  nurse  allows  an  old  man  to 
hesitate  a  few  moments  before  answering  a 
question,  he  receives  personal  validation 
in  his  reply.  Conversely,  the  nurse  who 
says,  brightly  and  with  total  indifference. 


"How  are  ya.  Gramps?"'.  and  moves  on 
without  waiting  for  an  answer,  leaves  that 
old  man  with  feelings  of  frustration  and 
loneliness. 

From  our  experience,  we  know  that  the 
elderly  move  more  slowly  but,  nonethe- 
less, need  to  feel  wanted  and  worthy  of 
respect  and  attention. 

One  way  we  cope  with  some  of  these 
feelings  in  our  hospital  is  to  involve  our 
senior  citizens  in  a  daily  program  of  sen- 
sory retraining.'  Borrowed  originally 
from  the  staff  at  the  Lynwood  Auxiliary 
Hospital  in  Edmonton,  Alberta,  the  pro- 


gram  combines  a  number  of  activities 
designed  to  reawaken  or  maintain  the  5 
senses:  sight,  sound,  taste,  smell,  and 
touch.  The  program  involves  graduate 
nurses,  students,  and/or  experienced  ward 
aides,  under  the  supervision  of  the  head 
nurse. 

If  possible,  the  same  leader  conducts 
each  session,  and  there  are  no  more  than  8 
patients,  preferably  of  both  sexes,  in  a 
"normal""  group.  Two  leaders  who  work 
well  together  can  help  the  group  by  using 
the  additional  observational  cues  picked 
up  by  the  other. 

Many  have  grown  old  in  our  institution, 
and  face  a  future  of  3  meals  a  day,  a  roof,  a 
bed,  the  best  of  intentions  from  all  discip- 
lines, but,  above  all,  the  crushing  boredom 
of  their  daily  routine. 

Sensory  retraining,  with  its  structured 
activities,  can  contribute  to  a  reawakened 
awareness  of  surroundings  and  can  assist 
our  patients  in  the  socialization  process. 

Socialization  is  defined  as  something 
"having  to  do  with  human  beings  in  their 
living  together  and  dealings  with  one 
another.""^  This  process  is  not  easy  for 
those  who  suffer  from  a  variety  of  ill- 
nesses, such  as:  senile  psychoses,  brain 
damage,  presenility,  Alzheimer"s  or 
Pick's  disease,  or  Huntington"s  Chorea, 
along  with  the  accompanying  disabilities 
of  contractures,  paraplegia,  and  arthritis. 

Method 

Our  method  of  sensory  retraining  is 
simple  and  basic.  Both  residents  and  staff 
should  enjoy  themselves,  as  the  "having 
fun""  part  is  a  powerful  stimulus.^ 

At  our  daily  meetings,  the  group  sits  in  a 
circle.  The  leader-therapist  sits  either  in 
the  middle  for  optimal  eye  contact,  or  is 
part  of  the  circle.  She  is  thus  alert  to  all 
cues  by  the  group  that  relate  to  the  pro- 
gram. 

The  next  step  is  to  say  "hello""  to  one 
another.  In  the  hustle  and  bustle  of  the 
nursing  home  or  auxiliary  hospital, 
"hello""  is  often  just  a  cheerful  voice  and  a 
bright  smile.  This  is  Fine  for  those  whose 
vision  and  hearing  are  adequate.  But,  as 
our  residents  pass  their  80th  and  90th 
birthdays,  their  hearing  becomes  less 
acute  and  their  vision  blurred.  Thus,  the 
added  touch  of  a  hand  makes  "hello"'  a 
little  more  meaningful.  We  find  that  many 
emotions  are  expressed  in  the  handshake, 
bringing  quick  tears  as  the  person  realizes 
there  are  others  in  his  universe. 

Looking  into  a  hand  mirror  can  also  be  a 
stimulus  to  reinforce  reality.  It  often 
brings  a  quick  laugh  and  smile,  and  words 
like,  "My,  I'm  getting  more  gray  hairs," 
or  "Is  that  me?"  It  also  encourages  resi- 


dents to  make  an  effort  to  improve  their 
personal  appearance. 

A  small  cloth  ball,  filled  with  soft  mat- 
erial, such  as  scraps  of  cloth  or  wool,  is 
used  to  stimulate  sight  and  muscle  coordi- 
nation. We  reactivate  motor  skill  by  call- 
ing out  a  person's  name  when  the  ball  is 
tossed  to  him.  Coordination  is  further 
stimulated  by  using  simple  hand  instru- 
ments to  keep  time  to  a  tape  recorder  or 
piano.  Many  just  enjoy  clapping  their 
hands  to  music. 

Singing  familiar  songs  brings  nostalgia 
to  most  of  us,  hence  a  lively  "sing-along" 
is  better  than,  say,  "Old  Black  Joe."  It  is 
not  unusual  to  discover  persons  in  the 
group  with  beautiful  singing  voices! 

After  a  song  or  two,  taste  is  stimulated 
by  passing  around  samples  of  salt,  sugar, 
and  so  on.  We  find  that,  about  half-way 
through  the  sessions,  a  treat  like  fresh 
bread,  a  cookie,  or  wild  strawberries  — 
something  patients  don't  have  every  day 
—  really  sparks  their  interest.  Often,  the 
very  sight  of  something  different  helps  re- 
vive old  memories  and  becomes  a  basis  for 
conversation  that  moves  along  to  many 
other  topics. 

As  we  grow  older,  we  need  stronger 
scents  to  tell  us  about  a  product.*  Often, 
when  an  empty  coffee  package  is  passed 
around,  the  group  mistakes  it  for  tobacco, 
or  tea.  Old  perfume  bottles  are  good 
stimuli,  too.  but  don't  expect  anyone  to 
name  the  brand! 

Touching  another  person ,  other  than  ac- 
cidentally or  when  receiving  personal 
care,  is  something  else  the  older  person  in 
hospital  is  deprived  of.  Often,  warm  feel- 
ings can  be  elicited  by  a  quick  hug.  When 
we  bring  young  children  to  the  group,  the 
women  wistfully  touch  their  hair  and  face, 
the  men  reach  out  for  their  hand.  As  for 
pets,  everyone  has  to  pat,  to  touch,  to  feel . 
The  daily  program  should  follow  a  gen- 
eral, but  not  rigid,  plan  for  the  stimulation 
of  each  sense.  Each  stimulus  is  presented 
to  everyone,  whether  or  not  there  is  visible 
response.  This  is  important,  as  some  are 
aware,  but  cannot  respond  at  will. 

We  find  it  helpful  to  close  a  session  with 
a  "grand  march""  around  the  room  — 
wheelchairs,  walkers,  and  all.  Besides 
providing  exercise,  it  becomes  a  further 
stimulus  to  relieve  boredom.  We  often 
close  with  refreshments,  and  a  promise  to 
meet  again  the  next  day  or,  if  it  is  a  Friday, 
on  Monday.  The  program  is  not  cancelled 
unless  necessary. 

The  group  is  enriched  if  one  member  is 
more  alert  than  the  others  and  can  act  as  a 
catalyst.  He  is  usually  first  to  answer  a 
question,  or  he  may  show  off  a  little  when 
given   the   opportunity.    This   helps   the 


others  make  appropriate  responses,  a 
renders  the  sessions  more  stimulating 

The  time  for  holding  the  sessions  is 
little  importance,  but  most  of  the  grcii 
seemed  to  prefer  morning  or  early  evenii 
sessions.  The  length  of  the  session  shon 
be  flexible  —  from  20  minutes  to  a  ma 
imum  of  I  hour,  depending  on  the  group 
span  of  concentration. 

A  central  area,  such  as  a  day  room 
solarium,  has  proved  to  be  the  most  sii 
able  place  to  hold  our  sessions,  as  oth 
outside  the  group  can  benefit  by  obser 
tion. 

Do  not  be  discouraged  if  some  refuse 
join  in.  Often,  members  come  in  alt 
watching  us  for  a  few  days,  and,  on 
accepted,  they  soon  become  active  p 
tici  pants. 

Results 

One  may  ask  what  we  have  achie\L 
Certainly,  not  all  our  people  show  su 
tained  improvement  outside  the  group  sc 
ting.  But  those  whose  diagnosis  limits  an 
long-lasting  benefits  are  given  a  pleasan 
happy ,  and  time-occupying  experience.  I 
nursing  the  elderiy.  one  does  not  expci 
giant  steps,  and  the  shy  smile  or  the  haiiin 
touch  of  a  hand  may  be  the  only  indicai; 
that  the  person  appreciates  the  therap\ 

Although  we  have  no  statistical  data  i 
support  this,  we  believe  that  there  is  I. 
incontinence  in  our  patients,  perhaps  ^- 
to  the  extra  attention  accorded  them,  an 
improved  social  interaction.  We  note  aK 
that  more  and  more  persons  are  wearin 
their  own  clothes.  They  ask  for  them.  sa\ 
ing  they  do  not  like  those  of  the  institution 

We  still  have  far  to  go.  Our  aim  is  t 
increase  the  spirit  of  independence  of  ou 
patients,  and  our  program  of  sensory  re 
training  has  begun  to  allow  better  things  i* 
happen  to  the  elderly. 

References 

1 .  Culhani.  M.,  et  al.  Sensory  retraining  —  < 
new  way  to  social  interaction  for  the  genu: 
ric  patient.  Ponoka,  Alta..  Alberta  Hospi 
tal.  1973.  (Unpublished)  ' 

2.  Webster,  Noah.  Webster's  popular  il.' 
trated  dictionary.  New  rev.  ed.  New  Yi  ; 
World  Syndicate  Publishing,  cl938,  1%^ 
p.  363. 

3.  Heidell.  Beth.  Sensory  training  puts  pu 
tients  "in  touch. "Morf.  Nurs.  Home  28:40 
Jun.  1972. 

4.  Loew,  Clemens  A.  and  Silverstone,  Bar-1 
bara  M.  A  program  of  intensified  stimula-. 
tion  and  response  facilitation  for  the  senile 
aged.  Gerontologist  11:341,  Winter  1971.1 


Psychiatric  management 
of  the  deaf  child 


The  difficulty  in  psychiatric  management  of  the  deaf  child  lies  in  our  inability  to 
understand  the  differences  in  his  developmental  pathways,  compared  to  the 
normal  child. 


Stanley  R.  Lesser  and  B.  Ruth  Easser 


ONE    CHILD    IN    A    THOUSAND    IS 
profoundly   deaf  before  the  onset 
It  speech.  Although  the  major  problem  for 
Jeaf  children  is  their  difficulty  in  com- 
nuiiicating,    this   difficulty   extends   far 
->c\ond   that   of  hearing   reception   and 
speech  expression.  Contrary  to  common 
-'c'ief,  the  compensatory  communicative 
Jes,  such  as  gestures  and  emotional 
;\pression  to  cue  himself  into  others  and 
thers  into  him.  develop  later  in  the  deaf 
hild  and  less  well  than  in  the  normal 
;hild. 

In  the  most  enlightened  medical  centers 

|ind  among  the  best-educated  populations, 

'profound  deafness  is  now  frequently  diag- 

losed  even  before  the  first  6  months  of  life 

iind  most  usually  before  2  years  of  age. 

Many  babies,  prior  to  one  year  of  age, 

wear  hearing  aids,  as  it  is  believed  that,  with 

•  -profoundly  deaf  child,  his  attention  to 

nd  produces  a  better  matrix,  a  better 

,;go  atmosphere  for  later  speech  and  hear- 

ng  education,  and  a  better  chance  for 

Jeeper  emotional  relationships  and  emo- 

uinal  growth. 

Currently,  the  emphasis  on 
:ommunity-based  treatment  places  the 
nother  in  the  role  of  prime  caretaker  of  her 
rhild,  the  best  aide  in  the  development  of 
ler  child,  and  the  best  advocate  for  her 
hild.  All  these  trends  have  made  the  fam- 
ly  the  central  agency  for  the  management 


vianley  R.  Lesser  (M.D.  Long  Island  College 

>t  Medicine  U.S.A.,)  is  Associate  Professor  of 

'-.\chiatry.  University  of  Toronto,  and  Staff 

jhiatrisi  at  the  Hospital  for  Sick  Children 

;  Mt.   Sinai   Hospital.  Toronto:   B.   Ruth 

^se^  (M.D.,  University  of  Toronto)  was 

Xvsociate  Professor  of  Psychiatr>-,  University 

i;  Toronto,  and  Staff  Psychiatrist  at  Mt.  Sinai 

4ospiial,  Toronto.  This  anicle  is  adapted  from 

aper  the  authors  presented  at  the  Canadian 

:hiatric  Association  annual  meeting  in  the 

of  1974. 

ni  CANADIAN  NURSE  —  October  1975 


of  the  deaf  child.  This  is  a  shift  from  the 
former  central  role  of  the  special  educator, 
the  institutional  caretaker. 

The  mother  is  the  person  most  emotion- 
ally involved  with  her  child  and,  at  the 
same  time,  the  most  confused  and  chal- 
lenged by  her  child.  She  needs  many  forms 
of  back-up  service  for  her  internal  comfort 
and  to  help  her  raise  her  child. 

IF  WE  KNOW  WHAT  A  NORMAL 
child  might  need  or  feel  in  a  given 
set  of  circumstances,  we  are  on  fairly  firm 
ground  in  assuming  that  the  deaf  child 
needs  at  least  as  much.  A  deaf  child  needs 
the  same  consideration  of  his  emotional 
needs  as  does  a  child  who  can  hear.  In 
approaching  the  deaf  child,  3  aspects  of 
knowledge  are  essential: 

nGrowth  and  Development:  All  children, 
whether  following  the  norm  or  the  deviant, 
go  through  the  same  general  trends  and 
trajectories  along  a  developmental  axis. 
n  Emotional  Development:  The  emo- 
tional aspect  of  the  child's  development  is 
partially  constitutional  but,  more  impor- 
tant, is  learned  and  developed  through  the 
give  and  take  of  transactional  activities 
between  the  child  and  those  persons 
closest  to  him  during  his  early  life. 
\Z\Social  Development:  The  child  is  not 
only  an  individual,  but  is  part  of  a  matrix 
that  includes  his  family  as  his  original  so- 
ciety and  those  extra-familial  people,  at- 
titudes, values,  and  institutions  that  we 
term  society. 

The  deaf,  suffering  from  a  particular 
truncation  of  perception,  cognition,  and 
verbal  communication,  have  special  diffi- 
culty with  all  forms  of  communication. 
These  communicative  limitations  restrict 
the  earliest  interpersonal  relationship,  that 
is,  the  mother-child  relationship.  This 
limitation,  as  we  have  stated,  affects  ver- 
bal learning,  emotional  communication, 
and  mutual  cuing  that  is  characteristic  of 


the  unimpaired  mother-child  twosome. 

Should  a  child  not  be  able  to  speak,  he 
then  tends  to  be  regarded  and,  in  the  end, 
to  regard  himself  more  as  a  dumb  beast 
than  as  a  human.  Psychiatry ,  psychiatrists, 
and  other  psychiatric  workers  share  these 
attitudes.  This  is  mainly  why  psychiatrists 
have  not  engaged  in  the  treatment  for  the 
deaf  until  the  past  10  years  or  so.  This 
attitude  had  to  be  overcome  before 
psychiatrists  would  venture  into  what  ap- 
peared to  be  such  an  unpromising  field. 

IF  WE  STUDY  THE  EFFECT  OF  A 
deaf  child  on  his  parents  and  on 
his  educators,  we  find  that  he  breeds  un- 
certainty and  confusion.  The  acceptance 
of  this  central  role  of  perplexity  and  confu- 
sion provides  a  bridge,  through  empathy 
and  identitlcation,  to  all  persons  charged 
with  the  responsibility  of  relationship, 
guidance,  or  therapy  with  the  deaf.' 

We  know  that  confusion  is  not  a  state  of 
mind  easily  tolerated  by  parents  or  by 
psychiatrists.  This  confusion,  which  ema- 
nates from  the  relationship  with  a  deaf 
child,  must  be  accepted,  however,  be- 
cause of  the  lack  of  emotional  and  intellec- 
tual cues  and  the  paucity  of  the  emotion- 
ally nourishing  feedback  that  normally 
motivates  a  parent  to  relate  closely  to  her 
child. 

The  deaf  child  appears,  overtly,  to  be 
stolid,  independent,  and  often  stoical. 
There  is  little  demonstration  of  clinging, 
whining,  or  the  other  usual  manifestations 
of  separation  anxiety,  apprehensiveness, 
or  fear  of  new  or  strange  situations.  It 
comes  as  a  shock  that  this  same  stolid 
youngster  will  suddenly  start  to  dart  about, 
will  inexplicably  go  into  a  rage,  or  throw  a 
temper  tantrum.  We  expect  some  signal  of 
emotion  before  such  a  behavioral  manifes- 
tation. 

This  impulsivity  of  the  deaf  child  is  bodi 
frightening  in  its  unexpectedness  and  in- 
furiating because  of  our  bewilderment. 

23 


What  is  missing  is  the  unexpressed  or 
unreceived  anxiety  and  inner  confusion 
of  the  child.  Some  threat  to  the  parent- 
child  relationship  has  emerged,  and  the 
child,  incapable  of  revealing  his  anxiety 
verbally  and  expressively,  has  short- 
circuited  it  into  an  "acting  out"  and  a 
rage.  When  this  situation  is  anticipated  or 
even  understood  in  retrospect,  the  disturb- 
ing behavioral  response  can  be  aborted  or 
remedied. 

The  key  to  this  situation  is  our  know- 
ledge that  parent-child  ties  exist  even 
when  they  may  not  be  obvious.  The  deaf 
child  has  as  intense  a  tie  to  his  mother  as 
does  the  child  who  hears.  His  equipment 
for  expressing  his  relational  feelings  is  de- 
fective and  his  modes  are  different.  In  fact, 
his  inability  to  contain  the  present  and  fu- 
ture presence  of  his  mother  through  verbal 
formulation  and  memory  makes  his  sep- 
aration anxiety  even  more  intense  than  that 
of  the  intact  child. 

His  dependence  on  the  actual  presence 
and  certainty  of  the  future  return  of  his 
mother  has  to  be  built  more  carefully,  and 
with  greater  deliberation.  Out  of  sight,  out 
of  mind,  is  more  characteristic  of  the  deaf 
child  in  this  regard.  Should  one  fail  to 
understand  the  specific  differences  of  the 
deaf  child,  many  errors  are  likely  in  the 
psychiatric  management,  whether  this 
psychiatric  intervention  be  guidance,  con- 
sultation, or  direct  therapy. 

The  rate  of  development  of  the  deaf 
child,  socially  and  emotionally,  is  differ- 
ent from  that  of  the  hearing  child.  Both  the 
differences  in  general  rate  of  development 
and  of  selective  areas  within  that  de- 
velopment are  important  in  the  psychiatric 
understanding  of  the  deaf  child,  as  it  influ- 
ences both  assessment  as  to  the  degree  of 
psychopathoiogy  and  the  prognosis.^ 
Greater  prognostic  optimism,  even  in 
those  deaf  children  who  show  severe  be- 
havior disorders,  becomes  an  important 
lever  in  the  treatment  of  the  deaf  child  and 
in  the  guidance  of  his  parents. 

MODERN  EDUCATORS  OF  THE 
deaf,  in  their  emphasis  on 
teaching  verbalization,  have  tried  to  pro- 
hibit the  children  or  their  mothers  from 
communicating  through  gestures  and  body 
language.  This  restrictive  educative  mo- 
dality not  only  prevents  communicative 
gestures,  but  also  inhibits  emotional  ex- 
pression and  emotional  communication. 

The  child's  interests  and  pleasures  in  the 
external  world  and  in  others  is  developed 
partially  from  a  convergence  of  his  own 
desires  with  their  gratification  by  the 
mothering  person.  The  mother's  responses 
direct  the  child's  interest  and  responses  to 


the  external  world. 

Should  the  mother  be  instructed  to  limit 
her  responses  to  verbalization,  she  then 
denies  the  child  a  totality  of  observation 
and  emotional  meaning.  If,  for  example, 
in  showing  a  Christmas  tree  to  her  child, 
she  refrains  from  pointing  at  it  with  ex- 
citement, merely  saying,  "Oh.  look  at  that 
Christmas  tree,"  the  child  is  stripped  of 
the  holistic  context. 

The  mutual  pleasure  of  doing  together 
and  of  learning  together  is  part  of  the  de- 
velopment of  the  self  as  a  "feeling"  self, 
is  part  of  the  pleasure  of  doing  and  of 
learning,  and  is  part  of  the  mutual  emo- 
tional attachment  between  the  child  and 
his  parent  and,  later,  the  child  and  others. 
The  deaf  person's  difficulty  with  the  em- 
pathic  reading  of  others  and  with  the  feel- 
ings and  motivations  of  others  is,  at  least  in 
part,  due  to  the  restrictions  of  these  early 
mother-child  interactions. 

The  teaching  games,  from  "patty- 
cake"  and  "this  little  piggy"  to  "hide  and 
seek."  are  all  an  admixture  of  touch,  emo- 
tional display,  sound,  and  language.  It 
should  not  be  forgotten  that  one  of  the 
common  complaints  of  mothers  of  deaf 
children  is  their  lack  of  pleasure  derived  in 
being  with  and  teaching  their  child.  The 
mother  who  is  instructed  purely  to  name 
objects  for  her  child  feels  constrained,  dis- 
tant, bored  and  stereotyped.  As  one 
mother  said,  "I  thought  and  hoped  that  I 
would  have  a  lot  of  fun  with  my  child,  but 
all  I  am  doing  is  leaching  and  disciplin- 
ing." 

That  which  binds  a  mother  to  her  child  is 
the  capacity  to  share  his  excitements  and 
discoveries.  As  for  the  child,  his  restric- 
tion gesturally  not  only  limits  his  pleasur- 
able mutuality,  but  also  leads  to  increased 
frustration  in  communication. 

Natural  experiments  in  the  observation 
of  the  deaf  child  bear  out  our  psychiatric 
knowledge  that  frustration  leads  to  aggres- 
sion. The  child  who  cannot  communicate 
his  hunger  substitutes  anger  for  the  more 
subtle  communication  of  his  desires.  He 
must  either  give  up  his  feeling  that  his 
mother  is  a  satisfying,  giving  person,  or  he 
must  coerce  her  aggressively  to  accede  to 
his  wants.  Often  he  does  both.  In  this  re- 
gard, we  must  again  take  a  leaf  from  our 
knowledge  of  the  normal  child  and  realize 
that  gesture  and  emotional  expressions  are 
of  the  utmost  importance  in  the  child's 
education. 

THE  NEED  TO  OVERCOME  THE 
loss  of  hearing  and  the  lack 
of  speech  has  created  a  narrow  focus  for 
educators  and  often  for  parents.  This  nar- 
row focus  leads  to  a  concentration  on 


overcoming  these  handicaps  through  tas 
learning  which,  although  understandable 
does  not  contribute  to  the  fullest  develof 
ment  of  the  child.  In  the  hope  of  quantit, 
tive  input,  there  is  a  neglect,  often  a  d^ 
nial,  of  the  common  conflicts  and  prob 
lems  of  the  child. 

These  biases,  motivated  by  narrow  edu 
cational  goals  and  a  lack  of  perception  i 
the  child's  emotional  needs,  have  cause- 
the  persons  who  rear  the  child  to  overlool 
vital  elements  in  the  child's  development 
such  as  his  attachment  to  transitional  ob 
jects,  toy-s  and  possessions,  and  sucl 
major  problems  for  children  as  nightmare 
and  eneuresis.  Moreover,  excessive  foci: 
on  the  handicap  reinforces  the  already  pres 
ent  narcissistic  injury.  This  leads  to  ; 
need  for  the  child  to  deny  the  difficulty  am. 
to  fixate  the  early  childhood  belief  tha 
cure  is  inevitable.  Also,  excessive  focu' 
on  the  handicap  leads  to  the  vicious  cycle 
in  which  all  problems  are  attributable  t( 
the  handicap,  and  all  problems  will  ane 
can  only  be  resolved  with  the  removal  ot 
the  handicap. 

The  child's  deafness,  with  its  attendant 
problems,  causes  profound  difficulties  not 
only  for  the  mother,  but  also  for  the  family 
as  a  whole  and  for  each  individual: 
member.  Thus,  our  approach  must  give 
consideration  to  all  these  factors  even 
though  we  must  assign  priorities. 

THE  EARLIEST  MOTHER-CHILD 
relationship  establishes  the  ma- 
trix for  both  the  emotional  and  the  cogni 
tive  development  of  the  child.  The  mother 
requires  professional  assistance.  Her  per- 
plexity in  relating  to  her  child,  who  cannot 
give  the  oral  or  even  the  expected  emo- 
tional cues,  is  compounded  by  the  diverse 
counseling  that  she  often  receives. 

At  this  point,  a  concrete  example  ma\ 
illustrate:  Parents  consulted  one  of  the  au- 
thors about  their  deaf,  8-year-old  child. 
They  were  troubled  by  his  hyperactivity, 
his  impulsivity,  his  lack  of  judgment,  and 
his  aggression  toward  his  younger  sibling 
The  child  had  been  diagnosed  as  deaf  ai 
months,  after  which  his  mother  developeu 
a  detached,  affectless,  mechanistic  ap- 
proach both  to  this  child  and  to  other  per- 
sons. The  father's  already  obsessive  inde- 
cisiveness  was  exacerbated  so  that  he  be- 
came unable  to  make  any  decisions. 

The  parents  had  been  advised  to  treat  the 
child  by  strict  oral  rearing  and  to  use  a 
behavioristic  approach  to  his  education 
and  discipline.  The  family  then  learned  of 
a  special  method  of  speech  training,  and 
relocated  in  the  city  where  the  method  was 
practiced. 

The  birth  of  a  younger  brother  4  years 


ater  disrupted  the  already  tenuous  ego  de- 
rclopment  of  this  deaf  child.  He  lagged  in 
earning,  became  more  detached  from  his 
larents,  and  began  to  show  increased 
lyperactivity  and  impulsivity .  After  a  year 
)r  so,  the  parents  removed  him  from  the 
chool  in  which  he  had  been  enrolled  and 
)laced  him  in  another  school  that  used  an 
intirely  different  educational  orientation. 

The  child  suffered  from  arrested  ego 
levelopment.  had  little  inhibition  of  im- 
Hilse,  and  a  paucity  of  frustration  toler- 
ince.  His  ego  development  and  his  reac- 
ion  to  environmental  stimuli  resembled 
hat  of  a  4-year-old.  rather  than  that  of  an 
J-year-old.  His  outbursts  and  undirected 
ictivity  appeared  to  coincide  with  any  re- 
lirection  of  his  mother's  attention  away 
Tom  himself. 

The  mother,  in  her  mechanistic  way, 
vas  performing  only  those  tasks  necessary 
or  the  family.  She  was  profoundly  fearful 
)f  any  emotionality  that  might  evoke  her 
lelplessness  and  depression.  The  father, 
inconsciously  jealous  of  the  attention  di- 
ected  toward  his  child,  and  unwilling  to 
idmit  the  effect  of  the  child's  difficulties 
m  his  own  pride  and  confidence,  was  ob- 
lessively  concerned  with  his  own  profes- 
ional  decisions.  He  attempted  to  substi- 
ute  these  neurotically  induced  profes- 
iional  difficulties  for  his  concern  about  the 
Md  and  the  child's  welfare. 

TO  INVOLVE  THE  MOTHER  IN  GUI- 
dance  and  treatment  effectively, 
t  is  not  enough  to  show  her  that  she  is 
,:)vercompensating  for  her  hostile  and  re- 
ecting  attitude,  nor  that  she  is  narcissisti- 
;ally  injured  by  having  produced  a  deaf 
;hild.  Neither  is  it  sufficient  to  advise  her 
o  continue  to  speak  to  the  child  to  increase 
lis  alertness  to  sound,  although  these  can 
tl!  be  of  great  help  in  the  therapeutic  ar- 
iiamentarium.  The  mother  of  a  deaf  child 
s  not  necessarily  suffering  from  an  unreal 
ir  neurotic  reaction. 

Here  are  some  of  the  difficulties  the 
nother  of  a  deaf  child  faces: 

Z  She  does  not  receive  from  the  child  the 
cues  with  which  a  mother  is  familiar. 
She  does  not  obtain  the  feedback  in 
speech,  in  emotional  response,  or  in 
achievement  with  which  a  normal  child 
increases  his  spontaneous  mothering. 

Z  She  must  control  and  regulate  the 
child's  behavior  in  proximity.  Thus, 
she  must  be  on  top  of  the  child:  she 
cannot  attract  his  attention  from  across 
the  room,  nor  can  she  reach  him  with  a 
■  no. "  Furthermore,  she  cannot  modify 

CANADIAN  NURSE  —  Oclobef  1975 


her  discipline  with  explanations  or  an- 
ticipations. She  cannot  say  "we  will  do 
this  later,"  or  "when  we  have  finished 
this ,  you  can  do  that . "  Control  replaces 
relationship  in  the  ordering  of  the  child. 

D  She  is  faced  with  a  child  who  is  infan- 
tile in  his  lack  of  impulse  control  and  in 
his  inability  to  understand  and  to  order 
his  world. 

D  She  is  often  embarrassed  by  her  child's 
behavior  with  his  peers  and  toward 
other  adults.  He  may  suddenly  utter 
weird  and  unintelligible  sounds,  may 
suddenly  dart  away,  or  may  touch  or 
climb  on  a  stranger.  She  feels  she  is 
being,  and  often  is  looked  upon  as.  an 
inadequate  and  incompetent  mother. 
One  writer  stated  that  his  wife,  when 
taking  her  deaf  daughter  out,  would 
pretend  to  be  the  nursemaid,  rather  than 
the  mother.' 

The  ability  to  understand  and  to  be  un- 
derstood is  itself  an  important  source  of 
strength  for  the  mother.  Specific  guidance 
in  the  need  to  exaggerate  in  mime  and 
gesture  the  partings  and  reunions,  the 
"hellos"  and  "good-byes"  minimizes  the 
separation  anxieties  and  reunions.  Emo- 
tional transactions  which,  in  the  deaf  child 
are  poorly  developed  by  alternative  com- 
munications, can  be  reinforced  when  the 
mother  looks  directly  into  the  child's  eyes 
when  she  is  relating  to  him.  This  increases 
his  responsiveness  and  enhances  her  own 
maternal  gratification. 

The  mother's  ability  to  anticipate  the 
child's  apparent  random  impulsivity 
through  her  knowledge  of  its  coincidence 
with  the  loss  of  attention,  with  separation, 
and  so  on,  enables  her  to  have  greater  trust 
in  her  own  resourcefulness  and  gradually 
increases  her  child's  ability  to  delay  and  to 
detour  his  responses.  Moreover,  her 
knowledge  that  his  delayed  speech  is  con- 
nected with  his  inability  to  delay  gratifica- 
tion of  his  needs  and  to  treat  her  as  a 
need-gratifying  object  increases  her  realis- 
tic hopes  that  he  will  be  able  to  have  a  more 
gratifying  and  a  more  normal  ego 
development.'' 

Tragedy  in  a  family  may  unite,  but  often 
divides.  Mutual  blame  and  disappoint- 
ment in  each  other  is  often  a  consequence 
of  a  family  tragedy.  Many  a  father,  rather 
than  face  his  hurt  and  anxiety,  will  be 
unable,  without  help,  to  relate  to  his  defec- 
tive child.  Extra  work,  extra-marital  af- 
fairs, and  displaced  anxiety  often  ensue. 
One  can  trace  the  lessening  of  satisfaction 
in  sexual  life  to  the  time  of  the  discovery  of 
a  problem   in  the  child.   Here,  marital 


therapy  may  be  effective,  and  group 
therapy  among  people  with  similar  prob- 
lems generalizes  the  problem  and  allows 
expression  rather  than  acting  out. 

IN  SUMMARY:  THE  DEAF  CHILDS 
problems  are  not  heard  by  those 
directly  concerned  with  his  care  and  treat- 
ment. The  difficulty  in  psychiatric  man- 
agement and  treatment  of  the  deaf  lies  in 
our  inability  to  understand  the  differences 
in  the  developmental  pathways  of  the  deaf 
child  while,  at  the  same  time ,  being  able  to 
correlate  these  with  the  development  of  the 
normal  child.  This  difficulty  is  shared 
alike  by  parents,  whom  we  would  not  ex- 
pect to  bridge  the  gap:  by  educators,  who, 
having  carried  the  major  burden  of  the 
deaf,  have  become  compartmentalized, 
divided,  and  polarized;  and  by  psychiat- 
rists and  others  working  in  psychiatry, 
who  have  not  applied  contemporary  know- 
ledge and  investigative  methods  to  the 
deaf. 

Changing  social  attitudes,  which  no 
longer  tolerate  the  sequestration  of  any 
group  within  our  community,  and  its  con- 
comitant mandate  to  ensure  the  greatest 
possible  growth,  development,  and  happi- 
ness for  all  individuals,  have  begun  to  re- 
vitalize our  approach  to  the  psychotherapy 
of  the  handicapped.  When  we  study  the 
development  and  the  interactions  of  the 
deaf  child,  we  are  struck  by  his  ego 
strengths  and  potential  integrative 
capacities,  while,  at  the  same  time,  noting 
the  extensive  difficulties  that  his  com- 
municative deficit  produce. 

Once  we  are  able  to  understand  the 
strengths  and  the  difficulties,  we  find  that 
a  modification  of  our  techniques  of  paren- 
tal guidance,  family  therapy,  and  indi- 
vidual psychotherapy  are  applicable  to  the 
emotional  problems  engendered  in  the 
deaf  child. 


References 

1.  Goldfarb,  William.  Childhood  schizop- 
hrenia. (Commonwealth  Fund  Publication 
Series.)  Cambridge,  Mass..  Harvard  Uni- 
versity Press,  1961 . 

2.  Lesser.  Stanley  R.  Personality  differences 
in  the  perceptually  handicapped.  J.  Amer. 
Acad.  Child  Psychiatry  11:3:458-66.  July 
1972. 

3.  West,  Paul.  Words  for  a  Deaf  Daughter. 
New  York.  Harper  &  Row.  1970. 

4.  Katan.  A.  Some  thoughts  about  the  role  of 
verbalization  in  early  childhood. 
Psychoanalytic  Study  Child  16:184-88. 
1961.  Vr 

25 


Non-Accidental 


"The  capacity  for  violence  exists  in  all  of 
us.  It's  like  an  inner  tiger.  Most  of  us  have 
our  tigers  .pretty  well  under  control,  but 
with  the  child  abuser,  the  tiger's  in  con- 
trol." —  Virginia  Coigney. 


M.  Colleen  Stainton 


Sometimes  we  encounter  situations  in  our 
work  that  stimulate  the  tiger  in  us,  and  we 
fight  to  control  it.  Such  is  the  presentation 
of  a  severely  injured  or  mistreated  child  by 
caretakers  who  give  a  vague  or  inconsis- 
tent history  of  how  the  injuries  occurred. 

A  nurse  in  this  instance  inevitably  ex- 
periences feelings  of  anger  and  revulsion 
that  may  render  her  ineffective  if  she  does 
not  understand  the  situation. 

Since  Dr.  Henry  Kempe  first  described 
a  specific  set  of  signs  and  symptoms  in 
children  as  "The  Battered  Child 
Syndrome,"'  the  problem  of  non- 
accidental  trauma  in  children  has  been 
studied  vigorously.  Current  knowledge 
suggests  that  this  is  a  major  health  problem 
with  far-reaching  effects,  for  it  crosses  all 
socioeconomic,  age,  and  racial  barriers  on 
this  continent  and  tends  to  repeat  itself 
from  generation  to  generation.  The  long- 
range  problems  are  serious.  The  battered 
child  has  a  high  risk  of  becoming  a  hard- 
core criminal  oriented  to  violence,  a 
psychotic  and/or  a  child  abuser. 

Much  has  been  learned  about  the  etiol- 
ogy and  variations  of  this  syndrome.  Cen- 
ters have  developed  that  focus  on  this 
problem  as  a  specialty,  laws  have  been 


C.  Stainton  (B.Sc.N.,  University  of  British 
Columbia;  M.S.,  University  of  California.  San 
Francisco)  is  an  Assistant  Professor.  Faculty  of 
Nursing.  University  of  Calgary,  and  a  member 
of  the  Child  Abuse  Advisory  Committee,  Fam- 
ily Resource  Centre,  Alberta  Children's  Hospi- 
tal, Calgary,  Alberta. 


changed  to  protect  those  who  report,  and 
reporting  procedures  and  subsequent  in- 
terventions have  been  streamlined.  How- 
ever, areas  of  treatment  of  the  child  abuser 
and  the  prevention  of  the  abuse  itself  re- 
main less  clear. 

Concern  continues  because  of  the  ap 
parent  rise  in  the  number  of  reported  case- 
of  non-accidental  trauma  or  anticipaleii 
danger  to  a  child.  Does  this  mean  child 
abuse  is  increasing?  Does  it  mean  publi 
city  has,  in  fact,  given  some  sanction  to 
child  abuse?  Or  has  it,  instead,  assisted 
persons  to  recognize  their  problem  and 
seek  help?  Is  non-accidental  trauma  better 
recognized  and  diagnosed  as  knowledge 
increases?  Has  economic  stress  from  infla- 
tion, the  North  American  materialistic 
value  system,  or  the  isolation  of  the  nu 
clear  family  contributed  to  a  significant  in- 
crease in  frustration  and  hence  trauma  to 
children?  Certainly  the  statistics  are  alarm- 
ing! 

Degrees  of  abuse 

Study  has  now  revealed  several  dimei 
sions  of  negative  child-rearing  practice 
that  may  lead  to  temporary  or  permanent 
maldevelopment  of  the  child.  Generalh  . 
the  terms  used  currently  refiect  the  varyini: 
degrees  of  non-accidental  trauma.  The\ 
are: 

D  Child  Battery:  The  willful  infliction  of 
repetitive  physical  and  emotional 
trauma  on  a  child  by  a  caretaking  per- 
son. This  is  the  most  serious  form, 
often  causing  permanent  damage  to  the 
child's  development.   Of  these  chil- 


Trauma  in  Children 


dren,  0.5-1.0%  are  dead  on  arrival  at 
hospital  from  the  first  violent  experi- 

nce.  If  this  condition  is  not  recog- 

ized,  the  child  will  be  dead  on  arrival 
to  hospital  in  the  very  near  future. 
'  hild  Abuse:  While  this  term  is  also 

^ed  as  the  overall  term  for  non- 
accidental  trauma  in  children,  it  is  often 
applied  when  the  physical  injuries  may 
not  render  the  child  critically  or  seri- 
ously ill.  It  may  be  harder  to  detect. 
This  term  includes  drug  abuse  (used  to 
^top  crying),  sexual  abuse  (usually 
girls,  509c  of  whom  are  under  12),  nu- 
tritional neglect  (food  and  water  with- 
held as  punishment,  or  the  child's  nutri- 
tional requirements  not  met  on  a  regular 
basis),  medical  problems  not  cared  for, 
and  emotional  abuse,  where  the  child  is 
subject  to  never-ending  "put-downs," 

hich  damage  the  self-image. 
railure  to  Thrive:  This  diagnosis  is 
used  if  a  child's  weight  is  below  the 
third  percentile  for  the  age  group  and 
sex.  However,  while  the  previous  2  def- 
fmitions  are  absolute  in  their  relation- 
ship to  non-accidental  trauma  in  chil- 
dren, this  diagnosis  is  not. 

Failure  to  thrive  can  certainly  result 
if  the  Child  is  not  fed  at  all  or  seldom,  is 
fed  foods  inappropriate  for  the  age,  if 
>ocialization  is  not  present  during  feed- 
ing, and  so  on.  However,  the  reasons 
tor  these  caretaking  behaviors  can  be 
willful  deprivation  of  the  child.  Failure 
to  thrive  often  occurs  because  of  im- 
maturity or  ignorance  on  the  part  of  the 
caretaker.  This  is  proven  by  the  fact 
that  50%  of  these  children  show 
marked  improvement  when  fed  age- 
appropriate  foods  regularly  by  a  warm, 
caring  person. 
Z  Child  Neglect:  This  includes  some  of 
the  failure-to-thrive  problems,  but  re- 
lates more  broadly  to  neglect  for  the 
child's  basic  needs,  such  as  warmth, 
hygiene,  sleep,  food,  stimulation,  and 
development  of  trust. 

)eveloping  a  theoretical  framework 

Basic  to  dealing  with  our  own  feelings 
nd  planning  interventions  is  a  knowledge 

ANADIAN  NURSE  —  October  1975 


of  the  general  characteristics  of  those  who 
mistreat  children. 

The  most  outstanding  characteristic  of 
the  person  who  abuses  a  child  is  lack  of 
knowledge  about  age-specific  norms  for 
children.  He  or  she  has  unrealistic  and 
highly  inflexible  expectations  for  the 
child's  behavior.  The  child  is  expected  to 
relate  to  the  caretaker  as  an  adult  —  any 
other  behavior  is  interpreted  as  insulting, 
requiring  discipline.  The  child  cannot 
meet  these  expectations,  and  a  negative, 
circular  feedback  mechanism  develops, 
provoking  more  and  more  severe  punish- 
ment in  an  effort  to  change  the  child. 

The  person  attempting  to  help  the  child 
abuser  must  have  a  theoretical  knowledge 
of  h>ehavioral  norms  for  children.  This  per- 
son needs  to  know  the  reasons  children 
respond  differently  at  each  developmental 
stage,  be  able  to  recognize  the  cognitive 
and  affective  skills  of  the  age  groups,  and 
be  able  to  interpret  all  this  to  others.  De- 
velopmental theory  is  vital. 

Second,  abusing  persons  are  often  those 
who  have  experienced  inadequate  parent- 
ing, leaving  them  unaware  of  normal  and 
helpful  responses  of  an  adult  to  a  child. 
They  have  not  acquired  trust  during  their 
own  development.  They  have  repeatedly 
experienced  failure  in  having  their  own 
needs  met  and,  as  a  consequence,  are  often 
isolates  in  society. 

These  persons  are  unable  to  have  the 
close  relationships  of  friends,  and  often 
have  a  less  than  satisfactory  relationship 
with  spouses.  The  need  to  be  loved,  ap- 
preciated and  cared  about  is  great,  and  the 
child  is  perceived  as  one  who  will  meet 
these  needs.  The  child  cannot  become  a 
loving  person  without  experiencing 
warmth  and  caring.  These  children  often 
can  be  detected  by  their  failure  to  cuddle, 
their  starey-eyed  expression,  and  their 
lack  of  response  to  stimulation.  Thus, 
theories  of  personality  development,  par- 
enting, and  role  theory  need  to  be  included 
in  the  framework. 

Certainly  a  significant  contribution  has 
been  made  by  Funke  and  Irby  in  beginning 
to  develop  predictive  criteria  for  maladap- 
tive mothering.^  As  this  theory  is  de- 


veloped, greater  emphasis  will  be  placed 
on  accurate,  preventive  interventions.  The 
developing  theory  in  the  area  of  mothering 
and  mother-infant  interaction  describes  in 
increasing  detail  this  role  as  having  a  large 
cognitive  component  as  well  as  an  affec- 
tive one  —  a  role  requiring  role  models 
and  planned  lessons  to  learn  the  be- 
haviors and  skills  required. 

Shydro  and  Chamberlain  describe 
specific  ways  to  detect  non-accidental 
trauma  in  children. ^-^  Each  person  work- 
ing with  young  families  in  the  child- 
bearing  and  child-rearing  stages  of  family 
life  can  become  familiar  with  these 
criteria.  Nursing  has  the  potential  for  sig- 
nificantly changing  the  child-abuse  pic- 
ture, as  the  nurse  has  access  to  families  in 
prenatal  classes  and  clinics,  doctors"  of- 
fices, maternity  and  pediatric  depart- 
ments, during  postpartum  and  well  baby 
clinics,  family-planning  clinics,  and 
schools.  This  situation  is  not  confined  to 
the  emergency  rooms  and  acute  care 
pediatric  settings. 

Patient  history 

Mrs  E.  was  a  single  parent  again  after  2 
unsuccessful  marriages.  She  had  an  unstable 
childhood  before  and  after  her  mother's  death, 
which  occurred  when  she  was  10  years  of  age. 
A  daughter  was  born  prematurely  and  now 
requires  some  minor  special  care.  This  child  is 
the  scapegoat  in  this  family,  often  the  focus  of 
screaming,  slapping,  being  ignored,  or  blamed 
for  family  problems.  Mrs.  E.  has  expressed 
verbally  that  "life  would  be  simpler  if  1  didn't 
have  to  pui  up  with  thai"  —  referring  either  to 
behavior  or  the  child. 

One  day.  a  minor  crisis  arose  in  which  Mrs. 
E.  requested  help  for  her  own  behavior  with 
this  child.  In  consultation  with  the  Child  Pro- 
tection Unit  and  after  several  home  visits  for 
assessment,  we  decided  to  try  a  role  model 
mother  in  this  home,  using  the  theory  that 
mothering  skills  are  learned,  and  new  role  be- 
haviors are  developed  through  learning  and  ob- 
servation from  role  models.  The  Homemaker 
Service  was  taken  into  confidence,  and  finan- 
cial arrangements  were  made  through  welfare. 
A  competent  woman  of  60  years  of  age  was 
chosen  for  the  2-week  assignment  of  role- 

27 


modelling  interaction  with  this  child  and  help- 
ing the  mother  learn  role-appropriate  behaviors 
for  herself  and  age-appropriate  behaviors  and 
expectations  for  the  child. 

When  Mrs.  E.  was  approached  about  this 
arrangement,   instead  of  hostile,   angry   be- 


havior, there  were  a  few  questions  about  "the 
lady  who  was  coming.  "  We  explained  that  it 
would  be  "sort-of-like  having  a  grandmother 
come  for  a  visit."  Mrs.  E.  was  silent  for  a  short 
time,  then  said  softly,  "l  think  we  could  all  use 
a  little  mothering  around  here."  She  honored 


her  contract  to  be  at  home  as  much  as  si 
usually  would  and  to  try  to  learn  from  thi- 
woman. 

Prevention  is  difficult  to  measure.  Conlaii 
was  maintained  for  a  time  with  this  family  unli! 
they  moved.  While  tensions  still  ran  high  occi 


iionally  during  the  contact  time.  Mrs.  E. 
earned  more  concerned  about  this  child's  on- 
joing  welfare,  and  blamed  fewer  of  her  prob- 
ems  on  the  child. 

guidelines  for  prevention 

Those  child  caretakers  who  have  the 
potential  for  mistreating  children  need 
to  be  identified,  and  referrals  must  be 
made  or  follow-up  provided.  This  re- 
quires careful  history  taking,  including 
those  elements  of  the  predictive 
criteria. 

Help  with  bonding  to  the  child  can 
begin  in  early  phases  of  parenting. 
Programs  in  high  schools  and  prenatal 
classes  can  present  information  to  help 
future  parents  develop  realistic  expec- 
tations of  their  children  at  various  ages. 
In  this  era  of  intensive  research  in  the 
area  of  child  development,  this  infor- 
mation is  not  readily  available  to  nor- 
mal parents,  let  alone  to  those  who  do 
not  adapt  well  to  children. 
Teaching  the  skills  appropriate  to  the 
role  can  help  those  who  care  for  chil- 
dren to  understand  the  child's  needs 
and  how  to  respond  to  them. 

D  Parents  can  be  advised  about  the  early 
developmental  crying  of  young  babies 
as  they  adapt  to  the  extra-uterine  envi- 
ronment, and  can  be  helped  to  modify 
this  crying  pattern  as  described  by 
Harley.' 

D  The  dangers  of  shaking  a  child  should 
be  widely  publicized. 

D  The  National  Film  Board's  Child  Be- 
havior =  You  could  be  shown  at  pre- 
natal classes  and  again  in  postpartum 
units.  Well  baby  clinics  and  waiting 
rooms  might  also  provide  this  film  and 
other  audiovisual  programs  on  child 
development  and  behavior.  Discussion 
could  follow  this  film. 

D  Observational  check-lists  can  be  used 
as  a  means  of  communication  between 
prenatal  classes  and  the  maternity  areas 
so  that  referrals  can  be  made  appro- 
priately as  time-series  observations  will 
indicate.*  Often,  labor  and  delivery  ob- 
servation includes  a  rating  of  itetns 
such   as    "eye-to-eye   contact,"    and 


"talking  to  baby."  If  this  type  of  rating 
is  to  be  done,  care  must  be  taken  to 
ensure  that  the  physical  position  of  the 
infant  and  parents  makes  this  possible. 
Raters  must  be  trained  to  ensure  that 
uniform  rating  occurs  when  these  tools 
are  used. 

D  We  need  to  develop  community  re- 
sources to  support  young  parents  espe- 
cially mothers.  Isolation  is  a  phenome- 
non of  many  new  mothers.  The  abusing 
parent  is  already  an  isolate,  and  hence 
feels  the  child  to  be  highly  intrusive. 
Can  the  needs  that  cause  abusive  be- 
havior toward  children  be  met  through 
community  resources'?  Do  single  par- 
ents have  a  greater  sense  of  isolation? 

D  The  temperament  of  young  children  has 
been  described  by  Thomas,  Chess,  and 
Brich  and  is  a  helpful  theory  in  explain- 
ing and  assisting  parents  to  understand 
a  child's  behavior.'' 

Guidelines  for  treatment 

D  A  team  approach  is  required  as  this 
problem  is  multifaceted,  and  no  one 
profession  possesses  all  the  skills  re- 
quired. This  situation  is  one  where  sev- 
eral caring  people  may  accelerate  the 
development  of  trust  and  a  sense  of 
being  cared  for. 

D  Goals  need  to  relate  to  this  client's  main 
needs,  that  is,  developing  trust  and  a 
feeling  of  self-worth  while  learning 
about  the  child.  Shydro  describes  an 
interesting  example  of  this  goal  being 
met.* 

n  The  team  members  need  support  from 
each  other  and  must  care  about  each 
other.  This  isolated  client  needs  to  see 
this  behavior  in  others  as  an  essential 
part  of  his  or  her  learning.  The  indi- 
vidual metnbers  of  the  team  will  need  to 
trust  other  members  of  the  team  and  be 
able  to  exhibit  this  trust.  If  the  atmos- 
phere tends  to  be  more  competitive  than 
caring,  the  client  will  perceive  this.  The 
client  will  at  times  be  angry,  un- 
cooperative, and  evasive,  and  will  re- 
quire much  patience. 

D  Treatment  measures  should  include  the 
total  family  —  the  various  dyads  and 


triads  may  require  separate  interven- 
tions as  part  of  the  care,  but  goals  need 
to  relate  to  the  family  as  a  whole. 
D  While  this  family  may  be  involved  in 
the  medical-legal  aspects  of  the  situa- 
tion, including  court  appearances,  the 
health  professionals  need  to  remain 
conscious  of  the  possible  punitive  at- 
titudes the  family  may  experience  in 
others  and  take  care  not  to  communi- 
cate similar  feelings. 

Conclusion 

The  detection  and  treatment  of 
families  at  risk  is  an  important  aspect  of 
nursing.  Comfort  in  dealing  with  such 
families  comes  only  from  knowing  the 
theoretical  aspects  related  to  their  mul- 
tiple problems  and  practice  in  applying 
these  theories  to  specific  situations.  In- 
dividual care  goes  without  saying.  The 
teaching  and  supportive  skills  of  nurses 
can  be  valuable  assets  to  the  team  in- 
volved. 

References 

1.  Kempe.C  Henry  ,  and  Heifer,  Ray  E.,  eds. 
Helping  the  Baiiered  Child  and  His  Family. 
Philadelphia.  Lippincott.  1972. 

2.  Funke.  Jeanetie.  and  Irby.  Margaret  I.  A 
study  of  predictive  criteria  in  relation  to 
mothering  behavior .  Unpublished  Master's 
Thesis.  Denver,  Col.  U.  of  Colorado,  1973. 

3.  Shydro.  Joanne.  Child  abuse.  Nursing  '72. 
2:12:37-41.  Dec.  1972. 

4.  Chamberlain,  Nancy.  The  nurse  and  the 
abusive  parent.  Nursing  '74  4:10:72.75-6, 
Oct.   1974. 

5  Harley.  Louis  M.  Fussing  and  crying  in 
young  infants.  Clinical  considerations  and 
practical  management.  C/;>i.  Pediat. 
8:3:138-41,  Mar.  I%9. 

6.  Rising.  Sharon  S.  The  fourth  stage  of  labor: 
familv  integration.  .Amer.  J.  Nurs. 
74:5:8'70-74.  May  1974. 

7.  Thomas.  Alexander,  et  ai.  The  origin  of 
personality.  Scientific  Amer. 
223:2:102-109.  Aug.  1970. 

8.  Shvdro.  loc.  cit.  «^ 


,z^ 


v-.'^*5!E!iy 


>4**';»?^T?SSf 


•^-=! 

-.•i*j*»- 


A  young  pregnant  girl 
tells  her  story 


Mary  Smith 

Wfiat  I  am  going  to  describe  is  only  one 
experience  of  hundreds.  All  these  experi- 
ences are  different,  but  each  of  us  had  the 
same  problem  —  being  unmarried  and 
pregnant. 

There  I  was.  14  years  old,  with  a  guv  F 
thought  was  God's  gift  to  women.  He  had 
chosen  me  over  umpteen  other  girls;  he 
was  a  guy  who  got  in  trouble  with  the 
police,  drank,  took  drugs,  and  drove  with- 
out a  licence.  I  thought  he  was  the  greatesti 
He  said  he  loved  me  and  that,  if  I  loved 
him,  I  "should  go  to  bed"  with  him  or  he 
would  leave  me. 

I  should  have  known  better;  I  should 
have  left  him.  But  I  thought  I  loved  him, 
and  even  though  I  was  scared,  we  had 
intercourse  3  times  before  we  broke  up. 
We  didn't  know  that  I  was  pregnant. 

Later,  I  wouldn't  believe  I  was  pregnant 
and  didn't  face  it.  until  I  was  6  months 
along.  I  was  scared,  because  I  had  no  way 
of  going  to  a  doctor.  I  couldn't  tell  my 
parents,  because  we  weren't  that  close, 
and  I  couldn't  confide  in  my  friends,  for 
fear  the  news  would  get  around.  I  was 
extremely  lonely,  forever  thinking  of  ways 
to  find  out  for  sure  if  I  were  pregnant,  and 
then  thinking  of  solutions  of  what  to  do, 
should  it  be  true. 

My  first  thought  was  to  run  away,  but  1 
had  no  money  and  nowhere  to  go.  I  tried 
putting  it  out  of  my  mind,  hoping  my 
period  would  start  and  that  God  would  not 
let  this  happen  to  me. 

I  even  fooled  myself  for  awhile  until  I 
started  lo  get  sick  in  the  mornings,  and 
people  at  school  began  giving  me  weird 
looks.  Some  even  came  up  and  asked  me  if 
I  were  pregnant.  I  would  just  laugh  and  ask 
where  they  had  got  that  information.  They 
would  say  either  that  I  was  fatter  or  that  my 
ex-boyfriend  had  told  them.  I  was  furious, 
because  not  even  he  knew  for  sure,  al- 
though he  did  know  that  I  had  missed  one 
period.  I  hated  him  because  he  couldn't 
keep  his  mouth  shut.  I  despised  him  be- 
cause he  didn't  care  enough  to  ask. 

To  me,  my  baby  didn't  really  exist  until 
the  6th  month;  in  fact,  I  worked  hard  at 
school  so  my  marks  wouldn't  indicate  a 


Mary  Smith  is  a  pseudon>m. 

THE  CANADIAN  NURSE  —  October  1975 


problem  to  my  parents.  1  had  severe 
headaches,  and  I  was  almost  always  de- 
pressed . 

The  last  thing  in  the  world  I  wanted  to 
do  was  hurt  my  parents.  They  were  well 
known,  and  I  didn't  want  todisgrace  them. 
As  1  said  before,  we  were  not  close,  but  I 
did  love  them.  I  guess  I  did  try  to  tell  my 
mother  once,  but  she  never  understood. 
Following  this.  I  wrote  a  letter  saying  how 
much  I  hated  them  andlhat  they  didn't  care 
about  me  as  they  were  always  out  with 
their  friends.  This  letter  hurt  my  mother, 
but  she  still  didn't  understand. 

Finally.  1  did  gather  enough  courage  to 
get  help.  I  went  to  my  guidance  counselor, 
not  my  parents,  and  he  was  the  one  who 
told  them  for  me.  I  was  terrified  they 
would  hate  me  and  tell  me  how  terrible  I 
was.  I  had  enough  pills  in  my  room  to  kill 
myself,  and  1  am  sure  1  would  have  taken 
them.  But  my  parents  reacted  differently 
than  I  had  expected;  instead  of  screaming. 
the_\  hugged  me.  What  hurt  the  most  was 
seeing  m\  father  cry. 

I  was  6  months  pregnant .  and  they  asked 
me  why  I  hadn't  told  them  sooner;  I  could 
have  had  an  abortion.  I  thought  abortion 
was  sintlil. 

From  here  on,  my  life  was  one  of  many 
changes  and  hurts.  I  first  wondered  if  the 
baby  would  be  put  up  for  adoption,  but  my 
parents  took  it  for  granted,  as  if  there  were 
no  other  way.  1  just  let  it  soak  in.  because 
my  baby  was  nowhere  in  sight. 

We  first  went  to  the  doctor.  This  is  when 
my  dad  really  had  to  believe  it.  He  said  on 
the  way  home  that  when  it  was  all  over  I 
would  have  to  be  at  home  when  they  were 
there,  and  in  a  definite  place  when  they 
went  out .  It  seemed  as  though  he  wanted  to 
hurt  me  more. 

Next ,  was  the  old  "  "dad  talk  to  the  father 
of  the  child"  bit.  which  ended  in  a  fight 
between  them  and  w  ith  me  in  a  complete 
flap  because  the  father  of  the  child  didn't 
give  a  damn. 

Finally,  I  had  to  go  away,  and  this  was 
also  taken  for  granted.  It  was  a  home  for 
unwed  mothers  but,  as  far  as  most  people 
were  concerned,  it  was  a  boarding  school 
in  another  city.  Not  even  my  younger 
brother  and  sister  knew. 

I  felt  a  mixture  of  happiness  because 
(Continued  on  page  34) 


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PHYSICAL  APPRAISAL  METHODS 

IN  NURSING  PRACTICE 

Eighteen  contributing  authors,  all  experts  in  their 
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By  J.  M.  SANA,  R.N.  and  R.  D.  JUDGE,  M.D. 

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By  MASSACHUSETTS  HOSPITAL,  Nursing  Dept. 

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INTRODUCTION  TO  CLINICAL 

PHARMACOLOGY 

Drug  therapy  is  one  of  the  most  important  modalities 
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By  J.  C.  SCHERER,  R.M.,  M.S. 

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LIPPINCOTT 

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everything  would  be  all  right,  and 
sadness  because  1  was  afraid.  I  thought  we 
would  go  directly  there,  but  I  had  to  be  hurt 
again.  My  dad  pulled  into  the  police  sta- 
tion and  told  me  to  charge  my  ex- 
boyfriend.  (I  can't  remember  the  name  of 
the  charge,  but  it  had  something  to  do  with 
statutory  rape,  because  I  was  only  fifteen.) 
I  didn't;  it  would  prove  nothing.  I  would 
have  to  go  on  the  stand  and  report  in  detail , 
while  all  he  had  to  do  was  get  his  friends  to 
say  they  had  had  me  too.  It  wouldn't  have 
been  true  and  I  would  have  been  hurt. 

I  thought  my  father  was  "out  to  get 
me,"  but  after  a  while  I  realized  he  was 
really  hurt  and  that  he  just  wanted  to  ease 
the  pain  awhile,  and  put  the  blame  on  the 
one  whose  fault  it  really  was.  My  parents 
thought  it  was  all  their  fault.  They  were 
really  hard  on  themselves. 

In  the  home  1  was  surrounded  by  girls 
who  were  all  in  my  condition,  ranging 
from  the  age  of  1 1  (a  rape  case)  to  24. 
Before  this  time,  1  thought  I  was  the 
"worst-off  person  in  the  world,  but 
compared  to  some  of  the  things  these  other 
girls  went  through,  just  having  parents 
who  cared  was  enough.  I  guess  it  never 


dawned  on  me  until  then  how  lucky  I  was 
to  have  parents  who  cared  and  helped, 
instead  of  those  who  beat  their  daughters 
and  threw  them  out. 

In  the  home,  I  kept  pretty  well  to  my- 
self, making  a  few  friends:  they  always  left 
for  the  hospital  too  soon.  I  was  lonely  and 
bored  stiff,  but  doing  the  chores  or  making 
crafts  kept  my  mind  occupied. 

I  had  a  really  nice  social  worker  with 
whom  I  talked  whenever  she  came  to  the 
home,  but  until  much  later  it  was  mostly 
school  that  we  talked  about.  I  felt  as 
though  I  were  serving  a  prison  term  for  bad 
behavior. 

My  parents  never  realized  how  hard  it 
was  for  me  and  how  hurt  I  was  until  they 
took  counseling.  It  seemed  funny  that  they 
needed  counseling  too,  but  they  under- 
stood the  problem  much  better. 

We  became  much  closer  during  the  9th 
month;  mom  and  I  talked  a  lot,  because  I 
was  scared.  The  nearer  the  time  drew,  the 
more  frightened  and  the  happier  I  became. 
I  wanted  it  to  be  over,  but  I  didn't  know 
what  it  would  be  like. 

The  date  the  doctor  had  calculated  went 
by.  I  began  to  believe  it  was  not  going  to 


happen,  that  I  would  be  there  forever, 
doctor  said  he  would  have  to  induce  hi 
if  I  were  not  in  by  the  next  week.  I  wai 
the  baby  to  come  naturally,  not  by  foi 
and  my  parents  and  I  had  fun  driving  i 
bumpy  roads  trying  to  bring  it  on.  It  dii: 
work. 

A  few  days  before  the  doctor's  t: 
date,  I  had  signs.  Afraid  that  it  was  faK 
didn't  tell  anyone;  but  when  I  timed  i 
self.  I  told  the  matron  right  away.  It  du 
hurl  much  for  awhile  and,  when  it  di 
wanted  to  postpone  the  delivery  —  I  du 
want  to  be  ready.  I  had  waited  for  mui 
and  I  wanted  to  wait  longer. 

The  time  came  and  I  telephoned  honi. 
tell  mom .  She  said  to  call  again  when  1  w 
finished.  Well,  into  the  hospital  I  we 
scared,  but  curious  about  what  was  to  h, 
pen.  Before  delivery,  I  experienced  nii 
pain  than  imaginable  because  I  could  i 
be  given  an  anesthetic.  My  blood  pressi 
had  skyrocketed,  and  the  doctor  didi 
want  to  take  any  chances.  So,  for  6  hour 
had  to  help  myself.  When  I  did  go  into  i 
case  room,  I  was  dazed,  but  interested 
my  surroundings .  I  was  worried  that  soni 
thing  would  go  wrong.  Nothing  did,  a 


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34 


second  my  baby  boy  came,  I  pulled  a 
mile  that  would  have  reached  the  moon. 

My  emotions  had  become  those  of  a 
wlher,  and  the  only  thing  I  wanted  to  do 
ras  hold  him.  I  did  the  whole  time  1  was  in 
le  recovery  room .  It  was  weird;  before  he 
ms  born.  I  didn't  even  want  to  see  him, 
ut  now  it  was  all  I  could  think  of.  All  that 
ain  was  worth  it,  to  see  something  that 
been  within  me  over  9  months  —  a 
liniature  person  in  perfect  health. 

I  was  proud,  I  wanted  to  tell  the  whole 
iOTld.  Previously,  1  didn't  want  anybody 
3  know,  but  now  I  was  willing  to  tell 
nyone  that  I  had  just  given  birth  to  my 
aby .  He  was  no  one  else's.  I  had  him  "by 
lyself,"  and  the  father,  as  far  as  I  was 
oncemed,  had  had  nothing  to  do  with  it  at 
II. 

I  telephoned  home  before  I  went  back  to 

y  bed,  but  no  one  was  there  to  hear  the 
lews.  This  didn't  bother  me  then  —  I  was 
oo  happy  —  but  after,  it  hit  me.  They 
ouldn't  be  bothered  to  stay  home  that  one 
ighi  —  they  had  to  go  to  a  party  instead. 

I  fed  my  baby  every  day  except  for  the 

ist.  I  knew  I  shouldn't  feed  him.  as  it 
vould  only  be  harder  to  leave  him.  I  knew 

had  to  give  him  up  but  I  figured  that  if  I 
ould  only  be  with  him  a  while.  I  would 

el  better  later,  knowing  I  had  held  him. 

I  had  to  give  up  my  child,  not  because  I 
:ally  wanted  to.  but  because  I  knew  it 

ould  be  better  for  him.  I  was  only  15. 
nth  a  grade  10  education,  no  husband, 
nd  no  means  of  support.  I  wanted  my 
hild  to  have  everything:  a  good  home, 
arents  who  loved  him.  and  a  future  that  I 
ouldn't  give  him.  But  only  God  knows 
ow  I  wish  I  could  have  kept  him. 

The  staff  at  the  hospital  were  extremely 
nderstanding.  The  last  3  nights  1  spent  at 
lie  hospital  were  hell,  for  I  knew  I  had  to 

ave  him.  1  was  usually  up  pacing  the 
oom,  not  being  able  to  sleep  and  question- 

g  myself  if  I  were  right  or  wrong.  I'd  go 
iver  the  bad  and  the  good  points  for  keep- 

ig  him  or  giving  him  up.  Adoption  al- 
k'ays  seemed  to  win.  The  nurses  would 

ivite  me  for  a  cup  of  tea.  talk  to  me.  and 
lelp  me  realize  that  whatever  decision  I 
lade  had  to  be  the  best  one  for  the  baby.  I 
lid  want  the  best  and  only  the  best  for  wv 
aby. 

When  I  had  to  fill  out  the  adoption  form, 
!  was  hard.  I  was  asked  if  I  wanted  to  give 
nything  to  the  baby  to  keep,  and  I  asked  if 
iC  could  keep  the  name  I  gave  him  — 
'Peter." 
My  parents  came  every  day,  but  not 


once  was  a  word  mentioned  about  Peter.  I 
wanted  them  to  see  him,  but  I  was  too 
afraid  to  ask  for  fear  they  might  say  "no," 
and  that,  1  couldn't  bear.  The  night  before 
1  was  to  come  home,  I  telephoned  mom 
and  told  her  that  I  loved  my  baby  and 
wanted  them  to  see  him.  Dad  was  away ,  so 
he  wouldn't  be  able  to  pick  me  up.  Mom 
said  that  dad  really  wanted  to  see  Peter,  but 
it  would  hurt  him  too  much.  I  understood 
this,  but  I  wasconcemed  that  if  no  one  saw 
him  except  for  a  few  friends,  it  would 
become  a  dream.  I  asked  if  she  would  see 
my  baby  when  she  came  to  pick  me  up. 
It  was  the  worst  night  of  my  life,  be- 
cause I  knew  that  the  next  day  1  would  be 
leaving  a  great  part  of  it  behind  me.  that 
part  of  my  life  that  had  brought  me  so 
much  love  in  such  a  short  time. 


I  didn't  feed  him  that  morning.  I  feh  he 
would  be  afraid  and  hate  me.  The  night 
before,  I  felt  as  if  he  knew  what  was  going 
to  happen  and,  when  he  looked  up  at  me 
and  smiled,  I  cried  with  him  in  my  arms. 

When  my  mom  did  come,  few  words 
were  spoken:  we  both  seemed  to  know 
within  our  hearts  that  this  was  the  right 
thing  to  do.  I  saw  Peter  one  last  time 
through  the  glass  window  and  my  arms 
ached  then,  as  they  still  do  now.  to  hold 
him.  I  turned  and  walked  away  and  didn't 
cry  at  all  —  until  I  got  home. 

My  brother  and  sister  didn't  understand 
what  was  wrong  or  why  1  cried  a  lot.  and 
they  didn't  say  anything  about  it.  I  don't 
know  why,  but  a  few  days  later  I  was  a  bit 
happier  and  my  little  brother  said,  "I'm 
glad  you  feel  better  now:  something  was 
wrong  with  you  before." 

I  had  no  problems  at  school  and  no  one 
seemed  to  look  down  on  me.  I  had  many 
friends ,  and  my  best  one  helped  me  a  lot  by 


letting  me  talk  to  her  and  by  letting  me  cry 
when  I  felt  the  need. 

1  hadn't  finished,  though:  I  still  had  to 
sign  the  final  papers.  My  parents  came 
with  me,  but  1  had  to  do  it  myself.  I  had  to 
put  my  hand  on  the  Bible  and  swear,  in  a 
manner  of  speaking,  that  I  was  no  longer 
the  real  mother  of  my  child. 

No  one  can  even  begin  to  realize  how 
hard  it  is  for  a  person  to  do  this,  unless 
she's  gone  through  it  herself.  The  child  I 
carried  for  9  months,  gave  birth  to,  fed, 
and  loved  as  only  a  mother  can  love  her 
child,  was  no  longer  mine.  1  left  that  place 
feeling  empty  and  torn  in  half. 

I  still  couldn't  be  sure  I  had  done  the 
right  thing,  but  1  knew  the  parents  were 
nice  people.  1  was  told  about  them,  not 
their  names  or  anything,  just  what  they 
were  like  and  their  life-style.  I  was  also 
told  that  they  kept  Peter's  name  and  that 
the  mother  asked  the  social  worker  to  tell 
me  "not  to  worry."  Il  made  me  feel  better, 
knowing  they  cared  about  me  too. 

This  all  happened  about  2  years  ago, 
and  I  will  never  forget  it.  I  still  love  my 
child  and  always  will.  1  have  picked  upthe 
pieces  and  now  have  a  slightly  better  home 
life,  but  my  parents  seem  to  want  to  forget 
everything.  I  know  I  never  will,  but  we  get 
along  and  1  am  trusted  more  than  I  ever 
was.  I  have  a  boyfriend  who  has  been 
really  good  to  me.  He  knows  of  my  past 
and  respects  me  for  it:  he  doesn't  "put  me 
down."  1  have  new  friends  and  a  different 
life.  I  am  not  the  same  person  1  was  when  I 
left .  I  feel  more  mature,  and  my  old  friends 
no  longer  seem  right  for  me. 

My  best  friend  and  I  are  still  the  same: 
we  talk  and  confide  in  one  another.  She 
never  left  me  in  the  cold  while  I  was  away 
or  when  I  came  back.  I  was  able  to  lean  on 
her  when  I  was  unhappy. 

I  pray  daily  for  my  child.  On  his  birth- 
day I  take  a  walk  and  wonder  what  he  is 
like.  When  he  grows  up,  I  only  hope  that 
he  realizes  I  love  him  and  that  it  was  love, 
not  hate,  that  let  me  give  him  to  wanting 
parents. 

This  is  a  true  story,  one  1  experienced 
and  one  that  is  similar  to  other  girls.  I  hope 
it  helps  you  understand.  1  am  happy  to 
know  some  people  do  wonder  what  we  go 
through  and  don't  categorize  us  simply  as 
"unwed  mothers."  Each  of  us  experi- 
ences more  emotion  and  pain  than  1  had 
ever  thought  possible.  Q 


35 


Home  clGlivGry  —  Dutch  styte 


A  Canadian  nurse  presently  living  in  Holland  shares  her  experience 
of  a  home  delivery,  describing  its  advantages  and  disadvantages. 


Linda  Edgar 


Having  a  baby  at  home  —  a  good  idea  or 
not?  Since  our  family  arrived  in  the 
Netherlands  over  a  year  ago,  I  had  been 
trying  to  find  my  own  answer  to  that  ques- 
tion. Our  3-year-old  daughter  was  born  in 
the  traditional  Canadian  hospital  setting, 
and  all  my  trust  was  geared  to  that  system 
ot  delivery.  My  reaction,  as  a  nurse,  to  the 
concept  of  care  at  home  was  sharply  nega- 
tive. ""Of  course  not.'  was  my  standard 
reply  to  the  questions  of  friends.  Far  too 
dangerous  and  unscientific,  I  had  decided. 

And  yet,  there  were  some  definite  ad- 
vantages to  staying  at  home.  Our  daughter 
had  reacted  strongly  to  our  recent  cultural 
upheaval  —  the  acquisition  of  a  new  coun- 
try, home,  and  language.  To  up.set  her 
further  by  a  physical  separation  from  her 
mother,  plus  the  appearance  of  a  sibling, 
seemed  unwise. 

The  Netherlands  has  the  lowest  infant 
mortality  rate  in  the  world,  while  Canada 
places  near  the  bottom  of  the  list.  (See 
box). 

My  reading  on  maternal  and  child  health 
and  family-centered  maternity  care  had 
impressed  me.  Psychological  and  emo- 
tional well-being  of  family  members  re- 
sults when  the  mother  remains  in  the  home 
and  the  family  can  assist  in  some  way  with 
the  birth. 


Linda  Edgar  (R.N.,  The  Hospital  for  Sick  Chil- 
dren, Toronto,  Ont.;  B.N.Sc,  Queens"  Uni- 
versity, Kingston.  Ont.)  is  presently  living  in 
the  Netherlands.  She  was  previously  a  nurse- 
teacher  in  diploma  nursing  programs. 


Many  Dutch  women  who  shared  their 
personal  experiences  with  me  spoke 
highly  of  a  home  delivery.  Several  women 
had  delivered  their  first  baby  in  hospital 
and  their  second  at  home.  These  women 
unanimously  favored  their  home  de- 
liveries. They  stressed  a  greater  feeling  of 
relaxation  at  home,  more  individual  free- 
dom, better  sleeping  habits,  more  comfort 
in  familiar  routines,  an  uninterrupted  rela- 
tionship with  their  other  children,  a  deeper 
closeness  with  their  husbands  who  partici- 
pated more  in  the  actual  delivery,  and 
fewer  indications  of  postpartum  depres- 


sion. These  women  assured  me  that  pe 
sonnel  in  Dutch  hospitals  attempt  to  brir 
the  atmosphere  of  a  home  delivery  to  tt^ 
hospital  setting.  For  example,  in  man 
hospitals  the  mother  is  allowed  to  ha\ 
labor,  give  birth,  and  recover  in  the  san 
bed! 

In  the  Netherlands,  both  home  and  ho- 
pital  deliveries  can  be  expensive  for  tho^ 
families  whose  income  is  above 
specified  level.  The  Dutch  medical  systei 
appears  to  favor  home  deliveries  in  a 
normal  circumstances.  In  general,  healt 
insurance  completely  covers  hospiti 


1971  Infant  Mortality  Statistics* 
(Per  1000  Live  Births) 


Netherlands 

9.1 

New  Zealand 

16.5 

Norway 

9.5 

France 

17.1 

Iceland 

9.8 

Australia 

17.3 

Sweden 

11.1 

England  &  Wales 

17.5 

Japan 

12.4 

Canada 

17.5 

Finland 

12.6 

East  Germany 

18.0 

Denmark 

13.5 

Hong  Kong 

18.4 

Switzerland 

14.4 

United  States  of  America 

19.1 

Ukranian  U.S.S.R. 

16.0 

Scotland 

19.9 

Byelorussian  U.S.S.R. 

16.3 

West  Germany 

23.3 

*      World  Health  Slalislics  Annual  Vol.   I .   Vital  Statistics.  Geneva.  Switzerland.   World  Health 
Organization  1974. 

t        Canada's  infant  mortality  rate  dropped  to  15.5  in  197} .  Vital  Statistics  1973  vol.  J.  table  25,  p. 
150.  Ottawa.  Information  Canada.  1975. 


Bliveries  only  when  there  is  a  definite 
ledical  indication. 

Conditions  such  as  preeclampsia,  tox- 
nia,  abnormal  fetal  position,  and  previ- 
[is  prolonged  labor  or  forceps  delivery. 
arrant  hospital  admission.  Some  women 
■e,  of  course,  ill-advised  to  have  their 
ibies  at  home;  these  include  those  under 
7  or  over  35,  and  those  expecting  their 
rst  or  perhaps  fourth  child. 

The  continued  reluctance  of  the  Dutch 
nguage  to  unfold  its  secrets  to  me  made 
le  dread  the  barrier  that  I  feared  must 
list  in  hospital  until  I  mastered  the  in- 
icacies  of  the  new  language. 

My  husband.  Bob,  felt  that  the  final 
x:ision  must  be  mine,  but  he  supported 
ly  positive  comments  about  remaining  at 
ome.  An  irrational,  but  persistent,  voice 
om  within  kept  repeating,  "All  those 
utch  women  cant  be  wrong!  If  they  can 
it,  why  can't  you?"'  I  also  knew  that 
)proximately  70<5f  of  all  births  occurred 

home.  What  a  giant  step  toward  integra- 
on  into  the  Dutch  community! 

My  doctor  was  encouraging.  Like  most 
actors  and  midwives  in  the  Netherlands, 
;  believed  firmly  in  their  system  of  home 
;liveries.  I  confronted  him  with  as  many 
guments  as  possible  against  remaining  at 
3me.  citing  various  obstetrical  emergen- 
es.  He  replied  that  he  could  cope  with 
ly  likely  emergency,  and  that  we  were 
ithin  minutes  of  the  nearest  hospital.  In 
ict,  due  to  the  small  size  and  high  popula- 
on  density  of  Holland,  it  is  estimated  that 
jarly  everyone  lives  within  1 5  minutes  of 
hospital . 

My  pregnancy  continued  normally, 
id,  by  my  seventh  month,  I  decided  to 
ive  my  baby  Dutch  style  —  at  home! 

'eparation 

I  received  from  a  nursing  agency  a  long 
it  of  equipment  to  be  bought,  borrowed, 
nted,  or  otherwise  obtained.  My  hus- 
md  and  I  studied  that  list  intently,  decid- 

■  CANADIAN  NURSE  —  Oclober  1975 


ing  if  omslag  luiers  were  the  same  as  on- 
derleggers  (they  are  not!),  and  wondering 
why  we  needed  two  lege  jampotjes  (2 
empty  jam  jars). 

Nursing  services  are  available  for  home 
delivery  and  for  postnatal  care  from  vari- 
ous agencies.  The  nurses,  who  are  on  a 
comparable  level  of  preparation  as  Cana- 
dian registered  nurses,  act  as  delivery 
room,  nursery  and  staff  nurses,  as  well  as 
cook,  dietitian,  laundress,  hostess,  child- 
care  worker,  and  cleaning  lady.  They  may 
be  hired  for  8-  or  24-hour  tours  of  duty,  or 
for  twice-a-day  home  visits. 

We  were  extremely  lucky,  for  a  Dutch 
friend  had  offered  to  assist  with  the  deliv- 
ery and  postnatal  care.  A  former  general 
duty  nurse,  she  first  helped  us  locate  all  the 
necessary  equipment.  Materials,  such  as  a 
4'  X  4'  absorbent  mattress  pad,  are  man- 
ufactured commercially  and  are  readily 
available.  We  borrowed  a  bedpan,  a  large 
rubber  sheet,  and  4  bed  supports  from  a 
nursing  agency,  and  rented  baby  scales 
from  a  drug  store.  Friends  had  offered  to 
care  for  our  daughter  when  labor  began,  so 
we  prepared  her  for  her  brief  absence  from 
home. 

I  followed  Erna  Wright's  book  on 
psycho-prophylaxis  in  childbirth,'  and  at- 
tended weekly  prenatal  gym  classes. 

My  estimated  delivery  date  came  and 
went.  But,  2  weeks  later,  I  woke  to  mild, 
irregular  contractions  that  gave  us  plenty 
of  time  to  complete  our  preparations.  We 
notified  the  doctor,  who  said  that  he 
wished  to  be  called  when  contractions 
were  5  minutes  apart.  Bob  and  I  spent  the 
evening  timing  contractions.  It  was  a 
peaceful  time,  yet  so  full  of  anticipation. 
We  were  calm.  We  both  felt  we  had  done 
all  we  could  to  prepare  for  this  birth. 

Delivery 

The  doctor  first  examined  me  at  7:00 
P.M.  and  returned  at  midnight  when  he 
pronounced  my  dilation  to  be  progressing 


slowly,  but  satisfactorily  at  4  centimeters. 
He  said  that  he  would  wait  an  hour  with  us 
to  observe  the  rate  of  change  of  contrac- 
tions. Bob  made  him  the  traditional  Dutch 
kopje  koffie.  and  they  chatted  quietly  in  the 
living  room  while  I,  in  my  delivery  room, 
felt  the  first  twinges  of  fear. 

The  aloneness  frightened  me.  I  found  it 
difficult  to  remember  the  correct  breathing 
techniques,  and  I  was  already  aware  of 
strong,  painful  contractions.  I  felt  that  if 
the  contractions  were  so  difficult  to  handle 
then,  I  could  not  possibly  cope  later.  I 
knew  that  analgesics  were  never  routinely 
employed. 

This  knowledge  of  no  "back-up"  sup- 
port in  terms  of  analgesics  or  other  pre- 
medication began  to  terrify  me.  The  doctor 
returned  home,  w  ith  instructions  to  call  the 
nurse  at  3:00  am.  when  he,  too,  would 
return.  Once  again  we  waited  alone. 

As  the  minutes  crept  slowly  by.  Bob 
encouraged  me  to  breathe  properly.  We 
called  our  nurse  earlier  than  planned,  to 
help  allay  my  anxiety.  The  sight  of  her  in  a 
familiar  white  uniform  was  reassuring. 
She  prepared  the  baby's  bed,  filled  warm 
water  bottles,  helped  me  with  my  breath- 
ing exercises,  and  generally  filled  a 
highly  supportive  role.  Soon  the  doctor 
returned,  donned  a  rubber  apron,  washed 
his  hands,  and  was  ready. 

After  another  painful  hour,  he  ruptured 
my  membranes,  only  to  discover  there  was 
little  amniotic  tluid.  We  had  all  expected  a 
large  baby,  and  this  was  further  confirma- 
tion. 

At  last,  the  magic  words. "  "you  can  push 
now."  And  push  I  did.  without  stirrups, 
my  feet  planted  firmly  on  the  bed.  and 
supported  by  our  nurse  and  Bob.  Our  son 
was  bom  just  as  dawn  was  breaking.  I 
vividly  remember  that  bright  blue  Dutch 
sky  appearing  through  the  steaminess  of  a 
night's  labor.  The  doctor  drew  a  large  d* 
on  the  window  for  all  the  world  to  see. 

The  umbilical  cord  was  not  tied  and  cut 

37 


until  placental  transfusion  had  occurred. 
Oxytocin  and  vitamin  K  are  never  given 
routinely  in  Holland,  but  Oxytocin  was 
considered  necessary  for  me.  A  mucous 
trap  cleared  the  baby"s  mouth  and  nose, 
and  he  was  then  ready  to  be  held,  weighed, 
and  washed. 

Time  to  relax 

Now  we  could  relax.  My  husband 
looked  exhausted,  but  relieved.  I  was 
elated.  The  doctor  was  tired,  but  pleased  to 
unwind  with  nborrel  (a  glass  of  traditional 
Dutch  gin)  while  he  waited  for  two  hours 
postnatally.  The  nurse  was  busy  with  our 
son  and  myself. 

By  midmorning,  our  daughter  had  re- 
turned home.  She  ran  excitedly  into  her 
room,  noted  that  the  baby  had  arrived  at 
last,  and  then  ran  outside  to  show  a  new 
toy  to  her  playmate  next  door.  Later  that 
morning,  several  neighbors  dropped  in  to 
express  congratulations.  They  had  heard 
the  first  cries  of  our  son . 

The  following  days  were  filled  with  joy 
and  a  strong  sense  of  family  togetherness. 
Our  nurse  was  a  source  of  perpetual  mo- 
tion, support,  and  capability.  She  spent  a 
week  of  8- hour  days  with  us,  caring  for  the 
baby  and  me.  washing  diapers,  shopping, 
cooking,  greeting  visitors,  and  making 
endless  cups  of  coffee.  She  also  provided 
much  emotional  support  and  health  teach- 
ing. The  doctor  visited  daily  for  10  days  to 
check  on  his  patients  and  read  the  nurse's 
notes  and  graphs. 

Evenings  and  nights  were  a  team  effort 
with  Bob  and  me  sharing  the  care  of  our 
son.  Breast  feeding  was  successful  from 
the  first  day.  As  the  average  Dutch  mother 
receives  little  or  no  medication  during 
labor  and  birth,  her  newborn  infant's  suck- 
ing reflex  is  not  affected  and  he  is  capable 
of  sucking  effectively  from  birth.  The  in- 
cidence of  breast  feeding  among  mothers 
who  give  birth  at  home  is  90%. 

Even  though  there  are  no  visiting  hours, 


neighbors  and  friends  respect  a  new 
mother's  need  for  rest,  and  time  their  visits 
accordingly.  At  the  end  of  10  days,  1  re- 
turned once  more  to  my  full-time  role  of 
wife  and  mother. 

Was  it  the  right  choice? 

In  the  weeks  that  followed,  1  spent  much 
time  reflecting  on  my  experiences.  From 
the  moment  of  birth,  all  my  memories 
have  been  positive  and  joyful.  Our  son  has 
become  a  delight,  both  in  his  disposition 
and  achievements.  Perhaps  the  home  envi- 
ronment, with  its  relaxed  atmosphere,  low 
noise  level,  and  subdued  lighting  wel- 
comes a  baby  into  a  less  hostile  world  than 
the  hospital  setting. 

A  French  obstetrician  has  recently  made 
medical  headlines  by  advocating  "soft" 
childbirth,  where  the  transition  from  in- 
trauterine to  external  life  is  achieved 
gradually.^  To  accomplish  this  gentle 
transition,  many  techniques  are  used  that 
are  similar  to  those  used  in  a  home  deliv- 
ery. 

There  are  risks,  however,  in  remaining 
at  home.  Risks  that  must  be  recognized 
and  accepted.  Three  main  difficulties  can 
be  encountered  that  cannot,  presently,  be 
foreseen:  a  prolapsed  cord,  postnatal 
hemorrhage,  and  neonatal  respiratory  dis- 
tress. 1  believe  that  the  possibility  of  these 
conditions  warrant  a  hospital  delivery. 

Luck  was  on  my  side,  and  now  I  marvel 
at  my  decision  to  remain  at  home!  But. 
waiting  alone  for  long  periods  at  such  a 
stressful  time  is  frightening.  The  absence 
of  available  specialized  equipment  and 
analgesia  terrified  me.  Throughout  my 
pregnancy  I  was  anemic,  and  anemia  can 
intensify  pain.^  Further,  my  episiotomy 
was  sutured  without  any  form  of  analgesia 
whatever!  The  memory  of  that  experience 
is.  unfortunately,  still  vivid. 

I  had  heard  about  the  Dutch  custom  of 
suturing  without  a  local  anesthetic,  but 
was   still   appalled   by   the   unnecessary 


cruelty.  I  believe  that  some  form  i 
analgesia,  if  needed  during  labor  and  di 
livery,  is  every  woman's  right.  Childbin 
is  a  normal  physiological  function  anl 
should  remain  as  uncomplicated  and  n' 
laxed  as  possible,  permitting  joy  and  sati: 
faction  to  emerge.  Where  possibilitit 
exist  for  raising  childbirth  to  a  truly  enricf 
ing  experience,  then  should  we  not  try  t 
discover  them? 

Perhaps  the  hospital  environment  coul 
be  modified  to  create  a  more  relaxed  seli 
ting  for  mother  and  baby .  Both  mother  anii 
child  could  return  home  within  3  to  2 
hours  after  a  normal  delivery,  and  nursin. 
services  could  then  be  employed  for  up  ti 
10  days.  This  system  of  hospital  deliver, 
with  its  safety  and  analgesia,  plus  honi' 
care,  with  its  comfort  and  joy,  is  present!; 
available  in  parts  of  Holland.  For  all  par 
ticipants  in  the  birth  process,  this  seems  ti 
combine  the  best  of  both  worlds. 

References 

1 .  Wrighl,  Ema.  The  new  childbirth.  Rev.  ed 
London,  Tandem.  1971. 

2.  Leboyer,  Frederick.  Pour  une  naissunn 
sans  violence.  New  York,  Knopf.  1975 

3.  Field,  Peggy-Anne.  Relief  of  pain  in  labor 
Canad.  Nurse  70:12:17-23.  Dec.  1974  — 


<■■ 


38 


Some  significant  fats 
and  figures  for  low 
cholesterol  dieters. 


100%  corn  oil  base  provides  40%  polyunsaturated  fats 
in  Fleischmann's  Soft  Margarine. 


As  a  further  forward  step  in  improving  the 
polyunsaturated  to  saturated  fat  relationship 
in  its  margarines,  Fleischmann's  has  just  raised 
the  polyunsaturates  to  4096  from  35%  .  The 
saturated  fats  remain  the  same  low  18%  . 

Basis  for  the  improved  ratio  is  an  increase 
in  the  liquid  corn  oil  content  from  5 1%  to  55%  . 
This  further  improves  the  soft  consistency  of 


the  product,  reduces  hydrogenated  oils,  and 
yields  the  higher  proportion  of  polyunsaturates. 

Fleischmann's  is  denved  from  100%  com 
oil  and  is  a  highly  nutritive  replacement  for 
butter.  It  contains  no  cholesterol 

If,  indeed,  intake  and  absorption  of  satu- 
rated fats  are  factors  in  atherosclerosis, 
Fleischmann's  Soft  Corn  Oil  Marganne  would 
appear  to  be  a  prudent  recommendation  for 
patients  with  a  present  or  potential  cholesterol 

problem.  In  fact,  it's  beneficial  for  everyone. 


Fleischmann's  Soft  Margarine 

A  product  of  Standard  Brands  Canada  Limited,  Montreal.  Canada. 


names 


Laura  Barr,  executive  director  of  the 
Registered  Nurses"  Association  of  On- 
tario has  been  named  president  des- 
ignate of  the  Institute  of  Association 
Executises.  The  lAF.  is  designed  to 
promote,  foster, 
and  encourage 
high  standards  of 
service  and  con- 
duct by  execu- 
tives profession- 
ally serving  pro- 
fessional business, 
trade,  and  sim- 
ilar associations. 
Incorporated  November  2nd.  1962.  the 
lAE  is  a  voice  for  specialists  and  repre- 
sents 800  groups  of  nonprofit  institu- 
tions. Barr  is  the  first  woman  president 
of  the  lAE. 


Barbara  C.  Kuhn  (R.N..  Victoria  Gener- 
al Hospital  school  of  nursing.  Halifax; 
B.N.,  M.Sc. 
(Appl.).  McGill 
University)  has 
been  appointed 
nursing  research 
consultant.  Royal 
Victoria  Hospital. 
Montreal.  She  has 
been  associated 
with  the  Order  of 
Nurses  of  Quebec  (formerly  arnpq) 
since  1960,  where  she  has  successively 
been  nurse  educator,  professional  sec- 
retary, and  nurse  consultant,  research 
and  studies. 

Following  specialization  in  psychiat- 
ric nursing  early  in  her  career.  Kuhn 
became  a  head  nurse  at  the  Allen 
Memorial  Hospital,  Montreal;  was  di- 
rector of  nursing  education,  Verdun 
Protestant  Hospital;  teacher  at  the 
Royal  Edward  Chest  Hospital, 
Montreal;  and,  later,  executive  assis- 
tant of  the  Quebec  Division  of  the 
Canadian  Mental  Health  Association. 


Margaret  P.  Morgan  (R.N.,  Hamilton 
General  Hospital  school  of  nursing; 
B.A.,  University  of  Toronto),  head  of 
the  Hamilton  civic  campus  of  the  de- 
partment of  nursing  of  Mohawk  Col- 
lege, has  retired  after  33  years  in  nurs- 
ing. Having  left  a  career  in  teaching  in 


primary  school,  Morgan  continued  to 
devote  her  nursing  career  to  teaching 
nursing.  She  became  assistant  director 
of  the  school  of  nursing  of  the  Hamilton 
Civic  Hospitals  in  1948. 


The  new  executive  of  the  Alberta  As- 
sociation of  Registered  Nurses  include 
the  following; 

President,  Audrey  Thompson  (R.N.. 
Holy  Cross  Hos- 
pital school  of 
nursing,  Calgary; 
B.  Sc.N.,  Uni- 
versity of  Al- 
berta, Edmonton; 
M.N.,  University 
of  Washington, 
Seattle)  is  asso- 
ciate director  of 
nursing.  Red  Deer  General  Hospital. 

President-Elect,  Valerie  Ay ris( R.N. , 
St.  MichaeTs  Hospital  school  of  nurs- 
ing. Lethbridge;  B.Sc.N.,  University 
of  Alberta)  is  an  assistant  instructor  at 
the  Lethbridge  Community  College. 
She  is  working  toward  her  degree  in 
master  of  education  at  the  University  of 
Alberta. 

Vice-President.  Norine  Renfree 
(R.N..  St.  John  General  Hospital 
school  of  nursing,  St.  John,  N.B.) 
works  casual  part-time  at  the  Grande 
Prairie  General  Hospital. 

Vice-President,  Brian  Wright 
(R.P.N.,  Alberta  Hospital,  Ponoka; 
B.Sc.N.,  University  of  Alberta)  is 
coordinator,  inservice  education  at  the 
Foothills  Hospital,  Calgary. 


Eileen  Mountain  (Reg.  N.,  St.  Joseph's 
school  of  nursing,  London;  B.Sc.N., 
University  of  Western  Ontario,  Lon- 
don; M.A.,  University  of  London, 
London,  England)  has  been  appointed 
to  the  half-time  position  of  assistant  to 
the  secretary-treasurer.  Canadian 
Nurses'  Foundation.  Ottawa.  She  will 
continue  to  act  as  executive  secretary  of 
the  Canadian  Association  of  University 
Schools  of  Nursing,  a  position  she  has 
held  since  1 97 1 .  She  has  devoted  much 
of  her  career  to  teaching,  including 
several  years  as  associate  professor. 
University  of  Western  Ontario. 


Lynda  Lafoley  (Reg. 
Hospital  school  of 


N.  St.  Michael's 
nursing,  Toronto. 
Dipl.  P.H.  Nurs- 
ing, University 
of  Toronto  school 
of  nursing)  has  ar- 
rived in  Nica- 
ragua to  join 
a  CARE-MEDICO 
team  working  in 
new  settlements 
in  an  isolated  ru- 
ral region  of  that  country.  She  has  had 
an  earlier  2-year  assignment  with 
CARE-MEDICO  in  Honduras,  prior  to 
which  she  was  in  Ghana,  West  Africa, 
with  the  Canadian  University  Services 
Overseas. 


Sharon  Dawe(R.N.,  Royal  Columbian 
Hospital  school  of  nursing.  New 
Westminster,  B.C.)  is  medico  Pro- 
gram Coordinator  for  all  care-medico 
team  programs  involving  doctors, 
nurses,  and  medical  technologists  in 
Surakarta  (Solo),  Indonesia,  in  the  pro- 
vince of  Central  Java. 

The  Canadian- 
funded  medico 
team  is  stationed 
at  the  R.S.U. 
Surakarta.  an 
850-bed  hospital 
complex  embrac- 
ing the  city's  3 
government  hos- 
pitals. The  20- 
member  care-medico  team,  com- 
posed largely  of  Canadians,  is  divided 
among  the  internal  medicine,  surgical, 
and  obstetrical  hospitals. 

Da  we  joined  MEDICO  in  1965  in 
Kluang,  Malaysia,  and  since  has  served 
in  Algeria,  Afghanistan,  and  twice  in 
Indonesia. 


Sharon  Turnbull  (B.Sc.N.,  M.P.H., 
University  of  Oklahoma,  Norman)  has 
been  appointed  director  of  continuing 
nursing  education  at  the  University  of 
British  Columbia.  She  was  formerly 
teaching  at  the  UBC  school  of  nursing 
and  has  been  an  educational  consultant 
to  the  UBC  Health  Sciences  Centre.  She 
is  currently  working  toward  a  doctorate 
in  educational  psychology.  - 


New...reaclytouse... 
"bolus"  prefilled  syringe. 

Xylocaine'100  mg 

(lidocaine  hydrochloride  injection,  USP) 

For  'Stat'  I.V.  treatment  of  life 
threatening  arrhythmias. 

n  Functions  like  a  standard  syringe. 

D  Calibrated  and  contains  5  ml  Xylocaine"2%. 

D  Package  designed  for  safe  and  easy 
storage  in  critical  care  area 

D  The  only  lidocaine  preparation 
with  specific  labelling 
information  concerning  its 
use  in  the  treatment  of  cardiac 
arrhythmias. 


U 


an  original  from 

ASTItA 


Xylocaine^  100  mg 

(lidocaine  hydrochlortde  injection  USP) 

INDICATIONS-Xylocainc  administered  intra- 
venousK  is  specificallv  indicated  in  the  acute 
management  of( I)  ventricular  arrhythmias  occur- 
nng  duiing  cardiac  manipulaiion.  such  as  cardiac 
surgery;  and(2>life-Ihreatening arrhythmias,  par- 
ticularly those  which  are  ventricular  in  origin,  such 
as  occur  dunng  acute  myocardial  infarctton. 

CONTRAINDICATIONS-Xylocainc  is  contra- 
indicated  (l>  in  pauents  with  a  known  history  of 
hyper^nsitivity  to  local  anesthetics  of  (he  amide 
ivpe:  and  (2)  in  patients  with  Adams-Siokcs  syn- 
drome or  wiih  severe  degrees  of  sinoainal.  atrio- 
ventncuiar  or  intraventricular  block 

WARNINGS -Constant  monitoring  with  an  elec- 
trocardiograph is  essential  in  the  proper  adminis- 
tration of  Xvlocaine  intravenously  Signs  of  exces- 
sive depression  of  cardiac  conductivity,  such  as 
prolongation  of  PR  interval  and  QRS  complex 
and  the  appearance  or  aggravation  of  arrhythmias, 
should  be  followed  by  prompt  cessation  of  the 
intravenous  infusion  of  this  agent.  It  is  mandators 
to  have  emergencv  resuscitaiive  equipment  and 
drugs  immediately  available  to  manage  possible 
adverse  reactions  involving  the  cardiovascular, 
respiratory  or  central  nervous  systems. 

Evidence  for  proper  usage  m  children  is  limited. 

PRECAtTIONS- Caution  should  be  employed 
in  the  repeated  use  of  Xylocaine  in  patients  with 
severe  liver  or  renal  disease  because  accumulation 
may  occur  and  may  lead  to  toxic  phenomena,  since 
Xvlocaine  is  metabolized  mainly  in  the  liver  and 
excreted  by  the  kidney  The  drug  should  also  be 
used  with  caution  in  patients  with  hypovolemia 
and  shock,  and  all  forms  of  heart  block  (see  CON- 
TRAINDICATIONS AND  WARNINGS). 

In  patients  with  sinus  bradycardia  the  adminis- 
tration of  Xvlocame  intravenously  for  the  elimina- 
tion of  ventricular  ectopic  beats  without  pnor 
acceleration  in  heart  rate  (e.g.  by  isoproterenol 
or  bv  electric  pacing!  may  provoke  more  frequent 
and  serious  ventricular  arrhythmias 

ADVERSE  REACTIONS- Systemic  reactions  of 
the  following  types  have  been  reported 

(1)  Central  Nervous  System:  lightheadedness, 
drowsiness:  dizziness:  apprehension:  euphoria; 
tinnitus:  blurred  or  double  vision:  vomiting;  sen- 
sations of  heaL  cold  or  numbness;  twitching; 
tremors:  convulsions;  unconsciousness;  and  rcspi- 
ratorv  depression  and  arrest. 

(2)  Cardiovascular  System:  hypotension;  car- 
diovascular collapse:  and  bradycardia  which  may 
lead  to  cardiac  arrest. 

There  have  been  no  reports  of  cross  sensitivity 
between  Xylocaine  and  procainamide  or  between 
Xylocaine  and  quinidine. 

DOSAGE  AND  ADMINISTRATION-Single 
Injection:  The  usual  dose  is  50  mg  to  100  mg 
administered  mtravenously  under  ECG  monitor- 
ing- This  dose  may  be  administered  at  the  rate 
of  approximately  25  mg  to  50  mg  per  minute- 
Sufficient  lime  should  be  allowed  to  enable  a  slow 
circulation  lo  carrv  the  drug  to  the  site  of  action 
If  the  initial  injection  of  50  mg  to  100  mg  does 
not  produce  a  desired  response,  a  second  dose  may 
be  repeated  after  10-20  minutes. 

NO  MORE  THAN  200  MG  TO  300  MG  OF 
XYLOCAINE  SHOULD  BE  ADMINISTERED 
DURING  A  ONE  HOUR  PERIOD 

In  children  expenence  with  the  drug  is  limited 

Continuous  Infusion:  Following  a  single  injection 
in  those  patients  m  whom  the  arrhythmia  tends 
to  recur  and  who  are  incapable  of  receiving  oral 
antiarrhvihmic  therapy,  intravenous  infusions  of 
Xylocaine  mav  be  administered  at  the  rate  of  I 
mg  to  2  mg  per  minute  (20  to  25  ug/kg  per  minute 
in  the  average  70  kg  mant,  Intravenous  infusions 
of  Xylocaine  must  be  administered  under  constant 
ECG  monitoring  to  avoid  potential  overdosage 
and  toxiatv.  Intravenous  infusion  should  be  ter- 
minated as  soon  as  the  patient's  basic  rhythm 
appears  to  be  stable  or  at  the  earliest  signs  of 
toxicity.  It  should  rarely  be  necessary  to  continue 
intravenous  infusions  beyond  24  hours  As  soon 
as  possible,  and  when  indicated,  patients  should 
be  changed  to  an  oral  antiarrhyihmic  agent  for 
maintenance  therapy. 

Solutions  for  intravenous  infusion  should  be 
prepared  bv  the  addition  of  one  50  ml  single  dose 
vial  of  Xvlocaine  2%  or  one  5  ml  Xylocaine  One 
Gram  Disposable  Transfer  Synnge  to  I  liter  of 
appropriate  solution  This  will  provide  a  O.lf 
solution;  that  is.  each  ml  wU  contain  I  mg  of 
Xvlocaine  HCl  Thus  I  ml  to  2  ml  per  minute 
will  provide  I  mg  to  2  mg  of  Xylocaine  HCl  per 
minute. 


av  aids 


LEARNING  PACKAGE 

n  A  learning  activity  package  on 
Grieving  Due  to  Loss  of  Body  Image, 
Part  I.  is  the  first  of  a  2-part  coopera- 
tive project  of  The  Ontario  Educational 
Communications  Authority,  the  Regis- 
tered Nurses  Association  of  Ontario, 
the  College  of  Nurses  of  Ontario,  and 
Colleges  of  Applied  Arts  and  Technol- 
ogy in  Ontario. 

The  instructional  program  is  de- 
signed to  be  used  in  nursing  education 
in  a  variety  of  ways.  The  approach  to 
the  subject  of  grieving  is  interdisci- 
plinary and  need  not  be  related  to  any 
one  specific  course  of  study. 

The  package  contains  a  videotape, 
an  audio  cassette,  slides,  and  a  blinder 
of  print  material. 

The  videotape,  entitled  "Don't  Cry 
for  David,'"  is  a  dramatized  treatment 
of  a  young  man's  sudden  loss  of  limb, 
his  grief,  and  that  of  those  involved 
with  him:  family,  girl  friend,  and  medi- 
cal staff.  The  audio  cassette,  extracted 
from  the  tape,  contains  two  discussions 
by  members  of  the  health  care  team. 

The  20  slides,  also  taken  from  the 
videotape,  were  chosen  to  be  used  in 
the  study  of  body  language.  The  print 
material  provides  guidelines  and  sug- 
gestions for  using  the  package. 

For  further  information  and  price, 
write  to:  Grieving  Due  to  Loss  of  Body 
Image.  The  Ontario  Educational 
Communications  Authority,  Box  19, 
Station  R,  Toronto.  Ont..  M4G  3Z3. 


LITERATURE  AVAILABLE 

DThe  United  Ostomy  Association, 
Inc.,  has  recently  pubVished Ileostomy: 
A  Guide.  It  completes  the  association's 
series  of  guides  on  the  3  main  ty[>es  of 
ostomy  surgery:  Colostomies:  a  Guide 
and  Urinary  Ostomies  —  a  Guidebook 
for  Patients. 

The  48-page  ileostomy  guidebook 
explains  care  and  management  of  this 
type  of  surgery,  and  includes  100  illust- 
rations. Copies  may  be  purchased 
from:  United  Ostomy  Association, 
Inc..  1111  Wilshire  Boulevard,  Los 
Angeles,  Calif,  90017,  U.S.A. 
D  Health  and  Welfare  Canada  has  re- 
cently introduced  a  series  of  folders 
containing    basic    information    about 


common  over-the-counter  medica- 
tions. The  first  3  pamphlets  in  the  series 
are:  Cough  Remedies,  which  describes 
the  ingredients  and  explains  the  actions 
of  cough  depressants  and  expectorants; 
Antacids,  which  explains  the  actions  of 
various  antacid  ingredients:  and  The 
Laxative  Habit. 

The  pamphlet  on  laxatives  explains 
the  actions  of  4  types  —  stimulants, 
saline  laxatives,  bulk-forming  laxa- 
tives, and  lubricants  —  and  warns 
against  excessive  or  frequent  use  of  any 
of  them. 

Free  copies  of  these  folders  may  be 
obtained  singly  or  in  sets  by  writing  or 
contacting  the  Health  Protection 
Branch  educational  consultant  in  one  of 
the  5  regional  offices  in  Halifax. 
Montreal,  Toronto,  Winnipeg,  Van- 
couver, or  the  district  office  in  Edmon- 
ton. The  folders  are  also  available 
from:  Educational  Services,  Health 
Protection  Branch.  Health  and  Welfare 
Canada.  Ottawa.  KIA  1B7. 
D  A  catalog  of  texts  and  AV  material  on 
medicine,  nursing,  and  allied  health 
areas  is  available  free  of  charge  from 
Rutherford  Audio  Visual.  It  lists 
books,  films,  audiotapes,  sound/color 
filmstrips,  overhead  transparencies, 
and  slides  available  for  purchase. 

To  obtain  a  copy  of  the  catalog,  write 
to:  Gail  Thorpe.  Product  Manager. 
Rutherford  Audio  Visual.  211  Laird 
Drive,  Toronto.  Ontario.  M4G  3W8. 


AUDIO  CASSETTE  PROGRAM 

n  A  new  audiovisual  learning  system 
to  teach  medical  terminology  of  or- 
thopedic disorders  and  surgery  is  avail- 
able from  Au-Vid.  Inc.  This  is  the 
fourth  in  a  series  on  medical  terminol- 
ogy: the  other  learning  systems  are: 
basic  anatomy,  cardiovascular  disor- 
ders and  surgery,  and  respiratory  disor- 
ders and  surgery. 

The  program  on  medical  terminol- 
ogy of  orthopedic  disorders  and  surgery 
includes  12  audio  cassettes,  an  illus- 
trated study  guide,  and  a  teaching  guide 
for  the  instructor.  For  more  informa- 
tion, write:  Nancy  Carson,  Customer 
Service  Coordinator,  Au-Vid,  Inc., 
12522  Brookhurst  St.,  Garden  Grove, 
CA  92640,  USA.  .. 


sofra-tulle 


The  bactericidal 
dressing 

Composition 

A  Irghtweighi  lano-paraffin  gauze  dressing  impfegnatea  .■. 
1%  Soframycin  (framycetin  sulphate  BP) 

Prop«rit«« 

The  addition  ot  the  antibiotic  Soframycin  to  the  paradin  ga 

ensures  the  prevention  or  eradication  of  superficial  bac'i: 

infection  from  wounds  m  a  few  hours,  thereby  reducinc 

need  for  systemic  antibiotics 

Soframycin  is  a  bactericidal  broad  spectrum  antibiotic,  er'- 

tive  against  many  organisms  which  have  become  resista 

other  antibiotics,  including; 

Staphylococcus  aureus 

Pseudomonas  pyocyanea 

Escherichia  coli 

Proteus  spp 

Soframycin  is  highly  soluble  in  water,  mixes  readily  with  ttXU 

dates,  and  is  not  inactivated  by  blood,  pus  or  serum,  Aithou^ 

it  is  urx;ommon,  sensitization  to  Soframycin  may  occur  m 

cross-sensiiization  between  Soframycin  and  chemica 

related  antibiotics,  eg  Neomycin,  Kanamycin  and  Paromomyi 

cm  is  common  Cross  resistance  between  Soframycin  and  tl " 

group  of  antibiotics  is  not  absolute 

Advantagtts 

Rapid  eradication  of  bacteria  from  the  wound 

Excellent  physical  protection 

Low  incidence  of  maceration  even  after  three  weeks  in  situ. 

Non-adherent  can  be  removed  painlessly 

Saves  dressing  time 

Reduces  wastage 

Each  (dressing  is  parchment-sheathed  tor  no-touch  handling. 

Sensitization  is  uncommon 

Indications 

Traumatic:  Lacerations,  abrasions,  grazes  (gravel  rash),  txtesi 
(animals  and  insects),  cuts  puncture  wounds,  crush  injurie 
Surgical  wounds  and  incisions,  traumatic  ulcers. 
Ulcarattve:  Varicose  ulcers,  diabetic  ulcers,  bedsores,  tropical 
ulcers 

Thermal:  Bums,  scalds 
Elacttva:  Skm  grafts  (donor  and  recippent  sites),  avulsion  of 
finger  or  toenails  circumcision 

Miscellaneous:  Secondarily  infected  skin  conditions  —  eg. 
eczema,  dermatitis,  fierpes  zoster,  colostomy,  acute  parony- 
chia, incised  atiscesses  (packing),  ingrowing  toenails 

Contraindications 

Sensitization  to  lanolin  or  to  Soframycin 

Application 

If  required,  the  wound  may  first  be  cleaned  A  single  layer  ot 
SOFRA-TULLE  should  be  applied  directly  to  the  wound  and 
covered  with  an  appropriate  dressing  such  as  gauze,  linen  or 
crepe  bandages  In  the  case  ot  leg  ulcers,  it  is  advisable  to  cut 
thedressingexactly  to  thesizeofthe  ulcer  in  order  to  minimize 
the  risk  of  sensitization  and  not  to  overlap  on  the  surrounding 
epidermis  When  the  infective  phase  has  cleared  the  dressing 
may  be  changed  to  a  non-impregnated  one  The  amount  of 
exudate  should  determine  the  frequency  of  dressing  changes. 

Precautions 

In  most  cases  absorption  of  the  antibiotic  is  so  slight  that  it  can 
be  discounted  Where  very  large  body  areas  are  involved  (eg. 
30%  or  more  body  burn)  the  possibility  of  ototoxicity  and  or 
nephrotoxicity  being  produced,  should  be  remembered. 

Packing 

10  cm  X  lOcm  (4"x4"), 

cartons  of  tO  and  50  sterile  single  units 
30cmx  I0cm(12"x4"), 

cartons  of  10  sterile  single  units. 


ROUSSEL 


Roussel  (Canada)  Ltd. 

153  Graveline 

Montreal,  Quebec  H4T1R4 


\bucan^see 
the  antibiotic  in 


The  invisible  ingredient  in  Sofra-tulle 
is  Soframycin— an  antibiotic.  Reserved 
exclusively  for  topical  use,  Soframycin  has 
a  comprehensive  spectrum  of  activity 
against  organisms  normally  encountered 
in  burns,  ulcers  and  wounds  Soframycin 
is  present  in  Sofra-tulle  in  a  bactericidal 
concentration,  and  maintains  its 


effectiveness  even  in  the  presence  of 
blood,  pus  and  serum  The  method  of 
manufacture  ensures  a  uniform 
distribution  of  Soframycin  on  the  wound 
and  sensitization  is  uncommon 

True,  you  can  t  see  the  antibiotic  in 
Sofra-tulle .... 


but  you  will  see 
the  results. 


ROUSSEL 


Roussel  (Canada)  Ltd. 

153Graveline 

Montreal,  Quebec  H4T  1R4 


:«^.  «..ii  Mt, 


dates 


October  5-8,  1975 

The  Association  of  Registered  Nurses  of 
Newfoundland  annual  meeting  is  to  be 
held  in  St.  Johns,  Nfld.  For  information, 
write:  Phyllis  Barrett,  ARNN,  67  LeMar- 
chant  Road,  St.  John  s,  Nfld. 

October  20-22,  1975 

Canadian  Conference  on  Medical  De- 
vices in  Health  Protection  to  be  held  in 
the  Government  Conference  Centre, 
Rideau  Street,  Ottawa,  Ontario.  For 
information,  write:  Jean  Anderson, 
Technical  Secretariat,  Health  Protection 
Branch,  Health  and  Welfare  Canada, 
Ottawa,  Ontario,  K1A  0L2. 

October  20-22,  1975 

Workshop  on  gynecology,  obstetrics, 
and  pediatrics  under  the  auspices  of 
continuing  nursing  education  to  be  held 
at  Clinical  Sciences  Building,  The  Uni- 
versity of  Alberta,  Edmonton,  Alberta. 

October  20-24,  1975 

Ontario  Occupational  Health  Nurses' 
Association  Conference,  Prince  Hotel, 
Toronto,  Ontario.  For  information,  write: 
Joan  Subasic,  Conference  Chairman, 
Medical  Department,  Bell  Canada,  393 
University  Ave.,  Toronto,  Ontario,  M5G 
1W9. 

October  27-28,  1975 

Public  Health  Association  of  Nova 
Scotia  annual  meeting  to  be  held  at 
Chateau  Halifax,  Halifax.  Registration 
opens  October  26.  For  information  write: 
Ralph  E.J.  Ricketts,  phans.  17  Alma 
Crescent.  Halifax,  N.S.  B3N  2C4. 

November  3-5,  1975 

National  conference  on  nursing  re- 
search to  be  held  at  Chateau  Lacombe 
Hotel,  Edmonton.  Alberta.  Final  evening 
open  to  the  full  community  of  nurses  For 
information,  contact:  Margaret  E.  Steed, 
Program  Coordinator,  National  Re- 
search Conference,  3rd  Floor,  Clinical 
Sciences  Building,  University  of  Alberta. 
Edmonton,  Alberta,  T6G  2G3. 


November  4-6,  1975 

Annual  meeting  of  the  Operating  Room 
Nurses'  Association  of  the  Province  of 
Quebec  to  be  held  at  the  Quebec  Hilton 
Hotel,  Quebec  City.  For  information, 
write:  Patrick  Murphy,  10  de  I'Espinay, 
Quebec  City,  Quebec  GIL  2H1. 

November  10-12,  1975 

Annual  meeting  of  the  Order  of  Nurses 
of  Quebec  to  be  held  at  the  Queen 
Elizabeth  Hotel,  Montreal,  Quebec. 

November  12-14,  1975 

Conference  "Health  Facilities  Planning 
and  Design:  a  comprehensive  view 
of  current  approaches  and  solutions  to 
develop  and  use  facilities  within  increas- 
ing cost  constraints,"  to  be  held  at  the 
University  of  Ottawa.  For  information, 
write:  Carolyn  Belzile,  Coordinator,  Con- 
tinuing Education,  School  of  Health  Ad- 
ministration, University  of  Ottawa,  Ot- 
tawa, Ontario  KIN  6N5. 

November  13-14,  1975 

Conference  sponsored  by  the  Recrea- 
tion and  Volunteers  Department  of  the 
Hospital  for  Sick  Children,  Toronto,  to  be 
held  at  the  Harbour  Castle  Hotel,  To- 
ronto. Theme  is  "Caring  for  emotional 
needs  "  Guest  speaker  is  Dr.  Lee  Salk. 
For  information,  write:  John  Sweeney, 
Department  of  Recreation  and  Volun- 
teers, The  Hospital  for  Sick  Children, 
555  University  Avenue,  Toronto,  On- 
tario, M5G  1X8. 

November  16,  1975 

First  forum.  Public  Safety  Officers 
Foundation  and  American  Medical  As- 
sociation at  the  Pick  Congress  Hotel, 
Chicago,  Illinois.  Subject:  basic  issues 
in  emergency  medical  services.  For  in- 
formation, write:  Sharon  Sparacino, 
PSOF,  Suite  2024,  307  North  Michigan, 
Chicago,  Illinois  60601,  U.S.A. 

November  20-21,  1975 

Workshop  "What  every  operating  room 
supervisor  should  know"  to  be  held  in 
Regina,   Saskatchewan.   For  informa- 


tion, write:  Norma  J.  Fulton,  Continuing 
Nursing  Education,  University  of  Sas- 
katchewan,   Saskatoon,    Sask. 

November  26-28,  1975 

Workshop  on  clinical  research  under  the 
auspices  of  the  Order  of  Nurses  of 
Quebec  to  be  held  at  Longueuil, 
Quebec.  For  information,  write:  ONQ, 
4200,  Dorchester  St.  W.,  Montreal, 
Quebec. 

December  3-5,  1975 

Workshop  on  strategies  in  administra- 
tion and  teaching,  sponsored  by  the  Na- 
tional League  for  Nursing  council  of  as- 
sociate degree  programs,  to  be  held  at 
the  New  York  Sheraton,  New  York  City. 
For  information,  write:  Convention  Ser- 
vices. National  League  for  Nursing,  10 
Columbus  Circle,  New  York,  NY. 
10019,  U.S.A. 

lune  13-17,  1976 

Biennial  Canadian  conference  on  social 
welfare  to  be  held  at  Skyline  Hotel,  To- 
ronto, Ontario.  Sponsored  by  the  Cana- 
dian Council  on  Social  Development. 
For  information,  write:  Reuben  C.  Baetz, 
Executive  Director,  CCSD,  Box  3505, 
Station  C,  Ottawa,  Ontario  K1Y  4G1. 

June  21-23,  1976 

Canadian  Nurses'  Association  annual 
meeting  and  convention  to  be  held  at 
Hotel  Nova  Scotian.  Halifax,  Nova 
Scotia.  Theme:  The  Quality  of  Life. 

lune  21-25,  1976 

13th  World  Rehabilitation  Congress  of 
Rehabilitation  International  to  be  held  in 
Tel-Aviv,  Israel.  For  information,  write: 
Secretariat,  13th  World  Rehabilitation 
Congress,  P.O.  Box  16271,  Tel-Aviv, 
Israel. 

July  23-25,  1976 

Kingston  Psychiatric  Hospital  Nurses' 
Alumnae  Association  Reunion  '76.  For 
information,  write  the  general  convenor, 
N.R.  Ferguson,  312  College  Street, 
Kingston,  Ontario,  K7L  4M4.  ■g? 


items  shown,  for  group  purchases,  graduation  gifts,  favors,  etc. 
6-11  Same  Items,  Deduct  10%:    12-24  Same  Items,  Deduct  15% 
25  or  More  Same  Items,  Deduct  20%  Q 

IMHMHMH% 


fwami  nn^  'n^  /kiH^...^m^  Xee^ 


IT'S  EASY  TO  ORDER  REEVES  NAME  PINS  FOR  YOURSELF  OR  FRIENDS ! 


Cfioose  style  you  want,  sr>own  nghi  Print  name  'ana  2nd 
line  if  desired)  on  dotted  tines  below  Check  other  mfo  in 
botes  on  chail.  clip  this  section  and  attach  to  coupon 


Bottom  fight  Artacf)  eitra  sheet  tor  additionai  pms 
NOTE  SAVINGS  ON  2  IDENTtCU  PINS  oiofe  convfnient. 
s^rc  in  cju  of  loss. 


LETTERING: 2ntl  LINE:. 


Mrs.  R.  F.  JOHNSON      „ 
SUPERVISOR__ /I 


BCSCWPTION 


ALL  METAL       S-\:orh   -.d..-.  ;-: 
L  cofners  Choose  Polished,  Satin,  or 
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background  *ith  poiisr>eO  edges 


□  Gold 
n  S.iver 


PLASTIC  LAMINATE       slimmer 

^  Drcaire'    ■?'igf3v€d  thru  surface  to 
istmg  cofe  color  Beveled 
border  matches  lettering. 


METAL  FRAMED       Classic 
(l^l^  design;  snow-white  plastic  with 
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MOLDED  PUSTIC       Simple,  smart, 
economical  Will  never  discolor. 
Smooth  rounded  corners  and  edges 


gps 


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LJ  Uuotone 
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Finest  Forged  Steel. 

I  Guaranteed  2  years. 


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Letters  only 


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TT 


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..?■■-.    2.49 
D  2  P.ns  3.M 


n  1  Pm    1-25 


D  2  P.ns  1.95 


a  I  Pm    2.49 

D  2  Pins  3.99 

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D  1  P'H     1-85 


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D  1  Pin    3-25 
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CHARLENE  HAYNES 


V\HS, 


IShnTl.pn. 


*U  pinbKks  nth  ultty  catcli 


LISTER  BANDAGE  SCISSORS 

Vi"  Mini-scisior.  T.ny,  handy,  slip  into 
uniform  pocket  or  purse  Choose  jewelers 
gold   Of   gleaming   chrome   plate    finish. 

No.  3500  aVi"  Mini 2.75 

No.  4500  4''3"  size.  Chrome  only  .  . .  2.95 

No.  5500  5'/i"  size.  Chrome  only  .  . .  3.25 

No.    702  7V4"  size.  Chrome  only  .  . ,  3.75 

For  engraved  initials  add  50«  per  instrument 


5V2"  OPERATING   SCISSORS 

Polished  Stainless  Steel  straight  blades 
No.  705  Sharp,'  Blunt  points  . .  .  2.95 
No.  706  Sharp/ Sharp  points  . .  .  2.95 
No.  710 4' 2"  IRISScis..  Straight  .  .  .3.75 
For  engraved  initials  add  50c  per  instrument 


KELLY   FORCEPS 

So  handy  for  every  nurse'  Ideal  for  clamping 
off  tubing,  etc.  Stainless  steel,  ^^'' 

No.  25-72  Straight.  Box  Lock 4^9 

No.  725  Curved,  Box  Lock 4.49 

No.  741  Thumb  Dressing  Forcep, 

Serrated.  Straight,  S'-i*  . .  3.75 

For  engraved  initials  add  50<  per  instrument 


MEDI-CARD   SET  Handiest    refer. 
ence  ever'  6  smooth  plastic  cards  \IW  »■ 
S'^")  crammed   with   information;   Equiv=-  '■. 
lencies  of  Apothecary  to  Metric  to  HousehoiO 
Meas..  Temp   X  to    f,  Prescrip,  Abbr.,  Urin- 
alysis. Body  Chem  ,  Blood  Chem..  Liver  Tests. 
Bone  Marrow.  Disease  Incub  Periods,  Adult 
Wgts..  etc,  in  white  vinyi  holder. 
No.  289  Card  Set  .  .  .  1.50  ea. 
Initials  gold-stamped  on  back  of 
holder,  add  SO*. 


POCKET  SAVERS 

Prevent  stains  and  wear!  Smooth,  pli- 
able pure  white  vinyl-  Ideal  low-cost 

otp  gifts  Of  favors. 
No.  21W  (far  left),  two  compartments 
with  ftap  gold  stamped  caduceus 
Packet  of  6  for  $1.80 
No  791  (left)  Deluxe  Saver.  3  compt.. 
change  pocket  S  hey  chain  . .  . 
Packet  of  6  for  $2.^. 


Nurses' POCKET  PAL  KIT 

Handiest  for  busy  nurses  Includes  white 
Deluxe  Pocket  Sa*er.  with  S"-^"  Lister  Scissors 
(both  shown  abovej.  Tn-Colof  ballpoint  pen 
plus  handsome  little  pen  light  .  all  silver 
finished  Change  compartment,  key  chain 

No.  291  Pal  Kit  .  .  .  6.50  ea. 

Initials  engraved  on  shears,  add  50< 


TIMEX  Pulsometer  WATCH 

Dependable  Iimei  Nurses  Pulsometer  Calendar  Watch. 
Moveable  outer  ring  computes  pulse  rate  Date  calen- 
dar, wtiite  numerals,  sweep-second  hand,  blue  dial. 
luminous,  white  strap.  Stainless  back,  water  and  dust- 
resistant.  Gift-boxed.  1  year  warrantee.  Initials  engraved 
in  back  Free. 
No.  237761  Nurses'  Watch 17.95  ea. 

PIN   GUARD  Sculptured  caduceus.  chained 
to  your  professional  tetters,  each  with  pinbacK/ 
safety  catch.  Or  replace  either  with  class  pin  Gold 
finish,  gilt  boied  Choose  RN.  LPN  or  LVN. 
No.  3420  Pin  Guard  .  .  .  2.95  ea. 

ENAMELED  PINS  eeautifully  sculptured  status 
insignia  2color  keyed,  hard-fired  enamel  on  gold 
plate  Oimesiied.  pin-back  Specify  RN.  IPN.  LVN.  or 
NA  on  coupon. 

No.  205  Enam.  Pin  1.95  ea. 


BZZZ   MEMO-TIMER    Time  hot  pac 
Ileal  lamps   park  meters   Remember  to  check  vital 
signs,  give  medication,  etc.  Lightweight.  com:.s:- 
\Wi"  dia.).  sets  to  buzz  5  to  60  min.  Ke> 
Swiss  made 

No.  M-22  Timer  .  .  .  6.95 


Free  init'iais  and 

Free  Scope  Sack  with  your  own 

Llttmanii  Nursescope! 

BRAND  ■ 


Famous  Littmann  nurses' 
diaphragm  stethoscope  .  .  . 
a  fine  precision  instrument, 
with  high  sensitivity  for 
blood  pressures,  apical  pulse 
rate.  Only  2  ozs.,  fits  in 
pocket,  with  gray  vinyl  anti- 
collapse  tubing,  non-chilling 
epoxy  diaphragm.  28"  over- 
all. Non-rotating  angled  ear 
tubes  and  chest  piece  beau- 
tifully styled  in  choice  of  5 
jewel-lilte  colors:  Goldtone, 
Silvertone.  Blue.  Green.  Pink.' 
•IMPORTANT:  New  Medallion"  styling  includes  tubing  in  colors  to  match 
metal  parts  If  desireif  jdd  51  ea.  to  price  above:  add  "M"  to  Order 
No.  2160M)  on  coupon. 

LITTMANN  COMBINATION  STETHOSCOPE 

Maximum  sensitivity  from  this  fine  professional  instrument  Con- 
venient 22"  overall  length,  weighs  only  3^  oz-  Chrome  binaurals 
fixed  at  correct  angle  Internal  spring,  stainless  chest  piece,  1*4" 
diaphragm  m"  bell  Removable  non-chill  sleeve  Gray  vmyl  tubing- 
Two  initials  engr-  on  chest  piece  TREE  SCOPE  SACK  INCLUDED 
No.  2100  Combo  Steth  . . .  29.95  ea.  Duty  Free 


FREE  INITIALS  AND  SACK! 

Your  intials  engraved  FREE  on 
chest  piece;  lend  individual 
distinction  and  help  prevent 
loss.  FREE  SCOPE  SACK  neatly 
carries  and  protects  Nurse- 
scope.  Heavy  frosted  vinyl,  with 
dust-proof  press  type  closure. 

No.  2160  Nursescope 

including  Free 
Initials  and  Sack 
Duty  Free   16.95  ea. 


NURSES  PERSONALIZED  SPHYG 
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COLOR    aUANT. 


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new  products 


Finger  joint  implant 

A  new  Silastic  finger  joint  implant  H. P. 
(Swanson  Design)  has  been  developed 
by  Dow  Coming.  It  is  designed  to  help 
patients  regain  the  use  of  hands  crip- 
pled by  rheumatoid,  degenerative,  or 
traumatic  arthritis. 


Made  of  silicone  elastomer,  the  im- 
plants are  durable  to  flexing  and  resis- 
tant to  tearing.  There  are  11  sizes,  all 
sterile  packed. 

Full  information  about  the  new  im- 
plant is  contained  in  Dow  Coming  Bul- 
letin 51-238,  available  from:  Dow 
Coming  Silicones  Inter-America  Ltd., 
1  Tippet  Road,  Downs  view,  Ontario, 
M3H  5T2. 


Contact  lens  emergencies 

To  assist  emergency  or  first-aid  per- 
sonnel in  the  care  of  patients  who  may 
be  wearing  contact  lenses,  the  Ameri- 
can Optometric  Association  has  pre- 
pared a  packet  that  contains: 
n  A  display  sticker,  outlining  contact 
lens  emergency  care  procedures.  This 
3V2"  X  4V2"  red-and-white  sticker  is 
designed  for  conspicuous  placement  in 
first-aid  areas  or  on  emergency  vehicles 
and  equipment. 

D  A  detailed  instruction  sheet,  "Con- 
tact Lenses:  Care  for  the  Injured." 
Step-by-step  instructions  on  how  to 
remove  contact  lenses  and  other  impor- 
tant information  on  caring  for  injured  or 
ill  contact  lens  wearers  are  provided  in 
this  sheet. 

n  A  reference  file  label  for  quick  iden- 
tification of  the  detailed  instruction 
sheet.  This  3"  x  •'/4"  sticker  in  red- 
and-white  alerts  personnel  to  the  file 


containing  information  on  "Contact 
lenses:  care  for  the  injured." 
D  A  comprehensive  pamphlet  entitled 
"Contact  Lenses:.  .  .a  vital  role  in  vi- 
sion care,"  which  presents  a  profile  of 
these  modem  visual  aids. 

For  information,  write:  American 
Optometric  Association,  7000  Chip- 
pewa Street,  St.  Louis,  Mo.  63119, 
U.S.A. 


Knee  immobilizer 

Adjustable  stays  and  straps  allow  the 
new  universal-size  knee  immobilizer 
from  Orthopedic  Equipment  Company 


Portable  electrocardioscope 

The  Cardioscan  is  an  cordless,  minia- 
ture, portable,  battery-operated 
electrocardioscope    with    integrated 


to  fit  all  leg  sizes.  This  design  prevents 
excessive  motion  of  the  knee  and  com- 
fortably achieves  effective  knee  im- 
mobilization. 

The  knee  immobilizer  is  made  of 
'/s-inch  thick  reticulated  (open-cell) 
foam  padding  laminated  to  a  strong, 
durable  outer  fabric.  It  has  a  pressure- 
sensitive  Velcro  hook  and  pile  for  se- 
cure closure,  dual  metal  stays  on  the 
lateral  and  medial  stay/strap  assembly 
system,  and  three  anatomically  formed 
metal  stays.  The  immobilizer  is  avail- 
able in  13",  18",  and  23"  lengths. 

For  information,  write:  Orthopedic 
Equipment  Company,  Bourbon,  Ind. 
46504,  U.S.A. 


electrodes  for  instant  diagnosis  in 
emergency  situations.  It  is  designed  for 
use  in  ambulance,  fire-police  rescue, 
industrial  first  aid,  doctor's  office, 
hospital  rounds,  emergency  room, 
intensive-coronary  care,  and  anes- 
thesia. 

On  placing  the  Cardioscan  on  the 
patient's  chest,  the  electrocardiograph 
is  displayed  within  5  seconds.  This 
permits  prompt,  exact  differential 
diagnosis  between  weak  heart  action, 
ventricular  fibrillation  and  asystole, 
thus  saving  valuable  time  for  resuscita- 
tion. 

After  the  starter  button  is  pressed, 
the  Cardioscan  will  o[)erate  for  1  mi- 
nute. At  this  rate,  a  set  of  4  C  batteries 
will  last  about  6  months. 

The  Cardioscan  provides  all  func- 
tions of  a  standard  cardioscof)e  for  con- 
tinuous monitoring  and  may  be  used  as 
a  module  in  the  monitor  frame  and  de- 
fibrillator. 

For  information,  write:  Resuscita- 
tion Laboratories,  P.O.  Box  3051, 
Bridgeport,  Conn.  06605,  U.S.A. 


46 


Foley  latex  catheter 

Perry  s  coated  and  noncoated  Foley 
latex  catheters  are  available  in  a  full 
range  of  French  and  balloon  sizes,  plus 
the  6  French,  2  cc  pediatric  size.  The  5 
types  of  catheters  are:  standard  pediat- 
ric, standard  2-way  retention,  3-way 
continuous  irrigation,  Coude,  and 
hemostatic . 

Perry  catheters  have  a  variety  of  tips: 
opposed  eyes,  staggered  eyes,  Coude. 
and  long  tip  irrigation. 

The  Foley  Teflon-coated  catheter 
features  sterile  sheath  packaging  and 
fail-safe  valve  design. 

The    sterile   sheath    inner   package 


facilitates  aseptic  handling  of  the  cathe- 
ter and  protects  the  patient  from  retro- 
grade infection  during  insertion.  The 
fail-safe,  free-flowing  valve  design  ac- 
commodates a  Luer-Lock  or  Luer-Slip 
syringe  tip  and  permits  operation  with 
one  hand.  A  special  coating  containing 
Teflon  on  the  inside  lumen  and  the  out- 
side diameter  of  the  catheter  protects 
the  patient's  urethra  mucosa,  permits 
faster  flow  rates,  reduces  incrustation, 
and  lasts  longer  in  vivo. 

Perry  catheters  also  are  available  in 
kits  that  include  a  two-way  retention 
Foley  catheter  or  hemostatic  catheter;  a 
prefilled.  sterile  (water)  syringe:  and  a 
5  g  packet  of  lubricant. 

For  further  information,  write  Af- 
filiated Medical  Products  Ltd.,  90 
Commercial  Ave.,  Ajax,  Ont. 


Quick-release  safety  belt 
A    new    safety    belt,    designed    for 
emergency  situations  in  the  field  or  in 
the  hospital,  is  now  available  from  the 


J.T.  Posey  Company,  Pasadena. 
California.  The  Posey  quick-release 
safety  belt  adapts  easily  to  any  guemey , 
stretcher,  or  operating  table. 

It  is  available  in  conductive  or  non- 
conductive  gray  nylon  webbing  and 
uses  airiine  buckles  for  easy-on.  easy- 
'  off  application.  It  comes  as  a  one-piece 
74'"  belt,  two-piece 51""  or6r'  belt. or 
for  solid  top  guemey  with  a  74"  belt. 

For  information,  contact:  Enns  and 
Gilmore  Limited.  2276  Dixie  Rd.. 
Mississauga.  Ontario. 


Serum  filter  isolator 

Accu-Sep.  a  new  disposable  serum  fil- 
ter/isolator for  use  wherever  blood 
samples  are  processed,  has  been  intro- 
duced by  Acculab  Division  of  Precision 
Technology  Inc. 

The  unit  permits  technicians  to 
rapidly  screen  out  fibrin  clots  from 
spun-down  blood  serum,  simulta- 
neously isolating  the  serum  for  required 
periods  of  storage  without  the  need  to 
decant.  Elimination  of  fibrin  from 
samples  helps  prevent  clogging  of 
blood  analyzers. 

A  one-way  valve  permits  serum  to 
flow  through  the  filter  into  an  upper 
storage  chamber,  but  prevents  its  return 
into  the  lower  chamber  where  blood 
cells  are  concentrated.  The  upper 
chamber  may  be  sealed  from  the  at- 
mosphere with  an  inert  plastic  cap. 

Because  all  materials  are  solid  and 
inert,  the  Acculab  unit  does  not  cause 
sample  contamination.  Samples  may 
be  stored  in  the  separation  unit  to  elimi- 
nate additional  labeling  of  sample  con- 
tainers. The  need  for  pipetting,  pour- 
ing, and  second  centrifugation  is  also 
eliminated. 

For  information  contact  Acculab, 
Division  of  Precision  Technology  Inc. , 
50  Maple  Street,  Norwood.  NJ  07648, 
U.S.A. 


Descriptions  of  "new  products"  are 
based  on  information  supplied  by 
the  manufacturer.  No  endorsement 
is  intended. 


When  you  are 
asked  about 
nursing  care... 

Health  Care  Services  Upjohn 
Limited  can  assist  you  and 
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Trois  Rivieres  •  Quebec  •  Halifax 


47 


HE  CANADIAN  NURSE  —  Oclober  1 975 


research  abstracts 


Feeney,  loanne.  A  study  of 
information-processing  among  am- 
bulatory patients. 

Montreal,    Que.,    1972.    Study 
(M.Sc.  (appl))  McGill  U. 

This  study  used  qualitative  research 
methods  to  investigate  the 
information-processing  activities  of  32 
ambulatory  patients  on  a  medical  ward 
to  determine  the  kinds  of  information 
sought  by  patients  in  the  later  stages  of 
recovery. 

Three  categories  of  information- 
processing  activities  and  6  categories  of 
statement  content  with  which  the 
information-processing  activities  were 
concerned  were  established  from  the 
data.  The  content  of  the  statements  de- 
termined the  category  they  would  form. 
The  activity  categories  were  arrived  at 
by  considering  how  a  statement  was 
used  or  responded  to. 

The  most  cogent  findings  were: 

1.  Informing  was  employed  most  fre- 
quently as  a  strategy  within  most  of  the 
content  categories  (4  out  of  6). 

2.  Listening  was  used  about  half  as  often 
as  informing.  About  half  of  listening  was 
concerned  with  medical  progress. 

3.  Except  when  concerning  course  of 
hospitalization,  questioning  was  the 
strategy  least  used  by  the  patients  studied. 

4.  Information-processing  generally 
concerned  medical  progress  and  course  of 
hospitalization.  Medical  progress  ac- 
counted for  over  half  the  listening  that  oc- 
curred. Course  of  hospitalization  and  medi- 
cal progress  together  accounted  for  nearly 
three-quarters  of  the  questioning. 

5.  One-third  of  informing  statements 
were  directed  to  other  patients. 

6.  The  largest  number  of  questions  were 
directed  to  the  doctor  (37%),  with  half  as 
many  to  the  nurse   (19%). 

7.  Doctors'  statements  constituted  the 
largest  proportion  (44%)  of  statements  lis- 
tened to  by  patients,  with  nurses  providing 
24%. 

The  nature  of  the  information- 
gathering  activities  with  which  patients 
were  concerned  and  the  types  of  indi- 
viduals involved  with  them  in  these  ac- 
tivities suggest  that  the  patients  were 
aware  of  the  effectiveness  of  the  differ- 
ent activities  for  different  types  of  in- 
formation. 

The  data  show  that  the  patients  were 


chiefly  concerned  with  their  progress 
from  illness  to  health  and  with  the  kind 
of  medical  treatments  and  tests  they 
were  to  receive.  It  was  evident  that  the 
doctor  was  consistently  regarded  as  the 
most  authoritative  source  of  medical 
information. 

The  relative  infrequency  of  the  ex- 
pression of  feelings  about  their  illness 
by  the  patients  and  the  high  emotional 
content  of  those  feelings  expressed, 
suggest  an  area  of  information  need  to 
which  the  nurse  might  direct  her  atten- 
tion in  caring  for  these  patients. 

For  the  nurse,  the  implication  of  the 
above  findings  is  to  be  aware  of  the 
patient's  concerns  on  the  ward,  of  how 
he  seeks  to  resolve  these  concerns,  and 
how  she  is  expected  to  assist  him. 

The  findings  suggest  further  studies 


One  time  offer . . . 

NURSING 

MEDIA 

INDEX 

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able to  Health  Science  educators  for 
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323  St.  Clair  Ave.,  E., 
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to  determine  how  information! 
gathering  activities  are  affected  by  th 
age  of  the  patient,  the  type  of  illness 
the  setting,  and  the  length  of  hospitali 
zation. 


Bell,  Janice  M.  Stressful  life  events  anc 
coping  methods  in  mental-illnesi 
and  wellness  behaviors.  Lomi 
Linda,  Calif.  1975.  Thesi; 
'(M.Sc.N.)  Loma  Linda  University. 

A  descriptive,  comparative  study  was 
done  to  examine  the  relationship  be 
tween  stressful  life  events  and  mental 
illness  and  wellness  behaviors,  and  the 
coping  methods  used  by  individual' 
exhibiting  each  behavior. 

Data  collection  included  the  use  ot 
the  Social  Readjustment  Rating  Scalc 
and  a  coping  scale  administered  to  the 
experimental  and  control  samples.  The 
experimental  group  consisted  of  30 
psychiatric  inpatients  of  3  general  hos- 
pitals who  were  oriented  in  3  spheres 

Subjects  in  the  control  group  had  no 
history  of  psychiatric  illness,  were  cur- 
rently not  receiving  medical  treatment, 
and  were  adequately  functioning  in  a 
socially  accepted  role.  They  were  ran- 
domly selected  to  match  the  patient  on 
the  basis  of  age  range  (plus  or  minus  2 
years),  sex,  and  county  of  residence 

The  experimental  group  reporieii 
significantly  more  stressful  life  events 
occurring  in  the  last  6  months  than  the 
control  group.  The  experimental  group 
also  reported  significantly  more  short- 
term  coping  methods  than  long-term 
methods,  when  compared  with  the 
healthy  controls. 

Sex  differences  between  the  2  groups 
were  noted.  Notable  differences  also 
existed  when  age  groups  within  the  ex 
perimental  and  control  sample  were 
compared.  A  significant  association 
was  found  between  high  stress  scores 
and  more  short-term  methods  reported 
for  coping  with  life  stress  by  subjects 
within  both  groups. 

The  concept  of  change  as  it  relates  to 
stress  and  its  effect  on  health  is  an  im- 
portant consideration  for  health  care 
professionals  whose  goal  is  health 
maintenance  and  the  prevention  of  ill- 
ness in  people.  V 


books 


Attention  nurse  researchers!  This  is  the 
ideal  guide  to  funding  sources. 

"A  British  survey  found  that  15  per- 
cent of  a  researcher's  time  is  spent  try- 
ing to  raise  money.  It  is  difficult  to 
imagine  that  it  is  much  less  in  Canada, 
given  the  difficulty  in  finding  informa- 
tion on  sources  of  funding."  This  first 
paragraph  of  the  editor's  preface  re- 
flects a  major  concern  of  the  Canadian 
Nurses'  Association's  ad  hoc  commit- 
tee on  nursing  research  for  the  need  of  a 
ready  guide  for  would-be  nurse  re- 
searchers to  sources  of  funds. 

After  exploring  various  ways  of 
meeting  this  need,  the  AUCC'^  Direc- 
tory appears  to  be  not  only  the  best 
resource  available,  but  also  an  excel- 
lent and  versatile  resource. 

The  Directory  is  arranged  for  max- 
imum facility  in  use.  The  first  sections 
discuss  the  agencies  generally,  how  to 
approach  them,  specific  aspects  of 
foundations  in  Canada,  the  United 
States,  and  British  charitable  trusts. 

The  section  "Descriptive  Direc- 
tory" is  an  alphabetical  listing  of  the 
agencies  in  Canada,  United  States,  and 
Britain,  with  addresses,  fields  of  in- 
terest, funding  data,  and  application 
information.  New  funding  agencies 
appear,  and  established  agencies  may 
change  their  areas  of  interest  or  cease  to 
exist,  and  so  no  list  can  be  up-to-date 
for  very  long. 

This  reviewer  found  a  few  additional 
agencies,  generally  new  since  1973,  of 
interest  for  nurse  researchers.  (See  list 
at  the  end  of  this  review. )  However,  the 
Directory  has  separate  listings  of  foun- 
dations that  do  not  award  grants,  and 
others  that  were,  or  were  being,  dis- 
solved at  the  time  of  publication.  The.se 
lists  help  researchers  to  avoid  "hope- 
less" approaches. 

In  the  Index  of  Canadian  Nursing 
Studies,  there  is  ample  evidence  of  the 
wide  diversity  of  research  fields  chosen 
by  nurse  researchers.  The  Directory 
provides  for  diversity  with  an  "Index 
of  Fields  of  Interest."  Under  the  head- 
ing "Health,"  there  is  a  subheading 
"Nursing,"  with  14  sources  of  funding 
shown.  However,  there  are  also  sub- 
headings for  "Health.  General  field 
of,"  and  this  is  where  we  find  the  na- 
tional health  grants;  "Health  care.  De- 
livery   of":    "Mental    Health";    and 


A  Canadian  Directory 
to  Foundations 

and  other  granting  agencies 


Edited  *nil  «ilh  iTiltui]ut:<or>  malcriAl  by  AlUn  .\rleM 
Awuviation  i?f  L'nivcfsiitc^  and  (ollr(«  of  Can^j 


A  Canadian  Directory  to  Foundations 
and  Other  Granting  Agencies,  3ed.. 
Edited  and  with  introductory  re- 
marks by  Allan  Arlett,  Ottawa.  As- 
sociation of  Universities  and  Col- 
leges of  Canada,  1973. 
Reviewed  by  Margaret  L.  Parkin, 
Librarian.  Canadian  Nurses'  As- 
sociation. Ottawa. 


"Public  Health."  Other  possible 
sources  are  found  under  "Education"; 
"Life  Sciences"  (e.g.,  care  in  specific 
diseases);  "Social  Development," 
which  includes  "Aged"  and  "Hand- 
icapped"; and  "Social  Sciences," 
such  as  "Human  Behavior." 

A  new  edition  of  the  Directory  is 
scheduled  for  1976  and.  if  the  hope 
expressed  by  the  editor  of  the  present 
edition  —  that  future  directories  would 
contain  additional  information  —  is 
met.  it  will  be  even  more  helpful  than 
this  already  useful  resource. 

A  supplementary  list  of  sources  of 
funding  for  research  in  areas  of  interest 
to  nurses  follows; 

Canada 

D  Canadian  Heart  Foundation,  Ste. 
1200,  1  Nicholas  Street,  Ottawa,  On- 
tario. Attn.  Robert  Guv. 


Nursing  research  fellowship.  (Study 
and    research    in    cardiovascular 
specialties  leading  to  a  master's  or  a 
Ph.D.  degree) 
D  Hospital  for  Sick  Children  Founda- 
tion. 555   University  Ave..  Toronto. 
Ontario.  M5G  1.X8. 

"Supports    projects    that   seem   to 
offer  benefit  to  the  health  (physical 
and  emotional  well-being)  of  chil- 
dren. " 
n  Many    universities    have    research 
committees  or  other  bodies  that  award 
grants  internally,  i.e..  to  faculty  for  re- 
search .  and  these  funds  could  be  used  to 
support  nursing  research.  These  uni- 
versities include; 

Memorial  University,  Newfound- 
land; Universite  de  Moncton, 
Nouveau  Brunswick;  University  ot 
New  Brunswick;  University  of  Man- 
itoba; and  University  of  British  Col- 
umbia. 

U.S.A. 

D  American  Lung  As.sociation  (ALA) 

Dept.  of  National  League  for  Nursine. 

10  Columbus  Circle,  New  York,  N.Y. 

10019,  U.S.A.  Atm.  SieginaM.  Frick, 

Director. 

Graduate  study  in  respiratory  dis- 
eases. Nursing  Fellowship  (U.S. 
and  Canadian  citizens)  $6,000  per 
year,  max..  2  years. 


Clinical  Nursing  Techniques,  3ed,  by 
Norma  Dison.  389  pages.  Saint 
Louis,  C.V.  Mosby,  1975. 
Reviewed  by  Kathleen  McAdam, 
Number  College,  Quo  Vadis  Cam- 
pus, Etobicoke.  Ontario. 

The  appearance,  soft  cover,  and  size  of 
the  book  are  most  pleasing  and  man- 
ageable. The  topics  are  distinctly  out- 
lined and  the  procedures  are  specifi- 
cally described,  informative,  simple, 
and  easy  to  grasp.  Principles  such  as 
gowning,  gloving,  scrubbing,  and 
catheterization  are  well  interpreted. 

The  illustrations  cover  the  most  re- 
cent type  of  equipment  with  distinct 
explanations  as  to  usage.  Specific  tech- 
niques are  well  outlined,  e.g.,  in- 
travenous therapy,  central  venous  pres- 
(Contlnued  on  page  50) 


•F  CANADIAN  NURSE  —  Oclobef  1975 


books 


(Continued  from  page  49) 

sure,  preparation  of  types  of  enemas, 
positive  pressure  breathing,  and  appli- 
cation of  heat  and  cold. 

The  most  detailed,  explicit  and  diag- 
rammed information,  I've  seen  in  a 
nursing  text,  is  offered  on  colostomies. 
Installation  of  eye,  ear,  and  nose  drops, 
plus  inhalation  of  nebulized  medica- 
tions, completes  the  comprehensive 
coverage  of  nursing  techniques.  At  the 
end  of  each  unit,  excellent  comprehen- 
sion questions  ard  selected  reference 
readings  are  offered. 

A  few  areas,  however,  would  have  to 
be  covered  from  other  sources,  e.g., 
role  or  action  of  friction  in  handwash- 
ing, the  reason  for  microbiology  in  iso- 
lation, and  the  hand  and  wrist  exercises 
needed  prior  to  crutch  walking.  This 
reader  would  like  to  see  more  informa- 
tion on  bandaging  with  illustrations  — 
perhaps  types  of  materials  used,  how  to 
choose,  and  why  adopted. 

This  new  book  is  impressive  and  this 
reader  would  highly  recommend  it  for 
teachers  of  nursing  and  nursing  stu- 
dents; to  be  used  in  conjunction  with 
other  reference  material. 


The  Nurse  as  Executive  by  Barbara  J. 
Stevens.  260  pages.  Wakefield, 
Mass.,  Contemporary  Publishing, 
1975. 

Reviewed  by  Margaret  D.  McLean, 
Director.  School  of  Nursing, 
Memorial  University,  St.  John's, 
Nfld. 

Barbara  J.  Stevens  wrote  "'The  Nurse 
as  Executive"  ■  for  nurses  in  administra- 
tive positions  in  service  or  education 
who  have  not  had  preparation  in  man- 
agement. 

The  author  states  that  this  "is  not  an 
authoritative  researched  work  in  prin- 
ciples of  nursing  administration  rather 
it  reflects  the  experiences  and  analyses 
of  the  author  while  in  positions  of  ad- 
ministration, in  nursing  service  and 
education."" 

The  author's  objective  seems  to  be  to 
describe  the  role  of  the  nurse  manager, 
list  the  capabilities  needed  by  the  man- 
ager, and  present  the  pros  and  cons  to 
various  methods  of  applying  the  princi- 
ples of  management  in  nursing  situa- 
tions. One-third  of  the  book  deals  with 
general  management  skills,  one-third 
with  management  applications  in  nurs- 
ing, and  one-third  with  the  theoretical 
and  educational  aspects. 

The  subjects  (such  as  management 
organization  concepts,  decision  mak- 
ing, communications  theory,  and  edu- 


cational aspects)  are  well  dealt  with  and 
will  be  helpful  to  the  reader.  A  few 
others  such  as  staffing  and  assigning  of 
nursing  personnel  are  less  well  co- 
vered. 

The  author  mentions  classification  of 
patients  according  to  their  nursing 
needs,  but  she  fails  to  comment  on  or 
describe  a  method(s)  for  doing  so.  This 
procedure  is  recognized  by  many  nurse 
managers  as  an  essential  tool  in  order  to 
staff  a  nursing  unit. 

Nurse-managers  without  preparation 
and  students  of  nursing  management 
will  derive  a  great  deal  of  help  in  iden- 
tifying the  role  of  the  manager,  the 
capabilities  that  managers  require,  and 
the  manager's  responsibilities.  Readers 
will  find  it  necessary  to  read  other  au- 
thors and  journal  articles  to  develop  a 
comprehensive  knowledge  of  the  vari- 
ous approaches  to  management. 

No  one  book,  can  cover  all  subjects 
and  therefore,  this  reviewer  believes 
that  the  author  did  achieve  her  objec- 
tive. 


Behavioral    Therapy   by    Halmuth    H. 
Schaefer  and  Patrick  L.  Martin.  378 

,  pages.  New  York,  McGraw-Hill, 
1975.  Canadian  Agent:  Scar- 
borough, Oni.,  McGraw-Hill  Ryer- 
son. 

Reviewed  by  Peggy  Webb.  Instruc- 
tor, School  of  Nursing,  University  of 
Calgary,  Calgary,  Alberta. 

This  is  a  simply  written  text  on  be- 
havioral therapv.  While  most  of  the 
book  deals  with  the  behavioral  man- 
agement of  "odd"  behaviors,  a  portion 
is  also  devoted  to  a  discussion  of  the 
basic  principles  and  techniques  in- 
volved in  this  mode  of  treatment. 

This  latter  aspect  is  considered  in  the 
early  chapters  of  the  book.  Here  the 
reader  will  become  familiar  with  the 
language  of  the  behaviorist,  as  well  as 
with  the  common  current  objections  to 
behavioral  therapy.  The  authors  dis- 
cuss the  humanists'  concern  with  the 
issue  of  control  of  human  behavior  and 
make  a  convincing  argument  favoring 
the  appropriateness  and  ethics  of  this 
treatment  modality.  Of  particular  in- 
terest to  nurses  will  be  the  section  enti- 


+  R0II  up 
your  sleeve 
to  save  a  life... 


tied,  "data  collection."  It  should  prove 
helpful  in  understanding  the  "whys" 
and  "how  to's"  of  record  keeping. 

As  stated  earlier,  behavioral  man- 
agement of  "odd"  behaviors  is  em- 
phasized. After  curiously  lumping 
problem  children,  psychotic  children, 
and  geriatric  patients  together  in  a  short 
chapter,  the  majority  of  the  discussion 
thereafter  centers  on  those  behaviors 
commonly  seen  in  the  mentally  ill  and 
mentally  retarded  client.  Typical  be- 
haviors discussed  are  delusions,  hal- 
lucinations, and  "crazy  talk"  as  well  as 
those  behaviors  more  commonly  seen 
in  the  long  term  regressed  client. 

This  text  would  undoubtedly  be 
helpful  as  a  resource  reference  for  the 
nursing  student  who  wishes  to  under- 
stand the  principles  underlying  be- 
havioral therapy  and  its  application  to 
patient  care.  As  well,  practicing 
psychiatric  nurses  should  find  it  a  help- 
ful addition  to  their  nursing  unit  li- 
braries. '■^ 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses'  Association  Library 
are  available  on  loan  —  with  the  excep- 
tion of  items  marked  R  —  to  cna  mem- 
bers, schools  of  nursing,  and  other  in- 
stitutions. Items  marked  R  include  re- 
ference and  archive  material  that  does 
not  go  out  on  loan.  Theses,  also  R,  are 
on  Reserve  and  go  out  on  Interlibrary 
Loan  only. 

Requests  for  loans,  maximum  3  at  a 
time,  should  be  made  on  a  standard 
Interlibrary  Loan  form  or  on  the  "Re- 
quest Form  for  Accession  List"  printed 
in  this  issue. 

If  you  wish  to  purchase  a  book,  con- 
tact your  local  bookstore  or  the  pub- 
lisher. 

BOOKS  AND  DOCUMENTS 

1.  Alberla  Association  of  Registered  Nurses. 
Nursing  Education  Planning  Committee.  Brief  to 
the  Commission  on  Educational  Planning.  Ed- 
monton. 1970.  51p. 

2.  Anderson.  Betly  Ann  et  al.  Interruptions  in 
family  health  during  pregnancy.  A  programmed 
text.  Toronto.  McGraw-Hill.  cl975.  508p.  (Her 
The  childbearing  family,  v. 2) 

3.  Association  des  Universiles  et  Colleges  du 
Canada.  Universites  et  colleges  du  Canada.  Ot- 
tawa, publiee  conjointement  par  AUCC  et  Statis- 
tique  Canada.  1975.  583p. 

4.  Association  of  Nurses  of  the  Province  of 
Quebec    and    La    Faculle    de    Nursing    de 


50 


accession  list 


I'Universile  de  Montreal.  A  study  of  the possihil- 
iry  of  conducting  a  course  in  the  French  language 
for  a  diploma  in  nursing  in  conjunction  with  the 
University  programme  in  nursing  i French!  using 
only  French  language  clinical  fields  in  the  health 
region  No.  I  of  the  province  of  New  Brunswick. 
New  Brunswick.  1973.  57p. 

5.  Associalion  of  Universilies  and  Colleges  of 
Canada.  Canadian  universities  and  colleges.  Ot- 
lawa.  published  jointly  by  AUCC  and  Statistics 
Canada,  1975.  583p. 

6.  Bailey.  Rosemary  E.  Pharmacology  for 
nurses.  4ed.  London.  Bailliere  Tindall,  cl975. 
383p.  (Nurses"  aids  series) 

7.  Beamish.  Betsey  S.  Reference  materials  for  a 
health-science  core  library,  led.  Los  Angeles. 
Pacific  Southwest  Regional  Medical  Library  Ser- 
vice. Biomedical  Library.  Univ.  of  California. 
1974.  48p. 

8.  Blau.  Peler  M\che\ .  On  the  nature  of  organiza- 
tions. New  York.  Wiley.  cl974.  358p. 

9.  Broadribb.  Violet  and  Corliss.  Charlotte. 
Maternal -child   nursing.    Toronto.    Lippincolt. 

1973.  702p. 

10.  Canadian  living  Webster  encyclopedic  dic- 
tionary of  the  English  language.  Chicago.  111.. 
English  language  Inst,  of  America.  cl974.  2\. 
(Including  French-English.  English-French  voc- 
abularies and  special  sections  for  French- 
speaking  Canadians.  Thirteen  reference  supple- 
ments) 

1  1.  Cara.  M.  et  Poisvert.  M.  Premiers  secours 
dans  les  detresses  respiraloires:  des  accidents  du 
trafic.  des  intoxications  et  des  maladies  aigues. 
2ed.  Paris.  Masson.  1975.  144p. 

12.  Care  of  the  critically  ill.  Edited  by  Stephen 
M.  Ayres  et  al.  2ed.  New  York.  Appleion- 
Century  Crofts.  cl974.  359p. 

13.  Cheshier.  Robert  G.  ed.  Principles  of  medi- 
cal librarianship:  the  environment  affecting 
health  sciences  libraries,  led.  Cleveland.  Ohio. 
Cleveland  Health  Sciences  Library,  c  1 975.  304p. 
(Health  sciences  information  series,  vol.2  no.  1 ) 

14.  Darling.    Vera  and   Thorpe.    Margaret   R 
Ophthalmic  nursing.  London.  Bailliere  Tindall. 
cl975.  205p.  (Nurses'  aids  series) 

15.  Davis.  MarcenaZakski.  Nurses  in  practice. 
A  perspective  on  work  environments,  edited 
by  .  .  .  Marlene  Kramerand  Anselm  Strauss.  St. 
Louis.  Mo..  1975.  273p. 

16.  Dorozynski.  Alexander.  Doctors  and  heal- 
ers. Ottawa.  International  Development  Re- 
search Centre.  cl975.  63p. 

17.  Evans.  Bergen,  comp.  Dictionary  of  quota- 
lions.  New  York.  Bonanza  Books.  1968.  2029p. 
R 

18.  Feldstein.  Martin  S.  Ecotuimic  analysis  for 
health  service  efficiency.  Econometric  studies  of 
the  British  National  Health  Service.  Chicago. 
Markham.  1968.  322p.  (Markham  series  in  pub- 
lic policy  analysis) 

19.  Flint.  Maurice  S.  Revised  Eskimo  grammar. 
Mississauga.  Ont..  St.  Hilary's  Anglican 
Church.  1974,  79p. 

20.  Ford,  Ann  Suter.  The  physician's  assistant. 


.4  national  and  local  analysis.  New  York. 
Praeger.  cl975.  245p. 

21  Foundation  Center.  The  foundation  direc- 
tory. 1975.  New  York.  Columbia  University 
Press.  1975.  5l6p.  R 

22.  Francois.   G.    et   al.   Abrege  de  medecine 
d'lirgence  et  d'anesthesie  reanimation.    Paris. 
Masson.  cl975.  326p. 
23    Gardner.  John  W.  .Vo  easy  victories.  Edited 


by  Helen  Rowan    New  York.  Harper  &  Row. 
c'l968.   177p. 

24.  G00/.S  in  nursing  education.  Melbourne. 
Royal  Australian  Nursing  Federation.  1975.  2v. 
Contents.  -Pt.l.  Changing  patterns  of  nursing 
education  in  Australia,  by  Shirley  Donaghue. 
Pt.2  Report  of  working  party. 
■25.  The  greater  medical  profession.  Report  of  a 

(Continued  on  page  52) 


Get  what  you've 

always  wanted 

from  nursing 


F 
^>^- 


Like  a  wealth  of  professional  experience 
to  enrich  your  career. 


Nursing  has  a  lot  to  offer  Remember'' 
But  sometimes  you  can  get  so  stuck  in 
a  rut  you  almost  forget  those  exciting 
challenges  that  made  you  choose  a 
nursing  career  in  the  first  place 

With  Medox,  you  can  revive  those 
challenges. 

Since  Medox  serves  almost  the 
entire  spectrum  of  nursing  services, 
you  can  get  more  variety  of 


assignments  in  a  month  than  you 
could  in  a  year  back  in  that 
comfortable  rut.  Operating  room. 
Intensive  Care  Cardiac  Unit.  Pediatric 
care. 

There's  more  to  nursing  than 
punching  a  time  clock. 

With  Medox.  there  can  be  a  lot 
more 


a  DRAKE  INTERNATIONAL  company 
CANIADA .  USA.  UK.  AUSTRALIA 


accession  list 


(Continued  from  page  51) 


symposium  sponsored  jointly  by  The  Royal  Soci- 
ety of  Medicine  andThe  J  osiah  MacyJr.  Founda- 
tion. New  York.  Josiah  Macy  Jr.  Foundallon. 
1973.  25.^p, 

26.  Green,  Richard,  \93b-  ed.  Human  sexuality: 
a  health  practitioner's  text.  Baltimore,  Williams 
and  Wiikins,  cl97.'i.  251p. 

27.  Hanbury,  Eric.  Nurse.  Photographs  by 
Dougal  Bichan.  Toronto,  McClelland  and 
Stewart,  cl97.S  by  the  Registered  Nurses'  As- 
sociation of  Ontario.   I4.3p. 

28.  Hilt,  Nancy  E.  and  Schmilt,  E.  William. 
1943  -  Pediatric  orthopedic  nursing.  St.  Louis, 
Mo.,  Mosby,  1975.  248p, 

29.  Knopf,  Lucille .  RN's  one  and  five  years  after 
graduation.  A  report  of  the  nurse-career  pattern 
study.  New  York,  National  League  for  Nursing, 
cl975.  I1.3p.  (NLN  Pub.  No.  19-I53.i) 

30.  McLaughlin,  Curtis  P.  and  Sheldon,  Alan. 
The  future  and  medical  care.  A  health  manager's 
guide  to  forecasting.  Cambridge,  Mass.,  Bal- 
linger,  cl974.  I25p. 

3 1 .  loria,  Josephine.  Childbirth: family-centered 
nursing.  .3ed.  Saint  Louis,  Mo.,  Mosby,  1975. 
468p. 

32.  Mangrum,  Robert  E.  1931-  Manual  of 
hematology.  Reston,  Va..  Reston,  cl975.  I80p. 

33.  Mayeroff,  Milton.  On  caring.  New  York, 
Harper  &  Row,  cl971.   106p. 

34.  Morion,  Leslie  Thomas.  The  use  of  medical 
literature.  Hamden,  Conn.,  Archon,  cl974. 
406p. 

35.  Murray,  Ruth  and  Zentner,  Judith.  Nursing 
assessment  and  health  promotion  through  the  life 
span.  Englewtxxi  Cliffs,  N.J.,  Prentice-Hall, 
C1975.  354p. 

36.  — .  Nursing  concepts  for  health  promotion. 
Englewood  Cliffs.  N.J.,  Prentice-Hall,  cl975. 
383p. 

37.  National  Conference  of  Nursing  Diagnosis, 
1st,  St.  Louis,  1973.  Classification  of  nursing 
diagnoses.  Edited  by  Kristine  M.  Gebbie  and 
Mary  Ann  Lavin.  St.  Louis,  Mo.,  Mosby,  1975. 
191p. 

38.  National  League  for  Nursing.  Council  of 
Home  Health  Agencies  and  Community  Health 
Services .  Directory  of  home  health  agencies  cer- 
tified as  Medicare  providers.  New  York,  cl975. 
I09p. 

39.  — .  Dept.  of  Baccalaureate  and  Higher  De- 
gree Programs .  Faculty  curriculum  development. 
New  York,  cl974.  Contents. -Pt.  1 .  The  process 
of  curriculum  development.  -Pt.2.  Curriculum 
evaluation.  -Pt.3.  Faculty  curriculum  develop- 
ment. -Pt.4.  Unifying  the  curriculum 

40.  — .  Dept.  of  Diploma  Programs.  CMrnVu/um 
relevance  within  a  changing  health  care  system. 
Papers  presented  at  four  1974  Workshops  of  the 
Department  of  Diploma  Program  held  at 
Chicago,  Denver,  New  York,  and  Washington, 
DC.  NY.,  National  League  for  Nursing,  c  1975. 
g9p.  (NLN  Publication  no.  16-1564) 

41. — .  Dept.  of  Home  Health  Agencies  and 
Community  Health  Services.  The  issue  is  leader- 


ship. Papers  presented  at  the  Annual  Meeting  of 
the  Council  ....  March  1974,  Washington, 
DC.  New  York, cl975.  I  I8p  (NLN  Publication 
no.  21-1570) 

42.  — .  Dept.  of  Hospital  and  Related  Institu- 
tional Nursing  Services.  Providing  a  climate  for 
the  utilization  of  nursing  personnel.  Papers  pre- 
sented at  the  Joint  Program  of  the  .  .  .  and  the 
American  Hospital  Association,  Nov.,  1974. 
New  York,  N.Y.,  cl975.  I31p.  (NLN  Publica- 
tion no.  20-1566) 

43.  The  National  Physician  Assistant  Program 
profile  1975-1976.  led.  Washington,  Associa- 
tion of  Physician  Assistant  Programs,  cl974. 
I26p. 

44.  Nuckolls,  Katherine  B.  et  al.  Pediatric  nurse 
practitioner  preparation  in  a  graduate  program. 
N.Y.,  National  League  for  Nursing,  cl975.  23p. 
(League  exchange  no.  105)  (NLN  Publication  no. 
15-1563) 

45.  Oman,  Robert  M.  An  introduction  to 
radiologic  science.  Toronto,  McGraw-Hill, 
cl975.  195p. 

46.  Pan  American  Health  Organization.  Health 
conditions  in  the  Americas  1969-1972.  Washing- 
ton, 1974.  226p.  (Pan  American  Sanitary 
Bureau.  Scientific  pub.  no.  287) 

47.  Pan  American  Sanitary  Bureau,  /feport  of  the 
director,  1973-  Washington,  1974.  Iv.  (Its  offi- 
cial document  no.  131,  etc.) 

48.  Practical  manual  of  pediatrics.  A  pocket  re- 
ference for  those  who  treat  children.  Edited  by 

WW.  Waring  and  Louis  O  Jeansonne,  III.  St. 
Louis,  Mo..  Mosby.  1975.  .343p. 

49.  Saxton,  Dolores  F.  and  Hyland.  Patricia  A. 
Planning  and  implementing  nursing  intervention. 
St.  Louis,  Mo.,  Mosby,  1975.  190p. 

50.  Storlie,  Frances.  Patient  teaching  in  critical 
care.  New  York,  Appleton-Century  Crofts, 
cl975.  180p. 

51.  Suthers,  Marie  H.  The  new  primer  in  par- 
liamentary procedure.  Chicago,  III.,  Dartnell, 
cl975.  256p. 

52.  Tri-Hospital  Diabetes  Education  Centre.  A 
manual  for  diabetics.  Toronto,  Tridec,  cl974. 
Iv  (Tridec  "located  at  Women's  College  Hospi- 
tal, Toronto") 

53.  Vaysse,  Andre  et  Pouchain,  Gerard.  Mon 
enfant  entre  en  sixieme.  Paris,  Librairie  Generale 
Fran^-aise,  1974.  I68p.  (Livre  de  poche) 

54.  Wallach .  Jacques .  Interpretation  of  diagnos- 
tic tests.  A  handbook  synopsis  of  laboratory 
medicine.  Boston,  Little,  Brown,  cl970.  44lp. 

PAMPHLETS 

55.  Association  of  Hospital  and  Institution  Lib- 
raries. Special  Committee  on  Library  Service  to 
Prisoners .  Jails  need  libraries  loo:  guidelines  for 
library  service  to  jails.  Chicago,  American  Lib- 
rary Assoc.,  1974.  15p. 

56.  Association  of  Registered  Nurses  of  New- 
foundland .  A  brief  to  the  Special  Joint  Committee 
of  Parliament  on  Immigration  Policy.  St.  John's, 

1975.  4p. 


57.  Corporation  professionnelle  des  medecins  J 
Quebec.  Avant-projet.  Reglement  concernant  l< 
actes  medicaux  qui  peuvent  eire  poses  par  dt 
classes  de  professionnels  autres  que  dt 
medecins.  Public  par  decision  du  Bureau  de  • 
corporation.  19  mars  197$.  Montreal,  197^ 
20p.  (Supplement  au  Bulletin  15:2,  avril  197? 

58.  Corporation  professionnelle  des  medecins  d 
Quebec.   Guide  de  I'exercice  de  Tanesthesu 
Puhlie  par  decision  du  Bureau  de  la  corporation 
14  mars  1975.  Montreal,  1975.  8p.  (Supplemem 
au  Bulletin  I5;2,  avril  1975) 

59.  Co-ordinating  Council  of  the  Universities  . 
Alberta.  Regulations  governing  schools  of  nur 
ing  in  the  province  of  Alberta.  Alberta.  197i 
I8p. 

60.  Food  is  more  than  just  something  to  eu 
Prepttred  by  U.S.  Depts.  of  Agriculture  uiu. 
Health  Education  and  Welfare  in  cooperation 
with  the  Grocery  Manufacturers  of  America,  and 
the  Advertising  Council.  New  York,  The  Adver- 
tising Council  Inc.,  1975.  30p. 

61.  George.  Madelon,  Ide,  Kazuyoshi  et  Vam- 
bery,  Clara  E.  L'equipe  de  la  sante:  un  modele 
conceptuel.  Montreal,  Association  des  Infir- 
mieres  el  Infirmiers  de  la  Province  de  Quebec, 
1973.  4p. 

62.  Hill,  Margaret.  Drugs  -  use,  misuse,  abuse: 
guidance  for  families.  New  York,  Public  Affairs 
Committee,  c  1974.  20p.  (Public  affairs  pamphlet 
no.  515) 

63.  Irwin,  Theodore.  Living  with  a  heart  ail- 
ment. New  York,  Public  Affairs  Committee, 
cl974.  28p.  (Public  affairs  pamphlet  no.  521) 

64.  Lobsenz,  Norman  M.  Sex  after  sixty-five. 
New  York,  Public  Affairs  Committee,  cl975. 
24p.  (Public  affairs  pamphlet  no.  519) 

65.  Metropolitan  Life  Insurance  Co.  Stress  and 
your  health.  Ottawa,  1975.  I4p. 

66.  National  League  f or  Nursmg.  Nursing  educa- 
tion accreditation,  report  numbers  1-6.  Ap- 
proved by  the  Executive  Committee  of  the  Board 
of  Directors.  New  York,  1974-1975. 

67.  Ogg,  Elizabeth.  Preparing  tomorrow' s  par- 
ents. New  York,  Public  Affairs  Committee, 
cl975.  28p.  (Public  affairs  pamphlet  no.  520) 

68.  Registered  Nurses'  Association  of  Nova 
Scotia.  A  brief  to  the  Nova  Scotia  Council  of 
Health.  Nursing  education  -  its  role  in  support  of 
health  care  services  in  Nova  Scotia.  Halifax, 
1972.  8p. 

69.  — .  Criteria  for  the  evaluation  of  programs 
in  nursing  education  in  Nova  Scotia.  Halifax, 

1972.  12p. 

70.  — .  What  and  why.  Halifax,  1975.  pam. 

7 1 .  Wallace,  Wimbum  L.  The  role  of  tests  in  the 
licensing  process.  New  York,  The  Psychological 
Corp.,  1974.  8p. 

72.  Zerr,  Sheila.  The  use  of  personalized  instruc- 
tion for  the  first  year  nursing  laboratory  prepara- 
tion. Paper  prepared  for  the  Workshop  for 
Nurse-Teacher  Educators.  Mar.  6.  1973.  Ot- 
tawa, School  of  Nursing,  University  of  Ottawa, 

1973.  14p. 


accession  list 


GOVERNMENT  DOCUMENTS 
Canada 

73.  Depl.  of  National  Health  and  Welfare. 
Emergency  Health  Services  Division.  Hospital 
emergency  planning  manual.  Rev.  ed.  Ottawa. 

1974.  Iv.  (various  pagings) 

74.  Labour  Canada.  Collective  bargaining:  how 
to  make  it  work.  Ottawa,  Information  Canada. 

1975.  7p. 

75.  Health  and  Welfare  Canada.  Health 
Economics  and  Statistics  Division  Health  Pro- 
grams Branch.  Sources  of  increase  in  operating 
expenditure  of  budget  review  hospitals  in 
Canada.  1961 -197 1.  Ottawa,  1974.  33p. 

76.  Law  Reform  Commission  of  Canada.  Ex- 
propriation. Ottawa.  Information  Canada,  1975. 

I06p. 

77.  — .  Imprisonment  and  release.  Ottawa.  In- 
formation Canada.  1975.  46p. 

78.  — .  Limits  of  criminal  law.  Obscenity:  a  test 
case.  Ottawa.  Information  Canada,  1975.  49p. 

79.  Manpower  and  Immigration.  Staff  Training 
and  Development  Division.  Write  your  own  job 
description.  A  self-instruction  manual.  Prepared 
by  Michael  Frayling.  Ottawa.  Information 
Canada.  cl974.  Iv.  (various  pagings) 

80.  Ministere  de  la  Sante  nationale  et  du  bien-etre 
social.  /,o/  des  aliments  et  drogues  et  des  regle- 
ments  des  aliments  et  drogues,  codification  ad- 


ministrative. Ottawa.  Information  Canada.  1972. 
Iv. 

81.  National  Conference  on  Women  and  Sport. 
May  24-26.  1974.  Toronto.  Report.  Ottawa. 
Health  and  Welfare  Canada.  cl974.  80p. 

82.  National  Library  of  Canada.  Ottawa.  Infor- 
mation Canada,  cl974.  36p. 

83.  — .  Summary  of  the  Federal  Government 
Library  Survev  Report.  Ottawa.  Information 
Canada.  1974.  355p. 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLEC- 
TION 

84.  Barry.  M.  Patricia  and  Stevens.  Irene.  Re- 
port of  opinion  suney  re  clinical  role  for  area 
supervisor  in  Wentworth  I  Programme .  Hamil- 
ton Psychiatric  Hospital,  Dept.  of  Nursing.  1973. 
49p.  R 

85.  Bregg.  Elizabeth  A.  et  al.  A  study  on  the 
nurses'  concept  of  death.  Teachers  College.  Col- 
umbia University.  New  York.  1953.  39p   R 

86.  Connors.  John  J.G.  Alberta's  emergency  air 
ambidance  service.  Edmonton.  1975.  201p. 
(Thesis  (M.H.S.A.)  -  Alberta)  R 

87.  — .  Special  report.  Alberta  emergency  air 
ambulance  services.  Edmonton.  Alberta  Health 
and  Social  Development,  1974.  60p   R 

88.  Deschenes,  Huguette.  Enseignement  aiLX 
meres  pour  I'infirmiere  en  vue  dune  participa- 


tion au  soin  de  leur  enfant  asthmatique. 
Montreal.  1973.  4lp  (These  (M.N.)-  Montreal) 
R 

89.  Kelsey  Institute  of  Applied  Arts  and  Sci- 
ences. Saskatoon.  Sask.  A  study  of  performance 
characteristics  related  to  program  objectives. 
Diploma  nursing  program.   Saskatoon.  Sask., 

1974.  40p.  R 

90.  — .  Suney  of  performance  characteristics 
related  to  program  objectives.  Diploma  nursing 
program,  Saskatchewan  Institute  of  Applied  Arts 
and  Sciences.  Saskatoon,  Sask.,  1972.  36p.  R 

91 .  Leioumeau.  Marguerite.  Trends  in  basic  dip- 
loma nursing  programs  within  the  provincial  sys- 
tems of  education  in  Canada  1964-1974.  Ottawa, 

1975.  4l5p.  (Thesis  -  Ottawa)  R 

92.  Pankratz.  Stella.  A  study  of  the  admissions 
procedure  to  the  diploma  nursing  program 
Kelsey  Institute  of  Applied  Arts  and  Science. 
1967-1971 .  Saskatoon.  Sask..  Kelsey  Institute  of 
Applied  Arts  and  Science.  1975.  27p.  R 

93.  Peever.  Mary  Vera.  Social  and  psychologi- 
cal factors  influencing  application  for  admission 
to  nursing  homes  in  the  City  of  Calgary.  Calgary. 
1974.  I02p.  (Thesis  (MA.)  -  Calgary)  R 

94.  Wilson.  Beverly  Ruth.  Nursing  needs  of 
families  during  three  stages  of  a  family  member's 
respiratory  illness.  Toronto.  1975.  161p.  (Thesis 
(M.N.)  -  Toronto)  R  '^2? 


Request  Form 
for  "Accession  List" 

CANADIAN  NURSES^ 
ASSOCIATION  LIBRARY 

Send  this  coupon  or  facsimile  to 
LIBRARIAN.  Canadian  Nurses'  Association, 
50  The  Driveway,  Ottawa  K2P  1E2.  Ontario. 

Please  lencj  ine  the  following  publications,  listed  m  the 

issue  of  The  Canadian  Nurse, 

or  add  my  name  to  the  waiting  list  to  receive  them  when 

available. 

Item  Author  Short  title  (for  loentification) 

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 

Date  of  request 


//\  iambi  on  €*oiiege 

Jp)^  of  Applied  .Arts  and  Technology 


PC    Box  969.  Sarnia.  Ontario 


DIRECTOR  —  SCHOOL  OF  NURSING 

The  Director  is  accountable  for  thie  (jevelopment  ancj 
administration  of  nursing  education  programs.  A 
background  in  nursing  service  with  instructional,  cur- 
riculum, and  administrative  experience  in  nursing 
education  is  required.  Candidates  should  possess  a 
minimum  of  a  B.Sc,  Nursing  degree  and  Ontario  Nurs- 
ing Registration, 

COORDINATOR 
DIPLOMA  NURSING  PROGRAM 

Duties  include  co-ordination  of  clinical  resources, 
teaching,  assisting  the  Director  and  Faculty  in  develop- 
ing and  implementing  a  new  curriculum.  Candidates 
should  have  Ontario  Nursing  Registration,  a  bac- 
calaureate degree  in  Nursing  or  its  equivalent,  and  at 
least  2  years  relevant  nursing  and  curriculum  experi- 
ence. 

Excellent  potential  exists  for  creative  educators  in  a 
beautiful  new  campus  setting. 

Please  reply  in  confidence  to: 

The  Personnel  Officer 
Lambton  College,  Box  969 
Sarnia,  Ontario  NTT  7K4 


:  CANADIAN  NURSE  —  Oclotier  1975 


53 


classified  advertisements 


ALBERTA 


BRITISH  COLUMBIA 


3 


ONTARIO 


REGISTERED  NURSES  required  for  70  bed  accredited  active 
treatment  Hospital  Full  time  and  summer  relief  All  AARN  per- 
sonnel policies  Apply  in  writing  to  the  Director  ot  Nursing 
Drumheller  General  Hospital,  Drumtieller  Alberta, 


GENERAL  DUTY  NURSES  required  for  50-bed  hospital  in 
central  Alberta,  mid  way  between  Calgary  and  Edmonton  on 
mam  highway  Salaries  and  personnel  policies  as  set  by  AARN 
agreement  Residence  accommodation  available  Contact  Mrs, 
L.  Sivacoe,  R  N  ,  Director  of  Nursing.  Lacombe  General  Hospital 
Box  1450.  Lacombe.  Alberta.  TOC  180, 


BRITISH  COLUMBIA 


OPERATING  ROOM  NURSE  wanted  for  active  mo- 
dern acute  hospital  Four  Certified  Surgeons  on 
attending  staff  Experience  of  training  desirable 
Must  be  eligible  for  B  C  Registration  Nurses 
residence  available  Salary  according  to  RNABC 
Contract.  Apply  to.  Director  of  Nursing.  Mills  Mem- 
orial Hospital.  2711  Tetrauit  St.  Terrace.  British 
Columbia, 


REGISTERED  NURSES,  eligible  for  B  C  Registration,  for  a  new 
25-t>ed  acute  care  hospital  Furnished  residence  accommoda- 
tion available  RNABC  policies  in  effect  Situated  1 80  miles  east 
of  Vancouver  and  70  miles  west  of  Penticton  in  mining  and 
logging  countfv  Many  recreational  facilities,  summer  and  winter 
available  Apply  to  Director  of  Nursing,  Princeton  General  Hospi- 
tal, Princeton,  British  Columbia,  VOX  IWO 


ADVERTISING 
RATES 

FOR    ALL 
CLASSIFIED   ADVERTISING 

$15.00   for   6   lines   or   less 
$2  50  for  each   odditionol    lir>e 

Rates    for    display 
odvertisemenTs   on   request 

Closing  dole  for  copy  and  concellotion  is 
6  weeks  prior  to  1st  doy  of  publication 
month. 

The  Co  nod  ion  Nurses'  Association  does 
not  review  the  personnel  policies  of 
the  hospitals  and  agencies  odvertising 
in  the  Journoi.  For  outhentic  informotion, 
prospective  opplicants  should  apply  to 
the  Registered  Nurses'  Association  of  the 
Province  in  which  they  ore  interested 
in    working. 


Address  correspondence  to: 


The 


Canadian  ^ 

Nurse        "" 


^Z7 


50  THE  DRIVEWAY 
OTTAWA,  ONTARIO 
K2P 1E2 


EXPERIENCED  NURSES  (eligible  for  B  C  registration)  required 
for  409-bed  acute  care,  teaching  hospital  located  in  Fraser 
Valley.  20  minutes  by  freeway  from  Vancouver,  and  within 
easy  access  of  varied  recreational  facilities  Excellent  Orienta- 
tion and  Continuing  Education  programmes  Salary  $1 .049  00  to 
Si. 239  00  Clinical  areas  include  Medicine.  General  and  Spe- 
cialized Surgery,  Obstetrics,  Pediatrics,  Coronary  Care,  Hemo- 
dialysis. Rehabilitation.  Operating  Room.  Intensive  Care  Emer- 
gency PRACTICAL  NURSES  (eligible  for  B  C  Licensel  also 
required  Apply  to  Administrative  Assistant.  Nursing  Personnel. 
Royal  Columbian  Hospital.  New  Westminster.  British  Columbia 
V3L  3W7 


GRADUATE  NURSES  —  Looking  tor  variety  in  your  work'' 
Consider  a  modern  10-bed  hospital  located  on  a  beautiful  fiord- 
lype  inlet  of  Vancouver  Island  s  west  coast.  Apply,  Administrator 
Box  399  Tahsis,  British  Columbia.  VOP  1X0 


GRADUATE  NURSES  for  21-bed  hospital  preferably 
with  obstetrical  experience.  Salary  in  accordance 
with  RNABC  Nurses  residence.  Apply  to  Matron. 
Tofino  General  Hospital,  Tolmo,  Vancouver  Island 
British  Columbia 


HEAD  NURSE  —  General  Duty  and  Specialty  Nuraing 
Positions  available  for  Fall  Staffing  of  Renovated  Areas.  Salary 
Range:  General  Duty  $1026  —$121 2.  Credit  for  past  experience 
and  Post-Graduate  training.  B  C  Registration  required.  Policies 
in  accordance  with  RNABC  Contract.  Limited  Residence 
Accommodation  available  Apply  now  to:  Director  of  Nursing. 
Powell  River  General  Hospital.  5871  Arbutus  Avenue.  Powell 
River.  British  Columbia.  V8A  4S3, 


EXPERIENCED  GENERAL  DUTY  NURSES  AND  LICENSED 
PRACTICAL  NURSES  required  for  small  upcoasi  hospital  Sal- 
ary and  personnel  policies  as  per  RNABC  and  H,E,U  contracts. 
Residence  accommodation  $25  00  per  month  Transportation 
paid  from  Vancouver,  Apply  to:  Director  of  Nursing,  St  Georges 
Hospital,  Alert  Bay.  British  Columbia.  VON  1A0 


GENERAL  DUTY  NURSES  for  modern  4t-bed  hospital  located 
on  the  Alaska  Highway  Salary  and  personnel  policies  in 
accordance  with  RNABC.  Accommodation  available  in  resi- 
dence. Apply:  Director  of  Nursing.  Fort  Nelson  General  Hospital. 
Fort  Nelson.  British  CoiumtMa 


GENERAL  DUTY  NURSES,  for  modern  35-bed  hospital  located 
in  southern  B  C  s  Boundary  Area  with  excellent  recreation  faci- 
lities. Salary  and  personnel  policies  in  accordance  with  RNABC 
Comfortable  Nurses  s  home.  Apply.  Director  of  Nursing.  Bound- 
ary Hospital.  Grand  Forks.  British  Columbia.  VOH  IHO 


WANTED:  GENERAL  DUTY  NURSES  for  modern  70- 
bed  hospital,  (48  acute  beds  —  22  Extended  Care) 
located  on  the  Sunshine  Coast,  2  hrs  from  Vancou- 
ver Salaries  and  Personnel  Policies  in  accordance 
with  RNABC  Agreement  Accommodation  available 
(female  nurses)  in  residence.  Apply  The  Director 
of  Nursing,  St,  Marys  Hospital,  PO  Box  678  Se- 
olielt.  British  Columbia. 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  cars 
hospital  in  Nonhern  B.C.  residence  accommodations  availat)le 
BfJABC  policies  in  effect  Apply  to  Director  of  Nursing,  Mills 
Memorial  Hospital,  Terrace.  Bntish  Columbia.  V8G  2W7-' 


NEW  BRUNSWICK 


REGISTERED  NURSES  required  for  a  fully  accredited  1 04-bed 
hospital  located  m  a  small  city  offering  a  varied  year  round 
recreational  program  Our  salaries  are  presently  $8,088  — 
$9,384  per  year,  increasing  to  $8,652  —  $10,044  effective  from 
Oclobet  1st  until  March  31  1976  when  the  present  contract 
expires  A  most  attractive  package  of  fringe  benefits  is  offered 
For  further  information  telephone  collect:  (506)  753-4451 ;  or  write 
to  The  Personnel  Supervisor.  Soldiers  Memorial  Hospital. 
Campbellton,  New  Brunswick    E3N  1L1, 


Queens  University  is  seeking  candidates  for  the  positid 
DEAN/DIRECTOR  of  the  School  of  Nursing,  Persons  aread 
with  earned  doctoral  degrees,  demonstrated  scholar] 
professional  achievement  and  competence  in  admimstr 
appropriate  for  effective  leadership  in  an  established  Univi 
with  other  professional  faculties  and  schools.  Reports  Ic 
Vice-Principal  (Health  Sciences).  Salary  commensurate 
educational  preparation  and  experience.  Excellent  fi 
benefits.  Applications  and  nominations  should  be  seni 
H  G,  Kelly.  Vice-Principal  (Health  Sciences).  Queen  s  Unii 
Kingston,  Ontarxj.  K7L  3N6. 


DIRECTOR  OF  PUBLIC  HEALTH  NURSING  required  for  i. 
trict  Health  Unit  with  a  population  of  approximately  150   I 
Duties  to  commence  January  1st.  1976  The  position  rea  '! 
assuming  responsibility  for  the  coordination  of  an  exten' 
lie  health  nursing  program    Good  personnel  policies 
negotiable  depending  upon  qualifications  and  experien. 
to    Dr    BT    Dale.  Medical  Officer  of  Health   and 
Wellington- Dutferin-Guelph  Health  Unit.  205  Queen  Stm. 
Fergus,  Ontario,  N1M  1T2 


REGISTERED    NURSES    for    34-bed    General    Hn,c 
Salary  $945  OO  to  $1,145  00  per  month,  plus  experien; 
ance.  Excellent  personnel  polrcies  Apply  to:  Director  oi  ■ 
Englehart  s  District  Hospital  Inc..  Englehart.  Ontario.  P  , 


REGISTERED    NURSES    AND    REGISTERED    NURS 
ASSISTANTS     for     45-bed     Hospital      Salary     ■ 
include      generous      experience      allowances 
salary  $1,045,  to  $1,245,  and  RNA,  s  salary  $735   ■ 
Nurses  residence  —  private  rooms  with  bath  —$60,  pe 
Apply  to:  The  Director  of  Nursing.  Geraldton  District  i 
Geraldton.  Ontario.  POT  IMO, 


REGISTERED  NURSES  required  for  our  ultramodern  accred' 
79-bed  General  Hospital  in  bilingual  community  of  Nonhern  i 
lario  French  language  an  asset,  but  not  compulsory  Salar 
$945  to  $1145  monthly  (subject  to  increase  July  1st)  with  allc 
ance  for  past  experience  and  4  weeks  vacation  after  i  yr 
Hospital  pays  100%  of  OH  IP  ,  Life  Insurance  (10,000 
Insurance  (75%  of  wages  to  the  age  of  65  with  u  I  C,  car.  • 
35J  drug  plan  and  a  dental  care  plan.  Master  rotation  r 
Rooming  accommodations  available  in  town.  Excellent  pers 
net  policies   Apply  to    Personnel  Director,  Notre-Dame  Hosti 
P  O   Box  8000,  Hearst.  Ontano  POL  1  NO  ' 


PRINCE  EDWARD  ISLAND 


REGISTERED     NURSES     AND     LICENCED     NURSir 
ASSISTANTS  wanted  immediately  for  13-bed  hospital  Apply 
Margaret  Kilbride.  R  N  ,  Director  of  Nursing,  Stewart  Memoi 
Health  Centre.  Tyne  Valley.  PEI,  Phone:  Tyne  Valley  36  ' 
66-11 


SASKATCHEWAN 


REGISTERED  NURSES  are  required  immediately  for  the  43-b« 
Wadena  Union  Hospital  This  is  a  modern,  attractive  acute  cai 
hospital  situated  in  the  town  of  Wadena,   Saskatchewan    i 
friendty  parltland  community  with  a  population  of  1500  Ar— 
salary  and  fringe  benefits  are  provided  under  the  Saska;. 
Union  of  Nurses  agreement  in  effect.  Please  direct  appi 
to  Administrator.  Wadena  Union  Hospital.  PO  Box  10.  Wd- 
Saskatchewan 


n.N.  required  Immediately  —  Porcupine  Carragana  Unic 
Hospital  requires  General  Duty  Registered  Nurse  immediateb 
Salary  scale  and  fringe  taenefits  as  negotiated  by  S.U.N,  Moder 
20-bed  hospital  Near  Provincial  Park  Progressive  community 
Apply,  in  writing,  to:  Administrator.  Porcupine  Carragana  Unk) 
Hospital.  Box  70.  Porcupine  Plain.  Saskatchewan.  SOE  IHO. 


S4 


SASKATCHEWAN 


:toR  of  NURSING:  immediate  apoiicaiions  are  mvfted 
■silion  o*  D'tecior  of  Nursmg  m  !he  -iS-bed  Wadena 
^piiai  Fnnge  benefits  include  Registered  Pension  Plan 
e  Insurance  and  Income  Replacement  Plan  This  is  a 
3r  old  well-equipped  hospital  m  a  town  of  1 500  popuia- 
-g  a  large  rural  population  Wadena  ts  centrally  located 
~  'rom  each  ot  two  maior  Saskatchewan  centres  Super- 
■  aertence  is  essential  Nursmg  Administration  course 
,1  e  Attractive  salary  scale  in  eflect  Apply  stating  qualifica- 

6 and  experience  to  Administrator,  Wadena  Union  Hospital. 

I.  Box  10,  Wadena,  Saskatchewan  SOA  4JC 


UNITED  STATES 


XAS  wants  you!  If  you  are  an  RN  experienced  or 
It  graduate  come  to  Corpus  Chnsti  Sparkling 
.     the     Sea  a     city     building     for     a     belter 

where  your  opportunities  fo'  recreation  and 
idies  are  limitless.  Memorial  Medical  Center  500- 
d.  general  teaching  hospital  encourages  career 
wancemeni  and  provides  tn-service  orientation 
Jary  from  S785  20  to  Si, 052  13  per  month,  com- 
nsurale  with  education  and  experience.  Differential 
evening  shifts,  available  Benefits  include  holl- 
ies, sick  leave,  vacations,  paid  hospitalization, 
alth.  life  insurance,  pension  program  Become  a 
al  part  of  a  modern  up-to-date  hospital  write  or 
II:  John  W  Gover,  Jr  Director  of  Personnel, 
imor;al  Medical  Center  P  O  Box  5280  Corpus 
nati,  Texas  78405 


Be  part  of  the  Nurses'  Asso- 
ciation of  Medical  Care, 
where  the  advantages  are: 

A  higher  salary, 

salary  and 
life  insurance, 

an  average  of  3  work 
days  per  week, 

paid  holidays 
after  6  months. 


For  information  call: 

(514)  871-0179 

or 
(514)  866-8091 


CLINICAL  CO-ORDINATOR 
EMERGENCY 
DEPARTMENT 

(Nursing) 


Required  for  380-bed,  fully  accredited  ge- 
neral hospital  in  the  Kawartha  Lakes  Dis- 

Iricl. 

Please  apply  to: 

Director  of  Personnel 

The  Peterborough  Civic  Hospital 

Weller  Street 

Peterborough,  Ontario 

K9J  706 


ST.  MICHAEL'S  HOSPITAL 
Toronto,  Ontario 

invites  applications  from 

REGISTERED  NURSES 

for 

RESPIRATORY 

INTENSIVE  CARE, 

CORONARY  CARE, 

and  ACUTE  CARE  UNITS 

Three  separate  but  adjoining  units,  of  14.  7.  and  24  beds 
respectively  Planned  onentalion  and  m-service  pro- 
gramme will  enable  you  to  collaborate  m  the  most  advan- 
ced of  treatment  regimens  tor  the  post -operative  cardio- 
vascular, cardiac  and  other  acutely  ill  patients  One  year  of 
nursing  experience  a  requirement 

For  details  apply  to: 

The  Director  of  Nursing 
St.  Michael's  Hospital 
Toronto.  Ontario 
MSB  1W8 


HOME 

CARE 

ADMINISTRATOR 


Required  early  October  by  Progressive  Healtri 
Unit  in  Central  Ontario  Applicants  should  tiave 
administrative  experience  and  baccalaureate  in 
nursing  Attractive  salary,  tnnge  benefits  and 
VKOrKing  conditions. 

Please  forward  curriculum  vitae  in  confidence 
to: 

Dr.  G.P.A.  Evans 
Medical  Officer  of  Health 
Waterloo  Regional  Health  Unit 
850  King  Street  West 
Kitchener,  Ontario 
N2G  1E8 


HEAD  NURSE 

for 

an  Obstetrical 
Department 

required  for  a  26  bed  unit  in  a  fully  accredited 
acute  treatment  general  hospital  Total  bed 
capacity  is  208  Qualifications:  Registered  Nurse 
with  additional  educational  preparation  in  obstet- 
rical nursing  and  administration  Salary  commen- 
surate with  experience  plus  a  liberal  fringe  benefit 
program  will  tie  offered 


Apply  to: 


Personnel  Officer, 
Woodstock  General  Hospital, 
270  Ridden  Street, 
Woodstock,  Ontario. 
N4S  6N6 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

ifivite  applications  from 

REGISTERED  NURSES 

54-becl  accredited  general  hospi- 
tal. Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquiries  and  applications 
to 

Miss  E.LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane.  Ontario 

POL  ICO 


REGISTERED  IMURSES 

and 
IMURSING  ASSISTANTS 


Required  for  1 10-bed  chest  hospital  situated  |usl 
55  miles  north  of  Montreal  in  the  heart  of  the 
Laurentians 

Residence  accommodations  available  Excellent 
personnel  policies  (Quebec  language  require- 
ments do  not  apply  for  Canadian  applicants) 


Apply: 


Director  of  Nursing 
P.O.  Box  1000 
Ste.  Agathe  des  Monts 
Que.  J8C  3A4 


:  CANADIAN  NURSE  —  OcloBer  1975 


FOOTHILLS  HOSPITAL 

Calgary,  Alberta 

Advanced  Neurological- 
Neurosurgical  Nursing 

for 
Graduate  Nurses 

a  five  monlh  clinical  and 

academic  prdgram 

ofteted  by 

The  Department  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

(Department  of  Surgery) 

Beginning:  March.  September 

Limited  to  8  panicipanis 
Applications  now  being  accepted 

For  further  information,  please  write  to: 

Co-ordinator  of  In-service  Education 

Foothills  Hospital 

1403  29  St.  N.W.  Calgary,  Alberta 

T2N  2T9 


ST.  MICHAELS  HOSPITAL 
Toronto.  Ontario 

This  university  hospital  in  metropolitan  area  in- 
vites applications  for  two  positions  of 

NURSING  CO-ORDINATOR, 
OBSTETRICS  &  GYNAECOLOGY 

STAFF  DEVELOPMENT  NURSE, 
LABOUR  &  DELIVERY  ROOMS 

for  active  department  (approx  2500  deliveries 
annually),  including  Ante-Partum  Unit  for  high  risk 
mothers,  Rooming-in  Unit,  2  nursehes,  Women  s 
Clinic. 

For  details  Contact: 

Director  of  Nursing  (416)  360-4106 


NORTHERN  NEWFOUNDLAND 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

Staff  nurses  tor  St.  Anthony  New  hospital  of 
150  beds,  accredited.  Active  treatment  in  Surgery, 
fyledicine,  Paediatncs,  Obstetrics.  Psychiatry 
Large  OPD  and  ICU,  Onentation  and  In-Service 
programs,  40-hour  week,  rotating  shifts,  PUBLIC 
HEALTH  has  challenge  of  large  remote  areas 
Furnished  living  accommodations  supplied  at  low 
cost.  Personnel  benefits  include  liberal  vacation 
and  sick  leave,  travel  arrangements  Staff  RN 
S637  —  S809,  prepared  PHN  $71 2  —  S903.  steps 
for  experience 


Apply  lo. 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Antltony.  Newfoundland 

AOK  4S0 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  ttian  an  tiour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound    in   our  clinics  and 

their  numbers  increase  daily  in  our 

Emergency. 

If   you   do   not   like   working  with 

children    and   with   their   families. 

you  would  not  like  it  here. 

If  you  do  like  children  and  their 
families,  we  would  like  you  on  our 
staff. 

Interested  qualified  applicants 
should  apply  to  the: 

DIRECTOR  OF  NURSING 
Montreal  Children  s  Hospital 
2300  Tupper  Street 
Montreal  108,  Quebec 


This 
.  Pul^icatk/n 
IS  Ai'ailaMe  in 

xMK^ROFORM 

. . .  from 


Xerox 
University 
Microfilms 

300  North  Zeeb  Road 
Ann  Arbor,  MIcfilgan  48106 

Xerox  University  Microfilms 

35  Mobile  Drive 
Toronto,  Ontario, 
Canada  M4A  1H6 

University  Microfilms  Limited 

St.  John's  Road, 

Tyler's  Green,  Penn, 

Buckinghamshire,  England 

PLEASE  WRITE  FOR 
COMPLETE  INFORMATION 


HEAD  NURSES 

OTTAWA  CIVIC  HOSPITAL 


Renal 

and 

Orthopedic  Units 


Tfiis  1000  bed  teactiing  tiospital  situated  in  tf 
Ottawa  Valley  is  affiliated  witti  tfie  University 
Ottawa 

Applications  and  inquiries  to: 

Miss  M.  Mills,  Reg.  N.,  B.Sc.N., 
Assistant  Director  of  Nursing  Service 
Ottawa  civic  Hospital, 
1053  Carting  Avenue, 
Ottawa,  Ontario.  K1Y  4E9 


GRACE  DART  HOSPITAL 

6085  Sherbrooke  Street  East, 

Montreal,  Ouebec 

H1N  1C2 


This  accredited  101  bed  hospital  offers  oppoi 
tunities  to  Nurses  interested  m  the  total  care  c 
long-term  patients  We  require  Licenced  Generj 
Duty  Nurses  and  Licenced  Nursing  Assistants  fo 
permanent  day,  evening  and  night  shifts 

Salary  based  on  qualifications  and  experience. 

Excellent  fringe  benefits 


Interested  applicants  are  requested  to  appi] 
to: 

DIRECTOR  OF  NURSING 


COMMUNITY  PSYCHIATRIC  CENTRE 
Douglas  Hospital  Centre 

Opportunity  for 

NURSES 

and 

NURSING  ASSISTANTS 

to  join  the  teams  on  our  admission  and  short-term 
treatment  units,  either  anglophone  or  fran- 
cophone 

These  in-patient  units  are  part  of  our  expanding 
Community  Psychiatric  Centre,  responsible  for 
the  mental  health  of  both  the  anglophone  and  the 
francophone  population  of  the  cities  of  Verdun 
and  LaSalle.  and  the  districts  of  Ville  Emard  and 
Pointe  St.  Charles 

For  further  information,  please  contact: 

Miss  H6l6ne  Berthelot, 
6875  LaSalle  Blvd., 
Verdun,  Ou6,  H4H  1R3 
Tel.:  761-6131,  Ext.  251 


CARIBOO 
COLLEGE 

KAMLOOPS 

BRITISH 
COLUMBIA 


Requires  a 

Nursing  Instructor 

Qualllicallons: 

An  MA.  degree  is  preferred.  Consideration  will  be  given  to  persons  with  a 
Baccalaureate  degree. 

a)  Service  and  leaching  experience  in  Medical  Surgical  Nursing 

b)  Eligibility  for  registration  in  British  Columbia 

DutiM:  (to  commence  January  1.  1976) 

1)  Classroom  leaching 

2)  Clinical  teaching  and  supervision 

3)  Participation  in  curriculum  planning,  and  other  faculty  activities 

Mail  applications  together  with  curriculum  vitae  and  letters  of 
reference  to:  The  Principal,  Cariboo  College,  Box  860. 
Kamloops,  British  Columbia,  V2C  5N3. 

Closing  date  for  applications  November  1,  1975. 


UNIVERSITY  HOSPITAL  OF  THE  WEST  INDIES 

NURSING  VACANCIES 

Applications  are  invited  from  suitably  qualified  Registered  Nurses  for  the  following  posts  at 
the  University  Hospital  of  the  West  Indies  which  is  a  Teaching  Hospital  with  500  beds  and 
also  conducts  a  School  of  Nursing  with  a  complement  of  300  students. 
Vacancies  exist  tn  the  following  areas 

(A)  NURSING  ADMINISTRATION 
1.Administrativ9  Sister 

Applicants  should  have  at  least  three  (3)  years  experience  m  Ward  Management  and 
possess  a  Certificate  or  Diploma  m  Nursir>g  Administration. 
SALARY  SCALE  S564D  x  300  -  6540  per  annum 
2./n-sefVfce  Education  Oflicer 

Applicants  should  have  nad  at  least  three  (3)  years  experience  in  a  Senior  Nursing 

Position 

Administrative  and  Teaching  experience  are  necessary  and  a  Diploma  in  Advanced 

Nursing  Education  wilt  be  an  asset 

SALARY  SCALE   S6540  x  360  -  7620  per  annum 

(B)  OBSTHRIC  DEPARTMENT 
Sister 

Applicants  should  have  post-graduate  training  in  Paediatrics  or  Premature  Baby 
Nursing. 
SALARY  SCALE   S4440  x  240  -  5640  per  annum 

(C)  MEDtCAL  WARD 
Sister 
Applicants  with 

(a)  Managerial  experience 

(b)  Evidence  of  post-graduate  Managenal  Training  need  only  apply 
SALARY  SCALE    S4440  x  240  -  5640  per  annum 

(D)  OTOLARYNGOLOGY 
Sister 

Applicants  must  hold  a  post-graudate  certificate  m  E  NT  training 
SALARY  SCALE  S4440  x  240  •  5640  per  annum 

(E)  STAFF  MIDWIVES 

Applicants  should  be  registered  or  registrable  Nurses  with  dual  training  (general  and 
midwifery)   No  single  trained  Midwtves  application  will  be  processed 
STAFF  NURSES  -  INTENSIVE  CARE  UNIT 

Applications  are  invited  from  registered  or  registrable  Nurses    Special  training  in 
Operaling  Theatre  Techniques  and  Intensive  Care  Unit  is  essential 
SALARY  SCALE   52880x180  -  4500  per  annum 
Applications  stating  full  details  of  nationality,  age.  marital  status,  qualifications  and 
•xperience  should  be  sent  to  the: 

Director  of  Nursing  Service. 

University  Hospital  ot  the  West  Indies. 

Mona. 

Kingston  7. 

Jamaica  W.I.  ^^_^__^^ 


Dr  Welby  is  a  . . . 
NURSE 


It  seems  clear  from 
watching  this  program 
that  poor  Dr  Welby  is 
spending  2/3  of  his 
time  NURSING. 

The  nursing  profession  at 

the  ROYAL  VICTORIA  HOSPITAL 

is  concerned  about  this. 
We  are  reviewing  nursing 
roles  in  depth  in  this 
teaching  hospital  center, 
and  we  feel  that  we  can 
relieve  Dr  Welby  of  his 
non-doctoring  functions. 

You  are  invited  to  join 

an  extensive  change 

program  in  the  nursing 

profession  at  the 

ROYAL  VICTORIA  HOSPITAL. 

Areas  where  you  can  be  a 
part  of  the  change  program 
are,  Medical  and  Surgical 
Specialties,  Intensive  Care 
Areas,  Operating  Room, 
Psychiatry,  Obstetrics, 
Emergency  and  Ambulatory 
Services. 

No  special  language 
requirement  for  Canadian 
Citizens,  but  the  opportunity 
to  improve  your  French  is 
open  to  you. 

For  Information,  Write  To: 

Anne  Bruce,  R.N., 

Nursing  Recruitment  Officer 
Royal  Victoria  Hospital 
687  Pine  Avenue  West 
Montreal,  Quebec,  Canada 
H3A  1A1. 


:  CANADIAN  NURSE  —  October  1975 


NORTH  YORK  GENERAL  HOSPITAL 

INVITES  APPLICATIONS  FROM: 

REGISTERED  NURSES  AND 
REGISTERED  NURSING  ASSISTANTS 

FULL  AND  PART-TIME  POSITIONS 

N.Y.G.H.  is  a  585-becl,  fully  accredited,  active  treatment  hospital 

located  in  North  Metropolitan  Toronto  offering  opportunities  in  all 

services. 

The  Hospital  embraces  the  full  concept  of  Progressive  Patient 

Care  featuring  a  Self  Care  Unit  and  a  Psychiatric  Day  Care 

Program. 

Our  Nursing  Philosophy  focuses  on  the  patient  as  an  individual  and 

recognizes    the    importance    of    continuing    education    for    the 

improvement  of  patient  care. 

An   active   Staff   Development   program   focusing   on   individual 

learning  needs  is  maintained.. 

Apply  to: 

Personnel  Department 
North  York  General  Hospital 
4001  Leslie  Street 
Wlllowdale,  Ontario 
M2K1E1 


DIRECTOR 
OF  NURSING  SERVICE 


Applications  are  invited  for  this  position  in  a  fifty-eight 
bed  fully  accredited  hospital  which  includes  a  sixteen 
bed  chronic  unit  and  has  a  nursing  staff  of  53. 

The  hospital  is  located  on  Manitoulin  Island  which  is 
noted  for  its  natural  beauty  and  recreational  facilities. 

Applicants  will  be  required  to  have  a  B.Sc.  Nursing 
and/or  previous  nursing  administrative  experience. 

Fringe  benefits  include  four  weeks  vacation,  Ontario 
Hospital  Insurance  and  Pension  Plan  and  Group  Life 
Insurance.  Salary  is  negotiable  and  will  be  commensu- 
rate with  qualifications  and  experience. 

Applications  and  inquiries  should  be  directed  to; 

Administrator 

SL  Joseph's  General  Hospital 

P.O.  Box  640 

Little  Current,  Ontario 


REGISTERED  NURSES 

Immediate  Openings  in  all  Services 


Come  work  and  play  in  Newfoundland  s  second  largest  city' 

Corner  Brook  has  a  population  of  approximately  35.000  with  a  temperate  climate  i 
comparison  with  most  of  Canada  Outdoor  lite  is  among  the  finest  to  be  found  m  Non 
America  The  airports  serving  Corner  Brook  are  at  Deer  Lake,  32  miles  away,  and  St( 
phenville,  50  miles  away  Connections  with  these  airports  make  readily  available  air  trav- 
anywhere  in  the  world 

—  Salary  Scale:  S7,652.  —  $9,715.  per  annum;  Contract  expires  March  3t 
1975. 

—  Service  Credits  —  One  step  for  four  years  expertence;  two  steps  for  sb 
years  experience  or  more. 

—  Educational  differential  for  B.N.  and  master's  degree  In  Nursing. 

—  $2.00  per  shift  for  Charge  Nurse. 

—  $50.00  uniform  allowance  annually. 

—  20  wording  days  annual  vacation. 

—  8  statutory  holidays. 

—  Sick  Leave  —  I  1/2  days  per  month. 

—  Accommodation  available. 

—  Two  week  orientation  on  commencement. 

—  Continuing  Staff  Education  program. 

—  Transportation  available. 

At  the  present  time,  a  major  expansion  project  is  in  progress  to  provide  regional  hospitj 
facilities  for  the  West  Coast  of  the  Province  The  Hospital  will  have  a  350  bed  capacity  b 
June,  1975  Services  include  Metficine.  Surgery,  Paediatrics,  Obstetrics,  Psychiatry,  CCt 
and  ICU, 


Lifters  of  application  ahould  ba  aubmlttad  to: 

Director  of  Personnel 
WESTERN  MEMORIAL  HOSPITAL 
CORNER  BROOK,  NFLD. 
A2H6J7 


i 


WE  CARE 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 

Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 

Free  Parking.  S 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


58 


REGISTERED  NURSES 

Southern  California 

IMS    'apidly    expanding    573-t)ed    Medical    Cenle'    has 
nn,T-, nines  fof  RN  s  interested  in  professional  growth 

T  Memorial  is  recognized  for  its  excellence  of  patient 
^rch  facilities  and  teaching  programs  and  offers  a  full 

patient  care  services  including  Intensive  Care. 
Care  Emergency  Room.  Neurosurgery,  Open  Heart 
and  Rehabilitation  Our  full  on-going  in-servtce 
in  and  training  program  includes  classes  in  Critical 
inatal  and  an  Arrhythmia  Recognition  Class   Other 

are  given  for  Medical-Surgical.  Rehabilitation  and 

Cardiology 

n  the  Rose  Bowl  capitol    Pasadena.   Califprma. 

1  Memorial  enjoys  the  year  around  mild  climate. 

■nr  Ocean.  Mountain,  and  Desert  sporis  and  activities. 

a  one  hour  drive    Our  hospital  is  located  m  a 
■'  area,  which  otters  excellent  living  conditions 
-   your  inquiry  concerning  our   salaries    t}enefils. 

worlring  conditions  and  facilities  We  will  also  assist 
^Ns  to  acquire  visas  for  those  interested  in  a  position 
•ogressive  Medical  Center 

le  Miss  Ann  Kaiser,  Dir.  of  Nursing 

HUNTINGTON  MEMORIAL  HOSPITAL 
747  S.  FAIRMONT  ST 
PASADENA.  CALIF  .  9110S 

An  equal  opportunity  nmployer 


THE  IZAAK  WALTON  KILUMVI  HOSPITAL 

FOR  CHILDREN 

HALIFAX.  NOVA  SCOTIA 

Otters  a  13-week 

POST    BASIC    PAEDIATRIC 
NURSING  PROGRAM 

for 
REGISTERED  NURSES 

CLASSES  ADMITTED 
JANUARY,  MAY,  SEPTEMBER 

For  further  information  and  details  write: 

Associate  Director  of  Nursing  Education 

THE  IZAAK  WALTON  KILLAM  HOSPITAL 

FOR  CHILDREN 

Halifax,  Nova  Scotia 


GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  gen- 
ral  hospital  expanding  to  343  beds  plus 
iroposed  75  bed  extended  care  unit. 
Clinical  areas  include:  medicine,  surgery, 
bstetrics,  paediatrics,  psychiatry,  activa- 
lon  &  rehabilitation,  operating  room, 
mergency  and  intensive  and  coronary 
are  unit. 

<ust  be  eligible  for  B.C.  Registration 
ersonnel    policies    in    accordance    with 
LN.A.B.C.  contract: 
SALARY:  $850  —  $1 020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


•MEETING  TODAYS  CHALLENGE  IN  NURSING" 

QUEEN     ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
Of  McGill  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 
Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


WANTED 

COMMUNITY 

MENTAL  HEALTH  NURSE 


To  won<  as  a  member  of  a  mental  health  team  of  a  Community  Mental  Health  Program  in 
Central  Nova  Scotia. 

The  community  mental  health  nurse  we  are  looking  for  should  have  interest  in  developing 
new  approaches  to  serve  children  and  families  and  in  participating  in  the  various  components 
of  the  overall  program.  These  components  include  a  child  and  family  information  and  training 
resource  to.  front-line  workers  (including  parents),  assessment  of  children's  devekspmental 
disorders,  corrective  and  remediation  services,  and  integration  with  other  community  pro- 
grams to  children  and  families. 

We  will  be  most  interested  in  applications  from  experienced  nurses  trained  up  to  and 
including  the  Masters  level,  with  a  basic  course  in  psychiatric  nursing  (or  equivalent)  with 
current  or  possible  registration  in  the  Province  of  Nova  Scotia.  Salary  depends  on  qualifica- 
tions. 


Send  resume  to: 


Executive  Director 
Cobequid  Mental  Health  Centre 
P.O.  Box  872 
Truro,  Nova  Scotia 


CJ^NAniAKJ  KJI  IP<^F  - 


.  fVlnhpr  IQ?*^ 


EXECUTIVE 
SECRETARY-TREASURER 

required  by 

NEW  BRUNSWICK  ASSOCIATION 
OF  REGISTERED  NURSES 

for  MAY  1976 


MAJOR  RESPONSIBILITIES 

Administration  of  Association  policies 

Co-ordination  of  all  NBARN  activities  including  finances. 

Secretariat  and  Consultant  Services  to  Council  and  Executive. 


QUALIFICATIONS 

Demonstrated  leadership  abilities 
Administration  or  management  experience. 
Baccalaureate  degree  required,  Masters  preferred. 
Professional  association  involvement  \ 
Bilingual  |  Preferable 

SALARY— 

commensurate  witti  experience  and  preparation. 


Apply  to: 


Personnel  Committee 

N.B.A.R.N. 

231  Saunders  Street 

Frederlcton,  N.B. 

E3B  1N6 


ASSISTANT 

NURSING  DIRECTOR 

SPECIALTY  UNITS 


Applications  are  invited  for  the  position  of  Assistant  Nursing  Direct 
in  a  560  bed  general  hospital.  The  administrative  responsibilities  v\ 
include  to  plan,  organize  and  coordinate  the  management  of  sp 
cialty  and  sub-specialty  areas  in  nursing  service. 
Applicarlts  with  a  baccalaureate  degree  in  nursing  and  a  minimum 
six  years  nursing  experience  or  the  equivalent. 

Please  reply  with  a  curriculum  vitae  to: 

Director  of  Nursing  Services 
Edmonton  General  Hospital 
11111  Jasper  Avenue 
EDMONTON,  Alberta 
T5K  0L4 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Setvice  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 


O^^ 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


I 


CANBERRA  HOSPITAL 

ft  ACTON.  A.C.T.  AUSTRALIA 

NURSE  EDUCATOR 

THREE  POSITIONS:- 


1.  Principal  Educator  Si  0.799  per  annum 

2.  Senior  Educator  for  two-year 

general  nursing  course     S  9.661  per  annum 

3.  Midwifery  Educator  S  9.051  per  annum 
Additional  payment  for  diploma  and  cenificates  up  to  SI  2  per 
week.  Total  tutorial  staff  —  23. 

Courses  under  control: 

GENERAL  NURSING  3  years 

GENERAL  NURSING  2  years 

MIDWIFERY  1  year 

INTENSIVE  CARE  1  year 

INURSING  AIDE  1  year 

JFull  accommodation  (single)  available  —  SI  4  per  week, 
iassistance  with  married  accommodation  may  be  offered. 

Ifor  further  particulars  and  application  forms  please  contact: 

MISS  J.  JAMES, 
Director  of  Nursing, 
Canberra  Hospital, 
ACTON,  A.C.T.  2601 
AUSTRALIA. 


'NUMBER  MEMORIAL  HOSPITAL 

200  Church  Street,  Weston,  M9R  2N7 
Telephone  (416)  249-8111  (Toronto) 

Registered  Nurses 

and 

Registered  Nursing  Assistants 

Required  for  all  Nursing  Units 
Intensive-Coronary  Care.  Psyctiiatry,  Med. -Surg.  etc. 

Excellent  —  Orientation  Programme 

—  Inservice  Education 

—  Continuing  Education 

Recognition  given  for  Recent  and  Related  Experience 

Salaries     Reg.  N.  Jan.  1st.  1975  —  915.  —  1.115. 
Apnl  1st.  1975  —945.  —  1.145. 

R.N.A.  Jan.  1st.  1975  —  686.  —  728. 
July  1st.  1975  —  738.  —780. 

Contact 
Director  of  Nursing 


\ 


I 


657  bed, accredited, modern, 
well  equipped  General  Hospital, 
rapidly  expanding... 


Saint  John 
General 
^ospitaL    ^ 

^^  Saint%hn,N.B., 

'REQUIRES-.  CANADA 

General  Staff  ^(urses  <^ 
Registered  Nursing  Assistants 


In  all  general  areas:  Medical,  Surgical, 
Pediatrics, Obstetrics,  Chronic  and 
Convalescent,  several  Intensive  Care 
areas  and  Psychiatry. 


0  Active,  progressive  in  service  education  program. 
Special  Attention  to  Orientation. 
Allowance  for  Experience  and  Post  Basic  Preparation 


fOfl  FURTHUR  INFORMATION  APPLY  TO 

'PERSONNEL  DIRECTOR 

^aintjohn  General  Hospital 

PO  BOX  2000  Saint  John.  New  Brunswick  E2L4L2 


DIRECTOR 
OF  NURSING 


Applications  are  invited  for  the  position  of  DIRECTOR  OF 
NURSING  for  this  progressive  general  hospital.  Bed  com- 
plement of  31 3-beds  is  made  up  of  2 1 3  active  treatment  and 
100  chronic  beds  with  an  active  rehabilitation  program. 


The  Hospital  is  affiliated  as  base  hospital  for  a  community 
college  School  of  Nursing  and  provides  other  services  on  a 
district  level.  Outpatient  Psychiathc  Day  Care  Program  is 
offered. 


Stratford  is  a  pleasant  city  of  25.000  located  ninety  miles 
from  Toronto,  forty  miles  from  London  and  twenty  six  miles 
from  Kitchener. 


Please  direct  correspondence  in  confidence  to: 

The  Executive  Director 
Stratford  General  Hospital 
Stratford,  Ontario 
N5A  2Y6 


:;ANADIAN  nurse  —  October  1975 


THE  NEW  CARDIAC  UNIT 

of  the 

OTTAWA  CIVIC  HOSPITAL 

Opening 

In  the  Spring 

of  1976 


Requires: 

Head  Nurses  &  G.S.N.'s 

— For  the  Medical  &  Surgical  Wards. 
—  OR.  Recovery  Room,  Intensive  Care, 
and  Coronary  Care  Units. 

Applications  and  inquiries  to: 

Miss  M.  Mills,  Reg.  N.,  B.Sc.N., 
Assistant  Director  of  Nursing  Service, 
Ottawa  Civic  Hospital, 
1053  Carling  Avenue, 
Ottawa,  Ontario,  K1Y  4E9 


ORTHOPAEDIC    ic    AR-THRI-TIC 
HOSPITAL 


\^i\^ 


43  WELLESLEY  STREET,  EAST 

TORONTO,  ONTARIO 
M4Y1H1 

Enlarging  Specialty  Hospital  offers  a  uniqu 
opportunity  to  nurses  and  nursing  assistant 
Interested  in  the  care  of  patients  with  bone  an 
joint  disorders. 

Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  a 
units 

Clinical  specialists  for  Operating  Room,  Intensiv 
Care,  Patient  Care  and  Education. 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 

teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

For  further  information,  please  write  to: 

PERSONNEL  SERVICES 

VANCOUVER  GENERAL  HOSPITAL 

855  WEST  12TH  AVE. 

VANCOUVER,  B.C. 


62 


Assistant  Director 
of  Nursing: 

$14,000  — $17,300 

The  Queen  Street  Mental  Health  Centre,  a  C.H.A.  Accredited 
rapidly  expanding  650  bed  psychiatric  centre  In  downtown  Toronto, 
offers  an  excellent  opportunity  to  exercise  progressive  administra- 
tive and  personnel  management  skills  in  a  flexible,  communlty- 
onented  nursing  service,  with  emphasis  on  comprehensive  care  of 
adult  and  adolescent  patients. 

Qualifications:  Candidates  should  have  a  B.Sc.N.  degree  or  its 

academic  equivalent  and  registration  In  Ontario  plus  three  years 
progressively  responsible  nursing  experience  supplemented  by 
administrative  and/or  supervisory  experience  and  demonstrated 
interest  In  community  mental  health  treatment. 

Please  submit  resumes  to:  The  Personnel  Officer,  999  Queen 
Street  West,  Toronto,  Ontario.  M6J  1H4 

This  position  is  open  equally  to  men  and  women. 
File  No:  HL-26-43/75 

^m\  Ontario 

oS^o  Public  Service 


WELCOME 


to 


"THE  NEURO' 


A  Teaching  Hospital 
of  McGill  University 

Positions  available 

for  nurses  in  all  areas 

including  Operating  Room 

Individualized  orientation 

On-going  staff  education 


(Quebec  language  requirements 
do  not  apply  to  Canadian  applicants) 


Apply  to: 

The  Director  of  Nursing. 

Montreal  Neurological  Hospital, 

3801  University  Street, 

Montreal  H3A  2B4, 

Quebec.  Canada. 


ST.  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

•  We  offer  opportunities  in  Emergency.  Operating  Room.   P.A.R.,   Intensive  Care  Unit.  Orttiopaedics.   Psyctiiatry, 
Paediatrics.  Obstetrics  and  Gynaecology.  General  Surgery  and  Medicine. 

•  We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Service  programs. 

•  We  offer  —  Toronto  —  with  some  of  Canada  s  finest  Theatres,  Restaurants  and  Social  events. 

•  We  offer  progressive  personnel  policies. 

•  We  offer  a  starting  salary,  depending  on  experience,  of: 

effective  April  1, 1975     -  $945  to  $1,145  per  montti. 

•  We  offer  monthly  educational  allowances  up  to  $1 20.  per  month  in  addition  to  the  above  starting  salary. 

Appiyto:  Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1 B5 


E  CANADIAN  NURSE  —  Oclober  1 975 


of  providing  health 
CQre  for  the 
Indian  people, 
of  Canada     ^^ 


1^ 


Health  Same  at 

and  Welfare      Bien-etre  social 

Canada  Canada 


/  ;,\\ 


Medical  Services  Branch 

Department  of  National  Health  and  Welfare 

Ottawa,  Ontario   K1A0K9 


Please  send  me  more  information  on  career 
opportunities  in  Indian  Health  Services. 


Name: 

Address: 

City: 


Prov: 


Index 
to 

Advertisers 
October  1975 

Astra  Pharmaceuticals 4 

Burroughs  Wellcome  &  Co. 

Canada  Limited Cover  ■ 

Hampton  Manufacturing  (1966)  Limited K 

Health  Care  Services  Upjohn  Limited  4' 

Hollister  Limited | 

J.B.  Lippincott  Co.  of  Canada  Limited 32,  X 

MedoX ' 5 

The  C.V.  Mosby  Company  Limited 12,  13,  \' 

V.  Mueller g^  ( 

Nursing  Media  Index 4J 

Procter  &  Gamble ' 

Reeves  Company 4< 

Roussel  (Canada)  Limited   42,  43 

W.B.  Saunders  Company  Canada  Limited    1 

Standard  Brands  (Canada)  Limited 39 

White  Sister  Uniform  Inc 5,  Covers  2,  3 


Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  1E2  (Ontario) 

Advertising  Representatives 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore.  Penna.  19003 
Telephone:  (215)649-1497 

Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills.  Ontario 
Telephone:  (416)444-4731 


Member  of  Canadian 
Circulations  Audit  Board  Inc. 


B£ia 


I 
4 


November  1975  I 


Nurse 


DEC  12  1975 


;C2A/  :^;    ONT.    ^' 


K^^ 


"■^^^ 


^ 


V 


%. 


V-. 


M 


N  :N5 


77q^  K: 
O'ttav/, 


^l*. 


'e. 


G. 


■>^ 


li^it-x^j-   WL-MOOIU  OIIVIKLIUI  I  Y 

WHITE  SISTER;  OF  COURSE 


Style  No.  45913 
sues:  3-  15         -       • 
Royale  Supreme 
Plain  Tricot  Knit 

White about  $20.00 

Royale  Corded  Tricot 
Yellow about  820. GO 


Style  No.  45404 

Sizes:  7-15 

Royale  Corded  Tricot 

White,  Yellow about  $27.00 


Style  l\lo.  4581 6 
Sizes:  3-13 
Royale  Seersucker 
100%  woven  polyester 
White,  Yellow.... about  333.00 


lllfHITE 
SISTER 


CAREER  APPARE 


SEE  OUR  NEW  LINE  OF  WHITES  AND  WATERCOL OUR.-s  AT  fimp  qtoditc  Ar>or^cc 


O  A  M  A  m  A 


Be  Prepared  for  1976 . . . 


. . .  with  this  detailed  text  on  medical-surgical  nursing. 
. . .  with  understanding  of  your  legal  duties, 
with  new  surgical  nursing  skills. 


. . .  with  this  complete 
reference  source. 


E,icvclopPfl« 
Medicine  ant* 


Your  library  just  isn't  complete 
without  Miller  &  Keane's  Ency- 
clopedia and  Dictionary  of 
Medicine  and  Nursing.  Its 
40,000-plus  entries  provide 
straightforward  information  on 
diseases,  drugs,  treatment  and 
equipment — and  special  sections 
detail  nursing  care  for  most  com- 
mon diseases,  conditions,  opera- 
tions and  accidents.  Quick- 
reference  tables,  anatomical  plates 
and  extensive  appendices  round 
out  its  comprehensive  coverage. 
By  the  late  Benjamin  F.  Miller, 
M.D.,  and  Claire  B.  Keane,  R.N., 
B.S.,  M.Ed.  1089  pp.  122  III.  16 
full-color  plates.  $12.70.  March 
1972.  Order  #6355-9. 


^ 

2 
g 


thep^^ 


..""^ 


The  new  third  edition  of 
LeMaitre  &  Finnegan's  The  Pa- 
tient in  Surgery:  A  Guide  for 
Nurses  examines  sequentially  all 
the  factors  involved  in  patient 
care,  from  the  components  of 
surgery,  to  the  individual  surgi- 
cal procedures  and  their  specific 
postoperative  care. 
Eighteen  new  chapters  examine 
topics  including:  laparoscopy, 
cholecystojejunostomy ,  lysis  of 
adhesions,  excision  of  testicular 
tumor,  bilateral  adrenalectomy, 
radical  pancreaticoduodenectomy, 
lumbar  sympathectomy,  aorto- 
iliac  bypass  ^raft,  and  breast 
biopsy. 

By  George  D.  LeMaitre,  M.D., 
and  Janet  A.  Finnegan,  R.N.  506 
pp.  108  figs.  Soft  cover.  $9.50. 
July  1975.  Order  #5717-6. 


It  takes  an  expert  to  understand  all 
the  legal  complications  that  to- 
day's nursing  practice  may 
entail — an  expert  like  Helen 
Crelghton,  who  is  a  nurse  and 
nursingeducator  as  well  as  an  ex- 
perienced lawyer. 
The  brand  new  third  edition  of  her 
book — Law  Every  Nurse  Should 
Know — has  been  totally  revised 
and  substantially  expanded  to  in- 
clude all  the  legal  information  you 
need  to  know  about:  A.N.A.  cer- 
tification; minors  and  birth  con- 
trol, abortion,  and  drug  abuse;  in- 
service  education;  students '  rights 
and  the  rights  of  expelled  or  sus- 
pended students;  care  of  psy- 
chiatric patients;  pronouncing  the 
patient  dead;  confidential  com- 
munications; narcotic  violations; 
legitimacy;  and  many  more 
topics. 

Its  emphasis  on  how  to  avoid  any 
legal  entanglements  makes  this 
one  reference  you'll  turn  to  fre- 
quently during  your  career. 
By  Helen  Creighton,  R.N.,  J.D. 
327  pp.  $11.15.  luly  1975. 

Order  #2752-8. 


Just  how  good  is  Luckmann  and 
Sorensen's  Medical-Surgical 
Nursing?  Here  are  only  a  few 
examples  of  what  nurses  are  al- 
ready saying: 

"A  truly  great  book!"...  "the 
most  complete  book  of  its  kind" 
.  .  "excellently  organized,  log- 
ically presented,  and  perti- 
nently illustrated  " .  .  .  "covers 
pathophysiology  to  a  greater  ex- 
tent than  other  nursing 
texts — plus  the  nursing  care  is 
more  detailed  than  usual"... 
"principles  underlying  nursing 
care  are  clearly  defined"  .  .  .  "it's 
about  time  that  a  greater 
psychophysiologic  approach  is 
used  in  nursing  texts"  .  .  .  "it  is 
very  unusual  for  a  med/surg 
text  to  offer  quantity  of  content 
and  quality  at  the  same  time"  .  .  . 
"probably  the  BEST medsurg  text 
ever  written".  .  .  . 
By  Joan  Luckmann,  R.N., 
M.A.,  and  Karen  Creason 
Sorensen,  R.N.,  M.N.  1634  pp. 
422  illus.  $20.95.  Sept.  1974. 
Order  #5805-9. 


W.  B.  SAUNDERS  COMPANY  CANADA  LTD. 

833  Oxford  Street,  Toronto,  Ontario  M8Z  5T9 

I     To  order  titles  on  30-day  approval,  enter  order  number  and  author 


W^ 


Prices  subject  to  change. 

N  IV'Ts"' 


AUTHOR 


AUTHOR 


AUTHOR 


Pfeaie  tpacify: 

3  Payment  enclosed— Saunders  pays  postage  &  handling 
a  Bill  me—  □  SendC.O.D. 

~  I  have  an  open  account  wttti  Saunders 

3  My  credit  cant  or  bank  account  reference  la: 


NAME  (Please  Print) 


AFFILIATION 


HOME  PHONE  NUMBER 


BAC 

MC 

AE 


HOME  ADDRESS 


CITY 


PROVINCE 


ZONE 


A  very  special  offer 

for  very  special  people. . . 


The  New  Evangeline  wrist  watch 
by  Westclox.  The  World's  Largest 
Manufacturer  of  Timepieces 

For  a  limited  time  only.  Registered  and  Student 

Nurses  may  order  this  watch  with  a  suggested 

retail  price  of  $39.95,at  the  ^  g^    /i  Q  CZ 


«24' 


exclusive  price  of  only 

(offer  expires  December  31,  1975) 

Designed  specifically  for  the  Nursing  profession,  the  Evangeline  is 
especially  easy  to  read  with  a  convenient  24-hour  Dial  and  bright  Red 
Sweep-second  Hand.  It  is  a  quality  timepiece  with:  17  Jewel  Incabloc  Swiss 
Movement  •  Fully  Jewelled  Lever  Escapement  •  Shock  Resistant  -Water 
Resistant  •  Gold  Colour  Case  with  Stainless  Steel  Back  •  White  Corfam 
Strap  •  Luminous  Hands  and  Hour  dots. 

And  for  your  convenience  you  can  SHOP  BY  MAIL!  You're 
protected  by  the  Westclox  1-year  guarantee.  Act  now  before  time  runs  out. 

Fill  out  and  mail  the  convenient  ^ 

order  form. 


C  WESTCLOX 
Division  of  General  Time  of  Canada,  Limited 
.4  Tallty  Industries  Company 

P.O.  Box  239,  Peterborough,  Ontario     K9J  6Z1 


Westclox,  General  Time  of  Canada  Limited 
P.O.  Box  239,  Peterborough,  Ontario,  K9J  6Z1 

Enclosed  please  find  my  cheque  or  money  orderin  the  ai 
of  $ for Evangeline  wrist  watch(es). 


Name_ 


Address- 


City_ 


_Prov. 


Note:  In  Ontario  please  add  5%  Sales  Tax  when  applicable. 


The 

Canadian 
Nurse 


''ZP 


A  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  bv  the  Canadian  Nurses'  Association 


Volume  71,  Number  11 


November  1975 


13      Screening  for  Adolescent  Idiopathic  Scoliosis U.V.  Reid 

16      Out  of  the  Mouths  of  Patients C.  Marcus 

18      Fashions  for  the  Physically  Handicapped  Woman  C.  Broome 

23  Frankly  Speaking: 

Six  Blind  Men  in  a  Hospital F.P.  Harrison 

24  Orientation  —  Would  It  Work  for  You? 

Pt.  1 :  Creating  A  Learning  Environment   K.  Nixon,  M.  Russell 

R.  2:  Recruiting  for  the  Far  North G.L.  Kjolberg,  K.  Glynn 

27      Artificial  Urinary  Sphincter P.A.  Schuster,  D.  Patterson 

34      New  Lenses  for  Old M.  L.  Kwitko 


The  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

8  News 

40  Names 

42  Dates 


44  Research  Abstracts 

49  Books 

50  Accession  List 

6A  Index  to  Advertisers 


Executive  Director:  Helen  K.  Mussallem  • 
Editor:  M.  Anne  Hanna  •  Assistant 
Editors:  Liv-Ellen  Lockeberg,  Lynda  S. 
Cranston  •  Production  Assistant:  Mary  Lou 
Oownes  •  Circulation  Manager  Beryl  Dar- 
ling •  Advertising    Manager:     Ceorglna    Clarke 

•  Subscription  Rales:  Canada:  one  year, 
$6.00:  two  years,  $11.00.  Foreign:  one  year, 
$6.50:  two  years,  $12.00.  Single  copies: 
$1.00  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  registration  number  in  a  pro- 
vincial nurses'  association,  where  applicable. 
Not  responsible  for  journals  lost  in  mail  due 
to  errors  in  address. 


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  rale 
MONTREAL.  P.Q.  Permit  No.  10,001. 
50    The    Driveway,    Ottawa,    Ontario,    K2P 1 E2 

©  Canadian  Nurses'  Association  1975. 


BEHIND  THE  SCENES 


"A  good  many  young  writers  make  the  mis- 
lake  of  enclosing  a  stamped,  self-addressed 
envelope,  big  enough  for  the  manuscript  to 
come  back  in.  This  is  too  much  of  a  temptation 
for  the  editor."  (Ring  Lardner.  How  to  Write 
Short  Stories). 

Every  once  in  a  while,  like  reports  of  the 
Loch  Ness  monster  or  Sasquatch,  a  rumor 
about  the  editorial  policy  of  this  journal 
emerges  in  conversation.  According  to  this 
rumor,  it  is  useless  to  submit  an  article  to 
The  Canadian  Nurse  unless  your  back- 
ground is  academic  and  your  work  appears 
regularly  In  scholarly  publications. 

The  "I  cant  write,  I'm  just  a  nurse"  syn- 
drome seems  to  be  both  widespread  and 
inhibiting.  It  is  not  only  false  but,  potentially, 
destructive.  Carried  to  its  logical  conclu- 
sion, there  would  be  no  more  national 
forum  for  nurses  who  actually  practice  in 
Canadian  hospitals,  clinics,  homes, 
schools,  industries,  and  doctor's  offices. 

That  is  why  it  distresses  me  to  hear  a 
nurse  explain  that  she  doesn't  write  for  her 
professional  journal  because  "THEY" 
would  never  publish  it.  Better  than  anyone 
else,  she  knows  "where  it's  at "  with  her  own 
work.  She  knows  that  sometimes  she  suc- 
ceeds in  delivering  better-than-average 
"care  "  under  a  system  that  leaves  much  to 
be  desired.  She  knows  that  sometimes  she 
finds  ways  to  make  "continuity  of  care" 
more  than  just  words.  She  has  come  to 
terms  with  accountability  —  to  her  em- 
ployer, to  her  patients  and  the  courts.  She 
knows  that,  if  she  shared  some  of  these 
experiences,  other  nurses  would  learn  from 
them. 

But  still  she  insists  "I  can't  write." 
Whether  this  statement  is  true  or  simply  the 
result  of  lack  of  confidence,  in  my  opinion, 
does  not  matter.  What  matters  is  that  this 
nurse  has  something  to  say  on  a  subject 
she  knows  intimately.  It  does  not  have  to  be 
profound  but  it  should  be  carefully  thought 
out,  relevant  to  the  needs  of  her  audience 
and  consistent  with  personal  observation.  If 
the  writing  is  poor,  the  presentation  muddy, 
or  lacking  in  visual  appeal  —  these  are 
problems  for  the  editorial  staff  of  the  publi- 
cation. 

That  is  why  The  Canadian  Nurse  has  a 
paid  editorial  staff.  We  want  to  help  you.  If 
you  think  you  have  an  idea  that  could  be 
developed  into  a  worthwhile  article,  ask  us 
about  it.  You  have  my  guarantee  that  any 
proposal  or  article  will  be  carefully  con- 
sidered. 

PS.  Just  don't  enclose  a  large,  stamped 
and  self-addressed  envelope. 

—  M.A.H. 


: CANADIAN  NURSE  —  November  1975 


letters 


Frankly  Speaking... 

Thought  provoking  comments  by 
Shirley  M.  Stinson  on  Mandatory- 
Continuing  Education  stimulate  many 
questions.  To  begin,  what  does  the 
term  "continuing  education"  mean? 
According  to  Webster's  New  Colle- 
giate Dictionary  ( 1973),  the  word  edu- 
cate is  synonymous  with  the  word 
teach.  The  shared  meaning  element  of 
the  two  words,  is  to  cause  to  acquire 
knowledge  or  skill. 

A  review  of  current  nursing  literature 
shows  concern  with  the  problem  of  en- 
suring a  high  level  of  nursing  compe- 
tence through  education.  "Comjje- 
tent"  and  "safe  to  practice"  are  not 
defined  in  any  way.  My  thought  is  that 
there  is  no  such  thing  as  safe-to- 
practice  nursing  when  one  considers 
the  broad  range  of  skills  and  expecta- 
tions which  make  up  nursing.  "Safe  to 
practice"  cannot  mean  the  same  thing 
in  the  intensive  care  unit  as  in 
psychiatry  or  a  home  for  the  aged.  We 
must  be  safe  to  practice  in  a  chosen 
area,  and  have  knowledge  of  what  we 
do  not  know. 

I  feel  that  as  the  nursing  profession 
matures  and  becomes  more  sophisti- 
cated, it  is  essential  to  be  clear  and 
precise  when  making  statements.  If  one 
accepts  that  the  half-life  of  the  science 
and  technology  which  affects  nursing 
care  is  three  to  five  years,  then  continu- 
ing education  is  indeed  mandatory. 
What  kind  of  continuing  education 
and  paid  for  by  whom?  Weir  (1930) 
states: 

"Two  main  classes  of  opinion,  re- 
garding problems  of  nursing  education, 
were  found  among  nurses  and  doctors. 
The  first  division  of  opinion  insisted 
that  nursing  standards  should  be  raised 
to  the  point  of  excluding  the  unfit  or 
uneducated  nurses.  Bui  what  should  be 
the  criterion  of  unfitness  and  how  high 
should  education  standards  be  ele- 
vated? In  these  matters,  wide  di- 
vergence of  opinion  was  manifest. 
Some  members  of  the  profession  ap- 
peared willing  that  these  standards 
should  be  nicely  adjusted  to  the  limit 
that  apparently  would  include  them- 
selves but  exclude  many  of  their  com- 
petitors." 

I  believe  that  terms  like  education, 
adult  education,  competence,  know- 
ledge and  skill,  are  being  used  with 
different    meaning,     and    without 


analysis  of  the  role  (indeed  changing 
role)  which  the  nurse  must  fill. 

When  considering  mandatory  con- 
tinuing education  two  important  as- 
pects are  —  who  pays,  and  who  pro- 
vides the  education?  Will  recognition 
and  credit  be  given  to  lectures  by  drug 
and  equipment  salesmen?  By  doctors 
and  allied  health  workers?  Or  is  "edu- 
cation" restricted  to  formal  classroom 
experience? 

What  criteria  will  be  used  to  evaluate 
the  effect  of  continuing  education  on 
practice?  Who  will  do  the  eval- 
uating? What  will  be  the  scope  and  the 
limitation  of  "safe  to  practice?" 

Is  there  no  way  to  give  recognition  to 
personal  endeavor  and  life  experience? 
in  other  words,  there  must  be  some  way 
to  recognize  and  acknowledge  the 
value  of  learning  done  by  the  individual 
practitioner  —  the  nurse  who  keeps  up 
to  date  and  is  able  to  use  the  required 
treatments  and  equipment  to  meet  her 
patients'  needs.  — Jane C.  Halihurton, 
Director  of  Education.  Yarmouth  Re- 
gional Hospital.  Yarmouth,  N.S. 


Room  for  Negotiation 

Anderson  et  al  have  clarified  some  crit- 
ical points  in  their  discussion  of  the 
expanded  role  for  the  nurse  (Canad. 
Nurse.  Sept.  1975).  Unfortunately, 
they  have  limited  their  options  to  the 
either/or  proposition  of  physician's 
handmaiden  or  independent  profes- 
sional practitioner.  They  infer  the  lat- 
ter is  the  only  way  for  the  nurse  to 
acquire  a  sense  of  responsibility  to  the 
patient,  mobility  in  planning  and  a  say 
in  management  decisions.  This  is  ac- 
ceptable if  all  nurses  plan  to  function  in 
the  north  woods  where  opposition  will 
be  limited:  if  they  prefer  the  city  to  the 
country  and  want  patients  to  realize  the 
benefits  of  their  skill  and  experience, 
they  will  have  to  negotiate  their  ac- 
tivities with  the  physician  who  main- 
tains the  legal  responsibility  for  the  care 
and  treatment  of  the  patient. 

The  legal  sysiem  and  physicians'  at- 
titudes will  change  when  nurses  who 
are  aware  of  their  potential  contribution 
to  the  care  of  patients  work  with  not 
against  the  physician  in  a  colleague  re- 
lationship. This  implies  interdepen- 
dence and  teamwork.  It  means  nurses 
must  be  willing  to  take  risks,  take  on 
responsibility  when  it  is  not  expected. 


and  communicate  with  physician 
openly,  without  the  customary  spar 
ring. 

It  means  the  nursing  profession  mus 
be  honest  with  itself,  for  the  administra 
tive  hierarchy  in  nursing  contributes  u 
this  problem.  The  nurse  is  primaril; 
responsible  to  her  supervisor,  not  th 
patient.  Upward  mobility  is  no 
achieved  through  competence  in  pa 
tient  care,  but  through  administrativi 
tasks  and  organization. 

If  nurses  truly  believe  they  have  im 
pqrtant  skills  to  offer  in  the  care  o 
patients,  then  it  is  imperative  that  pa 
tients  and  health  professionals  deriv- 
benefits  from  the  nurses'  unique  tal 
ents.  This  cannot  be  realized  unti 
nurses  begin  to  work  in  collaboratioi 
with  physicans  and  other  health  profes 
sionals  where  their  identity  as  a  chang 
ing.  growing  profession  is  recognized 
—  Rohyn  Tamblyn,  B.Sc.N.,  Researa 
Associate,  Programme  for  Educationa 
Development,  McMaster  U..  Hamil 
ton,  Ontario. 


A  Little  More  Help 
to  Help  Themselves 

1  suffered  a  stroke  2  years  ago,  bu 
recovered  sufficiently  so  that  now  m; 
left  arm,  sight,  hearing,  and  brain  func 
tion  fairly  well .  I  am  partially  paralyze( 
and  mostly  confined  to  a  wheelchair. 

During  the  long  months  of  recupera 
tion,  it  occurred  to  me  that  the  bes 
therapy  in  the  world  does  not  take  th 
place  of  proper  rehabilitation.  Resump 
tion  of  daily  living  to  one's  optimun 
doesn't  just  happen!  For  any  diseasi 
entity,  this  must  be  systematical!; 
taught  and  the  specifics  that  any  on( 
patient  must  know  will  be  different. 

Although  adjustments  do  take  placi 
after  the  patient  has  left  the  nurse': 
sheltering  wing,  the  initial  teaching  is  i 
nursing  function.  Rehabilitation  is  not  i 
concept  confined  to  spinal  cord  injuriei 
and  orthopedic  conditions.  Cardiac 
respiratory,  and  psychiatric  patient: 
must  all  know  the  pitfalls  to  avoid  anc 
the  activity  that  they  can  undertake 
Diets  and  the  use  of  medications  mus 
be  taught,  among  other  things. 

1  am  appealing  to  you  as  a  conceme( 
nurse  and  a  patient.  We  must  learn  t( 
give  our  patients  a  little  more  help  ii 
helping  themselves  —  Corinne  Tench 
R.S  .Victoria.  B.C. 


5TINCTIVELY  DESIGNER'S  CHOICE 


A  PROUD  CANADIAN  NAME 
N  THE  FASHION  INDUSTRY 


No  yolk  eggs 


Fleischmann's 

egg 
beaters  K, 

ie  Fleischmaiin  ®  ^^ 


JMS^ 


How  Fleischmann's 
hatched  a 
more  healthful  egg 
for  tow  lipid 
dieters 


C.H.D.  patients  and  others  with  hyperlipid  risk  may 
now  lool<  a  real  egg  in  the  face  without  concern  about 
cholesterol  or  triglyceride  build-up. 

This  is  made  possible  by  unique  new  Egg  Beaters 
from  Fleischmann's.  The  company  cracks  some 
500.000,000  fresh  farm  eggs  a  year  to  remove  their 
cholesterol-packed  yolks  and  replaces  them  with  a 
/itamin  and  mineral  fortified  corn  oil  nutrient  plus 
favouring  agents.  Egg  Beaters  are  then  pasteurized, 
lomogenized,  and  fast  frozen. 

Tastes  and  smells  like  fresh  farm  eggs 

Result  of  this  improvement  on  nature  is  an  egg 
squivalent  -  with  the  nutrition,  taste,  and  smell  of 
resh  whole  eggs.  Minus  the  cholesterol  disadvan- 
;ages. 

Thus  Egg  Beaters  can  beat  the  monotony  of  a  diet 
without  eggs. 

Only  3-4  mg  cholesterol  versus  480  or  more  mg  for 
two  whole  eggs 

They  can  be  scrambled,  made  into  omelettes  or 
French-toast  and  used  in  baking  or  quantity  cookery; 
jach  one  half  cup  serving  (4  fl  oz.)  replaces  two  large 
whole  eggs.  In  cholesterol  content  3-4  mg  for  Egg 
Beaters  compared  to  480  mg  or  more  for  whole  eggs. 

Send  coupon  at  right  for  certificate  to  obtain  free 
carton  of  Egg  Beaters  and  patient  recipe  brochures 

y^erely  complete  and  send  us  the  coupon  at  right  to 
pbtain: 

p)  Complimentary  certificate  for  a  carton  of  Egg 

Beaters. 

i)  Quantities  you  specify  of  the  50  recipe  "Cooking 
with  Egg  Beaters"  recipe  booklet  for  your  patients. 
Colour  illustrated,  the  booklet  supplies  many  basic 
recipes  in  which  Egg  Beaters  can  add  to  food  en- 
joyment without  lipid  risk. 


Standard  Brands  Canada  Limited 
Montreal,  Canada 


^ 


iixS* 


«»* 


•Reg.  Trade  Mark 

Standard  Brands  Canada  Limited 
Consumer  service  division 
550  Sherbroolte  Street  West 
Montreal,  Quebec 


Gentlemen; 

Please  send  me  one  certificate  for  a  complimentary  carton  of 

Egg  Beaters. 

I  would  also  appreciate  a  supply  of  your  "Cooking  witti  Egg 

Beaters"  recipe  booklet  for  my  patients  as  marked  below. 


No.  of  copies  requested 
English: 


French: 


(please  stamp  or  print) 


(Street) 


(City  or  town,  postal  code) 


news 


Canadian  Indian  Nurses 

Form  National  Committee 

The  first  national  conference  of  Cana- 
dian nurses  of  Indian  ancestry  held  in 
Montreal  in  early  Fall  has  resulted  in 
the  establishment  of  a  national  coor- 
dinating committee  which  will  suggest 
to  authorities  the  changes  needed  to 
solve  some  of  the  problems  of  the  In- 
dian community.  The  committee  re- 
gards itself  as  a  resource  group  of  peo- 
ple in  the  health  field  rather  than  a  pres- 
sure group.  One  of  its  first  tasks  will  be 
to  set  up  a  registry  of  nurses  of  Indian 
and  Inuit  origin. 

More  than  40  nurses  of  the  80  con- 
tacted before  the  meeting  were  able  to 
attend  the  conference.  Organizers  be- 
lieve there  could  be  as  many  as  200 
nurses  of  native  ancestry  across 
Canada. 

The  majority  of  nurses  working  with 
the  Indian  community  are  not  of  Indian 
ancestry.  One  of  the  major  concerns  of 
the  nurses"  group  is  to  give  to  the  Indian 
people  the  opportunity  of  being  cared 
for  by  their  own  nurses;  many  of  these 
are  not  practising  but,  according  to  or- 
ganizers, they  should  come  back  to  act 
as  resource  people. 


According  to  Jean  Goodwill,  coor- 
dinator of  native  women's  programs  at 
the  Secretary  of  State,  and  herself  a 
nurse  of  Indian  ancestry,  it's  not  aques- 
tion  of  turning  back  the  clock  but  of 
seeing  things  as  they  are  now  and  trying 
to  improve  the  system. 

June  Delisle,  keynote  speaker  and 
adviser  for  the  health  and  social  ser- 
vices of  the  Indians  of  Quebec  Associa- 
tion, stressed  the  importance  of  Indians 
taking  over  their  own  affairs  and  find- 
ing their  own  solutions.  Among  the 
problems  she  identified  were:  poor 
health,  poor  nutrition,  alcohol  abuse, 
unemployment  and  poor  housing.  She 
believes  it  is  the  responsibility  of  Indian 
nurses  to  go  to  their  people,  ask  ques- 
tions, find  answers  and  offer  them  con- 
structive alternatives,  without  letting 
frustrations  and  geographical  distances 
stand  in  their  way. 

Regional  respresentatives  on  the  na- 
tional committee  are:  Irene  Desjarlais 
(Sask.),  Cecilia  Curotte  (Que.),  Linda 
Stewart  (B.C.),  Elaine  Petawanakwat 
(Ont.),  Rhonda  Blood  (Alta.),  Lorraine 
Sevestre  (Ont.),  and  Margaret  Levy 
(N.B.). 


More  than  40  nurses  from  across  Canada  met  in  Montreal  for  the  first  national  conference  of 
nurses  of  native  ancestry.  From  left  to  right:  Jocelyne  Bruvere,  conference  coordinator;  Helen 
K.  Mussallem,  CNA  executive  director;  Jean  Goodwill,  coordinator  of  native  women's  pro- 
grams. Secretary  of  State. 


U  of  M  Offers  j 

New  Nursing  Program 

The  University  of  Manitoba  school 
nursing  has  announced  the  implementa  , 
tion  of  a   new  4- year  baccalaureate 
program  to  commence  in  Septemh 
1975.  Replacing  the  present  progra: 
for  students  entering  from  hign  scho- 
registered   nurses,   and  those  with 
bachelor's  degree,  the  new  program 
designed  to  provide  students  with  iIk, 
skrils  required  to  assume  the  respon-| 
sibilities   and   functions   of  a  family! 
health  care  practitioner.  Emphasis  will' 
be  on  the  primary  care  functions  inl 
today's  health  care  system.  ' 

Nursing  and  health  are  the  foci  of  li 
conceptual   framework.    Each   coui 
has  been  designed  to  provide  the  st 
dents  with  experiences  in  caring  U  . 
persons  of  all  age  groups,  and  in  all 
states  of  health  and  illness.  A  nursii 
process  model  developed  by  the  facul 
serves  as  the  framework  for  all  course 
The  nursing  courses  focus  on  the  pri 
cess  of  nursing,  e.g..  Health  Restora- 
tion in  Nursing,  Amelioration  of  lUne^- 
and  Disability  in  Nursing,  Preventii 
of  Illness  and  Disability  in  Nursin 
and  Promotion  of  Health  in  Nursini' 

The  increased  use  of  self-learning 
methods  and  materials  through  the  de- 
velopment of  a  multi-sensory  self- 
learning  laboratory  in  the  school  of 
nursing  is  emphasized. 

An  innovation  of  the  new  program  is 
the  institution  of  challenge  for  credit  for 
registered  nurses.  Challenge  for  credit 
will  consist  of  both  theoretical  and 
practical  examinations,  and  will  serve 
as  a  means  of  evaluation  of  previous 
nursing  courses  and  practical  experi- 
ences. Registered  nurse  students  who 
are  successful  will  be  given  credit  for 
the  course  that  has  been  challenged. 

The  academic  year  will  be  the  same 
as  that  of  the  regular  academic  year. 
The  required  May-June  courses  have 
been  discontinued.  Nursing  practice 
requirements  remain  the  same,  but  are 
accommodated  within  the  regular 
academic  year  through  a  reorganization 
of  courses  and  the  introduction  of  a 
nursing  elective  in  the  final  year. 

As  the  present  program  is  phased 
out,  nursing  courses  will  be  offered 
in  the  regular  summer  sessions. 


A  Question  Of  Needs 

If  you  really  need  to  see  a  doctor, 
chances  are  you'll  wait  longer  for  an 
appointment  than  someone  in  better 
health  than  you.  Not  only  that,  but  you 
are  less  likely  to  have  a  home  visit  from 
that  doctor  than  someone  whose  health 
needs  are  not  as  great  as  yours. 

These  are  two  of  the  findings  re- 
vealed in  a  500-page  study  of  social 
services  in  Canada  released  recently  by 
the  Canadian  Council  on  Social  De- 
velopment. The  study,  called  .4  Ques- 
tion of  Needs,  deals  with  the  areas  of 
education,  health,  housing,  personal 
social  services,  work  and  income.  The 
Council  reports  that,  in  contrast  to  pre- 
vious studies,  this  analysis  shows  "the 
disadvantaged  are  becoming  more  ar- 
ticulate about  their  needs  and  are  more 
likely  to  favor  measures  to  alleviate 
their  problems." 

With  the  exception  of  the  education 
system  which,  according  to  the  report, 
has  become  "the  single  most  discred- 
ited of  the  social  services  available  to 
Canadian  taxpayers,"  most  people  are 
generally  satisfied  with  the  services 
they  receive.  Nevertheless,  those 
Canadians  who  have  substantial  needs 
for  services,  are  still  having  difficulty 
obtaining  them.  "People  who  had  to 
wait  more  than  three  weeks  to  see  a 
doctor,  for  example,  had  greater  health 
needs  than  people  who  obtained  an  ap- 
pointment in  less  time.  People  who 
were  unable  to  get  a  doctor  to  visit  them 
at  home  had  greater  health  needs  than 
the  group  who  did  not  require  a  home 
visit  or  could  obtain  one." 

Residents  of  the  Atlantic  Provinces, 
along  with  Ontario  residents,  have 
more  extensive  health  needs  than  other 
Canadians,  according  to  the  author  of 
the  study,  Josette  Laframboise.  Yet, 
they  have  the  second-lowest  ratio  of 
general  practitioners  to  population  in 
the  country  (Quebec  has  the  lowest) 
and  the  lowest  ratio  of  specialists  to 
population. 

"Not  surprisingly,  then,  residents  of 
the  Atlantic  Provinces,  along  with 
Quebecers.  make  more  extensive  use  of 
outpatient  clinics  and  emergency  wards 
than  people  in  other  regions,  while  vis- 
its to  doctor's  offices  are  comparatively 
less  frequent.  Within  the  last  year,  only 


13.9%  of  the  respondents  from  the  At- 
lantic provinces,  compared  to  30%  in 
all  of  Canada,  consulted  the  small 
number  of  specialists  available." 

Most  Canadians,  according  to  the 
study  were  "highly  satisfied"  with 
doctors'  care  during  hospitalization. 
However,  18.4%  of  patients  hos- 
pitalized in  the  Atlantic  Provinces, 
compared  to  2.8%  of  hospitalized  pa- 
tients for  the  country  as  a  whole,  were 
more  or  less  dissatisfied  with  the  care 
given  by  hospital  employees  other  than 
doctors. 

Twenty-seven  percent  of  all  Cana- 
dians (compared  to  40%  in  Quebec) 
believe  the  government  should  increase 
the  number  of  residences  for  senior 
citizens.  Almost  two-thirds,  (65%)  of 
all  Canadians  favor  maintaining  the  el- 
derly in  their  own  home.  The  author  of 
the  study  notes  that  "it  is  particularly 
alarming  that  homemaker  services 
which  can  enable  many  people  to  re- 
main independent  are  so  little  known 
and  used."  More  than  60%  of  those 
interviewed  had  never  heard  of  these 
services,  and  they  were  used  by  only 
1.5%  of  the  respondents. 

The  report  concludes  that  "in  some 
cases,  most  notably  health  care,  there  is 
a  certain  amount  of  territorial  injustice, 
in  that  the  manpower  resources  are  in- 
adequate to  serve  the  population  in 
some  areas.  In  other  cases,  when  ser- 
vices are  available,  they  are  sometimes 
not  used  because  people  are  unaware  of 
them  or  because  people  feel  that  the 
services  'are  not  for  them"." 

Ren  To  Reconsider 

Withdrawal  From  ICN 

The  question  of  withdrawal  by  the 
Royal  College  of  Nurses  (Rcn)from  the 
International  Council  of  Nurses  has 
been  placed  on  the  agenda  of  the  annual 
meeting  of  the  College  to  be  held  this 
month.  The  move  to  reconsider  the 
withdrawal  is  the  result  of  an 
emergency  resolution  passed  by  an 
overwhelming  majority  of  the  Ren  rep- 
resentative body. 

The  decision  to  withdraw  was  made 
last  April  during  a  special  meeting,  but 
since  then  questions  have  arisen  about 
the  low  membership  vote:  only  796  of 
42,000    members    voted. 


When  you  are 
asked  about 
nursing  care... 

Health  Care  Services  Upjohn 
Limited  can  assist  you  and 
your  patients  by  providing 
qualified  Health  Care  Person- 
nel for: 

•  Private  Duty  Nursing 

•  Home  Health  Care 

•  Staff  Relief 

We  are  a  reliable  source  of 
nursing  care  with  whom  you 
can  trust  your  patients.  Our 
employees  are  carefully 
screened  for  character  and 
skill,  then  insured  (Including 
Workmen's  Compensation), 
bonded  and  made  subject  to 
our  high  operating  code  of 
ethics. 

Your  patients'  care  and  well- 
being  are  our  business. 

If  you  would  like  more  informa- 
tion about  our  services,  call  the 
Health  Care  Services  Upjohn 
Limited  office  nearest  you. 


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Upjohn  Limited 

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HCS  Upjohn) 

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Calgary  •  Winnipeg  •  Windsor  •  London 

St  Catharines  •  Hamilton  •  Toronto  West 

Toronto  East  •  Ottawa  •  Montreal 

Trois  Rivieres  •  Quebec  •  Halifax 


HE  CANADIAN  NURSE  —  November  1975 


news 

(Continued  from  page  9) 


RNABC  Questions 
Practical  Nurse  Program 

Too  many  questions  remain  unan- 
swered about  the  new  practical  nurse 
apprenticeship  program  being  de- 
veloped through  the  provincial  depart- 
ment of  labor,  warns  the  Registered 
Nurses"  Association  of  B.C.  The  associ- 
ation has  advised  its  members  not  to 
become  involved  in  the  program  pro- 
posed by  the  Hospital  Employees" 
Union,  the  B.C  Health  Association  and 
the  Apprenticeship  and  Industrial 
Training  branch,  B.C.  Labor  Dept. 

The  questions  raised  by  the  RNABC 
were  directed  to  the  joint  committee 
developing  the  program,  ministers,  and 
senior  officials  of  the  departments  of 
labor,  health,  and  education. 

They  concerned  the  possible  impact 
on  patient  care  in  B.C.  hospitals  that 
may  accept  practical  nurse  apprentices: 
Will  the  apprentices"  wages  come  from 
existing  hospital  funding,  resulting  in 
cutbacks  in  other  budget  areas  and  ac- 
companying reductions  in  patient  care? 


Registered  nurses  normally  supervise 
fully-qualified  practical  nurses:  Will 
this  be  carried  over  to  the  apprentice- 
ship program?  If  so,  will  additional 
staff  be  available  to  assume  part  of  the 
registered  nurses"  patient  load,  while 
they  are  supervising  untrained  person- 
nel? What  method  of  evaluation  will  be 
used  to  ensure  that  apprentices  com- 
pleting the  program  are  safe  to  work 
with  patients? 

Have  the  3  groups  developing  the 
program  sought  approval  from  the  B.C. 
Medical  Center,  which  is  responsible 
for  coordinating  the  education  of  health 
care  workers  in  the  province?  The  B.C. 
Council  of  College  Principals  voted 
earlier  this  month  to  refuse  to  accept  the 
classroom  portion  of  the  apprenticeship 
program  pending  further  details  on  cur- 
riculum and  funding. 

Two  pilot  classes  of  practical  nurses 
were  to  have  started  this  term  at  Camo- 
sun  and  Malaspina  colleges  but  the  col- 
leges declined  to  initiate  the  program 
because  of  curriculum  questions. 


Medicine  and  Law 

Legal  problems  in  the  health  tleld  ik 
cupied  the  attention  of  more  than  21" 
health    professionals,     legislator- 
lawyers     and    administrators     froi 
Canada,   the  United   States.   England 
and  France  during  a  recent  3-day  meet- 
ing   in    Ottawa.     Participants    heas 
lawyers  suggest  that  the  doctor-patici 
relationship  has  broken  down  and  that 
hospitals    must    control    the    doctor 
working  within  their  walls.  A  provii 
cial    minister   of  health   accused    il 
health  care  system  of  "lacking  huma; 
ity,""  and  a  representative  of  the  medi- 
cal profession  warned  that  proposed  re- 
strictions must  not  interfere  with  tl 
closeness  of  the  relationship  bet  wee 
doctor  and  patient. 

These  were  some  of  the  commen 
made  by  speakers  during  the  Nation.. 
Conference  on  Health  and  the  Law ,  Oc- 
tober 23  to  25.  The  meeting  was  spon- 
sored by  the  Canadian  Hospital  Associ- 
ation in  conjunction  with  the  Canadian 
Nurses"  Association,  the  Canadian  Bar 


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ition,  the  Canadian  Law  Reform 
^sion,  the  Canadian  Medical 
ition  and  the  Canadian  Public 
Association.  A  S30.000  grant 
ivided  by  Health  and  Welfare 

ireakdown  in  the  doctor- patient 

Nhip  has  led  to  an  increase  in  the 

:  of  malpractice  suits, ""  accord- 

harles  Scott,  an  Ottawa  lawyer. 

!id  that  the  number  of  malprac- 

is  has  increased  in  Canada  over 

past  decade,  though  not  in  propor- 

to  the  increase  in  doctors.  The  av- 

bility  of  legal  aid,  Scott  said,  has 

)ed  to  increase  malpractice  cases. 

ome  E.   Rozovsky.  departmental 

itor  with  the  Nova  Scotia  Health 

ikes  and   Insurance  Commission 

a    member    of    the    faculty    of 

lousie  University,  said.  "The  trend 

ard  greater  hospital  responsibility 

he  actions  of  its  medical  staff  is  not 

one  that  cannot  be  stopped,  but 

that  the  public  desires."  Thegrow- 

lumber  of  malpractice  suits  against 

iicians.  he  said,  is  evidence  that  the 

ising  system  as  it  is  established  at 

ent  has  not  been  effective  in  reduc- 

he  incidence  of  poor  medical  prac- 

ajor  issues  discussed  during  the 
ierence  included  malpractice,  re- 
isibility  for  quality  of  care,  and 

ic  control  of  health  occupations. 


^A  Studies 

)pout  Nurses 

/  nurses  are  iea\  ing  the  work  force 
:  focus  of  a  survey  being  conducted 
the  Saskatchewan  Registered 
es'  Association.  Those  900  nurses 
did  not  renew  their  1975  Saskatch- 
registralion  are  being  asked  to 
ment  on  their  inactive  status  rela- 
te family  responsibilities,  the  on- 
job  situation  and  any  other  factors 
consider  contributed  to  their  deci- 
•n  to  leave  the  work  force. 
le  survey  will  also  seek  informa- 
and  comments  on  child  care,  trans- 
tion  needs,  salaries,  and  shift 
.  A  5-year  follow-up  survey  will 
arried  out. 

terim  reports  will  be  made  avail- 
for  each  year  of  the  study.  The  in- 
ation  will  be  made  available  to  the 
ring  Committee  on  Nursing  Supply 
le  SRNA.  .„ 


POSEY  BODY  HOLDER 


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protection  and  ease  of  care.  To 
insure  the  original  quality  product, 
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The  Posey  Body  Holder  may  be  used 
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The  Posey  Tie-Back  Vest  ties  in  back 
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19=;    Flmico      ^^nntrflal    To!   •     fmAI     RA'l 


Jcreening  for 

dolescent  idiopathic  scoliosis 


gliosis  can  be  detected  by  the  simple  examination  of  a  child's 
:k.  The  author  describes  how  to  perform  this  procedure 
ich  takes  only  30  seconds  per  child. 


laV. 


Reid 


ire  1 


Scoliosis  is  an  important  orthopedic  condi- 
tion. "At  its  most  typical  it  is  a  deformity 
of  adolescent  girls,  coming  at  an  age  when 
they  are  self-conscious  and  have  a  dawn- 
ing awareness  of  the  need  to  be 
attractive."' 

Classification 

Scoliosis  is  a  lateral  curvature  of  the 
spine.  Although  the  cause  is  unknown, 
recent  evidence  suggests  that  idiopathic 
scoliosis  is  a  familial  condition.-  and  that 
the  mode  of  inheritance  is  sex  linked 
dominant.' 

The  incidence  of  scoliosis  ranges  from 
5-]0'7c.  depending  upon  the  population 
studied.  In  certain  geographic  areas  59^  of 
the  10-to  1 1-year  olds  have  minor  curves. 
Fifty  per  cent  of  these  are  girls  and  50%  are 
boys.  Of  these,  20%  will  show  an  increase 
in  the  degree  of  curvature.* 


Figure  2 


tANADIAN  NURSE  —  November  1975 


Una  V.  Reid,  R  N.,  b.Sc.n  was  a  student  in  the 
master's  program,  school  of  nursing.  Univer- 
sity of  British  Columbia.  Vancouver  when  she 
wrote  this  article.  Screening  for  idiopathic  sco- 
liosis was  written  as  part  of  a  nursing  project  in 
the  second  year  of  the  program.  Reid  will  grad- 
uate at  the  University  of  British  Columbia's 
fall  convocation. 

The  author  acknowledges  the  help  of  Dr. 
Stephen  J.  Tredwell,MD..F.RC.S.(C).  Division 
of  Orthopedic  Surgery,  University  of  British 
Columbia  in  reviewing  this  article.  Thanks  are 
also  due  to  the  Department  of  Biomedical 
Communications.  University  of  British 
Columbia,  for  preparing  the  illustrations  for  the 
article. 

13 


Idiopathic  scoliosis  is  mostly  found  in 
pre-teen  and  teenage  girls,  occurring  8 
times  more  frequently  in  teenage  girls  than 
in  boys. 

There  are  two  main  classifications  of 
idiopathic  scoliosis: 

•  Non-structural  scoliosis 

This  is  a  flexible  side-to-side  curvature 
of  the  spine  without  rotation.  Rotation  is 
the  turning  of  the  vertebral  body  on  the 
long  axis  of  its  body.  Because  ribs  and 
muscles  are  attached  to  the  body ,  this  rota- 
tion pulls  them  up,  resulting  in  a  hump. 

Non-structural  scoliosis  can  result  from 
one  leg  being  shorter  than  the  other,  or 
poor  posture,  or  pain  and  muscle  spasms.' 
The  functional  deformities  disappear 
when  bending  forward,  sitting  or  lying 
down.  This  condition  is  totally  correcta- 
ble. 

•  Structural  scoliosis 

This  is  a  fixed  side-to-side  curvature  of 
the  spine  with  rotation  of  the  vertebral 
bodies  in  the  area  of  the  major  curve.  The 
forward  bending  position  accentuates 
structural  scoliosis.  The  curve  identifies 
when  the  child  bends  forward,  as  a  shoul- 
der or  rib  hump  on  the  convexity  of  the 
curve.* 

Idiopathic  scoliosis  accounts  for 
80-90%  of  all  presenting  structural  curves. 
Its  onset  may  occur  at  any  stage  of  growth, 
and  it  has  three  well  defined  peak  periods 
—  infantile,  juvenile  and  adolescent.' 

The  onset  of  idiopathic  scoliosis  is  slow 
and  painless.  Thus,  the  curve  may  not  be 
detected  in  its  early  stage  of  development. 
The  most  vulnerable  age  for  idiopathic 
scoliosis  is  between  10  and  13  years.  This 
age  group  should  be  screened  and  although 
the  incidence  of  scoliosis  is  higher  among 
girls  than  boys  both  should  be  screened. 

The  results  are  better  when  treatment 
begins  with  the  curves  between  20  and  25 
degrees.*  Therefore,  the  goal  of  screening 
is  early  detection  of  idiopathic  scoliosis. 
This  procedure  requires  a  simple  examina- 
tion of  the  child's  back  and  takes  approxi- 
mately 30  seconds  per  child. 

The  examination 

1 .  Examine  the  child  undressed  except  for 
pants. 

2.  Have  the  child  stand  erect  with  feet  on 
the  ground  and  slightly  apart  (see  figure 
I). 

3.  Inspect  for  asymmetry  of  the  torso. 
That  is,  look  at  the  back  noticing  the  level 
of  the  shoulders.  One  shoulder  tends  to  be 
higher  on  the  side  of  the  convexity  of  the 
curve  if  scoliosis  is  present'  (see  figures 
2,  3  and  4). 

4.  Observe  the  level  of  the  waistline  and 


m. 


A 


Figu- 


Prominent 
Shoulder 


Figure  4 


^^^^j^^^ 


I 


V 


\. 


Figure  6 


/ 


\ 


r 


\ 


n 


Figure  7 


Figure  8 

HE  CANADIAN  NURSE  —  November  1975 


the  hips.  One  side  of  the  waistline  sinks  in 
more  than  the  other  in  scoliosis  and  the  hip 
on  the  opposite  side  of  the  high  shoulder  is 
elevated  (see  figures  4  and  5). 

5.  Have  the  child  bend  forward  (the  shor- 
ter examiner  may  find  it  easier  to  have  the 
child  bending  toward  him/her)  from  the 
waist,  knees  straight,  leading  with  the 
head  and  allowing  both  arms  to  dangle. 
Look  straight  down  the  back  (see  figure 
6). 

6.  Observe  for  the  lateral  curvature  of  the 
spine  with  prominence  of  the  rib  or  shoul- 
der hump  on  one  side  (see  figures  7  and  8). 
This  hump  is  caused  by  a  fixed  rotation  as 
previously  discussed.  The  rib  or  shoulder 
hump  on  forward  bending  is  the  cardinal 
sign  of  structural  scoliosis.  "* 

7.  Note  the  area  of  the  curve.  That  is, 
whether  thoracic,  thoracolumbar  or  lum- 
bar. 

8.  If  a  deformity  is  detected,  refer  the 
child  to  the  primary  care  physician  and 
notify  the  parents. 

Summary 

The  procedure  for  screening  children 
for  the  detection  of  idiopathic  scoliosis  has 
been  briefly  outlined.  The  earlier  that 
scoliosis  is  diagnosed  and  proper  care  in- 
stigated, the  less  expensive  will  be  the 
treatment  and  the  better  the  end  results. 


References 

I.James.  John  I. P.  Scoliosis.  Edinburgh, 
Livingstone.  1967.  p.   I . 

2.  Wynne-Davies.  R.  Familial  (idiopathic) 
scoliosis.  A  family  survey.  J.  Bone  and 
Joint  Surg.  508:24-30.  Feb.   1968. 

3.  Cowell.  Henry  R.  Genetic  aspects  of  or- 
thopedic diseases.  Amer.  J.  Ntirs. 
70:4:763-6.  Apr.   1970. 

4.  Personal  communication  with  Dr.  S.  J. 
Tredwell. 

5.  James,  op.  cit..  p.  3. 

6.  Ibid. 

7.  Steele.  S.  Nursing  care  of  the  child  nilh 
long-term  illness.  New  York,  Prentice 
Hall.  1971.  Chap.  8. 

8.  Winter.  Roberi  B.  A  plea  for  the  routine 
school  examination  of  children  for  spinal 
deformity  by  J.  Minnesota  Med.  and  John 
H.  Moe  57:419-23.  May  1974. 

9.  Hess.  W.E.  Scoliosis —  clues  to  early  rec- 
ognition. Rocky  Mountain  Med.  J. 
64:43-6.  Jan.  1967. 

10.  James,  op.  cit..  p.  21.  =■' 


Out  of  the  Mouths 
of  Patients 


, 


When  the  B.C.  government  asked  citizens  of  that  province  to  "us 
their  voice  in  major  health  security  decisions,"  residents  responde 
with  enthusiasm.  More  than  1,800  individuals,  health  professiona 
and  professional  associations,  sent  in  letters  voicing  their 
observations,  suggestions,  and  complaints. 


CLAIRE  MARCUS 


More  nurses  and  improved  and/or  ex- 
tended nursing  education  programs 
were  called  for  by  British  Columbians 
who  responded  to  a  write-in  campaign 
conducted  during  the  massive  study  of 
the  B.C.  health  services  system  by  Dr. 
Richard  G.  Foulkes.  The  letters  were 
solicited  in  a  newspaper  advertisement 
that  urged  residents  to  "use  their  voice 
in  major  health  security  decisions"  by 
writing  to  the  Health  Security  Pro- 
gramme Project  in  Victoria. 

The  1 .844  letters  received  are  re- 
viewed and  analyzed  in  two  working 
papers  prepared  for  the  study  :  Views  of 
the  Citizens  of  British  Columbia,  com- 
piled by  Donald  Hall,  then  a  journalist 
not  on  the  study  staff;  and  a  summary, 
marked  "Confidential,"  by  Hans  J. 
Kieferle,  research  consultant.  Both  re- 
ports are  dated  1973. 

The  majority  of  letters,  1 .70! ,  were 
from  profes^sionals,  professional  as- 
sociations and  health  care  institutions. 
Paramedical  services  in  general  ranked 
fourth  in  the  order  of  most  frequently 
mentioned  topics .  Number  one  was  ob- 
servations, suggestions  or  complaints 
about  the  overall  provincial  medical 
plan. 

More  nurses  were  wanted  by  44 
percent  of  the  34  writers  on  the  topic 
of  nursing,  and  41  percent  suggested 
that  nursing  training  be  improved 
and/or  extended.  Most  of  the  nursing 
letters  —  53  percent  —  were  from 


residents  in  the  Greater  Vancouver 
area,  while  47  percent  were  from  the 
rest  of  the  province. 

Almost  all  (97  percent)  of  the  88 
writers  who  mentioned  them  approved 
of,  and  had  various  suggestions  about, 
the  range  of  services  that  should  be 
provided  by  community  health  centers. 
Only  two  writers  were  totally  against 
the  concept. 

"Quite  a  number  of  writers  thought 
that  a  medical  ombudsman  would  be  a 
good  idea,"  Kieferle  wrote. 

Hairs  report  includes  excerpts  from 
letters  received  as  they  apply  to  the 
various  topics,  some  of  the  letters  mak- 
ing poignant  reading  about  insensitive 
or  downright  unkind  patient  care. 
Others  suggest  that  registered  nurses 
could  handle  services  now  carried  out 
by  doctors.  Some  samples: 

"The  doctor  spends  five  minutes 
with  the  patient  taking  the  blood 
pressure  reading.  They  are  then 
asked  to  return  the  following  month 
and  this  goes  on  ad  infinitum  for 
which  the  B.C.  Medical  Plan  is  billed 
for  a  first  visit  to  the  office.  I  do  think 
this  service  could  be  handled  by  a 
registered  nurse  who  does  this  duty 
quite  ably  in  a  hospital." 

"School  nurses  should  be  able  to 
make  more  basic  treatment  of  simple 
skin  infections,  etc.  instead  of  referring 
them  to  family  physicians." 

"I  like  the  idea  of  trained  nurses  or 


«i 


paramedics  taking  some  of  the  respo 
sibility  for  home  visits." 

A  hospital  nurse  wrote:  "I  wonder 
the  extra  miles  I  walk  in  the  name 
aestheticism  is  really  appreciated  by  tl 
designer  et  al?  Noisy  plumbing  distur 
patients.  Administrative  duties,  bett 
known  as  paper  work,  are  the  bane 
my  nursing  life.  I  strongly  support  tl 
use  of  dictaphones.  A  strange  emphas 
on  record  keeping  is  taking  precedent! 
over  bedside  nursing  with  the  result 
nurse  can  spend  less  time  with  a  pane; 
and  more  time  writing  about  him.  Th 
12-hour  shift  experiments  in  nursin 
units  are  looking  optimistic  to  me  " 

There  were  complaints  from  res 
dents  who  had  experienced  hospiti 
care,  "frequently"  about  physician' 
but  "more  often"  about  nurses  an 
other  members  of  hospital  stafl 
wrote  Hall. 

"They  didn't  look  after  her  properl 
because  the  wound  got  infected  so  the 
skin  grafted  and  took  some  flesh  fron] 
her  thighs  to  try  to  heal  the  operatioi' 
wound.  Then  her  thighs  got  infected 
She  slipped  and  fell  in  the  hospital  om 
day  and  the  nurses  just  laughed  at  her 
In  the  meantime,  the  wound  opened  u| 
again." 

"I  have  seen  nurses  leave  a  patien" 
with  a  broken  hip  in  a  cast  sitting  on  tht 
toilet  until  the  woman  wept." 

"We  deplore  the  lack  of  patient  con- 
sideration on  the  part  of  many  nurses . ' ' 


The  student  nurses  come  to  work 

with    hangovers.    I    am 

ii-'Htened  to  be  very  sick  and  be  hos- 

/ed  because  we  are  not  sure  the 

js  are  in  shape  to  look  after  us." 

1  was  amazed  to  find  that  the  main 

>ncem  of  the  nursing  staff  was  for 

omseives  and  not  the  patient.  Every- 

nii;  was  for  the  convenience  of  the 

>  first  and  the  patient  second  in- 

of  the  other  way  around." 

Nurses  wrote  about  their  problems. 

On  an  afternoon,  there  are  only  two 

an  R.N.  and  a  practical  nurse,  to 

or  up  to  26  patients  plus  maternity 

.   emergency  operations,  ouipa- 

.  admissions,  general  emergen- 

'  ^  and  numerous  telephone  calls." 

"Could  hospital  costs  be  cut  with 

le  use  of  more  practical  nurses?  It 

•ems  the  trained  nurses  are  being 

aded  with  a  lot  of  chores  and  book- 

ork    that    possibly    someone    else 

mid  do  adequately." 

The   area   of  administration   and 
iipervision  in  my  office  is  so  rigid  and 

E  CANADIAN  NURSE  —  November  1975 


in  such  a  pecking  order  it  is  (sic)  not 
only  inhibits  creativity,  but  actually 
hinders  work  efficiency." 

Inadequate  or  dirty  washrooms,  un- 
comfortably warm  beds,  and  smoking 
by  patients  and  visitors  in  hospital 
prompted  other  letters. 

"I  was  appalled  at  the  amount  of 
noise  from  outside  and  inside  the  hospi- 
tal in  which  cardiac  patients  were  very 
much  in  need  of  rest." 

"We  go  to  hospital  to  get  well  —  not 
to  be  poisoned  by  pollutants  given  off 
by  other  patients  and  visitors." 

These  are  but  a  few  of  the  feelings 
and  ideas  expressed  by  British  Colum- 
bians in  Hal]"s  report.  In  a  foreword.  Dr. 
Foulkes  expressed  gratitude  to  citizens 
for  "illuminating  problems  as  they  saw 
them.  .  .  helping  us  focus  upon  the 
shortcomings  of  the  system  and  the  real 
and  perceived  needs  of  patients  and 
communities.  They  also  have  demon- 
strated that  the  public  is  eager  to  accel- 
erate reasonable  movement  toward 
change." 


Foulkes  wrote  that  portions  of  the 
letters  were  read  to  a  group  of  physi- 
cians. "This  was  greeted  with  charges 
of  publicizing  the  outpourings  of  a 
minority  —  the  malcontents,"  he  re- 
ported, and  a  medical  educator 
stated  that  he  felt  he  was  'insulted  and 
demeaned." 

Native  and  non-English-speaking 
groups  were  not  represented  to  any  ex- 
tent in  the  campaign,  according  to  Dr. 
Foulkes.  director  of  the  health  security 
study.  Bui  a  few  writers  raised  the  prob- 
lem of  language  ditTiculties: 

"I  do  not  believe  that  God  did  speak 
only  English.  .  .  when  I  asked  the  B.C. 
Medical  to  give  me  addresses  of 
French-speaking  doctors,  they  refused 
to  do  that." 


Claire  Marcus  is  a  freelance  writer  and  com- 
munications consultant.  She  was  formerly  Di- 
rector of  Communication  Services  of  the 
Registered  Nurses"  Assocbiion  of  British 
Columbia.  C"" 

17 


FASHIONS 

for  the 

Physically  Handicapped  Woman 


Careful  wardrobe  selection,  adaptation,  and  ingenuity  make  it  possible  for 
the  ptiysically  tiandicapped  woman  to  be  fashionably,  comfortably,  and 
attractively  dressed. 


Attractive  dress  is  an  important  factor 
in  a  woman's  morale  and  well-being.  If 
this  woman  is  physically  handicapped, 
her  clothing  must  accommodate  her 
personal  problems  at  the  same  time  that 
it  helps  her  look  her  best.  Until  re- 
cently, her  search  for  clothes  that  were 
both  comfortable  and  attractive  was  a 
discouraging  one. 

Fashionable  clothes  are  mainly 
mass-produced  for  the  average,  normal 
figure.  Most  do  not  provide  for  the 
extra  stress  put  on  them  by  the  spastic 
woman's  dressing  activity,  or  for  the 
severe  figure  problems  of  the  woman 
kyphoscoliotic.  Most  do  not  allow 
room  for  orthopedic  braces,  or  make  it 
easy  for  the  arthritic  woman  with  lim- 
ited hand  or  shoulder  movement  to 
dress  herself. 

Fortunately,  today's  wider  range  of 
styles  in  ready-to-wear  clothing,  new 
patterns,  fabrics,  and  sewing  notions 


The  author  (B  a.,  Waterloo  Lutheran  Uni- 
versity. Walerloo,  Ontario;  r.n  .  Women's 
College  Hospital  school  of  nursing,  To- 
ronto) was  employed  in  the  library,  nursing 
department.  Ryerson  Polytechnical  Insti- 
tute, Toronto,  when  this  article  was  written. 
The  article  grew  out  of  several  inquiries  at 
the  library  for  this  type  of  information. 


CHARLOTTE  BROOME 


are  making  it  possible  for  her  to  build  a 
fashionable  wardrobe  adapted  to  her 
personal  problems. 

By  buying  tops,  skirts,  and  slacks 
separately  and  in  different  sizes,  she 
can  assemble  a  matched  costume  from 
casual  coordinates.  She  can  choose 
roomy  overblouses,  A-line  dresses, 
jumpers  or  tunics  that  do  not  pull  out  at 
the  waist,  allow  a  wide  range  of  shoul- 
der movement,  and  hide  relaxed  ab- 
dominal muscles.  She  can  find  skirts 
and  slacks  with  elasticized  waistbands 
that  fit  well  and  are  easier  to  manage 
than  waistbands  with  buttons  or  zip- 
pers. In  short,  with  a  little  care  and 
attention,  she  can  have  the  satisfaction 
of  increased  comfort  and  a  smarter  ap- 
pearance. 

Choosing  her  wardrobe 

Before  selecting  her  clothing,  the 
handicapped  woman  needs  to  evaluate 
her  physical  problems,  muscle 
strength,  range  of  motion,  and  coordi- 
nation. How  well  can  she  manage  back 
closures,  or  lift  her  arms  to  slip  into 
garments?  If  she  cannot  stand,  can  she 
lift  her  buttocks,  or  roll  from  side  to 
side  to  draw  up  step-in  items?  Does  she 
have  good  eye-hand  coordination? 
Does  she  have  bilateral  or  unilateral 
hand  function,  and  is  her  manual  dex- 


terity sufficient  to  cope  with  fasie 
ings?  Is  her  grasp  strong  enough 
allow  her  to  dress  independently  ' 

Having   realistically    appraised    hi 
abilities,  she  can  decide  the  type   ! 
clothing  she  needs  and  consider  i 
ifications  that  will  help  her  cope  u : 
her  problems. 

Fabrics  and  fastenings 

Easy-care  drip-dry  materials  th 
"give,"  such  as  crimplene  and  stretc 
knits,  stand  up  to  repeated  washinji 
and  are  less  likely  than  other  fabrics  l! 
tear  at  stress  points.  Terry  cloth 
bright,  washable,  and  absorbent  fc 
summer  wear.  Bonded  fabrics  or  slif 
pery  linings,  useful  for  ease  in  dre; 
sing,  do  not  stand  stress  well  and  usl 
ally  require  dry  cleaning.  Allover  pat 
terns  are  popular,  colorful,  and  tend  t 
hide  stains  better  than  solid  colors. 

Many  lightweight  synthetics  conn 
bine  crease  resistance  with  warmth  — 
especially  important  for  people  whi 
feel  the  cold  or  sit  for  long  periods 
Orion  capes  and  quilted  nylon  or  syr 
thetic  fur  coats  are  just  as  warm  an 
lighter  than  tweed  or  pure  wool  gar 
ments. 

Fastenings  require  a  varied  ariioun 
of  eye-hand  coordination  and  manua 
dexterity.   Nylon  coil  zippers  do  no 


igure  1 : 

'elcro  *  —  seamed  slacks  ensure  ease  in  dressing  by  a  second  person.  Slacks 
£  pen  from  waist  to  ankle  and  close  by  pressing  seams  together.  (Velcro  indicated 
y  heavy  lines). 

Velcro  is  a  Registered  Trademark  of  Velcro  Corp. 


catch  skin  in  their  teeth  and,  if  a  large, 
easily  grasped  ring  is  attached  to  the 
zipper  pull,  they  are  ideal  tront  closures 
for  the  less  dextrous.  Nylon  tape  clo- 
sures made  of  tiny  hooks  and  loops, 
(Velcro*)  need  only  be  pressed  to- 
gether to  hold  firmly,  although  they  do 
require  fair  hand  control.  If  alignment 
is  imperfect,  the  soft  woolly  side  of  this 
tape  should  be  the  one  manipulated  to 
lessen  skin  irritation.  Small  squares  of 
tape  match  and  pull  apart  more  easily 
than  long  strips.  They  can  be  sewn 
under  buttons,  thus  preserving  a  but- 
toned appearance  but  eliminating  the 
struggle  with  small  buttons  and  but- 
tonholes. 

Even    though    some    dexterity    is 
needed  to  manage  them,  large  hooks 


and  eyes  are  useful  as  waist  closures. 
Horizontal  buttonholes  will  not  open 
unexpectedly  when  a  person  bends  or 
stretches,  but  are  more  difficult  to  man- 
age than  vertical  ones.  Flat  buttons,  at 
least  5/8""  in  diameter,  with  high 
shanks,  may  be  chosen  by  individuals 
with  moderate  hand  movement,  but 
covered  buttons  are  best  left  for 
decoration  as  they  create  friction  with 
the  buttonholes. 

For  the  mildly  handicapped 

If  she  is  mobile  with  crutches,  canes, 
or  orthopedic  braces  and  has  good  sen- 
sation and  control  of  her  arms  and 
hands,  the  handicapped  woman  can 
often  find  ready-to-wear  clothes  in 
large  department  stores.  Wide  slacks 


will  cover  her  leg  braces  although  care 
should  be  taken  to  ensure  that  these  do 
not  present  a  hazard  to  her  mobility. 
Leg  seams  with  nylon  tape  closures  will 
allow  her  to  put  her  braces  on  after 
dressing.  Loosely  fitted  garments  with 
unrestricted  shoulder  movements  — 
overblouses,  A-line  or  shirtwaist  dres- 
ses, and  jumpers  with  large  armholes 
—  will  not  impede  her  use  of  crutches. 
Capes  last  longer  and  offer  more  free- 
dom than  coats  that  show  signs  of  wear 
where  crutches  rub. 

Slip-on  or  laced  shoes  with  smooth 
soles  and  sturdy  heels  let  her  slide  over 
carpets  more  easily  than  crepe-soled 
shoes.  Elastic  laces,  adjustable  buck- 
les, and  elastic  inserts  in  shoe  vamps 
lessen  constriction. 

Although  "knee-highs"  or  other 
hosiery  with  constrictive  elastic  tops 
are  inadvisable,  she  may  wear  a  garter 
belt  and  stockings  (especially  if  she 
needs  high  braces),  or  regular  or  sup- 
port panty  hose. 

For  the  moderately  handicapped 

A  person  confined  to  a  wheelchair 
for  long  periods  needs  clothing  with 
ample  shoulder  room  to  enable  her  to 
propel  her  wheelchair  in  comfort  and 
without  strain  on  her  garments.  Wrin- 
kled fabrics  or  bulky  seams  are  uncom- 
fortable, therefore,  front-pleated  or 
A-line  skirts  and  dresses,  or  slacks  are 
practical.  Flowing  clothes,  especially 
long  full  sleeves,  could  be  a  wheel 
hazard.  Outer  clothing  —  sweaters, 
capes,  and  jackets  —  should  reach  only 
to  the  chair  seat  to  prevent  extra  fabric 
from  bunching. 

Since  a  sitting  position  takes  up  extra 
material,  dresses  and  slacks  need  to  be 
slightly  longer  than  normal,  but  not 
long  enough  to  cause  tripping.  An- 
tiperspiranl  aids  and  dress  shields  are 
important  to  the  handicapped  woman  as 
she  uses  a  great  deal  of  energy  to  propel 
her  wheelchair.  They  not  only  protect 
her  clothing  from  perspiration,  but  skin 
from  the  friction  of  her  crutches.  Many 
styles  of  shields  are  available  in  de- 
partment stores.  Some  use  elastic  slip- 
ped over  the  arm  and  shoulder  or  hook 
in  front:  others  are  pinned  into  the  arm- 
holes  of  blouses  or  jackets.  These  re- 
quire good  hand  control  to  attach. 

When  buying  clothes,  the  moder- 
ately handicapped  woman  should  con- 
sider her  usual  dressing  position.  If  she 


FASHIONS 


Figure  2: 

Hip  seams  open  by  Velcro  or 
heavy-duty  zippers  enabling  bacl<  or 
front  sections  to  be  dropped.  Front 
view  (open)  and  side  view  (closed). 


dresses  while  lying  on  a  bed, 
wraparound  dresses  or  those  with  front 
or  side  openings  are  easier  to  manager 
than  other  styles.  Back  zippers  will 
press  against  her  skin  while  she  sits  in 
her  chair,  so  are  best  avoided.  She  may 
slide  elastic-waisted  slacks  or  skirts  on 
while  lying  down  before  transferring  to 
her  chair  to  finish  dressing. 

Raglan-sleeved  or  sleeveless  knit- 
ted, stretchy- necked  tops  without  fas- 
tenings are  easy  to  pull  over  her  head.  If 
she  finds  it  difficult  to  button  blouse 
cuffs,  2  buttons  with  elastic  thread 
sewn  between  act  as  stretchy  cuff  links 
through  which  she  can  slide  her  hand. 

Safety  and  ease  in  dressing  are  the 
main  needs  to  consider  in  modifying 
clothing  for  a  moderately  handicapped 
person . 

For  the  severely  handicapped 

The  woman  who  is  completely 
chairbound,  with  lessened  sensation 
and  little  voluntary  movement,  de- 
pends on  others  to  dress  her.  Her  clo- 
thing should  be  easy  to  put  on  while  she 
lies  on  the  bed,  before  being  transferred 
to  her  chair. 

Dresses  that  open  fully  and  button, 
dome,  or  tie  down  the  front  are  more 
convenient  for  her  helper  than  zippered 
wraparound,  or  over-the-head  styles. 
Slacks  with  leg  seams  wholly  or  par- 
tially replaced  by  nylon  tape  closures 
may  be  simpler  to  use  than  pull-up 
styles,  (see  figure  1)  Dresses  slit  up  the 


back  to  the  waist,  or  slacks  that  open  at 
both  hips  make  it  easier  to  attend  to 
bathroom  needs,  (see  figure  2). 

If  a  urinary  drainage  appliance  is 
necessary,  clothing  should  be  suffi- 
ciently roomy  to  allow  the  bag  to  be 
attached  to  the  leg  below  bladder  level 
or  to  be  placed  in  a  pocket  sewn  to  the 
inside  of  the  garment  itself.  Longer 
skirts  or  wide-legged  slacks  hide  a  leg 
urinal,  yet  give  ready  access  to  it. 

Inactivity,  poor  circulation,  or  a 
problem  with  the  thermoregulation  sys- 
tem invite  wide  fluctuations  of  body 
temperature.  Wool  knee  warmers, 
pilelined  socks,  long  skirts,  slacks,  and 
lap  robes  provide  needed  warmth  in 
cold  weather.  In  warm  weather,  cool, 
easy-care  cottons,  synthetics  or  soft, 
absorbent  terry  cloth  will  help  prevent 
overheating. 

It  is  tempting,  but  demoralizing,  to 
dress  the  severely  handicapped  woman 
mainly  in  housecoats;  a  more  normal 
wardrobe  can  raise  her  morale  consid- 
erably. 

Ease  of  dressing  by  an  assistant, 
proper  temperature  regulation,  and  use 
of  fabrics  that  do  not  collect  odor  are 
primary  considerations  in  her  wardrobe 
selections. 

Special  problems 

Undergarments  are  probably  the 
most  difficult  item  of  clothing  for  the 
handicapped  woman  to  manage.  A  reg- 
ular brassiere  cannot  be  used  if  she  is 


not  agile  enough  to  secure  its  back  fa:, 
tening,  or  if  the  hooks  cause  painfij 
pressure.  Bras  that  close  at  the  froi 
may  solve  these  problems,  but  som 
hand  dexterity  is  still  needed  to  faste 
them.  Specially  designed  bras  ma 
have  nylon  tape  closures  along  the  fror 
band,  or  be  made  entirely  of  elastic  t 
allow  them  to  be  pulled  up  from  th 
hips  or  over  the  head. 

A  small-breasted  woman  may  obtaii 
enough  support  from  a  snap-front  nyloi 
or  stretch-lace  sleep  bra,  while  a  full 
breasted  person  may  require  wid 
straps  with  elastic  inserts  or  even  foan 
shoulder  pads  under  the  straps  to  bi 
comfortable. 

The  woman  using  crutches  or  , 
wheelchair  may  prefer  the  "give"  o 
stretch  straps.  If  her  brassiere  strap' 
slide  down  her  shoulders,  a  piece  o 
elastic  stitched  to  the  straps  and  reach- 
ing across  her  back  will  hold  them  se- 
curely. 

Regular  underpants  are  usually  satis- 
factory if  large  enough  to  slide  easily 
over  the  hips.  Pants  of  slippery  nylon  or 
rayon  facilitate  sliding  transfers.  Knit-' 
ted  cotton  is  more  absorbent,  allows  air 
to  circulate,  and  does  not  ride  up. 
Longer  styles  are  warm,  but  may  bunch 
uncomfortably.  Seamless  seats  are  best 
if  movement  is  limited.  Marsupial 
styles  are  available  to  facilitate  per- 
sonal hygiene,  (see  figure  3) 

An  incontinent  woman  faces  physi- 
cal and  social  problems.  For  slight  spil- 


iQure  3: 

's  of  Incontinence  Brief 

Elongated  crotch  style*  pulled  up  between  legs,  showing 

Dosition  of  padding. 

Regular  crotch  style  with  let-down  panel  held  in  place 

:y  domes  or  other  fasteners. 

-'vn  "Aids  to  Independent  Living"  by  Lowman  and  Klinger 
j^c  with  permission  of  McGraw-Hill  Book  Company. 


3)  Marsupial  panty-i-  with  front-opening  waterproof  pouch 
containing  absorbent  pads.  Legs  must  fit  snugly  to 
prevent  leakage. 

4)  Disposable  plastic-backed  adult  diaper.  (Although 
practical  for  use,  it  does  not  encourage  social 
independence  and  may  be  damaging  psychologically). 

•^  From  "Incontinence  —  6:  The  Prevention  of  Soiling"  by 
Dr.  F.L.  Willington  in  Nursing  Times,  April,  1975. 


luge  of  urine,  a  sanitary  napkin  may 

suffice,    but    heavy    pads    can   cause 

perineal  pressure  and  pain.  If  she  does 

not  use  a  urinary  catheter  and  external 

appliance,  a  woman  needs  protective 

underwear  and  padding  that  must  be 

changed  as  soon  as  it  is  wet  to  prevent 

skin  excoriation  and  odor.  Extra  fluids, 

required  to  prevent  kidney  problems, 

rease  the  frequency  of  changes.  A 

lety  of  incontinence  garments  and 

ponable  pads  are  on  the  market,  and 

..iough  experiment,   she  can  find  a 

•-atisfactory  style. 

1 1  is  difficult  for  the  woman  with  loss 
hand  function  to  use  sanitary  belts 
and  tampons.  Several  styles  of  sanitary 
panties  are  available  with  moisture- 
proof  linings  and  elastic  straps  in  front 
and  back  to  hold  the  ends  of  a  napkin  in 
place,  but  they  require  good  hand  func- 
uon.  The  new  beltless  napkins  may 
prove  useful. 

Available  selection 

Clothing  designs  and  adaptations  for 

the  mildly  and  moderately  handicapped 

man   are   featured   in   publications 

;n  the  Vocational  Guidance  and  Re- 

^NADIAN  NURSE  —  November  1975 


habilitation  Services  in  the  United 
States  and  the  Disabled  Living  Founda- 
tion in  England.  Large  department 
stores  carry  specialized  lingerie,  such 
as  front-opening  brassieres  and  incon- 
tinence or  sanitary  briefs. 

Many  regular  sewing  patterns  may 
be  adjusted  for  the  woman  with  a  dis- 
ability. Lowering  the  hemline  on  one 
side  straightens  a  garment  if  one  hip  is 
higher  than  the  other;  long  jackets  and 
overblouses  hide  uneven  hips  and 
waist.  Loosely  fitted  two-piece  suits 
and  dresses  with  yoke  interest,  or  in- 
verted pleats  to  the  bodice,  distract  at- 
tention from  spinal  problems  and  hang 
more  evenly  that  fitted  styles.  An  un- 
sewn  pleat  behind  the  shoulder  creates 
an  "action  back."  (see  figure  4) 

Padded  heel  and  elbow  areas  in  stock- 
inet, available  from  hospital  sup- 
pliers, help  relieve  pressure  points  in 
the  decubiti- prone  woman,  but  possi- 
bly at  the  cost  of  some  mobility. 

Unsolved  problems 

Although  the  mildly  or  moderately 
disabled  woman  can  adapt  ready-made 
outfits  or  find  suitable  specialty  clo- 


thing, the  severely  handicapped  person 
is  the  "forgotten  woman"  of  fashion. 

•  The  spastic  woman,  for  example, 
inevitably  finds  that  ready-to-wear 
garments  tear  easily  at  points  of 
stress,  stretch  out  of  shape  or  have 
sleeves  so  narrow  that  an  assistant 
cannot  guide  her  hand  into  the  open- 
ing. These  articles  need  to  have  the 
seams  reinforced,  storm  cuffs  wi- 
dened, and  pleats  added  wherever 
practical. 

•  Undergarments  pose  additional 
problems.  Most  closures  require 
good  hand  control;  stretchy  bras- 
sieres eventually  tend  to  roll  at  the 
back;  rubber-based  or  plastic  pants 
retain  moisture  and  odor  and  even- 
tually cause  skin  irritations. 

•  The  perfect  physically  and 
psychologically  acceptable  inconti- 
nence garment  still  needs  to  be  de- 
veloped—  a  panty  that  is  light,  soft, 
cool,  odor-free,  waterproof  and  al- 
lows air  to  circulate. 

0  The  foreshortened  woman  has  diffi- 
culty buying  a  dressy  three-quarter 
length  coat  that  serves  as  a  full- 
length  coat,  although  casual  styles 


21 


FASHIONS 


Figure  4: 

Flattering  styles  for  severe  figure 
problems 

Basic  Plan 

1.  Cover  true  waistline  loosely 

2.  Adjust  hem  to  compensate  for 
uneven  hipline  and  shoulder. 

3.  Pad  jacket  shoulder. 

4.  Use  elastic  waistbands  for  snug  fit. 

5.  Hide  thin  arms  with  long  sleeves. 

6.  Create  bodice  interest  to  detract  from 
figure  deformities. 

7.  Create  illusion  of  slimness  and  height 
by  up-and-down  lines.  (Pattern 
catalogs  contain  many  ideas  for 
this). 


I 


are  available. 
•  Suitable  warm,  waterproof  winter 

footwear  still  needs  to  be  devised  for 

the    orthopedically    handicapped 

woman. 

These  are  some  of  the  problems  that 
remain  to  be  solved  before  the  clothing 
needs  of  the  physically  handicapped  are 
adequately  met. 

Bibliography: 

1 .  Krenzel,  Judith  R.  and  Rohrer,  Lois  M., 
Paraplegic  and  quadriplegic  individu- 
als:   handbook    of  care  for   nurses, 


Chicago,  National  Paraplegia  Founda- 
tion, 1966. 

Lowman,  Edward  W.  and  Klinger, 
Judith.  Aids  to  independent  living:  self- 
help  for  the  handicapped,  New  York, 
McGraw-Hill,  1969. 
Macartney,  Patricia.  Some  thoughts  on 
clothing.  In  Lovvry,  Peter  J.,  ed.  Notes 
for  the  MS  patient.  Toronto,  Multiple 
Sclerosis  Society  of  Canada, 

Residents  of  McLeod  House,  Cheshire 
Homes,  Toronto,  Ontario.  (Personal 
communication). 


3.  Willington,  F.L.  Incontinence- 
prevention  of  soiling.  Nurs. 
71:14:545-8,  Apr.  3,  1975. 


-  6:  Tht 
Times. 


Organizations 

Disabled  Living  Foundation.  436  Kensing- 
ton High  Street ,  London  W 1 4  8NS ,  Eng- 
land. 

FashionAble.  Rocky  Hill,  New  Jersey 
08553,  U.S.A. 

Vocational  Guidance  and  Rehabilitation 
Services.  2239  East  55ih  Street,  Cleve- 
land, Ohio  44103,  U.S.A.. 


22 


PRaNKLY  SPEAKING 

ibout  nursing  administration 


Six  Blind  Men  in  a  Hospital 


was  six  men  of  Indostan, 

0  learning  much  Inclined, 

Iho  went  to  see  the  Elephant 
'hough  all  of  them  were  blind), 
hat  each  by  observation 
light  satisfy  his  mind. 
nd  so  these  men  of  Indostan 
isputed  loud  and  long, 
3ch  in  his  own  opinion 
--eding  stiff  and  strong. 
gh  each  was  partly  in  the  right, 
all  were  in  the  wrong! 

he  director  of  nursing  in  a  400- bed  hospi- 
il  approached  me  recently  with  a  very 
.nusual  question:  Do  you  remember  the 
(arable  of  the  six  blind  men?  Hesitantly,  I 
iswered  positively,  while,  in  the  back  of 
ly  mind,  I  wondered  if  my  hearing  was 
aying  tricks  on  me. 

Later  that  morning,  over  a  cup  of  cof- 
e,  it  became  apparent  that  the  analogy  of 
e  six  blind  men  was  an  appropriate  one. 
ike  the  six  blind  men  trying  to  identify  an 
ephant,  my  caller  was  desperately  trying 

1  sort  out  priorities  in  her  leadership  role. 

Her  first  question  seemed  very  basic: 
Who  is  to  take  care  of  the  patient?"  The 
mphasis  nowadays  is  on  '"health,  well- 
ss,  community  services,  and  home  care, 
escriptive  terms  such  as  'postoperative 
nbolus"  and  "salmonella  infection"  are 
iVof-style  and,  yet,  patients  unfortunate 
lough  to  develop  or  acquire  such  condi- 

ms  are  begging  for  cure  and  in  need  of 
ire." 

Because  of  the  glorious  tributes  paid  in 
e  literature  to  community  nurses,  nurse 
"actitioners  and  physicians"  assistants, 
a  nurses  who  provide  nursing  care  within 
stitutional  walls  to  patients  with  every- 
ly  conditions  have  developed  an  attitude 
"we  are  only  staff  nurses." 
"Can  nurses  treat  illness  in  patients 
hile  still  focusing  on  the  wellness  of 

E  CANADIAN  NURSE  —  NovemDer  1975 


FERNANDE  P.   HARRISON 


Each  month  The  Canadian  Nurse  fea- 
tures a  column  presenting  the  views  of 
the  four  members-at-large.  This 
month's  column  is  written  by  the 
member-at-large  for  nursing  adminis- 
tration, Fernande  P.  Harrison.  She 
welcomes  your  comments. 


these  patients?  What  about  the  oppor- 
tunities afforded  to  staff  nurses  to  remain 
people-oriented  and,  just  as  important, 
health-minded?  What  is  happening  to  the 
notion  that  illness  is  often  the  first  step 
toward  health,  given  that  the  teaching  of 
preventive  measures  is  facilitated  during 
hospitalization?"  I  asked. 

""Irrelevant"  was  the  word  used  by  my 
friend  to  stop  my  arguments:  "The  execu- 
tive director  and  the  board  of  the  hospital 
regularly  inquire  about  nursing  activities 
in  terms  of  number  of  nursing  hours  spent 
assisting  with  surgical  procedures,  the 
number  of  nursing  care  hours  per  patient  in 
the  medical,  pediatric  and  obstetrical 
un'ts.  When  I  describe  my  attempts  to  de- 
velop a  preoperative  patient  teaching 
program,  the  attention  of  the  executive  di- 
rector dwindles  and  he  becomes  evasive. 
For  him,  the  introduction  of  this  new  idea 
only  serves  to  raise  more  unanswerable 
questions,  such  as:  "How  will  nurses  find 
time  for  such  activities?  Would  the  board 
consider  this  a  new  program?"  " 

■"I  still  feel  like  one  of  the  blindmen," 
my  visitor  persisted.  "Tell  me,  how  do  I 
convey  that  preoperative  teaching  is  part 
and  parcel  of  nursing  care?  How  do  I  en- 
courage staff  nurses  to  provide  com- 
prehensive patient  teaching  without  the 
support  of  the  administration  of  the  hospi- 
tal?" 

Almost  immediately,  another  important 
point  was  raised:  "Should  head  nurses  en- 


courage staff  nurses  to  be  honest  in  their 
dealings  with  patients?"  The  simplicity  of 
this  question  took  me  aback.  Fortunately 
for  me.  my  visitor  continued  by  saying: 
■"Do  patients  have  the  right  to  know  more 
than  the  generic  name  of  drugs  ordered  in 
an  indecipherable  prescription?  Explain- 
ing the  nature  of  their  illness  in  technical 
language  and  refusing  to  expand  on  their 
prognosis  under  the  pretext  that  "patients 
do  not  understand"  and  "patients  get  emo- 
tionally upset,"  is  not  acceptable. 

Why  is  it  that  from  the  time  of  admis- 
sion to  hospitals,  adults  functioning  in  re- 
sponsible positions  are  reduced  to  the 
status  of  incompetent  numbers,  a  notch 
above  idiocy?  Worse,  why  is  it  that  pa- 
tients asking  questions  regarding  their 
treatment  are  treated  as  naughty  and  dis- 
turbing children?'" 

Phrases  such  as  ""patients  bill  of 
rights,"  ""informed  consent,"  "'democra- 
tic system,"  "involvement  of  the  patient 
in  the  treatment  team'"  sprang  to  my  mind. 
Before  I  could  mention  them,  my  friend 
had  moved  on  to  other  questions. 

"What  are  the  best  strategies  to  convey 
to  board  and  administration  that  patient 
teaching  is  patient  care?  At  the  same  time, 
if  board  and  administration  are  interested 
in  quality  care,  what  mechanism  can  be 
devised  to  communicate  to  staff  nurses 
that  the  intangible  aspects  of  care  are  im- 
portant, that  they  are  monitored,  if  not 
quantified  and  valued,  within  and  outside 
the  institutional  walls?" 

It  would  be  nice  to  report  that,  as  a  result 
of  this  discussion,  my  friend  and  I  felt  we 
had  succeeded  in  identifying  the  elephant. 
Unfortunately  that  is  not  the  case  and  we 
only  succeeded,  like  the  six  blind  men,  in 
identifying  new  areas  of  uncertainty  and 
ignorance.  If  anyone  of  you  can  shed  some 
light  on  the  subject,  we  would  welcome 
your  assistance.  v 


23 


ORI€NTATION 
part  one 


Creating  a  Learning  Environment 


When  staffing  is  low  and  there  are  few  experienced  nurses  available,  how  do 
hospitals  cope  with  the  summer  influx  of  the  2-year  graduate?  The  authors 
describe  how  the  York-Finch  General  Hospital  coped  with  this  problem  and 
continued  to  meet  the  needs  of  the  new  graduates. 

Kathleen  Nixon  and  Meria  Russell 


In  most  hospitals  today  the  general  belief 
about  the  2-year  graduate  is  that  she  has 
not  had  enough  training  or  education  to 
cope  as  a  staff  nurse. 

Are  the  2-year  graduates  a  "problem" 
to  hospitals  and  patients  due  to  their  lack  of 
practical  experience?  Is  it  possible  to  edu- 
cate a  nurse  in  2  years?  How  do  hospitals 
cope  with  the  influx  of  the  2-year  graduate 
in  the  summer  —  a  time  when  staffing  is 
low  and  there  are  few  experienced  nurses 
available? 

At  York-Finch  General,  a  5-year  old, 
3(X)-bed  hospital  in  Metropolitan  Toronto, 
we  decided  to  set  up  a  new  orientation 
program  for  the  2-year  graduate.  Our  hos- 
pital is  progressive  and  oriented  to  the  con- 
tinuing education  of  all  staff  members. 
Our  objective  is  "to  develop  a  learning 
environment  in  which  all  health  care 
workers  will  be  encouraged  to  continually 
improve  their  standards  of  performance. " 

In  May  1974,  the  Departments  of  Nurs- 
ing and  Staff  Training  and  Development 


Kathleen  Nixon,  RN,  is  coordinator  of  Staff 
Training  and  Development  at  the  York-Finch 
General  Hospital,  Toronto.  MerIa  Russell,  RN, 
is  assistant  coordinator  of  Staff  Training  and 
Development  at  the  York-Finch  General  Hospi- 
tal Toronto. 


(hospital-wide  inservice)  reviewed  the 
staffing  needs  for  the  summer  and  fall.  We 
looked  at  what  was  available  to  fulfill 
these  staffing  needs  —  the  2-year 
graduate. 

Designing  the  program 

We  felt  that  the  new  graduates  would 
require  additional  help  in  becoming  mem- 
bers of  the  nursing  team.  A  5-week  orien- 
tation program  was  designed  to  fulfill  their 
need  for  learning  and  experience.  Our 
purpose  was  to  ease  them  quickly  onto  the 
nursing  team  that  they  might  gain  a  sense 
of  acceptance  and  performance  confi- 
dence. At  the  same  time  it  was  necessary 
to  ensure  that  the  other  team  members  felt 
comfortable  with  this  process.  Their  con- 
victions that  the  2-year  graduate  could 
never  cope  had  to  be  dealt  with. 

The  first  week  of  the  "new  graduate 
orientation  program"  was  an  expansion  of 
the  general  orientation  for  new  staff.  This 
allowed  an  increase  in  time  for  discus- 
sions, demonstrations,  and  return  dem- 
onstrations. 

On  the  first  day,  an  experience  checklist 
was  filled  out  by  the  graduates.  They  were 
asked  to  check  the  procedures  in  which 
they  had  theoretical  knowledge  and  indi- 
cate the  number  of  times  performed.  The 
completed  checklists  were  used  to  select 


the  particular  topics  for  week  II,  the  [ 
tient  assignments,  and  the  conferences 
weeks  III,  IV,  and  V. 

To  meet  the  needs  of  the  new  graduau 
it  was  essential  that  the  program  be  fie;! 
ble.  This  permitted  changes  in  topics  ' 
time  allocations  and  allowed  us  to  la 
advantage  of  learning  experiences  th 
arose.  The  atmosphere  in  the  classror 
and  on  the  nursing  levels  was  kept  inti 
mal  and  the  teacher-student  relationsh 
was  avoided  as  much  as  possible.  The  ne 
graduates  were  eager  to  try  out  their  kno\ 
ledge  —  "to  get  out  of  the  classroom  ar 
to  work  as  nurses." 

Medical-surgical  nursing  units  we 
selected  to  provide  the  clinical  experienc 
We  believed  that,  regardless  of  the  ne 
members"  selected  work  area,  the  knov 
ledge  gained  by  rotating  through  3  shif 
on  a  medical-surgical  unit  would  gi\ 
them  a  sound  basis  upon  which  to  buii 
further  skills. 

Experience  sharing  relationships 

The  clinical  instructors  (the  assistant  i 
Staff  Training  and  Development  and  j 
charge  nurse  from  one  of  the  medica 
surgical  units)  were  freed  from  their  noii 
mal  duties  to  work  along  with  the  new  stai' 
members  on  all  shifts.  Rather  than  th 
(Continued  on  page  2i 


WORK  FOR  YOU  ? 


part  two 


Recruiting  for  the  Far  North 


i.L.  Kjolberg  and  Karen  Glynn 


Two  years  ago  a  small  hospital  in 
a  remote  area  of  Manitoba  was 
faced  with  the  fact  that,  unless 
steps  were  taken  soon  to  make 
working  in  that  hospital  more  at- 
tractive, a  serious  shortage  of 
nursing  manpower  was  inevita- 
ble. The  solution  chosen  by  this 
hospital  was  consistent  with  the 
definition  of  the  new  nursing 
graduate  from  a  two-year  pro- 
gram as  a  "beginning  prac- 
titioner "  It  involved  development 
of  a  six-month  orientation  pro- 
gram providing  experience  in  all 
areas  of  the  hospital  so  that  the 
new  graduate  could  work  with 
senior  staff  and  gradually  as- 
sume increasing  responsibilities. 
The  program  is  now  in  its  second 
year  of  operation.  The  six  two- 
year-graduates  who  participated 
in  the  initial  program  gave  the 
scheme  their  unanimous  ap- 
proval; in  fact,  three  of  them  are 
assisting  in  the  orientation  of  the 
eight  nurses  chosen  for  the  1975 
program. 


Thompson  General  Hospital  is  located 
480  miles  north  of  Winnipeg.  It  is  a 
125-bed  hospital  with  a  high  obstetrics 
load  (over  900  births  per  year),  a  high 
pediatrics  load  and  a  fairly  active 
emergency  department  due  to  the  in- 
dustrial nature  of  the  community. 

Early  in  1974,  Thompson  General,  in 
reviewing  its  position,  recognized  the  fact 
that  new  graduates  from  nursing  schools 
were  not  applying  in  sufficient  numbers  to 
offset  a  developing  shortage  of  nursing 
manpower.  Until  the  preceding  year  when 
hospital  expansion  and  additional  recruit- 
ment by  other  agencies  produced  a  severe 
shortage  of  nurses  in  the  city,  the  hospital 
had  been  able  to  recruit  sufficient  nursing 
staff  from  the  community. 

A  recruitment  program  among  working 
nurses  and  new  graduates  in  southern 
Manitoba  met  with  very  limited  success. 
One  of  the  most  obvious  reasons  for  the 
reluctance  of  the  new  graduates  to  come  to 


G.L.  Kjolberg  was  adminisiraior  and  Karen 
Glynn  is  in-service  coordinator  of  Thompson 
General  Hospital.  This  article  is  based  on  a 
report  by  these  authors  which  appeared  in 
VITAL  SIGNS,  monthly  bulletin  of  Manitoba 
Health  Organizations  Incorporated,  June  1975, 
Vol.  3,  No.  6. 


iNADIAN  NURSE  —  November  1975 


Thompson  seemed  to  be  the  amount  of 
responsibility  they  would  face  without  ben- 
efit of  any  working  experience. 

The  problem  then  was  to  develop  a  re- 
cruitment program  that  would  attract 
nurses  to  Thompson  and  to  that  hospital.  It 
was  suggested  that  a  six-month  orienta- 
tion course  should  be  introduced.  New 
graduates  would  work  with  senior  staff 
and  gradually  assume  increasing  respon- 
sibilities. The  idea  was  based  on  recogni- 
tion of  the  two-year  graduate  as  a  "begin- 
ning practitioner."  It  was  intended  to  pre- 
vent the  kind  of  situation  in  which  a 
graduate  could  be  made  charge  nurse  in 
her  work  area  after  only  a  few  days'  orienta- 
tion. Under  the  new  program  she  would  be 
allowed  to  develop  her  potential  in  a  less 
stressfijl  situation. 

Cooperation  Key  to  Planning 
The  first  step  in  planning  the  program  con- 
sisted of  discussion  between  the  coor- 
dinator and  head  nurses  concerning  orien- 
tation in  their  various  areas.  It  was  disco- 
vered that  the  most  important  step  in  im- 
plementing the  orientation  is  obtaining  the 
cooperation  of  all  levels  of  nursing  staff  in 
assisting  with  the  actual  teaching.  The 
ideal  time  to  begin  the  program  is  early  in 
the  year.  Booklets  were  prepared  for  both 
(Continued  on  page  26) 

25 


Recruiting  — 

a  general  hospital  orientation  and  orienta- 
tion to  individual  wards. 

The  general  hospital  orientation  in- 
cluded the  following:  history  of  the  hospi- 
tal; area  served  by  the  hospital;  organiza- 
tion of  the  hospital;  who's  who;  maps  of 
the  hospital  and  a  tour;  services  available 
in  the  hospital;  hospital  policies;  health 
and  safety  programs;  code  •■99""  review; 
resources  available;  charting;  requisitions; 
isolation;  blood  administration;  pharmacy 
inservice;  physiotherapy  inservice:  res- 
piratory technologist  inservice;  and 
method  of  evaluation. 

During  the  week  of  general  orientation, 
the  new  nurses  were  assigned  to  the  first 
area  of  the  hospital  in  which  they  were  to 
be  orientated.  The  inservice  coordinator 
was  to  spend  a  fair  amount  of  lime  with 
them  in  the  conference  room.  Unfortu- 
nately, after  the  first  two  days,  she  became 
ill.  This  was  the  first  instance  of  teamwork 
paying  off,  as  the  physiotherapist,  phar- 
macist and  respiratory  technologist  carried 
on. 

During  their  six-month  orientation,  the 
nurses  rotated  through  the  hospital  as  fol- 
lows, although  not  necessarily  in  this 
order:  general  hospital  orientation  -  I 
week;  obstetrical  experience  -  6  weeks,  ( 1 
week  nursery;  1  week  postpartum,  4 
weeks  labor  and  delivery);  pediatrics  —  4 
weeks;  medicine  —  3  weeks;  surgery —  3 
weeks;  operating  room  —  3  weeks; 
emergency  —  3  weeks. 

Orientation  to  assigned  nursing  units  in- 
cluded an  orientation  to  physical  facilities, 
introduction  to  personnel,  review  of  medi- 
cation procedures  and  special  procedures 


for  that  area,  the  Kardex  and  charting.  In 
all  areas  the  senior  staff  did  the  majority  of 
the  orientation. 

Reaction  of  the  graduates 

The  three-week  experience  in  the 
operating  room  was  appreciated  by  all 
concerned.  Staff  felt  it  gave  new  graduates 
the  opportunity  to  understand  their  func- 
tion, to  appreciate  more  fully  what  hap- 
pens to  the  patient  in  the  operating  room 
and  the  opportunity  to  practice  new  nurs- 
ing skills.  Several  doctors  were  happy  to 
teach  while  performing  surgery.  Some 
graduates  commented  they  would  never 
again  be  afraid  to  suction;  all  of  them  ex- 
perienced the  novelty  of  being  on  call  for 
one  week. 

In  obstetrics  most  of  the  graduates  had 
the  opportunity  of  delivering  a  baby  with  a 
more  senior  nurse  and  obstetrician  ready  to 
help  should  problems  arise. 

In  the  emergency,  nurses  had  plenty  of 
new  experiences;  several  wished  they 
could  stay  longer. 

Two  different  methods  of  medication 
administration  are  used  at  Thompson.  On 
pediatrics,  each  nurse  gives  medications 
to  her  own  patients.  The  other  areas  use 
one  nurse  as  "medication  nurse'",  a  new 
experience  for  many  new  graduates.  One 
commented  after  her  day  as  medication 
nurse  that  she  had  given  more  I.M.'s  in 
that  day  than  during  her  entire  training 
period. 

Summary  of  Results 

Everyone  connected  with  the  orienta- 
tion program  felt  they  had  gained  from  the 
experience.  It  was  realized  that  the  new 


ce 

s- 


)r 


graduate  should  not  be  expected  to 
charge"  and  be  familiar  with  every  r 
ing  skill.  At  times,  a  common  lack  ollx 
perience  was  recognized.  For  exam  e. 
almost  everyone  needed  assistance 
their  first  shave  prep.  Also,  many  ni. 
took  time  out  during  a  busy  day  to  he  i 
explain  a  procedure.  By  helping  shari 
teaching  experience,  they  became  > 
involved  in  making  the  new  graduate- 
part  of  the  hospital  staff.  As  the  ii, 
became  familiar  with  the  hospital 
gradually    assumed    increasing    re^ 
sibilities.  This  was  done  on  an  indiv, 
basis;  some  were  ready  sooner  than  oth( 
Some  of  the  changes  recommended 
the   second   year   of  the   orientation 
eluded: 

•  more  doctor's  lectures 

•  different  evaluation  procedure 

•  more  participation  on  the  wards  by 
seivice  coordinator 

•  additional  experience  in  some  area- 
eluding,  emergency  ward,  the  nurser\ 
postpartum. 

A  letter  describing  the  revised  pre 
was  sent  early  in  1975  to  all  schoi 
nursing  in  Manitoba,  Saskatchewan 
tario  and  Alberta.  More  than  100  n 
replied.  They  received  an  appli^ 
form,  an  outline  of  the  orientation,  a  s 
scale,  description  of  benefits  ai 
brochures  and  maps  of  Thompson. 

Eight  applicants  were  selected  ft 
1975  program  which  commenced 
tember  8,^1975. 


Creating  — 

teacher-student  relationship,  we  encour- 
a^:ed  a  sharing  of  experiences  between  the 
seasoned  and  the  new.  Although  the  clini- 
cal instructors  were  available,  the 
graduates  were  encouraged  to  function  as 
team  members  and  use  the  expertise  of 
other  staff  as  often  as  possible. 

The  patient  assignments  were  initially 
selected  by  the  clinical  instructors,  to  pro- 
vide the  necessary  experiences  as  previ- 
ously indicated  by  the  graduates.  Later, 
patient  assignments  were  chosen  by  the 
graduates  and  the  team  leaders.  Daily  con- 
ferences were  held  by  the  clinical  instruc- 
tors and  the  topics  covered  new  or  unfamil- 
iar procedures  or  equipment,  e.g.. 
thoracentesis,  tracheostomy  care,  and  the 
care  of  the  body  after  death.  The  graduates 
were  encouraged  to  choose  topics  and  to 
participate  in  the  conferences. 

26 


Eased  in  rather  than  "thrown  in" 

Following  the  program,  evaluations  re- 
ceived from  the  participants,  instructors, 
and  charge  nurses  indicated  that  the 
5- week  orientation  was  vital.  The  new 
graduates  had  gained  confidence  in  them- 
selves and  in  their  ability  to  work  as  part  of 
the  nursing  team.  They  were  thankful  that 
they  had  been  eased  in,  instead  of  "thrown 
in."  The  charge  nurses  appreciated  the 
availability  of  the  clinical  instructors  in 
assisting  in  the  orientation  to  the  nursing 
units.  Other  team  members  were  eager  to 
assist  the  new  nurses  and  enjoyed  helping 
them  accept  their  expected  role  respon- 
sibilities. 

Recommendations  for  changes  in  the 
program  were  minimal,  involving  mainly 
time  structures.  The  hospital  and  nursing 
administration  believed  that  it  was  more 
important  to  have  confident  nursing 
graduates  than  just  "hands"  to  fill  a  va- 


cancy. This  program  was  a  success  n 
the  support  and  cooperation  of  all  hospi 
staff  members. 

What  did  this  orientation  prove 
York-Finch  General  Hospital?  The  2-ye 
graduate  need  not  be  a  problem.  To  de 
with  the  newness  and  insecurities  that  a 
so  much  a  part  of  a  first  position,  it  \ 
essential  that  these  graduates  be  assist'! 
through  such  a  program  .  "Our  ne 
graduates' '  learned  to  cope  well ,  and  at  tl 
end  of  their  3-month  probationary  peri( 
were  accepted  as  valuable  members  of  tl 
nursing  team. 


Copies  of  the  "New  Graduate  Orien(ati( 
Program"  are  available  on  request  from  tl 
authors. 


>r 


Artifical  urinary  sphincter 


The  artificial  urinary  sphincter  is  a  new  approach  to  the  treatment  of  total 
incontinence.  It  embraces  a  lengthy  preparatory  and  educational  program,  and 
for  the  patient  means  a  permanent,  internally  implanted  prosthetic  device  that 
allows  him  to  resume  a  normal  life. 


k 


ergons  with  total  urinary  incontinence 
,>  a  severe  problem  that  affects  all  as- 
^  of  their  lives  and  malces  normal 
-hological,  social,  occupational,  and 
lal  behavior  almost  impossible. 
\n  old  and  previously  unsolvable  prob- 
.  total  urinary  incontinence,  can  now 
c  treated  by  the  implantation  of  an  artifi- 
sphincler.  The  urinary  sphincter  pro- 
ire  was  developed  at  the  Baylor  Col- 
of  Medicine.  Houston.  Texas  and 
-equently     laboratory    and    animal 
J.  Following  this  testing  period,  a 
ii::e  group  of  patients  were  implanted  at 
i   Luke's  Hospital  in  Houston.  Texas.  In 
1  1974.  a  patient  at  Foothills  Hospital. 
!^ary .  Alberta,  became  the  first  person 
inada  to  receive  such  a  prosthetic  de- 
During  the  first  year  of  the  hospital's 
jram.  16  persons,  ranging  in  age  from 
83  years,  were  treated  for  inconti- 

,0. 

his  article  will  outline  a  program  de- 
ed at  Foothills  Hospital  to  meet  the 


)awn  Patterson  (R.N..  University  of  Alberta 
lospiial  school  of  nursing:  B.Sc.N..  Univer- 
ily  of  Alberta)  formerly  surgical  instructor  at 
'ooihills  Hospital.  Calgary,  is  now  on  faculis 
t  Cariboo  College.  Kaniloops.  B.C.  Patricia 
i.  Schuster  (R.N..  Holy  Cross  Hospital  school 
f  nursing.  Calgary:  B.Sc.N..  University  of 
Uberia)  is  the  surgical  inservice  instructor  at 
'oothills  Hospital.  Thev  acknowledge  the  as- 
istanee  and  encouragement  of  Dr.  Bernard 
^urchin  (Chief  of  Urology.  Foothills  Hospi- 
al)  who  was  initially  responsible  for  the  surgi- 
al  technique  and  development  of  the  sphincter 
rogram. 

HE  CANADIAN  NURSE  —  November  1975 


Dawn  Patterson  and  Patricia  A.  Schuster 

needs  of  a  patient  receiving  an  artificial 
urinary  sphincter.  A  nurse  was  made  re- 
sponsible for  the  teaching  program.  She 
was  given  the  title  of  nurse  practitioner  to 
clearly  identify  her  role  and  differentiate  it 
from  those  of  other  personnel. 

Urinary  incontinence  may  be  due  to: 
D  a  relative  loss  of  urethral  resistance 
(stress  incontinence): 
n  bladder    irritation    (urgency    inconti- 
nence): 

n  complete    loss   of  urethral  resistance 
(usually  due  to  combined  bladder  neck  and 
external  sphincter  damage); 
D  involuntary  contraction  of  the  bladder. 
as  seen  with  exaggerated  bladder  muscle 
reflex  (detrusor  hyperreflexia); 
D  incoordination   between   the   detrusor 
muscle  and  a  spastic  extemal  sphincter 
(detrusor  sphincter  dyskinesia):  or 
D  a  fistula." 

Treatment  for  the  first  3  conditions  was 
previously  ineffective:  now  the  artificial 
sphincter  has  become  the  treatinent  of 
choice. 

The  prosthesis 

The  artificial  sphincter  device  was  de- 
veloped through  the  combined  efforts  of 
the  departments  of  neurology  and  electri- 
cal engineering  at  the  University  of  Min- 
nesota Hospital  in  Minneapolis,  and  the 
department  of  urology  at  the  Baylor  Col- 
lege of  Medicine  in  Houston.  Texas. 

Several  factors  had  to  be  considered.  An 
artificial  urinary  device  had  to  allow  vol- 
untary control  by  the  patient  and  be  manu- 
ally and  externally  operated.  It  was  to  be 
cosmetically  undetectable,  with  no  exter- 
nal parts,  and  was  to  permit  normal  sexual 
relations.  It  had  to  avoid  contact  w  ith  urine 


to  eliminate  encrustation  problems.  As  it 
was  to  be  permanently  implanted,  it  was  to 
be  made  of  silicone  rubber  to  minimize 
rejection  problems.^ 

Design  and  placement 

The  prosthetic  sphincter,  manufactured 
by  the  American  Medical  Systems  Corpo- 
ration, is  a  hydraulic  system  consisting  of 
4  parts:  a  reservoir,  an  inflatable  cuff,  and 
2  pumps  (inflating  and  deflating).-'  (Fig- 
ure I.) 

The  reservoir  is  filled  w  ith  a  radiopaque 
fluid  (Hypaque).  and  is  attached  by  nonab- 
sorbable sutures  to  the  rectus  muscle 
sheath. 

The  inflatable  cuff,  a  ribbon-like  struc- 
ture w  ith  sutures  impregnated  in  its  back, 
forms  a  complete  ring  when  the  cuff  is 
threaded  around  the  urethra  and  the  ends  of 
the  sutures  tied.  Cuff  sizes  are  individually 
selected.  In  the  male,  the  cuff  is  placed 
around  the  bladder  neck  above  the  prostate 
gland  and.  in  the  female,  it  encircles  the 
urethra. 

Each  pump  is  composed  of  connecting 
tubing.  2  valves,  and  a  bulb."*  The  connect- 
ing tubes  and  valves  pass  through  the  in- 
guinal canal  and  are  attached  to  the  bulbs, 
which  lie  in  subcutaneous  pockets  created 
in  the  scrotum  of  a  male  or  in  the  labia  of  a 
female  (Figure  2). 

The  entire  sphincter  is  implanted  inter- 
nally. 

To  achieve  continence,  the  patient 
manually  compresses  the  inflate  bulb 
(Figure  J)  resulting  in  closure  of  the 
sphincter  cuff  (Figure  4).  On  subsequent 
compressions  of  the  deflate  bulb  (Figure 
5).  the  sphincter  cuff  is  opened,  allowing 
voiding  to  occur  (Figure  1). 

27 


FIGURE  1.  The  artificial  urinary  sphincter  mechanism 
The  artificial  sphincter  shown  In  an  open  (deflated)  position,  which 
allows  voiding  to  occur.     1.  Reservoir     2.  Inflatable  cuff    3.  Two 
pumps:    —  Inflating  pump  (patient's  right  side).    -  Deflating  pump 
(patient's  left  side). 


FIGURE  2.  Placement  of  the  connecting  tubings 
The   connecting   tubings   and   valves   passed    through   the   inguinal 
canal  and  attached  to  bulbs  situated  in  the  labia  of  a  female. 


The  patient 

Candidates  for  a  urinary  sphincter  im- 
plant are  persons  who  are  untreatable  by 
other  methods  and  who  face  either  urinary 
diversion  or  hfetime  condom  drainage.  At 
present,  they  are  those  with  postprostatec- 
tomy  incontinence  or  persons  with  urinary 
incontinence  associated  with  neurogenic 
bladder  (adult  traumatic  type),  multiple 
sclerosis,  and  congenital  trauma 
(myelomeningoceles). 

An  important  paradox  may  occur  in  pa- 
tients with  a  neurogenic  bladder.  While 
the  bladder  is  filling,  the  external  sphincter 
does  not  contract  efficiently  enough  to 
permit  continence  and.  during  voiding,  it 
does  not  relax  enough  to  permit  efficient 
emptying  of  the  bladder.  This  results  in 
detrusor  sphincter  dyskinesia.  Inefficient 
emptying  of  the  bladder  eventually  leads 
to;  residual  urine,  urinary  infections,  renal 
calculi,  urethral  inefficiency,  renal  fail- 
ure, and  death  of  the  patient.^ 

A  priority  in  patient  treatment  before 
implantation  is  to  achieve  complete  emp- 
tying of  the  bladder.  This  is  usually  done 
by  performing  a  sphincterotomy.  Patients 
must  be  in  a  state  of  physical  well-being 
prior  to  the  implantation.  Therefore, 
myelomeningoceles  must  be  satisfactorily 
repaired,  and  patients  rendered  free  from 
bladder  infections  through  the  use  of  an- 
tibiotic therapy. 

All  our  patients  are  studied  for  a  year 
prior  to  the  implant,  and  we  use  many  of 

28 


FIGURE  3.  Compression  of  the  inflate  bulb 
Compression  of  the  inflate  (right)  bulb  transports  fluid  from  the 
reservoir  to  the  cuff,  thus  closing  (inflating)  the  cuff. 


the  criteria  for  assessing  patients  de- 
veloped at  Baylor  College  and  the  Univer- 
sity of  Minnesota.* 

Patients  undergo  a  urological  work-up 
that  includes  a  complete  medical  history,  a 
physical,  and  a  neurological  examination. 
SMA  6/60.  SM.A  12/60.  and  creatinine 
clearance  tests  are  done.  Urine  studies  in- 
clude a  midstream  for  culture  and  sensitiv- 
ity, and  residual  urines  following  spon- 
taneous voiding.  Voiding  habits  are  care- 
fully observed.  Radiological  studies  in- 
clude intravenous  pyelogram  and  cine 
voiding  cystourethrograms. 
Urodynamic  studies  are  done  in  the 
rating  room  in  conjunction  with  cys- 
...^.opy .  Flow  rates  and  a  cystometrogram 
lare  completed  at  this  lime.  Additional  flow 
I  rates,  to  measure  how  long  it  takes  a  pa- 
;iieni  to  empty  his  bladder  completely,  are 
jdone  on  the  nursing  unit. 

The  above  tests  provide  information  on 
the  size  and  condition  of  a  patient's  blad- 
and  on  bladder  muscle  coordination. 
Ihe  patient's  ability  to  sit  and  stand 
A  hen  voiding  is  observed,  to  ascertain 
general  voiding  habits  to  be  expected  fol- 
lowing implantation. 

•  The  patient  must  demonstrate  interest 
and  a  w  illingness  to  operate  the  sphincter. 
His  hand  grasp,  sensation,  and  strength  are 
assessed  to  ensure  his  ability  to  grip  and 
squeeze  the  sphincter  bulbs.  His  level  of 
nderstanding  and  ability  to  operate  the 
phincter  are  carefully  noted,  as  he  must 


be  potentially  self-sufficient  to  be  con- 
sidered a  satisfactory  surgical  candidate. 

The  surgery 

Patients  usually  face  3  distinct  phases  of 
surgery:  sphincterotomy,  sphincter  inser- 
tion, and  sphincter  revision. 

Sphincterotomy  is  incising,  or  cutting, 
Ihe  external  sphincter  to  achieve  complete 
emptying  of  the  bladder.  Urinary  conti- 
nence can  then  be  restored  by  the  insertion 
of  the  artificial  urinary  sphincter. 

The  patient  is  closely  monitored  follow- 
ing the  sphincter  implant.  Should  techni- 
cal difficulties,  such  as  kinking  or  block- 
age of  the  tubing,  occur,  surgical  revision 
is  required. 

Management 

Standard  preoperative  orders  are  estab- 
lished, with  the  prime  objective  of  pre- 
venting infection. 

Standard  postoperative  orders  usually 
call  for  a  private  room  and  bed  rest  for  48 
hours  postoperatively.  To  reduce  edema, 
an  ice  pack  is  applied  directly  to  the  genital 
area.  An  abdominal  binder  is  applied  for 
support  and  suppression  of  internal  edema 
in  the  area  of  the  reservoir. 

An  indwelling  Foley  catheter  is  attached 
to  straight  drainage.  This  is  to  allow  urine 
to  flow  freely  and  the  edema  to  subside,  as 
well  as  to  assist  the  patient  to  tolerate  the 
frequent  and  rigorous  manipulation  of  the 
bulbs.  The  catheter  is  left  in  place  for  ap- 


proximately 5  days. 

To  keep  the  bulbs  supple,  they  are  in- 
flated and  deflated  daily.  The  sphincter 
cuff  otherwise  remains  deflated  until  the 
catheter  is  removed.  To  check  the  func- 
tioning of  the  apparatus,  an  abdominal 
x-ray  is  taken  48  hours  postoperatively. 

Skin  breakdown  in  the  genital  region  is 
prevented  through  good  basic  hygiene; 
but,  should  skin  problems  arise,  a  standard 
skin  care  regimen  is  followed. 

Operation  of  sphincter 

Patients  begin  their  program  of  training 
while  the  catheter  is  still  in  place.  Under 
close  supervision,  and  with  much  encour- 
agement by  the  staff,  they  first  feel  where 
the  sphincter  bulbs  are.  Then  they  are 
taught  to  inflate  and  deflate  them. 

Our  protocol  to  guide  patients  and  staff 
on  operating  the  urinary  sphincter  includes 
the  following  reminders: 
D  Bulbs  must  be  handled  gently. 
D  The  right  bulb  closes  the  sphincter  cuff 
and  the  left  opens  it. 
D  The  tubing  is  stabilized  between  the 
thumb  and  forefinger  of  the  left  hand.  If 
the  patient  is  left-handed,  the  opposite 
hand  is  used. 

D  The  bulb  is  squeezed  with  the  right 
hand.  The  number  of  manipulations 
needed  varies  with  each  mechanism  and 
with  each  patient.  The  inflate  (right)  bulb 
generally  requires  5  or  6  slow ,  firm  pumps 
or  squeezes  to  close  the  cuff  completely: 


FIGURE  4 
The  artificial  cuff  shown 
allows  for  continence. 


A  closed  sphincter  cuff 

in   a   closed    (inflated)   position  which 


FIGURE  5.  Compression  of  the  deflate  bulb 
Compression   of  the  deflate  (left)  bulb,  transports  fluid  from  the 
cuff  to  the  reservoir,  thus  opening  (deflating)  the  cuff. 


:  CANADIAN  NURSE  —  Novemce' 


Mr.  A.  had  been  incontinenl  for  the  two 
years  following  a  perineal  proslalectomy. 
Forty-six  years  old,  he  was  a  business  ex- 
ecutive with  a  family  of  4,  ranging  in  age 
from  16  to  5  years.  He  had  travelled  consid- 
erably and  had  been  actively  involved  in 
several  sports.  His  established  life-style  had 
been  shattered,  and  his  incontinence  caused 
him  much  scKial  embarrassment  and  in- 
creasingly difficult  marital  relations. 

Mr.  A.  had  had  an  indwelling  catheter  for 
a  year  following  the  surgery.  The  resultant 
frequent  bladder  and  kidney  infections  were 
further  aggravated  by  an  attempt  to  use  con- 
dom drainage.  When  Mr.  A.  was  temporar- 
ily infection-free  on  completion  of  antibi- 
otic therapy  for  his  most  recent  infection. 
his  urologist  recommended  the  insertion  of 
an  artificial  urinary  sphincter. 

Preoperative  course 

.Mr.  \.  entered  our  hospital  10  days  before 
the  anticipated  surgery.  Following  admis- 
sion, the  nurse  practitioner  met  with  him 
and  hl^  wife  to  assess  their  kno\\  ledge  of  the 
problem  and  the  prosthetic  imphtnl  and  to 
di.scuss  the  uiological  tests  he  would  un- 
dergo. 

During  the  preoperative  period,  Mr.  A. 
was  taught  what  he  needed  to  know  about 
the  sphincter  device.  He  learned  that  the 
intlation  bulb  would  be  positioned  in  the 
right  scrotum,  and  the  deflation  bulb  in  the 
left  scrotum,  in  subcutaneous  pockets 
created  by  blunt  dissection  in  the  scrotal 


Patient  Study 

tissue.  Silastic  tubing  would  then  be  con- 
nected to  the  cuff,  reservoir,  and  bulbs. 
Then  the  system,  which  had  previously 
been  filled  with  Hypaque  solution,  would 
become  functional. 

As  the  urinary  sphincter  is  placed  inside 
the  body  and  cannot  be  seen  externally,  Mr. 
A.  was  asked  to  purchase  a  .Medic-Alert 
bracelet,  to  identify  him  as  having  an  im- 
plant and  provide  immediate  access  to  med- 
ical information. 

Mr.  A.  was  given  a  perineal  skin  prep, 
PhisoHex  baths,  and  a  series  of  enemas  as 
preparation  for  surgery.  There  was  no  evi- 
dence of  skin  breakdown  as  a  result  of  his 
prolonged  incontinence.  He  had  been  on  a 
low-residue  diet  for  a  week  and  clear  fluids 
the  day  prior  to  surgery. 

Postoperative  course 

Following  the  surgical  procedure.  Mr.  A. 
returned  to  the  nursing  unit  with  an  in- 
travenous in  place.  This  was  kept  running 
until  he  was  passing  flatus. 

A  minimal  amount  of  swelling  occurred 
in  the  scrotal  area,  and  ice  packs  were  ap- 
plied continuously  to  that  region  until  dis- 
comfort and  swelling  subsided. 

A  Velcro  abdominal  binder  was  secured 
in  place. 

.■\  Foley  catheter  was  attached  to  straight 
drauiage  and  remained  in  the  bladder  for  .'^ 
days,  during  which  time  the  cuff  was  in- 
flated and  deflated  once  a  day.  Prior  to  this 
procedure,  an  analgesic  was  administered. 


as  the  bulb  manipulation  caused  severe  dis- 
comfort until  the  swelling  diminished. 

Except  for  the  daily  inflations,  which 
aided  in  keeping  the  bulbs  supple,  the  ap- 
paratus was  left  in  a  deflated  position  to 
assure  adequate  urinary  drainage. 

After  2  days  of  bed  rest,  Mr.  A  was  al- 
lowed up. 

Upon  removal  of  the  catheter,  Mr.  A. 
was  placed  on  a  schedule  of  2-hourly  cuff 
inflations  and  deflations.  From  the  time  of 
the  catheter  removal  and  the  first  inflation  of 
the  sphincter  device,  Mr.  A  was  dry  and  did 
not  leak  urine.  He  was  soon  able  to  increase 
the  time  between  inflations  as  he  had  normal 
bladder  sensation,  and  quickly  adjusted  to 
the  .prosthesis. 

Mrs.  A.  was  also  taught  to  compress  the 
bulbs.  She  was  able  to  open  the  cuff  with  3 
compressions  of  the  deflate  bulb  and  close  it 
with  .5  compressions  of  the  inflate  bulb 

Discharge 

Mr.  A.  had  an  uneventful  recovery.  At 
the  time  of  discharge,  he  was  inflating  and 
deflating  the  cuff  every  4  hours.  After  6 
weeks  at  home,  he  was  able  to  sleep  through 
the  night  without  having  to  void.  Mr.  A. 
inflated  and  deflated  his  cuff  in  a  standing 
position,  although  at  first  it  had  been  easier 
for  him  to  do  this  while  sitting. 

One  month  following  his  admission,  Mr. 
A.  was  totally  continent  and  confident  of  his 
ability  to  resuine  a  pattern  of  life  that  had 
been  disrupted  two  years  previously. 


and  the  deflate  (left)  bulb,  .^  or  4  pumps  to 
open  the  cuff  fully.  The  cuff  can  never  be 
overintlated  or  deflated. 
D  Crede  of  the  bladder  (manual  pressure 
applied  above  the  symphysis  pubis  to  ex- 
press urine)  is  done  by  the  patient  who 
cannot  normally  contract  his  bladder. 
n  Analgesics  are  given  to  patients  prior  to 
pumping  the  bulbs,  as  this  is  acutely  pain- 
ful at  first.  However,  patients  quickly  be- 
come accustomed  to  the  procedure  and  do 
not  need  analgesics  after  a  few  days. 
D  A  regular  voiding  schedule  must  be 
maintained.  Hence,  a  routine  is  estab- 
lished immediately  after  the  catheter  is 
removed.  The  schedule  begins  by  inflating 
(closing)  the  cuff  for  2  hours,  then  deflat- 
ing (opening)  it  to  void.  This  procedure  is 
repeated  every  2  hours. 

As  soon  as  the  patient  tolerates  the  ma- 
nipulations, the  time  interval  is  increased 


gradually  until  as  normal  as  possible  a 
voiding  pattern  is  achieved.  Children  in 
our  program  often  lack  bladder  sensation 
and  must,  therefore,  be  timed  and  trained 
to  void  at  regular  intervals. 

Unless  the  voiding  schedule  is  closely 
followed,  urine  is  involuntarily  forced 
beyond  the  closed  cuff.  This  leaves  the 
patient  incontinent  and  he  must  then  rem- 
edy the  situation  by  emptying  his  blad- 
der and  restarting  his  schedule.  Each  pa- 
tient has  an  individual  schedule. 

Patient  education 

The  nurse  practitioner  outlines  a  pro- 
gram of  education  for  each  patient  and  his 
family.  The  program  is  presented  in  stages 
appropriate  to  his  understanding  and  gen- 
eral knowledge  of  his  medical  condition 
and  forthcoming  surgery. 

We  find  that  patients  respond  in  a  more 


positive  manner  after  surgery  if  the\  ai 
told  that  various  members  of  the  nursm 
team  will  be  involved  in  their  postopcn 
five  care,  and  that  the  prograin's  nursj 
practitioner  will  be  responsible  for  the  inij 
tial  bulb  manipulations  for  both  male  an ' 
female  patients.  The  nursing  orderlies 
however,  play  a  vital  role  in  teaching  th 
adult  male  patient  to  operate  his  sphincter. 

It  is  also  helpful  to  identify  and  allay  . 
patient's  fears  and  those  of  his  family.  Thi 
patience  and  understanding  displayed  b} 
the  nursing  staff  have  proved  to  be  the  ke} 
to  gaining  a  patient's  confidence  am 
cooperation.  He  needs  a  great  deal  of  emo 
tional  support,  as  the  postoperative  courst 
is  often  tedious  and  lengthy. 

The  surgery  itself,  and  the  expected  re 
suits,  must  be  placed  in  the  proper  perspec 
live  for  the  patient.  He  is  told  that  there 
have  been  many  successes  with  the  use  o! 


the  sphincter  in  both  adults  and  children. 
wever.  the  surgery  is  experimental  and 
always  immediately  successful,  as  re- 
ins of  the  sphincter  may  be  required. 
IS  further  told  that  previous  medical 
Jitions.  such  as  a  neurogenic  bladder. 
not  corrected  by  the  sphincter  implant, 
s  the  person's  voiding  pattern  that  will 

ic  altered  by  surgery. 

Discharge  plans 

Planning  for  the  patient's  discharge  is 
un  early  by  the  nurse  practitioner,  in 

Min  with  the  appropriate  disciplines. 

Particular  consideration  is  given  to  the 

equipment  the  patient  will  need  at  home. 

md  the  prophylactic  antibiotics  and  anti- 

pasmodics  the  physician  will  order  for 

lim  as  needed. 

He  is  urged  to  obtain  a  Medic- Alert 
bracelet,  and  to  wear  it  constantly  to  en- 
;ure  ready  access  to  medical  information  if 
lecessary.  Discharge  instructions  are  pre- 
f  )ared  for  him  in  written  form. 

The  nurse  practitioner  w  ill  visit  the  pa- 
ient  at  home  routinely  if  he  is  a  child,  or 
vhen  needed,  if  he  is  an  adult.  If  required, 
lis  problems  will  be  referred  to  the  Vic- 
orian  Order  of  Nurses.  He  is  expected  to 
nake  follow-up  visits  to  his  physician's 
)ffice. 

)evelopment  of  our  program 

Six  months  before  our  program  began, 
he  hospital  administration  as  a  first  step 
ppointed  a  nurse  practitioner  whose  qual- 
ficalions  included  pre\  ious  surgical  and 
eaching  experience.  She  was  to  maintain 

close  liaison  with  the  physician,  nursing 

:am.  and  the  patient,  yet  work  indepen- 
lently.  Her  chief  responsibilities  were  to 
lirecl  an  educational  program  for  the  pa- 
lents  and  staff  and  to  guide  the  nursing 
Jam  in  assessing,  planning,  implement- 
ig  and  evaluating  nursing  care  for  the 
atients  who  were  to  be  in  the  program. 

A  meeting  to  discuss  the  anticipated 
urgery  was  attended  by  nursing  staff 
operating  room,  urology,  and  pediatrics). 
le  nurse  practitioner,  nursing  orderly 
upervisor.     medical    staff    (urologist. 

idiatrician.    and   radiologist),   and   ad- 

inistrative  staff. 

E  CANADIAN  NURSE  —  November  1975 


At  this  time,  the  lines  of  communication 
regarding  doctors'  pre-  and  postoperative 
orders  were  set  out.  It  was  also  decided 
that  all  patients  having  implants  be  cared 
for  in  the  urology  unit.  Now.  however, 
children  in  the  program  are  nursed  on  the 
pediatric  unit. 

Arrangements  were  made  for  obtaining 
equipment  needed  by  the  patient  while  in 
hospital. 

Discharge  plans  were  also  discussed, 
and  a  policy  was  established  to  assure 
early  involvement  of  appropriate  resource 
personnel,  such  as  the  social  service  de- 
partment and  the  Victorian  Order  of 
Nurses. 

The  operating  room  supervisor  chose  a 
team  from  members  of  the  OR  staff,  and 
the  attending  urologi.st  guided  them  in 
their  review  of  the  literature  and  the  pro- 
posed implant  method.  Medical  engineers 
from  the  American  Medical  Systems  Cor- 
poration were  to  be  in  attendance  w  hen  the 
surgery  was  initially  performed.  The 
nurses  on  the  team  adapted  a  pressure 
monitoring  device  to  allow  for  the  exact 
determination  of  pressure  required  for 
each  individual  system;  and  a  water  bath 
tank  to  aid  in  filling  the  sphincter  device, 
to  maintain  a  closed  system  during 
surgery. 

Educational  program 

The  nurse  practitioner,  with  the  assis- 
t;ince  of  the  urologist,  formulated  objec- 
tives to  serve  as  guidelines  for  the  pro- 
gram. 

Her  own  information  base  was  gathered 
from  appropriate  literature,  visual  aids, 
and  direct  observation  of  the  surgery.  She 
also  acquainted  herself  w  ith  the  procedure 
and  program  currently  in  force  at  St. 
Luke's  Episcopal  Hospital  in  Houston. 
Texas. 


■^    Four    records    were    designed   and    used; 

1.  permanent    record   for    physical    history; 

2.  senii-pernianeni  record  for  laboralor\  re- 
sults: 3.  flow  sheet  for  urod\naniic  studies; 
and  4.  inflation  and  deflation  record  for  the 
voidine  schedule. 


The  staff  attended  a  series  of  classes  that 
included:  a  review  of  the  anatomy  and 
physiology  of  the  urinary  system;  diagnos- 
tic methods;  design  and  operation  of  the 
artificial  sphincter;  surgical  procedure; 
nursing  care;  equipment;  special  records;* 
and  discharge  planning. 

The  nursing  staff  were  shown  how  to 
operate  the  sphincter  and  were  supervised 
at  least  twice  before  working  w  ith  patients 
who  had  had  the  implant. 

For  the  staff,  teaching  aids  included 
slides,  overhead  transparencies,  a  film, 
and  x-rays.  Although  some  of  these  had 
been  purchased,  most  were  designed  for 
our  own  program. 

For  adult  patients,  teaching  aids  in- 
cluded anatomical  drawings,  a  patient  in- 
formation booklet,  and  an  operable  model. 

Children  were  helped  to  understand 
their  problem  by  drawings,  diagrams, 
anatomical  models,  and  simulating  their 
operative  course  by  playing  with  dolls. 

Conclusion 

The  use  of  an  artifical  urinary  sphincter 
can  improve  the  physical  and  mental 
well-being  of  persons  who  would  other- 
wise face  a  lifetime  of  incontinence.  The 
staff  and  facilities  at  Foothills  Hospital  are 
making  this  a  reality  for  many  who  have 
the  problem  and  who  have  the  will  to  fol- 
low our  rigorous  and  lengthy  program  and 
to  accept  a  lifetime  prosthesis  as  an  in- 
tegral part  of  themselves. 

References 

1.  Churchill.  Bemard.  Tientmcm  of  iiriiuin- 
incominence  h\  impUiiirahle  nrosthelic  iiri- 
iitiry  .snhincli'r.  Calgar\.  University  ofCal- 
uar\ .  Depl.  of  Surgerv.  Division  o(  L'rol- 
og\.  197.V  p.   I.  (unpublished  paper). 

2.  Scott.  F.  Brantley,  et  al.  Treciimem  ofiiri- 
luiiy  incominence  by  implaniahle  nrosilieiic 
iirinciiy  snhincrer.  Houston.  Texas.  Divi- 
sion of  Urolog).  Ba\lor  College.  197.^.  p. 
1-2.  (unpublished  paper). 

}.  Scon.  F.  Brantley,  et  al.  Treatment  of  uri- 
nary incontinence  by  prosthetic  urinary 
sphincter.  Urology  1;.'<;2.^2.  Mar.  \9'7}. 

4.   Ibid. 

.'>.  Op.  cit..  Churchill,  p.  1 

6.  Op.  cit..  Scott.  Unpublished  paper,  p.  5.  vr 

31 


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TEXTBOOK  OF  MEDICAL-SURGICAL  NURSING 

By  Lillian  S.  Brunner,  R.N.,  M.S.;  Doris  S.  Suddarth,  R.N.,  B.S.N.E.,  M.S.N. 


bii 

lev 


Outstanding  in  its  depth  of  scientific  content  and  in  the  practicality  of  its  a 
cation,  this  leading  text  has  been  heavily  revised  and  updated,  with  much 
material.  In  the  unit.  Assessment  of  the  Patient,  three  new  chapters  have  te 
added:  Clinical  Interviewing  of  Patients;  Physical  Examination  by  the  Nurse;  mi 
Guidelines  for  Writing  Problem-Oriented  Records  to  promote  continuity  of  pa 
care.  Other  new  chapters  include  Care  of  the  Cardiovascular  Surgical  Pal 
and  The  Person  Experiencing  Pain.  Nursing  management  in  various  ell 
situations  is  frequently  outlined  in  tabular  form. 


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examination,  2)  examination  techniques,  3)  examples  of  selected  abnormalite 


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MASSACHUSETTS  GENERAL  HOSPITAL  MANUAL  Oil 
NURSING  PROCEDURES 

By  Department  of  Nursing,  M.G.H.  j 

General  procedures  for  efficient  and  effective  patient  care  are  covered,  as  we  ai 
more  specialized  material  on  cardiac  (including  cardiopulmonary  resuscitatiiil 
respiratory,  urological,  ostomy,  neurological,  orthopedic,  eye,  ear,  and  nose,  bfi 
and  psychiatric  nursing  care.  All  procedures  are  presented  in  a  clear,  stepy 
step  format.  When  necessary,  notes  stressing  the  rationale  behind  a  parties 
step,  critical  techniques,  and  specific  notes  on  good  care  are  also  offered,  v 
content  of  this  book  has  been  rigorously  tested,  reviewed  by  specialists,  k 
approved  by  a  board  of  reviewers  from  the  medical  and  nursing  staffs  at  H 
Massachusetts  General  Hospital.  ' 

$8.95  Illustrated  1975  389  Pa* 


SCIENTIFIC  FOUNDATIONS  OF  NURSING 

By  Madelyn  T.  Nordmark,  R.N.,  M.S.  (N.E.)  and  Anne  W.  Rohweder,  R.N.,  M.N 


This  thoroughly  revised  edition  applies  the  principles  and  facts  from  the  b 
physical,  social  and  behavioral  sciences  to  clinical  nursing.  It  is  expressly  t 
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CARE  OF  THE  ADULT  PATIENT 

Medical-Surgical  Nursing 

By  Dorothy  W.  Smith,  R.N.,  Ed.D.;  Carol  P.  Hanley 
^ermain,  R.N.,  M.S. 

lA  superbly  useful  tool  for  nursing  education  and  prac- 
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ivised,  updated  and  expanded,  and  provides  an  au- 
thoritative basis  for  understanding  the  patient's  thera- 
itic  regimen,  including  surgery,  drugs,  nursing 
rvention  and  rehabilitation.  The  nursing  process  is 
ijtressed  and  pathophysiologic  content  has  been 
expanded.  Each  chapter  emphasizes  assessment  of 

he  physical,  emotional  and  social  needs  of  the  patient 
and  his  family.  New  chapters  include  The  Nursing 
^recess,  Nursing  Assessment,  and  The  Development 
■"rocess. 

519.75  cloth 

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ASIC  PEDIATRICS  FOR  THE 
RIMARY  HEALTH  CARE  PROVIDER 

y  Catherine  DeAngelis,  M.D.,  R.N.,  M.P.H., 
he  goal  of  this  innovative  new  paperback  textbook  is 
)  impart  specific,  pertinent  knowledge  from  the  broad 
eld  of  pediatrics  that  will  be  useful  to  nonphysicians 
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(Organized  into  four  general  areas.  Part  I,  Date  Base, 
iscusses  history-taking,  physical  examination,  screen- 

lig  tests,  and  the  problem-oriented  record.  Part  II, 
herapy,  covers  immunizations  and  nutrition.  Part  III 

I'  'etails  Common  Signs,  Symptoms  and  Diseases  and  is 
rganized  by  organ  systems.  Three  special  chapters 
-on  allergies;  on  acute,  benign,  and  communicable 
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IIAGNOSTIC  PROCEDURES 

Reference  for  Health  Practitioners  and  a  Guide  for 

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avoided  except  in  obvious  instances  such  as  indica- 
tions for  surgery.  Teamwork,  with  a  strictly  colleague 
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SERVING  THE  HEALTH  PROFESSIONS  IN  CANADA  SINCE  1897 
75  HORNER  AVE.,  TORONTO,  ONTARIO  M8Z  4X7       (416)  252-5277 


New  lenses  for  old: 
a  promising  method 
of  treating  cataracts 


The  author  has  been  performing  the  intraocular  lens  implantation 
operation  in  cataract  patients  for  the  past  nine  years.  Although  the 
operation  cannot  be  used  for  all  patients,  it  promises  to  become  one  of 
the  significant  methods  of  treating  this  form  of  blindness  in  our  aging 
population. 


MARVIN  L.  KWITKO 

The  lens  is  a  transparent,  avascular 
biconvex  structure  held  in  position 
behind  the  pupil  by  fibers,  it  is  en- 
tirely surrounded  by  a  capsule  and 
has  a  single  layer  of  epithelial  cells 
beneath  the  anterior  capsule.  The 
lens  has  no  blood  supply,  its 
metabolism  is  mainly  anaerobic, 
and  most  of  its  energy  is  derived 
from  glycolysis. 

The  lens  is  one  of  the  main  refract- 
ing surfaces  of  the  eye.  Because  it 
contains  only  a  few  cells  and  all  of  its 
components  have  approximately  the 
same  index  of  refraction,  the  lens  is 
transparent.  Any  loss  of  transpar- 
ency is  called  cataract  or  lens  opac- 
ity. Cataracts  essentially  arise  from 
protein  denaturation  and  the  ac- 
cumulation of  water  (Frank  W. 
Newell,  "Ophthamology,  Principles 
and  Concepts  "^). 

Cataracts  vary  markedly  in  de- 
gree of  density,  size  and  location 
and  are  due  to  a  variety  of  causes. 
They  occur  most  commonly  in  older 
persons  (senile  cataract)  and  are 
present  to  some  degree  in  almost 
everyone  over  the  age  of  80.  Most 
are  bilateral,  although  the  rate  of 
progression  in  each  eye  is  seldom 
equal.  Traumatic  cataracts  and  con- 
genital cataracts  are  less  common. 

Cataractous  lenses  are  charac- 
terized by  lens  edema,  opacifica- 
tion, necrosis,  and  complete  disrup- 
tion of  the  normal  continuity  of  the 
lens  fibers.  Most  cataracts  are  not 
visible  to  the  casual  observer  until 
they  become  dense  enough  to  cause 
blindness  (Robert  Cook,  "General 
Ophthamology  "2). 


Modem  cataract  surgery  has  become  so 
sophisticated  that  the  average  operation 
takes  about  one  hour,  the  eye  patch  is 
removed  the  next  day  and  the  patient  can 
be  discharged  from  hospital  in  less  than  a 
week.  The  healing  process  generally  takes 
about  6  ueeks.  During  this  time  eye  drops 
are  instilled  on  the  eye  perhaps  once  or 
tw  ice  a  day .  after  which  the  patient  is  fitted 
with  cataract  glasses.  There  are  certain 
disadvantages  to  these  glasses:  the  cosme- 
tic appearance  is  bad.  the  size  of  the  image 
is  larger  than  normal,  doorways  appear 
curved,  the  peripheral  side  vision  is  re- 
stricted, objects  appear  to  be  closer  than 
they  really  are.  and  it  is  not  possible  to  use 
the  operated  eye  with  the  other  eye  until  it 
too  has  been  operated  upon,  (see  table  I) 

For  this  reason  many  cataract  patients 
are  fitted  with  contact  lenses  that  unfortu- 
nately require  a  high  degree  of  manual 
dexterit)  that  older  people  often  lack.  In 
addition,  contact  lenses  cannot  be  used  in  a 
dusty  environment,  in  patients  with  ocular 
allergies,  and  in  those  with  a  medical  eye 
condition  such  as  glaucoma.  This  applies 
to  both  the  hard  and  soft  contact  lenses. 

Because  of  these  problems  a  sizable 
proportion  of  cataract  patients  gi\e  up 
wearing  contact  lenses  even  though  they 
may  have  worn  them  successfully  at  first, 
(see  table  I) 


.Marvin  L.  Kwilko.  M.D..  F.R.C.S.  (C)  is  an 
ophlhalmologist  based  in  Montreal  and  af- 
t'illaled  with  St.  Mar\'s  Hospital.  He  has  writ- 
ten a  textbook  on  glaucoma  published  by 
.Appleton-Cenlurv  Crofts  and  is  presently 
working  on  a  book  on  cataracts  and  cataract 
sureer\ . 


When  Harold  Ridley^  of  England  ii 
planted  the  first  artificial  plastic  len^ 
1949   in   an   eye   that   had   undergon 
cataract  operation,  it  captured  the  imuy 
tion  of  ophthalmologists  everywhere.  : 
single  act.  if  successful,  would  solve  ii 
of  the  cataract  patient's  problems.  Un 
tunately  Ridley's  lens  and  the  ones  th| 
followed  produced  so  many  complicatio 
that   by    1957   the   procedure   had   I 
largely  abandoned. 

It  remained  for  Cornelius  Binkhorst^ 
reevaluate  the  whole  concept  and  his  u  >  i 
resulted  in  a  functional  artificial  lens    H 
first   implant  took  place  in  Hoi  Ian.: 
1958.  At  the  same  time  investigator^ 
other  parts  of  the  world  namely  Great  H: 
tain  (Choyce').  South  Africa  (Epstein^ 
United    States      (Galin^).      U.S.S  i 
(Fyodorov^),     Holland    (Worst'), 
Canada  (Kwitko'°)  persevered  so  thai  \ 
1970    a    workable    successful    series    ■ 
lenses  had  been  developed. 

A  number  of  the  earlier  models  ot 
transplants  had  been  used  in  Canada  ii 
I950's,  but  none  of  these  could  be  cons 
dered  successful  for  the  accompany ii 
complications  were  so  great  that  the  lenst 
had  to  be  removed  and  the  procedui 
abandoned.  The  first  successful  ler 
transplant  performed  in  this  country  too 
place  at  Bellechasse  Hospital.  Montrca 
1 8  December  1966.  The  patient's  eye  pi  ii 
to  surgery  is  shown  in  figure  I  and  the  tiv 
year  follow-up  photograph  is  shown  i 
figure  2. 

The  work  was  later  moved  to  St.  Mary' 
Hospital  where  other  styles  of  artifici; 
lenses  were  used  in  patients  (figures  3  to  .* 
after  the  first  cases  proved  successful. 

The  most  suitable  material  presently  av 
ailable  is  the  highly  transparen 
polymethylmethacrylate  (perspex).  Thi 
acrylic  is  very  light  with  a  specific  gra\it; 
of  1.19.  Processing  does  not  pose  grea 
problems  to  this  acrylic  and  it  has  beei 
shown  to  retain  its  chemical  compositioi 
and  transparency  for  extended  periods  (uj 
to  40  years). 

At  the  present  time,  this  form  of  treat 
ment  is  offered  to  all  eligible  cataract  pa 
tients.  About  one  half  accept  but  the  artifi- 


TABLE  I 

Comparisons  of  the  use  of  intraocular  lenses,  contact  lenses,  and  spectacles. 
(Based  on  original  work  of  Henry  Hirschman.) 


Visual  fields 

Image  size  magnification 

Twenty-four-hour  use 

Good  uncorrected  vision 

Flare 

Prismatic  Displacement 

Binocularity  (use  of  both  eyes) 

Depth  perception 

Useful  in  work  environments  Yes 

with  dust  and  chemicals 

Suitable  for  patients  Yes 

with  tremor,  neurosis, 
conjunctival  problems,  etc. 

Requires  dexterity  on  the 
patient's  part 

Useful  for  the  remainder 
of  the  patient's  life 

Immediate  convalescent  nursing 
care  following  cataract  surgery 

'Aphakic  —  pertaining  to  aphaKia:  having  no  lens  in  the  eye. 


Intraocular 

Contact 

Aphakic* 

Lens 

Lens 

Spectacles 

Full 

Full 

Limited 

1-2% 

7-10% 

30-33% 

Yes 

No 

No 

Yes 

No 

No 

No 

Yes 

No 

No 

Yes 

Yes 

Almost  always 

Frequently 

Rarely 

85°o 

About  50% 

30% 

No 


No 


Yes 


Yes 


No 

Yes 

No 

Yes 

Unlikely 

Likely 

Intense 

Simple 

Simple 

suits  in  90  percent  of  cases.  The  main 
complication  of  the  earlier  lenses  was  en- 
dothelial dystroph\'  of  the  cornea.  TTiis  con- 
dition is  believed  to  have  been  caused  bv 
contact  of  the  lens  supports  with  the 
corneal  endothelium.  The  present  genera- 
tion of  lenses  has  virtually  eliminated  this 
problem. 

Visual  acuity  loss  from  opacification  of 
the  crystalline  lens  is  restored  in  the  most 
natural  manner.  The  visual  field  is  normal, 
and  binocular  vision  is  obtained.  The  pupil 
has  a  diameter  of  3-3. 5mm.  The  natural 


human  lens  has  a  light  transmission  of  only 
65-80  percent  in  patients  over  age  60.  An 
artificial  intraocular  lens  has  a  light  trans- 
mission of  92-94  percent.  In  addtion.  the 
quality  of  the  optical  surfaces  of  the  artifi- 
cial lens  is  better  than  that  of  the  natural 
lens  surface  in  the  older  patient. 

Comparisons  of  the  different  means  of 
restoring  vision  to  the  cataract  patient  are 
summarized  in  table  i .  There  are  distinct 
advantages  with  the  intraocular  lens  over 
both  spectacles  and  contact  lenses  in  both 
unilateral  and  bilateral  senile  cataracts. 

35 


4P 


36 


PLAN 
VltW 


SID£ 
ELEVATION. 


IMPLANT  IN  SITU 


Figures  3A&3B: 

Maltese  Cross  Lens  implanted  in  1968 


Figure  3B 


Figure  4A 


»«DU 


6-0 


jUOl 


17-5 


ALL  MMCWtlONS  IN  MILUMCTCRS 


SECTION  ON  X  X 


Figures  4A&4B: 

Iris  Clip  Lens  implanted  in  1970 


=  CANADIAN  NURSE  —  November  1975 


Figure  48 


37 


CATARACT  OPERATION 


Figure  5A 


Figures  5A&  5B: 

Fyodorov  Iris  Plane  Lens 

implanted  in  1974 


Figure  5B 


Iris  Clip  Lens  after  Federov  (type  2) 


7.5 


5.0 


Loops  and 
Antenna 


RAD  2 


Section  on  XX 
All  Dimensions  in  Millimeters 


References 

1  Newell,  Frank  W.  Onhthahiioloay.  Priw 
pies  and  Concepts.  2ed.  Si.  Louis.  C. 
Mosby  Co..  1969.  p.  287. 

2.Cool<.  Robert  el  al.  General  Ophthalmt 
ogy.  2ed.  Los  Alios.  Calit'ornia.  Laij 
Medical  Publicalion.  I960,  p.   133. 

3.  Ridley.  Harold.  Intraocular  acrylic  lenst 
Jrans.  Opiuhal.  Soc.  U.K.  71:617,  195 

4.  Binkhorsl.  CD.  Iris-supported  artific 
pseudophakia.  A  new  development  in  inti 
ocular  artificial  lens  surgery.  Tran 
Ophthal.  Soc.  U.K.  79:.'i69,  19.S9. 

."^Choyce.  D.P.  The  mark  6.  mark  7.  ai 
mark  8  Choyce  anterior  chamber  implant 
Proc.  Roy.  .Soc.  Med.  .^8:729.  Sep.  196 

6.  Epstein.  E.  Modified  Ridley  lenses.  B//f.. 
Opiuhal.  43:29,  19.i9. 

7.Galin,  M.A.  Intraocular  lens  implant 
.4mer.  J.  Opiuhal.  6.^:932.  Jun.   1968. 

8.Fedorov.S.N.  (Use  of  intraocular  pupillan 
lenses  for  correction  of  aphakia.)  VesU 
Oftal.  78:76.  Sep. /Oct.  196.'i.  (Rus.) 

'^.  Worst,  J.G.F.  Note  on  fixation  of  the  Bin! 
horsl  iris  clip  lens.  Opiuhalmologic 
163:10,  1971. 
lO.Kwilko.  M.L.  Intraocular  lens  implaniatio 
following  cataract  surgery,  ,^-year  folloi* 
up.  University  of  Western  Ontario  .Medic, 
Seminar.  Sept.  11,  1971  London,  Ontaric 
(unpublished  paper).  '^ 


What  the  well-bandaged 
patient  should  wears 


Bandafix  is  a  seamless  round- 
woven  elastic  '"net"  bandage, 
composed  of  spun  latex 
threads  and  twined  cotton. 

Bandafix  has  a  maximum  of 
elasticity  (up  to  10-fold)  and 
therefore  makes  a  perfect 
fixation  bandage  that  never 
obstructs  or  causes  local 
pressure  on  the  blood  vessels 

Bandafix  is  not  air-tight, 
because  it  has  large  meshes;  it 
causes  no  skin  irritation  even 
when  used  for  the  fixation  of 
greasy  dressings.  The  mate- 
rial is  completely  non-reactive. 


Bandafix  stays  securely  in 
place ;  there  are  eight  sizes, 
which  if  used  correctly  will 
provide  an  excellent 
fixation  bandage  for 
every  part  of  the 
body. 


Bandafix  does  not  change  in 
the  presence  of  blood,  pus, 
serum,  urine,  water  or  any 
liquid  met  in  nursing. 

Bandafix  saves  time  when 
applying,  changing  and 
removing  bandages;  the  same 
bandage  may  be  used  several 
times ;  it  is  washable  and 
may  be  sterilized  in  an 
autoclave. 

Bandafix  is  an  up-to-date 
easy-to-use  bandage  in  line 
with  modern  efficiency. 

Bandafix  replaces  hydrophilic 
gauze  and  adhesive  plaster, 
s  very  quick  to  use  and 
has  many  possibilities  of 
application.  It  is  very  suit- 
able for  places  that  otherwise 
are  difficult  to  bandage. 

Bandafix  is  economical  in  use, 
not  only  because  of  its  rela- 
tively low  price  but  because 
the  same  bandage  may  be 
used  repeatedly. 


Bandafix  does  not  fray, 
because  every  connection 
between  the  latex  and  cotton 
threads  is  knotted ;  openings 
of  any  size  may  be  made  with 
scissors  or  the  fingers. 


Bandafix"" 


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THE  CANADIAN  NURSE  —  NovemtMi  1975 


names 


POSTHUMOUS  HONOR 

Colonel  Elizabeth  Smellie's  unique 
contribution  to  nursing  in  Canada  is 
permanently  recorded  on  a  historical 
plaque  erected  by  the  Ontario  Heritage 
Foundation,  an  agency  within  the  Min- 
istry of  Culture  and  Recreation.  This 
is  one  of  several  plaques  erected  during 
1975  to  honor  outstanding  women 
during  International  Women's  Year. 

The  plaque,  which  stands  in  front  of 
the  McKellar  General  Hospital  in 
Thunder  Bay,  Ontario,  was  unveiled 
this  summer.  It  bears  the  following  ins- 
cription: 


COL.  ELIZABETH  SMELLIE  1884-1968 
This  celebrated  Canadian  army  nurse  and  public  health  authorit>  was  born  in  Port  Arthur.  In 
1909  "Beth""  Smellie  became  night  supervisor  at  .McKellar  General  Hospital.  Joining  the 
Royal  Canadian  Army  Medical  Corps  in  1915,  she  served  in  France  and  England.  Elizabeth 
Smellie  was  demobilized  in  1920  and  three  years  later  became  Chief  Superiniendeni  of  the 
Victorian  Order  of  Nurses  for  Canada.  She  re-entered  the  army  in  1940  and  a  year  later 
supervised  the  organization  of  the  Canadian  Women's  Army  Corps.  The  first  woman  to 
attain  the  rank  of  Colonel  in  Canada's  Armed  Forces.  Col .  Smellie  achieved  many  honours, 
including  Commander  of  the  British  Empire  and  the  Royal  Red  Cross  Medal.  After  World 
War  II  she  returned  to  the  V.O.N..  and  retired  in  1947. 


Helen  Glass  (R.N.,  Royal  Victoria 
Hospital,  Montreal:  B.Sc,  M.A., 
M.Ed.,  Ed.D.,  Columbia  University) 
Director  of  the  school  of  nursing.  Uni- 
versity of  Manitoba  was  chosen  July 
nurse  of  the  month  by  the  Manitoba 
Association  of  Registered  Nurses.  She 
is  past  president  of  MARN  and  is  cur- 
rently chairman  of  its  committee  on 
nursing  research  and  of  the  special 
committee  to  compile  a  position  paper 
on  nursing  education  in  Manitoba,  and 
is  the  .MARN  representative  on  the  Man- 
itoba Educational  Research  Council. 
She  is  also  a  member  of  the  Canadian 
Nurses'  Association  special  committee 
on  nursing  research. 


Alberta's  nurse  of  the  year  is  Annie 
Pringle(R.N.,  Royal  Alexandra  Hospi- 
tal, Edmonton),  director  of  nursing  at 
Mountain  View-Kneehill  Nursing 
Home  in  Didsbury.  She  received  her 
award  at  the  annual  convention  banquet 
of  the  Alberta  Association  of  Regis- 
tered Nurses. 


Helen  Evans  (Reg.  N.,  Toronto  General 
Hospital  school  of  nursing:  B.Sc.N., 
University  of  Western  Ontario;  M.S., 
Boston  University)  has  been  appointed 
director  of  nursing.  North  York  Gen- 
eral Hospital,  Toronto.  She  has  been 
assistant  director  of  professional  stand- 
ards. College  of  Nurses  of  Ontario: 
assistant  chairman,  nursing,  at  the  Ger- 
rard  Campus  of  the  Ryerson  Polytech- 
nical  Institute:  and  director  of  nursing 
education,  the  Hospital  for  Sick  Chil- 
dren, Toronto. 


Norma  Hopps  (R.N.,  Regina  General 
Hospital  school  of  nursing;  B.S.N. , 
University  of  British  Columbia)  has  ac- 
cepted a  position  in  Winnipeg  with 
New  Careers,  a  community  health 
worker  program  under  the  direction  of 
the  planning  and  research  branch  of  the 
Manitoba  Department  of  Colleges  and 
Universities  Affairs.  She  was  formerly 
nursing  consultant  with  the  Saskatch- 
ewan Registered  Nurses'  Association. 


Marie  Campbell  (R.N.,  St.  Joseph 
school  of  nursing,  Glace  Bay)  has  been 
appointed  assistant  employment  rela- 
tions officer  with  the  New  Brunswick 
Provincial  Collective  Bargaining 
Councils  for  public  hospital  and  civil 
service  nurses.  She  has  worked  as  a 
staff  nurse  in  Sydney,  Edmonton,  Yel- 
lowknife,  Ottawa,  and  Gatineau. 
While  in  Gatineau  she  became  director 
of  nursing  at  the  Hospital  for  Hand- 
icapped Ch ildren ,  and  was  an  industrial 
nurse  at  Masonite  Canada  Ltd. 

Campbell  will  assist  Glenna 
Rowsell,  PCBC's  Employment  Relations 
Officer,  in  all  aspects  of  collective  bar- 
gaining for  nurses.  She  is  fluently 
bilingual. 

Jean-Claude  Cloutier  (B.Sc.N., 
M.A.H.,  University  of  Montreal)  who 
has  worked  on  the  project  on  legislation 
with  the  Order  of  Nurses  of  Quebec, 
has  been  appointed  assistant  registrar 
and  nursing  consultant  with  ONQ.  He 
has  been  on  the  teaching  faculty  of 
I'Hopital  St-Michel  Archange  of 
Quebec  and  is  currently  itinerant  pro- 
fessor in  community  health  at  the  Uni- 
versity of  Montreal. 


J.C.  Cloutier 


P.  Therriault 


Pauline  Therriault  (R.N.,  Hotel-Dieu 
school  of  nursing,  Edmundston;  B.N., 
University  of  Moncton)  has  been  ap- 
pointed director  of  nursing  education, 
Docteur  Georges  L.  Dumont  Hospital. 
Moncton,  New  Brunswick.  During  her 
career,  she  has  held  positions  of  hospi- 
tal staff  nurse  and  supervisor;  and  nurs- 
ing school  instructor,  assistant  director, 
and  director.  Except  for  a  year  of  gen- 
eral duty  at  Santa  Monica,  California. 
Therriault  has  worked  in  the  province 
of  New  Brunswick. 


. 


Beryl  Caspardy  (R.N.,  Toronto 
General  Hospital  school  of  nursing; 
B.Sc.N..  Univer- 
sity of  Western 
Ontario,  London) 
has  retired  from 
nursing  after  many 
years  of  nursing 
— _         ^  in    various    parts 

Ikjl^ll^i^^      of   Ontario.    She 
^^    ■nH     ^^^  recently  held 
^        hBHI     the    position    of 
director  of  nursing.  Queensway  Gen- 
eral Hospital.  Etobicoke.  Ontario,  and 
plans  to  live  in  Montreal. 

Mary  Irene  Mooney  (R.N..  Saint  John 
General   Hospital  school  of  nursing: 
C.H.  A. .  McGill  University )  has  retired 
as    assistant    di- 
rector of  nursing. 
Saint   John   Gen- 
eral     Hospital. 
Her    45- year   ca- 
reer   as    a    nurse 
has         included 
positions  of  ma- 
tron, Westminster 
!  Hospital,  London, 

Ontario;  district  matron  of  Medical  Dis- 
trict No.  2,  London,  Ontario;  and  head 
nurse  and  supervisor  of  various  de- 
partments at  the  Saint  John  General 
Hospital  during  her  27-year  tenure 
there.  She  lives  in  Saint  John  and 
spends  summers  at  St.  Andrews,  N.B. 


Edna  Moore  (R.N..  St.  Paul's  Hospital 
school  of  nursing.  Saskatoon;  Cert. 
P.H.  and  Admin.,  University  of  To- 
ronto) has  retired  as  Regional  Nursing 
Supervisor  of  the  Saskatoon  Rural 
Health  Region  following  32  years  of 
public  health  nursing  service  in  Sas- 
katchewan. 

Her  career  has  included  the  positions 
of  supervisor  in  the  North  Battleford. 
Swift  Current,  and  the  Rosetown- 
Biggar-Kindersley  Health  Regions. 

Judy  Prowse,  past  president  of  the  Al- 
berta Association  of  Registered 
Nurses,  has  been  awarded  the  $1,500 
Abe  Miller  Scholarship.  She  is  study- 
ing toward  a  master's  degree  in  health 


services  administration  at  the  Univer- 
sity of  Alberta.  Until  recently,  Prowse 
was  director  of  inservice  at  the  Royal 
Alexandra  Hospital  in  Edmonton. 


Suzanne  Brazeau  (R.N.,  Ottawa  Gen- 
eral Hospital  school  of  nursing; 
B.Sc.N.,  B.A.,  B.Th.,  M.A.  (Th), 
University  of 
Ottawa)  has  ac- 
cepted the  posi- 
tion of  director  of 
family  planning, 
social  service 
programs  branch. 
Health  and  Wel- 
fare Canada.  She 
was  formerly 
health  education  and  nursing  coor- 
dinator with  the  Canadian  Tuberculosis 
and  Respiratory  Diseases  Association, 
and  a  public  health  nurse,  Ottawa- 
Carleton  Regional  Area  Health  Unit. 

Carolynne  Ross  (R.N..  Winnipeg  Gen- 
eral Hospital;  B.Sc,  University  of  Al- 
berta, Edmonton)  has  been  appointed 
nurse  consultant  with  the  emergency 
health  services.  Province  of  Alberta. 
She  was  the  outpatient  ophthalmic 
nurse  at  the  Charles  Camsell  Hospital, 
Edmonton. 

Her  nursing  experience  includes 
general  duty  at  the  Deloraine  Memorial 
Hospital,  Deloraine,  Manitoba,  The 
Edmonton  General  Hospital,  and  the 
Charles  Camsell  Hospital,  Edmonton. 

Helen  MacDonald,  (R.N.,  St.  Pauls 
Hospital  school  of  nursing.  Saskatoon; 
Dipl.  P.H.N. ,  University  of  Saskatch- 
ewan) has  been  appointed  regional 
nursing  supervisor  of  the  Saskatoon 
Rural  Health  Region. 

Prior  to  joining  the  Saskatchewan 
Department  of  Public  Health  in  1954  as 
a  public  health  nurse,  she  had  been  en- 
gaged in  medical-surgical  nursing  at 
Notre  Dame  Hospital,  North  Bat- 
tleford. and  supervisory  work  at  Ed- 
monton General  Hospital.  As  a  provin- 
cial health  nurse  she  has  served  in 
the  North  Battleford,  Humboldt- 
Wadena,  Weyburn-Estevan.  and 
Saskatoon  Rural  Health  Regions.     ;_^ 


CANADIAN  NURSE  —  November  1975 


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dates 


November  17-21,  1975 

Remotivation-Therapy  course  to  be  held 
at  Douglas  Hospital,  Montreal.  For  In- 
formation, write:  Peter  Steibelt,  Director 
of  Remotivation  Therapy.  Douglas  Hos- 
pital, 6875  LaSalle  Blvd.,  Montreal, 
Quebec  H4H  1R3. 

November  24-23,  1975 

Conference:  "What  are  Health  Care 
Managers  Going  to  be  Doing  in  1980?" 
co-sponsored  by  the  Canadian  College 
of  Health  Service  Executives  and  the 
American  College  of  Hospital  Adminis- 
trators, to  be  held  at  the  Chantecler,  Ste. 
Adele,  Quebec.  For  information,  con- 
tact: Canadian  College  of  Health  Ser- 
vice Executives,  25  Imperial  Street,  To- 
ronto, Ontario,  M5P  1B9. 

November  26-28,  1975 

Workshop  on  clinical  research  underthe 
auspices  of  the  Order  of  Nurses  of 
Quebec  to  be  held  at  Longueuil, 
Quebec.  For  information,  write;  ONQ. 
4200  Dorchester  St.  W.,  Montreal, 
Quebec. 

December  2-3,  1975 

"Nursing  Audit"  study  session  spon- 
sored by  the  Order  of  Nurses  of  Quebec, 
to  be  held  at  the  Holiday  Inn,  50  de 
Serigny,  Longueuil,  Quebec.  For  infor- 
mation, contact:  ONQ,  4200  Dorchester 
Blvd.  W.,  Montreal,  Quebec. 

December  3-5,  1975 

Alberta  Hospital  Association  annual 
meeting  and  convention,  Edmonton.  For 
Information  write:  Alberta  Hospital  As- 
sociation. 10025-1 08th  St.  Edmonton, 
Alta. 

December  4-5,  1975 

Workshop  in  psychodrama  to  be  held  in 
Toronto  under  the  auspices  of  the  Uni- 
versity of  Toronto  faculty  of  nursing.  For 
information,  write:  Dorothy  Brooks, 
Chairman,  Continuing  Education  Pro- 
gram, 50  St.  George  Street,  Toronto, 
Ontario,  M5S  1A1. 

January  13-March  30,  1976 

Course  in  counseling  the  emo- 
tionally/mentally disturbed  patient.  Part 


I,  to  be  conducted  Tuesday  evenings  at 
the  Clarke  Institute  of  Psychiatry,  To- 
ronto. For  information,  write:  Dorothy 
Brooks.  Chairman,  Continuing  Educa- 
tion Program,  Faculty  of  Nursing,  Uni- 
versity of  Toronto,  50  St.  George  Street, 
Toronto,  Ontario,  M5S  1A1. 

January  12-April  5,  1976 

Course  in  counseling  the  emo- 
tionally/mentally disturbed  patient.  Part 

II,  to  be  conducted  Monday  evenings  at 
the  Clarke  Institute  of  Psychiatry,  To- 
ronto. For  information,  write:  Dorothy 
Brooks,  Chairman,  Continuing  Educa- 
tion Program,  Faculty  of  Nursing,  Uni- 
versity of  Toronto,  50  St.  George  Street, 
Toronto.  Ontario,  M5S  1A1. 

January  26-27,  1976 

Seminar:  "Conflicts  in  the  physical  re- 
habilitation team"  to  be  held  at  the  Uni- 
versity of  Ottawa.  For  information,  write: 
Carolyn  Belzile,  Coordinator,  Continu- 
ing Education  Program,  School  of 
Health  Administration,  University  of  Ot- 
tawa, Ontario  KIN  6N5. 

February  6-7,  1976 

Workshop:  Scientific  Writing  for  Nurses, 
to  be  held  at  the  University  of  Toronto 
Faculty  of  Nursing,  Toronto.  For  infor- 
mation, write:  Dorothy  Brooks,  Chair- 
man. Continuing  Education  Program, 
Faculty  of  Nursing,  University  of  To- 
ronto, 20  St.  George  Street,  Toronto, 
Ontario,  M5S  1A1. 

February  9-28,  1976 

Executive  development  program  for 
health  administrators  to  be  held  at  the 
Banff  Centre  School  of  Management 
Studies  at  Banff,  Alberta.  For  informa- 
tion, write:  Program  Manager,  Executive 
Development  Program  for  Health  Ad- 
ministrators, The  Banff  Centre,  School 
of  Management  Studies,  P.O.  Box  1020, 
Banff,  Alberta,  TOL  OCO. 

June  21-23,  1976 

Canadian  Nurses'  Association  annual 
meeting  and  convention  to  be  held  at 
Hotel  Nova  Scotian,  Halifax,  Nova 
Scotia.  Theme:  The  Quality  of  Life,   v, 


ii« 


I    i^P 


strip 


!  "sof  ra-tulle 

The  bactericidal 
dressing 

Compotillon 

A  lightweight  iano-paraffin  gauze  dressing  impregnated  wtO 
1%  Soframycin  (framycetin  sulphate  BP} 

Properties 

The  addition  of  the  antibiotic  Sotramycm  to  the  paraffin  gau2( 
enstifes  the  prevention  or  eradication  ot  superficial  bacteria- 
infection  from  wounds  m  a  few  hours,  thereby  reducing  Ihf 
need  for  systemic  antibiotics 
Sotramycm  is  a  bactericidal  broad  specif  urn  antibiotic,  etfec' 
tive  against  many  organisms  which  have  become  resistant  U 
other  antibiotics,  including 
Staphylococcus  aureus 
Pseudomonas  pyocyanea 
Escherichia  coli 
Proteus  spp 

Sotramycm  is  highly  soluble  m  water  mixes  readily  with  exu- 
dates, and  IS  not  inactivated  by  blood,  pus  or  serum  Although 
il  IS  uncommon  sensitization  to  Sotramycin  may  occur  arMl 
cross-sensilization  between  Sotramycm  and  chemically 
related  antibiotics  eg  Neomycin  Kanamycm  and  Paromomy- 
cin IS  common  Cross  resistance  between  Sotramycm  and  this 
group  of  antibiotics  is  not  absolute 

Advantages 

Rapid  eradication  ot  bacteria  from  the  wound 

Excellent  physical  protection 

Low  incidence  of  maceration  even  after  three  weeks  in  situ 

Non-adherent  can  be  removed  painlessly 

Saves  dressing  time 

Reduces  wastage 

Each  dressing  is  parchment-sheathed  tor  no-touch  handling 

Sensitization  is  uncommon 

IrxJIcallons 

Traumatic:  Lacerations,  abrasions,  grazes  (gravel  rash),  bttes 

(animals  and  insects),  cuts  puncture  wounds,  crush  injuries, 
surgical  wounds  and  incisions,  traumatic  ulcers 
Ulcerative:  Varicose  ulcers  diabetic  ulcers,  t>edsores  tropical 
ulcers 

Ttwrmal:  Burns,  scalds 

Elective:  Skin  grafts  (donor  and  recipient  sites),  avulsion  of 
finger  or  toenails. circumcision 

Miscellaneous:  Secondarily  infected  skm  conditions  —  eg 
eczema,  dermatitis  tierpes  zoster,  colostomy,  acute  parony- 
chia mcised  abscesses  (packing),  ingrowing  toenails 

Contraindications 

Sensitization  to  lanolin  or  to  Sotramycm 

Application 

If  required  the  wound  may  first  t>e  cleaned  A  single  layer  ol 
SOFRA-TULLE  Should  be  applied  directly  to  the  wound  and 
covered  with  an  appropriate  dressing  such  as  gauze  linen  or 
crepe  bandages  in  the  case  of  leg  ulcers,  it  is  advisable  to  cut 
the  dressing  exactly  to  the  size  ol  the  ulcer  m  order  to  minimize 
the  risk  ot  sensitization  and  not  to  overlap  on  the  surrounding 
epidermis  When  the  infective  phase  has  cleared  the  dressing 
may  be  changed  to  a  non-impregnated  one  The  amount  of 
exudate  should  determine  the  frequency  of  dressing  changes 

Precautions 

In  most  cases  absorption  of  the  antibiotic  issosiight  that  it  can 
be  discounted  Where  very  large  body  areas  are  involved  (eg 
30%  Of  more  body  burn)  the  possibility  of  ototoxicity  and'Of 
nephrotoxicity  being  produced,  should  be  remembered 

Packlny 

10  cm  X  10  cm  (4"  X  4"), 

cartons  of  10  and  50  sterile  single  units 
30  cm  X  10  cm  (12"  x  4"), 

cartons  of  10  sterile  single  units 


ROUSSEL 


Roussel  (Canada)  Ltd. 

153  Graveline 

Montreal,  Qu6bec  H4T  1R4 


Now  that  you  ve 
discovered 

antibiotic-impregnated 
^Sofra-TuUe'  in  this 
larger  size  .  .  . 


^o 


-<fe.o^ 


s< 


-c^^" 


=.vc-^ 


<^^ 


.,^> 


strip 


sulP^" 


Nt- 


•  •  •  you're  ready 
for  all  the 
other  interesting 
facts  that  are 
revealed  in  this 
new  audio-visual 
presentation. 


Sofra-Tulle®  is  available 
in  a  10cm  x  30cm  size,  in  addi- 
tion to  the  regular  1 0cm x  10cm 
format.  This  larger  presentation 
provides  three  times  more  cover- 
age to  facilitate  the  handling  and 
dressing  of  larger  lesions. 

Both  sizes  of  Sofra-Tulle 
contain  Soframycin  —  an  anti- 
biotic. Reserved  exclusively  for 
topical  use,  Sofreimycin  has  a 


comprehensive  spectrum  of  activ- 
ity against  organisms  normally 
encountered  in  bums,  ulcers  and 
wounds.  Soframycin  is  present  in 
Sofra-Tulle  in  a  bactericidal  con- 
centration, and  maintains  its  ef- 
fectiveness even  in  the  presence 
of  blood,  pus  and  serum.  The 
mesh  is  wide  enough  to  permit 
good  drainage  of  exudate,  thus 
preventing  maceration. 

ROUSSEL 


!•••••••• 


I  am  Interested  in  seeing  your  new   Sofra-Tulle 
Facts  &  Fallacies"  filmstrip  Please  ask  my  local 
Roussel  Representative  to  contact  me  at  the  ad- 
dress below  at  his  first  opportunity.  Thank  you. 


Name 


Position /Title 


Hospital 


Address 


City 


Prov 


Tel 


»RTM 


Roussel  (Canada)  Ltd. 

153  Graveline  Road 

Montreal,  Quebec    H4T  1R4 


To  arrange  for  a  viewing  of  this  new   Sofra-Tulle 
Facts  &  Fallacies"  filmstrip,  send  this  coupon  to: 
Mr.  D.  Fulcher.  Sofra-Tulle  Product  Ivlanager, 
Roussel  (Canada)  Ltd.,  153  Graveline,  Montreal, 
Quebec  H4T  1 R4. 


research  abstracts 


Neylan,  Margaret  S.  Literature  review: 
maintaining  the  competence  of 
health  professionals,  1970-73. 
Vancouver,  B.C.,  1974.  University 
of  British  Columbia. 

A  critical  review  of  the  health  sciences 
literature  indexed  on  Medline, 
1970-73,  was  undertaken  to  establish 
current  philosophy,  activities,  and 
proposals  regarding  mechanisms  to  as- 
sure the  maintenance  of  competence  of 
health  professionals. 

Ten  factors  were  identified  in  the  lit- 
erature: preparatory  and  advanced  edu- 
cation, accreditation  of  preparatory  and 
advanced  education,  ""credentialing,"" 
■"recredentialing,"  continuing  educa- 
tion, accreditation  of  continuing  educa- 
tion, self-regulation  (assessment,  ex- 
amination, audit,  review),  standards 
for  health  care,  records  for  health  care, 
and  accreditation  of  health  care  agen- 
cies. Factors  such  as  quality  controls  of 
education  within  institutions  were  im- 
plied but  not  discussed. 

Internal  and  external  controls  be- 
come diffuse,  complex,  and  voluntary 
as  the  individual  progresses  from  pre- 
paratory education  to  practice. 

The  relationship  of  continuing  edu- 
cation to  the  mamtenance  of  compe- 
tence is  a  major  issue  in  the  literature. 
Superficially,  recurring  continuing 
education  as  a  condition  of  relicensure 
appears  to  assure  competence.  An 
analysis  of  the  issue,  however,  raises 
grave  doubts  about  this  assumption. 

Although  it  is  recognized  that  con- 
tinued learning  is  essential  to  maintain 
competence,  there  is  increased  recogni- 
tion that  mandatory  continuing  educa- 
tion will  not  assure  competence.  Con- 
tinuing education  can  be  described  as 
necessary  but  not  sufficient.  The  falli- 
bility of  mandatory  continuing  educa- 
tion to  assure  competence  is  based  on 
the  following  problems: 

1 .  Presently,  standards  of  care  stated 
in  observable,  measurable  terms  are  in 
initial  stages  of  development.  It  will  be 
some  time  before  they  are  used  sys- 
tematically and  generally  in  health  care 
delivery. 

2.  Health  care  records  presently  do 
not  lend  themselves  to  indirect  assess- 
ment of  competence. 


3.  As  a  consequence  of  1  and  2,  the 
individual  professional  is  not  easily 
able  to  identify  what  he  needs  to  leam 
in  order  to  maintain  his/her  compe- 
tence. 

4.  Until  continuing  education  can  be 
prescribed  to  overcome  specific  gaps  in 
knowledge  and  skill,  participation  in 
continuing  education  will  not  necessar- 
ily assure  competence. 

Anderson,  Marjorie  Carolyn.  Cardiac 
response  to  showering  activity  in 
convalescent  myocardial  infarction 
patients.  Seattle,  Wash.,  1972, 
Thesis  (M.N.)  U.  of  Washington. 

This  study  measured  the  change  in 
heart  rate  and  other  electrocardio- 
graphic responses  to  a  sitting  versus 
standing  shower  as  performed  by  6 
male  post-myocardial  infarction  pa- 
tients during  their  second  and  third 
weeks  of  hospitalization. 

Data  were  obtained  by  continuous 
portable  electrocardiographic  monitor- 
ing of  the  patients  on  2  different  days 
during  a  sitting  and  standing  shower 
protocol  that  included  rest  and  recovery 
periods,  transportation,  shower,  and 
drying  and  dressing  periods. 

The  data  were  analyzed  for  modal 
heart  rate,  representing  the  most  fre- 
quent heart  rate  recorded  for  each 
period  of  the  protocol,  and  the  maxima! 
heart  rate,  indicating  the  peak  cardiac 
response  to  the  activity.  Modal  and 
maximal  heart  rate  data  and  change  in 
modal  heat  rate  from  rest,  for  each  pa- 
tient, and  the  mean  change  in  modal 
heart  rate  were  plotted  and  presented  in 
graph  form. 

All  except  one  patient  showed  a 
higher  heart  rate  for  the  standing 
shower  and  for  the  dry  and  dress  period 
that  followed  than  they  did  for  compar- 
able periods  during  the  sitting  shower. 
However,  only  3  patients  showed  great- 
er change  in  modal  heart  rate  during 
the  standing  and  the  dry  and  dress 
period  after  this  shower  than  with  the 
sitting  shower. 

The  mean  change  in  modal  heart  rate 
was  an  increase  ot  2U.5  beats  per  min- 
ute and  25.5  beats  per  minute  for  sit- 
ting and  standing  showers  respectively. 


and  a  mean  increase  of  24.5  and  25  ' 
beats  per  minute  respectively  for  th 
associated  dry  and  dress  periods. 

Thus,   the   mean   change   in   mod.; 
heart  rate  for  the  standing  shower  w;, 
only  5.0  beats  per  minute  higher  than 
for  the  sitting  shower  and  only  1.1  beats 
per  minute  higher  forthe  associated  dr\ 
and  dress  period. 

Rour  patients  showed  evidence  i 
1 .0  mm.  or  more  of  S-T  segment  deprc 
sion  during  some  phase  of  the  pn 
tocol,  with  2  of  them  having  S-T  depre 
sion  at  rest.  No  patient  complained  < 
chest  pain  during  the  study.  Only 
isolated  ectopic  beats  were  identifk 
during  the  study. 


Ryan,  Sheila  M.  A  study  of  change  in  n 
hospital:  the  implementation  of 
unit        management        system 
Edmonton,  Alberta,    1972.  Thesis 
(M.H.S.A.)  U.  of  Alberta. 

This  thesis  focuses  on  the  utility  of  2 
theories  of  formal  organizations  in  pro- 
viding an  understanding  of  organiza- 
tional behavior  during  change.  The 
case  study  of  the  implementation  of  a 
unit  management  system  in  4  wards  in  a 
teaching  hospital  shows  that  although 
bureaucratic  characteristics  of  a  hospi- 
tal are  responsible  for  the  stable  and 
dynamic  features  of  the  organization, 
change  emerges  from  a  continual  bar- 
gaining process  between  individuals, 
groups,  and  the  organization. 

Professional  nurses  defend  and  ex- 
tend their  positions  by  coping  with  both 
■"bureaucracy"  and  "negotiated 
order"  and  tradional  organization 
structures  in  the  hospital  are  frequently 
challenged  because  of  complex  rela- 
tionships and  agreements  that  emerge 
through  negotiations.  There  is  evidence 
that  power  in  bargaining  in  the  face  of 
change  depends  on  the  strength  of  per- 
sonal and  professional  goals  of  indi- 
viduals and  groups,  and  that  their  goals 
are  not  necessarily  the  goals  of  the  or- 
ganization. 

The  case  study  demonstrates  that 
Max  Weber's  theory  of  bureaucratic 
organization  and  the  "negotiated 
order"  concept  of  Strauss  and  his  as- 
sociates complement  each  other.       u 


New...readytouse... 
"bolus"  prefilled  syringe. 

Xylocaine'100  mg 

(lidocaine  hydrochloride  injection,  USP) 

For  'Stat'  I.V.  treatment  of  life 
threatening  arrhythmias. 

D  Functions  like  a  standard  syringe. 

ND  Calibrated  and  contains  5  ml  XylocaineV 
D  Package  designed  for  safe  and  easy 
storage  in  critical  care  area 


D  The  only  lidocaine  preparation 
with  specific  labelling 
information  concerning  its 
use  in  the  treatment  of  cardiac 
arrhythmias. 


an  original  from 


Xylocaine®  100  mg 

(lidocaine  hydrochloride  iniection  USP) 

INDICATIONS-Xytocaine  administered  lolra- 
venously  is  specifically  indicated  in  the  acute 
managemeni  of  ( I)  vcnincular  arrhythmias  occur- 
ring during  cardiac  manipulation,  such  as  cardiac 
surgery;  and(2)  life-threateoing arrhythmias,  par- 
ticularly those  which  arc  ventricular  in  ongin.  such 
as  occur  during  acute  myocardial  infarction. 

CONTRAINDICATIONS-Xylocaine  a  contra- 
indicated  (I)  in  pauents  with  a  known  history  of 
hypersensitivity  to  local  anesthetics  of  the  amide 
type,  and  (2)  in  patients  with  Adams-Stokes  syn- 
drome or  with  severe  degrees  of  sinoatnal,  atno- 
ventricuiar  or  intraventricular  block. 

WARNINGS- Constant  monitoring  with  an  elec- 
trocardiograph IS  essential  in  the  proper  adminis- 
tration of  Xylocaine  intravenously  Signs  of  exces- 
sive depression  of  cardiac  conductivity,  such  as 
prolongation  of  PR  interval  and  QRS  complex 
and  the  appearance  or  aggravation  of  arrhythmias, 
should  be  followed  by  prompt  cessation  of  the 
intravenous  infusion  of  this  agent.  U  is  mandatory 
to  have  emergency  resusciutive  equipment  and 
drugs  immediately  available  to  manage  possible 
adverse  reactions  involving  the  cardiovascular. 
respiratory  or  central  nervous  systems 

Evidence  for  proper  usage  in  children  is  limited. 

PRECALTIONS-Caution  should  be  employed 
in  the  repeated  use  of  Xylocaine  in  patients  with 
severe  liver  or  renal  disease  because  accumulation 
mav  occur  and  may  lead  to  toxic  phenomena,  since 
Xylocaine  is  metabolized  mainly  m  the  liver  and 
excreted  by  the  kidney  The  drug  should  also  be 
used  with  caution  in  patients  with  hypovolemia 
and  shock,  and  all  forms  of  heart  block  (sec  CON- 
TRAINDICATIONS AND  WARNINGS). 

In  patients  with  sinus  bradycardia  the  adminis- 
traiion  of  Xvlocaine  intravenously  for  the  elimina- 
tion of  ventricular  ectopic  beats  without  pnor 
acceleration  in  heart  rate  (e.g.  by  isoproterenol 
or  by  electric  pacing)  may  provoke  more  frequent 
and  serious  ventricular  arrhythmias. 

ADVERSE  REACTIONS- Systemic  reactions  of 
the  following  types  have  been  reponed 

(1)  Central  Nervous  System:  lightheadedness, 
drowsiness;  dizziness:  apprehension;  euphoria; 
tinnitus;  blurred  or  double  vision,  vomiting;  sen- 
sations of  heat,  cold  or  numbness;  twitching; 
tremors;  convulsions;  unconsciousness;  and  respi- 
ratory depression  and  arrest. 

(2)  Cardiovascular  System;  hypotension;  car- 
diovascular collapse;  and  bradycardia  which  may 
lead  to  cardiac  arrest. 

There  have  been  no  reports  of  cross  sensitivity 
between  Xylocaine  and  procainamide  or  between 
Xvlocaine  and  quinidine. 

DOSAGE  AND  ADMINISTRATION -Single 
Injection:  The  usual  dose  is  50  mg  to  100  mg 
administered  intravenously  under  ECG  monitor- 
ing This  dose  may  be  administered  at  the  rate 
of  approximately  25  mg  to  50  mg  per  minute. 
Sufficient  time  should  be  allowed  to  enable  a  slow 
circulation  to  carry  the  drug  to  the  site  of  aaion. 
If  the  initial  injection  of  50  mg  to  100  mg  docs 
not  produce  a  desired  response,  a  second  dose  may 
be  repeated  after  10-20  minutes 

NO  MORE  THAN  200  MG  TO  300  MG  OF 
XYLOCAINE  SHOULD  BE  ADMINISTERED 
DURING  A  ONE  HOUR  PERIOD 

In  children  expenence  with  the  drug  is  limited. 

Continaous  Infnskm:  Following  a  single  injection 
in  those  patients  in  whom  the  arrhythmia  tends 
to  recur  and  who  are  incapable  of  receiving  oral 
antiarrhythmic  therapy,  intravenous  infusions  of 
Xylocaine  mav  be  administered  at  the  rale  of  1 
mg  to  2  mg  per  minute  (20  to  25  ug/kg  per  minute 
in  the  average  70  kg  man)  Intravenous  infusions 
of  Xylocaine  must  be  admmisicred  under  constant 
ECG  monitoring  to  avoid  potential  overdosage 
and  toxiaty  Intravenous  infusion  should  be  ter- 
minated as  soon  as  the  patient's  basic  rhythm 
appears  to  be  stable  or  at  the  earliest  signs  of 
toxicity  It  should  rarely  be  necessary  to  continue 
intravenous  infusions  beyond  24  houn.  As  soon 
as  possible,  and  when  mdicated.  patients  should 
be  changed  to  an  oral  antiarrhythmic  agent  for 
mamtei^ncc  therapy 

Solutions  for  intravenous  infusion  should  be 
prepared  by  the  addition  of  one  50  mi  single  dose 
vial  of  Xvlocaine  2*f  or  one  5  ml  Xylocaine  One 
Gram  Disposable  Transfer  Synnge  to  1  liter  of 
appropnate  solution  This  will  provide  a  0.1% 
solution;  that  is.  each  ml  will  conUin  I  mg  of 
Xylocaine  HCl  Thus  I  ml  to  2  ml  per  minute 
will  provide  I  mg  lo  2  mg  of  Xylocaine  HCl  per 
minute. 


45 


rl€^A;  mosby  t€xt9 

H€LP  YOU  CR€>1Te 
L€:^D€R9 


MOSBY 

TIMES  MIRROR 

THE    C    V    MOSBY  COMPANY.  LTD 

86  NORTHLINE   ROAD 

TORONTO,  ONTARIO 

M4B  3E5 


ROOM 


MCDI01KURGI01L  MUR^inC 

New  6th  Edition!  MEDICAL-SURGICAL  NURSING.  By  Kathleen 
Newton  Shafer,  R.N.,  M.A.;  Janet  R.  Sawyer,  R.N.,  Ph.D.;  Audrey  M. 
McCluskey,  R.N.,  M.A.,  ScM.  Hyg.;  Edna  Lifgren  Beck,  R.N.,  M.A.: 
and  Wilma  J.  Phipps,  R.N.,  A.M.;  with  28  contributors.  This  new 
edition  retains  its  traditional  comprehensive  coverage  while 
adding  a  wealth  of  new  material.  A  new  larger  format,  new 
easy-to-read  type,  new  chapters  on  ecology  and  health,  neurologic 
diseases,  musculoskeletal  disorders  and  injuries  are  just  a  few  of 
its  features.  April,  1975. 1,048  pp.,  608  illus.  $17.35. 

A  New  Book!  CLINICAL  IMPLICATIONS  OF  LABORATORY  TESTS. 

BySarkoM.  Tilkian,  M.D.  andMaryH.  Conover,  R.N.,  B.S.N. Ed. :with  1 
contributor.  This  new  text  presents  a  concise  and  comprehensive 
guide  to  the  clinical  significance  of  laboratory  tests.  A  step-by-step 
approach  emphasizes  physiological  implications,  variations,  and 
interrelations  of  laboratory  values.  November,  1975.  Approx.  208 
pp.,42illus.  About  $7.30. 

New  2nd  Edition!  GASTROENTEROLOGY  IN  CLINICAL  NURSING. 

By  Barbara  A.  Given,  R.N,  B.S.N.,  M.S.  and  Sandra  J.  Simmons,  R.N., 
B.S.N.,  M.S.  This  useful  new  edition  offers  a  practical  guide  to  the 
care  of  patients  with  common  gastrointestinal  disorders.  It 
provides  a  systematic  approach  to  each  condition;  and  thoroughly 
examines  the  role  of  the  nurse  in  observation,  interpretation  of 
data,  correlation  of  laboratory  and  treatment  information,  etc. 
June,  1975.  330  pp.,  70  illus.  $8.40. 

A  New  Book!  PATIENT  CARE  STANDARDS.  Sy  Susan  Tucker,  R.N., 
B.S.N.,P.H.N..etal.  This  first-of-its-kind  book  includes  Patient  Care 
Standards  intended  to  guide  the  nurse  in  planning,  implementing 
and  evaluating  nursing  care.  More  than  400  Patient  Care 
Standards  are  divided  into  three  major  sections:  medical-surgical; 
obstetrics;  and  pediatrics.  More  than  70  illustrations  augment  the 
text.  September,  1975.  Approx.  360  pp.,  71  illus.  About  $12.00. 

New   2nd    Edition!    ORTHOPEDIC    NURSING:    A    Programmed 

Approach.  By  Nancy  A.  Brunner,  R.N.,  B.S.N. ,  M.S.  To  assist  the 
nurse  in  learning  orthopedic  nursing  principles,  this  new  edition 
offers  new  and  updated  information  in  this  specialty.  Assuming 
background  knowledge,  this  comprehensive  edition  includes 
material  on  joint  motion,  body  mechanics,  classification  of 
fractures.  Increased  emphasis  on  the  nursing  process  is  noted 
throughout  the  text.  May,  1975.234  pp.,  126  illus.  $7.10. 


46 


New  2nd  Edition!  REVIEW  OF  HEMODIALYSIS  FOR  NURSES 
AND  DIALYSIS  PERSONNEL  (Mosby's  Comprehensive  Re- 
view Series).  SyC.  F.  Gutch.  M.D.  and  Martha  H.  Stoner.  R.N..  M.S. 
Reflecting  recent  advances,  new  equipment  and  techniques, 
this  new  edition  offers  general  background  Infornfiation.  basic 
principles,  and  abroad  overview  of  dialysis,  its  applications  and 
problems.  The  question  and  answer  format  facilitates  greater 
student  understanding.  June,  1975.  276  pp..  illustrated.  $8.95. 

A/ew2ndEd/f/Of7.' ESSENTIALS  OFCOMMUNICABLE  DISEASE. 

By  Mary  Elizabeth  Mclnnes,  R.N..  B.Sc.N..  M.Sc.(Ed.).  Updated 
and  revised,  this  concise  new  edition  can  be  used  as  a  quick 
reference.  Emphasis  is  placed  on  presenting  basic  information 
on  communicable  diseases  still  surrounding  us  in  the  world 
today.  Sections  cover  bacterial  diseases,  enteric  diseases,  viral 
diseases,  arthropod-borne  diseases,  diseases  caused  by  fungi, 
and  Helminth  infections.  July,  1975.  412  pp.,  34  illustrations. 
$10.00. 

New  2nd  Edition!  THE  VITAL  SIGNS,  WITH  RELATED  CLINICAL 
MEASUREMENTS:  A  Programmed  Presentation.  By  Betty 
Mclnnes.  R.N..  B.Sc.N..  M.Sc.(Ed.).  Covering  more  than  basic 
vital  signs,  this  new  text  includes  all  aspects  of  measurement  of 
body  temperature  and  cardiac  activity.  The  authors  provide 
scientific  concepts  that  permit  understanding  and  assessment 
of  the  vital  signs.  Improved  programming  makes  this  edition 
systematic  as  well  as  comprehensive.  January,  1975. 144  pp.,  45 
illus.  $6.60. 

A  New  Book!  THE  NURSING  PROCESS:  A  Scientific  Approach 
to  Nursing  Care.  By  Ann  Marriner,  R.N.,  Ph.D.  This  comprehen- 
sive text  presents  a  compilation  of  various  theoretical  concepts 
of  the  four  phases  of  the  nursing  process:  assessment, 
planning,  Implementation  and  evaluation.  This  is  the  first  book 
of  Its  kind  to  provide  such  detailed  information  for  effective  and 
efficient  nursing  intervention.  Selected  readings  for  further 
explanation  are  presented  at  the  end  of  each  chapter.  June, 
1975.  256  pp.,  illustrated.  $7.10. 

PROBLEM-ORIENTED  MEDICAL  RECORD  IMPLEMENTA- 
TION (Allied  Health  Peer  Review).  By  Rosemarian  Berni,  R.N., 
M.N.  and  Helen  Readey,  R.N.,  M.S.  This  new  book  provides  a 
clear  direct  method  for  effective  use  of  patient  records.  A 
"how-to-do-it"  manual  using  the  "Problem-Oriented  Medical 
Record  '  method  organizes  patient  data  according  to:  problem 
identification  worksheet;  a  written  plan  for  each  proposed 
problem;  flow  sheets  or  graphs;  and  an  automatic,  updated 
index.  1974.  197  pp.,  14  illus.  $6.85. 

A  New  Book!  PLANNING  AND  IMPLEMENTING  NURSING 
INTERVENTION.By  Do/ores  F.  Saxton,  R.N.,  B.S.,  M.A.,  Ed.D.  and 
Patricia  A.  Hyland.  R.N..  B.S.,  M.S.,  M.Ed.  This  unique  new  text 
explores  the  concepts  of  stress  and  adaptation,  problem- 
solving,  and  21  nursing  problems.  Emphasis  Is  on  the  levels  of 
adaptation  and  their  relationship  to  nursing  intervention.  In  an 
integrated  approach,  the  authors  present  the  development  of  an 
assessment  graph  for  use  in  planning  nursing  intervention. 
January.  1975.  200  pp.,  46  illus.  $6.05. 


UNDERSTANDING   INHERITED  DISORDERS.  By 

Lucille  F.  Whaley.  R.N..  M.S.  Basic  concepts  of 
inherited  diseases  are  introduced  in  this  text  by  first 
presenting  general  principles  and  then  outlining  their 
applications  and  exceptions.  Comprehensive  mate- 
rial includes:  the  physical  basis  of  inheritance;  gene 
transmission  in  families;  single  gene  disorders;  etc. 
1974,  232  pp.,  121  illus.  $11.50. 


aiTioiL  erne 


A/ew3/-dEd/f/on/ COMPREHENSIVE  CARDIAC  CARE: 
A  Text  for  Nurses  and  Other  Health  Professionals. 

By  Kathleen  G.  Andreoli.  R.N..  B.S.N. .  M.S.N.;  Virginia 
K.  Hunn,  R.N.,  B.S.N.;  Douglas  P.  ZIpes,  M.D.;  and 
Andrew  G.  Wallace,  M.D.  With  emphasis  on  prevention 
of  cardiac  arrhythmias  and  early  rehabilitation,  this 
new  edition  now  considers  ihe  total  physical  assess- 
ment of  patients  with  coronary  artery  disease. 
September,  1975.  Approx.  288  pp.,  959  illus.  About 
$7.60. 

A  New  Book!  PSYCHOLOGICAL  ASPECTS  OF 
MYOCARDIAL  INFARCTION  AND  CORONARY 
CARE.  Edited  by  W.  Doyle  Gentry,  Ph.D.  and  Bedford  B. 
Williams,  Jr.,  M.D.;  with  8  contributors.  Authorities  from 
many  fields  (nursing,  psychology,  psychiatry,  etc.) 
pull  together  previously  fragmented  information  to 
discuss;  the  coronary  prone  personality;  occupa- 
tional stress  as  a  precursorto  Ml;  coping  in  acute  Ml; 
and  more.  June,  1975.  176  pp.,  8  illus.  $7.30. 

A  New  Book!  CARE  OF  THE  CARDIAC  SURGICAL 
PATIENT.  By  Ouida  M.  King,  R.N.;  with  6  contributors. 
This  new  book  details  all  current  innovations  as- 
sociated with  care  of  heart  surgery  patients.  You'll 
find  discussions  on  cardiopulmonary  bypass  proce- 
dures and  equipment,  profound  hypothermia  with 
total  circulatory  arrest  in  infants,  post-operative 
complications,  and  more!  August,  1975.  292  pp.,  175 
illus.  $13.60. 

A  New  Book!  SPATIAL  ANALYSIS  OF  THE  ELEC- 
TROCARDIOGRAM: A  Program.  By  Irwin  Hoffman, 
M.D.:JulienH.  Isaacs,  M.D.;  James  V.  Dooley.  M.D.;Phll 
R.  Manning.  M.D.;  and  Donald  A.  Dennis,  Ph.D.  A 
reinforcing  question-and-answer  format  helps  you 
master  spatial  analysis  of  any  electrocardiogram.  The 
authors  graphically  demonstrate  the  step-by-step 
approach  with  almost  200  illustrations.  May,  1975. 
160  pp.,  199  illus.  $7.30. 


eiTNITY 


BGH/1VIIOML  9CICnCC 


New  9th  Edition!  SOCIOLOGY:  Nurses  and  their  Patients  in  a 
Modern  Society.  By  Lida  F.  Thompson,  R.N.,  B.S.,  M.S.;  Michael  H. 
Miller,  Ph.D.;  and  Helen  F.  Bigler,  D.N.Sc.  Covering  health  and 
society  from  a  systems  theory  perspective,  this  new  text  provides 
sociological  perspectives  for  students  pursuing  careers  in  health. 
It  demonstrates  sociological  principles  in  terms  of  their  effects  on 
nurses  and  patients.  June,  1975.  290  pp.,  98  illus.  $8.35. 

9th  Edition.  ESSENTIALS  OF  PSYCHIATRIC  NURSING.  By  Doro% 

A.  Mereness,  R.N.,  Ed.D.  and  Cecelia  Monat  Taylor,  R.N.,  M.S.  In  a 
logically  organized  manner,  this  edition  presents  personality 
development,  communication  skills  as  a  therapeutic  tool,  and  the 
use  of  self  therapeutically  in  one-to-one  relationships  and  in 
groups.  Along  with  the  discussions  of  the  emotional  problems  of 
children  and  adolescents,  the  authors  include  material  on 
personality,  use  of  psychiatric  principles,  etc.  1974,  368  pp.,  26 
illus.  $10.45. 

A  New  Book!  A  GUIDE  TO  NURSING  MANAGEMENT  OF 
PSYCHIATRIC  PATIENTS.  By  Sharon  Dreyer,  R.N.,  M.S.;  David 
Bailey,  Ed.D.;  and  Wills  Doucet,  M.Ed.  Based  on  actual  clinical 
cases,  this  unique  new  book  Is  a  practical  guide  forthe  application 
of  psychiatric  nursing  techniques.  Topics  covered  include:  legal 
aspects;  patients  with  problems  related  to  alcohol  and  drug  abuse; 
behavior  disorders  in  children;  and  more.  Each  chapter  concludes 
with  useful  questionssimilartothosefound  on  State  Board  Exams. 
February,  1975.  260  pp.  $6.25. 

A  New  Book!  BEHAVIOR  AND  HEALTH  CARE:  A  Humanistic 
Helping  Process.  By  Jane  E.  Chapman,  R.N.,  Ph.D.  and  Harry  H. 
Chapman,  Ph.D.  This  new  interdisciplinary  text  can  assist  all 
professionals  in  life-saving,  life-sustaining,  and  life-enhancing 
aspects  of  health  care.  Its  conceptual  framework  helps  students 
and  instructors  determine  the  technical,  personal-social  and 
clinical  knowledge  required  in  any  helping  situation.  November, 
1975.  Approx.  216  pp.,  1  illus.  About  $7.90. 


A  New  Book!  PAIN:  Clinical  and  Experimental 
Perspectives.  Edited  by  Matisyohu  Weisenberg. 
Ph.D.  Here,  assembled  in  one  place,  are  selected 
samplesfrom  the  voluminous  literaturedealing  with 
pain.  Almost  all  of  the  nine  major  sections  include 
selections  made  of  both  experimental  and  clinical 
studies  in  the  area.  Topics  include:  "Measurement 
of  Pain,"  "Surgical  Intervention  to  Relieve  Pain, 
and  more!  July,  1975.  398  pp.,  86  illus.  $10.00. 


A  New  Book!  CHRONIC  ILLNESS  AND  THE  QUAL- 
ITY OF  LIFE.  By  Anselm  L  Strauss,  Ph.D.  Emphasiz- 
ing the  psychological  and  social  problems  faced  by 
patients  afflicted  with  chronic  diseases,  this  new 
book  shows  how  people  can  learn  to  live  with 
interruptive  and  difficult  symptoms  or  a  worsening 
of  disease,  and  maintain  a  normal  lifestyle.  Several 
case  studies  add  impact  to  the  presentation.  June, 
1975.  174  pp.  $6.05. 

A  New  Book!  HUMAN  SEXUALITY  IN  HEALTH  AND 

ILLNESS.  By  Nancy  Fugate  Woods,  R.N.,  M.N.  This 
new  book  prepares  your  students  to  help  clients 
cope  with  sexual  problems.  It  discusses  human 
sexual  response  in  a  life  cycle  framework;  adapta- 
tion to  events  that  threaten  sexual  integrity;  and 
adjustment  to  diseases  and  disabilities  which 
interfere  with  sexual  function.  April,  1975.  242  pp.,  7 
illus.  $7.30. 


A  New  Book!  APPLIED  BEHAVIOR  MODIFICATION.  Edited  by  W. 
Doyle  Gentry,  Ph.D.  This  new  text  explores  the  application  of 
behavior  modification  techniques  in:  homes,  with  parents  as 
modifiers;  schools;  mental  hospitals;  prisons,  etc.  It  also  considers 
legal,  moral,  and  ethical  issues  of  such  treatment.  April,  1975.  178 
pp.,  4  illus.  $6.25. 


MOSBV 

TIMES  MIRROR 

THE    C.  V.  MOSBY  COMPANY,  LTD. 
86   NORTHLINE   RQAO 
TORONTO,  ONTARIO 
tVI4B  3E5 


books 


Operating  Room  Orientation  Program 
for  the  New  Graduate  Nurse  by 
Diane  F.  Schoenrock,  Julie  A. 
Kneedler,  and  Carol  J.  Alexander. 
241  pages.  Denver.  AORN,  Inc., 
1974 

Reviewed  by  Linda  Ward,  OR  In- 
structor, and  Jean  Lowery,  Assis- 
tant Head  Nurse.  Cardio-Thoracic 
Unit,  Vancouver  General  Hospital, 
Vancouver,  B.C. 


This  manual  has  been  designed  lo  pro- 
vide guidelines  for  those  planning,  im- 
plementing, and  evaluating  orientation 
programs  for  graduates  new  to  the 
operating  room .  It  is  divided  into  4  sec- 
tions that  combine  to  give  a  total  picture 
of  the  requirements  for  an  orientation 
program. 

Section  I  establishes  the  criteria  for 
initiating  such  a  program.  Incorporated 
in  this  section  are  reasons  for  setting  up 
a  •'learner""  program,  personnel  re- 
sponsible, required  qualifications  for 
instructors,  and  the  interrelatedncss  of 
staff  development  and  orientation.  It 
overs  the  outlined  subject  matter  ade- 
quately, although  such  things  as  re- 
ijuired  qualifications  for  the  orienter 
ivould  vary  from  one  situation  to 
nother,  according  to  the  needs  of  indi- 
I'idual  programs. 

Section  II  deals  with  the  concepts  of 
caching  adults,  needs  of  the  adult 
ducator,  and  methods  of  imparting 
nowledge. 

This  is  beneficial  because  it  provides 
nsight  into  the  concepts  of  adult  educa- 
ion,  a  subject  of  value  to  anyone  con- 
emplating  the  initiation  of  teaching 
Tograms.  Floor  plans  and  photographs 
f  procedure  set-ups  would  necessarily 
lave  to  be  adapted  to  suit  the  individual 
ospital.  as  would  several  other  fea- 
ures.  because  of  impinging  factors 
uch  as  time,  money,  and  policies  of 
arious  institutions. 

Section  III  gives  examples  of  the  or- 
;anizational  tools  that  are  necessary  for 
n  orientation  program.  Included  in 
lese  tools  are  philosophies  of  OR 
ursing,  organizational  charts,  job 
escriptions.  personnel  and 
dministrative    policies,    and    OR 

Procedures .     A    framework    for    an 
rienlation  booklet  is  also  provided  in 
lis  section. 
— 


However,  some  of  the  material  is 
extraneous;  for  instance,  organiza- 
tional charts  of  the  hospital  should  be 
dealt  with  in  a  general  employee  orien- 
tation to  the  hospital,  rather  than  in  one 
that  pertains  to  a  specific  area,  such  as 
the  OR. 

Section  IV  contains  samples  of  in- 
ventories, personnel  experience  re- 
cords, employee  performance  reviews, 
standards  of  performance  for  operating 
room  nurses,  orientation  outlines,  and 
evaluation  of  an  orientation  program. 
The  subjects  of  time  and  money  come 
to  the  fore  again  as  one  studies  the 
length  of  the  suggested  program.  Some 
doubt  is  created  as  to  whether  this  is 
meant  to  be  specifically  an  orientation 
program,  or  a  combination  of  orienta- 
tion and  continuing  education  pro- 
grams. 

Although  this  text  is  lengthy  at  times 
and  repetitious  in  detail,  the  manual 
met  its  objectives  for  providing 
guidelines  for  an  orientation  program 
involving  new  graduates  in  the  OR. 


Canada's  Nursing  Sisters  by   G.W.L. 

Nicholson.  276  pages.  Toronto, 
Samuel  Stevens  and  Hakkert.  Publi- 
cation date:  October  23,  1975. 
The  Nursing  Sisters'  Association  of 
Canada  originated  this  historical 
project.  The  book  is  being  published 
under  the  auspices  of  the  Canadian 
War  Museum  as  one  of  a  series  of 
Historical  Publications. 

This  is  the  first  published  history  of  the 
nursing  sisters  who  have  served  for  al- 
most a  century  with  Canada"s  armed 
forces.  The  author.  Colonel  G.W.L. 
Nicholson,  is  a  well-known  and  highly 
respected  military  historian  who  travel- 
led across  Canada  talking  to  nursing 
sisters  who  participated  in  either  of  the 
two  World  Wars,  the  South  African 
War,  or  the  Korean  Operations. 

The  book  spans  the  activities  of  these 
nursing  sisters  from  1885-1973.  It 
opens  with  a  history  of  eariy  military 
nursing  and  Florence  Nightingale"s  en- 
deavors in  the  Crimean  War.  Chapters 
2  to  12  relate  an  exciting  account  of 
how  these  nursing  sisters  took  their 
place  among  the  men  of  this  country 


and  went  to  war.  The  book  describes 
how  they  coped  on  the  battlefields,  in 
the  casualty  clearing  stations,  and  with 
the  evacuation  of  the  wounded  by  land, 
sea.  and  air. 

Detailed  accounts  are  offered  of  the 
nurses  who  served  in  the  Air  Force  and 
Navy,  and  how  the  Department  of  Vet- 
eran Affairs"  hospitals  and  the  post-war 
programs  of  the  nursing  sisters  in  the 
Canadian  Forces  were  established. 

The  reader  should  not  expect  to  find 
in  this  book  the  light  comedy  of 
■"MASH"":  remembering  those  tragic 
times  brings  tears  to  the  eyes  of  man>  of 
the  heroines  of  ■■Canada"s  Nursing  Sis- 
ters . " " 

It  is  appropriate  that  this  book  should 
be  published  in  Intemational  Women's 
Year,  but  after  reading  this  account  of 
our  nursing  sisters  the  reader  must  con- 
clude that  they  have  had  equality  for 
years.  For  anyone  who  is  a  nurse  or  a 
lover  of  history  this  is  a  book  to  re- 
member. 


Approaches  to  the  Care  of  Adolescents 

by  Audrey  J.  Kalafatich.  241  pages. 
New  York.  Appleion-Century 
Crofts.  1975. 

Reviewed  by  Betsy  La  Sor,  A  ssistant 
Professor.  University  of  British 
Columbia,  Vancouver,  B.C. 

Most  curricula  in  nursing  education 
today  present  a  strong  foundation  in 
growth  and  developmental  stages, 
primarily  Erikson  and  Havinghursl.  In 
this  book  one  developmental  stage  is 
explored  in  depth  with  reference  to 
those  theorists. 

The  editor  introduces  this  book  by 
explaining  that  it  was  written  as  a  result 
of  a  continuing  education  workshop  on 
the  same  topic.  Initially  this  reader  was 
struck  by  the  rather  simplistic  presenta- 
tion and  redundant  quality  of  the  mater- 
ial. At  times  it  was  felt  that  the  ambi- 
ence was  a  workshop  one.  focusing  on 
a  review  of  many  areas  of  nursing. 

The  intended  audience  includes  the 
undergraduate  nursing  student,  but  it  is 
also  considered  a  resource  book  for 
other  nursing  personnel  who  have  pro- 
fessional contact  with  adolescents. 

(Continued  on  page  50) 


HJANADIAN  NURSE  —  November  1975 


49 


Next  Month  in 

The 

Canadian 
Nurse 


•  Coming  of  Age 
in  Nursing 

•  Is  There  Sex  Discriniinuiion 
in  Heallh  Care? 

•  Caring  for 

the  Untreated  Infant 

•  MANpower  in  Nursing 


^^P 


Photo  Credits 

for  November  1975 


Cover  I 

Detail  from  the  Third  Canadian 
Stationary  Hospital.  France.  Gerald 
E.  Moira.  part  of  the  Collection  of 
the  Canadian  War  Museum. 
National  Museum  of  Man,  National 
Museums  of  Canada.  (See  Canada's 
Nursing  Sisters,  p.  49) 


Dept.  of  Biomedical 
Communications 
U.B.C..  Vancouver.  B.C. 
pp.   1.^.  14.   l.'^ 

M.  Kwiiko, 

Montreal.  Quebec. 

pp.  36.  .^7.  .^8 


books 


(Continued  from  page  49) 


The  material  either  overlaps  much  of 
what  is  included  in  other  areas  of  nurs- 
ing or,  specializes  in  selected  areas, 
e.g..  the  chapters  on  venereal  disease, 
obesity,  and  the  unwed  mother.  Al- 
though the  material  on  adolescent  sui- 
cidal behavior  is  specialized,  the  infor- 
mation on  depression  is  excellent  and 
adaptable  to  any  clinical  area. 

An  overall  impression  of  this  book  is 
that  it  has  reviewed  much  material  that 
is  already  available  in  more  complete 
form. 

The  most  informative  chapter  and 
the  most  engaging  theoretical  input  is 
written  on  approaches  to  the  hos- 
pitalized teenager.  The  majority  of  this 
chapter  is  written  in  the  form  of  2  case 
histories.  There  is  a  very  sophisticated 
integration  of  an  analysis  of  psychoso- 
cial development  and  various  specific 
behaviours  exhibited  in  this  growth  and 
developmental  stage.  The  interventions 
include  the  approach  to  the  patient  as 
well  as  the  family  and  covers  a  span  of 
time  over  one  year.  A  clearly  defined 
rationale  follows  specific  intervention 
techniques.  The  focus  follows  from 
acute  care  to  the  rehabilitative  aspects 
of  chronic  care. 

The  chapters  are  written  by  clini- 
cians from  one  section  of  the  U.S. 
There  is  a  sense  that  each  is  an  excellent 
clinician  and  that  they  share  a  close 
colleague  relationship.  It  is  refreshing 
to  read  about  experiential  knowledge 
along  with  theory  instead  of  a  sterile 
presentation  of  theory  alone. 

Community  agencies,  including 
health  care  agencies  as  well  as  schools, 
are  explored  in  some  depth  and  al- 
though statistical  quotes  are  frequently 
presented,  and  often  rather  old,  the 
general  message  is  clear  and  useful. 
There  would  be  value  in  this  specific 
content  area  for  students  in  public 
health  if  the  material  presented  contri- 
buted something  new  and  refreshing.  It 
was  in  this  section  that  the  redundant 
and  simplistic  manner  of  communicat- 
ing was  felt. 

If  one  teaches  in  a  curriculm  that 
clearly  focuses  on  specific  maturational 


stages,  such  a  book  could  conceivab 
be  used  as  a  text.  In  the  overall  prese 
tation.  however,  this  book  would  see 
to  be  most  useful  as  a  student  and 
culty  reference. 


accession  list 


Publications  recently  received  in  i 
Canadian  Nurses"  Association  Libi 
are  available o//  loan  —  with  the  exc. 
tion  of  items  marked  R  —  to  CNA  mc 
bers,  schools  of  nursing,  and  othei 
stitulions.  Items  marked  R  include  ; 
er'ence  and  archive  material  that  d 
not  go  out  on  loan.  Theses,  also  R, 
on  Reserve  and  go  out  on  Interlibr.. 
Loan  only. 

Requests  for  loans,  maximum  3  ai 
time,   should  be  made  on  a  standai 
Interlihrary  Loan  form  or  by  letter  l 
ins:  author,  title  and  item  number  in  ; 
lisl. 

If  you  wish  to  purchase  a  book,  c 
tact  your  local  bookstore  or  the  p 
lisher. 

BOOKS  AND  DOCUMENTS 

1 .  .'1/m//<J('W  of  hospital  management  stnJ ui^ 
Ann  .^rbor.  Mich..  Cooperative  Informatioi 
Centre  for  HoNpital  Management  Studies.  Uni 
versity  of  Michigan.  \97S.  433p.  R 

2.  .American  Hospital  Association.  Coniniittet 
on  Infections  Within  Hospitals.  Infection  coniro, 
ill  llie hospital .  3ed.  Chicago,  111..  cI974.  l9,Sp. 
y.  Andrews.  Theodora.  A  bibliography  of  iht 
socioeconomic  aspects  of  medicine.  Littleton 
Colo..  Libraries  Unlimited.  \915.  209p. 
4  .^zarnoff.  Pat  and  Flegal,  Sharon.  A  pediairii 
play  program.  Developing  a  therapeutic  play 
program  for  children  in  medical  settings.  Spring- 
field. Charles  C.  Thomas.  cigT.-i.  lo:p. 
-^  Baeyer.  Renata  von.  The  hotplate  cookbook. 
Rev.  ed.  Vancouver.  Vancouver- Burrard  Pres- 
byierial  United  Church  Women.  1974.  9.'ip 

6.  Bernard.  Henri.  Le pelerinage:  iine  reponsea 
i alienation  des  malades  el  infirmes.  Montreal. 
Oratoire  Saint-Joseph  du  Mont-Royal.    1975. 

:4.sp. 

7.  Bernzv^eig,  Eli  P.  The  nurse's  liabiliry  for 
malpractice:  a  programmed  course.  2ed.  New 
York.  McGraw-Hill.  1975.  290p. 
S.  Building  for  the  future.  Kansas  City.  Mo., 
American  Nurses'  Association.  cl975.  54p. 

9.  Calnan.  James  and  Monks,  Brenda.  How  to 
speak  and  write.  A  practical  guide  for  nurses. 
London.  Heineman,  cl975.  I78p.  j 

10.  Canadian  Council  on  Social  Development. 
Annual  report.  Ottavsa.  Ont..  Canadian  Council 
on  Social  Development.  1975.  n.p. 

1 1.  Canadian  Nurses'  Association.  Countdown: 
Canadian  nursing  statistics.  Ottawa.  Canadian 


accession  list 


. 


Nurses'  Association,  1975.  I34p. 
12.  Canadian  Librar>  Association.  Annual  re- 
ports. 1974-7?.  Ottawa,  Canadian  Librar\  As- 
sociation. 1975.  64p. 

13  Canadian  Medical  Association.  .Annual 
meeting  Reports  to  the  General  Council  at  the 
lOSlh  annual  meeting.  Calgary.  June  2J.  24,  25, 
1975.  Ottawa,  CMA  House,  1975.  132p. 

14.  Canadian  medical  directory.  1975.  Don 
.Mills.  Seccombe  House,  1975.  268p.  R 

15.  Canadian  periodical  inde.x.  Ottawa.  Cana- 
dian Librarj  .Association  and  National  Librarj  of 
Canada.  1975.  454p.  R 

16.  Comprehensive  pediatric  nursing,  edited  by 
Gladys  M.  Scipien  et  al.  New  York.  McGraw- 
Hill,  CI975.  975p. 

17.  IDeAngelis,  Catherine.  Basic  pediatrics  for 
the  primary  health  care  provider.  Boston,  Little, 
Brown.  cl973,  cl975.  397p. 

18  La  defense  des  droits  de  /'  enfant:  respectons 
lenfanl  et  son  droit  d'etre  heureu.x.  Montreal, 
L"Association  canadienne  pour  la  Sante  mentale. 
Division  du  Quebec,  1974.  160p. 

19.  Dison.  Norma  Greenler.  Clinical  nursing 
techniques.  3ed.  St.  Louis.  .Mosby.  1975.  389p. 

20.  Fielo,  Sandra  B.  .4  summary  of  integrated 
nursing  theory.  Toronto,  McGraw-Hill,  cl975. 
186p 

21.  Ford.  Ann  Suler.  The  physician's  assistant. 
.4  national  and  local  analysis.  New  York, 
Praeger,  cl975.  254p. 

22.  Gentry,  William  Doyle  and  Williams.  Red- 
ford  B.  eds.  Psychological  aspects  of  myocardial 
infarction  and  coronary  care.  St.  Louis.  Mosby. 
1975.  I62p. 

23.  Given,  Barbara  A.  and  Simmons,  Sandra  J. 
Gastroenterology  in  clinical  nursing,  led.  St. 
Louis,  Mosby,  1975.  3l6p. 

24.  Grinker  Roy  Richard.  Psychiatry  in  broad 
perspective.  New  York.  Behavioral.  cl975. 
262p. 

25.  Gutch.CF.  and Sloner.  Martha H./ffi/Vivo/ 
hemodialysis  for  nurses  and  dialysis  personnel. 
2ed.  St.  Louis.  Mosby.  1975.  259p. 

26.  Hamilton,  Persis  Mary.  Basic  maternity 
nursing.  3ed.  St.  Louis,  Mosby.  1975.  248p. 

27.  Handling  special  materials  in  libraries. 
Edited  by  Frances  E.  Kaiser.  New  York.  Special 
Libraries  Association.  1974.  164p. 

28.  Hospital  Research  and  Educational  Trust 
On-the-job  training:  a  practical  guide  for  food 
senice  supervisors.  Chicago.  III.,  cl975.  89p. 

29.  Howard- Jones,  Norman.  The  scientific 
background  of  the  International  Sanitary  Confer- 
ences 1851-1938.  Geneva,  World  Health  Or- 
ganization, 1975  llOp.  (WHO  History  of  inter- 
national public  health,  no.  1) 

30.  Jenkins,  Astar  L.  1912-  ed.  Emergency  de- 
partment organization  and  management.  St. 
Louis,  Mosby.  1975.  256p. 

31.  Kelly,  Lucie  Young,  Dimensions  of  profes- 
sional nursing.  3ed.  New  York,  MacMillan. 
cl975.  573p. 

32.  Kohnke,  Mao  F   «'  "1.  Independent  nurse 


practitioner.  Garden  Grove.  Calif  .  Trainex. 
cl974.  180p. 

33  Larkin.  E.J.  The  treatment  of  alcoholism: 
theoiy.  practice  and  evaliuiiion.  Toronto.  .Addic- 
ton  Research  Foundation  of  Ontario,  c  1974.  73p. 
(WHO  Program  report  series  no.  I) 

34.  Lenburg.  Carrie  B.  ed.  Open  learning  and 
career  mobility  in  nursing.  St.  Louis.  Mosby, 
1975.  397p. 

35.  Liaison  meeting  with  nursinglmidwifery 
associations  on  WHO's  European  nurs- 
inglmidwifery programme.  Copenhagen.  26-28 
June  1974.  Report.  Copenhagen.  World  Health 
Organization.  Regional  Office  for  Europe.  1975. 
27p. 

36.  McWilliams.  Rose  Marie  et  al.  Every  OR 
supervisor  should  know.  Denver.  Colo. .  Associa- 
tion of  Operating  Room  Nurses.  cl974.  498p. 

37.  Marriner.  Ann.  The  nursing  process:  a  scien- 
tific approach  to  nursing  care.  St.  Louis.  Mosbv . 
C1975.  24lp. 

38.  Mayhew.  Lewis  B.  and  Ford.  Patrick  J.  Re- 
form in  graduate  and  professional  education .  San 

Francisco.  Jossey-Bass,  1974.  254p.  (Jossey- 
Bass  Series  in  Higher  Education) 

39.  Measuring  the  qiudity  of  library  service,  by 
M.G.  Fancher  Beeler  et  al.  Metuchen,  N.J. 
Scarecrow,  1974.  208p. 

40.  National  Commission  on  Libranes  and  In- 
formation Science.  A  national  program  Jor  li- 
brary information  services.  2d  draft. 
Washington,  1974.  I23p. 

41.  National  League  for  Nursing.  Dept.  of  Dip- 
loma Programs.  Strategies  for  effective  teaching 
— a  basis  for  creativity.  Papers  presented  at  four 
1973  Workshops,  held  at  Buffalo.  Indianapolis. 
Pittsburgh,  and  Atlanta.  New  York.  cl975. 
I95p.  (NLN  Publication  no.  16-1538) 

42. — Bylaws  as  amended  May  1975.  New  York. 
National  League  for  Nursing.  1975.  24p. 

43.  Newell.  Kenneth  W.  ed.  Health  by  the  peo- 
ple. Geneva.  World  Health  Organization.  1975. 
206p. 

44.  — .  Participation  et  sante.  Geneve.  Organi- 
sation Mondiale  de  la  Sante.  1975.  223p. 

45.  Ontario  Hospital  Association.  Dietetic  Ser- 
vices. Film  and  textbook  references.  Don  Mills, 
1975.  78p. 

46.  Parad,  Howard  J.  ed.  Crisis  intervention: 
selected  readings.  New  York,  Family  Service 
Association  of  America,  cl965.  368p. 

47.  Rothenberg,  Robert  E.  The  complete  book  of 
breast  care.  New  York,  Crown,  cl975.  244p. 

48.  Payne,  Stanley  L.  The  art  of  asking  ques- 
tions. Princeton.  N.J.,  Princeton  University 
Press.  1973,  cl95l.  249p. 

49.  Prior,  John  A.  Le  diagnostic  clinique.  Inter- 
rogatoire  et  e.xamen  du  malade.  Edile  par...  et 
Jack  S.  Silberstein.  4ed.  Traduit  de...  Physical 
diagnosis..., par  Philippe  Dionne.  St.  Hyacinthe, 
Quebec,  Edisem,  cl974.  457p. 

50.  Professional  nursing  guide.  1974.  Rich- 
mond. Va..  Health  Publications.  Inc.,  cl974. 
64p. 


51.  Readings   in   hospital   central   ser\uc 
Chicago  III  .   .American  Hospital   .Association. 
1975    |63p. 

52  Russell.  O  Ruth.  Freedom  to  die.  Moral  and 
legal  aspects  of  euthanasia.  New  'lork.  Human 
Sciences  Press.  cl975.  352p. 

53.  Saxton.  Dolores  F.  and  Haring.  Phyllis  W. 
Care  of  patients  with  emotional  problems.  A  te.xt- 
hook  for  practical  nurses,  lei.  St.  Louis,  Mosby, 
1975.  109p. 

54.  Schaefer,  Halmuth  H.  Behavioral  therapy. 
by...  and  Patrick  L.  .Manin.  Toronto.  McGraw- 
Hill.  C1969.  1975    378p. 

55.  Schaefer.  .Morris.  Administration  of  en- 
vironmental health  programmes:  a  systems  view. 
Geneva.  World  Health  Organization.  1974. 
242p  (World  Health  Organization.  Public  Health 
Papers.  No.  59» 

56  Schechter.  Daniel  S  Agenda  for  continuing 
education.  .A  challenge  to  health  care  institu- 
tions. Chicago.  Ill  ,  Hospital  Research  and  Edu- 
cational Trust.  cl974.  1  I2p 

57  Schoenrock.  Diane  F.  and  Kneedler.  Julie  A. 
Operating  room  orientation  program  for  the  new 
graduate  nurse.  Denver.  Colo..  Association  of 
Operating  Room  Nurses.  cl974.  241p. 

58.  Selbv.  Philip  Health  in  1980-1990.  A  per- 
spective based  on  an  international  inquiry  Spon- 
sored by  The  Henry  Dunani  Institute  of  the  Red 
Cross.  Geneva  and  Sandoz  Ltd  .  Basle  Basel. 
Karger.  1974.  85p  (Perspectives  in  medicine  no. 
6) 

59  Selkun.  Ewald  E.  ed.  Basic  physiology  for 
the  health  sciences.  Boston,  Little,  Brown, 
C1975.  662p. 

60.  Shafer.  Kathleen  Newton  et  al.  Medical- 
surgical  nursing,  bed.  St  Louis,  Mosby,  1975. 
I032p. 

61.  Smart,  Reginald  G.  and  Fejer,  Dianne.  Drifg 
education:  current  issues,  future  directions.  To- 
ronto, Addiction  Research  Foundation  of  On- 
tario, c  1974.  I  I2p.  ( Its  Program  repon  series  no. 
3) 

62  Sobol,  Evehn  G.  and  Robischon,  Paulelte. 
Family  nursing:  a  study  guide,  led.  St.  Louis. 
Mosby,  1975."  182p. 

63.  Southern  Regional  Education  Board.  Coun- 
cil on  Collegiate  Education  for  Nursing.  Meet- 
ing. 22nd,  Oct.  30— Nov.  1,  1974.  Atlanta.  Ga. 
Report  of  Regional  planning  for  nursing  project: 
Atlanta.  Ga..  1974.  105p 

64.  Sproul.  Carmen  Warner  and  .Mullanney  .  Pat- 
rick J.  eds.  Emergency  care:  assessment  and  in- 
tervention St.  Louis.  Mosby.  1974.  406p. 

65  Strauss.  Anselm  L.  Chronic  illness  and  the 
qualify  of  life .  St.  Louis,  Mosby,  1975.   160p. 

66  Taba,  Hilda.  Curriculum  development: 
theory  and  practice .  New  York,  Hancourt,  Brace 
&  World,  C1962.  526p. 

67.  Thompson,  Lida  F.  et  al.  Sociology:  nurses 
and  their  patients  in  a  modern  society.  9ed.  St. 
Louis.  Mosby.  1975.  280p. 

68.  Vander.  Arthur  J.  et  al.  Human  physiology: 

(Continued  on  page  52) 


IE  CANADIAN  NURSE  —  Novemtjef  1975 


accession  list 


(Continued  from  page  51) 


the  mechanisms  of  body  Jiimtions.  Toronto. 
McGraw-Hill.  cl970.  610p. 

69.  Verhonick.  Phyllis  J.  ed.  Nursing  research 
I.  Boston,  Little.  Brown.  cl975.  240p. 

70.  Vickery,  Donald  M.  Triage:  problem- 
orienled  sorting  of  patients.  Bowie.  Md..  Robert 
J.  Brady.  cl975.   I04p. 

71.  Visiting  Nurse  As,sociation  of  New  Haven. 
New  Haven.  Conn.  Child  health  conference  — 
nurses'  resource  manual.  New  York.  National 
League  for  Nursing.  cl97.'i.  127p.  (League  ex- 
change no.  101) 

72.  Visiting  Nurse  Association.  Inc..  Burling- 
ton. Vermont.  The  problem-oriented  system  in  a 
home  health  agency  —  a  training  manual.  New 
York.  National  League  for  Nursing.  1975.  127p. 
(The  League  exchange  no.  10.^) 

7.1.  Winnipeg  Centennial  Symposium.  Centen- 
nial Concen  Hall.  Winnipeg.  Oct.  21-iO.  1974. 
Dilemmas  of  modern  man.  Winnipeg.  Great- 
West  Life,  1975.  192p. 

74.  World  Health  Organization.  The  work  of 
WHO.  1974.  Annual  report  of  the  director- 
general  to  the  world  health  assembly  and  to  the 
United  Nations.  Geneva.  World  Health  Organi- 
zation, 1975.  .142p.(ltsOfncial  records  no.  221) 

75.  World  health  statistics  annual .  Vol.  i  Health 
personnel  and  hospital  establishments.  Geneva. 
World  Health  Organi/aiion.  1975.  202p. 

76.  The  world  of  learning.  1974-197^.  London. 
Europa.  1974.  2v.  R 

PAMPHLETS 

77.  American  Nurses'  Association.  Becoming 
aware  of  cultural  differences  in  nursing. 
Speeches  presented  during  the  48th  Convention. 
Kansas  Cily.  .Mo..  American  Nurses'  Associa- 
tion. 197.1.   I5p. 

78.  — .Schools  of  nursing:  a  directory  of  RN 
programs,  Kansas  City.  Miss.,  American 
Nurses"  Association.  1974.   Iv.  (unpaged) 

79.  Association  of  Nurses  of  Prince  Edward  Is- 
land. Folio  of  reports.  1975,  Charlottetown. 
1975    22p. 

80.  Baric.  Leo.  Conformity  and  deviance  in 
health  and  illness.  Geneva,  International  Journal 
of  Health  Education,  1975.  I2p.  (Suppl.  to  Vol. 
18.  no.  1) 

81.  Barman.  Alicerose.  Motivation  and  your 
child.  New  York.  Public  Affairs  Commillee, 
cl975.  20p.  (Public  affairs  pamphlet  no.  52.1) 

82.  Dickman.  Irving  R.  Independent  living:  new 
goal  for  disabled  persons.  New  York.  Public 
Affairs  Committee,  cl975.  28p.  (Public  affairs 
pamphlet  no.  522) 

83.  Hospital  for  Sick  Children  Foundation.  Re- 
port. Year  ending  September  30.  1974.  Toronto. 

1974.   I4p. 

84.  International  Council  of  Nurses.  Policy 
statements.  Geneva.  1974.  pam.  (Its  Pub.  no.  6) 

85.  Materiel  d'enseignement  relatif  a  la 
deonlologie  des  .'ioins  infirmiers.  Geneve.  Con- 
seil  international  des  infirmiers.  1974.  5pts. 

86.  Ozimek.  Dorothy  and  Yura,  Helen.  Who  is 
the  nurse  practitioner.'    New    York.    National 


League  for  Nursing,  Dept.  of  Baccalaureate  and 
Higher  Degree  Programs,  cl975.  I  v.  (unpaged) 

87.  Selected  list  of  reliable  and  unreliable  nutri- 
tion references.  Supplement.  Toronto,  compiled 
by  Ontario  Hospital  Association,  1974.  lOp. 

88.  Street.  Margaret  M.  Canadian  nursing  in 
perspective,  past,  present,  and  future.  An  ad- 
dress by...  15  Nov.  1974  at  the  University  of 
Alberta.  Edmonton.  University  of  Alberta.  1974. 
.lip. 

89.  Teaching  kit  on  nursing  ethics.  Geneva.  In- 
ternational Council  of  Nurses,  1974.  5pts. 

90.  Winnipeg  Centennial  Symposium.  Centen- 
nial Concen  Hall,  Winnipeg.  Oct.  27-.10,  1974. 
Dilemmas  of  modern  man.  Winnipeg  Great- West 
Life.  1975.  192p. 

91.  World  Health  Organization.  Communiry 
health  nursing .  Report  of  a  WHO  E.xpert  Commit- 
tee. Geneva.  1974.  28p.  (Its  Technical  report  no. 
5.58) 

GOVERNMENT  DOCUMENTS 
Canada 

92.  Assurance-chomage  Canada.  Rapport.  Ot- 
tawa, Information  Canada,  1975.   14p. 

9.1.  Canadian  International  Development 
Agency. /?f  Weil- 1970-74.  Taking  stock.  Ottawa. 
1974.  43p. 

94.  Canadian  Permanent  Committee  on  Geo- 
graphical Namef^.Gazeteer  of  Canada.  Ontario. 
Ottawa.  Surveys  and  Mapping  Branch.  Dept.  of 
Energy.  Mines  and  Resources,  1975.  82.1p.  R 

95.  Canadian  Radio-Television  Commission. 
List  of  broadcasting  stations  in  Canada.  Ottawa. 
Information  Canada.  1975.  197p.  R 

96.  Information  Canada.  Federal  services,  Ans 
&  recreation.  —  Citizenship.  —  Employment.  — 
Farming  and  fishing.  —  Health  and  social  secu- 
rity. —  Housing.  —  Senior  Citizens.  —  Youth. 
Ottawa,  cl973,  1975.  8v. 

97  Institut  canadien  d' Information  scientifique 
et  technique .  Repertoire  de  la  recherche  subven- 
tionnee  dans  les  universites  par  le  gouverne- 
menl federale.  Ottawa,  1975.  2v.  R 
98. — .  Societes  scientifiques  et  techniques  du 
Canada.  Ottawa,  Conseil  national  de  recherches 
Canada,  1974.  7p.  R 

Great  Britain 

99.  Joint  Board  of  Clinical  Nursing  Studies.  Re- 
port, Jan.  1975.  London.  Joint  Board  of  Clinical 
Nursing  Studies.  1975.  47p. 

Manitoba 

100.  Task  Force  on  Post- Secondary  Education  in 
Manitoba.  Report.  Winnipeg.  Queen's  Printer. 

1974.  228p. 

Ontario 

101.  Dept.  of  Labour.  Women's  Bureau.  Law 
and  women  in  Ontario.  Toronto.  Dept.  of 
Ubour.  1975.  47p. 

102.  L'Office  de  la  telecommunication 
educative  de  1  Ontario.  Service  de  distribution  de 
bandes    video    au.x    organismes    d'education. 


Toronto,  VIPS/OTEO,  c\974,  208p. 

103.  Ontario  Educational  Communications  Au- 
thority. A  video-tape  program  service  for  educa- 
tional institutions.  Toronto,  VIPS/OECA, 
C1974.  208p. 

United  Slates 

104.  Dept.  of  Health,  Education  and  Welfare. 
Preliminary  findings  of  the  first  health  and  nutri- 
tion examination  survey.  United  States, 
1971-1972:  anthropometric  and  clinical  find- 
ings. By  Sidney  Abraham.  Washington,  U.S. 
Govt.  Printing  Office.  1975.  82p.  (DHEW  Pub. 
no.  (HRA)  75-1229) 

105.  —  Public  Health  Service.  Health  Resources 
Administration.  The  supply  of  health  manpower, 
1970  profiles  and  projections  to  1990.  Washing- 
ton. U.S.  Govt.  Printing  Office,  1974:  222p. 
(DHEW  publication  no.  (HRA)  75-38) 

106.  National  Library  of  Medicine.  B/W/ograpM 
of  the  library  of  medicine.  Belhesda.  Md.  1975 
.109p.  R 

107.  National  Centre  for  Health  Slathtics.  Blood 
pressure  of  persons  18-74  years.  Washington. 
Public  Health  Service,  1975.  23p.  (Vital  and 
health  statistics,  series  1 1,  number  150) 

108.  — .  Distribution  and  properties  of  variance 
estimators  for  complex  multistage  probability 
samples:  an  empirical  distribution.  Washington. 
Public  Health  Service.  1975.  46p.  (Vital  and 
health  statistics  series  2,  number  65) 

109.  — .  Physician  visits:  volume  and  intersal 
since  last  visit.  United  States- 1971 .  Washington. 
Public  Health  Service,  1975.  56p.  (Vital  and 
health  statistics,  series  10,  number  97) 

1 10.  National  Center  for  Health  Statistics.  Self 
reported  health  behavior  and  attitudes  of  youths 
12-17 years.  Washington,  Public  Health  Service, 
1975.  88p.  (Vital  and  health  statistics,  series  1 1, 
number  147) 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLEC- 
TION 

111.  Depuis  qu'on  a  Vermeil. . .  Experience  d'un 
centre  communautaire  pour  personnes  agees, 
janv.  1972-nov.  1973.  Redaction  par  Huguette 
Plante-Granger...  et  al.  Montreal,  Place  Vermeil 
Inc.,  1975.  160p.  R 

112.  Francis,  Margaret  Rose.  Relationships  of 
school  nurses'  verbal  behavior  in  teacher-nurse 
conferences .  and  their  knowledge  of  principles  of 
human  development  and  their  attitudes  toward 
children's  behavior.  College  Park.  Md..  1968. 
146p.  (Thesis-Maryland)  R 

113.  McKay.  Reta  Lynn  (McLeod).  E.xpressed 
needs  of  women  having  abortions.  Vancouver, 
1974.  88p.  (Thesis  (M.Sc.N.)  —  UBC)  R 

1 14.  Melchior,  Lorraine.  Problems  encountered 
by  si.x  mothers  during  the  puerperium  and  their 
perceptions  of  crisis.  London.  1975.  72p.  (Thesis 
(M.Sc.N.)  —  Western  Ontario)  R 

115.  Ryan,  Sheila  M.  A  study  of  change  in  a 
hospital:  the  implementation  of  a  unit  manager 
.nstem.  Edmonton,  1972.  lOOp.  (Thesis  (MHSA) 
—  Alberta)  R  ■§•■ 


52 


"The  more  you 

want  from  iiursing,the 
more  reason 

you  should  be 
n/fedoxr 


Virginia  Flintoft,  R.N.,  Staff  Supervisor 


Do  you  want  to: 

^  increase  the  variety  of  your  work  and  gain 
*  experience  to  help  you  specialize? 


Work  In  a  hospital,  a  nursing  home  or  a  doctor's  office.  Enjoy  as- 
signments in  a  private  residence,  hotel  or  summer  camp.  Perhaps 
you  want  specialized  experience  in  CC,  IC  or  another  field.  Medox 
can  give  you  more  variety. 


worl(  f  or  a  company  that  takes  special  care 
of  its  nurses  in  every  way,  including  pay? 


Medox  employs  the  best  people  at  the  best  rates  of  pay  in  the 
temporary  nursing  field.  You  owe  it  to  yourself  to  contact  Medox. 


free  yourself  from  too  many  mandatory 
shifts  and  shift  rotation? 


Medox  nurses  get  the  best  of  both  worlds:  the  assignments  they 
want  and  the  shift  worl<  they  prefer.  Because  there  are  more  as- 
signments available. 


to  take  advantage  of  free-lance  nursing 
without  the  paperwork? 


When  you  work  with  Medox,  we  look  after  ail  paperwork.  We  pay  you 
weekly  and  make  normal  deductions.  Medox  is  your  employer:  the 
times,  shifts  and  assignments  are  yours  to  choose. 


trade  the  rigid  schedules  of  full-time  nurs- 
ing for  the  flexibility  of  temporary  or  part- 
time  work? 


As  a  Medox  nurse,  you  can  ease  off  the  strict  schedules  of  full-time 
nursing.  Cut  down  to  a  few  shifts  or  split  shifts  a  week:  the  choice  is 
yours. 


choose  to  work  only  one  or  two  days  a 
week? 


As  a  Medox  nurse,  you  can  pick  the  days  you  want  to  work:  you're 
automatically  on  call  for  the  time  you  want.  Medox  nurses  have  more 
time  to  themselves,  they  can  arrange  as  many  'free'  days  as  they 
want. 


work  shifts  that  tie  in  with  your  husband's 
work  schedule? 


Wouldn't  it  be  nice  to  work  the  same  shifts  as  your  husband:  both 
home  together  and  both  earning  good  incomes?  If  his  shifts  change, 
Medox  will  arrange  to  change  yours  too. 


retire  from  nursing,  but  not  completely? 


If  the  idea  of  retirement  appeals  to  you,  yet  not  the  thought  of  forced 
inactively,  becomes  a  Medox  nurse.  Be  retired  on  the  days  you  want. 


^^■^■j  "As  a  registered  nurse 
^Hfj^B  with  more  years  experi- 
H^^^l  ence  behind  me  than  I 
^^^IIJf^B  care  to  think  about,  I 
•  ■  know  how  important  it 
is  to  keep  growing  in  your  job — to 
avoid  that  awful  feeling  of  being 
stuck  in  the  same  rut.  Certainly 
what  you're  doing  is  tremendously 
worth-while,  and  heaven  knows 
there  is  a  desparate  shortage  of 
nurses.  But  your  job  must  be 
worthwhile  to  you.  or  else  you'll 
eventually  want  to  drop  out". 

"That's  why  Medox  has  so  much 
to  offer  a  nurse  today".  "You  see. 


at  Medox.  we  supply  quality  nurs- 
ing staff  on  a  temporary  assignment 
basis  to  hospitals,  clinics,  doctors" 
offices,  nursing  homes  and  private 
residences.  We're  a  part  of  the 
world-wide  Drake  International 
group  of  companies  and  we  operate 
in  major  cities  across  Canada,  the 
U.S.  U.K.  and  Australia". 

"As  far  as  you're  concerned, 
however,  the  key  phrase  is  "Tem- 
porary Assignments".  Because,  as 
you  can  see  by  the  chart  above,  you 
can  choose  just  about  any  working 
condition,  or  shift,  or  professional 
discipline  you  want".   "It  comes 


down  to  this:  if  you  want  more  from 
nursing  than  you're  getting  now, 
talk  to  Medox". 

"Write  to  me.  Virginia  Flintoft, 
R.N..  Staff  Supervisor.  Medox,  55 
Bloor  St.  W..  Toronto,  Ontario,  or 
call  the  local  Medox  office". 


MedoX 


a  DRAKE    INTERNATIONAL  company 

If  you  care  for  people, 
you're  Medox. 


53 


VIEW  WOUND  SITE  THROUGH  ACCESS 

CAP.  REMOVE  CAP  FOR  EXAMINATION  AND 

DRAIN  TUBE  ADJUSTMENT. 


•I- 


THE  HOLLISTER  DRAINING-WOUND 
MANAGEMENT  SYSTEM 

KEEPS  FLUIDS  AWAY  FROM 

PATIENT'S  SKIN  AND  GUARDS  AGAINST 

IRRITATION  AND  CONTAMINATION. 

Skin-conforming  Karaya  Blanket  protects  skin  around 
wound  site.  It  directs  discharge  into  odor-barrier,  translu- 
cent Drainage  Collector  wh\ch  holds  exudate  for  visual 
assessment  and  accurate  measurement. 

Ttiere  are  no  messy,  wet  dressings  to  handle  or  change 
. . .  ro  need  for  painful  dressing  removal. 

Supplied  sterile,  for  application  in  O.R.  or  patient's  room. 

The  better  alternative 
to  absorbent  dressings. 


H    Write  (or  more  information 
HOLLISTER 
Wnllictor      I   tH         TTC    rnncnmorc     PH        \AI 


HoMister    Ltd.,  332  Consumers  Rd  .  WiMowdale.  Ont,  M2J  1  P8 


CONSULTANT 

IN 

NURSING 


The  Health  Services  Insurance  Commission,  Province 
of  Nova  Scotia,  invites  applications  for  the  position  of 
Consultant  in  Nursing. 


MINIMUM  QUALIFICATIONS 

Bachelor  of  Science  degree  in  Nursing  with  eight  years 
hospital  experience,  preferably  with  some  experience 
in  nursing  education. 

DUTIES: 

The  successful  applicant  will  provide  a  consulting  ser- 
vice to  provincial  health  facilities  on  all  phases  of  nurs- 
ing service  and  nursing  education,  including;  staffing, 
budgeting,  standards  of  nursing  care,  design  of  nurs- 
ing units.  Will  conduct  visitations  and  research  on  all 
matters  related  to  nursing  and  prepare  reports  and 
recommendations  for  the  Commission. 

SALARY  RANGE: 

Commensurate  with  qualifications  and  experience. 
Full  Civil  Service  Benefits. 

Competition  is  open  to  both  men  and  women. 
Please  quote  competition  number  75-562. 


Application  forms  may  be  obtained  from  ttie 

Nova  Scotia  Civil  Service  Commission, 

P.O.  Box  943, 

Johnston  Building, 

Halifax,  B3J  2Vg, 

and  the  Provincial  Building, 

Sydney,  Nova  Scotia. 


classified  advertisements 


ALBERTA 


BRITISH  COLUMBIA 


ONTARIO 


itSTERED  NURSES  required  for  70  bed  accredited  active 
-^ospttal   Fult  time  and  summer  relief  All  AAR^4  perr 
:ies    Apply  m  writing  to  the    Director  of  Nursing 
General  Hospital   Drumheiler  Alberta. 


Dec:   active  treatment  hospital  requires  NURSES   FOR 
lERAL  DUTY.  O.R..  and  INTENSIVE  CARE  NURSING. 
cer  medical  staff    Personnel  policies  per  AARN 
—  starling  at  S900,  per  month    This  hospital  is 
I  ,  ne  southern  part  of  the  province  (30  miles  east  of 

fcrkjge)  which  enjoys  a  fairly  moderate  winter  climate  Easy 
|k^1o  winter  and  summer  recreational  activities  Apply: 
Hr  of  Nursing.  Tatter  General  Hospital.  Taber.  Alberta. 

Ttgo 


D  NURSE  for  modern  49-bed  hospital  on  Vancouver  Island 
nd  oersonnel  policies  m  accordance  with  the  RNABC 
aci  Accommodatton  available  m  residence  Apply  Director 
rsing  LadysmilhandDistnct  General  Hospital,  P  O  Box  10. 
smith   British  Columbia.  VOR  260 


BRITISH  COLUMBIA 


ISTEREO  and  GRADUATE  NURSES  required  for  new 

Id  acute  care  hospital,  200  miles  north  of  Vancouver,  60 
ffcm  Kamloops  Limited  furnished  accommodation  availa- 
ppiy  Director  of  Nursing.  Ashcroft  &  District  General  Hospi- 
shcroft  British  Columbia 


ADVERTISING 
RATES 

FOR   ALL 
CLASSIFIED    ADVERTISING 

$15.00   for   6   lines   or   less 
$2  50  for  each   additional   line 

Rates   for   display 
advertisements   on   request 

losing  dale  for  copy  and  cancellation  is 
weeks  prior  to  1st  day  of  publication 
onth 

ie     Canadian     Nurses'     Association    does 

or      review     the     personnel      policies     of 

e     hospitals     ond     agencies     advertising 

The   Journal,    For   authentic    information, 

cspective     applicants     should     apply     to 

16    Registered    Nurses'   Association   of   the 

rovlnce     in     which     they     ore     interested 

working 


•ddress  correspondence  to: 

The 

lanadian 
slurse 

OTHE  DRIVEWAY 
iTTAWA,  ONTARIO 
2P  1E2 


OPERATING  ROOM  NURSE  wanted  for  active  mo- 
dern acute  hospital  Four  Certified  Surgeons  on 
attending  staff  Experience  of  training  destrable, 
Musl  be-  eligible  for  B  C,  Registration,  Nurses 
residence  available.  Salary  according  to  RNABC 
Contract.  Apptv  to:  Director  of  Nursing.  Mills  Mem- 
orial Hospital.  2711  Tetrault  St,  Terrace.  British 
Columbia.  V8G  2W7 


EXPERIENCED  NURSES  letigiWe  tor  B  C  regtslralionl  required 
tor  409-bed  acuie  care  teaching  hospital  located  m  Fraser 
Valley.  20  minutes  by  *reeway  from  Vancouver,  and  within 
easy  access  of  varied  recreational  facilities  Excellent  Orienta- 
tion and  Conlinuing  Education  programmes  Salary  Si  ,049  00  to 
$1,239  00  Clincal  areas  include  Medione  General  and  Spe- 
cialized Surgery  Obstelncs  Pediatrics  Coronary  Care  Hemo- 
dialysis. RehaDil'talion,  Operating  Room.  Intensive  Care,  Emer- 
gency PRACTICAL  NURSES  (eligible  for  BC  License)  also 
required  Apply  lo  Administrative  Assistant  Nursing  Personnel. 
Royal  Columbian  Hospital,  New  Westminster  British  Columbia, 
V3L  3W7 


GRADUATE  NURSES  —  LooKing  for  variety  in  your  work"? 
Consider  a  mooern  i0-bed  hospital  located  on  a  beautiful  fiord- 
type  inlet  of  Vancouver  Island  s  west  coast  Apply:  Administrator. 
Box  399,  Tahsis,  British  Columbia,  VOP  1X0 


EXPERIENCED  GENERAL  DUTY  NURSES  required  for  small 
hospital  North  Vancouver  Island  area  Salary  and  personnel 
policies  as  per  RNABC  contracl  Residence  accommodation 
S30  00  per  month  Transpcrtal'on  paid  from  Vancouver  Apply  lo 
Direcior  of  Nursing.  Si  George  s  Hospital  Box  223  Alert  Bay 
British  Columbia  VON  lAO 


GENERAL  DUTY  NURSES  for  modern  41-bed  hospital  located 
on  the  Alaska  Hi^way.  Salary  and  personne*  policies  in 
accordance  with  RNABC  Accommodation  available  in  resi- 
dence Apply:  Director  of  Nursing,  Fort  Nelson  General  Hospital. 
Fort  Nelson.  British  Columbia 


GENERAL  DUTY  NURSES,  for  modern  35-bed  hospital  located 
in  southern  B  C,  s  Boundary  Area  with  excellent  recreation  faci- 
lities Salary  and  personnel  policies  tn  accordance  with  RNABC. 
Comfortable  Nurses  s  home  Apply:  Director  of  Nursing.  Bound- 
ary Hospital.  Grand  Forks.  British  Columbia.  VOH  IHC, 


GENERAL  DUTY  NURSES  required  for  an  87-bed  acute  care 
hospitt^;  in  Northern  B  C  residence  accommodations  available 
RNABC  policies  in  effect  Apply  to  Director  of  Nursing  Mills 
Memonal  Hospital.  Terrace.  Bntish  Columbia.  V8G  2W7 


MANITOBA 


NURSE.  5  6  or  over  and  strong,  without  dependents  lo  care  'or 
160  pound  handicapped  executive  wth  suoke  Live-m  '  :  yr  m 
Toronto  and  '  ;  yr  in  Miami  Preferably  a  non-smoker  Wage 
S190  00  -  S220  OC  weekly  net  depending  on  experience  plus 
Miami  bonus  Send  resume  to  M  D  C  .  3532  Eghnion  Avenue 
West,  Toronto.  Ontario.  M6M  1V6  Tel  416-763-3541 


REGISTERED  NURSES  for  34-bed  General  Hospital 
Salary  S945  00  lo  Si. 145  00  per  month  plus  experience  allow- 
ance Excellent  personnel  policies  Apply  to  Director  of  Nursing. 
Englehan  &  Distrtci  Hospital  Inc..  Englehan.  Oniano.  POJ  1H0 


REGISTERED  NURSES  AND  REGISTERED  NURSING 
ASSISTANTS  for  45-bed  Hospital.  Salary  ranges 
include  generous  experience  allowances  R  N  s 
salary  $1,045  to  S1  245  and  RNA  s  salary  S735  to  S810 
Nurses  residence  —  private  rooms  with  bath  — $60  per  month. 
Apply  to  The  Director  of  Nursing,  Geraldton  District  Hospital 
Geraidton.  Ontario.  POT  IMO. 


REGISTERED  NURSES  and  L.P.N.s  wanted  for  15-bed  acuve 

Genefai  HosDiiai  Salaries  and  personnel  policies  m  accordance 
wilM  MARN  Contracts  Please  apply  to  Director  of  Nursing,  Si 
Claude  Hosp'iai  St  Claude   Manitoba 


NEW  BRUNSWICK 


H 


REGISTERED  NURSES  required  for  a  fully  accredited  1 04-bed 

hospital  located  m  a  small  oiy  offering  a  varied  year  round 
recreat.onai  program  Our  salaries  are  presently  S8  088  — 
«9  384  per  year  Tncreasmg  lo  S8  652  —  $10,044  effective  from 
October  1st  until  March  31.  1976  when  the  preseni  contract 
expires  A  most  attractive  package  of  fringe  benefits  is  offered 
Fo>  furlher  information  telephone  collect  ( 5061  753-4451  or  write 
to  The  Personnel  Supervisor,  Soldiers  Memorial  Hospital. 
Campbeilton   New  Brunswick.  E3N  1L1 


SASKATCHEWAN 


DIRECTOR  OF  NURSING:  Immediate  applications  are  invited 
for  the  position  of  Director  of  Nursing  in  the  43-bed  Wadena 
Union  Hospital  Fringe  benefits  include  Registered  Pension  Plan. 
Group  Liie  Insurance  and  Income  Replacement  Plan  This  is  a 
seven  year  old  weil-equipped  hospital  n  a  town  of  1 500  oopula- 
tion  serving  a  large  rural  population  Wadena  is  centrally  located 
1 30  mjles  from  each  of  two  maior  Saskatchewan  centres  Super- 
visory experience  is  essential  Nursing  Admintslration  course 
desirable  Attractive  salary  scale  in  effect  Apply  slating  qualifica- 
tions and  experience  to  Administrator.  Wadena  Union  Hospital, 
P  O  Box  10.  Wadena.  Saskatchewan.  SOA  4JC 


REGISTERED  NURSES  are  required  immediately  for  the  43-bed 
Wadena  Union  Hospital  Triis  is  a  modern  attractive  acute  care 
hospital  Situated  in  the  tovm  of  Wadena  Saskatchewan,  a 
friendly  parkland  community  with  a  population  o*  1 500  Attrachve 
salary  and  fringe  benefits  are  provided  under  the  Saskatchewan 
Union  ot  Nurses  agreement  m  effect  Please  direct  applications 
to  Administrator.  Wadena  Union  Hospital  P  O  Box  tO  Wadena. 
Saskatchewan 


FOOTHILLS  HOSPITAL 

Calgary,  Alberta 

Advanced  Neurological- 
Neurosurgical  Nursing 

for 
Graduate  Nurses 

a  five  monih  clinical  and 

academic  program 

offered  by 

Tne  Deparlmeni  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

I  Deparlmeni  of  Surgery) 

Beginning:  March.  September 

bmited  to  8  pariicipants 
Applicalions  now  being  accepted 

For  further  mtorrrtatiort.  please  write  to: 

Co-ordinator  of  In-service  Education 

Foothills  Hospital 

1403  29  St.  N.W.  Calgary,  Alberta 

T2N  2T9 


;ANADIAN  nurse  —  November  1975 


UNITED  STATES 


TEXAS  wants  you!  If  you  are  an  RN,  experienced  or 
a  recenl  graduate,  come  lo  Corpus  Christi,  Sparkling 
City  by  Ihe  Sea  ,  .  .  a  city  building  for  a  better 
future,  where  your  opportunities  for  recreation  and 
studies  are  limitless  Memorial  Medical  Center,  500- 
bed,  general,  teaching  hospital  encourages  career 
advancemetit  and  provides  in-service  orientation 
Salary  from  $785  20  to  51,052.13  per  month,  com- 
mensurate with  education  and  experience.  Differential 
for  evening  shifts,  available  Benefits  include  holi- 
days, sick  leave,  vacations,  paid  hospitalization, 
health,  life  insurance,  pension  program.  Become  a 
vital  par!  of  a  modern,  up-to-date  hospital,  write  or 
call;  John  W,  Cover.  Jr  .  Director  of  Personnel. 
Memorial  Medical  Center,  P.O.  Box  5280.  Corpus 
Christi,  Texas,  78405. 


REGISTERED  NURSES 


REQUIRED 

For  a  1 38-bed  Active  Treatment  Regional  Hospi- 
tal in  Medicine,  Surgery,  Paediatrics,  Obstetrics, 
and  qualified  R.N.s  for  a  5-Bed  I.C.U.-C.C.U. 

Salaries  according  to  Provincial  Salary  Guide 

Usual  Fringe  Benefits 

Residence  accommodation  available 

Tfie  Hospital  is  located  in  the  beautiful  Annapolis 
Valley  which  is  a  one-hour  drive  to  the  Provincial 
Capital  of  Halifax, 

Apply  to: 

Director  of  Nursing 
Blanchard-Fraser  Memorial  Hospital 
186  Park  Street 
Kentvllle,  Nova  Scotia 
B4N  1 M7 


Be  part  of  the  Nurses'  Asso- 
ciation of  Medical  Care, 
where  the  advantages  are: 

A  higher  salary, 

salary  and 
life  insurance, 

an  average  of  3  work 
days  per  week, 

paid  holidays 
after  6  months. 


For  information  call: 

(514)  871-0179 

or 
(514)  866-8091 


DIRECTOR 

OF 

NURSING  EDUCATION 

L'Ecole  des  InfirmiSres  de  Bathurst  School 
of  Nursing,  Bathurst,  N.B.,  invites  applica- 
tions for  the  position  of  Director.  The  School 
of  Nursing  will  offer  a  two  year  diploma 
program  which  is  to  commence  in  Sep- 
tember, 1976. 

QUALIFICATIONS: 

(a)  Bilingual  (French  and  English) 

(b)  Registered  nurse  with  current  registra- 
tion in  New  Brunswick 

(c)  Master  s  degree  in  nursing  preferred 

(d)  Experience   in    nursing   service   and 
nursing  education  (preferably  5  years) 

(e)  Demonstrated  administrative  ability. 
Salary  is  in  accord  with  existing  salary 
schedules. 

Applicants  are  requested  to  apply  in  writ- 
ing to: 

L'Ecole    des    Infirmieres   de    Bathurst 

School  of  Nursing 

P.O.  Box  T 

Bathurst,  New  Brunswick 


NURSING 
INSTRUCTORS 


L'Ecole  des  Infirmieres  de  Bathurst  School 
of  Nursing,  Bathurst,  N.B.,  invites  applica- 
tions for  the  positions  of  nursing  instructors. 
The  School  of  Nursing  will  offer  a  two  year 
diploma  program  which  is  to  commence  in 
September,  1976. 


QUALIFICATIONS: 

(a)  Registered  nurse  with  current  registra- 
tion in  New  Brunswick 

(b)  Baccalaureate  degree  with  at  least  one 
year  of  continuous  nursing  experience 
and  preparation  in  teaching. 

Candidates  will  be  responsible  for  teaching, 
evaluation  and  curriculum  development. 
Salary  is  in  accord  with  existing  salary 
schedules. 


Applicants  are  requested  to  apply  in  writ- 
ing before  November  30,  1975,  to: 

Ltcole  des  Infirmieres  de  Bathurst 

School  of  Nursing 

P.O.  Box  T 

Bathurst,  New  Brunswick 


NORTHERN  COLLEGE  C 
APPLIED  ARTS  AND 
TECHNOLOGY 

KIRKLAND  LAKE  CAMPUS 

Requires 

NURSE-TEACHER 

To  leach  Psychiatric  Nursing  and  to  assis" 
teaching  Fundamentals  of  Nursing. 

Qualifications:  Baccalaureate  Degree,  two  . 
nursing  experience,  eligible  for  Ontario  N.. 
Registration. 

Send  complete  resume  to: 

Northern  College  of 

Applied  Arts  &  Technology 

140  Government  Road  East 

KIrkland  Lake,  Ontario 

P2N  3L2 

Competition  75-35 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invites  applications  fronn 

REGISTERED  NURSES 

54-bed  accredited  general  hos, 
tal.  Northeastern  Ontario.  Com; 
titive  salaries  and  generous  be 
fits.  Send  inquiries  and  applicatii: 
to: 

MISS  E.LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  ICO 


THE  GENERAL  HOSPITAL 


ST. 


JOHN'S,  NFLD. 
A1A  1E5 


Registered  nurses  with  experience  in  Re 
nal  Dialysis.  Intensive  Care  -  Medical  an 
Surgical,  Post-op  Cardiovascular  Surgen 
Coronary  Care. 

355  bed  hospital.  Major  teaching  hospits 
for  Memorial  University  of  Newfoundlao' 
Medical  School. 

Liberal  personnel  policies. 


For  further  information  or  applicatlor, 
form  write  to: 

Personnel  Director 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They  abound   in   our  clinics  and 

their  numbers  increase  daily  in  our 

Emergency. 

If  you   do    not   like  working  with 

children    and   with   their   families, 

you  would  not  like  it  here. 

if  you  do  like  children  and  their 
families,  we  would  like  you  on  our 
staff. 

Interested  qualified  applicants 
should  apply  to  the: 

DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
Montreal  108,  Quebec 


\perienced  nurses  are  needed  to 

ork      in      AFRICA.      LATIN 

MERICA.    and    PAPUA    NEW 

UINEA.   Background  in  public 

ealth  nursing  or  teaching  is  an 

sset. 

,ocal  salary;  transportation  costs 

aid  by  CUSO. 

or   more    information  contact: 


CUSO  Health  -  6 
151  Slater  St.. 
Ottawa.  Ont. 
K1P5H5 


NURSES 

YOU 

WONT  LOOK  BACK 
IF  YOU  JOIN  US 

AT  THE  SOUTH 

SASKATCHEWAN 

HOSPITAL  CENTRE 

REG  IN  A 


Chronic  Care 

Coronary  Care 

Emergency 

Family  Medicine  Unit 

Intensive  Care 

Maternity 


WE  OFFER  NURSING  IN: 

Medicine 
Mini  Care 
Nursery 

Operating  Room 
Pediatrics 
Psychiatry 


Recovery  Room 

Rehabilitation 

Research 

Surgery 

Teaching 


Myrna  Sinclair 

Nurse  Recruitment  Co-ordinator 

The  South  Saskatchewan 

Hospital  Centre 

4500  Wascana  Parkway 

Regina,  Saskatchewan 

CANADA  —  S4S  5W9 


Would  you  please  send  me  information  re- 
garding employment  with  the  South  Sas- 
katchewan Hospital  Centre 


"MEETING  TODAY'S  CHALLENGE  IN  NURSING" 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGIII  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 

Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  in  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


INADIAN  NURSE  —  NovemOer  1975 


57 


ST.  MICHAEL'S  HOSPITAL 
Toronto,  Ontario 

invites  applications  from 

REGISTERED  NURSES 

for 

RESPIRATORY 

INTENSIVE  CARE, 

CORONARY  CARE, 

and  ACUTE  CARE  UNITS 

Three  separate  bul  adjoining  unils.  of  14  7,  and  24  beds 
respectively  Planned  orientation  and  in-service  pro- 
gramme will  enable  you  lo  collaborate  m  the  mosi  advan- 
ced of  treatment  regimens  tor  the  post-operative  cardio- 
vascular, cardiac  and  other  acutely  ill  palientS-  One  year  of 
nursing  experience  a  requirement 

For  details  apply  to: 

The  Director  of  Nursing 
St.  Michael's  Hospital 
Toronto.  Ontario 
MSB  1W6 


COMMUNITY  PSYCHIATRIC  CENTRE 
Douglas  Hospital  Centre 

Opporlunity  for 

NURSES 

and 

NURSING  ASSISTANTS 

to  |Oin  the  teams  on  our  admission  and  short-term 
treatment  units,  either  anglophone  or  fran- 
cophone. 

These  in-patient  units  are  part  of  our  expanding 
Community  Psychiatric  Centre,  responsible  for 
the  mental  health  of  both  the  anglophone  and  the 
francophone  population  of  the  cities  of  Verdun 
and  LaSalle.  and  the  districts  of  Ville  Emard  and 
Poinle  St,  Charles, 

For  further  information,  please  contact: 

Miss  H6l6ne  Berthelot, 
6875  LaSalle  Blvd., 
Verdun.  Qu6.  H4H  1R3 
Tel.:  761-6131.  Ext.  251 


ST.  MICHAELS  HOSPITAL 
Toronto.  Ontario 

This  university  hospital  in  metropolitan  area  in- 
vites applications  for  two  positions  of 

NURSING  CO-ORDINATOR, 
OBSTETRICS  &  GYNAECOLOGY 

STAFF  DEVELOPMENT  NURSE, 
LABOUR  &  DELIVERY  ROOMS 

for  active  department  (approx.  2500  deliveries 
annually),  including  Ante-Partum  Unit  for  high  risk 
mothers.  Rooming-in  Unit.  2  nurseries,  Women's 
Clinic. 

For  details  Contact: 

Director  of  Nursing  (416)  360-4106 


CLINICAL  NURSING 
COORDINATOR 
ORTHOPAEDICS 

Responsible  for  coordination  of  all  nursing  ac- 
tivities related  to  the  delivery  of  quality  care  in  all 
orthopaedic  unils. 

Applicant  must  have  Degree  in  Nursing  and  ex- 
perience in  Orthopaedic  Nursing  and  Administra- 
tion of  approx.  3-4  years. 

Please  apply  In  writing  to: 

Helen  R.  Cunningham.  Reg. N., B.N. 
Director  of  Nursing  Service, 
Department  of  Nursing, 
Ottawa  Civic  Hospital, 
1053  Carling  Avenue. 
Ottawa.  Ontario.  K1Y  4E9 


NORTHERN  NEWFOUNDLAND 

rpqu'res 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

Staff  nurses  for  St.  Anthony.  New  hospit;-. 
150  beds,  accredited.  Active  treatment  in  Sure 
Ivtedicine.    Paedialncs.    Obstetncs.    Psych., 
Large  OPD  and  ICU.  Onentation  and  In-Ser. 
programs.  40-hour  week,  rotating  shifts.  PUB. 
HEALTH  has  challenge  of  large  remote  a-' 
Furnished  living  accommodations  supplied  at  Ic 
cost.  Personnel  benefits  include  liberal  vacati( 
and  sick  leave,  travel  arrangements.  Staff  R 
$637  —  5809.  prepared  PHN  $71 2  —  $903.  ste( 
for  experience. 


Apply  to: 


INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services 

St.  Anthony.  Newfoundland 

AOK  4S0 


HEAD  NURSES 

OTTAWA  CIVIC  HOSPITAL 


Renal 

and 

Orthopedic  Units 


This  1000  bed  teaching  hospital  situated  in  th 
Ottawa  Valley  is  affiliated  with  the  University  t 
Ottawa. 

Applications  and  inquiries  to: 

Miss  M.  Mills,  Reg.  N.,  B.Sc.N., 
Assistant  Director  of  Nursing  Service, 
Ottawa  Civic  Hospital. 
1053  Carling  Avenue. 
Ottawa.  Ontario.  K1Y  4E9 


REGISTERED  NURSES 

and 
NURSING  ASSISTANTS 


Required  for  1 10-bed  chest  hospital  situated  just 
55  miles  north  of  Montreal  in  the  heart  of  the 
Laurenlians 

Residence  accommodations  available.  Excellent 
personnel  policies  (Quebec  language  require- 
ments do  not  apply  for  Canadian  applicants). 


Apply: 


Director  of  Nursing 
P.O.  Box  1000 
Ste.  Agathe  des  Monts 
Que.  jeC  3A4 


DIRECTOR  OF  NURSING 


Director  of  Nursing  required  for 
200-bed  Active  Treatment  Hospital 
under  construction  (opening  July 
1976).  B.Sc.N.  required  with  proven 
managerial  ability. 

Apply  in  writing  to: 

Assistant  Executive 
Director-Patient  Services 
Queensway-Carleton  Hospital 
3045  Baseline  Road 
Ottawa,  Ontario 
K2H  8P4 


GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  c 
eral  hospital  expanding  to  343  beds  p 
proposed  75  bed  extended  care  unit.  . 

Clinical  areas  include:  medicine,  surgery,  I 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion   &    rehabilitation,    operating    room, 
emergency  and  intensive   and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R.N.A.B.C.  contract: 

SALARY:  S850  —  S 1020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


OPERATING  THEATRE 
NURSING  STAFF 

For 
NEW  ZEALAND 


The  Wellington  Hospital  Board  needs  experienced  mature-minded 
men  and  women,  who  may  be  seeking  opportunity  for  career  de- 
velopment. 

Applicants  must  hold  a  State  Registered  nursing  qualification. 

High  standards  are  set  but  those  who  are  able  to  meet  the  demand 
will  find  satisfaction  in  work  accomplished  and  the  rewards  offered. 

All  appointments  are  made  in  accordance  with  the  New  Zealand 
Hospital  Service  Determination  for  Nurses. 

Why  not  exercise  your  worthwhile  profession  in  a  country  worth 
living  in? 


Get  in  touch  with:  — 

The  Director  of  Nursing  Services, 
Wellington  Hospital, 
WELLINGTON,  NEW  ZEALAND 


EXECUTIVE 
SECRETARY-TREASURER 

required  by 

NEW  BRUNSWICK  ASSOCIATION 
OF  REGISTERED  NURSES 

for  tVlAY  1976 


MAJOR  RESPONSIBILITIES 

Administration  of  Association  policies 

Coordination  of  all  NBARN  activities  including  finances 

Secretariat  and  Consultant  Services  to  Council  and  Executive 


QUAUFICATIONS 

'Demonstrated  leadership  abilities. 
Administration  or  management  experience. 
Baccalaureate  degree  required,  Master  s  preferred. 
Professional  association  involvement ) 
3-lingual  ]  preferable 

SALARY— 

commensurate  with  experience  and  preparation. 


flpp/y  to: 


Personnel  Committee 

N.B.A.R.N. 

231  Saunders  Street 

Frederlcton,  N.B. 

E3B  1N6 


Consider  a 
Career  where 
Innovation  is 
aladtion! 


Since  1889,  the  dome  of  the  Johns 
Hopkins  administration  building  has 
been  a  symbol  for  great  forward  strides 
in  patient  care.  Today,  it  is  surrounded 
by  some  of  the  most  advanced  facili- 
ties in  medicine  .  and  a  dynamic 
new  building  program  is  adding  to 
the  ultra  modern  complex.  It's  an  ex- 
citing professional  environment  for 
career  development.  The  breadth  and 
depth  of  experiences  in  a  1,100  bed 
acute  patient  care,  teaching  and  re- 
search center  offer  limitless  opportu- 
nity to  extend  your  expertise 

If  you  are  an  expenenced  RN  or  about  to 
graduate  from  a  2,  i  or  4  year  program 
you  can  immediately  enter  the  specialty 
of  your  choice.  In  addition  to  a  con- 
tinuing career  path  tailored  to  your 
needs,  we  offer  an  intensive  5  week  ori- 
entation program  followed  by  special 
programs  in  staff  development  Our 
many  benefits  include  full  tuition  re- 
imbursement at  the  Baccalaureate  or 
Master's  level,  plus  excellent  salaries. 

For  more  intormation,  write  or  call 
301   955-5592  collect. 


THE 

JOHNS  HOPKINS 

HOSPITAL 

Where  innovation  is  a  tradition' 

An  tqudi  Opporlunily  Employer  M   F 


db 


ludy  Pyle,  R  N 

Office  of  Profesiiondl  RecruilmenI 

The  lohns  Hopkins  Hospital 

Bdllimore.  Md   2120S  CNT175 


RNO 
SNO 


Please  send  me  intormation  about  RN 
opportunilies  offered  by  Johns  Hopkins 
Hospital 

NAME  PHONE  _ 

ADDRESS . 


SPECIALTY  INTEREST 
DATE  AVAILABLE  


.ADIAN  NURSE  —  November  1975 


59 


DIRECTOR 
OF  NURSING 


Applications  are  invited  for  the  position  of  DIRECTOR  OF 
NURSING  for  this  progressive  general  hospital.  Bed  com- 
plement of  31 3-beds  is  made  up  of  21 3  active  treatment  and 
100  chronic  beds  with  an  active  rehabilitation  program. 


The  Hospital  is  affiliated  as  base  hospital  for  a  community 
college  School  of  Nursing  and  provides  other  services  on  a 
district  level.  Outpatient  Psychiatric  Day  Care  Program  is 
offered. 


Stratford  is  a  pleasant  city  of  25,000  located  ninety  miles 
from  Toronto,  forty  miles  from  London  and  twenty  six  miles 
from  Kitchener. 


Please  direct  correspondence  in  confidence  to: 

The  Executive  Director 
Stratford  General  Hospital 
Stratford,  Ontario 
N5A  2Y6 


THE  NEW  CARDIAC  UNIT 

of  the 

OTTAWA  CIVIC  HOSPITAL 

Opening 

in  the  Spring 

of  1976 


Requires: 

Head  Nurses  &  G.S.N.'s 

— For  the  Medical  &  Surgical  Wards. 
—  O.R.  Recovery  Room,  Intensive  Care, 
and  Coronary  Care  Units. 

Applications  and  inquiries  to: 

Miss  M.  Mills,  Reg.  N.,  B.Sc.N., 
Assistant  Director  of  Nursing  Service, 
Ottawa  Civic  Hospital, 
1053  Carling  Avenue, 
Ottawa,  Ontario,  K1Y  4E9 


ST.  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

•  We  offer  opportunities  in  Emergency,  Operating  Room,   P.A.R.,   Intensive  Care  Unit,  Orthopaedics,   Psychiatry, 
Paediatrics,  Obstetrics  and  Gynaecology,  General  Surgery  and  Medicine. 

•  We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Service  programs. 

•  We  offer  —  Toronto  —  with  some  of  Canada's  finest  Theatres,  Restaurants  and  Social  events. 

•  We  offer  progressive  personnel  policies. 

•  We  offer  a  starting  salary,  depending  on  experience,  of: 

^,    effective  April  1, 1975     -  $945  to  $1,145  per  month. 

•  We  offer  monthly  educational  allowances  up  to  $120.  per  month  in  addition  to  the  above  starting  salary. 

Appiyto:  Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1 B5 


60 


ORTHOPAEDIC    t£    AR-THRI-TIC 
HOSRITAU 


X/l~^^ 


43  WELLESLE Y  STR  EET,  EAST 
TORONTO,  ONTARIO 
M4Y1H1 

Enlarging  Specialty  Hospital  offers  a  unique 
opportunity  to  nurses  and  nursing  assistants 
interested  in  the  care  of  patients  with  bone  and 
joint  disorders. 

Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  all 
units 

Clinical  specialists  for  Operating  Room,  Intensive 
Care,  Patient  Care  and  Education. 


WE  CARE 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 

Furnished  -  shared. 

Swimming  Pool.  Tennis  Court,  Recreation  Room, 

Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


NURSES 

NORTHWEST  SASKATCHEWAN 
WELCOMES  YOU! 


William  S.  Patmore 
Executive  Director 
Northwest  Regional  Hospital 

Council 
Twin  City  Building 
North  Battleford.  Sask. 
S9A  2S5 

Would  you  please  send  me  informa- 
tion regarding  employment  in  the  fol- 
lowing Institution(s): 


The  hospitals  in  the  outer  area  of  the  wheel  have  vacancies. 


Name- 


Address  - 


Saskatchewan  offers  plenty  of  fresh 
air  and  an  unemployment  rate  of  2.7%. 
Your  spouse  may  find  work  readily 
available. 


ANAHIAN  Min.'SF  —  Nnuamber  197S 


SCHOOL  OF  NURSING 

McGILL  UNIVERSITY 


BACHELOR  OF  SCIENCE  IN  NURSING 

•  A  three  year  BASIC  program  to  prepare  a  begin- 
ning nurse  practitioner 

•  General  and  professional  courses  with  nursing 
experience  in  McGill  teaching  hospitals  and  selec- 
ted community  agencies 

•  Entrance  —  collegial  diploma  (D.E.C.  Sciences) 
or  the  equivalent 

MASTER  OF  NURSING 

Teachers  of  Nursing  in  the  rapidly  expanding  college 
system  for  Nursing  Education. 

One  calendar  year  for  nurses  graduated  from  basic 
baccalaureate  programs  (4-5  year  integrated  pro- 
gram). 


MASTER  OF  SCIENCE  (APPLIED)  | 

Options: 

(1)  Specialist  in  Nursing  in  all  clinical  fields  (Nurse 
Clinician),  including  the  expanded  function  of 
Nursing  in  Family  Health  and  Community  Health 
Centres. 

(2)  Research  in  Nursing  and  Health,  including  eva- 
luation of  health  care  and  delivery  systems. 

Two  academic  years  for  nurses  with  a  B.N.  or 
B.Sc.N. 

Persons  holding  a  d'egree  comparable  to  the  B.Sc.  or 
B.A.  degrees  at  McGill  may  be  admitted  following 
successful  completion  of  a  Qualifying  Year  in  Nur- 
sing. 


For  further  particulars  write  to: 

DIRECTOR,  SCHOOL  OF  NURSING,  McGILL  UNIVERSITY 

3506  UNIVERSITY  STREET,  MONTREAL,  QUEBEC,  H3A  2A7. 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEUROSURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  Intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


THE  REGISTERED  NURSES'  ASSOCIATION 
OF  BRITISH  COLUMBIA 

INVITES  APPLICATIONS  FOR  THE  POSITION  OF 

ASSISTANT 
EXECUTIVE  DIRECTOR 

The  applicant  should  have  a  broad  nursing  back- 
ground, administrative  experience  and  university  pre- 
paration preferably  at  the  master's  level.  A  back- 
ground in  professional  association  activities  would  be 
an  asset,  and  an  interest  in  professional  affairs  is 
essential. 

The  position  is  available  December  1,  1975. 

Fcr  complete  information,  including  job  descrip- 
tion and  salary  range,  write  to: 

Miss  F.  A.  Kennedy 

Executive  Director 

Registered  Nurses'  Association  of  British  Columbia 

2130  West  12th  Avenue 

Vancouver,  British  Columbia 

V6K  2N3 


657  bed, accredited, modern, 
well  equipped  General  Hospital. 
rapidly°expanding... 


Saint  John 

General 

hospital 


.'/ 


-11 


Y 


Saint%hn,N.B., 
CANADA 


"SQUIRES- 

General  Staff  isfurses  <^ 
Registered  Nursing  Assistants 


In  all  general  areas:  Medical,  Surgical, 
Pediatrics,  Obstetrics,  Chronic  and 
Convalescent,  several  Intensive  Care 
areas  and  Psychiatry. 


0  Active,  progressive  in  service  education  program. 
Special  Attention  to  Orientation. 
Allowance  for  Experience  and  Post  Basic  Preparation 


FOR  FURTHUR  INFORMATION  APPLY  TO 

"PERSONNEL  DIRECTOR 

^aintjohn  General  Hospital 

P.O.  BOX  2000  Saint  John.  New  Brunswick  e2L4L2 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 

teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 

For  further  infortnation,  please  write  to: 

PERSONNEL  SERVICES 

VANCOUVER  GENERAL  HOSPITAL 

855  WEST  12TH  AVE. 

VANCOUVER,  B.C. 


TAMAI^lAM  Ml  IHQP  - 


nl-icf    1Q7C, 


Arctic, 
M^armth 


-  •  •  -'when 

somebody 

cares. 


if  you  care, 

^     send  this 

r^   coupon  today. 


Medical  Services  Branch 
Department  of  National 
Health  and  Welfare 
Ottawa,  Ontario   K1 A  0K9 


Please  send  me  more  infornnation  on  nursing 
opportunities  in  Canada's  Northern  Health  Service. 


Name: 

Address: 

City: 


Prov: 


1^ 


Health  and  Wetlare       Sante  et  Bien-6tre  social 
Canada  Canada 


Index 
to 

Advertisers 
November  1975 

Astra  Pharmaceuticals 4 

General  Time  of  Canada  Limited , 

Hampton  Manufacturing  (1966)  Limited 1 ' 

Health  Care  Services  Upjohn  Limited  

Hollister  Limited ^ 

ICN  Canada  Limited 

J.B.  Lippincott  Co.  of  Canada  Limited 32. 

MedoX r 

The  C.V.  Mosby  Company  Limited 46,  47.  J 

Posey  Company i 

Reeves  Company 4 

Roussel  (Canada)  Limited    42.  -'• 

W.B.  Saunders  Company  Canada  Limited    

Standard  Brands  (Canada)  Limited    6,  7,  Cove; 

White  Sister  Uniform  Inc 5.  Covers  2. 


A  dvertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 
50  The  Driveway 
Ottawa  K2P  1E2  (Ontario) 

Advertising  Representatives 
Richard  P.  Wilson 
219  East  Lancaster  Avenue 
Ardmore.  Penna.  19003 
Telephone:  (215)649-1497 

Gordon  Tiffin 
2  Tremont  Crescent 
Don  Mills,  Ontario 
Telephone:  (416)444-4731 


Member  of  Canadian 
Circulations  Audit  Board  Inc. 


QEia 


December  1975   ^ 


773    Ki''ii    l------ 

Ottawa    -    Ontario 


,  <je- 


nECol  1975 


Zhe  season 's  best  wishes  to  you  and  your  entire  staff  who  give 
patience  and  understanding  all  year  'round. 


Your  Clinic  Shoemal<er  \i 


The 

Canadian 
Nurse 


^^17 


A  monthly  journal  for  the  nurses  of  Canada  published 

in  English  and  French  editions  by  the  Canadian  Nurses'  Association 


Volume  71,  Number  12  December  1975 

Special  Feature:  IWY  in  Retrospect 
15      Is  There  Sex  Discrimination  in  Health  Care? 

19      Coming  of  Age 

in  Nursing P.  Webb,  O.W.  Simpson,  Y.N.  Green,  J.  Jenny 

23      Nursing  MANpower M.  Phillips 

26      Caring  for  the  Untreated  Infant   C.  McElroy 

31      CNA  Intensifies  its  Role  as  National  Coordinator 

34  Frankly  Speaking: 
Working  With  You  Between  Jobs??? G.  Rowsell 

35  Child's  Play 
is  Therapy A.  Butler,  J.  Chapman,  M.  Stuible 

The  views  expressed  in  the  articles  are  those  of  the  authors  and  do  not  necessarily  represent  the 
policies  or  views  of  the  Canadian  Nurses'  Association. 


4  Letters 

8  Dates 

9  News 
38  Names 


39  Research  Abstracts 

41  Books 

44  Accession  List 

56  Index  to  Advertisers 


^ecutrve  Director:  Helen  K.  Mussallem  • 
ditor:  M.  Anne  Hanna  •  Assistant 
tdilors:  Liv-Ellen  Lockeberg,  Lynda  S. 
Cranston  •  Production  Assistant:  Mary  Lou 
Downes  •  Circulation  Ma.nager:  Beryl  Dar- 
ling •  Advertising    Manager:     Ceorgina    Clarke 

•  Subscrlplion  Rates:  Canada:  one  year, 
>ii  00:  two  years,  $11.00.  Foreign:  one  year, 
-f^  50:    two    years,    $12.00.    Single    copies: 

00    each.    Make    cheques   or    money    orders 
jvable    to   the   Canadian    Nurses'    Association. 

•  Change   of   Address:    Six    weeks'    notice;    the 
Id   address  as  well  as  the  new  are  necessary, 

aether    with    registration    number    in    a    pro- 
ncial    nurses'    association,    where    applicable. 
>ot    respor^sible   for   journals   lost    in    mail    due 
errors  in  address. 


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  rale 
MONTREAL.  P.Q.  Permit  No.  10,001. 
50    The    Driveway,    Ottawa,    Ontario,    K2P  IE2 

©  Canadian  Nurses'  Association  1975. 


IWY  in  retrospect 

History  has  already  begun  its  assessment 
of  the  events  of  International  Women's 
Year.  By  the  time  you  read  this,  1975  will 
have  become  "the  year  that  was "  —  or 
almost  was.  Leaving  aside  the  larger  ques- 
tion of  whether  women  can  achieve  equality 
in  the  face  of  global  economic  injustice,  the 
fundamental  question  for  each  of  us  must 
be,  how  did  IWY  affect  my  own  situation? 
Has  the  12-month  exposure  to  newspaper 
and  magazine  articles,  television  and  radio 
programs  and  public  debate,  changed  the 
way  nurses  feel  about  themselves  as  indi- 
viduals and  as  members  of  the  health  care 
team? 

These  are  questions  each  individual 
must  answer  for  himself.  What  we  have 
done  In  this  issue  of  The  Canadian  Nurse  Is 
to  try  to  give  you  some  Insight  into  the  col- 
lective attitudes  of  members  of  the  nursing 
profession. 

We  looked  first  of  all  to  you,  the  reader,  to 
enlighten  us  about  what  is  actually  happen- 
ing on  the  health  care  scene  today.  We 
asked  you  to  Indicate  injustices  within  this 
system.  Your  letters  show  that  sex  dis- 
crimination in  this  area  does  exist  and, 
when  It  occurs,  you  recognize  It  and  react 
accordingly. 

The  momentum  of  IWY,  carried  on  the 
crest  of  the  wave  of  feminism,  also  Inspired 
several  nurses  to  write  about  the  sociologi- 
cal changes  occurring  within  the  profes- 
sion. Three  of  these  submissions  were 
condensed  to  appear  In  this  special  issue. 

They  were  chosen  because  they  seem  to 
typify  an  attitude  which  has  encouraged 
many  nurses  to  question  tradlonal  assump- 
tions. It  Is  this  healthy  scepticism  which  has 
stimulated  questions  such  as:  "How  can  we 
talk  about  a  colleague  relationship  among 
members  of  the  health  team  if  we  take  for 
granted  that  women  are  necessarily  inferior 
to  men?  WIN  nursing  always  feel  obligated 
to  "fill  in  the  gaps '  In  the  health  care  system 
—  to  be  reluctant  to  carve  out  its  own 
sphere  of  competence?  Why  do  nurses 
who  demonstrate  more  than  their  share  of 
aggressiveness  and  Initiative  tend  to  be  re- 
jected by  their  colleagues?  Is  It  really  true 
that  the  nurse  who  demonstrates  good 
bedside  nursing  is  a  "better  nurse '  than  her 
co-worker  who  demonstrates  administra- 
tive capability?  Why  can  t  nurses  conthbute 
their  unique  expertise  to  planning  a  health 
care  system  that  really  does  serve  society? 
What  Is  wrong  with  becoming  a  change 
agent?" 

Last  year  was  not  the  first  time  that  these 
questions  occurred  to  nurses.  On  the  other 
hand,  no  group  or  Institution  exists  In  a  vac- 
uum and  IWY  gave  official  sanction  to  ideas 
that  had  been  brewing  for  some  time. 

Some  of  the  gains  were  illusory:  lip  ser- 
vice to  the  Ideal  of  equality  between  the 
sexes  can  be  more  dangerous  than  blatant 
chauvinism.  On  the  other  hand.  If  we  are 
prepared  to  work  to  turn  rhetoric  into  reality, 
1976  could  be  the  year  that  the  nursing 
profession  finds  the  answers  to  the  prob- 
lems it  has  learned  to  recognize.  —  M.A.H. 


Pampeis 


ives 


you  both 

abeak 


Ceeps 
lim  drier 


Instead  of  holding 
moisture,  Pampers 
hydrophobic  top  sheet 
allows  it  to  pass 
through  and  get 
"trapped"  in  the 
absorbent  wadding 
underneath.  The  inner 
sheet  stays  drier,  and 
baby's  bottom  stays 
drier  than  it  would  in 
cloth  diapers. 


SavevS 
you  time 

Pampers  construction '''« 
helps  prevent  moistunj'" 
from  soaking  through  L 
and  soiling  linens.  As  d 
result  of  this  superior 


i 


containment,  shirts, 
sheets,  blankets  and 
bed  pads  don't  have  to 
be  changed  as  often 
as  they  would  with 
conventional  cloth 
diapers.  And  when  les: 
time  is  spent  changingj 
linens,  those  who  take  j 
care  of  babies  have     U 
more  time  to  spend  onj- 
other  tasks. 


It  was  a  very  good 
year  (to  improve 
your  skills.) 


/ 


Saunders' 
1975 
Nursing 
Titles: 


DMJGSaSOUmONS 


KIANI  «  ^LBTCMKB 


IfisoNAL  VMIVC,  Alios  u 

KFi  \no\sllll-.  I»    IHt,  n<«  IICM.  XllKSF     ^"^'•''* 


TEXTBOOK 
1         OF 
-PEDIATRICS      hS 


VAUGMAN 


CERIATHIC  NURSING 


'  Phj^sics  for  the  Health  ScieiuMBs  SS'Ue  ' 


Law  Every  Nurse  Should  Know 


Nursing  Titles: 

'teighton:  Law  Every 
lurse  Should  Know, 

bird  Edition 


nmx  ewnow 


Saunders 


iy    Helen    Creighton.   327    pp. 
10.80  Order  #2752-8. 

sMaitre  &  FInnegan: 
he  Patient  in  Surgery: 
Guide  for  Nurses, 

iird  Edition 

1  George  D.  LeMaltre  and  Janet 
Hnnegan.  506  pp  $9.25. 

Order  #5717-6. 

'ood:  Nursing  Sl<ills  for  the 
Hied  Health  Services, 

olume  III 

i  Luclle  A.  Wood.  449  pp.  $7.75. 
Order  #9602-3. 

;he  Nursing  Clinics  of 
orth  America 

yearly    subscription    to    this 
)rdt50und  quarterly — $15.15. 

Order  #0003. 


Textbooks: 

Nave  &  Nave:  Physics  for 
the  Health  Sciences 

By  Carl  R.  Nave  and  Brenda  C. 
Nave.  300  pp.  $8  25. 

Order  #6665-5. 

Keane  &  Fletcher:  Drugs 
and  Solutions — A 
Programed  Introduction, 

Third  Edition 

By  Claire  B.  Keane  and  Sybil  M 
Fletcher.  245  pp  $4.65. 

Order  #5342-1. 

Nemir&  Schaller:  The 
School  Health  Program, 

Fourth  Edition 

By  the  late  Alma  Nemir  and  Warren 
E.  Schaller.  569  pp.  $11  85 

Order  #6748-1. 


Practical  Nursing 
Texts: 

Asperheim:  Pharmacology 
for  Practical  Nurses, 

Fourth  Edition 

By  Mary  Kaye  Asperheim.  199  pp 

$5  10  Order  #1445-0. 


Sfei^ens:  Geriatric  Nursing 
for  Practical  Nurses, 

Second  Edition 

By  Marion  Keith  Stevens.  244  pp. 
$5.10  Order  #8594-3. 


Stevens:  Personal  and 
Vocational  Relationships  of 
the  Practical  Nurse, 

Second  Edition 

By  Marion  Keith  Stevens.  316  pp. 
$510.  Order  #8596-X. 


ISAedical  Texts 

Useful  to  Nurses: 

Delp  &  Manning:  Major's 

Physical  Diagnosis,  Eighth 

Edition 

Edited  by  Mahlon  H.  Delp  and 

Robert  T.  Manning.  790  pp.  $1 6.25. 

Order  #301 2-X. 

Flint  &  Cain:  Emergency 
Treatment  and 
Management,  Fifth  Edition 

By  Thos.  Flint,  Jr.  and  Harvey  D. 
Cain.  794  pp.  $14.20 

Order  #3728-0. 
Morgan  &  Seaton: 
Occupational  Lung 
Diseases 

By  Wm.  Keith  C.  Morgan  and  An- 
thony Seaton.  391  pp  $18.55. 

Order  #6555-1. 
Vaughan  &  McKay:  Nelson 
Textbook  of  Pediatrkrs, 
Tenth  Edition 

Edited  by  Victor  C.  Vaughan  and  R. 
James  McKay.  1876  pp  $33.75 

Order  #9018-1. 


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letters 


Two  to  one  in  favor 

"Two  year  programs  are  not  inferior. 
They  do  require  mature  people,  quick 
to  adapt  to  responsibilities  and  new 
situations,  independent  and  self- 
confident.  Perhaps  those  who  don't  feel 
qualified  after  such  a  program  should 
choose  another  vocation."  — Helena 
Peters.  R.N.,  Swift  Current,  Sask. 

I'm  sure  that  both  the  two  and  three 
year  graduates  are  equally  competent. 
Bigotry  in  nursing  we  can  do  without. 
Surely,  all  that  matters  is  the  health  and 
welfare  of  the  patient  and  the  con- 
tinuance of  our  own  development. 
EmUy  Perry,  R.N.,  Ancaster,  Ont. 


After  graudating  from  a  two-year  pro- 
gram I  came  to  Scotland  to  study  mid- 
wifery. At  the  end  of  three  years, 
British  nurses  are  far  better  prepared  to 
become  staff  nurses  capable  of  running 
a  ward.  Nothing  beats  experience  — 
combine  this  third  year  with  the  excel- 
lent classwork  (better  in  Canada,  I  be- 
lieve) Canadian  nurses  receive  and  our 
training  would  serve  us  well  wherever 
we  choose  to  work  —  Iva  M. 
MacCausland,  Nurses'  Home, 
Woodend  Hospital,  Aberdeen,  Scot- 
land. 


Canadian  food  does  reach  Africans 

I  am  a  Canadian  nurse  working  in 
Lesotho.  I  receive  The  Canadian  Nurse 
and  read  it  attentively.  The  concern  ex- 
pressed for  the  poor  and  starving  people 
of  the  world  (Canadian  Nurse,  April, 
1975,  p.  4)  has  prompted  me  to  write 
that  Canadian  food  reaches  us ,  and  we 
appreciate  it. 

We  receive  food  from  different  parts 
of  the  world  through  the  World  Food 
Distribution  Organization.  Powdered 
milk,  wheat,  vegetable  cooking  oil, 
fish  and  canned  meat  are  some  of  the 
items.  The  Caritas  Lesotho  Organiza- 
tion in  Maseru,  1 10  miles  away,  re- 
ceives the  food  and  assures  its  distribu- 
tion to  preschool  clinics,  boarding 
schools,  and  hospitals.  We  pay  the 
transport  expenses.  We  report  to  the 
government  each  month  on  what  has 
been  received  and  consumed,  by  how 
many  people,  and  what  remains. 


This  food  distribution  is  important  to 
us,  as  mothers  coming  for  food  bring 
their  children  to  the  preschool  clinic  to 
be  weighed  and  immunized.  If  ill,  they 
are  immediately  referred  to  our  out- 
patient facilities  nearby.  At  our  clinics 
mothers  are  given  lectures  in  Sesutho, 
their  own  language,  on  health  and  the 
preparation  of  the  food  they  receive.  A 
small  fee  helps  defray  some  of  the 
transportation  costs  and  the  salaries  of 
the  nurse  and  her  attendants.  Sick 
babies  are  admitted  to  hospital  with 
their  mothers,  so  the  child  is  not  bottle- 
fed.  Here  we  are  poor,  yet  have  room 
for  everyone  in  hospital,  including 
mothers. 

You  may  have  heard  of  the  agricul- 
tural development  program  in  the 
Thaba-Tseka  region  (where  I  work)  of 
Lesotho  begun  by  the  Canadian  Inter- 
national Development  Agency.  In 
years  to  come,  our  region  may  furnish 
food  to  the  World  Food  Distribution 
Organization.  —  Sister  Saint  Ernest, 
S.C.O.,  R.N.,  Paray  Hospital,  Thaba- 
Tseka,  via  Maseru,  Lesotho,  South  Af- 
rica . 


ONQ  offers  few  English  worl<shops 

Recently  I  received  an  outline  of  the 
1975-76  workshops  from  the  Depart- 
ment of  Continuing  Education  in  Nurs- 
ing of  the  Order  of  Nurses  of  Quebec.  I 
was  most  discouraged  and  disgusted  to 
note  that  of  the  1 5  workshops  offered 
only  1  would  be  conducted  in  English. 
Supposedly,  one  of  the  aims  of  the 
ONQ  is  to  encourage  its  members  to  up- 
grade their  knowledge  by  attending 


SEASON'S  GREETINGS 


BE  A  +  BLOOD  DONOR 


these  workshops.  What  incentive  do. 
an  English-speaking  nurse  have  to  u 
tend  when  only  1  of  these  workshops 
conducted  in  English?  Yes,  the  on 
certainly  knows  how  to  encourage  i{ 
English-speaking  members  to  leave  tH 
province  —  Thern  Hicking,  Puhl 
Health  Nurse,  Douglas  Hospita- 
Montreal.  I 


Staffing  problems 

Gabrielle  Monaghan  in  her  artic 
"Nurses  and  the  myth  of  full  emplo 
ment"  (Canadian  Nurse  Sept.  197. 
mentions  several  concepts  that  are  sim 
lar  to  those  mentioned  by  Feme  Tro' 
in  her  article  "Placement  service  woul 
cure  staffing  ills"  (Dimensions  i 
Health  Services  July  1975).  The  con 
mon  element  is  the  need  for  a  "cenin 
replacement  service." 

We  need  more  information  on  th 
concept,  and  we  are  looking  to  you  i 
provide  it.  — Susan  McDonald,  R.S 
Toronto,  Ont. 


Down-to-earth 

Our  local  association  members  feel  Th 
Canadian  Nurse  holds  very  little  ir 
terest  to  us  as  practicing  nurses.  W 
believe  articles  about  patient  condition 
do  not  elaborate  enough  on  the  actui 
care  of  the  patient.  Articles  based  o 
once-in-a-while  situations  are  not  the 
interesting  to  those  in  active  duty 
Where  can  we  use  this  information? 
We  are  a  long  way  from  the  editor' 
office,  but  would  like  to  see  mor 
down-to-earth  articles  that  could  hel 
us  in  a  clinical  nursing  situation.  - 
Helen  Rowe,  R.N.,  Secretary,  Provos 
Chapter  #21,  AARN,  Alberta. 

Editor's  reply: 

If  The  Canadian  Nurse  is  to  reflect  accu 
rately  the  desires  and  thoughts  of  a  tnajoi 
ity  of  its  readers,  it  is  essential  to  hearfror, 
people  like  yourself.  You're  right  —  it  i 
too  far  from  the  editor's  desk  to  moi 
nurses.  This  is  a  physical  gap  I've  bee, 
trying  to  close  in  the  short  time  I  have  beei 
editor. 

I  hope  you  wilt  be  concerned  enough  /• 
take  a  positive  step  toward  helping  us  oh 
tain  the  down-to-earth  articles  we  all  knot 


we  need. 


DRUGS:  TO  BE  USED 
WITH  WISDOM 

found  in  the  new  edition  of 

PHARMACOLOGY 

IN  NURSING, 

13th  Edition 

"This  information  should  provide  .  .  .  the  means  for 

ensuring  rational  and  optimal  drug  therapy"  — This  has 
Jbeen  the  author's  goal  throughout  12  previous  editions 
lof  the  leading  text  in  the  field.  With  major  revisions  and 
'updating,    the    new    13th    edition    outlines    current 

concepts  of  pharmacology  in  relation  to  clinical  patient 

care.  Clear  and  comprehensive  discussions  cover  basic 

mechanisms  of  drug  action,  indications,  contraindica- 
tions, toxicity,  side  effects,  and  safe  therapeutic  dosage 

range.    Two   new   chapters   examine   "Antimicrobial 

agents"  and  "The  effects  of  drugs  on  human  sexuality, 

fetal    development,    and    lactation."    Pediatric    drug 

dosages  and  DESI  ratings  have  been  added. 

By  Betty  S.  Bergersen,  R.N.,  M.S.,  Ed.D.  and  in  consultation  with 

/Vndres  Goth.  M.D.  February,  1976.  Approx.  732  pages,  8"  x  10", 

jpprox.  143  illustrations.  About  $14.15. 

MOSBY 

TIMES  MIRROR 


fl 


C    V    MOSBY  COMPANY,  LTD 
86   NORTHLINE    ROAD 
TOROrMTO.  ONTARIO 
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III 


No  yolk  eggs 


Fleischmann's  ® 

ess 

beaters  , 

de  Fleischmann  ®  ^ ' 


v 


How  Fleischmann's 
hatched  a 
more  healthful  egg 
or  low  lipid 
lieters 


H.D.  patients  and  others  with  hyperlipid  risk  may 
low  look  a  real  egg  in  the  face  without  concern  about 
iholesterol  or  triglyceride  build-up. 

'his  is  made  possible  by  unique  new  Egg  Beaters 
rom  Fleischmann's.  The  company  cracks  some 
100,000,000  fresh  farm  eggs  a  year  to  remove  their 
;holesterol-packed  yolks  and  replaces  them  with  a 
itamin  and  mineral  fortified  corn  oil  nutrient  plus 
lavouring  agents.  Egg  Beaters  are  then  pasteurized, 
omogenized,  and  fast  frozen. 

'astes  and  smells  like  fresh  farm  eggs 

lesult  of  this  improvement  on  nature  is  an  egg 
quivalent  -  with  the  nutrition,  taste,  and  smell  of 
esh  whole  eggs.  Minus  the  cholesterol  disadvan- 
ges. 

hus  Egg  Beaters  can  beat  the  monotony  of  a  diet 
rithout  eggs. 

>nly  3-4  mg  cholesterol  versus  480  or  more  mg  for 
vo  whole  eggs 

hey  can  be  scrambled,  made  into  omelettes  or 
'rench-toast  and  used  in  baking  or  quantity  cookery; 
ach  one  half  cup  serving  (4  fl  oz.)  replaces  two  large 
hole  eggs.  In  cholesterol  content  3-4  mg  for  Egg 
eaters  compared  to  480  mg  or  more  for  whole  eggs. 


t 


nd  coupon  at  right  for  certificate  to  obtain  free 
rton  of  Egg  Beaters  and  patient  recipe  brochures 


erely  complete  and  send  us  the  coupon  at  right  to 
btain: 

I  Complimentary  certificate  for  a  carton  of  Egg 
Beaters. 

I  Quantities  you  specify  of  the  50  recipe  "Cooking 
j  with  Egg  Beaters"  recipe  booklet  for  your  patients. 
Colour  illustrated,  the  booklet  supplies  many  basic 
recipes  in  which  Egg  Beaters  can  add  to  food  en- 
joyment without  lipid  risk. 


Standard  Brands  Canada  Limited 
Montreal,  Canada 


ft  1  ^:s5^*^^^^J 


FleiscW"^'' 


2-'"  ..flfl  <,««** 


^®. 


*Reg.  Trade  Mark 


IK'*' 


.49* 


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Consumer  service  division 
550  Sherbrooke  Street  West 
Montreal,  Quebec 


Gentlemen: 

Please  send  me  one  certificate  for  a  complimentary  carton  of 

Egg  Beaters. 

I  would  also  appreciate  a  supply  of  your  "Cooking  with  Egg 

Beaters"  recipe  booklet  for  my  patients  as  marked  below. 


No.  of  copies  requested 
English: 


French: 


(please  stamp  or  print) 


(Street) 


(City  or  town,  postal  code) 


Next  Month  in 

The 

Canadian 
Nurse 


•  Blindness  Can  Be  Prevented 

•  Enjoy  Halifax: 

Your  Next  CNA  Convention 

»    Communicable  Diseases: 
Immunization 


^^P 


Photo  Credits 

for  December  1975 

Clarke  Institute  of  Psychiatry, 
Toronto,  Ontario, 

p.  24 

Health  and  Welfare  Canada, 
Ottawa,  Ontario, 
p.  17 

Information  Canada, 
Ottawa,  Ontario, 
Cover  I 

Montaigne  Photography, 
Pembroke,  Ontario, 
p.  15 

Studio  C.  Marcil, 
Ottawa,  Ontario, 
p.  9 

University  of  British  Columbia, 
School  of  Nursing, 
Vancouver,  B.C., 

p.  36 


dates 


January  15-March  18,  1976 

Course  in  Family  Dynamics  to  be  given 
Thursday  evenings  at  the  Clarke  Insti- 
tute of  Psychiatry,  Toronto.  For  informa- 
tion, write:  Dorothy  Brooks,  Chairman, 
Continuing  Education  Program,  Faculty 
of  Nursing,  University  of  Toronto,  20  St. 
George  Street,  Toronto,  Ontario, 
M5S  1A1. 

January  16-17,  1976 

Workshop:  "Power  Games  in  Health 
Administration"  to  be  held  at  New  York 
University,  New  York.  For  information, 
write:  Judith  Chodil,  Continuing  Educa- 
tion in  Nursing,  NYU  Division  of  Nursing, 
429  Shimkin  Hall,  New  York.  N.Y., 
10003,  U.S.A. 

January  19-March  15,  1976 

Course  In  Electronics  for  Nurses  to  be 
given  Monday  evenings  at  the  Univer- 
sity of  Toronto  Faculty  of  Nursing,  To- 
ronto. For  Information,  write:  Dorothy 
Brooks,  Chairman,  Continuing  Educa- 
tion Program,  Faculty  of  Nursing,  Uni- 
versity of  Toronto,  20  St.  George  Street, 
Toronto,  Ontario,  M5S  1A1. 

January  19-21,  1976 

Post-graduate  course  in  pediatric  re- 
habilitation for  nurses,  physiotherapists, 
and  occupational  therapists.  For  infor- 
mation, write;  Norma  Geddes,  Educa- 
tion Department,  Ontario  Crippled 
Children's  Centre,  350  Rumsey  Road, 
Toronto,  Ontario  M4G  1 R8. 

January  26-27,  1976 

Seminar:  "Conflicts  In  the  physical  re- 
habilitation team"  to  be  held  at  the  Uni- 
versity of  Ottawa.  For  information,  write: 
Carolyn  Be'lzile,  Coordinator,  Continu- 
ing Education  Program,  School  of 
Health  Administration,  University  of  Ot- 
tawa, Ontario  KIN  6N5. 

January  28-30,  1976 

"Curriculum  Development"  (for  bac- 
calaureate graduates)  to  be  offered  at 
the  Faculty  of  Nursing,  University  of  To- 
ronto, Toronto.  For  information,  write: 


Dorothy  Brooks,  Chairman,  Continuing 
Education  Program,  Faculty  of  Nursing, 
University  of  Toronto,  20  St.  George 
Street,  Toronto,  Ontario,  M5S  1A1. 

January  29-30,  1976 

National  League  for  Nursing  regional 
conference  on  collaboration  for  quality 
health  care  to  be  held  at  Stouffer's  At- 
lanta Inn,  Atlanta,  Ga.  For  Information, 
wrlt6:  Convention  Services,  N.L.N,,  10 
Columbus  Circle,  New  York,  NY 
10019,  USA. 

February  6-8,  1976 

Wanganul  Hospital  reunion  to; 
graduates  and  past  members  of  staf* 
For  information,  write:  Sister  Simpson 
Wanganul  Base  Hospital,  Private  Bag, 
Wanganul,  New  Zealand. 

February  17-18,  1976 

Clinical  nursing  program  to  be  held  at 
the  faculty  of  nursing.  University  of  To- 
ronto. For  Information,  write:  Dorothy 
Brooks,  Continuing  Education  Program 
Faculty  of  Nursing,  University  of  To- 
ronto, 50  St.  George  Street,  Toronto, 
Ontario,  M5S  1A1. 

February  19-20,  1976 

Update  in  Nursing  in  Inflammatory  and 
Ulcerative  Disease  of  the  Gastrointesti- 
nal Tract  to  be  held  at  Faculty  of  Nurs- 
ing, University  of  Toronto.  For  informa- 
tion, write:  Dorothy  Brooks,  Continuing 
Education  Program,  Faculty  of  Nursing, 
University  of  Toronto,  50  St.  George 
Street,  Toronto,  Ontario  M5S  1A1. 

March  14-17,  1976 

Annual  meeting  of  the  National  League 
for  nursing  Council  of  Associate  Degree 
Programs  to  be  held  at  the  Sheraton 
Park,  Washington,  D.C.  For  information, 
write:  Convention  Services,  National 
League  for  Nursing,  10  Columbus  Cir- 
cle, New  York,  N.Y.  10019,  U.S.A. 

June  21-23,  1976 

Canadian  Nurses'  Association  annual 
meeting  and  convention  to  be  held  at 
Hotel  Nova  Scotlan,  Halifax,  Nova 
Scotia.  Theme:  The  Quality  of  Life.    .=.~ 


news 


Breast  Cancer  Symposium 
Attracts  Authorities  In  Field 

■"Populations  living  in  different  geog- 
raphic areas  have,  in  fact,  had  different 
experiences  with  respect  to  the  level  of 
breast  cancer  frequency  and  changes  in 
the  rate  of  occurrence  over  time.  How- 
ever, the  range  of  rates  is  now  narrower 
than  in  previous  years:  rates  appear  to 
be  converging  towards  a  level  of  70  to 
75  breast  cancers  diagnosed  per 
100,000  women  per  year,"  Dr.  Sidney 
Culler  of  the  cancer  foundation  of  De- 
troit, told  more  than  300  participants  in 
the  National  Conference  on  Breast 
Cancer  held  in  Montreal  last  fall.  Dr. 
Cutler  interpreted  this  trend  toward 
stabilization  of  the  incidence  rate  to 
mean  that  "women  have  been  getting 
more  homogeneous  with  respect  to  risk 
factors,  e.g..  age  at  first  pregnancy  and 
diet,  or  that  women  with  different  risk 
factors  are  becoming  more  evenly  dis- 
tributed throughout  the  country  as  a  re- 
sult of  population  mobility."" 

Dr.  Cutler  also  pointed  out  that  "the 
risk  of  breast  cancer  is  low  in  young 
women  and  increases  continuously  dur- 
ing the  life  span.  In  Saskatchewan,""  he 
said,  ""the  incidence/mortality  ratio  has 
increased  from  1.91  to  2.36  in  a  period 
of  20  years,  and,""  he  emphasized,  "the 
increase  is  due  to  an  increase  in  the 
incidence  of  cancer,  while  the  mortality 
rates  have  remained  fairly  stable.  This 
trend  inplies  that  fewer  women  are 
dying  from  cancer  of  the  breast."" 

Dr.  Cutler  concluded  that "  "while  the 
mortalit}-  from  breast  cancer  is  decreas- 
ing in  Saskatchewan,  Connecticut,  and 
several  metropolitan  areas  of  the  United 
States,  the  incidence  of  breast  cancer  is 
increasing.  Breast  cancer  remains,""  he 
said,  "the  most  frequent  type  of  cancer 
in  women  and  deserves  as  much  re- 
search attention  as  is  possible.'" 

Dr.  David  Anderson  of  the  Univer- 
sity of  Texas  told  participants  that  gene- 
tic risks  have  been  found  to  differ  little 
in  magnitude  from  those  resulting  from 
comparisons  of  more  environmental 
types  of  factors,  e.g.,  single  versus 
married  women,  low  versus  high  par- 
ity, early  versus  late  menopause,  or  late 
versus  early  age  of  first  delivery.  This 
suggests  that  genetic  factors  must  play  a 
relatively  small  role  in  breast  cancer. 


Fourteen  Canadian  nurses  were  honored  at  the  annual  investiture  of  the 
Priory  of  Canada  of  the  Most  Venerable  Order  of  the  Hospital  of  St.  John  of 
Jerusalem  (the  Order  of  St.  John).  Shown  (standing  left  to  right)  during  the 
ceremonies  at  Government  House  last  October  are:  Ada  McEwen,  National 
Director  of  the  Victorian  Order  of  Nurses,  Huguette  Labelle,  president  of 
CNA  and  Health  and  Welfare's  Principal  Nursing  Officer,  and  Nicole 
Du  Mouchel,  Executive  Director  and  Secretary  of  the  Order  of  Nurses 
of  Quebec. 

The  Order  of  St.  John  has  been  specially  concerned  with  the  care  of  the 
sick  and  wounded  ever  since  it  was  first  founded  nearly  900  years  ago.  It 
can  lay  claim  to  being  the  oldest  continuing  welfare  organization  in  the 
world. 


"This  notion  of  a  small  genetic  effect  is 
now  being  perpetuated  by  findings 
from  population  comparisons  of  mi- 
grants to  native-bom  where  the  breast 
cancer  rates  in  migrants  are  approach- 
ing the  rates  of  the  locale  or  country  to 
which  they  migrate,  suggesting  en- 
vironmental influence  on  breast  cancer 
development." 

"Earlier  diagnosis  of  breast  cancer  is 
the  only  method  with  proven  potential 
for  lowering  the  death  rate  from  breast 
cancer,"  said  Dr.  Philip  Strax.  director 
of  the  Guttman  Institute  in  New  York. 
"Earlier  diagnosis,""  he  continued.  - 
"means  finding  the  cancer  before  it 
would  ordinarily  be  delected  in  the 
normal  course  of  events,  and  this  in- 
volves mass  screening  of  apparently 


well  women.  Breast  cancer  is  the 
number  one  killer  of  women  aged  35  to 
50  in  Canada  and  aged  40  to  44  in  the 
United  States.""  he  emphasized. 

Dr.  Strax  said  that  "'it  is  well  known 
that  detection  of  breast  cancer  at  a  time 
of  no  nodal  involvement  carries  with  it 
an  85  percent  five  year  survival.  When 
nodes  are  involved  the  figure  drops  to 
53  percent  or  even  lower  when  two  or 
three  glands  show  metastases.  At  the 
present  time  only  about  25  percent  of 
breast  cancer  patients  are  alive  and  well 
ten  years  after  diagnosis.  Perhaps.""  he 
said,  ""the  reason  for  this  poor  showing 
is  that  95  percent  of  the  time  breast 
cancer  is  diagnosed  by  the  patient  her- 
self."" 

(Continued  on  page  10) 


E  CANADJAN  NURSE  —  December  1975 


news 


(Continued  from  page  9) 


Representatives  of  the  Registered 
Nurses"  Association  of  British  Colum- 
bia, in  a  report  presented  to  Health 
Minister  Dennis  Cocke,  have  called  for 
the  implementation  of  the  breast  cancer 
screening  program. 

The  RNABC  also  intends  to  appeal 
to  B.C.  health  agencies  to  consider  es- 
tablishing preventative  breast  cancer 
screening  programs  that  would  involve 
local  communities. 


ICN  Recommends 
Nurses  Direct  Nursing 

The  International  Council  of  Nurses 
has  recommended  that  only  qualified 
nurses  be  allowed  to  direct  nursing  ser- 
vices in  all  types  of  health  care  facilities 
and  all  nursing  education  programs. 
The  resolution  was  one  of  several  ap- 
proved by  the  Council  of  National  Rep- 
resentatives (CNR)  ICN's  governing 
body,  in  Singapore  in  August. 

ICN  president,  Dorothy  Cornelius 
explained  that  the  ICN  board  of  direc- 
tors had  received  reports  of  attempts  in 
various  countries  to  withdraw  the  re- 
sponsibility for  nursing  service  from 
nurses  and  give  it  to  non-nurse  health 
administrative  personnel.  Therefore, 
ICN  believed  it  necessary  to  describe 
nursing's  responsibility  and  account- 
ability for  nursing  services  and  nursing 
education. 

The  resolution  is  worded  to  em- 
phasize that  not  only  must  it  be  nurses 
who  direct  nursing  education  and  ser- 
vices, but  that  these  nurses  must  have 
the  necessary  preparation  to  do  so. 

The  resolution  directs  that: 

"all  nursing  services  in  health  care 
facilities  of  ail  types  be  directed  by 
qualified  directors  who  are  nurses;  and 
all  nursing  education  programs  — 
basic,  post-basic  and  specialized  —  be 
directed  by  specially  qualified  nurses; 
and  all  teaching  of  nursing  courses, 
theory  and  practice,  be  done  by  nurses 
who  are  qualified  to  teach." 


Registered  Nurses 

Your  community  needs  the  benefit 
of  your  ski  lis  and  experience.  Volun- 
teer now  to  teach  Patient  Care  in 
The  Home  and  Chil^  Care  in  The 
Home  Courses. 


contact 


Cardiovascular  Nurses 
Hold  National  Meeting 

The  Canadian  Council  of  Cardiovascu- 
lar Nurses  (CCCN) .  founded  in  1 973  to 
promote  the  quality  of  health  care  as  it 
relates  to  cardiovascular  function,  has 
elected  new  officers  for  the  coming 
year.  Carolyn  Stockwell  of  Windsor 
and  Cecile  Boisvert  of  Montreal  will 
act  as  chairman  and  vice-chairman  of 
the  CCCN  which  is  affiliated  with  the 
Canadian  Heart  Foundation.  They  were 
elected  at  the  council's  third  annual 
meeting  in  Montreal  in  October. 

More  than  150  nurses  from  across 
Canada  attended  the  five-day  meeting 
which  was  held  in  conjunction  with  the 
annual  meeting  of  the  CHF. 

A  total  of  eight  sessions  of  special 
interest  to  cardiovascular  nurses  were 
held.  Participants  included  Rita  Martel, 
Cecile  Boisvert.  and  Madeleine 
Corbeil  of  Montreal  and  Patricia 
Adolphus,  Linda  Graham  and  Kathy 
Pallant  of  Toronto.  Rosemary  Coombs 
of  Ottawa,  a  clinical  nurse  specialist, 
presented  the  findings  of  her  research 
project  on  the  nurse  clinician's  role  in 
cardiac  surgery.  Coombs  concluded 
that  the  clinical  nurse  specialist 
demonstration  project  was  successful 
in  preparing  cardiac  surgery  nurse 
clinicians  to  carry  out  nurse  specialist 
activities  and  that  nurse  clinicians  were 
successful  in  demonstrating  and 
encouraging  nurse  specialist  activities 
on  both  the  cardiac  surgery  unit  and 
ward. 

The  objectives  of  the  CCCN  are:  To 
foster  continuing  education  in  car- 
diovascular nursing,  to  promote  com- 
munications among  nurses  and  related 
groups  of  health  workers  in  the  field  of 
cardiovascular  health  care,  to  stimulate 
research  designed  to  increase  the  body 
of  knowledge  in  cardiovascular  nurs- 
ing, and  to  identify  needs  and  trends 
related  to  cardiovascular  nursing  at  a 
national  level. 

CNF  Scholars 
Support  Foundation 

For  the  past  12  years  the  Canadian 
Nurses'  Foundation  (CNF)  has 
awarded  money  to  nurses  for  graduate 
education  or  research.  This  year  the 
roles  were  reversed  and  the  Foundation 
approached  former  CNF  scholars  with 
an  appeal  for  funds. 

The  appeal  yielded  a  total  of 
S3. 080. 00.  Close  to  two  thirds  of  the 
105  scholars  (65)  donated  funds  ac- 


cording to  results  announced  at  the 
CNF's  board  of  directors  meeting  las' 
October.  At  the  same  meeting,  the  CNl 
board  accepted  the  necessity  of  charg 
ing  a  fee  to  be  submitted  with  eaci 
application  for  scholarship  funds.  Thi- 
fee  is  being  introduced  to  defray  th^ 
costs  of  processing  applications.  Effec 
live  immediately,  CNF  members  wii 
be  asked  to  pay  $15.00  and  non 
members  $25.00. 

The  CNF  was  founded  in  1962  by 
nine  members  of  the  Canadian  Nurses' 
Association.  Since  then,  it  has  awarded 
a  total  of  $446,312.00  in  scholarships 
to  nurses  preparing  for  leadership  posi- 
tions. 

The  objects  of  the  Foundation  are: 
"To  provide  bursaries,  scholarships, 
and  fellowships  for  nurses  in  the  field 
of  graduate  studies  at  the  Master's  and 
Doctorate  levels;  to  provide  grants  in 
aid  of  or  to  undertake  research  in  nurs- 
ing science  which  may  help  to  advance 
the  knowledge  and  art  of  members  of 
the  nursing  profession  with  a  view  to 
providing  the  best  possible  nursing  care 
and  attention;  and  to  solicit,  acquire, 
accept  or  receive  gifts,  donations,  be- 
quests or  subscriptions  of  money,  or 
other  real  or  personal  property,  whether 
they  be  unconditional  or  subject  to  spe- 
cial conditions,  provided  any  special 
conditions  are  not  inconsistent  with  the 
above  objects." 
New  Clinic  Deals 
With  Facial  Deformities 

A  new  multi-disciplinary  clinic 
specializing  in  the  management  of  adult 
facial  deformities  has  been  established 
at  Sunnybrook  Medical  Centre  Uni- 
versity of  Toronto. 

Facial  deformities  seen  in  the  clinic 
stem  from  traumatic  incidents  such  as 
automobile  accidents  or  from  residual 
congenital  defects.  One  of  the  com- 
monest problems  seen  is  cleft  lip  and 
palate.  Unaware  that  treatment  was  av- 
ailable, many  adults  have  left  this  prob- 
lem unattended  since  birth. 

The  multi-disciplinary  team  ap- 
proach is  stressed,  under  the  division  of 
plastic  surgery.  Any  given  problem 
may  require  the  assistance  of  dentistry, 
otolaryngology,  ophthalmology,  neu- 
rosurgery, and/or  speech  pathology  at 
Sunnybrook  Medical  Centre. 

As  the  patient  load  increases,  it  is 
hoped  the  clinic  will  establish  Sunny- 
brook Medical  Centre  as  one  of  the 
leaders  in  the  management  of  ortho- 
dontal and  facial  deformities. 

(Continued  on  page  12) 


now  that  you  ve 
discovered 

antibiotic-impregnated 
^Sofra-TuUe®  in  this 


larger  size  .  .  . 


<<o 


,x>:^*^ 


\ 


8^ 


.fr^ 


strip ''"'" 


'4^^ 


•  .  .  you're  ready 
for  all  the 
other  interesting 
facts  that  are 
revealed  in  this 
new  audio*visual 
presentation. 


Sofra-Tulle*  is  available 
in  a  10cm  x  30cm  size,  in  addi- 
tion to  the  regular  10cm  x  10cm 
format.  This  larger  presentation 
provides  three  times  more  cover- 
age to  facilitate  the  handling  and 
dressing  of  larger  lesions. 

Both  sizes  of  Sofra-Tulle 
contain  Soframycin  —  an  anti- 
biotic. Reserved  exclusively  for 
topical  use,  Soframycin  has  a 


comprehensive  spectrum  of  activ- 
ity against  organisms  normally 
encountered  in  bums,  ulcers  and 
wounds.  Soframycin  is  present  in 
Sofra-Tulle  in  a  bactericidal  con- 
centration, and  maintains  its  ef- 
fectiveness even  in  the  presence 
of  blood,  pus  and  serum.  The 
mesh  is  wide  enough  to  permit 
good  drainage  of  exudate,  thus 
preventing  maceration. 

ROUSSEL 


I  am  interested  in  seeing  your  new    Sofra-Tulle 
Facts  &  Fallacies   filmstrip.  Please  ask  my  local 
Roussel  Representative  to  contact  me  at  the  ad- 
dress below  at  his  first  opportunity.  Thank  you. 


Name 


Position /Title 


Hospital 


Address 


C«y 


Prov, 


Tel. 


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(Continued  from  page  10) 


Ontario  Nurses  Hold 
Respiratory  Disease  Seminar 

Good  nursing  care  of  the  patient  with 
respiratory  disease  is  the  resuh  of  a 
combination  of  intuition  and  under- 
standing of  the  physiology  involved, 
according  to  University  of  Arizona  pro- 
fessor of  nursing  and  assistant  profes- 
sor of  internal  medicine.  Gayle  A. 
Traver.  The  internationally  known 
specialist  in  pediatric  and  adult  (pul- 
monary and  allergy)  respiratory  dis- 
eases directed  a  one-day  professional 
development  seminar  sponsored  by  the 
Toronto  Nurses'  Section  of  the  Ontario 
Lung  Association  in  Toronto  recently. 

"Know  what  you're  talking  about 
and  say  it  without  being  wishy- 
washy,"  Traver  told  her  audience  of 
close  to  200  nurses.  "A  colleague  rela- 
tionship between  members  of  the  health 
team  implies  communication  and  re- 
spect for  each  other's  expertise.  To 
achieve  this,  the  nurse  must  understand 
the  physiology  involved  so  that  she 
knows  what  she  is  seeing,  can  explain 
the  mechanism,  and  recognizes  what 
she  doesn't  know." 

"Nursing  initiative  and  intuition  are 
also  important,"  Traver  pointed  out. 
"because  assessment  of  respiratory 
disease  patients  is  usually  made  on  a 
short-term  basis,  without  opportunity 
for  clinical  research  or  experimenta- 
tion, and  clinical  applications  of  care 
are  not  investigated  in  the  literature 
available. 

"The  nurse  is  the  one  who  sho'ilc 
help  the  patient  and  family  develop  cop- 
ing mechanisms,  assume  responsibility 
for  patient  and  family  teaching,  insti- 
tute changes  in  the  treatment  program, 
and  interpret  the  effect  of  nursing  or- 
ders." 

To  assist  nurses  in  the  psychosocial 
aspect  of  care  of  respiratory  disease  pa- 
tients, the  speaker  presented  "Traver's 
Helpful  Hints"  including  the  warning 
that  nurses  should  not  "label"  or 
categorize  patients,  but  should  base 
their  care  on  understanding  of  what  the 
disease  means  to  that  patient  and  the 
previous  coping  mechanisms  of  that  pa- 
tient. "One  of  the  most  important 
things  you  can  tell  a  patient."  she 
stressed,  "is  that  he  won't  die  of  short- 
ness of  breath." 

"The  nurse  can  provide  both  help 
and  hope.  She  can  provide  status  in  the 
treatment  setting  that  will  compensate 
for  loss  of  status  in  the  patient's  former 
setting." 


The  seminar  was  the  first  event 
staged  by  the  recently  established 
Toronto  Nurses'  Section  of  the 
Ontario  Lung  Disease  Association. 
Cochairmen  of  the  event  were  Dorothy 
Sharp,  nursing  consultant.  Metro 
Toronto  Health  Department.  Ontario 
Lung  Association,  and  Jean  Bullen. 
senior  nurse  epidemiologist.  East 
York  Health  Unit,  Borouah  of  East 
York. 


Conference  Closes  1975 

"Too  many  of  Canada's  three  million 
working  women  are  in  "women's'  oc- 
cupations," according  to  the  director  of 
the  Women's  Bureau  of  the  federal  De- 
partment of  Labor,  Sylva  Gelber.  She 
warned  delegates  to  Action  "75,  a  na- 
tional conference  sponsored  by  the  In- 
ternational Women's  Year  Secretariat, 
that  this  constitutes  a  waste  of  our 
country's  human  resources. 

Action  '75,  held  in  Ottawa  in  Oc- 
tober, was  attended  by  some  350  mem- 
bers of  Canada's  business  and  execu- 
tive elite  (mostly  men).  They  had  been 
invited  by  the  prime  minister  to  discuss 
ways  of  ensuring  continuity  in  improv- 
ins  the  lot  of  women  after  the  end  of 
IWY. 

""We  are  still  talking  about  a  small 
group  of  educated  middle-class  women 
and  not  the  working  force  who  are  in 
great  need,"  said  panelist  Elsie 
McGill,  aeronautical  engineer  and 
former  commissioner  on  the  Royal 
Commission  on  the  Status  of  Women. 
She  believes  there  are  no  exceptional 
men  or  women,  only  those  with  a  more 
than  normal  degree  of  freedom  of 
choice  and  action.  ""It  is  this  freedom 
that  women  have  lacked,"  she  said. 

Shirley  Carr.  executive  vice- 
president  of  the  Canadian  Labour  Con- 
gress, urged  that  job  descriptions  be 
changed  toallow  for  equality:  that  jobs, 
rather  than  persons  performing  them, 
be  evaluated  and  that  training  be  open 
to  both  sexes. 

A  panel  on  advertising  emphasized 
image-making.  '"We  don't  object  to 
being  sexy,  but  to  being  depicted  as  sex 
objects,"  said  Dr.  Alice  Courtney,  as- 
sociate professor  of  marketing.  York 
University.  According  to  Dr.  Therese 
Sevigny.  vice-president,  operations. 
Old  Montreal  Communicators  Group 
Inc..  those  involved  in  image  making 


should  not  simply  reverse  roles.  ""Me 
and  women  should  work  together  c: 
newroles  for  future  society,"  she  said. 

Marc  Lalonde.  minister  responsib! 
for  the  Status  of  Women,  acknow 
ledged  that  there  is  ""real  concern  thai 
improvements   in  that   status   are   not 
being  realized."  He  promised  that  Ac- 
tion '75  would  mark  the  beginning  ot 
an  accelerated  effort  by  both  govern 
ment  and  the  private  sector  to  achievx 
the  goal  of  equality. 

""In  1974,  only  1 .7%  of  senior  gov 
ernment  executives  were  women,"  he 
continued,  ""A  more  explicit  and  ag- 
grejisive  policy  is  needed  ...  to  accel- 
erate the  desegregation  of  the  Public 
Service  work  force."  He  explained  one 
way   is  to   integrate  status-of-womcn 
concerns  in  all  areas  of  [governmeni] 
policy  and  program  development.  An 
interdepartmental    study    of    how    t< 
achieve  this  goal  is  to  be  presented  i 
Cabinet  by  the  end  of  1975. 


Trust  Offers  Funding 

The  ICN  Board  of  Directors  has  re 
minded  member  associations  of  the  ex- 
istence of  a  possible  source  of  funding 
for    specific    projects.    The    Edwinli 
Mountbatten  Trust  was  established  in 
I960  to  promote  and  improve  the  art 
and  practice  of  nursing.  The  sum  avai 
able  for  grants  in  1 974  was  £4.000  (aj' 
proximately  $8,000  in  Canadian  cur- 
rency). 

Grants  are  made  annually  tot 
specific  projects  to  advance  the  cause 
of  nursing.  Only  projects  which  cannot 
be  funded  from  other  sources  are  elisii- 
ble. 

Grants  are  made  to  or  through  a  rec- 
ognized nursing,  medical,  social,  or 
educational  organization.  If  individual 
nurses  wish  to  apply,  they  must  obtain 
the  recommendation  of  such  an  organi- 
zation. Details  of  the  project,  plus  a 
cost  estimate,  must  be  clearly  de- 
lineated. 

Any  request  for  grants  must  include 
details  of  the  organization  or  in  the  case 
of  an  individual  nurse  the  official  form 
must  be  accompanied  by  a  letter  giving 
reasons  for  the  application.  All  applica- 
tions must  be  addressed  to:  The  Honor- 
ary Secretary,  Nursing  Subcommittee, 
The  Edwina  Mountbatten  Trust,  1 
Grosvenor  Crescent,  London,  SWIX 
7EF,  England.  Deudlme  for  applica- 
tion in  1976  is  Jan  nan'  31 . 


GROUP  DISCOUNTS:  S^II  Sane  Itins 

Deduct  10%    1224  Same  Items.  15% 

2S  or  Mwe  Same  Item.  20% 


Mrs.  R.  F.  JOHNSON 

SUPERVISOR 


Four-day  Work  Week 

The  12-hour  shift  is  not  suitable  for 
nurses  working  in  the  ICU.  says  Dr. 
Elisabeth  Kiibler-Ross.  Austrian  born 
psychiatrist  now  living  near  Chicago 
and  internationally  known  author  and 
lecturer  on  death  and  dying. 

She  commented  on  the  longer  work 
day  in  reply  to  a  question  during  a  one- 
day  seminar  for  hospital  administrators 
and  staff  at  the  Hotel  Vancouver,  in 
Vancouver  this  fall. 

■"It  is  impossible  as  far  as  I'm  con- 
cerned," she  said.  "Maybe  they 
(nurses)  think  of  the  three  days  off  to 
preserve  their  sanity,  but  they  should 
also  think  of  how  they  could  be  in- 
volved for  12  hours." 

Ideally,  nurses  should  work  four 
hours  with  patients  in  ICU  and  spend 
the  other  half  of  the  day  on  another 
ward  or  doing  paper  work.  Otherwi.se, 
she  said,  the  nursing  care  becomes  de- 
humanized and  nurses  "have  to  check 
monitors  and  respirators  in  order  not  to 
become  involved." 

Dr.  KiJbler-Ross  held  that  the  doctor 
should  give  the  diagnosis  to  the  patient, 
although  many  are  uncomfortable 
doing  that,  but  nurses  can  help. 

"If  the  patient  asks  and  wants  you  to 
level  with  him,  why  not  be  honest  and 
say  "it  would  not  be  proper  for  me  to 
give  you  the  diagnosis,  but  nobody  says 
I  can"t  sit  down  and  talk  with  you'," 
she  told  nurses  in  the  audience.  "The 
patient  then  can  talk  and  .say  how  he 
knows  he  is  dying." 

Nurses  and  others  working  with 
dying  patients  need  a  "screaming 
room"  where  they  can  recharge  their 
batteries,  she  said.  This  can  be  any  pri- 
vate place  "where  anyone  working  on 
the  unit  can  go  and  do  whatever  is 
needed  for  a  few  minutes." 

The  seminar  was  one  in  a  series  of 
annual  presentations  by  the  Ba.xter 
Laboratories  of  Canada. 


New  Scholarship  Established 

The  International  .Association  for  En- 
terostomal Therapy  has  established  an 
annual  scholarship  grant  of  SI, 500  to 
be  awarded  in  August  to  a  registered 
nurse  who  is  interested  in  working  in 
this  speciality. 

The  applicant  must  be  a  registered 
nurse  employed  in  a  hospital  or  other 
related  facility.  She  must  have  a  sincere 
interest  in  the  total  rehabilitation  of  the 
ostomy  patient;  be  utilized  in  her  em- 


ployment in  the  nursins  care  planning 
and  teaching  of  the  nursing  staff:  and  be 
willing  to  use  her  expertise  and  know- 
ledge in  the  community. 

Information  about  this  grant  and  an 
application  form  may  be  obtained  from: 
Aileen  Barer,  R.N.E.T..  Chairman, 
Scholarship  Committee,  Enterostomal 
Therapy  Center,  Royal  Jubilee  Hospi- 
tal, Victoria,  B.C.,  Canada. 


Nursing  in  Jeopardy 

Operation  Health  Sciences,  a  joint  un- 
denaking  of  the  Quebec  Ministries  of 
Education  and  Social  Affairs,  has  stun- 
ned the  nursing  profession  in  that  prov- 
ince by  submitting  a  draft  of  proposed 
changes  in  the  health  system.  ONQ 
president  Jeannine  Tellier-Cormier  has 
reacted  to  the  draft  submitted  to  that 
association  last  Fall  by  charging  that 
the  proposals  threaten  the  very  exis- 
tence of  nursing. 

The  draft  specifies  the  need  for  a 
definition  of  objectives  within  the 
health  system  and  a  comprehensive 
educational  plan  for  professionals,  al- 
though higher  education  for  nurses  ap- 
pears to  be  almost  completely  ignored. 

According  to  the  Professional  Code 
and  the  Nurses"  Act,  the  ONQ  is  re- 
sponsible for  the  protection  of  the  pub- 
lic, controlling  nursing  practice,  selec- 
tion of  future  members  of  the  profes- 
sion, education,  improvement,  certifi- 
cation of  specialists,  quality  of  nursing 
care,  and  nursing  care  programs. 

To  avoid  a  hasty  decision,  the  ONQ 
has  submitted  three  recommendations: 
The  period  between  the  presentation  of 
the  draft  and  preparation  of  the  final 
text  be  extended  to  six  months,  to  en- 
able the  ONQ  to  submit  precise,  realis- 
tic, and  concrete  recommendations:  a 
delay  of  one  year  be  allowed  before  the 
implementation  of  the  report,  to  enable 
the  ONQ  to  submit  a  detailed  plan  of 
action  covering  the  entire  area  of  nurs- 
ing education:  and  that  education  pro- 
grams be  developed  according  to  the 
needs  of  the  population. 

Operation  Health  Sciences  was  un- 
dertaken by  the  Ministries  of  Education 
and  Social  Affairs  in  1972:  To  coordi- 
nate the  education  of  health  profession- 
als at  the  university  level,  to  predict  the 
human  and  financial  resources  needed 
to  meet  the  health  needs  of  Quebec,  to 
describe  the  evolving  role  of  the  health 
professionals,  and  to  predict  new  types 
of  health  professionals. 


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IS  THERE  SEX  DISCRIMINATION 
IN  HEALTH  CARE? 


f  you  doubted  it, 
HERE  ARE  YOUR  REPLIES 


i\'hen  The  Caniulian  Xurse  and 
.' Infirmi'ere  caiiadienne  asked  Ihe  nurses  of 
Tanada  lo  help  document  the  existence  of 
liscrimination  in  heahh  care,  you  re- 
ponded  with  enthusiasm. 

This  article  is  intended  to  make  you 
ware  of  what  your  colleagues  feel  is  hap- 
lening  today  in  this  area.  It  is  descriptive 
ather  than  definitive  because  of  the  nature 
if  the  subject  and  the  way  in  which  it  was 
pproached.  We  did  not  attempt  to  find  the 
ipinions  of  a  representative  sample  of  all 
le  nurses  in  Canada.  We  did  ask  readers  to 
li  in  a  foriTi  we  provided,  describing  how 

y  fell  about  se.x  discrimination  as  a  nurse 
fid  as  a  person. 

We  found  out  that  many  of  you  do  care 
nough  about  what  you  consider  a  violation 
if  your  rights,  to  let  us  know  about  il. 


When  the  light  blinked  on  above  3 1 8  in  the 
nursing  station.  Nurse  Z  shook  her  head  in 
disbelief. 

■"That  woman!  She  must  think  this  is  a 
hotel,  ringing  for  room  service  every  10 
minutes.  That's  been  going  on  all  night." 
she  told  the  nurse  just  coming  on  duty. 

''Just  another  difficult  woman,"  the 
second  nurse  agreed.  "At  least  we  don't 
have  these  problems  with  men  .  .  .  not 
until  their  wives  come  along  and  start 
complaining." 

This  conversation  could  have  taken 
place  in  any  hospital  in  this  country.  It 
illustrates  one  of  the  points  some  of  you 
raised  in  your  replies  to  The  Canadian 
Nurse's  questionnaire  on  sex  discrimina- 


tion in  health  care:  You  told  us  that  not  all 
the  bias  stems  frotii  male  chauvinism.  Dis- 
crimination against  female  patients  is  prac- 
ticed by  other  females  —  the  nurses  — 
who  in  turn  feel  discriminated  against  in 
many  ways.  Nurses  may  be  unconscious 
of  perpetuating  negative  attitudes  towards 
women  while  at  the  .same  time  resenting 
male  domination  in  the  health  services. 

The  Canadian  Nurse's  questionnaire 
was  an  effort  to  uncover  the  national  pic- 
ture of  sex  discrimination  in  health  care, 
and,  during  International  Women's  Year, 
highlight  the  problems  in  order  to  find 
solutions. 

Your  letters  were  full  of  personal  ex- 
periences of  discrimination.  While  some 


of  the  examples  were  not  unexpected  (they 
related  to  pay  and  hiring  practices),  the 
rephes  also  included  representation  from 
male  nurses  who  felt  that  they  too  were  not 
treated  fairly  within  the  profession  be- 
cause of  their  sex. 

To  return  to  the  example  above,  a 
former  patient  in  Victoria  who  considers 
the  nursing  profession  riddled  with  sex 
discrimination,  wrote  that  she  has  often 
heard  all  levels  of  nursing  personnel  say 
they  would  rather  care  for  a  male  than  a 
female  patient.  "According  to  these 
nurses,  male  patients  are  far  less  demand- 
ing, not  so  fussy,  not  so  inclined  to  whine 
and  much  more  appreciative.'" 

A  check  with  nursing  directors  and  per- 
sonnel officers  at  Ottawa  hospitals  failed 
to  substantiate  this  claim  in  any  conclusive 
way.  Perhaps  the  sample  was  too  small,  or 
perhaps  this  aversion  to  female  patients  is 
seldom  expressed  to  authorities.  How- 
ever, a  director  of  nursing  at  a  large 
Montreal  hospital  told  us,  "I  have  a  feel- 
ing nurses  prefer  to  care  for  men.  Perhaps 
men  are  less  demanding.  Perhaps  the 
workload  is  lighter  in  many  departments." 

In  any  case,  only  the  nurse  knows  her 
true  feelings.  Are  nurses  discriminating 
against  female  patients  and  justifying  it  on 
other  grounds?  If  this  kind  of  discrimina- 
tion is  widespread,  nurses  must  recognize 
that  this  tendency  exists  and  learn  to  deal 
with  it  in  a  constructive  way  as  a  profes- 
sion. 

Barbara  P.  Madden,  writing  \i\ Nursing 
Outlook,  touches  on  this  problem  when 
she  advises  that  "the  nursing  instructor 
can  reinforce  feminist  concepts  by  her  own 
interactions  with  other  women  —  staff, 
practitioners,  patients  and  other  faculty. 
Students  need  to  see  their  instructor  as  a 
role  model  for  working  relationships  with 
other  women,  and  they  need  to  see  that 
women  can  like  women  and  work  well 
with  them."' 

Patients'  rights  ... 

Your  letters  cited  tubal  ligations  and  abor- 
tion as  examples  of  male  discrimination 
towards  female  patients.  Laws  "made  by 
men"  would  certainly  be  different,  wrote 
a  nurse  from  Thunder  Bay,  if  men  had  to 
bear  the  consequences. 

Several  readers  complained  of  waiting 
many  months  for  hospital  beds  —  up  to 
eight  months  wasn't  unheard  of —  so  they 
could  have  laparoscopics.  "Hospitals  are 
indifferent  to  women's  concerns  over 
their  bodies  when  there  is  not  an  im- 
mediate threat  to  health,"  one  wrote. 


A  nurse-patient  complained  that  hospi- 
tals which  fail  to  provide  gynecological 
services  block  patients'  rights  to  health 
care.  Respondents  to  the  questionnaire 
also  wondered  why  women  are  refused 
tubal  ligations  if  their  husbands  refuse  to 
sign. 

The  question  of  liability  for  loss  or  dam- 
ages arising  out  of  treatment  of  one  partner 
in  a  marriage  without  the  consent  of  the 
other,  has  not  yet  been  finally  determined 
by  the  courts.  According  to  one  authority: 
"The  law  in  this  area  will  probably  un- 
dergo some  development  in  the  next  few 
years.  It  may  be  that  if  one  spouse  does  not 
concur  in  the  treatment  undertaken  by  the 
other,  the  remedy  will  be  divorce  and  not 
an  injunction  against  the  treatment  ....  In 
any  event,  the  physician  should  do  every- 
thing possible  to  obtain  the  consent  of  both 
the  husband  and  wife  before  carrying  out 
personal  operations  such  as  abortion  and 
sterilization."^ 

■"From  my  discussion  with  co- 
workers," wrote  a  nurse  with  experience 
in  many  hospitals,  "we  have  concluded 
that  we  hesitate  to  seek  medical  advice  for 
fear  of  being  labelled  'neurotic'.  If  one  is  a 
patient,  doctors  and  medical  staff  brush 
aside  our  hesitant  questions,  and  one  is 
made  to  look  foolish."  The  author  of  that 
letter  had  visited  a  G .  P.  with  a  documented 
case  of  cystitis.  He  told  her  it  was  highly 
likely  psychosomatic.  Two  years  later,  she 
required  medical  intervention  for  her 
"psychosomatic"  cystitis. 

A  nurse  who  developed  rheumatoid  ar- 
thritis at  26  years  of  age  discovered  that 
therapy  is  sex-related.  She  wrote  us  that  all 
rehabilitation  given  to  her  was  oriented  to- 
wards her  career  as  a  housewife:  baking 
cookies,  washing  clothes,  cleaning  bath- 
tubs. On  the  other  hand,  men  on  the  same 
ward  learned  to  cope  at  home  and  were 
encouraged  to  resume  their  work  or  adjust 
to  it.  "My  anger  rises  when  I  remember 
deciding  to  go  back  to  nursing  and  being 
told  by  my  doctor  that  I  would  probably 
have  an  exacerbation.  Would  they  have 
done  that  to  a  young  man?"  she  asked. 

.  .  .  And  nurse  privileges 

If  female  patients  feel  discriminated 
against  by  the  medical  fraternity,  nurses 
working  with  the  opposite  sex  feel  their 
professionalism  is  flouted  when  certain 
work  is  closed  to  them. 

A  male  RNA  wrote,  "Because  of  my 
sex  I  was  not  allowed  to  train  in  either 
obstetrics  or  child  care,  including  the  nur- 
sery. The  hospital  at  which  the  school  af- 


filiated was  Women's  College  hospita 
Toronto.  They  wouldn't  allow  men  ton, 
in  this  area  even  though  we  sit  the  regisi: 
tion  exam  like  everyone  else.  I  was  i 
prived  of  my  clinical  experience.  I  couK: 
even  change  a  diaper!" 

And  from  a  female  nurse:   "(Duriii 
vasectomies)  the  nurse  must  stand  oiii 
side,  waiting  for  a  signal  (a  kick  on  ili 
door)  from  the  doctor  which  indicate 
that  the  patient  is  covered  and  she  ma 
enter  to  assist  the  doctor  to  draw  up  loco 
anesthetics.  Then  she  must  leave  and  \\d 
outside  for  the  duration  of  surgery,  enter 
ing  only  in  answer  to  another  kick  on  i 
door."  She  concludes  by  asking  wh\ . 
male  doctors  and  male  nurses  are  allow 
to  be  present  at  a  pelvic  examination,  it  i 
considered  indecent  for  a  nurse  to  be  pres 
ent  at  a  vasectomy?  Why  are  the  mal 
patient's  feelings  considered,  but  not  thi 
female's?  We  can  only  ask,  why  indeed 

One  correspondent  criticized  Thi 
Canadian  Nurse  for  carrying  advertise 
ments  showing  nurses  in  a  subservieni 
role.  No  one  pointed  out  that  pharmaceuti 
cal  advertising,  wherever  it  is  found,  oftei 
shows  women  in  an  unfavorable  light.  Th< 
message  drug  ads  convey  is  that  womei 
patients,  who  clutter  doctors'  offices  wit! 
improbable  complaints,  can  be  treatec 
quickly  and  easily  by  simply  filling  out ; 
prescription  order. 

The  doctor-nurse  game 

The  ongoing  struggle  for  less  ranking 
and  more  equality  among  health  care  pro- 
fessionals brought  its  share  of  letters  tc 
The  Canadian  Nurse.  Nurses  wonderec 
why  they  must  have  a  doctor's  order  tc 
give  so  much  as  a  hot  water  bottle.  They 
asked  why  doctors  refuse  to  consider 
nurses  part  of  a  team,  and  even  go  so  far  as 
to  belittle  a  nurse's  education. 

When  a  doctor  wishes  to  be  away,  to 
sleep  or  simply  not  to  be  disturbed  he  be 
slows  privileges  upon  nurses  which  the> 
immediately  lose  when  he  is  present  at  the 
hospital .  This  view  came  from  a  nurse  who 
considers  herself  a  rebel  because  she  won't 
give  doctors  red  carpet  treatment.  She 
keeps  that  kind  of  treatment  for  her  pa- 
tients. 

Examples  of  paternalism  and  over- 
familiarity  of  male  medical  staff  were 
given  in  the  completed  questionnaires. 
The  elderly  doctor  who  puts  his  arms 
around  the  nurse's  waist,  the  intern  who 
puts  his  hands  into  her  pockets  looking  for 
scissors,  while  constituting  a  brand  of  ^t 
ism  not  peculiar  to  nursing,  illustrate  hv.. 


\ 


^ex  role  is  often  confused  with  the 
pational  role.  A  male  nurse  writing  in 
rvisor  Nurse  underscores  this  point 
Alien  he  claims  he's  found  "surprisingly 
ewer  of  those  traditional  doctor-nurse 
ensions  hanging  in  the  air  when  working 
vith  a  man.""^ 

An  article  by  Bonnie  Bullough  and  Vem 

Jullough  in  Nursing  Outlook  details  the 

;ffects  of  unsatisfactory  communication 

»etween  doctor  and  nurse. ■*  In  their  opin- 

on.  medical  care  suffers  from  this  com- 

nunications  gap.  The  authors  refer  to  the 

^r-nurse  game,  in  which  the  nurse 

s  the  role  of  manipulative  subordinate. 

|"his  is  how  it's  played.  Nurses  assess  the 

lent  24  hours  a  day,  but  under  the 

's  of  the  game,  pretend  they  never 

tgnose  or  recommend.    They  report 

mptoms  to  the  doctor  and  wait  for  the 

}propriate  order.  If  it  fails  to  come,  the 

iformation  is  accidentally  passed  on  to  a 

idem  or  attending  physician  who  then 

sues  the  "right"  response.  In  this  way, 

le  illusion  is  preserved  that  the  doctor 

ways  initiates  the  course  of  action  to  be 

allowed. 

y,  pension  and  promotion 

Those  unemployment  insurance  dues 
3u  pay  may  be  useless  to  you  if,  like  a 
irse  in  northern  Ontario,  you  move 
here  there  is  no  provision  for  an  R.N.  at 
linic.  In  this  case,  she  was  refused 
nefits  although  she  had  worked  for 
ven  years. 

The  extended  health  care  benefits  of  the 
■itish  Columbia  Government  Emp- 
yees'  Union  include  the  fees  of  a  regis- 
ed  nurse  only  if  she  is  "not  related  to  the 
vered  person  by  blood  or  marriage." 
erestingly,  the  plan  —  which  also  in- 
des  the  services  of  a  variety  of  health 
re  workers  from  first  aid  attendants  to 
iropractors  —  does  not  stipulate  that 
y  be  unrelated  to  the  patient. 
A  nurse  in  the  province  of  Quebec 
inted  out  that  her  life  insurance  policy 
uld  not  be  payable  to  her  spouse  at  her 
ith  unless  he  was  an  invalid.  At  the 
Tie  time,  the  beneficiaries  of  male  emp- 
ees  in  the  same  hospital  need  not  be 
ralids. 

A  similar  situation  arises  in  the  Ontario 
munity  college  system  where  a  nurse- 
cher  must  pay  six  percent  of  her  wages 
T  the  pension  plan.  If  she  dies,  her  hus- 
id  and  children  will  get  nothing  unless 
y  are  totally  dependent  on  her  for  sup- 
.  Under  the  same  plan  a  percentage  of 
nale  employee's  pension  is  paid  to  his 

CANADIAN  NURSE  —  Decembef  1975 


»    „  i  »krf'  >  ^ 


widow  and  children,  without  questioning 
their  dependence  on  him. 

The  discrepancy  in  wages  paid  to  male 
and  female  staff  doing  the  same  work  is 
always  raised  when  sex  discrimination  in 
nursing  is  discussed.  Replies  to  the  ques- 
tionnaire brought  more  evidence  of  this 
practice,  as  well  as  examples  of  the  low 
salaries  still  being  paid  to  some  nurses.  For 
example,  a  school  nurse  in  Quebec  with 
eight  years'  experience  who  works  a  36 
1/4  hour  week  says  she  nets  only  $6697.50 
annually. 

Is  anyone  surprised  to  learn  that  some 


registered  nurses  are  working  for  the  same 
wage  as  maintenance  men? 

Sylva  Gelber  of  the  women's  bureau, 
department  of  labour,  drew  attention  to  a 
more  subtle~fonn  of  discrimination  in  hir- 
ing at  the  1 975  annual  meeting  of  the  CNA 
in  Ottawa.  She  quoted  CNA  statistics 
showing  that,  although  male  nurses  make 
up  less  than  two  percent  of  the  entire  work 
force  of  registered  nurses,  they  hold  a  dis- 
proportionate share  of  supervisory  and 
administrative  positions.  In  1973,  five 
percent  of  male  nurses  were  directors  and 
assistants,  compared  to  less  than  three 


percent  of  female  nurses;  12  percent  of 
male  nurses  were  supervisors  and  assis- 
tants, in  contrast  to  six  percent  of  female 
nurses;  21  percent  of  male  nurses  were 
head  nurses  and  assistants,  while  11  per- 
cent of  female  nurses  held  this  position.  ^ 

A  nurse  in  industry  described  what  siie 
called  a  continuing  practice.  The  industrial 
health  team  usually  consists  of  a  part-time 
physician,  a  full-time  nurse  who  manages 
the  medical  program,  and  a  safety 
person  .  .  .  almost  exclusively  a  male 
position.  His  responsibilities  include  en- 
suring the  environment  is  physically  safe 
and  free  from  lexicological  hazards. 
"Safety  men,"  she  wrote,  "have  tradi- 
tionally been  trained  on  the  job,  many  of 
them  starting  on  the  job,  many  of  them 
starting  as  first-aiders.  Very  few  of  them 
have  any  formal  training.  Despite  the  lack 
of  a  professional  background,  these  people 
are  usually  paid  on  a  much  higher  scale 
than  nurses  (often  twice  as  much)." 

The  consequences  of  economic  in- 
equities caused  by  sexual  segregation  of 
jobs  can  affect  patient  care.  Ambitious 
nurses  leave  bedside  care  to  go  into  educa- 
tion or  administration.  With  them  goes  the 
nurse  with  the  greatest  career  commit- 
ment. 

Housing  and  hiring 

Salvos  from  both  sides  reached  us  in  the 
matter  of  housing.  From  a  male,  the  com- 
plaint that  male  nurses  are  not  accepted 
into  nurses'  residences  in  Alberta  hospi- 
tals. Translated  into  monetary  terms,  it 
means  the  female  nurse  in  residence 
spends  about  $70  a  month  for  room, 
board,  phone  and  parking,  while  a  male 
nurse  spends  $200  for  comparable  ac- 
commodation. 

From  the  other  side  of  the  fence,  a 
female  nurse  described  her  experience  of 
being  refused  accommodation  because  she 
is  a  nurse,  and  in  the  landlord's  words, 
"all  they  cause  is  trouble." 

The  more  experience,  the  harder  it  is  to 
find  jobs,  according  to  a  former  head  nurse 
in  Quebec.  He  points  to  the  practice  com- 
mon in  Quebec,  of  hiring  mainly  young 
nurses  in  order  to  pay  the  lowest  salaries. 
Nurses  over  40  looking  for  full-time  work 


are  offered  regular  or  occasional  part-time 
work,  or  temporary  full-time  work  with  no 
security,  instead. 

From  Prince  Rupert,  BC,  and  Hull, 
Que.  came  descriptions  of  the  consterna- 
tion caused  when  newly-hired  nurses  be- 
came pregnant.  The  unstated  belief  is  that 
nurses  who  are,  or  are  likely  to  become, 
pregnant  should  not  be  applying  for  full- 
time  work. 

On  the  same  theme  another  letter  related 
that  health  authorities  can  be  callous  when 
an  employee  transgresses  their  moral 
code.  An  unmarried  public  health  nurse  in 
Western  Canada  was  advised  that  the  right 
thing  to  do  would  be  to  give  up  her  child. 
Before  her  maternity  leave  expired  she 
was  told  she  would  not  return  to  her  old  job 
but  would  be  transferred  to  an  area  that  had 
difficulty  obtaining  PHNs.  "Now  that  my 
bursary  is  finished,"  she  wrote,  "I  am 
resigning  from  Public  Health  and  return- 
ing to  the  town  from  which  I  was  transfer- 
red. 1  feel  I  was  greatly  discriminated 
against  as  a  single  parent." 

Another  "form"  of  discrimination 

Nurses  and  patients  are  disenchanted 
with  forms.  Why  do  hospitals,  when  ad- 
mitting children,  list  only  the  father's 
name  as  next  of  kin?  Why  do  working 
women  have  to  put  their  husband's  emp- 
loyment on  their  admitting  form?  Why  do 
hospitals  require  nurses  to  use  their  mar- 
ried names?  Why  does  the  husband's  level 
of  education  appear  on  the  wife's  records? 

Women  make  up  only  .5  percent  of  the 
representation  on  hospital  boards,  but  in 
one  instance,  a  hospital  did  not  even  ack- 
nowledge an  application  from  a  woman  to 
serve  on  its  board. 

These,  then,  were  examples  of  sex  dis- 
crimination in  health  that  readers  sent  in 
response  to  The  Canadian  Nurse's  re- 
quest. Others  may  occur  to  you.  For  in- 
stance, the  lithotomy  position  is  generally 
conceded  to  be  undignified  and  even  un- 
necessary. 

Also,  hospital  regulations  that  admit 
only  husbands  to  the  room  where  a  woman 
lies  in  labor,  are  inhumane.  If  there  is  no 
husband,  or  if  he  cannot  be  present  during 
labor,  surely  the  rules  could  be  relaxed  to 


allow  a  close  friend  or  family  membci 
keep  the  patient  company. 

The  difference  which  persists  betv\ 
the  salaries  paid  to  directors  of  nursing 
administrative  heads  of  other  hospital 
partments,  could  also  be  considered 
example  of  pay  differential  based  on  : 
discrimination.  No  one  mentioned 
readiness  of  many  doctors  to  presci 
psychotropic  drugs  like  tranquilizers 
patients  they  judge  to  be  suffering  ti 
"housewives'  syndrome."  The  followirj 
quotation  from  Bullough  describes  tl 
problem  this  way:  "Physicians  tend  to  s» 
women  patients  as  more  complaining,  le 
likely  to  have  a  somatic  basis  for  the 
complaints,  and  more  in  need  of  moot 
modifying  drugs  than  men .  This  belief  sy 
tem  is  easily  transposed  into  get-rid-o 
her-with-a-tranquilizer  behavior,  and  tl 
result  is  the  discrepancy  between  men 
and  women's  use  of  prescribed  psych 
tropic  drugs."* 

Now  we  have  come  full  circle  to  whei 
we  began  this  article  with  the  'complaii 
ing  woman".  Nurses  may  agree  that  thej 
is  no  room  for  discrimination  in  heali 
care,  but  unless  each  of  us  —  as  a  profe 
sional  and  as  a  patient  —  works  to  erad 
cate  the  feminine  mystique,  Inlernation; 
Women's  Year  will  mark  no  turning  poii 
for  us. 


References 

1 .  Madden.  Barbara  P.  Raising  the  consti 
ness  of  nursing  students.  Nurs.  Oml 
2.^:.';:292-6,  May  1975. 

2.  Good,  Shirley  R.  Contemporary  issue' 
Canadian  taw  for  nurses,  by  .  .  .  and  J 
C.  Kerr.  Montreal,  Holt,  Rineharl  and  Vvii 
slon.  1973. 

3.  Marcus,  Janelle.  Chauvinism:  a  two  " 
street,  by  .  .  .  and  John  Marcus.  5m/)i 
Nurse  6:2:38-43.  Feb.  1975. 

4.  Bullough,  Bonnie.  Sex  di.scrimination  i 
health  care,  by  .  .  .  and  Vern  L.  Bullougl 
Nurs.  Outlook  23:1:40-45,  Jan.  1975. 

5.  Canadian  Nurses'  Association.  Coun. 
down:  Canadian  nursiitg  statistics.  1974 
Ottawa.  197=!.  p.  10. 

6.    Bullough.  Bonnie,  op.  cil..  p.  44.         ^ 


t 


Coming  of  Age  in  Nursing 


Editor's  Note 


"Putting-down""  International  Wonien"s  Year  has  become  a  popular 
pastime,  especially  among  the  intended  recipients  of  this  honor.  It  is 
hard  to  dispute  the  fact  that,  for  many  women,  the  12-month  celebra- 
tion has  made  little  or  no  tangible  difference  in  their  day-to-day  struggle 
to  survive. 

IWY  did.  however,  result  in  some  hard-to-measure  changes  in  the 
way  many  women  look  at  themselves,  their  jobs,  their  families  and 
their  relationships  with  co-workers. 

Some  of  you  have  been  kind  enough  to  share  these  impressions  with 


The  Canadian  Nurse.  Because  of  space  limitations,  the  three  selected 
submissions  have  been  condensed  into  one  article.  They  are  presented 
here  as  an  indication  of  what  Canadian  nurses  are  thinking  as  IWY 
draws  to  a  close.  If  the  three  papers  have  a  common  thread,  it  is  best 
illustrated  by  a  quotation  from  one  of  them; 

'  'Myths,  stereotypes  and  prejudice  have  noplace  in  nursing,  //nursing 
is  to  come  of  age  as  a  relevant  health  discipline,  it  must  seek  out  and  use 
the  potential  offered  by  all  members  of  society."  (Jean  Jenny) 


The  Trouble  with  Nursing 


Peggy  Webb 


•  Candidates  in  certain  chapters  of  provincial  nurses'  associa- 

Itions  are  routinely  elected  by  acclamation  because  of  the  short- 

|age  of  nurses  willing  to  serve  on  standing  committees. 

i  Only  1 1  nurses"  names  appeared  on  the  list  of  123  participants 

\n  the  last  national  convention  of  The  Canadian  Public  Health 

i^ssociation.  (This,  in  spite  of  the  fact  that  nurses  outnumber  all 

jther  categories  of  workers  in  that  particular  field.) 

Facts  such  as  these  clearly  indicate  the  degree  of  involvement 
|[or  lack  of  it)  that  we,  as  nurses,  have  in  the  affairs  of  our 
profession.  They  are  cited  here,  not  to  place  the  blame  on  any  of 
IS,  either  collectively  or  individually,  but,  rather,  to  illustrate 
)ur  lack  of  concern  and  attempt  to  find  the  reason  for  it. 

Our  problem  is  not  unique.  It  is  one  we  share  with  other 
t'omen:  nursing  as  a  profession  peopled  primarily  by  women 
lerely  reflects  more  glaringly  the  characteristics  attributed  col- 
lectively to  women.  Essentially,  this  is  the  message  of  many 
feminist  writers.  Germaine  Greer,  in  her  book,  The  Female 
uinnch.  states  that  "women  are  contoured  by  their  conditioning 
lo  abandon  autonomy  and  seek  guidance . " '  Another  writer  tells 
lis  that  "while  attributes  such  as  independence,  aggressiveness 
pd  competitiveness  are  rewarded  and  encouraged  in  males 
;cause  they  are  characteristics  perceived  as  essential  for  sue- 
less  in  traditionally  male  dominated  fields,  dependence,  passiv- 
ity and  compliance  are  rewarded  in  females."^ 

The  solution  is  also  found  in  feminist  literature.  First  of  all, 
ve  must  change  our  attitudes  towards  our  work.  Our  con- 
itioned  feelings  of  passivity  and  dependence  have  caused  many 
us  to  think  of  nursing  as  a  stopgap  occupation  to  be  relin- 


Vhen  this  article  was  written.  Peggy  Webb  was  a  member  of  the 
Faculty  of  Nursing,  University  of  Calgary,  Calgary,  Alberta.  She  is 
low  doing  graduate  studies  in  educational  psychology  at  the  same 
Iniversitv. 


HF  r  AMAniAN  Nji  IRSE  —  December  1 975 


quished  when  we  assume  the  more  comfortable  roles  of  wife  and 
mother.  Secondly,  we  must  begin  to  value  aggressiveness  — 
both  our  own  and  that  of  our  peers.  We  have  not  been  taught  to 
value  aggressiveness,  so  we  question  whether  it  is  appropriate  in 
ourselves  or  in  a  "sister."  We  know  that  aggressive  or  overly 
dominant  behavior  can  cause  a  nurse  to  be  rejected  by  her  peers. 
Nurses  labelled  as  too  aggressive  have  been  (and  are  being)  fired 
from  their  jobs  or  made  to  feel  so  uncomfortable  that  they  leave. 
It  seems  to  me  that  the  most  crucial  stumbling  block  in  our 
attempts  to  control  our  fate  is  the  problem  of  our  failure  or 
reluctance  to  be  supportive  of  one  another.  The  author  of  a 
Canadian  study  points  out  that  "another  equally  significant 
effect  of  female  socialization  is  seen  in  the  inferior  image  that 
women  have  of  each  other."'  Perhaps  this  explains  the  familiar 
comment  that  the  trouble  with  nursing  is  that  there  are  so  many 
women  in  it.  This  is  the  crucial  issue.  If  we  can  leam  to  value 
ourselves  and  each  other;  to  accept  other  than  the  traditional 
womanly  characteristics  in  our  peers  so  that  those  of  us  with 
leadership  abilities  can  emerge  and  flourish;  to  work  together 
with  mutual  acceptance  of  each  other;  then,  perhaps,  we  will 
become  vital  members  of  the  health  care  system.  We  must  stop 
blaming  ourselves  and  work  together  to  "find  joy  in  the 
struggle..  .  .  Joy  does  not  mean  riotous  glee,  but  it  does  mean 
pride  and  confidence.  It  does  mean  communication  and  cooper- 
ation with  others  based  on  delight  in  their  company  and  your 
own."* 

References 

1.  Greer,  Germaine.  The  female  eunuch,  London,  Paladin,  1971,  p. 
90 

2.  Greenglass,  Esther.  The  psychology  of  women.  In  Stephenson, 
Mary  lee  ed.  Women  in  Canada,  Toronto.  New  Press,  1973,  p.  110 

3.  Loc.  cit. 

4.  Greer,  Germaine,  op,  cil.,  p.  330 

19 


Androgynous  Nurses 


Olive  W.  Simpson 

and 

Yvonne  N.  Green 


There  are  two  sexes  in  the  mind  corresponding  to  the  two  st 
in  the  body.  .  .  .  If  one  is  a  man.  still  the  woman  part  of 
brain  must  have  effect:  and  a  woman  also  must  have  in: 
course  with  the  man  in  her.  Coleridge  perhaps  meant  this  n  ■ 
he  said  that  a  great  mind  is  androgynous.  (Virginia  Wool 

Sex-role  stereotyping  can  and  does  tragically  limit  the  uni^ 
development  of  the  human  personality. 

•  Caring  for  the  sick  is  the  natural  inclination  and  duty  i 
woman. 

•  Drudgery  is  a  woman's  right. 

•  Women  are  by  nature  dependent  and  self-sacrificing,  ! 
capable  of  initiative. 

How  many  times  have  you,  as  a  nurse,  allowed  these  l 
similar  statements  to  influence  your  actions  or  opinions? 

The  history  of  nursing  and  the  self-image  of  many  member 
of  the  profession  cleariy  illustrate  the  inhibiting  effect  of  th 
traditional  social  concept  of  woman's  role  in  society.  If  nurse 
could  bring  themselves  to  accept  an  androgynous  self-concep 
(i.e.  exhibiting  both  masculine  and  feminine  characteristics) 
consider  the  possible  benefits  to  society  and  the  profession 
"The  androgynous  person  might  be  both  masculine  am 
feminine,  both  assertive  and  yielding,  both  instrumental  am 
expressive  —  depending  on  the  situational  appropriateness  o 
these  various  behaviours."^ 

The  popular  image  of  the  nurse  is  based  on  attributes  such  a: 
tenderness,  passivity,  submissiveness.  and  emotionalism:  but  i 
is  essential  for  nurses  to  learn  to  recognize  and  accept  their  owi 
potential  for  a  more  diversified  expression  of  their  personality 
Historical  evidence  and  current  practice  provide  insight  inU 
how  this  can  be  accomplished. 

Historical  Image 

Florence  Nightingale's  warmth  and  human  sympathy  were 
matched  by  an  organizing  ability  which  could  assemble  a  staff  in 
less  than  a  week  and  transform  a  chaotic  military  institution  intc 
an  efficient  hospital  in  a  couple  of  months.^  When  women  were 
seen  as  too  frail ,  too  naive  and  too  self-centered  to  have  interests 
outside  their  homes,  she  believed  they  were  educable,  needed 
occupations  and  deserved  economic  independence.''  It  was  asi 
though  she  had  two  aspects  to  her  nature:  a  tremendous  will- 
power that  wilted  those  who  opposed  her  and  a  profound  com- 
passion for  suffering. 

With  the  development  of  scientific  knowledge,  the  status  of 
the  male  physician  increased,  and  the  nurse  became  more  sub- 
servient. In  recent  years  nurses  have  directed  their  energies 


Artwork  by  Arno  Slerngjass:  Reprinted  with  permission  from  The 
American  Journal  of  Nursing.  Vol.  71,  No.  8,  August  1971. 


Olive  W.   Simpson  (R.N.,   Victoria  Hospital  School  of  Nursiii; 
Renfrew;  B.Sc.N..M.  Ed..  University  of  Ollau a.  Ontario)  is  Assislani  ( 
Professor,  School  of  Nursing.  University  of  British  Columbia.  Yvonne  i 
N.  Green  (S.R.N..  Hackney  Hospital  School  of  Nursing.  Londr 
England:  R.M.N.,  Long  Grove  Hospital.  Surrey,  England.  B.S.N 
University   of  British  Columbia.   Vancouver,   B.C.)   is  P.sychiaii 
Nursing  Instructor.  British  Columbia  Institute  of  Technology. 


towards  development  of  specialized  knowledge  using  the  scien- 
tific method.  This  requires  assertiveness  and  an  affective  con- 
cern for  the  welfare  of  others.  Are  nurses  suited  for  this  task? 
Are  they  able  to  call  on  both  instrumental  and  expressive  aspects 
of  their  personality  to  pursue  these  aims?  The  Pubhc  Health 
Nurse  has  been  accepted  as  a  decision-maker  but  what  will 
happen  in  an  institutional  setting  if  the  nurse  strides  forth  armed 
with  these  attributes,  only  to  be  rejected  by  the  medical  profes- 
sion, and,  worse,  by  her  own  colleagues? 

Nurses'  Self-images 

Influences  brought  to  bear  in  the  training  of  nurses  seem  to 
have  been  directed  towards  de-emphasizing  feminity.  Students 
were  often  selected  because  of  their  single  status,  minimum  age 
of  thirty  and  homely  appearance.  They  were  forbidden  to  wear 
ornaments,  hair  was  crowned  with  a  veil  or  cap  and  the  natural 
feminine  contours  of  the  body  were  hidden.  Recently,  these 
defeminizing  aspects  have  become  less  pronounced  but,  nurses 
now  enter  the  profession  near  the  end  of  their  adolescence, 
before  they  have  firmly  established  a  feminine  identity. 

Throughout  her  education,  the  student  is  encouraged  to  ig- 
nore anatomical  differences  in  her  clients.  To  establish  her 
feminine  identity  she  must  neutralize  and  sublimate  her  aggres- 
sive, competitive  urges;  yet,  in  her  preparation  as  a  nurse  she 
learns  to  take  the  initiative  in  motivating  patients  and  staff,  and 
making  decisions  in  critical  incidents.  Confronted  with  depen- 
dent patients  she  is  expected  to  assume  an  assertive  role.  One  of 
the  consequences  of  this  defeminization  could  be  sex-role  adap- 
tability. Possibly,  many  individuals  in  nursing  can  adopt  an 
instrumental  and  an  expressive  orientation  —  can  be  both  am- 
bitious and  sensitive  to  the  needs  of  others. 

The  Ideal  Nurse 

In  an  effort  to  discover  how  nurses  see  themselves  today,  a 
pilot  study  was  designed  by  the  authors  recently  and  adminis- 


tered to  nurses  in  a  university  setting.  In  their  responses,  the 
subjects  did  not  characterize  male  and  female  roles  in  the  tradi- 
tional manner  —  '"men  are  independent,  objective,  active  and 
competitive;  women  are  dependent,  subjective,  passive,  non- 
competitive," —  though  approximately  50  percent  agreed  that 
the  sexes  are  differently  suited  to  various  work  roles.  Using  the 
Bern  Sex-Role  Inventory,  it  was  found  that  one  third  of  the 
subjects  endorsed  either  masculine  or  feminine  personality 
characteristics  —  15  percent  feminine,  19  percent  masculine. 
Of  the  remainder,  38  percent  described  themselves  in  an- 
drogynous terms,  i.e.  possessing  a  high  level  of  technical  com- 
petence, personally  alert,  concerned  and  responsive.  On  the 
basis  of  these  findings  the  authors  expect  further  studies  to 
reveal  evidence  of  a  strong  trend  towards  realization  of  the 
actual  image  of  the  nurse  as  a  blending  of  supportive  personal 
concern  with  technical  competence. 

Conclusion 

Social  factors  today  indicate  a  need  for  the  liberation  of  the 
"feminine"  aspect  of  the  male  personality  along  with  the 
"masculine"  part  of  the  female,  inhibited  from  full  expression 
in  many  men  and  women.  There  has  been  and  still  is,  a  reluc- 
tance on  the  part  of  many  nurses  to  acknowledge  these  qualities 
in  themselves  but  it  is  vital  that  all  nurses  explore  their  self- 
concepts  in  order  to  achieve  that  balance  for  which  our  society  is 
searching. 


References 

1 .  Woolf.  Virginia.  /I  room  of  one' sown.  New  York,  Harcourt  Brace, 
1929.  p.  170. 

2.  Bern,  S.L.  The  measurement  of  psychological  androgyny.  7.  Con- 
sult. Clin.  Psych.  42:2:155-162.  Apr.  1974. 

3.  Do! an.  Josephine  A.  Nursing  in  society:  a  historical  perspective. 
13  ed.  Philadelphia.  Saunders,  1973.  p.  168. 

4.  Barrilt,  Evelyn  R.  Florence  Nightingale's  values  and  modem  nurs- 
ing education.  Ni/ri.  Forum  12:1:6-47,  1973. 


The  Masculine  Minority 


Jean  Jenny 


Vlen  in  nursing  represent  one  half  of  society's  number;  without 
heir  contribution  nursing  will  always  lack  that  balance  required 
)f  a  humanistic  profession .  Too  often .  the  reasons  advanced  for 
lupporting  this  hypothesis  are  based  on  the  belief  that  men  could 
jring  to  nursing  all  of  those  masculine  attributes  that  women  do 
lot  possess  and  which  nursing  sorely  needs.  One  writer  expres- 
led  it  this  way:  "Men  could  bring  to  the  profession  the  adminis- 
rative  abilities,  supervisory  skills,  leadership  qualities,  drive, 
nitiative  and  ambition  and  independence  of  thought  which  are 
lot  (now)  present  in  sufficient  quality."' 

Intelligent  women  everywhere  will  reject  these  reasons  as 
nsulting  to  women  and  indicative  of  the  need  for  social  change. 
>rofessional  women  cannot  demand  of  others  what  they  them- 


A 


ean  Jenny  (R.N..  Royal  Victoria  Hospital,  school  of  nursing, 
lontreal.  Quebec.  B.Sc.  N.  Ed..  M.Ed..  University  of  Ottawa)  is 
:cturer  in  the  post  basic  program  at  the  University  of  Ottawa,  Ottawa, 
■)ntario. 


selves  cannot  or  will  not  achieve.  We  believe: 

"Men  are  needed  in  nursing.  They  can  offer  something 
special  —  a  sense  of  balance,  a  particular  understanding,  a 
different  viewpoint,  perhaps,  that  should  be  welcomed  by  their 
women  colleagues."^ 

It  is  reasonable  to  suppose  that  men  may  understand  human 
problems  from  a  different  perspective.  Perhaps  nursing  does 
reflect  a  set  of  priorities  particularly  dear  to  female  spirits  — a 
preoccupation  with  hygiene,  cleanliness,  order,  ritual,  tradi- 
tion, a  stereotype  of  the  "good  patient"  —  which  needs  to  be 
balanced  by  a  masculine  point  of  view.  Undeniably,  nursing 
needs  the  very  best  of  both  genders  and  to  deny  itself  the  abilities 
of  anyone  qualified,  is  to  be  the  poorer  for  it. 

Numbers 

By  tradition,  men  represent  a  minority  group  (one  percent)  in 
nursing  in  North  America.  Current  sociocultural  trends,  how- 
ever, are  producing  a  fundamental  reexamination  of  social  and 


sexual  roles  and  expectations  which  will  almost  surely  stimulate 
an  increased  enrollment  of  men  in  nursing. 

The  percentage  of  men  admitted  into  nursing  in  the  United 
States  nearly  doubled  between  1969  and  1972  —  from  3.5 
percent  to  6  percent  of  total  admissions.^ 

In  Canada,  men  represented  less  than  two  percent  (1884)  of 
registered  nurses  employed  in  nursing  (i  18,897)  in  1973.  Male 
students  in  diploma  programs  that  year  constituted  three  percent 
of  total  admissions,  three  percent  of  enrollments,  and  two  per- 
cent of  graduations.  The  percentage  of  male  students  enrolled  in 
basic  nursing  programs  increased  from  1.2  percent  (289)  in 
1964  to  3.1  percent  (749)  in  1973.* 

Although  the  numbers  are  still  small,  the  trend  is  obviously 
towards  an  increased  acceptance  of  men  in  the  profession  of 
nursing. 

Problems 

The  problems  encountered  by  men  in  nursing  can,  I  think,  be 
divided  into  six  specific  areas.  Excluding  problems  common  to 
all  nurses  and  students,  such  as  working  conditions,  pay  scales, 
shift  work,  transportation  difficulties,  etc.,  these  are  (in  de- 
scending order  of  magnitude): 

1 .  Masculine  stereotype 

"The  stereotype  traditionally  associated  with  the  man  who 
becomes  a  nurse  usually  embodies  one  of  two  negative  com- 
ments; either  he  is  "queer"  orheis  "powerdriven"  and  wanlsa 
top  position  in  a  field  he  can  dominate."' 

Male  patients  and  doctors  tend  to  give  the  nurse  a  "virility 
test,"  (Were  you  in  the  services?  Are  you  married?  Do  you  hunt 
and  fish?  Watch  football  games?  Is  this  another  way  to  get  into 
medicine?)  and  he  tends  to  develop  various  defence 
mechanisms  to  support  his  masculinity. 

2.  Lack  of  acceptance 

Although  men  nurses  reiterate  the  problem  of  nonacceptance 
by  women  colleagues,  it  seems  that  women  nurses  don't  per- 
ceive the  problem  to  the  same  extent.  In  a  recent  survey  of 
nursing  ethics  and  values,  88  percent  of  the  respondents  agreed 
that  men  are  a  vital  segment  of  nursing  and  should  be  given  the 
same  responsibilities  as  female  nurses.*  Are  men  nurses  over- 
sensitive in  their  perceptions  or  do  women  nurses  not  practice 
what  they  preach? 

3.  Burden  of  masculine  myth 

Masculine  stereotyping  embodies  a  variety  of  concepts  which 
could  affect  the  male  nurse:  i.e.,  men  should  not  show  feelings: 
men  are  even  tempered  and  emotionally  strong;  men  have  little 
need  for  affection;  men  are  not  sensitive  to  the  feelings  of  others; 
men  are  more  intelligent  and  logical  than  women;  men  must  lead 
while  women  must  follow. 

These  attitudes  contribute  to  the  assumption  that  men  in 
general  are:  aggressive,  individualistic,  noncompliant,  au- 
thoritarian, detached,  insensitive  to  others,  and  extremely  wary 
of  showing  behavior  such  as  compassion,  empathy,  tenderness 
or  delicacy.  The  strong  silent  male  may  indeed  experience 
difficulty  in  such  nursing  activities  as  sympathetic  listening, 
goal-directed  conversation,  exploring  verbally  the  nuances  of 
patient  replies,  or  in  demonstrating  overtly  to  the  patient  that  he 
cares  for  him  as  a  person  and  as  a  client. 

A  conscientious  instructor  will  examine  her  interaction  with 
men  students  to  ensure  that  she  neither  endows  them  with 
qualities  they  do  not  possess  nor  anticipates  behaviors  they 
cannot  or  will  not  demonstrate. 

4.  Discrimination 

Men  nurses  have  usually  been  associated  with  certain  areas  of 
health  care,  particularly  psychiatry,  anesthesia,  urology  and 

22 


administration.  In  addition  they  have  sometimes  been  deniei 
the  opportunity  to  practice  in  certain  clinical  areas,  notably  th^ 
delivery  suite  and  postpartum  floors.  Certain  aspects  of  patien 
care,  where  direct  contact  between  nurse  and  patient  is  required' 
have  been  labelled  taboo  to  men  nurses.  Male  specialty  areas  ai 
those  in  which  the  touch  aspect  of  nursing  care  is  minimal,  u 
clearly  confined  to  male  patients. 

A  successful  nurse  of  either  gender  must  develop  an  attitudi 
of  professional  competence,  mature  understanding  and  self  con 
fidence  that  will  ease  him  over  the  numerous  hurdles  of  intimau 
physical  or  emotional  patient  contact.  Touching,  or  the  laying  r 
of  hands,  is  an  integral  part  of  human  interaction  in  nursing  an 
deserves  to  be  divested  of  those  innuendoes  with  which  it 
sometimes  associated. 

5.  Minority  peer  group 

A  peer  group  is  an  important  means  to  reduce  feelings  > 
aloneness  or  rejection.  It  can  reinforce  feelings  of  acceptant. 
and  competence,  and  is  one  way  of  measuring  acceptability  u 
others,  and  exploring  the  nature  of  difficulties  with  equaN 
Although  the  teacher  cannot  take  the  place  of  peers,  she  can  ! 
more  aware  of  the  need  for  consultation  with  the  man  student 
and  encourage  discussion  whenever  possible. 

6.  Lack  of  role  models 

Where  does  the  man  nurse  look  to  identify  how  a  man  nurse 
should  think  and  act?  Male  models  available  in  the  clinical  area 
are  usually  orderlies  or  physicians,  both  occupying  a  distincth 
different  role  and  status  from  a  nurse.  The  woman  instructor 
may  act  as  a  professional  role  model  to  a  certain  extent  but 
cannot  demonstrate  a  masculine  interpretation  of  the  nurse  role 
The  .scarcity  of  men  teachers  in  nursing  is  a  serious  drawback  for 
the  male  student. 

Conclusion 

Nursing  is  a  person-centered  profession  and  must  extend  this 
focus  to  its  own  members.  Most  of  the  problems  faced  by  men  in 
nursing  are  attitudinal  in  nature.  They  can  only  be  solved  by  a 
major  change  of  attitude  on  the  pari  of  nursing  personnel  and 
society  at  large.  It  is  hoped  that  a  closer  examination  of  these 
adverse  feelings  will  promote  a  conscientious  examination  of 
their  validity  in  terms  of  today's  society. 


References 

1 .  Nursing:  an  outdated,  female  rolel Hospitals,  J.A.H.A.  46: 13: 1  16, 
Jul.  1972. 

2.  Robinson.  Alice  M.  Men  In  nursing:  their  goals  and  image  are 
changing.  RN  36:8:36-41.  Aug.  1973. 

3.  Johnson,  Waller  L.  Admission  of  men  and  ethnic  minorities 
schools  of  nursing.   1971-1972.  Nitrs.  Outlook  22:1:45-49,  Jan.  j 
1974.  I 

4.  Canadian  Nurses'  Association.  Countdown:  Canadian  nursing  ( 
statistics,  1974.  Ottawa,  1975. 

5.  Robinson,  Alice  M.  op.  cit.,  p.  39. 

6.  Nursing  ethics.  The  admirable  professional  standards  of  nurses:  a 
survey  report.  Part  2.  Nurs.  '74  4:10:65,  Oct.  1974.  ^ 


Nursing  MAN  power 


To  round  out  the  ratio  of  men  to  women  who  care  for  patients,  the 
Clarke  Institute  of  Psychiatry  began  five  years  ago  to  employ  male 
university  students  as  psychiatric  assistants.  This  program  has  been 
expanded  to  include  students  from  community  colleges  and  grad- 
uates of  high  schools  in  Toronto,  as  well  as  university  graduates,  who 
work  on  a  full  or  part-time  basis. 


MICHAEL  PHILLIPS 


istorically,  a  correlation  between  sex 
nd  occupation  has  existed  among  pro- 
iders  of  health  care:  there  is  a  prepon- 
erance  of  male  doctors  and  orderlies, 
id  a  majority  of  females  in  most  other 
ofessional  groups  in  the  health  fleld. 
his  is  aggravated  by  the  failure  of  the 
rsing  profession,  the  largest  group  in 
e  system,  to  attract  more  males,  al- 
ough  this  is  changing  slowly. 
In  April.  1970.  the  Clarke  Institute  of 
ychiatry  in  Toronto  began  a  program 
signed  to  counterbalance  the  prepon- 
rance  of  females  on  our  nursing  staff 
we  employed  male  university  stu- 
ents  to  help  staff  nurses  care  for  pa- 
ents.  This  was  in  line  with  our  objec- 
ves   of  providing   exemplary   and 
tecialized  care,  and  providing  the  pa- 
nt with  a  safe,  dynamic,  and  flexible 
erapeutic  environment  that  also  re- 
acts his  dignity  and  beliefs. 
Because  of  the  scarcity  of  professional 
ale  nurses  and  the  limited  time  that  male 
ff  doctors  and  residents  are  able  to 
:nd  with  patients,  it  was  considered  ap- 
opriate  for  these  university  students  to 


ichael  Phillips,  B.Sc.N.,  is  administrative 
irsing  supervisor  at  the  Clarke  Institute  of 
ychiatry.  Toronto,  and  is  responsible  for  the 
patient  units  at  the  institute. 

E  CANADIAN  NURSE  —  DecemDer  1975 


serve  as  role  models  for  some  patients,  and 
as  someone  with  whom  others  could  iden- 
tify. This  was  especially  relevant  for  ado- 
lescent and  young  adult  patients. 

Using  university  students  as  a  source 
of  hospital  help  is  not  a  new  idea. 
Rosenbaum  describes  a  program  in  the 
Bronx  State  Hospital  in  New  York  where 
college  students  were  used,  in  conjunction 
with  male  attendants,  to  complement  ex- 
isting professional  staff.'  The  program 
was  considered  successful  in  terms  of  its 
beneficial  effect  on  patient  care  and  the 
improved  functioning  of  the  entire  staff. 
Of  greater  importance  was  the  students" 
belief  that  the  experience  furthered  their 
education.  Bailey  also  suggests  that  col- 
lege and  high  school  students  are  an  excel- 
lent source  of  part-time  workers.^  He  goes 
on  to  propose  that  students  in  medical  and 
premedical  courses,  or  in  some  field  with  a 
relationship  to  hospitals,  welcome  the  op- 
portunity for  part-time  hospital  employ- 
ment. Students  employed  during  the 
school  year  are  also  an  excellent  source  of 
summer  relief  because  of  their  familiarity 
with  the  hospital. 

As  the  primary  function  of  the  students 
was  to  assist  in  providing  psychiatric  care 
to  patients,  we  decided  not  to  create  an 
orderly-type  category  for  them  but.  in- 
stead, to  call  them  psychiatric  assistants. 

Recruitment  was  carried  out  by  notices 


posted  at  the  University  of  Toronto  Place- 
ment Centre  and  the  faculty  of  medicine, 
as  well  as  by  word  of  mouth. 

Basis  of  employment 

Initially,  psychiatric  assistants  were 
employed  on  a  part-time  basis  (evenings, 
nights,  and  weekends)  when  there  was 
minimal  staff  coverage.  Later,  this  was 
extended  to  include  summer  employment 
for  three  months. 

At  the  end  of  the  first  year,  many  of 
the  group  who  had  graduated  had  no 
firm  future  plans  about  either  occupa- 
tion or  further  education.  We  believed 
that  full-time  employment  as  psychiat- 
ric assistants  would  introduce  them  to 
the  labor  market,  assist  them  in  making 
a  decision  about  their  future,  and  in- 
terest them  in  one  of  the  professions 
within  the  health  field. 

We  decided,  within  the  constraints  of 
our  budget,  to  employ  some  of  them  for  a 
period  of  one  year.  The  head  nurse  could 
extend  this  to  a  second  year,  but  after  this, 
the  psychiatric  assistant  was  expected  to 
return  to  school,  move  elsewhere,  or  re- 
vert to  part-time  work  (two  shifts  per 
week). 

The  nursing  supervisor  assigns  part- 
time  and  casual  psychiatric  assistants  to 
units  at  the  beginning  of  their  tour  of  duty, 

23 


Three  psychiatric  assistants  accept  assignments  from  evening  supervisor,  Mary  Kitchen, 
at  Clarke  Institute  of  Psychiatry. 


but  those  who  are  employed  full-time  are 
considered  part  of  the  staff  of  the  unit 
where  they  work. 

At  first,  psychiatric  assistants  were  re- 
quired to  be  university  students  or  recent 
university  graduates.  We  now  also  accept 
community  college  students  and  high 
school  graduates.  Our  committee  on  nurs- 
ing practice  decided  not  to  require  students 
to  be  enrolled  in  specific  courses  but,  in- 
stead, to  hire  jjersons  who  were  basically 
healthy,  had  the  ability  to  establish  good 
interpersonal  relationships,  an  interest  in 
mental  health,  ability  to  care  for  others, 
and  willingness  to  become  involved.  At 
the  time  of  their  appointment,  full-time 
psychiatric  assistants  must  indicate  to  the 
head  nurse  employing  them  some  definite 
plans  for  the  coming  year. 

Functions 

Psychiatric  assistants  are  expected  to 
assist  the  nurse  in  providing  care,  and  to 
help  manage  patients  who  are  very  dis- 
turbed and  acting-out.  They  work 
under  the  direction  of  the  team  leader  or 
charge  nurse  and  are  expected  to  func- 
tion as  responsible  members  of  the 
treatment  team. 

They  are  made  aware  of  the  institute's 
psychiatric  milieu  and  its  resources  as  they 
relate  to  patient  treatment.  They  are  en- 
couraged to  recognize  and  respect  the  feel- 


ings and  point  of  view  of  the  patients,  and 
to  communicate  these  to  fellow  staff. 

Full-time  psychiatric  assistants  are  ex- 
pected to  do  admissions  and  take  vital 
signs,  after  instruction  in  the  procedure,  in 
cases  where  the  patient  does  not  have  a 
medical  problem.  In  addition,  they  chart 
their  observation  of  the  patients'  progress 
and  interactions  (under  the  supervision  of 
the  team  leader  or  charge  nurse). 

They  are  expected  to  participate  in  all 
educational  programs  on  the  units  and, 
during  rounds,  to  contribute  information 
about  the  patients  with  whom  they  work. 

All  psychiatric  assistants  are  encour- 
aged to  explore  areas  of  persona!  interest 
and  self-growth  with  the  team  leader, 
charge  nurse,  or  nursing  supervisor  and, 
when  possible,  to  take  advantage  of  the 
educational  facilities  and  programs  avail- 
able to  the  Clarke  Institute  staff. 

Role  conflict 

A  major  problem  in  the  early  years  of 
the  program  related  to  the  orientation  of 
new  psychiatric  assistants.  Most  of  them 
had  no  previous  hospital  experience,  and 
orientation  was  often  haphazard  and  cur- 
sory. This  caused  role  confusion  and  fric- 
tion between  registered  nurses  and 
psychiatric  assistants.  Nurses  complained 
that  the  psychiatric  assistants  sometimes 
questioned  their  decisions  and,  although 


they  did  not  refuse  to  do  assigned  woi 
they  did  it  reluctantly.  On  their  part,  tl 
psychiatric  assistants  complained  that  il 
nurses  did  not  always  consider  their  ()| 
ions  and  often  viewed  them  as  little  n 
than  temporary  help  or  as  educated, 
unskilled,  nursing  assistants  or  order! ic 

To  overcome  these  problems,  psych i; 
ric  assistants  were  asked  to  appoint  re 
resentatives  to  all  nursing  committees 
encouraged  to  provide  input  in  terms 
their  work  and  ways  to  improve  it.  Tl 
orientation  procedure  was  changed 
allow  them  to  attend  the  two-week  orici 
tion  for  registered  nurses.  They  forme 
group  called  The  Psychiatric  Assisiai 
Association,  which  provided  them   \ 
identity  and  status. 

As  our  psychiatric  assistants  are 
pected  to  respond  to  emergencies  wiili 
the  hospital,  they  are  exposed  to  physi. 
contact  with  acting-out  patients.  ()i 
problem  that  developed  in  this  area  \^ : 
manifested  by  complaints  that  the  re^i 
tered  nurses  withdrew  when  a  diffim 
patient  had  to  be  restrained.  The  assi 
tants  protested  because  they  expectt 
the  registered  nurse,  who  had  estal 
lished  a  therapeutic  relationship  wii 
the  patient,  to  assist  and  reassure  tl 
patient  by  her  presence.  This  opini( 
was  reinforced  by  head  nurses,  chari 
nurses,  and  supervisors. 

The  psychiatric  assistants  then  d* 
veloped,  and  had  approved,  a  procedui 
for  responding  to  all  emergency  calls  f( 
male  staff.  This  has  made  responding  t 
psychiatric  emergencies  a  smoother  operf 
tion,  as  each  person  knows  where  h 
should  be  and  what  he  is  to  do. 

Some  areas  of  continuing  concern  I 
psychiatric  assistants  center  on  their  fe; 
of  litigation  and  genuine  concems  aboi 
patients"  rights.  We  have  attempted  t 
meet  these  through  discussions  with  med 
cal  and  nursing  staff  about  relevant  law 
and  previous  emergency  situations. 

We  have  also  had  to  deal  with  student 
who  saw  the  opportunity  of  working  at  th 
institute  as  a  means  of  solving  person! 
problems.  Fortunately,  there  have  bee 
few  of  these,  and  we  have  been  able  I 
isolate  them  early  in  their  employment. 

Assistants  speak  out 

Opinions  expressed  by  the  psychia;r 
assistants  on  their  experience  are  re\ 
ing; 


My  employment  has  given  me  invalu- 
able field  experience  in  the  mental  health 
care  system.  Too  often,  undergraduates  in 
university  choose  graduate  education  in 
the  helping  professions  with  a  limited  or 
biased  view  of  the  realities  of  working 
with  the  mentally  or  emotionally  dis- 
turbed. Individuals  who  plan  to  enter  these 
professions  could  learn  much  from  a 
summer  or  year  of  experience  in  a 
psychiatric  facility." 

One  who  was  later  accepted  in  medical 
school  said: 

"In  the  role  of  psychiatric  assistant,  I 
have  greater  opportunity  to  talk  to  patients 
than  any  other  member  of  the  team  as, 
most  of  the  time,  there  are  few  other  de- 
mands on  me.  This  helps  me  to  establish 
good  working  relationships  with  patients, 
to  share  their  problems  and  some  of  their 
normal  activities.  As  a  male  staff  member. 
I  have  at  times  been  able  to  offer  a  sense  of 
security  to  female  staff  members  in  deal- 
ing with  certain  violent  patients." 

Another  said  of  the  problem  he  encoun- 
tered: 

A  major  weakness  is  my  inclination  to 
3e  so  sympathetic  to  patients  that  I  feel 
fterward  I  have  been  manipulated  by 
hem.  Usually  this  takes  the  form  of  over- 
eacting  to  patients'  complaints  or  feeling 
ipologetic  about  a  ward  policy  that  I  can- 
lot  justify  by  any  other  criterion  than  the 
act  that  it  is  a  ward  policy.  This  has  im- 
)roved  recently,  with  support  from  fellow 
taff  members . " ' 

One  who  had  problems  in  adjusting 
aid:  "Fitting  in  was  rather  difficult  for 
ne.  At  first,  as  I  had  neither  thorough 
sychiatric  training  not  textbook  know- 
edge.  I  was  not  capable  of  meaningful 
nieraction  with  patients.  Now  I  realize 
lai  patients  seem  to  get  more  out  of  talk- 
ng.  and  that  the  psychiatric  understanding 
nd  terminology  follow  later.  It  is  difficult 
o  be  face-to-face  with  a  physically  or  ver- 
>ally  aggressive  patient,  for  I  find  myself 
hecking  my  approach  all  the  time,  and 
ack  the  confidence  to  relax  with  the  pa- 
ient.  As  I  come  in  contact  with  varied 
ituations  I  will,  perhaps,  be  more  relaxed 
nd  helpful." 

ale  help  welcomed 

The  patients'  point  of  view  is  best  sum- 
marized by  a  large  sign  in  one  of  the  units, 
Irhich  reads:  We  love  our  psychiatric  as- 
fstants. 


The  staff  made  comments  too,  most  of 
them  favorable: 

"The  nonmedical  orientation  of 
psychiatric  assistants  gives  us  a  different 
perspective,  and  having  a  few  fellows  on 
the  nursing  staff  does  a  lot  to  perk  up  the 
morale  of  the  patients,  not  to  mention  the 
staff!  However,  psychiatric  assistants 
should  not  be  given  too  much  responsibil- 
ity as  they  have  no  previous  training  in 
psychiatry,  in  most  cases." 

"Nursing  is  such  a  traditionally 
female  profession  that  a  male  viewpoint 
is  extremely  useful  at  times.  Patients 
accept  psychiatric  assistants  readily. 
Some  ask  who  they  are,  but  after  an 
explanation  they  are  satisfled." 

"The  'psych'  assistants  are  welcomed 
by  patients  and  staff.  Their  presence  helps 
ward  stability,  especially  when  the  atmos- 
phere is  filled  with  tension." 

"The  psychiatric  assistants  are  invalu- 
able team  members,  especially  in  dealing 
with  certain  patients  who  have  difficulty 
discussing  problems  with  females  or  relat- 
ing to  males,  and  who  need  practice  in  a 
relatively  nonthreatening  situation." 

"The  nursing  staff  appreciates  having 
knowledgeable  professional  part-time 
staff  who  require  minimum  orientation 
and  provide  an  interested,  caring  attitude 
toward  patients.  We  do  not  need  to  adver- 
tise when  further  positions  become  availa- 
ble, as  one  student  recommends  the  em- 
ployment opportunities  to  classmates." 

Conclusion 

The  program  has  paid  immense  di- 
vidends: 

•  Patients  have  an  added  staff  member 
who  is  concerned  about  their  welfare 
and  wants  to  do  something  to  help. 

•  Staff  have  an  additional  "team 
member"  contributing  to  patient  care. 

•  Psychiatric  assistants  themselves 
have  the  opportunity  to  help  others,  to 
grow,  and  to  determine  their  own  pro- 
fessional future. 

As  one  of  them  pul  it,  "My  problems 
have  been,  and  to  a  degree  still  are,  the 
same  as  many  of  the  disturbed  people  who 
are  here  for  help.  But  my  problems  are  less 
acute,  under  good  control,  and  well 
enough  understood  by  myself  to  make  me 
useful  in  helping  others  deal  with  their 
problems.  I  find  the  experience  enjoyable 
and  rewarding." 

We  are  aware  of  the  limits  of  a  position 


with  little  chance  for  leadership  or  ad- 
vancement. Many  psychiatric  assistants 
feel  their  employment  should  be  based  on 
a  set  level  of  education,  such  as  a  degree  in 
a  social  science,  and  many  believe  the 
position  should  be  instituted  on  a 
province-wide  basis  in  hospitals  and  social 
settings  where  the  need  exists. 

Some  point  to  the  Mental  Health  Tech- 
nicians program  at  the  Daytona  Beach 
Community  College'  and  wonder  about  a 
similar  program  in  Canada.  For  now,  we 
are  heartened  by  the  growing  awareness  of 
what  we  are  doing  and  encouraged  by  a 
recent  decision  of  the  University  of  To- 
ronto Faculty  of  Medicine  to  accept  work- 
ing as  a  psychiatric  assistant  as  an  elective 
experience  for  medical  students. 

For  those  who  have  worked  with 
psychiatric  assistants  over  the  years,  the 
ultimate  pleasure  is  to  see  them  leave  us 
and  be  accepted  by  the  universities  and 
community  colleges  in  medicine, 
psychology,  nursing,  social  work,  dentis- 
try, and  occupational  therapy.  Even  more 
rewarding  is  their  return  to  the  Clarke  In- 
stitute to  work  as  quahfied  professionals. 

References 

1 .  Rosenbaum.  Marilyn  J.  College  students  as 
a  source  of  attendant  help.  Perspect. 
Psychiat.  Care  7:5:228-234,  Sep. /Oct. 
1969. 

2.  Bailey,  Norman  D.  Hospital  personnel  ad- 
ministration. 2ed.  Berwyn,  III.,  Physicians 
Record  Co.,  1959. 

3.  Ally.  Louise  M.  A  new  technician  in  the 
mental  health  field.  Perspect.  Psychiat. 
Corf.   10:1:12-18,  Jan. /Mar.   1972.         t-^. 


■e  CANADIAN  NURSE  —  Decembet  1975 


CARING 

for  the 

UNTREATED  INFANT 


Not  infrequently,  in  large  referral  centers,  the  attending  staff  reach  a  point  in  the 
treatment  of  a  child  when  it  becomes  ethically*  and  morally  f  necessary  to  "back  off" 
—  to  terminate  active  and  aggressive  care  for  the  child.  Although  the  nursing  staff  is 
usually  not  involved  in  the  decision-making  process,  they  do  care  for  and  spend 
more  time  than  anyone  else  with  the  child.  It  is  not  easy,  therefore,  for  the  nurse  to 
cope  with  or  to  accept  such  a  decision. 


COLLEEN  Mcelroy 


THERE  ARE  NO  GUIDELINES.  NO 
set  criteria,  for  purposely 
"giving  up"  on  a  child  and  almost  cer- 
tainly leading  to  that  child's  death.  There 
is  no  "easy  out"  for  the  child  or  for  the 
doctors  who  hold  the  ""  power"  to  save  the 
child  and  yet  do  not.  There  is  no  quick, 
painless  way  out  for  the  family  of  such  an 
infant,  who  might  last  pitifully  for  weeks, 
or  for  the  nurses  who  must  care  for  this 
child.  No  chapter  in  any  pediatric  textbook 
tells  you  what  to  do  or  what  to  say. 

To  withhold  active  treatment  is  a  multi- 
faceted,  slowly  reached,  deliberate  deci- 
sion and  each  case  should  be  considered 
carefully. 

The  burden  this  child  will  place  on  the 
family  socially,  psychologically,  and  fi- 
nancially must  be  considered.  A 
hopelessly  slow  child  will  almost  certainly 
be  a  greater  burden  to  the  large  lower  class 
family  than  to  the  small  well-to-do  family. 

How  well  equipped  are  the  parents  to 
handle  the  problems  that  will  arise  with  an 
infant  who  is  severely  paralyzed  or  hy- 
drocephalic?   How    much   care   and    how 


Colleen  McElroy  R.N.  has  worked  us  a  pediat- 
ric nurse  since  she  graduated.  Her  purlicular 
inleresl  has  been  with  neurosurgical  and  prema- 
ture int'anls. 


'  ethically 
t  morally  - 

26 


-  referring  to  professional  judgement 
referring  to  personal  feelings 


many  hospital  admissions  will  there  be? 
What  does  this  child  mean  in  terms  of  the 
other  children  in  the  family?  What  is  the 
quality  of  the  life  that  can  be  offered  to  this 
child?  Living  is  a  high  price  to  pay  for 
being  attached  indefinitely  to  an  intraven- 
ous, a  suction  machine  and  a  respirator. 
Some  parents  rise  admirably  to  the  situa- 
tion, demonstrating  emotional  and  capable 
maturity,  but  to  others  it  becomes  the 
proverbial  straw,  pushing  them  into  depres- 
sion, alcoholism,  separation,  and  even 
divorce.  These  factors  must  be  considered 
carefully  before  the  decision  to  "let  the 
infant  go"  is  made. 

MY  GREATEST  CONCERN  HOWEVER, 
rests  with  the  infant.  What 
happens  to  him  when  active  care  is  stop)- 
ped?  In  many  cases,  he  is  wheeled  out  of 
the  Intensive  Care  Unit  and  into  a  room 
where  he  will  receive  a  minimum  amount 
of  care  and  handling.  Granted,  the  child 
cannot  hold  up  an  active  ICU  bed,  at  the 
expense  of  an  infant  who  requires  it,  but 
treated  or  not,  this  infant  is  still  a  human 
being.  Defenseless  in  a  "compassionate 
caring  jungle"  of  doctors  and  nurses,  he 
must  be  cafefully  protected. 

It  is  difficult  to  curb  curiosity,  and  re- 
frain from  ordering  a  CBC  on  the  pale, 
febrile,  septic  child  or  electrolytes  on  the 
infant  with  an  untreated  bowel  obstruction 
who  has  been  NPO,  vomiting,  and  without 
an  IV  for  several  weeks,  but  this  should 


not  be  allowed.  This  cannot  be  justified  - 
not  even  in  terms  of  learning  somethin 
that  will  aid  another  patient.  "Hands-ofT 
should  become  an  ironclad  rule  for  thes 
infants. 

An  untreated  infant  with  a  meningonni 
locele.  severe  paraplegia,  hydrocephalus 
and  a  complete  bowel  obstruction,  was  s 
grossly  dehydrated  after  a  month  ofvomii 
ing  bile  and  stool,  that  countless  stabs  o 
an  almost  non-existent  jugular  vein  pro 
duced  no  results  other  than  having  the  I\ 
nurse  near  tears,  and  the  infant  whimper 
ing,  exhausted  from  the  ordeal.  The  doc 
tors  were  suitably  impressed  with  the  re 
suits  — sodium  101,  potassium  1.7,  an, 
chlorides  65.  All  crowded  in  to  see  th 
infant  —  unique  and  defiant  in  her  survi 
val.  All  walked  out  without  a  word  abou 
treating  the  marked  itnbalance,  forgettin, 
that  it  was  a  needless,  pointless  and  crut 
thing  to  do. 

The  Guthrie  test  for  phenylketonuria  i 
required  by  law  on  each  newborn,  but  cir 
cumstances  should  be  considered.  If  th 
child  will  not  be  treated  for  his  main  medi 
cal  problem  it  is  unlikely  that  he  will  "- 
treated  for  PKU,  making  the  test  meanin- 
less,  and  an  extra  discomfort  for  the  infanll 

THE    ONLY    GOAL    IN    CARING    t 
this  child  should  be  comfort   i 
his  or  her  last  few  days,  and  common  sens^ 
and  kindness  should  be  the  guidelines 
planning  care.  Where  applicable,  thechi 


should  be  removed  from  his  isolette  and 
placed  warmly  dressed  in  a  bed.  Here,  it  is 
likely  that  people  will  stop  and  talk  to  him. 
and  he  will  be  able  to  hear  music  and 
sound. 

One  may  well  argue,  that  the  premature 
or  neuro  infant  who  has  difficulty  in  main- 
taining or  regulating  his  temperature,  will 
be  brought  to  his  end  more  rapidly  by 
allowing  him  to  become  profoundly 
hypothermic,  but  the  infant's  needs  for 
comfort  should  be  met.  Are  we  really 
being  kind  in  making  an  infant  literally 
freeze  in  order  to  hurry  his  demise  by  a  few 
days?  Or  is  it  easier  for  us  and  for  our 
consciences,  if  a  child  dies  quickly  —  not 
around  to  constantly  remind  us  of  our  limi- 
tations as  "healers.'" 

While  the  infant  has  no  cognition  of 
lime,  he  does  understand  comfort  and  se- 

urity.  and  even  if  he  does  live  longer  if 
kept  warm,  at  least  the  e.xtra  days  will  be  in 

easonable  comfort  and  dignity.  Whether 
or  not  the  infant  is  "spared"  the  ordeal  of 
life  by  a  few  days  will  probably  not  make 
nearly  as  great  an  impression  on  him  as 
will  his  warmth,  cleanliness,  dryness  and 

omfort. 
Comfort  should  be  considered  above  all 

hings  in  planning  care.  When  feasible, 
earring  esophageal  atresia  or  complete 
jowel  obstruction  or  absence  of  the  ap- 
propriate reflexes,  the  infant  should  be  of- 
fered some  form  of  warm  nourishment,  on 
i  regular  basis.  Many  of  these  infants,  if 
lot  hungry,  are  eager  to  drink  in  the  begin- 

ing.  For  the  child  with  a  partial  bowel 
obstruction  and  abdominal  distention,  or 
:he  infant  too  debilitated  to  drink  well  at 
3ne  feeding,  several  smaller  feedings 
.vould  make  him  more  comfortable. 

There  is  a  fine  line  between  prolonging 
i  life  with  active  treatment  and  simply 
naking  the  infant  comfortable.  Feeding 
ihould  not  be  supported  artificially  for  the 

HE  CANADIAN  NURSE  —  December  1975 


infant  who  will  not  or  cannot  drink.  But. 
for  the  conscious  child  interested  in  feed- 
ing it  should  be  allowed  as  long  as  the  child 
is  able  to  drink.  We  would  never  starve  an 
adult  or  an  animal  to  death.  Why  should  a 
child  be  subjected  to  this? 

In  the  advent  of  persistent  vomiting  and 
increasing  abdominal  distention,  feedings 
could  be  discontinued  and  the  use  of  a 
naso-gastric  tube  to  straight  drainage  be 
instituted,  without  peripheral  alimentation 
or  replacement  therapy.  The  physician 
may  well  argue  at  this  time  that  the  child 
will  become  more  dehydrated  being  fed  in 
the  face  of  ongoing  vomiting  than  if  he  was 


just  left  NPO  or  on  naso-gastric  therapy .  He 
would  then  die  more  quickly.  But  is  it 
really  kinder,  and  more  comfortable  —  for 
whom? 

The  use  of  a  N/G  tube  will  not  only  be  a 
comfort  measure  for  vomiting,  it  will 
serve  to  ease  or  alleviate  any  respiratory 
embarrassment  and  distress  caused  by  dis- 
tention. Elevating  the  head  of  the  bed  and 
allowing  the  diaphragm  to  move  down 
slightly  will  also  help  to  increase  lung  ex- 
pansion. While  an  untreated  infant's  life 
should  not  be  maintained  or  prolonged 
with  heroic  efforts,  he  need  not  be  distres- 
sed and  panicky  with  each  breath.  Simple 
gentle  suctioning,  without  physio,  of  the 
oral  and  nasal  pharynx,  should  be  allowed 
to  provide  more  comfort  in  feeding  and 
breathing. 

ONCE  THE  DECISION  IS  MADE 
not  to  treat  the  infant  with  a 
meningomyelocele,  he  should  be  removed 
from  his  Bradford  frame  and  a  clean  moist 
dressing  of  some  mild  antiseptic  solution 
placed  over  his  back.  With  a  diaper  binder 
and  donut  over  this  dressing  he  may  then 
be  nursed  comfortably,  picked  up,  and 
turned  easily  in  a  bed.  Passive  exercises 
and  range  of  joint  movements  of  the  in- 
volved limbs,  will  provide  greater  comfort 
by  preventing  contractures  and  skin 
breakdown.  Emptying  of  the  bladder  by 
simple  manual  intermittent  expression, 
thereby  preventing  overdistention,  infec- 
tion, constant  overflow  dribbling,  and  ex- 
coriation of  the  perineal  area,  should  also 
be  allowed. 

This  infant  frequently  does  not  die  for 
months.  Occasionally,  after  a  sufficient 
length  of  time  has  passed,  if  the  infant  is 
still  thriving,  the  surgeons  will  decide  to 
operate  thereby  raising  the  child's  status  to 
that  of  "treated".  Longstanding  contrac- 
tures and  infected  hydronephrosis  in  — ^ 

27 


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I 


Caring 

(Continued  from  page  27) 

these  children  then  become  distinct  liabili- 
ties. It  is  especially  cruel  for  the  family  of 
such  an  infant  to  finally  decide  to  love, 
accept  and  take  home  their  child  only  to 
have  him  die  within  a  year  or  two  with 
kidney  failure.  Neither  bladder  expression 
nor  exercise  will  prolong  a  life  indefini- 
tely, they  will  simply  increase  the  relative 
comfort  of  the  child. 

The  untreated  infant  has  a  great  need  for 
simple  basic  nursing  care,  particularly  in 
his  last  few  days  as  he  becomes  increas- 
ingly debilitated  from  malnutrition,  infec- 
tion and  metabolic  abnormalities.  Simple 
measures  such  as  frequent  turning,  careful 
positioning,  and  skin  and  mouth  care 
should  be  carried  out  routinely  regardless 
of  the  hopelessness  and  inevitability  of  the 
situation. 

All  too  often,  as  documented  by  many 
people  who  have  studied  dying  people,  the 
infant  is  placed  with  others  of  the  same 
position,  in  the  room  farthest  from  the 
nursing  station  and  visited  only  for  neces- 
sary care.  When  the  nurse  is  free  it  is  not 
one  of  these  children  she  usually  chooses 
to  hold,  but  some  "rewarding""  child  who 
laughs,  responds,  appreciates  and  will 
probably  get  well. 

The  untreated  infant  also  suffers  when 
the  unit  is  understaffed.  The  staffing  is 
diverted  to  healthier  more  active  and  vocal 
children.  While  the  sensibility  of  this  is 
evident,  one  should  also  remember  that 
often  these  infants  who  are  active  can  roll 
over,  change  their  own  positions,  and 
often  have  visitors  to  feed,  change,  and 
play  with  them.  With  this  in  mind,  it  is  not 
always  best  to  divert  nurses  to  these  infants 
at  the  expense  of  the  untreated  child.  It  is 
easy  to  justify  one's  lack  of  nursing  care 
for  these  infants  when  one  is  rushed, 
overworked,  and  pushed  for  time.  But. 
staffing  that  allows  for  good  care  to  all 
children  should  be  strongly  argued  for  and 
supported. 

THE       NURSE       WHO      CARES       FOR 
these  children  should  have  several 
qualities  and  be  chosen  very  carefully.  She 


should  be  familiar  and  comfortable  with 
the  philosophy  of  no  active  treatment  or 
resuscitation  for  this  child.  A  nurse  who 
feels  strongly  that  a  child  be  revived 
should  not  be  faulted  for  her  beliefs  — 
simply,  she  should  not  look  after  such  a 
child. 

The  nurse  caring  for  this  child  should 
also  be  chosen  for  her  feelings  about 
death.  A  nurse,  uncomfortable  with  death, 
afraid,  unsure,  and  unable  to  accept  death 
as  simply  a  final  stage  of  life  might  very 
well  give  this  infant  excellent  basic  care, 
but  spend  very  little  time  with  him  other- 
wise. 

ALL  DYING  PEOPLE  KNOW  THAT 
they  are  going  to  die  and  I 
sometimes  believe  that  even  an  infant  must 
know .  He  must  be  afraid  —  perhaps  not  of 
death  itself,  but  of  some  vague  horror 
ahead.  Not  even  debilitation,  infection, 
dehydration,  and  respiratory  problems 
alone  can  explain  the  dull,  hstless.  and 
panicky  look  in  a  child's  eyes.  They  musi 
know  that  we  have  given  up  hope  and  they 
too,  tend  to  give  up. 

You  cannot  hope  to  save  an  incurable 
child  with  love  and  comfort,  but  you  can 
soothe  his  fear,  reach  out  and  touch  his 


loneliness  for  a  little  while.  This  child 
not  just  an  incurable  disease  or  anothe 
untreated  meningocele  or  mongoloid  witl 
a  bowel  obstruction.  He  is  still  just  a  baby 
with  the  same  needs  as  all  babies.  He  i 
still  a  human  being  and  he  deserves  to  di' 
with  respect  and  dignity. 

We  strive  to  prolong  life  in  dying  adult; 
beyond  all  dignity  and  often  recognition 
while  seemingly,  we  begrudge  the  infant ; 
few  days.  He  must  die  in  the  quickes 
possible  manner,  without  any  help  fron 
us.  The  drunken  derelict,  homeless,  un 
wanted,  with  nowhere  to  go  will  be  treatec 
carefully  for  his  oesophageal  varices.  The 
terminal  cancer  patient  will  be  resuscitatec 
along  with  the  cardiac  cripples,  the  se- 
verely burned  patients,  the  ""bad""  motoi 
accident  victims  and  the  hopeless  de- 
generative neuro  diseases.  We  would  no 
dream  of  depriving  them  of  life.  But  th£ 
infant,  most  vulnerable  of  all  patients  en- 
trusted to  us,  must  suffer  endless  abuse  tc 
die  quickly  and  properly.  At  what  poini 
does  one  lose  or  gain  the  right  to  die  with 
purpose,  dignity  and  consideration? 


CNA  INTENSIFIES  ITS  ROLE 
AS  NATIONAL  COORDINATOR 


Programs  and  decisions  adopted  by  the  CNA  Board  of  Directors  during  the  past  year  all  express,  at 
different  levels,  the  aim  of  the  Association  to  intensify  its  role  as  a  national  coordinator.  At  the  last 
meeting,  15  to  17  October  1975,  Board  members  initiated  discussion  of  CNA's  role  and  position  in 
relation  to  special  interest  groups  of  nurses  and  chose  a  plan  of  action  which  encourages  formulation 
of  a  national  definition  and  standards  of  nursing  practice.  In  addition,  directors  took  a  stand  on  the 
coordination  of  accreditation  of  education  programs  in  the  health  disciplines  and  on  the  nurse's  role 
in  the  promotion  of  health. 


Definition  and  standards  of  nursing  practice: 

a  plan  of  action 

CNA  will  begin  almost  immediately  to  implement  a  plan  of 
action  that  aims,  in  its  first  phase,  to  evolve  a  conceptual 
framework  of  nursing  practice  and  basic  drafts  of  nursing  prac- 
tice standards.  Phase  II  will  be  the  implementation  and  testing  of 
the  proposed  standards  by  provincial  jurisdictions. 

A  full-time  project  director  will  be  sought  and  the  formation 
of  a  technical  coordinating  committee  is  recommended.  CNA  is 
presently  studying  the  possibility  of  obtaining  outside  funding, 
if  necessary,  funds  from  the  budget  category  "Contingency 
Fund  for  Special  Projects"  may  be  used  in  the  inital  phase. 

CNA  believes  that  development  of  these  standards  has  a  high 
priority  and  sees  itself  in  a  unique  position  to  develop  a  national 
stand.  Work  already  done  in  this  area  by  provincial  associations 
will  be  used  as  a  starting  point  and  the  provincial  associations 
hemselves  will  determine  the  priority  areas  for  which  standards 
should  be  established.  Since  the  ultimate  aim  is  to  improve  the 
quality  of  nursing  care,  standards  will  have  to  be  suitable  for 
mplementation  provincially. 


National  conference  on  health  and  the  law: 
CNA  protest 

Board  members  took  advantage  of  the  meeting  at  CN.A  House  to 
express  their  dissatisfaction  with  the  title  of  a  national  meeting 
in  Ottawa  in  September.  The  meeting.  "National  Conference 
on  Health  and  the  Law."  was  sponsored  by  the  Canadian 
Hospital  Association  and  received  funding  from  Health  and 
Welfare  Canada.  Many  nurses  have  pointed  out  that  although 
the  conference  title  inferred  a  wide  range  of  subject  matter,  in 
actual  fact,  the  discussion  was  primarily  medically  oriented. 

Reaction  against  the  lack  of  representation  from  other  health 
professions,  was  heightened  by  the  fact  that,  although  CNA  was 
only  a  member  of  the  subcommittee  on  program  planning,  the 
Associations's  name  appeared  on  the  program  as  a  co-sponsor. 

The  CNA  Board  resolved  to  communicate  to  CHA  and  the 
funding  agency  its  dissatisfaction  with  being  named  co-sponsor 
without  prior  knowledge  and  concern  regarding  the  misleading 
title  of  the  conference.  CNA  will  also  request  that  the  associa- 
tion be  included  in  the  planning  of  future  national  health  confer- 
ences. 


HE  CANADIAN  NURSE  —  December  1975 


Nursing  research  in  Canada: 
where  does  CNA  stand? 

The  question  of  nursing  research  in  Canada  was  discussed  at 
length  by  the  directors.  As  an  expression  of  support  to  nurse 
researchers,  directors  agreed  to  provide  secretariat  and  planning 
services  for  the  next  National  Conference  for  Nurse  Reseachers 
(tentatively  planned  for  Spring  1977),  provided  the  conference 
is  self-supporting.  Organizers  of  the  last  conference,  held  at  the 
University  of  Alberta  in  November  1975,  experienced  some 
problems  with  funding. 

In  addition,  a  resolution  was  passed  to  extend  the  term  of 
CN  A's  Special  Committee  on  Nursing  Research  until  it  presents 
a  report  containing  recommendations  on  its  role,  its  relationship 
with  CNA's  research  and  advisory  services  and  CNA's  role  in 
promotion  of  an  organization  for  nurse  researchers. 


Special  interest  groups  in  relation 
to  nursing  associations 

A  working  document  entitled  "The  Concept  of  Special  Interest 
Groups  in  Relation  to  the  Nursing  Associations,"  was  presented 
by  the  Western  Nurse-Midwives'  Association. 

One  of  the  recommendations  in  this  document  suggests  that 
special  interest  groups  and  the  respective  nursing  associations 
should  determine  areas  of  independent  and  interdependent  func- 
tioning. 

This  initiative  along  with  the  nurse  researchers'  request  for 
support  gave  CNA  directors  the  opportunity  to  discuss  the 
importance  and  urgency  of  establishing  policy  in  relation  to 
special  interest  groups.  In-depth  consideration  of  the  document 
will  take  place  at  the  next  meeting  of  the  Board  of  Directors. 

Implementation  of  administrative 
changes  in  the  CNA  Testing  Service 

In  line  with  changes  in  the  administrative  structure  of  the  Test- 
ing Service  already  approved  by  the  Board,  (see  The  Canadian 
Nurse,  June  '75,  p.  37),  two  bylaw  amendments  were  approved 
for  ratification  at  the  next  CNA  annual  meeting  in  June. 

The  first  amendment  consists  of  eliminating  from  article  16, 
the  section  (c)  (ii)  stipulating  that  the  Board  shall  have  the 
authority  to  appoint  "other  executive  officer  or  officers  for  the 
Testing  Service  and  to  delegate  responsibility  and  authority  for 
implementation  of  Association  policies  with  respect  to  the  Test- 
ing Service  to  such  other  executive  officer  or  officers."  The 
deletion  of  this  phrase  brings  the  Testing  Service  into  the  formal 
organizational  structure  of  CNA. 

32 


The  second  amendment  concerns  article  47.  Provision  ha 
been  added  to  ensure  the  permanency  under  bylaw  of  the  Te- 
ing  Service  Committee,  as  a  standing  committee,  rather  than 
special  committee. 

Directors  also  approved  a  resolution  presented  at  the  April 
1975.  meeting  by  the  Ad  Hoc  Committee  on  Testing  Service 
that  the  Board  should  establish  policy  on  the  extent  and  nature 
services  to  be  provided  by  the  Testing  Service. 


To  sell  or  not  to  sell  the  mailing  list 

Complaints  concerning  the  sale  of  the  CNA  mailing  list, 
prompted  directors  to  examine  present  policy.  This  policy  stipu- 
lates that  the  Association  may  offer  to  mail  to  its  members 
advertising  material  that  is  in  good  taste  and  compatible  with  thei 
ethics  of  the  profession,  provided  that  in  so  doing,  it  does  not 
contravene  any  public  legislation.  It  also  states  that  CNA  shall 
not  sell  the  journal  labels  to  professional  placement  agencies. 

Since  mailing  of  advertising  material  is  a  source  of  revenue 
for  CNA  and  considering  that  any  member  may  write  to  CNA 
House  requesting  that  her/his  name  only  be  used  for  CNA 
material,  the  Board  decided  to  maintain  present  policy. 

Concern  was  expressed  about  the  sale  of  the  mailing  list  to  a 
competitor,  but  no  decision  was  taken  in  this  matter. 


Teaching  nursing  in  Canada 

In  response  to  an  invitation  from  the  Association  of  University 
and  Colleges  of  Canada,  CNA  has  prepared  a  brief  on  the 
teaching  of  nursing  in  Canada.  This  document  will  be  submitted 
to  the  Bryans  and  Southall  Project  on  the  teaching  of  health 
sciences  in  Canada,  to  be  conducted  by  AUCC. 

The  brief  describes  the  crisis  in  nursing  teacher  preparation 
and  mentions  the  possibility  of  establishing  national  and  re- 
gional centers  to  assist  this  process. 

CNA  intends  to  inform  members  of  the  information  contained 
in  this  document  and  to  make  wide  use  of  the  findings. 

Change  of  name  . . . 

As  a  follow-up  to  a  resolution  adopted  at  the  1974  annual 
meeting  concerning  the  name  of  the  Association,  a  request  is 
being  sent  to  the  Minister  of  Consumer  and  Corporate  Affairs 
asking  for  permission  to  amend  the  Letters  Patent  of  CNA  so 
that  the  title  in  French  will  read  "L' Association  des  infirmieres 
et  intlrmiers  du  Canada." 


CNA  HAS  AN  11TH  MEMBER 

Directors  responded  with  enthusiasm  and  pride  to  a  request 
from  the  Northwest  Territories  Registered  Nurses"  Associa- 
tion for  membership  in  the  Canadian  Nurses'  Association. 

Since  September.  1975,  the  NWTRNA  has  been  officially 
responsible  for  registration  and  discipline  of  nurses  em- 
ployed in  the  NWT.  Registration  in  the  Territories  is  man- 
datory. 

Ceremonial  acceptance  into  CNA  will  take  place  during 
the  1 976  annual  CNA  meeting  and  convention .  The  last  time 
an  association  was  admitted  to  CNA  was  in  1 954,  when  the 
Association  of  Registered  Nurses  of  Newfoundland  joined. 


i 

'  CNA's  current  financial  status 
CNA"s  financial  situation  is  presently  in  line  with  the  deficit 
budget  voted  at  the  February  1 975  Board  meeting;  the  predicted 
deficit  then  totaled  $120,000.  Programs  outlined  for  1975-76 
are  being  followed  and  Board  members  asked  that  a  deficit 
budget  again  be  presented  for  1976-1977.  Directors  were  in- 
formed that  a  major  decision  will  have  to  be  taken  at  the 
February  Board  meeting  since  existing  financial  resources  will 
no  longer  allow  CNA  to  maintain  its  present  rate  of  operation. 


MEMBERSHIP  FEE  &  C.P.I.  TRENDS 


AVERAGE  MEM.  FEE 

1967 

1975 

1975 
ADJUSTED 

PROVINCIAL 

$29.84 

$67.42 

$42.40 

CNA 

$  8.74 

$  8.74 

S  5.50 

CNAXOF  TOTAL 

29t 

13=/: 

220 


200 


180 


160 


140 


120 


220 


100 


CNA 


1967    1968   1969   1970   1971    1972  1973  1974   1975 


Loan  Fund  to  be  maintained 

At  a  meeting  in  October  1973,  directors  requested  that  the  CNA 
Loan  Fund  be  maintained  until  December  1975  and  then  be 
discontinued  if  the  number  of  requests  for  loans  had  not  in- 
creased. Since  interest  has  increased  during  the  past  year,  CNA 
will  maintain  the  service  urtil  December  1980. 


.  riArprnhPr  1Q75 


CAUSN  and  accreditation 

In  a  brief  report  to  the  CNA  Board,  the  Canadian  Association  of 
University  Schools  of  Nursing  pointed  out  that  it  now  has 
representation  on  the  newly  formed  working  party  to  develop  a 
Coordinating  Council  for  Accreditation  of  Educational  Pro- 
grams in  the  Health  Sciences.  The  working  party  is  funded  by 
Health  and  Welfare  Canada,  and  administered  by  the  AUCC 
Joint  Committee  on  Health  Sciences  Education  and  Health 
Sciences  Accreditation. 

CAUSN  also  has  its  own  committee  on  accreditation  which  is 
charged  with  testing  the  criteria  developed  by  the  Association 
relative  to  university  nursing  education.  The  committee  has 
made  two  school  visits  and  is  planing  more  in  order  to  develop  a 
workable  method  of  data  collection  and  analysis  that  will  test 
these  criteria.  CAUSN  realizes  this  is  a  long-term  project  but 
believes  the  need  for  evaluation  of  university  schools  of  nursing 
is  great. 


Annual  meeting  and  convention: 
registration  fees  go  up 

Directors  commended  the  planning  committee  on  proposals  for 
a  convention  program  that  promises  to  be  of  interest  to  many 
nurses  (more  details  in  the  Jan.  1976  issue  of  The  Canadian 
Nurse). 

Since  tentative  convention  cost  estimates  are  close  to  $  1 5,000 
and  present  policy  directs  that  the  convention  should  be  self- 
supporting,  it  was  agreed  that  registration  fees  should  be  in- 
creased to  cover  expenses. 
New  rates: 
Full-time  registration: 

1)  RN $75 

2)  Student    $30 

Daily  fee: 

1)  RN $30 

2)  Student    $15 

Commenting  on  the  program,  directors  raised  the  subject  of 
special  interest  groups.  Although  the  program  does  not  include 
specific  sessions  for  these  groups,  CNA  will  give  them  the 
opportunity  to  meet  on  the  Thursday  or  Friday  following  the 
convention. 

Special  interest  groups  wishing  to  meet  in  Halifax  at  the  time  of 
the  convention  are  asked  to  advise  CNA  as  soon  as  possible. 

33 


frankly  speaking 

about  social  and  economic  welfare 


Working  With  You  Between  jobs  ? 


?  ? 


CLENNA   ROWSELL 


It  is  my  firm  conviction,  based  on  experi- 
ence over  the  past  five  years,  that  the 
nurses  of  Canada  are  not  receiving  a  fair 
deal  under  the  present  UIC  Act.  Having 
said  that,  I  will  try  to  present  the  facts  so 
that  you  may  judge  for  yourself. 

Until  four  years  ago,  professional 
nurses  in  this  country  were  not  affected  by 
provisions  of  the  Unemployment  Act. 
Like  several  other  categories  of  workers, 
they  did  not  pay  insurance  premiums  when 
they  were  working  and  they  did  not  collect 
benefits  when  they  were  nor  working.  This 
state  of  affairs  changed  when  amendments 
to  the  UIC  Act  were  approved  by  the  Par- 
liament of  Canada  on  June  27,  1971. 
The  intent  of  the  new  law  was  to  provide 
"protection"  for  the  majority  of  nurses  in 
Canada. 

Before  this  legislation  was  drafted  and 
passed.  CNA  realized  that  the  new  Act 
would  directly  affect  all  of  its  members. 
The  Association,  therefore,  made  rep- 
resentation twice  to  the  Committee  on 
Labour,  Manpower  and  Immigration  set 
up  to  recommend  changes  in  the  law. 

In  September  1970.  CNA  presented  a 
brief  to  this  committee.  Eight  months 
later,  in  May  1 97 1 ,  CNA  accepted  an  invi- 
tation from  the  Committee  to  submit  addi- 
tional comments. 

The  concerns  of  the  Association  were 
based  on  three  facts: 

1 .  professional  nurses  were  being  covered 
under  the  Act  for  the  first  time; 

2.  a  majority  of  practising  professional 
nurses  are  married; 

3.  a  substantial  number  of  these  nurses 
work  part-time. 

The  Association  pointed  out  to  the 
Committee  that,  in  the  light  of  these  facts. 


Each  month  The  Canadian  Nurse  fea- 
tures a  column  by  one  of  the  four  CNA 
members-at-large.  This  month's  col- 
umn is  by  Glenna  Rowsell  the 
member-at-large  for  social  and 
economic  welfare.  She  welcomes  your 
comments. 


it  was  possible  to  predict  certain  difficul- 
ties that  might  arise  in  the  interpretation  of 
the  Act.  The  circumstances  where  prob- 
lems could  be  foreseen  involved  ca.ses  in 
which  (a)  a  nurse  is  forced,  for  family 
reasons,  to  relocate  (b)  a  nurse  prefers  or  is 
only  able  to  work  part-time  (c)  an  attempt 
is  made  under  retraining  provisions,  to 
channel  a  nurse  out  of  the  profession. 

The  members  of  the  committee  assured 
CNA  that  there  was  no  reason  to  worry 
about  these  possibilities.  Three  years  later, 
however,  the  Association  concluded  that  it 
had  been  right  after  all.  In  a  brief  submit- 
ted to  the  Minister  of  Manpower  and  Im- 
migration, June  6,  1974,  CNA  pointed  out 
that  "after  three  years"  experience,  reports 
from  provincial  nurses"  associations  estab- 
lish that  these  areas  of  concern  have,  in- 
deed, become  problem  areas. 

These  problems  still  exist  today,  as 
many  nurses  will  testify.  Most  of  them 
stem  from  differences  in  interpretation  of 
the  law.  Nurses  assumed  that,  because  this 
is  a  Federal  Act,  implementation  would  be 
universal  (i.e.  applied  in  the  same  manner 
in  each  province,  city  or  town  in  Canada) 
but  this  is  definitely  not  the  case. 

To  date  no  detailed  national  guidelines 
or  policies  have  been  established  to  assist 


U.I.  officers  in  implementing  the  law  uni 
formly  throughout  the  country.  Each  U.I. 
Officer  interprets  the  Act  in  what  he  claims 
is  "a  reasonable  decision  based  on  the 
circumstances.""  The  result  is  that  nurses 
with  identical  or  similar  problems  do  not 
necessarily  receive  the  same  treatment 
under  the  law  when  their  unemployment 
insurance  claim  is  processed. 

Nurses  have  been  '"abused"  by  this  Act 
because  Sections  25  and  40  can  be  inter- 
preted in  such  a  rigid  way  that  they  are 
disqualified  from  receiving  benefits  for 
which  they  have,  in  fact,  paid. 

Part-time  nurses  who  pay  a  reduced 
premium  receive  limited  benefits  or  none 
at  all  if  they  refuse  full-time  employment. 
Most  nurses  work  part-time  because  of 
family  commitments  or  illness.  Should  the 
U.I.C.  collect  premiums  from  nurses  who 
cannot  collect  benefits? 

There  is  obviously  something  wrong 
with  an  Act  that  allows  two  nurses  in  the 
same  region,  both  seeking  employment 
weekly  without  success,  to  receive  widely 
different  treatment.  One  nurse  receives 
eight  weeks"  of  insurance  and  is  then  asked 
to  apply  for  positions  such  as  saleslady, 
cashier  etc.;  the  second  nurse  receives 
forty  weeks"  benefits  with  no  restrictions 
placed  on  her.  This  actually  happened  in  a 
Canadian  city  this  year;  many  similar  ex- 
amples could  be  cited. 

Certainly  there  are  nurses,  like  other 
categories  of  workers,  who  abuse  the  Act, 
and  in  these  cases  the  U.I.  Officer  is  within 
his  rights  to  correct  the  situation.  But,  ac- 
coiding  to  reports  from  the  provinces, 
most  often  it  is  the  nurse  who  is  the  victim 
of  abuse.  This  leads  to  an  important  ques- 
tion: "What  are  we  going  to  do  about  it?"' 


The  authors  show  how  the  therapeutic  use  of  play  makes 
hospitalization  easier  and  more  pleasant  for  the  preschool  child.  A 
few  simple  toys  or  props  and  the  presence  of  an  attentive  adult  are 
all  that  are  needed. 


ADA  BUTLER,  JEAN  CHAPMAN,  MARIA  STUIBLE 


Child's  play  is  therapy 


Background 

f  have  been  associated  with  children  and  their 
families  for  many  years.  In  community  set- 
'ings,  I  often  used  play  as  a  way  of  preparing  a 
Mid  to  enter  hospital  for  surgery  or  medical 
treatment.  When  the  child  returned  home 
again,  I  frequently  used  play  sessions  to  allow 
her  to  "work  out' '  her  feelings  about  the  hos- 
vital  experience. 

On  my  return  to  hospital  settings  after  an 
absence  of  several  years,  I  was  dismayed  to 
'ealize  how  little  was  being  done  to  apply  basic 
:oncepts  about  the  therapeutic  use  of  play  in 
nany  of  these  settings.  .Many  nursing  students 
seemed  reluctant  to  use  play  in  a  therapeutic 
•ay. 

I  wondered,  "Could  this  reluctance  be  due 
o  inferring  from  some  of  the  literature  that 
his  kind  of  play  is  sophisticated  and  places  too 
nany  demands  on  the  nurse  and  the  child? ' '  I 
vas  convinced  that,  given  appropriate  direc- 
ion,  many  more  nurses  could  be  stimulated  to 
tse  play  to  help  a  child  deal  with  fear  and 
nher  problems  associated  with  hospitaliza- 

in. 

Two  University  of  British  Columbia  nursing 
tudents,  Jean  Chapman  and  Maria  Stuible. 
ecenlly  agreed  to  base  a  special  project  on  the 
herapeutic  use  of  play  during  their  pediatric 
xperience.  We  worked  together  to  develop 
his  article,  which  summarizes  our  impres- 
ions,  experiences,  and  beliefs  in  relation  to 
he  therapeutic  use  of  play  with  the  hos- 
pitalized preschool  child. 

As  our  article  was  written  during  Jnterna- 
tonal  Women's  Year,  we  decided  to  refer  to 
He  child  as  "she."  —  Ada  Butler. 


da  Butler  (B.A.  Sc,  M.S.N.,  University  of 
Iriiish  Columbia)  is  assisiani  professor,  school 
f  nursing,  U.B.C.  Jean  Chapman  and  Maria 
luible  were  in  iheir  second  academic  year  of 
le  baccalaureate  program  in  nursing  at  U.B.C. 
/hen  writing  this  article. 


The  care  of  the  sick  child  has  changed 
considerably  in  recent  years.  Scientific 
advancement  has  modified  the  kinds  of 
treatment  available,  and  there  is  greater 
awareness  of  the  emotional  needs  of  the  ill 
child,  whether  at  home  or  in  hospital. 
However,  it  remains  true  that  the  hos- 
pitalized child  is  cut  off  from  familiar  sur- 
roundings once  she  is  brought  to  a  world  of 
new  people  and  strange  equipment.  Her 
daily  routine  is  altered  and  she  may  be 
introduced  to  needles,  intravenous  infu- 
sions, and  bed  pans. 

For  the  child,  this  new  world  is  puzzling 
and  often  painful.  For  concerned  adults, 
parents,  and  health  professionals,  the  re- 
sultant fear-tension-pain  reactions  of  the 
child  are  distressing  and  uncomfortable. 

The  article  is  based  on  our  experience  in 
using  therapeutic  play  "sessions'"  with 
hospitalized  preschool  children  as  a  means 
of  helping  the  child  restore  normal  aspects 
of  living,  and  reduce  feelings  of  anxiety. 
We  defined  the  therapeutic  use  of  play  as 
■"a  process  that  gives  the  child  encour- 
agement and  freedom  to  express  herself." 
We  believe  it  is  just  as  essential  a  therapeu- 
tic measure  as  medical  treatment. 

For  us,  play  sessions  were  enjoyable 
and  easy  to  carry  out,  and  our  efforts  were 
rewarded  by  the  enthusiastic  response  of 
both  children  and  parents. 


On  the  afternoon  before  four-year-old  Pat- 
ricia was  to  have  a  tonsillectomy,  the  nurse 
prepared  her  for  surgery,  using  guidelines 
developed  by  Peirillo. '  Patricia  was  then  en- 
couraged by  her  mother  to  play  "nurse. ' '  Pat- 
ricia put  her  doll  on  a  stretcher  and  took  it 
through  an  imaginary  hall  and  upstairs  on  an 
imaginary  elevator.  She  said '  'bye-bye' '  to  her 
doll  and  "I'll  see  you  soon." 


Patricia's  mother  then  allowed  her  to  put  an 
ice  collar  around  the  doll's  neck,  and  to  put 
the  doll  on  its  tummy  so  it  could  "spit  up." 
When  Patricia  went  to  the  operating  room  the 
next  morning,  the  operating  room  staff  said 
they  had  never  seen  a  child  who  was  so  calm 
before  surgery. 

Five-year-old  Michelle  had  recently  under- 
gone an  abdominal  operation.  She  was  pro- 
vided with  toys  and  the  equipment  used  in 
some  of  the  procedures  she  was  undergoing. 
This  included  a  syringe,  mask,  dressing, 
blood  pressure  cuff,  and  doll.  .Michelle  was 
eager  to  play  with  the  materials.  First,  she 
bandaged  her  doll  and  compared  the  bandage 
to  the  dressing  she  had  on  her  own  abdomen. 
Mext,  she  proceeded  to  give  "injections"  to 
her  doll  and  to  the  nurse.  Later,  she  played 
with  the  blood  pressure  cuff  and  stethoscope 
and  showed  tham  to  her  mother.  Her  parents 
felt  that  Michelle  cried  and  complained  less, 
and  generally  seemed  happier  following  sev- 
eral sessions  of  therapeutic  play. 

The  preschool  child 

The  preschool  age  group  (two-and-a- 
half  to  five  years)  was  chosen  because  we 
feel  this  group  may  be  especially  vulnera- 
ble to  the  effects  of  hospitalization.  At  this 
stage  the  child  is  normally  very  active.  She 
can  run,  climb,  dress  herself,  manipulate 
mechanical  toys,  and  express  herself 
through  drawings.  During  hospitalization, 
she  is  temporarily  removed  from  her 
rapidly  expanding  social  world.  Unless 
specific  care  is  taken,  her  ongoing  de- 
velopment of  physical,  intellectual,  and 
emotional  skills  may  be  curtailed. 

The  language  development  of  the  nor- 
mal preschooler  is  also  progressing.  She 
acquires  many  words  and  learns  to  use 
them  with  increasing  effect  in  communica- 
tion. She  talks  more  and  more,  and  asks 

35 


K^'i  ^i,^y> 


B^j 


4^ 


i 


The  team  approach  to  learning. 


««?* . 


>' 


Author,  Jean  Chapman,  explains  bandaging 
process. 


This  requires  concentration! 


Author,  Maria  Stuible,  supervises  a  procedure 
being  carried  out  by  small  patient. 


many  questions.  She  begins  to  understand 

vents  that  she  has  not  actually  experi- 

nced.  In  new  situations,  however,  she 

may  not  be  able  to  articulate  her  feelings. 

Yet  she  may  be  able  to  express  them  in 

lay ,  because  ability  to  play  is  more  highly 

developed  than  her  ability  to  use  language. 

Because  of  inability  or  lack  of  opportun- 
ty  to  verbalize  all  her  feelings,  the  pre- 
chool  child  may  develop  fears  and  anx- 
eties  during  hospitalization.  She  may  not 
nderstand,  or  be  confused  about,  the  na- 
ure  of  her  illness  and  hospital  stay.  She 
nay  misinterpret  the  reasons  why  she  has 
jeen  taken  from  home  and  placed  in  an 
nstitution.  If  other  siblings  live  at  home, 
he  child  may  feel  her  presence  there  is  not 

issed,  and  that  she  has  lost  possession  of 
ler  toys  and  other  belongings. 

The  preschooler  is  becoming  more  and 
nore  aware  of  her  own  body,  and  thus  is 
oncemed  with  maintaining  its  intactness. 
Zonsequently,  if  she  does  not  understand 
ler  illness  or  impending  surgery,  she  may 
ear  body  mutilation.  For  example,  if  she 
s  undergoing  surgery  to  her  hand,  she  may 
ear  that  her  entire  arm  will  be  amputated, 
f  the  child  is  unable  to  express  her  fears. 
he  may  become  hostile,  angry,  or  with- 

awn. 

lay  as  therapy 

Play  may  be  used  to  facilitate  expres- 
ion  of  the  child's  feelings.  This  kind  of 
lay  is  nondirective  and  allows  and  en- 
ourages  the  child  to  express  herself.  The 
lay  session  gives  her  a  comfortable  set- 
ng  in  which  to  work  out  anxieties  and 
oncerns. 

The  only  requirements  for  the  therapeu- 
c  use  of  play  are  toys  appropriate  to  the 
hild's  level  of  understanding,  and  the 
resence  of  a  person  sensitive  to  her  needs. 

Play  sessions  may  be  held  prior  to  tests 

procedures  that  are  unfamiliar  to  the 

hild.  The  play  props  provided  increase 

,e  child's  knowledge  and  allow  her  to 

ipress  her  feelings  about  the  procedure. 


Props,  such  as  medicine  cups,  syringes,  i  v 
tubing,  stethoscopes,  and  nurse  and  doctor 
dolls,  are  useful  for  explaining  new 
events. 

The  child  may  be  told  in  simple  terms 
about  an  operation,  the  incision  size  and 
site,  the  dressing,  and  type  of  pain  to  be 
expected.  Later,  as  the  child  plays  and 
talks,  she  has  the  opportunity  to  reveal  her 
fears  and  concerns.  It  then  becomes  possi- 
ble for  the  nurse  to  intervene  by  reassuring 
the  child,  and  clarifying  areas  of  confu- 
sion. 

Play  may  also  be  used  following  diag- 
nostic procedures  or  surgery  to  assist  the 
child  to  release  emotional  distress  and  to 
disclose  fears  and  fantasies.  The  child  is 
provided  with  a  variety  of  props  from 
which  she  may  choose  without  sugges- 
tions being  made. 

The  toys  and  props  should  include  ag- 
gressive articles,  such  as  drums,  paddles, 
and  other  items,  to  allow  expression  of 
anger  or  hostility.  Regressive  toys,  such  as 
baby  bottles  and  "soothers."  should  also 
be  provided  to  help  express  "babyish" 
feelings  if  the  child  has  this  desire.  Materi- 
als relevant  to  the  procedure  should  also  be 
included  so  that,  if  she  wishes,  she  can 
reenact  the  event  she  has  just  undergone. 
Fmger  paints,  crayons,  and  cardboard  or 
paper  will  give  additional  opportunity  for 
free  expression. 

Our  rules  for  play 

We  have  summarized  six  rules  we  found 
important  to  remember  whenever  we 
wished  to  initiate  effective  therapeutic  use 
of  play  with  a  preschool  child: 

1.  As  the  child  plays  and  talks,  look  for 
clues  as  to  her  thoughts  and  concerns. 

2.  Reflect  only  what  the  child  expres- 
ses. This  shows  the  child  that  you  are 
listening  and  interested  in  what  she  is 
saying.  The  child's  nonverbal  behavior 
should  not  be  interpreted.  This  last  ap- 
proach should  be  reserved  for  the  qual- 
ified play  therapist. 


3.  Encourage  the  child's  verbal  expres- 
sion. For  example,  if  the  child  is  paint- 
ing, say  to  her,  "Tell  me  about  your 
painting." 

4.  Avoid  directing  the  child's  actions  or 
verbal  expression.  Such  direction  may 
prevent  her  from  expressing  her  true 
feelings. 

5.  Allow  sufficient  time  for  the  child  to 
play  freely  without  interruption.  Play 
sessions  should  be  scheduled  around  the 
child's  medical  treatment  plan.  Sessions 
can  be  held  daily  and  may  last  from  10 
to  45  minutes. 

6.  Permit  the  child  to  play  at  her  own 
pace.  A  child  needs  time  to  express  feel- 
ings, and  hurrying  may  cause  suppres- 
sion of  feelings. 

Summary 

Play  can  be  a  simple,  effective  way  of 
helping  the  preschool  child  to  deal  with  the 
strange  and  sometimes  painful  hospital 
world  and  to  master  situations  that  might 
otherwise  be  overwhelming.  This  type  of 
play  can  be  incorporated  easily  into  the 
nursing  care  plan  and  can  become  an  es- 
sential aspect  of  the  care  of  the  hos- 
pitalized preschool  child.  The  results  are 
rewarding  in  terms  of  happier,  less  anx- 
ious children,  parents,  and  nursing  staff. 

Reference 

1 .  Petrillo.  Madeline  and  Sanger.  Sirgay 
Emotional  care  of  hospitalized  children:  an 
environmental  approach.  Toronlo,  Lippin- 
colt.  CI972. 


IE  CANADIAN  NIIRSF  —  Decembet  1975 


names 


Germaine  MacKinnon  (R.N.,  St. 
Joseph's  Hospital  school  of  nursing. 
Glace  Bay;  B.N.,  University  of 
New  Brunswick. 
Fredericton)  has 
been  appointed 
director  of  nurs- 
ing services.  Dr. 
Everett  Qialmers 
Hospital.  Fred- 
ericton, She  has 
worked  in  several 
hospitals  in  N.S. 
and  N.B.  Her  experience  includes 
pediatric,  medical-surgical  and  inten- 
sive care  nursing,  and  nursing  educa- 
tion. 


New  appointments  to  the  faculty  of 
nursing  of  The  University  of  Calgary 
are; 

Janice  M.  Bell  (B.Sc.  Walla  Walla 
College.  College  Place.  Washington. 
M.Sc,  Loma  Linda  University.  Loma 
Linda.  Ca.)  whose  recently  completed 
master's  degree  is  in  psychiatric- 
mental  health  nursing;  and 

Janet  Moore  (B.S.N.,  University  of 
Saskatchewan:  M.S.N..  University  of 
California.  San  Francisco)  who  has 
held  positions  at  Stanford  University 
Hospital;  California  State  University, 
Sacramento;  and  University  of  Illinois 
College  of  Nursing. 


Appointments  to  the  nursing  faculty  of 
Grant  MacEwan  Community  College. 
Edmonton.  Alberta  have  been  an- 
nounced: Connie 
Hanson  (B.S.N. 
University  of  Al- 
berta, Edmonton) 
has  had  experi- 
ence in  pediatric 
nursing  and  has 
taught  in  this 
area.  She  has  also 
been  coordinator 
in  pediatrics. 

Claire  Kibbler  (R  N.,  University 
Hospital.  Edmonton:  B.S.N. .  McGill 
University.  Montreal)  has  had  experi- 
ence in  psychiatric  nursing  and  child 
psychiatry.  She  has  taught  in  the  area  of 
psychiatric  nursing,  and  has  been  a  stu- 
dent counsellor. 


Patricia  Loth  (R.N.,  Royal 
Alexandra  Hospital,  Edmonton; 
B.S.N. ,  Pacific  Lutheran  University, 
Washington,  and  University  of  Alberta, 
Edmonton)  has  had  experience  in  gen- 
eral duty  and  private  outy  nursing  and 
has  taught  medical  and  surgical  nurs- 
ing. 

Ilia  Maher(R.N.,  St.  Josephs  Hospi- 
tal, Hamilton;  B.S.N. ,  University  of 
Western  Ontario.  London)  has  had  ex- 
perience in  public  health,  intensive 
care,  and  general  duty  nursing. 


f    l.iilh 


M.  Miiidieion 


M    I  ciiergreen 


Mane  Middleton  (R.N.,  Royal 
Alexandra  Hospital,  Edmonton; 
B.S.N. ,  University  of  Alberta,  Edmon- 
ton) has  had  experience  in  general  duty 
nursing,  office  nursing,  and  supervi- 
sion and  has  taught  in  the  areas  of 
medicine,  surgery,  and  obstetrics. 

Marina  Vetlergreen  (R.N. ,  St.  Paul's 
school  of  nursing.  Saskatoon;  B.S.N. , 
University  of  Alberta.  Edmonton)  has 
had  experience  in  rural  hospital  nurs- 
ing. She  is  teaching  in  the  areas  of 
medicine  and  surgery. 


New  appointments  to  the  faculty  of  the 
University  of  British  Columbia  school 
of  nursing  have  been  announced: 
Suzanne    Brewer   (B.S.,    Skidmore 


College,  Saratoga  Springs,  N.Y.: 
B.S.N. ,  Stanford  U.,  Stanford,  Ca), 
lecturer,  who  has  nursed  at  the  Alta 
Bates  Hospital,  Berkeley,  Ca.,  and  the 
Health  Sciences  Centre  Hospital,  Van 
couver; 

Patricia     Chisholm     (R.N.,     St 
Martha's    school    of    nursing.    An 
tigonish;  B.Sc.N.,  University  of  Al 
berta,  Edmonton),  lecturer,  who  has 
been  on  the  nursing  staff  of  the  Victoria 
General  Hospital,  Halifax;  Holy  Cross 
Hospital,  Calgary;  and  the  Royal  Alex- 
andra Hospital,  Edmonton; 

Sheila  Creegan  (R.N.,  Toronto  Gen- 
eral Hospital  school  of  nursing; 
B.Sc.N.,  University  of  Windsor; 
M.Sc.N.,  Univer- 
sity of  Western 
Ontario),  associate 
professor  and 
assistant  director, 
who  has  been  as- 
sistant profes.sor 
at  the  school  of 
nursing.  Univer- 
sity of  Western 
Ontario,  London,  and  director  of  the 
F*ublic  General  Hospital  school  of  nurs- 
ing in  Chatham,  Ontario; 

Maureen  Nott  (S.R.N.,  Edgware 
General  Hospital;  C.M.B.,  Dudley 
Road  Hospital;  S.C.M.,  Lordswood 
Hospital,  United  Kingdom;  B.S.N. , 
University  of  British  Columbia),  lec- 
turer, who  has  nursed  at  hospitals  in 
Hinton,  Alberta,  and  Vancouver;  and  al 
the  nursing  station,  Eskimo  Point, 
N.W.T.:  and 

Maureen  Olson  (R.N.,  Vancouver 
General  Hospital  school  of  nursing; 
B.S.N.,  University  of  British  Colum- 
bia), seasonal  lecturer,  who  has  been 
clinical  instructor  at  St.  Paul's  Hospi- 
tal, Vancouver,  and  at  the  British  Col- 
umbia Institute  of  Technology:  and  pa- 
tient instructor  at  the  diabetic  clinic. 
Chilli wack  General  Hospital. 


M.  Fay  McNaught  (R.N.,  Winnipeg 
General  Hospital  school  of  nursing, 
B.N.,  University  of  Manitoba)  has 
been  appointed  director  of  the  school  of 
nursing  division,  Misericordia  General 
Hospital,  Winnipeg.  She  is  a  past  pres- 
ident of  the  Manitoba  Association  of 
Registered  Nurses.  w 


38 


research  abstracts 


Letourneau,  Marguerite.  Trends  in  basic 
diploma  nursing  programs  within 
the  provincial  systems  of  education 
in  Canada  1964  to  1974.  Ottawa, 
Ont..  1975.  Thesis  (Ph.D.)  U.  of 
Ottawa. 

The  purpose  of  this  study  was  to  iden- 
tify trends  in  basic  diploma  nursing 
programs  within  the  provincial  systems 
of  education. 

The  move  to  the  system  of  education 
having  been  initiated  in  1964,  this 
study  was  primarily  concerned  with  the 
past  decade. 

Following  an  overview  of  diploma 
nursing  education  from  its  inception  in 
1874,  the  report  presents  an  analysis  of 
diploma  nursing  programs  in  the  vari- 
ous provincial  settings.  The  final  chap- 
ter consists  of  a  comparative  analysis  of 
forces,  characteristics  of  programs,  and 
trends  on  a  nation-wide  basis. 

Findings  indicated  that  the  trend 
away  from  hospital-oriented  and  to- 
ward college-centered  programs  has 
permeated  Canadian  diploma  nursing 
education.  The  process  is  complete  in 
Saskatchewan,  Ontario,  and  Quebec; 
partial  in  British  Columbia,  Alberta, 
and  Manitoba.  In  the  Atlantic  pro- 
vinces, it  is  non-existent,  but  trends 
point  to  future  changes.  Forces  at  the 
root  of  changes  were  political, 
economic,  social,  and  technical.  The 
trend  spells  the  demise  of  a  century-old 
system  and  the  continued  growth  of  a 
new  pattern. 

A  second  trend  is  the  continued  de- 
velopment of  programs  in  a  manner 
akin  to  other  similar  college  programs. 
The  move  is  toward  a  unijurisdictional 
form  of  control,  programs  being  sub- 
ject to  the  scrutiny  of  departments  of 
education.  Nurses  associations  tend  to 
lose  control  over  diploma  programs  and 
become  exclusively  regulator)  bodies; 
a  form  of  national  accreditation  is  be- 
coming the  accepted  body  for  the 
evaluation  of  programs.  Licensure  ex- 
aminations continue  to  serve  as  a  useful 
measure  in  the  selection  of  members, 
but  the  trend  is  away  from  the  present 
medical  model  and  toward  a  nursing 
model. 

A  third  trend  is  an  increased  effort  to 
clarify  the  focus  of  programs  in  the 
light  of  health  needs.  The  present  ill- 


defined  dissatisfaction  with  the  product 
of  diploma  programs  requires  clarifica- 
tion. 

A  fourth  trend  reflects  a  balance  be- 
tween general  and  nursing  education, 
although  finding  adequate  learning  ex- 
periences for  students  is  increasingly 
problematic. 

A  final  trend  is  the  continued  penury 
of  qualified  faculty  members. 

The  study  made  no  attempt  to 
evaluate  the  new  pattern  of  diploma 
nursing  education,  but  suggestions  for 
further  research  emerged. 

Melchior,  Lorraine.  Problems  encoun- 
tered by  six  mothers  during  the  puer- 
perium  and  their  perceptions  of  crisis . 
London,  Ontario,  1975.  Study 
(M.Sc.N.,  U.  of  Western  Ontario.) 

This  study  was  undertaken  to  determine 
the  kinds  of  problems  that  primiparas 
and  multiparas  encountered  during  the 
puerperium.  An  attempt  was  made  to 
determine  if  the  mothers  perceived  this 
period  as  a  time  of  crisis.  The  sample 
comprised  3  primiparas  and  3  mul- 
tiparas, who  met  the  criteria  of  the 
study. 

A  semi-structured  interview  guide 
was  used  to  examine  possible  problem 
areas  associated  with  the  functions  of 
the  nuclear  family.  There  was  an  initial 
contact  visit  to  the  mothers  in  hospital 
for  the  selection  of  the  sample,  then  the 
mothers  were  interviewed  4  times,  with 
the  use  of  the  guide.  During  the  home 
visits,  the  mothers  were  asked  if  they 
perceived  this  period  to  be  a  crisis. 

The  results  of  the  interviews  were 
presented  individually.  This  was  fol- 
lowed by  a  comparison  of  the  number 
of  problems  encountered.  The  indi- 
vidual interviews  have  shown  the  types 
of  problems  encountered  and  the 
mother's  perception  of  crisis,  whereas, 
the  group  analysis  has  specified  the 
numbers  of  problems  and  the  percep- 
tion of  crisis. 


Published  are  abstracts  of  studies 
selected  from  the  Canadian  Nurses" 
Association  Repository  Collection  of 
Nursing  Studies.  Abstract  manuscripts 
are  prepared  by  the  authors. 


It  was  noted  that  one  primipara  and 
one  multipara  expressed  the  fewest 
concerns  during  the  initial  hospital  in- 
terview. These  2  mothers,  at  no  time  in 
the  puerperium,  perceived  a  crisis  situ- 
ation. 

On  the  other  hand,  the  4  remaining 
mothers  perceived  a  crisis  situation  dur- 
ing the  puerperium.  Three  mothers 
(two  multiparas  and  one  primipara)  had 
difficulty  coping  during  the  first  month 
in  the  puerperium.  They  had  resolved 
the  crisis  situation  by  the  sixth  week 
postpartum. 

One  primipara  had  not  viewed  the 
first  month  as  a  period  of  crisis;  how- 
ever, at  the  6-week  period  perceived  a 
crisis.  This  mother  had  not  adjusted  to 
the  mothering  role  at  this  time. 

Since  4  of  the  6  mothers  perceived 
the  puerperium  as  a  period  of  crisis, 
these  mothers  were  more  receptive  to 
the  assistance  of  a  professional  health 
care  worker.  Therefore,  it  is  important 
for  hospital  postpartum  and  community 
nurses  to  be  able  to  utilize  crisis  inter- 
vention theory. 


Kay,  Gloria.  New  staff  nurses  percep- 
tions of  the  practice  environment  of 
a  university  medical  centre.  To- 
ronto, Ontario,  1975.  Study,  De- 
partment of  Nursing,  Sunnybrook 
Medical  Centre. 

Ninety-five  (28  experienced,  67  inex- 
perienced) new  staff  nurse  employees 
were  surveyed  by  questionnaire  to  de- 
termine factors  promoting  job  satisfac- 
tion and/or  dis.satisfaction  within  the 
environment  of  a  laree  medical  centre. 

Sample  charactenstics  revealed  the 
nursing  workforce  to  be  typically 
youthful,  relatively  inexperienced, 
mobile,  and  desirous  of  "'action."' 

Response  variables  included:  1.  fac- 
tors influencing  job  seeking  and  accep- 
tance: 2.  the  nurses"  perceptions  of 
specific  job  context  factors;  her  profes- 
sional competence:  patient  care:  imped- 
iments to  nursing  care;  her  needs,  prob- 
lems, and  resources,  and  3.  factors 
promoting  job  satisfaction  and  dissatis- 
faction. 

The  study  used  recognized  research 

methodology  in  obtaining  and  analyz- 

(Continued  on  page  40) 


THE  CANADIAN  NURSE  -  Decembei  1975 


39 


research  abstracts 


(Continued  from  page  39) 


ing  the  data.  Results  are  recorded  in  a 
functional  report  of  the  variables  to  ful- 
fill its  purposes  of:  documenting  per- 
ceived problems  in  nursing  practice  in 
the  work  situation,  serving  as  a  guide  in 
the  provision  of  improved  assistance  to 
staff,  and  recommending  changes 
needed  to  increase  job  satisfaction. 

Findings  and  discussion  have  gen- 
eral application  to  large  teaching  and 
general  hospitals.  Recommendations 
are  specific  to  the  study  agency. 

Allemang,  Margaret  May.  Nursing  Edu- 
cation in  the  United  States  and  Canada 
1873-1950:  leading  figures,  forces, 
views  on  education.  Seattle,  Wash.. 
1974.  Thesis  (Ph.D.)  U.  of  Washing- 
ton. 

The  purposes  of  this  inquiry  were  to 
trace  developments  in  the  thinking  of 
leaders  in  nursing  education  and  to  ex- 
amine their  ideas  in  the  context  of  his- 
torical change.  Special  attention  was 
given  to  changes  in  thought  on  the  prac- 
tice of  medicine,  the  role  and  function 
of  hospitals,  and  general  and  profes- 
sional education.  The  study  proceeds 
on  the  premise  that  a  recounting  of  the 
ideas  of  these  nurses  should  enhance 
understanding  of  how  nursing  educa- 
tion has  come  to  be  what  it  is  today. 

The  study  spans  the  years  from  1873 
to  1950.  The  former  year  marks  the 
beginning  in  North  America  of  training 
schools  for  nurses  based  on  Florence 
Nightingale's  plan.  The  latter  year 
ushers  in  an  era  in  nursing  education 
based  on  new  perspectives  too  complex 
for  the  scope  of  this  study.  The  study's 
setting  is  the  United  States  and  Canada 
which,  as  this  account  shows,  share  a 
common  heritage  in  the  development  of 
nursing  education. 

Sources  used  were  primary  and  sec- 
ondary materials  recording  the  ideas  of 
nursing  leaders  on  the  education  of 
nurses.  Evidence  was  drawn  primarily 
from  articles  in  The  American  Journal 
of  Nursing  and  The  Canadian  Nurse. 
Considerable  use  was  also  made  of  re- 
ports of  nursing  organizations  and 
committees,  and  publications,  reports, 
letters,  and  memoirs  of  selected  nurs- 
ing leaders. 

The  women  who  figure  prominently 
in  this  narrative  are  Isabel  Hampton 
Robb,  M.  Adelaide  Nutting,  Annie  W. 
Goodrich,  and  Isabel  M.  Stewart,  all 
from  the  United  States;  and  from 
Canada,  Ethel  I.  Johns,  Jean  I.  Gunn, 
E.  Kathleen  Russell,  and  Marion 
Lindeburgh. 


This  study  identifies  several  mam 
themes  in  nursing  education.  They  per- 
tain to  the  meaning  of  "nursing," 
nurse-physician  relationships,  the  so- 
cial aims  of  nursing  education, 
theory-practice  relationships  in  educa- 
tional programs,  and  the  role  and  qual- 
ifications of  teachers. 

These  themes  represent  clusters  of  is- 
sues with  which  nurse  educators  were 
mainly  concerned.  Because  these  is- 
sues were  not  fully  resolved  and  be- 
cause they  are  fundamental  to  any 
comprehensive  view  of  nursing  educa- 
tion, they  received  continuous  atten- 
tion. These  themes  may  be  recognized 
in  the  complex  motives  that  brought 
training  schools  for  nurses  into  exis- 
tence, in  the  training  methods  em- 
ployed by  them,  and  in  the  plans  and 
changes  that  followed. 

The  success  of  these  early  training 
schools  ensured  their  widespread  adop- 
tion in  large  and  small  hospitals.  Hospi- 
tals became  the  principal  institutional 
setting  for  the  education  of  nurses. 

As  new  generations  of  leaders  in 
nursing  recognized  the  weakness  of  this 
uncontrolled  growth,  the  clarification 
and  implementation  of  educational 
standards  became  their  foremost  con- 
cern. They  justified  their  self- 
appointed  tasks  and  activities  on  the 
basis  of  the  needs  and  demands  of  a 
changing  society. 

Advances  in  medical  science  and 
specialization,  in  the  public  health 
movement  and  community  nursing, 
and  in  educational  theory  and  practice 
provided  main  reasons  for  introducing 
a  theoretical  base  for  the  nurse's  in- 
creasing responsibilities.  Gradually,  as 
academic  education  in  nursing  pro- 
grams increased,  the  service  compo- 
nent was  reduced. 

This  movement  toward  the  liberali- 
zation of  nursing  education  gave  rise  to 
continued  dialogue  on  the  aims, 
methods,  facilities,  and  resources  for 
nursing  education.  The  dialogue  ac- 
companied the  movement  from  com- 
pletely practice-oriented  training  pro- 
grams under  hospital  control  toward 
comprehensive  nursing  programs  un- 
der university  jurisdiction. 


McKay,  Reta  Lynn.  Expressed  needs  of 
women  having  abortions. 
Vancouver,  B.C.,  1974.  Thesis 
(M.S.N.)  U.  of  British  Columbia. 

The  purpose  of  this  study  was  to  ex- 


plore the  abortion  experience  from  the 
woman's  point  of  view  to  discover  any 
unmet  needs.  All  the  women  were  hav- 
ing abortions  within  12  weeks  of  their 
last  menstrual  period. 

The  study  included  interviews  with 
19  women  at  3  stages:  before  the  opera- 
tion, 2  weeks  following,  and  4  months 
following  the  operation.  A  basically 
unstructured,  open-ended  interview 
method  was  used,  allowing  for  explora- 
tion of  areas  important  to  the  women. 

The  results  of  this  study  suggest  that 
some  women  having  abortions  do  ex- 
perience unmet  needs.  The  most  com- 
mon needs  identified  were: 

•  the  need  for  thorough  discussion  of 
birth  control  options,  coupled  with 
discussion  of  sexuality; 

•  the  need  for  readily  available  infor- 
mation about  all  aspects  of  abortion; 

•  the  need  for  abortion  counseling,  in- 
cluding discussion  of  ahematives  to 
abortion; 

•  the  need  for  emotional  support  dur- 
ing hospitalization  and ,  possibly ,  af- 
terward; and 

•  the  need  to  explore  the  meaning  of 
this  event  within  the  context  of  the 
woman's  life,  in  terms  of  her  expec- 
tations of  herself  and  her  relation- 
ships with  others. 

At  the  time  of  the  third  interview, 
many  of  the  women  described  changes 
in  their  sexual  relationships  related  to 
increased  feelings  of  control  and  de- 
termination. The  consistency  between 
the  developed  recognition  of  sexuality 
and  use  of  reliable  contraception  was 
evident  in  12  of  the  15  women  seen  at 
that  time. 

This  interview  revealed  that  all  the 
women  felt  they  had  made  the  best  de- 
cision at  the  time,  but  4  said  they  could 
not  go  through  with  an  abortion  again. 
The  event  was  profoundly  disturbing  to 
their  philosophical  beliefs.  This  aspect 
of  the  women's  lives  is  not  a  need  of  the 
same  order  as  the  others;  rather,  it  is  an 
area  to  be  understood  and  appreciated, 
but  not  subject  to  specific  intervention. 

This  study  has  identified,  from  a 
small  sample,  certain  unmet  needs  ex- 
perienced by  abortion  patients. 

Areas  that  require  further  research, 
involving  larger  numbers,  center 
around  the  following  questions: 

1 .  What  are  the  most  effective  ways  of 
meeting  the  identified  needs  of  women 
having  abortion? 

2.  What  are  the  longer  range  effects  on 
a  woman's  ability  to  cope  with  the  abor- 
tion and,  on  her  life  generally,  of  meet- 
ing these  needs'?  c^ 


books 


Maternal  and  Infant  Care  by  Elizabeth 
Dickason  and  Martha  Schuh.  604 
paaes.  New  York,  McGraw-Hill, 
1975. 

Reviewed  by  Mary  Ann  McLees, 
School  of  Nursing,  University  of 
Calgary,  Calgary,  Alberta. 

In  the  preface  the  editors  state  that  they 
have  prepared  this  book  to  encourage 
nursing  students  by  "telling  it  like  it 
is."  This  leads  one  toexpect  a  practical 
and  down-to-earth  approach  to 
maternal-infant  care,  and  this  is  more 
or  less  what  they  have  achieved.  There 
is  a  vast  amount  of  material  presented 
in  the  book  and  considering  that  each 
chapter  has  a  different  author,  there  is 
little  repetition  and  few  blanks. 

The  content  has  been  arranged  in  two 
parts.  Part  1  describes  all  aspects  of  a 
normal  healthy  pregnancy.  Material  is 
presented  emphasizing  various  themes. 
Of  particular  interest  and  value  are  the 
themes  relating  to  the  psychosocial  as- 
pects of  pregnancy .  parenthood,  educa- 
tion, and  support  during  the  child- 
bearing  cycle.  The  chapters  on  gene- 
tics, maternal  and  infant  nutrition,  and 
the  psychology  of  infancy  are  particu- 
larly valuable  with  the  increase  of  in- 
terest in  these  areas  and  the  dearth  of 
information  in  nursing  texts. 

Part  2  deals  with  the  high  risk  mother 
and  infant,  and  the  material  is  arranged 
according  to  body  systems  rather  than 
trimesters.  This  makes  for  a  more  com- 
pact and  logical  approach  to  problems 
that  may  occur  at  various  stages 
throughout  pregnancy. 

The  chapter  on  the  preterm  infant  is 
designed  to  illustrate  the  complex  prob- 
lems found  in  neonatal  intensive  care 
units.  This  will  be  useful  for  students 
v*  ho  may  not  have  much  opportunity  to 
participate  in  this  aspect  of  infant  care. 
The  material  presented  is  comprehen- 
sive and  sufficiently  detailed  to  give  an 
understanding  of  the  complexity  of 
neonatal  intensive  care  nursing. 

The  book  has  good  features:  its 
easy-to-read  presentation,  concise  ta- 
bles, and  clear  relevant  illustrations  and 
photographs.  The  references  and  bib- 
liographies at  the  end  of  each  chapter 
encourage  the  reader  to  delve  further 
into  topics  and  are  as  up-to-date  as  can 
be  expected.  There  are  several  good 
summaries  of  topics,  e.g.,  a  sample 


class  outline  for  psychoprophylaxis. 

The  book  is  comprehensive  and  be- 
cause of  this  some  conditions  are  dealt 
with  very  briefly.  The  statistics  given 
and  examples  of  services  available  per- 
tain to  the  U.S.A.,  but  would  not  de- 
tract from  the  book's  use  in  Canada. 
This  is  one  of  the  few  textbooks  that 
recognizes  the  role  of  the  nurse- 
midwife  in  North  America. 

This  book  has  a  strong  family  ap- 
proach and  emphasizes  the  role  that  the 
nurse  has  as  a  supporter  and  educator  of 
the  expectant  family.  It  would  be  a  use- 
ful text  for  students  in  basic  programs 
that  have  a  family  or  community  bias. 


Nurse  by  Eric  Handbury.  143  pages. 
Toronto.  McClelland  and  Stewart, 
1975. 

Reviewed  by  Dorothy  Starr,  Execu- 
tive Director,  Ottawa  Distress 
Centre,  and  formerly  Assistant 
Editor.  The  Canadian  Murse. 

In  the  foreword  of  this  book,  the  author 
says  that  its  Ut\e.  Nurse,  "embraces  all 
the  best  emotions  and  sacrifices  of  the 
human  being.  The  nurse  cares  and  this 
caring  quality  is  the  inherent  happiness 
and  plot  of  this  little  book."  Nurse 
was  sponsored  by  the  Registered 
Nurses"  Association  of  Ontario  to 
celebrate  its  50th  anniversary. 

The  author  and  the  photographer 
have  together  illustrated  most  facets  of 
nursing  practice  in  1975.  At  times,  the 
pictures  are  related  to  the  text:  other 
pictures  stand  alone  in  expressing  as- 
pects of  caring  for  which  words  would 
not  do.  The  book  includes  some  history 
of  nursing  in  Ontario  and.  at  the  end,  a 
science-fiction  look  at  nursing  in  50 
vears. 

The  author  has  listened  well  to 
nurses:  both  the  dialogue  and  the 
stream-of-consciousness  reporting  ring 
true.  Descriptive  words  about  nurses" 
age,  appearance,  and  educational  prep- 
aration are  minimal,  and  the  reader  can 
fit  herself  into  the  nursing  situation. 
The  book  passes  the  test  of  reader  in- 
volvement: several  times  I  had  to  put  it 
down  while  I  blew  my  nose  and  wiped 
my  eyes.  It  activated  memories  from 
my  own  nursing  practice. 

Dougal  Bichan.  the  photographer, 
uses  photographic  techniques  to  pro- 


duce a  variety  of  picture  styles,  but 
primarily  he  is  sensitive  to  pictures  thai 
have  high  emotional  impact  without 
"schmaltz""  —  the  subjects  are  real 
nurses. 

Nurse  will  interest  young  persons 
considering  a  career  in  nursing,  practic- 
ing nurses,  and  those  who  are  retired.  If 
no  one  gives  it  to  you.  buy  it  for  your- 
self. Of  course,  nursing  libraries  should 
have  one  or  more  copies. 


The    Rights    of    Hospital    Patients    by 

George  Annas.  246  pages.  New 
York,  Avon  Books,  1975. 
Reviewed  by  Myrtle  E.  Crawford, 
Associate  Professor,  College  of 
Nursing,  University  of  Saskatch- 
ewan. Saskatoon,  Saskatchewan. 

This  somewhat  frightening  little  book 
should  be  in  the  library  of  every  con- 
scientious nurse.  In  particular,  it  should 
be  carefully  read  by  every  nurse  in  an 
administrative  position.  The  American 
Civil  Liberties  Union  is  an  organization 
established  in  the  United  States.  The 
law  dealt  with  and  the  rights  stated  are 
those  of  the  United  States.  There  are, 
however,  a  sufficient  number  of  princi- 
ples involved  for  this  book  to  be  of 
significance  to  Canadian  nurses.  In  the 
preface  it  is  staled,  "The  hope  sur- 
rounding   these    publications    is    that 
Americans  informed  of  their  rights  will 
be  encouraged  to  exercice  them.""  In 
the  introduction,  the  author  states: 
""This  book  is  built  on  two  fundamental 
premises:  (1)  The  American  medical 
consumer    possesses    certain    interests 
many  of  which  may  properly  be  de- 
scribed as  rights,  that  he  does  not  au- 
tomatically forfeit  by  entering  a  hospital: 
(2)  most  hospitals  fail  to  recognize  the 
existence  of  these  Interests  and  rights, 
fail  to  provide  for  their  protection  and 
assertion  and  frequently  limit  their  exer- 
cise without  recourse  for  the  patient."" 
The  book  uses  a  question  and  answer 
format  which  makes  it  easy  to  find  a 
discussion  on  a  particular  problem.  The 
discussion  is  generally  supplemented 
with  notes  and  references  to  particular 
cases  that  apply.  The  majority  of  refer- 
ences are  to  American  cases,  but  at 
least  one  refers  to  a  New  Zealand  case 
and  there  are  references  to  British  med- 
(Continued  on  page  42) 


books 

(Continued  from  page  4 1) 


ical  journals.  These  references  are  in- 
tended to  help  the  patient's  lawyer  in 
preparing  his  case.  It  stales  in  the  pre- 
face, "If  you  encounter  a  specific  legal 
problem  in  an  area  discussed  in  one  of 
these  guide  books,  show  the  book  to 
your  attorney  ....  If  he  hasn"i  a 
great  deal  of  experience  in  the  area,  the 
guidebook  can  provide  some  helpful 
suggestions  in  how  to  proceed." 

While  all  the  laws  do  not  apply  to 
Canadian  situations,  there  are  a  number 
of  trends  discernible  in  the  attitude 
conveyed  by  the  author.  Patients  will 
be  increasingly  militant  in  expecting 
their  rights  lo  be  respected  by  hospital 
personnel.  The  discussion  regarding 
hospital  records  is  a  good  example  of 
this  concern.  Many  nurses  would  be 
wise  10  completely  revise  their  ap- 
proach to  the  care  and  handling  of  hos- 
pital charts. 

Canadian  nurses  are  warned  not  to 
rely  too  heavily  on  the  questions  deal- 
ing with  abortion  since  the  federal 
legislation  in  the  two  countries  is  estab- 
lished on  quite  different  principles. 

The  concept  of  another  new  health 


worker,  the  patient  rights  advocate,  is 
introduced.  Nurses  like  to  think  they 
can  fill  this  role,  however,  the  author  of 
this  book  seems  to  lump  nurses,  as  hos- 
pital employees,  with  the  enemy. 
Nurses  will  have  to  give  serious 
thought  as  to  where  their  loyalties  lie  in 
a  conflict  situation. 


Physical  Appraisal  Methods  in  Nursing 
Practice,  edited  by  Josephine  M. 
Sana  and  Richard  D.  Judge.  402 
pages.  Boston,  Mass.,  Little,  Brown 
and  Company,  1975. 
Reviewed  by  Ada  M.  Butler.  Assis- 
tant Professor.  School  of  Nursing. 
University'  of  British  Columbia. 
Vancouver.  B.C. 

The  editor's  purpose  is  to  provide  a 
resource  for  those  nurses  who  wish  to 
develop  or  improve  their  ability  to  use 
"more  precise  physical  appraisal 
methods  in  the  clinical  assessment  of 
patients."  The  book  is  written  by  and 
for  nurses  and  provides  a  specifically 
nursing-oriented  survey  of  all  aspects 


of  physical  examination  and  appraisal. 

The  content  of  Physical  Appraisal 
Methods  in  Nursing  Practice  is  or- 
ganized in  three  sections.  The  chapters 
in  section  I  provide  an  introductory 
contextual  framework  for  the  book  and 
cover  nursing  issues  such  as  the  ex- 
panded nursing  role,  the  nursing  pro- 
cess, and  the  problem-oriented 
documentation  of  nursing  care.  The 
discussion  of  problem  documentation 
focuses  on  nursing  as  it  is  practiced  in 
the  acute  hospital  setting,  structured 
around  the  medical  model  for  health 
care. 

The  first  chapter  of  section  II  is  de- 
vote,d  to  the  communication  process 
and  highlights  important  theoretical 
concepts  in  regard  to  the  nurse-patient 
relationship.  The  major  portion  of  sec- 
tion II  is  organized  around  the 
physiologic  systems  and  gives  informa- 
tion about  procedures  for  conducting 
physical  examinations.  Background 
data  is  provided  in  relation  to  the 
anatomy  and  physiology  basic  to  un- 
derstanding the  examination.  Normal 
findings  are  noted  and  abnormal  find- 


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ings  are  outlined  in  some  detail. 

Section  III  succinctly  overviews  as- 
pects of  physical  appraisal  that  are 
unique  to  the  very  young,  the  adoles- 
cent, and  the  aged. 

Many  chapters  open  with  a  useful 
glossary  defining  the  technical  ter- 
minology used  in  the  chapter.  The  il- 
lustrations are  well  done,  and  perhaps 
too  few  in  number.  A  more  liberal  use 
of  illustrations  might  help  the  descrip- 
tive material  become  more  alive  and 
meaningful  to  the  student  and  begin- 
ning practitioner. 

This  text  is  a  useful  resource  for  the 
practicing  nurse,  the  graduate,  and  the 
undergraduate  student.  It  could  well  be 
used  to  support  and  supplement  the 
content  that  is  usually  taught  in  nursing 
courses  related  to  physical  assessment. 
It  is  a  must  in  the  library  of  faculty  who 
teach  the  theory  and  practice  of  nursing 
assessment. 


The  Love  Bugs:  A  Natural  History  of  the 
V.D.'s  by  Richard  Stiller.  139 
pages.  New  York,  Thomas  Nelson 
Inc.,  1974. 

Reviewed  by  Mono  J.  Horrocks,  As- 
sociate Professor.  School  of  Nurs- 
ing Dalhousie  University,  Halifax, 
Nova  Scotia. 

"The  V.D.'s  are  for  everyone  —  equal 
opportunity  diseases  —  today  raging  as 
epidemics  throughout  all  segments  of 
our  society;  and  every  60  seconds,  one 
adolescent  becomes  infected  with 
either  syphilis  or  gonorrhea. ' "  So  reads 
the  jacket  of  this  book  designed  for 
teaching  adolescents  about  V.D. 

Amone  the  many  books  on  V.D. 
being  published  these  days.  The  Love 
Bugs  is  unique.  Besides  the  usual  list- 
ing of  the  venereal  diseases  and  some 
mention  of  common  sexually  transmit- 
ted problems;  Stiller  presents  a  history 
of  both  gonorrhea  and  syphilis,  their 
mention  in  literature,  famous  people 
who  had  V.D. ,  the  development  of  cur- 
rent treatment  and  possible  future  vac- 
cines, and  comparative  preventive 
health  measures  in  other  countries.  The 
book  is  clearly  written,  illustrated  (how 
many  schools  here  would  display  a 
poster  comparable  to  the  Swedish  an- 
tigonorrhea  one  reprinted  on  p.  133?), 
and  firmly  states  over  and  over  again  in 
various  ways  that  V.D.  is  a  disease,  not 
a  sin  or  payment  for  sin. 

One  of  the  thought  provoking  sec- 
tions of  the  book  outhnes  the  now  in- 
famous 1932  Tuskagee,  Alabama  ex- 


periment by  the  U.S.P.H.S.  on  black 
men  with  syphilis  (400  men  were  delib- 
erately not  treated).  One  could  wish 
that  Stiller  had  examined  the  drug  com- 
panies morality  more  closely. 

Three  minor  criticisms;  Although  a 
female  pelvic  examination  is  de- 
scribed, there  are  no  illustrations  to 
help  a  teenager  understand  what  will 
happen  to  her;  the  book  does  not  deal 
with  the  legal  medical  treatment  con- 
sent problems  which  still  exist  in  vari- 
ous parts  of  North  America;  and  fi- 
nally, it  deals  very  skimpily  with  other 
sexually  transmitted  problems  (warts, 
lice,  scabies,  vaginal  infections,  etc.) 

My  major  objections  to  this  very 
good  book  are  concerned  with  the  in- 
tended use  rather  than  the  contents.  I 
cannot  see  why  all  the  historical  infor- 
mation was  included  (except  for  school 
assignments?).  If  this  book  was  really 
written  specifically  for  teenagers,  the 
information  would  be  arranged  much 
more  to  the  point  with  far  less  verbiage 
and  with  the  '"how  not  to  get  it""  chap- 
ter very  near  the  beginning.  Adoles- 
cents care  far  less  that  Catherine  The 
Great  or  Goya  had  V.D.  than  how  they 
might  avoid  getting  it.  Also,  for  wide 
distribution  it  carries  a  fairly  stiff  price 
($5.95). 

Even  though  the  book  was  written 
for  teenagers  (and  thus  the  above  criti- 
cisms), I  feel  that  it  is  one  of  the  best 
resource  books  for  anyone  teaching 
about  V.D.  —  whether  public  health 
nurses,  or  nursing  school  instructors 
etc.  It"s  usefulness  and  interest  to  this 
group  is  untold  —  and  for  this  reason 
the  book  is  highly  recommended. 


Human  Physiology  —  the  Mechanisms 
of  Body  Function  by  Arthur  J.  Van- 
der.  James  H.  Sherman,  and 
Dorothy  S.  Luciano.  614  pages. 
New  York,  McGraw-Hill.  1975. 
Canadian  Agent;  Scarborough. 
Ont..  McGraw-Hill  Ryerson. 
Reviewed  by  Gina  Taam.  Lecturer, 
School  of  Nursing,  University  of 
Manitoba,  Winnipeg,  Manitoba. 

This  book  is  "intended  for  under- 
graduate students  regardless  of  their 
scientific  background."  The  physical, 
chemical,  and  biochemical  knowledge 
necessary  for  the  understanding  of 
human  physiology  are  presented  in  an 
integrated  manner  throughout  the  text. 
The  most  distinct  feature  of  this  book 
is  the  approach  used  to  present  the  sub- 
(Continued  on  page  44) 


ioC" 


tti 


lie 


strip 


The  bactericidal 
dressing 

Composition 

A  lightweight  lano-paraftm  gauze  Oressmg  impregnated  with 
l\  So'famycin  (framycetin  Sulphate  BP) 

Prop«r1t*a 

The  aOdiiion  ot  the  aniit»otic  Sotramycm  to  the  parartm  gauze 
ensures  the  prevention  o*  eradication  o*  superficial  bacterial 
intection  from  wounds  m  a  tew  hours  tfiereby  reducing  tt»e 
need  for  systemtc  antibotics 

Sofrarr^ycin  is  a  bactericidal  broad  spectrum  antibiotic   effec- 
tive agamsi  many  organisms  which  have  twcome  resistant  to 
other  antibiotics   including 
Staphylococcus  aureus 
Pseudomonas  pyocyanea 
Escherichia  coii 
Proteus  spp 

Soframycm  is  highly  soluble  in  water  mixes  readily  with  exu- 
dates and  IS  not  inaclivated  by  blood  pus  or  serum  Although 
It  IS  urx:omrnon  sensilizalton  to  Soframycm  may  occuf  and 
cross-sens'tizadon  between  Soframycm  and  chemically 
related  antitwotics  eg  Neomycin  Kanamycn  and  Paromomy- 
cin IS  common  Cfoss  resistance  t>etween  Sotramycm  and  this 
group  of  antibiotics  is  not  atisolute 

Advantages 

Rapid  eradication  of  bacteria  trom  the  wound 

Excellent  physical  protection 

Low  incidence  of  maceration  even  after  three  weeks  m  situ 

Non-adherent  can  be  removed  painlessly 

Saves  dressing  time 

Reduces  wastage 

Each  dressing  is  parchment-sheathed  for  ryj-touch  handling 

Sensitization  is  uncommon 

Indkcsllons 

TraumsWc:  Lacerations  abrasions  grazes  (gravel  rash)  bites 
(animals  and  insects),  cuts  puncture  wounds   crush  miunes 
Surgical  wounds  and  incisions  traumalx  ulcers 
Utcvratlvv:  vancose  ulcers  diabetic  ulcers  t>e<)sores  tropical 
ulcers 

Ths.iTial:  Burns  scalds 

Etectlvs:  Skin  grafts  (donor  and  recipient  Sites)  avulsion  ot 
linger  o'  toenails. circumcision 

Mlsceltan*ous:  Secondarily  miected  skm  conditions  —  eg 
eczema  dermatitis  herpes  zoster  colostomy  acute  parony- 
chia  incised  abscesses  (packing)  ingrowing  toenails 

Contra  Indic  altons 

Sensitization  to  lanolin  of  to  Soframycm 

Application 

If  required  the  wound  may  first  be  cleaned  A  single  layer  of 
SOFRATULLE  should  tje  applied  directly  to  the  wound  and 
covered  with  an  appropriate  dressing  such  as  gauze  imen  or 
crepe  bandages  in  the  case  of  leg  ulcers  it  is  advisable  to  cut 
the  dressing  exactly  to  the  size  of  the  ulcer  m  order  to  minimize 
the  risk  ot  sensitization  and  not  to  overlap  on  the  surrounding 
epidermis  When  the  infective  phase  has  cleared  the  dressing 
may  be  changed  to  a  non-impregnated  one  The  amount  of 
exudate  should  determine  the  frequency  of  dressir>g  changes 

Precautions 

In  most  cases  absorption  of  the  antibiotic  is  so  slight  that  it  can 
t>e  discounted  Where  very  large  body  areas  are  involved  (eg 
30%  or  more  body  burn)  ttie  possibility  of  ototoxicity  and-or 
nephrotoxicity  being  produced  should  be  remembered 

Packing 

10  cm  X  10cm  (4"  x4"), 

cartons  of  tO  and  50  sterile  smgie  units 
30cm  X  I0cm(l2"  x  4"). 

cartons  of  lO  sterile  single  units 


ROUSSEL 


Roussel  (Canada)  Ltd 

153  Graveline 

Montreal.  Quebec  H4T  1 R4 


books 


(Continued  from  page  43) 


ject  matter.  Unlike  the  conventional 
way  of  presenting  the  human  body  by 
its  individual  systems,  the  authors  con- 
stantly remind  us  that  the  human  body 
is  more  than  a  composit  of  different 
systems. 

To  discuss  nerves,  muscles,  and 
glands  as  specialized  cell  types,  and  as 
part  of  the  biological  control  system 
rather  than  individually  as  nervous, 
muscular,  and  endocrine  systems  in- 
troduces the  concept  of  internal  coordi- 
nation of  the  body.  Although  it  is  in- 
evitable to  use  some  "system"  ap- 
proach in  the  discussion  of  body  func- 
tion, the  concluding  chapters  on  the 
body's  defense  mechanisms,  and  the 
coordination  of  body  movements,  redi- 
rect the  reader's  focus  to  the  body  as  a 
whole. 

The  authors  devoted  an  entire  chap- 
ter to  the  discussion  of  consciousness 
and  behavior.  These  areas  often  receive 
little  or  no  attention  in  many  other 
physiology  textbooks,  and  it  is  this  ad- 
dition that  provides  the  bridge  between 
psychic  and  soma. 

This  book  is  very  suitable  for  use  in 
nursing  education,  because  its  holistic 
approach  to  the  human  body  would  not 
only  complement,  but  also  reinforce 
this  area  of  emphasis  in  nursing.  Suita- 
ble also  for  those  who  may  have  diffi- 
culty in  understanding  the  physical  and 
chemical  principles  related  to  the 
body's  function;  for  these  principles  are 
incorporated  into  the  discussion  and 
their  interrelationships  are  clearly  pre- 
sented. 

Therefore,  readers  with  weaker  sci- 
ence backgrounds  will  not  find  this 
book  beyond  their  comprehension,  and 
those  with  stronger  backgrounds  will 
find  that  this  book  serves  as  a  good 
review.  iC? 


accession  list 


Publications  recently  received  in  the 
Canadian  Nurses'  Association  Library 
are  available  on  loan  —  with  the  excep- 
tion of  items  marked  R  —  to  cna  mem- 
bers, schools  of  nursing,  and  other  in- 
stitutions. Items  marked  R  include  ref- 
erence and  archive  material  that  does 
not  go  out  on  loan.  Theses,  also  R,  are 
on  Reserve  and  go  out  on  Interlibrary 
Loan  only. 

Requests  for  loans,  maximum  3  at  a 
time,   should  be  made  on  a  standard 


Interlibrary  Loan  form  or  by  letter  giv- 
ing author,  title  and  item  number  in  this 
list. 

If  you  wish  to  purchase  a  book,  con- 
tact your  local  bookstore  or  the  pub- 
lisher. 


BOOKS  AND  DOCUMENTS 

1 .  American  Nurses'  Association.  Committee  on 
Skilled  Nursing  Care.  Nursing  and  long-term 
care:  toward  quality  care  for  the  aging.  Kansas 
City.  Mo..  C1975.  87p. 

2.  American  Nurses'  Association  Conference  for 
Members  and  F>rofessional  Employees  of  State 
Boards  of  Nursing  and  Members  of  the  ANA 
Advisory  Council.  Proceedings.  1974.  New 
York.  Kansas  City.  1974.  33p. 

.1.  Association  of  Canadian  Community  Col- 
leges. Clientele  and  community.  The  siiuleni  in  the 
Canadian  Community  College .  Ed.  by  Abram  G. 
Konrad.  Willowdale,  Ont..  cl974.  I58p. 
4.  AV.A  selective  bibliography  of  non-print  mat- 
erials in  the  health  sciences  with  emphasis  on 
nursing.  New  Westminster.  B.C.,  Douglas  Col- 
lege Library.  1975.  286p. 
.5.  Bauman.  John  W.  Renal  function,  physiologi- 
cal and  medical  aspects,  by.  .  .  and  Francis  P. 
Chinard.  St.  Louis,  Mosby,  1975.  15 Ip. 

6.  Becknell.  Eileen  Peadman.  System  of  nursing 
practice:  a  clinical  nursing  assessment  tool. 
by.  .  and  Dorothy  M.  Smith.  Philadelphia. 
Davis,  CI975.   I76p. 

7.  Beland,  Irene  L.  Clinical  nursing. 
Pathophysiological  and  psychosocial  ap- 
proaches, by.  .  .  and  Joyce  Y.  Passos.  .3ed.  New 

York,  Macmillan,  c  1975.  I120p. 

8 .  A  bibliography  of  basic  materials  in  the  health 
sciences  with  emphasis  on  nursing.  New  West- 
minster. B.C.  Douglas  College,  1974.  I09p. 

9.  Bowkef  s  medical  books  in  print.  1975.  New 
York.  Bowker.  1975.  Iv.  R. 

10.  Brunner,  Lilian  Sholtis.  Textbook  of 
medical-surgical  nursing.  3ed.  by.  .  .  and  Doris 
Smith  Suddarth.  Philadelphia.  Lippincott. 
cl975.  ll.56p. 

1  I.  Brunner.  Nancy  A.  Orthopedic  nursing:  a 
programmed  approach.  St.  Louis.  Mosby.  1975. 
224p. 

12.  Burkhalter.  Pamela  K.  Nursing  care  of  the 
alcoholic  and  drug  abuser.  New  York, 
McGraw-Hill.  1975.  297p. 
L^.  Canadian  Hospital  Association.  Canadian 
hospital  directory.  Toronto,  Canadian  Hospital 
Association,  1975.  348p.  R, 

14.  Canadian  Ross  Conference  on  Paediatric  Re- 
search. First.  Montebello.  P.Q..  Apr.  .^0  —  May 
2,  1973.  The  unmet  needs  of  Canadian  children. 
Montreal.  Ross  Laboratories,  cl974.  434p. 

1 5 .  Cara,  M .  Premiers  secours  dans  les  delresses 
respiratoires.  des  accidents  du  trafic.  des  intoxi- 
cations et  des  malades  aigues.  par.  .  .  et  M. 
Poisvert.  4.  ed.  Paris,  Masson,  cl975.  I44p. 

16.  Conference  Internationale  du  Travail,  6le 


session,  Geneve,  juin  \91b.  L'emploi  et  les  con-       I 
ditions  de  travail  el  de  vie  du  personnel  infirmier. 
Septieme  question  a  I'ordre  du  jour.  Geneve, 
Bureau   international   du  Travail,    1975.    Il9p 
(Son  rapport  7(1)) 

17.  Deal,  Jacquelyn.  Beginner's  guide  to  inten- 
sive coronary  care.  Bowie,  Md.,  Charles  Press. 
C1974.   159p. 

18.  Deloughery,  Grace  L.  Political  dynamics: 
impact  on  nurses  and  nursing,  by.  .  .  and  Kris- 
tine  M.  Gebbie.  St.  Louis,  Mosby,  1975.  236p 

19.  Dickason,  Elizabeth  J.  ei .  Maternal  and  in- 
fant care:  a  text  for  nurses.  Edited  by.  .  .  and 

Martha  Olsen  Schutt.  New  York,  McGraw-Hill, 
CI975.  604p. 

20.  EaxA\ey .  \nne. What  patients  thinkabout  the       ^ 
hospital:  a  report  on  500  inter\iews,  by.  .  .  and 
John  Wakefield.  Manchester,  Eng.  Christie  Hos- 
pital and  Holt  Radium  Institute,  Univ.  Hospital  of 
South  Manchester.  1973.  56p. 

2 1 .  Filing.  Ray  H.  Health  and  health  care  for  the 
urban  poor.  by.  .  .  and  Russell  F.  Martin.  North 
Haven.  Conn.,  Connecticut  Health  Services. 
1974.  I20p.  (Connecticut  Health  Services.  Re- 
search series,  no.  5) 

22.  Epstein,  Charlotte.  Nursing  the  dying  pa- 
tient. Learning  process  for  interaction.  Reslon. 
Va..  Reston.  cl975.  210p. 

23.  Encyclopedia  Britannica.  Book  of  the  year. 

1974.  Chicago,  Encyclopedia  Britannica.  1975. 
768p.  R. 

24.  Grubb,  Reba  Douglas.  \9\b.  Designing  hos- 
pital training  programs.  By.  .  .  and  Carolyn 
Jane  Mueller.  Springfield,  111..  Charles  C 
Thomas.  cl975.  I99p. 

25.  Health  Computer  Information  Bureau. 
Health  computer  applications  in  Canada: 
catalogue  and  descriptions,  vol.  2.  June  1975. 
Ottawa.  Health  Computer.  Information  Bureau, 
1978.  246  p.  R. 

26.  Hobson.  Lawrence  B.  Examination  of  the 
patient:  A  text  for  nursing  and  allied  health  per- 
sonnel. New  York.  McGraw-Hill.  cl975.  456p. 

27.  Hodkinson,  H.M.  An  outline  of  geriatrics. 
New  York,  Academic  Press.  1975.  159p. 

28.  Hoffman.  Irwin.  Spatial  analysis  of  the  elec- 
trocardiogram: a  program.  St.  Louis.  Mosby, 

1975.  I49p. 

29.  Hotel  Association  of  Canada.  Wrigley'  s  1975 
hotel  directory:  official  directory  of  Hotel  As- 
sociation of  Canada.  Vancouver,  Wrigley  Direc- 
tories' Ltd..  1975.  334p.  R. 

30.  Infante,  Mary  Sue.  The  clinical  laboratory  in 
nursing  education.  New  York,  Wiley,  cl975. 
I02p. 

31.  International  Labour  Conference,  61sl  ses- 
sion, Geneva.  June  1976.  Employment  and  con- 
ditions of  work  and  life  of  nursing  personnel. 
Seventh  item  on  the  agenda.  Geneva.  Interna- 
tional Labour  Office,  1975.  108p.  (It's  Report  7 
(D) 

32.  Issues  in  research:  social,  professional,  and 
methodological .  Selected  papers  from  the  Ameri- 
can Nurses'  Association  Council  of  Nurse  Re- 


accession  list 


searchers  Program  Meeting,  Aug.  22-24,  ISfli. 
Kansas  City.  Mo..  American  Nurses'  Associa- 
tion. 1974.  55p. 

33.  Krathwohl.  David  R.  Taxonomy  of  educa- 
tional objectives:  the  classification  of  educa- 
tional goals.  Handbook  II:  affective  domain, 
by.  .  ..  Benjamin  S.  Bloom,  and  Bertram  B. 
Masia.  New  York.  McKay,  1973.  cl964.  I96p. 

34.  Kunin.  Kalvin  M.  Detection,  prevention, 
and  management  of  urinary  tract  infections.  A 
manual  for  the  physician,  nurse,  and  allied  health 
worker.  2ed.  Philadelphia.  Lea&Febiger.  1974. 
370p. 

35.  Lea.  James.  1941.  Terminology  and  com- 
munication skills  in  the  health  sciences.  Reslon, 
Va..  Reslon,  cl975.  I52p. 

36.  Life  and  death  and  medicine .  San  Francisco, 
Freeman.  cl973.  147p.  (A  Scientific  American 
Book)  (Originally  appeared  as  articles  in  Sept. 
1973  issue  of  Scientific  American) 

37.  Mdnnes,  Mary  Elizabeth.  Essentials  of 
communicable  disease.  2ed.  St.  Louis.  Mosby. 
1975.  40lp. 

38.  Medical  Film  Library  of  Canada.  Catalogue 
of  educational  and  technical  films  for  the  medical 
profession.  Montreal.  City  Films  Ltd.,  1975 
54p. 

39.  Milio.  Nancy.  The  care  of  health  in  com- 
munities. Access  for  outcasts.  New  York.  Mac- 
Millan.  cl975.  402p. 

40.  Modrak,  Marion,  Better  living  and  brea- 
thing: a  manual  for  patients,  by.  .  .  el  al.  St 
Louis.  Mosby.  1975.  66p. 

41 .  Murray.  D.  Stark.  Blueprint  for  health.  Lon- 
don. Allen  &  Unwin.  cl973.  222p. 

42.  National  League  for  Nursing.  Department  of 
Diploma  Programs.  Personnel  management  for 
schools  of  nursing:  need  and  process.  Papers 
presented  at  three  1974  workshops  held  in 
Omaha.  Ne.  Memphis.  Tn.  andBoston.  Ma.  New 
York.  .National  League  for  Nursing.  1975.  58p. 

43.  Navaralham.  V'isvan.  The  human  heart  and 
circulation.  New  York.  Academic  Press.  1975. 
184p. 

44.  Orten.  James.  Human  biochemistry,  by.  . 
and  Otto  W.  Neuhaus.  St.  Louis.  Mosby.  1975. 
995p. 

45.  Pageau.  Solange  Lefebvre.  Controle  naturel 
des  naissances  par  la  methode  sympto- 
thermique.  Monueal,  Intermonde.  cl974.  I67p. 
-16.  Parrish,  John  Albert.  Dermatology  and  skin 
care.  New  York,  McGraw-Hill,  cl975.  302p. 

47.  Perspectives  in  pharmacy.  The  proceedings 
of  a  series  of  addresses  given  at  the  College  of 
Phurmacw  University  oj  Minnesota.  1974-I97S. 
Minneapolis.  Minn. .  College  of  Pharmacy  .  Univer- 
sity of  Minnesota.  1975.  98p. 

48.  The  Population  CouncW .  Report .  New  York. 
Population  Council.  1974.  138p. 

49.  Redman.  Barbara  Klug.  The  process  of  pa- 
tient teaching  in  nursing.  2ed.  St.  Louis,  Mosby, 

1972.  178p. 

50.  Registered  Nurses'  Association  of  British 
Columbia.  Z.;fcrar>  catalogue  books,  periodicals. 


audio-tapes,  June  1975 .  Vancouver,  1975.  I02p. 

51.  Registered  Nurses'  Association  of  Ontario. 
Folio  of  reports.  Toronto,  1975.  6lp. 

52.  Sana,  Josephine  M.  Physical  appraisal 
methods  in  nursing  practice.  Edited  by.  .  .  and 
Richard  D.  Judge.  Boston,  Little,  Brown,  c  1975. 
402p. 

53.  Special  Libraries  Association.  Illinois  Chap- 
ter. Special  libraries:  a  guide  for  management. 
Edited  by  Edward  G.  Strable.  New  York.  1975. 
74p. 

54.  Spradley.  Barbara  Walton,  ed.  Contempor- 
ary community  nursing.  Boston.  Little.  Brown. 
C1975.  467p. 

55.  The  Statesman' s  year-book:  statistical  and 
historical  annual  of  the  states  of  the  world  for  the 
year    1974-75.     London.    Macmillan.     1974. 

I556p.  R 

56 .  Stuan .  R  ichard  B .  Slim  chance  in  a  fat  world: 
behavioral  control  of  obesity  by .  .  .  and  Barbara 
Davis.  Champaign.  111..  Research  Press.  cl972. 
245p. 

57.  The  Sun  Valley  Forum  on  National  Health. 
Inc.  National  health  insurance:  can  we  learn 

from  Canada?  ed.  by  Spyros  Andreopoulos.  New 
York.  Wiley.  cl975.  273p. 

58.  Symposium  sur  I'enseignement  infirmier 
superieur.  La  Haye.  30  oci.  —  3  nov.  1972. 
L'enseignement  infirmier  superieur. 
Copenhague.  Bureau  regional  de  1' Europe.  Or- 
ganisation mondiale  de  la  Sante.  1975.  50p. 

59.  Toporek.  Milton.  1920.  Basic  chemistry  of 
life.  2ed.  New  York.  Appleton-Century-Crofts. 
cl975.  535p. 

60.  Victorian  Order  of  Nurses  for  Canada.  Re- 
port. Ottawa.  Victorian  Order  of  Nurses  for 
Canada,  1974.  77p. 

61.  Weisenberg,  Matisyohu,  ed.  Pain:  clinical 
and  experimental  perspectives.  St.  Louis, 
Mosby,  1975.  385p. 

PAMPHLETS 

62.  Alberta  Association  of  Registered  Nurses. 
Responsibilities  of  the  registered  nurse  in  the 
active  treatment  hospital,  the  auxiliary  hospital 
and  the  nursing  home  in  Alberta.  Compiled  by 
the  A. A. R.N.  Task  Committee  to  Define  Basic 
Nursing  Care  al  the  Acute,  Sub-acute  and  Re- 
habilitative Levels  (including  nursing  homes). 
Edmonton,  1970.  I  I  p. 

63  .American  Nurses'  Association. /Iccoun/aW/- 
ir\  of  the  nurse:  are  there  legal  barriers  to  assum- 
ing fid  I  professional  responsibility?  Speeches 
presented  during  the  48th  convention.  Kansas 
City,  Mo..  American  Nurses'  Association,  1973. 
12p. 

64.  American  Nurses'  Association.  Legislative 
Conference.  Proceedings.  Washington.  D.C.. 
American  Nurses'  Association.  1974.  29p. 

65.  Association  des  infirmieres  canadiennes. 
Memoire  au  Comite  special  du  Senat  et  de  la 
Chambre  des  Communes  sur  la  Politique  de 
I' Immigration,  Ottawa.  1975.  6p. 

66.  Association  of  Registered  Nurses  of  New- 


foundland. Recommendations  from  the  brief  to 
the  Royal  Commission  on  Nursing.  St.  John's. 
1973.  3p. 

67.  Contact  lens  emergency  care.  Information 
and  instruction  packet.  Prepared  by  the  American 
Optometric  .Association  Committee  on  Contact 
Lenses.  St.  Louis.  American  Optometric  Associ- 
ation, 1974.  4pls.  in  I . 

68.  Dartnell  Corp.  What  a  supervisor  should 
know  about  overcoming  resistance  to  change. 
Chicago.  1975.  23p. 

69.  King  Edward's  Hospital  Fund  for  London. 
Report.  .  .4London.  King  Edward' s  Hospital 
Fund  for  London,  1975.  35 p. 

70.  .National  League  for  Nursing.  This  is  the  Na- 
tional League  for  Nursing.  New  York.  1975. 
12p. 

71.  Queen's  Nursing  Institute.  Report.  London. 
Queen's  Nursing  Institute.  1974.  I9p. 

72.  National  League  for  Nursing.  Division  of 
Community  Planning.  Community  planning  for 
nursing:  a  selected  bibliography.  New  York. 
CI975.  27p. 

73.  L'ordre  des  infirmieres  et  infirmiers  du 
Quebec.  Decisions  du  Bureau  suite  a  avant- 
projet  presenle  par  la  Corporation  Profession- 
nelle  des  Medecins  du  Quebec.  Reglement  con- 
cernant  les  actes  medicaux  qui  peu\  em  etre  poses 
par  des  classes  de  personnes  aulres  que  les 
medecins.  Montreal.  1975.  29p. 

74.  New  Brunswick  Association  of  Registered 
Nurses.  Nursing  as  a  career.  Information  for 
guidance  counsellors.  Fredericton.  1974.  6p. 

75.  Press  code.  A  guide  for  hospital  staff  and  the 
news  media.  Toronto  Sunnybrook  Medical 
Centre.  University  of  Toronto.  1975.  12p. 

76.  The  Psychological  Corporation.  Qiuilifica- 
tions  of  the  professional  examination  division. 
New  York.  1974.  8p. 

77.  Royal  College  of  Nursing  and  National 
Council  of  Nurses  of  the  United  Kingdom.  Re- 
port. London.  Royal  College  of  Nurses.  1974. 

16p. 

78.  A  statement  on  continuing  nursing  educa- 
tion. St.  John's  Committee  on  Continuing  Educa- 
tion. School  of  Nursing.  Memorial  University  of 
Newfoundland.  1974.  6  p. 

79.  Street.  Richard.  A  manual  for  patients  with 
Parkinson's  disease,  by.  .  .and  Fletcher 
McDowell.  New  York.  American  Parkinson  Dis- 
ease Association.  1975.  I  v. 

GOVEBNMEI^  CXXIUMENTS 
Canada 

80.  Canada  Institute  for  Scientific  and  Technical 
Information.  Dirff/on  of  federally  supported  re- 
search in  universities.  Ottawa.  National  Re- 
search Council  of  Canada.  1975.  2v.  R 

81  — .  Scientific  and  technical  societies  of 
Canada.  Ottawa.  National  Research  Council  of 
Canada.  1974.  77p.  R 

82.  Centre  de  Recherches  pour  le 
Developpement  International.  Medecine  sans 
medecins.   par    .  .   Alexandre        Dorozynski. 


HE  CANADIAN  NURSE  —  DecemDei  1975 


accession  list 


(Continued  from  page  45) 


Ollawa.  CI975.  64p. 

83.  Commission  de  la  fonclion  publique.  Rap- 
port. Ottawa,  Information  Canada,  1975.  66p. 

84.  Conseil  de  la  Radio- Television  Canadienne. 
Nomenclature  Jes  stations  de  radiojiffusion  au 
Canada.  Ollawa,  Information  Canada,  1975. 
195p.  R 

85.  DeparlmenI  of  E.xlernal  Affairs.  Diplomatic 
corps  and  consular  and  other  representatives  in 
Canada.  Ottawa.  Information  Canada,  1975. 
86p.  R 

86.  Dept.  of  National  Revenue  E.\cise.  Certified 
public  hospital  list:  names  and  addresses  of  cer- 
tified bonafide  public  hospitals  for  the  purposes 
of  the  E.xcise  Act  and  the  E-xcise  Ja.\  Act.  Oltawa. 
Information  Canada,  1975.  n.p. 

87.  Economic  Council  of  Canada.  Report.  Ot- 
tawa, Information  Canada,  1975.  72p. 

88.  Environment  Canada.  The  clean  air  act  re- 
port:   l97i-74.    Ottawa,    Information   Canada, 

1975.  34p. 

89.  Health  and  Welfare  Canada.  Bad  trips  freak- 
outs  overdoses.  Published  by  authority  of  the 
Minister  of  National  Health  and  Welfare.  Ot- 
tawa, Information  Canada.   1975.  45p. 

90  — Health  manpower  development  program. 
Canada.  Objectives  and  goals  fiscal  year 
1975/76.  Approved  by  Health  Manpower  Com- 
mittee, 1  May  1975.  Ottawa,  1975.  7p. 

91  — .  Health  Protection  Branch.  Health  protec- 
tion and  food  laws.  Rev.  Oltawa,  Information 
Canada.  1975.  47p. 

92. — .    Long  Range  Planning  Branch.  Canada's 

older  population,  by  J.  A.  Clark  and  N.E.  Col- 

lishaw\  Ottawa.    1975.  25p.  (It's  Staff  papers. 

Long  range  planning  75 — 1 ). 

9.3 — .  Long  Range  Planning  Branch.  Hospitals 

and  the  elderly:  present  and  future  trends.  By 

Mary  K.  Rombout.  Ottawa.  1975.  34p.  (It's  Staff 

pa[)ers.  Long  range  planning  75-2) 

94 — .  Report  on  the  operation  of  agreements 

with  the  provinces  under  the  hospital  insurance 

and  diagnostic  services  act  for  the  fiscal  year 

ended  March  .i I.  1974.  Ottawa.  1974.  73p. 

95.  Information   Canada.   Organization   of  the 

government  of  Canada.    Ottawa.    Information 

Canada.  1975.  n.p. 

%.  Manpower  and  Immigration.  The  economic 

impact  of  immigration.   Canadian  immigration 

and  population  study  by  Louis  Parai   Information 

Canada.  1974.   1  18p. 

97 — .  A  report  of  the  Canadian  immigration  and 

population  study.  Information  Canada.  1974.  4v. 

98.  Medical  Research  Council.  Report  of  the 
President.  Ottawa,  Information  Canada,  1975. 
226p. 

99.  Ministere  de  la  Main-d'oeuvre  et  de 
rimmigralion.  Section  de  la  formation  el  du  per- 
fectionnement  du  personnel.  Redigez  voire  de- 
scription de  paste.  Un  manuel  d'enseignement 
sequentiel,  redige  par  Louise  Newton.  Ottawa, 
Information  Canada,  c  1 974.  Iv.  (various  paging) 

100.  National  Film  Board  of  Canada.  Film 
catalogue.  Ottawa.  National  Film  Board  of 
Canada.  1975.  182p. 


101.  National  Health  and  Welfare  Canada.  Film 
library  catalogue.  Ottawa,  Health  and  Welfare 
Canada,  1975.  I  v. 

102.  National  Research  Council  of  Canada.  Re- 
port. Ottawa,  Information  Canada.  1975.  77p. 

103  — .  Associate  Committee  on  Scientific 
Criteria  for  Environmental  Quality.  Environmen- 
tal Secretarial.  Status  report.  31  July.  1972  — 
Sept.  1974.  Ollawa.  1972-1974.  2v. 

104.  Parliament  House  of  Commons.  List  of 
members  of  the  House  of  Commons  of  Canada 
with  their  respective  constituencies  and  addres- 
ses. Oltawa,  Information  Canada,  1974.  91p.  R 

105.  Post  Office.  Safe  lifting  and  carrying.  Ot- 
tawa. Information  Canada.  cl975.  pam. 

106.  Public  Service  Commission.  Report.  Ot- 
tawa. Information  Canada.  1975.  64p. 

107.  Same  et  Bien-eire  social  Canada.  Prog- 
ramme de  perfectionnement  de  la  main-d'oeuvre 
sanitaire.  Canada.  Objectives  et  buts  annee 
hudgetaire  1975-76.  Approuve  par  le  Comite 
federal-provincial  de  la  main-d'oeuvre  sanitaire 
le  ler  niai.  1975.  7p. 

108.  Science  Council  of  Canada  Report.  Ol- 
lawa. Information  Canada.  1975.  52p. 

109.  Statistics  Canada.  Therapeutic  abortions 
1972-1973.  2v. 

110 — .  Bureau    du    conseiller    superieur    en 

integration.   Perspectives  Canada.  Receuil  de 

statistiques    sociales.     Ottawa.     Information 

Canada,  cl974.  331  p. 

111.  Unemployment  Insurance  Canada.  Report. 

Ottawa,  Information  Canada,  1975.   14p. 

I  12.  Transport    Canada.    Roadside   surveys   of 
drinking-driving  behaviour:  two  pilot  projects. 
Ottawa,  Information  Canada,  1974.   137p. 
Quebec 

1 13.  Regie  de  I'assurance  maladie  du  Quebec. 


THE  UNIVERSITY  OF  CALGAR/ 


FACULTY 
POSITIONS 

Positions  available  for  nursing  faculty 
in: 

(a)  An  undergraduate  program  being  re- 
vised. 

(b)  A  post-diploma  program  being  planned 
leading  to  a  baccalaureate  degree. 

Opportunities  exist  in  all  clinical  areas.  Pre- 
ference given  to  applicants  with  Master's  or 
Doctoral  degrees.  Appointments  to  be 
made  July  1st,  1976, 

CONTACT: 

Dean,  Faculty  of  Nursing 
University  of  Calgary 
CALGARY,  Alberta 
CANADA 
T2N  1N4 


Rapport.  Quebec,  Regie  de  I'assurance-maladie. 
1975.  87p. 
United  States 

1 14.  Dept.  of  Health,  tiducalion,  and  Welfare 
Evaluation  of  employment  opportunities  for 
newly  licensed  nurses.  Health  manpower  refer- 
ences. By  Patricia  M.  Nash.  Bethesda,  Md  , 
1975.  l,35p.  (DHEW  Pub.  no.  (HRA)  75-12) 
115 — .Licensed  practical  nurses  in  occupu 
tional  health.  By  Jane  A.  Lee,  et  al.  Cincinnati. 
Ohio,  U.S.  Dept.  of  Health,  Education,  and  Wel- 
fare, Public  Health  Service,  Center  for  Disease 
Control,  National  Institute  for  Occupational 
Safely  and  Health,  Division  of  Technical  Ser 
vices.  1974.  54p.  (It's  DHEW  Pub.  no.  (NIOSH  i 
74-102) 

1 16 — .  Public  Health  Service.  List  of  journals, 
indexed  in  Index  Medicus,  National  Library  oj 
Medicine,  1975.  Washington.  U.S.  Gov't.  Prim 
ing  Office,  1975.  Il2p.  R. 

117.  National  Institutes  of  Health.  ,4nn(«//  report 
of  international  activities,  fiscal  year  1974.  Pre- 
pared by  International  Cooperation  and  Geo 
graphic  Studies  Branch.  Fogarly  International 
Center.  Bethesda.  Md..   1975.   115p. 

STUDIES  DEPOSITED  IN  CNA  REPOSITORY  COLLEC 
TION 

118.  Allemang,  Margaret  May.  1974.  Nursing 
education  in  the  United  States  and  Canada 
1873-1950  leading  figures,  forces ,  views  on  edu- 
cation. Seattle.  cl974.  296p.  R 

119.  Bell.  Janice  M.  Stressful  life  events  and 
coping  methods  in  mental  illness  and  wellness 
behaviors.  Loma  Linda,  Calif.,  1975.  89p.  R 

1 20.  Gauthier.  Annette.  Absence  de  stimuli  chez 
le  patient  canceraux  par.  .  .  et  Frances  Belec. 
Ottawa,  1974.  45p.  R 

121.  Griffen.  Amy.  Hypnotics,  sleep  and  the 
hospitalized  obstetric  patient  by.  .  .  and  Edith 
Benoil  and  Sr.  Carmen  Morin.  London.  Univer- 
sity of  Western  Ontario.  1972.  43p. 

122.  Hales.  ML.  Patient  classification  and 
workload  index  .systems  and  where  they  have  led 
us.  Vancouver,  B.C.,  St.  Paul's  Hospital,  1975 

Iv.  (various  pagings)  R  . 

123.  Kay,  Gloria.  New  staff  nurses'  perceptions       j 
of  the  practice  environment  of  a  university  medi- 
cal   centre.     Toronto,     Sunnybrook     Medical 
Centre,  cl975.  187p.  R 

1 24 .  Lanclot ,  L  ise .  References  pour  le  nursing  en 
urologie.  Montreal,  1974.   167p.  R 

AUDIO-VISUAL  AIDS 

125.  Association  des  medecins  de  langue 
fran^aise  au  Canada.  Sonomed,  serie  2,  no.  7. 
Montreal,  Association  des  medecins  de  langue 
fran^aise  du  Canada,  1974.  I  casette.  Cote  A. 
Brachialgies  et  sports  de  raquette  "tennis 
elbow".  —  Cole  B.  Les  anxiolytique;  La  resec- 
tion sous-muqueuse. 

126 — .  Sonomed,  serie  2,  no.  6.  Montreal.  As- 
sociation des  medecins  de  langue  fran(;aise  du 
Canada.  1974.  I  caselle.  Cote  A.  Les  malades  el  ^ 
r avion  —  ColeB.  Les  malades  et  1' avion  (suite).  W 


classified  advertisements 


ALBERTA 


BRITISH  COLUMBIA 


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]mO  REGISTERED  NURSES  required  for  genera!  duly  <n 
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Rreatronal  facilities  Sala/y  according  to  A  H  A.  recommenda- 
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REGISTERED  NURSES  (2)  for  children  s  co-ed  camp  June27lh 
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REGISTERED  NURSES  required  for  70  bed  accredited  active 
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1EAD  NURSE  for  modern  49- bed  hospital  on  Vancouver  Island 
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)PERATING  ROOM  NURSE  wanted  for  active  mo- 
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Roles   for   display 
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Closing  dote  for  copy  and  conceliotion  is 
6  weeks  prior  to  1st  day  of  publicotion 
month. 

The  Canadian  Nurses'  Associotion  does 
not  review  the  personnel  policies  of 
the  hospitols  and  agencies  odvertising 
in  the  Journol.  For  oulhentic  information, 
prospective  oppliconts  should  apply  to 
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Address  correspondence  to: 

The 

Canadian  f^ 
Nurse 

50  THE  DRIVEWAY 

OTTAWA,  ONTARIO 

K2P  1E2 

E  CANADIAN  NURSE  —  December  1975 


^17 


EXPERIENCED  NURSES  (eligible  for  B  C  registration)  required 
for  409-bed  acute  care,  teactnmg  hospital  located  in  Fraser 
Valley.  20  minutes  by  freeway  from  Vancouver,  and  within 
easy  access  of  varied  recreational  facilities  Excellent  Orienta- 
tion and  Continuing  Education  programmes  Salary  $1 ,049  00  to 
Si. 239  00  Clinical  areas  include  Medicine.  General  and  Spe- 
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gency PRACTICAL  NURSES  (eligible  for  BC.  License)  also 
required  Apply  io:  Administrative  Assistant,  Nursing  Personnel. 
Royal  Columbian  Hospital.  New  Westminster,  British  Columbia. 
V3L  3W7 


EXPERIENCED  GENERAL  DUTY  NURSES  required  for  small 
hospital.  North  Vancouver  Island  area  Salary  and  personnel 
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Ditectoi  of  Nursing,  St  Georges  Hospital.  Box  223,  Alert  Bay, 
British  Columbia.  VON  lAO 


GENERAL  DUTY  NURSES  for  modern  41-bed  hospital  located 
on  the  Alaska  Highway.  Salary  arxJ  personnel  policies  in 
accordance  witfi  RNABC  Accommodation  available  in  resi- 
dence Apply.  Director  of  Nursing.  Fort  Nelson  General  Hospital. 
Fort  Nelson,  Bntisti  Columbia. 


GENERAL  DUTY  NURSES  for  modern  35-bed  hospital  located 
m  southern  B  C  s  Boundary  Area  with  excellent  recreation  faci- 
lities Salary  and  personnel  policies  in  accordance  with  RNABC 
Comfortable  Nurses  s  home.  Apply:  Director  of  Nursing,  Bound- 
ary Hospital,  Grand  Forks,  British  Columbia.  VOH  1H0. 


GENERAL  DUTY  NURSES  required  for  an  e7-bed  acute  care 
hospital  in  Northern  B.C.  residence  accommodations  available. 
RNABC  policies  m  effect  Apply  to:  Director  of  Nursing,  Mills 
Memorial  Hospital.  Teaace,  British  Columbia.  V8G  2W7, 


SASKATCHEWAN 


ONTARIO 


LAURENTIAN  UNIVERSITY  SCHOOL  OF  NURSING  invites 

applications  for  FACULTY  POSITIONS  in  a  small  B  Sc  N  pro- 
gramme (40  students  admitted  annuallyl  New  curriculum 
emphasis  on  primary  care  In  1976-77  positions  available  lo 
leach  nursing  process  m  acute,  life-threatening  and  long-term 
illness  Clinical  experience  and  masters  degree  m  medical- 
surgical  and/or  paediatnc  nursing  particularly  useful  Bilingual 
preferred  (French-English!  Rank  and  salary  negotiable  Excel- 
lent fringe  benefits  including  medical,  dental,  hospitalization  and 
drug  plans  Please  contact  Dorothy  Pnngle.  Director  School  of 
Nursing,  Laurentian  University,  Ramsey  Lake  Road.  Sudbury, 
Ontario   Phone  705-675-1151.  extension  346 


REGISTERED  NURSES  for  34-bed  General  Hospital. 
Salary  S945  CO  lo  SI. 145. CO  per  nronth.  plus  experience  allow- 
ance. Excellent  personnel  polrces  Appty  to:  Director  of  Nursing. 
Engtehart  &  Dtslricl  Hospital  Inc..  Englehan.  Ontario.  POJ  1H0 


REGISTERED  NURSES  AND  REGISTERED  NURSING 
ASSISTANTS  for  45-bed  Hospital  Salary  ranges 
incluoe  generous  experience  allowances,  R  N  s 
salary  S1.045  to  Si. 245  and  R  N  A  s  salary  S735  to  S810. 
Nurses  residence  —  private  rooms  with  bath  —  S60  per  month. 
Apply  to  The  Director  of  Nursing  Geraldion  District  Hospital 
Geraldton.  Ontario.  POT  1  MO- 


DIRECTOR  OF  NURSING:  Immediate  applications  are  mvtted 
for  the  position  of  Director  of  Nursing  m  the  43-bed  Wadena 
Union  Hospital  Fringe  benefits  include  Registered  Pension  Plan. 
Group  Lite  Insurance  and  Income  Replacement  Plan  This  is  a 
seven  year  old  well-equipped  hospital  m  a  town  of  1500  popula- 
tion serving  a  large  rural  population  Wadena  is  centrally  located 
1 30  mjles  from  each  of  two  major  Saskatchewan  centres  Super- 
visory experience  is  essential  Nursing  Administration  course 
desirable  Attractive  salary  scale  in  effect  Apply  stating  qualifica- 
tions and  experience  to  Administrator.  Wadena  Union  Hospital. 
P  O  Box  to  Wadena,  Saskatchewan,  SOA  4JC 


REGISTERED  NURSES  are  required  immediately  forthe43-bed 
Wadena  Union  Hospital,  This  is  a  modern,  attractive  acute  care 
hospital  Situated  m  the  town  of  Wadena.  Saskatchewan,  a 
friendly  parkland  community  with  a  population  of  1 500  Attractive 
salary  and  fringe  benefits  are  provided  under  the  Saskatchewan 
Union  of  Nurses  agreement  in  effect.  Please  direct  applications 
to  Administrator.  Wadena  Union  Hospital.  PO  Box  10.  Wadena. 
Saskatchewan 


UNITED  STATES 


TEXAS  wants  you!  If  you  are  an  RN,  expenenced  or 
a  recent  graduate,  come  to  Corpus  Chnsti,  Sparkling 
City  by  the  Sea  .  .  .  a  city  building  for  a  better 
future,  where  your  opportunities  for  recreation  and 
studies  are  limitless.  Memorial  Medical  Center,  500- 
bed,  general,  teaching  hospital  encourages  career 
advancement  and  provides  in-service  orientation. 
Salary  from  S785.20  lo  Si. 052. 13  per  month,  com- 
mensurate with  education  and  experience  Differenlial 
for  evening  shifts,  available.  Benefits  include  holi- 
days, sick  leave,  vacations,  paid  hospitalizalion. 
health.  life  insurance,  pension  program  Become  a 
vital  part  of  a  modern,  up-lo-daie  hospital,  wnle  or 
call:  John  W.  Gover.  Jr  .  Director  of  Personnel. 
Memorial  Medical  Center,  P  O,  Box  5280  Corpus 
Chnsti,  Texas.  78405. 


GENERAL  DUTY  NURSES 


Required  immediately  for  acute  care  gen- 
eral hospital  expanding  to  343  beds  plus 
proposed  75  bed  extended  care  unit. 
Clinical  areas  include:  medicine,  surgery, 
obstetrics,  paediatrics,  psychiatry,  activa- 
tion &  rehabilitation,  operating  room, 
emergency  and  intensive  and  coronary 
care  unit. 

Must  be  eligible  for  B.C.  Registration 
Personnel    policies    in    accordance    with 
R.N. A  B.C.  contract: 

SALARY:  $850  —  $1020  per  month 
(1974  rates) 

SHIFT  DIFFERENTIAL 

APPLY  TO: 

Director  of  Nursing 

Prince  George  Regional  Hospital 

Prince  George,  B.C. 


THE  LADY  MINTO  HOSPITAL 
AT  COCHRANE 

invites  applicalions  from 

REGISTERED  NURSES 

54-bed  accredited  general  hospi- 
tal. Northeastern  Ontario.  Compe- 
titive salaries  and  generous  bene- 
fits. Send  inquiries  and  applications 
to: 

MISS  E.LOCKE 

Director  of  Nursing 

The  Lady  Minto  Hospital  at 

Cochrane 

P.O.  Box  1660 

Cochrane,  Ontario 

POL  ICO 


CLINICAL  NURSING 
COORDINATOR 
ORTHOPAEDICS 

Responsible  for  coordination  of  afl  nursing  ac- 
tivities related  to  tfie  delivery  of  quality  care  in  all 
orthopaedic  units. 

Applicant  must  tiave  Degree  in  Nursing  and  ex- 
perience in  Orthopaedic  Nursing  and  Administra- 
tion of  approx.  3-4  years. 

Please  apply  In  writing  to: 

Helen  R.  Cunningham,  Reg. N., B.N. 
Director  of  Nursing  Service, 
Department  of  Nursing, 
Ottawa  Civic  Hospital, 
1053  Carling  Avenue, 
Ottawa,  Ontario.  K1Y  4E9 


REGISTERED  NURSES 

REGISTERED  NURSING 
ASSISTANT 

HEALTH  CARE  AIDES 

A  new  bilingual  (Italian-Canadian)  188-bed 
Home  for  the  Aged  require  the  services  of 
the  above  personnel.  Successful  applic- 
ants must  be  able  to  speak  Italian  and  pref- 
erably have  some  experience  in  Geriatric 
Nursing. 

Please  apply  to: 

Director  of  Nursing 
Villa  Colombo 
40  Playfair  Avenue 
Toronto,  Ontario 


FOOTHILLS  HOSPITAL 

Calgary,  Alberta 

Advanced  Neurological- 
Neurosurgical  Nursing 

for 
Graduate  Nurses 

a  five  month  clinical  and 

academic  program 

offered  by 

The  Deparlmeni  of  Nursing  Service 

and 

The  Division  of  Neurosurgery 

(Depanmeni  of  Surgery) 

Beginning:  March.  September 

Limited  to  8  participants 
Applications  now  being  accepted 


For  further  information,  plBBse  write  to: 

Co-ordinator  of  In-service  Education 

Foothilis  Hospitai 

1403  29  St.  N.W.  Calgary,  Alberta 

T2N  2T9 


THE  GENERAL  HOSPITAL 

ST.  JOHN'S,  NFLD. 
A1A  1E5 


Registered  nurses  with  experience  in  Re- 
nal Dialysis,  Intensive  Care  -  Medical  and 
Surgical.  Post-op  Cardiovascular  Surgery, 
Coronary  Care. 

355  bed  hospital.  Major  teaching  hospital 
for  Memorial  University  of  Newfoundland 
Medical  School. 

Liberal  personnel  policies. 


For  further  information  or  application 
form  write  to: 

Personnel  Director 


THE  UNIVERSITY  OF  ALBERTA 
EDMONTON,  ALBERTA 

DIRECTOR  OF  SCHOOL 
OF  NURSING 

The  University  of  Alberta  is  seeking  candi- 
dates, male  or  female,  for  the  position  of 
Director  of  Nursing  commencing  July  1, 
1 976.  Persons  are  sought  with  earned  doc- 
toral degrees,  demonstrated  scholarship, 
professional  achievement  and  competence 
in  administration  appropriate  for  effective 
leadership  in  an  established  university  with 
professional  faculties  and  schools.  Reports 
to  the  Vice-President  (Academic). 
Salary  commensurate  with  educational 
preparation  and  experience.  Excellent 
fringe  benefits. 

Applications  and  nominations  stiould  be 
sent  to: 

Dr.  M.  Horowitz 
Vice-President  (Academic) 
The  University  of  Alberta 
Edmonton,  Alberta  T6G  2J9 


CARE 


CANADA 


THE 
WORLD    OF   CARE: 

Providing  nutritious 
food  for  school  chil- 
dren and  pre-schoolers, 
health  services  for  the 
sick  and  handicapped, 
facilities  and  equip- 
ment for  basic  school- 
ing and  technical  train- 
ing, tools  and  equip- 
ment for  community 
endeavours.  Your  sup- 
port of  CARE  makes 
such  things  possible  for 
millions  of  individuals 
around  the  world. 


One  dollar   per   person 
each  year  would  do  it! 

63  Sparks  OTTAWA  (Ont  )  K1  P  5A6 


NURSING 
SUPERVISOR 


Required  immediately  by  an  active  100  bed 
acute  care  and  40  bed  extended  care  hospi- 
tal. B.C.  registration  plus  experience  in  ad- 
ministrative nursing  and/or  Baccalaureate 
degree  in  nursing,  with  experience  prefer- 
red. 
Salary  $1258  to  $1481  per  month. 


Apply  in  writing  to  the: 

Director  of  Nursing 

G.R.  Baker  Memorial  Hospital 

543  Front  Street 

Quesnel,  British  Columbia 

V2J  2K7 


ST.  MICHAEL'S  HOSPITAL 
Toronto,  Ontario 

invites  applications  from 


REGISTERED  NURSES 

for 

RESPIRATORY 

INTENSIVE  CARE, 

CORONARY  CARE, 

and  ACUTE  CARE  UNITS 

Three  separate  bul  adjoining  units,  of  14,  7,  and  24  beds 
respectrvely.  Planned  orienlaticn  and  in-service  pro- 
gramme will  enatwe  you  to  collaborate  m  the  most  advan- 
ced of  treatment  regimens  for  the  post-operative  cardio- 
vascular, cardiac  and  other  acutely  ill  patients.  One  year  of 
nursing  experience  a  requirement. 

for  details  apply  to: 

The  Director  of  Nursing 
St.  Michael's  Hospital 
Toronto,  Ontario 
MSB  1W8 


NORTH  NEWFOUNDLAND  &  LABRADOR 

requires 

REGISTERED  NURSES 
PUBLIC  HEALTH  NURSES 

International  Grenfell  Association  provides  medical 
services  for  Northern  Newfoundland  and  Labrador.  We 
staff  four  hospitals,  eleven  nursing  stations,  eleven 
Public  Health  units  Our  main  180-bed  accredited  hos- 
pital is  situated  at  St.  Anthony.  Newfoundland.  Active 
treatment  is  carried  on  in  Surgery,  Medicine,  Paediat- 
rics. Obstetrics.  Psychiatry.  Also,  Intensive  Care  Unit. 
Orientation  and  In-Service  programs.  40-hour  week, 
rotating  shifts  Living  accommodations  supplied  at  low 
cost.  PUBLIC  HEALTH  has  challenge  of  large  remote 
areas.  Excellent  personnel  benefits  include  liberal  vaca- 
tion and  sick  leave.  Union  approved  salaries  start  at 
S8t0.00. 
Apply  to: 

INTERNATIONAL  GRENFELL  ASSOCIATION 
Assistant  Administrator  of 

Nursing  Services, 
St.  Anthony,  Newfoundland. 


THE  MONTREAL 
CHILDREN'S  HOSPITAL 

REGISTERED  NURSES 
NURSING  ASSISTANTS 

Our  patient  population  consists  of 
the  baby  of  less  than  an  hour  old 
to  the  adolescent  who  has  just 
turned  seventeen.  We  see  them  in 
Intensive  Care,  in  one  of  the  Med- 
ical or  Surgical  General  Wards,  or 
in  some  of  the  Pediatric  Specialty 
areas. 

They   abound    in   our  clinics   and 

their  numbers  increase  daily  in  our 

Emergency. 

If   you   do   not   like  working  with 

children    and   with   their  families, 

you  would  not  like  it  here. 

If  you  do  like  children  and  their 
families,  we  would  like  you  on  our 

staff. 

Interested  qualified  applicants 
should  apply  to  the: 

DIRECTOR  OF  NURSING 
Montreal  Children's  Hospital 
2300  Tupper  Street 
IVIontreal  108,  Quebec 


The  College  of  New  Caledonia, 

a  comprehensive  regional 

college  in  Prince 

George,  B.C.,  requires 

NURSING 
FACULTY 


Positions  available  as  of  January,  1976,  to 
help  develop  a  new  two-year  Diploma  Nurs- 
ing Program.  This  program  will  begin  in 
September,  1976.  Applicants  should  be 
prepared  to  teach  basic  nursing  concepts 
and  skills  at  the  diploma  level. 

We  offer  —  Excellent  fringe  benefits,  relo- 
cation allowances,  excellent  salary  com- 
mensurate with  qualifications. 

Minimum  Requirements  —  Baccalaureate 
Degree  in  Nursing,  expenence  in  bedside 
nursing,  eligibility  for  B.C.  registration. 

Applicants  should  submit  a  curriculum  vitae 
and  the  names  of  three  references  to: 

MR.  GORDON  INGALLS 

ACTING  PRINCIPAL 

THE  COLLEGE  OF  NEW  CALEDONIA 

2001  CENTRAL  STREET 

PRINCE  GEORGE,  B.C.  V2N  1P8 

In  ihe  event  of  the  continuation  of  the  postal  sinke.  app*y 
by  telegram  or  telephone  siatmg  curriculum  vitae  and  the 
names  of  three  references  whom  we  may  contact 


"MEETING  TODAY'S  CHALLENGE  IN  NURSING" 

QUEEN    ELIZABETH    HOSPITAL    OF    MONTREAL 

CENTRE 

A  Teaching  Hospital 
of  McGill  University 

requires 

REGISTERED  NURSES 

AND 

REGISTERED  NURSING  ASSISTANTS 
Quebec  language  requirements  do  not  apply  to  Canadian  applicants. 

•  255-bed  General  Hospital  in  the  West  end  of  Montreal 

•  Clinical  areas  include  Progressive  Coronary  Care, 
Intensive  Care,  Medicine  and  Surgery,  Psychiatry. 

Interested  qualified  applicants  should  apply  In  writing  to: 

QUEEN  ELIZABETH  HOSPITAL  OF  MONTREAL  CENTRE 

DIRECTOR  OF  PERSONNEL 
2100  MARLOWE  AVE.,  MONTREAL,  QUE.,  H4A  3L6. 


CANADIAN  NURSE  —  Decembec  1975 


T 


NURSING  OPPORTUNITY 
IN  A  PROGRESSIVE  HOSPITAL 

SUPERVISOR  — 
OPERATING  ROOM 

AND 
RECOVERYROOM 

We  offer  an  active  staff  development  program  in  a  310-bed 
General  Hospital  involved  in  Acute.  Extended  and  Mental 
Health  Care. 

Competitive  salaries  and  fringe  benefits  based  on  educa- 
tional background  and  experience. 

Apply,  sending  complete  resume,  to: 

Director  of  Personnel 
Stratford  General  Hospital 
Stratford,  Ontario 
N5A  2Y6 

;) 

DIRECTOR 
OF  NURSING 

An  opportunity  exists  for  an  energetic,  experienced  Nurse 
Administrator  in  a  fully  accredited  130  bed  general  hospital, 
including  a  35-bed  chronic  unit  with  an  active  rehabilitation 
program. 

Reporting  to  the  Administrator,  the  Director  of  Nursing  will 
participate  in  the  development  of  programs  and  policies  for 
the  provision  of  optimum  patient  care,  the  on-going  review  of 
treatment  methods  and  the  recruitment  of  necessary  staff 

The  hospital  serves  a  district  population  of  approximately 
26,000  and  is  centrally  located  in  the  Village  of  Winchester 
(population  1800)  with  convenient  access  to  major  centres 
such  as  Ottawa,  Montreal  and  Toronto. 

Applicants  must  have  registration  as  a  nurse  in  Ontario 
and  satisfactory  completion  of.  or  be  presently  enrolled  in.  a 
recognized  post-graduate  course  in  nursing  science  or  ad- 
ministration. An  attractive  salary  and  fringe  benefits  package 
is  available  to  qualified  applicants. 

Please  send  application  and  resume,  including  date 
available  to 

Administrator 

Winchester  District  Memorial  Hospital 

Winchester,  Ontario 

KOC  2K0 

..m^                    I 

1- 

■ 

m 

ST.  JOSEPH'S  HOSPITAL 

TORONTO,  ONTARIO 

invites  applications  from 

REGISTERED  NURSES 

•  We  offer  opportunities  in  Emergency,  Operating  Room,  P.A.R.,   Intensive  Care  Unit,  Ortfiopaedics,  Psyctiiatry, 
Paediatrics,  Obstetrics  and  Gynaecology,  General  Surgery  and  Medicine. 

•  We  offer  an  Orientation  program  and  opportunities  for  Professional  Development  through  active  In-Service  programs. 

•  We  offer  —  Toronto  —  with  some  of  Canada's  finest  Theatres,  Restaurants  and  Social  events. 

•  We  offer  progressive  personnel  policies. 

•  We  offer  a  starting  salary,  depending  on  experience,  of: 

effective  April  1, 1975     -  $945  to  S1,145  per  month. 

•  We  offer  monthly  educational  allowances  up  to  $1 20.  per  month  in  addition  to  the  above  starting  salary. 

Appiyto:                                               Miss  M.  WOODCROFT 

Associate  Director  of  Nursing  Service 
St.  Joseph's  Hospital,  30  The  Queensway,  Toronto,  Ontario  M6R  1B5 

50 

ANNOUNCING 


volume  lEr 

INTHESERIESOF  ._»  «  i^^ 

Standard  'Nmsing  CarC'Tlans 


CORONARY  CARE 
EMERGENCY  CARE 
HEMODIALYSIS 
INTENSIVE  CARE 
PSYCHIATRIC  CARE 


w 


Here's  your  chance  to  purchase  the  second  unit  of  our  widely 
accepted  STANDARD  NURSING  CARE  PLANS.  Contained  in 
3-ring  loose-leaf  binder,  the  plans  include  an  index  and  biblio- 
graphy on  8'/:  X  1 1  sheets. 

STANDARD  NURSING  CARE  PLANS  have  become  a  profes- 
sional must  for  easily  implemented  patient  care. 

'  PLEASE  SEN D  ME Vo\l)MY'2~^r^/VD;4flb'«Vft^^ 
PLANS". 

Name Title 

Hospital 

Address ■ 

City 


.State. 


.Zip. 


□    I    am    enclosing   full   payment  for volumes  @  $20.00  U.  S. 

each,     or   .   .   . 

Q    Please  bill  the  hospital,  Purchase  Order  # for 

volumes  @  $20.00  U.  S.  each,  plus  postage  and  handling. 
Send  Orders  to:  K/P  MEDICAL  SYSTEMS,  P.O.  Box  8900 

Stockton,  CA.  95208  J 


THE  NEW  CARDIAC  UNIT 

of  the 

OTTAWA  CIVIC  HOSPITAL 

Opening 

In  the  Spring 

of  1976 


Requires: 

Head  Nurses  &  G.S.N.'s 

— For  the  Medical  &  Surgical  Wards. 
—  O.R.  Recovery  Room,  Intensive  Care, 
and  Coronary  Care  Units. 

Applications  and  inquiries  to: 

Miss  M.  Mills,  Reg.  N.,  B.Sc.N., 
Assistant  Director  of  Nursing  Service, 
Ottawa  Civic  Hospital, 
1053  Carling  Avenue, 
Ottawa,  Ontario,  K1Y  4E9 


../ 


INTERNATIONAL 
DEVELOPMENT 
RESEARCH  CENTRE 


Research  Associate  Awards 
for  Professionals 

The  International  Development  Research  Centre  offers  ten 
awards  for  training,  research  or  investigation  to  Canadian 
professionals/practitioners  for  tenure  during  1976-77. 

The  Award 

Stipend  up  to  $18,500 

Actual  Travel  costs  for  award  holder  &  family  variable 

Travel  in  the  field  up  to  $   1 ,000 

Research  costs  up  to  $   2,000 

And/or  actual  training  fees  variable 

The  candidate 

1-  The  professional  with  no  specific  experience  in  inter- 
national development,  who  wishes  to  devote  one  year 
to  research,  training  or  investigation  in  the  field  of 
international  development  with  a  view  to  pursuing  a 
future  career  in  this  field. 

2-  The  professional  already  working  in  the  development 
field  who  wishes  to  improve  skills  or  requires  a  period 
for  research. 

All  applicants  must  be  Canadian  citizens  or  have  a  min- 
imum of  three  years  landed  immigrant  status,  have  approx- 
imately ten  years  of  professional  experience,  and  be  at 
least  35  years  of  age. 

Research  and  training  areas 

Possible  fields  of  interest:  agriculture,  food  and  nutrition 
sciences,  information  and  communications,  population  and 
health  sciences,  rural-urban  dynamics,  social  sciences, 
technology  transfer,  education,  engineering,  etc. 

Tenure 

To  begin  before  January  1977  for  one  year  only. 

Applications 

The  application  forms  may  be  obtained  directly  from  the 
Centre.    They    must    be    submitted   by    February   28    to: 

Research  Associate  Award, 

Social  Sciences  and  Human  Resources  Division, 

International  Development  Research  Centre, 

P.O.  Box  8500, 

Ottawa,  Ontario,  Canada. 

KIG  3H9 

Announcement  of  awards  will  be  made  May   1st,   1976. 

The  International  Development  Research  Centre  is  a 
corporation  established  by  an  Act  of  the  Canadian  Parliament, 
May  13th,  1970.  The  centre  also  offers  Research  Associate 
awards  for  mid-career  professionals  from  developing  countries 
and  for  Ph.D.  Thesis  Research  in  the  field  of  international 
development. 


wc  r  AWaniANj  Ml  lp«;p  —  n«ar*»mhftf  1Q7.S 


ORTHORAEDIC    ic    ARTHRn-CC 
HOSR|-rAL_ 

43  WELLESLEY  STREET,  EAST 

TORONTO,  ONTARIO 
M4Y1H1 

Enlarging  Specialty  Hospital  offers  a  unique 
opportunity  to  nurses  and  nursing  assistants 
interested  in  the  care  of  patients  with  bone  and 
joint  disorders. 

Currently  required  — 

Registered  Nurses  and  Nursing  Assistants  for  all 
units 

Clinical  specialists  for  Operating  Room,  Intensive 
Care,  Patient  Care  and  Education. 


DIRECTOR  OF  IN-SERVICE 
EDUCATION 

The  Hospital 

A  Director  of  In-Service  Education  is  required  in  this  mod- 
ern, well-equipped  227  bed  accredited  hospital  providing 
general  acute,  out-patient  and  extended  care  services  in  a 
community  of  30,000  population  situated  on  the  sea  shore 
30  miles  by  freeway  south  of  Vancouver,  B.C. 

Duties 

Responsibilities  include  planning,  organizing,  co-ordinating 
and  fully  directing  all  aspects  of  in-service  education  in  the 
hospital.  The  director  will  be  a  member  of  the  senior  man- 
agement team  concerned  with  the  total  operation  of  the 
hospital. 

Qualifications 

Qualifications  required  are  several  years  experience  work- 
ing in  hospitals  plus  educational  experience  in  teaching. 

Salary 

This  position  offers  excellent  working  conditions  and  be- 
nefits. The  salary  is  open  to  negotiation.  The  position  is 
vacant  as  of  January  1,  1976. 

Interested  applicants  should  send  their  application  and 
resume  to: 

Derrald  L.  Thompson 

Administrator 

Peace  Arch  District  Hospital 

15521  Russell  Ave. 

White  Rock,  B.C.,  V4B  2R4 


REGISTERED  NURSES 

1260  BED  HOSPITAL  ADJACENT  TO 
UNIVERSITY  OF  ALBERTA  CAMPUS  OFFERS 
EMPLOYMENT  IN  MEDICINE,  SURGERY, 
PEDIATRICS,  OBSTETRICS,  PSYCHIATRY, 
REHABILITATION  AND  EXTENDED  CARE 
INCLUDING: 

•  INTENSIVE  CARE 

•  CORONARY  OBSERVATION  UNIT 

•  CARDIOVASCULAR  SURGERY 

•  BURNS  AND  PLASTICS 

•  NEONATAL  INTENSIVE  CARE 

•  RENAL  DIALYSIS 

•  NEURO-SURGERY 

Planned  Orientation  and  In-Service  Education 
programs.  Post  graduate  clinical  courses  in 
Cardiovascular  —  intensive  Care  Nursing  and 
Operating  Room  Technique  and  Management. 

Apply  to: 

RECRUITMENT  OFFICER  —  NURSING 
UNIVERSITY  OF  ALBERTA  HOSPITAL 
112  STREET  AND  84  AVENUE 
EDMONTON,  ALBERTA  T6G  2B7 


UNIVERSITY  OF 
ALBERTA  HOSPITAL 

EDMONTON,  ALBERTA 


WELCOME 


to 


"THE  NEURO" 


A  Teaching  Hospital 
of  iVIcGill  University 

Positions  available 

for  nurses  in  all  areas 

including  Operating  Room 

Individualized  orientation 

On-going  staff  education 


(Quebec  language  requirements 
do  not  apply  to  Canadian  applicants) 


Apply  to: 

The  Director  of  Nursing, 

IVIontreal  Neurological  Hospital, 

3801  University  Street, 

Montreal  H3A  2B4, 

Quebec,  Canada. 


THE  UNIVERSITY  OF  ALBERTA 
SCHOOL  OF  NURSING 


Invites  applications  for  the  following  positions: — 

Senior  Appointment.  Responsible  for  undergraduate  (bac- 
calaureate) programs.  Master's  or  higtier  degree  in  Nursing; 
teaching  experience  at  university  level;  administrative  skills 
and  preparation  in  curriculum  development. 

Assistant  Professor  in  Maternal-Child  Health  Nursing  in  Basic 
Baccalaureate  Program.  Master's  degree  or  higher;  experi- 
ence in  maternal-child  health  nursing. 

Assistant  Professor  in  Community  Mental  Health  Nursing  in  de- 
gree program  for  Registered  Nurses.  Master's  degree  or 
tiigher;  experience  and  preparation  in  community  mental 
health  nursing. 

Assistant  Professor  in  Community  Health  Nursing  in  degree  prog- 
ram for  Registered  Nurses.  Master's  degree  or  higher;  experi- 
ence in  community  health  nursing. 

Salary  and  rank  for  positions  commensurate  with  qualifica- 
tions and  experience,  and  in  accord  with  The  University  of 
Alberta  salary  schedule. 
Positions  open  to  male  and  female  applicants. 

Submit  curriculum  vitae  and  names  of  three  references 
to:— 

Ruth  E.  McClure,  M.P.H. 

Director 

School  of  Nursing 

The  University  of  Alberta 

Edmonton,  Alberta 

T6G  2G3 


Open  la  both 
men  and  women 


Healtli  and  Welfare  Canada 

Medical  Services 

Various  locations  in  Alberta 


COMIVIUNITY  HEALTH  NURSES 


Salary:   310,800  to  $12,800  per  annum  depending  on 
position,  qualifications  and  experience.  (To 
be  revised  to  $1 1,853  to  $13,952  effective 
December  29,  1975) 

Ref.  No:   75-E-2747 

If  you  are  looking  for  a  challenging  position  where  you  will 
also  be  involved  in  planning  and  decision  making;  and  if  you  | 
would  like  opportunities  for  liberal  educational  leave  and 
national  mobility,  come  with  us.. 

Medical  Services  Branch,  Alberta  Region,  has  openings 
at  various  nursing  stations  and  Health  Centres  serving  Indian  | 
communities  throughout  the  province. 

Subsidized  accommodation  is  available  to  employees 
at  a  nominal  rent.  A  cost  of  living  allowance  and  isolation 
pay  are  also  available  in  some  locations. 

Candidates  must  be  registered  or  eligibile  for  registra- 
tion in  a  Canadian  province  and  must  possess  a  Diploma  or 
Certificate  in  Public  Health  Nursing  or  in  the  specialty  rele- 
vant to  the  duties  of  the  position  or  a  Bachelor's  degree 
with  specialty  courses  relevant  to  the  duties  of  the  position. 
Facility  in  the  English  language  is  essential. 

If  you  are  interested  in  finding  out  more,  contact  the 
nearest  Zone  Nursing  Officer  at  (403)  425-6901  regarding 
Northern  Alberta  and  at  (403)  425-6903  regarding  South- 
ern Alberta. 


How  to  Apply 

Forward  completed  "Application  for  Employrrtent"  {Form 
PSC  367-41 10)  available  at  Post  Offices,  Canada  Manpower 
Centres  or  offices  of  the  Public  Service  Commission  of 
Canada,  to :      


Public  Service  Commission 
Room  300,  Confederation  Building 
10355  Jasper  Avenue 
Edmonton,  Alberta  T5J  1Y6 


Please  quote  tfye  applicable  reference  number  at  all  times. 


HOSPITAL: 

Accredited  modern  general  -  260  beds.  Expansion 
to  420  beds  in  progress. 

LOCATION: 

Immediately  north  of  Toronto. 
APARTMENTS: 
Furnished  -  shared. 

Swimming  Pool,  Tennis  Court,  Recreation  Room, 
Free  Parking. 

BENEFITS: 

Competitive  salaries  and  excellent  fringe  benefits. 
Planned  staff  development  programs. 

Please  address  all  enquiries  to: 
Assistant  Administrator  (Nursing) 
York  County  Hospital, 
NEWMARKET,  Ontario, 
L3Y2R1. 


DIRECTOR  OF  NURSING 

DEPARTMENT  OF  HEALTH 
PROVINCIAL  HOSPITAL  SAINT  JOHN 


A  Director  of  Nursing  is  required  immediately  for  the  Pro- 
vincial Hospital  located  in  Saint  John,  New  Brunswick. 
The  Provincial  Hospital  is  a  614  bed  psychiatric  facility  en- 
compassing an  Active  Treatment  Unit  and  an  Extended  Care 
Unit. 

Responsibilities  include  planning,  organizing  and  co- 
ordinating all  activities  of  the  Department  of  Nursing.  The 
Director  will  be  part  of  the  senior  management  team  involved 
in  the  planning  activities  of  the  hospital. 
The  Director  should  be  registered  with  the  New  Brunswick 
Association  of  Registered  Nurses,  or  eligible  for  registration. 
Considerable  experience  in  Psychiatric  Nursing  is  essential. 
Progressive  experience  in  a  supervisory  position  is  desira- 
ble. 
Salary  is  to  be  discussed. 

Interested  applicants  should  send  resume  and  state 
competition  number  NB  75-613  to: 

New  Brunswick  Civil  Service  Commission 

212  Queen  Street 

P.O.  Box  6000 

Fredericton,  New  Brunswick 

E3B  5H1 


VANCOUVER 
GENERAL  HOSPITAL 

Invites  applications  for 

REGULAR  and  RELIEF 
GENERAL  DUTY 

Nursing  positions  in  all  clinical  areas  of  an  active 

teaching  hospital,  closely  affiliated  with  the  University  of  B.C. 

and  the  development  of  the  B.C.  Medical  Centre. 


For  further  information,  please  write  to: 

PERSONNEL  SERVICES 

VANCOUVER  GENERAL  HOSPITAL 

855  WEST  12TH  AVE. 

VANCOUVER,  B.C. 


REGISTERED  NURSES 

Immediate  Openings  in  all  Services 


Come  work  and  play  in  Newfoundland's  second  largest  city! 

Corner  Brook  has  a  population  of  approximately  35.000  with  a  temperate  climate  in 
comparison  with  most  of  Canada,  Outdoor  life  is  among  the  finest  to  be  found  in  North 
America.  The  airports  serving  Corner  Brook  are  at  Deer  Lake.  32  miles  away,  and  Ste- 
phenville.  50  miles  away.  Connections  with  these  airports  make  readily  available  air  (ravel 
anywhere  in  the  world. 

—  Salary  Scale:  $7,652.  —  $9,715.  per  annum;  Contract  expires  March  31, 
1975. 

—  Service  Credits  —  One  step  for  four  years  experience;  two  steps  for  six 
years  experience  or  more. 

—  Educational  differential  for  B.N.  and  master's  degree  in  Nursing. 

—  $2.00  per  shift  for  Charge  Nurse. 

—  $50.00  uniform  allowance  annually. 

—  20  working  days  annual  vacation. 

—  8  statutory  holidays. 

—  Sick  Leave  —  11/2  days  per  month. 

—  Accommodation  available. 

—  Two  week  orientation  on  commencement. 

—  Continuing  Staff  Education  program. 

—  Transportation  available. 

A!  the  present  time,  a  major  expansion  project  is  in  progress  to  provide  regional  hospital 
facilities  for  the  West  Coast  of  the  Province.  The  Hospital  will  have  a  350  bed  capacity  by 
June,  1975.  Services  include  Medicine,  Surgery.  Paediatrics.  Obstetrics.  Psychiatry.  CCU 
and  ICU. 


Letters  of  application  should  be  submitted  to: 

Director  of  Personnel 
WESTERN  MEMORIAL  HOSPITAL 
CORNER  BROOK,  NFLD. 
A2H6J7 


V 


657  bed, accredited, modern, 
well  equipped  General  Hospital, 
rapidly  expanding... 


Saint  John 
General 
^ospitaL    ^        , 

^^  Saint%hn,N.B.\ 

'REQUIRES:  CANADA 

General  Staff  F^rses  ^a 
Registered  Nursing  Assistants 


In  all  general  areas:  Medical,  Surgical, 
Pediatrics, Obstetrics,  Chronic  and 
Convalescent,  several  Intensive  Care 
areas  and  Psychiatry. 


0  Active,  progressive  in-service  education  program. 
Special  Attention  to  Orientation. 
Allowance  for  Experience  and  Post  Basic  Preparation 


FOR  FURTHUR  INFORMATION  APPLY  TO 

'PERSONNEL  DIRECTOR 

^ainfjohn  General  Hospital 

P.O.BOX  2000  Saint  John,  New  Brunswick  E2L4L2 


If  Paris  appeals  to  you . . 


. .  .so  will  Montreal 


•  modern  700  bed  non-sectarian  hospital 

•  excellent  personnel  policies 

•  Registered  Nurses  and  Nursing  Assistants 


are  asked  to  apply 


•  active  In-Service  Education  program 

•  bursaries  available 

•  Quebec  language  requirements  do  not 
apply  to  Canadian  applicants 


Director,  Nursing  Service 
Jewish  General  Hospital 
3755  cote  ste.  Catherine  Road 
Montreal,  Quebec  H3T  1E2 


worth 
looking 
into... 


occupotionol 

heoltli 

nursing 

with  Canada's 

federal  public 

servants. 


I* 


Health  and  Weirarp       Sante  et  Bten-etre  social 

Canada  Cm.ifia 


Medical  Services  Branch 

Department  of  National  Health  and  Welfare 

Ottawa,  Ontario  K1A  0K9 


Ptease  send  me  information  on  career 
opportunities  in  this  service. 


Name: 

Address: 

City: 


Prov: 


!' 

Index 

to 

Advertisers 

December  1975 

1 

The  Clinic  Shoemakers 

.  .  .Cover  2  , 

Hampton  Manufacturing  ( 1966)  Limited  . . 

1 
14 

International  Development  Research  Centre 

5  ' 

K/P  Medical  Systems    

^':| 

J.B.  Lippincott  Co.  of  Canada  Limited  .  .  . 

.  .  .  .28.  29  j 

MedoX 

. .  .Cover  3 

The  C.V.  Mosby  Company  Limited 

5 

V.  Mueller 

Procter  &  Gamble   

-) 

Reeves  Company 

13 

Roussel  (Canada)  Limited 

....  1 1 .  43 

W.B.  Saunders  Company  Canada  Limited  . 

3 

Standard  Brands  Canada  Limited 

6,  7 

Advertising  Manager 
Georgina  Clarke 
The  Canadian  Nurse 

50  The  Driveway 

Ottawa  K2P  1E2  (Ontario) 

Advertising  Representatives 
Richard  P.  Wilson 

219  East  Lancaster  Avenue 

Ardmore.  Penna.  19003 

Telephone:  (215)649-1497 

Gordon  Tiffin 

2  Tremont  Crescent 

Don  Mills,  Ontario 

Telephone:  (416)444-4731 

Member  of  Canadian 
Circulations  Audit  Board  Inc. 

1 
i 

mm 

La  BZbta:)the.quz 
University  d' Ottawa 
Ech^ance 


The.  L-ibfLOAy 
University  of  Ottawa 
Date  Due 


APR  1 9  t98f 

FEB  2  5  1^ 

AUG  23 

AUG  ?  0  ^985